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Briley PM, Webster L, Boutry C, Oh H, Auer DP, Liddle PF, Morriss R. Magnetic resonance imaging connectivity features associated with response to transcranial magnetic stimulation in major depressive disorder. Psychiatry Res Neuroimaging 2024; 342:111846. [PMID: 38908353 DOI: 10.1016/j.pscychresns.2024.111846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 03/23/2024] [Accepted: 06/11/2024] [Indexed: 06/24/2024]
Abstract
Transcranial magnetic stimulation (TMS) is an FDA-approved neuromodulation treatment for major depressive disorder (MDD), thought to work by altering dysfunctional brain connectivity pathways, or by indirectly modulating the activity of subcortical brain regions. Clinical response to TMS remains highly variable, highlighting the need for baseline predictors of response and for understanding brain changes associated with response. This systematic review examined brain connectivity features, and changes in connectivity features, associated with clinical improvement following TMS in MDD. Forty-one studies met inclusion criteria, including 1097 people with MDD. Most studies delivered one of two types of TMS to left dorsolateral prefrontal cortex and measured connectivity using resting-state functional MRI. The subgenual anterior cingulate cortex was the most well-studied brain region, particularly its connectivity with the TMS target or with the "executive control network" of brain regions. There was marked heterogeneity in findings. There is a need for greater understanding of how cortical TMS modulates connectivity with, and the activity of, subcortical regions, and how these effects change within and across treatment sessions.
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Affiliation(s)
- P M Briley
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Nottingham National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Nottingham, United Kingdom; Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, United Kingdom.
| | - L Webster
- Nottingham National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Nottingham, United Kingdom; Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, United Kingdom
| | - C Boutry
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, United Kingdom; NIHR Applied Research Collaboration East Midlands, University of Nottingham, Nottingham, United Kingdom
| | - H Oh
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Nottingham National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Nottingham, United Kingdom; Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, United Kingdom
| | - D P Auer
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Nottingham National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Nottingham, United Kingdom; Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, United Kingdom
| | - P F Liddle
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, United Kingdom
| | - R Morriss
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Nottingham National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Nottingham, United Kingdom; Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, United Kingdom; NIHR Applied Research Collaboration East Midlands, University of Nottingham, Nottingham, United Kingdom; NIHR Mental Health (MindTech) Health Technology Collaboration, University of Nottingham, Nottingham, United Kingdom
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Pezoa-Peña I, Julio-Ramos T, Cigarroa I, Martella D, Solomons D, Toloza-Ramirez D. Neuropsychological and Anatomical-Functional Effects of Transcranial Magnetic Stimulation in Post-Stroke Patients with Cognitive Impairment and Aphasia: A Systematic Review. Neuropsychol Rev 2024:10.1007/s11065-024-09644-4. [PMID: 38867020 DOI: 10.1007/s11065-024-09644-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 05/14/2024] [Indexed: 06/14/2024]
Abstract
Transcranial magnetic stimulation (TMS) has been found to be promising in the neurorehabilitation of post-stroke patients. Aphasia and cognitive impairment (CI) are prevalent post-stroke; however, there is still a lack of consensus about the characteristics of interventions based on TMS and its neuropsychological and anatomical-functional benefits. Therefore, studies that contribute to creating TMS protocols for these neurological conditions are necessary. To analyze the evidence of the neuropsychological and anatomical-functional TMS effects in post-stroke patients with CI and aphasia and determine the characteristics of the most used TMS in research practice. The present study followed the PRISMA guidelines and included articles from PubMed, Scopus, Web of Science, ScienceDirect, and EMBASE databases, published between January 2010 and March 2023. In the 15 articles reviewed, it was found that attention, memory, executive function, language comprehension, naming, and verbal fluency (semantic and phonological) are the neuropsychological domains that improved post-TMS. Moreover, TMS in aphasia and post-stroke CI contribute to greater frontal activation (in the inferior frontal gyrus, pars triangularis, and opercularis). Temporoparietal effects were also found. The observed effects occur when TMS is implemented in repetitive modality, at a frequency of 1 Hz, in sessions of 30 min, and that last more than 2 weeks in duration. The use of TMS contributes to the neurorehabilitation process in post-stroke patients with CI and aphasia. However, it is still necessary to standardize future intervention protocols based on accurate TMS characteristics.
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Affiliation(s)
- Ignacio Pezoa-Peña
- Master's program in Neuroscience, Universidad Autonoma de Chile, Temuco, Chile
| | - Teresa Julio-Ramos
- Laboratory of Language Rehabilitation and Stimulation (LARES), Speech and Language Therapy School, Health Sciences Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- PhD Program in Health Sciences and Engineering, Universidad de Valparaiso, Valparaiso, Chile
| | - Igor Cigarroa
- Escuela de kinesiología, Facultad de Ciencias de la Salud, Universidad Católica Silva Henríquez, Santiago, Chile
- Facultad de Ciencias de la Salud, Universidad Arturo Prat, Victoria, Chile
| | - Diana Martella
- Departamento de Psicología, Facultad de Ciencias Sociales y Humanas, Universidad Loyola, Campus Sevilla, Sevilla, España
| | - Daniel Solomons
- Institute for Biological and Medical Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millenium Institute for Intelligent Healthcare Engineering (iHEALTH), Santiago, Chile
| | - David Toloza-Ramirez
- Exercise and Rehabilitation Sciences Institute, School of Speech Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Fernández Concha 700, Las Condes, Santiago, 7591538, Chile.
- Interdisciplinary Center for Neuroscience, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Xia AWL, Jin M, Qin PPI, Kan RLD, Zhang BBB, Giron CG, Lin TTZ, Li ASM, Kranz GS. Instantaneous effects of prefrontal transcranial magnetic stimulation on brain oxygenation: A systematic review. Neuroimage 2024; 293:120618. [PMID: 38636640 DOI: 10.1016/j.neuroimage.2024.120618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 04/20/2024] Open
Abstract
This systematic review investigates how prefrontal transcranial magnetic stimulation (TMS) immediately influences neuronal excitability based on oxygenation changes measured by functional magnetic resonance imaging (fMRI) or functional near-infrared spectroscopy (fNIRS). A thorough understanding of TMS-induced excitability changes may enable clinicians to adjust TMS parameters and optimize treatment plans proactively. Five databases were searched for human studies evaluating brain excitability using concurrent TMS/fMRI or TMS/fNIRS. Thirty-seven studies (13 concurrent TMS/fNIRS studies, 24 concurrent TMS/fMRI studies) were included in a qualitative synthesis. Despite methodological inconsistencies, a distinct pattern of activated nodes in the frontoparietal central executive network, the cingulo-opercular salience network, and the default-mode network emerged. The activated nodes included the prefrontal cortex (particularly dorsolateral prefrontal cortex), insula cortex, striatal regions (especially caudate, putamen), anterior cingulate cortex, and thalamus. High-frequency repetitive TMS most consistently induced expected facilitatory effects in these brain regions. However, varied stimulation parameters (e.g., intensity, coil orientation, target sites) and the inter- and intra-individual variability of brain state contribute to the observed heterogeneity of target excitability and co-activated regions. Given the considerable methodological and individual variability across the limited evidence, conclusions should be drawn with caution.
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Affiliation(s)
- Adam W L Xia
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Minxia Jin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Penny P I Qin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Rebecca L D Kan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Bella B B Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Cristian G Giron
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Tim T Z Lin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Ami S M Li
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Georg S Kranz
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; Mental Health Research Center (MHRC), The Hong Kong Polytechnic University, Hong Kong, China; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.
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Wang JB, Hassan U, Bruss JE, Oya H, Uitermarkt BD, Trapp NT, Gander PE, Howard MA, Keller CJ, Boes AD. Effects of transcranial magnetic stimulation on the human brain recorded with intracranial electrocorticography. Mol Psychiatry 2024; 29:1228-1240. [PMID: 38317012 DOI: 10.1038/s41380-024-02405-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/19/2023] [Accepted: 01/02/2024] [Indexed: 02/07/2024]
Abstract
Transcranial magnetic stimulation (TMS) is increasingly used as a noninvasive technique for neuromodulation in research and clinical applications, yet its mechanisms are not well understood. Here, we present the neurophysiological effects of TMS using intracranial electrocorticography (iEEG) in neurosurgical patients. We first evaluated safety in a gel-based phantom. We then performed TMS-iEEG in 22 neurosurgical participants with no adverse events. We next evaluated intracranial responses to single pulses of TMS to the dorsolateral prefrontal cortex (dlPFC) (N = 10, 1414 electrodes). We demonstrate that TMS is capable of inducing evoked potentials both locally within the dlPFC and in downstream regions functionally connected to the dlPFC, including the anterior cingulate and insular cortex. These downstream effects were not observed when stimulating other distant brain regions. Intracranial dlPFC electrical stimulation had similar timing and downstream effects as TMS. These findings support the safety and promise of TMS-iEEG in humans to examine local and network-level effects of TMS with higher spatiotemporal resolution than currently available methods.
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Affiliation(s)
- Jeffrey B Wang
- Biophysics Graduate Program, Stanford University Medical Center, Stanford, CA, 94305, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA, 94305, USA
| | - Umair Hassan
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA, 94305, USA
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, 94305, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
| | - Joel E Bruss
- Department of Neurology, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
- Department of Pediatrics, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Hiroyuki Oya
- Department of Neurosurgery, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Brandt D Uitermarkt
- Department of Pediatrics, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Nicholas T Trapp
- Department of Psychiatry, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
- Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, 52242, USA
| | - Phillip E Gander
- Department of Neurosurgery, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
- Department of Radiology, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Matthew A Howard
- Department of Neurosurgery, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Corey J Keller
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA, 94305, USA
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, 94305, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
| | - Aaron D Boes
- Department of Neurology, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
- Department of Pediatrics, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
- Department of Psychiatry, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
- Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, 52242, USA.
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Chang KY, Tik M, Mizutani-Tiebel Y, Schuler AL, Taylor P, Campana M, Vogelmann U, Huber B, Dechantsreiter E, Thielscher A, Bulubas L, Padberg F, Keeser D. Neural response during prefrontal theta burst stimulation: Interleaved TMS-fMRI of full iTBS protocols. Neuroimage 2024; 291:120596. [PMID: 38554783 DOI: 10.1016/j.neuroimage.2024.120596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Left prefrontal intermittent theta-burst stimulation (iTBS) has emerged as a safe and effective transcranial magnetic stimulation (TMS) treatment protocol in depression. Though network effects after iTBS have been widely studied, the deeper mechanistic understanding of target engagement is still at its beginning. Here, we investigate the feasibility of a novel integrated TMS-fMRI setup and accelerated echo planar imaging protocol to directly observe the immediate effects of full iTBS treatment sessions. OBJECTIVE/HYPOTHESIS In our effort to explore interleaved iTBS-fMRI feasibility, we hypothesize that TMS will induce acute BOLD signal changes in both the stimulated area and interconnected neural regions. METHODS Concurrent TMS-fMRI with full sessions of neuronavigated iTBS (i.e. 600 pulses) of the left dorsolateral prefrontal cortex (DLPFC) was investigated in 18 healthy participants. In addition, we conducted four TMS-fMRI sessions in a single patient on long-term maintenance iTBS for bipolar depression to test the transfer to clinical cases. RESULTS Concurrent TMS-fMRI was feasible for iTBS sequences with 600 pulses. During interleaved iTBS-fMRI, an increase of the BOLD signal was observed in a network including bilateral DLPFC regions. In the clinical case, a reduced BOLD response was found in the left DLPFC and the subgenual anterior cingulate cortex, with high variability across individual sessions. CONCLUSIONS Full iTBS sessions as applied for the treatment of depressive disorders can be established in the interleaved iTBS-fMRI paradigm. In the future, this experimental approach could be valuable in clinical samples, for demonstrating target engagement by iTBS protocols and investigating their mechanisms of therapeutic action.
