Suppression of visual perception by transcranial magnetic stimulation--experimental findings in healthy subjects and patients with optic neuritis

The visual system as target of non-invasive brain stimulation for migraine treatment: Current insights and future challenges

The visual network is crucially implicated in the pathophysiology of migraine. Several lines of evidence indicate that migraine is characterized by an altered visual cortex excitability both during and between attacks. Visual symptoms, the most common clinical manifestation of migraine aura, are likely the result of cortical spreading depression originating from the extrastriate area V3A. Photophobia, a clinical hallmark of migraine, is linked to an abnormal sensory processing of the thalamus which is converged with the non-image forming visual pathway. Finally, visual snow is an increasingly recognized persistent visual phenomenon in migraine, possibly caused by increased perception of subthreshold visual stimuli. Emerging research in non-invasive brain stimulation (NIBS) has vastly developed into a diversity of areas with promising potential. One of its clinical applications is the single-pulse transcranial magnetic stimulation (sTMS) applied over the occipital cortex which has been approved for treating migraine with aura, albeit limited evidence. Studies have also investigated other NIBS techniques, such as repetitive TMS (rTMS) and transcranial direct current stimulation (tDCS), for migraine prophylaxis but with conflicting results. As a dynamic brain disorder with widespread pathophysiology, targeting migraine with NIBS is challenging. Furthermore, unlike the motor cortex, evidence suggests that the visual cortex may be less plastic. Controversy exists as to whether the same fundamental principles of NIBS, based mainly on findings in the motor cortex, can be applied to the visual cortex. This review aims to explore existing literature surrounding NIBS studies on the visual system of migraine. We will first provide an overview highlighting the direct implication of the visual network in migraine. Next, we will focus on the rationale behind using NIBS for migraine treatment, including its effects on the visual cortex, and the shortcomings of currently available evidence. Finally, we propose a broader perspective of how novel approaches, the concept of brain networks and the integration of multimodal imaging with computational modeling, can help refine current NIBS methods, with the ultimate goal of optimizing a more individualized treatment for migraine.

Can processing of face trustworthiness bypass early visual cortex? A transcranial magnetic stimulation masking study

As a highly social species, we constantly evaluate human faces to decide whether we can trust someone. Previous studies suggest that face trustworthiness can be processed unconsciously, but the underlying neural pathways remain unclear. Specifically, the question remains whether processing of face trustworthiness relies on early visual cortex (EVC), required for conscious perception. If processing of trustworthiness can bypass EVC, then disrupting EVC should impair subjective (conscious) trustworthiness perception while leaving objective (forced-choice) trustworthiness judgment intact. We applied double-pulse transcranial magnetic stimulation (TMS) to right EVC, at different stimulus onset asynchronies (SOAs) from presentation of a face in either the left or right hemifield. Faces were slightly rotated clockwise or counterclockwise, and were either trustworthy or untrustworthy. On each trial, participants discriminated 1) trustworthiness, 2) stimulus rotation, and 3) reported subjective visibility of trustworthiness. At early SOAs and specifically in the left hemifield, performance on the rotation task was impaired by TMS. Crucially, though TMS also impaired subjective visibility of trustworthiness, no effects on trustworthiness discrimination were obtained. Thus, conscious perception of face trustworthiness (captured by subjective visibility ratings) relies on intact EVC, while objective forced-choice trustworthiness judgments may not. These results are consistent with the hypothesis that objective trustworthiness processing can bypass EVC. For basic visual features, extrastriate pathways are well-established; but face trustworthiness depends on a complex configuration of features. Its potential processing without EVC is therefore of particular interest, further highlighting its ecological relevance.

The chronometry of visual perception: review of occipital TMS masking studies

Transcranial magnetic stimulation (TMS) continues to deliver on its promise as a research tool. In this review article we focus on the application of TMS to early visual cortex (V1, V2, V3) in studies of visual perception and visual awareness. Depending on the asynchrony between visual stimulus onset and TMS pulse (SOA), TMS can suppress visual perception, allowing one to track the time course of functional relevance (chronometry) of early visual cortex for vision. This procedure has revealed multiple masking effects ('dips'), some consistently (∼+100ms SOA) but others less so (∼-50ms, ∼-20ms, ∼+30ms, ∼+200ms SOA). We review the state of TMS masking research, focusing on the evidence for these multiple dips, the relevance of several experimental parameters to the obtained 'masking curve', and the use of multiple measures of visual processing (subjective measures of awareness, objective discrimination tasks, priming effects). Lastly, we consider possible future directions for this field. We conclude that while TMS masking has yielded many fundamental insights into the chronometry of visual perception already, much remains unknown. Not only are there several temporal windows when TMS pulses can induce visual suppression, even the well-established 'classical' masking effect (∼+100ms) may reflect more than one functional visual process.

