fMRI-guided Transcranial Magnetic Stimulation Research Articles

Utilizing fMRI to Guide TMS Targets: the Reliability and Sensitivity of fMRI Metrics at 3T and 1.5T.

US Food and Drug Administration (FDA) cleared a Transcranial Magnetic Stimulation (TMS) system with functional Magnetic Resonance Imaging-guided (fMRI) individualized treatment protocol for major depressive disorder, which employs resting state-fMRI (RS-fMRI) functional connectivity (FC) to pinpoint the target individually to increase the accuracy and effeteness of the stimulation. Furthermore, task activation-guided TMS, as well as the use of RS-fMRI local metrics for targeted the specific abnormal brain regions, are considered a precise scheme for TMS targeting. Since 1.5T MRI is more available in hospitals, systematic evaluation of the test-retest reliability and sensitivity of fMRI metrics on 1.5T and 3T MRI may provide reference for the application of fMRI-guided individualized-precise TMS stimulation. Twenty participants underwent three RS-fMRI scans and one scan of finger-tapping task fMRI with self-initiated (SI) and visual-guided (VG) conditions at both 3T and 1.5T. Then the location reliability derived by FC (with three seed regions) and peak activation were assessed by intra-individual distance. The test-retest reliability and sensitivity of five RS-fMRI local metrics were evaluated using intra-class correlation and effect size, separately. The intra-individual distance of peak activation location between 1.5T and 3T was 15.8mm and 19mm for two conditions, respectively. The intra-individual distance for the FC derived targets at 1.5T was 9.6-31.2mm, compared to that of 3T (7.6-31.1mm). The test-retest reliability and sensitivity of RS-fMRI local metrics showed similar trends on 1.5T and 3T. These findings hasten the application of fMRI-guided individualized TMS treatment in clinical practice.

Converging evidence that left extrastriate body area supports visual sensitivity to social interactions

Navigating our complex social world requires processing the interactions we observe. Recent psychophysical and neuroimaging studies provide parallel evidence that the human visual system may be attuned to efficiently perceive dyadic interactions. This work implies, but has not yet demonstrated, that activity in body-selective cortical regions causally supports efficient visual perception of interactions. We adopt a multi-method approach to close this important gap. First, using a large fMRI dataset (n= 92), we found that the left hemisphere extrastriate body area (EBA) responds more to face-to-face than non-facing dyads. Second, we replicated a behavioral marker of visual sensitivity to interactions: categorization of facing dyads is more impaired by inversion than non-facing dyads. Third, in a pre-registered experiment, we used fMRI-guided transcranial magnetic stimulation to show that online stimulation of the left EBA, but not a nearby control region, abolishes this selective inversion effect. Activity in left EBA, thus, causally supports the efficient perception of social interactions.

Hitting the Target of Image-Guided Psychiatry?

Hitting the Target of Image-Guided Psychiatry?

Functional Imaging to Guide Network-Based TMS Treatments: Toward a Tailored Medicine Approach in Alzheimer's Disease.

A growing number of studies is using fMRI-based connectivity to guide transcranial magnetic stimulation (TMS) target identification in both normal and clinical populations. TMS has gained increasing attention as a potential therapeutic strategy also in Alzheimer’s disease (AD), but an endorsed target localization strategy in this population is still lacking. In this proof of concept study, we prove the feasibility of a tailored TMS targeting approach for AD, which stems from a network-based perspective. Based on functional imaging, the procedure allows to extract individual optimal targets meanwhile accounting for functional variability. Single-subject resting-state fMRI was used to extract individual target coordinates of two networks primarily affected in AD, the default mode and the fronto-parietal network. The localization of these targets was compared to that of traditional group-level approaches and tested against varying degrees of TMS focality. The distance between individual fMRI-derived coordinates and traditionally defined targets was significant for a supposed TMS focality of 12 mm and in some cases up to 20 mm. Comparison with anatomical labels confirmed a lack of 1:1 correspondence between anatomical and functional targets. The proposed network-based fMRI-guided TMS approach, while accounting for inter-individual functional variability, allows to target core AD networks, and might thus represent a step toward tailored TMS interventions for AD.

