scholarly journals HF-rTMS Treatment in Medication-Resistant Melancholic Depression: Results from 18FDG-PET Brain Imaging

CNS Spectrums ◽  
2009 ◽  
Vol 14 (8) ◽  
pp. 439-448 ◽  
Author(s):  
Chris Baeken ◽  
Rudi De Raedt ◽  
Christian Van Hove ◽  
Peter Clerinx ◽  
Johan De Mey ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Rating Scale ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Positive Outcome ◽  
Anterior Cingulate ◽  
18Fdg Pet ◽  
Positron Emission ◽  
Dorsolateral Prefrontal ◽  
Before And After ◽  
Brodmann Areas

ABSTRACTIntroduction: High frequency repetitive transcranial magnetic stimulation (HF-rTMS) of the left dorsolateral prefrontal cortex (DLPFC) might be a promising strategy to treat depression, but not all patients show a positive outcome.Objective: In this open study, we evaluate whether a favorable HF-rTMS treatment outcome could be predicted by baseline prefrontal brain glucose metabolism (CMRglc), measured by 18fluorodeoxyglucose positron emission tomography (18FDG-PET).Methods: A sample of 21 antidepressant-free, treatment-resistant depression (TRD) patients of the melancholic subtype received 10 sessions of HF-rTMS delivered on the left DLPFC. Patients underwent a static 18FDG-PET before and after HF-rTMS treatment.Results: Forty-three percent of the patients showed a reduction of at least 50% on their Hamilton Rating Scale for Depression scores. Higher baseline metabolic activities in the DLPFC and the anterior cingulate cortex (ACC) were associated with better clinical outcome. Successful HF-rTMS treatment was related to metabolic changes in subdivisions of the ACC (Brodmann areas 24 and 32).Conclusion: This biological impact of HF-rTMS on regional brain CMRglc explains to some extent how HF-rTMS may improve moods in TRD patients. Larger sham-controlled HF-rTMS treatment studies are needed to confirm these results.

scholarly journals Can Salivary Cortisol Assessment from a Single HF-rTMS Session Predict Clinical Outcome in Melancholic Depressed Patients? A Pilot Study

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
C. Baeken ◽  
L. Santermans ◽  
D. Zeeuws ◽  
R. de Raedt ◽  
N. Vanderbruggen
Keyword(s):  
Clinical Outcome ◽  
Hpa Axis ◽  
Salivary Cortisol ◽  
Rating Scale ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Positive Outcome ◽  
Depressed Patients ◽  
Successful Treatment Outcome ◽  
Dorsolateral Prefrontal ◽  
Personality Features

Aim:The underlying physiological mechanisms as to why repetitive transcranial magnetic stimulation (rTMS) can treat depressed patients remains unclear and no clear biological markers are available to indicate a positive outcome for a given patient. Some data suggest that rTMS can influence hypothalamic-pituitary-adrenal (HPA) processes. In this study, we wanted to evaluate whether one session of high frequency (HF)-rTMS applied on the left dorsolateral prefrontal cortex (DLPFC) can predict a successful treatment outcome in a sample of antidepressant free unipolar depressed patients of the melancholic subtype.Methods:Twenty one right-handed treatment resistant depressed patients were studied. Fifty two percent of the patients were considered as treatment responders, as defined by a 50% reduction in her/his baseline 17-item Hamilton Depression Rating Scale (HDRS) score. To examine acute HF-rTMS effects on the HPA- axis, we analyzed salivary cortisol levels, using a sham-controlled, ‘single’ blind, crossover design. Areas under the curves (AUC) were calculated for both real and sham HF-rTMS.Results:Real HF-rTMS resulted in salivary cortisol decreases, however only in HF-rTMS non-responders. No HF-rTMS influences were found in the responder group. Sham stimulation did not affect the HPA-axis. Non-responders were found to display a higher level of co-morbid personality disorders.Conclusion:Our results may provide more insight into the underlying working mechanisms of HF-rTMS and could add further information about endocrinological functioning in affective disorders. Furthermore, personality features in combination with a ‘super-sensitive’ HPA system could be of importance to predict clinical outcome.

scholarly journals Hypothalamus-Anchored Resting Brain Network Changes before and after Sertraline Treatment in Major Depression

