1
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Vucic S, Stanley Chen KH, Kiernan MC, Hallett M, Benninger DH, Di Lazzaro V, Rossini PM, Benussi A, Berardelli A, Currà A, Krieg SM, Lefaucheur JP, Long Lo Y, Macdonell RA, Massimini M, Rosanova M, Picht T, Stinear CM, Paulus W, Ugawa Y, Ziemann U, Chen R. Clinical diagnostic utility of transcranial magnetic stimulation in neurological disorders. Updated report of an IFCN committee. Clin Neurophysiol 2023; 150:131-175. [PMID: 37068329 PMCID: PMC10192339 DOI: 10.1016/j.clinph.2023.03.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/28/2023] [Accepted: 03/09/2023] [Indexed: 03/31/2023]
Abstract
The review provides a comprehensive update (previous report: Chen R, Cros D, Curra A, Di Lazzaro V, Lefaucheur JP, Magistris MR, et al. The clinical diagnostic utility of transcranial magnetic stimulation: report of an IFCN committee. Clin Neurophysiol 2008;119(3):504-32) on clinical diagnostic utility of transcranial magnetic stimulation (TMS) in neurological diseases. Most TMS measures rely on stimulation of motor cortex and recording of motor evoked potentials. Paired-pulse TMS techniques, incorporating conventional amplitude-based and threshold tracking, have established clinical utility in neurodegenerative, movement, episodic (epilepsy, migraines), chronic pain and functional diseases. Cortical hyperexcitability has emerged as a diagnostic aid in amyotrophic lateral sclerosis. Single-pulse TMS measures are of utility in stroke, and myelopathy even in the absence of radiological changes. Short-latency afferent inhibition, related to central cholinergic transmission, is reduced in Alzheimer's disease. The triple stimulation technique (TST) may enhance diagnostic utility of conventional TMS measures to detect upper motor neuron involvement. The recording of motor evoked potentials can be used to perform functional mapping of the motor cortex or in preoperative assessment of eloquent brain regions before surgical resection of brain tumors. TMS exhibits utility in assessing lumbosacral/cervical nerve root function, especially in demyelinating neuropathies, and may be of utility in localizing the site of facial nerve palsies. TMS measures also have high sensitivity in detecting subclinical corticospinal lesions in multiple sclerosis. Abnormalities in central motor conduction time or TST correlate with motor impairment and disability in MS. Cerebellar stimulation may detect lesions in the cerebellum or cerebello-dentato-thalamo-motor cortical pathways. Combining TMS with electroencephalography, provides a novel method to measure parameters altered in neurological disorders, including cortical excitability, effective connectivity, and response complexity.
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Affiliation(s)
- Steve Vucic
- Brain, Nerve Research Center, The University of Sydney, Sydney, Australia.
| | - Kai-Hsiang Stanley Chen
- Department of Neurology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Matthew C Kiernan
- Brain and Mind Centre, The University of Sydney; and Department of Neurology, Royal Prince Alfred Hospital, Australia
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health, Bethesda, Maryland, United States
| | - David H Benninger
- Department of Neurology, University Hospital of Lausanne (CHUV), Switzerland
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Paolo M Rossini
- Department of Neurosci & Neurorehab IRCCS San Raffaele-Rome, Italy
| | - Alberto Benussi
- Centre for Neurodegenerative Disorders, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alfredo Berardelli
- IRCCS Neuromed, Pozzilli; Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Antonio Currà
- Department of Medico-Surgical Sciences and Biotechnologies, Alfredo Fiorini Hospital, Sapienza University of Rome, Terracina, LT, Italy
| | - Sandro M Krieg
- Department of Neurosurgery, Technical University Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Jean-Pascal Lefaucheur
- Univ Paris Est Creteil, EA4391, ENT, Créteil, France; Clinical Neurophysiology Unit, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Yew Long Lo
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, and Duke-NUS Medical School, Singapore
| | | | - Marcello Massimini
- Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi di Milano, Milan, Italy; Istituto Di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Mario Rosanova
- Department of Biomedical and Clinical Sciences University of Milan, Milan, Italy
| | - Thomas Picht
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Cluster of Excellence: "Matters of Activity. Image Space Material," Humboldt University, Berlin Simulation and Training Center (BeST), Charité-Universitätsmedizin Berlin, Germany
| | - Cathy M Stinear
- Department of Medicine Waipapa Taumata Rau, University of Auckland, Auckland, Aotearoa, New Zealand
| | - Walter Paulus
- Department of Neurology, Ludwig-Maximilians-Universität München, München, Germany
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Japan
| | - Ulf Ziemann
- Department of Neurology and Stroke, Eberhard Karls University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany; Hertie Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, Otfried-Müller-Straße 27, 72076 Tübingen, Germany
| | - Robert Chen
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital-UHN, Division of Neurology-University of Toronto, Toronto Canada
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2
