TMS for Spatial Navigation

Overseen By Malte Gueth

Age: 18 - 65

Sex: Any

Trial Phase: Academic

Sponsor: Rutgers, The State University of New Jersey

Must not be taking: CNS medications

Disqualifiers: Neurological disorders, Bipolar, Schizophrenia, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 3

Duration: 2 weeks

60 Participants Needed

Trial Summary

What is the purpose of this trial?

Our specific aim is to examine the effects of TMS on spatial processing during goal-directed navigation. In these experiments the investigators will utilize a scalp-recorded brain oscillation called right posterior theta that is believed to index the sensitivity of the parahippocampal cortex to spatial context. Here the investigators will asked whether this electrophysiological signal can be modulated up or down using TMS while participants engage in virtual navigation tasks, and if so, whether it would affect the spatial encoding of rewards and subsequent choices during task performance.

Will I have to stop taking my current medications?

The trial information does not specify if you need to stop taking your current medications. However, it mentions that participants should not be on uninterruptable central nervous system medication, which might imply some restrictions.

What data supports the effectiveness of the treatment TMS for Spatial Navigation?

Research shows that TMS applied to the parietal cortex can influence attention and sensorimotor processes, which are important for spatial navigation. Studies have demonstrated that TMS can disrupt or enhance visuospatial tasks, suggesting its potential to affect spatial navigation abilities. ^{1 2 3 4 5}

Is Transcranial Magnetic Stimulation (TMS) safe for humans?

Transcranial Magnetic Stimulation (TMS) is generally considered safe for humans, with single-pulse TMS being particularly safe. However, repetitive TMS (rTMS) can be more powerful and has been associated with rare cases of seizures. Guidelines have been developed to ensure its safe use, and studies have shown it to be safe in conditions like migraine prevention, with only minor side effects reported. ^{3 6 7 8 9}

How does TMS for spatial navigation differ from other treatments for this condition?

Transcranial magnetic stimulation (TMS) is unique because it uses magnetic fields to stimulate specific areas of the brain non-invasively, allowing for precise targeting of brain regions involved in spatial navigation. Unlike other treatments, TMS can directly influence brain activity and has been shown to affect attention and sensorimotor processes, making it a novel approach for conditions related to spatial navigation. ^{1 3 4 10 11}

Research Team

Travis E Baker

Principal Investigator

Rutgers University

Eligibility Criteria

This trial is for adults aged 18-55 with stable mental and physical health, who haven't had substance abuse treatment in the last month. Participants must not be pregnant, have a history of significant brain disorders or metal implants that affect MRI scans, and should be able to follow study procedures.

Inclusion Criteria

I am between 18 and 55 years old.

Not received substance abuse treatment within the previous 30 days

I am in stable mental and physical health.

Exclusion Criteria

Contraindication to MRI (e.g., presence of metal in the skull, orbits or intracranial cavity, claustrophobia)

I have a history of autoimmune, endocrine, viral, or vascular brain disorders.

I do not have a history of major neurological issues, head injuries, or any metal implants in my head.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Treatment

Participants undergo TMS sessions to assess the effects on spatial processing during goal-directed navigation tasks

2 weeks

3 sessions (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Treatment Details

Interventions

• Active 10-Hz TMS to the parietal cortex
• Active single pulse TMS to the parietal cortex
• Sham 10-Hz TMS to the right parietal cortex
• Sham single-pulse rTMS the right parietal cortex
• Sham TMS to the right parietal cortex

Trial Overview The trial tests how Transcranial Magnetic Stimulation (TMS) affects spatial processing during virtual navigation tasks. It compares active TMS pulses against sham (placebo) pulses on the parietal cortex to see if they influence spatial memory and decision-making.

Participant Groups

Group I: Active single-pulse rTMS Experimental Treatment 1 Intervention

For the first TMS session, participants will receive a single TMS pulse during the phase target of each task trial and delivered at 110% of participants' resting motor threshold over the predefined parietal target for a total of 300 pulses. For the second TMS session, participants will receive single pulse TMS during the phase target of each task trial and delivered at 110% of participants' resting motor threshold over the predefined parietal target for a total of 200 pulses.

Group II: Active 10-Hz rTMS Experimental Treatment 1 Intervention

For the first TMS session, participants will receive 10-Hz repetitive TMS (rTMS) delivered at 110% of participants' resting motor threshold over the predefined parietal target for a total of 2250 pulses. For the second TMS session, participants will receive single pulse TMS during the phase target of each task trial and delivered at 110% of participants' resting motor threshold over the predefined parietal target for a total of 200 pulses.

