Markers of TMS-evoked visual conscious experience in a patient with altitudinal hemianopia

Bypassing input to V1 in visual awareness: A TMS-EROS investigation

Early visual cortex (V1-V3) is believed to be critical for normal visual awareness by providing the necessary feedforward input. However, it remains unclear whether visual awareness can occur without further involvement of early visual cortex, such as re-entrant feedback. It has been challenging to determine the importance of feedback activity to these areas because of the difficulties in dissociating this activity from the initial feedforward activity. Here, we applied single-pulse transcranial magnetic stimulation (TMS) over the left posterior parietal cortex to elicit phosphenes in the absence of direct visual input to early visual cortex. Immediate neural activity after the TMS pulse was assessed using the event-related optical signal (EROS), which can measure activity under the TMS coil without artifacts. Our results show that: 1) The activity in posterior parietal cortex 50 ms after TMS was related to phosphene awareness, and 2) Activity related to awareness was observed in a small portion of V1 140 ms after TMS, but in contrast (3) Activity in V2 was a more robust correlate of awareness. Together, these results are consistent with interactive models proposing that sustained and recurrent loops of activity between cortical areas are necessary for visual awareness to emerge. In addition, we observed phosphene-related activations of the anteromedial cuneus and lateral occipital cortex, suggesting a functional network subserving awareness comprising these regions, the parietal cortex and early visual cortex.

Mapping the routes of perception: Hemispheric asymmetries in signal propagation dynamics

The visual system has long been considered equivalent across hemispheres. However, an increasing amount of data shows that functional differences may exist in this regard. We therefore tried to characterize the emergence of visual perception and the spatiotemporal dynamics resulting from the stimulation of visual cortices in order to detect possible interhemispheric asymmetries. Eighteen participants were tested. Each of them received 360 transcranial magnetic stimulation (TMS) pulses at phosphene threshold intensity over left and right early visual areas while electroencephalography was being recorded. After each single pulse, participants had to report the presence or absence of a phosphene. Local mean field power analysis of TMS-evoked potentials showed an effect of both site (left vs. right TMS) of stimulation and hemisphere (ipsilateral vs. contralateral to the TMS): while right TMS determined early stronger activations, left TMS determined later stronger activity in contralateral electrodes. The interhemispheric signal propagation index revealed differences in how TMS-evoked activity spreads: left TMS-induced activity diffused contralaterally more than right stimulation. With regard to phosphenes perception, distinct electrophysiological patterns were found to reflect similar perceptual experiences: left TMS-evoked phosphenes are associated with early occipito-parietal and frontal activity followed by late central activity; right TMS-evoked phosphenes determine only late, fronto-central, and parietal activations. Our results show that left and right occipital TMS elicits differential electrophysiological patterns in the brain, both per se and as a function of phosphene perception. These distinct activation patterns may suggest a different role of the two hemispheres in processing visual information and giving rise to perception.

Coherent activity within and between hemispheres: cortico-cortical connectivity revealed by rTMS of the right posterior parietal cortex

Introduction

Low frequency (1 Hz) repetitive transcranial stimulation (rTMS) applied over right posterior parietal cortex (rPPC) has been shown to reduce cortical excitability both of the stimulated area and of the interconnected contralateral homologous areas. In the present study, we investigated the whole pattern of intra- and inter-hemispheric cortico-cortical connectivity changes induced by rTMS over rPPC.

Methods

To do so, 14 healthy participants underwent resting state EEG recording before and after 30 min of rTMS at 1 Hz or sham stimulation over the rPPC (electrode position P6). Real stimulation was applied at 90% of motor threshold. Coherence values were computed on the electrodes nearby the stimulated site (i.e., P4, P8, and CP6) considering all possible inter- and intra-hemispheric combinations for the following frequency bands: delta (0.5-4 Hz), theta (4-8 Hz), alpha (8-12Hz), low beta (12-20 Hz), high beta (20-30 Hz), and gamma (30-50 Hz).

Results and discussion

Results revealed a significant increase in coherence in delta, theta, alpha and beta frequency bands between rPPC and the contralateral homologous sites. Moreover, an increase in coherence in theta, alpha, beta and gamma frequency bands was found between rPPC and right frontal sites, reflecting the activation of the fronto-parietal network within the right hemisphere. Summarizing, subthreshold rTMS over rPPC revealed cortico-cortical inter- and intra-hemispheric connectivity as measured by the increase in coherence among these areas. Moreover, the present results further confirm previous evidence indicating that the increase of coherence values is related to intra- and inter-hemispheric inhibitory effects of rTMS. These results can have implications for devising evidence-based rehabilitation protocols after stroke.

