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Salatino A, Berra E, Troni W, Sacco K, Cauda F, D'Agata F, Geminiani G, Duca S, Dimanico U, Ricci R. Behavioral and neuroplastic effects of low-frequency rTMS of the unaffected hemisphere in a chronic stroke patient: a concomitant TMS and fMRI study. Neurocase 2014; 20:615-26. [PMID: 23962174 DOI: 10.1080/13554794.2013.826691] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Repetitive Transcranial Magnetic Stimulation (rTMS) ameliorates motor and neuropsychological deficits following stroke, but little is known about the underlying neuroplasticity. We investigated neuroplastic changes following 5 days of low-frequency rTMS on the intact motor cortex to promote motor recovery in a chronic patient with subcortical stroke. The feasibility of administering multiple treatments was also assessed 6 months later by applying the same protocol over the patient's parietal cortex to improve visuospatial disorders. Behavioral improvements and no adverse events were observed. Neuroimaging findings indicated that motor symptoms amelioration was associated with downregulation and cortical reorganization of hyperactive contralesional hemisphere.
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Affiliation(s)
- Adriana Salatino
- a Department of Psychology , University of Turin , Turin , Italy
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Ommaya AK, Adams KM, Allman RM, Collins EG, Cooper RA, Dixon CE, Fishman PS, Henry JA, Kardon R, Kerns RD, Kupersmith J, Lo A, Macko R, McArdle R, McGlinchey RE, McNeil MR, O'Toole TP, Peckham PH, Tuszynski MH, Waxman SG, Wittenberg GF. Guest editorial: Opportunities in rehabilitation research. ACTA ACUST UNITED AC 2013; 50:vii-xxxii. [PMID: 24203548 DOI: 10.1682/jrrd.2012.09.0167] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Bradnam LV, Stinear CM, Byblow WD. Ipsilateral motor pathways after stroke: implications for non-invasive brain stimulation. Front Hum Neurosci 2013; 7:184. [PMID: 23658541 PMCID: PMC3647244 DOI: 10.3389/fnhum.2013.00184] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 04/23/2013] [Indexed: 12/17/2022] Open
Abstract
In humans the two cerebral hemispheres have essential roles in controlling the upper limb. The purpose of this article is to draw attention to the potential importance of ipsilateral descending pathways for functional recovery after stroke, and the use of non-invasive brain stimulation (NBS) protocols of the contralesional primary motor cortex (M1). Conventionally NBS is used to suppress contralesional M1, and to attenuate transcallosal inhibition onto the ipsilesional M1. There has been little consideration of the fact that contralesional M1 suppression may also reduce excitability of ipsilateral descending pathways that may be important for paretic upper limb control for some patients. One such ipsilateral pathway is the cortico-reticulo-propriospinal pathway (CRPP). In this review we outline a neurophysiological model to explain how contralesional M1 may gain control of the paretic arm via the CRPP. We conclude that the relative importance of the CRPP for motor control in individual patients must be considered before using NBS to suppress contralesional M1. Neurophysiological, neuroimaging, and clinical assessments can assist this decision making and facilitate the translation of NBS into the clinical setting.
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Affiliation(s)
- Lynley V Bradnam
- Brain Research Laboratory, Centre for Neuroscience, School of Medicine, Flinders University Adelaide, SA, Australia ; Effectiveness of Therapy Group, Centre for Clinical Change and Healthcare Research, School of Medicine, Flinders University Adelaide, SA, Australia
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Lefebvre S, Thonnard JL, Laloux P, Peeters A, Jamart J, Vandermeeren Y. Single session of dual-tDCS transiently improves precision grip and dexterity of the paretic hand after stroke. Neurorehabil Neural Repair 2013; 28:100-10. [PMID: 23486918 DOI: 10.1177/1545968313478485] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND After stroke, deregulated interhemispheric interactions influence residual paretic hand function. Anodal or cathodal transcranial direct current stimulation (tDCS) can rebalance these abnormal interhemispheric interactions and improve motor function. OBJECTIVE We explored whether dual-hemisphere tDCS (dual-tDCS) in participants with chronic stroke can improve fine hand motor function in 2 important aspects: precision grip and dexterity. METHODS In all, 19 chronic hemiparetic individuals with mild to moderate impairment participated in a double-blind, randomized trial. During 2 separate cross-over sessions (real/sham), they performed 10 precision grip movements with a manipulandum and the Purdue Pegboard Test (PPT) before, during, immediately after, and 20 minutes after dual-tDCS applied simultaneously over the ipsilesional (anodal) and contralateral (cathodal) primary motor cortices. RESULTS The precision grip performed with the paretic hand improved significantly 20 minutes after dual-tDCS, with reduction of the grip force/load force ratio by 7% and in the preloading phase duration by 18% when compared with sham. The dexterity of the paretic hand started improving during dual-tDCS and culminated 20 minutes after the end of dual-tDCS (PPT score +38% vs +5% after sham). The maximal improvements in precision grip and dexterity were observed 20 minutes after dual-tDCS. These improvements correlated negatively with residual hand function quantified with ABILHAND. CONCLUSIONS One bout of dual-tDCS improved the motor control of precision grip and digital dexterity beyond the time of stimulation. These results suggest that dual-tDCS should be tested in longer protocols for neurorehabilitation and with moderate to severely impaired patients. The precise timing of stimulation after stroke onset and associated training should be defined.
