Improving the efficacy and reliability of rTMS language mapping by increasing the stimulation frequency.
Charlotte NettekovenJulia PieczewskiVolker NeuschmeltingKristina JonasRoland GoldbrunnerChristian Grefkes HermannCarolin Weiss LucasPublished in: Human brain mapping (2021)
Repetitive TMS (rTMS) with a frequency of 5-10 Hz is widely used for language mapping. However, it may be accompanied by discomfort and is limited in the number and reliability of evoked language errors. We, here, systematically tested the influence of different stimulation frequencies (i.e., 10, 30, and 50 Hz) on tolerability, number, reliability, and cortical distribution of language errors aiming at improved language mapping. 15 right-handed, healthy subjects (m = 8, median age: 29 yrs) were investigated in two sessions, separated by 2-5 days. In each session, 10, 30, and 50 Hz rTMS were applied over the left hemisphere in a randomized order during a picture naming task. Overall, 30 Hz rTMS evoked significantly more errors (20 ± 12%) compared to 50 Hz (12 ± 8%; p <.01), whereas error rates were comparable between 30/50 and 10 Hz (18 ± 11%). Across all conditions, a significantly higher error rate was found in Session 1 (19 ± 13%) compared to Session 2 (13 ± 7%, p <.05). The error rate was poorly reliable between sessions for 10 (intraclass correlation coefficient, ICC = .315) and 30 Hz (ICC = .427), whereas 50 Hz showed a moderate reliability (ICC = .597). Spatial reliability of language errors was low to moderate with a tendency toward increased reliability for higher frequencies, for example, within frontal regions. Compared to 10 Hz, both, 30 and 50 Hz were rated as less painful. Taken together, our data favor the use of rTMS-protocols employing higher frequencies for evoking language errors reliably and with reduced discomfort, depending on the region of interest.
Keyphrases
- transcranial magnetic stimulation
- autism spectrum disorder
- high frequency
- high intensity
- patient safety
- adverse drug
- high resolution
- clinical trial
- computed tomography
- emergency department
- electronic health record
- machine learning
- high density
- randomized controlled trial
- mass spectrometry
- transcranial direct current stimulation
- quality improvement
- functional connectivity
- artificial intelligence
- high speed