Neuromodulation for Depression

Depression ◽  
2019 ◽  
pp. 318-342
Author(s):  
John P. Coetzee ◽  
Nolan Williams
Keyword(s):  
Magnetic Stimulation ◽  
Focused Ultrasound ◽  
Anterior Cingulate ◽  
Theta Burst Stimulation ◽  
Burst Stimulation ◽  
Subgenual Anterior Cingulate Cortex ◽  
Low Intensity ◽  
Dorsolateral Prefrontal ◽  
Epidural Cortical Stimulation ◽  
Theta Burst

Neuromodulation (also known as neurostimulation) is a growing and important category of treatments for depression. First-line treatments such as pharmacotherapy and counseling often fail to achieve remission, and neuromodulation can help many such patients. Neuromodulatory techniques can be broadly divided into invasive approaches, which include deep brain stimulation, epidural cortical stimulation, and vagal nerve stimulation, and noninvasive approaches, which include electroconvulsive therapy, transcranial magnetic stimulation, theta burst stimulation, and transcranial direct-current stimulation, among others. While efficacy varies among techniques, those with the most efficacy tend to be those that target nodes of a proposed tripartate functional connected circuit that includes left dorsolateral prefrontal cortex, subgenual anterior cingulate cortex, and vagus nerve. Treatments currently being developed that hold promise include accelerated intermittent theta burst stimulation and low-intensity focused ultrasound pulsation.

scholarly journals Reliability of transcranial magnetic stimulation evoked potentials to detect the effects of theta-burst stimulation of the prefrontal cortex

2021 ◽  
Author(s):  
Adriano Henrique de Matos Moffa ◽  
Stevan Nikolin ◽  
Donel Martin ◽  
Colleen Loo ◽  
Tjeerd W. Boonstra
Keyword(s):  
Prefrontal Cortex ◽  
Transcranial Magnetic Stimulation ◽  
Evoked Potentials ◽  
Magnetic Stimulation ◽  
Cortical Excitability ◽  
Theta Burst Stimulation ◽  
Burst Stimulation ◽  
Neural Excitability ◽  
Dorsolateral Prefrontal ◽  
Theta Burst

Background: Transcranial magnetic stimulation (TMS) with simultaneous electroencephalography (EEG) is a novel method for assessing cortical properties outside the motor region. Theta burst stimulation (TBS), a form of repetitive TMS, can non-invasively modulate cortical excitability and has been increasingly used to treat psychiatric disorders by targetting the dorsolateral prefrontal cortex (DLPFC). The TMS-evoked potentials (TEPs) analysis has been used to evaluate cortical excitability changes after TBS. However, it remains unclear whether TEPs can detect the neuromodulatory effects of TBS. Objectives: To confirm the reliability of TEP components within and between sessions and to measure changes in neural excitability induced by intermittent (iTBS) and continuous TBS (cTBS) applied to the left DLPFC. Methods: Test-retest reliability of TEPs and TBS-induced changes in cortical excitability were assessed in twenty-four healthy participants by stimulating the DLPFC in five separate sessions, once with sham and twice with iTBS and cTBS. EEG responses were recorded of 100 single TMS pulses before and after TBS, and the reproducibility measures were quantified with the concordance correlation coefficient (CCC). Results: The N100 and P200 components presented substantial reliability within the baseline block (CCCs>0.8) and moderate concordance between sessions (CCCmax≈0.7). Both N40 and P60 TEP amplitudes showed little concordance between sessions. Changes in TEP amplitudes after iTBS were marginally reliable for N100 (CCCmax=0.52), P200 (CCCmax=0.47) and P60 (CCCmax=0.40), presenting only fair levels of concordance at specific time points. Conclusions: The present findings show that only the N100 and P200 components had good concordance between sessions. The reliability of earlier components may have been affected by TMS-evoked artefacts. The poor reliability to detect changes in neural excitability induced by TBS indicates that TEPs do not provide a precise estimate of the changes in excitability in the DLPFC or, alternatively, that TBS did not induce consistent changes in neural excitability.

scholarly journals Intermittent theta burst stimulation at personalized targets reduces the functional connectivity of the default mode network in healthy subjects

