Visual awareness suppression by pre-stimulus brain stimulation; a neural effect

Meta-analysis of experimental factors influencing single-pulse TMS effects on the early visual cortex

Background

Single-pulse transcranial magnetic stimulation (spTMS) applied to the Early Visual Cortex (EVC) has demonstrated the ability to suppress the perception on visual targets, akin to the effect of visual masking. However, the reported spTMS suppression effects across various studies have displayed inconsistency.

Objective

We aim to test if the heterogeneity of the spTMS effects can be attributable to variations in experimental factors.

Methods

We conducted a meta-analysis using data collected from the PubMed and Web of Science databases spanning from 1995 to March 2024. The meta-analysis encompassed a total of 40 independent experiments drawn from 33 original articles.

Results

The findings unveiled an overall significant spTMS suppression effect on visual perception. Nevertheless, there existed substantial heterogeneity among the experiments. Univariate analysis elucidated that the spTMS effects could be significantly influenced by TMS intensity, visual angle of the stimulus, coil type, and TMS stimulators from different manufacturers. Reliable spTMS suppression effects were observed within the time windows of -80 to 0 ms and 50 to 150 ms. Multivariate linear regression analyses, which included SOA, TMS intensity, visual angle of the stimulus, and coil type, identified SOA as the key factor influencing the spTMS effects. Within the 50 to 150 ms time window, optimal SOAs were identified as 112 ms and 98 ms for objective and subjective performance, respectively. Collectively, multiple experimental factors accounted for 22.9% (r = 0.3353) and 39.9% (r = 0.3724) of the variance in objective and subjective performance, respectively. Comparing univariate and multivariate analyses, it was evident that experimental factors had different impacts on objective performance and subjective performance.

Conclusion

The present study provided quantitative recommendations for future experiments involving the spTMS effects on visual targets, offering guidance on how to configure experimental factors to achieve the optimal masking effect.

Towards causal mechanisms of consciousness through focused transcranial brain stimulation

Conscious experience represents one of the most elusive problems of empirical science, namely neuroscience. The main objective of empirical studies of consciousness has been to describe the minimal sets of neural events necessary for a specific neuronal state to become consciously experienced. The current state of the art still does not meet this objective but rather consists of highly speculative theories based on correlates of consciousness and an ever-growing list of knowledge gaps. The current state of the art is defined by the limitations of past stimulation techniques and the emphasis on the observational approach. However, looking at the current stimulation technologies that are becoming more accurate, it is time to consider an alternative approach to studying consciousness, which builds on the methodology of causal explanations via causal alterations. The aim of this methodology is to move beyond the correlates of consciousness and focus directly on the mechanisms of consciousness with the help of the currently focused brain stimulation techniques, such as geodesic transcranial electric neuromodulation. This approach not only overcomes the limitations of the correlational methodology but will also become another firm step in the following science of consciousness.

Spontaneous Fluctuations in Oscillatory Brain State Cause Differences in Transcranial Magnetic Stimulation Effects Within and Between Individuals

Transcranial magnetic stimulation (TMS) can cause measurable effects on neural activity and behavioral performance in healthy volunteers. In addition, TMS is increasingly used in clinical practice for treating various neuropsychiatric disorders. Unfortunately, TMS-induced effects show large intra- and inter-subject variability, hindering its reliability, and efficacy. One possible source of this variability may be the spontaneous fluctuations of neuronal oscillations. We present recent studies using multimodal TMS including TMS-EMG (electromyography), TMS-tACS (transcranial alternating current stimulation), and concurrent TMS-EEG-fMRI (electroencephalography, functional magnetic resonance imaging), to evaluate how individual oscillatory brain state affects TMS signal propagation within targeted networks. We demonstrate how the spontaneous oscillatory state at the time of TMS influences both immediate and longer-lasting TMS effects. These findings indicate that at least part of the variability in TMS efficacy may be attributable to the current practice of ignoring (spontaneous) oscillatory fluctuations during TMS. Ignoring this state-dependent spread of activity may cause great individual variability which so far is poorly understood and has proven impossible to control. We therefore also compare two technical solutions to directly account for oscillatory state during TMS, namely, to use (a) tACS to externally control these oscillatory states and then apply TMS at the optimal (controlled) brain state, or (b) oscillatory state-triggered TMS (closed-loop TMS). The described multimodal TMS approaches are paramount for establishing more robust TMS effects, and to allow enhanced control over the individual outcome of TMS interventions aimed at modulating information flow in the brain to achieve desirable changes in cognition, mood, and behavior.

