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Beydler EM, Koire A, Steuber E, Taylor JJ, Mergler RJ. Rapid-Acting Treatments for Perinatal Depression: Clinical Landscapes and Future Horizons. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2025; 22:546. [PMID: 40283771 PMCID: PMC12027204 DOI: 10.3390/ijerph22040546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2025] [Revised: 03/24/2025] [Accepted: 03/26/2025] [Indexed: 04/29/2025]
Abstract
Perinatal depression affects approximately 1 in 5 women and is the leading cause of maternal mortality in the United States. In addition to evidence-based treatment with antidepressant medications, there has been a push to identify rapid-acting options for pregnant and postpartum individuals. This paper reviews the evidence behind new pharmacological agents (neurosteroids and ketamine) and non-pharmacological approaches (transcranial magnetic stimulation). The paper also highlights the risks and benefits of electroconvulsive therapy and selective serotonin reuptake inhibitors. Based on recent studies and research, the paper provides considerations when prescribing these modalities including: timing of symptom onset, severity of presentation, breastfeeding priorities, prior treatment response and treatment availability and cost.
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Affiliation(s)
- Emily M. Beydler
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA;
- Penn Center for Women’s Behavioral Wellness, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Amanda Koire
- AMC Department of Psychiatry, Mass General Brigham, Boston, MA 02115, USA; (A.K.); (J.J.T.)
- Mary Horrigan Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA;
| | - Elizabeth Steuber
- Harvard Medical School, Boston, MA 02115, USA;
- Department of Psychiatry, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Joseph J. Taylor
- AMC Department of Psychiatry, Mass General Brigham, Boston, MA 02115, USA; (A.K.); (J.J.T.)
- Harvard Medical School, Boston, MA 02115, USA;
- Center for Brain Circuit Therapeutics, Mass General Brigham, Boston, MA 02115, USA
| | - Reid J. Mergler
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA;
- Penn Center for Women’s Behavioral Wellness, University of Pennsylvania, Philadelphia, PA 19104, USA
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Zhang Y, Mu N, Qi S, Sun C, Rao Y, Yang X, Guo J, Mu Y. Improved brain functional network in major depressive disorder with suicidal ideation after individual target-transcranial magnetic stimulation treatment: a graph-theory analysis. Front Psychiatry 2025; 16:1486835. [PMID: 39911328 PMCID: PMC11794214 DOI: 10.3389/fpsyt.2025.1486835] [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: 08/27/2024] [Accepted: 01/03/2025] [Indexed: 02/07/2025] Open
Abstract
Introduction Major depressive disorder with suicidal ideation (MDD/SI+) is characterized by high prevalence, high recurrence rate, high disability rate and low response rate. There is an urgent need for clarifying the pathogenesis and developing novel treatment methods. Methods Subjects were recruited for the collection of Magnetic Resonance Imaging data and clinical scales. Individual target-transcranial magnetic stimulation (IT-TMS) using Stanford Neuromodulation Therapy over individualized left dorsolateral prefrontal cortex was performed to treat MDD/SI+ with the ethical approval (KY20212218-C-1). GRETNA software was used to analyze brain network characteristics according to graph theory. Results A total of 32 patients (aged 18-55) and 28 healthy controls (aged 20-51) had been recruited. Patients after IT-TMS treatment had significant reduction in suicidal ideation and depressive symptom. The functional network of all three groups conformed to small-world topology. There was a renormalization in topology structure after IT-TMS treatment. Decreased functional connectivity between right insula and left anterior cingulate gyrus correlated with improvement in Beck Scale for Suicide Ideation scores. Discussion The current study highlights that MDD/SI+ patients in this cohort showed abnormal brain network connections compared to healthy controls, and that IT-TMS may exert its treatment effects by reducing spontaneous hyper-connectivity in the salience network and insula.
