Low-resolution Brain Electromagnetic Tomography Research Articles

The Use of Heart Rate Variability Biofeedback and Neurofeedback for Traumatic Brain Injury

The Use of Heart Rate Variability Biofeedback and Neurofeedback for Traumatic Brain Injury

Association of cerebrospinal fluid tap-related oscillatory activity and shunt outcome in idiopathic normal-pressure hydrocephalus.

Idiopathic normal-pressure hydrocephalus (iNPH) is a neuropsychiatric syndrome characterized by the clinical triad of gait disturbance, urinary dysfunction, and cognitive impairment. The aim of the present study was to find specific EEG patterns associated with shunt response in iNPH. Twenty five iNPH patients (10 shunt responders and 15 non-responders) were enrolled in this study. We performed current source density (CSD) analysis in several frequency bands (delta: 2-4 Hz, theta: 4-8 Hz, alpha: 8-13 Hz, beta: 13-30 Hz, gamma: 30-60 Hz) using exact Low Resolution Brain Electromagnetic Tomography (eLORETA). CSD distribution was compared between shunt responders and non-responders for each frequency band before and after CSF tap test. Shunt responders showed increased gamma CSD in the left temporal cortex before CSF tapping relative to non-responders. However, after CSF tapping, shunt response was associated with significantly higher CSDs in several frequency bands, specifically theta, alpha, beta and gamma, involving mainly the frontal and temporal areas. Using eLORETA analysis, we were able to identify cortical oscillatory activity before and after CSF tap test related to clinical recovery due to shunt operation in iNPH. Our findings support and extend the results of previous studies examining the effects of CSF tap test and shunt operation in patients with iNPH, possibly indicating electrophysiological features of shunt response in this disease. These findings warrant future studies to use EEG for prediction of shunt response in iNPH.

Decisional impairments in cocaine addiction, reward bias, and cortical oscillation "unbalance".

A vast amount of research has suggested that subjects with substance use disorder (SUD) might have difficulty making advantageous decisions that opt in favor of a longer-term, larger reward than an immediate, smaller reward. The current research explored the impact of reward bias and cortical frontal asymmetry (left lateralization effect) in SUD in response to a decisional task (Iowa Gambling Task). Fifty SUD participants and 40 controls (CG) were tested using the Iowa Gambling Task. Electrophysiology (electroencephalography) recording was performed during task execution. We measured left and right dorsolateral prefrontal cortex power activity. Behavioral responses (gain/loss options); frequency band modulation (asymmetry index) for delta, theta, alpha, and beta band; and cortical source localization (standardized low-resolution brain electromagnetic tomography) were considered. The SUD group opted in favor of the immediate reward option (loss) more frequently than the long-term option (gain) when compared to the CG. Secondly, SUD showed increased left-hemisphere activation in response to losing (with immediate reward) choices in comparison with the CG. The left hemispheric unbalance effect and the “reward bias” were adduced to explain the decisional impairment in SUD.

Emotion Regulation of Neuroticism: Emotional Information Processing Related to Psychosomatic State Evaluated by Electroencephalography and Exact Low-Resolution Brain Electromagnetic Tomography

