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Chen SY, Tsou MH, Chen KY, Liu YC, Lin MT. Impact of repetitive transcranial magnetic stimulation on cortical activity: a systematic review and meta-analysis utilizing functional near-infrared spectroscopy evaluation. J Neuroeng Rehabil 2024; 21:108. [PMID: 38915003 PMCID: PMC11194950 DOI: 10.1186/s12984-024-01407-9] [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: 03/10/2024] [Accepted: 06/19/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Repeated transcranial magnetic stimulation (rTMS) could induce alterations in cortical excitability and promote neuroplasticity. To precisely quantify these effects, functional near-infrared spectroscopy (fNIRS), an optical neuroimaging modality adept at detecting changes in cortical hemodynamic responses, has been employed concurrently alongside rTMS to measure and tailor the impact of diverse rTMS protocols on the brain cortex. OBJECTIVE This systematic review and meta-analysis aimed to elucidate the effects of rTMS on cortical hemodynamic responses over the primary motor cortex (M1) as detected by fNIRS. METHODS Original articles that utilized rTMS to stimulate the M1 cortex in combination with fNIRS for the assessment of cortical activity were systematically searched across the PubMed, Embase, and Scopus databases. The search encompassed records from the inception of these databases up until April, 2024. The assessment for risk of bias was also conducted. A meta-analysis was also conducted in studies with extractable raw data. RESULTS Among 312 studies, 14 articles were eligible for qualitative review. 7 studies were eligible for meta-analysis. A variety of rTMS protocols was employed on M1 cortex. In inhibitory rTMS, multiple studies observed a reduction in the concentration of oxygenated hemoglobin [HbO] at the ipsilateral M1, contrasted by an elevation at the contralateral M1. Meta-analysis also corroborated this consistent trend. Nevertheless, certain investigations unveiled diminished [HbO] in bilateral M1. Several studies also depicted intricate inhibitory or excitatory interplay among distinct cortical regions. CONCLUSION Diverse rTMS protocols led to varied patterns of cortical activity detected by fNIRS. Meta-analysis revealed a trend of increasing [HbO] in the contralateral cortices and decreasing [HbO] in the ipsilateral cortices following low frequency inhibitory rTMS. However, due to the heterogeneity between studies, further research is necessary to comprehensively understand rTMS-induced alterations in brain activity.
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Affiliation(s)
- Shao-Yu Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7 Chung-Shan South Road, Taipei City, 10002, Taiwan
| | - Meng-Hsuan Tsou
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, 3F., No.17, Xuzhou Rd., Zhongzheng Dist, Taipei City, 10002, Taiwan
| | - Kuan-Yu Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7 Chung-Shan South Road, Taipei City, 10002, Taiwan
| | - Yan-Ci Liu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, 3F., No.17, Xuzhou Rd., Zhongzheng Dist, Taipei City, 10002, Taiwan.
- Physical Therapy Center, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 1, Changde St., Zhongzheng Dist, Taipei City, 10022, Taiwan.
| | - Meng-Ting Lin
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7 Chung-Shan South Road, Taipei City, 10002, Taiwan.
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Gorban C, Zhang Z, Mensen A, Khatami R. The Comparison of Early Hemodynamic Response to Single-Pulse Transcranial Magnetic Stimulation following Inhibitory or Excitatory Theta Burst Stimulation on Motor Cortex. Brain Sci 2023; 13:1609. [PMID: 38002568 PMCID: PMC10670137 DOI: 10.3390/brainsci13111609] [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: 10/12/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
We present a new study design aiming to enhance the understanding of the mechanism by which continuous theta burst stimulation (cTBS) or intermittent theta burst stimulation (iTBS) paradigms elicit cortical modulation. Using near-infrared spectroscopy (NIRS), we compared the cortical hemodynamics of the previously inhibited (after cTBS) or excited (after iTBS) left primary motor cortex (M1) as elicited by single-pulse TMS (spTMS) in a cross-over design. Mean relative changes in hemodynamics within 6 s of the stimulus were compared using a two-sample t-test (p < 0.05) and linear mixed model between real and sham stimuli and between stimuli after cTBS and iTBS. Only spTMS after cTBS resulted in a significant increase (p = 0.04) in blood volume (BV) compared to baseline. There were no significant changes in other hemodynamic parameters (oxygenated/deoxygenated hemoglobin). spTMS after cTBS induced a larger increase in BV than spTMS after iTBS (p = 0.021) and sham stimulus after cTBS (p = 0.009). BV showed no significant difference between real and sham stimuli after iTBS (p = 0.37). The greater hemodynamic changes suggest increased vasomotor reactivity after cTBS compared to iTBS. In addition, cTBS could decrease lateral inhibition, allowing activation of surrounding areas after cTBS.
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Affiliation(s)
- Corina Gorban
- Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid, 5017 Barmelweid, Switzerland; (C.G.); (A.M.); (R.K.)
- Department of Neurology, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
| | - Zhongxing Zhang
- Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid, 5017 Barmelweid, Switzerland; (C.G.); (A.M.); (R.K.)
| | - Armand Mensen
- Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid, 5017 Barmelweid, Switzerland; (C.G.); (A.M.); (R.K.)
| | - Ramin Khatami
- Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid, 5017 Barmelweid, Switzerland; (C.G.); (A.M.); (R.K.)
- Department of Neurology, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
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Ma H, Zhai Y, Xu Z, Fan S, Wu X, Xu J, Wu S, Ma C. Increased cerebral cortex activation in stroke patients during electrical stimulation of cerebellar fastigial nucleus with functional near-infrared spectroscopy. Front Neurosci 2022; 16:895237. [PMID: 36061594 PMCID: PMC9433974 DOI: 10.3389/fnins.2022.895237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 07/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background Electrical stimulation of the cerebellar fastigial nucleus (FNS) has been shown to protect animals against cerebral ischemic injury. However, the changes in cortical activation as a response to FNS have not been illustrated in humans. Objective This study aims to detect functional connectivity changes in the brain of stroke patients, and investigate the cortical activation caused by FNS through measuring the oxygenated hemoglobin concentration (HBO) in the cerebral cortex of stroke patients and healthy controls (HCs). Methods This study recruited 20 patients with stroke and 20 HCs with all the following factors matched: age, gender and BMI. The experiment session was made up of the pre-task baseline, FNS task period, and post-task baseline. FNS task period contains 5 blocks, each block encompassing the resting state (30 s) and the FNS state (30 s). HBO signals were acquired by functional near-infrared spectroscopy (fNIRS) from the Prefrontal Cortex (PFC), the Motor Cortex (MC) and the Occipital Cortex (OC) throughout the experiment. The Pearson correlation coefficient was used to calculate the resting-state functional connectivity strength between the two groups, and the general linear model (GLM) was used to calculate the activation of 39 fNIRS channels during FNS in stroke patients and HCs, respectively. Results The coupling strength of stroke patients were significantly decreased in the following regions: right MC and left MC (t = 4.65, p = 0.0007), right MC and left OC (t = 2.93, p = 0.04), left MC and left OC (t = 2.81, p = 0.04). In stroke patients, the changes in cerebral oxygenated hemoglobin (ΔHBO) among 12 channels (CH) in the bilateral PFC and bilateral MC regions were significantly increased during the FNS state (FDR corrected p < 0.05) compared with the resting state. In HCs, only 1 channel was increased (FDR corrected p < 0.05) in the left PFC during FNS. Conclusion By using the FNS and fNIRS techniques, the characteristics of functional connectivity were found to decrease in stroke patients. It was also noticed that FNS activates the PFC and MC regions. These findings may help to guide functional rehabilitation in stroke patients.
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Huo C, Xu G, Li W, Xie H, Zhang T, Liu Y, Li Z. A review on functional near-infrared spectroscopy and application in stroke rehabilitation. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2021. [DOI: 10.1016/j.medntd.2021.100064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Jiang S, Huang J, Yang H, Wagoner R, Kozel FA, Currier G, Jiang H. Neuroimaging of depression with diffuse optical tomography during repetitive transcranial magnetic stimulation. Sci Rep 2021; 11:7328. [PMID: 33795763 PMCID: PMC8016845 DOI: 10.1038/s41598-021-86751-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 03/10/2021] [Indexed: 12/02/2022] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is an effective and safe treatment for depression; however, its potential has likely been hindered due to non-optimized targeting, unclear ideal stimulation parameters, and lack of information regarding how the brain is physiologically responding during and after stimulation. While neuroimaging is ideal for obtaining such critical information, existing modalities have been limited due to poor resolutions, along with significant noise interference from the electromagnetic spectrum. In this study, we used a novel diffuse optical tomography (DOT) device in order to advance our understanding of the neurophysiological effects of rTMS in depression. Healthy and depressed subjects aged 18–70 were recruited. Treatment parameters were standardized with targeting of the left dorsolateral prefrontal cortex with a magnetic field intensity of 100% of motor threshold, pulse frequency of 10 per second, a 4 s stimulation time and a 26 s rest time. DOT imaging was simultaneously acquired from the contralateral dorsolateral prefrontal cortex. Six healthy and seven depressed subjects were included for final analysis. Hemoglobin changes and volumetric three-dimensional activation patterns were successfully captured. Depressed subjects were observed to have a delayed and less robust response to rTMS with a decreased volume of activation compared to healthy subjects. In this first-in-human study, we demonstrated the ability of DOT to safely and reliably capture and compare cortical response patterns to rTMS in depressed and healthy subjects. We introduced this emerging optical functional imaging modality as a novel approach to investigating targeting, new treatment parameters, and physiological effects of rTMS in depression.