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Kandel M, Beis JM, Le Chapelain L, Guesdon H, Paysant J. Non-invasive cerebral stimulation for the upper limb rehabilitation after stroke: A review. Ann Phys Rehabil Med 2012; 55:657-80. [DOI: 10.1016/j.rehab.2012.09.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 09/06/2012] [Accepted: 09/06/2012] [Indexed: 11/26/2022]
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Abstract
Stroke is a leading cause of disability, and the number of stroke survivors continues to rise. Traditional neurorehabilitation strategies aimed at restoring function to weakened limbs provide only modest benefit. New brain stimulation techniques designed to augment traditional neurorehabilitation hold promise for reducing the burden of stroke-related disability. Investigators discovered that repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), and epidural cortical stimulation (ECS) can enhance neural plasticity in the motor cortex post-stroke. Improved outcomes may be obtained with activity-dependent stimulation, in which brain stimulation is contingent on neural or muscular activity during normal behavior. We review the evidence for improved motor function in stroke patients treated with rTMS, tDCS, and ECS and discuss the mediating physiological mechanisms. We compare these techniques to activity-dependent stimulation, discuss the advantages of this newer strategy for stroke rehabilitation, and suggest future applications for activity-dependent brain stimulation.
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Transcranial magnetic stimulation for the prediction and enhancement of rehabilitation treatment effects. J Neurol Phys Ther 2012; 36:87-93. [PMID: 22592064 DOI: 10.1097/npt.0b013e3182564d26] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In this update on rehabilitation technology, transcranial magnetic stimulation (TMS), a technique that allows noninvasive stimulation of the brain, is examined. The background and basic principles of TMS are reviewed, and its usefulness as a tool to inform and possibly augment the rehabilitation process is discussed. The three main paradigms by which TMS is applied-physiological measurement, disruption/virtual lesion studies, and modulation of cortical excitability-are discussed relative to the types of scientific information each paradigm can provide and their potential clinical usefulness in the future. One of the more exciting prospects is that, when combined with rehabilitation training, TMS modulation of cortical excitability could potentially enhance the effects of rehabilitation and lead to greater levels of recovery than are currently attainable with rehabilitation alone. It is concluded that current studies must focus on the mechanisms of recovery based on the specific structures and processes affected by the disorder and the neural effects of specific rehabilitation interventions in order for the potential of TMS-augmented rehabilitation to be realized.
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Yang YR, Tseng CY, Chiou SY, Liao KK, Cheng SJ, Lai KL, Wang RY. Combination of rTMS and Treadmill Training Modulates Corticomotor Inhibition and Improves Walking in Parkinson Disease. Neurorehabil Neural Repair 2012; 27:79-86. [DOI: 10.1177/1545968312451915] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Repetitive transcranial magnetic stimulation (rTMS) of the brain has been shown to modulate cortical excitability. Combinations of rehabilitation therapies with rTMS might enhance the therapeutic effects. Objective. The purpose of this study was to investigate the effects of high-frequency rTMS followed by treadmill training on cortical inhibition and walking function in individuals with Parkinson disease (PD). Methods. A total of 20 patients with PD were randomized into an experimental group and a control group. Participants received rTMS (experimental group) or sham rTMS (control group) followed by treadmill training (30 minutes) for 12 sessions over 4 weeks. Repetitive TMS was applied at a 5-Hz frequency over the leg area of the motor cortex contralaterally to the more affected side for 6 minutes. Outcomes, including corticomotor inhibition and walking performance, were measured before and after training. Results. The results showed significant time effects on almost all corticomotor and functional variables. There are significant interaction effects between group and time of evaluation on the motor threshold, duration of the cortical silent period, and short interval intracortical inhibition of the contralateral hemisphere relatively to the more affected side as well as on the fast walking speed and timed up and go. Conclusions. The findings suggested that combination of rTMS and treadmill training enhances the effect of treadmill training on modulation of corticomotor inhibition and improvement of walking performance in those with PD.
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Affiliation(s)
- Yea-Ru Yang
- National Yang-Ming University, Taipei, Taiwan
- Taipei City Hospital, Taipei, Taiwan
| | | | | | - Kwong-Kum Liao
- National Yang-Ming University, Taipei, Taiwan
- Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Kuan-Lin Lai
- National Yang-Ming University, Taipei, Taiwan
- Taipei Veterans General Hospital, Taipei, Taiwan
- Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan
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Hsu WY, Cheng CH, Liao KK, Lee IH, Lin YY. Effects of Repetitive Transcranial Magnetic Stimulation on Motor Functions in Patients With Stroke. Stroke 2012; 43:1849-57. [DOI: 10.1161/strokeaha.111.649756] [Citation(s) in RCA: 245] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
The purpose of this study was to perform a meta-analysis of studies that investigated the effects of repetitive transcranial magnetic stimulation (rTMS) on upper limb motor function in patients with stroke.
