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Roxburgh AD, White DJ, Grillon C, Cornwell BR. A neural oscillatory signature of sustained anxiety. COGNITIVE, AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2023; 23:1534-1544. [PMID: 37880568 PMCID: PMC10684633 DOI: 10.3758/s13415-023-01132-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Anxiety is a sustained response to uncertain threats; yet few studies have explored sustained neurobiological activities underlying anxious states, particularly spontaneous neural oscillations. To address this gap, we reanalysed magnetoencephalographic (MEG) data recorded during induced anxiety to identify differences in sustained oscillatory activity between high- and low-anxiety states. METHODS We combined data from three previous MEG studies in which healthy adults (total N = 51) were exposed to alternating periods of threat of unpredictable shock and safety while performing a range of cognitive tasks (passive oddball, mixed-saccade or stop-signal tasks). Spontaneous, band-limited, oscillatory activity was extracted from middle and late intervals of the threat and safe periods, and regional power distributions were reconstructed with adaptive beamforming. Conjunction analyses were used to identify regions showing overlapping spectral power differences between threat and safe periods across the three task paradigms. RESULTS MEG source analyses revealed a robust and widespread reduction in beta (14-30 Hz) power during threat periods in bilateral sensorimotor cortices extending into right prefrontal regions. Alpha (8-13 Hz) power reductions during threat were more circumscribed, with notable peaks in left intraparietal sulcus and thalamus. CONCLUSIONS Threat-induced anxiety is underpinned by a sustained reduction in spontaneous beta- and alpha-band activity in sensorimotor and parietal cortical regions. This general oscillatory pattern likely reflects a state of heightened action readiness and vigilance to cope with uncertain threats. Our findings provide a critical reference for which to identify abnormalities in cortical oscillatory activities in clinically anxious patients as well as evaluating the efficacy of anxiolytic treatments.
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Affiliation(s)
- Ariel D Roxburgh
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia.
- Turning Point, Eastern Health, Melbourne, Australia.
| | - David J White
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia
| | | | - Brian R Cornwell
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia
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2
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Kummar AS, Correia H, Tan J, Fujiyama H. An 8-week compassion and mindfulness-based exposure therapy program improves posttraumatic stress symptoms. Clin Psychol Psychother 2023. [PMID: 37947043 DOI: 10.1002/cpp.2929] [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: 01/17/2023] [Revised: 10/09/2023] [Accepted: 10/15/2023] [Indexed: 11/12/2023]
Abstract
The persistence of posttraumatic stress symptoms (PTSS) can be debilitating. However, many people experiencing such symptoms may not qualify for or may not seek treatment. Potentially contributing to ongoing residual symptoms of PTSS is emotion dysregulation. Meanwhile, the research area of mindfulness and compassion has grown to imply emotion regulation as one of its underlying mechanisms; yet, its influence on emotion regulation in PTSS cohort is unknown. Here, we explored the potential effectiveness of an 8-week Compassion-oriented and Mindfulness-based Exposure Therapy (CoMET) for individuals with PTSS using a waitlist control design. A total of 28 individuals (27 females, age range = 18-39 years) participated in the study (17 CoMET; 11 waitlist control). Following CoMET, participants reported significant decreases in PTSS severity (from clinical to non-clinical levels), emotion dysregulation and experiential avoidance, as well as significant increases in mindfulness, self-compassion and quality of life. Electroencephalogram-based brain network connectivity analysis revealed an increase in alpha-band connectivity following CoMET in a network that includes the amygdala, suggesting that CoMET successfully induced changes in functional connectivity between brain regions that play a crucial role in emotion regulation. In sum, the current study demonstrated promising intervention outcomes of CoMET in effectively alleviating the symptoms of PTSS via enhanced emotion regulation.
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Affiliation(s)
- Auretta Sonia Kummar
- School of Psychology, College of Health & Education, Murdoch University, Perth, Western Australia, Australia
| | - Helen Correia
- School of Psychology, College of Health & Education, Murdoch University, Perth, Western Australia, Australia
- Psychological Sciences, Australian College of Applied Professions, Perth, Western Australia, Australia
| | - Jane Tan
- School of Psychology, College of Health & Education, Murdoch University, Perth, Western Australia, Australia
| | - Hakuei Fujiyama
- School of Psychology, College of Health & Education, Murdoch University, Perth, Western Australia, Australia
- Centre for Healthy Ageing, Health Futures Institute, Murdoch University, Perth, Western Australia, Australia
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Perth, Western Australia, Australia
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3
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Sawalma AS, Kiefer CM, Boers F, Shah NJ, Khudeish N, Neuner I, Herzallah MM, Dammers J. The effects of trauma on feedback processing: an MEG study. Front Neurosci 2023; 17:1172549. [PMID: 38027493 PMCID: PMC10651751 DOI: 10.3389/fnins.2023.1172549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
The cognitive impact of psychological trauma can manifest as a range of post-traumatic stress symptoms that are often attributed to impairments in learning from positive and negative outcomes, aka reinforcement learning. Research on the impact of trauma on reinforcement learning has mainly been inconclusive. This study aimed to circumscribe the impact of psychological trauma on reinforcement learning in the context of neural response in time and frequency domains. Two groups of participants were tested - those who had experienced psychological trauma and a control group who had not - while they performed a probabilistic classification task that dissociates learning from positive and negative feedback during a magnetoencephalography (MEG) examination. While the exposure to trauma did not exhibit any effects on learning accuracy or response time for positive or negative feedback, MEG cortical activity was modulated in response to positive feedback. In particular, the medial and lateral orbitofrontal cortices (mOFC and lOFC) exhibited increased activity, while the insular and supramarginal cortices showed decreased activity during positive feedback presentation. Furthermore, when receiving negative feedback, the trauma group displayed higher activity in the medial portion of the superior frontal cortex. The timing of these activity changes occurred between 160 and 600 ms post feedback presentation. Analysis of the time-frequency domain revealed heightened activity in theta and alpha frequency bands (4-10 Hz) in the lOFC in the trauma group. Moreover, dividing the two groups according to their learning performance, the activity for the non-learner subgroup was found to be lower in lOFC and higher in the supramarginal cortex. These differences were found in the trauma group only. The results highlight the localization and neural dynamics of feedback processing that could be affected by exposure to psychological trauma. This approach and associated findings provide a novel framework for understanding the cognitive correlates of psychological trauma in relation to neural dynamics in the space, time, and frequency domains. Subsequent work will focus on the stratification of cognitive and neural correlates as a function of various symptoms of psychological trauma. Clinically, the study findings and approach open the possibility for neuromodulation interventions that synchronize cognitive and psychological constructs for individualized treatment.
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Affiliation(s)
- Abdulrahman S. Sawalma
- Institute of Neuroscience and Medicine (INM-4), Forschungszentrum Jülich GmbH, Jülich, Germany
- Faculty of Medicine, RWTH Aachen University, Aachen, Germany
- Palestinian Neuroscience Initiative, Al-Quds University, Abu Dis, Palestine
| | - Christian M. Kiefer
- Institute of Neuroscience and Medicine (INM-4), Forschungszentrum Jülich GmbH, Jülich, Germany
- Faculty of Mathematics, Computer Science and Natural Sciences, RWTH Aachen University, Aachen, Germany
| | - Frank Boers
- Institute of Neuroscience and Medicine (INM-4), Forschungszentrum Jülich GmbH, Jülich, Germany
| | - N. Jon Shah
- Institute of Neuroscience and Medicine (INM-4), Forschungszentrum Jülich GmbH, Jülich, Germany
- Institute of Neuroscience and Medicine (INM-11), Jülich Aachen Research Alliance (JARA), Forschungszentrum Jülich GmbH, Jülich, Germany
- Jülich Aachen Research Alliance (JARA)-Brain – Translational Medicine, Aachen, Germany
- Department of Neurology, University Hospital RWTH Aachen, Aachen, Germany
| | - Nibal Khudeish
- Institute of Neuroscience and Medicine (INM-4), Forschungszentrum Jülich GmbH, Jülich, Germany
- Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Irene Neuner
- Institute of Neuroscience and Medicine (INM-4), Forschungszentrum Jülich GmbH, Jülich, Germany
- Jülich Aachen Research Alliance (JARA)-Brain – Translational Medicine, Aachen, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Mohammad M. Herzallah
- Palestinian Neuroscience Initiative, Al-Quds University, Abu Dis, Palestine
- Center for Molecular and Behavioral Neuroscience, Rutgers University, Newark, NJ, United States
| | - Jürgen Dammers
- Institute of Neuroscience and Medicine (INM-4), Forschungszentrum Jülich GmbH, Jülich, Germany
- Faculty of Medicine, RWTH Aachen University, Aachen, Germany
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4
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Heesbeen EJ, Bijlsma EY, Verdouw PM, van Lissa C, Hooijmans C, Groenink L. The effect of SSRIs on fear learning: a systematic review and meta-analysis. Psychopharmacology (Berl) 2023; 240:2335-2359. [PMID: 36847831 PMCID: PMC10593621 DOI: 10.1007/s00213-023-06333-7] [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: 07/04/2022] [Accepted: 01/31/2023] [Indexed: 03/01/2023]
Abstract
RATIONALE Selective serotonin reuptake inhibitors (SSRIs) are considered first-line medication for anxiety-like disorders such as panic disorder, generalized anxiety disorder, and post-traumatic stress disorder. Fear learning plays an important role in the development and treatment of these disorders. Yet, the effect of SSRIs on fear learning are not well known. OBJECTIVE We aimed to systematically review the effect of six clinically effective SSRIs on acquisition, expression, and extinction of cued and contextual conditioned fear. METHODS We searched the Medline and Embase databases, which yielded 128 articles that met the inclusion criteria and reported on 9 human and 275 animal experiments. RESULTS Meta-analysis showed that SSRIs significantly reduced contextual fear expression and facilitated extinction learning to cue. Bayesian-regularized meta-regression further suggested that chronic treatment exerts a stronger anxiolytic effect on cued fear expression than acute treatment. Type of SSRI, species, disease-induction model, and type of anxiety test used did not seem to moderate the effect of SSRIs. The number of studies was relatively small, the level of heterogeneity was high, and publication bias has likely occurred which may have resulted in an overestimation of the overall effect sizes. CONCLUSIONS This review suggests that the efficacy of SSRIs may be related to their effects on contextual fear expression and extinction to cue, rather than fear acquisition. However, these effects of SSRIs may be due to a more general inhibition of fear-related emotions. Therefore, additional meta-analyses on the effects of SSRIs on unconditioned fear responses may provide further insight into the actions of SSRIs.
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Affiliation(s)
- Elise J Heesbeen
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Elisabeth Y Bijlsma
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - P Monika Verdouw
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Caspar van Lissa
- Department of Methodology, Tilburg University, Tilburg, Netherlands
| | - Carlijn Hooijmans
- Department of Anaesthesiology, Pain and Palliative Care, Radboud University Medical Center, Nijmegen, Netherlands
| | - Lucianne Groenink
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands.
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Askovic M, Soh N, Elhindi J, Harris AW. Neurofeedback for post-traumatic stress disorder: systematic review and meta-analysis of clinical and neurophysiological outcomes. Eur J Psychotraumatol 2023; 14:2257435. [PMID: 37732560 PMCID: PMC10515677 DOI: 10.1080/20008066.2023.2257435] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 07/22/2023] [Indexed: 09/22/2023] Open
Abstract
Background: Posttraumatic stress disorder (PTSD) is a debilitating condition affecting millions of people worldwide. Existing treatments often fail to address the complexity of its symptoms and functional impairments resulting from severe and prolonged trauma. Electroencephalographic Neurofeedback (NFB) has emerged as a promising treatment that aims to reduce the symptoms of PTSD by modulating brain activity.Objective: We conducted a systematic review and meta-analysis of ten clinical trials to answer the question: how effective is NFB in addressing PTSD and other associated symptoms across different trauma populations, and are these improvements related to neurophysiological changes?Method: The review followed the Preferred Reporting Items for Systematic Reviews and Meta analyses guidelines. We considered all published and unpublished randomised controlled trials (RCTs) and non-randomised studies of interventions (NRSIs) involving adults with PTSD as a primary diagnosis without exclusion by type of trauma, co-morbid diagnosis, locality, or sex. Ten controlled studies were included; seven RCTs and three NRSIs with a total number of participants n = 293 (128 male). Only RCTs were included in the meta-analysis (215 participants; 88 male).Results: All included studies showed an advantage of NFB over control conditions in reducing symptoms of PTSD, with indications of improvement in symptoms of anxiety and depression and related neurophysiological changes. Meta-analysis of the pooled data shows a significant reduction in PTSD symptoms post-treatment SMD of -1.76 (95% CI -2.69, -0.83), and the mean remission rate was higher in the NFB group (79.3%) compared to the control group (24.4%). However, the studies reviewed were mostly small, with heterogeneous populations and varied quality.Conclusions: The effect of NFB on the symptoms of PTSD was moderate and mechanistic evidence suggested that NFB leads to therapeutic changes in brain functioning. Future research should focus on more rigorous methodological designs, expanded sample size and longer follow-up.
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Affiliation(s)
- Mirjana Askovic
- New South Wales Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), Sydney, NSW, Australia
- Specialty of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Brain Dynamics Centre, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Nerissa Soh
- Specialty of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - James Elhindi
- Research and Education Network, Western Sydney Local Health District, Sydney, NSW, Australia
| | - Anthony W.F. Harris
- Specialty of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Brain Dynamics Centre, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia
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6
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Huang MX, Harrington DL, Angeles-Quinto A, Ji Z, Robb-Swan A, Huang CW, Shen Q, Hansen H, Baumgartner J, Hernandez-Lucas J, Nichols S, Jacobus J, Song T, Lerman I, Bazhenov M, Krishnan GP, Baker DG, Rao R, Lee RR. EMG-projected MEG High-Resolution Source Imaging of Human Motor Execution: Brain-Muscle Coupling above Movement Frequencies. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.06.23.23291825. [PMID: 37425691 PMCID: PMC10327237 DOI: 10.1101/2023.06.23.23291825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Magnetoencephalography (MEG) is a non-invasive functional imaging technique for pre-surgical mapping. However, movement-related MEG functional mapping of primary motor cortex (M1) has been challenging in presurgical patients with brain lesions and sensorimotor dysfunction due to the large numbers of trails needed to obtain adequate signal to noise. Moreover, it is not fully understood how effective the brain communication is with the muscles at frequencies above the movement frequency and its harmonics. We developed a novel Electromyography (EMG)-projected MEG source imaging technique for localizing M1 during ~1 minute recordings of left and right self-paced finger movements (~1 Hz). High-resolution MEG source images were obtained by projecting M1 activity towards the skin EMG signal without trial averaging. We studied delta (1-4 Hz), theta (4-7 Hz), alpha (8-12 Hz), beta (15-30 Hz), and gamma (30-90 Hz) bands in 13 healthy participants (26 datasets) and two presurgical patients with sensorimotor dysfunction. In healthy participants, EMG-projected MEG accurately localized M1 with high accuracy in delta (100.0%), theta (100.0%), and beta (76.9%) bands, but not alpha (34.6%) and gamma (0.0%) bands. Except for delta, all other frequency bands were above the movement frequency and its harmonics. In both presurgical patients, M1 activity in the affected hemisphere was also accurately localized, despite highly irregular EMG movement patterns in one patient. Altogether, our EMG-projected MEG imaging approach is highly accurate and feasible for M1 mapping in presurgical patients. The results also provide insight into movement related brain-muscle coupling above the movement frequency and its harmonics.
