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Tan V, Downar J, Nestor S, Vila-Rodriguez F, Daskalakis ZJ, Blumberger DM, Hawco C. Effects of repetitive transcranial magnetic stimulation on individual variability of resting-state functional connectivity in major depressive disorder. J Psychiatry Neurosci 2024; 49:E172-E181. [PMID: 38729664 PMCID: PMC11090631 DOI: 10.1503/jpn.230135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/30/2024] [Accepted: 03/16/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for major depressive disorder (MDD), but substantial heterogeneity in outcomes remains. We examined a potential mechanism of action of rTMS to normalize individual variability in resting-state functional connectivity (rs-fc) before and after a course of treatment. METHODS Variability in rs-fc was examined in healthy controls (baseline) and individuals with MDD (baseline and after 4-6 weeks of rTMS). Seed-based connectivity was calculated to 4 regions associated with MDD: left dorsolateral prefrontal cortex (DLPFC), right subgenual anterior cingulate cortex (sgACC), bilateral insula, and bilateral precuneus. Individual variability was quantified for each region by calculating the mean correlational distance of connectivity maps relative to the healthy controls; a higher variability score indicated a more atypical/idiosyncratic connectivity pattern. RESULTS We included data from 66 healthy controls and 252 individuals with MDD in our analyses. Patients with MDD did not show significant differences in baseline variability of rs-fc compared with controls. Treatment with rTMS increased rs-fc variability from the right sgACC and precuneus, but the increased variability was not associated with clinical outcomes. Interestingly, higher baseline variability of the right sgACC was significantly associated with less clinical improvement (p = 0.037, uncorrected; did not survive false discovery rate correction).Limitations: The linear model was constructed separately for each region of interest. CONCLUSION This was, to our knowledge, the first study to examine individual variability of rs-fc related to rTMS in individuals with MDD. In contrast to our hypotheses, we found that rTMS increased the individual variability of rs-fc. Our results suggest that individual variability of the right sgACC and bilateral precuneus connectivity may be a potential mechanism of rTMS.
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Affiliation(s)
- Vinh Tan
- From the Campbell Family Research Centre, Centre for Addiction and Mental Health, Toronto, Ont. (Tan, Blumberger, Hawco); the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (Downar, Nestor); the Harquail Centre for Neuromodulation, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont. (Nestor, Blumberger, Hawco); the Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC (Vila-Rodriguez); the Department of Psychiatry, University of California, San Diego (Daskalakis); the Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ont. (Blumberger)
| | - Jonathan Downar
- From the Campbell Family Research Centre, Centre for Addiction and Mental Health, Toronto, Ont. (Tan, Blumberger, Hawco); the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (Downar, Nestor); the Harquail Centre for Neuromodulation, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont. (Nestor, Blumberger, Hawco); the Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC (Vila-Rodriguez); the Department of Psychiatry, University of California, San Diego (Daskalakis); the Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ont. (Blumberger)
| | - Sean Nestor
- From the Campbell Family Research Centre, Centre for Addiction and Mental Health, Toronto, Ont. (Tan, Blumberger, Hawco); the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (Downar, Nestor); the Harquail Centre for Neuromodulation, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont. (Nestor, Blumberger, Hawco); the Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC (Vila-Rodriguez); the Department of Psychiatry, University of California, San Diego (Daskalakis); the Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ont. (Blumberger)
| | - Fidel Vila-Rodriguez
- From the Campbell Family Research Centre, Centre for Addiction and Mental Health, Toronto, Ont. (Tan, Blumberger, Hawco); the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (Downar, Nestor); the Harquail Centre for Neuromodulation, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont. (Nestor, Blumberger, Hawco); the Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC (Vila-Rodriguez); the Department of Psychiatry, University of California, San Diego (Daskalakis); the Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ont. (Blumberger)