Resting fMRI-guided TMS results in subcortical and brain network modulation indexed by interleaved TMS/fMRI.

Traditional non-invasive imaging methods describe statistical associations of functional co-activation over time. They cannot easily establish hierarchies in communication as done in non-human animals using invasive methods. Here, we interleaved functional MRI (fMRI) recordings with non-invasive transcranial magnetic stimulation (TMS) to map causal communication between the frontal cortex and subcortical target structures including the subgenual anterior cingulate cortex (sgACC) and the amygdala. Seed-based correlation maps from each participant's resting fMRI scan determined individual stimulation sites with high temporal correlation to targets for the subsequent TMS/fMRI session(s). The resulting TMS/fMRI images were transformed to quantile responses, so that regions of high-/low-quantile response corresponded to the areas of the brain with the most positive/negative evoked response relative to the global brain response. We then modeled the average quantile response for a given region (e.g., structure or network) to determine whether TMS was effective in the relative engagement of the downstream targets. Both the sgACC and amygdala were differentially influenced by TMS. Furthermore, we found that the sgACC distributed brain network was modulated in response to fMRI-guided TMS. The amygdala, but not its distributed network, also responded to TMS. Our findings suggest that individual targeting and brain response measurements reflect causal circuit mapping to the sgACC and amygdala in humans. These results set the stage to further map circuits in the brain and link circuit pathway integrity to clinical intervention outcomes, especially when the intervention targets specific pathways and networks as is possible with TMS.

Temporally-precise disruption of prefrontal cortex informed by the timing of beta bursts impairs human action-stopping

Human action-stopping is thought to rely on a prefronto-basal ganglia-thalamocortical network, with right inferior frontal cortex (rIFC) posited to play a critical role in the early stage of implementation. Here we sought causal evidence for this idea in experiments involving healthy human participants. We first show that action-stopping is preceded by bursts of electroencephalographic activity in the beta band over prefrontal electrodes, putatively rIFC, and that the timing of these bursts correlates with the latency of stopping at a single-trial level: earlier bursts are associated with faster stopping. From this we reasoned that the integrity of rIFC at the time of beta bursts might be critical to successful stopping. We then used fMRI-guided transcranial magnetic stimulation (TMS) to disrupt rIFC at the approximate time of beta bursting. Stimulation prolonged stopping latencies and, moreover, the prolongation was most pronounced in individuals for whom the pulse appeared closer to the presumed time of beta bursting. These results help validate a model of the neural architecture and temporal dynamics of action-stopping. They also highlight the usefulness of prefrontal beta bursts to index an apparently important sub-process of stopping, the timing of which might help explain within- and between-individual variation in impulse control.

Modulation of hippocampal brain networks produces changes in episodic simulation and divergent thinking

Prior functional magnetic resonance imaging (fMRI) studies indicate that a core network of brain regions, including the hippocampus, is jointly recruited during episodic memory, episodic simulation, and divergent creative thinking. Because fMRI data are correlational, it is unknown whether activity increases in the hippocampus, and the core network more broadly, play a causal role in episodic simulation and divergent thinking. Here we employed fMRI-guided transcranial magnetic stimulation (TMS) to assess whether temporary disruption of hippocampal brain networks impairs both episodic simulation and divergent thinking. For each of two TMS sessions, continuous θ-burst stimulation (cTBS) was applied to either a control site (vertex) or to a left angular gyrus target region. The target region was identified on the basis of a participant-specific resting-state functional connectivity analysis with a hippocampal seed region previously associated with memory, simulation, and divergent thinking. Following cTBS, participants underwent fMRI and performed a simulation, divergent thinking, and nonepisodic control task. cTBS to the target region reduced the number of episodic details produced for the simulation task and reduced idea production on divergent thinking. Performance in the control task did not statistically differ as a function of cTBS site. fMRI analyses revealed a selective and simultaneous reduction in hippocampal activity during episodic simulation and divergent thinking following cTBS to the angular gyrus versus vertex but not during the nonepisodic control task. Our findings provide evidence that hippocampal-targeted TMS can specifically modulate episodic simulation and divergent thinking, and suggest that the hippocampus is critical for these cognitive functions.

