Altered Brain Function and Causal Connectivity Induced by Repetitive Transcranial Magnetic Stimulation Treatment for Major Depressive Disorder

Neural Electrical Correlates of Subjective Happiness

Happiness is a subjective experience that can serve as the ultimate goal for humans. A recent study that employed resting-state functional magnetic resonance imaging (fMRI) reported that spontaneous fluctuation (fractional amplitude of low-frequency fluctuation: fALFF) in the precuneus is negatively associated with subjective happiness. However, little is known about the neural electrical correlates of subjective happiness, which can provide direct evidence of neural activity and insights regarding the underlying psychological, cellular, and neurotransmitter mechanisms. Therefore, we measured 400-channel whole-head magnetoencephalography (MEG) during resting state in participants whose subjective happiness was evaluated using questionnaires. We conducted source reconstruction analysis utilizing bandpass-filtered MEG data and analyzed the fALFF of the band-limited power time series as an index of spontaneous neural fluctuation. Gamma-band fALFF values in the right precuneus were negatively associated with subjective happiness scores (partial correlation coefficient = -0.56). These findings indicate that subjective happiness has a neural electrical correlate of reduced spontaneous fluctuation of gamma-band neuronal oscillations in the right precuneus, and that it could be mediated by a reduction in wandering, clinging self-consciousness through heightened N-methyl-d-aspartate-dependent gamma-aminobutyric acid-ergic parvalbumin inhibitory interneuron activity.

Brain connectivity and transcriptional changes induced by rTMS in first-episode major depressive disorder

Repetitive transcranial magnetic stimulation (rTMS) is a widely utilized non-invasive brain stimulation technique with demonstrated efficacy in treating major depressive disorder (MDD). However, the mechanisms underlying its therapeutic effects, particularly in modulating neural connectivity and influencing gene expression, remain incompletely understood. In this study, we investigated the voxel-wise degree centrality (DC) induced by 10 Hz rTMS targeting the left dorsolateral prefrontal cortex, as well as their associations with transcriptomic data from the Allen Human Brain Atlas. The results indicated that the active treatment significantly reduced clinical symptoms and increased DC in the left superior medial frontal gyrus, left middle occipital gyrus, and right anterior cingulate cortex. Partial least squares regression analysis revealed that genes associated with DC alternations were enriched biological processes related to neural plasticity and synaptic connectivity. Furthermore, protein-protein interaction (PPI) analysis identified key hub genes, including SCN1A, SNAP25, and PVALB, whose expression levels were positively correlated with DC changes. Notably, SCN1A emerged as a significant predictor on DC changes. These findings suggest that rTMS may exert its therapeutic effects in MDD by modulating specific molecular pathways and neural networks, providing valuable insights into its mechanisms of action.

Neural mechanisms of CALM intervention to improve CRCI in breast cancer survivors: an fMRI-based study

BACKGROUND

Managing Cancer and Living Meaningfully (CALM) intervention's impact on chemotherapy-related cognitive impairment (CRCI) in breast cancer survivors (BCs) was investigated through resting-state functional magnetic resonance imaging (rs-fMRI) to elucidate the underlying neural mechanisms involved.

METHODS

68 BCs were randomly assigned to either the CALM group (33 patients) or the care-as-usual (CAU) group (35 patients). Cognitive function was assessed before and after the intervention in both groups using the Mini Mental State Examination (MMSE) scale. Pre- and post-intervention rs-fMRI data were also collected for regional homogeneity (ReHo) and functional connectivity (FC) analyses in the CALM group. A total of 68 BCs were randomly assigned to either the CALM group (n = 33) or the care-as-usual (CAU) group (n = 35). Cognitive function was evaluated pre- and post-intervention using the Mini-Mental State Examination (MMSE). In the CALM group, rs-fMRI data were acquired before and after the intervention to assess alterations in regional homogeneity (ReHo) and functional connectivity (FC).

RESULTS

CALM intervention demonstrated a greater enhancement in cognitive function compared to CAU (P = 0.004). Following CALM, ReHo exhibited an increase in bilateral occipital and temporal regions, including the superior, middle, and inferior occipital gyri, lingual gyrus, as well as the middle and superior temporal gyri, while a decrease was observed in frontal and cingulate regions, including the bilateral middle, medial, and dorsolateral superior frontal gyri, anterior cingulate and paracingulate gyri, precuneus, posterior cingulate, and left angular gyrus. FC analysis revealed diminished connectivity between the middle frontal gyrus and occipital/calcarine regions, whereas connectivity strengthened with the left anterior cingulate/paracingulate and right orbital frontal regions. ΔMMSE exhibited a positive correlation with ReHo in the left middle frontal gyrus (r = 0.355, P = 0.042) and a reduction in middle frontal-occipital FC (left calcarine: r = 0.353, P = 0.044; right/left middle occipital: r = 0.388/0.423, P = 0.029/0.014).

