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Phylactou P, Pham TNM, Narskhani N, Diya N, Seminowicz DA, Schabrun SM. Phosphene and motor transcranial magnetic stimulation thresholds are correlated: A meta-analytic investigation. Prog Neuropsychopharmacol Biol Psychiatry 2024; 133:111020. [PMID: 38692474 DOI: 10.1016/j.pnpbp.2024.111020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 04/22/2024] [Accepted: 04/28/2024] [Indexed: 05/03/2024]
Abstract
Transcranial magnetic stimulation (TMS) is commonly delivered at an intensity defined by the resting motor threshold (rMT), which is thought to represent cortical excitability, even if the TMS target area falls outside of the motor cortex. This approach rests on the assumption that cortical excitability, as measured through the motor cortex, represents a 'global' measure of excitability. Another common approach to measure cortical excitability relies on the phosphene threshold (PT), measured through the visual cortex of the brain. However, it remains unclear whether either estimate can serve as a singular measure to infer cortical excitability across different brain regions. If PT and rMT can indeed be used to infer cortical excitability across brain regions, they should be correlated. To test this, we systematically identified previous studies that measured PT and rMT to calculate an overall correlation between the two estimates. Our results, based on 16 effect sizes from eight studies, indicated that PT and rMT are correlated (ρ = 0.4), and thus one measure could potentially serve as a measure to infer cortical excitability across brain regions. Three exploratory meta-analyses revealed that the strength of the correlation is affected by different methodologies, and that PT intensities are higher than rMT. Evidence for a PT-rMT correlation remained robust across all analyses. Further research is necessary for an in-depth understanding of how cortical excitability is reflected through TMS.
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Affiliation(s)
- P Phylactou
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada; The Gray Centre for Mobility and Activity, Parkwood Institute, London, ON, Canada.
| | - T N M Pham
- The Gray Centre for Mobility and Activity, Parkwood Institute, London, ON, Canada
| | - N Narskhani
- The Gray Centre for Mobility and Activity, Parkwood Institute, London, ON, Canada
| | - N Diya
- The Gray Centre for Mobility and Activity, Parkwood Institute, London, ON, Canada
| | - D A Seminowicz
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada
| | - S M Schabrun
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada; The Gray Centre for Mobility and Activity, Parkwood Institute, London, ON, Canada
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Kabar M, Lopez-Chau L, Araujo-Banchon WJ. A real-world retrospective cohort study comparing two bilateral stimulation protocols of add-on rTMS in patients with treatment resistant depression and severe anxiety. Asian J Psychiatr 2024; 96:104013. [PMID: 38554561 DOI: 10.1016/j.ajp.2024.104013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/15/2024] [Accepted: 03/17/2024] [Indexed: 04/01/2024]
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) has been shown to improve response and remission in patients with treatment resistant depression. The objective of this study was to compare the efficacy of two bilateral rTMS protocols with different protocols in patients with treatment resistant depression and comorbid severe anxiety. METHODS A retrospective cohort study involving 67 patients who underwent two different bilateral TMS protocols and who met the specified eligibility criteria was conducted. Group 1 received stimulation with 85% RMT intermittent theta burst (iTBS) in the left DLPFC + 120% RMT (1 Hz) in the right DLPFC. Group 2 received stimulation with 100% RMT (iTBS) in the left DLPFC + 110% RMT (1 Hz) in the left DLPFC. RESULTS After the magnetic stimulation treatment, 55% (n=22) achieved response to depression symptoms in group 1 and 62% (n=18) in group 2. Remission of depression symptoms was achieved in 13% in group 1 (n=5) and 24% in group 2 (n=7). There were no significant differences between the two protocols after TMS CONCLUSIONS: Different bilateral protocol parameters in individuals undergoing TMS may have an impact on symptom response and remission. Further studies with larger sample sizes are needed.
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Affiliation(s)
| | - Luis Lopez-Chau
- Instituto de Neuroestimulación de Lima. Lima, Peru; Escuela de Medicina, Universidad Científica del Sur. Lima, Peru.
| | - William J Araujo-Banchon
- Escuela de Medicina Humana, Universidad Cesar Vallejo. Piura, Peru; Estudios Cimedical. Lima, Peru
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Walther S, Alexaki D, Weiss F, Baumann-Gama D, Kyrou A, Nuoffer MG, Wüthrich F, Lefebvre S, Nadesalingam N. Psychomotor Slowing in Psychosis and Inhibitory Repetitive Transcranial Magnetic Stimulation: A Randomized Clinical Trial. JAMA Psychiatry 2024; 81:563-571. [PMID: 38416468 PMCID: PMC10902782 DOI: 10.1001/jamapsychiatry.2024.0026] [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: 08/28/2023] [Accepted: 12/19/2023] [Indexed: 02/29/2024]
Abstract
Importance Psychomotor slowing is a frequent symptom of psychosis, impairing gross and fine motor behavior. It is associated with poor outcomes and functioning, and no treatment is available. Objective To investigate whether 15 sessions of inhibitory repetitive transcranial magnetic stimulation (rTMS) may reduce psychomotor slowing. Design, Setting, and Participants This was a 4-arm, double-blind, randomized, sham-controlled trial at a university hospital in Switzerland. Enrollment took place from March 2019 to August 2022. Adults aged 18 to 60 years with schizophrenia spectrum disorders and severe psychomotor slowing were eligible. All patients continued existing medications, including antipsychotics and benzodiazepines. Those with substance misuse (other than nicotine), conditions associated with impaired or aberrant movement, convulsions, history of hearing problems, other conditions typically excluded from magnetic resonance imaging or TMS, any TMS treatment in the past 3 months, or those who were pregnant or breastfeeding were excluded. Of 615 patients screened for eligibility, 103 were randomized and 88 received at least 1 session of rTMS: 22 were assigned to 1-Hz rTMS, 22 to iTBS, 22 to sham, and 22 to the waiting group. Follow-up was conducted at 6 weeks and 24 weeks following the week 3 assessments including clinical, functional, and motor measures. Interventions Fifteen sessions of rTMS in 3 weeks over the supplementary motor area: 1-Hz rTMS, iTBS, sham, or no treatment (waiting). After 3 weeks, the waiting group received 15 sessions of 1-Hz rTMS over the supplementary motor area. Main Outcomes and Measures The main outcome was the proportion of responders at week 3 in the Salpêtrière Retardation Rating Scale (SRRS) defined as a 30% or greater reduction from baseline (last-observation-carried-forward). The SRRS has 15 items and a maximum total score of 60. Results Of the 88 participants analyzed, 45 were men and 43 were women. The mean (SD) age was 36.3 (12.4) years and the mean (SD) SRRS score was 24.0 (5.9). A total of 69 participants completed the study. At week 3, response rates differed between groups: 15 of 22 (68%) in the 1-Hz rTMS group, 8 of 22 (36%) in the iTBS group, 7 of 22 (32%) in the sham group, and 4 of 22 (18%) in the waiting group (χ23 = 12.1; P = .007). The 1-Hz rTMS group had more responders than sham (odds ratio [OR], 0.13; 95% CI, 0.02-0.65; P = .03), iTBS (OR, 0.12; 95% CI, 0.02-0.61; P = .02), and waiting (OR, 0.04; 95% CI, 0.01-0.22; P = .003). In the waiting group, 10 of 16 participants (63%) responded after receiving 15 sessions of 1-Hz rTMS. No serious adverse events occurred. Conclusions and Relevance In this study, inhibitory add-on rTMS safely alleviated psychomotor slowing in psychosis compared with iTBS, sham, and no treatment. The treatment was also effective with delayed onset. Future studies need to explore the neural changes associated with supplementary motor area rTMS in psychosis. Trial Registration ClinicalTrials.gov Identifier: NCT03921450.
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Affiliation(s)
- Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Danai Alexaki
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Florian Weiss
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Daniel Baumann-Gama
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Alexandra Kyrou
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Melanie G. Nuoffer
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Florian Wüthrich
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Stephanie Lefebvre
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Niluja Nadesalingam
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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Jin K, Chen B, Han S, Dong J, Cheng S, Qin B, Lu J. Repetitive Transcranial Magnetic Stimulation (rTMS) Improves Cognitive Impairment and Intestinal Microecological Dysfunction Induced by High-Fat Diet in Rats. RESEARCH (WASHINGTON, D.C.) 2024; 7:0384. [PMID: 38826566 PMCID: PMC11140411 DOI: 10.34133/research.0384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/17/2024] [Indexed: 06/04/2024]
Abstract
Consuming a high-fat diet (HFD) is widely recognized to cause obesity and result in chronic brain inflammation that impairs cognitive function. Repetitive transcranial magnetic stimulation (rTMS) has shown effectiveness in both weight loss and cognitive improvement, although the exact mechanism is still unknown. Our study examined the effects of rTMS on the brain and intestinal microecological dysfunction. rTMS successfully reduced cognitive decline caused by an HFD in behavioral assessments involving the Y maze and novel object recognition. This was accompanied by an increase in the number of new neurons and the transcription level of genes related to synaptic plasticity (spindlin 1, synaptophysin, and postsynaptic protein-95) in the hippocampus. It was reached that rTMS decreased the release of high mobility group box 1, activation of microglia, and inflammation in the brains of HFD rats. rTMS also reduced hypothalamic hypocretin levels and improved peripheral blood lipid metabolism. In addition, rTMS recovered the HFD-induced gut microbiome imbalances, metabolic disorders, and, in particular, reduced levels of the microvirus. Our research emphasized that rTMS enhanced cognitive abilities, resulting in positive impacts on brain inflammation, neurodegeneration, and the microbiota in the gut, indicating the potential connection between the brain and gut, proposing that rTMS could be a new approach to addressing cognitive deficits linked to obesity.
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Affiliation(s)
- Kangyu Jin
- Department of Psychiatry, the First Affiliated Hospital,
Zhejiang University School of Medicine, Hangzhou 310003, China
- The Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou 310003, China
| | - Bing Chen
- Department of Psychiatry, the First Affiliated Hospital,
Zhejiang University School of Medicine, Hangzhou 310003, China
- The Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou 310003, China
| | - Shengyi Han
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital,
Zhejiang University School of Medicine, Hangzhou City 310003, China
| | - Jingyi Dong
- School of Life Sciences,
Zhejiang Chinese Medical University, Hangzhou, China
| | - Shangping Cheng
- Department of Psychiatry, the First Affiliated Hospital,
Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Bin Qin
- School of Life Sciences,
Zhejiang Chinese Medical University, Hangzhou, China
| | - Jing Lu
- Department of Psychiatry, the First Affiliated Hospital,
Zhejiang University School of Medicine, Hangzhou 310003, China
- The Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou 310003, China
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Lu M, Ueno S. Impact of Titanium Skull Plate on Transcranial Magnetic Stimulation: Analysis of Induced Electric Fields. Life (Basel) 2024; 14:642. [PMID: 38792662 PMCID: PMC11122346 DOI: 10.3390/life14050642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/22/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Implanted titanium skull plates (TSPs) in cranioplasty are used to replace or reconstruct areas of the skull that have been damaged or removed due to trauma, surgery, or other medical conditions. However, the presence of a TSP in the head may influence the distribution of the electric field induced during transcranial magnetic stimulation (TMS) procedures. The purpose of this study was to determine how the presence of TSP would interfere with TMS-induced cortical electric fields. METHODS The TMS with a figure-of-eight coil was applied to a realistic head model with TSPs. The distribution of the induced electric field in head tissues was calculated by employing the impedance method, and the results were compared with that of a normal head without TSP. RESULTS Simulation results show that the distribution of the induced electric field has changed greatly for the head model with TSP. The maximum value of the induced electric field in head tissues was present under one of the circular coil wings rather than in the tissues beneath the junction of the two wings of the Fo8 coil. CONCLUSIONS The induced electric field in deep brain regions was increased for the head model with TSP, which could potentially lead to deep brain stimulation. Since the presence of metallic TSP can greatly influence the distribution of the induced electric field in TMS applications, it is important to adjust the treatment scheme when considering TMS for individuals with cranial titanium plates.
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Affiliation(s)
- Mai Lu
- Key Laboratory of Opto-Electronic Technology and Intelligent Control of Ministry of Education, Lanzhou Jiaotong University, Lanzhou 730070, China
| | - Shoogo Ueno
- Department of Biomedical Engineering, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan;
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Moussiopoulou J, Handrack‐Bonnet M, Pross B, Pogarell O, Keeser D, Halle M, Falkai P, Scherr J, Hasan A, Roeh A. Comparative electroencephalography analysis: Marathon runners during tapering versus sedentary controls reveals no significant differences. Brain Behav 2024; 14:e3480. [PMID: 38680019 PMCID: PMC11056696 DOI: 10.1002/brb3.3480] [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: 06/23/2023] [Revised: 01/26/2024] [Accepted: 03/18/2024] [Indexed: 05/01/2024] Open
Abstract
INTRODUCTION Previous studies described various adaptive neuroplastic brain changes associated with physical activity (PA). EEG studies focused mostly on effects during or shortly after short bouts of exercise. This is the first study to investigate the capability of EEG to display PA-induced long-lasting plasticity in runners compared to a sedentary control group. METHODS Thirty trained runners and 30 age- and sex-matched sedentary controls (SC) were included as a subpopulation of the ReCaP (Running effects on Cognition and Plasticity) study. PA was measured with the International Physical Activity Questionnaire (IPAQ). Resting-state EEG of the runners was recorded in the tapering phase of the training for the Munich marathon 2017. Power spectrum analyses were conducted using standardized low-resolution electromagnetic tomography (sLORETA) and included the following frequency bands: delta: 1.5-6 Hz, theta: 6.5-8.0 Hz, alpha1: 8.5-10 Hz, alpha2: 10.5-12.0 Hz, beta1: 12.5-18.0 Hz, beta2: 18.5-21.0 Hz, beta3: 21.5-30.0 Hz, and total power (1.5-30 Hz). RESULTS PA (IPAQ) and BMI differed significantly between the groups. The other included demographic parameters were comparable. Statistical nonparametric mapping showed no significant power differences in EEG between the groups. DISCUSSION Heterogeneity in study protocols, especially in time intervals between exercise cessation and EEG recordings and juxtaposition of acute exercise-induced effects on EEG in previous studies, could be possible reasons for the differences in results. Future studies should record EEG at different time points after exercise cessation and in a broader spectrum of exercise intensities and forms to further explore the capability of EEG in displaying long-term exercise-induced plasticity.
