Clinical review: The therapeutic use of theta-burst stimulation in mental disorders and tinnitus

Schwippel, Tobias; Schroeder, Philipp A.; Fallgatter, Andreas J.; Plewnia, Christian

doi:10.1016/j.pnpbp.2019.01.014

Cited by 40 publications

(23 citation statements)

References 85 publications

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“…Theta burst stimulation (TBS), a modified delivery of rTMS, mimics endogenous theta rhythms and could improve induction of synaptic long-term potentiation (Huang et al, 2005). Intermittent TBS (iTBS), which delivers TBS pulses for 2 s every 10 s (Huang et al, 2005), can facilitate cortical excitability and has a comparable performance to conventional rTMS in the treatment for depression (Blumberger et al, 2018), but with shorter stimulation duration (3 min) and lower total TMS pulses and intensity (Huang et al, 2005;Schwippel et al, 2019).…”

mentioning

confidence: 99%

Intermittent theta burst stimulation over the posterior superior temporal sulcus for children with autism spectrum disorder: A 4-week randomized blinded controlled trial followed by another 4-week open-label intervention

Chen

Chao

et al. 2021

Autism

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The posterior superior temporal sulcus is a potential therapeutic target of brain stimulation for autism spectrum disorder. We conducted a 4-week randomized, single-blind parallel sham-controlled trial, followed by additional 4-week open-label intervention to evaluate the feasibility and efficacy regarding intermittent theta burst stimulation over the bilateral posterior superior temporal sulcus in autism spectrum disorder. In total, 78 intellectually able children and adolescents were randomized to the active ( n = 40) and sham groups ( n = 38). During the first 4 weeks, the active group received two-session/week intermittent theta burst stimulation, whereas the sham group received the same number of sham stimulation. After unblinding, both groups received eight-session real stimulation over the additional 4 weeks. In total, 91% participants completed the protocol with mild and transitory side-effects. There was no significant group-by-time interaction for active versus sham group on clinical symptoms and social cognitive performances in the first 4 weeks. The within-group analysis revealed 8 weeks (including a 4-week blind trial and a 4-week open-label intervention) of intermittent theta burst stimulation achieved greater efficacy than 4-week interventions. Participants with higher intelligence, better social cognitive performances, alongside less attention-deficit hyperactivity disorder severity at baseline, were more likely to be responders. Our study demonstrated the feasibility of long-term intermittent theta burst stimulation over the posterior superior temporal sulcus in children and adolescents with autism spectrum disorder. However, the findings from the first 4-week blind trial do not support the therapeutic efficacy of intermittent theta burst stimulation over the posterior superior temporal sulcus on the clinical symptoms and cognitive performance of social impairment, given the current stimulation protocol. The exploratory analyses suggest that the therapeutic efficacy might be moderated by several individual characteristics and more intermittent theta burst stimulation sessions. Lay abstract Intermittent theta burst stimulation is a varied form of repetitive transcranial magnetic non-invasive brain stimulation technique used to treat several neurological and psychiatric disorders. Its feasibility and therapeutic effects on the bilateral posterior superior temporal sulcus in children with autism are unknown. We conducted a single-blind, sham-controlled parallel randomized clinical trial in a hitherto largest sample of intellectually able children with autism ( N = 78). Participants randomized to the active group received two-session/week intermittent theta burst stimulation for continuous 8 weeks. Those in the sham group received two-session/week sham stimulations in the first 4 weeks and then active intervention for the following 4 weeks after unblinding. First, we found that continuous 8-week intermittent theta burst stimulation on the bilateral posterior superior temporal sulcus in children with autism is safe and tolerable. Second, we found that 8-week intermittent theta burst stimulation produced greater therapeutic efficacy, although we did not find any significant effects of 4-week intermittent theta burst stimulation on core symptoms and social cognitive performances in autism. Further analysis revealed that participants with higher intelligence and better social cognitive performance, alongside less attention-deficit hyperactivity disorder severity at baseline, were more likely to be responders. This study identified that the factors contribute to responders and the results suggest that longer courses of non-invasive brain stimulation may be needed to produce therapeutic benefits in autism, with consideration of heterogeneous responses.

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mentioning

confidence: 99%

Intermittent theta burst stimulation over the posterior superior temporal sulcus for children with autism spectrum disorder: A 4-week randomized blinded controlled trial followed by another 4-week open-label intervention

Chen

Chao

et al. 2021

Autism

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“…TMS is a broad term that includes different types of stimulations, such as single pulse stimulation for motor threshold evaluation or therapeutic rTMS. iTBS is one type of rTMS protocol (Schwippel et al, 2019). As a comparison to a commonly used 10 Hz rTMS (G2), we applied two other protocols: iTBS over the left DLPFC (G3), and 1 Hz rTMS over the right DLPFC (G1).…”

Section: Tmsmentioning

confidence: 99%

“…LF rTMS consisted of 1 Hz stimulation in 2 trains, each lasting for 60 s, and spaced at 3-min intervals (120 impulses in total) (Klein et al, 1999). iTBS consisted of 2 s 50 Hz three-pulse bursts that were presented at 5 Hz frequency, applied in 20 trains and spaced at 8-s intervals (600 impulses in total) (Huang et al, 2011;Schwippel et al, 2019). The stimulation site was chosen by the psychiatrist according to the prevailing symptoms of depression.…”

Section: Tmsmentioning

confidence: 99%

Statistical Analysis of Graph-Theoretic Indices to Study EEG-TMS Connectivity in Patients With Depression

Olejarczyk

Jóźwik

Valiulis

et al. 2021

Front. Neuroinform.