Individualized perturbation of the human connectome reveals reproducible biomarkers of network dynamics relevant to cognition.

Large-scale brain networks are often described using resting-state functional magnetic resonance imaging (fMRI). However, the blood oxygenation level-dependent (BOLD) signal provides an indirect measure of neuronal firing and reflects slow-evolving hemodynamic activity that fails to capture the faster timescale of normal physiological function. Here we used fMRI-guided transcranial magnetic stimulation (TMS) and simultaneous electroencephalography (EEG) to characterize individual brain dynamics within discrete brain networks at high temporal resolution. TMS was used to induce controlled perturbations to individually defined nodes of the default mode network (DMN) and the dorsal attention network (DAN). Source-level EEG propagation patterns were network-specific and highly reproducible across sessions 1 month apart. Additionally, individual differences in high-order cognitive abilities were significantly correlated with the specificity of TMS propagation patterns across DAN and DMN, but not with resting-state EEG dynamics. Findings illustrate the potential of TMS-EEG perturbation-based biomarkers to characterize network-level individual brain dynamics at high temporal resolution, and potentially provide further insight on their behavioral significance.

Confident false memories for spatial location are mediated by V1

ABSTRACTPrior functional magnetic resonance imaging (fMRI) results suggest that true memories, but not false memories, activate early sensory cortex. It is thought that false memories, which reflect conscious processing, do not activate early sensory cortex because these regions are associated with nonconscious processing. We posited that false memories may activate the earliest visual cortical processing region (i.e., V1) when task conditions are manipulated to evoke conscious processing in this region. In an fMRI experiment, abstract shapes were presented to the left or right of fixation during encoding. During retrieval, old shapes were presented at fixation and participants characterized each shape as previously on the "left" or "right" followed by an "unsure"–"sure"–"very sure" confidence rating. False memories for spatial location (i.e., "right"/left or "left"/right trials with "sure" or "very sure" confidence ratings) were associated with activity in bilateral early visual regions, including V1. In a follow-up fMRI-guided transcranial magnetic stimulation (TMS) experiment that employed the same paradigm, we assessed whether V1 activity was necessary for false memory construction. Between the encoding phase and the retrieval phase of each run, TMS (1 Hz, 8 min) was used to target the location of false memory activity (identified in the fMRI experiment) in left V1, right V1, or the vertex (control site). Confident false memories for spatial location were significantly reduced following TMS to V1, as compared to vertex. The results of the present experiments provide convergent evidence that early sensory cortex can contribute to false memory construction under particular task conditions.

Recurrent Processing of Contour Integration in the Human Visual Cortex as Revealed By fMRI-Guided TMS.

Contour integration is a critical step in visual perception because it groups discretely local elements into perceptually global contours. Previous investigations have suggested that striate and extrastriate visual areas are involved in this mid-level processing of visual perception. However, the temporal dynamics of these areas in the human brain during contour integration is less understood. The present study used functional magnetic resonance imaging-guided transcranial magnetic stimulation (TMS) to briefly disrupt 1 of 2 visual areas (V1/V2 and V3B) and examined the causal contributions of these areas to contour detection. The results demonstrated that the earliest critical time window at which behavioral detection performance was impaired by TMS pluses differed between V1/V2 and V3B. The first critical window of V3B (90-110 ms after stimulus onset) was earlier than that of V1/V2 (120-140 ms after stimulus onset), thus indicating that feedback connection from higher to lower area was necessary for complete contour integration. These results suggested that the fine processing of contour-related information in V1/V2 follows the generation of a coarse template in the higher visual areas, such as V3B. Our findings provide direct causal evidence that a recurrent mechanism is necessary for the integration of contours from cluttered background in the human brain.

Not all visual symmetry is equal: Partially distinct neural bases for vertical and horizontal symmetry.

