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Kinjo M, Honda S, Wada M, Nakajima S, Koike S, Noda Y. A comparative study of the dorsolateral prefrontal cortex targeting approaches for transcranial magnetic stimulation treatment: Insights from the healthy control data. Brain Res 2024; 1838:148989. [PMID: 38723740 DOI: 10.1016/j.brainres.2024.148989] [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: 02/11/2024] [Revised: 05/05/2024] [Accepted: 05/06/2024] [Indexed: 05/13/2024]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) to the left dorsolateral prefrontal cortex (DLPFC) is an established treatment for medication-resistant depression. Several targeting methods for the left DLPFC have been proposed including identification with resting-state functional magnetic resonance imaging (rs-fMRI) neuronavigation, stimulus coordinates based on structural MRI, or electroencephalography (EEG) F3 site by Beam F3 method. To date, neuroanatomical and neurofunctional differences among those approaches have not been investigated on healthy subjects, which are structurally and functionally unaffected by psychiatric disorders. This study aimed to compare the mean location, its dispersion, and its functional connectivity with the subgenual cingulate cortex (SGC), which is known to be associated with the therapeutic outcome in depression, of various approaches to target the DLPFC in healthy subjects. Fifty-seven healthy subjects underwent MRI scans to identify the stimulation site based on their resting-state functional connectivity and were measured their head size for targeting with Beam F3 method. In addition, we included two fixed stimulus coordinates over the DLPFC in the analysis, as recommended in previous studies. From the results, the rs-fMRI method had, as expected, more dispersed target sites across subjects and the greatest anticorrelation with the SGC, reflecting the known fact that personalized neuronavigation yields the greatest antidepressant effect. In contrast, the targets located by the other methods were relatively close together with less dispersion, and did not differ in anticorrelation with the SGC, implying their limitation of the therapeutic efficacy and possible interchangeability of them.
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Affiliation(s)
- Megumi Kinjo
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Shiori Honda
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Masataka Wada
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Shinichiro Nakajima
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Shinsuke Koike
- Center for Evolutionary Cognitive Sciences, Graduate School of Art and Sciences, The University of Tokyo, Tokyo, Japan
| | - Yoshihiro Noda
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
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Godet A, Serrand Y, Léger B, Moirand R, Bannier E, Val-Laillet D, Coquery N. Functional near-infrared spectroscopy-based neurofeedback training targeting the dorsolateral prefrontal cortex induces changes in cortico-striatal functional connectivity. Sci Rep 2024; 14:20025. [PMID: 39198481 PMCID: PMC11358514 DOI: 10.1038/s41598-024-69863-w] [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: 07/06/2023] [Accepted: 08/09/2024] [Indexed: 09/01/2024] Open
Abstract
Due to its central role in cognitive control, the dorso-lateral prefrontal cortex (dlPFC) has been the target of multiple brain modulation studies. In the context of the present pilot study, the dlPFC was the target of eight repeated neurofeedback (NF) sessions with functional near infrared spectroscopy (fNIRS) to assess the brain responses during NF and with functional and resting state magnetic resonance imaging (task-based fMRI and rsMRI) scanning. Fifteen healthy participants were recruited. Cognitive task fMRI and rsMRI were performed during the 1st and the 8th NF sessions. During NF, our data revealed an increased activity in the dlPFC as well as in brain regions involved in cognitive control and self-regulation learning (pFWE < 0.05). Changes in functional connectivity between the 1st and the 8th session revealed increased connectivity between the posterior cingulate cortex and the dlPFC, and between the posterior cingulate cortex and the dorsal striatum (pFWE < 0.05). Decreased left dlPFC-left insula connectivity was also observed. Behavioural results revealed a significant effect of hunger and motivation on the participant control feeling and a lower control feeling when participants did not identify an effective mental strategy, providing new insights on the effects of behavioural factors that may affect the NF learning.
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Affiliation(s)
- A Godet
- INRAE, INSERM, CHU Rennes, Nutrition Metabolisms and Cancer, NuMeCan, Univ Rennes, Rennes, France
| | - Y Serrand
- INRAE, INSERM, CHU Rennes, Nutrition Metabolisms and Cancer, NuMeCan, Univ Rennes, Rennes, France
| | - B Léger
- INRAE, INSERM, CHU Rennes, Nutrition Metabolisms and Cancer, NuMeCan, Univ Rennes, Rennes, France
| | - R Moirand
- INRAE, INSERM, CHU Rennes, Nutrition Metabolisms and Cancer, NuMeCan, Univ Rennes, Rennes, France
- Unité d'Addictologie, CHU Rennes, Rennes, France
| | - E Bannier
- Inria, CRNS, Inserm, IRISA UMR 6074, Empenn U1228, Univ Rennes, Rennes, France.
- Radiology Department, CHU Rennes, Rennes, France.
| | - D Val-Laillet
- INRAE, INSERM, CHU Rennes, Nutrition Metabolisms and Cancer, NuMeCan, Univ Rennes, Rennes, France.
| | - N Coquery
- INRAE, INSERM, CHU Rennes, Nutrition Metabolisms and Cancer, NuMeCan, Univ Rennes, Rennes, France
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Sun W, Billot A, Du J, Wei X, Lemley RA, Daneshzand M, Nummenmaa A, Buckner RL, Eldaief MC. Precision Network Modeling of TMS Across Individuals Suggests Therapeutic Targets and Potential for Improvement. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.08.15.24311994. [PMID: 39185539 PMCID: PMC11343249 DOI: 10.1101/2024.08.15.24311994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
Higher-order cognitive and affective functions are supported by large-scale networks in the brain. Dysfunction in different networks is proposed to associate with distinct symptoms in neuro-psychiatric disorders. However, the specific networks targeted by current clinical transcranial magnetic stimulation (TMS) approaches are unclear. While standard-of-care TMS relies on scalp-based landmarks, recent FDA-approved TMS protocols use individualized functional connectivity with the subgenual anterior cingulate cortex (sgACC) to optimize TMS targeting. Leveraging previous work on precision network estimation and recent advances in network-level TMS targeting, we demonstrate that clinical TMS approaches target different functional networks between individuals. Homotopic scalp positions (left F3 and right F4) target different networks within and across individuals, and right F4 generally favors a right-lateralized control network. We also modeled the impact of targeting the dorsolateral prefrontal cortex (dlPFC) zone anticorrelated with the sgACC and found that the individual-specific anticorrelated region variably targets a network coupled to reward circuitry. Combining individualized, precision network mapping and electric field (E-field) modeling, we further illustrate how modeling can be deployed to prospectively target distinct closely localized association networks in the dlPFC with meaningful spatial selectivity and E-field intensity. Lastly, our findings emphasize differences between selectivity and maximal intensity, highlighting the need to consider both metrics in precision TMS efforts.
