[De rol van hart-hersenkoppeling bij het personaliseren van hersenstimulatie]. / De rol van hart-hersenkoppeling bij het personaliseren van hersenstimulatie.

BACKGROUND: rTMS or TMS is an effective treatment method for the treatment of depression. AIM: In clinical practice, different stimulation sites can be used for TMS. An important question is how knowledge of functional networks in depression, can lead to a better selection of TMS location, and thus a greater chance of treatment success. METHOD: In this essay, various localization methods that have been used and investigated in the application of TMS in depression are described. RESULTS: Although heuristics used in practice, such as the 5-centimeter rule and the Beam-F3 method, are effective methods, there is a clear development in which ‘anatomy’ thinking is shifting to thinking in functional networks. Currently, there are two promising methods that may result in more personalized stimulation locations. These both utilize knowledge about known functional networks in depression, focused on the subgenual anterior cingulate cortex (sgACC). The first promising method, involves functional MRI (fMRI)-based TMS, targeting prefrontal locations anticorrelated to the sgACC. The second promising method is based on TMS-induced heart-brain coupling, utilizing the overlap between the depression network and the fronto-vagal network, including the sgACC. CONCLUSION: Currently, the network hypothesis of depression is the most widely accepted explanatory model for TMS effects in depression. Although the new methods, namely the fMRI-based method and the heart-brain coupling method, are promising, it has not yet been sufficiently proven that they are superior to standard methods.

[Consensus statement on the application of rTMS in depression in the Netherlands and Belgium]. / Consensusverklaring voor de toepassing van rTMS bij depressie in Nederland en België.

BACKGROUND: Since 2017, repetitive transcranial magnetic stimulation (rTMS) has become eligible for reimbursement for the treatment of therapy-resistant depression in the Dutch healthcare system.
AIM: To initiate a guideline in the Netherlands and Belgium for the safe and effective application of rTMS for the treatment of depression.
METHOD: Based on literature review, existing guidelines and consensus among Dutch rTMS experts, recommendations were developed regarding the implementation of rTMS as a treatment of depression. All available evidence was weighed and discussed among all co-authors and recommendations were reached by consensus among the group.
RESULTS: rTMS targeting the dorsolateral prefrontal cortex (DLPFC) should be seen as a first choice in the treatment of depression using high-frequency rTMS (left) or, as an alternative, low-frequency rTMS (right). Stimulation protocols should use more than 1000 pulses per session for an average of 20-30 sessions, offered in 2-5 sessions per week. Contraindications for rTMS include epilepsy, intracranial presence of (magnetisable) metals, pacemaker and cochlear implant.
CONCLUSION: rTMS, performed by competent professionals is an effective and safe treatment for depression.

Differences in Cortical Sources of the Event-Related P3 Potential Between Young and Old Participants Indicate Frontal Compensation.

The event-related P3 potential, as elicited in auditory signal detection tasks, originates from neural activity of multiple cortical structures and presumably reflects an overlap of several cognitive processes. The fact that the P3 is affected by aging makes it a potential metric for age-related cognitive change. The P3 in older participants is thought to encompass frontal compensatory activity in addition to task-related processes. The current study investigates this by decomposing the P3 using group independent component analysis (ICA). Independent components (IC) of young and old participants were compared in order to investigate the effects of aging. Exact low-resolution tomography analysis (eLORETA) was used to compare current source densities between young and old participants for the P3-ICs to localize differences in cortical source activity for every IC. One of the P3-related ICs reflected a different constellation of cortical generators in older participants compared to younger participants, suggesting that this P3-IC reflects shifts in neural activations and compensatory processes with aging. This P3-IC was localized to the orbitofrontal/temporal, and the medio-parietal regions. For this IC, older participants showed more frontal activation and less parietal activation as measured on the scalp. The differences in cortical sources were localized in the precentral gyrus and the parahippocampal gyrus. This finding might reflect compensatory activity recruited from these cortical sources during a signal detection task.

Neurofeedback: One of today's techniques in psychiatry?

