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Lattanzi S, Trinka E, Meletti S, Striano P, Matricardi S, Silvestrini M, Brigo F. A profile of azetukalner for the treatment of epilepsy: from pharmacology to potential for therapy. Expert Rev Clin Pharmacol 2024; 17:423-432. [PMID: 38571335 DOI: 10.1080/17512433.2024.2337012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/27/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION Epilepsies are a group of heterogeneous brain disorder, and antiseizure medications (ASMs) are the mainstay of treatment. Despite the availability of more than 30 drugs, at least one third of individuals with epilepsy are drug-resistant. This emphasizes the need for novel compounds that combine efficacy with improved tolerability. AREAS COVERED A literature review on the pharmacology, efficacy, tolerability, and safety of azetukalner (XEN1101), a second-generation opener of neuronal potassium channels currently in Phase 3 development as ASM. EXPERT OPINION Results from the phase 2b clinical trial strongly support the ongoing clinical development of azetukalner as a new ASM. Its pharmacokinetic properties support convenient once-daily dosing, eliminating the need for titration at initiation or tapering at the conclusion of treatment. CYP3A4 is the main enzyme involved in its metabolism and drug-drug interactions can affect the drug exposure. Preliminary analysis of an ongoing open-label study reveals no reported pigmentary abnormalities. The upcoming Phase 3 clinical trials are expected to provide further insight into the efficacy, tolerability, and safety of azetukalner in treating focal-onset and primary generalized tonic-clonic seizures. Structurally distinct from currently marketed ASMs, azetukalner has the potential to be the only-in-class Kv7.2/7.3 opener on the market upon regulatory approval.
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Affiliation(s)
- Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Eugen Trinka
- Department of Neurology, Neurointensive Care, and Neurorehabilitation, Christian Doppler University Hospital, Salzburg, Austria
- Neuroscience Institute, Center for Cognitive Neuroscience, Christian Doppler University Hospital Salzburg, Salzburg, Austria
- Public Health, Health Services Research and HTA, University for Health Sciences, Medical Informatics and Technology, Hall, Austria
| | - Stefano Meletti
- Department of Biomedical, Metabolic and Neural Science, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, "G. Gaslini" Institute, University of Genoa, Genova, Italy
| | - Sara Matricardi
- Department of Pediatrics, University of Chieti, Chieti, Italy
| | - Mauro Silvestrini
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Francesco Brigo
- Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy
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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: 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: 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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Vranic-Peters M, O'Brien P, Seneviratne U, Reynolds A, Lai A, Grayden DB, Cook MJ, Peterson ADH. Response to photic stimulation as a measure of cortical excitability in epilepsy patients. Front Neurosci 2024; 17:1308013. [PMID: 38249581 PMCID: PMC10796504 DOI: 10.3389/fnins.2023.1308013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/12/2023] [Indexed: 01/23/2024] Open
Abstract
Studying states and state transitions in the brain is challenging due to nonlinear, complex dynamics. In this research, we analyze the brain's response to non-invasive perturbations. Perturbation techniques offer a powerful method for studying complex dynamics, though their translation to human brain data is under-explored. This method involves applying small inputs, in this case via photic stimulation, to a system and measuring its response. Sensitivity to perturbations can forewarn a state transition. Therefore, biomarkers of the brain's perturbation response or "cortical excitability" could be used to indicate seizure transitions. However, perturbing the brain often involves invasive intracranial surgeries or expensive equipment such as transcranial magnetic stimulation (TMS) which is only accessible to a minority of patient groups, or animal model studies. Photic stimulation is a widely used diagnostic technique in epilepsy that can be used as a non-invasive perturbation paradigm to probe brain dynamics during routine electroencephalography (EEG) studies in humans. This involves changing the frequency of strobing light, sometimes triggering a photo-paroxysmal response (PPR), which is an electrographic event that can be studied as a state transition to a seizure state. We investigate alterations in the response to these perturbations in patients with genetic generalized epilepsy (GGE), with (n = 10) and without (n = 10) PPR, and patients with psychogenic non-epileptic seizures (PNES; n = 10), compared to resting controls (n = 10). Metrics of EEG time-series data were evaluated as biomarkers of the perturbation response including variance, autocorrelation, and phase-based synchrony measures. We observed considerable differences in all group biomarker distributions during stimulation compared to controls. In particular, variance and autocorrelation demonstrated greater changes in epochs close to PPR transitions compared to earlier stimulation epochs. Comparison of PPR and spontaneous seizure morphology found them indistinguishable, suggesting PPR is a valid proxy for seizure dynamics. Also, as expected, posterior channels demonstrated the greatest change in synchrony measures, possibly reflecting underlying PPR pathophysiologic mechanisms. We clearly demonstrate observable changes at a group level in cortical excitability in epilepsy patients as a response to perturbation in EEG data. Our work re-frames photic stimulation as a non-invasive perturbation paradigm capable of inducing measurable changes to brain dynamics.
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Affiliation(s)
- Michaela Vranic-Peters
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, VIC, Australia
| | - Patrick O'Brien
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, VIC, Australia
| | - Udaya Seneviratne
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, VIC, Australia
| | - Ashley Reynolds
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, VIC, Australia
| | - Alan Lai
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, VIC, Australia
| | - David B. Grayden
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, VIC, Australia
| | - Mark J. Cook
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, VIC, Australia
| | - Andre D. H. Peterson
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, VIC, Australia
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Sohn MN, Brown JC, Sharma P, Ziemann U, McGirr A. Pharmacological adjuncts and transcranial magnetic stimulation-induced synaptic plasticity: a systematic review. J Psychiatry Neurosci 2024; 49:E59-E76. [PMID: 38359933 PMCID: PMC10890793 DOI: 10.1503/jpn.230090] [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] [Received: 06/02/2023] [Revised: 10/23/2023] [Accepted: 11/08/2023] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) is a noninvasive neurostimulation modality that has been used to study human synaptic plasticity. Leveraging work in ex vivo preparations, mechanistically informed pharmacological adjuncts to TMS have been used to improve our fundamental understanding of TMS-induced synaptic plasticity. METHODS We systematically reviewed the literature pairing pharmacological adjuncts with TMS plasticity-induction protocols in humans. We searched MEDLINE, PsycINFO, and Embase from 2013 to Mar. 10, 2023. Studies published before 2013 were extracted from a previous systematic review. We included studies using repetitive TMS, theta-burst stimulation, paired associative stimulation, and quadripulse stimulation paradigms in healthy and clinical populations. RESULTS Thirty-six studies met our inclusion criteria (28 in healthy and 8 in clinical populations). Most pharmacological agents have targeted the glutamatergic N-methyl-d-aspartate (NMDA; 15 studies) or dopamine receptors (13 studies). The NMDA receptor is necessary for TMS-induced plasticity; however, sufficiency has not been shown across protocols. Dopaminergic modulation of TMS-induced plasticity appears to be dose-dependent. The GABAergic, cholinergic, noradrenergic, and serotonergic neurotransmitter systems have small evidence bases supporting modulation of TMS-induced plasticity, as do voltage-gated calcium and sodium channels. Studies in clinical populations suggest that pharmacological adjuncts to TMS may rescue motor cortex plasticity, with implications for therapeutic applications of TMS and a promising clinical trial in depression. LIMITATIONS This review is limited by the predominance in the literature of studies with small sample sizes and crossover designs. CONCLUSION Pharmacologically enhanced TMS largely parallels findings from ex vivo preparations. As this area expands and novel targets are tested, adequately powered samples in healthy and clinical populations will inform the mechanisms of TMS-induced plasticity in health and disease.
