Individualized connectome-targeted transcranial magnetic stimulation for neuropsychiatric sequelae of repetitive traumatic brain injury in a retired NFL player

Abstract

The recent advent of individualized resting-state network mapping (RSNM) has revealed substantial inter-individual variability in anatomical localization of brain networks identified using resting-state functional MRI (rsfMRI). Such variability may be particularly important after repetitive traumatic brain injury (TBI), which is associated with treatment-resistant depression. RSNM enables personalized targeting of repetitive transcranial magnetic stimulation (rTMS), a focal brain stimulation technique that relieves depression when administered over dorsolateral prefrontal cortex.RSNM was used to identify left/right dorsolateral prefrontal rTMS targets with maximal difference between dorsal attention network and default mode network (DMN) correlations. These targets were spatially distinct from those identified by prior methods. The method was evaluated by administering twenty sessions of left-sided excitatory and right-sided inhibitory rTMS to a retired NFL defensive lineman with progressive treatment-resistant neuropsychiatric disturbances. Treatment led to improvement in Montgomery-Asberg Depression Rating Scale (72%), cognitive testing, and headache scales. In comparison with healthy individuals and subjects with TBI-associated depression, baseline rsfMRI revealed substantially elevated DMN connectivity with medial temporal lobe (MTL). Serial rsfMRI scans showed gradual improvement in MTL-DMN connectivity and stimulation site connectivity with subgenual anterior cingulate cortex. This highlights the possibility of individualized neuromodulation and biomarker-based monitoring for neuropsychiatric sequelae of repetitive TBI.

National Institutes of Health Toolbox Emotion Battery for English- and Spanish-speaking adults: normative data and factor-based summary scores

“…Additionally, the battery demonstrated sensitivity to improvement with treatment (transcranial magnet stimulation) in a recent case study of traumatic brain injury. 34 Nonetheless, given its novelty, continued work to support the sensitivity of the NIHTB-EB to mental health disease is needed. In addition, calculations for the current NIHTB-EB summary scores and norms have been programmed into a recent update of the NIHTB iPad app for use in ongoing and new studies.…”

Using Brain Imaging to Improve Spatial Targeting of Transcranial Magnetic Stimulation for Depression

“…Research efforts over the past 2 decades have aimed to improve the efficacy and consistency of treatment effects across individuals. While optimal stimulation parameters and dosing are important, one major source of interindividual heterogeneity in treatment outcomes arises from variation in the stimulated site across the spatial extent of the DLPFC (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17).…”

“…Many have suggested that rTMS might be improved by personalizing the stimulation site based on individual differences in connectivity (5,6,9,11,12,16,(92)(93)(94)(95)(96). Recent work demonstrates that SGC FC shows considerable interindividual variation across the spatial extent of the DLPFC (5,92,96).…”

Chronic traumatic encephalopathy—a blueprint for the bridge between neurological and psychiatric disorders

“…For example, many reports describe an increase in depressive-like behavior in models of TBI, in good accordance with the clinical studies. The most convincing hallmark of those reports is the concurrence of the depressive-like phenotype, which is recognized despite the fact that these studies are being handled in different institutes using a wide range of parameters, such as age, animal species, injury models, severity of injury and time post-injury 100,101,[114][115][116][117][118][119] . Therefore, these findings suggest that depression is a robust consequence of TBI.…”