Cited by 168Transcranial Magnetic Stimulation StudiesElectroconvulsive Therapy StudiesDeep Brain Stimulation and Movement Disorders

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Theta Burst Stimulation of the Prefrontal Cortex: Safety and Impact on Cognition, Mood, and Resting Electroencephalogram

Grossheinrich, Nicola, Rau, Anne, Pogarell, Oliver, Hennig-Fast, Kristina, Reinl, Maren, Karch, Susanne, Dieler, Alica, Leicht, Gregor, Mulert, Christoph, Sterr, Andrea, Padberg, Frank·2009·Biological Psychiatry

DOI 10.1016/j.biopsych.2008.10.029

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Abstract

Background Because standard repetitive transcranial magnetic stimulation (rTMS) protocols exhibit post-stimulus effects of short duration, novel protocols such as theta burst stimulation (TBS), are promising approaches to enhance the effectiveness of rTMS. However, little is known about the side effect profile of such protocols. Thus, the present study explores whether TBS is safe particularly in terms of effects on cognition, mood, and electroencephalogram (EEG) measures in healthy subjects. Methods Twenty-four healthy volunteers participated in 2 randomized, placebo-controlled, cross-over experiments and underwent continuous TBS (cTBS), intermittent TBS (iTBS), and shamTBS either over the left dorsolateral prefrontal cortex (DLPFC, n = 12) or the medial prefrontal cortices (mPFC, n = 12). Clinical side effects, performance in a neuropsychological battery, mood changes, and resting EEG were recorded. Results Neither a seizure nor epileptiform EEG activity was observed. The most prominent side effect was the occurrence of vagal reactions during TBS; otherwise no serious side effects were found. Standardized low-resolution brain electromagnetic tomography showed current density changes in the alpha2 band after iTBS of the DLPFC, which remained detectable up to 50 min after stimulation. The few changes in neuropsychological performance were concordant with stimulation site. No impact on mood was detected. Conclusions Although TBS protocols of the human prefrontal cortex seem to be safe in healthy subjects, future studies need to address the occurrence of vagal reactions. Excitatory and inhibitory properties of motor cortex TBS might not be transferable to prefrontal sites, and the action of specific TBS protocols needs to be further investigated prior to clinical application.

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Authors: Grossheinrich, N., Rau, A., Pogarell, O., Hennig-Fast, K., Reinl, M., Karch, S., Dieler, A., Leicht, G., Mulert, C., Sterr, A., & Padberg, F.
Affiliations: Ludwig-Maximilians-Universität München (DE)
Corresponding author: Padberg, Frank
ORCID: Grossheinrich, Nicola
Pogarell, Oliver
Karch, Susanne
Leicht, Gregor
Mulert, Christoph
Padberg, Frank
Venue: Biological Psychiatry
Publisher: Elsevier BV
Published: 2009-05
Volume: 65
Issue: 9
Pages: 778-784
ISSN: 0006-3223 (ISSN-L)
DOI: 10.1016/j.biopsych.2008.10.029
OpenAlex: W2066716661
Cited by: 168
References: 30
Citations by year: 2026: 9 · 2025: 8 · 2024: 10 · 2023: 9 · 2022: 12 · 2021: 9 · 2020: 8 · 2019: 11 · 2018: 12 · 2017: 11 · 2016: 9 · 2015: 7 · 2014: 9 · 2013: 6 · 2012: 8
FWCI: 6.60
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Biological Psychiatry (publishedVersion)
PubMed (publishedVersion)
Topics: Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
Health Sciences › Medicine › Clinical Neurology › Deep Brain Stimulation and Movement Disorders
Keywords: theta burst stimulation, repetitive transcranial magnetic stimulation, prefrontal cortex, dorsolateral prefrontal cortex, medial prefrontal cortex, stimulation safety, adverse effects, resting-state EEG, neuropsychological performance, mood, sham stimulation
MeSH terms: Adult, Affect, Cognition, Electroencephalography, Female, Humans, Male, Neuropsychological Tests, Placebos, Psychomotor Performance, Prefrontal Cortex, Cross-Over Studies, Transcranial Magnetic Stimulation

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Theta Burst Stimulation of the Prefrontal Cortex: Safety and Impact on Cognition, Mood, and Resting Electroencephalogram

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