Name: employing transcranial magnetic stimulation in a resource limited environment to establish brain-behavior relationships
Uploaded: 2022-04-20T13:00:00
Description: Watch this Scientific Journal Video about Employing Transcranial Magnetic Stimulation in a Resource Limited Environment to Establish Brain-Behavior Relationships at JoVE.com

LSAMP (Louis Stokes Alliance for Minority Participation), Wehner, and The Crawford Foundation, the Kessler Foundation are all thanked for their support.

The research presented here was approved by the Institutional Review Board (IRB) committee of Montclair State University. All participants have been treated within the ethical guidelines of the APA.
1. Participants
<ol>
	<li>First, obtain IRB Committee Review Approval for the protocol (see Discussion for non- Research 1 institutions). Consultation with experienced researchers is recommended. Obtain forms such as Screening (Supplementary File 1) and Side Effe...

<ol>
	<li>Academic Research and Development. Science and Engineering Indicators 2020. National Science Board, National Science Foundation Available from: <a target="_blank" href="https://incses.nsf.gov/pubs/nsb20202">https://incses.nsf.gov/pubs/nsb20202</a> (2020)</li><li>. Rutgers School of Graduate Education. Overview of R1 Serving Hispanic Institutions Available from: <a target="_blank" href="https://cmsi.gse.rutgers.edu/sites/default/files/HSI_Report_R2_0.pdf">https://cmsi.gse.rutgers.edu/sites/default/files/HSI_Report_R2_0.pdf</a> (2022)</li><li>Maeda, F., Keenan, J. P., Pascual-Leone, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Interhemispheric+asymmetry+of+motor+cortical+excitability+in+major+depression+as+measured+by+transcranial+magnetic+stimulation.">Interhemispheric asymmetry of motor cortical excitability in major depression as measured by transcranial magnetic stimulation.</a> The British Journal of Psychiatry. 177 (2), 169-173 (2000).</li><li>Maeda, F., Keenan, J. P., Tormos, J. M., Topka, H., Pascual-Leone, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Modulation+of+corticospinal+excitability+by+repetitive+transcranial+magnetic+stimulation.">Modulation of corticospinal excitability by repetitive transcranial magnetic stimulation.</a> Clinical Neurophysiology. 111 (5), 800-805 (2000).</li><li>Pascual-Leone, A., Bartres-Faz, D., Keenan, J. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transcranial+magnetic+stimulation:+studying+the+brain-behaviour+relationship+by+induction+of+'virtual+lesions.">Transcranial magnetic stimulation: studying the brain-behaviour relationship by induction of 'virtual lesions.</a> Philosophical Transactions of the Royal Society of London. Series B: Biological Sciences. 354 (1387), 1229-1238 (1999).</li><li>Amati, F., Oh, H., Kwan, V. S., Jordan, K., Keenan, J. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Overclaiming+and+the+medial+prefrontal+cortex:+A+transcranial+magnetic+stimulation+study.">Overclaiming and the medial prefrontal cortex: A transcranial magnetic stimulation study.</a> Cognitive Neuroscience. 1 (4), 268-276 (2010).</li><li>Tang, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Stimulating+the+right+temporoparietal+junction+with+tDCS+decreases+deception+in+moral+hypocrisy+and+unfairness.">Stimulating the right temporoparietal junction with tDCS decreases deception in moral hypocrisy and unfairness.</a> Frontiers in Psychology. 8, 2033 (2017).</li><li>Kelly, K. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effect+of+deception+on+motor+cortex+excitability.">The effect of deception on motor cortex excitability.</a> Social Neuroscience. 4 (6), 570-574 (2009).</li><li>Farrow, T. F., Burgess, J., Wilkinson, I. D., Hunter, M. