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Jiao X, Hu Q, Tang Y, Zhang T, Zhang J, Wang X, Sun J, Wang J. Abnormal Global Cortical Responses in Drug-Naïve Patients With Schizophrenia Following Orbitofrontal Cortex Stimulation: A Concurrent Transcranial Magnetic Stimulation-Electroencephalography Study. Biol Psychiatry 2024; 96:342-351. [PMID: 38852897 DOI: 10.1016/j.biopsych.2024.05.024] [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: 06/07/2023] [Revised: 05/16/2024] [Accepted: 05/31/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Abnormalities in cortical excitability and plasticity have been considered to underlie the pathophysiology of schizophrenia. Transcranial magnetic stimulation combined with electroencephalography (TMS-EEG) can provide a direct evaluation of cortical responses to TMS. Here, we employed TMS-EEG to investigate cortical responses to orbitofrontal cortex (OFC) stimulation in schizophrenia. METHODS In total, we recruited 92 drug-naïve patients with first-episode schizophrenia and 51 age- and sex-matched healthy individuals. For each participant, one session of 1-Hz repetitive TMS (rTMS) was delivered to the right OFC, and TMS-EEG data were obtained to explore the change in cortical-evoked activities before and immediately after rTMS during the eyes-closed state. The MATRICS Consensus Cognitive Battery was used to assess neurocognitive performance. RESULTS The cortical responses indexed by global mean field amplitudes (i.e., P30, N45, and P60) were larger in patients with schizophrenia than in healthy control participants at baseline. Furthermore, after one session of 1-Hz rTMS over the right OFC, the N100 amplitude was significantly reduced in the healthy control group but not in the schizophrenia group. In the healthy control participants, there was a significant correlation between modulation of P60 amplitude by rTMS and working memory; however, this correlation was absent in patients with schizophrenia. CONCLUSIONS Aberrant global cortical responses following right OFC stimulation were found in patients with drug-naïve first-episode schizophrenia, supporting its significance in the primary pathophysiology of schizophrenia.
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Affiliation(s)
- Xiong Jiao
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Med.-X Engineering Research Center, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Qiang Hu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Psychiatry, Zhenjiang Mental Health Center, Jiangsu, China
| | - Yingying Tang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China
| | - Tianhong Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Med.-X Engineering Research Center, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Xijin Wang
- The First Psychiatric Hospital of Harbin, Harbin, Heilongjiang Province, China
| | - Junfeng Sun
- Shanghai Med.-X Engineering Research Center, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China.
| | - Jijun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Sciences, Shanghai, China; Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China.
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Hall JD, Green JM, Chen YCA, Liu Y, Zhang H, Sundman MH, Chou YH. Exploring the potential of combining transcranial magnetic stimulation and electroencephalography to investigate mild cognitive impairment and Alzheimer's disease: a systematic review. GeroScience 2024; 46:3659-3693. [PMID: 38356029 PMCID: PMC11226590 DOI: 10.1007/s11357-024-01075-6] [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: 09/11/2023] [Accepted: 01/02/2024] [Indexed: 02/16/2024] Open
Abstract
Transcranial magnetic stimulation (TMS) and electroencephalography (EEG) are non-invasive techniques used for neuromodulation and recording brain electrical activity, respectively. The integration of TMS-EEG has emerged as a valuable tool for investigating the complex mechanisms involved in age-related disorders, such as mild cognitive impairment (MCI) and Alzheimer's disease (AD). By systematically synthesizing TMS-EEG studies, this review aims to shed light on the neurophysiological mechanisms underlying MCI and AD, while also exploring the practical applications of TMS-EEG in clinical settings. PubMed, ScienceDirect, and PsychInfo were selected as the databases for this review. The 22 eligible studies included a total of 592 individuals with MCI or AD as well as 301 cognitively normal adults. TMS-EEG assessments unveiled specific patterns of corticospinal excitability, plasticity, and brain connectivity that distinguished individuals on the AD spectrum from cognitively normal older adults. Moreover, the TMS-induced EEG features were observed to be correlated with cognitive performance and the presence of AD pathological biomarkers. The comprehensive examination of the existing studies demonstrates that the combination of TMS and EEG has yielded valuable insights into the neurophysiology of MCI and AD. This integration shows great potential for early detection, monitoring disease progression, and anticipating response to treatment. Future research is of paramount importance to delve into the potential utilization of TMS-EEG for treatment optimization in individuals with MCI and AD.
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Affiliation(s)
- J D Hall
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, 1230 N Cherry Ave., Tucson, AZ, USA
| | - Jacob M Green
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, 1230 N Cherry Ave., Tucson, AZ, USA
| | - Yu-Chin A Chen
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, 1230 N Cherry Ave., Tucson, AZ, USA
| | - Yilin Liu
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, 1230 N Cherry Ave., Tucson, AZ, USA
| | - Hangbin Zhang
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, 1230 N Cherry Ave., Tucson, AZ, USA
| | - Mark H Sundman
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, 1230 N Cherry Ave., Tucson, AZ, USA
| | - Ying-Hui Chou
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, 1230 N Cherry Ave., Tucson, AZ, USA.
- Evelyn F McKnight Brain Institute, Arizona Center On Aging, and BIO5 Institute, University of Arizona, Tucson, AZ, USA.
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Dell’Acqua C, Moretta T, Messerotti Benvenuti S. Reduced approach disposition in familial risk for depression: Evidence from time-frequency alpha asymmetries. PLoS One 2024; 19:e0307524. [PMID: 39047003 PMCID: PMC11268641 DOI: 10.1371/journal.pone.0307524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 07/07/2024] [Indexed: 07/27/2024] Open
Abstract
Despite the promising role of alpha and delta power in reflecting reduced approach disposition in depression, to date, it is unclear whether these measures can be employed to identify at-risk individuals. Hence, the present study investigated affective disposition in 32 unaffected individuals with a family history of depression (23 F) and 30 individuals without a family history of depression (21 F) through a data-driven analysis of alpha and delta time-frequency power during the viewing of pleasant, neutral, and unpleasant pictures. Different patterns of posterior alpha asymmetry emerged within each group. Particularly, controls showed greater right posterior alpha desynchronization ~ 600 ms following emotional relative to neutral pictures presentation. Conversely, the group with a family history of depression showed greater posterior left alpha desynchronization only to unpleasant relative to neutral images in a later time window (> 900 ms). Hence, depression vulnerability seems to be characterized by a blunted reactivity to pleasant and delayed reactivity to unpleasant stimuli with a distinct posterior distribution relative to the controls. Finally, the two groups showed a comparable pattern of greater delta power to emotional relative to neutral cues. Overall, initial support was provided for the employment of time-frequency alpha power changes during affective processing in identifying blunted approach disposition in unaffected at-risk individuals.