Inferring Causality from Noninvasive Brain Stimulation in Cognitive Neuroscience

Noninvasive brain stimulation (NIBS) techniques, such as transcranial magnetic stimulation or transcranial direct and alternating current stimulation, are advocated as measures to enable causal inference in cognitive neuroscience experiments. Transcending the limitations of purely correlative neuroimaging measures and experimental sensory stimulation, they allow to experimentally manipulate brain activity and study its consequences for perception, cognition, and eventually, behavior. Although this is true in principle, particular caution is advised when interpreting brain stimulation experiments in a causal manner. Research hypotheses are often oversimplified, disregarding the underlying (implicitly assumed) complex chain of causation, namely, that the stimulation technique has to generate an electric field in the brain tissue, which then evokes or modulates neuronal activity both locally in the target region and in connected remote sites of the network, which in consequence affects the cognitive function of interest and eventually results in a change of the behavioral measure. Importantly, every link in this causal chain of effects can be confounded by several factors that have to be experimentally eliminated or controlled to attribute the observed results to their assumed cause. This is complicated by the fact that many of the mediating and confounding variables are not directly observable and dose-response relationships are often nonlinear. We will walk the reader through the chain of causation for a generic cognitive neuroscience NIBS study, discuss possible confounds, and advise appropriate control conditions. If crucial assumptions are explicitly tested (where possible) and confounds are experimentally well controlled, NIBS can indeed reveal cause-effect relationships in cognitive neuroscience studies.

Apparent Motion Induces Activity Suppression in Early Visual Cortex and Impairs Visual Detection

Apparent motion (AM) is induced when two stationary visual stimuli are presented in alternating sequence. Intriguingly, AM leads to an impaired detectability of stimuli along the AM path (i.e., AM-induced masking). It has been hypothesized that AM triggers an internal representation of a moving object in early visual cortex, which competes with stimulus-evoked representations of visual stimuli on the motion path in early visual cortex of 25 human adults (16 female). We tested this hypothesis by measuring BOLD responses in early visual cortex during the process of AM-induced masking, using fMRI and population receptive field methods. Surprisingly, and counter to our hypothesis, we showed that AM suppressed, rather than increased, BOLD responses along early visual (V1 and V2) representations of the AM path, including regions that were not directly activated by the AM inducer stimuli. This activity suppression of the visual response predicted the subsequent reduction in detectability of the target that appeared in the middle of the AM path. Our data thereby provide direct empirical evidence for suppressive neural mechanisms underlying AM and suggest that illusory motion can render us blind to objects on the motion path by suppressing neural activity at the earliest cortical stages of visual perception.SIGNIFICANCE STATEMENT When two spatially distinct visual objects are presented in alternating sequence, apparent motion (AM) occurs and impairs detectability of stimuli along its path. The underlying mechanism is thought to be that increased activation in human early visual cortex evoked by AM interferes with the representation of the stimulus. Strikingly, however, we show that AM suppresses neural activity along the motion path, and the strength of activity suppression predicts the subsequent behavioral performance decrement in terms of detecting a stimulus along the AM path. Our findings provide empirical evidence for a suppressive, rather than faciliatory, mechanism underlying AM.

Can processing of face trustworthiness bypass early visual cortex? A transcranial magnetic stimulation masking study

As a highly social species, we constantly evaluate human faces to decide whether we can trust someone. Previous studies suggest that face trustworthiness can be processed unconsciously, but the underlying neural pathways remain unclear. Specifically, the question remains whether processing of face trustworthiness relies on early visual cortex (EVC), required for conscious perception. If processing of trustworthiness can bypass EVC, then disrupting EVC should impair subjective (conscious) trustworthiness perception while leaving objective (forced-choice) trustworthiness judgment intact. We applied double-pulse transcranial magnetic stimulation (TMS) to right EVC, at different stimulus onset asynchronies (SOAs) from presentation of a face in either the left or right hemifield. Faces were slightly rotated clockwise or counterclockwise, and were either trustworthy or untrustworthy. On each trial, participants discriminated 1) trustworthiness, 2) stimulus rotation, and 3) reported subjective visibility of trustworthiness. At early SOAs and specifically in the left hemifield, performance on the rotation task was impaired by TMS. Crucially, though TMS also impaired subjective visibility of trustworthiness, no effects on trustworthiness discrimination were obtained. Thus, conscious perception of face trustworthiness (captured by subjective visibility ratings) relies on intact EVC, while objective forced-choice trustworthiness judgments may not. These results are consistent with the hypothesis that objective trustworthiness processing can bypass EVC. For basic visual features, extrastriate pathways are well-established; but face trustworthiness depends on a complex configuration of features. Its potential processing without EVC is therefore of particular interest, further highlighting its ecological relevance.