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Affiliation(s)
- Shixie Jiang
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
| | - Jingyu Huang
- Department of Medical Engineering, University of South Florida, 4202 E. Fowler Avenue, ENG 030, Tampa, FL, USA
| | - Hao Yang
- Department of Medical Engineering, University of South Florida, 4202 E. Fowler Avenue, ENG 030, Tampa, FL, USA
| | - Ryan Wagoner
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
| | - F Andrew Kozel
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA.,Department of Behavioral Sciences and Social Medicine, Florida State University, Tallahassee, FL, USA
| | - Glenn Currier
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
| | - Huabei Jiang
- Department of Medical Engineering, University of South Florida, 4202 E. Fowler Avenue, ENG 030, Tampa, FL, USA.
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Struckmann W, Persson J, Weigl W, Gingnell M, Bodén R. Modulation of the prefrontal blood oxygenation response to intermittent theta-burst stimulation in depression: A sham-controlled study with functional near-infrared spectroscopy. World J Biol Psychiatry 2021; 22:247-256. [PMID: 32640854 DOI: 10.1080/15622975.2020.1785007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To better understand the neural mechanisms behind the effect of intermittent theta-burst stimulation (iTBS), we investigated how the prefrontal blood oxygenation response measured by changes in oxygenated haemoglobin (oxy-Hb) was modulated during a sham-controlled iTBS treatment course, and whether this was related to depressive symptom change. METHODS In this randomised, double-blind study, patients with ongoing treatment-resistant depression received either active (n = 18) or sham (n = 21) iTBS over the dorsomedial prefrontal cortex for ten to fifteen days with two sessions daily. Event-related functional near-infrared spectroscopy (fNIRS) was measured during each iTBS train, and resting-state oxy-Hb was compared before and after each iTBS session at the first, fifth, and last treatment day. RESULTS Patients receiving active iTBS had an increase of the event-related oxy-Hb response compared to the sham group on the fifth (bilateral prefrontal cortices p < .001) and last (left prefrontal p = .007, right prefrontal p = .025) treatment day. Resting-state analysis showed suppressed oxy-Hb change in active iTBS compared to sham iTBS on the last treatment day (p = .024). Oxy-Hb change was unrelated to depressive symptom change (p = .474). CONCLUSIONS This study describes a modulation of the blood oxygenation response over the prefrontal cortex that was built up during the course of active iTBS treatment in depression.
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Affiliation(s)
- Wiebke Struckmann
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Jonas Persson
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Wojciech Weigl
- Department of Surgical Science, Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
| | - Malin Gingnell
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden.,Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Robert Bodén
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
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Goldsworthy MR, Hordacre B, Rothwell JC, Ridding MC. Effects of rTMS on the brain: is there value in variability? Cortex 2021; 139:43-59. [PMID: 33827037 DOI: 10.1016/j.cortex.2021.02.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/16/2021] [Accepted: 02/26/2021] [Indexed: 01/02/2023]
Abstract
The ability of repetitive transcranial magnetic stimulation (rTMS) to non-invasively induce neuroplasticity in the human cortex has opened exciting possibilities for its application in both basic and clinical research. Changes in the amplitude of motor evoked potentials (MEPs) elicited by single-pulse transcranial magnetic stimulation has so far provided a convenient model for exploring the neurophysiology of rTMS effects on the brain, influencing the ways in which these stimulation protocols have been applied therapeutically. However, a growing number of studies have reported large inter-individual variability in the mean MEP response to rTMS, raising legitimate questions about the usefulness of this model for guiding therapy. Although the increasing application of different neuroimaging approaches has made it possible to probe rTMS-induced neuroplasticity outside the motor cortex to measure changes in neural activity that impact other aspects of human behaviour, the high variability of rTMS effects on these measurements remains an important issue for the field to address. In this review, we seek to move away from the conventional facilitation/inhibition dichotomy that permeates much of the rTMS literature, presenting a non-standard approach for measuring rTMS-induced neuroplasticity. We consider the evidence that rTMS is able to modulate an individual's moment-to-moment variability of neural activity, and whether this could have implications for guiding the therapeutic application of rTMS.
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Affiliation(s)
- Mitchell R Goldsworthy
- Lifespan Human Neurophysiology Group, Adelaide Medical School, University of Adelaide, Adelaide, Australia; Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Discipline of Psychiatry, Adelaide Medical School, University of Adelaide, Adelaide, Australia.
| | - Brenton Hordacre
- Innovation, IMPlementation and Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide, Australia
| | - John C Rothwell
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Michael C Ridding
- Innovation, IMPlementation and Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide, Australia
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Pinto N, Gonçalves H, Silva R, Duarte M, Gama J, Vaz Pato M. Theta burst stimulation over the prefrontal cortex: Effects on cerebral oximetry and cardiovascular measures in healthy humans. Neurosci Lett 2021; 752:135792. [PMID: 33652088 DOI: 10.1016/j.neulet.2021.135792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/10/2021] [Accepted: 02/24/2021] [Indexed: 01/26/2023]
Abstract
Theta Burst Stimulation (TBS) is a non-invasive neurophysiological technique, able to induce changes in synaptic activity. Research suggests that TBS may induce changes in cerebral oxygenation, cerebral blood flow, blood pressure and heart rate but there are conflicting results across studies. Thus, the objective of our sham-controlled study is to evaluate if TBS applied to the dorsolateral prefrontal cortex (DLPFC) of healthy volunteers produces changes in cerebral oximetry, heart rate and blood pressure. Forty-nine volunteers of both sexes were randomly allocated to one of five stimulation groups. Before and after real TBS or sham stimulation, blood pressure, heart rate, and cerebral oxygenation of the volunteers were measured. Cerebral oxygenation values were obtained with a near infra-red spectroscopy system. We found a significant reduction in left cortex oximetry after continuous TBS (cTBS) over the left DLPFC (p = 0.039) and a non-significant reduction in right cortex oximetry (p = 0.052). Right hemisphere inhibition (using cTBS) seemed to originate a significant reduction of 8 mmHg in systolic arterial pressure. No other changes were seen in oximetry, cardiac frequency and diastolic arterial pressure. In our group of normal subjects, cTBS applied to the left DLPFC was able to reduce oxygenation in the left cortex. Right hemisphere inhibition was associated with a significant reduction in systolic pressure.
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Affiliation(s)
- Nuno Pinto
- Faculty of Health Sciences, University of Beira Interior, Covilhã, 6200-506, Portugal; CICS-Health Sciences Research Centre, University of Beira Interior, Covilhã, 6200-506, Portugal.
| | - Helena Gonçalves
- Faculty of Health Sciences, University of Beira Interior, Covilhã, 6200-506, Portugal.
| | - Ricardo Silva
- Faculty of Health Sciences, University of Beira Interior, Covilhã, 6200-506, Portugal.
| | - Marta Duarte
- Faculty of Health Sciences, University of Beira Interior, Covilhã, 6200-506, Portugal.
| | - Jorge Gama
- Faculty of Health Sciences, University of Beira Interior, Covilhã, 6200-506, Portugal; University of Beira Interior, Department of Mathematics, Covilhã, 6200-506, Portugal.
| | - Maria Vaz Pato
- Faculty of Health Sciences, University of Beira Interior, Covilhã, 6200-506, Portugal; CICS-Health Sciences Research Centre, University of Beira Interior, Covilhã, 6200-506, Portugal.
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Huang J, Jiang S, Wagoner R, Yang H, Currier G, Jiang H. Three-dimensional optical imaging of brain activation during transcranial magnetic stimulation. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2021; 29:891-902. [PMID: 34397443 DOI: 10.3233/xst-210900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) of the brain is an effective clinical treatment for psychiatric disorders. Noninvasive neuroimaging during rTMS allows visualization of cortical brain activations and responses, and it is a potential tool for investigating the neurophysiological response occurring actively during stimulation. In this paper, we present a fast diffuse optical tomography (DOT) approach for three-dimensional brain mapping of hemodynamics during rTMS. Eight healthy subjects were enrolled in the study. These subjects received 10 Hz stimulation with 80%and 100%of resting motor threshold (rMT), respectively, for 4 seconds for each stimulation. Significant hemodynamic activation was observed in all cases with the strongest response when 100%rMT stimulation was applied. This work demonstrates that fast DOT has the potential to become a powerful tool for noninvasive three-dimensional imaging of the brain during rTMS.
