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

Brain Stimul. 2020 May-Jun;13(3):931-938. doi: 10.1016/j.brs.2020.03.002. Epub 2020 Mar 12.

Authors

Manreena Kaur¹, Jessica A Michael², Kate E Hoy², Bernadette M Fitzgibbon², Megan S Ross², Tabitha A Iseger³, Martijn Arns⁴, Abdul-Rahman Hudaib⁵, Paul B Fitzgerald²

Affiliations

¹ Epworth Centre for Innovation in Mental Health, Epworth HealthCare and Department of Psychiatry, Monash University, Camberwell, Victoria, Australia; Neuroscience Research Australia, Sydney, Australia; School of Psychiatry, University of New South Wales, Sydney Australia. Electronic address: m.kaur@neura.edu.au.
² Epworth Centre for Innovation in Mental Health, Epworth HealthCare and Department of Psychiatry, Monash University, Camberwell, Victoria, Australia.
³ Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, The Netherlands; neuroCare Group, Munich, Germany.
⁴ Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, The Netherlands; neuroCare Group, Munich, Germany; Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands.
⁵ Monash Alfred Psychiatry Research Centre, The Alfred and the Central Clinical School, Monash University, Australia.

PMID: 32205066
DOI: 10.1016/j.brs.2020.03.002

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.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Depressive Disorder, Treatment-Resistant / physiopathology
Depressive Disorder, Treatment-Resistant / therapy
Electrocardiography / methods
Female
Heart Rate / physiology*
Humans
Male
Middle Aged
Neural Pathways / physiology
Prefrontal Cortex / physiology*
Transcranial Magnetic Stimulation / methods*
Vagus Nerve / physiology*
Young Adult