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Jiang Y, Yuan C, Sun P, Li C, Wang L. Efficacy and safety of high-frequency repetitive transcranial magnetic stimulation (rTMS) for migraine: a meta-analysis of randomized controlled trials. Acta Neurol Belg 2024; 124:1167-1176. [PMID: 38748342 DOI: 10.1007/s13760-024-02570-5] [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: 03/17/2024] [Accepted: 05/06/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVE To assess the efficacy and safety of high-frequency repetitive transcranial magnetic stimulation in the prevention or treatment of migraine by conducting a pooled analysis of relevant randomized controlled trials. METHODS The PubMed, Embase, Cochrane, OVID, SCOPUS, Web of Science, and clinicaltrials.gov databases were systematically searched for randomized controlled trials (RCTs) comparing high-frequency rTMS and sham stimulation for the prevention or treatment of migraine. A meta-analysis of relevant outcome measures was performed using RevMan 5.3 software. RESULTS Eight RCTs with a total of 384 patients were included. A total of 23 patients dropped out, and thus, 361 patients were ultimately included for analysis. The high-frequency rTMS group had a lower frequency of attacks than the sham group (MD = - 5.10; 95% CI: - 8.10, - 2.09; P = 0.0009). The rTMS group has less intense headaches than the sham group (SMD = - 0.74; 95% CI - 1.04, - 0.44; P < 0.00001). High-frequency rTMS improved patient disability (SMD = - 0.45; 95% CI - 0.75, - 0.16; P = 0.003). High-frequency rTMS led to no advantage in reducing the number of abortive medications (MD = - 1.10; 95% CI - 3.28, 1.08; P = 0.32), but it increased the occurrence of adverse events (RR = 1.69; 95% CI 1.09, 2.64; P = 0.02). CONCLUSIONS High-frequency rTMS reduces the frequency of attacks and headache intensity in migraine patients and improves the patient's disability, but it also increases adverse events.
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Affiliation(s)
- Yumin Jiang
- Department of Internal Medicine-Neurology I, Qingdao Central Hospital, University of Health and Rehabilitation Sciences (Qingdao Central Medical Group), Qingdao, 266042, Shandong, China
| | - Chen Yuan
- Department of Health Management Center, Qingdao Central Hospital, University of Health and Rehabilitation Sciences (Qingdao Central Medical Group), Qingdao, 266042, Shandong, China
| | - Pengpeng Sun
- Department of Intensive Care Unit, Qingdao Central Hospital, University of Health and Rehabilitation Sciences (Qingdao Central Medical Group), Qingdao, 266042, Shandong, China
| | - Changjia Li
- Department of Colorectal and Anal Surgery, Qingdao Central Hospital, University of Health and Rehabilitation Sciences (Qingdao Central Medical Group), Qingdao, 266042, Shandong, China
| | - Ling Wang
- Department of Internal Medicine-Neurology I, Qingdao Central Hospital, University of Health and Rehabilitation Sciences (Qingdao Central Medical Group), Qingdao, 266042, Shandong, China.
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Chen J, Chen Z, Zhang Y, Fan X, Zhang C, Zhu J, Song C, Zhang S, Zhang D, Tang L, Li B, Yang W, Hu Q. Effective alleviation of depressive and anxious symptoms and sleep disorders in benzodiazepine-dependent patients through repetitive transcranial magnetic stimulation. Addict Biol 2024; 29:e13425. [PMID: 39051484 PMCID: PMC11270051 DOI: 10.1111/adb.13425] [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: 11/22/2023] [Revised: 03/15/2024] [Accepted: 06/13/2024] [Indexed: 07/27/2024]
Abstract
Benzodiazepine (BZD) dependence poses a significant challenge in mental health, prompting the exploration of treatments like repetitive transcranial magnetic stimulation (rTMS). This research aims to assess the impact of rTMS on alleviating symptoms of BZD dependence. A randomized control trial was employed to study 40 BZD-dependent inpatients. Their symptoms were quantified using the Hamilton Anxiety Rating Scale (HAMA), Montgomery-Åsberg Depression Rating Scale (MADRS) and Pittsburgh Sleep Quality Index (PSQI). Participants were divided into a conventional treatment group (daily diazepam with gradual tapering) with supportive psychotherapy and another group receiving the same treatment supplemented with rTMS (five weekly sessions for 2 weeks). Significant improvements were observed in both groups over baseline in MADRS, HAMA and PSQI scores at the 2nd, 4th, 8th and 12th week assessments (p < 0.05). The group receiving rTMS in addition to conventional treatment exhibited superior improvements in all measures at the 8th and 12th weeks. The addition of rTMS to conventional treatment methods for BZD dependence significantly betters the recovery in terms of depression, anxiety and sleep quality, highlighting the role of rTMS as an effective adjunct therapy.
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Affiliation(s)
- Jinbo Chen
- Department of PsychiatryZhenjiang Mental Health CenterZhenjiangChina
| | - Zixuan Chen
- Department of PsychiatryZhenjiang Mental Health CenterZhenjiangChina
| | - Yanli Zhang
- Department of PsychiatryZhenjiang Mental Health CenterZhenjiangChina
| | - Xiaohe Fan
- Department of PsychiatryHongqi Hospital Affiliated to Mudanjiang Medical UniversityMudanjiangChina
| | - Changchun Zhang
- Department of PsychiatryZhenjiang Mental Health CenterZhenjiangChina
| | - Jun Zhu
- Department of PsychiatryZhenjiang Mental Health CenterZhenjiangChina
| | - Chuanfu Song
- Department of PsychiatryThe Fourth People's Hospital of WuhuWuhuChina
| | | | - Danwei Zhang
- Department of PsychiatryZhenjiang Mental Health CenterZhenjiangChina
| | - Lijuan Tang
- Department of PsychiatryZhenjiang Mental Health CenterZhenjiangChina
| | - Benhan Li
- Department of PsychiatryZhenjiang Mental Health CenterZhenjiangChina
| | - Weibian Yang
- Department of PsychiatryHongqi Hospital Affiliated to Mudanjiang Medical UniversityMudanjiangChina
| | - Qiang Hu
- Department of PsychiatryZhenjiang Mental Health CenterZhenjiangChina
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Kujovic M, Benz D, Riesbeck M, Bahr C, Kriegs C, Reinermann D, Jänner M, Neufang S, Margittai Z, Kamp D, Plewnia C, Meisenzahl E. Theta burst stimulation add on to dialectical behavioral therapy in borderline-personality-disorder: methods and design of a randomized, single-blind, placebo-controlled pilot trial. Eur Arch Psychiatry Clin Neurosci 2024; 274:87-96. [PMID: 37710135 PMCID: PMC10787000 DOI: 10.1007/s00406-023-01692-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/26/2023] [Indexed: 09/16/2023]
Abstract
Specialized psychotherapeutic treatments like dialectical behavioral therapy (DBT) are recommended as first treatment for borderline personality disorder (BPD). In recent years, studies have emerged that focus on repetitive transcranial magnetic stimulation (rTMS) in BPD. Both have independently demonstrated efficacy in the treatment of BPD. Intermitted theta burst stimulation (iTBS), a modified design of rTMS, is thought to increase the excitability of neurons and could be a supplement to psychotherapy in addition to being a standalone treatment. However, no studies to date have investigated the combination of DBT and rTMS/iTBS. This study protocol describes the methods and design of a randomized, single-blinded, sham-controlled clinical pilot study in which BPD patients will be randomly assigned to either iTBS or sham during four consecutive weeks (20 sessions in total) in addition to standardized DBT treatment. The stimulation will focus on the unilateral stimulation of the left dorsolateral prefrontal cortex (DLPFC), which plays an important role in the control of impulsivity and risk-taking. Primary outcome is the difference in borderline symptomatology, while secondary target criteria are depressive symptoms, general functional level, impulsivity and self-compassion. Statistical analysis of therapy response will be conducted by Mixed Model Repeated Measurement using a 2 × 2-factorial between-subjects design with the between-subject factor stimulation (TMS vs. Sham) and the within-subject factor time (T0 vs. T1). Furthermore, structural magnetic resonance imaging (MRI) will be conducted and analyzed. The study will provide evidence and insight on whether iTBS has an enhancing effect as add-on to DBT in BPD.Trial registration: drks.de (DRKS00020413) registered 13/01/2020.
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Affiliation(s)
- Milenko Kujovic
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
| | - Daniel Benz
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Mathias Riesbeck
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Christian Bahr
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Christian Kriegs
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Dirk Reinermann
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Michaela Jänner
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Susanne Neufang
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Zsofia Margittai
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Daniel Kamp
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Christian Plewnia
- Department of Psychiatry and Psychotherapy, University Hospital of Psychiatry and Psychotherapy, Tübingen, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
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Liu Z, Yu S, Hu Y, Wang D, Wang S, Tang Z, Li W. Efficacy and safety of repeated transcranial magnetic stimulation combined with escitalopram in the treatment of major depressive disorder: a meta-analysis. Front Psychiatry 2024; 14:1275839. [PMID: 38234362 PMCID: PMC10791764 DOI: 10.3389/fpsyt.2023.1275839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/14/2023] [Indexed: 01/19/2024] Open
Abstract
Objective This study was designed to systematically review the efficacy and safety of repeated transcranial magnetic stimulation (rTMS) combined with escitalopram in treating major depressive disorder (MDD). Methods Databases including PubMed, Embase, Cochrane, Web of Science, CNKI, Wanfang, VIP Journal, and China Biomedical Literature databases were electronically searched for randomized controlled trials of rTMS combined with escitalopram intervention for MDD treatment from the inception of these databases to 27 May 2023. Two reviewers independently screened the studies, extracted the data, and assessed the quality of the included studies. R 4.2.2 was then used for a meta-analysis. Results In total, 19 articles involving 1,032 patients were included. The results of the meta-analysis showed that Hamilton Depression Rating Scale (HAMD) scores were significantly lower in the group receiving rTMS combined with escitalopram (experimental group) than that in the control group [weighted mean difference (WMD) = -5.30, 95% confidence interval (95% CI): -6.44 to -4.17, p < 0.01]. The response rate of the experimental group was significantly higher than that of the control group [odds ratio (OR): 5.48; 95% CI: 3.72 to 8.07; p < 0.01]. No significant difference in the adverse reaction rate was observed between the two groups (OR: 1.04, 95% CI: 0.71 to 1.52, p = 0.82). Conclusion Our findings suggest that rTMS combined with escitalopram can benefit patients with MDD in a safe manner, which may help in guiding clinical practice. Systematic review registration DOI number: 10.37766/inplasy2023.11.0114, INPLASY2023110114.
