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Godfrey K, Muthukumaraswamy SD, Stinear CM, Hoeh NR. Resting-state EEG connectivity recorded before and after rTMS treatment in patients with treatment-resistant depression. Psychiatry Res Neuroimaging 2024; 338:111767. [PMID: 38183848 DOI: 10.1016/j.pscychresns.2023.111767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 11/12/2023] [Accepted: 12/08/2023] [Indexed: 01/08/2024]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) has shown efficacy and tolerability in Major Depressive Disorder (MDD). However, the underlying mechanisms of its antidepressant effects remain unclear. This open-label study investigated electroencephalography (EEG) functional connectivity markers associated with response and the antidepressant effects of rTMS. Resting-state EEG data were collected from 28 participants with MDD before and after a four-week rTMS course. Source-space functional connectivity between 38 cortical regions was compared using an orthogonalised amplitude approach. Depressive symptoms significantly improved following rTMS, with 43 % of participants classified as responders. While the study's functional connectivity findings did not withstand multiple comparison corrections, exploratory analyses suggest an association between theta band connectivity and rTMS treatment mechanisms. Fronto-parietal theta connectivity increased after treatment but did not correlate with antidepressant response. Notably, low baseline theta connectivity was associated with greater response. However, due to the exploratory nature and small sample size, further replication is needed. The findings provide preliminary evidence that EEG functional connectivity, particularly within the theta band, may reflect the mechanisms by which rTMS exerts its therapeutic effects.
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Affiliation(s)
- Kate Godfrey
- School of Pharmacy, The University of Auckland, Auckland, New Zealand; Division of Psychiatry, Imperial College London, London, United Kingdom.
| | | | - Cathy M Stinear
- School of Medicine, The University of Auckland, Auckland, New Zealand
| | - Nicholas R Hoeh
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand; Auckland District Health Board, Auckland, New Zealand
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2
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Gonsalves MA, White TL, Barredo J, DeMayo MM, DeLuca E, Harris AD, Carpenter LL. Cortical glutamate, Glx, and total N-acetylaspartate: potential biomarkers of repetitive transcranial magnetic stimulation treatment response and outcomes in major depression. Transl Psychiatry 2024; 14:5. [PMID: 38184652 PMCID: PMC10771455 DOI: 10.1038/s41398-023-02715-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 12/06/2023] [Accepted: 12/13/2023] [Indexed: 01/08/2024] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for individuals with major depressive disorder (MDD) who have not improved with standard therapies. However, only 30-45% of patients respond to rTMS. Predicting response to rTMS will benefit both patients and providers in terms of prescribing and targeting treatment for maximum efficacy and directing resources, as individuals with lower likelihood of response could be redirected to more suitable treatment alternatives. In this exploratory study, our goal was to use proton magnetic resonance spectroscopy to examine how glutamate (Glu), Glx, and total N-acetylaspartate (tNAA) predict post-rTMS changes in overall MDD severity and symptoms, and treatment response. Metabolites were measured in a right dorsal anterior cingulate cortex voxel prior to a standard course of 10 Hz rTMS to the left DLPFC in 25 individuals with MDD. MDD severity and symptoms were evaluated via the Inventory of Depression Symptomatology Self-Report (IDS-SR). rTMS response was defined as ≥50% change in full-scale IDS-SR scores post treatment. Percent change in IDS-SR symptom domains were evaluated using principal component analysis and established subscales. Generalized linear and logistic regression models were used to evaluate the relationship between baseline Glu, Glx, and tNAA and outcomes while controlling for age and sex. Participants with baseline Glu and Glx levels in the lower range had greater percent change in full scale IDS-SR scores post-treatment (p < 0.001), as did tNAA (p = 0.007). Low glutamatergic metabolite levels also predicted greater percent change in mood/cognition symptoms (p ≤ 0.001). Low-range Glu, Glx, and tNAA were associated with greater improvement on the immuno-metabolic subscale (p ≤ 0.003). Baseline Glu predicted rTMS responder status (p = 0.025) and had an area under the receiving operating characteristic curve of 0.81 (p = 0.009), demonstrating excellent discriminative ability. Baseline Glu, Glx, and tNAA significantly predicted MDD improvement after rTMS; preliminary evidence also demonstrates metabolite association with symptom subdomain improvement post-rTMS. This work provides feasibility for a personalized medicine approach to rTMS treatment selection, with individuals with Glu levels in the lower range potentially being the best candidates.
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Affiliation(s)
- Meghan A Gonsalves
- Neuroscience Graduate Program, Brown University, Providence, RI, USA.
- Butler Hospital Neuromodulation Research Facility, Providence, RI, USA.
- Center of Biomedical Research Excellence (COBRE) for Neuromodulation, Butler Hospital, Providence, RI, USA.
| | - Tara L White
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
- Carney Institute for Brain Sciences, Brown University, Providence, RI, USA
| | - Jennifer Barredo
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA
- Providence VA Medical Center, Providence, RI, USA
- Clinical Neuroimaging Research Core, Brown University, Providence, RI, USA
| | - Marilena M DeMayo
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Emily DeLuca
- Clinical Neuroimaging Research Core, Brown University, Providence, RI, USA
| | - Ashley D Harris
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Linda L Carpenter
- Butler Hospital Neuromodulation Research Facility, Providence, RI, USA
- Center of Biomedical Research Excellence (COBRE) for Neuromodulation, Butler Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA
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3
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Li CT, Chen CS, Cheng CM, Chen CP, Chen JP, Chen MH, Bai YM, Tsai SJ. Prediction of antidepressant responses to non-invasive brain stimulation using frontal electroencephalogram signals: Cross-dataset comparisons and validation. J Affect Disord 2023; 343:86-95. [PMID: 37579885 DOI: 10.1016/j.jad.2023.08.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND 10-Hz repetitive transcranial magnetic stimulation(rTMS) and intermittent theta-burst stimulation(iTBS) over left prefrontal cortex are FDA-approved, effective options for treatment-resistant depression (TRD). Optimal prediction models for iTBS and rTMS remain elusive. Therefore, our primary objective was to compare prediction accuracy between classification by frontal theta activity alone and machine learning(ML) models by linear and non-linear frontal signals. The second objective was to study an optimal ML model for predicting responses to rTMS and iTBS. METHODS Two rTMS and iTBS datasets (n = 163) were used: one randomized controlled trial dataset (RCTD; n = 96) and one outpatient dataset (OPD; n = 67). Frontal theta and non-linear EEG features that reflect trend, stability, and complexity were extracted. Pretreatment frontal EEG and ML algorithms, including classical support vector machine(SVM), random forest(RF), XGBoost, and CatBoost, were analyzed. Responses were defined as ≥50 % depression improvement after treatment. Response rates between those with and without pretreatment prediction in another independent outpatient cohort (n = 208) were compared. RESULTS Prediction accuracy using combined EEG features by SVM was better than frontal theta by logistic regression. The accuracy for OPD patients significantly dropped using the RCTD-trained SVM model. Modern ML models, especially RF (rTMS = 83.3 %, iTBS = 88.9 %, p-value(ACC > NIR) < 0.05 for iTBS), performed significantly above chance and had higher accuracy than SVM using both selected features (p < 0.05, FDR corrected for multiple comparisons) or all EEG features. Response rates among those receiving prediction before treatment were significantly higher than those without prediction (p = 0.035). CONCLUSION The first study combining linear and non-linear EEG features could accurately predict responses to left PFC iTBS. The bootstraps-based ML model (i.e., RF) had the best predictive accuracy for rTMS and iTBS.
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Affiliation(s)
- Cheng-Ta Li
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan; Institute of Brain Science and Brain Research Center, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan; Institute of Cognitive Neuroscience, National Central University, Jhongli, Taiwan.
| | - Chi-Sheng Chen
- Graduate Institute of Biomedical Electronics and Bioinformatics College of Electrical Engineering and Computer Science, National Taiwan University, Taipei, Taiwan
| | - Chih-Ming Cheng
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chung-Ping Chen
- Graduate Institute of Biomedical Electronics and Bioinformatics College of Electrical Engineering and Computer Science, National Taiwan University, Taipei, Taiwan
| | - Jen-Ping Chen
- Division of Psychiatry, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan; Institute of Brain Science and Brain Research Center, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan; Institute of Brain Science and Brain Research Center, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan; Institute of Brain Science and Brain Research Center, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
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Chu SA, Tadayonnejad R, Corlier J, Wilson AC, Citrenbaum C, Leuchter AF. Rumination symptoms in treatment-resistant major depressive disorder, and outcomes of repetitive Transcranial Magnetic Stimulation (rTMS) treatment. Transl Psychiatry 2023; 13:293. [PMID: 37684229 PMCID: PMC10491586 DOI: 10.1038/s41398-023-02566-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 09/10/2023] Open
Abstract
Rumination is a maladaptive style of regulating thoughts and emotions. It is a common symptom of Major Depressive Disorder (MDD), and more severe rumination is associated with poorer medication and psychotherapy treatment outcomes, particularly among women. It is unclear to what extent rumination may influence the outcomes of, or be responsive to, repetitive Transcranial Magnetic Stimulation (rTMS) treatment of MDD. We retrospectively examined data collected during rTMS treatment of 155 patients (age 42.52 ± 14.22, 79 female) with moderately severe treatment-resistant MDD. The severity of rumination and depression was assessed before and during a course of 30 sessions of measurement-based rTMS treatment using the Ruminative Responses Scale (RSS) and the Patient Health Questionnaire (PHQ-9), respectively. Relationships among baseline levels of rumination, depression, and treatment outcome were assessed using a series of repeated measures linear mixed effects models. Both depression and rumination symptoms significantly improved after treatment, but improvement in depression was not a significant mediator of rumination improvement. Higher baseline rumination (but not depression severity) was associated with poorer depression outcomes independently of depression severity. Female gender was a significant predictor of worse outcomes for all RRS subscales. Both depressive and ruminative symptoms in MDD improved following rTMS treatment. These improvements were correlated, but improvement in rumination was not fully explained by reduction in depressive symptoms. These findings suggest that while improvement in rumination and depression severity during rTMS treatment are correlated, they are partly independent processes. Future studies should examine whether rumination symptoms should be specifically targeted with different rTMS treatment parameters.
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Affiliation(s)
- Stephanie A Chu
- Neuroscience Interdepartmental Program, UCLA, Los Angeles, USA.
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA.
