Real-time TMS-EEG for brain state-controlled research and precision treatment: a narrative review and guide.

Publisher: Institute of Physics Pub Country of Publication: England NLM ID: 101217933 Publication Model: Electronic Cited Medium: Internet ISSN: 1741-2552 (Electronic) Linking ISSN: 17412552 NLM ISO Abbreviation: J Neural Eng Subsets: MEDLINE

Original Publication: Bristol, U.K. : Institute of Physics Pub., 2004-

Transcranial Magnetic Stimulation*/methods ; Electroencephalography*/methods ; Brain*/physiology; Humans ; Precision Medicine/methods ; Computer Systems

Transcranial magnetic stimulation (TMS) modulates neuronal activity, but the efficacy of an open-loop approach is limited due to the brain state's dynamic nature. Real-time integration with electroencephalography (EEG) increases experimental reliability and offers personalized neuromodulation therapy by using immediate brain states as biomarkers. Here, we review brain state-controlled TMS-EEG studies since the first publication several years ago. A summary of experiments on the sensorimotor mu rhythm (8-13 Hz) shows increased cortical excitability due to TMS pulse at the trough and decreased excitability at the peak of the oscillation. Pre-TMS pulse mu power also affects excitability. Further, there is emerging evidence that the oscillation phase in theta and beta frequency bands modulates neural excitability. Here, we provide a guide for real-time TMS-EEG application and discuss experimental and technical considerations. We consider the effects of hardware choice, signal quality, spatial and temporal filtering, and neural characteristics of the targeted brain oscillation. Finally, we speculate on how closed-loop TMS-EEG potentially could improve the treatment of neurological and mental disorders such as depression, Alzheimer's, Parkinson's, schizophrenia, and stroke.
(Creative Commons Attribution license.)

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R01 MH136053 United States MH NIMH NIH HHS

Keywords: brain states; closed-loop neuromodulation; electroencephalography; precision treatment; transcranial magnetic stimulation

Date Created: 20241023 Date Completed: 20241101 Latest Revision: 20241103

20241103

PMC11528152

10.1088/1741-2552/ad8a8e

39442548