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Affiliation(s)
| | | | | | | | | | - Zhaohui Tang
- Basic Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Weihong Li
- Basic Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Luo G, Wang S, Yao S, Quan D, Guo G, Gao J, Zheng H. Direct changes of neurometabolic concentrations in the pregenual anterior cingulate cortex among obsessive-compulsive patients after repetitive transcranial magnetic stimulation treatment. J Affect Disord 2023; 333:79-85. [PMID: 37080494 DOI: 10.1016/j.jad.2023.04.052] [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: 01/13/2023] [Revised: 04/01/2023] [Accepted: 04/14/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND AND AIM Although Repetitive Transcranial Magnetic Stimulation (rTMS) is a promising new noninvasive brain stimulation therapy, its underlying mechanisms of action remain unknown. OCD patients exhibit impaired response control and attention shifting, which is linked to some brain areas such as anterior cingulate cortex and basal ganglia. OCD patients also display altered neurometabolic concentrations in cortical cortical-striatal-thalamic-cortical (CSTC). In this study, we aimed to elucidate efficacy of rTMS treatment in alleviating related symptoms and pregenual anterior cingulate cortex (pACC) neurometabolites. METHODS OCD patients were randomly divided into either drug (n = 23) or drug + rTMS (n = 29) groups, and those in the latter group subjected to 4-week rTMS treatment. All participants were visited twice, at baseline and follow-up after four weeks. During both visits, all patients were subjected to 1H-MRS, then Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Global Assessment Function (GAF) used to assess severity of obsessive-compulsive symptoms. We also evaluated synchronous anxiety and depression by Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Hamilton Anxiety Scale (HAM-A) and Hamilton Depression Scale (HAM-D). RESULTS After 4 weeks of treatment, patients in the Drug + rTMS group displayed significantly lower Y-BOCS (p = 0.038), BDI (p = 0.009), HAM-D (p = 0.013), HAM-A (p = 0.012) scores than their counterparts in the Drug group. Conversely, patients in the Drug + rTMS group had significantly higher tNAA concentrations (p = 0.030) than those in the Drug group. Notably, the Drug + rTMS group exhibited higher, but insignificant Glu (p = 0.055) and Glx (p = 0.068) concentrations compared to the Drug group. Partial correlation analysis revealed a significant negative correlation between post HAM-A scores and 4-week change of pACC glutamate levels in the Drug + rTMS group (r = -0.434, p = 0.02). CONCLUSION rTMS treatment is an efficacious treatment therapy for OCD, mainly by inducing changes in neurometabolites.
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Affiliation(s)
- Guowei Luo
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; Shantou University Medical College, Shantou, China
| | - Shibin Wang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Siyu Yao
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Dongming Quan
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Guangquan Guo
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Junling Gao
- Department of Medicine, University of Hong Kong, Hong Kong, China
| | - Huirong Zheng
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China; South China University of Technology School of Medicine, Guangzhou, China; Shantou University Medical College, Shantou, China.
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6
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Murgaš M, Unterholzner J, Stöhrmann P, Philippe C, Godbersen GM, Nics L, Reed MB, Vraka C, Vanicek T, Wadsak W, Kranz GS, Hahn A, Mitterhauser M, Hacker M, Kasper S, Lanzenberger R, Baldinger-Melich P. Effects of bilateral sequential theta-burst stimulation on 5-HT 1A receptors in the dorsolateral prefrontal cortex in treatment-resistant depression: a proof-of-concept trial. Transl Psychiatry 2023; 13:33. [PMID: 36725835 PMCID: PMC9892572 DOI: 10.1038/s41398-023-02319-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 01/09/2023] [Accepted: 01/12/2023] [Indexed: 02/03/2023] Open
Abstract
Theta-burst stimulation (TBS) represents a brain stimulation technique effective for treatment-resistant depression (TRD) as underlined by meta-analyses. While the methodology undergoes constant refinement, bilateral stimulation of the dorsolateral prefrontal cortex (DLPFC) appears promising to restore left DLPFC hypoactivity and right hyperactivity found in depression. The post-synaptic inhibitory serotonin-1A (5-HT1A) receptor, also occurring in the DLPFC, might be involved in this mechanism of action. To test this hypothesis, we performed PET-imaging using the tracer [carbonyl-11C]WAY-100635 including arterial blood sampling before and after a three-week treatment with TBS in 11 TRD patients compared to sham stimulation (n = 8 and n = 3, respectively). Treatment groups were randomly assigned, and TBS protocol consisted of excitatory intermittent TBS to the left and inhibitory continuous TBS to the right DLPFC. A linear mixed model including group, hemisphere, time, and Hamilton Rating Scale for Depression (HAMD) score revealed a 3-way interaction effect of group, time, and HAMD on specific distribution volume (VS) of 5-HT1A receptor. While post-hoc comparisons showed no significant changes of 5-HT1A receptor VS in either group, higher 5-HT1A receptor VS after treatment correlated with greater difference in HAMD (r = -0.62). The results of this proof-of-concept trial hint towards potential effects of TBS on the distribution of the 5-HT1A receptor. Due to the small sample size, all results must, however, be regarded with caution.
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Affiliation(s)
- Matej Murgaš
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Jakob Unterholzner
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Peter Stöhrmann
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Cécile Philippe
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Godber M Godbersen
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Lukas Nics
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Murray B Reed
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Chrysoula Vraka
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Thomas Vanicek
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Wadsak
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Georg S Kranz
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Andreas Hahn
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Markus Mitterhauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute Applied Diagnostics, Vienna, Austria
- Department of Chemistry, Institute of Inorganic Chemistry, University of Vienna, Vienna, Austria
| | - Marcus Hacker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria.
| | - Rupert Lanzenberger
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria.
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria.
| | - Pia Baldinger-Melich
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
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Hadden LM, Penny H, Jones AL, Partridge AM, Lancaster TM, Allen C. Pre-frontal stimulation does not reliably increase reward responsiveness. Cortex 2023; 159:268-285. [PMID: 36669446 PMCID: PMC10823575 DOI: 10.1016/j.cortex.2022.11.011] [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: 07/04/2022] [Revised: 10/17/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022]
Abstract
Depression is the leading cause of disability worldwide and its effects can be fatal, with over 800,000 people dying by suicide each year. Neuromodulatory treatments such as transcranial magnetic stimulation (TMS) are being used to treat depression. Despite its endorsement by two regulatory bodies: NICE (2016) and the FDA (2008), there are major questions about the treatment efficacy and biological mechanisms of TMS. Ahn et al.'s (2013) justified the use of TMS in a clinical context in an important study indicating that excitatory TMS increases reward responsiveness. A pseudo-replication of this study by Duprat et al., (2016) also found a similar effect of active TMS, but only with the addition of an exploratory covariate to the analyses-trait reward responsiveness. Here we replicate Ahn et al.'s (2013) key study, and to test the reliability of the effects, and their dependency on trait reward responsiveness as described by Duprat et al., (2016). Using excitatory and sham TMS, we tested volunteers using the probabilistic learning task to measure their reward responsiveness both before and after stimulation. We also examined affect (positive, negative) following stimulation. Irrespective of TMS, the task was shown to be sensitive to reward responsiveness. However, we did not show TMS to be effective in increasing reward responsiveness and we did not replicate Ahn et al., (2013) or Duprat et al., (2016)'s key findings for TMS efficacy, where we provide evidence favouring the null. Moreover, exploratory analyses suggested following active stimulation, positive affect was reduced. Given our findings, we question the basic effects, which support the use of TMS for depression, particularly considering potential deleterious effects of reduced positive affect in patients with depression.
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Affiliation(s)
- L M Hadden
- Cardiff University, School of Psychology, Tower Building, Park Place, Cardiff, CF10 3AT, UK
| | - H Penny
- Cardiff University, School of Psychology, Tower Building, Park Place, Cardiff, CF10 3AT, UK; Aneurin Bevan University Health Board, St Cadoc's Hospital, Lodge Road, Caerleon, NP18 3XQ, UK
| | - A L Jones
- School of Psychology, Faculty of Medicine, Health, and Life Sciences, Singleton Park, Swansea University, SA2 8PP, UK
| | - A M Partridge
- University of Sheffield, Research Services, New Spring House, 231 Glossop Road, Sheffield, S10 2GW, UK
| | - T M Lancaster
- Cardiff University, School of Psychology, Tower Building, Park Place, Cardiff, CF10 3AT, UK; University of Bath, Department of Psychology, Claverton Down, BA2 7AY, UK
| | - C Allen
- Cardiff University, School of Psychology, Tower Building, Park Place, Cardiff, CF10 3AT, UK; Department of Psychology, Durham University, Durham, DH1 3LE, UK.
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8
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Du XD, Li Z, Yuan N, Yin M, Zhao XL, Lv XL, Zou SY, Zhang J, Zhang GY, Li CW, Pan H, Yang L, Wu SQ, Yue Y, Wu YX, Zhang XY. Delayed improvements in visual memory task performance among chronic schizophrenia patients after high-frequency repetitive transcranial magnetic stimulation. World J Psychiatry 2022; 12:1169-1182. [PMID: 36186505 PMCID: PMC9521529 DOI: 10.5498/wjp.v12.i9.1169] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/24/2022] [Accepted: 07/22/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cognitive impairments are core characteristics of schizophrenia, but are largely resistant to current treatments. Several recent studies have shown that high-frequency repetitive transcranial magnetic stimulation (rTMS) of the left dor-solateral prefrontal cortex (DLPFC) can reduce negative symptoms and improve certain cognitive deficits in schizophrenia patients. However, results are inconsistent across studies. AIM To examine if high-frequency rTMS of the DLPFC can improve visual memory deficits in patients with schizophrenia. METHODS Forty-seven chronic schizophrenia patients with severe negative symptoms on stable treatment regimens were randomly assigned to receive active rTMS to the DLPFC (n = 25) or sham stimulation (n = 22) on weekdays for four consecutive weeks. Patients performed the pattern recognition memory (PRM) task from the Cambridge Neuropsychological Test Automated Battery at baseline, at the end of rTMS treatment (week 4), and 4 wk after rTMS treatment (week 8). Clinical symptoms were also measured at these same time points using the Scale for the Assessment of Negative Symptoms (SANS) and the Positive and Negative Syndrome Scale (PANSS). RESULTS There were no significant differences in PRM performance metrics, SANS total score, SANS subscores, PANSS total score, and PANSS subscores between active and sham rTMS groups at the end of the 4-wk treatment period, but PRM performance metrics (percent correct and number correct) and changes in these metrics from baseline were significantly greater in the active rTMS group at week 8 compared to the sham group (all P < 0.05). Active rTMS treatment also significantly reduced SANS score at week 8 compared to sham treatment. Moreover, the improvement in visual memory was correlated with the reduction in negative symptoms at week 8. In contrast, there were no between-group differences in PANSS total score and subscale scores at either week 4 or week 8 (all P > 0.05). CONCLUSION High-frequency transcranial magnetic stimulation improves visual memory and reduces negative symptoms in schizophrenia, but these effects are delayed, potentially due to the requirement for extensive neuroplastic changes within DLPFC networks.