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Affiliation(s)
- Yao Zhang
- Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Nan Mu
- Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Shun Qi
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, The Key Laboratory of Neuro-informatics & Rehabilitation Engineering of Ministry of Civil Affairs, Xi’an Jiaotong University, Xi’an, China
| | - Chuanzhu Sun
- Shaanxi Brain Modulation and Scientific Research Center, Xi’an, Shaanxi, China
| | - Yang Rao
- Shaanxi Brain Modulation and Scientific Research Center, Xi’an, Shaanxi, China
| | - Xinyi Yang
- Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Jianying Guo
- Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Yunfeng Mu
- Department of Gynecological Oncology, Shaanxi Provincial Cancer Hospital, Xi’an, China
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Wang Y, He WY, Zhan CAA, Pan SL, Wu W, Li FX, Zhang HF. Protocol for prognosticating PPD using EEG changes during labor pain by uterine contractions: a prospective cohort study in the first stage of labor. BMC Pregnancy Childbirth 2025; 25:49. [PMID: 39844134 PMCID: PMC11753153 DOI: 10.1186/s12884-025-07167-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/09/2025] [Indexed: 01/24/2025] Open
Abstract
BACKGROUND Lack of motivation and behavioral abnormalities are the hallmarks of postpartum depression (PPD). Severe uterine contractions during labor are pain triggers for psychiatric disorders, including PPD in women during the puerperium. Creating biomarkers to monitor PPD may help in its early detection and treatment. It has been suggested that uterine contraction-induced labor pain plays a role in the emergence of this syndrome. Therefore, abnormal electroencephalography (EEG) patterns during the first stage of labor may provide useful information. Here, we propose that aberrant EEG patterns caused by painful uterine contractions may be predictive markers for PPD. METHODS This study is a single-centre prospective cohort planned for 331 parturients for vaginal delivery in the maternity ward of Zhujiang Hospital from 2022 to 2023. At baseline, online or paper-based questionnaires, including the Edinburgh Postnatal Depression Scale (EPDS) and demographic data, will be collected when the parturient is admitted to labor. EEG, electrocardiography (ECG) and electrohysterography (EHG) signals will be monitored and recorded during the first stage of labor in the ward. Follow-up will be taken at the postpartum timepoints of day 3, day 42, and 3, 6 and 12 months, respectively. Power spectral density and functional connections will be quantified. The connections between PPD severity and EEG measurements as a function of time will be assessed using linear mixed-effects models. Maternal age, parity, and whether oxytocin is used during labor, all have an impact on the incidence of PPD, hence a stratified analysis will be carried out. DISCUSSION We expect EEG changes caused by painful uterine contractions in the first labor may predict early PPD. The results from this study may act as a predictor for the development of PPD which may enhance long-term quality of life for the parturient and her offspring. TRIAL REGISTRATION Name of registry: EEG Alterations of Uterine Contractions in the First Stage of Labor Predicting PPD. TRIAL REGISTRATION NUMBER NCT05217251; registration date on the ClinicalTrial.gov platform: February, 1/2022.
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Affiliation(s)
- Yan Wang
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Institute of Perioperative Medicine and Organ Protection, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Wan-Ying He
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Department of Anesthesiology, Zhongshan City People's Hospital, Zhongshan, China
| | - Chang' An A Zhan
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
| | - Shi-Lei Pan
- Department of Obstetrics and Gynaecology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Wen Wu
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Feng-Xian Li
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
- Institute of Perioperative Medicine and Organ Protection, Zhujiang Hospital of Southern Medical University, Guangzhou, China.
| | - Hong-Fei Zhang
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
- Institute of Perioperative Medicine and Organ Protection, Zhujiang Hospital of Southern Medical University, Guangzhou, China.
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Kendall-Tackett K. Treatment Advances in Perinatal Depression: Innovations and Promising Approaches. J Clin Med 2024; 13:7744. [PMID: 39768666 PMCID: PMC11679868 DOI: 10.3390/jcm13247744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2024] [Revised: 12/03/2024] [Accepted: 12/16/2024] [Indexed: 01/11/2025] Open
Abstract
Background/Objectives: Psychotherapy and antidepressants are the standard treatment for depression during pregnancy or postpartum. However, several new treatments for depression represent major advances and paradigm changes. This commentary highlights some innovative treatment options that are on the horizon. Most of these modalities are promising, and most are non-invasive. Many of these modalities have been used in the general population, where evidence supports their use. The methods have only recently been used for pregnant and postpartum women. Other modalities are specifically for perinatal women but do not have an established track record. Methods: This commentary describes some promising approaches to treatment, while acknowledging that the literature is preliminary. The goal is to highlight some interesting approaches drawn from a recent comprehensive review of the entire literature on treatment for perinatal mental illness. Results: Integrative treatments include vitamin D, infant massage, mindfulness-based cognitive therapy, acupuncture, and repetitive transcranial magnetic stimulation (rTMS). Many studies in the general population have found that these methods are effective, and they also show promise for perinatal women without side effects associated with medications. Some of these treatments can also be adjuncts to what is considered standard care. Two new medications, brexanolone and esketamine, quickly and effectively treat severe depression and work on GABA and glutamate receptors rather than serotonin or norepinephrine. These medications become less effective after 30 days but can be combined with selective serotonin reuptake inhibitors (SSRIs). Conclusions: Pregnant and postpartum women seeking care for depression and other mental health conditions have many options beyond psychotherapy and SSRI/SNRI antidepressants. These modalities can also be added to their care.
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Ganho-Ávila A, Sobral M, Berg MLVD. Transcranial magnetic stimulation and transcranial direct current stimulation in reducing depressive symptoms during the peripartum period. Curr Opin Psychiatry 2024; 37:337-349. [PMID: 38994808 DOI: 10.1097/yco.0000000000000954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
PURPOSE OF REVIEW To present the latest data on the efficacy, safety, and acceptability of transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) in peripartum depression (PPD), complemented by notes emerging from our clinical and research experience. RECENT FINDINGS TMS and tDCS show promising results to manage mild to moderate depressive symptoms in the peripartum period. Evidence of TMS efficacy during pregnancy and the postpartum comes from two small randomized controlled trials (RCTs) with encouraging but still inconsistent results. Evidence of tDCS efficacy during pregnancy comes from one small RCT and in the postpartum the first RCT is just now being conducted and results are highly expected. The safety profile (with transient mild adverse effect to women and no known risk to the foetus/newborn) and acceptability by women seems overall good. However, the perspectives from health professionals and managers are unclear. SUMMARY Whereas TMS accelerated protocols (e.g., more than one session/day) and shorter sessions (e.g., theta burst stimulation) could address the need for fast results in PPD, home-based tDCS systems could address accessibility issues. Currently, the evidence on the efficacy of TMS and tDCS in PPD is limited warranting further research to support stronger evidence-based clinical guidelines.
