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Tikka SK, Godi SM, Siddiqui MA, Garg S. Evidence from Indian studies on safety and efficacy of therapeutic transcranial magnetic stimulation across neuropsychiatric disorders- A systematic review and meta-analysis. Indian J Psychiatry 2023; 65:18-35. [PMID: 36874512 PMCID: PMC9983459 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_572_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/03/2022] [Accepted: 12/11/2022] [Indexed: 01/13/2023] Open
Abstract
UNLABELLED Repetitive transcranial magnetic stimulation (rTMS) is potentially effective as an augmentation strategy in the treatment of many neuropsychiatric conditions. Several Indian studies have been conducted in this regard. We aimed to quantitatively synthesize evidence from Indian studies assessing efficacy and safety of rTMS across broad range of neuropsychiatric conditions. Fifty two studies- both randomized controlled and non-controlled studies were included for a series of random-effects meta-analyses. Pre-post intervention effects of rTMS efficacy were estimated in "active only" rTMS treatment arms/groups and "active vs sham" (sham-controlled) studies using pooled Standardized Mean Differences (SMDs). The outcomes were 'any depression', depression in unipolar/bipolar depressive disorder, depression in obsessive compulsive disorder (OCD), depression in schizophrenia, schizophrenia symptoms (positive, negative, total psychopathology, auditory hallucinations and cognitive deficits), obsessive compulsive symptoms of OCD, mania, craving/compulsion in substance use disorders (SUDs) and migraine (headache severity and frequency). Frequencies and odds ratios (OR) for adverse events were calculated. Methodological quality of included studies, publication bias and sensitivity assessment for each meta-analyses was conducted. Meta-analyses of "active only" studies suggested a significant effect of rTMS for all outcomes, with moderate to large effect sizes, at both end of treatment as well as at follow-up. However, except for migraine (headache severity and frequency) with large effect sizes at end of treatment only and craving in alcohol dependence where moderate effect size at follow-up only, rTMS was not found to be effective for any outcome in the series of "active vs sham" meta-analyses. Significant heterogeneity was seen. Serious adverse events were rare. Publication bias was common and the sham controlled positive results lost significance in sensitivity analysis. We conclude that rTMS is safe and shows positive results in 'only active' treatment groups for all the studied neuropsychiatric conditions. However, the sham-controlled evidence for efficacy is negative from India. CONCLUSION rTMS is safe and shows positive results in "only active" treatment groups for all the studied neuropsychiatric conditions. However, the sham-controlled evidence for efficacy is negative from India.
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Affiliation(s)
- Sai Krishna Tikka
- Department of Psychiatry, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Sangha Mitra Godi
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - M Aleem Siddiqui
- Department of Psychiatry, Era's Lucknow Medical College, Lucknow, Uttar Pradesh, India
| | - Shobit Garg
- Department of Psychiatry, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India
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Balderston NL, Beer JC, Seok D, Makhoul W, Deng ZD, Girelli T, Teferi M, Smyk N, Jaskir M, Oathes DJ, Sheline YI. Proof of concept study to develop a novel connectivity-based electric-field modelling approach for individualized targeting of transcranial magnetic stimulation treatment. Neuropsychopharmacology 2022; 47:588-598. [PMID: 34321597 PMCID: PMC8674270 DOI: 10.1038/s41386-021-01110-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 11/08/2022]
Abstract
Resting state functional connectivity (rsFC) offers promise for individualizing stimulation targets for transcranial magnetic stimulation (TMS) treatments. However, current targeting approaches do not account for non-focal TMS effects or large-scale connectivity patterns. To overcome these limitations, we propose a novel targeting optimization approach that combines whole-brain rsFC and electric-field (e-field) modelling to identify single-subject, symptom-specific TMS targets. In this proof of concept study, we recruited 91 anxious misery (AM) patients and 25 controls. We measured depression symptoms (MADRS/HAMD) and recorded rsFC. We used a PCA regression to predict symptoms from rsFC and estimate the parameter vector, for input into our e-field augmented model. We modeled 17 left dlPFC and 7 M1 sites using 24 equally spaced coil orientations. We computed single-subject predicted ΔMADRS/HAMD scores for each site/orientation using the e-field augmented model, which comprises a linear combination of the following elementwise products (1) the estimated connectivity/symptom coefficients, (2) a vectorized e-field model for site/orientation, (3) rsFC matrix, scaled by a proportionality constant. In AM patients, our connectivity-based model predicted a significant decrease depression for sites near BA9, but not M1 for coil orientations perpendicular to the cortical gyrus. In control subjects, no site/orientation combination showed a significant predicted change. These results corroborate previous work suggesting the efficacy of left dlPFC stimulation for depression treatment, and predict better outcomes with individualized targeting. They also suggest that our novel connectivity-based e-field modelling approach may effectively identify potential TMS treatment responders and individualize TMS targeting to maximize the therapeutic impact.