Feedforward and quick recurrent processes in early visual cortex revealed by TMS?

Transcranial magnetic stimulation (TMS) can be applied to occipital cortex to abolish (conscious) perception of visual stimuli. TMS research has revealed several time windows of masking relative to visual stimulus onset, most consistently a time window around 100ms post-stimulus. However, the exact nature of visual processing in this 'classical' time window, e.g. whether it represents the feedforward processing of the visual information, or rather a feedback projection from higher visual areas, remains unclear. Here, we used TMS to mask in the same participants two types of stimuli of different complexities (orientation Gratings and Faces) over different time windows. Interestingly, the masking functions were not the same for both stimulus types. We found an earlier peak masking latency for orientation stimuli, and a slower recovery for Faces. In a second, follow-up experiment, we superimposed both types of stimuli to create one composite stimulus set. Depending on the instruction, participants could then perform orientation or face discrimination tasks on the exact same stimuli. In addition, for each participant, stimuli were calibrated to equate task difficulties. The peak masking latency was now identical for both tasks, but the masking function revealed again a slower recovery during the face discrimination task, suggesting top-down (recurrent) effects in the second half of the masking function. Hence, rather than this masking window reflecting either feedforward or feedback processing, the early part of what is traditionally considered one masking window may reflect feedforward processing, while the latter part may already reflect recurrent processing. These findings shed new light on recurrent models of vision and related theoretical accounts of visual awareness.

Two phases of V1 activity for visual recognition of natural images

Present theories of visual recognition emphasize the role of interactive processing across populations of neurons within a given network, but the nature of these interactions remains unresolved. In particular, data describing the sufficiency of feedforward algorithms for conscious vision and studies revealing the functional relevance of feedback connections to the striate cortex seem to offer contradictory accounts of visual information processing. TMS is a good method to experimentally address this issue, given its excellent temporal resolution and its capacity to establish causal relations between brain function and behavior. We studied 20 healthy volunteers in a visual recognition task. Subjects were briefly presented with images of animals (birds or mammals) in natural scenes and were asked to indicate the animal category. MRI-guided stereotaxic single TMS pulses were used to transiently disrupt striate cortex function at different times after image onset (SOA). Visual recognition was significantly impaired when TMS was applied over the occipital pole at SOAs of 100 and 220 msec. The first interval has consistently been described in previous TMS studies and is explained as the interruption of the feedforward volley of activity. Given the late latency and discrete nature of the second peak, we hypothesize that it represents the disruption of a feedback projection to V1, probably from other areas in the visual network. These results provide causal evidence for the necessity of recurrent interactive processing, through feedforward and feedback connections, in visual recognition of natural complex images.

Occipital transcranial magnetic stimulation has opposing effects on visual and auditory stimulus detection: implications for multisensory interactions

Multisensory interactions occur early in time and in low-level cortical areas, including primary cortices. To test current models of early auditory-visual (AV) convergence in unisensory visual brain areas, we studied the effect of transcranial magnetic stimulation (TMS) of visual cortex on behavioral responses to unisensory (auditory or visual) or multisensory (simultaneous auditory-visual) stimulus presentation. Single-pulse TMS was applied over the occipital pole at short delays (30-150 ms) after external stimulus onset. Relative to TMS over a control site, reactions times (RTs) to unisensory visual stimuli were prolonged by TMS at 60-75 ms poststimulus onset (visual suppression effect), confirming stimulation of functional visual cortex. Conversely, RTs to unisensory auditory stimuli were significantly shortened when visual cortex was stimulated by TMS at the same delays (beneficial interaction effect of auditory stimulation and occipital TMS). No TMS-effect on RTs was observed for AV stimulation. The beneficial interaction effect of combined unisensory auditory and TMS-induced visual cortex stimulation matched and was correlated with the RT-facilitation after external multisensory AV stimulation without TMS, suggestive of multisensory interactions between the stimulus-evoked auditory and TMS-induced visual cortex activities. A follow-up experiment showed that auditory input enhances excitability within visual cortex itself (using phosphene-induction via TMS as a measure) over a similarly early time-window (75-120 ms). The collective data support a mechanism of early auditory-visual interactions that is mediated by auditory-driven sensitivity changes in visual neurons that coincide in time with the initial volleys of visual input.