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Affiliation(s)
- Jingyu Huang
- Department of Medical Engineering, University of South Florida, Tampa, Florida, USA
| | - Shixie Jiang
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, Florida, USA
| | - Ryan Wagoner
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, Florida, USA
| | - Hao Yang
- Department of Medical Engineering, University of South Florida, Tampa, Florida, USA
| | - Glenn Currier
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, Florida, USA
| | - Huabei Jiang
- Department of Medical Engineering, University of South Florida, Tampa, Florida, USA
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Applications of Functional Near-Infrared Spectroscopy in Fatigue, Sleep Deprivation, and Social Cognition. Brain Topogr 2019; 32:998-1012. [DOI: 10.1007/s10548-019-00740-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 10/18/2019] [Indexed: 01/05/2023]
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Li R, Potter T, Wang J, Shi Z, Wang C, Yang L, Chan R, Zhang Y. Cortical Hemodynamic Response and Connectivity Modulated by Sub-threshold High-Frequency Repetitive Transcranial Magnetic Stimulation. Front Hum Neurosci 2019; 13:90. [PMID: 30941025 PMCID: PMC6434517 DOI: 10.3389/fnhum.2019.00090] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 02/25/2019] [Indexed: 01/06/2023] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) at sub-threshold intensity is a viable clinical strategy to enhance the sensory and motor functions of extremities by increasing or decreasing motor cortical excitability. Despite this, it remains unclear how sub-threshold rTMS modulates brain cortical excitability and connectivity. In this study, we applied functional near-infrared spectroscopy (fNIRS) to investigate the alterations in hemodynamic responses and cortical connectivity patterns that are induced by high-frequency rTMS at a sub-threshold intensity. Forty high-frequency (10 Hz) trains of rTMS at 90% resting motor threshold (RMT) were delivered through a TMS coil placed over 1–2 cm lateral from the vertex. fNIRS signals were acquired from the frontal and bilateral motor areas in healthy volunteers (n = 20) during rTMS administration and at rest. A significant reduction in oxygenated hemoglobin (HbO) concentration was observed in most defined regions of interest (ROIs) during the stimulation period (p < 0.05). Decreased functional connectivity within prefrontal areas as well as between symmetrical ROI-pairs was also observed in most participants during the stimulation (p < 0.05). Results suggest that fNIRS imaging is able to provide a reliable measure of regional cortical brain activation that advances our understanding of the manner in which sub-threshold rTMS affects cortical excitability and brain connectivity.
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Affiliation(s)
- Rihui Li
- Department of Biomedical Engineering, University of Houston, Houston, TX, United States
| | - Thomas Potter
- Department of Biomedical Engineering, University of Houston, Houston, TX, United States
| | - Jun Wang
- Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, China
| | - Zhixi Shi
- Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, China
| | - Chushan Wang
- Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, China
| | - Lingling Yang
- Department of Computer Science, Sun Yat-sen University, Guangzhou, China
| | - Rosa Chan
- Department of Electrical Engineering, City University of Hong Kong, Hong Kong, China
| | - Yingchun Zhang
- Department of Biomedical Engineering, University of Houston, Houston, TX, United States
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Kozel FA, Van Trees K, Larson V, Phillips S, Hashimie J, Gadbois B, Johnson S, Gallinati J, Barrett B, Toyinbo P, Weisman M, Centorino M, Gibson CA, Catalano G. One hertz versus ten hertz repetitive TMS treatment of PTSD: A randomized clinical trial. Psychiatry Res 2019; 273:153-162. [PMID: 30641346 DOI: 10.1016/j.psychres.2019.01.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/19/2018] [Accepted: 01/01/2019] [Indexed: 02/06/2023]
Abstract
The purpose of this trial was to test whether right prefrontal cortex 1 Hz versus 10 Hz rTMS provides a significantly greater improvement in PTSD symptoms and/or function. Veterans 18 to 50 years of age suffering from PTSD were randomized to right prefrontal 1 Hz rTMS [2400 pulses/session] versus right prefrontal 10 Hz rTMS [2400 pulses/session]. The treatments were performed 5 days a week for 6 weeks with a 3-week taper using the NeuroStar system. There were one month and three months post treatment follow-up evaluations. Forty-four participants were enrolled with 17 being randomized to 1 Hz rTMS and 18 to 10 Hz rTMS. Both groups had significant improvement in PTSD and depression scores from baseline to the end of acute treatment. The 10 Hz group but not the 1 Hz group demonstrated significant improvement in function. Although both groups demonstrated significant improvement in PTSD and depression symptoms, a significant advantage for either the 1 Hz or 10 Hz frequency group on any of the scales acquired was not demonstrated. Further work is required with larger samples sizes to test whether low or high frequency is superior or if individual differences would indicate the more effective frequency.
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Affiliation(s)
- F Andrew Kozel
- Mental Health and Behavioral Sciences, James A. Haley Veterans' Administration Hospital and Clinics, Tampa, FL, USA; HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Administration Hospital and Clinics, Tampa, FL, USA; Department of Psychiatry and Behavioral Sciences, University of South Florida, Tampa, FL, USA.
| | - Kimberly Van Trees
- Nursing Services, James A. Haley Veterans' Administration Hospital and Clinics, Tampa, FL, USA
| | - Valerie Larson
- HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Administration Hospital and Clinics, Tampa, FL, USA
| | - Sean Phillips
- Mental Health and Behavioral Sciences, James A. Haley Veterans' Administration Hospital and Clinics, Tampa, FL, USA; Department of Psychiatry and Behavioral Sciences, University of South Florida, Tampa, FL, USA
| | - Jaffrey Hashimie
- Mental Health and Behavioral Sciences, James A. Haley Veterans' Administration Hospital and Clinics, Tampa, FL, USA; Department of Psychiatry and Behavioral Sciences, University of South Florida, Tampa, FL, USA
| | - Brian Gadbois
- Mental Health and Behavioral Sciences, James A. Haley Veterans' Administration Hospital and Clinics, Tampa, FL, USA; Department of Psychiatry and Behavioral Sciences, University of South Florida, Tampa, FL, USA
| | - Suzanne Johnson
- Mental Health and Behavioral Sciences, James A. Haley Veterans' Administration Hospital and Clinics, Tampa, FL, USA
| | - Jessica Gallinati
- Mental Health and Behavioral Sciences, James A. Haley Veterans' Administration Hospital and Clinics, Tampa, FL, USA
| | - Blake Barrett
- HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Administration Hospital and Clinics, Tampa, FL, USA; VISN 8 Patient Safety Center of Inquiry, James A. Haley Veterans' Administration Hospital and Clinics, Tampa, FL, USA
| | - Peter Toyinbo
- HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Administration Hospital and Clinics, Tampa, FL, USA; Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Mark Weisman
- Mental Health and Behavioral Sciences, James A. Haley Veterans' Administration Hospital and Clinics, Tampa, FL, USA; Department of Psychiatry and Behavioral Sciences, University of South Florida, Tampa, FL, USA
| | - Michael Centorino
- Mental Health and Behavioral Sciences, James A. Haley Veterans' Administration Hospital and Clinics, Tampa, FL, USA; Department of Psychiatry and Behavioral Sciences, University of South Florida, Tampa, FL, USA
| | - Carri-Ann Gibson
- Mental Health and Behavioral Sciences, James A. Haley Veterans' Administration Hospital and Clinics, Tampa, FL, USA; Department of Psychiatry and Behavioral Sciences, University of South Florida, Tampa, FL, USA
| | - Glenn Catalano
- Mental Health and Behavioral Sciences, James A. Haley Veterans' Administration Hospital and Clinics, Tampa, FL, USA; Department of Psychiatry and Behavioral Sciences, University of South Florida, Tampa, FL, USA
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Curtin A, Tong S, Sun J, Wang J, Onaral B, Ayaz H. A Systematic Review of Integrated Functional Near-Infrared Spectroscopy (fNIRS) and Transcranial Magnetic Stimulation (TMS) Studies. Front Neurosci 2019; 13:84. [PMID: 30872985 PMCID: PMC6403189 DOI: 10.3389/fnins.2019.00084] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/25/2019] [Indexed: 01/10/2023] Open
Abstract
Background: The capacity for TMS to elicit neural activity and manipulate cortical excitability has created significant expectation regarding its use in both cognitive and clinical neuroscience. However, the absence of an ability to quantify stimulation effects, particularly outside of the motor cortex, has led clinicians and researchers to pair noninvasive brain stimulation with noninvasive neuroimaging techniques. fNIRS, as an optical and wearable neuroimaging technique, is an ideal candidate for integrated use with TMS. Together, TMS+fNIRS may offer a hybrid alternative to "blind" stimulation to assess NIBS in therapy and research. Objective: In this systematic review, the current body of research into the transient and prolonged effects of TMS on fNIRS-based cortical hemodynamic measures while at rest and during tasks are discussed. Additionally, studies investigating the relation of fNIRS to measures of cortical excitability as produced by TMS-evoked Motor-Evoked-Potential (MEP) are evaluated. The aim of this review is to outline the integrated use of TMS+fNIRS and consolidate findings related to use of fNIRS to monitor changes attributed to TMS and the relationship of fNIRS to cortical excitability itself. Methods: Key terms were searched in PubMed and Web-of-Science to identify studies investigating the use of both fNIRS and TMS. Works from Google-Scholar and referenced works in identified papers were also assessed for relevance. All published experimental studies using both fNIRS and TMS techniques in the study methodology were included. Results: A combined literature search of neuroimaging and neurostimulation studies identified 53 papers detailing the joint use of fNIRS and TMS. 22/53 investigated the immediate effects of TMS at rest in the DLPFC and M1 as measured by fNIRS. 21/22 studies reported a significant effect in [HbO] for 40/54 stimulation conditions with 14 resulting an increase and 26 in a decrease. While 15/22 studies also reported [HbR], only 5/37 conditions were significant. Task effects of fNIRS+TMS were detailed in 16 studies, including 10 with clinical populations. Most studies only reported significant changes in [HbO] related measures. Studies comparing fNIRS to changes in MEP-measured cortical excitability suggest that fNIRS measures may be spatially more diffuse but share similar traits. Conclusion: This review summarizes the progress in the development of this emerging hybrid neuroimaging & neurostimulation methodology and its applications. Despite encouraging progress and novel applications, a lack of replicated works, along with highly disparate methodological approaches, highlight the need for further controlled studies. Interpretation of current research directions, technical challenges of TMS+fNIRS, and recommendations regarding future works are discussed.
