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Yang Y, Pan H, Pan W, Liu Y, Song X, Niu CM, Feng W, Wang J, Xie Q. Repetitive Transcranial Magnetic Stimulation on the Affected Hemisphere Enhances Hand Functional Recovery in Subacute Adult Stroke Patients: A Randomized Trial. Front Aging Neurosci 2021; 13:636184. [PMID: 34093164 PMCID: PMC8171119 DOI: 10.3389/fnagi.2021.636184] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/09/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Either motor training or repetitive transcranial magnetic stimulation (rTMS) could modulate the neural plasticity after stroke. Therefore, synchronizing the two interventions may optimize the efficiency of recovery. In the present study, we aim to investigate the effect of rTMS along with hand grip training on the neurobehavioral and hand functional recovery in one cohort of subacute stroke patients. Methods: Thirty-nine stroke patients were enrolled in a single-center, single-blinded, randomized clinical trial. We tested different intervention effects of rTMS and hand grip training (group A), rTMS alone (group B), and hand grip training alone (group C). For the rTMS-treated groups, patients received 10 consecutive sessions of 5-Hz stimulation over the affected hemisphere with 750 pulses. Jebsen-Taylor Hand Function Test (JTHFT), Fugl-Meyer assessment of upper extremity (FMA-UE), grip strength, modified Barthel index (mBI), and ipsilesional motor evoked potential (iMEP) latency were assessed and compared across the groups. Results: We found that only rTMS along with hand grip training group all improved in JTHFT, FMA-UE, grip strength, and mBI (p ≤ 0.01) compared with the baseline among the three groups. Furthermore, this study demonstrated that rTMS plus hand grip training had much better results in improvement of neurobehavioral outcomes compared to the rTMS alone- and hand grip training alone-treated patients (p < 0.05). However, no significant differences were detected in neurophysiologic outcome between intra-groups and inter-groups (p > 0.05). Conclusion: These proof-of-concept results suggested that rTMS alone with hand grip training was a unique approach to promote hand functional recovery in stroke patients. It provided important information to design a large-scale multi-center clinical trial to further demonstrate the efficiency of the combination of central and peripheral stimulation. Clinical Trial Registration: http://www.chictr.org.cn (#ChiCTR1900023443).
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Affiliation(s)
- Yawen Yang
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huijuan Pan
- Department of Rehabilitation Medicine, Shanghai Ruijin Rehabilitation Hospital, Shanghai, China
| | - Wenxiu Pan
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yang Liu
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaohui Song
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chuanxin M Niu
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wuwei Feng
- Department of Neurology, Duke University School of Medicine, Durham, NC, United States
| | - Jixian Wang
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Xie
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Rehabilitation Medicine, Shanghai Ruijin Rehabilitation Hospital, Shanghai, China
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Opie GM, Liao WY, Semmler JG. Interactions Between Cerebellum and the Intracortical Excitatory Circuits of Motor Cortex: a Mini-Review. CEREBELLUM (LONDON, ENGLAND) 2021; 21:159-166. [PMID: 33978934 DOI: 10.1007/s12311-021-01278-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 05/03/2021] [Indexed: 12/28/2022]
Abstract
Interactions between cerebellum (CB) and primary motor cortex (M1) are critical for effective motor function. Although the associated neurophysiological processes are yet to be fully characterised, a growing body of work using non-invasive brain stimulation (NIBS) techniques has significantly progressed our current understanding. In particular, recent developments with both transcranial magnetic (TMS) and direct current (tDCS) stimulation suggest that CB modulates the activity of local excitatory interneuronal circuits within M1. These circuits are known to be important both physiologically and functionally, and understanding the nature of their connectivity with CB therefore has the potential to provide important insight for NIBS applications. Consequently, this mini-review provides an overview of the emerging literature that has investigated interactions between CB and the intracortical excitatory circuits of M1.
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Affiliation(s)
- George M Opie
- Discipline of Physiology, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, 5005, Australia
| | - Wei-Yeh Liao
- Discipline of Physiology, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, 5005, Australia
| | - John G Semmler
- Discipline of Physiology, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, 5005, Australia.
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Desarkar P, Rajji TK, Ameis SH, Blumberger DM, Lai MC, Lunsky Y, Daskalakis ZJ. Assessing and stabilizing atypical plasticity in autism spectrum disorder using rTMS: Results from a proof-of-principle study. Clin Neurophysiol 2021; 141:109-118. [PMID: 34011467 DOI: 10.1016/j.clinph.2021.03.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/08/2021] [Accepted: 03/05/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Emerging evidence implicates atypical plasticity in the neurophysiology of autism spectrum disorder (ASD). Specifically, autistic people demonstrated hyperplasticity in response to theta-burst stimulation (TBS). We hypothesized that autistic adults would display hyperplasticity to TBS and that repetitive transcranial magnetic stimulation (rTMS) - which potentiates brain inhibitory mechanisms - would 'stabilize' hyperplasticity. METHODS Using a randomized, cross-over design, plasticity was assessed using TBS in the left motor cortex (M1) in 31 autistic adults and 30 sex-, intelligence quotient-, and age-matched controls. Autistic adults (n = 29) were further randomized (1:1) to receive a single session of active (n = 14) or sham (n = 15) rTMS (6000 pulses at 20 Hz) over left M1 and plasticity was reassessed on the next day following rTMS. RESULTS Both long-term potentiation (LTP) and long-term depression (LTD) were significantly increased in the ASD group, indicating hyperplasticity. Active, but not sham rTMS, attenuated LTD in autistic adults. CONCLUSIONS We provided further evidence for the presence of brain hyperplasticity in ASD. To our knowledge, this is the first study to show preliminary evidence that an excessive LTD in ASD can be 'stabilized' using rTMS. Such 'stabilizing' effect of rTMS on LTP was not observed, likely due to small sample size or a more specific 'attenuating' effect of rTMS on LTD, compared to LTP. SIGNIFICANCE These findings indicate atypical brain inhibitory mechanisms behind hyperplasticity in ASD. Utilizing a larger sample, future replication studies could investigate therapeutic opportunities of 'mechanism-driven' rTMS.
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Affiliation(s)
- Pushpal Desarkar
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Tarek K Rajji
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Stephanie H Ameis
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Daniel M Blumberger
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Meng-Chuan Lai
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of California San Diego, San Diego, CA, USA
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Padberg F, Bulubas L, Mizutani-Tiebel Y, Burkhardt G, Kranz GS, Koutsouleris N, Kambeitz J, Hasan A, Takahashi S, Keeser D, Goerigk S, Brunoni AR. The intervention, the patient and the illness - Personalizing non-invasive brain stimulation in psychiatry. Exp Neurol 2021; 341:113713. [PMID: 33798562 DOI: 10.1016/j.expneurol.2021.113713] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/09/2021] [Accepted: 03/28/2021] [Indexed: 02/08/2023]
Abstract
Current hypotheses on the therapeutic action of non-invasive brain stimulation (NIBS) in psychiatric disorders build on the abundant data from neuroimaging studies. This makes NIBS a very promising tool for developing personalized interventions within a precision medicine framework. NIBS methods fundamentally vary in their neurophysiological properties. They comprise repetitive transcranial magnetic stimulation (rTMS) and its variants (e.g. theta burst stimulation - TBS) as well as different types of transcranial electrical stimulation (tES), with the largest body of evidence for transcranial direct current stimulation (tDCS). In the last two decades, significant conceptual progress has been made in terms of NIBS targets, i.e. from single brain regions to neural circuits and to functional connectivity as well as their states, recently leading to brain state modulating closed-loop approaches. Regarding structural and functional brain anatomy, NIBS meets an individually unique constellation, which varies across normal and pathophysiological states. Thus, individual constitutions and signatures of disorders may be indistinguishable at a given time point, but can theoretically be parsed along course- and treatment-related trajectories. We address precision interventions on three levels: 1) the NIBS intervention, 2) the constitutional factors of a single patient, and 3) the phenotypes and pathophysiology of illness. With examples from research on depressive disorders, we propose solutions and discuss future perspectives, e.g. individual MRI-based electrical field strength as a proxy for NIBS dosage, and also symptoms, their clusters, or biotypes instead of disorder focused NIBS. In conclusion, we propose interleaved research on these three levels along a general track of reverse and forward translation including both clinically directed research in preclinical model systems, and biomarker guided controlled clinical trials. Besides driving the development of safe and efficacious interventions, this framework could also deepen our understanding of psychiatric disorders at their neurophysiological underpinnings.
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Affiliation(s)
- Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Germany; Center for Non-invasive Brain Stimulation Munich-Augsburg (CNBS(MA)), Germany
| | - Lucia Bulubas
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Germany; Center for Non-invasive Brain Stimulation Munich-Augsburg (CNBS(MA)), Germany; International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Yuki Mizutani-Tiebel
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Germany; Center for Non-invasive Brain Stimulation Munich-Augsburg (CNBS(MA)), Germany
| | - Gerrit Burkhardt
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Germany; Center for Non-invasive Brain Stimulation Munich-Augsburg (CNBS(MA)), Germany
| | - Georg S Kranz
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, SAR, China; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Germany; Max-Planck Institute of Psychiatry, Munich, Germany
| | - Joseph Kambeitz
- Department of Psychiatry, University of Cologne, Faculty of Medicine and University Hospital Cologne, 50937, Germany
| | - Alkomiet Hasan
- Center for Non-invasive Brain Stimulation Munich-Augsburg (CNBS(MA)), Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, BKH Augsburg, Dr.-Mack-Str. 1, 86156 Augsburg, Germany; Department of Clinical Radiology, LMU Hospital, Munich, Germany
| | - Shun Takahashi
- Department of Neuropsychiatry, Wakayama Medical University, 811-1 Kimiidera, 6410012 Wakayama, Japan
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Germany; Center for Non-invasive Brain Stimulation Munich-Augsburg (CNBS(MA)), Germany
| | - Stephan Goerigk
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Germany; Center for Non-invasive Brain Stimulation Munich-Augsburg (CNBS(MA)), Germany; Department of Psychological Methodology and Assessment, Ludwig-Maximilians-University, Leopoldstraße 13, 80802 Munich, Germany; Hochschule Fresenius, University of Applied Sciences, Infanteriestraße 11A, 80797 Munich, Germany
| | - Andre R Brunoni
- Laboratory of Neurosciences (LIM-27), Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo & Hospital Universitário, Universidade de São Paulo, Av. Prof Lineu Prestes 2565, 05508-000 São Paulo, Brazil
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Andrews SC, Curtin D, Hawi Z, Wongtrakun J, Stout JC, Coxon JP. Intensity Matters: High-intensity Interval Exercise Enhances Motor Cortex Plasticity More Than Moderate Exercise. Cereb Cortex 2021; 30:101-112. [PMID: 31041988 DOI: 10.1093/cercor/bhz075] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/05/2019] [Accepted: 03/07/2019] [Indexed: 12/15/2022] Open
Abstract
A single bout of cardiovascular exercise can enhance plasticity in human cortex; however, the intensity required for optimal enhancement is debated. We investigated the effect of exercise intensity on motor cortex synaptic plasticity, using transcranial magnetic stimulation. Twenty healthy adults (Mage = 35.10 ± 13.25 years) completed three sessions. Measures of cortico-motor excitability (CME) and inhibition were obtained before and after a 20-min bout of either high-intensity interval exercise, moderate-intensity continuous exercise, or rest, and again after intermittent theta burst stimulation (iTBS). Results showed that high-intensity interval exercise enhanced iTBS plasticity more than rest, evidenced by increased CME and intracortical facilitation, and reduced intracortical inhibition. In comparison, the effect of moderate-intensity exercise was intermediate between high-intensity exercise and rest. Importantly, analysis of each participant's plasticity response profile indicated that high-intensity exercise increased the likelihood of a facilitatory response to iTBS. We also established that the brain-derived neurotrophic factor Val66Met polymorphism attenuated plasticity responses following high-intensity exercise. These findings suggest that high-intensity interval exercise should be considered not only when planning exercise interventions designed to enhance neuroplasticity, but also to maximize the therapeutic potential of non-invasive brain stimulation. Additionally, genetic profiling may enhance efficacy of exercise interventions for brain health.