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Al-Sharif NB, Zavaliangos-Petropulu A, Narr KL. A review of diffusion MRI in mood disorders: mechanisms and predictors of treatment response. Neuropsychopharmacology 2024:10.1038/s41386-024-01894-3. [PMID: 38902355 DOI: 10.1038/s41386-024-01894-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/15/2024] [Accepted: 05/21/2024] [Indexed: 06/22/2024]
Abstract
By measuring the molecular diffusion of water molecules in brain tissue, diffusion MRI (dMRI) provides unique insight into the microstructure and structural connections of the brain in living subjects. Since its inception, the application of dMRI in clinical research has expanded our understanding of the possible biological bases of psychiatric disorders and successful responses to different therapeutic interventions. Here, we review the past decade of diffusion imaging-based investigations with a specific focus on studies examining the mechanisms and predictors of therapeutic response in people with mood disorders. We present a brief overview of the general application of dMRI and key methodological developments in the field that afford increasingly detailed information concerning the macro- and micro-structural properties and connectivity patterns of white matter (WM) pathways and their perturbation over time in patients followed prospectively while undergoing treatment. This is followed by a more in-depth summary of particular studies using dMRI approaches to examine mechanisms and predictors of clinical outcomes in patients with unipolar or bipolar depression receiving pharmacological, neurostimulation, or behavioral treatments. Limitations associated with dMRI research in general and with treatment studies in mood disorders specifically are discussed, as are directions for future research. Despite limitations and the associated discrepancies in findings across individual studies, evolving research strongly indicates that the field is on the precipice of identifying and validating dMRI biomarkers that could lead to more successful personalized treatment approaches and could serve as targets for evaluating the neural effects of novel treatments.
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Affiliation(s)
- Noor B Al-Sharif
- Departments of Neurology and Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
| | - Artemis Zavaliangos-Petropulu
- Departments of Neurology and Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Katherine L Narr
- Departments of Neurology and Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Kaneko N, Wada M, Nakajima S, Takano M, Taniguchi K, Honda S, Mimura M, Noda Y. Neuroplasticity of the left dorsolateral prefrontal cortex in patients with treatment-resistant depression as indexed with paired associative stimulation: a TMS-EEG study. Cereb Cortex 2024; 34:bhad515. [PMID: 38204301 PMCID: PMC10839839 DOI: 10.1093/cercor/bhad515] [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: 10/10/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 01/12/2024] Open
Abstract
Major depressive disorder affects over 300 million people globally, with approximately 30% experiencing treatment-resistant depression (TRD). Given that impaired neuroplasticity underlies depression, the present study focused on neuroplasticity in the dorsolateral prefrontal cortex (DLPFC). Here, we aimed to investigate the differences in neuroplasticity between 60 individuals with TRD and 30 age- and sex-matched healthy controls (HCs). To induce neuroplasticity, participants underwent a paired associative stimulation (PAS) paradigm involving peripheral median nerve stimulation and transcranial magnetic stimulation (TMS) targeting the left DLPFC. Neuroplasticity was assessed by using measurements combining TMS with EEG before and after PAS. Both groups exhibited significant increases in the early component of TMS-evoked potentials (TEP) after PAS (P < 0.05, paired t-tests with the bootstrapping method). However, the HC group demonstrated a greater increase in TEPs than the TRD group (P = 0.045, paired t-tests). Additionally, event-related spectral perturbation analysis highlighted that the gamma power significantly increased after PAS in the HC group, whereas it was decreased in the TRD group (P < 0.05, paired t-tests with the bootstrapping method). This gamma power modulation revealed a significant group difference (P = 0.006, paired t-tests), indicating an inverse relationship for gamma power modulation. Our findings underscore the impaired neuroplasticity of the DLPFC in individuals with TRD.
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Affiliation(s)
- Naotsugu Kaneko
- Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo, 3-8-1 Komaba, Meguro, Tokyo 153-8902, Japan
| | - Masataka Wada
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Shinichiro Nakajima
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Mayuko Takano
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
- Teijin Pharma Limited, 4-3-2 Asahigaoka, Hino, Tokyo 191-8512, Japan
| | - Keita Taniguchi
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Shiori Honda
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Yoshihiro Noda
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
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Lu H, Wang Y, Shen D, Ruan J, Lu J, Wang L, Song Y, Fan J, Li D, Shi L, Xia M, Xu T. Effects and central mechanism of electroacupuncture and MRI-navigated rTMS for PSD: study protocol for an fMRI-based single-center, randomized, controlled, open-label trial. Front Psychiatry 2024; 14:1226777. [PMID: 38250275 PMCID: PMC10799680 DOI: 10.3389/fpsyt.2023.1226777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/27/2023] [Indexed: 01/23/2024] Open
Abstract
Background Post-stroke depression (PSD) is the most common mental complication after stroke and has a serious impact on functional outcomes and quality of life for stroke patients. Antidepressants are the first-line treatment for PSD; however, many reported side effects remain. Clinical research and practice guidelines have shown that electro-acupuncture (EA) or rTMS have a positive effect on PSD. However, there are few clinical studies on EA and MRI-navigated rTMS for PSD that explore the fMRI-based central mechanism in depression. Methods In this randomized, controlled, open-label trial, 64 patients with PSD will be randomly allocated into the experiment group (n = 32) or control group (n = 32). The experiment group will receive EA and MRI-navigated rTMS and the control group will receive MRI-navigated rTMS treatment, in 12-20 sessions over 4 weeks. In addition, 10 healthy people for fMRI scanning will be recruited as a healthy control group without any intervention. The primary outcome will be the change from baseline in the Hamilton Depression Scale-24 item (HAMD-24) scores at week 4. The primary analysis of the central mechanism will mainly involve cortical morphology, local spontaneous brain activity, and the default mode network (DMN) functional connectivity based on fMRI at 0 and 4 weeks. Secondary outcomes will include the neuro-patho-physiological and quality of life changes in cortical excitability, determined using the motor evoked potential test (MEP), National Institutes of Health Stroke Scale (NIHSS), EuroQol Five Dimensions Questionnaire (EQ-5D) Scale, Modified Barthel Index (MBI) Scale, and Health Scale of Traditional Chinese Medicine (HSTCM). Additional indicators will include the Acceptability Questionnaire and Health Economics Evaluation (cost-effectiveness analysis) to assess the acceptability and economic practicality of the treatment under study. Outcomes will be assessed at baseline and post intervention. Discussion EA and MRI-navigated rTMS therapy could become an alternative treatment for PSD, and it is expected that this trial will provide reliable clinical evidence and a potential central mechanism for the future use of EA and MRI-navigated rTMS for PSD. Clinical trial registration NCT05516680, ClinicalTrials.gov (registered in August 2022).
