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Hernández-Sauret A, Martin de la Torre O, Redolar-Ripoll D. Use of transcranial magnetic stimulation (TMS) for studying cognitive control in depressed patients: A systematic review. COGNITIVE, AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2024:10.3758/s13415-024-01193-w. [PMID: 38773020 DOI: 10.3758/s13415-024-01193-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 05/23/2024]
Abstract
Major depressive disorder (MDD) is a debilitating mental disorder and the leading cause of disease burden. Major depressive disorder is associated with emotional impairment and cognitive deficit. Cognitive control, which is the ability to use perceptions, knowledge, and information about goals and motivations to shape the selection of goal-directed actions or thoughts, is a primary function of the prefrontal cortex (PFC). Psychotropic medications are one of the main treatments for MDD, but they are not effective for all patients. An alternative treatment is transcranial magnetic stimulation (TMS). Previous studies have provided mixed results on the cognitive-enhancing effects of TMS treatment in patients with MDD. Some studies have found significant improvement, while others have not. There is a lack of understanding of the specific effects of different TMS protocols and stimulation parameters on cognitive control in MDD. Thus, this review aims to synthesize the effectiveness of the TMS methods and a qualitative assessment of their potential benefits in improving cognitive functioning in patients with MDD. We reviewed 21 studies in which participants underwent a treatment of any transcranial magnetic stimulation protocol, such as repetitive TMS or theta-burst stimulation. One of the primary outcome measures was any change in the cognitive control process. Overall, the findings indicate that transcranial magnetic stimulation (TMS) may enhance cognitive function in patients with MDD. Most of the reviewed studies supported the notion of cognitive improvement following TMS treatment. Notably, improvements were predominantly observed in inhibition, attention, set shifting/flexibility, and memory domains. However, fewer significant improvements were detected in evaluations of visuospatial function and recognition, executive function, phonemic fluency, and speed of information processing. This review found evidence supporting the use of TMS as a treatment for cognitive deficits in patients with MDD. The results are promising, but further research is needed to clarify the specific TMS protocol and stimulation locations that are most effective.
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Affiliation(s)
- Ana Hernández-Sauret
- Cognitive Neurolab, Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), Rambla del Poblenou 156, Barcelona, Spain.
- Instituto Brain360, Unidad Neuromodulación y Neuroimagen, Calle Maó 9, Barcelona, Spain.
| | - Ona Martin de la Torre
- Cognitive Neurolab, Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), Rambla del Poblenou 156, Barcelona, Spain
- Instituto Brain360, Unidad Neuromodulación y Neuroimagen, Calle Maó 9, Barcelona, Spain
| | - Diego Redolar-Ripoll
- Cognitive Neurolab, Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), Rambla del Poblenou 156, Barcelona, Spain
- Instituto Brain360, Unidad Neuromodulación y Neuroimagen, Calle Maó 9, Barcelona, Spain
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Pan WG, Hu XY, Zhu DD, Li L, Bao F, Ren L, Mao PX, Ma X, Ren YP, Tang YL. The cognitive effects of adjunctive repetitive transcranial magnetic stimulation for late-onset depression: a randomized controlled trial with 4 week follow-up. Front Psychiatry 2023; 14:1240261. [PMID: 37614650 PMCID: PMC10442575 DOI: 10.3389/fpsyt.2023.1240261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/27/2023] [Indexed: 08/25/2023] Open
Abstract
Objectives Cognitive impairment is common and linked to poor outcomes in patients with late-onset depression (LOD). The cognitive effects of repetitive transcranial magnetic stimulation (rTMS) for LOD are not well understood. This study aimed to investigate the effects of rTMS on cognitive function in elderly patients with LOD. Methods In total, 58 elderly patients (aged 60 to 75 years) with depression were enrolled and randomly assigned to an active rTMS group or a sham group. The participants received active or sham rTMS over the left dorsolateral prefrontal cortex for 4 weeks, 5 days a week, at a frequency of 10 Hz rTMS and 120% of the motor threshold (MT). Cognitive function was assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) at baseline, the end of the 4 week treatment period, and at the 4 week follow-up. Results The active rTMS group showed significant improvements in immediate memory and attention scores on the RBANS compared to the sham group. However, no significant differences were observed between the two groups in other cognitive domains assessed by the RBANS. No serious adverse events related to rTMS treatment were observed. Conclusion Treatment with 120% MT rTMS was associated with improvement in cognitive defects related to the active phase of LOD. These findings suggest that rTMS could provide early improvements in cognitive function in clinical settings for elderly patients with LOD.Clinical trial registration: https://www.chictr.org.cn/showproj.html?proj=40698, identifier ChiCTR1900024445.
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Affiliation(s)
- Wei-gang Pan
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Xiao-yue Hu
- Department of Psychiatry, Xicheng District Pingan Hospital, Beijing, China
| | - Dan-di Zhu
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Li Li
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Feng Bao
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Li Ren
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Pei-xian Mao
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Xin Ma
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yan-ping Ren
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yi-lang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GE, United States
- Mental Health Service Line, Atlanta VA Medical Center, Decatur, GE, United States
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Adu MK, Shalaby R, Chue P, Agyapong VIO. Repetitive Transcranial Magnetic Stimulation for the Treatment of Resistant Depression: A Scoping Review. Behav Sci (Basel) 2022; 12:bs12060195. [PMID: 35735405 PMCID: PMC9220129 DOI: 10.3390/bs12060195] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/07/2022] [Accepted: 06/13/2022] [Indexed: 12/28/2022] Open
Abstract
Treatment-resistant depression (TRD) is associated with significant disability, and due to its high prevalence, it results in a substantive socio-economic burden at a global level. TRD is the inability to accomplish and/or achieve remission after an adequate trial of antidepressant treatments. Studies comparing repetitive transcranial magnetic stimulation (rTMS) with electroconvulsive therapy (ECT) and pharmacotherapy have revealed evidence of the therapeutic efficacy of rTMS in TRD. These findings suggest a crucial role for rTMS in the management of TRD. This article aims to conduct a comprehensive scoping review of the current literature concerning the use of rTMS and its therapeutic efficacy as a treatment modality for TRD. PubMed, PsycINFO, Medline, Embase, and Cinahl were used to identify important articles on rTMS for TRD. The search strategy was limited to English articles within the last five years of data publication. Articles were included if they reported on a completed randomized controlled trial (RCT) of rTMS intervention for TRD. The exclusion criteria involved studies with rTMS for the treatment of conditions other than TRD, and study and experimental protocols of rTMS on TRD. In total, 17 studies were eligible for inclusion in this review. The search strategy spanned studies published in the last five years, to the date of the data search (14 February 2022). The regional breakdown of the extracted studies was North American (n = 9), European (n = 5), Asian (n = 2) and Australian (n = 1). The applied frequencies of rTMS ranged from 5 Hz to 50 Hz, with stimulation intensities ranging from 80% MT to 120% MT. Overall, 16 out of the 17 studies suggested that rTMS treatment was effective, safe and tolerated in TRD. For patients with TRD, rTMS appears to provide significant benefits through the reduction of depressive symptoms, and while there is progressive evidence in support of the same, more research is needed in order to define standardized protocols of rTMS application in terms of localization, frequency, intensity, and pulse parameters.
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Affiliation(s)
- Medard Kofi Adu
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre (WMC), 8440 112 St NW, Edmonton, AB T6G 2B7, Canada; (R.S.); (P.C.); (V.I.O.A.)
- Correspondence:
| | - Reham Shalaby
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre (WMC), 8440 112 St NW, Edmonton, AB T6G 2B7, Canada; (R.S.); (P.C.); (V.I.O.A.)
| | - Pierre Chue
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre (WMC), 8440 112 St NW, Edmonton, AB T6G 2B7, Canada; (R.S.); (P.C.); (V.I.O.A.)
| | - Vincent I. O. Agyapong
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre (WMC), 8440 112 St NW, Edmonton, AB T6G 2B7, Canada; (R.S.); (P.C.); (V.I.O.A.)
