rTMS stimulation on left DLPFC affects emotional cue retrieval as a function of anxiety level and gender

Neural correlates of approach-avoidance behavior in healthy subjects: Effects of low-frequency repetitive transcranial magnetic stimulation (rTMS) over the right dorsolateral prefrontal cortex

The dorsolateral prefrontal cortex (dlPFC) is implicated in top-down regulation of emotion, but the detailed network mechanisms require further elucidation. To investigate network-level functions of the dlPFC in emotion regulation, this study measured changes in task-based activation, resting-state and task-based functional connectivity (FC) patterns following suppression of dlPFC excitability by 1-Hz repetitive transcranial magnetic stimulation (rTMS). In a sham-controlled within-subject design, 1-Hz active or sham rTMS was applied to the right dlPFC of 19 healthy volunteers during two separate counterbalanced sessions. Following active and sham rTMS, functional magnetic resonance imaging (fMRI) was conducted in the resting state (rs-fMRI) and during approach-avoidance task responses to pictures with positive and negative emotional content (task-based fMRI). Activation and generalized psychophysiological interaction analyses were performed on task-based fMRI, and seed-based FC analysis was applied to rs-fMRI data. Task-based fMRI revealed greater and more lateralized activation in the right hemisphere during negative picture responses compared to positive picture responses. After active rTMS, greater activation was observed in the left middle prefrontal cortex compared to sham rTMS. Further, rTMS reduced response times and error rates in approach to positive pictures compared to negative pictures. Significant FC changes due to rTMS were observed predominantly in the frontoparietal network (FPN) and visual network (VN) during the task, and in the default mode network (DMN) and VN at rest. Suppression of right dlPFC activity by 1-Hz rTMS alters large-scale neural networks and modulates emotion, supporting potential applications for the treatment of mood disorders.

An insula-based network mediates the relation between rumination and interoceptive sensibility in the healthy population

BACKGROUND

Individuals sometimes continuously centered their attention on the same thoughts. When such process tends to be negative and self-referential, we delineated this mental state as rumination, which may undermine body's perception of endogenous signal, but little is known about the certainly relationship and the potential neural mechanisms.

METHODS

Rumination and interoceptive sensibility were measured by questionnaires, then insula-related network of rumination dimensions were examined by the whole brain resting-state functional connectivity (FC) in 479 college students, and whether the insula-based network mediate the relationship between rumination and interoceptive sensibility were tested.

RESULTS

Rumination (including brooding reflective pondering) and interoceptive sensibility showed positive correlations. The neural mechanisms of brooding and reflective pondering were all related to the insula-networks, to be specific, brooding was positively correlated with the FC between the left posterior insula (PI) and left parahippocampal gyrus/ hippocampus (PHG), reflective pondering were positively correlated with the FC between the insula subregion and the dorsolateral prefrontal cortex. Moreover, the relationship between brooding and interoceptive sensibility was mediated by the FC between left PI and left PHG.

LIMITATIONS

We just tested the relationship between rumination and interoceptive sensibility at a cross-sectional level, but it is unclear that whether the longitudinal relationship would be predicted by the related network.

CONCLUSIONS

Our findings provided new insights into neural mechanisms of brooding and reflective pondering, also the integration of brooding and interoceptive sensibility. The insula-related networks may contribute crucially to rumination and interoception.