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Affiliation(s)
- Ming-Xiong Huang
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego, CA, USA
- Department of Electrical and Computer Engineering, University of California, San Diego, CA, USA
| | - Deborah L. Harrington
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego, CA, USA
| | | | - Zhengwei Ji
- Department of Radiology, University of California, San Diego, CA, USA
| | - Ashley Robb-Swan
- Department of Radiology, University of California, San Diego, CA, USA
| | - Charles W. Huang
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Qian Shen
- Department of Radiology, University of California, San Diego, CA, USA
| | - Hayden Hansen
- Department of Radiology, University of California, San Diego, CA, USA
| | - Jared Baumgartner
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
| | | | - Sharon Nichols
- Department of Neurosciences, University of California, San Diego, CA, USA
| | - Joanna Jacobus
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Tao Song
- Department of Radiology, University of California, San Diego, CA, USA
| | - Imanuel Lerman
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
| | - Maksim Bazhenov
- Department of Medicine, University of California, San Diego, CA, USA
| | - Giri P Krishnan
- Department of Medicine, University of California, San Diego, CA, USA
| | - Dewleen G. Baker
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
- VA Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
| | - Ramesh Rao
- Department of Electrical and Computer Engineering, University of California, San Diego, CA, USA
| | - Roland R. Lee
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego, CA, USA
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7
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Edgar JC, Franzen RE, McNamee M, Green HL, Shen G, DiPiero M, Liu S, Airey M, Goldin S, Blaskey L, Kuschner ES, Kim M, Konka K, Roberts TP, Chen Y. A comparison of resting-state eyes-closed and dark-room alpha-band activity in children. Psychophysiology 2023; 60:e14285. [PMID: 36929476 PMCID: PMC11097109 DOI: 10.1111/psyp.14285] [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: 05/03/2022] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 03/18/2023]
Abstract
In a relaxed and awake state with the eyes closed, 8-12 Hz neural oscillations are the dominant rhythm, most prominent in parietal-occipital regions. Resting-state (RS) alpha is associated with processing speed and is also thought to be central to how networks process information. Unfortunately, the RS eyes-closed (EC) exam can only be used with individuals who can remain awake with their eyes closed for an extended period. As such, infants, toddlers, and individuals with intellectual disabilities are usually excluded from RS alpha studies. Previous research suggests obtaining RS alpha measures in a dark room with the eyes open as a viable alternative to the traditional RS EC exam. To further explore this, RS EC and RS dark room (DR) eyes-open alpha activity was recorded using magnetoencephalography in children with typical development (TD; N = 37) and children with autism spectrum disorder (ASD; N = 30) 6.9-12.6 years old. Findings showed good reliability for the RS EC and DR peak alpha frequency (frequency with strongest alpha power; interclass correlation (ICC) = 0.83). ICCs for posterior alpha power were slightly lower (ICCs in the 0.70 s), with an ~ 5% reduction in posterior alpha power in the DR than EC condition. No differences in the EC and DR associations were observed between the TD and ASD groups. Finally, age was associated with both EC and DR peak alpha frequency. Findings thus indicate the DR exam as a viable way to obtain RS alpha measures in populations frequently excluded from electrophysiology RS studies.
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Affiliation(s)
- J. Christopher Edgar
- Lurie Family Foundations MEG Imaging Center, Department of Radiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania
| | - Rose E. Franzen
- Lurie Family Foundations MEG Imaging Center, Department of Radiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Marybeth McNamee
- Lurie Family Foundations MEG Imaging Center, Department of Radiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Heather L. Green
- Lurie Family Foundations MEG Imaging Center, Department of Radiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Guannan Shen
- Lurie Family Foundations MEG Imaging Center, Department of Radiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Marissa DiPiero
- Lurie Family Foundations MEG Imaging Center, Department of Radiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Song Liu
- Lurie Family Foundations MEG Imaging Center, Department of Radiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Megan Airey
- Lurie Family Foundations MEG Imaging Center, Department of Radiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sophia Goldin
- Lurie Family Foundations MEG Imaging Center, Department of Radiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lisa Blaskey
- Lurie Family Foundations MEG Imaging Center, Department of Radiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania
- Center for Autism Research, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Emily S. Kuschner
- Lurie Family Foundations MEG Imaging Center, Department of Radiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Center for Autism Research, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mina Kim
- Lurie Family Foundations MEG Imaging Center, Department of Radiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kimberly Konka
- Lurie Family Foundations MEG Imaging Center, Department of Radiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Timothy P.L. Roberts
- Lurie Family Foundations MEG Imaging Center, Department of Radiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania
| | - Yuhan Chen
- Lurie Family Foundations MEG Imaging Center, Department of Radiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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8
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Gimbel SI, Wang CC, Hungerford L, Twamley EW, Ettenhofer ML. Associations of mTBI and post-traumatic stress to amygdala structure and functional connectivity in military Service Members. FRONTIERS IN NEUROIMAGING 2023; 2:1129446. [PMID: 37554633 PMCID: PMC10406312 DOI: 10.3389/fnimg.2023.1129446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/07/2023] [Indexed: 08/10/2023]
Abstract
INTRODUCTION Traumatic brain injury (TBI) is one of the highest public health priorities, especially among military personnel where comorbidity with post-traumatic stress symptoms and resulting consequences is high. Brain injury and post-traumatic stress symptoms are both characterized by dysfunctional brain networks, with the amygdala specifically implicated as a region with both structural and functional abnormalities. METHODS This study examined the structural volumetrics and resting state functional connectivity of 68 Active Duty Service Members with or without chronic mild TBI (mTBI) and comorbid symptoms of Post-Traumatic Stress (PTS). RESULTS AND DISCUSSION Structural analysis of the amygdala revealed no significant differences in volume between mTBI and healthy comparison participants with and without post-traumatic stress symptoms. Resting state functional connectivity with bilateral amygdala revealed decreased anterior network connectivity and increased posterior network connectivity in the mTBI group compared to the healthy comparison group. Within the mTBI group, there were significant regions of correlation with amygdala that were modulated by PTS severity, including networks implicated in emotional processing and executive functioning. An examination of a priori regions of amygdala connectivity in the default mode network, task positive network, and subcortical structures showed interacting influences of TBI and PTS, only between right amygdala and right putamen. These results suggest that mTBI and PTS are associated with hypo-frontal and hyper-posterior amygdala connectivity. Additionally, comorbidity of these conditions appears to compound these neural activity patterns. PTS in mTBI may change neural resource recruitment for information processing between the amygdala and other brain regions and networks, not only during emotional processing, but also at rest.
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Affiliation(s)
- Sarah I. Gimbel
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, United States
- Traumatic Brain Injury Clinic, Naval Medical Center San Diego, San Diego, CA, United States
- General Dynamics Information Technology, Falls Church, VA, United States
| | - Cailynn C. Wang
- Department of Psychology, University of California, San Diego, San Diego, CA, United States
| | - Lars Hungerford
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, United States
- Traumatic Brain Injury Clinic, Naval Medical Center San Diego, San Diego, CA, United States
- General Dynamics Information Technology, Falls Church, VA, United States
| | - Elizabeth W. Twamley
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Mark L. Ettenhofer
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, United States
- Traumatic Brain Injury Clinic, Naval Medical Center San Diego, San Diego, CA, United States
- General Dynamics Information Technology, Falls Church, VA, United States
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
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9
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Popescu M, Popescu EA, DeGraba TJ, Hughes JD. Cognitive flexibility in post-traumatic stress disorder: Sustained interference associated with altered modulation of cortical oscillatory activity during task-switching. Neuroimage Clin 2023; 37:103297. [PMID: 36563647 PMCID: PMC9795531 DOI: 10.1016/j.nicl.2022.103297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/16/2022] [Accepted: 12/17/2022] [Indexed: 12/23/2022]
Abstract
Post-traumatic stress disorder (PTSD) is associated with deficits in cognitive flexibility, with evidence suggesting that these deficits may be a risk factor for the development of core PTSD symptoms. Understanding the neurophysiological substrate of this association could aid the development of effective therapies for PTSD. In this study, we investigated the relationship between post-traumatic stress severity (PTSS) in service members with combat exposure and the modulation of cortical oscillatory activity during a test of cognitive flexibility. Participants were assigned to three groups based on PTSS scores: low (well below a threshold consistent with a diagnosis of PTSD, n = 30), moderate (n = 32), and high (n = 29) symptom severity. Magnetoencephalography data were recorded while participants performed a cued rule-switching task in which two matching rules were repeated or switched across consecutive trials. Participants with high PTSS had longer reaction times for both switch and repeat trials, and showed evidence of sustained residual interference during repeat trials. During the cue-stimulus interval, participants with moderate and high PTSS showed higher relative theta power in switch trials over left dorsolateral prefrontal cortex (DLPFC). After test-stimulus onset, participants with high PTSS showed less suppression of beta band activity, which was present over multiple prefrontal, parietal, and temporal regions in switch trials, but it was confined to ventromedial prefrontal cortex in repeat trials. Higher theta band activity is a marker of effortful voluntary shifting of attention, while lower suppression of beta band activity reflects difficulties with inhibition of competing perceptual information and courses of action. These findings are consistent with a role for altered suppression of beta band activity, which can be due to less effective top-down bias signals exerted by DLPFC, in the etiology of cognitive flexibility deficits in PTSD.
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Affiliation(s)
- Mihai Popescu
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Elena-Anda Popescu
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Thomas J DeGraba
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - John D Hughes
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA; Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
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10
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Choi JJ, Martins JS, Hwang S, Sinha R, Seo D. Neural correlates linking trauma and physical symptoms. Psychiatry Res Neuroimaging 2022; 327:111560. [PMID: 36327865 PMCID: PMC9757618 DOI: 10.1016/j.pscychresns.2022.111560] [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: 06/27/2022] [Revised: 10/13/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
Trauma and chronic pain frequently co-occur, but the underlying neurological mechanisms are poorly understood. The current study investigated the neural correlates of stress and physical symptoms in trauma patients using functional magnetic resonance imaging (fMRI) and follow-up smartphone surveys. Participants were 10 patients diagnosed with Trauma- and Stressor-Related Disorders and 18 demographically-matched healthy controls who completed a fMRI stress provocation task in which they viewed stressful and neutral-relaxing images. Subsequently, participants completed daily smartphone surveys which prospectively monitored their stress and physical symptoms for 30 days. The trauma group experienced a significantly higher frequency of physical symptoms than controls during the follow-up period. During stress, trauma patients exhibited increased activity in the hippocampus, insula, and sensorimotor areas, but decreased activity in the ventromedial prefrontal cortex (vmPFC), lateral prefrontal cortex (LPFC), and dorsal striatum relative to controls. In all participants, higher physical symptom frequency was significantly associated with a hyperactive left hippocampal response to stress. The current study reports that trauma is characterized by greater physical symptoms and decreased prefrontal but increased limbic responses to stress. Our findings suggest that trauma may increase physical health symptoms by compromising hippocampal function, which could also increase vulnerability to stress- and pain-related disorders.
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Affiliation(s)
- Justin J Choi
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States of America.
| | - Jorge S Martins
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States of America; William James Center for Research, ISPA-Instituto Universitário, Lisbon, Portugal
| | - Seungju Hwang
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States of America
| | - Rajita Sinha
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States of America; Department of Neuroscience, Yale University School of Medicine, New Haven, CT, United States of America
| | - Dongju Seo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States of America.
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11
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Reuveni I, Herz N, Peri T, Schreiber S, Harpaz Y, Geisser R, Bonne O, Goldstein A. Neural oscillations while remembering traumatic memories in post-traumatic stress disorder. Clin Neurophysiol 2022; 139:58-68. [DOI: 10.1016/j.clinph.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 02/06/2022] [Accepted: 04/01/2022] [Indexed: 11/03/2022]
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12
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Fischer S, Schumacher S, Daniels J. Neurobiological Changes in Posttraumatic Stress Disorder and Their Reversibility by Psychotherapy. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2022. [DOI: 10.1026/1616-3443/a000650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Abstract. Background: Posttraumatic stress disorder (PTSD) is a debilitating illness associated with distressing symptoms and a high societal burden. Objective: To investigate the neurobiological underpinnings of PTSD to improve our understanding of this disorder and its treatment. Methods: This article reviews currently researched mechanisms that can explain the development of PTSD symptoms. It presents key findings on neural (i. e., brain functioning and brain structure), neuroendocrine (i. e., noradrenergic and hypothalamic-pituitary-adrenal axis activity), and related (epi)genetic changes in individuals with PTSD. Furthermore, it presents preliminary research examining the reversibility of these alterations during psychotherapeutic treatment. Results: PTSD is characterized by specific neurobiological alterations, with preliminary findings indicating that at least some of these may normalize during psychotherapy. Discussion: A multidimensional perspective on the development, maintenance, and treatment of PTSD has the potential to improve our understanding of the causal processes underlying the disorder and may ultimately inform the conception of novel treatments.