Methods—
We searched for randomized controlled trials published between January 1990 and October 2011 in PubMed, Medline, Cochrane, and CINAHL using the following key words: stroke, cerebrovascular accident, and repetitive transcranial magnetic stimulation. The mean effect size and a 95% CI were estimated for the motor outcome and motor threshold using fixed and random effect models.
Results—
Eighteen of the 34 candidate articles were included in this analysis. The selected studies involved a total of 392 patients. A significant effect size of 0.55 was found for motor outcome (95% CI, 0.37–0.72). Further subgroup analyses demonstrated more prominent effects for subcortical stroke (mean effect size, 0.73; 95% CI, 0.44–1.02) or studies applying low-frequency rTMS (mean effect size, 0.69; 95% CI, 0.42–0.95). Only 4 patients of the 18 articles included in this analysis reported adverse effects from rTMS.
Conclusions—
rTMS has a positive effect on motor recovery in patients with stroke, especially for those with subcortical stroke. Low-frequency rTMS over the unaffected hemisphere may be more beneficial than high-frequency rTMS over the affected hemisphere. Recent limited data suggest that intermittent theta-burst stimulation over the affected hemisphere might be a useful intervention. Further well-designed studies in a larger population are required to better elucidate the differential roles of various rTMS protocols in stroke treatment.
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Affiliation(s)
- Wan-Yu Hsu
- From the Institute of Brain Science (W.-Y.H., C.-H.C., I.-H.L., Y.-Y.L.), the Department of Neurology (K.-K.L., I.-H.L., Y.-Y.L.), the Institute of Physiology (Y.-Y.L.), and the Institute of Clinical Medicine (Y.-Y.L.), National Yang-Ming University, Taipei, Taiwan; and the Laboratory of Neurophysiology (W.-Y.H., C.-H.C., Y.-Y.L.) and the Department of Neurology (K.-K.L., I.-H.L., Y.-Y.L.), Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Hsiung Cheng
- From the Institute of Brain Science (W.-Y.H., C.-H.C., I.-H.L., Y.-Y.L.), the Department of Neurology (K.-K.L., I.-H.L., Y.-Y.L.), the Institute of Physiology (Y.-Y.L.), and the Institute of Clinical Medicine (Y.-Y.L.), National Yang-Ming University, Taipei, Taiwan; and the Laboratory of Neurophysiology (W.-Y.H., C.-H.C., Y.-Y.L.) and the Department of Neurology (K.-K.L., I.-H.L., Y.-Y.L.), Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kwong-Kum Liao
- From the Institute of Brain Science (W.-Y.H., C.-H.C., I.-H.L., Y.-Y.L.), the Department of Neurology (K.-K.L., I.-H.L., Y.-Y.L.), the Institute of Physiology (Y.-Y.L.), and the Institute of Clinical Medicine (Y.-Y.L.), National Yang-Ming University, Taipei, Taiwan; and the Laboratory of Neurophysiology (W.-Y.H., C.-H.C., Y.-Y.L.) and the Department of Neurology (K.-K.L., I.-H.L., Y.-Y.L.), Taipei Veterans General Hospital, Taipei, Taiwan
| | - I-Hui Lee
- From the Institute of Brain Science (W.-Y.H., C.-H.C., I.-H.L., Y.-Y.L.), the Department of Neurology (K.-K.L., I.-H.L., Y.-Y.L.), the Institute of Physiology (Y.-Y.L.), and the Institute of Clinical Medicine (Y.-Y.L.), National Yang-Ming University, Taipei, Taiwan; and the Laboratory of Neurophysiology (W.-Y.H., C.-H.C., Y.-Y.L.) and the Department of Neurology (K.-K.L., I.-H.L., Y.-Y.L.), Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yung-Yang Lin
- From the Institute of Brain Science (W.-Y.H., C.-H.C., I.-H.L., Y.-Y.L.), the Department of Neurology (K.-K.L., I.-H.L., Y.-Y.L.), the Institute of Physiology (Y.-Y.L.), and the Institute of Clinical Medicine (Y.-Y.L.), National Yang-Ming University, Taipei, Taiwan; and the Laboratory of Neurophysiology (W.-Y.H., C.-H.C., Y.-Y.L.) and the Department of Neurology (K.-K.L., I.-H.L., Y.-Y.L.), Taipei Veterans General Hospital, Taipei, Taiwan
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Hoyer EH, Celnik PA. Understanding and enhancing motor recovery after stroke using transcranial magnetic stimulation. Restor Neurol Neurosci 2012; 29:395-409. [PMID: 22124033 DOI: 10.3233/rnn-2011-0611] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Stroke is the leading cause of long-term disability. Understanding how people recover from stroke and other brain lesions remain one of the biggest conundrums in neuroscience. As a result, concerted efforts in recent years have focused on investigating the neurophysiological changes that occur in the brain after stroke, and in developing novel strategies to enhance motor recovery. In particular, transcranial magnetic stimulation (TMS) is a non-invasive tool that has been used to investigate the brain plasticity changes resulting from stroke and as a therapeutic modality to safely improve motor function. In this review, we discuss the contributions of TMS to understand how different motor areas, such as the ipsilesional hemisphere, secondary motor areas, and contralesional hemisphere are involved in motor recovery. We also consider recent studies using repetitive TMS (rTMS) in stroke patients to enhance upper extremity function. Although further studies are needed, these investigations provide an important starting point to understand the stimulation parameters and patient characteristics that may influence the optimal response to non-invasive brain stimulation. Future directions of rTMS are discussed in the context of post-stroke motor recovery.
