Using diffusion tensor imaging to effectively target TMS to deep brain structures

• Published in: NeuroImage (Orlando, Fla.) Vol. 249; p. 118863
• Main Authors: Luber, Bruce, Davis, Simon W., Deng, Zhi-De, Murphy, David, Martella, Andrew, Peterchev, Angel V., Lisanby, Sarah H.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2022; Elsevier Limited; Elsevier
• Subjects: Adult; Brain - diagnostic imaging; Brain Mapping; Brodmann's area; Connectivity; Deep Brain Stimulation; Diffusion imaging tractography; Diffusion Tensor Imaging; Dopamine; FDA approval; Female; Functional magnetic resonance imaging; Gyrus Cinguli - diagnostic imaging; Humans; Male; Mental depression; Mental disorders; Neural networks; Neuroimaging; Neurological diseases; Obsessive compulsive disorder; Prefrontal Cortex - diagnostic imaging; Remission (Medicine); Scalp; Subgenual cingulate cortex; Targeting; TMS; Transcranial Magnetic Stimulation; Young Adult; Subgenual cingulate cortex; Connectivity; Diffusion imaging tractography; TMS; Targeting; deep brain stimulation
• ISSN: 1053-8119; 1095-9572; 1095-9572
• DOI: 10.1016/j.neuroimage.2021.118863

TMS has become a powerful tool to explore cortical function, and in parallel has proven promising in the development of therapies for various psychiatric and neurological disorders. Unfortunately, much of the inference of the direct effects of TMS has been assumed to be limited to the area a few centimeters beneath the scalp, though clearly more distant regions are likely to be influenced by structurally connected stimulation sites. In this study, we sought to develop a novel paradigm to individualize TMS coil placement to non-invasively achieve activation of specific deep brain targets of relevance to the treatment of psychiatric disorders. In ten subjects, structural diffusion imaging tractography data were used to identify an accessible cortical target in the right frontal pole that demonstrated both anatomic and functional connectivity to right Brodmann area 25 (BA25). Concurrent TMS-fMRI interleaving was used with a series of single, interleaved TMS pulses applied to the right frontal pole at four intensity levels ranging from 80% to 140% of motor threshold. In nine of ten subjects, TMS to the individualized frontal pole sites resulted in significant linear increase in BOLD activation of BA25 with increasing TMS intensity. The reliable activation of BA25 in a dosage-dependent manner suggests the possibility that the careful combination of imaging with TMS can make use of network properties to help overcome depth limitations and allow noninvasive brain stimulation to influence deep brain structures.