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Affiliation(s)
- Hai Lu
- Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Yang Wang
- Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Diwen Shen
- Department of Medical Psychology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Jianguo Ruan
- Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Jiaming Lu
- Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Linlin Wang
- Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Yang Song
- Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Jia Fan
- Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Dongna Li
- Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Lijing Shi
- Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Meng Xia
- Alberta College of Acupuncture & Traditional Chinese Medicine, Calgary, AB, Canada
| | - Tianshu Xu
- Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
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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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Hasan NI, Wang D, Gomez LJ. Fast and accurate computational E-field dosimetry for group-level transcranial magnetic stimulation targeting. Comput Biol Med 2023; 167:107614. [PMID: 37913615 PMCID: PMC10880124 DOI: 10.1016/j.compbiomed.2023.107614] [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: 09/19/2023] [Revised: 10/11/2023] [Accepted: 10/23/2023] [Indexed: 11/03/2023]
Abstract
Transcranial magnetic stimulation (TMS) is used to study brain function and treat mental health disorders. During TMS, a coil placed on the scalp induces an E-field in the brain that modulates its activity. TMS is known to stimulate regions that are exposed to a large E-field. Clinical TMS protocols prescribe a coil placement based on scalp landmarks. There are inter-individual variations in brain anatomy that result in variations in the TMS-induced E-field at the targeted region and its outcome. These variations across individuals could in principle be minimized by developing a large database of head subjects and determining scalp landmarks that maximize E-field at the targeted brain region while minimizing its variation using computational methods. However, this approach requires repeated execution of a computational method to determine the E-field induced in the brain for a large number of subjects and coil placements. We developed a probabilistic matrix decomposition-based approach for rapidly evaluating the E-field induced during TMS for a large number of coil placements due to a pre-defined coil model. Our approach can determine the E-field induced in over 1 Million coil placements in 9.5 h, in contrast, to over 5 years using a brute-force approach. After the initial set-up stage, the E-field can be predicted over the whole brain within 2-3 ms and to 2% accuracy. We tested our approach in over 200 subjects and achieved an error of <2% in most and <3.5% in all subjects. We will present several examples of bench-marking analysis for our tool in terms of accuracy and speed. Furthermore, we will show the methods' applicability for group-level optimization of coil placement for illustration purposes only. The software implementation link is provided in the appendix.
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Affiliation(s)
- Nahian I Hasan
- Elmore Family School of Electrical and Computer Engineering, Purdue University, 465, Northwestern Ave, West Lafayette, 47907, IN, USA.
| | - Dezhi Wang
- Elmore Family School of Electrical and Computer Engineering, Purdue University, 465, Northwestern Ave, West Lafayette, 47907, IN, USA.
| | - Luis J Gomez
- Elmore Family School of Electrical and Computer Engineering, Purdue University, 465, Northwestern Ave, West Lafayette, 47907, IN, USA.
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Tik M, Vasileiadi M, Woletz M, Linhardt D, Schuler AL, Williams N, Windischberger C. Concurrent TMS/fMRI reveals individual DLPFC dose-response pattern. Neuroimage 2023; 282:120394. [PMID: 37805020 DOI: 10.1016/j.neuroimage.2023.120394] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 09/04/2023] [Accepted: 09/25/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND TMS is a valuable tool in both research and clinical settings, playing a crucial role in understanding brain-behavior relationships and providing treatment for various neurological and psychiatric conditions. Importantly, TMS over left DLPFC is an FDA approved treatment for MDD. Despite its potential, response variability to TMS remains a challenge, with stimulation parameters, particularly the stimulation intensity, being a primary contributor to these differences. OBJECTIVE The objective of this study was to establish dose-response relationships of TMS stimulation in DLPFC by means of concurrent TMS/fMRI. METHODS Here, we stimulated 15 subjects at different stimulation intensities of 80, 90, 100 and 110 % relative to the motor threshold during concurrent TMS/fMRI. The experiment comprised two sessions: one session to collect anatomical data in order to perform neuronavigation and one session dedicated to dose-response mapping. We calculated GLMs for each intensity level and each subject, as well as at a group-level per intensity. RESULTS On a group level, we show that the strongest BOLD-response was at 100 % stimulation. However, investigating individual dose response-relationships showed differences in response patterns across the group: subjects that responded to subthreshold stimulation, subjects that required above threshold stimulation in order to show a significant BOLD-response and atypical responders. CONCLUSIONS We observed qualitative inter-subject variability in terms of dose-response relationship to TMS over left DLPFC, which hints towards the motor threshold not being directly transferable to the excitability of the DLPFC. Concurrent TMS/fMRI might have the potential to improve response rates to rTMS applications. As such, it may be valuable in the future to consider implementing this approach prior to clinical TMS or validating more cost-effective methods to determine dose and target with respect to changes in clinical symptoms.
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Affiliation(s)
- Martin Tik
- MR Center of Excellence, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Lazarettgasse 14, Vienna 1090, Austria; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Maria Vasileiadi
- MR Center of Excellence, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Lazarettgasse 14, Vienna 1090, Austria
| | - Michael Woletz
- MR Center of Excellence, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Lazarettgasse 14, Vienna 1090, Austria
| | - David Linhardt
- MR Center of Excellence, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Lazarettgasse 14, Vienna 1090, Austria
| | - Anna-Lisa Schuler
- MR Center of Excellence, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Lazarettgasse 14, Vienna 1090, Austria
| | - Nolan Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Christian Windischberger
- MR Center of Excellence, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Lazarettgasse 14, Vienna 1090, Austria.
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Szücs-Bencze L, Vékony T, Pesthy O, Szabó N, Kincses TZ, Turi Z, Nemeth D. Modulating Visuomotor Sequence Learning by Repetitive Transcranial Magnetic Stimulation: What Do We Know So Far? J Intell 2023; 11:201. [PMID: 37888433 PMCID: PMC10607545 DOI: 10.3390/jintelligence11100201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/23/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023] Open
Abstract
Predictive processes and numerous cognitive, motor, and social skills depend heavily on sequence learning. The visuomotor Serial Reaction Time Task (SRTT) can measure this fundamental cognitive process. To comprehend the neural underpinnings of the SRTT, non-invasive brain stimulation stands out as one of the most effective methodologies. Nevertheless, a systematic list of considerations for the design of such interventional studies is currently lacking. To address this gap, this review aimed to investigate whether repetitive transcranial magnetic stimulation (rTMS) is a viable method of modulating visuomotor sequence learning and to identify the factors that mediate its efficacy. We systematically analyzed the eligible records (n = 17) that attempted to modulate the performance of the SRTT with rTMS. The purpose of the analysis was to determine how the following factors affected SRTT performance: (1) stimulated brain regions, (2) rTMS protocols, (3) stimulated hemisphere, (4) timing of the stimulation, (5) SRTT sequence properties, and (6) other methodological features. The primary motor cortex (M1) and the dorsolateral prefrontal cortex (DLPFC) were found to be the most promising stimulation targets. Low-frequency protocols over M1 usually weaken performance, but the results are less consistent for the DLPFC. This review provides a comprehensive discussion about the behavioral effects of six factors that are crucial in designing future studies to modulate sequence learning with rTMS. Future studies may preferentially and synergistically combine functional neuroimaging with rTMS to adequately link the rTMS-induced network effects with behavioral findings, which are crucial to develop a unified cognitive model of visuomotor sequence learning.
