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Marcolini F, Ravaglia A, Tempia Valenta S, Bosco G, Marconi G, De Ronchi D, Atti AR. Severe enduring anorexia nervosa (SE-AN) treatment options and their effectiveness: a review of literature. J Eat Disord 2024; 12:48. [PMID: 38654374 DOI: 10.1186/s40337-024-01006-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
INTRODUCTION For nearly 20% of patients diagnosed with Anorexia Nervosa (AN), the eating disorder (ED) is prolonged and becomes long-lasting. It has been reported that patients diagnosed with Severe Enduring Anorexia Nervosa (SE-AN) have worse ED symptoms, higher rates of lifetime hospitalization, and lower psychosocial well-being compared to patients with shorter disease duration. OBJECTIVES This review aims to describe the treatments proposed to date and their effectiveness on SE-AN-related outcomes. METHODS We conducted a PubMed search for studies addressing the issue of treatment approach to SE-AN adults, that were published between 2003 and 2023, peer-reviewed, written in the English language, and available in full-text. Next, we inductively created relevant macro-themes by synthesizing the data from the included articles. RESULTS Of 251 PubMed studies, 25 articles were considered for data extraction, all published between 2003 and 2022. We identified three macro-themes. The first macro-theme, "Psychotherapy", mostly takes into consideration treatment effectiveness of cognitive behavioral therapy (CBT). Various reports determined its greater effectiveness compared to Specialist Supportive Clinical Management (SSCM), and one study proved that outpatient CBT is a valid alternative to hospitalization. The second one involves "Pharmacological Treatments". Research on dronabinol, a synthetic orexigenic cannabinoid, antipsychotics (in particular, olanzapine and haloperidol), and ketamine showed some mixed results regarding the often-complementary areas of weight gain and improvement in ED-related symptoms. Regarding the third macro-theme, "Brain Stimulation Therapies," such as Repetitive Transcranial Magnetic Stimulation (rTMS) and Deep Brain Stimulation (DBS), we found promising results in improving ED-related psychological traits (such as mood and anxiety), affective regulation, and quality of life. However, we have observed divergent results regarding outcome measures such as BMI and weight gain. CONCLUSIONS SE-AN patients are predicted to encounter both medical complications and psychological distress of increasing severity that will inevitably affect their quality of life; to our knowledge, research evidence on treatment options for SE-AN remains limited, and the methodological quality of studies is generally low. These findings denote the need to focus future research efforts on effective treatment strategies specific to long-lasting EDs.
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Affiliation(s)
- Federica Marcolini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy.
| | - Alessandro Ravaglia
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy
| | - Silvia Tempia Valenta
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy
| | - Giovanna Bosco
- Department of Clinical Nutrition, AUSL Bologna, Bologna, Italy
| | - Giorgia Marconi
- U.O. Cure Primarie, AUSL Area Vasta Romagna, Ambito di Rimini, Rimini, Italy
| | - Diana De Ronchi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy
| | - Anna Rita Atti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy
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Han C, Tang J, Tang B, Han T, Pan J, Wang N. The effectiveness and safety of noninvasive brain stimulation technology combined with speech training on aphasia after stroke: A systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e36880. [PMID: 38215135 PMCID: PMC10783273 DOI: 10.1097/md.0000000000036880] [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: 11/07/2023] [Accepted: 12/15/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Although the effectiveness of noninvasive brain stimulation (NIBS) technology in assisting rehabilitation is widely recognized, its therapeutic efficacy in patients with poststroke aphasia (PSA) requires further validation. Here, we aimed to explore the efficacy and safety of the NIBS technique combined with speech training in PSA by traditional Meta-analysis and to compare the intervention effects of the 2 NIBS techniques by Network meta-analysis. METHODS Randomized controlled trials of the NIBS technique combined with speech training for treating PSA in 9 databases, including Web of Science, PubMed, and CNKI, and 2 clinical trial registries were searched by computer. Literature screening was performed using EndNote X9 software, and data analysis and presentation of results were performed using RevMan 5.4.1 and Stata 17.0 software. RESULTS Screening yielded 17 studies with 1013 patients with PSA. Meta-analysis showed that aphasia quotient scores were higher in the intervention group than in the control group [standardized mean difference (SMD) = 1.06, 95% confidence interval (CI) (0.63, 1.49), Z = 4.80, P < .00001]; Western aphasia battery scores on all 4 subscales were higher than those of the control group, the spontaneous language score is [SMD = 0.62, 95% CI (0.46, 0.78), Z = 7.52, P < .00001], the listening comprehension score is [SMD = 0.46, 95% CI (0.30, 0.62), Z = 5.62, P < .00001], the repetition score is [SMD = 1.14, 95% CI (0.59, 1.70), Z = 4.04, P < .0001], the naming score is [SMD = 1.06, 95% CI (0.79, 1.32), Z = 7.85, P < .00001]; The effective rate of the intervention group was higher than that of the control group [odd ratio = 4.19, 95% CI (2.39, 7.37), Z = 4.99, P < .00001]. The results of the Network meta-analysis showed that the best probability ranking of the 2 NIBS techniques combined with speech training in improving aphasia quotient scores was repetitive transcranial magnetic stimulation group (92.2%) > transcranial direct current stimulation group (55.7%). Regarding safety, it was not found that the NIBS technique combined with speech training to treat PSA increases the risk of adverse reactions. CONCLUSION The NIBS technique combined with speech training can effectively improve the recovery of language function in PSA patients with minimal adverse effects, and the clinic can give priority to r TMS combined with speech training in treating PSA.
