The frontal pole as a target for transcranial magnetic stimulation: A retrospective analysis of feasibility and tolerability
Open accessAbstract
The frontal pole (FP) of the medial prefrontal cortex (Brodmann Area 10) is one of the most densely connected cortical brain regions in humans [1]. It has greater dendritic number and spine density than any other cortical region [2]. From a functional perspective, the frontal pole (FP) of the medial prefrontal cortex (Brodmann Area 10) appears to have a specialized role in information integration and inhibition of extraneous information – a process which is compromised in many psychiatric disease states.
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Multiple studies and meta-analyses demonstrate that TMS, administered to a variety of brain locations including the DLPFC, does not induce more significant numbers of adverse events among individuals with mTBI than among individuals without mTBI.
“Further, multiple studies and meta-analyses demonstrate that TMS, administered to a variety of brain locations, including the DLPFC, does not induce more significant numbers of AEs among individuals with mTBI than among individuals without mTBI [23,25,62,63].”
From Frontal Pole Neuromodulation for Impulsivity and Suicidality in Veterans With Mild Traumatic Brain Injury and Common Co-Occurring Mental Health Conditions: Protocol for a Pilot Randomized Controlled Trial (2024) · cites this paper as [63]
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Experimental — accuracy not yet measuredThe right frontal pole anatomical location is easily identifiable using anatomical landmarks and correlates with electrode FP2 on a 10-20 EEG, a region overlapping with the right VMPFC.
“The anatomical location is easily identifiable using anatomical landmarks and correlates with electrode frontal polar cortex (FP; FP2) on a 10 to 20 electroencephalogram, a region overlapping with the right VMPFC [22,63,82].”
From Frontal Pole Neuromodulation for Impulsivity and Suicidality in Veterans With Mild Traumatic Brain Injury and Common Co-Occurring Mental Health Conditions: Protocol for a Pilot Randomized Controlled Trial (2024) · cites this paper as [63]
The Introduction identifies the frontal pole as part of the medial prefrontal cortex, and the Methods use a 10–20 EEG position to target it. But the Methods specify FP1, not the claimed right-sided FP2; the paper does not say the location is easily identified by anatomical landmarks or that it overlaps the right VMPFC. Page numbers are unavailable in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measurediTBS can be applied to the frontal pole to target the VMPFC, and iTBS to the frontal pole is tolerable, with no more subjective pain than TMS.
“iTBS can be applied to the frontal pole to target the VMPFC, and iTBS to the frontal pole is tolerable, with no more subjective pain than TMS [63].”
From Frontal Pole Neuromodulation for Impulsivity and Suicidality in Veterans With Mild Traumatic Brain Injury and Common Co-Occurring Mental Health Conditions: Protocol for a Pilot Randomized Controlled Trial (2024) · cites this paper as [63]
The Methods report continuous theta-burst stimulation at the frontal pole (FP1), but intermittent theta-burst stimulation (iTBS) at F3, not the frontal pole. The Results and Conclusions find that ramped frontal-pole TMS was tolerable and not significantly more painful than DLPFC TMS; they do not establish this specifically for frontal-pole iTBS. The Introduction identifies the frontal pole as part of the medial prefrontal cortex but does not identify the stimulated site as the VMPFC. (LLM, conf=0.90)
Experimental — accuracy not yet measuredFrontal pole iTBS allows for more direct stimulation of the VMPFC and modulation of the limbic system.
“This approach allows for more direct stimulation of the VMPFC and modulation of the limbic system [63,82].”
From Frontal Pole Neuromodulation for Impulsivity and Suicidality in Veterans With Mild Traumatic Brain Injury and Common Co-Occurring Mental Health Conditions: Protocol for a Pilot Randomized Controlled Trial (2024) · cites this paper as [63]
The Introduction (page unavailable) identifies the frontal pole as part of the medial prefrontal cortex and discusses TMS modulation of frontal-pole activity. But the Methods (page unavailable) specify continuous theta-burst stimulation at the frontal pole and iTBS at F3, not the frontal pole. The paper does not establish more direct VMPFC stimulation or limbic-system modulation by frontal-pole iTBS. (LLM, conf=0.83)
Experimental — accuracy not yet measuredFrontal pole iTBS is tolerable with good safety outcomes in individuals without mTBI.
“Furthermore, studies demonstrated frontal pole iTBS is tolerable with good safety outcomes in individuals without mTBI [63].”
From Frontal Pole Neuromodulation for Impulsivity and Suicidality in Veterans With Mild Traumatic Brain Injury and Common Co-Occurring Mental Health Conditions: Protocol for a Pilot Randomized Controlled Trial (2024) · cites this paper as [63]
The Methods identify continuous theta-burst stimulation at the frontal pole (FP1), but place intermittent theta-burst stimulation (iTBS) at F3, not the frontal pole. The concluding discussion says frontal-pole TMS was well tolerated, but the passages do not establish safety outcomes for frontal-pole iTBS or specify a population without mTBI. (LLM, conf=0.88)
Experimental — accuracy not yet measured
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- Authors
- Smith, H. R., Imperatore, J. P., & Hanlon, C. A.
- Affiliations
- Wake Forest University Health Sciences (US)
- Medical University of South Carolina (US)
- Atrium Health Wake Forest Baptist (US)
- Corresponding author
- Hanlon, Colleen A.
- Venue
- Brain Stimulation
- Publisher
- Elsevier BV
- Published
- 2021-05
- Volume
- 14
- Issue
- 3
- Pages
- 655-657
- ISSN
- 1876-4754 (ISSN-L)
- 1935-861X
- OpenAlex
- W3149930003
- Cited by
- 14
- References
- 10
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 4 · 2023: 1 · 2022: 1
- FWCI
- 0.60
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Brain stimulation (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Institutes of Health (DA044471, DA044503, AA027705, DA041610, AA010761)
- Topics
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Health Sciences › Medicine › Neurology › Neurological disorders and treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Keywords
- frontal pole, medial prefrontal cortex, Brodmann area 10, transcranial magnetic stimulation, stimulation target selection, feasibility, tolerability, information integration
- MeSH terms
- Feasibility Studies, Frontal Lobe, Retrospective Studies, Transcranial Magnetic Stimulation
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