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De Carvalho M, Swash M. Transcranial magnetic stimulation to monitor disease progression in ALS: a review. Amyotroph Lateral Scler Frontotemporal Degener 2022. [DOI: 10.1080/21678421.2022.2160649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Mamede De Carvalho
- Instituto de Fisiologia, Instituto de Medicina Molecular, Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Department of Neurosciences and Mental Health, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal, and
| | - Michael Swash
- Instituto de Fisiologia, Instituto de Medicina Molecular, Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Barts and the London School of Medicine, Queen Mary University of London, UK
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3
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Fournier CN. Considerations for Amyotrophic Lateral Sclerosis (ALS) Clinical Trial Design. Neurotherapeutics 2022; 19:1180-1192. [PMID: 35819713 PMCID: PMC9275386 DOI: 10.1007/s13311-022-01271-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 11/20/2022] Open
Abstract
Thoughtful clinical trial design is critical for efficient therapeutic development, particularly in the field of amyotrophic lateral sclerosis (ALS), where trials often aim to detect modest treatment effects among a population with heterogeneous disease progression. Appropriate outcome measure selection is necessary for trials to provide decisive and informative results. Investigators must consider the outcome measure's reliability, responsiveness to detect change when change has actually occurred, clinical relevance, and psychometric performance. ALS clinical trials can also be performed more efficiently by utilizing statistical enrichment techniques. Innovations in ALS prediction models allow for selection of participants with less heterogeneity in disease progression rates without requiring a lead-in period, or participants can be stratified according to predicted progression. Statistical enrichment can reduce the needed sample size and improve study power, but investigators must find a balance between optimizing statistical efficiency and retaining generalizability of study findings to the broader ALS population. Additional progress is still needed for biomarker development and validation to confirm target engagement in ALS treatment trials. Selection of an appropriate biofluid biomarker depends on the treatment mechanism of interest, and biomarker studies should be incorporated into early phase trials. Inclusion of patients with ALS as advisors and advocates can strengthen clinical trial design and study retention, but more engagement efforts are needed to improve diversity and equity in ALS research studies. Another challenge for ALS therapeutic development is identifying ways to respect patient autonomy and improve access to experimental treatment, something that is strongly desired by many patients with ALS and ALS advocacy organizations. Expanded access programs that run concurrently to well-designed and adequately powered randomized controlled trials may provide an opportunity to broaden access to promising therapeutics without compromising scientific integrity or rushing regulatory approval of therapies without adequate proof of efficacy.
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Affiliation(s)
- Christina N Fournier
- Department of Neurology, Emory University, Atlanta, GA, USA.
- Department of Veterans Affairs, Atlanta, GA, USA.
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4
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Kearney-Ramos T, Haney M. Repetitive transcranial magnetic stimulation as a potential treatment approach for cannabis use disorder. Prog Neuropsychopharmacol Biol Psychiatry 2021; 109:110290. [PMID: 33677045 PMCID: PMC9165758 DOI: 10.1016/j.pnpbp.2021.110290] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/22/2021] [Accepted: 02/19/2021] [Indexed: 01/22/2023]
Abstract
The expanding legalization of cannabis across the United States is associated with increases in cannabis use, and accordingly, an increase in the number and severity of individuals with cannabis use disorder (CUD). The lack of FDA-approved pharmacotherapies and modest efficacy of psychotherapeutic interventions means that many of those who seek treatment for CUD relapse within the first few months. Consequently, there is a pressing need for innovative, evidence-based treatment development for CUD. Preliminary evidence suggests that repetitive transcranial magnetic stimulation (rTMS) may be a novel, non-invasive therapeutic neuromodulation tool for the treatment of a variety of substance use disorders (SUDs), including recently receiving FDA clearance (August 2020) for use as a smoking cessation aid in tobacco cigarette smokers. However, the potential of rTMS for CUD has not yet been reviewed. This paper provides a primer on therapeutic neuromodulation techniques for SUDs, with a particular focus on reviewing the current status of rTMS research in people who use cannabis. Lastly, future directions are proposed for rTMS treatment development in CUD, with suggestions for study design parameters and clinical endpoints based on current gold-standard practices for therapeutic neuromodulation research.
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Affiliation(s)
- Tonisha Kearney-Ramos
- New York State Psychiatric Institute, New York, NY, USA; Columbia University Irving Medical Center, New York, NY, USA.
