Chi-Hung Juan

Unleashing Potential: Transcranial Direct Current Stimulation over the Right Posterior Parietal Cortex Improves Change Detection in Low-Performing Individuals

The limits of human visual short-term memory (VSTM) have been well documented, and recent neuroscientific studies suggest that VSTM performance is associated with activity in the posterior parietal cortex. Here we show that artificially elevating parietal activity via positively charged electric current through the skull can rapidly and effortlessly improve peoples VSTM performance. This artificial improvement, however, comes with an interesting twist: it interacts with peoples natural VSTM capability such that low performers who tend to remember less information benefitted from the stimulation, whereas high performers did not. This behavioral dichotomy is explained by event-related potentials around the parietal regions: low performers showed increased waveforms in N2pc and contralateral delay activity (CDA), which implies improvement in attention deployment and memory access in the current paradigm, respectively. Interestingly, these components are found during the presentation of the test array instead of the retention interval, from the parietal sites ipsilateral to the target location, thus suggesting that transcranial direct current stimulation (tDCS) was mainly improving ones ability to suppress no-change distractors located on the irrelevant side of the display during the comparison stage. The high performers, however, did not benefit from tDCS as they showed equally large waveforms in N2pc and CDA, or SPCN (sustained parietal contralateral negativity), before and after the stimulation such that electrical stimulation could not help any further, which also accurately accounts for our behavioral observations. Together, these results suggest that there is indeed a fixed upper limit in VSTM, but the low performers can benefit from neurostimulation to reach that maximum via enhanced comparison processes, and such behavioral improvement can be directly quantified and visualized by the magnitude of its associated electrophysiological waveforms.

Control of prepotent responses by the superior medial frontal cortex.

The inhibitory control of prepotent action is vital for appropriate behaviour. An example of the importance of such control can be seen in the inhibition of aggressive behavior, deficits in which may have broader consequences for society. Many studies have related lesions or the under-development of the prefrontal cortex to inefficiency of inhibitory control. Here we used transcranial magnetic stimulation and a stop-signal task, which occasionally requires the inhibition of a prepotent motor response, to investigate the role of pre-supplementary motor area (Pre-SMA) in inhibitory control. While no effects were seen on the ability to generate responses, TMS delivered over the Pre-SMA disrupted the ability to respond to a stop signal. These results are the first to establish a casual link between Pre-SMA and inhibitory control in normal subjects. The understanding of the underlying mechanisms of inhibitory control may lead to clearer understanding of the neural basis of inappropriate behaviour.

Segregation of visual selection and saccades in human frontal eye fields.

The premotor theory of attention suggests that target processing and generation of a saccade to the target are interdependent. Temporally precise transcranial magnetic stimulation (TMS) was delivered over the human frontal eye fields, the area most frequently associated with the premotor theory in association with eye movements, while subjects performed a visually instructed pro-/antisaccade task. Visual analysis and saccade preparation were clearly separated in time, as indicated by 2 distinct time points of TMS delivery that resulted in elevated saccade latencies. These results show that visual analysis and saccade preparation, although frequently enacted together, are dissociable processes.

Transcranial direct current stimulation over right posterior parietal cortex changes prestimulus alpha oscillation in visual short-term memory task.

Alpha band activity changes accompanied with the level attentional state, and recent studies suggest that such oscillation is associated with activities in the posterior parietal cortex. Here we show that artificially elevating parietal activity via positively-charged electric current through the skull can rapidly and effortlessly change peoples prestimulus alpha power and improve subsequent performance on a visual short-term memory (VSTM) task. This modulation of alpha power and behavioral performance, however, is dependent on peoples natural VSTM capability such that only the low performers benefitted from the stimulation, whereas high performers did not. This behavioral dichotomy is accounted by prestimulus alpha powers around the parieto-occipital regions: low performers showed decreased prestimulus alpha power, suggesting improvement in attention deployment in the current paradigm, whereas the high performers did not benefit from tDCS as they showed equally-low prestimulus alpha power before and after the stimulation. Together, these results suggest that prestimulus alpha power, especially in low performers, can be modulated by anodal stimulation and alter subsequent VSTM performance/capacity. Thus, measuring alpha before stimulus onset may be as important as measuring other VSTM-related electrophysiological components such as attentional allocation and memory capacity related components (i.e. N2 posterior-contralateral, N2pc, or contralateral delay activity, CDA). In addition, low VSTM performers perhaps do not suffer not only from poor VSTM capacity, but also from broad attentional mechanisms, and prestimulus alpha may be an useful tool in understanding the nature of individual differences in VSTM.

