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Velickovic Z, Radunovic G. Repetitive Transcranial Magnetic Stimulation in Fibromyalgia: Exploring the Necessity of Neuronavigation for Targeting New Brain Regions. J Pers Med 2024; 14:662. [PMID: 38929883 PMCID: PMC11204413 DOI: 10.3390/jpm14060662] [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: 05/16/2024] [Revised: 06/15/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024] Open
Abstract
Fibromyalgia and osteoarthritis are among the most prevalent rheumatic conditions worldwide. Nonpharmacological interventions have gained scientific endorsements as the preferred initial treatments before resorting to pharmacological modalities. Repetitive transcranial magnetic stimulation (rTMS) is among the most widely researched neuromodulation techniques, though it has not yet been officially recommended for fibromyalgia. This review aims to summarize the current evidence supporting rTMS for treating various fibromyalgia symptoms. Recent findings: High-frequency rTMS directed at the primary motor cortex (M1) has the strongest support in the literature for reducing pain intensity, with new research examining its long-term effectiveness. Nonetheless, some individuals may not respond to M1-targeted rTMS, and symptoms beyond pain can be prominent. Ongoing research aims to improve the efficacy of rTMS by exploring new brain targets, using innovative stimulation parameters, incorporating neuronavigation, and better identifying patients likely to benefit from this treatment. Summary: Noninvasive brain stimulation with rTMS over M1 is a well-tolerated treatment that can improve chronic pain and overall quality of life in fibromyalgia patients. However, the data are highly heterogeneous, with a limited level of evidence, posing a significant challenge to the inclusion of rTMS in official treatment guidelines. Research is ongoing to enhance its effectiveness, with future perspectives exploring its impact by targeting additional areas of the brain such as the medial prefrontal cortex, anterior cingulate cortex, and inferior parietal lobe, as well as selecting the right patients who could benefit from this treatment.
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Affiliation(s)
| | - Goran Radunovic
- Institute of Rheumatology, Resavska 69, 11000 Belgrade, Serbia;
- School of Medicine, University of Belgrade, Dr Subotića 1, 11000 Belgrade, Serbia
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Herrero Babiloni A, Provost C, Charlebois-Plante C, De Koninck BP, Apinis-Deshaies A, Lavigne GJ, Martel MO, De Beaumont L. One session of repetitive transcranial magnetic stimulation induces mild and transient analgesic effects among female individuals with painful temporomandibular disorders. J Oral Rehabil 2024; 51:827-839. [PMID: 38225806 DOI: 10.1111/joor.13655] [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: 06/29/2023] [Revised: 11/11/2023] [Accepted: 01/05/2024] [Indexed: 01/17/2024]
Abstract
OBJECTIVE Temporomandibular disorders (TMD) are characterised by chronic pain and dysfunction in the jaw joint and masticatory muscles. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a potential non-invasive treatment for chronic pain; however, its effectiveness in individuals with TMD has not been thoroughly investigated. This study aimed to evaluate the immediate and sustained (over seven consecutive days) effects of a single session of active rTMS compared to sham stimulation on pain intensity and pain unpleasantness in individuals with TMD. METHODS A randomised, double-blind, sham-controlled trial enrolled 41 female participants with chronic TMD. Pain intensity and pain unpleasantness were assessed immediately pre- and post-intervention, as well as twice daily for 21 days using electronic diaries. Secondary outcomes included pain interference, sleep quality, positive and negative affect and pain catastrophizing. Adverse effects were monitored. Repeated measures ANOVA and multilevel modelling regression analyses were employed for data analysis. RESULT Active rTMS demonstrated a significant immediate mild reduction in pain intensity and pain unpleasantness compared to sham stimulation. However, these effects were not sustained over the 7-day post-intervention period. No significant differences were observed between interventions for pain interference, sleep quality and negative affect. A minority of participants reported minor and transient side effects, including headaches and fatigue. CONCLUSION A single session of active rTMS was safe and led to immediate mild analgesic effects in individuals with TMD compared to sham stimulation. However, no significant differences were observed between interventions over the 7-day post-intervention period. Based on this study, rTMS stimulation appears to be a promising safe approach to be tested in TMD patients with longer stimulation protocols.
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Affiliation(s)
- Alberto Herrero Babiloni
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
- Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Catherine Provost
- Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Camille Charlebois-Plante
- Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Beatrice P De Koninck
- Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Amelie Apinis-Deshaies
- Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Gilles J Lavigne
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
- Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada
- Faculty of Dental Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Marc O Martel
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
- Department of Anesthesia, McGill University, Montreal, Quebec, Canada
| | - Louis De Beaumont
- Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
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Frank C, Albertazzi A, Murphy C. The effect of the apolipoprotein E ε4 allele and olfactory function on odor identification networks. Brain Behav 2024; 14:e3524. [PMID: 38702902 PMCID: PMC11069025 DOI: 10.1002/brb3.3524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 04/11/2024] [Accepted: 04/17/2024] [Indexed: 05/06/2024] Open
Abstract
INTRODUCTION The combination of apolipoprotein E ε4 (ApoE ε4) status, odor identification, and odor familiarity predicts conversion to mild cognitive impairment (MCI) and Alzheimer's disease (AD). METHODS To further understand olfactory disturbances and AD risk, ApoE ε4 carrier (mean age 76.38 ± 5.21) and ε4 non-carrier (mean age 76.8 ± 3.35) adults were given odor familiarity and identification tests and performed an odor identification task during fMRI scanning. Five task-related functional networks were detected using independent components analysis. Main and interaction effects of mean odor familiarity ratings, odor identification scores, and ε4 status on network activation and task-modulation of network functional connectivity (FC) during correct and incorrect odor identification (hits and misses), controlling for age and sex, were explored using multiple linear regression. RESULTS Findings suggested that sensory-olfactory network activation was positively associated with odor identification scores in ε4 carriers with intact odor familiarity. The FC of sensory-olfactory, multisensory-semantic integration, and occipitoparietal networks was altered in ε4 carriers with poorer odor familiarity and identification. In ε4 carriers with poorer familiarity, connectivity between superior frontal areas and the sensory-olfactory network was negatively associated with odor identification scores. CONCLUSIONS The results contribute to the clarification of the neurocognitive structure of odor identification processing and suggest that poorer odor familiarity and identification in ε4 carriers may signal multi-network dysfunction. Odor familiarity and identification assessment in ε4 carriers may contribute to the predictive value of risk for MCI and AD due to the breakdown of sensory-cognitive network integration. Additional research on olfactory processing in those at risk for AD is warranted.
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Affiliation(s)
- Conner Frank
- SDSU/UC San Diego Joint Doctoral Program in Clinical PsychologySan DiegoCaliforniaUSA
| | - Abigail Albertazzi
- Department of PsychologySan Diego State UniversitySan DiegoCaliforniaUSA
| | - Claire Murphy
- Department of PsychologySan Diego State UniversitySan DiegoCaliforniaUSA
- Department of PsychiatryUniversity of California San DiegoLa JollaCaliforniaUSA
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Neri F, Cappello C, Viberti F, Donniacuo A, Burzi L, Cinti A, Benelli A, Luca Smeralda C, Romanella S, Santarnecchi E, Mandalà M, Rossi S. rTMS of the auditory association cortex improves speech intelligibility in patients with sensorineural hearing loss. Clin Neurophysiol 2024; 160:38-46. [PMID: 38395005 DOI: 10.1016/j.clinph.2024.02.007] [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: 11/17/2022] [Revised: 12/30/2023] [Accepted: 02/03/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVE Sensorineural hearing-loss (SHL) is accompanied by changes in the entire ear-brain pathway and its connected regions. While hearing-aid (HA) partially compensates for SHL, speech perception abilities often continue to remain poor, resulting in consequences in everyday activities. Repetitive transcranial magnetic stimulation (rTMS) promotes cortical network plasticity and may enhance language comprehension in SHL patients. METHODS 27 patients using HA and with SHL were randomly assigned to a treatment protocol consisting of five consecutive days of either real (Active group: 13 patients) or placebo rTMS (Sham group: 14 patients). The stimulation parameters were as follows: 2-second trains at 10 Hz, 4-second inter-train-interval, and 1800 pulses. Neuronavigated rTMS was applied over the left superior temporal sulcus. Audiological tests were administered before (T0), immediately after (T1), and one week following treatment completion (T2) to evaluate the speech reception threshold (SRT) and the Pure Tone Average (PTA). RESULTS In the context of a general improvement likely due to learning, the treatment with real rTMS induced significant reduction of the SRT and PTA at T1 and T2 versus placebo. CONCLUSIONS The long-lasting effects on SRT and PTA observed in the Active group indicates that rTMS administered over the auditory cortex could promote sustained neuromodulatory-induced changes in the brain, improving the perception of complex sentences and pure tones reception skills. SIGNIFICANCE Five days of rTMS treatment enhances overall speech intelligibility and PTA in SHL patients.
