Daily prefrontal closed-loop repetitive transcranial magnetic stimulation (rTMS) produces progressive EEG quasi-alpha phase entrainment in depressed adults
Transcranial magnetic stimulation (TMS) is a non-invasive neuromodulation modality that can treat depression, obsessive-compulsive disorder, or help smoking cessation. Research suggests that timing the delivery of TMS relative to an endogenous brain state may affect efficacy and short-term brain dyn...
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| Published in | Brain stimulation Vol. 15; no. 2; pp. 458 - 471 |
|---|---|
| Main Authors | , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
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United States
Elsevier Inc
01.03.2022
Elsevier |
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| Abstract | Transcranial magnetic stimulation (TMS) is a non-invasive neuromodulation modality that can treat depression, obsessive-compulsive disorder, or help smoking cessation. Research suggests that timing the delivery of TMS relative to an endogenous brain state may affect efficacy and short-term brain dynamics.
To investigate whether, for a multi-week daily treatment of repetitive TMS (rTMS), there is an effect on brain dynamics that depends on the timing of the TMS relative to individuals’ prefrontal EEG quasi-alpha rhythm (between 6 and 13 Hz).
We developed a novel closed-loop system that delivers personalized EEG-triggered rTMS to patients undergoing treatment for major depressive disorder. In a double blind study, patients received daily treatments of rTMS over a period of six weeks and were randomly assigned to either a synchronized or unsynchronized treatment group, where synchronization of rTMS was to their prefrontal EEG quasi-alpha rhythm.
When rTMS is applied over the dorsal lateral prefrontal cortex (DLPFC) and synchronized to the patient's prefrontal quasi-alpha rhythm, patients develop strong phase entrainment over a period of weeks, both over the stimulation site as well as in a subset of areas distal to the stimulation site. In addition, at the end of the course of treatment, this group's entrainment phase shifts to be closer to the phase that optimally engages the distal target, namely the anterior cingulate cortex (ACC). These entrainment effects are not observed in the group that is given rTMS without initial EEG synchronization of each TMS train.
The entrainment effects build over the course of days/weeks, suggesting that these effects engage neuroplastic changes which may have clinical consequences in depression or other diseases.
•Major depressive disorder patients were treated with closed-loop EEG-triggered rTMS over DLPFC for six weeks.•Patients were randomized to rTMS triggered either synchronously or asynchronously timed to their quasi-alpha EEG oscillation.•Sync patients showed increased entrainment over sessions and decreased optimal phase difference for anterior cingulate.•Entrainment was observed both locally over the stimulation site and distally over the anterior cingulate.•The entrainment effects build over the course of days/weeks, suggesting that these effects engage neuroplastic changes. |
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| AbstractList | Transcranial magnetic stimulation (TMS) is a non-invasive neuromodulation modality that can treat depression, obsessive-compulsive disorder, or help smoking cessation. Research suggests that timing the delivery of TMS relative to an endogenous brain state may affect efficacy and short-term brain dynamics.
To investigate whether, for a multi-week daily treatment of repetitive TMS (rTMS), there is an effect on brain dynamics that depends on the timing of the TMS relative to individuals' prefrontal EEG quasi-alpha rhythm (between 6 and 13 Hz).
We developed a novel closed-loop system that delivers personalized EEG-triggered rTMS to patients undergoing treatment for major depressive disorder. In a double blind study, patients received daily treatments of rTMS over a period of six weeks and were randomly assigned to either a synchronized or unsynchronized treatment group, where synchronization of rTMS was to their prefrontal EEG quasi-alpha rhythm.
When rTMS is applied over the dorsal lateral prefrontal cortex (DLPFC) and synchronized to the patient's prefrontal quasi-alpha rhythm, patients develop strong phase entrainment over a period of weeks, both over the stimulation site as well as in a subset of areas distal to the stimulation site. In addition, at the end of the course of treatment, this group's entrainment phase shifts to be closer to the phase that optimally engages the distal target, namely the anterior cingulate cortex (ACC). These entrainment effects are not observed in the group that is given rTMS without initial EEG synchronization of each TMS train.