- Department of Psychiatry, Dalhousie University, Halifax, NS B3H 4R2, Canada
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Gregory EC, Torres IJ, Blumberger DM, Downar J, Daskalakis ZJ, Vila-Rodriguez F. Repetitive Transcranial Magnetic Stimulation Shows Longitudinal Improvements in Memory in Patients With Treatment-Resistant Depression. Neuromodulation 2022; 25:596-605. [DOI: 10.1016/j.neurom.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/27/2021] [Accepted: 09/13/2021] [Indexed: 10/19/2022]
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Asgharian Asl F, Vaghef L. The effectiveness of high-frequency left DLPFC-rTMS on depression, response inhibition, and cognitive flexibility in female subjects with major depressive disorder. J Psychiatr Res 2022; 149:287-292. [PMID: 35313201 DOI: 10.1016/j.jpsychires.2022.01.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 01/02/2022] [Accepted: 01/09/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND The purpose of the present study was to investigate the effect of high-frequency repetitive transcranial magnetic stimulation on depression severity, response inhibition, and cognitive flexibility in subjects with major depressive disorder. METHODS Twenty-eight female subjects with major depressive disorder were randomly divided into experimental and control groups. High frequency (20 Hz) rTMS stimulation at 85% of the MT consisted of 25 trains of 5 s duration, a total of 2500 pulses/session or sham stimulation was applied over the left DLPFC for five consecutive days per week, for two weeks. Depression severity, response inhibition, and cognitive flexibility of subjects were assessed by Beck Depression Inventory, Go/NoGo, and Wisconsin sort cards (WCST) tests, respectively, pre- and post-TMS intervention. RESULTS rTMS over the left DLPFC significantly decreased the depression severity at the Beck Depression Inventory, enhanced accuracy, and decreased reaction time at the Go/NoGo task. In the Wisconsin Card Sort Test, perseverative and non-perseverative errors and failure to maintain a set index significantly decreased following rTMS treatment. CONCLUSIONS Findings indicate that 20-Hz rTMS treatment on the left DLPFC has a positive effect on depression severity, response inhibition, and cognitive flexibility in depressed subjects.
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Affiliation(s)
- Fatemeh Asgharian Asl
- Department of Psychology, Faculty of Education & Psychology, Azarbaijan Shahid Madani University, Tabriz, Iran.
| | - Ladan Vaghef
- Department of Psychology, Faculty of Education & Psychology, Azarbaijan Shahid Madani University, Tabriz, Iran
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Eydi-Baygi M, Aflakseir A, Imani M, Goodarzi MA, Harirchian MH. Mindfulness-based cognitive therapy combined with repetitive transracial magnetic stimulation (rTMS) on information processing and working memory of patients with multiple sclerosis. CASPIAN JOURNAL OF INTERNAL MEDICINE 2022; 13:607-616. [PMID: 35974943 PMCID: PMC9348202 DOI: 10.22088/cjim.13.3.607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/28/2021] [Accepted: 09/20/2021] [Indexed: 10/31/2022]
Abstract
Background MS is a demyelinating disease that can result in significant disability. Along with physical complications, this disease is associated with significant psychological complications, including cognitive decline. Therefore, this study aimed to determine the efficacy of mindfulness-based cognitive therapy in combination with rTMS on information processing and working memory in patients with MS. Methods The current study used a single-case experimental design and included a follow-up (A-B-A). The statistical population of the present study was all MS patients in Tehran who referred to Imam Khomeini Hospital in Tehran in 2020. The present study sample consisted of 5 MS patients selected by the sampling methods available. Subjects were assessed three times before, during, and after the intervention using the Zahlen-Verbindongs and n-back tests in the two-back position. Subjects received cognitive therapy based on mindfulness and rTMS at a frequency of 10 Hz. Visual and graphical recovery percentage and effect size methods were used to analyze the data. Results The current study's findings indicate that combining mindfulness with rTMS has a beneficial effect on the information processing and working memory of MS patients. Overall, 67.24% recovered following the intervention stage, 53.64% recovered following the follow-up for information processing, 104.04% recovered following the intervention stage, and 76.98% recovered following the follow-up for working memory. Conclusion The study shows the effect of mindfulness combined with rTMS on cognitive problems in MS patients. Significant improvements in MS patients' information processing, working memory, and therapeutic outcomes were observed throughout the follow-up period.
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Affiliation(s)
- Majid Eydi-Baygi
- Department of Clinical Psychology, Faculty of Psychology and Education Sciences, Shiraz University, Shiraz, Iran
| | - Abdolaziz Aflakseir
- Department of Clinical Psychology, Faculty of Psychology and Education Sciences, Shiraz University, Shiraz, Iran,Correspondence: Abdolaziz Aflakseir, Department of Clinical psychology, Faculty of Psychology and Education Sciences, Shiraz University, Eram Blvd., Eram, Shiraz, Iran. E-mail: , Tel: 0098 7136276708, Fax: 0098 7136286441
| | - Mehdi Imani
- Department of Clinical Psychology, Faculty of Psychology and Education Sciences, Shiraz University, Shiraz, Iran
| | - Mohammad Ali Goodarzi
- Department of Clinical Psychology, Faculty of Psychology and Education Sciences, Shiraz University, Shiraz, Iran
| | - Mohammad Hossein Harirchian
- Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Bonotis K, Anargyros K, Liaskopoulos N, Barlogianni AM. Evaluation of memory performance in patients with brain disorders following rTMS treatment. A systematic review. Clin Neurophysiol 2021; 135:126-153. [DOI: 10.1016/j.clinph.2021.11.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 10/24/2021] [Accepted: 11/29/2021] [Indexed: 12/01/2022]
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Holczer A, Németh VL, Vékony T, Kocsis K, Király A, Kincses ZT, Vécsei L, Klivényi P, Must A. The Effects of Bilateral Theta-burst Stimulation on Executive Functions and Affective Symptoms in Major Depressive Disorder. Neuroscience 2021; 461:130-139. [PMID: 33731314 DOI: 10.1016/j.neuroscience.2021.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/25/2021] [Accepted: 03/02/2021] [Indexed: 01/02/2023]
Abstract
Major depressive disorder (MDD) is characterized by severe affective as well as cognitive symptoms. Moreover, cognitive impairment in MDD can persist after the remission of affective symptoms. Theta-burst stimulation (TBS) is a promising tool to manage the affective symptoms of major depressive disorder (MDD); however, its cognition-enhancing effects are sparsely investigated. Here, we aimed to examine whether the administration of bilateral TBS has pro-cognitive effects in MDD. Ten daily sessions of neuronavigated active or sham TBS were delivered bilaterally over the dorsolateral prefrontal cortex to patients with MDD. The n-back task and the attention network task were administered to assess working memory and attention, respectively. Affective symptoms were measured using the 21-item Hamilton Depression Rating Scale. We observed moderate evidence that the depressive symptoms of patients receiving active TBS improved compared to participants in the sham stimulation. No effects of TBS on attention and working memory were detected, supported by a moderate-to-strong level of evidence. The effects of TBS on psychomotor processing speed should be further investigated. Bilateral TBS has a substantial antidepressive effect with no immediate adverse effects on executive functions.
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Affiliation(s)
- Adrienn Holczer
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Health Centre, University of Szeged, Szeged, Hungary
| | - Viola Luca Németh
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Health Centre, University of Szeged, Szeged, Hungary
| | - Teodóra Vékony
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Health Centre, University of Szeged, Szeged, Hungary; Lyon Neuroscience Research Center (CRNL), INSERM, CNRS, Université Claude Bernard Lyon 1, Lyon, France
| | - Krisztián Kocsis
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Health Centre, University of Szeged, Szeged, Hungary
| | - András Király
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Health Centre, University of Szeged, Szeged, Hungary; Central European Institute of Technology, Brno, Czech Republic
| | - Zsigmond Tamás Kincses
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Health Centre, University of Szeged, Szeged, Hungary; Department of Radiology, Albert Szent-Györgyi Health Centre, University of Szeged, Szeged, Hungary
| | - László Vécsei
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Health Centre, University of Szeged, Szeged, Hungary; MTA-SZTE Neuroscience Research Group, Szeged, Hungary
| | - Péter Klivényi
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Health Centre, University of Szeged, Szeged, Hungary
| | - Anita Must
- Institute of Psychology, Faculty of Arts, University of Szeged, Szeged, Hungary.
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Evaluation and Treatment of Vascular Cognitive Impairment by Transcranial Magnetic Stimulation. Neural Plast 2020. [PMID: 33193753 DOI: 10.1155/2020/8820881.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The exact relationship between cognitive functioning, cortical excitability, and synaptic plasticity in dementia is not completely understood. Vascular cognitive impairment (VCI) is deemed to be the most common cognitive disorder in the elderly since it encompasses any degree of vascular-based cognitive decline. In different cognitive disorders, including VCI, transcranial magnetic stimulation (TMS) can be exploited as a noninvasive tool able to evaluate in vivo the cortical excitability, the propension to undergo neural plastic phenomena, and the underlying transmission pathways. Overall, TMS in VCI revealed enhanced cortical excitability and synaptic plasticity that seem to correlate with the disease process and progression. In some patients, such plasticity may be considered as an adaptive response to disease progression, thus allowing the preservation of motor programming and execution. Recent findings also point out the possibility to employ TMS to predict cognitive deterioration in the so-called "brains at risk" for dementia, which may be those patients who benefit more of disease-modifying drugs and rehabilitative or neuromodulatory approaches, such as those based on repetitive TMS (rTMS). Finally, TMS can be exploited to select the responders to specific drugs in the attempt to maximize the response and to restore maladaptive plasticity. While no single TMS index owns enough specificity, a panel of TMS-derived measures can support VCI diagnosis and identify early markers of progression into dementia. This work reviews all TMS and rTMS studies on VCI. The aim is to evaluate how cortical excitability, plasticity, and connectivity interact in the pathophysiology of the impairment and to provide a translational perspective towards novel treatments of these patients. Current pitfalls and limitations of both studies and techniques are also discussed, together with possible solutions and future research agenda.