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Reza Tadayonnejad
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Division of the Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA
| | - Juliana Corlier
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Andrew C Wilson
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Cole Citrenbaum
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Andrew F Leuchter
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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5
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Shahabi MS, Shalbaf A, Rostami R. Prediction of response to repetitive transcranial magnetic stimulation for major depressive disorder using hybrid Convolutional recurrent neural networks and raw Electroencephalogram Signal. Cogn Neurodyn 2023; 17:909-920. [PMID: 37522037 PMCID: PMC10374518 DOI: 10.1007/s11571-022-09881-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 08/03/2022] [Accepted: 08/28/2022] [Indexed: 11/30/2022] Open
Abstract
Major Depressive Disorder (MDD) is a high prevalence disease that needs an effective and timely treatment to prevent its progress and additional costs. Repetitive Transcranial Magnetic Stimulation (rTMS) is an effective treatment option for MDD patients which uses strong magnetic pulses to stimulate specific regions of the brain. However, some patients do not respond to this treatment which causes the waste of multiple weeks as treatment time and clinical resources. Therefore developing an effective way for the prediction of response to the rTMS treatment of depression is necessary. In this work, we proposed a hybrid model created by pre-trained Convolutional Neural Networks (CNN) models and Bidirectional Long Short-Term Memory (BLSTM) cells to predict response to rTMS treatment from raw EEG signal. Three pre-trained CNN models named VGG16, InceptionResNetV2, and EffecientNetB0 were utilized as Transfer Learning (TL) models to construct hybrid TL-BLSTM models. Then an ensemble of these models was created using weighted majority voting which the weights were optimized by Differential Evolution (DE) optimization algorithm. Evaluation of these models shows the superior performance of the ensemble model by the accuracy of 98.51%, sensitivity of 98.64%, specificity of 98.36%, F1-score of 98.6%, and AUC of 98.5%. Therefore, the ensemble of the proposed hybrid convolutional recurrent networks can efficiently predict the treatment outcome of rTMS using raw EEG data.
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Affiliation(s)
- Mohsen Sadat Shahabi
- Department of Biomedical Engineering and Medical Physics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmad Shalbaf
- Department of Biomedical Engineering and Medical Physics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Rostami
- Department of Psychology, University of Tehran, Tehran, Iran
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6
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Sadat Shahabi M, Nobakhsh B, Shalbaf A, Rostami R, Kazemi R. Prediction of treatment outcome for repetitive transcranial magnetic stimulation in major depressive disorder using connectivity measures and ensemble of pre-trained deep learning models. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2023.104822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
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7
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Shahabi MS, Shalbaf A, Rostami R, Kazemi R. A convolutional recurrent neural network with attention for response prediction to repetitive transcranial magnetic stimulation in major depressive disorder. Sci Rep 2023; 13:10147. [PMID: 37349335 PMCID: PMC10287753 DOI: 10.1038/s41598-023-35545-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 05/19/2023] [Indexed: 06/24/2023] Open
Abstract
Prediction of response to Repetitive Transcranial Magnetic Stimulation (rTMS) can build a very effective treatment platform that helps Major Depressive Disorder (MDD) patients to receive timely treatment. We proposed a deep learning model powered up by state-of-the-art methods to classify responders (R) and non-responders (NR) to rTMS treatment. Pre-treatment Electro-Encephalogram (EEG) signal of public TDBRAIN dataset and 46 proprietary MDD subjects were utilized to create time-frequency representations using Continuous Wavelet Transform (CWT) to be fed into the two powerful pre-trained Convolutional Neural Networks (CNN) named VGG16 and EfficientNetB0. Equipping these Transfer Learning (TL) models with Bidirectional Long Short-Term Memory (BLSTM) and attention mechanism for the extraction of most discriminative spatiotemporal features from input images, can lead to superior performance in the prediction of rTMS treatment outcome. Five brain regions named Frontal, Central, Parietal, Temporal, and occipital were assessed and the highest evaluated performance in 46 proprietary MDD subjects was acquired for the Frontal region using the TL-LSTM-Attention model based on EfficientNetB0 with accuracy, sensitivity, specificity, and Area Under the Curve (AUC) of 97.1%, 97.3%, 97.0%, and 0.96 respectively. Additionally, to test the generalizability of the proposed models, these TL-BLSTM-Attention models were evaluated on a public dataset called TDBRAIN and the highest accuracy of 82.3%, the sensitivity of 80.2%, the specificity of 81.9% and the AUC of 0.83 were obtained. Therefore, advanced deep learning methods using a time-frequency representation of EEG signals from the frontal brain region and the convolutional recurrent neural networks equipped with the attention mechanism can construct an accurate platform for the prediction of response to the rTMS treatment.
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Affiliation(s)
- Mohsen Sadat Shahabi
- Department of Biomedical Engineering and Medical Physics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmad Shalbaf
- Department of Biomedical Engineering and Medical Physics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Reza Rostami
- Department of Psychology, University of Tehran, Tehran, Iran
| | - Reza Kazemi
- Department of Cognitive Psychology, Institute for Cognitive Science Studies, Tehran, Iran
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8
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Alterations in EEG functional connectivity in individuals with depression: A systematic review. J Affect Disord 2023; 328:287-302. [PMID: 36801418 DOI: 10.1016/j.jad.2023.01.126] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 01/22/2023] [Accepted: 01/30/2023] [Indexed: 02/19/2023]
Abstract
The brain works as an organised, network-like structure of functionally interconnected regions. Disruptions to interconnectivity in certain networks have been linked to symptoms of depression and impairments in cognition. Electroencephalography (EEG) is a low-burden tool by which differences in functional connectivity (FC) can be assessed. This systematic review aims to provide a synthesis of evidence relating to EEG FC in depression. A comprehensive electronic literature search for terms relating to depression, EEG, and FC was conducted on studies published before the end of November 2021, according to PRISMA guidelines. Studies comparing EEG measures of FC of individuals with depression to that of healthy control groups were included. Data was extracted by two independent reviewers, and the quality of EEG FC methods was assessed. Fifty-two studies assessing EEG FC in depression were identified: 36 assessed resting-state FC, and 16 assessed task-related or other (i.e., sleep) FC. Somewhat consistent findings in resting-state studies suggest for no differences between depression and control groups in EEG FC in the delta and gamma frequencies. However, while most resting-state studies noted a difference in alpha, theta, and beta, no clear conclusions could be drawn about the direction of the difference, due to considerable inconsistencies between study design and methodology. This was also true for task-related and other EEG FC. More robust research is needed to understand the true differences in EEG FC in depression. Given that the FC between brain regions drives behaviour, cognition, and emotion, characterising how FC differs in depression is essential for understanding the aetiology of depression.
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Nobakhsh B, Shalbaf A, Rostami R, Kazemi R, Rezaei E, Shalbaf R. An effective brain connectivity technique to predict repetitive transcranial magnetic stimulation outcome for major depressive disorder patients using EEG signals. Phys Eng Sci Med 2023; 46:67-81. [PMID: 36445618 DOI: 10.1007/s13246-022-01198-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 11/06/2022] [Indexed: 11/30/2022]
Abstract
One of the most effective treatments for drug-resistant Major depressive disorder (MDD) patients is repetitive transcranial magnetic stimulation (rTMS). To improve treatment efficacy and reduce health care costs, it is necessary to predict the treatment response. In this study, we intend to predict the rTMS treatment response in MDD patients from electroencephalogram (EEG) signals before starting the treatment using machine learning approaches. Effective brain connectivity of 19-channel EEG data of MDD patients was calculated by the direct directed transfer function (dDTF) method. Then, using three feature selection methods, the best features were selected and patients were classified as responders or non-responders to rTMS treatment by using the support vector machine (SVM). Results on the 34 MDD patients indicated that the Fp2 region in the delta and theta frequency bands has a significant difference between the two groups and can be used as a significant brain biomarker to assess the rTMS treatment response. Also, the highest accuracy (89.6%) using the SVM classifier for the best features of the dDTF method based on the area under the receiver operating characteristic curve (AUC-ROC) criteria was obtained by combining the delta and theta frequency bands. Consequently, the proposed method can accurately detect the rTMS treatment response in MDD patients before starting treatment on the EEG signal to avoid financial and time costs to patients and medical centers.
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Affiliation(s)
- Behrouz Nobakhsh
- Department of Biomedical Engineering and Medical Physics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmad Shalbaf
- Department of Biomedical Engineering and Medical Physics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Reza Rostami
- Department of Psychology, University of Tehran, Tehran, Iran
| | - Reza Kazemi
- Department of Cognitive Psychology, Institute for Cognitive Science Studies, Tehran, Iran
| | - Erfan Rezaei
- Department of Biomedical Engineering and Medical Physics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Shalbaf
- Institute for Cognitive Science Studies, Tehran, Iran
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10
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Deng Y, Li W, Zhang B. Functional Activity in the Effect of Transcranial Magnetic Stimulation Therapy for Patients with Depression: A Meta-Analysis. J Pers Med 2023; 13:jpm13030405. [PMID: 36983590 PMCID: PMC10051603 DOI: 10.3390/jpm13030405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/22/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023] Open
Abstract
Depression is a long-lasting mental disorder that affects more than 264 million people worldwide. Transcranial magnetic stimulation (TMS) can be a safe and effective choice for the treatment of depression. Functional neuroimaging provides unique insights into the neuropsychiatric effects of antidepressant TMS. In this meta-analysis, we aimed to assess the functional activity of brain regions caused by TMS for depression. A literature search was conducted from inception to 5 January 2022. Studies were then selected according to predetermined inclusion and exclusion criteria. Activation likelihood estimation was applied to analyze functional activation. Five articles were ultimately included after selection. The main analysis results indicated that TMS treatment for depression can alter the activity in the right precentral gyrus, right posterior cingulate, left inferior frontal gyrus and left middle frontal gyrus. In resting-state studies, increased activation was shown in the right precentral gyrus, right posterior cingulate, left inferior frontal gyrus and left superior frontal gyrus associated with TMS treatment. In task-related studies, clusters in the right middle frontal gyrus, left sub-gyrus, left middle frontal gyrus and left posterior cingulate were hyperactivated post-treatment. Our study offers an overview of brain activity changes in patients with depression after TMS treatment.