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Affiliation(s)
- Adrian Curtin
- Drexel University, School of Biomedical Engineering, Science and Health Systems, Philadelphia, PA, United States.,School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Shanbao Tong
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Junfeng Sun
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jijun Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Banu Onaral
- Drexel University, School of Biomedical Engineering, Science and Health Systems, Philadelphia, PA, United States
| | - Hasan Ayaz
- Drexel University, School of Biomedical Engineering, Science and Health Systems, Philadelphia, PA, United States.,Department of Family and Community Health, University of Pennsylvania, Philadelphia, PA, United States.,Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, United States
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Hernandez-Martin E, Marcano F, Modroño-Pascual C, Casanova-González O, Plata-Bello J, González-Mora JL. Is it possible to measure hemodynamic changes in the prefrontal cortex through the frontal sinus using continuous wave DOT systems? BIOMEDICAL OPTICS EXPRESS 2019; 10:817-837. [PMID: 30800517 PMCID: PMC6377888 DOI: 10.1364/boe.10.000817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/11/2018] [Accepted: 12/23/2018] [Indexed: 05/20/2023]
Abstract
The present work shows the capability of near infrared (NIR) light to reach the cerebral cortex through the frontal sinus using continuous-wave techniques (CW-DOT) in a dual study. On the one hand, changes in time during the tracking of a blood dye in the prefrontal cortex were monitored. On the other hand, hemodynamic changes induced by low frequency of transcranial magnetic stimulation applied on the prefrontal cortex were recorded. The results show how NIR light projected through the frontal sinus reaches the cerebral cortex target, providing enough information to have a reliable measurement of cortical hemodynamic changes using CW-DOT.
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15
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Tse CY, Yip LY, Lui TKY, Xiao XZ, Wang Y, Chu WCW, Parks NA, Chan SSM, Neggers SFW. Establishing the functional connectivity of the frontotemporal network in pre-attentive change detection with Transcranial Magnetic Stimulation and event-related optical signal. Neuroimage 2018; 179:403-413. [DOI: 10.1016/j.neuroimage.2018.06.053] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/05/2018] [Accepted: 06/17/2018] [Indexed: 11/16/2022] Open
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16
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Blood oxygenation changes resulting from subthreshold high frequency repetitive transcranial magnetic stimulation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2017:1513-1516. [PMID: 29060167 DOI: 10.1109/embc.2017.8037123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Effects of high frequency repetitive transcranial magnetic stimulation (rTMS) with a subthreshold intensity on hemodynamic response in brain cortices (both motor and prefrontal cortices) was investigated using the functional near infrared spectroscopy (fNIRS) technique. FNIRS signals of the motor and prefrontal cortices were acquired in healthy volunteers (n=7) at rest and during rTMS intervention. A significant reduction in oxygenated hemoglobin (HbO) concentration during the entire stimulation process was observed from both motor and prefrontal cortices. Results showed that the fNIRS technique can provide a reliable measure of regional cortical brain activation that could be valuable in studying cortical excitability connectivity in combination with rTMS.
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Bridges NR, McKinley RA, Boeke D, Sherwood MS, Parker JG, McIntire LK, Nelson JM, Fletchall C, Alexander N, McConnell A, Goodyear C, Nelson JT. Single Session Low Frequency Left Dorsolateral Prefrontal Transcranial Magnetic Stimulation Changes Neurometabolite Relationships in Healthy Humans. Front Hum Neurosci 2018; 12:77. [PMID: 29632477 PMCID: PMC5879132 DOI: 10.3389/fnhum.2018.00077] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 02/12/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Dorsolateral prefrontal cortex (DLPFC) low frequency repetitive transcranial magnetic stimulation (LF-rTMS) has shown promise as a treatment and investigative tool in the medical and research communities. Researchers have made significant progress elucidating DLPFC LF-rTMS effects—primarily in individuals with psychiatric disorders. However, more efforts investigating underlying molecular changes and establishing links to functional and behavioral outcomes in healthy humans are needed. Objective: We aimed to quantify neuromolecular changes and relate these to functional changes following a single session of DLPFC LF-rTMS in healthy participants. Methods: Eleven participants received sham-controlled neuronavigated 1 Hz rTMS to the region most activated by a 7-letter Sternberg working memory task (SWMT) within the left DLPFC. We quantified SWMT performance, functional magnetic resonance activation and proton Magnetic resonance spectroscopy (MRS) neurometabolite measure changes before and after stimulation. Results: A single LF-rTMS session was not sufficient to change DLPFC neurometabolite levels and these changes did not correlate with DLPFC activation changes. Real rTMS, however, significantly altered neurometabolite correlations (compared to sham rTMS), both with baseline levels and between the metabolites themselves. Additionally, real rTMS was associated with diminished reaction time (RT) performance improvements and increased activation within the motor, somatosensory and lateral occipital cortices. Conclusion: These results show that a single session of LF-rTMS is sufficient to influence metabolite relationships and causes widespread activation in healthy humans. Investigating correlational relationships may provide insight into mechanisms underlying LF-rTMS.
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Affiliation(s)
| | - Richard A McKinley
- Warfighter Interfaces Division, Applied Neuroscience Branch, Wright-Patterson AFB (WPAFB), Dayton, OH, United States
| | - Danielle Boeke
- Warfighter Interfaces Division, Applied Neuroscience Branch, Wright-Patterson AFB (WPAFB), Dayton, OH, United States
| | - Matthew S Sherwood
- Wright State Research Institute, Wright State University, Dayton, OH, United States
| | - Jason G Parker
- Kettering Health Network Innovation Center, Kettering, OH, United States
| | | | | | - Catherine Fletchall
- Grandview Medical Center, Kettering Health Network, Dayton, OH, United States
| | - Natasha Alexander
- Grandview Medical Center, Kettering Health Network, Dayton, OH, United States
| | - Amanda McConnell
- Grandview Medical Center, Kettering Health Network, Dayton, OH, United States
| | | | - Jeremy T Nelson
- Research Imaging Institute, School of Medicine, University of Texas Health Science Center, San Antonio, San Antonio, TX, United States
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18
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Seewoo BJ, Etherington SJ, Feindel KW, Rodger J. Combined rTMS/fMRI Studies: An Overlooked Resource in Animal Models. Front Neurosci 2018; 12:180. [PMID: 29628873 PMCID: PMC5876299 DOI: 10.3389/fnins.2018.00180] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 03/06/2018] [Indexed: 12/11/2022] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation technique, which has brain network-level effects in healthy individuals and is also used to treat many neurological and psychiatric conditions in which brain connectivity is believed to be abnormal. Despite the fact that rTMS is being used in a clinical setting and animal studies are increasingly identifying potential cellular and molecular mechanisms, little is known about how these mechanisms relate to clinical changes. This knowledge gap is amplified by non-overlapping approaches used in preclinical and clinical rTMS studies: preclinical studies are mostly invasive, using cellular and molecular approaches, while clinical studies are non-invasive, including functional magnetic resonance imaging (fMRI), TMS electroencephalography (EEG), positron emission tomography (PET), and behavioral measures. A non-invasive method is therefore needed in rodents to link our understanding of cellular and molecular changes to functional connectivity changes that are clinically relevant. fMRI is the technique of choice for examining both short and long term functional connectivity changes in large-scale networks and is becoming increasingly popular in animal research because of its high translatability, but, to date, there have been no reports of animal rTMS studies using this technique. This review summarizes the main studies combining different rTMS protocols with fMRI in humans, in both healthy and patient populations, providing a foundation for the design of equivalent studies in animals. We discuss the challenges of combining these two methods in animals and highlight considerations important for acquiring clinically-relevant information from combined rTMS/fMRI studies in animals. We believe that combining rTMS and fMRI in animal models will generate new knowledge in the following ways: functional connectivity changes can be explored in greater detail through complementary invasive procedures, clarifying mechanism and improving the therapeutic application of rTMS, as well as improving interpretation of fMRI data. And, in a more general context, a robust comparative approach will refine the use of animal models of specific neuropsychiatric conditions.
