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Dellink A, Hebbrecht K, Zeeuws D, Baeken C, De Fré G, Bervoets C, De Witte S, Sabbe B, Morrens M, Coppens V. Continuous theta burst stimulation for bipolar depression: A multicenter, double-blind randomized controlled study exploring treatment efficacy and predictive potential of kynurenine metabolites. J Affect Disord 2024; 361:693-701. [PMID: 38936704 DOI: 10.1016/j.jad.2024.06.078] [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: 03/14/2024] [Revised: 06/14/2024] [Accepted: 06/22/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND While theta burst stimulation (TBS) shows promise in Major Depressive Disorder (MDD), its effectiveness in bipolar depression (BD-D) remains uncertain. Optimizing treatment parameters is crucial in the pursuit of rapid symptom relief. Moreover, aligning with personalized treatment strategies and increased interest in immunopsychiatry, biomarker-based stratification of patients most likely to benefit from TBS might improve remission rates. We investigated treatment effectiveness of continuous TBS (cTBS) compared to sham in BD-D, and assessed the capacity of plasma kynurenine pathway metabolites to predict treatment outcome. METHODS Thirty-seven patients with BD-D underwent accelerated active or sham cTBS treatment in a multicenter, double-blind, randomized controlled trial. Depressive symptoms were measured with the 17-item Hamilton Depression Rating Scale (HDRS-17) before treatment (T0), 3-4 days posttreatment (T1) and 10-11 days posttreatment (T2). Plasma tryptophan, kynurenine, kynurenic acid and quinolinic acid concentrations were quantified with ELISA. Linear mixed models were used for statistical analyses. RESULTS Although the total sample showed depressive symptom improvement, active cTBS did not demonstrate greater symptom alleviation compared to sham. However, higher baseline quinolinic acid significantly predicted symptom improvement in the active treatment group, not in sham-stimulated patients. LIMITATIONS The modest sample size limited the power to detect significant differences with regard to treatment effect. Also, the follow-up period was 10-11 days, whereas similar studies usually follow up for at least one month. CONCLUSION More research is required to optimize cTBS for BD-D and explore the involvement of quinolinic acid in treatment outcome.
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Affiliation(s)
- Annelies Dellink
- Scientific Initiative of Neuropsychiatric and Psychopharmacological Studies (SINAPS), University Psychiatric Centre Duffel, Duffel, Belgium; Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
| | - Kaat Hebbrecht
- Scientific Initiative of Neuropsychiatric and Psychopharmacological Studies (SINAPS), University Psychiatric Centre Duffel, Duffel, Belgium; Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium
| | - Dieter Zeeuws
- Department of Psychiatry, Universitair Ziekenhuis Brussel, Brussels, Belgium; Neuroprotection and Neuromodulation Research Group (NEUR), Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Chris Baeken
- Department of Psychiatry, Universitair Ziekenhuis Brussel, Brussels, Belgium; Neuroprotection and Neuromodulation Research Group (NEUR), Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium
| | | | - Chris Bervoets
- Department of Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium
| | - Sara De Witte
- Neuroprotection and Neuromodulation Research Group (NEUR), Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium
| | - Bernard Sabbe
- Scientific Initiative of Neuropsychiatric and Psychopharmacological Studies (SINAPS), University Psychiatric Centre Duffel, Duffel, Belgium; Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Manuel Morrens
- Scientific Initiative of Neuropsychiatric and Psychopharmacological Studies (SINAPS), University Psychiatric Centre Duffel, Duffel, Belgium; Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Violette Coppens
- Scientific Initiative of Neuropsychiatric and Psychopharmacological Studies (SINAPS), University Psychiatric Centre Duffel, Duffel, Belgium; Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Slan AR, Citrenbaum C, Corlier J, Ngo D, Vince-Cruz N, Jackson NJ, Valles TE, Wilke SA, Hoftman GD, Koek RJ, Leuchter MK, Krantz DE, Strouse TB, Tadayonnejad R, Ginder ND, Distler MG, Lee JH, Adelekun AE, Einstein EH, Oughli HA, Leuchter AF. The role of sex and age in the differential efficacy of 10 Hz and intermittent theta-burst (iTBS) repetitive transcranial magnetic stimulation (rTMS) treatment of major depressive disorder (MDD). J Affect Disord 2024; 366:106-112. [PMID: 39187197 DOI: 10.1016/j.jad.2024.08.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 07/22/2024] [Accepted: 08/23/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND Sex- and age-dependent outcome differences have been observed in treatment of Major Depressive Disorder (MDD), including 10 Hz repetitive Transcranial Magnetic Stimulation (rTMS). We examined whether there are sex- and age-dependent differences in outcome with intermittent Theta Burst Stimulation (iTBS), another rTMS protocol. METHODS The relationship between biological sex, age, and treatment outcome was retrospectively examined among 414 patients with MDD treated with 10 Hz or iTBS rTMS. Linear mixed-effects modeling was used to examine the association between treatment and change in the 30-item Inventory of Depressive Symptomatology Self-Report (IDS-SR30) score from baseline to treatments 10 and 30, with biological sex (M/F), protocol (iTBS/10 Hz), age (≥/<50 years old), and time (treatment 1/10/30) included as fixed effects. The three-way sex-protocol-time and age-protocol-time interactions were used to determine any differential relationships between protocol and outcome dependent on sex and age. Post-hoc t-tests were conducted to examine differences in improvement. RESULTS There was a significant three-way sex-protocol-time interaction at treatments 10 (p = 0.016) and 30 (p = 0.031). Males showed significantly greater improvement with iTBS than females at treatments 10 (p = 0.041) and 30 (p = 0.035), while females showed numerically greater improvement with 10 Hz treatment. While there was not a significant three-way age-protocol-time interaction, there was a significant interaction between age (≥50 years old) and time at treatments 10 (p = 0.007) and 30 (p = 0.042), and among age, sex, and time at treatment 30 (p = 0.028). LIMITATIONS Retrospective naturalistic treatment protocol. CONCLUSIONS iTBS appeared less efficacious in females than in males, and rTMS overall was more efficacious in patients over fifty, particularly females.
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Affiliation(s)
- Aaron R Slan
- 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
| | - 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
| | - Doan Ngo
- 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
| | - Nikita Vince-Cruz
- 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
| | - Nicholas J Jackson
- Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Thomas E Valles
- 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
| | - Scott A Wilke
- 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
| | - Gil D Hoftman
- 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
| | - Ralph J Koek
- 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
| | - Michael K 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
| | - David E Krantz
- 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
| | - Thomas B Strouse
- 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 Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA
| | - Nathaniel D Ginder
- 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
| | - Margaret G Distler
- 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
| | - John H Lee
- 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
| | - Adesewa E Adelekun
- 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
| | - Evan H Einstein
- 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
| | - Hanadi A Oughli
- 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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Afshar HT, Fishbein JN, Martinez EJ, Chu GM, Shenasa MA, Ramanathan D, Herbert MS. Effects of Chronic Pain Diagnoses on the Antidepressant Efficacy of Transcranial Magnetic Stimulation. Psychosom Med 2024; 86:541-546. [PMID: 38666648 DOI: 10.1097/psy.0000000000001311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
OBJECTIVE Major depressive disorder (MDD) and chronic pain are highly comorbid and bidirectionally related. Repetitive transcranial magnetic stimulation (rTMS) over the dorsolateral prefrontal cortex is effective in treating MDD, but additional research is needed to determine if chronic pain interferes with rTMS for MDD. METHODS Participants were 124 veterans ( Mage = 49.14, SD = 13.83) scheduled for 30 sessions of rTMS across 6 weeks. Depression severity was monitored weekly using the Patient Health Questionnaire-9 (PHQ-9). Having any pain diagnosis, low back pain, or headache/migraine were assessed by chart review. We fit latent basis models to estimate total change by pain diagnosis in depression scores and quadratic latent growth models to examine differences in growth rates. Then, we computed χ2 tests of group differences in response (PHQ-9 reduction ≥50%) and remission rates (final PHQ-9 < 5). RESULTS A total of 92 participants (74%) had a documented pain diagnosis, 58 (47%) had low back pain, and 32 (26%) had headache/migraine. In growth models, depression scores initially decreased (linear slope estimate = -2.04, SE = 0.26, p < .0001), but the rate of decrease slowed over time (quadratic slope estimate = 0.18, SE = 0.04, p < .001). Overall change was not different as a function of any pain diagnosis ( p = .42), low back pain (p = .11 ), or headache/migraine ( p = .28). However, we found that low back pain was a negative predictor of response ( p = .032). CONCLUSIONS These data support rTMS as a viable treatment option for comorbid populations. Although patients with comorbid chronic pain conditions are likely to receive benefit from rTMS for depression, adjunctive pain treatment may be indicated.
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Affiliation(s)
- Houtan Totonchi Afshar
- From the VA San Diego Healthcare System (Afshar, Fishbein, Martinez, Chu, Shenasa, Ramanathan, Herbert); Department of Psychiatry (Afshar, Fishbein, Shenasa, Ramanathan, Herbert), University of California; and VA Center of Excellence for Stress and Mental Health (Fishbein, Chu, Ramanathan, Herbert), San Diego, California
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Aljeradat B, Kumar D, Abdulmuizz S, Kundu M, Almealawy YF, Batarseh DR, Atallah O, Ennabe M, Alsarafandi M, Alan A, Weinand M. Neuromodulation and the Gut-Brain Axis: Therapeutic Mechanisms and Implications for Gastrointestinal and Neurological Disorders. PATHOPHYSIOLOGY 2024; 31:244-268. [PMID: 38804299 PMCID: PMC11130832 DOI: 10.3390/pathophysiology31020019] [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: 03/31/2024] [Revised: 05/13/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024] Open
Abstract
The gut-brain axis (GBA) represents a complex, bidirectional communication network that intricately connects the gastrointestinal tract with the central nervous system (CNS). Understanding and intervening in this axis opens a pathway for therapeutic advancements for neurological and gastrointestinal diseases where the GBA has been proposed to play a role in the pathophysiology. In light of this, the current review assesses the effectiveness of neuromodulation techniques in treating neurological and gastrointestinal disorders by modulating the GBA, involving key elements such as gut microbiota, neurotrophic factors, and proinflammatory cytokines. Through a comprehensive literature review encompassing PubMed, Google Scholar, Web of Science, and the Cochrane Library, this research highlights the role played by the GBA in neurological and gastrointestinal diseases, in addition to the impact of neuromodulation on the management of these conditions which include both gastrointestinal (irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and gastroesophageal reflux disease (GERD)) and neurological disorders (Parkinson's disease (PD), Alzheimer's disease (AD), autism spectrum disorder (ASD), and neuropsychiatric disorders). Despite existing challenges, the ability of neuromodulation to adjust disrupted neural pathways, alleviate pain, and mitigate inflammation is significant in improving the quality of life for patients, thereby offering exciting prospects for future advancements in patient care.
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Affiliation(s)
- Baha’ Aljeradat
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Danisha Kumar
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- Dow Medical College, Dow University of Health Sciences, Karachi 74200, Pakistan
| | - Sulaiman Abdulmuizz
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- College of Health Sciences, University of Ilorin, Ilorin 240003, Kwara, Nigeria
| | - Mrinmoy Kundu
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- Institute of Medical Sciences and SUM Hospital, Bhubaneswar 751029, India
| | - Yasser F. Almealawy
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- Faculty of Medicine, University of Kufa, Kufa P.O. Box 21, Iraq
| | - Dima Ratib Batarseh
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Oday Atallah
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- Department of Neurosurgery, Hannover Medical School, 30625 Hannover, Germany
| | - Michelle Ennabe
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- College of Medicine, The University of Arizona College of Medicine, Phoenix, AZ 85004, USA
| | - Muath Alsarafandi
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- College of Medicine, Islamic University of Gaza, Rafa Refugee Camp, Rafa P.O. Box 108, Palestine
- Faculty of Medicine, Islamic University of Gaza, Gaza P.O. Box 108, Palestine
| | - Albert Alan
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- Department of Neurosurgery, University of Arizona, Tucson, AZ 85724, USA;
- College of Medicine, The University of Arizona College of Medicine, Tucson, AZ 85004, USA
| | - Martin Weinand
- Department of Neurosurgery, University of Arizona, Tucson, AZ 85724, USA;
- College of Medicine, The University of Arizona College of Medicine, Tucson, AZ 85004, USA
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Copa D, Erritzoe D, Giribaldi B, Nutt D, Carhart-Harris R, Tagliazucchi E. Predicting the outcome of psilocybin treatment for depression from baseline fMRI functional connectivity. J Affect Disord 2024; 353:60-69. [PMID: 38423367 DOI: 10.1016/j.jad.2024.02.089] [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: 07/15/2023] [Revised: 02/14/2024] [Accepted: 02/26/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Psilocybin is a serotonergic psychedelic drug under assessment as a potential therapy for treatment-resistant and major depression. Heterogeneous treatment responses raise interest in predicting the outcome from baseline data. METHODS A machine learning pipeline was implemented to investigate baseline resting-state functional connectivity measured with functional magnetic resonance imaging (fMRI) as a predictor of symptom severity in psilocybin monotherapy for treatment-resistant depression (16 patients administered two 5 mg capsules followed by 25 mg, separated by one week). Generalizability was tested in a sample of 22 patients who participated in a psilocybin vs. escitalopram trial for moderate-to-severe major depression (two separate doses of 25 mg of psilocybin 3 weeks apart plus 6 weeks of daily placebo vs. two separate doses of 1 mg of psilocybin 3 weeks apart plus 6 weeks of daily oral escitalopram). The analysis was repeated using both samples combined. RESULTS Functional connectivity of visual, default mode and executive networks predicted early symptom improvement, while the salience network predicted responders up to 24 weeks after treatment (accuracy≈0.9). Generalization performance was borderline significant. Consistent results were obtained from the combined sample analysis. Fronto-occipital and fronto-temporal coupling predicted early and late symptom reduction, respectively. LIMITATIONS The number of participants and differences between the two datasets limit the generalizability of the findings, while the lack of a placebo arm limits their specificity. CONCLUSIONS Baseline neurophysiological measurements can predict the outcome of psilocybin treatment for depression. Future research based on larger datasets should strive to assess the generalizability of these predictions.
