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Reddy PV, Basavaraju R, Sanjay TN, Ramesh A, Chowdhury P, Mehta UM, Venkatasubramanian G, Thirthalli J, Kesavan M. Investigational applications of transcranial magnetic stimulation (TMS) in Mood Disorders: Studies from a tertiary care center in India. Asian J Psychiatr 2024; 97:104054. [PMID: 38728813 DOI: 10.1016/j.ajp.2024.104054] [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: 11/30/2023] [Revised: 04/16/2024] [Accepted: 04/19/2024] [Indexed: 05/12/2024]
Abstract
The investigational potential of TMS in psychiatry is largely underutilized. In the current article, we present the results of five studies with similar TMS protocols that looked at the investigative applications of TMS via measuring cortical reactivity as potential biomarkers in mood disorders. The first two studies, evaluate potential of TMS parameters and Motor neuron system (MNS) as state or trait markers of BD. Third and fourth studies evaluate these as endophenotypic markers of BD. The fifth study which is an RCT evaluating add-on yoga in UD, evaluates if markers of CI can index the therapeutic response of yoga. In study one MT1 was significantly greater in the SM (symptomatic-mania) group compared to HC (healthy-control) (P=0.032). The cortical inhibition measures SICI was reduced in SM(P=0.021) and BD (remitted Bipolar) (P=0.023) groups compared to HC. LICI was increased in the SM(0.021) and BD(P=0.06) groups compared to HC. In study two, a significant group x time interaction effect was observed indicating higher putative MNS-activity mediation in patients compared to HC on SlCl(P=0.024), LlCl(P=0.033). There were no significant group differences noted in the endophenotype studies. The fifth study showed a significant time X group interaction for CSP, favoring improvement in YG (yoga-group) (p<0.01).No significant change was observed for LICI(p=0.2), SICI(p=0.5). Limitations of these studies notwithstanding, we conclude that cortical reactivity measured using TMS is a potential biomarker across the course of mood disorders, starting from state and trait markers to understanding the therapeutic mechanism of a particular treatment modality in these disorders.
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Affiliation(s)
- Preethi V Reddy
- Department of Psychiatry, NIMHANS, Hosur Road, Bengaluru 560029, India
| | | | - Tarasingh N Sanjay
- Department of Psychiatry, NIMHANS, Hosur Road, Bengaluru 560029, India; Psychiatry Registrar, North West Area Mental Health (NWAMH), Melbourne Health, Melbourne, Victoria, Australia
| | - Abhishek Ramesh
- Department of Psychiatry, NIMHANS, Hosur Road, Bengaluru 560029, India
| | - Praerna Chowdhury
- Center for Consciousness Studies, Department of Neurophysiology, Hosur Road NIMHANS, Bengaluru 560029, India
| | - Urvakhsh M Mehta
- Department of Psychiatry, NIMHANS, Hosur Road, Bengaluru 560029, India
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Taniguchi K, Kaneko N, Wada M, Moriyama S, Nakajima S, Mimura M, Noda Y. Neurophysiological profiles of patients with bipolar disorders as probed with transcranial magnetic stimulation: A systematic review. Neuropsychopharmacol Rep 2024. [PMID: 38932486 DOI: 10.1002/npr2.12458] [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: 02/13/2024] [Revised: 05/13/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
AIM Bipolar disorder (BD) has a significant impact on global health, yet its neurophysiological basis remains poorly understood. Conventional treatments have limitations, highlighting the need for a better understanding of the neurophysiology of BD for early diagnosis and novel therapeutic strategies. DESIGN Employing a systematic review approach of the PRISMA guidelines, this study assessed the usefulness and validity of transcranial magnetic stimulation (TMS) neurophysiology in patients with BD. METHODS Databases searched included PubMed, MEDLINE, Embase, and PsycINFO, covering studies from January 1985 to January 2024. RESULTS Out of 6597 articles screened, nine studies met the inclusion criteria, providing neurophysiological insights into the pathophysiological basis of BD using TMS-electromyography and TMS-electroencephalography methods. Findings revealed significant neurophysiological impairments in patients with BD compared to healthy controls, specifically in cortical inhibition and excitability. In particular, short-interval cortical inhibition (SICI) was consistently diminished in BD across the studies, which suggests a fundamental impairment of cortical inhibitory function in BD. This systematic review corroborates the potential utility of TMS neurophysiology in elucidating the pathophysiological basis of BD. Specifically, the reduced cortical inhibition in the SICI paradigm observed in patients with BD suggests gamma-aminobutyric acid (GABA)-A receptor-mediated dysfunction, but results from other TMS paradigms have been inconsistent. Thus, complex neurophysiological processes may be involved in the pathological basis underlying BD. This study demonstrated that BD has a neural basis involving impaired GABAergic function, and it is highly expected that further research on TMS neurophysiology will further elucidate the pathophysiological basis of BD.