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Affiliation(s)
| | - Tania Moretta
- Department of General Psychology, University of Padua, Padua, Italy
| | - Simone Messerotti Benvenuti
- Department of General Psychology, University of Padua, Padua, Italy
- Padova Neuroscience Center (PNC), University of Padua, Padua, Italy
- Hospital Psychology Unit, Padua University Hospital, Padua, Italy
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Li D, Li X, Li J, Liu J, Luo R, Li Y, Wang D, Zhou D, Zhang XY. Neurophysiological markers of disease severity and cognitive dysfunction in major depressive disorder: A TMS-EEG study. Int J Clin Health Psychol 2024; 24:100495. [PMID: 39282218 PMCID: PMC11402404 DOI: 10.1016/j.ijchp.2024.100495] [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: 03/22/2024] [Accepted: 08/12/2024] [Indexed: 09/18/2024] Open
Abstract
Background Transcranial magnetic stimulation-electroencephalography (TMS-EEG) is a powerful technique to study the neuropathology and biomarkers of major depressive disorder (MDD). This study investigated cortical activity and its relationship with clinical symptoms and cognitive dysfunction in MDD patients by indexing TMS-EEG biomarkers in the dorsolateral prefrontal cortex (DLPFC). Methods 133 patients with MDD and 76 healthy individuals participated in this study. Single-pulse TMS was performed on the left DLPFC to obtain TMS-evoked potential (TEP) indices. TMS-EEG waveforms and components were determined by global mean field amplitude. We used the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) to measure participants' cognitive function. Results Patients with MDD had a lower excitatory P180 index compared to healthy controls, and P180 amplitude was negatively correlated with the severity of depressive and anxiety symptoms in patients with MDD. In the MDD group, P30 amplitude was negatively associated with RBANS Visuospatial/ Constructional index and total score. Conclusions TMS-EEG findings suggest that abnormal cortical excitation and inhibition induced by TMS on the DLPFC are associated with the severity of clinical symptoms and cognitive dysfunction in patients with MDD. P180 and P30 have the potential to serve as neurophysiological biomarkers of clinical symptoms and cognitive dysfunction in MDD patients, respectively.
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Affiliation(s)
- Deyang Li
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xingxing Li
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
- Department of psychiatry, Affiliated Kangning Hospital of Ningbo University, Ningbo, Zhejiang, China
- Department of psychiatry, Ningbo Kangning Hospital, Ningbo, Zhejiang, China
| | - Jiaxin Li
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Junyao Liu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Ruichenxi Luo
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yanli Li
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Dongmei Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Dongsheng Zhou
- Department of psychiatry, Affiliated Kangning Hospital of Ningbo University, Ningbo, Zhejiang, China
- Department of psychiatry, Ningbo Kangning Hospital, Ningbo, Zhejiang, China
| | - Xiang-Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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She X, Nix KC, Cline CC, Qi W, Tugin S, He Z, Baumer FM. Stability of transcranial magnetic stimulation electroencephalogram evoked potentials in pediatric epilepsy. Sci Rep 2024; 14:9045. [PMID: 38641629 PMCID: PMC11031596 DOI: 10.1038/s41598-024-59468-8] [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: 12/11/2023] [Accepted: 04/11/2024] [Indexed: 04/21/2024] Open
Abstract
Transcranial magnetic stimulation paired with electroencephalography (TMS-EEG) can measure local excitability and functional connectivity. To address trial-to-trial variability, responses to multiple TMS pulses are recorded to obtain an average TMS evoked potential (TEP). Balancing adequate data acquisition to establish stable TEPs with feasible experimental duration is critical when applying TMS-EEG to clinical populations. Here we aim to investigate the minimum number of pulses (MNP) required to achieve stable TEPs in children with epilepsy. Eighteen children with Self-Limited Epilepsy with Centrotemporal Spikes, a common epilepsy arising from the motor cortices, underwent multiple 100-pulse blocks of TMS to both motor cortices over two days. TMS was applied at 120% of resting motor threshold (rMT) up to a maximum of 100% maximum stimulator output. The average of all 100 pulses was used as a "gold-standard" TEP to which we compared "candidate" TEPs obtained by averaging subsets of pulses. We defined TEP stability as the MNP needed to achieve a concordance correlation coefficient of 80% between the candidate and "gold-standard" TEP. We additionally assessed whether experimental or clinical factors affected TEP stability. Results show that stable TEPs can be derived from fewer than 100 pulses, a number typically used for designing TMS-EEG experiments. The early segment (15-80 ms) of the TEP was less stable than the later segment (80-350 ms). Global mean field amplitude derived from all channels was less stable than local TEP derived from channels overlying the stimulated site. TEP stability did not differ depending on stimulated hemisphere, block order, or antiseizure medication use, but was greater in older children. Stimulation administered with an intensity above the rMT yielded more stable local TEPs. Studies of TMS-EEG in pediatrics have been limited by the complexity of experimental set-up and time course. This study serves as a critical starting point, demonstrating the feasibility of designing efficient TMS-EEG studies that use a relatively small number of pulses to study pediatric epilepsy and potentially other pediatric groups.
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Affiliation(s)
- Xiwei She
- Department of Neurology, Stanford University, Stanford, CA, USA
| | - Kerry C Nix
- Department of Neurology, Stanford University, Stanford, CA, USA
| | - Christopher C Cline
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Wendy Qi
- Department of Neurology, Stanford University, Stanford, CA, USA
| | - Sergei Tugin
- Department of Neurology, Stanford University, Stanford, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Zihuai He
- Department of Neurology, Stanford University, Stanford, CA, USA
| | - Fiona M Baumer
- Department of Neurology, Stanford University, Stanford, CA, USA.
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Fitzsimmons SMDD, Oostra E, Postma TS, van der Werf YD, van den Heuvel OA. Repetitive Transcranial Magnetic Stimulation-Induced Neuroplasticity and the Treatment of Psychiatric Disorders: State of the Evidence and Future Opportunities. Biol Psychiatry 2024; 95:592-600. [PMID: 38040046 DOI: 10.1016/j.biopsych.2023.11.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 11/16/2023] [Accepted: 11/18/2023] [Indexed: 12/03/2023]
Abstract
Neuroplasticity, or activity-dependent neuronal change, is a crucial mechanism underlying the mechanisms of effect of many therapies for neuropsychiatric disorders, one of which is repetitive transcranial magnetic stimulation (rTMS). Understanding the neuroplastic effects of rTMS at different biological scales and on different timescales and how the effects at different scales interact with each other can help us understand the effects of rTMS in clinical populations and offers the potential to improve treatment outcomes. Several decades of research in the fields of neuroimaging and blood biomarkers is increasingly showing its clinical relevance, allowing measurement of the synaptic, functional, and structural changes involved in neuroplasticity in humans. In this narrative review, we describe the evidence for rTMS-induced neuroplasticity at multiple levels of the nervous system, with a focus on the treatment of psychiatric disorders. We also describe the relationship between neuroplasticity and clinical effects, discuss methods to optimize neuroplasticity, and identify future research opportunities in this area.