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Affiliation(s)
- Débora Copa
- Universidad de Buenos Aires, Facultad de Ingeniería, Instituto de Bioingeniería, Buenos Aires, Argentina.
| | - David Erritzoe
- Centre for Psychedelic Research, Division of Academic Psychiatry, Imperial College London, London, United Kingdom
| | - Bruna Giribaldi
- Centre for Psychedelic Research, Division of Academic Psychiatry, Imperial College London, London, United Kingdom
| | - David Nutt
- Centre for Psychedelic Research, Division of Academic Psychiatry, Imperial College London, London, United Kingdom
| | - Robin Carhart-Harris
- Centre for Psychedelic Research, Division of Academic Psychiatry, Imperial College London, London, United Kingdom; Psychedelics Division, Neuroscape, Department of Neurology, University of California, San Francisco, USA
| | - Enzo Tagliazucchi
- Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Física, Ciudad Universitaria, Buenos Aires, Argentina; CONICET - Universidad de Buenos Aires, Instituto de Física Interdisciplinaria y Aplicada (INFINA), Ciudad Universitaria, Buenos Aires, Argentina; Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibañez, Santiago, Chile
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Mehta DD, Siddiqui S, Ward HB, Steele VR, Pearlson GD, George TP. Functional and structural effects of repetitive transcranial magnetic stimulation (rTMS) for the treatment of auditory verbal hallucinations in schizophrenia: A systematic review. Schizophr Res 2024; 267:86-98. [PMID: 38531161 DOI: 10.1016/j.schres.2024.03.016] [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: 07/05/2023] [Revised: 02/26/2024] [Accepted: 03/15/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Auditory verbal hallucinations (AVH) are a disabling symptom for people with schizophrenia (SCZ), and do not always respond to antipsychotics. Repetitive transcranial magnetic stimulation (rTMS) has shown efficacy for medication-refractory AVH, though the underlying neural mechanisms by which rTMS produces these effects remain unclear. This systematic review evaluated the structural and functional impact of rTMS for AVH in SCZ, and its association with clinical outcomes. METHODS A systematic search was conducted in Medline, PsychINFO, and PubMed using terms for four key concepts: AVH, SCZ, rTMS, neuroimaging. Using PRISMA guidelines, 18 studies were identified that collected neuroimaging data of an rTMS intervention for AVH in SCZ. Risk of bias assessments was conducted. RESULTS Low frequency (<5 Hz) rTMS targeting left hemispheric language processing regions may normalize brain abnormalities in AVH patients at structural, functional, electrophysiological, and topological levels, with concurrent symptom improvement. Amelioration of aberrant neural activity in frontotemporal networks associated with speech and auditory processing was commonly observed, as well as in cerebellar and emotion regulation regions. Neuroimaging analyses identified neural substrates with direct correlations to post-rTMS AVH severity, propounding their use as therapeutic targets. DISCUSSION Combined rTMS-neuroimaging highlights the multidimensional alterations of rTMS on brain activity and structure in treatment-resistant AVH, which may be used to develop more efficacious therapies. Larger randomized, sham-controlled studies are needed. Future studies should explore alternate stimulation targets, investigate the neural effects of high-frequency rTMS and evaluate long-term neuroimaging outcomes.
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Affiliation(s)
- Dhvani D Mehta
- Institute of Medical Sciences, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, Vanderbilt University, Nashville, TN, USA; Hartford Hospital and Department of Psychiatry and Behavioural Sciences, Yale University, New Haven, CT, USA; Department of Psychiatry, University of Toronto, Canada; Addictions Division and Institute for Mental Health Policy and Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
| | - Salsabil Siddiqui
- Institute of Medical Sciences, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, Vanderbilt University, Nashville, TN, USA; Hartford Hospital and Department of Psychiatry and Behavioural Sciences, Yale University, New Haven, CT, USA; Department of Psychiatry, University of Toronto, Canada; Addictions Division and Institute for Mental Health Policy and Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Heather B Ward
- Institute of Medical Sciences, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, Vanderbilt University, Nashville, TN, USA; Hartford Hospital and Department of Psychiatry and Behavioural Sciences, Yale University, New Haven, CT, USA; Department of Psychiatry, University of Toronto, Canada; Addictions Division and Institute for Mental Health Policy and Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Vaughn R Steele
- Institute of Medical Sciences, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, Vanderbilt University, Nashville, TN, USA; Hartford Hospital and Department of Psychiatry and Behavioural Sciences, Yale University, New Haven, CT, USA; Department of Psychiatry, University of Toronto, Canada; Addictions Division and Institute for Mental Health Policy and Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Godfrey D Pearlson
- Institute of Medical Sciences, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, Vanderbilt University, Nashville, TN, USA; Hartford Hospital and Department of Psychiatry and Behavioural Sciences, Yale University, New Haven, CT, USA; Department of Psychiatry, University of Toronto, Canada; Addictions Division and Institute for Mental Health Policy and Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Tony P George
- Institute of Medical Sciences, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, Vanderbilt University, Nashville, TN, USA; Hartford Hospital and Department of Psychiatry and Behavioural Sciences, Yale University, New Haven, CT, USA; Department of Psychiatry, University of Toronto, Canada; Addictions Division and Institute for Mental Health Policy and Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
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Choi Y, Lee S, Kim M, Chang W. Effects of Neuromuscular Electrical Stimulation with Gastrocnemius Strengthening on Foot Morphology in Stroke Patients: A Randomized Controlled Trial. Healthcare (Basel) 2024; 12:777. [PMID: 38610199 PMCID: PMC11011460 DOI: 10.3390/healthcare12070777] [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: 01/20/2024] [Revised: 04/01/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024] Open
Abstract
This study aimed to investigate the effects of neuromuscular electrical stimulation (NMES) with gastrocnemius (GCM) strength exercise on foot morphology in patients with stroke. Herein, 31 patients with chronic stroke meeting the study criteria were enrolled and divided into two groups; 16 patients were randomized to the gastrocnemius neuromuscular electrical stimulation (GCMNMES) group, and 15 patients to the conventional neuromuscular electrical stimulation (CNMES) group. The GCMNMES group conducted GCM-strengthening exercise with NMES. CNMES group conducted NMES at paretic tibialis anterior muscle with ankle dorsiflexion movement. These patients underwent therapeutic interventions lasting 30 min/session, five times a week for 4 weeks. To analyze changes in foot morphology, 3D foot scanning was used, while a foot-pressure measurement device was used to evaluate foot pressure and weight-bearing area. In an intra-group comparison of 3D-foot-scanning results, the experimental group showed significant changes in longitudinal arch angle (p < 0.05), medial longitudinal arch angle (MLAA) (p < 0.01), transverse arch angle (TAA) (p < 0.01), rearfoot angle (RA) (p < 0.05), foot length (FL) (p < 0.05), foot width (FW) (p < 0.05), and arch height index (AHI) (p < 0.01) of the paretic side and in TAA (p < 0.05) and AHI (p < 0.05) of the non-paretic side. The CNMES group showed significant changes in TAA (p < 0.05) and FW (p < 0.05) of the paretic side and TAA (p < 0.05) and AHI (p < 0.05) of the non-paretic side. An inter-group comparison showed significant differences in MLAA (p < 0.05) and RA (p < 0.05) of the paretic side. In an intra-group comparison of foot pressure assessment, the experimental group showed significant differences in footprint area (FPA) (p < 0.05) of the paretic side and FPA symmetry (p < 0.05). The CNMES group showed a significant difference in only FPA symmetry (p < 0.05). An inter-group comparison showed no significant difference between the two groups (p < 0.05). Thus, NMES with GCM-strengthening exercises yielded positive effects on foot morphology in patients with stroke.
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Affiliation(s)
- Yusik Choi
- Department of Physical Therapy, Seoul Metropolitan Seonam Hospital, Yangcheon-gu, Seoul 08049, Republic of Korea;
| | - Sooyong Lee
- Department of Physical Therapy, Severance Rehabilitation Hospital, Yonsei University, Seodaemun-gu, Seoul 03722, Republic of Korea;
| | - Minhyuk Kim
- Department of Physical Therapy, Graduate School, Yong In University, Yongin-si 17092, Gyeonggi-do, Republic of Korea;
| | - Woonam Chang
- Department of Physical Therapy, College of Health & Welfare Science, Yong In University, Yongin-si 17092, Gyeonggi-do, Republic of Korea
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8
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Ikawa H, Takeda Y, Osawa R, Sato A, Mizuno H, Noda Y. A Retrospective Case-Control Study on the Differences in the Effectiveness of Theta-Burst Stimulation Therapy for Depression with and without Antidepressant Medication. J Clin Med 2024; 13:399. [PMID: 38256534 PMCID: PMC10816069 DOI: 10.3390/jcm13020399] [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: 12/27/2023] [Revised: 01/03/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
Transcranial magnetic stimulation (TMS) therapy has few side effects and comparable therapeutic effects to antidepressant treatment, but few studies have introduced TMS therapy as an initial treatment for MDD. The objective of this study was to retrospectively compare the clinical outcomes between 50 MDD patients without antidepressants (i.e., TMS monotherapy) and 50 MDD patients with antidepressants plus TMS therapy, matched for age, sex, and depression severity. The presence or absence of antidepressant therapy in first-line treatment was determined via a detailed interview by psychiatrists. The study design was a retrospective observational case-control study using the TMS registry data. The key inclusion criteria were adult patients who met the diagnosis of MDD and received 20-30 sessions of intermittent theta-burst stimulation (iTBS) therapy to the left dorsolateral prefrontal cortex (DLPFC). In this study, the Montgomery-Åsberg Depression Rating Scale (MADRS) was used as the primary outcome measure. No significant group differences existed in the baseline MADRS total score between the unmedicated and medicated patient groups. Following TMS therapy, no significant group differences in response rate, remission rate, or relative total score change in the MADRS were observed. The main limitations were the retrospective design and the use of registry data as a source. Our findings suggest that TMS monotherapy may be as effective as TMS add-on therapy to antidepressants when used as the first-line therapy for MDD, but randomized controlled trials are needed.
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Affiliation(s)
- Haruki Ikawa
- Tokyo Yokohama TMS Clinic, Kawasaki 211-0063, Japan
| | - Yuya Takeda
- Tokyo Yokohama TMS Clinic, Kawasaki 211-0063, Japan
| | - Ryota Osawa
- Tokyo Yokohama TMS Clinic, Kawasaki 211-0063, Japan
| | - Akiko Sato
- Tokyo Yokohama TMS Clinic, Kawasaki 211-0063, Japan
| | | | - Yoshihiro Noda
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo 160-8582, Japan
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9
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Sobstyl M, Prokopienko M, Pietras T. The ventral capsule and ventral striatum-Stereotactic targets for the management of treatment-resistant depression. A systematic literature review. Front Psychiatry 2023; 14:1100609. [PMID: 37928918 PMCID: PMC10622982 DOI: 10.3389/fpsyt.2023.1100609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 07/24/2023] [Indexed: 11/07/2023] Open
Abstract
Background Deep brain stimulation (DBS) is still an experimental treatment modality for psychiatric disorders including treatment-resistant depression (TRD). There is preliminary evidence that stimulation of brain reward circuit structures including the ventral striatum (VS) may exert an antidepressant effect. The main nucleus of the reward circuit is the nucleus accumbens (NAc). The NAc is a major structure of VS that plays a critical role in reward-seeking behavior, motivation, and addiction. Aims This study aimed to review the current studies including randomized clinical trials, open-label trials, and case reports of NAc/VS and VC DBS for TRD in humans. Method The literature was reviewed using a medical database-Medical Literature, Analysis, and Retrieval System Online (MEDLINE) on NAc/VS or VC DBS in TRD. The identified studies were assessed based on the patient's characteristics, clinical outcomes, and adverse events related to DBS as well as the stereotactic technique used to guide the implantation of DBS electrodes. The inclusion and exclusion criteria of DBS for TRD were presented and discussed. Results The searched literature revealed one case report, three open-label studies (OLS), one multicenter open-label study (mOLS), and two randomized clinical trials (RCTs). There were three additional studies reporting the clinical outcomes in the long term in TRD patients included in the two mentioned RCTs. The total number of patients with TRD treated by NAc/VS or VC is estimated to be 85 individuals worldwide. The response rate to DBS defined as a 50% reduction of postoperative Montgomery-Asberg Depression Rating Scale (MADRS) scores was achieved in 39.8% of the operated patients (range, 23-53%). The remission defined as MADRS scores of < 10 was found in 17.8% after DBS (range, 0-40%). The mean follow-up was 19.7 months (range 3.7-24 months). Conclusion The current results of NAc/VS and VC DBS are still limited by a relatively small number of patients treated worldwide. Nevertheless, the results suggest that NAc/VS and VC can be regarded as promising and efficacious targets for DBS, taking into account the response and remission rates among TRD patients with no other treatment option. The adverse events of NAc/VS and VC DBS are reversible due to the adjustment of stimulation parameters. The most common adverse events were hypomanic/manic states, suicidal thoughts/attempts, and suicides. Patients with TRD after NAc/VS and VC DBS should be strictly followed to prevent or diminish these stimulation-induced adverse events.
