Low Intensity TMS Enhances Perception of Visual Stimuli

Meta-analysis of experimental factors influencing single-pulse TMS effects on the early visual cortex

Background

Single-pulse transcranial magnetic stimulation (spTMS) applied to the Early Visual Cortex (EVC) has demonstrated the ability to suppress the perception on visual targets, akin to the effect of visual masking. However, the reported spTMS suppression effects across various studies have displayed inconsistency.

Objective

We aim to test if the heterogeneity of the spTMS effects can be attributable to variations in experimental factors.

Methods

We conducted a meta-analysis using data collected from the PubMed and Web of Science databases spanning from 1995 to March 2024. The meta-analysis encompassed a total of 40 independent experiments drawn from 33 original articles.

Results

The findings unveiled an overall significant spTMS suppression effect on visual perception. Nevertheless, there existed substantial heterogeneity among the experiments. Univariate analysis elucidated that the spTMS effects could be significantly influenced by TMS intensity, visual angle of the stimulus, coil type, and TMS stimulators from different manufacturers. Reliable spTMS suppression effects were observed within the time windows of -80 to 0 ms and 50 to 150 ms. Multivariate linear regression analyses, which included SOA, TMS intensity, visual angle of the stimulus, and coil type, identified SOA as the key factor influencing the spTMS effects. Within the 50 to 150 ms time window, optimal SOAs were identified as 112 ms and 98 ms for objective and subjective performance, respectively. Collectively, multiple experimental factors accounted for 22.9% (r = 0.3353) and 39.9% (r = 0.3724) of the variance in objective and subjective performance, respectively. Comparing univariate and multivariate analyses, it was evident that experimental factors had different impacts on objective performance and subjective performance.

Conclusion

The present study provided quantitative recommendations for future experiments involving the spTMS effects on visual targets, offering guidance on how to configure experimental factors to achieve the optimal masking effect.

Advances in Non-Invasive Neuromodulation Techniques for Improving Cognitive Function: A Review

Non-invasive neuromodulation techniques are widely utilized to study and improve cognitive function, with the aim of modulating different cognitive processes. For workers performing high-intensity mental and physical tasks, extreme fatigue may not only affect their working efficiency but may also lead to cognitive decline or cognitive impairment, which, in turn, poses a serious threat to their physical health. The use of non-invasive neuromodulation techniques has important research value for improving and enhancing cognitive function. In this paper, we review the research status, existing problems, and future prospects of transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS), transcranial magnetic stimulation (TMS), and transcutaneous acupoint stimulation (TAS), which are the most studied physical methods in non-invasive neuromodulation techniques to improve and enhance cognition. The findings presented in this paper will be of great reference value for the in-depth study of non-invasive neuromodulation techniques in the field of cognition.

Non-invasive brain stimulation for patients and healthy subjects: Current challenges and future perspectives

Non-invasive brain stimulation (NIBS) techniques have a rich historical background, yet their utilization has witnessed significant growth only recently. These techniques encompass transcranial electrical stimulation and transcranial magnetic stimulation, which were initially employed in neuroscience to explore the intricate relationship between the brain and behaviour. However, they are increasingly finding application in research contexts as a means to address various neurological, psychiatric, and neurodegenerative disorders. This article aims to fulfill two primary objectives. Firstly, it seeks to showcase the current state of the art in the clinical application of NIBS, highlighting how it can improve and complement existing treatments. Secondly, it provides a comprehensive overview of the utilization of NIBS in augmenting the brain function of healthy individuals, thereby enhancing their performance. Furthermore, the article delves into the points of convergence and divergence between these two techniques. It also addresses the existing challenges and future prospects associated with NIBS from ethical and research standpoints.

How to Test the Association Between Baseline Performance Level and the Modulatory Effects of Non-Invasive Brain Stimulation Techniques

Behavioral effects of non-invasive brain stimulation techniques (NIBS) can dramatically change as a function of different factors (e.g., stimulation intensity, timing of stimulation). In this framework, lately there has been a growing interest toward the importance of considering the inter-individual differences in baseline performance and how they are related with behavioral NIBS effects. However, assessing how baseline performance level is associated with behavioral effects of brain stimulation techniques raises up crucial methodological issues. How can we test whether the performance at baseline is predictive of the effects of NIBS, when NIBS effects themselves are estimated with reference to baseline performance? In this perspective article, we discuss the limitations connected to widely used strategies for the analysis of the association between baseline value and NIBS effects, and review solutions to properly address this type of question.