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Affiliation(s)
- Ana Ganho-Ávila
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra (Portugal), Coimbra, Portugal
| | - Mónica Sobral
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra (Portugal), Coimbra, Portugal
| | - Mijke Lambregtse-van den Berg
- Departments of Psychiatry and Child & Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
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Chen K, Yang J, Li F, Chen J, Chen M, Shao H, He C, Cai D, Zhang X, Wang L, Luo Y, Cheng B, Wang J. Molecular basis underlying default mode network functional abnormalities in postpartum depression with and without anxiety. Hum Brain Mapp 2024; 45:e26657. [PMID: 38544486 PMCID: PMC10973776 DOI: 10.1002/hbm.26657] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/04/2024] [Accepted: 02/27/2024] [Indexed: 11/12/2024] Open
Abstract
Although Postpartum depression (PPD) and PPD with anxiety (PPD-A) have been well characterized as functional disruptions within or between multiple brain systems, however, how to quantitatively delineate brain functional system irregularity and the molecular basis of functional abnormalities in PPD and PPD-A remains unclear. Here, brain sample entropy (SampEn), resting-state functional connectivity (RSFC), transcriptomic and neurotransmitter density data were used to investigate brain functional system irregularity, functional connectivity abnormalities and associated molecular basis for PPD and PPD-A. PPD-A exhibited higher SampEn in medial prefrontal cortex (MPFC) and posterior cingulate cortex (PPC) than healthy postnatal women (HPW) and PPD while PPD showed lower SampEn in PPC compared to HPW and PPD-A. The functional connectivity analysis with MPFC and PPC as seed areas revealed decreased functional couplings between PCC and paracentral lobule and between MPFC and angular gyrus in PPD compared to both PPD-A and HPW. Moreover, abnormal SampEn and functional connectivity were associated with estrogenic level and clinical symptoms load. Importantly, spatial association analyses between functional changes and transcriptome and neurotransmitter density maps revealed that these functional changes were primarily associated with synaptic signaling, neuron projection, neurotransmitter level regulation, amino acid metabolism, cyclic adenosine monophosphate (cAMP) signaling pathways, and neurotransmitters of 5-hydroxytryptamine (5-HT), norepinephrine, glutamate, dopamine and so on. These results reveal abnormal brain entropy and functional connectivities primarily in default mode network (DMN) and link these changes to transcriptome and neurotransmitters to establish the molecular basis for PPD and PPD-A for the first time. Our findings highlight the important role of DMN in neuropathology of PPD and PPD-A.
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Affiliation(s)
- Kexuan Chen
- Faculty of Life Science and TechnologyKunming University of Science and TechnologyKunmingChina
- Medical SchoolKunming University of Science and TechnologyKunmingChina
| | - Jia Yang
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational MedicineKunming University of Science and TechnologyKunmingChina
- Yunnan Key Laboratory of Primate Biomedical ResearchKunmingChina
| | - Fang Li
- Medical SchoolKunming University of Science and TechnologyKunmingChina
| | - Jin Chen
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational MedicineKunming University of Science and TechnologyKunmingChina
- Yunnan Key Laboratory of Primate Biomedical ResearchKunmingChina
| | - Meiling Chen
- Department of Clinical Psychology, the First People's Hospital of Yunnan ProvinceThe Affiliated Hospital of Kunming University of Science and TechnologyKunmingChina
| | - Heng Shao
- Department of Geriatrics, the First People's Hospital of Yunnan ProvinceThe Affiliated Hospital of Kunming University of Science and TechnologyKunmingChina
| | - Chongjun He
- People's Hospital of Lijiangthe Affiliated Hospital of Kunming University of Science and TechnologyLijiangChina
| | - Defang Cai
- The Second People's Hospital of Yuxithe Affiliated Hospital of Kunming University of Science and TechnologyYuxiChina
| | - Xing Zhang
- The Second People's Hospital of Yuxithe Affiliated Hospital of Kunming University of Science and TechnologyYuxiChina
| | - Libo Wang
- The Second People's Hospital of Yuxithe Affiliated Hospital of Kunming University of Science and TechnologyYuxiChina
| | - Yuejia Luo
- Medical SchoolKunming University of Science and TechnologyKunmingChina
- Center for Brain Disorders and Cognitive Sciences, School of PsychologyShenzhen UniversityShenzhenChina
- The State Key Lab of Cognitive and Learning, Faculty of PsychologyBeijing Normal UniversityBeijingChina
| | - Bochao Cheng
- Department of RadiologyWest China Second University Hospital of Sichuan UniversityChengduChina
| | - Jiaojian Wang
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational MedicineKunming University of Science and TechnologyKunmingChina
- Yunnan Key Laboratory of Primate Biomedical ResearchKunmingChina
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Liu Q, Zhao Y, Attanti S, Voss JL, Schoenbaum G, Kahnt T. Midbrain signaling of identity prediction errors depends on orbitofrontal cortex networks. Nat Commun 2024; 15:1704. [PMID: 38402210 PMCID: PMC10894191 DOI: 10.1038/s41467-024-45880-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/06/2024] [Indexed: 02/26/2024] Open
Abstract
Outcome-guided behavior requires knowledge about the identity of future rewards. Previous work across species has shown that the dopaminergic midbrain responds to violations in expected reward identity and that the lateral orbitofrontal cortex (OFC) represents reward identity expectations. Here we used network-targeted transcranial magnetic stimulation (TMS) and functional magnetic resonance imaging (fMRI) during a trans-reinforcer reversal learning task to test the hypothesis that outcome expectations in the lateral OFC contribute to the computation of identity prediction errors (iPE) in the midbrain. Network-targeted TMS aiming at lateral OFC reduced the global connectedness of the lateral OFC and impaired reward identity learning in the first block of trials. Critically, TMS disrupted neural representations of expected reward identity in the OFC and modulated iPE responses in the midbrain. These results support the idea that iPE signals in the dopaminergic midbrain are computed based on outcome expectations represented in the lateral OFC.