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Affiliation(s)
- Michał Sobstyl
- Department of Neurosurgery, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Marek Prokopienko
- Department of Neurosurgery, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Tadeusz Pietras
- Second Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
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Surya JR, Habelhah B, Haroon J, Mahdavi K, Jordan K, Becerra S, Venkatraman V, Deveney C, Bystritsky A, Kuhn T, Jordan S. Functional MRI Lateralization [M1] of dlPFC and Implications for Transcranial Magnetic Stimulation (TMS) Targeting. Diagnostics (Basel) 2023; 13:2690. [PMID: 37627949 PMCID: PMC10453109 DOI: 10.3390/diagnostics13162690] [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: 07/13/2023] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
The present study investigates a potential method of optimizing effective strategies for the functional lateralization of the dorsolateral prefrontal cortex (dlPFC) while in a scanner. Effective hemisphere lateralization of the dlPFC is crucial for lowering the functional risks connected to specific interventions (such as neurosurgery and transcranial magnetic stimulation (TMS), as well as increasing the effectiveness of a given intervention by figuring out the optimal location. This task combines elements of creative problem solving, executive decision making based on an internal rule set, and working memory. A retrospective analysis was performed on a total of 58 unique participants (34 males, 24 females, Mage = 42.93 years, SDage = 16.38). Of these participants, 47 were classified as right-handed, 7 were classified as left-handed, and 4 were classified as ambidextrous, according to the Edinburgh Handedness Inventory. The imaging data were qualitatively judged by two trained, blinded investigators (neurologist and neuropsychologist) for dominant handedness (primary motor cortex) and dominant dorsolateral prefrontal cortex (dlPFC). The results demonstrated that 21.4% of right-handed individuals showed a dominant dlPFC localized to the right hemisphere rather than the assumed left, and 16.7% of left-handers were dominant in their left hemisphere. The task completed in the scanner might be an efficient method for localizing a potential dlPFC target for the purpose of brain stimulation (e.g., TMS), though further study replications are needed to extend and validate these findings.
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Affiliation(s)
- Jean Rama Surya
- Neurological Associates—The Interventional Group, 2811 Wilshire Blvd #790, Santa Monica, CA 90403, USA; (B.H.); (J.H.); (C.D.)
| | - Barshen Habelhah
- Neurological Associates—The Interventional Group, 2811 Wilshire Blvd #790, Santa Monica, CA 90403, USA; (B.H.); (J.H.); (C.D.)
| | - Jonathan Haroon
- Neurological Associates—The Interventional Group, 2811 Wilshire Blvd #790, Santa Monica, CA 90403, USA; (B.H.); (J.H.); (C.D.)
| | - Kennedy Mahdavi
- Neurological Associates—The Interventional Group, 2811 Wilshire Blvd #790, Santa Monica, CA 90403, USA; (B.H.); (J.H.); (C.D.)
| | - Kaya Jordan
- Neurological Associates—The Interventional Group, 2811 Wilshire Blvd #790, Santa Monica, CA 90403, USA; (B.H.); (J.H.); (C.D.)
| | - Sergio Becerra
- Neurological Associates—The Interventional Group, 2811 Wilshire Blvd #790, Santa Monica, CA 90403, USA; (B.H.); (J.H.); (C.D.)
| | - Victoria Venkatraman
- Neurological Associates—The Interventional Group, 2811 Wilshire Blvd #790, Santa Monica, CA 90403, USA; (B.H.); (J.H.); (C.D.)
| | - Chloe Deveney
- Neurological Associates—The Interventional Group, 2811 Wilshire Blvd #790, Santa Monica, CA 90403, USA; (B.H.); (J.H.); (C.D.)
| | - Alexander Bystritsky
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, Le Conte Ave, Los Angeles, CA 10833, USA
| | - Taylor Kuhn
- Neurological Associates—The Interventional Group, 2811 Wilshire Blvd #790, Santa Monica, CA 90403, USA; (B.H.); (J.H.); (C.D.)
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, Le Conte Ave, Los Angeles, CA 10833, USA
| | - Sheldon Jordan
- Neurological Associates—The Interventional Group, 2811 Wilshire Blvd #790, Santa Monica, CA 90403, USA; (B.H.); (J.H.); (C.D.)
- Department of Neurology, UCLA School of Medicine, Le Conte Ave, Los Angeles, CA 10833, USA
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11
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Wade B, Barbour T, Ellard K, Camprodon J. Predicting Dimensional Antidepressant Response to Repetitive Transcranial Magnetic Stimulation using Pretreatment Resting-state Functional Connectivity. RESEARCH SQUARE 2023:rs.3.rs-3204245. [PMID: 37609235 PMCID: PMC10441516 DOI: 10.21203/rs.3.rs-3204245/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for depression and has been shown to modulate resting-state functional connectivity (RSFC) of depression-relevant neural circuits. To date, however, few studies have investigated whether individual treatment-related symptom changes are predictable from pretreatment RSFC. We use machine learning to predict dimensional changes in depressive symptoms using pretreatment patterns of RSFC. We hypothesized that changes in dimensional depressive symptoms would be predicted more accurately than scale total scores. Patients with depression (n=26) underwent pretreatment RSFC MRI. Depressive symptoms were assessed with the 17-item Hamilton Depression Rating Scale (HDRS-17). Random forest regression (RFR) models were trained and tested to predict treatment-related symptom changes captured by the HDRS-17, HDRS-6 and three previously identified HDRS subscales: core mood/anhedonia (CMA), somatic disturbances, and insomnia. Changes along the CMA, HDRS-17, and HDRS-6 were predicted significantly above chance, with 9%, 2%, and 2% of out-of-sample outcome variance explained, respectively (all p<0.01). CMA changes were predicted more accurately than the HDRS-17 (p<0.05). Higher baseline global connectivity (GC) of default mode network (DMN) subregions and the somatomotor network (SMN) predicted poorer symptom reduction, while higher GC of the right dorsal attention (DAN) frontoparietal control (FPCN), and visual networks (VN) predicted reduced CMA symptoms. HDRS-17 and HDRS-6 changes were predicted with similar GC patterns. These results suggest that RSFC spanning the DMN, SMN, DAN, FPCN, and VN subregions predict dimensional changes with greater accuracy than syndromal changes following rTMS. These findings highlight the need to assess more granular clinical dimensions in therapeutic studies, particularly device neuromodulation studies, and echo earlier studies supporting that dimensional outcomes improve model accuracy.
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12
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Magnuson J, Ozdemir MA, Mathieson E, Kirkman S, Passera B, Rampersad S, Dufour AB, Brooks D, Pascual-Leone A, Fried PJ, Shafi MM, Ozdemir RA. Neuromodulatory effects and reproducibility of the most widely used repetitive transcranial magnetic stimulation protocols. PLoS One 2023; 18:e0286465. [PMID: 37352290 PMCID: PMC10289434 DOI: 10.1371/journal.pone.0286465] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/16/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is widely used in both research and clinical settings to modulate human brain function and behavior through the engagement of the mechanisms of plasticity. Based upon experiments using single-pulse TMS as a probe, the physiologic mechanism of these effects is often assumed to be via changes in cortical excitability, with 10 Hz rTMS increasing and 1 Hz rTMS decreasing the excitability of the stimulated region. However, the reliability and reproducibility of these rTMS protocols on cortical excitability across and within individual subjects, particularly in comparison to robust sham stimulation, have not been systematically examined. OBJECTIVES In a cohort of 28 subjects (39 ± 16 years), we report the first comprehensive study to (1) assess the neuromodulatory effects of traditional 1 Hz and 10 Hz rTMS on corticospinal excitability against both a robust sham control, and two other widely used patterned rTMS protocols (intermittent theta burst stimulation, iTBS; and continuous theta burst stimulation, cTBS), and (2) determine the reproducibility of all rTMS protocols across identical repeat sessions. RESULTS At the group level, neither 1 Hz nor 10 Hz rTMS significantly modulated corticospinal excitability. 1 Hz and 10 Hz rTMS were also not significantly different from sham and both TBS protocols. Reproducibility was poor for all rTMS protocols except for sham. Importantly, none of the real rTMS and TBS protocols demonstrated greater neuromodulatory effects or reproducibility after controlling for potential experimental factors including baseline corticospinal excitability, TMS coil deviation and the number of individual MEP trials. CONCLUSIONS These results call into question the effectiveness and reproducibility of widely used rTMS techniques for modulating corticospinal excitability, and suggest the need for a fundamental rethinking regarding the potential mechanisms by which rTMS affects brain function and behavior in humans.
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Affiliation(s)
- Justine Magnuson
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Department of Neurology, Harvard Medical School, Boston, MA, United States of America
- Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, CA
| | - Mehmet A. Ozdemir
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Department of Neurology, Harvard Medical School, Boston, MA, United States of America
- Department of Biomedical Engineering, Izmir Katip Celebi University, Izmir, Turkey
| | - Elon Mathieson
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Sofia Kirkman
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Brice Passera
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Department of Neurology, Harvard Medical School, Boston, MA, United States of America
| | - Sumientra Rampersad
- Department of Physics, University of Massachusetts, Boston, MA, United States of America
- Department of Electrical and Computer Engineering, Northeastern University, Boston, MA, United States of America
| | - Alyssa B. Dufour
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew Senior Life, Boston, MA, United States of America
| | - Dana Brooks
- Department of Electrical and Computer Engineering, Northeastern University, Boston, MA, United States of America
| | - Alvaro Pascual-Leone
- Department of Neurology, Harvard Medical School, Boston, MA, United States of America
- Hinda and Arthur Marcus Institute for Aging Research and Deanne and Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Boston, MA, United States of America
- Guttmann Brain Health Institute, Institut Guttmann de Neurorehabilitació, Universitat Autonoma de Barcelona, Badalona, Spain
| | - Peter J. Fried
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Department of Neurology, Harvard Medical School, Boston, MA, United States of America
| | - Mouhsin M. Shafi
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Department of Neurology, Harvard Medical School, Boston, MA, United States of America
| | - Recep A. Ozdemir
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Department of Neurology, Harvard Medical School, Boston, MA, United States of America
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13
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Han S, Li XX, Wei S, Zhao D, Ding J, Xu Y, Yu C, Chen Z, Zhou DS, Yuan TF. Orbitofrontal cortex-hippocampus potentiation mediates relief for depression: A randomized double-blind trial and TMS-EEG study. Cell Rep Med 2023:101060. [PMID: 37263267 DOI: 10.1016/j.xcrm.2023.101060] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 02/01/2023] [Accepted: 05/07/2023] [Indexed: 06/03/2023]
Abstract
It has been 15 years since repetitive transcranial magnetic stimulation (rTMS) targeting the dorsolateral prefrontal cortex (DLPFC) was approved by the FDA for clinical depression treatment. Yet, the underlying mechanisms for rTMS-induced depression relief are not fully elucidated. This study analyzes TMS-electroencephalogram (EEG) data from 64 healthy control (HC) subjects and 53 patients with major depressive disorder (MDD) before and after rTMS treatment. Prior to treatment, patients with MDD have lower activity in the DLPFC, the hippocampus (HPC), the orbitofrontal cortex (OFC), and DLPFC-OFC connectivity compared with HCs. Following active rTMS treatment, patients with MDD show a significant increase in the DLPFC, HPC, and OFC. Notably, the increase in HPC activity is specifically associated with amelioration of depressive symptoms but not anxiety or sleep quality. The orbitofrontal-hippocampal pathway plays a crucial role in mediating depression relief following rTMS treatment. These findings suggest potential alternative targets for brain stimulation therapy against depression (chictr.org.cn: ChiCTR2100052007).
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Affiliation(s)
- Sizhu Han
- Department of Psychiatry, Ningbo Kangning Hospital, Ningbo 315201, China; Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai 200030, China
| | - Xing-Xing Li
- Department of Psychiatry, Ningbo Kangning Hospital, Ningbo 315201, China
| | - Shuochi Wei
- Department of Psychiatry, Ningbo Kangning Hospital, Ningbo 315201, China
| | - Di Zhao
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai 200030, China
| | - Jinjun Ding
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai 200030, China
| | - Yongming Xu
- Department of Psychiatry, Ningbo Kangning Hospital, Ningbo 315201, China
| | - Chang Yu
- Department of Psychiatry, Ningbo Kangning Hospital, Ningbo 315201, China
| | - Zan Chen
- Department of Psychiatry, Ningbo Kangning Hospital, Ningbo 315201, China
| | - Dong-Sheng Zhou
- Department of Psychiatry, Ningbo Kangning Hospital, Ningbo 315201, China.
| | - Ti-Fei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai 200030, China; Co-innovation Center of Neuroregeneration, Nantong University, Nantong 226019, China.
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14
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Baeken C, Arns M, Brunelin J, Chanes L, Filipcic I, Ganho-Ávila A, Hirnstein M, Rachid F, Sack AT, O'shea J, D'urso G, Antal A. European reclassification of non-invasive brain stimulation as class III medical devices: A call to action. Brain Stimul 2023; 16:564-566. [PMID: 36870602 DOI: 10.1016/j.brs.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/22/2023] [Indexed: 03/06/2023] Open
Affiliation(s)
- Chris Baeken
- Faculty of Medicine and Health Sciences, Department of Head and Skin, Ghent Experimental Psychiatry (GHEP) lab, Ghent University, Ghent, Belgium; Department of Psychiatry, University Hospital (UZBrussel), Brussels, Belgium; Eindhoven University of Technology, Department of Electrical Engineering, Eindhoven, the Netherlands
| | - Martijn Arns
- Research Institute Brainclinics, Nijmegen, the Netherlands
| | - Jerome Brunelin
- CH Le Vinatier, Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, PSYR2, F-69500, Bron, France
| | - Lorena Chanes
- Department of Clinical and Health Psychology-Institut de Neurociències, Universitat Autònoma de Barcelona, Catalunya, Spain; Serra Húnter Programme, Generalitat de Catalunya Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Spain
| | | | - Ana Ganho-Ávila
- Faculty of Psychology and Educational Sciences, University of Coimbra, 3000-115, Coimbra, Portugal
| | - Marco Hirnstein
- Department of biological and medical psychology, University of Bergen, Bergen, Norway
| | - Fady Rachid
- Private Practice, 7, place de la Fusterie, 1204, Geneva, Switzerland
| | - Alexander T Sack
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, the Netherlands; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Brain+Nerve Centre, Maastricht University Medical Centre+ (MUMC+), the Netherlands
| | - Jacinta O'shea
- Oxford Centre for Human Brain Activity (OHBA), Wellcome Centre for Integrative Neuroimaging, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 9DU, UK
| | - Giordano D'urso
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Andrea Antal
- Department of Neurology, University Medical Center Göttingen, Germany.
