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Sack AT, Paneva J, Küthe T, Dijkstra E, Zwienenberg L, Arns M, Schuhmann T. Target Engagement and Brain State Dependence of Transcranial Magnetic Stimulation: Implications for Clinical Practice. Biol Psychiatry 2024; 95:536-544. [PMID: 37739330 DOI: 10.1016/j.biopsych.2023.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/31/2023] [Accepted: 09/12/2023] [Indexed: 09/24/2023]
Abstract
Transcranial magnetic stimulation (TMS) is capable of noninvasively inducing lasting neuroplastic changes when applied repetitively across multiple treatment sessions. In recent years, repetitive TMS has developed into an established evidence-based treatment for various neuropsychiatric disorders such as depression. Despite significant advancements in our understanding of the mechanisms of action of TMS, there is still much to learn about how these mechanisms relate to the clinical effects observed in patients. If there is one thing about TMS that we know for sure, it is that TMS effects are state dependent. In this review, we describe how the effects of TMS on brain networks depend on various factors, including cognitive brain state, oscillatory brain state, and recent brain state history. These states play a crucial role in determining the effects of TMS at the moment of stimulation and are therefore directly linked to what is referred to as target engagement in TMS therapy. There is no control over target engagement without considering the different brain state dependencies of our TMS intervention. Clinical TMS protocols are largely ignoring this fundamental principle, which may explain the large variability and often still limited efficacy of TMS treatments. We propose that after almost 30 years of research on state dependency of TMS, it is time to change standard clinical practice by taking advantage of this fundamental principle. Rather than ignoring TMS state dependency, we can use it to our clinical advantage to improve the effectiveness of TMS treatments.
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Affiliation(s)
- Alexander T Sack
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands; Brain + Nerve Center, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Jasmina Paneva
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Tara Küthe
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Eva Dijkstra
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands; Heart and Brain Group, Brainclinics Foundation, Nijmegen, the Netherlands; Neurowave, Amsterdam, the Netherlands
| | - Lauren Zwienenberg
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands; Heart and Brain Group, Brainclinics Foundation, Nijmegen, the Netherlands; Synaeda Psycho Medisch Centrum, Leeuwarden, the Netherlands
| | - Martijn Arns
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands; Brain + Nerve Center, Maastricht University Medical Center, Maastricht, the Netherlands; Heart and Brain Group, Brainclinics Foundation, Nijmegen, the Netherlands
| | - Teresa Schuhmann
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
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Huang F, Fu X, Song J, Ren J, Li F, Zhao Q. Divergent thinking benefits from functional antagonism of the left IFG and right TPJ: a transcranial direct current stimulation study. Cereb Cortex 2024; 34:bhad531. [PMID: 38204300 DOI: 10.1093/cercor/bhad531] [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: 10/17/2023] [Revised: 12/17/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
Divergent thinking is assumed to benefit from releasing the constraint of existing knowledge (i.e. top-down control) and enriching free association (i.e. bottom-up processing). However, whether functional antagonism between top-down control-related and bottom-up processing-related brain structures is conducive to generating original ideas is largely unknown. This study was designed to investigate the effect of functional antagonism between the left inferior frontal gyrus and the right temporoparietal junction on divergent thinking performance. A within-subjects design was adopted for three experiments. A total of 114 participants performed divergent thinking tasks after receiving transcranial direct current stimulation over target regions. In particular, cathodal stimulation over the left inferior frontal gyrus and anodal stimulation over the right inferior frontal gyrus (Experiment 1), anodal stimulation over the right temporoparietal junction (Experiment 2), and both cathodal stimulation over the left inferior frontal gyrus and anodal stimulation over the right temporoparietal junction (Experiment 3) were manipulated. Compared with sham stimulation, the combination of hyperpolarization of the left inferior frontal gyrus and depolarization of the right temporoparietal junction comprehensively promoted the fluency, flexibility, and originality of divergent thinking without decreasing the rationality of generated ideas. Functional antagonism between the left inferior frontal gyrus (hyperpolarization) and right temporoparietal junction (depolarization) has a "1 + 1 > 2" superposition effect on divergent thinking.