Preparatory Activity in Posterior Temporal Cortex Causally Contributes to Object Detection in Scenes

Theories of visual selective attention propose that top-down preparatory attention signals mediate the selection of task-relevant information in cluttered scenes. Neuroimaging and electrophysiology studies have provided correlative evidence for this hypothesis, finding increased activity in target-selective neural populations in visual cortex in the period between a search cue and target onset. In this study, we used online TMS to test whether preparatory neural activity in visual cortex is causally involved in naturalistic object detection. In two experiments, participants detected the presence of object categories (cars, people) in a diverse set of photographs of real-world scenes. TMS was applied over a region in posterior temporal cortex identified by fMRI as carrying category-specific preparatory activity patterns. Results showed that TMS applied over posterior temporal cortex before scene onset (-200 and -100 msec) impaired the detection of object categories in subsequently presented scenes, relative to vertex and early visual cortex stimulation. This effect was specific to category level detection and was related to the type of attentional template participants adopted, with the strongest effects observed in participants adopting category level templates. These results provide evidence for a causal role of preparatory attention in mediating the detection of objects in cluttered daily-life environments.

Spatially specific vs. unspecific disruption of visual orientation perception using chronometric pre-stimulus TMS

Transcranial magnetic stimulation (TMS) over occipital cortex can impair visual processing. Such "TMS masking" has repeatedly been shown at several stimulus onset asynchronies (SOAs), with TMS pulses generally applied after the onset of a visual stimulus. Following increased interest in the neuronal state-dependency of visual processing, we recently explored the efficacy of TMS at "negative SOAs", when no visual processing can yet occur. We could reveal pre-stimulus TMS disruption, with results moreover hinting at two separate mechanisms in occipital cortex biasing subsequent orientation perception. Here we extended this work, including a chronometric design to map the temporal dynamics of spatially specific and unspecific mechanisms of state-dependent visual processing, while moreover controlling for TMS-induced pupil covering. TMS pulses applied 60-40 ms prior to a visual stimulus decreased orientation processing independent of stimulus location, while a local suppressive effect was found for TMS applied 30-10 ms pre-stimulus. These results contribute to our understanding of spatiotemporal mechanisms in occipital cortex underlying the state-dependency of visual processing, providing a basis for future work to link pre-stimulus TMS suppression effects to other known visual biasing mechanisms.

Probing feedforward and feedback contributions to awareness with visual masking and transcranial magnetic stimulation

A number of influential theories posit that visual awareness relies not only on the initial, stimulus-driven (i.e., feedforward) sweep of activation but also on recurrent feedback activity within and between brain regions. These theories of awareness draw heavily on data from masking paradigms in which visibility of one stimulus is reduced due to the presence of another stimulus. More recently transcranial magnetic stimulation (TMS) has been used to study the temporal dynamics of visual awareness. TMS over occipital cortex affects performance on visual tasks at distinct time points and in a manner that is comparable to visual masking. We draw parallels between these two methods and examine evidence for the neural mechanisms by which visual masking and TMS suppress stimulus visibility. Specifically, both methods have been proposed to affect feedforward as well as feedback signals when applied at distinct time windows relative to stimulus onset and as a result modify visual awareness. Most recent empirical evidence, moreover, suggests that while visual masking and TMS impact stimulus visibility comparably, the processes these methods affect may not be as similar as previously thought. In addition to reviewing both masking and TMS studies that examine feedforward and feedback processes in vision, we raise questions to guide future studies and further probe the necessary conditions for visual awareness.