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15
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Chino T, Kinoshita S, Abo M. Repetitive Transcranial Magnetic Stimulation and Rehabilitation Therapy for Upper Limb Hemiparesis in Stroke Patients: A Narrative Review. Prog Rehabil Med 2023; 8:20230005. [PMID: 36866154 PMCID: PMC9970844 DOI: 10.2490/prm.20230005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 01/31/2023] [Indexed: 03/04/2023] Open
Abstract
Recent technological advances in non-invasive brain stimulation (NIBS) have led to the development of therapies for post-stroke upper extremity paralysis. Repetitive transcranial magnetic stimulation (rTMS), a NIBS technique, controls regional activity by non-invasively stimulating selected areas of the cerebral cortex. The therapeutic principle by which rTMS is thought to work is the correction of interhemispheric inhibition imbalances. The guidelines for rTMS for post-stroke upper limb paralysis have graded it as a highly effective treatment, and, based on functional brain imaging and neurophysiological testing, it has been shown to result in progress toward normalization. Our research group has published many reports showing improvement in upper limb function after administration of the NovEl Intervention Using Repetitive TMS and intensive one-to-one therapy (NEURO), demonstrating its safety and efficacy. Based on the findings to date, rTMS should be considered as a treatment strategy based on a functional assessment of the severity of upper extremity paralysis (Fugl-Meyer Assessment), and NEURO should be combined with pharmacotherapy, botulinum treatment, and extracorporeal shockwave therapy to maximize therapeutic effects. In the future, it will be important to establish tailormade treatments in which stimulation frequency and sites are adjusted according to the pathological conditions of interhemispheric imbalance, as revealed by functional brain imaging.
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Affiliation(s)
- Toshifumi Chino
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Shoji Kinoshita
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Masahiro Abo
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
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16
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Qi S, Tian M, Rao Y, Sun C, Li X, Qiao J, Huang ZG. Applying transcranial magnetic stimulation to rehabilitation of poststroke lower extremity function and an improvement: Individual-target TMS. WILEY INTERDISCIPLINARY REVIEWS. COGNITIVE SCIENCE 2023; 14:e1636. [PMID: 36437474 DOI: 10.1002/wcs.1636] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/21/2022] [Accepted: 10/26/2022] [Indexed: 11/29/2022]
Abstract
Stroke is the leading cause of disability globally in need of novel and effective methods of rehabilitation. Intermittent theta burst stimulation (iTBS) has been adopted as a Level B recommendation for lower limb spasticity in guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS). Nonetheless, the methodological differences and deficits of existing work bring about heterogenous results and therefore limit the universal clinical use of rTMS in lower extremity (LE) rehabilitation. The variation of stimulated targets across motor cortex contributes mainly to these heterogeneities. This narrative review includes studies of rTMS on LE motor function rehabilitation in patients after stroke until now. Some analyses of brain imaging and electromagnetic simulation and quantification through computational modeling were also performed. rTMS appears capable of fostering LE motor rehabilitation after stroke, but the actually stimulated targets are considerably bias making it difficult to confirm effectiveness. The main reason for this phenomenon is probably inaccurate targeting of motor cortical leg representation. An underlying updated method is proposed as Individual-Target TMS (IT-TMS) combined with brain imaging. rTMS is a promising validated method for LE function regaining. Future studies should systematically compare the effects of IT-TMS with traditional rTMS using large samples in random clinical trials. This article is categorized under: Neuroscience > Clinical Neuroscience.
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Affiliation(s)
- Shun Qi
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, The Key Laboratory of Neuro-informatics & Rehabilitation Engineering of Ministry of Civil Affairs, Xi'an, Shaanxi, People's Republic of China.,Shaanxi Brain Modulation and Scientific Research Center, Xi'an, Shaanxi, People's Republic of China
| | - Meng Tian
- National TCM Academic School Inheritance Studio Project-Chang'an Mi Shi Internal Medicine School Inheritance Studio, Xi'an, Shaanxi, People's Republic of China
| | - Yang Rao
- Shaanxi Brain Modulation and Scientific Research Center, Xi'an, Shaanxi, People's Republic of China
| | - Chuanzhu Sun
- Shaanxi Brain Modulation and Scientific Research Center, Xi'an, Shaanxi, People's Republic of China
| | - Xiang Li
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, The Key Laboratory of Neuro-informatics & Rehabilitation Engineering of Ministry of Civil Affairs, Xi'an, Shaanxi, People's Republic of China.,Shaanxi Brain Modulation and Scientific Research Center, Xi'an, Shaanxi, People's Republic of China
| | - Jin Qiao
- Department of Rehabilitation, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Zi-Gang Huang
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, The Key Laboratory of Neuro-informatics & Rehabilitation Engineering of Ministry of Civil Affairs, Xi'an, Shaanxi, People's Republic of China.,Research Center for Brain-inspired Intelligence, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China.,The State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, People's Republic of China
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17
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Sasaki N, Yamatoku M, Tsuchida T, Sato H, Yamaguchi K. Effect of Repetitive Transcranial Magnetic Stimulation on Long Coronavirus Disease 2019 with Fatigue and Cognitive Dysfunction. Prog Rehabil Med 2023; 8:20230004. [PMID: 36861061 PMCID: PMC9968785 DOI: 10.2490/prm.20230004] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/07/2023] [Indexed: 03/02/2023] Open
Abstract
Objectives There is no established treatment for chronic fatigue and various cognitive dysfunctions (brain fog) caused by long coronavirus disease 2019 (COVID-19). We aimed to clarify the effectiveness of repetitive transcranial magnetic stimulation (rTMS) for treating these symptoms. Methods High-frequency rTMS was applied to occipital and frontal lobes in 12 patients with chronic fatigue and cognitive dysfunction 3 months after severe acute respiratory syndrome coronavirus 2 infection. Before and after ten sessions of rTMS, Brief Fatigue Inventory (BFI), Apathy Scale (AS), and Wechsler Adult Intelligence Scale-fourth edition (WAIS4) were determined and N-isopropyl-p-[123I]iodoamphetamine single photon emission computed tomography (SPECT) was performed. Results Twelve subjects completed ten sessions of rTMS without adverse events. The mean age of the subjects was 44.3 ± 10.7 years, and the mean duration of illness was 202.4 ± 114.5 days. BFI, which was 5.7 ± 2.3 before the intervention, decreased significantly to 1.9 ± 1.8 after the intervention. The AS was significantly decreased after the intervention from 19.2 ± 8.7 to 10.3 ± 7.2. All WAIS4 sub-items were significantly improved after rTMS intervention, and the full-scale intelligence quotient increased from 94.6 ± 10.9 to 104.4 ± 13.0. Hypoperfusion in the bilateral occipital and frontal lobes observed on SPECT improved in extent and severity after ten sessions of rTMS. Conclusions Although we are still in the early stages of exploring the effects of rTMS, the procedure has the potential for use as a new non-invasive treatment for the symptoms of long COVID.
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Affiliation(s)
- Nobuyuki Sasaki
- Department of Rehabilitation Medicine, St. Marianna
University School of Medicine, Kawasaki, Japan
| | - Masato Yamatoku
- Department of Rehabilitation Medicine, St. Marianna
University School of Medicine, Kawasaki, Japan
| | - Tomoya Tsuchida
- Department of Internal Medicine, Division of General
Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hiroyuki Sato
- Department of Medical Radiology, St. Marianna University
School of Medicine, Kawasaki, Japan
| | - Keiichiro Yamaguchi
- Department of Medical Radiology, St. Marianna University
School of Medicine, Kawasaki, Japan
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18
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Arnsten AFT, Joyce MKP, Roberts AC. The Aversive Lens: Stress effects on the prefrontal-cingulate cortical pathways that regulate emotion. Neurosci Biobehav Rev 2023; 145:105000. [PMID: 36529312 PMCID: PMC9898199 DOI: 10.1016/j.neubiorev.2022.105000] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 12/08/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
ARNSTEN, A.F.T., M.K.P. Joyce and A.C. Roberts. The Aversive Lens: Stress effects on the prefrontal-cingulate cortical pathways that regulate emotion. NEUROSCI BIOBEHAV REV XXX-XXX, 2022. The symptoms of major-depressive-disorder include psychic pain and anhedonia, i.e. seeing the world through an "aversive lens". The neurobiology underlying this shift in worldview is emerging. Here these data are reviewed, focusing on how activation of subgenual cingulate (BA25) induces an "aversive lens", and how higher prefrontal cortical (PFC) areas (BA46/10/32) provide top-down regulation of BA25 but are weakened by excessive dopamine and norepinephrine release during stress exposure, and dendritic spine loss with chronic stress exposure. These changes may generate an attractor state, which maintains the brain under the control of BA25, requiring medication or neuromodulatory treatments to return connectivity to a more flexible state. In line with this hypothesis, effective anti-depressant treatments reduce the activity of BA25 and restore top-down regulation by higher circuits, e.g. as seen with SSRI medications, ketamine, deep brain stimulation of BA25, or rTMS to strengthen dorsolateral PFC. This research has special relevance in an era of chronic stress caused by the COVID19 pandemic, political unrest and threat of climate change.
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Affiliation(s)
- Amy F T Arnsten
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT 06510, USA.
| | - Mary Kate P Joyce
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT 06510, USA.
| | - Angela C Roberts
- Department Physiology, Development and Neuroscience, and Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge CB2 3DY, UK.
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19
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Zheng HB, Liu B, Shen J, Xie F, Ji QM, Zhu XY. Non-invasive brain stimulation for treating psychiatric symptoms in Parkinson’s disease: A systematic review and meta-analysis. J Clin Neurosci 2022; 106:83-90. [DOI: 10.1016/j.jocn.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/30/2022] [Accepted: 10/12/2022] [Indexed: 11/07/2022]
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20
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Huang W, Chen Q, Liu J, Liu L, Tang J, Zou M, Zeng T, Li H, Jiang Q, Jiang Q. Transcranial Magnetic Stimulation in Disorders of Consciousness: An Update and Perspectives. Aging Dis 2022:AD.2022.1114. [PMID: 37163434 PMCID: PMC10389824 DOI: 10.14336/ad.2022.1114] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/14/2022] [Indexed: 05/12/2023] Open
Abstract
Disorders of consciousness (DOC) is a state in which consciousness is affected by brain injuries, leading to dysfunction in vigilance, awareness, and behavior. DOC encompasses coma, vegetative state, and minimally conscious state based on neurobehavioral function. Currently, DOC is one of the most common neurological disorders with a rapidly increasing incidence worldwide. Therefore, DOC not only impacts the lives of individuals and their families but is also becoming a serious public health threat. Repetitive transcranial magnetic stimulation (rTMS) can stimulate electrical activity using a pulsed magnetic field in the brain, with great value in the treatment of chronic pain, neurological diseases, and mental illnesses. However, the clinical application of rTMS in patients with DOC is debatable. Herein, we report the recent main findings of the clinical therapeutics of rTMS for DOC, including its efficacy and possible mechanisms. In addition, we discuss the potential key parameters (timing, location, frequency, strength, and secession of rTMS applications) that affect the therapeutic efficiency of rTMS in patients with DOC. This review may help develop clinical guidelines for the therapeutic application of rTMS in DOC.
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Affiliation(s)
| | | | - Jun Liu
- Department of Neurosurgery, Ganzhou People's Hospital, Jiangxi, China
| | - Lin Liu
- Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases of Ministry of Education, Gannan Medical University, Jiangxi, China
| | - Jianhong Tang
- Laboratory Animal Engineering Research Center of Ganzhou, Gannan Medical University, Jiangxi, China
| | - Mingang Zou
- Department of Neurosurgery, Ganzhou People's Hospital, Jiangxi, China
| | - Tianxiang Zeng
- Department of Neurosurgery, Ganzhou People's Hospital, Jiangxi, China
| | - Huichen Li
- Department of Neurosurgery, Ganzhou People's Hospital, Jiangxi, China
| | - Qing Jiang
- Department of Neurosurgery, Ganzhou People's Hospital, Jiangxi, China
| | - QiuHua Jiang
- Department of Neurosurgery, Ganzhou People's Hospital, Jiangxi, China
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21
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Lee J, Lee CW, Jang Y, You JS, Park YS, Ji E, Yu H, Oh S, Ryoo HA, Cho N, Park JY, Yoon J, Baek JH, Park HY, Ha TH, Myung W. Efficacy and safety of daily home-based transcranial direct current stimulation as adjunct treatment for bipolar depressive episodes: Double-blind sham-controlled randomized clinical trial. Front Psychiatry 2022; 13:969199. [PMID: 36203828 PMCID: PMC9530445 DOI: 10.3389/fpsyt.2022.969199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background Although transcranial direct current stimulation (tDCS) is known to be a promising therapeutic modality for unipolar depression, the efficacy and safety of tDCS for bipolar depressive episodes (BD) are still unknown and clinical trials of home-based tDCS treatment are scarce. As a result, we set out to investigate the efficacy and safety of home-based tDCS for the treatment BD. Methods Participants (n = 64), diagnosed as bipolar disorder as per the diagnostic and statistical manual of mental disorders (DSM-5), were randomly assigned to receive tDCS. Hamilton Depression Rating Scale (HDRS-17) scores were measured at the baseline, week 2, 4, and 6, and home-based tDCS (for 30 min with 2 mA) was self-administered daily. Results Of the 64 patients (15.6% bipolar disorder I, 84.4% bipolar disorder II), 41 patients completed the entire assessment. In the intention-to-treat analysis, time-group interaction for the HDRS-17 [F (3, 146.36) = 2.060; p = 0.108] and adverse effect differences between two groups were not statistically significant, except the pain score, which was higher in the active group than the sham group (week 0-2: p < 0.01, week 2-4: p < 0.05, and week 4-6: p < 0.01). Conclusion Even though we found no evidence for the efficacy of home-based tDCS for patients with BD, this tool was found to be a safe and tolerable treatment modality for BD. Clinical trial registration [https://clinicaltrials.gov/show/NCT03974815], identifier [NCT03974815].
