Assessing Neuromodulation Effects of Theta Burst Stimulation to the Prefrontal Cortex Using Transcranial Magnetic Stimulation Electroencephalography (TMS-EEG)

Theta burst stimulation (TBS), a form of repetitive transcranial magnetic stimulation (TMS), is capable of non-invasively modulating cortical excitability. TBS is gaining popularity as a therapeutic tool for psychiatric disorders such as depression, in which the dorsolateral prefrontal cortex (DLPFC) is the main therapeutic target. However, the neuromodulatory effects of TBS on prefrontal regions remain unclear. Concurrent transcranial magnetic stimulation and electroencephalography (TMS-EEG) can assess neuromodulation in non-motor regions using TMS-evoked potentials (TEPs) and event-related synchronisation/desynchronisation (ERS/D). We assessed 24 healthy participants (13 males, mean age 25.2 ± 9.9 years) in a single-blinded crossover study design, following intermittent TBS, continuous TBS and sham applied to the left DLPFC. TEPs and ERS/D were obtained at baseline and 2-, 15- and 30-min post-stimulation. Four TEP components (N40, P60, N100 and P200) and two frequency bands (theta and gamma) were analysed using mixed effects repeated measures models (MRMM). Results indicated no significant effects for any assessed components or frequency bands. Relative to sham, the largest TEP effect size was obtained for the N100 component at 15 min post-iTBS (d = -0.50), and the largest frequency effect was obtained for gamma ERS at 15 min post-cTBS (d = 0.53). These results were in the same direction but smaller than found in previous studies, suggesting that effect sizes of the neuromodulatory effects of TBS may be lower than previously reported.