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Affiliation(s)
- Congli Han
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Jiqin Tang
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- The First Clinical Medical College of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Bingshun Tang
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Tao Han
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Jienuo Pan
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Nan Wang
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
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Effects of repetitive transcranial magnetic stimulation combined with action-observation-execution on social interaction and communication in autism spectrum disorder: Feasibility study. Brain Res 2023; 1804:148258. [PMID: 36702183 DOI: 10.1016/j.brainres.2023.148258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 01/12/2023] [Accepted: 01/20/2023] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To investigate the feasibility of a combined high-frequency rTMS (HF-rTMS) with action observation and execution (AOE) on social interaction and communication in children with Autistic Spectrum Disorder (ASD). MATERIALS AND METHODS Fifteen children underwent 10 sessions of 5-Hz HF-rTMS on the right inferior frontal gyrus combined with AOE. An experimental group received the real HF-rTMS while the control group received the sham one. For the AOE protocol, they were instructed to watch and imitate a video showing the procedure, including reaching and grasping tasks, gustatory tasks, and facial expressions. Their behavioural outcomes were evaluated using the Vineland Adaptive Behaviour Scale (VABS) and electroencephalograms (EEGs) recorded at three time points: baseline, immediately after each treatment, and at the 1-week follow-up after the 10th treatment. RESULTS There were increased VABS subitem scores in the experimental group, including the receptive, expressive, domestic, and community scores but no such increase was observed in the control group. For the EEG, the beta rhythm at C3 and C4 increased in the experimental group. Additionally, positive correlations were observed between changes in the scores for the expressive subitem and changes in the beta rhythm on the C4 electrode at baseline and immediately after treatment in the experimental group. The control group showed no significant differences in any items for both observation and imitation times. CONCLUSION Ten sessions of HF-rTMS combined with AOE could improve both the subitems of communication and daily living skills domain in children aged 7-12 years with ASD. Although it is still inconclusive, this behavioural improvement may be partly attributable to increased cortical activity, as evidenced by beta rhythms.
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Neacsiu AD, Szymkiewicz V, Galla JT, Li B, Kulkarni Y, Spector CW. The neurobiology of misophonia and implications for novel, neuroscience-driven interventions. Front Neurosci 2022; 16:893903. [PMID: 35958984 PMCID: PMC9359080 DOI: 10.3389/fnins.2022.893903] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/28/2022] [Indexed: 11/25/2022] Open
Abstract
Decreased tolerance in response to specific every-day sounds (misophonia) is a serious, debilitating disorder that is gaining rapid recognition within the mental health community. Emerging research findings suggest that misophonia may have a unique neural signature. Specifically, when examining responses to misophonic trigger sounds, differences emerge at a physiological and neural level from potentially overlapping psychopathologies. While these findings are preliminary and in need of replication, they support the hypothesis that misophonia is a unique disorder. In this theoretical paper, we begin by reviewing the candidate networks that may be at play in this complex disorder (e.g., regulatory, sensory, and auditory). We then summarize current neuroimaging findings in misophonia and present areas of overlap and divergence from other mental health disorders that are hypothesized to co-occur with misophonia (e.g., obsessive compulsive disorder). Future studies needed to further our understanding of the neuroscience of misophonia will also be discussed. Next, we introduce the potential of neurostimulation as a tool to treat neural dysfunction in misophonia. We describe how neurostimulation research has led to novel interventions in psychiatric disorders, targeting regions that may also be relevant to misophonia. The paper is concluded by presenting several options for how neurostimulation interventions for misophonia could be crafted.
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Affiliation(s)
- Andrada D. Neacsiu
- Duke Center for Misophonia and Emotion Regulation, Duke Brain Stimulation Research Center, Department of Psychiatry and Behavioral Neuroscience, School of Medicine, Duke University, Durham, NC, United States
- *Correspondence: Andrada D. Neacsiu,
| | - Victoria Szymkiewicz
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Jeffrey T. Galla
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Brenden Li
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Yashaswini Kulkarni
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Cade W. Spector
- Department of Philosophy, Duke University, Durham, NC, United States
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5
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Barra A, Monti M, Thibaut A. Noninvasive Brain Stimulation Therapies to Promote Recovery of Consciousness: Where We Are and Where We Should Go. Semin Neurol 2022; 42:348-362. [PMID: 36100229 DOI: 10.1055/s-0042-1755562] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Therapeutic options for patients with disorders of consciousness (DoC) are still underexplored. Noninvasive brain stimulation (NIBS) techniques modulate neural activity of targeted brain areas and hold promise for the treatment of patients with DoC. In this review, we provide a summary of published research using NIBS as therapeutic intervention for DoC patients, with a focus on (but not limited to) randomized controlled trials (RCT). We aim to identify current challenges and knowledge gaps specific to NIBS research in DoC. Furthermore, we propose possible solutions and perspectives for this field. Thus far, the most studied technique remains transcranial electrical stimulation; however, its effect remains moderate. The identified key points that NIBS researchers should focus on in future studies are (1) the lack of large-scale RCTs; (2) the importance of identifying the endotypes of responders; and (3) the optimization of stimulation parameters to maximize the benefits of NIBS.
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Affiliation(s)
- Alice Barra
- Coma Science Group, GIGA Consciousness - GIGA Research, University of Liège, Liège, Belgium.,Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Martin Monti
- Department of Psychology, University of California Los Angeles, Los Angeles, California.,Department of Neurosurgery, UCLA Brain Injury Research Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Aurore Thibaut
- Coma Science Group, GIGA Consciousness - GIGA Research, University of Liège, Liège, Belgium.,Centre du Cerveau, University Hospital of Liège, Liège, Belgium
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6
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He J, Tang Y, Lin J, Faulkner G, Tsang HWH, Chan SHW. Non-invasive brain stimulation combined with psychosocial intervention for depression: a systematic review and meta-analysis. BMC Psychiatry 2022; 22:273. [PMID: 35439977 PMCID: PMC9016381 DOI: 10.1186/s12888-022-03843-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 03/07/2022] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES This review investigates the efficacy and safety of non-invasive brain stimulation (NIBS) combined with psychosocial intervention on depressive symptoms. MATERIALS AND METHODS We systematically searched five electronic databases from their inception to June 2021: PubMed, Embase, PsycINFO, Web of Science, and Medline. Randomized or non-randomized clinical trials in which NIBS plus psychosocial intervention was compared to control conditions in people with depressive symptoms were included. RESULTS A total of 17 eligible studies with 660 participants were included. The meta-analysis results showed that NIBS combined with psychosocial therapy had a positive effect on moderate to severe depression ([SMD = - 0.46, 95%CI (- 0.90, - 0.02), I2 = 73%, p < .01]), but did not significantly improve minimal to mild depression ([SMD = - 0.12, 95%CI (- 0.42, 0.18), I2 = 0%, p = .63]). Compared with NIBS alone, the combination treatment had a significantly greater effect in alleviating depressive symptoms ([SMD = - 0.84, 95%CI (- 1.25, - 0.42), I2 = 0%, p = .93]). However, our results suggested that the pooled effect size of ameliorating depression of NIBS plus psychosocial intervention had no significant difference compared with the combination of sham NIBS [SMD = - 0.12, 95%CI (- 0.31, 0.07), I2 = 0%, p = .60] and psychosocial intervention alone [SMD = - 0.97, 95%CI (- 2.32, 0.38), I2 = 72%, p = .01]. CONCLUSION NIBS when combined with psychosocial intervention has a significant positive effect in alleviating moderately to severely depressive symptoms. Further well-designed studies of NIBS combined with psychosocial intervention on depression should be carried out to consolidate the conclusions and explore the in-depth underlying mechanism.
