Investigating high- and low-frequency neuro-cardiac-guided TMS for probing the frontal vagal pathway

Kaur, Manreena; Michael, Jessica A.; Hoy, Kate E.; Fitzgibbon, Bernadette M.; Ross, Megan S.; Iseger, Tabitha A.; Arns, Martijn; Hudaib, Abdul‐Rahman; Fitzgerald, Paul B.

doi:10.1016/j.brs.2020.03.002

Cited by 28 publications

(15 citation statements)

References 29 publications

(53 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…When the changes in heart rate of patients during TMS application are a clinical concern, then our results indicate that stimulation during diastole can prevent these unwanted changes. In contrast, synchronization of TMS with systolic activity might be relevant for treatment of clinical subgroups, such as depression, which is often associated with decreased heart rate variability and increased heart rate [32][33][34] . Our results, therefore, suggest that application of TMS during systole or diastole might be helpful to optimize clinical protocols, which should be addressed in future studies.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Activity Impacts Cortical Motor Excitability

Stephani

Engelhardt

et al. 2021

Preprint

View full text Add to dashboard Cite

Human cognition and action can be influenced by internal bodily processes such as heartbeats. For instance, somatosensory perception is impaired both during the systolic phase of the cardiac cycle and when heartbeats evoke stronger cortical responses. Here, we test whether these cardiac effects originate from overall changes in cortical excitability. Cortical and corticospinal excitability were assessed using electroencephalographic and electromyographic responses to transcranial magnetic stimulation while concurrently monitoring cardiac activity with electrocardiography. Cortical and corticospinal excitability were found to be highest during systole and following stronger cortical responses to heartbeats. Furthermore, in a motor task, hand-muscle activity and the associated desynchronization of sensorimotor oscillations were stronger during systole. These results suggest that systolic cardiac signals have a facilitatory effect on motor excitability – in contrast to sensory attenuation that was previously reported for somatosensory perception. Thus, distinct time windows may exist across the cardiac cycle that either optimize perception or action.

show abstract

Section: Discussionmentioning

confidence: 99%

Cardiac Activity Impacts Cortical Motor Excitability

Stephani

Engelhardt

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…There was variability between subjects in their optimal stimulation location although the most common effects were seen at the F3/F4 for EEG sites. A second study has provided a partial replication of these findings and also indicated that there may be variations that are frequency and hemisphere specific [26]. To date, studies investigating this NCG-TMS approach have established differences in heart rate variability between EEG sites.…”

Section: How Do We Localize Treatment To the Dlpfc?mentioning

confidence: 80%

Targeting repetitive transcranial magnetic stimulation in depression: do we really know what we are stimulating and how best to do it?

Fitzgerald¹

2021

Brain Stimulation

Self Cite

View full text Add to dashboard Cite

Background: Repetitive transcranial magnetic stimulation (rTMS) is an established treatment for patients with depression who have not achieved optimal outcomes with one or more trials of antidepressant medication. It is an effective antidepressant treatment but there remains considerable scope for improving clinical outcomes. One method to potentially enhance the efficacy of rTMS is through the improvement of methods of stimulation localization. Objective: The purpose of this paper is to review the literature pertaining to rTMS localization methods and approaches relevant to the treatment of major depressive disorder (MDD) and provide specific opinions on the state of the art in regards to targeting of rTMS treatment in depression. Methods: A targeted review of the literature on rTMS targeting in depression. Results: There is emerging evidence that optimal rTMS treatment outcomes are likely to be achieved with stimulation at a relatively anterior stimulation site in the left dorsolateral prefrontal cortex (DLPFC). However, some lines of research suggest that there may be two effective stimulation sites: one quite posterior, and one more anterior, in the DLPFC. The 'Beam F3' method provides reasonable localization to the anterior stimulation site and the posterior stimulation site corresponds to that typically used in studies using the '5 cm method'. Neuro-navigational methods are generally most likely to consistently ensure placement of the TMS coil such that it results in stimulation of a selected cortical site. fMRI e connectivity based approaches to targeting specific circuits in the DLPFC are intellectually attractive but it may not be possible to demonstrate differential effectiveness of these over the methods most commonly been used in clinical practice. Conclusions: There is an emerging literature helping to improve our understanding of the optimal methods for targeting rTMS treatment for depression. However, we lack substantive prospective clinical trials demonstrating improved clinical outcomes with these techniques.

show abstract

“…Some have suggested that the 1 Hz rTMS may be better tolerated than HF protocols, while also having a better safety profile. 74 – 76 Low frequency, 1 Hz rTMS can also be delivered on more affordable equipment than HF protocols, which could decrease costs and therefore potentially increase accessibility to rTMS. 73 …”

Section: Obstacles To the Current Care Delivery Model And Effectiveness Issuesmentioning

confidence: 99%

“…Several studies in human subjects have also reported that DLPFC stimulation reliably modulates HR compared to other neighboring cortical areas, such as the motor cortex, that had no such effect on cardiac activity. 75 , 81 , 82 As such, neuro-cardiac-guided TMS (NCG-TMS) could show promise to improve target selection and optimize treatment response.…”

Section: Obstacles To the Current Care Delivery Model And Effectiveness Issuesmentioning

confidence: 99%

Repetitive transcranial magnetic stimulation for major depressive disorder: basic principles and future directions

Miron

Jodoin

Lespérance

et al. 2021

Therapeutic Advances in Psychopharmacology

View full text Add to dashboard Cite

Repetitive transcranial magnetic stimulation (rTMS) is a safe and well-tolerated intervention for major depressive disorder (MDD). Over 150 randomized controlled trials (RCTs) have been carried out, and its efficacy has been confirmed in dozens of meta-analyses. Real world data has also confirmed the effectiveness of rTMS for MDD in clinical practice, with the most recent literature indicating response rates of 40–50% and remission rates of 25–30%. In this review, we first offer an historical perspective, followed by a review of basic principles, such as putative mechanisms, procedures and protocols, stimulation targets, efficacy and durability of response, side effects, and the placebo controversy. In the second part of this review, we first discuss solutions to increase accessibility to rTMS, such as modifications to treatment equipment, protocols and setting. We continue with possible means to further increase effectiveness, such as treatment personalization and extension. We conclude by addressing the scheduling issue, with accelerated rTMS (arTMS) as a possible solution.

show abstract

Investigating high- and low-frequency neuro-cardiac-guided TMS for probing the frontal vagal pathway

Cited by 28 publications

References 29 publications

Cardiac Activity Impacts Cortical Motor Excitability

Cardiac Activity Impacts Cortical Motor Excitability

Targeting repetitive transcranial magnetic stimulation in depression: do we really know what we are stimulating and how best to do it?

Repetitive transcranial magnetic stimulation for major depressive disorder: basic principles and future directions

Contact Info

Product

Resources

About