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Continuous theta-burst stimulation to the sensorimotor cortex affects contralateral gamma-aminobutyric acid level and resting-state networks. PLoS One 2022; 17:e0272268. [PMID: 35969537 PMCID: PMC9377603 DOI: 10.1371/journal.pone.0272268] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 07/15/2022] [Indexed: 11/19/2022] Open
Abstract
Continuous theta-burst stimulation (cTBS) is a noninvasive repetitive brain stimulation protocol that suppresses the excitability of the primary motor cortex. It induces cerebral cortical inhibition by increasing inhibitory interneuronal excitability that is associated with increases in gamma-aminobutyric acid (GABA) concentration in the stimulated cortices. cTBS has been applied in the rehabilitation of stroke patients to modulate interhemispheric imbalance. However, the precise mechanisms of cTBS in remote brain areas remain uncertain. We evaluated cTBS-induced GABA level changes in bilateral sensorimotor cortices using GABA-edited magnetic resonance spectroscopy, alternations of motor evoked potentials (MEPs), and resting-state networks (RSNs) using resting-state functional magnetic resonance imaging in 24 healthy right-handed adults (mean age: 34.4 ± 5.0 years). GABA levels in the stimulated left hemisphere significantly increased from baseline (p = 0.013), which was comparable with those of previous reports. GABA levels in the unstimulated right hemisphere showed a trend decrease. cTBS induced a significant decrease in right hand-MEP amplitudes (22.06% ± 43.50%) from baseline (p = 0.026) in accordance with GABA concentrations. However, multiple RSNs, including the default mode and primary motor networks, did not show any obvious differences between pre- and post-stimulus comparisons in the sensorimotor network using the dual regression approach. These results suggest that cTBS simultaneously increases ipsilateral GABA in the stimulated left hemisphere and decreases contralateral GABA in the unstimulated right hemisphere. Neuromodulation following cTBS may be associated with the interhemispheric inhibition because of alterations in GABA levels between the stimulated and unstimulated cortices.
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Ivan C, Andrea A, Simon ES, Walter P, Leif S, Konrad M, Mathias B, Onnen M, Caspar S. The role of the TMS parameters for activation of the corticospinal pathway to the diaphragm. Clin Neurophysiol 2022; 138:173-185. [DOI: 10.1016/j.clinph.2022.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/12/2022] [Accepted: 03/20/2022] [Indexed: 11/03/2022]
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Caulfield KA, Brown JC. The Problem and Potential of TMS' Infinite Parameter Space: A Targeted Review and Road Map Forward. Front Psychiatry 2022; 13:867091. [PMID: 35619619 PMCID: PMC9127062 DOI: 10.3389/fpsyt.2022.867091] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/21/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive, effective, and FDA-approved brain stimulation method. However, rTMS parameter selection remains largely unexplored, with great potential for optimization. In this review, we highlight key studies underlying next generation rTMS therapies, particularly focusing on: (1) rTMS Parameters, (2) rTMS Target Engagement, (3) rTMS Interactions with Endogenous Brain Activity, and (4) Heritable Predisposition to Brain Stimulation Treatments. METHODS We performed a targeted review of pre-clinical and clinical rTMS studies. RESULTS Current evidence suggests that rTMS pattern, intensity, frequency, train duration, intertrain interval, intersession interval, pulse and session number, pulse width, and pulse shape can alter motor excitability, long term potentiation (LTP)-like facilitation, and clinical antidepressant response. Additionally, an emerging theme is how endogenous brain state impacts rTMS response. Researchers have used resting state functional magnetic resonance imaging (rsfMRI) analyses to identify personalized rTMS targets. Electroencephalography (EEG) may measure endogenous alpha rhythms that preferentially respond to personalized stimulation frequencies, or in closed-loop EEG, may be synchronized with endogenous oscillations and even phase to optimize response. Lastly, neuroimaging and genotyping have identified individual predispositions that may underlie rTMS efficacy. CONCLUSIONS We envision next generation rTMS will be delivered using optimized stimulation parameters to rsfMRI-determined targets at intensities determined by energy delivered to the cortex, and frequency personalized and synchronized to endogenous alpha-rhythms. Further research is needed to define the dose-response curve of each parameter on plasticity and clinical response at the group level, to determine how these parameters interact, and to ultimately personalize these parameters.