Emotion regulation is the process that adjusts the type or amount of emotion when we experience an emotional situation. The aim of this study was to reveal quantitative changes in brain activity during emotional information processing related to psychosomatic states and to determine electrophysiological features of neuroticism. Twenty-two healthy subjects (mean age 25 years, 14 males and 8 females) were registered. Electroencephalography (EEG) was measured during an emotional audiovisual memory task under three conditions (neutral, pleasant and unpleasant sessions). We divided the subjects into two groups using the Cornell Medical Index (CMI): (CMI-I: control group, n = 10: CMI-II, III or IV: neuroticism group, n = 12). We analyzed the digital EEG data using exact low-resolution brain electromagnetic tomography (eLORETA) current source density (CSD) and functional connectivity analysis in several frequency bands (δ, θ, α, β, γ and whole band). In all subjects, bilateral frontal α CSD in the unpleasant session increased compared to the pleasant session, especially in the control group (p < 0.05). CSD of the neuroticism group was significantly higher than that of the control group in the full band at the amygdala and inferior temporal gyrus, and in the α band at the right temporal lobe (p < 0.05). Additionally, we found an increase in functional connectivity between the left insular cortex and right superior temporal gyrus in all subjects during the unpleasant session compared to the pleasant session (p < 0.05). In this study, using EEG analysis, we could find a novel cortical network related to brain mechanisms underlying emotion regulation. Overall findings indicate that it is possible to characterize neuroticism electrophysiologically, which may serve as a neurophysiological marker of this personality trait.

Conflict monitoring and adjustment in the task-switching paradigm under different memory load conditions: an ERP/sLORETA analysis.

The aim of the present study was to examine electrophysiological and behavioral changes caused by different memory loads in a task-switching paradigm. A total of 31 healthy individuals were subjected to a task, in which the stimulus-response reversal paradigm was combined with the task-switching paradigm. The event-related potentials were recorded and the N2 component, an index of conflict processing, was measured. In addition, the neural sources of N2 were further analyzed by standardized low-resolution brain electromagnetic tomography. The event-related potential results showed that high memory load triggered a higher N2 mean amplitude. Moreover, the standardized low-resolution brain electromagnetic tomography data showed that high memory load caused an increase in current densities at the anterior cingulate cortex and the prefrontal cortex in the task-switching paradigm. In summary, our findings provide electrophysiological evidence to interpret possible influences of memory loads on conflict monitoring and modulation during the task switching. These results imply that the working memory load overrules the influence of task-switching performance on the intensification of cognitive control.

Effects of caffeine and maltodextrin mouth rinsing on P300, brain imaging, and cognitive performance.

Caffeine (CAF) and maltodextrin (MALT) mouth rinses (MR) improve exercise performance. The current experiment aims to determine the effect of CAF and MALT MR on cognitive performance and brain activity. Ten healthy male subjects (age 27 ± 3 yr) completed three experimental trials. Each trial included four Stroop tasks: two familiarization tasks, and one task before and one task after an MR period. The reaction time (in milliseconds) and accuracy (percent) of simple, congruent, and incongruent stimuli were assessed. Electroencephalography was applied throughout the experiment to record brain activity. The amplitudes and latencies of the P300 were determined during the Stroop tasks before and after the MR period. Subjects received MR with CAF (0.3 g/25 ml), MALT (1.6 g/25 ml), or placebo (PLAC) in a randomized, double-blind, crossover design. During MR, the brain imaging technique standardized low-resolution brain electromagnetic tomography was applied. Magnitude-based inferences showed that CAF MR is likely trivial (63.5%) and likely beneficial (36.4%) compared with PLAC MR, and compared with MALT MR likely beneficial to reaction time on incongruent stimuli (61.6%). Additionally, both the orbitofrontal and dorsolateral prefrontal cortex were activated only during CAF MR, potentially explaining the likely beneficial effect on reaction times. MALT MR increased brain activity only within the orbitofrontal cortex. However, this brain activation did not alter the reaction time. Furthermore, no significant differences in the accuracy of stimuli responses were observed between conditions. In conclusion, only CAF MR exerted a likely beneficial effect on reaction time due to the subsequent activation of both the orbitofrontal and dorsolateral prefrontal cortexes.