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Rui Yang ◽  
Hongbo Zhang ◽  
Xiaoping Wu ◽  
Junle Yang ◽  
Mingyue Ma ◽  
...  
Keyword(s):  
Major Depression ◽  
Rating Scale ◽  
Antidepressant Treatment ◽  
Inferior Frontal Gyrus ◽  
Brain Network ◽  
Anterior Cingulate ◽  
Efficacious Treatment ◽  
Dorsolateral Prefrontal ◽  
Before And After ◽  
Brain Circuitry

Sertraline, one of the oldest antidepressants, remains to be the most efficacious treatment for depression. However, major depression disorder (MDD) is characterized by altered emotion processing and deficits in cognitive control. In cognitive interference tasks, patients with MDD have shown excessive hypothalamus activity. The purpose of this study was to examine the effects of antidepressant treatment (sertraline) on hypothalamus-anchored resting brain circuitry. Functional magnetic resonance imaging was conducted on depressed patients(n=12)both before and after antidepressant treatment. After eight weeks of antidepressant treatment, patients with depression showed significantly increased connectivity between the hypothalamus and dorsolateral prefrontal cortex, orbitofrontal cortex, anterior cingulate cortex, insula, putamen, caudate, and claustrum. By contrast, decreased connectivity of the hypothalamus-related areas was primarily located in the inferior frontal gyrus, medial frontal gyrus, cingulated gyrus, precuneus, thalamus, and cerebellum. After eight weeks of antidepressant therapy, 8 out of the 12 depressed subjects achieved 70% reduction or better in depressive symptoms, as measured on the Hamilton depression rating scale. Our findings may infer that antidepressant treatment can alter the functional connectivity of the hypothalamus resting brain to achieve its therapeutic effect.

scholarly journals Connectivity changes in major depressive disorder after rTMS: a review of functional and structural connectivity data

2021 ◽  
Vol 30 ◽  
Author(s):  
G. Schiena ◽  
G. Franco ◽  
A. Boscutti ◽  
G. Delvecchio ◽  
E. Maggioni ◽  
...  
Keyword(s):  
Diffusion Tensor ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Small Sample Size ◽  
Structural Connectivity ◽  
Unipolar Depression ◽  
Brain Regions ◽  
Small Sample ◽  
Anterior Cingulate ◽  
Antidepressant Effect ◽  
Dorsolateral Prefrontal

Abstract Aims In the search for effective therapeutic strategies for depression, repetitive transcranial magnetic stimulation (rTMS) emerged as a non-invasive, promising treatment. This is because the antidepressant effect of rTMS might be related to neuronal plasticity mechanisms possibly reverting connectivity alterations often observed in depression. Therefore, in this review, we aimed at providing an overview of the findings reported by studies investigating functional and structural connectivity changes after rTMS in depression. Methods A bibliographic search was conducted on PubMed, including studies that used unilateral, excitatory (⩾10 Hz) rTMS treatment targeted on the left dorsolateral prefrontal cortex (DLPFC) in unipolar depressed patients. Results The majority of the results showed significant TMS-induced changes in functional connectivity (FC) between areas important for emotion regulation, including the DLPFC and the subgenual anterior cingulate cortex, and among regions that are part of the major resting-state networks, such as the Default Mode Network, the Salience Networks and the Central Executive Network. Finally, in diffusion tensor imaging studies, it has been reported that rTMS appeared to increase fractional anisotropy in the frontal lobe. Limitations The small sample size, the heterogeneity of the rTMS stimulation parameters, the concomitant use of psychotropic drugs might have limited the generalisability of the results. Conclusions Overall, rTMS treatment induces structural and FC changes in brain regions and networks implicated in the pathogenesis of unipolar depression. However, whether these changes underlie the antidepressant effect of rTMS still needs to be clarified.

The role of σ-receptors in levodopa-induced dyskinesia in patients with advanced Parkinson disease: a positron emission tomography study

2004 ◽  
Vol 100 (4) ◽  
pp. 606-610 ◽  
Author(s):  
Taro Nimura ◽  
Tadashi Ando ◽  
Keiichiro Yamaguchi ◽  
Takeshi Nakajima ◽  
Reizo Shirane ◽  
...  
Keyword(s):  
Parkinson Disease ◽  
Severity Score ◽  
Rating Scale ◽  
Binding Potential ◽  
Strong Positive Correlation ◽  
Female Ratio ◽  
Content Type ◽  
Positron Emission ◽  
Before And After ◽  
Fine Print