The entrainment effects build over the course of days/weeks, suggesting that these effects engage neuroplastic changes which may have clinical consequences in depression or other diseases. Background: Transcranial magnetic stimulation (TMS) is a non-invasive neuromodulation modality that can treat depression, obsessive-compulsive disorder, or help smoking cessation. Research suggests that timing the delivery of TMS relative to an endogenous brain state may affect efficacy and short-term brain dynamics. Objective: To investigate whether, for a multi-week daily treatment of repetitive TMS (rTMS), there is an effect on brain dynamics that depends on the timing of the TMS relative to individuals’ prefrontal EEG quasi-alpha rhythm (between 6 and 13 Hz). Method: We developed a novel closed-loop system that delivers personalized EEG-triggered rTMS to patients undergoing treatment for major depressive disorder. In a double blind study, patients received daily treatments of rTMS over a period of six weeks and were randomly assigned to either a synchronized or unsynchronized treatment group, where synchronization of rTMS was to their prefrontal EEG quasi-alpha rhythm. Results: When rTMS is applied over the dorsal lateral prefrontal cortex (DLPFC) and synchronized to the patient's prefrontal quasi-alpha rhythm, patients develop strong phase entrainment over a period of weeks, both over the stimulation site as well as in a subset of areas distal to the stimulation site. In addition, at the end of the course of treatment, this group's entrainment phase shifts to be closer to the phase that optimally engages the distal target, namely the anterior cingulate cortex (ACC). These entrainment effects are not observed in the group that is given rTMS without initial EEG synchronization of each TMS train. Conclusions: The entrainment effects build over the course of days/weeks, suggesting that these effects engage neuroplastic changes which may have clinical consequences in depression or other diseases. Transcranial magnetic stimulation (TMS) is a non-invasive neuromodulation modality that can treat depression, obsessive-compulsive disorder, or help smoking cessation. Research suggests that timing the delivery of TMS relative to an endogenous brain state may affect efficacy and short-term brain dynamics. To investigate whether, for a multi-week daily treatment of repetitive TMS (rTMS), there is an effect on brain dynamics that depends on the timing of the TMS relative to individuals’ prefrontal EEG quasi-alpha rhythm (between 6 and 13 Hz). We developed a novel closed-loop system that delivers personalized EEG-triggered rTMS to patients undergoing treatment for major depressive disorder. In a double blind study, patients received daily treatments of rTMS over a period of six weeks and were randomly assigned to either a synchronized or unsynchronized treatment group, where synchronization of rTMS was to their prefrontal EEG quasi-alpha rhythm. When rTMS is applied over the dorsal lateral prefrontal cortex (DLPFC) and synchronized to the patient's prefrontal quasi-alpha rhythm, patients develop strong phase entrainment over a period of weeks, both over the stimulation site as well as in a subset of areas distal to the stimulation site. In addition, at the end of the course of treatment, this group's entrainment phase shifts to be closer to the phase that optimally engages the distal target, namely the anterior cingulate cortex (ACC). These entrainment effects are not observed in the group that is given rTMS without initial EEG synchronization of each TMS train. The entrainment effects build over the course of days/weeks, suggesting that these effects engage neuroplastic changes which may have clinical consequences in depression or other diseases. •Major depressive disorder patients were treated with closed-loop EEG-triggered rTMS over DLPFC for six weeks.•Patients were randomized to rTMS triggered either synchronously or asynchronously timed to their quasi-alpha EEG oscillation.•Sync patients showed increased entrainment over sessions and decreased optimal phase difference for anterior cingulate.•Entrainment was observed both locally over the stimulation site and distally over the anterior cingulate.•The entrainment effects build over the course of days/weeks, suggesting that these effects engage neuroplastic changes. Transcranial magnetic stimulation (TMS) is a non-invasive neuromodulation modality that can treat depression, obsessive-compulsive disorder, or help smoking cessation. Research suggests that timing the delivery of TMS relative to an endogenous brain state may affect efficacy and short-term brain dynamics.BACKGROUNDTranscranial magnetic stimulation (TMS) is a non-invasive neuromodulation modality that can treat depression, obsessive-compulsive disorder, or help smoking cessation. Research suggests that timing the delivery of TMS relative to an endogenous brain state may affect efficacy and short-term brain dynamics.To investigate whether, for a multi-week daily treatment of repetitive TMS (rTMS), there is an effect on brain dynamics that depends on the timing of the TMS relative to individuals' prefrontal EEG quasi-alpha rhythm (between 6 and 13 Hz).OBJECTIVETo investigate whether, for a multi-week daily treatment of repetitive TMS (rTMS), there is an effect on brain dynamics that depends on the timing of the TMS relative to individuals' prefrontal EEG quasi-alpha rhythm (between 6 and 13 Hz).We developed a novel closed-loop system that delivers personalized EEG-triggered rTMS to patients undergoing treatment for major depressive disorder. In a double blind study, patients received daily treatments of rTMS over a period of six weeks and were randomly assigned to either a synchronized or unsynchronized treatment group, where synchronization of rTMS was to their prefrontal EEG quasi-alpha rhythm.METHODWe developed a novel closed-loop system that delivers personalized EEG-triggered rTMS to patients undergoing treatment for major depressive disorder. In a double blind study, patients received daily treatments of rTMS over a period of six weeks and were randomly assigned to either a synchronized or unsynchronized treatment group, where synchronization of rTMS was to their prefrontal EEG quasi-alpha rhythm.When rTMS is applied over the dorsal lateral prefrontal cortex (DLPFC) and synchronized to the patient's prefrontal quasi-alpha rhythm, patients develop strong phase entrainment over a period of weeks, both