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Y Intensive Course in TMS P October 2016 O C T Translational - PowerPoint PPT Presentation

Feb 23, 2023 •159 likes •753 views

Y Intensive Course in TMS P October 2016 O C T Translational value of TMS studies O in healthy subjects N into clinical populations O D E Shirley Fecteau S A Canada Research Chair in Cognitive Neuroplasticity E Associate

  1. Y Intensive Course in TMS P October 2016 O C T Translational value of TMS studies O in healthy subjects N into clinical populations O D E Shirley Fecteau S A Canada Research Chair in Cognitive Neuroplasticity E Associate Professor, Medical School, Université Laval sfecteau@bidmc.harvard.edu L P

  2. Y Transcranial Magnetic Stimulation (TMS) and P transcranial Electric Current Stimulation (tES) over O the dorsolateral prefrontal cortex (DLPFC) can modulate behaviors in healthy subjects. C T O N O Impair Improve D ( virtual lesion ) ( neuroenhancement ) E S A E Can this be relevant Can this be a concern L P for my patients? for my patients?

  3. Y Plan P O 1. Noninvasive brain stimulation (NIBS) can modulate human C behaviours (e.g., decision-making) in healthy subjects. T O N 2. Translational clinical relevance of this: proof-of-concept O evidence supporting that NIBS might be a valuable adjunct in D the treatment of substance use disorders. E S A 3. NIBS can modulate other human behaviours (e.g., motor E learning, language): potential translational clinical relevance? L P

  4. Y TMS and tES over the DLPFC can modulate a vast variety of behaviours in healthy subjects: P O C - Risk-taking - Attention Mevorach et al. 2010 J Neurosci Knoch et al. 2006 J Neurosci, Science T Fecteau et al. 2007a J Neurosci O - Impulsivity - Self-control N Beeli et al. 2008a, b Behav Brain Funct Knoch et al. 2009 PNAS Cho et al., 2010 Brain Stimul Figner et al. 2010 Nat Neurosci O Hsu et al. 2011 Neuroimage D - Emotional processing - Planning D � Alfonso et al. 2000 Neurosci Lett Dockery et al. 2009 J Cogn Neurosci E Harmer et al. 2001 Nat Neurosci van Honk et al. 2002 Biol Psychiatry S van Rijn et al. 2005 Eur J Neurosci - Reward seeking A Fecteau et al. 2007b J Neurosci E L They are all involved in decision-making skills. P

  5. Decision-making appears to rely upon a distributed bi-hemispheric network Y including the DLPFC, the orbitofrontal cortex, the anterior cingulated cortex, P and the insula. O C Patients with PFC lesion Neuroimaging studies in healthy subjects T O N O D E One role of the DLPFC is to integrate cognitive and emotionally relevant S information during decision-making. A E Cognitive, Reflective, Emotional, Reflexive, L Deliberative System Automatic System P inhibitory control / executive functions reward processing / motivation Damasio et al. 1996; Bechara 2005; Ernst & Paulus 2005; Sanfey et al. 2003 ; Evans 2008

  6. Y P Examples of how TMS or tES when applied over the DLPFC can O modulate decision-making processes in healthy subjects. C T O N O D E S A E L P

  7. 1 Hz rTMS over the right (R) DLPFC can increase risk taking at the Risk Task Y in healthy subjects. P O C T O N O The Risk Task � D E S A E L P Knoch, Gianotti, Pascual-Leone, Treyer, Regard, Hohmann, Brugger (2006) Journal of Neuroscience

  8. Can we decrease risk taking at the Risk Task in healthy subjects? Y P O C T O N The Risk Task O D 1Hz rTMS over anodal tDCS over the the R DLPFC R DLPFC E S A E L increased risk-taking decrease risk-taking ? P

  9. tDCS (anodal over the R DLPFC coupled with cathodal over the left (L) Y DLPFC) can decrease risk taking and reward seeking at the Risk Task in P healthy subjects. O C T O N O The Risk Task � D E S A E L P Fecteau, Knoch, Fregni, Sultani, Boggio, Pascual-Leone (2007a) Journal of Neuroscience

  10. tDCS over the DLFPC can decrease risk taking at the BART task in healthy Y subjects. P O C T O N O D E bilateral R DLPFC S bilateral L DLPFC unilateral L DLPFC unilateral R DLPFC A sham E L P Fecteau, Pascual-Leone, Zald, Liguori, Theoret, Boggio, Fregni (2007b) Journal of Neuroscience

  11. cTBS over the R DLPFC can suppress impulsivity at the Delayed Discounting Y Task in healthy subjects. P O Would you prefer to receive: C $20 now $26 tomorrow T O N O D E S A E L P Cho, Pellecchia, Ko, Ray, Obeso, Houle, Strafella (2012) Brain Stimulation

  12. tACS targeting prefrontal theta activity can suppress impulsivity at the Delayed Y Discounting Task and augment theta oscillatory activity in healthy subjects. P Would you prefer to receive: O $20 now $26 tomorrow C T O N O D Mean theta power for electrode locations DDT E P4 P3 S A E L P Dickler, Wensing, Joyal, Thiffault, Timofeev, Fecteau ( SOBP meeting , 2015; submitted article)