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Cantone M, Lanza G, Fisicaro F, Pennisi M, Bella R, Di Lazzaro V, Di Pino G. Evaluation and Treatment of Vascular Cognitive Impairment by Transcranial Magnetic Stimulation. Neural Plast 2020; 2020:8820881. [PMID: 33193753 PMCID: PMC7641667 DOI: 10.1155/2020/8820881] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/23/2020] [Accepted: 10/12/2020] [Indexed: 02/07/2023] Open
Abstract
The exact relationship between cognitive functioning, cortical excitability, and synaptic plasticity in dementia is not completely understood. Vascular cognitive impairment (VCI) is deemed to be the most common cognitive disorder in the elderly since it encompasses any degree of vascular-based cognitive decline. In different cognitive disorders, including VCI, transcranial magnetic stimulation (TMS) can be exploited as a noninvasive tool able to evaluate in vivo the cortical excitability, the propension to undergo neural plastic phenomena, and the underlying transmission pathways. Overall, TMS in VCI revealed enhanced cortical excitability and synaptic plasticity that seem to correlate with the disease process and progression. In some patients, such plasticity may be considered as an adaptive response to disease progression, thus allowing the preservation of motor programming and execution. Recent findings also point out the possibility to employ TMS to predict cognitive deterioration in the so-called "brains at risk" for dementia, which may be those patients who benefit more of disease-modifying drugs and rehabilitative or neuromodulatory approaches, such as those based on repetitive TMS (rTMS). Finally, TMS can be exploited to select the responders to specific drugs in the attempt to maximize the response and to restore maladaptive plasticity. While no single TMS index owns enough specificity, a panel of TMS-derived measures can support VCI diagnosis and identify early markers of progression into dementia. This work reviews all TMS and rTMS studies on VCI. The aim is to evaluate how cortical excitability, plasticity, and connectivity interact in the pathophysiology of the impairment and to provide a translational perspective towards novel treatments of these patients. Current pitfalls and limitations of both studies and techniques are also discussed, together with possible solutions and future research agenda.
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Affiliation(s)
- Mariagiovanna Cantone
- 1Department of Neurology, Sant'Elia Hospital, ASP Caltanissetta, Caltanissetta 93100, Italy
| | - Giuseppe Lanza
- 2Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania 95123, Italy
- 3Department of Neurology IC, Oasi Research Institute–IRCCS, Troina 94108, Italy
| | - Francesco Fisicaro
- 4Department of Biomedical and Biotechnological Sciences, University of Catania, Catania 95123, Italy
| | - Manuela Pennisi
- 4Department of Biomedical and Biotechnological Sciences, University of Catania, Catania 95123, Italy
| | - Rita Bella
- 5Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Catania 95123, Italy
| | - Vincenzo Di Lazzaro
- 6Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome 00128, Italy
| | - Giovanni Di Pino
- 7Research Unit of Neurophysiology and Neuroengineering of Human-Technology Interaction (NeXTlab), Università Campus Bio-Medico di Roma, Rome 00128, Italy
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Jia QF, Chen P, Zhu HL, Chen SS, Gu XC, Yin XY, Wu YH, Yin GZ, Hui L. Cognitive Impairments in First-Episode Drug-Naïve Versus Medicated Depressive Patients: RBANS in a Chinese Population. Psychiatr Q 2019; 90:471-480. [PMID: 31079346 DOI: 10.1007/s11126-019-09641-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cognitive deficits are a core feature of major depressive disorder (MDD). However, there are no previous studies that directly compare cognitive performance between first-episode drug-naive depressive patients (FDDP) and medicated depressive patients (MDP). Therefore, the aim of this study was to investigate whether there were the differences in cognitive functions between FDDP and MDP. Sixty-two FDDP, 111 MDP and 90 healthy controls were enrolled in a Chinese population. Cognitive functions were assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). There were the differences in the RBANS total score (F = 26.55, p < 0.001), subscales of immediate memory (F = 3.95, p = 0.02), language (F = 54.11, p < 0.001) and delayed memory (F = 11.19, p = 0.001) among the three groups after controlling for gender, education, smoking and body mass index (BMI). These differences in the RBANS total score, subscales of language and delayed memory passed the Bonferroni corrections (all, p < 0.05). Compared to healthy controls, FDDP and MDP had poorer cognitive performance including the RBANS total score, and subscales of language and delayed memory (all, p < 0.05) after controlling for the variables. FDDP experienced greater language deficits than MDP (p < 0.05) after controlling for the variables. Education was correlated with the language score in FDDP (r = 0.61, p < 0.001). Multivariate regression analysis indicated that education was an independent contributor to the language score in FDDP (ß = 3.11, t = 5.48, p < 0.001). Our findings indicated that FDDP had poorer language performance than MDP. Moreover, education could influence the language performance in FDDP.
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Affiliation(s)
- Qiu Fang Jia
- Institute of Mental Health, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, Jiangsu, People's Republic of China
| | - Peng Chen
- Institute of Mental Health, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, Jiangsu, People's Republic of China
| | - Hong Liang Zhu
- Institute of Mental Health, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, Jiangsu, People's Republic of China
| | - Shan Shan Chen
- Institute of Mental Health, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, Jiangsu, People's Republic of China
| | - Xiao Chu Gu
- Institute of Mental Health, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, Jiangsu, People's Republic of China
| | - Xu Yuan Yin
- Institute of Mental Health, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, Jiangsu, People's Republic of China
| | - Yan Hai Wu
- Anhui Rongjun Hospital, Bengbu, 233499, Anhui, People's Republic of China
| | - Guang Zhong Yin
- Institute of Mental Health, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, Jiangsu, People's Republic of China
| | - Li Hui
- Institute of Mental Health, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, Jiangsu, People's Republic of China.
- Institute of Mental Health, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, No. 11 Guangqian Road, Suzhou, 215137, Jiangsu Province, People's Republic of China.
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Lantrip C, Delaloye S, Baird L, Dreyer-Oren S, Brady RE, Roth RM, Gunning F, Holtzheimer P. Effects of Left Versus Right Dorsolateral Prefrontal Cortex Repetitive Transcranial Magnetic Stimulation on Affective Flexibility in Healthy Women: A Pilot Study. Cogn Behav Neurol 2019; 32:69-75. [PMID: 31205120 DOI: 10.1097/wnn.0000000000000190] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the antidepressant mechanism of action for repetitive transcranial magnetic stimulation (rTMS) to the left dorsolateral prefrontal cortex (DLPFC) in healthy women. Our primary hypothesis was that a single session of left DLPFC rTMS, compared with a session of right DLPFC rTMS, would result in better (reduced) negative nonaffective switch costs in healthy women. BACKGROUND The antidepressant mechanism of action for rTMS is not clear. It is possible that rTMS to the DLPFC improves emotion regulation, which could be a part of its antidepressant mechanism. METHODS Twenty-five healthy women were randomized to receive left high-frequency (HF) rTMS versus right HF rTMS in one session and then contralateral stimulation during a second session. Emotion regulation was assessed via switch costs for reappraisal of negatively valenced information on an affective flexibility task. RESULTS For negative nonaffective switch costs, the interaction effect in the two-way ANOVA was not significant (F1,19=3.053, P=0.097). Given that left HF rTMS is the approved treatment for depression, post hoc t tests were completed with particular interest in the left-side findings. These tests confirmed that negative nonaffective switch costs significantly improved immediately after left rTMS (t1,19=2.664, P=0.015) but not right rTMS. CONCLUSIONS These findings suggest that left DLPFC HF rTMS may lead to antidepressant effects by improving the regulation of emotion.