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Affiliation(s)
- J. Moussiopoulou
- Department of Psychiatry and PsychotherapyLMU University Hospital, LMU MunichMunichGermany
| | - M. Handrack‐Bonnet
- Department of Psychiatry and PsychotherapyLMU University Hospital, LMU MunichMunichGermany
| | - B. Pross
- Department of Psychiatry and PsychotherapyLMU University Hospital, LMU MunichMunichGermany
- Medical Faculty, Department of Psychiatry, Psychotherapy and Psychosomatics, Bezirkskrankenhaus AugsburgUniversity of AugsburgAugsburgGermany
| | - O. Pogarell
- Department of Psychiatry and PsychotherapyLMU University Hospital, LMU MunichMunichGermany
| | - D. Keeser
- Department of Psychiatry and PsychotherapyLMU University Hospital, LMU MunichMunichGermany
| | - M. Halle
- Department of Prevention and Sports MedicineKlinikum rechts der Isar, Technische Universitaet MuenchenMunichGermany
- Partner Site Munich Heart AllianceDeutsches Zentrum für Herz‐ und Kreislauf‐Forschung (DZHK) e.V. (German Center for Cardiovascular Research)MunichGermany
| | - P. Falkai
- Department of Psychiatry and PsychotherapyLMU University Hospital, LMU MunichMunichGermany
| | - J. Scherr
- Department of Prevention and Sports MedicineKlinikum rechts der Isar, Technische Universitaet MuenchenMunichGermany
- University Center for Preventive and Sports Medicine, Balgrist University Hospital, University of ZurichZurichSwitzerland
| | - A. Hasan
- Medical Faculty, Department of Psychiatry, Psychotherapy and Psychosomatics, Bezirkskrankenhaus AugsburgUniversity of AugsburgAugsburgGermany
| | - A. Roeh
- Medical Faculty, Department of Psychiatry, Psychotherapy and Psychosomatics, Bezirkskrankenhaus AugsburgUniversity of AugsburgAugsburgGermany
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Liu Y, Zhao J, Tang Z, Hsien Y, Han K, Shan L, Zhang X, Zhang H. Prolonged intermittent theta burst stimulation for post-stroke aphasia: protocol of a randomized, double-blinded, sham-controlled trial. Front Neurol 2024; 15:1348862. [PMID: 38725649 PMCID: PMC11079432 DOI: 10.3389/fneur.2024.1348862] [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: 12/07/2023] [Accepted: 04/11/2024] [Indexed: 05/12/2024] Open
Abstract
Background Post-stroke aphasia (PSA) is one of the most devastating symptoms after stroke, yet limited treatment options are available. Prolonged intermittent theta burst stimulation (piTBS) is a promising therapy for PSA. However, its efficacy remains unclear. Therefore, we aim to investigate the efficacy of piTBS over the left supplementary motor area (SMA) in improving language function for PSA patients and further explore the mechanism of language recovery. Methods This is a randomized, double-blinded, sham-controlled trial. A total of 30 PSA patients will be randomly allocated to receive either piTBS stimulation or sham stimulation for 15 sessions over a period of 3 weeks. The primary outcome is the Western Aphasia Battery Revised (WAB-R) changes after treatment. The secondary outcomes include The Stroke and Aphasia Quality of Life Scale (SAQOL-39 g), resting-state electroencephalogram (resting-state EEG), Event-related potentials (ERP), brain derived neurotrophic factor (BDNF). These outcome measures are assessed before treatment, after treatment, and at 4-weeks follow up. This study was registered in Chinese Clinical Trial Registry (No. ChiCTR23000203238). Discussion This study protocol is promising for improving language in PSA patients. Resting-state EEG, ERP, and blood examination can be used to explore the neural mechanisms of PSA treatment with piTBS. Clinical trial registration https://www.chictr.org.cn/index.html, ChiCTR2300074533.
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Affiliation(s)
- Ying Liu
- School of Rehabilitation, Capital Medical University, Beijing, China
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Jingdu Zhao
- School of Rehabilitation, Capital Medical University, Beijing, China
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Zhiqing Tang
- School of Rehabilitation, Capital Medical University, Beijing, China
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Yikuang Hsien
- School of Rehabilitation, Capital Medical University, Beijing, China
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Kaiyue Han
- School of Rehabilitation, Capital Medical University, Beijing, China
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Lei Shan
- School of Rehabilitation, Capital Medical University, Beijing, China
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Xiaonian Zhang
- School of Rehabilitation, Capital Medical University, Beijing, China
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Hao Zhang
- School of Rehabilitation, Capital Medical University, Beijing, China
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- School of Life and Health Sciences, University of Health and Rehabilitation Sciences, Qingdao, China
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Dahrendorff J, Currier G, Uddin M. Leveraging DNA methylation to predict treatment response in major depressive disorder: A critical review. Am J Med Genet B Neuropsychiatr Genet 2024:e32985. [PMID: 38650309 DOI: 10.1002/ajmg.b.32985] [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] [Received: 09/26/2023] [Revised: 03/18/2024] [Accepted: 04/02/2024] [Indexed: 04/25/2024]
Abstract
Major depressive disorder (MDD) is a debilitating and prevalent mental disorder with a high disease burden. Despite a wide array of different treatment options, many patients do not respond to initial treatment attempts. Selection of the most appropriate treatment remains a significant clinical challenge in psychiatry, highlighting the need for the development of biomarkers with predictive utility. Recently, the epigenetic modification DNA methylation (DNAm) has emerged to be of great interest as a potential predictor of MDD treatment outcomes. Here, we review efforts to date that seek to identify DNAm signatures associated with treatment response in individuals with MDD. Searches were conducted in the databases PubMed, Scopus, and Web of Science with the concepts and keywords MDD, DNAm, antidepressants, psychotherapy, cognitive behavior therapy, electroconvulsive therapy, transcranial magnetic stimulation, and brain stimulation therapies. We identified 32 studies implicating DNAm patterns associated with MDD treatment outcomes. The majority of studies (N = 25) are focused on selected target genes exploring treatment outcomes in pharmacological treatments (N = 22) with a few studies assessing treatment response to electroconvulsive therapy (N = 3). Additionally, there are few genome-scale efforts (N = 7) to characterize DNAm patterns associated with treatment outcomes. There is a relative dearth of studies investigating DNAm patterns in relation to psychotherapy, electroconvulsive therapy, or transcranial magnetic stimulation; importantly, most existing studies have limited sample sizes. Given the heterogeneity in both methods and results of studies to date, there is a need for additional studies before existing findings can inform clinical decisions.
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Affiliation(s)
- Jan Dahrendorff
- Genomics Program, College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Glenn Currier
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, Florida, USA
| | - Monica Uddin
- Genomics Program, College of Public Health, University of South Florida, Tampa, Florida, USA
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van Wegen EEH, van Balkom TD, Hirsch MA, Rutten S, van den Heuvel OA. Non-Pharmacological Interventions for Depression and Anxiety in Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2024:JPD230228. [PMID: 38607762 DOI: 10.3233/jpd-230228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Affiliation(s)
- Erwin E H van Wegen
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Ageing & Vitality, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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| | - Tim D van Balkom
- Department of Anatomy & Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Compulsivity, Impulsivity & Attention, Neurodegeneration, Amsterdam, The Netherlands
| | - Mark A Hirsch
- Carolinas Medical Center, Atrium Health Carolinas Rehabilitation, Department of Physical Medicine and Rehabilitation, Charlotte, NC, USA
- Wake Forest School of Medicine, Department of Orthopedic Surgery and Rehabilitation, Winston-Salem, NC, USA
| | - Sonja Rutten
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Compulsivity, Impulsivity & Attention, Neurodegeneration, Amsterdam, The Netherlands
| | - Odile A van den Heuvel
- Department of Anatomy & Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Compulsivity, Impulsivity & Attention, Neurodegeneration, Amsterdam, The Netherlands
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Whittaker HT, Khayyat L, Fortier-Lavallée J, Laverdière M, Bélanger C, Zatorre RJ, Albouy P. Information-based rhythmic transcranial magnetic stimulation to accelerate learning during auditory working memory training: a proof-of-concept study. Front Neurosci 2024; 18:1355565. [PMID: 38638697 PMCID: PMC11024337 DOI: 10.3389/fnins.2024.1355565] [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: 12/14/2023] [Accepted: 03/14/2024] [Indexed: 04/20/2024] Open
Abstract
Introduction Rhythmic transcranial magnetic stimulation (rhTMS) has been shown to enhance auditory working memory manipulation, specifically by boosting theta oscillatory power in the dorsal auditory pathway during task performance. It remains unclear whether these enhancements (i) persist beyond the period of stimulation, (ii) if they can accelerate learning and (iii) if they would accumulate over several days of stimulation. In the present study, we investigated the lasting behavioral and electrophysiological effects of applying rhTMS over the left intraparietal sulcus (IPS) throughout the course of seven sessions of cognitive training on an auditory working memory task. Methods A limited sample of 14 neurologically healthy participants took part in the training protocol with an auditory working memory task while being stimulated with either theta (5 Hz) rhTMS or sham TMS. Electroencephalography (EEG) was recorded before, throughout five training sessions and after the end of training to assess to effects of rhTMS on behavioral performance and on oscillatory entrainment of the dorsal auditory network. Results We show that this combined approach enhances theta oscillatory activity within the fronto-parietal network and causes improvements in auditoryworking memory performance. We show that compared to individuals who received sham stimulation, cognitive training can be accelerated when combined with optimized rhTMS, and that task performance benefits can outlast the training period by ∼ 3 days. Furthermore, we show that there is increased theta oscillatory power within the recruited dorsal auditory network during training, and that sustained EEG changes can be observed ∼ 3 days following stimulation. Discussion The present study, while underpowered for definitive statistical analyses, serves to improve our understanding of the causal dynamic interactions supporting auditory working memory. Our results constitute an important proof of concept for the potential translational impact of non-invasive brain stimulation protocols and provide preliminary data for developing optimized rhTMS and training protocols that could be implemented in clinical populations.
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Affiliation(s)
- Heather T. Whittaker
- Cognitive Neuroscience Unit, Montreal Neurological Institute, McGill University, Montréal, QC, Canada
- International Laboratory for Brain, Music and Sound Research (BRAMS) - Centre for Research on Brain Language and Music (CRBLM), Montreal, QC, Canada
| | - Lina Khayyat
- Cognitive Neuroscience Unit, Montreal Neurological Institute, McGill University, Montréal, QC, Canada
| | | | - Megan Laverdière
- CERVO Brain Research Centre, School of Psychology, Université Laval, Québec City, QC, Canada
| | - Carole Bélanger
- CERVO Brain Research Centre, School of Psychology, Université Laval, Québec City, QC, Canada
| | - Robert J. Zatorre
- Cognitive Neuroscience Unit, Montreal Neurological Institute, McGill University, Montréal, QC, Canada
- International Laboratory for Brain, Music and Sound Research (BRAMS) - Centre for Research on Brain Language and Music (CRBLM), Montreal, QC, Canada
| | - Philippe Albouy
- Cognitive Neuroscience Unit, Montreal Neurological Institute, McGill University, Montréal, QC, Canada
- International Laboratory for Brain, Music and Sound Research (BRAMS) - Centre for Research on Brain Language and Music (CRBLM), Montreal, QC, Canada
- CERVO Brain Research Centre, School of Psychology, Université Laval, Québec City, QC, Canada
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11
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Lefebvre S, Gehrig G, Nadesalingam N, Nuoffer MG, Kyrou A, Wüthrich F, Walther S. The pathobiology of psychomotor slowing in psychosis: altered cortical excitability and connectivity. Brain 2024; 147:1423-1435. [PMID: 38537253 PMCID: PMC10994557 DOI: 10.1093/brain/awad395] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/23/2023] [Accepted: 11/03/2023] [Indexed: 04/06/2024] Open
Abstract
Psychomotor slowing is a frequent symptom of schizophrenia. Short-interval intracortical inhibition assessed by transcranial magnetic stimulation demonstrated inhibitory dysfunction in schizophrenia. The inhibitory deficit results from additional noise during information processing in the motor system in psychosis. Here, we tested whether cortical inhibitory dysfunction was linked to psychomotor slowing and motor network alterations. In this cross-sectional study, we included 60 patients with schizophrenia and psychomotor slowing determined by the Salpêtrière Retardation Rating Scale, 23 patients without slowing and 40 healthy control participants. We acquired single and double-pulse transcranial magnetic stimulation effects from the left primary motor cortex, resting-state functional connectivity and diffusion imaging on the same day. Groups were compared on resting motor threshold, amplitude of the motor evoked potentials, as well as short-interval intracortical inhibition. Regression analyses calculated the association between motor evoked potential amplitudes or cortical inhibition with seed-based resting-state functional connectivity from the left primary motor cortex and fractional anisotropy at whole brain level and within major motor tracts. In patients with schizophrenia and psychomotor slowing, we observed lower amplitudes of motor evoked potentials, while the short-interval intracortical inhibition/motor evoked potentials amplitude ratio was higher than in healthy controls, suggesting lower cortical inhibition in these patients. Patients without slowing also had lower amplitudes of motor evoked potentials. Across the combined patient sample, cortical inhibition deficits were linked to more motor coordination impairments. In patients with schizophrenia and psychomotor slowing, lower amplitudes of motor evoked potentials were associated with lower fractional anisotropy in motor tracts. Moreover, resting-state functional connectivity between the primary motor cortex, the anterior cingulate cortex and the cerebellum increased with stronger cortical inhibition. In contrast, in healthy controls and patients without slowing, stronger cortical inhibition was linked to lower resting-state functional connectivity between the left primary motor cortex and premotor or parietal cortices. Psychomotor slowing in psychosis is linked to less cortical inhibition and aberrant functional connectivity of the primary motor cortex. Higher neural noise in the motor system may drive psychomotor slowing and thus may become a treatment target.