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Neural+correlates+of+self-deception+and+impression-management.">Neural correlates of self-deception and impression-management.</a> Neuropsychologia. 67, 159-174 (2015).</li><li>Uddin, L. Q., Iacoboni, M., Lange, C., Keenan, J. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+self+and+social+cognition:+the+role+of+cortical+midline+structures+and+mirror+neurons.">The self and social cognition: the role of cortical midline structures and mirror neurons.</a> Trends in Cognitive Sciences. 11 (4), 153-157 (2007).</li><li>Luber, B., Lou, H. C., Keenan, J. P., Lisanby, S. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Self-enhancement+processing+in+the+default+network:+a+single-pulse+TMS+study.">Self-enhancement processing in the default network: a single-pulse TMS study.</a> Experimental Brain Research. 223 (2), 177-187 (2012).</li><li>Barrios, V., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Elucidating+the+neural+correlates+of+egoistic+and+moralistic+self-enhancement.">Elucidating the neural correlates of egoistic and moralistic self-enhancement.</a> Consciousness and Cognition. 17 (2), 451-456 (2008).</li><li>Kwan, V. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessing+the+neural+correlates+of+self-enhancement+bias:+a+transcranial+magnetic+stimulation+study.">Assessing the neural correlates of self-enhancement bias: a transcranial magnetic stimulation study.</a> Experimental Brain Research. 182 (3), 379-385 (2007).</li><li>Taylor-Lillquist, B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Preliminary+evidence+of+the+role+of+medial+prefrontal+cortex+in+self-enhancement:+a+transcranial+magnetic+stimulation+study.">Preliminary evidence of the role of medial prefrontal cortex in self-enhancement: a transcranial magnetic stimulation study.</a> Brain Sciences. 10 (8), 535 (2020).</li><li>Bikson, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Guidelines+for+TMS/tES+clinical+services+and+research+through+the+COVID-19+pandemic.">Guidelines for TMS/tES clinical services and research through the COVID-19 pandemic.</a> Brain Stimulation. 13 (4), 1124-1149 (2020).</li><li>Lerner, A. J., Wassermann, E. M., Tamir, D. I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Seizures+from+transcranial+magnetic+stimulation+2012-2016:+Results+of+a+survey+of+active+laboratories+and+clinics.">Seizures from transcranial magnetic stimulation 2012-2016: Results of a survey of active laboratories and clinics.</a> Clinical Neurophysiology. 130 (8), 1409-1416 (2019).</li><li>Pascual-Leone, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Safety+of+rapid-rate+transcranial+magnetic+stimulation+in+normal+volunteers.">Safety of rapid-rate transcranial magnetic stimulation in normal volunteers.</a> Electroencephalography and Clinical Neurophysiology. 89 (2), 120-130 (1993).</li><li>Rossi, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Safety+and+recommendations+for+TMS+use+in+healthy+subjects+and+patient+populations,+with+updates+on+training,+ethical+and+regulatory+issues:+Expert+Guidelines.">Safety and recommendations for TMS use in healthy subjects and patient populations, with updates on training, ethical and regulatory issues: Expert Guidelines.</a> Clinical Neurophysiology. 132 (1), 269-306 (2021).</li><li>Wassermann, E. 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The protocol (and variations of) outlined here has been used in over 50 studies at Montclair State University. The entire set-up can be created for under $15,000 (US). Further, we have found our coordinates match well with underlying brain structures using fiducial procedures.
Variations of&#160;this method are often used. For example, control conditions can include stimulating different brain areas, applying TMS different timings (i.e, apply TMS at a timing that should have no effect), using ...

