Lack of target engagement following low-frequency deep transcranial magnetic stimulation of the anterior insula
Open accessAbstract
Objective To evaluate the safety and efficacy of low-frequency, inhibitory, deep rTMS with a novel H-coil specifically designed to stimulate the insula. Methods In a randomized, crossover order, 16 healthy volunteers underwent two sessions (sham; active) of 1 Hz repetitive TMS at an intensity of 120% of individual motor threshold, over the right anterior insular cortex localized using a neuronavigation system. Before, immediately after, and one hour after rTMS, subjects performed two tasks that have previously been shown in fMRI experiments to activate insular cortex: A blink suppression task and a forced-choice risk-taking task. Results No drop-outs or adverse events occurred. Active deep rTMS did not result in decreased urge to blink compared to sham. Similarly, no significant time × condition interaction on risk-taking behavior was found. Conclusions Low-frequency deep rTMS using a novel H8 coil was shown to be safe but did not affect any of the behavioral markers, also used to investigate modulation of insula activity. Our findings highlight the challenges of modulating the activity of deep brain regions with TMS. Further studies are necessary to identify effective stimulation parameters for deep targets, and to characterize the effects of deep TMS on overlying cortical regions.
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In healthy volunteers, one session of low-frequency rTMS (1 Hz) to the right aIC using an H-coil was unable to affect the activity of the insula, as measured by behavioral markers.
“It should be noted that one study found that in healthy volunteers, one session of low-frequency rTMS (1 Hz) to the right aIC using an H-coil was unable to affect the activity of the insula, as measured by behavioral markers (i.e., a blink suppression task and a forced-choice risk-taking task) (Spagnolo et al., 2019).”
From The Insula: A Brain Stimulation Target for the Treatment of Addiction (2019) · cites this paper as Spagnolo et al., 2019
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- Authors
- Spagnolo, P. A., Wang, H., Srivanitchapoom, P., Schwandt, M., Heilig, M., & Hallett, M.
- Affiliations
- National Institutes of Health (US)
- Linköping University (SE)
- Corresponding author
- Spagnolo, Primavera A.
- ORCID
- Venue
- Neuromodulation Technology at the Neural Interface
- Publisher
- Elsevier BV
- Published
- 2019-12
- Volume
- 22
- Issue
- 8
- Pages
- 877-883
- ISSN
- 1094-7159 (ISSN-L)
- PMC
- PMC6488455
- OpenAlex
- W2898654082
- Cited by
- 39
- References
- 42
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 7 · 2023: 10 · 2022: 5 · 2021: 6 · 2020: 2 · 2019: 3
- FWCI
- 1.24
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Neuromodulation Technology at the Neural Interface (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Neurological Disorders and Stroke (Intramural Research Program)
- National Institutes of Health
- Topics
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Health Sciences › Medicine › Neurology › Neurological disorders and treatments
- Physical Sciences › Engineering › Biomedical Engineering › Ultrasound and Hyperthermia Applications
- Keywords
- deep transcranial magnetic stimulation, anterior insula, target engagement, blink suppression, risk-taking, insula, stimulation safety, inhibitory stimulation
- MeSH terms
- Adult, Blinking, Cerebral Cortex, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Repression, Psychology, Risk-Taking, Cross-Over Studies, Neuronavigation, Transcranial Magnetic Stimulation, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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