Revisiting the backward masking deficit in schizophrenia: individual differences in performance and modeling with transcranial magnetic stimulation

BACKGROUND

Deficits in backward masking have been variably reported in schizophrenia patients, but individual differences in the expression of these deficits have not been explicitly investigated. In addition, increased knowledge of the visual system has opened the door for new techniques such as transcranial magnetic stimulation (TMS) to explore these deficits physiologically.

METHODS

Patients with schizophrenia and healthy controls were tested using a backward masking paradigm. In order to examine the functionality of visual pathways involved in backward masking, subjects were retested on a backward masking paradigm using single pulse TMS applied to occipital cortex in lieu of the masking stimuli.

RESULTS

Compared with controls, patients had significantly delayed recovery from visual backward masking. However, 23.5% of patients (compared to 5% of controls) never recovered to levels approaching unmasked performance. When these subjects were segregated from the analysis, group differences vanished. In addition, stimulus masking with occipital TMS followed the same pattern in both patients and controls.

CONCLUSIONS

Observations of individual differences in visual masking performance may identify a subgroup of schizophrenia patients. The TMS data suggest that this deficit may not localize to the occipital cortex. However, TMS can be a useful tool for localizing processing deficits in schizophrenia.

Role of the calcarine cortex (V1) in perception of visual cues for saccades

OBJECTIVE

To determine the initial level at which the pathways for cue perception, saccades and antisaccades diverge.

METHODS

Two procedures: single pulse transcranial magnetic stimulation (sTMS) over posterior occiput and backward masking were used. A visual cue directed saccades to the left or right, either a pro-saccade (to the side of the cue but beyond it) or an antisaccade, i.e., contraversive saccade. No visual target was presented.

RESULTS

Latencies of the two types of saccades did not differ. Focal sTMS applied unilaterally over V1 suppressed both perception of a cue flashed 80-90ms earlier contralaterally (but not ipsilaterally) and the appropriate saccade. Masking at a delay of 100ms abolished the appropriate saccade and cue perception.

CONCLUSIONS

V1 is essential for the perception of a flashed cue and for executing appropriate pro- and contraversive saccades. Masking may occur beyond V1, where the pathways for perception and for saccades at least to the next visual processing level start separating.

SIGNIFICANCE

VI is needed for rapid, accurate perceptual and motor responses to the crudest (left versus right) cues. It is unlikely that the "where" system can have a major direct input bypassing V1.

Masking visual stimuli by transcranial magnetic stimulation

Transcranial magnetic stimulation (TMS) applied over the occipital pole can suppress visual perception. Since its first description in 1989 by Amassian et al., this technique has widely been used to investigate visual processing at the cortical level. This article presents a review of experiments masking visual stimuli by TMS. The psychophysical characterization of TMS masking, the dependence on stimulus onset asynchrony between visual stimulus and TMS pulse, and the topography of masking within the visual field are considered. The relation between visual masking and the generation of phosphenes is discussed as well as the underlying physiological mechanisms.

Transcranial magnetic stimulation in the visual system. I. The psychophysics of visual suppression

When applied over the occipital pole, transcranial magnetic stimulation (TMS) disrupts visual perception and induces phosphenes. Both the underlying mechanisms and the brain structures involved are still unclear. The first part of the study characterizes the suppressive effect of TMS by psychophysical methods. Luminance increment thresholds for orientation discrimination were determined in four subjects using an adaptive staircase procedure. Coil position was controlled with a stereotactic positioning device. Threshold values were modulated by TMS, reaching a maximum effect at a stimulus onset asynchrony (SOA) of approx. 100 ms after visual target presentation. Stronger TMS pulses increased the maximum threshold while decreasing the SOA producing the maximum effect. Slopes of the psychometric function were flattened with TMS masking by a factor of 2, compared to control experiments in the absence of TMS. No change in steepness was observed in experiments using a light flash as the mask instead of TMS. Together with the finding that at higher TMS intensities, threshold elevation occurs even with shorter SOAs, this suggests lasting inhibitory processes as masking mechanisms, contradicting the assumption that the phosphene as excitatory equivalent causes masking. In the companion contribution to this one we present perimetric measurements and phosphene forms as a function of the stimulation site in the brain and discuss the putative generator structures.

