Effect of repetitive transcranial magnetic stimulation (rTMS) for insomnia: a protocol for a systematic review

The role of the left dorsolateral prefrontal cortex in conflict control during insomnia disorder

BACKGROUND

Patients with insomnia are often accompanied by cognitive dysfunction, which seriously affects the quality of life of patients. Repetitive transcranial magnetic stimulation (rTMS) can induce brain neuroplasticity, regulate brain cognitive function and inhibitory control ability.

OBJECTIVE

To explore the intervention effect of rTMS on conflict control and sleep quality in patients with insomnia.

METHODS

In this single-blind, randomized controlled trial, 39 people with insomnia disorder were randomly divided into real stimulation group and sham stimulation group. The stimulation parameters were stimulation frequency 1 Hz, stimulation intensity 80 % resting motor threshold (RMT), total pulse number 1500 times, time 25 min, and the whole course of treatment lasted 7 days. The Insomnia Severity Index(ISI)、Pittsburgh Sleep Quality Index(PSQI)、Multidimensional Fatigue Inventory(MFI) and Beck Anxiety Inventory(BAI) were assessed at pretest (baseline) and posttest (day 7 after intervention), and the color-word stroop task was used to measure the conflict control ability of the subjects.

RESULTS

The sleep quality, correct rate and reaction time of the posttest in the real stimulus group were higher than those in the pretest. However, there was no significant difference between the pretest and posttest in the sham stimulation group.

CONCLUSIONS

rTMS stimulation of the left dorsolateral prefrontal cortex (LDLPFC) in patients with insomnia can significantly improve the conflict control ability and sleep quality of patients with insomnia.

Non-invasive brain stimulation for patients and healthy subjects: Current challenges and future perspectives

Non-invasive brain stimulation (NIBS) techniques have a rich historical background, yet their utilization has witnessed significant growth only recently. These techniques encompass transcranial electrical stimulation and transcranial magnetic stimulation, which were initially employed in neuroscience to explore the intricate relationship between the brain and behaviour. However, they are increasingly finding application in research contexts as a means to address various neurological, psychiatric, and neurodegenerative disorders. This article aims to fulfill two primary objectives. Firstly, it seeks to showcase the current state of the art in the clinical application of NIBS, highlighting how it can improve and complement existing treatments. Secondly, it provides a comprehensive overview of the utilization of NIBS in augmenting the brain function of healthy individuals, thereby enhancing their performance. Furthermore, the article delves into the points of convergence and divergence between these two techniques. It also addresses the existing challenges and future prospects associated with NIBS from ethical and research standpoints.

Therapeutic non-invasive brain treatments in Alzheimer's disease: recent advances and challenges

Alzheimer's disease (AD) is one of the major neurodegenerative diseases and the most common form of dementia. Characterized by the loss of learning, memory, problem-solving, language, and other thinking abilities, AD exerts a detrimental effect on both patients' and families' quality of life. Although there have been significant advances in understanding the mechanism underlying the pathogenesis and progression of AD, there is no cure for AD. The failure of numerous molecular targeted pharmacologic clinical trials leads to an emerging research shift toward non-invasive therapies, especially multiple targeted non-invasive treatments. In this paper, we reviewed the advances of the most widely studied non-invasive therapies, including photobiomodulation (PBM), transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and exercise therapy. Firstly, we reviewed the pathological changes of AD and the challenges for AD studies. We then introduced these non-invasive therapies and discussed the factors that may affect the effects of these therapies. Additionally, we review the effects of these therapies and the possible mechanisms underlying these effects. Finally, we summarized the challenges of the non-invasive treatments in future AD studies and clinical applications. We concluded that it would be critical to understand the exact underlying mechanisms and find the optimal treatment parameters to improve the translational value of these non-invasive therapies. Moreover, the combined use of non-invasive treatments is also a promising research direction for future studies and sheds light on the future treatment or prevention of AD.

The Subjective and Objective Improvement of Non-Invasive Treatment of Schumann Resonance in Insomnia-A Randomized and Double-Blinded Study

Purpose

Accumulated studies revealed that electromagnetic field can affect human brain and sleep, and the extremely low-frequency electromagnetic field, Schumann resonance, may have the potential to reduce insomnia symptoms. The purpose of this study was to investigate the responses of patients with insomnia to a non-invasive treatment, Schumann resonance (SR), and to evaluate its effectiveness by subjective and objective sleep assessments.

Patients and Methods

We adopted a double-blinded and randomized design and 40 participants (70% female; 50.00 ± 13.38 year) with insomnia completed the entire study. These participants were divided into the SR-sleep-device group and the placebo-device group and were followed up for four weeks. The study used polysomnography (PSG) to measure objective sleep and used sleep diaries, Pittsburgh Sleep Quality Inventory (PSQI), Epworth Sleepiness Scale (ESS), and visual analogy of sleep satisfaction to measure subjective sleep. The 36-Item Short-Form Health Survey (SF-36) was used to evaluate quality of life. Chi-square test, Mann-Whitney U-test, and Wilcoxon test were used to analyze the data.

