Dose-Dependent Target Engagement of a Clinical Intermittent Theta Burst Stimulation Protocol: An Interleaved Transcranial Magnetic Stimulation–Functional Magnetic Resonance Imaging Study in Healthy People

Chang, Kai-Yen; Tik, Martin ; Mizutani-Tiebel, Yuki ; Taylor, Paul C. J. ; Hattem, Timo van; Falkai, Peter ; Padberg, Frank ; Bulubas, Lucia und Keeser, Daniel (2025): Dose-Dependent Target Engagement of a Clinical Intermittent Theta Burst Stimulation Protocol: An Interleaved Transcranial Magnetic Stimulation–Functional Magnetic Resonance Imaging Study in Healthy People. In: Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, Vol. 10, No. 8: pp. 804-813

Abstract

Background: Intermittent theta burst stimulation (iTBS) of the dorsolateral prefrontal cortex (DLPFC) is widely applied as a therapeutic intervention in mental health; however, the understanding of its mechanisms is still incomplete. Prior magnetic resonance imaging (MRI) studies have mainly used offline iTBS or short sequences in concurrent transcranial magnetic stimulation (TMS)–functional MRI (fMRI). This study investigated a full 600-stimuli iTBS protocol using interleaved TMS-fMRI in comparison with 2 control conditions in healthy subjects.

Methods: In a crossover design, 18 participants underwent 3 sessions of interleaved iTBS-fMRI: 1) the left DLPFC at 40% resting motor threshold (rMT) intensity, 2) the left DLPFC at 80% rMT intensity, and 3) the left primary motor cortex (M1) at 80% rMT intensity. We compared immediate blood oxygen level–dependent (BOLD) responses during interleaved iTBS-fMRI across these conditions including correlations between individual fMRI BOLD activation and iTBS-induced electric field strength at the target sites.

Results: Whole-brain analysis showed increased activation in several regions following iTBS. Specifically, the left DLPFC, as well as the bilateral M1, anterior cingulate cortex, and insula, showed increased activation during 80% rMT left DLPFC stimulation. Increased BOLD activity in the left DLPFC was observed with neither 40% rMT left DLPFC stimulation nor left M1 80% rMT iTBS, whereas activation in other regions was found to overlap between conditions. Of note, BOLD activation and electric field intensities were only correlated for M1 stimulation and not for the DLPFC conditions.

Conclusions: This interleaved TMS-fMRI study showed dosage- and target-specific BOLD activation during a 600-stimuli iTBS protocol in healthy individuals. Future studies may use our approach for investigating target engagement in clinical samples.

• Item Type: Journal article
• Keywords: Clinical TMS protocol; Concurrent TMS-fMRI; Depression treatment; fMRI; Functional MRIInterleaved iTBS-fMRI; Neuromodulation; Personalized brain stimulation; TMS; Transcranial magnetic stimulation
• Faculties: Psychology and Education Science > Department Psychology; Medicine > Medical Center of the University of Munich > Clinic and Polyclinic for Psychiatry and Psychotherapy
• Research Centers: Munich Center for Neurosciences – Brain & Mind
• Subjects: 100 Philosophy and Psychology > 150 Psychology; 600 Technology > 610 Medicine and health
• ISSN: 24519022
• Language: English
• DFG: Gefördert durch die Deutsche Forschungsgemeinschaft (DFG) - 277061809