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Thai M, Nair AU, Klimes-Dougan B, Albott CS, Silamongkol T, Corkrum M, Hill D, Roemer JW, Lewis CP, Croarkin PE, Lim KO, Widge AS, Nahas Z, Eberly LE, Cullen KR. Deep transcranial magnetic stimulation for adolescents with treatment-resistant depression: A preliminary dose-finding study exploring safety and clinical effectiveness. J Affect Disord 2024; 354:589-600. [PMID: 38484878 PMCID: PMC11163675 DOI: 10.1016/j.jad.2024.03.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 02/20/2024] [Accepted: 03/09/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) is an intervention for treatment-resistant depression (TRD) that modulates neural activity. Deep TMS (dTMS) can target not only cortical but also deeper limbic structures implicated in depression. Although TMS has demonstrated safety in adolescents, dTMS has yet to be applied to adolescent TRD. OBJECTIVE/HYPOTHESIS This pilot study evaluated the safety, tolerability, and clinical effects of dTMS in adolescents with TRD. We hypothesized dTMS would be safe, tolerable, and efficacious for adolescent TRD. METHODS 15 adolescents with TRD (Age, years: M = 16.4, SD = 1.42) completed a six-week daily dTMS protocol targeting the left dorsolateral prefrontal cortex (BrainsWay H1 coil, 30 sessions, 10 Hz, 3.6 s train duration, 20s inter-train interval, 55 trains; 1980 total pulses per session, 80 % to 120 % of motor threshold). Participants completed clinical, safety, and neurocognitive assessments before and after treatment. The primary outcome was depression symptom severity measured by the Children's Depression Rating Scale-Revised (CDRS-R). RESULTS 14 out of 15 participants completed the dTMS treatments. One participant experienced a convulsive syncope; the other participants only experienced mild side effects (e.g., headaches). There were no serious adverse events and minimal to no change in cognitive performance. Depression symptom severity significantly improved pre- to post-treatment and decreased to a clinically significant degree after 10 treatment sessions. Six participants met criteria for treatment response. LIMITATIONS Main limitations include a small sample size and open-label design. CONCLUSIONS These findings provide preliminary evidence that dTMS may be tolerable and associated with clinical improvement in adolescent TRD.
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Affiliation(s)
- Michelle Thai
- Department of Psychology, University of Minnesota, Twin Cities, MN, United States of America; Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA, United States of America; Department of Psychiatry, Harvard Medical School, United States of America.
| | - Aparna U Nair
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Bonnie Klimes-Dougan
- Department of Psychology, University of Minnesota, Twin Cities, MN, United States of America
| | - C Sophia Albott
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Thanharat Silamongkol
- Graduate School of Applied and Professional Psychology, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States of America
| | - Michelle Corkrum
- Columbia University Medical Center, New York, NY, United States of America
| | - Dawson Hill
- University of Michigan Medical School, Ann Arbor, MI, United States of America
| | - Justin W Roemer
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Charles P Lewis
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States of America
| | - Kelvin O Lim
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Alik S Widge
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Ziad Nahas
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Lynn E Eberly
- Division of Biostatistics, School of Public Health, University of Minnesota, United States of America
| | - Kathryn R Cullen
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
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Facilitation of Motor Evoked Potentials in Response to a Modified 30 Hz Intermittent Theta-Burst Stimulation Protocol in Healthy Adults. Brain Sci 2021; 11:brainsci11121640. [PMID: 34942942 PMCID: PMC8699605 DOI: 10.3390/brainsci11121640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/06/2021] [Accepted: 12/11/2021] [Indexed: 12/24/2022] Open
Abstract
Theta-burst stimulation (TBS) is a form of repetitive transcranial magnetic stimulation (rTMS) developed to induce neuroplasticity. TBS usually consists of 50 Hz bursts at 5 Hz intervals. It can facilitate motor evoked potentials (MEPs) when applied intermittently, although this effect can vary between individuals. Here, we sought to determine whether a modified version of intermittent TBS (iTBS) consisting of 30 Hz bursts repeated at 6 Hz intervals would lead to lasting MEP facilitation. We also investigated whether recruitment of early and late indirect waves (I-waves) would predict individual responses to 30 Hz iTBS. Participants (n = 19) underwent single-pulse TMS to assess MEP amplitude at baseline and variations in MEP latency in response to anterior-posterior, posterior-anterior, and latero-medial stimulation. Then, 30 Hz iTBS was administered, and MEP amplitude was reassessed at 5-, 20- and 45-min. Post iTBS, most participants (13/19) exhibited MEP facilitation, with significant effects detected at 20- and 45-min. Contrary to previous evidence, recruitment of early I-waves predicted facilitation to 30 Hz iTBS. These observations suggest that 30 Hz/6 Hz iTBS is effective in inducing lasting facilitation in corticospinal excitability and may offer an alternative to the standard 50 Hz/5 Hz protocol.