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Affiliation(s)
- Laura Szücs-Bencze
- Department of Neurology, University of Szeged, Semmelweis utca 6, H-6725 Szeged, Hungary
| | - Teodóra Vékony
- Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, INSERM, CNRS, Université Claude Bernard Lyon 1, 95 Boulevard Pinel, F-69500 Bron, France
| | - Orsolya Pesthy
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Izabella utca 46, H-1064 Budapest, Hungary
- Brain, Memory and Language Research Group, Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, Magyar Tudósok Körútja 2, H-1117 Budapest, Hungary
- Institute of Psychology, ELTE Eötvös Loránd Universiry, Izabella utca 46, H-1064 Budapest, Hungary
| | - Nikoletta Szabó
- Department of Neurology, University of Szeged, Semmelweis utca 6, H-6725 Szeged, Hungary
| | - Tamás Zsigmond Kincses
- Department of Neurology, University of Szeged, Semmelweis utca 6, H-6725 Szeged, Hungary
- Department of Radiology, University of Szeged, Semmelweis utca 6, H-6725 Szeged, Hungary
| | - Zsolt Turi
- Department of Neuroanatomy, Institute of Anatomy and Cell Biology, Faculty of Medicine, University of Freiburg, Albertstrasse 17, D-79104 Freiburg, Germany
| | - Dezso Nemeth
- Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, INSERM, CNRS, Université Claude Bernard Lyon 1, 95 Boulevard Pinel, F-69500 Bron, France
- BML-NAP Research Group, Institute of Psychology & Institute of Cognitive Neuroscience and Psychology, ELTE Eötvös Loránd University & Research Centre for Natural Sciences, Damjanich utca 41, H-1072 Budapest, Hungary
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11
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Zhang W, Liu N, Zhao Y, Yao C, Yang D, Yang C, Sun H, Wei X, Sweeney JA, Liang H, Zhang M, Gong Q, Lui S. The acute effects of repetitive transcranial magnetic stimulation on laminar diffusion anisotropy of neocortical gray matter. MedComm (Beijing) 2023; 4:e335. [PMID: 37560755 PMCID: PMC10407029 DOI: 10.1002/mco2.335] [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: 02/10/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 08/11/2023] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is increasingly used to treat neuropsychiatric disorders. Inhibitory and excitatory regimens have been both adopted but the exact mechanism of action remains unclear, and investigating their differential effects on laminar diffusion profiles of neocortex may add important evidence. Twenty healthy participants were randomly assigned to receive a low-frequency/inhibitory or high-frequency/excitatory rTMS targeting the left dorsolateral prefrontal cortex (DLPFC). With the brand-new submillimeter diffusion tensor imaging of whole brain and specialized surface-based laminar analysis, fractional anisotropy (FA) and mean diffusion (MD) profiles of cortical layers at different cortical depths were characterized before/after rTMS. Inhibitory and excitatory rTMS both showed impacts on diffusion metrics of somatosensory, limbic, and sensory regions, but different patterns of changes were observed-increased FA with inhibitory rTMS, whereas decreased FA with excitatory rTMS. More importantly, laminar analysis indicated laminar specificity of changes in somatosensory regions during different rTMS patterns-inhibitory rTMS affected the superficial layers contralateral to the DLPFC, while excitatory rTMS led to changes in the intermediate/deep layers bilateral to the DLPFC. These findings provide novel insights into acute neurobiological effects on diffusion profiles of rTMS that may add critical evidence relevant to different protocols of rTMS on neocortex.
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Affiliation(s)
- Wenjing Zhang
- Department of Radiologyand Functional and Molecular Imaging Key Laboratory of Sichuan ProvinceWest China Hospital of Sichuan UniversityChengduChina
- Huaxi MR Research Center (HMRRC)West China Hospital of Sichuan UniversityChengduChina
- Research Unit of PsychoradiologyChinese Academy of Medical SciencesChengduChina
| | - Naici Liu
- Department of Radiologyand Functional and Molecular Imaging Key Laboratory of Sichuan ProvinceWest China Hospital of Sichuan UniversityChengduChina
- Huaxi MR Research Center (HMRRC)West China Hospital of Sichuan UniversityChengduChina
- Research Unit of PsychoradiologyChinese Academy of Medical SciencesChengduChina
| | - Youjin Zhao
- Department of Radiologyand Functional and Molecular Imaging Key Laboratory of Sichuan ProvinceWest China Hospital of Sichuan UniversityChengduChina
- Huaxi MR Research Center (HMRRC)West China Hospital of Sichuan UniversityChengduChina
- Research Unit of PsychoradiologyChinese Academy of Medical SciencesChengduChina
| | - Chenyang Yao
- Department of Radiologyand Functional and Molecular Imaging Key Laboratory of Sichuan ProvinceWest China Hospital of Sichuan UniversityChengduChina
- Huaxi MR Research Center (HMRRC)West China Hospital of Sichuan UniversityChengduChina
- Research Unit of PsychoradiologyChinese Academy of Medical SciencesChengduChina
| | - Dan Yang
- Department of Radiologyand Functional and Molecular Imaging Key Laboratory of Sichuan ProvinceWest China Hospital of Sichuan UniversityChengduChina
| | - Chengmin Yang
- Department of Radiologyand Functional and Molecular Imaging Key Laboratory of Sichuan ProvinceWest China Hospital of Sichuan UniversityChengduChina
- Huaxi MR Research Center (HMRRC)West China Hospital of Sichuan UniversityChengduChina
- Research Unit of PsychoradiologyChinese Academy of Medical SciencesChengduChina
| | - Hui Sun
- Department of Radiologyand Functional and Molecular Imaging Key Laboratory of Sichuan ProvinceWest China Hospital of Sichuan UniversityChengduChina
- Huaxi MR Research Center (HMRRC)West China Hospital of Sichuan UniversityChengduChina
- Research Unit of PsychoradiologyChinese Academy of Medical SciencesChengduChina
| | - Xia Wei
- Department of Radiologyand Functional and Molecular Imaging Key Laboratory of Sichuan ProvinceWest China Hospital of Sichuan UniversityChengduChina
- Huaxi MR Research Center (HMRRC)West China Hospital of Sichuan UniversityChengduChina
- Research Unit of PsychoradiologyChinese Academy of Medical SciencesChengduChina
| | - John A. Sweeney
- Huaxi MR Research Center (HMRRC)West China Hospital of Sichuan UniversityChengduChina
- Department of Psychiatry and Behavioral NeuroscienceUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | | | | | - Qiyong Gong
- Department of Radiologyand Functional and Molecular Imaging Key Laboratory of Sichuan ProvinceWest China Hospital of Sichuan UniversityChengduChina
- Huaxi MR Research Center (HMRRC)West China Hospital of Sichuan UniversityChengduChina
- Research Unit of PsychoradiologyChinese Academy of Medical SciencesChengduChina
- Department of RadiologyWest China Xiamen Hospital of Sichuan UniversityXiamenFujianChina
| | - Su Lui
- Department of Radiologyand Functional and Molecular Imaging Key Laboratory of Sichuan ProvinceWest China Hospital of Sichuan UniversityChengduChina
- Huaxi MR Research Center (HMRRC)West China Hospital of Sichuan UniversityChengduChina
- Research Unit of PsychoradiologyChinese Academy of Medical SciencesChengduChina
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Cosmo C, Zandvakili A, Petrosino NJ, Toutain TGLDO, Miranda JGV, Philip NS. Examining the neural mechanisms of rTMS: a naturalistic pilot study of acute and serial effects in pharmacoresistant depression. Front Neural Circuits 2023; 17:1161826. [PMID: 37206978 PMCID: PMC10188923 DOI: 10.3389/fncir.2023.1161826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/10/2023] [Indexed: 05/21/2023] Open
Abstract
