Probing Homeostatic Plasticity With Priming Theta-burst Stimulation of the Dorsolateral Prefrontal Cortex

Dr Georg Kranz

Status: Completed

Conditions: Depression Minor

Treatments: Device: Theta-burst stimulation (TBS)

Study type: Interventional

Funder types: Other

Identifiers

NCT04031105

PolyU 251002/19M

Details and patient eligibility

About

Priming stimulation is a highly promising tool to boost the beneficial effects of therapeutic repetitive transcranial magnetic stimulation (rTMS) in psychiatry. The potentiating effects of priming stimulation, however, depend on the time interval between the priming and the test stimulation. Although it is known that too short and too long intervals have no effects, systematic studies that identify the time needed to maximize efficacy have not yet been done. Thus, there is a need for studies to investigate the effects of priming stimulation in order to fully utilize the potential benefits and advantages of this promising new rTMS protocol. This study will systematically investigate the neuromodulatory process underlying priming stimulation to enhance metaplasticity in the left dorsolateral prefrontal cortex (DLPFC) - one of the main targets for therapeutic rTMS - in individuals with subclinical depression.

The brain is a highly plastic organ and its activity can be influenced using rTMS. At the same time, the brain also has a mechanism - called homeostatic metaplasticity - which counteracts extreme plastic changes. Homeostatic metaplasticity therefore can limit the beneficial effects of brain stimulation interventions. However, priming stimulation protocols that include both a priming and a test stimulation session may utilize homeostatic metaplasticity to increase the beneficial effects of brain stimulation, although the optimal treatment parameters for priming are not known. Moreover, little is known about homeostatic metaplasticity in the DLPFC, an area that is particularly relevant for psychiatric conditions given its role in the top-down control of emotions. Here, the investigators will systematically study metaplasticity using priming theta-burst stimulation (TBS), a potent form of rTMS in the left DLPFC. Changes in blood oxygenation that signal brain activity changes will be assessed using functional near-infrared spectroscopy (fNIRS) at rest and during engagement in several cognitive tasks. The findings from this study will (1) elucidate the optimal time interval between priming and test stimulation; (2) elucidate the influence of priming TBS on emotion discrimination as well as executive function and its underlying brain activity in subclinical depression; and (3) validate homeostatic metaplasticity in the left DLPFC.

Full description

No detailed description

Enrollment: 160 patients

Sex: All

Ages: 18 to 35 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

1. age 18-35
2. education level of primary six or above
3. right-handedness
4. normal or corrected-to-normal vision
5. being able to understand the verbal instructions
6. willingness to sign the informed consent form

Exclusion criteria

1. a history of seizures
2. current or past psychiatric disorders
3. current or past severe internal or neurological illness
4. ferromagnetic implants <20cm from the head, cardiac pacemaker, deep brain stimulation and other common TMS exclusion criteria
5. history of substance dependence or abuse within the last 3 months
6. intake of any medication known to affect the excitation threshold (i.e., benzodiazepines, anticonvulsants).

Trial design

Primary purpose: Basic Science

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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160 participants in 4 patient groups

Condition 1

Experimental group

Description:

Priming sham TBS, followed by iTBS after an inter-stimulation-interval (ISI) of 0 minutes

Treatment:

Device: Theta-burst stimulation (TBS)

Condition 2

Experimental group

Description:

Priming cTBS, followed by iTBS after an ISI of 0 minutes

Treatment:

Device: Theta-burst stimulation (TBS)

Condition 3

Experimental group

Description:

Priming cTBS, followed by iTBS after an ISI of 10 minutes

Treatment:

Device: Theta-burst stimulation (TBS)

Condition 4

Experimental group

Description:

Priming cTBS, followed by iTBS after an ISI of 20 minutes

Treatment:

Device: Theta-burst stimulation (TBS)