我们要感谢大卫投手他对这个实验的TMS宝贵贡献。这项研究是由来自莱维 - 爱德生 - 吉特研究所的脑映射到BS，从沃尔夫森基金会授予的奖学金资助;授予65/08及1657至1608年从以色列科学基金会和英国文化协会研究人员交流计划，以黏实验是在沃尔学院高级成像，特拉维夫夫Sourasky医学中心进行的一项旅费补助。

该实验是在两个单独的会话进行。在第一届会议的功能磁共振成像实验（ 如功能性定位器）进行，以确定对个别科目进行所需的TMS的目标区域。 fMRI的结果，然后送入一个立体定位导航系统针对一个准确的TMS。第二届会议举行后的fMRI数据，在此期间，脑电图的同时TMS记录的分析。这里所描述的方案经特拉维夫夫Sourasky医学中心的伦理委员会。 在本文中给出的实例中，数据是用MATLAB 7.7版（R2008b）进行分析。统计参数图（SPM 5）软件MATLAB和MarsBar工具箱SPM 23被用于fMRI数据处理。 1，fMRI的Session和功能磁共振成像数据分析<ol><li>利用平面回波成像（EPI）的测序运行功能磁共振成像任务e来确定激活与TMS为目标所需的焦点。对于相邻的区域，如在OFA和EBA在下面的例子之间的更好的解离，高分辨率扫描推荐。为3mm 3或更小的体素，用MRI头部线圈的8个信道以上获得足够用于划定相邻的区域。 </li><li>运行T1加权结构扫描，以获得神经解剖学数据。确保参与者的脸上完全包含在视此扫描领域，由于图像上的外部标记（鼻如尖）将用于以后coregister对象的头部，其扫描。 </li><li>数据收集后，使用MarsBar工具箱SPM的基础上，实验条件之间的对比来定义感兴趣期望的大脑区域。使用反差面临&gt;对象来定义枕部面孔区（OFA），和机构&gt;来定义Extrastirate体面积（EBA）的对象。为了进一步确保第在两个皮质目标在功能上是不同的，用"相结合"（在MarsBar）从每个投资回报率掩盖任何体素应对其他实验条件（从EBA排除面体素，以及身体的体素从OFA）。 </li><li>与功能性扫描Corregister结构的T1图像，使用SPM。 </li><li>为了上传到导航系统的结构扫描的文件，以及相关的功能的对比文件，复制到便携式驱动器。 </li></ol> 2，准备一个范式脑电图-TMS实验，使提取的ERP 描述在下面的部分是对的方式，允许提取可靠的和可复制的有效保护率在19 TMS的应用脑电图收集数据的方法。这种技术的优点是，它可以轻松地处理二次，持久，TMS工件，并具有足够的鲁棒甚至允许在位于正下方的TMSÇ电极恢复数据的油，那里的神器是最高电压和持续时间最长的。 <ol><li>范式的组织<ol><li>运行在单独的块中的不同TMS条件（不同的目标脑区，以及一个无TMS条件）。 </li><li>内的每个块给出与所有的刺激条件（ 例如面孔，对象，场景等），随机的事件相关设计的参与者。 </li><li>对于ERP系统的更好的质量和TMS噪声模板（如下），请确保让每个条件至少有50次试验。 </li></ol></li><li>在TMS脉冲/脉冲的定时设置为图像发病后所需的等待时间。这是通过写入一个并行端口，从该电缆进入到TMS刺激器完成的。此功能可在大多数的软件进行心理实验，如Psychtoolbox的MATLAB 24或E-首相（3个版本2或）（见材料表 ）。抖动的相互刺激间隔（ISI），以减少刺激（脉冲）可预测性（例如，在每个ISI加0至500毫秒之间的一个随机值）。 </li><li>准备一个额外的空白屏幕条件: <ol><li>准备期间，TMS将在相同的强度得到应用，但屏幕上没有刺激呈现的试验。这些空白屏幕TMS试验，会被计算TMS神器模板在没有视觉刺激。 </li><li>设置空白试验的重复次数是相同的块内的实验条件中任一项的重复数。 </li><li>对于TMS剩余工件的形状的精确表示，随机在整个块，而不是介绍他们都在开头或结尾的空白试验。 </li></ol></li></ol> 3，建立了脑电图和神经导航系统，并进行了实验的单独定义的ROI定位准确TMS为可能与使用立体定位导航的gation系统，由红外摄像头，安装在参与者的头部，和一个专门的软件红外传感器。 <ol><li>基于TMS的安全标准屏幕的参与者。从参与主体具有自我癫痫史或家族史排除，科目与其他神经系统疾病，或有频繁的偏头痛，以及精神药物科目。虽然通常不筛选，受试者怀疑为植物神经紊乱如血管迷走神经syncopes（大多表现为一种倾向，容易晕）也可被排除在外。至少2小时前实验指导参加者，以避免酒精饮料开始前晚上，含咖啡因的饮料。为了进一步说明和安全的讨论，见罗西等人 25，和Magstim安全审查（ <a href="http://joedevlin.psychol.ucl.ac.uk/tms/docs/magstim_safety.pdf">http://joedevlin.psychol.ucl.ac.uk/tms/docs/magstim_safety.pdf</a> ）。 </li><li>准备吨他神经导航系统: <ol><li>之前的会话启动，饲料结构的扫描文件到导航系统的软件。 </li><li>在结构图像叠加功能磁共振成像结果（在对比）。 </li><li>使用神经导航软件，标记在图像上期望的目标，以及外部的解剖标志，这将有助于对配准:在鼻尖，鼻桥通常被称为鼻根的最深部分，并且每个的耳屏耳。 </li></ol></li><li>安装在参与者的头部脑电图帽和连接电极: <ol><li>尽量保持电极阻抗不超过5KΩ高。 </li><li>为了避免电极的TMS相关的供热，用尽可能少的凝胶越好。为了达到良好的阻抗与凝胶的少量进行彻底的皮肤准备。或者，要求学员来到实验前要洗自己的头发。 </li><li>确保电极线不交叉EA通道和其它被定向远离线圈的位置。避免在导线环路。 </li><li>使用高采样率的噪声伪影的更好的代表性。这是推荐使用1 kHz或以上，如用此方法最先前的研究已经做7,26-28。 </li><li>将参考电极和接地电极从线圈尽可能远。在这个例子中，在枕叶皮质区用鼻子参考和Fz的地面7被瞄准了。对于其他的例子见3,4,27,29,30。注意，数据可以被重新引用脱机到一个新的参考根据需要，如常见的平均值。 注意:对于有关TMS-EEG设置的优化审查，看Veniero 等 31。 </li></ol></li><li> Coregister被检者的头与扫描，如下所示: <ol><li>安装在参与者的头部的红外探测器。 </li><li> Coregister头位置使用预定义的标记（尖端导航系统鼻子等。参见图3）。这是应重复块之间的配准，以确保准确的线圈​​放置在所有阶段。 </li></ol></li><li>找到目标区域: <ol><li>让主体与坐在离屏幕适当的距离，下巴搁在腮托。 </li><li>确保参加者在舒适的椅子上，因为他们被要求从运动过程中，实验组（用于精确的噪声测量模板很重要），以避免。 </li><li>从导航系统图3选择TMS目标。 </li><li>使用指针工具（见材料表 ），让导航系统引导用户的最佳线圈的位置，并将其与电极帽的小贴纸标记。以保持指针垂直于所述头部是很重要的。重复此阶段每块之前。请注意，这是不推荐的块中使用的在线导航（导航线圈本身，而持有它），因为任何一个线圈的运动应避免在TMS神器模板的最佳测量。人们发现，预先定义与标记的TMS的位置是实现稳定的刺激的最佳方式。 </li><li>引导线圈的精确中心到该标记时，同时保持由一个夹持器。请确保它是相切的头部。 </li></ol></li><li>设置在TMS强度为所需的值。管理一个测试脉冲为参加者的批准。 </li><li>运行试验块。 </li><li>无TMS的条件:如果一个专门的伪TMS线圈不可用，在TMS线圈放在旁边的对象的头部，并倾斜90°。运行该块像往常一样，包括空白试验。 读者也可参阅安灯和Zatorre 32的朱庇特的视频文件导航系统的进一步论证。 </li></ol> 4，分析的脑电数据和计算ERP <ol><li>除去眼前的脉冲ARTIF行为，如下所示: <ol><li>如果剪切设备不可用（见上文），在脑电数据处理的第一步是将切出眼前的TMS脉冲神器本身的数据。注意，该步骤可以，如果不想要的过滤器被跳过。但是，如果应用的过滤器，神器的锐边形状将在数据造成扭曲。脉冲发病后窄的时间窗口为10至15毫秒就足够了，但可以肯定的是数据的目视检查，以验证这一点。 </li><li>连接脉冲去除后创建的两个切口。两种主要的方法实现这一点已经提出在以前的报告:1简单地加入脉冲切除后剩余的两端连接在一起（见Fuggetta 等[26]和图1）;。 2，由它们产生7之间等距值内插两切端之间的一条线。用于这种插值的方程如下:对于每个丢失的数据点y处的样品的x，计算Y = Y 0 +（（Y 1-Y 0）*（XX 0））/（X 1-X 0），其中x 0和y0 顷的切段之前的最后一个数据点的坐标，并且x 1和Y 1为切段之后的第一个数据点的坐标。这两种技术确保过滤器能够在数据被应用，而不会产生因急剧的电压的步骤波纹，如在图1中 ，参考工作由赖欣巴哈和同事27为更复杂的三阶多项式插值。 </li></ol></li><li>运用减法的方法: <ol><li>对于每个实验模块，包括一个无TMS控制状态（如果存在），通过时间锁定他们进行审判开始计算一个平均的ERP系统，以空白画面试验（好像图像已提交）。 </li><li>减去这个平均值从模板的所有其他刺激条件下每次试验。如果有多个块被执行对于相同的刺激部位，分别做这对于每个块，作为模板将是各块之间略有不同。 </li></ol></li><li>所有其他的预处理和加工步骤进行如在任何其他ERP实验。 </li></ol>