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Affiliation(s)
- Bhedita J Seewoo
- Experimental and Regenerative Neurosciences, School of Biological Sciences, The University of Western Australia, Perth, WA, Australia.,Centre for Microscopy, Characterization and Analysis, Research Infrastructure Centers, The University of Western Australia, Perth, WA, Australia
| | - Sarah J Etherington
- School of Veterinary and Life Sciences, Murdoch University, Perth, WA, Australia
| | - Kirk W Feindel
- Centre for Microscopy, Characterization and Analysis, Research Infrastructure Centers, The University of Western Australia, Perth, WA, Australia.,School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
| | - Jennifer Rodger
- Experimental and Regenerative Neurosciences, School of Biological Sciences, The University of Western Australia, Perth, WA, Australia.,Brain Plasticity Group, Perron Institute for Neurological and Translational Research, Perth, WA, Australia
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19
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Kozel FA, Motes MA, Didehbani N, DeLaRosa B, Bass C, Schraufnagel CD, Jones P, Morgan CR, Spence JS, Kraut MA, Hart J. Repetitive TMS to augment cognitive processing therapy in combat veterans of recent conflicts with PTSD: A randomized clinical trial. J Affect Disord 2018; 229:506-514. [PMID: 29351885 DOI: 10.1016/j.jad.2017.12.046] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 11/22/2017] [Accepted: 12/26/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND The objective was to test whether repetitive Transcranial Magnetic Stimulation (rTMS) just prior to Cognitive Processing Therapy (CPT) would significantly improve the clinical outcome compared to sham rTMS prior to CPT in veterans with PTSD. METHODS Veterans 18-60 years of age with current combat-related PTSD symptoms were randomized, using a 1:1 ratio in a parallel design, to active (rTMS+CPT) versus sham (sham+CPT) rTMS just prior to weekly CPT for 12-15 sessions. Blinded raters evaluated veterans at baseline, after the 5th and 9th treatments, and at 1, 3, and 6 months post-treatment. Clinician Administered PTSD Scale (CAPS) was the primary outcome measure with the PTSD Checklist (PCL) as a secondary outcome measure. The TMS coil (active or sham) was positioned over the right dorsolateral prefrontal cortex (110% MT, 1Hz continuously for 30min, 1800 pulses/treatment). RESULTS Of the 515 individuals screened for the study, 103 participants were randomized to either active (n = 54) or sham rTMS (n = 49). Sixty-two participants (60%) completed treatment and 59 (57%) completed the 6-month assessment. The rTMS+CPT group showed greater symptom reductions from baseline on both CAPS and PCL across CPT sessions and follow-up assessments, t(df ≥ 325) ≤ -2.01, p ≤ 0.023, one-tailed and t(df ≥ 303) ≤ -2.14, p ≤ 0.017, one-tailed, respectively. LIMITATIONS Participants were predominantly male and limited to one era of conflicts as well as those who could safely undergo rTMS. CONCLUSIONS The addition of rTMS to CPT compared to sham with CPT produced significantly greater PTSD symptom reduction early in treatment and was sustained up to six months post-treatment.
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Affiliation(s)
- F Andrew Kozel
- Mental Health and Behavioral Sciences & HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital and Clinics, Tampa, FL, USA; Department of Psychiatry and Behavioral Sciences, University of South Florida, Tampa, FL, USA.
| | | | | | | | | | | | | | | | | | - Michael A Kraut
- Department of Radiology and Radiologic Sciences, Johns Hopkins, University School of Medicine, Baltimore, MD, USA
| | - John Hart
- University of Texas, Dallas, Dallas, TX, USA; Depts. of Neurology and Neurotherapeutics and Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
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20
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Curtin A, Sun J, Ayaz H, Qian Z, Onaral B, Wang J, Tong S. Evaluation of evoked responses to pulse-matched high frequency and intermittent theta burst transcranial magnetic stimulation using simultaneous functional near-infrared spectroscopy. NEUROPHOTONICS 2017; 4:041405. [PMID: 28840157 PMCID: PMC5559641 DOI: 10.1117/1.nph.4.4.041405] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 07/07/2017] [Indexed: 06/07/2023]
Abstract
Transcranial magnetic stimulation (TMS) is a noninvasive method used to excite or inhibit cortical activity for experimental, diagnostic, and therapeutic interventions. However, nonmotor regions of the brain targeted in TMS therapies, such as the dorsolateral prefrontal cortex (DLPFC), offer no extrinsic response to stimulation, resulting in a need for a practical method for the evaluation of treatment. We sought to determine the capability of a continuous-wave light emitting diodes (LED)-based functional near-infrared spectroscopy (fNIRS) system to measure evoked cortical hemoglobin changes in the DLPFC during the simultaneous application of TMS to the left-DLPFC under brief stimulation paradigms used in the clinic. Seventeen healthy participants received short TMS trains at F3 in four different stimulation conditions (single pulse, high frequency, intermittent theta burst, and sham) while adjacent fNIRS measurements were recorded. Ten 2-s trains of each stimulation type were delivered with an intertrial interval of 40 s. Results indicated that high-frequency stimulation produces a larger and more evident response than other measured conditions. These findings show that a continuous-wave LED-based fNIRS system can be used to measure TMS-evoked responses and that future TMS applications can benefit from concurrent assessment of localized cortical activation changes.
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Affiliation(s)
- Adrian Curtin
- Shanghai Jiao Tong University, School of Biomedical Engineering, Shanghai, China
- Drexel University, School of Biomedical Engineering, Science, and Health Systems, Philadelphia, Pennsylvania, United States
| | - Junfeng Sun
- Shanghai Jiao Tong University, School of Biomedical Engineering, Shanghai, China
| | - Hasan Ayaz
- Drexel University, School of Biomedical Engineering, Science, and Health Systems, Philadelphia, Pennsylvania, United States
- University of Pennsylvania, Department of Family and Community Health, Philadelphia, Pennsylvania, United States
- Children’s Hospital of Philadelphia, The Division of General Pediatrics, Philadelphia, Pennsylvania, United States
| | - Zhenying Qian
- Shanghai Jiao Tong University, School of Medicine, Shanghai Mental Health Center, Shanghai, China
| | - Banu Onaral
- Drexel University, School of Biomedical Engineering, Science, and Health Systems, Philadelphia, Pennsylvania, United States
| | - Jijun Wang
- Shanghai Jiao Tong University, School of Medicine, Shanghai Mental Health Center, Shanghai, China
| | - Shanbao Tong
- Shanghai Jiao Tong University, School of Biomedical Engineering, Shanghai, China
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21
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Sato K, Fukuda M, Sato Y, Hiraishi T, Takao T, Fujii Y. Cortico-cortical evoked hemodynamic responses in human language systems using intraoperative near-infrared spectroscopy during direct cortical stimulation. Neurosci Lett 2016; 630:136-140. [PMID: 27453057 DOI: 10.1016/j.neulet.2016.07.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/20/2016] [Accepted: 07/20/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Understanding of cortico-cortical activity in eloquent areas intraoperatively is crucial for neurosurgical procedures. Here, we used intraoperative near-infrared spectroscopy (iNIRS) during direct cortical stimulation as a robust tool to better understand the cortico-cortical connectivity in language systems. METHODS We applied iNIRS to 3 patients who underwent epilepsy surgery due to lesions (cavernous angioma, epidermoid cyst, and low-grade glioma) located in language areas. Using iNIRS, we measured the blood concentration changes of oxyhemoglobin (HbO2) and deoxyhemoglobin (HbR) in the lateral temporal cortex during direct cortical stimulation (50Hz) at the inferior frontal area where Broca's area was probabilistically located. RESULTS In all patients, 50Hz stimulation elicited hemodynamic changes in the superior temporal gyrus (STG). During 0.8-4.8s after stimulation, HbO2 increased and HbR decreased in the posterior part of the STG (Wernicke's area). Similar responses were observed in the anterior part of the STG 1.3-8.0s after stimulation. Finally, these changes were disappeared in the middle temporal gyrus. CONCLUSIONS Our results suggest that cortical stimulation of Broca's area elicits hemodynamic responses in Wernicke's area via cortico-cortical connectivity. We demonstrated cortico-cortical evoked responses in language systems using iNIRS during direct cortical stimulation. Our iNIRS data will provide useful information about cortico-cortical networks underlying human brain functions intraoperatively and will contribute to neurosurgical treatment in eloquent areas.
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Affiliation(s)
- Keisuke Sato
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan.
| | - Masafumi Fukuda
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
| | - Yosuke Sato
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
| | - Tetsuya Hiraishi
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
| | - Tetsuro Takao
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
| | - Yukihiko Fujii
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
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Fu G, Wan NJA, Baker JM, Montgomery JW, Evans JL, Gillam RB. A Proof of Concept Study of Function-Based Statistical Analysis of fNIRS Data: Syntax Comprehension in Children with Specific Language Impairment Compared to Typically-Developing Controls. Front Behav Neurosci 2016; 10:108. [PMID: 27375448 PMCID: PMC4894897 DOI: 10.3389/fnbeh.2016.00108] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 05/19/2016] [Indexed: 11/16/2022] Open
Abstract
Functional near infrared spectroscopy (fNIRS) is a neuroimaging technology that enables investigators to indirectly monitor brain activity in vivo through relative changes in the concentration of oxygenated and deoxygenated hemoglobin. One of the key features of fNIRS is its superior temporal resolution, with dense measurements over very short periods of time (100 ms increments). Unfortunately, most statistical analysis approaches in the existing literature have not fully utilized the high temporal resolution of fNIRS. For example, many analysis procedures are based on linearity assumptions that only extract partial information, thereby neglecting the overall dynamic trends in fNIRS trajectories. The main goal of this article is to assess the ability of a functional data analysis (FDA) approach for detecting significant differences in hemodynamic responses recorded by fNIRS. Children with and without SLI wore two, 3 × 5 fNIRS caps situated over the bilateral parasylvian areas as they completed a language comprehension task. FDA was used to decompose the high dimensional hemodynamic curves into the mean function and a few eigenfunctions to represent the overall trend and variation structures over time. Compared to the most popular GLM, we did not assume any parametric structure and let the data speak for itself. This analysis identified significant differences between the case and control groups in the oxygenated hemodynamic mean trends in the bilateral inferior frontal and left inferior posterior parietal brain regions. We also detected significant group differences in the deoxygenated hemodynamic mean trends in the right inferior posterior parietal cortex and left temporal parietal junction. These findings, using dramatically different approaches, experimental designs, data sets, and foci, were consistent with several other reports, confirming group differences in the importance of these two areas for syntax comprehension. The proposed FDA was consistent with the temporal characteristics of fNIRS, thus providing an alternative methodology for fNIRS analyses.
