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

Non-invasive brain stimulation and vision rehabilitation: a clinical perspective

Non-invasive brain stimulation techniques allow targeted modulation of brain regions and have emerged as a promising tool for vision rehabilitation. This review presents an overview of studies that have examined the use of non-invasive brain stimulation techniques for improving vision and visual functions. A description of the proposed neural mechanisms that underpin non-invasive brain stimulation effects is also provided. The clinical implications of non-invasive brain stimulation in vision rehabilitation are examined, including their safety, effectiveness, and potential applications in specific conditions such as amblyopia, post-stroke hemianopia, and central vision loss associated with age-related macular degeneration. Additionally, the future directions of research in this field are considered, including the need for larger and more rigorous clinical trials to validate the efficacy of these techniques. Overall, this review highlights the potential for brain stimulation techniques as a promising avenue for improving visual function in individuals with impaired vision and underscores the importance of continued research in this field.

Maximizing brain networks engagement via individualized connectome-wide target search

BACKGROUND

In recent years, the possibility to noninvasively interact with the human brain has led to unprecedented diagnostic and therapeutic opportunities. However, the vast majority of approved interventions and approaches still rely on anatomical landmarks and rarely on the individual structure of networks in the brain, drastically reducing the potential efficacy of neuromodulation.

OBJECTIVE

Here we implemented a target search algorithm leveraging on mathematical tools from Network Control Theory (NCT) and whole brain connectomics analysis. By means of computational simulations, we aimed to identify the optimal stimulation target(s)- at the individual brain level- capable of reaching maximal engagement of the stimulated networks' nodes.

RESULTS

At the model level, in silico predictions suggest that stimulation of NCT-derived cerebral sites might induce significantly higher network engagement, compared to traditionally employed neuromodulation sites, demonstrating NCT to be a useful tool in guiding brain stimulation. Indeed, NCT allows us to computationally model different stimulation scenarios tailored on the individual structural connectivity profiles and initial brain states.

CONCLUSIONS

The use of NCT to computationally predict TMS pulse propagation suggests that individualized targeting is crucial for more successful network engagement. Future studies will be needed to verify such prediction in real stimulation scenarios.

Manipulation of Attention Affects Subitizing Performance: A Systematic Review and Meta-analysis

Subitizing is the fast and accurate enumeration of small sets. Whether attention is necessary for subitizing remains controversial considering (1) subitizing is claimed to be "pre-attentive", and (2) existing experimental methods and results are inconsistent. To determine whether manipulations to attention demonstratively affect subitizing, the current study comprises a systematic review and meta-analysis. Results from fourteen studies (22 experiments, 35 comparisons) suggest that changes to attentional demands interferes with enumeration of small sets; leading to slower response times, lower accuracy, and poorer Weber acuity (p <.010; p <.001; p <.001; respectively)-notwithstanding a potential publication bias. A unifying framework is proposed to explain the role of attention in visual enumeration, with progressively greater attentional involvement from estimation to subitizing to counting. Our findings suggest attention is integral for subitizing and highlights the need to emphasise attentional mechanisms into neurocognitive models of numerosity processing. We also discuss the possible role of attention in numerical processing difficulties (e.g., dyscalculia).

Shape from Contour: Computation and Representation

The human visual system reliably extracts shape information from complex natural scenes in spite of noise and fragmentation caused by clutter and occlusions. A fast, feedforward sweep through ventral stream involving mechanisms tuned for orientation, curvature, and local Gestalt principles produces partial shape representations sufficient for simpler discriminative tasks. More complete shape representations may involve recurrent processes that integrate local and global cues. While feedforward discriminative deep neural network models currently produce the best predictions of object selectivity in higher areas of the object pathway, a generative model may be required to account for all aspects of shape perception. Research suggests that a successful model will account for our acute sensitivity to four key perceptual dimensions of shape: topology, symmetry, composition, and deformation.

Plasticity of the human visual brain after an early cortical lesion

In adults, partial damage to V1 or optic radiations abolishes perception in the corresponding part of the visual field, causing a scotoma. However, it is widely accepted that the developing cortex has superior capacities to reorganize following an early lesion to endorse adaptive plasticity. Here we report a single patient case (G.S.) with near normal central field vision despite a massive unilateral lesion to the optic radiations acquired early in life. The patient underwent surgical removal of a right hemisphere parieto-temporal-occipital atypical choroid plexus papilloma of the right lateral ventricle at four months of age, which presumably altered the visual pathways during in utero development. Both the tumor and surgery severely compromised the optic radiations. Residual vision of G.S. was tested psychophysically when the patient was 7 years old. We found a close-to-normal visual acuity and contrast sensitivity within the central 25° and a great impairment in form and contrast vision in the far periphery (40-50°) of the left visual hemifield. BOLD response to full field luminance flicker was recorded from the primary visual cortex (V1) and in a region in the residual temporal-occipital region, presumably corresponding to the middle temporal complex (MT+), of the lesioned (right) hemisphere. A population receptive field analysis of the BOLD responses to contrast modulated stimuli revealed a retinotopic organization just for the MT+ region but not for the calcarine regions. Interestingly, consistent islands of ipsilateral activity were found in MT+ and in the parieto-occipital sulcus (POS) of the intact hemisphere. Probabilistic tractography revealed that optic radiations between LGN and V1 were very sparse in the lesioned hemisphere consistently with the post-surgery cerebral resection, while normal in the intact hemisphere. On the other hand, strong structural connections between MT+ and LGN were found in the lesioned hemisphere, while the equivalent tract in the spared hemisphere showed minimal structural connectivity. These results suggest that during development of the pathological brain, abnormal thalamic projections can lead to functional cortical changes, which may mediate functional recovery of vision.