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Affiliation(s)
- Keita Taniguchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Naotsugu Kaneko
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
- Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo, Tokyo, Japan
| | - Masataka Wada
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Sotaro Moriyama
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Shinichiro Nakajima
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Yoshihiro Noda
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
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Farzan F. Transcranial Magnetic Stimulation-Electroencephalography for Biomarker Discovery in Psychiatry. Biol Psychiatry 2024; 95:564-580. [PMID: 38142721 DOI: 10.1016/j.biopsych.2023.12.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 12/08/2023] [Accepted: 12/15/2023] [Indexed: 12/26/2023]
Abstract
Current diagnosis and treatment of psychiatric illnesses are still based on behavioral observations and self-reports, commonly leading to prolonged untreated illness. Biological markers (biomarkers) may offer an opportunity to revolutionize clinical psychiatry practice by helping provide faster and potentially more effective therapies. Transcranial magnetic stimulation concurrent with electroencephalography (TMS-EEG) is a noninvasive brain mapping methodology that can assess the functions and dynamics of specific brain circuitries in awake humans and aid in biomarker discovery. This article provides an overview of TMS-EEG-based biomarkers that may hold potential in psychiatry. The methodological readiness of the TMS-EEG approach and steps in the validation of TMS-EEG biomarkers for clinical utility are discussed. Biomarker discovery with TMS-EEG is in the early stages, and several validation steps are still required before clinical implementations are realized. Thus far, TMS-EEG predictors of response to magnetic brain stimulation treatments in particular have shown promise for translation to clinical practice. Larger-scale studies can confirm validation followed by biomarker-informed trials to assess added value compared to existing practice.
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Affiliation(s)
- Faranak Farzan
- eBrain Lab, School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
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Mehta UM, Ektare A, Jakhar J, Basavaraju R, Sanjay TN, Naik SS, Syed FA, Bhargav PH, Reddy PV, Kelkar RS, Arumugham SS, Kesavan M, Thirthalli J, Gangadhar BN. A transdiagnostic evaluation of cortical inhibition in severe mental disorders using Transcranial Magnetic Stimulation. J Psychiatr Res 2021; 143:364-369. [PMID: 34571321 DOI: 10.1016/j.jpsychires.2021.09.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/16/2021] [Accepted: 09/23/2021] [Indexed: 10/20/2022]
Abstract
Multiple lines of investigations suggest the presence of cortical inhibition aberrations as central to the phenotypic manifestations of severe mental disorders. Transcranial Magnetic Stimulation (TMS) combined with electromyography can characterize these inhibitory processes in the motor cortex with satisfactory temporal precision. We examined TMS-evoked short- (SICI) and long-interval intracortical inhibition (LICI) and cortical silent period (CSP) as markers of GABAA- (SICI) and GABAB-mediated (LICI and CSP) cortical neurotransmission in symptomatic individuals with mania (n = 40), schizophrenia (n = 76), unipolar depression (n = 86), and OCD (n = 43), and compared them against similar recordings in healthy subjects (n = 125). We hypothesized transdiagnostic GABAA deficits across all the clinical groups and diagnosis-specific GABAB alterations in mania (increased) and OCD (decreased). After controlling for potential confounder variables (gender, education, benzodiazepine prescription, and motor threshold) using the ANCOVA, we observed no significant group difference in SICI (F = 1.04, P = 0.38), but a significant group effect in LICI (F = 16.29, P < 0.001) and CSP (F = 3.02, P = 0.018). Post-hoc analyses revealed that LICI was significantly reduced in OCD but increased in mania and schizophrenia with reference to the healthy group. Similarly, CSP was significantly reduced in OCD and depression groups as compared to the reference group. We observed that LICI and CSP, both followed similar descending gradients from mania through schizophrenia and depression to OCD; with significant elevation in mania, and reduction in depression and OCD, as compared to the healthy group. This pattern of GABAB-mediated cortical inhibition aberrations needs independent validation as potential state-markers of distinct clinical categories.
