The Dynamic Duo: Combining noninvasive brain stimulation with cognitive interventions

Sathappan, Aakash; Luber, Bruce; Lisanby, Sarah H.

doi:10.1016/j.pnpbp.2018.10.006

Cited by 145 publications

(115 citation statements)

References 114 publications

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“…Alternative procedures such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulationespecially in combination with cognitive interventions-may be promising techniques to stimulate neurorecovery and plasticity in adults [55]. TMS has been found to be safe in children and adolescents with central nervous system disorders [4].…”

Section: Conclusion and Thoughts On Further Researchmentioning

confidence: 99%

Post-operative cerebellar mutism syndrome: rehabilitation issues

et al. 2019

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Introduction Tumors of the cerebellum are the most common brain tumors in children. Modern treatment and aggressive surgery have improved the overall survival. Consequently, growing numbers of survivors are at high risk for developing adverse and long-term neurological deficits including deficits of cognition, behavior, speech, and language. Post-operative cerebellar mutism syndrome (pCMS) is a well-known and frequently occurring complication of cerebellar tumor surgery in children. In the acute stage, children with pCMS may show deterioration of cerebellar motor function as well as pyramidal and cranial neuropathies. Most debilitating is the mutism or the severe reduction of speech and a range of neurobehavioral symptoms that may occur. In the long term, children that recover from pCMS continue to have more motor, behavioral, and cognitive problems than children who did not develop pCMS after cerebellar tumor surgery. The severity of these long-term sequelae seems to be related to the length of the mute phase. Aim of this narrative review The impact of pCMS on patients and families cannot be overstated. This contribution aims to discuss the present knowledge on the natural course, recovery, and rehabilitation of children with pCMS. We suggest future priorities in developing rehabilitation programs in order to improve the long-term quality of life and participation of children after cerebellar tumor surgery and after pCMS in particular.

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Section: Conclusion and Thoughts On Further Researchmentioning

confidence: 99%

Post-operative cerebellar mutism syndrome: rehabilitation issues

et al. 2019

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“…Accordingly, to distinguish between these two possibilities, we targeted this region with 10 Hz rTMS, based on previous results showing excitatory effects with high-frequency (>5 Hz) stimulation [10]. Because brain state at the time of stimulation influences response to the stimulation [11], we delivered the stimulation during the maintenance interval of the Sternberg working memory paradigm, a task known to activate the dlPFC [12], to facilitate the effectiveness of this stimulation. We also used this task to identify individualized functional TMS targets, representing the peak BOLD activity during the maintenance interval in the dlPFC for each subject, and used iterative electric-field modeling to optimize the coil position [13].…”

Section: Introductionmentioning

confidence: 99%

Mechanistic link between right prefrontal cortical activity and anxious arousal revealed using transcranial magnetic stimulation in healthy subjects

Balderston

Beydler

Roberts

et al. 2019

Neuropsychopharmacol.

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Much of the mechanistic research on anxiety focuses on subcortical structures such as the amygdala; however, less is known about the distributed cortical circuit that also contributes to anxiety expression. One way to learn about this circuit is to probe candidate regions using transcranial magnetic stimulation (TMS). In this study, we tested the involvement of the dorsolateral prefrontal cortex (dlPFC), in anxiety expression using 10 Hz repetitive TMS (rTMS). In a within-subject, crossover experiment, the study measured anxiety in healthy subjects before and after a session of 10 Hz rTMS to the right dorsolateral prefrontal cortex (dlPFC). It used threat of predictable and unpredictable shock to induce anxiety and anxiety potentiated startle to assess anxiety. Counter to our hypotheses, results showed an increase in anxiety-potentiated startle following active but not sham rTMS. These results suggest a mechanistic link between right dlPFC activity and physiological anxiety expression. This result supports current models of prefrontal asymmetry in affect, and lays the groundwork for further exploration into the cortical mechanisms mediating anxiety, which may lead to novel anxiety treatments.