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Affiliation(s)
- Kai-Yen Chang
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Neuroimaging Core Unit Munich - NICUM, University Hospital, LMU Munich, Munich, Germany
| | - Martin Tik
- High Field MR Center, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria; Brain Stimulation Lab, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, USA.
| | - Yuki Mizutani-Tiebel
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Neuroimaging Core Unit Munich - NICUM, University Hospital, LMU Munich, Munich, Germany
| | - Anna-Lisa Schuler
- Lise Meitner Research Group Cognition and Plasticity, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Paul Taylor
- Department of Psychology, LMU Munich, Munich, Germany
| | - Mattia Campana
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Neuroimaging Core Unit Munich - NICUM, University Hospital, LMU Munich, Munich, Germany
| | - Ulrike Vogelmann
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Barbara Huber
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Esther Dechantsreiter
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Axel Thielscher
- Department of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark; Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Denmark
| | - Lucia Bulubas
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Neuroimaging Core Unit Munich - NICUM, University Hospital, LMU Munich, Munich, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Neuroimaging Core Unit Munich - NICUM, University Hospital, LMU Munich, Munich, Germany
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Neuroimaging Core Unit Munich - NICUM, University Hospital, LMU Munich, Munich, Germany.
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Solomon EA, Wang JB, Oya H, Howard MA, Trapp NT, Uitermarkt BD, Boes AD, Keller CJ. TMS provokes target-dependent intracranial rhythms across human cortical and subcortical sites. Brain Stimul 2024; 17:698-712. [PMID: 38821396 DOI: 10.1016/j.brs.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 05/25/2024] [Accepted: 05/26/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) is believed to alter ongoing neural activity and cause circuit-level changes in brain function. While the electrophysiological effects of TMS have been extensively studied with scalp electroencephalography (EEG), this approach generally evaluates low-frequency neural activity at the cortical surface. However, TMS can be safely used in patients with intracranial electrodes (iEEG), allowing for direct assessment of deeper and more localized oscillatory responses across the frequency spectrum. OBJECTIVE/HYPOTHESIS Our study used iEEG to understand the effects of TMS on human neural activity in the spectral domain. We asked (1) which brain regions respond to cortically-targeted TMS, and in what frequency bands, (2) whether deeper brain structures exhibit oscillatory responses, and (3) whether the neural responses to TMS reflect evoked versus induced oscillations. METHODS We recruited 17 neurosurgical patients with indwelling electrodes and recorded neural activity while patients underwent repeated trials of single-pulse TMS at either the dorsolateral prefrontal cortex (DLPFC) or parietal cortex. iEEG signals were analyzed using spectral methods to understand the oscillatory responses to TMS. RESULTS Stimulation to DLPFC drove widespread low-frequency increases (3-8 Hz) in frontolimbic cortices and high-frequency decreases (30-110 Hz) in frontotemporal areas, including the hippocampus. Stimulation to parietal cortex specifically provoked low-frequency responses in the medial temporal lobe. While most low-frequency activity was consistent with phase-locked evoked responses, anterior frontal regions exhibited induced theta oscillations following DLPFC stimulation. CONCLUSIONS By combining TMS with intracranial EEG recordings, our results suggest that TMS is an effective means to perturb oscillatory neural activity in brain-wide networks, including deeper structures not directly accessed by stimulation itself.
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Affiliation(s)
- Ethan A Solomon
- Dept. of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Palo Alto, 94305, CA, USA; Wu Tsai Neurosciences Institute, Stanford University, Stanford, 94305, CA, USA.
| | - Jeffrey B Wang
- Dept. of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Palo Alto, 94305, CA, USA; Biophysics Graduate Program, Stanford University Medical Center, Stanford, 94305, CA, USA
| | - Hiroyuki Oya
- Department of Neurosurgery, Carver College of Medicine, University of Iowa, Iowa City, 52242, IA, USA
| | - Matthew A Howard
- Department of Neurosurgery, Carver College of Medicine, University of Iowa, Iowa City, 52242, IA, USA
| | - Nicholas T Trapp
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, 52242, IA, USA; Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, 52242, IA, USA
| | - Brandt D Uitermarkt
- Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, 52242, IA, USA
| | - Aaron D Boes
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, 52242, IA, USA; Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, 52242, IA, USA; Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, 52242, IA, USA
| | - Corey J Keller
- Dept. of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Palo Alto, 94305, CA, USA; Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, 94305, CA, USA; Wu Tsai Neurosciences Institute, Stanford University, Stanford, 94305, CA, 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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8
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Dengler J, Deck BL, Stoll H, Fernandez-Nunez G, Kelkar AS, Rich RR, Erickson BA, Erani F, Faseyitan O, Hamilton RH, Medaglia JD. Enhancing cognitive control with transcranial magnetic stimulation in subject-specific frontoparietal networks. Cortex 2024; 172:141-158. [PMID: 38330778 DOI: 10.1016/j.cortex.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/26/2023] [Accepted: 11/28/2023] [Indexed: 02/10/2024]
Abstract
BACKGROUND Cognitive control processes, including those involving frontoparietal networks, are highly variable between individuals, posing challenges to basic and clinical sciences. While distinct frontoparietal networks have been associated with specific cognitive control functions such as switching, inhibition, and working memory updating functions, there have been few basic tests of the role of these networks at the individual level. METHODS To examine the role of cognitive control at the individual level, we conducted a within-subject excitatory transcranial magnetic stimulation (TMS) study in 19 healthy individuals that targeted intrinsic ("resting") frontoparietal networks. Person-specific intrinsic networks were identified with resting state functional magnetic resonance imaging scans to determine TMS targets. The participants performed three cognitive control tasks: an adapted Navon figure-ground task (requiring set switching), n-back (working memory), and Stroop color-word (inhibition). OBJECTIVE Hypothesis: We predicted that stimulating a network associated with externally oriented control [the "FPCN-B" (fronto-parietal control network)] would improve performance on the set switching and working memory task relative to a network associated with attention (the Dorsal Attention Network, DAN) and cranial vertex in a full within-subjects crossover design. RESULTS We found that set switching performance was enhanced by FPCN-B stimulation along with some evidence of enhancement in the higher-demand n-back conditions. CONCLUSION Higher task demands or proactive control might be a distinguishing role of the FPCN-B, and personalized intrinsic network targeting is feasible in TMS designs.
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Affiliation(s)
- Julia Dengler
- School of Biomedical Engineering Science and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Benjamin L Deck
- Department of Psychological & Brain Sciences, Drexel University, Philadelphia, PA, USA
| | - Harrison Stoll
- Department of Psychological & Brain Sciences, Drexel University, Philadelphia, PA, USA
| | | | - Apoorva S Kelkar
- Department of Psychological & Brain Sciences, Drexel University, Philadelphia, PA, USA
| | - Ryan R Rich
- Department of Psychological & Brain Sciences, Drexel University, Philadelphia, PA, USA
| | - Brian A Erickson
- Department of Psychological & Brain Sciences, Drexel University, Philadelphia, PA, USA
| | - Fareshte Erani
- Department of Psychological & Brain Sciences, Drexel University, Philadelphia, PA, USA
| | | | - Roy H Hamilton
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - John D Medaglia
- Department of Psychological & Brain Sciences, Drexel University, Philadelphia, PA, USA; Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.
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Baldi S, Schuhmann T, Goossens L, Schruers KRJ. Individualized, connectome-based, non-invasive stimulation of OCD deep-brain targets: A proof-of-concept. Neuroimage 2024; 288:120527. [PMID: 38286272 DOI: 10.1016/j.neuroimage.2024.120527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/09/2023] [Accepted: 01/26/2024] [Indexed: 01/31/2024] Open
Abstract
Treatment-resistant obsessive-compulsive disorder (OCD) generally improves with deep-brain stimulation (DBS), thought to modulate neural activity at both the implantation site and in connected brain regions. However, its invasive nature, side-effects, and lack of customization, make non-invasive treatments preferable. Harnessing the established remote effects of cortical transcranial magnetic stimulation (TMS), connectivity-based approaches have emerged for depression that aim at influencing distant regions connected to the stimulation site. We here investigated whether effective OCD DBS targets (here subthalamic nucleus [STN] and nucleus accumbens [NAc]) could be modulated non-invasively with TMS. In a proof-of-concept study with nine healthy individuals, we used 7T magnetic resonance imaging (MRI) and probabilistic tractography to reconstruct the fiber tracts traversing manually segmented STN/NAc. Two TMS targets were individually selected based on the strength of their structural connectivity to either the STN, or both the STN and NAc. In a sham-controlled, within-subject cross-over design, TMS was administered over the personalized targets, located around the precentral and middle frontal gyrus. Resting-state functional 3T MRI was acquired before, and at 5 and 25 min after stimulation to investigate TMS-induced changes in the functional connectivity of the STN and NAc with other regions of the brain. Static and dynamic seed-to-voxel correlation analyses were conducted. TMS over both targets was able to modulate the functional connectivity of the STN and NAc, engaging both overlapping and distinct regions, and unfolding following different temporal dynamics. Given the relevance of the engaged connected regions to OCD pathology, we argue that a personalized, connectivity-based procedure is worth investigating as potential treatment for refractory OCD.
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Affiliation(s)
- Samantha Baldi
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.
| | - Teresa Schuhmann
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands; Maastricht Brain Imaging Centre, Maastricht, the Netherlands
| | - Liesbet Goossens
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Koen R J Schruers
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
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10
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Betzel R, Puxeddu MG, Seguin C, Bazinet V, Luppi A, Podschun A, Singleton SP, Faskowitz J, Parakkattu V, Misic B, Markett S, Kuceyeski A, Parkes L. Controlling the human connectome with spatially diffuse input signals. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.02.27.581006. [PMID: 38463980 PMCID: PMC10925126 DOI: 10.1101/2024.02.27.581006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
The human brain is never at "rest"; its activity is constantly fluctuating over time, transitioning from one brain state-a whole-brain pattern of activity-to another. Network control theory offers a framework for understanding the effort - energy - associated with these transitions. One branch of control theory that is especially useful in this context is "optimal control", in which input signals are used to selectively drive the brain into a target state. Typically, these inputs are introduced independently to the nodes of the network (each input signal is associated with exactly one node). Though convenient, this input strategy ignores the continuity of cerebral cortex - geometrically, each region is connected to its spatial neighbors, allowing control signals, both exogenous and endogenous, to spread from their foci to nearby regions. Additionally, the spatial specificity of brain stimulation techniques is limited, such that the effects of a perturbation are measurable in tissue surrounding the stimulation site. Here, we adapt the network control model so that input signals have a spatial extent that decays exponentially from the input site. We show that this more realistic strategy takes advantage of spatial dependencies in structural connectivity and activity to reduce the energy (effort) associated with brain state transitions. We further leverage these dependencies to explore near-optimal control strategies such that, on a per-transition basis, the number of input signals required for a given control task is reduced, in some cases by two orders of magnitude. This approximation yields network-wide maps of input site density, which we compare to an existing database of functional, metabolic, genetic, and neurochemical maps, finding a close correspondence. Ultimately, not only do we propose a more efficient framework that is also more adherent to well-established brain organizational principles, but we also posit neurobiologically grounded bases for optimal control.
