scholarly journals Towards personalized rTMS in tinnitus: reliability of individualized stimulation protocols in behavioral and electrophysiological responses

2021 ◽  
Author(s):  
Stefan Schoisswohl ◽  
Berthold Langguth ◽  
Tobias Hebel ◽  
Mohamed A. Abdelnaim ◽  
Gregor Volberg ◽  
...  
Keyword(s):  
Repetitive Transcranial Magnetic Stimulation ◽  
Brain Activity ◽  
Clinical Effectiveness ◽  
Individual Variability ◽  
Group Level ◽  
Non Invasive ◽  
Electrophysiological Responses ◽  
Before And After ◽  
Oscillatory Brain Activity ◽  
Test Retest Reliability

AbstractBackgroundRepetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation tool potentially modulating pathological brain activity. Its clinical effectiveness is hampered by varying results and characterized by inter-individual variability in treatment responses. RTMS individualization might constitute a useful strategy to overcome this variability. A precondition for this approach would be that repeatedly applied protocols result in reliable effects. The condition tinnitus provides the advantage of immediate behavioral consequences (tinnitus loudness changes) after interventions and thus offers an excellent model to exemplify TMS personalization.ObjectiveThe aim was to investigate the test-retest reliability of short rTMS stimulations in modifying tinnitus loudness and oscillatory brain activity as well as to examine the feasibility of rTMS individualization in tinnitus.MethodsThree short verum (1Hz, 10Hz, 20Hz; 200 pulses) and one sham (0.1Hz; 20 pulses) rTMS protocol were administered on two different days in 22 tinnitus patients. Before and after each protocol, oscillatory brain activity was recorded with electroencephalography (EEG) together with behavioral tinnitus loudness ratings. Stimulation responders were identified via consistent and sham-superior behavioral or electrophysiological responses according to the prevalent neurophysiological models for tinnitus.ResultsIt was feasible to identify individualized rTMS protocols featuring reliable tinnitus loudness changes (55% responder), alpha increases (91% responder) and gamma decreases (100% responder) respectively. Contrary, test-retest correlation analyses per protocol on a group-level were not significant neither for behavioral nor for electrophysiological effects. No associations between behavioral and EEG responses were given.ConclusionRTMS individualization via behavioral and electrophysiological data in tinnitus can be considered as a feasible approach to overcome low reliability on group-level. The present results open the discussion favoring personalization utilizing neurophysiological markers rather than behavioral responses. These insights are not only useful for the rTMS treatment of tinnitus but also for neuromodulation interventions in other pathologies as our results suggest that the individualization of stimulation protocols is feasible despite absent group-level reliability.

scholarly journals Heading for Personalized rTMS in Tinnitus: Reliability of Individualized Stimulation Protocols in Behavioral and Electrophysiological Responses

2021 ◽  
Vol 11 (6) ◽  
pp. 536
Author(s):  
Stefan Schoisswohl ◽  
Berthold Langguth ◽  
Tobias Hebel ◽  
Mohamed A. Abdelnaim ◽  
Gregor Volberg ◽  
...  
Keyword(s):  
Repetitive Transcranial Magnetic Stimulation ◽  
Brain Activity ◽  
Clinical Effectiveness ◽  
Individual Variability ◽  
Alpha Power ◽  
Group Level ◽  
Electrophysiological Responses ◽  
Before And After ◽  
Gamma Power ◽  
Oscillatory Brain Activity

