Large-scale analysis of interindividual variability in single and paired-pulse TMS data

Corp, Daniel T; Bereznicki, Hannah; Clark, Gillian M.; Youssef, George; Fried, Peter J.; Jannati, Ali; Davies, Charlotte B.; Gomes‐Osman, Joyce; Kirkovski, Melissa; Albein‐Urios, Natalia; Fitzgerald, Paul B.; Koch, Giacomo; Lazzaro, Vincenzo Di; Pascual‐Leone, Álvaro; Enticott, Peter G.

doi:10.1016/j.clinph.2021.06.014

Cited by 55 publications

(55 citation statements)

References 82 publications

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“…If TMS effects are not sufficiently reliable, they thus have limited use as a biomarker for individual changes in neuroplasticity and concomitant desirable changes in cognition and behavior ( Schambra et al, 2015 ). It is therefore important to identify the factors that contribute to the variability of TMS effects ( Corp et al, 2020 , 2021 ), such that the consistency and efficacy of TMS can be improved. We here discuss one possible source of this variance, namely, spontaneous fluctuations in neuronal oscillations ( Buzsáki and Draguhn, 2004 ; Pasley et al, 2009 ; Iscan et al, 2016 ; Bergmann, 2018 ).…”

Section: Immediate and Aftereffects Of Transcranial Magnetic Stimulation Show High Inter- And Intra-subject Variabilitymentioning

confidence: 99%

Spontaneous Fluctuations in Oscillatory Brain State Cause Differences in Transcranial Magnetic Stimulation Effects Within and Between Individuals

Janssens

Sack

2021

Front. Hum. Neurosci.

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Transcranial magnetic stimulation (TMS) can cause measurable effects on neural activity and behavioral performance in healthy volunteers. In addition, TMS is increasingly used in clinical practice for treating various neuropsychiatric disorders. Unfortunately, TMS-induced effects show large intra- and inter-subject variability, hindering its reliability, and efficacy. One possible source of this variability may be the spontaneous fluctuations of neuronal oscillations. We present recent studies using multimodal TMS including TMS-EMG (electromyography), TMS-tACS (transcranial alternating current stimulation), and concurrent TMS-EEG-fMRI (electroencephalography, functional magnetic resonance imaging), to evaluate how individual oscillatory brain state affects TMS signal propagation within targeted networks. We demonstrate how the spontaneous oscillatory state at the time of TMS influences both immediate and longer-lasting TMS effects. These findings indicate that at least part of the variability in TMS efficacy may be attributable to the current practice of ignoring (spontaneous) oscillatory fluctuations during TMS. Ignoring this state-dependent spread of activity may cause great individual variability which so far is poorly understood and has proven impossible to control. We therefore also compare two technical solutions to directly account for oscillatory state during TMS, namely, to use (a) tACS to externally control these oscillatory states and then apply TMS at the optimal (controlled) brain state, or (b) oscillatory state-triggered TMS (closed-loop TMS). The described multimodal TMS approaches are paramount for establishing more robust TMS effects, and to allow enhanced control over the individual outcome of TMS interventions aimed at modulating information flow in the brain to achieve desirable changes in cognition, mood, and behavior.

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Section: Immediate and Aftereffects Of Transcranial Magnetic Stimulation Show High Inter- And Intra-subject Variabilitymentioning

confidence: 99%

Spontaneous Fluctuations in Oscillatory Brain State Cause Differences in Transcranial Magnetic Stimulation Effects Within and Between Individuals

Janssens

Sack

2021

Front. Hum. Neurosci.