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F., Walsh, V., Kiss, M., Eimer, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cortico-cortical+interactions+in+spatial+attention:+A+combined+ERP/TMS+study.">Cortico-cortical interactions in spatial attention: A combined ERP/TMS study.</a> J Neurophysiol. 95, 3277-3280 (2006).</li><li>Reichenbach, A., Whittingstall, K., Thielscher, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+transcranial+magnetic+stimulation+on+visual+evoked+potentials+in+a+visual+suppression+task.">Effects of transcranial magnetic stimulation on visual evoked potentials in a visual suppression task.</a> Neuroimage. 54, 1375-1384 (2011).</li><li>Taylor, P. C., Walsh, V., Eimer, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+neural+signature+of+phosphene+perception.">The neural signature of phosphene perception.</a> Human Brain Mapping. 31, 1408-1417 (2010).</li><li>Iwahashi, M., Katayama, Y., Ueno, S., Iramina, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+transcranial+magnetic+stimulation+on+P300+of+event-related+potential.">Effect of transcranial magnetic stimulation on P300 of event-related potential.</a> Conf Proc IEEE Eng Med Biol Soc. , 1359-1362 (2009).</li><li>Zanon, M., Busan, P., Monti, F., Pizzolato, G., Battaglini, P. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cortical+connections+between+dorsal+and+ventral+visual+streams+in+humans:+Evidence+by+TMS/EEG+co-registration.">Cortical connections between dorsal and ventral visual streams in humans: Evidence by TMS/EEG co-registration.</a> Brain Topogr. 22, 307-317 (2010).</li><li>Veniero, D., Bortoletto, M., Miniussi, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=TMS-EEG+co-registration:+on+TMS-induced+artifact.">TMS-EEG co-registration: on TMS-induced artifact.</a> Clin Neurophysiol. 120, 1392-1399 (2009).</li><li>Andoh, J., Zatorre, R. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mapping+the+after-effects+of+theta+burst+stimulation+on+the+human+auditory+cortex+with+functional+imaging.">Mapping the after-effects of theta burst stimulation on the human auditory cortex with functional imaging.</a> J Vis Exp. , (2012).</li><li>Thierry, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+event-related+potential+component+sensitive+to+images+of+the+human+body.">An event-related potential component sensitive to images of the human body.</a> Neuroimage. 32, 871-879 (2006).</li><li>Pitcher, D., Charles, L., Devlin, J. T., Walsh, V., Duchaine, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Triple+dissociation+of+faces,+bodies,+and+objects+in+extrastriate+cortex.">Triple dissociation of faces, bodies, and objects in extrastriate cortex.</a> Curr Biol. 19, 319-324 (2009).</li><li>Pitcher, D., Walsh, V., Yovel, G., Duchaine, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=TMS+evidence+for+the+involvement+of+the+right+occipital+face+area+in+early+face+processing.">TMS evidence for the involvement of the right occipital face area in early face processing.</a> Curr Biol. 17, 1568-1573 (2007).</li></ol>