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Affiliation(s)
- Erik H Hoyer
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Medical Institution, Baltimore, MD 21287, USA
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Seniów J, Bilik M, Leśniak M, Waldowski K, Iwański S, Członkowska A. Transcranial Magnetic Stimulation Combined With Physiotherapy in Rehabilitation of Poststroke Hemiparesis. Neurorehabil Neural Repair 2012; 26:1072-9. [DOI: 10.1177/1545968312445635] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Low-frequency repetitive transcranial magnetic stimulation (rTMS) of the contralesional primary motor cortex (M1) may improve recovery in patients with hemiparetic stroke. Objective. To evaluate the effectiveness of applying 1 Hz rTMS to the contralesional M1 in addition to physiotherapy during early rehabilitation for stroke patients with hand hemiparesis in a randomized, sham-controlled, double-blind study. Methods. Forty patients with moderate upper extremity hemiparesis were randomized to receive 3 weeks of motor training (45 minutes daily) preceded by 30 minutes of 1 Hz rTMS applied to the contralesional M1 or 30 minutes of sham rTMS. Functional assessment of the paretic hand using the Wolf Motor Function Test was performed before, immediately after, and 3 months after completing treatment. Results. No statistically significant differences were found between the experimental and the control group for hand function (Wolf Motor Function Test; P = .92) or the level of neurological deficit ( National Institutes of Health Stroke Scale [NIHSS]; P = .82) after treatment. Effect sizes for the experimental ( d = 0.5) and the control group ( d = 0.47) were small. Similar results were observed at the 3-month follow-up. Conclusions. The findings did not suggest that rTMS suppression of the contralesional motor cortex augments the effect of early neurorehabilitation for upper limb hemiparesis. Larger trials that stratify subjects based on residual motor function or physiological measures of excitation and inhibition may identify responders in the future.
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Affiliation(s)
- Joanna Seniów
- Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Marta Bilik
- Institute of Psychiatry and Neurology, Warsaw, Poland
| | | | | | | | - Anna Członkowska
- Institute of Psychiatry and Neurology, Warsaw, Poland
- Medical University, Warsaw, Poland
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Byblow WD, Stinear CM, Smith MC, Bjerre L, Flaskager BK, McCambridge AB. Mirror symmetric bimanual movement priming can increase corticomotor excitability and enhance motor learning. PLoS One 2012; 7:e33882. [PMID: 22457799 PMCID: PMC3310871 DOI: 10.1371/journal.pone.0033882] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 02/23/2012] [Indexed: 11/19/2022] Open
Abstract
Repetitive mirror symmetric bilateral upper limb may be a suitable priming technique for upper limb rehabilitation after stroke. Here we demonstrate neurophysiological and behavioural after-effects in healthy participants after priming with 20 minutes of repetitive active-passive bimanual wrist flexion and extension in a mirror symmetric pattern with respect to the body midline (MIR) compared to an control priming condition with alternating flexion-extension (ALT). Transcranial magnetic stimulation (TMS) indicated that corticomotor excitability (CME) of the passive hemisphere remained elevated compared to baseline for at least 30 minutes after MIR but not ALT, evidenced by an increase in the size of motor evoked potentials in ECR and FCR. Short and long-latency intracortical inhibition (SICI, LICI), short afferent inhibition (SAI) and interhemispheric inhibition (IHI) were also examined using pairs of stimuli. LICI differed between patterns, with less LICI after MIR compared with ALT, and an effect of pattern on IHI, with reduced IHI in passive FCR 15 minutes after MIR compared with ALT and baseline. There was no effect of pattern on SAI or FCR H-reflex. Similarly, SICI remained unchanged after 20 minutes of MIR. We then had participants complete a timed manual dexterity motor learning task with the passive hand during, immediately after, and 24 hours after MIR or control priming. The rate of task completion was faster with MIR priming compared to control conditions. Finally, ECR and FCR MEPs were examined within a pre-movement facilitation paradigm of wrist extension before and after MIR. ECR, but not FCR, MEPs were consistently facilitated before and after MIR, demonstrating no degradation of selective muscle activation. In summary, mirror symmetric active-passive bimanual movement increases CME and can enhance motor learning without degradation of muscle selectivity. These findings rationalise the use of mirror symmetric bimanual movement as a priming modality in post-stroke upper limb rehabilitation.