Motor Cortical Correlates of Paired Associative Stimulation Induced Plasticity: A TMS-EEG Study

Paired associative stimulation (PAS) is a non-invasive brain stimulation technique that modulates synaptic plasticity in the human motor cortex (M1). Since previous studies have primarily used motor-evoked potentials (MEPs) as outcome measure, cortical correlates of PAS-induced plasticity remain unknown. Therefore, the aim of this observational study was to investigate cortical correlates of a standard PAS induced plasticity in the primary motor cortex by using a combined TMS-EEG approach in a cohort of eighteen healthy subjects. In addition to the expected long-lasting facilitatory modulation of MEPs amplitude, PAS intervention also induced a significant increase in transcranial magnetic stimulation-evoked potentials (TEPs) P30 and P60 amplitude. No significant correlation between the magnitude of PAS-induced changes in TEP components and MEP amplitude were observed. However, the linear regression analysis revealed that the combined changes in P30 and P60 component amplitudes significantly predicted the MEP facilitation after PAS. The findings of our study offer novel insight into the neurophysiological changes associated with PAS-induced plasticity at M1 cortical level and suggest a complex relationship between TEPs and MEPs changes following PAS.

Late Positivity Does Not Meet the Criteria to be Considered a Proper Neural Correlate of Perceptual Awareness

Contrastive analysis has been widely employed in the search for the electrophysiological neural correlates of consciousness. However, despite its clear logic, it has been argued that it may not succeed in isolating neural processes solely involved in the emergence of perceptual awareness. In fact, data from contrastive analysis would be contaminated by potential confounding factors reflecting distinct, though related, processes either preceding or following the conscious perception. At present, the ERP components representing the proper correlates of perceptual awareness still remain to be identified among those correlating with awareness (i.e., Visual Awareness Negativity, VAN and Late Positivity, LP). In order to dissociate visual awareness from post-perceptual confounds specifically related to decision making, we manipulated the response criterion, which affects how a percept is translated into a decision. In particular, while performing an orientation discrimination task, participants were asked to shift their response criterion across sessions. As a consequence, the resulting modulation should concern the ERP component(s) not exclusively reflecting mechanisms regulating the subjective conscious experience itself but rather the processes accompanying it. Electrophysiological results showed that N1 and P3 were sensitive to the response criterion adopted by participants. Additionally, the more the participants shifted their response criterion, the bigger the ERP modulation was; this was consequently indicative of the critical role of these components in the decision-making processes regardless of awareness level. When considering data independently from the response criterion, the aware vs. unaware contrast showed that both VAN and LP were significant. Crucially, the LP component was also modulated by the interaction of awareness and response criterion, while VAN results to be unaffected. In agreement with previous literature, these findings provide evidence supporting the hypothesis that VAN tracks the emergence of visual awareness by encoding the conscious percept, whereas LP reflects the contribution from post-perceptual processes related to response requirements. This excludes a direct functional role of this later component in giving rise to perceptual awareness.

Reliability in reporting perceptual experience: Behaviour and electrophysiology in hemianopic patients

Patients with hemianopia can present with the so called blindsight phenomenon: the ability to perform above chance in the absence of acknowledged awareness. Proper awareness reports are, thus, crucial to distinguish pure forms of blindsight from forms of conscious, yet degraded, vision. It has, in fact, been recently shown that 1) dichotomous and graded measures to assess awareness can lead to different behavioural results in patients with hemianopia and that 2) different grades of perceptual clarity show different electrophysiological correlates in healthy participants. Here, in hemianopic patients, we assessed awareness by means of the four-point Perceptual Awareness Scale (PAS) and investigated its neural correlates with Event Related Potentials (ERPs). Results showed that patients, in most of the cases, can rate the clarity of their perceptual experience in a graded manner. Moreover, graded perceptual experiences correlated with the amplitude of deflections in ERPs. These results call for the need to assess perceptual awareness with graded measures and for the importance to use electrophysiological data to correlate behaviour with neural processing.

Where Are the fMRI Correlates of Phosphene Perception?

Pulses of transcranial magnetic stimulation (TMS) over occipital cortex can induce transient visual percepts called phosphenes. Phosphenes are an interesting stimulus for the study of the human visual system, constituting conscious percepts without visual inputs, elicited by neural activation beyond retinal and subcortical processing stages in the visual hierarchy. The same TMS pulses, applied at threshold intensity phosphene threshold (PT), will prompt phosphene reports on half of all trials ("P-yes") but not on the other half ("P-no"). Contrasting brain activity (P-yes > P-no) can provide unique information on neural mechanisms underlying conscious percepts, as has been demonstrated by published EEG studies. Yet to our knowledge no articles reporting analogous contrasts with functional magnetic resonance imaging (fMRI) have been published. Since it seems unlikely that such studies have never been performed, this straightforward and technically feasible idea may have been explored in multiple failed, and unpublished, attempts. Here, we argue why such unsuccessful attempts, even small-scale, best be shared. We also report our own failed attempt to find phosphene-related activity in fMRI. Threshold phosphenes are weak percepts, and their detection subjective and difficult. If fMRI correlates of phosphenes are obtainable with this contrast, small-scale ('pilot') measurements may not be sufficiently powerful to detect them. At the same time, due to the challenges and costs involved in TMS-fMRI, attempts might not often get beyond the piloting stage. We propose that the only way out of this quandary is the communication and sharing of such unsuccessful attempts and associated data.