A Network Model of Perceptual Suppression Induced by Transcranial Magnetic Stimulation

We modeled the inhibitory effects of transcranial magnetic stimulation (TMS) on a neural population. TMS is a noninvasive technique, with high temporal resolution, that can stimulate the brain via a brief magnetic pulse from a coil placed on the scalp. Because of these advantages, TMS is extensively used as a powerful tool in experimental studies of motor, perception, and other functions in humans. However, the mechanisms by which TMS interferes with neural activities, especially in terms of theoretical aspects, are totally unknown. In this study, we focused on the temporal properties of TMS-induced perceptual suppression, and we computationally analyzed the response of a simple network model of a sensory feature detector system to a TMS-like perturbation. The perturbation caused the mean activity to transiently increase and then decrease for a long period, accompanied by a loss in the degree of activity localization. When the afferent input consisted of a dual phase, with a strong transient component and a weak sustained component, there was a critical latency period of the perturbation during which the network activity was completely suppressed and converged to the resting state. The range of the suppressive period increased with decreasing afferent input intensity and reached more than 10 times the time constant of the neuron. These results agree well with typical experimental data for occipital TMS and support the conclusion that dynamical interaction in a neural population plays an important role in TMS-induced perceptual suppression.

Combining backward masking and transcranial magnetic stimulation in human observers

Both backward masking and transcranial magnetic stimulation (TMS) are capable of hindering perception of a visual target. To study the relationship between these two methods we applied TMS over the occipital pole in combination with the visual backward masking technique shine-through. The recently discovered weak shine-through mask consists of a horizontal grating with 25 vernier elements. In three subjects we determined discrimination thresholds for vernier acuity without and with the shine-through mask. Modulation of the vernier discrimination threshold was determined in both conditions with TMS at various stimulus onset asynchronies (SOAs). In the unmasked condition TMS deteriorates discrimination moderately around 120 ms TMS SOA from 25" (arc seconds) to about 130". If in addition to TMS the vernier is backward-masked, discrimination of the vernier offset is completely abolished (>300"). Therefore, TMS and backward masking can interact in a non-linear manner, strongly interfering with early visual processing.

Transcranial magnetic stimulation as an investigative tool in the study of visual function

Transcranial magnetic stimulation (TMS) is a novel and powerful probe to study the relationship between human brain function and behavior. TMS is being widely used to investigate memory, language, attention, learning, and motor function and is even being utilized therapeutically in the treatment of depression. Some of the earliest applications of TMS have been directed toward the investigation of human visual perception. For example, a strong TMS pulse delivered to the occipital cortex in a sighted or even blind individual can evoke the sensation of perceiving light (visual phosphenes). TMS can also be used to suppress visual perception and investigate the timing of visual information processing. Furthermore, the functional connectivity between different brain areas can be mapped using TMS, thus establishing a causal link between visual cortical function and visual perception. The present article is meant as an overview of the technique of TMS and a review of the literature as it pertains to the study of visual function. The application of TMS in the diagnosis as well as possible therapeutic use in various visual disorders is also discussed.

Mapping of the human visual cortex using image-guided transcranial magnetic stimulation

We describe a protocol using transcranial magnetic stimulation (TMS) to systematically map the visual sensations induced by focal and non-invasive stimulation of the human occipital cortex. TMS is applied with a figure of eight coil to 28 positions arranged in a 2x2-cm grid over the occipital area. A digitizing tablet connected to a PC computer running customized software, and audio and video recording are used for detailed and accurate data collection and analysis of evoked phosphenes. A frameless image-guided neuronavigational device is used to describe the position of the actual sites of the stimulation coils relative to the cortical surface. Our results show that TMS is able to elicit phosphenes in almost all sighted subjects and in a proportion of blind subjects. Evoked phosphenes are topographically organized. Despite minor inter-individual variations, the mapping results are reproducible and show good congruence among different subjects. This procedure has potential to improve our understanding of physiologic organization and plastic changes in the human visual system and to establish the degree of remaining functional visual cortex in blind subjects. Such a non-invasive method is critical for selection of suitable subjects for a cortical visual prosthesis.

