Vertex Stimulation as a Control Site for Transcranial Magnetic Stimulation: A Concurrent TMS/fMRI Study

JeYoung Jung, Andreas Bungert, Richard Bowtell, Stephen R Jackson, JeYoung Jung, Andreas Bungert, Richard Bowtell, Stephen R Jackson

Abstract

Background: A common control condition for transcranial magnetic stimulation (TMS) studies is to apply stimulation at the vertex. An assumption of vertex stimulation is that it has relatively little influence over on-going brain processes involved in most experimental tasks, however there has been little attempt to measure neural changes linked to vertex TMS. Here we directly test this assumption by using a concurrent TMS/fMRI paradigm in which we investigate fMRI blood-oxygenation-level-dependent (BOLD) signal changes across the whole brain linked to vertex stimulation.

Methods: Thirty-two healthy participants to part in this study. Twenty-one were stimulated at the vertex, at 120% of resting motor threshold (RMT), with short bursts of 1 Hz TMS, while functional magnetic resonance imaging (fMRI) BOLD images were acquired. As a control condition, we delivered TMS pulses over the left primary motor cortex using identical parameters to 11 other participants.

Results: Vertex stimulation did not evoke increased BOLD activation at the stimulated site. By contrast we observed widespread BOLD deactivations across the brain, including regions within the default mode network (DMN). To examine the effects of vertex stimulation a functional connectivity analysis was conducted.

Conclusion: The results demonstrated that stimulating the vertex with suprathreshold TMS reduced neural activity in brain regions related to the DMN but did not influence the functional connectivity of this network. Our findings provide brain imaging evidence in support of the use of vertex simulation as a control condition in TMS but confirm that vertex TMS induces regional widespread decreases in BOLD activation.

Keywords: Concurrent TMS/fMRI; Transcranial magnetic stimulation; Vertex stimulation.

Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1
Figure 1
Experimental design and coil locations. Top: in the experiment, there were 18 blocks and each block (30 s) consisted of a TMS phase (11 s) and a No-TMS phase (19 s). Middle: Synchronisation of TMS and fMRI. The figure shows one EPI acquisition consisting of 30 slices. In 1 s, half of the slices are collected leaving a 200 ms gap. The TMS pulse is applied in the gap after the first slice acquisition. Bottom: (left) the vertex TMS coil positioned upright, (middle) the vertex TMS coil positioned inverted, (right) left M1 TMS.
Figure 2
Figure 2
Brain areas that showed significant deactivation following vertex stimulation. (A) Inverted coil orientation; (B) upright coil orientation; (C) conjunction analysis (p 

Figure 3

Brain areas that showed activation…

Figure 3

Brain areas that showed activation and deactivation for left M1 stimulation compared to…

Figure 3
Brain areas that showed activation and deactivation for left M1 stimulation compared to the vertex stimulation. Red colour indicates activation and blue colour indicates deactivation. S1: primary sensory cortex; SMA: supplementary motor area; OP1: Operculum 1; M1: primary motor cortex; SPL: superior parietal lobe. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Figure 4

The results of functional connectivity…

Figure 4

The results of functional connectivity analysis. Black bars represent the TMS condition. White…

Figure 4
The results of functional connectivity analysis. Black bars represent the TMS condition. White bars represent the No-TMS condition. Error bars represent the standard error. *p 
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References
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Figure 3
Figure 3
Brain areas that showed activation and deactivation for left M1 stimulation compared to the vertex stimulation. Red colour indicates activation and blue colour indicates deactivation. S1: primary sensory cortex; SMA: supplementary motor area; OP1: Operculum 1; M1: primary motor cortex; SPL: superior parietal lobe. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
Figure 4
Figure 4
The results of functional connectivity analysis. Black bars represent the TMS condition. White bars represent the No-TMS condition. Error bars represent the standard error. *p 

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