Neural response during prefrontal theta burst stimulation: Interleaved TMS-fMRI of full iTBS protocols

Background: Left prefrontal intermittent theta-burst stimulation (iTBS) has emerged as a safe and effective transcranial magnetic stimulation (TMS) treatment protocol in depression. Though network effects after iTBS have been widely studied, the deeper mechanistic understanding of target engagement...

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Main Authors: Kai-Yen Chang, Martin Tik, Yuki Mizutani-Tiebel, Anna-Lisa Schuler, Paul Taylor, Mattia Campana, Ulrike Vogelmann, Barbara Huber, Esther Dechantsreiter, Axel Thielscher, Lucia Bulubas, Frank Padberg, Daniel Keeser
Format: Article
Language:English
Published: Elsevier 2024-05-01
Series:NeuroImage
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Online Access:http://www.sciencedirect.com/science/article/pii/S1053811924000910
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author Kai-Yen Chang
Martin Tik
Yuki Mizutani-Tiebel
Anna-Lisa Schuler
Paul Taylor
Mattia Campana
Ulrike Vogelmann
Barbara Huber
Esther Dechantsreiter
Axel Thielscher
Lucia Bulubas
Frank Padberg
Daniel Keeser
author_facet Kai-Yen Chang
Martin Tik
Yuki Mizutani-Tiebel
Anna-Lisa Schuler
Paul Taylor
Mattia Campana
Ulrike Vogelmann
Barbara Huber
Esther Dechantsreiter
Axel Thielscher
Lucia Bulubas
Frank Padberg
Daniel Keeser
author_sort Kai-Yen Chang
collection DOAJ
description Background: Left prefrontal intermittent theta-burst stimulation (iTBS) has emerged as a safe and effective transcranial magnetic stimulation (TMS) treatment protocol in depression. Though network effects after iTBS have been widely studied, the deeper mechanistic understanding of target engagement is still at its beginning. Here, we investigate the feasibility of a novel integrated TMS-fMRI setup and accelerated echo planar imaging protocol to directly observe the immediate effects of full iTBS treatment sessions. Objective/hypothesis: In our effort to explore interleaved iTBS-fMRI feasibility, we hypothesize that TMS will induce acute BOLD signal changes in both the stimulated area and interconnected neural regions. Methods: Concurrent TMS-fMRI with full sessions of neuronavigated iTBS (i.e. 600 pulses) of the left dorsolateral prefrontal cortex (DLPFC) was investigated in 18 healthy participants. In addition, we conducted four TMS-fMRI sessions in a single patient on long-term maintenance iTBS for bipolar depression to test the transfer to clinical cases. Results: Concurrent TMS-fMRI was feasible for iTBS sequences with 600 pulses. During interleaved iTBS-fMRI, an increase of the BOLD signal was observed in a network including bilateral DLPFC regions. In the clinical case, a reduced BOLD response was found in the left DLPFC and the subgenual anterior cingulate cortex, with high variability across individual sessions. Conclusions: Full iTBS sessions as applied for the treatment of depressive disorders can be established in the interleaved iTBS-fMRI paradigm. In the future, this experimental approach could be valuable in clinical samples, for demonstrating target engagement by iTBS protocols and investigating their mechanisms of therapeutic action.