Spatial and temporal characteristics of visual motion perception involving V5 visual cortex

The anatomical substrates of the perception of motion have not yet been established in a detailed way on an individual level. The aim of this study was to develop a systematic procedure for mapping the visual cortex using Transcranial Magnetic Stimulation (TMS). The results showed that such an individual and detailed map of the spatial and temporal characteristics of motion perception can be constructed using TMS.

Tickling the brain: studying visual sensation, perception and cognition by transcranial magnetic stimulation

Transcranial magnetic stimulation (TMS) is a means of stimulating the brain from outside the skull with little, and occasionally no discomfort for the subject. A single TMS pulse, lasting less than 1 ms, can briefly disrupt the normal activity of a targeted region of the brain for tens of milliseconds, allowing the effects of disruption on specific perceptual and cognitive tasks to be measured behaviorally. Rapid, repeated pulses can disrupt activity for correspondingly longer periods. The reversibility of the effects make it possible to create 'virtual patients' who can be tested in the same way as actual patients with real brain damage in order to explore regional functional specialization. Although several aspects of TMS continue to be evaluated, such as its safety, the extent and localization of the effective region of induced electrical current, the importance of the waveform of the pulse, the configuration and positioning of the coil, its productivity has been firmly established in little more than 10 years of systematic use. Examples of the latter are given from investigations of the nature of visual phosphenes produced by TMS applied to different regions of the visual cortex in normal subjects and subjects with occipital or ocular damage in an attempt to reveal the role of visual cortex in visual awareness.

Transcranial magnetic stimulation and cognitive neuroscience

Transcranial magnetic stimulation has been used to investigate almost all areas of cognitive neuroscience. This article discusses the most important (and least understood) considerations regarding the use of transcranial magnetic stimulation for cognitive neuroscience and outlines advances in the use of this technique for the replication and extension of findings from neuropsychology. We also take a more speculative look forward to the emerging development of strategies for combining transcranial magnetic stimulation with other brain imaging technologies and methods in the cognitive neurosciences.

Magnetically induced phosphenes in sighted, blind and blindsighted observers

Direct stimulation of visual cortex can produce illusory flashes of light, called phosphenes. Here we describe the spatial and motion properties of phosphenes produced by transcranial magnetic stimulation in normal subjects and in two subjects with peripheral or cortical blindness. The totally retinally blind subject experienced normal phosphenes, apart from their concentration in the centre of the visual field, whereas the hemianopic subject, lacking area V1, did not experience phosphenes when his surviving extrastriate visual areas were stimulated. In the absence of V1, magnetically induced activity was unable to generate a conscious visual percept in the field defect.

Suppression of vision by transcranial magnetic stimulation: a third mechanism

We recently reported three periods when single-pulse transcranial magnetic stimulation (TMS) of the occipital pole impaired performance on a forced-choice visual letter-identification task. TMS-induced suppression during these periods is best explained by a blink-associated covering of the pupils and by a direct interference with letter-processing neural activity. We now report TMS-induced suppression at times that seem too late for the suppression to be explained by the first mechanism and too early for the suppression to be explained by the second mechanism. The most likely explanation is a blink-associated interference with letter-processing neural activity.

The application of d.c. electrical stimulation in evoking and recording gustatory brain potentials

Evidence exists which supports the hypothesis that electrical stimulation of appropriate parameters can fulfil the fundamental requirements for an effective evoked potential taste stimulus. Nevertheless, it had previously been considered that electrical taste stimulation is inadequate for evoking gustatory brain potentials. Consequently, the majority of the earlier attempts to record gustatory evoked potentials (GEPs) reported in the literature have employed chemical stimulus techniques. The design of an electrical taste stimulator and its interface to an evoked potential recording unit is described. The first human brain potentials recorded with this system are presented, among which are those attributable to taste pathway activation. Following future work to unequivocally confirm that taste evoked brain potentials are achievable with this system, it has potential to become a clinically valuable tool.

