Single high-frequency repetitive transcranial magnetic stimulation and intermittent theta pulse stimulation promote working memory behavior in participants: An event-related potential study.

Repetitive transcranial magnetic stimulation (rTMS) to the left dorsolateral prefrontal cortex (L-DLPFC) has an improving effect in cognitive function, but it is still not clear in what specific cognitive domains. We here combined a single session of TMS (HF-rTMS/iTBS) with electroencephalography (EEG) to clarify the effects of magnetic stimulation techniques on executive function, working memory, and visuospatial attention in healthy participants, and to investigate the underlying neurophysiological mechanisms. Fifty-one healthy participants were randomly assigned to three stimulation groups (HF-rTMS, iTBS, and sham groups). Classical psychological paradigms (task-switching, 2-back with visual Oddball) and event-related potentials (ERPs) were performed to compare the behavioral indices of each paradigm before and after the two stimulations, as well as the changes in the ERP components. Analysis of behavioral indicators showed that reaction times in the 2-back paradigm were faster after HF-rTMS and iTBS than after sham stimulation. However, no statistically significant differences were observed in the behavioral changes in the task-switching and visual Oddball paradigms. ERP analysis showed that N2 amplitude in the frontal and central regions of the participants increased during the 2-back paradigm following HF-rTMS and iTBS; however, no statistically significant differences were observed between the ERP components of the task-switching and visual Oddball paradigms. Single sessions of HF-rTMS and iTBS on the L-DLPFC specifically enhanced working memory performance, with no significant effects on executive function and visuospatial attention. Both true stimulations elicited more negative N2 in the frontal and central channels during the 2-back paradigm, suggesting increased recruitment of cognitive resources from these brain areas. Although iTBS and HF-rTMS improved working memory behavior, iTBS's shorter stimulation time suggests it may have greater potential for clinical applications in terms of time-benefit costs.

Hu L ，He J ，Han M ，Wang Z ，Gao Y ，Zhang B ，Zhou S ，Wang K ，Li S ，Wu X ... -  《-》

Effects of repetitive transcranial magnetic stimulation combined with cognitive training for improving response inhibition: A proof-of-concept, single-blind randomised controlled study.

Impaired response inhibition is a common characteristic of various psychiatric disorders. Cognitive training (CT) can improve cognitive function, but the benefits may be limited. Repetitive transcranial magnetic stimulation (rTMS) is a promising tool to enhance neuroplasticity, and thereby augment the effects of CT. We aimed to investigate the augmentation effects of rTMS on CT for response inhibition in healthy participants. Sixty healthy participants were randomly assigned to two experimental groups: one with prolonged intermittent theta burst stimulation (iTBS) + CT and the other with sham iTBS + CT over four experimental sessions. Prolonged iTBS (1800 pulses) was used to stimulate the right inferior frontal cortex (rIFC) and pre-supplementary motor area (pre-SMA) in a counterbalanced order. Participants completed a Stop Signal training task following iTBS over one brain region, followed by the Go/No-Go training task after iTBS over the other brain region. The Stroop task with concomitant electroencephalography was conducted before and immediately after the intervention. There were no significant differences between groups in behavioural outcomes on the Stop Signal task, Go/No-Go task, Stroop task or Behavior Rating Inventory of Executive Functioning for Adults. Similarly, analysis of event-related potentials (ERPs) from the Stroop task (N200 and N400) and exploratory cluster-based permutation analysis did not reveal any significant differences between groups. Subgroup analyses revealed that individuals with higher baseline impulsivity exhibited better learning effects in the active group. This first proof of concept study did not find evidence that four sessions of active rTMS + CT could induce cognitive or neurophysiological effects on response inhibition in healthy participants. However, subgroup analyses suggests that rTMS combined with CT could be useful in improving response inhibition in individuals with high impulsivity. It is recommended that future proof of concept studies examine its potential in this clinical population.

Xu X ，Nikolin S ，Moffa AH ，Xu M ，Cao TV ，Loo CK ，Martin DM ... -  《-》

Increasing mind wandering with accelerated intermittent theta burst stimulation over the left dorsolateral prefrontal cortex.

Mind wandering (MW) is the intentional or unintentional experience of attending to internal task-unrelated thoughts while being occupied with an external task. Even though maintaining task focus is assumed to require executive functions (EF), it is not clear how and to what extent MW and EF interact. Research has found that activity in the dorsolateral prefrontal cortex (DLPFC) is associated with EF and MW. To understand the causal role of the DLPFC in relation to MW and EF, researchers have turned to non-invasive brain stimulation. Thus far, most studies have used transcranial direct current stimulation, but the results have been inconclusive. To further elucidate the relationship between the DLPFC, EF and MW, we conducted a pre-registered, sham-controlled, triple-blinded within-subject experiment by combining intermittent theta burst stimulation (iTBS) interleaved with a recently developed MW-EF task. In contrast to our expectations, participants reported significantly more MW following real iTBS as compared to sham stimulation. However, at the same time, psychomotor precision and EF improved, indicating that participants were able to engage in resource-intensive MW while simultaneously performing well on the task. We argue that iTBS enhanced the underlying executive resources that could be used to increase both MW and task performance in line with the resource-control view of MW. This finding opens exciting avenues for studying the complex interplay between MW and EF and provides empirical support for the utility of iTBS in improving executive performance during a demanding cognitive task.

