Real-time optimization to enhance noninvasive cortical excitability assessment in the human dorsolateral prefrontal
Sara Parmigiani1,2,3, Christopher C Cline1,2,3, Manjima Sarkar1,2,3
1Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA.
Objective:
We 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.
Methods:
This 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).
Results:
In 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.
Conclusions:
Real-time optimization of TMS parameters during dlPFC stimulation can enhance the EL-TEP.
Significance:
Enhancing our ability to measure prefrontal excitability is important for monitoring pathological states and treatment response.
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