The neurological or psychiatric diseases distort the communication in the brain’s connected networks. In a sense, a person with a brain disorder can become unreachable due to dysfunctional integration within and across brain networks as well as impaired processing and integration of incoming sensory signals. The brain’s ability to adapt depends on feedback signaled through the five sensory channels, which produce neuronal synchrony which drives neuronal plasticity. Hence, deficiencies in communication via the senses requires alternative ways to engage adaptation in a diseased brain— one potent way is via transcranial neuromodulation, bypassing the afferents sensory channels, another one is to use the brain activity translated into signals sent as feedback via multimodal sensory channels (brain based neurofeedback).

Even in our personal experience, sometimes the ‘magic’ understanding with a dear person can get sick, we do not understand each other anymore. And, which is the wisest advice in this case? TO LISTEN!

Aiming at developing proper neuromodulation interventions, we propose listening to the brain affected by a disease via proper neuroimaging techniques.

Symposium speakers will present methods and proper strategies to define targets for neuroenhancing brain stimulation. Risto Ilmoniemi will describe the concept of feedback-controlled multi-coil TMS showing initial results. Frank Scharnowski will describe how to define targets for connectivity-based neurofeedback training aiming at normalizing dysfunctional brain networks; Toni Valero-Cabré, how to interact by invasive and non-invasive recordings and stimulations with rhythmic brain activity, with an example against neglect in stroke patients; Hartwig Siebner will describe how modeling can enhance noninvasive transcranial brain stimulation at the biophysical, network, and cognitive level; Franca Tecchio, how to personalize non-invasive neuromodulation anatomically or exploiting the neuronal dynamics of the target area, with a successful example against multiple sclerosis fatigue.

Changing the locus of transcranial magnetic stimulation (TMS) with present mechanically moved TMS coils is too slow for real-time feedback-controlled targeting. To overcome this limitation and to allow algorithmically guided closed-loop stimulation, we have introduced the concept of multi-coil TMS (mTMS) and developed technology to realize it with multiple overlapping coils. We have demonstrated that the new technology allows electronic control of stimulation location with arbitrarily small delays. In addition, with the new electronics, we have shown that TMS pulse shaping can yield information about neuronal ion-channel kinetics. I will discuss possible applications.

<p>Brain training via real-time fMRI-based neurofeedback can improve performance and clinical symptoms in neurological and psychiatric patients. Here, we inform the training by the connectivity between brain areas rather than the activity of a single node. Using this novel connectivity-based neurofeedback, we improved emotion regulation by training participants to voluntarily increase top-down connectivity from cognitive prefrontal areas onto limbic structures. Moreover, neurofeedback can help substance use disorder patients to learn voluntary control over neurotransmitter centers such as the dopaminergic midbrain, thus indirectly modifying their dopaminergic reward system. These novel methodological innovations allow to more specifically target disease-related brain malfunctions.</p>

<p>We are manipulating the brain activity by means of non-invasive and invasive bursts, in dependence on surface and intracerebral EEG recordings. In healthy humans, the rhythmic bursts TMS manipulation of the right Frontal Eye Fields increases the fronto-parietal synchrony and the conscious visual detection in a frequency specific manner. In treatment-resistant epilepsy patients implanted with depth electrodes, stimulated for clinical purposes with electrical bursts, the local neuronal power increases in a manner dependent on stimulation intensity, frequency, phase and position. We will discuss how manipulating brain networks’ synchrony may open new avenues to treat stroke visuo‑spatial neglect.</p>

The human brain can be stimulated with a wide range of non-invasive transcranial brain stimulation (NTBS) techniques. These methods have great potential as neuroscientific and therapeutic tools, but the application is hampered by substantial intra- and inter-subject variability of the acute and outlasting NTBS effects on brain function. In this talk, I will provide an overview over our recent attempts to obtain a mechanistic understanding of NTBS applying a triple-M approach, consisting of brain mapping, modeling and modulation. I will show how anatomically and physiologically informed NTBS can be used to shape human brain function. I will then show how multi-level modelling at the biophysical, local and network level can reveal how NTBS shapes neural activity in the human brain. Finally, I will touch on novel realizations of NTBS such as targeting brain oscillations with TMS or ultra-high frequency repetitive TMS.

I will present a successful example of adapting to fatigue-related brain dysfunction in people with multiple sclerosis a transcranial direct current stimulation (tDCS), which had increased endurance against fatigue in healthy subjects. The adaptation required a personalized electrode designed and positioned based on the patient’s 3D-brain MRI. While this compensation required an anatomical personalization, we are also personalizing a current-modulated transcranial electric stimulation (tES), by mimicking the local dynamics of the ongoing neuronal activity of the target region. We derived the target neurodynamics by Functional Source Separation (FSS)-equipped electroencephalography (EEG) and we obtained an enhancement of the neuromodulation effects, in particular at individual level.