Analysis of Electroencephalogram Resting State in Diffuse Axonal Injury ? A Pilot Study

Traumatic brain injury (TBI) is caused by an external mechanical force. The most common causes of TBI are car crash, falls, assaults and thefts and accidents during recreational activity. The acceleration-deceleration mechanism responsible for DAI, often damage the lateral and ventral regions of the frontal and temporal lobes. Deficits in attention and memory, difficulty in learning new information, solving problems and planning are common sequelae. Impulsivity and lack of self-control are also common after a TBI. Our goal was to correlate functional changes obtained in the electroencephalogram (EEG) with the cognitive decline in diffuse axonal injury (DAI) and understand the pathophysiology of this injury. Ten patients with diffuse axonal lesion and 5 control subjects were recruited by the Group of Cognitive Rehabilitation after TBI in the Division of Neurology, Clinics Hospital, Faculty of Medicine, University of Sao Paulo. A high-resolution EEG with 128 channels were performed at the Psychiatry Institute (LIM-23), University of Sao Paulo. The cortical sources of EEG rhythms were estimated by analysis of low resolution brain electromagnetic tomography (LORETA), which revealed that patients with DAI had reduced alpha activity and increased theta activity, indicating a slowing of brain activity. In contrast, control subjects showed a predominance of alpha activity and hippocampal activation during the exam, which was not observed in the group with DAI. The DAI patients showed reduced brain activity and little or no hippocampal activation, which is consistent with memory complaints presented by these patients.

Neuroplastic effects of combined computerized physical and cognitive training in elderly individuals at risk for dementia: an eLORETA controlled study on resting states.

The present study investigates whether a combined cognitive and physical training may induce changes in the cortical activity as measured via electroencephalogram (EEG) and whether this change may index a deceleration of pathological processes of brain aging. Seventy seniors meeting the clinical criteria of mild cognitive impairment (MCI) were equally divided into 5 groups: 3 experimental groups engaged in eight-week cognitive and/or physical training and 2 control groups: active and passive. A 5-minute long resting state EEG was measured before and after the intervention. Cortical EEG sources were modelled by exact low resolution brain electromagnetic tomography (eLORETA). Cognitive function was assessed before and after intervention using a battery of neuropsychological tests including the minimental state examination (MMSE). A significant training effect was identified only after the combined training scheme: a decrease in the post- compared to pre-training activity of precuneus/posterior cingulate cortex in delta, theta, and beta bands. This effect was correlated to improvements in cognitive capacity as evaluated by MMSE scores. Our results indicate that combined physical and cognitive training shows indices of a positive neuroplastic effect in MCI patients and that EEG may serve as a potential index of gains versus cognitive declines and neurodegeneration. This trial is registered with ClinicalTrials.gov Identifier NCT02313935.

Sleep affects cortical source modularity in temporal lobe epilepsy: A high-density EEG study

ObjectiveInterictal epileptiform discharges (IEDs) constitute a perturbation of ongoing cerebral rhythms, usually more frequent during sleep. The aim of the study was to determine whether sleep influences the spread of IEDs over the scalp and whether their distribution depends on vigilance-related modifications in cortical interactions. MethodsWake and sleep 256-channel electroencephalography (EEG) data were recorded in 12 subjects with right temporal lobe epilepsy (TLE) differentiated by whether they had mesial or neocortical TLE. Spikes were selected during wake and sleep. The averaged waking signal was subtracted from the sleep signal and projected on a bidimensional scalp map; sleep and wake spike distributions were compared by using a t-test. The superimposed signal of sleep and wake traces was obtained; the rising phase of the spike, the peak, and the deflections following the spike were identified, and their cortical generator was calculated using low-resolution brain electromagnetic tomography (LORETA) for each group. ResultsA mean of 21 IEDs in wake and 39 in sleep per subject were selected. As compared to wake, a larger IED scalp projection was detected during sleep in both mesial and neocortical TLE (p<0.05). A series of EEG deflections followed the spike, the cortical sources of which displayed alternating activations of different cortical areas in wake, substituted by isolated, stationary activations in sleep in mesial TLE and a silencing in neocortical TLE. ConclusionDuring sleep, the IED scalp region increases, while cortical interaction decreases. SignificanceThe interaction of cortical modules in sleep and wake in TLE may influence the appearance of IEDs on scalp EEG; in addition, IEDs could be proxies for cerebral oscillation perturbation.

