Brain entropy and neurotrophic molecular markers accompanying clinical improvement after ketamine: Preliminary evidence in adolescents with treatment-resistant depression.

BACKGROUND: Current theory suggests that treatment-resistant depression (TRD) involves impaired neuroplasticity resulting in cognitive and neural rigidity, and that clinical improvement may require increasing brain flexibility and adaptability. AIMS: In this hypothesis-generating study, we sought to identify preliminary evidence of brain flexibility correlates of clinical change within the context of an open-label ketamine trial in adolescents with TRD, focusing on two promising candidate markers of neural flexibility: (a) entropy of resting-state functional magnetic resonance imaging (fMRI) signals; and (b) insulin-stimulated phosphorylation of mammalian target of rapamycin (mTOR) and glycogen synthase-3-beta (GSK3ß) in peripheral blood mononuclear cells. METHODS: We collected resting-state functional magnetic resonance imaging data and blood samples from 13 adolescents with TRD before and after a series of six ketamine infusions over 2 weeks. Usable pre/post ketamine data were available from 11 adolescents for imaging and from 10 adolescents for molecular signaling. We examined correlations between treatment response and changes in the central and peripheral flexibility markers. RESULTS: Depression reduction correlated with increased nucleus accumbens entropy. Follow-up analyses suggested that physiological changes were associated with treatment response. In contrast to treatment non-responders (n=6), responders (n=5) showed greater increase in nucleus accumbens entropy after ketamine, together with greater post-treatment insulin/mTOR/GSK3ß signaling. CONCLUSIONS: These data provide preliminary evidence that changes in neural flexibility may underlie symptom relief in adolescents with TRD following ketamine. Future research with adequately powered samples is needed to confirm resting-state entropy and insulin-stimulated mTOR and GSK3ß as brain flexibility markers and candidate targets for future clinical trials. CLINICAL TRIAL NAME: Ketamine in adolescents with treatment-resistant depressionURL: https://clinicaltrials.gov/ct2/show/NCT02078817Registration number: NCT02078817.

A randomized controlled trial of transcranial direct-current stimulation and cognitive training in children with fetal alcohol spectrum disorder.

BACKGROUND: This study was a randomized double-blind sham-controlled trial examining the effects of transcranial direct current stimulation (tDCS) augmented cognitive training (CT) in children with Fetal Alcohol Spectrum Disorders (FASD). Prenatal alcohol exposure has profound detrimental effects on brain development and individuals with FASD commonly present with deficits in executive functions including attention and working memory. The most commonly studied treatment for executive deficits is CT, which involves repeated drilling of exercises targeting the impaired functions. As currently implemented, CT requires many hours and the observed effect sizes are moderate. Neuromodulation via tDCS can enhance brain plasticity and prior studies demonstrate that combining tDCS with CT improves efficacy and functional outcomes. TDCS-augmented CT has not yet been tested in FASD, a condition in which there are known abnormalities in neuroplasticity and few interventions. METHODS: This study examined the feasibility and efficacy of this approach in 44 children with FASD. Participants were randomized to receive five sessions of CT with either active or sham tDCS targeting the dorsolateral prefrontal cortex, a region of the brain that is heavily involved in executive functioning. RESULTS: The intervention was feasible and well-tolerated in children with FASD. The tDCS group showed nominally significant improvement in attention on a continuous performance test compared to sham (p = .043). Group differences were observed at the third, fourth and fifth treatment sessions. There was no effect of tDCS on working memory (p = .911). Further, we found no group differences on a trail making task (p = .659) or on the verbal fluency test (p = .826). In the active tDCS group, a significant correlation was observed between improvement in attention scores and decrease in parent-reported attention deficits (p = .010). CONCLUSIONS: These results demonstrate that tDCS-augmented CT is well tolerated in children with FASD and potentially offers benefits over and above CT alone.

Deactivation in the posterior mid-cingulate cortex reflects perceptual transitions during binocular rivalry: Evidence from simultaneous EEG-fMRI.

Binocular rivalry is a phenomenon in which perception spontaneously shifts between two different images that are dichoptically presented to the viewer. By elucidating the cortical networks responsible for these stochastic fluctuations in perception, we can potentially learn much about the neural correlates of visual awareness. We obtained concurrent EEG-fMRI data for a group of 20 healthy human subjects during the continuous presentation of dichoptic visual stimuli. The two eyes' images were tagged with different temporal frequencies so that eye specific steady-state visual evoked potential (SSVEP) signals could be extracted from the EEG data for direct comparison with changes in fMRI BOLD activity associated with binocular rivalry. We additionally included a smooth replay condition that emulated the perceptual transitions experienced during binocular rivalry as a control stimulus. We evaluated a novel SSVEP-informed fMRI analysis in this study in order to delineate the temporal dynamics of rivalry-related BOLD activity from both an electrophysiological and behavioral perspective. In this manner, we assessed BOLD activity during rivalry that was directly correlated with peaks and crosses of the two rivaling, frequency-tagged SSVEP signals, for comparison with BOLD activity associated with subject reported perceptual transitions. Our findings point to a critical role of a right lateralized fronto-parietal network in the processing of bistable stimuli, given that BOLD activity in the right superior/inferior parietal lobules was significantly elevated throughout binocular rivalry and in particular during perceptual transitions, compared with the replay condition. Based on the SSVEP-informed analysis, rivalry was further associated with significantly enhanced BOLD suppression in the posterior mid-cingulate cortex during perceptual transitions, compared with SSVEP crosses. Overall, this work points to a careful interplay between early visual areas, the right posterior parietal cortex and the mid-cingulate cortex in mediating the spontaneous perceptual changes associated with binocular rivalry and has significant implications for future multimodal imaging studies of perception and awareness.

SSVEP signatures of binocular rivalry during simultaneous EEG and fMRI.

BACKGROUND: Binocular rivalry is a perceptual phenomenon that arises when two incompatible images are presented separately, one to each eye, and the observer experiences involuntary perceptual alternations between the two images. If the two images are flickering at two distinct frequencies, electroencephalography (EEG) can be used to track the frequency-tagged steady-state visually evoked potential (SSVEP) driven by each image as they compete for awareness, providing an objective measure of the subjective perceptual state. This spontaneous alternation in perceptual dominance is believed to be driven by neural processes across widespread regions in the brain, but the real-time mechanisms of these processes remain unclear. NEW METHOD: The goal of this study was to determine the feasibility of investigating binocular rivalry using a simultaneous EEG-fMRI approach in order to leverage the high temporal resolution of EEG with the high spatial resolution of fMRI. RESULTS: We have developed novel techniques for artifact removal and signal optimization for the rivalry-related SSVEP data collected simultaneously during fMRI. COMPARISON WITH EXISTING METHODS: Our methods address several significant technical challenges of recording SSVEP data in the noisy fMRI environment, and enabled us to successfully reconstruct SSVEP signatures of rivalry in a group of healthy human subjects. CONCLUSION: Further development and application of these techniques will enable more comprehensive integration of EEG and fMRI data collected simultaneously and could have significant implications for EEG-fMRI studies of brain activity in general.