Introduction Previous studies have demonstrated the effectiveness of therapeutic repetitive transcranial magnetic stimulation (rTMS) to treat pharmacoresistant depression. Nevertheless, these trials have primarily focused on the therapeutic and neurophysiological effects of rTMS following a long-term treatment course. Identifying brain-based biomarkers of early rTMS therapeutic response remains an important unanswered question. In this pilot study, we examined the effects of rTMS on individuals with pharmacoresistant depression using a graph-based method, called Functional Cortical Networks (FCN), and serial electroencephalography (EEG). We hypothesized that changes in brain activity would occur early in treatment course. Methods A total of 15 patients with pharmacoresistant depression underwent five rTMS sessions (5Hz over the left dorsolateral prefrontal cortex, 120%MT, up to 4,000 pulses/session). Five participants received additional rTMS treatment, up to 40 sessions. Resting EEG activity was measured at baseline and following every five sessions, using 64-channel EEG, for 10 minutes with eyes closed. An FCN model was constructed using time-varying graphs and motif synchronization. The primary outcome was acute changes in weighted-node degree. Secondary outcomes included serial FFT-based power spectral analysis and changes in depressive symptoms measured by the 9-Item Patient Health Questionnaire (PHQ-9) and the 30-item Inventory of Depressive Symptoms-Self Report (IDS-SR). Results We found a significant acute effect over the left posterior area after five sessions, as evidenced by an increase in weighted-node degree of 37,824.59 (95% CI, 468.20 to 75,180.98) and a marginal enhancement in the left frontal region (t (14) = 2.0820, p = 0.056). One-way repeated measures ANOVA indicated a significant decrease in absolute beta power over the left prefrontal cortex (F (7, 28) = 2.37, p = 0.048) following ten rTMS sessions. Furthermore, a significant clinical improvement was observed following five rTMS sessions on both PHQ-9 (t (14) = 2.7093, p = 0.017) and IDS-SR (t (14) = 2.5278, p = 0.024) and progressed along the treatment course. Discussion Our findings suggest that FCN models and serial EEG may contribute to a deeper understanding of mechanisms underlying rTMS treatment. Additional research is required to investigate the acute and serial effects of rTMS in pharmacoresistant depression and assess whether early EEG changes could serve as predictors of therapeutic rTMS response.
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Affiliation(s)
- Camila Cosmo
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Brown University, Providence, RI, United States
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, United States
| | - Amin Zandvakili
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Brown University, Providence, RI, United States
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, United States
| | - Nicholas J. Petrosino
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Brown University, Providence, RI, United States
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, United States
| | | | | | - Noah S. Philip
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Brown University, Providence, RI, United States
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, United States
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Lu H, Li J, Zhang L, Meng L, Ning Y, Jiang T. Pinpointing the precise stimulation targets for brain rehabilitation in early-stage Parkinson's disease. BMC Neurosci 2023; 24:24. [PMID: 36991320 PMCID: PMC10061909 DOI: 10.1186/s12868-023-00791-7] [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] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 03/15/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) is increasingly used as a promising non-pharmacological treatment for Parkinson's disease (PD). Scalp-to-cortex distance (SCD), as a key technical parameter of TMS, plays a critical role in determining the locations of treatment targets and corresponding dosage. Due to the discrepancies in TMS protocols, the optimal targets and head models have yet to be established in PD patients. OBJECTIVE To investigate the SCDs of the most popular used targets in left dorsolateral prefrontal cortex (DLPFC) and quantify its impact on the TMS-induced electric fields (E-fields) in early-stage PD patients. METHODS Structural magnetic resonance imaging scans from PD patients (n = 47) and normal controls (n = 36) were drawn from the NEUROCON and Tao Wu datasets. SCD of left DLPFC was measured by Euclidean Distance in TMS Navigation system. The intensity and focality of SCD-dependent E-fields were examined and quantified using Finite Element Method. RESULTS Early-stage PD patients showed an increased SCDs, higher variances in the SCDs and SCD-dependent E-fields across the seven targets of left DLPFC than normal controls. The stimulation targets located on gyral crown had more focal and homogeneous E-fields. The SCD of left DLPFC had a better performance in differentiating early-stage PD patients than global cognition and other brain measures. CONCLUSION SCD and SCD-dependent E-fields could determine the optimal TMS treatment targets and may also be used as a novel marker to differentiate early-stage PD patients. Our findings have important implications for developing optimal TMS protocols and personalized dosimetry in real-world clinical practice.
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Affiliation(s)
- Hanna Lu
- G27, Multi-Centre, Department of Psychiatry, The Chinese University of Hong Kong, Tai Po Hospital, Hong Kong SAR, China.
- Centre for Neuromodulation and Rehabilitation, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Jing Li
- G27, Multi-Centre, Department of Psychiatry, The Chinese University of Hong Kong, Tai Po Hospital, Hong Kong SAR, China
| | - Li Zhang
- Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Lin Meng
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Yuping Ning
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Tianzi Jiang
- Brainnetome Center, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- Research Center for Augmented Intelligence, Zhejiang Lab, Hangzhou, 311100, China
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14
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Osipowicz K, Profyris C, Mackenzie A, Nicholas P, Rudder P, Taylor HM, Young IM, Joyce AW, Dobbin L, Tanglay O, Thompson L, Mashilwane T, Sughrue ME, Doyen S. Real world demonstration of hand motor mapping using the structural connectivity atlas. Clin Neurol Neurosurg 2023; 228:107679. [PMID: 36965417 DOI: 10.1016/j.clineuro.2023.107679] [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: 12/19/2022] [Revised: 03/12/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Locating the hand-motor-cortex (HMC) is an essential component within many neurosurgeries. Despite advancements in these localization methods there are still downfalls for each. Additionally, the importance of presurgical planning calls for increasingly accurate and efficient methods of locating specific cortical regions. OBJECTIVE In this study we aimed to test the ability of the Structural Connectivity Atlas (SCA), a machine-learning based method to parcellate the human cortex, to locate the HMC in a small cohort study. METHODS Using MRI and DTI images obtained from adult subjects (n = 11), personalized brain maps were created for each individual based on a SCA paired with the Brainnetome region for the HMC. Subjects received single pulse TMS, over the HMC region through the use of a neuronavigation system. If they responded with motor movement, this was recorded. The SCA identified HMC region was compared to the visual-determined HMC through identifying the Omega fold on the Precentral Gyrus, which was completed by a trained neuroanatomist. A Kendall's Tau B correlation was conducted between anatomical match and visual movement. RESULTS This study concluded that the SCA was capable of locating the HMC in healthy and distorted brains. Overall, the SCA defined the anatomical area of the HMC in 90 % of subjects and triggered a motor response in 61 %. CONCLUSION The SCA could be suitable for incorporation into presurgical planning practices due to its ability to map anatomically abnormal brains. Further studies on larger cohorts and targeting different areas of cortex could be beneficial.