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Affiliation(s)
- Winston D Byblow
- Movement Neuroscience Laboratory, Department of Sport & Exercise Science, The University of Auckland, Auckland, New Zealand.
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63
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Fan F, Zhu C, Chen H, Qin W, Ji X, Wang L, Zhang Y, Zhu L, Yu C. Dynamic brain structural changes after left hemisphere subcortical stroke. Hum Brain Mapp 2012; 34:1872-81. [PMID: 22431281 DOI: 10.1002/hbm.22034] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 12/06/2011] [Accepted: 12/06/2011] [Indexed: 11/07/2022] Open
Abstract
This study aimed to quantify dynamic structural changes in the brain after subcortical stroke and identify brain areas that contribute to motor recovery of affected limbs. High-resolution structural MRI and neurological examinations were conducted at five consecutive time points during the year following stroke in 10 patients with left hemisphere subcortical infarctions involving motor pathways. Gray matter volume (GMV) was calculated using an optimized voxel-based morphometry technique, and dynamic changes in GMV were evaluated using a mixed-effects model. After stroke, GMV was decreased bilaterally in brain areas that directly or indirectly connected with lesions, which suggests the presence of regional damage in these "healthy" brain tissues in stroke patients. Moreover, the GMVs of these brain areas were not correlated with the Motricity Index (MI) scores when controlling for time intervals after stroke, which indicates that these structural changes may reflect an independent process (such as axonal degeneration) but cannot affect the improvement of motor function. In contrast, the GMV was increased in several brain areas associated with motor and cognitive functions after stroke. When controlling for time intervals after stroke, only the GMVs in the cognitive-related brain areas (hippocampus and precuneus) were positively correlated with MI scores, which suggests that the structural reorganization in cognitive-related brain areas may facilitate the recovery of motor function. However, considering the small sample size of this study, further studies are needed to clarify the exact relationships between structural changes and recovery of motor function in stroke patients.
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Affiliation(s)
- Fengmei Fan
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, People's Republic of China
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64
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Adeyemo BO, Simis M, Macea DD, Fregni F. Systematic review of parameters of stimulation, clinical trial design characteristics, and motor outcomes in non-invasive brain stimulation in stroke. Front Psychiatry 2012; 3:88. [PMID: 23162477 PMCID: PMC3495265 DOI: 10.3389/fpsyt.2012.00088] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 09/22/2012] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION/OBJECTIVES Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation are two powerful non-invasive neuromodulatory therapies that have the potential to alter and evaluate the integrity of the corticospinal tract. Moreover, recent evidence has shown that brain stimulation might be beneficial in stroke recovery. Therefore, investigating and investing in innovative therapies that may improve neurorehabilitative stroke recovery are next steps in research and development. Participants/Materials and Methods: This article presents an up-to-date systematic review of the treatment effects of rTMS and tDCS on motor function. A literary search was conducted, utilizing search terms "stroke" and "transcranial stimulation." Items were excluded if they failed to: (1) include stroke patients, (2) study motor outcomes, or (3) include rTMS/tDCS as treatments. Other exclusions included: (1) reviews, editorials, and letters, (2) animal or pediatric populations, (3) case reports or sample sizes ≤2 patients, and (4) primary outcomes of dysphagia, dysarthria, neglect, or swallowing. RESULTS Investigation of PubMed English Database prior to 01/01/2012 produced 695 applicable results. Studies were excluded based on the aforementioned criteria, resulting in 50 remaining studies. They included 1314 participants (1282 stroke patients and 32 healthy subjects) evaluated by motor function pre- and post-tDCS or rTMS. Heterogeneity among studies' motor assessments was high and could not be accounted for by individual comparison. Pooled effect sizes for the impact of post-treatment improvement revealed consistently demonstrable improvements after tDCS and rTMS therapeutic stimulation. Most studies provided limited follow-up for long-term effects. CONCLUSION It is apparent from the available studies that non-invasive stimulation may enhance motor recovery and may lead to clinically meaningful functional improvements in the stroke population. Only mild to no adverse events have been reported. Though results have been positive results, the large heterogeneity across articles precludes firm conclusions.
