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Lányi O, Koleszár B, Schulze Wenning A, Balogh D, Engh MA, Horváth AA, Fehérvari P, Hegyi P, Molnár Z, Unoka Z, Csukly G. Excitation/inhibition imbalance in schizophrenia: a meta-analysis of inhibitory and excitatory TMS-EMG paradigms. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2024; 10:56. [PMID: 38879590 PMCID: PMC11180212 DOI: 10.1038/s41537-024-00476-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/16/2024] [Indexed: 06/19/2024]
Abstract
Cortical excitation-inhibition (E/I) imbalance is a potential model for the pathophysiology of schizophrenia. Previous research using transcranial magnetic stimulation (TMS) and electromyography (EMG) has suggested inhibitory deficits in schizophrenia. In this meta-analysis we assessed the reliability and clinical potential of TMS-EMG paradigms in schizophrenia following the methodological recommendations of the PRISMA guideline and the Cochrane Handbook. The search was conducted in three databases in November 2022. Included articles reported Short-Interval Intracortical Inhibition (SICI), Intracortical Facilitation (ICF), Long-Interval Intracortical Inhibition (LICI) and Cortical Silent Period (CSP) in patients with schizophrenia and healthy controls. Meta-analyses were conducted using a random-effects model. Subgroup analysis and meta-regressions were used to assess heterogeneity. Results of 36 studies revealed a robust inhibitory deficit in schizophrenia with a significant decrease in SICI (Cohen's d: 0.62). A trend-level association was found between SICI and antipsychotic medication. Our findings support the E/I imbalance hypothesis in schizophrenia and suggest that SICI may be a potential pathophysiological characteristic of the disorder.
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Affiliation(s)
- Orsolya Lányi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Boróka Koleszár
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | | | - David Balogh
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Marie Anne Engh
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - András Attila Horváth
- Neurocognitive Research Center, Nyírő Gyula National Institute of Psychiatry and Addictology, Budapest, Hungary
| | - Péter Fehérvari
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Biostatistics, University of Veterinary Medicine Budapest, Budapest, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Zsolt Molnár
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
- Department of Anesthesiology and Intensive Therapy, Poznan University of Medical Sciences, Poznan, Poland
| | - Zsolt Unoka
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Gábor Csukly
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary.
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Kahl CK, Swansburg R, Hai T, Wrightson JG, Bell T, Lemay JF, Kirton A, MacMaster FP. Differences in neurometabolites and transcranial magnetic stimulation motor maps in children with attention-deficit/hyperactivity disorder. J Psychiatry Neurosci 2022; 47:E239-E249. [PMID: 35793906 PMCID: PMC9262400 DOI: 10.1503/jpn.210186] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/01/2022] [Accepted: 03/04/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Although much is known about cognitive dysfunction in attention-deficit/hyperactivity disorder (ADHD), few studies have examined the pathophysiology of disordered motor circuitry. We explored differences in neurometabolite levels and transcranial magnetic stimulation (TMS)-derived corticomotor representations among children with ADHD and typically developing children. METHODS We used magnetic resonance spectroscopy (MRS) protocols to measure excitatory (glutamate + glutamine [Glx]) and inhibitory (γ-aminobutyric acid [GABA]) neurometabolite levels in the dominant primary motor cortex (M1) and the supplementary motor area (SMA) in children with ADHD and typically developing children. We used robotic neuronavigated TMS to measure corticospinal excitability and create corticomotor maps. RESULTS We collected data from 26 medication-free children with ADHD (aged 7-16 years) and 25 typically developing children (11-16 years). Children with ADHD had lower M1 Glx (p = 0.044, d = 0.6); their mean resting motor threshold was lower (p = 0.029, d = 0.8); their map area was smaller (p = 0.044, d = 0.7); and their hotspot density was higher (p = 0.008, d = 0.9). M1 GABA levels were associated with motor map area (p = 0.036).Limitations: Some TMS data were lost because the threshold of some children exceeded 100% of the machine output. The relatively large MRS voxel required to obtain sufficient signal-to-noise ratio and reliably measure GABA levels encompassed tissue beyond the M1, making this measure less anatomically specific. CONCLUSION The neurochemistry and neurophysiology of key nodes in the motor network may be altered in children with ADHD, and the differences appear to be related to each other. These findings suggest potentially novel neuropharmacological and neuromodulatory targets for ADHD.