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Affiliation(s)
- Susanne Fischer
- Clinical Psychology and Psychotherapy, Institute of Psychology, University of Zurich, Switzerland
| | - Sarah Schumacher
- Clinical Psychology and Psychotherapy, Faculty of Health, Health and Medical University, Potsdam, Germany
| | - Judith Daniels
- Clinical Psychology, Faculty of Behavioral and Social Sciences, University of Groningen, The Netherlands
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13
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Földi T, Lőrincz ML, Berényi A. Temporally Targeted Interactions With Pathologic Oscillations as Therapeutical Targets in Epilepsy and Beyond. Front Neural Circuits 2021; 15:784085. [PMID: 34955760 PMCID: PMC8693222 DOI: 10.3389/fncir.2021.784085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/10/2021] [Indexed: 11/13/2022] Open
Abstract
Self-organized neuronal oscillations rely on precisely orchestrated ensemble activity in reverberating neuronal networks. Chronic, non-malignant disorders of the brain are often coupled to pathological neuronal activity patterns. In addition to the characteristic behavioral symptoms, these disturbances are giving rise to both transient and persistent changes of various brain rhythms. Increasing evidence support the causal role of these "oscillopathies" in the phenotypic emergence of the disease symptoms, identifying neuronal network oscillations as potential therapeutic targets. While the kinetics of pharmacological therapy is not suitable to compensate the disease related fine-scale disturbances of network oscillations, external biophysical modalities (e.g., electrical stimulation) can alter spike timing in a temporally precise manner. These perturbations can warp rhythmic oscillatory patterns via resonance or entrainment. Properly timed phasic stimuli can even switch between the stable states of networks acting as multistable oscillators, substantially changing the emergent oscillatory patterns. Novel transcranial electric stimulation (TES) approaches offer more reliable neuronal control by allowing higher intensities with tolerable side-effect profiles. This precise temporal steerability combined with the non- or minimally invasive nature of these novel TES interventions make them promising therapeutic candidates for functional disorders of the brain. Here we review the key experimental findings and theoretical background concerning various pathological aspects of neuronal network activity leading to the generation of epileptic seizures. The conceptual and practical state of the art of temporally targeted brain stimulation is discussed focusing on the prevention and early termination of epileptic seizures.
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Affiliation(s)
- Tamás Földi
- MTA-SZTE "Momentum" Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged, Hungary.,Neurocybernetics Excellence Center, University of Szeged, Szeged, Hungary.,HCEMM-USZ Magnetotherapeutics Research Group, University of Szeged, Szeged, Hungary.,Child and Adolescent Psychiatry, Department of the Child Health Center, University of Szeged, Szeged, Hungary
| | - Magor L Lőrincz
- MTA-SZTE "Momentum" Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged, Hungary.,Neurocybernetics Excellence Center, University of Szeged, Szeged, Hungary.,Department of Physiology, Anatomy and Neuroscience, Faculty of Sciences University of Szeged, Szeged, Hungary.,Neuroscience Division, Cardiff University, Cardiff, United Kingdom
| | - Antal Berényi
- MTA-SZTE "Momentum" Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged, Hungary.,Neurocybernetics Excellence Center, University of Szeged, Szeged, Hungary.,HCEMM-USZ Magnetotherapeutics Research Group, University of Szeged, Szeged, Hungary.,Neuroscience Institute, New York University, New York, NY, United States
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14
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du Bois N, Bigirimana AD, Korik A, Kéthina LG, Rutembesa E, Mutabaruka J, Mutesa L, Prasad G, Jansen S, Coyle DH. Neurofeedback with low-cost, wearable electroencephalography (EEG) reduces symptoms in chronic Post-Traumatic Stress Disorder. J Affect Disord 2021; 295:1319-1334. [PMID: 34706446 DOI: 10.1016/j.jad.2021.08.071] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 07/19/2021] [Accepted: 08/25/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The study examines the effectiveness of both neurofeedback and motor-imagery brain-computer interface (BCI) training, which promotes self-regulation of brain activity, using low-cost electroencephalography (EEG)-based wearable neurotechnology outside a clinical setting, as a potential treatment for post-traumatic stress disorder (PTSD) in Rwanda. METHODS Participants received training/treatment sessions along with a pre- and post- intervention clinical assessment, (N = 29; control n = 9, neurofeedback (NF, 7 sessions) n = 10, and motor-imagery (MI, 6 sessions) n = 10). Feedback was presented visually via a videogame. Participants were asked to regulate (NF) or intentionally modulate (MI) brain activity to affect/control the game. RESULTS The NF group demonstrated an increase in resting-state alpha 8-12 Hz bandpower following individual training sessions, termed alpha 'rebound' (Pz channel, p = 0.025, all channels, p = 0.024), consistent with previous research findings. This alpha 'rebound', unobserved in the MI group, produced a clinically relevant reduction in symptom severity in NF group, as revealed in three of seven clinical outcome measures: PCL-5 (p = 0.005), PTSD screen (p = 0.005), and HTQ (p = 0.005). LIMITATIONS Data collection took place in environments that posed difficulties in controlling environmental factors. Nevertheless, this limitation improves ecological validity, as neurotechnology treatments must be deployable outside controlled environments, to be a feasible technological treatment. CONCLUSIONS The study produced the first evidence to support a low-cost, neurotechnological solution for neurofeedback as an effective treatment of PTSD for victims of acute trauma in conflict zones in a developing country.
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Affiliation(s)
- N du Bois
- Intelligent Systems Research Centre, Ulster University (UU), Magee Campus, NI, United Kingdom
| | - A D Bigirimana
- Intelligent Systems Research Centre, Ulster University (UU), Magee Campus, NI, United Kingdom
| | - A Korik
- Intelligent Systems Research Centre, Ulster University (UU), Magee Campus, NI, United Kingdom
| | - L Gaju Kéthina
- Department of Clinical Psychology, College of Medicine and Health Sciences, University of Rwanda (UR), Huye, Rwanda
| | - E Rutembesa
- Department of Clinical Psychology, College of Medicine and Health Sciences, University of Rwanda (UR), Huye, Rwanda
| | - J Mutabaruka
- Department of Clinical Psychology, College of Medicine and Health Sciences, University of Rwanda (UR), Huye, Rwanda
| | - L Mutesa
- Centre for Human Genetics, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda (UR), Huye, Rwanda
| | - G Prasad
- Intelligent Systems Research Centre, Ulster University (UU), Magee Campus, NI, United Kingdom
| | - S Jansen
- Department of Clinical Psychology, College of Medicine and Health Sciences, University of Rwanda (UR), Huye, Rwanda
| | - D H Coyle
- Intelligent Systems Research Centre, Ulster University (UU), Magee Campus, NI, United Kingdom.
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15
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Pieper J, Chang DG, Mahasin SZ, Swan AR, Quinto AA, Nichols S, Diwakar M, Huang C, Swan J, Lee R, Baker DG, Huang M. Brain Amygdala Volume Increases in Veterans and Active-Duty Military Personnel With Combat-Related Posttraumatic Stress Disorder and Mild Traumatic Brain Injury. J Head Trauma Rehabil 2021; 35:E1-E9. [PMID: 31033749 PMCID: PMC6814512 DOI: 10.1097/htr.0000000000000492] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To identify amygdalar volumetric differences associated with posttraumatic stress disorder (PTSD) in individuals with comorbid mild traumatic brain injury (mTBI) compared with those with mTBI-only and to examine the effects of intracranial volume (ICV) on amygdala volumetric measures. SETTING Marine Corps Base and VA Healthcare System. PARTICIPANTS A cohort of veterans and active-duty military personnel with combat-related mTBI (N = 89). DESIGN Twenty-nine participants were identified with comorbid PTSD and mTBI. The remaining 60 formed the mTBI-only control group. Structural images of brains were obtained with a 1.5-T MRI scanner using a T1-weighted 3D-IR-FSPGR pulse sequence. Automatic segmentation was performed in Freesurfer. MAIN MEASURES Amygdala volumes with/without normalizations to ICV. RESULTS The comorbid mTBI/PTSD group had significantly larger amygdala volumes, when normalized to ICV, compared with the mTBI-only group. The right and left amygdala volumes after normalization to ICV were 0.122% ± 0.012% and 0.118% ± 0.011%, respectively, in the comorbid group compared with 0.115% ± 0.012% and 0.112% ± 0.009%, respectively, in the mTBI-only group (corrected P < .05). CONCLUSIONS The ICV normalization analysis performed here may resolve previous literature discrepancies. This is an intriguing structural finding, given the role of the amygdala in the challenging neuroemotive symptoms witnessed in casualties of combat-related mTBI and PTSD.
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Affiliation(s)
- Joel Pieper
- Department of Internal Medicine, University of California, San Diego, CA, USA
| | - Douglas G. Chang
- Department of Orthopaedic Surgery, University of California, San Diego, CA, USA
| | | | - Ashley Robb Swan
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego, CA, USA
| | - Annemarie Angeles Quinto
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego, CA, USA
| | - Sharon Nichols
- Department of Neuroscience, University of California, San Diego, CA, USA
| | - Mithun Diwakar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Charles Huang
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - James Swan
- Department of Management Information Systems, San Diego State University, San Diego, CA, USA
| | - Roland Lee
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego, CA, USA
| | - Dewleen G. Baker
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
- VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Mingxiong Huang
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego, CA, USA
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16
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Okonogi T, Sasaki T. Theta-Range Oscillations in Stress-Induced Mental Disorders as an Oscillotherapeutic Target. Front Behav Neurosci 2021; 15:698753. [PMID: 34177486 PMCID: PMC8219864 DOI: 10.3389/fnbeh.2021.698753] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/14/2021] [Indexed: 12/13/2022] Open
Abstract
Emotional behavior and psychological disorders are expressed through coordinated interactions across multiple brain regions. Brain electrophysiological signals are composed of diverse neuronal oscillations, representing cell-level to region-level neuronal activity patterns, and serve as a biomarker of mental disorders. Here, we review recent observations from rodents demonstrating how neuronal oscillations in the hippocampus, amygdala, and prefrontal cortex are engaged in emotional behavior and altered by psychiatric changes such as anxiety and depression. In particular, we focus mainly on theta-range (4–12 Hz) oscillations, including several distinct oscillations in this frequency range. We then discuss therapeutic possibilities related to controlling such mental disease-related neuronal oscillations to ameliorate psychiatric symptoms and disorders in rodents and humans.
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Affiliation(s)
- Toya Okonogi
- Laboratory of Chemical Pharmacology, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
| | - Takuya Sasaki
- Laboratory of Chemical Pharmacology, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
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17
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Huang MX, Huang CW, Harrington DL, Nichols S, Robb-Swan A, Angeles-Quinto A, Le L, Rimmele C, Drake A, Song T, Huang JW, Clifford R, Ji Z, Cheng CK, Lerman I, Yurgil KA, Lee RR, Baker DG. Marked Increases in Resting-State MEG Gamma-Band Activity in Combat-Related Mild Traumatic Brain Injury. Cereb Cortex 2021; 30:283-295. [PMID: 31041986 DOI: 10.1093/cercor/bhz087] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 01/08/2023] Open
Abstract
Combat-related mild traumatic brain injury (mTBI) is a leading cause of sustained impairments in military service members and veterans. Recent animal studies show that GABA-ergic parvalbumin-positive interneurons are susceptible to brain injury, with damage causing abnormal increases in spontaneous gamma-band (30-80 Hz) activity. We investigated spontaneous gamma activity in individuals with mTBI using high-resolution resting-state magnetoencephalography source imaging. Participants included 25 symptomatic individuals with chronic combat-related blast mTBI and 35 healthy controls with similar combat experiences. Compared with controls, gamma activity was markedly elevated in mTBI participants throughout frontal, parietal, temporal, and occipital cortices, whereas gamma activity was reduced in ventromedial prefrontal cortex. Across groups, greater gamma activity correlated with poorer performances on tests of executive functioning and visuospatial processing. Many neurocognitive associations, however, were partly driven by the higher incidence of mTBI participants with both higher gamma activity and poorer cognition, suggesting that expansive upregulation of gamma has negative repercussions for cognition particularly in mTBI. This is the first human study to demonstrate abnormal resting-state gamma activity in mTBI. These novel findings suggest the possibility that abnormal gamma activities may be a proxy for GABA-ergic interneuron dysfunction and a promising neuroimaging marker of insidious mild head injuries.
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Affiliation(s)
- Ming-Xiong Huang
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Radiology, University of California, San Diego, CA, USA
| | - Charles W Huang
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Deborah L Harrington
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Radiology, University of California, San Diego, CA, USA
| | - Sharon Nichols
- Department of Neuroscience, University of California, San Diego, CA, USA
| | - Ashley Robb-Swan
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Radiology, University of California, San Diego, CA, USA
| | - Annemarie Angeles-Quinto
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Radiology, University of California, San Diego, CA, USA
| | - Lu Le
- ASPIRE Center, VASDHS Residential Rehabilitation Treatment Program, San Diego, CA, USA
| | - Carl Rimmele
- ASPIRE Center, VASDHS Residential Rehabilitation Treatment Program, San Diego, CA, USA
| | - Angela Drake
- Cedar Sinai Medical Group Chronic Pain Program, Beverly Hills, CA, USA
| | - Tao Song
- Department of Radiology, University of California, San Diego, CA, USA
| | - Jeffrey W Huang
- Department of Computer Science, Columbia University, New York, NY, USA
| | - Royce Clifford
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, CA, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Zhengwei Ji
- Department of Radiology, University of California, San Diego, CA, USA
| | - Chung-Kuan Cheng
- Department of Computer Science and Engineering, University of California, San Diego, CA, USA
| | - Imanuel Lerman
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
| | - Kate A Yurgil
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA.,Department of Psychological Sciences, Loyola University, New Orleans, LA, USA
| | - Roland R Lee
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Radiology, University of California, San Diego, CA, USA
| | - Dewleen G Baker
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, CA, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
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18
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Hämäläinen M, Huang M, Bowyer SM. Magnetoencephalography Signal Processing, Forward Modeling, Magnetoencephalography Inverse Source Imaging, and Coherence Analysis. Neuroimaging Clin N Am 2021; 30:125-143. [PMID: 32336402 DOI: 10.1016/j.nic.2020.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Magnetoencephalography (MEG) is a noninvasive functional imaging technique for the brain. MEG directly measures the magnetic signal due to neuronal activation in gray matter with high spatial localization accuracy. The first part of this article covers the overall concepts of MEG and the forward and inverse modeling techniques. It is followed by examples of analyzing evoked and resting-state MEG signals using a high-resolution MEG source imaging technique. Next, different techniques for connectivity and network analysis are reviewed with examples showing connectivity estimates from resting-state and epileptic activity.
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Affiliation(s)
- Matti Hämäläinen
- Department of Radiology, Athinoula A. Martinos Center, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA; Harvard Medical School, Boston, MA, USA
| | - Mingxiong Huang
- Department of Radiology, UCSD Radiology Imaging Lab, University of California, San Diego, 3510 Dunhill Street, San Diego, CA 92121, USA
| | - Susan M Bowyer
- Department of Neurology, MEG Lab, Henry Ford Hospital, 2799 West Grand Boulevard, CFP 079, Detroit, MI 48202, USA; Wayne State University School of Medicine, Detroit, MI, USA; Department of Physics, Oakland University, Rochester, MI, USA.