There are a number of challenges to investigating brain-behavior correlates at research institutions with limited resources (often referred to as &#39;teaching universities&#39;). According to data provided by the National Science Foundation (NSF), almost all academic research is completed by a small percentage of higher education institutions in the United States. When examining over 4,400 post-secondary degree-granting institutions, the top 115 universities/institutes perform and publish 75% of all research1. In the United States, there are 131 research 1 (R1: The highest status level a university can achieve in terms of research ranking) universities which receive the bulk of federal funding.
This top-heavy funding disparity limits research options for many principal investigators as well as students; for example, only 1.9% of R1 universities are Hispanic-Serving institutes. Further, non-R1 institutes are limited in terms of research space, grants awarded, and time made available for research, and these schools often do not have medical school affiliations2. Given these obstacles, we provide the methods that have successfully allowed for the investigation of brain-behavior relationships in deception in a resource limited environment. While these methods are suitable for any institute, we believe that those at smaller/teaching intensive universities will receive the maximum benefit from these methods.
Our laboratory has focused primarily on the brain regions responsible for producing self-deception and self-enhancement. Establishing causation in terms of the underlying cortical regions is achievable by a number of techniques, and these data help confirm correlative neuroimaging methods and experimental patient trials3,4,5.
To investigate self-deception with causal neuroimaging techniques, a number of innovative methods have been employed, mainly with single pulse Transcranial Magnetic Stimulation (TMS) and repetitive TMS (rTMS6;&#160;Figure 1). While tDCS (transcranial Direct Cortical Stimulation) has been employed successfully7 and can be modified to replicate the methods, procedures, and results presented here, the flexibility of TMS still makes it the optimal choice for the neuromodulation of self-deception. At its most common implementation, researchers inhibit, excite, disrupt, or measure cortical excitability (not covered here, but see reference8).
The Medial Prefrontal Cortex (MPFC) appears to be involved in self-deceptive responding9. Given the role of the Cortical Midline Structures (CMS) in terms of self-awareness in general10, it is not surprising that self-deception is correlated with MPFC activity. To determine causation in terms of frontal regions, TMS was relied on to create &#39;virtual lesions&#39; while measuring bouts of self-deception11. Measuring self-deception has been achieved via two main methods: Self-enhancement and overclaiming6.
We have found that disruption of the MPFC leads to the reduction of self-deception6,8,11,12,13. Furthermore, we have discovered that such a reduction (i.e., the lowering of self-deception) is related to a decrease in a person&#39;s affect (i.e., negative mood increases and positive mood decreases).
Because neuro-navigation/individual MRI&#39;s are not employed (due to expense, most laboratories do not have these resources), concern may be raised over positioning and accuracy in TMS targeting. We have compensated for this by occasionally doing fiducial procedures in which a contrast target (e.g., a vitamin E tablet) is placed on the cap and the participant(s) is/are subsequently scanned in a structural MRI11,12. These methods have confirmed the accuracy of the methods outlined here, and we are targeting the medial aspect of the MPFC at the border of BA 10/9 which lies above the Medial Frontal Gyrus (0, ~40, ~30).
Clearly, higher spatial resolution can be obtained using other methods such as neuro-navigation, however, these methods are not employed without drawbacks which include participant drop-out, participant exclusion, increased length of experimental duration, additional training and screening, added expense and often multiple site visits for participants. Therefore, the methods presented here offer an excellent alternative to neuro-navigation in many circumstances.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Android Samsung Tablet (for MEPs)</td>
			<td>Samsung</td>
			<td>SM-T500NZSAXAR</td>
			<td></td>
		</tr>
		<tr>
			<td>Cloth Measuring Tape</td>
			<td>GDMINLO</td>
			<td>B08TWNCDNS(AMZ)</td>
			<td></td>
		</tr>
		<tr>
			<td>Figure of 8 Copper TMS Coil</td>
			<td>Magstim</td>
			<td>4150-00</td>
			<td>This is the current model</td>
		</tr>
		<tr>
			<td>Lenovo T490 Laptop</td>
			<td>Lenovo</td>
			<td>20RY0002US</td>
			<td></td>
		</tr>
		<tr>
			<td>Magstim 200 Single Pulse</td>
			<td>MagStim</td>
			<td>Magstim200/2</td>
			<td>This is the current model</td>
		</tr>
		<tr>
			<td>Magstim Standard Coil Holder</td>
			<td>MagStim</td>
			<td>AFC/SS</td>
			<td>This is the current model</td>
		</tr>
		<tr>
			<td>Speedo Swim Caps</td>
			<td>Speedo</td>
			<td>751104-100</td>
			<td></td>
		</tr>
		<tr>
			<td>Testable.Org Account and Software</td>
			<td>Testable</td>
			<td>NA</td>
			<td></td>
		</tr>
		<tr>
			<td>Trigno 2 Lead Sensor (for MEPs)</td>
			<td>DelSys</td>
			<td>SP-W06-018B</td>
			<td></td>
		</tr>
		<tr>
			<td>Trigno Base and Plot Software (for MEPs)</td>
			<td>DelSys</td>
			<td>DS-203-D00</td>
			<td></td>
		</tr>
	</tbody>
</table>

