Investigating the Neural Basis of Theta Burst Stimulation to Premotor Cortex on Emotional Vocalization Perception: A Combined TMS-fMRI Study

Intermittent theta burst stimulation and functional connectivity in people living with HIV/AIDS who smoke tobacco cigarettes: a preliminary pilot study

Background

People living with HIV (PLWHA) smoke at three times the rate of the general population and respond poorly to cessation strategies. Previous studies examined repetitive transcranial magnetic stimulation (rTMS) over left dorsolateral prefrontal cortex (L. dlPFC) to reduce craving, but no studies have explored rTMS among PLWHA who smoke. The current pilot study compared the effects of active and sham intermittent theta-burst stimulation (iTBS) on resting state functional connectivity (rsFC), cigarette cue attentional bias, and cigarette craving in PLWHA who smoke.

Methods

Eight PLWHA were recruited (single-blind, within-subject design) to receive one session of iTBS (n=8) over the L. dlPFC using neuronavigation and, four weeks later, sham iTBS (n=5). Cigarette craving and attentional bias assessments were completed before and after both iTBS and sham iTBS. rsFC was assessed before iTBS (baseline) and after iTBS and sham iTBS.

Results

Compared to sham iTBS, iTBS enhanced rsFC between the L. dlPFC and bilateral medial prefrontal cortex and pons. iTBS also enhanced rsFC between the right insula and right occipital cortex compared to sham iTBS. iTBS also decreased cigarette craving and cigarette cue attentional bias.

Conclusion

iTBS could potentially offer a therapeutic option for smoking cessation in PLWHA.

A systematic review of the neurobiological effects of theta-burst stimulation (TBS) as measured using functional magnetic resonance imaging (fMRI)

Theta burst stimulation (TBS) is associated with the modulation of a range of clinical, cognitive, and behavioural outcomes, but specific neurobiological effects remain somewhat unclear. This systematic literature review investigated resting-state and task-based functional magnetic resonance imaging (fMRI) outcomes post-TBS in healthy human adults. Fifty studies that applied either continuous-or intermittent-(c/i) TBS, and adopted a pretest-posttest or sham-controlled design, were included. For resting-state outcomes following stimulation applied to motor, temporal, parietal, occipital, or cerebellar regions, functional connectivity generally decreased in response to cTBS and increased in response to iTBS, though there were some exceptions to this pattern of response. These findings are mostly consistent with the assumed long-term depression (LTD)/long-term potentiation (LTP)-like plasticity effects of cTBS and iTBS, respectively. Task-related outcomes following TBS were more variable. TBS applied to the prefrontal cortex, irrespective of task or state, also produced more variable responses, with no consistent patterns emerging. Individual participant and methodological factors are likely to contribute to the variability in responses to TBS. Future studies assessing the effects of TBS via fMRI must account for factors known to affect the TBS outcomes, both at the level of individual participants and of research methodology.

Continuous theta burst stimulation over left and right supramarginal gyri demonstrates their involvement in auditory feedback control of vocal production

The supramarginal gyrus (SMG) has been implicated in auditory-motor integration for vocal production. However, whether the SMG is bilaterally or unilaterally involved in auditory feedback control of vocal production in a causal manner remains unclear. The present event-related potential (ERP) study investigated the causal roles of the left and right SMG to auditory-vocal integration using neuronavigated continuous theta burst stimulation (c-TBS). Twenty-four young adults produced sustained vowel phonations and heard their voice unexpectedly pitch-shifted by ±200 cents after receiving active or sham c-TBS over the left or right SMG. As compared to sham stimulation, c-TBS over the left or right SMG led to significantly smaller vocal compensations for pitch perturbations that were accompanied by smaller cortical P2 responses. Moreover, no significant differences were found in the vocal and ERP responses when comparing active c-TBS over the left vs. right SMG. These findings provide neurobehavioral evidence for a causal influence of both the left and right SMG on auditory feedback control of vocal production. Decreased vocal compensations paralleled by reduced P2 responses following c-TBS over the bilateral SMG support their roles for auditory-motor transformation in a bottom-up manner: receiving auditory feedback information and mediating vocal compensations for feedback errors.

