Cumulative effects of single TMS pulses during beta-tACS are stimulation intensity-dependent

Effects of distant biofield energy healing on adults associated with psychological and mental health-related symptoms: a randomized, placebo-controlled, double-blind study

Background

In recent years, popularity of Biofield energy healing therapy has increased tremendously parallel to conventional therapy. However, due to insufficient scientific studies on biofield therapies, authors planned this clinical trial to examine the safety and effectiveness of biofield therapy in treating symptoms of psychological and mental health and to explore parameters for its effectiveness.

Methods

One hundred fourteen participants (55 male, 59 female) underwent clinical trials. This trial was randomized, placebo-controlled, three parallel-groups, double-blind, and single-center with subjects who have one or more psychological and mental symptoms. Two sessions of distant (virtual) biofield energy attunement were given on days 0 and 90 for about 5 minutes to the subjects of biofield intervention group (n=39). Besides, control (n=35) and sham control (n=40) group subjects also received kind of treatment in a similar manner to nullify baseline responses. Subjects were assessed by psychological questionnaire scoring using standard scale of assessment and safety parameters.

Results

Perceived psychological symptoms/scores (fatigue/tiredness, sleep disturbances, stress, cognitive impairment, loss of memory, mental restlessness, emotional trauma, anxiety, depression, confusion, financial crises and dissatisfaction, low libido, motivation, confidence, lack of perception, relationship, and social behaviors, etc.) were significantly (p <.0001) improved in biofield intervention group compared to the naïve control and sham control groups. Besides, biofield intervention did not show any study-related adverse effects in all three groups throughout the trial.

Conclusions

The distant (virtual) biofield energy healing therapy significantly improved psychological and mental health-related symptoms without affecting safety concerns, and improved overall health and quality of life.

Resolving equivocal gain modulation of corticospinal excitability

The ratio between the input and output of neuronal populations, usually referred to as gain modulation, is rhythmically modulated along the oscillatory cycle. Previous research on spinal neurons, however, revealed contradictory findings: both uni- and bimodal patterns of increased responsiveness for synaptic input have been proposed for the oscillatory beta rhythm. In this study, we compared previous approaches of phase estimation directly on simulated data and empirically tested the corresponding predictions in healthy males and females. We applied single-pulse transcranial magnetic stimulation over the primary motor cortex at rest, and assessed the spinal output generated by this input. Specifically, the peak-to-peak amplitude of the motor evoked potential in the contralateral forearm was estimated as a function of the EMG phase at which the stimulus was applied. The findings indicated that human spinal neurons adhere to a unimodal pattern of increased responsiveness, and suggest that the rising phase of the upper beta band maximizes gain modulation. Importantly, a bimodal pattern of increased responsiveness was shown to result in an artifact during data analysis and filtering. This observation of invalid preprocessing could be generalized to other frequency bands (i.e., delta, theta, alpha, and gamma), different task conditions (i.e., voluntary muscle contraction), and EEG-based phase estimations. Appropriate analysis algorithms, such as broad-band filtering, enable us to accurately determine gain modulation of neuronal populations and to avoid erroneous phase estimations. This may facilitate novel phase-specific interventions for targeted neuromodulation.

Oscillatory neurofeedback networks and poststroke rehabilitative potential in severely impaired stroke patients

Motor restoration after severe stroke is often limited. However, some of the severely impaired stroke patients may still have a rehabilitative potential. Biomarkers that identify these patients are sparse. Eighteen severely impaired chronic stroke patients with a lack of volitional finger extension participated in an EEG study. During sixty-six trials of kinesthetic motor imagery, a brain-machine interface turned event-related beta-band desynchronization of the ipsilesional sensorimotor cortex into opening of the paralyzed hand by a robotic orthosis. A subgroup of eight patients participated in a subsequent four-week rehabilitation training. Changes of the movement extent were captured with sensors which objectively quantified even discrete improvements of wrist movement. Albeit with the same motor impairment level, patients could be differentiated into two groups, i.e., with and without task-related increase of bilateral cortico-cortical phase synchronization between frontal/premotor and parietal areas. This fronto-parietal integration (FPI) was associated with a significantly higher volitional beta modulation range in the ipsilesional sensorimotor cortex. Following the four-week training, patients with FPI showed significantly higher improvement in wrist movement than those without FPI. Moreover, only the former group improved significantly in the upper extremity Fugl-Meyer-Assessment score. Neurofeedback-related long-range oscillatory coherence may differentiate severely impaired stroke patients with regard to their rehabilitative potential, a finding that needs to be confirmed in larger patient cohorts.

