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Keller, C. J.

Publications and source records attributed to Keller, C. J..

At least 19 recordsLinked to original sources

SafeLens: A Statistically Controlled Nonlinear Machine Learning Framework for Characterizing Hidden Dynamics in Event-Locked Neural Activity

Machine learning has advanced rapidly over the past decade, yet event-locked neural activity is still analyzed predominantly with traditional statistics and linear models. While traditional linear methods provide computationally tractable statistical control for pre-selected features or trial-averaged waveforms, they miss subtle nonlinear and trial-varying neural dynamics. Nonlinear models can capture these complex patterns, but their feature reliance is opaque and notoriously difficult to threshold statistically. We introduce SafeLens (Searchlight Analysis of Fluctuation Events, Leveraging Extensive Null Sampling) to combine the power of nonlinear machine learning with the rigorous false-positive control of traditional statistical inference. At each position of a sliding window, a random forest learns to discriminate event-locked activity from interleaved resting-state neural activity using multiscale temporal derivatives. Randomized feature ablation inverts slope polarity in held-out trials to map the random forest models' reliance on specific rising versus falling excursions across the time-frequency space. SafeLens then establishes an empirical null by running the same pipeline on separate resting-state recordings, training forests to discriminate rest from rest. This empirical null translates each channel's complex nonlinear resting dynamics into a model-matched noise floor on the map's linear reliance scale, allowing a single threshold to control the family-wise error rate against the channel's own background structure rather than a summary statistic of its baseline. When we injected simulated cortico-cortical evoked potentials (CCEPs) into resting intracranial EEG recordings, SafeLens recovered ~2.5 times as many polarity-resolved deflections as trial-average thresholding and the closest data-driven method, maintaining its advantage under trial-to-trial variability while yielding ~5-11 times fewer false components, ~2-5 times lower mean boundary error, and superior single-trial latency tracking as a timing prior. In eight patients, CCEPs remained detectable above chance until 1,040 ms after stimulation, compared with 570 and 455 ms for those benchmarks. Together, these findings establish SafeLens as a novel solution for enabling nonlinear models to uncover subtle, trial-varying neural dynamics under strict statistical control.

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Intracranial electrophysiology reveals distinct neural representations of nociception and salience in the human brain

Neuroimaging studies have shown close overlap between neural representations of nociceptive stimuli and non-nociceptive, salient stimuli (such as low-probability sounds), leading to the proposal that nociception and salience share a common neural substrate in the human brain. Here we use high-resolution intracranial recordings from 13 neurosurgical patients (2,018 total electrodes) to show that neural representations of nociception and salience are anatomically and functionally distinct in the human brain. 77% of 107 electrodes that encoded nociceptive stimuli did not encode low-probability sounds ("nociceptive representations"), whereas 23% encoded both nociceptive and low-probability sounds ("salience representations"). Nociceptive representations were distinct from salience representations in terms of anatomical prevalence (posterior insula, inferior parietal, and perirolandic cortex vs. anterior insula, thalamus, and inferior frontal gyrus), timing (nociception preceded salience by 120 ms on a trial-by-trial basis), and function (intracranial electrical stimulation was more likely to cause sensory experience when applied near nociceptive representations, as compared to salience representations). These results provide strong evidence that nociception and salience have distinct neural substrates in the human brain, and that selective measurement of these distinct processes may help understand patient-to-patient variability in chronic pain and develop personalized brain stimulation treatments.