| | - Margaret Haney
- New York State Psychiatric Institute, New York, New York, USA,Columbia University Irving Medical Center, New York, New York, USA
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5
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Nazarova M, Novikov P, Ivanina E, Kozlova K, Dobrynina L, Nikulin VV. Mapping of multiple muscles with transcranial magnetic stimulation: absolute and relative test-retest reliability. Hum Brain Mapp 2021; 42:2508-2528. [PMID: 33682975 PMCID: PMC8090785 DOI: 10.1002/hbm.25383] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 12/13/2022] Open
Abstract
The spatial accuracy of transcranial magnetic stimulation (TMS) may be as small as a few millimeters. Despite such great potential, navigated TMS (nTMS) mapping is still underused for the assessment of motor plasticity, particularly in clinical settings. Here, we investigate the within-limb somatotopy gradient as well as absolute and relative reliability of three hand muscle cortical representations (MCRs) using a comprehensive grid-based sulcus-informed nTMS motor mapping. We enrolled 22 young healthy male volunteers. Two nTMS mapping sessions were separated by 5-10 days. Motor evoked potentials were obtained from abductor pollicis brevis (APB), abductor digiti minimi, and extensor digitorum communis. In addition to individual MRI-based analysis, we studied normalized MNI MCRs. For the reliability assessment, we calculated intraclass correlation and the smallest detectable change. Our results revealed a somatotopy gradient reflected by APB MCR having the most lateral location. Reliability analysis showed that the commonly used metrics of MCRs, such as areas, volumes, centers of gravity (COGs), and hotspots had a high relative and low absolute reliability for all three muscles. For within-limb TMS somatotopy, the most common metrics such as the shifts between MCR COGs and hotspots had poor relative reliability. However, overlaps between different muscle MCRs were highly reliable. We, thus, provide novel evidence that inter-muscle MCR interaction can be reliably traced using MCR overlaps while shifts between the COGs and hotspots of different MCRs are not suitable for this purpose. Our results have implications for the interpretation of nTMS motor mapping results in healthy subjects and patients with neurological conditions.
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Affiliation(s)
- Maria Nazarova
- Center for Cognition and Decision Making, Institute for Cognitive Neuroscience, National Research University Higher School of EconomicsMoscowRussian Federation
- Federal State Budgetary Institution «Federal center of brain research and neurotechnologies» of the Federal Medical Biological AgencyMoscowRussian Federation
| | - Pavel Novikov
- Center for Cognition and Decision Making, Institute for Cognitive Neuroscience, National Research University Higher School of EconomicsMoscowRussian Federation
| | - Ekaterina Ivanina
- Center for Cognition and Decision Making, Institute for Cognitive Neuroscience, National Research University Higher School of EconomicsMoscowRussian Federation
| | - Ksenia Kozlova
- Center for Cognition and Decision Making, Institute for Cognitive Neuroscience, National Research University Higher School of EconomicsMoscowRussian Federation
| | | | - Vadim V. Nikulin
- Center for Cognition and Decision Making, Institute for Cognitive Neuroscience, National Research University Higher School of EconomicsMoscowRussian Federation
- Department of NeurologyMax Planck Institute for Human Cognitive and Brain SciencesLeipzigGermany
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6
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Wainger BJ, Macklin EA, Vucic S, McIlduff CE, Paganoni S, Maragakis NJ, Bedlack R, Goyal NA, Rutkove SB, Lange DJ, Rivner MH, Goutman SA, Ladha SS, Mauricio EA, Baloh RH, Simmons Z, Pothier L, Kassis SB, La T, Hall M, Evora A, Klements D, Hurtado A, Pereira JD, Koh J, Celnik PA, Chaudhry V, Gable K, Juel VC, Phielipp N, Marei A, Rosenquist P, Meehan S, Oskarsson B, Lewis RA, Kaur D, Kiskinis E, Woolf CJ, Eggan K, Weiss MD, Berry JD, David WS, Davila-Perez P, Camprodon JA, Pascual-Leone A, Kiernan MC, Shefner JM, Atassi N, Cudkowicz ME. Effect of Ezogabine on Cortical and Spinal Motor Neuron Excitability in Amyotrophic Lateral Sclerosis: A Randomized Clinical Trial. JAMA Neurol 2021; 78:186-196. [PMID: 33226425 DOI: 10.1001/jamaneurol.2020.4300] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease of the motor nervous system. Clinical studies have demonstrated cortical and spinal motor neuron hyperexcitability using transcranial magnetic stimulation and threshold tracking nerve conduction studies, respectively, although metrics of excitability have not been used as pharmacodynamic biomarkers in multi-site clinical trials. Objective To ascertain whether ezogabine decreases cortical and spinal motor neuron excitability in ALS. Design, Setting, and Participants This double-blind, placebo-controlled phase 2 randomized clinical trial sought consent from eligible participants from November 3, 2015, to November 9, 2017, and was conducted at 12 US sites within the Northeast ALS Consortium. Participants were randomized in equal numbers to a higher or lower dose of ezogabine or to an identical matched placebo, and they completed in-person visits at screening, baseline, week 6, and week 8 for clinical assessment and neurophysiological measurements. Interventions Participants were randomized to receive 600 mg/d or 900 mg/d of ezogabine or a matched placebo for 10 weeks. Main Outcomes and Measures The primary outcome was change in short-interval intracortical inhibition (SICI; SICI-1 was used in analysis to reflect stronger inhibition from an increase in amplitude) from pretreatment mean at screening and baseline to the full-dose treatment mean at weeks 6 and 8. The secondary outcomes included levels of cortical motor neuron excitability (including resting motor threshold) measured by transcranial magnetic stimulation and spinal motor neuron excitability (including strength-duration time constant) measured by threshold tracking nerve conduction studies. Results A total of 65 participants were randomized to placebo (23), 600 mg/d of ezogabine (23), and 900 mg/d of ezogabine (19 participants); 45 were men (69.2%) and the mean (SD) age was 58.3 (8.8) years. The SICI-1 increased by 53% (mean ratio, 1.53; 95% CI, 1.12-2.09; P = .009) in the 900-mg/d ezogabine group vs placebo group. The SICI-1 did not change in the 600-mg/d ezogabine group vs placebo group (mean ratio, 1.15; 95% CI, 0.87-1.52; P = .31). The resting motor threshold increased in the 600-mg/d ezogabine group vs placebo group (mean ratio, 4.61; 95% CI, 0.21-9.01; P = .04) but not in the 900-mg/d ezogabine group vs placebo group (mean ratio, 1.95; 95% CI, -2.64 to 6.54; P = .40). Ezogabine caused a dose-dependent decrease in excitability by several other metrics, including strength-duration time constant in the 900-mg/d ezogabine group vs placebo group (mean ratio, 0.73; 95% CI, 0.60 to 0.87; P < .001). Conclusions and Relevance Ezogabine decreased cortical and spinal motor neuron excitability in participants with ALS, suggesting that such neurophysiological metrics may be used as pharmacodynamic biomarkers in multisite clinical trials. Trial Registration ClinicalTrials.gov Identifier: NCT02450552.
