Abstract
The vertex has been used as a suitable control stimulation site in repetitive transcranial magnetic stimulation studies. The objectives of this study are (1) to assess cognitive performance (CP) after theta burst stimulation (TBS); (2) to evaluate whether clinically relevant cortical areas might be reached by vertex stimulation and how that might influence CP. Twenty young healthy subjects performed a cognitive task prior to and immediately after intermittent TBS (iTBS) and continuous TBS (cTBS) of two active cortical stimulation sites and the vertex. We used the Wilcoxon signed-rank test to compare the pre- and post-stimulation reaction times (RTs) and a mixed ANOVA analysis to evaluate the effect of the stimulation on changes in RTs. A three-dimensional finite-element model (FEM) was used to calculate the vertex TBS-induced electrical field (E-field) in the adjacent regions of interest (ROIs). Correlation analyses were performed between E-fields in the ROIs and cognitive outcomes. We found a significant effect only of the stimulation time factor (F (1,12) = 65.37, p < 0.001) on RT shortening, with no superiority of the active site stimulation compared to the vertex stimulation. In 73.5% of vertex TBS sessions, a significant E-field was induced in at least one ROI. We found a negative association between the magnitude of the iTBS-induced E-fields and RT changes (R = − 0.54, p = 0.04). TBS protocols may lead to changes in CP when applied over the craniometrically targeted vertex. We therefore suggest not using a conventional approach as a vertex targeting method.
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Data availability
Data are stored at the CEITEC, Masaryk University repository for a minimum of 10 years. Data will be disclosed on request and after approval of the proposed use of the data by the study committee.
Code availability
The SimNIBS pipeline is available at https://simnibs.github.io/simnibs/build/html/index.html.
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Acknowledgements
We acknowledge the contribution of the core facility MAFIL of CEITEC supported by the MEYS CR (LM2018129 Czech-BioImaging). Many thanks also to Anne Johnson for proofreading. The study was not registered as a trial with any European database, since this was not required by the Czech Health Research Council and there is no such rule in the Czech Republic.
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This work was supported by the Ministry of Health of the Czech Republic [Grant No. AZV 16-31868A] and by the Czech Science Foundation grant 21-13462L.
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Pizem, D., Novakova, L., Gajdos, M. et al. Is the vertex a good control stimulation site? Theta burst stimulation in healthy controls. J Neural Transm 129, 319–329 (2022). https://doi.org/10.1007/s00702-022-02466-9
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DOI: https://doi.org/10.1007/s00702-022-02466-9