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Caulfield KA, LaPorta SM, Walton RM, Collins EV, Summers PM, Cho JY, Antonucci MU, Opitz A, George MS, McTeague LM. Mitigating the risk of overdosing TMS due to coil-to-scalp distance: An electric field modeling study. Brain Stimul 2024; 17:970-974. [PMID: 39127097 DOI: 10.1016/j.brs.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 08/04/2024] [Accepted: 08/05/2024] [Indexed: 08/12/2024] Open
Affiliation(s)
- Kevin A Caulfield
- Brain Stimulation Division, Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, SC, USA.
| | - Samantha M LaPorta
- Brain Stimulation Division, Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, SC, USA
| | - Rhiannon M Walton
- Brain Stimulation Division, Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, SC, USA
| | - Elisabeth V Collins
- Brain Stimulation Division, Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, SC, USA
| | - Philipp M Summers
- Brain Stimulation Division, Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, SC, USA
| | - Jennifer Y Cho
- College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Michael U Antonucci
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Alexander Opitz
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Mark S George
- Brain Stimulation Division, Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Lisa M McTeague
- Brain Stimulation Division, Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson VA Medical Center, Charleston, SC, USA
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Grosshagauer S, Woletz M, Vasileiadi M, Linhardt D, Nohava L, Schuler AL, Windischberger C, Williams N, Tik M. Chronometric TMS-fMRI of personalized left dorsolateral prefrontal target reveals state-dependency of subgenual anterior cingulate cortex effects. Mol Psychiatry 2024:10.1038/s41380-024-02535-3. [PMID: 38532009 DOI: 10.1038/s41380-024-02535-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 03/28/2024]
Abstract
Transcranial magnetic stimulation (TMS) applied to a left dorsolateral prefrontal cortex (DLPFC) area with a specific connectivity profile to the subgenual anterior cingulate cortex (sgACC) has emerged as a highly effective non-invasive treatment option for depression. However, antidepressant outcomes demonstrate significant variability among therapy plans and individuals. One overlooked contributing factor is the individual brain state at the time of treatment. In this study we used interleaved TMS-fMRI to investigate the influence of brain state on acute TMS effects, both locally and remotely. TMS was performed during rest and during different phases of cognitive task processing. Twenty healthy participants were included in this study. In the first session, imaging data for TMS targeting were acquired, allowing for identification of individualized targets in the left DLPFC based on highest anti-correlation with the sgACC. The second session involved chronometric interleaved TMS-fMRI measurements, with 10 Hz triplets of TMS administered during rest and at distinct timings during an N-back task. Consistent with prior findings, interleaved TMS-fMRI revealed significant BOLD activation changes in the targeted network. The precise timing of TMS relative to the cognitive states during the task demonstrated distinct BOLD response in clinically relevant brain regions, including the sgACC. Employing a standardized timing approach for TMS using a task revealed more consistent modulation of the sgACC at the group level compared to stimulation during rest. In conclusion, our findings strongly suggest that acute local and remote effects of TMS are influenced by brain state during stimulation. This study establishes a basis for considering brain state as a significant factor in designing treatment protocols, possibly improving TMS treatment outcomes.
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Affiliation(s)
- Sarah Grosshagauer
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Michael Woletz
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Maria Vasileiadi
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - David Linhardt
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Lena Nohava
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Anna-Lisa Schuler
- Research Group Cognition and Plasticity, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Christian Windischberger
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Nolan Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Martin Tik
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.
