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Dannhauer M, Gomez LJ, Robins PL, Wang D, Hasan NI, Thielscher A, Siebner HR, Fan Y, Deng ZD. Electric Field Modeling in Personalizing Transcranial Magnetic Stimulation Interventions. Biol Psychiatry 2024; 95:494-501. [PMID: 38061463 PMCID: PMC10922371 DOI: 10.1016/j.biopsych.2023.11.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/21/2023] [Accepted: 11/25/2023] [Indexed: 01/21/2024]
Abstract
The modeling of transcranial magnetic stimulation (TMS)-induced electric fields (E-fields) is a versatile technique for evaluating and refining brain targeting and dosing strategies, while also providing insights into dose-response relationships in the brain. This review outlines the methodologies employed to derive E-field estimations, covering TMS physics, modeling assumptions, and aspects of subject-specific head tissue and coil modeling. We also summarize various numerical methods for solving the E-field and their suitability for various applications. Modeling methodologies have been optimized to efficiently execute numerous TMS simulations across diverse scalp coil configurations, facilitating the identification of optimal setups or rapid cortical E-field visualization for specific brain targets. These brain targets are extrapolated from neurophysiological measurements and neuroimaging, enabling precise and individualized E-field dosing in experimental and clinical applications. This necessitates the quantification of E-field estimates using metrics that enable the comparison of brain target engagement, functional localization, and TMS intensity adjustments across subjects. The integration of E-field modeling with empirical data has the potential to uncover pivotal insights into the aspects of E-fields responsible for stimulating and modulating brain function and states, enhancing behavioral task performance, and impacting the clinical outcomes of personalized TMS interventions.
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Affiliation(s)
- Moritz Dannhauer
- Computational Neurostimulation Research Program, Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, Maryland
| | - Luis J Gomez
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, Indiana
| | - Pei L Robins
- Computational Neurostimulation Research Program, Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, Maryland
| | - Dezhi Wang
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, Indiana
| | - Nahian I Hasan
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, Indiana
| | - Axel Thielscher
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Hartwig R Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark; Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Yong Fan
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Zhi-De Deng
- Computational Neurostimulation Research Program, Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, Maryland.
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Natalizi F, Piras F, Vecchio D, Spalletta G, Piras F. Preoperative Navigated Transcranial Magnetic Stimulation: New Insight for Brain Tumor-Related Language Mapping. J Pers Med 2022; 12:1589. [PMID: 36294728 PMCID: PMC9604795 DOI: 10.3390/jpm12101589] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 08/30/2023] Open
Abstract
Preoperative brain mapping methods are particularly important in modern neuro-oncology when a tumor affects eloquent language areas since damage to parts of the language circuits can cause significant impairments in daily life. This narrative review examines the literature regarding preoperative and intraoperative language mapping using repetitive navigated transcranial magnetic stimulation (rnTMS) with or without direct electrical stimulation (DES) in adult patients with tumors in eloquent language areas. The literature shows that rnTMS is accurate in detecting preexisting language disorders and positive intraoperative mapping regions. In terms of the region extent and clinical outcomes, rnTMS has been shown to be accurate in identifying positive sites to guide resection, reducing surgery duration and craniotomy size and thus improving clinical outcomes. Before incorporating rnTMS into the neurosurgical workflow, the refinement of protocols and a consensus within the neuro-oncology community are required.
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Affiliation(s)
- Federica Natalizi
- Laboratory of Neurophychiatry, IRCSS Santa Lucia Fundation, Via Ardeatina 306, 00134 Rome, Italy
- Department of Psychology, “Sapienza” University of Rome, Via dei Marsi 78, 00185 Rome, Italy
- PhD Program in Behavioral Neuroscience, Sapienza University of Rome, 00161 Rome, Italy
| | - Federica Piras
- Laboratory of Neurophychiatry, IRCSS Santa Lucia Fundation, Via Ardeatina 306, 00134 Rome, Italy
| | - Daniela Vecchio
- Laboratory of Neurophychiatry, IRCSS Santa Lucia Fundation, Via Ardeatina 306, 00134 Rome, Italy
| | - Gianfranco Spalletta
- Laboratory of Neurophychiatry, IRCSS Santa Lucia Fundation, Via Ardeatina 306, 00134 Rome, Italy
| | - Fabrizio Piras
- Laboratory of Neurophychiatry, IRCSS Santa Lucia Fundation, Via Ardeatina 306, 00134 Rome, Italy
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Wende T, Wilhelmy F, Kasper J, Prasse G, Franke C, Arlt F, Frydrychowicz C, Meixensberger J, Nestler U. Usefulness and Limits of Tractography for Surgery in the Precentral Gyrus—A Case Report. Clin Pract 2022; 12:231-236. [PMID: 35447855 PMCID: PMC9025938 DOI: 10.3390/clinpract12020027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/02/2022] [Accepted: 04/05/2022] [Indexed: 11/16/2022] Open
Abstract
The resection of tumors within the primary motor cortex is a constant challenge. Although tractography may help in preoperative planning, it has limited application. While it can give valuable information on subcortical fibers, it is less accurate in the cortical layer of the brain. A 38-year-old patient presented with paresis of the right hand and focal epileptic seizures due to a tumor in the left precentral gyrus. Transcranial magnetic stimulation was not applicable due to seizures, so microsurgical resection was performed with preoperative tractography and intraoperative direct electrical stimulation. A histopathological assessment revealed a diagnosis of glioblastoma. Postoperative magnetic resonance imaging (MRI) showed complete resection. The paresis dissolved completely during follow-up. Surgery within the precentral gyrus is of high risk and requires multimodal functional planning. If interpreted with vigilance and consciousness of the underlying physical premises, tractography can provide helpful information within its limitations, which is especially subcortically. However, it may also help in the identification of functional cortex columns of the brain in the presence of a tumor.
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Affiliation(s)
- Tim Wende
- Department of Neurosurgery, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany; (F.W.); (J.K.); (C.F.); (F.A.); (J.M.); (U.N.)
- Correspondence:
| | - Florian Wilhelmy
- Department of Neurosurgery, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany; (F.W.); (J.K.); (C.F.); (F.A.); (J.M.); (U.N.)
| | - Johannes Kasper
- Department of Neurosurgery, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany; (F.W.); (J.K.); (C.F.); (F.A.); (J.M.); (U.N.)
| | - Gordian Prasse
- Institute of Neuroradiology, University Hospital Leipzig, 04103 Leipzig, Germany;
| | - Christian Franke
- Department of Neurosurgery, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany; (F.W.); (J.K.); (C.F.); (F.A.); (J.M.); (U.N.)
| | - Felix Arlt
- Department of Neurosurgery, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany; (F.W.); (J.K.); (C.F.); (F.A.); (J.M.); (U.N.)
| | - Clara Frydrychowicz
- Institute of Neuropathology, University Hospital Leipzig, 04103 Leipzig, Germany;
| | - Jürgen Meixensberger
- Department of Neurosurgery, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany; (F.W.); (J.K.); (C.F.); (F.A.); (J.M.); (U.N.)
| | - Ulf Nestler
- Department of Neurosurgery, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany; (F.W.); (J.K.); (C.F.); (F.A.); (J.M.); (U.N.)
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