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Affiliation(s)
- Cynthia K Kahl
- From the Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kahl, Swansburg, MacMaster); the Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kahl, Swansburg, Lemay, Kirton, MacMaster); the Hotchkiss Brain Institute, University of Calgary, Calgary, Alta. (Kahl, Wrightson, Bell, Kirton, MacMaster); the Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alta. (Kahl, Bell, Kirton, MacMaster); the Department of Educational Psychology, University of Alberta, Edmonton, Alta. (Hai); the Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Bell); the Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kirton); and the Strategic Clinical Network for Addictions and Mental Health, Calgary, Alta. (MacMaster)
| | - Rose Swansburg
- From the Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kahl, Swansburg, MacMaster); the Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kahl, Swansburg, Lemay, Kirton, MacMaster); the Hotchkiss Brain Institute, University of Calgary, Calgary, Alta. (Kahl, Wrightson, Bell, Kirton, MacMaster); the Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alta. (Kahl, Bell, Kirton, MacMaster); the Department of Educational Psychology, University of Alberta, Edmonton, Alta. (Hai); the Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Bell); the Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kirton); and the Strategic Clinical Network for Addictions and Mental Health, Calgary, Alta. (MacMaster)
| | - Tasmia Hai
- From the Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kahl, Swansburg, MacMaster); the Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kahl, Swansburg, Lemay, Kirton, MacMaster); the Hotchkiss Brain Institute, University of Calgary, Calgary, Alta. (Kahl, Wrightson, Bell, Kirton, MacMaster); the Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alta. (Kahl, Bell, Kirton, MacMaster); the Department of Educational Psychology, University of Alberta, Edmonton, Alta. (Hai); the Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Bell); the Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kirton); and the Strategic Clinical Network for Addictions and Mental Health, Calgary, Alta. (MacMaster)
| | - James G Wrightson
- From the Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kahl, Swansburg, MacMaster); the Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kahl, Swansburg, Lemay, Kirton, MacMaster); the Hotchkiss Brain Institute, University of Calgary, Calgary, Alta. (Kahl, Wrightson, Bell, Kirton, MacMaster); the Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alta. (Kahl, Bell, Kirton, MacMaster); the Department of Educational Psychology, University of Alberta, Edmonton, Alta. (Hai); the Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Bell); the Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kirton); and the Strategic Clinical Network for Addictions and Mental Health, Calgary, Alta. (MacMaster)
| | - Tiffany Bell
- From the Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kahl, Swansburg, MacMaster); the Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kahl, Swansburg, Lemay, Kirton, MacMaster); the Hotchkiss Brain Institute, University of Calgary, Calgary, Alta. (Kahl, Wrightson, Bell, Kirton, MacMaster); the Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alta. (Kahl, Bell, Kirton, MacMaster); the Department of Educational Psychology, University of Alberta, Edmonton, Alta. (Hai); the Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Bell); the Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kirton); and the Strategic Clinical Network for Addictions and Mental Health, Calgary, Alta. (MacMaster)
| | - Jean-François Lemay
- From the Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kahl, Swansburg, MacMaster); the Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kahl, Swansburg, Lemay, Kirton, MacMaster); the Hotchkiss Brain Institute, University of Calgary, Calgary, Alta. (Kahl, Wrightson, Bell, Kirton, MacMaster); the Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alta. (Kahl, Bell, Kirton, MacMaster); the Department of Educational Psychology, University of Alberta, Edmonton, Alta. (Hai); the Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Bell); the Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kirton); and the Strategic Clinical Network for Addictions and Mental Health, Calgary, Alta. (MacMaster)
| | - Adam Kirton