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Affiliation(s)
- Jiali He
- grid.16890.360000 0004 1764 6123Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Yiling Tang
- grid.17091.3e0000 0001 2288 9830School of Kinesiology, University of British Columbia, Vancouver, British Columbia Canada
| | - Jingxia Lin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong. .,Mental Health Research Centre, The Hong Kong Polytechnic University, Hong Kong, SAR, China.
| | - Guy Faulkner
- grid.17091.3e0000 0001 2288 9830School of Kinesiology, University of British Columbia, Vancouver, British Columbia Canada
| | - Hector W. H. Tsang
- grid.16890.360000 0004 1764 6123Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong ,grid.16890.360000 0004 1764 6123Mental Health Research Centre, The Hong Kong Polytechnic University, Hong Kong, SAR China
| | - Sunny H. W. Chan
- grid.6518.a0000 0001 2034 5266School of Health and Social Wellbeing, University of the West of England, England, UK
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Poh EZ, Green C, Agostinelli L, Penrose-Menz M, Karl AK, Harvey AR, Rodger J. Manipulating the Level of Sensorimotor Stimulation during LI-rTMS Can Improve Visual Circuit Reorganisation in Adult Ephrin-A2A5 -/- Mice. Int J Mol Sci 2022; 23:ijms23052418. [PMID: 35269561 PMCID: PMC8910719 DOI: 10.3390/ijms23052418] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/16/2022] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation technique that has the potential to treat a variety of neurologic and psychiatric disorders. The extent of rTMS-induced neuroplasticity may be dependent on a subject's brain state at the time of stimulation. Chronic low intensity rTMS (LI-rTMS) has previously been shown to induce beneficial structural and functional reorganisation within the abnormal visual circuits of ephrin-A2A5-/- mice in ambient lighting. Here, we administered chronic LI-rTMS in adult ephrin-A2A5-/- mice either in a dark environment or concurrently with voluntary locomotion. One day after the last stimulation session, optokinetic responses were assessed and fluorescent tracers were injected to map corticotectal and geniculocortical projections. We found that LI-rTMS in either treatment condition refined the geniculocortical map. Corticotectal projections were improved in locomotion+LI-rTMS subjects, but not in dark + LI-rTMS and sham groups. Visuomotor behaviour was not improved in any condition. Our results suggest that the beneficial reorganisation of abnormal visual circuits by rTMS can be significantly influenced by simultaneous, ambient visual input and is enhanced by concomitant physical exercise. Furthermore, the observed pathway-specific effects suggest that regional molecular changes and/or the relative proximity of terminals to the induced electric fields influence the outcomes of LI-rTMS on abnormal circuitry.
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Affiliation(s)
- Eugenia Z. Poh
- School of Biological Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (E.Z.P.); (M.P.-M.); (A.-K.K.)
- School of Human Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (C.G.); (L.A.); (A.R.H.)
- Perron Institute for Neurological and Translational Research, 8 Verdun St, Nedlands, WA 6009, Australia
- Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, 1105 BA Amsterdam, The Netherlands
| | - Courtney Green
- School of Human Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (C.G.); (L.A.); (A.R.H.)
| | - Luca Agostinelli
- School of Human Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (C.G.); (L.A.); (A.R.H.)
| | - Marissa Penrose-Menz
- School of Biological Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (E.Z.P.); (M.P.-M.); (A.-K.K.)
| | - Ann-Kathrin Karl
- School of Biological Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (E.Z.P.); (M.P.-M.); (A.-K.K.)
- Department of Neurology, University Hospital of Würzburg, Josef-Schneider-Strasse 11, 97080 Würzburg, Germany
| | - Alan R. Harvey
- School of Human Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (C.G.); (L.A.); (A.R.H.)
- Perron Institute for Neurological and Translational Research, 8 Verdun St, Nedlands, WA 6009, Australia
| | - Jennifer Rodger
- School of Biological Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (E.Z.P.); (M.P.-M.); (A.-K.K.)
- Perron Institute for Neurological and Translational Research, 8 Verdun St, Nedlands, WA 6009, Australia
- Correspondence: ; Tel.: +61-8-6488-2245
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Dalton B, Austin A, Ching BCF, Potterton R, McClelland J, Bartholdy S, Kekic M, Campbell IC, Schmidt U. 'My dad was like "it's your brain, what are you doing?"': Participant experiences of repetitive transcranial magnetic stimulation treatment in severe enduring anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2022; 30:237-249. [PMID: 35150473 PMCID: PMC9304183 DOI: 10.1002/erv.2890] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/22/2021] [Accepted: 01/27/2022] [Indexed: 01/14/2023]
Abstract
Objective Repetitive transcranial magnetic stimulation (rTMS) is a promising emerging treatment for anorexia nervosa (AN). However, to date, patients' views and experiences of this treatment have not been fully explored. To assess these, we integrated a qualitative study into a feasibility randomised controlled trial of rTMS in individuals with severe enduring AN. Method Twenty‐nine (of 34) trial participants contributed to this study. Semi‐structured interviews were conducted 3‐months following the completion of rTMS treatment (4‐months post‐randomisation), prior to unblinding. Transcripts were analysed using content analysis. Results rTMS was deemed an acceptable but time‐consuming treatment. Many emphasised how their lives had changed to some extent during, but mainly after treatment by making them more positive, open‐minded, flexible and willing to try new things in relation to their AN and other aspects of their lives. Conclusions These qualitative data will be valuable in shaping participant information, recruitment and planning of future large‐scale trials of rTMS in AN. Trial Registration ISRCTN14329415, registered 23rd July 2015, https://www.isrctn.com/ISRCTN14329415 This study is the first to systematically explore participants' experiences of repetitive transcranial magnetic stimulation (rTMS) treatment for severe enduring anorexia nervosa (AN), as part of a randomised controlled feasibility trial. Participants expressed that rTMS was an acceptable but time‐consuming treatment. Many participants who received real rTMS described positive changes in relation to AN and quality of life. Findings from this qualitative study will help to shape future research of rTMS treatment for AN.
