Daily prefrontal closed-loop repetitive transcranial magnetic stimulation (rTMS) produces progressive EEG quasi-alpha phase entrainment in depressed adults

Faller, Josef; Doose, Jayce; Sun, Xiaoxiao; Mclntosh, James; Saber, Golbarg T.; Lin, Yong-Jun; Teves, Joshua B.; Blankenship, Aidan; Huffman, Sarah; Goldman, Robin I.; George, Mark S.; Brown, Truman R.; Sajda, Paul

doi:10.1016/j.brs.2022.02.008

Cited by 26 publications

(30 citation statements)

References 61 publications

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“…Besides successful alpha-band synchronization of rTMS pulse delivery, this study showed that alpha-synchronized rTMS but not static rTMS—that is, modified iTBS, with bursts at 100 Hz—reduced left frontal resting-state alpha power and increased TMS-induced beta oscillations over mesial frontocentral channels. The therapeutic potential of alpha-synchronized rTMS in depression was separately demonstrated in a recent study 152 . The intertrial phase coherence (a measure used to quantify event-related phase modulations) was different after alpha-synchronized rTMS compared to unsynchronized stimulation.…”

Section: The Futurementioning

confidence: 96%

“…The therapeutic potential of alpha-synchronized rTMS in depression was separately demonstrated in a recent study. 152 The intertrial phase coherence (a measure used to quantify event-related phase modulations) was different after alpha-synchronized rTMS compared to unsynchronized stimulation. Specifically, EEG-synchronized rTMS was associated with greater entrainment of post-stimulation quasi-alpha (8-13 Hz range) entrainment.…”

Section: Can Electrophysiological Biomarkers Optimize Accelerated The...mentioning

confidence: 99%

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Accelerated Repetitive Transcranial Magnetic Stimulation to Treat Major Depression: The Past, Present, and Future

Chen

Klooster

Tik

et al. 2023

Harv Rev Psychiatry

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Repetitive transcranial magnetic stimulation (rTMS) is an effective and evidence-based therapy for treatment-resistant major depressive disorder. A conventional course of rTMS applies 20-30 daily sessions over 4-6 weeks. The schedule of rTMS delivery can be accelerated by applying multiple stimulation sessions per day, which reduces the duration of a treatment course with a predefined number of sessions. Accelerated rTMS reduces time demands, improves clinical efficiency, and potentially induces faster onset of antidepressant effects. However, considerable heterogeneity exists across study designs. Stimulation protocols vary in parameters such as the stimulation target, frequency, intensity, number of pulses applied per session or over a course of treatment, and duration of intersession intervals. In this article, clinician-researchers and neuroscientists who have extensive research experience in accelerated rTMS synthesize a consensus based on two decades of investigation and development, from early studies ("Past") to contemporaneous theta burst stimulation, a time-efficient form of rTMS gaining acceptance in clinical settings ("Present"). We propose descriptive nomenclature for accelerated rTMS, recommend avenues to optimize therapeutic and efficiency potential, and suggest using neuroimaging and electrophysiological biomarkers to individualize treatment protocols ("Future"). Overall, empirical studies show that accelerated rTMS protocols are well tolerated and not associated with serious adverse effects. Importantly, the antidepressant efficacy of accelerated rTMS appears comparable to conventional, once daily rTMS protocols. Whether accelerated rTMS induces antidepressant effects more quickly remains uncertain. On present evidence, treatment protocols incorporating high pulse dose and multiple treatments per day show promise and improved efficacy.

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Section: The Futurementioning

confidence: 96%

Section: Can Electrophysiological Biomarkers Optimize Accelerated The...mentioning

confidence: 99%

Accelerated Repetitive Transcranial Magnetic Stimulation to Treat Major Depression: The Past, Present, and Future

Chen

Klooster

Tik

et al. 2023

Harv Rev Psychiatry

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“…Aktuelle Closed-loop-Protokolle zielen insbesondere darauf ab, Hirnoszillationen in bestimmten Phasen zu stimulieren 92 . Erste Studien haben gezeigt, dass beispielsweise die Closed-loop-rTMS auf der Basis frontaler Alpha-Oszillation netzwerkspezifische Plastizität anregen kann, die mit der konventionellen rTMS nicht erreicht wird 93 , 94 . Closed-loop-Verfahren versprechen, die neuralen Substrate (d. h., oszillatorische Quellen, Netzwerke) spezifischer Krankheitssymptome zu identifizieren und somit das Anwendungsspektrum von Neuromodulationsverfahren zu erweitern bzw.…”