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Affiliation(s)
- Kevin A Caulfield
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, United States
| | - Joshua C Brown
- Departments of Psychiatry and Neurology, Brown University Medical School, Providence, RI, United States
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Sorkhabi MM, Gingell F, Wendt K, Benjaber M, Ali K, Rogers DJ, Denison T. Design Analysis and Circuit Topology Optimization for Programmable Magnetic Neurostimulator. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:6384-6389. [PMID: 34892573 DOI: 10.1109/embc46164.2021.9630915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Transcranial magnetic stimulation (TMS) is a form of non-invasive brain stimulation commonly used to modulate neural activity. Despite three decades of examination, the generation of flexible magnetic pulses is still a challenging technical question. It has been revealed that the characteristics of pulses influence the bio-physiology of neuromodulation. In this study, a second-generation programmable TMS (xTMS) equipment with advanced stimulus shaping is introduced that uses cascaded H-bridge inverters and a phase-shifted pulse-width modulation (PWM). A low-pass RC filter model is used to estimate stimulated neural behavior, which helps to design the magnetic pulse generator, according to neural dynamics. The proposed device can generate highly adjustable magnetic pulses, in terms of waveform, polarity and pattern. We present experimental measurements of different stimuli waveforms, such as monophasic, biphasic and polyphasic shapes with peak coil current and the delivered energy of up to 6 kA and 250 J, respectively. The modular and scalable design idea presented here is a potential solution for generating arbitrary and highly customizable magnetic pulses and transferring repetitive paradigms.
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Precise Modulation Strategies for Transcranial Magnetic Stimulation: Advances and Future Directions. Neurosci Bull 2021; 37:1718-1734. [PMID: 34609737 DOI: 10.1007/s12264-021-00781-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/23/2021] [Indexed: 10/20/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) is a popular modulatory technique for the noninvasive diagnosis and therapy of neurological and psychiatric diseases. Unfortunately, current modulation strategies are only modestly effective. The literature provides strong evidence that the modulatory effects of TMS vary depending on device components and stimulation protocols. These differential effects are important when designing precise modulatory strategies for clinical or research applications. Developments in TMS have been accompanied by advances in combining TMS with neuroimaging techniques, including electroencephalography, functional near-infrared spectroscopy, functional magnetic resonance imaging, and positron emission tomography. Such studies appear particularly promising as they may not only allow us to probe affected brain areas during TMS but also seem to predict underlying research directions that may enable us to precisely target and remodel impaired cortices or circuits. However, few precise modulation strategies are available, and the long-term safety and efficacy of these strategies need to be confirmed. Here, we review the literature on possible technologies for precise modulation to highlight progress along with limitations with the goal of suggesting future directions for this field.
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Tugin S, Souza VH, Nazarova MA, Novikov PA, Tervo AE, Nieminen JO, Lioumis P, Ziemann U, Nikulin VV, Ilmoniemi RJ. Effect of stimulus orientation and intensity on short-interval intracortical inhibition (SICI) and facilitation (SICF): A multi-channel transcranial magnetic stimulation study. PLoS One 2021; 16:e0257554. [PMID: 34550997 PMCID: PMC8457500 DOI: 10.1371/journal.pone.0257554] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/03/2021] [Indexed: 11/18/2022] Open
Abstract
Besides stimulus intensities and interstimulus intervals (ISI), the electric field (E-field) orientation is known to affect both short-interval intracortical inhibition (SICI) and facilitation (SICF) in paired-pulse transcranial magnetic stimulation (TMS). However, it has yet to be established how distinct orientations of the conditioning (CS) and test stimuli (TS) affect the SICI and SICF generation. With the use of a multi-channel TMS transducer that provides electronic control of the stimulus orientation and intensity, we aimed to investigate how changes in the CS and TS orientation affect the strength of SICI and SICF. We hypothesized that the CS orientation would play a major role for SICF than for SICI, whereas the CS intensity would be more critical for SICI than for SICF. In eight healthy subjects, we tested two ISIs (1.5 and 2.7 ms), two CS and TS orientations (anteromedial (AM) and posteromedial (PM)), and four CS intensities (50, 70, 90, and 110% of the resting motor threshold (RMT)). The TS intensity was fixed at 110% RMT. The intensities were adjusted to the corresponding RMT in the AM and PM orientations. SICI and SICF were observed in all tested CS and TS orientations. SICI depended on the CS intensity in a U-shaped manner in any combination of the CS and TS orientations. With 70% and 90% RMT CS intensities, stronger PM-oriented CS induced stronger inhibition than weaker AM-oriented CS. Similar SICF was observed for any CS orientation. Neither SICI nor SICF depended on the TS orientation. We demonstrated that SICI and SICF could be elicited by the CS perpendicular to the TS, which indicates that these stimuli affected either overlapping or strongly connected neuronal populations. We concluded that SICI is primarily sensitive to the CS intensity and that CS intensity adjustment resulted in similar SICF for different CS orientations.
