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PreprintCited by 37Transcranial Magnetic Stimulation StudiesElectromagnetic Fields and Biological EffectsElectroconvulsive Therapy Studies

A Systematic Review and Large-Scale tES and TMS Electric Field Modeling Study Reveals How Outcome Measure Selection Alters Results in a Person- and Montage-Specific Manner

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Van Hoornweder, Sybren, Nuyts, Marten, Frieske, Joana, Verstraelen, Stefanie, Meesen, Raf L.J., Caulfield, Kevin A.·2023·NeuroImage
DOI 10.1101/2023.02.22.529540PMC PMC11008458

Preprint — published as 10.1016/j.neuroimage.2023.120379

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Abstract

Background: Electric field (E-field) modeling is a potent tool to examine the cortical effects of transcranial magnetic and electrical stimulation (TMS and tES, respectively) and to address the high variability in efficacy observed in the literature. However, outcome measures used to report E-field magnitude vary considerably and have not yet been compared in detail. Objectives: The goal of this two-part study, encompassing a systematic review and modeling experiment, was to provide an overview of the different outcome measures used to report the magnitude of tES and TMS E-fields, and to conduct a direct comparison of these measures across different stimulation montages. Methods: Three electronic databases were searched for tES and/or TMS studies reporting E-field magnitude. We extracted and discussed outcome measures in studies meeting the inclusion criteria. Additionally, outcome measures were compared via models of four common tES and two TMS modalities in 100 healthy younger adults. Results: In the systematic review, we included 118 studies using 151 outcome measures related to E-field magnitude. Structural and spherical regions of interest (ROI) analyses and percentile-based whole-brain analyses were used most often. In the modeling analyses, we found that there was an average of only 6% overlap between ROI and percentile-based whole-brain analyses in the investigated volumes within the same person. The overlap between ROI and whole-brain percentiles was montage- and person-specific, with more focal montages such as 4×1 and APPS-tES, and figure-of-eight TMS showing up to 73%, 60%, and 52% overlap between ROI and percentile approaches respectively. However, even in these cases, 27% or more of the analyzed volume still differed between outcome measures in every analyses. Conclusions: The choice of outcome measures meaningfully alters the interpretation of tES and TMS E-field models. Well-considered outcome measure selection is imperative for accurate interpretation of results, valid between-study comparisons, and depends on stimulation focality and study goals. We formulated four recommendations to increase the quality and rigor of E-field modeling outcome measures. With these data and recommendations, we hope to guide future studies towards informed outcome measure selection, and improve the comparability of studies.

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  • The observed E-field values are considered to be in the therapeutic range and consistent with expectations given 120% rMT stimulation.

    “These values are considered to be in the therapeutic range and consistent with expectations given 120% rMT stimulation [52].”

    From A phase I trial of accelerated intermittent theta burst rTMS for amnestic MCI (2024) · cites this paper as [52]

    The Electric Field Models section (p. 5) reports simulations at 50% stimulator output, not 120% resting motor threshold. Recommendation #3 (pp. 28–29) discusses why an optimal E-field dose depends on the outcome measure and other factors, but does not identify a therapeutic range or establish that the citing paper’s values fall within one. Searches for 120% rMT and a therapeutic E-field range found no passage addressing either assertion. (LLM, conf=0.76)

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Authors
Van Hoornweder, S., Nuyts, M., Frieske, J., Verstraelen, S., Meesen, R. L. J., & Caulfield, K. A.
Affiliations
  • Hasselt University (BE)
  • Medical University of South Carolina (US)
Corresponding author
Caulfield, Kevin A.
ORCID
Venue
NeuroImage
Publisher
openRxiv
Published
2023-02-22
Volume
281
Pages
120379-120379
ISSN
1053-8119 (ISSN-L)
DOI
10.1101/2023.02.22.529540
PMC
PMC11008458
OpenAlex
W4386782759
Cited by
37
References
254
Citations by year
2026: 12 · 2025: 10 · 2024: 10 · 2023: 5
FWCI
0.96
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • NeuroImage (publishedVersion, cc-by)
  • bioRxiv (Cold Spring Harbor Laboratory) (acceptedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion, cc-by)
  • PubMed Central (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Document Server@UHasselt (UHasselt) (submittedVersion, cc-by)
  • Lirias (KU Leuven) (submittedVersion, cc-by)
Funders
  • Fonds Wetenschappelijk Onderzoek (G1129923N, BOF20KP18)
  • Universiteit Hasselt (BOF20KP18)
  • Vlaamse regering
  • National Institutes of Health (5u54mh091657-05, F31 NRSA, 1U54‐MH‐091657)
  • McDonnell Center for Systems Neuroscience (1U54MH091657)
  • Bijzonder Onderzoeksfonds UGent (BOF20KP18)
  • National Institute of Mental Health (U54-MH091657)
  • National Cancer Institute (R01CA241159)
  • National Institute of Neurological Disorders and Stroke (1U54MH091657, F31NS126019)
  • National Institute of Biomedical Imaging and Bioengineering (P41EB027061)
  • NIH Blueprint for Neuroscience Research (1U54-MH-091657)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (P2CHD086844)
Topics
  • Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Biophysics › Electromagnetic Fields and Biological Effects
  • Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
Keywords
electric field modeling, transcranial electrical stimulation, transcranial magnetic stimulation, outcome measures, gray matter volume, region of interest, reproducibility, reporting guidelines

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