How structural and functional MRI can inform dual-site tACS parameters: A case study in a clinical population and its pragmatic implications

Abstract

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Closing the loop between brain and electrical stimulation: Towards precision neuromodulation treatments

“…Stimulation model: A model that includes technical properties of the stimulator and its mechanism of action to predict the optimized protocol based on the inputs from the stimulation model. activity/connectivity [21]. For example, Stanford neuromodulation therapy (SNT) paradigm provided by Cole et al [22], reported that individualized functional-connectivity-guided targeting using resting-state fMRI in a high dose intermittent theta burst stimulation (iTBS) trial was more effective than sham stimulation for treatment resistant depression [22].…”

Electric Current and Emotional Control

“…Neither patients nor caregivers believed that a technique like tDCS can completely replace psychotherapy or 'talking'. In fact, 'talking', personal contact and the role of the caregiver are regarded as the most important aspects of psychotherapy 44 that positively contribute to willingness to participate in research (especially among traumatized patients 55 ), treatment acceptability 53,56 , therapeutic effectivity, and self-efficacy in managing symptoms 43,53,[56][57][58][59] . Accordingly, treatments for PTSD and anxiety without these interpersonal aspects (e.g.…”

“…At the same time, disrupted functioning of other areas in the prefrontal cortex (such as dorsolateral and ventrolateral parts) leads to exaggerated expectations of danger and avoidance behavior. Impaired activation of these areas has been associated with impaired emotion regulation and impaired executive control functions such as attention deficits and impulsivity 44,56,57 . Hence, targeting activity in dorsolateral and ventrolateral prefrontal cortex regions may restore impairments in regulatory functions like emotion regulation and executive control and thereby support adaptive coping with stress.…”

“…56 ), this suggests that tDCS might have had little opportunity to further enhance training processes in our study. Moreover, patients with stress-related disorders may specifically show impulsivity in the emotional domain 57 , and tDCS effects on cognitive and emotional outcomes seem to depend on active emotion regulation, cognitive effort and neural activity in the targeted area 13,58,59 . Our response inhibition training may have failed to adequately incorporate these factors due to its non-emotional nature and low cognitive load.…”

“…Some evidence for the effectivity of rTMS and tDCS in modulating stress-and emotion-related processes comes from NBS interventions that have been carried out in the area of stressrelated affective disorders. For example, applying rTMS over the DLPFC can reduce symptoms of depression [52][53][54][55] , PTSD [56][57][58][59][60] , and possibly also generalized anxiety and panic disorder [61][62][63][64][65] . However, some studies showed no effects 66,67 and uncertainties remain regarding the optimal rTMS settings, such as pulse frequency 68 and target region 59 .…”