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Affiliation(s)
- Yongyan Deng
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou 510370, China
- Peking University Sixth Hospital, Beijing 100191, China
| | - Wenyue Li
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou 510370, China
| | - Bin Zhang
- Institute of Mental Health, Tianjin Anding Hospital, Tianjin Medical University, Tianjin 300222, China
- Correspondence:
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11
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Shahabi MS, Shalbaf A, Nobakhsh B, Rostami R, Kazemi R. Attention-Based Convolutional Recurrent Deep Neural Networks for the Prediction of Response to Repetitive Transcranial Magnetic Stimulation for Major Depressive Disorder. Int J Neural Syst 2023; 33:2350007. [PMID: 36641543 DOI: 10.1142/s0129065723500077] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Repetitive Transcranial Magnetic Stimulation (rTMS) is proposed as an effective treatment for major depressive disorder (MDD). However, because of the suboptimal treatment outcome of rTMS, the prediction of response to this technique is a crucial task. We developed a deep learning (DL) model to classify responders (R) and non-responders (NR). With this aim, we assessed the pre-treatment EEG signal of 34 MDD patients and extracted effective connectivity (EC) among all electrodes in four frequency bands of EEG signal. Two-dimensional EC maps are put together to create a rich connectivity image and a sequence of these images is fed to the DL model. Then, the DL framework was constructed based on transfer learning (TL) models which are pre-trained convolutional neural networks (CNN) named VGG16, Xception, and EfficientNetB0. Then, long short-term memory (LSTM) cells are equipped with an attention mechanism added on top of TL models to fully exploit the spatiotemporal information of EEG signal. Using leave-one subject out cross validation (LOSO CV), Xception-BLSTM-Attention acquired the highest performance with 98.86% of accuracy and 97.73% of specificity. Fusion of these models as an ensemble model based on optimized majority voting gained 99.32% accuracy and 98.34% of specificity. Therefore, the ensemble of TL-LSTM-Attention models can predict accurately the treatment outcome.
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Affiliation(s)
- Mohsen Sadat Shahabi
- Department of Biomedical Engineering and Medical Physics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmad Shalbaf
- Department of Biomedical Engineering and Medical Physics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behrooz Nobakhsh
- Department of Biomedical Engineering and Medical Physics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Rostami
- Department of Psychology, University of Tehran, Tehran, Iran
| | - Reza Kazemi
- Department of Cognitive Psychology, Institute for Cognitive Science Studies, Tehran, Iran
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12
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Corlier J, Tadayonnejad R, Wilson AC, Lee JC, Marder KG, Ginder ND, Wilke SA, Levitt J, Krantz D, Leuchter AF. Repetitive transcranial magnetic stimulation treatment of major depressive disorder and comorbid chronic pain: response rates and neurophysiologic biomarkers. Psychol Med 2023; 53:823-832. [PMID: 34154683 PMCID: PMC9976020 DOI: 10.1017/s0033291721002178] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 04/16/2021] [Accepted: 05/13/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) and chronic pain are highly comorbid, and pain symptoms are associated with a poorer response to antidepressant medication treatment. It is unclear whether comorbid pain also is associated with a poorer response to treatment with repetitive transcranial magnetic stimulation (rTMS). METHODS 162 MDD subjects received 30 sessions of 10 Hz rTMS treatment administered to the left dorsolateral prefrontal cortex (DLPFC) with depression and pain symptoms measured before and after treatment. For a subset of 96 patients, a resting-state electroencephalogram (EEG) was recorded at baseline. Clinical outcome was compared between subjects with and without comorbid pain, and the relationships among outcome, pain severity, individual peak alpha frequency (PAF), and PAF phase-coherence in the EEG were examined. RESULTS 64.8% of all subjects reported pain, and both depressive and pain symptoms were significantly reduced after rTMS treatment, irrespective of age or gender. Patients with severe pain were 27% less likely to respond to MDD treatment than pain-free individuals. PAF was positively associated with pain severity. PAF phase-coherence in the somatosensory and default mode networks was significantly lower for MDD subjects with pain who failed to respond to MDD treatment. CONCLUSIONS Pain symptoms improved after rTMS to left DLPFC in MDD irrespective of age or gender, although the presence of chronic pain symptoms reduced the likelihood of treatment response. Individual PAF and baseline phase-coherence in the sensorimotor and midline regions may represent predictors of rTMS treatment outcome in comorbid pain and MDD.
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Affiliation(s)
- Juliana Corlier
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90024, USA
| | - Reza Tadayonnejad
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90024, USA
- Division of the Humanities and Social Sciences, California Institute of Technology, Pasadena, CA 91125, USA
| | - Andrew C Wilson
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90024, USA
| | - Jonathan C Lee
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90024, USA
| | - Katharine G Marder
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90024, USA
| | - Nathaniel D Ginder
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90024, USA
- VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA 90073, USA
| | - Scott A Wilke
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90024, USA
| | - Jennifer Levitt
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90024, USA
| | - David Krantz
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90024, USA
| | - Andrew F Leuchter
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90024, USA
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Ippolito G, Bertaccini R, Tarasi L, Di Gregorio F, Trajkovic J, Battaglia S, Romei V. The Role of Alpha Oscillations among the Main Neuropsychiatric Disorders in the Adult and Developing Human Brain: Evidence from the Last 10 Years of Research. Biomedicines 2022; 10:biomedicines10123189. [PMID: 36551945 PMCID: PMC9775381 DOI: 10.3390/biomedicines10123189] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/03/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
Alpha oscillations (7-13 Hz) are the dominant rhythm in both the resting and active brain. Accordingly, translational research has provided evidence for the involvement of aberrant alpha activity in the onset of symptomatological features underlying syndromes such as autism, schizophrenia, major depression, and Attention Deficit and Hyperactivity Disorder (ADHD). However, findings on the matter are difficult to reconcile due to the variety of paradigms, analyses, and clinical phenotypes at play, not to mention recent technical and methodological advances in this domain. Herein, we seek to address this issue by reviewing the literature gathered on this topic over the last ten years. For each neuropsychiatric disorder, a dedicated section will be provided, containing a concise account of the current models proposing characteristic alterations of alpha rhythms as a core mechanism to trigger the associated symptomatology, as well as a summary of the most relevant studies and scientific contributions issued throughout the last decade. We conclude with some advice and recommendations that might improve future inquiries within this field.
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Affiliation(s)
- Giuseppe Ippolito
- Centro Studi e Ricerche in Neuroscienze Cognitive, Dipartimento di Psicologia, Alma Mater Studiorum—Università di Bologna, 47521 Cesena, Italy
| | - Riccardo Bertaccini
- Centro Studi e Ricerche in Neuroscienze Cognitive, Dipartimento di Psicologia, Alma Mater Studiorum—Università di Bologna, 47521 Cesena, Italy
| | - Luca Tarasi
- Centro Studi e Ricerche in Neuroscienze Cognitive, Dipartimento di Psicologia, Alma Mater Studiorum—Università di Bologna, 47521 Cesena, Italy
| | - Francesco Di Gregorio
- UO Medicina Riabilitativa e Neuroriabilitazione, Azienda Unità Sanitaria Locale, 40133 Bologna, Italy
| | - Jelena Trajkovic
- Centro Studi e Ricerche in Neuroscienze Cognitive, Dipartimento di Psicologia, Alma Mater Studiorum—Università di Bologna, 47521 Cesena, Italy
| | - Simone Battaglia
- Centro Studi e Ricerche in Neuroscienze Cognitive, Dipartimento di Psicologia, Alma Mater Studiorum—Università di Bologna, 47521 Cesena, Italy
- Dipartimento di Psicologia, Università di Torino, 10124 Torino, Italy
| | - Vincenzo Romei
- Centro Studi e Ricerche in Neuroscienze Cognitive, Dipartimento di Psicologia, Alma Mater Studiorum—Università di Bologna, 47521 Cesena, Italy
- Correspondence:
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Smith EE, Bel-Bahar TS, Kayser J. A systematic data-driven approach to analyze sensor-level EEG connectivity: Identifying robust phase-synchronized network components using surface Laplacian with spectral-spatial PCA. Psychophysiology 2022; 59:e14080. [PMID: 35478408 PMCID: PMC9427703 DOI: 10.1111/psyp.14080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 04/04/2022] [Accepted: 04/07/2022] [Indexed: 11/27/2022]
Abstract
Although conventional averaging across predefined frequency bands reduces the complexity of EEG functional connectivity (FC), it obscures the identification of resting-state brain networks (RSN) and impedes accurate estimation of FC reliability. Extending prior work, we combined scalp current source density (CSD; spherical spline surface Laplacian) and spectral-spatial PCA to identify FC components. Phase-based FC was estimated via debiased-weighted phase-locking index from CSD-transformed resting EEGs (71 sensors, 8 min, eyes open/closed, 35 healthy adults, 1-week retest). Spectral PCA extracted six robust alpha and theta components (86.6% variance). Subsequent spatial PCA for each spectral component revealed seven robust regionally focused (posterior, central, and frontal) and long-range (posterior-anterior) alpha components (peaks at 8, 10, and 13 Hz) and a midfrontal theta (6 Hz) component, accounting for 37.0% of FC variance. These spatial FC components were consistent with well-known networks (e.g., default mode, visual, and sensorimotor), and four were sensitive to eyes open/closed conditions. Most FC components had good-to-excellent internal consistency (odd/even epochs, eyes open/closed) and test-retest reliability (ICCs ≥ .8). Moreover, the FC component structure was generally present in subsamples (session × odd/even epoch, or smaller subgroups [n = 7-10]), as indicated by high similarity of component loadings across PCA solutions. Apart from systematically reducing FC dimensionality, our approach avoids arbitrary thresholds and allows quantification of meaningful and reliable network components that may prove to be of high relevance for basic and clinical research applications.