over the stimulation site as well as in a subset of areas distal to the stimulation site. In addition, at the end of the course of treatment, this group's entrainment phase shifts to be closer to the phase that optimally engages the distal target, namely the anterior cingulate cortex (ACC). These entrainment effects are not observed in the group that is given rTMS without initial EEG synchronization of each TMS train.RESULTSWhen rTMS is applied over the dorsal lateral prefrontal cortex (DLPFC) and synchronized to the patient's prefrontal quasi-alpha rhythm, patients develop strong phase entrainment over a period of weeks, both over the stimulation site as well as in a subset of areas distal to the stimulation site. In addition, at the end of the course of treatment, this group's entrainment phase shifts to be closer to the phase that optimally engages the distal target, namely the anterior cingulate cortex (ACC). These entrainment effects are not observed in the group that is given rTMS without initial EEG synchronization of each TMS train.The entrainment effects build over the course of days/weeks, suggesting that these effects engage neuroplastic changes which may have clinical consequences in depression or other diseases.CONCLUSIONSThe entrainment effects build over the course of days/weeks, suggesting that these effects engage neuroplastic changes which may have clinical consequences in depression or other diseases. |
| Author | Huffman, Sarah Saber, Golbarg T. Faller, Josef Sajda, Paul Goldman, Robin I. Doose, Jayce Lin, Yida Teves, Joshua B. George, Mark S. Sun, Xiaoxiao Mclntosh, James R. Blankenship, Aidan Brown, Truman R. |
| AuthorAffiliation | 1 Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA 3 US DEVCOM Army Research Laboratory, Aberdeen Proving Ground, MD 20115, USA 5 Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC 29425, USA 4 Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY 10032, USA 6 Department of Neurology, University of Chicago, Chicago, IL 60637, USA 2 Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC 29425, USA 10 Ralph H. Johnson VA Medical Center, Charleston, SC 29401, USA 9 Center for Healthy Minds, University of Wisconsin-Madison, Madison, WI 53705, USA 7 Department of Computer Science, Columbia University, New York, NY 10027, USA 12 Department of Electrical Engineering, Columbia University, New York, NY 10027, USA 8 Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA 13 Data Science Institute, Co |
| AuthorAffiliation_xml | – name: 7 Department of Computer Science, Columbia University, New York, NY 10027, USA – name: 13 Data Science Institute, Columbia University, New York, NY 10027, USA – name: 3 US DEVCOM Army Research Laboratory, Aberdeen Proving Ground, MD 20115, USA – name: 10 Ralph H. Johnson VA Medical Center, Charleston, SC 29401, USA – name: 4 Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY 10032, USA – name: 11 Department of Radiology, Columbia University Irving Medical Center, New York, NY 10032, USA – name: 9 Center for Healthy Minds, University of Wisconsin-Madison, Madison, WI 53705, USA – name: 6 Department of Neurology, University of Chicago, Chicago, IL 60637, USA – name: 1 Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA – name: 2 Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC 29425, USA – name: 5 Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC 29425, USA – name: 8 Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA – name: 12 Department of Electrical Engineering, Columbia University, New York, NY 10027, USA |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/35231608$$D View this record in MEDLINE/PubMed |
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| Keywords | Closed-loop neurostimulation Electroencephalography (EEG) Repetitive transcranial magnetic stimulation (rTMS) Inter-trial phase coherence (ITPC) Major depressive disorder (MDD) |
| Language | English |
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| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3 Josef Faller: conceptualization, methodology, software, writing-original draft All persons who meet authorship criteria are listed as authors, and all authors certify that they have participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, analysis, writing, or revision of the manuscript. Golbarg T.Saber: conceptualization, methodology, data curation Joshua B. Teves: investigation, data curation Aidan Blankenship: investigation, data curation Mark S. George: conceptualization, methodology, writing-review & editing, funding acquisition, project administration, supervision Paul Sajda: conceptualization, methodology, writing-original draft, writing-review & editing, funding acquisition, project administration, supervision Robin Goldman: conceptualization, methodology, writing-review & editing, funding acquisition, project administration, supervision Jayce Doose: conceptualization, investigation, data curation, writing-original draft, writing-review & editing Xiaoxiao Sun: methodology, formal analysis, writing-original draft, writing-review & editing, Visualization James Mclntosh: conceptualization, methodology, software, data curation, writing-review & editing contributed equally Yida Lin: software Truman R. Brown: conceptualization, methodology, writing-review & editing, funding acquisition, project administration, supervision Sarah Huffman: investigation |
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| Snippet | Transcranial magnetic stimulation (TMS) is a non-invasive neuromodulation modality that can treat depression, obsessive-compulsive disorder, or help smoking... Background: Transcranial magnetic stimulation (TMS) is a non-invasive neuromodulation modality that can treat depression, obsessive-compulsive disorder, or... |
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| SubjectTerms | Adult Alpha Rhythm Brain Closed-loop neurostimulation Depressive Disorder, Major - therapy Electroencephalography (EEG) Humans Inter-trial phase coherence (ITPC) Major depressive disorder (MDD) Prefrontal Cortex - physiology Repetitive transcranial magnetic stimulation (rTMS) Transcranial Magnetic Stimulation - adverse effects Treatment Outcome |
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| Title | Daily prefrontal closed-loop repetitive transcranial magnetic stimulation (rTMS) produces progressive EEG quasi-alpha phase entrainment in depressed adults |
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