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Affiliation(s)
- Guifang Fu
- Department of Mathematics and Statistics, Utah State University Logan, UT, USA
| | | | - Joseph M Baker
- Center for Interdisciplinary Brain Sciences Research, Division of Brain Sciences, Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University Stanford, CA, USA
| | | | - Julia L Evans
- School of Behavioral and Brain Sciences, University of Texas at Dallas Richardson, TX, USA
| | - Ronald B Gillam
- Department of Communicative Disorders and Deaf Education, Utah State University Logan, UT, USA
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Tian F, Hase SN, Gonzalez-Lima F, Liu H. Transcranial laser stimulation improves human cerebral oxygenation. Lasers Surg Med 2016; 48:343-9. [PMID: 26817446 PMCID: PMC5066697 DOI: 10.1002/lsm.22471] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2015] [Indexed: 12/31/2022]
Abstract
Background and Objective Transcranial laser stimulation of the brain with near‐infrared light is a novel form of non‐invasive photobiomodulation or low‐level laser therapy (LLLT) that has shown therapeutic potential in a variety of neurological and psychological conditions. Understanding of its neurophysiological effects is essential for mechanistic study and treatment evaluation. This study investigated how transcranial laser stimulation influences cerebral hemodynamics and oxygenation in the human brain in vivo using functional near‐infrared spectroscopy (fNIRS). Materials and Methods Two separate experiments were conducted in which 1,064‐nm laser stimulation was administered at (1) the center and (2) the right side of the forehead, respectively. The laser emitted at a power of 3.4 W and in an area of 13.6 cm2, corresponding to 0.25 W/cm2 irradiance. Stimulation duration was 10 minutes. Nine healthy male and female human participants of any ethnic background, in an age range of 18–40 years old were included in each experiment. Results In both experiments, transcranial laser stimulation induced an increase of oxygenated hemoglobin concentration (Δ[HbO2]) and a decrease of deoxygenated hemoglobin concentration (Δ[Hb]) in both cerebral hemispheres. Improvements in cerebral oxygenation were indicated by a significant increase of differential hemoglobin concentration (Δ[HbD] = Δ[HbO2] − Δ[Hb]). These effects increased in a dose‐dependent manner over time during laser stimulation (10 minutes) and persisted after laser stimulation (6 minutes). The total hemoglobin concentration (Δ[HbT] = Δ[HbO2] + Δ[Hb]) remained nearly unchanged in most cases. Conclusion Near‐infrared laser stimulation applied to the forehead can transcranially improve cerebral oxygenation in healthy humans. Lasers Surg. Med. 48:343–349, 2016. © 2016 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Fenghua Tian
- Department of Bioengineering, University of Texas, Arlington, Texas, 76010
| | - Snehal N Hase
- Department of Bioengineering, University of Texas, Arlington, Texas, 76010
| | - F Gonzalez-Lima
- Department of Psychology and Institute for Neuroscience, University of Texas, Austin, Texas, 78712
| | - Hanli Liu
- Department of Bioengineering, University of Texas, Arlington, Texas, 76010
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24
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Ho CSH, Zhang MWB, Ho RCM. Optical Topography in Psychiatry: A Chip Off the Old Block or a New Look Beyond the Mind-Brain Frontiers? Front Psychiatry 2016; 7:74. [PMID: 27199781 PMCID: PMC4844608 DOI: 10.3389/fpsyt.2016.00074] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 04/13/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Cyrus S H Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore , Singapore
| | - Melvyn W B Zhang
- National Addictions Management Service (NAMS), Institute of Mental Health , Singapore
| | - Roger C M Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore , Singapore
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25
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Torres F, Villalon E, Poblete P, Moraga-Amaro R, Linsambarth S, Riquelme R, Zangen A, Stehberg J. Retrospective Evaluation of Deep Transcranial Magnetic Stimulation as Add-On Treatment for Parkinson's Disease. Front Neurol 2015; 6:210. [PMID: 26579065 PMCID: PMC4620693 DOI: 10.3389/fneur.2015.00210] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 09/16/2015] [Indexed: 11/25/2022] Open
Abstract
Objective To evaluate the safety and assess the different symptom improvements found after a combined low-frequency primary motor cortex and high-frequency prefrontal cortex (PFC) stimulation using the deep TMS (dTMS) H-coil, as an add-on treatment for Parkinson’s disease (PD). Methods Forty-five PD patients underwent 14 dTMS sessions; each consisting of 1 Hz stimulation of the primary motor cortex for 15 min, followed by 10 Hz stimulation of the PFC for 15 min. Clinical assessments were performed, BEFORE, at the MIDDLE, and END of therapy as well as at FOLLOW-UP after 30 days, using Movement Disorder Society-Unified Parkinson’s Disease Rating Scale, TINETTI, UP&GO, SCOPA, HDRS21, Beck Depression Inventory, and self-applied daily motor assessment scales. Results Treatment was well-tolerated, without serious adverse effects. dTMS-induced significant PD symptom improvements at END and at FOLLOW-UP, in all subscales of the UPDRS, gait speed, depressive symptoms, balance, autonomic symptoms, and a 73% increase in daily ON time. Conclusion In the cohort of PD patients treated, dTMS was well-tolerated with only minor adverse effects. The dTMS-induced significant improvements in motor, postural, and motivational symptoms of PD patients and may potentiate concurrent levodopa treatment. Significance The present study demonstrates that dTMS may have a much wider spectrum of beneficial effects than previously reported for TMS, including enhancement of levodopa effects, suggesting that future clinical trials with dTMS should include a broader range of symptom measurements.
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Affiliation(s)
| | | | | | - Rodrigo Moraga-Amaro
- Laboratorio de Neurobiología, Centro de Investigaciones Biomédicas, Universidad Andres Bello , Santiago , Chile
| | - Sergio Linsambarth
- Laboratorio de Neurobiología, Centro de Investigaciones Biomédicas, Universidad Andres Bello , Santiago , Chile
| | | | - Abraham Zangen
- Neuroscience Laboratory, Ben-Gurion University of the Negev , Beersheva , Israel
| | - Jimmy Stehberg
- Laboratorio de Neurobiología, Centro de Investigaciones Biomédicas, Universidad Andres Bello , Santiago , Chile
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Statistical analysis of fNIRS data: A comprehensive review. Neuroimage 2014; 85 Pt 1:72-91. [DOI: 10.1016/j.neuroimage.2013.06.016] [Citation(s) in RCA: 248] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 04/20/2013] [Accepted: 06/07/2013] [Indexed: 11/16/2022] Open
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A Near Infra-Red Study of Blood Oxygenation Changes Resulting From High and Low Frequency Repetitive Transcranial Magnetic Stimulation. Brain Stimul 2013; 6:922-4. [DOI: 10.1016/j.brs.2013.04.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 04/18/2013] [Accepted: 04/18/2013] [Indexed: 11/30/2022] Open
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Parks NA. Concurrent application of TMS and near-infrared optical imaging: methodological considerations and potential artifacts. Front Hum Neurosci 2013; 7:592. [PMID: 24065911 PMCID: PMC3776952 DOI: 10.3389/fnhum.2013.00592] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 09/03/2013] [Indexed: 12/02/2022] Open
Abstract
The simultaneous application of transcranial magnetic stimulation (TMS) with non-invasive neuroimaging provides a powerful method for investigating functional connectivity in the human brain and the causal relationships between areas in distributed brain networks. TMS has been combined with numerous neuroimaging techniques including, electroencephalography (EEG), functional magnetic resonance imaging (fMRI), and positron emission tomography (PET). Recent work has also demonstrated the feasibility and utility of combining TMS with non-invasive near-infrared optical imaging techniques, functional near-infrared spectroscopy (fNIRS) and the event-related optical signal (EROS). Simultaneous TMS and optical imaging affords a number of advantages over other neuroimaging methods but also involves a unique set of methodological challenges and considerations. This paper describes the methodology of concurrently performing optical imaging during the administration of TMS, focusing on experimental design, potential artifacts, and approaches to controlling for these artifacts.