Background: Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation tool potentially modulating pathological brain activity. Its clinical effectiveness is hampered by varying results and characterized by inter-individual variability in treatment responses. RTMS individualization might constitute a useful strategy to overcome this variability. A precondition for this approach would be that repeatedly applied protocols result in reliable effects. The condition tinnitus provides the advantage of immediate behavioral consequences (tinnitus loudness changes) after interventions and thus offers an excellent model to exemplify TMS personalization. Objective: The aim was to investigate the test–retest reliability of short rTMS stimulations in modifying tinnitus loudness and oscillatory brain activity as well as to examine the feasibility of rTMS individualization in tinnitus. Methods: Three short verum (1, 10, 20 Hz; 200 pulses) and one sham (0.1 Hz; 20 pulses) rTMS protocol were administered on two different days in 22 tinnitus patients. Before and after each protocol, oscillatory brain activity was recorded with electroencephalography (EEG), together with behavioral tinnitus loudness ratings. RTMS individualization was executed on the basis of behavioral and electrophysiological responses. Stimulation responders were identified via consistent sham-superior increases in tinnitus loudness (behavioral responders) and alpha power increases or gamma power decreases (alpha responders/gamma responders) in accordance with the prevalent neurophysiological models for tinnitus. Results: It was feasible to identify individualized rTMS protocols featuring reliable tinnitus loudness changes (55% behavioral responder), alpha increases (91% alpha responder) and gamma decreases (100% gamma responder), respectively. Alpha responses primary occurred over parieto-occipital areas, whereas gamma responses mainly appeared over frontal regions. On the contrary, test–retest correlation analyses per protocol at a group level were not significant neither for behavioral nor for electrophysiological effects. No associations between behavioral and EEG responses were found. Conclusion: RTMS individualization via behavioral and electrophysiological data in tinnitus can be considered as a feasible approach to overcome low reliability at the group level. The present results open the discussion favoring personalization utilizing neurophysiological markers rather than behavioral responses. These insights are not only useful for the rTMS treatment of tinnitus but also for neuromodulation interventions in other pathologies, as our results suggest that the individualization of stimulation protocols is feasible despite absent group-level reliability.

scholarly journals Cerebellar rTMS in PSP: a Double-Blind Sham-Controlled Study Using Mobile Health Technology

2021 ◽  
Author(s):  
Andrea Pilotto ◽  
Maria Cristina Rizzetti ◽  
Alberto Lombardi ◽  
Clint Hansen ◽  
Michele Biggi ◽  
...  
Keyword(s):  
Digital Technology ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Health Technology ◽  
Controlled Study ◽  
Double Blind ◽  
Non Invasive ◽  
Lower Back ◽  
Before And After ◽  
Double Blind Design ◽  
Theta Burst

AbstractThere are no effective treatments in progressive supranuclear palsy (PSP). The aim of this study was to test the efficacy of theta burst repetitive transcranial magnetic stimulation (rTMS) on postural instability in PSP. Twenty PSP patients underwent a session of sham or real cerebellar rTMS in a crossover design. Before and after stimulation, static balance was evaluated with instrumented (lower back accelerometer, Rehagait®, Hasomed, Germany) 30-s trials in semitandem and tandem positions. In tandem and semitandem tasks, active stimulation was associated with increase in time without falls (both p=0.04). In the same tasks, device-extracted parameters revealed significant improvement in area (p=0.007), velocity (p=0.005), acceleration and jerkiness of sway (p=0.008) in real versus sham stimulation. Cerebellar rTMS showed a significant effect on stability in PSP patients, when assessed with mobile digital technology, in a double-blind design. These results should motivate larger and longer trials using non-invasive brain stimulation for PSP patients.

scholarly journals Understanding the neurological mechanism involved in enhanced memory recall task following binaural beat: a pilot study

2021 ◽  
Author(s):  
Muhammad Danish Mujib ◽  
Muhammad Abul Hasan ◽  
Saad Ahmed Qazi ◽  
Aleksandra Vuckovic
Keyword(s):  
Short Term Memory ◽  
Brain Activity ◽  
Digit Span ◽  
Memory Task ◽  
Neural Mechanism ◽  
Alpha Power ◽  
Before And After ◽  
Gamma Power ◽  
Group A ◽  
Oscillatory Brain Activity