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Affiliation(s)
- Xiang-Dong Du
- Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou 215008, Jiangsu Province, China
| | - Zhe Li
- Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou 215008, Jiangsu Province, China
| | - Nian Yuan
- Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou 215008, Jiangsu Province, China
| | - Ming Yin
- Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou 215008, Jiangsu Province, China
| | - Xue-Li Zhao
- Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou 215008, Jiangsu Province, China
| | - Xiao-Li Lv
- Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou 215008, Jiangsu Province, China
| | - Si-Yun Zou
- Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou 215008, Jiangsu Province, China
| | - Jun Zhang
- Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou 215008, Jiangsu Province, China
| | - Guang-Ya Zhang
- Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou 215008, Jiangsu Province, China
| | - Chuan-Wei Li
- Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou 215008, Jiangsu Province, China
| | - Hui Pan
- Department of Psychiatry, Third People’s Hospital of Changshu, Changshu 215501, Jiangsu Province, China
| | - Li Yang
- Department of Psychiatry, Third People’s Hospital of Changshu, Changshu 215501, Jiangsu Province, China
| | - Si-Qi Wu
- School of Psychology and Mental Health, North China University of Science and Technology, Langfang 065201, Hebei Province, China
| | - Yan Yue
- Department of Psychiatry, Medical College of Soochow University, Suzhou 215000, Jiangsu Province, China
| | - Yu-Xuan Wu
- Department of Psychiatry, Medical College of Soochow University, Suzhou 215000, Jiangsu Province, China
| | - Xiang-Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China
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Stillianesis G, Cavaleri R, Tang CY, Summers SJ. Exploring Patient Perceptions of Noninvasive Brain Stimulation: A Systematic Review. Neuromodulation 2022; 25:487-493. [PMID: 35667767 DOI: 10.1111/ner.13461] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/15/2021] [Accepted: 04/26/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To synthesize and critically appraise literature exploring patient perceptions regarding the therapeutic use of noninvasive brain stimulation. MATERIAL AND METHODS A systematic search of CINHAL, PUBMED, Web of Science, and Medline was performed. Reference lists of relevant articles were also screened. Studies exploring participant perceptions regarding the therapeutic use of noninvasive brain stimulation were eligible for inclusion. Perceptions were divided into three domains: knowledge, experience, and attitudes. Noninvasive brain stimulation was defined as any neuromodulation technique that alters brain activity but does not require invasive methods such as surgery. No restrictions were placed upon study design or participant population. Two reviewers performed data extraction and risk of bias assessment. Data relating to methodological characteristics, participant demographics, type of noninvasive brain stimulation, and nature of perceptions (knowledge, experience, or attitudes) were extracted. RESULTS Four studies comprising data from 163 participants met the inclusion criteria. All studies investigated perceptions of repetitive transcranial magnetic stimulation (rTMS) in psychiatric populations. Most participants perceived rTMS to be safe and beneficial, demonstrated low levels of fear, and were willing to recommend the intervention to others. No studies were found investigating patient perception of transcranial direct current stimulation (tDCS). CONCLUSION The findings from this review suggest that rTMS is well accepted as a therapeutic treatment among psychiatric populations, providing support for its clinical utility. Future work is needed to determine if similar findings exist for other conditions (eg, chronic pain) and for other therapeutic forms of brain stimulation (eg, tDCS).
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Affiliation(s)
- Georgia Stillianesis
- School of Health Sciences, Western Sydney University, Sydney, NSW, Australia; Brain Stimulation and Rehabilitation (BrainStAR) Lab, Western Sydney University, Sydney, NSW, Australia
| | - Rocco Cavaleri
- School of Health Sciences, Western Sydney University, Sydney, NSW, Australia; Brain Stimulation and Rehabilitation (BrainStAR) Lab, Western Sydney University, Sydney, NSW, Australia
| | - Clarice Y Tang
- School of Health Sciences, Western Sydney University, Sydney, NSW, Australia; College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
| | - Simon J Summers
- Brain Stimulation and Rehabilitation (BrainStAR) Lab, Western Sydney University, Sydney, NSW, Australia; Research School of Biology, Australian National University, Canberra, ACT, Australia; Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, Canberra, ACT, Australia.
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Huang M, Luo X, Zhang C, Xie YJ, Wang L, Wan T, Chen R, Xu F, Wang JX. Effects of repeated transcranial magnetic stimulation in the dorsolateral prefrontal cortex versus motor cortex in patients with neuropathic pain after spinal cord injury: a study protocol. BMJ Open 2022; 12:e053476. [PMID: 35277402 PMCID: PMC8919439 DOI: 10.1136/bmjopen-2021-053476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Neuropathic pain is one of the common complications of spinal cord injuries (SCI), which will slow down the recovery process and result in lower quality of life. Previous studies have shown that repeated transcranial magnetic stimulation (rTMS) of the motor cortex (M1) can reduce the average pain and the most severe pain of neuropathic pain after SCI. The dorsolateral prefrontal cortex (DLPFC) area is a common target of rTMS. Recently, a few studies found that rTMS of DLPFC may relieve the neuropathic pain of SCI. Compared with the M1 area, the efficacy of rTMS treatment in the DLPFC area in improving neuropathic pain and pain-related symptoms in patients with SCI is still unclear. Therefore, our study aims to evaluate the non-inferiority of rTMS in the DLPFC vs M1 in patients with neuropathic pain after SCI, in order to provide more options for rTMS in treating neuropathic pain after SCI. METHODS AND ANALYSIS We will recruit 50 subjects with neuropathic pain after SCI. They will be randomly assigned to the DLPFC- rTMS and M1-rTMS groups and be treated with rTMS for 4 weeks. Except for the different stimulation sites, the rTMS treatment programmes of the two groups are the same: 10 Hz, 1250 pulses, 115% intensity threshold, once a day, five times a week for 4 weeks. VAS, simplified McGill Pain Questionnaire, Spinal Cord Injury Pain Date Set, Pittsburgh Sleep Quality Index and Hamilton Anxiety Scale will be evaluated at baseline, second week of treatment, fourth week of treatment and 4 weeks after the end of treatment. And VAS change will be calculated. ETHICS AND DISSEMINATION The Ethics Committee of the Affiliated Hospital of Southwest Medical University has approved this trial, which is numbered KY2020041. Written informed consent will be provided to all participants after verification of the eligibility criteria. The results of the study will be published in peer-reviewed publications. TRIAL REGISTRATION NUMBER ChiCTR2000032362.
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Affiliation(s)
- Maomao Huang
- Department of Rehabilitation, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Laboratory of Neurological Disease and Brain Function, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Xi Luo
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Chi Zhang
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Yu-Jie Xie
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Li Wang
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Tenggang Wan
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Ruyan Chen
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Fangyuan Xu
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Jian-Xiong Wang
- Department of Rehabilitation, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Laboratory of Neurological Disease and Brain Function, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
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11
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Vrba D, Malena L, Albrecht J, Fricova J, Anders M, Rokyta R, Rodrigues D, Vrba J. Numerical analysis of transcranial magnetic stimulation application in patients with orofacial pain. IEEE Trans Neural Syst Rehabil Eng 2022; 30:590-599. [PMID: 35239486 DOI: 10.1109/tnsre.2022.3156703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In this paper, we monitored the accuracy of non-navigated application of repetitive Transcranial Magnetic Stimulation (rTMS) in 10 patients suffering from orofacial pain by using functional magnetic resonance (fMRI), computer modeling and numerical simulation. Through a unique process, each fMRI scan was used to define a Region of Interest (ROI) where the source of the orofacial pain was located, which was to be stimulated using rTMS. For each patient, MRI scans with a spatial resolution of 0.7 mm were converted into an anatomically accurate head model. The head model including the ROI was then co-registered with a model of the stimulation coil in an electromagnetic field numerical simulator. The accuracy of rTMS application was evaluated based on the calculations of electric field intensity distribution in the ROI. The research has yielded unique insight into ROIs (with average volume 904mm3) in patients with orofacial pain and has also extended further possibilities of human head MRI image semi-automatic segmentation. According to the calculations performed, the average ROI volume that was stimulated by an electric field with an intensity of over 80 V/m was only 4.4%, with the maximum ROI volume being 20.5%. Furthermore, a numerical study of the impact of coil rotation and translation was performed. It demonstrated a) the optimal placement of the stimulation coil can significantly increase the volume of the stimulated ROI up to 60% and b) patients with orofacial pain would need precise coil positioning with a navigation error lower than 10 mm. Due to an acceptable proccessing time of up to 6 hours, described numerical simulation opens up new options for precise rTMS treatment planning. This planning platform together withpatient-specific navigated rTMS, could lead to significant increase of treatment outcomes in patients suffering from orofacial pain.
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12
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Feasibility of Combining Transcranial Direct Current Stimulation and Active Fully Embodied Virtual Reality for Visual Height Intolerance: A Double-Blind Randomized Controlled Study. J Clin Med 2022; 11:jcm11020345. [PMID: 35054039 PMCID: PMC8779186 DOI: 10.3390/jcm11020345] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/02/2022] [Accepted: 01/05/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Transcranial Direct Current Stimulation (tDCS) and Virtual Reality Exposure Therapy (VRET) are individually increasingly used in psychiatric research. OBJECTIVE/HYPOTHESIS Our study aimed to investigate the feasibility of combining tDCS and wireless 360° full immersive active and embodied VRET to reduce height-induced anxiety. METHODS We carried out a pilot randomized, double-blind, controlled study associating VRET (two 20 min sessions with a 48 h interval, during which, participants had to cross a plank at rising heights in a building in construction) with online tDCS (targeting the ventromedial prefrontal cortex) in 28 participants. The primary outcomes were the sense of presence level and the tolerability. The secondary outcomes were the anxiety level (Subjective Unit of Discomfort) and the salivary cortisol concentration. RESULTS We confirmed the feasibility of the association between tDCS and fully embodied VRET associated with a good sense of presence without noticeable adverse effects. In both groups, a significant reduction in the fear of height was observed after two sessions, with only a small effect size of add-on tDCS (0.1) according to the SUD. The variations of cortisol concentration differed in the tDCS and sham groups. CONCLUSION Our study confirmed the feasibility of the association between wireless online tDCS and active, fully embodied VRET. The optimal tDCS paradigm remains to be determined in this context to increase effect size and then adequately power future clinical studies assessing synergies between both techniques.
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Transcranial magnetic stimulation in the treatment of adolescent depression: a systematic review and meta-analysis of aggregated and individual-patient data from uncontrolled studies. Eur Child Adolesc Psychiatry 2022; 31:1501-1525. [PMID: 35751003 PMCID: PMC9532325 DOI: 10.1007/s00787-022-02021-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/01/2022] [Indexed: 12/31/2022]
Abstract
Transcranial magnetic stimulation (TMS) is a non-invasive treatment for adolescent major depressive disorder (MDD). Existing evidence on the efficacy of TMS in adolescent MDD awaits quantitative synthesis. A systematic literature search was conducted, and data from eligible studies were synthesized using random-effects models. Treatment-covariate interactions were examined in exploratory analyses of individual-patient data (IPD). Systematic search of the literature yielded 1264 hits, of which 10 individual studies (2 randomized trials) were included for quantitative synthesis of mainly uncontrolled studies. Individual patient data (IPD) were available from five trials (all uncontrolled studies). Quantitative synthesis of aggregated data revealed a statistically significant negative overall standardized mean change (pooled SMCC = 2.04, 95% CI [1.46; 2.61], SE = 0.29, p < .001), as well as a significant overall treatment response rate (Transformed Proportion = 41.30%, 95% CI [31.03; 51.57], SE = 0.05; p < 0.001), considering data from baseline to post-treatment. Exploratory IPD analyses suggests TMS might be more effective in younger individuals and individuals with more severe depression, and efficacy might be enhanced with certain treatment modality settings, including higher number of TMS sessions, longer treatment durations, and unilateral and not bilateral stimulation. Existing studies exhibit methodological shortcomings, including small-study effects and lack of control group, blinding, and randomization-compromising the credibility of the present results. To date, two randomized controlled trials on TMS in adolescent depression have been published, and the only large-scale randomized trial suggests TMS is not more effective than sham stimulation. Future large-scale, randomized, and sham-controlled trials are warranted. Future trials should ensure appropriate selection of patients for TMS treatment and guide precision medicine approaches for stimulation protocols.