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Affiliation(s)
- Francesco Neri
- Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, University of Siena, Italy; Oto-Neuro-Tech Conjoined Lab, Policlinico Le Scotte, University of Siena, Italy.
| | | | | | | | - Lucia Burzi
- Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, University of Siena, Italy
| | - Alessandra Cinti
- Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, University of Siena, Italy
| | - Alberto Benelli
- Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, University of Siena, Italy
| | - Carmelo Luca Smeralda
- Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, University of Siena, Italy
| | - Sara Romanella
- Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, University of Siena, Italy
| | - Emiliano Santarnecchi
- Precision Neuroscience & Neuromodulation Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Marco Mandalà
- Oto-Neuro-Tech Conjoined Lab, Policlinico Le Scotte, University of Siena, Italy; Otolaryngology Department, University of Siena, Italy
| | - Simone Rossi
- Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, University of Siena, Italy; Oto-Neuro-Tech Conjoined Lab, Policlinico Le Scotte, University of Siena, Italy
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Hamzei F, Ritter A, Pohl K, Stäps P, Wieduwild E. Different Effect Sizes of Motor Skill Training Combined with Repetitive Transcranial versus Trans-Spinal Magnetic Stimulation in Healthy Subjects. Brain Sci 2024; 14:165. [PMID: 38391739 PMCID: PMC10887384 DOI: 10.3390/brainsci14020165] [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: 12/19/2023] [Revised: 01/14/2024] [Accepted: 01/31/2024] [Indexed: 02/24/2024] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is used to enhance motor training (MT) performance. The use of rTMS is limited under certain conditions, such as after a stroke with severe damage to the corticospinal tract. This raises the question as to whether repetitive trans-spinal magnetic stimulation (rSMS) can also be used to improve MT. A direct comparison of the effect size between rTMS and rSMS on the same MT is still lacking. Before conducting the study in patients, we determined the effect sizes of different stimulation approaches combined with the same motor training in healthy subjects. Two experiments (E1 and E2) with 96 subjects investigated the effect size of combining magnetic stimulation with the same MT. In E1, high-frequency rTMS, rSMS, and spinal sham stimulation (sham-spinal) were applied once in combination with MT, while one group only received the same MT (without stimulation). In E2, rTMS, rSMS, and sham-spinal were applied in combination with MT over several days. In all subjects, motor tests and motor-evoked potentials were evaluated before and after the intervention period. rTMS had the greatest effect on MT, followed by rSMS and then sham-spinal. Daily stimulation resulted in additional training gains. This study suggests that rSMS increases excitability and also enhances MT performance. This current study provides a basis for further research to discover whether patients who cannot be treated effectively with rTMS would benefit from rSMS.
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Affiliation(s)
- Farsin Hamzei
- Section of Neurological Rehabilitation, Hans-Berger-Hospital of Neurology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
- Department of Neurology, Moritz Klinik, Hermann-Sachse-Straße 46, 07639 Bad Klosterlausnitz, Germany
| | - Alexander Ritter
- Section of Neurological Rehabilitation, Hans-Berger-Hospital of Neurology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Kristin Pohl
- Section of Neurological Rehabilitation, Hans-Berger-Hospital of Neurology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
- Department of Neurology, Moritz Klinik, Hermann-Sachse-Straße 46, 07639 Bad Klosterlausnitz, Germany
| | - Peggy Stäps
- Department of Neurology, Moritz Klinik, Hermann-Sachse-Straße 46, 07639 Bad Klosterlausnitz, Germany
| | - Eric Wieduwild
- Section of Neurological Rehabilitation, Hans-Berger-Hospital of Neurology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
- Department of Neurology, Moritz Klinik, Hermann-Sachse-Straße 46, 07639 Bad Klosterlausnitz, Germany
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Hormovas J, Dadario NB, Tang SJ, Nicholas P, Dhanaraj V, Young I, Doyen S, Sughrue ME. Parcellation-Based Connectivity Model of the Judgement Core. J Pers Med 2023; 13:1384. [PMID: 37763153 PMCID: PMC10532823 DOI: 10.3390/jpm13091384] [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: 08/14/2023] [Revised: 09/12/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Judgement is a higher-order brain function utilized in the evaluation process of problem solving. However, heterogeneity in the task methodology based on the many definitions of judgement and its expansive and nuanced applications have prevented the identification of a unified cortical model at a level of granularity necessary for clinical translation. Forty-six task-based fMRI studies were used to generate activation-likelihood estimations (ALE) across moral, social, risky, and interpersonal judgement paradigms. Cortical parcellations overlapping these ALEs were used to delineate patterns in neurocognitive network engagement for the four judgement tasks. Moral judgement involved the bilateral superior frontal gyri, right temporal gyri, and left parietal lobe. Social judgement demonstrated a left-dominant frontoparietal network with engagement of right-sided temporal limbic regions. Moral and social judgement tasks evoked mutual engagement of the bilateral DMN. Both interpersonal and risk judgement were shown to involve a right-sided frontoparietal network with accompanying engagement of the left insular cortex, converging at the right-sided CEN. Cortical activation in normophysiological judgement function followed two separable patterns involving the large-scale neurocognitive networks. Specifically, the DMN was found to subserve judgement centered around social inferences and moral cognition, while the CEN subserved tasks involving probabilistic reasoning, risk estimation, and strategic contemplation.
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Affiliation(s)
- Jorge Hormovas
- Centre for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Level 7 Prince of Wales Private Hospital, Randwick, NSW 2031, Australia; (J.H.); (V.D.)
| | - Nicholas B. Dadario
- Robert Wood Johnson Medical School, Rutgers University, 125 Paterson St., New Brunswick, NJ 08901, USA;
| | - Si Jie Tang
- School of Medicine, 21772 University of California Davis Medical Center, 2315 Stockton Blvd., Sacramento, CA 95817, USA
| | - Peter Nicholas
- Omniscient Neurotechnology, Level 10/580 George Street, Haymarket, NSW 2000, Australia; (P.N.); (I.Y.); (S.D.)
| | - Vukshitha Dhanaraj
- Centre for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Level 7 Prince of Wales Private Hospital, Randwick, NSW 2031, Australia; (J.H.); (V.D.)
| | - Isabella Young
- Omniscient Neurotechnology, Level 10/580 George Street, Haymarket, NSW 2000, Australia; (P.N.); (I.Y.); (S.D.)
| | - Stephane Doyen
- Omniscient Neurotechnology, Level 10/580 George Street, Haymarket, NSW 2000, Australia; (P.N.); (I.Y.); (S.D.)
| | - Michael E. Sughrue
- Centre for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Level 7 Prince of Wales Private Hospital, Randwick, NSW 2031, Australia; (J.H.); (V.D.)
- Omniscient Neurotechnology, Level 10/580 George Street, Haymarket, NSW 2000, Australia; (P.N.); (I.Y.); (S.D.)
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Evancho A, Tyler WJ, McGregor K. A review of combined neuromodulation and physical therapy interventions for enhanced neurorehabilitation. Front Hum Neurosci 2023; 17:1151218. [PMID: 37545593 PMCID: PMC10400781 DOI: 10.3389/fnhum.2023.1151218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 06/30/2023] [Indexed: 08/08/2023] Open
Abstract
Rehabilitation approaches for individuals with neurologic conditions have increasingly shifted toward promoting neuroplasticity for enhanced recovery and restoration of function. This review focuses on exercise strategies and non-invasive neuromodulation techniques that target neuroplasticity, including transcranial magnetic stimulation (TMS), vagus nerve stimulation (VNS), and peripheral nerve stimulation (PNS). We have chosen to focus on non-invasive neuromodulation techniques due to their greater potential for integration into routine clinical practice. We explore and discuss the application of these interventional strategies in four neurological conditions that are frequently encountered in rehabilitation settings: Parkinson's Disease (PD), Traumatic Brain Injury (TBI), stroke, and Spinal Cord Injury (SCI). Additionally, we discuss the potential benefits of combining non-invasive neuromodulation with rehabilitation, which has shown promise in accelerating recovery. Our review identifies studies that demonstrate enhanced recovery through combined exercise and non-invasive neuromodulation in the selected patient populations. We primarily focus on the motor aspects of rehabilitation, but also briefly address non-motor impacts of these conditions. Additionally, we identify the gaps in current literature and barriers to implementation of combined approaches into clinical practice. We highlight areas needing further research and suggest avenues for future investigation, aiming to enhance the personalization of the unique neuroplastic responses associated with each condition. This review serves as a resource for rehabilitation professionals and researchers seeking a comprehensive understanding of neuroplastic exercise interventions and non-invasive neuromodulation techniques tailored for specific diseases and diagnoses.
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Affiliation(s)
- Alexandra Evancho
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - William J. Tyler
- Department of Biomedical Engineering, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
- Department of Physical Medicine and Rehabilitation, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Keith McGregor
- Department of Clinical and Diagnostic Studies, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
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Han X, Zhu Z, Luan J, Lv P, Xin X, Zhang X, Shmuel A, Yao Z, Ma G, Zhang B. Effects of repetitive transcranial magnetic stimulation and their underlying neural mechanisms evaluated with magnetic resonance imaging-based brain connectivity network analyses. Eur J Radiol Open 2023; 10:100495. [PMID: 37396489 PMCID: PMC10311181 DOI: 10.1016/j.ejro.2023.100495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/03/2023] [Indexed: 07/04/2023] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive brain modulation and rehabilitation technique used in patients with neuropsychiatric diseases. rTMS can structurally remodel or functionally induce activities of specific cortical regions and has developed to an important therapeutic method in such patients. Magnetic resonance imaging (MRI) provides brain data that can be used as an explanation tool for the neural mechanisms underlying rTMS effects; brain alterations related to different functions or structures may be reflected in changes in the interaction and influence of brain connections within intrinsic specific networks. In this review, we discuss the technical details of rTMS and the biological interpretation of brain networks identified with MRI analyses, comprehensively summarize the neurobiological effects in rTMS-modulated individuals, and elaborate on changes in the brain network in patients with various neuropsychiatric diseases receiving rehabilitation treatment with rTMS. We conclude that brain connectivity network analysis based on MRI can reflect alterations in functional and structural connectivity networks comprising adjacent and separated brain regions related to stimulation sites, thus reflecting the occurrence of intrinsic functional integration and neuroplasticity. Therefore, MRI is a valuable tool for understanding the neural mechanisms of rTMS and practically tailoring treatment plans for patients with neuropsychiatric diseases.