Efficacy of prefrontal theta-burst stimulation in refractory depression: a randomized sham-controlled study

Theta-burst transcranial magnetic stimulation could modulate cortical excitability and has the potential to treat refractory depression. However, there has been a lack of large randomized studies of the antidepressant efficacy of different forms of theta-burst stimulation, such as intermittent and continuous theta-burst stimulation. A randomized sham-controlled study was conducted to investigate antidepressant efficacy of theta-burst stimulation and to compare efficacy among left-prefrontal intermittent theta-burst stimulation, right-prefrontal continuous theta-burst stimulation and a combination of them in patients showing different levels of antidepressant refractoriness. A group of 60 treatment-refractory patients with recurrent major depressive disorder were recruited and randomized to four groups (Group A: continuous theta-burst stimulation; Group B: intermittent theta-burst stimulation; Group C: a combination of continuous and intermittent theta-burst stimulation; and Group D: sham theta-burst stimulation; 15 patients were included in each group). After 2 weeks of theta-burst stimulation treatment, depression improved in all groups. Groups B and C had better antidepressant responses (as reflected by % decreases in depression score) than Groups A and D (P = 0.001, post hoc analysis: B > A, B > D, C > A, and C > D), even after controlling for age and refractoriness scores. The mean antidepressant effect was highest in Group C and followed by that in Group B. Additionally, a significant placebo effect was found in patients with low refractoriness; this disappeared in patients with moderate-to-high refractoriness. A significant correlation existed between refractoriness scores and treatment responses. Treatment refractoriness was a significant factor negatively predicting efficacy of theta-burst stimulation (P = 0.039). This randomized sham-controlled study demonstrated that active theta-burst stimulation is a well-tolerated form of repetitive transcranial magnetic stimulation and has good antidepressant efficacy, particularly in depressed subjects within a certain range of treatment refractoriness.

Open vs. Closed Skill Sports and the Modulation of Inhibitory Control

Background Inhibitory control, or the ability to suppress planned but inappropriate prepotent actions in the current environment, plays an important role in the control of human performance. Evidence from empirical studies utilizing a sport-specific design has shown that athletes have superior inhibitory control. However, less is known about whether this superiority might (1) still be seen in a general cognitive task without a sport-related context; (2) be modulated differentially by different sporting expertise (e.g., tennis versus swimming). Methodology/Principal Findings Here we compared inhibitory control across tennis players, swimmers and sedentary non-athletic controls using a stop-signal task without a sport-specific design. Our primary finding showed that tennis players had shorter stop-signal reaction times (SSRTs) when compared to swimmers and sedentary controls, whereas no difference was found between swimmers and sedentary controls. Importantly, this effect was further confirmed after considering potential confounding factors (e.g., BMI, training experience, estimated levels of physical activity and VO2max), indicative of better ability to inhibit unrequired responses in tennis players. Conclusions/Significance This suggests that fundamental inhibitory control in athletes can benefit from open skill training. Sport with both physical and cognitive demands may provide a potential clinical intervention for those who have difficulties in inhibitory control.

Right Temporoparietal Junction and Attentional Reorienting

The interaction between goal‐directed and stimulus‐driven attentional control allows humans to rapidly reorient to relevant objects outside the focus of attention—a phenomenon termed contingent reorienting. Neuroimaging studies have observed activation of the ventral and dorsal attentional networks, but specific involvement of each network remains unclear. The present study aimed to determine whether both networks are critical to the processes of top‐down contingent reorienting. To this end, we combined the contingent attentional capture paradigm with the use of transcranial magnetic stimulation (TMS) to interfere with temporoparietal junction (TPJ; ventral network) and frontal eye field (dorsal network) activity. The results showed that only right TPJ (rTPJ) TMS modulated contingent orienting. Furthermore, this modulation was highly dependent on visual fields: rTPJ TMS increased contingent capture in the left visual field and decreased the effect in the right visual field. These results demonstrate a critical involvement of the ventral network in attentional reorienting and reveal the spatial selectivity within such network. Hum Brain Mapp, 2013.

