Does rTMS Alter Neurocognitive Functioning in Patients with Panic Disorder/Agoraphobia? An fNIRS-Based Investigation of Prefrontal Activation during a Cognitive Task and Its Modulation via Sham-Controlled rTMS

Deppermann, Saskia; Vennewald, Nadja; Diemer, Julia; Sickinger, Stephanie; Haeußinger, Florian B.; Notzon, Swantje; Laeger, Inga; Arolt, Volker; Ehlis, Ann‐Christine; Zwanzger, Peter; Fallgatter, Andreas J.

doi:10.1155/2014/542526

Cited by 32 publications

(49 citation statements)

References 56 publications

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“…In the end, both active and sham rTMS groups showed substantial improvement of PD symptoms, without significant difference between groups. There were no improvements in prefrontal hypoactivity or verbal fluency following iTBS (Deppermann et al, ).…”

Section: Resultsmentioning

confidence: 98%

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Transcranial magnetic stimulation in anxiety and trauma‐related disorders: A systematic review and meta‐analysis

et al. 2019

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Background Transcranial magnetic stimulation (TMS) has been evaluated as an effective treatment option for patients with major depressive disorder. However, there are limited studies that have evaluated the efficacy of TMS for other neuropsychiatric disorders such as anxiety and trauma‐related disorders. We reviewed the literature that has evaluated TMS as a treatment for anxiety and trauma‐related disorders. Methods We searched for articles published up to December 2017 in Embase, Medline, and ISI Web of Science databases, following the Preferred Items for Reporting of Systematic Reviews and Meta‐Analyses (PRISMA) statement. Articles ( n = 520) evaluating TMS in anxiety and trauma‐related disorders were screened and a small subset of these that met the eligibility criteria ( n = 17) were included in the systematic review, of which nine evaluated TMS in posttraumatic stress disorder (PTSD), four in generalized anxiety disorder (GAD), two in specific phobia (SP), and two in panic disorder (PD). The meta‐analysis was performed with PTSD and GAD since PD and SP had an insufficient number of studies and sample sizes. Results Among anxiety and trauma‐related disorders, TMS has been most widely studied as a treatment for PTSD. TMS demonstrated large overall treatment effect for both PTSD (ES = −0.88, 95% CI: −1.42, −0.34) and GAD (ES = −2.06, 95% CI: −2.64, −1.48), including applying high frequency over the right dorsolateral prefrontal cortex. Since few studies have evaluated TMS for SP and PD, few conclusions can be drawn. Conclusions Our meta‐analysis suggests that TMS may be an effective treatment for GAD and PTSD.

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Section: Resultsmentioning

confidence: 98%

“…Two double-blind, randomized, sham-controlled trials evaluated the efficacy of rTMS or iTBS, respectively, as a treatment of PD(Deppermann et al, 2014;Mantovani, Aly, Dagan, Allart, & Lisanby, 2013). One study evaluated the treatment of comorbid PD and MDD with rTMS(Mantovani et al, 2013).…”

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confidence: 99%

Transcranial magnetic stimulation in anxiety and trauma‐related disorders: A systematic review and meta‐analysis

et al. 2019

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“…Inclusion criteria, implementation of fNIRS and iTBS application were identical to the procedures described in Deppermann et al (2014) but, for more clarity, will be delineated again in the following sections.…”

Section: Methodsmentioning

confidence: 99%

“…Do to so, we applied a cognitive task as well as an emotional task. Whereas the results of the cognitive task and the corresponding clinical data collected during the first three weeks of iTBS treatment have been published in Deppermann et al (2014) , this manuscript focuses on the results of the emotional paradigm (Emotional Stroop task) and the clinical data which was collected over the whole time course of CBT. More specifically, the following hypotheses were tested: (1) PD/agoraphobia patients are characterised by prefrontal hypoactivation, as assessed by fNIRS, during a task that requires emotion regulation and cognitive control (Emotional Stroop task) compared to controls.…”

Section: Introductionmentioning

confidence: 99%

Neurobiological and clinical effects of fNIRS-controlled rTMS in patients with panic disorder/agoraphobia during cognitive-behavioural therapy