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Affiliation(s)
- Brian J Wainger
- The Sean M. Healey and AMG Center for ALS and the Neurological Clinical Research Institute, Department of Neurology, Massachusetts General Hospital, Boston.,Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital, Boston.,Harvard Medical School, Boston MA.,Harvard Stem Cell Institute, Cambridge.,Broad Institute of MIT and Harvard, Cambridge
| | - Eric A Macklin
- Harvard Medical School, Boston MA.,Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Steve Vucic
- Department of Neurology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Courtney E McIlduff
- Harvard Medical School, Boston MA.,Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Sabrina Paganoni
- The Sean M. Healey and AMG Center for ALS and the Neurological Clinical Research Institute, Department of Neurology, Massachusetts General Hospital, Boston.,Harvard Medical School, Boston MA.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | | | - Richard Bedlack
- Department of Neurology, Duke University Medical Center, Durham, North Carolina
| | - Namita A Goyal
- Department of Neurology, University of California Irvine, Irvine
| | - Seward B Rutkove
- Harvard Medical School, Boston MA.,Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Dale J Lange
- Department of Neurology, Hospital for Special Surgery, New York, New York
| | - Michael H Rivner
- Department of Neurology, Augusta University Medical Center, Augusta, Georgia
| | | | - Shafeeq S Ladha
- Department of Neurology, Barrow Neurological Institute, Phoenix, Arizona
| | | | - Robert H Baloh
- Department of Neurology, Cedars Sinai Medical Center, Los Angeles, California
| | - Zachary Simmons
- Department of Neurology, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | - Lindsay Pothier
- The Sean M. Healey and AMG Center for ALS and the Neurological Clinical Research Institute, Department of Neurology, Massachusetts General Hospital, Boston
| | - Sylvia Baedorf Kassis
- The Sean M. Healey and AMG Center for ALS and the Neurological Clinical Research Institute, Department of Neurology, Massachusetts General Hospital, Boston
| | - Thuong La
- The Sean M. Healey and AMG Center for ALS and the Neurological Clinical Research Institute, Department of Neurology, Massachusetts General Hospital, Boston
| | - Meghan Hall
- Department of Neurology, Barrow Neurological Institute, Phoenix, Arizona
| | - Armineuza Evora
- The Sean M. Healey and AMG Center for ALS and the Neurological Clinical Research Institute, Department of Neurology, Massachusetts General Hospital, Boston
| | - David Klements
- The Sean M. Healey and AMG Center for ALS and the Neurological Clinical Research Institute, Department of Neurology, Massachusetts General Hospital, Boston
| | - Aura Hurtado
- Harvard Medical School, Boston MA.,Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Joao D Pereira
- The Sean M. Healey and AMG Center for ALS and the Neurological Clinical Research Institute, Department of Neurology, Massachusetts General Hospital, Boston.,Harvard Medical School, Boston MA
| | - Joan Koh
- The Sean M. Healey and AMG Center for ALS and the Neurological Clinical Research Institute, Department of Neurology, Massachusetts General Hospital, Boston
| | - Pablo A Celnik
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
| | - Vinay Chaudhry
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
| | - Karissa Gable
- Department of Neurology, Duke University Medical Center, Durham, North Carolina
| | - Vern C Juel
- Department of Neurology, Duke University Medical Center, Durham, North Carolina
| | - Nicolas Phielipp
- Department of Neurology, University of California Irvine, Irvine
| | - Adel Marei
- Department of Neurology, Hospital for Special Surgery, New York, New York
| | - Peter Rosenquist
- Department of Psychiatry, Augusta University Medical Center, Augusta, Georgia
| | - Sean Meehan
- School of Kinesiology, University of Michigan, Ann Arbor
| | | | - Richard A Lewis
- Department of Neurology, Cedars Sinai Medical Center, Los Angeles, California