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Affiliation(s)
- Sophie M D D Fitzsimmons
- Department of Psychiatry, Amsterdam University Medical Centers, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Anatomy and Neurosciences, Amsterdam University Medical Centers, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Neuroscience, Compulsivity Impulsivity and Attention Program, Amsterdam, the Netherlands.
| | - Eva Oostra
- Department of Psychiatry, Amsterdam University Medical Centers, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Anatomy and Neurosciences, Amsterdam University Medical Centers, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, the Netherlands; GGZ inGeest Mental Health Care, Amsterdam, the Netherlands
| | - Tjardo S Postma
- Department of Psychiatry, Amsterdam University Medical Centers, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Anatomy and Neurosciences, Amsterdam University Medical Centers, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Neuroscience, Compulsivity Impulsivity and Attention Program, Amsterdam, the Netherlands; GGZ inGeest Mental Health Care, Amsterdam, the Netherlands
| | - Ysbrand D van der Werf
- Department of Anatomy and Neurosciences, Amsterdam University Medical Centers, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Neuroscience, Compulsivity Impulsivity and Attention Program, Amsterdam, the Netherlands
| | - Odile A van den Heuvel
- Department of Psychiatry, Amsterdam University Medical Centers, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Anatomy and Neurosciences, Amsterdam University Medical Centers, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Neuroscience, Compulsivity Impulsivity and Attention Program, Amsterdam, the Netherlands
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Panebianco M, Bresnahan R, Marson AG. Lamotrigine add-on therapy for drug-resistant focal epilepsy. Cochrane Database Syst Rev 2023; 12:CD001909. [PMID: 38078494 PMCID: PMC10712213 DOI: 10.1002/14651858.cd001909.pub4] [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] [Indexed: 12/18/2023]
Abstract
BACKGROUND This is an updated version of a Cochrane Review last updated in 2020. Epilepsy is a common neurological disorder, affecting 0.5% to 1% of the population. In nearly 30% of cases, epilepsy is resistant to currently available drugs. Pharmacological treatment remains the first choice to control epilepsy. Lamotrigine is a second-generation antiseizure medication. When used as an add-on (in combination with other antiseizure medications), lamotrigine can reduce seizures, but with some adverse effects. OBJECTIVES To evaluate the benefits and harms of add-on lamotrigine, compared with add-on placebo or no add-on treatment in people with drug-resistant focal epilepsy. SEARCH METHODS For this update, we searched the Cochrane Register of Studies (CRS Web) and MEDLINE (Ovid) on 3 October 2022 with no language restrictions. CRS Web includes randomised and quasi-randomised controlled trials from PubMed, Embase, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP), Cochrane Central Register of Controlled Trials (CENTRAL), and the Specialised Registers of Cochrane Review Groups, including Epilepsy. SELECTION CRITERIA We included randomised controlled trials (RCTs) that investigated add-on lamotrigine versus add-on placebo or no add-on treatment in people of any age with drug-resistant focal epilepsy. We used data from the first period of eligible cross-over trials. DATA COLLECTION AND ANALYSIS For this update, two review authors independently selected trials and extracted data. Our primary outcome was 50% or greater reduction in seizure frequency. Our secondary outcomes were treatment withdrawal, adverse effects, cognitive effects, and quality of life. Primary analyses were by intention-to-treat. We performed sensitivity best- and worse-case analyses to account for missing outcome data. We calculated pooled risk ratios (RRs) with 95% confidence intervals (95% Cls) for dichotomous outcomes. MAIN RESULTS We identified no new studies for this update, so the results and conclusions of the review are unchanged. We included five parallel-group studies in adults or children, eight cross-over studies in adults or children, and one parallel study with a responder-enriched design in infants. In total, these 14 studies enroled 1806 eligible participants (38 infants, 199 children, 1569 adults). Baseline phases ranged from four to 12 weeks and treatment phases ranged from eight to 36 weeks. We rated 11 studies (1243 participants) at low overall risk of bias and three (697 participants) at unclear overall risk of bias due to lack of information on study design. Four studies (563 participants) reported effective blinding. Lamotrigine compared with placebo probably increases the likelihood of achieving 50% or greater reduction in seizure frequency (RR 1.80, 95% CI 1.45 to 2.23; 12 trials, 1322 participants (adults and children); moderate-certainty evidence). There is probably little or no difference in risk of treatment withdrawal for any reason among people treated with lamotrigine versus people treated with placebo (RR 1.11, 95% CI 0.91 to 1.37; 14 trials; 1806 participants; moderate-certainty evidence). Lamotrigine compared with placebo is probably associated with a greater risk of ataxia (RR 3.34, 99% Cl 2.01 to 5.55; 12 trials; 1525 participants; moderate-certainty evidence), dizziness (RR 1.76, 99% Cl 1.28 to 2.43; 13 trials; 1768 participants; moderate-certainty evidence), nausea (RR 1.81, 99% CI 1.22 to 2.68; 12 studies, 1486 participants; moderate-certainty evidence), and diplopia (RR 3.79, 99% Cl 2.15 to 6.68; 3 trials, 944 participants; moderate-certainty evidence). There is probably little or no difference in the risk of fatigue between lamotrigine and placebo (RR 0.82, 99% CI 0.55 to 1.22; 12 studies, 1552 participants; moderate-certainty evidence). AUTHORS' CONCLUSIONS Lamotrigine as an add-on treatment for drug-resistant focal seizures is probably effective for reducing seizure frequency. Certain adverse effects (ataxia, dizziness, diplopia, and nausea) are probably more likely to occur with lamotrigine compared with placebo. There is probably little or no difference in the number of people who withdraw from treatment with lamotrigine versus placebo. The trials were of relatively short duration and provided no long-term evidence. In addition, some trials had few participants. Further trials are needed to assess the long-term effects of lamotrigine and to compare lamotrigine with other add-on drugs.
