Centre for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China.
Department of Anesthesiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
Neurotherapeutics. 2024 Oct;21(6):e00451. doi: 10.1016/j.neurot.2024.e00451. Epub 2024 Sep 19.
Accelerated intermittent theta burst stimulation (AiTBS) has attracted much attention in the past few years as a new form of brain stimulation paradigm. However, it is unclear the relative efficacy of AiTBS on cortical excitability compared to conventional high-frequency rTMS. Using concurrent TMS and electroencephalogram (TMS-EEG), this study systematically compared the efficacy on cortical excitability and a typical clinical application (i.e. pain), between AiTBS with different intersession interval (ISIs) and 10-Hz rTMS. Participants received 10-Hz rTMS, AiTBS-15 (3 iTBS sessions with a 15-min ISI), AiTBS-50 (3 iTBS sessions with a 50-min ISI), or Sham stimulation over the primary motor cortex on four separate days. All four protocols included a total of 1800 pulses but with different session durations (10-Hz rTMS = 18, AiTBS-15 = 40, and AiTBS-50 = 110 min). AiTBS-50 and 10-Hz rTMS were more effective in pain reduction compared to AiTBS-15. Using single-pulse TMS-induced oscillation, our data revealed low gamma oscillation as a shared cortical excitability change across all three active rTMS protocols but demonstrated completely opposite directions. Changes in low gamma oscillation were further associated with changes in pain perception across the three active conditions. In contrast, a distinct pattern of TMS-evoked potentials (TEPs) was revealed, with 10-Hz rTMS decreasing inhibitory N100 amplitude and AiTBS-15 reducing excitatory P60 amplitude. These changes in TEPs were also covarying with low gamma power changes. Sham stimulation indicated no significant effect on either cortical excitability or pain perception. These results are relevant only for provoked experimental pain, without being predictive for chronic pain, and revealed a change in low gamma oscillation, particularly around the very particular frequency of 40 Hz, shared between AiTBS and high-frequency rTMS. Conversely, cortical excitability (balance between excitation and inhibition) assessed by TEP recording was modulated differently by AiTBS and high-frequency rTMS paradigms.
加速间歇 theta 爆发刺激 (AiTBS) 在过去几年中作为一种新的脑刺激范式引起了广泛关注。然而，与传统的高频 rTMS 相比，AiTBS 对皮质兴奋性的相对疗效尚不清楚。本研究采用经颅磁刺激和脑电图 (TMS-EEG) 联合检测，系统比较了不同间隔时间 (ISIs) 的 AiTBS 与 10-Hz rTMS 对皮质兴奋性和典型临床应用 (即疼痛) 的疗效。参与者在四天内分别接受了 10-Hz rTMS、AiTBS-15(3 次 iTBS 刺激，间隔 15 分钟)、AiTBS-50(3 次 iTBS 刺激，间隔 50 分钟)或假刺激。所有四个方案共包含 1800 个脉冲，但刺激持续时间不同(10-Hz rTMS=18 分钟，AiTBS-15=40 分钟，AiTBS-50=110 分钟)。与 AiTBS-15 相比，AiTBS-50 和 10-Hz rTMS 更能有效减轻疼痛。使用单脉冲 TMS 诱导的振荡，我们的数据显示低伽马振荡是所有三种主动 rTMS 方案共有的皮质兴奋性变化，但表现出完全相反的方向。低伽马振荡的变化与三种主动条件下的疼痛感知变化有关。相比之下，TMS 诱发的电位 (TEP) 呈现出一种截然不同的模式，10-Hz rTMS 降低了抑制性 N100 幅度，而 AiTBS-15 降低了兴奋性 P60 幅度。TEP 的这些变化也与低伽马功率变化相关。假刺激对皮质兴奋性或疼痛感知均无显著影响。这些结果仅与诱发的实验性疼痛有关，不能预测慢性疼痛，并显示出低伽马振荡的变化，特别是在 AiTBS 和高频 rTMS 之间共享的非常特殊的 40 Hz 频率附近。相反，通过 TEP 记录评估的皮质兴奋性 (兴奋和抑制之间的平衡) 被 AiTBS 和高频 rTMS 范式以不同的方式调节。