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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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Guo H, Xiao Y, Sun D, Yang J, Wang J, Wang H, Pan C, Li C, Zhao P, Zhang Y, Wu J, Zhang X, Wang F. Early-Stage Repetitive Transcranial Magnetic Stimulation Altered Posterior-Anterior Cerebrum Effective Connectivity in Methylazoxymethanol Acetate Rats. Front Neurosci 2021; 15:652715. [PMID: 34093113 PMCID: PMC8176023 DOI: 10.3389/fnins.2021.652715] [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: 01/13/2021] [Accepted: 03/29/2021] [Indexed: 11/13/2022] Open
Abstract
The aim of the current resting-state functional magnetic resonance imaging (fMRI) study was to investigate the potential mechanism of schizophrenia through the posterior-anterior cerebrum imbalance in methylazoxymethanol acetate (MAM) rats and to evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) as an early-stage intervention. The rats were divided into four groups: the MAM-sham group, vehicle-sham group, MAM-rTMS group, and vehicle-rTMS group. The rTMS treatment was targeted in the visual cortex (VC) in adolescent rats. Granger Causality Analysis (GCA) was used to evaluate the effective connectivity between regions of interest. Results demonstrated a critical right VC-nucleus accumbens (Acb)-orbitofrontal cortex (OFC) pathway in MAM rats; significant differences of effective connectivity (EC) were found between MAM-sham and vehicle-sham groups (from Acb shell to OFC: t = -2.553, p = 0.021), MAM-rTMS and MAM-sham groups (from VC to Acb core: t = -2.206, p = 0.043; from Acb core to OFC: t = 4.861, p < 0.001; from Acb shell to OFC: t = 4.025, p = 0.001), and MAM-rTMS and vehicle-rTMS groups (from VC to Acb core: t = -2.482, p = 0.025; from VC to Acb shell: t = -2.872, p = 0.012; from Acb core to OFC: t = 4.066, p = 0.001; from Acb shell to OFC: t = 3.458, p = 0.004) in the right hemisphere. Results of the early-stage rTMS intervention revealed that right nucleus accumbens played the role as a central hub, and VC was a potentially novel rTMS target region during adolescent schizophrenia. Moreover, the EC of right nucleus accumbens shell and orbitofrontal cortex was demonstrated to be a potential biomarker. To our knowledge, this was the first resting-state fMRI study using GCA to assess the deficits of a visual-reward neural pathway and the effectiveness of rTMS treatment in MAM rats. More randomized controlled trials in both animal models and schizophrenia patients are needed to further elucidate the disease characteristics.
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Affiliation(s)
- Huiling Guo
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China.,Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, China
| | - Yao Xiao
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, China.,Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Dandan Sun
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jingyu Yang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China.,Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, China
| | - Jie Wang
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, China
| | - Huaning Wang
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Chunyu Pan
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, China.,School of Computer Science and Engineering, Northeastern University, Shenyang, China
| | - Chao Li
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Pengfei Zhao
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yanbo Zhang
- Department of Psychiatry, Faculty of Medicine and Dentistry, The Neuroscience and Mental Health Institute (NMHI), University of Alberta, Alberta, AB, Canada
| | - Jinfeng Wu
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, China
| | - Xizhe Zhang
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China.,Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Fei Wang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China.,Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, China
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Oberman LM, Hynd M, Nielson DM, Towbin KE, Lisanby SH, Stringaris A. Repetitive Transcranial Magnetic Stimulation for Adolescent Major Depressive Disorder: A Focus on Neurodevelopment. Front Psychiatry 2021; 12:642847. [PMID: 33927653 PMCID: PMC8076574 DOI: 10.3389/fpsyt.2021.642847] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/18/2021] [Indexed: 12/31/2022] Open
Abstract
Adolescent depression is a potentially lethal condition and a leading cause of disability for this age group. There is an urgent need for novel efficacious treatments since half of adolescents with depression fail to respond to current therapies and up to 70% of those who respond will relapse within 5 years. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising treatment for major depressive disorder (MDD) in adults who do not respond to pharmacological or behavioral interventions. In contrast, rTMS has not demonstrated the same degree of efficacy in adolescent MDD. We argue that this is due, in part, to conceptual and methodological shortcomings in the existing literature. In our review, we first provide a neurodevelopmentally focused overview of adolescent depression. We then summarize the rTMS literature in adult and adolescent MDD focusing on both the putative mechanisms of action and neurodevelopmental factors that may influence efficacy in adolescents. We then identify limitations in the existing adolescent MDD rTMS literature and propose specific parameters and approaches that may be used to optimize efficacy in this uniquely vulnerable age group. Specifically, we suggest ways in which future studies reduce clinical and neural heterogeneity, optimize neuronavigation by drawing from functional brain imaging, apply current knowledge of rTMS parameters and neurodevelopment, and employ an experimental therapeutics platform to identify neural targets and biomarkers for response. We conclude that rTMS is worthy of further investigation. Furthermore, we suggest that following these recommendations in future studies will offer a more rigorous test of rTMS as an effective treatment for adolescent depression.
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Oroz R, Kung S, Croarkin PE, Cheung J. Transcranial magnetic stimulation therapeutic applications on sleep and insomnia: a review. SLEEP SCIENCE AND PRACTICE 2021. [DOI: 10.1186/s41606-020-00057-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AbstractRepetitive transcranial magnetic stimulation (rTMS) is a neuromodulatory technique approved by the US Food and Drug Administration for use in treatment-resistant major depressive disorder. It works by generating localized magnetic fields that create depolarizing electrical currents in neurons a few centimeters below the scalp. This localized effect is believed to stimulate neural plasticity, activate compensatory processes, and influence cortical excitability. Additionally, rTMS has been used in a variety of clinical trials for neurological and psychiatric conditions such as anxiety, post-traumatic stress disorder and epilepsy. Beneficial effects in sleep parameters have been documented in these trials, as well as in major depressive disorder, and have led to an interest in using rTMS in the field of sleep medicine for specific disorders such as insomnia, hypersomnia, and restless legs syndrome. It is unknown whether rTMS has intrinsically beneficial properties when applied to primary sleep disorders, or if it only acts on sleep through mood disorders. This narrative review sought to examine available literature regarding the application of rTMS for sleep disorder to identify knowledge gaps and inform future study design. The literature in this area remains scarce, with few randomized clinical trials on rTMS and insomnia. Available studies have found mixed results, with some studies reporting subjective sleep improvement while objective improvement is less consistent. Due to the heterogeneity of results and the variations in rTMS protocols, no definitive conclusions have been reached, signaling the need for further research.
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Kar SK, Menon V. Repetitive Transcranial Magnetic Stimulation in Persistent Auditory Hallucination in Schizophrenia: Predictors of Response. Curr Behav Neurosci Rep 2020. [DOI: 10.1007/s40473-020-00218-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Effects of repetitive transcranial magnetic stimulation in subjects with sleep disorders. Sleep Med 2020; 71:113-121. [DOI: 10.1016/j.sleep.2020.01.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 01/06/2020] [Accepted: 01/31/2020] [Indexed: 01/08/2023]
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Aamir A, Girach A, Sarrigiannis PG, Hadjivassiliou M, Paladini A, Varrassi G, Zis P. Repetitive Magnetic Stimulation for the Management of Peripheral Neuropathic Pain: A Systematic Review. Adv Ther 2020; 37:998-1012. [PMID: 31989485 DOI: 10.1007/s12325-020-01231-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Repetitive magnetic stimulation (rMS) is a safe and well-tolerated intervention. Transcranial magnetic stimulation (TMS) is used for the treatment of depression and for the treatment and prevention of migraine. Over the last few years, several reports and randomised controlled studies of the use of rMS for the treatment of pain have been published. The aim of this systematic review was to identify the available literature regarding the use of rMS in the treatment of peripheral neuropathic pain. METHODS After a systematic Medline search we identified 12 papers eligible to be included in this review. RESULTS The majority of the studies were on patients with phantom limb pain, followed by radiculopathy, plexopathy, post-traumatic pain and peripheral neuropathy. The treatment protocols vary significantly from study to study and, therefore, pooling the results together is currently difficult. However, rMS has a definite immediate effect in pain relief which, in the majority of studies, is maintained for a few weeks. CONCLUSION rMS seems to be a promising intervention in the treatment of peripheral neuropathic pain. Further research is in the field is needed. Use of neuronavigation might increase the precision of stimulation and subsequently its effectiveness.
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Affiliation(s)
| | - Ayesha Girach
- Medical School, University of Sheffield, Sheffield, UK
| | | | - Marios Hadjivassiliou
- Academic Directorate of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Zis P, Shafique F, Hadjivassiliou M, Blackburn D, Venneri A, Iliodromiti S, Mitsikostas DD, Sarrigiannis PG. Safety, Tolerability, and Nocebo Phenomena During Transcranial Magnetic Stimulation: A Systematic Review and Meta-Analysis of Placebo-Controlled Clinical Trials. Neuromodulation 2019; 23:291-300. [PMID: 30896060 DOI: 10.1111/ner.12946] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 12/28/2018] [Accepted: 01/23/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND The methodology used for the application of repetitive transcranial magnetic stimulation (TMS) is such that it may induce a placebo effect. Respectively, adverse events (AEs) can occur when using a placebo, a phenomenon called nocebo. The primary aim of our meta-analysis is to establish the nocebo phenomena during TMS. Safety and tolerability of TMS were also studied. METHODS After a systematic Medline search for TMS randomized controlled trials (RCTs), we assessed the number of patients reporting at least one AE and the number of discontinuations because of AE in active and sham TMS groups. RESULTS Data were extracted from 93 RCTs. The overall pooled estimate of active TMS and placebo treated patients who discontinued treatment because of AEs was 2.5% (95% CI 1.9%-3.2%) and 2.7% (95% CI 2.0%-3.5%), respectively. The pooled estimate of active TMS and placebo treated patients experiencing at least one AE was 29.3% (95% CI 19.0%-22.6%) and 13.6% (95% CI 11.6%-15.8%), respectively, suggesting that the odds of experiencing an AE is 2.60 times higher (95% CI 1.75-3.86) in the active treatment group compared to placebo (p < 0.00001). The most common AE was headache, followed by dizziness. Secondary meta-analyses in depression and psychotic disorders showed that the odds of experiencing an AE is 3.98 times higher (95% CI 2.14-7.40) and 2.93 times higher (95% CI 1.41-6.07), respectively, in the active treatment groups compared to placebo. CONCLUSIONS TMS is a safe and well-tolerated intervention. Nocebo phenomena do occur during TMS treatment and should be acknowledged during clinical trial design and daily clinical practice.
