Sabrina Brückner

Comparing the after-effects of continuous theta burst stimulation and conventional 1 Hz rTMS on semantic processing.

Our aim was to evaluate continuous theta burst stimulation (cTBS) as a tool to induce temporary impairment (virtual lesion) in semantic processing. Four groups with 20 subjects each were stimulated. In the three experimental groups the stimulation site was the left superior temporal cortex. Stimulation was either 1Hz repetitive transcranial magnetic stimulation (rTMS) at 100% resting motor threshold (RMT) or cTBS, with intensities of 80% or 90% active motor threshold (AMT). The TMS-control group was stimulated at the right medial prefrontal cortex with 1 Hz rTMS. After stimulation subjects accomplished a lexical decision task with a duration of about 20 min. In an additional fifth group the lexical decision task was performed without TMS. Reaction times were not influenced by cTBS applied with 80% AMT, but prolonged for about 80 ms with 90% AMT compared to the no stimulation condition. An increase of 140 ms was found after 1 Hz rTMS. The effect lasted for the whole task, but declined from the first to the second half of the experiment. The direct comparison of cTBS and 1 Hz rTMS suggests that both stimulation patterns can induce virtual lesions in the left superior temporal cortex and impair semantic processing. We suppose that cTBS could replace 1 Hz rTMS in this field since the application is faster and it is more comfortable to the subjects.

No Modulation of Visual Cortex Excitability by Transcranial Direct Current Stimulation.

Measuring phosphene thresholds (PTs) is often used to investigate changes in the excitability of the human visual cortex through different brain stimulation methods like repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS). In several studies, PT increase or decrease has been shown after rTMS or tDCS application. Recently, using PT measurements we showed that the state of the neurons in the visual cortex after rTMS might have an influence on the modulatory effects of stimulation. In the present study we aimed to investigate whether visual cortex activity following stimulation influences the modulatory effects of tDCS as well. In a between-group design, anodal or cathodal tDCS was applied to the visual cortex twice per subject, with either high or low visual demand following stimulation. We observed no modulation of PT neither directly following both anodal and cathodal tDCS nor following the visual demand periods. We rather found high inter-individual variability in the response to tDCS, and intra-individual reliability in the direction of modulation was observed for cathodal tDCS only. Thus, our results do not confirm the modulatory effects of tDCS on visual cortex excitability published previously. Moreover, they support the confirmation that tDCS effects have little reliability on varied TMS outcome measurements.

High visual demand following theta burst stimulation modulates the effect on visual cortex excitability

Modulatory effects of repetitive transcranial magnetic stimulation (TMS) depend on the activity of the stimulated cortical area before, during, and even after application. In the present study, we investigated the effects of theta burst stimulation (TBS) on visual cortex excitability using phosphene threshold (PTs). In a between-group design either continuous or intermittent TBS was applied with 100% of individual PT intensity. We varied visual demand following stimulation in form of high demand (acuity task) or low demand (looking at the wall). No change of PTs was observed directly after TBS. We found increased PTs only if subjects had high visual demand following continuous TBS. With low visual demand following stimulation no change of PT was observed. Intermittent TBS had no effect on visual cortex excitability at all. Since other studies showed increased PTs following continuous TBS using subthreshold intensities, our results highlight the importance of stimulation intensity applying TBS to the visual cortex. Furthermore, the state of the neurons in the stimulated cortex area not only before but also following TBS has an important influence on the effects of stimulation, making it necessary to scrupulously control for activity during the whole experimental session in a study.

Modulation of Visual Cortex Excitability by Continuous Theta Burst Stimulation Depends on Coil Type

Subthreshold continuous theta burst stimulation of the visual cortex has been reported to cause inhibitory effects on phosphene threshold. In contrast, we observed no inhibition in a former study applying higher stimulation intensities. The main discrepancies between our experiments and the former studies were stimulation intensity and coil type. We aimed at investigating the role of these factors on the modulatory effects of continuous theta burst stimulation applied to the visual cortex. In a between-group-design, we used either a figure-of-eight-coil or a round coil, respectively. We measured phosphene thresholds prior and after continuous theta burst stimulation applied at 80% of individual phosphene threshold. With the figure-of-eight-coil, phosphene thresholds significantly decreased following stimulation. This is in line with the results of our former study but contrary to the increase observed in the other two studies. Using a round coil, no significant effect was observed. A correlation analysis revealed an inhibitory effect in subjects with higher phosphene thresholds only. Furthermore, the slope of the baseline phosphene threshold seems to predict the direction of modulation, independent from coil type. Thus, modulatory effects of continuous theta burst stimulation seem to depend on coil type and psychophysics parameters, probably due to different cortex volumes stimulated. Stochastic resonance phenomena might account for the differences observed.

Is theta burst stimulation applied to visual cortex able to modulate peripheral visual acuity

Repetitive transcranial magnetic stimulation is usually applied to visual cortex to explore the effects on cortical excitability. Most researchers therefore concentrate on changes of phosphene threshold, rarely on consequences for visual performance. Thus, we investigated peripheral visual acuity in the four quadrants of the visual field using Landolt C optotypes before and after repetitive stimulation of the visual cortex. We applied continuous and intermittend theta burst stimulation with various stimulation intensities (60%, 80%, 100%, 120% of individual phosphene threshold) as well as monophasic and biphasic 1 Hz stimulation, respectively. As an important result, no serious adverse effects were observed. In particular, no seizure was induced, even with theta burst stimulation applied with 120% of individual phosphene threshold. In only one case stimulation was ceased because the subject reported intolerable pain. Baseline visual acuity decreased over sessions, indicating a continuous training effect. Unexpectedly, none of the applied transcranial magnetic stimulation protocols had an effect on performance: no change in visual acuity was found in any of the four quadrants of the visual field. Binocular viewing as well as the use of peripheral instead of foveal presentation of the stimuli might have contributed to this result. Furthermore, intraindividual variability could have masked the TMS- induced effects on visual acuity.