MinR 10/20 system: Quantitative and reproducible cranial landmark setting method for MRI based on minimum initial reference points

MNI2CPC: A probabilistic cortex-to-scalp mapping for non-invasive brain stimulation targeting

BACKGROUND

Synthesis of neural imaging information from many studies is valuable for identifying stable cortical targets for non-invasive brain stimulation (NIBS). Typically, these targets are specified in Montreal Neurological Institute (MNI) standard brain space. However, in practical NIBS applications, localizing MNI cortical targets often relies on the International 10-20 system or heuristic scalp approaches, which often lacks precision or applies only to specific targets.

OBJECTIVE/HYPOTHESIS

We aim to establish a probabilistic mapping from any cortical target in MNI space to continuous proportional coordinate (CPC) standard scalp space (MNI2CPC) and assess the performance of this mapping for NIBS targeting.

METHODS

The MNI2CPC mapping was calculated based on a large MRI dataset (n = 114). Its targeting error was evaluated via cross-individual validation using a leave-one-out approach, as well as through independent validation across race (n = 27) and across patient (n = 58) cohorts.

RESULTS

The cross-individual validation demonstrated targeting errors of 4.03 ± 0.69 mm on the scalp and 3.30 ± 0.59 mm in the cortex. For independent cohorts, targeting errors were 4.71 ± 0.81 mm (scalp) and 3.85 ± 0.64 mm (cortex) across race, and 4.66 ± 0.77 mm (scalp) and 3.77 ± 0.61 mm (cortex) across patient. We publish a free online tool to enable querying of the CPC coordinate for any given MNI cortical target. The resulting CPC coordinates enable rapid and accurate manual localization on the scalp in a user-friendly manner.

CONCLUSIONS

The MNI2CPC mapping developed in this study allows for manual localization of any MNI cortical target, which improves the accessibility and ease of application of NIBS in diverse settings.

Neuronavigated Cerebellar 50 Hz tACS: Attenuation of Stimulation Effects by Motor Sequence Learning

Cerebellar transcranial alternating current stimulation (tACS) is an emerging non-invasive technique that induces electric fields to modulate cerebellar function. Although the effect of cortical tACS seems to be state-dependent, the impact of concurrent motor activation and the duration of stimulation on the effects of cerebellar tACS has not yet been examined. In our study, 20 healthy subjects received neuronavigated 50 Hz cerebellar tACS for 40 s or 20 min, each during performance using a motor sequence learning task (MSL) and at rest. We measured the motor evoked potential (MEP) before and at two time points after tACS application to assess corticospinal excitability. Additionally, we investigated the online effect of tACS on MSL. Individual electric field simulations were computed to evaluate the distribution of electric fields, showing a focal electric field in the right cerebellar hemisphere with the highest intensities in lobe VIIb, VIII and IX. Corticospinal excitability was only increased after tACS was applied for 40 s or 20 min at rest, and motor activation during tACS (MSL) cancelled this effect. In addition, performance was better (shorter reaction times) for the learned sequences after 20 min of tACS, indicating more pronounced learning under 20 min of tACS compared to tACS applied only in the first 40 s.

Age-related changes of the periocular morphology: a two- and three-dimensional anthropometry study in Caucasians

PURPOSE

To determine age-and sex-related changes in periocular morphology in Caucasians using a standardized protocol.

METHODS

Healthy Caucasian volunteers aged 18-35 and 60-90 years old were recruited from the Department of Ophthalmology, Faculty of Medicine and University Hospital, Cologne, between October 2018 and May 2020. Volunteers with facial asymmetry, facial deformities, history of facial trauma, facial surgery, botox injection, eyelid ptosis, strabismus, or nystagmus, were excluded. Standardized three-dimensional facial photos of 68 young volunteers and 73 old volunteers were taken in this clinical practice. Position changes of endocanthion, pupil center, and exocanthion were analyzed in different age and gender groups, including palpebral fissure width (PFW): distance between endocanthions (En-En), pupil centers (Pu-Pu), exocanthions (Ex-Ex), endocanthion and nasion (En-Na), pupil center and nasion (Pu-Na), exocanthion and nasion (Ex-Na), endocanthion and pupil center (Pu-En), exocanthion and pupil center (Pu-Ex), and palpebral fissure inclination (PFI); angle of endocanthions to nasion (En-Na-En), pupils to nasion (Pu-Na-Pu), exocanthions to nasion (Ex-Na-Ex); endocanthion inclination (EnI), and exocanthion inclination (ExI).

RESULTS

PFW, En-En, Ex-Na, Pu-Ex, PFI, ExI, and Ex-Na-Ex were significantly different between the young and old groups (p ≤ 0.004). There were sex-related differences in PFW, Ex-Ex, En-Na, Pu-Na, Ex-Na, Pu-En, PFI, and EnI between both groups (p ≤ 0.041).