Recurrent Processing in the Formation of Shape Percepts

The human visual system must extract reliable object information from cluttered visual scenes several times per second, and this temporal constraint has been taken as evidence that the underlying cortical processing must be strictly feedforward. Here we use a novel rapid reinforcement paradigm to probe the temporal dynamics of the neural circuit underlying rapid object shape perception and thus test this feedforward assumption. Our results show that two shape stimuli are optimally reinforcing when separated in time by ∼60 ms, suggesting an underlying recurrent circuit with a time constant (feedforward + feedback) of 60 ms. A control experiment demonstrates that this is not an attentional cueing effect. Instead, it appears to reflect the time course of feedback processing underlying the rapid perceptual organization of shape.

SIGNIFICANCE STATEMENT

Human and nonhuman primates can spot an animal shape in complex natural scenes with striking speed, and this has been taken as evidence that the underlying cortical mechanisms are strictly feedforward. Using a novel paradigm to probe the dynamics of shape perception, we find that two shape stimuli are optimally reinforcing when separated in time by 60 ms, suggesting a fast but recurrent neural circuit. This work (1) introduces a novel method for probing the temporal dynamics of cortical circuits underlying perception, (2) provides direct evidence against the feedforward assumption for rapid shape perception, and (3) yields insight into the role of feedback connections in the object pathway.

Low Intensity TMS Enhances Perception of Visual Stimuli

BACKGROUND

Transcranial magnetic stimulation (TMS) is a popular functional mapping tool in cognitive and sensory neuroscience. While strong TMS typically degrades performance, two recent studies have demonstrated that weak TMS, delivered to visual cortex, can improve performance on simple visual tasks. The improvement was interpreted as the summation of visually-evoked and TMS-elicited neuronal activity in visual cortex, but the nature of this interaction remains unclear.

OBJECTIVE

The present experiments sought to determine whether these weak pulses of TMS assist subjects to see the visual stimulus itself or create a distinct "melded" percept that may not be recognizable as the visual stimulus.

METHODS

We measured contrast thresholds in an orientation discrimination task in which participants reported the orientation (left or right) of gratings tilted 45° from vertical.

RESULTS

Weak TMS improved sensitivity for identifying gratings, suggesting that TMS sums with but preserves orientation information so that the subject can recognize the visual stimulus. We explain the effect using a mechanism of non-linear transduction of sensory signals in the brain.

CONCLUSIONS

The capability of low-intensity TMS to augment the neural signal while preserving information encoded in the stimulus can be employed as a novel approach to study the neural correlates of consciousness by selectively "pushing" an unconscious stimulus into consciousness.

Spatially specific vs. unspecific disruption of visual orientation perception using chronometric pre-stimulus TMS

Transcranial magnetic stimulation (TMS) over occipital cortex can impair visual processing. Such "TMS masking" has repeatedly been shown at several stimulus onset asynchronies (SOAs), with TMS pulses generally applied after the onset of a visual stimulus. Following increased interest in the neuronal state-dependency of visual processing, we recently explored the efficacy of TMS at "negative SOAs", when no visual processing can yet occur. We could reveal pre-stimulus TMS disruption, with results moreover hinting at two separate mechanisms in occipital cortex biasing subsequent orientation perception. Here we extended this work, including a chronometric design to map the temporal dynamics of spatially specific and unspecific mechanisms of state-dependent visual processing, while moreover controlling for TMS-induced pupil covering. TMS pulses applied 60-40 ms prior to a visual stimulus decreased orientation processing independent of stimulus location, while a local suppressive effect was found for TMS applied 30-10 ms pre-stimulus. These results contribute to our understanding of spatiotemporal mechanisms in occipital cortex underlying the state-dependency of visual processing, providing a basis for future work to link pre-stimulus TMS suppression effects to other known visual biasing mechanisms.