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Affiliation(s)
| | - Sibylle Delaloye
- Kaiser Southern California Permanente Medical Group, Los Angeles, California
| | | | | | - Robert E Brady
- Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Robert M Roth
- Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Faith Gunning
- Department of Psychiatry, Weill Cornell Medicine, New York, New York
| | - Paul Holtzheimer
- Departments of Psychiatry and Surgery
- Executive Division, National Center for Posttraumatic Stress Disorder, White River Junction, Vermont
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13
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Gellersen HM, Kedzior KK. Antidepressant outcomes of high-frequency repetitive transcranial magnetic stimulation (rTMS) with F8-coil and deep transcranial magnetic stimulation (DTMS) with H1-coil in major depression: a systematic review and meta-analysis. BMC Psychiatry 2019; 19:139. [PMID: 31064328 PMCID: PMC6505129 DOI: 10.1186/s12888-019-2106-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 04/08/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The current study aims to systematically assess and compare the antidepressant outcomes of repetitive transcranial magnetic stimulation (rTMS) with the figure-of-eight (F8)-coil and deep transcranial magnetic stimulation (DTMS) with the H1-coil in studies matched on stimulation frequency in unipolar major depressive disorder (MDD). METHODS Electronic search of Medline and PsycInfo identified 19 studies with stimulation frequency of 18-20 Hz using F8-coil (k = 8 randomised sham-controlled trials, RCTs, k = 3 open-label; n = 168 patients) or H1-coil (k = 1 RCT, k = 7 open-label; n = 200). Depression severity (the primary outcome) and response/remission rates (the secondary outcomes) were assessed at session 10. RESULTS Effects pooled with random-effects meta-analysis showed a large reduction in depression severity, 29% response, and 15% remission rates after 10 sessions of active stimulation with either coil relative to baseline. Reduction in depression severity was greater in studies with younger patients using either coil. The comparison between coils showed a larger reduction in depression severity in H1-coil vs. F8-coil studies (independent of the study design or the concurrent pharmacotherapy) and a trend towards higher remission rates in F8-coil vs. H1-coils studies. These effects are based on a low volume of studies, are not controlled for placebo, and may not be clinically-relevant. The stimulation protocols differed systematically because stimulation was more focal but less intense (80-110% of the resting motor threshold, MT) in the F8-coil studies and less focal but more intense (120% MT) in the H1-coil studies. Two seizures occurred in the H1-coil studies relative to none in the F8-coil studies. CONCLUSION When matched on frequency, the higher-intensity and less focal stimulation with the H1-coil reduces depression more than the lower-intensity and more focal stimulation with the F8-coil. Head-to-head trials should compare the antidepressant outcomes of F8-coil and H1-coil to identify the most optimal stimulation protocols for acute and longer-lasting efficacy.
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Affiliation(s)
- Helena M. Gellersen
- 0000000121885934grid.5335.0Department of Psychology, University of Cambridge, Cambridge, UK
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14
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Abd Elghany SE, Al Ashkar DS, El-Barbary AM, El Khouly RM, Aboelhawa MA, Nada DW, Darwish NF, Hussein MS, Rageh ES, Abo-Zaid MH, Eldesoky IF, Afifi S. Regenerative injection therapy and repetitive transcranial magnetic stimulation in primary fibromyalgia treatment: A comparative study. J Back Musculoskelet Rehabil 2019; 32:55-62. [PMID: 30149440 DOI: 10.3233/bmr-181127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study compared the effectiveness of regenerative injection therapy (RIT), i.e. prolotherapy, and repetitive transcranial magnetic stimulation (rTMS) in the treatment of fibromyalgia syndrome. PATIENTS AND METHODS This study included 120 female, age-matched fibromyalgia patients. All patients underwent a clinical examination, pain assessment by VAS, assessment of tender points, psychiatric and functional assessment using the Beck Depression Inventory (BDI), Fibromyalgia Impact Questionnaire Revised (RFIQ), and measurement of cortical auditory evoked potentials CAEPs elicited at 1000 Hz. Patients were divided into two equal groups; Group 1 received prolotherapy three times, two weeks apart, and Group 2 received rTMS sessions every other day for one month. Assessment was performed before treatment, immediately after treatment, and one month later. RESULTS A significant improvement of pain measured by the mean score of VAS was remarked in Group 1 compared to Group 2 immediately after treatment and one month later. There was statistically significant difference of mean scores for the number of tender points in Group 1 compared to Group 2 after treatment and one month later. The patients improved functionally, with a statistically significant difference in mean score of RFIQ, in Group 1 compared to Group 2 one month after treatment. However, there was a significant difference in mean score of BDI in Group 2 compared to Group 1 after treatment and one month later. Further, CAEPs showed better improvement, with a significant difference in Group 2, one month after treatment. CONCLUSION RIT had the advantage in clinical and functional improvement in fibromyalgia patients, while rTMS had better results regarding depression and the cortical component of AEPs. These results might draw attention to the evaluability of a combination of both techniques for a better therapeutic response.
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Affiliation(s)
| | - Doaa S Al Ashkar
- Physical Medicine, Rheumatology and Rehabilitation Department, Tanta University, Tanta, Egypt
| | - Amal M El-Barbary
- Physical Medicine, Rheumatology and Rehabilitation Department, Tanta University, Tanta, Egypt
| | - Radwa M El Khouly
- Physical Medicine, Rheumatology and Rehabilitation Department, Tanta University, Tanta, Egypt
| | - Marwa A Aboelhawa
- Physical Medicine, Rheumatology and Rehabilitation Department, Tanta University, Tanta, Egypt
| | - Doaa W Nada
- Physical Medicine, Rheumatology and Rehabilitation Department, Tanta University, Tanta, Egypt
| | - Nivine F Darwish
- Physical Medicine, Rheumatology and Rehabilitation Department, Tanta University, Tanta, Egypt
| | - Manal S Hussein
- Physical Medicine, Rheumatology and Rehabilitation Department, Tanta University, Tanta, Egypt
| | - El Sayed Rageh
- Physical Medicine, Rheumatology and Rehabilitation Department, Tanta University, Tanta, Egypt
| | - Mohamed H Abo-Zaid
- Physical Medicine, Rheumatology and Rehabilitation Department, Tanta University, Tanta, Egypt
| | - Islam F Eldesoky
- Neurology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Samah Afifi
- Neurology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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15
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Kim TD, Hong G, Kim J, Yoon S. Cognitive Enhancement in Neurological and Psychiatric Disorders Using Transcranial Magnetic Stimulation (TMS): A Review of Modalities, Potential Mechanisms and Future Implications. Exp Neurobiol 2019; 28:1-16. [PMID: 30853820 PMCID: PMC6401552 DOI: 10.5607/en.2019.28.1.1] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/07/2019] [Accepted: 02/15/2019] [Indexed: 02/06/2023] Open
Abstract
Cognitive enhancement refers to the improvement of cognitive function related to deficits that occurred as part of a certain illness. However, the term cognitive enhancement does not yet have a definitive meaning, and its connotations often vary depending on the research of interest. Recently, research interests are growing towards enhancing human cognition beyond what has traditionally been considered necessary using various brain devices. The phenomenon of exceeding the cognitive abilities of individuals who are already functional has also introduced new terminologies as means to classify between cognitive enhancing procedures that are part of treatment versus simply supplementary. Of the many devices used to attain cognitive enhancement, transcranial magnetic stimulation (TMS) is a unique neurostimulatory device that has demonstrated significant improvements in various cognitive domains including memory and cognitive processing skills. While many studies have supported the safety and efficacy of TMS in treatment, there has yet to be an optimization in parameter for TMS that is catered to a certain target group. The current paper aims to review with perspective the many studies that have used TMS for the purpose of cognitive enhancement and provide further insight on the development of an optimal stimulation parameter. The paper reviews 41 peer-reviewed articles that used TMS for cognitive enhancement, summarizes the findings that were apparent for each distinct parameter, and discusses future directions regarding TMS as an elective tool for healthy individuals while considering some of the ethical perspectives that may be warranted.
