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Xu M, Nikolin S, Moffa AM, Xu XM, Su Y, Li R, Chan HF, Loo CK, Martin DM. Prolonged intermittent theta burst stimulation targeting the left prefrontal cortex and cerebellum does not affect executive functions in healthy individuals. Sci Rep 2024; 14:11847. [PMID: 38782921 PMCID: PMC11116424 DOI: 10.1038/s41598-024-61404-9] [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: 01/24/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) for alleviating negative symptoms and cognitive dysfunction in schizophrenia commonly targets the left dorsolateral prefrontal cortex (LDLPFC). However, the therapeutic effectiveness of rTMS at this site remains inconclusive and increasingly, studies are focusing on cerebellar rTMS. Recently, prolonged intermittent theta-burst stimulation (iTBS) has emerged as a rapid-acting form of rTMS with promising clinical benefits. This study explored the cognitive and neurophysiological effects of prolonged iTBS administered to the LDLPFC and cerebellum in a healthy cohort. 50 healthy participants took part in a cross-over study and received prolonged (1800 pulses) iTBS targeting the LDLPFC, cerebellar vermis, and sham iTBS. Mixed effects repeated measures models examined cognitive and event-related potentials (ERPs) from 2-back (P300, N200) and Stroop (N200, N450) tasks after stimulation. Exploratory non-parametric cluster-based permutation tests compared ERPs between conditions. There were no significant differences between conditions for behavioural and ERP outcomes on the 2-back and Stroop tasks. Exploratory cluster-based permutation tests of ERPs did not identify any significant differences between conditions. We did not find evidence that a single session of prolonged iTBS administered to either the LDLPFC or cerebellum could cause any cognitive or ERP changes compared to sham in a healthy sample.
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Affiliation(s)
- Mei Xu
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, School of Clinical Medicine, University of New South Wales, High St, Kensington, Sydney, NSW, 2052, Australia
- Black Dog Institute, Sydney, Australia
| | - Stevan Nikolin
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, School of Clinical Medicine, University of New South Wales, High St, Kensington, Sydney, NSW, 2052, Australia
- Black Dog Institute, Sydney, Australia
| | - Adriano M Moffa
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, School of Clinical Medicine, University of New South Wales, High St, Kensington, Sydney, NSW, 2052, Australia
- Black Dog Institute, Sydney, Australia
| | - Xiao Min Xu
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, School of Clinical Medicine, University of New South Wales, High St, Kensington, Sydney, NSW, 2052, Australia
| | - Yon Su
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, School of Clinical Medicine, University of New South Wales, High St, Kensington, Sydney, NSW, 2052, Australia
| | - Roger Li
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, School of Clinical Medicine, University of New South Wales, High St, Kensington, Sydney, NSW, 2052, Australia
| | - Ho Fung Chan
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, School of Clinical Medicine, University of New South Wales, High St, Kensington, Sydney, NSW, 2052, Australia
| | - Colleen K Loo
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, School of Clinical Medicine, University of New South Wales, High St, Kensington, Sydney, NSW, 2052, Australia
- Black Dog Institute, Sydney, Australia
- The George Institute for Global Health, Sydney, Australia
| | - Donel M Martin
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, School of Clinical Medicine, University of New South Wales, High St, Kensington, Sydney, NSW, 2052, Australia.
- Black Dog Institute, Sydney, Australia.
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Martin DM, Su Y, Chan HF, Dielenberg V, Chow E, Xu M, Wang A, Nikolin S, Moffa AH, Loo CK. Individualised Transcranial Magnetic Stimulation Targeting of the Left Dorsolateral Prefrontal Cortex for Enhancing Cognition: A Randomised Controlled Trial. Brain Sci 2024; 14:299. [PMID: 38671951 PMCID: PMC11048387 DOI: 10.3390/brainsci14040299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/28/2024] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) has been demonstrated to produce cognitive enhancing effects across different neuropsychiatric disorders; however, so far, these effects have been limited. This trial investigated the efficacy of using a novel individualised approach to target the left dorsolateral prefrontal cortex (L-DLPFC) for enhancing cognitive flexibility based on performance on a cognitive task. First, forty healthy participants had their single target site at the L-DLPFC determined based on each individual's performance on a random letter generation task. Participants then received, in a cross-over single-blinded experimental design, a single session of intermittent theta burst stimulation (iTBS) to their individualised DLPFC target site, an active control site and sham iTBS. Following each treatment condition, participants completed the Task Switching task and Colour-Word Stroop test. There was no significant main effect of treatment condition on the primary outcome measure of switch reaction times from the Task Switching task [F = 1.16 (2, 21.6), p = 0.33] or for any of the secondary cognitive outcome measures. The current results do not support the use of our novel individualised targeting methodology for enhancing cognitive flexibility in healthy participants. Research into alternative methodological targeting approaches is required to further improve rTMS's cognitive enhancing effects.