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Cognitive load modulates cortical excitability in the human prefrontal cortex

The prefrontal cortex dynamically adjusts its excitability to meet changing cognitive demands, yet our understanding of how these rapid state changes unfold in real time remains limited. Existing evidence relies predominantly on correlational neuroimaging and invasive electrophysiology in clinical populations, neither of which affords causal measurement in healthy humans. Here, using concurrent single-pulse TMS-EEG during a parametric cognitive multi-source interference task (MSIT) in 27 healthy participants, we causally probed left prefrontal excitability across conditions spanning a range of cognitive interference levels. Prefrontal excitability scaled systematically with cognitive load, peaking at intermediate incongruency levels where trial-type uncertainty was greatest, and differentiating high-from low-conflict trials at the single-subject level. Critically, prefrontal excitability and midfrontal theta power showed parallel state dependency patterns, linking causal perturbation of prefrontal circuit responsiveness to an established oscillatory marker of cognitive control. The observed excitability modulation was selective to the left prefrontal cortex: stimulation of right dlPFC, pre-SMA, and vertex in a separate control cohort (N=5) produced no load-dependent effects. These results position prefrontal excitability as a real-time, regionally selective physiological readout of how the human prefrontal cortex adapts to cognitive demand. HighlightsO_LIWe evaluated the links between cognitive interference, prefrontal excitability, and intrinsic theta activity during a multi-source interference task C_LIO_LICognitive load, estimated based on behavioral performance, was greatest at at intermediate interference levels (33% congruent), where trial-type uncertainty was maximal C_LIO_LIPrefrontal excitability, measured via single-pulse TMS-evoked potentials, scaled with cognitive load C_LIO_LIEffects were observed at the single subject level and were specific to prefrontal stimulation C_LIO_LIPrefrontal excitability changes and midfrontal theta power showed parallel scaling with cognitive load, linking causal probing to established oscillatory markers C_LIO_LIThis noninvasive technique provides causal measurement of prefrontal engagement during cognitive processing C_LIO_LIThe methodology demonstrates potential for tracking brain state dynamics in both healthy cognition and neuropsychiatric disorders C_LI

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Ibogaine is associated with reorganization of high-beta brain networks in veterans with post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is a debilitating condition that affects millions of veterans. A recent observational study in 30 veterans showed that a single dose of the atypical psychedelic ibogaine can be highly effective at treating PTSD up to twelve months later. Although a prior study demonstrated that ibogaine transiently alters electroencephalography (EEG) power in various frequency bands, the long-term, network-level neural mechanisms targeted by ibogaine are unclear. Here, we investigated whether ibogaine-related clinical improvements are associated with the reorganization of certain brain networks. We applied a novel framework, FREQuency-resolved brain Network Estimation via Source Separation (FREQ-NESS), to identify frequency-specific brain networks in resting-state EEG data acquired at baseline, three to four days after treatment (immediate-post), and one month after ibogaine. At both the immediate-post and one month-post timepoints, high-beta (24 and 25 Hz) networks shifted away from frontal areas and towards posterior regions, an effect that was replicated in an independent EEG dataset on ibogaine treatment for opioid use disorder. This posterior shift was significantly correlated with improvements in PTSD symptoms at both timepoints. Neural field modeling demonstrated that these posterior high-beta shifts are associated with increases in corticocortical, but not corticothalamic, connectivity. Our results are consistent with prior evidence implicating aberrant frontal beta-band activity in PTSD. Overall, we demonstrate that the reconfiguration of high-beta brain networks could be a robust biomarker for ibogaines therapeutic effects.

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Transcranial magnetic stimulation to the dorsolateral prefrontal cortex modulates single-neuron activity in humans

Transcranial magnetic stimulation (TMS) to the dorsolateral prefrontal cortex (dlPFC) is an FDA-cleared treatment for depression, yet how cortical stimulation influences single neurons in deep brain circuits remains unknown. Using intracranial microelectrode recordings in four neurosurgical patients, we resolved single-neuron spikes as early as 8 ms from 185 single neurons after single-pulse left dlPFC TMS. TMS elicited time-locked firing responses in 46% of neurons across deep cortical and subcortical structures bilaterally. TMS facilitated putative interneuron spiking in striato-thalamic regions from [~]8 ms, peaking at [~]80-100 ms, and lasting to [~]1000 ms, while suppressing putative pyramidal cell spiking with a delayed and slower time course. Trial-by-trial single-neuron modulations were positively correlated with cortico-striato-thalamic network activity and anti-correlated with limbic network activity. These findings reveal that dlPFC TMS facilitates inhibitory firing in executive control networks while suppressing limbic excitatory drive, providing a cellular mechanism for how cortical stimulation modulates distributed brain networks.