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Affiliation(s)
- Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India.
| | - Aboli Ektare
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Jitender Jakhar
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Rakshathi Basavaraju
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Tarasingh N Sanjay
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Shalini S Naik
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Farooq Ali Syed
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Praerna Hemant Bhargav
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Preethi V Reddy
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Radhika Suneel Kelkar
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Muralidharan Kesavan
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Bangalore N Gangadhar
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
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Fatih P, Kucuker MU, Vande Voort JL, Doruk Camsari D, Farzan F, Croarkin PE. A Systematic Review of Long-Interval Intracortical Inhibition as a Biomarker in Neuropsychiatric Disorders. Front Psychiatry 2021; 12:678088. [PMID: 34149483 PMCID: PMC8206493 DOI: 10.3389/fpsyt.2021.678088] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/06/2021] [Indexed: 12/23/2022] Open
Abstract
Long-interval intracortical inhibition (LICI) is a paired-pulse transcranial magnetic stimulation (TMS) paradigm mediated in part by gamma-aminobutyric acid receptor B (GABAB) inhibition. Prior work has examined LICI as a putative biomarker in an array of neuropsychiatric disorders. This review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) sought to examine existing literature focused on LICI as a biomarker in neuropsychiatric disorders. There were 113 articles that met the inclusion criteria. Existing literature suggests that LICI may have utility as a biomarker of GABAB functioning but more research with increased methodologic rigor is needed. The extant LICI literature has heterogenous methodology and inconsistencies in findings. Existing findings to date are also non-specific to disease. Future research should carefully consider existing methodological weaknesses and implement high-quality test-retest reliability studies.
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Affiliation(s)
- Parmis Fatih
- Mayo Clinic Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - M Utku Kucuker
- Mayo Clinic Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Jennifer L Vande Voort
- Mayo Clinic Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Deniz Doruk Camsari
- Mayo Clinic Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Faranak Farzan
- School of Mechatronic Systems Engineering, Centre for Engineering-Led Brain Research, Simon Fraser University, Surrey, BC, Canada
| | - Paul E Croarkin
- Mayo Clinic Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
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Abstract
PURPOSE OF REVIEW This current review summarizes the investigational and therapeutic applications of transcranial magnetic stimulation (TMS) in schizophrenia. RECENT FINDINGS Fairly consistent findings of an impaired cortical excitation-inhibition balance, cortical plasticity, and motor resonance have been reported in schizophrenia. Cortical connectivity impairments have also been demonstrated in motor and prefrontal brain regions. In terms of treatment, the best support is for 1-Hz TMS to the left temporoparietal cortex for the short-term treatment of persistent auditory hallucinations. High-frequency TMS to the left prefrontal cortex improves negative and cognitive symptoms, but with inconsistent and small effects. TMS combined with diverse brain mapping techniques and clinical evaluation can unravel critical brain-behavior relationships relevant to schizophrenia. These provide critical support to the conceptualization of schizophrenia as a connectopathy with anomalous cortical plasticity. Adaptive modulation of these aberrant brain networks in a neuroscience-informed manner drives short-term therapeutic gains in difficult-to-treat symptoms of schizophrenia.
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Basavaraju R, Mehta UM, Pascual-Leone A, Thirthalli J. Elevated mirror neuron system activity in bipolar mania: Evidence from a transcranial magnetic stimulation study. Bipolar Disord 2019; 21:259-269. [PMID: 30422373 PMCID: PMC7610514 DOI: 10.1111/bdi.12723] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The role of the "mirror neuron system" (MNS) in the pathophysiology of mood disorders is not well studied. Given its posited role in the often-impaired socio-emotional processes like intention detection, empathy, and imitation, we compared putative MNS-activity in patients with bipolar mania and healthy comparison subjects. We also examined the association between putative MNS-activity and hyper-imitative behaviors in patients. METHODS We studied 39 medication-free individuals diagnosed with mania and 45 healthy comparison subjects. TMS-evoked motor cortical reactivity was measured via single- and paired-pulse stimuli (assessing SICI-short and LICI-long interval intracortical inhibition) while subjects viewed a static image and goal-directed actions. Manic symptom severity and imitative behaviors were quantified using the Young's Mania Rating Scale and a modification of the Echolalia Questionnaire. RESULTS Two-way repeated measures analysis of variance demonstrated a significant group ×time interaction effect indicating greater facilitation of cortical reactivity during action-observation (putative MNS-activity) in the patient group as compared to the healthy group. While LICI-mediated MNS-activity had a significant association with manic symptom severity (r = 0.35, P = 0.038), SICI-mediated MNS-activity was significantly associated with incidental echolalia scores in a subgroup of 17 patients with incidental echolalia (r = 0.75, P < 0.001). CONCLUSIONS Our findings demonstrate that putative MNS-activity is heightened in mania, possibly because of disinhibition, and associated with behavioral consequences (incidental echolalia).
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Affiliation(s)
- Rakshathi Basavaraju
- Department of Psychiatry, National institute of Mental Health & Neurosciences (NIMHANS), Bangalore, india
| | - Urvakhsh M. Mehta
- Department of Psychiatry, National institute of Mental Health & Neurosciences (NIMHANS), Bangalore, india
| | - Alvaro Pascual-Leone
- Division of Cognitive Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Jagadisha Thirthalli
- Department of Psychiatry, National institute of Mental Health & Neurosciences (NIMHANS), Bangalore, india
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