作者宣称，他们有没有竞争的财务权益。

具有独特的能力，暂时中断在选定的皮质区正常神经元的活动，在精确的时间点，并具有相对良好的空间精度，TMS允许因果关系与行为或神经生理学测量链路一个刺激大脑区域。在本文中，我们描述了一种在并发应用TMS脑电图测量，目标定义功能皮层区，并应用分析，使ERP系统响应的可靠的测量。我们举了一个例子来自于它的TMS被用于与EEG和fMRI的组合来询问是否给予fMRI的定义的大脑区域（ 即 OFA和EBA）是因果关系与ERP回应他们的首选刺激（ 即面孔和身体）相关的文献。 描述的减法技术，这是验证19和一些研究7,26,27应用，有几个值得注意的优点:它允许消除的残差人长期TMS神器占地最显著的ERP成分的时间窗口;它同样消除了伪影分量从肌肉，机械（电气干扰到电极）和非期望的皮层（ 例如，听觉）的起源;并且它是坚固和可靠的，即使在电极的正下方或其附近的线圈躺。注意，线路噪声，也可以显着在这些电极中，除了增强的振幅的TMS脉冲的工件，由于线圈可能接触或趴在靠近电极或导线。这里展示的技术能够有效保护率在这些电极部位的提取，以及。这是最重要的，因为很多时候感兴趣的诱发反应起源于或接近刺激皮质区。此外，从整个头皮恢复的信号是必要的，其中源重建算法所需的箱子。 研究工具的组合SUCH为TMS，EEG和fMRI的，每一个提出的神经活动的不同方面和攻击从不同的角度类似的问题，是一种很有前途前进的人类认知和脑功能的研究。它可以预料，TMS将越来越多地用于与脑电图结合因果联营认知或行为功能的电活动，并进一步探讨目前正在开发领域，如同步，脑震荡和连通性，在高时空分辨率。

经颅磁刺激（TMS）产生瞬时干扰到大脑中的靶区域的正常神经活动。通过创建这个短暂的神经干扰和测量行为或生理的变化，我们可以得出目标区域和实验测量结果之间的因果关系（综述见帕斯夸尔，塞拉利昂等和泰勒等人 1,2）。这样的实验效果可以是，例如，在认知任务或在电生理（EEG）活动的变化的性能。事实上，近年来的研究人员已经开始使用TMS与脑电图结合直接关系皮质区与事件相关电位（ERP）或振荡活动模式（ 如 2-7）。在这种方法论文章中，我们将描述相结合的TMS和脑电图特定的和有用的框架:在一个ERP实验fMRI的引导TMS。首先，我们将详细介绍如何TMS适用于FM预定义区域RI，同时记录脑电数据。然后，我们将描述一个实验设计，允许提取可靠的ERP系统。这样的实验的目标是与因果功能磁共振成像的利息ERP成分透露链路的大脑区域。最后，我们将给予有关脸部和身体的选择性与ERP的脸和身体被发现与选择功能磁共振成像领域研究的一个具体例子。 什么是联用功能磁共振成像激活脑电信号的好处？脑电图和功能磁共振成像是常用的工具来测量皮层反应，视觉输入。例如，类选择性在视觉通路被评定为不同的视觉对象的类别，如脸部，身体部位，并书面文字，无论是通过ERP系统的手段从脑电数据8,9和功能磁共振成像10-12提取。然而，这两个共同的研究工具测得的信号是根本不同的性质，，。脑电图怀揣着伟大的时间有关的神经电活动信息精度，但是非常低的空间分辨率，并可以反映许多单独的底层源的混合物。功能磁共振成像提供了神经元活动的间接测量依赖于刺激呈现和/或任务执行中出现的慢血流动力学改变，但提出这一活动具有更高的空间分辨率。从而确立了两项措施之间的相关性可以有很大的兴趣，但在有限的，它并不意味着头皮记录的电生理反应和功能磁共振成像揭示了区域之间的因果关系。即使同时测量（ 例如 13-15），脑电图和功能定义皮质区的活动之间的双向因果关系无法确定。 TMS是一个可以帮助实现建立这样一个因果关系的工具。 一个同时脑电图-TMS研究在方法论上是具有挑战性的，这主要是由于引入脑电图信号b高压神器y中的磁刺激（ 见图1，综述见Ilmoniemi 等。16）。这神器由一个短的瞬态脉冲生活相关的干扰，往往紧接着就是可能会持续几百毫秒的脉冲传递图2A后，超然的兴趣最ERP成分较慢的二级（或剩余）神器。这个次级伪影可以包括机械源，如由磁脉冲感应到布线和这些电流在皮肤的缓慢衰减的电流，和生理来源，例如在头皮和听觉或体感诱发电位由操作引起的肌肉活动线圈17-20。虽然干扰的机械源可能产生较大振幅的文物比生理的，这些不同的工件不能分离，其中的任何信号中的存在，可以混淆的结果。一个可能使禄讯是重复的脉冲TMS前脑电图记录（"离线TMS"）的应用，而不是同时进行脑电图-TMS。上皮层活动这样一个协议的抑制作用持续几分钟（而长达一个半小时）的刺激后，和脑电图可以在此有效时间窗内进行测量，并与基线相比，预TMS，脑电图数据。重复刺激，然而，是通过定义缺乏，网上TMS可以提供​​，其中脉冲可以在精确的时间相对要给予审判开始在毫秒级的分辨率高时间分辨率。重复刺激的效果也可以通过跨越更广阔的领域皮层连接比期望的传播，因此显著降低空间分辨率为好。 为了充分利用双方的空间和时间分辨率的TMS可以提供​​，同时脑电图-TMS组合可以应用。然而，这需要用于去除伪影的方法通过对脑电信号的磁刺激产生的。为TMS假象去除很少下线的数学解决方案已被提出16,21,22，虽然没有方法达成一致，也没有一个方法可能是最适合所有的实验设计。 A"剪切"的系统，包括一个采样保持电路，也被开发过程中的TMS脉冲传递20到暂时停止脑电信号采集，这种技术不仅需要专门的硬件，但可能无法完全去除残余的TMS神器。在本文中，我们将介绍由Thut和他的同事19，特别适合于ERP系统的研究开发的EEG-TMS方法的适应。这种技术可以让ERP系统的可靠提取，同时消除所造成的一切TMS脉冲图2中的残余噪声成分。我们将进一步提供迈向成功的EEG-TMS实验装置一般指引。 在TMS研究的另一个挑战寻址的In这个方法的论文是找到所需皮质区的准确定位的最佳线圈的位置和角度。我们将描述使用立体定位导航系统的给coregister被检者的头部与预采集功能MRI图像。虽然导航系统可用于定位解剖定义的大脑结构，因为许多功能和效果的实验活化的精确位置，不能从单独的解剖标记推断的功能磁共振成像引导的定位是特别有用的。对于感兴趣区域（ROI）这样的功能区域，一个区域的定义是为每个单独的参与者。 为了说明上述所有的，我们将提供我们以前进行的，其中脑电图是同时与TMS通过功能磁共振成像激活7引导记录进行研究的例子。在这项研究中，一个双解离面选择性和体内选择性的事件相关电位之间作出:虽然面部和身体的ERP豌豆ķ围绕同一延迟和电极位置，在横向枕叶靶向单独定义面选择性和体内选择性区域使我们能够离解的神经网络的每个ERP响应相关。最后，我们会尽量给更广泛的意见，以在TMS优化应用脑电记录。