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Affiliation(s)
- Sergei Tugin
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland
- BioMag Laboratory, University of Helsinki and Helsinki University Hospital, HUS Medical Imaging Centre, Helsinki, Finland
- * E-mail:
| | - Victor H. Souza
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland
- BioMag Laboratory, University of Helsinki and Helsinki University Hospital, HUS Medical Imaging Centre, Helsinki, Finland
- School of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Maria A. Nazarova
- Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, National Research University Higher School of Economics, Moscow, Russia
- Federal State Budgetary Institution “Federal Center of Brain Research and Neurotechnologies” of the Federal Medical Biological Agency, Moscow, Russia
| | - Pavel A. Novikov
- Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, National Research University Higher School of Economics, Moscow, Russia
| | - Aino E. Tervo
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland
- BioMag Laboratory, University of Helsinki and Helsinki University Hospital, HUS Medical Imaging Centre, Helsinki, Finland
| | - Jaakko O. Nieminen
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland
- BioMag Laboratory, University of Helsinki and Helsinki University Hospital, HUS Medical Imaging Centre, Helsinki, Finland
| | - Pantelis Lioumis
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland
- BioMag Laboratory, University of Helsinki and Helsinki University Hospital, HUS Medical Imaging Centre, Helsinki, Finland
| | - Ulf Ziemann
- Department of Neurology and Stroke, Eberhard Karls University, Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Eberhard Karls University, Tübingen, Germany
| | - Vadim V. Nikulin
- Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, National Research University Higher School of Economics, Moscow, Russia
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Risto J. Ilmoniemi
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland
- BioMag Laboratory, University of Helsinki and Helsinki University Hospital, HUS Medical Imaging Centre, Helsinki, Finland
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Andò A, Vasilotta ML, Zennaro A. The modulation of emotional awareness using non-invasive brain stimulation techniques: a literature review on TMS and tDCS. JOURNAL OF COGNITIVE PSYCHOLOGY 2021. [DOI: 10.1080/20445911.2021.1954013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Agata Andò
- Department of Psychology, University of Turin, Turin, Italy
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Estimation of the Motor Threshold for Near-Rectangular Stimuli Using the Hodgkin-Huxley Model. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2021; 2021:4716161. [PMID: 34194485 PMCID: PMC8184325 DOI: 10.1155/2021/4716161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/09/2021] [Accepted: 05/21/2021] [Indexed: 12/28/2022]
Abstract
The motor threshold measurement is a standard in preintervention probing in TMS experiments. We aim to predict the motor threshold for near-rectangular stimuli to efficiently determine the motor threshold size before any experiments take place. Estimating the behavior of large-scale networks requires dynamically accurate and efficient modeling. We utilized a Hodgkin-Huxley (HH) type model to evaluate motor threshold values and computationally validated its function with known true threshold data from 50 participants trials from state-of-the-art published datasets. For monophasic, bidirectional, and unidirectional rectangular stimuli in posterior-anterior or anterior-posterior directions as generated by the cTMS device, computational modeling of the HH model captured the experimentally measured population-averaged motor threshold values at high precision (maximum error ≤ 8%). The convergence of our biophysically based modeling study with experimental data in humans reveals that the effect of the stimulus shape is strongly correlated with the activation kinetics of the voltage-gated ion channels. The proposed method can reliably predict motor threshold size using the conductance-based neuronal models and could therefore be embedded in new generation neurostimulators. Advancements in neural modeling will make it possible to enhance treatment procedures by reducing the number of delivered magnetic stimuli to participants.
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Suran T, Rumiati RI, Piretti L. The contribution of the left inferior frontal gyrus in affective processing of social groups. Cogn Neurosci 2019; 10:186-195. [PMID: 30913979 DOI: 10.1080/17588928.2019.1593127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We investigated the contribution of the pars opercularis of the left inferior frontal gyrus (LIFGop) in representing knowledge about social groups. We asked healthy individuals to categorize words preceded by semantically congruent or incongruent primes while stimulating the LIFGop. Previous studies showing an involvement of the LIFGop both in processing social stimuli and negative valence words led us to predict that its stimulation would affect responses to negative social category words. Compared to the Vertex as control site, the stimulation of the LIFGop increased the speed of categorization of negative social groups, and disrupted the semantic priming effect for negative words overall. Within the framework of recent theories of semantic memory, we argue that the present results provide initial evidence of the representation of social groups being characterized by affective properties, whose processing is supported by the LIFGop.