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19
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Huang MX, Huang CW, Harrington DL, Robb-Swan A, Angeles-Quinto A, Nichols S, Huang JW, Le L, Rimmele C, Matthews S, Drake A, Song T, Ji Z, Cheng CK, Shen Q, Foote E, Lerman I, Yurgil KA, Hansen HB, Naviaux RK, Dynes R, Baker DG, Lee RR. Resting-state magnetoencephalography source magnitude imaging with deep-learning neural network for classification of symptomatic combat-related mild traumatic brain injury. Hum Brain Mapp 2021; 42:1987-2004. [PMID: 33449442 PMCID: PMC8046098 DOI: 10.1002/hbm.25340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 11/16/2020] [Accepted: 12/23/2020] [Indexed: 12/20/2022] Open
Abstract
Combat‐related mild traumatic brain injury (cmTBI) is a leading cause of sustained physical, cognitive, emotional, and behavioral disabilities in Veterans and active‐duty military personnel. Accurate diagnosis of cmTBI is challenging since the symptom spectrum is broad and conventional neuroimaging techniques are insensitive to the underlying neuropathology. The present study developed a novel deep‐learning neural network method, 3D‐MEGNET, and applied it to resting‐state magnetoencephalography (rs‐MEG) source‐magnitude imaging data from 59 symptomatic cmTBI individuals and 42 combat‐deployed healthy controls (HCs). Analytic models of individual frequency bands and all bands together were tested. The All‐frequency model, which combined delta‐theta (1–7 Hz), alpha (8–12 Hz), beta (15–30 Hz), and gamma (30–80 Hz) frequency bands, outperformed models based on individual bands. The optimized 3D‐MEGNET method distinguished cmTBI individuals from HCs with excellent sensitivity (99.9 ± 0.38%) and specificity (98.9 ± 1.54%). Receiver‐operator‐characteristic curve analysis showed that diagnostic accuracy was 0.99. The gamma and delta‐theta band models outperformed alpha and beta band models. Among cmTBI individuals, but not controls, hyper delta‐theta and gamma‐band activity correlated with lower performance on neuropsychological tests, whereas hypo alpha and beta‐band activity also correlated with lower neuropsychological test performance. This study provides an integrated framework for condensing large source‐imaging variable sets into optimal combinations of regions and frequencies with high diagnostic accuracy and cognitive relevance in cmTBI. The all‐frequency model offered more discriminative power than each frequency‐band model alone. This approach offers an effective path for optimal characterization of behaviorally relevant neuroimaging features in neurological and psychiatric disorders.
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Affiliation(s)
- Ming-Xiong Huang
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, California, USA.,Department of Radiology, University of California, San Diego, California, USA
| | - Charles W Huang
- Department of Bioengineering, Stanford University, Stanford, California, USA
| | - Deborah L Harrington
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, California, USA.,Department of Radiology, University of California, San Diego, California, USA
| | - Ashley Robb-Swan
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, California, USA.,Department of Radiology, University of California, San Diego, California, USA
| | - Annemarie Angeles-Quinto
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, California, USA.,Department of Radiology, University of California, San Diego, California, USA
| | - Sharon Nichols
- Department of Neurosciences, University of California, San Diego, California, USA
| | - Jeffrey W Huang
- Department of Computer Science, Columbia University, New York, New York, USA
| | - Lu Le
- ASPIRE Center, VASDHS Residential Rehabilitation Treatment Program, San Diego, California, USA
| | - Carl Rimmele
- ASPIRE Center, VASDHS Residential Rehabilitation Treatment Program, San Diego, California, USA
| | - Scott Matthews
- ASPIRE Center, VASDHS Residential Rehabilitation Treatment Program, San Diego, California, USA
| | - Angela Drake
- Cedar Sinai Medical Group Chronic Pain Program, Beverly Hills, California, USA
| | - Tao Song
- Department of Radiology, University of California, San Diego, California, USA
| | - Zhengwei Ji
- Department of Radiology, University of California, San Diego, California, USA
| | - Chung-Kuan Cheng
- Department of Computer Science and Engineering, University of California, San Diego, California, USA
| | - Qian Shen
- Department of Radiology, University of California, San Diego, California, USA
| | - Ericka Foote
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, California, USA
| | - Imanuel Lerman
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, California, USA
| | - Kate A Yurgil
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychological Sciences, Loyola University New Orleans, Louisiana, USA
| | - Hayden B Hansen
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, California, USA
| | - Robert K Naviaux
- Department of Medicine, University of California, San Diego, California, USA.,Department of Pediatrics, University of California, San Diego, California, USA.,Department of Pathology, University of California, San Diego, California, USA
| | - Robert Dynes
- Department of Physics, University of California, San Diego, California, USA
| | - Dewleen G Baker
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, California, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA
| | - Roland R Lee
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, California, USA.,Department of Radiology, University of California, San Diego, California, USA
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20
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Zhang J, Wong SM, Richardson JD, Jetly R, Dunkley BT. Predicting PTSD severity using longitudinal magnetoencephalography with a multi-step learning framework. J Neural Eng 2020; 17. [PMID: 33166947 DOI: 10.1088/1741-2552/abc8d6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 11/09/2020] [Indexed: 12/29/2022]
Abstract
Objective The present study explores the effectiveness of incorporating temporal information in predicting Post-Traumatic Stress Disorder (PTSD) severity using magnetoencephalography (MEG) imaging data. The main objective was to assess the relationship between longitudinal MEG functional connectome data, measured across a variety of neural oscillatory frequencies and collected at two-timepoints (Phase I & II), against PTSD severity captured at the later time point. Approach We used an in-house developed informatics solution, featuring a two-step process featuring pre-learn feature selection (CV-SVR-rRF-FS, cross-validation with support vector regression and recursive random forest feature selection) and deep learning (long-short term memory recurrent neural network, LSTM-RNN) techniques. Main results The pre-learn step selected a small number of functional connections (or edges) from Phase I MEG data associated with Phase II PTSD severity, indexed using the PTSD CheckList (PCL) score. This strategy identified the functional edges affected by traumatic exposure and indexed disease severity, either permanently or evolving dynamically over time, for optimal predictive performance. Using the selected functional edges, LSTM modelling was used to incorporate the Phase II MEG data into longitudinal regression models. Single timepoint (Phase I and Phase II MEG data) SVR models were generated for comparison. Assessed with holdout test data, alpha and high gamma bands showed enhanced predictive performance with the longitudinal models comparing to the Phase I single timepoint models. The best predictive performance was observed for lower frequency ranges compared to the higher frequencies (low gamma), for both model types. Significance This study identified the neural oscillatory signatures that benefited from additional temporal information when estimating the outcome of PTSD severity using MEG functional connectome data. Crucially, this approach can similarly be applied to any other mental health challenge, using this effective informatics foundation for longitudinal tracking of pathological brain states and predicting outcome with a MEG-based neurophysiology imaging system.
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Affiliation(s)
- Jing Zhang
- Hospital for Sick Children, Toronto, Ontario, M5G 1X8, CANADA
| | - Simeon M Wong
- Hospital for Sick Children, Toronto, Ontario, CANADA
| | | | - Rakesh Jetly
- Canadian Forces Health Services HQ, Ottawa, Ontario, CANADA
| | - Benjamin T Dunkley
- Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, CANADA
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21
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Clifford RE, Baker D, Risbrough VB, Huang M, Yurgil KA. Impact of TBI, PTSD, and Hearing Loss on Tinnitus Progression in a US Marine Cohort. Mil Med 2020; 184:839-846. [PMID: 30793178 DOI: 10.1093/milmed/usz016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/18/2018] [Accepted: 01/14/2019] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Mild TBI (TBI) is associated with up to a 75.7% incidence of tinnitus, and 33.0% of tinnitus patients at the US Veterans Administration carry a diagnosis of post-traumatic stress syndrome (PTSD). Yet factors contributing to new onset or exacerbation of tinnitus remain unclear. MATERIALS AND METHODS Here we measure intermittent and constant tinnitus at two time points to ascertain whether pre-existing or co-occurring traumatic brain injury (TBI), hearing loss, or post-traumatic stress disorder (PTSD) predicts new onset, lack of recovery and/or worsening of tinnitus in 2,600 United States Marines who were assessed before and after a combat deployment. RESULTS Ordinal regression revealed that constant tinnitus before deployment was likely to continue after deployment (odds ratio [OR] = 28.62, 95% confidence interval [CI]: 9.84,83.26). Prior intermittent tinnitus increased risk of post-deployment constant tinnitus (OR = 4.95, CI: 2.97,8.27). Likelihood of tinnitus progression increased with partial PTSD (OR = 2.39, CI: 1.50,3.80) and TBI (OR = 1.59, CI: 1.13,2.23), particularly for blast TBI (OR = 2.01, CI: 1.27,3.12) and moderate to severe TBI (OR = 2.57, CI: 1.46,4.51). Tinnitus progression also increased with low frequency hearing loss (OR = 1.94, CI: 1.05,3.59), high frequency loss (OR = 3.01, CI: 1.91,4.76) and loss across both low and high frequency ranges (OR = 5.73, CI: 2.67,12.30). CONCLUSIONS Screening for pre-existing or individual symptoms of PTSD, TBI, and hearing loss may allow for more focused treatment programs of comorbid disorders. Identification of those personnel vulnerable to tinnitus or its progression may direct increased acoustic protection for those at risk.
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Affiliation(s)
- Royce E Clifford
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA.,Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Drive, San Diego, CA.,Harvard University School of Public Health, 677 Huntington Ave, Boston, MA
| | - Dewleen Baker
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA.,Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Drive, San Diego, CA.,Department of Psychiatry, University of California San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA
| | - Victoria B Risbrough
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA.,Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Drive, San Diego, CA.,Department of Psychiatry, University of California San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA
| | - Mingxiong Huang
- Department of Radiology, University of California San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA
| | - Kate A Yurgil
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA.,Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Drive, San Diego, CA.,Department of Psychological Sciences, Loyola University New Orleans, 6363 St. Charles Ave., Box 194, New Orleans, LA
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22
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Fitzgerald JM, Belleau EL, Miskovich TA, Pedersen WS, Larson CL. Multi-voxel pattern analysis of amygdala functional connectivity at rest predicts variability in posttraumatic stress severity. Brain Behav 2020; 10:e01707. [PMID: 32525273 PMCID: PMC7428479 DOI: 10.1002/brb3.1707] [Citation(s) in RCA: 6] [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: 12/05/2019] [Revised: 04/16/2020] [Accepted: 05/15/2020] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Resting state functional magnetic resonance imaging (rsfMRI) studies demonstrate that individuals with posttraumatic stress disorder (PTSD) exhibit atypical functional connectivity (FC) between the amygdala, involved in the generation of emotion, and regions responsible for emotional appraisal (e.g., insula, orbitofrontal cortex [OFC]) and regulation (prefrontal cortex [PFC], anterior cingulate cortex). Consequently, atypical amygdala FC within an emotional processing and regulation network may be a defining feature of PTSD, although altered FC does not seem constrained to one brain region. Instead, altered amygdala FC involves a large, distributed brain network in those with PTSD. The present study used a machine-learning data-driven approach, multi-voxel pattern analysis (MVPA), to predict PTSD severity based on whole-brain patterns of amygdala FC. METHODS Trauma-exposed adults (N = 90) completed the PTSD Checklist-Civilian Version to assess symptoms and a 5-min rsfMRI. Whole-brain FC values to bilateral amygdala were extracted and used in a relevance vector regression analysis with a leave-one-out approach for cross-validation with permutation testing (1,000) to obtain significance values. RESULTS Results demonstrated that amygdala FC predicted PCL-C scores with statistically significant accuracy (r = .46, p = .001; mean sum of squares = 130.46, p = .001; R2 = 0.21, p = .001). Prediction was based on whole-brain amygdala FC, although regions that informed prediction (top 10%) included the OFC, amygdala, and dorsolateral PFC. CONCLUSION Findings demonstrate the utility of MVPA based on amygdala FC to predict individual severity of PTSD symptoms and that amygdala FC within a fear acquisition and regulation network contributed to accurate prediction.
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Affiliation(s)
| | - Emily L Belleau
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Walker S Pedersen
- Center for Healthy Minds, University of Wisconsin-Madison, Madison, WI, USA
| | - Christine L Larson
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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23
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Huang M, Lewine JD, Lee RR. Magnetoencephalography for Mild Traumatic Brain Injury and Posttraumatic Stress Disorder. Neuroimaging Clin N Am 2020; 30:175-192. [DOI: 10.1016/j.nic.2020.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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24
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Nicholson AA, Ros T, Jetly R, Lanius RA. Regulating posttraumatic stress disorder symptoms with neurofeedback: Regaining control of the mind. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2020. [DOI: 10.3138/jmvfh.2019-0032] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Neurofeedback is emerging as a psychophysiological treatment where self-regulation is achieved through online feedback of neural states. Novel personalized medicine approaches are particularly important for the treatment of posttraumatic stress disorder (PTSD), as symptom presentation of the disorder, as well as responses to treatment, are highly heterogeneous. Learning to achieve control of specific neural substrates through neurofeedback has been shown to display therapeutic evidence in patients with a wide variety of psychiatric disorders, including PTSD. This article outlines the neural mechanisms underlying neurofeedback and examines converging evidence for the efficacy of neurofeedback as an adjunctive treatment for PTSD via both electroencephalography (EEG) and real-time functional magnetic resonance imaging (fMRI) modalities. Further, implications for the treatment of PTSD via neurofeedback in the military member and Veteran population is examined.