Probing feedforward and feedback contributions to awareness with visual masking and transcranial magnetic stimulation

A number of influential theories posit that visual awareness relies not only on the initial, stimulus-driven (i.e., feedforward) sweep of activation but also on recurrent feedback activity within and between brain regions. These theories of awareness draw heavily on data from masking paradigms in which visibility of one stimulus is reduced due to the presence of another stimulus. More recently transcranial magnetic stimulation (TMS) has been used to study the temporal dynamics of visual awareness. TMS over occipital cortex affects performance on visual tasks at distinct time points and in a manner that is comparable to visual masking. We draw parallels between these two methods and examine evidence for the neural mechanisms by which visual masking and TMS suppress stimulus visibility. Specifically, both methods have been proposed to affect feedforward as well as feedback signals when applied at distinct time windows relative to stimulus onset and as a result modify visual awareness. Most recent empirical evidence, moreover, suggests that while visual masking and TMS impact stimulus visibility comparably, the processes these methods affect may not be as similar as previously thought. In addition to reviewing both masking and TMS studies that examine feedforward and feedback processes in vision, we raise questions to guide future studies and further probe the necessary conditions for visual awareness.

Transcranial magnetic stimulation for investigating causal brain-behavioral relationships and their time course

Transcranial magnetic stimulation (TMS) is a safe, non-invasive brain stimulation technique that uses a strong electromagnet in order to temporarily disrupt information processing in a brain region, generating a short-lived "virtual lesion." Stimulation that interferes with task performance indicates that the affected brain region is necessary to perform the task normally. In other words, unlike neuroimaging methods such as functional magnetic resonance imaging (fMRI) that indicate correlations between brain and behavior, TMS can be used to demonstrate causal brain-behavior relations. Furthermore, by varying the duration and onset of the virtual lesion, TMS can also reveal the time course of normal processing. As a result, TMS has become an important tool in cognitive neuroscience. Advantages of the technique over lesion-deficit studies include better spatial-temporal precision of the disruption effect, the ability to use participants as their own control subjects, and the accessibility of participants. Limitations include concurrent auditory and somatosensory stimulation that may influence task performance, limited access to structures more than a few centimeters from the surface of the scalp, and the relatively large space of free parameters that need to be optimized in order for the experiment to work. Experimental designs that give careful consideration to appropriate control conditions help to address these concerns. This article illustrates these issues with TMS results that investigate the spatial and temporal contributions of the left supramarginal gyrus (SMG) to reading.

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.

The Timing and Neuroanatomy of Conscious Vision as Revealed by TMS-induced Blindsight

Following damage to the primary visual cortex, some patients exhibit “blindsight,” where they report a loss of awareness while retaining the ability to discriminate visual stimuli above chance. Transient disruption of occipital regions with TMS can produce a similar dissociation, known as TMS-induced blindsight. The neural basis of this residual vision is controversial, with some studies attributing it to the retinotectal pathway via the superior colliculus whereas others implicate spared projections that originate predominantly from the LGN. Here we contrasted these accounts by combining TMS with visual stimuli that either activate or bypass the retinotectal and magnocellular (R/M) pathways. We found that the residual capacity of TMS-induced blindsight occurs for stimuli that bypass the R/M pathways, indicating that such pathways, which include those to the superior colliculus, are not critical. We also found that the modulation of conscious vision was time and pathway dependent. TMS applied either early (0–40 msec) or late (280–320 msec) after stimulus onset modulated detection of stimuli that did not bypass R/M pathways, whereas during an intermediate period (90–130 msec) the effect was pathway independent. Our findings thus suggest a prominent role for the R/M pathways in supporting both the preparatory and later stages of conscious vision. This may help resolve apparent conflict in previous literature by demonstrating that the roles of the retinotectal and geniculate pathways are likely to be more nuanced than simply corresponding to the unconscious/conscious dichotomy.

Early recurrent feedback facilitates visual object recognition under challenging conditions

Standard models of the visual object recognition pathway hold that a largely feedforward process from the retina through inferotemporal cortex leads to object identification. A subsequent feedback process originating in frontoparietal areas through reciprocal connections to striate cortex provides attentional support to salient or behaviorally-relevant features. Here, we review mounting evidence that feedback signals also originate within extrastriate regions and begin during the initial feedforward process. This feedback process is temporally dissociable from attention and provides important functions such as grouping, associational reinforcement, and filling-in of features. Local feedback signals operating concurrently with feedforward processing are important for object identification in noisy real-world situations, particularly when objects are partially occluded, unclear, or otherwise ambiguous. Altogether, the dissociation of early and late feedback processes presented here expands on current models of object identification, and suggests a dual role for descending feedback projections.

Phosphene-guided transcranial magnetic stimulation of occipital but not parietal cortex suppresses stimulus visibility

Transcranial magnetic stimulation (TMS) applied over the occipital lobe approximately 100 ms after the onset of a stimulus decreases its visibility if it appears in the location of the phosphene. Because phosphenes can also be elicited by stimulation of the parietal regions, we asked if the same procedure that is used to reduce visibility of stimuli with occipital TMS will lead to decreased stimulus visibility when TMS is applied to parietal regions. TMS was randomly applied at 0-130 ms after the onset of the stimulus in steps of 10 ms in occipital and parietal regions. Participants responded to the orientation of the line stimulus and rated its visibility. We replicate previous reports of phosphenes from both occipital and parietal TMS. As previously reported, we also observed visual suppression around the classical 100 ms window both in the objective line orientation and subjective visibility responses with occipital TMS. Parietal stimulation, on the other hand, did not consistently reduce stimulus visibility in any time window.

