Short-term high-frequency transcutaneous electrical nerve stimulation decreases human motor cortex excitability

Short-interval intracortical inhibition is modulated by high-frequency peripheral mixed nerve stimulation

Cortical excitability can be modulated by manipulation of afferent input. We investigated the influence of peripheral mixed nerve stimulation on the excitability of the motor cortex. Motor evoked potentials (MEPs), short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF) in the right abductor pollicis brevis (APB), extensor carpi radialis (ECR) and first dorsal interosseous (FDI) muscles were evaluated using paired-pulse transcranial magnetic stimulation (TMS) before and after high-frequency peripheral mixed nerve stimulation (150 Hz, 30 min) over the right median nerve at the wrist. The MEP amplitude and SICI of the APB muscle decreased transiently 0-10 min after the intervention, whereas the ICF did not change. High-frequency peripheral mixed nerve stimulation reduced the excitability of the motor cortex. The decrement in the SICI, which reflects the function of GABA(A)ergic inhibitory interneurons, might compensate for the reduced motor cortical excitability after high-frequency peripheral mixed nerve stimulation.

Abnormal plasticity of the sensorimotor cortex to slow repetitive transcranial magnetic stimulation in patients with writer's cramp

Previous studies demonstrated functional abnormalities in the somatosensory system, including a distorted functional organization of the somatosensory cortex (S1) in patients with writer's cramp. We tested the hypothesis that these functional alterations render S1 of these patients more susceptible to the "inhibitory" effects of subthreshold 1 Hz repetitive transcranial magnetic stimulation (rTMS) given to S1. Seven patients with writer's cramp and eight healthy subjects were studied. Patients also received rTMS to the motor cortex hand area (M1). As an outcome measure, short-latency afferent inhibition (SAI) was tested. SAI was studied in the relaxed first dorsal interosseous muscle using conditioning electrical stimulation of the index finger and TMS pulses over the contralateral M1. Baseline SAI did not differ between groups. S1 but not M1 rTMS reduced SAI in patients. rTMS had no effects on SAI in healthy subjects. Because SAI is mediated predominantly at a cortical level in the sensorimotor cortex, we conclude that there is an abnormal responsiveness of this area to 1 Hz rTMS in writer's cramp, which may represent a trait toward maladaptive plasticity in the sensorimotor system in these patients.

Excitability of Spinal Motor Neuron Function after the Transcutaneous Electrical Stimulation (TES) in Healthy Subjects -F-wave Study

To clarify the excitability of spinal motor neuron function after transcutaneous electrical stimulation (TES), we investigated the F-wave before and after TES. Fourteen healthy volunteers with a mean age of 23.4 years were studied. TES was applied to the flexor hallucis brevis (FHB) for 15 minutes. F-wave and M-wave were recorded from the FHB after tibial nerve stimulation at the ankle before TES, just after TES, 10, 20 and 30 minutes after TES. TES evoked full flexion of the great toe. F-wave was analyzed for the amplitude ratio of F/M, latency and duration. The amplitude ratio of F/ M was 3.1% before TES, 1.4% just after TES, 1.6% 10 minutes after, 1.9% 20 minutes after and 1.7% 30 minutes after TES. Each amplitude ratio of F/M after TES was significantly lower than that before TES (p<0.05). There was no statistically significant difference in the latency and the duration. These results suggest that the excitability of spinal motor neuron function after TES to muscles under this condition was reduced in healthy subjects.

TENS to the posterior aspect of the legs decreases postural sway during stance

The purpose of this study was to examine the effect of Transcutaneous Electrical Nerve Stimulation (TENS) applied to the posterior aspect of the legs, on postural sway during stance. Thirty healthy subjects were tested while standing on a force platform under four stimulation conditions: no TENS, bilateral TENS, and unilateral left and right TENS. Thirty-second long tests, employing detection threshold amplitudes, were performed in three blocks. In each block, the four conditions were applied both with and without vision in a random order. The results indicate that the application of TENS brought about a decrease in postural sway as expressed by average sway velocity, in addition to a decrease in the absolute values of maximal and minimal medio-lateral and anterior-posterior velocity. Thus, similar to sub-threshold random electrical noise, it appears that the application of low-amplitude TENS to the lower limbs decreases postural sway during stance. Considering the ease of TENS application and the high prevalence of postural disorders, the potential clinical significance of this observation is to be determined by further studies.