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Affiliation(s)
- Stephanie Lefebvre
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern, Switzerland
- Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, 3000 Bern, Switzerland
| | - Gwendolyn Gehrig
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern, Switzerland
| | - Niluja Nadesalingam
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern, Switzerland
- Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, 3000 Bern, Switzerland
| | - Melanie G Nuoffer
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern, Switzerland
- Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, 3000 Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, 3000 Bern, Switzerland
| | - Alexandra Kyrou
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern, Switzerland
| | - Florian Wüthrich
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern, Switzerland
- Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, 3000 Bern, Switzerland
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern, Switzerland
- Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, 3000 Bern, Switzerland
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12
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Schoisswohl S, Kanig C, Osnabruegge M, Agboada D, Langguth B, Rethwilm R, Hebel T, Abdelnaim MA, Mack W, Seiberl W, Kuder M, Schecklmann M. Monitoring Changes in TMS-Evoked EEG and EMG Activity During 1 Hz rTMS of the Healthy Motor Cortex. eNeuro 2024; 11:ENEURO.0309-23.2024. [PMID: 38565296 PMCID: PMC11015949 DOI: 10.1523/eneuro.0309-23.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/13/2023] [Accepted: 01/08/2024] [Indexed: 04/04/2024] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation technique capable of inducing neuroplasticity as measured by changes in peripheral muscle electromyography (EMG) or electroencephalography (EEG) from pre-to-post stimulation. However, temporal courses of neuromodulation during ongoing rTMS are unclear. Monitoring cortical dynamics via TMS-evoked responses using EMG (motor-evoked potentials; MEPs) and EEG (transcranial-evoked potentials; TEPs) during rTMS might provide further essential insights into its mode of action - temporal course of potential modulations. The objective of this study was to first evaluate the validity of online rTMS-EEG and rTMS-EMG analyses, and second to scrutinize the temporal changes of TEPs and MEPs during rTMS. As rTMS is subject to high inter-individual effect variability, we aimed for single-subject analyses of EEG changes during rTMS. Ten healthy human participants were stimulated with 1,000 pulses of 1 Hz rTMS over the motor cortex, while EEG and EMG were recorded continuously. Validity of MEPs and TEPs measured during rTMS was assessed in sensor and source space. Electrophysiological changes during rTMS were evaluated with model fitting approaches on a group- and single-subject level. TEPs and MEPs appearance during rTMS was consistent with past findings of single pulse experiments. Heterogeneous temporal progressions, fluctuations or saturation effects of brain activity were observed during rTMS depending on the TEP component. Overall, global brain activity increased over the course of stimulation. Single-subject analysis revealed inter-individual temporal courses of global brain activity. The present findings are in favor of dose-response considerations and attempts in personalization of rTMS protocols.
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Affiliation(s)
- Stefan Schoisswohl
- Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany
- Department of Human Sciences, Institute of Psychology, Universität der Bundeswehr München, 85579 Neubiberg, Germany
| | - Carolina Kanig
- Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany
- Department of Human Sciences, Institute of Psychology, Universität der Bundeswehr München, 85579 Neubiberg, Germany
| | - Mirja Osnabruegge
- Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany
- Department of Human Sciences, Institute of Psychology, Universität der Bundeswehr München, 85579 Neubiberg, Germany
| | - Desmond Agboada
- Department of Human Sciences, Institute of Psychology, Universität der Bundeswehr München, 85579 Neubiberg, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany
| | - Roman Rethwilm
- Department of Human Sciences, Institute of Sport Science, Universität der Bundeswehr München, 85579 Neubiberg, Germany
| | - Tobias Hebel
- Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany
| | - Mohamed A Abdelnaim
- Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany
| | - Wolfgang Mack
- Department of Human Sciences, Institute of Psychology, Universität der Bundeswehr München, 85579 Neubiberg, Germany
| | - Wolfgang Seiberl
- Department of Human Sciences, Institute of Sport Science, Universität der Bundeswehr München, 85579 Neubiberg, Germany
| | - Manuel Kuder
- Department of Electrical Engineering, Universität der Bundeswehr München, 85579 Neubiberg, Germany
| | - Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany
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Chu M, Li S, Wang Y, Lui SSY, Chan RCK. The effect of noninvasive brain stimulation on anhedonia in patients with schizophrenia and depression: A systematic review and meta-analysis. Psych J 2024; 13:166-175. [PMID: 38151800 PMCID: PMC10990806 DOI: 10.1002/pchj.723] [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: 02/08/2023] [Accepted: 11/28/2023] [Indexed: 12/29/2023]
Abstract
Anhedonia is a transdiagnostic symptom found in patients with schizophrenia and depression. Current pharmacological interventions for anhedonia are unsatisfactory in a considerable proportion of patients. There has been growing interest in applying noninvasive brain stimulation (NIBS) to patients with anhedonia. However, evidence for the efficacy of NIBS for anhedonia remain inconsistent. This study systematically identified all studies that measured anhedonia and applied NIBS in patients with schizophrenia or depression. We conducted a search using the various databases in English (PubMed, EBSCOHost (PsycInfo/PsycArticles), Web of Science) and Chinese (China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform) languages, and reviewed original research articles on NIBS published from January 1989 to July 2023. Our search had identified 15 articles for quantitative synthesis, with three concerning schizophrenia samples, 11 concerning samples with depression, and one concerning both clinical samples. We conducted a meta-analysis based on the 15 included studies, and the results suggested that NIBS could improve anhedonia symptoms in schizophrenia patients and patients with depression, with a medium-to-large effect size. Our findings are preliminary, given the limited number of included studies. Future NIBS research should measure anhedonia as a primary outcome and should recruit transdiagnostic samples.
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Affiliation(s)
- Min‐yi Chu
- Shanghai Mental Health CenterShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Shuai‐biao Li
- Shanghai Mental Health CenterShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yi Wang
- Neuropsychology and Applied Cognitive Neuroscience LaboratoryCAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of SciencesBeijingChina
- Department of PsychologyUniversity of Chinese Academy of SciencesBeijingChina
| | - Simon S. Y. Lui
- Department of Psychiatry, School of Clinical MedicineThe University of Hong KongHong KongChina
| | - Raymond C. K. Chan
- Shanghai Mental Health CenterShanghai Jiao Tong University School of MedicineShanghaiChina
- Neuropsychology and Applied Cognitive Neuroscience LaboratoryCAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of SciencesBeijingChina
- Department of PsychologyUniversity of Chinese Academy of SciencesBeijingChina
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14
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Xue H, Li YX, Xiao YS, Fan WH, He HX. Repetitive transcranial magnetic stimulation for Alzheimer's disease: an overview of systematic reviews and meta-analysis. Front Aging Neurosci 2024; 16:1383278. [PMID: 38572153 PMCID: PMC10987751 DOI: 10.3389/fnagi.2024.1383278] [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: 02/07/2024] [Accepted: 03/11/2024] [Indexed: 04/05/2024] Open
Abstract
Objective Alzheimer's disease (AD) is a prevalent neurodegenerative condition that significantly impacts both individuals and society. This study aims to evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) as a treatment for AD by summarizing the evidence from systematic reviews (SRs) and meta-analyses (MAs). Methods SRs/MAs of rTMS for AD were collected by searching Embase, Web of Science, Cochrane Library, PubMed, CNKI, VIP, Sino-Med, and Wanfang databases. The search was conducted from database creation to January 23, 2024. Methodological quality, reporting quality and risk of bias were assessed using the Assessing Methodological Quality of Systematic Reviews 2 (AMSTAR-2), Risk of Bias in Systematic Reviews (ROBIS) tool and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). In addition, the quality of evidence for outcome measures was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Results Eight SRs/MAs included in this study met the inclusion criteria. Based on the AMSTAR-2, 4 of the SRs/MA were classified as low quality, while the remaining 4 were deemed to be of very low quality. The PRISMA analysis revealed that out of the 27 items reporting, 16 achieved full reporting (100%). However, there were still some deficiencies in reporting, particularly related to protocol and registration, search strategy, risk of bias, and additional analysis. The ROBIS tool indicated that only 3 SRs/MAs had a low risk of bias. The GRADE assessment indicated that 6 outcomes were of moderate quality (18.75%), 16 were of low quality (50%), and 10 were classified as very low quality (31.25%). Conclusion Based on the evidence collected, rTMS appears to be effective in improving cognitive function in AD patients, although the methodological quality of the SRs/MAs reduces the reliability of the conclusions and the overall quality is low. However, based on the available results, we still support the value of rTMS as an intervention to improve cognitive function in AD. In future studies, it is necessary to confirm the efficacy of rTMS in AD patients and provide more reliable and scientific data to contribute to evidence-based medicine.
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Affiliation(s)
- Hua Xue
- Department of Neurology, Sichuan Taikang Hospital, Chengdu, Sichuan, China
| | - Ya-xin Li
- Department of Neurology, Sichuan Taikang Hospital, Chengdu, Sichuan, China
| | - Ya-song Xiao
- Department of Geriatric, Sichuan Taikang Hospital, Chengdu, Sichuan, China
| | - Wen-hui Fan
- Department of Neurology, Sichuan Taikang Hospital, Chengdu, Sichuan, China
| | - Hong-xian He
- Department of Rehabilitation, Sichuan Taikang Hospital, Chengdu, Sichuan, China
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15
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Sack AT, Paneva J, Küthe T, Dijkstra E, Zwienenberg L, Arns M, Schuhmann T. Target Engagement and Brain State Dependence of Transcranial Magnetic Stimulation: Implications for Clinical Practice. Biol Psychiatry 2024; 95:536-544. [PMID: 37739330 DOI: 10.1016/j.biopsych.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/31/2023] [Accepted: 09/12/2023] [Indexed: 09/24/2023]
Abstract
Transcranial magnetic stimulation (TMS) is capable of noninvasively inducing lasting neuroplastic changes when applied repetitively across multiple treatment sessions. In recent years, repetitive TMS has developed into an established evidence-based treatment for various neuropsychiatric disorders such as depression. Despite significant advancements in our understanding of the mechanisms of action of TMS, there is still much to learn about how these mechanisms relate to the clinical effects observed in patients. If there is one thing about TMS that we know for sure, it is that TMS effects are state dependent. In this review, we describe how the effects of TMS on brain networks depend on various factors, including cognitive brain state, oscillatory brain state, and recent brain state history. These states play a crucial role in determining the effects of TMS at the moment of stimulation and are therefore directly linked to what is referred to as target engagement in TMS therapy. There is no control over target engagement without considering the different brain state dependencies of our TMS intervention. Clinical TMS protocols are largely ignoring this fundamental principle, which may explain the large variability and often still limited efficacy of TMS treatments. We propose that after almost 30 years of research on state dependency of TMS, it is time to change standard clinical practice by taking advantage of this fundamental principle. Rather than ignoring TMS state dependency, we can use it to our clinical advantage to improve the effectiveness of TMS treatments.