Functional connectivity changes in adults with developmental stuttering: a preliminary study using quantitative electro-encephalography.

Introduction: Stuttering is defined as speech characterized by verbal dysfluencies, but should not be seen as an isolated speech disorder, but as a generalized sensorimotor timing deficit due to impaired communication between speech related brain areas. Therefore we focused on resting state brain activity and functional connectivity.Method: We included 11 patients with developmental stuttering and 11 age matched controls. To objectify stuttering severity and the impact on quality of life (QoL), we used the Dutch validated Test for Stuttering Severity-Readers (TSS-R) and the Overall Assessment of the Speaker’s Experience of Stuttering (OASES), respectively. Furthermore, we used standardized low resolution brain electromagnetic tomography (sLORETA) analyses to look at resting state activity and functional connectivity differences and their correlations with the TSS-R and OASES.Results: No significant results could be obtained when looking at neural activity, however significant alterations in resting state functional connectivity could be demonstrated between persons who stutter (PWS) and fluently speaking controls, predominantly interhemispheric, i.e., a decreased functional connectivity for high frequency oscillations (beta and gamma) between motor speech areas (BA44 and 45) and the contralateral premotor (BA6) and motor (BA4) areas. Moreover, a positive correlation was found between functional connectivity at low frequency oscillations (theta and alpha) and stuttering severity, while a mixed increased and decreased functional connectivity at low and high frequency oscillations correlated with QoL.Discussion: PWS are characterized by decreased high frequency interhemispheric functional connectivity between motor speech, premotor and motor areas in the resting state, while higher functional connectivity in the low frequency bands indicates more severe speech disturbances, suggesting that increased interhemispheric and right sided functional connectivity is maladaptive.

Zazen meditation and no-task resting EEG compared with LORETA intracortical source localization.

Meditation is a self-induced and willfully initiated practice that alters the state of consciousness. The meditation practice of Zazen, like many other meditation practices, aims at disregarding intrusive thoughts while controlling body posture. It is an open monitoring meditation characterized by detached moment-to-moment awareness and reduced conceptual thinking and self-reference. Which brain areas differ in electric activity during Zazen compared to task-free resting? Since scalp electroencephalography (EEG) waveforms are reference-dependent, conclusions about the localization of active brain areas are ambiguous. Computing intracerebral source models from the scalp EEG data solves this problem. In the present study, we applied source modeling using low resolution brain electromagnetic tomography (LORETA) to 58-channel scalp EEG data recorded from 15 experienced Zen meditators during Zazen and no-task resting. Zazen compared to no-task resting showed increased alpha-1 and alpha-2 frequency activity in an exclusively right-lateralized cluster extending from prefrontal areas including the insula to parts of the somatosensory and motor cortices and temporal areas. Zazen also showed decreased alpha and beta-2 activity in the left angular gyrus and decreased beta-1 and beta-2 activity in a large bilateral posterior cluster comprising the visual cortex, the posterior cingulate cortex and the parietal cortex. The results include parts of the default mode network and suggest enhanced automatic memory and emotion processing, reduced conceptual thinking and self-reference on a less judgmental, i.e., more detached moment-to-moment basis during Zazen compared to no-task resting.