| | - Zafiris J Daskalakis
- From the Campbell Family Research Centre, Centre for Addiction and Mental Health, Toronto, Ont. (Tan, Blumberger, Hawco); the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (Downar, Nestor); the Harquail Centre for Neuromodulation, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont. (Nestor, Blumberger, Hawco); the Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC (Vila-Rodriguez); the Department of Psychiatry, University of California, San Diego (Daskalakis); the Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ont. (Blumberger)
| | - Daniel M Blumberger
- From the Campbell Family Research Centre, Centre for Addiction and Mental Health, Toronto, Ont. (Tan, Blumberger, Hawco); the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (Downar, Nestor); the Harquail Centre for Neuromodulation, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont. (Nestor, Blumberger, Hawco); the Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC (Vila-Rodriguez); the Department of Psychiatry, University of California, San Diego (Daskalakis); the Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ont. (Blumberger)
| | - Colin Hawco
- From the Campbell Family Research Centre, Centre for Addiction and Mental Health, Toronto, Ont. (Tan, Blumberger, Hawco); the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (Downar, Nestor); the Harquail Centre for Neuromodulation, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont. (Nestor, Blumberger, Hawco); the Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC (Vila-Rodriguez); the Department of Psychiatry, University of California, San Diego (Daskalakis); the Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ont. (Blumberger)
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Voineskos AN, Hawco C, Neufeld NH, Turner JA, Ameis SH, Anticevic A, Buchanan RW, Cadenhead K, Dazzan P, Dickie EW, Gallucci J, Lahti AC, Malhotra AK, Öngür D, Lencz T, Sarpal DK, Oliver LD. Functional magnetic resonance imaging in schizophrenia: current evidence, methodological advances, limitations and future directions. World Psychiatry 2024; 23:26-51. [PMID: 38214624 PMCID: PMC10786022 DOI: 10.1002/wps.21159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
Functional neuroimaging emerged with great promise and has provided fundamental insights into the neurobiology of schizophrenia. However, it has faced challenges and criticisms, most notably a lack of clinical translation. This paper provides a comprehensive review and critical summary of the literature on functional neuroimaging, in particular functional magnetic resonance imaging (fMRI), in schizophrenia. We begin by reviewing research on fMRI biomarkers in schizophrenia and the clinical high risk phase through a historical lens, moving from case-control regional brain activation to global connectivity and advanced analytical approaches, and more recent machine learning algorithms to identify predictive neuroimaging features. Findings from fMRI studies of negative symptoms as well as of neurocognitive and social cognitive deficits are then reviewed. Functional neural markers of these symptoms and deficits may represent promising treatment targets in schizophrenia. Next, we summarize fMRI research related to antipsychotic medication, psychotherapy and psychosocial interventions, and neurostimulation, including treatment response and resistance, therapeutic mechanisms, and treatment targeting. We also review the utility of fMRI and data-driven approaches to dissect the heterogeneity of schizophrenia, moving beyond case-control comparisons, as well as methodological considerations and advances, including consortia and precision fMRI. Lastly, limitations and future directions of research in the field are discussed. Our comprehensive review suggests that, in order for fMRI to be clinically useful in the care of patients with schizophrenia, research should address potentially actionable clinical decisions that are routine in schizophrenia treatment, such as which antipsychotic should be prescribed or whether a given patient is likely to have persistent functional impairment. The potential clinical utility of fMRI is influenced by and must be weighed against cost and accessibility factors. Future evaluations of the utility of fMRI in prognostic and treatment response studies may consider including a health economics analysis.