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Noninvasive profiling of input-output excitability curves in human prefrontal cortex

Abstract.O_ST_ABSBackgroundC_ST_ABSThe prefrontal cortex plays a critical role in cognitive control and behavior, and its dysfunction has been linked to numerous psychiatric and neurological disorders. However, noninvasive measurement of prefrontal activity remains challenging, limiting our understanding of how to optimize prefrontal treatments. Input-output relationships reveal how neural circuits respond to different inputs and are essential for determining optimal treatment parameters and understanding individual variability in treatment response, yet systematic investigation of prefrontal input-output relationships has been lacking. ObjectiveTo characterize human prefrontal excitability with input-output (I/O) curves. MethodsWe employed transcranial magnetic stimulation (TMS) with electroencephalography in a randomized mixed-block design with 28 healthy participants receiving single-pulse TMS to left dorsolateral prefrontal cortex (dlPFC) across 12 stimulation intensities (60-140% of resting motor threshold). We quantified prefrontal excitability using early local TMS-evoked potentials (EL-TEPs), cortical responses measured locally 20-60 ms post-stimulus. ResultsWe observed a strong effect of TMS intensity on prefrontal EL-TEP amplitudes. Sigmoidal EL-TEP I/O curves were observed in 57% of participants, with the sigmoidality partially explained by EL-TEP signal quality. Correlations were observed between EL-TEP and motor-evoked potential curve parameters, but intensity parameterization approaches did not significantly differ in explaining inter-individual EL-TEP response variability. Reliable EL-TEPs could be obtained using fewer TMS pulses at high intensities, and test- retest assessments revealed robust I/O curve profiles. ConclusionsThese findings provide a systematic noninvasive characterization of prefrontal input-output physiology, establishing a framework for estimating prefrontal excitability. The comparison of various intensity parameterizations motivates the need for enhanced models and individualized measurement of stimulation responses. HighlightsO_LIWe present noninvasive input-output curves for prefrontal TMS. C_LIO_LIEL-TEPs exhibit robust dose-dependent responses to TMS intensity. C_LIO_LISigmoidal I/O curves observed in 57% of participants, with a strong dependence on signal quality. C_LIO_LICorrelations observed between MEP and prefrontal EL-TEP curve parameters. C_LIO_LIHigh test-retest reliability and rapid protocols at [≥]110% rMT C_LI

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Early Brain Functional Connectivity Changes Induced by Antidepressants and Placebo

Major depressive disorder (MDD) is a common and debilitating condition with limited treatment precision. While brain imaging has linked neural features to MDD diagnosis and treatment response, the underlying circuits and their early modulation by treatment remain unclear. To examine changes in functional connectivity within the first two weeks of treatment, we analyzed two independent cohorts of MDD patients receiving antidepressants or placebo. Across patients, a visual-precuneus-thalamus network showed increased functional connectivity regardless of treatment arm or clinical outcome. Placebo response involved attention and striatal systems, while drug-specific effects were localized to the amygdala, mid-cingulate, orbitofrontal cortex, and cerebellum, emerging only in a subset of medicated patients. Notably, the responses of those without drug-specific changes can be predicted with a placebo response prediction model. These early functional connectivity changes reveal common and distinct mechanisms of treatment effects, offering insights that could inform more personalized interventions for MDD.