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Affiliation(s)
- Mariangela Panebianco
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Rebecca Bresnahan
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Anthony G Marson
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
- Liverpool Health Partners, Liverpool, UK
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Almairac F, Isan P, Onno M, Papadopoulo T, Mondot L, Chanalet S, Fernandez C, Clerc M, Deriche R, Fontaine D, Filipiak P. Identifying subcortical connectivity during brain tumor surgery: a multimodal study. Brain Struct Funct 2023; 228:815-830. [PMID: 36840759 DOI: 10.1007/s00429-023-02623-0] [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: 10/14/2022] [Accepted: 02/16/2023] [Indexed: 02/26/2023]
Abstract
Bipolar direct electrical stimulation (DES) of an awake patient is the reference technique for identifying brain structures to achieve maximal safe tumor resection. Unfortunately, DES cannot be performed in all cases. Alternative surgical tools are, therefore, needed to aid identification of subcortical connectivity during brain tumor removal. In this pilot study, we sought to (i) evaluate the combined use of evoked potential (EP) and tractography for identification of white matter (WM) tracts under the functional control of DES, and (ii) provide clues to the electrophysiological effects of bipolar stimulation on neural pathways. We included 12 patients (mean age of 38.4 years) who had had a dMRI-based tractography and a functional brain mapping under awake craniotomy for brain tumor removal. Electrophysiological recordings of subcortical evoked potentials (SCEPs) were acquired during bipolar low frequency (2 Hz) stimulation of the WM functional sites identified during brain mapping. SCEPs were successfully triggered in 11 out of 12 patients. The median length of the stimulated fibers was 43.24 ± 19.55 mm, belonging to tracts of median lengths of 89.84 ± 24.65 mm. The electrophysiological (delay, amplitude, and speed of propagation) and structural (number and lengths of streamlines, and mean fractional anisotropy) measures were correlated. In our experimental conditions, SCEPs were essentially limited to a subpart of the bundles, suggesting a selectivity of action of the DES on the brain networks. Correlations between functional, structural, and electrophysiological measures portend the combined use of EPs and tractography as a potential intraoperative tool to achieve maximum safe resection in brain tumor surgery.
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Affiliation(s)
- Fabien Almairac
- Neurosurgery Department, Pasteur 2 Hospital, University Hospital of Nice, 30 Avenue de La Voie Romaine, 06000, Nice, France.
- UR2CA PIN, Université Côte d'Azur, Nice, France.
| | - Petru Isan
- Neurosurgery Department, Pasteur 2 Hospital, University Hospital of Nice, 30 Avenue de La Voie Romaine, 06000, Nice, France
- UR2CA PIN, Université Côte d'Azur, Nice, France
- Athena Team, Centre Inria d'Université Côte d'Azur, Sophia Antipolis, France
| | - Marie Onno
- Neurosurgery Department, Pasteur 2 Hospital, University Hospital of Nice, 30 Avenue de La Voie Romaine, 06000, Nice, France
| | | | - Lydiane Mondot
- Neuroradiology Department, Pasteur 2 Hospital, University Hospital of Nice, Nice, France
- UR2CA URRIS, Université Côte d'Azur, Nice, France
| | - Stéphane Chanalet
- Neuroradiology Department, Pasteur 2 Hospital, University Hospital of Nice, Nice, France
| | - Charlotte Fernandez
- Neurosurgery Department, Pasteur 2 Hospital, University Hospital of Nice, 30 Avenue de La Voie Romaine, 06000, Nice, France
| | - Maureen Clerc
- Athena Team, Centre Inria d'Université Côte d'Azur, Sophia Antipolis, France
| | - Rachid Deriche
- Athena Team, Centre Inria d'Université Côte d'Azur, Sophia Antipolis, France
| | - Denys Fontaine
- Neurosurgery Department, Pasteur 2 Hospital, University Hospital of Nice, 30 Avenue de La Voie Romaine, 06000, Nice, France
- UR2CA PIN, Université Côte d'Azur, Nice, France
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Farzan F, Bortoletto M. Identification and verification of a 'true' TMS evoked potential in TMS-EEG. J Neurosci Methods 2022; 378:109651. [PMID: 35714721 DOI: 10.1016/j.jneumeth.2022.109651] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 04/05/2022] [Accepted: 06/09/2022] [Indexed: 11/19/2022]
Abstract
The concurrent combination of transcranial magnetic stimulation and electroencephalography (TMS-EEG) can unveil functional neural mechanisms with applications in basic and clinical research. In particular, TMS-evoked potentials (TEPs) potentially allow studying excitability and connectivity of the cortex in a causal manner that is not easily or non-invasively attainable with other neuroimaging techniques. The TEP waveform is obtained by isolating the EEG responses phase-locked to the time of TMS application. The intended component in a TEP waveform is the cortical activation by the TMS-induced electric current, free of instrumental and physiological artifact sources. This artifact-free cortical activation can be referred to as 'true' TEP. However, due to many unwanted auxiliary effects of TMS, the interpretation of 'true' TEPs has not been free of controversy. This paper reviews the most recent understandings of 'true' TEPs and their application. In the first part of the paper, TEP components are defined according to recommended methodologies. In the second part, the verification of 'true' TEP is discussed along with its sensitivity to brain-state, age, and disease. The various proposed origins of TEP components are then presented in the context of existing literature. Throughout the paper, lessons learned from the past TMS-EEG studies are highlighted to guide the identification and interpretation of 'true' TEPs in future studies.
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Affiliation(s)
- Faranak Farzan
- eBrain Lab, School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia, Canada; University of Toronto, Department of Psychiatry, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
| | - Marta Bortoletto
- Neurophysiology lab, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
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di Hou M, Santoro V, Biondi A, Shergill SS, Premoli I. A systematic review of TMS and neurophysiological biometrics in patients with schizophrenia. J Psychiatry Neurosci 2021; 46:E675-E701. [PMID: 34933940 PMCID: PMC8695525 DOI: 10.1503/jpn.210006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 08/06/2021] [Accepted: 09/06/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Transcranial magnetic stimulation can be combined with electromyography (TMS-EMG) and electroencephalography (TMS-EEG) to evaluate the excitatory and inhibitory functions of the cerebral cortex in a standardized manner. It has been postulated that schizophrenia is a disorder of functional neural connectivity underpinned by a relative imbalance of excitation and inhibition. The aim of this review was to provide a comprehensive overview of TMS-EMG and TMS-EEG research in schizophrenia, focused on excitation or inhibition, connectivity, motor cortical plasticity and the effect of antipsychotic medications, symptom severity and illness duration on TMS-EMG and TMS-EEG indices. METHODS We searched PsycINFO, Embase and Medline, from database inception to April 2020, for studies that included TMS outcomes in patients with schizophrenia. We used the following combination of search terms: transcranial magnetic stimulation OR tms AND interneurons OR glutamic acid OR gamma aminobutyric acid OR neural inhibition OR pyramidal neurons OR excita* OR inhibit* OR GABA* OR glutam* OR E-I balance OR excitation-inhibition balance AND schizoaffective disorder* OR Schizophrenia OR schizophreni*. RESULTS TMS-EMG and TMS-EEG measurements revealed deficits in excitation or inhibition, functional connectivity and motor cortical plasticity in patients with schizophrenia. Increased duration of the cortical silent period (a TMS-EMG marker of γ-aminobutyric acid B receptor activity) with clozapine was a relatively consistent finding. LIMITATIONS Most of the studies used patients with chronic schizophrenia and medicated patients, employed cross-sectional group comparisons and had small sample sizes. CONCLUSION TMS-EMG and TMS-EEG offer an opportunity to develop a novel and improved understanding of the physiologic processes that underlie schizophrenia and to assess the therapeutic effect of antipsychotic medications. In the future, these techniques may also help predict disease progression and further our understanding of the excitatory/inhibitory balance and its implications for mechanisms that underlie treatment-resistant schizophrenia.