High Gamma and Beta Temporal Interference Stimulation in the Human Motor Cortex Improves Motor Functions

Background: Temporal interference (TI) stimulation is a new technique of non-invasive brain stimulation. Envelope-modulated waveforms with two high-frequency carriers can activate neurons in target brain regions without stimulating the overlying cortex, which has been validated in mouse brains. However, whether TI stimulation can work on the human brain has not been elucidated.

Objective: To assess the effectiveness of the envelope-modulated waveform of TI stimulation on the human primary motor cortex (M1).

Methods: Participants attended three sessions of 30-min TI stimulation during a random reaction time task (RRTT) or a serial reaction time task (SRTT). Motor cortex excitability was measured before and after TI stimulation.

Results: In the RRTT experiment, only 70 Hz TI stimulation had a promoting effect on the reaction time (RT) performance and excitability of the motor cortex compared to sham stimulation. Meanwhile, compared with the sham condition, only 20 Hz TI stimulation significantly facilitated motor learning in the SRTT experiment, which was significantly positively correlated with the increase in motor evoked potential.

Conclusion: These results indicate that the envelope-modulated waveform of TI stimulation has a significant promoting effect on human motor functions, experimentally suggesting the effectiveness of TI stimulation in humans for the first time and paving the way for further explorations.

Biomedical Applications of Electromagnetic Detection: A Brief Review

This paper presents a review on the biomedical applications of electromagnetic detection in recent years. First of all, the thermal, non-thermal, and cumulative thermal effects of electromagnetic field on organism and their biological mechanisms are introduced. According to the electromagnetic biological theory, the main parameters affecting electromagnetic biological effects are frequency and intensity. This review subsequently makes a brief review about the related biomedical application of electromagnetic detection and biosensors using frequency as a clue, such as health monitoring, food preservation, and disease treatment. In addition, electromagnetic detection in combination with machine learning (ML) technology has been used in clinical diagnosis because of its powerful feature extraction capabilities. Therefore, the relevant research involving the application of ML technology to electromagnetic medical images are summarized. Finally, the future development to electromagnetic detection for biomedical applications are presented.

A specific phase of transcranial alternating current stimulation at the β frequency boosts repetitive paired-pulse TMS-induced plasticity

Transcranial alternating current stimulation (tACS) at 20 Hz (β) has been shown to modulate motor evoked potentials (MEPs) when paired with transcranial magnetic stimulation (TMS) in a phase-dependent manner. Repetitive paired-pulse TMS (rPPS) with I-wave periodicity (1.5 ms) induced short-lived facilitation of MEPs. We hypothesized that tACS would modulate the facilitatory effects of rPPS in a frequency- and phase-dependent manner. To test our hypothesis, we investigated the effects of combined tACS and rPPS. We applied rPPS in combination with peak or trough phase tACS at 10 Hz (α) or β, or sham tACS (rPPS alone). The facilitatory effects of rPPS in the sham condition were temporary and variable among participants. In the β tACS peak condition, significant increases in single-pulse MEPs persisted for over 30 min after the stimulation, and this effect was stable across participants. In contrast, β tACS in the trough condition did not modulate MEPs. Further, α tACS parameters did not affect single-pulse MEPs after the intervention. These results suggest that a rPPS-induced increase in trans-synaptic efficacy could be strengthened depending on the β tACS phase, and that this technique could produce long-lasting plasticity with respect to cortical excitability.