Stochastic resonance at early visual cortex during figure orientation discrimination using transcranial magnetic stimulation

Visual noise usually reduces the visibility of stimuli. However, very low contrast or subliminal visual noise can sometimes enhance the visibility of low-contrast stimuli. It has been suggested that this enhancement occurs at the visual cortex. The aims of this study are to clarify the role of the early visual cortex (V1/V2) in the enhancement effect and to clarify the relationship of the SR characteristics among different experiments. Noise was added directly to the visual cortex by using transcranial magnetic stimulation (TMS) with randomly varying intensity. The location on the scalp and the timing (stimulus onset asynchrony, SOA) of TMS were specifically adjusted to target the early visual cortex. Contrast thresholds for figure orientation discrimination were measured as a function of TMS noise intensity. With increasing TMS noise intensity the contrast threshold for figure discrimination first decreased (enhancement) and then increased (impairment). These effects were clearly dependent both on scalp location and timing (SOA). The optimum SOA was around 60 ms, while the optimum location varied across participants. Outside the optimum location and SOA values, no TMS effects were found. The enhancement effect can be accounted for by the stochastic resonance (SR) theory based on a threshold device. In addition, we reveal similarity in characteristics of the SR phenomenon between different experiments.

Intensity- and timing-dependent modulation of motion perception with transcranial magnetic stimulation of visual cortex

Despite the widespread use of transcranial magnetic stimulation (TMS) in research and clinical care, the dose-response relations and neurophysiological correlates of modulatory effects remain relatively unexplored. To fill this gap, we studied modulation of visual processing as a function of TMS parameters. Our approach combined electroencephalography (EEG) with application of single pulse TMS to visual cortex as participants performed a motion perception task. During each participants' first visit, motion coherence thresholds, 64-channel visual evoked potentials (VEPs), and TMS resting motor thresholds (RMT) were measured. In second and third visits, single pulse TMS was delivered at one of two latencies, either 30 ms before the onset of motion or at the onset latency of the N2 VEP component derived from the first session. TMS was delivered at 0%, 80%, 100%, or 120% of RMT over the site of N2 peak activity, or at 120% over vertex. Behavioral results demonstrated a significant main effect of TMS timing on accuracy, with better performance when TMS was applied at the N2-Onset timing versus Pre-Onset, as well as a significant interaction, indicating that 80% intensity produced higher accuracy than other conditions at the N2-Onset. TMS effects on the P3 VEP showed reduced amplitudes in the 80% Pre-Onset condition, an increase for the 120% N2-Onset condition, and monotonic amplitude scaling with stimulation intensity. The N2 component was not affected by TMS. These findings reveal the influence of TMS intensity and timing on visual perception and electrophysiological responses, with optimal facilitation at stimulation intensities below RMT.

Stochastic resonance model of synaesthesia

In synaesthesia, stimulation of one sensory modality evokes additional experiences in another modality (e.g. sounds evoking colours). Along with these cross-sensory experiences, there are several cognitive and perceptual differences between synaesthetes and non-synaesthetes. For example, synaesthetes demonstrate enhanced imagery, increased cortical excitability and greater perceptual sensitivity in the concurrent modality. Previous models suggest that synaesthesia results from increased connectivity between corresponding sensory regions or disinhibited feedback from higher cortical areas. While these models explain how one sense can evoke qualitative experiences in another, they fail to predict the broader phenotype of differences observed in synaesthetes. Here, we propose a novel model of synaesthesia based on the principles of stochastic resonance. Specifically, we hypothesize that synaesthetes have greater neural noise in sensory regions, which allows pre-existing multisensory pathways to elicit supra-threshold activation (i.e. synaesthetic experiences). The strengths of this model are (a) it predicts the broader cognitive and perceptual differences in synaesthetes, (b) it provides a unified framework linking developmental and induced synaesthesias, and (c) it explains why synaesthetic associations are inconsistent at onset but stabilize over time. We review research consistent with this model and propose future studies to test its limits. This article is part of a discussion meeting issue 'Bridging senses: novel insights from synaesthesia'.