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Affiliation(s)
- Meng di Hou
- From the Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK (Hou, Shergill); the Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK (Santoro, Biondi, Premoli); and the Kent and Medway Medical School, Canterbury, UK (Shergill)
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Lamotrigine Attenuates Neuronal Excitability, Depresses GABA Synaptic Inhibition, and Modulates Theta Rhythms in Rat Hippocampus. Int J Mol Sci 2021; 22:ijms222413604. [PMID: 34948401 PMCID: PMC8705017 DOI: 10.3390/ijms222413604] [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: 11/01/2021] [Revised: 11/29/2021] [Accepted: 12/05/2021] [Indexed: 12/03/2022] Open
Abstract
Theta oscillations generated in hippocampal (HPC) and cortical neuronal networks are involved in various aspects of brain function, including sensorimotor integration, movement planning, memory formation and attention. Disruptions of theta rhythms are present in individuals with brain disorders, including epilepsy and Alzheimer’s disease. Theta rhythm generation involves a specific interplay between cellular (ion channel) and network (synaptic) mechanisms. HCN channels are theta modulators, and several medications are known to enhance their activity. We investigated how different doses of lamotrigine (LTG), an HCN channel modulator, and antiepileptic and neuroprotective agent, would affect HPC theta rhythms in acute HPC slices (in vitro) and anaesthetized rats (in vivo). Whole-cell patch clamp recordings revealed that LTG decreased GABAA-fast transmission in CA3 cells, in vitro. In addition, LTG directly depressed CA3 and CA1 pyramidal neuron excitability. These effects were partially blocked by ZD 7288, a selective HCN blocker, and are consistent with decreased excitability associated with antiepileptic actions. Lamotrigine depressed HPC theta oscillations in vitro, also consistent with its neuronal depressant effects. In contrast, it exerted an opposite, enhancing effect, on theta recorded in vivo. The contradictory in vivo and in vitro results indicate that LTG increases ascending theta activating medial septum/entorhinal synaptic inputs that over-power the depressant effects seen in HPC neurons. These results provide new insights into LTG actions and indicate an opportunity to develop more precise therapeutics for the treatment of dementias, memory disorders and epilepsy.
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The Effect of Epilepsy and Antiepileptic Drugs on Cortical Motor Excitability in Patients With Temporal Lobe Epilepsy. Clin Neuropharmacol 2021; 43:175-184. [PMID: 32969972 DOI: 10.1097/wnf.0000000000000412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Transcranial magnetic stimulation (TMS) has been used to assess cortical disinhibition/excitation with epilepsy and determine the degree of patients' response to antiepileptic drugs (AEDs). However, the results of studies are variable and conflicting. We assessed cortical motor excitability in adults with temporal lobe epilepsy (TLE). METHODS The TMS parameters used for assessment were: resting (RMT) and active (AMT) motor thresholds, cortical silent period (CSP), and central motor conduction time (CMCT). RESULTS AND CONCLUSIONS This study included 40 adults (males, 22; females, 18) with TLE with impaired awareness or to bilateral tonic clonic seizures (mean age, 32.50 ± 3.38 years; duration of illness, 6.15 ± 2.02 years) and on treatment with AEDs (valproate, 15; carbamazepine, 15; levetiracetam, 10]. The majority (62.5%) were seizure-free for ≥1 year on AEDs before TMS testing. All had normal brain magnetic resonance imaging except two, who had mesial temporal sclerosis. Comparing the entire patients with controls, patients had significantly bihemispheric higher RMT and AMT particularly over the epileptic hemisphere and shorter CSP and CMCT in the epileptic hemisphere. Shorter CSP and CMCT were observed in patients on valproate or carbamazepine and those who were uncontrolled on medications but not with levetiracetam. Significant correlations were identified between RMT and AMT (P = 0.01) and between CSP and CMCT (P = 0.001). We conclude that chronic TLE had increased cortical disinhibition in the epileptic hemisphere which can spread outside the epileptogenic zone despite the apparent control on AEDs. The TMS studies using CSP and CMCT may help future prediction of pharmacoresistance and, therefore, the need of combined AEDs with multiple mechanisms of action.
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O'Donnell P, Dijkstra FM, Damar U, Quanhong L, de Goede AA, Xu L, Pascual-Leone A, Buhl DL, Zuiker R, Ruijs TQ, Heuberger JAAC, MacMullin P, Lubell M, Asgharnejad M, Murthy V, Rotenberg A, Jacobs GE, Rosen L. Transcranial magnetic stimulation as a translational biomarker for AMPA receptor modulation. Transl Psychiatry 2021; 11:325. [PMID: 34045439 PMCID: PMC8160137 DOI: 10.1038/s41398-021-01451-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 04/05/2021] [Accepted: 05/12/2021] [Indexed: 11/09/2022] Open
Abstract
TAK-653 is a novel α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR)-positive allosteric modulator being developed as a potential therapeutic for major depressive disorder (MDD). Currently, there are no translational biomarkers that evaluate physiological responses to the activation of glutamatergic brain circuits available. Here, we tested whether noninvasive neurostimulation, specifically single-pulse or paired-pulse motor cortex transcranial magnetic stimulation (spTMS and ppTMS, respectively), coupled with measures of evoked motor response captures the pharmacodynamic effects of TAK-653 in rats and healthy humans. In the rat study, five escalating TAK-653 doses (0.1-50 mg/kg) or vehicle were administered to 31 adult male rats, while measures of cortical excitability were obtained by spTMS coupled with mechanomyography. Twenty additional rats were used to measure brain and plasma TAK-653 concentrations. The human study was conducted in 24 healthy volunteers (23 males, 1 female) to assess the impact on cortical excitability of 0.5 and 6 mg TAK-653 compared with placebo, measured by spTMS and ppTMS coupled with electromyography in a double-blind crossover design. Plasma TAK-653 levels were also measured. TAK-653 increased both the mechanomyographic response to spTMS in rats and the amplitude of motor-evoked potentials in humans at doses yielding similar plasma concentrations. TAK-653 did not affect resting motor threshold or paired-pulse responses in humans. This is the first report of a translational functional biomarker for AMPA receptor potentiation and indicates that TMS may be a useful translational platform to assess the pharmacodynamic profile of glutamate receptor modulators.