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Affiliation(s)
- Tammy D Kim
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul 03760, Korea.,Ewha Brain Institute, Ewha Womans University, Seoul 03760, Korea
| | - Gahae Hong
- Ewha Brain Institute, Ewha Womans University, Seoul 03760, Korea
| | - Jungyoon Kim
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul 03760, Korea.,Ewha Brain Institute, Ewha Womans University, Seoul 03760, Korea
| | - Sujung Yoon
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul 03760, Korea.,Ewha Brain Institute, Ewha Womans University, Seoul 03760, Korea
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16
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Monteiro DC, Cantilino A. Use of a Double-Cone Coil in Transcranial Magnetic Stimulation for Depression Treatment. Neuromodulation 2018; 22:867-870. [PMID: 30506758 DOI: 10.1111/ner.12896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/18/2018] [Accepted: 09/26/2018] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Approximately 15% of all people will experience a depressive episode throughout their lives, and by 2020, depression will be the second largest cause of disability around the world. Transcranial magnetic stimulation (TMS) has been shown to be an effective option for treating this condition. Devices such as the double-cone coil may bring new insights regarding depression treatment. METHODS A literature search was performed on PubMed, ScienceDirect, Cochrane, LILACS, and Google Scholar by applying the descriptors "depression" AND "transcranial magnetic stimulation" AND "double cone-coil." RESULTS Six studies were considered eligible (three clinical trials, two case series, and one isolated case report). All of them described treatments with transcranial magnetic stimulation by double-cone coil (DC-TMS) at 10 Hz over the dorsomedial prefrontal cortex, achieving response and remission rates of 40-52.4% and 34.7-47.6%, respectively. Two clinical trials investigated both intermittent theta-burst stimulation and 10 Hz TMS, suggesting a slight advantage of the latter. They also found no additional gains by combining both techniques. CONCLUSION Despite the small number of controlled clinical trials and the small sample sizes, which limit the generalization of the obtained results, the collected data provide an optimistic perspective on the effectiveness of using DC-TMS for depression treatment.
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Affiliation(s)
- Dennison Carreiro Monteiro
- Neuropsychiatry, Behavioral Science Postgraduate Program at the Universidade Federal de Pernambuco, Recife, Brazil
| | - Amaury Cantilino
- Neuropsychiatry, Behavioral Science Postgraduate Program at the Universidade Federal de Pernambuco, Recife, Brazil
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17
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Schulze L, Feffer K, Lozano C, Giacobbe P, Daskalakis ZJ, Blumberger DM, Downar J. Number of pulses or number of sessions? An open-label study of trajectories of improvement for once-vs. twice-daily dorsomedial prefrontal rTMS in major depression. Brain Stimul 2017; 11:327-336. [PMID: 29153439 DOI: 10.1016/j.brs.2017.11.002] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 10/31/2017] [Accepted: 11/03/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) shows efficacy in the treatment of major depressive episodes (MDEs), but can require ≥4-6 weeks for maximal effect. Recent studies suggest that multiple daily sessions of rTMS can accelerate response without reducing therapeutic efficacy. However, it is unresolved whether therapeutic effects track cumulative number of pulses, or cumulative number of sessions. OBJECTIVE This open-label study reviewed clinical outcomes over a 20-30 session course of high-frequency bilateral dorsomedial prefrontal cortex (DMPFC)-rTMS among patients receiving 6000 pulses/day delivered either in twice-daily sessions 80 min apart (at 20 Hz) or single, longer, once-daily sessions (at 10 Hz). METHODS A retrospective chart review identified 130 MDD patients who underwent 20-30 daily sessions of bilateral DMPFC-rTMS (Once-daily, n = 65; Twice-daily, n = 65) at a single Canadian clinic. RESULTS Mixed-effects modeling revealed significantly faster improvement (group-by-time interaction) for twice-daily versus once-daily DMPFC-rTMS. Across both groups, the pace of improvement showed a consistent relationship with number of cumulative sessions, but not with cumulative number of pulses. Although the twice-daily group completed treatment in half as many days, final clinical outcomes did not differ significantly between groups on dichotomous measures (response/remission rates: once-daily, 35.4%/33.8%; twice-daily, 41.5%/35.4%), or continuous measures, or on overall response distribution. CONCLUSIONS Twice-daily rTMS appears feasible, tolerable, and capable of achieving comparable results to once-daily rTMS, while also reducing course length approximately twofold. Therapeutic gains tracked the cumulative number of sessions, not pulses. Future randomized studies comparing once-daily to multiple-daily rTMS sessions, while controlling for number of pulses, may be warranted.
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Affiliation(s)
- Laura Schulze
- MRI-Guided rTMS Clinic, Department of Psychiatry, University Health Network, Canada; Institute of Medical Science, University of Toronto, Canada
| | - Kfir Feffer
- MRI-Guided rTMS Clinic, Department of Psychiatry, University Health Network, Canada; Shalvata Mental Health Center, Hod-Hasharon, Israel; Department of Psychiatry, University of Toronto, Canada
| | | | - Peter Giacobbe
- MRI-Guided rTMS Clinic, Department of Psychiatry, University Health Network, Canada; Institute of Medical Science, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Canada
| | - Zafiris J Daskalakis
- Institute of Medical Science, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Canada; Campbell Family Mental Health Research Institute and Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Canada
| | - Daniel M Blumberger
- Institute of Medical Science, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Canada; Campbell Family Mental Health Research Institute and Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Canada
| | - Jonathan Downar
- MRI-Guided rTMS Clinic, Department of Psychiatry, University Health Network, Canada; Institute of Medical Science, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Canada; Krembil Research Institute, University Health Network, Canada.
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18
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Thomas-Ollivier V, Foyer E, Bulteau S, Pichot A, Valriviere P, Sauvaget A, Deschamps T. Cognitive component of psychomotor retardation in unipolar and bipolar depression: Is verbal fluency a relevant marker? Impact of repetitive transcranial stimulation. Psychiatry Clin Neurosci 2017; 71:612-623. [PMID: 28419623 DOI: 10.1111/pcn.12529] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 03/14/2017] [Accepted: 04/10/2017] [Indexed: 12/26/2022]
Abstract
AIMS In the literature, psychomotor retardation (PMR) is increasingly highlighted as a relevant marker for depression. Currently, we chose to focus on the fluency capacities as an evaluation of the frontal lobes functioning to reach a better understanding of cognitive and neurobiological mechanisms involved in PMR in depression. The aims of this study were: (i) to explore the cognitive component of PMR through the analysis of verbal fluency (VF) performance in unipolar and bipolar depression; and (ii) to examine whether a repetitive transcranial magnetic stimulation treatment could improve concomitantly the PMR and VF capacities, as a relevant marker characteristic of the cognitive component of PMR. METHODS Fifteen unipolar and 15 bipolar patients were compared to 15 healthy adults. Before treatment, the results showed VF deficits, particularly marked in the bipolar group. The investigation of the interplay between PMR, VF performance, Montgomery-Åsberg Depression Rating Scale scores, and Montreal Cognitive Assessment scores showed that the deficits in these various dimensions were not homogeneous. RESULTS The absence of correlation between the psychomotor retardation scale (the French Retardation Rating Scale for Depression) and VF, and the correlation with MoCA raise the hypothesis of a more global cognitive impairment associated with PMR in the BD group. The repetitive transcranial magnetic stimulation treatment had a positive impact on depression, PMR, and fluency scores. CONCLUSION Correlations between the Retardation Rating Scale for Depression and VF performances appeared after treatment, showing the cognitive role of psychomotor functioning in depression. Further analyses, including other cognitive measures in an objective evaluation of PMR, are required for a better understanding of these complex relationships.
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Affiliation(s)
- Véronique Thomas-Ollivier
- Laboratory 'Movement, Interactions, Performance' (EA 4334), Faculty of Sport Sciences, University of Nantes, Nantes, France
| | - Emmanuelle Foyer
- Laboratory 'Movement, Interactions, Performance' (EA 4334), Faculty of Sport Sciences, University of Nantes, Nantes, France.,Addictology and Liaison Psychiatry Department, University Hospital of Nantes, Nantes, France
| | - Samuel Bulteau
- Addictology and Liaison Psychiatry Department, University Hospital of Nantes, Nantes, France.,EA SPHERE 4275 MethodS for Patients-centered outcomes and Health Research, University of Nantes, Nantes, France
| | - Anne Pichot
- Addictology and Liaison Psychiatry Department, University Hospital of Nantes, Nantes, France
| | - Pierre Valriviere
- Addictology and Liaison Psychiatry Department, University Hospital of Nantes, Nantes, France
| | - Anne Sauvaget
- Addictology and Liaison Psychiatry Department, University Hospital of Nantes, Nantes, France.,EA SPHERE 4275 MethodS for Patients-centered outcomes and Health Research, University of Nantes, Nantes, France
| | - Thibault Deschamps
- Laboratory 'Movement, Interactions, Performance' (EA 4334), Faculty of Sport Sciences, University of Nantes, Nantes, France
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19
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Tovar-Perdomo S, McGirr A, Van den Eynde F, Rodrigues Dos Santos N, Berlim MT. High frequency repetitive transcranial magnetic stimulation treatment for major depression: Dissociated effects on psychopathology and neurocognition. J Affect Disord 2017; 217:112-117. [PMID: 28407553 DOI: 10.1016/j.jad.2017.03.075] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 03/30/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This open-label pilot study explored the effects of a course of accelerated high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) on two neurocognitive domains (decision-making and impulse control) in patients with major depressive disorder (MDD). METHODS Participants with MDD and a treatment resistant major depressive episode (n=24) underwent twice-daily HF-rTMS targeted at the left dorsolateral prefrontal cortex (lDLPFC) over two weeks. Psychopathology was assessed by clinician-administered and self-reported measures of depression and anxiety; decision-making was assessed by the Iowa Gambling Task, the Balloon Analog Risk Task and the Game of Dice Task; impulse control was assessed by the Stroop Color-Word Task, the Continuous Performance Task and the Stop-Signal Task. RESULTS Depression and anxiety scores significantly improved from pre-post HF-rTMS treatment. However, none of the decision-making or impulse control variables of interest changed significantly from pre-post HF-rTMS. Moreover, there was no correlation between changes in psychopathological symptoms and in neurocognition. LIMITATIONS This is a moderately sized open label trial, and the confounds of ongoing psychotropics and illness chronicity can not be excluded in this treatment resistant sample. CONCLUSIONS There is dissociation between acute symptomatic benefit after a course of accelerated HF-rTMS applied to the lDLPFC in treatment resistant MDD and performance on tests of decision making and impulse control. Though rTMS appears cognitively safe, additional research is warranted to understand this potential dissociation and its putative clinical implications.