Group III: Sham 10-Hz rTMS Placebo Group 1 Intervention

Identical parameters of the active 10-Hz rTMS group will be applied to the SHAM group with the exception that the TMS coil will be flipped 180º to mimic auditory stimulation.

Group IV: Sham single-pulse rTMS Placebo Group 1 Intervention

Identical parameters of the active single-pulse rTMS group will be applied to the SHAM group with the exception that the TMS coil will be flipped 180º to mimic auditory stimulation.

Who Is Running the Clinical Trial?

Rutgers, The State University of New Jersey

Lead Sponsor

Trials

471

Recruited

81,700+

Findings from Research

A new TMS 'hunting paradigm' was developed to quickly and reliably identify a specific site over the right anterior intraparietal sulcus (IPS) that can modulate visuospatial behavior, particularly in detecting peripheral gaps in visual tasks.

TMS applied at this identified site can either disrupt or enhance sensitivity to visual stimuli depending on the location of the target, demonstrating the spatial specificity of TMS effects and establishing a method to tailor TMS intensity based on individual motor thresholds.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Novel 'hunting' method using transcranial magnetic stimulation over parietal cortex disrupts visuospatial sensitivity in relation to motor thresholds. Oliver, R., Bjoertomt, O., Driver, J., et al.[2022]

Repetitive transcranial magnetic stimulation (rTMS) at 5 Hz applied to the parietal cortex significantly improved reaction times in a working memory task without affecting accuracy, indicating its potential efficacy for enhancing cognitive performance.

The timing of rTMS application is crucial, as improvements were observed only during the retention phase of the task, suggesting that specific stimulation conditions can optimize working memory performance.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Facilitation of performance in a working memory task with rTMS stimulation of the precuneus: frequency- and time-dependent effects. Luber, B., Kinnunen, LH., Rakitin, BC., et al.[2019]

Transcranial magnetic stimulation (TMS) has been effectively used to study the parietal cortex's role in attention and sensorimotor processes, highlighting its high temporal resolution as a key advantage.

Research indicates that specific regions of the parietal cortex are crucial for updating attention and movement representations, particularly when these are redirected.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

TMS in the parietal cortex: updating representations for attention and action. Rushworth, MF., Taylor, PC.[2022]

A single pulse of TMS applied to the left parietal cortex disrupted interhemispheric remapping, leading to increased reaction times when subjects had their arms crossed, indicating a significant effect on sensory-motor processing.

Regardless of the TMS location, the study found that TMS generally reduced reaction times, suggesting a non-specific startle reflex effect, but the left parietal TMS specifically impaired the normal processing of sensory information related to arm position.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Inter-hemispheric remapping between arm proprioception and vision of the hand is disrupted by single pulse TMS on the left parietal cortex. Fautrelle, L., Gueugnon, M., Barbieri, G., et al.[2013]

Transcranial magnetic stimulation (TMS) of the right parietal cortex impairs visuospatial judgment and alters neural activity in a specific right-hemispheric network, highlighting the role of this network in visuospatial tasks.

The study demonstrates that visuospatial deficits after parietal damage are likely due to disruptions in a broader frontoparietal network rather than just the damaged parietal area, suggesting interconnected brain regions play a crucial role in cognitive functions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Imaging the brain activity changes underlying impaired visuospatial judgments: simultaneous FMRI, TMS, and behavioral studies. Sack, AT., Kohler, A., Bestmann, S., et al.[2022]

In a study involving 100 adult migraine patients, high-rate repetitive transcranial magnetic stimulation (rTMS) significantly reduced headache frequency by 78.7% and severity by 76.6% compared to sham stimulation after one month.

The treatment was found to be safe, with only one patient experiencing transient drowsiness, indicating that rTMS is a promising option for migraine prophylaxis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

High-rate repetitive transcranial magnetic stimulation in migraine prophylaxis: a randomized, placebo-controlled study. Misra, UK., Kalita, J., Bhoi, SK.[2022]

Repetitive transcranial magnetic stimulation (rTMS) is a powerful tool that can effectively treat clinical depression and potentially other brain disorders, but it carries risks, including the potential to induce seizures, as evidenced by 7 known cases by 1996.