Visual mirror symmetry plays an important role in visual perception in both human and animal vision; its importance is reflected in the fact that it can be extracted automatically during early stages of visual processing. However, how this extraction is implemented at the cortical level remains an open question. Given the importance of symmetry in visual perception, one possibility is that there is a network which extracts all types of symmetry irrespective of axis of orientation; alternatively, symmetry along different axes might be encoded by different brain regions, implying that there is no single neural mechanism for symmetry processing. Here we used fMRI-guided transcranial magnetic stimulation (TMS) to compare the neural basis of the two main types of symmetry found in the natural world, vertical and horizontal symmetry. TMS was applied over either right Lateral Occipital Cortex (LO), right Occipital Face Area (OFA) or Vertex while participants were asked to detect symmetry in low-level dot configurations. Whereas detection of vertical symmetry was impaired by TMS over both LO and OFA, detection of horizontal symmetry was delayed by stimulation of LO only. Thus, different types of visual symmetry rely on partially distinct cortical networks.

Hierarchically Organized Medial Frontal Cortex-Basal Ganglia Loops Selectively Control Task- and Response-Selection.

Adaptive behavior requires context-sensitive configuration of task-sets that specify time-varying stimulus-response mappings. Intriguingly, response time costs associated with changing task-sets and motor responses are known to be strongly interactive: switch costs at the task level are small in the presence of a response-switch but large when accompanied by a response-repetition, and vice versa for response-switch costs. The reasons behind this well known interdependence between task- and response-level control processes are currently not well understood. Here, we formalized and tested a model assuming a hierarchical organization of superordinate task-set and subordinate response-set selection processes to account for this effect. The model was found to successfully explain the full range of behavioral task- and response-switch costs across first and second order trial transitions. Using functional magnetic resonance imaging (fMRI) in healthy humans, we then characterized the neural circuitry mediating these effects. We found that presupplementary motor area (preSMA) activity tracked task-set control costs, SMA activity tracked response-set control costs, and basal ganglia (BG) activity mirrored the interaction between task- and response-set regulation processes that characterized participants' response times. A subsequent fMRI-guided transcranial magnetic stimulation experiment confirmed dissociable roles of the preSMA and SMA in determining response costs. Together, these data provide evidence for a hierarchical organization of posterior medial frontal cortex and its interaction with the BG, where a superordinate preSMA-BG loop establishes task-set selection, which imposes a (unidirectional) constraint on a subordinate SMA-BG loop that determines response-selection, resulting in the characteristic interdependence in task- and response-switch costs in behavior.SIGNIFICANCE STATEMENT The ability to use context-sensitive task-sets to guide our responses is central to human adaptive behavior. Task and response selection are strongly interactive: it is more difficult to repeat a response in the context of a changing task-set, and vice versa. However, the neurocognitive architecture giving rise to this interdependence is currently not understood. Here we use modeling, neuroimaging, and noninvasive neurostimulation to show that this phenomenon derives from a hierarchical organization of posterior medial frontal cortex and its interaction with the basal ganglia, where a more anterior corticostriatal loop establishes task-set selection, which constrains a more posterior loop responsible for response-selection. These data provide a neural explanation for a key behavioral signature of human cognitive control.

Involvement of human primary somatosensory cortex in vibrotactile detection depends on task demand

Detecting and discriminating sensory stimuli are fundamental functions of the nervous system. Electrophysiological and lesion studies suggest that macaque primary somatosensory cortex (SI) is critically involved in discriminating between stimuli, but is not required simply for detecting stimuli. By contrast, transcranial magnetic stimulation (TMS) studies in humans have shown near-complete disruption of somatosensory detection when a single pulse of TMS is delivered over SI. To address this discrepancy, we measured the sensitivity and decision criteria of participants detecting vibrotactile stimuli with individually-tailored fMRI-guided TMS over SI, over a control site not activated by vibrotactile stimuli (inferior parietal lobule, IPL), or away from the head (a no TMS condition). In a one-interval detection task, TMS increased participants' likelihood of reporting ‘no’ target present regardless of site, but TMS over SI also decreased detection sensitivity, and prevented improvement in tactile sensitivity over time. We then measured tactile thresholds in a series of two-interval forced-choice (2IFC) detection and discrimination tasks with lower dependence on response criteria and short-term memory load. We found that thresholds for detecting stimuli were comparable with TMS over SI and IPL, but TMS over SI specifically and significantly impaired frequency discrimination. We conclude that, in accordance with macaque studies, human SI is required for discriminating between tactile stimuli and for maintaining stimulus representations over time, or under high task demand, but may not be required for simple tactile detection. Significant statementStudies on monkeys have suggested that the primary somatosensory cortex is responsible for discriminating between different vibrations on the fingertips, but not just for detecting these vibrations. However, similar studies in humans suggest that the somatosensory cortex is required both for detecting and discriminating between tactile stimuli. We used magnetic brain stimulation to interfere with human somatosensory cortex while healthy volunteers detected and discriminated between vibrations applied to their fingertips. We found that the somatosensory cortex is required for keeping vibrotactile stimuli in memory for short periods of time and for comparing two vibrotactile stimuli, but is not required merely for detecting vibrotactile stimulation. This suggests that human primary somatosensory cortex is not always needed for vibrotactile detection.