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Affiliation(s)
- Santiago Tovar-Perdomo
- Neuromodulation Research Clinic, Douglas Mental Health University Institute and McGill University, Montréal, Québec, Canada
| | - Alexander McGirr
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Frederique Van den Eynde
- Neuromodulation Research Clinic, Douglas Mental Health University Institute and McGill University, Montréal, Québec, Canada
| | - Nicole Rodrigues Dos Santos
- Neuromodulation Research Clinic, Douglas Mental Health University Institute and McGill University, Montréal, Québec, Canada
| | - Marcelo T Berlim
- Neuromodulation Research Clinic, Douglas Mental Health University Institute and McGill University, Montréal, Québec, Canada; Depressive Disorders Program, Douglas Mental Health University Institute and McGill University, Montréal, Québec, Canada.
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Effects of Transcranial Magnetic Stimulation on the Cognitive Control of Emotion: Potential Antidepressant Mechanisms. J ECT 2017; 33:73-80. [PMID: 28072659 DOI: 10.1097/yct.0000000000000386] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Depression negatively impacts quality of life and is associated with high mortality rates. Recent research has demonstrated that improvement in depression symptoms with transcranial magnetic stimulation (TMS) to the dorsolateral prefrontal cortex (DLPFC) may involve changes in the cognitive control network, a regulatory system modulating the function of cognitive and emotional systems, composed of the DLPFC, dorsal anterior cingulate, and posterior parietal cortices. Transcranial magnetic stimulation to the DLPFC node of the cognitive control network may have antidepressant efficacy via direct effects on cognitive control processes involved in emotion regulation. This review provides a review of the impact of TMS on cognitive control processes, especially those related to emotion regulation, and posits that these effects are critical to the mechanism of action of TMS for depression. Treatment implications and future directions for study are discussed.
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21
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Deschamps T, Sauvaget A, Pichot A, Valrivière P, Maroulidès M, Bois A, Bulteau S, Thomas-Ollivier V. Posture-cognitive dual-tasking: A relevant marker of depression-related psychomotor retardation. An illustration of the positive impact of repetitive transcranial magnetic stimulation in patients with major depressive disorder. J Psychiatr Res 2016; 83:86-93. [PMID: 27580486 DOI: 10.1016/j.jpsychires.2016.08.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/14/2016] [Accepted: 08/18/2016] [Indexed: 12/28/2022]
Abstract
This study examined whether postural control variables, particularly the center-of-pressure (COP) velocity-based parameters, could be a relevant hallmark of depression-related psychomotor retardation (PMR). We first aimed at investigating the interplay between the PMR scores and the COP performance in patients with major depressive disorder (MDD), as compared to age-matched healthy controls; secondly, we focused on the impact of a repetitive transcranial magnetic stimulation (rTMS) treatment on depression, PMR scores and postural performance. 16 MDD patients, and a control group of 16 healthy adults, were asked to maintain quiet standing balance during two trials with or without vision, and while backward counting (dual task). All the position and velocity-based COP variables were computed. Before and after the rTMS session (n eligible MDD = 10), we assessed the depression level with the Montgomery-Asberg Depression Rating Scale (MADRS), the PMR scores with the French Retardation Rating Scale for Depression (ERD), and postural performance. Before the treatment, significant positive partial correlations were found between the pre-ERD scores and the velocity-based COP variables, especially in the dual-task conditions (p < 0.05). In contrast, there was no significant correlation between the post-ERD scores and any postural parameter after the treatment. The MADRS and ERD scores showed a significant decrease between before and after the rTMS intervention. For the first time, the findings clearly validated the view that the assessment of postural performance - easy to envisage in clinical settings-constitutes a reliable and objective marker of PMR in MDD patients.
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Affiliation(s)
- Thibault Deschamps
- Laboratory "Movement, Interactions, Performance" (E.A. 4334), University of Nantes, France.
| | - Anne Sauvaget
- CHU de Nantes, Service d'Addictologie et Psychiatrie de liaison, France; EA SPHERE 4275 Methods for Patients-centered outcomes and Health Research, University of Nantes, Nantes, France
| | - Anne Pichot
- CHU de Nantes, Service d'Addictologie et Psychiatrie de liaison, France
| | - Pierre Valrivière
- CHU de Nantes, Service d'Addictologie et Psychiatrie de liaison, France
| | - Maxime Maroulidès
- Laboratory "Movement, Interactions, Performance" (E.A. 4334), University of Nantes, France
| | - Aurore Bois
- Laboratory "Movement, Interactions, Performance" (E.A. 4334), University of Nantes, France
| | - Samuel Bulteau
- CHU de Nantes, Service d'Addictologie et Psychiatrie de liaison, France
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22
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Assessing the Effects of Repetitive Transcranial Magnetic Stimulation on Cognition in Major Depressive Disorder Using Computerized Cognitive Testing. J ECT 2016; 32:169-73. [PMID: 26934275 DOI: 10.1097/yct.0000000000000308] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES A range of different treatment approaches are available for depression; however, there is an ongoing concern about the cognitive impairment associated with many treatments. This study investigated the effect of treatment with repetitive transcranial magnetic stimulation (rTMS) on cognition in patients with major depressive disorder. Cognition before and after treatment was assessed using a computerized cognitive testing battery, which provided comprehensive assessment across a range of cognitive domains. This was a naturalistic study involving patients attending an outpatient clinical rTMS service. METHODS A total of 63 patients with treatment-resistant depression completed the IntegNeuro cognitive test battery, a well-validated comprehensive computerized assessment tool before and after receiving 18 or 20 treatments of sequential bilateral rTMS. Change in the various cognitive domains was assessed, and analyses were undertaken to determine whether any change in cognition was associated with a change in rating of depression severity. RESULTS There was a significant decrease in Hamilton Depression Rating Scale scores from baseline to posttreatment. There was no decline in performance on any of the cognitive tests. There were significant improvements in maze completion time and the number of errors in the maze task. However, these were accounted for by improvement in mood when change in depressive symptoms was included as a covariate. CONCLUSIONS This open-label study provides further support for the efficacy and safety of rTMS as a treatment option for people with major depressive disorder in a naturalistic clinical setting. Using a comprehensive, robust computerized battery of cognitive tests, the current study indicated that there was no significant cognitive impairment associated with rTMS and that any improvements in cognitive functioning were associated with a reduction in depressive symptoms.
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23
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Aerobic Exercises for Cognition Rehabilitation following Stroke: A Systematic Review. J Stroke Cerebrovasc Dis 2016; 25:2780-2789. [PMID: 27554073 DOI: 10.1016/j.jstrokecerebrovasdis.2016.07.035] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 07/18/2016] [Accepted: 07/22/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Cognitive impairments are highly prevalent in stroke survivors and can substantially affect their physical rehabilitation and quality of life. The management of these impairments currently remains limited, but increasing studies reported the effect of aerobic exercise on cognitive performance in patients suffering from stroke. The purpose of this review was to assess the effects of aerobic exercise on cognitive function following stroke. METHODS Seven electronic databases (China National Knowledge Infrastructure [CNKI], Chinese Science and Technology Periodical Database [VIP], Wanfang, China Biology Medicine disc [CBM], Science Citation Index [SCI], EMBASE, and PubMed) were searched from their inception to May 31, 2015, for the effects of aerobic exercise on cognitive ability compared to usual physical activity in stroke survivors. RevMan V5.3 (The Nordic Cochrane Centre) was used to analyze the data and to evaluate the methodological quality of the included studies. RESULTS Ten eligible studies including 394 participants were identified. Six studies showed that aerobic exercise significantly improved global cognitive ability in stroke survivors. Four studies reported aerobic exercise to be beneficial in improving memory, but only one showed statistical significance. Two studies investigated the effects of aerobic exercise on attention, and one showed a significant improvement. One study reported a significant benefit of aerobic exercise on visuospatial ability in stroke survivors. No adverse events were reported in the included studies. CONCLUSIONS Aerobic exercise may have a positive effect on improving global cognitive ability and a potential benefit on memory, attention, and the visuospatial domain of cognition in stroke survivors. However, further large, rigorously designed trials are needed to confirm these findings.