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Affiliation(s)
- Ezra E. Smith
- Division of Translational Epidemiology, New York State Psychiatric Institute, New York, NY, USA
| | - Tarik S. Bel-Bahar
- Division of Translational Epidemiology, New York State Psychiatric Institute, New York, NY, USA
| | - Jürgen Kayser
- Division of Translational Epidemiology, New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA
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Watts D, Pulice RF, Reilly J, Brunoni AR, Kapczinski F, Passos IC. Predicting treatment response using EEG in major depressive disorder: A machine-learning meta-analysis. Transl Psychiatry 2022; 12:332. [PMID: 35961967 PMCID: PMC9374666 DOI: 10.1038/s41398-022-02064-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/27/2022] [Accepted: 07/06/2022] [Indexed: 11/09/2022] Open
Abstract
Selecting a course of treatment in psychiatry remains a trial-and-error process, and this long-standing clinical challenge has prompted an increased focus on predictive models of treatment response using machine learning techniques. Electroencephalography (EEG) represents a cost-effective and scalable potential measure to predict treatment response to major depressive disorder. We performed separate meta-analyses to determine the ability of models to distinguish between responders and non-responders using EEG across treatments, as well as a performed subgroup analysis of response to transcranial magnetic stimulation (rTMS), and antidepressants (Registration Number: CRD42021257477) in Major Depressive Disorder by searching PubMed, Scopus, and Web of Science for articles published between January 1960 and February 2022. We included 15 studies that predicted treatment responses among patients with major depressive disorder using machine-learning techniques. Within a random-effects model with a restricted maximum likelihood estimator comprising 758 patients, the pooled accuracy across studies was 83.93% (95% CI: 78.90-89.29), with an Area-Under-the-Curve (AUC) of 0.850 (95% CI: 0.747-0.890), and partial AUC of 0.779. The average sensitivity and specificity across models were 77.96% (95% CI: 60.05-88.70), and 84.60% (95% CI: 67.89-92.39), respectively. In a subgroup analysis, greater performance was observed in predicting response to rTMS (Pooled accuracy: 85.70% (95% CI: 77.45-94.83), Area-Under-the-Curve (AUC): 0.928, partial AUC: 0.844), relative to antidepressants (Pooled accuracy: 81.41% (95% CI: 77.45-94.83, AUC: 0.895, pAUC: 0.821). Furthermore, across all meta-analyses, the specificity (true negatives) of EEG models was greater than the sensitivity (true positives), suggesting that EEG models thus far better identify non-responders than responders to treatment in MDD. Studies varied widely in important features across models, although relevant features included absolute and relative power in frontal and temporal electrodes, measures of connectivity, and asymmetry across hemispheres. Predictive models of treatment response using EEG hold promise in major depressive disorder, although there is a need for prospective model validation in independent datasets, and a greater emphasis on replicating physiological markers. Crucially, standardization in cut-off values and clinical scales for defining clinical response and non-response will aid in the reproducibility of findings and the clinical utility of predictive models. Furthermore, several models thus far have used data from open-label trials with small sample sizes and evaluated performance in the absence of training and testing sets, which increases the risk of statistical overfitting. Large consortium studies are required to establish predictive signatures of treatment response using EEG, and better elucidate the replicability of specific markers. Additionally, it is speculated that greater performance was observed in rTMS models, since EEG is assessing neural networks more likely to be directly targeted by rTMS, comprising electrical activity primarily near the surface of the cortex. Prospectively, there is a need for models that examine the comparative effectiveness of multiple treatments across the same patients. However, this will require a thoughtful consideration towards cumulative treatment effects, and whether washout periods between treatments should be utilised. Regardless, longitudinal cross-over trials comparing multiple treatments across the same group of patients will be an important prerequisite step to both facilitate precision psychiatry and identify generalizable physiological predictors of response between and across treatment options.
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Affiliation(s)
- Devon Watts
- grid.25073.330000 0004 1936 8227Neuroscience Graduate Program, McMaster University, Hamilton, Canada
| | - Rafaela Fernandes Pulice
- grid.8532.c0000 0001 2200 7498School of Medicine, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, RS Brasil ,grid.414449.80000 0001 0125 3761Laboratório de Molecular Psychiatry, Centro de Pesquisa Experimental (CPE) and Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS Brasil
| | - Jim Reilly
- grid.25073.330000 0004 1936 8227Department of Electrical & Computer Engineering, McMaster University, Hamilton, ON Canada
| | - Andre R. Brunoni
- grid.11899.380000 0004 1937 0722Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Institute of Psychiatry, University of São Paulo, São Paulo, Brasil ,grid.11899.380000 0004 1937 0722Departamento de Clínica Médica, Faculdade de Medicina da USP, São Paulo, Brasil
| | - Flávio Kapczinski
- grid.25073.330000 0004 1936 8227Neuroscience Graduate Program, McMaster University, Hamilton, Canada ,grid.414449.80000 0001 0125 3761Laboratório de Molecular Psychiatry, Centro de Pesquisa Experimental (CPE) and Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS Brasil ,Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, RS Brasil ,grid.25073.330000 0004 1936 8227Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON Canada
| | - Ives Cavalcante Passos
- School of Medicine, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, RS, Brasil. .,Laboratório de Molecular Psychiatry, Centro de Pesquisa Experimental (CPE) and Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brasil.
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Rostami R, Kazemi R, Nasiri Z, Ataei S, Hadipour AL, Jaafari N. Cold Cognition as Predictor of Treatment Response to rTMS; A Retrospective Study on Patients With Unipolar and Bipolar Depression. Front Hum Neurosci 2022; 16:888472. [PMID: 35959241 PMCID: PMC9358278 DOI: 10.3389/fnhum.2022.888472] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/06/2022] [Indexed: 01/10/2023] Open
Abstract
BackgroundCognitive impairments are prevalent in patients with unipolar and bipolar depressive disorder (UDD and BDD, respectively). Considering the fact assessing cognitive functions is increasingly feasible for clinicians and researchers, targeting these problems in treatment and using them at baseline as predictors of response to treatment can be very informative.MethodIn a naturalistic, retrospective study, data from 120 patients (Mean age: 33.58) with UDD (n = 56) and BDD (n = 64) were analyzed. Patients received 20 sessions of bilateral rTMS (10 Hz over LDLPFC and 1 HZ over RDLPFC) and were assessed regarding their depressive symptoms, sustained attention, working memory, and executive functions, using the Beck Depression Inventory (BDI-II) and Neuropsychological Test Automated Battery Cambridge, at baseline and after the end of rTMS treatment course. Generalized estimating equations (GEE) and logistic regression were used as the main statistical methods to test the hypotheses.ResultsFifty-three percentage of all patients (n = 64) responded to treatment. In particular, 53.1% of UDD patients (n = 34) and 46.9% of BDD patients (n = 30) responded to treatment. Bilateral rTMS improved all cognitive functions (attention, working memory, and executive function) except for visual memory and resulted in more modulations in the working memory of UDD compared to BDD patients. More improvements in working memory were observed in responded patients and visual memory, age, and sex were determined as treatment response predictors. Working memory, visual memory, and age were identified as treatment response predictors in BDD and UDD patients, respectively.ConclusionBilateral rTMS improved cold cognition and depressive symptoms in UDD and BDD patients, possibly by altering cognitive control mechanisms (top-down), and processing negative emotional bias.
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Affiliation(s)
- Reza Rostami
- Department of Psychology, University of Tehran, Tehran, Iran
- *Correspondence: Reza Rostami
| | - Reza Kazemi
- Department of Cognitive Psychology, Institute for Cognitive Science Studies>, Tehran, Iran
| | - Zahra Nasiri
- Convergent Technologies Research Center, University of Tehran, Tehran, Iran
| | - Somayeh Ataei
- Department of Neuropsychology, Faculty of Psychology, Institute of Cognitive Neuroscience, Ruhr-University Bochum, Bochum, Germany
| | - Abed L. Hadipour
- Department of Cognitive Sciences, University of Messina, Messina, Italy
| | - Nematollah Jaafari
- Unité de Recherche Clinique Intersectorielle en Psychiatrie Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, France
- University Poitiers & CHU Poitiers, INSERM U1084, Laboratoire Expérimental et Clinique en Neurosciences, Poitiers, France
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Kayasandik CB, Velioglu HA, Hanoglu L. Predicting the Effects of Repetitive Transcranial Magnetic Stimulation on Cognitive Functions in Patients With Alzheimer's Disease by Automated EEG Analysis. Front Cell Neurosci 2022; 16:845832. [PMID: 35663423 PMCID: PMC9160828 DOI: 10.3389/fncel.2022.845832] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Alzheimer's disease (AD) is a progressive, neurodegenerative brain disorder that generally affects the elderly. Today, after the limited benefit of the pharmacological treatment strategies, numerous noninvasive brain stimulation techniques have been developed. Transcranial magnetic stimulation (TMS), based on electromagnetic stimulation, is one of the most widely used methods. The main problem in the use of TMS is the existence of large individual variability in the results. This causes a waste of money, time, and more importantly, a burden for delicate patients. Hence, it is a necessity to form an efficient and personalized TMS application protocol. In this paper, we performed a machine-learning analysis to see whether it is possible to predict the responses of patients with AD to TMS by analyzing their electroencephalography (EEG) signals. For that purpose, we analyzed both the EEG signals collected before and after the TMS application (EEG1 and EEG2, respectively). Through correlating EEG1 and repetitive transcranial magnetic stimulation (rTMS) outcomes, we tried to see whether it is possible to predict patients' responses before the treatment application. On the other hand, by EEG2 analysis, we investigated TMS impacts on EEG, more importantly if this impact is correlated with patients' response to the treatment. We used the support vector machine (SVM) classifier due to its multiple advantages for the current task with feature selection processes by stepwise linear discriminant analysis (SWLDA) and SVM. However, to justify our numerical analysis framework, we examined and compared the performances of different feature selection and classification techniques. Since we have a limited sample number, we used the leave-one-out method for the validation with the Monte Carlo technique to eliminate bias by a small sample size. In the conclusion, we observed that the correlation between rTMS outcomes and EEG2 is stronger than EEG1, since we observed, respectively, 93 and 79% of accuracies during our data analysis. Besides the informative features of EEG2 are focused on theta band, it indicates that TMS is characterizing the theta band signals in patients with AD in direct relation to patients' response to rTMS. This shows that it is more possible to determine patients' benefit from the TMS at the early stages of the treatment, which would increase the efficiency of rTMS applications in patients with Alzheimer's disease.