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Affiliation(s)
- Qingfang Liu
- National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, 21224, USA
| | - Yao Zhao
- National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, 21224, USA
| | - Sumedha Attanti
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, 85259, USA
| | - Joel L Voss
- Department of Neurology, The University of Chicago, Chicago, IL, 60611, USA
| | - Geoffrey Schoenbaum
- National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, 21224, USA
| | - Thorsten Kahnt
- National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, 21224, USA.
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Shi R, Wang Z, Yang D, Hu Y, Zhang Z, Lan D, Su Y, Wang Y. Short-term and long-term efficacy of accelerated transcranial magnetic stimulation for depression: a systematic review and meta-analysis. BMC Psychiatry 2024; 24:109. [PMID: 38326789 PMCID: PMC10851556 DOI: 10.1186/s12888-024-05545-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 01/21/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND In recent years, accelerated transcranial magnetic stimulation (aTMS) has been developed, which has a shortened treatment period. The aim of this study was to evaluate the efficacy and long-term maintenance effects of aTMS in patients with major depressive disorder (MDD). METHODS We systematically searched online databases for aTMS studies in patients with MDD published before February 2023 and performed a meta-analysis on the extracted data. RESULTS Four randomized controlled trials (RCTs) and 10 before-and-after controlled studies were included. The findings showed that depression scores significantly decreased following the intervention (SMD = 1.80, 95% CI (1.31, 2.30), p < 0.00001). There was no significant difference in antidepressant effectiveness between aTMS and standard TMS (SMD = -0.67, 95% CI (-1.62, 0.27), p = 0.16). Depression scores at follow-up were lower than those directly after the intervention based on the depression rating scale (SMD = 0.22, 95% CI (0.06, 0.37), p = 0.006), suggesting a potential long-term maintenance effect of aTMS. Subgroup meta-analysis results indicated that different modes of aTMS may have diverse long-term effects. At the end of treatment with the accelerated repetitive transcranial magnetic stimulation (arTMS) mode, depressive symptoms may continue to improve (SMD = 0.29, 95% CI (0.10, 0.49), I2 = 22%, p = 0.003), while the accelerated intermittent theta burst stimulation (aiTBS) mode only maintains posttreatment effects (SMD = 0.01, 95% CI (-0.45, 0.47), I2 = 66%, p = 0.98). CONCLUSIONS Compared with standard TMS, aTMS can rapidly improve depressive symptoms, but there is no significant difference in efficacy. aTMS may also have long-term maintenance effects, but longer follow-up periods are needed to assess this possibility. TRIAL REGISTRATION This article is original and not under simultaneous consideration for publication. The study was registered on PROSPERO ( https://www.crd.york.ac.uk/prospero/ ) (number: CRD42023406590).
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Affiliation(s)
- Ruifeng Shi
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China, No. 32, West 2nd Section, 1st Ring Road, 610031, Chengdu, Qingyang District, China
| | - Zuxing Wang
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China, No. 32, West 2nd Section, 1st Ring Road, 610031, Chengdu, Qingyang District, China
| | - Dong Yang
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China, No. 32, West 2nd Section, 1st Ring Road, 610031, Chengdu, Qingyang District, China
| | - Yujie Hu
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China, No. 32, West 2nd Section, 1st Ring Road, 610031, Chengdu, Qingyang District, China
| | - Zhongyang Zhang
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China, No. 32, West 2nd Section, 1st Ring Road, 610031, Chengdu, Qingyang District, China
| | - Daotao Lan
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China, No. 32, West 2nd Section, 1st Ring Road, 610031, Chengdu, Qingyang District, China
| | - Yihan Su
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China, No. 32, West 2nd Section, 1st Ring Road, 610031, Chengdu, Qingyang District, China.
| | - Yunqiong Wang
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China, No. 32, West 2nd Section, 1st Ring Road, 610031, Chengdu, Qingyang District, China.