<table border="0" cellpadding="0" cellspacing="0" width="596">
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			<td height="43" style="height:43px;width:209px;">3.0T Signa MRI scanner</td>
			<td style="width:107px;">General Electric</td>
			<td style="width:113px;"></td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="42">
			<td height="63" rowspan="2" style="height:63px;width:209px;">BrainAmp&#160; amplifier&#160;</td>
			<td rowspan="2" style="width:107px;"><a name="RANGE!B3">Brain Products GmbH</a></td>
			<td rowspan="2" style="width:113px;">BP-01300</td>
			<td rowspan="2" style="width:167px;"></td>
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			<td height="64" style="height:64px;width:209px;">Electrode input box</td>
			<td style="width:107px;">Brain Products GmbH</td>
			<td style="width:113px;"></td>
			<td style="width:167px;">Optional</td>
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		<tr height="64">
			<td height="64" style="height:64px;width:209px;">PowerPack - battery for amplifier</td>
			<td style="width:107px;">Brain Products GmbH</td>
			<td style="width:113px;">BP-02615</td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="146">
			<td height="167" rowspan="2" style="height:167px;width:209px;">BrainCap - 32 flat electrodes on a flexible cap&#160;</td>
			<td rowspan="2" style="width:107px;">Brain Products GmbH</td>
			<td rowspan="2" style="width:113px;">BP-0300MR</td>
			<td rowspan="2" style="width:167px;">Flat electrodes should be used to assure a shorter distance beween coil and scalp. If larger (e.g. pin type) electrodes are used, remove the ones under the coil</td>
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			<td height="43" style="height:43px;width:209px;">TMS Super Rapid2 stimulator</td>
			<td style="width:107px;">Magstim</td>
			<td style="width:113px;"></td>
			<td style="width:167px;"></td>
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			<td height="22" style="height:22px;width:209px;">50mm double coil</td>
			<td style="width:107px;">Magstim</td>
			<td style="width:113px;"></td>
			<td style="width:167px;"></td>
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			<td height="169" style="height:169px;width:209px;">Coil holder&#160;</td>
			<td style="width:107px;"></td>
			<td style="width:113px;"></td>
			<td style="width:167px;">Any mechanical arm or tripod that can hold the coil, be adjusted to the right angle and location, and keep the coil steady during stimulation</td>
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			<td height="22" style="height:22px;width:209px;">Chinrest</td>
			<td style="width:107px;"></td>
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			<td style="width:167px;"></td>
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			<td height="43" style="height:43px;width:209px;">Polaris infrared camera</td>
			<td style="width:107px;">Rogue Research Inc</td>
			<td style="width:113px;"></td>
			<td style="width:167px;"></td>
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		<tr height="43">
			<td height="43" style="height:43px;width:209px;">Polaris trackers and pointer tool</td>
			<td style="width:107px;">Rogue Research Inc</td>
			<td style="width:113px;"></td>
			<td style="width:167px;"></td>
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			<td height="43" style="height:43px;width:209px;">BrainSight workstation and software</td>
			<td style="width:107px;">Rogue Research Inc</td>
			<td style="width:113px;"></td>
			<td style="width:167px;"></td>
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			<td height="64" style="height:64px;width:209px;">BrainVision Recorder software</td>
			<td style="width:107px;">Brain Products GmbH</td>
			<td style="width:113px;">BP-00010</td>
			<td style="width:167px;"></td>
		</tr>
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			<td height="64" style="height:64px;width:209px;">MATLAB software</td>
			<td style="width:107px;">The MathWorks Icn.</td>
			<td style="width:113px;"></td>
			<td style="width:167px;"></td>
		</tr>
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			<td height="106" style="height:106px;width:209px;">SPM for Matlab</td>
			<td style="width:107px;">Wellcome Department of Imaging Neuroscience, London, UK&#160;</td>
			<td style="width:113px;"></td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="43">
			<td height="43" style="height:43px;width:209px;">MarsBar region of interest toolbox for SPM</td>
			<td style="width:107px;"></td>
			<td style="width:113px;"></td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="211">
			<td height="211" style="height:211px;width:209px;">Psychtoolbox for MATLAB</td>
			<td style="width:107px;"></td>
			<td style="width:113px;"></td>
			<td style="width:167px;">This toolbox and the E-prime software (below) are examples for stimulus presentation software capable of delivering commands to the TMS stimulator and to the EEG recorder with reliable timing</td>
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		<tr height="64">
			<td height="64" style="height:64px;width:209px;">E-Prime software</td>
			<td style="width:107px;">Psychology Software Tools, Inc.</td>
			<td style="width:113px;"></td>
			<td style="width:167px;"></td>
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	</tbody>
</table>

extracting visual evoked potentials from eeg data recorded during fmri-guided transcranial magnetic stimulation