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Affiliation(s)
- Myren N Sohn
- From the Hotchkiss Brain Institute, University of Calgary, Calgary, Alta., Canada (Sohn, McGirr); the Department of Psychiatry, University of Calgary, Alta., Canada (Sohn, McGirr); the Mathison Centre for Mental Health Research and Education, Calgary, Alta., Canada (Sohn, McGirr); the McLean Hospital, Division of Neurotherapeutics, Belmont, Mass., USA (Brown, Sharma); the Department of Psychiatry, Harvard Medical School, Boston, Mass., USA (Brown); the Department of Neurology & Stroke, Eberhard-Karls University, Tübingen, Germany (Ziemann); and the Hertie-Institute for Clinical Brain Research, Eberhard-Karls University, Tübingen, Germany (Ziemann)
| | - Joshua C Brown
- From the Hotchkiss Brain Institute, University of Calgary, Calgary, Alta., Canada (Sohn, McGirr); the Department of Psychiatry, University of Calgary, Alta., Canada (Sohn, McGirr); the Mathison Centre for Mental Health Research and Education, Calgary, Alta., Canada (Sohn, McGirr); the McLean Hospital, Division of Neurotherapeutics, Belmont, Mass., USA (Brown, Sharma); the Department of Psychiatry, Harvard Medical School, Boston, Mass., USA (Brown); the Department of Neurology & Stroke, Eberhard-Karls University, Tübingen, Germany (Ziemann); and the Hertie-Institute for Clinical Brain Research, Eberhard-Karls University, Tübingen, Germany (Ziemann)
| | - Prayushi Sharma
- From the Hotchkiss Brain Institute, University of Calgary, Calgary, Alta., Canada (Sohn, McGirr); the Department of Psychiatry, University of Calgary, Alta., Canada (Sohn, McGirr); the Mathison Centre for Mental Health Research and Education, Calgary, Alta., Canada (Sohn, McGirr); the McLean Hospital, Division of Neurotherapeutics, Belmont, Mass., USA (Brown, Sharma); the Department of Psychiatry, Harvard Medical School, Boston, Mass., USA (Brown); the Department of Neurology & Stroke, Eberhard-Karls University, Tübingen, Germany (Ziemann); and the Hertie-Institute for Clinical Brain Research, Eberhard-Karls University, Tübingen, Germany (Ziemann)
| | - Ulf Ziemann
- From the Hotchkiss Brain Institute, University of Calgary, Calgary, Alta., Canada (Sohn, McGirr); the Department of Psychiatry, University of Calgary, Alta., Canada (Sohn, McGirr); the Mathison Centre for Mental Health Research and Education, Calgary, Alta., Canada (Sohn, McGirr); the McLean Hospital, Division of Neurotherapeutics, Belmont, Mass., USA (Brown, Sharma); the Department of Psychiatry, Harvard Medical School, Boston, Mass., USA (Brown); the Department of Neurology & Stroke, Eberhard-Karls University, Tübingen, Germany (Ziemann); and the Hertie-Institute for Clinical Brain Research, Eberhard-Karls University, Tübingen, Germany (Ziemann)
| | - Alexander McGirr
- From the Hotchkiss Brain Institute, University of Calgary, Calgary, Alta., Canada (Sohn, McGirr); the Department of Psychiatry, University of Calgary, Alta., Canada (Sohn, McGirr); the Mathison Centre for Mental Health Research and Education, Calgary, Alta., Canada (Sohn, McGirr); the McLean Hospital, Division of Neurotherapeutics, Belmont, Mass., USA (Brown, Sharma); the Department of Psychiatry, Harvard Medical School, Boston, Mass., USA (Brown); the Department of Neurology & Stroke, Eberhard-Karls University, Tübingen, Germany (Ziemann); and the Hertie-Institute for Clinical Brain Research, Eberhard-Karls University, Tübingen, Germany (Ziemann)
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Ramantani G, Westover MB, Gliske S, Sarnthein J, Sarma S, Wang Y, Baud MO, Stacey WC, Conrad EC. Passive and active markers of cortical excitability in epilepsy. Epilepsia 2023; 64 Suppl 3:S25-S36. [PMID: 36897228 PMCID: PMC10512778 DOI: 10.1111/epi.17578] [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: 02/01/2023] [Revised: 03/07/2023] [Accepted: 03/07/2023] [Indexed: 03/11/2023]
Abstract
Electroencephalography (EEG) has been the primary diagnostic tool in clinical epilepsy for nearly a century. Its review is performed using qualitative clinical methods that have changed little over time. However, the intersection of higher resolution digital EEG and analytical tools developed in the past decade invites a re-exploration of relevant methodology. In addition to the established spatial and temporal markers of spikes and high-frequency oscillations, novel markers involving advanced postprocessing and active probing of the interictal EEG are gaining ground. This review provides an overview of the EEG-based passive and active markers of cortical excitability in epilepsy and of the techniques developed to facilitate their identification. Several different emerging tools are discussed in the context of specific EEG applications and the barriers we must overcome to translate these tools into clinical practice.
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Affiliation(s)
- Georgia Ramantani
- Department of Neuropediatrics and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - M Brandon Westover
- Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Data Science, Massachusetts General Hospital McCance Center for Brain Health, Boston, Massachusetts, USA
- Research Affiliate Faculty, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Research Affiliate Faculty, Broad Institute, Cambridge, Massachusetts, USA
| | - Stephen Gliske
- Department of Neurosurgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Johannes Sarnthein
- Department of Neurosurgery, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Sridevi Sarma
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Yujiang Wang
- Interdisciplinary Computing and Complex BioSystems, School of Computing Science, Newcastle University, Newcastle Upon Tyne, UK
| | - Maxime O Baud
- Sleep-Wake-Epilepsy Center, NeuroTec, Center for Experimental Neurology, Department of Neurology, Inselspital Bern, University Hospital, University of Bern, Bern, Switzerland
| | - William C Stacey
- Department of Neurology, BioInterfaces Institute, University of Michigan, Ann Arbor, Michigan, USA
- Department of Biomedical Engineering, BioInterfaces Institute, University of Michigan, Ann Arbor, Michigan, USA
- Division of Neurology, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Erin C Conrad
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Neurology, Penn Epilepsy Center, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Tokatly Latzer I, Hanson E, Bertoldi M, García-Cazorla À, Tsuboyama M, MacMullin P, Rotenberg A, Roullet JB, Pearl PL. Autism spectrum disorder and GABA levels in children with succinic semialdehyde dehydrogenase deficiency. Dev Med Child Neurol 2023; 65:1596-1606. [PMID: 37246331 DOI: 10.1111/dmcn.15659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/30/2023] [Accepted: 05/03/2023] [Indexed: 05/30/2023]
Abstract
AIM To elucidate the etiological aspects of autism spectrum disorder (ASD) in succinic semialdehyde dehydrogenase deficiency (SSADHD), related to dysregulation of γ-aminobutyric acid (GABA) and the imbalance of excitatory and inhibitory neurotransmission. METHOD In this prospective, international study, individuals with SSADHD underwent neuropsychological assessments, as well as biochemical, neurophysiological, and neuroimaging evaluations. RESULTS Of the 29 individuals (17 females) enrolled (median age [IQR] 10 years 5 months [5 years 11 months-18 years 1 month]), 16 were diagnosed with ASD. ASD severity significantly increased with age (r = 0.67, p < 0.001) but was inversely correlated with plasma GABA (r = -0.67, p < 0.001) and γ-hydroxybutyrate levels (r = -0.538, p = 0.004), and resting motor threshold as measured by transcranial magnetic stimulation (r = -0.44, p = 0.03). A discriminative analysis indicated that an age older than 7 years 2 months (p = 0.004) and plasma GABA levels less than 2.47 μM (p = 0.01) are the threshold values beyond which the likelihood of ASD presenting in individuals with SSADHD is increased. INTERPRETATION ASD is prevalent but not universal in SSADHD, and it can be predicted by lower levels of plasma GABA and GABA-related metabolites. ASD severity in SSADHD increases with age and the loss of cortical inhibition. These findings add insight into the pathophysiology of ASD and may facilitate its early diagnosis and intervention in individuals with SSADHD.
