Likewise, the increasing interest in clinical applications of non-invasive brain stimulation bolster the need for patient-tailored solutions to optimize treatment efficacy yet specific regimes at the single-subject level are difficult to set up, due to the intricacies of the interactions between the externally applied stimulation and ongoing brain dynamics. The principles governing interactions within and between functional neural networks have taken center stage in modern neuroscience, yet many of their fundamental characteristics remain unknown. Concurrent TMS-EEG-fMRI opens an exciting noninvasive avenue of subject-tailored network research into dynamic cognitive circuits and their dysfunction. In participants with adequate motor network reactivity, strong pre-TMS alpha power reduced TMS-evoked hemodynamic activations throughout the bilateral cortico-subcortical motor system (including striatum and thalamus), suggesting shunted network connectivity. To demonstrate the utility of this multimodal triad, we assessed how pre-TMS EEG power fluctuations influenced motor network activations induced by subthreshold TMS to right dorsal premotor cortex. Here, we show that concurrent TMS-EEG-fMRI enables precise and direct monitoring of causal dependencies between oscillatory states and signal propagation throughout cortico-subcortical networks. However, this approach ignores ongoing oscillatory fluctuations which strongly affect network excitability and concomitant behavior. Transcranial Magnetic Stimulation (TMS) allows to noninvasively probe neural excitability, while concurrent fMRI can log the induced activity propagation through connected network nodes. Despite growing interest, the causal mechanisms underlying human neural network dynamics remain elusive.
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