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Gupta D, Du X, Summerfelt A, Hong LE, Choa FS. Brain Connectivity Signature Extractions from TMS Invoked EEGs. SENSORS (BASEL, SWITZERLAND) 2023; 23:4078. [PMID: 37112420 PMCID: PMC10146617 DOI: 10.3390/s23084078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 06/19/2023]
Abstract
(1) Background: The correlations between brain connectivity abnormality and psychiatric disorders have been continuously investigated and progressively recognized. Brain connectivity signatures are becoming exceedingly useful for identifying patients, monitoring mental health disorders, and treatment. By using electroencephalography (EEG)-based cortical source localization along with energy landscape analysis techniques, we can statistically analyze transcranial magnetic stimulation (TMS)-invoked EEG signals, for obtaining connectivity among different brain regions at a high spatiotemporal resolution. (2) Methods: In this study, we analyze EEG-based source localized alpha wave activity in response to TMS administered to three locations, namely, the left motor cortex (49 subjects), left prefrontal cortex (27 subjects), and the posterior cerebellum, or vermis (27 subjects) by using energy landscape analysis techniques to uncover connectivity signatures. We then perform two sample t-tests and use the (5 × 10-5) Bonferroni corrected p-valued cases for reporting six reliably stable signatures. (3) Results: Vermis stimulation invoked the highest number of connectivity signatures and the left motor cortex stimulation invoked a sensorimotor network state. In total, six out of 29 reliable, stable connectivity signatures are found and discussed. (4) Conclusions: We extend previous findings to localized cortical connectivity signatures for medical applications that serve as a baseline for future dense electrode studies.
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Affiliation(s)
- Deepa Gupta
- Computer Science and Electrical Engineering, University of Maryland Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21227, USA
| | - Xiaoming Du
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD 21201, USA
| | - Ann Summerfelt
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD 21201, USA
| | - L. Elliot Hong
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD 21201, USA
| | - Fow-Sen Choa
- Computer Science and Electrical Engineering, University of Maryland Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21227, USA
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2
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Ozturk H, Venugopal S. Transcranial Magnetic Stimulation as a Therapeutic Option for Neurologic Diseases and Psychiatric Disorders: A Systematic Review. Cureus 2022; 14:e28259. [PMID: 36158376 PMCID: PMC9491149 DOI: 10.7759/cureus.28259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 11/05/2022] Open
Abstract
In the last two decades, transcranial magnetic stimulation (TMS) has attracted considerable interest in the research field and clinical applications because of its capacity to induce adequate electric current non-invasively for depolarizing cortex networks and superficial axons. Notably, the interest in TMS has been due to its ability to be utilized in exploring brain functioning. Indeed, reports have pointed out that TMS may effectively be used as a diagnostic and therapeutic approach for many neuropsychiatric diseases. However, they have not been sufficiently conclusive on the topic, with evidence showing mixed results. Against this backdrop, this systematic review explores TMS as a therapy option for neurologic diseases and psychiatric disorders. It summarizes and illustrates the current therapeutic uses of TMS in adults and children for detecting and treating neuropsychiatric conditions and prospective future applications. Using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 guidelines, findings show that TMS is viable and has neuro-modulatory potential that can be employed successfully as a therapy alternative for neuropsychiatric disorders. Conversely, it is essential to more deeply understand the underlying mechanisms, alongside stimulation protocol optimization, of TMS for more practical applications.
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Somaa FA, de Graaf TA, Sack AT. Transcranial Magnetic Stimulation in the Treatment of Neurological Diseases. Front Neurol 2022; 13:793253. [PMID: 35669870 PMCID: PMC9163300 DOI: 10.3389/fneur.2022.793253] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/25/2022] [Indexed: 12/16/2022] Open
Abstract
Transcranial Magnetic Stimulation (TMS) has widespread use in research and clinical application. For psychiatric applications, such as depression or OCD, repetitive TMS protocols (rTMS) are an established and globally applied treatment option. While promising, rTMS is not yet as common in treating neurological diseases, except for neurorehabilitation after (motor) stroke and neuropathic pain treatment. This may soon change. New clinical studies testing the potential of rTMS in various other neurological conditions appear at a rapid pace. This can prove challenging for both practitioners and clinical researchers. Although most of these neurological applications have not yet received the same level of scientific/empirical scrutiny as motor stroke and neuropathic pain, the results are encouraging, opening new doors for TMS in neurology. We here review the latest clinical evidence for rTMS in pioneering neurological applications including movement disorders, Alzheimer's disease/mild cognitive impairment, epilepsy, multiple sclerosis, and disorders of consciousness.