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Affiliation(s)
- Sophie C Andrews
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
- Neuroscience Research Australia, Sydney, Australia
- University of New South Wales, School of Psychology, Sydney, Australia
| | - Dylan Curtin
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Ziarih Hawi
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Jaeger Wongtrakun
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Julie C Stout
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - James P Coxon
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
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Guerra A, Rocchi L, Grego A, Berardi F, Luisi C, Ferreri F. Contribution of TMS and TMS-EEG to the Understanding of Mechanisms Underlying Physiological Brain Aging. Brain Sci 2021; 11:405. [PMID: 33810206 PMCID: PMC8004753 DOI: 10.3390/brainsci11030405] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/19/2021] [Accepted: 03/19/2021] [Indexed: 12/21/2022] Open
Abstract
In the human brain, aging is characterized by progressive neuronal loss, leading to disruption of synapses and to a degree of failure in neurotransmission. However, there is increasing evidence to support the notion that the aged brain has a remarkable ability to reorganize itself, with the aim of preserving its physiological activity. It is important to develop objective markers able to characterize the biological processes underlying brain aging in the intact human, and to distinguish them from brain degeneration associated with many neurological diseases. Transcranial magnetic stimulation (TMS), coupled with electromyography or electroencephalography (EEG), is particularly suited to this aim, due to the functional nature of the information provided, and thanks to the ease with which it can be integrated with behavioral manipulation. In this review, we aimed to provide up to date information about the role of TMS and TMS-EEG in the investigation of brain aging. In particular, we focused on data about cortical excitability, connectivity and plasticity, obtained by using readouts such as motor evoked potentials and transcranial evoked potentials. Overall, findings in the literature support an important potential contribution of TMS to the understanding of the mechanisms underlying normal brain aging. Further studies are needed to expand the current body of information and to assess the applicability of TMS findings in the clinical setting.
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Affiliation(s)
| | - Lorenzo Rocchi
- Department of Clinical and Movements Neurosciences, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK;
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Alberto Grego
- Department of Neuroscience, University of Padua, 35122 Padua, Italy; (A.G.); (F.B.); (C.L.)
| | - Francesca Berardi
- Department of Neuroscience, University of Padua, 35122 Padua, Italy; (A.G.); (F.B.); (C.L.)
| | - Concetta Luisi
- Department of Neuroscience, University of Padua, 35122 Padua, Italy; (A.G.); (F.B.); (C.L.)
| | - Florinda Ferreri
- Department of Neuroscience, University of Padua, 35122 Padua, Italy; (A.G.); (F.B.); (C.L.)
- Department of Clinical Neurophysiology, Kuopio University Hospital, University of Eastern Finland, 70210 Kuopio, Finland
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Guerra A, Asci F, Zampogna A, D'Onofrio V, Berardelli A, Suppa A. The effect of gamma oscillations in boosting primary motor cortex plasticity is greater in young than older adults. Clin Neurophysiol 2021; 132:1358-1366. [PMID: 33781703 DOI: 10.1016/j.clinph.2021.01.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/29/2020] [Accepted: 01/14/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE In healthy subjects, the long-term potentiation (LTP)-like plasticity of the primary motor cortex (M1) induced by intermittent theta-burst stimulation (iTBS) can be boosted by modulating gamma (γ) oscillations through transcranial alternating current stimulation (tACS). γ-tACS also reduces short-interval intracortical inhibition (SICI). We tested whether the effects of γ-tACS differ between young (YA) and older adults (OA). METHODS Twenty YA (27.2 ± 2.7 years) and twenty OA (65.3 ± 9.5 years) underwent iTBS-γ tACS and iTBS-sham tACS in randomized sessions. In a separate session, we delivered γ-tACS alone and recorded SICI during stimulation. RESULTS iTBS-sham tACS produced comparable motor evoked potential (MEP) facilitation between groups. While iTBS-γ tACS boosted MEP facilitation in both the YA and OA groups, the magnitude of its effect was significantly lower in OA. Similarly, γ-tACS-induced modulation of GABA-A-ergic neurotransmission, as tested by SICI, was reduced in OA. The effect of iTBS-γ tACS negatively correlated with the age of OA subjects. CONCLUSIONS Mechanisms underlying the effects of γ oscillations on LTP-like plasticity become less efficient in older adults. This could reflect age-related changes in neural elements of M1 resonant to γ oscillations, including GABA-A-ergic interneurons. SIGNIFICANCE The beneficial effect of γ-tACS on iTBS-induced plasticity is reduced in older adults.
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Affiliation(s)
- Andrea Guerra
- IRCCS Neuromed, Via Atinense 18, 86077 Pozzilli, IS, Italy
| | - Francesco Asci
- IRCCS Neuromed, Via Atinense 18, 86077 Pozzilli, IS, Italy
| | - Alessandro Zampogna
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, 00185 Rome, Italy
| | - Valentina D'Onofrio
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, 00185 Rome, Italy
| | - Alfredo Berardelli
- IRCCS Neuromed, Via Atinense 18, 86077 Pozzilli, IS, Italy; Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, 00185 Rome, Italy.
| | - Antonio Suppa
- IRCCS Neuromed, Via Atinense 18, 86077 Pozzilli, IS, Italy; Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, 00185 Rome, Italy
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Aberrant plasticity in musculoskeletal pain: a failure of homeostatic control? Exp Brain Res 2021; 239:1317-1326. [PMID: 33635391 DOI: 10.1007/s00221-021-06062-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 02/10/2021] [Indexed: 10/22/2022]
Abstract
Aberrant synaptic plasticity is hypothesised to underpin chronic pain. Yet, synaptic plasticity regulated by homeostatic mechanisms have received limited attention in pain. We investigated homeostatic plasticity in the human primary motor cortex (M1) of 21 healthy individuals in response to experimentally induced muscle pain for several days. Experimental pain was induced by injecting nerve growth factor into the muscle belly of the right extensor carpi radialis brevis muscle. Pain and disability were monitored until day 21. Homeostatic plasticity was induced on day 0, 2, 4, 6, and 14 in the left M1 using anodal transcranial direct stimulation (tDCS) applied for 7 and 5 min, separated by a 3-min rest period. Motor-evoked potentials (MEP) to transcranial magnetic stimulation assessed the homeostatic response. On days 0 and 14, MEPs increased following the first block of tDCS (p < 0.004), and decreased following the second block of tDCS (p < 0.001), consistent with a normal homeostatic response. However, on days 2 (p = 0.07) and 4 (p = 0.7), the decrease in MEPs after the second block of tDCS was attenuated, representing an impaired homeostatic response. Findings demonstrate altered homeostatic plasticity in the M1 with the greatest alteration observed after 4 days of sustained pain. This study provides longitudinal insight into homeostatic plasticity in response to the development, maintenance, and resolution of pain over the course of 14 days.
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Flanagan SD, Proessl F, Dunn-Lewis C, Sterczala AJ, Connaboy C, Canino MC, Beethe AZ, Eagle SR, Szivak TK, Onate JA, Volek JS, Maresh CM, Kaeding CC, Kraemer WJ. Differences in brain structure and theta burst stimulation-induced plasticity implicate the corticomotor system in loss of function after musculoskeletal injury. J Neurophysiol 2021; 125:1006-1021. [PMID: 33596734 DOI: 10.1152/jn.00689.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Traumatic musculoskeletal injury (MSI) may involve changes in corticomotor structure and function, but direct evidence is needed. To determine the corticomotor basis of MSI, we examined interactions among skeletomotor function, corticospinal excitability, corticomotor structure (cortical thickness and white matter microstructure), and intermittent theta burst stimulation (iTBS)-induced plasticity. Nine women with unilateral anterior cruciate ligament rupture (ACL) 3.2 ± 1.1 yr prior to the study and 11 matched controls (CON) completed an MRI session followed by an offline plasticity-probing protocol using a randomized, sham-controlled, double-blind, cross-over study design. iTBS was applied to the injured (ACL) or nondominant (CON) motor cortex leg representation (M1LEG) with plasticity assessed based on changes in skeletomotor function and corticospinal excitability compared with sham iTBS. The results showed persistent loss of function in the injured quadriceps, compensatory adaptations in the uninjured quadriceps and both hamstrings, and injury-specific increases in corticospinal excitability. Injury was associated with lateralized reductions in paracentral lobule thickness, greater centrality of nonleg corticomotor regions, and increased primary somatosensory cortex leg area inefficiency and eccentricity. Individual responses to iTBS were consistent with the principles of homeostatic metaplasticity; corresponded to injury-related differences in skeletomotor function, corticospinal excitability, and corticomotor structure; and suggested that corticomotor adaptations involve both hemispheres. Moreover, iTBS normalized skeletomotor function and corticospinal excitability in ACL. The results of this investigation directly confirm corticomotor involvement in chronic loss of function after traumatic MSI, emphasize the sensitivity of the corticomotor system to skeletomotor events and behaviors, and raise the possibility that brain-targeted therapies could improve recovery.NEW & NOTEWORTHY Traumatic musculoskeletal injuries may involve adaptive changes in the brain that contribute to loss of function. Our combination of neuroimaging and theta burst transcranial magnetic stimulation (iTBS) revealed distinct patterns of iTBS-induced plasticity that normalized differences in muscle and brain function evident years after unilateral knee ligament rupture. Individual responses to iTBS corresponded to injury-specific differences in brain structure and physiological activity, depended on skeletomotor deficit severity, and suggested that corticomotor adaptations involve both hemispheres.
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Affiliation(s)
- Shawn D Flanagan
- Department of Human Sciences, The Ohio State University, Columbus, Ohio.,Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Felix Proessl
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Courtenay Dunn-Lewis
- Department of Cardiothoracic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Adam J Sterczala
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Chris Connaboy
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Maria C Canino
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anne Z Beethe
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Shawn R Eagle
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tunde K Szivak
- Department of Health Sciences, Merrimack College, North Andover, Massachusetts
| | - James A Onate
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Jeff S Volek
- Department of Human Sciences, The Ohio State University, Columbus, Ohio
| | - Carl M Maresh
- Department of Human Sciences, The Ohio State University, Columbus, Ohio
| | - Christopher C Kaeding
- Sports Health and Performance Institute, Department of Orthopaedics, The Ohio State University, Columbus, Ohio
| | - William J Kraemer
- Department of Human Sciences, The Ohio State University, Columbus, Ohio
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Korai SA, Ranieri F, Di Lazzaro V, Papa M, Cirillo G. Neurobiological After-Effects of Low Intensity Transcranial Electric Stimulation of the Human Nervous System: From Basic Mechanisms to Metaplasticity. Front Neurol 2021; 12:587771. [PMID: 33658972 PMCID: PMC7917202 DOI: 10.3389/fneur.2021.587771] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 01/04/2021] [Indexed: 12/19/2022] Open
Abstract
Non-invasive low-intensity transcranial electrical stimulation (tES) of the brain is an evolving field that has brought remarkable attention in the past few decades for its ability to directly modulate specific brain functions. Neurobiological after-effects of tES seems to be related to changes in neuronal and synaptic excitability and plasticity, however mechanisms are still far from being elucidated. We aim to review recent results from in vitro and in vivo studies that highlight molecular and cellular mechanisms of transcranial direct (tDCS) and alternating (tACS) current stimulation. Changes in membrane potential and neural synchronization explain the ongoing and short-lasting effects of tES, while changes induced in existing proteins and new protein synthesis is required for long-lasting plastic changes (LTP/LTD). Glial cells, for decades supporting elements, are now considered constitutive part of the synapse and might contribute to the mechanisms of synaptic plasticity. This review brings into focus the neurobiological mechanisms and after-effects of tDCS and tACS from in vitro and in vivo studies, in both animals and humans, highlighting possible pathways for the development of targeted therapeutic applications.