Object. Levodopa-induced dyskinesia (LID) in patients with Parkinson disease (PD) mimics acute dystonic reactions induced by antipsychotic agents, possibly mediated by σ-receptors; however, there are few reports in which the relationship between σ-receptors and LID in advanced PD is investigated. The binding potential of cerebellar σ-receptors before and after a pallidal surgery for dyskinesia in patients with advanced PD is assessed. Methods. Six patients with advanced PD (male/female ratio 3:3, age 56.7 ± 9.8 years) underwent stereotactic pallidal surgery (two posteroventral pallidotomy procedures and four deep brain stimulation of the globus pallidus internus, including one bilateral case). Clinical features of patients with PD were assessed using Hoehn and Yahr (H & Y) stages, the Unified Parkinson's Disease Rating Scale (UPDRS), and the Schwab and England Activities of Daily Life Scale (S & E). The LID was evaluated by LID severity score. The binding potential of cerebellar σ-receptors was determined before and after the surgery by 11C-nemonapride positron emission tomoraphy, a specific radioligand for σ-receptors in the cerebellum. All clinical scores, especially the LID severity score, were dramatically improved after the surgery (p < 0.05). Preoperatively, contralateral cerebellar binding potential was significantly elevated (p < 0.01), and it was reduced after the surgery, but it was still higher than that of healthy volunteers (p < 0.05). The ipsilateral cerebellar binding potential remained unchanged after the surgery. The level of binding potential did not correlate with H & Y stage, UPDRS, or S & E score, but a strong positive correlation was seen between the binding potential and the preoperative LID severity score when the patients were receiving medication (r = 0.893, p < 0.05). Conclusions. Cerebellar σ-receptors may potentially involve the genesis of LID in advanced PD.

scholarly journals FDG-PET patterns associated with underlying pathology in corticobasal syndrome

Neurology ◽  
2019 ◽  
Vol 92 (10) ◽  
pp. e1121-e1135 ◽  
Author(s):  
Matteo Pardini ◽  
Edward D. Huey ◽  
Salvatore Spina ◽  
William C. Kreisl ◽  
Silvia Morbelli ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Fdg Pet ◽  
Primary Motor Cortex ◽  
Rating Scale ◽  
Corticobasal Degeneration ◽  
Anterior Cingulate ◽  
Corticobasal Syndrome ◽  
Control Group ◽  
Pathologic Diagnosis ◽  
Pet Scans

ObjectiveTo evaluate brain 18Fluorodeoxyglucose PET (FDG-PET) differences among patients with a clinical diagnosis of corticobasal syndrome (CBS) and distinct underling primary pathologies.MethodsWe studied 29 patients with a diagnosis of CBS who underwent FDG-PET scan and postmortem neuropathologic examination. Patients were divided into subgroups on the basis of primary pathologic diagnosis: CBS-corticobasal degeneration (CBS-CBD) (14 patients), CBS-Alzheimer disease (CBS-AD) (10 patients), and CBS–progressive supranuclear palsy (CBS-PSP) (5 patients). Thirteen age-matched healthy patients who underwent FDG-PET were the control group (HC). FDG-PET scans were compared between the subgroups and the HC using SPM-12, with a threshold of pFWE < 0.05.ResultsThere were no differences in Mattis Dementia Rating Scale or finger tapping scores between CBS groups. Compared to HC, the patients with CBS presented significant hypometabolism in frontoparietal regions, including the perirolandic area, basal ganglia, and thalamus of the clinically more affected hemisphere. Patients with CBS-CBD showed a similar pattern with a more marked, bilateral involvement of the basal ganglia. Patients with CBS-AD presented with posterior, asymmetric hypometabolism, including the lateral parietal and temporal lobes and the posterior cingulate. Finally, patients with CBS-PSP disclosed a more anterior hypometabolic pattern, including the medial frontal regions and the anterior cingulate. A conjunction analysis revealed that the primary motor cortex was the only common area of hypometabolism in all groups, irrespective of pathologic diagnosis.Discussion and conclusionsIn patients with CBS, different underling pathologies are associated with different patterns of hypometabolism. Our data suggest that FDG-PET scans could help in the etiologic diagnosis of CBS.