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Affiliation(s)
- Patricio O'Donnell
- Takeda Pharmaceuticals International, Inc., Cambridge, MA, USA.
- McLean Hospital, Department of Psychiatry, Harvard Medical School, Belmont, MA, USA.
| | - Francis M Dijkstra
- Centre for Human Drug Research (CHDR), Leiden, The Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Ugur Damar
- Neuromodulation Program, Department of Neurology and F.M. Kirby Center for Neurobiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lei Quanhong
- Takeda Pharmaceuticals International, Inc., Cambridge, MA, USA
| | | | - Lin Xu
- Takeda Pharmaceuticals International, Inc., Cambridge, MA, USA
| | - Andres Pascual-Leone
- Neuromodulation Program, Department of Neurology and F.M. Kirby Center for Neurobiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Derek L Buhl
- Takeda Pharmaceuticals International, Inc., Cambridge, MA, USA
| | - Rob Zuiker
- Centre for Human Drug Research (CHDR), Leiden, The Netherlands
| | - Titia Q Ruijs
- Centre for Human Drug Research (CHDR), Leiden, The Netherlands
| | | | - Paul MacMullin
- Neuromodulation Program, Department of Neurology and F.M. Kirby Center for Neurobiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Martin Lubell
- Takeda Pharmaceuticals International, Inc., Cambridge, MA, USA
| | | | | | - Alexander Rotenberg
- Neuromodulation Program, Department of Neurology and F.M. Kirby Center for Neurobiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gabriel E Jacobs
- Centre for Human Drug Research (CHDR), Leiden, The Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Laura Rosen
- Takeda Pharmaceuticals International, Inc., Cambridge, MA, USA
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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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Hamed SA. Cortical excitability in epilepsy and the impact of antiepileptic drugs: transcranial magnetic stimulation applications. Expert Rev Neurother 2020; 20:707-723. [PMID: 3251028 DOI: 10.1080/14737175.2020.1780122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Epileptic conditions are characterized by impaired cortical excitation/inhibition balance and interneuronal disinhibition. Transcranial magnetic stimulation (TMS) is a neurophysiological method that assesses brain excitation/inhibition. AREA COVERED This review was written after a detailed search in PubMed, EMBASE, ISI web of science, SciELO, Scopus, and Cochrane Controlled Trials databases from 1990 to 2020. It summarizes TMS applications for diagnostic and therapeutic purposes in epilepsy. TMS studies help to distinguish different epilepsy conditions and explore the antiepileptic drugs' (AEDs') effects on neuronal microcircuits and plasticity mechanisms. Repetitive TMS studies showed that low-frequency rTMS (0.33-1 Hz) can reduce seizures' frequency in refractory epilepsy or pause ongoing seizures; however, there is no current approval for its use in such patients as adjunctive treatment to AEDs. EXPERT OPINION There are variable and conflicting TMS results which reflect the distinct pathogenic mechanisms of each epilepsy condition, the dynamic epileptogenic process over the long disease course resulting in the development of recurrent spontaneous seizures and/or progression of epilepsy after it is established, and the differential effect of AEDs on cortical excitability. Future epilepsy research should focus on combined TMS/functional connectivity studies that explore the complex cortical excitability circuits and networks using different TMS parameters and techniques.
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Affiliation(s)
- Sherifa Ahmed Hamed
- Department of Neurology and Psychiatry, Assiut University Hospital , Assiut, Egypt
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Silverstein BH, Asano E, Sugiura A, Sonoda M, Lee MH, Jeong JW. Dynamic tractography: Integrating cortico-cortical evoked potentials and diffusion imaging. Neuroimage 2020; 215:116763. [PMID: 32294537 DOI: 10.1016/j.neuroimage.2020.116763] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/02/2020] [Accepted: 03/17/2020] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Cortico-cortical evoked potentials (CCEPs) are utilized to identify effective networks in the human brain. Following single-pulse electrical stimulation of cortical electrodes, evoked responses are recorded from distant cortical areas. A negative deflection (N1) which occurs 10-50 ms post-stimulus is considered to be a marker for direct cortico-cortical connectivity. However, with CCEPs alone it is not possible to observe the white matter pathways that conduct the signal or accurately predict N1 amplitude and latency at downstream recoding sites. Here, we develop a new approach, termed "dynamic tractography," which integrates CCEP data with diffusion-weighted imaging (DWI) data collected from the same patients. This innovative method allows greater insights into cortico-cortical networks than provided by each method alone and may improve the understanding of large-scale networks that support cognitive functions. The dynamic tractography model produces several fundamental hypotheses which we investigate: 1) DWI-based pathlength predicts N1 latency; 2) DWI-based pathlength negatively predicts N1 voltage; and 3) fractional anisotropy (FA) along the white matter path predicts N1 propagation velocity. METHODS Twenty-three neurosurgical patients with drug-resistant epilepsy underwent both extraoperative CCEP recordings and preoperative DWI scans. Subdural grids of 3 mm diameter electrodes were used for stimulation and recording, with 98-128 eligible electrodes per patient. CCEPs were elicited by trains of 1 Hz stimuli with an intensity of 5 mA and recorded at a sample rate of 1 kHz. N1 peak and latency were defined as the maximum of a negative deflection within 10-50 ms post-stimulus with a z-score > 5 relative to baseline. Electrodes and DWI were coregistered to construct electrode connectomes for white matter quantification. RESULTS Clinical variables (age, sex, number of anti-epileptic drugs, handedness, and stimulated hemisphere) did not correlate with the key outcome measures (N1 peak amplitude, latency, velocity, or DWI pathlength). All subjects and electrodes were therefore pooled into a group-level analysis to determine overall patterns. As hypothesized, DWI path length positively predicted N1 latency (R2 = 0.81, β = 1.51, p = 4.76e-16) and negatively predicted N1 voltage (R2 = 0.79, β = -0.094, p = 9.30e-15), while FA predicted N1 propagation velocity (R2 = 0.35, β = 48.0, p = 0.001). CONCLUSION We have demonstrated that the strength and timing of the CCEP N1 is dependent on the properties of the underlying white matter network. Integrated CCEP and DWI visualization allows robust localization of intact axonal pathways which effectively interconnect eloquent cortex.