Revealing the brain's adaptability and the transcranial direct current stimulation facilitating effect in inhibitory control by multiscale entropy

The abilities to inhibit impulses and withdraw certain responses are critical for humans survival in a fast-changing environment. These processes happen fast, in a complex manner, and sometimes are difficult to capture with fMRI or mean electrophysiological brain signal alone. Therefore, an alternative measure that can reveal the efficiency of the neural mechanism across multiple timescales is needed for the investigation of these brain functions. The present study employs a new approach to analyzing electroencephalography (EEG) signal: the multiscale entropy (MSE), which groups data points with different timescales to reveal any occurrence of repeated patterns, in order to theoretically quantify the complexity (indicating adaptability and efficiency) of neural systems during the process of inhibitory control. From this MSE perspective, EEG signals of successful stop trials are more complex and information rich than that of unsuccessful stop trials. We further applied transcranial direct current stimulation (tDCS), with anodal electrode over presupplementary motor area (preSMA), to test the relationship between behavioral modification with the complexity of EEG signals. We found that tDCS can further increase the EEG complexity of the frontal lobe. Furthermore, the MSE pattern was found to be different between high and low performers (divided by their stop-signal reaction time), where the high-performing group had higher complexity in smaller scales and less complexity in larger scales in comparison to the low-performing group. In addition, this between-group MSE difference was found to interact with the anodal tDCS, where the increase of MSE in low performers benefitted more from the anodal tDCS. Together, the current study demonstrates that participants who suffer from poor inhibitory control can efficiently improve their performance with 10min of electrical stimulation, and such cognitive improvement can be effectively traced back to the complexity within the EEG signals via MSE analysis, thereby offering a theoretical basis for clinical intervention via tDCS for deficits in inhibitory control.

Brain stimulation and inhibitory control.

Inhibitory control mechanisms are important in a range of behaviours to prevent execution of motor acts which, having been planned, are no longer necessary or appropriate. Examples of this can be seen in a range of sports, such as cricket and baseball, where the choice between execution and inhibition of a bat swing must be made in a very brief time window. Deficits in inhibitory control have been associated with problems in behavioural regulation in impulsive violence as well as a range of clinical disorders. The roles of various areas, including the frontal eye fields (FEF), the pre-supplementary motor area (pre-SMA) and the inferior frontal gyrus, in inhibitory control have been investigated using an inhibitory control task and both transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). Typically effects on response inhibition but no effects on response generation have been seen. The contributions of these areas to performance seem to differ with, for example, pre-SMA being involved when the task is relatively novel whereas this is not the case for FEF. The findings from brain stimulation studies offer both insight into which areas are necessary for effective inhibitory control and recent extension of findings for the role of the inferior frontal gyrus illustrate how the specific functions by which these areas contribute may be further clarified. Future work, including making use of the temporal specificity of TMS and combination of TMS/tDCS with other neuroimaging techniques, may further clarify the nature and functions played by the network of areas involved in inhibitory control.

The timing of the involvement of the frontal eye fields and posterior parietal cortex in visual search

The frontal eye fields (FEFs) and posterior parietal cortex (PPC) are important for target detection in conjunction visual search but the relative timings of their contribution have not been compared directly. We addressed this using temporally specific double pulse transcranial magnetic stimulation delivered at different times over FEFs and PPC during performance of a visual search task. Disruption of performance was earlier (0/40 ms) with FEF stimulation than with PPC stimulation (120/160 ms), revealing a clear and substantial temporal dissociation of the involvement of these two areas in conjunction visual search. We discuss these timings with reference to the respective roles of FEF and PPC in the modulation of extrastriate visual areas and selection of responses.