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Affiliation(s)
- Cihan Bilge Kayasandik
- Department of Computer Engineering, School of Engineering and Natural Sciences, Istanbul Medipol University, Istanbul, Turkey
| | - Halil Aziz Velioglu
- Department of Women's and Childrens' Health, Karolinska Institutet, Stockholm, Sweden
- Functional Imaging and Cognitive-Affective Neuroscience Lab (fINCAN), Regenerative and Restorative Medicine Research Center (REMER), Health Sciences and Technology Research Institute (SABITA), Istanbul Medipol University, Istanbul, Turkey
| | - Lutfu Hanoglu
- Department of Neurology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
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Repetitive Transcranial Magnetic Stimulation-Associated Changes in Neocortical Metabolites in Major Depression: A Systematic Review. Neuroimage Clin 2022; 35:103049. [PMID: 35738081 PMCID: PMC9233277 DOI: 10.1016/j.nicl.2022.103049] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/01/2022] [Accepted: 05/12/2022] [Indexed: 11/23/2022]
Abstract
We reviewed 12 studies that measured metabolites pre and post rTMS in MDD. Frontal lobe Glu, Gln, NAA, and GABA increased after rTMS. Increases in metabolites were often associated with MDD symptom improvement. We propose novel intracellular mechanisms by which metabolites are altered by rTMS.
Introduction Repetitive Transcranial magnetic stimulation (rTMS) is an FDA approved treatment for major depressive disorder (MDD). However, neural mechanisms contributing to rTMS effects on depressive symptoms, cognition, and behavior are unclear. Proton magnetic resonance spectroscopy (MRS), a noninvasive neuroimaging technique measuring concentrations of biochemical compounds within the brain in vivo, may provide mechanistic insights. Methods This systematic review summarized published MRS findings from rTMS treatment trials to address potential neurometabolic mechanisms of its antidepressant action. Using PubMed, Google Scholar, Web of Science, and JSTOR, we identified twelve empirical studies that evaluated changes in MRS metabolites in a within-subjects, pre- vs. post-rTMS treatment design in patients with MDD. Results rTMS protocols ranged from four days to eight weeks duration, were applied at high frequency to the left dorsolateral prefrontal cortex (DLPFC) in most studies, and were conducted in patients aged 13-to-70. Most studies utilized MRS point resolved spectroscopy acquisitions at 3 Tesla in the bilateral anterior cingulate cortex and DLPFC. Symptom improvements were correlated with rTMS-related increases in the concentration of glutamatergic compounds (glutamate, Glu, and glutamine, Gln), GABA, and N-acetylated compounds (NAA), with some results trend-level. Conclusions This is the first in-depth systematic review of metabolic effects of rTMS in individuals with MDD. The extant literature suggests rTMS stimulation does not produce changes in neurometabolites independent of clinical response; increases in frontal lobe glutamatergic compounds, N-acetylated compounds and GABA following high frequency left DLPFC rTMS therapy were generally associated with clinical improvement. Glu, Gln, GABA, and NAA may mediate rTMS treatment effects on MDD symptomatology through intracellular mechanisms.
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Yamazaki R, Inoue Y, Matsuda Y, Kodaka F, Kitamura Y, Kita Y, Shigeta M, Kito S. Laterality of prefrontal hemodynamic response measured by functional near-infrared spectroscopy before and after repetitive transcranial magnetic stimulation: A potential biomarker of clinical outcome. Psychiatry Res 2022; 310:114444. [PMID: 35190340 DOI: 10.1016/j.psychres.2022.114444] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 02/07/2022] [Accepted: 02/12/2022] [Indexed: 10/19/2022]
Abstract
The factors associated with the clinical outcomes of repetitive transcranial magnetic stimulation (rTMS) in patients with major depressive disorder (MDD) remain largely unexplored. Therefore, this study aimed to examine whether rTMS can change the functional laterality of the prefrontal hemodynamic response and whether baseline functional laterality can predict the clinical outcomes of rTMS using functional near-infrared spectroscopy (fNIRS). We included 19 patients with MDD who were treated with high-frequency rTMS. The verbal fluency task was used as the activation task. We calculated the laterality index (LI) based on the task-related oxygenation response in the frontal region. First, the LI was compared before and after rTMS treatment. Second, the reduction in the Montgomery-Åsberg Depression Rating Scale (MADRS) score was compared between the rightward dominance group (pre-LI < 0) and the leftward dominance group (pre-LI ≥ 0). The findings showed a significant change in the LI after rTMS treatment. The rightward dominance group had a significantly greater reduction in MADRS score than the leftward dominance group. Subsequently, the laterality of the task-related hemodynamic response of the prefrontal region shifted leftward following left high-frequency rTMS treatment. Thus, the pre-LI calculated using fNIRS data is a possible predictor of rTMS outcomes in patients with MDD.
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Affiliation(s)
- Ryuichi Yamazaki
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan.
| | - Yuki Inoue
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuki Matsuda
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Fumitoshi Kodaka
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuzuki Kitamura
- Graduate School of Design, Kyushu University, Fukuoka, Japan; Japan Society for the Promotion of Science, Tokyo, Japan
| | - Yosuke Kita
- Mori Arinori Center for Higher Education and Global Mobility, Hitotsubashi University, Tokyo, Japan; Cognitive Brain Research Unit (CBRU), Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Masahiro Shigeta
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Shinsuke Kito
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan; Department of Psychiatry, National Center of Neurology and Psychiatry, Tokyo, Japan
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Effectiveness of Repetitive Transcranial Magnetic Stimulation in the Treatment of Bipolar Disorder in Comparison to the Treatment of Unipolar Depression in a Naturalistic Setting. Brain Sci 2022; 12:brainsci12030298. [PMID: 35326255 PMCID: PMC8946641 DOI: 10.3390/brainsci12030298] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 01/27/2023] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is effective in the treatment of depression. However, for the subset of patients with bipolar disorder, less data is available and overall strength of evidence is weaker than for its use in unipolar depression. A cohort of 505 patients (of which 46 had a diagnosis of bipolar disorder) with depression who were treated with rTMS were analyzed retrospectively with regards to their response to several weeks of treatment. Hamilton Depression Rating Scale (HDRS) was assessed as main outcome. Unipolar and bipolar patients with depression did not differ significantly in baseline demographic variables or severity of depression. Both groups did not differ significantly in their response to treatment as indicated by absolute and relative changes in the HDRS and response and remission rates. On HDRS subitem-analysis, bipolar patients showed superior amelioration of the symptom “paranoid symptoms” in a statistically significant manner. In conclusion, depressed patients with a diagnosis of bipolar disorder benefit from rTMS in a similar fashion as patients with unipolar depression in a naturalistic setting. rTMS might be more effective in reducing paranoia in bipolar than in unipolar patients.
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Hu B, Yu Y, Yan L, Qi G, Wu D, Li Y, Shi A, Liu C, Shang Y, Li Z, Cui G, Wang W. Intersubject correlation analysis reveals the plasticity of cerebral functional connectivity in the long‐term use of social media. Hum Brain Mapp 2022; 43:2262-2275. [PMID: 35072320 PMCID: PMC8996346 DOI: 10.1002/hbm.25786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/27/2021] [Accepted: 01/08/2022] [Indexed: 12/18/2022] Open
Abstract
Owing to the limitations of cross‐sectional studies, it is unclear whether social media induce brain changes, or if individuals with certain biological traits are more likely to use social media. Functional connectivity (FC) can reflect cerebral functional plasticity, and if social media can influence cerebral FC, then the FC of light social media users should be more similar to that of heavy users after they “heavily” used social media for a long period. We combined longitudinal study design and intersubject correlation (ISC) analysis to investigate this similarity. Thirty‐five heavy and 21 light social media users underwent cognitive tests and functional MRIs. The 21 light social media users underwent another functional MRI scan after completing an additional four‐week social media task. We conducted the ISC at the group, individual, and brain‐region levels to investigate the similarity of FC and locate the brain regions most affected by social media. The FC of light social media users was more similar to that of heavy social media users after they completed the four‐week social media task. Then, social media had an impact on half of the brain, involving almost all brain networks. Finally, cerebral FC that mostly affected by social media was associated with selective attention. We concluded that the impact of social media use on cerebral functional connectivity changes is revealed by ISC method and longitudinal design, which may provide guidance for clinical practice. The methods used in the current research could also be applied to similar domains.
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Affiliation(s)
- Bo Hu
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital Fourth Military Medical University (Air Force Medical University) Xi’an Shaanxi China
| | - Ying Yu
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital Fourth Military Medical University (Air Force Medical University) Xi’an Shaanxi China
| | - Lin‐Feng Yan
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital Fourth Military Medical University (Air Force Medical University) Xi’an Shaanxi China
| | - Guo‐Qing Qi
- Institution of Basic Medicine, Fourth Military Medical University (Air Force Medical University) Xi’an Shaanxi China
| | - Dong Wu
- Institution of Basic Medicine, Fourth Military Medical University (Air Force Medical University) Xi’an Shaanxi China
| | - Yu‐Ting Li
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital Fourth Military Medical University (Air Force Medical University) Xi’an Shaanxi China
| | - An‐Ping Shi
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital Fourth Military Medical University (Air Force Medical University) Xi’an Shaanxi China
| | - Chen‐Xi Liu
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital Fourth Military Medical University (Air Force Medical University) Xi’an Shaanxi China
| | - Yu‐Xuan Shang
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital Fourth Military Medical University (Air Force Medical University) Xi’an Shaanxi China
| | - Ze‐Yang Li
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital Fourth Military Medical University (Air Force Medical University) Xi’an Shaanxi China
| | - Guang‐Bin Cui
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital Fourth Military Medical University (Air Force Medical University) Xi’an Shaanxi China
| | - Wen Wang
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital Fourth Military Medical University (Air Force Medical University) Xi’an Shaanxi China
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22
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Oscillatory brain network changes after transcranial magnetic stimulation treatment in patients with major depressive disorder. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2021.100277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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23
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Gold MC, Yuan S, Tirrell E, Kronenberg EF, Kang JWD, Hindley L, Sherif M, Brown JC, Carpenter LL. Large-scale EEG neural network changes in response to therapeutic TMS. Brain Stimul 2022; 15:316-325. [PMID: 35051642 PMCID: PMC8957581 DOI: 10.1016/j.brs.2022.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 01/04/2022] [Accepted: 01/10/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) is an effective therapy for patients with treatment-resistant depression. TMS likely induces functional connectivity changes in aberrant circuits implicated in depression. Electroencephalography (EEG) "microstates" are topographies hypothesized to represent large-scale resting networks. Canonical microstates have recently been proposed as markers for major depressive disorder (MDD), but it is not known if or how they change following TMS. METHODS Resting EEG was obtained from 49 MDD patients at baseline and following six weeks of daily TMS. Polarity-insensitive modified k-means clustering was used to segment EEGs into constituent microstates. Microstates were localized via sLORETA. Repeated-measures mixed models tested for within-subject differences over time and t-tests compared microstate features between TMS responder and non-responder groups. RESULTS Six microstates (MS-1 - MS-6) were identified from all available EEG data. Clinical response to TMS was associated with increases in features of MS-2, along with decreased metrics of MS-3. Nonresponders showed no significant changes in any microstate. Change in occurrence and coverage of both MS-2 (increased) and MS-3 (decreased) correlated with symptom change magnitude over the course of TMS treatment. CONCLUSIONS We identified EEG microstates associated with clinical improvement following a course of TMS therapy. Results suggest selective modulation of resting networks observable by EEG, which is inexpensive and easily acquired in the clinic setting.