Brain State-dependent Gain Modulation of Corticospinal Output in the Active Motor System

The communication through coherence hypothesis suggests that only coherently oscillating neuronal groups can interact effectively and predicts an intrinsic response modulation along the oscillatory rhythm. For the motor cortex (MC) at rest, the oscillatory cycle has been shown to determine the brain's responsiveness to external stimuli. For the active MC, however, the demonstration of such a phase-specific modulation of corticospinal excitability (CSE) along the rhythm cycle is still missing. Motor evoked potentials in response to transcranial magnetic stimulation (TMS) over the MC were used to probe the effect of cortical oscillations on CSE during several motor conditions. A brain-machine interface (BMI) with a robotic hand orthosis allowed investigating effects of cortical activity on CSE without the confounding effects of voluntary muscle activation. Only this BMI approach (and not active or passive hand opening alone) revealed a frequency- and phase-specific cortical modulation of CSE by sensorimotor beta-band activity that peaked once per oscillatory cycle and was independent of muscle activity. The active MC follows an intrinsic response modulation in accordance with the communication through coherence hypothesis. Furthermore, the BMI approach may facilitate and strengthen effective corticospinal communication in a therapeutic context, for example, when voluntary hand opening is no longer possible after stroke.

Impact of β-range-induced oscillatory activity on human input-output relationship of the corticospinal pathway

Objective: The aim of the study was to show that short-lasting (90 s) transcranial alternating current stimulation (tACS) at 20 Hz delivered over the left primary motor cortex (M1) is able to change the shape of recruitment curve of the corticospinal pathway.Methods: The corticospinal pathway was studied during tACS by means of the relationship between the intensity of transcranial magnetic stimulation (TMS) delivered over the left M1 and corresponding motor evoked potentials (MEPs) recorded from the right first dorsal interosseus muscle (FDI), in nine healthy subjects. In order to extract characteristics of the input-output relationship that have particular physiological relevance, data were fitted to the Boltzmann sigmoidal function by the Levenberg-Marquardt nonlinear, least mean squares algorithm.Results: The β-rhythm tACS influenced the shape and parameters of the input-output relation, so that the initial segment of the conditioned curve (from threshold to 30% of maximum muscle size) diverged, while the subsequent segment converged to overlap the unconditioned control curve.Discussion: β-rhythm tACS conditions only a definite subset of corticospinal elements influencing less than 30% of the entire motoneuronal pool. The fact that β-rhythm tACS mainly affects the most excitable motoneurons could explain the observed antikinetic effect of the tACS at β-rhythm applied in the motor regions.

Safety and recommendations for TMS use in healthy subjects and patient populations, with updates on training, ethical and regulatory issues: Expert Guidelines

This article is based on a consensus conference, promoted and supported by the International Federation of Clinical Neurophysiology (IFCN), which took place in Siena (Italy) in October 2018. The meeting intended to update the ten-year-old safety guidelines for the application of transcranial magnetic stimulation (TMS) in research and clinical settings (Rossi et al., 2009). Therefore, only emerging and new issues are covered in detail, leaving still valid the 2009 recommendations regarding the description of conventional or patterned TMS protocols, the screening of subjects/patients, the need of neurophysiological monitoring for new protocols, the utilization of reference thresholds of stimulation, the managing of seizures and the list of minor side effects. New issues discussed in detail from the meeting up to April 2020 are safety issues of recently developed stimulation devices and pulse configurations; duties and responsibility of device makers; novel scenarios of TMS applications such as in the neuroimaging context or imaging-guided and robot-guided TMS; TMS interleaved with transcranial electrical stimulation; safety during paired associative stimulation interventions; and risks of using TMS to induce therapeutic seizures (magnetic seizure therapy). An update on the possible induction of seizures, theoretically the most serious risk of TMS, is provided. It has become apparent that such a risk is low, even in patients taking drugs acting on the central nervous system, at least with the use of traditional stimulation parameters and focal coils for which large data sets are available. Finally, new operational guidelines are provided for safety in planning future trials based on traditional and patterned TMS protocols, as well as a summary of the minimal training requirements for operators, and a note on ethics of neuroenhancement.

Sensorimotor Oscillatory Phase-Power Interaction Gates Resting Human Corticospinal Output

Oscillatory activity within sensorimotor networks is characterized by time-varying changes in phase and power. The influence of interactions between sensorimotor oscillatory phase and power on human motor function, like corticospinal output, is unknown. We addressed this gap in knowledge by delivering transcranial magnetic stimulation (TMS) to the human motor cortex during electroencephalography recordings in 20 healthy participants. Motor evoked potentials, a measure of corticospinal excitability, were categorized offline based on the mu (8-12 Hz) and beta (13-30 Hz) oscillatory phase and power at the time of TMS. Phase-dependency of corticospinal excitability was evaluated across a continuous range of power levels using trial-by-trial linear mixed-effects models. For mu, there was no effect of PHASE or POWER (P > 0.51), but a significant PHASE × POWER interaction (P = 0.002). The direction of phase-dependency reversed with changing mu power levels: corticospinal output was higher during mu troughs versus peaks when mu power was high while the opposite was true when mu power was low. A similar PHASE × POWER interaction was not present for beta oscillations (P > 0.11). We conclude that the interaction between sensorimotor oscillatory phase and power gates human corticospinal output to an extent unexplained by sensorimotor oscillatory phase or power alone.

