Accelerated TMS - moving quickly into the future of depression treatment

Neuropsychopharmacology, Journal Year: 2023, Volume and Issue: 49(1), P. 128 - 137

Published: May 22, 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 safety profiles compared the FDA-cleared protocols for treat major depressive disorder (MDD), yet accelerated research remains at a very early stage in development. The few applied have not been standardized vary significantly across set core elements. In this review, we consider nine elements that include parameters (i.e., frequency inter-stimulation interval), cumulative exposure number days, sessions per day, pulses session), individualized target dose), brain state context concurrent treatments). Precisely which these critical what are most optimal MDD unclear. Other important considerations durability effect, as doses increase over time, possibility advantage functional neuronavigation, use biological readouts, accessibility patients need treatment. Overall, appears hold promise time achieve rapid reduction symptoms, but significant work be done. Rigorous clinical trials combining outcomes neuroscientific measures such electroencephalogram, magnetic resonance imaging e-field modeling needed define future MDD.

Language: Английский

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Functional magnetic resonance imaging in schizophrenia: current evidence, methodological advances, limitations and future directions

World Psychiatry, Journal Year: 2024, Volume and Issue: 23(1), P. 26 - 51

Published: Jan. 12, 2024

Functional neuroimaging emerged with great promise and has provided fundamental insights into the neurobiology of schizophrenia. However, it faced challenges criticisms, most notably a lack clinical translation. This paper provides comprehensive review critical summary literature on functional neuroimaging, in particular magnetic resonance imaging (fMRI), We begin by reviewing research fMRI biomarkers schizophrenia high risk phase through historical lens, moving from case-control regional brain activation to global connectivity advanced analytical approaches, more recent machine learning algorithms identify predictive features. Findings studies negative symptoms as well neurocognitive social cognitive deficits are then reviewed. neural markers these may represent promising treatment targets Next, we summarize related antipsychotic medication, psychotherapy psychosocial interventions, neurostimulation, including response resistance, therapeutic mechanisms, targeting. also utility data-driven approaches dissect heterogeneity schizophrenia, beyond comparisons, methodological considerations advances, consortia precision fMRI. Lastly, limitations future directions field discussed. Our suggests that, order for be clinically useful care patients should address potentially actionable decisions that routine treatment, such which prescribed or whether given patient is likely have persistent impairment. The potential influenced must weighed against cost accessibility factors. Future evaluations prognostic consider health economics analysis.

Language: Английский

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Accelerated Theta Burst Stimulation: Safety, Efficacy, and Future Advancements

Biological Psychiatry, Journal Year: 2024, Volume and Issue: 95(6), P. 523 - 535

Published: Feb. 19, 2024

Language: Английский

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Default mode network functional connectivity as a transdiagnostic biomarker of cognitive function

Biological Psychiatry Cognitive Neuroscience and Neuroimaging, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 1, 2025

Language: Английский

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Personalized and Circuit-Based Transcranial Magnetic Stimulation: Evidence, Controversies, and Opportunities

Biological Psychiatry, Journal Year: 2023, Volume and Issue: 95(6), P. 510 - 522

Published: Nov. 29, 2023

The development of neuroimaging methodologies to map brain connectivity has transformed our understanding psychiatric disorders, the distributed effects stimulation, and how transcranial magnetic stimulation can be best employed target ameliorate symptoms. In parallel, research revealed that higher-order regions such as prefrontal cortex, which represent most common therapeutic targets for show some highest levels interindividual variation in connectivity. These findings provide rationale personalized site selection based on person-specific network architecture. Recent advances have made it possible determine reproducible with millimeter precision clinically tractable acquisition times. enable potential advantages spatially targeting evaluated translated basic clinical applications. this review, we outline motivation personalization, preliminary support (mostly depression), convergent evidence from other modalities, generalizability beyond depression cortex. We end by detailing methodological recommendations, controversies, notable alternatives. Overall, while area appears highly promising, value remains unclear, dedicated large prospective randomized trials using validated methodology are critical.

Language: Английский

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Closed-Loop Brain Stimulation

Biological Psychiatry, Journal Year: 2023, Volume and Issue: 95(6), P. 545 - 552

Published: Sept. 22, 2023

In the same way that beauty lies in eye of beholder, what a stimulus does to brain is determined not simply by nature stimulus, but receiving at instant time. Therapeutic stimulation, over past decades, typically applied open-loop fixed protocols and has largely ignored this principle. Only recent neuro-technological advancements enabled us predict (i.e., electrophysiological state next time) with sufficient temporal precision range milliseconds, using feedforward algorithms EEG time series data. This allows stimulation exclusively whenever targeted area prespecified excitability or connectivity state. Preclinical studies showed repetitive during particular (e.g., high-excitability state), other states, results lasting modification long-term potentiation) stimulated circuits. Here we survey evidence also possible systems level human cortex, EEG-informed transcranial magnetic (EEG-TMS). We discuss critically opportunities difficulties develop state-dependent for more effective pathological networks major depressive disorder) than achievable conventional protocols. The real-time EEG-TMS technology will allow closing loop recording effects stimulation. information may serve protocol adaptation maximize treatment response. way, states control introducing paradigm-shift from closed-loop