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Affiliation(s)
- Andrew A. Nicholson
- Department of Psychological Research and Research Methods, University of Vienna, Vienna, Austria
- Neurology and Imaging of Cognition Lab, University of Geneva, Geneva, Switzerland
- Canadian Forces Health Services Group, Department of National Defence, Government of Canada, Ottawa
- Department of Psychology, Western University, London, Ontario
| | - Tomas Ros
- Department of Psychological Research and Research Methods, University of Vienna, Vienna, Austria
- Neurology and Imaging of Cognition Lab, University of Geneva, Geneva, Switzerland
- Canadian Forces Health Services Group, Department of National Defence, Government of Canada, Ottawa
- Department of Psychology, Western University, London, Ontario
| | - Rakesh Jetly
- Department of Psychological Research and Research Methods, University of Vienna, Vienna, Austria
- Neurology and Imaging of Cognition Lab, University of Geneva, Geneva, Switzerland
- Canadian Forces Health Services Group, Department of National Defence, Government of Canada, Ottawa
- Department of Psychology, Western University, London, Ontario
| | - Ruth A. Lanius
- Department of Psychological Research and Research Methods, University of Vienna, Vienna, Austria
- Neurology and Imaging of Cognition Lab, University of Geneva, Geneva, Switzerland
- Canadian Forces Health Services Group, Department of National Defence, Government of Canada, Ottawa
- Department of Psychology, Western University, London, Ontario
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25
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Intrinsic sensory disinhibition contributes to intrusive re-experiencing in combat veterans. Sci Rep 2020; 10:936. [PMID: 31969671 PMCID: PMC6976606 DOI: 10.1038/s41598-020-57963-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 01/07/2020] [Indexed: 12/16/2022] Open
Abstract
Intrusive re-experiencing of traumatic events is a hallmark symptom of posttraumatic stress disorder, characterized by rich and vivid sensory details as reported in "flashbacks". While prevailing models of trauma intrusions focus on dysregulated emotional processes, we hypothesize that a deficiency in intrinsic sensory inhibition could drive overactivation of sensory representations of trauma memories, precipitating sensory-rich intrusions. In a sample of combat veterans, we examined resting-state alpha (8-12 Hz) oscillatory activity (in both power and posterior→frontal connectivity), given its role in sensory cortical inhibition, in association with intrusive re-experiencing symptoms. Veterans further participated in an odor task (including both combat and non-combat odors) to assess olfactory trauma memory and emotional response. We observed an association between intrusive re-experiencing symptoms and attenuated resting-state posterior→frontal alpha connectivity, which were both correlated with olfactory trauma memory. Importantly, olfactory trauma memory was identified as a mediator of the relationship between alpha connectivity and intrusive re-experiencing, suggesting that deficits in intrinsic sensory inhibition contributed to intrusive re-experiencing of trauma via heightened trauma memory. Therefore, by permitting unfiltered sensory cues to enter information processing and activate sensory representations of trauma, sensory disinhibition can constitute a sensory mechanism of intrusive re-experiencing in trauma-exposed individuals.
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26
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Takeuchi Y, Berényi A. Oscillotherapeutics - Time-targeted interventions in epilepsy and beyond. Neurosci Res 2020; 152:87-107. [PMID: 31954733 DOI: 10.1016/j.neures.2020.01.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/18/2019] [Accepted: 12/19/2019] [Indexed: 02/09/2023]
Abstract
Oscillatory brain activities support many physiological functions from motor control to cognition. Disruptions of the normal oscillatory brain activities are commonly observed in neurological and psychiatric disorders including epilepsy, Parkinson's disease, Alzheimer's disease, schizophrenia, anxiety/trauma-related disorders, major depressive disorders, and drug addiction. Therefore, these disorders can be considered as common oscillation defects despite having distinct behavioral manifestations and genetic causes. Recent technical advances of neuronal activity recording and analysis have allowed us to study the pathological oscillations of each disorder as a possible biomarker of symptoms. Furthermore, recent advances in brain stimulation technologies enable time- and space-targeted interventions of the pathological oscillations of both neurological disorders and psychiatric disorders as possible targets for regulating their symptoms.
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Affiliation(s)
- Yuichi Takeuchi
- MTA-SZTE 'Momentum' Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged, 6720, Hungary; Department of Neuropharmacology, Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya, 467-8603, Japan.
| | - Antal Berényi
- MTA-SZTE 'Momentum' Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged, 6720, Hungary; HCEMM-SZTE Magnetotherapeutics Research Group, University of Szeged, Szeged, 6720, Hungary; Neuroscience Institute, New York University, New York, NY 10016, USA.
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27
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Huang MX, Robb Swan A, Angeles Quinto A, Huang JW, De-la-Garza BG, Huang CW, Hesselink JR, Bigler ED, Wilde EA, Max JE. Resting-State Magnetoencephalography Source Imaging Pilot Study in Children with Mild Traumatic Brain Injury. J Neurotrauma 2019; 37:994-1001. [PMID: 31724480 DOI: 10.1089/neu.2019.6417] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Mild traumatic brain injury (mTBI) accounts for the vast majority of all pediatric TBI. An important minority of children who have suffered an mTBI have enduring cognitive and emotional symptoms. However, the mechanisms of chronic symptoms in children with pediatric mTBI are not fully understood. This is in part due to the limited sensitivity of conventional neuroimaging technologies. The present study examined resting-state magnetoencephalography (rs-MEG) source images in 12 children who had mTBI and 12 age-matched control children. The rs-MEG exams were performed in children with mTBI 6 months after injury when they reported no clinically significant post-injury psychiatric changes and few if any somatic sensorimotor symptoms but did report cognitive symptoms. MEG source magnitude images were obtained for different frequency bands in alpha (8-12 Hz), beta (15-30 Hz), gamma (30-90 Hz), and low-frequency (1-7 Hz) bands. In contrast to the control participants, rs-MEG source imaging in the children with mTBI showed: 1) hyperactivity from the bilateral insular cortices in alpha, beta, and low-frequency bands, from the left amygdala in alpha band, and from the left precuneus in beta band; 2) hypoactivity from the bilateral dorsolateral prefrontal cortices (dlPFC) in alpha and beta bands, from the ventromedial prefrontal cortex (vmPFC) in beta band, from the ventrolateral prefrontal cortex (vlPFC) in gamma band, from the anterior cingulate cortex (ACC) in alpha band, and from the right precuneus in alpha band. The present study showed that MEG source imaging technique revealed abnormalities in the resting-state electromagnetic signals from the children with mTBI.
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Affiliation(s)
- Ming-Xiong Huang
- Department of Radiology, University of California, San Diego, California.,Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, California
| | - Ashley Robb Swan
- Department of Radiology, University of California, San Diego, California.,Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, California
| | - Annemarie Angeles Quinto
- Department of Radiology, University of California, San Diego, California.,Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, California
| | - Jeffrey W Huang
- Department of Computer Sciences, Columbia University, New York, New York
| | | | - Charles W Huang
- Department of Bioengineering, Stanford University, Stanford, California
| | - John R Hesselink
- Department of Radiology, University of California, San Diego, California
| | - Erin D Bigler
- Department of Neurology, University of Utah, Salt Lake City, Utah
| | | | - Jeffrey E Max
- Department of Psychiatry, University of California, San Diego, California.,Department of Psychiatry, Rady Children's Hospital, San Diego, California
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28
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Popescu M, Popescu EA, DeGraba TJ, Hughes JD. Altered modulation of beta band oscillations during memory encoding is predictive of lower subsequent recognition performance in post-traumatic stress disorder. Neuroimage Clin 2019; 25:102154. [PMID: 31951934 PMCID: PMC6965746 DOI: 10.1016/j.nicl.2019.102154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/25/2019] [Accepted: 12/26/2019] [Indexed: 11/23/2022]
Abstract
We studied the relationship between electrophysiological markers of memory encoding, subsequent recognition performance, and severity of PTSD symptoms in service members with combat exposure (n = 40, age: 41.2 ± 7.2 years) and various levels of PTSD symptom severity assessed using the PTSD Check List for DSM V version (PCL-5). Brain activity was recorded using magnetoencephalography during a serial presentation of 86 images of outdoor scenes that were studied by participants for an upcoming recognition test. In a second session, the original images were shown intermixed with an equal number of novel images while participants performed the recognition task. Participants recognized 76.0% ± 12.1% of the original images and correctly categorized as novel 89.9% ± 7.0% of the novel images. A negative correlation was present between PCL-5 scores and discrimination performance (Spearman rs = -0.38, p = 0.016). PCL-5 scores were also negatively correlated with the recognition accuracy for original images (rs = -0.37, p = 0.02). Increases in theta and gamma power and decreases in alpha and beta power were observed over distributed brain networks during memory encoding. Higher PCL-5 scores were associated with less suppression of beta band power in bilateral ventral and medial temporal regions and in the left orbitofrontal cortex. These regions also showed positive correlations between the magnitude of suppression of beta power during encoding and subsequent recognition accuracy. These findings indicate that the lower recognition performance in participants with greater PTSD symptom severity may be due in part to ineffective encoding reflected in altered modulation of beta band oscillatory activity.
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Affiliation(s)
- Mihai Popescu
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Elena-Anda Popescu
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Thomas J DeGraba
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - John D Hughes
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, United States; Behavioral Biology Branch, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD 20910, United States.
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29
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Lewine JD, Plis S, Ulloa A, Williams C, Spitz M, Foley J, Paulson K, Davis J, Bangera N, Snyder T, Weaver L. Quantitative EEG Biomarkers for Mild Traumatic Brain Injury. J Clin Neurophysiol 2019; 36:298-305. [DOI: 10.1097/wnp.0000000000000588] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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30
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Koek RJ, Roach J, Athanasiou N, van 't Wout-Frank M, Philip NS. Neuromodulatory treatments for post-traumatic stress disorder (PTSD). Prog Neuropsychopharmacol Biol Psychiatry 2019; 92:148-160. [PMID: 30641094 DOI: 10.1016/j.pnpbp.2019.01.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 12/19/2018] [Accepted: 01/10/2019] [Indexed: 12/12/2022]
Abstract
Electroconvulsive therapy has been used successfully in some individuals with posttraumatic stress disorder (PTSD) whose symptoms have not improved with other treatments. But there are only a few reports. Meanwhile, an array of new neuromodulation strategies, including repetitive transcranial magnetic stimulation, transcranial direct current stimulation, vagus nerve stimulation, trigeminal nerve stimulation, and deep brain stimulation have been developed and applied experimentally in the treatment of other psychiatric disorders. This article will review the clinical evidence and mechanistic basis for their use in PTSD.
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Affiliation(s)
- Ralph J Koek
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at Los Angeles, CA, USA; Sepulveda Ambulatory Care Center, Veterans Administration Greater Los Angeles Healthcare System, North Hills, CA, USA.
| | - Janine Roach
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at Los Angeles, CA, USA; Oliveview Medical Center, Sylmar, CA, USA
| | - Nicholas Athanasiou
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at Los Angeles, CA, USA; San Fernando Mental Health Center, Granada Hills, CA, USA
| | - Mascha van 't Wout-Frank
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Noah S Philip
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, USA
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31
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Spadoni AD, Huang M, Simmons AN. Emerging Approaches to Neurocircuits in PTSD and TBI: Imaging the Interplay of Neural and Emotional Trauma. Curr Top Behav Neurosci 2019; 38:163-192. [PMID: 29285732 PMCID: PMC8896198 DOI: 10.1007/7854_2017_35] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) commonly co-occur in general and military populations and have a number of overlapping symptoms. While research suggests that TBI is risk factor for PTSD and that PTSD may mediate TBI-related outcomes, the mechanisms of these relationships are not well understood. Neuroimaging may help elucidate patterns of neurocircuitry both specific and common to PTSD and TBI and thus help define the nature of their interaction, refine diagnostic classification, and may potentially yield opportunities for targeted treatments. In this review, we provide a summary of some of the most common and the most innovative neuroimaging approaches used to characterize the neural circuits associated with PTSD, TBI, and their comorbidity. We summarize the state of the science for each disorder and describe the few studies that have explicitly attempted to characterize the neural substrates of their shared and dissociable influence. While some promising targets in the medial frontal lobes exist, there is not currently a comprehensive understanding of the neurocircuitry mediating the interaction of PTSD and TBI. Future studies should exploit innovative neuroimaging approaches and longitudinal designs to specifically target the neural mechanisms driving PTSD-TBI-related outcomes.
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Affiliation(s)
- Andrea D Spadoni
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA.
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
| | - Mingxiong Huang
- Radiology and Research Services, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Alan N Simmons
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
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32
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Ruzich E, Crespo‐García M, Dalal SS, Schneiderman JF. Characterizing hippocampal dynamics with MEG: A systematic review and evidence-based guidelines. Hum Brain Mapp 2019; 40:1353-1375. [PMID: 30378210 PMCID: PMC6456020 DOI: 10.1002/hbm.24445] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 10/12/2018] [Accepted: 10/16/2018] [Indexed: 12/12/2022] Open
Abstract
The hippocampus, a hub of activity for a variety of important cognitive processes, is a target of increasing interest for researchers and clinicians. Magnetoencephalography (MEG) is an attractive technique for imaging spectro-temporal aspects of function, for example, neural oscillations and network timing, especially in shallow cortical structures. However, the decrease in MEG signal-to-noise ratio as a function of source depth implies that the utility of MEG for investigations of deeper brain structures, including the hippocampus, is less clear. To determine whether MEG can be used to detect and localize activity from the hippocampus, we executed a systematic review of the existing literature and found successful detection of oscillatory neural activity originating in the hippocampus with MEG. Prerequisites are the use of established experimental paradigms, adequate coregistration, forward modeling, analysis methods, optimization of signal-to-noise ratios, and protocol trial designs that maximize contrast for hippocampal activity while minimizing those from other brain regions. While localizing activity to specific sub-structures within the hippocampus has not been achieved, we provide recommendations for improving the reliability of such endeavors.
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Affiliation(s)
- Emily Ruzich
- Department of Clinical Neurophysiology and MedTech West, Institute of Neuroscience and PhysiologySahlgrenska Academy & the University of GothenburgGothenburgSweden
| | | | - Sarang S. Dalal
- Center of Functionally Integrative NeuroscienceAarhus UniversityAarhus CDenmark
| | - Justin F. Schneiderman
- Department of Clinical Neurophysiology and MedTech West, Institute of Neuroscience and PhysiologySahlgrenska Academy & the University of GothenburgGothenburgSweden
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Viard A, Mutlu J, Chanraud S, Guenolé F, Egler PJ, Gérardin P, Baleyte JM, Dayan J, Eustache F, Guillery-Girard B. Altered default mode network connectivity in adolescents with post-traumatic stress disorder. NEUROIMAGE-CLINICAL 2019; 22:101731. [PMID: 30831461 PMCID: PMC6402428 DOI: 10.1016/j.nicl.2019.101731] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 02/14/2019] [Accepted: 02/20/2019] [Indexed: 11/22/2022]
Abstract
Post-traumatic stress disorder (PTSD) is characterized by intrusions, re-experiencing, avoidance and hyperarousal. These symptoms might be linked to dysfunction in core neurocognitive networks subserving self-referential mental processing (default mode network, DMN), detection of salient stimuli (salience network, SN) and cognitive dysfunction (central executive network, CEN). Resting state studies in adolescent PTSD are scarce and findings are inconsistent, probably due to differences in patient symptom severity. Resting state brain activity was measured in 14 adolescents with severe PTSD and 24 age-matched controls. Seed-based connectivity analyses were used to examine connectivity between the DMN and the whole brain, including regions from other networks (SN and CEN). The relationships of network properties with symptom dimensions (severity, anxiety and depression) and episodic memory were also examined. Analyses revealed decreased within-DMN connectivity (between PCC and occipital cortex) in patients compared to controls. Furthermore, within-DMN connectivity (between PCC and hippocampus) correlated negatively with symptom dimensions (severity and anxiety), while increased connectivity (DMN-SN and DMN-CEN) correlated positively with episodic memory measures. These abnormal network properties found in adolescent PTSD corroborate those previously reported in adult PTSD. Decreased within-DMN connectivity and disrupted DMN-SN and DMN-CEN coupling could form the basis for intrusive trauma recollection and impaired episodic autobiographical recall in PTSD. Adolescent PTSD is linked to dysfunction in core neurocognitive networks. Results show decreased within-DMN connectivity in patients compared to controls. Within-DMN connectivity correlates negatively with severity and anxiety. Increased DMN-SN connectivity correlates positively with episodic memory. Disrupted connectivity may form the basis for intrusive trauma recollection in PTSD.