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3
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Dannhauer M, Gomez LJ, Robins PL, Wang D, Hasan NI, Thielscher A, Siebner HR, Fan Y, Deng ZD. Electric Field Modeling in Personalizing Transcranial Magnetic Stimulation Interventions. Biol Psychiatry 2024; 95:494-501. [PMID: 38061463 PMCID: PMC10922371 DOI: 10.1016/j.biopsych.2023.11.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/21/2023] [Accepted: 11/25/2023] [Indexed: 01/21/2024]
Abstract
The modeling of transcranial magnetic stimulation (TMS)-induced electric fields (E-fields) is a versatile technique for evaluating and refining brain targeting and dosing strategies, while also providing insights into dose-response relationships in the brain. This review outlines the methodologies employed to derive E-field estimations, covering TMS physics, modeling assumptions, and aspects of subject-specific head tissue and coil modeling. We also summarize various numerical methods for solving the E-field and their suitability for various applications. Modeling methodologies have been optimized to efficiently execute numerous TMS simulations across diverse scalp coil configurations, facilitating the identification of optimal setups or rapid cortical E-field visualization for specific brain targets. These brain targets are extrapolated from neurophysiological measurements and neuroimaging, enabling precise and individualized E-field dosing in experimental and clinical applications. This necessitates the quantification of E-field estimates using metrics that enable the comparison of brain target engagement, functional localization, and TMS intensity adjustments across subjects. The integration of E-field modeling with empirical data has the potential to uncover pivotal insights into the aspects of E-fields responsible for stimulating and modulating brain function and states, enhancing behavioral task performance, and impacting the clinical outcomes of personalized TMS interventions.
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Affiliation(s)
- Moritz Dannhauer
- Computational Neurostimulation Research Program, Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, Maryland
| | - Luis J Gomez
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, Indiana
| | - Pei L Robins
- Computational Neurostimulation Research Program, Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, Maryland
| | - Dezhi Wang
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, Indiana
| | - Nahian I Hasan
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, Indiana
| | - Axel Thielscher
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Hartwig R Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark; Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Yong Fan
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Zhi-De Deng
- Computational Neurostimulation Research Program, Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, Maryland.
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Van Hoornweder S, Nuyts M, Frieske J, Verstraelen S, Meesen RLJ, Caulfield KA. Outcome measures for electric field modeling in tES and TMS: A systematic review and large-scale modeling study. Neuroimage 2023; 281:120379. [PMID: 37716590 PMCID: PMC11008458 DOI: 10.1016/j.neuroimage.2023.120379] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/18/2023] [Accepted: 09/13/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND Electric field (E-field) modeling is a potent tool to estimate the amount of transcranial magnetic and electrical stimulation (TMS and tES, respectively) that reaches the cortex and to address the variable behavioral effects observed in the field. However, outcome measures used to quantify E-fields vary considerably and a thorough comparison is missing. OBJECTIVES This two-part study aimed to examine the different outcome measures used to report on tES and TMS induced E-fields, including volume- and surface-level gray matter, region of interest (ROI), whole brain, geometrical, structural, and percentile-based approaches. The study aimed to guide future research in informed selection of appropriate outcome measures. METHODS Three electronic databases were searched for tES and/or TMS studies quantifying E-fields. The identified outcome measures were compared across volume- and surface-level E-field data in ten tES and TMS modalities targeting two common targets in 100 healthy individuals. RESULTS In the systematic review, we extracted 308 outcome measures from 202 studies that adopted either a gray matter volume-level (n = 197) or surface-level (n = 111) approach. Volume-level results focused on E-field magnitude, while surface-level data encompassed E-field magnitude (n = 64) and normal/tangential E-field components (n = 47). E-fields were extracted in ROIs, such as brain structures and shapes (spheres, hexahedra and cylinders), or the whole brain. Percentiles or mean values were mostly used to quantify E-fields. Our modeling study, which involved 1,000 E-field models and > 1,000,000 extracted E-field values, revealed that different outcome measures yielded distinct E-field values, analyzed different brain regions, and did not always exhibit strong correlations in the same within-subject E-field model. CONCLUSIONS Outcome measure selection significantly impacts the locations and intensities of extracted E-field data in both tES and TMS E-field models. The suitability of different outcome measures depends on the target region, TMS/tES modality, individual anatomy, the analyzed E-field component and the research question. To enhance the quality, rigor, and reproducibility in the E-field modeling domain, we suggest standard reporting practices across studies and provide four recommendations.
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Affiliation(s)
- Sybren Van Hoornweder
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, University of Hasselt, Diepenbeek, Belgium.
| | - Marten Nuyts
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, University of Hasselt, Diepenbeek, Belgium
| | - Joana Frieske
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, University of Hasselt, Diepenbeek, Belgium; Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - Stefanie Verstraelen
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, University of Hasselt, Diepenbeek, Belgium
| | - Raf L J Meesen
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, University of Hasselt, Diepenbeek, Belgium; Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - Kevin A Caulfield
- Brain Stimulation Laboratory, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, United States.