Interaction between dorsal and ventral processing streams: where, when and how?

The execution of complex visual, auditory, and linguistic behaviors requires a dynamic interplay between spatial ('where/how') and non-spatial ('what') information processed along the dorsal and ventral processing streams. However, while it is acknowledged that there must be some degree of interaction between the two processing networks, how they interact, both anatomically and functionally, is a question which remains little explored. The current review examines the anatomical, temporal, and behavioral evidence regarding three potential models of dual stream interaction: (1) computations along the two pathways proceed independently and in parallel, reintegrating within shared target brain regions; (2) processing along the separate pathways is modulated by the existence of recurrent feedback loops; and (3) information is transferred directly between the two pathways at multiple stages and locations along their trajectories.

Spatiotemporal dynamics in understanding hand-object interactions

It is generally accepted that visual perception results from the activation of a feed-forward hierarchy of areas, leading to increasingly complex representations. Here we present evidence for a fundamental role of backward projections to the occipito-temporal region for understanding conceptual object properties. The evidence is based on two studies. In the first study, using high-density EEG, we showed that during the observation of how objects are used there is an early activation of occipital and temporal areas, subsequently reaching the pole of the temporal lobe, and a late reactivation of the visual areas. In the second study, using transcranial magnetic stimulation over the occipital lobe, we showed a clear impairment in the accuracy of recognition of how objects are used during both early activation and, most importantly, late occipital reactivation. These findings represent strong neurophysiological evidence that a top-down mechanism is fundamental for understanding conceptual object properties, and suggest that a similar mechanism might be also present for other higher-order cognitive functions.

Unconscious Priming Requires Early Visual Cortex at Specific Temporal Phases of Processing

Although examples of unconscious shape priming have been well documented, whether such priming requires early visual cortex (V1/V2) has not been established. In the current study, we used TMS of V1/V2 at varying temporal intervals to suppress the visibility of preceding shape primes while the interval between primes and targets was kept constant. Our results show that, although conscious perception requires V1/V2, unconscious priming can occur without V1/V2 at an intermediate temporal interval but not at early (5–25 msec) or later (65–125 msec) stages of processing. Because the later time window of unconscious priming suppression has been proposed to interfere with feedback processing, our results further suggest that feedback processing is also essential for unconscious priming and may not be a sufficient condition for conscious vision.

Neuromodulation of Early Multisensory Interactions in the Visual Cortex

Merging information derived from different sensory channels allows the brain to amplify minimal signals to reduce their ambiguity, thereby improving the ability of orienting to, detecting, and identifying environmental events. Although multisensory interactions have been mostly ascribed to the activity of higher-order heteromodal areas, multisensory convergence may arise even in primary sensory-specific areas located very early along the cortical processing stream. In three experiments, we investigated early multisensory interactions in lower-level visual areas, by using a novel approach, based on the coupling of behavioral stimulation with two noninvasive brain stimulation techniques, namely, TMS and transcranial direct current stimulation (tDCS). First, we showed that redundant multisensory stimuli can increase visual cortical excitability, as measured by means of phosphene induction by occipital TMS; such physiological enhancement is followed by a behavioral facilitation through the amplification of signal intensity in sensory-specific visual areas. The more sensory inputs are combined (i.e., trimodal vs. bimodal stimuli), the greater are the benefits on phosphene perception. Second, neuroelectrical activity changes induced by tDCS in the temporal and in the parietal cortices, but not in the occipital cortex, can further boost the multisensory enhancement of visual cortical excitability, by increasing the auditory and tactile inputs from temporal and parietal regions, respectively, to lower-level visual areas.

Cortical response tracking the conscious experience of threshold duration visual stimuli indicates visual perception is all or none

At perceptual threshold, some stimuli are available for conscious access whereas others are not. Such threshold inputs are useful tools for investigating the events that separate conscious awareness from unconscious stimulus processing. Here, viewing unmasked, threshold-duration images was combined with recording magnetoencephalography to quantify differences among perceptual states, ranging from no awareness to ambiguity to robust perception. A four-choice scale was used to assess awareness: "didn't see" (no awareness), "couldn't identify" (awareness without identification), "unsure" (awareness with low certainty identification), and "sure" (awareness with high certainty identification). Stimulus-evoked neuromagnetic signals were grouped according to behavioral response choices. Three main cortical responses were elicited. The earliest response, peaking at ∼100 ms after stimulus presentation, showed no significant correlation with stimulus perception. A late response (∼290 ms) showed moderate correlation with stimulus awareness but could not adequately differentiate conscious access from its absence. By contrast, an intermediate response peaking at ∼240 ms was observed only for trials in which stimuli were consciously detected. That this signal was similar for all conditions in which awareness was reported is consistent with the hypothesis that conscious visual access is relatively sharply demarcated.