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Affiliation(s)
- Armelle Viard
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000 Caen, France.
| | - Justine Mutlu
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000 Caen, France
| | - Sandra Chanraud
- INCIA CNRS UMR 5287, PSL Research University, EPHE, Université Bordeaux, Bordeaux, France
| | - Fabian Guenolé
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000 Caen, France; CHU de Caen, Service de Psychiatrie de l'Enfant et de l'Adolescent, Caen, France
| | - Pierre-Jean Egler
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000 Caen, France; CHU de Caen, Service de Psychiatrie de l'Enfant et de l'Adolescent, Caen, France
| | - Priscille Gérardin
- CHU de Rouen, Fédération hospitalo-universitaire de psychiatrie de l'enfant et de l'adolescent, Rouen, France
| | - Jean-Marc Baleyte
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000 Caen, France; CHU de Caen, Service de Psychiatrie de l'Enfant et de l'Adolescent, Caen, France
| | - Jacques Dayan
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000 Caen, France; CHGR Rennes-I, Service de Psychiatrie de l'Enfant et de l'Adolescent, Rennes, France
| | - Francis Eustache
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000 Caen, France
| | - Bérengère Guillery-Girard
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000 Caen, France
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Matsubara T, Ogata K, Hironaga N, Uehara T, Mitsudo T, Shigeto H, Maekawa T, Tobimatsu S. Monaural 40-Hz auditory steady-state magnetic responses can be useful for identifying epileptic focus in mesial temporal lobe epilepsy. Clin Neurophysiol 2018; 130:341-351. [PMID: 30669010 DOI: 10.1016/j.clinph.2018.11.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/19/2018] [Accepted: 11/28/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Patients with mesial temporal lobe epilepsy (mTLE) often exhibit central auditory processing (CAP) dysfunction. Monaural 40-Hz auditory steady-state magnetic responses (ASSRs) were recorded to explore the pathophysiology of mTLE. METHODS Eighteen left mTLE patients, 11 right mTLE patients and 16 healthy controls (HCs) were examined. Monaural clicks were presented at a rate of 40 Hz. Phase-locking factor (PLF) and power values were analyzed within bilateral Heschl's gyri. RESULTS Monaural 40-Hz ASSR demonstrated temporal frequency dynamics in both PLF and power data. Symmetrical hemispheric contralaterality was revealed in HCs. However, predominant contralaterality was absent in mTLE patients. Specifically, right mTLE patients exhibited a lack of contralaterality in response to left ear but not right ear stimulation, and vice versa in left mTLE patients. CONCLUSION This is the first study to use monaural 40-Hz ASSR with unilateral mTLE patients to clarify the relationship between CAP and epileptic focus. CAP dysfunction was characterized by a lack of contralaterality corresponding to epileptic focus. SIGNIFICANCE Monaural 40-Hz ASSR can provide useful information for localizing epileptic focus in mTLE patients.
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Affiliation(s)
- Teppei Matsubara
- Department of Clinical Neurophysiology, Neurological Institute, Faculty of Medicine, Graduate School of Medical Sciences, Kyushu University, Japan.
| | - Katsuya Ogata
- Department of Clinical Neurophysiology, Neurological Institute, Faculty of Medicine, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Naruhito Hironaga
- Department of Clinical Neurophysiology, Neurological Institute, Faculty of Medicine, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Taira Uehara
- Department of Clinical Neurophysiology, Neurological Institute, Faculty of Medicine, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Takako Mitsudo
- Department of Clinical Neurophysiology, Neurological Institute, Faculty of Medicine, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Hiroshi Shigeto
- Epilepsy and Sleep Center, Fukuoka Sanno Hospital, Fukuoka, Japan
| | | | - Shozo Tobimatsu
- Department of Clinical Neurophysiology, Neurological Institute, Faculty of Medicine, Graduate School of Medical Sciences, Kyushu University, Japan
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Dunkley BT, Urban K, Da Costa L, Wong SM, Pang EW, Taylor MJ. Default Mode Network Oscillatory Coupling Is Increased Following Concussion. Front Neurol 2018; 9:280. [PMID: 29755402 PMCID: PMC5932404 DOI: 10.3389/fneur.2018.00280] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 04/09/2018] [Indexed: 11/13/2022] Open
Abstract
Concussion is a common form of mild traumatic brain injury. Despite the descriptor "mild," a single injury can leave long-lasting and sustained alterations to brain function, including changes to localized activity and large-scale interregional communication. Cognitive complaints are thought to arise from such functional deficits. We investigated the impact of injury on neurophysiological and functionally specialized resting networks, known as intrinsic connectivity networks (ICNs), using magnetoencephalography. We assessed neurophysiological connectivity in 40 males, 20 with concussion and 20 without. Regions-of-interest that comprise nodes of ICNs were defined, and their time courses derived using a beamformer approach. Pairwise fluctuations and covariations in band-limited amplitude envelopes were computed reflecting measures of functional connectivity. Intra-network connectivity was compared between groups using permutation testing and correlated with symptoms. We observed increased resting spectral connectivity in the default mode network (DMN) and motor networks (MOTs) in our concussion group when compared with controls, across alpha through gamma ranges. Moreover, these differences were not explained by power spectrum density within the ICNs. Furthermore, this increased coupling was significantly associated with symptoms in the DMN and MOTs-but once accounting for comorbidities (including, depression, anxiety, and ADHD) only the DMN continued to be associated with symptoms. The DMN plays a critical role in shifting between cognitive tasks. These data suggest even a single concussion can perturb the intrinsic coupling of this functionally specialized network in the brain, and may explain persistent and wide-ranging symptomatology.
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Affiliation(s)
- Benjamin T. Dunkley
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
- Neurosciences & Mental Health Program, Sick Kids Research Institute, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Karolina Urban
- Holland-Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | | | - Simeon M Wong
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | - Elizabeth W. Pang
- Neurosciences & Mental Health Program, Sick Kids Research Institute, Toronto, ON, Canada
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Margot J. Taylor
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
- Neurosciences & Mental Health Program, Sick Kids Research Institute, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- Department of Psychology, University of Toronto, Toronto, ON, Canada
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Philip NS, Barredo J, van ‘t Wout-Frank M, Tyrka AR, Price LH, Carpenter LL. Network Mechanisms of Clinical Response to Transcranial Magnetic Stimulation in Posttraumatic Stress Disorder and Major Depressive Disorder. Biol Psychiatry 2018; 83:263-272. [PMID: 28886760 PMCID: PMC6679924 DOI: 10.1016/j.biopsych.2017.07.021] [Citation(s) in RCA: 162] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 07/21/2017] [Accepted: 07/21/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (TMS) therapy can modulate pathological neural network functional connectivity in major depressive disorder (MDD). Posttraumatic stress disorder is often comorbid with MDD, and symptoms of both disorders can be alleviated with TMS therapy. This is the first study to evaluate TMS-associated changes in connectivity in patients with comorbid posttraumatic stress disorder and MDD. METHODS Resting-state functional connectivity magnetic resonance imaging was acquired before and after TMS therapy in 33 adult outpatients in a prospective open trial. TMS at 5 Hz was delivered, in up to 40 daily sessions, to the left dorsolateral prefrontal cortex. Analyses used a priori seeds relevant to TMS, posttraumatic stress disorder, or MDD (subgenual anterior cingulate cortex [sgACC], left dorsolateral prefrontal cortex, hippocampus, and basolateral amygdala) to identify imaging predictors of response and to evaluate clinically relevant changes in connectivity after TMS, followed by leave-one-out cross-validation. Imaging results were explored using data-driven multivoxel pattern activation. RESULTS More negative pretreatment connectivity between the sgACC and the default mode network predicted clinical improvement, as did more positive amygdala-to-ventromedial prefrontal cortex connectivity. After TMS, symptom reduction was associated with reduced connectivity between the sgACC and the default mode network, left dorsolateral prefrontal cortex, and insula, and reduced connectivity between the hippocampus and the salience network. Multivoxel pattern activation confirmed seed-based predictors and correlates of treatment outcomes. CONCLUSIONS These results highlight the central role of the sgACC, default mode network, and salience network as predictors of TMS response and suggest their involvement in mechanisms of action. Furthermore, this work indicates that there may be network-based biomarkers of clinical response relevant to these commonly comorbid disorders.
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Affiliation(s)
- Noah S. Philip
- Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence RI 02908,Butler Hospital Mood Disorders Research Program and Neuromodulation Research Facility Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence RI, 02906,Address correspondence to: Noah S. Philip MD, Providence VA Medical Center, 830 Chalkstone Ave, Providence RI 02908;
| | - Jennifer Barredo
- Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence RI 02908
| | - Mascha van ‘t Wout-Frank
- Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence RI 02908
| | - Audrey R. Tyrka
- Butler Hospital Mood Disorders Research Program and Neuromodulation Research Facility Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence RI, 02906
| | - Lawrence H. Price
- Butler Hospital Mood Disorders Research Program and Neuromodulation Research Facility Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence RI, 02906
| | - Linda L. Carpenter
- Butler Hospital Mood Disorders Research Program and Neuromodulation Research Facility Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence RI, 02906
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Badura-Brack A, McDermott TJ, Becker KM, Ryan TJ, Khanna MM, Pine DS, Bar-Haim Y, Heinrichs-Graham E, Wilson TW. Attention training modulates resting-state neurophysiological abnormalities in posttraumatic stress disorder. Psychiatry Res 2018; 271:135-141. [PMID: 29174765 PMCID: PMC5741514 DOI: 10.1016/j.pscychresns.2017.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 11/02/2017] [Accepted: 11/12/2017] [Indexed: 12/12/2022]
Abstract
Recent research indicates the relative benefits of computerized attention control treatment (ACT) and attention bias modification treatment (ABMT) for posttraumatic stress disorder (PTSD); however, neural changes underlying these therapeutic effects remain unknown. This study examines how these two types of attention training modulate neurological dysfunction in veterans with PTSD. A community sample of 46 combat veterans with PTSD participated in a randomized double-blinded clinical trial of ACT versus ABMT and 32 of those veterans also agreed to undergo resting-state magnetoencephalography (MEG) recordings. Twenty-four veterans completed psychological and MEG assessments at pre- and post-training to evaluate treatment effects. MEG data were imaged using an advanced Bayesian reconstruction method and examined using statistical parametric mapping. In this report, we focus on the neural correlates and the differential treatment effects observed using MEG; the results of the full clinical trial have been described elsewhere. Our results indicated that ACT modulated occipital and ABMT modulated medial temporal activity more strongly than the comparative treatment. PTSD symptoms decreased significantly from pre- to post-test. These initial neurophysiological outcome data suggest that ACT modulates visual pathways, while ABMT modulates threat-processing regions, but that both are associated with normalizing aberrant neural activity in veterans with PTSD.
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Affiliation(s)
- Amy Badura-Brack
- Department of Psychology, Creighton University, 2500 California Plaza, Omaha, NE 68178, USA.
| | - Timothy J McDermott
- Department of Psychology, Creighton University, 2500 California Plaza, Omaha, NE 68178, USA; Center for Magnetoencephalography (MEG), University of Nebraska Medical Center (UNMC), Omaha, NE, USA
| | - Katherine M Becker
- Center for Magnetoencephalography (MEG), University of Nebraska Medical Center (UNMC), Omaha, NE, USA; Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | - Tara J Ryan
- Department of Psychology, Creighton University, 2500 California Plaza, Omaha, NE 68178, USA; Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Maya M Khanna
- Department of Psychology, Creighton University, 2500 California Plaza, Omaha, NE 68178, USA
| | - Daniel S Pine
- Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA
| | - Yair Bar-Haim
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel; The Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Elizabeth Heinrichs-Graham
- Center for Magnetoencephalography (MEG), University of Nebraska Medical Center (UNMC), Omaha, NE, USA; Department of Neurological Sciences, UNMC, Omaha, NE, USA
| | - Tony W Wilson
- Center for Magnetoencephalography (MEG), University of Nebraska Medical Center (UNMC), Omaha, NE, USA; Department of Neurological Sciences, UNMC, Omaha, NE, USA
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Edgar JC, Fisk CL, Chen YH, Stone-Howell B, Hunter MA, Huang M, Bustillo JR, Cañive JM, Miller GA. By our bootstraps: Comparing methods for measuring auditory 40 Hz steady-state neural activity. Psychophysiology 2017; 54:1110-1127. [PMID: 28421620 DOI: 10.1111/psyp.12876] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 03/10/2017] [Accepted: 03/16/2017] [Indexed: 11/29/2022]
Abstract
Although the 40 Hz auditory steady-state response (ASSR) is of clinical interest, the construct validity of EEG and MEG measures of 40 Hz ASSR cortical microcircuits is unclear. This study evaluated several MEG and EEG metrics by leveraging findings of (a) an association between the 40 Hz ASSR and age in the left but not right hemisphere, and (b) right- > left-hemisphere differences in the strength of the 40 Hz ASSR. The contention is that, if an analysis method does not demonstrate a left 40 Hz ASSR and age relationship or hemisphere differences, then the obtained measures likely have low validity. Fifty-three adults were presented 500 Hz stimuli modulated at 40 Hz while MEG and EEG were collected. ASSR activity was examined as a function of phase similarity (intertrial coherence) and percent change from baseline (total power). A variety of head models (spherical and realistic) and a variety of dipole source modeling strategies (dipole source localization and dipoles fixed to Heschl's gyri) were compared. Several sensor analysis strategies were also tested. EEG sensor measures failed to detect left 40 Hz ASSR and age associations or hemisphere differences. A comparison of MEG and EEG head-source models showed similarity in the 40 Hz ASSR measures and in estimating age and left 40 Hz ASSR associations, indicating good construct validity across models. Given a goal of measuring the 40 Hz ASSR cortical microcircuits, a source-modeling approach was shown to be superior in measuring this construct versus methods that rely on EEG sensor measures.