| | - Divpreet Kaur
- Department of Neurology, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | | | - Clifford J Woolf
- Harvard Medical School, Boston MA.,Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - Kevin Eggan
- The Sean M. Healey and AMG Center for ALS and the Neurological Clinical Research Institute, Department of Neurology, Massachusetts General Hospital, Boston.,Harvard Medical School, Boston MA.,Harvard Stem Cell Institute, Cambridge.,Broad Institute of MIT and Harvard, Cambridge.,Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, Massachusetts
| | | | - James D Berry
- The Sean M. Healey and AMG Center for ALS and the Neurological Clinical Research Institute, Department of Neurology, Massachusetts General Hospital, Boston.,Harvard Medical School, Boston MA
| | - William S David
- The Sean M. Healey and AMG Center for ALS and the Neurological Clinical Research Institute, Department of Neurology, Massachusetts General Hospital, Boston.,Harvard Medical School, Boston MA
| | - Paula Davila-Perez
- Harvard Medical School, Boston MA.,Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Joan A Camprodon
- The Sean M. Healey and AMG Center for ALS and the Neurological Clinical Research Institute, Department of Neurology, Massachusetts General Hospital, Boston.,Harvard Medical School, Boston MA.,Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Alvaro Pascual-Leone
- Harvard Medical School, Boston MA.,Marcus Institute and Center for Memory Health, Hebrew SeniorLife, Boston, Massachusetts.,Institut Guttmann, Universitat Autonoma, Barcelona, Spain
| | - Matthew C Kiernan
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia.,Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Jeremy M Shefner
- Department of Neurology, Barrow Neurological Institute, Phoenix, Arizona
| | - Nazem Atassi
- The Sean M. Healey and AMG Center for ALS and the Neurological Clinical Research Institute, Department of Neurology, Massachusetts General Hospital, Boston.,Harvard Medical School, Boston MA
| | - Merit E Cudkowicz
- The Sean M. Healey and AMG Center for ALS and the Neurological Clinical Research Institute, Department of Neurology, Massachusetts General Hospital, Boston.,Harvard Medical School, Boston MA
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7
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Weiss MD, Macklin EA, McIlduff CE, Vucic S, Wainger BJ, Kiernan MC, Goutman SA, Goyal NA, Rutkove SB, Ladha SS, Chen IHA, Harms MB, Brannagan TH, Lacomis D, Zivkovic S, Ma M, Wang LH, Simmons Z, Rivner MH, Shefner JM, Cudkowicz ME, Atassi N. Effects of mexiletine on hyperexcitability in sporadic amyotrophic lateral sclerosis: Preliminary findings from a small phase II randomized controlled trial. Muscle Nerve 2020; 63:371-383. [PMID: 33340120 DOI: 10.1002/mus.27146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND To collect preliminary data on the effects of mexiletine on cortical and axonal hyperexcitability in sporadic amyotrophic lateral sclerosis (ALS) in a phase 2 double-blind randomized controlled trial. METHODS Twenty ALS subjects were randomized to placebo and mexiletine 300 or 600 mg daily for 4 wk and assessed by transcranial magnetic stimulation and axonal excitability studies. The primary endpoint was change in resting motor threshold (RMT). RESULTS RMT was unchanged with 4 wk of mexiletine (combined active therapies) as compared to placebo, which showed a significant increase (P = .039). Reductions of motor evoked potential (MEP) amplitude (P = .013) and accommodation half-time (P = .002), secondary outcome measures of cortical and axonal excitability, respectively, were also evident at 4 wk on mexiletine. CONCLUSIONS The relative stabilization of RMT in the treated subjects was unexpected and could be attributed to unaccounted sources of error or chance. However, a possible alternative cause is neuromodulation preventing an increase. The change in MEP amplitude and accommodation half-time supports the reduction of cortical and axonal hyperexcitability with mexiletine.