State-Dependent Gain Modulation of Spinal Motor Output

Afferent somatosensory information plays a crucial role in modulating efferent motor output. A better understanding of this sensorimotor interplay may inform the design of neurorehabilitation interfaces. Current neurotechnological approaches that address motor restoration after trauma or stroke combine motor imagery (MI) and contingent somatosensory feedback, e.g., via peripheral stimulation, to induce corticospinal reorganization. These interventions may, however, change the motor output already at the spinal level dependent on alterations of the afferent input. Neuromuscular electrical stimulation (NMES) was combined with measurements of wrist deflection using a kinematic glove during either MI or rest. We investigated 360 NMES bursts to the right forearm of 12 healthy subjects at two frequencies (30 and 100 Hz) in random order. For each frequency, stimulation was assessed at nine intensities. Measuring the induced wrist deflection across different intensities allowed us to estimate the input-output curve (IOC) of the spinal motor output. MI decreased the slope of the IOC independent of the stimulation frequency. NMES with 100 Hz vs. 30 Hz decreased the threshold of the IOC. Human-machine interfaces for neurorehabilitation that combine MI and NMES need to consider bidirectional communication and may utilize the gain modulation of spinal circuitries by applying low-intensity, high-frequency stimulation.

State-Dependent Effects of Transcranial Oscillatory Currents on the Motor System during Action Observation

We applied transcranial alternating current stimulation (tACS) to the primary motor cortex (M1) at different frequencies during an index–thumb pinch-grip observation task. To estimate changes in the corticospinal output, we used the size of motor evoked potentials (MEPs) obtained by transcranial magnetic stimulation (TMS) of M1 using an online MRI-guided simultaneous TMS-tACS approach. The results of the beta-tACS confirm a non-selective increase in corticospinal excitability in subjects at rest; an increase was observed for both of the tested hand muscles, the first dorsal interosseous (FDI) and the abductor digiti minimi (ADM). However, during action observation of the pinch-grip movement, the increase of corticospinal excitability was only observed for the prime mover FDI muscle and took place during alpha-tACS, while gamma-tACS affected both the FDI and control muscle (ADM) responses. These phenomena likely reflect the hypothesis that the mu and gamma rhythms specifically index the downstream modulation of primary sensorimotor areas by engaging mirror neuron activity. The current neuromodulation approach confirms that tACS can be used to induce neurophysiologically detectable state-dependent enhancement effects, even in complex motor-cognitive tasks.

Distinct Beta-band Oscillatory Circuits Underlie Corticospinal Gain Modulation

Rhythmic synchronization of neurons is known to affect neuronal interactions. In the motor system, oscillatory power fluctuations modulate corticospinal excitability. However, previous research addressing phase-specific gain modulation in the motor system has resulted in contradictory findings. It remains unclear how many time windows of increased responsiveness each oscillatory cycle provides. Moreover, we still lack conclusive evidence as to whether the motor cortex entails an intrinsic response modulation along the rhythm cycle, as shown for spinal neurons. We investigated this question with single-pulse transcranial magnetic stimulation over the primary motor cortex at rest. Application of near-motor threshold stimuli revealed a frequency- and phase-specific gain modulation at both cortical and spinal level, independent of the spontaneous oscillatory power fluctuations at each level. We detected bilateral sensorimotor circuits in the lower beta-band (14–17 Hz) and unilateral corticospinal circuits in the upper beta-band (20–24 Hz). These findings provide novel evidence that intrinsic activity in the human motor cortex modulates input gain along the beta oscillatory cycle within distinct circuits. In accordance with periodic alternations of synchronous hyper- and depolarization, increased neuronal responsiveness occurred once per oscillatory beta cycle. This information may lead to new brain state-dependent and circuit-specific interventions for targeted neuromodulation.