Transcranial stimulation and cognition

Noninvasive brain stimulation (NIBS) is a unique method for studying cognitive function. For the study of cognition, NIBS has gained popularity as a complementary method to functional neuroimaging. By bypassing the correlative approaches of standard imaging techniques, it is possible to establish a putative relationship between brain cognition. In fact, functional neuroimaging data cannot demonstrate the actual role of a particular cortical activation in a specific function because an activated area may simply be correlated with task performance, rather than being responsible for it. NIBS can induce a temporary modification of performance only if the stimulated area is causally engaged in the task. In analogy with lesion studies, NIBS can provide information about where and when a particular process occurs. Based on this assumption, NIBS has been used in many different cognitive domains. However, one of the most interesting questions in neuroscience may not be where and when, but how cognitive activity occurs. Beyond localization approaches, NIBS can be employed to study brain mechanisms. NIBS techniques have the potential to influence behavior transiently by altering neuronal activity, which may have facilitatory or inhibitory behavioral effects. NIBS techniques include transcranial magnetic stimulation (TMS) and transcranial electrical stimulation (tES). TMS has been shown transiently to modulate neural excitability in a manner that is dependent mainly on the timing and frequency of stimulation (high versus low). The mechanism underlying tES is a change in neuronal membrane potentials that appears to be dependent mainly on the direction of current flow (anodal versus cathodal). Nevertheless, the final effects induced by TMS or tES depend on many technical parameters used during stimulation, such as the intensity of stimulation, coil orientation, site of the reference electrode, and time of application. Moreover, an important factor is the possible interactions between these factors and the physiological and cognitive state of the subject. To use NIBS in cognition, it is important to understand not only how NIBS functions but also the brain mechanisms being studied and the features of the area of interest. To describe better the advanced knowledge provided by NIBS in cognition, we will treat each NIBS technique separately and underline the related hypotheses beyond applications.

The temporal dynamics of early visual cortex involvement in behavioral priming

Transcranial magnetic stimulation (TMS) allows for non-invasive interference with ongoing neural processing. Applied in a chronometric design over early visual cortex (EVC), TMS has proved valuable in indicating at which particular time point EVC must remain unperturbed for (conscious) vision to be established. In the current study, we set out to examine the effect of EVC TMS across a broad range of time points, both before (pre-stimulus) and after (post-stimulus) the onset of symbolic visual stimuli. Behavioral priming studies have shown that the behavioral impact of a visual stimulus can be independent from its conscious perception, suggesting two independent neural signatures. To assess whether TMS-induced suppression of visual awareness can be dissociated from behavioral priming in the temporal domain, we thus implemented three different measures of visual processing, namely performance on a standard visual discrimination task, a subjective rating of stimulus visibility, and a visual priming task. To control for non-neural TMS effects, we performed electrooculographical recordings, placebo TMS (sham), and control site TMS (vertex). Our results suggest that, when considering the appropriate control data, the temporal pattern of EVC TMS disruption on visual discrimination, subjective awareness and behavioral priming are not dissociable. Instead, TMS to EVC disrupts visual perception holistically, both when applied before and after the onset of a visual stimulus. The current findings are discussed in light of their implications on models of visual awareness and (subliminal) priming.

Mapping the after-effects of theta burst stimulation on the human auditory cortex with functional imaging

Auditory cortex pertains to the processing of sound, which is at the basis of speech or music-related processing. However, despite considerable recent progress, the functional properties and lateralization of the human auditory cortex are far from being fully understood. Transcranial Magnetic Stimulation (TMS) is a non-invasive technique that can transiently or lastingly modulate cortical excitability via the application of localized magnetic field pulses, and represents a unique method of exploring plasticity and connectivity. It has only recently begun to be applied to understand auditory cortical function. An important issue in using TMS is that the physiological consequences of the stimulation are difficult to establish. Although many TMS studies make the implicit assumption that the area targeted by the coil is the area affected, this need not be the case, particularly for complex cognitive functions which depend on interactions across many brain regions. One solution to this problem is to combine TMS with functional Magnetic resonance imaging (fMRI). The idea here is that fMRI will provide an index of changes in brain activity associated with TMS. Thus, fMRI would give an independent means of assessing which areas are affected by TMS and how they are modulated. In addition, fMRI allows the assessment of functional connectivity, which represents a measure of the temporal coupling between distant regions. It can thus be useful not only to measure the net activity modulation induced by TMS in given locations, but also the degree to which the network properties are affected by TMS, via any observed changes in functional connectivity. Different approaches exist to combine TMS and functional imaging according to the temporal order of the methods. Functional MRI can be applied before, during, after, or both before and after TMS. Recently, some studies interleaved TMS and fMRI in order to provide online mapping of the functional changes induced by TMS. However, this online combination has many technical problems, including the static artifacts resulting from the presence of the TMS coil in the scanner room, or the effects of TMS pulses on the process of MR image formation. But more importantly, the loud acoustic noise induced by TMS (increased compared with standard use because of the resonance of the scanner bore) and the increased TMS coil vibrations (caused by the strong mechanical forces due to the static magnetic field of the MR scanner) constitute a crucial problem when studying auditory processing. This is one reason why fMRI was carried out before and after TMS in the present study. Similar approaches have been used to target the motor cortex, premotor cortex, primary somatosensory cortex and language-related areas, but so far no combined TMS-fMRI study has investigated the auditory cortex. The purpose of this article is to provide details concerning the protocol and considerations necessary to successfully combine these two neuroscientific tools to investigate auditory processing. Previously we showed that repetitive TMS (rTMS) at high and low frequencies (resp. 10 Hz and 1 Hz) applied over the auditory cortex modulated response time (RT) in a melody discrimination task. We also showed that RT modulation was correlated with functional connectivity in the auditory network assessed using fMRI: the higher the functional connectivity between left and right auditory cortices during task performance, the higher the facilitatory effect (i.e. decreased RT) observed with rTMS. However those findings were mainly correlational, as fMRI was performed before rTMS. Here, fMRI was carried out before and immediately after TMS to provide direct measures of the functional organization of the auditory cortex, and more specifically of the plastic reorganization of the auditory neural network occurring after the neural intervention provided by TMS. Combined fMRI and TMS applied over the auditory cortex should enable a better understanding of brain mechanisms of auditory processing, providing physiological information about functional effects of TMS. This knowledge could be useful for many cognitive neuroscience applications, as well as for optimizing therapeutic applications of TMS, particularly in auditory-related disorders.