Section: Closed-loop-neuromodulation Und Andere Neue Ansätzeunclassified

“…Alpha-Oszillation netzwerkspezifische Plastizität anregen kann, die mit der konventionellen rTMS nicht erreicht wird [93,94]. Closed-loop-Verfahren versprechen, die neuralen Sub strate (d. h., oszillatorische Quellen, Netzwerke) spezifischer Krankheitssymptome zu identifizieren und somit das Anwendungsspektrum von Neuromodulationsverfahren zu erweitern bzw.…”

Section: Closed-loop-neuromodulation Und Andere Neue Ansätzeunclassified

Behandlung depressiver Störungen mittels nicht invasiver Neuromodulation

Buthut¹,

Haslacher²,

Soekadar³

2023

Nervenheilkunde

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ZUSAMMENFASSUNGZur evidenzbasierten Behandlung depressiver Störungen gehören neben pharmako- und psychotherapeutischen Ansätzen auch nicht invasive Neuromodulationsverfahren. Während die Elektrokrampftherapie (EKT) in der Öffentlichkeit am bekanntesten ist, sind andere Techniken wie die transkranielle elektrische oder magnetische Stimulation (TES/TMS) weniger bekannt, auch in Fachkreisen, obwohl beispielsweise die TMS in verschiedene Behandlungsleitlinien aufgenommen wurde. Innovative Ansätze zur gezielten Modulation neuronaler Aktivität, wie die Closed-loop-Neuromodulation, bei der die Stimulationsparameter kontinuierlich an die aktuelle Hirnaktivität angepasst werden, sowie die transkranielle fokussierte Ultraschallstimulation (tFUS) und temporale Interferenzstimulation (TIS), die eine gezielte Stimulation tiefer Hirnregionen ermöglichen sollen, versprechen neue Perspektiven für die Behandlung depressiver Störungen.

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“…Under the hypothesis that the EEG alpha phase could act as a gating mechanism where different phases in the cycle are associated with states of low and high excitability across or within the network [18, 23], our group developed a novel closed-loop EEG-synchronized rTMS system to individualize the timing of rTMS pulse train delivery for TRD patients receiving treatment [24]. Specifically, our system synchronizes the delivery of the rTMS with ongoing prefrontal brain activity by triggering an rTMS pulse train at a specific phase of a patient’s prefrontal EEG alpha (6-13 Hz) rhythm determined by a simultaneous fMRI-EEG-TMS (fET) scan to optimally engage the therapeutic target region [23, 25, 26], which forms a strategic stimulation encompassing both spatial (targeting specific locations) and temporal (concerning other cerebral events) precision (see Fig. 1c).…”

Section: Introductionmentioning

confidence: 99%

Increased entrainment and decreased excitability predict efficacious treatment of closed-loop phase-locked rTMS for treatment-resistant depression

Sun,

Doose,

Faller

et al. 2023

Preprint

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Transcranial magnetic stimulation (TMS) is an FDA-approved therapy for major depressive disorder (MDD), specifically for patients who have treatment-resistant depression (TRD). However, TMS produces response or remission in about 50% of patients but is ineffective for the other 50%. Limits on efficacy may be due to individual patient variability, but to date, there are no good biomarkers or measures of target engagement. In addition, TMS efficacy is typically not assessed until a six-week treatment ends, precluding the evaluation of intermediate improvements during the treatment duration. Here, we report on results using a closed-loop phase-locked repetitive TMS (rTMS) treatment that synchronizes the delivery of rTMS based on the timing of the pulses relative to a patient’s individual electroencephalographic (EEG) prefrontal alpha oscillation informed by functional magnetic resonance imaging (fMRI). We find that, in responders, synchronized delivery of rTMS produces two systematic changes in brain dynamics. The first change is a decrease in global cortical excitability, and the second is an increase in the phase entrainment of cortical dynamics. These two effects predict clinical outcomes in the synchronized treatment group but not in an active-treatment unsynchronized control group. The systematic decrease in excitability and increase in entrainment correlated with treatment efficacy at the endpoint and intermediate weeks during the synchronized treatment. Specifically, we show that weekly tracking of these biomarkers allows for efficacy prediction and potential of dynamic adjustments through a treatment course, improving the overall response rates.

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Daily prefrontal closed-loop repetitive transcranial magnetic stimulation (rTMS) produces progressive EEG quasi-alpha phase entrainment in depressed adults

Cited by 26 publications

References 61 publications

Accelerated Repetitive Transcranial Magnetic Stimulation to Treat Major Depression: The Past, Present, and Future

Accelerated Repetitive Transcranial Magnetic Stimulation to Treat Major Depression: The Past, Present, and Future

Behandlung depressiver Störungen mittels nicht invasiver Neuromodulation

Increased entrainment and decreased excitability predict efficacious treatment of closed-loop phase-locked rTMS for treatment-resistant depression

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