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A Practical Preprocessing Pipeline for Concurrent TMS-iEEG: Critical Steps and Methodological Considerations

Transcranial magnetic stimulation combined with intracranial EEG (TMS-iEEG) has emerged as a powerful approach for probing the causal organization and dynamics of the human brain. Despite its promise, the presence of TMS-induced artifacts poses significant challenges for accurately characterizing and interpreting evoked neural responses. In this study, we present a practical preprocessing pipeline for single pulse TMS-iEEG data, incorporating key steps of re-referencing, filtering, artifact interpolation, and detrending. Using both real and simulated data, we systematically evaluated the effects of each step and compared alternative methodological choices. Our results demonstrate that this pipeline effectively attenuated various types of artifacts and noise, yielding cleaner signals for the subsequent analysis of intracranial TMS-evoked potentials (iTEPs). Moreover, we showed that methodological choices can substantially influence iTEPs outcomes. In particular, referencing methods might strongly affect iTEP morphology and amplitude, underscoring the importance of tailoring the referencing strategy to specific signal characteristics and research objectives. For filtering, we recommend a segment-based strategy, i.e., applying filters to data segments excluding the artifact window, to minimize distortion from abrupt TMS-related transients. Overall, this work represents an important step toward establishing a general preprocessing framework for TMS-iEEG data. We hope it encourages broader adoption and methodological development in concurrent TMS-iEEG research, ultimately advancing our understanding of brain organization and TMS mechanisms. HighlightsO_LIWe presented a practical preprocessing pipeline for single pulse TMS-iEEG data, incorporating key steps of re-referencing, filtering, artifact interpolation, and detrending. C_LIO_LIThe pipeline effectively attenuates multiple types of artifacts and noise, enabling accurate characterization of evoked neural responses. C_LIO_LIMethodological alternatives for each preprocessing step were evaluated using real and/or simulated datasets. C_LIO_LIRe-referencing substantially affects the morphology and amplitude of intracranial TMS-evoked potentials and requires careful consideration. C_LIO_LIA segment-based filtering strategy is recommended to better minimize distortion from TMS-related artifacts. C_LI

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Sensory Entrained TMS (seTMS) enhances motor cortex plasticity

Neural excitability fluctuates with sensory events, creating windows of opportunity to enhance brain stimulation. Repetitive transcranial magnetic stimulation (TMS), including intermittent theta burst stimulation (iTBS), is a promising treatment for neurological and psychiatric disorders, but does not account for fluctuations in neural excitability, likely contributing to variable outcomes. Sensory Entrained TMS (seTMS) leverages sensorimotor oscillations to enhance corticospinal responses, but the sustained effects as a repetitive protocol are unknown. We extended seTMS to iTBS measuring motor-evoked potentials (MEPs) as a physiological readout in a randomized crossover study comparing standard iTBS with sensory entrained iTBS (se-iTBS, n=20). se-iTBS more than doubled the MEP effect (55% vs. 26% MEP enhancement) and persisted for at least 30 minutes. Notably, more than 80% of participants showed larger responses with se-iTBS at all time points. se-iTBS may provide a robust and practical framework for optimizing TMS that bridges electrophysiological mechanisms and clinical applications.

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Excitation-Inhibition Balance and Fronto-Limbic Connectivity Drive TMS Treatment Outcomes in Refractory Depression

Depression affects over 350 million people worldwide, with treatment resistance occurring in up to 30% of cases. Intermittent theta burst stimulation (iTBS) targeting the left dorsolateral prefrontal cortex (DLPFC) has emerged as a promising intervention, yet the neurophysiological mechanisms determining which patients will respond remain poorly understood. Here, we combined transcranial magnetic stimulation with electroencephalography and whole-brain computational modeling to uncover the mechanistic basis of treatment efficacy in 90 patients with treatment-resistant depression. We identified two distinct neurophysiological signatures that differentiate responders from non-responders: (1) post-treatment shifts in excitation-inhibition balance toward greater inhibitory control, and (2) a pre-treatment brain state characterized by anticorrelated dynamics between subgenual anterior cingulate cortex and DLPFC. These features were significantly correlated with clinical improvement and could not be explained by non-specific factors. Our findings provide a neurophysiologically-informed framework for developing personalized and optimized neuromodulation approaches in treatment-resistant depression.