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Affiliation(s)
- Itay Tokatly Latzer
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ellen Hanson
- Human Neurobehavioral Core Services, Division of Neurology, Boston Children's Hospital, Boston, MA, USA
- Rosamund Stone Zander Translational Neuroscience Center, Boston Children's Hospital, MA, USA
| | - Mariarita Bertoldi
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Àngeles García-Cazorla
- Neurometabolic Unit, Neurology Department, Institut de Recerca, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Melissa Tsuboyama
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul MacMullin
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexander Rotenberg
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- FM Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, USA
| | - Jean-Baptiste Roullet
- Department of Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA, USA
| | - Phillip L Pearl
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Krile L, Ensafi E, Cole J, Noor M, Protzner AB, McGirr A. A dose-response characterization of transcranial magnetic stimulation intensity and evoked potential amplitude in the dorsolateral prefrontal cortex. Sci Rep 2023; 13:18650. [PMID: 37903906 PMCID: PMC10616119 DOI: 10.1038/s41598-023-45730-y] [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: 05/26/2023] [Accepted: 10/23/2023] [Indexed: 11/01/2023] Open
Abstract
By combining transcranial magnetic stimulation (TMS) with electroencephalography, human cortical circuits can be directly interrogated. The resulting electrical trace contains TMS-evoked potential (TEP) components, and it is not known whether the amplitudes of these components are stimulus intensity dependent. We examined this in the left dorsolateral prefrontal cortex in nineteen healthy adult participants and extracted TEP amplitudes for the N40, P60, N120, and P200 components at 110%, 120%, and 130% of resting motor threshold (RMT). To probe plasticity of putative stimulus intensity dose-response relationships, this was repeated after participants received intermittent theta burst stimulation (iTBS; 600 pulses, 80% RMT). The amplitude of the N120 and P200 components exhibited a stimulus intensity dose-response relationship, however the N40 and P60 components did not. After iTBS, the N40 and P60 components continued to exhibit a lack of stimulus intensity dose-dependency, and the P200 dose-response was unchanged. In the N120 component, however, we saw evidence of change within the stimulus intensity dose-dependent relationship characterized by a decrease in absolute peak amplitudes at lower stimulus intensities. These data suggest that TEP components have heterogeneous dose-response relationships, with implications for standardizing and harmonizing methods across experiments. Moreover, the selective modification of the N120 dose-response relationship may provide a novel marker for iTBS plasticity in health and disease.
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Affiliation(s)
- Louisa Krile
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Elnaz Ensafi
- Department of Psychiatry, University of Calgary, 3280 Hospital Drive NW, TRW-4D68, Calgary, AB, T2N 4Z6, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Mathison Centre for Mental Health Research and Education, Calgary, AB, Canada
| | - Jaeden Cole
- Department of Psychiatry, University of Calgary, 3280 Hospital Drive NW, TRW-4D68, Calgary, AB, T2N 4Z6, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Mathison Centre for Mental Health Research and Education, Calgary, AB, Canada
| | - Mah Noor
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Andrea B Protzner
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Mathison Centre for Mental Health Research and Education, Calgary, AB, Canada
| | - Alexander McGirr
- Department of Psychiatry, University of Calgary, 3280 Hospital Drive NW, TRW-4D68, Calgary, AB, T2N 4Z6, Canada.
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
- Mathison Centre for Mental Health Research and Education, Calgary, AB, Canada.
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Li W, Li Y, Cao D, Qian Z, Tang Y, Wang J. TMS-EEG signatures of facilitated cognitive reappraisal in emotion regulation by left ventrolateral prefrontal cortex stimulation. Neuropsychologia 2023; 184:108560. [PMID: 37028796 DOI: 10.1016/j.neuropsychologia.2023.108560] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 02/15/2023] [Accepted: 04/04/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVE Left ventrolateral prefrontal cortex (VLPFC) has been demonstrated to be a crucial region involved in the down-regulation of negative affect by cognitive reappraisal. However, the neural evidence of causality is still lacking. The current study was to investigate the contribution of left VLPFC in cognitive reappraisal by using single-pulse transcranial magnetic stimulation (spTMS) and electroencephalogram (EEG). METHODS Fifteen participants repeated the cognitive reappraisal task at different TMS settings: no stimulation, spTMS applied at 300 ms after image onset to the left VLPFC, and to the vertex as a control site. EEG and behavioral data were concurrently recorded. TMS-evoked potential (TEP) and late positive potential (LPP) were investigated. RESULTS In cognitive reappraisal, left VLPFC stimulation elicited stronger TEPs than vertex stimulation at 180 ms after TMS onset. Increased source activation of TEPs was identified in the precentral gyrus. Emotion regulation by reappraisal enlarged the trough of TEP at stimulation site. The left VLPFC stimulation led to enhanced LPP in cognitive reappraisal, which was negatively correlated with self-reported arousal. CONCLUSIONS The TMS stimulation over left VLPFC influences the cognitive reappraisal process by potentiating the neural responses. Accordingly, the cortical region responsible for the execution of cognitive reappraisal is activated. The modulated neural activity is related to the behavioral response. The present study provided neural signatures for the facilitated execution of emotion regulation by left VLPFC stimulation, potentially contributing to the therapeutic protocols for mood disorders.
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Affiliation(s)
- Wenjie Li
- School of Communication and Information Engineering, Shanghai University, Shanghai, 200444, China; School of Microelectronics and Control Engineering, Changzhou University, Changzhou, Jiangsu, 213164, China
| | - Yingjie Li
- Institute of Biomedical Engineering, School of Life Science, Shanghai University, Shanghai, 200444, China; College of International Education, Shanghai University, Shanghai, 200444, China.
| | - Dan Cao
- Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, 100089, China
| | - Zhenying Qian
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Yingying Tang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Jijun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
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Ricci L, Croce P, Pulitano P, Boscarino M, Zappasodi F, Narducci F, Lanzone J, Sancetta B, Mecarelli O, Di Lazzaro V, Tombini M, Assenza G. Levetiracetam Modulates EEG Microstates in Temporal Lobe Epilepsy. Brain Topogr 2022; 35:680-691. [PMID: 36098891 DOI: 10.1007/s10548-022-00911-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022]
Abstract
To determine the effects of Levetiracetam (LEV) therapy using EEG microstates analysis in a population of newly diagnosed Temporal Lobe Epilepsy (TLE) patients. We hypothesized that the impact of LEV therapy on the electrical activity of the brain can be globally explored using EEG microstates. Twenty-seven patients with TLE were examined. We performed resting-state microstate EEG analysis and compared microstate metrics between the EEG performed at baseline (EEGpre) and after 3 months of LEV therapy (EEGpost). The microstates A, B, C and D emerged as the most stable. LEV induced a reduction of microstate B and D mean duration and occurrence per second (p < 0.01). Additionally, LEV treatment increased the directional predominance of microstate A to C and microstate B to D (p = 0.01). LEV treatment induces a modulation of resting-state EEG microstates in newly diagnosed TLE patients. Microstates analysis has the potential to identify a neurophysiological indicator of LEV therapeutic activity. This study of EEG microstates in people with epilepsy opens an interesting path to identify potential LEV activity biomarkers that may involve increased neuronal inhibition of the epileptic network.