Behavior in oblivion: the neurobiology of subliminal priming

Subliminal priming refers to behavioral modulation by an unconscious stimulus, and can thus be regarded as a form of unconscious visual processing. Theories on recurrent processing have suggested that the neural correlate of consciousness (NCC) comprises of the non-hierarchical transfer of stimulus-related information. According to these models, the neural correlate of subliminal priming (NCSP) corresponds to the visual processing within the feedforward sweep. Research from cognitive neuroscience on these two concepts and the relationship between them is discussed here. Evidence favoring the necessity of recurrent connectivity for visual awareness is accumulating, although some questions, such as the need for global versus local recurrent processing, are not clarified yet. However, this is not to say that recurrent processing is sufficient for consciousness, as a neural definition of consciousness in terms of recurrent connectivity would imply. We argue that the limited interest cognitive neuroscience currently has for the NCSP is undeserved, because the discovery of the NCSP can give insight into why people do (and do not) express certain behavior.

Early and sustained supramarginal gyrus contributions to phonological processing

Reading is a difficult task that, at a minimum, requires recognizing a visual stimulus and linking it with its corresponding sound and meaning. Neurologically, this involves an anatomically distributed set of brain regions cooperating to solve the problem. It has been hypothesized that the supramarginal gyrus (SMG) contributes preferentially to phonological aspects of word processing and thus plays an important role in visual word recognition. Here, we used chronometric transcranial magnetic stimulation (TMS) to investigate the functional specificity and timing of SMG involvement in reading visually presented words. Participants performed tasks designed to focus on either the phonological, semantic, or visual aspects of written words while double pulses of TMS (delivered 40 ms apart) were used to temporarily interfere with neural information processing in the left SMG at five different time windows. Stimulation at 80/120, 120/160, and 160/200 ms post-stimulus onset significantly slowed subjects' reaction times in the phonological task. This inhibitory effect was specific to the phonological condition, with no effect of TMS in the semantic or visual tasks, consistent with claims that SMG contributes preferentially to phonological aspects of word processing. The fact that the effect began within 80-120 ms of the onset of the stimulus and continued for approximately 100 ms, indicates that phonological processing initiates early and is sustained over time. These findings are consistent with accounts of visual word recognition that posit parallel activation of orthographic, phonological, and semantic information that interact over time to settle into a distributed, but stable, representation of a word.

Direct injection of noise to the visual cortex decreases accuracy but increases decision confidence

The relationship between accuracy and confidence in psychophysical tasks traditionally has been assumed to be mainly positive, i.e., the two typically increase or decrease together. However, recent studies have reported examples of exceptions, where confidence and accuracy dissociate from each other. Explanations for such dissociations often involve dual-channel models, in which a cortical channel contributes to both accuracy and confidence, whereas a subcortical channel only contributes to accuracy. Here, we show that a single-channel model derived from signal detection theory (SDT) can also account for such dissociations. We applied transcranial magnetic stimulation (TMS) to the occipital cortex to disrupt the internal representation of a visual stimulus. The results showed that consistent with previous research, occipital TMS decreased accuracy. However, counterintuitively, it also led to an increase in confidence ratings. The data were predicted well by a single-channel SDT model, which posits that occipital TMS increased the variance of the internal stimulus distributions. A formal model comparison analysis that used information theoretic methods confirmed that this model was preferred over single-channel models, in which occipital TMS changed the signal strength or dual-channel models, which assume two different processing routes. Thus our results show that dissociations between accuracy and confidence can, at least in some cases, be accounted for by a single-channel model.