Using brain stimulation to disentangle neural correlates of conscious vision

Research into the neural correlates of consciousness (NCCs) has blossomed, due to the advent of new and increasingly sophisticated brain research tools. Neuroimaging has uncovered a variety of brain processes that relate to conscious perception, obtained in a range of experimental paradigms. But methods such as functional magnetic resonance imaging or electroencephalography do not always afford inference on the functional role these brain processes play in conscious vision. Such empirical NCCs could reflect neural prerequisites, neural consequences, or neural substrates of a conscious experience. Here, we take a closer look at the use of non-invasive brain stimulation (NIBS) techniques in this context. We discuss and review how NIBS methodology can enlighten our understanding of brain mechanisms underlying conscious vision by disentangling the empirical NCCs.

The chronometry of visual perception: review of occipital TMS masking studies

Transcranial magnetic stimulation (TMS) continues to deliver on its promise as a research tool. In this review article we focus on the application of TMS to early visual cortex (V1, V2, V3) in studies of visual perception and visual awareness. Depending on the asynchrony between visual stimulus onset and TMS pulse (SOA), TMS can suppress visual perception, allowing one to track the time course of functional relevance (chronometry) of early visual cortex for vision. This procedure has revealed multiple masking effects ('dips'), some consistently (∼+100ms SOA) but others less so (∼-50ms, ∼-20ms, ∼+30ms, ∼+200ms SOA). We review the state of TMS masking research, focusing on the evidence for these multiple dips, the relevance of several experimental parameters to the obtained 'masking curve', and the use of multiple measures of visual processing (subjective measures of awareness, objective discrimination tasks, priming effects). Lastly, we consider possible future directions for this field. We conclude that while TMS masking has yielded many fundamental insights into the chronometry of visual perception already, much remains unknown. Not only are there several temporal windows when TMS pulses can induce visual suppression, even the well-established 'classical' masking effect (∼+100ms) may reflect more than one functional visual process.

Phosphene-guided transcranial magnetic stimulation of occipital but not parietal cortex suppresses stimulus visibility

Transcranial magnetic stimulation (TMS) applied over the occipital lobe approximately 100 ms after the onset of a stimulus decreases its visibility if it appears in the location of the phosphene. Because phosphenes can also be elicited by stimulation of the parietal regions, we asked if the same procedure that is used to reduce visibility of stimuli with occipital TMS will lead to decreased stimulus visibility when TMS is applied to parietal regions. TMS was randomly applied at 0-130 ms after the onset of the stimulus in steps of 10 ms in occipital and parietal regions. Participants responded to the orientation of the line stimulus and rated its visibility. We replicate previous reports of phosphenes from both occipital and parietal TMS. As previously reported, we also observed visual suppression around the classical 100 ms window both in the objective line orientation and subjective visibility responses with occipital TMS. Parietal stimulation, on the other hand, did not consistently reduce stimulus visibility in any time window.

Pre- and post-stimulus EEG patterns associated with the touch-induced illusory flash

Pairing two brief auditory beeps with a single flash can evoke the percept of a second, illusory, flash. Investigations of the underlying neural mechanisms are limited to post-stimulus effects of this sound-induced illusory flash. We investigated whether touch modulates the visual evoked potential in a similar vein, and also looked at pre-stimulus activity. Electroencephalogram (EEG) was recorded over occipital and parieto-occipital areas of 12 observers. We compared bimodal EEG to its unimodal constituents (i.e., the difference waves) and found significant positive deflections around 110 ms and 200 ms and negative deflections around 330 ms and 390 ms from stimulus onset. These results are similar to those reported for the sound-induced illusion, albeit somewhat later. Furthermore, comparison of the EEG activity between those trials in which the illusion was perceived and those in which it was absent revealed that the phase of pre-stimulus alpha was linked to perceiving the illusion or not. We conclude that touch can modulate activity in the visual cortex and that similar neural mechanisms underlie perception of the sound- and touch-induced illusory flash and that the phase of the alpha wave at the moment of presentation that affects perception.