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Affiliation(s)
- Aristotle N Voineskos
- Campbell Family Mental Health Research Institute and Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Colin Hawco
- Campbell Family Mental Health Research Institute and Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nicholas H Neufeld
- Campbell Family Mental Health Research Institute and Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jessica A Turner
- Department of Psychiatry and Behavioral Health, Wexner Medical Center, Ohio State University, Columbus, OH, USA
| | - Stephanie H Ameis
- Campbell Family Mental Health Research Institute and Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Cundill Centre for Child and Youth Depression and McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Alan Anticevic
- Interdepartmental Neuroscience Program, Yale University, New Haven, CT, USA
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Robert W Buchanan
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kristin Cadenhead
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Erin W Dickie
- Campbell Family Mental Health Research Institute and Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Julia Gallucci
- Campbell Family Mental Health Research Institute and Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Adrienne C Lahti
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anil K Malhotra
- Institute for Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Psychiatry, Zucker Hillside Hospital Division of Northwell Health, Glen Oaks, NY, USA
| | - Dost Öngür
- McLean Hospital/Harvard Medical School, Belmont, MA, USA
| | - Todd Lencz
- Institute for Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Psychiatry, Zucker Hillside Hospital Division of Northwell Health, Glen Oaks, NY, USA
| | - Deepak K Sarpal
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lindsay D Oliver
- Campbell Family Mental Health Research Institute and Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
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Wang L, Ambite JL, Appaji A, Bijsterbosch J, Dockes J, Herrick R, Kogan A, Lander H, Marcus D, Moore SM, Poline JB, Rajasekar A, Sahoo SS, Turner MD, Wang X, Wang Y, Turner JA. NeuroBridge: a prototype platform for discovery of the long-tail neuroimaging data. Front Neuroinform 2023; 17:1215261. [PMID: 37720825 PMCID: PMC10500076 DOI: 10.3389/fninf.2023.1215261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/01/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction Open science initiatives have enabled sharing of large amounts of already collected data. However, significant gaps remain regarding how to find appropriate data, including underutilized data that exist in the long tail of science. We demonstrate the NeuroBridge prototype and its ability to search PubMed Central full-text papers for information relevant to neuroimaging data collected from schizophrenia and addiction studies. Methods The NeuroBridge architecture contained the following components: (1) Extensible ontology for modeling study metadata: subject population, imaging techniques, and relevant behavioral, cognitive, or clinical data. Details are described in the companion paper in this special issue; (2) A natural-language based document processor that leveraged pre-trained deep-learning models on a small-sample document corpus to establish efficient representations for each article as a collection of machine-recognized ontological terms; (3) Integrated search using ontology-driven similarity to query PubMed Central and NeuroQuery, which provides fMRI activation maps along with PubMed source articles. Results The NeuroBridge prototype contains a corpus of 356 papers from 2018 to 2021 describing schizophrenia and addiction neuroimaging studies, of which 186 were annotated with the NeuroBridge ontology. The search portal on the NeuroBridge website https://neurobridges.org/ provides an interactive Query Builder, where the user builds queries by selecting NeuroBridge ontology terms to preserve the ontology tree structure. For each return entry, links to the PubMed abstract as well as to the PMC full-text article, if available, are presented. For each of the returned articles, we provide a list of clinical assessments described in the Section "Methods" of the article. Articles returned from NeuroQuery based on the same search are also presented. Conclusion The NeuroBridge prototype combines ontology-based search with natural-language text-mining approaches to demonstrate that papers relevant to a user's research question can be identified. The NeuroBridge prototype takes a first step toward identifying potential neuroimaging data described in full-text papers. Toward the overall goal of discovering "enough data of the right kind," ongoing work includes validating the document processor with a larger corpus, extending the ontology to include detailed imaging data, and extracting information regarding data availability from the returned publications and incorporating XNAT-based neuroimaging databases to enhance data accessibility.
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Affiliation(s)
- Lei Wang
- Psychiatry and Behavioral Health Department, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - José Luis Ambite
- Information Sciences Institute and Computer Science, University of Southern California, Los Angeles, CA, United States
| | - Abhishek Appaji
- Department of Medical Electronics Engineering, BMS College of Engineering, Bangalore, India
| | - Janine Bijsterbosch
- Department of Radiology, Washington University in St. Louis, St. Louis, MO, United States
| | - Jerome Dockes
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Rick Herrick
- Department of Radiology, Washington University in St. Louis, St. Louis, MO, United States
| | - Alex Kogan
- Psychiatry and Behavioral Health Department, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Howard Lander
- Renaissance Computing Institute, Chapel Hill, NC, United States
| | - Daniel Marcus
- Department of Radiology, Washington University in St. Louis, St. Louis, MO, United States
| | - Stephen M. Moore
- Department of Radiology, Washington University in St. Louis, St. Louis, MO, United States
| | - Jean-Baptiste Poline
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Arcot Rajasekar
- Renaissance Computing Institute, Chapel Hill, NC, United States
- School of Information and Library Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Satya S. Sahoo
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, United States
| | - Matthew D. Turner
- Psychiatry and Behavioral Health Department, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Xiaochen Wang
- College of Information Sciences and Technology, Pennsylvania State University, State College, PA, United States
| | - Yue Wang
- School of Information and Library Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jessica A. Turner
- Psychiatry and Behavioral Health Department, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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