307 results on '"Abraham Zangen"'
Search Results
2. Bilateral deep transcranial magnetic stimulation of motor and prefrontal cortices in Parkinson’s disease: a comprehensive review
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Colleen A. Hanlon, Daniel H. Lench, Gaby Pell, Yiftach Roth, Abraham Zangen, and Aron Tendler
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rTMS ,Deep TMS ,Parkinson’s disease ,prefrontal cortex ,neuromodulation ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
Parkinson’s disease (PD) is a prevalent neurodegenerative disorder characterized by both motor and non-motor symptoms, many of which are resistant to currently available treatments. Since the discovery that non-invasive transcranial magnetic stimulation (TMS) can cause dopamine release in PD patients, there has been growing interest in the use of TMS to fill existing gaps in the treatment continuum for PD. This review evaluates the safety and efficacy of a unique multifocal, bilateral Deep TMS protocol, which has been evaluated as a tool to address motor and non-motor symptoms of PD. Six published clinical trials have delivered a two-stage TMS protocol with an H-Coil targeting both the prefrontal cortex (PFC) and motor cortex (M1) bilaterally (220 PD patients in total; 108 from two randomized, sham-controlled studies; 112 from open label or registry studies). In all studies TMS was delivered to M1 bilaterally (Stage 1) and then to the PFC bilaterally (Stage 2) with approximately 900 pulses per stage. For Stage 1 (M1), two studies delivered 10 Hz at 90% motor threshold (MT) while four studies delivered 1 Hz at 110% MT. For Stage 2 (PFC), all studies delivered 10 Hz at 100% MT. The results suggest that this two-stage Deep TMS protocol is a safe, moderately effective treatment for motor symptoms of PD, and that severely impaired patients have the highest benefits. Deep TMS also improves mood symptoms and cognitive function in these patients. Further research is needed to establish optimal dosing and the long-term durability of treatment effects.
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- 2024
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3. Efficacy of insula deep repetitive transcranial magnetic stimulation combined with varenicline for smoking cessation: A randomized, double-blind, sham controlled trial
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Christine Ibrahim, Victor M. Tang, Daniel M. Blumberger, Saima Malik, Rachel F. Tyndale, Alisson P. Trevizol, Mera S. Barr, Zafiris J. Daskalakis, Abraham Zangen, and Bernard Le Foll
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Deep transcranial magnetic stimulation ,Insula ,Varenicline ,Smoking cessation ,Tobacco use disorder ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
Background: Current smoking cessation treatments are limited in terms of efficacy, particularly with regards to long term abstinence. There is a large amount of evidence implicating the insula in nicotine addiction. Objective: To examine the efficacy of bilateral repetitive transcranial magnetic stimulation (rTMS) directed to the insular cortex with the H11 coil, relative to sham stimulation, on smoking abstinence and smoking outcomes in smokers who are receiving standard varenicline treatment. Methods: This randomized, double-blind, sham controlled trial recruited 42 participants who were randomized to receive either active (n = 24) or sham (n = 18) high frequency rTMS directed to the insula (4 weeks), while receiving varenicline treatment (12 weeks). The primary outcome was 7-day point prevalence abstinence at the end of 12 weeks. Results: Smokers in the active group had significantly higher abstinence rates than those in the sham group (82.4% vs. 30.7%, p = 0.013) at the end of treatment (Week 12). Secondary outcome measures of abstinence rate at the end of rTMS treatment (Week 4), abstinence rate at 6 months, and smoking outcomes (e.g., craving, withdrawal) showed no significant differences between groups. No differences were found in adverse events reported between the groups. Conclusion: This study provides evidence of the potential benefit of having a combined treatment for smoking cessation using insula rTMS with the H11 coil and varenicline. Maintenance rTMS sessions and continuation of varenicline for those in abstinence may induce longer-term effects and should be considered in future studies.
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- 2023
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4. Deep magnetic stimulation targeting the medial prefrontal and anterior cingulate cortices for methamphetamine use disorder: a randomised, double-blind, sham-controlled study
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Yi Zhang, Di Zhao, Ti-Fei Yuan, Ningning Zeng, Hang-Bin Zhang, Jiatong Shan, Huichun Luo, and Abraham Zangen
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Psychiatry ,RC435-571 - Published
- 2023
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5. Trajectories of Response to deep TMS in Major Depression: Results from a Multicenter Randomized Controlled Trial
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Stephan Goerigk, Yiftach Roth, Aron Tendler, Lucia Bulubas, Gerrit Burkhardt, Abraham Zangen, and Frank Padberg
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Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Published
- 2023
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6. XV. brain stimulation therapeutics
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Xingbao Li, Mark S George, and Abraham Zangen
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Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
This chapter covers how repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS) presently affects smoking cessation. 14 human studies have examined the efficacy of rTMS on cue craving, cigarette consumption, or smoking cessation using a variety of different coils, locations, and treatment parameters. These studies included 7 randomized-controlled trials (RCT) and 7 experimental studies. Most studies (12/14) reported that rTMS reduced cue-induced craving, 5 showed that it decreased cigarette consumption, and 3/4 reported that multiple sessions of rTMS increased the quit rate. In contrast to rTMS, tDCS has 6 RCT studies, of which only 2 studies reported that tDCS reduced craving, and only 1 reported that it reduced cigarette consumption. Three studies failed to find an effect of tDCS on cravings. No tDCS studies reported changing quitting rates in people who smoke. Despite the early positive results of tDCS on nicotine dependence symptoms, 2 larger RCTs recently failed to find a therapeutic effect of tDCS for smoking cessation. In conclusion, rTMS studies demonstrate that multiple sessions help quit smoking, and it has gained FDA approval for that purpose. However, more studies are needed to examine the effect of tDCS with different treatment parameters.
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- 2023
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7. Pursuing personalized medicine for depression by targeting the lateral or medial prefrontal cortex with Deep TMS
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Abraham Zangen, Samuel Zibman, Aron Tendler, Noam Barnea-Ygael, Uri Alyagon, Daniel M. Blumberger, Geoffrey Grammer, Hadar Shalev, Tatiana Gulevski, Tanya Vapnik, Alexander Bystritsky, Igor Filipčić, David Feifel, Ahava Stein, Frederic Deutsch, Yiftach Roth, and Mark S. George
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Clinical trials ,Neuroscience ,Medicine - Abstract
BACKGROUND Major depressive disorder (MDD) can benefit from novel interventions and personalization. Deep transcranial magnetic stimulation (Deep TMS) targeting the lateral prefrontal cortex (LPFC) using the H1 coil was FDA cleared for treatment of MDD. However, recent preliminary data indicate that targeting the medial prefrontal cortex (MPFC) using the H7 coil might induce outcomes that are as good or even better. Here, we explored whether Deep TMS targeting the MPFC is noninferior to targeting the LPFC and whether electrophysiological or clinical markers for patient selection can be identified.METHODS The present prospective, multicenter, randomized study enrolled 169 patients with MDD for whom antidepressants failed in the current episode. Patients were randomized to receive 24 Deep TMS sessions over 6 weeks, using either the H1 coil or the H7 coil. The primary efficacy endpoint was the change from baseline to week 6 in Hamilton Depression Rating Scale scores.RESULTS Clinical efficacy and safety profiles were similar and not significantly different between groups, with response rates of 60.9% for the H1 coil and 64.2% for the H7 coil. Moreover, brain activity measured by EEG during the first treatment session correlated with clinical outcomes in a coil-specific manner, and a cluster of baseline clinical symptoms was found to potentially distinguish between patients who can benefit from each Deep TMS target.CONCLUSION This study provides a treatment option for MDD, using the H7 coil, and initial guidance to differentiate between patients likely to respond to LPFC versus MPFC stimulation targets, which require further validation studies.TRIAL REGISTRATION ClinicalTrials.gov NCT03012724.FUNDING BrainsWay Ltd.