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Affiliation(s)
- Brian H Silverstein
- Translational Neuroscience Program, Wayne State University, Detroit, MI, USA
| | - Eishi Asano
- Translational Neuroscience Program, Wayne State University, Detroit, MI, USA; Dept. of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA; Dept. of Neurology, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA
| | - Ayaka Sugiura
- Dept. of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA
| | - Masaki Sonoda
- Dept. of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA
| | - Min-Hee Lee
- Dept. of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA; Translational Imaging Laboratory, Wayne State University, Detroit, MI, USA
| | - Jeong-Won Jeong
- Translational Neuroscience Program, Wayne State University, Detroit, MI, USA; Dept. of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA; Dept. of Neurology, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA; Translational Imaging Laboratory, Wayne State University, Detroit, MI, USA.
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Panebianco M, Bresnahan R, Ramaratnam S, Marson AG. Lamotrigine add-on therapy for drug-resistant focal epilepsy. Cochrane Database Syst Rev 2020; 3:CD001909. [PMID: 32196639 PMCID: PMC7083514 DOI: 10.1002/14651858.cd001909.pub3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND This is an updated version of the Cochrane Review previously published in 2016. Epilepsy is a common neurological disorder, affecting 0.5% to 1% of the population. For nearly 30% of these people, their epilepsy is resistant to currently available drugs. Pharmacological treatment remains the first choice to control epilepsy. Lamotrigine is one of the newer antiepileptic drugs. Lamotrigine, in combination with other antiepileptic drugs (add-on), can reduce seizures, but with some adverse effects. OBJECTIVES To determine the effects of lamotrigine on (1) seizures, (2) adverse-effect profile, and (3) cognition and quality of life, compared to placebo, when used as an add-on treatment for people with drug-resistant focal epilepsy. SEARCH METHODS For the latest update of the review, we searched the following databases on 9 March 2020: Cochrane Register of Studies (CRS Web), MEDLINE (Ovid, 1946 to March 06, 2020). CRS Web includes randomized or quasi-randomized, controlled trials from PubMed, EMBASE, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP), the Cochrane Central Register of Controlled Trials (CENTRAL), and the Specialized Registers of Cochrane Review Groups including Epilepsy. No language restrictions were imposed. SELECTION CRITERIA Randomised placebo-controlled trials of people with drug-resistant focal epilepsy of any age, in which an adequate method of concealment of randomisation was used. The studies were double-, single- or unblinded, placebo-controlled. For cross-over studies, the first treatment period was treated as a parallel trial. Eligible participants were adults or children with drug-resistant focal epilepsy. DATA COLLECTION AND ANALYSIS For this update, two review authors independently assessed the trials for inclusion, and extracted data. Outcomes included 50% or greater reduction in seizure frequency, treatment withdrawal (any reason), adverse effects, effects on cognition and quality of life. Primary analyses were by intention-to-treat. Sensitivity best- and worse-case analyses were undertaken to account for missing outcome data. Pooled risk ratios (RRs) with 95% confidence intervals (95% Cls) were estimated for the primary outcomes of seizure frequency and treatment withdrawal. For adverse effects, we calculated pooled RRs and 99% Cls. MAIN RESULTS We did not identify any new studies for this update, therefore, the results and conclusions are unchanged. In previous updates of this review, the authors found five parallel add-on studies, eight cross-over studies in adults or children with drug-resistant focal epilepsy, and one parallel add-on study with a responder-enriched design in infants. In total, these 14 studies included 1806 eligible participants (38 infants, 199 children, 1569 adults). Baseline phases ranged from four to 12 weeks; treatment phases from eight to 36 weeks. Overall, 11 studies (1243 participants) were rated as having low risk of bias, and three (697 participants) had unclear risk of bias due to lack of reported information around study design. Effective blinding of studies was reported in four studies (563 participants). The overall risk ratio (RR) for 50% or greater reduction in seizure frequency was 1.80 (95% CI 1.45 to 2.23; 12 trials, 1322 participants (adults and children); moderate-certainty evidence) indicating that lamotrigine was significantly more effective than placebo in reducing seizure frequency. The overall RR for treatment withdrawal (for any reason) was 1.11 (95% CI 0.91 to 1.37; 14 trials; 1806 participants; moderate-certainty evidence). The adverse events significantly associated with lamotrigine were: ataxia, dizziness, diplopia (double vision), and nausea. The RR of these adverse effects were as follows: ataxia 3.34 (99% Cl 2.01 to 5.55; 12 trials; 1525 participants; high-certainty evidence); dizziness 2.00 (99% Cl 1.52 to 2.64;13 trials; 1768 participants; moderate-certainty evidence); diplopia 3.79 (99% Cl 2.15 to 6.68; 3 trials, 944 participants; high-certainty evidence); nausea 1.81 (99% Cl 1.22 to 2.68; 12 studies,1486 participants; moderate-certainty evidence). The limited data available precluded any conclusions about effects on cognition and quality of life. No important heterogeneity between studies was found for any of the outcomes. Overall, we assessed the evidence as high to moderate certainty, due to incomplete data for some outcomes. AUTHORS' CONCLUSIONS Lamotrigine as an add-on treatment for drug-resistant focal seizures appears to be effective in reducing seizure frequency, and seems to be fairly well-tolerated. However, the trials were of relatively short duration and provided no evidence for the long term. Further trials are needed to assess the long-term effects of lamotrigine, and to compare lamotrigine with other add-on drugs.