Boosting Learning Efficacy with Noninvasive Brain Stimulation in Intact and Brain-Damaged Humans

Numerous behavioral studies have shown that visual function can improve with training, although perceptual refinements generally require weeks to months of training to attain. This, along with questions about long-term retention of learning, limits practical and clinical applications of many such paradigms. Here, we show for the first time in female and male human participants that just 10 d of visual training coupled with transcranial random noise stimulation (tRNS) over visual areas causes dramatic improvements in visual motion perception. Relative to control conditions and anodal stimulation, tRNS-enhanced learning was at least twice as fast, and, crucially, it persisted for 6 months after the end of training and stimulation. Notably, tRNS also boosted learning in patients with chronic cortical blindness, leading to recovery of motion processing in the blind field after just 10 d of training, a period too short to elicit enhancements with training alone. In sum, our results reveal a remarkable enhancement of the capacity for long-lasting plastic and restorative changes when a neuromodulatory intervention is coupled with visual training.SIGNIFICANCE STATEMENT Our work demonstrates that visual training coupled with brain stimulation can dramatically reduce the training period from months to weeks, and lead to fast improvement in neurotypical subjects and chronic cortically blind patients, indicating the potential of our procedure to help restore damaged visual abilities for currently untreatable visual dysfunctions. Together, these results indicate the critical role of early visual areas in perceptual learning and reveal its capacity for long-lasting plastic changes promoted by neuromodulatory intervention.

The mixed-polarity benefit of stereopsis arises in early visual cortex

Depth perception is better when observers view stimuli containing a mixture of bright and dark visual features. It is currently unclear where in the visual system sensory processing benefits from the availability of different contrast polarity. To address this question, we applied transcranial magnetic stimulation to the visual cortex to modulate normal neural activity during processing of single- or mixed-polarity random-dot stereograms. In line with previous work, participants gave significantly better depth judgments for mixed-polarity stimuli. Stimulation of early visual cortex (V1/V2) significantly increased this benefit for mixed-polarity stimuli, and it did not affect performance for single-polarity stimuli. Stimulation of disparity responsive areas V3a and LO had no effect on perception. Our findings show that disparity processing in early visual cortex gives rise to the mixed-polarity benefit. This is consistent with computational models of stereopsis at the level of V1 that produce a mixed polarity benefit.

Proposal for an accurate TMS-MRI co-registration process via 3D laser scanning

An important technical issue in transcranial magnetic stimulation (TMS) usage is how accurately the specific brain areas activated by TMS are assessed. However, in practice, electric field induced in TMS is dispersed and therefore actual estimation is still difficult. As a preliminary step, the projection line which is perpendicular to the TMS stimulation coil beneath the center of the coil must be accurately estimated into the brain. Therefore, we have developed a new TMS-MRI co-registration procedure that employs a 3D laser-scanner system that is very useful for general hand-manipulated TMS, and which easily estimates the TMS projection point onto the brain. The proposed system accurately captures the positional relationship between the TMS coil and anatomical images. The results of 3D image processing revealed that the registration error at each stage was kept within the submillimeter level. In addition, a motor evoked potential experiment examining the right finger motor area revealed that understandable responses were obtained when stimulation was targeted to the three different motor areas according to Penfield's map. 3D laser scanning is a technique of substantial recent interest for anatomical co-registration. The proposed method demonstrated submillimeter level accuracy of TMS-MRI co-registration.