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Affiliation(s)
- Panagiotis Zis
- Academic Department of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,Medical School, University of Cyprus, Nicosia, Cyprus
| | - Faiza Shafique
- Academic Department of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Marios Hadjivassiliou
- Academic Department of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Daniel Blackburn
- Sheffield Institute for Translational Neuroscience, Sheffield, UK
| | - Annalena Venneri
- Sheffield Institute for Translational Neuroscience, Sheffield, UK
| | | | | | - Ptolemaios G Sarrigiannis
- Academic Department of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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22
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Effectiveness and Predictors of Response to 1-Hz Repetitive Transcranial Magnetic Stimulation in Patients With Obsessive-Compulsive Disorder. J ECT 2019; 35:61-66. [PMID: 30095555 DOI: 10.1097/yct.0000000000000530] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The present study aimed to assess the effectiveness of repetitive transcranial magnetic stimulation (rTMS) treatment targeting either supplementary motor area (SMA) or orbitofrontal cortex (OFC) among patients with OCD in real-world clinical practice settings. Also, the present study explored for potential predictors of response to rTMS treatment. METHODS Retrospective review and analysis of records of 79 patients with medication-refractory OCD, all of whom had received 20 sessions of 1-Hz rTMS as part of routine clinical care. Of 79 patients, 46 received rTMS over the bilateral SMA and 33 over the left OFC. A reduction of 25% and 35% in Yale-Brown Obsessive Compulsive Scale (YBOCS) scores was used to classify outcome as partial and complete response, respectively. Statistical analysis was done using SPSS version 23.0. RESULTS There was a significant decrease in mean YBOCS score from baseline to end of treatment (7.68 ± 5.62; t = 12.14, P < 0.001). Forty-five patients (57%) met criteria for partial response, of which 32 patients (40.5%) showed complete response. There was no significant difference in outcomes between patients receiving rTMS over SMA or OFC. Binary logistic regression analysis revealed presence of comorbid depression and higher baseline YBOCS score to be associated with lesser likelihood of response to rTMS. CONCLUSIONS This study provided evidence for overall effectiveness of adjunctive 1-Hz rTMS treatment over either SMA or OFC in patients with medication-refractory OCD, and reported comorbid depression and higher pretreatment YBOCS scores as potential predictors of poor response to rTMS.
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23
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Duret G, Polali S, Anderson ED, Bell AM, Tzouanas CN, Avants BW, Robinson JT. Magnetic Entropy as a Proposed Gating Mechanism for Magnetogenetic Ion Channels. Biophys J 2019; 116:454-468. [PMID: 30665695 PMCID: PMC6369444 DOI: 10.1016/j.bpj.2019.01.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 12/22/2018] [Accepted: 01/02/2019] [Indexed: 12/25/2022] Open
Abstract
Magnetically sensitive ion channels would allow researchers to better study how specific brain cells affect behavior in freely moving animals; however, recent reports of "magnetogenetic" ion channels based on biogenic ferritin nanoparticles have been questioned because known biophysical mechanisms cannot explain experimental observations. Here, we reproduce a weak magnetically mediated calcium response in HEK cells expressing a previously published TRPV4-ferritin fusion protein. We find that this magnetic sensitivity is attenuated when we reduce the temperature sensitivity of the channel but not when we reduce the mechanical sensitivity of the channel, suggesting that the magnetic sensitivity of this channel is thermally mediated. As a potential mechanism for this thermally mediated magnetic response, we propose that changes in the magnetic entropy of the ferritin particle can generate heat via the magnetocaloric effect and consequently gate the associated temperature-sensitive ion channel. Unlike other forms of magnetic heating, the magnetocaloric mechanism can cool magnetic particles during demagnetization. To test this prediction, we constructed a magnetogenetic channel based on the cold-sensitive TRPM8 channel. Our observation of a magnetic response in cold-gated channels is consistent with the magnetocaloric hypothesis. Together, these new data and our proposed mechanism of action provide additional resources for understanding how ion channels could be activated by low-frequency magnetic fields.
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Affiliation(s)
- Guillaume Duret
- Department of Electrical and Computer Engineering, Rice University, Houston, Texas
| | - Sruthi Polali
- Department of Electrical and Computer Engineering, Rice University, Houston, Texas; Applied Physics Program, Rice University, Houston, Texas
| | - Erin D Anderson
- Department of Bioengineering, Rice University, Houston, Texas
| | - A Martin Bell
- Department of Electrical and Computer Engineering, Rice University, Houston, Texas; Applied Physics Program, Rice University, Houston, Texas
| | | | - Benjamin W Avants
- Department of Electrical and Computer Engineering, Rice University, Houston, Texas
| | - Jacob T Robinson
- Department of Electrical and Computer Engineering, Rice University, Houston, Texas; Department of Bioengineering, Rice University, Houston, Texas; Applied Physics Program, Rice University, Houston, Texas; Department of Neuroscience, Baylor College of Medicine, Houston, Texas.
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24
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Feng J, Zhang Q, Zhang C, Wen Z, Zhou X. The Effect of sequential bilateral low-frequency rTMS over dorsolateral prefrontal cortex on serum level of BDNF and GABA in patients with primary insomnia. Brain Behav 2019; 9:e01206. [PMID: 30609300 PMCID: PMC6379591 DOI: 10.1002/brb3.1206] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 12/06/2018] [Accepted: 12/09/2018] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the effect of sequential bilateral low-frequency repetitive transcranial magnetic stimulation (rTMS) over dorsolateral prefrontal cortex (DLPFC) on patients with primary insomnia (PI). METHODS A total of 32 eligible right-handed participants diagnosed by PI according to International classification of sleep disorders (ICD-3) were recruited into this study. Participants received 10 daily sessions of sequential bilateral 1 Hz rTMS over DLPFC. Before and after the whole procedure of rTMS, patients were assessed by Pittsburgh Sleep Quality Index (PSQI) for the severity of sleep disturbance. Meanwhile, serum concentration of brain-derived neurotrophic factor (BDNF) and gamma-aminobutyric acid (GABA) in patients was measured by ELISA and UPLC, respectively. Moreover, the amplitude of MEPs reflecting the right cortical excitability was examined. Finally, Pearson correlation analysis was performed to evaluate the correlation among the change of these variables. RESULTS After rTMS treatment, the PSQI score was markedly decreased as compared to pre-rTMS; the concentrations of serum BDNF and GABA were significantly higher; the amplitude of MEPs was markedly reduced. Pearson correlation analysis revealed that the change of PSQI score was negatively associated with the alteration of serum BDNF level and serum GABA level, and positively associated with the change of MEPs amplitude; the change of MEPs amplitude was negatively associated with fold change in the serum BDNF level and the serum GABA level; the increase in serum GABA level was positively associated with the serum BDNF level. CONCLUSIONS A sequential bilateral low-frequency rTMS over DLPFC significantly improves primary insomnia probably by increasing the level of BDNF and GABA in the brain and reducing cortical excitability.
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Affiliation(s)
- Jie Feng
- Department of NeurologyThe Second Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Qing Zhang
- Laboratory of Neurological, Department of Neurology, Changzhou No.2 People’s HospitalThe Affiliated Hospital of Nanjing Medical UniversityChangzhouChina
| | - Chengliang Zhang
- Laboratory of Neurological, Department of Neurology, Changzhou No.2 People’s HospitalThe Affiliated Hospital of Nanjing Medical UniversityChangzhouChina
| | - Zhongmin Wen
- Department of NeurologyThe Second Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Xianju Zhou
- Laboratory of Neurological, Department of Neurology, Changzhou No.2 People’s HospitalThe Affiliated Hospital of Nanjing Medical UniversityChangzhouChina
- Department of Neurology, Integrated Hospital of Traditional Chinese MedicineSouthern Medical UniversityGuangzhouChina
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25
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Xu Y, Qiu Z, Zhu J, Liu J, Wu J, Tao J, Chen L. The modulation effect of non-invasive brain stimulation on cognitive function in patients with mild cognitive impairment: a systematic review and meta-analysis of randomized controlled trials. BMC Neurosci 2019; 20:2. [PMID: 30602377 PMCID: PMC6317253 DOI: 10.1186/s12868-018-0484-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 12/21/2018] [Indexed: 01/17/2023] Open
Abstract
Background To prevent and control dementia, many scholars have focused on the transition stage between normal ageing and dementia, mild cognitive impairment (MCI) which is a key interventional target for dementia. Studies have shown that non-invasive brain stimulation (NIBS) is beneficial to improve cognitive function of MCI patients. However, whether NIBS is conducive to the protection of cognitive ability in MCI patients remains unknown due to limited evidence. The aim of the study was to systematically evaluate the modulation effect of NIBS on cognitive function (global cognitive ability and specific domains of cognition) in patients with MCI. Results A total of 11 RCTs comprising a total of 367 MCI participants. Meta-analysis showed that NIBS can significantly improve global cognition (n = 271, SMD = 0.94, 95% CI 0.47–1.41, p < 0.0001) and verbal fluency (n = 72, MD = 2.03, 95% CI 0.17–3.88, p = 0.03). However, there was no significant improvement in other domains of cognition. Conclusions NIBS has a positive effect on improving global cognitive function and verbal fluency. At the same time, it has a small positive effect on improving executive function. However, these findings should be interpreted carefully due to the limitations of the study. Electronic supplementary material The online version of this article (10.1186/s12868-018-0484-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ying Xu
- Rehabilitation Medicine College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Zhijie Qiu
- Rehabilitation Medicine College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jingfang Zhu
- Rehabilitation Medicine College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jiao Liu
- National Rehabilitation Research Center of Traditional Chinese Medicine, Fuzhou, China
| | - Jingsong Wu
- Rehabilitation Medicine College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jing Tao
- Rehabilitation Medicine College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Lidian Chen
- Fujian University of Traditional Chinese Medicine, Fuzhou, China.
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Liu H, Zhang C, Ji Y, Yang L. Biological and Psychological Perspectives of Resilience: Is It Possible to Improve Stress Resistance? Front Hum Neurosci 2018; 12:326. [PMID: 30186127 PMCID: PMC6110926 DOI: 10.3389/fnhum.2018.00326] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 07/25/2018] [Indexed: 12/23/2022] Open
Abstract
The term “resilience” refers to the ability to adapt successfully to stress, trauma and adversity, enabling individuals to avoid stress-induced mental disorders such as depression, posttraumatic stress disorder (PTSD) and anxiety. Here, we review evidence from both animal models and humans that is increasingly revealing the neurophysiological and neuropsychological mechanisms that underlie stress susceptibility, as well as active mechanisms underlying the resilience phenotype. Ultimately, this growing understanding of the neurobiological mechanisms of resilience should result in the development of novel interventions that specifically target neural circuitry and brain areas that enhance resilience and lead to more effective treatments for stress-induced disorders. Stress resilience can be improved, but the outcomes and effects depend on the type of intervention and the species treated.