AbstractBinaural beat (BB) is a promising technique for memory improvement in elderly or people with neurological conditions. However, the related modulation of cortical networks followed by behavioral changes has not been investigated. The objective of this study is to establish a relationship between BB oscillatory brain activity evoked by stimulation and a behavioral response in a short term memory task. Three Groups A, B, and C of 20 participants each received alpha (10 Hz), beta (14 Hz), and gamma (30 Hz) BB, respectively, for 15 min. Their EEG was recorded in pre, during, and post BB states. Participants performed a digit span test before and after a BB session. A significant increase in the cognitive score was found only for Group A while a significant decrease in reaction time was noted for Groups A and C. Group A had a significant decrease of theta and increase of alpha power, and a significant increase of theta and decrease of gamma imaginary coherence (ICH) post BB. Group C had a significant increase in theta and gamma power accompanied by the increase of theta and gamma ICH post BB. The effectiveness of BB depends on the frequency of stimulation. A putative neural mechanism involves an increase in theta ICH in parieto-frontal and interhemispheric frontal networks.

scholarly journals Cerebellar rTMS in PSP: a double blind sham-controlled study using mobile health technology

2020 ◽  
Author(s):  
Andrea Pilotto ◽  
Maria Cristina Rizzetti ◽  
Alberto Lombardi ◽  
Clint Hansen ◽  
Michele Biggi ◽  
...  
Keyword(s):  
Digital Technology ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Postural Instability ◽  
Controlled Study ◽  
Double Blind ◽  
Non Invasive ◽  
Lower Back ◽  
Before And After ◽  
Double Blind Design ◽  
Theta Burst

SUMMARYThere are no effective treatments for postural instability and falls in Progressive Supranuclear Palsy (PSP). Objective of the study was to test the efficacy of theta burst repetitive transcranial magnetic stimulation (rTMS) on postural instability in PSP. Twenty probable PSP patients underwent a session of sham or cerebellar rTMS in a cross-over design. Before and after stimulation, static balance was evaluated with instrumented (lower back accelerometer, Rehagait®, Hasomed, Germany) 30-seconds-trials in semitandem and tandem positions. In tandem and semitandem tasks, active stimulation was associated with longer time without support falls (both p=0.04). In the same tasks, device-extracted parameters revealed significant improvement in area (p=0.007), velocity (p=0.005) and acceleration and jerkiness of sway (p=0.008) in real versus sham stimulation. Cerebellar rTMS thus showed a significant effect on stability in PSP patients, when assessed with mobile digital technology, in a double-blind design. These results should motivate larger and longer trials using non-invasive brain stimulation for PSP patients.

scholarly journals Effects of Spatial Memory Processing on Hippocampal Ripples

2021 ◽  
Vol 12 ◽  
Author(s):  
Daniel Lachner-Piza ◽  
Lukas Kunz ◽  
Armin Brandt ◽  
Matthias Dümpelmann ◽  
Aljoscha Thomschewski ◽  
...  
Keyword(s):  
Spatial Memory ◽  
Brain Activity ◽  
Spatial Navigation ◽  
Brain Regions ◽  
Interictal Spikes ◽  
Navigation Task ◽  
Brain Functions ◽  
Before And After ◽  
Surgical Evaluation ◽  
Oscillatory Brain Activity