- From the Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kahl, Swansburg, MacMaster); the Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kahl, Swansburg, Lemay, Kirton, MacMaster); the Hotchkiss Brain Institute, University of Calgary, Calgary, Alta. (Kahl, Wrightson, Bell, Kirton, MacMaster); the Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alta. (Kahl, Bell, Kirton, MacMaster); the Department of Educational Psychology, University of Alberta, Edmonton, Alta. (Hai); the Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Bell); the Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kirton); and the Strategic Clinical Network for Addictions and Mental Health, Calgary, Alta. (MacMaster)
| | - Frank P MacMaster
- From the Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kahl, Swansburg, MacMaster); the Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kahl, Swansburg, Lemay, Kirton, MacMaster); the Hotchkiss Brain Institute, University of Calgary, Calgary, Alta. (Kahl, Wrightson, Bell, Kirton, MacMaster); the Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alta. (Kahl, Bell, Kirton, MacMaster); the Department of Educational Psychology, University of Alberta, Edmonton, Alta. (Hai); the Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Bell); the Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kirton); and the Strategic Clinical Network for Addictions and Mental Health, Calgary, Alta. (MacMaster)
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Bolden LB, Griffis JC, Nenert R, Allendorfer JB, Szaflarski JP. Cortical excitability and seizure control influence attention performance in patients with idiopathic generalized epilepsies (IGEs). Epilepsy Behav 2018; 89:135-142. [PMID: 30415135 DOI: 10.1016/j.yebeh.2018.10.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/08/2018] [Accepted: 10/21/2018] [Indexed: 02/05/2023]
Abstract
We recently found that higher cortical excitability is associated with poorer attention performance in healthy adults. While patients with idiopathic generalized epilepsies (IGEs), previously termed genetic generalized epilepsies, are known to demonstrate increased cortical excitability and cognitive deficits, a relationship between these variables in IGEs has not been investigated. Therefore, we aimed to characterize the effects of cortical excitability and seizure control on cognitive performance in IGEs. We studied 30 patients with IGEs (16 patients with controlled IGEs (cIGEs) and 14 patients with treatment-resistant IGEs (trIGEs)) and 24 healthy controls (HCs). Transcranial magnetic stimulation (TMS) was used to measure cortical excitability, including long-interval intracortical inhibition (LICI). Attention was assessed with the Digit Span Forwards, Digit Span Backwards, Trails A, and Flanker tasks. Executive functioning was assessed using Trails B, Stroop Color and Word, and the Wisconsin Card Sorting Task. Two-way multivariate analyses of variance (MANOVAs) were conducted to assess the influences of seizure control (HCs vs. cIGEs vs. trIGEs) and cortical excitability (inhibitory vs. excitatory) on composite measures of attention and executive functions. Attention performance was significantly affected by cortical excitability and seizure control. Participants with primarily excitatory LICI responses, indicating higher cortical excitability, performed worse than inhibitory responders on composite attention (Wilks' lambda = 0.748, F(4, 44) = 3.72, p = 0.011). While participants with cIGEs and trIGEs did not significantly differ in attention performance, participants with trIGEs performed worse on the Digit Forwards (False Discovery Rate (FDR)p < 0.001), Digit Backwards (FDRp = 0.015), and Flanker (FDRp = 0.0075) tasks compared with HCs. These results provide support for the relationship between cortical excitability and attention dysfunction in IGEs. Further investigation is needed to determine whether there is a causal relationship between these variables and whether intracortical gamma-aminobutyric acid (GABA)B networks may be targeted to improve attention deficits in clinical populations with decreased LICI. Findings also suggest that additional research directly comparing cognition in patients with cIGEs and trIGEs is warranted.
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Affiliation(s)
- Lauren B Bolden
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Joseph C Griffis
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rodolphe Nenert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
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