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Affiliation(s)
- Haoran Liu
- School of Psychology, Center for Studies of Psychological Application, South China Normal University, Guangzhou, China
| | - Chenfeng Zhang
- School of Psychology, Center for Studies of Psychological Application, South China Normal University, Guangzhou, China
| | - Yannan Ji
- School of Life Sciences, South China Normal University, Guangzhou, China
| | - Li Yang
- School of Psychology, Center for Studies of Psychological Application, South China Normal University, Guangzhou, China.,Institute for Brain Research and Rehabilitation, South China Normal University, Guangzhou, China
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The Effect of Low-Frequency Repetitive Transcranial Magnetic Stimulation at Orbitofrontal Cortex in the Treatment of Patients With Medication-Refractory Obsessive-Compulsive Disorder: A Retrospective Open Study. J ECT 2018; 34:e16-e19. [PMID: 29053484 DOI: 10.1097/yct.0000000000000462] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Obsessive-compulsive disorder (OCD) is a chronic debilitating psychiatric disorder, with significant proportion of patients failing to respond with current first-line treatments. The present study assesses the safety and effectiveness of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) over left-orbitofrontal cortex (Lt-OFC) as a potential augmentation strategy in treatment of patients with medication-refractory OCD in real-world clinical setting. The present report also aims to examine the factors affecting response to rTMS and the durability of effects produced by rTMS over 1 month of follow-up period. METHODS Retrospective review and analysis of clinical case files of 25 patients with medication-refractory OCD, all of whom had received 20 sessions of LF-rTMS over Lt-OFC as part of routine clinical care. A reduction of 25% and 35% in Yale-Brown Obsessive Compulsive Scale scores was used to determine the proportion of partial and complete responders, respectively. RESULTS There was a significant decrease in mean Yale-Brown Obsessive Compulsive Scale score at the end of 20 sessions of rTMS compared with baseline (7.04 ± 5.07; P < 0.001), with no further significant change during the subsequent 1-month follow-up period (0.20 ± 1.38; P = 0.47). Thirteen patients (52%) met criteria for partial response, of which 11 patients (44%) showed complete response. Furthermore, higher number of failed medication trials was found to be significantly associated with greater chances of nonresponse to rTMS treatment. CONCLUSIONS There is a role of applying LF-rTMS over Lt-OFC as an augmentation strategy in ameliorating clinical symptoms among patients with medication-refractory OCD.
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28
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Aleman A, Enriquez-Geppert S, Knegtering H, Dlabac-de Lange JJ. Moderate effects of noninvasive brain stimulation of the frontal cortex for improving negative symptoms in schizophrenia: Meta-analysis of controlled trials. Neurosci Biobehav Rev 2018; 89:111-118. [DOI: 10.1016/j.neubiorev.2018.02.009] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 01/24/2018] [Accepted: 02/12/2018] [Indexed: 01/28/2023]
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Kumar S, Singh S, Kumar N, Verma R. The Effects of Repetitive Transcranial Magnetic Stimulation at Dorsolateral Prefrontal Cortex in the Treatment of Migraine Comorbid with Depression: A Retrospective Open Study. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2018; 16:62-66. [PMID: 29397668 PMCID: PMC5810452 DOI: 10.9758/cpn.2018.16.1.62] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 05/18/2017] [Accepted: 06/20/2017] [Indexed: 01/08/2023]
Abstract
Objective The literature on managing migraine non-responsive to pharmacological approaches and that co-occurring with depression is scanty. The comorbid condition predicts a poorer prognosis for migraine as well as depression. The present report assesses efficacy and tolerability of high frequency repetitive transcranial magnetic stimulation (rTMS) over left dorsolateral prefrontal cortex as a treatment modality for migraine with comorbid depression. Methods The current retrospective chart review assesses effectiveness of high frequency rTMS over left dorsolateral prefrontal cortex as a treatment modality to manage migraine occurring comorbid with depression in 14 subjects. Results The mean scores on Migraine Disability Assessment Test (MIDAS) and depression rating scale reduced significantly from 21.14±3.01 and 20.71±3.95 at baseline to 13.93±6.09 and 14.21±5.52 respectively, after rTMS. There was significant improvement in migraine frequency, severity and functional disability assessed using MIDAS scores (p<0.05) following high frequency rTMS compared to baseline. Conclusion There is a role of applying rTMS as a potential therapeutic modality in the integrated management of a distinct subgroup of migraine patients with comorbid depression.
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Affiliation(s)
- Saurabh Kumar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Swarndeep Singh
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Nand Kumar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Verma
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
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Liu CS, Rau A, Gallagher D, Rajji TK, Lanctôt KL, Herrmann N. Using transcranial direct current stimulation to treat symptoms in mild cognitive impairment and Alzheimer's disease. Neurodegener Dis Manag 2017; 7:317-329. [DOI: 10.2217/nmt-2017-0021] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Transcranial direct current stimulation (tDCS) has recently been investigated as a potential nonpharmacological treatment for individuals with mild cognitive impairment (MCI) and Alzheimer's disease (AD). A comprehensive literature search was performed on tDCS studies published until March 2017 using MEDLINE, Embase and PsychINFO databases. 12 articles with a total of 202 MCI or AD participants were included. Although ten of the 12 studies demonstrated positive findings with tDCS, two studies reported no effect on cognition. There was a wide range of methodological approaches used and in the cognitive functions measured. The variability in treatment response may be related to the heterogeneity in stimulation parameters including the site of stimulation, and cognitive assessments used. Patient-related factors including individual psychological, biological, and physiological status at the time of stimulation may also influence treatment response. We recommend that more comparative studies using similar patient factors and study parameters are needed in order to better understand the efficacy of tDCS in MCI and AD.
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Affiliation(s)
- Celina S Liu
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada
- Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Allison Rau
- Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Damien Gallagher
- Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Tarek K Rajji
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Geriatric Psychiatry Division, Centre for Addiction & Mental Health, Toronto, ON, Canada
| | - Krista L Lanctôt
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada
- Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Nathan Herrmann
- Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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31
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Aleman A, Lincoln TM, Bruggeman R, Melle I, Arends J, Arango C, Knegtering H. Treatment of negative symptoms: Where do we stand, and where do we go? Schizophr Res 2017; 186:55-62. [PMID: 27293137 DOI: 10.1016/j.schres.2016.05.015] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 05/16/2016] [Accepted: 05/17/2016] [Indexed: 12/16/2022]
Abstract
Negative symptoms, e.g. social withdrawal, reduced initiative, anhedonia and affective flattening, are notoriously difficult to treat. In this review, we take stock of recent research into treatment of negative symptoms by summarizing psychosocial as well as pharmacological and other biological treatment strategies. Major psychosocial approaches concern social skills training, cognitive behavior therapy for psychosis, cognitive remediation and family intervention. Some positive findings have been reported, with the most robust improvements observed for social skills training. Although cognitive behavior therapy shows significant effects for negative symptoms as a secondary outcome measure, there is a lack of data to allow for definite conclusions of its effectiveness for patients with predominant negative symptoms. With regard to pharmacological interventions, antipsychotics have been shown to improve negative symptoms, but this seems to be limited to secondary negative symptoms in acute patients. It has also been suggested that antipsychotics may aggravate negative symptoms. Recent studies have investigated glutamatergic compounds, e.g. glycine receptor inhibitors and drugs that target the NMDA receptor or metabotropic glutamate 2/3 (mGlu2/3) receptor, but no consistent evidence of improvement of negative symptoms was found. Finally, some small studies have suggested improvement of negative symptoms after non-invasive electromagnetic neurostimulation, but this has only been partly replicated and it is still unclear whether these are robust improvements. We address methodological issues, in particular the heterogeneity of negative symptoms and treatment response, and suggest avenues for future research. There is a need for more detailed studies that focus on different dimensions of negative symptoms.
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Affiliation(s)
- André Aleman
- University of Groningen, University Medical Center Groningen, Department of Neuroscience, Groningen, The Netherlands.
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Hamburg, Germany
| | - Richard Bruggeman
- University of Groningen, University Medical Center Groningen and Rob Giel Research Center, Department of Psychiatry, Groningen, The Netherlands
| | - Ingrid Melle
- NORMENT and K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway
| | - Johan Arends
- GGZ Drenthe Mental Health Center, Department of Psychotic Disorders, Assen, The Netherlands
| | - Celso Arango
- Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Madrid, Spain
| | - Henderikus Knegtering
- University of Groningen, University Medical Center Groningen, Department of Neuroscience, Groningen, The Netherlands; GGZ Lentis Mental Health Center, Department of Psychotic Disorders, Groningen, The Netherlands
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Singh J, Singh A, Kar SK, Pahuja E. Early Augmentation Response with Low-frequency Repetitive Transcranial Magnetic Stimulation in Treatment Resistant Depression. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2017; 15:197-198. [PMID: 28449572 PMCID: PMC5426499 DOI: 10.9758/cpn.2017.15.2.197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/19/2016] [Accepted: 04/20/2016] [Indexed: 01/26/2023]
Affiliation(s)
- Jyoti Singh
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Amit Singh
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sujita Kumar Kar
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Erika Pahuja
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
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Goetz SM, Deng ZD. The development and modelling of devices and paradigms for transcranial magnetic stimulation. Int Rev Psychiatry 2017; 29:115-145. [PMID: 28443696 PMCID: PMC5484089 DOI: 10.1080/09540261.2017.1305949] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 03/03/2017] [Accepted: 03/09/2017] [Indexed: 12/20/2022]
Abstract
Magnetic stimulation is a non-invasive neurostimulation technique that can evoke action potentials and modulate neural circuits through induced electric fields. Biophysical models of magnetic stimulation have become a major driver for technological developments and the understanding of the mechanisms of magnetic neurostimulation and neuromodulation. Major technological developments involve stimulation coils with different spatial characteristics and pulse sources to control the pulse waveform. While early technological developments were the result of manual design and invention processes, there is a trend in both stimulation coil and pulse source design to mathematically optimize parameters with the help of computational models. To date, macroscopically highly realistic spatial models of the brain, as well as peripheral targets, and user-friendly software packages enable researchers and practitioners to simulate the treatment-specific and induced electric field distribution in the brains of individual subjects and patients. Neuron models further introduce the microscopic level of neural activation to understand the influence of activation dynamics in response to different pulse shapes. A number of models that were designed for online calibration to extract otherwise covert information and biomarkers from the neural system recently form a third branch of modelling.