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DLPFC Stimulation Suppresses High-Frequency Neural Activity in the Human sgACC

Transcranial magnetic stimulation (TMS) to the dorsolateral prefrontal cortex (DLPFC) is hypothesized to relieve symptoms of depression by inhibiting activity in the subgenual anterior cingulate cortex (sgACC). However, we have a limited understanding of how TMS influences neural activity in the sgACC, owing to its deep location within the brain. To better understand the mechanism of antidepressant response to TMS, we recruited two neurosurgical patients with indwelling electrodes and delivered TMS pulses to the DLPFC while simultaneously recording local field potentials from the sgACC. Spectral analysis revealed a decrease in high-frequency activity (HFA; 70-180 Hz) after each stimulation pulse, which was especially pronounced in the sgACC relative to other regions. TMS-evoked HFA power was generally anticorrelated between the DLPFC and sgACC, even while low-frequency phase locking between the two regions was enhanced. Together, these findings support the notion that TMS to the DLPFC can suppress neural firing in the sgACC, suggesting a possible mechanism by which this treatment regulates mood.

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Dorsolateral prefrontal cortex TMS evokes responses in the subgenual anterior cingulate cortex: Evidence from human intracranial EEG

Transcranial magnetic stimulation combined with intracranial local field potential recordings in humans (TMS-iEEG) represents a new method for investigating electrophysiologic effects of TMS with spatiotemporal precision. We applied TMS-iEEG to the dorsolateral prefrontal cortex (dlPFC) in two subjects and demonstrate evoked activity in the subgenual anterior cingulate cortex (sgACC). This study provides direct electrophysiologic evidence that dlPFC TMS, as targeted for depression treatment, can modulate brain activity in the sgACC.

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NaviNIBS: a comprehensive and open-source software toolbox for neuronavigated noninvasive brain stimulation.

Image-guided positioning, or neuronavigation, is critical for precise targeting of transcranial magnetic stimulation (TMS) and other noninvasive brain stimulation. However, existing commercial systems have limitations in flexibility and extensibility for research applications. We present new open-source software for neuronavigated non-invasive brain stimulation (NaviNIBS) that provides comprehensive functionality for TMS experiments. NaviNIBS supports imaging data import, target planning, head registration, real-time tool tracking, and integration with robotic positioning and electrophysiology systems. Key features include flexible target specification, support for multiple tracking hardware options, refined head registration techniques, and an extensible addon system. We describe the software architecture, core functionality, characterization of tracking performance, and example applications of NaviNIBS. This software aims to facilitate methodological improvements and novel experimental paradigms in noninvasive brain stimulation research.

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Contrastive functional connectivity defines neurophysiology-informed symptom dimensions in major depression

BackgroundMajor depressive disorder (MDD) is a prevalent psychiatric disorder characterized by substantial clinical and neurobiological heterogeneity. Conventional studies that solely focus on clinical symptoms or neuroimaging metrics often fail to capture the intricate relationship between these modalities, limiting their ability to disentangle the complexity in MDD. Moreover, patient neuroimaging data typically contains normal sources of variance shared with healthy controls, which can obscure disorder-specific variance and complicate the delineation of disease heterogeneity. MethodsWe employed contrastive principal component analysis to extract disorder-specific variations in fMRI-based resting-state functional connectivity (RSFC) by contrasting MDD patients (N=233) with age-matched healthy controls (N=285). We then applied sparse canonical correlation analysis to identify latent dimensions in the disorder variations by linking the extracted contrastive connectivity features to clinical symptoms in MDD patients. ResultsTwo significant and generalizable dimensions linking distinct brain circuits and clinical profiles were discovered. The first dimension, associated with an apparent "internalizing-externalizing" symptom dimension, was characterized by self-connections within the visual network and also associated with choice reaction times of cognitive tasks. The second dimension, associated with personality facets such as extraversion and conscientiousness typically inversely associated with depression symptoms, is primarily driven by self-connections within the dorsal attention network. This "depression-protective personality" dimension is also associated with multiple cognitive task performances related to psychomotor slowing and cognitive control. ConclusionsOur contrastive RSFC-based dimensional approach offers a new avenue to dissect clinical heterogeneity underlying MDD. By identifying two stable, neurophysiology-informed symptom dimensions in MDD patients, our findings may enhance disease mechanism insights and facilitate precision phenotyping, thus advancing the development of targeted therapeutics for precision mental health. Trial RegistrationEstablishing Moderators and Biosignatures of Antidepressant Response for Clinical Care for Depression (EMBARC), NCT#01407094