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van Rooij SJH, Arulpragasam AR, McDonald WM, Philip NS. Accelerated TMS - moving quickly into the future of depression treatment. Neuropsychopharmacology 2024; 49:128-137. [PMID: 37217771 PMCID: PMC10700378 DOI: 10.1038/s41386-023-01599-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/20/2023] [Accepted: 04/22/2023] [Indexed: 05/24/2023]
Abstract
Accelerated TMS is an emerging application of Transcranial Magnetic Stimulation (TMS) aimed to reduce treatment length and improve response time. Extant literature generally shows similar efficacy and safety profiles compared to the FDA-cleared protocols for TMS to treat major depressive disorder (MDD), yet accelerated TMS research remains at a very early stage in development. The few applied protocols have not been standardized and vary significantly across a set of core elements. In this review, we consider nine elements that include treatment parameters (i.e., frequency and inter-stimulation interval), cumulative exposure (i.e., number of treatment days, sessions per day, and pulses per session), individualized parameters (i.e., treatment target and dose), and brain state (i.e., context and concurrent treatments). Precisely which of these elements is critical and what parameters are most optimal for the treatment of MDD remains unclear. Other important considerations for accelerated TMS include durability of effect, safety profiles as doses increase over time, the possibility and advantage of individualized functional neuronavigation, use of biological readouts, and accessibility for patients most in need of the treatment. Overall, accelerated TMS appears to hold promise to reduce treatment time and achieve rapid reduction in depressive symptoms, but at this time significant work remains to be done. Rigorous clinical trials combining clinical outcomes and neuroscientific measures such as electroencephalogram, magnetic resonance imaging and e-field modeling are needed to define the future of accelerated TMS for MDD.
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Affiliation(s)
- Sanne J H van Rooij
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
| | - Amanda R Arulpragasam
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, USA
| | - William M McDonald
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
| | - Noah S Philip
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA.
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, USA.
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Han X, Zhu Z, Luan J, Lv P, Xin X, Zhang X, Shmuel A, Yao Z, Ma G, Zhang B. Effects of repetitive transcranial magnetic stimulation and their underlying neural mechanisms evaluated with magnetic resonance imaging-based brain connectivity network analyses. Eur J Radiol Open 2023; 10:100495. [PMID: 37396489 PMCID: PMC10311181 DOI: 10.1016/j.ejro.2023.100495] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/03/2023] [Indexed: 07/04/2023] Open
Abstract
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.
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Affiliation(s)
- Xiaowei Han
- Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, China
- Medical Imaging Center, Affiliated Drum Tower Hospital, Medical School of Nanjing University, China
- Nanjing University Institute of Medical Imaging and Artificial Intelligence, Nanjing University, China
| | - Zhengyang Zhu
- Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, China
- Medical Imaging Center, Affiliated Drum Tower Hospital, Medical School of Nanjing University, China
- Nanjing University Institute of Medical Imaging and Artificial Intelligence, Nanjing University, China
| | - Jixin Luan
- China-Japan Friendship Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, China
| | - Pin Lv
- Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, China
- Medical Imaging Center, Affiliated Drum Tower Hospital, Medical School of Nanjing University, China
- Nanjing University Institute of Medical Imaging and Artificial Intelligence, Nanjing University, China
| | - Xiaoyan Xin
- Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, China
- Medical Imaging Center, Affiliated Drum Tower Hospital, Medical School of Nanjing University, China
- Nanjing University Institute of Medical Imaging and Artificial Intelligence, Nanjing University, China
| | - Xin Zhang
- Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, China
- Medical Imaging Center, Affiliated Drum Tower Hospital, Medical School of Nanjing University, China
- Nanjing University Institute of Medical Imaging and Artificial Intelligence, Nanjing University, China
| | - Amir Shmuel
- Montreal Neurological Institute, McGill University, Canada
| | - Zeshan Yao
- Biomedical Engineering Institute, Jingjinji National Center of Technology Innovation, China
| | - Guolin Ma
- Department of Radiology, China-Japan Friendship Hospital, China
| | - Bing Zhang
- Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, China
- Medical Imaging Center, Affiliated Drum Tower Hospital, Medical School of Nanjing University, China
- Nanjing University Institute of Medical Imaging and Artificial Intelligence, Nanjing University, China
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11
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Qi S, Tian M, Rao Y, Sun C, Li X, Qiao J, Huang ZG. Applying transcranial magnetic stimulation to rehabilitation of poststroke lower extremity function and an improvement: Individual-target TMS. WILEY INTERDISCIPLINARY REVIEWS. COGNITIVE SCIENCE 2023; 14:e1636. [PMID: 36437474 DOI: 10.1002/wcs.1636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/21/2022] [Accepted: 10/26/2022] [Indexed: 11/29/2022]
Abstract
Stroke is the leading cause of disability globally in need of novel and effective methods of rehabilitation. Intermittent theta burst stimulation (iTBS) has been adopted as a Level B recommendation for lower limb spasticity in guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS). Nonetheless, the methodological differences and deficits of existing work bring about heterogenous results and therefore limit the universal clinical use of rTMS in lower extremity (LE) rehabilitation. The variation of stimulated targets across motor cortex contributes mainly to these heterogeneities. This narrative review includes studies of rTMS on LE motor function rehabilitation in patients after stroke until now. Some analyses of brain imaging and electromagnetic simulation and quantification through computational modeling were also performed. rTMS appears capable of fostering LE motor rehabilitation after stroke, but the actually stimulated targets are considerably bias making it difficult to confirm effectiveness. The main reason for this phenomenon is probably inaccurate targeting of motor cortical leg representation. An underlying updated method is proposed as Individual-Target TMS (IT-TMS) combined with brain imaging. rTMS is a promising validated method for LE function regaining. Future studies should systematically compare the effects of IT-TMS with traditional rTMS using large samples in random clinical trials. This article is categorized under: Neuroscience > Clinical Neuroscience.
