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Customizing TMS Applications in Traumatic Brain Injury Using Neuroimaging
Amy A Herrold1, Shan H Siddiqi, Sherri L Livengood
1Edward Hines Jr VA Hospital, Research Service, Hines, Illinois (Drs Herrold, Livengood, and Bender Pape); Dept. of Psychiatry & Behavioral Sciences (Dr Herrold), Dept. of Physical Medicine and Rehabilitation (Drs Livengood, Bender Pape, and Raij), Dept. of Radiology (Mr Higgins), Feinberg School of Medicine, Northwestern University Interdepartmental Neuroscience Program (Dr Raij), and Department of Neurobiology, Weinberg College of Arts and Sciences (Dr Raij), Northwestern University, Chicago, Illinois; Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, Boston, Massachusetts (Dr Siddiqi); Department of Psychiatry, Harvard Medical School, Boston, Massachusetts (Dr Siddiqi); Rehabilitation Service, VA Palo Alto Health Care System, Palo Alto, California (Dr Adamson); Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California (Dr Adamson); Department of Anesthesiology, Center for Pain Medicine, UCSD School of Medicine, La Jolla, California (Dr Leung); Center for Pain and Headache Research VA San Diego Healthcare System, San Diego, California (Dr Leung); and Center for Brain Stimulation, Shirley Ryan AbilityLab, Chicago, Illinois (Dr Raij).
Abstract:
Optimizing transcranial magnetic stimulation (TMS) treatments in traumatic brain injury (TBI) and co-occurring conditions may benefit from neuroimaging-based customization.
Participants:
Our total sample (N = 97) included 58 individuals with TBI (49 mild, 8 moderate, and 1 severe in a state of disordered consciousness), of which 24 had co-occurring conditions (depression in 14 and alcohol use disorder in 10). Of those without TBI, 6 individuals had alcohol use disorder and 33 were healthy controls. Of our total sample, 54 were veterans and 43 were civilians.
Design:
Proof-of-concept study incorporating data from 5 analyses/studies that used multimodal approaches to integrate neuroimaging with TMS.
Main Measures:
Multimodal neuroimaging methods including structural magnetic resonance imaging (MRI), MRI-guided TMS navigation, functional MRI, diffusion MRI, and TMS-induced electric fields. Outcomes included symptom scales, neuropsychological tests, and physiological measures.
Results:
It is feasible to use multimodal neuroimaging data to customize TMS targets and understand brain-based changes in targeted networks among people with TBI.
Conclusions:
TBI is an anatomically heterogeneous disorder. Preliminary evidence from the 5 studies suggests that using multimodal neuroimaging approaches to customize TMS treatment is feasible. To test whether this will lead to increased clinical efficacy, studies that integrate neuroimaging and TMS targeting data with outcomes are needed.