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Affiliation(s)
- Lorenzo Ricci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Pierpaolo Croce
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy.
| | - Patrizia Pulitano
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Marilisa Boscarino
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Filippo Zappasodi
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy.,Institute for Advanced Biomedical Technologies (ITAB), G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Flavia Narducci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Jacopo Lanzone
- Neurorehabilitation Department, IRCCS Salvatore Maugeri Foundation, Institute of Milan, Milan, Italy
| | - Biagio Sancetta
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Oriano Mecarelli
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Mario Tombini
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Giovanni Assenza
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy
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10
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Perellón-Alfonso R, Redondo-Camós M, Abellaneda-Pérez K, Cattaneo G, Delgado-Gallén S, España-Irla G, Solana Sánchez J, Tormos JM, Pascual-Leone A, Bartrés-Faz D. Prefrontal reactivity to TMS perturbation as a toy model of mental health outcomes during the COVID-19 pandemic. Heliyon 2022; 8:e10208. [PMID: 35991299 PMCID: PMC9383955 DOI: 10.1016/j.heliyon.2022.e10208] [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: 03/22/2022] [Revised: 05/24/2022] [Accepted: 08/03/2022] [Indexed: 11/29/2022] Open
Abstract
Psychosocial hardships associated with the COVID-19 pandemic led many individuals to suffer adverse mental health consequences, however, others show no negative effects. We hypothesized that the electroencephalographic (EEG) response to transcranial magnetic stimulation (TMS) could serve as a toy-model of an individual's capacity to resist psychological stress, in this case linked to the COVID-19 pandemic. We analyzed data from 74 participants who underwent mental health monitoring and concurrent electroencephalography with transcranial magnetic stimulation of the left dorsolateral prefrontal cortex (L-DLPFC) and left inferior parietal lobule (L-IPL). Within the following 19 months, mental health was reassessed at three timepoints during lock-down confinement and different phases of de-escalation in Spain. Compared with participants who remained stable, those who experienced increased mental distress showed, months earlier, significantly larger late EEG responses locally after L-DLPFC stimulation (but not globally nor after L-IPL stimulation). This response, together with years of formal education, was significantly predictive of mental health status during the pandemic. These findings reveal that the effect of TMS perturbation offers a predictive toy model of psychosocial stress response, as exemplified by the COVID-19 pandemic.
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Affiliation(s)
- Ruben Perellón-Alfonso
- Faculty of Medicine and Health Sciences, and Institute of Neurosciences, University of Barcelona, Barcelona, Spain.,Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - María Redondo-Camós
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Kilian Abellaneda-Pérez
- Faculty of Medicine and Health Sciences, and Institute of Neurosciences, University of Barcelona, Barcelona, Spain.,Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
| | - Gabriele Cattaneo
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Selma Delgado-Gallén
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Goretti España-Irla
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Javier Solana Sánchez
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - José M Tormos
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Alvaro Pascual-Leone
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain.,Hinda and Arthur Marcus Institute for Aging Research and Deanna and Sidney Wolk Center for Memory Health, Hebrew Senior Life, Boston, MA, USA.,Department of Neurology, Harvard Medical School; Boston, MA, USA
| | - David Bartrés-Faz
- Faculty of Medicine and Health Sciences, and Institute of Neurosciences, University of Barcelona, Barcelona, Spain.,Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
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11
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Identifying novel biomarkers with TMS-EEG - Methodological possibilities and challenges. J Neurosci Methods 2022; 377:109631. [PMID: 35623474 DOI: 10.1016/j.jneumeth.2022.109631] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 05/09/2022] [Accepted: 05/21/2022] [Indexed: 12/17/2022]
Abstract
Biomarkers are essential for understanding the underlying pathologies in brain disorders and for developing effective treatments. Combined transcranial magnetic stimulation and electroencephalography (TMS-EEG) is an emerging neurophysiological tool that can be used for biomarker development. This method can identify biomarkers associated with the function and dynamics of the inhibitory and excitatory neurotransmitter systems and effective connectivity between brain areas. In this review, we outline the current state of the TMS-EEG biomarker field by summarizing the existing protocols and the possibilities and challenges associated with this methodology.
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12
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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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13
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Biondi A, Rocchi L, Santoro V, Rossini PG, Beatch GN, Richardson MP, Premoli I. Spontaneous and TMS-related EEG changes as new biomarkers to measure anti-epileptic drug effects. Sci Rep 2022; 12:1919. [PMID: 35121751 PMCID: PMC8817040 DOI: 10.1038/s41598-022-05179-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/05/2022] [Indexed: 01/02/2023] Open
Abstract
Robust biomarkers for anti-epileptic drugs (AEDs) activity in the human brain are essential to increase the probability of successful drug development. The frequency analysis of electroencephalographic (EEG) activity, either spontaneous or evoked by transcranial magnetic stimulation (TMS-EEG) can provide cortical readouts for AEDs. However, a systematic evaluation of the effect of AEDs on spontaneous oscillations and TMS-related spectral perturbation (TRSP) has not yet been provided. We studied the effects of Lamotrigine, Levetiracetam, and of a novel potassium channel opener (XEN1101) in two groups of healthy volunteers. Levetiracetam suppressed TRSP theta, alpha and beta power, whereas Lamotrigine decreased delta and theta but increased the alpha power. Finally, XEN1101 decreased TRSP delta, theta, alpha and beta power. Resting-state EEG showed a decrease of theta band power after Lamotrigine intake. Levetiracetam increased theta, beta and gamma power, while XEN1101 produced an increase of delta, theta, beta and gamma power. Spontaneous and TMS-related cortical oscillations represent a powerful tool to characterize the effect of AEDs on in vivo brain activity. Spectral fingerprints of specific AEDs should be further investigated to provide robust and objective biomarkers of biological effect in human clinical trials.
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Affiliation(s)
- Andrea Biondi
- Division of Neuroscience, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Maurice Wohl Clinical Neuroscience Institute, Ground Floor (G.33.08), 5 Cutcombe Road, Camberwell, London, SE5 9RX, UK.
| | - L Rocchi
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK.,Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - V Santoro
- Division of Neuroscience, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Maurice Wohl Clinical Neuroscience Institute, Ground Floor (G.33.08), 5 Cutcombe Road, Camberwell, London, SE5 9RX, UK
| | - P G Rossini
- Division of Neuroscience, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Maurice Wohl Clinical Neuroscience Institute, Ground Floor (G.33.08), 5 Cutcombe Road, Camberwell, London, SE5 9RX, UK
| | - G N Beatch
- Xenon Pharmaceuticals Inc., Burnaby, Canada
| | - M P Richardson
- Division of Neuroscience, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Maurice Wohl Clinical Neuroscience Institute, Ground Floor (G.33.08), 5 Cutcombe Road, Camberwell, London, SE5 9RX, UK
| | - I Premoli
- Division of Neuroscience, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Maurice Wohl Clinical Neuroscience Institute, Ground Floor (G.33.08), 5 Cutcombe Road, Camberwell, London, SE5 9RX, UK
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14
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TMS-EEG responses across the lifespan: Measurement, methods for characterisation and identified responses. J Neurosci Methods 2022; 366:109430. [PMID: 34856320 DOI: 10.1016/j.jneumeth.2021.109430] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/02/2021] [Accepted: 11/25/2021] [Indexed: 01/29/2023]
Abstract
The combination of transcranial magnetic stimulation (TMS) and electroencephalography (EEG) allows probing of the neurophysiology of any neocortical brain area in vivo with millisecond accuracy. TMS-EEG is particularly unique compared with other available neurophysiological methods, as it can measure the state and dynamics of excitatory and inhibitory systems separately. Because of these capabilities, TMS-EEG responses are sensitive to the brain state, and the responses are influenced by brain maturation and ageing, making TMS-EEG a suitable method to study age-specific pathophysiology. In this review, we outline the TMS-EEG measurement procedure, the existing methods used for characterising TMS-EEG responses and the challenges associated with identifying the responses. We also summarise the findings thus far on how TMS-EEG responses change across the lifespan and the TMS-EEG features that separate typical and atypical brain maturation and ageing. Finally, we give an overview of the gaps in current knowledge to provide directions for future studies.