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Affiliation(s)
- J Christopher Edgar
- Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Charles L Fisk
- Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yu-Han Chen
- Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Breannan Stone-Howell
- University of New Mexico School of Medicine, Department of Psychiatry, Center for Psychiatric Research, Albuquerque, New Mexico.,New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, New Mexico
| | - Michael A Hunter
- University of New Mexico School of Medicine, Department of Psychiatry, Center for Psychiatric Research, Albuquerque, New Mexico.,New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, New Mexico
| | - Mingxiong Huang
- University of California, San Diego, Department of Radiology, San Diego, California.,San Diego VA Healthcare System, Department of Radiology, San Diego, California
| | - Juan R Bustillo
- University of New Mexico School of Medicine, Department of Psychiatry, Center for Psychiatric Research, Albuquerque, New Mexico
| | - José M Cañive
- University of New Mexico School of Medicine, Department of Psychiatry, Center for Psychiatric Research, Albuquerque, New Mexico.,New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, New Mexico
| | - Gregory A Miller
- University of California, Los Angeles, Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, Los Angeles, California
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Nicholson AA, Rabellino D, Densmore M, Frewen PA, Paret C, Kluetsch R, Schmahl C, Théberge J, Neufeld RW, McKinnon MC, Reiss J, Jetly R, Lanius RA. The neurobiology of emotion regulation in posttraumatic stress disorder: Amygdala downregulation via real-time fMRI neurofeedback. Hum Brain Mapp 2017; 38:541-560. [PMID: 27647695 PMCID: PMC6866912 DOI: 10.1002/hbm.23402] [Citation(s) in RCA: 129] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 08/31/2016] [Accepted: 08/31/2016] [Indexed: 12/11/2022] Open
Abstract
Amygdala dysregulation has been shown to be central to the pathophysiology of posttraumatic stress disorder (PTSD) representing a critical treatment target. Here, amygdala downregulation was targeted using real-time fMRI neurofeedback (rt-fMRI-nf) in patients with PTSD, allowing us to examine further the regulation of emotional states during symptom provocation. Patients (n = 10) completed three sessions of rt-fMRI-nf with the instruction to downregulate activation in the amygdala, while viewing personalized trauma words. Amygdala downregulation was assessed by contrasting (a) regulate trials, with (b) viewing trauma words and not attempting to regulate. Training was followed by one transfer run not involving neurofeedback. Generalized psychophysiological interaction (gPPI) and dynamic causal modeling (DCM) analyses were also computed to explore task-based functional connectivity and causal structure, respectively. It was found that PTSD patients were able to successfully downregulate both right and left amygdala activation, showing sustained effects within the transfer run. Increased activation in the dorsolateral and ventrolateral prefrontal cortex (PFC), regions related to emotion regulation, was observed during regulate as compared with view conditions. Importantly, activation in the PFC, rostral anterior cingulate cortex, and the insula, were negatively correlated to PTSD dissociative symptoms in the transfer run. Increased functional connectivity between the amygdala- and both the dorsolateral and dorsomedial PFC was found during regulate, as compared with view conditions during neurofeedback training. Finally, our DCM analysis exploring directional structure suggested that amygdala downregulation involves both top-down and bottom-up information flow with regard to observed PFC-amygdala connectivity. This is the first demonstration of successful downregulation of the amygdala using rt-fMRI-nf in PTSD, which was critically sustained in a subsequent transfer run without neurofeedback, and corresponded to increased connectivity with prefrontal regions involved in emotion regulation during the intervention. Hum Brain Mapp 38:541-560, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Andrew A. Nicholson
- Department of NeuroscienceWestern UniversityLondonOntarioCanada
- Department of PsychiatryWestern UniversityLondonOntarioCanada
- Department of ImagingLawson Health Research InstituteLondonOntarioCanada
| | - Daniela Rabellino
- Department of PsychiatryWestern UniversityLondonOntarioCanada
- Department of ImagingLawson Health Research InstituteLondonOntarioCanada
| | - Maria Densmore
- Department of ImagingLawson Health Research InstituteLondonOntarioCanada
| | - Paul A. Frewen
- Department of NeuroscienceWestern UniversityLondonOntarioCanada
- Department of PsychologyWestern UniversityLondonOntarioCanada
| | - Christian Paret
- Department of NeuroimagingCentral Institute of Mental Health Mannheim, Medical, Faculty Mannheim/Heidelberg UniversityHeidelbergGermany
- Department of Psychosomatic Medicine and PsychotherapyCentral Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg UniversityHeidelbergGermany
| | - Rosemarie Kluetsch
- Department of Psychosomatic Medicine and PsychotherapyCentral Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg UniversityHeidelbergGermany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and PsychotherapyCentral Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg UniversityHeidelbergGermany
| | - Jean Théberge
- Department of PsychiatryWestern UniversityLondonOntarioCanada
- Department of ImagingLawson Health Research InstituteLondonOntarioCanada
- Department of Medical ImagingWestern UniversityLondonOntarioCanada
- Department ofMedial Biophysics, Western UniversityLondonOntarioCanada
- Department of Diagnostic ImagingSt. Joseph's HealthcareLondonOntarioCanada
| | - Richard W.J. Neufeld
- Department of NeuroscienceWestern UniversityLondonOntarioCanada
- Department of PsychiatryWestern UniversityLondonOntarioCanada
- Department of PsychologyWestern UniversityLondonOntarioCanada
| | - Margaret C. McKinnon
- Mood Disorders Program and Clinical Neuropsychology ServiceSt. Joseph's HealthcareHamiltonOntarioCanada
- Department of Psychiatry and Behavioural NeuroscienceMcMaster UniversityHamiltonOntarioCanada
| | - Jim Reiss
- Department of PsychiatryWestern UniversityLondonOntarioCanada
| | - Rakesh Jetly
- Canadian Forces, Health ServicesOttawaOntarioCanada
| | - Ruth A. Lanius
- Department of NeuroscienceWestern UniversityLondonOntarioCanada
- Department of PsychiatryWestern UniversityLondonOntarioCanada
- Department of ImagingLawson Health Research InstituteLondonOntarioCanada
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Huang MX, Harrington DL, Robb Swan A, Angeles Quinto A, Nichols S, Drake A, Song T, Diwakar M, Huang CW, Risbrough VB, Dale A, Bartsch H, Matthews S, Huang JW, Lee RR, Baker DG. Resting-State Magnetoencephalography Reveals Different Patterns of Aberrant Functional Connectivity in Combat-Related Mild Traumatic Brain Injury. J Neurotrauma 2016; 34:1412-1426. [PMID: 27762653 DOI: 10.1089/neu.2016.4581] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Blast mild traumatic brain injury (mTBI) is a leading cause of sustained impairment in military service members and veterans. However, the mechanism of persistent disability is not fully understood. The present study investigated disturbances in brain functioning in mTBI participants using a source-imaging-based approach to analyze functional connectivity (FC) from resting-state magnetoencephalography (rs-MEG). Study participants included 26 active-duty service members or veterans who had blast mTBI with persistent post-concussive symptoms, and 22 healthy control active-duty service members or veterans. The source time courses from regions of interest (ROIs) were used to compute ROI to whole-brain (ROI-global) FC for different frequency bands using two different measures: 1) time-lagged cross-correlation and 2) phase-lock synchrony. Compared with the controls, blast mTBI participants showed increased ROI-global FC in beta, gamma, and low-frequency bands, but not in the alpha band. Sources of abnormally increased FC included the: 1) prefrontal cortex (right ventromedial prefrontal cortex [vmPFC], right rostral anterior cingulate cortex [rACC]), and left ventrolateral and dorsolateral prefrontal cortex; 2) medial temporal lobe (bilateral parahippocampus, hippocampus, and amygdala); and 3) right putamen and cerebellum. In contrast, the blast mTBI group also showed decreased FC of the right frontal pole. Group differences were highly consistent across the two different FC measures. FC of the left ventrolateral prefrontal cortex correlated with executive functioning and processing speed in mTBI participants. Altogether, our findings of increased and decreased regionalpatterns of FC suggest that disturbances in intrinsic brain connectivity may be the result of multiple mechanisms, and are associated with cognitive sequelae of the injury.
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Affiliation(s)
- Ming-Xiong Huang
- 1 Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System , San Diego, California.,2 Department of Radiology, University of California , San Diego, California
| | - Deborah L Harrington
- 1 Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System , San Diego, California.,2 Department of Radiology, University of California , San Diego, California
| | - Ashley Robb Swan
- 1 Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System , San Diego, California.,2 Department of Radiology, University of California , San Diego, California
| | - Annemarie Angeles Quinto
- 1 Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System , San Diego, California.,2 Department of Radiology, University of California , San Diego, California
| | - Sharon Nichols
- 3 Department of Neuroscience, University of California , San Diego, California
| | | | - Tao Song
- 2 Department of Radiology, University of California , San Diego, California
| | - Mithun Diwakar
- 2 Department of Radiology, University of California , San Diego, California
| | - Charles W Huang
- 5 Department of Bioengineering, University of California , San Diego, California
| | - Victoria B Risbrough
- 6 Department of Psychiatry, University of California , San Diego, California.,7 VA Center of Excellence for Stress and Mental Health , San Diego, California
| | - Anders Dale
- 2 Department of Radiology, University of California , San Diego, California
| | - Hauke Bartsch
- 2 Department of Radiology, University of California , San Diego, California
| | - Scott Matthews
- 1 Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System , San Diego, California.,6 Department of Psychiatry, University of California , San Diego, California.,8 Aspire Center , VASDHS Residential Rehabilitation Treatment Program, San Diego, California
| | | | - Roland R Lee
- 1 Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System , San Diego, California.,2 Department of Radiology, University of California , San Diego, California
| | - Dewleen G Baker
- 1 Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System , San Diego, California.,6 Department of Psychiatry, University of California , San Diego, California.,7 VA Center of Excellence for Stress and Mental Health , San Diego, California
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Back SE, McCauley JL, Korte KJ, Gros DF, Leavitt V, Gray KM, Hamner MB, DeSantis SM, Malcolm R, Brady KT, Kalivas PW. A Double-Blind, Randomized, Controlled Pilot Trial of N-Acetylcysteine in Veterans With Posttraumatic Stress Disorder and Substance Use Disorders. J Clin Psychiatry 2016; 77:e1439-e1446. [PMID: 27736051 PMCID: PMC5226873 DOI: 10.4088/jcp.15m10239] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 04/20/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The antioxidant N-acetylcysteine is being increasingly investigated as a therapeutic agent in the treatment of substance use disorders (SUDs). This study explored the efficacy of N-acetylcysteine in the treatment of posttraumatic stress disorder (PTSD), which frequently co-occurs with SUD and shares impaired prefrontal cortex regulation of basal ganglia circuitry, in particular at glutamate synapses in the nucleus accumbens. METHODS Veterans with PTSD and SUD per DSM-IV criteria (N = 35) were randomly assigned to receive a double-blind, 8-week course of N-acetylcysteine (2,400 mg/d) or placebo plus cognitive-behavioral therapy for SUD (between March 2013 and April 2014). Primary outcome measures included PTSD symptoms (Clinician-Administered PTSD Scale, PTSD Checklist-Military) and craving (Visual Analog Scale). Substance use and depression were also assessed. RESULTS Participants treated with N-acetylcysteine compared to placebo evidenced significant improvements in PTSD symptoms, craving, and depression (β values < -0.33; P values < .05). Substance use was low for both groups, and no significant between-group differences were observed. N-acetylcysteine was well tolerated, and retention was high. CONCLUSIONS This is the first randomized controlled trial to investigate N-acetylcysteine as a pharmacologic treatment for PTSD and SUD. Although preliminary, the findings provide initial support for the use of N-acetylcysteine in combination with psychotherapy among individuals with co-occurring PTSD and SUD. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02499029.
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Affiliation(s)
- Sudie E. Back
- Medical University of South Carolina, Charleston, SC,Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | | | - Kristina J. Korte
- Medical University of South Carolina, Charleston, SC,Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | - Daniel F. Gros
- Medical University of South Carolina, Charleston, SC,Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | | | - Kevin M. Gray
- Medical University of South Carolina, Charleston, SC
| | - Mark B. Hamner
- Medical University of South Carolina, Charleston, SC,Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | | | - Robert Malcolm
- Medical University of South Carolina, Charleston, SC,Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | - Kathleen T. Brady
- Medical University of South Carolina, Charleston, SC,Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
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McCloskey MS, Phan KL, Angstadt M, Fettich KC, Keedy S, Coccaro EF. Amygdala hyperactivation to angry faces in intermittent explosive disorder. J Psychiatr Res 2016; 79:34-41. [PMID: 27145325 DOI: 10.1016/j.jpsychires.2016.04.006] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 04/20/2016] [Accepted: 04/21/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Individuals with intermittent explosive disorder (IED) were previously found to exhibit amygdala hyperactivation and relatively reduced orbital medial prefrontal cortex (OMPFC) activation to angry faces while performing an implicit emotion information processing task during functional magnetic resonance imaging (fMRI). This study examines the neural substrates associated with explicit encoding of facial emotions among individuals with IED. METHOD Twenty unmedicated IED subjects and twenty healthy, matched comparison subjects (HC) underwent fMRI while viewing blocks of angry, happy, and neutral faces and identifying the emotional valence of each face (positive, negative or neutral). We compared amygdala and OMPFC reactivity to faces between IED and HC subjects. We also examined the relationship between amygdala/OMPFC activation and aggression severity. RESULTS Compared to controls, the IED group exhibited greater amygdala response to angry (vs. neutral) facial expressions. In contrast, IED and control groups did not differ in OMPFC activation to angry faces. Across subjects amygdala activation to angry faces was correlated with number of prior aggressive acts. CONCLUSIONS These findings extend previous evidence of amygdala dysfunction in response to the identification of an ecologically-valid social threat signal (processing angry faces) among individuals with IED, further substantiating a link between amygdala hyperactivity to social signals of direct threat and aggression.