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Similarities and differences in working memory and neurometabolism of obsessive-compulsive disorder and major depressive disorder. J Affect Disord 2022; 311:556-564. [PMID: 35588910 DOI: 10.1016/j.jad.2022.05.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/07/2022] [Accepted: 05/13/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) and major depressive disorder (MDD) both showed cognitive impairment, and the altered neurometabolic may associate with cognitive impairment. However, there are limited comparative working memory (WM) and neuroimaging studies on these two disorders. Therefore, we investigated the characteristics of WM and neurometabolic changes in patients with OCD and MDD. METHODS A total of 64 unmedicated patients (32 OCD and 32 MDD), and 33 healthy controls (HC) were included to conduct WM assessment comprising Digit Span Test (DST), 2-back task and Stroop Color and Word Test (SCWT). Additionally, all subjects underwent protons magnetic resonance spectroscopy (1H-MRS) to collect neurometabolic ratios of N-acetyl aspartate (NAA) and choline-containing compounds (Cho) to creatine (Cr) in the prefrontal cortex (PFC) and lentiform nucleus (LN). Finally, differential and correlation analysis were conducted to investigate their characteristics and relationships. RESULTS Compared with HC, both OCD and MDD patients exhibited a lower accuracy rate in the 2-back task, and only MDD patients performed worse in DST scores and longer reaction times in SCWT (all p < 0.05). Both OCD and MDD patients had lower NAA/Cr ratios in bilateral PFC (all p < 0.05). And the decreased NAA/Cr ratios in right PFC were positively correlated to DST scores in MDD group (r = 0.518, p = 0.003). CONCLUSIONS Both OCD and MDD showed WM impairment and neurometabolic alterations in PFC. Besides, MDD performed more severe and broader WM impairment compared to OCD. Moreover, the dysfunction of PFC may underlie the neural basis of WM impairment in MDD.
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Dannhauer M, Huang Z, Beynel L, Wood E, Bukhari-Parlakturk N, Peterchev AV. TAP: targeting and analysis pipeline for optimization and verification of coil placement in transcranial magnetic stimulation. J Neural Eng 2022; 19:10.1088/1741-2552/ac63a4. [PMID: 35377345 PMCID: PMC9131512 DOI: 10.1088/1741-2552/ac63a4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/01/2022] [Indexed: 11/12/2022]
Abstract
Objective.Transcranial magnetic stimulation (TMS) can modulate brain function via an electric field (E-field) induced in a brain region of interest (ROI). The ROI E-field can be computationally maximized and set to match a specific reference using individualized head models to find the optimal coil placement and stimulus intensity. However, the available software lacks many practical features for prospective planning of TMS interventions and retrospective evaluation of the experimental targeting accuracy.Approach.The TMS targeting and analysis pipeline (TAP) software uses an MRI/fMRI-derived brain target to optimize coil placement considering experimental parameters such as the subject's hair thickness and coil placement restrictions. The coil placement optimization is implemented in SimNIBS 3.2, for which an additional graphical user interface (TargetingNavigator) is provided to visualize/adjust procedural parameters. The coil optimization process also computes the E-field at the target, allowing the selection of the TMS device intensity setting to achieve specific E-field strengths. The optimized coil placement information is prepared for neuronavigation software, which supports targeting during the TMS procedure. The neuronavigation system can record the coil placement during the experiment, and these data can be processed in TAP to quantify the accuracy of the experimental TMS coil placement and induced E-field.Main results.TAP was demonstrated in a study consisting of three repetitive TMS sessions in five subjects. TMS was delivered by an experienced operator under neuronavigation with the computationally optimized coil placement. Analysis of the experimental accuracy from the recorded neuronavigation data indicated coil location and orientation deviations up to about 2 mm and 2°, respectively, resulting in an 8% median decrease in the target E-field magnitude compared to the optimal placement.Significance.TAP supports navigated TMS with a variety of features for rigorous and reproducible stimulation delivery, including planning and evaluation of coil placement and intensity selection for E-field-based dosing.