Low-Frequency TMS Results in Condition-Related Dynamic Activation Changes of Stimulated and Contralateral Inferior Parietal Lobule

Non-invasive brain stimulation is a promising approach to study the causal relationship between brain function and behavior. However, it is difficult to interpret behavioral null results as dynamic brain network changes have the potential to prevent stimulation from affecting behavior, ultimately compensating for the stimulation. The present study investigated local and remote changes in brain activity via functional magnetic resonance imaging (fMRI) after offline disruption of the inferior parietal lobule (IPL) or the vertex in human participants via 1 Hz repetitive transcranial magnetic stimulation (rTMS). Since the IPL acts as a multimodal hub of several networks, we implemented two experimental conditions in order to robustly engage task-positive networks, such as the fronto-parietal control network (on-task condition) and the default mode network (off-task condition). The condition-dependent neural after-effects following rTMS applied to the IPL were dynamic in affecting post-rTMS BOLD activity depending on the exact time-window. More specifically, we found that 1 Hz rTMS applied to the right IPL led to a delayed activity increase in both, the stimulated and the contralateral IPL, as well as in other brain regions of a task-positive network. This was markedly more pronounced in the on-task condition suggesting a condition-related delayed upregulation. Thus together, our results revealed a dynamic compensatory reorganization including upregulation and intra-network compensation which may explain mixed findings after low-frequency offline TMS.

The immediate impact of transcranial magnetic stimulation on brain structure: Short-term neuroplasticity following one session of cTBS

Recent evidence demonstrates that activation-dependent neuroplasticity on a structural level can occur in a short time (2 hour or less) in the human brain. However, the exact time scale of structural plasticity in the human brain remains unclear. Using voxel-based morphometry (VBM), we investigated changes in grey matter (GM) after one session of continuous theta-burst stimulation (cTBS) delivered to the anterior temporal lobe (ATL). Twenty-five participants received cTBS over the left ATL or the occipital pole as a control site outside of the scanner, followed by structural and functional imaging. During functional imaging, participants performed a semantic association task and a number judgment task as a control task. VBM results revealed decreased GM in the left ATL and right cerebellum after the ATL stimulation compared to the control stimulation. In addition, cTBS over the left ATL induced slower semantic reaction times, reduced regional activity at the target site, and altered functional connectivity between the left and right ATL during semantic processing. Furthermore, the decreased ATL GM density was associated with the interhemispheric ATL-connectivity changes after the ATL stimulation. These results demonstrate that structural alterations caused by one session of cTBS are mirrored in the functional reorganizations in the semantic representation system, showing the rapid dynamics of cortical plasticity. Our findings support fast adapting neuronal plasticity such as synaptic morphology changes. Our results suggest that TBS is able to produce powerful changes in regional synaptic activity in the adult human brain.

Is theta burst stimulation ready as a clinical treatment for depression?

Introduction: Major depression is a common and debilitating mental disorder that can be difficult to treat. Substantive evidence over the past two decades has established repetitive transcranial magnetic stimulation (rTMS) as an effective antidepressant therapy, although scope exists to improve its efficacy and efficiency. Theta burst stimulation (TBS) is a novel rTMS pattern attracting much research interest as a tool to study neurophysiology and treat neuropsychiatric disorders. Areas covered: This article outlines rTMS' state of development and explores the physiology studies underpinning TBS development and its observable neuronal conditioning and metabolic effects. We present a systematic review of studies that applied TBS to treat depression, followed by commentary on safety and practical considerations. Expert opinion: Much experimental and clinical research have advanced our understanding of the antidepressant effects of TBS, although unanswered questions remain relating to its physiological effects, response variability and optimal parameters for therapeutic purposes. A small number of sham-controlled trials, and one large comparative trial, support the therapeutic efficacy of TBS and demonstrates its non-inferiority relative to traditional rTMS. In this light, TBS can reasonably be offered as an alternative to rTMS in treatment-resistant depression, while ongoing research is likely to inform its therapeutic potential.

Lateralized Brainstem and Cervical Spinal Cord Responses to Aversive Sounds: A Spinal fMRI Study

Previous research has delineated the networks of brain structures involved in the perception of emotional auditory stimuli. These include the amygdala, insula, and auditory cortices, as well as frontal-lobe, basal ganglia, and cerebellar structures involved in the planning and execution of motoric behaviors. The aim of the current research was to examine whether emotional sounds also influence activity in the brainstem and cervical spinal cord. Seventeen undergraduate participants completed a spinal functional magnetic resonance imaging (fMRI) study consisting of two fMRI runs. One run consisted of three one-minute blocks of aversive sounds taken from the International Affective Digitized Sounds (IADS) stimulus set; these blocks were interleaved by 40-s rest periods. The other block consisted of emotionally neutral stimuli also drawn from the IADS. The results indicated a stark pattern of lateralization. Aversive sounds elicited greater activity than neutral sounds in the right midbrain and brainstem, and in right dorsal and ventral regions of the cervical spinal cord. Neutral stimuli, on the other hand, elicited less neural activity than aversive sounds overall; these responses were left lateralized and were found in the medial midbrain and the dorsal sensory regions of the cervical spinal cord. Together, these results demonstrate that aversive auditory stimuli elicit increased sensorimotor responses in brainstem and cervical spinal cord structures.