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Affiliation(s)
- Mariangela Panebianco
- Institute of Translational Medicine, University of LiverpoolDepartment of Molecular and Clinical PharmacologyClinical Sciences Centre for Research and Education, Lower LaneLiverpoolUKL9 7LJ
| | - Rebecca Bresnahan
- Institute of Translational Medicine, University of LiverpoolDepartment of Molecular and Clinical PharmacologyClinical Sciences Centre for Research and Education, Lower LaneLiverpoolUKL9 7LJ
| | - Sridharan Ramaratnam
- The Nerve CentreDepartment of Neurology5/1 Rajachar StreetT NagarChennaiTamil NaduIndia600017
| | - Anthony G Marson
- Institute of Translational Medicine, University of LiverpoolDepartment of Molecular and Clinical PharmacologyClinical Sciences Centre for Research and Education, Lower LaneLiverpoolUKL9 7LJ
- The Walton Centre NHS Foundation TrustLiverpoolUK
- Liverpool Health PartnersLiverpoolUK
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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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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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Zrenner B, Zrenner C, Gordon PC, Belardinelli P, McDermott EJ, Soekadar SR, Fallgatter AJ, Ziemann U, Müller-Dahlhaus F. Brain oscillation-synchronized stimulation of the left dorsolateral prefrontal cortex in depression using real-time EEG-triggered TMS. Brain Stimul 2019; 13:197-205. [PMID: 31631058 DOI: 10.1016/j.brs.2019.10.007] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 10/02/2019] [Accepted: 10/09/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) of the left dorsolateral prefrontal cortex (DLPFC) is an effective treatment for major depressive disorder (MDD), but response rates are low and effect sizes small. Synchronizing TMS pulses with instantaneous brain oscillations can reduce variability and increase efficacy of TMS-induced plasticity. OBJECTIVE To study whether brain oscillation-synchronized rTMS is feasible, safe and has neuromodulatory effects when targeting the DLPFC of patients with MDD. METHODS Using real-time EEG-triggered TMS we conducted a pseudo-randomized controlled single-session crossover trial of brain oscillation-synchronized rTMS of left DLPFC in 17 adult patients with antidepressant-resistant MDD. Stimulation conditions in separate sessions were: (1) rTMS triggered at the negative EEG peak of instantaneous alpha oscillations (alpha-synchronized rTMS), (2) a variation of intermittent theta-burst stimulation (modified iTBS), and (3) a random alpha phase control condition. RESULTS Triggering TMS at the negative peak of instantaneous alpha oscillations by real-time analysis of the electrode F5 EEG signal was successful in 15 subjects. Two subjects reported mild transient discomfort at the site of stimulation during stimulation; no serious adverse events were reported. Alpha-synchronized rTMS, but not modified iTBS or the random alpha phase control condition, reduced resting-state alpha activity in left DLPFC and increased TMS-induced beta oscillations over frontocentral channels. CONCLUSIONS Alpha-synchronized rTMS of left DLPFC is feasible, safe and has specific single-session neuromodulatory effects in patients with antidepressant-resistant MDD. Future studies need to further elucidate the mechanisms, optimize the parameters and investigate the therapeutic potential and efficacy of brain oscillation-synchronized rTMS in MDD.
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Affiliation(s)
- Brigitte Zrenner
- Department of Neurology and Stroke, And Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Germany
| | - Christoph Zrenner
- Department of Neurology and Stroke, And Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Germany
| | - Pedro Caldana Gordon
- Department of Neurology and Stroke, And Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Germany; Service of Interdisciplinary Neuromodulation, Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Psychiatry (INBioN), Department and Institute of Psychiatry, Hospital Das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Paolo Belardinelli
- Department of Neurology and Stroke, And Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Germany
| | - Eric J McDermott
- Department of Neurology and Stroke, And Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Germany
| | - Surjo R Soekadar
- Department of Psychiatry and Psychotherapy, Eberhard Karls University Tübingen, Germany; Clinical Neurotechnology Laboratory, Neuroscience Research Center (NWFZ) & Department of Psychiatry and Psychotherapy, Charité - University Medicine Berlin, Germany
| | - Andreas J Fallgatter
- Department of Psychiatry and Psychotherapy, Eberhard Karls University Tübingen, Germany
| | - Ulf Ziemann
- Department of Neurology and Stroke, And Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Germany.
| | - Florian Müller-Dahlhaus
- Department of Neurology and Stroke, And Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Germany; Department of Psychiatry and Psychotherapy, Johannes Gutenberg University Medical Center Mainz, Germany
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Chung SW, Thomson CJ, Lee S, Worsley RN, Rogasch NC, Kulkarni J, Thomson RH, Fitzgerald PB, Segrave RA. The influence of endogenous estrogen on high-frequency prefrontal transcranial magnetic stimulation. Brain Stimul 2019; 12:1271-1279. [DOI: 10.1016/j.brs.2019.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 04/03/2019] [Accepted: 05/06/2019] [Indexed: 01/06/2023] Open
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22
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Perceptual and Physiological Consequences of Dark Adaptation: A TMS-EEG Study. Brain Topogr 2019; 32:773-782. [DOI: 10.1007/s10548-019-00715-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 05/04/2019] [Indexed: 10/26/2022]
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23
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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: 55] [Impact Index Per Article: 9.2] [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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Hironaga N, Kimura T, Mitsudo T, Gunji A, Iwata M. Proposal for an accurate TMS-MRI co-registration process via 3D laser scanning. Neurosci Res 2018; 144:30-39. [PMID: 30170008 DOI: 10.1016/j.neures.2018.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/06/2018] [Accepted: 08/27/2018] [Indexed: 01/20/2023]
Abstract
An important technical issue in transcranial magnetic stimulation (TMS) usage is how accurately the specific brain areas activated by TMS are assessed. However, in practice, electric field induced in TMS is dispersed and therefore actual estimation is still difficult. As a preliminary step, the projection line which is perpendicular to the TMS stimulation coil beneath the center of the coil must be accurately estimated into the brain. Therefore, we have developed a new TMS-MRI co-registration procedure that employs a 3D laser-scanner system that is very useful for general hand-manipulated TMS, and which easily estimates the TMS projection point onto the brain. The proposed system accurately captures the positional relationship between the TMS coil and anatomical images. The results of 3D image processing revealed that the registration error at each stage was kept within the submillimeter level. In addition, a motor evoked potential experiment examining the right finger motor area revealed that understandable responses were obtained when stimulation was targeted to the three different motor areas according to Penfield's map. 3D laser scanning is a technique of substantial recent interest for anatomical co-registration. The proposed method demonstrated submillimeter level accuracy of TMS-MRI co-registration.
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Affiliation(s)
- Naruhito Hironaga
- Brain Center, Faculty of Medicine, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Takahiro Kimura
- Research Institute, Kochi University of Technology, Tosayamada, Kami, Kochi, 782-8502, Japan; Institute of Liberal Arts and Science, Kanazawa University, Kakuma-machi, Kanazawa, Ishikawa, 920-1192, Japan
| | - Takako Mitsudo
- Department of Clinical Neurophysiology, Faculty of Medicine, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Atsuko Gunji
- College of Education, Yokohama National University, 79-2 Tokiwadai, Hodogaya-ku, Yokohama 240-8501 Japan; National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8551, Japan
| | - Makoto Iwata
- Research Institute, Kochi University of Technology, Tosayamada, Kami, Kochi, 782-8502, Japan
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25
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Premoli I, Király J, Müller-Dahlhaus F, Zipser CM, Rossini P, Zrenner C, Ziemann U, Belardinelli P. Short-interval and long-interval intracortical inhibition of TMS-evoked EEG potentials. Brain Stimul 2018; 11:818-827. [DOI: 10.1016/j.brs.2018.03.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 03/02/2018] [Accepted: 03/13/2018] [Indexed: 12/29/2022] Open
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