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Affiliation(s)
- Moritz Dannhauer
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC 27710, USA
| | - Ziping Huang
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC 27710, USA
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Lysianne Beynel
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC 27710, USA
| | - Eleanor Wood
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC 27710, USA
| | | | - Angel V. Peterchev
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC 27710, USA
- Department of Electrical and Computer Engineering, Duke University, Durham, NC 27708, USA
- Department of Neurosurgery, Duke University, Durham, NC 27710, USA
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
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Beynel L, Dannhauer M, Palmer H, Hilbig SA, Crowell CA, Wang JE, Michael AM, Wood EA, Luber B, Lisanby SH, Peterchev AV, Cabeza R, Davis SW, Appelbaum LG. Network-based rTMS to modulate working memory: The difficult choice of effective parameters for online interventions. Brain Behav 2021; 11:e2361. [PMID: 34651464 PMCID: PMC8613413 DOI: 10.1002/brb3.2361] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/06/2021] [Accepted: 09/06/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Online repetitive transcranialmagnetic stimulation (rTMS) has been shown to modulate working memory (WM) performance in a site-specific manner, with behavioral improvements due to stimulation of the dorsolateral prefrontal cortex (DLPFC), and impairment from stimulation to the lateral parietal cortex (LPC). Neurobehavioral studies have demonstrated that subprocesses of WM allowing for the maintenance and manipulation of information in the mind involve unique cortical networks. Despite promising evidence of modulatory effects of rTMS on WM, no studies have yet demonstrated distinct modulatory control of these two subprocesses. The current study therefore sought to explore this possibility through site-specific stimulation during an online task invoking both skills. METHODS Twenty-nine subjects completed a 4-day protocol, in which active or sham 5Hz rTMS was applied over the DLPFC and LPC in separate blocks of trials while participants performed tasks that required either maintenance alone, or both maintenance and manipulation (alphabetization) of information. Stimulation targets were defined individually based on fMRI activation and structural network properties. Stimulation amplitude was adjusted using electric field modeling to equate induced current in the target region across participants. RESULTS Despite the use of advanced techniques, no significant differences or interactions between active and sham stimulation were found. Exploratory analyses testing stimulation amplitude, fMRI activation, and modal controllability showed nonsignificant but interesting trends with rTMS effects. CONCLUSION While this study did not reveal any significant behavioral changes in WM, the results may point to parameters that contribute to positive effects, such as stimulation amplitude and functional activation.
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Affiliation(s)
- Lysianne Beynel
- Department of Psychiatry and Behavioral ScienceDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Moritz Dannhauer
- Department of Psychiatry and Behavioral ScienceDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Hannah Palmer
- Department of Psychiatry and Behavioral ScienceDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Susan A. Hilbig
- Department of Psychiatry and Behavioral ScienceDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Courtney A. Crowell
- Department of Psychiatry and Behavioral ScienceDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Joyce E‐H. Wang
- Department of Psychiatry and Behavioral ScienceDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Andrew M. Michael
- Duke Institute for Brain SciencesDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Eleanor A. Wood
- Department of Psychiatry and Behavioral ScienceDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Bruce Luber
- Noninvasive Neuromodulation UnitExperimental Therapeutics and Pathophysiology BranchNational Institute of Mental HealthBethesdaMarylandUSA
| | - Sarah H. Lisanby
- Noninvasive Neuromodulation UnitExperimental Therapeutics and Pathophysiology BranchNational Institute of Mental HealthBethesdaMarylandUSA
| | - Angel V. Peterchev
- Department of Psychiatry and Behavioral ScienceDuke University School of MedicineDurhamNorth CarolinaUSA
- Department of Biomedical EngineeringDuke University School of MedicineDurhamNorth CarolinaUSA
- Department of Electrical and Computer EngineeringDuke University School of MedicineDurhamNorth CarolinaUSA
- Department of NeurosurgeryDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Roberto Cabeza
- Center for Cognitive NeuroscienceDuke UniversityDurhamNorth CarolinaUSA
- Department of Psychology & NeuroscienceDuke UniversityDurhamNorth CarolinaUSA
| | - Simon W. Davis
- Center for Cognitive NeuroscienceDuke UniversityDurhamNorth CarolinaUSA
- Department of NeurologyDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Lawrence G. Appelbaum
- Department of Psychiatry and Behavioral ScienceDuke University School of MedicineDurhamNorth CarolinaUSA
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