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Real-time optimization to enhance noninvasive cortical excitability assessment in the human dorsolateral prefrontal cortex

ObjectiveWe currently lack a robust noninvasive method to measure prefrontal excitability in humans. Concurrent TMS and EEG in the prefrontal cortex is usually confounded by artifacts. Here we asked if real-time optimization could reduce artifacts and enhance a TMS-EEG measure of left prefrontal excitability. MethodsThis closed-loop optimization procedure adjusts left dlPFC TMS coil location, angle, and intensity in real-time based on the EEG response to TMS. Our outcome measure was the left prefrontal early (20-60 ms) and local TMS-evoked potential (EL-TEP). ResultsIn 18 healthy participants, this optimization of coil angle and brain target significantly reduced artifacts by 63% and, when combined with an increase in intensity, increased EL-TEP magnitude by 75% compared to a non-optimized approach. ConclusionsReal-time optimization of TMS parameters during dlPFC stimulation can enhance the EL-TEP. SignificanceEnhancing our ability to measure prefrontal excitability is important for monitoring pathological states and treatment response. HighlightsO_LIWe developed a real-time closed-loop optimization procedure to obtain high amplitude early local TEPs (EL-TEPs) from dlPFC TMS. C_LIO_LISequential optimization of coil angle and brain target reduced artifacts by 63%. C_LIO_LISequential optimization of coil angle, brain target, and intensity increased EL-TEP amplitude by 75%. C_LI

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Reliability of the TMS-evoked potential in dorsolateral prefrontal cortex

BackgroundWe currently lack a robust and reliable method to probe cortical excitability noninvasively from the human dorsolateral prefrontal cortex (dlPFC), a region heavily implicated in psychiatric disorders. We recently found that the strength of early and local dlPFC single pulse transcranial magnetic stimulation (TMS)-evoked potentials (EL-TEPs) varied widely depending on the anatomical subregion probed, with more medial regions eliciting stronger responses than anterolateral sites. Despite these differences in amplitude of response, the reliability at each target is not known. ObjectiveTo evaluate the reliability of EL-TEPs across the dlPFC. MethodsIn 15 healthy subjects, we quantified within-session reliability of dlPFC EL-TEPs after single pulse TMS to six dlPFC subregions. We evaluated the concordance correlation coefficient (CCC) across targets and analytical parameters including time window, quantification method, region of interest, sensor-vs. source-space, and number of trials. ResultsAt least one target in the anterior and posterior dlPFC produced reliable EL-TEPs (CCC>0.7). The medial target was most reliable (CCC = 0.78) and the most anterior target was least reliable (CCC = 0.24). ROI size and type (sensor vs. source space) did not affect reliability. Longer (20-60 ms, CCC = 0.62) and later (30-60 ms, CCC = 0.61) time windows resulted in higher reliability compared to earlier and shorter (20-40 ms, CCC 0.43; 20-50 ms, CCC = 0.55) time windows. Peak-to-peak quantification resulted in higher reliability than the mean of the absolute amplitude. Reliable EL-TEPs (CCC up to 0.86) were observed using only 25 TMS trials for a medial dlPFC target. ConclusionsMedial TMS location, wider time window (20-60ms), and peak-to-peak quantification improved reliability. Highly reliable EL-TEPs can be extracted from dlPFC after only a small number of trials. HighlightsO_LIMedial dlPFC target improved EL-TEP reliability compared to anterior targets. C_LIO_LIAfter optimizing analytical parameters, at least one anterior and one posterior target was reliable (CCC>0.7). C_LIO_LILonger (20-60 ms) and later (30-60 ms) time windows were more reliable than earlier and shorter (20-40 ms or 20-50 ms) latencies. C_LIO_LIPeak-to-peak quantification resulted in higher reliability compared to the mean of the absolute amplitude. C_LIO_LIAs low as 25 trials can yield reliable EL-TEPs from the dlPFC. C_LI