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15
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Ruijs TQ, Heuberger JAAC, Goede AA, Ziagkos D, Otto ME, Doll RJ, Putten MJAM, Groeneveld GJ. TRANSCRANIAL MAGNETIC STIMULATION AS BIOMARKER OF EXCITABILITY IN DRUG DEVELOPMENT: A RANDOMIZED, DOUBLE‐BLIND, PLACEBO‐CONTROLLED, CROSS‐OVER STUDY. Br J Clin Pharmacol 2022; 88:2926-2937. [PMID: 35028950 PMCID: PMC9303426 DOI: 10.1111/bcp.15232] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 11/18/2021] [Accepted: 12/22/2021] [Indexed: 11/02/2022] Open
Affiliation(s)
- Titia Q. Ruijs
- Centre for Human Drug Research Leiden The Netherlands
- Leiden University Medical Center (LUMC) Leiden The Netherlands
| | | | - Annika A. Goede
- Centre for Human Drug Research Leiden The Netherlands
- University of Twente Enschede The Netherlands
| | | | | | | | | | - Geert Jan Groeneveld
- Centre for Human Drug Research Leiden The Netherlands
- Leiden University Medical Center (LUMC) Leiden The Netherlands
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16
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Yahya AA, Asiri Y, Alyami I. Social Media Analytics for Pharmacovigilance of Antiepileptic Drugs. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:8965280. [PMID: 35027943 PMCID: PMC8752219 DOI: 10.1155/2022/8965280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 12/04/2021] [Indexed: 11/17/2022]
Abstract
Epilepsy is a common neurological disorder worldwide and antiepileptic drug (AED) therapy is the cornerstone of its treatment. It has a laudable aim of achieving seizure freedom with minimal, if any, adverse drug reactions (ADRs). Too often, AED treatment is a long-lasting journey, in which ADRs have a crucial role in its administration. Therefore, from a pharmacovigilance perspective, detecting the ADRs of AEDs is a task of utmost importance. Typically, this task is accomplished by analyzing relevant data from spontaneous reporting systems. Despite their wide adoption for pharmacovigilance activities, the passiveness and high underreporting ratio associated with spontaneous reporting systems have encouraged the consideration of other data sources such as electronic health databases and pharmaceutical databases. Social media is the most recent alternative data source with many promising potentials to overcome the shortcomings of traditional data sources. Although in the literature some attempts have investigated the validity and utility of social media for ADR detection of different groups of drugs, none of them was dedicated to the ADRs of AEDs. Hence, this paper presents a novel investigation of the validity and utility of social media as an alternative data source for the detection of AED ADRs. To this end, a dataset of consumer reviews from two online health communities has been collected. The dataset is preprocessed; the unigram, bigram, and trigram are generated; and the ADRs of each AED are extracted with the aid of consumer health vocabulary and ADR lexicon. Three widely used measures, namely, proportional reporting ratio, reporting odds ratio, and information component, are used to measure the association between each ADR and AED. The resulting list of signaled ADRs for each AED is validated against a widely used ADR database, called Side Effect Resource, in terms of the precision of ADR detection. The validation results indicate the validity of online health community data for the detection of AED ADRs. Furthermore, the lists of signaled AED ADRs are analyzed to answer questions related to the common ADRs of AEDs and the similarities between AEDs in terms of their signaled ADRs. The consistency of the drawn answers with the existing pharmaceutical knowledge suggests the utility of the data from online health communities for AED-related knowledge discovery tasks.
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Affiliation(s)
- Anwar Ali Yahya
- Department of Computer Science, Najran University, Najran, Saudi Arabia
| | - Yousef Asiri
- Department of Computer Science, Najran University, Najran, Saudi Arabia
| | - Ibrahim Alyami
- Department of Computer Science, Najran University, Najran, Saudi Arabia
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17
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Dose-response of intermittent theta burst stimulation of the prefrontal cortex: a TMS-EEG study. Clin Neurophysiol 2022; 136:158-172. [DOI: 10.1016/j.clinph.2021.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 12/01/2021] [Accepted: 12/26/2021] [Indexed: 01/01/2023]
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18
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Perellón-Alfonso R, Redondo-Camós M, Abellaneda-Pérez K, Cattaneo G, Delgado-Gallén S, España-Irla G, Sánchez JS, Tormos JM, Pascual-Leone A, Bartrés-Faz D. TMS-Evoked Prefrontal Perturbation as a Toy Model of Brain Resilience to Stress During the COVID-19 Pandemic. RESEARCH SQUARE 2021:rs.3.rs-1139350. [PMID: 34931185 PMCID: PMC8687479 DOI: 10.21203/rs.3.rs-1139350/v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Psychosocial hardships associated with the COVID-19 pandemic led many individuals to suffer adverse mental health consequences, however, others show no negative effects. We hypothesized that the electroencephalographic (EEG) response to transcranial magnetic stimulation (TMS) could serve as a toy-model of an individual's capacity to resist psychological stress, in this case linked to the COVID-19 pandemic. We analyzed data from 74 participants who underwent mental health monitoring and concurrent electroencephalography with transcranial magnetic stimulation of the left dorsolateral prefrontal cortex (L-DLPFC) and left inferior parietal lobule (L-IPL). Within the following 19 months, mental health was reassessed at three time points during lock-down confinement and different phases of de-escalation in Spain. Compared with participants who remained stable, those who experienced increased mental distress showed, months earlier, significantly larger late EEG responses locally after L-DLPFC stimulation (but not globally nor after L-IPL stimulation). This response, together with years of formal education, was significantly predictive of mental health status during the pandemic. These findings reveal that the effect of TMS perturbation offers a predictive toy model of psychosocial stress resilience, as exemplified by the COVID-19 pandemic, and point to the L-DLPFC as a promising target for resilience promotion.
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19
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Goldsworthy MR, Rogasch NC, Ballinger S, Graetz L, Van Dam JM, Harris R, Yu S, Pitcher JB, Baune BT, Ridding MC. Age-related decline of neuroplasticity to intermittent theta burst stimulation of the lateral prefrontal cortex and its relationship with late-life memory performance. Clin Neurophysiol 2020; 131:2181-2191. [DOI: 10.1016/j.clinph.2020.06.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 04/09/2020] [Accepted: 06/01/2020] [Indexed: 01/08/2023]
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20
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Cortical Excitability, Synaptic Plasticity, and Cognition in Benign Epilepsy With Centrotemporal Spikes: A Pilot TMS-EMG-EEG Study. J Clin Neurophysiol 2020; 37:170-180. [PMID: 32142025 DOI: 10.1097/wnp.0000000000000662] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Children with benign epilepsy with centrotemporal spikes have rare seizures emerging from the motor cortex, which they outgrow in adolescence, and additionally may have language deficits of unclear etiology. We piloted the use of transcranial magnetic stimulation paired with EMG and EEG (TMS-EMG, TMS-EEG) to test the hypotheses that net cortical excitability decreases with age and that use-dependent plasticity predicts learning. METHODS We assessed language and motor learning in 14 right-handed children with benign epilepsy with centrotemporal spikes. We quantified two TMS metrics of left motor cortex excitability: the resting motor threshold (measure of neuronal membrane excitability) and amplitude of the N100-evoked potential (an EEG measure of GABAergic tone). To test plasticity, we applied 1 Hz repetitive TMS to the motor cortex to induce long-term depression-like changes in EMG- and EEG-evoked potentials. RESULTS Children with benign epilepsy with centrotemporal spikes tolerate TMS; no seizures were provoked. Resting motor threshold decreases with age but is elevated above maximal stimulator output for half the group. N100 amplitude decreases with age after controlling for resting motor threshold. Motor cortex plasticity correlates significantly with language learning and at a trend level with motor learning. CONCLUSIONS Transcranial magnetic stimulation is safe and feasible for children with benign epilepsy with centrotemporal spikes, and TMS-EEG provides more reliable outcome measures than TMS-EMG in this group because many children have unmeasurably high resting motor thresholds. Net cortical excitability decreases with age, and motor cortex plasticity predicts not only motor learning but also language learning, suggesting a mechanism by which motor cortex seizures may interact with language development.