OBJECTIVES: Neurofeedback is a technique that aims to teach a subject to regulate a brain parameter measured by a technical interface to modulate his/her related brain and cognitive activities. However, the use of neurofeedback as a therapeutic tool for psychiatric disorders remains controversial. The aim of this review is to summarize and to comment the level of evidence of electroencephalogram (EEG) neurofeedback and real-time functional magnetic resonance imaging (fMRI) neurofeedback for therapeutic application in psychiatry. METHOD: Literature on neurofeedback and mental disorders but also on brain computer interfaces (BCI) used in the field of neurocognitive science has been considered by the group of expert of the Neurofeedback evaluation & training (NExT) section of the French Association of biological psychiatry and neuropsychopharmacology (AFPBN). RESULTS: Results show a potential efficacy of EEG-neurofeedback in the treatment of attentional-deficit/hyperactivity disorder (ADHD) in children, even if this is still debated. For other mental disorders, there is too limited research to warrant the use of EEG-neurofeedback in clinical practice. Regarding fMRI neurofeedback, the level of evidence remains too weak, for now, to justify clinical use. The literature review highlights various unclear points, such as indications (psychiatric disorders, pathophysiologic rationale), protocols (brain signals targeted, learning characteristics) and techniques (EEG, fMRI, signal processing). CONCLUSION: The field of neurofeedback involves psychiatrists, neurophysiologists and researchers in the field of brain computer interfaces. Future studies should determine the criteria for optimizing neurofeedback sessions. A better understanding of the learning processes underpinning neurofeedback could be a key element to develop the use of this technique in clinical practice.

[Non-invasive brain stimulation techniques in psychiatric disorders: influential factors and combination of interventions]. / Niet-invasieve hersenstimulatie bij psychiatrische stoornissen: beïnvloedende factoren en combinatie van interventies.

BACKGROUND: The causal influence of cortico-subcortical connectivity by means of brain stimulation seems to be an effective biological treatment in psychiatric patients. AIM: To review the working mechanisms and moderating factors of two non-invasive brain stimulation techniques (NIBS), namely repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS). METHOD: We reviewed the current literature on the use of nibs in neuropsychiatric disorders. RESULTS: First of all, stimulation parameters (location of the stimulation, intensity and duration of the stimulation, number of sessions) are important for the effect of nibs. Secondly, it is important to consider the non-specific neuroplasticity that results from NIBS. Thirdly, recent studies suggest that NIBS should be combined with neurobehavioral interventions, namely cognitive interventions, for the purpose of modulating specific neural processes (i.e. specific neuroplasticity). CONCLUSION: If we want to improve the NIBS treatment in neuropsychiatric patients, we need to consider the factors that influence the patients' response to treatment with rTMS and tDCS.

Circulating fibrinogen is a prognostic and predictive biomarker in malignant pleural mesothelioma.

BACKGROUND: To investigate the clinical utility of pretreatment plasma fibrinogen levels in malignant pleural mesothelioma (MPM) patients. METHODS: A retrospective multicenter study was performed in histologically proven MPM patients. All fibrinogen levels were measured at the time of diagnosis and clinical data were retrospectively collected after approval of the corresponding ethics committees. RESULTS: In total, 176 MPM patients (mean age: 63.5 years ± 10.4 years, 38 females and 138 males) were analysed. Most patients (n=154, 87.5%) had elevated (≥ 390 mg dl(-1)) plasma fibrinogen levels. When patients were grouped by median fibrinogen, patients with low level (≤ 627 mg dl(-1)) had significantly longer overall survival (OS) (19.1 months, confidence interval (CI) 14.5-23.7 months) when compared with those with high level (OS 8.5; CI 6.2-10.7 months). In multivariate survival analyses, fibrinogen was found to be an independent prognostic factor (hazard ratio 1.81, CI 1.23-2.65). Most interestingly, fibrinogen (cutoff 75th percentile per 750 mg dl(-1)) proved to be a predictive biomarker indicating treatment benefit achieved by surgery within multimodality therapy (interaction term: P=0.034). Accordingly, only patients below the 75th percentile benefit from surgery within multimodality therapy (31.3 vs 5.3 months OS). CONCLUSIONS: Fibrinogen is a novel independent prognostic biomarker in MPM. Most importantly, fibrinogen predicted treatment benefit achieved by surgery within multimodality therapy.