Investigating the Causal Role of rOFA in Holistic Detection of Mooney Faces and Objects: An fMRI-guided TMS Study

The right occipital face area (rOFA) is known to be involved in face discrimination based on local featural information. Whether this region is also involved in global, holistic stimulus processing is not known. We used fMRI-guided transcranial magnetic stimulation (TMS) to investigate whether rOFA is causally implicated in stimulus detection based on holistic processing, by the use of Mooney stimuli. Two studies were carried out: In Experiment 1, participants performed a detection task involving Mooney faces and Mooney objects; Mooney stimuli lack distinguishable local features and can be detected solely via holistic processing (i.e. at a global level) with top-down guidance from previously stored representations. Experiment 2 required participants to detect shapes which are recognized via bottom-up integration of local (collinear) Gabor elements and was performed to control for specificity of rOFA's implication in holistic detection. In Experiment 1, TMS over rOFA and rLO impaired detection of all stimulus categories, with no category-specific effect. In Experiment 2, shape detection was impaired when TMS was applied over rLO but not over rOFA. Our results demonstrate that rOFA is causally implicated in the type of top-down holistic detection required by Mooney stimuli and that such role is not face-selective. In contrast, rOFA does not appear to play a causal role in detection of shapes based on bottom-up integration of local components, demonstrating that its involvement in processing non-face stimuli is specific for holistic processing.

The causal role of the occipital face area (OFA) and lateral occipital (LO) cortex in symmetry perception.

Symmetry is an important cue in face and object perception. Here we used fMRI-guided transcranial magnetic stimulation (TMS) to shed light on the role of the occipital face area (OFA), a key region in face processing, and the lateral occipital (LO) cortex, a key area in object processing, in symmetry detection. In the first experiment, we applied TMS over the rightOFA, its left homolog (leftOFA), rightLO, and vertex (baseline) while participants were discriminating between symmetric and asymmetric dot patterns. Stimulation of rightOFA and rightLO impaired performance, causally implicating these two regions in detection of symmetry in low-level dot configurations. TMS over rightLO but not rightOFA also significantly impaired detection of nonsymmetric shapes defined by collinear Gabor patches, demonstrating that rightOFA responds to symmetry but not to all cues mediating figure-ground segregation. The second experiment showed a causal role for rightOFA but not rightLO in facial symmetry detection. Overall, our results demonstrate that both the rightOFA and rightLO are sensitive to symmetry in dot patterns, whereas only rightOFA is causally involved in facial symmetry detection.

Extracting visual evoked potentials from EEG data recorded during fMRI-guided transcranial magnetic stimulation.

Transcranial Magnetic Stimulation (TMS) is an effective method for establishing a causal link between a cortical area and cognitive/neurophysiological effects. Specifically, by creating a transient interference with the normal activity of a target region and measuring changes in an electrophysiological signal, we can establish a causal link between the stimulated brain area or network and the electrophysiological signal that we record. If target brain areas are functionally defined with prior fMRI scan, TMS could be used to link the fMRI activations with evoked potentials recorded. However, conducting such experiments presents significant technical challenges given the high amplitude artifacts introduced into the EEG signal by the magnetic pulse, and the difficulty to successfully target areas that were functionally defined by fMRI. Here we describe a methodology for combining these three common tools: TMS, EEG, and fMRI. We explain how to guide the stimulator's coil to the desired target area using anatomical or functional MRI data, how to record EEG during concurrent TMS, how to design an ERP study suitable for EEG-TMS combination and how to extract reliable ERP from the recorded data. We will provide representative results from a previously published study, in which fMRI-guided TMS was used concurrently with EEG to show that the face-selective N1 and the body-selective N1 component of the ERP are associated with distinct neural networks in extrastriate cortex. This method allows us to combine the high spatial resolution of fMRI with the high temporal resolution of TMS and EEG and therefore obtain a comprehensive understanding of the neural basis of various cognitive processes.