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Affiliation(s)
- Alexander T Sack
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands; Brain + Nerve Center, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Jasmina Paneva
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Tara Küthe
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Eva Dijkstra
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands; Heart and Brain Group, Brainclinics Foundation, Nijmegen, the Netherlands; Neurowave, Amsterdam, the Netherlands
| | - Lauren Zwienenberg
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands; Heart and Brain Group, Brainclinics Foundation, Nijmegen, the Netherlands; Synaeda Psycho Medisch Centrum, Leeuwarden, the Netherlands
| | - Martijn Arns
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands; Brain + Nerve Center, Maastricht University Medical Center, Maastricht, the Netherlands; Heart and Brain Group, Brainclinics Foundation, Nijmegen, the Netherlands
| | - Teresa Schuhmann
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
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16
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Farzan F. Transcranial Magnetic Stimulation-Electroencephalography for Biomarker Discovery in Psychiatry. Biol Psychiatry 2024; 95:564-580. [PMID: 38142721 DOI: 10.1016/j.biopsych.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 12/08/2023] [Accepted: 12/15/2023] [Indexed: 12/26/2023]
Abstract
Current diagnosis and treatment of psychiatric illnesses are still based on behavioral observations and self-reports, commonly leading to prolonged untreated illness. Biological markers (biomarkers) may offer an opportunity to revolutionize clinical psychiatry practice by helping provide faster and potentially more effective therapies. Transcranial magnetic stimulation concurrent with electroencephalography (TMS-EEG) is a noninvasive brain mapping methodology that can assess the functions and dynamics of specific brain circuitries in awake humans and aid in biomarker discovery. This article provides an overview of TMS-EEG-based biomarkers that may hold potential in psychiatry. The methodological readiness of the TMS-EEG approach and steps in the validation of TMS-EEG biomarkers for clinical utility are discussed. Biomarker discovery with TMS-EEG is in the early stages, and several validation steps are still required before clinical implementations are realized. Thus far, TMS-EEG predictors of response to magnetic brain stimulation treatments in particular have shown promise for translation to clinical practice. Larger-scale studies can confirm validation followed by biomarker-informed trials to assess added value compared to existing practice.
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Affiliation(s)
- Faranak Farzan
- eBrain Lab, School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
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17
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Yu H, Shu X, Zhou Y, Zhou S, Wang X. Intermittent theta burst stimulation combined with cognitive training improves cognitive dysfunction and physical dysfunction in patients with post-stroke cognitive impairment. Behav Brain Res 2024; 461:114809. [PMID: 38081516 DOI: 10.1016/j.bbr.2023.114809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 11/27/2023] [Accepted: 12/08/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE Post-stroke cognitive impairment (PSCI) is a common complication of stroke. Intermittent theta burst stimulation (iTBS) can inducing motor learning. We observed the effects of combination of iTBS with cognitive training on physical/cognitive dysfunctions in PSCI patients. METHODS PSCI patients treated with basic treatment & cognitive training (Control group)/iTBS & cognitive training (iTBS group) were enrolled, with Mini-mental State Examination (MMSE)/Montreal Cognitive Assessment (MoCA)/Frontal Assessment Battery (FAB)/barthel index (BI)/Upper Limb Fugl-Meyer Assessment (U-FMA)/Action Research Arm Test (ARAT) scores compared. Gait spatiotemporal parameters/dynamic parameters were analyzed by 3D gait analysis. Correlations between MMSE/MoCA scores and gait parameters in PSCI patients after iTBS & cognitive training were analyzed by Spearman analysis. RESULTS Increased MMSE/MoCA/FAB/BI/U-FMA/ARAT scores, step speed, step frequency, stride length, step width, step length on the affected side, percentage of swing phase on the affected side, hip joint flexion angle on the affected side, knee joint flexion angle on the affected side, and ankle plantar flexion angle on the affected side and reduced gait period on the affected side and percentage of stance phase on the affected side were found in patients of both groups after treatment, with the effects in the iTBS group more profound. CONCLUSION iTBS & cognitive training obviously improved the cognitive function scores/upper limb function scores/gait parameters in PSCI patients versus cognitive training treatment. After combination therapy, the MMSE/MoCA scores of PSCI patients were significantly correlated with gait parameters. This provided more data support for iTBS & cognitive training application in the rehabilitation treatment of PSCI patients.
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Affiliation(s)
- Hong Yu
- Rahabilitation Assessment and Treatment Center, Zhejiang Rehabilitation Medical Center, Hangzhou, China
| | - Xinxin Shu
- Rahabilitation Assessment and Treatment Center, Zhejiang Rehabilitation Medical Center, Hangzhou, China.
| | - Yuda Zhou
- Rahabilitation Assessment and Treatment Center, Zhejiang Rehabilitation Medical Center, Hangzhou, China.
| | - Siwei Zhou
- Department of Geriatric Rehabilitation, Zhejiang Rehabilitation Medical Center, Hangzhou, China
| | - Xiaojun Wang
- Rahabilitation Assessment and Treatment Center, Zhejiang Rehabilitation Medical Center, Hangzhou, China
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18
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Lin H, Liang J, Wang Q, Shao Y, Song P, Li S, Bai Y. Effects of accelerated intermittent theta-burst stimulation in modulating brain of Alzheimer's disease. Cereb Cortex 2024; 34:bhae106. [PMID: 38517175 DOI: 10.1093/cercor/bhae106] [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: 09/20/2023] [Revised: 01/27/2024] [Accepted: 02/16/2024] [Indexed: 03/23/2024] Open
Abstract
Intermittent theta-burst stimulation (iTBS) is emerging as a noninvasive therapeutic strategy for Alzheimer's disease (AD). Recent advances highlighted a new accelerated iTBS (aiTBS) protocol, consisting of multiple sessions per day and higher overall pulse doses, in brain modulation. To examine the possibility of applying the aiTBS in treating AD patients, we enrolled 45 patients in AD at early clinical stages, and they were randomly assigned to either receive real or sham aiTBS. Neuropsychological scores were evaluated before and after treatment. Moreover, we detected cortical excitability and oscillatory activity changes in AD, by the single-pulse TMS in combination with EEG (TMS-EEG). Real stimulation showed markedly better performances in the group average of Auditory Verbal Learning Test scores compared to baseline. TMS-EEG revealed that aiTBS has reinforced this memory-related cortical mechanism by increasing cortical excitability and beta oscillatory activity underlying TMS target. We also found an enhancement of local natural frequency after aiTBS treatment. The novel findings implicated that high-dose aiTBS targeting left DLPFC is rapid-acting, safe, and tolerable in AD patients. Furthermore, TMS-related increase of specific neural oscillation elucidates the mechanisms of the AD cognitive impairment ameliorated by aiTBS.
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Affiliation(s)
- Hua Lin
- Department of Neurology, Xuanwu Hospital, Capital Medical University, 45th, Changchun Street, Beijing 100053, China
| | - Junhua Liang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, 45th, Changchun Street, Beijing 100053, China
| | - Qianqian Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, 45th, Changchun Street, Beijing 100053, China
| | - Yuxuan Shao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, 45th, Changchun Street, Beijing 100053, China
| | - Penghui Song
- Department of Neurology, Xuanwu Hospital, Capital Medical University, 45th, Changchun Street, Beijing 100053, China
| | - Siran Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, 45th, Changchun Street, Beijing 100053, China
| | - Yang Bai
- Affiliated Rehabilitation Hospital, Jiangxi Medical College, Nanchang University, 133th, south road of square Street, Nanchang 330006, Jiangxi, China
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19
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Grob AM, Heinbockel H, Milivojevic B, Doeller CF, Schwabe L. Causal role of the angular gyrus in insight-driven memory reconfiguration. eLife 2024; 12:RP91033. [PMID: 38407185 PMCID: PMC10942625 DOI: 10.7554/elife.91033] [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] [Indexed: 02/27/2024] Open
Abstract
Maintaining an accurate model of the world relies on our ability to update memory representations in light of new information. Previous research on the integration of new information into memory mainly focused on the hippocampus. Here, we hypothesized that the angular gyrus, known to be involved in episodic memory and imagination, plays a pivotal role in the insight-driven reconfiguration of memory representations. To test this hypothesis, participants received continuous theta burst stimulation (cTBS) over the left angular gyrus or sham stimulation before gaining insight into the relationship between previously separate life-like animated events in a narrative-insight task. During this task, participants also underwent EEG recording and their memory for linked and non-linked events was assessed shortly thereafter. Our results show that cTBS to the angular gyrus decreased memory for the linking events and reduced the memory advantage for linked relative to non-linked events. At the neural level, cTBS targeting the angular gyrus reduced centro-temporal coupling with frontal regions and abolished insight-induced neural representational changes for events linked via imagination, indicating impaired memory reconfiguration. Further, the cTBS group showed representational changes for non-linked events that resembled the patterns observed in the sham group for the linked events, suggesting failed pruning of the narrative in memory. Together, our findings demonstrate a causal role of the left angular gyrus in insight-related memory reconfigurations.
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Affiliation(s)
- Anna-Maria Grob
- Department of Cognitive Psychology, Institute of Psychology, Universität HamburgHamburgGermany
| | - Hendrik Heinbockel
- Department of Cognitive Psychology, Institute of Psychology, Universität HamburgHamburgGermany
| | - Branka Milivojevic
- Radboud University, Donders Institute for Brain, Cognition and BehaviourNijmegenNetherlands
| | - Christian F Doeller
- Kavli Institute for Systems Neuroscience, Centre for Neural Computation, The Egil and Pauline Braathen and Fred Kavli Centre for Cortical Microcircuits, Jebsen Centre for Alzheimer’s Disease, Norwegian University of Science and TechnologyTrondheimNorway
- Max-Planck-Insitute for Human Cognitive and Brain SciencesLeipzigGermany
- Wilhelm Wundt Institute of Psychology, Leipzig UniversityLeipzigGermany
| | - Lars Schwabe
- Department of Cognitive Psychology, Institute of Psychology, Universität HamburgHamburgGermany
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20
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He Y, Zhang Q, Ma TT, Liang YH, Guo RR, Li XS, Liu QJ, Feng TY. Effect of repetitive transcranial magnetic stimulation-assisted training on lower limb motor function in children with hemiplegic cerebral palsy. BMC Pediatr 2024; 24:136. [PMID: 38383331 PMCID: PMC10882917 DOI: 10.1186/s12887-024-04605-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 01/30/2024] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVE To explore the effect of repetitive transcranial magnetic stimulation (rTMS)-assisted training on lower limb motor function in children with hemiplegic cerebral palsy (HCP). METHOD Thirty-one children with HCP who met the inclusion criteria were selected and randomly divided into a control group (n = 16) and an experimental group (n = 15). The control group received routine rehabilitation treatment for 30 min each time, twice a day, 5 days a week for 4 weeks. Based on the control group, the experimental group received rTMS for 20 min each time, once a day, 5 days a week for 4 weeks. The outcome measures included a 10-metre walk test (10MWT), a 6-minute walk distance (6MWD) test, D- and E-zone gross motor function measurements (GMFM), the symmetry ratio of the step length and stance time and the muscle tone of the triceps surae and the hamstrings (evaluated according to the modified Ashworth scale), which were obtained in both groups of children before and after treatment. RESULTS After training, the 10MWT (P < 0.05), 6MWD (P < 0.01), GMFM (P < 0.001) and the symmetry ratio of the step length and stance time of the two groups were significantly improved (P < 0.05), there was more of an improvement in the experimental group compared with the control group. There was no significant change in the muscle tone of the hamstrings between the two groups before and after treatment (P > 0.05). After treatment, the muscle tone of the triceps surae in the experimental group was significantly reduced (P < 0.05), but there was no significant change in the control group (P > 0.05). CONCLUSION Repetitive TMS-assisted training can improve lower limb motor function in children with HCP.
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Affiliation(s)
- Yan He
- Department of Paediatric Physiotherapy, China Rehabilitation Research Center, Beijing Bo'ai Hospital, No. 10 of Jiaomen North street, Fengtai District, Beijing, 100068, China
- Capital Medical University School of Rehabilitation Medicine, No. 10 of Jiaomen North Street, Fengtai District, Beijing, 100068, China
| | - Qi Zhang
- Department of Paediatric Physiotherapy, China Rehabilitation Research Center, Beijing Bo'ai Hospital, No. 10 of Jiaomen North street, Fengtai District, Beijing, 100068, China.