P17. Isolated effective coherence (iCoh) based on estimated electric neuronal activity using exact low resolution brain electromagnetic tomography (eLORETA)

A problem of great interest in real world systems, where multiple time series measurements are available, is the estimation of the intra-system casual relations. For instance, electric cortical signals are used for studying functional connectivity between different brain areas, the directionality, the direct or indirect nature of the connections, and the spectral characteristics such as which frequencies are transmitted. The earliest spectral measure of causality was Akaike’s (1968) seminal work on the noise contribution ratio (NCR), reflecting direct and indirect connections. Later, the partial directed coherence (PDC) of Baccala and Sameshima (2001) was proposed for direct connections. In this study, the partial coherence is estimated under a stable, stationary multivariate auto-regressive model with stable isolated self-auto-regressions. The new measure of direct causal coherence, namely the isolated causal coherence (iCC), is defined under the “a posteriori” assumption that all irrelevant connections are zero. It is shown that when these assumptions are applied to the NCR, it produces the iCC, thus enriching its interpretability. In comparison with the iCC, it is shown that the PDC is affected by irrelevant connections to such an extent that it can misrepresent the frequency response. Toy examples are included to demonstrate these properties. Analysis of real EEG data is also included.

P37. Decreased functional electrophysiological cortical connectivity in first episode medication-naive schizophrenics: A three-center study

Aims Abnormality of thought and emotion in schizophrenic patients is widely hypothesized to be caused by functional dissociation between brain processes. Analyses of the typically small groups of schizophrenic patients yielded different neurophysiological findings, because small patient groups are likely to comprise different schizophrenia subtypes. We wanted to see whether there are identical deteriorated cortical functional EEG connectivities in different patient groups. Methods Multichannel no-task resting eyes-closed EEG from three small groups of acutely ill, first episode productive schizophrenic patients before start of medication (from three centers: Bern N = 9; Osaka N = 9; Berlin N = 12) and their controls was analyzed. Using LORETA (low resolution brain electromagnetic tomography), we computed intracortical source model-based lagged functional connectivity (not biased by volume conduction effects) between 19 cortical regions of interest (ROIs). The connectivities were compared between controls and patients of each group. The results across groups were combined using conjunction analysis. Results Six aberrant cortical functional connectivities were identical in the three patient groups as determined by conjunction analysis. Four of these occurred in the facilitating EEG alpha 1 frequency band; they were decreased in the patients. Another two of these occurred in the inhibiting EEG delta frequency band; they were increased in the patients. Thus, all six reduced the functional interactions between the concerned brain regions. The principal spatial orientation of the six aberrant cortical functional connectivities was sagittal; five of them involved both hemispheres. Conclusions The study shows that, common across schizophrenia subtypes in the three patient groups, a core set of functional connections between the preprocessing functions in posterior brain areas and the evaluation and behavior control functions in anterior brain areas is compromised. The results also support the concept of functional dissociation in schizophrenia.

P.1.b.015 Effects of smoked cannabis on EEG, on standardised low-resolution brain electromagnetic tomography (sLORETA) and on prepulse inhibition

P.1.b.015 Effects of smoked cannabis on EEG, on standardised low-resolution brain electromagnetic tomography (sLORETA) and on prepulse inhibition

Location of Irritative Zone in Epileptic Brains of Schizencephalic Patients.

Although many schizencephaly patients suffer from epilepsy, the relationship between schizencephalic lesions and epileptic foci remains unclear. Previous studies have shown that schizencephalic lesions may be associated with, rather than contain, epileptogenic zones. Thus, the purpose of this study was to investigate the current source distribution (CSD) of epileptiform discharges in schizencephalic patients and to correlate this activity with existing structural lesions. A consecutive series of 30 schizencephalic patients who were diagnosed using brain magnetic resonance imaging (MRI) were selected retrospectively and prospectively. Of the original 30 subjects selected, 13 had epilepsy, and 6 of these patients exhibited schizencephaly, epilepsy, and interictal spikes on electroencephalograms (EEG) and were enrolled in the present study investigating the current source analysis of interictal spikes. The CSDs of the initial rising phases and the peak points of the interictal spikes were obtained using standardized low-resolution brain electromagnetic tomography (LORETA). Five patients exhibited a single focus of interictal spikes, while 1 patient showed 2 foci. Relative to the structural brain lesions, 5 patients displayed extrinsically localized CSDs, while 1 patient showed a partially intrinsically localized CSD. The present findings demonstrate that the CSDs of interictal spikes in schizencephalic patients are in general anatomically distinct from the cerebral schizencephalic lesions and that these lesions may display an extrinsic epileptogenicity.