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Affiliation(s)
- Michael C. Gold
- Butler Hospital TMS Clinic and Neuromodulation Research Facility, Providence RI,Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University
| | - Shiwen Yuan
- Butler Hospital TMS Clinic and Neuromodulation Research Facility, Providence RI,Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University
| | - Eric Tirrell
- Butler Hospital TMS Clinic and Neuromodulation Research Facility, Providence RI
| | | | - Jee Won D. Kang
- Butler Hospital TMS Clinic and Neuromodulation Research Facility, Providence RI
| | - Lauren Hindley
- Butler Hospital TMS Clinic and Neuromodulation Research Facility, Providence RI
| | - Mohamed Sherif
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University,Lifespan Physician Group, Rhode Island Hospital, Providence RI
| | - Joshua C. Brown
- Butler Hospital TMS Clinic and Neuromodulation Research Facility, Providence RI,Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University
| | - Linda L. Carpenter
- Butler Hospital TMS Clinic and Neuromodulation Research Facility, Providence RI,Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University
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24
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Wang X, Qin J, Zhu R, Zhang S, Tian S, Sun Y, Wang Q, Zhao P, Tang H, Wang L, Si T, Yao Z, Lu Q. Predicting treatment selections for individuals with major depressive disorder according to functional connectivity subgroups. Brain Connect 2021; 12:699-710. [PMID: 34913731 DOI: 10.1089/brain.2021.0153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is a highly prevalent and disabling disease. Currently, patients' treatment choices depend on their clinical symptoms observed by clinicians, which are subjective. Rich evidence suggests that different functional networks' dysfunctions correspond to different intervention preferences. Here, we aimed to develop a prediction model based on data-driven subgroups to provide treatment recommendations. METHODS All 630 participants enrolled from four sites underwent functional magnetic resonances imaging at baseline. In the discovery dataset (n=228), we firstly identified MDD subgroups by the hierarchical clustering method using the canonical variates of resting-state functional connectivity (FC) through canonical correlation analyses. The demographic, symptom improvement and FC were compared among subgroups. The preference intervention for each subgroup was also determined. Next, we predicted the individual treatment strategy. Specifically, a patient was assigned into predefined subgroups based on FC similarities and then his/her treatment strategy was determined by the subgroups' preferred interventions. RESULTS Three subgroups with specific treatment recommendations were emerged including: (1) a selective serotonin reuptake inhibitors-oriented subgroup with early improvements in working and activities. (2) a stimulation-oriented subgroup with more alleviation in suicide. (3) a selective serotonin noradrenaline reuptake inhibitors-oriented subgroup with more alleviation in hypochondriasis. Through cross-dataset testing respectively conducted on three testing datasets, results showed an overall accuracy of 72.83%. CONCLUSIONS Our works revealed the correspondences between subgroups and their treatment preferences and predicted individual treatment strategy based on such correspondences. Our model has the potential to support psychiatrists in early clinical decision making for better treatment outcomes.
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Affiliation(s)
- Xinyi Wang
- Southeast University, 12579, School of Biological Sciences & Medical Engineering, Nanjing, Jiangsu, China.,Southeast University, 12579, Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing, Jiangsu, China;
| | - Jiaolong Qin
- Nanjing University of Science and Technology, 12436, The Key Laboratory of Intelligent Perception and Systems for High-Dimensional Information of Ministry of Education, School of Computer Science and Engineering, Nanjing, Jiangsu, China;
| | - Rongxin Zhu
- Nanjing Medical University Affiliated Brain Hospital, 56647, Department of Psychiatry, Nanjing, Jiangsu, China;
| | - Siqi Zhang
- Southeast University, 12579, School of Biological Sciences & Medical Engineering, Nanjing, China.,Southeast University, 12579, Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing, Jiangsu, China;
| | - Shui Tian
- Southeast University, 12579, School of Biological Sciences & Medical Engineering, Nanjing, Jiangsu, China.,Southeast University, 12579, Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing, Jiangsu, China;
| | - Yurong Sun
- Southeast University, 12579, School of Biological Sciences & Medical Engineering, Nanjing, Jiangsu, China.,Southeast University, 12579, Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing, Jiangsu, China;
| | - Qiang Wang
- Nanjing Drum Tower Hospital, 66506, Nanjing, Jiangsu, China;
| | - Peng Zhao
- Nanjing Drum Tower Hospital, 66506, Nanjing, Jiangsu, China;
| | - Hao Tang
- Nanjing Medical University Affiliated Brain Hospital, 56647, Department of Psychiatry, Nanjing, Jiangsu, China;
| | - Li Wang
- Peking University Institute of Mental Health, 74577, Beijing, Beijing, China;
| | - Tianmei Si
- Peking University Institute of Mental Health, 74577, Beijing, Beijing, China;
| | - Zhijian Yao
- Nanjing Medical University Affiliated Brain Hospital, 56647, Department of psychiatry, Nanjing, Jiangsu, China.,Nanjing Brain Hospital, 56647, Medical School of Nanjing University, Nanjing, Nanjing, China;
| | - Qing Lu
- Southeast University, 12579, School of Biological Sciences & Medical Engineering, Nanjing, China.,Southeast University, 12579, Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing, Jiangsu, China;
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25
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Shi X, Guo Y, Zhu L, Wu W, Hordacre B, Su X, Wang Q, Chen X, Lan X, Dang G. Electroencephalographic connectivity predicts clinical response to repetitive transcranial magnetic stimulation in patients with insomnia disorder. Sleep Med 2021; 88:171-179. [PMID: 34773788 DOI: 10.1016/j.sleep.2021.10.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/10/2021] [Accepted: 10/12/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Accumulating evidence suggests that low frequency repetitive transcranial magnetic stimulation (rTMS), which generally decreases cortical excitability and remodels plastic connectivity, improves sleep quality in patients with insomnia disorder. However, the effects of rTMS vary substantially across individuals and treatment is sometimes unsatisfactory, calling for biomarkers for predicting clinical outcomes. OBJECTIVE This study aimed to investigate whether functional connectivity of the target network in electroencephalography is associated with the clinical response to low frequency rTMS in patients with insomnia disorder. METHODS Twenty-five patients with insomnia disorder were subjected to 10 sessions of treatment with 1 Hz rTMS over the right dorsolateral prefrontal cortex. Resting-state electroencephalography was collected before rTMS. Pittsburgh Sleep Quality Index, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, and Mini-Mental State Exam were performed before and after rTMS treatment, with a follow-up after one month. Electroencephalographic connectivity was measured by the power envelope connectivity at the source level. Partial least squares regression identified models of connectivity that maximally accounted for the rTMS response. RESULTS Scores of Pittsburgh Sleep Quality Index, Hamilton Depression Rating Scale, and Hamilton Anxiety Rating Scale were decreased after rTMS and one-month later. Baseline weaker connectivity of a network in the beta and alpha bands between a brain region approximating the stimulated right dorsolateral prefrontal cortex and areas located in the frontal, insular, and limbic cortices was associated with a greater change in Pittsburgh Sleep Quality Index and Hamilton Depression Rating Scale following rTMS. CONCLUSIONS Low frequency rTMS could improve sleep quality and depressive moods in patients with insomnia disorder. Moreover, electroencephalographic functional connectivity would potentially be a robust biomarker for predicting the therapeutic effects.
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Affiliation(s)
- Xue Shi
- Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, 518020, Guangdong, China
| | - Yi Guo
- Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, 518020, Guangdong, China; Shenzhen Bay Laboratory, Shenzhen, 518020, Guangdong, China
| | - Lin Zhu
- Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, 518020, Guangdong, China
| | - Wei Wu
- School of Automation Science and Engineering, South China University of Technology, Guangzhou, 510641, China
| | - Brenton Hordacre
- Innovation, Implementation and Clinical Translation (IIMPACT) in Health, Allied Health and Human Performance, University of South Australia, Australia
| | - Xiaolin Su
- Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, 518020, Guangdong, China
| | - Qian Wang
- Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, 518020, Guangdong, China
| | - Xiaoxia Chen
- Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, 518020, Guangdong, China
| | - Xiaoyong Lan
- Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, 518020, Guangdong, China
| | - Ge Dang
- Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, 518020, Guangdong, China.
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26
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Understanding complex functional wiring patterns in major depressive disorder through brain functional connectome. Transl Psychiatry 2021; 11:526. [PMID: 34645783 PMCID: PMC8513388 DOI: 10.1038/s41398-021-01646-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/20/2021] [Accepted: 09/29/2021] [Indexed: 02/06/2023] Open
Abstract
Brain function relies on efficient communications between distinct brain systems. The pathology of major depressive disorder (MDD) damages functional brain networks, resulting in cognitive impairment. Here, we reviewed the associations between brain functional connectome changes and MDD pathogenesis. We also highlighted the utility of brain functional connectome for differentiating MDD from other similar psychiatric disorders, predicting recurrence and suicide attempts in MDD, and evaluating treatment responses. Converging evidence has now linked aberrant brain functional network organization in MDD to the dysregulation of neurotransmitter signaling and neuroplasticity, providing insights into the neurobiological mechanisms of the disease and antidepressant efficacy. Widespread connectome dysfunctions in MDD patients include multiple, large-scale brain networks as well as local disturbances in brain circuits associated with negative and positive valence systems and cognitive functions. Although the clinical utility of the brain functional connectome remains to be realized, recent findings provide further promise that research in this area may lead to improved diagnosis, treatments, and clinical outcomes of MDD.