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Affiliation(s)
- Xiaowei Han
- Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, China
- Medical Imaging Center, Affiliated Drum Tower Hospital, Medical School of Nanjing University, China
- Nanjing University Institute of Medical Imaging and Artificial Intelligence, Nanjing University, China
| | - Zhengyang Zhu
- Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, China
- Medical Imaging Center, Affiliated Drum Tower Hospital, Medical School of Nanjing University, China
- Nanjing University Institute of Medical Imaging and Artificial Intelligence, Nanjing University, China
| | - Jixin Luan
- China-Japan Friendship Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, China
| | - Pin Lv
- Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, China
- Medical Imaging Center, Affiliated Drum Tower Hospital, Medical School of Nanjing University, China
- Nanjing University Institute of Medical Imaging and Artificial Intelligence, Nanjing University, China
| | - Xiaoyan Xin
- Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, China
- Medical Imaging Center, Affiliated Drum Tower Hospital, Medical School of Nanjing University, China
- Nanjing University Institute of Medical Imaging and Artificial Intelligence, Nanjing University, China
| | - Xin Zhang
- Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, China
- Medical Imaging Center, Affiliated Drum Tower Hospital, Medical School of Nanjing University, China
- Nanjing University Institute of Medical Imaging and Artificial Intelligence, Nanjing University, China
| | - Amir Shmuel
- Montreal Neurological Institute, McGill University, Canada
| | - Zeshan Yao
- Biomedical Engineering Institute, Jingjinji National Center of Technology Innovation, China
| | - Guolin Ma
- Department of Radiology, China-Japan Friendship Hospital, China
| | - Bing Zhang
- Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, China
- Medical Imaging Center, Affiliated Drum Tower Hospital, Medical School of Nanjing University, China
- Nanjing University Institute of Medical Imaging and Artificial Intelligence, Nanjing University, China
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Motzkin JC, Kanungo I, D’Esposito M, Shirvalkar P. Network targets for therapeutic brain stimulation: towards personalized therapy for pain. FRONTIERS IN PAIN RESEARCH 2023; 4:1156108. [PMID: 37363755 PMCID: PMC10286871 DOI: 10.3389/fpain.2023.1156108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/19/2023] [Indexed: 06/28/2023] Open
Abstract
Precision neuromodulation of central brain circuits is a promising emerging therapeutic modality for a variety of neuropsychiatric disorders. Reliably identifying in whom, where, and in what context to provide brain stimulation for optimal pain relief are fundamental challenges limiting the widespread implementation of central neuromodulation treatments for chronic pain. Current approaches to brain stimulation target empirically derived regions of interest to the disorder or targets with strong connections to these regions. However, complex, multidimensional experiences like chronic pain are more closely linked to patterns of coordinated activity across distributed large-scale functional networks. Recent advances in precision network neuroscience indicate that these networks are highly variable in their neuroanatomical organization across individuals. Here we review accumulating evidence that variable central representations of pain will likely pose a major barrier to implementation of population-derived analgesic brain stimulation targets. We propose network-level estimates as a more valid, robust, and reliable way to stratify personalized candidate regions. Finally, we review key background, methods, and implications for developing network topology-informed brain stimulation targets for chronic pain.
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Affiliation(s)
- Julian C. Motzkin
- Departments of Neurology and Anesthesia and Perioperative Care (Pain Management), University of California, San Francisco, San Francisco, CA, United States
| | - Ishan Kanungo
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Mark D’Esposito
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Prasad Shirvalkar
- Departments of Neurology and Anesthesia and Perioperative Care (Pain Management), University of California, San Francisco, San Francisco, CA, United States
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
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Kurkin S, Gordleeva S, Savosenkov A, Grigorev N, Smirnov N, Grubov VV, Udoratina A, Maksimenko V, Kazantsev V, Hramov AE. Transcranial Magnetic Stimulation of the Dorsolateral Prefrontal Cortex Increases Posterior Theta Rhythm and Reduces Latency of Motor Imagery. SENSORS (BASEL, SWITZERLAND) 2023; 23:4661. [PMID: 37430576 DOI: 10.3390/s23104661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 07/12/2023]
Abstract
Experiments show activation of the left dorsolateral prefrontal cortex (DLPFC) in motor imagery (MI) tasks, but its functional role requires further investigation. Here, we address this issue by applying repetitive transcranial magnetic stimulation (rTMS) to the left DLPFC and evaluating its effect on brain activity and the latency of MI response. This is a randomized, sham-controlled EEG study. Participants were randomly assigned to receive sham (15 subjects) or real high-frequency rTMS (15 subjects). We performed EEG sensor-level, source-level, and connectivity analyses to evaluate the rTMS effects. We revealed that excitatory stimulation of the left DLPFC increases theta-band power in the right precuneus (PrecuneusR) via the functional connectivity between them. The precuneus theta-band power negatively correlates with the latency of the MI response, so the rTMS speeds up the responses in 50% of participants. We suppose that posterior theta-band power reflects attention modulation of sensory processing; therefore, high power may indicate attentive processing and cause faster responses.
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Affiliation(s)
- Semen Kurkin
- Baltic Center for Neurotechnology and Artificial Intelligence, Immanuel Kant Baltic Federal University, 236016 Kaliningrad, Russia
| | - Susanna Gordleeva
- Neurodynamics and Cognitive Technology Laboratory, Lobachevsky State University of Nizhny Novgorod, 603105 Nizhniy Novgorod, Russia
| | - Andrey Savosenkov
- Baltic Center for Neurotechnology and Artificial Intelligence, Immanuel Kant Baltic Federal University, 236016 Kaliningrad, Russia
- Neurodynamics and Cognitive Technology Laboratory, Lobachevsky State University of Nizhny Novgorod, 603105 Nizhniy Novgorod, Russia
| | - Nikita Grigorev
- Baltic Center for Neurotechnology and Artificial Intelligence, Immanuel Kant Baltic Federal University, 236016 Kaliningrad, Russia
- Neurodynamics and Cognitive Technology Laboratory, Lobachevsky State University of Nizhny Novgorod, 603105 Nizhniy Novgorod, Russia
| | - Nikita Smirnov
- Baltic Center for Neurotechnology and Artificial Intelligence, Immanuel Kant Baltic Federal University, 236016 Kaliningrad, Russia
| | - Vadim V Grubov
- Baltic Center for Neurotechnology and Artificial Intelligence, Immanuel Kant Baltic Federal University, 236016 Kaliningrad, Russia
| | - Anna Udoratina
- Neurodynamics and Cognitive Technology Laboratory, Lobachevsky State University of Nizhny Novgorod, 603105 Nizhniy Novgorod, Russia
| | - Vladimir Maksimenko
- Baltic Center for Neurotechnology and Artificial Intelligence, Immanuel Kant Baltic Federal University, 236016 Kaliningrad, Russia
- Neurodynamics and Cognitive Technology Laboratory, Lobachevsky State University of Nizhny Novgorod, 603105 Nizhniy Novgorod, Russia
| | - Victor Kazantsev
- Neurodynamics and Cognitive Technology Laboratory, Lobachevsky State University of Nizhny Novgorod, 603105 Nizhniy Novgorod, Russia
| | - Alexander E Hramov
- Baltic Center for Neurotechnology and Artificial Intelligence, Immanuel Kant Baltic Federal University, 236016 Kaliningrad, Russia
- Neurodynamics and Cognitive Technology Laboratory, Lobachevsky State University of Nizhny Novgorod, 603105 Nizhniy Novgorod, Russia
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11
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Van Malderen S, Hehl M, Verstraelen S, Swinnen SP, Cuypers K. Dual-site TMS as a tool to probe effective interactions within the motor network: a review. Rev Neurosci 2023; 34:129-221. [PMID: 36065080 DOI: 10.1515/revneuro-2022-0020] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/02/2022] [Indexed: 02/07/2023]
Abstract
Dual-site transcranial magnetic stimulation (ds-TMS) is well suited to investigate the causal effect of distant brain regions on the primary motor cortex, both at rest and during motor performance and learning. However, given the broad set of stimulation parameters, clarity about which parameters are most effective for identifying particular interactions is lacking. Here, evidence describing inter- and intra-hemispheric interactions during rest and in the context of motor tasks is reviewed. Our aims are threefold: (1) provide a detailed overview of ds-TMS literature regarding inter- and intra-hemispheric connectivity; (2) describe the applicability and contributions of these interactions to motor control, and; (3) discuss the practical implications and future directions. Of the 3659 studies screened, 109 were included and discussed. Overall, there is remarkable variability in the experimental context for assessing ds-TMS interactions, as well as in the use and reporting of stimulation parameters, hindering a quantitative comparison of results across studies. Further studies examining ds-TMS interactions in a systematic manner, and in which all critical parameters are carefully reported, are needed.