Human High-Frequency-Oscillations (HFO) in the ripple band are oscillatory brain activity in the frequency range between 80 and 250 Hz. HFOs may comprise different subgroups that either play a role in physiologic or pathologic brain functions. An exact differentiation between physiologic and pathologic HFOs would help elucidate their relevance for cognitive and epileptogenic brain mechanisms, but the criteria for differentiating between physiologic and pathologic HFOs remain controversial. In particular, the separation of pathologic HFOs from physiologic HFOs could improve the identification of epileptogenic brain regions during the pre-surgical evaluation of epilepsy patients. In this study, we performed intracranial electroencephalography recordings from the hippocampus of epilepsy patients before, during, and after the patients completed a spatial navigation task. We isolated hippocampal ripples from the recordings and categorized the ripples into the putative pathologic group iesRipples, when they coincided with interictal spikes, and the putative physiologic group isolRipples, when they did not coincide with interictal spikes. We found that the occurrence of isolRipples significantly decreased during the task as compared to periods before and after the task. The rate of iesRipples was not modulated by the task. In patients who completed the spatial navigation task on two consecutive days, we furthermore examined the occurrence of ripples in the intervening night. We found that the rate of ripples that coincided with sleep spindles and were therefore putatively physiologic correlated with the performance improvement on the spatial navigation task, whereas the rate of all ripples did not show this relationship. Together, our results suggest that the differentiation of HFOs into putative physiologic and pathologic subgroups may help identify their role for spatial memory and memory consolidation processes. Conversely, excluding putative physiologic HFOs from putative pathologic HFOs may improve the HFO-based identification of epileptogenic brain regions in future studies.

scholarly journals Evaluation of the Clinical Effectiveness of High Frequency Left Prefrontal Repetitive Transcranial Magnetic Stimulation (rTMS) versus Electroconvulsive Therapy (ECT) in the Treatment-Resistant Depression (TRD)

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Malik M ◽  
Kumari S ◽  
Doumas S ◽  
Afzal S ◽  
Manalai P ◽  
...  
Keyword(s):  
High Frequency ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Clinical Effectiveness ◽  
Treatment Resistant ◽  
Major Depressive ◽  
Non Invasive ◽  
Track Record ◽  
Prevalence Of Depression ◽  
The Central Nervous System ◽  
Resistant Depression

Major Depressive Disorder (MDD) is a highly prevalent, persistent, and disabling mental illness. Statistically, the lifetime prevalence of depression is 17%, but only 6% of those living with depression receive standard treatments. ECT has a long track record of success; it is one of the oldest forms of treatment for TRD. On the other hand, rTMS is a non-invasive, painless stimulation of the Central Nervous System (CNS) used to treat TRD.

The role of microRNAs in gliomas – Therapeutic implications

2020 ◽  
Vol 13 ◽  
Author(s):  
Theodora Katsila ◽  
Dimitrios Kardamakis
Keyword(s):  
Complex Disease ◽  
Malignant Gliomas ◽  
Kappa Statistic ◽  
Individual Variability ◽  
Response To Treatment ◽  
Disease Phenotype ◽  
Therapeutic Implications ◽  
Non Invasive ◽  
Gene Environment ◽  
Sas Macro

Background: Malignant gliomas constitute a complex disease phenotype that demands optimum decisionmaking. Despite being the most common type of primary brain tumors, gliomas are highly heterogeneous when their pathophysiology and response to treatment are considered. Such inter-individual variability also renders differential and early diagnosis extremely difficult. Recent evidence highlight that the gene-environment interplay becomes of fundamental importance in oncogenesis and progression of gliomas. Objective: To unmask key features of the gliomas disease phenotype and map the inter-individual variability of patients, we explore genotype-to-phenotype associations. Emphasis is put on microRNAs as they regulate gene expression, have been implicated in the pathogenesis of gliomas and may serve as theranostics, empowering non-invasive strategies (circulating free or in exosomes). Method: We mined text and omic datasets (as of 2019) and conducted a mixed-method content analysis. A novel framework was developed to meet the aims of our analysis, interrogating data in terms of content and context. We relied on literature data from PubMed/Medline and Scopus, as they are considered the largest abstract and citation databases of peer-reviewed literature. To avoid selection biases, both publicly available and private texts have been assessed. Both percent agreement and Cohen's kappa statistic have been calculated to avoid biases by SAS macro MAGREE with multicategorical ratings. Results: Gliomas serve as a paradigm for multifaceted datasets, despite data sparsity and scarcity. miRNAs and miRNAbased therapeutics are ready for prime time. Exosomal miRNAs empower non-invasive strategies, surpassing circulating free miRNAs, when accuracy and precision are considered. Conclusion: miRNAs holds promise as theranostics.

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