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Affiliation(s)
- Nicholas L Balderston
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
| | - Joanne C Beer
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Darsol Seok
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Walid Makhoul
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutics & Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Tommaso Girelli
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Marta Teferi
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Nathan Smyk
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Marc Jaskir
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Desmond J Oathes
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Yvette I Sheline
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
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Vergallito A, Gallucci A, Pisoni A, Punzi M, Caselli G, Ruggiero GM, Sassaroli S, Romero Lauro LJ. Effectiveness of noninvasive brain stimulation in the treatment of anxiety disorders: a meta-analysis of sham or behaviour-controlled studies. J Psychiatry Neurosci 2021; 46:E592-E614. [PMID: 34753789 PMCID: PMC8580831 DOI: 10.1503/jpn.210050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/23/2021] [Accepted: 07/02/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The possibility of using noninvasive brain stimulation to treat mental disorders has received considerable attention recently. Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are considered to be effective treatments for depressive symptoms. However, no treatment recommendation is currently available for anxiety disorders, suggesting that evidence is still limited. We conducted a systematic review of the literature and a quantitative analysis of the effectiveness of rTMS and tDCS in the treatment of anxiety disorders. METHODS Following PRISMA guidelines, we screened 3 electronic databases up to the end of February 2020 for English-language, peer-reviewed articles that included the following: a clinical sample of patients with an anxiety disorder, the use of a noninvasive brain stimulation technique, the inclusion of a control condition, and pre/post scores on a validated questionnaire that measured symptoms of anxiety. RESULTS Eleven papers met the inclusion criteria, comprising 154 participants assigned to a stimulation condition and 164 to a sham or control group. We calculated Hedge's g for scores on disorder-specific and general anxiety questionnaires before and after treatment to determine effect size, and we conducted 2 independent random-effects meta-analyses. Considering the well-known comorbidity between anxiety and depression, we ran a third meta-analysis analyzing outcomes for depression scores. Results showed a significant effect of noninvasive brain stimulation in reducing scores on disorder-specific and general anxiety questionnaires, as well as depressive symptoms, in the real stimulation compared to the control condition. LIMITATIONS Few studies met the inclusion criteria; more evidence is needed to strengthen conclusions about the effectiveness of noninvasive brain stimulation in the treatment of anxiety disorders. CONCLUSION Our findings showed that noninvasive brain stimulation reduced anxiety and depression scores compared to control conditions, suggesting that it can alleviate clinical symptoms in patients with anxiety disorders.
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Affiliation(s)
| | | | - Alberto Pisoni
- From the Department of Psychology, University of Milano Bicocca, Milan, Italy (Vergallito, Pisoni, Punzi, Romero Lauro); the Neuromi, Milan, Italy (Vergallito, Gallucci, Pisoni, Romero Lauro); the Department of Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy (Gallucci); the Studi Cognitivi, Milan, Italy (Caselli, Ruggiero, Sassaroli); and the Faculty of Psychology, Sigmund Freud University, Milan, Italy (Caseli, Ruggiero, Sassaroli)
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Colella M, Paffi A, De Santis V, Apollonio F, Liberti M. Effect of skin conductivity on the electric field induced by transcranial stimulation techniques in different head models. Phys Med Biol 2021; 66:035010. [PMID: 33496268 DOI: 10.1088/1361-6560/abcde7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This study aims at quantifying the effect that using different skin conductivity values has on the estimation of the electric (E)-field distribution induced by transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) in the brain of two anatomical models. The induced E-field was calculated with numerical simulations inside MIDA and Duke models, assigning to the skin a conductivity value estimated from a multi-layered skin model and three values taken from literature. The effect of skin conductivity variations on the local E-field induced by tDCS in the brain was up to 70%. In TMS, minor local differences, in the order of 20%, were obtained in regions of interest for the onset of possible side effects. Results suggested that an accurate model of the skin is necessary in all numerical studies that aim at precisely estimating the E-field induced during TMS and tDCS applications. This also highlights the importance of further experimental studies on human skin characterization, especially at low frequencies.