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Raij TT, Komulainen E, Aydogan DB, Pamilo S, Isometsä E, Raij T. Depression core network-based individualized targeting for transcranial magnetic stimulation. Brain Stimul 2023; 16:619-627. [PMID: 36931462 PMCID: PMC10404717 DOI: 10.1016/j.brs.2023.03.005] [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: 12/20/2022] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) of the dorsolateral prefrontal cortex (DLPFC) is an established treatment for major depressive disorder (MDD). Recent attempts to improve TMS efficacy by individually targeting DLPFC subregions that are functionally connected to the subgenual anterior cingulate cortex (sgACC) appear promising. However, sgACC covers only a small subset of core MDD-related areas. Further, fMRI connectivity of sgACC is poorly repeatable within subjects. METHODS Based on an fMRI database analysis, we first constructed a novel core network model (CNM), capturing voxelwise emotion regulation- and MDD-related DLPFC connectivity. Then, in a sample of 15 healthy subjects and 29 MDD patients, we assessed (i) within-subject repeatability of the DLPFC connectivity patterns computed from time segments of varying lengths of individual-level fMRI data and (ii) association of MDD severity with the individual DLPFC connectivity strengths. We extracted group-level connectivity strengths in CNM from individual DLPFC coordinates stimulated with neuronavigated TMS in a separate sample of 25 MDD patients. These connectivity strengths were then correlated with individual TMS efficacy. RESULTS Compared with sgACC connectivity, CNM increased intraindividual repeatability 5-fold. DLPFC connectivity strength from CNM was associated with MDD severity and TMS efficacy. While the locations of CNM-based individual TMS targets remained constant within individuals, they varied considerably between individuals. CONCLUSIONS CNM increased repeatability of functional targeting to a clinically feasible level. The observed association of MDD severity and TMS efficacy with DLPFC connectivity supports the validity of the CNM. The interindividual differences in target locations motivate future individualized clinical trials leveraging the CNM.
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Affiliation(s)
- Tuukka T Raij
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 590, FI-00029, HUS, Helsinki, Finland; Department of Neuroscience and Biomedical Engineering, and Advanced Magnetic Imaging Center, Aalto NeuroImaging, Aalto University School of Science, P.O Box 13000, FI-00076, AALTO, Espoo, Finland.
| | - Emma Komulainen
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 590, FI-00029, HUS, Helsinki, Finland.
| | - Dogu Baran Aydogan
- Department of Neuroscience and Biomedical Engineering, and Advanced Magnetic Imaging Center, Aalto NeuroImaging, Aalto University School of Science, P.O Box 13000, FI-00076, AALTO, Espoo, Finland; A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland.
| | - Siina Pamilo
- Department of Neuroscience and Biomedical Engineering, and Advanced Magnetic Imaging Center, Aalto NeuroImaging, Aalto University School of Science, P.O Box 13000, FI-00076, AALTO, Espoo, Finland.
| | - Erkki Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 590, FI-00029, HUS, Helsinki, Finland.
| | - Tommi Raij
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA; Department of Radiology, Harvard Medical School, Boston, MA, USA.
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Shu Z, Wu J, Li H, Liu J, Lu J, Lin J, Liang S, Wu J, Han J, Yu N. fNIRS-based functional connectivity signifies recovery in patients with disorders of consciousness after DBS treatment. Clin Neurophysiol 2023; 147:60-68. [PMID: 36702043 DOI: 10.1016/j.clinph.2022.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 11/20/2022] [Accepted: 12/12/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVE While deep brain stimulation (DBS) has proved effective for certain patients with disorders of consciousness (DOC), the working neural mechanism is not clear, the response varies for patients, and the assessment is inadequate. This paper aims to quantify the DBS-induced changes of consciousness in DOC patients at the neural functional level. METHODS Ten DOC patients were included for DBS surgery. The DBS target was the right centromedian-parafascicular (CM-pf) nuclei for four patients and the bilateral CM-pf nuclei for six patients. Functional near-infrared spectroscopy (fNIRS) was taken to measure the neural activation of patients, in parallel with Coma Recovery Scale-Revised (CRS-R), before the DBS surgery and one month after. The fNIRS signals were recorded from the frontal, parietal, and occipital lobes. Functional connectivity analysis quantified the communication between brain regions, area communication strength, and global communication efficiency. Linear regression analysis was conducted between the changes of indices based on functional connectivity analysis and the changes of the CRS-R index. RESULTS Patients with trauma (n = 4) exhibited a greater increase of CRS-R scores after DBS treatment compared with patients with hemorrhage (n = 4) and brainstem infarction (n = 2). Global communication efficiency changed consistently with the CRS-R index (slope = 57.384, p < 0.05, R2=0.483). No significant relationship was found between the changes of area communication strength of six brain lobes and the changes of the CRS-R index. CONCLUSIONS The cause of DOC is essential for the outcome of DBS treatment, and brain communication efficiency is a promising functional marker for DOC recovery. SIGNIFICANCE fNIRS-based functional connectivity analysis on brain network signifies changes of consciousness in DOC patients after DBS treatment.
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Affiliation(s)
- Zhilin Shu
- College of Artificial Intelligence, Nankai University, Tianjin 300350, China; Tianjin Key Laboratory of Intelligent Robotics, Nankai University, Tianjin 300350, China
| | - Jingchao Wu
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin 300350, China
| | - Haitao Li
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin 300350, China
| | - Jinrui Liu
- College of Artificial Intelligence, Nankai University, Tianjin 300350, China; Tianjin Key Laboratory of Intelligent Robotics, Nankai University, Tianjin 300350, China
| | - Jiewei Lu
- College of Artificial Intelligence, Nankai University, Tianjin 300350, China; Tianjin Key Laboratory of Intelligent Robotics, Nankai University, Tianjin 300350, China
| | - Jianeng Lin
- College of Artificial Intelligence, Nankai University, Tianjin 300350, China; Tianjin Key Laboratory of Intelligent Robotics, Nankai University, Tianjin 300350, China
| | - Siquan Liang
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin 300350, China.
| | - Jialing Wu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin 300350, China; Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin Huanhu Hospital, Tianjin 300350, China.
| | - Jianda Han
- College of Artificial Intelligence, Nankai University, Tianjin 300350, China; Tianjin Key Laboratory of Intelligent Robotics, Nankai University, Tianjin 300350, China.
| | - Ningbo Yu
- College of Artificial Intelligence, Nankai University, Tianjin 300350, China; Tianjin Key Laboratory of Intelligent Robotics, Nankai University, Tianjin 300350, China.