[The role of sleep in ADHD: possibilities for prevention of ADHD?]. / De rol van slaap bij ADHD: mogelijkheden voor preventie van ADHD?

BACKGROUND: Personalized medicine aims to provide the right treatment for the right person at the right time, as opposed to the currently employed 'one-size-fits-all ' approach. This development relies on identification of ADHD subgroups using biomarkers. One important ADHD subgroup is characterised by impaired vigilance regulation, as quantified by the EEG and this sub-group responds well to stimulant medication and neurofeedback. Recent insights suggest a clear association between reduced sleep duration and ADHD complaints in this sub-group of ADHD patients. A recently published model explains how different treatments e.g. chronobiological treatments and neurofeedback impact on this neural circuitry and mediate ADHD symptom improvement. AIM: To test this recently published model predicting a relationship between solar intensity and ADHD prevalence. METHOD: A literature survey on studies using identical methods to estimate the prevalence of ADHD in different geographical areas and compare those to worldwide solar intensity data. RESULTS: A clear relationship between solar intensity and the worldwide prevalence of ADHD was found, explaining 34-57% of the variance in ADHD prevalence, where a lower prevalence of ADHD was found in areas with high solar-intensity. CONCLUSION: The preventative effect of high solar intensity may be related to improvement of circadian clock disturbances. These findings likely apply to a substantial sub-group of ADHD patients and have major implications for our understanding of the etiology and possibly prevention of ADHD.

[Non-invasive brain stimulation for the treatment of depression]. / Niet-invasieve hersenstimulatie als behandeling voor depressie.

Depression is one of the most common psychiatric disorders and is a heavy burden, not only for the patient and his or her environment but also in economic and social terms. 35% of depressed patients do not recover after standard treatment with medication or psychotherapy. There is a need for more effective treatment options for depression. In recent decades, new forms of brain stimulation have been developed for the treatment of depression, the most important of which is transcranial magnetic stimulation (TMS). TMS uses magnetic pulses to influence brain activity. Meta-analyses show approximately 30-40% of patients respond to treatment with repetitive TMS. The depression goes into remission in about 20-30% of cases. Research has led to new treatment protocols and variations on the conventional TMS method. More research into the effectiveness of these developments is needed. We recommend using TMS as an add-on treatment more often when the patient has completed two steps of the treatment guideline.

Normalization of EEG in depression after antidepressant treatment with sertraline? A preliminary report.

BACKGROUND: MDD patients with abnormal EEG patterns seem more likely to be non-responsive to the antidepressants escitalopram and venlafaxine, but not sertraline, than patients without EEG abnormalities. This finding suggests that patients with both MDD and abnormal EEGs may differentially respond to antidepressant treatment. In the current study, we investigated whether depressed patients with an abnormal EEG show a normalization of the EEG related to antidepressant treatment and response and whether such effect is drug specific, and whether having had early life stress (ELS) increases the chance of abnormal activity. METHODS: Baseline and week 8 EEGs and depression symptoms were extracted from a large multicenter study (iSPOT-D, n = 1008) where depressed patients were randomized to escitalopram, sertraline, or venlafaxine-XR treatment. We calculated Odds Ratios of EEG normalization and depression response in patients with an abnormal EEG at baseline, comparing sertraline versus other antidepressants. RESULTS: Fifty seven patients with abnormal EEGs were included. EEGs did not normalize significantly more with sertraline compared to other antidepressants (OR = 1.9, p = .280). However, patients with a normalized EEG taking sertraline were 5.2 times more likely to respond than subjects taking other antidepressants (p = .019). ELS was not significantly related to abnormal activity. LIMITATIONS: Neurophysiological recordings were limited in time (two times 2-minute EEGs) and statistical power (n = 57 abnormal EEGs). CONCLUSIONS: Response rates in patients with normalized EEG taking sertraline were significantly larger than in subjects treated with escitalopram/venlafaxine. This adds to personalized medicine and suggests a possible drug repurposing for sertraline.

