Effects of online repetitive transcranial magnetic stimulation (rTMS) on cognitive processing: A meta-analysis and recommendations for future studies.


Online repetitive transcranial magnetic stimulation (rTMS), applied while subjects are performing a task, is widely used to disrupt brain regions underlying cognition. However, online rTMS has also induced "paradoxical enhancement". Given the rapid proliferation of this approach, it is crucial to develop a better understanding of how online stimulation influences cognition, and the optimal parameters to achieve desired effects. To accomplish this goal, a quantitative meta-analysis was performed with random-effects models fitted to reaction time (RT) and accuracy data. The final dataset included 126 studies published between 1998 and 2016, with 244 total effects for reaction times, and 202 for accuracy. Meta-analytically, rTMS at 10 Hz and 20 Hz disrupted accuracy for attention, executive, language, memory, motor, and perception domains, while no effects were found with 1 Hz or 5 Hz. Stimulation applied at and 10 and 20 Hz slowed down RTs in attention and perception tasks. No performance enhancement was found. Meta-regression analysis showed that fMRI-guided targeting and short inter-trial intervals are associated with increased disruptive effects with rTMS.





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Publication Info

Beynel, Lysianne, Lawrence G Appelbaum, Bruce Luber, Courtney A Crowell, Susan A Hilbig, Wesley Lim, Duy Nguyen, Nicolas A Chrapliwy, et al. (2019). Effects of online repetitive transcranial magnetic stimulation (rTMS) on cognitive processing: A meta-analysis and recommendations for future studies. Neuroscience and biobehavioral reviews, 107. pp. 47–58. 10.1016/j.neubiorev.2019.08.018 Retrieved from https://hdl.handle.net/10161/20727.

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Simon Wilton Davis

Associate Professor in Neurology

My research centers around the use of structural and functional imaging measures to study the shifts in network architecture in the aging brain. I am specifically interested in changes in how changes in structural and functional connectivity associated with aging impact the semantic retrieval of word or fact knowledge. Currently this involves asking why older adults have particular difficulty in certain kinds of semantic retrieval, despite the fact that vocabularies and knowledge stores typically improve with age.

A second line of research involves asking questions about how this semantic system is organized in young adults, understanding which helps form a basis for asking questions about older adults. To what degree are these semantic retrieval processes lateralized? What cognitive factors affect this laterality? How are brain structures like the corpus callosum involved in mediating distributed activation patterns associated with semantic retrieval? 


Roberto Cabeza

Professor of Psychology and Neuroscience

My laboratory investigates the neural correlates of memory and cognition in young and older adults using fMRI. We have three main lines of research: First, we distinguish the neural correlates of various episodic memory processes. For example, we have compared encoding vs. retrieval, item vs. source memory, recall vs. recognition, true vs. false memory, and emotional vs. nonemotional memory. We are particularly interested in the contribution of prefrontal cortex (PFC) and medial temporal lobe (MTL) subregions and their interactions. Second, we investigate similarities and differences between the neural correlates of episodic memory and other memory and cognitive functions (working, semantic, implicit, and procedural memory; attention; perception, etc.). The main goal of this cross-functional approach is to understand the contributions of brain regions shared by different cognitive functions. Finally, in both episodic memory and cross-function studies, we also examine the effects of healthy and pathological aging. Regarding episodic memory, we have linked processes differentially affected by aging (e.g., item vs. source memory, recall vs. recognition) to the effects of aging on specific PFC and MTL subregions. Regarding cross-function comparisons, we identify age-related changes in activity that are common to various functions. For example, we have found an age-related increase in bilaterality that occurs for many functions (memory, attention, language, perception, and motor) and is associated with functional compensation.


Sarah Hollingsworth Lisanby

Professor Emeritus of Psychiatry and Behavioral Sciences

Sarah Hollingsworth “Holly” Lisanby, MD, is an experienced translational researcher and innovator of neuromodulation technologies to study and treat psychiatric disorders. Dr. Lisanby is Director of the Division of Translational Research at NIMH, which funds research on the discovery of preventions, treatments, and cures for mental illness across the lifespan.  She is Founder and Director of the Noninvasive Neuromodulation Unit in the NIMH Intramural Research Program, a multi-disciplinary clinical research program specializing in the innovation of new brain stimulation tools to measure and modulate neuroplasticity to improve mental health.  Dr. Lisanby is former Chair of the Duke Department of Psychiatry & Behavioral Sciences, and JP Gibbons Endowed Professor at Duke University.  She founded and directed both the Duke and the Columbia University Divisions of Brain Stimulation, where she built interdisciplinary research programs specializing in the convergence of Psychiatry, Neuroscience and Engineering. She co-led the NIH BRAIN Initiative Team focused on large-scale neural recording and modulation devices. Dr. Lisanby has been principal investigator on a series of federally funded grants on the development of novel neuromodulation technologies, including the rational design of magnetic and electrical seizure therapies.  Her team pioneered magnetic seizure therapy (MST) as a novel depression treatment from the stages of animal testing, first-in-human, and international clinical trials.  She led a series of studies involving transcranial magnetic stimulation, electroconvulsive therapy (ECT), MST, vagus nerve stimulation, and deep brain stimulation. She has received numerous international recognitions, including the Max Hamilton Memorial Prize of the Collegium Internationale Neuro-Psychopharmacologicum, the Gerald Klerman Award from the National Depression and Manic Depression Association, and the Eva King Killam Research Award from the American College of Neuropsychopharmacology.  She has been a member of the NIMH Board of Scientific Counselors. Dr. Lisanby served on the FDA Neurological Devices Advisory Panel and has held key leadership positions with numerous professional associations, including serving as President for the Association for Convulsive Therapy/International Society of Neurostimulation, and the International Society for Transcranial Stimulation, and Chair of the American Psychiatric Association Task Force to Revise the Practice on ECT. 

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