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Affiliation(s)
- Fahad A. Somaa
- Department of Occupational Therapy, Faculty of Medical Rehabilitation, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Tom A. de Graaf
- Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
- Center of Integrative Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Alexander T. Sack
- Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
- Center of Integrative Neuroscience, Maastricht University, Maastricht, Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Brain + Nerve Centre, Maastricht University Medical Centre+, Maastricht, Netherlands
- *Correspondence: Alexander T. Sack
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Ma H, Lin J, He J, Lo DHT, Tsang HWH. Effectiveness of TES and rTMS for the Treatment of Insomnia: Meta-Analysis and Meta-Regression of Randomized Sham-Controlled Trials. Front Psychiatry 2021; 12:744475. [PMID: 34744835 PMCID: PMC8569107 DOI: 10.3389/fpsyt.2021.744475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/03/2021] [Indexed: 02/05/2023] Open
Abstract
Objectives: Transcranial electric stimulation (TES) and repetitive transcranial magnetic stimulation (rTMS) have experienced significant development in treating insomnia. This review aims to examine the effectiveness of randomized sham-controlled trials of TES and rTMS in improving insomnia and examine potential moderators associated with the effect of the treatment. Methods: Nine electronic databases were searched for studies comparing the effects of TES/rTMS with sham group on insomnia from the inception of these databases to June 25, 2021, namely, Medline, Embase, PsycINFO, CINAHL, Cochrane Library, Web of Science, PubMed, ProQuest Dissertation and Thesis, and CNKI. Meta-analyses were conducted to examine the effect of TES and rTMS in treating insomnia. Univariate meta-regression was performed to explore potential treatment moderators that may influence the pooled results. Risk of bias was assessed by using the Cochrane Risk of Bias Tool. Results: A total of 16 TES studies and 27 rTMS studies were included in this review. The pooled results indicated that there was no significant difference between the TES group and the sham group in improving objective measures of sleep. rTMS was superior to its sham group in improving sleep efficiency, total sleep time, sleep onset latency, wake up after sleep onset, and number of awakenings (all p < 0.05). Both TES and rTMS were superior to their sham counterparts in improving sleep quality as measured by the Pittsburgh Sleep Quality Index at post-intervention. The weighted mean difference for TES and rTMS were -1.17 (95% CI: -1.98, -0.36) and -4.08 (95% CI: -4.86, -3.30), respectively. Gender, total treatment sessions, number of pulses per session, and length of treatment per session were associated with rTMS efficacy. No significant relationship was observed between TES efficacy and the stimulation parameters. Conclusions: It seems that TES and rTMS have a chance to play a decisive role in the therapy of insomnia. Possible dose-dependent and gender difference effects of rTMS are suggested.
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Affiliation(s)
- Haixia Ma
- Department of Rehabilitation, The Hong Kong Polytechnic University, Kowloon, Hong Kong, SAR China
- Mental Health Research Centre, The Hong Kong Polytechnic University, Kowloon, Hong Kong, SAR China
| | - Jingxia Lin
- Department of Rehabilitation, The Hong Kong Polytechnic University, Kowloon, Hong Kong, SAR China
- Mental Health Research Centre, The Hong Kong Polytechnic University, Kowloon, Hong Kong, SAR China
| | - Jiali He
- Department of Rehabilitation, The Hong Kong Polytechnic University, Kowloon, Hong Kong, SAR China
| | - Dilys Hoi Ting Lo
- Department of Rehabilitation, The Hong Kong Polytechnic University, Kowloon, Hong Kong, SAR China
| | - Hector W. H. Tsang
- Department of Rehabilitation, The Hong Kong Polytechnic University, Kowloon, Hong Kong, SAR China
- Mental Health Research Centre, The Hong Kong Polytechnic University, Kowloon, Hong Kong, SAR China
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Colella M, Paffi A, De Santis V, Apollonio F, Liberti M. Effect of skin conductivity on the electric field induced by transcranial stimulation techniques in different head models. Phys Med Biol 2021; 66:035010. [PMID: 33496268 DOI: 10.1088/1361-6560/abcde7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This study aims at quantifying the effect that using different skin conductivity values has on the estimation of the electric (E)-field distribution induced by transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) in the brain of two anatomical models. The induced E-field was calculated with numerical simulations inside MIDA and Duke models, assigning to the skin a conductivity value estimated from a multi-layered skin model and three values taken from literature. The effect of skin conductivity variations on the local E-field induced by tDCS in the brain was up to 70%. In TMS, minor local differences, in the order of 20%, were obtained in regions of interest for the onset of possible side effects. Results suggested that an accurate model of the skin is necessary in all numerical studies that aim at precisely estimating the E-field induced during TMS and tDCS applications. This also highlights the importance of further experimental studies on human skin characterization, especially at low frequencies.