Timing of activity in early visual cortex as revealed by transcranial magnetic stimulation

To determine the timing of visual processing in the early visual cortex, we applied single pulse transcranial magnetic stimulation to the occipital pole of healthy subjects while they were engaged in a forced-choice visual letter-identification task. We found two separate periods of activity, the first ranging from 20 to 60 ms after the onset of the visual stimulus, and the second ranging from 100 to 140 ms after the onset of the visual stimulus. We suggest that these two periods reflect necessary activity in V1, before and after re-entry.

Are recognition deficits following occipital lobe TMS explained by raised detection thresholds?

It is known that transcranial magnetic stimulation (TMS) administered over the occipital pole suppresses recognition of visual objects. Our aim was to ascertain whether this suppression can be interpreted as a change in visual contrast threshold. Four subjects detected the orientation of an U-shaped hook flashed for 21 ms. Under control conditions, mean contrast threshold was found at 0.88 log units Weber contrast. Thresholds were raised if TMS was applied 40-200 ms after the visual stimulus. Maximum elevation was 1.67 log units under TMS at 120 ms stimulus onset asynchrony. This phenomenon can be interpreted as a reduction in signal-to-noise ratio of the visual stimuli by TMS, which can be compensated for by increasing the contrast of the stimuli.

Tracing the timing of human analysis of motion and chromatic signals from occipital to temporo-parieto-occipital cortex: a transcranial magnetic stimulation study

In human visual analysis, the initial processing of motion and chromatic signals may be mediated by feed-forward pathways from striate cortex to segregated areas of extrastriate cortex. The time-course of occipital to temporo-parieto-occipital motion processing was unknown, as was the selectivity of the effect of transcranial magnetic stimulation (TMS) on motion processing. TMS delivered over occipital cortex degraded the discrimination of motion-defined form (MDF) in a discrete time window beginning 100-120 ms from the onset of the visual stimulus. Bilateral focal TMS delivered over the temporo-parieto-occipital junction (TPO) disrupted the discrimination of MDF in a time window beginning 20-40 ms later than the effect of TMS delivered over occipital cortex. Bilateral focal TMS delivered over TPO also degraded the discrimination of CDF, motion direction, and color.

Transcranial magnetic stimulation in study of the visual pathway

The authors critically reviewed experiments in which transcranial magnetic stimulation (TMS) and repetitive TMS (rTMS) of the higher visual pathway were used. Topics include basic mechanisms of neural excitation by TMS and their relevance to the visual pathway (excitatory and inhibitory effects), TMS and rTMS of calcarine cortex (suppression, unmasking, and phosphenes), TMS of V5 (suppression), TMS and rTMS of higher level temporoparietooccipital areas (perceptual errors, unmasking, and inattention), the role of frontal lobe output in visual perception, and vocalization of perceived visual stimuli (role of consciousness of linguistic symbols).

Magnetic stimulation of visual cortex: factors influencing the perception of phosphenes

Using transcranial magnetic stimulation of occipital cortex, the authors studied the stimulus parameters that generate phosphenes in healthy volunteers. Single pulses or trains of stimuli readily elicited phosphenes in all subjects. The threshold current needed to elicit perception of phosphenes was essentially the same for stimulus trains from 250 msec to 2000 msec in length, but increased dramatically for trains of shorter duration. The effect of stimulus frequency was variable, with each subject having a distinctive "frequency tuning curve," but overall, the threshold current necessary to produce phosphenes decreased as frequency of stimulation increased. Using paired pulses, the perceptual threshold was flat for interstimulus intervals between 2 msec and 100 msec, but increased rapidly as the interstimulus interval was increased above 100 msec. Stimulation of sites lateral to the midline elicited phosphenes in the contralateral visual field. Phosphenes were dominant in the lower and peripheral aspects of the visual fields. The findings are discussed in relation to similar studies of electrical stimulation of somatosensory cortex.

Visual hemifield mapping using transcranial magnetic stimulation coregistered with cortical surfaces derived from magnetic resonance images

The perception of a visual stimulus can be inhibited by occipital transcranial magnetic stimulation. This visual suppression effect has been attributed to disruption in the cortical gray matter of primary visual cortex or in the fiber tracts leading to V1 from the thalamus. However, others have suggested that the visual suppression effect is caused by disruption in secondary visual cortex. Here the authors used a figure-eight coil, which produces a focal magnetic field, and a Quadropulse stimulator to produce visual suppression contralateral to the stimulated hemisphere in five normal volunteer subjects. The authors coregistered the stimulation sites with magnetic resonance images in these same subjects using optical digitization. The stimulation sites were mapped onto the surface of the occipital lobes in three-dimensional reconstructions of the cortical surface to show the distribution of the visual suppression effect. The results were consistent with disruption of secondary visual cortical areas.