- Capital Medical University School of Rehabilitation Medicine, No. 10 of Jiaomen North Street, Fengtai District, Beijing, 100068, China.
| | - Ting-Ting Ma
- Department of Paediatric Physiotherapy, China Rehabilitation Research Center, Beijing Bo'ai Hospital, No. 10 of Jiaomen North street, Fengtai District, Beijing, 100068, China
- Capital Medical University School of Rehabilitation Medicine, No. 10 of Jiaomen North Street, Fengtai District, Beijing, 100068, China
| | - Yan-Hua Liang
- Department of Paediatric Physiotherapy, China Rehabilitation Research Center, Beijing Bo'ai Hospital, No. 10 of Jiaomen North street, Fengtai District, Beijing, 100068, China
- Capital Medical University School of Rehabilitation Medicine, No. 10 of Jiaomen North Street, Fengtai District, Beijing, 100068, China
| | - Rong-Rong Guo
- Department of Paediatric Physiotherapy, China Rehabilitation Research Center, Beijing Bo'ai Hospital, No. 10 of Jiaomen North street, Fengtai District, Beijing, 100068, China
| | - Xiao-Song Li
- Department of Paediatric Physiotherapy, China Rehabilitation Research Center, Beijing Bo'ai Hospital, No. 10 of Jiaomen North street, Fengtai District, Beijing, 100068, China
- Capital Medical University School of Rehabilitation Medicine, No. 10 of Jiaomen North Street, Fengtai District, Beijing, 100068, China
| | - Qian-Jin Liu
- Department of Paediatric Physiotherapy, China Rehabilitation Research Center, Beijing Bo'ai Hospital, No. 10 of Jiaomen North street, Fengtai District, Beijing, 100068, China
| | - Tian-Yang Feng
- Department of Paediatric Physiotherapy, China Rehabilitation Research Center, Beijing Bo'ai Hospital, No. 10 of Jiaomen North street, Fengtai District, Beijing, 100068, China
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Kaneko N, Wada M, Nakajima S, Takano M, Taniguchi K, Honda S, Mimura M, Noda Y. Neuroplasticity of the left dorsolateral prefrontal cortex in patients with treatment-resistant depression as indexed with paired associative stimulation: a TMS-EEG study. Cereb Cortex 2024; 34:bhad515. [PMID: 38204301 PMCID: PMC10839839 DOI: 10.1093/cercor/bhad515] [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: 10/10/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 01/12/2024] Open
Abstract
Major depressive disorder affects over 300 million people globally, with approximately 30% experiencing treatment-resistant depression (TRD). Given that impaired neuroplasticity underlies depression, the present study focused on neuroplasticity in the dorsolateral prefrontal cortex (DLPFC). Here, we aimed to investigate the differences in neuroplasticity between 60 individuals with TRD and 30 age- and sex-matched healthy controls (HCs). To induce neuroplasticity, participants underwent a paired associative stimulation (PAS) paradigm involving peripheral median nerve stimulation and transcranial magnetic stimulation (TMS) targeting the left DLPFC. Neuroplasticity was assessed by using measurements combining TMS with EEG before and after PAS. Both groups exhibited significant increases in the early component of TMS-evoked potentials (TEP) after PAS (P < 0.05, paired t-tests with the bootstrapping method). However, the HC group demonstrated a greater increase in TEPs than the TRD group (P = 0.045, paired t-tests). Additionally, event-related spectral perturbation analysis highlighted that the gamma power significantly increased after PAS in the HC group, whereas it was decreased in the TRD group (P < 0.05, paired t-tests with the bootstrapping method). This gamma power modulation revealed a significant group difference (P = 0.006, paired t-tests), indicating an inverse relationship for gamma power modulation. Our findings underscore the impaired neuroplasticity of the DLPFC in individuals with TRD.
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Affiliation(s)
- Naotsugu Kaneko
- Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo, 3-8-1 Komaba, Meguro, Tokyo 153-8902, Japan
| | - Masataka Wada
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Shinichiro Nakajima
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Mayuko Takano
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
- Teijin Pharma Limited, 4-3-2 Asahigaoka, Hino, Tokyo 191-8512, Japan
| | - Keita Taniguchi
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Shiori Honda
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Yoshihiro Noda
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
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Yang Y, Shangguan Y, Wang X, Liu R, Shen Z, Tang M, Jiang G. The efficacy and safety of third-generation antiseizure medications and non-invasive brain stimulation to treat refractory epilepsy: a systematic review and network meta-analysis study. Front Neurol 2024; 14:1307296. [PMID: 38264091 PMCID: PMC10804851 DOI: 10.3389/fneur.2023.1307296] [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: 10/05/2023] [Accepted: 12/13/2023] [Indexed: 01/25/2024] Open
Abstract
Background The new antiseizure medications (ASMs) and non-invasive brain stimulation (NIBS) are controversial in controlling seizures. So, this network meta-analysis aimed to evaluate the efficacy and safety of five third-generation ASMs and two NIBS therapies for the treatment of refractory epilepsy. Methods We searched PubMed, EMBASE, Cochrane Library and Web of Science databases. Brivaracetam (BRV), cenobamate (CNB), eslicarbazepine acetate (ESL), lacosamide (LCM), perampanel (PER), repetitive transcranial magnetic stimulation (rTMS), and transcranial direct current stimulation (tDCS) were selected as additional treatments for refractory epilepsy in randomized controlled studies and other cohort studies. Randomized, double-blind, placebo-controlled, add-on studies that evaluated the efficacy or safety of medication and non-invasive brain stimulation and included patients with seizures were uncontrolled by one or more concomitant ASMs were identified. A random effects model was used to incorporate possible heterogeneity. The primary outcome was the change in seizure frequency from baseline, and secondary outcomes included the proportion of patients with ≥50% reduction in seizure frequency, and the rate of treatment-emergent adverse events. Results Forty-five studies were analyzed. The five ASMs and two NIBS decreased seizure frequency from baseline compared with placebo. The 50% responder rates of the five antiseizure drugs were significantly higher than that of placebo, and the ASMs were associated with fewer adverse events than placebo (p < 0.05). The surface under the cumulative ranking analysis revealed that ESL was most effective in decreasing the seizure frequency from baseline, whereas CNB provided the best 50% responder rate. BRV was the best tolerated. No significant publication bias was identified for each outcome index. Conclusion The five third-generation ASMs were more effective in controlling seizures than placebo, among which CNB, ESL, and LCM were most effective, and BRV exhibited better safety. Although rTMS and tDCS did not reduce seizure frequency as effectively as the five drugs, their safety was confirmed. Systematic review registration PROSPERO, https://www.crd.york.ac.uk/prospero/ (CRD42023441097).
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Affiliation(s)
- Yang Yang
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, China
| | - Yafei Shangguan
- Department of Neurology, The First People’s Hospital of Guiyang, Guiyang, China
| | - Xiaoming Wang
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, China
| | - Ruihong Liu
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, China
| | - Ziyi Shen
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, China
| | - Ming Tang
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, China
| | - Guohui Jiang
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, China
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Tuppurainen H, Määttä S, Könönen M, Julkunen P, Kautiainen H, Hyvärinen S, Vaurio O, Joensuu M, Vanhanen M, Aho-Mustonen K, Mervaala E, Tiihonen J. Navigated and individual α-peak-frequency-guided transcranial magnetic stimulation in male patients with treatment-refractory schizophrenia. J Psychiatry Neurosci 2024; 49:E87-E95. [PMID: 38428970 PMCID: PMC10914400 DOI: 10.1503/jpn.230063] [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: 04/21/2023] [Revised: 08/25/2023] [Accepted: 12/07/2023] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Previous electroencephalography (EEG) studies have indicated altered brain oscillatory α-band activity in schizophrenia, and treatment with repetitive transcranial magnetic stimulation (rTMS) using individualized α-frequency has shown therapeutic effects. Magnetic resonance imaging-based neuronavigation methods allow stimulation of a specific cortical region and improve targeting of rTMS; therefore, we sought to study the efficacy of navigated, individual α-peak-frequency-guided rTMS (αTMS) on treatment-refractory schizophrenia. METHODS We recruited medication-refractory male patients with schizophrenia or schizoaffective disorder in this doubleblind, sham-controlled study. We randomized patients to a 3-week course of either active αTMS or sham stimulation applied to the left dorsolateral prefrontal cortex (DLPFC). We assessed participants with the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression Scale (CGI) at baseline and after treatment. We conducted a follow-up assessment with the PANSS 3 months after intervention. RESULTS We included 44 patients. After treatment, we observed a significantly higher PANSS total score (p = 0.029), PANSS general psychopathology score (p = 0.027) and PANSS 5-factor model cognitive-disorganized factor score (p = 0.011) in the αTMS group than the sham group. In addition, the CGI-Improvement score was significantly higher among those who received αTMS compared with sham stimulation (p = 0.048). LIMITATIONS The limited number of study participants included only male patients. Depression was not formally evaluated. CONCLUSION Navigated αTMS to the left DLPFC reduced total, general psychopathological, and cognitive-disorganized symptoms of schizophrenia. These results provide evidence for the therapeutic efficacy of individual α-peak-frequency-guided rTMS in treatment-refractory schizophrenia. CLINICAL TRIAL REGISTRATION NCT01941251; ClinicalTrials.gov.
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Affiliation(s)
- Heli Tuppurainen
- From the Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tuppurainen, Hyvärinen, Vaurio, Joensuu, Vanhanen, Aho-Mustonen, Tiihonen); the Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland (Määttä, Könönen, Julkunen, Mervaala); the Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland (Könönen); the Department of Technical Physics, University of Eastern Finland, Kuopio, Finland (Julkunen); the Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland (Kautiainen); the Folkhälsan Research Center, Helsinki, Finland (Kautiainen); Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland (Mervaala); the Department of Clinical Neuroscience, Karolinska Institutet, and Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden (Tiihonen)
| | - Sara Määttä
- From the Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tuppurainen, Hyvärinen, Vaurio, Joensuu, Vanhanen, Aho-Mustonen, Tiihonen); the Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland (Määttä, Könönen, Julkunen, Mervaala); the Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland (Könönen); the Department of Technical Physics, University of Eastern Finland, Kuopio, Finland (Julkunen); the Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland (Kautiainen); the Folkhälsan Research Center, Helsinki, Finland (Kautiainen); Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland (Mervaala); the Department of Clinical Neuroscience, Karolinska Institutet, and Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden (Tiihonen)
| | - Mervi Könönen
- From the Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tuppurainen, Hyvärinen, Vaurio, Joensuu, Vanhanen, Aho-Mustonen, Tiihonen); the Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland (Määttä, Könönen, Julkunen, Mervaala); the Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland (Könönen); the Department of Technical Physics, University of Eastern Finland, Kuopio, Finland (Julkunen); the Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland (Kautiainen); the Folkhälsan Research Center, Helsinki, Finland (Kautiainen); Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland (Mervaala); the Department of Clinical Neuroscience, Karolinska Institutet, and Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden (Tiihonen)
| | - Petro Julkunen
- From the Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tuppurainen, Hyvärinen, Vaurio, Joensuu, Vanhanen, Aho-Mustonen, Tiihonen); the Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland (Määttä, Könönen, Julkunen, Mervaala); the Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland (Könönen); the Department of Technical Physics, University of Eastern Finland, Kuopio, Finland (Julkunen); the Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland (Kautiainen); the Folkhälsan Research Center, Helsinki, Finland (Kautiainen); Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland (Mervaala); the Department of Clinical Neuroscience, Karolinska Institutet, and Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden (Tiihonen)
| | - Hannu Kautiainen
- From the Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tuppurainen, Hyvärinen, Vaurio, Joensuu, Vanhanen, Aho-Mustonen, Tiihonen); the Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland (Määttä, Könönen, Julkunen, Mervaala); the Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland (Könönen); the Department of Technical Physics, University of Eastern Finland, Kuopio, Finland (Julkunen); the Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland (Kautiainen); the Folkhälsan Research Center, Helsinki, Finland (Kautiainen); Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland (Mervaala); the Department of Clinical Neuroscience, Karolinska Institutet, and Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden (Tiihonen)
| | - Soile Hyvärinen
- From the Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tuppurainen, Hyvärinen, Vaurio, Joensuu, Vanhanen, Aho-Mustonen, Tiihonen); the Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland (Määttä, Könönen, Julkunen, Mervaala); the Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland (Könönen); the Department of Technical Physics, University of Eastern Finland, Kuopio, Finland (Julkunen); the Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland (Kautiainen); the Folkhälsan Research Center, Helsinki, Finland (Kautiainen); Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland (Mervaala); the Department of Clinical Neuroscience, Karolinska Institutet, and Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden (Tiihonen)
| | - Olli Vaurio
- From the Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tuppurainen, Hyvärinen, Vaurio, Joensuu, Vanhanen, Aho-Mustonen, Tiihonen); the Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland (Määttä, Könönen, Julkunen, Mervaala); the Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland (Könönen); the Department of Technical Physics, University of Eastern Finland, Kuopio, Finland (Julkunen); the Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland (Kautiainen); the Folkhälsan Research Center, Helsinki, Finland (Kautiainen); Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland (Mervaala); the Department of Clinical Neuroscience, Karolinska Institutet, and Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden (Tiihonen)
| | - Mikko Joensuu
- From the Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tuppurainen, Hyvärinen, Vaurio, Joensuu, Vanhanen, Aho-Mustonen, Tiihonen); the Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland (Määttä, Könönen, Julkunen, Mervaala); the Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland (Könönen); the Department of Technical Physics, University of Eastern Finland, Kuopio, Finland (Julkunen); the Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland (Kautiainen); the Folkhälsan Research Center, Helsinki, Finland (Kautiainen); Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland (Mervaala); the Department of Clinical Neuroscience, Karolinska Institutet, and Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden (Tiihonen)
| | - Matti Vanhanen
- From the Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tuppurainen, Hyvärinen, Vaurio, Joensuu, Vanhanen, Aho-Mustonen, Tiihonen); the Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland (Määttä, Könönen, Julkunen, Mervaala); the Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland (Könönen); the Department of Technical Physics, University of Eastern Finland, Kuopio, Finland (Julkunen); the Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland (Kautiainen); the Folkhälsan Research Center, Helsinki, Finland (Kautiainen); Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland (Mervaala); the Department of Clinical Neuroscience, Karolinska Institutet, and Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden (Tiihonen)
| | - Kati Aho-Mustonen
- From the Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tuppurainen, Hyvärinen, Vaurio, Joensuu, Vanhanen, Aho-Mustonen, Tiihonen); the Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland (Määttä, Könönen, Julkunen, Mervaala); the Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland (Könönen); the Department of Technical Physics, University of Eastern Finland, Kuopio, Finland (Julkunen); the Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland (Kautiainen); the Folkhälsan Research Center, Helsinki, Finland (Kautiainen); Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland (Mervaala); the Department of Clinical Neuroscience, Karolinska Institutet, and Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden (Tiihonen)
| | - Esa Mervaala
- From the Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tuppurainen, Hyvärinen, Vaurio, Joensuu, Vanhanen, Aho-Mustonen, Tiihonen); the Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland (Määttä, Könönen, Julkunen, Mervaala); the Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland (Könönen); the Department of Technical Physics, University of Eastern Finland, Kuopio, Finland (Julkunen); the Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland (Kautiainen); the Folkhälsan Research Center, Helsinki, Finland (Kautiainen); Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland (Mervaala); the Department of Clinical Neuroscience, Karolinska Institutet, and Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden (Tiihonen)
| | - Jari Tiihonen
- From the Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tuppurainen, Hyvärinen, Vaurio, Joensuu, Vanhanen, Aho-Mustonen, Tiihonen); the Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland (Määttä, Könönen, Julkunen, Mervaala); the Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland (Könönen); the Department of Technical Physics, University of Eastern Finland, Kuopio, Finland (Julkunen); the Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland (Kautiainen); the Folkhälsan Research Center, Helsinki, Finland (Kautiainen); Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland (Mervaala); the Department of Clinical Neuroscience, Karolinska Institutet, and Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden (Tiihonen)
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Agboada D, Osnabruegge M, Rethwilm R, Kanig C, Schwitzgebel F, Mack W, Schecklmann M, Seiberl W, Schoisswohl S. Semi-automated motor hotspot search (SAMHS): a framework toward an optimised approach for motor hotspot identification. Front Hum Neurosci 2023; 17:1228859. [PMID: 38164193 PMCID: PMC10757939 DOI: 10.3389/fnhum.2023.1228859] [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: 05/25/2023] [Accepted: 11/23/2023] [Indexed: 01/03/2024] Open
Abstract
Background Motor hotspot identification represents the first step in the determination of the motor threshold and is the basis for the specification of stimulation intensity used for various Transcranial Magnetic Stimulation (TMS) applications. The level of experimenters' experience and the methodology of motor hotspot identification differ between laboratories. The need for an optimized and time-efficient technique for motor hotspot identification is therefore substantial. Objective With the current work, we present a framework for an optimized and time-efficient semi-automated motor hotspot search (SAMHS) technique utilizing a neuronavigated robot-assisted TMS system (TMS-cobot). Furthermore, we aim to test its practicality and accuracy by a comparison with a manual motor hotspot identification method. Method A total of 32 participants took part in this dual-center study. At both study centers, participants underwent manual hotspot search (MHS) with an experienced TMS researcher, and the novel SAMHS procedure with a TMS-cobot (hereafter, called cobot hotspot search, CHS) in a randomized order. Resting motor threshold (RMT), and stimulus intensity to produce 1 mV (SI1mV) peak-to-peak of motor-evoked potential (MEP), as well as MEPs with 120% RMT and SI1mV were recorded as outcome measures for comparison. Results Compared to the MHS method, the CHS produced lower RMT, lower SI1mV and a trend-wise higher peak-to-peak MEP amplitude in stimulations with SI1mV. The duration of the CHS procedure was longer than that of the MHS (15.60 vs. 2.43 min on average). However, accuracy of the hotspot was higher for the CHS compared to the MHS. Conclusions The SAMHS procedure introduces an optimized motor hotspot determination system that is easy to use, and strikes a fairly good balance between accuracy and speed. This new procedure can thus be deplored by experienced as well as beginner-level TMS researchers.