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“…Evidence has demonstrated progressively that the neurobiological, behavioral, and antidepressant effects of NIBS are dependent on the ''state'' of the targeted neural area at the time of stimulation. 18 For example, in depression, patients exhibiting higher rostral anterior cingulate cortex (ACC) activity prior to stimulation showed a better antidepressant response to subsequent rTMS. 99 This raises the prospect of experimentally controlled ''pre-shaping'' of brain states, induced by cognitive tasks and/or NIBS techniques, to more effectively target stimulation to redress neurobiological imbalances in depression.…”

Section: Convulsive Modalitiesmentioning

confidence: 99%

“…For instance, hyperconnectivity between the ACC and the medial prefrontal cortex (mPFC) has been linked to maladaptive depressive ruminations, and both CBT and rTMS, each alone, have been shown to downregulate this dysfunctional brain activity. 18 Could pairing these interventions yield synergistic effects? In an interesting pilot study, concurrent rTMS and self-system therapy (SST, a modality similar to CBT) were performed in (albeit only five) depressed subjects, with positive results.…”

Section: Convulsive Modalitiesmentioning

confidence: 99%

“…In this context, the development of a ''precision NIN'' approach could both enhance clinical usability of NIN techniques (by improving efficacy and/or maximizing tolerability) and unveil their neurobiological mechanisms of action, which to date remain poorly understood. Additional challenges for precision NIN are the ability to combine them with other interventions 18 and their spatiotemporal resolution, as the effects of NIN can be enhanced or decreased according to the site of application of the coils or electrodes and their synchronization with ongoing neuronal activity. 19 Knowledge acquired from computer modeling and functional neuroimaging can be directed toward this purpose (Figure 1).…”

Section: Introductionmentioning

confidence: 99%

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Precision non-implantable neuromodulation therapies: a perspective for the depressed brain

Borrione

Bellini

Razza

et al. 2020

Braz. J. Psychiatry

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Current first-line treatments for major depressive disorder (MDD) include pharmacotherapy and cognitive-behavioral therapy. However, one-third of depressed patients do not achieve remission after multiple medication trials, and psychotherapy can be costly and time-consuming. Although nonimplantable neuromodulation (NIN) techniques such as transcranial magnetic stimulation, transcranial direct current stimulation, electroconvulsive therapy, and magnetic seizure therapy are gaining momentum for treating MDD, the efficacy of non-convulsive techniques is still modest, whereas use of convulsive modalities is limited by their cognitive side effects. In this context, we propose that NIN techniques could benefit from a precision-oriented approach. In this review, we discuss the challenges and opportunities in implementing such a framework, focusing on enhancing NIN effects via a combination of individualized cognitive interventions, using closed-loop approaches, identifying multimodal biomarkers, using computer electric field modeling to guide targeting and quantify dosage, and using machine learning algorithms to integrate data collected at multiple biological levels and identify clinical responders. Though promising, this framework is currently limited, as previous studies have employed small samples and did not sufficiently explore pathophysiological mechanisms Brazilian Psychiatric Association 0 0 0 0 0 0 0 0 -0 0 0 2 -7 3 1 6 -1 1 8 5 associated with NIN response and side effects. Moreover, cost-effectiveness analyses have not been performed. Nevertheless, further advancements in clinical trials of NIN could shift the field toward a more ''precision-oriented'' practice. DisclosureZ-DD is listed as inventor on patents/patent applications related to brain stimulation technology, assigned to Columbia University and NEVA Electromagnetics, not licensed, and with no remuneration. Although he is an employee of the U.S. government, the views expressed Braz J Psychiatry. 2020;00 (00) Precision NIN for depression

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The Dynamic Duo: Combining noninvasive brain stimulation with cognitive interventions

Cited by 145 publications

References 114 publications

Post-operative cerebellar mutism syndrome: rehabilitation issues

Post-operative cerebellar mutism syndrome: rehabilitation issues

Mechanistic link between right prefrontal cortical activity and anxious arousal revealed using transcranial magnetic stimulation in healthy subjects

Precision non-implantable neuromodulation therapies: a perspective for the depressed brain

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