Excitotoxic hippocampal lesions disrupt allocentric spatial learning in mice: effects of strain and task demands.

Spatial discrimination of ibotenic acid-lesioned C57BL/6 (B6) and DBA/2 (D2) mice was tested in two-choice water maze and plus maze tasks. B6 but not D2 mice learned the spatial discrimination in the water maze, but strains did not differ in learning a spatial discrimination in the plus maze paradigm. Ibotenic acid lesions of the hippocampus impaired percentage correct choices in the water maze spatial discrimination task in B6 but not in D2 mice, the latter of which may have been due to a floor effect. Furthermore, lesioned mice were more thigmotaxic, the distance travelled until a choice was made was longer and animals made more errors of omission. Despite the poor performance during water maze acquisition, lesioned animals, as well as sham-lesioned D2 mice, eventually acquired some place response in the water maze, as was evident when the location of the platform was reversed. However, hippocampus-lesioned mice of both strains were impaired when tested in the plus maze spatial discrimination task. Thus, ibotenic acid-induced lesions of the hippocampus impair acquisition of spatial discrimination in mice. These deficits were strain-dependent and likely comprise impaired accuracy as well as changes in non-mnemonic types of behaviour. Importantly, lesions in both strains impaired spatial learning, and whether a deficit was seen in mice of the D2 strain seemed to depend on the demands of the task.

Technical note: equine skeletal preservation techniques to enhance teaching effectiveness.

When the decision was made to euthanatize an acutely laminitic Thoroughbred broodmare, graduate students from the Department of Animal Sciences and Industry reconstructed the skeleton for use as a teaching tool. The reproductive and gastrointestinal tracts were removed and preserved in formalin. The hide, muscle, tendons, ligaments, and organs were removed, and the bones were boiled in water for > or = 48 h to remove all remaining tissue. After boiling, the bones were soaked in gasoline to remove fat from the marrow cavities and then soaked in a bleach/detergent mixture as a final cleaning step. The bones were allowed to dry for several weeks, then a semi-gloss clear lacquer was applied to aid in preservation. The bones were connected with 17-gauge wire and supported by two 1.91-cm galvanized steel rods on a mobile platform. The vertebral column was aligned on flexible copper tube with a 1.27-cm diameter. Additional support was provided for the head and neck by aluminum and steel rods extending from the front support. The final product is a complete, mobile skeleton that will be used as a teaching aid in equine classes. The skeleton serves a function for all levels of the cognitive learning domain. Examples of applications include memorization, identification, and location of bones; use in case studies for synthesis and demonstration of brainstorming efforts; and evaluation of joint ailments for more advanced levels of learning.

Effects of oxytocin, lipopolysaccharide (LPS), and polyunsaturated fatty acids on prostaglandin secretion and gene expression in equine endometrial explant cultures.

Increased secretion of prostaglandin F(2)α (PGF(2)α) within the uterus because of uterine inflammation can cause luteolysis and result in early embryonic loss. Supplementation with polyunsaturated fatty acids (PUFAs) has been shown to influence PG production in many species, although the effects on the mare remain unknown. The present study aimed to determine fatty acid uptake in equine endometrial explants and evaluate their influence on PG secretion and expression of enzymes involved in PG synthesis in vitro. Equine endometrial explants were treated with 100 µM arachidonic acid, eicosapentaenoic acid, or docosahexaenoic acid and then challenged with oxytocin (250 nM) or lipopolysaccharide (LPS; 1 µg/mL). Production of PGF(2)α and PG E(2) (PGE(2)) was measured, and mRNA expression of enzymes involved in PG synthesis was determined with quantitative real-time PCR. Media concentrations of PGF(2)α and PGE(2) were higher (P < 0.0001) from endometrial explants challenged with oxytocin or LPS compared with controls despite which fatty acid was added. Only DHA lowered (P < 0.0001) media concentrations of PGF(2)α and PGE(2) from explants. Endometrial explants stimulated with oxytocin had increased expression of PG-endoperoxide synthase 1 (PTGS1; P < 0.02), PG-endoperoxide synthase 2 (PTGS2; P < 0.001), PG F(2)α synthase (PGFS; P < 0.01), PG E(2) synthase (PGES; P < 0.01), and phospholipase A(2) (PLA(2); P < 0.005) compared with controls and regardless of fatty acid treatment; whereas stimulation with LPS increased expression of PTGS2 (P < 0.004), PGFS (P < 0.03), PGES (P < 0.01), and PLA(2) (P < 0.01) compared with controls and regardless of fatty acid treatment. Treatment with PUFAs, specifically DHA, can influence PG secretion in vitro through mechanisms other than enzyme expression.