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Affiliation(s)
- Shun Qi
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, The Key Laboratory of Neuro-informatics & Rehabilitation Engineering of Ministry of Civil Affairs, Xi'an, Shaanxi, People's Republic of China.,Shaanxi Brain Modulation and Scientific Research Center, Xi'an, Shaanxi, People's Republic of China
| | - Meng Tian
- National TCM Academic School Inheritance Studio Project-Chang'an Mi Shi Internal Medicine School Inheritance Studio, Xi'an, Shaanxi, People's Republic of China
| | - Yang Rao
- Shaanxi Brain Modulation and Scientific Research Center, Xi'an, Shaanxi, People's Republic of China
| | - Chuanzhu Sun
- Shaanxi Brain Modulation and Scientific Research Center, Xi'an, Shaanxi, People's Republic of China
| | - Xiang Li
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, The Key Laboratory of Neuro-informatics & Rehabilitation Engineering of Ministry of Civil Affairs, Xi'an, Shaanxi, People's Republic of China.,Shaanxi Brain Modulation and Scientific Research Center, Xi'an, Shaanxi, People's Republic of China
| | - Jin Qiao
- Department of Rehabilitation, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Zi-Gang Huang
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, The Key Laboratory of Neuro-informatics & Rehabilitation Engineering of Ministry of Civil Affairs, Xi'an, Shaanxi, People's Republic of China.,Research Center for Brain-inspired Intelligence, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China.,The State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, People's Republic of China
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12
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Li S, Mu Y, Rao Y, Sun C, Li X, Liu H, Yu X, Yan X, Ding Y, Wang Y, Fei Z. Preoperative individual-target transcranial magnetic stimulation demonstrates an effect comparable to intraoperative direct electrical stimulation in language-eloquent glioma mapping and improves postsurgical outcome: A retrospective fiber-tracking and electromagnetic simulation study. Front Oncol 2023; 13:1089787. [PMID: 36816968 PMCID: PMC9936080 DOI: 10.3389/fonc.2023.1089787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/20/2023] [Indexed: 02/05/2023] Open
Abstract
Background Efforts to resection of glioma lesions located in brain-eloquent areas must balance the extent of resection (EOR) and functional preservation. Currently, intraoperative direct electrical stimulation (DES) is the gold standard for achieving the maximum EOR while preserving as much functionality as possible. However, intraoperative DES inevitably involves risks of infection and epilepsy. The aim of this study was to verify the reliability of individual-target transcranial magnetic stimulation (IT-TMS) in preoperative mapping relative to DES and evaluate its effectiveness based on postsurgical outcomes. Methods Sixteen language-eloquent glioma patients were enrolled. Nine of them underwent preoperative nTMS mapping (n=9, nTMS group), and the other seven were assigned to the non-nTMS group and did not undergo preoperative nTMS mapping (n=7). Before surgery, online IT-TMS was performed during a language task in the nTMS group. Sites in the cortex at which this task was disturbed in three consecutive trials were recorded and regarded as positive and designated nTMS hotspots (HSnTMS). Both groups then underwent awake surgery and intraoperative DES mapping. DES hotspots (HSDES) were also determined in a manner analogous to HSnTMS. The spatial distribution of HSnTMS and HSDES in the nTMS group was recorded, registered in a single brain template, and compared. The center of gravity (CoG) of HSnTMS (HSnTMS-CoG)-based and HSDES-CoG-based diffusion tensor imaging-fiber tracking (DTI-FT) was performed. The electromagnetic simulation was conducted, and the values were then compared between the nTMS and DES groups, as were the Western Aphasia Battery (WAB) scale and fiber-tracking values. Results HSnTMS and HSDES showed similar distributions (mean distance 6.32 ± 2.6 mm, distance range 2.2-9.3 mm, 95% CI 3.9-8.7 mm). A higher fractional anisotropy (FA) value in nTMS mapping (P=0.0373) and an analogous fiber tract length (P=0.2290) were observed. A similar distribution of the electric field within the brain tissues induced by nTMS and DES was noted. Compared with the non-nTMS group, the integration of nTMS led to a significant improvement in language performance (WAB scores averaging 78.4 in the nTMS group compared with 59.5 in the non-nTMS group, P=0.0321 < 0.05) as well as in brain-structure preservation (FA value, P=0.0156; tract length, P=0.0166). Conclusion Preoperative IT-TMS provides data equally crucial to DES and thus facilitates precise brain mapping and the preservation of linguistic function.