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- 2023
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8. Abnormal functional asymmetry and its behavioural correlates in adults with ADHD: A TMS-EEG study.
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Amir Avnit, Samuel Zibman, Uri Alyagon, and Abraham Zangen
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Medicine ,Science - Abstract
ObjectivesAbnormal functional brain asymmetry and deficient response inhibition are two core symptoms of attention deficit hyperactivity disorder (ADHD). We investigated whether these symptoms are inter-related and whether they are underlined by altered frontal excitability and by compromised interhemispheric connectivity.MethodsWe studied these issues in 52 ADHD and 43 non-clinical adults by comparing: (1) stop-signal reaction time (SSRT); (2) frontal asymmetry of the N200 event-related potential component, which is evoked during response inhibition and is lateralised to the right hemisphere; (3) TMS-evoked potential (TEP) in the right frontal hemisphere, which is indicative of local cortical excitability; and (4) frontal right-to-left interhemispheric TMS signal propagation (ISP), which is reversely indicative of interhemispheric connectivity.ResultsCompared to controls, the ADHD group demonstrated elongated SSRT, reduced N200 right-frontal-asymmetry, weaker TEP, and stronger ISP. Moreover, in the ADHD group, N200 right-frontal-asymmetry correlated with SSRT, with TEP, and with symptoms severity. Conversely, no relationship was observed between ISP and N200 right-frontal-asymmetry, and both TEP and ISP were found to be unrelated to SSRT.ConclusionsOur results indicate that abnormal frontal asymmetry is related to a key cognitive symptom in ADHD and suggest that it is underlined by reduced right-frontal excitability.
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- 2023
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9. Cortico-cortical frontal paired associative stimulation for modulation of interhemispheric activity
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Uri Alyagon, Yasmin Abergel, Ron Mayer, Iuly Treger, and Abraham Zangen
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Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Published
- 2023
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10. A general within-treatment EEG biomarker for rTMS outcome
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Uri Alyagon and Abraham Zangen
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Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Published
- 2022
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11. Effectiveness of high frequency rTMS stimulation with the H7 coil over the mPFC versus with the H1 coil over the dlPFC in patients with MDD: A multicenter randomized controlled non-inferiority trial
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Aron Tendler, Samuel Zibman, Gaby Pell, Yiftach Roth, Abraham Zangen, Geoffrey Grammar, Daniel Blumberger, Igor Filipcic, Hader Shalev, Alexander Bystritsky, David Feifel, and Mark George
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Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Published
- 2022
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12. Deep TMS for major depression: Results from a large post-marketing data analysis
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Aron Tendler, Stephan Goerigk, Yiftach Roth, Samuel Zibman, Gaby S. Pell, Abraham Zangen, and Frank Padberg
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Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Published
- 2022
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13. Influence of inter-pulse interval on inter-hemispheric cortico-cortical frontal paired associative stimulation: Preliminary results
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Uri Alyagon, Yasmin Abergel, Ron Mayer, Iuly Treger, and Abraham Zangen
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Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Published
- 2022
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14. Electrical field measurements and simulations of the H7 and D-B80 coils: Non-equivalence of the TMS coils for obsessive compulsive disorder
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Marietta Tzirini, Yiftach Roth, Tal Harmelech, Samuel Zibman, Gaby S. Pell, Vasilios Kimiskidis, Aron Tendler, Abraham Zangen, and Theodoros Samaras
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Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Published
- 2021
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15. Preliminary Report of the Safety and Tolerability of 1 Hz Repetitive Transcranial Magnetic Stimulation in Temporal Lobe Epilepsy
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Roman Gersner PhD, Lindsay M. Oberman PhD, Maria J Sanchez MD, Nicolas Chiriboga MD, Harper L Kaye BA, Alvaro Pascual-Leone MD, PhD, Abraham Zangen PhD, and Alexander Rotenberg MD, PhD
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Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Background Low frequency (≤1 Hz) repetitive transcranial magnetic stimulation (rTMS) has been shown to suppress cortical excitability and is beginning to be trialed for the treatment of refractory epilepsy. Purpose As a step toward a larger trial, the current pilot study was aimed to test the tolerability and safety of temporal lobe rTMS using H-coil for the treatment of temporal lobe epilepsy (TLE). Research Design 1800 pulses of active or sham rTMS were applied 5 days a week for 2 weeks over the temporal lobe of the affected hemisphere. Results Nine participants were enrolled and randomized to verum or sham stimulation. One participant dropped out from the sham group after 5 rTMS sessions. In-session, 3 patients had typical seizures during sham stimulation. One patient had seizures also during active stimulation (albeit fewer than during sham). Minor reported adverse events during stimulation otherwise included transient neck pain and headache, and were reported in equal numbers in both groups. Major adverse events were not reported. Our results indicate that H-coil rTMS was well-tolerated. Conclusion Given the relatively high prevalence of individuals with TLE who are treatment-resistant and the preliminary results of this study, we suggest that a larger safety and efficacy trial of 1 Hz rTMS for the treatment of TLE is warranted.
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- 2022
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16. Revisiting the Rotational Field TMS Method for Neurostimulation
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Yiftach Roth, Samuel Zibman, Gaby S. Pell, Abraham Zangen, and Aron Tendler
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transcranial magnetic stimulation ,rotational field ,TMS 360° ,neurostimulation ,orientational sensitivity ,depolarization ,Medicine - Abstract
Transcranial magnetic stimulation (TMS) is a non-invasive technique that has shown high efficacy in the treatment of major depressive disorder (MDD) and is increasingly utilized for various neuropsychiatric disorders. However, conventional TMS is limited to activating only a small fraction of neurons that have components parallel to the induced electric field. This likely contributes to the significant variability observed in clinical outcomes. A novel method termed rotational field TMS (rfTMS or TMS 360°) enables the activation of a greater number of neurons by reducing the sensitivity to orientation. Recruitment of a larger number of neurons offers the potential to enhance efficacy and reduce variability in the treatment of clinical indications for which neuronal recruitment and organization may play a significant role, such as MDD and stroke. The potential of the method remains to be validated in clinical trials. Here, we revisit and describe in detail the rfTMS method, its principles, mode of operation, effects on the brain, and potential benefits for clinical TMS.
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- 2023
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17. Auditory Fine-Tuned Suppressor of TMS-Clicks (TMS-Click AFTS): A Novel, Perceptually Driven/Tuned Approach for the Reduction in AEP Artifacts in TMS-EEG Studies
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Konstantinos Pastiadis, Ioannis Vlachos, Evangelia Chatzikyriakou, Yiftach Roth, Samuel Zibman, Abraham Zangen, Dimitris Kugiumtzis, and Vasilios K. Kimiskidis
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TMS-EEG ,acoustic artifact ,AEP suppression ,Technology ,Engineering (General). Civil engineering (General) ,TA1-2040 ,Biology (General) ,QH301-705.5 ,Physics ,QC1-999 ,Chemistry ,QD1-999 - Abstract
TMS contaminates concurrent EEG recordings with Auditory Evoked Potentials (AEPs), which are caused by the perceived impulsive acoustic noise of the TMS coils. We hereby introduce a novel and perceptually motivated/tuned method for the suppression of auditory evoked EEG artifacts of rTMS under the name of “Auditory Fine-Tuned Suppressor of TMS-Clicks” (TMS-click AFTS). The proposed method is based on the deployment of a psychophysically-matched wide-band noise (WBN) masking stimulus, whose parametric synthesis and presentation are based upon adaptive psychophysical optimization. The masking stimulus is constructed individually for each patient/subject, thus facilitating aspects of precision medicine. A specially designed automation software is used for the realization of an adaptive procedure for optimal parameterization of masking noise level, optimizing both the subject’s comfort and the degree of AEP reduction. The proposed adaptive procedure also takes into account the combined effect of TMS intensity level and can as well account for any possibly available subject’s hearing acuity data. To assess the efficacy of the proposed method in reducing the acoustic effects of TMS, we performed TMS-EEG recordings with a 60 channel TMS-compatible EEG system in a cohort of healthy subjects (n = 10) and patients with epilepsy (n = 10) under four conditions (i.e., resting EEG with and without acoustic mask and sham TMS-EEG with and without acoustic mask at various stimulus intensity levels). The proposed approach shows promising results in terms of efficiency of AEP suppression and subject’s comfort and warrants further investigation in research and clinical settings.