CONCLUSION

The position change of the pupil is minimal relative to age; it is preferred to establish the reference plane to describe periocular changes. The endocanthion tends to move temporally and inferiorly, while the exocanthion tends to shift nasally and inferiorly with age.

Optimizing the Montage for Cerebellar Transcranial Alternating Current Stimulation (tACS): a Combined Computational and Experimental Study

OBJECTIVE

The application of cerebellar transcranial alternating current stimulation (tACS) is limited by the absence of commonly agreed montages and also the presence of unpleasant side effects. We aimed to find the most effective cerebellar tACS montage with minimum side effects (skin sensations and phosphenes).

APPROACH

We first simulated cerebellar tACS with five montages (return electrode on forehead, buccinator, jaw, and neck positions, additionally focal montage with high-definition ring electrodes) to compare induced cerebellar current, then stimulated healthy participants and evaluated side effects for different montages and varying stimulation frequencies.

MAIN RESULTS

The simulation revealed a descending order of current density in the cerebellum from forehead to buccinator, jaw, neck and ring montage respectively. Montages inducing higher current intensity in the eyeballs during the simulation resulted in stronger and broader phosphenes during tACS sessions. Strong co-stimulation of the brainstem was observed for the neck. Skin sensations did not differ between montages or frequencies. We propose the jaw montage as an optimal choice for maximizing cerebellar stimulation while minimizing unwanted side effects.

SIGNIFICANCE

These findings contribute to adopting a standard cerebellar tACS protocol. The combination of computational modelling and experimental data offers improved experimental control, safety, effectiveness, and reproducibility to all brain stimulation practices.

Investigation of physical activity, sleep, and mental health recovery in treatment resistant depression (TRD) patients receiving repetitive transcranial magnetic stimulation (rTMS) treatment

•

Repetitive transcranial magnetic stimulation (rTMS) is effective in treating depression; however, the effect on physical activity, sleep and recovery is unclear.

•

PHQ-9, GAD-7 and ReQol scores significantly improved with large effect sizes. Fitbit activity and sleep results werenon-significant.

•

Improvements on the ReQoL and aspects of sleep and activity indicate the positive impact of rTMS on functioning and quality of life.

Background

Methods

Results

Limitations

Conclusions

Connectivity-Guided Theta Burst Transcranial Magnetic Stimulation Versus Repetitive Transcranial Magnetic Stimulation for Treatment-Resistant Moderate to Severe Depression: Magnetic Resonance Imaging Protocol and SARS-CoV-2-Induced Changes for a Randomized Double-blind Controlled Trial

Background

Depression is a substantial health and economic burden. In approximately one-third of patients, depression is resistant to first-line treatment; therefore, it is essential to find alternative treatments. Transcranial magnetic stimulation (TMS) is a neuromodulatory treatment involving the application of magnetic pulses to the brain that is approved in the United Kingdom and the United States in treatment-resistant depression. This trial aims to compare the clinical effectiveness, cost-effectiveness, and mechanism of action of standard treatment repetitive TMS (rTMS) targeted at the F3 electroencephalogram site with a newer treatment—a type of TMS called theta burst stimulation (TBS) targeted based on measures of functional brain connectivity. This protocol outlines brain imaging acquisition and analysis for the Brain Imaging Guided Transcranial Magnetic Stimulation in Depression (BRIGhTMIND) study trial that is used to create personalized TMS targets and answer the proposed mechanistic hypotheses.

Objective

The aims of the imaging arm of the BRIGhTMIND study are to identify functional and neurochemical brain signatures indexing the treatment mechanisms of rTMS and connectivity-guided intermittent theta burst TMS and to identify imaging-based markers predicting response to treatment.

Methods

The study is a randomized double-blind controlled trial with 1:1 allocation to either 20 sessions of TBS or standard rTMS. Multimodal magnetic resonance imaging (MRI) is acquired for each participant at baseline (before TMS treatment) with T1-weighted and task-free functional MRI during rest used to estimate TMS targets. For participants enrolled in the mechanistic substudy, additional diffusion-weighted sequences are acquired at baseline and at posttreatment follow-up 16 weeks after treatment randomization. Core data sets of T1-weighted and task-free functional MRI during rest are acquired for all participants and are used to estimate TMS targets. Additional sequences of arterial spin labeling, magnetic resonance spectroscopy, and diffusion-weighted images are acquired depending on the recruitment site for mechanistic evaluation. Standard rTMS treatment is targeted at the F3 electrode site over the left dorsolateral prefrontal cortex, whereas TBS treatment is guided using the coordinate of peak effective connectivity from the right anterior insula to the left dorsolateral prefrontal cortex. Both treatment targets benefit from the level of MRI guidance, but only TBS is provided with precision targeting based on functional brain connectivity.