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Affiliation(s)
- Bethan Dalton
- Department of Psychological Medicine, Section of Eating Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Amelia Austin
- Department of Psychological Medicine, Section of Eating Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Brian C F Ching
- Department of Psychological Medicine, Section of Eating Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rachel Potterton
- Department of Psychological Medicine, Section of Eating Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jessica McClelland
- Department of Psychological Medicine, Section of Eating Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Savani Bartholdy
- Department of Psychological Medicine, Section of Eating Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Maria Kekic
- Department of Psychological Medicine, Section of Eating Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Iain C Campbell
- Department of Psychological Medicine, Section of Eating Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ulrike Schmidt
- Department of Psychological Medicine, Section of Eating Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
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Vergallito A, Gallucci A, Pisoni A, Punzi M, Caselli G, Ruggiero GM, Sassaroli S, Romero Lauro LJ. Effectiveness of noninvasive brain stimulation in the treatment of anxiety disorders: a meta-analysis of sham or behaviour-controlled studies. J Psychiatry Neurosci 2021; 46:E592-E614. [PMID: 34753789 PMCID: PMC8580831 DOI: 10.1503/jpn.210050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/23/2021] [Accepted: 07/02/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The possibility of using noninvasive brain stimulation to treat mental disorders has received considerable attention recently. Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are considered to be effective treatments for depressive symptoms. However, no treatment recommendation is currently available for anxiety disorders, suggesting that evidence is still limited. We conducted a systematic review of the literature and a quantitative analysis of the effectiveness of rTMS and tDCS in the treatment of anxiety disorders. METHODS Following PRISMA guidelines, we screened 3 electronic databases up to the end of February 2020 for English-language, peer-reviewed articles that included the following: a clinical sample of patients with an anxiety disorder, the use of a noninvasive brain stimulation technique, the inclusion of a control condition, and pre/post scores on a validated questionnaire that measured symptoms of anxiety. RESULTS Eleven papers met the inclusion criteria, comprising 154 participants assigned to a stimulation condition and 164 to a sham or control group. We calculated Hedge's g for scores on disorder-specific and general anxiety questionnaires before and after treatment to determine effect size, and we conducted 2 independent random-effects meta-analyses. Considering the well-known comorbidity between anxiety and depression, we ran a third meta-analysis analyzing outcomes for depression scores. Results showed a significant effect of noninvasive brain stimulation in reducing scores on disorder-specific and general anxiety questionnaires, as well as depressive symptoms, in the real stimulation compared to the control condition. LIMITATIONS Few studies met the inclusion criteria; more evidence is needed to strengthen conclusions about the effectiveness of noninvasive brain stimulation in the treatment of anxiety disorders. CONCLUSION Our findings showed that noninvasive brain stimulation reduced anxiety and depression scores compared to control conditions, suggesting that it can alleviate clinical symptoms in patients with anxiety disorders.
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Affiliation(s)
| | | | - Alberto Pisoni
- From the Department of Psychology, University of Milano Bicocca, Milan, Italy (Vergallito, Pisoni, Punzi, Romero Lauro); the Neuromi, Milan, Italy (Vergallito, Gallucci, Pisoni, Romero Lauro); the Department of Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy (Gallucci); the Studi Cognitivi, Milan, Italy (Caselli, Ruggiero, Sassaroli); and the Faculty of Psychology, Sigmund Freud University, Milan, Italy (Caseli, Ruggiero, Sassaroli)
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10
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Potvin-Desrochers A, Paquette C. Potential Non-invasive Brain Stimulation Targets to Alleviate Freezing of Gait in Parkinson's Disease. Neuroscience 2021; 468:366-376. [PMID: 34102265 DOI: 10.1016/j.neuroscience.2021.05.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/14/2021] [Accepted: 05/31/2021] [Indexed: 11/15/2022]
Abstract
Freezing of gait (FOG) is a common motor symptom in Parkinson's disease (PD). Although FOG reduces quality of life, affects mobility and increases the risk of falls, there are little to no effective treatments to alleviate FOG. Non-invasive brain stimulation (NIBS) has recently yielded attention as a potential treatment to reduce FOG symptoms however, stimulation parameters and protocols remain inconsistent and require further research. Specifically, targets for stimulation require careful review. Thus, with current neuroimaging and neuro-electrophysiological evidence, we consider potential cortical targets thought to be involved in the pathophysiology of FOG according to the Interference model, and within reach of NIBS. We note that the primary motor cortex, the supplementary motor area and the dorsolateral prefrontal cortex have already drawn attention as NIBS targets for FOG, but based on neuroimaging evidence the premotor cortex, the medial prefrontal cortex, the cerebellum, and more particularly, the posterior parietal cortex should be considered as potential regions for stimulation. We also discuss different methodological considerations, such as stimulation type, medication state, and hemisphere to target, and future perspectives for NIBS protocols in FOG.
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Affiliation(s)
- Alexandra Potvin-Desrochers
- Department of Kinesiology and Physical Education, Currie Gymnasium, 475 Pine Avenue West, McGill University, Montréal, Québec H2W 1S4, Canada; Integrated Program in Neuroscience, Montreal Neurological Institute, 3801 University Street, McGill University, Montréal, Québec H3A 2B4, Canada; Centre for Interdisciplinary Research in Rehabilitation (Jewish Rehabilitation Hospital Research Site and CISSS Laval), 3205 Place Alton-Goldbloom, Laval, Québec H7V 1R2, Canada
| | - Caroline Paquette
- Department of Kinesiology and Physical Education, Currie Gymnasium, 475 Pine Avenue West, McGill University, Montréal, Québec H2W 1S4, Canada; Integrated Program in Neuroscience, Montreal Neurological Institute, 3801 University Street, McGill University, Montréal, Québec H3A 2B4, Canada; Centre for Interdisciplinary Research in Rehabilitation (Jewish Rehabilitation Hospital Research Site and CISSS Laval), 3205 Place Alton-Goldbloom, Laval, Québec H7V 1R2, Canada.
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Clinicians' views on neuromodulation as a treatment for eating disorders: A qualitative study. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT ÖSTERREICHISCHER NERVENÄRZTE UND PSYCHIATER 2020; 35:84-91. [PMID: 33231833 DOI: 10.1007/s40211-020-00372-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/22/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Neuromodulation techniques, such as repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS) and deep brain stimulation (DBS), are emerging as promising treatment options in eating disorders (EDs). To date, the views of ED clinicians regarding these interventions have not been explored. METHODS Eighteen clinicians were recruited from a specialist ED Service in London, UK. Following a short educational presentation on rTMS, tDCS and DBS, they completed a semi-structured interview to explore their views on the use of these treatment options in EDs. RESULTS Clinician knowledge of neuromodulation techniques was low. They raised safety and ethical (particularly capacity to consent) concerns mainly with regard to DBS. Neuromodulation treatments were considered most appropriate as an adjunct to psychotherapy and for patients with severe, enduring illness (who had completed previous psychological treatments). CONCLUSIONS Improving clinicians' knowledge and understanding of neuromodulation is fundamental for bridging the gap between research and clinical work. This is especially so given the predominance of psychological theory and practice in the treatment of EDs.