employing transcranial magnetic stimulation in a resource limited environment to establish brain-behavior relationships

Neuroimaging is typically perceived as a resource demanding discipline. While this is the case in certain circumstances, institutions with limited resources have historically contributed significantly to the field of neuroscience, including neuroimaging. In the study of self-deception, we have successfully employed single-pulse TMS to determine the brain correlates of abilities including overclaiming and self-enhancement. Even without the use of neuro-navigation, methods provided here lead to successful outcomes. For example, it was discovered that decreases in self-deceptive responding lead to a decrease in affect. These methods provide data that are reliable and valid, and such methods provide research opportunities otherwise unavailable.&#160;Through the use of these methods, the overall knowledge base in the field of neuroscience is expanded, providing research opportunities to students such as those at our institution&#160;(Montclair State University is a Hispanic-Serving Institute) who are often denied such research experiences.

Figure 2, from Taylor-Lilquist et al.14, involved four brain sites: MPFC, SMA, PZ, and a Sham site. These sites were utilized to determine the correlates of overclaiming. Overclaiming is a participant indicating that they know a word when it is actually not a word. 12 participants were tested in both social and non-social settings. The social settings represented pressure to either know a word (high-social pressure; n=6) or not know a word (low-social pressure; n=6). ...

Watch this Scientific Journal Video about Employing Transcranial Magnetic Stimulation in a Resource Limited Environment to Establish Brain-Behavior Relationships at JoVE.com

Employing Transcranial Magnetic Stimulation in a Resource Limited Environment to Establish Brain-Behavior Relationships

Transcranial Magnetic Stimulation (TMS) and low-frequency TMS (lfTMS) have&#160;been demonstrated to be major contributors to brain literature. Here we highlight the methods for investigating the cortical correlates of self-deception using TMS.

Neuroimaging is typically perceived as a resource demanding discipline. While this is the case in certain circumstances, institutions with limited ...

Vital discoveries in neuroscience can be made in resource limited environments. Here, we detail how to employ transcranial magnetic stimulation using valid and reliable methods. Single pulse and low frequency TMS provides causal, not correlational brain behavior relationships.This allows one to make much stronger conclusions about brain behavior relationships. TMS is used routinely to treat depression. By training minorities and other resource limited students in TMS, we are expanding the pool of trained professionals.TMS is used in almost every clinical and scientific application. However, it has been able to answer questions on consciousness and self-awareness that have baffled great thinkers for centuries. Anyone starting out with TMS should work on motor systems because you can actually see the effects of TMS immediately with a hand or leg movement.The other possibility is working on the visual system and asking participants to report the phosphenes that they see. Both systems give feedback immediately to the learning student. Begin by marking swim caps along the nasion or inion line and the midpoint taken using a magic marker.Measure pre-auricular points and take those midpoints, as well. From here, plot 10/20 coordinates. Using the right hemisphere pre-auricular line, go 33%down in the ventral direction and begin searching for the optimal location for the Abductor Pollicis Brevis or APB using the TMS coil.Discharge the TMS machine using the coil trigger, the foot switch, and disengaging the safety. Orient the TMS coil at 45 degrees for all searches in TMS deliveries, then start the stimulation output at 20%total machine output by using the dial on the front of the machine. Raise in 2%increments using the dial until a movement is noted.Here, as the stimulation is increased in terms of intensity, move the location also. There is a careful interplay between coil movement and stimulation intensity. Mark the coil tip site on the cap to allow an accurate placement and trace the entire anterior portion of the coil onto the swim cap using a magic marker.Once the optimal location is found, that is the site that provided the maximum APB response, determined the MT.For the visual inspection method, start at 20%of machine intensity and workup. The dial should be raised and lowered in response to increased or decreased finger movements. Use approximately 20 pulses to find what stimulation level results in 5 out of 10 APB responses.Once 5 out of 10 responses have been obtained, record the individual's MT by noting what the machine is displaying as the intensity. For the MEP method, place disposable electrodes on the APB and the tendon of the thumb and a ground. Define a positive MEP response as an MEP with greater than or equal to 50 microvolts peak-to-peak amplitude.Similar to visual inspection, stimulate until 5 out of 10 positive MEPs are observed. The MEPs should be greater than 50 microvolts. If 50%of the MEPs are above, it can be said that MT has been identified.Set the TMS machine to the appropriate stimulation level. 90%of the motor threshold is an ideal balance between effective, active TMS and safety. Randomly select the order of all sites.Place the coil over the active site and start a presentation software. Stimulation should proceed automatically and in sync with stimuli. Collect all behavioral data using the presentation software.Give two practice trials and introduce the analog scale to the participants. All participants easily adjust to the equipment. The instructions are given orally and the participants are told to rate how well they know the word.If the word is familiar to them, it should be given a high rating. If they sort of know the word, they are to give a medium rating. If the word is not that familiar to them, they will assign a low rating.A total of 144 words should be used. Participants have unlimited time to respond. Following the response on the analog scale, the next word is presented.Self-deception can be modulated using TMS. Participants were given social pressure to know words in one condition and no social pressure in another condition. The social pressure was a series of verbal prompts that indicated that every person knew these words and they were easy or that the words were difficult and most people did not know them.Means and the standard errors are presented here. Because social cognition is a medial prefrontal cortex, or MPFC function, it was assumed that TMS delivered in an inhibitory manner would decrease overclaiming. This was found to be the case.Measuring out the 10/20 system and correctly gauging motor threshold is important for safety and reliable results. Instead of the 10/20 system, narrow navigation can be used. TMS was a first major technique that determined causal relationships between brain and behavior.Additionally, it is now a major therapeutic technique using the treatment of depression.