DBH -1021C>T and COMT Val108/158Met genotype are not associated with the P300 ERP in an auditory oddball task.

OBJECTIVE: The amplitude and latency of the P300 may be associated by variations in dopaminergic genes. The current study was conducted to determine whether functional variants of the catechol-O-methyltransferase (COMT) and dopamine beta-hydroxylase (DBH) gene were associated with P300 amplitude and latency in an auditory oddball task. METHODS: The P300 ERP was assessed by a two-tone auditory oddball paradigm in a large sample of 320 healthy volunteers. The Val108/158Met polymorphism (rs4680) of the COMT gene and the -1021C>T polymorphism (rs1611115) of the DBH gene were genotyped. P300 amplitude and latency were compared across genotype groups using analysis of variance. RESULTS: There were no differences in demographic characteristics in subjects for genotypic subgroups. No genotype associations were observed for the P300 amplitude and latency on frontal, central and parietal electrode positions. CONCLUSIONS: COMT Val108/158Met and DBH -1021C>T polymorphisms do not show evidence of association with characteristics of the P300 ERP in an auditory oddball paradigm in healthy volunteers. SIGNIFICANCE: We failed to find evidence for the association between dopaminergic enzymatic polymorphisms and the P300 ERP in healthy volunteers, in the largest study undertaken to date.

An investigation of EEG, genetic and cognitive markers of treatment response to antidepressant medication in patients with major depressive disorder: a pilot study.

The aim of this study was to investigate if biomarkers in QEEG, genetic and neuropsychological measures are suitable for the prediction of antidepressant treatment outcome in depression. Twenty-five patients diagnosed with major depressive disorder were assessed twice, pretreatment and at 8-wk follow-up, on a variety of QEEG and neuropsychological tasks. Additionally, cheek swab samples were collected to assess genetic predictors of treatment outcome. The primary outcome measure was the absolute decrease on the HAM-D rating scale. Regression models were built in order to investigate which markers contribute most to the decrease in absolute HAM-D scores. Patients who had a better clinical outcome were characterized by a decrease in the amplitude of the Auditory Oddball N1 at baseline. The 'Met/Met' variant of the COMT gene was the best genetic predictor of treatment outcome. Impaired verbal memory performance was the best cognitive predictor. Raised frontal Theta power was the best EEG predictor of change in HAM-D scores. A tentative integrative model showed that a combination of N1 amplitude at Pz and verbal memory performance accounted for the largest part of the explained variance. These markers may serve as new biomarkers suitable for the prediction of antidepressant treatment outcome.

Disorder specificity despite comorbidity: resting EEG alpha asymmetry in major depressive disorder and post-traumatic stress disorder.

The approach-withdrawal and valence-arousal models highlight that specific brain laterality profiles may distinguish depression and anxiety. However, studies remain to be conducted in multiple clinical populations that directly test the diagnostic specificity of these hypotheses. The current study compared electroencephalographic data under resting state, eyes closed conditions in patients with major depressive disorder (MDD) (N=15) and post-traumatic stress disorder (PTSD) (N=14) relative to healthy controls (N=15) to examine the specificity of brain laterality in these disorders. Key findings included (1) reduced left-frontal activity in MDD, (2) a positive correlation between PTSD severity and right-frontal lateralisation, (3) greater activity in PTSD patients relative to MDD within the right-parietotemporal region, and (4) globally increased alpha power in MDD. Findings partially support the diagnostic applicability of the theoretical frameworks. Future studies may benefit from examining task-driven differences between groups.