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27
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Precise Modulation Strategies for Transcranial Magnetic Stimulation: Advances and Future Directions. Neurosci Bull 2021; 37:1718-1734. [PMID: 34609737 DOI: 10.1007/s12264-021-00781-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/23/2021] [Indexed: 10/20/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) is a popular modulatory technique for the noninvasive diagnosis and therapy of neurological and psychiatric diseases. Unfortunately, current modulation strategies are only modestly effective. The literature provides strong evidence that the modulatory effects of TMS vary depending on device components and stimulation protocols. These differential effects are important when designing precise modulatory strategies for clinical or research applications. Developments in TMS have been accompanied by advances in combining TMS with neuroimaging techniques, including electroencephalography, functional near-infrared spectroscopy, functional magnetic resonance imaging, and positron emission tomography. Such studies appear particularly promising as they may not only allow us to probe affected brain areas during TMS but also seem to predict underlying research directions that may enable us to precisely target and remodel impaired cortices or circuits. However, few precise modulation strategies are available, and the long-term safety and efficacy of these strategies need to be confirmed. Here, we review the literature on possible technologies for precise modulation to highlight progress along with limitations with the goal of suggesting future directions for this field.
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28
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Leuchter AF, Wilson AC, Vince-Cruz N, Corlier J. Novel method for identification of individualized resonant frequencies for treatment of Major Depressive Disorder (MDD) using repetitive Transcranial Magnetic Stimulation (rTMS): A proof-of-concept study. Brain Stimul 2021; 14:1373-1383. [PMID: 34425244 DOI: 10.1016/j.brs.2021.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 07/28/2021] [Accepted: 08/11/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Repetitive Transcranial Magnetic Stimulation (rTMS) is an effective treatment for Major Depressive Disorder (MDD), but therapeutic benefit is highly variable. Clinical improvement is related to changes in brain circuits, which have preferred resonant frequencies (RFs) and vary across individuals. OBJECTIVE We developed a novel rTMS-electroencephalography (rTMS-EEG) interrogation paradigm to identify RFs using the association of power/connectivity measures with symptom severity and treatment outcome. METHODS 35 subjects underwent rTMS interrogation at 71 frequencies ranging from 3 to 17 Hz administered to left dorsolateral prefrontal cortex (DLPFC). rTMS-EEG was used to assess resonance in oscillatory power/connectivity changes (phase coherence [PC], envelope correlation [EC], and spectral correlation coefficient [SCC]) after each frequency. Multiple regression was used to detect relationships between 10 Hz resonance and baseline symptoms as well as clinical improvement after 10 sessions of 10 Hz rTMS treatment. RESULTS Baseline symptom severity was significantly associated with SCC resonance in left sensorimotor (SM; p < 0.0004), PC resonance in fronto-parietal (p = 0.001), and EC resonance in centro-posterior channels (p = 0.002). Subjects significantly improved with 10 sessions of rTMS treatment. Only decreased SCC SM resonance was significantly associated with clinical improvement (r = 0.35, p = 0.04). Subjects for whom 10 Hz SM SCC was highly ranked as an RF among all stimulation frequencies had better outcomes from 10 Hz treatment. CONCLUSIONS Resonance of 10 Hz stimulation measured using SCC correlated with both symptom severity and improvement with 10 Hz rTMS treatment. Research should determine whether this interrogation paradigm can identify individualized rTMS treatment frequencies.
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Affiliation(s)
- Andrew F Leuchter
- From the TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, And the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Andrew C Wilson
- From the TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, And the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Nikita Vince-Cruz
- From the TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, And the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Juliana Corlier
- From the TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, And the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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29
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Lee JC, Corlier J, Wilson AC, Tadayonnejad R, Marder KG, Ngo D, Krantz DE, Wilke SA, Levitt JG, Ginder ND, Leuchter AF. Subthreshold stimulation intensity is associated with greater clinical efficacy of intermittent theta-burst stimulation priming for Major Depressive Disorder. Brain Stimul 2021; 14:1015-1021. [PMID: 34186465 DOI: 10.1016/j.brs.2021.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Intermittent theta-burst stimulation priming (iTBS-P) can improve clinical outcome of patients with Major Depressive Disorder (MDD) who do not show early benefit from 10 Hz stimulation of left dorsolateral prefrontal cortex (DLPFC), also known as high-frequency left-sided (HFL) stimulation. The intensity and pulse number for iTBS-P needed to induce clinical benefit have not been systematically examined. OBJECTIVE To study the effect of intensity and pulse number on the clinical efficacy of iTBS-P. METHODS We conducted a retrospective review of 71 participants who received at least five sessions of HFL with limited clinical benefit and received iTBS-P augmentation for between 5 and 25 sessions. Intensity of iTBS-P priming stimuli ranged from 75 to 120% of motor threshold (MT) and pulse number ranged from 600 to 1800. Associations among intensity, pulse number, and clinical outcome were analyzed using a mixed methods linear model with change in IDS-SR as the primary outcome variable, priming stimulation intensity (subthreshold or suprathreshold), pulse number (<1200 or >1200 pulses), and gender as fixed factors, and number of iTBS-P treatments and age as continuous covariates. RESULTS Subjects who received subthreshold intensity iTBS-P experienced greater reduction in depressive symptoms than those who received suprathreshold iTBS-P (p = 0.011) with no effect of pulse number after controlling for stimulus intensity. CONCLUSIONS Subthreshold intensity iTBS-P was associated with greater clinical improvement than suprathreshold stimulation. This finding is consistent with iTBS-P acting through homeostatic plasticity mechanisms.
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Affiliation(s)
- Jonathan C Lee
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, And the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA, 90024, USA.
| | - Juliana Corlier
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, And the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA, 90024, USA
| | - Andrew C Wilson
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, And the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA, 90024, USA
| | - Reza Tadayonnejad
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, And the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA, 90024, USA; California Institute of Technology, Division of the Humanities and Social Sciences, 1200 E California Blvd, Pasadena, CA, 91125, USA
| | - Katharine G Marder
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, And the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA, 90024, USA
| | - Doan Ngo
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, And the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA, 90024, USA
| | - David E Krantz
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, And the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA, 90024, USA
| | - Scott A Wilke
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, And the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA, 90024, USA
| | - Jennifer G Levitt
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, And the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA, 90024, USA
| | - Nathaniel D Ginder
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, And the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA, 90024, USA; VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA
| | - Andrew F Leuchter
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, And the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA, 90024, USA
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30
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An investigation of working memory deficits in depression using the n-back task: A systematic review and meta-analysis. J Affect Disord 2021; 284:1-8. [PMID: 33581489 DOI: 10.1016/j.jad.2021.01.084] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/12/2021] [Accepted: 01/31/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Depression is associated with cognitive deficits across multiple domains, including working memory. The n-back task, a convenient psychometric tool capable of computerised delivery and concurrent use with neuroimaging, can provide enhanced insight into working memory dysfunction in depression. This meta-analysis sought to investigate the n-back task under varying cognitive load conditions (i.e. different levels of 'n') to clarify the pattern of working memory deficits in depression. METHODS We conducted a systematic review and meta-analysis of studies involving unipolar depressed participants and matched controls utilising the n-back task. Meta-analyses were performed for accuracy and response times at four levels of cognitive load (0-, 1-, 2-, and 3-back). RESULTS 31 studies (total 1,666 participants) met inclusion criteria and were included for quantitative analyses. Depressed individuals had significantly reduced accuracy compared to controls for 1-, 2-, and 3-back tasks, but not the attentional 0-back task. Likewise, response latencies were prolonged for all task levels (0-, 1-, 2-, and 3-back). Additional meta-regression analyses indicated that participant age and clinical status (i.e. inpatient/outpatient) may exacerbate working memory deficits associated with depression. LIMITATIONS Our results indicate high levels of heterogeneity between studies, particularly for response times. CONCLUSIONS Accuracy impairments were worse at higher levels of n, with the largest effect size obtained on the 2-back task, suggesting deficits to higher executive functions. Response times were consistently prolonged at all cognitive loads in agreement with a pattern of generalised psychomotor retardation.
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31
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Fitzgerald PB. An update on the clinical use of repetitive transcranial magnetic stimulation in the treatment of depression. J Affect Disord 2020; 276:90-103. [PMID: 32697721 DOI: 10.1016/j.jad.2020.06.067] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 06/03/2020] [Accepted: 06/23/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is an increasingly used treatment for patients with depression. The use of rTMS in depression is supported by over 20 years of clinical trials. There has been a significant increase in knowledge around the use of rTMS in recent years. OBJECTIVE The aim of this paper was to review the use of rTMS in depression to provide an update for rTMS practitioners and clinicians interested in the clinical use of this treatment. METHODS A targeted review of the literature around the use of rTMS treatment of depression with a specific focus on studies published in the last 3 years. RESULTS High-frequency rTMS applied to the left dorsolateral prefrontal cortex is an effective treatment for acute episodes of major depressive disorder. There are several additional methods of rTMS delivery that are supported by clinical trials and meta-analyses but no substantive evidence that any one approach is any more effective than any other. rTMS is effective in unipolar depression and most likely bipolar depression. rTMS courses may be repeated in the management of depressive relapse but there is less evidence for the use of rTMS in the maintenance phase. CONCLUSIONS The science around the use of rTMS is rapidly evolving and there is a considerable need for practitioners to remain abreast of the current state of this literature and its implications for clinical practice. rTMS is an effective antidepressant treatment but its optimal use should be continually informed by knowledge of the state of the art.
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Affiliation(s)
- Paul B Fitzgerald
- Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Monash University Central Clinical School, 888 Toorak Rd, Camberwell, Victoria 3004, Australia.