Results

About 70% of the subjects were women, with an average age of 50±13.38 years and an average history of insomnia of 9.68±8.86 years. We found that in the SR-sleep-device group, objective sleep measurements (sleep-onset-latency, SOL, and total-sleep-time, TST) and subjective sleep questionnaires (SOL, TST, sleep-efficiency, sleep-quality, daytime-sleepiness, and sleep-satisfaction) were significantly improved after using the SR-sleep-device; in the placebo-device group, only such subjective sleep improvements as PSQI and sleep-satisfaction were observed.

Conclusion

This study demonstrates that the SR-sleep-device can reduce the insomnia symptoms through both objective and subjective tests, with minimal adverse effects. Future studies can explore the possible mechanism of SR and health effects and, with a longer tracking time, verify the effectiveness and side effects.

The long-term effect of repetitive transcranial magnetic stimulation in the treatment of intractable insomnia

OBJECTIVE

To explore the differences in clinical efficacy of different courses of repetitive transcranial magnetic stimulation (rTMS) in the treatment of intractable insomnia and the duration of clinical efficacy after cessation of treatment.

METHOD

70 patients with intractable insomnia were randomly divided into 1 treatment course group and 2 treatment courses group. The rTMS course consisted of daily sessions of 1200 stimuli for the r-DLPFC at a frequency of 1 Hz and 800 stimuli for parietal lobe (CPZ) at a frequency of 1 Hz. The pitchburg sleep index (PSQI), Hamilton depression scale (HAMD), Hamilton anxiety scale (HAMA), and cardiopulmonary coupled sleep (CPC) were assessed for 35 patients in each group at baseline, at 2 weeks, and at 1 and 3 months after treatment.

RESULT

The scores of PSQI, HAMD and HAMA in the 2 groups were significantly improved after 1 month of follow-up after rTMS treatment (p < 0.01). The long-term effect of different treatment courses is different. After 2 consecutive courses of treatment, there was still a significant difference between the 3-month follow-up and the pre-treatment period (p < 0.05). However, there was no statistical difference between the 3-month follow-up of one course of treatment and the pre-treatment period. The results of CPC test showed that the improvement of total sleep time (TST), and deep sleep time (DST) was basically consistent with the assessment of PSQI, HAMD and HAMA that the clinical efficacy of the 3-month follow-up was better than that of one course of treatment after 2 consecutive courses of treatment.

CONCLUSION

The treatment of refractory insomnia by rTMS is effective, and the duration of the curative effect is related to the course of treatment. 2 consecutive courses of treatment still have a certain effect after 3 months, which is worthy of clinical promotion.

Can a tDCS treatment enhance subjective and objective sleep among student-athletes?

INTRODUCTION

Previous studies have shown that student-athletes suffer from sleep difficulties. This study explored the impact of tDCS on sleep parameters among student-athletes.

METHOD

Thirty student-athletes (15 females, 15 males, age 21.1 ± 2.1 years) were recruited. All participants underwent a series of questions to rule out depressive and anxiety disorders or any specific tDCS exclusion criteria. All participants were advised to maintain their usual sleep schedule.

RESULTS

Compared polysomnographic and Psychomotor Vigilance Task data analyses did not show any improvement after experimental tDCS. Regardless of groups, PVT mean reaction time was decreased. Regarding the questionnaires, data analyses showed improvement on the PSQI (p < .001), ISI (p < .001) and ASSQ (p < .007) scores after tDCS.

DISCUSSION

tDCS appears to increase total sleep time and should be further explored. Improvements in subjective sleep suggest that tDCS bears interesting possibilities into the enhancement of sleep among student-athletes.

The therapeutic effect of repetitive transcranial magnetic stimulation in elderly depression patients

BACKGROUND

Depression, a common psychiatric disorder in elderly, serves as a remarkable precipitating factor for suicide among the elderly people. Here, a randomized double-blinded study was performed to investigate the efficacy of repetitive transcranial magnetic stimulation (rTMS) on improving the clinical symptoms and reducing suicidal ideation in elderly patients with depression.

METHODS

In this study, 103 elderly patients with depression and suicidal ideation were randomly divided into 2 groups, 48 cases in the rTMS group and 55 cases in the control group (sham rTMS). Both groups received routine drug therapy with rTMS or sham rTMS. The patients received evaluation by Hamilton depression scale and self-rating idea of suicide scale before treatment and after 2 and 4 weeks of treatment, respectively.

