Reliability and Validity of Transcranial Magnetic Stimulation–Electroencephalography Biomarkers

Parmigiani, Sara; Ross, Jessica M.; Cline, Christopher C.; Minasi, Christopher; Gogulski, Juha; Keller, Corey J.

doi:10.1016/j.bpsc.2022.12.005

Cited by 13 publications

(19 citation statements)

References 115 publications

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“…In both groups, single-pulse TMS determined several early (<100 ms) voltage deflections >5 μv ( Figure 1 ), which is consistent with effective cortical stimulation [ 30 , 49 ]. In addition, the relatively low amplitude of late (>100 ms) TEP components suggested an effective suppression of “off-target” auditory artifacts [ 38 , 44 ].…”

Section: Resultssupporting

confidence: 68%

Natural Oscillatory Frequency Slowing in the Premotor Cortex of Early-Course Schizophrenia Patients: A TMS-EEG Study

et al. 2023

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Despite the heavy burden of schizophrenia, research on biomarkers associated with its early course is still ongoing. Single-pulse Transcranial Magnetic Stimulation coupled with electroencephalography (TMS-EEG) has revealed that the main oscillatory frequency (or “natural frequency”) is reduced in several frontal brain areas, including the premotor cortex, of chronic patients with schizophrenia. However, no study has explored the natural frequency at the beginning of illness. Here, we used TMS-EEG to probe the intrinsic oscillatory properties of the left premotor cortex in early-course schizophrenia patients (<2 years from onset) and age/gender-matched healthy comparison subjects (HCs). State-of-the-art real-time monitoring of EEG responses to TMS and noise-masking procedures were employed to ensure data quality. We found that the natural frequency of the premotor cortex was significantly reduced in early-course schizophrenia compared to HCs. No correlation was found between the natural frequency and age, clinical symptom severity, or dose of antipsychotic medications at the time of TMS-EEG. This finding extends to early-course schizophrenia previous evidence in chronic patients and supports the hypothesis of a deficit in frontal cortical synchronization as a core mechanism underlying this disorder. Future work should further explore the putative role of frontal natural frequencies as early pathophysiological biomarkers for schizophrenia.

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Section: Resultssupporting

confidence: 68%

Natural Oscillatory Frequency Slowing in the Premotor Cortex of Early-Course Schizophrenia Patients: A TMS-EEG Study

et al. 2023

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“…Moreover, no statistically significant differences have been found for M1-P15 amplitude and latency between the contracted and the relaxed ipsilateral hand (Zazio et al, 2022). Therefore, these data suggest that M1-P15 amplitude can be measured with high stability at a single subject level and meet crucial criteria for developing cortico-cortical connectivity-based biomarkers (Julkunen et al, 2022;Parmigiani et al, 2022), provided the same TMS parameters of the original studies (Bortoletto et al, 2021;Zazio et al, 2022). Further studies will be needed to understand if these results can be generalized to different target areas and other TEP components, as previous works have reported inconsistencies in replicability (de Goede et al, 2020;Kerwin et al, 2018), which may also depend on signal preprocessing (Bertazzoli et al, 2021).…”

Section: Discussionmentioning

confidence: 81%

Effects of transcranial magnetic stimulation (TMS) current direction and pulse waveform on cortico‐cortical connectivity: A registered report TMS‐EEG study

Guidali,

Zazio,

Lucarelli

et al. 2023

Eur J of Neuroscience

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Transcranial magnetic stimulation (TMS)‐evoked potentials (TEPs) are a promising proxy for measuring effective connectivity, that is, the directed transmission of physiological signals along cortico‐cortical tracts, and for developing connectivity‐based biomarkers. A crucial point is how stimulation parameters may affect TEPs, as they may contribute to the general variability of findings across studies. Here, we manipulated two TMS parameters (i.e. current direction and pulse waveform) while measuring (a) an early TEP component reflecting contralateral inhibition of motor areas, namely, M1‐P15, as an operative model of interhemispheric cortico‐cortical connectivity, and (b) motor‐evoked potentials (MEP) for the corticospinal pathway. Our results showed that these two TMS parameters are crucial to evoke the M1‐P15, influencing its amplitude, latency, and replicability. Specifically, (a) M1‐P15 amplitude was strongly affected by current direction in monophasic stimulation; (b) M1‐P15 latency was significantly modulated by current direction for monophasic and biphasic pulses. The replicability of M1‐P15 was substantial for the same stimulation condition. At the same time, it was poor when stimulation parameters were changed, suggesting that these factors must be controlled to obtain stable single‐subject measures. Finally, MEP latency was modulated by current direction, whereas non‐statistically significant changes were evident for amplitude. Overall, our study highlights the importance of TMS parameters for early TEP responses recording and suggests controlling their impact in developing connectivity biomarkers from TEPs. Moreover, these results point out that the excitability of the corticospinal tract, which is commonly used as a reference to set TMS intensity, may not correspond to the excitability of cortico‐cortical pathways.

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“…Most importantly, future work should also explore whether this experimental approach can be used for real-time measurement of monitoring the neural effects of TMS trains. If successful, this real-time approach has important implications in developing closed-loop adaptive TMS treatments 59 .…”

Section: Discussionmentioning

confidence: 99%

Neural effects of TMS trains on the human prefrontal cortex

Ross

Cline

Sarkar

et al. 2023

Preprint

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Despite adoption of repetitive TMS (rTMS) for the treatment of neuropsychiatric disorders, a lack of understanding of its neural effects limits our ability to monitor, personalize, and adapt treatments. Here we address the methodological limitations in capturing the neural response to a single TMS train, the fundamental building block of treatment. We developed methods to measure these effects noninvasively and evaluated the acute neural response to single and sequential TMS trains. In 16 healthy adults, we applied 10 Hz trains to the dorsolateral prefrontal cortex (dlPFC) in a randomized, sham-controlled, event-related design and assessed changes to the TMS-evoked potential (TEP), a measure of local cortical excitability. We hypothesized that single TMS trains would induce changes in the local TEP amplitude that would accumulate across trains, but we found no evidence in support of this hypothesis. However, exploratory analyses demonstrated modulations non-locally and in phase and source space. Single and sequential TMS trains may not be sufficient to modulate the local TEP amplitude, but induce acute neural changes measured in alternative ways. This work should be contextualized as methods development for the monitoring of transient neural changes during rTMS and contributes to a growing understanding of the neural effects of rTMS.

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Reliability and Validity of Transcranial Magnetic Stimulation–Electroencephalography Biomarkers

Cited by 13 publications

References 115 publications

Natural Oscillatory Frequency Slowing in the Premotor Cortex of Early-Course Schizophrenia Patients: A TMS-EEG Study

Natural Oscillatory Frequency Slowing in the Premotor Cortex of Early-Course Schizophrenia Patients: A TMS-EEG Study

Effects of transcranial magnetic stimulation (TMS) current direction and pulse waveform on cortico‐cortical connectivity: A registered report TMS‐EEG study

Neural effects of TMS trains on the human prefrontal cortex

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