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Affiliation(s)
- Richard Betzel
- Department of Psychological and Brain Sciences, Indiana University, Bloomington IN 47401
- Cognitive Science Program, Indiana University, Bloomington IN 47401
- Program in Neuroscience, Indiana University, Bloomington IN 47401
| | - Maria Grazia Puxeddu
- Department of Psychological and Brain Sciences, Indiana University, Bloomington IN 47401
| | - Caio Seguin
- Department of Psychological and Brain Sciences, Indiana University, Bloomington IN 47401
| | - Vincent Bazinet
- Montréal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Andrea Luppi
- Montréal Neurological Institute, McGill University, Montréal, QC, Canada
| | | | | | - Joshua Faskowitz
- Department of Psychological and Brain Sciences, Indiana University, Bloomington IN 47401
| | - Vibin Parakkattu
- Department of Psychological and Brain Sciences, Indiana University, Bloomington IN 47401
- Cognitive Science Program, Indiana University, Bloomington IN 47401
| | - Bratislav Misic
- Montréal Neurological Institute, McGill University, Montréal, QC, Canada
| | | | - Amy Kuceyeski
- Department of Radiology, Weill Cornell Medicine, New York, NY
- Department of Computational Biology, Cornell University, Ithaca, NY
| | - Linden Parkes
- Department of Psychiatry, Brain Health Institute, Rutgers University, Piscataway, NJ, USA
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11
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Roalf DR, Figee M, Oathes DJ. Elevating the field for applying neuroimaging to individual patients in psychiatry. Transl Psychiatry 2024; 14:87. [PMID: 38341414 PMCID: PMC10858949 DOI: 10.1038/s41398-024-02781-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 12/06/2023] [Accepted: 01/15/2024] [Indexed: 02/12/2024] Open
Abstract
Although neuroimaging has been widely applied in psychiatry, much of the exuberance in decades past has been tempered by failed replications and a lack of definitive evidence to support the utility of imaging to inform clinical decisions. There are multiple promising ways forward to demonstrate the relevance of neuroimaging for psychiatry at the individual patient level. Ultra-high field magnetic resonance imaging is developing as a sensitive measure of neurometabolic processes of particular relevance that holds promise as a new way to characterize patient abnormalities as well as variability in response to treatment. Neuroimaging may also be particularly suited to the science of brain stimulation interventions in psychiatry given that imaging can both inform brain targeting as well as measure changes in brain circuit communication as a function of how effectively interventions improve symptoms. We argue that a greater focus on individual patient imaging data will pave the way to stronger relevance to clinical care in psychiatry. We also stress the importance of using imaging in symptom-relevant experimental manipulations and how relevance will be best demonstrated by pairing imaging with differential treatment prediction and outcome measurement. The priorities for using brain imaging to inform psychiatry may be shifting, which compels the field to solidify clinical relevance for individual patients over exploratory associations and biomarkers that ultimately fail to replicate.
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Affiliation(s)
- David R Roalf
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Neurodevelopment & Psychosis Section, University of Pennsylvania, Philadelphia, PA, USA
| | - Martijn Figee
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Desmond J Oathes
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Center for Brain Imaging and Stimulation, University of Pennsylvania, Philadelphia, PA, USA.
- Center for Neuromodulation in Depression and Stress, University of Pennsylvania, Philadelphia, PA, USA.
- Penn Brain Science Translation, Innovation, and Modulation Center, University of Pennsylvania, Philadelphia, PA, USA.
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12
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Soleimani G, Joutsa J, Moussawi K, Siddiqi SH, Kuplicki R, Bikson M, Paulus MP, Fox MD, Hanlon CA, Ekhtiari H. Converging Evidence for Frontopolar Cortex as a Target for Neuromodulation in Addiction Treatment. Am J Psychiatry 2024; 181:100-114. [PMID: 38018143 DOI: 10.1176/appi.ajp.20221022] [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] [Indexed: 11/30/2023]
Abstract
Noninvasive brain stimulation technologies such as transcranial electrical and magnetic stimulation (tES and TMS) are emerging neuromodulation therapies that are being used to target the neural substrates of substance use disorders. By the end of 2022, 205 trials of tES or TMS in the treatment of substance use disorders had been published, with heterogeneous results, and there is still no consensus on the optimal target brain region. Recent work may help clarify where and how to apply stimulation, owing to expanding databases of neuroimaging studies, new systematic reviews, and improved methods for causal brain mapping. Whereas most previous clinical trials targeted the dorsolateral prefrontal cortex, accumulating data highlight the frontopolar cortex as a promising therapeutic target for transcranial brain stimulation in substance use disorders. This approach is supported by converging multimodal evidence, including lesion-based maps, functional MRI-based maps, tES studies, TMS studies, and dose-response relationships. This review highlights the importance of targeting the frontopolar area and tailoring the treatment according to interindividual variations in brain state and trait and electric field distribution patterns. This converging evidence supports the potential for treatment optimization through context, target, dose, and timing dimensions to improve clinical outcomes of transcranial brain stimulation in people with substance use disorders in future clinical trials.
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Affiliation(s)
- Ghazaleh Soleimani
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Soleimani, Ekhtiari); Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, and Neurocenter and Turku PET Center, Turku University Hospital, Turku, Finland (Joutsa); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Moussawi); Center for Brain Circuit Therapeutics and Departments of Neurology, Psychiatry, Neurosurgery, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston (Siddiqi, Fox); Laureate Institute for Brain Research, Tulsa, Okla. (Kuplicki, Paulus, Ekhtiari); Department of Biomedical Engineering, City College of New York, New York (Bikson); Department Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, N.C. (Hanlon)
| | - Juho Joutsa
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Soleimani, Ekhtiari); Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, and Neurocenter and Turku PET Center, Turku University Hospital, Turku, Finland (Joutsa); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Moussawi); Center for Brain Circuit Therapeutics and Departments of Neurology, Psychiatry, Neurosurgery, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston (Siddiqi, Fox); Laureate Institute for Brain Research, Tulsa, Okla. (Kuplicki, Paulus, Ekhtiari); Department of Biomedical Engineering, City College of New York, New York (Bikson); Department Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, N.C. (Hanlon)
| | - Khaled Moussawi
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Soleimani, Ekhtiari); Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, and Neurocenter and Turku PET Center, Turku University Hospital, Turku, Finland (Joutsa); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Moussawi); Center for Brain Circuit Therapeutics and Departments of Neurology, Psychiatry, Neurosurgery, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston (Siddiqi, Fox); Laureate Institute for Brain Research, Tulsa, Okla. (Kuplicki, Paulus, Ekhtiari); Department of Biomedical Engineering, City College of New York, New York (Bikson); Department Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, N.C. (Hanlon)
| | - Shan H Siddiqi
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Soleimani, Ekhtiari); Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, and Neurocenter and Turku PET Center, Turku University Hospital, Turku, Finland (Joutsa); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Moussawi); Center for Brain Circuit Therapeutics and Departments of Neurology, Psychiatry, Neurosurgery, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston (Siddiqi, Fox); Laureate Institute for Brain Research, Tulsa, Okla. (Kuplicki, Paulus, Ekhtiari); Department of Biomedical Engineering, City College of New York, New York (Bikson); Department Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, N.C. (Hanlon)
| | - Rayus Kuplicki
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Soleimani, Ekhtiari); Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, and Neurocenter and Turku PET Center, Turku University Hospital, Turku, Finland (Joutsa); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Moussawi); Center for Brain Circuit Therapeutics and Departments of Neurology, Psychiatry, Neurosurgery, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston (Siddiqi, Fox); Laureate Institute for Brain Research, Tulsa, Okla. (Kuplicki, Paulus, Ekhtiari); Department of Biomedical Engineering, City College of New York, New York (Bikson); Department Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, N.C. (Hanlon)
| | - Marom Bikson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Soleimani, Ekhtiari); Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, and Neurocenter and Turku PET Center, Turku University Hospital, Turku, Finland (Joutsa); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Moussawi); Center for Brain Circuit Therapeutics and Departments of Neurology, Psychiatry, Neurosurgery, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston (Siddiqi, Fox); Laureate Institute for Brain Research, Tulsa, Okla. (Kuplicki, Paulus, Ekhtiari); Department of Biomedical Engineering, City College of New York, New York (Bikson); Department Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, N.C. (Hanlon)
| | - Martin P Paulus
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Soleimani, Ekhtiari); Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, and Neurocenter and Turku PET Center, Turku University Hospital, Turku, Finland (Joutsa); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Moussawi); Center for Brain Circuit Therapeutics and Departments of Neurology, Psychiatry, Neurosurgery, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston (Siddiqi, Fox); Laureate Institute for Brain Research, Tulsa, Okla. (Kuplicki, Paulus, Ekhtiari); Department of Biomedical Engineering, City College of New York, New York (Bikson); Department Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, N.C. (Hanlon)
| | - Michael D Fox
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Soleimani, Ekhtiari); Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, and Neurocenter and Turku PET Center, Turku University Hospital, Turku, Finland (Joutsa); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Moussawi); Center for Brain Circuit Therapeutics and Departments of Neurology, Psychiatry, Neurosurgery, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston (Siddiqi, Fox); Laureate Institute for Brain Research, Tulsa, Okla. (Kuplicki, Paulus, Ekhtiari); Department of Biomedical Engineering, City College of New York, New York (Bikson); Department Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, N.C. (Hanlon)
| | - Colleen A Hanlon
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Soleimani, Ekhtiari); Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, and Neurocenter and Turku PET Center, Turku University Hospital, Turku, Finland (Joutsa); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Moussawi); Center for Brain Circuit Therapeutics and Departments of Neurology, Psychiatry, Neurosurgery, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston (Siddiqi, Fox); Laureate Institute for Brain Research, Tulsa, Okla. (Kuplicki, Paulus, Ekhtiari); Department of Biomedical Engineering, City College of New York, New York (Bikson); Department Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, N.C. (Hanlon)
| | - Hamed Ekhtiari
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Soleimani, Ekhtiari); Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, and Neurocenter and Turku PET Center, Turku University Hospital, Turku, Finland (Joutsa); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Moussawi); Center for Brain Circuit Therapeutics and Departments of Neurology, Psychiatry, Neurosurgery, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston (Siddiqi, Fox); Laureate Institute for Brain Research, Tulsa, Okla. (Kuplicki, Paulus, Ekhtiari); Department of Biomedical Engineering, City College of New York, New York (Bikson); Department Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, N.C. (Hanlon)
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13
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van Rooij SJH, Arulpragasam AR, McDonald WM, Philip NS. Accelerated TMS - moving quickly into the future of depression treatment. Neuropsychopharmacology 2024; 49:128-137. [PMID: 37217771 PMCID: PMC10700378 DOI: 10.1038/s41386-023-01599-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/20/2023] [Accepted: 04/22/2023] [Indexed: 05/24/2023]
Abstract
Accelerated TMS is an emerging application of Transcranial Magnetic Stimulation (TMS) aimed to reduce treatment length and improve response time. Extant literature generally shows similar efficacy and safety profiles compared to the FDA-cleared protocols for TMS to treat major depressive disorder (MDD), yet accelerated TMS research remains at a very early stage in development. The few applied protocols have not been standardized and vary significantly across a set of core elements. In this review, we consider nine elements that include treatment parameters (i.e., frequency and inter-stimulation interval), cumulative exposure (i.e., number of treatment days, sessions per day, and pulses per session), individualized parameters (i.e., treatment target and dose), and brain state (i.e., context and concurrent treatments). Precisely which of these elements is critical and what parameters are most optimal for the treatment of MDD remains unclear. Other important considerations for accelerated TMS include durability of effect, safety profiles as doses increase over time, the possibility and advantage of individualized functional neuronavigation, use of biological readouts, and accessibility for patients most in need of the treatment. Overall, accelerated TMS appears to hold promise to reduce treatment time and achieve rapid reduction in depressive symptoms, but at this time significant work remains to be done. Rigorous clinical trials combining clinical outcomes and neuroscientific measures such as electroencephalogram, magnetic resonance imaging and e-field modeling are needed to define the future of accelerated TMS for MDD.