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AimThe objective of this work was to demonstrate the usefulness of a novel statistical method to study the impact of transcranial magnetic stimulation (TMS) on brain connectivity in patients with depression using different stimulation protocols, i.e., 1 Hz repetitive TMS over the right dorsolateral prefrontal cortex (DLPFC) (protocol G1), 10 Hz repetitive TMS over the left DLPFC (G2), and intermittent theta burst stimulation (iTBS) consisting of three 50 Hz burst bundle repeated at 5 Hz frequency (G3).MethodsElectroencephalography (EEG) connectivity analysis was performed using Directed Transfer Function (DTF) and a set of 21 indices based on graph theory. The statistical analysis of graph-theoretic indices consisted of a combination of the k-NN rule, the leave-one-out method, and a statistical test using a 2 × 2 contingency table.ResultsOur new statistical approach allowed for selection of the best set of graph-based indices derived from DTF, and for differentiation between conditions (i.e., before and after TMS) and between TMS protocols. The effects of TMS was found to differ based on frequency band.ConclusionA set of four brain asymmetry measures were particularly useful to study protocol- and frequency-dependent effects of TMS on brain connectivity.SignificanceThe new approach would allow for better evaluation of the therapeutic effects of TMS and choice of the most appropriate stimulation protocol.

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“…A recent rTMS metaanalysis in the treatment of depressive episodes indicates that the technique yields statistically significant results improving 30% of patients receiving active excitatory rTMS compared to 10% of patients receiving sham treatment (analysis based in 29 randomized, double-blind, and controlled clinical trials) (32). Recently, a new form of rTMS, the theta-burst mode stimulation (TBS) was introduced and appears to produce at least similar effects on brain activity than standard rTMS (33)(34)(35)(36). In addition to greater efficacy, the reduced duration of administration may be another advantage of TBS compared to conventional rTMS procedure, standard TMS sessions last about 45 min, whereas TBS requires less than 10 min of stimulation (33,37).…”

Section: Introductionmentioning

confidence: 99%

“…Recently, a new form of rTMS, the theta-burst mode stimulation (TBS) was introduced and appears to produce at least similar effects on brain activity than standard rTMS (33)(34)(35)(36). In addition to greater efficacy, the reduced duration of administration may be another advantage of TBS compared to conventional rTMS procedure, standard TMS sessions last about 45 min, whereas TBS requires less than 10 min of stimulation (33,37). There are two types of TBS stimulation: intermittent (iTBS) and continuous (cTBS), with facilitating and inhibitory effects, respectively (36).…”

Section: Introductionmentioning

confidence: 99%

Efficacy, Safety, and Tolerability of Theta-Burst Stimulation in Mixed Depression: Design, Rationale, and Objectives of a Randomized, Double-Blinded, Sham-Controlled Trial

et al. 2020

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Introduction: Mixed-specifier mood disorders are probably a different subgroup in terms of response to treatment, socio-demographic parameters, course, and family history.Here we describe the rationale and design of a clinical trial aimed to test the efficacy, safety, and tolerability of a non-pharmacological treatment known as theta-burst stimulation (TBS) for treating the mixed depressive episodes of both bipolar (I or II), and unipolar depression. Methods:The study is designed as a randomized, sham-controlled, double-blinded clinical trial evaluating TBS for the treatment of moderate or severe major depressive episodes with mixed features of patients receiving at least one first or second-line pharmacological treatment for depressive episodes without adequate response. Ninety adult (18 to 65 years old) patients will be enrolled and submitted to 6-week (comprising 5 consecutive days a week sessions for the first 3 weeks and then 2 days a week for a further 3 week) of inhibitory followed by excitatory TBS in dorsolateral prefrontal cortex. Participants will be assessed using clinical and neuropsychological tests before and after the intervention. The primary outcome is change in Montgomery-Åsberg Depression Scale (MADRS) score over time and across groups. Cognitive parameters will also be assessed with neuropsychological tests. Results:The clinical results will provide evidence about TBS as an adjunctive treatment for mixed depression treatment and neuropsychological parameters will contribute toward an improved understanding the effects of TBS in cognition. Conclusion:Our results could introduce a novel therapeutic technique for mixed depressive episodes of both bipolar and unipolar disorders.

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Clinical review: The therapeutic use of theta-burst stimulation in mental disorders and tinnitus

Cited by 40 publications

References 85 publications

Intermittent theta burst stimulation over the posterior superior temporal sulcus for children with autism spectrum disorder: A 4-week randomized blinded controlled trial followed by another 4-week open-label intervention

Intermittent theta burst stimulation over the posterior superior temporal sulcus for children with autism spectrum disorder: A 4-week randomized blinded controlled trial followed by another 4-week open-label intervention

Statistical Analysis of Graph-Theoretic Indices to Study EEG-TMS Connectivity in Patients With Depression

Efficacy, Safety, and Tolerability of Theta-Burst Stimulation in Mixed Depression: Design, Rationale, and Objectives of a Randomized, Double-Blinded, Sham-Controlled Trial

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