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Affiliation(s)
- Sohaib Ali Korai
- Division of Human Anatomy - Laboratory of Neuronal Networks, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Federico Ranieri
- Neurology Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Vincenzo Di Lazzaro
- Neurology, Neurophysiology and Neurobiology Unit, University Campus Bio-Medico, Rome, Italy
| | - Michele Papa
- Division of Human Anatomy - Laboratory of Neuronal Networks, University of Campania "Luigi Vanvitelli", Naples, Italy.,ISBE Italy, SYSBIO Centre of Systems Biology, Milan, Italy
| | - Giovanni Cirillo
- Division of Human Anatomy - Laboratory of Neuronal Networks, University of Campania "Luigi Vanvitelli", Naples, Italy.,Neurology Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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61
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Pham MV, Miyaguchi S, Watanabe H, Saito K, Otsuru N, Onishi H. Effect of Repetitive Passive Movement Before Motor Skill Training on Corticospinal Excitability and Motor Learning Depend on BDNF Polymorphisms. Front Hum Neurosci 2021; 15:621358. [PMID: 33633556 PMCID: PMC7901944 DOI: 10.3389/fnhum.2021.621358] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/07/2021] [Indexed: 11/13/2022] Open
Abstract
A decrease in cortical excitability tends to be easily followed by an increase induced by external stimuli via a mechanism aimed at restoring it; this phenomenon is called “homeostatic plasticity.” In recent years, although intervention methods aimed at promoting motor learning using this phenomenon have been studied, an optimal intervention method has not been established. In the present study, we examined whether subsequent motor learning can be promoted further by a repetitive passive movement, which reduces the excitability of the primary motor cortex (M1) before motor learning tasks. We also examined the relationship between motor learning and the brain-derived neurotrophic factor. Forty healthy subjects (Val/Val genotype, 17 subjects; Met carrier genotype, 23 subjects) participated. Subjects were divided into two groups of 20 individuals each. The first group was assigned to perform the motor learning task after an intervention consisting in the passive adduction–abduction movement of the right index finger at 5 Hz for 10 min (RPM condition), while the second group was assigned to perform the task without the passive movement (control condition). The motor learning task consisted in the visual tracking of the right index finger. The results showed that the corticospinal excitability was transiently reduced after the passive movement in the RPM condition, whereas it was increased to the level detected in the control condition after the motor learning task. Furthermore, the motor learning ability was decreased immediately after the passive movement; however, the motor performance finally improved to the level observed in the control condition. In individuals carrying the Val/Val genotype, higher motor learning was also found to be related to the more remarkable changes in corticospinal excitability caused by the RPM condition. This study revealed that the implementation of a passive movement before a motor learning tasks did not affect M1 excitatory changes and motor learning efficiency; in contrast, in subjects carrying the Val/Val polymorphism, the more significant excitatory changes in the M1 induced by the passive movement and motor learning task led to the improvement of motor learning efficiency. Our results also suggest that homeostatic plasticity occurring in the M1 is involved in this improvement.
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Affiliation(s)
- Manh Van Pham
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Graduate School, Niigata University of Health and Welfare, Niigata, Japan.,Department of Physical Therapy, Hai Duong Medical Technical University, Hai Duong, Vietnam
| | - Shota Miyaguchi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Hiraku Watanabe
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Graduate School, Niigata University of Health and Welfare, Niigata, Japan
| | - Kei Saito
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Naofumi Otsuru
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Hideaki Onishi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
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62
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Zhang JJ, Fong KNK. The Effects of Priming Intermittent Theta Burst Stimulation on Movement-Related and Mirror Visual Feedback-Induced Sensorimotor Desynchronization. Front Hum Neurosci 2021; 15:626887. [PMID: 33584232 PMCID: PMC7878678 DOI: 10.3389/fnhum.2021.626887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 01/06/2021] [Indexed: 11/24/2022] Open
Abstract
The potential benefits of priming intermittent theta burst stimulation (iTBS) with continuous theta burst stimulation (cTBS) have not been examined in regard to sensorimotor oscillatory activities recorded in electroencephalography (EEG). The objective of this study was to investigate the modulatory effect of priming iTBS (cTBS followed by iTBS) delivered to the motor cortex on movement-related and mirror visual feedback (MVF)-induced sensorimotor event-related desynchronization (ERD), compared with iTBS alone, on healthy adults. Twenty participants were randomly allocated into Group 1: priming iTBS—cTBS followed by iTBS, and Group 2: non-priming iTBS—sham cTBS followed by iTBS. The stimulation was delivered to the right primary motor cortex daily for 4 consecutive days. EEG was measured before and after 4 sessions of stimulation. Movement-related ERD was evaluated during left-index finger tapping and MVF-induced sensorimotor ERD was evaluated by comparing the difference between right-index finger tapping with and without MVF. After stimulation, both protocols increased movement-related ERD and MVF-induced sensorimotor ERD in high mu and low beta bands, indicated by significant time effects. A significant interaction effect favoring Group 1 in enhancing movement-related ERD was observed in the high mu band [F(1,18) = 4.47, p = 0.049], compared with Group 2. Our experiment suggests that among healthy adults priming iTBS with cTBS delivered to the motor cortex yields similar effects with iTBS alone on enhancing ERD induced by MVF-based observation, while movement-related ERD was more enhanced in the priming iTBS condition, specifically in the high mu band.
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Affiliation(s)
- Jack Jiaqi Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Kenneth N K Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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63
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Cantone M, Lanza G, Ranieri F, Opie GM, Terranova C. Editorial: Non-invasive Brain Stimulation in the Study and Modulation of Metaplasticity in Neurological Disorders. Front Neurol 2021; 12:721906. [PMID: 34276553 PMCID: PMC8277922 DOI: 10.3389/fneur.2021.721906] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/10/2021] [Indexed: 02/05/2023] Open
Affiliation(s)
- Mariagiovanna Cantone
- Department of Neurology, Sant'Elia Hospital, ASP Caltanissetta, Caltanissetta, Italy
- *Correspondence: Mariagiovanna Cantone orcid.org/0000-0002-9072-4971
| | - Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
- Department of Neurology IC, Oasi Research Institute–IRCCS, Troina, Italy
| | - Federico Ranieri
- Unit of Neurology, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - George M. Opie
- Discipline of Physiology, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Carmen Terranova
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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64
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Habich A, Fehér KD, Antonenko D, Boraxbekk CJ, Flöel A, Nissen C, Siebner HR, Thielscher A, Klöppel S. Stimulating aged brains with transcranial direct current stimulation: Opportunities and challenges. Psychiatry Res Neuroimaging 2020; 306:111179. [PMID: 32972813 DOI: 10.1016/j.pscychresns.2020.111179] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 06/30/2020] [Accepted: 09/03/2020] [Indexed: 02/06/2023]
Abstract
Ageing involves significant neurophysiological changes that are both systematic while at the same time exhibiting divergent trajectories across individuals. These changes underlie cognitive impairments in elderly while also affecting the response of aged brains to interventions like transcranial direct current stimulation (tDCS). While the cognitive benefits of tDCS are more variable in elderly, older adults also respond differently to stimulation protocols compared to young adults. The age-related neurophysiological changes influencing the responsiveness to tDCS remain to be addressed in-depth. We review and discuss the premise that, in comparison to the better calibrated brain networks present in young adults, aged systems perform further away from a homoeostatic set-point. We argue that this age-related neurophysiological deviation from the homoeostatic optimum extends the leeway for tDCS to modulate the aged brain. This promotes the potency of immediate tDCS effects to induce directional plastic changes towards the homoeostatic equilibrium despite the impaired plasticity induction in elderly. We also consider how age-related neurophysiological changes pose specific challenges for tDCS that necessitate proper adaptations of stimulation protocols. Appreciating the distinctive properties of aged brains and the accompanying adjustment of stimulation parameters can increase the potency and reliability of tDCS as a treatment avenue in older adults.
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Affiliation(s)
- Annegret Habich
- University Hospital of Old Age Psychiatry and Psychotherpa, University of Bern, Bolligenstrasse 111, 3000 Bern, Switzerland; Faculty of Biology, University of Freiburg, Schänzlestrasse 1, 79104 Freiburg, Germany.
| | - Kristoffer D Fehér
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000 Bern, Switzerland
| | - Daria Antonenko
- Department of Neurology, University of Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
| | - Carl-Johan Boraxbekk
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Østvej, 2650 Hvidovre, Denmark; Department of Radiation Sciences, Umeå University, 90187 Umeå, Sweden; Institute of Sports Medicine Copenhagen (ISMC), Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Agnes Flöel
- Department of Neurology, University of Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany; German Center for Neurodegenerative Diseases, Ellernholzstraße 1-2, 17489 Greifswald, Germany
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000 Bern, Switzerland; Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Freiburg, Hauptstraße 5, 79104 Freiburg, Germany
| | - Hartwig Roman Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Østvej, 2650 Hvidovre, Denmark; Department of Neurology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark; Institute for Clinical Medicine, Faculty of Medical and Health Sciences, University of Copenhagen, Nørre Allé 20, 2200 Copenhagen, Denmark
| | - Axel Thielscher
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Østvej, 2650 Hvidovre, Denmark; Department of Electrical Engineering, Technical University of Denmark, Ørsteds Pl. 348, 2800 Kgs. Lyngby, Denmark
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherpa, University of Bern, Bolligenstrasse 111, 3000 Bern, Switzerland
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65
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tDCS over posterior parietal cortex increases cortical excitability but decreases learning: An ERPs and TMS-EEG study. Brain Res 2020; 1753:147227. [PMID: 33385376 DOI: 10.1016/j.brainres.2020.147227] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 11/27/2020] [Accepted: 11/30/2020] [Indexed: 11/21/2022]
Abstract
The application of anodal transcranial direct current stimulation (AtDCS) is generally associated with increased neuronal excitability and enhanced cognitive functioning. Nevertheless, previous work showed that applying this straight reasoning does not always lead to the desired results at behavioural level. Here, we investigated electrophysiological markers of AtDCS-mediated effects on visuo-spatial contextual learning (VSCL). In order to assess cortical excitability changes after 3 mA AtDCS applied over posterior parietal cortex, event-related potentials (ERPs) were collected during task performance. Additionally, AtDCS-induced effects on cortical excitability were explored by measuring TMS-evoked potentials (TEPs) collected before AtDCS, after AtDCS and after AtDCS and VSCL interaction. Behavioural results revealed that the application of AtDCS induced a reduction of VSCL. At the electrophysiological level, ERPs showed enhanced cortical response (P2 component) in the group receiving Real-AtDCS as compared to Sham-AtDCS. Cortical responsiveness at rest as measured by TEP, did not indicate any significant difference between Real- and Sham-tDCS groups, albeit a trend was present. Overall, our results suggest that AtDCS increases cortical response to incoming visuo-spatial stimuli, but with no concurrent increase in learning. Detrimental effects on behaviour could result from the interaction between AtDCS- and task-mediated cortical activation. This interaction might enhance cortical excitability and hinder normal task-related neuroplastic phenomena subtending learning.
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66
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Katagiri N, Yoshida S, Koseki T, Kudo D, Namba S, Tanabe S, Huang YZ, Yamaguchi T. Interindividual Variability of Lower-Limb Motor Cortical Plasticity Induced by Theta Burst Stimulation. Front Neurosci 2020; 14:563293. [PMID: 33281542 PMCID: PMC7691321 DOI: 10.3389/fnins.2020.563293] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/24/2020] [Indexed: 11/23/2022] Open
Abstract
Theta burst stimulation (TBS) has been used as a tool to induce synaptic plasticity and improve neurological disorders. However, there is high interindividual variability in the magnitude of the plastic changes observed after TBS, which hinders its clinical applications. The electric field induced by transcranial magnetic stimulation (TMS) is strongly affected by the depth of the stimulated brain region. Therefore, it is possible that the variability in the response to TBS over the lower-limb motor cortex is different for the hand area. This study investigated the variability of TBS-induced synaptic plasticity in the lower-limb motor cortex, for intermittent TBS (iTBS), continuous TBS (cTBS), and sham iTBS, in 48 healthy young participants. The motor cortical and intracortical excitability of the tibialis anterior was tested before and after TBS using TMS. The results showed that iTBS had facilitatory effects on motor cortex excitability and intracortical inhibition, whereas cTBS exerted opposite effects. Twenty-seven percent of individuals exhibited enhanced motor cortical plasticity after iTBS, whereas 63% of participants showed enhanced plasticity after cTBS. In addition, the amount of TBS-induced plasticity was correlated with the intracortical excitability and the variability of the motor evoked potential prior to TBS. Our study demonstrated the high variability of the iTBS-induced lower-limb motor cortical plasticity, which was affected by the sensitivity of intracortical interneuronal circuits. These findings provide further insights into the variation of the response to TBS according to the anatomy of the stimulated brain region and the excitability of the intracortical circuit.