Pre-stimulus sham TMS facilitates target detection

Transcranial magnetic stimulation (TMS) allows non-invasive manipulation of brain activity during active task performance. Because every TMS pulse is accompanied by non-neural effects such as a clicking sound and somato-sensation on the head, control conditions are required to ensure that changes in task behavior are indeed due to the induced neural effects. However, the non-neural effects of TMS in the context of a given task performance are largely unknown and, consequently, it is unclear what constitutes a valid control condition. We explored the non-neural effects of TMS on visual target detection. Participants received single pulse sham TMS to each hemisphere at different time points prior to target appearance during a visual target detection task. It was hypothesized that the clicking sound of a sham TMS pulse differentially affects performance depending on the location of the coil and the timing of the pulse.Our results show that, first, sham TMS caused a facilitation of reaction times when preceding the target stimulus by 150, 200, and 250 ms, whereas earlier and later time windows were not effective. Second, positioning the TMS coil ipsilateral instead of contralateral relative to the target stimulus improved reaction times. Third, infrequent noTMS trials that were interleaved with sham TMS trials had oddball-like properties resulting in increased reaction times during noTMS. The clicking sound produced by sham TMS influences task performance in multiple ways. These non-neural effects of TMS need to be controlled for in TMS research and the present findings provide an empirical basis for deciding what constitutes a valid control condition.

The temporal dynamics of early visual cortex involvement in behavioral priming

Transcranial magnetic stimulation (TMS) allows for non-invasive interference with ongoing neural processing. Applied in a chronometric design over early visual cortex (EVC), TMS has proved valuable in indicating at which particular time point EVC must remain unperturbed for (conscious) vision to be established. In the current study, we set out to examine the effect of EVC TMS across a broad range of time points, both before (pre-stimulus) and after (post-stimulus) the onset of symbolic visual stimuli. Behavioral priming studies have shown that the behavioral impact of a visual stimulus can be independent from its conscious perception, suggesting two independent neural signatures. To assess whether TMS-induced suppression of visual awareness can be dissociated from behavioral priming in the temporal domain, we thus implemented three different measures of visual processing, namely performance on a standard visual discrimination task, a subjective rating of stimulus visibility, and a visual priming task. To control for non-neural TMS effects, we performed electrooculographical recordings, placebo TMS (sham), and control site TMS (vertex). Our results suggest that, when considering the appropriate control data, the temporal pattern of EVC TMS disruption on visual discrimination, subjective awareness and behavioral priming are not dissociable. Instead, TMS to EVC disrupts visual perception holistically, both when applied before and after the onset of a visual stimulus. The current findings are discussed in light of their implications on models of visual awareness and (subliminal) priming.

Behavior in oblivion: the neurobiology of subliminal priming

Subliminal priming refers to behavioral modulation by an unconscious stimulus, and can thus be regarded as a form of unconscious visual processing. Theories on recurrent processing have suggested that the neural correlate of consciousness (NCC) comprises of the non-hierarchical transfer of stimulus-related information. According to these models, the neural correlate of subliminal priming (NCSP) corresponds to the visual processing within the feedforward sweep. Research from cognitive neuroscience on these two concepts and the relationship between them is discussed here. Evidence favoring the necessity of recurrent connectivity for visual awareness is accumulating, although some questions, such as the need for global versus local recurrent processing, are not clarified yet. However, this is not to say that recurrent processing is sufficient for consciousness, as a neural definition of consciousness in terms of recurrent connectivity would imply. We argue that the limited interest cognitive neuroscience currently has for the NCSP is undeserved, because the discovery of the NCSP can give insight into why people do (and do not) express certain behavior.

Feedforward and quick recurrent processes in early visual cortex revealed by TMS?

Transcranial magnetic stimulation (TMS) can be applied to occipital cortex to abolish (conscious) perception of visual stimuli. TMS research has revealed several time windows of masking relative to visual stimulus onset, most consistently a time window around 100ms post-stimulus. However, the exact nature of visual processing in this 'classical' time window, e.g. whether it represents the feedforward processing of the visual information, or rather a feedback projection from higher visual areas, remains unclear. Here, we used TMS to mask in the same participants two types of stimuli of different complexities (orientation Gratings and Faces) over different time windows. Interestingly, the masking functions were not the same for both stimulus types. We found an earlier peak masking latency for orientation stimuli, and a slower recovery for Faces. In a second, follow-up experiment, we superimposed both types of stimuli to create one composite stimulus set. Depending on the instruction, participants could then perform orientation or face discrimination tasks on the exact same stimuli. In addition, for each participant, stimuli were calibrated to equate task difficulties. The peak masking latency was now identical for both tasks, but the masking function revealed again a slower recovery during the face discrimination task, suggesting top-down (recurrent) effects in the second half of the masking function. Hence, rather than this masking window reflecting either feedforward or feedback processing, the early part of what is traditionally considered one masking window may reflect feedforward processing, while the latter part may already reflect recurrent processing. These findings shed new light on recurrent models of vision and related theoretical accounts of visual awareness.