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Affiliation(s)
- Donel M. Martin
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
- Black Dog Institute, Sydney, NSW 2031, Australia
| | - Yon Su
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Ho Fung Chan
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Victoria Dielenberg
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Esther Chow
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Mei Xu
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
- Black Dog Institute, Sydney, NSW 2031, Australia
| | - Ashley Wang
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Stevan Nikolin
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
- Black Dog Institute, Sydney, NSW 2031, Australia
| | - Adriano H. Moffa
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
- Black Dog Institute, Sydney, NSW 2031, Australia
| | - Colleen K. Loo
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
- Black Dog Institute, Sydney, NSW 2031, Australia
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Zhang Y, Zhang Y, Chen Z, Ren P, Fu Y. Continuous high-frequency repetitive transcranial magnetic stimulation at extremely low intensity affects exploratory behavior and spatial cognition in mice. Behav Brain Res 2024; 458:114739. [PMID: 37926334 DOI: 10.1016/j.bbr.2023.114739] [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: 07/20/2023] [Revised: 10/13/2023] [Accepted: 11/01/2023] [Indexed: 11/07/2023]
Abstract
High-frequency repetitive transcranial magnetic stimulation (HF-rTMS) has been shown to be effective for cognitive intervention. However, whether HF-rTMS with extremely low intensity could influence cognitive functions is still under investigation. The present study systematically investigated the effects of continuous 40 Hz and 10 Hz rTMS on cognition in young adult mice at extremely low intensity (10 mT and 1 mT) for 11 days (30 min/day). Cognitive functions were assessed using diverse behavioral tasks, including the open field, Y-maze, and Barnes maze paradigms. We found that 40 Hz rTMS significantly impaired exploratory behavior and spatial memory in both 10 mT and 1 mT conditions. In addition, 40 Hz rTMS induced remarkably different effects on exploratory behavior between 10 mT and 1mT, compared to 10 Hz stimulation. Our results indicate that extremely low intensity rTMS can significantly alter cognitive performance depending on intensity and frequency, shedding light on the understanding of the mechanism of rTMS effects.
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Affiliation(s)
- Yunfan Zhang
- Medical School, Kunming University of Science & Technology, Kunming, Yunnan 650500, China
| | - Yunbin Zhang
- Medical School, Kunming University of Science & Technology, Kunming, Yunnan 650500, China
| | - Zhuangfei Chen
- Medical School, Kunming University of Science & Technology, Kunming, Yunnan 650500, China
| | - Ping Ren
- Department of Geriatric Psychiatry, Shenzhen Mental Health Center / Shenzhen Kangning Hospital, Shenzhen, Guangdong 518020, China.
| | - Yu Fu
- Medical School, Kunming University of Science & Technology, Kunming, Yunnan 650500, China.