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Affiliation(s)
- Shanti Van Malderen
- Department of Movement Sciences, Movement Control & Neuroplasticity Research Group, Group Biomedical Sciences, KU Leuven, Heverlee 3001, Belgium.,Neuroplasticity and Movement Control Research Group, Rehabilitation Research Institute (REVAL), Hasselt University, Diepenbeek 3590, Belgium
| | - Melina Hehl
- Department of Movement Sciences, Movement Control & Neuroplasticity Research Group, Group Biomedical Sciences, KU Leuven, Heverlee 3001, Belgium.,Neuroplasticity and Movement Control Research Group, Rehabilitation Research Institute (REVAL), Hasselt University, Diepenbeek 3590, Belgium
| | - Stefanie Verstraelen
- Neuroplasticity and Movement Control Research Group, Rehabilitation Research Institute (REVAL), Hasselt University, Diepenbeek 3590, Belgium
| | - Stephan P Swinnen
- Department of Movement Sciences, Movement Control & Neuroplasticity Research Group, Group Biomedical Sciences, KU Leuven, Heverlee 3001, Belgium.,KU Leuven, Leuven Brain Institute (LBI), Leuven, Belgium
| | - Koen Cuypers
- Department of Movement Sciences, Movement Control & Neuroplasticity Research Group, Group Biomedical Sciences, KU Leuven, Heverlee 3001, Belgium.,Neuroplasticity and Movement Control Research Group, Rehabilitation Research Institute (REVAL), Hasselt University, Diepenbeek 3590, Belgium
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12
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Li B, Solanas MP, Marrazzo G, Raman R, Taubert N, Giese M, Vogels R, de Gelder B. A large-scale brain network of species-specific dynamic human body perception. Prog Neurobiol 2023; 221:102398. [PMID: 36565985 DOI: 10.1016/j.pneurobio.2022.102398] [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: 07/27/2022] [Revised: 11/25/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
This ultrahigh field 7 T fMRI study addressed the question of whether there exists a core network of brain areas at the service of different aspects of body perception. Participants viewed naturalistic videos of monkey and human faces, bodies, and objects along with mosaic-scrambled videos for control of low-level features. Independent component analysis (ICA) based network analysis was conducted to find body and species modulations at both the voxel and the network levels. Among the body areas, the highest species selectivity was found in the middle frontal gyrus and amygdala. Two large-scale networks were highly selective to bodies, dominated by the lateral occipital cortex and right superior temporal sulcus (STS) respectively. The right STS network showed high species selectivity, and its significant human body-induced node connectivity was focused around the extrastriate body area (EBA), STS, temporoparietal junction (TPJ), premotor cortex, and inferior frontal gyrus (IFG). The human body-specific network discovered here may serve as a brain-wide internal model of the human body serving as an entry point for a variety of processes relying on body descriptions as part of their more specific categorization, action, or expression recognition functions.
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Affiliation(s)
- Baichen Li
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht 6200 MD, the Netherlands
| | - Marta Poyo Solanas
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht 6200 MD, the Netherlands
| | - Giuseppe Marrazzo
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht 6200 MD, the Netherlands
| | - Rajani Raman
- Laboratory for Neuro, and Psychophysiology, Department of Neurosciences, KU Leuven Medical School, Leuven 3000, Belgium; Leuven Brain Institute, KU Leuven, Leuven 3000, Belgium
| | - Nick Taubert
- Section for Computational Sensomotorics, Centre for Integrative Neuroscience & Hertie Institute for Clinical Brain Research, University Clinic Tübingen, Tübingen 72076, Germany
| | - Martin Giese
- Section for Computational Sensomotorics, Centre for Integrative Neuroscience & Hertie Institute for Clinical Brain Research, University Clinic Tübingen, Tübingen 72076, Germany
| | - Rufin Vogels
- Laboratory for Neuro, and Psychophysiology, Department of Neurosciences, KU Leuven Medical School, Leuven 3000, Belgium; Leuven Brain Institute, KU Leuven, Leuven 3000, Belgium
| | - Beatrice de Gelder
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht 6200 MD, the Netherlands; Department of Computer Science, University College London, London WC1E 6BT, UK.
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13
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Liu Y, Lim K, Sundman MH, Ugonna C, Ton That V, Cowen S, Chou YH. Association Between Responsiveness to Transcranial Magnetic Stimulation and Interhemispheric Functional Connectivity of Sensorimotor Cortex in Older Adults. Brain Connect 2023; 13:39-50. [PMID: 35620910 PMCID: PMC9942174 DOI: 10.1089/brain.2021.0180] [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] [Indexed: 11/13/2022] Open
Abstract
Introduction: Repetitive transcranial magnetic stimulation (rTMS) is a promising therapeutic technique, and is believed to accomplish its effect by influencing the stimulated and remotely connected areas. However, responsiveness to rTMS shows high interindividual variability, and this intersubject variability is particularly high in older adults. It remains unclear whether baseline resting-state functional connectivity (rsFC) contributes to this variability in older adults. The aims of this study are to (1) examine rTMS effects over the primary motor cortex (M1) in older adults, and (2) identify baseline network properties that may contribute to the interindividual variability. Methods: We tested response to intermittent theta burst stimulation (iTBS), an effective rTMS protocol, over M1 by using both electromyography and resting-state functional magnetic resonance imaging in older adults. Outcome measures included motor-evoked potential (MEP) elicited by single-pulse transcranial magnetic stimulation and rsFC before and after an iTBS session. Results: iTBS significantly increased MEP amplitudes and rsFC between the stimulation site, sensorimotor cortex, and supplementary motor area (SMA) in older adults. iTBS-induced changes in MEP amplitude were positively correlated with increases in interhemispheric rsFC after iTBS. Furthermore, older adults with lower baseline interhemispheric rsFC between sensorimotor cortex and SMA exhibited stronger MEP response after iTBS. Discussion: Findings of the study suggest that different levels of interhemispheric communication during resting state might contribute to the response heterogeneity to iTBS in older adults. Interhemispheric rsFC may have great potential serving as a useful marker for predicting iTBS responsiveness in older adults. ClinicalTrials.gov ID: 1707654427 Impact statement Factors contributing to interindividual variability of the responsive to repetitive transcranial magnetic stimulation (rTMS) in older adults remain poorly understood. In this study, we examined the effects of rTMS over the primary motor cortex in older adults, and found that response to rTMS is associated with prestimulation interhemispheric connectivity in the sensorimotor and premotor areas. Findings of the study have great potential to be translated into a connectivity-based strategy for identification of responders for rTMS in older adults.
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Affiliation(s)
- Yilin Liu
- Department of Psychology and University of Arizona, Tucson, Arizona, USA
| | - Koeun Lim
- Department of Psychology and University of Arizona, Tucson, Arizona, USA
| | - Mark H. Sundman
- Department of Psychology and University of Arizona, Tucson, Arizona, USA
| | - Chidi Ugonna
- Department of Psychology and University of Arizona, Tucson, Arizona, USA
- Department of Biomedical Engineering, University of Arizona, Tucson, Arizona, USA
| | - Viet Ton That
- Department of Psychology and University of Arizona, Tucson, Arizona, USA
| | - Stephen Cowen
- Department of Psychology and University of Arizona, Tucson, Arizona, USA
- Evelyn F McKnight Brain Institute, Arizona Center on Aging, and BIO5 Institute, University of Arizona, Tucson, Arizona, USA
| | - Ying-hui Chou
- Department of Psychology and University of Arizona, Tucson, Arizona, USA
- Evelyn F McKnight Brain Institute, Arizona Center on Aging, and BIO5 Institute, University of Arizona, Tucson, Arizona, USA
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14
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Cheyuo C, Germann J, Yamamoto K, Vetkas A, Loh A, Sarica C, Milano V, Zemmar A, Flouty O, Harmsen IE, Hodaie M, Kalia SK, Tang-Wai D, Lozano AM. Connectomic neuromodulation for Alzheimer's disease: A systematic review and meta-analysis of invasive and non-invasive techniques. Transl Psychiatry 2022; 12:490. [PMID: 36411282 PMCID: PMC9678946 DOI: 10.1038/s41398-022-02246-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 10/24/2022] [Accepted: 10/28/2022] [Indexed: 11/23/2022] Open
Abstract
Deep brain stimulation (DBS) and non-invasive neuromodulation are currently being investigated for treating network dysfunction in Alzheimer's Disease (AD). However, due to heterogeneity in techniques and targets, the cognitive outcome and brain network connectivity remain unknown. We performed a systematic review, meta-analysis, and normative functional connectivity to determine the cognitive outcome and brain networks of DBS and non-invasive neuromodulation in AD. PubMed, Embase, and Web of Science were searched using three concepts: dementia, brain connectome, and brain stimulation, with filters for English, human studies, and publication dates 1980-2021. Additional records from clinicaltrials.gov were added. Inclusion criteria were AD study with DBS or non-invasive neuromodulation and a cognitive outcome. Exclusion criteria were less than 3-months follow-up, severe dementia, and focused ultrasound intervention. Bias was assessed using Centre for Evidence-Based Medicine levels of evidence. We performed meta-analysis, with subgroup analysis based on type and age at neuromodulation. To determine the patterns of neuromodulation-induced brain network activation, we performed normative functional connectivity using rsfMRI of 1000 healthy subjects. Six studies, with 242 AD patients, met inclusion criteria. On fixed-effect meta-analysis, non-invasive neuromodulation favored baseline, with effect size -0.40(95% [CI], -0.73, -0.06, p = 0.02), while that of DBS was 0.11(95% [CI] -0.34, 0.56, p = 0.63), in favor of DBS. In patients ≥65 years old, DBS improved cognitive outcome, 0.95(95% [CI] 0.31, 1.58, p = 0.004), whereas in patients <65 years old baseline was favored, -0.17(95% [CI] -0.93, 0.58, p = 0.65). Functional connectivity regions were in the default mode (DMN), salience (SN), central executive (CEN) networks, and Papez circuit. The subgenual cingulate and anterior limb of internal capsule (ALIC) showed connectivity to all targets of neuromodulation. This meta-analysis provides level II evidence of a difference in response of AD patients to DBS, based on age at intervention. Brain stimulation in AD may modulate DMN, SN, CEN, and Papez circuit, with the subgenual cingulate and ALIC as potential targets.