CONCLUSION

CALM intervention mitigates CRCI in BCs, with the middle frontal gyrus may play a critical.

Longitudinal neurofunctional alterations following nonpharmacological treatments and the mediating role of regional homogeneity in subclinical depression comorbid with sleep disorders among college students

BACKGROUND

Clinical guidelines recommend nonpharmacological treatment (nPHT) as the primary intervention for subthreshold depression management. Counseling (CS) and electroacupuncture (EA) are two promising nonpharmacological approaches for improving both depression and sleep disturbance. However, the intrinsic neuroimaging mechanisms underlying the antidepressant effects of these nPHTs are not yet fully understood.

METHODS

We analyzed longitudinal resting-state functional magnetic resonance imaging (rs-fMRI) data from a randomized, single-blind clinical trial involving 96 first-episode, drug-naïve college students with subclinical depression and sleep disorders (sDSD; mean age 20.43 ± 2.72 years; 66.7% female) and 90 healthy controls (HCs; mean age 21.02 ± 2.68 years; 61.1% female). Participants with sDSD were randomly assigned to receive either scalp EA (n = 47) or CS (n = 49) for six weeks. The regional homogeneity (ReHo) and amplitude of low-frequency fluctuation (ALFF) before and after nPHT were calculated. Correlation and mediation analyses were performed to investigate the complex relationships between fMRI indicators and clinical symptoms.

RESULTS

The ALFF in the left paracentral lobule in sDSD patients presented an interaction effect between group and time following six weeks of nPHT. In the CS group, the ALFF in the left paracentral lobule decreased (p < 0.001), and in the EA group, it increased (p < 0.05). Compared with HCs, the baseline sDSD has many abnormal brain regions in terms of ALFF and ReHo. The whole-brain average ReHo was negatively correlated with depression scores (r = -0.26, p < 0.001) and sleep quality scores (r = -0.25, p < 0.001) and mediated the association between depression and sleep disorders [β = 0.2857, p < 0.001, 95% CI (0.23, 0.35)].

CONCLUSIONS

Nonpharmacological therapies provide different therapeutic outcomes in terms of the same rs-fMRI indicator. ALFF in the left paracentral lobule could be used as an imaging biomarker in nPHT selection. Rs-fMRI indicators are promising for understanding the neural basis of the complex relationship between subclinical depression and insomnia comorbidities in young adults.

Modulation effects of repetitive transcranial magnetic stimulation on target and indirect target nodes in patients with major depressive disorder

Clinical studies intensively highlight two critical brain regions, i,e, dorsal lateral prefrontal cortex (DLPFC) (target node) and subgenual anterior cingulate cortex (sgACC) (indirect target node) for the treatment of neuroimaging-guided repetitive transcranial magnetic stimulation (rTMS) in major depressive disorder (MDD). However, it remains unclear whether the clinical rTMS treatment could modulate the activity of the target and indirect target nodes in MDD patients. We aim to identify the rTMS-induced alteration of brain local and functional connectivity (FC) activities in the target and indirect target nodes. 38 patients with MDD were recruited for taking part in the 2-week rTMS treatment. We identified left DLPFC and right sgACC as the target and indirect target nodes for each participant, using the neuroimaging guided method, and further explored the rTMS-induced modulation on the brain functional activity of the two nodes. Ultimately, 28 patients were included in the analysis. We found that subjects had significant improvement in depressive symptoms, and their brain functional activities were reorganized. rTMS reduced the FC activity between the target and indirect target nodes, while the brain local activity in these nodes did not show rTMS-induced changes. The FC reduction was not associated with improvement in depressive symptoms. These results confirmed the clinical significance of the target node (DLPFC) and indirect target node (sgACC) in the rTMS treatment of MDD, and further shed light on the brain functional reorganization underpinning clinical practice of rTMS.