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Kedzior KK, Gierke L, Gellersen HM, Berlim MT. Cognitive functioning and deep transcranial magnetic stimulation (DTMS) in major psychiatric disorders: A systematic review. J Psychiatr Res 2016; 75:107-15. [PMID: 26828370 DOI: 10.1016/j.jpsychires.2015.12.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/18/2015] [Accepted: 12/18/2015] [Indexed: 10/22/2022]
Abstract
Deep transcranial magnetic stimulation (DTMS) is a non-invasive brain stimulation method mostly utilised in the treatment of major depression. The aim of the current study was to systematically review the literature on the cognitive effects of DTMS applied with the H-coil system in major psychiatric disorders. Following a literature search in PsycInfo and PubMed (any time to December 2015), 13 out of 32 studies on DTMS and cognitive functioning were included in the current review. Three studies included 38 healthy participants, eight studies included 158 unipolar or bipolar depression patients and two studies included 45 schizophrenia patients. Low-frequency DTMS (1-3 sessions) had little effect on cognitive functioning in healthy participants. The most consistent cognitive and clinical improvements were reported in the short-term (after 20 daily sessions of high-frequency DTMS with H1-coil) in studies with major depression patients. There was also a trend towards a short-term cognitive and clinical improvement in studies with schizophrenia patients. High-frequency DTMS might improve cognitive functioning and alleviate clinical symptoms in the short-term, particularly in major depression. However, this conclusion is based on data from mostly uncontrolled, open-label studies with patients receiving concurrent antidepressants or antipsychotics. Randomised, sham-controlled trials are needed to investigate the magnitude of the cognitive outcomes of DTMS in the short-term and beyond the daily stimulation phase in major psychiatric disorders.
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Affiliation(s)
| | - Lioba Gierke
- Institute of Psychology and Transfer, University of Bremen, Bremen, Germany
| | | | - Marcelo T Berlim
- Department of Psychiatry, McGill University, and Neuromodulation Research Clinic, Douglas Institute, Montreal, Canada
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Serafini G, Pompili M, Belvederi Murri M, Respino M, Ghio L, Girardi P, Fitzgerald PB, Amore M. The effects of repetitive transcranial magnetic stimulation on cognitive performance in treatment-resistant depression. A systematic review. Neuropsychobiology 2016; 71:125-39. [PMID: 25925699 DOI: 10.1159/000381351] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 02/27/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is a disabling illness associated with significant functional and psychosocial impairment. Although many psychopharmacological agents are currently available for its treatment, many MDD patients suffer from treatment-resistant depression (TRD). METHODS A systematic review of the current literature (Pubmed/Medline, Scopus and ScienceDirect search) has been conducted with the primary aim to investigate the role of repetitive transcranial magnetic stimulation (rTMS) in improving neurocognition in patients with TRD. Studies were included according to the following criteria: (a) being an original paper in a peer-reviewed journal and (b) having analyzed the effect of rTMS on neurocognitive functioning in TRD. RESULTS The combined search strategy yielded a total of 91 articles, of which, after a complete analysis, 22 fulfilled our inclusion criteria. Based on the main findings, most of the selected studies suggested the existence of a trend towards improvements in the neurocognitive profile using rTMS. Negative findings have also been reported. However, most studies were limited by their small sample size or included mixed samples, or the adopted single-blind designs potentially biased the blinding of the study design. CONCLUSION rTMS is a noninvasive brain stimulation that may be considered a valuable and promising technique for cognitive enhancement in TRD.
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Affiliation(s)
- Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy
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Concerto C, Lanza G, Cantone M, Ferri R, Pennisi G, Bella R, Aguglia E. Repetitive transcranial magnetic stimulation in patients with drug-resistant major depression: A six-month clinical follow-up study. Int J Psychiatry Clin Pract 2015; 19:252-8. [PMID: 26398527 DOI: 10.3109/13651501.2015.1084329] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE In this study we aimed to assess the long-term efficacy of repetitive Transcranial Magnetic Stimulation (rTMS) on depressive symptoms and cognitive performance in patients with drug-resistant major depressive disorder (MDD). METHODS Fifteen drug-resistant depressed outpatients completed an acute trial with augmentative high-frequency rTMS over the left dorsolateral prefrontal cortex (DLPFC) and were compared with 15 drug-resistant MDD patients who underwent sham procedure. Depressive symptoms were evaluated with the Hamilton Depression Rating Scale and Montgomery-Asberg Depression Rating Scale. The Frontal Assessment Battery and the Stroop Color-Word Test Interference (Stroop T) were used to probe executive functions. Outcome measures were obtained at baseline, 4 weeks after the rTMS, as well as 3 months and 6 months after the end of the stimulation protocol. RESULTS After the active rTMS, patients showed a significant decrease in the scores at the depression rating scales that lasted for 6 months. A transient improvement was also observed at the Stroop T, although it did not persist in time. CONCLUSIONS High-frequency rTMS over the left DLPFC may have long-term antidepressant effect in drug-resistant MDD. TMS is a valuable tool for the add-on treatment of mood disorders and for the design of customized stimulation protocols.
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Affiliation(s)
- Carmen Concerto
- a Department of Clinical and Experimental Medicine , Psychiatry Unit, University of Catania , Via Santa Sofia, Catania , Italy
| | - Giuseppe Lanza
- a Department of Clinical and Experimental Medicine , Psychiatry Unit, University of Catania , Via Santa Sofia, Catania , Italy
| | - Mariagiovanna Cantone
- b Department of Neurology I.C. , "Oasi" Institute for Research on Mental Retardation and Brain Aging (I.R.C.C.S.) . Via Conte Ruggero, Troina (EN) , Italy
| | - Raffaele Ferri
- b Department of Neurology I.C. , "Oasi" Institute for Research on Mental Retardation and Brain Aging (I.R.C.C.S.) . Via Conte Ruggero, Troina (EN) , Italy
| | - Giovanni Pennisi
- c Department "Specialità Medico-Chirurgiche" , University of Catania , Via Santa Sofia, Catania , Italy
| | - Rita Bella
- d Department of Medical and Surgical Sciences and Advanced Technologies , Section of Neurosciences , Via Santa Sofia, Catania , Italy
| | - Eugenio Aguglia
- a Department of Clinical and Experimental Medicine , Psychiatry Unit, University of Catania , Via Santa Sofia, Catania , Italy
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Ketamine, Transcranial Magnetic Stimulation, and Depression Specific Yoga and Mindfulness Based Cognitive Therapy in Management of Treatment Resistant Depression: Review and Some Data on Efficacy. DEPRESSION RESEARCH AND TREATMENT 2015; 2015:842817. [PMID: 26509083 PMCID: PMC4609854 DOI: 10.1155/2015/842817] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 08/29/2015] [Accepted: 09/10/2015] [Indexed: 12/13/2022]
Abstract
Depression affects about 121 million people worldwide and prevalence of major depressive disorder (MDD) in US adults is 6.4%. Treatment resistant depression (TRD) accounts for approximately 12-20% of all depression patients and costs $29-$48 billion annually. Ketamine and repetitive transcranial magnetic stimulation (rTMS) have useful roles in TRD, but their utility in long term is unknown. As per the latest literature, the interventions using Yoga and meditation including the mindfulness based cognitive therapy (MBCT) have been useful in treatment of depression and relapse prevention. We present a review of rTMS, ketamine, and MBCT and also report efficacy of a depression specific, innovative, and translational model of Yoga and mindfulness based cognitive therapy (DepS Y-MBCT), developed by the first author. DepS Y-MBCT as an adjunctive treatment successfully ameliorated TRD symptoms in 27/32 patients in an open label pilot trial in TRD patients. Considering the limitations of existing treatment options, including those of ketamine and rTMS when used as the sole modality of treatment, we suggest a "tiered approach for TRD" by combining ketamine and rTMS (alone or along with antidepressants) for rapid remission of acute depression symptoms and to use DepS Y-MBCT for maintaining remission and preventing relapse.