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Affiliation(s)
| | | | - Luca Piretti
- a Area of Neuroscience, SISSA , Trieste , Italy.,c Department of Psychology and Cognitive Sciences, University of Trento , Rovereto , Italy.,d Fondazione ONLUS Marica De Vincenzi , Rovereto , Italy
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Wilson MT, Fulcher BD, Fung PK, Robinson P, Fornito A, Rogasch NC. Biophysical modeling of neural plasticity induced by transcranial magnetic stimulation. Clin Neurophysiol 2018; 129:1230-1241. [DOI: 10.1016/j.clinph.2018.03.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/28/2018] [Accepted: 03/14/2018] [Indexed: 10/17/2022]
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Halawa I, Goldental A, Shirota Y, Kanter I, Paulus W. Less Might Be More: Conduction Failure as a Factor Possibly Limiting the Efficacy of Higher Frequencies in rTMS Protocols. Front Neurosci 2018; 12:358. [PMID: 29910706 PMCID: PMC5992401 DOI: 10.3389/fnins.2018.00358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 05/08/2018] [Indexed: 01/17/2023] Open
Abstract
Introduction: rTMS has been proven effective in the treatment of neuropsychiatric conditions, with class A (definite efficacy) evidence for treatment of depression and pain (Lefaucheur et al., 2014). The efficacy in stimulation protocols is, however, quite heterogeneous. Saturation of neuronal firing by HFrTMS without allowing time for recovery may lead to neuronal response failures (NRFs) that compromise the efficacy of stimulation with higher frequencies. Objectives: To examine the efficacy of different rTMS temporal stimulation patterns focusing on a possible upper stimulation limit related to response failures. Protocol patterns were derived from published clinical studies on therapeutic rTMS for depression and pain. They were compared with conduction failures in cell cultures. Methodology: From 57 papers using protocols rated class A for depression and pain (Lefaucheur et al., 2014) we extracted Inter-train interval (ITI), average frequency, total duration and total number of pulses and plotted them against the percent improvement on the outcome scale. Specifically, we compared 10 Hz trains with ITIs of 8 s (protocol A) and 26 s (protocol B) in vitro on cultured cortical neurons. Results: In the in vitro experiments, protocol A with 8-s ITIs resulted in more frequent response failures, while practically no response failures occurred with protocol B (26-s intervals). The HFrTMS protocol analysis exhibited no significant effect of ITIs on protocol efficiency. Discussion: In the neuronal culture, longer ITIs appeared to allow the neuronal response to recover. In the available human dataset on both depression and chronic pain, data concerning shorter ITIs is does not allow a significant conclusion. Significance: NRF may interfere with the efficacy of rTMS stimulation protocols when the average stimulation frequency is too high, proposing ITIs as a variable in rTMS protocol efficacy. Clinical trials are necessary to examine effect of shorter ITIs on the clinical outcome in a controlled setting.
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Affiliation(s)
- Islam Halawa
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Göttingen, Germany
| | - Amir Goldental
- Department of Physics, Bar-Ilan University, Ramat-Gan, Israel
| | - Yuichiro Shirota
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Göttingen, Germany
| | - Ido Kanter
- Department of Physics, Bar-Ilan University, Ramat-Gan, Israel.,Goodman Faculty of Life Sciences, Gonda Interdisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel
| | - Walter Paulus
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Göttingen, Germany
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Wilson MT, Tang AD, Iyer K, McKee H, Waas J, Rodger J. The challenges of producing effective small coils for transcranial magnetic stimulation of mice. Biomed Phys Eng Express 2018. [DOI: 10.1088/2057-1976/aab525] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Shirota Y, Dhaka S, Paulus W, Sommer M. Current direction-dependent modulation of human hand motor function by intermittent theta burst stimulation (iTBS). Neurosci Lett 2017; 650:109-113. [PMID: 28435045 DOI: 10.1016/j.neulet.2017.04.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 04/08/2017] [Accepted: 04/18/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) with different current directions can activate different sets of neurons. Current direction can also affect the results of repetitive TMS. OBJECTIVE To test the influence of uni-directional intermittent theta burst stimulation (iTBS) using different current directions, namely posteroanterior (PA) and anteroposterior (AP), on motor behaviour. METHODS In a cross-over design, PA- and AP-iTBS was applied over the left primary motor cortex in 19 healthy, right-handed volunteers. Performance of a finger-tapping task was recorded before and 0, 10, 20, and 30min after the iTBS. The task was conducted with the right and left hands separately at each time point. As a control, AP-iTBS with reduced intensity was applied to 14 participants in a separate session (APweak condition). RESULTS The finger-tapping count with the left hand was decreased after PA-iTBS. Neither AP- nor APweak-iTBS altered the performance. CONCLUSIONS Current direction had a significant impact on the after-effects of iTBS.
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Affiliation(s)
- Yuichiro Shirota
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Göttingen, Germany.
| | - Suman Dhaka
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Göttingen, Germany; Indian Institute of Technology, Guwahati, Assam, India.
| | - Walter Paulus
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Göttingen, Germany.
| | - Martin Sommer
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Göttingen, Germany.
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MagPy: A Python toolbox for controlling Magstim transcranial magnetic stimulators. J Neurosci Methods 2017; 276:33-37. [DOI: 10.1016/j.jneumeth.2016.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 11/10/2016] [Accepted: 11/10/2016] [Indexed: 11/22/2022]
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