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Affiliation(s)
- Desmond Agboada
- Institute of Psychology, University of the Bundeswehr Munich, Neubiberg, Germany
| | - Mirja Osnabruegge
- Institute of Psychology, University of the Bundeswehr Munich, Neubiberg, Germany
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Roman Rethwilm
- Institute of Sport Science, University of the Bundeswehr Munich, Neubiberg, Germany
| | - Carolina Kanig
- Institute of Psychology, University of the Bundeswehr Munich, Neubiberg, Germany
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Florian Schwitzgebel
- Department of Electrical Engineering, University of the Bundeswehr Munich, Neubiberg, Germany
| | - Wolfgang Mack
- Institute of Psychology, University of the Bundeswehr Munich, Neubiberg, Germany
| | - Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Wolfgang Seiberl
- Institute of Sport Science, University of the Bundeswehr Munich, Neubiberg, Germany
| | - Stefan Schoisswohl
- Institute of Psychology, University of the Bundeswehr Munich, Neubiberg, Germany
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
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25
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Drabek M, Hodkinson D, Horvath S, Millar B, Pszczolkowski Parraguez S, Tench CR, Tanasescu R, Lankappa S, Morriss R, Walsh D, Auer DP. Brain connectivity-guided, Optimised theta burst transcranial magnetic stimulation to improve Central Pain Modulation in knee Osteoarthritis Pain (BoostCPM): protocol of a pilot randomised clinical trial in a secondary care setting in the UK. BMJ Open 2023; 13:e073378. [PMID: 37844981 PMCID: PMC10582853 DOI: 10.1136/bmjopen-2023-073378] [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: 03/03/2023] [Accepted: 09/14/2023] [Indexed: 10/18/2023] Open
Abstract
INTRODUCTION Chronic pain is a common health problem that is not efficiently managed by standard analgesic treatments. There is evidence that treatment resistance may result from maladaptive brain changes in areas that are fundamental to the perception of pain. Knee osteoarthritis is one of the most prevalent causes of chronic pain and commonly associated with negative affect. Chronic knee osteoarthritis pain is also associated with altered right anterior insula functional connectivity. We posit that reversal of these brain circuit alterations may be critical to alleviate chronic pain and associated negative affect, and that this can be achieved through non-invasive neuromodulation techniques. Despite growing interest in non-invasive neuromodulation for pain relief and proven efficacy in depression, results in chronic pain are mixed with limited high-quality evidence for clinical and mechanistic efficacy. Limitations include patient heterogeneity, imprecision of target selection, uncertain blinding and protocols that may deliver pulses at subclinical efficacy. METHODS AND ANALYSIS We hence developed an optimised treatment protocol of connectivity-guided intermittent theta-burst stimulation (iTBS) targeting the left dorsolateral prefrontal cortex with accelerated delivery on four consecutive days (allowing 4 days within the same week as protocol variation) with five daily treatment sessions that will be piloted in a sham-controlled design in 45 participants with chronic knee pain. This pilot study protocol will assess feasibility, tolerability and explore mechanistic efficacy through serial functional/structural magnetic resonance imaging (MRI) and quantitative sensory testing. ETHICS AND DISSEMINATION This pilot trial has been approved by the Ethics Committee Cornwall and Plymouth.Results of the pilot trial will be submitted to peer-reviewed journals, presented at research conferences and may be shared with participants and PPI/E advisors. TRIAL REGISTRATION NUMBER ISRCTN15404076.
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Affiliation(s)
- Marianne Drabek
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- Nottingham NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK
| | - Duncan Hodkinson
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- Nottingham NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK
| | - Suzanne Horvath
- Nottingham NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Bonnie Millar
- Nottingham NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Stefan Pszczolkowski Parraguez
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- Nottingham NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Christopher R Tench
- Nottingham NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Radu Tanasescu
- Nottingham NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK
- Clinical Neurology, Nottingham University Hospital Trusts, Nottingham, UK
| | - Sudheer Lankappa
- Adult Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Richard Morriss
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- Nottingham NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - David Walsh
- Nottingham NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Dorothee P Auer
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- Nottingham NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK
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Rashid-López R, Macías-García P, Sánchez-Fernández FL, Cano-Cano F, Sarrias-Arrabal E, Sanmartino F, Méndez-Bértolo C, Lozano-Soto E, Gutiérrez-Cortés R, González-Moraleda Á, Forero L, López-Sosa F, Zuazo A, Gómez-Molinero R, Gómez-Ramírez J, Paz-Expósito J, Rubio-Esteban G, Espinosa-Rosso R, Cruz-Gómez ÁJ, González-Rosa JJ. Neuroimaging and serum biomarkers of neurodegeneration and neuroplasticity in Parkinson's disease patients treated by intermittent theta-burst stimulation over the bilateral primary motor area: a randomized, double-blind, sham-controlled, crossover trial study. Front Aging Neurosci 2023; 15:1258315. [PMID: 37869372 PMCID: PMC10585115 DOI: 10.3389/fnagi.2023.1258315] [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: 07/13/2023] [Accepted: 09/12/2023] [Indexed: 10/24/2023] Open
Abstract
Background and objectives Intermittent theta-burst stimulation (iTBS) is a patterned form of excitatory transcranial magnetic stimulation that has yielded encouraging results as an adjunctive therapeutic option to alleviate the emergence of clinical deficits in Parkinson's disease (PD) patients. Although it has been demonstrated that iTBS influences dopamine-dependent corticostriatal plasticity, little research has examined the neurobiological mechanisms underlying iTBS-induced clinical enhancement. Here, our primary goal is to verify whether iTBS bilaterally delivered over the primary motor cortex (M1) is effective as an add-on treatment at reducing scores for both motor functional impairment and nonmotor symptoms in PD. We hypothesize that these clinical improvements following bilateral M1-iTBS could be driven by endogenous dopamine release, which may rebalance cortical excitability and restore compensatory striatal volume changes, resulting in increased striato-cortico-cerebellar functional connectivity and positively impacting neuroglia and neuroplasticity. Methods A total of 24 PD patients will be assessed in a randomized, double-blind, sham-controlled crossover study involving the application of iTBS over the bilateral M1 (M1 iTBS). Patients on medication will be randomly assigned to receive real iTBS or control (sham) stimulation and will undergo 5 consecutive sessions (5 days) of iTBS over the bilateral M1 separated by a 3-month washout period. Motor evaluation will be performed at different follow-up visits along with a comprehensive neurocognitive assessment; evaluation of M1 excitability; combined structural magnetic resonance imaging (MRI), resting-state electroencephalography and functional MRI; and serum biomarker quantification of neuroaxonal damage, astrocytic reactivity, and neural plasticity prior to and after iTBS. Discussion The findings of this study will help to clarify the efficiency of M1 iTBS for the treatment of PD and further provide specific neurobiological insights into improvements in motor and nonmotor symptoms in these patients. This novel project aims to yield more detailed structural and functional brain evaluations than previous studies while using a noninvasive approach, with the potential to identify prognostic neuroprotective biomarkers and elucidate the structural and functional mechanisms of M1 iTBS-induced plasticity in the cortico-basal ganglia circuitry. Our approach may significantly optimize neuromodulation paradigms to ensure state-of-the-art and scalable rehabilitative treatment to alleviate motor and nonmotor symptoms of PD.
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Affiliation(s)
- Raúl Rashid-López
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
- Department of Neurology, Puerta del Mar University Hospital, Cadiz, Spain
| | - Paloma Macías-García
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
- Department of Psychology, University of Cadiz, Cádiz, Spain
| | - F. Luis Sánchez-Fernández
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
- Department of Psychology, University of Cadiz, Cádiz, Spain
| | - Fátima Cano-Cano
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
| | - Esteban Sarrias-Arrabal
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
- Department of Psychology, University of Cadiz, Cádiz, Spain
| | - Florencia Sanmartino
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
- Department of Psychology, University of Cadiz, Cádiz, Spain
| | - Constantino Méndez-Bértolo
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
- Department of Psychology, University of Cadiz, Cádiz, Spain
| | - Elena Lozano-Soto
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
- Department of Psychology, University of Cadiz, Cádiz, Spain
| | - Remedios Gutiérrez-Cortés
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
| | - Álvaro González-Moraleda
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
- Department of Psychology, University of Cadiz, Cádiz, Spain
| | - Lucía Forero
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
- Department of Neurology, Puerta del Mar University Hospital, Cadiz, Spain
| | - Fernando López-Sosa
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
- Department of Psychology, University of Cadiz, Cádiz, Spain
| | - Amaya Zuazo
- Department of Radiodiagnostic and Medical Imaging, Puerta del Mar University Hospital, Cadiz, Spain
| | | | - Jaime Gómez-Ramírez
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
| | - José Paz-Expósito
- Department of Radiodiagnostic and Medical Imaging, Puerta del Mar University Hospital, Cadiz, Spain
| | | | - Raúl Espinosa-Rosso
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
- Department of Neurology, Jerez de la Frontera University Hospital, Jerez de la Frontera, Spain
| | - Álvaro J. Cruz-Gómez
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
- Department of Psychology, University of Cadiz, Cádiz, Spain
| | - Javier J. González-Rosa
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
- Department of Psychology, University of Cadiz, Cádiz, Spain
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McNerney MW, Gurkoff GG, Beard C, Berryhill ME. The Rehabilitation Potential of Neurostimulation for Mild Traumatic Brain Injury in Animal and Human Studies. Brain Sci 2023; 13:1402. [PMID: 37891771 PMCID: PMC10605899 DOI: 10.3390/brainsci13101402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/25/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
Neurostimulation carries high therapeutic potential, accompanied by an excellent safety profile. In this review, we argue that an arena in which these tools could provide breakthrough benefits is traumatic brain injury (TBI). TBI is a major health problem worldwide, with the majority of cases identified as mild TBI (mTBI). MTBI is of concern because it is a modifiable risk factor for dementia. A major challenge in studying mTBI is its inherent heterogeneity across a large feature space (e.g., etiology, age of injury, sex, treatment, initial health status, etc.). Parallel lines of research in human and rodent mTBI can be collated to take advantage of the full suite of neuroscience tools, from neuroimaging (electroencephalography: EEG; functional magnetic resonance imaging: fMRI; diffusion tensor imaging: DTI) to biochemical assays. Despite these attractive components and the need for effective treatments, there are at least two major challenges to implementation. First, there is insufficient understanding of how neurostimulation alters neural mechanisms. Second, there is insufficient understanding of how mTBI alters neural function. The goal of this review is to assemble interrelated but disparate areas of research to identify important gaps in knowledge impeding the implementation of neurostimulation.