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Affiliation(s)
- Sanne J H van Rooij
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
| | - Amanda R Arulpragasam
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, USA
| | - William M McDonald
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
| | - Noah S Philip
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA.
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, USA.
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14
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Berger T, Xu T, Opitz A. Systematic cross-species comparison of prefrontal cortex functional networks targeted via Transcranial Magnetic Stimulation. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.12.20.572653. [PMID: 38187657 PMCID: PMC10769354 DOI: 10.1101/2023.12.20.572653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Transcranial Magnetic Stimulation (TMS) is a non-invasive brain stimulation method that safely modulates neural activity in vivo. Its precision in targeting specific brain networks makes TMS invaluable in diverse clinical applications. For example, TMS is used to treat depression by targeting prefrontal brain networks and their connection to other brain regions. However, despite its widespread use, the underlying neural mechanisms of TMS are not completely understood. Non-human primates (NHPs) offer an ideal model to study TMS mechanisms through invasive electrophysiological recordings. As such, bridging the gap between NHP experiments and human applications is imperative to ensure translational relevance. Here, we systematically compare the TMS-targeted functional networks in the prefrontal cortex in humans and NHPs. To conduct this comparison, we combine TMS electric field modeling in humans and macaques with resting-state functional magnetic resonance imaging (fMRI) data to compare the functional networks targeted via TMS across species. We identified distinct stimulation zones in macaque and human models, each exhibiting variations in the impacted networks (macaque: Frontoparietal Network, Somatomotor Network; human: Frontoparietal Network, Default Network). We identified differences in brain gyrification and functional organization across species as the underlying cause of found network differences. The TMS-network profiles we identified will allow researchers to establish consistency in network activation across species, aiding in the translational efforts to develop improved TMS functional network targeting approaches.
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15
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Perera ND, Alekseichuk I, Shirinpour S, Wischnewski M, Linn G, Masiello K, Butler B, Russ BE, Schroeder CE, Falchier A, Opitz A. Dissociation of Centrally and Peripherally Induced Transcranial Magnetic Stimulation Effects in Nonhuman Primates. J Neurosci 2023; 43:8649-8662. [PMID: 37852789 PMCID: PMC10727178 DOI: 10.1523/jneurosci.1016-23.2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/02/2023] [Accepted: 10/10/2023] [Indexed: 10/20/2023] Open
Abstract
Transcranial magnetic stimulation (TMS) is a noninvasive brain stimulation method that is rapidly growing in popularity for studying causal brain-behavior relationships. However, its dose-dependent centrally induced neural mechanisms and peripherally induced sensory costimulation effects remain debated. Understanding how TMS stimulation parameters affect brain responses is vital for the rational design of TMS protocols. Studying these mechanisms in humans is challenging because of the limited spatiotemporal resolution of available noninvasive neuroimaging methods. Here, we leverage invasive recordings of local field potentials in a male and a female nonhuman primate (rhesus macaque) to study TMS mesoscale responses. We demonstrate that early TMS-evoked potentials show a sigmoidal dose-response curve with stimulation intensity. We further show that stimulation responses are spatially specific. We use several control conditions to dissociate centrally induced neural responses from auditory and somatosensory coactivation. These results provide crucial evidence regarding TMS neural effects at the brain circuit level. Our findings are highly relevant for interpreting human TMS studies and biomarker developments for TMS target engagement in clinical applications.SIGNIFICANCE STATEMENT Transcranial magnetic stimulation (TMS) is a widely used noninvasive brain stimulation method to stimulate the human brain. To advance its utility for clinical applications, a clear understanding of its underlying physiological mechanisms is crucial. Here, we perform invasive electrophysiological recordings in the nonhuman primate brain during TMS, achieving a spatiotemporal precision not available in human EEG experiments. We find that evoked potentials are dose dependent and spatially specific, and can be separated from peripheral stimulation effects. This means that TMS-evoked responses can indicate a direct physiological stimulation response. Our work has important implications for the interpretation of human TMS-EEG recordings and biomarker development.
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Affiliation(s)
- Nipun D Perera
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota 55455
| | - Ivan Alekseichuk
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota 55455
| | - Sina Shirinpour
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota 55455
| | - Miles Wischnewski
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota 55455
| | - Gary Linn
- Translational Neuroscience Lab Division, Center for Biomedical Imaging and Neuromodulation, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York 10962
- Department of Psychiatry, NYU Grossman School of Medicine, New York, New York 10016
| | - Kurt Masiello
- Translational Neuroscience Lab Division, Center for Biomedical Imaging and Neuromodulation, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York 10962
| | - Brent Butler
- Translational Neuroscience Lab Division, Center for Biomedical Imaging and Neuromodulation, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York 10962
| | - Brian E Russ
- Translational Neuroscience Lab Division, Center for Biomedical Imaging and Neuromodulation, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York 10962
| | - Charles E Schroeder
- Translational Neuroscience Lab Division, Center for Biomedical Imaging and Neuromodulation, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York 10962
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York 10032
- Department of Neurosurgery, The Neurological Institute of New York, Columbia University Irving Medical Center, New York, New York 10032
| | - Arnaud Falchier
- Translational Neuroscience Lab Division, Center for Biomedical Imaging and Neuromodulation, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York 10962
- Department of Psychiatry, NYU Grossman School of Medicine, New York, New York 10016
| | - Alexander Opitz
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota 55455
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16
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Soleimani G, Kuplicki R, Camchong J, Opitz A, Paulus MP, Lim KO, Ekhtiari H. Are we really targeting and stimulating DLPFC by placing transcranial electrical stimulation (tES) electrodes over F3/F4? Hum Brain Mapp 2023; 44:6275-6287. [PMID: 37750607 PMCID: PMC10619406 DOI: 10.1002/hbm.26492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/16/2023] [Accepted: 09/08/2023] [Indexed: 09/27/2023] Open
Abstract
In many clinical trials involving transcranial electrical stimulation (tES), target electrodes are typically placed over DLPFC with the assumption that this will primarily stimulate the underlying brain region. However, our study aimed to evaluate the electric fields (EF) that are actually delivered and identify prefrontal regions that may be inadvertently targeted in DLPFC tES. Head models were generated from the Human Connectome Project database's T1 + T2-weighted MRIs of 80 healthy adults. Two common DLPFC montages were simulated; symmetric-F4/F3, and asymmetric-F4/Fp1. Averaged EF was extracted from (1) the center of the target electrode (F4), and (2) the top 1% of voxels showing the strongest EF in individualized EF maps. Interindividual variabilities were quantified with the standard deviation of EF peak location/value. Similar steps were repeated with 66 participants with methamphetamine use disorder (MUDs) as an independent clinical population. In healthy adults, the group-level location of EF peaks was situated in the medial-frontopolar, and the individualized EF peaks were positioned in a cube with a volume of 29 cm3 /46 cm3 (symmetric/asymmetric montages). EFs in the frontopolar area were significantly higher than EF "under" the target electrode in both symmetric (peak: 0.41 ± 0.06, F4:0.22 ± 0.04) and asymmetric (peak: 0.38 ± 0.04, F4:0.2 ± 0.04) montages (Heges'g > 0.7). Similar results with slight between-group differences were found in MUDs. We highlighted that in common DLPFC tES montages, in addition to interindividual/intergroup variability, the frontopolar received the highest EFs rather than DLPFC as the main target. We specifically recommended considering the potential involvement of the frontopolar area as a mechanism underlying the effectiveness of DLPFC tES protocols.
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Affiliation(s)
- Ghazaleh Soleimani
- Department of Psychiatry and Behavioral SciencesUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Rayus Kuplicki
- Laureate Institute for Brain Research (LIBR)TulsaOklahomaUSA
| | - Jazmin Camchong
- Department of Psychiatry and Behavioral SciencesUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Alexander Opitz
- Department of Biomedical EngineeringUniversity of MinnesotaMinneapolisMinnesotaUSA
| | | | - Kelvin O. Lim
- Department of Psychiatry and Behavioral SciencesUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Hamed Ekhtiari
- Department of Psychiatry and Behavioral SciencesUniversity of MinnesotaMinneapolisMinnesotaUSA
- Laureate Institute for Brain Research (LIBR)TulsaOklahomaUSA
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17
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Patel M, Teferi M, Casalvera A, Lynch K, Nitchie F, Makhoul W, Oathes DJ, Sheline Y, Balderston NL. Interleaved TMS/fMRI shows that threat decreases dlPFC-mediated top-down regulation of emotion processing. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.11.23298414. [PMID: 37986856 PMCID: PMC10659468 DOI: 10.1101/2023.11.11.23298414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Background The right dorsolateral prefrontal cortex (dlPFC) has been indicated to be a key region in the cognitive regulation of emotion by many previous neuromodulation and neuroimaging studies. However, there is little direct causal evidence supporting this top-down regulation hypothesis. Furthermore, it is unclear whether contextual threat impacts this top-down regulation. By combining TMS/fMRI, this study aimed to uncover the impact of unpredictable threat on TMS-evoked BOLD response in dlPFC-regulated emotional networks. Based on the previous findings linking the dlPFC to the downregulation of emotional network activity, we hypothesized TMS pulses would deactivate activity in anxiety expression regions, and that threat would reduce this top-down regulation. Methods 44 healthy controls (no current or history of psychiatric disorders) were recruited to take part in a broader study. Subjects completed the neutral, predictable, and unpredictable (NPU) threat task while receiving TMS pulses to either the right dlPFC or a control region. dlPFC targeting was based on data from a separate targeting session, where subjects completed the Sternberg working memory (WM) task inside the MRI scanner. Results When compared to safe conditions, subjects reported significantly higher levels of anxiety under threat conditions. Additionally, TMS-evoked responses in the left insula (LI), right sensory/motor cortex (RSM), and a region encompassing the bilateral SMA regions (BSMA) differed significantly between safe and threat conditions. There was a significant TMS-evoked deactivation in safe periods that was significantly attenuated in threat periods across all 3 regions. Conclusions These findings suggest that threat decreases dlPFC-regulated emotional processing by attenuating the top-down control of emotion, like the left insula. Critically, these findings provide support for the use of right dlPFC stimulation as a potential intervention in anxiety disorders.