2019 ◽  
Author(s):  
Aditya Singh ◽  
Tracy Erwin-Grabner ◽  
Grant Sutcliffe ◽  
Walter Paulus ◽  
Peter Dechent ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Functional Connectivity ◽  
Default Mode Network ◽  
Healthy Subjects ◽  
Magnetic Stimulation ◽  
Anterior Cingulate ◽  
Single Session ◽  
Theta Burst Stimulation ◽  
Burst Stimulation ◽  
Theta Burst

AbstractUnderstanding the mechanisms by which transcranial magnetic stimulation protocols exert changes in the default mode network (DMN) is paramount to develop therapeutically more effective approaches in the future. A full session (3000 pulses) of 10 Hz repetitive transcranial magnetic stimulation (HF-rTMS) reduces the functional connectivity (FC) of the DMN and the subgenual anterior cingulate cortex but current understanding of the effects of a single session of intermittent theta burst stimulation (iTBS) on the DMN in healthy subjects is limited. To reduce the effects of inter-individual variability in functional architectures, we used a novel personalized target selection approach based on each subject’s resting state fMRI for an unprecedented investigation into the effects of a single session (1800 pulses) of iTBS over the DMN in healthy controls. 26 healthy subjects participated in a double-blind, crossover, sham-controlled study. After iTBS to the personalized left dorsolateral prefrontal cortex (DLPFC) targets, we investigated the time lapse of effects in the DMN and its relationship to the harm avoidance (HA) personality trait measure (Temperament and Character Inventory/TCI). Approx. 25-30 minutes after stimulation, we observed reduced FC between the DMN and the rostral anterior cingulate cortex (rACC). About 45 minutes after stimulation the FC of rACC strongly decreased further, as did the FC of right anterior insula (rAI) with the DMN. We also report a positive correlation between the FC decrease in the rACC and the HA domain of TCI. Our results show how iTBS at personalized left-DLPFC targets reduces the FC between DMN and the rACC and rAI, regions typically described as nodes of the salience network. We find that HA scores can potentially predict iTBS response, as has been observed for HF-rTMS.

scholarly journals Effects of a single session of cathodal transcranial direct current stimulation primed intermittent theta-burst stimulation on heart rate variability and cortical excitability measures

2021 ◽  
Vol 65 ◽  
pp. 162-166
Author(s):  
B. N. Keerthy ◽  
Sai Sreevalli Sarma Sreepada ◽  
Shalini S. Naik ◽  
Anushree Bose ◽  
Raju Hanumegowda ◽  
...  
Keyword(s):  
Healthy Volunteers ◽  
Dorsolateral Prefrontal Cortex ◽  
Cortical Excitability ◽  
Single Session ◽  
Theta Burst Stimulation ◽  
Burst Stimulation ◽  
Cathodal Tdcs ◽  
Dorsolateral Prefrontal ◽  
Before And After ◽  
Theta Burst

Objectives: Transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) have been used as neuromodulators in neuropsychiatric conditions. This study is aimed to find the effects of a single session of priming cathodal tDCS with intermittent theta-burst stimulation (iTBS) over left dorsolateral prefrontal cortex on heart rate variability (HRV) and cortical excitability parameters before and after perturbation. Materials and Methods: The neuromodulatory techniques used in the study were Cathodal tDCS for 20 min followed by iTBS for 3 min on the left dorsolateral prefrontal cortex (DLPFC). HRV variables and TMS parameters were recorded before and after this intervention of combined neuromodulation in 31 healthy volunteers (20 males and 11 females; age range of 19–35 years with Mean ± SD = 24.2 ± 4.7 years). Results: The results showed an overall increase in cortical excitability and parasympathetic dominance in healthy volunteers. Other measures of cortical excitability and HRV did not change significantly following single session of combined neuromodulation. Conclusion: This study showed that there is an overall increase in cortical excitability and parasympathetic dominance in the cohort of healthy volunteers following a combination of neuromodulation involving cathodal tDCS followed by iTBS over left DLPFC. Future studies exploring the effects of other possible combinations with sham stimulation could be carried out to explore the utility of dual stimulation as add-on therapy in disorders.

