title: Extended remediation of sleep deprived-induced working memory deficits using fMRI-guided transcranial magnetic stimulation.
abstract: OBJECTIVE
  We attempted to prevent the development of working memory (WM) impairments caused by sleep deprivation using fMRI-guided repetitive transcranial magnetic stimulation (rTMS). Novel aspects of our fMRI-guided rTMS paradigm included the use of sophisticated covariance methods to identify functional networks in imaging data, and the use of fMRI-targeted rTMS concurrent with task performance to modulate plasticity effects over a longer term.
  
  
  METHODS
  Between-groups mixed model.
  
  
  METHODS
  TMS, MRI, and sleep laboratory study.
  
  
  METHODS
  27 subjects (13 receiving Active rTMS, and 14 Sham) completed the sleep deprivation protocol, with another 21 (10 Active, 11 Sham) non-sleep deprived subjects run in a second experiment.
  
  
  METHODS
  Our previous covariance analysis had identified a network, including occipital cortex, which demonstrated individual differences in resilience to the deleterious effects of sleep deprivation on WM performance. Five Hz rTMS was applied to left lateral occipital cortex while subjects performed a WM task during 4 sessions over the course of 2 days of total sleep deprivation.
  
  
  RESULTS
  At the end of the sleep deprivation period, Sham sleep deprived subjects exhibited degraded performance in the WM task. In contrast, those receiving Active rTMS did not show the slowing and lapsing typical in sleep deprivation, and instead performed similarly to non- sleep deprived subjects. Importantly, the Active sleep deprivation group showed rTMS-induced facilitation of WM performance a full 18 hours after the last rTMS session.
  
  
  CONCLUSIONS
  Over the course of sleep deprivation, these results indicate that rTMS applied concurrently with WM task performance affected neural circuitry involved in WM to prevent its full impact.
authors.affiliation: Departments of Psychiatry and Behavioral Sciences, Duke University, Durham, NC 27710, USA. bruce.luber@duke.edu
authors.forename: Bruce
authors.initials: B
authors.lastname: Luber
authors.forename: Jason
authors.initials: J
authors.lastname: Steffener
authors.forename: Adrienne
authors.initials: A
authors.lastname: Tucker
authors.forename: Christian
authors.initials: C
authors.lastname: Habeck
authors.forename: Angel V
authors.initials: AV
authors.lastname: Peterchev
authors.forename: Zhi-De
authors.initials: ZD
authors.lastname: Deng
authors.forename: Robert C
authors.initials: RC
authors.lastname: Basner
authors.forename: Yaakov
authors.initials: Y
authors.lastname: Stern
authors.forename: Sarah H
authors.initials: SH
authors.lastname: Lisanby
mesh_terms: D001921:Brain / Q000503:physiopathology; D005260:Female; D059907:Functional Neuroimaging / Q000379:methods; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008569:Memory Disorders / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D008570:Memory, Short-Term / Q000502:physiology; D009483:Neuropsychological Tests; D012892:Sleep Deprivation / Q000503:physiopathology / Q000523:psychology*; D050781:Transcranial Magnetic Stimulation / Q000379:methods; D055815:Young Adult
keywords: TMS; fMRI; neuroplasticity; sleep deprivation; working memory