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Affiliation(s)
- Jangwon Lee
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Chan Woo Lee
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Yoonjeong Jang
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Ji Seon You
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Yun Seong Park
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Eunjeong Ji
- Medical Research Collaborating Centre, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Hyeona Yu
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Sunghee Oh
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Hyun A. Ryoo
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Nayoung Cho
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Ji Yoon Park
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Joohyun Yoon
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Ji Hyun Baek
- Department of Psychiatry, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hye Youn Park
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Tae Hyon Ha
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
| | - Woojae Myung
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
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22
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Nakamura S, Kishimoto Y, Sekino M, Nakamura M, Tsutsui KI. Depression induced by low-frequency repetitive transcranial magnetic stimulation to ventral medial frontal cortex in monkeys. Exp Neurol 2022; 357:114168. [PMID: 35809630 DOI: 10.1016/j.expneurol.2022.114168] [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: 02/02/2022] [Revised: 07/01/2022] [Accepted: 07/03/2022] [Indexed: 11/25/2022]
Abstract
The medial frontal cortex (MFC), especially its ventral part, has long been of great interest with respect to the pathology of mood disorders. A number of human brain imaging studies have demonstrated the abnormalities of this brain region in patients with mood disorders, however, whether it is critically and causally involved in the pathogenesis of such disorders remains to be fully elucidated. In this study, we examined how the suppression of neural activity in the ventral region of the MFC (vMFC) affects the behavioral and physiological states of monkeys by using repetitive transcranial magnetic stimulation (rTMS). By using low-frequency rTMS (LF-rTMS) as an inhibitory intervention, we found that LF-rTMS targeting the vMFC temporarily induced a depression-like state in monkeys, which was characterized by a reduced movement activity level, impaired sociability, and decreased motivation level, as well as increased plasma cortisol level. On the other hand, no such significant changes in behavioral and physiological states were observed when targeting the other MFC regions, dorsal or posterior. We further found that the administration of an antidepressant agent, ketamine, ameliorated the abnormal behavioral and physiological states induced by the LF-rTMS intervention. These findings causally indicate the involvement of the vMFC in the regulation of mood and the validity of the LF-rTMS-induced dysfunction of the vMFC as a nonhuman primate model of depression.
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Affiliation(s)
- Shinya Nakamura
- Laboratory of Systems Neuroscience, Graduate School of Life Sciences, Tohoku University, Sendai 980-8577, Japan
| | - Yodai Kishimoto
- Department of Electrical Engineering and Information Systems, Graduate School of Engineering, The University of Tokyo, Tokyo 113-8656, Japan
| | - Masaki Sekino
- Department of Electrical Engineering and Information Systems, Graduate School of Engineering, The University of Tokyo, Tokyo 113-8656, Japan
| | - Motoaki Nakamura
- Medical Institute of Developmental Disabilities Research, Showa University, Tokyo 157-8577, Japan
| | - Ken-Ichiro Tsutsui
- Laboratory of Systems Neuroscience, Graduate School of Life Sciences, Tohoku University, Sendai 980-8577, Japan.
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23
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Joshi S, Weedon BD, Esser P, Liu YC, Springett DN, Meaney A, Inacio M, Delextrat A, Kemp S, Ward T, Izadi H, Dawes H, Ayaz H. Neuroergonomic assessment of developmental coordination disorder. Sci Rep 2022; 12:10239. [PMID: 35715433 PMCID: PMC9206023 DOI: 10.1038/s41598-022-13966-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 05/31/2022] [Indexed: 12/29/2022] Open
Abstract
Until recently, neural assessments of gross motor coordination could not reliably handle active tasks, particularly in realistic environments, and offered a narrow understanding of motor-cognition. By applying a comprehensive neuroergonomic approach using optical mobile neuroimaging, we probed the neural correlates of motor functioning in young people with Developmental Coordination Disorder (DCD), a motor-learning deficit affecting 5-6% of children with lifelong complications. Neural recordings using fNIRS were collected during active ambulatory behavioral task execution from 37 Typically Developed and 48 DCD Children who performed cognitive and physical tasks in both single and dual conditions. This is the first of its kind study targeting regions of prefrontal cortical dysfunction for identification of neuropathophysiology for DCD during realistic motor tasks and is one of the largest neuroimaging study (across all modalities) involving DCD. We demonstrated that DCD is a motor-cognitive disability, as gross motor /complex tasks revealed neuro-hemodynamic deficits and dysfunction within the right middle and superior frontal gyri of the prefrontal cortex through functional near infrared spectroscopy. Furthermore, by incorporating behavioral performance, decreased neural efficiency in these regions were revealed in children with DCD, specifically during motor tasks. Lastly, we provide a framework, evaluating disorder impact in ecologically valid contexts to identify when and for whom interventional approaches are most needed and open the door for precision therapies.
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Affiliation(s)
- Shawn Joshi
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA.
- College of Medicine, Drexel University, Philadelphia, PA, USA.
- Centre for Movement, Occupation and Rehabilitation Services, Oxford Brookes University, Oxford, UK.
- Nuffield Department of Clinical Neurology, University of Oxford, Oxford, UK.
| | - Benjamin D Weedon
- Centre for Movement, Occupation and Rehabilitation Services, Oxford Brookes University, Oxford, UK
- Nuffield Department of Clinical Neurology, University of Oxford, Oxford, UK
| | - Patrick Esser
- Centre for Movement, Occupation and Rehabilitation Services, Oxford Brookes University, Oxford, UK
- Nuffield Department of Clinical Neurology, University of Oxford, Oxford, UK
| | - Yan-Ci Liu
- Centre for Movement, Occupation and Rehabilitation Services, Oxford Brookes University, Oxford, UK
- Nuffield Department of Clinical Neurology, University of Oxford, Oxford, UK
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Physical Therapy Center, National Taiwan University Hospita, Taipei, Taiwan
| | - Daniella N Springett
- Centre for Movement, Occupation and Rehabilitation Services, Oxford Brookes University, Oxford, UK
- Nuffield Department of Clinical Neurology, University of Oxford, Oxford, UK
- Department for Health, University of Bath, Bath, UK
| | - Andy Meaney
- Centre for Movement, Occupation and Rehabilitation Services, Oxford Brookes University, Oxford, UK
- NHS Foundation Trust, Oxford University Hospitals, Oxford, UK
| | - Mario Inacio
- Centre for Movement, Occupation and Rehabilitation Services, Oxford Brookes University, Oxford, UK
- Research Center in Sports Sciences, Health Sciences and Human Development, University of Maia, Porto, Portugal
| | - Anne Delextrat
- Centre for Movement, Occupation and Rehabilitation Services, Oxford Brookes University, Oxford, UK
| | - Steve Kemp
- Centre for Movement, Occupation and Rehabilitation Services, Oxford Brookes University, Oxford, UK
| | - Tomás Ward
- Insight SFI Research Centre for Data Analytics, Dublin City University, Dublin, Ireland
| | - Hooshang Izadi
- School of Engineering, Computing and Mathematics, School of Technology, Design and Environment, Oxford Brookes University, Oxford, UK
| | - Helen Dawes
- Nuffield Department of Clinical Neurology, University of Oxford, Oxford, UK
- Intersect@Exeter, College of Medicine and Health, University of Exeter, Exeter, UK
- Oxford Health BRC, University of Oxford, Oxford, UK
| | - Hasan Ayaz
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA
- Department of Psychological and Brain Sciences, College of Arts and Sciences, Drexel University, Philadelphia, PA, USA
- Drexel Solution Institute, Drexel University, Philadelphia, PA, USA
- Department of Family and Community Health, University of Pennsylvania, Philadelphia, PA, USA
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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24
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Hines CE, Mooney S, Watson NL, Looney SW, Wilkie DJ. Repetitive Transcranial Magnetic Stimulation Promotes Rapid Psychiatric Stabilization in Acutely Suicidal Military Service Members. J ECT 2022; 38:103-109. [PMID: 35613009 DOI: 10.1097/yct.0000000000000810] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study presents data for using accelerated transcranial magnetic stimulation (TMS) as an intervention for suicidal crisis (SC). METHODS This prospective, single-site, randomized, double-blind trial enrolled active-duty military participants with SC to receive either active TMS (n = 59) or sham TMS (n = 61) 3 times per day for 3 consecutive days. Our primary outcome, the Beck Scale for Suicidal Ideation-current (SSI-C), was measured before each session of TMS. Secondary outcomes measured both the SSI-C and the Beck Scale for Suicidal Ideation-total daily for the 3 intervention days and at 1, 3, and 6 months of follow-up. RESULTS In the modified intention to treat (mITT) analysis of SSI-C changes over treatment sessions, the TMS active group had accelerated decline in suicidal ideation as compared with sham: β for interaction was 0.12 points greater SSI-C decline per session (standard error [SE], 0.06) in TMS versus sham (P = 0.04). In both the mITT and per-protocol active TMS groups, the mean final SSI-C scores were below 3. These scores remained below 3 for the entire 6-month follow-up period. CONCLUSIONS In this military trial of suicidal patients, we found that both active and sham accelerated TMS rapidly reduces SC. Moreover, in the mITT analysis, there was a statistically significant antisuicidal benefit of active TMS versus sham TMS in the primary outcome. Both the mITT and per-protocol groups moved from higher to approximately 7 times lower suicide risk strata and remained there for the duration of the study. Further studies are warranted to understand accelerated TMS' full potential as a treatment for SC.
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Affiliation(s)
| | - Scott Mooney
- Neuroscience and Rehabilitation Center, Eisenhower Army Medical Center, Fort Gordon, GA
| | - Nora L Watson
- Department of Research Programs, Walter Reed National Military Medical Center, Bethesda, MD
| | | | - David J Wilkie
- Neuroscience and Rehabilitation Center, Eisenhower Army Medical Center, Fort Gordon, GA
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25
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Wu Y, Zheng Y, Li J, Liu Y, Liang X, Chen Y, Zhang H, Wang N, Weng X, Qiu S, Wang J. Subregion-specific, modality-dependent and timescale-sensitive hippocampal connectivity alterations in patients with first-episode, drug-naïve major depression disorder. J Affect Disord 2022; 305:159-172. [PMID: 35218862 DOI: 10.1016/j.jad.2022.02.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/11/2022] [Accepted: 02/18/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Despite accumulating evidence for the hippocampus as a key dysfunctional node in major depressive disorder (MDD), previous findings are controversial possibly due to heterogeneous and small clinical samples, complicated hippocampal structure, and different imaging modalities and analytical methods. METHODS We collected structural and resting-state functional MRI data from 100 first-episode, drug-naïve MDD patients and 99 healthy controls. A subset of the participants (34 patients and 33 controls) also completed a battery of neuropsychological tests and childhood trauma questionnaires. Seed-based morphological and functional (static and dynamic) connectivity were calculated for ten hippocampal subregions, followed by analyses of dynamic functional connectivity states (k-means clustering), connectivity cross-modality relationships (cosine similarity), and connectivity associations with clinical and neuropsychological variables (Spearman correlation). RESULTS Between-group comparisons revealed abnormal hippocampal connectivity in the patients that depended on 1) hippocampal subdivisions: the cornu ammonis (CA) was the most seriously affected subregion, in particular the right CA1 for functional connectivity alterations; 2) imaging modality: morphological connectivity revealed seldom and sporadic alterations with different lobes, while functional connectivity identified numerous and convergent alterations with prefrontal regions; and 3) time scale: dynamic functional connectivity was more sensitive than static functional connectivity, in particular in revealing alterations between the right CA1 and contralateral prefrontal cortex. Among the 34 patients, functional connectivity alterations of the CA1 were related to the history of childhood trauma in the patients. LIMITATIONS Only a subset of the patients completed the neuropsychological tests, which may cause underestimation of cognitive relevance of hippocampal connectivity alterations. CONCLUSIONS Disrupted hippocampal CA1 functional connectivity plays key roles in the pathophysiology of MDD and may act as a potential diagnostic biomarker for the disease.
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Affiliation(s)
- Yujie Wu
- Institute for Brain Research and Rehabilitation, South China Normal University, 510631 Guangzhou, China; School of Psychology, South China Normal University, Guangzhou, China
| | - Yanting Zheng
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong 510405, China; Department of Radiology, Guangzhou First People's Hospital, Guangdong 510180, China
| | - Junle Li
- Institute for Brain Research and Rehabilitation, South China Normal University, 510631 Guangzhou, China
| | - Yujie Liu
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong 510405, China; Department of Radiology, Guangzhou First People's Hospital, Guangdong 510180, China
| | - Xinyu Liang
- The First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, China
| | - Yaoping Chen
- The Third Affliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
| | - Hanyue Zhang
- Department of Radiology, Guangzhou First People's Hospital, Guangdong 510180, China
| | - Ningkai Wang
- Institute for Brain Research and Rehabilitation, South China Normal University, 510631 Guangzhou, China
| | - Xuchu Weng
- Institute for Brain Research and Rehabilitation, South China Normal University, 510631 Guangzhou, China; Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; Center for Studies of Psychological Application, South China Normal University, 510631 Guangzhou, China; Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, 510631 Guangzhou, China
| | - Shijun Qiu
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong 510405, China.
| | - Jinhui Wang
- Institute for Brain Research and Rehabilitation, South China Normal University, 510631 Guangzhou, China; Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; Center for Studies of Psychological Application, South China Normal University, 510631 Guangzhou, China; Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, 510631 Guangzhou, China.