Occipital sources of resting-state alpha rhythms are related to local gray matter density in subjects with amnesic mild cognitive impairment and Alzheimer's disease

Occipital sources of resting-state electroencephalographic (EEG) alpha rhythms are abnormal, at the group level, in patients with amnesic mild cognitive impairment (MCI) and Alzheimer's disease (AD). Here, we evaluated the hypothesis that amplitude of these occipital sources is related to neurodegeneration in occipital lobe as measured by magnetic resonance imaging. Resting-state eyes-closed EEG rhythms were recorded in 45 healthy elderly (Nold), 100 MCI, and 90 AD subjects. Neurodegeneration of occipital lobe was indexed by weighted averages of gray matter density, estimated from structural MRIs. EEG rhythms of interest were alpha 1 (8–10.5 Hz) and alpha 2 (10.5–13 Hz). EEG cortical sources were estimated by low-resolution brain electromagnetic tomography. Results showed a positive correlation between occipital gray matter density and amplitude of occipital alpha 1 sources in Nold, MCI, and AD subjects as a whole group (r = 0.3, p = 0.000004, N = 235). Furthermore, there was a positive correlation between the amplitude of occipital alpha 1 sources and cognitive status as revealed by Mini Mental State Examination score across all subjects (r = 0.38, p = 0.000001, N = 235). Finally, amplitude of occipital alpha 1 sources allowed a moderate classification of individual Nold and AD subjects (sensitivity: 87.8%; specificity: 66.7%; area under the receiver operating characteristic curve: 0.81). These results suggest that the amplitude of occipital sources of resting-state alpha rhythms is related to AD neurodegeneration in occipital lobe along pathologic aging.

Functionally aberrant electrophysiological cortical connectivities in first episode medication-naive schizophrenics from three psychiatry centers.

Functional dissociation between brain processes is widely hypothesized to account for aberrations of thought and emotions in schizophrenic patients. The typically small groups of analyzed schizophrenic patients yielded different neurophysiological findings, probably because small patient groups are likely to comprise different schizophrenia subtypes. We analyzed multichannel eyes-closed resting EEG from three small groups of acutely ill, first episode productive schizophrenic patients before start of medication (from three centers: Bern N = 9; Osaka N = 9; Berlin N = 12) and their controls. Low resolution brain electromagnetic tomography (LORETA) was used to compute intracortical source model-based lagged functional connectivity not biased by volume conduction effects between 19 cortical regions of interest (ROIs). The connectivities were compared between controls and patients of each group. Conjunction analysis determined six aberrant cortical functional connectivities that were the same in the three patient groups. Four of these six concerned the facilitating EEG alpha-1 frequency activity; they were decreased in the patients. Another two of these six connectivities concerned the inhibiting EEG delta frequency activity; they were increased in the patients. The principal orientation of the six aberrant cortical functional connectivities was sagittal; five of them involved both hemispheres. In sum, activity in the posterior brain areas of preprocessing functions and the anterior brain areas of evaluation and behavior control functions were compromised by either decreased coupled activation or increased coupled inhibition, common across schizophrenia subtypes in the three patient groups. These results of the analyzed three independent groups of schizophrenics support the concept of functional dissociation.

From episodic to habitual prospective memory: ERP-evidence for a linear transition.