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Affiliation(s)
- Linda L Carpenter
- Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Carpenter, Philip); Butler Hospital TMS Clinic and Neuromodulation Research Facility, Providence (Carpenter); and Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence (Philip)
| | - Noah S Philip
- Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Carpenter, Philip); Butler Hospital TMS Clinic and Neuromodulation Research Facility, Providence (Carpenter); and Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence (Philip)
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Pulopulos M, Allaert J, Vanderhasselt MA, Sanchez-Lopez A, De Witte S, Baeken C, De Raedt R. Effects of HF-rTMS over the left and right DLPFC on proactive and reactive cognitive control. Soc Cogn Affect Neurosci 2020; 17:109-119. [PMID: 32613224 PMCID: PMC8824550 DOI: 10.1093/scan/nsaa082] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 03/24/2020] [Accepted: 06/15/2020] [Indexed: 01/02/2023] Open
Abstract
Previous research supports the distinction between proactive and reactive control. Although the dorsolateral prefrontal cortex (DLPFC) has been consistently related to these processes, lateralization of proactive and reactive control is still under debate. We manipulated brain activity to investigate the role of the left and right DLPFC in proactive and reactive cognitive control. Using a single-blind, sham-controlled crossover within-subjects design, 25 young healthy females performed the 'AX' Continuous Performance Task after receiving sham versus active High-Frequency repetitive Transcranial Magnetic Stimulation (HF-rTMS) to increase left and right DLPFC activity. RTs and pupillometry were used to assess patterns of proactive and reactive cognitive control and task-related resource allocation respectively. We observed that, compared to sham, HF-rTMS over the left DLPFC increased proactive control. After right DLPFC HF-rTMS, participants showed slower RTs on AX trials, suggesting more reactive control. However, this latter result was not supported by RTs on BX trials (i.e. the trial that specifically assess reactive control). Pupil measures showed a sustained increase in resource allocation after both active left and right HF-rTMS. Our results with RT data provide evidence on the role of the left DLPFC in proactive control and suggest that the right DLPFC is implicated in reactive control.
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Affiliation(s)
- Matias Pulopulos
- Department of Experimental Clinical and Health Psychology, Ghent University, Belgium
| | - Jens Allaert
- Department of Experimental Clinical and Health Psychology, Ghent University, Belgium.,Department of Head and Skin, Ghent University, Belgium.,Ghent Experimental Psychiatry (GHEP) Lab, Belgium
| | - Marie-Anne Vanderhasselt
- Department of Experimental Clinical and Health Psychology, Ghent University, Belgium.,Department of Head and Skin, Ghent University, Belgium.,Ghent Experimental Psychiatry (GHEP) Lab, Belgium
| | - Alvaro Sanchez-Lopez
- Department of Personality, Evaluation and Psychological Treatment, Complutense University of Madrid, Spain
| | - Sara De Witte
- Department of Experimental Clinical and Health Psychology, Ghent University, Belgium.,Department of Head and Skin, Ghent University, Belgium.,Ghent Experimental Psychiatry (GHEP) Lab, Belgium
| | - Chris Baeken
- Department of Head and Skin, Ghent University, Belgium.,Ghent Experimental Psychiatry (GHEP) Lab, Belgium.,Department of Psychiatry, University Hospital Brussels (UZBrussel), Belgium
| | - Rudi De Raedt
- Department of Experimental Clinical and Health Psychology, Ghent University, Belgium
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Trambaiolli LR, Biazoli CE. Resting-state global EEG connectivity predicts depression and anxiety severity. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:3707-3710. [PMID: 33018806 DOI: 10.1109/embc44109.2020.9176161] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
There is a recent interest in finding neurophysiological biomarkers which will facilitate the diagnosis and understanding of the neural basis of different psychiatric disorders. In this paper, we evaluated the resting-state global EEG connectivity as a potential biomarker for depressive and anxiety symptoms. For this, we evaluated a population of 119 subjects, including 75 healthy subjects and 44 patients with major depressive disorder. We calculated the global connectivity (spectral coherence) in a setup of 60 EEG channels, for six different spectral bands: theta, alpha1, alpha2, beta1, beta2, and gamma. These global connectivity scores were used to train a Support Vector Regressor to predict symptoms measured by the Beck Depression Inventory (BDI) and the Spielberger Trait Anxiety Inventory (TAI). Experiments showed a significant prediction of both symptoms, with a mean absolute error (MAE) of 8.07±6.98 and 11.52±8.7 points, respectively. Among the most discriminating features, the global connectivity in the alpha2 band (10.0-12.0Hz) presented significantly positive Spearman's correlation with the depressive (rho = 0.32, pFDR <0.01), and the anxiety symptoms (rho = 0.26, pFDR<0.01).Clinical relevance-This study demonstrates that EEG global connectivity can be used to predict depression and anxiety symptoms measured by widely used questionnaires.
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Zhang X, Liu B, Li N, Li Y, Hou J, Duan G, Wu D. Transcranial Direct Current Stimulation Over Prefrontal Areas Improves Psychomotor Inhibition State in Patients With Traumatic Brain Injury: A Pilot Study. Front Neurosci 2020; 14:386. [PMID: 32508560 PMCID: PMC7251071 DOI: 10.3389/fnins.2020.00386] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 03/30/2020] [Indexed: 01/10/2023] Open
Abstract
Objectives Many post-traumatic patients with minimally conscious state are complicated by psychomotor inhibition state (PIS), which impedes further rehabilitation. The treatment of PIS is not satisfactory. This pilot study aimed to investigate effects of anodal transcranial direct current stimulation (A-tDCS) on PIS in post-traumatic patients and examine the altered cortical activation after tDCS using non-linear electroencephalogram (EEG). Methods The study included 10 patients with post-traumatic PIS. An A–B design was used. The patients received 4 weeks of sham tDCS during Phase A, and they received A-tDCS over the prefrontal area and left dorsolateral prefrontal cortex (DLPFC) for 4 weeks (40 sessions) during Phase B. Conventional treatments were administered throughout both phases. JFK Coma Recovery Scale-Revised (CRS-R), apathy evaluation scale (AES), and the EEG non-linear indices of approximate entropy (ApEn) and cross approximate entropy (C-ApEn) were measured before Phase A, before Phase B, and after Phase B. Results After A-tDCS treatment, CRS-R and AES were improved significantly. ApEn and C-ApEn results showed that the local cortical connection of bilateral sensorimotor areas with their peripheral areas could be activated by affected painful stimuli, while bilateral cerebral hemispheres could be activated by the unaffected painful-stimuli condition. Linear regression analysis revealed that the affected sensorimotor cortex excitability and unaffected local and distant cortical networks connecting the sensorimotor area to the prefrontal area play a major role in AES improvement. Conclusion A-tDCS over the prefrontal area and left DLPFC improves PIS. The recovery might be related to increased excitability in local and distant cortical networks connecting the sensorimotor area to the prefrontal area. Thus, tDCS may be an alternative treatment for post-traumatic PIS.
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Affiliation(s)
- Xu Zhang
- Department of Rehabilitation, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Baohu Liu
- Department of Rehabilitation, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Nan Li
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Yuanyuan Li
- Department of Rehabilitation, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Jun Hou
- Department of Rehabilitation, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Guoping Duan
- Department of Rehabilitation, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Dongyu Wu
- Department of Rehabilitation, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
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Nugent AC, Ballard ED, Gilbert JR, Tewarie PK, Brookes MJ, Zarate CA. The Effect of Ketamine on Electrophysiological Connectivity in Major Depressive Disorder. Front Psychiatry 2020; 11:519. [PMID: 32655423 PMCID: PMC7325927 DOI: 10.3389/fpsyt.2020.00519] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/21/2020] [Indexed: 01/06/2023] Open
Abstract
Major depressive disorder (MDD) is highly prevalent and frequently disabling. Only about 30% of patients respond to a first-line antidepressant treatment, and around 30% of patients are classified as "treatment-resistant" after failing to respond to multiple adequate trials. While most antidepressants target monoaminergic targets, ketamine is an N-methyl-D-aspartate (NMDA) antagonist that has shown rapid antidepressant effects when delivered intravenously or intranasally. While there is evidence that ketamine exerts its effects via enhanced α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) throughput, its mechanism for relieving depressive symptoms is largely unknown. This study acquired resting-state magnetoencephalography (MEG) recordings after both ketamine and placebo infusions and investigated functional connectivity using a multilayer amplitude-amplitude correlation technique spanning the canonical frequency bands. Twenty-four healthy volunteers (HVs) and 27 unmedicated participants with MDD took part in a double-blind, placebo-controlled, crossover trial of 0.5 mg/kg IV ketamine. Order of infusion was randomized, and participants crossed over to receive the second infusion after two weeks. The results indicated widespread ketamine-induced reductions in connectivity in the alpha and beta bands that did not correlate with magnitude of antidepressant response. In contrast, the magnitude of ketamine's antidepressant effects in MDD participants was associated with cross-frequency connectivity for delta-alpha and delta-gamma bands, with HVs and ketamine non-responders showing connectivity decreases post-ketamine and ketamine responders demonstrating small increases in connectivity. These results may indicate functional subtypes of MDD and also suggest that neural responses to ketamine are fundamentally different between responders and non-responders.
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Affiliation(s)
- Allison C Nugent
- MEG Core Facility, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States.,Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Elizabeth D Ballard
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Jessica R Gilbert
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Prejaas K Tewarie
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom
| | - Matthew J Brookes
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom
| | - Carlos A Zarate
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
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Garnaat SL, Fukuda AM, Yuan S, Carpenter LL. Identification of Clinical Features and Biomarkers that may inform a Personalized Approach to rTMS for Depression. ACTA ACUST UNITED AC 2019; 17-18:4-16. [PMID: 33954269 DOI: 10.1016/j.pmip.2019.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Repetitive transcranial magnetic stimulation (rTMS), an established treatment for treatment-resistant depression, may hold promise as a personalized medicine approach for the treatment of major depressive disorder (MDD). Clinical research has begun to identify patient-specific factors that could be used to guide rTMS treatment decisions or individualized treatment approaches. This literature review describes a range of patient factors which have been evaluated as potential biomarkers of rTMS treatment response, including patient- and illness-related characteristics, genetic factors, and biomarkers derived from neuroimaging and EEG. We highlight the need for validation data for imaging and electrophysiological biomarkers associated with rTMS as well as prospective evaluation of clinical predictors. Finally, we consider implications for future efforts to move toward a personalized medicine approach in the treatment of depression with rTMS.
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Affiliation(s)
- Sarah L Garnaat
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 345 Blackstone Blvd., Providence, RI, 02906, USA.,Butler Hospital, Providence, RI, 345 Blackstone Blvd., Providence, RI, 02906, USA
| | - Andrew M Fukuda
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 345 Blackstone Blvd., Providence, RI, 02906, USA.,Butler Hospital, Providence, RI, 345 Blackstone Blvd., Providence, RI, 02906, USA
| | - Shiwen Yuan
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 345 Blackstone Blvd., Providence, RI, 02906, USA.,Butler Hospital, Providence, RI, 345 Blackstone Blvd., Providence, RI, 02906, USA
| | - Linda L Carpenter
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 345 Blackstone Blvd., Providence, RI, 02906, USA.,Butler Hospital, Providence, RI, 345 Blackstone Blvd., Providence, RI, 02906, USA
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