The effects of theta-burst stimulation on sleep and vigilance in humans

Armand Mensen,Corina Gorban,Marcel Niklaus,Eva Kuske,Ramin Khatami

doi:10.3389/fnhum.2014.00420

Armand Mensen, Corina Gorban + Show 3 more

Open Access

https://doi.org/10.3389/fnhum.2014.00420

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Abstract

Repetitive transcranial magnetic stimulation (TMS) has become a popular tool to modulate neuronal networks and associated brain functions in both clinical and basic research. Yet few studies have examined the potential effects of cortical stimulation on general levels of vigilance. In this exploratory study, we used theta-burst protocols, both continuous (cTBS) and intermittent (iTBS) patterns, to examine whether inhibition or excitation of the left dorso-lateral prefrontal cortex (dlPFC) was able to induce reliable and acute changes to vigilance measures, compared to the left dorso-lateral associative visual cortex (dlAVC) as a control site in line with previous work. Partially sleep restricted participants underwent four separate sessions in a single day, in a between subjects design for TBS stimulation type and within subjects for locaton, each consisting of maintenance of wakefulness test (MWT), a sleep latency test, and a psychomotor vigilance task (PVT). TBS significantly affected measures of sleep consolidation, namely latency to sleep stage 2 and sleep efficiency, but had no effects on sleep drive or psychomotor vigilance levels for either TBS type or location. Contrary to our initial hypothesis of the dlAVC as a control site, stimulation to this region resulted in the largest differential effects between stimulation types. Moreover, the effect of TBS was found to be consistent throughout the day. These data may provide the basis for further investigation into therapeutic applications of TBS in sleep disorders.

Highlights

Transcranial magnetic stimulation (TMS) has become a wellestablished tool in research and is increasingly being applied in clinical situations
Strafella et al have investigated how certain patterns of magnetic stimulation over the cortex can have pronounced effects on sub-cortical dopamine levels (Strafella et al, 2001, 2003). In their initial study they found a significant release of dopamine in striatal regions after a Repetitive TMS (rTMS) protocol to the left dorso-lateral prefrontal cortex, but no specific release after stimulation of the control site, the left dorso-lateral associative visual cortex
Taken together, the specific effects to the latency to N2, along with changes to the overall sleep efficiency in the naps point to a direct effect of the TBS protocols on mechanisms of sleep consolidation which warrant further studies. This is opposed to an effect of the sleep initiation or wake/attention promoting systems as both the latency to N1, the maintenance of wakefulness test (MWT), and the psychomotor vigilance task (PVT) measures were not affected by TBS

Summary

Introduction

Transcranial magnetic stimulation (TMS) has become a wellestablished tool in research and is increasingly being applied in clinical situations. Strafella et al have investigated how certain patterns of magnetic stimulation over the cortex can have pronounced effects on sub-cortical dopamine levels (Strafella et al, 2001, 2003). In their initial study they found a significant release of dopamine in striatal regions after a rTMS protocol to the left dorso-lateral prefrontal cortex (dlPFC), but no specific release after stimulation of the control site, the left dorso-lateral associative visual cortex (dlAVC). More recently theta-burst TMS (TBS), a pattern of stimulation shown to be effective at inducing longer lasting changes to cortical levels of excitation (Huang et al, 2005), and in particular intermittent TBS (iTBS) of the left dlPFC has been shown to significantly reduce levels of striatal dopamine, presumably by decreasing cortical excitability (Ko et al, 2008)

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