Magnetic coil suppression of extrafoveal visual perception using disappearance targets

We used magnetic brain stimulation with a butterfly coil over the occipital lobes to study extrafoveal visual field effects in six subjects. The visual test pattern was a grid of asterisks around a central fixation point, and the target was the disappearance of one asterisk for a single frame of the video monitor. Using single magnetic pulses at stimulator outputs of 55-95%, we noted robust interference effects at latencies < or = 100 ms, peaking at approximately 50-90 ms. Suppression of visual perception occurred with both transverse and sagittal alignments of the coil. When the coil was moved laterally over either occipital lobe, perception of target disappearance was consistently suppressed in the contralateral visual field. Movement of the coil rostrally produced consistent suppression in the lower and middle field, but preferential suppression of the upper field could not be obtained. This altitudinal asymmetry may be correlated with the anatomy of the occipital lobe in relation to the scalp surface.

Magnetic coil suppression of visual perception at an extracalcarine site

Perception of extrafoveal visual targets can be suppressed by magnetic stimulation over the occipital lobes, but the site of interference for this and similar phenomena has not been well defined. We modified a previously used technique to determine the locus of magnetic activation. Using butterfly stimulus coils of different sizes and electric field profiles, we determined a scalp position of minimum threshold and a level of stimulator output that produced 50% error rates for each coil. Intersection of the corresponding electric field profiles in air and in a saline model head was similar and identified superficial occipital cortex rather than the primary visual area as the site of perceptual suppression. Less direct analyses involving the distribution of induced electric fields produced the same conclusion. These results suggest specific hypotheses about the effects of magnetic stimulation on visual physiology.

Transcranial magnetic stimulation of extrastriate cortex degrades human motion direction discrimination

The human temporo-parieto-occipital junction is an extrastriate visual area that may mediate motion vision processing. We determined if transcranial magnetic stimulation (TMS) delivered over this extrastriate area would degrade motion discrimination, similar to the transient decrease in spatial acuity observed when TMS is delivered over striate cortex. TMS was delivered 50-250 msec after the onset of a brief, random dot, motion direction discrimination task or a spatial acuity task. TMS significantly reduced correct motion discrimination when delivered 100-150 msec after the random dot stimulus. During the same time window TMS did not significantly effect spatial acuity. TMS over the left extrastriate cortex reduced motion discrimination in both hemifields and its effect had a crude topographical organization. TMS safely perturbs extrastriate visual areas and may reveal the temporal sequence of higher perceptual processing.

The polarity of the induced electric field influences magnetic coil inhibition of human visual cortex: implications for the site of excitation

Human perception of 3 briefly flashed letters in a horizontal array that subtends a visual angle of 3 degrees or less is reduced by a magnetic coil (MC) pulse given, e.g., 90 msec later. Either a round or a double square MC is effective when the lower windings or central junction region, respectively, are tangential to the skull overlying calcarine cortex and symmetrical across the midline. The modeled, induced electric field has peak amplitude at the midline, but the peak spatial derivatives lie many centimeters laterally. Thus, the foveal representation near the midline is closer to the peak electric field than to its peak spatial derivatives, i.e., excitation of calcarine cortex differs from excitation of a straight nerve. With an MC pulse that induces an electric field which is substantially monophasic in amplitude, the lateral-most letter (usually the right-hand letter) in the trigram is preferentially suppressed when the electric field in the contralateral occipital lobe is directed towards the midline. Inferences from using peripheral nerve models imply that medially located bends in geniculo-calcarine or corticofugal fibers are the relevant sites of excitation in visual suppression; end excitation of fiber arborizations or apical dendrites is considered less likely. This conclusion is supported by the fact that the induced electric field polarity in paracentral lobule for optimally eliciting foot movements is opposite to that for visual suppression, the major bends occurring at different portions of the fiber trajectories in the two systems.