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“…Because TMS is widely used, intersubject and intrasubject variabilities in response to TMS are matters of concern. Many studies have reported that intersubject and intrasubject variability in response to rTMS may reduce or even lose the effect of rTMS ( Corp et al, 2021 , Corp et al, 2020 , Ellaway et al, 1998 , Hamada et al, 2013 ). Up to 50% of participants can fail to have an “expected” response to the rTMS protocol ( Hamada et al, 2013 ).…”

Section: Introductionmentioning

confidence: 99%

“…Up to 50% of participants can fail to have an “expected” response to the rTMS protocol ( Hamada et al, 2013 ). In addition to rTMS, single- and paired-pulse TMS exhibit intersubject and intrasubject variability in the response, thus possibly affecting the sensitivity and reproducibility of TMS measurements ( Corp et al, 2021 , Ellaway et al, 1998 , Goldsworthy et al, 2016 , Wassermann, 2002 ). Previous studies reported that multiple factors are associated with the variability in response to rTMS including physiological states of participants and methodological factors.…”

Section: Introductionmentioning

confidence: 99%

“…Intake of substances, medications, sleep deprivation, exercise, and arousal state are modifiable factors that may interfere in intersubject or intrasubject variability in the response to rTMS ( Guerra et al, 2020 , Huang et al, 2017 , Mang et al, 2014 ). Oscillations in the electroencephalogram, motor threshold, and baseline MEP amplitude may be associated with intersubject or intrasubject variability in the response to single- or paired-pulse TMS ( Corp et al, 2021 , Iscan et al, 2016 ).…”

Section: Introductionmentioning

confidence: 99%

“…The use of neuronavigation was reported as a predict factor for individual single-pulse TMS amplitude ( Corp et al, 2021 ). Therefore, technical factors should be considered crucial for the variability of results.…”

Section: Introductionmentioning

confidence: 99%

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Impact of operator experience on transcranial magnetic stimulation

Lin

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Huang

2022

Clinical Neurophysiology Practice

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Neurophysiological effects of a combined treatment of lovastatin and minocycline in patients with fragile X syndrome: Ancillary results of the LOVAMIX randomized clinical trial

Morin‐Parent,

Champigny,

Côté

et al. 2024

Autism Research

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Fragile X syndrome (FXS) is the primary hereditary cause of intellectual disability and autism spectrum disorder. It is characterized by exacerbated neuronal excitability, and its correction is considered an objective measure of treatment response in animal models, a marker albeit rarely used in clinical trials. Here, we used an extensive transcranial magnetic stimulation (TMS) battery to assess the neurophysiological effects of a therapy combining two disease‐modifying drugs, lovastatin (40 mg) and minocycline (100 mg), administered alone for 8 weeks and in combination for 12 weeks, in 19 patients (mean age of 23.58 ± 1.51) with FXS taking part in the LOVAmix trial. The TMS battery, which included the resting motor threshold, short‐interval intracortical inhibition, long‐interval intracortical inhibition, corticospinal silent period, and intracortical facilitation, was completed at baseline after 8 weeks of monotherapy (visit 2 of the clinical trial) and after 12 weeks of dual therapy (visit 4 of the clinical trial). Repeated measure ANOVAs were performed between baseline and visit 2 (monotherapy) and visit 3 (dual therapy) with interactions for which monotherapy the participants received when they began the clinical trial. Results showed that dual therapy was associated with reduced cortical excitability after 20 weeks. This was reflected by a significant increase in the resting‐motor threshold after dual therapy compared to baseline. There was a tendency for enhanced short‐intracortical inhibition, a marker of GABAa‐mediated inhibition after 8 weeks of monotherapy compared to baseline. Together, these results suggest that a combined therapy of minocycline and lovastatin might act on the core neurophysiopathology of FXS. This trial was registered at clinicaltrials.gov (NCT02680379).

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Large-scale analysis of interindividual variability in single and paired-pulse TMS data

Cited by 55 publications

References 82 publications

Spontaneous Fluctuations in Oscillatory Brain State Cause Differences in Transcranial Magnetic Stimulation Effects Within and Between Individuals

Spontaneous Fluctuations in Oscillatory Brain State Cause Differences in Transcranial Magnetic Stimulation Effects Within and Between Individuals

Impact of operator experience on transcranial magnetic stimulation

Neurophysiological effects of a combined treatment of lovastatin and minocycline in patients with fragile X syndrome: Ancillary results of the LOVAMIX randomized clinical trial

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