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Affiliation(s)
- Natsuki Katagiri
- Department of Physical Therapy, Yamagata Prefectural University of Health Sciences, Yamagata, Japan
| | - Shinya Yoshida
- Department of Physical Therapy, Yamagata Prefectural University of Health Sciences, Yamagata, Japan
| | - Tadaki Koseki
- Department of Physical Therapy, Yamagata Prefectural University of Health Sciences, Yamagata, Japan
| | - Daisuke Kudo
- Department of Physical Therapy, Yamagata Prefectural University of Health Sciences, Yamagata, Japan
| | - Shigehiro Namba
- Department of Physical Therapy, Yamagata Prefectural University of Health Sciences, Yamagata, Japan
| | - Shigeo Tanabe
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Aichi, Japan
| | - Ying-Zu Huang
- Neuroscience Research Center and Department of Neurology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tomofumi Yamaguchi
- Department of Physical Therapy, Yamagata Prefectural University of Health Sciences, Yamagata, Japan.,Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
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67
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Sundman MH, Lim K, Ton That V, Mizell JM, Ugonna C, Rodriguez R, Chen NK, Fuglevand AJ, Liu Y, Wilson RC, Fellous JM, Rapcsak S, Chou YH. Transcranial magnetic stimulation reveals diminished homoeostatic metaplasticity in cognitively impaired adults. Brain Commun 2020; 2:fcaa203. [PMID: 33376989 PMCID: PMC7750948 DOI: 10.1093/braincomms/fcaa203] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 09/22/2020] [Accepted: 10/13/2020] [Indexed: 12/13/2022] Open
Abstract
Homoeostatic metaplasticity is a neuroprotective physiological feature that counterbalances Hebbian forms of plasticity to prevent network destabilization and hyperexcitability. Recent animal models highlight dysfunctional homoeostatic metaplasticity in the pathogenesis of Alzheimer's disease. However, the association between homoeostatic metaplasticity and cognitive status has not been systematically characterized in either demented or non-demented human populations, and the potential value of homoeostatic metaplasticity as an early biomarker of cognitive impairment has not been explored in humans. Here, we report that, through pre-conditioning the synaptic activity prior to non-invasive brain stimulation, the association between homoeostatic metaplasticity and cognitive status could be established in a population of non-demented human subjects (older adults across cognitive spectrums; all within the non-demented range). All participants (n = 40; age range, 65-74, 47.5% female) underwent a standardized neuropsychological battery, magnetic resonance imaging and a transcranial magnetic stimulation protocol. Specifically, we sampled motor-evoked potentials with an input/output curve immediately before and after repetitive transcranial magnetic stimulation to assess neural plasticity with two experimental paradigms: one with voluntary muscle contraction (i.e. modulated synaptic activity history) to deliberately introduce homoeostatic interference, and one without to serve as a control condition. From comparing neuroplastic responses across these experimental paradigms and across cohorts grouped by cognitive status, we found that (i) homoeostatic metaplasticity is diminished in our cohort of cognitively impaired older adults and (ii) this neuroprotective feature remains intact in cognitively normal participants. This novel finding suggests that (i) future studies should expand their scope beyond just Hebbian forms of plasticity that are traditionally assessed when using non-invasive brain stimulation to investigate cognitive ageing and (ii) the potential value of homoeostatic metaplasticity in serving as a biomarker for cognitive impairment should be further explored.
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Affiliation(s)
- Mark H Sundman
- Department of Psychology, University of Arizona, Tucson, AZ 85721, USA
| | - Koeun Lim
- Department of Psychology, University of Arizona, Tucson, AZ 85721, USA
| | - Viet Ton That
- Department of Psychology, University of Arizona, Tucson, AZ 85721, USA
| | | | - Chidi Ugonna
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ 85721, USA
- Department of Medical Imaging, University of Arizona, Tucson, AZ 85721, USA
| | - Rudolph Rodriguez
- Department of Psychology, University of Arizona, Tucson, AZ 85721, USA
| | - Nan-Kuei Chen
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ 85721, USA
- Department of Medical Imaging, University of Arizona, Tucson, AZ 85721, USA
| | - Andrew J Fuglevand
- Department of Physiology, College of Medicine, University of Arizona, Tucson, AZ 85721, USA
- Department of Neuroscience, College of Medicine, University of Arizona, Tucson, AZ 85721, USA
| | - Yilin Liu
- Department of Psychology, University of Arizona, Tucson, AZ 85721, USA
| | - Robert C Wilson
- Department of Psychology, University of Arizona, Tucson, AZ 85721, USA
| | - Jean-Marc Fellous
- Department of Psychology, University of Arizona, Tucson, AZ 85721, USA
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ 85721, USA
| | - Steven Rapcsak
- Department of Psychology, University of Arizona, Tucson, AZ 85721, USA
- Department of Neurology, University of Arizona, Tucson, AZ 85721, USA
| | - Ying-Hui Chou
- Department of Psychology, University of Arizona, Tucson, AZ 85721, USA
- Evelyn F. McKnight Brain Institute, Arizona Center on Aging, and BIO5 Institute, University of Arizona, Tucson, AZ 85721, USA
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68
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Thomson AC, Sack AT. How to Design Optimal Accelerated rTMS Protocols Capable of Promoting Therapeutically Beneficial Metaplasticity. Front Neurol 2020; 11:599918. [PMID: 33224103 PMCID: PMC7674552 DOI: 10.3389/fneur.2020.599918] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/22/2020] [Indexed: 12/11/2022] Open
Affiliation(s)
- Alix C Thomson
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht, Netherlands.,Centre for Integrative Neuroscience, Faculty of Psychology and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Alexander T Sack
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht, Netherlands.,Centre for Integrative Neuroscience, Faculty of Psychology and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
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69
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Guerra A, Asci F, Zampogna A, D'Onofrio V, Petrucci S, Ginevrino M, Berardelli A, Suppa A. Gamma-transcranial alternating current stimulation and theta-burst stimulation: inter-subject variability and the role of BDNF. Clin Neurophysiol 2020; 131:2691-2699. [DOI: 10.1016/j.clinph.2020.08.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/03/2020] [Accepted: 08/11/2020] [Indexed: 12/12/2022]
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70
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Abstract
Neuroplasticity is an area of expanding interest in psychiatry. Plasticity and metaplasticity are processes contributing to the scaling up and down of neuronal connections, and they are involved with changes in learning, memory, mood, and sleep. Effective mood treatments, including repetitive transcranial magnetic stimulation (rTMS), are reputed to work via changes in neuronal circuitry. This article explores the interrelatedness of sleep, plasticity, and rTMS treatment. A PubMed-based literature review was conducted to identify all available studies examining the relationship of rTMS, plasticity, and sleep. Key words used in this search included "TMS," "transcranial magnetic stimulation," "plasticity," "metaplasticity," "sleep," and "insomnia." Depressed mood tends to be associated with impaired neural plasticity, while antidepressant treatments can augment neural plasticity. rTMS impacts plasticity, yielding long-lasting effects, with differing impacts on the waking and sleeping brain. Higher quality sleep promotes plasticity and learning. Reports on the sleep impact of high-frequency and low-frequency rTMS are mixed. The efficacy of rTMS may rely on brain plasticity manipulation, enhanced via the stimulation of neural circuits. Total sleep time and sleep continuity are sleep qualities that are likely necessary but insufficient for the homeostatic plasticity driven by slow-wave sleep. Understanding the relationship between sleep and rTMS treatment is likely critical to enhancing outcomes.
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71
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Tscherpel C, Grefkes C. Funktionserholung nach Schlaganfall und die therapeutische Rolle der nicht-invasiven Hirnstimulation. KLIN NEUROPHYSIOL 2020. [DOI: 10.1055/a-1272-9435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ZusammenfassungIm Bereich der non-invasiven Hirnstimulation stellen die transkranielle Magnetstimulation (engl. transcranial magnetic stimulation, TMS) sowie die transkranielle Gleichstromstimulation (engl. transcranial direct current stimulation, tDCS) bis heute die wichtigsten Techniken zur Modulation kortikaler Erregbarkeit dar. Beide Verfahren induzieren Nacheffekte, welche die Zeit der reinen Stimulation überdauern, und ebnen damit den Weg für ihren therapeutischen Einsatz beim Schlaganfall. In diesem Übersichtsartikel diskutieren wir die aktuelle Datenlage TMS- und tDCS-vermittelter Therapien für die häufigsten schlaganfallbedingten Defizite wie Hemiparese, Aphasie und Neglect. Darüber hinaus adressieren wir mögliche Einschränkungen der gegenwärtigen Ansätze und zeigen Ansatzpunkte auf, um Neuromodulation nach Schlaganfall effektiver zu gestalten und damit das Outcome der Patienten zu verbessern.
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Affiliation(s)
- Caroline Tscherpel
- Klinik und Poliklinik für Neurologie, Universitätsklinik Köln
- Institut für Neurowissenschaften und Medizin (INM-3), Forschungszentrum Jülich
| | - Christian Grefkes
- Klinik und Poliklinik für Neurologie, Universitätsklinik Köln
- Institut für Neurowissenschaften und Medizin (INM-3), Forschungszentrum Jülich
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72
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Cheng I, Scarlett H, Zhang M, Hamdy S. Preconditioning human pharyngeal motor cortex enhances directional metaplasticity induced by repetitive transcranial magnetic stimulation. J Physiol 2020; 598:5213-5230. [DOI: 10.1113/jp279977] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/11/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
- Ivy Cheng
- Centre for Gastrointestinal Sciences, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health University of Manchester Manchester UK
| | - Honor Scarlett
- Division of Neuroscience & Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health University of Manchester Manchester UK
| | - Mengqing Zhang
- Centre for Gastrointestinal Sciences, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health University of Manchester Manchester UK
- Department of Rehabilitation Medicine, The Third Affiliated Hospital Sun Yat‐sen University Guangzhou China
| | - Shaheen Hamdy
- Centre for Gastrointestinal Sciences, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health University of Manchester Manchester UK
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The Effects of 1 mA tACS and tRNS on Children/Adolescents and Adults: Investigating Age and Sensitivity to Sham Stimulation. Neural Plast 2020; 2020:8896423. [PMID: 32855633 PMCID: PMC7443018 DOI: 10.1155/2020/8896423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/10/2020] [Accepted: 07/14/2020] [Indexed: 12/24/2022] Open
Abstract
The aim of this study was to investigate the effect of transcranial random noise (tRNS) and transcranial alternating current (tACS) stimulation on motor cortex excitability in healthy children and adolescents. Additionally, based on our recent results on the individual response to sham in adults, we explored this effect in the pediatric population. We included 15 children and adolescents (10-16 years) and 28 adults (20-30 years). Participants were stimulated four times with 20 Hz and 140 Hz tACS, tRNS, and sham stimulation (1 mA) for 10 minutes over the left M1HAND. Single-pulse MEPs (motor evoked potential), short-interval intracortical inhibition, and facilitation were measured by TMS before and after stimulation (baseline, 0, 30, 60 minutes). We also investigated aspects of tolerability. According to the individual MEPs response immediately after sham stimulation compared to baseline (Wilcoxon signed-rank test), subjects were regarded as responders or nonresponders to sham. We did not find a significant age effect. Regardless of age, 140 Hz tACS led to increased excitability. Incidence and intensity of side effects did not differ between age groups or type of stimulation. Analyses on responders and nonresponders to sham stimulation showed effects of 140 Hz, 20 Hz tACS, and tRNS on single-pulse MEPs only for nonresponders. In this study, children and adolescents responded to 1 mA tRNS and tACS comparably to adults regarding the modulation of motor cortex excitability. This study contributes to the findings that noninvasive brain stimulation is well tolerated in children and adolescents including tACS, which has not been studied before. Finally, our study supports a modulating role of sensitivity to sham stimulation on responsiveness to a broader stimulation and age range.
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Galli G, Miniussi C, Pellicciari MC. Transcranial electric stimulation as a neural interface to gain insight on human brain functions: current knowledge and future perspective. Soc Cogn Affect Neurosci 2020; 17:4-14. [PMID: 32756871 DOI: 10.1093/scan/nsaa099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/12/2020] [Accepted: 07/11/2020] [Indexed: 11/12/2022] Open
Abstract
The use of brain-stimulation approaches in social and affective science has greatly increased over the last two decades. The interest in social factors has grown along with technological advances in brain research. Transcranial electric stimulation (tES) is a research tool that allows scientists to establish contributory causality between brain functioning and social behaviour, therefore deepening our understanding of the social mind. Preliminary evidence is also starting to demonstrate that tES, either alone or in combination with pharmacological or behavioural interventions, can alleviate the symptomatology of individuals with affective or social cognition disorders. This review offers an overview of the application of tES in the field of social and affective neuroscience. We discuss issues and challenges related to this application and suggest avenue for future basic and translational research.
