TMS and the functional neuroanatomy of attention

Unraveling Causal Mechanisms of Top-Down and Bottom-Up Visuospatial Attention with Non-invasive Brain Stimulation

Attention is a process of selection that allows us to intelligently navigate the abundance of information in our world. Attention can be either directed voluntarily based on internal goals-"top-down" or goal-directed attention-or captured automatically, by salient stimuli-"bottom-up" or stimulus-driven attention. Do these two modes of attention control arise from same or different brain circuits? Do they share similar or distinct neural mechanisms? In this review, we explore this dichotomy between the neural bases of top-down and bottom-up attention control, with a special emphasis on insights gained from non-invasive neurostimulation techniques, specifically, transcranial magnetic stimulation (TMS). TMS enables spatially focal and temporally precise manipulation of brain activity. We explore a significant literature devoted to investigating the role of fronto-parietal brain regions in top-down and bottom-up attention with TMS, and highlight key areas of convergence and debate. We also discuss recent advances in combinatorial paradigms that combine TMS with other imaging modalities, such as functional magnetic resonance imaging or electroencephalography. These paradigms are beginning to bridge essential gaps in our understanding of the neural pathways by which TMS affects behavior, and will prove invaluable for unraveling mechanisms of attention control, both in health and in disease.

TMS SMART - Scalp mapping of annoyance ratings and twitches caused by Transcranial Magnetic Stimulation

BACKGROUND

The magnetic pulse generated during transcranial magnetic stimulation (TMS) also stimulates cutaneous nerves and muscle fibres, with the most commonly reported side effect being muscle twitches and sometimes painful sensations. These sensations affect behaviour during experimental tasks, presenting a potential confound for 'online' TMS studies.

NEW METHOD

Our objective was to systematically map the degree of disturbance (ratings of annoyance, pain, and muscle twitches) caused by TMS at 43 locations across the scalp. Ten participants provided ratings whilst completing a choice reaction time task, and ten different participants provided ratings whilst completing a 'flanker' reaction time task.

RESULTS

TMS over frontal and inferior regions resulted in the highest ratings of annoyance, pain, and muscle twitches caused by TMS. We predicted the difference in reaction times (RT) under TMS by scalp location and subjective ratings. Frontal and inferior scalp locations showed the greatest cost to RTs under TMS (i.e., slowing), with midline sites showing no or minimal slowing. Increases in subjective ratings of disturbance predicted longer RTs under TMS. Critically, ratings were a better predictor of the cost of TMS than scalp location or scalp-to-cortex distance. The more difficult 'flanker' task showed a greater effect of subjective disturbance.

COMPARISON WITH EXISTING METHODS

We provide the data as an online resource (www.tms-smart.info) so that researchers can select control sites that account for the level of general interference in task performance caused by online single-pulse TMS.

CONCLUSIONS

The peripheral sensations and discomfort caused by TMS pulses significantly and systematically influence RTs during single-pulse, online TMS experiments.

The time course for visual extinction after a 'virtual' lesion of right posterior parietal cortex

Our understanding of the attentional networks in the human brain largely relies on neuropsychological studies in patients with lesions to the posterior parietal cortex (PPC), particularly in the right hemisphere, that may cause severe disruptions of attentional functions. However, lesion studies only capture a point in time when the dysfunctions caused by the damage have triggered a chain of adaptive responses in the brain. To disentangle deficits and ensuing cortical plasticity, here we examined the time course for one's ability to detect objects in the visual periphery after an inhibitory continuous theta-burst stimulation (cTBS) protocol to the left or right PPC. Our results showed that cTBS of right PPC caused participants to be less sensitive to objects appearing on the left side as well as to objects appearing on both sides at the same time, consistent with an overall shift of attention to the right side of space. In addition, we found that participants missed more objects during bilateral presentations similar to patients with visual extinction. Critically, extinction evolved over time; that is, visual extinction for ipsilateral objects improved after 10 min whereas contralateral extinction peaked around 15-25 min after cTBS. Our findings suggest that lesions to the PPC impair competition between the two visual hemifields, resulting in contralateral extinction as a secondary response, arguably due to ensuing disruptions in interhemispheric balance.

Contextual knowledge configures attentional control networks

Contextual cues are predictive and provide behaviorally relevant information; they are not the main objective of the current task but can make behavior more efficient. Using fMRI, we investigated the brain networks involved in representing contextual information and translating it into an attentional control signal. Human subjects performed a visual search task for a low-contrast target accompanied by a single non-target that was either perceptually similar or more salient (i.e., higher contrast). Shorter reaction times (RTs) and higher accuracy were found on salient trials, suggesting that the salient item was rapidly identified as a non-target and immediately acts as a spatial "anti-cue" to reorient attention to the target. The relative saliency of the non-target determined BOLD responses in the left temporoparietal junction (TPJ) and inferior frontal gyrus (IFG). IFG correlated with RT specifically on salient non-target trials. In contrast, bilateral dorsal frontoparietal regions [including the frontal eye fields (FEFs)] were correlated with RT in all conditions. Effective connectivity analyses using dynamic causal modeling found an excitatory pathway from TPJ to IFG to FEF, suggesting that this was the pathway by which the contextual cue was translated into an attentional control signal that facilitated behavior. Additionally, the connection from FEF to TPJ was negatively modulated during target-similar trials, consistent with the inhibition of TPJ by dorsal attentional control regions during top-down serial visual search. We conclude that left TPJ and IFG form a sensory-driven network that integrates contextual knowledge with ongoing sensory information to provide an attentional control signal to FEF.

Predictability of saccadic behaviors is modified by transcranial magnetic stimulation over human posterior parietal cortex

Predictability in the visual environment provides a powerful cue for efficient processing of scenes and objects. Recently, studies have suggested that the directionality and magnitude of saccade curvature can be informative as to how the visual system processes predictive information. The present study investigated the role of the right posterior parietal cortex (rPPC) in shaping saccade curvatures in the context of predictive and non-predictive visual cues. We used an orienting paradigm that incorporated manipulation of target location predictability and delivered transcranial magnetic stimulation (TMS) over rPPC. Participants were presented with either an informative or uninformative cue to upcoming target locations. Our results showed that rPPC TMS generally increased saccade latency and saccade error rates. Intriguingly, rPPC TMS increased curvatures away from the distractor only when the target location was unpredictable and decreased saccadic errors towards the distractor. These effects on curvature and accuracy were not present when the target location was predictable. These results dissociate the strong contingency between saccade latency and saccade curvature and also indicate that rPPC plays an important role in allocating and suppressing attention to distractors when the target demands visual disambiguation. Furthermore, the present study suggests that, like the frontal eye fields, rPPC is critically involved in determining saccade curvature and the generation of saccadic behaviors under conditions of differing target predictability.