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Affiliation(s)
- Michael D Weiss
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Eric A Macklin
- Department of Medicine, Biostatistics Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Courtney E McIlduff
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Steve Vucic
- Department of Neurology, Royal Prince Alfred Hospital; and the Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Brian J Wainger
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Matthew C Kiernan
- Department of Neurology, Royal Prince Alfred Hospital; and the Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Stephen A Goutman
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Namita A Goyal
- Department of Neurology, University of California, Irvine, California, USA
| | - Seward B Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Shafeeq S Ladha
- Department of Neurology, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - I-Hweii Amy Chen
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Matthew B Harms
- Department of Neurology, Columbia University, New York, New York, USA
| | | | - David Lacomis
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sasha Zivkovic
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Maxwell Ma
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Leo H Wang
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Zachary Simmons
- Department of Neurology, Penn State University, Hershey, Pennsylvania, USA
| | - Michael H Rivner
- Department of Neurology, Augusta University, Augusta, Georgia, USA
| | - Jeremy M Shefner
- Department of Neurology, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Merit E Cudkowicz
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nazem Atassi
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
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8
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Iglesias AH. Transcranial Magnetic Stimulation as Treatment in Multiple Neurologic Conditions. Curr Neurol Neurosci Rep 2020; 20:1. [PMID: 32020300 DOI: 10.1007/s11910-020-1021-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Transcranial magnetic stimulation (TMS) is a method of Non-Invasive Brain Stimulation that is based on electro-physical principles discovered by Michael Faraday. A TMS device is made of one or two copper coils, positioned superficially to a site of interest in the brain, to non-invasively produce a brief magnetic pulse to an estimated depth from the surface of the scalp with the following axonal depolarization. This axonal depolarization activates cortical and subcortical networks with multiple effects. There are different methods of TMS used, all with different mechanisms of action. TMS is well tolerated with very few side effects. RECENT FINDINGS TMS is now approved for major depression disorder and obsessive-compulsive disorder. There is significant data to consider approval of TMS for many neurological disorders. This is a review of the uses of TMS in diverse neurological conditions, including stroke and spasticity, migraine, and dementia. TMS is a device that utilizes non-invasive brain stimulation, and it has shown promising results with objective clinical and basic science data. Its ability to trigger neuronal plasticity and potentiating synaptic transmission gives it incredible therapeutic potential. There are diverse mechanisms of action, and this could be troublesome in elaborating clinical trials and standardization of therapy.
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Affiliation(s)
- Antonio H Iglesias
- Neurology, Department of Neurology, Loyola University Chicago, Stritch School of Medicine, 2160 S. First Avenue, Maywood, IL, 60153, USA.
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Cengiz B, Kuruoğlu R. A new parameter to discriminate amyotrophic lateral sclerosis patients from healthy participants by motor cortical excitability changes. Muscle Nerve 2020; 61:354-362. [PMID: 31875983 DOI: 10.1002/mus.26786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/08/2019] [Accepted: 12/22/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION We sought a combination of abnormalities to define a more sensitive measure of cortical excitability in amyotrophic lateral sclerosis (ALS). METHODS The automatic threshold tracking method was employed to assess the resting motor threshold, intracortical facilitation (ICF), short-interval intracortical inhibition (SICI), and short-interval intracortical faciilitation (SICF) in patients and controls. RESULTS SICF at interstimulus intervals (ISI) between 1 and 1.8 ms and 2 and 3 ms as well as average SICI and SICI at ISIs of 1 and 2.5 ms were significantly reduced in ALS. The SICI curve was altered, displaying a solitary peak. Discriminant analysis revealed that the combination of SICI 2.5 ms and the mean SICF between 1 and 1.8 ms ISIs was the most sensitive parameter to distinguish patients with ALS from healthy participants. DISCUSSION Along with the reduced SICI and its altered shape, connectivity between motor cortical circuits is changed in ALS. Combination with SICF increases the diagnostic utility of SICI in ALS.
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Affiliation(s)
- Bülent Cengiz
- Department of Neurology, Clinical Neurophysiology Division, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Reha Kuruoğlu
- Department of Neurology, Clinical Neurophysiology Division, Gazi University Faculty of Medicine, Ankara, Turkey
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Wu YK, Levine JM, Wecht JR, Maher MT, LiMonta JM, Saeed S, Santiago TM, Bailey E, Kastuar S, Guber KS, Yung L, Weir JP, Carmel JB, Harel NY. Posteroanterior cervical transcutaneous spinal stimulation targets ventral and dorsal nerve roots. Clin Neurophysiol 2019; 131:451-460. [PMID: 31887616 DOI: 10.1016/j.clinph.2019.11.056] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 10/24/2019] [Accepted: 11/17/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE We aim to non-invasively facilitate activation of spared neural circuits after cervical spinal cord injury (SCI) and amyotrophic lateral sclerosis (ALS). We developed and tested a novel configuration for cervical transcutaneous spinal stimulation (cTSS). METHODS cTSS was delivered via electrodes placed over the midline at ~T2-T4 levels posteriorly and ~C4-C5 levels anteriorly. Electromyographic responses were measured in arm and hand muscles across a range of stimulus intensities. Double-pulse experiments were performed to assess homosynaptic post-activation depression (PAD). Safety was closely monitored. RESULTS More than 170 cTSS sessions were conducted without major safety or tolerability issues. A cathode-posterior, 2 ms biphasic waveform provided optimal stimulation characteristics. Bilateral upper extremity muscle responses were easily obtained in subjects with SCI and ALS. Resting motor threshold at the abductor pollicis brevis muscle ranged from 5.5 to 51.0 mA. As stimulus intensity increased, response latencies to all muscles decreased. PAD was incomplete at lower stimulus intensities, and decreased at higher stimulus intensities. CONCLUSIONS Posteroanterior cTSS has the capability to target motor neurons both trans-synaptically via large-diameter afferents and non-synaptically via efferent motor axons. SIGNIFICANCE Posteroanterior cTSS is well tolerated and easily activates upper extremity muscles in individuals with SCI and ALS.