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Transcranial magnetic stimulation in major depressive disorder: Response modulation and state dependency. J Affect Disord 2020; 266:793-801. [PMID: 32217261 DOI: 10.1016/j.jad.2020.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/13/2020] [Accepted: 02/01/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Transcranial Magnetic Stimulation (TMS) has emerged as a valid therapeutic option in the treatment of depression, especially in cases of inadequate response to antidepressant agents. Despite the recognized efficacy of this technique, its mechanisms of action are still debated and optimal protocols have not yet been established. METHODS The present review focuses on TMS protocols that either engage the targeted brain circuits or synchronize the stimulation frequency to individual neuronal oscillations to increase the antidepressant efficacy. RESULTS TMS efficacy was found to be enhanced by preliminary or concomitant modulation of the functional state of the targeted brain networks. Conversely, there is not enough evidence of higher efficacy of TMS protocols with individual selection of the stimulation frequency compared to standard ones. LIMITATIONS Most studies included small patient samples. CONCLUSIONS Our results suggest that a good option to enhance rTMS efficacy might be to follow synaptic potentiation and depression rules.
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Spagnolo PA, Montemitro C, Pettorruso M, Martinotti G, Di Giannantonio M. Better Together? Coupling Pharmacotherapies and Cognitive Interventions With Non-invasive Brain Stimulation for the Treatment of Addictive Disorders. Front Neurosci 2020; 13:1385. [PMID: 31998061 PMCID: PMC6967837 DOI: 10.3389/fnins.2019.01385] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 12/09/2019] [Indexed: 01/11/2023] Open
Affiliation(s)
- Primavera A Spagnolo
- Human Motor Control Section, Medical Neurology Branch, National Institute on Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Chiara Montemitro
- Department of Neuroscience, Imaging and Clinical Sciences, G. D'Annunzio University, Chieti, Italy.,Neuroimaging Research Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, United States
| | - Mauro Pettorruso
- Department of Neuroscience, Imaging and Clinical Sciences, G. D'Annunzio University, Chieti, Italy
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging and Clinical Sciences, G. D'Annunzio University, Chieti, Italy
| | - Massimo Di Giannantonio
- Department of Neuroscience, Imaging and Clinical Sciences, G. D'Annunzio University, Chieti, Italy
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Gao BY, Sun CC, Xia GH, Zhou ST, Zhang Y, Mao YR, Liu PL, Zheng Y, Zhao D, Li XT, Xu J, Xu DS, Bai YL. Paired associated magnetic stimulation promotes neural repair in the rat middle cerebral artery occlusion model of stroke. Neural Regen Res 2020; 15:2047-2056. [PMID: 32394960 PMCID: PMC7716041 DOI: 10.4103/1673-5374.282266] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Paired associative stimulation has been used in stroke patients as an innovative recovery treatment. However, the mechanisms underlying the therapeutic effectiveness of paired associative stimulation on neurological function remain unclear. In this study, rats were randomly divided into middle cerebral occlusion model (MCAO) and paired associated magnetic stimulation (PAMS) groups. The MCAO rat model was produced by middle cerebral artery embolization. The PAMS group received PAMS on days 3 to 20 post MCAO. The MCAO group received sham stimulation, three times every week. Within 18 days after ischemia, rats were subjected to behavioral experiments—the foot-fault test, the balance beam walking test, and the ladder walking test. Balance ability was improved on days 15 and 17, and the foot-fault rate was less in their affected limb on day 15 in the PAMS group compared with the MCAO group. Western blot assay showed that the expression levels of brain derived neurotrophic factor, glutamate receptor 2/3, postsynaptic density protein 95 and synapsin-1 were significantly increased in the PAMS group compared with the MCAO group in the ipsilateral sensorimotor cortex on day 21. Resting-state functional magnetic resonance imaging revealed that regional brain activities in the sensorimotor cortex were increased in the ipsilateral hemisphere, but decreased in the contralateral hemisphere on day 20. By finite element simulation, the electric field distribution showed a higher intensity, of approximately 0.4 A/m2, in the ischemic cortex compared with the contralateral cortex in the template. Together, our findings show that PAMS upregulates neuroplasticity-related proteins, increases regional brain activity, and promotes functional recovery in the affected sensorimotor cortex in the rat MCAO model. The experiments were approved by the Institutional Animal Care and Use Committee of Fudan University, China (approval No. 201802173S) on March 3, 2018.