The effects of 30 Hz, 50 Hz AND 100 Hz continuous theta burst stimulation via transcranial magnetic stimulation on the electrophysiological parameters in healthy individuals

2021 ◽  
Vol 74 (1-2) ◽  
pp. 41-49
Author(s):  
Zeynep Ozdemir ◽  
Erkan Acar ◽  
Aysun Soysal
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Short Interval ◽  
Motor Evoked Potential ◽  
Individual Variability ◽  
Theta Burst Stimulation ◽  
Burst Stimulation ◽  
Resting Motor Threshold ◽  
Theta Burst ◽  
Continuous Theta Burst Stimulation

Transcranial magnetic stimulation is a non-invasive procedure that uses robust magnetic fields to create an electrical current in the cerebral cortex. Dual stimulation consists of administering subthre­shold conditioning stimulation (CS), then suprathreshold test stimulation (TS). When the interstimulus interval (ISI) is 1-6 msec, the motor evoked potential (MEP) decreases in amplitude; this decrease is termed “short interval intracortical inhibition” (SICI); when the ISI is 7-30 msec, an increase in MEP amplitude occurs, termed “short interval intracortical facilitation” (SICF). Continuous theta burst stimulation (cTBS), often applied at a frequency of 50 Hz, has been shown to decrease cortical excitability. The primary objective is to determine which duration of cTBS achieves better inhibition or excitation. The secondary objective is to compare 50 Hz cTBS to 30 Hz and 100 Hz cTBS. The resting motor threshold (rMT), MEP, SICI, and SICF were studied in 30 healthy volunteers. CS and TS were administered at 80%-120% and 70%-140% of rMT at 2 and 3-millisecond (msec) intervals for SICI, and 10- and 12-msec intervals for SICF. Ten individuals in each group received 30, 50, or 100 Hz, followed by administration of rMT, MT-MEP, SICI, SICF immediately and at 30 minutes. Greater inhibition was achieved with 3 msec than 2 msec in SICI, whereas better facilitation occurred at 12 msec than 10 msec in SICF. At 30 Hz, cTBS augmented inhibition and suppressed facilitation, while 50 Hz yielded less inhibition and greater inter-individual variability. At 100 Hz, cTBS provided slight facilitation in MEP amplitudes with less interindividual variability. SICI and SICF did not differ significantly between 50 Hz and 100 Hz cTBS. Our results suggest that performing SICI and SICF for 3 and 12 msec, respectively, and CS and TS at 80%-120% of rMT, demonstrate safer inhibition and facilitation. Recently, TBS has been used in the treatment of various neurological diseases, and we recommend preferentially 30 Hz over 50 Hz cTBS for better inhibition with greater safety and less inter-individual variability.

scholarly journals Single Session Transcranial Magnetic Stimulation Ameliorates Hand Gesture Deficits in Schizophrenia

2019 ◽  
Author(s):  
Sebastian Walther ◽  
Maribel Kunz ◽  
Manuela Müller ◽  
Caroline Zürcher ◽  
Irena Vladimirova ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Inferior Frontal Gyrus ◽  
Manual Dexterity ◽  
Secondary Outcome ◽  
Hand Gesture ◽  
Theta Burst Stimulation ◽  
Burst Stimulation ◽  
The Right ◽  
Theta Burst

Abstract Social interaction is impaired in schizophrenia, including the use of hand gestures, which is linked to poor social perception and outcome. Brain imaging suggests reduced neural activity in a left-lateralized frontoparietal network during gesture preparation; therefore, gesturing might be improved through facilitation of left hemispheric brain areas or via disruption of interhemispheric inhibition from the right homolog. This study tested whether repetitive transcranial magnetic stimulation (rTMS) protocols would improve gesture performance in schizophrenia. This randomized, placebo-controlled, double-blind, crossover trial applied 3 different protocols of rTMS separated by 48 h. Twenty right-handed schizophrenia patients and 20 matched healthy controls received facilitatory intermittent theta burst stimulation (iTBS) over the left inferior frontal gyrus (IFG), inhibitory continuous theta burst stimulation (cTBS) over right inferior parietal lobe (IPL), and placebo over left IPL in randomized order. Primary outcome was change in the test of upper limb apraxia (TULIA), rated from video recordings of hand gesture performance. Secondary outcome was change in manual dexterity using the coin rotation task. Participants improved on both tasks following rTMS compared with baseline. Only patients improved gesture performance following right IPL cTBS compared with placebo (P = .013). The results of the coin rotation parallel those of the TULIA, with improvements following right IPL cTBS in patients (P = .001). Single sessions of cTBS on the right IPL substantially improved both gesture performance accuracy and manual dexterity. The findings point toward an inhibition of interhemispheric rivalry as a potential mechanism of action.

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