Journal article
Individualized Connectome-Targeted Transcranial Magnetic Stimulation for Neuropsychiatric Sequelae of Repetitive Traumatic Brain Injury in a Retired NFL Player
The journal of neuropsychiatry and clinical neurosciences, Vol.31(3), pp.254-263
2019
DOI: 10.1176/appi.neuropsych.18100230
PMID: 30945588
Abstract
The recent advent of individualized resting-state network mapping (RSNM) has revealed substantial interindividual variability in anatomical localization of brain networks identified by using resting-state functional MRI (rsfMRI). RSNM enables personalized targeting of focal neuromodulation techniques such as repetitive transcranial magnetic stimulation (rTMS). rTMS is believed to exert antidepressant efficacy by modulating connectivity between the stimulation site, the default mode network (DMN), and the subgenual anterior cingulate cortex (sgACC). Personalized rTMS may be particularly useful after repetitive traumatic brain injury (TBI), which is associated with neurodegenerative tauopathy in medial temporal limbic structures. These degenerative changes are believed to be related to treatment-resistant neurobehavioral disturbances observed in many retired athletes.
The authors describe a case in which RSNM was successfully used to target rTMS to treat these neuropsychiatric disturbances in a retired NFL defensive lineman whose symptoms were not responsive to conventional treatments. RSNM was used to identify left-right dorsolateral prefrontal rTMS targets with maximal difference between dorsal attention network and DMN correlations. These targets were spatially distinct from those identified by prior methods. Twenty sessions of left-sided excitatory and right-sided inhibitory rTMS were administered at these targets.
Treatment led to improvement in Montgomery-Åsberg Depression Rating Scale (72%), cognitive testing, and headache scales scores. Compared with healthy individuals and subjects with TBI-associated depression, baseline rsfMRI revealed substantially elevated DMN connectivity with the medial temporal lobe (MTL). Serial rsfMRI scans revealed gradual improvement in MTL-DMN connectivity and stimulation site connectivity with sgACC.
These results highlight the possibility of individualized neuromodulation and biomarker-based monitoring for neuropsychiatric sequelae of repetitive TBI.
Details
- Title: Subtitle
- Individualized Connectome-Targeted Transcranial Magnetic Stimulation for Neuropsychiatric Sequelae of Repetitive Traumatic Brain Injury in a Retired NFL Player
- Creators
- Shan H Siddiqi - The Departments of Psychiatry, Neurology, and Neurosurgery, Washington University School of Medicine, St. Louis (Siddiqi, Trapp, Laumann, Kandala, Shahim, Carter, Brody, Hacker); and Department of Neurology, Harvard Medical School, McLean Hospital, Boston (Siddiqi); and the Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md. (Siddiqi, Shahim); and Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa (Trapp)Nicholas T Trapp - The Departments of Psychiatry, Neurology, and Neurosurgery, Washington University School of Medicine, St. Louis (Siddiqi, Trapp, Laumann, Kandala, Shahim, Carter, Brody, Hacker); and Department of Neurology, Harvard Medical School, McLean Hospital, Boston (Siddiqi); and the Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md. (Siddiqi, Shahim); and Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa (Trapp)Pashtun Shahim - The Departments of Psychiatry, Neurology, and Neurosurgery, Washington University School of Medicine, St. Louis (Siddiqi, Trapp, Laumann, Kandala, Shahim, Carter, Brody, Hacker); and Department of Neurology, Harvard Medical School, McLean Hospital, Boston (Siddiqi); and the Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md. (Siddiqi, Shahim); and Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa (Trapp)Carl D Hacker - The Departments of Psychiatry, Neurology, and Neurosurgery, Washington University School of Medicine, St. Louis (Siddiqi, Trapp, Laumann, Kandala, Shahim, Carter, Brody, Hacker); and Department of Neurology, Harvard Medical School, McLean Hospital, Boston (Siddiqi); and the Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md. (Siddiqi, Shahim); and Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa (Trapp)Timothy O Laumann - The Departments of Psychiatry, Neurology, and Neurosurgery, Washington University School of Medicine, St. Louis (Siddiqi, Trapp, Laumann, Kandala, Shahim, Carter, Brody, Hacker); and Department of Neurology, Harvard Medical School, McLean Hospital, Boston (Siddiqi); and the Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md. (Siddiqi, Shahim); and Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa (Trapp)Sridhar Kandala - The Departments of Psychiatry, Neurology, and Neurosurgery, Washington University School of Medicine, St. Louis (Siddiqi, Trapp, Laumann, Kandala, Shahim, Carter, Brody, Hacker); and Department of Neurology, Harvard Medical School, McLean Hospital, Boston (Siddiqi); and the Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md. (Siddiqi, Shahim); and Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa (Trapp)Alexandre R Carter - The Departments of Psychiatry, Neurology, and Neurosurgery, Washington University School of Medicine, St. Louis (Siddiqi, Trapp, Laumann, Kandala, Shahim, Carter, Brody, Hacker); and Department of Neurology, Harvard Medical School, McLean Hospital, Boston (Siddiqi); and the Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md. (Siddiqi, Shahim); and Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa (Trapp)David L Brody - The Departments of Psychiatry, Neurology, and Neurosurgery, Washington University School of Medicine, St. Louis (Siddiqi, Trapp, Laumann, Kandala, Shahim, Carter, Brody, Hacker); and Department of Neurology, Harvard Medical School, McLean Hospital, Boston (Siddiqi); and the Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md. (Siddiqi, Shahim); and Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa (Trapp)
- Resource Type
- Journal article
- Publication Details
- The journal of neuropsychiatry and clinical neurosciences, Vol.31(3), pp.254-263
- DOI
- 10.1176/appi.neuropsych.18100230
- PMID
- 30945588
- NLM abbreviation
- J Neuropsychiatry Clin Neurosci
- ISSN
- 0895-0172
- eISSN
- 1545-7222
- Publisher
- United States
- Language
- English
- Date published
- 2019
- Academic Unit
- Psychiatry; Iowa Neuroscience Institute
- Record Identifier
- 9984003463402771
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