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Affiliation(s)
- Cletus Cheyuo
- grid.231844.80000 0004 0474 0428Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON Canada
| | - Jurgen Germann
- grid.231844.80000 0004 0474 0428Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON Canada ,grid.231844.80000 0004 0474 0428Krembil Research Institute, Toronto, ON Canada
| | - Kazuaki Yamamoto
- grid.231844.80000 0004 0474 0428Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON Canada ,Functional Neurosurgery Center, Shonan Fujisawa Tokushukai Hospital, Fujisawa, Kanagawa Japan
| | - Artur Vetkas
- grid.231844.80000 0004 0474 0428Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON Canada ,grid.412269.a0000 0001 0585 7044Neurology Clinic, Department of Neurosurgery, Tartu University Hospital, University of Tartu, Tartu, Estonia
| | - Aaron Loh
- grid.231844.80000 0004 0474 0428Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON Canada
| | - Can Sarica
- grid.231844.80000 0004 0474 0428Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON Canada
| | - Vanessa Milano
- grid.414997.60000 0004 0450 2040JFK Neuroscience Institute, Edison, NJ USA
| | - Ajmal Zemmar
- grid.266623.50000 0001 2113 1622Department of Neurosurgery, University of Louisville, School of Medicine, Louisville, KY USA
| | - Oliver Flouty
- grid.170693.a0000 0001 2353 285XDepartment of Neurosurgery, University of South Florida, College of Medicine, Tampa, FL USA
| | - Irene E. Harmsen
- grid.231844.80000 0004 0474 0428Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON Canada
| | - Mojgan Hodaie
- grid.231844.80000 0004 0474 0428Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON Canada ,grid.231844.80000 0004 0474 0428Krembil Research Institute, Toronto, ON Canada
| | - Suneil K. Kalia
- grid.231844.80000 0004 0474 0428Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON Canada ,grid.231844.80000 0004 0474 0428Krembil Research Institute, Toronto, ON Canada
| | - David Tang-Wai
- grid.17063.330000 0001 2157 2938Department of Neurology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON Canada
| | - Andres M. Lozano
- grid.231844.80000 0004 0474 0428Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON Canada ,grid.231844.80000 0004 0474 0428Krembil Research Institute, Toronto, ON Canada
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15
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Argaman Y, Granovsky Y, Sprecher E, Sinai A, Yarnitsky D, Weissman-Fogel I. Resting-state functional connectivity predicts motor cortex stimulation-dependent pain relief in fibromyalgia syndrome patients. Sci Rep 2022; 12:17135. [PMID: 36224244 PMCID: PMC9556524 DOI: 10.1038/s41598-022-21557-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/28/2022] [Indexed: 01/04/2023] Open
Abstract
MRI-based resting-state functional connectivity (rsFC) has been shown to predict response to pharmacological and non-pharmacological treatments for chronic pain, but not yet for motor cortex transcranial magnetic stimulation (M1-rTMS). Twenty-seven fibromyalgia syndrome (FMS) patients participated in this double-blind, crossover, and sham-controlled study. Ten daily treatments of 10 Hz M1-rTMS were given over 2 weeks. Before treatment series, patients underwent resting-state fMRI and clinical pain evaluation. Significant pain reduction occurred following active, but not sham, M1-rTMS. The following rsFC patterns predicted reductions in clinical pain intensity after the active treatment: weaker rsFC of the default-mode network with the middle frontal gyrus (r = 0.76, p < 0.001), the executive control network with the rostro-medial prefrontal cortex (r = 0.80, p < 0.001), the thalamus with the middle frontal gyrus (r = 0.82, p < 0.001), and the pregenual anterior cingulate cortex with the inferior parietal lobule (r = 0.79, p < 0.001); and stronger rsFC of the anterior insula with the angular gyrus (r = - 0.81, p < 0.001). The above regions process the attentional and emotional aspects of pain intensity; serve as components of the resting-state networks; are modulated by rTMS; and are altered in FMS. Therefore, we suggest that in FMS, the weaker pre-existing interplay between pain-related brain regions and networks, the larger the pain relief resulting from M1-rTMS.
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Affiliation(s)
- Yuval Argaman
- grid.6451.60000000121102151Clinical Neurophysiology Lab, Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
| | - Yelena Granovsky
- grid.6451.60000000121102151Clinical Neurophysiology Lab, Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel ,grid.413731.30000 0000 9950 8111Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Elliot Sprecher
- grid.413731.30000 0000 9950 8111Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Alon Sinai
- grid.413731.30000 0000 9950 8111Department of Neurosurgery, Rambam Health Care Campus, Haifa, Israel
| | - David Yarnitsky
- grid.6451.60000000121102151Clinical Neurophysiology Lab, Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel ,grid.413731.30000 0000 9950 8111Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Irit Weissman-Fogel
- grid.18098.380000 0004 1937 0562Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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16
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The effects of concurrent bilateral anodal tDCS of primary motor cortex and cerebellum on corticospinal excitability: a randomized, double-blind sham-controlled study. Brain Struct Funct 2022; 227:2395-2408. [PMID: 35984496 PMCID: PMC9418272 DOI: 10.1007/s00429-022-02533-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 06/30/2022] [Indexed: 11/11/2022]
Abstract
Transcranial direct current stimulation (tDCS) applied to the primary motor cortex (M1), and cerebellum (CB) can change the level of M1 corticospinal excitability (CSE). A randomized double-blinded crossover, the sham-controlled study design was used to investigate the effects of concurrent bilateral anodal tDCS of M1 and CB (concurrent bilateral a-tDCSM1+CB) on the CSE. Twenty-one healthy participants were recruited in this study. Each participant received anodal-tDCS (a-tDCS) of 2 mA, 20 min in four pseudo-randomized, counterbalanced sessions, separated by at least 7 days (7.11 days ± 0.65). These sessions were bilateral M1 stimulation (bilateral a-tDCSM1), bilateral cerebellar stimulation (bilateral a-tDCSCB), concurrent bilateral a-tDCSM1+CB, and sham stimulation (bilateral a-tDCSSham). Transcranial magnetic stimulation (TMS) was delivered over the left M1, and motor evoked potentials (MEPs) of a contralateral hand muscle were recorded before and immediately after the intervention to measure CSE changes. Short-interval intracortical inhibition (SICI), intracortical facilitation (ICF), and long interval intracortical inhibition (LICI) were assessed with paired-pulse TMS protocols. Anodal-tDCS significantly increased CSE after concurrent bilateral a-tDCSM1+CB and bilateral a-tDCSCB. Interestingly, CSE was decreased after bilateral a-tDCSM1. Respective alterations in SICI, LICI, and ICF were seen, including increased SICI and decreased ICF, which indicate the involvement of glutamatergic and GABAergic systems in these effects. These results confirm that the concurrent bilateral a-tDCSM1+CB have a facilitatory effect on CSE, whereas bilateral a-tDCSM1 exert some inhibitory effects. Moreover, the effects of the 2 mA, 20 min a-tDCS on the CB were consistent with its effects on the M1.
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17
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TMS Does Not Increase BOLD Activity at the Site of Stimulation: A Review of All Concurrent TMS-fMRI Studies. eNeuro 2022; 9:9/4/ENEURO.0163-22.2022. [PMID: 35981879 PMCID: PMC9410768 DOI: 10.1523/eneuro.0163-22.2022] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/14/2022] [Accepted: 06/30/2022] [Indexed: 11/21/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) is widely used for understanding brain function in neurologically intact subjects and for the treatment of various disorders. However, the precise neurophysiological effects of TMS at the site of stimulation remain poorly understood. The local effects of TMS can be studied using concurrent TMS-functional magnetic resonance imaging (fMRI), a technique where TMS is delivered during fMRI scanning. However, although concurrent TMS-fMRI was developed over 20 years ago and dozens of studies have used this technique, there is still no consensus on whether TMS increases blood oxygen level-dependent (BOLD) activity at the site of stimulation. To address this question, here we review all previous concurrent TMS-fMRI studies that reported analyses of BOLD activity at the target location. We find evidence that TMS increases local BOLD activity when stimulating the primary motor (M1) and visual (V1) cortices but that these effects are likely driven by the downstream consequences of TMS (finger twitches and phosphenes). However, TMS does not appear to increase BOLD activity at the site of stimulation for areas outside of the M1 and V1 when conducted at rest. We examine the possible reasons for such lack of BOLD signal increase based on recent work in nonhuman animals. We argue that the current evidence points to TMS inducing periods of increased and decreased neuronal firing that mostly cancel each other out and therefore lead to no change in the overall BOLD signal.
