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Randomized Controlled Trial
. 2023 Dec;25(1):24-32.
doi: 10.1080/19585969.2023.2186189.

Effects of intermittent theta-burst transcranial magnetic stimulation on cognition and hippocampal volumes in bipolar depression

Ivan J Torres  1   2 , Ruiyang Ge  1 , Alexander McGirr  3   4 , Fidel Vila-Rodriguez  5 , Sharon Ahn  1 , Jayasree Basivireddy  1 , Nazlin Walji  1 , Sophia Frangou  1 , Raymond W Lam  1 , Lakshmi N Yatham  1
Affiliations
Randomized Controlled Trial

Effects of intermittent theta-burst transcranial magnetic stimulation on cognition and hippocampal volumes in bipolar depression

Ivan J Torres et al. Dialogues Clin Neurosci. 2023 Dec.

Abstract

Introduction: Repetitive transcranial magnetic stimulation (TMS) is increasingly used to treat neurocognitive symptoms in mood disorders. Intermittent theta burst stimulation (iTBS) is a brief version of TMS that may preferentially target cognitive functions. This study evaluated whether iTBS leads to cognitive improvements and associated increased hippocampal volumes in bipolar depression.

Methods: In a two-site double-blind randomised sham controlled trial (NCT02749006), 16 patients received active iTBS to the Left Dorsolateral Prefrontal Cortex (DLPF) and 15 patients received sham stimulation across four weeks. A composite neuropsychological score and declarative memory scores served as the cognitive outcomes. Hippocampal volumes were derived from T1 weighted MRI scans using the longitudinal ComBat method to harmonise data across sites.

Results: No significant improvements were observed in any cognitive variables in the active relative to the sham group; however, there was a trend for increased left hippocampal volume in the former. Left hippocampal volume increases were associated with improvements in nonverbal memory in the active group.

Conclusions: Although cognitive improvements were not associated with iTBS, the finding that hippocampal volume increases were associated with memory improvement suggests there may be some level of prefrontal-temporal neuroplasticity that could support cognitive change in future studies of iTBS in bipolar disorder.

Keywords: Bipolar disorder; cognition; cognitive impairment; memory; rTMS; theta-burst.

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Conflict of interest statement

IJT has received consulting fees from Lundbeck Canada, Sumitomo Dainippon, and Community Living British Columbia. AM has served on an advisory board for Allergan Canada. FVR receives research support from CIHR, Brain Canada, Michael Smith Foundation for Health Research, Vancouver Coastal Health Research Institute, and Weston Brain Institute for investigator-initiated research. Philanthropic support from Seedlings Foundation. In-kind equipment support for this investigator-initiated trial from MagVenture. He has received honoraria for participation in an advisory board for Janssen. RWL has received funds for speaking/consulting or research from: Allergan, Asia-Pacific Economic Cooperation, BC Leading Edge Foundation, Canadian Institutes of Health Research, Canadian Network for Mood and Anxiety Treatments, Healthy Minds Canada, Janssen, Lundbeck, Lundbeck Institute, Michael Smith Foundation for Health Research, MITACS, Myriad Neuroscience, Ontario Brain Institute, Otsuka, Unity Health, Vancouver Coastal Health Research Institute, Viatris, and VGH-UBCH Foundation. LNY is a consultant and/or has received speaker fees and/or sits on the advisory board and/or receives research funding from Abbvie, Alkermes, Allergan, Canadian Network for Mood and Anxiety Treatments (CANMAT), Canadian Institutes of Health Research (CIHR), Dainippon Sumitomo Pharma, Gedeon Richter, Intracellular Therapies, Lundbeck, Merck, Otsuka, Sanofi and Sunovion over the past three years. All other authors have no conflicts to declare.

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