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21
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22
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Rogasch NC, Zipser C, Darmani G, Mutanen TP, Biabani M, Zrenner C, Desideri D, Belardinelli P, Müller-Dahlhaus F, Ziemann U. The effects of NMDA receptor blockade on TMS-evoked EEG potentials from prefrontal and parietal cortex. Sci Rep 2020; 10:3168. [PMID: 32081901 PMCID: PMC7035341 DOI: 10.1038/s41598-020-59911-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 01/21/2020] [Indexed: 12/24/2022] Open
Abstract
Measuring the brain’s response to transcranial magnetic stimulation (TMS) with electroencephalography (EEG) offers unique insights into the cortical circuits activated following stimulation, particularly in non-motor regions where less is known about TMS physiology. However, the mechanisms underlying TMS-evoked EEG potentials (TEPs) remain largely unknown. We assessed TEP sensitivity to changes in excitatory neurotransmission mediated by n-methyl-d-aspartate (NMDA) receptors following stimulation of non-motor regions. In fourteen male volunteers, resting EEG and TEPs from prefrontal (PFC) and parietal (PAR) cortex were measured before and after administration of either dextromethorphan (NMDA receptor antagonist) or placebo across two sessions in a double-blinded pseudo-randomised crossover design. At baseline, there were amplitude differences between PFC and PAR TEPs across a wide time range (15–250 ms), however the signals were correlated after ~80 ms, suggesting early peaks reflect site-specific activity, whereas late peaks reflect activity patterns less dependent on the stimulated sites. Early TEP peaks were not reliably altered following dextromethorphan compared to placebo, although findings were less clear for later peaks, and low frequency resting oscillations were reduced in power. Our findings suggest that early TEP peaks (<80 ms) from PFC and PAR reflect stimulation site specific activity that is largely insensitive to changes in NMDA receptor-mediated neurotransmission.
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Affiliation(s)
- Nigel C Rogasch
- Brain, Mind and Society Research Hub, School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia. .,Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia. .,Discipline of Psychiatry, Adelaide Medical School, University of Adelaide, Adelaide, Australia.
| | - Carl Zipser
- Department of Neurology and Stroke, and Hertie Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Ghazaleh Darmani
- Department of Neurology and Stroke, and Hertie Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Tuomas P Mutanen
- Centre for Cognitive Neuroimaging, Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
| | - Mana Biabani
- Brain, Mind and Society Research Hub, School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Christoph Zrenner
- Department of Neurology and Stroke, and Hertie Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Debora Desideri
- Department of Neurology and Stroke, and Hertie Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Paolo Belardinelli
- Department of Neurology and Stroke, and Hertie Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Florian Müller-Dahlhaus
- Department of Neurology and Stroke, and Hertie Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, Tübingen, Germany.,Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Ulf Ziemann
- Department of Neurology and Stroke, and Hertie Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, Tübingen, Germany
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23
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Noda Y. Toward the establishment of neurophysiological indicators for neuropsychiatric disorders using transcranial magnetic stimulation-evoked potentials: A systematic review. Psychiatry Clin Neurosci 2020; 74:12-34. [PMID: 31587446 DOI: 10.1111/pcn.12936] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 08/14/2019] [Accepted: 09/23/2019] [Indexed: 12/24/2022]
Abstract
Transcranial magnetic stimulation (TMS) can depolarize the neurons directly under the coil when applied to the cerebral cortex, and modulate the neural circuit associated with the stimulation site, which makes it possible to measure the neurophysiological index to evaluate excitability and inhibitory functions. Concurrent TMS and electroencephalography (TMS-EEG) has been developed to assess the neurophysiological characteristics of cortical regions other than the motor cortical region noninvasively. The aim of this review is to comprehensively discuss TMS-EEG research in the healthy brain focused on excitability, inhibition, and plasticity following neuromodulatory TMS paradigms from a neurophysiological perspective. A search was conducted in PubMed to identify articles that examined humans and that were written in English and published by September 2018. The search terms were as follows: (TMS OR 'transcranial magnetic stimulation') AND (EEG OR electroencephalog*) NOT (rTMS OR 'repetitive transcranial magnetic stimulation' OR TBS OR 'theta burst stimulation') AND (healthy). The study presents an overview of TMS-EEG methodology and neurophysiological indices and reviews previous findings from TMS-EEG in healthy individuals. Furthermore, this review discusses the potential application of TMS-EEG neurophysiology in the clinical setting to study healthy and diseased brain conditions in the future. Combined TMS-EEG is a powerful tool to probe and map neural circuits in the human brain noninvasively and represents a promising approach for determining the underlying pathophysiology of neuropsychiatric disorders.
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Affiliation(s)
- Yoshihiro Noda
- Multidisciplinary Translational Research Lab, Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
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24
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Tensor decomposition of TMS-induced EEG oscillations reveals data-driven profiles of antiepileptic drug effects. Sci Rep 2019; 9:17057. [PMID: 31745223 PMCID: PMC6864053 DOI: 10.1038/s41598-019-53565-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/30/2019] [Indexed: 12/23/2022] Open
Abstract
Transcranial magnetic stimulation combined with electroencephalography is a powerful tool to probe human cortical excitability. The EEG response to TMS stimulation is altered by drugs active in the brain, with characteristic “fingerprints” obtained for drugs of known mechanisms of action. However, the extraction of specific features related to drug effects is not always straightforward as the complex TMS-EEG induced response profile is multi-dimensional. Analytical approaches can rely on a-priori assumptions within each dimension or on the implementation of cluster-based permutations which do not require preselection of specific limits but may be problematic when several experimental conditions are tested. We here propose an alternative data-driven approach based on PARAFAC tensor decomposition, which provides a parsimonious description of the main profiles underlying the multidimensional data. We validated reliability of PARAFAC on TMS-induced oscillations before extracting the features of two common anti-epileptic drugs (levetiracetam and lamotrigine) in an integrated manner. PARAFAC revealed an effect of both drugs, significantly suppressing oscillations in the alpha range in the occipital region. Further, this effect was stronger under the intake of levetiracetam. This study demonstrates, for the first time, that PARAFAC can easily disentangle the effects of subject, drug condition, frequency, time and space in TMS-induced oscillations.
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Rossini P, Di Iorio R, Bentivoglio M, Bertini G, Ferreri F, Gerloff C, Ilmoniemi R, Miraglia F, Nitsche M, Pestilli F, Rosanova M, Shirota Y, Tesoriero C, Ugawa Y, Vecchio F, Ziemann U, Hallett M. Methods for analysis of brain connectivity: An IFCN-sponsored review. Clin Neurophysiol 2019; 130:1833-1858. [DOI: 10.1016/j.clinph.2019.06.006] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 05/08/2019] [Accepted: 06/18/2019] [Indexed: 01/05/2023]
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Premoli I, Rossini PG, Goldberg PY, Posadas K, Green L, Yogo N, Pimstone S, Abela E, Beatch GN, Richardson MP. TMS as a pharmacodynamic indicator of cortical activity of a novel anti-epileptic drug, XEN1101. Ann Clin Transl Neurol 2019; 6:2164-2174. [PMID: 31568714 PMCID: PMC6856596 DOI: 10.1002/acn3.50896] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/10/2019] [Accepted: 08/24/2019] [Indexed: 12/24/2022] Open
Abstract
Objective Transcranial magnetic stimulation (TMS) produces characteristic deflections in the EEG signal named TMS‐evoked EEG potentials (TEPs), which can be used to assess drug effects on cortical excitability. TMS can also be used to determine the resting motor threshold (RMT) for eliciting a minimal muscle response, as a biomarker of corticospinal excitability. XEN1101 is a novel potassium channel opener undergoing clinical development for treatment of epilepsy. We used TEPs and RMT to measure the effects of XEN1101 in the human brain, to provide evidence that XEN1101 alters cortical excitability at doses that might be used in future clinical trials. Methods TMS measurements were incorporated in this Phase I clinical trial to evaluate the extent to which XEN1101 modulates TMS parameters of cortical and corticospinal excitability. TEPs and RMT were collected before and at 2‐, 4‐, and 6‐hours post drug intake in a double‐blind, placebo‐controlled, randomized, two‐period crossover study of 20 healthy male volunteers. Results Consistent with previous TMS investigations of antiepileptic drugs (AEDs) targeting ion channels, the amplitude of TEPs occurring at early (15–55 msec after TMS) and at late (150–250 msec after TMS) latencies were significantly suppressed from baseline by 20 mg of XEN1101. Furthermore, the RMT showed a significant time‐dependent increase that correlated with the XEN1101 plasma concentration. Interpretation Changes from baseline in TMS measures provided evidence that 20 mg of XEN1101 suppressed cortical and corticospinal excitability, consistent with the effects of other AEDs. These results support the implementation of TMS as a tool to inform early‐stage clinical trials.