Is selective primary visual cortex stimulation achievable with TMS?

The primary visual cortex (V1) has been the target of stimulation in a number of transcranial magnetic stimulation (TMS) studies. In this study, we estimated the actual sites of stimulation by modeling the cortical location of the TMS-induced electric field when participants reported visual phosphenes or scotomas. First, individual retinotopic areas were identified by multifocal functional magnetic resonance imaging (mffMRI). Second, during the TMS stimulation, the cortical stimulation sites were derived from electric field modeling. When an external anatomical landmark for V1 was used (2 cm above inion), the cortical stimulation landed in various functional areas in different individuals, the dorsal V2 being the most affected area at the group level. When V1 was specifically targeted based on the individual mffMRI data, V1 could be selectively stimulated in half of the participants. In the rest, the selective stimulation of V1 was obstructed by the intermediate position of the dorsal V2. We conclude that the selective stimulation of V1 is possible only if V1 happens to be favorably located in the individual anatomy. Selective and successful targeting of TMS pulses to V1 requires MRI-navigated stimulation, selection of participants and coil positions based on detailed retinotopic maps of individual functional anatomy, and computational modeling of the TMS-induced electric field distribution in the visual cortex. It remains to be resolved whether even more selective stimulation of V1 could be achieved by adjusting the coil orientation according to sulcal orientation of the target site.

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.

Visual awareness suppression by pre-stimulus brain stimulation; a neural effect

Transcranial magnetic stimulation (TMS) has established the functional relevance of early visual cortex (EVC) for visual awareness with great temporal specificity non-invasively in conscious human volunteers. Many studies have found a suppressive effect when TMS was applied over EVC 80-100 ms after the onset of the visual stimulus (post-stimulus TMS time window). Yet, few studies found task performance to also suffer when TMS was applied even before visual stimulus presentation (pre-stimulus TMS time window). This pre-stimulus TMS effect, however, remains controversially debated and its origin had mainly been ascribed to TMS-induced eye-blinking artifacts. Here, we applied chronometric TMS over EVC during the execution of a visual discrimination task, covering an exhaustive range of visual stimulus-locked TMS time windows ranging from -80 pre-stimulus to 300 ms post-stimulus onset. Electrooculographical (EoG) recordings, sham TMS stimulation, and vertex TMS stimulation controlled for different types of non-neural TMS effects. Our findings clearly reveal TMS-induced masking effects for both pre- and post-stimulus time windows, and for both objective visual discrimination performance and subjective visibility. Importantly, all effects proved to be still present after post hoc removal of eye blink trials, suggesting a neural origin for the pre-stimulus TMS suppression effect on visual awareness. We speculate based on our data that TMS exerts its pre-stimulus effect via generation of a neural state which interacts with subsequent visual input.

TMS to the lateral occipital cortex disrupts object processing but facilitates scene processing

The study of brain-damaged patients and advancements in neuroimaging have lead to the discovery of discrete brain regions that process visual image categories, such as objects and scenes. However, how these visual image categories interact remains unclear. For example, is scene perception simply an extension of object perception, or can global scene "gist" be processed independently of its component objects? Specifically, when recognizing a scene such as an "office," does one need to first recognize its individual objects, such as the desk, chair, lamp, pens, and paper to build up the representation of an "office" scene? Here, we show that temporary interruption of object processing through repetitive TMS to the left lateral occipital cortex (LO), an area known to selectively process objects, impairs object categorization but surprisingly facilitates scene categorization. This result was replicated in a second experiment, which assessed the temporal dynamics of this disruption and facilitation. We further showed that repetitive TMS to left LO significantly disrupted object processing but facilitated scene processing when stimulation was administered during the first 180 msec of the task. This demonstrates that the visual system retains the ability to process scenes during disruption to object processing. Moreover, the facilitation of scene processing indicates disinhibition of areas involved in global scene processing, likely caused by disrupting inhibitory contributions from the LO. These findings indicate separate but interactive pathways for object and scene processing and further reveal a network of inhibitory connections between these visual brain regions.

Evoked potentials in large-scale cortical networks elicited by TMS of the visual cortex

Single pulses of transcranial magnetic stimulation (TMS) result in distal and long-lasting oscillations, a finding directly challenging the virtual lesion hypothesis. Previous research supporting this finding has primarily come from stimulation of the motor cortex. We have used single-pulse TMS with simultaneous EEG to target seven brain regions, six of which belong to the visual system [left and right primary visual area V1, motion-sensitive human middle temporal cortex, and a ventral temporal region], as determined with functional MRI-guided neuronavigation, and a vertex "control" site to measure the network effects of the TMS pulse. We found the TMS-evoked potential (TMS-EP) over visual cortex consists mostly of site-dependent theta- and alphaband oscillations. These site-dependent oscillations extended beyond the stimulation site to functionally connected cortical regions and correspond to time windows where the EEG responses maximally diverge (40, 200, and 385 ms). Correlations revealed two site-independent oscillations ∼350 ms after the TMS pulse: a theta-band oscillation carried by the frontal cortex, and an alpha-band oscillation over parietal and frontal cortical regions. A manipulation of stimulation intensity at one stimulation site (right hemisphere V1-V3) revealed sensitivity to the stimulation intensity at different regions of cortex, evidence of intensity tuning in regions distal to the site of stimulation. Together these results suggest that a TMS pulse applied to the visual cortex has a complex effect on brain function, engaging multiple brain networks functionally connected to the visual system with both invariant and site-specific spatiotemporal dynamics. With this characterization of TMS, we propose an alternative to the virtual lesion hypothesis. Rather than a technique that simulates lesions, we propose TMS generates natural brain signals and engages functional networks.