Smart Device-Driven Corticolimbic Plasticity in Cognitive–Emotional Restructuring of Space-Related Neuropsychiatric Disease and Injury

Escalating government and commercial efforts to plan and deploy viable manned near-to-deep solar system exploration and habitation over the coming decades now drives next-generation space medicine innovations. The application of cutting-edge precision medicine, such as brain stimulation techniques, provides powerful clinical and field/flight situation methods to selectively control vagal tone and neuroendocrine-modulated corticolimbic plasticity, which is affected by prolonged cosmic radiation exposure, social isolation or crowding, and weightlessness in constricted operational non-terran locales. Earth-based clinical research demonstrates that brain stimulation approaches may be combined with novel psychotherapeutic integrated memory structure rationales for the corrective reconsolidation of arousing or emotional experiences, autobiographical memories, semantic schema, and other cognitive structures to enhance neuropsychiatric patient outcomes. Such smart cotherapies or countermeasures, which exploit natural, pharmaceutical, and minimally invasive neuroprosthesis-driven nervous system activity, may optimize the cognitive-emotional restructuring of astronauts suffering from space-related neuropsychiatric disease and injury, including mood, affect, and anxiety symptoms of any potential severity and pathophysiology. An appreciation of improved neuropsychiatric healthcare through the merging of new or rediscovered smart theragnostic medical technologies, capable of rendering personalized neuroplasticity training and managed psychotherapeutic treatment protocols, will reveal deeper insights into the illness states experienced by astronauts. Future work in this area should emphasize the ethical role of telemedicine and/or digital clinicians to advance the (semi)autonomous, technology-assisted medical prophylaxis, diagnosis, treatment, monitoring, and compliance of astronauts for elevated health, safety, and performance in remote extreme space and extraterrestrial environments.

Augmentation of fear extinction by theta-burst transcranial magnetic stimulation of the prefrontal cortex in humans

BACKGROUND

Fear extinction alone does not erase the original fear memory. Interventions that enhance extinction can be beneficial for the treatment of fear-related disorders. Repetitive transcranial magnetic stimulation has been shown to improve memory performance. The present study examined the effects of intermittent theta-burst stimulation (iTBS) on fear extinction and the return of fear memory in humans.

METHODS

Ninety-one young healthy volunteers underwent 3 experiments using a randomized controlled experimental design. Participants first acquired fear conditioning, after which they received 30 Hz iTBS before and after extinction training. The iTBS was applied to 1 of 2 targets: the left dorsolateral prefrontal cortex (dlPFC) and the vertex (control). Fear responses were measured 24 hours later and 1 month later.

RESULTS

During the spontaneous recovery and reinstatement tests, iTBS of the left dlPFC before and after extinction significantly reduced fear response, whereas iTBS of the vertex had no effect on fear memory performance. This combined approach had a relatively long-lasting effect (i.e., at least 1 month).

LIMITATIONS

We did not explore the effect of iTBS of the dlPFC on the expression of fear without extinction training. The neural mechanisms of iTBS with fear extinction to inhibit the fear response are unclear. Our results are preliminary and should be interpreted with caution.

CONCLUSION

`The present results showed that 30 Hz iTBS of the left dlPFC enhanced retention of fear extinction. Our study introduces a new intervention for fear memory and suggests that the left dlPFC may be a treatment target for fear-related disorders.

Low-frequency parietal repetitive transcranial magnetic stimulation reduces fear and anxiety

Anxiety disorders are the most prevalent mental disorders, with few effective neuropharmacological treatments, making treatments development critical. While noninvasive neuromodulation can successfully treat depression, few treatment targets have been identified specifically for anxiety disorders. Previously, we showed that shock threat increases excitability and connectivity of the intraparietal sulcus (IPS). Here we tested the hypothesis that inhibitory repetitive transcranial magnetic stimulation (rTMS) targeting this region would reduce induced anxiety. Subjects were exposed to neutral, predictable, and unpredictable shock threat, while receiving double-blinded, 1 Hz active or sham IPS rTMS. We used global brain connectivity and electric-field modelling to define the single-subject targets. We assessed subjective anxiety with online ratings and physiological arousal with the startle reflex. Startle stimuli (103 dB white noise) probed fear and anxiety during the predictable (fear-potentiated startle, FPS) and unpredictable (anxiety-potentiated startle, APS) conditions. Active rTMS reduced both FPS and APS relative to both the sham and no stimulation conditions. However, the online anxiety ratings showed no difference between the stimulation conditions. These results were not dependent on the laterality of the stimulation, or the subjects' perception of the stimulation (i.e. active vs. sham). Results suggest that reducing IPS excitability during shock threat is sufficient to reduce physiological arousal related to both fear and anxiety, and are consistent with our previous research showing hyperexcitability in this region during threat. By extension, these results suggest that 1 Hz parietal stimulation may be an effective treatment for clinical anxiety, warranting future work in anxiety patients.