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Xie WS, Shehzadi K, Ma HL, Liang JH. A Potential Strategy for Treatment of Neurodegenerative Disorders by Regulation of Adult Hippocampal Neurogenesis in Human Brain. Curr Med Chem 2022; 29:5315-5347. [DOI: 10.2174/0929867329666220509114232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/13/2022] [Accepted: 03/17/2022] [Indexed: 11/22/2022]
Abstract
Abstract:
Adult hippocampal neurogenesis is a multistage mechanism that continues throughout the lifespan of human and non-human mammals. These adult-born neurons in the central nervous system (CNS) play a significant role in various hippocampus-dependent processes, including learning, mood regulation, pattern recognition, etc. Reduction of adult hippocampal neurogenesis, caused by multiple factors such as neurological disorders and aging, would impair neuronal proliferation and differentiation and result in memory loss. Accumulating studies have indicated that functional neuron impairment could be restored by promoting adult hippocampal neurogenesis. In this review, we summarized the small molecules that could efficiently promote the process of adult neurogenesis, particularly the agents that have the capacity of crossing the blood-brain barrier (BBB), and showed in vivo efficacy in mammalian brains. This may pave the way for the rational design of drugs to treat humnan neurodegenerative disorders in the future.
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Affiliation(s)
- Wei-Song Xie
- Key Laboratory of Medical Molecule Science and Pharmaceutics Engineering, School of Chemistry and Chemical Engineering, Beijing Institute of Technology, Beijing 102488, China
| | - Kiran Shehzadi
- Key Laboratory of Medical Molecule Science and Pharmaceutics Engineering, School of Chemistry and Chemical Engineering, Beijing Institute of Technology, Beijing 102488, China
| | - Hong-Le Ma
- Key Laboratory of Medical Molecule Science and Pharmaceutics Engineering, School of Chemistry and Chemical Engineering, Beijing Institute of Technology, Beijing 102488, China
| | - Jian-Hua Liang
- Key Laboratory of Medical Molecule Science and Pharmaceutics Engineering, School of Chemistry and Chemical Engineering, Beijing Institute of Technology, Beijing 102488, China
- Yangtze Delta Region Academy of Beijing Institute of Technology, Jiaxing 314019, China
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Bulteau S, Laurin A, Pere M, Fayet G, Thomas-Ollivier V, Deschamps T, Auffray-Calvier E, Bukowski N, Vanelle JM, Sébille V, Sauvaget A. Intermittent theta burst stimulation (iTBS) versus 10-Hz high-frequency repetitive transcranial magnetic stimulation (rTMS) to alleviate treatment-resistant unipolar depression: A randomized controlled trial (THETA-DEP). Brain Stimul 2022; 15:870-880. [DOI: 10.1016/j.brs.2022.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 05/04/2022] [Accepted: 05/09/2022] [Indexed: 12/31/2022] Open
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Continuous but not intermittent theta burst stimulation decreases striatal dopamine release and cortical excitability. Exp Neurol 2022; 354:114106. [DOI: 10.1016/j.expneurol.2022.114106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/12/2022] [Accepted: 05/01/2022] [Indexed: 11/22/2022]
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Is repetitive transcranial magnetic stimulation (rTMS) an effective and safe treatment option for postpartum and peripartum depression? A Systematic Review. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Kim H, Jung J, Park S, Joo Y, Lee S, Lee S. Effects of Repetitive Transcranial Magnetic Stimulation on the Primary Motor Cortex of Individuals with Fibromyalgia: A Systematic Review and Meta-Analysis. Brain Sci 2022; 12:570. [PMID: 35624957 PMCID: PMC9139594 DOI: 10.3390/brainsci12050570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/17/2022] [Accepted: 04/26/2022] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to quantify the effect of repetitive transcranial magnetic stimulation (rTMS), which is recommended for the improvement of some pain-related symptoms and for antidepressant treatment, on the primary motor cortex (M1) in patients with fibromyalgia (FM). We searched for studies comparing rTMS and sham rTMS in the M1 of FM patients. Pain intensity, quality of life, health status, and depression were compared with or without rTMS for at least 10 sessions. We searched four databases. Quality assessment and quantitative analysis were performed using RevMan 5.4. After screening, five randomized controlled trials of 170 patients with FM were included in the analysis. As a result of the meta-analysis of rTMS on the M1 of individuals with FM, high-frequency rTMS resulted in a significant improvement on quality of life (MD = -2.50; 95% CI: -3.99 to -1.01) compared with sham rTMS. On the other hand, low-frequency rTMS resulted in a significant improvement on health status (MD = 15.02; 95% CI: 5.59 to 24.45). The application of rTMS to the M1 is proposed as an adjunctive measure in the treatment of individuals with FM. Because rTMS has various effects depending on each application site, it is necessary to classify sites or set frequencies as variables.
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Affiliation(s)
- Hyunjoong Kim
- Department of Physical Therapy, Graduate School, Sahmyook University, 815, Hwarang-ro, Seoul 01795, Korea; (H.K.); (S.P.); (Y.J.); (S.L.)
| | - Jihye Jung
- Institute of SMART Rehabilitation, Sahmyook University, 815, Hwarang-ro, Seoul 01795, Korea;
| | - Sungeon Park
- Department of Physical Therapy, Graduate School, Sahmyook University, 815, Hwarang-ro, Seoul 01795, Korea; (H.K.); (S.P.); (Y.J.); (S.L.)
| | - Younglan Joo
- Department of Physical Therapy, Graduate School, Sahmyook University, 815, Hwarang-ro, Seoul 01795, Korea; (H.K.); (S.P.); (Y.J.); (S.L.)
| | - Sangbong Lee
- Department of Physical Therapy, Graduate School, Sahmyook University, 815, Hwarang-ro, Seoul 01795, Korea; (H.K.); (S.P.); (Y.J.); (S.L.)
| | - Seungwon Lee
- Department of Physical Therapy, Sahmyook University, 815, Hwarang-ro, Seoul 01795, Korea
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Thomas PJ, Leow A, Klumpp H, Phan KL, Ajilore O. Network Diffusion Embedding Reveals Transdiagnostic Subnetwork Disruption and Potential Treatment Targets in Internalizing Psychopathologies. Cereb Cortex 2022; 32:1823-1839. [PMID: 34521109 PMCID: PMC9070362 DOI: 10.1093/cercor/bhab314] [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: 05/18/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 11/14/2022] Open
Abstract
Network diffusion models are a common and powerful way to study the propagation of information through a complex system and they offer straightforward approaches for studying multimodal brain network data. We developed an analytic framework to identify brain subnetworks with perturbed information diffusion capacity using the structural basis that best maps to resting state functional connectivity and applied it towards a heterogeneous dataset of internalizing psychopathologies (IPs), a set of psychiatric conditions in which similar brain network deficits are found across the swath of the disorders, but a unifying neuropathological substrate for transdiagnostic symptom expression is currently unknown. This research provides preliminary evidence of a transdiagnostic brain subnetwork deficit characterized by information diffusion impairment of the right area 8BM, a key brain region involved in organizing a broad spectrum of cognitive tasks, which may underlie previously reported dysfunction of multiple brain circuits in the IPs. We also demonstrate that models of neuromodulation involving targeting this brain region normalize IP diffusion dynamics towards those of healthy controls. These analyses provide a framework for multimodal methods that identify both brain subnetworks with disrupted information diffusion and potential targets of these subnetworks for therapeutic neuromodulatory intervention based on previously well-characterized methodology.
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Affiliation(s)
- Paul J Thomas
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, USA
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
| | - Alex Leow
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, USA
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
| | - Heide Klumpp
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - K Luan Phan
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH 43210, USA
| | - Olusola Ajilore
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, USA
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Mahoney JJ, Koch-Gallup N, Scarisbrick DM, Berry JH, Rezai AR. Deep brain stimulation for psychiatric disorders and behavioral/cognitive-related indications: Review of the literature and implications for treatment. J Neurol Sci 2022; 437:120253. [DOI: 10.1016/j.jns.2022.120253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 02/23/2022] [Accepted: 04/03/2022] [Indexed: 11/15/2022]
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Sobstyl M, Kupryjaniuk A, Prokopienko M, Rylski M. Subcallosal Cingulate Cortex Deep Brain Stimulation for Treatment-Resistant Depression: A Systematic Review. Front Neurol 2022; 13:780481. [PMID: 35432155 PMCID: PMC9012165 DOI: 10.3389/fneur.2022.780481] [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: 09/21/2021] [Accepted: 01/04/2022] [Indexed: 11/25/2022] Open
Abstract
Background Deep brain stimulation (DBS) is considered a relatively new and still experimental therapeutic modality for treatment-resistant depression (TRD). There is clinical evidence to suggest that stimulation of the subcallosal cingulate cortex (SCC) involved in the pathogenesis of TRD may exert an antidepressant effect. Aims To conduct a systematic review of current studies, such as randomized clinical trials (RCTs), open-label trials, and placebo-controlled trials, examining SCC DBS for TRD in human participants. Method A formal review of the academic literature was performed using the Medical Literature, Analysis, and Retrieval System Online (MEDLINE) and Cochrane Central Register of Controlled Trials (CENTRAL) databases. This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Suitable studies were screened and assessed based on patient characteristics, clinical outcomes, adverse events related to DBS, and the stereotactic technique used to guide the implantation of DBS electrodes. Results The literature search identified 14 clinical studies that enrolled a total of 230 patients with TRD who underwent SCC DBS. The average duration of follow-up was 14 months (range 6–24 months). The response and remission rates at the last available follow-up visit ranged between 23–92% and 27–66.7%, respectively. Conclusion The current results of SCC DBS are limited by the relatively small number of patients treated worldwide. Nevertheless, studies to date suggest that SCC can be a promising and efficacious target for DBS, considering the high response and remission rates among patients with TRD. The adverse events of SCC DBS are usually transient and stimulation-induced.
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Affiliation(s)
- Michał Sobstyl
- Department of Neurosurgery, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Anna Kupryjaniuk
- Department of Neurosurgery, Institute of Psychiatry and Neurology, Warsaw, Poland
- *Correspondence: Anna Kupryjaniuk
| | - Marek Prokopienko
- Department of Neurosurgery, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Marcin Rylski
- Department of Radiology, Institute of Psychiatry and Neurology, Warsaw, Poland
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Johnstone S, Sorkhou M, Al-Saghir N, Lowe DJE, Steele VR, Pearlson GD, Castle DJ, George TP. Neuromodulation to Treat Substance Use Disorders in People With Schizophrenia and Other Psychoses: A Systematic Review. Front Psychiatry 2022; 13:793938. [PMID: 35237187 PMCID: PMC8882683 DOI: 10.3389/fpsyt.2022.793938] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/14/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Substance use disorders (SUDs) are a common yet poorly studied comorbidity in individuals with psychotic disorders. The co-occurrence of the two complicates recovery and interferes with pharmacological and behavioral treatment response and adherence. Recently, researchers have been exploring both invasive and non-invasive neuromodulation techniques as potential treatment methods for SUDs. We review the evidence that neuromodulation may reduce substance craving and consumption in individuals with schizophrenia. METHODS A comprehensive literature search of PubMed, MEDLINE, and PsycINFO databases was conducted (N = 1,432). Of these, we identified seven studies examining the effects of repetitive transcranial magnetic stimulation (rTMS) and two studies using transcranial direct current stimulation (tDCS) on drug consumption and craving in schizophrenia or schizoaffective disorders. RESULTS Despite the limited number of studies in this area, the evidence suggests that rTMS to the dorsolateral prefrontal cortex (DLPFC) may reduce cannabis and tobacco use in patients with schizophrenia and schizoaffective disorder. Findings with tDCS, however, were inconclusive. DISCUSSION Our systematic review suggests that rTMS applied to DLPFC is a safe and promising therapeutic technique for the management of comorbid schizophrenia and SUDs, with the majority of the evidence in tobacco use disorder. However, there was substantial heterogeneity in study methods, underscoring the need to optimize stimulation parameters (e.g., frequency, duration, and target regions). Larger clinical trials are needed to establish the efficacy of rTMS in reducing drug consumption and craving in psychotic patients, ideally in comparison to existing pharmacological and behavioral interventions.
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Affiliation(s)
- Samantha Johnstone
- Addictions Division, Department of Psychiatry, Centre for Complex Interventions, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Maryam Sorkhou
- Addictions Division, Department of Psychiatry, Centre for Complex Interventions, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Nada Al-Saghir
- Addictions Division, Department of Psychiatry, Centre for Complex Interventions, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Darby J. E. Lowe
- Addictions Division, Department of Psychiatry, Centre for Complex Interventions, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Vaughn R. Steele
- Olin Center for Neuropsychiatric Research, Institute of Living, Hartford, CT, United States
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Godfrey D. Pearlson
- Olin Center for Neuropsychiatric Research, Institute of Living, Hartford, CT, United States
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - David J. Castle
- Addictions Division, Department of Psychiatry, Centre for Complex Interventions, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Tony P. George
- Addictions Division, Department of Psychiatry, Centre for Complex Interventions, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
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Braden AA, Weatherspoon SE, Boardman T, Williard T, Adkins A, Gibbs SK, Wheless JW, Narayana S. Image-guided TMS is safe in a predominately pediatric clinical population. Clin Neurophysiol 2022; 137:193-206. [DOI: 10.1016/j.clinph.2022.01.133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 01/18/2022] [Accepted: 01/21/2022] [Indexed: 11/28/2022]
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Wang Q, Zeng L, Hong W, Luo M, Zhao N, Hu X, Shi M, Qiu J, Shen Y, Teng X, Min H, Liu W. Inflammatory Cytokines Changed in Patients With Depression Before and After Repetitive Transcranial Magnetic Stimulation Treatment. Front Psychiatry 2022; 13:925007. [PMID: 35722555 PMCID: PMC9201075 DOI: 10.3389/fpsyt.2022.925007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/16/2022] [Indexed: 12/28/2022] Open
Abstract
Studies have found that repetitive transcranial magnetic stimulation rTMS can produce antidepressant effects by affecting inflammatory cytokines in patients with depression, which plays a key role in the therapeutic mechanism of antidepressants. This study aimed to explore the changes in inflammatory cytokine levels in patients with depression after 4 weeks of rTMS treatment to determine the possible antidepressant mechanism of rTMS. This prospective, double-blind, pseudo-stimulus-controlled study was conducted, and a total of 57 patients with depression and 30 healthy controls were recruited. Patients were randomly divided into the active rTMS (n = 29) and sham rTMS groups (n = 28). The Hamilton Depression Scale was used to evaluate depressive symptoms and their severity. The serum levels of seven inflammatory cytokines were measured using enzyme-linked immunosorbent assay. Inflammatory cytokines include high-sensitivity C-reactive protein (CRP-hc); tumor necrosis factor (TNF-α); interferon (IFN-γ); interleukin-2 (IL-2); interleukin-4 (IL-4); interleukin-6 (IL-6); and interleukin-8 (IL-8). At baseline, TNF-α (F = 36.699, p < 0.001), IFN-γ (F = 8.907, p < 0.001), IL-4 (F = 66.256, p < 0.001), and IL-2 (F = 9.162, p < 0.001) levels in the depression group were significantly different from those of healthy controls. In the self-control analysis of the active rTMS group, the levels of IL-2 and CRP-hc increased significantly after 2 and 12 weeks of treatment. In the sham-rTMS group, IFN-γ increased after 2 and 12 weeks of treatment. Our results revealed that the changes in inflammatory cytokines after rTMS treatment showed different patterns compared to the sham group, suggesting that the antidepressant effect of rTMS may be related to changes in inflammatory cytokines.