Deficits in Selective Attention Following Bilateral Anterior Cingulotomy

1991 ◽  
Vol 3 (3) ◽  
pp. 231-241 ◽  
Author(s):  
Kevin W. Janer ◽  
José V. Pardo
Keyword(s):  
Anterior Cingulate Cortex ◽  
Cingulate Cortex ◽  
Anterior Cingulate ◽  
Neuropsychological Measures ◽  
Positron Emission ◽  
Cognitive Operations ◽  
Before And After ◽  
Attentional System ◽  
Cortical Regions ◽  
High Level

Positron emission tomographic (PET) studies of normal humans undergoing specific cognitive activation paradigms have identified a region of the anterior cingulate cortex as a component of an anterior, midline attentional system involved in high-level processing selection. However, deficits in attention have not been demonstrated in patients following bilateral anterior cingulotomy, a procedure that results in lesions of adjacent anterior cingulate cortex. Task paradigms used in PET studies that recruit the anterior cingulate cortex were applied to normal, control subjects and to a patient before and after cingulotomy to provide highly sensitive and functionally targeted reaction time measures of attentional performance. In contrast to unchanged performance in several neuropsychological measures, this patient demonstrated specific deficits in attention during the subacute postoperative period, which resolved spontaneously several months after surgery. Such impairment is consistent with the evolving view of the anterior cingulate's involvement in high-level processing selection. These data show the feasibility of using information from PET activation studies of normals in the design of novel chronometric tasks useful for probing abnormalities in specific cognitive operations associated with discrete cortical regions.

The Influence of HF-rTMS Treatment on Psychomotor Symptoms in Medication-resistant Depressed Patients of the Melancholic Subtype

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
L. Santermans ◽  
N. Vanderbruggen ◽  
M. Meers ◽  
C. Baeken
Keyword(s):  
Clinical Outcome ◽  
Rating Scale ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Clinical Results ◽  
Psychomotor Retardation ◽  
Current Evidence ◽  
Psychomotor Activity ◽  
Depressed Patients ◽  
Dorsolateral Prefrontal ◽  
Psychomotor Symptoms

Aims:Current evidence suggests that high frequency repetitive Transcranial Magnetic Stimulation (HF-rTMS) of the left dorsolateral prefrontal cortex (DLPFC) might be a promising treatment strategy for depression. However, due to rather modest clinical results, the efficacy of rTMS in depressed patients is still under debate. As melancholic depression seems to affect psychomotor activity, in this study, we wanted to evaluate whether HF-rTMS treatment affects psychomotor activity. We also wanted to examine whether the severity of psychomotor retardation could predict clinical outcome.Method:Our group consisted of twenty antidepressant-free unipolar depressed patients of the melancholic subtype. All were considered at least stage II treatment resistant. Depression severity was assessed with the Hamilton Depression Rating Scale (HDRS) and psychomotor symptoms with the Depressive Retardation Rating Scale (DRRS). All received 10 sessions of HF-rTMS delivered on the left DLPFC.Results:Forty percent of the patients showed a reduction of at least 50% on their initial HDRS score and were defined as HF-rTMS responders.The severity of psychomotor retardation, as measured with the DDRS, did not predict clinical outcome. HF-rTMS treatment resulted in significant decreases in DDRS scores for responders as well as for non-responders. However: the better the clinical outcome, the higher the observed level of psychomotor improvement.Conclusion:Our results suggest that HF-rTMS might act on the ‘psychomotor’ level and this might add some further information as to why this kind of treatment can be beneficial for severely depressed patients of the melancholic subtype.

Altered Metabolism in Frontal Brain Circuits in Cluster Headache

Cephalalgia ◽  
2007 ◽  
Vol 27 (9) ◽  
pp. 1033-1042 ◽  
Author(s):  
T Sprenger ◽  
KV Ruether ◽  
H Boecker ◽  
M Valet ◽  
A Berthele ◽  
...  
Keyword(s):  
Cluster Headache ◽  
Fdg Pet ◽  
Brain Metabolism ◽  
Temporal Cortex ◽  
Cingulate Cortex ◽  
Brain Structures ◽  
Acute Attack ◽  
Posterior Cingulate Cortex ◽  
Anterior Cingulate ◽  
Positron Emission