Research

JoVE Journal

Neuroscience

A Novel Approach for Documenting Phosphenes Induced by Transcranial Magnetic Stimulation

Stimulation of the human visual cortex produces a transient perception of light, known as a phosphene. Phosphenes are induced by invasive electrical ...

Combining Transcranial Magnetic Stimulation and fMRI to Examine the Default Mode Network

The default mode network is a group of brain regions that are active when an individual is not focused on the outside world and the brain is at "wakeful ...

State-Dependency Effects on TMS:  A Look at Motive Phosphene Behavior

Transcranial magnetic stimulation (TMS) is a non-invasive neurostimulatory and neuromodulatory technique that can transiently or lastingly modulate ...

The Use of Magnetic Resonance Spectroscopy as a Tool for the Measurement of Bi-hemispheric Transcranial Electric Stimulation Effects on Primary Motor Cortex Metabolism

Transcranial direct current stimulation (tDCS) is a neuromodulation technique that has been increasingly used over the past decade in the treatment of ...

Effects of Transcranial Alternating Current Stimulation on the Primary Motor Cortex by Online Combined Approach with Transcranial Magnetic Stimulation

Transcranial Alternating Current Stimulation (tACS) is a neuromodulatory technique able to act through sinusoidal electrical waveforms in a specific ...

Online Transcranial Magnetic Stimulation Protocol for Measuring Cortical Physiology Associated with Response Inhibition

We describe the development of a reproducible, child-friendly motor response inhibition task suitable for online Transcranial Magnetic Stimulation (TMS) ...

Combined Transcranial Magnetic Stimulation and Electroencephalography of the Dorsolateral Prefrontal Cortex

Transcranial magnetic stimulation (TMS) is a non-invasive method that produces neural excitation in the cortex by means of brief, time-varying magnetic ...

Bilateral Assessment of the Corticospinal Pathways of the Ankle Muscles Using Navigated Transcranial Magnetic Stimulation

Distal leg muscles receive neural input from motor cortical areas via the corticospinal tract, which is one of the main motor descending pathway in humans ...

Measuring and Manipulating Functionally Specific Neural Pathways in the Human Motor System with Transcranial Magnetic Stimulation

Understanding interactions between brain areas is important for the study of goal-directed behavior. Functional neuroimaging of brain connectivity has ...

Conventional and Threshold-Tracking Transcranial Magnetic Stimulation Tests for Single-handed Operation

Most single-pulse transcranial magnetic stimulation (TMS) parameters (e.g., motor threshold, stimulus-response function, cortical silent period) are used ...