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- 2023
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18. Cluster of baseline symptoms differentiates between responders to high frequency rTMS with the H7 coil over the mPFC versus with the H1 coil over the dlPFC in patients with MDD
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Samuel Zibman, Gaby Pell, Yiftach Roth, Abraham Zangen, and Aron Tendler
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Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Published
- 2022
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19. Detailed measurements and simulations of electric field distribution of two TMS coils cleared for obsessive compulsive disorder in the brain and in specific regions associated with OCD.
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Marietta Tzirini, Yiftach Roth, Tal Harmelech, Samuel Zibman, Gaby S Pell, Vasilios K Kimiskidis, Aron Tendler, Abraham Zangen, and Theodoros Samaras
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Medicine ,Science - Abstract
The FDA cleared deep transcranial magnetic stimulation (Deep TMS) with the H7 coil for obsessive-compulsive disorder (OCD) treatment, following a double-blinded placebo-controlled multicenter trial. Two years later the FDA cleared TMS with the D-B80 coil on the basis of substantial equivalence. In order to investigate the induced electric field characteristics of the two coils, these were placed at the treatment position for OCD over the prefrontal cortex of a head phantom, and the field distribution was measured. Additionally, numerical simulations were performed in eight Population Head Model repository models with two sets of conductivity values and three Virtual Population anatomical head models and their homogeneous versions. The H7 was found to induce significantly higher maximal electric fields (p
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- 2022
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20. Rotational field TMS: Comparison with conventional TMS based on motor evoked potentials and thresholds in the hand and leg motor cortices
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Yiftach Roth, Gaby S. Pell, Noam Barnea-Ygael, Moria Ankry, Yafit Hadad, Ami Eisen, Yuri Burnishev, Aron Tendler, Elisha Moses, and Abraham Zangen
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TMS ,Rotational field ,Unidirectional ,Motor cortex ,MEP ,Motor threshold ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
Background: Transcranial magnetic stimulation (TMS) is a rapidly expanding technology utilized in research and neuropsychiatric treatments. Yet, conventional TMS configurations affect primarily neurons that are aligned parallel to the induced electric field by a fixed coil, making the activation orientation-specific. A novel method termed rotational field TMS (rfTMS), where two orthogonal coils are operated with a 90° phase shift, produces rotation of the electric field vector over almost a complete cycle, and may stimulate larger portion of the neuronal population within a given brain area. Objective: To compare the physiological effects of rfTMS and conventional unidirectional TMS (udTMS) in the motor cortex. Methods: Hand and leg resting motor thresholds (rMT), and motor evoked potential (MEP) amplitudes and latencies (at 120% of rMT), were measured using a dual-coil array based on the H7-coil, in 8 healthy volunteers following stimulation at different orientations of either udTMS or rfTMS. Results: For both target areas rfTMS produced significantly lower rMTs and much higher MEPs than those induced by udTMS, for comparable induced electric field amplitude. Both hand and leg rMTs were orientation-dependent. Conclusions: rfTMS induces stronger physiologic effects in targeted brain regions at significantly lower intensities. Importantly, given the activation of a much larger population of neurons within a certain brain area, repeated application of rfTMS may induce different neuroplastic effects in neural networks, opening novel research and clinical opportunities.
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- 2020
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21. Theta burst deep TMS for the treatment of major depression
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Yiftach Roth, Aron Tendler, Gaby S. Pell, Samual Zibman, and Abraham Zangen
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Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Published
- 2021
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22. Electrical field measurements of the H7 coil and D-B80 Coil and the implications for patients with obsessive compulsive disorder
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Yiftach Roth, Aron Tendler, Tal Harmelech, Samual Zibman, and Abraham Zangen
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Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Published
- 2021
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23. The Relation between Induced Electric Field and TMS-Evoked Potentials: A Deep TMS-EEG Study
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Ioannis Vlachos, Marietta Tzirini, Evangelia Chatzikyriakou, Ioannis Markakis, Maria Anastasia Rouni, Theodoros Samaras, Yiftach Roth, Abraham Zangen, Alexander Rotenberg, Dimitris Kugiumtzis, and Vasilios K. Kimiskidis
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EEG-TMS ,E-field ,deep TMS ,Technology ,Engineering (General). Civil engineering (General) ,TA1-2040 ,Biology (General) ,QH301-705.5 ,Physics ,QC1-999 ,Chemistry ,QD1-999 - Abstract
Transcranial magnetic stimulation (TMS) in humans induces electric fields (E-fields, EF) that perturb and modulate the brain’s endogenous neuronal activity and result in the generation of TMS-evoked potentials (TEPs). The exact relation of the characteristics of the induced E-field and the intensity of the brains’ response, as measured by electroencephalography (EEG), is presently unclear. In this pilot study, conducted on three healthy subjects and two patients with generalized epilepsy (total: 3 males, 2 females, mean age of 26 years; healthy: 2 males, 1 female, mean age of 25.7 years; patients: 1 male, 1 female, mean age of 26.5 years), we investigated the temporal and spatial relations of the E-field, induced by single-pulse stimuli, and the brain’s response to TMS. Brain stimulation was performed with a deep TMS device (BrainsWay Ltd., Jerusalem, Israel) and an H7 coil placed over the central area. The induced EF was computed on personalized anatomical models of the subjects through magneto quasi-static simulations. We identified specific time instances and brain regions that exhibit high positive or negative associations of the E-field with brain activity. In addition, we identified significant correlations of the brain’s response intensity with the strength of the induced E-field and finally prove that TEPs are better correlated with E-field characteristics than with the stimulator’s output. These observations provide further insight in the relation between E-field and the ensuing cortical activation, validate in a clinically relevant manner the results of E-field modeling and reinforce the view that personalized approaches should be adopted in the field of non-invasive brain stimulation.
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- 2022
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24. Repetitive Transcranial Magnetic Stimulation With H-Coil in Alzheimer's Disease: A Double-Blind, Placebo-Controlled Pilot Study
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Letizia Leocani, Gloria Dalla Costa, Elisabetta Coppi, Roberto Santangelo, Marco Pisa, Laura Ferrari, Maria Paola Bernasconi, Monica Falautano, Abraham Zangen, Giuseppe Magnani, and Giancarlo Comi
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repetitive transcranial magnetic stimulation ,Alzheimer's disease ,ADAS-cog ,H-coil ,neuromodualtion ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Focal repetitive transcranial magnetic stimulation (rTMS) has been applied to improve cognition in Alzheimer's disease (AD) with conflicting results. We applied rTMS in AD in a pilot placebo-controlled study using the H2-coil. H-coils are suitable for targeting wider neuronal structures compared with standard focal coils, in particular the H2-coil stimulates simultaneously the frontal-parietal-temporal lobes bilaterally. Thirty patients (mean age 70.9 year, SD 8.1; mean MMSE score 16.9, SD 5.5) were randomized to sham or real 10 Hz rTMS stimulation with the H2-coil. Each patient underwent 3 sessions/week for 4 weeks, followed by 4 weeks with maintenance treatment (1 session/week). Primary outcome was improvement of ADAS-cog at 4 and 8 weeks compared with baseline. A trend toward an improved ADAS-cog score over time was observed for patients undergoing real rTMS, with actively treated patients experiencing a mean decrease of −1.01 points at the ADAS-Cog scale score per time point (95% CIs −0.02 to −3.13, p < 0.04). This trend was no longer evident 2 months after the end of treatment. Real rTMS showed no significant effect on MMSE and BDI changes over time. These preliminary findings suggest that rTMS with H-coil is feasible and safe in patients with probable AD and might provide beneficial, even though transient, effects on cognition. This study prompts larger studies in the early stages of AD, combining rTMS and cognitive rehabilitation.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT04562506.