Normative data on changes in transcranial magnetic stimulation measures over a ten hour period

OBJECTIVE

To establish normative data on the single-subject variation of resting motor thresholds and silent periods over 10 h using transcranial magnetic stimulation (TMS).

METHODS

Seventeen neurologically normal volunteers aged 18-36 underwent a series of seven TMS sessions conducted over the course of a single 10-h period. During each session, resting motor threshold and cortical silent period were recorded for the first dorsal interosseus muscle of each hand during focal TMS of the contralateral motor area.

RESULTS

We provide data on the normal limits of variability in these measures for averaged group data and for single subjects. Specifically, we report intersession, intrasession, and interhemispheric variability of data for each subject individually.

CONCLUSIONS

Although group averages are highly reliable, individual subjects showed substantial variability over time, especially for silent periods. Interhemispheric asymmetry was a less stable indicator than previously reported.

SIGNIFICANCE

These norms may guide the interpretation of changes in TMS measures within groups or within an individual patient over brief periods of time or as an immediate response to intervention.

Mechanomyographic response to transcranial magnetic stimulation from biceps brachii and during transcutaneous electrical nerve stimulation on extensor carpi radialis

Transcranial magnetic stimulation (TMS) elicits short latency excitatory responses in the target muscles, termed motor evoked potential (MEP). When TMS is delivered during a voluntary contraction, the MEP is followed by a period of silence called silent period (SP). These MEP parameters are in general recordable by electromyography (EMG). Mechanomyography (MMG) on the other hand is the mechanical counterpart of EMG. Thus, this study has been conducted to observe whether the MEP parameters from MMG signals showed similar trait of EMG recordings. Five normal healthy male subjects were included in this study. The subjects were required to perform right biceps brachii muscles contraction at diverse graded of load level at 5, 10, 20, 30, 40, 60, and 100% maximum voluntary contraction (MVC). MEPs by single pulse TMS on left hemisphere were obtained from both EMG electrode and MMG accelerometer at rest and at different levels of predetermined load level. MEP amplitude and area obtained both from EMG and MMG record were increased with the increase of muscle contraction with a maximum of 60% MVC. With increasing the level of contraction there was a shortening of onset latency and decreasing in the length of silent period in both EMG and MMG signals. We also recorded the EMG- and MMG-MEP from the right extensor carpi radialis muscle during transcutaneous electric nerve stimulation in order to observe neural changes in sensory stimulation from both EMG and MMG responses. The EMG-MEP was not visible in electrical artifact whereas it was obvious in MMG responses. In accordance with other study, this study showed that the voluntary contraction of biceps brachii muscle influenced the MEP parameter which are moreover obtainable by MMG even in electrical noise may provide insight for future study.

Effective treatment of symptomatic diabetic polyneuropathy by high-frequency external muscle stimulation

AIMS/HYPOTHESIS

Diabetic distal symmetrical sensory polyneuropathy (DSP) affects 20-30% of diabetic patients. Transcutaneous electrical nerve stimulation (TENS) and electrical spinal cord stimulation have been proposed as physical therapies. We performed a controlled, randomised pilot trial to compare the effects of high-frequency external muscle stimulation (HF) with those of TENS in patients with symptomatic DSP.

METHODS

Patients with type 2 diabetes and DSP (n=41) were randomised to receive treatment with TENS or HF using strata for non-painful (n=20) and painful sensory symptoms (n=21). Both lower extremities were treated for 30 min daily for three consecutive days. The patients' degree of symptoms and pain were graded daily on a scale of one to ten, before, during and 2 days after treatment termination. Responders were defined by the alleviation of one or more symptoms by at least three points.

