Functional Imaging to Guide Network-Based TMS Treatments: Toward a Tailored Medicine Approach in Alzheimer’s Disease

• Published in: Frontiers in neuroscience Vol. 15; p. 687493
• Main Authors: Bagattini, Chiara, Brignani, Debora, Bonnì, Sonia, Quattrini, Giulia, Gasparotti, Roberto, Pievani, Michela
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Research Foundation 05.07.2021; Frontiers Media S.A
• Subjects: Alzheimer's disease; connectivity; Feasibility studies; functional brain networks; Functional magnetic resonance imaging; Localization; Magnetic fields; Magnetic resonance imaging; Neurodegenerative diseases; Neuroscience; repetitive transcranial magnetic stimulation; resting-state fMRI; tailored treatment; Transcranial magnetic stimulation; Italy; tailored treatment; Alzheimer’s disease; connectivity; resting-state fMRI; functional brain networks; repetitive transcranial magnetic stimulation
• ISSN: 1662-453X; 1662-4548; 1662-453X
• DOI: 10.3389/fnins.2021.687493

A growing number of studies is using fMRI-based connectivity to guide transcranial magnetic stimulation (TMS) target identification in both normal and clinical populations. TMS has gained increasing attention as a potential therapeutic strategy also in Alzheimer’s disease (AD), but an endorsed target localization strategy in this population is still lacking. In this proof of concept study, we prove the feasibility of a tailored TMS targeting approach for AD, which stems from a network-based perspective. Based on functional imaging, the procedure allows to extract individual optimal targets meanwhile accounting for functional variability. Single-subject resting-state fMRI was used to extract individual target coordinates of two networks primarily affected in AD, the default mode and the fronto-parietal network. The localization of these targets was compared to that of traditional group-level approaches and tested against varying degrees of TMS focality. The distance between individual fMRI-derived coordinates and traditionally defined targets was significant for a supposed TMS focality of 12 mm and in some cases up to 20 mm. Comparison with anatomical labels confirmed a lack of 1:1 correspondence between anatomical and functional targets. The proposed network-based fMRI-guided TMS approach, while accounting for inter-individual functional variability, allows to target core AD networks, and might thus represent a step toward tailored TMS interventions for AD.