A workshop established safety guidelines for rTMS, emphasizing the importance of monitoring, ethical considerations, and the expertise required for its administration to minimize risks and enhance therapeutic outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Risk and safety of repetitive transcranial magnetic stimulation: report and suggested guidelines from the International Workshop on the Safety of Repetitive Transcranial Magnetic Stimulation, June 5-7, 1996. Wassermann, EM.[2022]

A new sham rTMS method was developed that effectively mimics the look, sound, and feel of active rTMS without producing a significant magnetic field, making it suitable for double-blind, placebo-controlled studies.

In tests with naïve subjects, they could not distinguish between active and sham stimulation, indicating the sham method's validity; however, experienced subjects could tell the difference, highlighting the need for careful participant selection in studies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Sham Transcranial Magnetic Stimulation Using Electrical Stimulation of the Scalp. Mennemeier, M., Triggs, W., Chelette, K., et al.[2023]

Different sham transcranial magnetic stimulation (TMS) techniques can produce varying levels of cortical stimulation, with some sham conditions inducing significant brain activity, which could affect trial outcomes.

The study found that a two-wing 45-degree tilt sham condition resulted in only 24% lower voltage than active TMS, indicating that not all sham methods are equally effective in mimicking a true placebo, highlighting the importance of selecting appropriate sham techniques in clinical trials.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Sham TMS: intracerebral measurement of the induced electrical field and the induction of motor-evoked potentials. Lisanby, SH., Gutman, D., Luber, B., et al.[2022]

Transcranial magnetic stimulation (TMS) is a non-invasive brain imaging technique that can causally link specific cortical areas to physiological responses, making it more precise than other imaging methods.

Navigated TMS has shown clinical effectiveness in mapping motor areas, assessing recovery after stroke, and treating conditions like depression, but further development of targeting and dosing protocols is needed for improved accuracy and reproducibility in clinical settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Navigated transcranial magnetic stimulation. Ruohonen, J., Karhu, J.[2016]

Neuronavigated low-frequency rTMS significantly enhances motor-evoked potentials and improves motor behavior, such as reaction time and grip strength, compared to non-navigated rTMS in healthy subjects.

The study involved 10 participants and demonstrated that navigated rTMS leads to more pronounced effects on the contralateral hemisphere, suggesting its potential for better therapeutic outcomes in stroke recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Neuronavigation increases the physiologic and behavioral effects of low-frequency rTMS of primary motor cortex in healthy subjects. Bashir, S., Edwards, D., Pascual-Leone, A.[2022]

References

1. England pubmed.ncbi.nlm.nih.gov

Novel 'hunting' method using transcranial magnetic stimulation over parietal cortex disrupts visuospatial sensitivity in relation to motor thresholds. [2022]

2. Netherlands pubmed.ncbi.nlm.nih.gov

Facilitation of performance in a working memory task with rTMS stimulation of the precuneus: frequency- and time-dependent effects. [2019]

3. England pubmed.ncbi.nlm.nih.gov

TMS in the parietal cortex: updating representations for attention and action. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Inter-hemispheric remapping between arm proprioception and vision of the hand is disrupted by single pulse TMS on the left parietal cortex. [2013]

5. United States pubmed.ncbi.nlm.nih.gov

Imaging the brain activity changes underlying impaired visuospatial judgments: simultaneous FMRI, TMS, and behavioral studies. [2022]

6. Germany pubmed.ncbi.nlm.nih.gov

High-rate repetitive transcranial magnetic stimulation in migraine prophylaxis: a randomized, placebo-controlled study. [2022]

7. Ireland pubmed.ncbi.nlm.nih.gov

Risk and safety of repetitive transcranial magnetic stimulation: report and suggested guidelines from the International Workshop on the Safety of Repetitive Transcranial Magnetic Stimulation, June 5-7, 1996. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

Sham Transcranial Magnetic Stimulation Using Electrical Stimulation of the Scalp. [2023]

9. United States pubmed.ncbi.nlm.nih.gov

Sham TMS: intracerebral measurement of the induced electrical field and the induction of motor-evoked potentials. [2022]

10. France pubmed.ncbi.nlm.nih.gov

Navigated transcranial magnetic stimulation. [2016]

11. United States pubmed.ncbi.nlm.nih.gov

Neuronavigation increases the physiologic and behavioral effects of low-frequency rTMS of primary motor cortex in healthy subjects. [2022]