经颅磁刺激（TMS）是一种有效的方法，建立一个皮质区和认知/神经生理效应之间的因果关系。具体地，通过创建一个瞬态干扰的目标区域的正常活动并测量变化的电生理学信号，我们可以建立刺激大脑区域或网络和我们记录电生理信号之间的因果关系。如果目标脑区都与之前的fMRI扫描功能定义，TMS可以用来记录与诱发电位连接的功能磁共振成像激活。然而，在进行这样的实验呈现给由磁脉冲引入到脑电信号的高振幅文物显著的技术挑战，困难，成功地针对该功能进行了功能磁共振成像所定义的区域。在这里，我们描述了一种方法用于混合这三种常用工具:TMS，脑电图和功能磁共振成像。我们将解释如何引导刺激＆＃39，S线圈到所需的目标区域使用解剖或功能性磁共振成像数据，如何在并发TMS记录脑电图，如何设计适合脑电图-TMS组合，以及如何提取可靠的ERP系统从记录的数据的ERP研究。我们将提供有代表性的结果从先前公布的研究中，功能磁共振成像制导TMS是同时使用脑电图表明，面对选择性N1和ERP的身体选择性N1成分都与不同的神经网络在纹外皮层有关。这种方法可以让我们的fMRI的高空间分辨率结合TMS和脑电图的高时间分辨率，因此获得各种认知过程的神经基础的全面了解。

并发脑电图-TMS调查是用来揭示了ERP响应面，并记录在枕颞部头皮机构是否分离。当视觉刺激呈现，一个突出的N1成分被记录在后外侧电极位置。特别是，N1成分通常是较大的脸上，身上，而不是其他的刺激类别8,33。通过评估刺激对面部和与fMRI的它们各自的面部和身体N1组件定义体选择性脑区的影响，我们试图揭示面部和身体N1回应是否反映（至少部分地）不重叠的来源，或者说同样的网络活动与定量不同的激活水平。 我们采用了双脉冲刺激，在60毫秒和100毫秒的图像后发病（例如，参见投手等人 34,35），在脸上选择性和体内选择性区域在横向occip<html> ITAL皮质-枕叶面孔区（OFA）和纹外体面积（EBA）（ 图4A，见上面的相关功能磁共振成像的定义第1.3节的对比）。这两个区域被刺激在不同的区块，同时观察受试者的面孔和无头尸体的图像。结果表明，刺激的OFA提升N1振幅的面孔而不是身体，而刺激到EBA提升N1到身体，却不能到面。 图2B描绘了脸N1之前和TMS残留神器减法之后， 图4B示TMS的N1成分作为刺激面积的函数的具体效果。 这些结果表明并发脑电记录时如何fMRI的引导TMS可用于评估两个（或更多）的神经网络是否被解离，以及建立一个功能定义的大脑区域和电生理信号之间的因果关系。 ove_content"FO:保持together.within页="总是"&gt; <img alt="图1" fo:content-width="5in" fo:src="/files/ftp_upload/51063/51063fig1highres.jpg" src="/files/ftp_upload/51063/51063fig1.jpg" /> 。有代表性的主题图1数据处理原始数据和处理数据，在横向枕电极PO8（一）原始脑电数据，包括两项试验中，40毫秒（红色箭头）分隔每个包含两个TMS脉冲;（B）放大到脉冲切除后的数据。两个脉冲在每个试验从数据通过切削周围的双脉冲的一个窗口（2毫秒的第一脉冲之前到16毫秒的第二脉冲之后）除去。切割边缘，然后由内插（红色箭头）的连接方式如4.1.2所述，（C）内插的段允许滤波，而无需创建边缘伪影。在该图中，40赫兹的低通滤波的ERP（红色）作图其非滤波版本（灰色），（D）作为替代插补，被维持脉冲除去后的自由端可连接在一起（例如，参见Fugetta 等[26]，并在文本点4.1.2）。这里，两种方法进行比较，并显示高度相似的波形（蓝色和红色迹线大多重叠），之后在40赫兹的低通滤波。红色轨迹:线性插值的方法;蓝色轨迹:无插值（连接边缘拆开仅供密谋宗旨，不断时间轴的一致性） <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/51063/51063fig1highres.jpg" target="_blank">请点击此处查看这个数字的放大版本。</a> <img alt="图2" fo:content-width="5in" fo:src="/files/ftp_upload/51063/51063fig2highres.jpg" src="/files/ftp_upload/51063/51063fig2.jpg" /> 图2:TMS文物和减法技术。<html> （一）左- ERP的时间锁定到面部的图像的呈现，与双脉冲TMS在60毫秒和100毫秒图像后发病。每一行代表一个电极。请注意，对于某些电极直接TMS工件之后是一个较长的残留伪影。正确的-大概线圈的位置是由两个红色圆圈象征，和一些电极被标记为方向，（B）神器-减法的过程。眼前的脉冲神器被删除（隐藏），剩余噪声的模板是基于"只有TMS"试验中测出，并从全试验中减去。改编自Sadeh 等[7]的权限。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/51063/51063fig2highres.jpg" target="_blank">请点击此处查看该图的放大版本。</a> p_upload/51063/51063fig3highres.jpg"SRC ="/ files/ftp_upload/51063/51063fig3.jpg"/&gt; 图3。立体定向导航系统。上图:地标设置为corregistration。为了corregister头的结构的扫描与在实验过程中的实际头位置，解剖标志被标记的图像上，如箭头所示。然后，在对被检者的头部相同的地标空间位置提供给系统与由相机底部检测出一个专门的跟踪器的帮助下:脑功能区可以精确定位。激活重叠的解剖图像上，并希望区域标记并保存。会议期间，实验者可以加载一个预先定义的区域来定位TMS。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/51063/51063fig3highres.jpg" target="_blank">请点击此处查看该图的放大版本。</a> 图4代表性结果。双脉冲TMS施加要么向右OFA或向右EBA，在60毫秒和100毫秒的一个面或一个无头体图像的后发病。面对-N1和体N1反应之间的分离作出（A）这两个目标区域中有代表性的题目，（B）左-面部和身体网络之间的双重分离。 TMS到OFA增强N1的响应面，而不是机构，相对于TMS的EBA。相反的图案示为无头体的刺激。右键 - N1峰值振幅的面孔和身体，下面的OFA的刺激，EBA刺激，无TMS刺激。误差棒表示SEM。这个数字是改编自Sadeh许可<em&gt;等7。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/51063/51063fig4highres.jpg" target="_blank">请点击此处查看该图的放大版本。</a>