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Affiliation(s)
- Bamidele O Adeyemo
- Laboratory of Neuromodulation, Spaulding Rehabilitation Hospital, Harvard Medical School Boston, MA, USA ; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School Boston, MA, USA
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Lefaucheur JP, André-Obadia N, Poulet E, Devanne H, Haffen E, Londero A, Cretin B, Leroi AM, Radtchenko A, Saba G, Thai-Van H, Litré CF, Vercueil L, Bouhassira D, Ayache SS, Farhat WH, Zouari HG, Mylius V, Nicolier M, Garcia-Larrea L. [French guidelines on the use of repetitive transcranial magnetic stimulation (rTMS): safety and therapeutic indications]. Neurophysiol Clin 2011; 41:221-95. [PMID: 22153574 DOI: 10.1016/j.neucli.2011.10.062] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 10/18/2011] [Indexed: 12/31/2022] Open
Abstract
During the past decade, a large amount of work on transcranial magnetic stimulation (TMS) has been performed, including the development of new paradigms of stimulation, the integration of imaging data, and the coupling of TMS techniques with electroencephalography or neuroimaging. These accumulating data being difficult to synthesize, several French scientific societies commissioned a group of experts to conduct a comprehensive review of the literature on TMS. This text contains all the consensual findings of the expert group on the mechanisms of action, safety rules and indications of TMS, including repetitive TMS (rTMS). TMS sessions have been conducted in thousands of healthy subjects or patients with various neurological or psychiatric diseases, allowing a better assessment of risks associated with this technique. The number of reported side effects is extremely low, the most serious complication being the occurrence of seizures. In most reported seizures, the stimulation parameters did not follow the previously published recommendations (Wassermann, 1998) [430] and rTMS was associated to medication that could lower the seizure threshold. Recommendations on the safe use of TMS / rTMS were recently updated (Rossi et al., 2009) [348], establishing new limits for stimulation parameters and fixing the contraindications. The recommendations we propose regarding safety are largely based on this previous report with some modifications. By contrast, the issue of therapeutic indications of rTMS has never been addressed before, the present work being the first attempt of a synthesis and expert consensus on this topic. The use of TMS/rTMS is discussed in the context of chronic pain, movement disorders, stroke, epilepsy, tinnitus and psychiatric disorders. There is already a sufficient level of evidence of published data to retain a therapeutic indication of rTMS in clinical practice (grade A) in chronic neuropathic pain, major depressive episodes, and auditory hallucinations. The number of therapeutic indications of rTMS is expected to increase in coming years, in parallel with the optimisation of stimulation parameters.
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Affiliation(s)
- J-P Lefaucheur
- EA 4391, faculté de médecine, université Paris-Est-Créteil, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
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Wang RY, Tseng HY, Liao KK, Wang CJ, Lai KL, Yang YR. rTMS Combined With Task-Oriented Training to Improve Symmetry of Interhemispheric Corticomotor Excitability and Gait Performance After Stroke. Neurorehabil Neural Repair 2011; 26:222-30. [DOI: 10.1177/1545968311423265] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. The model of interhemispheric competition after stroke has been established for the upper but not for the lower extremity. Repetitive transcranial magnetic stimulation (rTMS) of the brain has been shown to modulate cortical excitability. Objective. The purpose of this study was to investigate the effects of rTMS followed by task-oriented training on cortical excitability and walking performance in individuals with chronic stroke. Methods. A total of 24 patients with average Fugl-Meyer lower limb scores of 17.88 ± 5.27 and average walking speeds of 63.81 ± 18.25 cm/s were randomized into an experimental group and a control group. Participants received rTMS (experimental group) or sham rTMS (control group) followed by task-oriented training (30 minutes) for 10 sessions over 2 weeks. Repetitive TMS was applied at a 1-Hz frequency over the leg area of the motor cortex of the unaffected hemisphere for 10 minutes. Outcomes, including motor-evoked potential (MEP), lower-extremity Fugl-Meyer score, and gait performance, were measured before and after training. Results. Decreased interhemispheric asymmetry of the amplitude of the MEP was noted after rTMS and task-oriented training. Improvement in spatial asymmetry of gait was comparable with increased symmetry in interhemispheric excitability. Motor control and walking ability were also significantly improved after rTMS and task-oriented training. Conclusions. rTMS enhances the effect of task-oriented training in those with chronic stroke, especially by increasing gait spatial symmetry and corticomotor excitability symmetry.