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Affiliation(s)
- Furong Huang
- School of Psychology, Jiangxi Normal University, Nanchang 330022, China
| | - Xiaqing Fu
- School of Psychology, Jiangxi Normal University, Nanchang 330022, China
| | - Jiajun Song
- School of Psychology, Jiangxi Normal University, Nanchang 330022, China
| | - Jingyuan Ren
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen 6525EN, The Netherlands
| | - Fuhong Li
- School of Psychology, Jiangxi Normal University, Nanchang 330022, China
| | - Qingbai Zhao
- School of Psychology, Central China Normal University, Wuhan 430079, China
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Guidali G, Bagattini C, De Matola M, Brignani D. Influence of frontal-to-parietal connectivity in pseudoneglect: A cortico-cortical paired associative stimulation study. Cortex 2023; 169:50-64. [PMID: 37862830 DOI: 10.1016/j.cortex.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/27/2023] [Accepted: 08/23/2023] [Indexed: 10/22/2023]
Abstract
Pseudoneglect is a set of visuospatial biases that entails a behavioral advantage for stimuli appearing in the left hemifield compared to the right one. Although right hemisphere dominance for visuospatial processing has been invoked to explain this phenomenon, its neurophysiological mechanisms are still debated, and the role of intra- and inter-hemispheric connectivity is yet to be defined. The present study explored the possibility of modulating pseudoneglect in healthy participants through a cortico-cortical paired associative stimulation protocol (ccPAS): a non-invasive brain stimulation protocol that manipulates the interplay between brain regions through the repeated, time-locked coupling of two transcranial magnetic stimulation (TMS) pulses. In the first experiment, healthy participants underwent a frontal-to-parietal (FP) and a parietal-to-frontal (PF) ccPAS. In the FP protocol, the first TMS pulse targeted the right frontal eye field (FEF), and the second pulse the right inferior parietal lobule (IPL), two critical areas for visuospatial and attentional processing. In the PF condition, the order of the pulses was reversed. In both protocols, the inter-stimulus interval (ISI) was 10 ms. Before and after stimulation, pseudoneglect was assessed with a landmark task and a manual line bisection task. A second experiment controlled for ccPAS timing dependency by testing FP-ccPAS with a longer ISI of 100 ms. Results showed that after administering the FP-ccPAS with the ISI of 10 ms, participants' leftward bias in the landmark task increased significantly, with no effects in the manual line bisection task. The other two protocols tested were ineffective. Our findings showed that ccPAS could be used to modulate pseudoneglect by exploiting frontal-to-parietal connectivity, possibly through increased top-down attentional control. FP-ccPAS could represent a promising tool to investigate connectivity properties within visuospatial and attentional networks in the healthy and as a potential rehabilitation protocol in patients suffering from severe visuospatial pathologies.
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Affiliation(s)
- Giacomo Guidali
- Neurophysiology Lab, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
| | - Chiara Bagattini
- Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Matteo De Matola
- Neurophysiology Lab, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Debora Brignani
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
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Vossel S, Mengotti P, Fink GR. From local match/mismatch signals to updating of task-relevant beliefs: The temporo-parietal junction and its embedment in cortical networks: Comment on "Left and right temporal-parietal junctions (TPJs) as "match/mismatch" hedonic machines: A unifying account of TPJ function" by Doricchi et al. Phys Life Rev 2023; 44:184-186. [PMID: 36773389 DOI: 10.1016/j.plrev.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 01/29/2023] [Indexed: 02/04/2023]
Affiliation(s)
- Simone Vossel
- Cognitive Neuroscience, Institute of Neuroscience & Medicine (INM-3), Forschungszentrum Jülich, 52425 Jülich, Germany; Department of Psychology, Faculty of Human Sciences, University of Cologne, 50923 Cologne, Germany.
| | - Paola Mengotti
- Cognitive Neuroscience, Institute of Neuroscience & Medicine (INM-3), Forschungszentrum Jülich, 52425 Jülich, Germany
| | - Gereon R Fink
- Cognitive Neuroscience, Institute of Neuroscience & Medicine (INM-3), Forschungszentrum Jülich, 52425 Jülich, Germany; Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
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Cember ATJ, Deck BL, Kelkar A, Faseyitan O, Zimmerman JP, Erickson B, Elliott MA, Coslett HB, Hamilton RH, Reddy R, Medaglia JD. Glutamate-Weighted Magnetic Resonance Imaging (GluCEST) Detects Effects of Transcranial Magnetic Stimulation to the Motor Cortex. Neuroimage 2022; 256:119191. [PMID: 35413447 DOI: 10.1016/j.neuroimage.2022.119191] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 03/18/2022] [Accepted: 04/05/2022] [Indexed: 11/18/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) is used in several FDA-approved treatments and, increasingly, to treat neurological disorders in off-label uses. However, the mechanism by which TMS causes physiological change is unclear, as are the origins of response variability in the general population. Ideally, objective in vivo biomarkers could shed light on these unknowns and eventually inform personalized interventions. Continuous theta-burst stimulation (cTBS) is a form of TMS observed to reduce motor evoked potentials (MEPs) for 60 min or longer post-stimulation, although the consistency of this effect and its mechanism continue to be under debate. Here, we use glutamate-weighted chemical exchange saturation transfer (gluCEST) magnetic resonance imaging (MRI) at ultra-high magnetic field (7T) to measure changes in glutamate concentration at the site of cTBS. We find that the gluCEST signal in the ipsilateral hemisphere of the brain generally decreases in response to cTBS, whereas consistent changes were not detected in the contralateral region of interest (ROI) or in subjects receiving sham stimulation.
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Affiliation(s)
- Abigail T J Cember
- Center for Advanced Metabolic Imaging in Precision Medicine, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Benjamin L Deck
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, USA
| | - Apoorva Kelkar
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, USA
| | - Olu Faseyitan
- Department of Neurology, Laboratory for Cognition and Neural Stimulation, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jared P Zimmerman
- Department of Neurology, Laboratory for Cognition and Neural Stimulation, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Brian Erickson
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, USA
| | - Mark A Elliott
- Center for Advanced Metabolic Imaging in Precision Medicine, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - H Branch Coslett
- Department of Neurology, Laboratory for Cognition and Neural Stimulation, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Roy H Hamilton
- Department of Neurology, Laboratory for Cognition and Neural Stimulation, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ravinder Reddy
- Center for Advanced Metabolic Imaging in Precision Medicine, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - John D Medaglia
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, USA; Department of Neurology, Laboratory for Cognition and Neural Stimulation, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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