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18
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Dannhauer M, Huang Z, Beynel L, Wood E, Bukhari-Parlakturk N, Peterchev AV. TAP: targeting and analysis pipeline for optimization and verification of coil placement in transcranial magnetic stimulation. J Neural Eng 2022; 19:10.1088/1741-2552/ac63a4. [PMID: 35377345 PMCID: PMC9131512 DOI: 10.1088/1741-2552/ac63a4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/01/2022] [Indexed: 11/12/2022]
Abstract
Objective.Transcranial magnetic stimulation (TMS) can modulate brain function via an electric field (E-field) induced in a brain region of interest (ROI). The ROI E-field can be computationally maximized and set to match a specific reference using individualized head models to find the optimal coil placement and stimulus intensity. However, the available software lacks many practical features for prospective planning of TMS interventions and retrospective evaluation of the experimental targeting accuracy.Approach.The TMS targeting and analysis pipeline (TAP) software uses an MRI/fMRI-derived brain target to optimize coil placement considering experimental parameters such as the subject's hair thickness and coil placement restrictions. The coil placement optimization is implemented in SimNIBS 3.2, for which an additional graphical user interface (TargetingNavigator) is provided to visualize/adjust procedural parameters. The coil optimization process also computes the E-field at the target, allowing the selection of the TMS device intensity setting to achieve specific E-field strengths. The optimized coil placement information is prepared for neuronavigation software, which supports targeting during the TMS procedure. The neuronavigation system can record the coil placement during the experiment, and these data can be processed in TAP to quantify the accuracy of the experimental TMS coil placement and induced E-field.Main results.TAP was demonstrated in a study consisting of three repetitive TMS sessions in five subjects. TMS was delivered by an experienced operator under neuronavigation with the computationally optimized coil placement. Analysis of the experimental accuracy from the recorded neuronavigation data indicated coil location and orientation deviations up to about 2 mm and 2°, respectively, resulting in an 8% median decrease in the target E-field magnitude compared to the optimal placement.Significance.TAP supports navigated TMS with a variety of features for rigorous and reproducible stimulation delivery, including planning and evaluation of coil placement and intensity selection for E-field-based dosing.
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Affiliation(s)
- Moritz Dannhauer
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC 27710, USA
| | - Ziping Huang
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC 27710, USA
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Lysianne Beynel
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC 27710, USA
| | - Eleanor Wood
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC 27710, USA
| | | | - Angel V. Peterchev
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC 27710, USA
- Department of Electrical and Computer Engineering, Duke University, Durham, NC 27708, USA
- Department of Neurosurgery, Duke University, Durham, NC 27710, USA
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
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19
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Chou Y, Chang C, Remedios SW, Butman JA, Chan L, Pham DL. Automated Classification of Resting-State fMRI ICA Components Using a Deep Siamese Network. Front Neurosci 2022; 16:768634. [PMID: 35368292 PMCID: PMC8971556 DOI: 10.3389/fnins.2022.768634] [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: 08/31/2021] [Accepted: 02/09/2022] [Indexed: 11/24/2022] Open
Abstract
Manual classification of functional resting state networks (RSNs) derived from Independent Component Analysis (ICA) decomposition can be labor intensive and requires expertise, particularly in large multi-subject analyses. Hence, a fully automatic algorithm that can reliably classify these RSNs is desirable. In this paper, we present a deep learning approach based on a Siamese Network to learn a discriminative feature representation for single-subject ICA component classification. Advantages of this supervised framework are that it requires relatively few training data examples and it does not require the number of ICA components to be specified. In addition, our approach permits one-shot learning, which allows generalization to new classes not seen in the training set with only one example of each new class. The proposed method is shown to out-perform traditional convolutional neural network (CNN) and template matching methods in identifying eleven subject-specific RSNs, achieving 100% accuracy on a holdout data set and over 99% accuracy on an outside data set. We also demonstrate that the method is robust to scan-rescan variation. Finally, we show that the functional connectivity of default mode and salience networks identified by the proposed technique is altered in a group analysis of mild traumatic brain injury (TBI), severe TBI, and healthy subjects.
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Affiliation(s)
- Yiyu Chou
- Center for Neuroscience and Regenerative Medicine, Bethesda, MD, United States
- *Correspondence: Yiyu Chou,
| | - Catie Chang
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, United States
| | - Samuel W. Remedios
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, United States
| | - John A. Butman
- Center for Neuroscience and Regenerative Medicine, Bethesda, MD, United States
- Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, United States
| | - Leighton Chan
- Center for Neuroscience and Regenerative Medicine, Bethesda, MD, United States
- Rehabilitation Medicine Department at Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Dzung L. Pham
- Center for Neuroscience and Regenerative Medicine, Bethesda, MD, United States
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20
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Mizutani-Tiebel Y, Tik M, Chang KY, Padberg F, Soldini A, Wilkinson Z, Voon CC, Bulubas L, Windischberger C, Keeser D. Concurrent TMS-fMRI: Technical Challenges, Developments, and Overview of Previous Studies. Front Psychiatry 2022; 13:825205. [PMID: 35530029 PMCID: PMC9069063 DOI: 10.3389/fpsyt.2022.825205] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/09/2022] [Indexed: 11/13/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) is a promising treatment modality for psychiatric and neurological disorders. Repetitive TMS (rTMS) is widely used for the treatment of psychiatric and neurological diseases, such as depression, motor stroke, and neuropathic pain. However, the underlying mechanisms of rTMS-mediated neuronal modulation are not fully understood. In this respect, concurrent or simultaneous TMS-fMRI, in which TMS is applied during functional magnetic resonance imaging (fMRI), is a viable tool to gain insights, as it enables an investigation of the immediate effects of TMS. Concurrent application of TMS during neuroimaging usually causes severe artifacts due to magnetic field inhomogeneities induced by TMS. However, by carefully interleaving the TMS pulses with MR signal acquisition in the way that these are far enough apart, we can avoid any image distortions. While the very first feasibility studies date back to the 1990s, recent developments in coil hardware and acquisition techniques have boosted the number of TMS-fMRI applications. As such, a concurrent application requires expertise in both TMS and MRI mechanisms and sequencing, and the hurdle of initial technical set up and maintenance remains high. This review gives a comprehensive overview of concurrent TMS-fMRI techniques by collecting (1) basic information, (2) technical challenges and developments, (3) an overview of findings reported so far using concurrent TMS-fMRI, and (4) current limitations and our suggestions for improvement. By sharing this review, we hope to attract the interest of researchers from various backgrounds and create an educational knowledge base.
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Affiliation(s)
- Yuki Mizutani-Tiebel
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany.,Neuroimaging Core Unit Munich - NICUM, University Hospital LMU, Munich, Germany
| | - Martin Tik
- High Field MR Center, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Kai-Yen Chang
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany.,Neuroimaging Core Unit Munich - NICUM, University Hospital LMU, Munich, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany.,Neuroimaging Core Unit Munich - NICUM, University Hospital LMU, Munich, Germany
| | - Aldo Soldini
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany.,Neuroimaging Core Unit Munich - NICUM, University Hospital LMU, Munich, Germany.,International Max Planck Research School for Translational Psychiatry, Munich, Germany
| | - Zane Wilkinson
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany.,Neuroimaging Core Unit Munich - NICUM, University Hospital LMU, Munich, Germany
| | - Cui Ci Voon
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany.,Neuroimaging Core Unit Munich - NICUM, University Hospital LMU, Munich, Germany
| | - Lucia Bulubas
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany.,Neuroimaging Core Unit Munich - NICUM, University Hospital LMU, Munich, Germany.,International Max Planck Research School for Translational Psychiatry, Munich, Germany
| | - Christian Windischberger
- High Field MR Center, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany.,Neuroimaging Core Unit Munich - NICUM, University Hospital LMU, Munich, Germany.,Department of Radiology, University Hospital LMU, Munich, Germany
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21
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da Silva Machado CB, da Silva LM, Gonçalves AF, Andrade PRD, Mendes CKTT, de Assis TJCF, Godeiro Júnior CDO, Andrade SM. Multisite non-invasive brain stimulation in Parkinson's disease: A scoping review. NeuroRehabilitation 2021; 49:515-531. [PMID: 34776426 PMCID: PMC8764602 DOI: 10.3233/nre-210190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND: Parkinson’s disease (PD) is a progressive neurodegenerative disorder, characterized by cardinal motor symptoms in addition to cognitive impairment. New insights concerning multisite non-invasive brain stimulation effects have been gained, which can now be used to develop innovative treatment approaches. OBJECTIVE: Map the researchs involving multisite non-invasive brain stimulation in PD, synthesize the available evidence and discuss future directions. METHODS: The databases PubMed, PsycINFO, CINAHL, LILACS and The Cochrane Library were searched from inception until April 2020, without restrictions on the date of publication or the language in which it was published. The reviewers worked in pairs and sequentially evaluated the titles, abstracts and then the full text of all publications identified as potentially relevant. RESULTS: Twelve articles met the inclusion criteria. The target brain regions included mainly the combination of a motor and a frontal area, such as stimulation of the primary motor córtex associated with the dorsolateral prefrontal cortex. Most of the trials showed that this modality was only more effective for the motor component, or for the cognitive and/or non-motor, separately. CONCLUSIONS: Despite the results being encouraging for the use of the multisite aproach, the indication for PD management should be carried out with caution and deserves scientific deepening.