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Affiliation(s)
- Qiang Wang
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
| | - Lingyun Zeng
- Department of Psychiatric Rehabilitation, Shenzhen Kangning Hospital, Shenzhen, China
| | - Wenjuan Hong
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
| | - Mingying Luo
- Department of Anatomy, Histology and Embryology, Kunming Medical University, Kunming, China
| | - Nan Zhao
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
| | - Xiaofen Hu
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
| | - Meili Shi
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
| | - Jing Qiu
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
| | - Yanmin Shen
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
| | - Xiuju Teng
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
| | - Haiying Min
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
| | - Weiqing Liu
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
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Prosvetov A, Tsygankov B, Guekht A, Kuznetsov E, Less U, Tumurov D, Popov G, Tsygankov D, Rangus S. Transcranial magnetic stimulation in the treatment of depressive disorder in Parkinson’s disease. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:79-85. [DOI: 10.17116/jnevro202212209179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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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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Anatomical and fMRI-network comparison of multiple DLPFC targeting strategies for repetitive transcranial magnetic stimulation treatment of depression. Brain Stimul 2022; 15:63-72. [PMID: 34767967 PMCID: PMC8900427 DOI: 10.1016/j.brs.2021.11.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 10/14/2021] [Accepted: 11/08/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The efficacy of repetitive transcranial magnetic stimulation (rTMS) for depression may vary depending on the subregion stimulated within the dorsolateral prefrontal cortex (DLPFC). Clinical TMS typically uses scalp-based landmarks for DLPFC targeting, rather than individualized MRI guidance. OBJECTIVE In rTMS patients, determine the brain systems targeted by multiple DLPFC stimulation rules by computing several surrogate measures: underlying brain targets labeled with connectivity-based atlases, subgenual cingulate anticorrelation strength, and functionally connected networks. METHODS Forty-nine patients in a randomized controlled trial of rTMS therapy for treatment resistant major depression underwent structural and functional MRI. DLPFC rules were applied virtually using MR-image guidance. Underlying cortical regions were labeled, and connectivity with the subgenual cingulate and whole-brain computed. RESULTS Scalp-targeting rules applied post hoc to these MRIs that adjusted for head size, including Beam F3, were comparably precise, successful in directly targeting classical DLPFC and frontal networks, and anticorrelated with the subgenual cingulate. In contrast, all rules involving fixed distances introduced variability in regions and networks targeted. The 5 cm rule targeted a transitional DLPFC region with a different connectivity profile from the adjusted rules. Seed-based connectivity analyses identified multiple regions, such as posterior cingulate and inferior parietal lobe, that warrant further study in order to understand their potential contribution to clinical response. CONCLUSION EEG-based rules consistently targeted DLPFC brain regions with resting-state fMRI features known to be associated with depression response. These results provide a bridge from lab to clinic by enabling clinicians to relate scalp-targeting rules to functionally connected brain systems.
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Di Iorio R, Rossi S, Rossini PM. One century of healing currents into the brain from the scalp: From electroconvulsive therapy to repetitive transcranial magnetic stimulation for neuropsychiatric disorders. Clin Neurophysiol 2021; 133:145-151. [PMID: 34864511 DOI: 10.1016/j.clinph.2021.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/01/2021] [Accepted: 10/30/2021] [Indexed: 11/27/2022]
Abstract
Electroconvulsive therapy (ECT) was applied for the first time in humans in 1938: after 80 years, it remains conceptually similar today except for modifications of the original protocol aimed to reduce adverse effects (as persistent memory deficits) without losing clinical efficacy. We illustrate the stages of development as well as ups and downs of ECT use in the last eighty years, and the impact that it still maintains for treatment of certain psychiatric conditions. Targeted, individualized and safe noninvasive neuromodulatory interventions are now possible for many neuropsychiatric disorders thanks to repetitive transcranial magnetic stimulation (rTMS) that injects currents in the brain through electromagnetic induction, powerful enough to depolarize cortical neurons and related networks. Although ECT and rTMS differ in basic concepts, mechanisms, tolerability, side effects and acceptability, and beyond their conceptual remoteness (ECT) or proximity (rTMS) to "precision medicine" approaches, the two brain stimulation techniques may be considered as complementary rather than competing in the current treatment of certain neuropsychiatric disorders.
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Affiliation(s)
- Riccardo Di Iorio
- Neurology Unit, Policlinic A. Gemelli Foundation IRCCS, Rome, Italy.
| | - Simone Rossi
- Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience, Section of Neurology and Clinical Neurophysiology, Policlinico Le Scotte, University of Siena, Italy
| | - Paolo M Rossini
- Department of Neuroscience & Neurorehabilitation, IRCCS San Raffaele-Pisana, Rome, Italy
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Zhang M, Wang R, Luo X, Zhang S, Zhong X, Ning Y, Zhang B. Repetitive Transcranial Magnetic Stimulation Target Location Methods for Depression. Front Neurosci 2021; 15:695423. [PMID: 34566561 PMCID: PMC8458642 DOI: 10.3389/fnins.2021.695423] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/03/2021] [Indexed: 01/18/2023] Open
Abstract
Major depressive disorder (MDD) is a substantial global public health problem in need of novel and effective treatment strategies. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive and promising treatment for depression that has been approved by the U.S. Food and Drug Administration (FDA). However, the methodological weaknesses of existing work impairs the universal clinical use of rTMS. The variation of stimulated targets across the dorsolateral prefrontal cortex may account for most of the heterogeneity in the efficacy of rTMS. Many rTMS target location methods for MDD have been developed in recent decades. This review was conducted to assess this emerging field and to improve treatment outcomes in clinical practice.
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Affiliation(s)
- Min Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Runhua Wang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xin Luo
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Si Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaomei Zhong
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuping Ning
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.,The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Bin Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
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Chouzouris T, Roth N, Cakan C, Obermayer K. Applications of optimal nonlinear control to a whole-brain network of FitzHugh-Nagumo oscillators. Phys Rev E 2021; 104:024213. [PMID: 34525550 DOI: 10.1103/physreve.104.024213] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/26/2021] [Indexed: 01/21/2023]
Abstract
We apply the framework of optimal nonlinear control to steer the dynamics of a whole-brain network of FitzHugh-Nagumo oscillators. Its nodes correspond to the cortical areas of an atlas-based segmentation of the human cerebral cortex, and the internode coupling strengths are derived from diffusion tensor imaging data of the connectome of the human brain. Nodes are coupled using an additive scheme without delays and are driven by background inputs with fixed mean and additive Gaussian noise. Optimal control inputs to nodes are determined by minimizing a cost functional that penalizes the deviations from a desired network dynamic, the control energy, and spatially nonsparse control inputs. Using the strength of the background input and the overall coupling strength as order parameters, the network's state-space decomposes into regions of low- and high-activity fixed points separated by a high-amplitude limit cycle, all of which qualitatively correspond to the states of an isolated network node. Along the borders, however, additional limit cycles, asynchronous states, and multistability can be observed. Optimal control is applied to several state-switching and network synchronization tasks, and the results are compared to controllability measures from linear control theory for the same connectome. We find that intuitions from the latter about the roles of nodes in steering the network dynamics, which are solely based on connectome features, do not generally carry over to nonlinear systems, as had been previously implied. Instead, the role of nodes under optimal nonlinear control critically depends on the specified task and the system's location in state space. Our results shed new light on the controllability of brain network states and may serve as an inspiration for the design of new paradigms for noninvasive brain stimulation.
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Affiliation(s)
- Teresa Chouzouris
- Institut für Softwaretechnik und Theoretische Informatik, Technische Universität Berlin, Marchstraße 23, 10587 Berlin, Germany
| | - Nicolas Roth
- Institut für Softwaretechnik und Theoretische Informatik, Technische Universität Berlin, Marchstraße 23, 10587 Berlin, Germany
| | - Caglar Cakan
- Institut für Softwaretechnik und Theoretische Informatik, Technische Universität Berlin, Marchstraße 23, 10587 Berlin, Germany.,Bernstein Center for Computational Neuroscience Berlin, Philippstraße 13, 10115 Berlin, Germany
| | - Klaus Obermayer
- Institut für Softwaretechnik und Theoretische Informatik, Technische Universität Berlin, Marchstraße 23, 10587 Berlin, Germany.,Bernstein Center for Computational Neuroscience Berlin, Philippstraße 13, 10115 Berlin, Germany
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Hines CE, Mooney S, DeAngelo A, Bartocci A. REM Sleep and Total Sleep Time Improvement After Routine Repetitive Transcranial Magnetic Stimulation in Active Duty Service Members With Depression. J ECT 2021; 37:189-194. [PMID: 34048374 DOI: 10.1097/yct.0000000000000767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The prevalence of depression and insomnia in the military are substantial. Several transcranial magnetic stimulation (TMS) studies have used self-report sleep data as secondary research outcomes; however, there are limited studies using the gold standard of polysomnography (PSG) to ascertain actual sleep changes. Here, we provide data from a pilot and feasibility study using PSG to measure sleep changes after repetitive TMS. METHODS Thirty-eight active duty service members (ADSM) were consented, of which 20 completed the study. The ADSM who met study criteria where sent for an initial PSG and completed baseline self-report measures. They then completed a standard course of TMS, and self-report measures were completed every fifth session. After TMS completion, ADSM underwent final PSG. RESULTS Comparison of baseline and postintervention PSG sleep parameters highlight that total rapid eye movement sleep improved after a course of TMS, regardless of improvements in depression. Total sleep time also improved, but only in the TMS responders subgroup. The Public Health Questionnaire-9 showed statistically significant improvement as did the Insomnia Severity Index and some components of the RAND Medical Outcomes Short Form 36. CONCLUSION Our small study confirms the feasibility of obtaining pre and post PSG for research purposes. We found similar results to previous studies with regard to depression improvement and self-reported sleep. Interestingly, almost all (including electroconvulsive therapy) somatic depression treatments have been shown to decrease REM, whereas our study found an increase in REM. Overall, this study helps further our understanding of TMS effects on sleep and presents new questions for potential larger follow-on studies.
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Affiliation(s)
| | | | - Alan DeAngelo
- Pulmonary Disease Service, Eisenhower Army Medical Center, Fort Gordon, GA
| | - Angelo Bartocci
- From the Outpatient Behavioral Health Service, Eisenhower Army Medical Center, Fort Gordon
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Schaffer DR, Okhravi HR, Neumann SA. Low-Frequency Transcranial Magnetic Stimulation (LF-TMS) in Treating Depression in Patients With Impaired Cognitive Functioning. Arch Clin Neuropsychol 2021; 36:801-814. [PMID: 33140093 DOI: 10.1093/arclin/acaa095] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 04/17/2020] [Accepted: 09/30/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Common methodologies for treating depressive symptoms have demonstrated decreased efficacy among individuals with impaired cognitive functioning. While transcranial magnetic stimulation (TMS) has been approved to treat major depressive disorder, few studies have analyzed the ability of TMS to treat depressive symptoms among individuals with cognitive impairments. The present study had two objectives: to determine whether low-frequency TMS (LF-TMS) might demonstrate efficacy in treating depressive symptoms among individuals with impaired cognitive functioning; and to determine whether LF-TMS might improve neurocognitive functioning above and beyond depressive symptom improvements. METHODS Data were derived from a pre-existing database at Eastern Virginia Medical School. Fifty-three (N=53) participants completed LF-TMS treatment. The Beck Depression Inventory II (BDI-II) and CNS Vital Signs (CNS-VS) neurocognitive assessment were administered at multiple time points throughout treatment. Participants were classified as impaired cognitive functioning or average cognitive functioning based on baseline CNS-VS scores. Data were analyzed using restricted maximum likelihood (REML) measures-within-persons longitudinal hierarchical linear modeling (HLM) with time-varying covariates. RESULTS LF-TMS produced significant reductions in depressive symptoms for individuals in both cognitive functioning groups; however, a significant group-by-time interaction indicates differential effects between these two groups. Low-frequency TMS produced significant improvements in three neurocognitive domains above and beyond improvements in depressive symptoms; however, the reliability of these changes may be questionable. CONCLUSIONS This study adds to the growing body of empirical findings for LF-TMS treatment in improving neurocognitive functioning above and beyond other treatment-related effects.