Transcranial magnetic stimulation reveals high test-retest reliability for phosphenes but not for suppression of visual perception

OBJECTIVE

To investigate test-retest reliability of visual cortical excitatory and inhibitory phenomena.

METHODS

Transcranial magnetic stimulation (TMS) was applied over occipital cortex twice in 22 healthy young adults with at least a one-month interval between both measurements. The test-retest reliability of the phosphenes and TMS-induced suppression of visual perception was assessed using correlation and calculation of the repeatability coefficient.

RESULTS

Both analyses revealed a high reliability for phosphenes but not for the suppression of visual perception.

CONCLUSIONS

It seems likely that the phosphenes may be better used than the TMS-induced suppression of visual perception in experiments which need repeated measurements (e.g., longitudinal studies or studies with pharmacological and non-pharmacological interventions).

SIGNIFICANCE

The study demonstrates a rather limited value of the TMS-induced suppression of visual perception for studies with repeated measurements.

Redundant spoken labels facilitate perception of multiple items

Because of the strong associations between verbal labels and the visual objects that they denote, hearing a word may quickly guide the deployment of visual attention to the named objects. We report six experiments in which we investigated the effect of hearing redundant (noninformative) object labels on the visual processing of multiple objects from the named category. Even though the word cues did not provide additional information to the participants, hearing a label resulted in faster detection of attention probes appearing near the objects denoted by the label. For example, hearing the word chair resulted in more effective visual processing of all of the chairs in a scene relative to trials in which the participants attended to the chairs without actually hearing the label. This facilitation was mediated by stimulus typicality. Transformations of the stimuli that disrupted their association with the label while preserving the low-level visual features eliminated the facilitative effect of the labels. In the final experiment, we show that hearing a label improves the accuracy of locating multiple items matching the label, even when eye movements are restricted. We posit that verbal labels dynamically modulate visual processing via top-down feedback--an instance of linguistic labels greasing the wheels of perception.

TMS-induced blinking assessed with high-speed video: optical disruption of visual perception

It is known that TMS can induce blinking, but it is unknown to what extent and at what time TMS-induced blinking can cover the pupil. We applied single-pulse TMS with a leftward and rightward monophasic current through a round coil over the occipital pole in 8 healthy subjects, using high-speed video to monitor left or right eye with a spatial resolution of 0.1 mm and a temporal resolution of 2 ms. We plotted eyelid position relative to upper and lower pupil borders as a function of time after TMS for each subject and current direction. We found 2 blinks in every subject, an isolated late blink with one current direction and a superimposed early and late blink with the other current direction, in accordance with our previously reported association between a leftward and rightward lower coil rim current and an early blink in right and left eye, respectively. Blink extent varied, but 4 subjects showed total pupil covering with both current directions. Blink timing varied, but pupil covering was initiated as early as 32 ms after TMS and pupil uncovering was completed as late as 200 ms after TMS. We found no saccades. We conclude that TMS can cause an important optical disruption of visual perception.

A chronometric exploration of high-resolution 'sensitive TMS masking' effects on subjective and objective measures of vision

Transcranial magnetic stimulation (TMS) can induce masking by interfering with ongoing neural activity in early visual cortex. Previous work has explored the chronometry of occipital involvement in vision by using single pulses of TMS with high temporal resolution. However, conventionally TMS intensities have been high and the only measure used to evaluate masking was objective in nature. Recent studies have begun to incorporate subjective measures of vision, alongside objective ones. The current study goes beyond previous work in two regards. First, we explored both objective vision (an orientation discrimination task) and subjective vision (a stimulus visibility rating on a four-point scale), across a wide range of time windows with high temporal resolution. Second, we used a very sensitive TMS-masking paradigm: stimulation was at relatively low TMS intensities, with a figure-8 coil, and the small stimulus was difficult to discriminate already at baseline level. We hypothesized that this should increase the effective temporal resolution of our paradigm. Perhaps for this reason, we are able to report a rather interesting masking curve. Within the classical-masking time window, previously reported to encompass broad SOAs anywhere between 60 and 120 ms, we report not one, but at least two dips in objective performance, with no masking in-between. The subjective measure of vision did not mirror this pattern. These preliminary data from our exploratory design suggest that, with sensitive TMS masking, we might be able to reveal visual processes in early visual cortex previously unreported.

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.