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Affiliation(s)
- Sanzhong Li
- Department of Neurosurgery, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China,*Correspondence: Sanzhong Li, ; Zhou Fei,
| | - Yunfeng Mu
- Department of Gynecological Oncology, Shaanxi Provincial Cancer Hospital, Xi’an, China
| | - Yang Rao
- Shaanxi Brain Modulation and Scientific Research Center, Xi'an, Shaanxi, China
| | - Chuanzhu Sun
- Shaanxi Brain Modulation and Scientific Research Center, Xi'an, Shaanxi, China
| | - Xiang Li
- Shaanxi Brain Modulation and Scientific Research Center, Xi'an, Shaanxi, China,The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Huan Liu
- School of Mathematics and Statistics, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Xun Yu
- Product Department, Solide Brain Medical Technology, Ltd., Xi’an, Shaanxi, China
| | - Xiao Yan
- Shaanxi Brain Modulation and Scientific Research Center, Xi'an, Shaanxi, China
| | - Yunxia Ding
- Shaanxi Brain Modulation and Scientific Research Center, Xi'an, Shaanxi, China
| | - Yangtao Wang
- Shaanxi Brain Modulation and Scientific Research Center, Xi'an, Shaanxi, China
| | - Zhou Fei
- Department of Neurosurgery, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China,*Correspondence: Sanzhong Li, ; Zhou Fei,
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13
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Yao S, Kendrick KM. Reduced homotopic interhemispheric connectivity in psychiatric disorders: evidence for both transdiagnostic and disorder specific features. PSYCHORADIOLOGY 2022; 2:129-145. [PMID: 38665271 PMCID: PMC11003433 DOI: 10.1093/psyrad/kkac016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/24/2022] [Accepted: 10/28/2022] [Indexed: 04/28/2024]
Abstract
There is considerable interest in the significance of structural and functional connections between the two brain hemispheres in terms of both normal function and in relation to psychiatric disorders. In recent years, many studies have used voxel mirrored homotopic connectivity analysis of resting state data to investigate the importance of connectivity between homotopic regions in the brain hemispheres in a range of neuropsychiatric disorders. The current review summarizes findings from these voxel mirrored homotopic connectivity studies in individuals with autism spectrum disorder, addiction, attention deficit hyperactivity disorder, anxiety and depression disorders, and schizophrenia, as well as disorders such as Alzheimer's disease, mild cognitive impairment, epilepsy, and insomnia. Overall, other than attention deficit hyperactivity disorder, studies across psychiatric disorders report decreased homotopic resting state functional connectivity in the default mode, attention, salience, sensorimotor, social cognition, visual recognition, primary visual processing, and reward networks, which are often associated with symptom severity and/or illness onset/duration. Decreased homotopic resting state functional connectivity may therefore represent a transdiagnostic marker for general psychopathology. In terms of disorder specificity, the extensive decreases in homotopic resting state functional connectivity in autism differ markedly from attention deficit hyperactivity disorder, despite both occurring during early childhood and showing extensive co-morbidity. A pattern of more posterior than anterior regions showing reductions in schizophrenia is also distinctive. Going forward, more studies are needed to elucidate the functions of these homotopic functional connections in both health and disorder and focusing on associations with general psychopathology, and not only on disorder specific symptoms.
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Affiliation(s)
- Shuxia Yao
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Keith M Kendrick
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu 611731, China
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14
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Lu S, Shao J, Feng Q, Wu C, Fang Z, Jia L, Wang Z, Hu S, Xu Y, Huang M. Aberrant interhemispheric functional connectivity in major depressive disorder with and without anhedonia. BMC Psychiatry 2022; 22:688. [PMID: 36348342 PMCID: PMC9644581 DOI: 10.1186/s12888-022-04343-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/27/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Anhedonia is a core feature of major depressive disorder (MDD), and as a subtype of depression, MDD with anhedonia may have exceptional neurobiological mechanisms. However, the neuropathology of anhedonia in MDD remains unclear. Thus, this study aimed to investigate the brain functional differences between MDD with and without anhedonia. METHODS A total of 62 individuals including 22 MDD patients with anhedonia, 20 MDD patients without anhedonia, and 20 healthy controls (HCs) were recruited for this study. All participants underwent 3.0-T functional magnetic resonance imaging scan. Voxel-mirrored homotopic connectivity (VMHC) was employed to quantitatively describe bilateral functional connectivity. Analyses of variance (ANOVA) were performed to obtain brain regions with significant differences among three groups and then post hoc tests were calculated for inter-group comparisons. RESULTS The ANOVA revealed significant VMHC differences among three groups in the bilateral middle temporal gyrus (MTG), superior frontal gyrus (SFG), and inferior parietal lobule (IPL) (F = 10.47 ~ 15.09, p < 0.05, AlphaSim corrected). Relative to HCs, MDD with anhedonia showed significantly decreased VMHC in the bilateral MTG (t = -5.368, p < 0.05, AlphaSim corrected), as well as increased VMHC in the bilateral SFG (t = -4.696, p < 0.05, AlphaSim corrected). Compared to MDD without anhedonia, MDD with anhedonia showed significantly decreased VMHC in the bilateral MTG and IPL (t = -5.629 ~ -4.330, p < 0.05, AlphaSim corrected), while increased VMHC in the bilateral SFG (t = 3.926, p < 0.05, AlphaSim corrected). However, no significant difference was found between MDD without anhedonia and HCs. CONCLUSION The present findings suggest that MDD with and without anhedonia exhibit different patterns of interhemispheric connectivity. Anhedonia in MDD is related to aberrant interhemispheric connectivity within brain regions involved in the frontal-temporal-parietal circuit.