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Hasan NI, Wang D, Gomez LJ. Fast And Accurate Population Level Transcranial Magnetic Stimulation via Low-Rank Probabilistic Matrix Decomposition (PMD). BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.02.08.527758. [PMID: 36798321 PMCID: PMC9934653 DOI: 10.1101/2023.02.08.527758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Transcranial magnetic stimulation (TMS) is used to study brain function and treat mental health disorders. During TMS, a coil placed on the scalp induces an E-field in the brain that modulates its activity. TMS is known to stimulate regions that are exposed to a large E-field. Clinical TMS protocols prescribe a coil placement based on scalp landmarks. There are inter-individual variations in brain anatomy that result in variations in the TMS-induced E-field at the targeted region and its outcome. These variations across individuals could in principle be minimized by developing a large database of head subjects and determining scalp landmarks that maximize E-field at the targeted brain region while minimizing its variation using computational methods. However, this approach requires repeated execution of a computational method to determine the E-field induced in the brain for a large number of subjects and coil placements. We developed a probabilistic matrix decomposition-based approach for rapidly evaluating the E-field induced during TMS for a large number of coil placements. Our approach can determine the E-field induced in over 1 Million coil placements in 9.5 hours, in contrast, to over 5 years using a bruteforce approach. After the initial set-up stage, the E-field can be predicted over the whole brain within 2-3 milliseconds and to 2% accuracy. We tested our approach in over 200 subjects and achieved an error of < 2% in most and < 3.5% in all subjects. We will present several examples of bench-marking analysis for our tool in terms of accuracy and speed across and its applicability for population level optimization of coil placement. Highlights A method for practical E-field informed population-level TMS coil placement strategies is developed.This algorithm enables the determination of E-field informed optimal coil placement in seconds enabling it’s use for close-loop and on-the-fly reconfiguration of TMS.After the initial set-up stage of less than 10 hours, the E-field can be predicted for any coil placement across the whole brain within in 2-3 milliseconds.
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Arnsten AFT, Joyce MKP, Roberts AC. The Aversive Lens: Stress effects on the prefrontal-cingulate cortical pathways that regulate emotion. Neurosci Biobehav Rev 2023; 145:105000. [PMID: 36529312 PMCID: PMC9898199 DOI: 10.1016/j.neubiorev.2022.105000] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 12/08/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
ARNSTEN, A.F.T., M.K.P. Joyce and A.C. Roberts. The Aversive Lens: Stress effects on the prefrontal-cingulate cortical pathways that regulate emotion. NEUROSCI BIOBEHAV REV XXX-XXX, 2022. The symptoms of major-depressive-disorder include psychic pain and anhedonia, i.e. seeing the world through an "aversive lens". The neurobiology underlying this shift in worldview is emerging. Here these data are reviewed, focusing on how activation of subgenual cingulate (BA25) induces an "aversive lens", and how higher prefrontal cortical (PFC) areas (BA46/10/32) provide top-down regulation of BA25 but are weakened by excessive dopamine and norepinephrine release during stress exposure, and dendritic spine loss with chronic stress exposure. These changes may generate an attractor state, which maintains the brain under the control of BA25, requiring medication or neuromodulatory treatments to return connectivity to a more flexible state. In line with this hypothesis, effective anti-depressant treatments reduce the activity of BA25 and restore top-down regulation by higher circuits, e.g. as seen with SSRI medications, ketamine, deep brain stimulation of BA25, or rTMS to strengthen dorsolateral PFC. This research has special relevance in an era of chronic stress caused by the COVID19 pandemic, political unrest and threat of climate change.
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Affiliation(s)
- Amy F T Arnsten
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT 06510, USA.
| | - Mary Kate P Joyce
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT 06510, USA.
| | - Angela C Roberts
- Department Physiology, Development and Neuroscience, and Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge CB2 3DY, UK.
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Cao Z, Xiao X, Zhao Y, Jiang Y, Xie C, Paillère-Martinot ML, Artiges E, Li Z, Daskalakis ZJ, Yang Y, Zhu C. Targeting the pathological network: Feasibility of network-based optimization of transcranial magnetic stimulation coil placement for treatment of psychiatric disorders. Front Neurosci 2023; 16:1079078. [PMID: 36685239 PMCID: PMC9846047 DOI: 10.3389/fnins.2022.1079078] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/05/2022] [Indexed: 01/06/2023] Open
Abstract
It has been recognized that the efficacy of TMS-based modulation may depend on the network profile of the stimulated regions throughout the brain. However, what profile of this stimulation network optimally benefits treatment outcomes is yet to be addressed. The answer to the question is crucial for informing network-based optimization of stimulation parameters, such as coil placement, in TMS treatments. In this study, we aimed to investigate the feasibility of taking a disease-specific network as the target of stimulation network for guiding individualized coil placement in TMS treatments. We present here a novel network-based model for TMS targeting of the pathological network. First, combining E-field modeling and resting-state functional connectivity, stimulation networks were modeled from locations and orientations of the TMS coil. Second, the spatial anti-correlation between the stimulation network and the pathological network of a given disease was hypothesized to predict the treatment outcome. The proposed model was validated to predict treatment efficacy from the position and orientation of TMS coils in two depression cohorts and one schizophrenia cohort with auditory verbal hallucinations. We further demonstrate the utility of the proposed model in guiding individualized TMS treatment for psychiatric disorders. In this proof-of-concept study, we demonstrated the feasibility of the novel network-based targeting strategy that uses the whole-brain, system-level abnormity of a specific psychiatric disease as a target. Results based on empirical data suggest that the strategy may potentially be utilized to identify individualized coil parameters for maximal therapeutic effects.
