Combining Transcranial Magnetic Stimulation and Deep Brain Stimulation: Current Knowledge, Relevance and Future Perspectives

Abstract

Deep brain stimulation (DBS) has emerged as an invasive neuromodulation technique for the treatment of several neurological disorders, but the mechanisms underlying its effects remain partially elusive. In this context, the application of Transcranial Magnetic Stimulation (TMS) in patients treated with DBS represents an intriguing approach to investigate the neurophysiology of cortico-basal networks. Experimental studies combining TMS and DBS that have been performed so far have mainly aimed to evaluate the effects of DBS on the cerebral cortex and thus to provide insights into DBS’s mechanisms of action. The modulation of cortical excitability and plasticity by DBS is emerging as a potential contributor to its therapeutic effects. Moreover, pairing DBS and TMS stimuli could represent a method to induce cortical synaptic plasticity, the therapeutic potential of which is still unexplored. Furthermore, the advent of new DBS technologies and novel treatment targets will present new research opportunities and prospects to investigate brain networks. However, the application of the combined TMS-DBS approach is currently limited by safety concerns. In this review, we sought to present an overview of studies performed by combining TMS and DBS in neurological disorders, as well as available evidence and recommendations on the safety of their combination. Additionally, we outline perspectives for future research by highlighting knowledge gaps and possible novel applications of this approach.

Recent Advances in Magnetically Actuated Droplet Manipulation for Biomedical Applications

“…Among them, magnetic control has unique advantages because it can control droplets in a non-contact manner, and magnetic energy is easy to obtain and portable, laying the foundation for POC detection. Magnetic manipulation is becoming a common requirement in the biomedical field, such as for strain/enzyme activity screening [119], cell separation [120][121][122], magnetic biosensors [123,124], therapy (thermal cancer treatment) [125], drug and gene delivery [126,127], deep brain stimulation and tissue engineering for regenerative medicine [128,129], MRI diagnostics [130], theranostics [131], magnetic microreactors [132], etc. Combining magnetic hyperthermia (MHT) and immunotherapy can be used to ablate primary tumors and simulate metastatic tumor suppression.…”

Subthalamic deep brain stimulation alleviates motor symptoms without restoring deficits in corticospinal suppression during movement preparation in Parkinson’s disease

“…To address these hypotheses, in two sessions on two consecutive days, we applied TMS over M1 in PD patients implanted with bilateral STN-DBS while they executed an instructed-delay choice reaction time (RT) task. Even though TMS has been safely performed in DBS patients in previous studies, [39][40][41] CSE investigations in DBS patients are remarkably rare, especially with concurrent behavioural measures. 29 Here, patients were tested either ON-or OFF-DBS, while taking their regular DRT in both sessions; they were matched with healthy controls (HCs), also performing two sessions on consecutive days.…”

Unraveling the complex interplay between insomnia, anxiety, and brain networks

“…Future research may also broaden the scope by examining anxious patients with and without insomnia symptoms, which can offer a more comprehensive understanding of the neurobiological underpinnings of these conditions. In addition, the circuits identified in this study could be targeted with treatments such as transcranial magnetic stimulation and deep brain stimulation to provide evidence for the causal relationship [ 33 , 34 ]. Implementing these approaches will contribute to an expanded understanding of the causal relationship between insomnia and anxiety.…”