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Affiliation(s)
- Isabella Premoli
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Pierre G Rossini
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | | | - Louise Green
- Clinical Research Facility, King's College Hospital, London, UK
| | - Noah Yogo
- Clinical Research Facility, King's College Hospital, London, UK
| | - Simon Pimstone
- Xenon Pharmaceuticals Inc., Burnaby, Canada.,Department of General Internal Medicine, University of British Columbia, Vancouver, Canada
| | - Eugenio Abela
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Mark P Richardson
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Usami K, Korzeniewska A, Matsumoto R, Kobayashi K, Hitomi T, Matsuhashi M, Kunieda T, Mikuni N, Kikuchi T, Yoshida K, Miyamoto S, Takahashi R, Ikeda A, Crone NE. The neural tides of sleep and consciousness revealed by single-pulse electrical brain stimulation. Sleep 2019; 42:zsz050. [PMID: 30794319 PMCID: PMC6559171 DOI: 10.1093/sleep/zsz050] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 02/01/2019] [Indexed: 12/12/2022] Open
Abstract
Wakefulness and sleep arise from global changes in brain physiology that may also govern the flow of neural activity between cortical regions responsible for perceptual processing versus planning and action. To test whether and how the sleep/wake cycle affects the overall propagation of neural activity in large-scale brain networks, we applied single-pulse electrical stimulation (SPES) in patients implanted with intracranial EEG electrodes for epilepsy surgery. SPES elicited cortico-cortical spectral responses at high-gamma frequencies (CCSRHG, 80-150 Hz), which indexes changes in neuronal population firing rates. Using event-related causality (ERC) analysis, we found that the overall patterns of neural propagation among sites with CCSRHG were different during wakefulness and different sleep stages. For example, stimulation of frontal lobe elicited greater propagation toward parietal lobe during slow-wave sleep than during wakefulness. During REM sleep, we observed a decrease in propagation within frontal lobe, and an increase in propagation within parietal lobe, elicited by frontal and parietal stimulation, respectively. These biases in the directionality of large-scale cortical network dynamics during REM sleep could potentially account for some of the unique experiential aspects of this sleep stage. Together these findings suggest that the regulation of conscious awareness and sleep is associated with differences in the balance of neural propagation across large-scale frontal-parietal networks.
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Affiliation(s)
- Kiyohide Usami
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Neurology, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Anna Korzeniewska
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Riki Matsumoto
- Department of Neurology, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Katsuya Kobayashi
- Department of Neurology, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Takefumi Hitomi
- Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
- Department of Respiratory Care and Sleep Control Medicine, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Masao Matsuhashi
- Research and Educational Unit of Leaders for Integrated Medical System, Kyoto University Graduate School of medicine, Sakyo-ku, Kyoto, Japan
- Human Brain Research Center, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Takeharu Kunieda
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
- Department of Neurosurgery, Ehime University Graduate School of Medicine, Shizukawa Toon city, Ehime, Japan
| | - Nobuhiro Mikuni
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
- Department of Neurosurgery, Sapporo Medical University, Chuo-ku, Sapporo, Japan
| | - Takayuki Kikuchi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Kazumichi Yoshida
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Ryosuke Takahashi
- Department of Neurology, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Akio Ikeda
- Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Nathan E Crone
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
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Tremblay S, Rogasch NC, Premoli I, Blumberger DM, Casarotto S, Chen R, Di Lazzaro V, Farzan F, Ferrarelli F, Fitzgerald PB, Hui J, Ilmoniemi RJ, Kimiskidis VK, Kugiumtzis D, Lioumis P, Pascual-Leone A, Pellicciari MC, Rajji T, Thut G, Zomorrodi R, Ziemann U, Daskalakis ZJ. Clinical utility and prospective of TMS–EEG. Clin Neurophysiol 2019; 130:802-844. [DOI: 10.1016/j.clinph.2019.01.001] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 01/07/2019] [Accepted: 01/08/2019] [Indexed: 12/15/2022]
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Darmani G, Ziemann U. Pharmacophysiology of TMS-evoked EEG potentials: A mini-review. Brain Stimul 2019; 12:829-831. [PMID: 30837122 DOI: 10.1016/j.brs.2019.02.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 11/15/2022] Open
Affiliation(s)
- Ghazaleh Darmani
- Department of Neurology & Stroke, and Hertie Institute for Clinical Brain Research, University of Tübingen, Germany
| | - Ulf Ziemann
- Department of Neurology & Stroke, and Hertie Institute for Clinical Brain Research, University of Tübingen, Germany.
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30
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Darmani G, Bergmann TO, Zipser C, Baur D, Müller-Dahlhaus F, Ziemann U. Effects of antiepileptic drugs on cortical excitability in humans: A TMS-EMG and TMS-EEG study. Hum Brain Mapp 2018; 40:1276-1289. [PMID: 30549127 DOI: 10.1002/hbm.24448] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 09/21/2018] [Accepted: 10/17/2018] [Indexed: 12/29/2022] Open
Abstract
Brain responses to transcranial magnetic stimulation (TMS) recorded by electroencephalography (EEG) are emergent noninvasive markers of neuronal excitability and effective connectivity in humans. However, the underlying physiology of these TMS-evoked EEG potentials (TEPs) is still heavily underexplored, impeding a broad application of TEPs to study pathology in neuropsychiatric disorders. Here we tested the effects of a single oral dose of three antiepileptic drugs with specific modes of action (carbamazepine, a voltage-gated sodium channel (VGSC) blocker; brivaracetam, a ligand to the presynaptic vesicle protein VSA2; tiagabine, a gamma-aminobutyric acid (GABA) reuptake inhibitor) on TEP amplitudes in 15 healthy adults in a double-blinded randomized placebo-controlled crossover design. We found that carbamazepine decreased the P25 and P180 TEP components, and brivaracetam the N100 amplitude in the nonstimulated hemisphere, while tiagabine had no effect. Findings corroborate the view that the P25 represents axonal excitability of the corticospinal system, the N100 in the nonstimulated hemisphere propagated activity suppressed by inhibition of presynaptic neurotransmitter release, and the P180 late activity particularly sensitive to VGSC blockade. Pharmaco-physiological characterization of TEPs will facilitate utilization of TMS-EEG in neuropsychiatric disorders with altered excitability and/or network connectivity.
