论文标题

TMS-EEG生物标志物的可靠性和有效性

Reliability and validity of TMS-EEG biomarkers

论文作者

Parmigiani, Sara, Ross, Jessica M., Cline, Christopher, Minasi, Christopher B., Gogulski, Juha, Keller, Corey J

论文摘要

无创脑刺激和神经影像学已经彻底改变了人类神经科学,包括众多应用,包括诊断性亚型,治疗优化和复发预测。因此,确定将症状与其潜在神经机制联系起来的稳健和临床上有价值的脑生物标志物特别重要。脑生物标志物必须在实验室内的类似实验中可重现(即具有内部可靠性),并且在实验设置,实验室,大脑区域和疾病状态中可以推广(即具有外部可靠性)。但是,可靠性(内部和外部)并不足够;生物标志物也必须具有有效性。有效性描述了与潜在神经信号或疾病状态的真实度量的亲密关系。我们建议在使用任何生物标志物用于治疗决策之前,应评估和优化这两个指标,可靠性和有效性。在这里,我们讨论了这些指标与因果脑连接性生物标志物,从偶联的经颅磁刺激(TMS)与脑电图(EEG)(EEG)。我们讨论了围绕TMS-EEG的争议,这是由于多个大型脱靶成分(噪声)和相对较弱的真实大脑反应(信号)的争议,不幸的是,人类神经科学常常是这种情况。我们回顾了TMS-EEG录音的当前状态,该记录由可靠的噪声和不可靠的信号组成。我们描述了评估TMS-EEG生物标志物的方法,包括如何评估设施,认知状态,脑网络和疾病之间的内部和外部可靠性,以及如何使用侵入性神经记录或治疗反应来验证这些生物标志物。我们提供建议,以提高可靠性和有效性,讨论经验教训,并建议对该领域的未来方向。

Noninvasive brain stimulation and neuroimaging have revolutionized human neuroscience, with a multitude of applications including diagnostic subtyping, treatment optimization, and relapse prediction. It is therefore particularly relevant to identify robust and clinically valuable brain biomarkers linking symptoms to their underlying neural mechanisms. Brain biomarkers must be reproducible (i.e., have internal reliability) across similar experiments within a laboratory and be generalizable (i.e., have external reliability) across experimental setups, laboratories, brain regions, and disease states. However, reliability (internal and external) is not alone sufficient; biomarkers also must have validity. Validity describes closeness to a true measure of the underlying neural signal or disease state. We propose that these two metrics, reliability and validity, should be evaluated and optimized before any biomarker is used to inform treatment decisions. Here, we discuss these metrics with respect to causal brain connectivity biomarkers from coupling transcranial magnetic stimulation (TMS) with electroencephalography (EEG). We discuss controversies around TMS-EEG stemming from the multiple large off-target components (noise) and relatively weak genuine brain responses (signal), as is unfortunately often the case with human neuroscience. We review the current state of TMS-EEG recordings, which consist of a mix of reliable noise and unreliable signal. We describe methods for evaluating TMS-EEG biomarkers, including how to assess internal and external reliability across facilities, cognitive states, brain networks, and disorders, and how to validate these biomarkers using invasive neural recordings or treatment response. We provide recommendations to increase reliability and validity, discuss lessons learned, and suggest future directions for the field.

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