Performing a prospective memory task repeatedly changes the nature of the task from episodic to habitual. The goal of the present study was to investigate the neural basis of this transition. In two experiments, we contrasted event-related potentials (ERPs) evoked by correct responses to prospective memory targets in the first, more episodic part of the experiment with those of the second, more habitual part of the experiment. Specifically, we tested whether the early, middle, or late ERP-components, which are thought to reflect cue detection, retrieval of the intention, and post-retrieval processes, respectively, would be changed by routinely performing the prospective memory task. The results showed a differential ERP effect in the middle time window (450–650 ms post-stimulus). Source localization using low resolution brain electromagnetic tomography analysis suggests that the transition was accompanied by an increase of activation in the posterior parietal and occipital cortex. These findings indicate that habitual prospective memory involves retrieval processes guided more strongly by parietal brain structures. In brief, the study demonstrates that episodic and habitual prospective memory tasks recruit different brain areas.

Does sensorimotor cortex activity change with quadriceps femoris torque output? A human electroencephalography study

Encoding muscular force output during voluntary contractions is widely perceived to result, at least in part, from modulations in neuronal activity within the sensorimotor cortex. However the underlying electrophysiological phenomena associated with increased force output remains unclear. This study directly assessed sensorimotor cortex activity using electroencephalography (EEG) in humans performing isometric knee-extensions at a range of discrete torque levels. Fifteen healthy males (age 24 (s=5) years) completed one familiarization and one experimental trial. Participants performed a cyclic series of 60 isometric knee-extension contractions with the right leg, including 15 contractions of a 5-s duration at each of four discrete torque levels: 15%, 30%, 45% and 60% of maximal voluntary torque (MVT). Isometric knee-extension torque, quadriceps electromyography and EEG were recorded at rest and throughout all the contractions. EEG (0.5–50Hz) was collected using a 32-channel active-electrode cap. A voxel-based low-resolution brain electromagnetic tomography (LORETA) analysis calculated cortical activation within the sensorimotor cortex (one of 27 MNI coordinates) for the entire 0.5–50-Hz range (cortical current density (CCD)), as well as for each constituent frequency band in this range (delta, theta, alpha, beta and gamma). Gamma band (30–50Hz) cortical activity increased with contraction torque (analysis of variance [ANOVA], P=0.03). Conversely, activity within the other frequency bands was not modulated by torque (P⩾0.09), nor was overall CCD (P=0.11). Peripheral neuromuscular activation (quadriceps electromyography (EMG) amplitude) demonstrated distinct increases between each torque level (P<0.01). In conclusion, sensorimotor cortical activity within the gamma band demonstrated an overall increase with contraction torque, whereas both CCD and each of the other constituent frequency bands were not modulated by increments in torque magnitude during isometric knee-extension contractions up to 60%MVT.

The effects of 3 weeks of rTMS treatment on P200 amplitude in patients with depression

Previous studies have reported that repetitive transcranial magnetic stimulation (rTMS) induces neuronal plasticity in the brain. Although event-related potential (ERP) is an exploration tool, the rTMS effects on ERPs in patients with major depression have not been fully explored. We demonstrated that rTMS treatment induces changes in brain function in patients with medication-resistant major depression using the ERP. Eighteen patients with medication-resistant major depression (five males and 13 females) participated in this study. The patients received rTMS treatment for 3 weeks. All patients completed clinical scales, including the Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Scale (HAM-A), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (SAI, TAI), Ruminative Response Scale, Emotion Regulation Questionnaire, and Cognitive Emotion Regulation Questionnaire (CERQ), as well as the ERP auditory oddball task, at their first visit (baseline) and at the 3-week visit (3-weeks). The HAM-D, HAM-A, BDI, SAI, and “blaming others” scale of the CERQ decreased significantly after rTMS treatment. In ERP auditory oddball task, when FP1, FP2, FZ, FCZ, CZ, and PZ channels were analyzed, P200 amplitudes showed a main effect for time of measurement and increased after 3 weeks of rTMS treatment. Standardized low-resolution brain electromagnetic tomography showed significant activation in the left middle frontal gyrus by 3 weeks of rTMS treatment. The results suggest that relatively longer rTMS treatment induces changes in brain function in patients with medication-resistant major depression, which can be identified using ERP.