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Affiliation(s)
- M. Windy McNerney
- Mental Illness Research Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA; (M.W.M.); (C.B.)
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Gene G. Gurkoff
- Department of Neurological Surgery, and Center for Neuroscience, University of California, Davis, Sacramento, CA 95817, USA;
- Department of Veterans Affairs, VA Northern California Health Care System, Martinez, CA 94553, USA
| | - Charlotte Beard
- Mental Illness Research Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA; (M.W.M.); (C.B.)
- Program in Neuroscience and Behavioral Biology, Emory University, Atlanta, GA 30322, USA
| | - Marian E. Berryhill
- Programs in Cognitive and Brain Sciences, and Integrative Neuroscience, Department of Psychology, University of Nevada, Reno, NV 89557, USA
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Chang CH, Chou PH, Chuang HY, Yao CY, Chen WJ, Tsai HC. Efficacy of Non-Invasive Brain Stimulation for Treating Depression in Patients with Traumatic Brain Injury: A Meta-Analysis and Meta-Regression of Randomized Controlled Trials. J Clin Med 2023; 12:6030. [PMID: 37762970 PMCID: PMC10531948 DOI: 10.3390/jcm12186030] [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: 05/09/2023] [Revised: 08/31/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
OBJECTIVE This meta-analysis aimed to ascertain the efficacy of non-invasive brain stimulation (NIBS)-comprising repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS)-for depression in traumatic brain injury (TBI) patients. METHODS Comprehensive searches were conducted in PubMed, Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials up to 28 January 2023. Random-effects models assessed the treatment effects, and heterogeneity was evaluated through I2 statistics and funnel plot inspection. RESULTS From 10 trials (234 participants; 8 rTMS, 2 tDCS), NIBS was found significantly more effective than sham in alleviating depressive symptoms (SMD: 0.588, 95% CI: 0.264-0.912; p < 0.001). rTMS, specifically, showed higher efficacy (SMD: 0.707, 95% CI: 0.306-1.108; p = 0.001) compared to sham, whereas tDCS outcomes were inconclusive (SMD: 0.271, 95% CI: -0.230 to 0.771; p = 0.289). Meta-regression found no correlation with the number of sessions, treatment intensity, or total dose. Notably, while post-treatment effects were significant, they diminished 1-2 months post intervention. Adverse events associated with NIBS were minimal, with no severe outcomes like seizures and suicide reported. CONCLUSIONS rTMS emerged as a potent short-term intervention for depression in TBI patients, while tDCS findings remained equivocal. The long-term efficacy of NIBS is yet to be established, warranting further studies. The low adverse event rate reaffirms NIBS's potential safety.
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Affiliation(s)
- Chun-Hung Chang
- Institute of Clinical Medical Science, China Medical University, Taichung 406040, Taiwan;
- Department of Psychiatry & Brain Disease Research Center, China Medical University Hospital, Taichung 404327, Taiwan
- An Nan Hospital, China Medical University, Tainan 709204, Taiwan; (C.-Y.Y.); (W.-J.C.)
| | - Po-Han Chou
- Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Hsinchu 302056, Taiwan
- Department of Psychiatry, China Medical University Hospital, China Medical University, Taichung 404327, Taiwan
| | - Hao-Yu Chuang
- Department of Neurosurgery, An Nan Hospital, China Medical University, Tainan 709204, Taiwan;
| | - Chi-Yu Yao
- An Nan Hospital, China Medical University, Tainan 709204, Taiwan; (C.-Y.Y.); (W.-J.C.)
| | - Wei-Jen Chen
- An Nan Hospital, China Medical University, Tainan 709204, Taiwan; (C.-Y.Y.); (W.-J.C.)
| | - Hsin-Chi Tsai
- Department of Psychiatry, Tzu-Chi General Hospital, Hualien 970473, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien 970473, Taiwan
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Cruciani A, Mancuso M, Sveva V, Maccarrone D, Todisco A, Motolese F, Santoro F, Pilato F, Spampinato DA, Rocchi L, Di Lazzaro V, Capone F. Using TMS-EEG to assess the effects of neuromodulation techniques: a narrative review. Front Hum Neurosci 2023; 17:1247104. [PMID: 37645690 PMCID: PMC10461063 DOI: 10.3389/fnhum.2023.1247104] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/01/2023] [Indexed: 08/31/2023] Open
Abstract
Over the past decades, among all the non-invasive brain stimulation (NIBS) techniques, those aiming for neuromodulatory protocols have gained special attention. The traditional neurophysiological outcome to estimate the neuromodulatory effect is the motor evoked potential (MEP), the impact of NIBS techniques is commonly estimated as the change in MEP amplitude. This approach has several limitations: first, the use of MEP limits the evaluation of stimulation to the motor cortex excluding all the other brain areas. Second, MEP is an indirect measure of brain activity and is influenced by several factors. To overcome these limitations several studies have used new outcomes to measure brain changes after neuromodulation techniques with the concurrent use of transcranial magnetic stimulation (TMS) and electroencephalogram (EEG). In the present review, we examine studies that use TMS-EEG before and after a single session of neuromodulatory TMS. Then, we focused our literature research on the description of the different metrics derived from TMS-EEG to measure the effect of neuromodulation.
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Affiliation(s)
- Alessandro Cruciani
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology, and Psychiatry, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Marco Mancuso
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Valerio Sveva
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Davide Maccarrone
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Antonio Todisco
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology, and Psychiatry, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Francesco Motolese
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology, and Psychiatry, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Francesca Santoro
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology, and Psychiatry, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Fabio Pilato
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology, and Psychiatry, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | | | - Lorenzo Rocchi
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Vincenzo Di Lazzaro
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology, and Psychiatry, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Fioravante Capone
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology, and Psychiatry, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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30
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Zhang W, Liu N, Zhao Y, Yao C, Yang D, Yang C, Sun H, Wei X, Sweeney JA, Liang H, Zhang M, Gong Q, Lui S. The acute effects of repetitive transcranial magnetic stimulation on laminar diffusion anisotropy of neocortical gray matter. MedComm (Beijing) 2023; 4:e335. [PMID: 37560755 PMCID: PMC10407029 DOI: 10.1002/mco2.335] [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: 02/10/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 08/11/2023] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is increasingly used to treat neuropsychiatric disorders. Inhibitory and excitatory regimens have been both adopted but the exact mechanism of action remains unclear, and investigating their differential effects on laminar diffusion profiles of neocortex may add important evidence. Twenty healthy participants were randomly assigned to receive a low-frequency/inhibitory or high-frequency/excitatory rTMS targeting the left dorsolateral prefrontal cortex (DLPFC). With the brand-new submillimeter diffusion tensor imaging of whole brain and specialized surface-based laminar analysis, fractional anisotropy (FA) and mean diffusion (MD) profiles of cortical layers at different cortical depths were characterized before/after rTMS. Inhibitory and excitatory rTMS both showed impacts on diffusion metrics of somatosensory, limbic, and sensory regions, but different patterns of changes were observed-increased FA with inhibitory rTMS, whereas decreased FA with excitatory rTMS. More importantly, laminar analysis indicated laminar specificity of changes in somatosensory regions during different rTMS patterns-inhibitory rTMS affected the superficial layers contralateral to the DLPFC, while excitatory rTMS led to changes in the intermediate/deep layers bilateral to the DLPFC. These findings provide novel insights into acute neurobiological effects on diffusion profiles of rTMS that may add critical evidence relevant to different protocols of rTMS on neocortex.
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Affiliation(s)
- Wenjing Zhang
- Department of Radiologyand Functional and Molecular Imaging Key Laboratory of Sichuan ProvinceWest China Hospital of Sichuan UniversityChengduChina
- Huaxi MR Research Center (HMRRC)West China Hospital of Sichuan UniversityChengduChina
- Research Unit of PsychoradiologyChinese Academy of Medical SciencesChengduChina
| | - Naici Liu
- Department of Radiologyand Functional and Molecular Imaging Key Laboratory of Sichuan ProvinceWest China Hospital of Sichuan UniversityChengduChina
- Huaxi MR Research Center (HMRRC)West China Hospital of Sichuan UniversityChengduChina
- Research Unit of PsychoradiologyChinese Academy of Medical SciencesChengduChina
| | - Youjin Zhao
- Department of Radiologyand Functional and Molecular Imaging Key Laboratory of Sichuan ProvinceWest China Hospital of Sichuan UniversityChengduChina
- Huaxi MR Research Center (HMRRC)West China Hospital of Sichuan UniversityChengduChina
- Research Unit of PsychoradiologyChinese Academy of Medical SciencesChengduChina
| | - Chenyang Yao
- Department of Radiologyand Functional and Molecular Imaging Key Laboratory of Sichuan ProvinceWest China Hospital of Sichuan UniversityChengduChina
- Huaxi MR Research Center (HMRRC)West China Hospital of Sichuan UniversityChengduChina
- Research Unit of PsychoradiologyChinese Academy of Medical SciencesChengduChina
| | - Dan Yang
- Department of Radiologyand Functional and Molecular Imaging Key Laboratory of Sichuan ProvinceWest China Hospital of Sichuan UniversityChengduChina
| | - Chengmin Yang
- Department of Radiologyand Functional and Molecular Imaging Key Laboratory of Sichuan ProvinceWest China Hospital of Sichuan UniversityChengduChina
- Huaxi MR Research Center (HMRRC)West China Hospital of Sichuan UniversityChengduChina
- Research Unit of PsychoradiologyChinese Academy of Medical SciencesChengduChina
| | - Hui Sun
- Department of Radiologyand Functional and Molecular Imaging Key Laboratory of Sichuan ProvinceWest China Hospital of Sichuan UniversityChengduChina
- Huaxi MR Research Center (HMRRC)West China Hospital of Sichuan UniversityChengduChina
- Research Unit of PsychoradiologyChinese Academy of Medical SciencesChengduChina
| | - Xia Wei
- Department of Radiologyand Functional and Molecular Imaging Key Laboratory of Sichuan ProvinceWest China Hospital of Sichuan UniversityChengduChina
- Huaxi MR Research Center (HMRRC)West China Hospital of Sichuan UniversityChengduChina
- Research Unit of PsychoradiologyChinese Academy of Medical SciencesChengduChina
| | - John A. Sweeney
- Huaxi MR Research Center (HMRRC)West China Hospital of Sichuan UniversityChengduChina
- Department of Psychiatry and Behavioral NeuroscienceUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | | | | | - Qiyong Gong
- Department of Radiologyand Functional and Molecular Imaging Key Laboratory of Sichuan ProvinceWest China Hospital of Sichuan UniversityChengduChina
- Huaxi MR Research Center (HMRRC)West China Hospital of Sichuan UniversityChengduChina
- Research Unit of PsychoradiologyChinese Academy of Medical SciencesChengduChina
- Department of RadiologyWest China Xiamen Hospital of Sichuan UniversityXiamenFujianChina
| | - Su Lui
- Department of Radiologyand Functional and Molecular Imaging Key Laboratory of Sichuan ProvinceWest China Hospital of Sichuan UniversityChengduChina
- Huaxi MR Research Center (HMRRC)West China Hospital of Sichuan UniversityChengduChina
- Research Unit of PsychoradiologyChinese Academy of Medical SciencesChengduChina
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31
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Luo X, Zhou Y, Yuan S, Chen X, Zhang B. The changes in metabolomics profile induced by intermittent theta burst stimulation in major depressive disorder: an exploratory study. BMC Psychiatry 2023; 23:550. [PMID: 37516823 PMCID: PMC10387200 DOI: 10.1186/s12888-023-05044-9] [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] [Received: 02/10/2023] [Accepted: 07/22/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND Recently, there has been an ongoing interest in the mechanism of intermittent theta burst stimulation (iTBS) in major depressive disorder. Studying the metabolite changes induced by iTBS may help to understand the mechanism. METHODS Eleven participants with major depressive disorder received 10 days iTBS treatment. Magnetic resonance imaging (MRI) was used to target the region of the left dorsolateral prefrontal cortex (DLPFC) in each participant. We analyzed the effects of iTBS on metabolites using high-throughput profiling and assessed its impact on depressive symptoms. These analyses were considered exploratory, and no correction for multiple comparisons was applied. RESULTS Among the 318 measured metabolites, a significant increase in cystine, asymmetric dimethylarginine (ADMA), 1-methylhistidine, indoleacetic acid (IAA), diethanolamine (DEA), dopa, riboflavin-5'-monophosphate (FMN), and a significant decrease in alphalinolenic acid (ALA), gamma-linolenic acid (GLA), serotonin, linoleic acid (LA) (p < 0.05) were detected in the patients after iTBS treatment. In Pearson correlation analysis, the plasma levels of LA, FMN and ADMA at baseline were significantly related to the reduction rate of the 17-item Hamilton Depression Rating Scale and the Patient Health Questionnaire-9 scores (p < 0.05). CONCLUSIONS Our study highlights that LA, FMN, ADMA and their relationship with oxidative stress, may be key factors in the antidepressant efficacy of iTBS.