Watch this Scientific Journal Video about Extracting Visual Evoked Potentials from EEG Data Recorded During fMRI-guided Transcranial Magnetic Stimulation at JoVE.com

Extracting Visual Evoked Potentials from EEG Data Recorded During fMRI-guided Transcranial Magnetic Stimulation

本文介绍了并行经颅磁刺激（TMS），通过激活与功能性磁共振成像（fMRI）发现引导过程中收集和分析脑电图（EEG）数据的方法。一种用于TMS假象去除事件相关电位的提取方法被描述，以及考虑在范型设计和实验装置。

提取脑电数据视觉诱发电位记录在功能磁共振成像引导下经颅磁刺激

Transcranial Magnetic Stimulation (TMS) is an effective method for establishing a causal link between a cortical area and cognitive/neurophysiological ...

extracting-visual-evoked-potentials-from-eeg-data-recorded-during

Nanyang Technological University

Research

JoVE Journal

Neuroscience

13.7K 次观看.  Tel-Aviv University. 本文介绍了并行经颅磁刺激（TMS），通过激活与功能性磁共振成像（fMRI）发现引导过程中收集和分析脑电图（EEG）数据的方法。一种用于TMS假象去除事件相关电位的提取方法被描述，以及考虑在范型设计和实验装置。 

视频: Extracting Visual Evoked Potentials from EEG Data Recorded During fMRI-guided Transcranial Magnetic Stimulation

A Novel Approach for Documenting Phosphenes Induced by Transcranial Magnetic Stimulation

Stimulation of the human visual cortex produces a transient perception of light, known as a phosphene. Phosphenes are induced by invasive electrical stimulation of the occipital cortex, but also by non-invasive Transcranial Magnetic Stimulation (TMS)1 of the same cortical regions. The intensity at which a phosphene is induced (phosphene threshold) is a well established measure of visual cortical excitability and is used to study cortico-cortical interactions, functional organization 2, susceptibility to pathology 3,4 and visual processing 5-7. Phosphenes are typically defined by three characteristics: they are observed in the visual hemifield contralateral to stimulation; they are induced when the subject s eyes are open or closed, and their spatial location changes with the direction of gaze 2. Various methods have been used to document phosphenes, but a standardized methodology is lacking. We demonstrate a reliable procedure to obtain phosphene threshold values and introduce a novel system for the documentation and analysis of phosphenes. We developed the Laser Tracking and Painting system (LTaP), a low cost, easily built and operated system that records the location and size of perceived phosphenes in real-time. The LTaP system provides a stable and customizable environment for quantification and analysis of phosphenes.

Phosphenes are transient percepts of light that can be induced by applying Transcranial Magnetic Stimulation (TMS) to visually sensitive regions of cortex. We demonstrate a standard protocol for determining the phosphene threshold value and introduce a novel method for quantifying and analyzing perceived phosphenes.

一个新颖的方法记录经颅磁刺激诱发幻视

Stimulation of the human visual cortex produces a transient perception of light, known as a phosphene. Phosphenes are induced by invasive electrical ...

科研

神经科学

Combining Transcranial Magnetic Stimulation and fMRI to Examine the Default Mode Network

The default mode network is a group of brain regions that are active when an individual is not focused on the outside world and the brain is at "wakeful rest."1,2,3 It is thought the default mode network corresponds to self-referential or "internal mentation".2,3
It has been hypothesized that, in humans, activity within the default mode network is correlated with certain pathologies (for instance, hyper-activation has been linked to schizophrenia 4,5,6 and autism spectrum disorders 7 whilst hypo-activation of the network has been linked to Alzheimer's and other neurodegenerative diseases 8). As such, noninvasive modulation of this network may represent a potential therapeutic intervention for a number of neurological and psychiatric pathologies linked to abnormal network activation. One possible tool to effect this modulation is Transcranial Magnetic Stimulation: a non-invasive neurostimulatory and neuromodulatory technique that can transiently or lastingly modulate cortical excitability (either increasing or decreasing it) via the application of localized magnetic field pulses.9
In order to explore the default mode network's propensity towards and tolerance of modulation, we will be combining TMS (to the left inferior parietal lobe) with functional magnetic resonance imaging (fMRI). Through this article, we will examine the protocol and considerations necessary to successfully combine these two neuroscientific tools.

In this article, we examine the methodology and considerations relevant to the combination of TMS and fMRI to examine the effects of brain stimulation on the default network.

结合经颅磁刺激和功能磁共振成像检查默认模式网络

The default mode network is a group of brain regions that are active when an individual is not focused on the outside world and the brain is at "wakeful ...

Applications of EEG Neuroimaging Data: Event-related Potentials, Spectral Power, and Multiscale Entropy

When considering human neuroimaging data, an appreciation of signal variability represents a fundamental innovation in the way we think about brain signal. Typically, researchers represent the brain's response as the mean across repeated experimental trials and disregard signal fluctuations over time as "noise". However, it is becoming clear that brain signal variability conveys meaningful functional information about neural network dynamics. This article describes the novel method of multiscale entropy (MSE) for quantifying brain signal variability. MSE may be particularly informative of neural network dynamics because it shows timescale dependence and sensitivity to linear and nonlinear dynamics in the data.