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- 2021
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25. Bilateral Repetitive Transcranial Magnetic Stimulation With the H-Coil in Parkinson's Disease: A Randomized, Sham-Controlled Study
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Francesca Spagnolo, Mario Fichera, Raffaella Chieffo, Gloria Dalla Costa, Marco Pisa, Maria Antonietta Volonté, Monica Falautano, Abraham Zangen, Giancarlo Comi, and Letizia Leocani
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rTMS (repetitive transcranial magnetic stimulation) ,H-coil = hesed coil ,motor cortex ,movement disorder ,non-invasive brain stimulation (NIBS) ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Background: Pilot open-label application of high-frequency repetitive transcranial magnetic stimulation (rTMS) with H-coil in Parkinson's Disease (PD) have shown promising results.Objective: To evaluate safety and efficacy of high-frequency rTMS with H-coil in PD in a double-blind, placebo-controlled, randomized study.Methods: Sixty patients with PD were randomized into 3 groups: M1-PFC (real stimulation on primary motor-M1 and pre-frontal cortices-PFC), M1 (real rTMS on M1, sham on PFC), Sham (apparent stimulation). Primary outcome was baseline-normalized percent improvement in UPDRS part III OFF-therapy at the end of treatment (12 rTMS sessions, 4 weeks). Secondary outcomes were improvement in UPDRS part III sub-scores, timed tests, and neuropsychological tests. Statistical analysis compared improvement following real and sham stimulation at the end of the protocol using either a t-test or a Mann-Whitney test.Results: All patients tolerated the treatment and concluded the study. One patient from M1-PFC group was excluded from the analysis due to newly discovered uncontrolled diabetes mellitus. No serious adverse effect was recorded. At the end of treatment, patients receiving real rTMS (M1-PFC and M1 combined) showed significantly greater improvement compared to sham in UPDRS part III total score (p = 0.007), tremor subscore (p = 0.011), and lateralized sub-scores (p = 0.042 for the more affected side; p = 0.012 for the less affected side). No significant differences have been oserved in safety and efficacy outcomes between the two real rTMS groups. Notably, mild, not-distressing and transient dyskinesias occurred in 3 patients after real rTMS in OFF state.Conclusions: The present findings suggest that high-frequency rTMS with H-coil is a safe and potentially effective procedure and prompt larger studies for validation as add-on treatment in PD.
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- 2021
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26. A functional magnetic resonance imaging investigation of prefrontal cortex deep transcranial magnetic stimulation efficacy in adults with attention deficit/hyperactive disorder: A double blind, randomized clinical trial
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Maya Bleich-Cohen, Guy Gurevitch, Noa Carmi, Mordekhay Medvedovsky, Noa Bregman, Naomi Nevler, Karin Elman, Amit Ginou, Abraham Zangen, and Elissa L. Ash
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ADHD ,fMRI ,dTMS ,PFC ,Inattention ,Working-memory ,Computer applications to medicine. Medical informatics ,R858-859.7 ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
ADHD is one of the most prevalent neurocognitive disorders. Deep Transcranial Magnetic Stimulation (dTMS) is a non-invasive neuromodulation tool that holds promise in treatment of neurocognitive disorders. Hypoactivity of the prefrontal cortex (PFC) has been observed in ADHD. This study examined the clinical, cognitive, and neural effects of dTMS to the PFC in adults with ADHD by using functional magnetic resonance imaging (fMRI). High frequency repetitive dTMS was applied to either the right or left PFC in 62 adults with ADHD in a randomized, double blind, placebo controlled protocol with 3 study groups: 2 treatment arms (rPFC, or lPFC) and a Sham arm. The study included 15 dTMS/cognitive training treatment sessions. Clinical effects were assessed with the Conners Adult ADHD Rating Scale (CAARS) self-report and the Clinical Global Impression score (CGI) as primary outcome measures. Self-report/observer questionnaires and computerized cognitive testing were also performed to assess clinical and cognitive effects. Neural effects were assessed with fMRI using working-memory (WM) and resting-state paradigms. While the study did not show improvement in the primary endpoints, significant improvements were observed in the CAARS (self-report) inattention/memory sub-scale, as well as increased activations in the rDLPFC, right parietal-cortex and right insula/IFG during WM conditions after treatment in the right stimulation group. Increased rDLPFC activation was associated with larger symptom improvement in the right stimulation group. This study indicates that dTMS is effective in modulating attention related brain networks, and is a feasible technique that may improve attention symptoms in adults with ADHD.
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- 2021
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27. Deep TMS for the treatment of comorbid anxiety
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Gaby S. Pell, Sam Zibman, Yiftach Roth, Aron Tendler, and Abraham Zangen
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Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Published
- 2021
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28. Analysis of multi-center MDD trials indicates direct, polysymptomatic effect of rTMS on depression and anxiety with H1-coil and delayed, indirect effect on anxiety with figure-8 coil
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Samuel Zibman, Gaby Pell, Yiftach Roth, Stephan Goerigk, Frank Padberg, and Abraham Zangen
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Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Published
- 2021
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29. Real-world efficacy of deep TMS for obsessive-compulsive disorder: interim post-marketing analysis of 192 patients from twenty-two sites
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Geoffrey Grammer, Aron Tendler, Mehmet Kemal Arikan, Ryan Vidrine, David Kent, Owen Muir, Carlene MacMillan, Leah Casuto, William Sauve, Kellie Tolin, Steven A. Harvey, Misty Borst, Robert Rifkin, Manish Sheth, Brandon Cornejo, Raul Rodriguez, Saad Shakir, Taylor Porter, Deborah Kim, Brent Peterson, Julia Swofford, Brendan Roe, Rebecca Sinclair, Tal Harmelech, Abraham Zangen, and Yiftach Roth
- Subjects
Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Published
- 2020
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30. Deep TMS for major depression, interim post-marketing analysis of 1040 patients.
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Steven A. Harvey, Aron Tendler, Mark DeLuca, Jimmy Stehberg, Richard Naimark, David Schmidt, Owen Muir, Carlene McMillan, Saad Shakir, Todd Antin, Diana Ghelber, Walter Duffy, Natalie Lender, Michael Goodman, Moshe Isserles, Kenneth Melman, Juan Cabrera, Jr., Faisal A. Munasifi, David Jones, Jagdeep Kaur, Irkali Mania, Sabeen Faris, Zeeshan Faruqui, Shahid Insaf, Deborah Kim, Susan Rushing, Brent Nelson, Abraham Zangen, and Yiftach Roth
- Subjects
Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Published
- 2020
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31. Efficacy of Deep TMS with the H1 Coil for Anxious Depression
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Gaby S. Pell, Tal Harmelech, Sam Zibman, Yiftach Roth, Aron Tendler, and Abraham Zangen
- Subjects
depression ,anxiety ,comorbid anxiety ,anxious depression ,transcranial magnetic stimulation ,non-invasive brain stimulation ,Medicine - Abstract
(1) Background: While the therapeutic efficacy of Transcranial Magnetic Stimulation (TMS) for major depressive disorder (MDD) is well established, less is known about the technique’s efficacy for treating comorbid anxiety. (2) Methods: Data were retrospectively analyzed from randomized controlled trials (RCTs) that used Deep TMS with the H1 Coil for MDD treatment. The primary endpoint was the difference relative to sham treatment following 4 weeks of stimulation. The effect size was compared to literature values for superficial TMS and medication treatments. (3) Results: In the pivotal RCT, active Deep TMS compared with sham treatment showed significantly larger improvements in anxiety score (effect size = 0.34, p = 0.03 (FDR)) which were sustained until 16 weeks (effect size = 0.35, p = 0.04). The pooled effect size between all the RCTs was 0.55, which compares favorably to alternative treatments. A direct comparison to Figure-8 Coil treatment indicated that treatment with the H1 Coil was significantly more effective (p = 0.042). In contrast to previously reported studies using superficial TMS and medication for which anxiety has been shown to be a negative predictor of effectiveness, higher baseline anxiety was found to be predictive of successful outcome for the H1-Coil treatment. (4) Conclusions: Deep TMS is effective in treating comorbid anxiety in MDD and, unlike alternative treatments, the outcome does not appear to be adversely affected by high baseline anxiety levels.
