Investigating high- and low-frequency neuro-cardiac-guided TMS for probing the frontal vagal pathway

Manreena Kaur; Jessica A. Michael; Kate E. Hoy; Bernadette M. Fitzgibbon; Megan S. Ross; Tabitha A. Iseger; Martijn Arns; Abdul Rahman Hudaib; Paul B. Fitzgerald

doi:10.1016/j.brs.2020.03.002

Investigating high- and low-frequency neuro-cardiac-guided TMS for probing the frontal vagal pathway

Manreena Kaur^*, Jessica A. Michael, Kate E. Hoy, Bernadette M. Fitzgibbon, Megan S. Ross, Tabitha A. Iseger, Martijn Arns, Abdul Rahman Hudaib, Paul B. Fitzgerald

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

27 Citations (Scopus)

Abstract

Background: Investigating approaches for determining a functionally meaningful dorsolateral prefrontal cortex (DLPFC) stimulation site is imperative for optimising repetitive transcranial magnetic stimulation (rTMS) response rates for treatment-resistant depression. One proposed approach is neuro-cardiac-guided rTMS (NCG-TMS) in which high frequency rTMS is applied to the DLPFC to determine the site of greatest heart rate deceleration. This site is thought to index a frontal-vagal autonomic pathway that intersects a key pathway believed to underlie rTMS response. Objective: We aimed to independently replicate previous findings of high-frequency NCG-TMS and extend it to evaluate the use of low-frequency rTMS for NCG-TMS. Methods: Twenty healthy participants (13 female; aged 38.6 ± 13.9) underwent NCG-TMS on frontal, fronto-central (active) and central (control) sites. For high-frequency NCG-TMS, three 5 s trains of 10 Hz were provided at each left hemisphere site. For low-frequency NCG-TMS, 60 s trains of 1 Hz were applied to left and right hemispheres and heart rate and heart rate variability outcome measures were analysed. Results: For high-frequency NCG-TMS, heart rate deceleration was observed at the left frontal compared with the central site. For low-frequency NCG-TMS, accelerated heart rate was found at the right frontal compared with central sites. No other site differences were observed. Conclusion: Opposite patterns of heart rate activity were found for high- and low-frequency NCG-TMS. The high-frequency NCG-TMS data replicate previous findings and support further investigations on the clinical utility of NCG-TMS for optimising rTMS site localisation. Further work assessing the value of low-frequency NCG-TMS for rTMS site localisation is warranted.

Original language	English
Pages (from-to)	931-938
Number of pages	8
Journal	Brain Stimulation
Volume	13
Issue number	3
DOIs	https://doi.org/10.1016/j.brs.2020.03.002
Publication status	Published - 1 May 2020
Externally published	Yes

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10.1016/j.brs.2020.03.002

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title = "Investigating high- and low-frequency neuro-cardiac-guided TMS for probing the frontal vagal pathway",

abstract = "Background: Investigating approaches for determining a functionally meaningful dorsolateral prefrontal cortex (DLPFC) stimulation site is imperative for optimising repetitive transcranial magnetic stimulation (rTMS) response rates for treatment-resistant depression. One proposed approach is neuro-cardiac-guided rTMS (NCG-TMS) in which high frequency rTMS is applied to the DLPFC to determine the site of greatest heart rate deceleration. This site is thought to index a frontal-vagal autonomic pathway that intersects a key pathway believed to underlie rTMS response. Objective: We aimed to independently replicate previous findings of high-frequency NCG-TMS and extend it to evaluate the use of low-frequency rTMS for NCG-TMS. Methods: Twenty healthy participants (13 female; aged 38.6 ± 13.9) underwent NCG-TMS on frontal, fronto-central (active) and central (control) sites. For high-frequency NCG-TMS, three 5 s trains of 10 Hz were provided at each left hemisphere site. For low-frequency NCG-TMS, 60 s trains of 1 Hz were applied to left and right hemispheres and heart rate and heart rate variability outcome measures were analysed. Results: For high-frequency NCG-TMS, heart rate deceleration was observed at the left frontal compared with the central site. For low-frequency NCG-TMS, accelerated heart rate was found at the right frontal compared with central sites. No other site differences were observed. Conclusion: Opposite patterns of heart rate activity were found for high- and low-frequency NCG-TMS. The high-frequency NCG-TMS data replicate previous findings and support further investigations on the clinical utility of NCG-TMS for optimising rTMS site localisation. Further work assessing the value of low-frequency NCG-TMS for rTMS site localisation is warranted.",

keywords = "Heart rate, Heart rate variability, High-frequency, Low-frequency, Neuro-cardiac-guided rTMS",

author = "Manreena Kaur and Michael, {Jessica A.} and Hoy, {Kate E.} and Fitzgibbon, {Bernadette M.} and Ross, {Megan S.} and Iseger, {Tabitha A.} and Martijn Arns and Hudaib, {Abdul Rahman} and Fitzgerald, {Paul B.}",

note = "Publisher Copyright: {\textcopyright} 2020 The Author(s)",

year = "2020",

month = may,

day = "1",

doi = "10.1016/j.brs.2020.03.002",

language = "English",

volume = "13",

pages = "931--938",

journal = "Brain Stimulation",

issn = "1935-861X",

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T1 - Investigating high- and low-frequency neuro-cardiac-guided TMS for probing the frontal vagal pathway

AU - Kaur, Manreena

AU - Michael, Jessica A.