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spelling doaj.art-4fdc07453c7b432eaaf4acd054885fdc2024-04-10T04:28:41ZengElsevierNeuroImage1095-95722024-05-01291120596Neural response during prefrontal theta burst stimulation: Interleaved TMS-fMRI of full iTBS protocolsKai-Yen Chang0Martin Tik1Yuki Mizutani-Tiebel2Anna-Lisa Schuler3Paul Taylor4Mattia Campana5Ulrike Vogelmann6Barbara Huber7Esther Dechantsreiter8Axel Thielscher9Lucia Bulubas10Frank Padberg11Daniel Keeser12Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Neuroimaging Core Unit Munich - NICUM, University Hospital, LMU Munich, Munich, GermanyHigh Field MR Center, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria; Brain Stimulation Lab, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, USA; Corresponding authors at: Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Neuroimaging Core Unit Munich - NICUM, University Hospital, LMU Munich, Munich, GermanyLise Meitner Research Group Cognition and Plasticity, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, GermanyDepartment of Psychology, LMU Munich, Munich, GermanyDepartment of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Neuroimaging Core Unit Munich - NICUM, University Hospital, LMU Munich, Munich, GermanyDepartment of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, GermanyDepartment of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, GermanyDepartment of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, GermanyDepartment of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark; Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, DenmarkDepartment of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Neuroimaging Core Unit Munich - NICUM, University Hospital, LMU Munich, Munich, GermanyDepartment of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Neuroimaging Core Unit Munich - NICUM, University Hospital, LMU Munich, Munich, GermanyDepartment of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Neuroimaging Core Unit Munich - NICUM, University Hospital, LMU Munich, Munich, Germany; Corresponding authors at: Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.Background: Left prefrontal intermittent theta-burst stimulation (iTBS) has emerged as a safe and effective transcranial magnetic stimulation (TMS) treatment protocol in depression. Though network effects after iTBS have been widely studied, the deeper mechanistic understanding of target engagement is still at its beginning. Here, we investigate the feasibility of a novel integrated TMS-fMRI setup and accelerated echo planar imaging protocol to directly observe the immediate effects of full iTBS treatment sessions. Objective/hypothesis: In our effort to explore interleaved iTBS-fMRI feasibility, we hypothesize that TMS will induce acute BOLD signal changes in both the stimulated area and interconnected neural regions. Methods: Concurrent TMS-fMRI with full sessions of neuronavigated iTBS (i.e. 600 pulses) of the left dorsolateral prefrontal cortex (DLPFC) was investigated in 18 healthy participants. In addition, we conducted four TMS-fMRI sessions in a single patient on long-term maintenance iTBS for bipolar depression to test the transfer to clinical cases. Results: Concurrent TMS-fMRI was feasible for iTBS sequences with 600 pulses. During interleaved iTBS-fMRI, an increase of the BOLD signal was observed in a network including bilateral DLPFC regions. In the clinical case, a reduced BOLD response was found in the left DLPFC and the subgenual anterior cingulate cortex, with high variability across individual sessions. Conclusions: Full iTBS sessions as applied for the treatment of depressive disorders can be established in the interleaved iTBS-fMRI paradigm. In the future, this experimental approach could be valuable in clinical samples, for demonstrating target engagement by iTBS protocols and investigating their mechanisms of therapeutic action.http://www.sciencedirect.com/science/article/pii/S1053811924000910Functional MRI (fMRI)Transcranial magnetic stimulation (TMS)Concurrent TMS-fMRIInterleaved iTBS-fMRINon-invasive brain stimulationNeuromodulation
spellingShingle Kai-Yen Chang
Martin Tik
Yuki Mizutani-Tiebel
Anna-Lisa Schuler
Paul Taylor
Mattia Campana
Ulrike Vogelmann
Barbara Huber
Esther Dechantsreiter
Axel Thielscher
Lucia Bulubas
Frank Padberg
Daniel Keeser
Neural response during prefrontal theta burst stimulation: Interleaved TMS-fMRI of full iTBS protocols
NeuroImage
Functional MRI (fMRI)
Transcranial magnetic stimulation (TMS)
Concurrent TMS-fMRI
Interleaved iTBS-fMRI
Non-invasive brain stimulation
Neuromodulation
title Neural response during prefrontal theta burst stimulation: Interleaved TMS-fMRI of full iTBS protocols
title_full Neural response during prefrontal theta burst stimulation: Interleaved TMS-fMRI of full iTBS protocols
title_fullStr Neural response during prefrontal theta burst stimulation: Interleaved TMS-fMRI of full iTBS protocols
title_full_unstemmed Neural response during prefrontal theta burst stimulation: Interleaved TMS-fMRI of full iTBS protocols
title_short Neural response during prefrontal theta burst stimulation: Interleaved TMS-fMRI of full iTBS protocols
title_sort neural response during prefrontal theta burst stimulation interleaved tms fmri of full itbs protocols
topic Functional MRI (fMRI)
Transcranial magnetic stimulation (TMS)
Concurrent TMS-fMRI
Interleaved iTBS-fMRI
Non-invasive brain stimulation
Neuromodulation
url http://www.sciencedirect.com/science/article/pii/S1053811924000910
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