Extracting Visual Evoked Potentials from EEG Data Recorded During fMRI-guided Transcranial Magnetic Stimulation

Extracting Visual Evoked Potentials from EEG Data Recorded During fMRI-guided Transcranial Magnetic Stimulation

Extended Remediation of Sleep Deprived-Induced Working Memory Deficits Using fMRI-guided Transcranial Magnetic Stimulation

We attempted to prevent the development of working memory (WM) impairments caused by sleep deprivation using fMRI-guided repetitive transcranial magnetic stimulation (rTMS). Novel aspects of our fMRI-guided rTMS paradigm included the use of sophisticated covariance methods to identify functional networks in imaging data, and the use of fMRI-targeted rTMS concurrent with task performance to modulate plasticity effects over a longer term. Between-groups mixed model. TMS, MRI, and sleep laboratory study. 27 subjects (13 receiving Active rTMS, and 14 Sham) completed the sleep deprivation protocol, with another 21 (10 Active, 11 Sham) non-sleep deprived subjects run in a second experiment. Our previous covariance analysis had identified a network, including occipital cortex, which demonstrated individual differences in resilience to the deleterious effects of sleep deprivation on WM performance. Five Hz rTMS was applied to left lateral occipital cortex while subjects performed a WM task during 4 sessions over the course of 2 days of total sleep deprivation. At the end of the sleep deprivation period, Sham sleep deprived subjects exhibited degraded performance in the WM task. In contrast, those receiving Active rTMS did not show the slowing and lapsing typical in sleep deprivation, and instead performed similarly to non- sleep deprived subjects. Importantly, the Active sleep deprivation group showed rTMS-induced facilitation of WM performance a full 18 hours after the last rTMS session. Over the course of sleep deprivation, these results indicate that rTMS applied concurrently with WM task performance affected neural circuitry involved in WM to prevent its full impact.

Charting the functional relevance of Broca’s area for visual word recognition and picture naming in Dutch using fMRI-guided TMS

Magnetoencephalography (MEG) has shown pseudohomophone priming effects at Broca’s area (specifically pars opercularis of left inferior frontal gyrus and precentral gyrus; LIFGpo/PCG) within ∼100ms of viewing a word. This is consistent with Broca’s area involvement in fast phonological access during visual word recognition. Here we used online transcranial magnetic stimulation (TMS) to investigate whether LIFGpo/PCG is necessary for (not just correlated with) visual word recognition by ∼100ms. Pulses were delivered to individually fMRI-defined LIFGpo/PCG in Dutch speakers 75–500ms after stimulus onset during reading and picture naming. Reading and picture naming reactions times were significantly slower following pulses at 225–300ms. Contrary to predictions, there was no disruption to reading for pulses before 225ms. This does not provide evidence in favour of a functional role for LIFGpo/PCG in reading before 225ms in this case, but does extend previous findings in picture stimuli to written Dutch words.

Recurrent Processing in V1/V2 Contributes to Categorization of Natural Scenes

Humans are able to categorize complex natural scenes very rapidly and effortlessly, which has led to an assumption that such ultra-rapid categorization is driven by feedforward activation of ventral brain areas. However, recent accounts of visual perception stress the role of recurrent interactions that start rapidly after the activation of V1. To study whether or not recurrent processes play a causal role in categorization, we applied fMRI-guided transcranial magnetic stimulation on early visual cortex (V1/V2) and lateral occipital cortex (LO) while the participants categorized natural images as containing animals or not. The results showed that V1/V2 contributed to categorization speed and to subjective perception during a long activity period before and after the contribution of LO had started. This pattern of results suggests that recurrent interactions in visual cortex between areas along the ventral stream and striate cortex play a causal role in categorization and perception of natural scenes.