- Published
- 2022
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32. Alleviation of ADHD symptoms by non-invasive right prefrontal stimulation is correlated with EEG activity
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Uri Alyagon, Hamutal Shahar, Aviad Hadar, Noam Barnea-Ygael, Avi Lazarovits, Hadar Shalev, and Abraham Zangen
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Repetitive transcranial magnetic stimulation ,Attention deficit hyperactivity disorder ,Electroencephalogram ,Biomarker ,Clinical-trial ,Computer applications to medicine. Medical informatics ,R858-859.7 ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Attention deficit hyperactivity disorder (ADHD) is a prevalent disorder with effective pharmacological treatment that benefits most patients. However, about one-third fail to benefit while others search non-pharmacological alternatives, and for those options are scarce. One alternative treatment option is to alter abnormal right prefrontal cortex (rPFC) activity, given that rPFC abnormality has been repeatedly implicated in ADHD neurophathology. Here, we evaluated whether targeting the rPFC with multiple sessions of repetitive transcranial magnetic stimulation (rTMS), which can modulate neuronal excitability, activity, and plasticity in a non-invasive manner, will affect clinical symptoms in adults suffering from ADHD. Concomitantly, we used EEG to characterize electrophysiological alterations induced by treatment and to search for correlation between baseline neuronal activity and clinical response.Forty-three drug free adults with ADHD were randomized to receive either Real, Active Control, or Sham treatment (13 females, age ranging 21-46; n = 15, 14, 14, respectively), and underwent three weeks of daily high-frequency (18 Hz) stimulation sessions. We found that Real treatment was safe and resulted in significant improvement of symptoms (η2p = 0.34; Cohen's d(against Sham) = 0.96; Cohen's d(against AC) = 0.68; p = 0.00085). Furthermore, based on EEG recorded within the first treatment session we established a novel biomarker, composed of the Alpha and Low-gamma power, which highly correlated the magnitude of the clinical outcome (r = 0.92, p = 0.0001).Taken together, the results of this pilot study indicate safety and effectiveness of rTMS directed to the rPFC for treatment of adult ADHD patients. The biomarker is suggested to reflect the responsiveness of the cortex to this rTMS intervention. Following validation of the results in larger samples, this study may represent a step towards a non-pharmacological treatment for adults with ADHD using EEG-based selection of optimal candidates for treatment.
- Published
- 2020
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33. A Method to Provoke Obsessive Compulsive Symptoms for Basic Research and Clinical Interventions
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Aron Tendler, Elyssa Sisko, Noam Barnea-Ygael, Abraham Zangen, and Eric A. Storch
- Subjects
deep repetitive transcranial magnetic stimulation ,obsessive compulsive disorder ,provocation ,cognitive paired associative stimulation ,exposure and response prevention ,Psychiatry ,RC435-571 - Abstract
The efficacy of deep repetitive transcranial magnetic stimulation (dTMS) for obsessive compulsive disorder (OCD) was recently confirmed in a Food and Drug Administration-regulated, multicenter, sham-controlled study. In this study, patients who failed pharmacotherapy underwent individually tailored provocations just prior to each stimulation session, in the attempt to activate the relevant circuitry and making it labile to change. The procedure that was developed reliably evoked moderate intensity symptoms, making it effective on the one hand and mild enough to allow the patient to continue with the dTMS session on the other. This methodology article describes in a detailed step wise fashion how to evaluate the patient’s specific symptoms and design the individualized provocations. Additionally, the article explains how to instruct relevant personnel to administer the provocations, gauge their efficacy, and overcome possible obstacles. This method, apart from its ongoing role in the clinical treatment of OCD by dTMS, may be used for provocation of symptoms in basic studies [e.g., imaging with Electroencephalogram (EEG) or Functional magnetic resonance imaging fMRI] as well as other treatments.
- Published
- 2019
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34. Do comorbid OCD-MDD patients need two separate dTMS protocols?
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Tal Harmelech, Aron Tendler, Yiftach Roth, and Abraham Zangen
- Subjects
Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Published
- 2020
- Full Text
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35. Comment on 'Transcranial magnetic stimulation of the medial prefrontal cortex for psychiatric disorders: a systematic review'
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Rodrigo C. Marques, Amaury Cantilino, and Abraham Zangen
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Psychiatry ,RC435-571 - Published
- 2020
- Full Text
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36. The Insula: A Brain Stimulation Target for the Treatment of Addiction
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Christine Ibrahim, Dafna S. Rubin-Kahana, Abhiram Pushparaj, Martin Musiol, Daniel M. Blumberger, Zafiris J. Daskalakis, Abraham Zangen, and Bernard Le Foll
- Subjects
insula ,addiction ,brain stimulation ,transcranial magnetic stimulation (TMS) ,transcranial direct current stimulation (tDCS) ,deep brain stimulation (DBS) ,Therapeutics. Pharmacology ,RM1-950 - Abstract
Substance use disorders (SUDs) are a growing public health concern with only a limited number of approved treatments. However, even approved treatments are subject to limited efficacy with high long-term relapse rates. Current treatment approaches are typically a combination of pharmacotherapies and behavioral counselling. Growing evidence and technological advances suggest the potential of brain stimulation techniques for the treatment of SUDs. There are three main brain stimulation techniques that are outlined in this review: transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and deep brain stimulation (DBS). The insula, a region of the cerebral cortex, is known to be involved in critical aspects underlying SUDs, such as interoception, decision making, anxiety, pain perception, cognition, mood, threat recognition, and conscious urges. This review focuses on both the preclinical and clinical evidence demonstrating the role of the insula in addiction, thereby demonstrating its promise as a target for brain stimulation. Future research should evaluate the optimal parameters for brain stimulation of the insula, through the use of relevant biomarkers and clinical outcomes for SUDs.
- Published
- 2019
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37. Prisoners of Addictive Cues: Biobehavioral Markers of Overweight and Obese Adults with Food Addiction
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Roni Aviram-Friedman, Lior Kafri, Guy Baz, Uri Alyagon, and Abraham Zangen
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food addiction ,obesity ,brain asymmetry ,event-related potentials ,food stroop ,attention bias ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Obesity is associated with food and eating addiction (FA), but the biobehavioral markers of this condition are poorly understood. To characterize FA, we recruited 18 healthy controls and overweight/obese adults with (n = 31) and without (n = 17) FA (H-C, FAOB, NFAOB, respectively) to assess alpha brain asymmetry at rest using electroencephalogram; event-related potentials following exposure to high-calorie food (HCF), low-calorie food (LCF), and nonfood (NF) images in a Stroop paradigm; reaction time reflective of the Stroop bias; and symptoms of depression and disordered eating behavior. The FAOB group had the greatest emotional and uncontrollable eating, depressive, and binge-eating symptoms. The FAOB group displayed lower resting left alpha brain asymmetry than that of the NFAOB group. Differently from the other groups, the FAOB group presented attenuated Stroop bias following exposure to HCF relative to NF images, as well as a lower late positive potential component (LPPb; 450–495 ms) in both frontal and occipital regions. In the total cohort, a correlation was found between the Stroop bias and the LPPb amplitude. These results point to biobehavioral hypervigilance in response to addictive food triggers in overweight/obese adults with FA. This resembles other addictive disorders but is absent in overweight/obesity without FA.