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Affiliation(s)
- Bei-Yao Gao
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Cheng-Cheng Sun
- Rehabilitation Section, Department of Spine Surgery, Tongji Hospital, Medical School of Tongji University, Shanghai, China
| | - Guo-Hua Xia
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA, USA
| | - Shao-Ting Zhou
- Department of Neurology, Minhang Hospital Affiliated to Fudan University, Shanghai, China
| | - Ye Zhang
- Rehabilitation Section, Department of Spine Surgery, Tongji Hospital, Medical School of Tongji University, Shanghai, China
| | - Ye-Ran Mao
- Rehabilitation Section, Department of Spine Surgery, Tongji Hospital, Medical School of Tongji University, Shanghai, China
| | - Pei-Le Liu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Ya Zheng
- Rehabilitation Section, Department of Spine Surgery, Tongji Hospital, Medical School of Tongji University, Shanghai, China
| | - Dan Zhao
- Rehabilitation Section, Department of Spine Surgery, Tongji Hospital, Medical School of Tongji University, Shanghai, China
| | - Xu-Tong Li
- Department of Neurology, Minhang Hospital Affiliated to Fudan University, Shanghai, China
| | - Janie Xu
- Brownell Talbot School, Omaha, NE, USA
| | - Dong-Sheng Xu
- Rehabilitation Section, Department of Spine Surgery, Tongji Hospital, Medical School of Tongji University, Shanghai, China
| | - Yu-Long Bai
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
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Edwards DJ, Cortes M, Rykman-Peltz A, Chang J, Elder J, Thickbroom G, Mariman JJ, Gerber LM, Oromendia C, Krebs HI, Fregni F, Volpe BT, Pascual-Leone A. Clinical improvement with intensive robot-assisted arm training in chronic stroke is unchanged by supplementary tDCS. Restor Neurol Neurosci 2019; 37:167-180. [DOI: 10.3233/rnn-180869] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Dylan J. Edwards
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA
- Burke Neurological Institute, White Plains, NY, USA
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
- Edith Cowan University, School of Medical and Health Sciences, Joondalup, Australia
| | - Mar Cortes
- Burke Neurological Institute, White Plains, NY, USA
- Department of PM&R, Weill Cornell Medicine, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Avrielle Rykman-Peltz
- Burke Neurological Institute, White Plains, NY, USA
- Department of PM&R, Weill Cornell Medicine, New York, NY, USA
| | - Johanna Chang
- Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Jessica Elder
- Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, CT, USA
| | - Gary Thickbroom
- Burke Neurological Institute, White Plains, NY, USA
- Department of PM&R, Weill Cornell Medicine, New York, NY, USA
| | - Juan J. Mariman
- Metropolitan University of Educational Sciences, Santiago, Chile
- University of Chile, Neurosystems Laboratory, Santiago, Chile
| | - Linda M. Gerber
- Department of Healthcare Policy and Research, Weill Cornell Medicine, Division of Biostatistics and Epidemiology, New York, NY, USA
| | - Clara Oromendia
- Department of Healthcare Policy and Research, Weill Cornell Medicine, Division of Biostatistics and Epidemiology, New York, NY, USA
| | - Hermano I Krebs
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Boston, MA, USA
| | - Felipe Fregni
- Department of PM&R, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Bruce T. Volpe
- Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Alvaro Pascual-Leone
- Department of Neurology, Beth Israel Deaconess Medical Center, Berenson-Allen Center for Noninvasive Brain Stimulation, and Harvard Medical School, Boston, MA, USA
- Institut de Neurorehabilitacio Guttmann, Universitat Autonoma Barcelona, Barcelona, Spain
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16
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Neacsiu A, Luber BM, Davis S, Bernhardt E, Strauman TJ, Lisanby SH. On the Concurrent Use of Self-System Therapy and Functional Magnetic Resonance Imaging-Guided Transcranial Magnetic Stimulation as Treatment for Depression. J ECT 2018; 34:266-273. [PMID: 30308570 PMCID: PMC6242750 DOI: 10.1097/yct.0000000000000545] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Despite the growing use of repetitive transcranial magnetic stimulation (rTMS) as a treatment for unipolar depression, its typical effect sizes have been modest, and methodological and conceptual challenges remain regarding how to optimize its efficacy. Linking rTMS to a model of the neurocircuitry underlying depression and applying such a model to personalize the site of stimulation may improve the efficacy of rTMS. Recent developments in the psychology and neurobiology of self-regulation offer a conceptual framework for identifying mechanisms of action in rTMS for depression, as well as for developing guidelines for individualized rTMS treatment. We applied this framework to develop a multimodal treatment for depression by pairing self-system therapy (SST) with simultaneously administered rTMS delivered to an individually targeted region of dorsolateral prefrontal cortex identified via functional magnetic resonance imaging (fMRI). METHODS In this proof-of-concept study, we examined the acceptability, feasibility, and preliminary efficacy of combining individually fMRI-targeted rTMS with SST. Using the format of a cognitive paired associative stimulation paradigm, the treatment was administered to 5 adults with unipolar depression in an open-label trial. RESULTS The rTMS/SST combination was well tolerated, feasible, and acceptable. Preliminary evidence of efficacy also was promising. We hypothesized that both treatment modalities were targeting the same neural circuitry through cognitive paired associative stimulation, and observed changes in task-based fMRI were consistent with our model. These neural changes were directly related to improvements in depression severity. CONCLUSIONS The new combination treatment represents a promising exemplar for theory-based, individually targeted, multimodal intervention in mood disorders.
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Affiliation(s)
| | - Bruce M. Luber
- Department of Psychiatry and Behavioral Neuroscience
- National Institute of Mental Health, Bethesda, MD, USA
| | - Simon Davis
- Department of Neurology, Duke University, Durham, NC, USA
| | | | | | - Sarah H. Lisanby
- Department of Psychiatry and Behavioral Neuroscience
- National Institute of Mental Health, Bethesda, MD, USA
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17
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Harvey RL, Edwards D, Dunning K, Fregni F, Stein J, Laine J, Rogers LM, Vox F, Durand-Sanchez A, Bockbrader M, Goldstein LB, Francisco GE, Kinney CL, Liu CY, Ryan S, Morales-Quezada L, Worthen-Chaudhari L, Labar D, Schambra H, Kappy CR, Kissela B, Pratt W. Randomized Sham-Controlled Trial of Navigated Repetitive Transcranial Magnetic Stimulation for Motor Recovery in Stroke. Stroke 2018; 49:2138-2146. [PMID: 30354990 DOI: 10.1161/strokeaha.117.020607] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- We aimed to determine whether low-frequency electric field navigated repetitive transcranial magnetic stimulation to noninjured motor cortex versus sham repetitive transcranial magnetic stimulation avoiding motor cortex could improve arm motor function in hemiplegic stroke patients when combined with motor training. Methods- Twelve outpatient US rehabilitation centers enrolled participants between May 2014 and December 2015. We delivered 1 Hz active or sham repetitive transcranial magnetic stimulation to noninjured motor cortex before each of eighteen 60-minute therapy sessions over a 6-week period, with outcomes measured at 1 week and 1, 3, and 6 months after end of treatment. The primary end point was the percentage of participants improving ≥5 points on upper extremity Fugl-Meyer score 6 months after end of treatment. Secondary analyses assessed changes on the upper extremity Fugl-Meyer and Action Research Arm Test and Wolf Motor Function Test and safety. Results- Of 199 participants, 167 completed treatment and follow-up because of early discontinuation of data collection. Upper extremity Fugl-Meyer gains were significant for experimental ( P<0.001) and sham groups ( P<0.001). Sixty-seven percent of the experimental group (95% CI, 58%-75%) and 65% of sham group (95% CI, 52%-76%) improved ≥5 points on 6-month upper extremity Fugl-Meyer ( P=0.76). There was also no difference between experimental and sham groups in the Action Research Arm Test ( P=0.80) or the Wolf Motor Function Test ( P=0.55). A total of 26 serious adverse events occurred in 18 participants, with none related to the study or device, and with no difference between groups. Conclusions- Among patients 3 to 12 months poststroke, goal-oriented motor rehabilitation improved motor function 6 months after end of treatment. There was no difference between the active and sham repetitive transcranial magnetic stimulation trial arms. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT02089464.