Neuroimaging studies have explored cerebral activation patterns in patients with cluster headache (CH) during attacks and have revealed activation of multiple brain areas known to belong to the general pain-processing network. However, it is still unclear which changes in brain metabolism are inherent to the shift from the ‘in bout’ to the ‘out of bout’ period. We measured cerebral glucose metabolism in 11 episodic CH patients during the cluster and again during the remission period with 18F-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) and compared these data with 11 healthy controls. ‘In bout’ compared with ‘out of bout’ scans were associated with increases of metabolism in the perigenual anterior cingulate cortex (ACC), posterior cingulate cortex, prefrontal cortex, insula, thalamus and temporal cortex. Decreases in metabolism were observed in the cerebellopontine area. Compared with healthy volunteers, hypometabolism in the patient group (‘in bout’ and ‘out of bout’) was found in the perigenual ACC, prefrontal and orbitofrontal cortex. Thus, FDG-PET in CH patients revealed ‘in bout’ activation of brain structures which are involved in descending pain control. Compared with controls, the regional brain metabolism was constitutively decreased in most of these structures, irrespective of the bout. This finding indicates a deficient top-down modulation of antinociceptive circuits in CH patients. We suggest that trigger mechanisms of CH are insufficiently controlled and thus promote the initiation of the bout period and acute attack.

Cortical Representation of the Sensory Dimension of Pain

2001 ◽  
Vol 86 (1) ◽  
pp. 402-411 ◽  
Author(s):  
Robert K. Hofbauer ◽  
Pierre Rainville ◽  
Gary H. Duncan ◽  
M. Catherine Bushnell
Keyword(s):  
Pain Intensity ◽  
Somatosensory Cortex ◽  
Insular Cortex ◽  
Anterior Cingulate ◽  
Experimental Conditions ◽  
Noxious Heat ◽  
Positron Emission ◽  
Before And After ◽  
Dimensions Of Pain ◽  
Hypnotic Suggestions

It is well accepted that pain is a multidimensional experience, but little is known of how the brain represents these dimensions. We used positron emission tomography (PET) to indirectly measure pain-evoked cerebral activity before and after hypnotic suggestions were given to modulate the perceived intensity of a painful stimulus. These techniques were similar to those of a previous study in which we gave suggestions to modulate the perceived unpleasantness of a noxious stimulus. Ten volunteers were scanned while tonic warm and noxious heat stimuli were presented to the hand during four experimental conditions: alert control, hypnosis control, hypnotic suggestions for increased-pain intensity and hypnotic suggestions for decreased-pain intensity. As shown in previous brain imaging studies, noxious thermal stimuli presented during the alert and hypnosis-control conditions reliably activated contralateral structures, including primary somatosensory cortex (S1), secondary somatosensory cortex (S2), anterior cingulate cortex, and insular cortex. Hypnotic modulation of the intensity of the pain sensation led to significant changes in pain-evoked activity within S1 in contrast to our previous study in which specific modulation of pain unpleasantness (affect), independent of pain intensity, produced specific changes within the ACC. This double dissociation of cortical modulation indicates a relative specialization of the sensory and the classical limbic cortical areas in the processing of the sensory and affective dimensions of pain.

scholarly journals Data-driven analysis of kappa opioid receptor binding in major depressive disorder measured by positron emission tomography

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kelly Smart ◽  
Ashley Yttredahl ◽  
Maria A. Oquendo ◽  
J. John Mann ◽  
Ansel T. Hillmer ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Rating Scale ◽  
Kappa Opioid Receptor ◽  
Anterior Cingulate ◽  
Emission Tomography ◽  
Kappa Opioid ◽  
Major Depressive ◽  
Positron Emission

AbstractPreclinical studies have implicated kappa opioid receptors (KORs) in stress responses and depression-related behaviors, but evidence from human studies is limited. Here we present results of a secondary analysis of data acquired using positron emission tomography (PET) with the KOR radiotracer [11C]GR103545 in 10 unmedicated, currently depressed individuals with major depressive disorder (MDD; 32.6 ± 6.5 years, 5 women) and 13 healthy volunteers (34.8 ± 10 years, 6 women). Independent component analysis was performed to identify spatial patterns of coherent variance in KOR binding (tracer volume of distribution, VT) across all subjects. Expression of each component was compared between groups and relationships to symptoms were explored using the 17-item Hamilton Depression Rating Scale (HDRS). Three components of variation in KOR availability across ROIs were identified, spatially characterized by [11C]GR103545 VT in (1) bilateral frontal lobe; (2) occipital and parietal cortices, right hippocampus, and putamen; and (3) right anterior cingulate, right superior frontal gyrus and insula, coupled to negative loading in left middle cingulate. In MDD patients, component 3 was negatively associated with symptom severity on the HDRS (r = −0.85, p = 0.0021). There were no group-wise differences in expression of any component between patients and controls. These preliminary findings suggest that KOR signaling in cortical regions relevant to depression, particularly right anterior cingulate, could reflect MDD pathophysiology.

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