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- 2020
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38. Transcranial Magnetic Stimulation of Medial Prefrontal and Cingulate Cortices Reduces Cocaine Self-Administration: A Pilot Study
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Diana Martinez, Nina Urban, Alex Grassetti, Dinissa Chang, Mei-Chen Hu, Abraham Zangen, Frances R. Levin, Richard Foltin, and Edward V. Nunes
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addiction ,cocaine ,transcranial magnetic stimulation ,prefrontal cortex ,self administration ,Psychiatry ,RC435-571 - Abstract
BackgroundPrevious studies have shown that repetitive transcranial magnetic stimulation (rTMS) to the dorsolateral prefrontal cortex may serve as a potential treatment for cocaine use disorder (CUD), which remains a public health problem that is refractory to treatment. The goal of this pilot study was to investigate the effect of rTMS on cocaine self-administration in the laboratory. In the self-administration sessions, CUD participants chose between cocaine and an alternative reinforcer (money) in order to directly measure cocaine-seeking behavior. The rTMS was delivered with the H7 coil, which provides stimulation to the medial prefrontal cortex (mPFC) and anterior cingulate cortex (ACC). These brain regions were targeted based on previous imaging studies demonstrating alterations in their activation and connectivity in CUD.MethodsVolunteers with CUD were admitted to an inpatient unit for the entire study and assigned to one of three rTMS groups: high frequency (10 Hz), low frequency (1 Hz), and sham. Six participants were included in each group and the rTMS was delivered on weekdays for 3 weeks. The cocaine self-administration sessions were performed at three time points: at baseline (pre-TMS, session 1), after 4 days of rTMS (session 2), and after 13 days of rTMS (session 3). During each self-administration session, the outcome measure was the number of choices for cocaine.ResultsThe results showed a significant group by time effect (p = 0.02), where the choices for cocaine decreased between sessions 2 and 3 in the high frequency group. There was no effect of rTMS on cocaine self-administration in the low frequency or sham groups.ConclusionTaken in the context of the existing literature, these results contribute to the data showing that high frequency rTMS to the prefrontal cortex may serve as a potential treatment for CUD.
- Published
- 2018
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39. Answering the missed call: Initial exploration of cognitive and electrophysiological changes associated with smartphone use and abuse.
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Aviad Hadar, Itay Hadas, Avi Lazarovits, Uri Alyagon, Daniel Eliraz, and Abraham Zangen
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Medicine ,Science - Abstract
Smartphone usage is now integral to human behavior. Recent studies associate extensive usage with a range of debilitating effects. We sought to determine whether excessive usage is accompanied by measurable neural, cognitive and behavioral changes.Subjects lacking previous experience with smartphones (n = 35) were compared to a matched group of heavy smartphone users (n = 16) on numerous behavioral and electrophysiological measures recorded using electroencephalogram (EEG) combined with transcranial magnetic stimulation (TMS) over the right prefrontal cortex (rPFC). In a second longitudinal intervention, a randomly selected sample of the original non-users received smartphones for 3 months while the others served as controls. All measurements were repeated following this intervention.Heavy users showed increased impulsivity, hyperactivity and negative social concern. We also found reduced early TMS evoked potentials in the rPFC of this group, which correlated with severity of self-reported inattention problems. Heavy users also obtained lower accuracy rates than nonusers in a numerical processing. Critically, the second part of the experiment revealed that both the numerical processing and social cognition domains are causally linked to smartphone usage.Heavy usage was found to be associated with impaired attention, reduced numerical processing capacity, changes in social cognition, and reduced right prefrontal cortex (rPFC) excitability. Memory impairments were not detected. Novel usage over short period induced a significant reduction in numerical processing capacity and changes in social cognition.
- Published
- 2017
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40. Neuromodulation of Attentional Control in Major Depression: A Pilot DeepTMS Study
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Jodie Naim-Feil, John L. Bradshaw, Dianne M. Sheppard, Oded Rosenberg, Yechiel Levkovitz, Pinhas Dannon, Paul B. Fitzgerald, Moshe Isserles, and Abraham Zangen
- Subjects
Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
While Major Depressive Disorder (MDD) is primarily characterized by mood disturbances, impaired attentional control is increasingly identified as a critical feature of depression. Deep transcranial magnetic stimulation (deepTMS), a noninvasive neuromodulatory technique, can modulate neural activity and induce neuroplasticity changes in brain regions recruited by attentional processes. This study examined whether acute and long-term high-frequency repetitive deepTMS to the dorsolateral prefrontal cortex (DLPFC) can attenuate attentional deficits associated with MDD. Twenty-one MDD patients and 26 matched control subjects (CS) were administered the Beck Depression Inventory and the Sustained Attention to Response Task (SART) at baseline. MDD patients were readministered the SART and depressive assessments following a single session (n=21) and after 4 weeks (n=13) of high-frequency (20 Hz) repetitive deepTMS applied to the DLPFC. To control for the practice effect, CS (n=26) were readministered the SART a further two times. The MDD group exhibited deficits in sustained attention and cognitive inhibition. Both acute and long-term high-frequency repetitive frontal deepTMS ameliorated sustained attention deficits in the MDD group. Improvement after acute deepTMS was related to attentional recovery after long-term deepTMS. Longer-term improvement in sustained attention was not related to antidepressant effects of deepTMS treatment.
- Published
- 2016
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41. Modelling of the Electric Field Distribution in Deep Transcranial Magnetic Stimulation in the Adolescence, in the Adulthood, and in the Old Age.
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Serena Fiocchi, Michela Longhi, Paolo Ravazzani, Yiftach Roth, Abraham Zangen, and Marta Parazzini
- Published
- 2016
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42. Repetitive transcranial magnetic stimulation for smoking cessation: a pivotal multicenter double‐blind randomized controlled trial
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Moran Lipkinsky Grosz, Mark S. George, Dan V. Iosifescu, Alexander Bystritsky, Oscar G. Morales, Ahava Stein, Leah S. Casuto, Noam Barnea-Ygael, Aron Tendler, Abraham Zangen, Doron Toder, Jaron Winston, Yiftach Roth, Tanya Vapnik, David Feifel, Xingbao Li, Theodore Wirecki, Diana Martinez, Herbert E. Ward, Frederic Deutsch, Edward V. Nunes, Walter Duffy, and Hagar Moshe
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,media_common.quotation_subject ,Research Reports ,Craving ,Abstinence ,law.invention ,Transcranial magnetic stimulation ,Psychiatry and Mental health ,chemistry.chemical_compound ,Randomized controlled trial ,chemistry ,law ,Internal medicine ,Brain stimulation ,medicine ,Smoking cessation ,Pshychiatric Mental Health ,medicine.symptom ,Psychiatry ,business ,Cotinine ,Depression (differential diagnoses) ,media_common - Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a non‐invasive brain stimulation method increasingly used to treat psychiatric disorders, primarily depression. Initial studies suggest that rTMS may help to treat addictions, but evaluation in multicenter randomized controlled trials (RCTs) is needed. We conducted a multicenter double‐blind RCT in 262 chronic smokers meeting DSM‐5 criteria for tobacco use disorder, who had made at least one prior failed attempt to quit, with 68% having made at least three failed attempts. They received three weeks of daily bilateral active or sham rTMS to the lateral prefrontal and insular cortices, followed by once weekly rTMS for three weeks. Each rTMS session was administered following a cue‐induced craving procedure, and participants were monitored for a total of six weeks. Those in abstinence were monitored for additional 12 weeks. The primary outcome measure was the four‐week continuous quit rate (CQR) until Week 18 in the intent‐to‐treat efficacy set, as determined by daily smoking diaries and verified by urine cotinine measures. The trial was registered at ClinicalTrials.gov (NCT02126124). In the intent‐to‐treat analysis set (N=234), the CQR until Week 18 was 19.4% following active and 8.7% following sham rTMS (X(2)=5.655, p=0.017). Among completers (N=169), the CQR until Week 18 was 28.0% and 11.7%, respectively (X(2)=7.219, p=0.007). The reduction in cigarette consumption and craving was significantly greater in the active than the sham group as early as two weeks into treatment. This study establishes a safe treatment protocol that promotes smoking cessation by stimulating relevant brain circuits. It represents the first large multicenter RCT of brain stimulation in addiction medicine, and has led to the first clearance by the US Food and Drug Administration for rTMS as an aid in smoking cessation for adults.