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Affiliation(s)
- Giulia Galli
- Department of Psychology, Kingston University, Penrhyn Road, Kingston Upon Thames, KT1 2EE, United Kingdom
| | - Carlo Miniussi
- Center for Mind/Brain Sciences - CIMeC, University of Trento, Corso Bettini, 31, 38068 Rovereto, TN Italy
| | - Maria Concetta Pellicciari
- UniCamillus - Saint Camillus International University of Health Sciences, via di Sant'Alessandro 8, 00131, Rome, Italy
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75
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Investigating the influence of paired-associative stimulation on multi-session skill acquisition and retention in older adults. Clin Neurophysiol 2020; 131:1497-1507. [DOI: 10.1016/j.clinph.2020.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/19/2020] [Accepted: 04/13/2020] [Indexed: 12/26/2022]
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76
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Yu F, Tang X, Hu R, Liang S, Wang W, Tian S, Wu Y, Yuan TF, Zhu Y. The After-Effect of Accelerated Intermittent Theta Burst Stimulation at Different Session Intervals. Front Neurosci 2020; 14:576. [PMID: 32670006 PMCID: PMC7330092 DOI: 10.3389/fnins.2020.00576] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/11/2020] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE The study aims to investigate the after-effect of three sessions of intermittent theta-burst stimulation (iTBS) on motor cortical excitability. The iTBS was induced over the primary motor cortex (M1) at different time intervals. METHODS The study has a crossover design. Sixteen participants were assigned to three groups and received different accelerated iTBS (aiTBS) protocols during each visit: (1) three continuous sessions with no interval (iTBS18000); (2) three iTBS sessions with 10-min intervals (iTBS600 × 3∗10); and (3) three iTBS sessions with 30-min intervals (iTBS600 × 3∗30). As washout period, each visit is separated by at least 7 days. We measured the motor cortical excitability changes and intracortical inhibition. RESULTS A dose of 1,800 pulses of aiTBS per day is tolerable. The iTBS1800 led to a reduced cortical excitability; whereas iTBS600 × 3∗10 and iTBS600 × 3∗30 enhanced cortical excitability to a differential extent. After a total dose of 1,800 pulses, iTBS600 × 3∗30 exhibited the longer effect and highest percentage of individuals with enhanced cortical excitability. CONCLUSION The results suggest that aiTBS protocols at different time intervals result in different motor cortical excitability after-effects.
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Affiliation(s)
- Fengyun Yu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Xinwei Tang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Ruiping Hu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Sijie Liang
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Weining Wang
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Shan Tian
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yi Wu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Ti-Fei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Co-innovation Center of Neuroregeneration, Nantong University, Nantong, China
| | - Yulian Zhu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
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77
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Bergmann TO, Hartwigsen G. Inferring Causality from Noninvasive Brain Stimulation in Cognitive Neuroscience. J Cogn Neurosci 2020; 33:195-225. [PMID: 32530381 DOI: 10.1162/jocn_a_01591] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Noninvasive brain stimulation (NIBS) techniques, such as transcranial magnetic stimulation or transcranial direct and alternating current stimulation, are advocated as measures to enable causal inference in cognitive neuroscience experiments. Transcending the limitations of purely correlative neuroimaging measures and experimental sensory stimulation, they allow to experimentally manipulate brain activity and study its consequences for perception, cognition, and eventually, behavior. Although this is true in principle, particular caution is advised when interpreting brain stimulation experiments in a causal manner. Research hypotheses are often oversimplified, disregarding the underlying (implicitly assumed) complex chain of causation, namely, that the stimulation technique has to generate an electric field in the brain tissue, which then evokes or modulates neuronal activity both locally in the target region and in connected remote sites of the network, which in consequence affects the cognitive function of interest and eventually results in a change of the behavioral measure. Importantly, every link in this causal chain of effects can be confounded by several factors that have to be experimentally eliminated or controlled to attribute the observed results to their assumed cause. This is complicated by the fact that many of the mediating and confounding variables are not directly observable and dose-response relationships are often nonlinear. We will walk the reader through the chain of causation for a generic cognitive neuroscience NIBS study, discuss possible confounds, and advise appropriate control conditions. If crucial assumptions are explicitly tested (where possible) and confounds are experimentally well controlled, NIBS can indeed reveal cause-effect relationships in cognitive neuroscience studies.
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Affiliation(s)
| | - Gesa Hartwigsen
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
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78
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Mezes M, Havu R, Tolmacheva A, Lioumis P, Mäkelä JP, Shulga A. The impact of TMS and PNS frequencies on MEP potentiation in PAS with high-frequency peripheral component. PLoS One 2020; 15:e0233999. [PMID: 32470028 PMCID: PMC7259644 DOI: 10.1371/journal.pone.0233999] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/15/2020] [Indexed: 11/18/2022] Open
Abstract
Paired associative stimulation (PAS) combines transcranial magnetic stimulation (TMS) and peripheral nerve stimulation (PNS) to induce plastic changes in the corticospinal tract. PAS employing single 0.2-Hz TMS pulses synchronized with the first pulse of 50–100 Hz PNS trains potentiates motor-evoked potentials (MEPs) in a stable manner in healthy participants and enhances voluntary motor output in spinal cord injury (SCI) patients. We further investigated the impact of settings of this PAS variant on MEP potentiation in healthy subjects. In experiment 1, we compared 0.2-Hz vs 0.4-Hz PAS. In experiment 2, PNS frequencies of 100 Hz, 200 Hz, and 400 Hz were compared. In experiment 3, we added a second TMS pulse. When compared with 0.4-Hz PAS, 0.2-Hz PAS was significantly more effective after 30 minutes (p = 0.05) and 60 minutes (p = 0.014). MEP potentiation by PAS with 100-Hz and 200-Hz PNS did not differ. PAS with 400-Hz PNS was less effective than 100-Hz (p = 0.023) and 200-Hz (p = 0.013) PNS. Adding an extra TMS pulse rendered PAS strongly inhibitory. These negative findings demonstrate that the 0.2-Hz PAS with 100-Hz PNS previously used in clinical studies is optimal and the modifications employed here do not enhance its efficacy.
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Affiliation(s)
- Magdolna Mezes
- Department of Neurology, Christian Doppler Medical Centre, Paracelsus Medical University and Centre for Cognitive Neuroscience, Salzburg, Austria
| | - Roope Havu
- BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Aleksandra Tolmacheva
- BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pantelis Lioumis
- BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Helsinki, Finland
| | - Jyrki P. Mäkelä
- BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anastasia Shulga
- BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- * E-mail:
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79
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Double Trouble: Treatment Considerations for Patients with Comorbid PTSD and Depression. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s40501-020-00213-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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80
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Transcranial magnetic stimulation in major depressive disorder: Response modulation and state dependency. J Affect Disord 2020; 266:793-801. [PMID: 32217261 DOI: 10.1016/j.jad.2020.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/13/2020] [Accepted: 02/01/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Transcranial Magnetic Stimulation (TMS) has emerged as a valid therapeutic option in the treatment of depression, especially in cases of inadequate response to antidepressant agents. Despite the recognized efficacy of this technique, its mechanisms of action are still debated and optimal protocols have not yet been established. METHODS The present review focuses on TMS protocols that either engage the targeted brain circuits or synchronize the stimulation frequency to individual neuronal oscillations to increase the antidepressant efficacy. RESULTS TMS efficacy was found to be enhanced by preliminary or concomitant modulation of the functional state of the targeted brain networks. Conversely, there is not enough evidence of higher efficacy of TMS protocols with individual selection of the stimulation frequency compared to standard ones. LIMITATIONS Most studies included small patient samples. CONCLUSIONS Our results suggest that a good option to enhance rTMS efficacy might be to follow synaptic potentiation and depression rules.
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81
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Acute aerobic exercise and neuroplasticity of the motor cortex: A systematic review. J Sci Med Sport 2020; 23:408-414. [DOI: 10.1016/j.jsams.2019.10.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/02/2019] [Accepted: 10/22/2019] [Indexed: 01/30/2023]
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82
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Hassanzahraee M, Nitsche MA, Zoghi M, Jaberzadeh S. Determination of anodal tDCS duration threshold for reversal of corticospinal excitability: An investigation for induction of counter-regulatory mechanisms. Brain Stimul 2020; 13:832-839. [PMID: 32289714 DOI: 10.1016/j.brs.2020.02.027] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/18/2020] [Accepted: 02/21/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) is used to induce neuroplasticity in the human brain. Within certain limits of stimulation duration, anodal tDCS (a-tDCS) over the primary motor cortex induces long term potentiation- (LTP) like plasticity. A reversal of the direction of plasticity has however been described with prolonged a-tDCS protocols. OBJECTIVE We aimed to systematically investigate the intervention duration threshold for reversal of a-tDCS-induced effects on corticospinal excitability (CSE) and to determine the probable mechanisms involved in these changes. METHODS Fifteen healthy participants received a-tDCS of 1 mA for five different durations in pseudo-random session order. Transcranial magnetic stimulation (TMS) was delivered over the left M1, and motor evoked potentials (MEPs) of a contralateral hand muscle were recorded before, immediately and 30 min following intervention to measure CSE changes. Short-interval intracortical inhibition (SICI), intracortical facilitation (ICF), and long interval facilitation (LIF) were assessed via paired-pulse TMS protocols. RESULTS A-tDCS significantly increased CSE as expected at stimulation durations of 22 and 24 min. However, this effect of a-tDCS on CSE decreased and even reversed when stimulation duration increased to 26, 28, and 30 min. Respective alterations of ICF, LIF, and SICI indicate the involvement of glutamatergic, and GABAergic systems in these effects. CONCLUSIONS These results confirm a duration threshold for reversal of the excitability-enhancing effect of a-tDCS with stimulation durations ≥ 26 min. Counter-regulatory mechanisms are discussed as a mechanistic foundation for these effects, which might prevent excessive brain activation.
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Affiliation(s)
- Maryam Hassanzahraee
- Non-invasive Brain Stimulation & Neuroplasticity Laboratory, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Australia.
| | - Michael A Nitsche
- Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany; Dept. Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Maryam Zoghi
- Department of Rehabilitation, Nutrition and Sport, School of Allied Health, Discipline of Physiotherapy, La Trobe University, Melbourne, Australia
| | - Shapour Jaberzadeh
- Non-invasive Brain Stimulation & Neuroplasticity Laboratory, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Australia
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83
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Capone F, Pellegrino G, Motolese F, Rossi M, Musumeci G, Di Lazzaro V. Extremely Low Frequency Magnetic Fields Do Not Affect LTP-Like Plasticity in Healthy Humans. Front Hum Neurosci 2020; 14:14. [PMID: 32116603 PMCID: PMC7014826 DOI: 10.3389/fnhum.2020.00014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/14/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Several studies explored the biological effects of extremely low-frequency magnetic fields (ELF-MFs) in vitro, reporting the induction of functional changes in neuronal activity. In particular, ELF-MFs can influence synaptic plasticity both in vitro and in animal models but some studies reported an increase in long-term potentiation (LTP) whereas others suggested its reduction. However, no specific study has investigated such effect on humans. Aims To evaluate whether ELF-MFs affect the propensity of the human cortex to undergo LTP-like plasticity. Methods We designed a randomized, single-blind, sham-controlled, cross-over study on 10 healthy subjects. Cortical plasticity was induced by intermittent theta burst stimulation (iTBS) before and after 45-min ELF-MFs (75 Hz; 1.8 mT) or sham exposure and was estimated by measuring the changes of motor evoked potentials (MEP) amplitude before and after each iTBS. Results No adverse events were reported. No significant effects of ELF-MFs on cortical plasticity were found. Conclusion Whole-brain exposure to ELF-MFs (75 Hz; 1.8 mT) is safe and does not seem to significantly affect LTP-like plasticity in human motor cortex.
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Affiliation(s)
- Fioravante Capone
- Unit of Neurology, Neurophysiology, and Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy.,NeXT: Neurophysiology and Neuroengineering of Human-Technology Interaction Research Unit, Campus Bio-Medico University, Rome, Italy
| | - Giovanni Pellegrino
- Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Francesco Motolese
- Unit of Neurology, Neurophysiology, and Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy.,NeXT: Neurophysiology and Neuroengineering of Human-Technology Interaction Research Unit, Campus Bio-Medico University, Rome, Italy
| | - Mariagrazia Rossi
- Unit of Neurology, Neurophysiology, and Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy.,NeXT: Neurophysiology and Neuroengineering of Human-Technology Interaction Research Unit, Campus Bio-Medico University, Rome, Italy
| | - Gabriella Musumeci
- Unit of Neurology, Neurophysiology, and Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy.,NeXT: Neurophysiology and Neuroengineering of Human-Technology Interaction Research Unit, Campus Bio-Medico University, Rome, Italy
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, and Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
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84
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Cameron IGM, Cretu AL, Struik F, Toni I. The Effects of a TMS Double Perturbation to a Cortical Network. eNeuro 2020; 7:ENEURO.0188-19.2019. [PMID: 31924733 PMCID: PMC7004488 DOI: 10.1523/eneuro.0188-19.2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 12/02/2019] [Accepted: 12/04/2019] [Indexed: 12/01/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) is often used to understand the function of individual brain regions, but this ignores the fact that TMS may affect network-level rather than nodal-level processes. We examine the effects of a double perturbation to two frontoparietal network nodes, compared with the effects of single lesions to either node. We hypothesized that Bayesian evidence for the absence of effects that build upon one another indicates that a single perturbation is consequential to network-level processes. Twenty-three humans performed pro-saccades (look toward) and anti-saccades (look away) after receiving continuous theta-burst stimulation (cTBS) to right frontal eye fields (FEFs), dorsolateral prefrontal cortex (DLPFC), or somatosensory cortex (S1; the control region). On a subset of trials, a TMS pulse was applied to right posterior parietal cortex (PPC). FEF, DLPFC, and PPC are important frontoparietal network nodes for generating anti-saccades. Bayesian t tests were used to test hypotheses for enhanced double perturbation effects (cTBS plus TMS pulse) on saccade behaviors, against the alternative hypothesis that double perturbation effects to a network are not greater than single perturbation effects. In one case, we observed strong evidence [Bayes factor (BF10) = 325] that PPC TMS following DLPFC cTBS enhanced impairments in ipsilateral anti-saccade amplitudes over DLPFC cTBS alone, and not over the effect of the PPC pulse alone (BF10 = 0.75), suggesting that double perturbation effects do not augment one another. Rather, this suggests that computations are distributed across the network, and in some cases there can be compensation for cTBS perturbations.