The Neuroanatomical Basis of Two Subcomponents of Rumination: A VBM Study

Rumination is a trait that includes two subcomponents, namely brooding and reflective pondering, respectively construed as maladaptive and adaptive response styles to negative experiences. Existing evidence indicates that rumination in general is associated with structural and functional differences in the anterior cingulate cortex (ACC) and the dorsal lateral prefrontal cortex (DLPFC). However, conclusive evidence on the specific neural structural basis of each of the two subcomponents is lacking. In this voxel-based morphometry study, we investigated the independent and specific neural structural basis of brooding and reflective pondering in 30 healthy young adults, who belonged to high or low brooding or reflective pondering groups. Consistent with past research, modest but significant positive correlation was found between brooding and reflective pondering. When controlling for reflective pondering, high-brooding group showed increased gray matter volumes in the left DLPFC and ACC. Further analysis on extracted gray matter values showed that gray matter of the same DLPFC and ACC regions also showed significant negative effects of reflective pondering. Taken together, our findings indicate that the two subcomponents of rumination might share some common processes yet also have distinct neural basis. In view of the significant roles of the left DLPFC and ACC in attention and self-related emotional processing/regulation, our findings provide insight into how the potentially shared and distinct cognitive, affective and neural processes of brooding and reflective pondering can be extended to clinical populations to further elucidate the neurobehavioral relationships between rumination and prefrontal abnormality.

Affective Processing in Non-invasive Brain Stimulation Over Prefrontal Cortex

The prefrontal cortex (PFC) is the most frequently targeted brain region by non-invasive brain stimulation (NBS) studies. Non-invasively stimulating the PFC has been shown to both modulate affective processing and improve the clinical symptoms of several psychiatric disorders, such as depression and schizophrenia. The magnitude of the modulation depends on several factors, including the stimulation frequency, the number of stimulation sessions, and the specific sub-region of the PFC that is stimulated. Although some of the potential underlying mechanisms have been identified, the exact mechanisms that underlie these cognitive and affective changes remain unclear. The present review aims to summarize recent advances in the study of affective processing using NBS over the PFC. We will provide a theoretical framework for better understanding how affective processing changes are induced by NBS, with the goal of providing testable hypotheses for future studies.

An Exploratory TMS Study on Prefrontal Lateralization in Valence Categorization of Facial Expressions

Abstract. Converging neuroimaging and patient data suggest that the dorsolateral prefrontal cortex (DLPFC) is involved in emotional processing. However, it is still not clear whether the DLPFC in the left and right hemisphere is differentially involved in emotion recognition depending on the emotion considered. Here we used transcranial magnetic stimulation (TMS) to shed light on the possible causal role of the left and right DLPFC in encoding valence of positive and negative emotional facial expressions. Participants were required to indicate whether a series of faces displayed a positive or negative expression, while TMS was delivered over the right DLPFC, the left DLPFC, and a control site (vertex). Interfering with activity in both the left and right DLPFC delayed valence categorization (compared to control stimulation) to a similar extent irrespective of emotion type. Overall, we failed to demonstrate any valence-related lateralization in the DLPFC by using TMS. Possible methodological limitations are discussed.