- Published
- 2021
43. A Novel, Modular and Hybrid Method and Software for the Reduction of AEP Artifacts in TMS-EEG Studies
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Vasilios K. Kimiskidis, Dimitris Kugiumtzis, Abraham Zangen, Samuel Ziebman, Yiftach Roth, Evangelia Chatzikyriakou, Ioannis Vlahos, Iurii Venglovskyi, and Konstantinos Pastiadis
- Published
- 2022
44. Deep TMS H1 Coil treatment for depression: Results from a large post marketing data analysis
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Aron Tendler, Stephan Goerigk, Samuel Zibman, Salomé Ouaknine, Tal Harmelech, Gaby S Pell, Abraham Zangen, Steven A. Harvey, Geoffrey Grammer, Jimmy Stehberg, Oluremi Adefolarin, Owen Muir, Carlene MacMillan, Diana Ghelber, Walter Duffy, Irakli Mania, Zeeshan Faruqui, Faisal Munasifi, Todd Antin, Frank Padberg, and Yiftach Roth
- Subjects
Psychiatry and Mental health ,Biological Psychiatry - Published
- 2023
45. Electrical field measurements and simulations of the H7 and D-B80 coils: Non-equivalence of the TMS coils for obsessive compulsive disorder
- Author
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Tal Harmelech, Theodoros Samaras, Marietta Tzirini, Yiftach Roth, Gaby S. Pell, Samuel Zibman, Abraham Zangen, Aron Tendler, and Vasilios K. Kimiskidis
- Subjects
Physics ,Obsessive-Compulsive Disorder ,Field (physics) ,Obsessive compulsive ,General Neuroscience ,Quantum electrodynamics ,Biophysics ,Humans ,Neurosciences. Biological psychiatry. Neuropsychiatry ,Neurology (clinical) ,Transcranial Magnetic Stimulation ,Equivalence (measure theory) ,RC321-571 - Published
- 2021
46. Behavioral and Functional Brain Activity Alterations Induced by TMS Coils with Different Spatial Distributions
- Author
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Gaby S. Pell, Yiftach Roth, Hamutal Shachar, Moshe Isserles, Noam Barnea-Ygael, and Abraham Zangen
- Subjects
General Neuroscience ,General Medicine - Abstract
Previous investigation of cognitive processes using transcranial magnetic stimulation (TMS) have explored the response to different stimulation parameters such as frequency and coil location. In this study, we attempt to add another parameter by exploiting the spatial profiles of TMS coils to infer regional information concerning reward-related behavior. We used different TMS coils to modulate activity in the prefrontal cortex (PFC) and examined resulting changes in behavior and associated brain activity. More specifically, we used the Figure-8 coil to stimulate a portion of the dorsolateral PFC (DLPFC) and the H-Coil to stimulate a larger volume within the lateral PFC (LPFC). Healthy human volunteers completed behavioral questionnaires (n = 29) or performed a reward-related decision-making functional MRI (fMRI) task (n = 21) immediately before and after acute high-frequency stimulation (10 Hz) with either a Figure-8 coil, H-Coil, or a sham coil. Stimulation was found to induce behavioral changes as well as changes in brain activation in key nodes of the reward network. Right LPFC, but not right DLPFC or sham, stimulation was found to induce changes in both behavioral scores and brain activation in key nodes of the reward system. In conclusion, this study supports the role of the right LPFC in reward-related behavior and suggest that the pathways through which the observed effects were generated are located outside the area of the DLPFC that is traditionally targeted with TMS. These results demonstrate the use of TMS coils with different spatial profiles as an informative tool to investigate anatomic and functional correlates of behavior.
- Published
- 2023
47. Efficacy and Safety of Deep Transcranial Magnetic Stimulation for Obsessive-Compulsive Disorder: A Prospective Multicenter Randomized Double-Blind Placebo-Controlled Trial
- Author
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Eric Hollander, Yiftach Roth, Alexander Bystritsky, Abraham Zangen, Kyle A.B. Lapidus, Aron Tendler, Wayne K. Goodman, Daniel M. Blumberger, Joseph Zohar, Herbert E. Ward, Lior Carmi, Leah S. Casuto, David Feifel, Jeff Daskalakis, and Noam Barnea-Ygael
- Subjects
Adult ,Male ,medicine.medical_specialty ,Obsessive-Compulsive Disorder ,Placebo-controlled study ,Prefrontal Cortex ,behavioral disciplines and activities ,Gyrus Cinguli ,Double blind ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Physical medicine and rehabilitation ,Double-Blind Method ,Obsessive compulsive ,mental disorders ,Medicine ,Humans ,Deep transcranial magnetic stimulation ,Aged ,business.industry ,Middle Aged ,Transcranial Magnetic Stimulation ,030227 psychiatry ,Psychiatry and Mental health ,Treatment Outcome ,Influential Publication ,Female ,business ,030217 neurology & neurosurgery - Abstract
Obsessive-compulsive disorder (OCD) is a chronic and disabling condition that often responds unsatisfactorily to pharmacological and psychological treatments. Converging evidence suggests a dysfunction of the cortical-striatal-thalamic-cortical circuit in OCD, and a previous feasibility study indicated beneficial effects of deep transcranial magnetic stimulation (dTMS) targeting the medial prefrontal cortex and the anterior cingulate cortex. The authors examined the therapeutic effect of dTMS in a multicenter double-blind sham-controlled study.At 11 centers, 99 OCD patients were randomly allocated to treatment with either high-frequency (20 Hz) or sham dTMS and received daily treatments following individualized symptom provocation, for 6 weeks. Clinical response to treatment was determined using the Yale-Brown Obsessive Compulsive Scale (YBOCS), and the primary efficacy endpoint was the change in score from baseline to posttreatment assessment. Additional measures were response rates (defined as a reduction of ≥30% in YBOCS score) at the posttreatment assessment and after another month of follow-up.Eighty-nine percent of the active treatment group and 96% of the sham treatment group completed the study. The reduction in YBOCS score among patients who received active dTMS treatment was significantly greater than among patients who received sham treatment (reductions of 6.0 points and 3.3 points, respectively), with response rates of 38.1% and 11.1%, respectively. At the 1-month follow-up, the response rates were 45.2% in the active treatment group and 17.8% in the sham treatment group. Significant differences between the groups were maintained at follow-up.High-frequency dTMS over the medial prefrontal cortex and anterior cingulate cortex significantly improved OCD symptoms and may be considered as a potential intervention for patients who do not respond adequately to pharmacological and psychological interventions.