Results

Recruitment began in January 2019 and is ongoing. Data collection is expected to continue until January 2023.

Conclusions

This trial will determine the impact of precision MRI guidance on rTMS treatment and assess the neural mechanisms underlying this treatment in treatment-resistant depressed patients.

Trial Registration

ISRCTN Registry ISRCTN19674644; https://www.isrctn.com/ISRCTN19674644

International Registered Report Identifier (IRRID)

DERR1-10.2196/31925

Transcranial brain atlas for school-aged children and adolescents

BACKGROUND

Both fNIRS optodes and TMS coils are placed on the scalp, while the targeted brain activities are inside the brain. An accurate cranio-cortical correspondence is crucial to the precise localization of the cortical area under imaging or stimulation (i.e. transcranial locating), as well as guiding the placement of optodes/coils (i.e. transcranial targeting). However, the existing normative cranio-cortical correspondence data used as transcranial references are predominantly derived from the adult population, and whether and how correspondence changes during childhood and adolescence is currently unclear.

OBJECTIVE

This study aimed to build the age-specific cranio-cortical correspondences for school-aged children and adolescents and investigate its differences to adults.

METHODS

Age-specific transcranial brain atlases (TBAs) were built with age groups: 6-8, 8-10, 10-12, 12-14, 14-16, and 16-18 years. We compared the performance in both transcranial locating and targeting when using the age-appropriate TBA versus the adult TBA (derived from adult population) for children.

RESULTS

These atlases provide age-specific probabilistic cranio-cortical correspondence at a high resolution (average scalp spacing of 2.8 mm). Significant differences in cranio-cortical correspondence between children/adolescents and adults were found: the younger the child, the greater the differences. For children (aged 6-12 years), locating and targeting errors when using the adult TBA reached 10 mm or more in the bilateral temporal lobe and frontal lobe. In contrast, the age-matched TBA reduced these errors to 4-5 mm, an approximately 50% reduction in error.

CONCLUSION

Our work provides an accurate and effective anatomical reference for studies in children and adolescents.

Repetitive transcranial magnetic stimulation (rTMS) for depression: outcomes in a United Kingdom (UK) clinical practice

Objective: The aim of this paper is to present the outcomes data from the largest United Kingdom's (UK) National Health Service (NHS) clinical rTMS service treating treatment resistant depression (TRD). Methods: The study was a retrospective investigation of routinely collected data on patients receiving rTMS between 2015 and 2017. Measures used were the clinician-rated Clinical Global Impression (CGI) and Hamilton Depression Rating Scale (HAM-D), and patient rated Beck Depression Inventory (BDI). The outcome data of 73 patients with TRD were analysed. The sample included patients with co-morbid psychiatric diagnosis. Results: Response and remission rates, respectively, were 40.4% and 25.5% for the HAM-D; 35.6% and 20.8% for the BDI; and 51.1% and 52.1% for the CGI. Effect sizes were medium (0.54, 0.52 and 0.56, respectively). Conclusions: The results show that a UK-based clinical service achieves similar results to those published internationally and that clinical rTMS can have significant impact on symptoms of depression in many patients with TRD. Health services are under pressure to make financial savings, investment in rTMS could reduce the long-term treatment costs associated with TRD.

Transcranial brain atlas

We introduce here the concept of a transcranial brain atlas (TBA), a new kind of brain atlas specialized for transcranial techniques. A TBA is a probabilistic mapping from scalp space to atlas label space, relating scalp locations to anatomical, functional, network, genetic, or other labels. TBAs offer a new way to integrate and present structural and functional organization of the brain and allow previously subsurface and invisible atlas labels visible on the scalp surface to accurately guide the placement of transcranial devices directly on the scalp surface in a straightforward, visual manner. We present here a framework for building TBAs that includes (i) a new, continuous proportional coordinate system devised for the scalp surface to allow standardized specification of scalp positions; (ii) a high-resolution, large sample-based (114-participant) mapping from scalp space to brain space to accurately and reliably describe human cranio-cortical correspondence; and (iii) a two-step Markov chain to combine the probabilistic scalp-brain mapping with a traditional brain atlas, bringing atlas labels to the scalp surface. We assessed the reproducibility (consistency of TBAs generated from different groups) and predictiveness (prediction accuracy of labels for individuals without brain images) of the TBAs built via our framework. Moreover, we present an application of TBAs to a functional near-infrared spectroscopy finger-tapping experiment, illustrating the utility and benefits of TBAs in transcranial studies. Our results demonstrate that TBAs can support ongoing efforts to map the human brain using transcranial techniques, just as traditional brain atlases have supported magnetic resonance imaging and positron emission tomography studies.