Language: Английский

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The future of brain circuit-targeted therapeutics

Neuropsychopharmacology, Journal Year: 2023, Volume and Issue: 49(1), P. 179 - 188

Published: July 31, 2023

Language: Английский

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Evaluating Robustness of Brain Stimulation Biomarkers for Depression: A Systematic Review of Magnetic Resonance Imaging and Electroencephalography Studies

Biological Psychiatry, Journal Year: 2023, Volume and Issue: 95(6), P. 553 - 563

Published: Sept. 19, 2023

Non-invasive brain stimulation (NIBS) treatments have gained considerable attention as a potential therapeutic intervention for psychiatric disorders. The identification of reliable biomarkers predicting clinical response to NIBS has been major focus research in recent years. Neuroimaging techniques, such electroencephalography (EEG) and (functional) magnetic resonance imaging (fMRI), used identify that could predict NIBS. However, identifying clinically actionable requires robustness.In this systematic review, we aimed summarize the current state biomarker depression, focusing only on well-powered studies (N≥88) and/or at independently replicating prior findings, either successfully or unsuccessfully. A total 220 were initially identified, which 18 MRI EEG adhered inclusion criteria, all focused repetitive transcranial treatment depression.After reviewing included studies, found following be most robust: 1) fMRI-based functional connectivity between dorsolateral prefrontal cortex subgenual anterior cingulate cortex, 2) network connectivity, 3) task-induced frontal-midline theta, 4) individual alpha frequency.Future prospective should further investigate actionability these specific bring closer reality.

Language: Английский

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Elevating the field for applying neuroimaging to individual patients in psychiatry

Translational Psychiatry, Journal Year: 2024, Volume and Issue: 14(1)

Published: Feb. 10, 2024

Abstract Although neuroimaging has been widely applied in psychiatry, much of the exuberance decades past tempered by failed replications and a lack definitive evidence to support utility imaging inform clinical decisions. There are multiple promising ways forward demonstrate relevance for psychiatry at individual patient level. Ultra-high field magnetic resonance is developing as sensitive measure neurometabolic processes particular that holds promise new way characterize abnormalities well variability response treatment. Neuroimaging may also be particularly suited science brain stimulation interventions given can both targeting changes circuit communication function how effectively improve symptoms. We argue greater focus on data will pave stronger care psychiatry. stress importance using symptom-relevant experimental manipulations best demonstrated pairing with differential treatment prediction outcome measurement. The priorities shifting, which compels solidify patients over exploratory associations biomarkers ultimately fail replicate.

Language: Английский

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Targeting VMPFC‐amygdala circuit with TMS in substance use disorder: A mechanistic framework

Addiction Biology, Journal Year: 2025, Volume and Issue: 30(1)

Published: Jan. 1, 2025

Abstract The ventromedial prefrontal cortex (VMPFC), located along the medial aspect of frontal area, plays a critical role in regulating arousal/emotions. Its intricate connections with subcortical structures, including striatum and amygdala, highlight VMPFC's importance neurocircuitry addiction. Due to these features, VMPFC is considered promising target for transcranial magnetic stimulation (TMS) substance use disorders (SUD). By end 2023, all 21 studies targeting SUD used anatomical landmarks (e.g., Fp1/Fp2 EEG system) define coil location fixed orientation. Nevertheless, one‐size‐fits‐all TMS over has yielded variable outcomes. Here, we suggested pipeline based on tailored framework aimed at optimally modulating VMPFC‐amygdala circuit an individual basis. We collected MRI data from 60 participants methamphetamine (MUDs). examined variability task‐based functional connectivity between amygdala using psychophysiological interaction (PPI) analysis. Electric fields (EF) were calculated vs. optimized (Fp1/Fp2 individualized maximal PPI), orientation (AF7/AF8 algorithm) intensity (constant adjusted) maximize engagement. In our pipeline, left identified as brain region highest (0.31 ± 0.29) fMRI drug cue reactivity, was selected seed region. voxel most positive amygdala‐VMPFC PPI each participant (MNI‐coordinates: [12.6, 64.23, −0.8] [13.64, 3.50, 11.01]). This significantly correlated VAS craving after exposure (R = 0.27, p 0.03). Coil increase EF strength targeted (0.99 0.21 V/m approach: Fp1: 0.56 0.22 Fp2: 0.78 0.25 V/m) harmonized across population. study highlights potential enhance treatment outcomes addiction, specifically personalized circuit.

Language: Английский

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