Aasen SR ，Drevland RN ，Csifcsák G ，Mittner M ... -  《-》

Classical, spaced, or accelerated transcranial magnetic stimulation of motor cortex for treating neuropathic pain: A 3-arm parallel non-inferiority study.

Mussigmann T ，Bardel B ，Casarotto S ，Senova S ，Rosanova M ，Vialatte F ，Lefaucheur JP ... -  《-》

Repetitive transcranial magnetic stimulation for post-traumatic stress disorder in adults.

The estimated lifetime prevalence of post-traumatic stress disorder (PTSD) in adults worldwide has been estimated at 3.9%. PTSD appears to contribute to alterations in neuronal network connectivity patterns. Current pharmacological and psychotherapeutic treatments for PTSD are associated with inadequate symptom improvement and high dropout rates. Repetitive transcranial magnetic stimulation (rTMS), a non-invasive therapy involving induction of electrical currents in cortical brain tissue, may be an important treatment option for PTSD to improve remission rates and for people who cannot tolerate existing treatments. To assess the effects of repetitive transcranial magnetic stimulation (rTMS) on post-traumatic stress disorder (PTSD) in adults. We searched the Cochrane Common Mental Disorders Controlled Trials Register, CENTRAL, MEDLINE, Embase, three other databases, and two clinical trials registers. We checked reference lists of relevant articles. The most recent search was January 2023. We included randomized controlled trials (RCTs) assessing the efficacy and safety of rTMS versus sham rTMS for PTSD in adults from any treatment setting, including veterans. Eligible trials employed at least five rTMS treatment sessions with both active and sham conditions. We included trials with combination interventions, where a pharmacological agent or psychotherapy was combined with rTMS for both intervention and control groups. We included studies meeting the above criteria regardless of whether they reported any of our outcomes of interest. Two review authors independently extracted data and assessed the risk of bias in accordance with Cochrane standards. Primary outcomes were PTSD severity immediately after treatment and serious adverse events during active treatment. Secondary outcomes were PTSD remission, PTSD response, PTSD severity at two follow-up time points after treatment, dropouts, and depression and anxiety severity immediately after treatment. We included 13 RCTs in the review (12 published; 1 unpublished dissertation), with 577 participants. Eight studies included stand-alone rTMS treatment, four combined rTMS with an evidence-based psychotherapeutic treatment, and one investigated rTMS as an adjunctive to treatment-as-usual. Five studies were conducted in the USA, and some predominantly included white, male veterans. Active rTMS probably makes little to no difference to PTSD severity immediately following treatment (standardized mean difference (SMD) -0.14, 95% confidence interval (CI) -0.54 to 0.27; 3 studies, 99 participants; moderate-certainty evidence). We downgraded the certainty of evidence by one level for imprecision (sample size insufficient to detect a difference of medium effect size). We deemed one study as having a low risk of bias and the remaining two as having 'some concerns' for risk of bias. A sensitivity analysis of change-from-baseline scores enabled inclusion of a greater number of studies (6 studies, 252 participants). This analysis yielded a similar outcome to our main analysis but also indicated significant heterogeneity in efficacy across studies, including two studies with a high risk of bias. Reported rates of serious adverse events were low, with seven reported (active rTMS: 6; sham rTMS: 1). The evidence is very uncertain about the effect of active rTMS on serious adverse events (odds ratio (OR) 5.26, 95% CI 0.26 to 107.81; 5 studies, 251 participants; very low-certainty evidence [Active rTMS: 23/1000, sham rTMS: 4/1000]). We downgraded the evidence by one level for risk of bias and two levels for imprecision. We rated four of five studies as having a high risk of bias, and the fifth as 'some concerns' for bias. We were unable to assess PTSD remission immediately after treatment as none of the included studies reported this outcome. Based on moderate-certainty evidence, our review suggests that active rTMS probably makes little to no difference to PTSD severity immediately following treatment compared to sham stimulation. However, significant heterogeneity in efficacy was detected when we included a larger number of studies in sensitivity analysis. We observed considerable variety in participant and protocol characteristics across studies included in this review. For example, studies tended to be weighted towards inclusion of either male veterans or female civilians. Studies varied greatly in terms of the proportion of the sample with comorbid depression. Study protocols differed in treatment design and stimulation parameters (e.g. session number/duration, treatment course length, stimulation intensity/frequency, location of stimulation). These differences may affect efficacy, particularly when considering interactions with participant factors. Reported rates of serious adverse events were very low (< 1%) across active and sham conditions. It is uncertain whether rTMS increases the risk of serious adverse event occurrence, as our certainty of evidence was very low. Studies frequently lacked clear definitions for serious adverse events, as well as detail on tracking/assessment of data and information on the safety population. Increased reporting on these elements would likely aid the advancement of both research and clinical recommendations of rTMS for PTSD. Currently, there is insufficient evidence to meta-analyze PTSD remission, PTSD treatment response, and PTSD severity at different periods post-treatment. Further research into these outcomes could inform the clinical use of rTMS. Additionally, the relatively large contribution of data from trials that focused on white male veterans may limit the generalizability of our conclusions. This could be addressed by prioritizing recruitment of more diverse participant samples.

Brown R ，Cherian K ，Jones K ，Wickham R ，Gomez R ，Sahlem G ... -  《Cochrane Database of Systematic Reviews》