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Affiliation(s)
- Ian G M Cameron
- Donders Institute for Brain Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, 6525 EN, Nijmegen, The Netherlands
| | - Andreea L Cretu
- Donders Institute for Brain Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, 6525 EN, Nijmegen, The Netherlands
| | - Femke Struik
- Donders Institute for Brain Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, 6525 EN, Nijmegen, The Netherlands
| | - Ivan Toni
- Donders Institute for Brain Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, 6525 EN, Nijmegen, The Netherlands
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85
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Yang YW, Pan WX, Xie Q. Combined effect of repetitive transcranial magnetic stimulation and physical exercise on cortical plasticity. Neural Regen Res 2020; 15:1986-1994. [PMID: 32394946 PMCID: PMC7716032 DOI: 10.4103/1673-5374.282239] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Physical exercise can minimize dysfunction and optimize functional motor recovery after stroke by modulating cortical plasticity. However, the limitation of physical exercise is that large amounts of time and effort are necessary to significantly improve motor function, and even then, substantial exercise may not be sufficient to normalize the observed improvements. Thus, interventions that could be used to strengthen physical exercise-induced neuroplasticity may be valuable in treating hemiplegia after stroke. Repetitive transcranial magnetic stimulation seems to be a viable strategy for enhancing such plasticity. As a non-invasive cortical stimulation technique, repetitive transcranial magnetic stimulation is able to induce long-term plastic changes in the motor system. Recently, repetitive transcranial magnetic stimulation was found to optimize the plastic changes caused by motor training, thereby enhancing the long-term effects of physical exercise in stroke patients. Therefore, it is believed that the combination of repetitive transcranial magnetic stimulation and physical exercise may represent a superior method for restoring motor function after stroke.
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Affiliation(s)
- Ya-Wen Yang
- Department of Rehabilitation Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wen-Xiu Pan
- Department of Rehabilitation Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qing Xie
- Department of Rehabilitation Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University; Department of Rehabilitation Medicine, Shanghai Ruijin Rehabilitation Hospital, Shanghai, China
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86
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Sato D, Yamashiro K, Yamazaki Y, Ikarashi K, Onishi H, Baba Y, Maruyama A. Priming Effects of Water Immersion on Paired Associative Stimulation-Induced Neural Plasticity in the Primary Motor Cortex. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010215. [PMID: 31892253 PMCID: PMC6982345 DOI: 10.3390/ijerph17010215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 12/21/2019] [Accepted: 12/23/2019] [Indexed: 11/16/2022]
Abstract
We aimed to verify whether indirect-wave (I-wave) recruitment and cortical inhibition can regulate or predict the plastic response to paired associative stimulation with an inter-stimulus interval of 25 ms (PAS25), and also whether water immersion (WI) can facilitate the subsequent PAS25-induced plasticity. To address the first question, we applied transcranial magnetic stimulation (TMS) to the M1 hand area, while alternating the direction of the induced current between posterior-to-anterior and anterior-to-posterior to activate two independent synaptic inputs to the corticospinal neurons. Moreover, we used a paired stimulation paradigm to evaluate the short-latency afferent inhibition (SAI) and short-interval intracortical inhibition (SICI). To address the second question, we examined the motor evoked potential (MEP) amplitudes before and after PAS25, with and without WI, and used the SAI, SICI, and MEP recruitment curves to determine the mechanism underlying priming by WI on PAS25. We demonstrated that SAI, with an inter-stimulus interval of 25 ms, might serve as a predictor of the response to PAS25, whereas I-wave recruitment evaluated by the MEP latency difference was not predictive of the PAS25 response, and found that 15 min WI prior to PAS25 facilitated long-term potentiation (LTP)-like plasticity due to a homeostatic increase in cholinergic activity.
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Affiliation(s)
- Daisuke Sato
- Department of Health and Sports, Niigata University of Health and Welfare, Shimamicho 1398, Kita-ku, Niigata City, Niigata 950-3198, Japan; (K.Y.); (Y.B.)
- Institute for Human Movement and Medical Science, Niigata University of Health and Welfare, Shimamicho 1398, Kita-ku, Niigata City, Niigata 950-3198, Japan; (Y.Y.); (K.I.); (H.O.)
- Correspondence:
| | - Koya Yamashiro
- Department of Health and Sports, Niigata University of Health and Welfare, Shimamicho 1398, Kita-ku, Niigata City, Niigata 950-3198, Japan; (K.Y.); (Y.B.)
- Institute for Human Movement and Medical Science, Niigata University of Health and Welfare, Shimamicho 1398, Kita-ku, Niigata City, Niigata 950-3198, Japan; (Y.Y.); (K.I.); (H.O.)
| | - Yudai Yamazaki
- Institute for Human Movement and Medical Science, Niigata University of Health and Welfare, Shimamicho 1398, Kita-ku, Niigata City, Niigata 950-3198, Japan; (Y.Y.); (K.I.); (H.O.)
- Graduate School, Niigata University of Health and Welfare, Shimamicho 1398, Kita-ku, Niigata City, Niigata 950-3198, Japan
| | - Koyuki Ikarashi
- Institute for Human Movement and Medical Science, Niigata University of Health and Welfare, Shimamicho 1398, Kita-ku, Niigata City, Niigata 950-3198, Japan; (Y.Y.); (K.I.); (H.O.)
- Graduate School, Niigata University of Health and Welfare, Shimamicho 1398, Kita-ku, Niigata City, Niigata 950-3198, Japan
| | - Hideaki Onishi
- Institute for Human Movement and Medical Science, Niigata University of Health and Welfare, Shimamicho 1398, Kita-ku, Niigata City, Niigata 950-3198, Japan; (Y.Y.); (K.I.); (H.O.)
| | - Yasuhiro Baba
- Department of Health and Sports, Niigata University of Health and Welfare, Shimamicho 1398, Kita-ku, Niigata City, Niigata 950-3198, Japan; (K.Y.); (Y.B.)
| | - Atsuo Maruyama
- Department of Rehabilitation Medicine, Kagoshima University, Sakuragaoka 8-35-1, Kagoshima City, Kagoshima 890-8520, Japan;
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Pineda-Pardo JA, Obeso I, Guida P, Dileone M, Strange BA, Obeso JA, Oliviero A, Foffani G. Static magnetic field stimulation of the supplementary motor area modulates resting-state activity and motor behavior. Commun Biol 2019; 2:397. [PMID: 31701026 PMCID: PMC6823375 DOI: 10.1038/s42003-019-0643-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 09/10/2019] [Indexed: 12/12/2022] Open
Abstract
Focal application of a strong static magnetic field over the human scalp induces measurable local changes in brain function. Whether it also induces distant effects across the brain and how these local and distant effects collectively affect motor behavior remains unclear. Here we applied transcranial static magnetic field stimulation (tSMS) over the supplementary motor area (SMA) in healthy subjects. At a behavioral level, tSMS increased the time to initiate movement while decreasing errors in choice reaction-time tasks. At a functional level, tSMS increased SMA resting-state fMRI activity and bilateral functional connectivity between the SMA and both the paracentral lobule and the lateral frontotemporal cortex, including the inferior frontal gyrus. These results suggest that tSMS over the SMA can induce behavioral aftereffects associated with modulation of both local and distant functionally-connected cortical circuits involved in the control of speed-accuracy tradeoffs, thus offering a promising protocol for cognitive and clinical research.
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Affiliation(s)
- José A. Pineda-Pardo
- CINAC, Hospital Universitario HM Puerta del Sur, Móstoles, Universidad CEU-San Pablo, Madrid, Spain
| | - Ignacio Obeso
- CINAC, Hospital Universitario HM Puerta del Sur, Móstoles, Universidad CEU-San Pablo, Madrid, Spain
| | - Pasqualina Guida
- CINAC, Hospital Universitario HM Puerta del Sur, Móstoles, Universidad CEU-San Pablo, Madrid, Spain
| | - Michele Dileone
- CINAC, Hospital Universitario HM Puerta del Sur, Móstoles, Universidad CEU-San Pablo, Madrid, Spain
| | - Bryan A. Strange
- Laboratory for Clinical Neuroscience, CTB, Universidad Politecnica de Madrid, Madrid, Spain
- Department of Neuroimaging, Alzheimer’s Disease Research Centre, Reina Sofia-CIEN Foundation, Madrid, Spain
| | - José A. Obeso
- CINAC, Hospital Universitario HM Puerta del Sur, Móstoles, Universidad CEU-San Pablo, Madrid, Spain
- CIBERNED, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Guglielmo Foffani
- CINAC, Hospital Universitario HM Puerta del Sur, Móstoles, Universidad CEU-San Pablo, Madrid, Spain
- Hospital Nacional de Parapléjicos, Toledo, Spain
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88
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Kortuem V, Kadish NE, Siniatchkin M, Moliadze V. Efficacy of tRNS and 140 Hz tACS on motor cortex excitability seemingly dependent on sensitivity to sham stimulation. Exp Brain Res 2019; 237:2885-2895. [PMID: 31482197 DOI: 10.1007/s00221-019-05640-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 08/27/2019] [Indexed: 11/25/2022]
Abstract
This study investigates the effect of corticospinal excitability during sham stimulation on the individual response to transcranial non-invasive brain stimulation (tNIBS). Thirty healthy young adults aged 24.2 ± 2.8 S.D. participated in the study. Sham, as well as 1 mA of tRNS and 140 Hz tACS stimulation were applied for 10 min each at different sessions. The effect of each stimulation type was quantified by recording TMS-induced, motor evoked potentials (MEPs) before (baseline) and at fixed time points after stimulation (T0, T30, T60 min.). According to the individual response to sham stimulation at T0 in comparison to baseline MEPs, subjects were regarded as responder or non-responder to sham. Following, MEPs at T0, T30 and T60 after verum or sham stimulation were assessed with a repeated measures ANOVA with the within-subject factor stimulation (sham, tRNS, 140 Hz tACS) and the between-subjects factor group (responder vs non-responder). We found that individuals who did not show immediately changes in excitability in sham stimulation sessions were the ones who responded to active stimulation conditions. On the other hand, individuals who responded to sham condition, by either increases or decreases in MEPS, did not respond to active verum stimulation. This result suggests that the presence or lack of responses to sham stimulation can provide a marker for how individuals will respond to tRNS/tACS and thus provide an explanation for the variability in interindividual response. The results of this study draw attention to the general reactivity of the brain, which can be taken into account when planning future studies using tNIBS.
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Affiliation(s)
- Viktoria Kortuem
- Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig Holstein, Kiel University, Preußerstraße 1-9, 24105, Kiel, Germany
| | - Navah Ester Kadish
- Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig Holstein, Kiel University, Preußerstraße 1-9, 24105, Kiel, Germany
| | - Michael Siniatchkin
- Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig Holstein, Kiel University, Preußerstraße 1-9, 24105, Kiel, Germany.,Clinic for Child and Adolescent Psychiatry, Hospital Bethel, Remterweg 13a, 33617, Bielefeld, Germany
| | - Vera Moliadze
- Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig Holstein, Kiel University, Preußerstraße 1-9, 24105, Kiel, Germany.