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Affiliation(s)
| | | | - Kwong-Kum Liao
- National Yang-Ming University, Taipei, Taiwan
- Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Kuan-Lin Lai
- National Yang-Ming University, Taipei, Taiwan
- Taipei Veterans General Hospital, Taipei, Taiwan
- Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan
| | - Yea-Ru Yang
- National Yang-Ming University, Taipei, Taiwan
- Taipei City Hospital, Taipei, Taiwan
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Bashir S, Mizrahi I, Weaver K, Fregni F, Pascual-Leone A. Assessment and modulation of neural plasticity in rehabilitation with transcranial magnetic stimulation. PM R 2011; 2:S253-68. [PMID: 21172687 DOI: 10.1016/j.pmrj.2010.10.015] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Accepted: 10/20/2010] [Indexed: 01/21/2023]
Abstract
Despite intensive efforts to improve outcomes after acquired brain injury, functional recovery is often limited. One reason for this limitation is the challenge in assessing and guiding plasticity after brain injury. In this context, transcranial magnetic stimulation (TMS), a noninvasive tool of brain stimulation, could play a major role. TMS has been shown to be a reliable tool for measuring plastic changes in the motor cortex associated with interventions in the motor system, such as motor training and motor cortex stimulation. In addition, as illustrated by the experience in promoting recovery from stroke, TMS is a promising therapeutic tool to minimize motor, speech, cognitive, and mood deficits. In this review, we will focus on stroke to discuss how TMS can provide insights into the mechanisms of neurologic recovery and how it can be used for measurement and modulation of plasticity after an acquired brain insult.
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Affiliation(s)
- Shahid Bashir
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA 02215, USA
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68
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Cortical Stimulation as an Adjuvant to Upper Limb Rehabilitation After Stroke. PM R 2010; 2:S269-78. [DOI: 10.1016/j.pmrj.2010.09.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 09/15/2010] [Accepted: 09/24/2010] [Indexed: 11/23/2022]
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Dawson AM, Buxbaum LJ, Duff SV. The impact of left hemisphere stroke on force control with familiar and novel objects: neuroanatomic substrates and relationship to apraxia. Brain Res 2009; 1317:124-36. [PMID: 19945445 DOI: 10.1016/j.brainres.2009.11.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Revised: 11/10/2009] [Accepted: 11/16/2009] [Indexed: 10/20/2022]
Abstract
Fingertip force scaling for lifting objects frequently occurs in anticipation of finger contact. An ongoing question concerns the types of memories that are used to inform predictive control. Object-specific information such as weight may be stored and retrieved when previously encountered objects are lifted again. Alternatively, visual size and shape cues may provide estimates of object density each time objects are encountered. We reasoned that differences in performance with familiar versus novel objects would provide support for the former possibility. Anticipatory force production with both familiar and novel objects was assessed in six left hemisphere stroke patients, two of whom exhibited deficient actions with familiar objects (ideomotor apraxia; IMA), along with five control subjects. In contrast to healthy controls and stroke participants without IMA, participants with IMA displayed poor anticipatory scaling with familiar objects. However, like the other groups, IMA participants learned to differentiate fingertip forces with repeated lifts of both familiar and novel objects. Finally, there was a significant correlation between damage to the inferior parietal and superior and middle temporal lobes and impaired anticipatory control for familiar objects. These data support the hypotheses that anticipatory control during lifts of familiar objects in IMA patients are based on object-specific memories and that the ventro-dorsal stream is involved in the long-term storage of internal models used for anticipatory scaling during object manipulation.
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Affiliation(s)
- Amanda M Dawson
- Moss Rehabilitation Research Institute, Philadelphia, PA 19141, USA.
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70
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Khedr EM, Abdel-Fadeil MR, Farghali A, Qaid M. Role of 1 and 3 Hz repetitive transcranial magnetic stimulation on motor function recovery after acute ischaemic stroke. Eur J Neurol 2009; 16:1323-30. [DOI: 10.1111/j.1468-1331.2009.02746.x] [Citation(s) in RCA: 149] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Nowak DA, Grefkes C, Ameli M, Fink GR. Interhemispheric competition after stroke: brain stimulation to enhance recovery of function of the affected hand. Neurorehabil Neural Repair 2009; 23:641-56. [PMID: 19531606 DOI: 10.1177/1545968309336661] [Citation(s) in RCA: 339] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE Within the concept of interhemispheric competition, technical modulation of the excitability of motor areas in the contralesional and ipsilesional hemisphere has been applied in an attempt to enhance recovery of hand function following stroke. This review critically summarizes the data supporting the use of novel electrophysiological concepts in the rehabilitation of hand function after stroke. SUMMARY OF REVIEW Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are powerful tools to inhibit or facilitate cortical excitability. Modulation of cortical excitability may instantaneously induce plastic changes within the cortical network of sensorimotor areas, thereby improving motor function of the affected hand after stroke. No significant adverse effects have been noted when applying brain stimulation in stroke patients. To date, however, the clinical effects are small to moderate and short lived. Future work should elucidate whether repetitive administration of rTMS or tDCS over several days and the combination of these techniques with behavioral training (ie, physiotherapy) could result in an enhanced effectiveness. CONCLUSION Brain stimulation is a safe and promising tool to induce plastic changes in the cortical sensorimotor network to improve motor behavior after stroke. However, several methodological issues remain to be answered to further improve the effectiveness of these new approaches.
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Affiliation(s)
- Dennis A Nowak
- Department of Neurology, University Hospital, University of Cologne, Cologne, Germany.