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Affiliation(s)
- Nathan A Parks
- Department of Psychological Science, University of Arkansas Fayetteville, AR, USA
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Mesquita RC, Faseyitan OK, Turkeltaub PE, Buckley EM, Thomas A, Kim MN, Durduran T, Greenberg JH, Detre JA, Yodh AG, Hamilton RH. Blood flow and oxygenation changes due to low-frequency repetitive transcranial magnetic stimulation of the cerebral cortex. JOURNAL OF BIOMEDICAL OPTICS 2013; 18:067006. [PMID: 23757042 PMCID: PMC3678989 DOI: 10.1117/1.jbo.18.6.067006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Transcranial magnetic stimulation (TMS) modulates processing in the human brain and is therefore of interest as a treatment modality for neurologic conditions. During TMS administration, an electric current passing through a coil on the scalp creates a rapidly varying magnetic field that induces currents in the cerebral cortex. The effects of low-frequency (1 Hz), repetitive TMS (rTMS) on motor cortex cerebral blood flow (CBF) and tissue oxygenation in seven healthy adults, during/after 20 min stimulation, is reported. Noninvasive optical methods are employed: diffuse correlation spectroscopy (DCS) for blood flow and diffuse optical spectroscopy (DOS) for hemoglobin concentrations. A significant increase in median CBF (33%) on the side ipsilateral to stimulation was observed during rTMS and persisted after discontinuation. The measured hemodynamic parameter variations enabled computation of relative changes in cerebral metabolic rate of oxygen consumption during rTMS, which increased significantly (28%) in the stimulated hemisphere. By contrast, hemodynamic changes from baseline were not observed contralateral to rTMS administration (all parameters, p>0.29). In total, these findings provide new information about hemodynamic/metabolic responses to low-frequency rTMS and, importantly, demonstrate the feasibility of DCS/DOS for noninvasive monitoring of TMS-induced physiologic effects.
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Affiliation(s)
- Rickson C Mesquita
- University of Pennsylvania, Department of Physics and Astronomy, Philadelphia, Pennsylvania 19104, USA.
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Furubayashi T, Mochizuki H, Terao Y, Arai N, Hanajima R, Hamada M, Matsumoto H, Nakatani-Enomoto S, Okabe S, Yugeta A, Inomata-Terada S, Ugawa Y. Cortical hemoglobin concentration changes underneath the coil after single-pulse transcranial magnetic stimulation: a near-infrared spectroscopy study. J Neurophysiol 2013; 109:1626-37. [DOI: 10.1152/jn.00980.2011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Using near-infrared spectroscopy (NIRS) and multichannel probes, we studied hemoglobin (Hb) concentration changes when single-pulse transcranial magnetic stimulation (TMS) was applied over the left hemisphere primary motor cortex (M1). Seventeen measurement probes were centered over left M1. Subjects were studied in both active and relaxed conditions, with TMS intensity set at 100%, 120%, and 140% of the active motor threshold. The magnetic coils were placed so as to induce anteromedially directed currents in the brain. Hb concentration changes were more prominent at channels over M1 and posterior to it. Importantly, Hb concentration changes at M1 after TMS differed depending on whether the target muscle was in an active or relaxed condition. In the relaxed condition, Hb concentration increased up to 3–6 s after TMS, peaking at ∼6 s, and returned to the baseline. In the active condition, a smaller increase in Hb concentrations continued up to 3–6 s after TMS (early activation), followed by a decrease in Hb concentration from 9 to 12 s after TMS (delayed deactivation). Hb concentration changes in the active condition at higher stimulus intensities were more pronounced at locations posterior to M1 than at M1. We conclude that early activation occurs when M1 is activated transsynaptically. The relatively late deactivation may result from the prolonged inhibition of the cerebral cortex after activation. The posterior-dominant activation at higher intensities in the active condition may result from an additional activation of the sensory cortex due to afferent inputs from muscle contraction evoked by the TMS.
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Affiliation(s)
- Toshiaki Furubayashi
- Department of Rehabilitation, Faculty of Medical Science and Welfare, Tohoku Bunka Gakuen University, Sendai, Japan
- Department of Neurology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hitoshi Mochizuki
- Department of Neurology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yasuo Terao
- Department of Neurology, Division of Neuroscience, The University of Tokyo, Tokyo, Japan
| | - Noritoshi Arai
- Department of Neurology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Ritsuko Hanajima
- Department of Neurology, Division of Neuroscience, The University of Tokyo, Tokyo, Japan
| | - Masashi Hamada
- Department of Neurology, Division of Neuroscience, The University of Tokyo, Tokyo, Japan
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom; and
| | - Hideyuki Matsumoto
- Department of Neurology, Division of Neuroscience, The University of Tokyo, Tokyo, Japan
| | - Setsu Nakatani-Enomoto
- Department of Neurology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Shingo Okabe
- Department of Neurology, Division of Neuroscience, The University of Tokyo, Tokyo, Japan
| | - Akihiro Yugeta
- Department of Neurology, Division of Neuroscience, The University of Tokyo, Tokyo, Japan
| | - Satomi Inomata-Terada
- Department of Neurology, Division of Neuroscience, The University of Tokyo, Tokyo, Japan
| | - Yoshikazu Ugawa
- Department of Neurology, School of Medicine, Fukushima Medical University, Fukushima, Japan
- JST, Research Seeds Program, Fukushima, Japan
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Groiss SJ, Mochizuki H, Furubayashi T, Kobayashi S, Nakatani-Enomoto S, Nakamura K, Ugawa Y. Quadri-pulse stimulation induces stimulation frequency dependent cortical hemoglobin concentration changes within the ipsilateral motor cortical network. Brain Stimul 2013; 6:40-8. [DOI: 10.1016/j.brs.2011.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 12/09/2011] [Accepted: 12/09/2011] [Indexed: 01/10/2023] Open
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Croarkin PE, Wall CA, Nakonezny PA, Buyukdura JS, Husain MM, Sampson SM, Emslie GJ, Kozel FA. Increased cortical excitability with prefrontal high-frequency repetitive transcranial magnetic stimulation in adolescents with treatment-resistant major depressive disorder. J Child Adolesc Psychopharmacol 2012; 22:56-64. [PMID: 22257125 DOI: 10.1089/cap.2011.0054] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To examine changes in motor cortical excitability in adolescent subjects receiving 30 sessions of high-frequency prefrontal repetitive transcranial magnetic stimulation (rTMS). METHODS Eight adolescents with treatment-resistant major depressive disorder (MDD) enrolled in an open augmentation trial of 10 Hz rTMS. Resting motor thresholds were obtained by the visualization of movement method with a maximum likelihood threshold hunting computer algorithm at baseline and after every five sessions of rTMS. Motor threshold was recorded as the percentage of total machine output at each measurement. RESULTS Motor threshold data from baseline, weeks 2, 4, and 5 were included in a mixed model repeated measure analysis to examine a change in least square mean effect over time. The omnibus effect did not reach statistical significance (F=1.25, p=0.32). However, multiple comparisons from the overall model demonstrated a decrease in the least square mean motor threshold. The mean contrast from baseline to week 5 approached significance (p=0.07). Moreover, a post-hoc analysis with a Wilcoxon signed ranks test demonstrated a significant decrease at week 5 (p=0.03). CONCLUSIONS This suggests that high-frequency rTMS may increase cortical excitability in adolescents with treatment-resistant MDD.
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Affiliation(s)
- Paul E Croarkin
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, UT Southwestern Medical Center Dallas, Dallas, Texas 75390-8589, USA.
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Intensity dependent repetitive transcranial magnetic stimulation modulation of blood oxygenation. J Affect Disord 2012; 136:1243-6. [PMID: 21875752 DOI: 10.1016/j.jad.2011.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 07/11/2011] [Accepted: 08/03/2011] [Indexed: 11/22/2022]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is increasingly being investigated in clinical settings for the treatment of neurological and psychiatric disorders such as dystonia, schizophrenia, and major depressive disorder (MDD). Using near infra-red spectroscopy (NIRS), very short trains of rTMS have previously been shown to modulate cortical blood oxygenation. METHODS In order to investigate the effect of longer, clinically relevant trains of 1 Hz rTMS on oxy-hemoglobin (HbO) at prefrontal cortex, the current study applied ten minute trains of rTMS at both subthreshold and suprathreshold intensities. RESULTS A similar profile of oxygenation change was observed during the beginning 30-40 s of the trains, however for the remainder, subthreshold rTMS returned to baseline while the suprathreshold TMS resulted in a long period of reduced oxygenation. LIMITATIONS Small sample size. CONCLUSIONS The differences observed may be a product of changes in HbO requirements by inhibitory/excitatory neural circuits, either by reduced HbO demand or by increased HbO consumption, while sustained HbO reduction may be a consequence of a modulation of vaso-motor reactivity. This study has implications for understanding the mechanisms involved in the physiological changes evoked by rTMS and efficacious clinical application of rTMS in disorders such as MDD.
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Croarkin PE, Wall CA, Lee J. Applications of transcranial magnetic stimulation (TMS) in child and adolescent psychiatry. Int Rev Psychiatry 2011; 23:445-53. [PMID: 22200134 DOI: 10.3109/09540261.2011.623688] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Transcranial magnetic stimulation (TMS) is emerging as a new treatment and neurophysiological research tool for psychiatric disorders. Recent publications suggest that this modality will also serve as a treatment and research tool in child and adolescent psychiatry. Current reports on therapeutic trials of repetitive transcranial magnetic stimulation (rTMS) in adolescents have primarily focused on depression. However, other pilot work involves the treatment of attention-deficit/hyperactivity disorder (ADHD), autism and schizophrenia. Neurophysiological studies typically utilize single and paired-pulse TMS paradigms which index cortical excitability and inhibition. Initial studies have focused on ADHD, autism, and depression. General knowledge regarding TMS among child and adolescent psychiatrists is lacking. The aim of this review is to provide an overview of TMS in the context of child and adolescent psychiatry, discuss recent therapeutic and neurophysiological studies, and examine relevant ethical considerations.