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Affiliation(s)
- Richard L. Harvey
- The Shirley Ryan AbilityLab, Northwestern University Feinberg School of Medicine, Chiago, IL (R.L.H., L.M.R.)
| | - Dylan Edwards
- Burke Neurological Institute, Weill Cornell Neurology, White Plains, NY (D.E.)
| | - Kari Dunning
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, OH (K.D.)
| | - Felipe Fregni
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA (F.F.)
| | - Joel Stein
- Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, NY (J.S.)
| | - Jarmo Laine
- Nexstim Corporation, Helsinki, Finland (J.L.)
| | - Lynn M. Rogers
- The Shirley Ryan AbilityLab, Northwestern University Feinberg School of Medicine, Chiago, IL (R.L.H., L.M.R.)
| | - Ford Vox
- Shepherd Center, Clinical Research, Atlanta, GA (F.V.)
| | - Ana Durand-Sanchez
- Baylor College of Medicine, Physical Medicine and Rehabilitation, TIRR Memorial Herrmann, Houston, TX (A.D.-S.)
| | - Marcia Bockbrader
- Physical Medicine and Rehabilitation, Ohio State University, Columbus (M.B.)
| | - Larry B. Goldstein
- Kentucky Neuroscience Institute, University of Kentucky, Lexington (L.B.G.)
| | - Gerard E. Francisco
- Physical Medicine and Rehabilitation, University of Texas Health Science Center, TIRR Memorial Herrmann, Houston (G.E.F.)
| | - Carolyn L. Kinney
- Mayo Clinic Arizona, Mayo Clinic Hospital, Physical Medicine and Rehabilitation, Phoenix (C.L.K.)
| | - Charles Y. Liu
- USC Neurorestoration Center, Rancho Los Amigos National Rehabilitation Center, Los Angeles, CA (C.Y.L.)
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18
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Cocchi L, Zalesky A, Nott Z, Whybird G, Fitzgerald PB, Breakspear M. Transcranial magnetic stimulation in obsessive-compulsive disorder: A focus on network mechanisms and state dependence. NEUROIMAGE-CLINICAL 2018; 19:661-674. [PMID: 30023172 PMCID: PMC6047114 DOI: 10.1016/j.nicl.2018.05.029] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 02/07/2023]
Abstract
Background Transcranial magnetic stimulation (TMS) is a non-invasive brain stimulation technique that has shown promise as an adjunct treatment for the symptoms of Obsessive-Compulsive Disorder (OCD). Establishing a clear clinical role for TMS in the treatment of OCD is contingent upon evidence of significant efficacy and reliability in reducing symptoms. Objectives We present the basic principles supporting the effects of TMS on brain activity with a focus on network-based theories of brain function. We discuss the promises and pitfalls of this technique as a means of modulating brain activity and reducing OCD symptoms. Methods Synthesis of trends and critical perspective on the potential benefits and limitations of TMS interventions in OCD. Findings Our critical synthesis suggests the need to better quantify the role of TMS in a clinical setting. The context in which the stimulation is performed, the neural principles supporting the effects of local stimulation on brain networks, and the heterogeneity of neuroanatomy are often overlooked in the clinical application of TMS. The lack of consideration of these factors may partly explain the variable efficacy of TMS interventions for OCD symptoms. Conclusions Results from existing clinical studies and emerging knowledge about the effects of TMS on brain networks are encouraging but also highlight the need for further research into the use of TMS as a means of selectively normalising OCD brain network dynamics and reducing related symptoms. The combination of neuroimaging, computational modelling, and behavioural protocols known to engage brain networks affected by OCD has the potential to improve the precision and therapeutic efficacy of TMS interventions. The efficacy of this multimodal approach remains, however, to be established and its effective translation in clinical contexts presents technical and implementation challenges. Addressing these practical, scientific and technical issues is required to assess whether OCD can take its place alongside major depressive disorder as an indication for the use of TMS.
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Affiliation(s)
- Luca Cocchi
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.
| | - Andrew Zalesky
- Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, Australia; Department of Biomedical Engineering, University of Melbourne, Melbourne, Australia
| | - Zoie Nott
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | | | - Paul B Fitzgerald
- Epworh Clinic Epworth Healthcare, Camberwell, Victoria Australia and the MAPrc, Monash University Central Clinical School and The Alfred, Melbourne, Australia
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19
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Bikson M, Brunoni AR, Charvet LE, Clark VP, Cohen LG, Deng ZD, Dmochowski J, Edwards DJ, Frohlich F, Kappenman ES, Lim KO, Loo C, Mantovani A, McMullen DP, Parra LC, Pearson M, Richardson JD, Rumsey JM, Sehatpour P, Sommers D, Unal G, Wassermann EM, Woods AJ, Lisanby SH. Rigor and reproducibility in research with transcranial electrical stimulation: An NIMH-sponsored workshop. Brain Stimul 2018; 11:465-480. [PMID: 29398575 PMCID: PMC5997279 DOI: 10.1016/j.brs.2017.12.008] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 12/01/2017] [Accepted: 12/21/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Neuropsychiatric disorders are a leading source of disability and require novel treatments that target mechanisms of disease. As such disorders are thought to result from aberrant neuronal circuit activity, neuromodulation approaches are of increasing interest given their potential for manipulating circuits directly. Low intensity transcranial electrical stimulation (tES) with direct currents (transcranial direct current stimulation, tDCS) or alternating currents (transcranial alternating current stimulation, tACS) represent novel, safe, well-tolerated, and relatively inexpensive putative treatment modalities. OBJECTIVE This report seeks to promote the science, technology and effective clinical applications of these modalities, identify research challenges, and suggest approaches for addressing these needs in order to achieve rigorous, reproducible findings that can advance clinical treatment. METHODS The National Institute of Mental Health (NIMH) convened a workshop in September 2016 that brought together experts in basic and human neuroscience, electrical stimulation biophysics and devices, and clinical trial methods to examine the physiological mechanisms underlying tDCS/tACS, technologies and technical strategies for optimizing stimulation protocols, and the state of the science with respect to therapeutic applications and trial designs. RESULTS Advances in understanding mechanisms, methodological and technological improvements (e.g., electronics, computational models to facilitate proper dosing), and improved clinical trial designs are poised to advance rigorous, reproducible therapeutic applications of these techniques. A number of challenges were identified and meeting participants made recommendations made to address them. CONCLUSIONS These recommendations align with requirements in NIMH funding opportunity announcements to, among other needs, define dosimetry, demonstrate dose/response relationships, implement rigorous blinded trial designs, employ computational modeling, and demonstrate target engagement when testing stimulation-based interventions for the treatment of mental disorders.
