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. 2024 May 1:291:120596.
doi: 10.1016/j.neuroimage.2024.120596. Epub 2024 Mar 29.

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

Kai-Yen Chang  1 , Martin Tik  2 , Yuki Mizutani-Tiebel  1 , Anna-Lisa Schuler  3 , Paul Taylor  4 , Mattia Campana  1 , Ulrike Vogelmann  5 , Barbara Huber  5 , Esther Dechantsreiter  5 , Axel Thielscher  6 , Lucia Bulubas  1 , Frank Padberg  1 , Daniel Keeser  7
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Free article

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

Kai-Yen Chang et al. Neuroimage. .
Free article

Abstract

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.

Keywords: Concurrent TMS-fMRI; Functional MRI (fMRI); Interleaved iTBS-fMRI; Neuromodulation; Non-invasive brain stimulation; Transcranial magnetic stimulation (TMS).

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Conflict of interest statement

Declaration of competing interest This work is a part of K-YC's Ph.D. program at Munich Medical Research School. YM-T received remuneration from neuroCare Group AG as a part-time office worker. FP is a member of the European Scientific Advisory Board of Brainsway Inc., Jerusalem, Israel, and the International Scientific Advisory Board of Sooma, Helsinki, Finland. He has received speaker's honoraria from Mag&More GmbH, the neuroCare Group, Munich, Germany, and Brainsway Inc. His-lab has received support with equipment from neuroConn GmbH, Ilmenau, Germany, Mag&More GmbH and Brainsway Inc. MT, A-LS, PT, MC, UV, BH, ED, AT, LB, & DK reported no potential conflicts of interest.

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