Local brain abnormalities in emotional disorders: Evidence from resting state fMRI studies

Emotional disorders inflict an enormous burden on society. Research on brain abnormalities implicated in emotional disorders has witnessed great progress over the past decades. Using cross-sectional and longitudinal designs, resting state functional magnetic resonance imaging (rs-fMRI) and its analytic approaches have been applied to characterize the local properties of patients with emotional disorders. Additionally, brain activity alterations of emotional disorders have shown frequency-specific. Despite the gains in understanding the roles of brain abnormalities in emotional disorders, the limitation of the small sample size needs to be highlighted. Lastly, we proposed that evidence from the positive psychology research stream presents it as a viable discipline, whose suggestions could be developed in future emotional disorders research. Such interdisciplinary research may produce novel treatments and intervention options. This article is categorized under: Psychology > Brain Function and Dysfunction.

Should rTMS be considered a first-line treatment for major depressive episodes in adults?

Treatment-resistant depression (TRD) is an epidemic with rising social, economic, and political costs. In a patient whose major depressive episode (MDE) persists through an adequate antidepressant trial, insurance companies often cover alternative treatments which may include repetitive transcranial magnetic stimulation (rTMS). RTMS is an FDA-cleared neuromodulation technique for TRD which is safe, efficacious, noninvasive, and well-tolerated. Recent developments in the optimization of rTMS algorithms and targeting have increased the efficacy of rTMS in treating depression, improved the clinical convenience of these treatments, and decreased the cost of a course of rTMS. In this opinion paper, we make a case for why conventional FDA-cleared rTMS should be considered as a first-line treatment for all adult MDEs. RTMS is compared to other first-line treatments including psychotherapy and SSRIs. These observations suggest that rTMS has similar efficacy, fewer side-effects, lower risk of serious adverse events, comparable compliance, the potential for more rapid relief, and cost-effectiveness. This suggestion, however, would be strengthened by further research with an emphasis on treatment-naive subjects in their first depressive episode, and trials directly contrasting rTMS with SSRIs or psychotherapy.

Altered dynamic neural activities in individuals with obsessive-compulsive disorder and comorbid depressive symptoms

Objectives

Depressive symptoms are the most prevalent comorbidity in individuals with obsessive-compulsive disorder (OCD). The objective of this study was to investigate the dynamic characteristics of resting-state neural activities in OCD patients with depressive symptoms.

Methods

We recruited 29 OCD patients with depressive symptoms, 21 OCD patients without depressive symptoms, and 27 healthy controls, and collected data via structural and functional magnetic resonance imaging (fMRI). We analyzed the fMRI results using the dynamic amplitude of low-frequency fluctuation (dALFF) and support vector machine (SVM) techniques.

Results

Compared with OCD patients without depressive symptoms, OCD patients with depressive symptoms exhibited an increased dALFF in the left precuneus and decreased dALFF in the right medial frontal gyrus. The SVM indicated that the integration of aberrant dALFF values in the left precuneus and right medial frontal gyrus led to an overall accuracy of 80%, a sensitivity of 79%, and a specificity of 100% in detecting depressive symptoms among OCD patients.

Conclusion

Therefore, our study reveals that OCD patients with depressive symptoms display neural activities with unique dynamic characteristics in the resting state. Accordingly, abnormal dALFF values in the left precuneus and right medial frontal gyrus could be used to identify depressive symptoms in OCD patients.

Impaired effective functional connectivity in the social preference of children with autism spectrum disorder

Background

The medial prefrontal cortex (mPFC), amygdala (Amyg), and nucleus accumbens (NAc) have been identified as critical players in the social preference of individuals with ASD. However, the specific pathophysiological mechanisms underlying this role requires further clarification. In the current study, we applied Granger Causality Analysis (GCA) to investigate the neural connectivity of these three brain regions of interest (ROIs) in patients with ASD, aiming to elucidate their associations with clinical features of the disorder.

Methods

Resting-state functional magnetic resonance imaging (rs-fMRI) data were acquired from the ABIDE II database, which included 37 patients with ASD and 50 typically developing (TD) controls. The mPFC, Amyg, and NAc were defined as ROIs, and the differences in fractional amplitude of low-frequency fluctuations (fALFF) within the ROIs between the ASD and TD groups were computed. Subsequently, we employed GCA to investigate the bidirectional effective connectivity between the ROIs and the rest of the brain. Finally, we explored whether this effective connectivity was associated with the social responsiveness scale (SRS) scores of children with ASD.

Results

The fALFF values in the ROIs were reduced in children with ASD when compared to the TD group. In terms of the efferent connectivity from the ROIs to the whole brain, the ASD group exhibited increased connectivity in the right cingulate gyrus and decreased connectivity in the right superior temporal gyrus. Regarding the afferent connectivity from the whole brain to the ROIs, the ASD group displayed increased connectivity in the right globus pallidus and decreased connectivity in the right cerebellar Crus 1 area and left cingulate gyrus. Additionally, we demonstrated a positive correlation between effective connectivity derived from GCA and SRS scores.