The role of the dorsolateral prefrontal cortex in early threat processing: a TMS study

Previous studies demonstrated that excitatory (high frequency) offline transcranial magnetic stimulation (TMS) over the left and right dorsolateral prefrontal cortex (DLPFC) modulates attention allocation on threatening stimuli in non-clinical samples. These studies only employed offline TMS protocol that did not allow investigating the effect of the stimulation on the early stage of threat processing. In this study, the role of the right and left dorsolateral prefrontal cortex in early threat processing was investigated in high and low anxious individuals by means of an inhibitory single-pulse online TMS protocol. Our results demonstrated the role of the left DLPFC in an early stage of threat processing and that this effect is modulated by individuals' anxiety level. The inhibitory stimulation of the left DLPFC determined a disengagement bias in high anxious individuals, while the same stimulation determined an attentional avoidance in low anxious individuals. The findings of the present study suggest that right and left DLPFC are differently involved in early threat processing of healthy individuals.

Transcranial Magnetic Stimulation of Left Dorsolateral Prefrontal Cortex Induces Brain Morphological Changes in Regions Associated with a Treatment Resistant Major Depressive Episode: An Exploratory Analysis

BACKGROUND

Repetitive transcranial magnetic stimulation (TMS) is an FDA-approved antidepressant treatment but little is known of its mechanism of action. Specifically, downstream effects of TMS remain to be elucidated.

OBJECTIVE/HYPOTHESIS

This study aims to identify brain structural changes from TMS treatment of a treatment resistant depressive episode through an exploratory analysis.

METHODS

Twenty-seven subjects in a DSM-IV current major depressive episode and on a stable medication regimen had a 3T magnetic resonance T1 structural scan before and after five weeks of standard TMS treatment to the left dorsolateral prefrontal cortex. Twenty-seven healthy volunteer (HVs) subjects had the same brain MRI acquisition. Voxel-based morphometry was performed using high dimensional non-linear diffusomorphic anatomical registration (DARTEL).

RESULTS

Six clusters of gray matter volume (GMV) that were lower in pre-treatment MRIs of depressed subjects than in HVs. GMV in four of these regions increased in MDD after TMS treatment by 3.5-11.2%. The four brain regions that changed with treatment were centered in the left anterior cingulate cortex, the left insula, the left superior temporal gyrus and the right angular gyrus. Increases in the anterior cingulate GMV with TMS correlated with improvement in depression severity.

CONCLUSIONS

To our knowledge, this is the first study of brain structural changes during TMS treatment of depression. The affected brain areas are involved in cognitive appraisal, decision-making and subjective experience of emotion. These effects may have potential relevance for the antidepressant action of TMS.

Empathy, Approach Attitude, and rTMs on Left DLPFC Affect Emotional Face Recognition and Facial Feedback (EMG)

Abstract. Empathic trait (Balanced Emotional Empathy Scale [BEES]) and emotional attitude (Behavior Activation System [BAS]) were supposed to modulate emotional face recognition, based on left dorsolateral prefrontal (DLPFC) cortex contribution. High-empathic trait (high-BEES) was compared with low-empathic trait (low-BEES), when detection performance (Accuracy Index; Response Times [RTs]) and facial activity (electromyogram, EMG, i.e., zygomatic and corrugators muscle activity) were analyzed. Moreover, the implication of the left DLPFC was tested by using low-frequency rTMS (repeated Transcranial Magnetic Stimulation) to induce a decreased response to facial expression of emotions when subjects (N = 46) were required to empathize with the emotional stimuli. EMG and behavioral responses were found to be modulated by BEES and BAS, with a decreased performance and a reduced facial responsiveness in response to happiness for high-BEES and high-BAS in the case of TMS on left DLPFC. Secondly, an emotion-specific effect was found: the DLPFC effect was observed for the positive emotion (happiness) more than for the negative emotions (anger and fear) with a decreased performance (lower Accuracy Index [AI] and higher RTs) and a decreased zygomatic muscle activity. Finally, a direct correlation was found between BEES and BAS and the latter was revealed to be predictive (regression analysis) of the behavioral and EMG modulation induced by TMS. These results suggest significant effect by empathic and emotional attitude component on both EMG and behavioral level in emotional face recognition. This mechanism appears to be supported and regulated by DLPFC. The lateralization (left) effect was discussed in light of the valence model of emotions.

