Precision non-invasive transcranial electromagnetic stimulation: a thematic review of optimizing spatial, temporal, and dose dimensions

European Archives of Psychiatry and Clinical Neuroscience, vol. 276, pp. 2739–2749

Abstract

Transcranial magnetic stimulation (TMS) and transcranial electrical stimulation (TES) have been extensively used in experimental and clinical research in psychiatry, neurology, and rehabilitation. Several advanced approaches for delivering transcranial electromagnetic stimulation have been proposed to maximize the temporal and spatial precision of conventional stimulation protocols or to optimize stimulation parameters for enhanced efficacy during neuromodulation. Here, we thematically reviewed several advanced neuromodulatory approaches: (1) using prior or real-time brain states to guide the delivery of stimulation through priming protocols or brain-state-dependent stimulation interfaces (temporal precision); (2) facilitating the stimulation target engagement, either from a single brain region to an interregional brain connection using cortico-cortical paired associative stimulation or dual-site in/anti-phase transcranial alternating current stimulation, or from a superficial brain target to a deep brain region using temporal interference stimulation (spatial precision); and (3) strengthening or accelerating the plasticity modulation outcomes using high-dose protocols (dose optimization). While results from these efforts are promising, challenges exist in terms of the optimal timing of brain states and stimulation parameters, treatment durability, as well as the complexity in aggregating different advanced approaches. Future research should focus on exploring the underlying mechanisms, optimizing parameters, and assessing the efficacy in well-designed proof-of-concept experiments and clinical trials.

Authors 12

1. Ruixuan Lin

   Hong Kong Polytechnic University

   Affiliation as printed

   Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong S.A.R., China

2. Weijia He

   Xiamen University · First Affiliated Hospital of Xiamen University

   Affiliation as printed

   Department of Rehabilitation Medicine, School of Medicine, the First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, China

3. Usman Jawed Shaikh Aachen Division of Clinical Cognitive Sciences Department of Neurology

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Division of Clinical Cognitive Sciences, Department of Neurology, University Hospital RWTH Aachen, Aachen, Germany

4. Lukas Lorentz Aachen Division of Clinical Cognitive Sciences Department of Neurology

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Division of Clinical Cognitive Sciences, Department of Neurology, University Hospital RWTH Aachen, Aachen, Germany

5. Rong Zeng

   Hong Kong Polytechnic University

   Affiliation as printed

   Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong S.A.R., China

6. Patrick Wai-Hang Kwong

   Hong Kong Polytechnic University

   Affiliation as printed

   Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong S.A.R., China

7. Tiev Miller

   Hong Kong Polytechnic University

   Affiliation as printed

   Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong S.A.R., China

8. Pablo Cruz González

   Hong Kong Polytechnic University · Nanyang Technological University · Rehabilitation Research Institute of Singapore

   Affiliation as printed

   Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong S.A.R., China

   Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore

9. Ananda Sidarta

   Nanyang Technological University · Rehabilitation Research Institute of Singapore

   Affiliation as printed

   Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore

10. Ferdinand Binkofski Aachen Division of Clinical Cognitive Sciences Department of Neurology

    Universitätsklinikum Aachen · RWTH Aachen University

    Affiliation as printed

    Division of Clinical Cognitive Sciences, Department of Neurology, University Hospital RWTH Aachen, Aachen, Germany

11. David M. A. Mehler Aachen Department of Psychiatry, Psychotherapy and Psychosomatics

    University of Münster · Universitätsklinikum Aachen · RWTH Aachen University

    Affiliation as printed

    Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital RWTH Aachen, Aachen, Germany

    Institute for Translational Psychiatry, University of Münster, Münster, Germany

12. J X Zhang corresponding

    Hong Kong Polytechnic University

    Affiliation as printed

    Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong S.A.R., China. jack-jiaqi.zhang@polyu.edu.hk