The Effect of sequential bilateral low‐frequency rTMS over dorsolateral prefrontal cortex on serum level of BDNF and GABA in patients with primary insomnia

Abstract

Objective This study aimed to investigate the effect of sequential bilateral low‐frequency repetitive transcranial magnetic stimulation (rTMS) over dorsolateral prefrontal cortex (DLPFC) on patients with primary insomnia (PI). Methods A total of 32 eligible right‐handed participants diagnosed by PI according to International classification of sleep disorders (ICD‐3) were recruited into this study. Participants received 10 daily sessions of sequential bilateral 1 Hz rTMS over DLPFC. Before and after the whole procedure of rTMS, patients were assessed by Pittsburgh Sleep Quality Index (PSQI) for the severity of sleep disturbance. Meanwhile, serum concentration of brain‐derived neurotrophic factor (BDNF) and gamma‐aminobutyric acid (GABA) in patients was measured by ELISA and UPLC, respectively. Moreover, the amplitude of MEPs reflecting the right cortical excitability was examined. Finally, Pearson correlation analysis was performed to evaluate the correlation among the change of these variables. Results After rTMS treatment, the PSQI score was markedly decreased as compared to pre‐rTMS; the concentrations of serum BDNF and GABA were significantly higher; the amplitude of MEPs was markedly reduced. Pearson correlation analysis revealed that the change of PSQI score was negatively associated with the alteration of serum BDNF level and serum GABA level, and positively associated with the change of MEPs amplitude; the change of MEPs amplitude was negatively associated with fold change in the serum BDNF level and the serum GABA level; the increase in serum GABA level was positively associated with the serum BDNF level. Conclusions A sequential bilateral low‐frequency rTMS over DLPFC significantly improves primary insomnia probably by increasing the level of BDNF and GABA in the brain and reducing cortical excitability.

Transcranial magnetic stimulation therapeutic applications on sleep and insomnia: a review

“…In one study of patients with primary insomnia (Feng et al 2019), γ-aminobutyric acid (GABA) neurotransmitter levels and brain-derived neurotrophic factor (BDNF) levels in blood serum were measured as objective indicators of sleep with higher levels associated to better sleep regulation (Datta et al 2015;Gottesman 2002). Motorevoked potentials (MEP) were also measured to reflect cortical excitability.…”

“…rTMS can be used as a mapping tool to study neuronal networks for pre-surgical planning, diagnostic purposes (Valero-cabré et al 2017), and to examine brain cortex functionalities (Valero-cabré et al 2017;Nardone et al 2013). In addition, it has recently been explored in neurology and psychiatry communities to determine its therapeutic potential for different sleep pathologies such as insomnia (Feng et al 2019), sleep bruxism (Zhou et al 2016), and restless legs syndrome (Lin et al 2015). To date, the exact mechanism by which rTMS is thought to influence sleep has yet to be fully explained.…”

Effect of low frequency repetitive magnetic stimulation at Shenmen (HT7) on sleep quality in patients with chronic insomnia

“…[ 31 ] Hence, aim to improve subjects compliance and achieve acupoint effect, we choose rMS at HT7 acupoint in the experimental group in a high-quality randomized controlled trial. Although studies have showed the efficacy of rTMS for CI, [ 32 , 33 ] it is still lack rMS at acupoint randomized controlled trial, as well as the relevant mechanism research.…”

Effects of repetitive transcranial magnetic stimulation on children with low‐function autism

“…A large number of studies within the medical literature attest to a correlation between the activity of parvalbumin cells, gamma oscillations, and social deficits. Modulation of gamma oscillations, especially over the dorsolateral prefrontal cortex DLPFC), has been associated with improvements in cognitive performance …”