Deppermann

Vennewald²,

Diemer³

et al. 2017

NeuroImage: Clinical

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BackgroundA relevant proportion of patients with panic disorder (PD) does not improve even though they receive state of the art treatment for anxiety disorders such as cognitive-behavioural therapy (CBT). At the same time, it is known, that from a neurobiological point of view, PD patients are often characterised by prefrontal hypoactivation. Intermittent Theta Burst Stimulation (iTBS) is a non-invasive type of neurostimulation which can modulate cortical activity and thus has the potential to normalise prefrontal hypoactivity found in PD. We therefore aimed at investigating the effects of iTBS as an innovative add-on to CBT in the treatment for PD.MethodsIn this double-blind, bicentric study, 44 PD patients, randomised to sham or verum stimulation, received 15 sessions of iTBS over the left prefrontal cortex (PFC) in addition to 9 weeks of group CBT. Cortical activity during a cognitive as well as an emotional (Emotional Stroop) paradigm was assessed both at baseline and post-iTBS treatment using functional near-infrared spectroscopy (fNIRS) and compared to healthy controls.ResultsIn this manuscript we only report the results of the emotional paradigm; for the results of the cognitive paradigm please refer to Deppermann et al. (2014).During the Emotional Stroop test, PD patients showed significantly reduced activation to panic-related compared to neutral stimuli for the left PFC at baseline. Bilateral prefrontal activation for panic-related stimuli significantly increased after verum iTBS only. Clinical ratings significantly improved during CBT and remained stable at follow-up. However, no clinical differences between the verum- and sham-stimulated group were identified, except for a more stable reduction of agoraphobic avoidance during follow-up in the verum iTBS group.LimitationsLimitations include insufficient blinding, the missing control for possible state-dependent iTBS effects, and the timing of iTBS application during CBT.ConclusionPrefrontal hypoactivity in PD patients was normalised by add-on iTBS. Clinical improvement of anxiety symptoms was not affected by iTBS.

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“…Two studies were conducted using repetitive transcranial magnetic stimulation (rTMS) along with cognitive and additional emotional Stroop tasks, and the results associated with PFC activations/deactivations were compared with those of healthy persons. 155,156 At the baseline (without rTMS), the fNIRS measurements associated with the VFT revealed hypofrontality in the dorsolateral PFC, in panic disorder patients, which signi¯cantly di®ered from the activations observed in healthy persons. However, after sham rTMS, a signi¯cant increase in activation was reported in the left inferior frontal gyrus.…”

Section: Verbal°uency Taskmentioning

confidence: 96%

Application of functional near-infrared spectroscopy in the healthcare industry: A review

Hong

Yaqub

2019

J. Innov. Opt. Health Sci.

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Functional near-infrared spectroscopy (fNIRS), a growing neuroimaging modality, has been utilized over the past few decades to understand the neuronal behavior in the brain. The technique has been used to assess the brain hemodynamics of impaired cohorts as well as able-bodied. Neuroimaging is a critical technique for patients with impaired cognitive or motor behaviors. The portable nature of the fNIRS system is suitable for frequent monitoring of the patients who exhibit impaired brain activity. This study comprehensively reviews brain-impaired patients: The studies involving patient populations and the diseases discussed in more than 10 works are included. Eleven diseases examined in this paper include autism spectrum disorder, attention-deficit hyperactivity disorder, epilepsy, depressive disorders, anxiety and panic disorder, schizophrenia, mild cognitive impairment, Alzheimer’s disease, Parkinson’s disease, stroke, and traumatic brain injury. For each disease, the tasks used for examination, fNIRS variables, and significant findings on the impairment are discussed. The channel configurations and the regions of interest are also outlined. Detecting the occurrence of symptoms at an earlier stage is vital for better rehabilitation and faster recovery. This paper illustrates the usability of fNIRS for early detection of impairment and the usefulness in monitoring the rehabilitation process. Finally, the limitations of the current fNIRS systems (i.e., nonexistence of a standard method and the lack of well-established features for classification) and future research directions are discussed. The authors hope that the findings in this paper would lead to advanced breakthrough discoveries in the fNIRS field in the future.

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Does rTMS Alter Neurocognitive Functioning in Patients with Panic Disorder/Agoraphobia? An fNIRS-Based Investigation of Prefrontal Activation during a Cognitive Task and Its Modulation via Sham-Controlled rTMS

Cited by 32 publications

References 56 publications

Transcranial magnetic stimulation in anxiety and trauma‐related disorders: A systematic review and meta‐analysis

Transcranial magnetic stimulation in anxiety and trauma‐related disorders: A systematic review and meta‐analysis

Neurobiological and clinical effects of fNIRS-controlled rTMS in patients with panic disorder/agoraphobia during cognitive-behavioural therapy

Application of functional near-infrared spectroscopy in the healthcare industry: A review

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