  13. 1 Hz rTMS over the R DLPFC can modulate self-interest at the Ultimatum Y Game in healthy subjects. P The Ultimatum Game O The proposer has $10 and offers you $2 C If you accept : If you reject : The proposer gets $0 and you get $0 The proposer gets $8 and you get $2 T O 1Hz rTMS over the R DLPFC N Elicited activity in both DLPFCs when contrasting Accepted more often unfair offers O unfair > fair offers D E S A E L P Knoch et al. (2006) Science Baumgartner et al. (2011) Nature Neuroscience

  14. Y P Why is this relevant for patients? O C T O N O D E S A E L P

  15. Rational of using NIBS in substance use disorders to reduce craving and Y consumption. P O - Risky decision-making: a characteristic Integration of relevant information C behavioural phenotype of substance use disorders. T O Reflective System N inhibitory control - Craving: powerful driving force balancing Reflexive System decisions toward maladaptive choices. reward processing O D E - Craving levels positively correlate with activations in the DLPFC. S A E L P Goldstein & Volkow (2002) American Journal of Psychiatry Epstein, Bang, Botvin (2007) Addictive Behaviors Wilson, Sayette, Fiez (2004) Nature Neuroscience

  16. Patients with substance use disorders take greater risk at the Risk Task. Y P O C T O N O D E S A E L P Rogers, Everitt, Baldacchino, Blackshaw, Swainson, Wynne, Baker, Hunter, Carthy, Booker, London, Deakin, Sahakian, Robbins (1999) Neuropsychopharmacology

  17. Patients with tobacco use disorders take greater risk at the BART. Y P O C T O N O D E S A E L P Lejuez, Aklin, Jones, Richards, Strong, Kahler, Read (2003) Experimental and Clinical Psychopharmacology

  18. Patients with tobacco use disorders are more impulsive at the Delayed Y Discounting Task. P O Would you prefer to receive: C $20 now $26 tomorrow T O Smokers choose more often the smaller, immediate offer of money. N O D E S A E L P Mitchell & Wilson (2012) Psychopharmacology

  19. Patients with tobacco use disorders display greater self-interest at the Y Ultimatum Game when the reward is relevant . P O C The proposer has $10 and offers you $2 T Ultimatum Game If you accept : If you reject : O The proposer gets $8 and you get $2 The proposer gets $0 and you get $0 N Smokers (and nonsmokers) reject most of the time unfair offers of money. O D E S The proposer has 10 cigarettes and offers you 2 cigarettes A Ultimatum Game If you reject : If you accept : E The proposer gets 0 and you get 0 cigarette The proposer gets 8 and you get 2 cigarettes L P Smokers accept most of the time unfair offers of cigarette. Takahashi (2007) NeuroEndocrinology Letters

  20. Y P O NIBS over the DLPFC of healthy subjects can modulate decision-making behaviours. C T O N Impaired decision making processes seem to be linked to increased vulnerability for substance use disorders (behavioural phenotype). O D E S What happens when we apply NIBS over the DLPFC of individuals with A E substance use disorders? L P

  21. Proof-of concept data supporting that tDCS can reduce craving for: Y - Nicotine P O - Alcohol C - Food T - Marijuana O - Psychostimulant N O D E S A E L P Jansen, Daams, Koeter, Veltman, van den Brink, Goudriaan (2013) Neuroscience and Biobehavioral Reviews

  22. NIBS in patients with tobacco use disorders. Craving Use Y P 1 x 20Hz L DLPFC (Johann et al. 2003) O 1 x 20Hz L DLPFC (Eichhammer et al. 2003) C 10 x 10Hz L DLPFC (Amiaz et al. 2009) T 1 x 1Hz L SFG (Rose et al. 2011) rTMS O 1 x 10Hz SFG (Rose et al. 2011) N 1 x 10Hz L DLPFC (Li et al. 2013) 1 x 10Hz L DLPFC (Pripfl et al. 2013) O = 4 x 1Hz L DLPFC (Hayashi et al. 2013) D 13 x HF lateral PFC (Dinur-Klein et al. 2014) E = 10 x 1Hz R DLPFC (Trojak et al. 2015) S 1 x 2mA R/L DLPFC (Fregni et al. 2008) A E 5 x 2mA R/L DLPFC (Boggio et al. 2009) tDCS L 5 x 2mA R/L DLPFC (Fecteau et al. 2014) P = 1 x 2mA L DLPFC/ R supraorbital area (Xu et al. 2013) 1 x 1mA occipital / FPT (Meng et al. 2014) 1 x 1mA L DLPFC/ R supraorbital area (Faclone et al. 2015)

  23. tDCS over the DLPFC suppressed craving in nicotine smokers. Y P This was a 3-arm, crossover, sham controlled, blind at 3 levels (subjects, tDCS provider, outcome assessors) study with smokers who do not wish to quit smoking receiving 3 single tDCS sessions. O C 7 Sham L DLPFC T Smoking craving (VAS) * � R DLPFC O 6 * � N 5 O D 4 E S post-tDCS pre-tDCS pre-tDCS post-tDCS pre-cue exposure post-cue exposure pre-cue exposure post-cue exposure A E L P Visual analog scale (VAS) VAS VAS VAS Fregni, Liguori, Fecteau, Nitsche, Pascual-Leone, Boggio (2008) J Clin Psychiatry

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