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Affiliation(s)
- Micol Colella
- Department of Information Engineering, Electronics and Telecommunications (DIET), University of Rome 'La Sapienza', Rome, Italy
| | - Alessandra Paffi
- Department of Information Engineering, Electronics and Telecommunications (DIET), University of Rome 'La Sapienza', Rome, Italy
| | - Valerio De Santis
- Department of Industrial and Information Engineering and Economics (DIIEE), University of L'Aquila, L'Aquila, Italy
| | - Francesca Apollonio
- Department of Information Engineering, Electronics and Telecommunications (DIET), University of Rome 'La Sapienza', Rome, Italy
| | - Micaela Liberti
- Department of Information Engineering, Electronics and Telecommunications (DIET), University of Rome 'La Sapienza', Rome, Italy
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Pourzitaki C, Dardalas I, Poutoglidou F, Kouvelas D, Kimiskidis VK. The Combination of rTMS and Pharmacotherapy on In Vitro Models: A Mini-Review. CNS & NEUROLOGICAL DISORDERS-DRUG TARGETS 2020; 19:220-226. [PMID: 32418533 DOI: 10.2174/1871527319666200518100716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 04/05/2020] [Accepted: 04/05/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Repetitive Transcranial Magnetic Stimulation (rTMS) is a non-invasive brain stimulation technique that is being actively explored as a potential therapeutic modality in various neuropsychiatric disorders, such as depression, neuropathic pain, epilepsy, multiple sclerosis, and neurodegenerative disorders, including the Parkinson's and Alzheimer's disease. The Food and Drug Administration (FDA) approved rTMS for the treatment of major depression, migraine-associated headaches, and Obsessive Compulsive Disorder (OCD). The fact that a significant proportion of patients suffering from these disorders fail to respond to current pharmacological interventions indicates the need for alternative therapies like rTMS. OBJECTIVE The objective was to find and summarize all studies combining the use of rTMS and pharmacological interference in vitro, in order to facilitate future studies. METHODS The results of studies combining the use of rTMS with pharmacological interference in vitro were focused on. The PubMed database was searched using the terms "rTMS", "repetitive", "transcranial", "magnetic", "stimulation", "in vitro", "in vivo", "cell cultures" untilMarch 2019 and 7 eligible studies were found. RESULTS Overall results show a synergistic effect of rTMS and pharmacotherapy in vitro with additive effectiveness, better prognosis, and superior potential management. CONCLUSION The limited amount of knowledge denotes the need for additional in vitro studies on the combination of rTMS and pharmacotherapy, which could be extended to in vivo studies and ultimately help design clinical trials so as to improve the therapeutic management of patients with a wide array of neuropsychiatric disorders.
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Affiliation(s)
- Chryssa Pourzitaki
- Department of Clinical Pharmacology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Ioannis Dardalas
- Department of Clinical Pharmacology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Frideriki Poutoglidou
- Department of Clinical Pharmacology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Dimitrios Kouvelas
- Department of Clinical Pharmacology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Vasilios K Kimiskidis
- Laboratory of Clinical Neurophysiology, AHEPA University Hospital, Aristotle University of Thessaloniki, 54006, Thessaloniki, Greece
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