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Chantigian DP, Larson M, Chen M, Gillick BT, Cross TJ, Keller-Ross ML. Heart rate and blood pressure responses to corticomotor stimulation in young, healthy adults. Clin Neurophysiol Pract 2021; 6:206-208. [PMID: 34377873 PMCID: PMC8327479 DOI: 10.1016/j.cnp.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/02/2021] [Accepted: 06/06/2021] [Indexed: 12/02/2022] Open
Affiliation(s)
- Daniel P Chantigian
- Division of Rehabilitation Science, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Mia Larson
- Division of Rehabilitation Science, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Mo Chen
- Non-Invasive Neuromodulation Laboratory, MnDRIVE Initiative, University of Minnesota, Minneapolis, MN, USA.,Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Bernadette T Gillick
- Division of Rehabilitation Science, Medical School, University of Minnesota, Minneapolis, MN, USA.,Division of Physical Therapy, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Troy J Cross
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.,Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Manda L Keller-Ross
- Division of Rehabilitation Science, Medical School, University of Minnesota, Minneapolis, MN, USA.,Division of Physical Therapy, Medical School, University of Minnesota, Minneapolis, MN, USA
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Ferrulli A, Massarini S, Macrì C, Luzi L. Safety and tolerability of repeated sessions of deep transcranial magnetic stimulation in obesity. Endocrine 2021; 71:331-343. [PMID: 32964308 PMCID: PMC7881959 DOI: 10.1007/s12020-020-02496-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/07/2020] [Indexed: 01/24/2023]
Abstract
PURPOSE Repetitive Transcranial Magnetic Stimulation (rTMS) has been demonstrated to be effective in body weight control in individuals with obesity. Most clinical trials on rTMS provided a reassuring safety profile. In the present work, we present an extensive analysis on both severe and mild Adverse Events (AEs) in obese individuals treated with rTMS. METHODS We examined the intensity, duration, correlation with the treatment, up to 1 year after the end of rTMS treatment. RESULTS Descriptive analysis included a total of 63 subjects undergoing a 5-week deep rTMS experimental treatment for obesity (age 48.3 ± 10.4 years; BMI 36.3 ± 4.4 kg/m2): 31 patients were treated with high-frequency rTMS (HF), 13 with low-frequency rTMS (LF), and 19 were sham treated (Sham). Thirty-two subjects (50.8%) reported a total of 52 AEs, including mainly moderate (51.9%) events. The most frequently reported side effects were headaches of moderate intensity (40.4%) and local pain/discomfort (19.2%) and resulted significantly more frequent in HF group compared to other groups (p < 0.05). No significant differences among groups were found for the other reported AEs: drowsiness, insomnia, paresthesia, vasovagal reactions, hypertensive crisis. No AEs potentially related to the rTMS arised up to 1 year from the end of the treatment. CONCLUSIONS This is the first comprehensive safety analysis in obese patients treated with rTMS. The analysis did not reveal any unexpected safety concerns. Only headaches and local pain/discomfort have been significantly more frequent in the HF group, confirming the good tolerability of rTMS even in the obese population potentially more susceptible to side effects of brain stimulation.
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Affiliation(s)
- Anna Ferrulli
- Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli 31, 20133, Milan, Italy
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Via Milanese 300, 20099, Sesto San Giovanni (MI), Italy
| | - Stefano Massarini
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Via Milanese 300, 20099, Sesto San Giovanni (MI), Italy
| | - Concetta Macrì
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Via Milanese 300, 20099, Sesto San Giovanni (MI), Italy
| | - Livio Luzi
- Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli 31, 20133, Milan, Italy.