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Affiliation(s)
| | - K Luan Phan
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA; Mental Health Service Line, Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Mike Angstadt
- Department of Psychiatry, The University of Michigan, Ann Arbor, MI, USA
| | - Karla C Fettich
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Sarah Keedy
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
| | - Emil F Coccaro
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
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Alpha oscillations and their impairment in affective and post-traumatic stress disorders. Neurosci Biobehav Rev 2016; 68:794-815. [PMID: 27435239 DOI: 10.1016/j.neubiorev.2016.07.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 06/26/2016] [Accepted: 07/06/2016] [Indexed: 12/28/2022]
Abstract
Affective and anxiety disorders are debilitating conditions characterized by impairments in cognitive and social functioning. Elucidating their neural underpinnings may assist in improving diagnosis and developing targeted interventions. Neural oscillations are fundamental for brain functioning. Specifically, oscillations in the alpha frequency range (alpha rhythms) are prevalent in the awake, conscious brain and play an important role in supporting perceptual, cognitive, and social processes. We review studies utilizing various alpha power measurements to assess abnormalities in brain functioning in affective and anxiety disorders as well as obsessive compulsive and post-traumatic stress disorders. Despite some inconsistencies, studies demonstrate associations between aberrant alpha patterns and these disorders both in response to specific cognitive and emotional tasks and during a resting state. We conclude by discussing methodological considerations and future directions, and underscore the need for much further research on the role of alpha functionality in social contexts. As social dysfunction accompanies most psychiatric conditions, research on alpha's involvement in social processes may provide a unique window into the neural mechanisms underlying these disorders.
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Nicholson AA, Ros T, Frewen PA, Densmore M, Théberge J, Kluetsch RC, Jetly R, Lanius RA. Alpha oscillation neurofeedback modulates amygdala complex connectivity and arousal in posttraumatic stress disorder. Neuroimage Clin 2016; 12:506-516. [PMID: 27672554 PMCID: PMC5030332 DOI: 10.1016/j.nicl.2016.07.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 04/13/2016] [Accepted: 07/12/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Electroencephalogram (EEG) neurofeedback aimed at reducing the amplitude of the alpha-rhythm has been shown to alter neural networks associated with posttraumatic stress disorder (PTSD), leading to symptom alleviation. Critically, the amygdala is thought to be one of the central brain regions mediating PTSD symptoms. In the current study, we compare directly patterns of amygdala complex connectivity using fMRI, before and after EEG neurofeedback, in order to observe subcortical mechanisms associated with behavioural and alpha oscillatory changes among patients. METHOD We examined basolateral (BLA), centromedial (CMA), and superficial (SFA) amygdala complex resting-state functional connectivity using a seed-based approach via SPM Anatomy Toolbox. Amygdala complex connectivity was measured in twenty-one individuals with PTSD, before and after a 30-minute session of EEG neurofeedback targeting alpha desynchronization. RESULTS EEG neurofeedback was associated with a shift in amygdala complex connectivity from areas implicated in defensive, emotional, and fear processing/memory retrieval (left BLA and left SFA to the periaqueductal gray, and left SFA to the left hippocampus) to prefrontal areas implicated in emotion regulation/modulation (right CMA to the medial prefrontal cortex). This shift in amygdala complex connectivity was associated with reduced arousal, greater resting alpha synchronization, and was negatively correlated to PTSD symptom severity. CONCLUSION These findings have significant implications for developing targeted non-invasive treatment interventions for PTSD patients that utilize alpha oscillatory neurofeedback, showing evidence of neuronal reconfiguration between areas highly implicated in the disorder, in addition to acute symptom alleviation.
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Affiliation(s)
| | - Tomas Ros
- Laboratory of Neurology and Imaging of Cognition, Department of Neuroscience, University of Geneva, Geneva, Switzerland
| | - Paul A. Frewen
- Department of Neuroscience, Western University, London, ON, Canada
- Department of Psychology, Western University, London, ON, Canada
| | - Maria Densmore
- Imaging, Lawson Health Research Institute, London, ON, Canada
| | - Jean Théberge
- Department of Psychiatry, Western University, London, ON, Canada
- Department of Medical Imaging, Western University, London, ON, Canada
- Department of Medial Biophysics, Western University, London, ON, Canada
- Imaging, Lawson Health Research Institute, London, ON, Canada
- Department of Diagnostic Imaging, St. Joseph's Healthcare, London, ON, Canada
| | - Rosemarie C. Kluetsch
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim Heidelberg University, Mannheim, Germany
| | - Rakesh Jetly
- Canadian Forces, Health Services, Ottawa, Ontario, Canada
| | - Ruth A. Lanius
- Department of Neuroscience, Western University, London, ON, Canada
- Department of Psychiatry, Western University, London, ON, Canada
- Imaging, Lawson Health Research Institute, London, ON, Canada
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McDermott TJ, Badura-Brack AS, Becker KM, Ryan TJ, Khanna MM, Heinrichs-Graham E, Wilson TW. Male veterans with PTSD exhibit aberrant neural dynamics during working memory processing: an MEG study. J Psychiatry Neurosci 2016; 41:251-60. [PMID: 26645740 PMCID: PMC4915934 DOI: 10.1503/jpn.150058] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is associated with executive functioning deficits, including disruptions in working memory. In this study, we examined the neural dynamics of working memory processing in veterans with PTSD and a matched healthy control sample using magnetoencephalography (MEG). METHODS Our sample of recent combat veterans with PTSD and demographically matched participants without PTSD completed a working memory task during a 306-sensor MEG recording. The MEG data were preprocessed and transformed into the time-frequency domain. Significant oscillatory brain responses were imaged using a beamforming approach to identify spatiotemporal dynamics. RESULTS Fifty-one men were included in our analyses: 27 combat veterans with PTSD and 24 controls. Across all participants, a dynamic wave of neural activity spread from posterior visual cortices to left frontotemporal regions during encoding, consistent with a verbal working memory task, and was sustained throughout maintenance. Differences related to PTSD emerged during early encoding, with patients exhibiting stronger α oscillatory responses than controls in the right inferior frontal gyrus (IFG). Differences spread to the right supramarginal and temporal cortices during later encoding where, along with the right IFG, they persisted throughout the maintenance period. LIMITATIONS This study focused on men with combat-related PTSD using a verbal working memory task. Future studies should evaluate women and the impact of various traumatic experiences using diverse tasks. CONCLUSION Posttraumatic stress disorder is associated with neurophysiological abnormalities during working memory encoding and maintenance. Veterans with PTSD engaged a bilateral network, including the inferior prefrontal cortices and supramarginal gyri. Right hemispheric neural activity likely reflects compensatory processing, as veterans with PTSD work to maintain accurate performance despite known cognitive deficits associated with the disorder.
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Affiliation(s)
| | - Amy S. Badura-Brack
- Correspondence to: A.S. Badura-Brack, Department of Psychology, Creighton University, 2500 California Plaza, Omaha, NE 68178, USA;
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Popescu M, Hughes JD, Popescu EA, Riedy G, DeGraba TJ. Reduced prefrontal MEG alpha-band power in mild traumatic brain injury with associated posttraumatic stress disorder symptoms. Clin Neurophysiol 2016; 127:3075-3085. [PMID: 27472543 DOI: 10.1016/j.clinph.2016.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 06/01/2016] [Accepted: 06/03/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine if changes in cortical alpha-band power in patients with mild traumatic brain injury (mTBI) are associated with the severity of their post-traumatic stress disorder (PTSD) symptoms, and if injury severity and level of exposure to psychologically traumatic events are predictors of these electrophysiological changes. METHODS Resting-state magnetoencephalographic recordings were analyzed in 32 patients with mTBI. Alpha-band power was estimated for each patient in 68 cortical regions and was compared between groups of patients with low versus high PTSD symptoms severity. RESULTS Participants with high PTSD symptom severity showed reduced alpha-band power bilaterally in the superior and middle frontal gyri and frontal poles, and in the left inferior frontal gyrus. Alpha-band power in bilateral middle frontal gyri and frontal poles was negatively correlated with scores reflecting symptoms of emotional numbing. Loss of consciousness (LOC) associated with mTBI and level of exposure to psychologically traumatic events were predictors of decreased prefrontal alpha-band power in some of these regions. CONCLUSION Altered prefrontal alpha-band activity, shown to be partly explained by mTBI-related LOC, is associated with PTSD symptoms severity. SIGNIFICANCE Our findings will guide future studies addressing the electrophysiological mechanisms underlying a higher incidence of PTSD in patients with mTBI.
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Affiliation(s)
- Mihai Popescu
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - John D Hughes
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA; Department of NeuroTrauma, Naval Medical Research Center, Silver Spring, MD, USA.
| | - Elena-Anda Popescu
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Gerard Riedy
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Thomas J DeGraba
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
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Huang CW, Huang MX, Ji Z, Swan AR, Angeles AM, Song T, Huang JW, Lee RR. High-resolution MEG source imaging approach to accurately localize Broca’s area in patients with brain tumor or epilepsy. Clin Neurophysiol 2016; 127:2308-16. [DOI: 10.1016/j.clinph.2016.02.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 12/15/2015] [Accepted: 02/09/2016] [Indexed: 11/28/2022]
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Serotonin 2C receptor antagonist improves fear discrimination and subsequent safety signal recall. Prog Neuropsychopharmacol Biol Psychiatry 2016; 65:78-84. [PMID: 26344640 PMCID: PMC5425091 DOI: 10.1016/j.pnpbp.2015.08.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/19/2015] [Accepted: 08/31/2015] [Indexed: 01/30/2023]
Abstract
UNLABELLED The capacity to discriminate between safety and danger is fundamental for survival, but is disrupted in individuals with posttraumatic stress disorder (PTSD). Acute stressors cause a release of serotonin (5-HT) in the forebrain, which is one mechanism for enhanced fear and anxiety; these effects are mediated by the 5-HT2Creceptor. Using a fear discrimination paradigm where a danger signal conditioned stimulus (CS+) co-terminates with a mild footshock and a safety signal (CS-) indicates the absence of shock, we demonstrate that danger/safety discrimination and fear inhibition develop over the course of 4 daily conditioning sessions. Systemic administration of the 5-HT2Creceptor antagonist SB 242084 (0.25 or 1.0mg/kg) prior to conditioning reduced behavioral freezing during conditioning, and improved learning and subsequent inhibition of fear by the safety signal. Discrimination was apparent in the first recall test, and discrimination during training was evident after 3days of conditioning versus 5days in the vehicle treated controls. These results suggest a novel therapeutic use for 5-HT2Creceptor antagonists to improve learning under stressful circumstances. Potential anatomical loci for 5-HT2Creceptor modulation of fear discrimination learning and cognitive performance enhancement are discussed. ETHICAL STATEMENT John P. Christianson and Allison R. Foilb, the authors, verify that animal research was carried out in accordance with the National Institute of Health Guide for the Care and Use of Laboratory Animals (NIH Publications No. 80-23) and all procedures involving animals were reviewed and approved by the Boston College Animal Care and Use Committee. All efforts were made to limit the number of animals used and their suffering.
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Closely Spaced MEG Source Localization and Functional Connectivity Analysis Using a New Prewhitening Invariance of Noise Space Algorithm. Neural Plast 2015; 2016:4890497. [PMID: 26819768 PMCID: PMC4706973 DOI: 10.1155/2016/4890497] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 08/13/2015] [Accepted: 08/18/2015] [Indexed: 12/29/2022] Open
Abstract
This paper proposed a prewhitening invariance of noise space (PW-INN) as a new magnetoencephalography (MEG) source analysis method, which is particularly suitable for localizing closely spaced and highly correlated cortical sources under real MEG noise. Conventional source localization methods, such as sLORETA and beamformer, cannot distinguish closely spaced cortical sources, especially under strong intersource correlation. Our previous work proposed an invariance of noise space (INN) method to resolve closely spaced sources, but its performance is seriously degraded under correlated noise between MEG sensors. The proposed PW-INN method largely mitigates the adverse influence of correlated MEG noise by projecting MEG data to a new space defined by the orthogonal complement of dominant eigenvectors of correlated MEG noise. Simulation results showed that PW-INN is superior to INN, sLORETA, and beamformer in terms of localization accuracy for closely spaced and highly correlated sources. Lastly, source connectivity between closely spaced sources can be satisfactorily constructed from source time courses estimated by PW-INN but not from results of other conventional methods. Therefore, the proposed PW-INN method is a promising MEG source analysis to provide a high spatial-temporal characterization of cortical activity and connectivity, which is crucial for basic and clinical research of neural plasticity.
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Dunkley BT, Doesburg SM, Jetly R, Sedge PA, Pang EW, Taylor MJ. Characterising intra- and inter-intrinsic network synchrony in combat-related post-traumatic stress disorder. Psychiatry Res 2015; 234:172-81. [PMID: 26422117 DOI: 10.1016/j.pscychresns.2015.09.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 07/21/2015] [Accepted: 09/01/2015] [Indexed: 12/12/2022]
Abstract
Soldiers with post-traumatic stress disorder (PTSD) exhibit elevated gamma-band synchrony in left fronto-temporal cortex, and connectivity measures in these regions correlate with comorbidities and PTSD severity, which suggests increased gamma synchrony is related to symptomology. However, little is known about the role of intrinsic, phase-synchronised networks in the disorder. Using magnetoencephalography (MEG), we characterised spectral connectivity in the default-mode, salience, visual, and attention networks during resting-state in a PTSD population and a trauma-exposed control group. Intrinsic network connectivity was examined in canonical frequency bands. We observed increased inter-network synchronisation in the PTSD group compared with controls in the gamma (30-80 Hz) and high-gamma range (80-150 Hz). Analyses of connectivity and symptomology revealed that PTSD severity was positively associated with beta synchrony in the ventral-attention-to-salience networks, and gamma synchrony within the salience network, but also negatively correlated with beta synchrony within the visual network. These novel results show that frequency-specific, network-level atypicalities may reflect trauma-related alterations of ongoing functional connectivity, and correlations of beta synchrony in attentional-to-salience and visual networks with PTSD severity suggest complicated network interactions mediate symptoms. These results contribute to accumulating evidence that PTSD is a complicated network-based disorder expressed as altered neural interactions.
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Affiliation(s)
- Benjamin T Dunkley
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada; Neuroscience & Mental Health Program, The Hospital for Sick Children Research Institute, Toronto, Canada; Department of Medical Imaging, University of Toronto, Toronto, Canada.
| | - Sam M Doesburg
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada; Neuroscience & Mental Health Program, The Hospital for Sick Children Research Institute, Toronto, Canada; Department of Medical Imaging, University of Toronto, Toronto, Canada; Department of Psychology, University of Toronto, Toronto, Canada
| | - Rakesh Jetly
- Directorate of Mental Health, Canadian Forces Health Services, Ottawa, Canada
| | - Paul A Sedge
- Directorate of Mental Health, Canadian Forces Health Services, Ottawa, Canada
| | - Elizabeth W Pang
- Neuroscience & Mental Health Program, The Hospital for Sick Children Research Institute, Toronto, Canada; Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Margot J Taylor
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada; Neuroscience & Mental Health Program, The Hospital for Sick Children Research Institute, Toronto, Canada; Department of Medical Imaging, University of Toronto, Toronto, Canada; Department of Psychology, University of Toronto, Toronto, Canada
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