AU - Hoy, Kate E.

AU - Fitzgibbon, Bernadette M.

AU - Ross, Megan S.

AU - Iseger, Tabitha A.

AU - Arns, Martijn

AU - Hudaib, Abdul Rahman

AU - Fitzgerald, Paul B.

PY - 2020/5/1

Y1 - 2020/5/1

N2 - Background: Investigating approaches for determining a functionally meaningful dorsolateral prefrontal cortex (DLPFC) stimulation site is imperative for optimising repetitive transcranial magnetic stimulation (rTMS) response rates for treatment-resistant depression. One proposed approach is neuro-cardiac-guided rTMS (NCG-TMS) in which high frequency rTMS is applied to the DLPFC to determine the site of greatest heart rate deceleration. This site is thought to index a frontal-vagal autonomic pathway that intersects a key pathway believed to underlie rTMS response. Objective: We aimed to independently replicate previous findings of high-frequency NCG-TMS and extend it to evaluate the use of low-frequency rTMS for NCG-TMS. Methods: Twenty healthy participants (13 female; aged 38.6 ± 13.9) underwent NCG-TMS on frontal, fronto-central (active) and central (control) sites. For high-frequency NCG-TMS, three 5 s trains of 10 Hz were provided at each left hemisphere site. For low-frequency NCG-TMS, 60 s trains of 1 Hz were applied to left and right hemispheres and heart rate and heart rate variability outcome measures were analysed. Results: For high-frequency NCG-TMS, heart rate deceleration was observed at the left frontal compared with the central site. For low-frequency NCG-TMS, accelerated heart rate was found at the right frontal compared with central sites. No other site differences were observed. Conclusion: Opposite patterns of heart rate activity were found for high- and low-frequency NCG-TMS. The high-frequency NCG-TMS data replicate previous findings and support further investigations on the clinical utility of NCG-TMS for optimising rTMS site localisation. Further work assessing the value of low-frequency NCG-TMS for rTMS site localisation is warranted.

AB - Background: Investigating approaches for determining a functionally meaningful dorsolateral prefrontal cortex (DLPFC) stimulation site is imperative for optimising repetitive transcranial magnetic stimulation (rTMS) response rates for treatment-resistant depression. One proposed approach is neuro-cardiac-guided rTMS (NCG-TMS) in which high frequency rTMS is applied to the DLPFC to determine the site of greatest heart rate deceleration. This site is thought to index a frontal-vagal autonomic pathway that intersects a key pathway believed to underlie rTMS response. Objective: We aimed to independently replicate previous findings of high-frequency NCG-TMS and extend it to evaluate the use of low-frequency rTMS for NCG-TMS. Methods: Twenty healthy participants (13 female; aged 38.6 ± 13.9) underwent NCG-TMS on frontal, fronto-central (active) and central (control) sites. For high-frequency NCG-TMS, three 5 s trains of 10 Hz were provided at each left hemisphere site. For low-frequency NCG-TMS, 60 s trains of 1 Hz were applied to left and right hemispheres and heart rate and heart rate variability outcome measures were analysed. Results: For high-frequency NCG-TMS, heart rate deceleration was observed at the left frontal compared with the central site. For low-frequency NCG-TMS, accelerated heart rate was found at the right frontal compared with central sites. No other site differences were observed. Conclusion: Opposite patterns of heart rate activity were found for high- and low-frequency NCG-TMS. The high-frequency NCG-TMS data replicate previous findings and support further investigations on the clinical utility of NCG-TMS for optimising rTMS site localisation. Further work assessing the value of low-frequency NCG-TMS for rTMS site localisation is warranted.

KW - Heart rate

KW - Heart rate variability

KW - High-frequency

KW - Low-frequency

KW - Neuro-cardiac-guided rTMS

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U2 - 10.1016/j.brs.2020.03.002

DO - 10.1016/j.brs.2020.03.002

M3 - Article

SN - 1935-861X

VL - 13

SP - 931

EP - 938

JO - Brain Stimulation

JF - Brain Stimulation

IS - 3

ER -

Investigating high- and low-frequency neuro-cardiac-guided TMS for probing the frontal vagal pathway

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