Augmented reality-based electrode guidance system for reliable electroencephalography

Background

In longitudinal electroencephalography (EEG) studies, repeatable electrode positioning is essential for reliable EEG assessment. Conventional methods use anatomical landmarks as fiducial locations for the electrode placement. Since the landmarks are manually identified, the EEG assessment is inevitably unreliable because of individual variations among the subjects and the examiners. To overcome this unreliability, an augmented reality (AR) visualization-based electrode guidance system was proposed.

Methods

The proposed electrode guidance system is based on AR visualization to replace the manual electrode positioning. After scanning and registration of the facial surface of a subject by an RGB-D camera, the AR of the initial electrode positions as reference positions is overlapped with the current electrode positions in real time. Thus, it can guide the position of the subsequently placed electrodes with high repeatability.

Results

The experimental results with the phantom show that the repeatability of the electrode positioning was improved compared to that of the conventional 10–20 positioning system.

Conclusion

The proposed AR guidance system improves the electrode positioning performance with a cost-effective system, which uses only RGB-D camera. This system can be used as an alternative to the international 10–20 system.

A Preliminary Study on Precision Image Guidance for Electrode Placement in an EEG Study

Conventional methods for positioning electroencephalography electrodes according to the international 10/20 system are based on the manual identification of the principal 10/20 landmarks via visual inspection and palpation, inducing intersession variations in their determined locations due to structural ambiguity or poor visibility. To address the variation issue, we propose an image guidance system for precision electrode placement. Following the electrode placement according to the 10/20 system, affixed electrodes are laser-scanned together with the facial surface. For subsequent procedures, the laser scan is conducted likewise after positioning the electrodes in an arbitrary manner, and following the measurement of fiducial electrode locations, frame matching is performed to determine a transformation from the coordinate frame of the position tracker to that of the laser-scanned image. Finally, by registering the intra-procedural scan of the facial surface to the reference scan, the current tracking data of the electrodes can be visualized relative to the reference goal positions without manually measuring the four principal landmarks for each trial. The experimental results confirmed that use of the electrode navigation system significantly improved the electrode placement precision compared to the conventional 10/20 system (p < 0.005). The proposed system showed the possibility of precise image-guided electrode placement as an alternative to the conventional manual 10/20 system.

Semi-automatic 10/20 Identification Method for MRI-Free Probe Placement in Transcranial Brain Mapping Techniques

The International 10/20 system is an important head-surface-based positioning system for transcranial brain mapping techniques, e.g., fNIRS and TMS. As guidance for probe placement, the 10/20 system permits both proper ROI coverage and spatial consistency among multiple subjects and experiments in a MRI-free context. However, the traditional manual approach to the identification of 10/20 landmarks faces problems in reliability and time cost. In this study, we propose a semi-automatic method to address these problems. First, a novel head surface reconstruction algorithm reconstructs head geometry from a set of points uniformly and sparsely sampled on the subject's head. Second, virtual 10/20 landmarks are determined on the reconstructed head surface in computational space. Finally, a visually-guided real-time navigation system guides the experimenter to each of the identified 10/20 landmarks on the physical head of the subject. Compared with the traditional manual approach, our proposed method provides a significant improvement both in reliability and time cost and thus could contribute to improving both the effectiveness and efficiency of 10/20-guided MRI-free probe placement.

Visualizing Shape Deformations with Variation of Geometric Spectrum

This paper presents a novel approach based on spectral geometry to quantify and visualize non-isometric deformations of 3D surfaces by mapping two manifolds. The proposed method can determine multi-scale, non-isometric deformations through the variation of Laplace-Beltrami spectrum of two shapes. Given two triangle meshes, the spectra can be varied from one to another with a scale function defined on each vertex. The variation is expressed as a linear interpolation of eigenvalues of the two shapes. In each iteration step, a quadratic programming problem is constructed, based on our derived spectrum variation theorem and smoothness energy constraint, to compute the spectrum variation. The derivation of the scale function is the solution of such a problem. Therefore, the final scale function can be solved by integral of the derivation from each step, which, in turn, quantitatively describes non-isometric deformations between two shapes. To evaluate the method, we conduct extensive experiments on synthetic and real data. We employ real epilepsy patient imaging data to quantify the shape variation between the left and right hippocampi in epileptic brains. In addition, we use longitudinal Alzheimer data to compare the shape deformation of diseased and healthy hippocampus. In order to show the accuracy and effectiveness of the proposed method, we also compare it with spatial registration-based methods, e.g., non-rigid Iterative Closest Point (ICP) and voxel-based method. These experiments demonstrate the advantages of our method.