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Affiliation(s)
| | | | | | | | | | | | - Clécio de Oliveira Godeiro Júnior
- Division of Neurology, CHU of Grenoble, Grenoble Alpes University, La Tronche, Grenoble, France.,Division of Neurology, Hospital Universitario Onofre Lopes, Federal University of Rio Grande do Norte, Natal, Brazil
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22
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Stimulating Memory: Reviewing Interventions Using Repetitive Transcranial Magnetic Stimulation to Enhance or Restore Memory Abilities. Brain Sci 2021; 11:brainsci11101283. [PMID: 34679348 PMCID: PMC8533697 DOI: 10.3390/brainsci11101283] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/24/2021] [Accepted: 09/25/2021] [Indexed: 12/18/2022] Open
Abstract
Human memory systems are imperfect recording devices that are affected by age and disease, but recent findings suggest that the functionality of these systems may be modifiable through interventions using non-invasive brain stimulation such as repetitive transcranial magnetic stimulation (rTMS). The translational potential of these rTMS interventions is clear: memory problems are the most common cognitive complaint associated with healthy aging, while pathological conditions such as Alzheimer's disease are often associated with severe deficits in memory. Therapies to improve memory or treat memory loss could enhance independence while reducing costs for public health systems. Despite this promise, several important factors limit the generalizability and translational potential of rTMS interventions for memory. Heterogeneity of protocol design, rTMS parameters, and outcome measures present significant challenges to interpretation and reproducibility. However, recent advances in cognitive neuroscience, including rTMS approaches and recent insights regarding functional brain networks, may offer methodological tools necessary to design new interventional studies with enhanced experimental rigor, improved reproducibility, and greater likelihood of successful translation to clinical settings. In this review, we first discuss the current state of the literature on memory modulation with rTMS, then offer a commentary on developments in cognitive neuroscience that are relevant to rTMS interventions, and finally close by offering several recommendations for the design of future investigations using rTMS to modulate human memory performance.
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23
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The immediate impact of transcranial magnetic stimulation on brain structure: Short-term neuroplasticity following one session of cTBS. Neuroimage 2021; 240:118375. [PMID: 34245868 PMCID: PMC8456691 DOI: 10.1016/j.neuroimage.2021.118375] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 06/30/2021] [Accepted: 07/07/2021] [Indexed: 12/21/2022] Open
Abstract
Recent evidence demonstrates that activation-dependent neuroplasticity on a structural level can occur in a short time (2 hour or less) in the human brain. However, the exact time scale of structural plasticity in the human brain remains unclear. Using voxel-based morphometry (VBM), we investigated changes in grey matter (GM) after one session of continuous theta-burst stimulation (cTBS) delivered to the anterior temporal lobe (ATL). Twenty-five participants received cTBS over the left ATL or the occipital pole as a control site outside of the scanner, followed by structural and functional imaging. During functional imaging, participants performed a semantic association task and a number judgment task as a control task. VBM results revealed decreased GM in the left ATL and right cerebellum after the ATL stimulation compared to the control stimulation. In addition, cTBS over the left ATL induced slower semantic reaction times, reduced regional activity at the target site, and altered functional connectivity between the left and right ATL during semantic processing. Furthermore, the decreased ATL GM density was associated with the interhemispheric ATL-connectivity changes after the ATL stimulation. These results demonstrate that structural alterations caused by one session of cTBS are mirrored in the functional reorganizations in the semantic representation system, showing the rapid dynamics of cortical plasticity. Our findings support fast adapting neuronal plasticity such as synaptic morphology changes. Our results suggest that TBS is able to produce powerful changes in regional synaptic activity in the adult human brain.
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24
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Hare SM, Du X, Adhikari BM, Chen S, Mo C, Summerfelt A, Kvarta MD, Garcia L, Kochunov P, Elliot Hong L. Mapping local and long-distance resting connectivity markers of TMS-related inhibition reduction in schizophrenia. NEUROIMAGE-CLINICAL 2021; 31:102688. [PMID: 33991855 PMCID: PMC8135038 DOI: 10.1016/j.nicl.2021.102688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 03/07/2021] [Accepted: 04/26/2021] [Indexed: 11/17/2022]
Abstract
Short interval intracortical inhibition (SICI) is a biomarker for altered motor inhibition in schizophrenia, but the manner in which distant sites influence the inhibitory cortical-effector response remains elusive. Our study investigated local and long-distance resting state functional connectivity (rsFC) markers of SICI in a sample of N = 23 patients with schizophrenia and N = 29 controls. Local functional connectivity was quantified using regional homogeneity (ReHo) analysis and long-range connectivity was estimated using seed-based rsFC analysis. Direct and indirect effects of connectivity measures on SICI were modeled using mediation analysis. Higher SICI ratios (indicating reduced inhibition) in patients were associated with lower ReHo in the right insula. Follow-up rsFC analyses showed that higher SICI scores (indicating reduced inhibition) were associated with reduced connectivity between right insula and hubs of the corticospinal pathway: sensorimotor cortex and basal ganglia. Mediation analysis supported a model in which the direct effect of local insular connectivity strength on SICI is mediated by the interhemispheric connectivity between insula and left sensorimotor cortex. The broader clinical implications of these findings are discussed with emphasis on how these preliminary findings might inform novel interventions designed to restore or improve SICI in schizophrenia and deepen our understanding of motor inhibitory control and impact of abnormal signaling in motor-inhibitory pathways in schizophrenia.
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Affiliation(s)
- Stephanie M Hare
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States.
| | - Xiaoming Du
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Bhim M Adhikari
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Shuo Chen
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Chen Mo
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Ann Summerfelt
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Mark D Kvarta
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Laura Garcia
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Peter Kochunov
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - L Elliot Hong
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
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25
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Bergmann TO, Varatheeswaran R, Hanlon CA, Madsen KH, Thielscher A, Siebner HR. Concurrent TMS-fMRI for causal network perturbation and proof of target engagement. Neuroimage 2021; 237:118093. [PMID: 33940146 DOI: 10.1016/j.neuroimage.2021.118093] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/06/2021] [Accepted: 04/14/2021] [Indexed: 12/12/2022] Open
Abstract
The experimental manipulation of neural activity by neurostimulation techniques overcomes the inherent limitations of correlative recordings, enabling the researcher to investigate causal brain-behavior relationships. But only when stimulation and recordings are combined, the direct impact of the stimulation on neural activity can be evaluated. In humans, this can be achieved non-invasively through the concurrent combination of transcranial magnetic stimulation (TMS) with functional magnetic resonance imaging (fMRI). Concurrent TMS-fMRI allows the assessment of the neurovascular responses evoked by TMS with excellent spatial resolution and full-brain coverage. This enables the functional mapping of both local and remote network effects of TMS in cortical as well as deep subcortical structures, offering unique opportunities for basic research and clinical applications. The purpose of this review is to introduce the reader to this powerful tool. We will introduce the technical challenges and state-of-the art solutions and provide a comprehensive overview of the existing literature and the available experimental approaches. We will highlight the unique insights that can be gained from concurrent TMS-fMRI, including the state-dependent assessment of neural responsiveness and inter-regional effective connectivity, the demonstration of functional target engagement, and the systematic evaluation of stimulation parameters. We will also discuss how concurrent TMS-fMRI during a behavioral task can help to link behavioral TMS effects to changes in neural network activity and to identify peripheral co-stimulation confounds. Finally, we will review the use of concurrent TMS-fMRI for developing TMS treatments of psychiatric and neurological disorders and suggest future improvements for further advancing the application of concurrent TMS-fMRI.
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Affiliation(s)
- Til Ole Bergmann
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Langenbeckstr. 1, 55131, Mainz, Germany; Leibniz Institute for Resilience Research, Wallstraße 7-9, 55122, Mainz, Germany.
