Individualized fMRI neuromodulation enhances visuospatial perception: a guided approach targeted towards the neuro-rehabilitation of cortical blindness and deceleration of subjective cognitive impairment.

Neuromodulation is a growing precision-medicine approach to modulating neural activity that can be used to treat neuropsychiatric, and general pathophysiologic conditions. We developed individualized fMRI neuromodulation (iNM) to study the mechanisms of visuospatial perception modulation with the long-term goal of applying it in low-vision patient populations having cortical blindness or visuospatial impairment preceding subjective cognitive impairment. To determine these mechanisms, we developed a direction and coherence discrimination task to engage visual perception (VP), visual imagery (VI), selective extero- intero-ceptive attention (SEIA), and motor planning (MP) networks. Participants discriminated up and down direction, at full and subthreshold coherence under iNM or control (no iNM). We determined the blood-oxygen-level-dependent (BOLD) magnitude as area under the curve (AUC) for VI, SEIA, and MP encoded networks and used a decoder to predict the stimulus from brain maps. The increased AUC BOLD magnitude under iNM across directions and coherences ranged from: 48-76% for SEIA, 26-59% for MP, 20-47% for VI, and 100% for strong VP coherences, but decreased for weak coherences. iNM increased classification performance. Our results imply a causal role of iNM-induced visuospatial mechanisms in strengthening these networks and provide a pathway for more accurate encoding models and effective treatment. ### Competing Interest Statement T. D. Papageorgiou: Individualized Brain Neurotherapeutics, and the following pending patent applications: U.S. Patent Application No.: 16/954,256; European Patent Application No. 19 753 851.5, WIPO Publication No. WO 2019/160754; S. A. Sheth: Consultant for Boston Scientific, Neuropace, Koh Young, Zimmer Biomet, Sensoria Therapeutics, Varian Medical; Co-Founder of Motif Neurotech.