Does non-invasive brain stimulation applied over the dorsolateral prefrontal cortex non-specifically influence mood and emotional processing in healthy individuals?

The dorsolateral prefrontal cortex (DLPFC) is often targeted with non-invasive brain stimulation (NIBS) to modulate in vivo human behaviors. This brain region plays a key role in mood, emotional processing, and attentional processing of emotional information. In this article, we ask the question: when we target the DLPFC with NIBS, do we modulate these processes altogether, non-specifically, or can we modulate them selectively? We thus review articles investigating the effects of NIBS applied over the DLPFC on mood, emotional processing, and attentional processing of emotional stimuli in healthy subjects. We discuss that NIBS over the DLPFC can modulate emotional processing and attentional processing of emotional stimuli, without specifically influencing mood. Indeed, there seems to be a lack of evidence that NIBS over the DLPFC influences mood in healthy individuals. Finally, there appears to be a hemispheric lateralization: when applied over the left DLPFC, NIBS improved processing of positive stimuli and reduced selective attention for stimuli expressing anger, whereas when applied over the right DLPFC, it increased selective attention for stimuli expressing anger.

Benefits of using culturally unfamiliar stimuli in ambiguous emotion identification: A cross-cultural study

A novel emotion recognition task that employs photos of a Japanese mask representing a highly ambiguous stimulus was evaluated. As non-Asians perceive and/or label emotions differently from Asians, we aimed to identify patterns of task-performance in non-Asian healthy volunteers with a view to future patient studies. The Noh mask test was presented to 42 adult German participants. Reaction times and emotion attribution patterns were recorded. To control for emotion identification abilities, a standard emotion recognition task was used among others. Questionnaires assessed personality traits. Finally, results were compared to age- and gender-matched Japanese volunteers. Compared to other tasks, German participants displayed slowest reaction times on the Noh mask test, indicating higher demands of ambiguous emotion recognition. They assigned more positive emotions to the mask than Japanese volunteers, demonstrating culture-dependent emotion identification patterns. As alexithymic and anxious traits were associated with slower reaction times, personality dimensions impacted on performance, as well. We showed an advantage of ambiguous over conventional emotion recognition tasks. Moreover, we determined emotion identification patterns in Western individuals impacted by personality dimensions, suggesting performance differences in clinical samples. Due to its properties, the Noh mask test represents a promising tool in the differential diagnosis of psychiatric disorders, e.g. schizophrenia.

Sexual dimorphism and brain lateralization impact behavioral and histological outcomes following hypoxia-ischemia in P3 and P7 rats

Neonatal cerebral hypoxia-ischemia (HI) is a major cause of neurological disorders and the most common cause of death and permanent disability worldwide, affecting 1-2/1000 live term births and up to 60% of preterm births. The Levine-Rice is the main experimental HI model; however, critical variables such as the age of animals, sex and hemisphere damaged still receive little attention in experimental design. We here investigated the influence of sex and hemisphere injured on the functional outcomes and tissue damage following early (hypoxia-ischemia performed at postnatal day 3 (HIP3)) and late (hypoxia-ischemia performed at postnatalday 7 (HIP7)) HI injury in rats. Male and female 3- (P3) or 7-day-old (P7) Wistar rats had their right or left common carotid artery occluded and exposed to 8% O2 for 1.5h. Sham animals had their carotids exposed but not occluded nor submitted to the hypoxic atmosphere. Behavioral impairments were assessed in the open field arena, in the Morris water maze and in the inhibitory avoidance task; volumetric extent of tissue damage was assessed using cresyl violet staining at adult age, after completing behavioral assessment. The overall results demonstrate that: (1) HI performed at the two distinct ages cause different behavioral impairments and histological damage in adult rats (2) behavioral deficits following neonatal HIP3 and HIP7 are task-specific and dependent on sex and hemisphere injured (3) HIP7 animals presented the expected motor and cognitive deficits (4) HIP3 animals displayed discrete but significant cognitive impairments in the left hemisphere-injured females (5) HI brain injury and its consequences are determined by animal's sex and the damaged hemisphere, markedly in HIP3-injured animals.