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89
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Thomson AC, de Graaf TA, Kenis G, Rutten BP, Schuhmann T, Sack AT. No additive meta plasticity effects of accelerated iTBS with short inter-session intervals. Brain Stimul 2019; 12:1301-1303. [DOI: 10.1016/j.brs.2019.05.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 05/13/2019] [Indexed: 12/15/2022] Open
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90
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Morris TP, Davila-Pérez P, Jannati A, Menardi A, Pascual-Leone A, Fried PJ. Aftereffects of Intermittent Theta-Burst Stimulation in Adjacent, Non-Target Muscles. Neuroscience 2019; 418:157-165. [PMID: 31476358 DOI: 10.1016/j.neuroscience.2019.08.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 08/01/2019] [Accepted: 08/22/2019] [Indexed: 11/18/2022]
Abstract
To assess motor cortex neurophysiology, including the mechanisms of neuroplasticity, transcranial magnetic stimulation (TMS) is typically applied to the motor "hotspot"- the optimal site for inducing a twitch in a given target muscle. It is known that the effects of suprathreshold repetitive TMS (rTMS) spread along functional connections beyond the specific cortical stimulation target, and yet, it is unknown whether the aftereffects of subthreshold intermittent theta-burst stimulation (iTBS), an ultra-high frequency patterned rTMS protocol, extend beyond the targeted muscle. We investigated whether and to what extent iTBS induces changes in the cortical output to other intrinsic hand muscles with adjacent cortical representation to the target. Sixteen healthy adults underwent neuronavigated TMS-iTBS targeting the first dorsal interosseus (FDI) hotspot. Proportion of motor evoked potentials (MEPs) at the resting motor threshold (RMT), baseline MEP amplitude, and iTBS-induced changes in MEP amplitude were compared between FDI, abductor pollicis brevis (APB) and abductor digiti minimi (ADM) muscles. MEP amplitudes recorded from the three muscles at RMT and suprathreshold intensities indicated the chosen hotspots were relatively selective for FDI. Nevertheless, iTBS induced significant facilitation of MEPs recorded from both FDI and APB, but not ADM. Surprisingly, the MEP modulation was greater in APB, even when controlling for the baseline MEP amplitude. These results indicate that iTBS modulation of cortico-spinal excitability extends beyond the representation of the targeted muscle. Results have implications both for how iTBS may be used in clinical treatment and for the safety guidelines for the application of iTBS.
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Affiliation(s)
- Timothy P Morris
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Paula Davila-Pérez
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Neuroscience and Motor Control Group (NEUROcom), Institute for Biomedical Research (INIBIC), Universidade de A Coruña, A Coruña, Spain
| | - Ali Jannati
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Neuromodulation Program and Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Arianna Menardi
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of General Psychology, University of Padova, Italy
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Institut Guttman de Neurorehabilitació, Universitat Autónoma de Barcelona, Badalona, Barcelona, Spain
| | - Peter J Fried
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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91
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Huot-Lavoie M, Ting WKC, Demers M, Mercier C, Ethier C. Impaired Motor Learning Following a Pain Episode in Intact Rats. Front Neurol 2019; 10:927. [PMID: 31507526 PMCID: PMC6718695 DOI: 10.3389/fneur.2019.00927] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 08/09/2019] [Indexed: 01/22/2023] Open
Abstract
Motor learning and pain are important factors influencing rehabilitation. Despite being mostly studied independently from each other, important interactions exist between them in the context of spinal cord injury, whether to the spinal cord or the body. Ongoing or recent past episodes of nociceptive activity can prevent motor learning in spinalized rats. In intact animals, it has been proposed that supraspinal activity could counter the repressive effect of nociception on motor system plasticity, but this has not yet been verified in behavioral conditions. The aim of this study was to test whether a recent episode of nociception affects subsequent motor learning in intact animals. We trained rodents to walk on a custom-made horizontal ladder. After initial training, the rats underwent a week-long rest, during which they were randomly assigned to a control group, or one out of two pain conditions. Nociceptive stimuli of different durations were induced through capsaicin or Complete Freund's Adjuvant injections and timed so that the mechanical hypersensitivity had entirely subsided by the end of the resting period. Training then resumed on a modified version of the horizontal ladder. We evaluated the animals' ability to adapt to the modified task by measuring their transit time and paw misplacements over 4 days. Our results show that prior pain episodes do affect motor learning in neurologically intact rats. Motor learning deficits also seem to be influenced by the duration of the pain episode. Rats receiving a subcutaneous injection of capsaicin displayed immediate signs of mechanical hypersensitivity, which subsided rapidly. Nonetheless, they still showed learning deficits 24 h after injection. Rats who received a Complete Freund's Adjuvant injection displayed mechanical hypersensitivity for up to 7 days during the resting period. When trained on the modified ladder task upon returning to normal sensitivity levels, these rats exhibited more prolonged motor learning deficits, extending over 3 days. Our results suggest that prior pain episodes can negatively influence motor learning, and that the duration of the impairment relates to the duration of the pain episode. Our results highlight the importance of addressing pain together with motor training after injury.
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Affiliation(s)
- Maxime Huot-Lavoie
- CERVO Research Center, Psychiatry and Neurosciences Department, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Windsor Kwan-Chun Ting
- CERVO Research Center, Psychiatry and Neurosciences Department, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Maxime Demers
- CERVO Research Center, Psychiatry and Neurosciences Department, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Catherine Mercier
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Christian Ethier
- CERVO Research Center, Psychiatry and Neurosciences Department, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
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92
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Zamorano AM, Montoya P, Cifre I, Vuust P, Riquelme I, Kleber B. Experience-dependent neuroplasticity in trained musicians modulates the effects of chronic pain on insula-based networks - A resting-state fMRI study. Neuroimage 2019; 202:116103. [PMID: 31437550 DOI: 10.1016/j.neuroimage.2019.116103] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 07/02/2019] [Accepted: 08/14/2019] [Indexed: 10/26/2022] Open
Abstract
Recent resting-state fMRI studies associated extensive musical training with increased insula-based connectivity in large-scale networks involved in salience, emotion, and higher-order cognitive processes. Similar changes have also been found in chronic pain patients, suggesting that both types of experiences can have comparable effects on insula circuitries. Based on these observations, the current study asked the question whether, and if so in what way, different forms of experience-dependent neuroplasticity may interact. Here we assessed insula-based connectivity during fMRI resting-state between musicians and non-musicians both with and without chronic pain, and correlated the results with clinical pain duration and intensity. As expected, insula connectivity was increased in chronic pain non-musicians relative to healthy non-musicians (with cingulate cortex and supplementary motor area), yet no differences were found between chronic pain non-musicians and healthy musicians. In contrast, musicians with chronic pain showed decreased insula connectivity relative to both healthy musicians (with sensorimotor and memory regions) and chronic pain non-musicians (with the hippocampus, inferior temporal gyrus, and orbitofrontal cortex), as well as lower pain-related inferences with daily activities. Pain duration correlated positively with insula connectivity only in non-musicians, whereas pain intensity exhibited distinct relationships across groups. We conclude that although music-related sensorimotor training and chronic pain, taken in isolation, can lead to increased insula-based connectivity, their combination may lead to higher-order plasticity (metaplasticity) in chronic pain musicians, engaging brain mechanisms that can modulate the consequences of maladaptive experience-dependent neural reorganization (i.e., pain chronification).
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Affiliation(s)
- Anna M Zamorano
- Research Institute of Health Sciences (IUNICS-IdISBa), University of the Balearic Islands, Palma de Mallorca, Spain; Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, Denmark.
| | - Pedro Montoya
- Research Institute of Health Sciences (IUNICS-IdISBa), University of the Balearic Islands, Palma de Mallorca, Spain
| | - Ignacio Cifre
- University Ramon Llull, Blanquerna, FPCEE, Barcelona, Spain
| | - Peter Vuust
- Center for Music in the Brain, Department of Clinical Medicine, Aarhus University & The Royal Academy of Music, Aarhus/Aalborg, Denmark
| | - Inmaculada Riquelme
- Research Institute of Health Sciences (IUNICS-IdISBa), University of the Balearic Islands, Palma de Mallorca, Spain; Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma de Mallorca, Spain
| | - Boris Kleber
- Center for Music in the Brain, Department of Clinical Medicine, Aarhus University & The Royal Academy of Music, Aarhus/Aalborg, Denmark; Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
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93
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Simultaneously applying cathodal tDCS with low frequency rTMS at the motor cortex boosts inhibitory aftereffects. J Neurosci Methods 2019; 324:108308. [DOI: 10.1016/j.jneumeth.2019.05.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 05/30/2019] [Accepted: 05/30/2019] [Indexed: 11/20/2022]
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94
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Lin Y, Liu T, Huang Q, Su Y, Chen W, Gao D, Tian X, Huang T, Zhen Z, Han T, Ye H, Wang Y. Electroencephalography and Functional Magnetic Resonance Imaging-Guided Simultaneous Transcranial Direct Current Stimulation and Repetitive Transcranial Magnetic Stimulation in a Patient With Minimally Conscious State. Front Neurosci 2019; 13:746. [PMID: 31417339 PMCID: PMC6685103 DOI: 10.3389/fnins.2019.00746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 07/05/2019] [Indexed: 12/23/2022] Open
Abstract
Objective A minimally conscious state (MCS) is characterized by discernible behavioral evidence of consciousness that cannot be reproduced consistently. This condition is highly challenging to treat. Recent studies have demonstrated the potential therapeutic effect of non-invasive brain stimulation in patients with MCS. In one patient in an MCS, we delivered simultaneous transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) based on an individual brain network analysis and evaluated the therapeutic effect. Methods The directional transfer function (DTF) was calculated based on electroencephalograph (EEG) analysis. Global brain connectivity was calculated based on functional magnetic resonance imaging (fMRI) analysis. By referring to the EEG and fMRI results, we identified inferior parietal lobes (IPLs) as targets. In the 2-week treatment period, 14 sessions were applied to the identified bilateral parietal regions. Simultaneous 1.5-mA anodal tDCS and 5-Hz rTMS were delivered for 20 min per hemisphere in each session. Clinical evaluation scores were recorded weekly throughout the treatment. A second patient given the routine treatment was evaluated as a control. Results The clinical scores of patient 1 with MCS improved after 2 weeks of stimulation treatment, and the effect lasted for up to 1 month. EEG analysis showed a significant increase (p < 0.001) in the DTF value in the gamma band in a bilateral set of posterior regions, and fMRI showed a trend toward normalized activity in the IPLs. The clinical scores of patient 2 with coma did not improve much after 2 weeks of routine treatment. The EEG analysis showed a significant increase (p = 0.021) in the DTF value in the gamma band in a bilateral set of posterior regions. Conclusion The application of EEG and fMRI to characterize the functional connectivity features of the network in an MCS patient provided a reasonable and accurate stimulation target and verified the changes in functional connectivity resulting from stimulation.
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Affiliation(s)
- Yicong Lin
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tiaotiao Liu
- School of Biomedical Engineering, Tianjin Medical University, Tianjin, China
| | - Qian Huang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yingying Su
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Weibi Chen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Daiquan Gao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xin Tian
- School of Biomedical Engineering, Tianjin Medical University, Tianjin, China
| | - Taicheng Huang
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Zonglei Zhen
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Tao Han
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hong Ye
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,The Beijing Key Laboratory of Neuromodulation, Beijing, China.,Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
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95
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Lacroix A, Proulx-Bégin L, Hamel R, De Beaumont L, Bernier PM, Lepage JF. Static magnetic stimulation of the primary motor cortex impairs online but not offline motor sequence learning. Sci Rep 2019; 9:9886. [PMID: 31285526 PMCID: PMC6614538 DOI: 10.1038/s41598-019-46379-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 06/19/2019] [Indexed: 12/14/2022] Open
Abstract
Static magnetic fields (SMFs) are known to alter neural activity, but evidence of their ability to modify learning-related neuroplasticity is lacking. The present study tested the hypothesis that application of static magnetic stimulation (SMS), an SMF applied transcranially via a neodymium magnet, over the primary motor cortex (M1) would alter learning of a serial reaction time task (SRTT). Thirty-nine participants took part in two experimental sessions separated by 24 h where they had to learn the SRTT with their right hand. During the first session, two groups received SMS either over contralateral (i.e., left) or ipsilateral (i.e., right) M1 while a third group received sham stimulation. SMS was not applied during the second session. Results of the first session showed that application of SMS over contralateral M1 impaired online learning as compared to both ipsilateral and sham groups, which did not differ. Results further revealed that application of SMS did not impair offline learning or relearning. Overall, these results are in line with those obtained using other neuromodulatory techniques believed to reduce cortical excitability in the context of motor learning and suggest that the ability of SMS to alter learning-related neuroplasticity is temporally circumscribed to the duration of its application.