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Affiliation(s)
- Ghazaleh Darmani
- Department of Neurology & Stroke, and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Til O Bergmann
- Department of Neurology & Stroke, and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Carl Zipser
- Department of Neurology & Stroke, and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - David Baur
- Department of Neurology & Stroke, and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Florian Müller-Dahlhaus
- Department of Neurology & Stroke, and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Ulf Ziemann
- Department of Neurology & Stroke, and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
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31
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Bodart O, Fecchio M, Massimini M, Wannez S, Virgillito A, Casarotto S, Rosanova M, Lutz A, Ricard M, Laureys S, Gosseries O. Meditation-induced modulation of brain response to transcranial magnetic stimulation. Brain Stimul 2018; 11:1397-1400. [DOI: 10.1016/j.brs.2018.08.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 08/27/2018] [Accepted: 08/30/2018] [Indexed: 01/25/2023] Open
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Bialer M, Johannessen SI, Koepp MJ, Levy RH, Perucca E, Tomson T, White HS. Progress report on new antiepileptic drugs: A summary of the Fourteenth Eilat Conference on New Antiepileptic Drugs and Devices (EILAT XIV). I. Drugs in preclinical and early clinical development. Epilepsia 2018; 59:1811-1841. [DOI: 10.1111/epi.14557] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/08/2018] [Accepted: 08/08/2018] [Indexed: 01/06/2023]
Affiliation(s)
- Meir Bialer
- Faculty of Medicine; School of Pharmacy and David R. Bloom Center for Pharmacy; Institute for Drug Research; Hebrew University of Jerusalem; Jerusalem Israel
| | - Svein I. Johannessen
- National Center for Epilepsy; Sandvika Norway
- Department of Pharmacology; Oslo University Hospital; Oslo Norway
| | - Matthias J. Koepp
- Department of Clinical and Experimental Epilepsy; UCL Institute of Neurology; London UK
| | - René H. Levy
- Departments of Pharmaceutics and Neurological Surgery; University of Washington; Seattle Washington
| | - Emilio Perucca
- Department of Internal Medicine and Therapeutics; University of Pavia; Pavia Italy
- IRCCS Mondino Foundation; Pavia Italy
| | - Torbjörn Tomson
- Department of Clinical Neuroscience; Karolinska Institute; Stockholm Sweden
| | - H. Steve White
- Department of Pharmacy; School of Pharmacy; University of Washington; Seattle Washington
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Mégevand P, Groppe DM, Bickel S, Mercier MR, Goldfinger MS, Keller CJ, Entz L, Mehta AD. The Hippocampus and Amygdala Are Integrators of Neocortical Influence: A CorticoCortical Evoked Potential Study. Brain Connect 2018; 7:648-660. [PMID: 28978234 DOI: 10.1089/brain.2017.0527] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Brain stimulation is increasingly viewed as an effective approach to treat neuropsychiatric disease. The brain's organization in distributed networks suggests that the activity of a remote brain structure could be modulated by stimulating cortical areas that strongly connect to the target. Most connections between cerebral areas are asymmetric, and a better understanding of the relative direction of information flow along connections could improve the targeting of stimulation to influence deep brain structures. The hippocampus and amygdala, two deep-situated structures that are crucial to memory and emotions, respectively, have been implicated in multiple neurological and psychiatric disorders. We explored the directed connectivity between the hippocampus and amygdala and the cerebral cortex in patients implanted with intracranial electrodes using corticocortical evoked potentials (CCEPs) evoked by single-pulse electrical stimulation. The hippocampus and amygdala were connected with most of the cortical mantle, either directly or indirectly, with the inferior temporal cortex being most directly connected. Because CCEPs assess the directionality of connections, we could determine that incoming connections from cortex to hippocampus were more direct than outgoing connections from hippocampus to cortex. We found a similar, although smaller, tendency for connections between the amygdala and cortex. Our results support the roles of the hippocampus and amygdala to be integrators of widespread cortical influence. These results can inform the targeting of noninvasive neurostimulation to influence hippocampus and amygdala function.
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Affiliation(s)
- Pierre Mégevand
- 1 Department of Neurosurgery, Hofstra North Shore LIJ School of Medicine, and Feinstein Institute for Medical Research , Manhasset, New York
| | - David M Groppe
- 1 Department of Neurosurgery, Hofstra North Shore LIJ School of Medicine, and Feinstein Institute for Medical Research , Manhasset, New York
| | - Stephan Bickel
- 1 Department of Neurosurgery, Hofstra North Shore LIJ School of Medicine, and Feinstein Institute for Medical Research , Manhasset, New York.,2 Department of Neurology, Montefiore Medical Center , Bronx, New York
| | - Manuel R Mercier
- 2 Department of Neurology, Montefiore Medical Center , Bronx, New York.,3 Department of Neuroscience, Albert Einstein College of Medicine , Bronx, New York
| | - Matthew S Goldfinger
- 1 Department of Neurosurgery, Hofstra North Shore LIJ School of Medicine, and Feinstein Institute for Medical Research , Manhasset, New York
| | - Corey J Keller
- 1 Department of Neurosurgery, Hofstra North Shore LIJ School of Medicine, and Feinstein Institute for Medical Research , Manhasset, New York.,3 Department of Neuroscience, Albert Einstein College of Medicine , Bronx, New York
| | - László Entz
- 4 Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences , Hungarian Academy of Sciences, Budapest, Hungary .,5 National Institute of Clinical Neuroscience , Budapest, Hungary .,6 Faculty of Information Technology and Bionics, Péter Pázmány Catholic University , Budapest, Hungary
| | - Ashesh D Mehta
- 1 Department of Neurosurgery, Hofstra North Shore LIJ School of Medicine, and Feinstein Institute for Medical Research , Manhasset, New York
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34
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Ter Braack EM, de Goede AA, van Putten MJAM. Resting Motor Threshold, MEP and TEP Variability During Daytime. Brain Topogr 2018; 32:17-27. [PMID: 30019114 PMCID: PMC6326963 DOI: 10.1007/s10548-018-0662-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 07/06/2018] [Indexed: 12/17/2022]
Abstract
Humans show a variation in physiological processes during the day. To reliably assess (changes in) cortical excitability with transcranial magnetic stimulation (TMS), it is relevant to know the natural variation in TMS readouts during the day. In case of significant daytime variations, this should be taken into account when scheduling (follow-up) measurements. This study aims to evaluate the influence of the time of day on the resting motor threshold (RMT), motor evoked potential (MEP) and TMS evoked potential (TEP) in healthy controls. TMS–EMG–EEG was recorded in 16 healthy subjects. At both motor cortices, we administered 75 pulses at an intensity of 110% RMT. Subjects were stimulated during five sessions in one day (8:00 AM, 10:30 AM, 1:00 PM, 3:30 PM and 6:00 PM) while keeping the stimulation intensity constant. We compared the TEP waveforms between the five sessions with a cluster-based permutation analysis, and the RMT and MEP amplitude with rmANOVA. In general there were no significant differences between the five sessions in the RMT, MEP amplitude or TEP. Only for the left side, N100 amplitude was larger at 3:30 PM than 10:30 AM. The standard deviation of the P30 and N100 amplitude was significantly higher between subjects within one session than within single subjects during the day. The TEP is highly reproducible during the day, with a low intra-individual variation compared to the inter-individual variation. In addition, we found no significant variation of the RMT and MEP amplitude between multiple sessions on one day.
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Affiliation(s)
- Esther M Ter Braack
- Department of Clinical Neurophysiology, Technical Medical Centre, University of Twente, Carré CR 3.623, P.O. 217, 7500 AE, Enschede, The Netherlands.
| | - Annika A de Goede
- Department of Clinical Neurophysiology, Technical Medical Centre, University of Twente, Carré CR 3.623, P.O. 217, 7500 AE, Enschede, The Netherlands
| | - Michel J A M van Putten
- Department of Clinical Neurophysiology, Technical Medical Centre, University of Twente, Carré CR 3.623, P.O. 217, 7500 AE, Enschede, The Netherlands.,Department of Clinical Neurophysiology, Medisch Spectrum Twente, Enschede, The Netherlands
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35
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Premoli I, Costantini A, Rivolta D, Biondi A, Richardson MP. The Effect of Lamotrigine and Levetiracetam on TMS-Evoked EEG Responses Depends on Stimulation Intensity. Front Neurosci 2017; 11:585. [PMID: 29104528 PMCID: PMC5655014 DOI: 10.3389/fnins.2017.00585] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 10/05/2017] [Indexed: 12/29/2022] Open
Abstract
The combination of transcranial magnetic stimulation and electroencephalography (TMS-EEG) has uncovered underlying mechanisms of two anti-epileptic medications: levetiracetam and lamotrigine. Despite their different mechanism of action, both drugs modulated TMS-evoked EEG potentials (TEPs) in a similar way. Since both medications increase resting motor threshold (RMT), the current aim was to examine the similarities and differences in post-drug TEPs, depending on whether stimulation intensity was adjusted to take account of post-drug RMT increase. The experiment followed a placebo controlled, double blind, crossover design, involving a single dose of either lamotrigine or levetiracetam. When a drug-induced increase of RMT occurred, post-drug measurements involved two blocks of stimulations, using unadjusted and adjusted stimulation intensity. A cluster based permutation analysis of differences in TEP amplitude between adjusted and unadjusted stimulation intensity showed that lamotrigine induced a stronger modulation of the N45 TEP component compared to levetiracetam. Results highlight the impact of adjusting stimulation intensity.
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Affiliation(s)
- Isabella Premoli
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Alyssa Costantini
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Davide Rivolta
- School of Psychology, University of East London, London, United Kingdom.,Department of Education, Psychology and Communication, University of Bari Aldo Moro, Bari, Italy
| | - Andrea Biondi
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Mark P Richardson
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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