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Affiliation(s)
- Shaojia Lu
- grid.13402.340000 0004 1759 700XDepartment of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Mental Disorder’s Management of Zhejiang Province, Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, Zhejiang China
| | - Jiamin Shao
- grid.13402.340000 0004 1759 700XDepartment of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Mental Disorder’s Management of Zhejiang Province, Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, Zhejiang China ,grid.13402.340000 0004 1759 700XFaculty of Clinical Medicine, Zhejiang University School of Medicine, Hangzhou, Zhejiang China
| | - Qian Feng
- grid.13402.340000 0004 1759 700XDepartment of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Mental Disorder’s Management of Zhejiang Province, Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, Zhejiang China ,grid.13402.340000 0004 1759 700XFaculty of Clinical Medicine, Zhejiang University School of Medicine, Hangzhou, Zhejiang China
| | - Congchong Wu
- grid.13402.340000 0004 1759 700XDepartment of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Mental Disorder’s Management of Zhejiang Province, Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, Zhejiang China ,grid.13402.340000 0004 1759 700XFaculty of Clinical Medicine, Zhejiang University School of Medicine, Hangzhou, Zhejiang China
| | - Zhe Fang
- grid.13402.340000 0004 1759 700XDepartment of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Mental Disorder’s Management of Zhejiang Province, Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, Zhejiang China ,grid.13402.340000 0004 1759 700XFaculty of Clinical Medicine, Zhejiang University School of Medicine, Hangzhou, Zhejiang China
| | - Lili Jia
- grid.13402.340000 0004 1759 700XDepartment of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Mental Disorder’s Management of Zhejiang Province, Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, Zhejiang China ,grid.13402.340000 0004 1759 700XFaculty of Clinical Medicine, Zhejiang University School of Medicine, Hangzhou, Zhejiang China ,Department of Clinical Psychology, The Fifth Peoples’ Hospital of Lin’an District, Hangzhou, Zhejiang China
| | - Zheng Wang
- grid.13402.340000 0004 1759 700XDepartment of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Mental Disorder’s Management of Zhejiang Province, Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, Zhejiang China
| | - Shaohua Hu
- grid.13402.340000 0004 1759 700XDepartment of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Mental Disorder’s Management of Zhejiang Province, Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, Zhejiang China
| | - Yi Xu
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Mental Disorder's Management of Zhejiang Province, Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, Zhejiang, China.
| | - Manli Huang
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Mental Disorder's Management of Zhejiang Province, Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, Zhejiang, China.
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15
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Wu J, Wu J, Guo R, Chu L, Li J, Zhang S, Ren H. The decreased connectivity in middle temporal gyrus can be used as a potential neuroimaging biomarker for left temporal lobe epilepsy. Front Psychiatry 2022; 13:972939. [PMID: 36032260 PMCID: PMC9399621 DOI: 10.3389/fpsyt.2022.972939] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 07/08/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE We aimed to explore voxel-mirrored homotopic connectivity (VMHC) abnormalities between the two brain hemispheres in left temporal lobe epilepsy (lTLE) patients and to determine whether these alterations could be leveraged to guide lTLE diagnosis. MATERIALS AND METHODS Fifty-eight lTLE patients and sixty healthy controls (HCs) matched in age, sex, and education level were recruited to receive resting state functional magnetic resonance imaging (rs-fMRI) scan. Then VHMC analyses of bilateral brain regions were conducted based on the results of these rs-fMRI scans. The resultant imaging data were further analyzed using support vector machine (SVM) methods. RESULTS Compared to HCs, patients with lTLE exhibited decreased VMHC values in the bilateral middle temporal gyrus (MTG) and middle cingulum gyrus (MCG), while no brain regions in these patients exhibited increased VMHC values. SVM analyses revealed the diagnostic accuracy of reduced bilateral MTG VMHC values to be 75.42% (89/118) when differentiating between lTLE patients and HCs, with respective sensitivity and specificity values of 74.14% (43/58) and 76.67% (46/60). CONCLUSION Patients with lTLE exhibit abnormal VMHC values corresponding to the impairment of functional coordination between homotopic regions of the brain. These altered MTG VMHC values may also offer value as a robust neuroimaging biomarker that can guide lTLE patient diagnosis.
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Affiliation(s)
- Jinlong Wu
- Department of Imaging Center, Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China.,Key Laboratory of Occupational Hazards and Identification, Wuhan University of Science and Technology, Wuhan, China
| | - Jun Wu
- Department of Neurosurgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ruimin Guo
- Department of Imaging Center, Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Linkang Chu
- Department of Imaging Center, Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Jun Li
- Department of Neurosurgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sheng Zhang
- Liyuan Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongwei Ren
- Department of Imaging Center, Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
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