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Affiliation(s)
- Angélina Lacroix
- Department of Pediatrics, Sherbrooke University, 3001-12th Ave. North, Sherbrooke, Canada.,Sherbrooke University Research Center, 3001-12th Ave. North, Sherbrooke, Canada
| | - Léa Proulx-Bégin
- Department of Psychology, Montreal University, 90 Ave. Vincent d'Indy, Montréal, Canada
| | - Raphaël Hamel
- Department of Pediatrics, Sherbrooke University, 3001-12th Ave. North, Sherbrooke, Canada.,Sherbrooke University Research Center, 3001-12th Ave. North, Sherbrooke, Canada.,Faculty of Physical Activity Sciences, Sherbrooke University, 2500 de l'Université Blvd., Sherbrooke, Canada
| | - Louis De Beaumont
- Department of Surgery, Faculty of Medicine, Pavillon Roger-Gaudry C.P, 6128, Montréal, Canada
| | - Pierre-Michel Bernier
- Faculty of Physical Activity Sciences, Sherbrooke University, 2500 de l'Université Blvd., Sherbrooke, Canada
| | - Jean-François Lepage
- Department of Pediatrics, Sherbrooke University, 3001-12th Ave. North, Sherbrooke, Canada. .,Sherbrooke University Research Center, 3001-12th Ave. North, Sherbrooke, Canada.
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96
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Opie GM, Hand BJ, Coxon JP, Ridding MC, Ziemann U, Semmler JG. Visuomotor task acquisition is reduced by priming paired associative stimulation in older adults. Neurobiol Aging 2019; 81:67-76. [PMID: 31247460 DOI: 10.1016/j.neurobiolaging.2019.05.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 05/16/2019] [Accepted: 05/23/2019] [Indexed: 12/21/2022]
Abstract
Transcranial magnetic stimulation may represent an effective means for improving motor function in the elderly. The aim of this study was therefore to investigate the effects of paired associative stimulation (PAS; a plasticity-inducing transcranial magnetic stimulation paradigm) on acquisition of a novel visuomotor task in young and older adults. Fourteen young (20.4 ± 0.6 years) and 13 older (69.0 ± 1.6 years) adults participated in 3 experimental sessions during which training was preceded (primed) by PAS. Within each session, the interstimulus interval used for PAS was set at either the N20 latency plus 5 ms (PASLTP), the N20 latency minus 10 ms (PASLTD), or a constant 100 ms (PASControl). After training, the level of motor skill was not different between PAS conditions in young subjects (all p-values > 0.2), but was reduced by both PASLTP (p = 0.02) and PASLTD (p = 0.0001) in older subjects. Consequently, priming PAS was detrimental to skill acquisition in older adults, possibly suggesting a need for interventions that are optimized for use in elderly populations.
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Affiliation(s)
- George M Opie
- Discipline of Physiology, Adelaide Medical School, The University of Adelaide, Adelaide, Australia; Discipline of Obstetrics and Gynaecology, Adelaide Medical School and Robinson Research Institute, The University of Adelaide, Adelaide, Australia
| | - Brodie J Hand
- Discipline of Physiology, Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - James P Coxon
- School of Psychological Sciences, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Victoria, Australia
| | - Michael C Ridding
- Discipline of Obstetrics and Gynaecology, Adelaide Medical School and Robinson Research Institute, The University of Adelaide, Adelaide, Australia
| | - Ulf Ziemann
- Department of Neurology and Stroke, Hertie-Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - John G Semmler
- Discipline of Physiology, Adelaide Medical School, The University of Adelaide, Adelaide, Australia.
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97
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Portaro S, Russo M, Bramanti A, Leo A, Billeri L, Manuli A, La Rosa G, Naro A, Calabrò RS. The role of robotic gait training and tDCS in Friedrich ataxia rehabilitation: A case report. Medicine (Baltimore) 2019; 98:e14447. [PMID: 30813143 PMCID: PMC6407999 DOI: 10.1097/md.0000000000014447] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
RATIONALE Friedrich ataxia (FA) is the most common inherited neurodegenerative cerebellar ataxic syndrome. In patients with FA, physiotherapy is highly recommended to improve motor function outcome. Cerebellar transcranial direct current stimulation (tDCS) has been demonstrated to be effective in improving symptoms by modulating cerebellar excitability. Recently, robotic rehabilitation with Lokomat-Pro has been used to treat motor impairment in ataxic syndromes by "modulating" cortical plasticity and cerebello-motor connectivity. PATIENT CONCERNS A 29-year-old Italian male with FA, come to our Institute to undergo intensive rehabilitation training. He presented a moderate-to-severe spastic tetraparesis, brisk deep tendon reflexes, moderate dysarthria, occasional difficulty in speaking, and mild delay in swallowing. He was able to stand for at least 10 seconds in the natural position with constant support, and thus he used a wheelchair. DIAGNOSIS Tetraparesis in a young patient with FA. INTERVENTIONS The effects of a stand-alone robotic gait training with Lokomat-Pro preceded by cerebellar anodal tDCS (a-tDCS) versus Lokomat-Pro preceded by cathodal-tDCS (c-tDCS) are compared. OUTCOMES The coupled approach (i.e., tDCS and Lokomat) demonstrated better improvement in functional motor outcomes on the Scale for the Assessment and Rating of Ataxia (SARA). LESSONS Although only a single case is described, we found that the combined neuromodulation-neurorobotic approach could become a promising tool in the rehabilitation of cerebellar ataxias, possibly by shaping cerebello-cerebral plasticity and connectivity.
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98
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Terranova C, Rizzo V, Cacciola A, Chillemi G, Calamuneri A, Milardi D, Quartarone A. Is There a Future for Non-invasive Brain Stimulation as a Therapeutic Tool? Front Neurol 2019; 9:1146. [PMID: 30733704 PMCID: PMC6353822 DOI: 10.3389/fneur.2018.01146] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 12/11/2018] [Indexed: 01/11/2023] Open
Abstract
Several techniques and protocols of non-invasive transcranial brain stimulation (NIBS), including transcranial magnetic and electrical stimuli, have been developed in the past decades. These techniques can induce long lasting changes in cortical excitability by promoting synaptic plasticity and thus may represent a therapeutic option in neuropsychiatric disorders. On the other hand, despite these techniques have become popular, the fragility and variability of the after effects are the major challenges that non-invasive transcranial brain stimulation currentlyfaces. Several factors may account for such a variability such as biological variations, measurement reproducibility, and the neuronal state of the stimulated area. One possible strategy, to reduce this variability is to monitor the neuronal state in real time using EEG and trigger TMS pulses only at pre-defined state. In addition, another strategy under study is to use the spaced application of multiple NIBS protocols within a session to improve the reliability and extend the duration of NIBS effects. Further studies, although time consuming, are required for improving the so far limited effect sizes of NIBS protocols for treatment of neurological or psychiatric disorders.
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Affiliation(s)
- Carmen Terranova
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Vincenzo Rizzo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Alberto Cacciola
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | | | | | | | - Angelo Quartarone
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
- IRCCS Centro Neurolesi ‘Bonino Pulejo’, Messina, Italy
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Latin American and Caribbean consensus on noninvasive central nervous system neuromodulation for chronic pain management (LAC 2-NIN-CP). Pain Rep 2019; 4:e692. [PMID: 30801041 PMCID: PMC6370142 DOI: 10.1097/pr9.0000000000000692] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 09/05/2018] [Indexed: 12/16/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. Introduction: Chronic pain (CP) is highly prevalent and generally undertreated health condition. Noninvasive brain stimulation may contribute to decrease pain intensity and influence other aspects related to CP. Objective: To provide consensus-based recommendations for the use of noninvasive brain stimulation in clinical practice. Methods: Systematic review of the literature searching for randomized clinical trials followed by consensus panel. Recommendations also involved a cost-estimation study. Results: The systematic review wielded 24 transcranial direct current stimulation (tDCS) and 22 repetitive transcranial magnetic stimulation (rTMS) studies. The following recommendations were provided: (1) Level A for anodal tDCS over the primary motor cortex (M1) in fibromyalgia, and level B for peripheral neuropathic pain, abdominal pain, and migraine; bifrontal (F3/F4) tDCS and M1 high-definition (HD)-tDCS for fibromyalgia; Oz/Cz tDCS for migraine and for secondary benefits such as improvement in quality of life, decrease in anxiety, and increase in pressure pain threshold; (2) level A recommendation for high-frequency (HF) rTMS over M1 for fibromyalgia and neuropathic pain, and level B for myofascial or musculoskeletal pain, complex regional pain syndrome, and migraine; (3) level A recommendation against the use of anodal M1 tDCS for low back pain; and (4) level B recommendation against the use of HF rTMS over the left dorsolateral prefrontal cortex in the control of pain. Conclusion: Transcranial DCS and rTMS are recommended techniques to be used in the control of CP conditions, with low to moderate analgesic effects, and no severe adverse events. These recommendations are based on a systematic review of the literature and a consensus made by experts in the field. Readers should use it as part of the resources available to decision-making.
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da Graca-Tarragó M, Lech M, Angoleri LDM, Santos DS, Deitos A, Brietzke AP, Torres IL, Fregni F, Caumo W. Intramuscular electrical stimulus potentiates motor cortex modulation effects on pain and descending inhibitory systems in knee osteoarthritis: a randomized, factorial, sham-controlled study. J Pain Res 2019; 12:209-221. [PMID: 30655690 PMCID: PMC6322702 DOI: 10.2147/jpr.s181019] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Neuroplastic changes in nociceptive pathways contribute to severity of symptoms in knee osteoarthritis (KOA). A new look at neuroplastic changes management includes modulation of the primary motor cortex by transcranial direct current stimulation (tDCS). Objectives We investigated whether tDCS combined with intramuscular electrical stimulation (EIMS) would be more efficacious than a sham (s) intervention (s-tDCS/s-EIMS) or a single active(a)-tDCS/s-EIMS intervention and/or s-tDCS/a-EIMS in the following domains: pain measures (visual analog scale [VAS] score and descending pain modulatory system [DPMS], and outcomes, and analgesic use, disability, and pain pressure threshold (PPT) for secondary outcomes. Registration The trial is registered in Clinicaltrials.gov: NCT01747070. Methods Sixty women with KOA, aged 50–75 years old, randomly received five sessions of one of the four interventions (a-tDCS/a-EIMS, s-tDCS/s-EIMS, a-tDCS/s-EIMS, and s-tDCS/a-EIMS). tDCS was applied over the primary motor cortex (M1), for 30 minutes at 2 mA and the EIMS paraspinal of L1–S2. Results A generalized estimating equation model revealed the main effect of the a-tDCS/a-EIMS in the VAS pain scores at end treatment compared with the other three groups (P<0.0001). There existed a significant effect of time and a significant interaction between group and time (P<0.01 for both). The delta-(Δ) pain score on VAS in the a-tDCS/a-EIMS group was −3.59, 95% CI: −4.10 to −2.63. The (Δ) pain scores on VAS in the other three groups were: a-tDCS/s-EIMS=−2.13, 95% CI: −2.48 to −1.64; s-tDCS/a-EIMS=−2.25, 95% CI: −2.59 to −1.68; s-tDCS/s-EIMS MR =–1.77, 95% CI: −2.08 to −1.38. The a-tDCS/a-EIMS led to better effect in DPMS, PPT, analgesic use, and disability related to pain. Conclusion This study provides additional evidence regarding additive clinical effects to improve pain measures and descending pain inhibitory controls when the neuromodulation of the primary motor cortex with tDCS is combined with a bottom-up modulation with EIMS in KOA. Also, it improved the ability to walk due to reduced pain and reduced analgesic use.
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Affiliation(s)
- Maria da Graca-Tarragó
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil, .,Laboratory of Pain and Neuromodulation, HCPA, Porto Alegre, Brazil,
| | - Mateus Lech
- Laboratory of Pain and Neuromodulation, HCPA, Porto Alegre, Brazil,
| | | | | | - Alícia Deitos
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil, .,Laboratory of Pain and Neuromodulation, HCPA, Porto Alegre, Brazil,
| | - Aline Patrícia Brietzke
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil, .,Laboratory of Pain and Neuromodulation, HCPA, Porto Alegre, Brazil,
| | - Iraci Ls Torres
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil, .,Pharmacology Department, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Felipe Fregni
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Wolnei Caumo
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil, .,Laboratory of Pain and Neuromodulation, HCPA, Porto Alegre, Brazil, .,Surgery Department, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil, .,Pain and Palliative Care Service, HCPA, Porto Alegre, Brazil,
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