Motivational mechanisms (BAS) and prefrontal cortical activation contribute to recognition memory for emotional words. rTMS effect on performance and EEG (alpha band) measures

The present research addressed the question of where memories for emotional words could be represented in the brain. A second main question was related to the effect of personality traits, in terms of the Behavior Activation System (BAS), in emotional word recognition. We tested the role of the left DLPFC (LDLPFC) by performing a memory task in which old (previously encoded targets) and new (previously not encoded distractors) positive or negative emotional words had to be recognized. High-BAS and low-BAS subjects were compared when a repetitive TMS (rTMS) was applied on the LDLPFC. We found significant differences between high-BAS vs. low-BAS subjects, with better performance for high-BAS in response to positive words. In parallel, an increased left cortical activity (alpha desynchronization) was observed for high-BAS in the case of positive words. Thus, we can conclude that the left approach-related hemisphere, underlying BAS, may support faster recognition of positive words.

Transcranial magnetic stimulation modulates left premotor cortex activity in facial expression recognition as a function of anxiety level

Recognition of emotional facial expressions is based on simulation and mirroring processes, and the premotor cortex is supposed to support this simulation mechanism. The role of this prefrontal area in processing emotional faces with different valence (anger, fear, happiness and neutral) was explored taking into account the effect of the lateralization model (more right-side activation for negative emotions; more left-side activation for positive emotions) of face processing and anxiety level (high vs low). High-frequency repetitive transcranial magnetic stimulation (rTMS, 10 Hz) was applied to the left prefrontal area to induce an increased activation response within the left premotor cortex. Twenty-nine subjects, who were divided into two different groups depending on their anxiety level (high/low anxiety; State-Trait-Anxiety Inventory (STAI), were asked to detect emotion / no emotion. Accuracy (AcI) and response times (RTs) were considered in response to the experimental conditions. A general significant increased performance was found in response to positive emotions in the case of left-side stimulation. Moreover, whereas high-anxiety subjects revealed a significant negative-valence bias in absence of stimulation, they showed a more significant AcI increasing and RTs decreasing in response to positive emotions in case of left premotor brain activation. The present results highlight the role of the premotor system for facial expression processing as a function of emotional type, supporting the existence of a valence-specific lateralized system within the prefrontal area. Finally, a sort of “restoring effect” induced by TMS was suggested for high-anxiety subjects.

State-dependent effects of prefrontal repetitive transcranial magnetic stimulation on emotional working memory

BACKGROUND

A growing body of findings illustrates the importance of state-dependency in studies using brain stimulation.

OBJECTIVE

We aimed to investigate the effects of tDCS priming followed by rTMS applied over the right dorsolateral prefrontal cortex (DLPFC) on emotional working memory.

METHODS

In a randomized single-blind within-subjects design, participants performed an emotional 3-back task at baseline and after tDCS priming (anodal, cathodal) and subsequent low-frequency rTMS (active, sham) of the right DLPFC. Stimuli consisted of words related to the distinct emotion categories fear and anger as well as neutral words.

RESULTS

Task accuracy increased for fear-related words and decreased for neutral words across stimulation conditions. No general state-dependent effects of prefrontal rTMS on working memory were found. We further showed a detrimental effect of negative emotional content on working memory performance.

CONCLUSIONS

Our findings support a hemispheric lateralization of emotion processing by demonstrating that the withdrawal-related emotion fear is associated with the right DLPFC and contribute to clarifying the interaction between working memory and emotion.