Developing personalized brain state-dependent TMS to target residual corticospinal connections after stroke

Résumé fourni par la source

The corticospinal tract (CST) is the chief contributor to voluntary hand movement, and many stroke survivors have residual CST connections.Brain state-dependent transcranial magnetic stimulation (BSD-TMS) interventions could promote residual CST function and improve poststroke hand motor recovery.Given that individual stroke survivors are heterogenous in their lesion patterns, magnitude of recovery-related adaptive plasticity, and motor impairments, poststroke BSD-TMS interventions should be delivered during personalized brain states reflecting strong CST activation.In this study, we developed and tested a novel real-time machine learning-driven EEG-TMS system that accurately identifies and targets personalized EEG activity patterns during which TMS elicits large (i.e., strong states) or small MEPs (i.e., weak states).In neurotypical adults (N¼19), our system accurately identified and targeted the desired state 83-95% of the time (p<0.001).At 120% RMT, MEPs elicited in real-time during strong states were significantly larger than those elicited during both weak and random states (p<0.04).At 110% RMT, MEPs did not differ between states (p>0.33).MEPs were overall less variable during personalized strong than weak states (p¼0.04).Although participants exhibited unique patterns of pre-stimulus EEG power differences between states, right centroparietal alpha power and whole-scalp theta power were typically higher during strong than weak states.Preliminary analysis of data acquired from stroke survivors (N¼3) showed that our system accurately identified and targeted the desired state 86-95% of the time.MEPs elicited in real-time during strong states were on average larger than those elicited during weak and random states, and stroke survivors with more severe upper extremity motor impairments showed smaller state-dependent MEP amplitude variation.Results demonstrate that real-time personalized BSD-TMS is both feasible and accurate in neurotypical adults and stroke survivors.Overall, our findings represent a key step towards using personalized BSD-TMS interventions to improve residual CST transmission and promote poststroke hand motor recovery.

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