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Affiliation(s)
- Micol Colella
- Department of Information Engineering, Electronics and Telecommunications (DIET), University of Rome 'La Sapienza', Rome, Italy
| | - Alessandra Paffi
- Department of Information Engineering, Electronics and Telecommunications (DIET), University of Rome 'La Sapienza', Rome, Italy
| | - Valerio De Santis
- Department of Industrial and Information Engineering and Economics (DIIEE), University of L'Aquila, L'Aquila, Italy
| | - Francesca Apollonio
- Department of Information Engineering, Electronics and Telecommunications (DIET), University of Rome 'La Sapienza', Rome, Italy
| | - Micaela Liberti
- Department of Information Engineering, Electronics and Telecommunications (DIET), University of Rome 'La Sapienza', Rome, Italy
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Treating major depression and comorbid disorders with transcranial magnetic stimulation. J Affect Disord 2020; 276:453-460. [PMID: 32871677 PMCID: PMC7505211 DOI: 10.1016/j.jad.2020.07.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Major Depressive Disorder (MDD) is a global disorder that negatively affects mood and quality of life. Antidepressant medication and psychotherapy are the most commonly prescribed treatments, but prior research has called their clinical efficacy into question. These treatments may be less effective when the patient has a diagnosed comorbid disorder. METHOD A systematic review of the literature was conducted to investigate whether an alternative method of treatment, Transcranial Magnetic Stimulation (TMS), is effective for MDD with a diagnosed comorbidity. 110 articles were identified, of which 8 were included in the current review. RESULTS Response and remission rates vary. A range of 39.5-70% of participants experienced an antidepressant response to treatment, and 16.6-76.9% of patients achieved remission from MDD. A range of 48.6-84.6% of participants responded to treatment of their comorbid disorder, and 50-84.6% achieved remission of comorbid symptoms. LIMITATIONS Limitations of the current review include small sample sizes, limited statistical power, homogenous samples, and a lack of sham or placebo-controlled studies. CONCLUSION Preliminary results support that TMS is effective at treating symptoms of MDD and a comorbid disorder. Additional studies are needed to confirm these results.
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Vicario CM, Salehinejad MA, Felmingham K, Martino G, Nitsche MA. A systematic review on the therapeutic effectiveness of non-invasive brain stimulation for the treatment of anxiety disorders. Neurosci Biobehav Rev 2018; 96:219-231. [PMID: 30543906 DOI: 10.1016/j.neubiorev.2018.12.012] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 12/04/2018] [Accepted: 12/08/2018] [Indexed: 10/27/2022]
Abstract
The interest in the use of non-invasive brain stimulation for enhancing neural functions and reducing symptoms in anxiety disorders is growing. Based on the DSM-V classification for anxiety disorders, we examined all available research using repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) for the treatment of specific phobias, social anxiety disorder, panic disorder, agoraphobia, and generalized anxiety disorder. A systematic literature search conducted in PubMed and Google Scholar databases provided 26 results: 12 sham-controlled studies and 15 not sham-controlled studies. With regard to the latter sub-group of studies, 9 were case reports, and 6 open label studies. Overall, our work provides preliminary evidence that both, excitatory stimulation of the left prefrontal cortex and inhibitory stimulation of the right prefrontal cortex can reduce symptom severity in anxiety disorders. The current results are discussed in the light of a model for the treatment for anxiety disorders via non-invasive brain stimulation, which is based on up-/downregulation mechanisms and might serve as guide for future systematic investigations in the field.
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Affiliation(s)
- C M Vicario
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e degli studi culturali, Università di Messina, Messina, Italy; Dept. Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany; School of Psychology, University of Tasmania, Hobart, TAS, Australia.
| | - Mohammad Ali Salehinejad
- Dept. Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany; International Graduate School of Neuroscience, Ruhr University Bochum, Bochum, Germany
| | - K Felmingham
- School of Psychological Sciences, University of Melbourne, Australia
| | - G Martino
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e degli studi culturali, Università di Messina, Messina, Italy
| | - M A Nitsche
- Dept. Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany; Dept. Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany
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