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Affiliation(s)
- Stefan M Goetz
- a Department of Psychiatry & Behavioral Sciences, Division for Brain Stimulation & Neurophysiology , Duke University , Durham , NC , USA
- b Department of Electrical & Computer Engineering , Duke University , Durham , NC , USA
- c Department of Neurosurgery , Duke University , Durham , NC , USA
| | - Zhi-De Deng
- a Department of Psychiatry & Behavioral Sciences, Division for Brain Stimulation & Neurophysiology , Duke University , Durham , NC , USA
- d Intramural Research Program, Experimental Therapeutics & Pathophysiology Branch, Noninvasive Neuromodulation Unit , National Institutes of Health, National Institute of Mental Health , Bethesda , MD , USA
- e Duke Institute for Brain Sciences , Duke University , Durham , NC , USA
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Tong E, Sugrue L, Wintermark M. Understanding the Neurophysiology and Quantification of Brain Perfusion. Top Magn Reson Imaging 2017; 26:57-65. [PMID: 28277465 DOI: 10.1097/rmr.0000000000000128] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Newer neuroimaging technology has moved beyond pure anatomical imaging and ventured into functional and physiological imaging. Perfusion magnetic resonance imaging (PWI), which depicts hemodynamic conditions of the brain at the microvascular level, has an increasingly important role in clinical central nervous system applications. This review provides an overview of the established role of PWI in brain tumor and cerebrovascular imaging, as well as some emerging applications in neuroimaging. PWI allows better characterization of brain tumors, grading, and monitoring. In acute stroke imaging, PWI is utilized to distinguish penumbra from infarcted tissue. PWI is a promising tool in the assessment of neurodegenerative and neuropsychiatric diseases, although its clinical role is not yet defined.
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Affiliation(s)
- Elizabeth Tong
- *Department of Radiology & Biomedical Imaging, University of California, San Francisco †Department of Neuroradiology, Stanford University Medical Center, Palo Alto, CA
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Dlabac-de Lange JJ, Liemburg EJ, Bais L, van de Poel-Mustafayeva AT, de Lange-de Klerk ES, Knegtering H, Aleman A. Effect of Bilateral Prefrontal rTMS on Left Prefrontal NAA and Glx Levels in Schizophrenia Patients with Predominant Negative Symptoms: An Exploratory Study. Brain Stimul 2017; 10:59-64. [DOI: 10.1016/j.brs.2016.08.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 07/25/2016] [Accepted: 08/01/2016] [Indexed: 11/28/2022] Open
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Deschamps T, Sauvaget A, Pichot A, Valrivière P, Maroulidès M, Bois A, Bulteau S, Thomas-Ollivier V. Posture-cognitive dual-tasking: A relevant marker of depression-related psychomotor retardation. An illustration of the positive impact of repetitive transcranial magnetic stimulation in patients with major depressive disorder. J Psychiatr Res 2016; 83:86-93. [PMID: 27580486 DOI: 10.1016/j.jpsychires.2016.08.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/14/2016] [Accepted: 08/18/2016] [Indexed: 12/28/2022]
Abstract
This study examined whether postural control variables, particularly the center-of-pressure (COP) velocity-based parameters, could be a relevant hallmark of depression-related psychomotor retardation (PMR). We first aimed at investigating the interplay between the PMR scores and the COP performance in patients with major depressive disorder (MDD), as compared to age-matched healthy controls; secondly, we focused on the impact of a repetitive transcranial magnetic stimulation (rTMS) treatment on depression, PMR scores and postural performance. 16 MDD patients, and a control group of 16 healthy adults, were asked to maintain quiet standing balance during two trials with or without vision, and while backward counting (dual task). All the position and velocity-based COP variables were computed. Before and after the rTMS session (n eligible MDD = 10), we assessed the depression level with the Montgomery-Asberg Depression Rating Scale (MADRS), the PMR scores with the French Retardation Rating Scale for Depression (ERD), and postural performance. Before the treatment, significant positive partial correlations were found between the pre-ERD scores and the velocity-based COP variables, especially in the dual-task conditions (p < 0.05). In contrast, there was no significant correlation between the post-ERD scores and any postural parameter after the treatment. The MADRS and ERD scores showed a significant decrease between before and after the rTMS intervention. For the first time, the findings clearly validated the view that the assessment of postural performance - easy to envisage in clinical settings-constitutes a reliable and objective marker of PMR in MDD patients.
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Affiliation(s)
- Thibault Deschamps
- Laboratory "Movement, Interactions, Performance" (E.A. 4334), University of Nantes, France.
| | - Anne Sauvaget
- CHU de Nantes, Service d'Addictologie et Psychiatrie de liaison, France; EA SPHERE 4275 Methods for Patients-centered outcomes and Health Research, University of Nantes, Nantes, France
| | - Anne Pichot
- CHU de Nantes, Service d'Addictologie et Psychiatrie de liaison, France
| | - Pierre Valrivière
- CHU de Nantes, Service d'Addictologie et Psychiatrie de liaison, France
| | - Maxime Maroulidès
- Laboratory "Movement, Interactions, Performance" (E.A. 4334), University of Nantes, France
| | - Aurore Bois
- Laboratory "Movement, Interactions, Performance" (E.A. 4334), University of Nantes, France
| | - Samuel Bulteau
- CHU de Nantes, Service d'Addictologie et Psychiatrie de liaison, France
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Kim YI, Kim SM, Kim H, Han DH. The Effect of High-Frequency Repetitive Transcranial Magnetic Stimulation on Occupational Stress among Health Care Workers: A Pilot Study. Psychiatry Investig 2016; 13:622-629. [PMID: 27909453 PMCID: PMC5128350 DOI: 10.4306/pi.2016.13.6.622] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/16/2015] [Accepted: 07/29/2015] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Repetitive transcranial magnetic stimulation (rTMS) was approved by the Food and Drug Administration to alleviate symptoms of treatment-resistant depression. This study aimed to evaluate the effectiveness of rTMS treatment on alleviating occupational stress by evaluating clinical symptoms and quantitative electroencephalography (QEEG). METHODS Twenty-four health care workers were randomized to receive 12 sessions of active or sham rTMS delivered to the left dorsolateral prefrontal cortex (DLPFC). Each session consisted of 32 trains of 10 Hz repetitive TMS delivered in 5-second trains at 110% of the estimated prefrontal cortex threshold. Before and after the intervention, the Korean version of the occupational stress inventory (K-OSI), Beck's depression inventory (BDI), and Beck's anxiety inventory (BAI) were administered and EEG was performed using a 21-channel digital EEG system. RESULTS After TMS, the average scores for the affective responses to stressors on the personal strain questionnaire (PSQ) subscale of K-OSI and BDI decreased significantly for the active-TMS group compared to the sham-TMS group. Also, the active-TMS group showed a significantly greater decrease in relative alpha in the F3 electrode and a significantly greater increase in the F4 electrode. CONCLUSION High-frequency rTMS on the left DLPFC had stress-relieving and mood-elevating effects in health care workers, likely by stimulating the left frontal lobe.
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Affiliation(s)
- Young In Kim
- Department of Psychiatry, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Sun Mi Kim
- Department of Psychiatry, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Hyungjin Kim
- Department of Psychology, Rice University, Houston, TX, USA
| | - Doug Hyun Han
- Department of Psychiatry, Chung-Ang University Hospital, Seoul, Republic of Korea
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Bayrlee A, Ganeshalingam N, Kurczewski L, Brophy GM. Treatment of Super-Refractory Status Epilepticus. Curr Neurol Neurosci Rep 2016; 15:66. [PMID: 26299274 DOI: 10.1007/s11910-015-0589-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Super-refractory status epilepticus (SRSE) is a devastating neurological condition with limited treatment options. We conducted an extensive literature search to identify and summarize the therapeutic options for SRSE. The search mainly resulted in case reports of various pharmacologic and non-pharmacologic treatments. The success rate of each of the following agents, ketamine, inhaled anesthetics, intravenous immunoglobulin G (IVIG), IV steroids, ketogenic diet, hypothermia, electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), and vagal nerve stimulation (VNS), are discussed in greater detail. The choice of appropriate treatment options for a given patient is based on clinical presentation. This review focuses on evidence-based, pharmacotherapeutic strategies for patients in SRSE.
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Affiliation(s)
- Ahmad Bayrlee
- Department of Neurology, Virginia Commonwealth University, P.O. Box 980599, Richmond, VA, 23298, USA,
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The Role of Psychotropic Medications in the Management of Anorexia Nervosa: Rationale, Evidence and Future Prospects. CNS Drugs 2016; 30:419-42. [PMID: 27106297 PMCID: PMC4873415 DOI: 10.1007/s40263-016-0335-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Anorexia nervosa (AN) is a severe psychiatric disorder without approved medication intervention. Every class of psychoactive medication has been tried to improve treatment outcome; however, randomized controlled trials have been ambiguous at best and across studies have not shown robust improvements in weight gain and recovery. Here we review the available literature on pharmacological interventions since AN came to greater public recognition in the 1960s, including a critical review of why those trials may not have been successful. We further provide a neurobiological background for the disorder and discuss how cognition, learning, and emotion-regulating circuits could become treatment targets in the future. Making every effort to develop effective pharmacological treatment options for AN is imperative as it continues to be a complex psychiatric disorder with high disease burden and mortality.
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Short-term effects of repetitive transcranial magnetic stimulation on sleep bruxism - a pilot study. Int J Oral Sci 2016; 8:61-5. [PMID: 27025267 PMCID: PMC4822180 DOI: 10.1038/ijos.2015.35] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2015] [Indexed: 11/24/2022] Open
Abstract
The purpose of this study was to investigate the effects of repetitive transcranial magnetic stimulation (rTMS) on patients with sleep bruxism (SB). Twelve patients with SB were included in an open, single-intervention pilot study. rTMS at 1 Hz and an intensity of 80% of the active motor threshold was applied to the ‘hot spot' of the masseter muscle representation at the primary motor cortex bilaterally for 20 min per side each day for 5 consecutive days. The jaw-closing muscle electromyographic (EMG) activity during sleep was recorded with a portable EMG recorder at baseline, during rTMS treatment and at follow-up for 5 days. In addition, patients scored their jaw-closing muscle soreness on a 0–10 numerical rating scale (NRS). Data were analysed with analysis of variance. The intensity of the EMG activity was suppressed during and after rTMS compared to the baseline (P = 0.04; P = 0.02, respectively). The NRS score of soreness decreased significantly during and after rTMS compared with baseline (P < 0.01). These findings indicated a significant inhibition of jaw-closing muscle activity during sleep along with a decrease of muscle soreness. This pilot study raises the possibility of therapeutic benefits from rTMS in patients with bruxism and calls for further and more controlled studies.
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Cortical Anatomical Variations and Efficacy of rTMS in the Treatment of Auditory Hallucinations. Brain Stimul 2015; 8:1162-7. [DOI: 10.1016/j.brs.2015.06.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 04/23/2015] [Accepted: 06/07/2015] [Indexed: 11/20/2022] Open
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Kubera KM, Barth A, Hirjak D, Thomann PA, Wolf RC. Noninvasive brain stimulation for the treatment of auditory verbal hallucinations in schizophrenia: methods, effects and challenges. Front Syst Neurosci 2015; 9:131. [PMID: 26528145 PMCID: PMC4601083 DOI: 10.3389/fnsys.2015.00131] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 09/07/2015] [Indexed: 12/12/2022] Open
Abstract
This mini-review focuses on noninvasive brain stimulation techniques as an augmentation method for the treatment of persistent auditory verbal hallucinations (AVH) in patients with schizophrenia. Paradigmatically, we place emphasis on transcranial magnetic stimulation (TMS). We specifically discuss rationales of stimulation and consider methodological questions together with issues of phenotypic diversity in individuals with drug-refractory and persistent AVH. Eventually, we provide a brief outlook for future investigations and treatment directions. Taken together, current evidence suggests TMS as a promising method in the treatment of AVH. Low-frequency stimulation of the superior temporal cortex (STC) may reduce symptom severity and frequency. Yet clinical effects are of relatively short duration and effect sizes appear to decrease over time along with publication of larger trials. Apart from considering other innovative stimulation techniques, such as transcranial Direct Current Stimulation (tDCS), and optimizing stimulation protocols, treatment of AVH using noninvasive brain stimulation will essentially rely on accurate identification of potential responders and non-responders for these treatment modalities. In this regard, future studies will need to consider distinct phenotypic presentations of AVH in patients with schizophrenia, together with the putative functional neurocircuitry underlying these phenotypes.