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18
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Chai Y, Sheline YI, Oathes DJ, Balderston NL, Rao H, Yu M. Functional connectomics in depression: insights into therapies. Trends Cogn Sci 2023; 27:814-832. [PMID: 37286432 PMCID: PMC10476530 DOI: 10.1016/j.tics.2023.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 06/09/2023]
Abstract
Depression is a common mental disorder characterized by heterogeneous cognitive and behavioral symptoms. The emerging research paradigm of functional connectomics has provided a quantitative theoretical framework and analytic tools for parsing variations in the organization and function of brain networks in depression. In this review, we first discuss recent progress in depression-associated functional connectome variations. We then discuss treatment-specific brain network outcomes in depression and propose a hypothetical model highlighting the advantages and uniqueness of each treatment in relation to the modulation of specific brain network connectivity and symptoms of depression. Finally, we look to the future promise of combining multiple treatment types in clinical practice, using multisite datasets and multimodal neuroimaging approaches, and identifying biological depression subtypes.
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Affiliation(s)
- Ya Chai
- Key Laboratory of Brain-Machine Intelligence for Information Behavior (Ministry of Education and Shanghai), School of Business and Management, Shanghai International Studies University, Shanghai, China; Center for Functional Neuroimaging, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yvette I Sheline
- Center for Neuromodulation in Depression and Stress (CNDS), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Desmond J Oathes
- Center for Neuromodulation in Depression and Stress (CNDS), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Penn Brain Science, Translation, Innovation and Modulation Center (brainSTIM), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Nicholas L Balderston
- Center for Neuromodulation in Depression and Stress (CNDS), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Hengyi Rao
- Key Laboratory of Brain-Machine Intelligence for Information Behavior (Ministry of Education and Shanghai), School of Business and Management, Shanghai International Studies University, Shanghai, China; Center for Functional Neuroimaging, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Meichen Yu
- Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Network Science Institute, Bloomington, IN, USA.
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19
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Vasileiadi M, Woletz M, Linhardt D, Grosshagauer S, Tik M, Windischberger C. Improved brain stimulation targeting by optimising image acquisition parameters. Neuroimage 2023; 276:120175. [PMID: 37201640 DOI: 10.1016/j.neuroimage.2023.120175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/10/2023] [Accepted: 05/15/2023] [Indexed: 05/20/2023] Open
Abstract
Functional connectivity analysis from rs-fMRI data has been used for determining cortical targets in therapeutic applications of non-invasive brain stimulation using transcranial magnetic stimulation (TMS). Reliable connectivity measures are therefore essential for every rs-fMRI-based TMS targeting approach. Here, we examine the effect of echo time (TE) on the reproducibility and spatial variability of resting-state connectivity measures. We acquired multiple runs of single-echo fMRI data with either short (TE = 30 ms) or long (TE = 38 ms) echo time to investigate inter-run spatial reproducibility of a clinically relevant functional connectivity map, i.e., originating from the sgACC. We find that connectivity maps obtained from TE = 38 ms rs-fMRI data are significantly more reliable than those obtained from TE = 30 ms data sets. Our results clearly show that optimizing sequence parameters can be beneficial for ensuring high-reliability resting-state acquisition protocols to be used for TMS targeting. The differences between reliability in connectivity measures for different TEs could inform future clinical research in optimising MR sequences.
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Affiliation(s)
- Maria Vasileiadi
- High Field MR Center, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Michael Woletz
- High Field MR Center, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - David Linhardt
- High Field MR Center, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Sarah Grosshagauer
- High Field MR Center, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Martin Tik
- High Field MR Center, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria; Department of Psyschiatry & Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Christian Windischberger
- High Field MR Center, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.
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20
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Tan V, Jeyachandra J, Ge R, Dickie EW, Gregory E, Vanderwal T, Vila-Rodriguez F, Hawco C. Subgenual cingulate connectivity as a treatment predictor during low-frequency right dorsolateral prefrontal rTMS: A concurrent TMS-fMRI study. Brain Stimul 2023; 16:1165-1172. [PMID: 37543171 DOI: 10.1016/j.brs.2023.07.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 07/19/2023] [Accepted: 07/25/2023] [Indexed: 08/07/2023] Open
Abstract
INTRODUCTION Repetitive transcranial magnetic stimulation (rTMS) to the dorsolateral prefrontal cortex (DLPFC) is effective in alleviating treatment-resistant depression (TRD). It has been proposed that regions within the left DLPFC that are anti-correlated with the right subgenual anterior cingulate cortex (sgACC) may represent optimal individualized target sites for high-frequency left rTMS (HFL). OBJECTIVE/HYPOTHESIS This study aimed to explore the effects of low-frequency right rTMS (LFR) on left sgACC connectivity during concurrent TMS-fMRI. METHODS 34 TRD patients underwent an imaging session that included both a resting-state fMRI run (rs-fMRI0) and a run during which LFR was applied to the right DLPFC (TMS-fMRI). Participants subsequently completed four weeks of LFR treatment. The left sgACC functional connectivity was compared between the rs-fMRI0 run and TMS-fMRI run. Personalized e-fields and a region-of-interest approach were used to calculate overlap of left sgACC functional connectivity at the TMS target and to assess for a relationship with treatment effects. RESULTS TMS-fMRI increased left sgACC functional connectivity to parietal regions within the ventral attention network; differences were not significantly associated with clinical improvements. Personalized e-fields were not significant in predicting treatment outcomes (p = 0.18). CONCLUSION This was the first study to examine left sgACC anti-correlation with the right DLPFC during an LFR rTMS protocol. In contrast to studies that targeted the left DLPFC, we did not find that higher anti-correlation was associated with clinical outcomes. Our results suggest that the antidepressant mechanism of action of LFR to the right DLPFC may be different than for HFL.
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Affiliation(s)
- Vinh Tan
- Kimel Family Translational Imaging Genetics Research Laboratory, Centre for Addiction and Mental Health, Toronto, Canada
| | - Jerrold Jeyachandra
- Kimel Family Translational Imaging Genetics Research Laboratory, Centre for Addiction and Mental Health, Toronto, Canada
| | - Ruiyang Ge
- Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Erin W Dickie
- Kimel Family Translational Imaging Genetics Research Laboratory, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Elizabeth Gregory
- Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Tamara Vanderwal
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Fidel Vila-Rodriguez
- Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Colin Hawco
- Kimel Family Translational Imaging Genetics Research Laboratory, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
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21
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Soleimani G, Conelea CA, Kuplicki R, Opitz A, Lim KO, Paulus MP, Ekhtiari H. Optimizing Individual Targeting of Fronto-Amygdala Network with Transcranial Magnetic Stimulation (TMS): Biophysical, Physiological and Behavioral Variations in People with Methamphetamine Use Disorder. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.02.23288047. [PMID: 37066153 PMCID: PMC10104226 DOI: 10.1101/2023.04.02.23288047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Background Previous studies in people with substance use disorders (SUDs) have implicated both the frontopolar cortex and amygdala in drug cue reactivity and craving, and amygdala-frontopolar coupling is considered a marker of early relapse risk. Accumulating data highlight that the frontopolar cortex can be considered a promising therapeutic target for transcranial magnetic stimulation (TMS) in SUDs. However, one-size-fits-all approaches to TMS targets resulted in substantial variation in both physiological and behavioral outcomes. Individualized TMS approaches to target cortico-subcortical circuits like amygdala-frontopolar have not yet been investigated in SUDs. Objective Here, we (1) defined individualized TMS target location based on functional connectivity of the amygdala-frontopolar circuit while people were exposed to drug-related cues, (2) optimized coil orientation based on maximizing electric field (EF) perpendicular to the individualized target, and (3) harmonized EF strength in targeted brain regions across a population. Method MRI data including structural, resting-state, and task-based fMRI data were collected from 60 participants with methamphetamine use disorders (MUDs). Craving scores based on a visual analog scale were collected immediately before and after the MRI session. We analyzed inter-subject variability in the location of TMS targets based on the maximum task-based connectivity between the left medial amygdala (with the highest functional activity among subcortical areas during drug cue exposure) and frontopolar cortex using psychophysiological interaction (PPI) analysis. Computational head models were generated for all participants and EF simulations were calculated for fixed vs. optimized coil location (Fp1/Fp2 vs. individualized maximal PPI location), orientation (AF7/AF8 vs. orientation optimization algorithm), and stimulation intensity (constant vs. adjusted intensity across the population). Results Left medial amygdala with the highest (mean ± SD: 0.31±0.29) functional activity during drug cue exposure was selected as the subcortical seed region. Amygdala-to-whole brain PPI analysis showed a significant cluster in the prefrontal cortex (cluster size: 2462 voxels, cluster peak in MNI space: [25 39 35]) that confirms cortico-subcortical connections. The location of the voxel with the most positive amygdala-frontopolar PPI connectivity in each participant was considered as the individualized TMS target (mean ± SD of the MNI coordinates: [12.6 64.23 -0.8] ± [13.64 3.50 11.01]). Individual amygdala-frontopolar PPI connectivity in each participant showed a significant correlation with VAS scores after cue exposure (R=0.27, p=0.03). Averaged EF strength in a sphere with r = 5mm around the individualized target location was significantly higher in the optimized (mean ± SD: 0.99 ± 0.21) compared to the fixed approach (Fp1: 0.56 ± 0.22, Fp2: 0.78 ± 0.25) with large effect sizes (Fp1: p = 1.1e-13, Hedges'g = 1.5, Fp2: p = 1.7e-5, Hedges'g = 1.26). Adjustment factor to have identical 1 V/m EF strength in a 5mm sphere around the individualized targets ranged from 0.72 to 2.3 (mean ± SD: 1.07 ± 0.29). Conclusion Our results show that optimizing coil orientation and stimulation intensity based on individualized TMS targets led to stronger electric fields in the targeted brain regions compared to a one-size-fits-all approach. These findings provide valuable insights for refining TMS therapy for SUDs by optimizing the modulation of cortico-subcortical circuits.
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Affiliation(s)
- Ghazaleh Soleimani
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, MN, USA
| | - Christine A. Conelea
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, MN, USA
| | | | - Alexander Opitz
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, MN, USA
| | - Kelvin O Lim
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, MN, USA
| | | | - Hamed Ekhtiari
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, MN, USA
- Laureate Institute for Brain Research (LIBR), OK, USA
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22
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Acute TMS/fMRI response explains offline TMS network effects - An interleaved TMS-fMRI study. Neuroimage 2023; 267:119833. [PMID: 36572133 DOI: 10.1016/j.neuroimage.2022.119833] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 11/22/2022] [Accepted: 12/22/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) is an FDA-approved therapeutic option for treatment resistant depression. However, exact mechanisms-of-action are not fully understood and individual responses are variable. Moreover, although previously suggested, the exact network effects underlying TMS' efficacy are poorly understood as of today. Although, it is supposed that DLPFC stimulation indirectly modulates the sgACC, recent evidence is sparse. METHODS Here, we used concurrent interleaved TMS/fMRI and state-of-the-science purpose-designed MRI head coils to delineate networks and downstream regions activated by DLPFC-TMS. RESULTS We show that regions of increased acute BOLD signal activation during TMS resemble a resting-state brain network previously shown to be modulated by offline TMS. There was a topographical overlap in wide spread cortical and sub-cortical areas within this specific RSN#17 derived from the 1000 functional connectomes project. CONCLUSION These data imply a causal relation between DLPFC-TMS and activation of the ACC and a broader network that has been implicated in MDD. In the broader context of our recent work, these data imply a direct relation between initial changes in BOLD activity mediated by connectivity to the DLPFC target site, and later consolidation of connectivity between these regions. These insights advance our understanding of the mechanistic targets of DLPFC-TMS and may provide novel opportunities to characterize and optimize TMS therapy in other neurological and psychiatric disorders.