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Affiliation(s)
- Xin Luo
- Psychiatric & Psychological Neuroimage Laboratory (PsyNI Lab), The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuwen Zhou
- Institute of Mental Health, Tianjin Anding Hospital, Tianjin Medical University, Tianjin, China
| | - Shiqi Yuan
- Psychiatric & Psychological Neuroimage Laboratory (PsyNI Lab), The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaoyu Chen
- Psychiatric & Psychological Neuroimage Laboratory (PsyNI Lab), The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Bin Zhang
- Institute of Mental Health, Tianjin Anding Hospital, Tianjin Medical University, Tianjin, China.
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Wang Y, Dong T, Li X, Zhao H, Yang L, Xu R, Fu Y, Li L, Gai X, Qin D. Research progress on the application of transcranial magnetic stimulation in spinal cord injury rehabilitation: a narrative review. Front Neurol 2023; 14:1219590. [PMID: 37533475 PMCID: PMC10392830 DOI: 10.3389/fneur.2023.1219590] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/05/2023] [Indexed: 08/04/2023] Open
Abstract
Traumatic or non-traumatic spinal cord injury (SCI) can lead to severe disability and complications. The incidence of SCI is high, and the rehabilitation cycle is long, which increases the economic burden on patients and the health care system. However, there is no practical method of SCI treatment. Recently, transcranial magnetic stimulation (TMS), a non-invasive brain stimulation technique, has been shown to induce changes in plasticity in specific areas of the brain by regulating the activity of neurons in the stimulation site and its functionally connected networks. TMS is a new potential method for the rehabilitation of SCI and its complications. In addition, TMS can detect the activity of neural circuits in the central nervous system and supplement the physiological evaluation of SCI severity. This review describes the pathophysiology of SCI as well as the basic principles and classification of TMS. We mainly focused on the latest research progress of TMS in the physiological evaluation of SCI as well as the treatment of motor dysfunction, neuropathic pain, spasticity, neurogenic bladder, respiratory dysfunction, and other complications. This review provides new ideas and future directions for SCI assessment and treatment.
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Affiliation(s)
- Yuhong Wang
- Department of Rehabilitation Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Tingting Dong
- Department of Rehabilitation Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Xiahuang Li
- Department of Neurosurgery, Mengzi People’s Hospital, Mengzi, China
| | - Huiyun Zhao
- Department of Rehabilitation Medicine, Dongchuan District People’s Hospital, Kunming, China
| | - Lili Yang
- Department of Rehabilitation Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Rui Xu
- Department of Rehabilitation Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Yi Fu
- Department of Pulmonary and Critical Care Medicine, Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, China
| | - Li Li
- Department of Emergency Trauma Surgery, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Xuesong Gai
- Department of Rehabilitation Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Dongdong Qin
- Key Laboratory of Traditional Chinese Medicine for Prevention and Treatment of Neuropsychiatric Diseases, Yunnan University of Chinese Medicine, Kunming, China
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Cheng S, Xin R, Zhao Y, Wang P, Feng W, Liu P. Evaluation of fMRI activation in post-stroke patients with movement disorders after repetitive transcranial magnetic stimulation: a scoping review. Front Neurol 2023; 14:1192545. [PMID: 37404941 PMCID: PMC10315664 DOI: 10.3389/fneur.2023.1192545] [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: 03/23/2023] [Accepted: 05/25/2023] [Indexed: 07/06/2023] Open
Abstract
Background Movement disorders are one of the most common stroke residual effects, which cause a major stress on their families and society. Repetitive transcranial magnetic stimulation (rTMS) could change neuroplasticity, which has been suggested as an alternative rehabilitative treatment for enhancing stroke recovery. Functional magnetic resonance imaging (fMRI) is a promising tool to explore neural mechanisms underlying rTMS intervention. Object Our primary goal is to better understand the neuroplastic mechanisms of rTMS in stroke rehabilitation, this paper provides a scoping review of recent studies, which investigate the alteration of brain activity using fMRI after the application of rTMS over the primary motor area (M1) in movement disorders patients after stroke. Method The database PubMed, Embase, Web of Science, WanFang Chinese database, ZhiWang Chinese database from establishment of each database until December 2022 were included. Two researchers reviewed the study, collected the information and the relevant characteristic extracted to a summary table. Two researchers also assessed the quality of literature with the Downs and Black criteria. When the two researchers unable to reach an agreement, a third researcher would have been consulted. Results Seven hundred and eleven studies in all were discovered in the databases, and nine were finally enrolled. They were of good quality or fair quality. The literature mainly involved the therapeutic effect and imaging mechanisms of rTMS on improving movement disorders after stroke. In all of them, there was improvement of the motor function post-rTMS treatment. Both high-frequency rTMS (HF-rTMS) and low-frequency rTMS (LF-rTMS) can induce increased functional connectivity, which may not directly correspond to the impact of rTMS on the activation of the stimulated brain areas. Comparing real rTMS with sham group, the neuroplastic effect of real rTMS can lead to better functional connectivity in the brain network in assisting stroke recovery. Conclusion rTMS allows the excitation and synchronization of neural activity, promotes the reorganization of brain function, and achieves the motor function recovery. fMRI can observe the influence of rTMS on brain networks and reveal the neuroplasticity mechanism of post-stroke rehabilitation. The scoping review helps us to put forward a series of recommendations that might guide future researchers exploring the effect of motor stroke treatments on brain connectivity.
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Affiliation(s)
- Siman Cheng
- Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Rong Xin
- Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Yan Zhao
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Pu Wang
- Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Wuwei Feng
- Department of Neurology, Medical University of South Carolina, Charleston, SC, United States
| | - Peng Liu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
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Li X, Chen M, Liu Q, Zheng C, Yu C, Hou G, Chen Z, Chen Y, Chen Y, Zhu G, Zhou D, Xu W. TMS-evoked potential in the dorsolateral prefrontal cortex to assess the severity of depression disease: a TMS-EEG study. Front Pharmacol 2023; 14:1207020. [PMID: 37342593 PMCID: PMC10277673 DOI: 10.3389/fphar.2023.1207020] [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: 04/17/2023] [Accepted: 05/24/2023] [Indexed: 06/23/2023] Open
Abstract
Objective: The combined use of transcranial magnetic stimulation and electroencephalography (TMS-EEG), as a powerful technique that can non-invasively probe the state of the brain, can be used as a method to study neurophysiological markers in the field of psychiatric disorders and discover potential diagnostic predictors. This study used TMS-evoked potentials (TEPs) to study the cortical activity of patients with major depressive disorder depression (MDD) and the correlation with clinical symptoms to provide an electrophysiological basis for the clinical diagnosis. Methods: A total of 41 patients and 42 healthy controls were recruited to study. Using TMS-EEG techniques to measure the left dorsolateral prefrontal cortex (DLPFC) 's TEP index and evaluate the clinical symptoms of MDD patients using the Hamilton Depression Scale-24 (HAMD-24). Results: MDD subjects performing TMS-EEG on the DLPFC showed lower cortical excitability P60 index levels than healthy controls. Further analysis revealed that the degree of P60 excitability within the DLPFC of MDD patients was significantly negatively correlated with the severity of depression. Conclusion: The low levels of P60 exhibited in DLPFC reflect low excitability in MDD; the P60 component can be used as a biomarker for MDD in clinical assessment tools.
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Affiliation(s)
- Xingxing Li
- Ningbo Kangning Hospital, Ningbo, Zhejiang, China
| | - Meng Chen
- Ningbo Kangning Hospital, Ningbo, Zhejiang, China
| | - Qinqin Liu
- Qingdao Mental Health Center, Qingdao, Shandong, China
| | - Chao Zheng
- Ningbo Kangning Hospital, Ningbo, Zhejiang, China
| | - Chang Yu
- Ningbo Kangning Hospital, Ningbo, Zhejiang, China
| | - Guangwei Hou
- Yu Yao Third People’s Hospital, Ningbo, Zhejiang, China
| | - Zan Chen
- Ningbo Kangning Hospital, Ningbo, Zhejiang, China
| | - Yiqing Chen
- Yu Yao Third People’s Hospital, Ningbo, Zhejiang, China
| | - Yinping Chen
- Yu Yao Third People’s Hospital, Ningbo, Zhejiang, China
| | - Guidong Zhu
- The Second People’s Hospital of Lishui, Lishui, Zhejiang, China
| | | | - Weiqian Xu
- Taizhou Second People’s Hospital, Taizhou, Zhejiang, China
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Cai DB, Qin ZJ, Lan XJ, Liu QM, Qin XD, Wang JJ, Goya-Maldonado R, Huang XB, Ungvari GS, Ng CH, Zheng W, Xiang YT. Accelerated intermittent theta burst stimulation for major depressive disorder or bipolar depression: A systematic review and meta-analysis. Asian J Psychiatr 2023; 85:103618. [PMID: 37201381 DOI: 10.1016/j.ajp.2023.103618] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 05/20/2023]
Abstract
We aimed to systematically evaluate the clinical efficacy and safety of accelerated intermittent theta burst stimulation (aiTBS) for patients with major depressive disorder (MDD) or bipolar depression (BD). A random-effects model was adopted to analyze the primary and secondary outcomes using the Review Manager, Version 5.3 software. This meta-analysis (MA) identified five double-blind randomized controlled trials (RCTs) comprising 239 MDD or BD patients with a major depressive episode. Active aiTBS overperformed sham stimulation in the study-defined response. This MA found preliminary evidence that active aiTBS resulted in a greater response in treating major depressive episodes in MDD or BD patients than sham stimulation.
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Affiliation(s)
- Dong-Bin Cai
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China; The Fourth Clinical College, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Zhen-Juan Qin
- The Brain Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, China
| | - Xian-Jun Lan
- The Brain Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, China
| | - Qi-Man Liu
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiu-De Qin
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China; The Fourth Clinical College, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Jian-Jun Wang
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China; The Fourth Clinical College, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Roberto Goya-Maldonado
- Laboratory of Systems Neuroscience and Imaging in Psychiatry (SNIP-Lab), Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Xing-Bing Huang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Gabor S Ungvari
- University of Notre Dame Australia, Fremantle, Australia; Division of Psychiatry, School of Medicine, University of Western Australia/Graylands Hospital, Perth, Australia
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, Victoria, Australia.
| | - Wei Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China.
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Non-Invasive Neuromodulation Methods to Alleviate Symptoms of Huntington's Disease: A Systematic Review of the Literature. J Clin Med 2023; 12:jcm12052002. [PMID: 36902788 PMCID: PMC10004225 DOI: 10.3390/jcm12052002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/23/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
Huntington's disease (HD) is a progressive and debilitating neurodegenerative disease. There is growing evidence for non-invasive neuromodulation tools as therapeutic strategies in neurodegenerative diseases. This systematic review aims to investigate the effectiveness of noninvasive neuromodulation in HD-associated motor, cognitive, and behavioral symptoms. A comprehensive literature search was conducted in Ovid MEDLINE, Cochrane Central Register of Clinical Trials, Embase, and PsycINFO from inception to 13 July 2021. Case reports, case series, and clinical trials were included while screening/diagnostic tests involving non-invasive neuromodulation, review papers, experimental studies on animal models, other systematic reviews, and meta-analyses were excluded. We have identified 19 studies in the literature investigating the use of ECT, TMS, and tDCS in the treatment of HD. Quality assessments were performed using Joanna Briggs Institute's (JBI's) critical appraisal tools. Eighteen studies showed improvement of HD symptoms, but the results were very heterogeneous considering different intervention techniques and protocols, and domains of symptoms. The most noticeable improvement involved depression and psychosis after ECT protocols. The impact on cognitive and motor symptoms is more controversial. Further investigations are required to determine the therapeutic role of distinct neuromodulation techniques for HD-related symptoms.
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Transcranial Magnetic Stimulation Improves Executive Functioning through Modulation of Social Cognitive Networks in Patients with Mild Cognitive Impairment: Preliminary Results. Diagnostics (Basel) 2023; 13:diagnostics13030415. [PMID: 36766520 PMCID: PMC9914912 DOI: 10.3390/diagnostics13030415] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/26/2023] Open
Abstract
(1) Background: Patients with mild cognitive impairment (MCI) often present impairment in executive functions (EFs). This study aimed to investigate the effect of high-frequency repetitive transcranial magnetic stimulation (rTMS) on EFs in patients with MCI. (2) Methods: A prospective trial was conducted on 11 patients with MCI. Participants underwent 25 min of 20 Hz rTMS for ten days on the right temporo-parietal junction (RTPJ) and medial prefrontal cortex (MPFC). Before (T0) and after rTMS treatment (T1), global cognitive profile and EFs were investigated using the Montreal cognitive assessment (MoCA), trial making test (TMT) A and B, and frontal assessment battery (FAB). Depression symptoms were assessed using the geriatric depression scale (GDS). Statistical analysis included Wilcoxon signed-rank test. (3) Results: After treatment, patients showed a significant improvement in the MoCA EFs subtask (T0 vs. T1, p = 0.015) and TMT-B (T0 vs. T1, p = 0.028). Five MCI patients with EF impairment showed full recovery of these deficits. No significant changes in the GDS were observed. (4) Conclusions: rTMS stimulation over the TPJ and MPFC induced significant short-term improvements in EFs in MCI patients. These findings suggest that the TPJ and MPFC may be involved in the attention-executive skills to redirect attention toward behaviorally relevant stimuli.
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