Network-targeted cerebellar transcranial magnetic stimulation improves attentional control
Open accessAbstract
Developing non-invasive brain stimulation interventions to improve attentional control is extremely relevant to a variety of neurological and psychiatric populations, yet few studies have identified reliable biomarkers that can be readily modified to improve attentional control. One potential biomarker of attention is functional connectivity in the core cortical network supporting attention - the dorsal attention network (DAN). We used a network-targeted cerebellar transcranial magnetic stimulation (TMS) procedure, intended to enhance cortical functional connectivity in the DAN. Specifically, in healthy young adults we administered intermittent theta burst TMS (iTBS) to the midline cerebellar node of the DAN and, as a control, the right cerebellar node of the default mode network (DMN). These cerebellar targets were localized using individual resting-state fMRI scans. Participants completed assessments of both sustained (gradual onset continuous performance task, gradCPT) and transient attentional control (attentional blink) immediately before and after stimulation, in two sessions (cerebellar DAN and DMN). Following cerebellar DAN stimulation, participants had significantly fewer attentional lapses (lower commission error rates) on the gradCPT. In contrast, stimulation to the cerebellar DMN did not affect gradCPT performance. Further, in the DAN condition, individuals with worse baseline gradCPT performance showed the greatest enhancement in gradCPT performance. These results suggest that temporarily increasing functional connectivity in the DAN via network-targeted cerebellar stimulation can enhance sustained attention, particularly in those with poor baseline performance. With regard to transient attention, TMS stimulation improved attentional blink performance across both stimulation sites, suggesting increasing functional connectivity in both networks can enhance this aspect of attention. These findings have important implications for intervention applications of TMS and theoretical models of functional connectivity.
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The possibility that CBM-iTBS has differential effects on distinct cognitive functions aligns with prior studies.
“which aligns with prior studies (Casula et al., 2016; Esterman et al., 2017; Ferrari et al., 2018; Gatti et al., 2021; Lesage et al., 2012; Shinn et al., 2023)”
From A double-blind, randomized, sham-controlled clinical trial of cerebellar intermittent theta burst stimulation for bipolar disorder: Safety, tolerability, mood and cognitive effects (2025) · cites this paper as Esterman et al., 2017
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- Authors
- Esterman, M., Thai, M., Okabe, H., DeGutis, J., Saad, E., Laganiere, S. E., & Halko, M. A.
- Affiliations
- Boston University (US)
- VA Boston Healthcare System (US)
- Harvard University (US)
- Beth Israel Deaconess Medical Center (US)
- Corresponding author
- Esterman, Michael
- Venue
- NeuroImage
- Publisher
- Elsevier BV
- Published
- 2017-08
- Volume
- 156
- Pages
- 190-198
- ISSN
- 1053-8119 (ISSN-L)
- PMC
- PMC5973536
- OpenAlex
- W2613477659
- Cited by
- 71
- References
- 97
- Citations by year
- 2026: 3 · 2025: 12 · 2024: 7 · 2023: 10 · 2022: 4 · 2021: 9 · 2020: 9 · 2019: 11 · 2018: 4 · 2017: 2
- FWCI
- 3.54
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- NeuroImage (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Clinical Science Research & Development Career Development Award (1IK2CX000706-01A2)
- National Institutes of Health (1R01MH112706)
- Topics
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Life Sciences › Neuroscience › Cognitive Neuroscience › Functional Brain Connectivity Studies
- Keywords
- cerebellar transcranial magnetic stimulation, dorsal attention network, default mode network, functional connectivity, sustained attention, transient attention, attentional blink, intermittent theta burst stimulation, non-invasive brain stimulation, attentional lapses
- MeSH terms
- Attention, Cerebellum, Female, Humans, Magnetic Resonance Imaging, Male, Neural Pathways, Transcranial Magnetic Stimulation, Young Adult
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