Sara Rafique

TMS to object cortex affects both object and scene remote networks while TMS to scene cortex only affects scene networks.

Viewing the world involves many computations across a great number of regions of the brain, all the while appearing seamless and effortless. We sought to determine the connectivity of object and scene processing regions of cortex through the influence of transient focal neural noise in discrete nodes within these networks. We consecutively paired repetitive transcranial magnetic stimulation (rTMS) with functional magnetic resonance-adaptation (fMR-A) to measure the effect of rTMS on functional response properties at the stimulation site and in remote regions. In separate sessions, rTMS was applied to the object preferential lateral occipital region (LO) and scene preferential transverse occipital sulcus (TOS). Pre- and post-stimulation responses were compared using fMR-A. In addition to modulating BOLD signal at the stimulation site, TMS affected remote regions revealing inter and intrahemispheric connections between LO, TOS, and the posterior parahippocampal place area (PPA). Moreover, we show remote effects from object preferential LO to outside the ventral perception network, in parietal and frontal areas, indicating an interaction of dorsal and ventral streams and possibly a shared common framework of perception and action.

Altered white matter structure in the visual system following early monocular enucleation

Partial visual deprivation from early monocular enucleation (the surgical removal of one eye within the first few years of life) results in a number of long‐term morphological adaptations in adult cortical and subcortical visual, auditory, and multisensory brain regions. In this study, we investigated whether early monocular enucleation also results in the altered development of white matter structure. Diffusion tensor imaging and probabilistic tractography were performed to assess potential differences in visual system white matter in adult participants who had undergone early monocular enucleation compared to binocularly intact controls. To examine the microstructural properties of these tracts, mean diffusion parameters including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were extracted bilaterally. Asymmetries opposite to those observed in controls were found for FA, MD, and RD in the optic radiations, the projections from primary visual cortex (V1) to the lateral geniculate nucleus (LGN), and the interhemispheric V1 projections of early monocular enucleation participants. Early monocular enucleation was also associated with significantly lower FA bidirectionally in the interhemispheric V1 projections. These differences were consistently greater for the tracts contralateral to the enucleated eye, and are consistent with the asymmetric LGN volumes and optic tract diameters previously demonstrated in this group of participants. Overall, these results indicate that early monocular enucleation has long‐term effects on white matter structure in the visual pathway that results in reduced fiber organization in tracts contralateral to the enucleated eye. Hum Brain Mapp 39:133–144, 2018.

rTMS reduces cortical imbalance associated with visual hallucinations after occipital stroke

Objective: To investigate the efficacy of multiday repetitive transcranial magnetic stimulation (rTMS) to the occipital cortex in a patient with continuous visual phosphene hallucinations for more than 2 years following occipital stroke. Methods: Low-frequency rTMS (1 Hz) was applied to the lesion site for 30 minutes daily over 5 consecutive days. Functional MRI (fMRI) was performed before and after rTMS treatment. Results: Increased application of rTMS corresponded with a reduction in intensity of visual phosphene hallucinations and was reflected in altered blood oxygen level–dependent signal. fMRI revealed focal excitatory discharges at the border of the lesion, highlighting the origin of phosphenes. Post-rTMS, rTMS did not simply suppress activity in the patient but rather redistributed the previously imbalanced cortical activity not only at the stimulation site but in remote cortical regions so that it more closely resembled that of controls. Conclusions: This case is rare in its presentation of chronic continuous visual phosphene hallucinations following occipital stroke. We present a case of multiday application of rTMS to visual cortex and demonstrate that rTMS provides a valuable therapeutic intervention in modulating visual hallucinations following occipital damage. Classification of evidence: This study provides Class IV evidence in a single-case report that multiday rTMS reduces intrahemispheric and interhemispheric imbalance and associated visual phosphene hallucinations following occipital stroke.

Altered white matter connectivity associated with visual hallucinations following occipital stroke

Visual hallucinations that arise following vision loss stem from aberrant functional activity in visual cortices and an imbalance of activity across associated cortical and subcortical networks subsequent to visual pathway damage. We sought to determine if structural changes in white matter connectivity play a role in cases of chronic visual hallucinations associated with visual cortical damage.