- Published
- 2022
48. Rotational field TMS: Comparison with conventional TMS based on motor evoked potentials and thresholds in the hand and leg motor cortices
- Author
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Abraham Zangen, Elisha Moses, Yafit Hadad, Moria Ankry, Yiftach Roth, Noam Barnea-Ygael, Ami Eisen, Aron Tendler, Yuri Burnishev, and Gaby S. Pell
- Subjects
Adult ,Male ,medicine.medical_treatment ,Population ,Biophysics ,Stimulation ,050105 experimental psychology ,lcsh:RC321-571 ,Motor threshold ,03 medical and health sciences ,0302 clinical medicine ,Rotational field ,Electric field ,Neuroplasticity ,medicine ,Humans ,0501 psychology and cognitive sciences ,Evoked potential ,education ,lcsh:Neurosciences. Biological psychiatry. Neuropsychiatry ,Physics ,Leg ,education.field_of_study ,Electromyography ,General Neuroscience ,05 social sciences ,MEP ,Evoked Potentials, Motor ,Hand ,Transcranial Magnetic Stimulation ,Transcranial magnetic stimulation ,medicine.anatomical_structure ,Electromagnetic coil ,TMS ,Unidirectional ,Motor cortex ,Female ,Neurology (clinical) ,Neuroscience ,030217 neurology & neurosurgery - Abstract
Background Transcranial magnetic stimulation (TMS) is a rapidly expanding technology utilized in research and neuropsychiatric treatments. Yet, conventional TMS configurations affect primarily neurons that are aligned parallel to the induced electric field by a fixed coil, making the activation orientation-specific. A novel method termed rotational field TMS (rfTMS), where two orthogonal coils are operated with a 90° phase shift, produces rotation of the electric field vector over almost a complete cycle, and may stimulate larger portion of the neuronal population within a given brain area. Objective To compare the physiological effects of rfTMS and conventional unidirectional TMS (udTMS) in the motor cortex. Methods Hand and leg resting motor thresholds (rMT), and motor evoked potential (MEP) amplitudes and latencies (at 120% of rMT), were measured using a dual-coil array based on the H7-coil, in 8 healthy volunteers following stimulation at different orientations of either udTMS or rfTMS. Results For both target areas rfTMS produced significantly lower rMTs and much higher MEPs than those induced by udTMS, for comparable induced electric field amplitude. Both hand and leg rMTs were orientation-dependent. Conclusions rfTMS induces stronger physiologic effects in targeted brain regions at significantly lower intensities. Importantly, given the activation of a much larger population of neurons within a certain brain area, repeated application of rfTMS may induce different neuroplastic effects in neural networks, opening novel research and clinical opportunities.
- Published
- 2020
49. Repetitive transcranial magnetic stimulation targeting the insular cortex for reduction of heavy drinking in treatment-seeking alcohol-dependent subjects: a randomized controlled trial
- Author
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Markus Heilig, Abraham Zangen, Michal Pietrzak, Andreas Löfberg, Hanna Karlsson, Theodor Arlestig, Irene Perini, and Robin Kämpe
- Subjects
Male ,medicine.medical_specialty ,Alcohol Drinking ,medicine.medical_treatment ,Craving ,Stimulation ,Insular cortex ,behavioral disciplines and activities ,Article ,law.invention ,Nicotine ,03 medical and health sciences ,0302 clinical medicine ,Physical medicine and rehabilitation ,Double-Blind Method ,Randomized controlled trial ,law ,mental disorders ,medicine ,Humans ,Cerebral Cortex ,Pharmacology ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,Middle Aged ,Transcranial Magnetic Stimulation ,3. Good health ,030227 psychiatry ,Transcranial magnetic stimulation ,Alcoholism ,Psychiatry and Mental health ,nervous system ,Female ,medicine.symptom ,business ,Insula ,psychological phenomena and processes ,030217 neurology & neurosurgery ,medicine.drug - Abstract
Insula responses to drug cues are correlated with cravings, and lesions in this area reduce nicotine seeking. Here, we investigated the potential efficacy of repetitive transcranial magnetic stimulation (rTMS) targeting the insula in alcohol addiction. Treatment-seeking alcohol-dependent patients (Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition; N = 56) participated in this double-blind, sham-controlled, randomized trial. Participants received 10 Hz rTMS or sham using an H8 coil, 5 days a week for 3 weeks. Stimulation targeted insular cortex and overlaying regions bilaterally, while excluding anterior prefrontal areas. Craving and self-reported as well as biomarker-based drinking measures were collected at baseline, during treatment, and through 12 weeks. Resting-state magnetic resonance imaging (rsMRI) data were collected before and after treatment. Task-based MRI was used to probe brain correlates of reward processing, affective responses, and alcohol following completion of treatment. A marked overall decrease in craving and drinking measures was observed during treatment, but did not differ between rTMS or sham stimulation. Both groups equally increased their alcohol use following completion of treatment and through the 12-week follow-up. Analysis using seeds in the insula identified differences in resting-state connectivity between active and sham groups at completion of treatment, potentially indicating an ability of treatment to modify insula function. However, while each task robustly replicated brain responses established in the literature, no effects of rTMS were found. Collectively, this study does not support efficacy of rTMS targeting the insula in alcohol addiction.
- Published
- 2019
50. From self-induced to perceived errors – A generalized over-monitoring activity in obsessive–compulsive disorder
- Author
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Abraham Zangen, Reuven Dar, Joseph Zohar, Lior Carmi, Noam Barnea-Ygael, and Uri Alyagon
- Subjects
Adult ,Male ,Obsessive-Compulsive Disorder ,medicine.medical_specialty ,Adolescent ,Theta activity ,Electroencephalography ,Audiology ,behavioral disciplines and activities ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Family group ,Obsessive compulsive ,mental disorders ,medicine ,Humans ,Pharmacology (medical) ,Theta Rhythm ,First-degree relatives ,Evoked Potentials ,Pathological ,Biological Psychiatry ,Aged ,Pharmacology ,medicine.diagnostic_test ,business.industry ,Siblings ,Brain ,Middle Aged ,030227 psychiatry ,Psychiatry and Mental health ,Neurology ,Eeg activity ,Case-Control Studies ,Stroop Test ,Female ,Neurology (clinical) ,business ,Psychomotor Performance ,030217 neurology & neurosurgery ,Stroop effect - Abstract
Well-functioning error monitoring of the inner and outer environments is essential for adaptively altering behavior, while malfunction characterizes conditions such as obsessive–compulsive disorder (OCD). The underlying brain processing is manifested as Error-Related Negativity (ERN) signal elicited following error comission, and Perceived Error Related Theta Activity (PERTA) signal elicited following detection of discrepancy in the environment. Yet, while enhanced ERN was repeatedly demonstrated in OCD patients and was found to be potentiated among their unaffected first degree relatives, no comparable observations were reported with regard to PERTA. We recorded EEG activity while OCD patients, OCD patients’ siblings (Family), and healthy controls (HC) performed computerized tasks. For the examination of ERN we used the Stroop task and for the examination of PERTA we presented correct and incorrect mathematical equations. Increased ERN (0–120 ms post response) was observed in both the OCD and Family groups, but only the OCD patients’ signal significantly differed from that of HC's. Similarly, modified PERTA activity was observed in both the OCD and Family groups in the N1 peak (65–125 ms post perceived error), but only for the OCD group this activity significantly differed from that of HC. Both ERN and PERTA's N1 are fast occurring peaks, which suggests that OCD is associate with a constantly over-activated detection system that monitors the inner and outer environment and reacts promptly following detection of a mistake. Furthermore, the modified but non-significantly different activity of the Family group suggests that the pathological condition evolves in vulnerable individuals with neuronal predisposition.
- Published
- 2019
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