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Affiliation(s)
- Daniel R Schaffer
- Virginia Consortium Program in Clinical Psychology (VCPCP), Norfolk, VA 23504, USA.,Eastern Virginia Medical School (EVMS), Norfolk, VA 23507, USA
| | - Hamid R Okhravi
- Eastern Virginia Medical School (EVMS), Norfolk, VA 23507, USA
| | - Serina A Neumann
- Virginia Consortium Program in Clinical Psychology (VCPCP), Norfolk, VA 23504, USA.,Eastern Virginia Medical School (EVMS), Norfolk, VA 23507, USA
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45
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Huang P, Xu L, Xie Y. Biomedical Applications of Electromagnetic Detection: A Brief Review. BIOSENSORS 2021; 11:225. [PMID: 34356696 PMCID: PMC8301974 DOI: 10.3390/bios11070225] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/29/2021] [Accepted: 07/03/2021] [Indexed: 01/01/2023]
Abstract
This paper presents a review on the biomedical applications of electromagnetic detection in recent years. First of all, the thermal, non-thermal, and cumulative thermal effects of electromagnetic field on organism and their biological mechanisms are introduced. According to the electromagnetic biological theory, the main parameters affecting electromagnetic biological effects are frequency and intensity. This review subsequently makes a brief review about the related biomedical application of electromagnetic detection and biosensors using frequency as a clue, such as health monitoring, food preservation, and disease treatment. In addition, electromagnetic detection in combination with machine learning (ML) technology has been used in clinical diagnosis because of its powerful feature extraction capabilities. Therefore, the relevant research involving the application of ML technology to electromagnetic medical images are summarized. Finally, the future development to electromagnetic detection for biomedical applications are presented.
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Affiliation(s)
- Pu Huang
- School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing 100191, China;
| | - Lijun Xu
- Beijing Advanced Innovation Centre for Big Data-Based Precision Medicine, Beihang University, Beijing 100191, China;
| | - Yuedong Xie
- School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing 100191, China;
- Beijing Advanced Innovation Centre for Big Data-Based Precision Medicine, Beihang University, Beijing 100191, China;
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46
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Lintel H, Corpuz T, Paracha SUR, Grossberg GT. Mood Disorders and Anxiety in Parkinson's Disease: Current Concepts. J Geriatr Psychiatry Neurol 2021; 34:280-288. [PMID: 34219518 DOI: 10.1177/08919887211018267] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Mood disorders and anxiety significantly impact the prognosis and disease course of Parkinson's disease. Non-motor symptoms of Parkinson's disease such as apathy, anhedonia, and fatigue overlap with diagnostic criteria for anxiety and depression, thus making accurate diagnosis of mood disorders in Parkinson's disease patients difficult. Furthermore, treatment options for mood disorders can produce motor complications leading to poor adherence and impaired quality of life in Parkinson's disease patients. This review aims to clarify the current state of diagnostic and treatment options pertaining to anxiety and mood disorders in Parkinson's disease. It explores both the pharmacologic and non-pharmacologic treatment modalities for various mood disorders in comorbid Parkinson's disease with a brief discussion of the future outlook of the field given the current state of the literature.
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Affiliation(s)
- Hendrik Lintel
- 7547Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Timothy Corpuz
- 7547Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Saif-Ur-Rahman Paracha
- Department of Psychiatry and Behavioral Neuroscience, 7547Saint Louis University School of Medicine, MO, USA
| | - George T Grossberg
- Samuel W. Fordyce Professor and Director of Geriatric Psychiatry, 7547Saint Louis University School of Medicine, MO, USA
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47
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Won AS, Barreau AC, Gaertner M, Stone T, Zhu J, Wang CY, Mackey S. Assessing the Feasibility of an Open-Source Virtual Reality Mirror Visual Feedback Module for Complex Regional Pain Syndrome: Pilot Usability Study. J Med Internet Res 2021; 23:e16536. [PMID: 34037530 PMCID: PMC8190641 DOI: 10.2196/16536] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 01/07/2021] [Accepted: 03/16/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Complex regional pain syndrome (CRPS) is a rare and severe chronic pain condition, with effective treatment options not established for many patients. The underlying pathophysiology remains unclear, but there is a growing appreciation for the role of central mechanisms which have formed the basis for brain-based therapies such as transcranial magnetic stimulation and mirror visual feedback (MVF). MVF has been deployed in the treatment of CRPS using both conventional mirrors and virtual reality (VR). OBJECTIVE The aim of this study was to further investigate the use of VR in the treatment of patients with unilateral upper limb CRPS. VR has the potential advantage of more flexible and more motivating tasks, as well as the option of tracking patient improvement through the use of movement data. METHODS We describe the development, acceptability, feasibility, and usability of an open-source VR program MVF module designed to be used with consumer VR systems for the treatment of CRPS. The development team was an interdisciplinary group of physical therapists, pain researchers, and VR researchers. Patients recruited from a pain clinic completed 3-5 visits each to trial the system and assessed their experiences in pre- and post-treatment questionnaires. RESULTS All 9 (100%) participants were able to use the system for 3, 4, or 5 trials each. None of the participants quit any trial due to cybersickness. All 9 (100%) participants reported interest in using the module in the future. Participants' reported average pain scores in the affected limb were not significantly different from baseline during treatment or after treatment (P=.16). We did not find a statistically significant effect on participants' self-reported average pain scores. CONCLUSIONS We propose that this module could be a useful starting point for modification and testing for other researchers. We share modifications to make this module usable with standalone headsets and finger tracking. Next steps include adapting this module for at-home use, or for use with participants with lower limb pain.
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Affiliation(s)
| | - Ariana C Barreau
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, IL, United States
| | - Mark Gaertner
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Tristan Stone
- Department of Computer Science, Cornell University, Ithaca, NY, United States
| | - Joshua Zhu
- Department of Information Science, Cornell University, Ithaca, NY, United States
| | - Cheng Yao Wang
- Department of Information Science, Cornell University, Ithaca, NY, United States
| | - Sean Mackey
- Stanford Neuroscience and Pain Lab, Stanford University, Palo Alto, CA, United States
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Guo H, Xiao Y, Sun D, Yang J, Wang J, Wang H, Pan C, Li C, Zhao P, Zhang Y, Wu J, Zhang X, Wang F. Early-Stage Repetitive Transcranial Magnetic Stimulation Altered Posterior-Anterior Cerebrum Effective Connectivity in Methylazoxymethanol Acetate Rats. Front Neurosci 2021; 15:652715. [PMID: 34093113 PMCID: PMC8176023 DOI: 10.3389/fnins.2021.652715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/29/2021] [Indexed: 11/13/2022] Open
Abstract
The aim of the current resting-state functional magnetic resonance imaging (fMRI) study was to investigate the potential mechanism of schizophrenia through the posterior-anterior cerebrum imbalance in methylazoxymethanol acetate (MAM) rats and to evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) as an early-stage intervention. The rats were divided into four groups: the MAM-sham group, vehicle-sham group, MAM-rTMS group, and vehicle-rTMS group. The rTMS treatment was targeted in the visual cortex (VC) in adolescent rats. Granger Causality Analysis (GCA) was used to evaluate the effective connectivity between regions of interest. Results demonstrated a critical right VC-nucleus accumbens (Acb)-orbitofrontal cortex (OFC) pathway in MAM rats; significant differences of effective connectivity (EC) were found between MAM-sham and vehicle-sham groups (from Acb shell to OFC: t = -2.553, p = 0.021), MAM-rTMS and MAM-sham groups (from VC to Acb core: t = -2.206, p = 0.043; from Acb core to OFC: t = 4.861, p < 0.001; from Acb shell to OFC: t = 4.025, p = 0.001), and MAM-rTMS and vehicle-rTMS groups (from VC to Acb core: t = -2.482, p = 0.025; from VC to Acb shell: t = -2.872, p = 0.012; from Acb core to OFC: t = 4.066, p = 0.001; from Acb shell to OFC: t = 3.458, p = 0.004) in the right hemisphere. Results of the early-stage rTMS intervention revealed that right nucleus accumbens played the role as a central hub, and VC was a potentially novel rTMS target region during adolescent schizophrenia. Moreover, the EC of right nucleus accumbens shell and orbitofrontal cortex was demonstrated to be a potential biomarker. To our knowledge, this was the first resting-state fMRI study using GCA to assess the deficits of a visual-reward neural pathway and the effectiveness of rTMS treatment in MAM rats. More randomized controlled trials in both animal models and schizophrenia patients are needed to further elucidate the disease characteristics.
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Affiliation(s)
- Huiling Guo
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China.,Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, China
| | - Yao Xiao
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, China.,Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Dandan Sun
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jingyu Yang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China.,Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, China
| | - Jie Wang
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, China
| | - Huaning Wang
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Chunyu Pan
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, China.,School of Computer Science and Engineering, Northeastern University, Shenyang, China
| | - Chao Li
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Pengfei Zhao
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yanbo Zhang
- Department of Psychiatry, Faculty of Medicine and Dentistry, The Neuroscience and Mental Health Institute (NMHI), University of Alberta, Alberta, AB, Canada
| | - Jinfeng Wu
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, China
| | - Xizhe Zhang
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China.,Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Fei Wang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China.,Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, China
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Tan XW, Abdin E, Tor PC. Accelerated transcranial magnetic stimulation (aTMS) to treat depression with treatment switching: study protocol of a pilot, randomized, delayed-start trial. Pilot Feasibility Stud 2021; 7:104. [PMID: 33952345 PMCID: PMC8097929 DOI: 10.1186/s40814-021-00845-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 04/28/2021] [Indexed: 12/28/2022] Open
Abstract
Background Repetitive transcranial magnetic stimulation (rTMS) is a technique for stimulating brain activity using a transient magnetic field to induce an electrical current in the brain producing depolarization of focal groups of brain cells. TMS is a protocol approved by the U.S. Food and Drug Administration in routine clinical practice as a treatment for depression. A major limitation of rTMS is the large amount of time taken for a standard protocol (38 min a day for 20–30 working days). The optimal type and duration of TMS are still uncertain, as is the optimal strategy for continuing or changing the type of rTMS if there is a poor initial response. Objectives The trial aims to assess whether a 1-week compressed course of left dorsolateral prefrontal (L DLPFC) 5 Hz accelerated rTMS (aTMS) treatment is as effective as an established 4-week course of non-accelerated rTMS and if additional 5 Hz L DLPFC aTMS treatments will be efficacious in non-responders as compared to 1 Hz right DLPFC aTMS treatment. Methods A randomized, single-blind, delayed-start trial was planned to commence in Jan 2020. A total of 60 patients will be enrolled from the Institute of Mental Health Singapore within a 2-year period and randomized into the early or delayed-start phase of the trial. The primary outcome of the trial is the improvement of Montgomery-Asberg Depression Rating scale at the end of the active treatment phase. Discussion If this study protocol proves to be effective, the findings of this trial will be updated to the College of Psychiatrists, Academy of Medicine Singapore, as well as published in a peer-reviewed journal to enhance local and international TMS treatment guidelines. Trial registration ClinicalTrials.gov ID: NCT03941106
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Affiliation(s)
- Xiao Wei Tan
- Department of Mood and Anxiety, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, 539747, Singapore
| | - Phern Chern Tor
- Department of Mood and Anxiety, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore. .,Neurostimulation Service, Institute of Mental Health, Singapore, 539747, Singapore. .,Duke-NUS Graduate Medical School, Singapore, 169857, Singapore.
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50
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Tsai TY, Wang TY, Liu YC, Lee PW, Chang WH, Lu TH, Tseng HH, Lee SY, Chang YH, Yang Y, Chen PS, Chen KC, Yang YK, Lu RB. Add-on repetitive transcranial magnetic stimulation in patients with opioid use disorder undergoing methadone maintenance therapy. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2021; 47:330-343. [PMID: 33426970 DOI: 10.1080/00952990.2020.1849247] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Repetitive transcranial magnetic stimulation (rTMS) shows potential therapeutic effects for individuals with addiction, but few studies have examined individuals with opioid use disorder (OUD).Objectives: We conducted an add-on double-blinded, sham-controlled rTMS feasibility pilot trial to examine OUD participants undergoing methadone maintenance therapy (MMT). The current report focused on the effects of rTMS on (1) craving and heroin use behavior and (2) depression, impulsivity, and attention.Methods: Active or sham rTMS treatment was applied to the left dorsolateral prefrontal cortex (DLPFC) over a total of 11 sessions in 4 weeks (15-Hz frequency, 4 seconds per train, intertrain interval of 26 seconds, 40 trains per session) in OUD participants (ClinicalTrials.gov registration number: NCT03229642). Craving, heroin use severity, urine morphine tests, the Hamilton Depression Rating Scale (HDRS), the Barratt Impulsiveness Scale-11 (BIS-11), and the Continuous Performance Tests (CPTs) were measured.Results: Twenty-two OUD participants were enrolled, of which eleven (8 males) were undergoing active rTMS and nine (8 males) were in the sham rTMS group. After 12 weeks of follow-up, the active rTMS group did not show significantly greater improvements than the sham group with respect to craving, heroin use, or urine morphine test results. However, HDRS scores, BIS-11 attentional subscales, and CPTs commission T-scores (C-TS) were significantly lower in the active rTMS group (P = .003, 0.04, and 0.02, respectively) than in the sham group.Conclusion: Add-on rTMS did not appear to improve heroin use behavior but may have benefitted depressive symptoms, impulse control and attention in OUD participants undergoing MMT.
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Affiliation(s)
- Tsung-Yu Tsai
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tzu-Yun Wang
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Neuroimaging Research Branch, National Institute on Drug Abuse, Intramural Research Programs, National Institutes of Health, Baltimore, MD, USA
| | - Yu Chia Liu
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po-Wei Lee
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei Hung Chang
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tsung-Hua Lu
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Huai-Hsuan Tseng
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sheng-Yu Lee
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yun-Hsuan Chang
- Department of Psychology, Asia University, Taichung, Taiwan.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Yihong Yang
- Neuroimaging Research Branch, National Institute on Drug Abuse, Intramural Research Programs, National Institutes of Health, Baltimore, MD, USA
| | - Po See Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kao Chin Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yen Kuang Yang
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Psychiatry, Tainan Hospital, Ministry of Health and Welfare Tainan, Tainan, Taiwan
| | - Ru-Band Lu
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Yanjiao Furen Hospital, Hebei, China
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