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Affiliation(s)
- Yu-Kuang Wu
- James J. Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468, USA; Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA
| | - Jonah M Levine
- James J. Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468, USA
| | - Jaclyn R Wecht
- James J. Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468, USA
| | - Matthew T Maher
- James J. Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468, USA
| | - James M LiMonta
- James J. Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468, USA
| | - Sana Saeed
- James J. Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468, USA
| | - Tiffany M Santiago
- James J. Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468, USA
| | - Eric Bailey
- James J. Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468, USA
| | - Shivani Kastuar
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA
| | - Kenneth S Guber
- James J. Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468, USA
| | - Lok Yung
- James J. Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468, USA
| | - Joseph P Weir
- University of Kansas, 1301 Sunnyside Avenue, Lawrence, KS 66045, USA
| | - Jason B Carmel
- Columbia University, 650 West 168th Street, New York, NY 10032, USA
| | - Noam Y Harel
- James J. Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468, USA; Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA.
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Fang X, Liu M, Lu C, Zhao Y, Liu X. Current status and potential application of navigated transcranial magnetic stimulation in neurosurgery: a literature review. Chin Neurosurg J 2019; 5:12. [PMID: 32922912 PMCID: PMC7398385 DOI: 10.1186/s41016-019-0159-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/25/2019] [Indexed: 12/13/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) is a noninvasive neurophysiologic technique that can stimulate the human brain. Positioning of the coil was often performed based merely on external landmarks on the head, meaning that the anatomical target in the cortex remains inaccurate. Navigated transcranial magnetic stimulation (nTMS) combines a frameless stereotactic navigational system and TMS coil and can provide a highly accurate delivery of TMS pulses with the guidance of imaging. Therefore, many novel utilities for TMS could be explored due to the ability of precise localization. Many studies have been published, which indicate nTMS enables presurgical functional mapping. This review aimed to provide a comprehensive literature review on nTMS, especially the principles and clinical applications of nTMS. All articles in PubMed with keywords of "motor mapping," "presurgical mapping," "navigated transcranial magnetic stimulation," and "language mapping" published from 2000 to 2018 were included in the study. Frequently cited publications before 2000 were also included. The most valuable published original and review articles related to our objective were selected. Motor mapping of nTMS is validated to be a trustful tool to recognize functional areas belonging to both normal and lesioned primary motor cortex. It can offer reliable mapping of speech and motor regions at cortex prior to operation and has comparable accuracy as direct electrical cortical stimulation. nTMS is a powerful tool for mapping of motor and linguistic function prior to operation, has high application value in neurosurgery and the treatment of neurological and psychiatric diseases, and has gained increasing acceptance in neurosurgical centers across the world.
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Affiliation(s)
- Xiaojing Fang
- Department of Neurology, Peking University International Hospital, 1 Life Science St, Changping District, Beijing, 102206 China
| | - Meige Liu
- Department of Neurology, Peking University People's Hospital, Beijing, 100044 China
| | - Changyu Lu
- Department of Neurosurgery, Peking University International Hospital, Beijing, 102206 China
| | - Yuanli Zhao
- Neurosurgery Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070 China.,Department of Neurosurgery, Peking University International Hospital, Beijing, 102206 China
| | - Xianzeng Liu
- Department of Neurology, Peking University International Hospital, 1 Life Science St, Changping District, Beijing, 102206 China
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Accuracy of Estimating the Area of Cortical Muscle Representations from TMS Mapping Data Using Voronoi Diagrams. Brain Topogr 2019; 32:859-872. [PMID: 31073791 DOI: 10.1007/s10548-019-00714-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 05/02/2019] [Indexed: 12/13/2022]
Abstract
Motor evoked potentials (MEPs) caused by transcranial magnetic stimulation (TMS) provide a possibility of noninvasively mapping cortical muscle representations for clinical and research purposes. The interpretation of such results is complicated by the high variability in MEPs and the lack of a standard optimal mapping protocol. Comparing protocols requires the determination of the accuracy of estimated representation parameters (such as the area), which is problematic without ground truth data. We addressed this problem and obtained two main results: (1) the development of a bootstrapping-based approach for estimating the within-session variability and bias of representation parameters and (2) estimations of the area and amplitude-weighted area accuracies for motor representations using this approach. The method consists in the simulation of TMS mapping results by subsampling MEPs from a single map with a large number of stimuli. We studied the extensor digitorum communis (EDC) and flexor digitorum superficialis (FDS) muscle maps of 15 healthy subjects processed using Voronoi diagrams. We calculated the (decreasing) dependency of the errors in the area and weighted area on the number of stimuli. This result can be used to choose a number of stimuli sufficient for studying the effects of a given size (e.g., the protocol with 150 stimuli leads to relative errors of 7% for the area and 11% for the weighted area in 90% of the maps). The approach is applicable to other parameters (e.g., the center of gravity) and other map processing methods, such as spline interpolation.