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Näsi T, Mäki H, Kotilahti K, Nissilä I, Haapalahti P, Ilmoniemi RJ. Magnetic-stimulation-related physiological artifacts in hemodynamic near-infrared spectroscopy signals. PLoS One 2011; 6:e24002. [PMID: 21887362 PMCID: PMC3162598 DOI: 10.1371/journal.pone.0024002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Accepted: 07/28/2011] [Indexed: 12/26/2022] Open
Abstract
Hemodynamic responses evoked by transcranial magnetic stimulation (TMS) can be measured with near-infrared spectroscopy (NIRS). This study demonstrates that cerebral neuronal activity is not their sole contributor. We compared bilateral NIRS responses following brain stimulation to those from the shoulders evoked by shoulder stimulation and contrasted them with changes in circulatory parameters. The left primary motor cortex of ten subjects was stimulated with 8-s repetitive TMS trains at 0.5, 1, and 2 Hz at an intensity of 75% of the resting motor threshold. Hemoglobin concentration changes were measured with NIRS on the stimulated and contralateral hemispheres. The photoplethysmograph (PPG) amplitude and heart rate were recorded as well. The left shoulder of ten other subjects was stimulated with the same protocol while the hemoglobin concentration changes in both shoulders were measured. In addition to PPG amplitude and heart rate, the pulse transit time was recorded. The brain stimulation reduced the total hemoglobin concentration (HbT) on the stimulated and contralateral hemispheres. The shoulder stimulation reduced HbT on the stimulated shoulder but increased it contralaterally. The waveforms of the HbT responses on the stimulated hemisphere and shoulder correlated strongly with each other (r = 0.65–0.87). All circulatory parameters were also affected. The results suggest that the TMS-evoked NIRS signal includes components that do not result directly from cerebral neuronal activity. These components arise from local effects of TMS on the vasculature. Also global circulatory effects due to arousal may affect the responses. Thus, studies involving TMS-evoked NIRS responses should be carefully controlled for physiological artifacts and effective artifact removal methods are needed to draw inferences about TMS-evoked brain activity.
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Affiliation(s)
- Tiina Näsi
- Department of Biomedical Engineering and Computational Science, Aalto University School of Science, Espoo, Finland.
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McClintock SM, Freitas C, Oberman L, Lisanby SH, Pascual-Leone A. Transcranial magnetic stimulation: a neuroscientific probe of cortical function in schizophrenia. Biol Psychiatry 2011; 70:19-27. [PMID: 21571254 PMCID: PMC3270326 DOI: 10.1016/j.biopsych.2011.02.031] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 02/21/2011] [Accepted: 02/25/2011] [Indexed: 12/20/2022]
Abstract
Transcranial magnetic stimulation (TMS) is a neuropsychiatric tool that can serve as a useful method to better understand the neurobiology of cognitive function, behavior, and emotional processing. The purpose of this article is to examine the utility of TMS as a means to measure neocortical function in neuropsychiatric disorders in general, and schizophrenia in particular, for the Cognitive Neuroscience Treatment Research to Improve Cognition in Schizophrenia initiative. When incorporating TMS paradigms in research studies, methodologic considerations include technical aspects of TMS, cohort selection and confounding factors, and subject safety. Available evidence suggests benefits of TMS alone or in combination with neurophysiologic and neuroimaging methods, including positron emission tomography, single photon emission computed tomography, magnetic resonance imaging, functional magnetic resonance imaging, functional near infrared spectroscopy, magnetoencephalography, and electroencephalography, to explore neocortical function. With the multiple TMS techniques including single-pulse, paired-pulse, paired associative stimulation, and repetitive TMS and theta burst stimulation, combined with neurophysiologic and neuroimaging methods, there exists a plethora of TMS experimental paradigms to modulate neocortical physiologic processes. Specifically, TMS can measure cortical excitability, intracortical inhibitory and excitatory mechanisms, and local and network cortical plasticity. Coupled with functional and electrophysiologic modalities, TMS can provide insight into the mechanisms underlying healthy neurodevelopment and aging, as well as neuropsychiatric pathology. Thus, TMS could be a useful tool in the Cognitive Neuroscience Treatment Research to Improve Cognition in Schizophrenia armamentarium of biomarker methods. Future investigations are warranted to optimize TMS methodologies for this purpose.
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Affiliation(s)
- Shawn M. McClintock
- Brain Stimulation Lab, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA, Division of Brain Stimulation and Therapeutic Modulation, Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Catarina Freitas
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Lindsay Oberman
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sarah H. Lisanby
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham North Carolina, USA
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA, Institut Universitari de Neurorehabilitació Guttmann, Universidad Autónoma de Barcelona, Badalona, Spain., Corresponding Author: Alvaro Pascual-Leone, MD, PhD, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA. T: 617.667-0203; Fax: 617.975-5322.
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Reithler J, Peters J, Sack A. Multimodal transcranial magnetic stimulation: Using concurrent neuroimaging to reveal the neural network dynamics of noninvasive brain stimulation. Prog Neurobiol 2011; 94:149-65. [DOI: 10.1016/j.pneurobio.2011.04.004] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 03/31/2011] [Accepted: 04/06/2011] [Indexed: 10/18/2022]
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Thomson RH, Daskalakis ZJ, Fitzgerald PB. A near infra-red spectroscopy study of the effects of pre-frontal single and paired pulse transcranial magnetic stimulation. Clin Neurophysiol 2011; 122:378-82. [PMID: 20817548 DOI: 10.1016/j.clinph.2010.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Revised: 08/05/2010] [Accepted: 08/06/2010] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Concentration changes in hemoglobin following single and paired pulse (2 and 15 ms inter-stimulus interval) transcranial magnetic stimulation (TMS) was investigated using near infra-red spectroscopy (NIRS). METHODS TMS was delivered to left pre-frontal cortex at typical intensities used in neuroscience research and concentrations of deoxyhemoglobin (Hb), oxyhemoglobin (HbO) and total hemoglobin (HbT) were measured. RESULTS Significant drops in concentration of HbO and HbT were observed and while there was no effect of the different pulse types on amplitude, there was a difference in the time taken to return to baseline. CONCLUSIONS The changes observed imply that in pre-frontal cortex, the different TMS pulse types result in differential effects on oxygen consumption. SIGNIFICANCE This study aids our understanding of the physiological effects of single and paired pulse TMS.
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Affiliation(s)
- Richard H Thomson
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University School of Psychology, Psychiatry and Psychological Medicine, Vic., Australia
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Ziemann U. Transcranial magnetic stimulation at the interface with other techniques: a powerful tool for studying the human cortex. Neuroscientist 2011; 17:368-81. [PMID: 21311054 DOI: 10.1177/1073858410390225] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Transcranial magnetic stimulation (TMS) has developed into a very powerful tool in the hands of basic and clinical neuroscientists alike to study function and dysfunction of the human brain noninvasively and painlessly. However, as a stand-alone technique, the potential of TMS to gain knowledge is relatively limited. This potential can be strongly enhanced by combining TMS with simultaneous measurements in other electrophysiological (EEG) or imaging modalities (PET, fMRI, NIRS, MRS) or by combining TMS with exposure to neuroactive drugs (pharmaco-TMS). This review provides an up-to-date synopsis of these combined approaches and highlights important examples that have advanced our understanding of how TMS interacts with neuronal networks in the human brain.
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Affiliation(s)
- Ulf Ziemann
- Department of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany.
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40
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SASSAROLI ANGELO, ZHENG FENG, PIERRO MICHELE, BERGETHON PETERR, FANTINI SERGIO. PHASE DIFFERENCE BETWEEN LOW-FREQUENCY OSCILLATIONS OF CEREBRAL DEOXY- AND OXY-HEMOGLOBIN CONCENTRATIONS DURING A MENTAL TASK. JOURNAL OF INNOVATIVE OPTICAL HEALTH SCIENCES 2011; 4:151-158. [PMID: 21915189 PMCID: PMC3170731 DOI: 10.1142/s1793545811001332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Hemodynamic low-frequency (~0.1 Hz) spontaneous oscillations as detected in the brain by near-infrared spectroscopy have potential applications in the study of brain activation, cerebral autoregulation, and functional connectivity. In this work, we have investigated the phase lag between oscillations of cerebral deoxy- and oxy-hemoglobin concentrations in the frequency range 0.05-0.10 Hz in a human subject during a mental workload task. We have obtained a measure of such phase lag using two different methods: (1) phase synchronization analysis as used in the theory of chaotic oscillators and (2) a novel cross-correlation phasor approach. The two methods yielded comparable initial results of a larger phase lag between low-frequency oscillations of deoxy- and oxy-hemoglobin concentrations during mental workload with respect to a control, rest condition.
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