On the Mechanisms of Transcranial Magnetic Stimulation (TMS): How Brain State and Baseline Performance Level Determine Behavioral Effects of TMS

The behavioral effects of Transcranial Magnetic Stimulation (TMS) can change qualitatively when stimulation is preceded by initial state manipulations such as priming or adaptation. In addition, baseline performance level of the participant has been shown to play a role in modulating the impact of TMS. Here we examined the link between these two factors. This was done using data from a previous study using a TMS-priming paradigm, in which, at group level, TMS selectively facilitated targets incongruent with the prime while having no statistically significant effects on other prime-target congruencies. Correlation and linear mixed-effects analyses indicated that, for all prime-target congruencies, a significant linear relationship between baseline performance and the magnitude of the induced TMS effect was present: low levels of baseline performance were associated with TMS-induced facilitations and high baseline performance with impairments. Thus as performance level increased, TMS effects turned from facilitation to impairment. The key finding was that priming shifted the transition from facilitatory to disruptive effects for targets incongruent with the prime, such that TMS-induced facilitations were obtained until a higher level of performance than for other prime-target congruencies. Given that brain state manipulations such as priming operate via modulations of neural excitability, this result is consistent with the view that neural excitability, coupled with non-linear neural effects, underlie behavioral effects of TMS.

Common framework for "virtual lesion" and state-dependent TMS: The facilitatory/suppressive range model of online TMS effects on behavior

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Transcranial magnetic stimulation can either facilitate or impair behavior.

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Nature of behavioral effects depends on factors such as brain state and intensity.

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We present a common framework to account for these effects.

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There are distinct intensity ranges for facilitatory and suppressive effects of TMS.

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Changes in excitability shift these ranges and account for behavioral effects.

The behavioral effects of Transcranial Magnetic Stimulation (TMS) are often nonlinear; factors such as stimulation intensity and brain state can modulate the impact of TMS on observable behavior in qualitatively different manner. Here we propose a theoretical framework to account for these effects. In this model, there are distinct intensity ranges for facilitatory and suppressive effects of TMS – low intensities facilitate neural activity and behavior whereas high intensities induce suppression. The key feature of the model is that these ranges are shifted by changes in neural excitability: consequently, a TMS intensity, which normally induces suppression, can have a facilitatory effect if the stimulated neurons are being inhibited by ongoing task-related processes or preconditioning. For example, adaptation reduces excitability of adapted neurons; the outcome is that TMS intensities which inhibit non-adapted neurons induce a facilitation on adapted neural representations, leading to reversal of adaptation effects. In conventional “virtual lesion” paradigms, similar effects occur because neurons not involved in task-related processes are inhibited by the ongoing task. The resulting reduction in excitability can turn high intensity “inhibitory” TMS to low intensity “facilitatory” TMS for these neurons, and as task-related neuronal representations are in the inhibitory range, the outcome is a reduction in signal-to-noise ratio and behavioral impairment.

Initial activation state, stimulation intensity and timing of stimulation interact in producing behavioral effects of TMS

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TMS effects depend on various factors such as intensity, brain state and timing.

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We examined how these factors interact to give rise to behavioral effects.

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TMS was applied while participants performed a behavioral priming task.

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State dependency of TMS effect was found to interact with intensity and timing.

Behavioral effects of transcranial magnetic stimulation (TMS) have been shown to depend on various factors, such as neural activation state, stimulation intensity, and timing of stimulation. Here we examined whether these factors interact, by applying TMS at either sub- or suprathreshold intensity (relative to phosphene threshold, PT) and at different time points during a state-dependent TMS paradigm. The state manipulation involved a behavioral task in which a visual prime (color grating) was followed by a target stimulus which could be either congruent, incongruent or partially congruent with the color and orientation of the prime. In Experiment 1, single-pulse TMS was applied over the early visual cortex (V1/V2) or Vertex (baseline) at the onset of the target stimulus – timing often used in state-dependent TMS studies. With both subthreshold and suprathreshold stimulation, TMS facilitated the detection of incongruent stimuli while not significantly affecting other stimulus types. In Experiment 2, TMS was applied at 100 ms after target onset –a time window in which V1/V2 is responding to visual input. Only TMS applied at suprathreshold intensity facilitated the detection of incongruent stimuli, with no effect with subthreshold stimulation. The need for higher stimulation intensity is likely to reflect reduced susceptibility to TMS of neurons responding to visual stimulation. Furthermore, the finding that in Experiment 2 only suprathreshold TMS induced a behavioral facilitation on incongruent targets (whereas facilitations in the absence of priming have been reported with subthreshold TMS) indicates that priming, by reducing neural excitability to incongruent targets, shifts the facilitatory/inhibitory range of TMS effects.