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TMS provokes target-dependent intracranial rhythms across human cortical and subcortical sites

Transcranial magnetic stimulation (TMS) is increasingly deployed in the treatment of neuropsychiatric illness, under the presumption that stimulation of specific cortical targets can alter ongoing neural activity and cause circuit-level changes in brain function. While the electrophysiological effects of TMS have been extensively studied with scalp electroencephalography (EEG), this approach is most useful for evaluating low-frequency neural activity at the cortical surface. As such, little is known about how TMS perturbs rhythmic activity among deeper structures - such as the hippocampus and amygdala - and whether stimulation can alter higher-frequency oscillations. Recent work has established that TMS can be safely used in patients with intracranial electrodes (iEEG), allowing for direct neural recordings at sufficient spatiotemporal resolution to examine localized oscillatory responses across the frequency spectrum. To that end, we recruited 17 neurosurgical patients with indwelling electrodes and recorded neural activity while patients underwent repeated trials of single-pulse TMS at several cortical sites. Stimulation to the dorsolateral prefrontal cortex (DLPFC) drove widespread low-frequency increases (3-8Hz) in frontolimbic cortices, as well as high-frequency decreases (30-110Hz) in frontotemporal areas, including the hippocampus. Stimulation to parietal cortex specifically provoked low-frequency responses in the medial temporal lobe. While most low-frequency activity was consistent with brief evoked responses, anterior frontal regions exhibited induced theta oscillations following DLPFC stimulation. Taken together, we established that non-invasive stimulation can (1) provoke a mixture of low-frequency evoked power and induced theta oscillations and (2) suppress high-frequency activity in deeper brain structures not directly accessed by stimulation itself.

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Neural effects of TMS trains on the human prefrontal cortex

How does a train of TMS pulses modify neural activity in humans? Despite adoption of repetitive TMS (rTMS) for the treatment of neuropsychiatric disorders, we still do not understand how rTMS changes the human brain. This limited understanding stems in part from a lack of methods for noninvasively measuring the neural effects of a single TMS train -- a fundamental building block of treatment -- as well as the cumulative effects of consecutive TMS trains. Gaining this understanding would provide foundational knowledge to guide the next generation of treatments. Here, to overcome this limitation, we developed methods to noninvasively measure causal and acute changes in cortical excitability and evaluated this neural response to single and sequential TMS trains. In 16 healthy adults, standard 10 Hz trains were applied to the dorsolateral prefrontal cortex (dlPFC) in a randomized, sham-controlled, event-related design and changes were assessed based on the TMS-evoked potential (TEP), a measure of cortical excitability. We hypothesized that single TMS trains would induce changes in the local TEP amplitude and that those changes would accumulate across sequential trains, but primary analyses did not indicate evidence in support of either of these hypotheses. Exploratory analyses demonstrated non-local neural changes in sensor and source space and local neural changes in phase and source space. Together these results suggest that single and sequential TMS trains may not be sufficient to modulate local cortical excitability indexed by typical TEP amplitude metrics but may cause neural changes that can be detected outside the stimulation area or using phase or source space metrics. This work should be contextualized as methods development for the monitoring of transient noninvasive neural changes during rTMS and contributes to a growing understanding of the neural effects of rTMS.

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