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23
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Webler RD, Oathes DJ, van Rooij SJH, Gewirtz JC, Nahas Z, Lissek SM, Widge AS. Causally mapping human threat extinction relevant circuits with depolarizing brain stimulation methods. Neurosci Biobehav Rev 2023; 144:105005. [PMID: 36549377 DOI: 10.1016/j.neubiorev.2022.105005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/17/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
Laboratory threat extinction paradigms and exposure-based therapy both involve repeated, safe confrontation with stimuli previously experienced as threatening. This fundamental procedural overlap supports laboratory threat extinction as a compelling analogue of exposure-based therapy. Threat extinction impairments have been detected in clinical anxiety and may contribute to exposure-based therapy non-response and relapse. However, efforts to improve exposure outcomes using techniques that boost extinction - primarily rodent extinction - have largely failed to date, potentially due to fundamental differences between rodent and human neurobiology. In this review, we articulate a comprehensive pre-clinical human research agenda designed to overcome these failures. We describe how connectivity guided depolarizing brain stimulation methods (i.e., TMS and DBS) can be applied concurrently with threat extinction and dual threat reconsolidation-extinction paradigms to causally map human extinction relevant circuits and inform the optimal integration of these methods with exposure-based therapy. We highlight candidate targets including the amygdala, hippocampus, ventromedial prefrontal cortex, dorsal anterior cingulate cortex, and mesolimbic structures, and propose hypotheses about how stimulation delivered at specific learning phases could strengthen threat extinction.
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Affiliation(s)
- Ryan D Webler
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA.
| | - Desmond J Oathes
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Jonathan C Gewirtz
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA; Department of Psychology, Arizona State University, AZ, USA
| | - Ziad Nahas
- Department of Psychology, Arizona State University, AZ, USA
| | - Shmuel M Lissek
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Alik S Widge
- Department of Psychiatry and Medical Discovery Team on Addictions, University of Minnesota Medical School, MN, USA
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24
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Riddle J, Scimeca JM, Pagnotta MF, Inglis B, Sheltraw D, Muse-Fisher C, D’Esposito M. A guide for concurrent TMS-fMRI to investigate functional brain networks. Front Hum Neurosci 2022; 16:1050605. [PMID: 36590069 PMCID: PMC9799237 DOI: 10.3389/fnhum.2022.1050605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
Transcranial Magnetic Stimulation (TMS) allows for the direct activation of neurons in the human neocortex and has proven to be fundamental for causal hypothesis testing in cognitive neuroscience. By administering TMS concurrently with functional Magnetic Resonance Imaging (fMRI), the effect of cortical TMS on activity in distant cortical and subcortical structures can be quantified by varying the levels of TMS output intensity. However, TMS generates significant fluctuations in the fMRI time series, and their complex interaction warrants caution before interpreting findings. We present the methodological challenges of concurrent TMS-fMRI and a guide to minimize induced artifacts in experimental design and post-processing. Our study targeted two frontal-striatal circuits: primary motor cortex (M1) projections to the putamen and lateral prefrontal cortex (PFC) projections to the caudate in healthy human participants. We found that TMS parametrically increased the BOLD signal in the targeted region and subcortical projections as a function of stimulation intensity. Together, this work provides practical steps to overcome common challenges with concurrent TMS-fMRI and demonstrates how TMS-fMRI can be used to investigate functional brain networks.
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Affiliation(s)
- Justin Riddle
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Jason M. Scimeca
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, United States
| | - Mattia F. Pagnotta
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, United States
| | - Ben Inglis
- Henry H. Wheeler Jr. Brain Imaging Center, University of California, Berkeley, Berkeley, CA, United States
| | - Daniel Sheltraw
- Henry H. Wheeler Jr. Brain Imaging Center, University of California, Berkeley, Berkeley, CA, United States
| | - Chris Muse-Fisher
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, United States
| | - Mark D’Esposito
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, United States
- Henry H. Wheeler Jr. Brain Imaging Center, University of California, Berkeley, Berkeley, CA, United States
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25
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Effect of group-based vs individualized stimulation site selection on reliability of network-targeted TMS. Neuroimage 2022; 264:119714. [PMID: 36309331 DOI: 10.1016/j.neuroimage.2022.119714] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 09/23/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) is a widely used technique for the noninvasive assessment and manipulation of brain activity and behavior. Although extensively used for research and clinical purposes, recent studies have questioned the reliability of TMS findings because of the high inter-individual variability that has been observed. OBJECTIVE In this study, we compared the efficacy and reliability of different targeting scenarios on the TMS-evoked response. METHODS 24 subjects underwent a single pulse stimulation protocol over two parietal nodes belonging to the Dorsal Attention (DAN) and Default Mode (DMN) Networks respectively. Across visits, the stimulated target for both networks was chosen either based on group-derived networks' maps or personalized network topography based on individual anatomy and functional profile. All stimulation visits were conducted twice, one month apart, during concomitant electroencephalography recording. RESULTS At the network level, we did not observe significant differences in the TMS-evoked response between targeting conditions. However, reliable patterns of activity were observed- for both networks tested- following the individualized targeting approach. When the same analyses were carried out at the electrode space level, evidence of reliable patterns was observed following the individualized stimulation of the DAN, but not of the DMN. CONCLUSIONS Our findings suggest that individualization of stimulation sites might ensure reliability of the evoked TMS-response across visits. Furthermore, individualized stimulation sites appear to be of foremost importance in highly variable, high order task-positive networks, such as the DAN.
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Abstract
The neuropeptide system encompasses the most diverse family of neurotransmitters, but their expression, cellular localization, and functional role in the human brain have received limited attention. Here, we study human postmortem samples from prefrontal cortex (PFC), a key brain region, and employ RNA sequencing and RNAscope methods integrated with published single-cell data. Our aim is to characterize the distribution of peptides and their receptors in 17 PFC subregions and to explore their role in chemical signaling. The results suggest that the well-established anatomical and functional heterogeneity of human PFC is also reflected in the expression pattern of the neuropeptides. Our findings support ongoing efforts from academia and pharmaceutical companies to explore the potential of neuropeptide receptors as targets for drug development. Human prefrontal cortex (hPFC) is a complex brain region involved in cognitive and emotional processes and several psychiatric disorders. Here, we present an overview of the distribution of the peptidergic systems in 17 subregions of hPFC and three reference cortices obtained by microdissection and based on RNA sequencing and RNAscope methods integrated with published single-cell transcriptomics data. We detected expression of 60 neuropeptides and 60 neuropeptide receptors in at least one of the hPFC subregions. The results reveal that the peptidergic landscape in PFC consists of closely located and functionally different subregions with unique peptide/transmitter–related profiles. Neuropeptide-rich PFC subregions were identified, encompassing regions from anterior cingulate cortex/orbitofrontal gyrus. Furthermore, marked differences in gene expression exist between different PFC regions (>5-fold; cocaine and amphetamine–regulated transcript peptide) as well as between PFC regions and reference regions, for example, for somatostatin and several receptors. We suggest that the present approach allows definition of, still hypothetical, microcircuits exemplified by glutamatergic neurons expressing a peptide cotransmitter either as an agonist (hypocretin/orexin) or antagonist (galanin). Specific neuropeptide receptors have been identified as possible targets for neuronal afferents and, interestingly, peripheral blood-borne peptide hormones (leptin, adiponectin, gastric inhibitory peptide, glucagon-like peptides, and peptide YY). Together with other recent publications, our results support the view that neuropeptide systems may play an important role in hPFC and underpin the concept that neuropeptide signaling helps stabilize circuit connectivity and fine-tune/modulate PFC functions executed during health and disease.
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TMS Does Not Increase BOLD Activity at the Site of Stimulation: A Review of All Concurrent TMS-fMRI Studies. eNeuro 2022; 9:9/4/ENEURO.0163-22.2022. [PMID: 35981879 PMCID: PMC9410768 DOI: 10.1523/eneuro.0163-22.2022] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/14/2022] [Accepted: 06/30/2022] [Indexed: 11/21/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) is widely used for understanding brain function in neurologically intact subjects and for the treatment of various disorders. However, the precise neurophysiological effects of TMS at the site of stimulation remain poorly understood. The local effects of TMS can be studied using concurrent TMS-functional magnetic resonance imaging (fMRI), a technique where TMS is delivered during fMRI scanning. However, although concurrent TMS-fMRI was developed over 20 years ago and dozens of studies have used this technique, there is still no consensus on whether TMS increases blood oxygen level-dependent (BOLD) activity at the site of stimulation. To address this question, here we review all previous concurrent TMS-fMRI studies that reported analyses of BOLD activity at the target location. We find evidence that TMS increases local BOLD activity when stimulating the primary motor (M1) and visual (V1) cortices but that these effects are likely driven by the downstream consequences of TMS (finger twitches and phosphenes). However, TMS does not appear to increase BOLD activity at the site of stimulation for areas outside of the M1 and V1 when conducted at rest. We examine the possible reasons for such lack of BOLD signal increase based on recent work in nonhuman animals. We argue that the current evidence points to TMS inducing periods of increased and decreased neuronal firing that mostly cancel each other out and therefore lead to no change in the overall BOLD signal.
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Jagger-Rickels A, Rothlein D, Stumps A, Evans TC, Bernstein J, Milberg W, McGlinchey R, DeGutis J, Esterman M. An executive function subtype of PTSD with unique neural markers and clinical trajectories. Transl Psychiatry 2022; 12:262. [PMID: 35760805 PMCID: PMC9237057 DOI: 10.1038/s41398-022-02011-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/19/2022] [Accepted: 05/27/2022] [Indexed: 11/18/2022] Open
Abstract
Previous work identified a cognitive subtype of PTSD with impaired executive function (i.e., impaired EF-PTSD subtype) and aberrant resting-state functional connectivity between frontal parietal control (FPCN) and limbic (LN) networks. To better characterize this cognitive subtype of PTSD, this study investigated (1) alterations in specific FPCN and LN subnetworks and (2) chronicity of PTSD symptoms. In a post-9/11 veteran sample (N = 368, 89% male), we identified EF subgroups using a standardized neuropsychological battery and a priori cutoffs for impaired, average, and above-average EF performance. Functional connectivity between two subnetworks of the FPCN and three subnetworks of the LN was assessed using resting-state fMRI (n = 314). PTSD chronicity over a 1-2-year period was assessed using a reliable change index (n = 175). The impaired EF-PTSD subtype had significantly reduced negative functional connectivity between the FPCN subnetwork involved in top-down control of emotion and two LN subnetworks involved in learning/memory and social/emotional processing. This impaired EF-PTSD subtype had relatively chronic PTSD, while those with above-average EF and PTSD displayed greater symptom reduction. Lastly, FPCN-LN subnetworks partially mediated the relationship between EF and PTSD chronicity (n = 121). This study reveals (1) that an impaired EF-PTSD subtype has a specific pattern of FPCN-LN subnetwork connectivity, (2) a novel above-average EF-PTSD subtype displays reduced PTSD chronicity, and (3) both cognitive and neural functioning predict PTSD chronicity. The results indicate a need to investigate how individuals with this impaired EF-PTSD subtype respond to treatment, and how they might benefit from personalized and novel approaches that target these neurocognitive systems.