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Via Milanese 300, 20099, Sesto San Giovanni (MI), Italy.
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Van Dam J, Goldsworthy M. Case report of a vasovagal pre-syncope event during single-pulse transcranial magnetic stimulation in a healthy adult participant. Clin Neurophysiol 2020; 131:981-982. [PMID: 32008908 DOI: 10.1016/j.clinph.2019.12.401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 12/17/2019] [Accepted: 12/30/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Jago Van Dam
- Adelaide Medical School, University of Adelaide, Australia; South Australian Health and Medical Research Institute (SAHMRI), Australia.
| | - Mitchell Goldsworthy
- Adelaide Medical School, University of Adelaide, Australia; South Australian Health and Medical Research Institute (SAHMRI), Australia
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Keller-Ross ML, Chantigian DP, Rich TL, Chen M, Chen CY, Gillick BT. Stability of the cardiovascular response during single-pulse TMS in perinatal stroke. Brain Stimul 2018; 12:371-373. [PMID: 30502011 DOI: 10.1016/j.brs.2018.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 11/17/2018] [Indexed: 11/15/2022] Open
Affiliation(s)
- Manda L Keller-Ross
- Division of Rehabilitation Science, Medical School, University of Minnesota, Minneapolis, MN, USA; Division of Physical Therapy, Medical School, University of Minnesota, Minneapolis, MN, USA.
| | - Daniel P Chantigian
- Division of Rehabilitation Science, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Tonya L Rich
- Division of Rehabilitation Science, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Mo Chen
- Institute for Engineering and Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Chao-Ying Chen
- Division of Physical Therapy, Medical School, University of Minnesota, Minneapolis, MN, USA; Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Bernadette T Gillick
- Division of Rehabilitation Science, Medical School, University of Minnesota, Minneapolis, MN, USA; Division of Physical Therapy, Medical School, University of Minnesota, Minneapolis, MN, USA
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Kirton A. Advancing non-invasive neuromodulation clinical trials in children: Lessons from perinatal stroke. Eur J Paediatr Neurol 2017; 21:75-103. [PMID: 27470654 DOI: 10.1016/j.ejpn.2016.07.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 06/21/2016] [Accepted: 07/02/2016] [Indexed: 12/18/2022]
Abstract
Applications of non-invasive brain stimulation including therapeutic neuromodulation are expanding at an alarming rate. Increasingly established scientific principles, including directional modulation of well-informed cortical targets, are advancing clinical trial development. However, high levels of disease burden coupled with zealous enthusiasm may be getting ahead of rational research and evidence. Experience is limited in the developing brain where additional issues must be considered. Properly designed and meticulously executed clinical trials are essential and required to advance and optimize the potential of non-invasive neuromodulation without risking the well-being of children and families. Perinatal stroke causes most hemiplegic cerebral palsy and, as a focal injury of defined timing in an otherwise healthy brain, is an ideal human model of developmental plasticity. Advanced models of how the motor systems of young brains develop following early stroke are affording novel windows of opportunity for neuromodulation clinical trials, possibly directing neuroplasticity toward better outcomes. Reviewing the principles of clinical trial design relevant to neuromodulation and using perinatal stroke as a model, this article reviews the current and future issues of advancing such trials in children.
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Affiliation(s)
- Adam Kirton
- Departments of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, 2888 Shaganappi Trail NW, Calgary, AB T3B6A8, Canada.
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Case Report of Syncope During a Single Pulse Transcranial Magnetic Stimulation Experiment in a Healthy Adult Participant. Brain Stimul 2016; 9:471-472. [PMID: 27050115 DOI: 10.1016/j.brs.2016.03.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/14/2016] [Accepted: 03/16/2016] [Indexed: 11/23/2022] Open
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Witnessing loss of consciousness during TMS – Syncope in contrast to seizure. Clin Neurophysiol Pract 2016. [DOI: 10.1016/j.cnp.2016.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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