Precision TMS with integrated visualization and analysis of real-time E-field and EEG source imaging

Summary Transcranial magnetic stimulation (TMS) is an FDA-approved treatment for several brain diseases, such as major depressive disorder, obsessive-compulsive disorder, migraine with aura, and smoking cessation. However, the response rate varies significantly across subjects related to several suboptimal treatment parameters such as stimulation intensity and brain target for individual patients. To overcome the limitations, we will develop novel software and computational techniques that integrate real-time navigated electric-field mapping and source- space electroencephalogram (EEG) analysis during TMS to significantly improve the accuracy of targeting and dosimetry for individualized subjects to enhance treatment efficacy. We propose a novel subject-specific target localization method that integrates diffusion MRI tractography and resting-state functional brain networks to select target regions in the dorsolateral prefrontal cortex (DLPFC) and the inferior parietal lobule (IPL) of the frontoparietal network. We will use the electric field and source space EEG mapping techniques to guide the stimulation of the target regions and examine related changes in cognitive control functions. We will complete the proposed work with three aims. In Aim 1, we will further develop the SlicerTMS software from our previous work to provide real-time E-field mapping and quantitative measures during TMS treatment. In Aim 2, we will incorporate real-time source-space TMS-EEG measures in SlicerTMS2.0 to provide real-time feedback for target engagement and brain activity. In Aim 3, we will validate SlicerTMS2.0 online measures by comparing them with standard offline analysis methods with TMS-EEG experiments using the proposed DLPFC and IPL targets. We will also examine TMS-related changes in the choice reaction time in modified multi-source interference tasks. The outcomes of this grant will provide new tools to improve TMS stimulation targeting and dosimetry, which can significantly enhance TMS treatment response for brain diseases.