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Affiliation(s)
- Marom Bikson
- Department of Biomedical Engineering, The City College of the City University of New York, United States
| | - Andre R Brunoni
- Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of Sao Paulo, Sao Paulo, Brazil
| | - Leigh E Charvet
- Department of Neurology, New York University School of Medicine, New York, NY, United States
| | - Vincent P Clark
- Department of Psychology, University of New Mexico, Albuquerque, NM, United States
| | - Leonardo G Cohen
- Human Cortical Physiology and Neurorehabilitation Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States
| | - Zhi-De Deng
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, United States
| | - Jacek Dmochowski
- Department of Biomedical Engineering, The City College of the City University of New York, United States
| | - Dylan J Edwards
- Non-invasive Brain Stimulation and Human Motor Control Laboratory, Burke Rehabilitation and Research, Burke-Cornell Medical Research Facility, White Plains, New York and School of Medicine and Health Sciences, Edith Cowan University, Perth, Australia
| | - Flavio Frohlich
- Department of Psychiatry, Cell Biology and Physiology, Biomedical Engineering, and Neurology, Carolina Center for Neurostimulation, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Emily S Kappenman
- Department of Psychology, San Diego State University, San Diego, CA, United States
| | - Kelvin O Lim
- Department of Psychiatry, University of Minnesota, Minneapolis Veterans Administration Health Care System, and Defense Veterans Brain Injury Center, Minneapolis, MN, United States
| | - Colleen Loo
- School of Psychiatry and Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Antonio Mantovani
- Department of Physiology, Pharmacology and Neuroscience, City College of the City University of New York, New York, NY, United States
| | - David P McMullen
- Division of Translational Research, National Institute of Mental Health, Bethesda, MD, United States
| | - Lucas C Parra
- Department of Biomedical Engineering, The City College of the City University of New York, United States
| | - Michele Pearson
- Division of Translational Research, National Institute of Mental Health, Bethesda, MD, United States
| | - Jessica D Richardson
- Department of Speech and Hearing Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Judith M Rumsey
- Division of Translational Research, National Institute of Mental Health, Bethesda, MD, United States.
| | - Pejman Sehatpour
- Department of Psychiatry, Columbia University, New York, NY, United States
| | - David Sommers
- Scientific Review Branch, National Institute of Mental Health, Bethesda, MD, United States
| | - Gozde Unal
- Department of Biomedical Engineering, The City College of the City University of New York, United States
| | - Eric M Wassermann
- Behavioral Neurology Unit, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States
| | - Adam J Woods
- Department of Clinical and Health Psychology, Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, United States
| | - Sarah H Lisanby
- Division of Translational Research, National Institute of Mental Health, Bethesda, MD, United States
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Simultaneous rTMS and psychotherapy in major depressive disorder: Clinical outcomes and predictors from a large naturalistic study. Brain Stimul 2018; 11:337-345. [DOI: 10.1016/j.brs.2017.11.004] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 11/05/2017] [Accepted: 11/08/2017] [Indexed: 12/28/2022] Open
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21
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Dalton B, Bartholdy S, Campbell IC, Schmidt U. Neurostimulation in Clinical and Sub-clinical Eating Disorders: A Systematic Update of the Literature. Curr Neuropharmacol 2018; 16:1174-1192. [PMID: 29308739 PMCID: PMC6187753 DOI: 10.2174/1570159x16666180108111532] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/17/2017] [Accepted: 01/04/2017] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Whilst psychological therapies are the main approach to treatment of eating disorders (EDs), advances in aetiological research suggest the need for the development of more targeted, brain-focused treatments. A range of neurostimulation approaches, most prominently repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS) and deep brain stimulation (DBS), are rapidly emerging as potential novel interventions. We have previously reviewed these techniques as potential treatments of EDs. AIM To provide an update of the literature examining the effects of DBS, rTMS and tDCS on eating behaviours, body weight and associated symptoms in people with EDs and relevant analogue populations. METHODS Using PRISMA guidelines, we reviewed articles in PubMed, Web of Science, and PsycINFO from 1st January 2013 until 14th August 2017, to update our earlier search. Studies assessing the effects of neurostimulation techniques on eating and weight-related outcomes in people with EDs and relevant analogue populations were included. Data from both searches were combined. RESULTS We included a total of 32 studies (526 participants); of these, 18 were newly identified by our update search. Whilst findings are somewhat mixed for bulimia nervosa, neurostimulation techniques have shown potential in the treatment of other EDs, in terms of reduction of ED and associated symptoms. Studies exploring cognitive, neural, and hormonal correlates of these techniques are also beginning to appear. CONCLUSIONS Neurostimulation approaches show promise as treatments for EDs. As yet, large wellconducted randomised controlled trials are lacking. More information is needed about treatment targets, stimulation parameters and mechanisms of action.
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Affiliation(s)
- Bethan Dalton
- Section of Eating Disorders, Department of Psychological Medicine, King`s College London, London, United Kingdom
| | - Savani Bartholdy
- Section of Eating Disorders, Department of Psychological Medicine, King`s College London, London, United Kingdom
| | - Iain C Campbell
- Section of Eating Disorders, Department of Psychological Medicine, King`s College London, London, United Kingdom
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, King`s College London, London, United Kingdom
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Abstract
PURPOSE OF REVIEW Psychological interventions are the treatment of choice for most eating disorders; however, significant proportions of patients do not recover with these. Advances in understanding of the neurobiology of eating disorders have led to the development of targeted treatments, such as deep brain stimulation (DBS), noninvasive brain stimulation (NIBS), and neurofeedback. We review the emerging clinical evidence for the use of these interventions in eating disorders and obesity, together with their theoretical rationale. Finally, we reflect on future developments. RECENT FINDINGS During the last 20 months, seven case studies/series and seven randomized controlled trials (RCTs) of NIBS or neurofeedback in different eating disorders, obesity, or food craving have appeared. These have largely had promising results. One NIBS trial, using a multisession protocol, was negative. A case series of subcallosal DBS in anorexia nervosa has also shown promise. A search of trial registries identified a further 21 neuromodulation/feedback studies in progress, indicating that neuromodulation/feedback is an area of growing interest. SUMMARY At present, neuromodulation and neurofeedback are largely experimental interventions; however, growing understanding of the mechanisms involved, together with the rising number of studies in this area, means that the clinical utility of these interventions is likely to become clearer soon.
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