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Affiliation(s)
- Katharina M Kubera
- Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg Heidelberg, Germany
| | - Anja Barth
- Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg Heidelberg, Germany
| | - Dusan Hirjak
- Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg Heidelberg, Germany
| | - Philipp A Thomann
- Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg Heidelberg, Germany
| | - Robert C Wolf
- Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg Heidelberg, Germany ; Department of Psychiatry, Psychotherapy and Psychosomatics, Saarland University Homburg, Germany
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Abstract
Psychosis is relatively common in later life and can present in a wide variety of contexts, including early-onset and late-onset schizophrenia, delusional disorder, mood disorders, and various dementias. It can also occur as the result of numerous medical and neurological diseases and from the use of certain medications. Although identifying the cause of psychosis in older patients can be challenging, the unique clinical features associated with the different disorders can help in making the diagnosis. Accurate diagnosis of psychosis in older populations is essential, as its treatment varies depending on the context in which it appears. Despite the safety concerns regarding the use of antipsychotics in older patients, certain pharmacological treatments appear to be both efficacious and reasonably safe in treating psychosis in older populations. Additionally, although research is limited, numerous psychosocial therapies appear promising. This review summarizes the literature on the epidemiology, clinical characteristics, neuroimaging, and treatment of psychosis in later life, and serves as an update to past reviews on this topic.
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Abstract
OBJECTIVE This paper aims to review the available evidence for the use of clozapine and electroconvulsive therapy (ECT) in combination. METHODOLOGY Electronic searches were carried out to identify reports describing the combined use of clozapine and ECT. RESULTS Forty reports including 208 patients were identified. The majority of reports were in the form of case reports and case series, with few retrospective and open-label studies. The majority of patients were aged between 18 and 65 years and diagnosed with schizophrenia or schizoaffective disorder. Most of the patients refractory to clozapine were started on ECT as an augmentation therapy; however, in some reports, both ECT and clozapine were started concurrently, and in few cases clozapine was started after ECT. In terms of effectiveness, 37.5-100% patients improved in short-term, and sustained long-term improvement (3 weeks to 24 months) was described in few studies. In terms of the side-effect profile, five patients each had delirium and tachycardia and only four patients were described to have prolonged seizures. Overall, the combination was considered effective and safe. CONCLUSION There is evidence for the effectiveness and safety of the clozapine-ECT combination and it should be used in patients with treatment-resistant schizophrenia who do not respond to clozapine.
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TMS-related potentials and artifacts in combined TMS-EEG measurements: Comparison of three different TMS devices. Neurophysiol Clin 2015; 45:159-66. [DOI: 10.1016/j.neucli.2015.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 12/12/2014] [Accepted: 02/15/2015] [Indexed: 11/20/2022] Open
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Kedzior KK, Reitz SK, Azorina V, Loo C. Durability of the antidepressant effect of the high-frequency repetitive transcranial magnetic stimulation (rTMS) In the absence of maintenance treatment in major depression: a systematic review and meta-analysis of 16 double-blind, randomized, sham-controlled trials. Depress Anxiety 2015; 32:193-203. [PMID: 25683231 DOI: 10.1002/da.22339] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 10/30/2014] [Accepted: 11/11/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The aim of the current meta-analysis was to investigate predictors of the durability of the antidepressant effect of high-frequency (>1 Hz) repetitive transcranial magnetic stimulation (rTMS) of the left dorsolateral prefrontal cortex in the absence of active maintenance treatment. METHODS Following a systematic literature search of Medline and PsycInfo, N = 16 double-blind, parallel-design, randomized-controlled trials (RCTs) with high-frequency rTMS and inactive sham were included in the current meta-analysis. The effect size (Cohen's d) was the standardized mean difference in depression scores between sham and rTMS groups (baseline -follow-up). Meta-analysis was conducted according to a random-effects model with inverse-variance weights. RESULTS Most RCTs reported only short follow-up phases of 2 weeks (range of 1-16 weeks). The antidepressant effect was observed during follow-up (in the absence of maintenance treatment) compared to baseline (overall mean weighted d = -.48, 95% confidence interval: -.70, -.25, P < .001, N = 16 RCTs with 495 patients). Such an antidepressant effect during follow-up was higher in RCTs with patients who were less severely ill, unipolar, nonpsychotic, treatment-resistant, and on antidepressants (either started with rTMS or continued at stable doses during acute treatment phases). The effect sizes were lower in RCTs with longer (8-16 weeks) compared to shorter (1-4 weeks) follow-up periods. The risk of publication bias was low. CONCLUSIONS High-frequency rTMS has only a small antidepressant effect during follow-up after short acute treatment (5-15 sessions) in the absence of active maintenance treatment. This effect depends on illness severity, decreases over time, and appears to be enhanced by antidepressants.
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Affiliation(s)
- Karina Karolina Kedzior
- Institute of Psychology and Transfer, University of Bremen, Bremen, Germany; Bremen International Graduate School of Social Sciences (BIGSSS), Jacobs University Bremen, Bremen, Germany
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Stanley SA, Sauer J, Kane RS, Dordick JS, Friedman JM. Remote regulation of glucose homeostasis in mice using genetically encoded nanoparticles. Nat Med 2015; 21:92-98. [PMID: 25501906 PMCID: PMC4894538 DOI: 10.1038/nm.3730] [Citation(s) in RCA: 145] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 08/11/2014] [Indexed: 12/15/2022]
Abstract
Means for temporally regulating gene expression and cellular activity are invaluable for elucidating underlying physiological processes and would have therapeutic implications. Here we report the development of a genetically encoded system for remote regulation of gene expression by low-frequency radio waves (RFs) or a magnetic field. Iron oxide nanoparticles are synthesized intracellularly as a GFP-tagged ferritin heavy and light chain fusion. The ferritin nanoparticles associate with a camelid anti-GFP-transient receptor potential vanilloid 1 fusion protein, αGFP-TRPV1, and can transduce noninvasive RF or magnetic fields into channel activation, also showing that TRPV1 can transduce a mechanical stimulus. This, in turn, initiates calcium-dependent transgene expression. In mice with stem cell or viral expression of these genetically encoded components, remote stimulation of insulin transgene expression with RF or a magnet lowers blood glucose. This robust, repeatable method for remote regulation in vivo may ultimately have applications in basic science, technology and therapeutics.
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Affiliation(s)
- Sarah A Stanley
- Laboratory of Molecular Genetics, Rockefeller University, New York, New York, USA
| | - Jeremy Sauer
- Department of Chemical and Biological Engineering, Department of Biology, Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, New York, USA
| | - Ravi S Kane
- Department of Chemical and Biological Engineering, Department of Biology, Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, New York, USA
| | - Jonathan S Dordick
- Department of Chemical and Biological Engineering, Department of Biology, Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, New York, USA
| | - Jeffrey M Friedman
- Laboratory of Molecular Genetics, Rockefeller University, New York, New York, USA
- Howard Hughes Medical Institute, New York, New York, USA
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Neuroimaging Effects of 1 Hz Right Temporoparietal rTMS on Normal Auditory Processing. J Clin Neurophysiol 2014; 31:541-6. [DOI: 10.1097/wnp.0000000000000098] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Beynel L, Chauvin A, Guyader N, Harquel S, Szekely D, Bougerol T, Marendaz C. What saccadic eye movements tell us about TMS-induced neuromodulation of the DLPFC and mood changes: a pilot study in bipolar disorders. Front Integr Neurosci 2014; 8:65. [PMID: 25191234 PMCID: PMC4137451 DOI: 10.3389/fnint.2014.00065] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 07/31/2014] [Indexed: 12/30/2022] Open
Abstract
The study assumed that the antisaccade (AS) task is a relevant psychophysical tool to assess (i) short-term neuromodulation of the dorsolateral prefrontal cortex (DLPFC) induced by intermittent theta burst stimulation (iTBS); and (ii) mood change occurring during the course of the treatment. Saccadic inhibition is known to strongly involve the DLPFC, whose neuromodulation with iTBS requires less stimulation time and lower stimulation intensity, as well as results in longer aftereffects than the conventional repetitive transcranial magnetic stimulation (rTMS). Active or sham iTBS was applied every day for 3 weeks over the left DLPFC of 12 drug-resistant bipolar depressed patients. To assess the iTBS-induced short-term neuromodulation, the saccadic task was performed just before (S1) and just after (S2) the iTBS session, the first day of each week. Mood was evaluated through Montgomery and Asberg Depression Rating Scale (MADRS) scores and the difference in scores between the beginning and the end of treatment was correlated with AS performance change between these two periods. As expected, only patients from the active group improved their performance from S1 to S2 and mood improvement was significantly correlated with AS performance improvement. In addition, the AS task also discriminated depressive bipolar patients from healthy control subjects. Therefore, the AS task could be a relevant and useful tool for clinicians to assess if the Transcranial magnetic stimulation (TMS)-induced short-term neuromodulation of the DLPFC occurs as well as a “trait vs. state” objective marker of depressive mood disorder.
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Affiliation(s)
- Lysianne Beynel
- Department of Psychology, Laboratory of Psychology and Neurocognition, Grenoble Alpes University, Université Pierre Mendes France Grenoble, France
| | - Alan Chauvin
- Department of Psychology, Laboratory of Psychology and Neurocognition, Grenoble Alpes University, Université Pierre Mendes France Grenoble, France
| | - Nathalie Guyader
- Department of Images and Signal, Grenoble Image Parole et Signal Automatique-Lab, Grenoble Alpes University, St Martin d'Héres Grenoble, France
| | - Sylvain Harquel
- Department of Psychology, Laboratory of Psychology and Neurocognition, Grenoble Alpes University, Université Pierre Mendes France Grenoble, France ; Department of Psychology, IRMaGe, Grenoble Alpes University Grenoble, France
| | - David Szekely
- Department of Psychiatry and Neurology, Hospital of Grenoble, Grenoble Alpes University La Tronche, France
| | - Thierry Bougerol
- Department of Psychiatry and Neurology, Hospital of Grenoble, Grenoble Alpes University La Tronche, France
| | - Christian Marendaz
- Department of Psychology, Laboratory of Psychology and Neurocognition, Grenoble Alpes University, Université Pierre Mendes France Grenoble, France
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