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Affiliation(s)
- Audreyana Jagger-Rickels
- National Center for PTSD (NCPTSD), VA Boston Healthcare System, Boston, MA, USA. .,Boston Attention and Learning Lab (BALLAB), VA Boston Healthcare System, Boston, MA, USA. .,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
| | - David Rothlein
- grid.410370.10000 0004 4657 1992National Center for PTSD (NCPTSD), VA Boston Healthcare System, Boston, MA USA ,grid.410370.10000 0004 4657 1992Boston Attention and Learning Lab (BALLAB), VA Boston Healthcare System, Boston, MA USA
| | - Anna Stumps
- grid.410370.10000 0004 4657 1992Boston Attention and Learning Lab (BALLAB), VA Boston Healthcare System, Boston, MA USA ,grid.33489.350000 0001 0454 4791Department of Psychological and Brain Sciences, University of Delaware, Newark, DE USA ,grid.410370.10000 0004 4657 1992Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA USA
| | - Travis Clark Evans
- grid.410370.10000 0004 4657 1992Boston Attention and Learning Lab (BALLAB), VA Boston Healthcare System, Boston, MA USA ,grid.189504.10000 0004 1936 7558Department of Psychiatry, Boston University School of Medicine, Boston, MA USA
| | - John Bernstein
- grid.410370.10000 0004 4657 1992Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA USA
| | - William Milberg
- grid.410370.10000 0004 4657 1992Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Psychiatry, Harvard Medical School, Boston, MA USA ,grid.410370.10000 0004 4657 1992Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA USA
| | - Regina McGlinchey
- grid.410370.10000 0004 4657 1992Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Psychiatry, Harvard Medical School, Boston, MA USA ,grid.410370.10000 0004 4657 1992Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA USA
| | - Joseph DeGutis
- grid.410370.10000 0004 4657 1992Boston Attention and Learning Lab (BALLAB), VA Boston Healthcare System, Boston, MA USA ,grid.410370.10000 0004 4657 1992Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Psychiatry, Harvard Medical School, Boston, MA USA
| | - Michael Esterman
- grid.410370.10000 0004 4657 1992National Center for PTSD (NCPTSD), VA Boston Healthcare System, Boston, MA USA ,grid.410370.10000 0004 4657 1992Boston Attention and Learning Lab (BALLAB), VA Boston Healthcare System, Boston, MA USA ,grid.189504.10000 0004 1936 7558Department of Psychiatry, Boston University School of Medicine, Boston, MA USA ,grid.410370.10000 0004 4657 1992Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA USA ,grid.410370.10000 0004 4657 1992Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, MA USA
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Sydnor VJ, Cieslak M, Duprat R, Deluisi J, Flounders MW, Long H, Scully M, Balderston NL, Sheline YI, Bassett DS, Satterthwaite TD, Oathes DJ. Cortical-subcortical structural connections support transcranial magnetic stimulation engagement of the amygdala. SCIENCE ADVANCES 2022; 8:eabn5803. [PMID: 35731882 PMCID: PMC9217085 DOI: 10.1126/sciadv.abn5803] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 05/04/2022] [Indexed: 05/31/2023]
Abstract
The amygdala processes valenced stimuli, influences emotion, and exhibits aberrant activity across anxiety disorders, depression, and PTSD. Interventions modulating amygdala activity hold promise as transdiagnostic psychiatric treatments. In 45 healthy participants, we investigated whether transcranial magnetic stimulation (TMS) elicits indirect changes in amygdala activity when applied to ventrolateral prefrontal cortex (vlPFC), a region important for emotion regulation. Harnessing in-scanner interleaved TMS/functional MRI (fMRI), we reveal that vlPFC neurostimulation evoked acute and focal modulations of amygdala fMRI BOLD signal. Larger TMS-evoked changes in the amygdala were associated with higher fiber density in a vlPFC-amygdala white matter pathway when stimulating vlPFC but not an anatomical control, suggesting this pathway facilitated stimulation-induced communication between cortex and subcortex. This work provides evidence of amygdala engagement by TMS, highlighting stimulation of vlPFC-amygdala circuits as a candidate treatment for transdiagnostic psychopathology. More broadly, it indicates that targeting cortical-subcortical structural connections may enhance the impact of TMS on subcortical neural activity and, by extension, subcortex-subserved behaviors.
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Affiliation(s)
- Valerie J. Sydnor
- Penn Lifespan Informatics and Neuroimaging Center (PennLINC), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Matthew Cieslak
- Penn Lifespan Informatics and Neuroimaging Center (PennLINC), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Romain Duprat
- Center for Neuromodulation in Depression and Stress (CNDS), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Joseph Deluisi
- Center for Neuromodulation in Depression and Stress (CNDS), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Matthew W. Flounders
- Center for Neuromodulation in Depression and Stress (CNDS), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Hannah Long
- Center for Neuromodulation in Depression and Stress (CNDS), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Morgan Scully
- Center for Neuromodulation in Depression and Stress (CNDS), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Nicholas L. Balderston
- Center for Neuromodulation in Depression and Stress (CNDS), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Yvette I. Sheline
- Center for Neuromodulation in Depression and Stress (CNDS), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Dani S. Bassett
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Electrical and Systems Engineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Physics and Astronomy, College of Arts and Sciences, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Santa Fe Institute, Santa Fe, NM 87501, USA
| | - Theodore D. Satterthwaite
- Penn Lifespan Informatics and Neuroimaging Center (PennLINC), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Desmond J. Oathes
- Center for Neuromodulation in Depression and Stress (CNDS), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Penn Brain Science, Translation, Innovation, and Modulation Center (brainSTIM), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Klooster DCW, Ferguson MA, Boon PAJM, Baeken C. Personalizing Repetitive Transcranial Magnetic Stimulation Parameters for Depression Treatment Using Multimodal Neuroimaging. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022; 7:536-545. [PMID: 34800726 DOI: 10.1016/j.bpsc.2021.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/24/2021] [Accepted: 11/09/2021] [Indexed: 06/13/2023]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a tool that can be used to administer treatment for neuropsychiatric disorders such as major depressive disorder, although the clinical efficacy is still rather modest. Overly general stimulation protocols that consider neither patient-specific depression symptomology nor individualized brain characteristics, such as anatomy or structural and functional connections, may be the cause of the high inter- and intraindividual variability in rTMS clinical responses. Multimodal neuroimaging can provide the necessary insights into individual brain characteristics and can therefore be used to personalize rTMS parameters. Optimal coil positioning should include a three-step process: 1) identify the optimal (indirect) target area based on the exact symptom pattern of the patient; 2) derive the cortical (direct) target location based on functional and/or structural connectomes derived from functional and diffusion magnetic resonance imaging data; and 3) determine the ideal coil position by computational modeling, such that the electric field distribution overlaps with the cortical target. These TMS-induced electric field simulations, derived from anatomical and diffusion magnetic resonance imaging data, can be further applied to compute optimal stimulation intensities. In addition to magnetic resonance imaging, electroencephalography can provide complementary information regarding the ongoing brain oscillations. This information can be used to determine the optimal timing and frequency of the stimuli. The heightened benefits of these personalized stimulation approaches are logically reasoned, but speculative. Randomized clinical trials will be required to compare clinical responses from standard rTMS protocols to personalized protocols. Ultimately, an optimized clinical response may result from precision protocols derived from combinations of personalized stimulation parameters.
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Affiliation(s)
- Deborah C W Klooster
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; 4Brain, Department of Head and Skin, Ghent University, Ghent, Belgium; Ghent Experimental Psychiatry Laboratory, Department of Head and Skin, Ghent University, Ghent, Belgium.
| | - Michael A Ferguson
- Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Paul A J M Boon
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; 4Brain, Department of Head and Skin, Ghent University, Ghent, Belgium; Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Chris Baeken
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Ghent Experimental Psychiatry Laboratory, Department of Head and Skin, Ghent University, Ghent, Belgium; Department of Psychiatry, University Hospital Brussels, Jette, Belgium
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31
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Cember ATJ, Deck BL, Kelkar A, Faseyitan O, Zimmerman JP, Erickson B, Elliott MA, Coslett HB, Hamilton RH, Reddy R, Medaglia JD. Glutamate-Weighted Magnetic Resonance Imaging (GluCEST) Detects Effects of Transcranial Magnetic Stimulation to the Motor Cortex. Neuroimage 2022; 256:119191. [PMID: 35413447 DOI: 10.1016/j.neuroimage.2022.119191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 03/18/2022] [Accepted: 04/05/2022] [Indexed: 11/18/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) is used in several FDA-approved treatments and, increasingly, to treat neurological disorders in off-label uses. However, the mechanism by which TMS causes physiological change is unclear, as are the origins of response variability in the general population. Ideally, objective in vivo biomarkers could shed light on these unknowns and eventually inform personalized interventions. Continuous theta-burst stimulation (cTBS) is a form of TMS observed to reduce motor evoked potentials (MEPs) for 60 min or longer post-stimulation, although the consistency of this effect and its mechanism continue to be under debate. Here, we use glutamate-weighted chemical exchange saturation transfer (gluCEST) magnetic resonance imaging (MRI) at ultra-high magnetic field (7T) to measure changes in glutamate concentration at the site of cTBS. We find that the gluCEST signal in the ipsilateral hemisphere of the brain generally decreases in response to cTBS, whereas consistent changes were not detected in the contralateral region of interest (ROI) or in subjects receiving sham stimulation.
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Affiliation(s)
- Abigail T J Cember
- Center for Advanced Metabolic Imaging in Precision Medicine, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Benjamin L Deck
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, USA
| | - Apoorva Kelkar
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, USA
| | - Olu Faseyitan
- Department of Neurology, Laboratory for Cognition and Neural Stimulation, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jared P Zimmerman
- Department of Neurology, Laboratory for Cognition and Neural Stimulation, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Brian Erickson
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, USA
| | - Mark A Elliott
- Center for Advanced Metabolic Imaging in Precision Medicine, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - H Branch Coslett
- Department of Neurology, Laboratory for Cognition and Neural Stimulation, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Roy H Hamilton
- Department of Neurology, Laboratory for Cognition and Neural Stimulation, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ravinder Reddy
- Center for Advanced Metabolic Imaging in Precision Medicine, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - John D Medaglia
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, USA; Department of Neurology, Laboratory for Cognition and Neural Stimulation, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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32
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Cole RC, Okine DN, Yeager BE, Narayanan NS. Neuromodulation of cognition in Parkinson's disease. PROGRESS IN BRAIN RESEARCH 2022; 269:435-455. [PMID: 35248205 DOI: 10.1016/bs.pbr.2022.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Neuromodulation is a widely used treatment for motor symptoms of Parkinson's disease (PD). It can be a highly effective treatment as a result of knowledge of circuit dysfunction associated with motor symptoms in PD. However, the mechanisms underlying cognitive symptoms of PD are less well-known, and the effects of neuromodulation on these symptoms are less consistent. Nonetheless, neuromodulation provides a unique opportunity to modulate motor and cognitive circuits while minimizing off-target side effects. We review the modalities of neuromodulation used in PD and the potential implications for cognitive symptoms. There have been some encouraging findings with both invasive and noninvasive modalities of neuromodulation, and there are promising advances being made in the field of therapeutic neuromodulation. Substantial work is needed to determine which modulation targets are most effective for the different types of cognitive deficits of PD.