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Xu X, Xu M, Su Y, Cao TV, Nikolin S, Moffa A, Loo C, Martin D. Efficacy of Repetitive Transcranial Magnetic Stimulation (rTMS) Combined with Psychological Interventions: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Brain Sci 2023; 13:1665. [PMID: 38137113 PMCID: PMC10741493 DOI: 10.3390/brainsci13121665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/17/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: Psychological interventions are effective in alleviating neuropsychiatric symptoms, though results can vary between patients. Repetitive transcranial magnetic stimulation (rTMS) has been proven to improve clinical symptoms and cognition. It remains unclear whether rTMS can augment the efficacy of psychological interventions. (2) Methods: We examined the effects of rTMS combined with psychological interventions on clinical, functional, and cognitive outcomes from randomized controlled trials conducted in healthy and clinical populations. We searched PubMed, EMBASE, Cochrane Library, and PsycINFO databases up to April 2023. (3) Results: Twenty-seven studies were ultimately included. Compared to sham rTMS combined with psychological interventions, active rTMS combined with psychological interventions significantly improved overall clinical symptoms (k = 16, SMD = 0.31, CIs 0.08 to 0.54, p < 0.01). We found that 10 or more sessions of rTMS combined with cognitive behavioural therapy significantly improved clinical outcomes overall (k = 3, SMD = 0.21, CIs 0.05 to 0.36, Z = 2.49, p < 0.01). RTMS combined with cognitive training (CT) significantly improved cognition overall compared to sham rTMS combined with CT (k = 13, SMD = 0.28, CIs 0.15 to 0.42, p < 0.01), with a significant effect on global cognition (k = 11, SMD = 0.45, CIs 0.21 to 0.68, p < 0.01), but not on the other cognitive domains. (4) Conclusion: The current results provide preliminary support for the augmentation effects of active rTMS on clinical and cognitive outcomes across diverse populations. Future clinical trials are required to confirm these augmentation effects for specific psychological interventions in specific clinical populations.
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Affiliation(s)
- Xiaomin Xu
- Discipline of Psychiatry & Mental Health, School of Clinical Medicine, Faulty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Mei Xu
- Discipline of Psychiatry & Mental Health, School of Clinical Medicine, Faulty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
- Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia
| | - Yon Su
- Discipline of Psychiatry & Mental Health, School of Clinical Medicine, Faulty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Thanh Vinh Cao
- Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia
| | - Stevan Nikolin
- Discipline of Psychiatry & Mental Health, School of Clinical Medicine, Faulty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
- Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia
| | - Adriano Moffa
- Discipline of Psychiatry & Mental Health, School of Clinical Medicine, Faulty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
- Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia
| | - Colleen Loo
- Discipline of Psychiatry & Mental Health, School of Clinical Medicine, Faulty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
- Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia
| | - Donel Martin
- Discipline of Psychiatry & Mental Health, School of Clinical Medicine, Faulty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
- Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia
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Wang P, Guan X, Su X, Wu F, Xiu M. A pilot study to examine the association between COX-2 rs5275 polymorphism and the response to repetitive transcranial stimulation in schizophrenia. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:56. [PMID: 37684257 PMCID: PMC10491610 DOI: 10.1038/s41537-023-00386-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 07/26/2023] [Indexed: 09/10/2023]
Abstract
High frequency (HF)-rTMS has been shown to improve cognitive functions in patients with schizophrenia (SCZ). This study aimed to investigate whether COX-2 rs5275 variants were associated with cognitive improvements following rTMS treatment in patients with SCZ. Forty-eight hospitalized patients with SCZ were assigned to the neuronavigation HF-rTMS group and 28 patients to the sham group over left DLPFC for 1 month. Cognitive function was evaluated using the repeatable battery for the assessment of neuropsychological status (RBANS) at weeks 0 and 4. COX-2 rs5275 polymorphism was genotyped by a technician. At baseline, C allele carriers showed better cognitive performance relative to patients with TT homozygote. Additionally, C allele carriers had greater improvement in memory from the follow-up to baseline following rTMS stimulation, while patients with the TT genotype showed no significant improvement in memory index. More importantly, we found that COX-2 rs5275 was correlated with the response to rTMS after controlling for the covariates. This study data indicate that COX-2 rs5275 was associated with improvements in immediate memory after HF-rTMS treatment in patients with SCZ. rTMS shows an effect on memory only in C allele carriers, but not in those with the TT genotype.
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Affiliation(s)
- Pingping Wang
- Neurology Department, Xuan Wu Hospital of Capital Medical University, Beijing, China
| | - Xiaoni Guan
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China
| | - Xiuru Su
- Hebei Rongjun Hospital, Baoding, China
| | - Fengchun Wu
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.
- Department of Biomedical Engineering, Guangzhou Medical University, Guangzhou, China.
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China.
| | - Meihong Xiu
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China.
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