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Sparing R, Thimm M, Hesse MD, Küst J, Karbe H, Fink GR. Bidirectional alterations of interhemispheric parietal balance by non-invasive cortical stimulation. Brain 2009; 132:3011-20. [PMID: 19528092 DOI: 10.1093/brain/awp154] [Citation(s) in RCA: 216] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- R Sparing
- Department of Neurology, University Hospital Cologne, Kerpenerstr. 62, 50924 Cologne, Germany.
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Plow EB, Carey JR, Nudo RJ, Pascual-Leone A. Invasive cortical stimulation to promote recovery of function after stroke: a critical appraisal. Stroke 2009; 40:1926-31. [PMID: 19359643 DOI: 10.1161/strokeaha.108.540823] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Residual motor deficits frequently linger after stroke. Search for newer effective strategies to promote functional recovery is ongoing. Brain stimulation, as a means of directing adaptive plasticity, is appealing. Animal studies and Phase I and II trials in humans have indicated safety, feasibility, and efficacy of combining rehabilitation and concurrent invasive cortical stimulation. However, a recent Phase III trial showed no advantage of the combination. We critically review results of various trials and discuss the factors that contributed to the distinctive result. SUMMARY OF REVIEW Regarding cortical stimulation, it is important to determine the (1) location of peri-infarct representations by integrating multiple neuroanatomical and physiological techniques; (2) role of other mechanisms of stroke recovery; (3) viability of peri-infarct tissue and descending pathways; (4) lesion geometry to ensure no alteration/displacement of current density; and (5) applicability of lessons generated from noninvasive brain stimulation studies in humans. In terms of combining stimulation with rehabilitation, we should understand (1) the principle of homeostatic plasticity; (2) the effect of ongoing cortical activity and phases of learning; and (3) that subject-specific intervention may be necessary. CONCLUSIONS Future cortical stimulation trials should consider the factors that may have contributed to the peculiar results of the Phase III trial and address those in future study designs.
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Affiliation(s)
- Ela B Plow
- Berenson-Allen Center for Noninvasive Brain Stimulation, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
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Wang LE, Fink GR, Dafotakis M, Grefkes C. Noradrenergic stimulation and motor performance: Differential effects of reboxetine on movement kinematics and visuomotor abilities in healthy human subjects. Neuropsychologia 2009; 47:1302-12. [DOI: 10.1016/j.neuropsychologia.2009.01.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Revised: 11/28/2008] [Accepted: 01/15/2009] [Indexed: 10/21/2022]
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Cárdenas-Morales L, Nowak DA, Kammer T, Wolf RC, Schönfeldt-Lecuona C. Mechanisms and applications of theta-burst rTMS on the human motor cortex. Brain Topogr 2009; 22:294-306. [PMID: 19288184 DOI: 10.1007/s10548-009-0084-7] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Accepted: 02/17/2009] [Indexed: 12/14/2022]
Abstract
Theta-burst Stimulation (TBS) is a novel form of repetitive transcranial magnetic stimulation (rTMS). Applied over the primary motor cortex it has been successfully used to induce changes in cortical excitability. The advantage of this stimulation paradigm is that it is able to induce strong and long lasting effects using a lower stimulation intensity and a shorter time of stimulation compared to conventional rTMS protocols. Since its first description, TBS has been used in both basic and clinical research in the last years and more recently it has been expanded to other domains than the motor system. Its capacity to induce synaptic plasticity could lead to therapeutic implications for neuropsychiatric disorders. The neurobiological mechanisms of TBS are not fully understood at present; they may involve long-term potentiation (LTP)- and depression (LTD)-like processes, as well as inhibitory mechanisms modulated by GABAergic activity. This article highlights current hypotheses regarding the mechanisms of action of TBS and some central factors which may influence cortical responses to TBS. Furthermore, previous and ongoing research performed in the field of TBS on the motor cortex is summarized.
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Ziemann U, Paulus W, Nitsche MA, Pascual-Leone A, Byblow WD, Berardelli A, Siebner HR, Classen J, Cohen LG, Rothwell JC. Consensus: Motor cortex plasticity protocols. Brain Stimul 2008; 1:164-82. [PMID: 20633383 DOI: 10.1016/j.brs.2008.06.006] [Citation(s) in RCA: 443] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2008] [Accepted: 06/09/2008] [Indexed: 12/11/2022] Open
Abstract
Noninvasive transcranial stimulation is being increasingly used by clinicians and neuroscientists to alter deliberately the status of the human brain. Important applications are the induction of virtual lesions (for example, transient dysfunction) to identify the importance of the stimulated brain network for a certain sensorimotor or cognitive task, and the induction of changes in neuronal excitability, synaptic plasticity or behavioral function outlasting the stimulation, for example, for therapeutic purposes. The aim of this article is to review critically the properties of the different currently used stimulation protocols, including a focus on their particular strengths and weaknesses, to facilitate their appropriate and conscientious application.
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Affiliation(s)
- Ulf Ziemann
- Department Neurology, Goethe-University Frankfurt, Germany.
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