Department of Psychology, Experimental Psychology, University of Groningen, Groningen, The Netherlands.
Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States of America.
J Neural Eng. 2024 Nov 1;21(6):061001. doi: 10.1088/1741-2552/ad8a8e.
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.
经颅磁刺激（TMS）可调节神经元活动，但由于大脑状态的动态性质，开环方法的疗效有限。通过将脑电图（EEG）实时集成，利用即时大脑状态作为生物标志物，可提高实验的可靠性并提供个性化的神经调节治疗。本文回顾了自几年前首次发表以来基于大脑状态控制的 TMS-EEG 研究。对感觉运动 mu 节律（8-13 Hz）的实验总结表明，TMS 脉冲在振荡的波谷处增加了皮质兴奋性，而在峰值处降低了兴奋性。预 TMS 脉冲 mu 功率也会影响兴奋性。此外，越来越多的证据表明，theta 和 beta 频带中的振荡相位调节神经兴奋性。本文为实时 TMS-EEG 的应用提供了指导，并讨论了实验和技术方面的考虑因素。我们考虑了硬件选择、信号质量、空间和时间滤波以及目标大脑振荡的神经特征的影响。最后，我们推测闭环 TMS-EEG 如何可能改善抑郁症、阿尔茨海默病、帕金森病、精神分裂症和中风等神经和精神疾病的治疗。
