Real-time optimization to enhance noninvasive cortical excitability assessment in the human dorsolateral prefrontal cortex

Abstract

ObjectiveWe currently lack a robust noninvasive method to measure prefrontal excitability in humans. Concurrent TMS and EEG in the prefrontal cortex is usually confounded by artifacts. Here we asked if real-time optimization could reduce artifacts and enhance a TMS-EEG measure of left prefrontal excitability.MethodsThis closed-loop optimization procedure adjusts left dlPFC TMS coil location, angle, and intensity in real-time based on the EEG response to TMS. Our outcome measure was the left prefrontal early (20-60 ms) and local TMS-evoked potential (EL-TEP).ResultsIn 18 healthy participants, this optimization of coil angle and brain target significantly reduced artifacts by 63% and, when combined with an increase in intensity, increased EL-TEP magnitude by 75% compared to a non-optimized approach.ConclusionsReal-time optimization of TMS parameters during dlPFC stimulation can enhance the EL-TEP.SignificanceEnhancing our ability to measure prefrontal excitability is important for monitoring pathological states and treatment response.HighlightsWe developed a real-time closed-loop optimization procedure to obtain high amplitude early local TEPs (EL-TEPs) from dlPFC TMS.Sequential optimization of coil angle and brain target reduced artifacts by 63%.Sequential optimization of coil angle, brain target, and intensity increased EL-TEP amplitude by 75%.