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Affiliation(s)
- Rachel C Cole
- Department of Neurology, University of Iowa, Iowa City, IA, United States
| | - Derrick N Okine
- Department of Neurology, University of Iowa, Iowa City, IA, United States
| | - Brooke E Yeager
- Department of Neurology, University of Iowa, Iowa City, IA, United States
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33
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Balderston NL, Beer JC, Seok D, Makhoul W, Deng ZD, Girelli T, Teferi M, Smyk N, Jaskir M, Oathes DJ, Sheline YI. Proof of concept study to develop a novel connectivity-based electric-field modelling approach for individualized targeting of transcranial magnetic stimulation treatment. Neuropsychopharmacology 2022; 47:588-598. [PMID: 34321597 PMCID: PMC8674270 DOI: 10.1038/s41386-021-01110-6] [Citation(s) in RCA: 4] [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: 03/25/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 11/08/2022]
Abstract
Resting state functional connectivity (rsFC) offers promise for individualizing stimulation targets for transcranial magnetic stimulation (TMS) treatments. However, current targeting approaches do not account for non-focal TMS effects or large-scale connectivity patterns. To overcome these limitations, we propose a novel targeting optimization approach that combines whole-brain rsFC and electric-field (e-field) modelling to identify single-subject, symptom-specific TMS targets. In this proof of concept study, we recruited 91 anxious misery (AM) patients and 25 controls. We measured depression symptoms (MADRS/HAMD) and recorded rsFC. We used a PCA regression to predict symptoms from rsFC and estimate the parameter vector, for input into our e-field augmented model. We modeled 17 left dlPFC and 7 M1 sites using 24 equally spaced coil orientations. We computed single-subject predicted ΔMADRS/HAMD scores for each site/orientation using the e-field augmented model, which comprises a linear combination of the following elementwise products (1) the estimated connectivity/symptom coefficients, (2) a vectorized e-field model for site/orientation, (3) rsFC matrix, scaled by a proportionality constant. In AM patients, our connectivity-based model predicted a significant decrease depression for sites near BA9, but not M1 for coil orientations perpendicular to the cortical gyrus. In control subjects, no site/orientation combination showed a significant predicted change. These results corroborate previous work suggesting the efficacy of left dlPFC stimulation for depression treatment, and predict better outcomes with individualized targeting. They also suggest that our novel connectivity-based e-field modelling approach may effectively identify potential TMS treatment responders and individualize TMS targeting to maximize the therapeutic impact.
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Affiliation(s)
- Nicholas L Balderston
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
| | - Joanne C Beer
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Darsol Seok
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Walid Makhoul
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutics & Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Tommaso Girelli
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Marta Teferi
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Nathan Smyk
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Marc Jaskir
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Desmond J Oathes
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Yvette I Sheline
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
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34
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Mizutani-Tiebel Y, Tik M, Chang KY, Padberg F, Soldini A, Wilkinson Z, Voon CC, Bulubas L, Windischberger C, Keeser D. Concurrent TMS-fMRI: Technical Challenges, Developments, and Overview of Previous Studies. Front Psychiatry 2022; 13:825205. [PMID: 35530029 PMCID: PMC9069063 DOI: 10.3389/fpsyt.2022.825205] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/09/2022] [Indexed: 11/13/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) is a promising treatment modality for psychiatric and neurological disorders. Repetitive TMS (rTMS) is widely used for the treatment of psychiatric and neurological diseases, such as depression, motor stroke, and neuropathic pain. However, the underlying mechanisms of rTMS-mediated neuronal modulation are not fully understood. In this respect, concurrent or simultaneous TMS-fMRI, in which TMS is applied during functional magnetic resonance imaging (fMRI), is a viable tool to gain insights, as it enables an investigation of the immediate effects of TMS. Concurrent application of TMS during neuroimaging usually causes severe artifacts due to magnetic field inhomogeneities induced by TMS. However, by carefully interleaving the TMS pulses with MR signal acquisition in the way that these are far enough apart, we can avoid any image distortions. While the very first feasibility studies date back to the 1990s, recent developments in coil hardware and acquisition techniques have boosted the number of TMS-fMRI applications. As such, a concurrent application requires expertise in both TMS and MRI mechanisms and sequencing, and the hurdle of initial technical set up and maintenance remains high. This review gives a comprehensive overview of concurrent TMS-fMRI techniques by collecting (1) basic information, (2) technical challenges and developments, (3) an overview of findings reported so far using concurrent TMS-fMRI, and (4) current limitations and our suggestions for improvement. By sharing this review, we hope to attract the interest of researchers from various backgrounds and create an educational knowledge base.
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Affiliation(s)
- Yuki Mizutani-Tiebel
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany.,Neuroimaging Core Unit Munich - NICUM, University Hospital LMU, Munich, Germany
| | - Martin Tik
- High Field MR Center, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Kai-Yen Chang
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany.,Neuroimaging Core Unit Munich - NICUM, University Hospital LMU, Munich, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany.,Neuroimaging Core Unit Munich - NICUM, University Hospital LMU, Munich, Germany
| | - Aldo Soldini
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany.,Neuroimaging Core Unit Munich - NICUM, University Hospital LMU, Munich, Germany.,International Max Planck Research School for Translational Psychiatry, Munich, Germany
| | - Zane Wilkinson
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany.,Neuroimaging Core Unit Munich - NICUM, University Hospital LMU, Munich, Germany
| | - Cui Ci Voon
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany.,Neuroimaging Core Unit Munich - NICUM, University Hospital LMU, Munich, Germany
| | - Lucia Bulubas
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany.,Neuroimaging Core Unit Munich - NICUM, University Hospital LMU, Munich, Germany.,International Max Planck Research School for Translational Psychiatry, Munich, Germany
| | - Christian Windischberger
- High Field MR Center, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany.,Neuroimaging Core Unit Munich - NICUM, University Hospital LMU, Munich, Germany.,Department of Radiology, University Hospital LMU, Munich, Germany
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35
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Brethel-Haurwitz KM, Oathes DJ, Kable JW. Causal Role of the Right Temporoparietal Junction in Selfishness Depends on the Social Partner. Soc Cogn Affect Neurosci 2021; 17:541-548. [PMID: 34922402 PMCID: PMC9164207 DOI: 10.1093/scan/nsab136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/02/2021] [Accepted: 12/17/2021] [Indexed: 11/25/2022] Open
Abstract
The right temporoparietal junction (rTPJ) is a hub of the mentalizing network, but its causal role in social decisions remains an area of active investigation. While prior studies using causal neurostimulation methods have confirmed the role of the rTPJ in mentalizing and strategic social interactions, most of the evidence for its role in resource-sharing decisions comes from correlational neuroimaging studies. Further, it remains unclear if the influence of the rTPJ on decisions about sharing resources depends on whether the other person is salient and identifiable. To clarify the causal role of the rTPJ in social decision making, we examined the effects of putatively inhibitory rTPJ transcranial magnetic stimulation (TMS) on Dictator Game behavior with one partner that was physically present and one that was only minimally identified. Under control conditions, participants tended to create more advantageous inequity toward the partner that was only minimally identified, selfishly keeping more resources themselves. rTPJ TMS reduced this differential treatment of the two partners. Clarifying prior mixed findings, results suggest that the rTPJ may play a role in differentiating between others when deciding how equitably to divide resources, but may not play a general role in reducing selfishness by promoting aversion to advantageous inequity.
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Affiliation(s)
- Kristin M Brethel-Haurwitz
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA.,MindCORE, University of Pennsylvania, Philadelphia, PA, USA
| | - Desmond J Oathes
- MindCORE, University of Pennsylvania, Philadelphia, PA, USA.,Department of Psychiatry and Center for Neuromodulation in Depression and Stress, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph W Kable
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA.,MindCORE, University of Pennsylvania, Philadelphia, PA, USA
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36
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Bergmann TO, Varatheeswaran R, Hanlon CA, Madsen KH, Thielscher A, Siebner HR. Concurrent TMS-fMRI for causal network perturbation and proof of target engagement. Neuroimage 2021; 237:118093. [PMID: 33940146 DOI: 10.1016/j.neuroimage.2021.118093] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/06/2021] [Accepted: 04/14/2021] [Indexed: 12/12/2022] Open
Abstract
The experimental manipulation of neural activity by neurostimulation techniques overcomes the inherent limitations of correlative recordings, enabling the researcher to investigate causal brain-behavior relationships. But only when stimulation and recordings are combined, the direct impact of the stimulation on neural activity can be evaluated. In humans, this can be achieved non-invasively through the concurrent combination of transcranial magnetic stimulation (TMS) with functional magnetic resonance imaging (fMRI). Concurrent TMS-fMRI allows the assessment of the neurovascular responses evoked by TMS with excellent spatial resolution and full-brain coverage. This enables the functional mapping of both local and remote network effects of TMS in cortical as well as deep subcortical structures, offering unique opportunities for basic research and clinical applications. The purpose of this review is to introduce the reader to this powerful tool. We will introduce the technical challenges and state-of-the art solutions and provide a comprehensive overview of the existing literature and the available experimental approaches. We will highlight the unique insights that can be gained from concurrent TMS-fMRI, including the state-dependent assessment of neural responsiveness and inter-regional effective connectivity, the demonstration of functional target engagement, and the systematic evaluation of stimulation parameters. We will also discuss how concurrent TMS-fMRI during a behavioral task can help to link behavioral TMS effects to changes in neural network activity and to identify peripheral co-stimulation confounds. Finally, we will review the use of concurrent TMS-fMRI for developing TMS treatments of psychiatric and neurological disorders and suggest future improvements for further advancing the application of concurrent TMS-fMRI.
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Affiliation(s)
- Til Ole Bergmann
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Langenbeckstr. 1, 55131, Mainz, Germany; Leibniz Institute for Resilience Research, Wallstraße 7-9, 55122, Mainz, Germany.
| | - Rathiga Varatheeswaran
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Langenbeckstr. 1, 55131, Mainz, Germany; Leibniz Institute for Resilience Research, Wallstraße 7-9, 55122, Mainz, Germany
| | - Colleen A Hanlon
- Department of Cancer Biology, Wake Forest School of Medicine, 1 Medical Center Blvd., Winston-Salem, NC 27157, USA
| | - Kristoffer H Madsen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650, Hvidovre, Denmark; Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Axel Thielscher
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650, Hvidovre, Denmark; Department of Electrical Engineering, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Hartwig Roman Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650, Hvidovre, Denmark; Department of Neurology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400 København NV, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
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