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No change in neuropsychological functioning after receiving repetitive transcranial magnetic stimulation treatment for major depression. J ECT 2014; 30:320-4. [PMID: 24625717 PMCID: PMC4162863 DOI: 10.1097/yct.0000000000000096] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Early studies of transcranial magnetic stimulation (TMS) have shown no adverse effects on neuropsychological function. However, further research using higher TMS intensities as well as a greater number of TMS pulses and with larger sample sizes is needed. We studied 68 patients with major depressive disorder who were randomized to receive either 15 sessions of sham or real TMS at 110% of the estimated prefrontal cortex threshold to the left dorsolateral prefrontal cortex. Each session consisted of 32 5-second trains of 10-Hz repetitive TMS at 110% adjusted motor threshold. A total of 24,000 pulses were given. Neuropsychological function was assessed before and immediately after TMS treatment with a battery of 8 tests. Using a higher TMS intensity as well as a greater number of pulses and having a larger sample size compared with most previous studies, this study found no negative neuropsychological effects of TMS. Changes in neuropsychological function were unrelated to changes in depression.
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Kedzior KK, Reitz SK. Short-term efficacy of repetitive transcranial magnetic stimulation (rTMS) in depression- reanalysis of data from meta-analyses up to 2010. BMC Psychol 2014; 2:39. [PMID: 25685354 PMCID: PMC4317138 DOI: 10.1186/s40359-014-0039-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 09/23/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND According to a narrative review of 13 meta-analyses (published up to 2010), repetitive transcranial magnetic stimulation (rTMS) has a moderate, short-term antidepressant effect in the treatment of major depression. The aim of the current study was to reanalyse the data from these 13 meta-analyses with a uniform meta-analytical procedure and to investigate predictors of such an antidepressant response. METHODS A total of 40 double-blind, randomised, sham-controlled trials with parallel designs, utilising rTMS of the dorsolateral prefrontal cortex in the treatment of major depression, was included in the current meta-analysis. The studies were conducted in 15 countries on 1583 patients and published between 1997-2008. Depression severity was measured using the Hamilton Depression Rating Scale, Beck Depression Inventory, or Montgomery Åsberg Depression Rating Scale at baseline and after the last rTMS. A random-effects model with the inverse-variance weights was used to compute the overall mean weighted effect size, Cohen's d. RESULTS There was a significant and moderate reduction in depression scores from baseline to final, favouring rTMS over sham (overall d = -.54, 95% CI: -.68, -.41, N = 40 studies). Predictors of such a response were investigated in the largest group of studies (N = 32) with high-frequency (>1 Hz) left (HFL) rTMS. The antidepressant effect of HFL rTMS was present univariately in studies with patients receiving antidepressants (at stable doses or started concurrently with rTMS), with treatment-resistance, and with unipolar (or bipolar) depression without psychotic features. Univariate meta-regressions showed that depression scores were significantly lower after HFL rTMS in studies with higher proportion of female patients. There was little evidence for publication bias in the current analysis. CONCLUSIONS Daily rTMS (with any parameters) has a moderate, short-term antidepressant effect in studies published up to 2008. The clinical efficacy of HFL rTMS may be better in female patients not controlling for any other study parameters.
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Affiliation(s)
- Karina Karolina Kedzior
- Bremen International Graduate School of Social Sciences (BIGSSS), Jacobs University Bremen, Campus Ring 1, 28759 Bremen, Germany
| | - Sarah Kim Reitz
- Bremen International Graduate School of Social Sciences (BIGSSS), Jacobs University Bremen, Campus Ring 1, 28759 Bremen, Germany
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Beynel L, Chauvin A, Guyader N, Harquel S, Szekely D, Bougerol T, Marendaz C. What saccadic eye movements tell us about TMS-induced neuromodulation of the DLPFC and mood changes: a pilot study in bipolar disorders. Front Integr Neurosci 2014; 8:65. [PMID: 25191234 PMCID: PMC4137451 DOI: 10.3389/fnint.2014.00065] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 07/31/2014] [Indexed: 12/30/2022] Open
Abstract
The study assumed that the antisaccade (AS) task is a relevant psychophysical tool to assess (i) short-term neuromodulation of the dorsolateral prefrontal cortex (DLPFC) induced by intermittent theta burst stimulation (iTBS); and (ii) mood change occurring during the course of the treatment. Saccadic inhibition is known to strongly involve the DLPFC, whose neuromodulation with iTBS requires less stimulation time and lower stimulation intensity, as well as results in longer aftereffects than the conventional repetitive transcranial magnetic stimulation (rTMS). Active or sham iTBS was applied every day for 3 weeks over the left DLPFC of 12 drug-resistant bipolar depressed patients. To assess the iTBS-induced short-term neuromodulation, the saccadic task was performed just before (S1) and just after (S2) the iTBS session, the first day of each week. Mood was evaluated through Montgomery and Asberg Depression Rating Scale (MADRS) scores and the difference in scores between the beginning and the end of treatment was correlated with AS performance change between these two periods. As expected, only patients from the active group improved their performance from S1 to S2 and mood improvement was significantly correlated with AS performance improvement. In addition, the AS task also discriminated depressive bipolar patients from healthy control subjects. Therefore, the AS task could be a relevant and useful tool for clinicians to assess if the Transcranial magnetic stimulation (TMS)-induced short-term neuromodulation of the DLPFC occurs as well as a “trait vs. state” objective marker of depressive mood disorder.
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Affiliation(s)
- Lysianne Beynel
- Department of Psychology, Laboratory of Psychology and Neurocognition, Grenoble Alpes University, Université Pierre Mendes France Grenoble, France
| | - Alan Chauvin
- Department of Psychology, Laboratory of Psychology and Neurocognition, Grenoble Alpes University, Université Pierre Mendes France Grenoble, France
| | - Nathalie Guyader
- Department of Images and Signal, Grenoble Image Parole et Signal Automatique-Lab, Grenoble Alpes University, St Martin d'Héres Grenoble, France
| | - Sylvain Harquel
- Department of Psychology, Laboratory of Psychology and Neurocognition, Grenoble Alpes University, Université Pierre Mendes France Grenoble, France ; Department of Psychology, IRMaGe, Grenoble Alpes University Grenoble, France
| | - David Szekely
- Department of Psychiatry and Neurology, Hospital of Grenoble, Grenoble Alpes University La Tronche, France
| | - Thierry Bougerol
- Department of Psychiatry and Neurology, Hospital of Grenoble, Grenoble Alpes University La Tronche, France
| | - Christian Marendaz
- Department of Psychology, Laboratory of Psychology and Neurocognition, Grenoble Alpes University, Université Pierre Mendes France Grenoble, France
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Abstract
Late life depression (LLD) frequently presents with cognitive impairment, and growing evidence suggests that these disease processes are "linked" in multiple ways. For some individuals, LLD may be a recurrence of a long-standing depressive illness, while for others it may be the leading symptom of a developing neuropathological disorder. Overall, studies investigating the relationship between treatment of LLD and improvement in cognitive functioning have yielded mixed results. Research suggests that a subset of individuals with LLD and cognitive dysfunction will experience an improvement in cognitive function after antidepressant treatment, though a significant proportion will continue to exhibit cognitive impairment following resolution of their depressive symptoms. From a treatment standpoint, it is critical to ensure that an individual's depressive symptoms have been treated to remission, measured by a standardized rating scale such as the Geriatric Depression Scale (GDS). SSRI or SNRI monotherapy is often effective, and may be enhanced by employing an evidence-based psychotherapy such as Problem Solving Therapy (PST) or Interpersonal Therapy (IPT), modified to accommodate cognitive impairments that may be present. With respect to specific treatment of cognitive dysfunction, cognitive augmentation or training strategies can be helpful for some patients, and may be explored in combination with treatment of the primary depressive episode. While the introduction of a cholinesterase inhibitor (e.g. donepezil) may be considered, the potential benefit (modest improvement in cognition and functioning) must be weighed against an increased risk for worsening or recurrent depression. Finally, lifestyle factors-such as aerobic exercise, follow-up with a primary care physician for management of co-morbid medical illnesses, and regular participation in stimulating activities (such as through a senior center)-are important and should be included as part of the overall treatment plan.
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Affiliation(s)
- Aaron M Koenig
- Department of Psychiatry, University of Pittsburgh School of Medicine (Pittsburgh, PA, USA)
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh School of Medicine (Pittsburgh, PA, USA)
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