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Affiliation(s)
- Zhengcao Cao
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Xiang Xiao
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Neuroimaging Research Branch, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, United States
| | - Yang Zhao
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Yihan Jiang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Cong Xie
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Marie-Laure Paillère-Martinot
- Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, APHP.Sorbonne Université, Paris, France
- INSERM U A10 Developmental Trajectories and Psychiatry, Ecole Normale Supérieure Paris-Saclay, CNRS, Center Borelli, University of Paris-Saclay, Gif-sur-Yvette, France
| | - Eric Artiges
- INSERM U A10 Developmental Trajectories and Psychiatry, Ecole Normale Supérieure Paris-Saclay, CNRS, Center Borelli, University of Paris-Saclay, Gif-sur-Yvette, France
- Department of Psychiatry, Etablissement Public de Santé (EPS) Barthélemy Durand, tampes, France
| | - Zheng Li
- State Key Laboratory of Cognitive Neuroscience and Learning, Center for Cognition and Neuroergonomics, Beijing Normal University at Zhuhai, Zhuhai, China
- IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Zafiris J. Daskalakis
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Yihong Yang
- Neuroimaging Research Branch, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, United States
| | - Chaozhe Zhu
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
- Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal University, Beijing, China
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Lu H, Li J, Chan SSM, Yue WWY, Lam LCW. Decoding the radiomic features of dorsolateral prefrontal cortex in individuals with accelerated cortical changes: implications for personalized transcranial magnetic stimulation. J Med Imaging (Bellingham) 2023; 10:015001. [PMID: 36619873 PMCID: PMC9811135 DOI: 10.1117/1.jmi.10.1.015001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 12/20/2022] [Indexed: 01/05/2023] Open
Abstract
Purpose Image-guided transcranial magnetic stimulation (TMS) is an emerging research field in neuroscience and rehabilitation medicine. Cortical morphometry, as a radiomic phenotype of aging, plays a vital role in developing personalized TMS model, yet few studies are afoot to examine the aging effects on region-specific morphometry and use it in the estimation of TMS-induced electric fields. Our study was aimed to investigate the radiomic features of bilateral dorsolateral prefrontal cortex (DLPFC) and quantify the TMS-induced electric fields during aging. Approach Baseline, 1-year and 3-year structural magnetic resonance imaging (MRI) scans from normal aging (NA) adults ( n = 32 ) and mild cognitive impairment (MCI) converters ( n = 22 ) were drawn from the Open Access Series of Imaging Studies. The quantitative measures of radiomics included cortical thickness, folding, and scalp-to-cortex distance. Realistic head models were developed to simulate the impacts of radiomic features on TMS-induced E-fields using the finite-element method. Results A pronounced aging-related decrease was found in the gyrification of left DLPFC in MCI converters ( t = 2.21 , p = 0.035 ), which could predict the decline of global cognition at 3-year follow up. Along with the decreased gyrification in left DLPFC, the magnitude of TMS-induced E-fields was rapidly decreased in MCI converters ( t = 2.56 , p = 0.018 ). Conclusions MRI-informed radiomic features of the treatment targets have significant effects on the intensity and distribution of the stimulation-induced electric fields in prodromal dementia patients. Our findings highlight the importance of region-specific radiomics when conducting the transcranial brain stimulation in individuals with accelerated cortical changes, such as Alzheimer's disease.
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Affiliation(s)
- Hanna Lu
- The Chinese University of Hong Kong, Department of Psychiatry, Hong Kong, China
- The Affiliated Brain Hospital of Guangzhou Medical University, Centre for Neuromodulation and Rehabilitation, Guangzhou, China
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jing Li
- The Chinese University of Hong Kong, Department of Psychiatry, Hong Kong, China
| | - Sandra Sau Man Chan
- The Chinese University of Hong Kong, Department of Psychiatry, Hong Kong, China
| | | | - Linda Chiu Wa Lam
- The Chinese University of Hong Kong, Department of Psychiatry, Hong Kong, China
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Young IM, Osipowicz K, Mackenzie A, Clarke O, Taylor H, Nicholas P, Ryan M, Holle J, Tanglay O, Doyen S, Sughrue ME. Comparison of consistency between image guided and craniometric transcranial magnetic stimulation coil placement. Brain Stimul 2022; 15:1465-1466. [PMID: 36309343 DOI: 10.1016/j.brs.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/16/2022] [Accepted: 10/20/2022] [Indexed: 12/30/2022] Open
Affiliation(s)
| | | | | | | | - Hugh Taylor
- Omniscient Neurotechnology, Sydney, 2000, Australia
| | | | - Mark Ryan
- Cingulum Health, Rosebery, 2018, Australia
| | | | - Onur Tanglay
- Omniscient Neurotechnology, Sydney, 2000, Australia
| | | | - Michael E Sughrue
- Omniscient Neurotechnology, Sydney, 2000, Australia; Cingulum Health, Rosebery, 2018, Australia.
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22
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Marques RC, Marques D, Vieira L. Adapting Stanford Neuromodulation Therapy (SNT) for clinical feasibility: rationale and results of a small case series. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Caulfield KA, Fleischmann HH, Cox CE, Wolf JP, George MS, McTeague LM. Neuronavigation maximizes accuracy and precision in TMS positioning: Evidence from 11,230 distance, angle, and electric field modeling measurements. Brain Stimul 2022; 15:1192-1205. [PMID: 36031059 PMCID: PMC10026380 DOI: 10.1016/j.brs.2022.08.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Researchers and clinicians have traditionally relied on elastic caps with markings to reposition the transcranial magnetic stimulation (TMS) coil between trains and sessions. Newer neuronavigation technology co-registers the patient's head and structural magnetic resonance imaging (MRI) scan, providing the researcher with real-time feedback about how to adjust the coil to be on-target. However, there has been no head to head comparison of accuracy and precision across treatment sessions. OBJECTIVE /Hypothesis: In this two-part study, we compared elastic cap and neuronavigation targeting methodologies on distance, angle, and electric field (E-field) magnitude values. METHODS In 42 participants receiving up to 50 total accelerated rTMS sessions in 5 days, we compared cap and neuronavigation targeting approaches in 3408 distance and 6816 angle measurements. In Experiment 1, TMS administrators saved an on-target neuronavigation location at Beam F3, which served as the landmark for all other measurements. Next, the operators placed the TMS coil based on cap markings or neuronavigation software to measure the distance and angle differences from the on-target sample. In Experiment 2, we saved each XYZ coordinate of the TMS coil from cap and neuronavigation targeting in 12 participants to compare the E-field magnitude differences at the cortical prefrontal target in 1106 cap and neuronavigation models. RESULTS Cap targeting was significantly off-target for distance, placing the coil an average of 10.66 mm off-target (Standard error of the mean; SEM = 0.19 mm) compared to 0.3 mm (SEM = 0.03 mm) for neuronavigation (p < 0.0001). Cap targeting also significantly deviated for angles off-target, averaging 7.79 roll/pitch degrees (SEM = 1.07°) off-target and 5.99 yaw degrees (SEM = 0.12°) off-target; in comparison, neuronavigation targeting positioned the coil 0.34 roll/pitch degrees (SEM = 0.01°) and 0.22 yaw (SEM = 0.004°) off-target (both p < 0.0001). Further analyses revealed that there were significant inter-operator differences on distance and angle positioning for F3 (all p < 0.05), but not neuronavigation. Lastly, cap targeting resulted in significantly lower E-fields at the intended prefrontal cortical target, with equivalent E-fields as 110.7% motor threshold (MT; range = 58.3-127.4%) stimulation vs. 119.9% MT (range = 115-123.3%) from neuronavigated targeting with 120% MT stimulation applied (p < 0.001). CONCLUSIONS Cap-based targeting is an inherent source of target variability compared to neuronavigation. Additionally, cap-based coil placement is more prone to differences across operators. Off-target coil placement secondary to cap-based measurements results in significantly lower amounts of stimulation reaching the cortical target, with some individuals receiving only 48.6% of the intended on-target E-field. Neuronavigation technology enables more precise and accurate TMS positioning, resulting in the intended stimulation intensities at the targeted cortical level.
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Affiliation(s)
- Kevin A Caulfield
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA.
| | - Holly H Fleischmann
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA; Department of Psychology, University of Georgia, Athens, GA, USA
| | - Claire E Cox
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Julia P Wolf
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Mark S George
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Lisa M McTeague
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson VA Medical Center, Charleston, SC, USA
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