| | - Rathiga Varatheeswaran
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Langenbeckstr. 1, 55131, Mainz, Germany; Leibniz Institute for Resilience Research, Wallstraße 7-9, 55122, Mainz, Germany
| | - Colleen A Hanlon
- Department of Cancer Biology, Wake Forest School of Medicine, 1 Medical Center Blvd., Winston-Salem, NC 27157, USA
| | - Kristoffer H Madsen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650, Hvidovre, Denmark; Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Axel Thielscher
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650, Hvidovre, Denmark; Department of Electrical Engineering, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Hartwig Roman Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650, Hvidovre, Denmark; Department of Neurology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400 København NV, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
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26
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Hodkinson DJ, Bungert A, Bowtell R, Jackson SR, Jung J. Operculo-insular and anterior cingulate plasticity induced by transcranial magnetic stimulation in the human motor cortex: a dynamic casual modeling study. J Neurophysiol 2021; 125:1180-1190. [PMID: 33625934 DOI: 10.1152/jn.00670.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/12/2021] [Indexed: 11/22/2022] Open
Abstract
The ability to induce neuroplasticity with noninvasive brain stimulation techniques offers a unique opportunity to examine the human brain systems involved in pain modulation. In experimental and clinical settings, the primary motor cortex (M1) is commonly targeted to alleviate pain, but its mechanism of action remains unclear. Using dynamic causal modeling (DCM) and Bayesian model selection (BMS), we tested seven competing hypotheses about how transcranial magnetic stimulation (TMS) modulates the directed influences (or effective connectivity) between M1 and three distinct cortical areas of the medial and lateral pain systems, including the insular cortex (INS), anterior cingulate cortex (ACC), and parietal operculum cortex (PO). The data set included a novel fMRI acquisition collected synchronously with M1 stimulation during rest and while performing a simple hand motor task. DCM and BMS showed a clear preference for the fully connected model in which all cortical areas receive input directly from M1, with facilitation of the connections INS→M1, PO→M1, and ACC→M1, plus increased inhibition of their reciprocal connections. An additional DCM analysis comparing the reduced models only corresponding to networks with a sparser connectivity within the full model showed that M1 input into the INS is the second-best model of plasticity following TMS manipulations. The results reported here provide a starting point for investigating whether pathway-specific targeting involving M1↔INS improves analgesic response beyond conventional targeting. We eagerly await future empirical data and models that tests this hypothesis.NEW & NOTEWORTHY Transcranial magnetic stimulation of the primary motor cortex (M1) is a promising treatment for chronic pain, but its mechanism of action remains unclear. Competing dynamic causal models of effective connectivity between M1 and medial and lateral pain systems suggest direct input into the insular, anterior cingulate cortex, and parietal operculum. This supports the hypothesis that analgesia produced from M1 stimulation most likely acts through the activation of top-down processes associated with intracortical modulation.
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Affiliation(s)
- Duncan J Hodkinson
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- National Institute for Health Research, Nottingham Biomedical Research Centre, Queens Medical Center, Nottingham, United Kingdom
- Versus Arthritis Pain Centre, University of Nottingham, Nottingham, United Kingdom
| | - Andreas Bungert
- Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Richard Bowtell
- Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Stephen R Jackson
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
| | - JeYoung Jung
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
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27
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Jung J, Lambon Ralph MA. Enhancing vs. inhibiting semantic performance with transcranial magnetic stimulation over the anterior temporal lobe: Frequency- and task-specific effects. Neuroimage 2021; 234:117959. [PMID: 33744456 PMCID: PMC8204263 DOI: 10.1016/j.neuroimage.2021.117959] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 11/24/2022] Open
Abstract
Accumulating, converging evidence indicates that the anterior temporal lobe (ATL) appears to be the transmodal hub for semantic representation. A series of repetitive transcranial magnetic stimulation (rTMS) investigations utilizing the ‘virtual lesion’ approach have established the brain-behavioural relationship between the ATL and semantic processing by demonstrating that inhibitory rTMS over the ATL induced impairments in semantic performance in healthy individuals. However, a growing body of rTMS studies suggest that rTMS might also be a tool for cognitive enhancement and rehabilitation, though there has been no previous exploration in semantic cognition. Here, we explored a potential role of rTMS in enhancing and inhibiting semantic performance with contrastive rTMS protocols (1 Hz vs. 20 Hz) by controlling practice effects. Twenty-one healthy participants were recruited and performed an object category judgement task and a pattern matching task serving as a control task before and after the stimulation over the ATL (1 Hz, 20 Hz, and sham). A task familiarization procedure was performed prior to the experiment in order to establish a ‘stable baseline’ prior to stimulation and thus minimize practice effect. Our results demonstrated that it is possible to modulate semantic performance positively or negatively depending on the ATL stimulation frequency: 20 Hz rTMS was optimal for facilitating cortical processing (faster RT in a semantic task) contrasting with diminished semantic performance after 1 Hz rTMS. In addition to cementing the importance of the ATL to semantic representation, our findings suggest that 20 Hz rTMS leads to semantic enhancement in healthy individuals and potentially could be used for patients with semantic impairments as a therapeutic tool.
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Affiliation(s)
- JeYoung Jung
- School of Psychology, University of Nottingham, University Park, Nottingham NG7 2RD, UK.
| | - Matthew A Lambon Ralph
- MRC Cognition and Brain Science Unit (CBU), University of Cambridge, Cambridge CB2 7EF, UK.
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28
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Proessl F, Canino MC, Beckner ME, Sinnott AM, Eagle SR, LaGoy AD, Conkright WR, Sterczala AJ, Connaboy C, Ferrarelli F, Germain A, Nindl BC, Flanagan SD. Characterizing off-target corticospinal responses to double-cone transcranial magnetic stimulation. Exp Brain Res 2021; 239:1099-1110. [PMID: 33547521 DOI: 10.1007/s00221-021-06044-5] [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: 10/07/2020] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The double-cone coil (D-CONE) is frequently used in transcranial magnetic stimulation (TMS) experiments that target the motor cortex (M1) lower-limb representation. Anecdotal evidence and modeling studies have shed light on the off-target effects of D-CONE TMS but the physiological extent remains undetermined. PURPOSE To characterize the off-target effects of D-CONE TMS based on bilateral corticospinal responses in the legs and hands. METHODS Thirty (N = 30) participants (9 women, age: 26 ± 5yrs) completed a stimulus-response curve procedure with D-CONE TMS applied to the dominant vastus lateralis (cVL) and motor-evoked potentials (MEPs) recorded in each active VL and resting first dorsal interosseous (FDI). As a positive control (CON), the dominant FDI was directly targeted with a figure-of-eight coil and MEPs were similarly recorded in each active FDI and resting VL. MEPMAX, V50 and MEP latencies were compared with repeated-measures ANOVAs or mixed-effects analysis and Bonferroni-corrected pairwise comparisons. RESULTS Off-target responses were evident in all muscles, with similar MEPMAX in the target (cVL) and off-target (iVL) leg (p = 0.99) and cFDI compared with CON (p = 0.99). cFDI and CON MEPMAX were greater than iFDI (p < 0.01). A main effect of target (p < 0.001) indicated that latencies were shorter with CON but similar in all muscles with D-CONE. DISCUSSION Concurrent MEP recordings in bilateral upper- and lower-extremity muscles confirm that lower-limb D-CONE TMS produces substantial distance-dependent off-target effects. In addition to monitoring corticospinal responses in off-target muscles to improve targeting accuracy in real-time, future studies may incorporate off-target information into statistical models post-hoc.
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Affiliation(s)
- F Proessl
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, 3860 South Water St, Pittsburgh, PA, 15203, USA
| | - M C Canino
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, 3860 South Water St, Pittsburgh, PA, 15203, USA
| | - M E Beckner
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, 3860 South Water St, Pittsburgh, PA, 15203, USA
| | - A M Sinnott
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, 3860 South Water St, Pittsburgh, PA, 15203, USA
| | - S R Eagle
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, 3860 South Water St, Pittsburgh, PA, 15203, USA
| | - A D LaGoy
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, 3860 South Water St, Pittsburgh, PA, 15203, USA.,Department of Psychiatry, University of Pittsburgh Medical School, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - W R Conkright
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, 3860 South Water St, Pittsburgh, PA, 15203, USA
| | - A J Sterczala
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, 3860 South Water St, Pittsburgh, PA, 15203, USA
| | - C Connaboy
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, 3860 South Water St, Pittsburgh, PA, 15203, USA
| | - F Ferrarelli
- Department of Psychiatry, University of Pittsburgh Medical School, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - A Germain
- Department of Psychiatry, University of Pittsburgh Medical School, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - B C Nindl
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, 3860 South Water St, Pittsburgh, PA, 15203, USA
| | - S D Flanagan
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, 3860 South Water St, Pittsburgh, PA, 15203, USA.
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29
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Vittala A, Murphy N, Maheshwari A, Krishnan V. Understanding Cortical Dysfunction in Schizophrenia With TMS/EEG. Front Neurosci 2020; 14:554. [PMID: 32547362 PMCID: PMC7270174 DOI: 10.3389/fnins.2020.00554] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/05/2020] [Indexed: 12/16/2022] Open
Abstract
In schizophrenia and related disorders, a deeper mechanistic understanding of neocortical dysfunction will be essential to developing new diagnostic and therapeutic techniques. To this end, combined transcranial magnetic stimulation and electroencephalography (TMS/EEG) provides a non-invasive tool to simultaneously perturb and measure neurophysiological correlates of cortical function, including oscillatory activity, cortical inhibition, connectivity, and synchronization. In this review, we summarize the findings from a variety of studies that apply TMS/EEG to understand the fundamental features of cortical dysfunction in schizophrenia. These results lend to future applications of TMS/EEG in understanding the pathophysiological mechanisms underlying cognitive deficits in schizophrenia.
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Affiliation(s)
- Aadith Vittala
- Department of Biosciences, Rice University, Houston, TX, United States
| | - Nicholas Murphy
- Department of Psychiatry and Behavioral Science, Baylor College of Medicine, Houston, TX, United States
| | - Atul Maheshwari
- Department of Neurology, Baylor College of Medicine, Houston, TX, United States.,Department of Neuroscience, Baylor College of Medicine, Houston, TX, United States
| | - Vaishnav Krishnan
- Department of Psychiatry and Behavioral Science, Baylor College of Medicine, Houston, TX, United States.,Department of Neurology, Baylor College of Medicine, Houston, TX, United States.,Department of Neuroscience, Baylor College of Medicine, Houston, TX, United States
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