Conclusion

Impairments in social preference ASD children is linked to impaired effective connectivity in brain regions associated with social cognition, emotional responses, social rewards, and social decision-making. This finding further reveals the potential neuropathological mechanisms underlying ASD.

Effects of high-frequency transcranial magnetic stimulation on theta-gamma oscillations and coupling in the prefrontal cortex of rats during working memory task

High-frequency rTMS has been widely used to improve working memory (WM) impairment; however, the underlying neurophysiological mechanisms are unclear. We evaluated the effect of high-frequency rTMS on behaviors relevant to WM as well as coupling between theta and gamma oscillations in the prefrontal cortex (PFC) of rats. Accordingly, Wistar rats received high-frequency rTMS daily for 14 days (5 Hz, 10 Hz, and 15 Hz stimulation; 600 pulses; n = 6 per group), whereas the control group received sham stimulation. Electrophysiological signals were recorded simultaneously to obtain the local field potential (LFP) from the PFC, while the rats performed T-maze tasks for the evaluation of WM. Phase-amplitude coupling (PAC) was utilized to determine the effect of high-frequency rTMS on the theta-gamma coupling of LFPs. We observed that rats in the rTMS groups needed a smaller number of training days to complete the WM task as compared to the control group. High-frequency rTMS reinforced the coupling connection strength in the PFC of rats. Notably, the effect of rTMS at 15 Hz was the most effective among the three frequencies, i.e., 5 Hz, 10 Hz, and 15 Hz. The results suggested that rTMS can improve WM impairment in rats by modulating the coupling of theta and gamma rhythms. Hence, the current study provides a scientific basis for the optimization of TMS models, which would be relevant for clinical application.

Effects of repetitive transcranial magnetic stimulation and their underlying neural mechanisms evaluated with magnetic resonance imaging-based brain connectivity network analyses

Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive brain modulation and rehabilitation technique used in patients with neuropsychiatric diseases. rTMS can structurally remodel or functionally induce activities of specific cortical regions and has developed to an important therapeutic method in such patients. Magnetic resonance imaging (MRI) provides brain data that can be used as an explanation tool for the neural mechanisms underlying rTMS effects; brain alterations related to different functions or structures may be reflected in changes in the interaction and influence of brain connections within intrinsic specific networks. In this review, we discuss the technical details of rTMS and the biological interpretation of brain networks identified with MRI analyses, comprehensively summarize the neurobiological effects in rTMS-modulated individuals, and elaborate on changes in the brain network in patients with various neuropsychiatric diseases receiving rehabilitation treatment with rTMS. We conclude that brain connectivity network analysis based on MRI can reflect alterations in functional and structural connectivity networks comprising adjacent and separated brain regions related to stimulation sites, thus reflecting the occurrence of intrinsic functional integration and neuroplasticity. Therefore, MRI is a valuable tool for understanding the neural mechanisms of rTMS and practically tailoring treatment plans for patients with neuropsychiatric diseases.

Immediate modulatory effects of transcutaneous auricular vagus nerve stimulation on the resting state of major depressive disorder

BACKGROUND

Previous studies have found that transcutaneous auricular vagus nerve stimulation (taVNS) is clinically effective in the treatment of major depressive disorder (MDD), and its efficacy mechanism is related to modulation of the default mode network (DMN) and cognitive control network (CCN). However, the mechanism of the immediate effect of taVNS for MDD remains to be elucidated.

METHODS

A total of 58 patients with MDD and 54 healthy controls(HCs) were included in this study. The MDD group was treated with taVNS for 30 min (20 Hz, 4-6 mA) immediately, and we observed amplitude of low-frequency fluctuations (ALFF) abnormalities in the MDD group and changes in ALFF and functional connectivity (FC) before and after immediate treatment. The ALFF brain regions altered by taVNS induction were used as regions of interest to analyze whole-brain FC changes in the MDD group.

RESULTS

After taVNS treatment, ALFF in the right precuneus was decreased in the MDD group. The FC of the right precuneus with the left middle frontal gyrus, the left posterior cingulate gyrus and the left angular gyrus were decreased in the MDD group. Correlation analysis showed that the FC values between the right precuneus and the left posterior cingulate gyrus in the pre-treatment MDD group was negatively correlated with the 17-item Hamilton depression rating scale scores.

CONCLUSION

TaVNS has an immediate modulatory effect on DMN and CCN. It would be proposed that these functional networks may be effective targets for the long-term treatment of MDD patients with taVNS.