Neuroimaging researchers typically consider the brain's response as the mean activity across repeated experimental trials and disregard signal variability over time as "noise". However, it is becoming clear that there is signal in that noise. This article describes the novel method of multiscale entropy for quantifying brain signal variability in the time domain.

脑电图神经影像数据:事件相关电位，光谱功率，和多尺度熵的应用

When considering human neuroimaging data, an appreciation of signal variability represents a fundamental innovation in the way we think about brain ...

Somatosensory Event-related Potentials from Orofacial Skin Stretch Stimulation

Cortical processing associated with orofacial somatosensory function in speech has received limited experimental attention due to the difficulty of providing precise and controlled stimulation. This article introduces a technique for recording somatosensory event-related potentials (ERP) that uses a novel mechanical stimulation method involving skin deformation using a robotic device. Controlled deformation of the facial skin is used to modulate kinesthetic inputs through excitation of cutaneous mechanoreceptors. By combining somatosensory stimulation with electroencephalographic recording, somatosensory evoked responses can be successfully measured at the level of the cortex. Somatosensory stimulation can be combined with the stimulation of other sensory modalities to assess multisensory interactions. For speech, orofacial stimulation is combined with speech sound stimulation to assess the contribution of multi-sensory processing including the effects of timing differences. The ability to precisely control orofacial somatosensory stimulation during speech perception and speech production with ERP recording is an important tool that provides new insight into the neural organization and neural representations for speech.

This paper introduces a method for obtaining somatosensory event-related potentials following orofacial skin stretch stimulation. The current method can be used to evaluate the contribution of somatosensory afferents to both speech production and speech perception.

从口面皮肤牵拉刺激体感事件相关电位

Cortical processing associated with orofacial somatosensory function in speech has received limited experimental attention due to the difficulty of ...

Simultaneous Recording of Electroretinography and Visual Evoked Potentials in Anesthetized Rats

The electroretinogram (ERG) and visual evoked potential (VEP) are commonly used to assess the integrity of the visual pathway. The ERG measures the electrical responses of the retina to light stimulation, while the VEP measures the corresponding functional integrity of the visual pathways from the retina to the primary visual cortex following the same light event. The ERG waveform can be broken down into components that reflect responses from different retinal neuronal and glial cell classes. The early components of the VEP waveform represent the integrity of the optic nerve and higher cortical centers. These recordings can be conducted in isolation or together, depending on the application. The methodology described in this paper allows simultaneous assessment of retinal and cortical visual evoked electrophysiology from both eyes and both hemispheres. This is a useful way to more comprehensively assess retinal function and the upstream effects that changes in retinal function can have on visual evoked cortical function.

This protocol describes simultaneous measurement of electroretinogram and visual evoked potentials in anesthetized rats.

电图同时记录和麻醉大鼠视觉诱发电位

The electroretinogram (ERG) and visual evoked potential (VEP) are commonly used to assess the integrity of the visual pathway. The ERG measures the ...

Effects of Transcranial Alternating Current Stimulation on the Primary Motor Cortex by Online Combined Approach with Transcranial Magnetic Stimulation

Transcranial Alternating Current Stimulation (tACS) is a neuromodulatory technique able to act through sinusoidal electrical waveforms in a specific frequency and in turn modulate ongoing cortical oscillatory activity. This neurotool allows the establishment of a causal link between endogenous oscillatory activity and behavior. Most of the tACS studies have shown online effects of tACS. However, little is known about the underlying action mechanisms of this technique because of the AC-induced artifacts on Electroencephalography (EEG) signals. Here we show a unique approach to investigate online physiological frequency-specific effects of tACS of the primary motor cortex (M1) by using single pulse Transcranial Magnetic Stimulation (TMS) to probe cortical excitability changes. In our setup, the TMS coil is placed over the tACS electrode while Motor Evoked Potentials (MEPs) are collected to test the effects of the ongoing M1-tACS. So far, this approach has mainly been used to study the visual and motor systems. However, the current tACS-TMS setup can pave the way for future investigations of cognitive functions. Therefore, we provide a step-by-step manual and video guidelines for the procedure.

Transcranial Alternating Current Stimulation (tACS) allows the modulation of cortical excitability in a frequency-specific fashion. Here we show a unique approach which combines online tACS with single pulse Transcranial Magnetic Stimulation (TMS) in order to "probe" cortical excitability by means of Motor Evoked Potentials.

经颅磁刺激在线联合方法对经颅交流电刺激对原发性运动皮层的影响

Transcranial Alternating Current Stimulation (tACS) is a neuromodulatory technique able to act through sinusoidal electrical waveforms in a specific ...

Visual Evoked Potential Recordings in Mice Using a Dry Non-invasive Multi-channel Scalp EEG Sensor

For scalp EEG research environments with laboratory mice, we designed a dry-type 16 channel EEG sensor which is non-invasive, deformable, and re-usable because of the plunger-spring-barrel structural facet and mechanical strengths resulting from metal materials. The whole process for acquiring the VEP responses in vivo from a mouse consists of four steps: (1) sensor assembly, (2) animal preparation, (3) VEP measurement, and (4) signal processing. This paper presents representative measurements of VEP responses from multiple mice with a submicro-voltage signal resolution and sub-hundred millisecond temporal resolution. Although the proposed method is safer and more convenient compared to other previously reported animal EEG acquiring methods, there are remaining issues including how to enhance the signal-to-noise ratio and how to apply this technique with freely moving animals. The proposed method utilizes easily available resources and shows a repetitive VEP response with a satisfactory signal quality. Therefore, this method could be utilized for longitudinal experimental studies and reliable translational research exploiting non-invasive paradigms.

We designed a dry-type 16 channel EEG sensor which is non-invasive, deformable, and re-usable. This paper describes the whole process from manufacturing the proposed EEG electrode to signal processing of visual evoked potential (VEP) signals measured on a mouse scalp using a dry non-invasive multi-channel EEG sensor.

干无创多通道头皮脑电传感器在小鼠视觉诱发电位记录中的应用

For scalp EEG research environments with laboratory mice, we designed a dry-type 16 channel EEG sensor which is non-invasive, deformable, and re-usable ...