RESULTS

The two treatment groups were similar in terms of baseline characteristics, such as age, duration of diabetes, neurological symptoms scores and neurological disability scores. The responder rate was significantly higher (p<0.05) in the HF group (80%, 16 out of 20) than in the TENS group (33%, seven out of 21). Subgroup analysis revealed that HF was more effective than TENS in relieving the symptoms of non-painful neuropathy (HF: 100%, seven out of seven; TENS: 44%, four out of nine; p<0.05) and painful neuropathy (HF: 69%, nine out of 13; TENS: 25%, three out of 12; p<0.05). The responders did not differ in terms of the reduction in mean symptom intensity during the trial.

CONCLUSIONS/INTERPRETATION

This pilot study shows, for the first time, that HF can ameliorate the discomfort and pain associated with DSP, and suggests that HF is more effective than TENS. External muscle stimulation offers a new therapeutic option for DSP.

Reliability of motor-evoked potentials during resting and active contraction conditions

PURPOSE

To determine the reliability of motor-evoked potentials (MEP) obtained using transcranial magnetic stimulation (TMS) in the first dorsal interosseous (FDI) and biceps brachii muscles.

METHODS

Fourteen college subjects attended the laboratory on three separate days. TMS was used to obtain MEP with the subject relaxed (resting condition) at stimulation intensities of 70%, 85%, and 100% of maximal stimulator output. MEP were also obtained during four active contraction conditions involving contractions of 25%, 50%, 75%, and 100% of maximal effort (MVC). Reliability was measured using an intraclass correlation analysis of variance (ANOVA) design.

RESULTS

In the resting condition, substantial increases in MEP amplitude were observed for both muscles from day 1 to day 2. Intraclass reliability estimates were higher for the biceps muscle (ICC = 0.95-0.99) than for the FDI muscle (ICC = 0.60-0.81). During the active conditions, the greatest MEP were observed at 25% and 50% MVC, with smaller MEP at 75% and 100% MVC. Intraclass correlations in the active condition were approximately 0.63-0.73.

CONCLUSIONS

: Moderate to good reliability of MEP amplitude in the biceps and FDI muscles can be obtained using TMS in both resting and active contraction conditions.

Long-lasting modulation of human motor cortex following prolonged transcutaneous electrical nerve stimulation (TENS) of forearm muscles: evidence of reciprocal inhibition and facilitation

Several lines of evidence indicate that motor cortex excitability can be modulated by manipulation of afferent inputs, like peripheral electrical stimulation. Most studies in humans mainly dealt with the effects of prolonged low-frequency peripheral nerve stimulation on motor cortical excitability, despite its being known from animal studies that high-frequency stimulation can also result in changes of the cortical excitability. To investigate the possible effects of high-frequency peripheral stimulation on motor cortical excitability we recorded motor-evoked potentials (MEPs) to transcranial magnetic stimulation (TMS) of the left motor cortex from the right flexor carpi radialis (FCR), extensor carpi radialis (ECR), and first dorsal interosseous (FDI) in normal subjects, before and after transcutaneous electrical nerve stimulation (TENS) of 30 min duration applied over the FCR. The amplitude of MEPs from the FRC was significantly reduced from 10 to 35 min after TENS while the amplitude of MEPs from ECR was increased. No effects were observed in the FDI muscle. Indices of peripheral nerve (M-wave) and spinal cord excitability (H waves) did not change throughout the experiment. Electrical stimulation of the lateral antebrachial cutaneous nerve has no significant effect on motor cortex excitability. These findings suggest that TENS of forearm muscles can induce transient reciprocal inhibitory and facilitatory changes in corticomotoneuronal excitability of forearm flexor and extensor muscles lasting several minutes. These changes probably may occur at cortical site and seem to be mainly dependent on stimulation of muscle afferents. These findings might eventually lead to practical applications in rehabilitation, especially in those syndromes in which the excitatory and inhibitory balance between agonist and antagonist is severely impaired, such as spasticity and dystonia.