RESULTS

The measurement from the present study demonstrated that Hamilton depression scale and self-rating idea of suicide scale scores decreased to varying degrees in the 2 groups after treatment, and the decrease was more significant in rTMS group. The rate of marked effectiveness was much higher in rTMS group after 2 weeks of treatment compared with the control group. Furthermore, the rate of moderate effectiveness at 4 weeks after treatment was significantly higher in rTMS group compared with the control group.

CONCLUSION

Together, the present study shows that rTMS with routine drug therapy exhibited effect with quick onset to improve the clinical symptoms and reduce suicidal ideation in elderly patients with depression.

The effect of repetitive transcranial magnetic stimulation for insomnia: a systematic review and meta-analysis

BACKGROUND

Repetitive transcranial magnetic stimulation (rTMS) might be a promising technique in treating insomnia. A comprehensive meta-analysis of the available literature is conducted to offer evidence.

OBJECTIVE

To evaluate the efficacy and safety of rTMS for insomnia, either as monotherapy or as a complementary strategy.

METHODS

CENTRAL, PubMed, EMBASE, PsycINFO, CINAHL, PEDro, CBM, CNKI, WANFANG, and VIP were searched from earliest record to August 2019. Randomized control trials (RCTs) published in English and Chinese examining effects of rTMS on patients with insomnia were included. Two authors independently completed the article selection, data extraction and rating. Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality of the included studies. The RevMan software was used for meta-analysis. The quality of the evidence was assessed by Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

RESULTS

A total of 36 trials from 28 eligible studies were included, involving a total of 2357 adult participants (mean age, 48.80 years; 45.33% males). Compared with sham rTMS, rTMS was associated with improved PSQI total score (SMD -2.31, 95% CI -2.95 to -1.66; Z = 7.01, P < 0.00001) and scores of seven subscales. Compared to other treatment, rTMS as an adjunct to other treatment was associated with improved PSQI total score (SMD -1.44, 95% CI -2.00 to -0.88; Z = 5.01, P < 0.00001), and may have effects on scores of seven subscales. Compared with other treatment, rTMS was associated with improved Pittsburgh sleep quality index (PSQI) total score (SMD -0.63, 95% CI -1.22 to -0.04; Z = 2.08, P = 0.04), and may have a better score in sleep latency, sleep disturbance and hypnotic using of seven subscales. In the three pair of comparisons, the results for polysomnography (PSG) outcomes were varied. In general, rTMS may improve sleep quality through increasing slow wave and rapid eye movement (REM) sleep. The rTMS group was more prone to headache than the sham or blank control group (RR 1.71, 95% CI 1.03 to 2.85; Z = 2.07, P = 0.04). No severe adverse events were reported. Reporting biases and low and very low grade of some evidences should be considered when interpreting the results of this meta-analysis.

CONCLUSIONS

Our findings indicate that rTMS may be a safe and effective option for insomnia. Further international, multicenter, high-quality RCTs with more objective, quality of life related and follow-up assessments are needed.

Motor recovery and antidepressant effects of repetitive transcranial magnetic stimulation on Parkinson disease: A PRISMA-compliant meta-analysis

BACKGROUND

Clinical symptoms of Parkinson disease (PD) included both motor and nonmotor symptoms. Previous studies indicated inconsistent results for the therapeutic effects of repetitive transcranial magnetic stimulation (rTMS) on motor and depression in PD. The study aimed to assess the therapeutic effect of rTMS with different mode on motor and depression in PD using a meta-analysis.

METHODS

Articles published before July 2019 were searched based on the following databases (PubMed, Web of Science, Medline, Embase, and Google Scholar). The therapeutic effects were assessed by computing the standard mean difference (SMD) and a 95% confidence interval (CI).

RESULTS

The present study indicated that rTMS showed significant therapeutic effects on motor in PD (SMD 2.05, 95% CI 1.57-2.53, I = 93.0%, P < .001). Both high-frequency (HF)-rTMS and low-frequency rTMS showed therapeutic effects on motor; stimulation over primary motor cortex (M1), supplementary motor area, dorsal lateral prefrontal cortex (DLPFC) or M1+DLPFC showed therapeutic effects; stimulation during "on" and "off" states showed therapeutic effects; the study showed long-term effect of rTMS on motor in PD. In addition, the study indicated that rTMS showed significant therapeutic effects on depression in PD (SMD 0.80, 95% CI 0.31-1.29, I = 89.1%, P < .001). Stimulation over left DLPFC showed significant therapeutic effects on depression in PD; only HF-rTMS showed therapeutic effects; ages, disease durations, numbers of pulses, and session durations displayed influence on the therapeutic effects of rTMS on depression in PD; the therapeutic effects on depression was long term. However, no significant difference in therapeutic effects on depression were showed between rTMS and oral Fluoxetine (SMD 0.74, 95% CI -0.83 to 2.31, I = 92.5%, P < .001).

CONCLUSION

The rTMS showed significant therapeutic effects on motor in PD. HF-rTMS showed a significant positive antidepressive effect in PD only over DLPFC.