Combined Transcranial Magnetic Stimulation and Electroencephalography of the Dorsolateral Prefrontal Cortex

Transcranial magnetic stimulation (TMS) is a non-invasive method that produces neural excitation in the cortex by means of brief, time-varying magnetic field pulses. The initiation of cortical activation or its modulation depends on the background activation of the neurons of the cortical region activated, the characteristics of the coil, its position and its orientation with respect to the head. TMS combined with simultaneous electrocephalography (EEG) and neuronavigation (nTMS-EEG) allows for the assessment of cortico-cortical excitability and connectivity in almost all cortical areas in a reproducible manner. This advance makes nTMS-EEG a powerful tool that can accurately assess brain dynamics and neurophysiology in test-retest paradigms that are required for clinical trials. Limitations of this method include artifacts that cover the initial brain reactivity to stimulation. Thus, the process of removing artifacts may also extract valuable information. Moreover, the optimal parameters for dorsolateral prefrontal (DLPFC) stimulation are not fully known and current protocols utilize variations from the motor cortex (M1) stimulation paradigms. However, evolving nTMS-EEG designs hope to address these issues. The protocol presented here introduces some standard practices for assessing neurophysiological functioning from stimulation to the DLPFC that can be applied in patients with treatment resistant psychiatric disorders that receive treatment such as transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), magnetic seizure therapy (MST) or electroconvulsive therapy (ECT).

The protocol presented here is for TMS-EEG studies utilizing intracortical excitability test-retest design paradigms. The intent of the protocol is to produce reliable and reproducible cortical excitability measures for assessing neurophysiological functioning related to therapeutic interventions in the treatment of neuropsychiatric diseases such as major depression.

侧前额叶皮质联合经颅磁刺激与脑电图的研究

Transcranial magnetic stimulation (TMS) is a non-invasive method that produces neural excitation in the cortex by means of brief, time-varying magnetic ...

Event Related Potentials (ERPs) and other EEG Based Methods for Extracting Biomarkers of Brain Dysfunction: Examples from Pediatric Attention Deficit/Hyperactivity Disorder (ADHD)

Neuropsychiatric diagnoses like ADHD are based on subjective methods like interviews, rating scales and observations. There is a need for more brain-based supplements. Stimulant medication is the most common treatment for ADHD. Clinically useful predictors of response have so far not been reported. The aim of this paper is to describe the EEG based methods we apply to extract potential biomarkers for brain dysfunction. Examples relate to biomarkers for pediatric ADHD, and prediction of medication response. The main emphasis is on Event Related Potentials (ERPs).
A nineteen channel EEG is recorded during a 3 min eyes-opened task, a 3 min eyes-closed task, and a 20 min cued visual GO/NOGO task (VCPT). ERPs are recorded during this task. The goal of the ERP protocol is to extract biomarkers of assumed brain dysfunctions that significantly differentiate between a patient group and healthy controls. The protocol includes recording during standard conditions and artifact correction. ERP waves can be used or transformed into latent components. The components of the patient group are compared with controls, empathizing components that, when compared, show relatively high effect sizes. Sub-groups of the patients are selected on the basis of the cluster analysis in the space of the components. Treatment procedure (such as medication, tDCS or neurofeedback protocol) can be applied and the changes in components related to treatment in the subgroups are observed, forming the basis for clinical recommendations.
The methods described were applied in a study of 87 pediatric ADHD patients. The index of medication response discriminated significantly between responders and non-responders with a large, and clinically meaningful effect size (d = 1.84). In an ongoing study comparing ADHD children with matched controls, several variables discriminate significantly between patients and controls. The global index will exceed d = .8. The EEG based methods described here could be clinically meaningful.

Event Related Potentials ERPs and other EEG Based Methods for Extracting Biomarkers of Brain Dysfunction: Examples from Pediatric Attention Deficit/Hyperactivity Disorder ADHD

EEG-methods are applied for extracting biomarkers of brain dysfunctions. The focus is on multi-channel event-related potentials (ERPs) recorded in a cued GO/NOGO task. Non-brain artifacts are corrected and ERPs are compared with the normative data. Examples relate to biomarkers for ADHD diagnosis and prediction of medication response.

事件相关电位 （ERPs） 和其他基于脑电图的提取大脑功能障碍生物标志物的方法:从小儿注意力缺陷/多动障碍 （ADHD） 中的例子

Neuropsychiatric diagnoses like ADHD are based on subjective methods like interviews, rating scales and observations. There is a need for more brain-based ...

Simultaneous Application of Transcranial Direct Current Stimulation during Virtual Reality Exposure

Transcranial direct current stimulation (tDCS) is a form of non-invasive brain stimulation that changes the likelihood of neuronal firing through modulation of neural resting membranes. Compared to other techniques, tDCS is relatively safe, cost-effective, and can be administered while individuals are engaged in controlled, specific cognitive processes. This latter point is important as tDCS may predominantly affect intrinsically active neural regions. In an effort to test tDCS as a potential treatment for psychiatric illness, the protocol described here outlines a novel procedure that allows the simultaneous application of tDCS during exposure to trauma-related cues using virtual reality (tDCS+VR) for veterans with posttraumatic stress disorder (NCT03372460). In this double-blind protocol, participants are assigned to either receive 2 mA tDCS, or sham stimulation, for 25 minutes while passively watching three 8-minute standardized virtual reality drives through Iraq or Afghanistan, with virtual reality events increasing in intensity during each drive. Participants undergo six sessions of tDCS+VR over the course of 2-3 weeks, and psychophysiology (skin conductance reactivity) is measured throughout each session. This allows testing for within and between session changes in hyperarousal to virtual reality events and adjunctive effects of tDCS. Stimulation is delivered through a built-in rechargeable battery-driven tDCS device using a 1 (anode) x 1 (cathode) unilateral electrode set-up. Each electrode is placed in a 3 x 3 cm (current density 2.22 A/m2) reusable sponge pocket saturated with 0.9% normal saline. Sponges with electrodes are attached to the participant&#8217;s skull using a rubber headband with the electrodes placed such that they target regions within the ventromedial prefrontal cortex. The virtual reality headset is placed over the tDCS montage in such a way as to avoid electrode interference.

This manuscript outlines a novel protocol to allow the simultaneous application of transcranial direct current stimulation during exposure to warzone trauma-related cues using virtual reality for veterans with posttraumatic stress disorder.