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Sinitsyn DO, Chernyavskiy AY, Poydasheva AG, Bakulin IS, Suponeva NA, Piradov MA. Optimization of the Navigated TMS Mapping Algorithm for Accurate Estimation of Cortical Muscle Representation Characteristics. Brain Sci 2019; 9:brainsci9040088. [PMID: 31010190 PMCID: PMC6523347 DOI: 10.3390/brainsci9040088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 04/16/2019] [Accepted: 04/17/2019] [Indexed: 12/13/2022] Open
Abstract
Navigated transcranial magnetic stimulation (nTMS) mapping of cortical muscle representations allows noninvasive assessment of the state of a healthy or diseased motor system, and monitoring changes over time. These applications are hampered by the heterogeneity of existing mapping algorithms and the lack of detailed information about their accuracy. We aimed to find an optimal motor evoked potential (MEP) sampling scheme in the grid-based mapping algorithm in terms of the accuracy of muscle representation parameters. The abductor pollicis brevis (APB) muscles of eight healthy subjects were mapped three times on consecutive days using a seven-by-seven grid with ten stimuli per cell. The effect of the MEP variability on the parameter accuracy was assessed using bootstrapping. The accuracy of representation parameters increased with the number of stimuli without saturation up to at least ten stimuli per cell. The detailed sampling showed that the between-session representation area changes in the absence of interventions were significantly larger than the within-session fluctuations and thus could not be explained solely by the trial-to-trial variability of MEPs. The results demonstrate that the number of stimuli has no universally optimal value and must be chosen by balancing the accuracy requirements with the mapping time constraints in a given problem.
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Affiliation(s)
- Dmitry O Sinitsyn
- Department of Neurorehabilitation and Physiotherapy, Research Center of Neurology, 125367 Moscow, Russia.
| | - Andrey Yu Chernyavskiy
- Department of Neurorehabilitation and Physiotherapy, Research Center of Neurology, 125367 Moscow, Russia.
- Quantum Computer Physics Laboratory, Valiev Institute of Physics and Technology of Russian Academy of Sciences, 117218 Moscow, Russia.
| | - Alexandra G Poydasheva
- Department of Neurorehabilitation and Physiotherapy, Research Center of Neurology, 125367 Moscow, Russia.
| | - Ilya S Bakulin
- Department of Neurorehabilitation and Physiotherapy, Research Center of Neurology, 125367 Moscow, Russia.
| | - Natalia A Suponeva
- Department of Neurorehabilitation and Physiotherapy, Research Center of Neurology, 125367 Moscow, Russia.
| | - Michael A Piradov
- Department of Neurorehabilitation and Physiotherapy, Research Center of Neurology, 125367 Moscow, Russia.
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Novikov PA, Nazarova MA, Nikulin VV. TMSmap - Software for Quantitative Analysis of TMS Mapping Results. Front Hum Neurosci 2018; 12:239. [PMID: 30038562 PMCID: PMC6046372 DOI: 10.3389/fnhum.2018.00239] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 05/24/2018] [Indexed: 12/13/2022] Open
Abstract
The use of the MRI-navigation system ensures accurate targeting of TMS. This, in turn, results in TMS motor mapping becoming a routinely used procedure in neuroscience and neurosurgery. However, currently, there is no standardized methodology for assessment of TMS motor-mapping results. Therefore, we developed TMSmap—free standalone graphical interface software for the quantitative analysis of the TMS motor mapping results (http://tmsmap.ru/). In addition to the estimation of standard parameters (such as the size of cortical muscle representation and the center of gravity location), it allows estimation of the volume of cortical representations, excitability profile of the cortical surface map, and the overlap between cortical representations. The input data for the software includes the coordinates of the coil position (or electric field maximum) and the corresponding response in each stimulation point. TMSmap has been developed for versatile assessment and comparison of TMS maps relating to different experimental interventions including, but not limited to longitudinal, pharmacological and clinical studies (e.g., stroke recovery). To illustrate the use of TMSmap we provide examples of the actual TMS motor-mapping analysis of two healthy subjects and one chronic stroke patient.
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Affiliation(s)
- Pavel A Novikov
- Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, National Research University Higher School of Economics, Moscow, Russia
| | - Maria A Nazarova
- Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, National Research University Higher School of Economics, Moscow, Russia
| | - Vadim V Nikulin
- Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, National Research University Higher School of Economics, Moscow, Russia.,Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Neurophysics Group, Department of Neurology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Traub R, Mitsumoto H. Recent advances and opportunities for improving diagnosis of amyotrophic lateral sclerosis. Expert Opin Orphan Drugs 2016. [DOI: 10.1080/21678707.2016.1213164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Rebecca Traub
- Department of Neurology, Columbia University, New York, NY, USA
| | - Hiroshi Mitsumoto
- Department of Neurology, The Eleanor and Lou Gehrig MDA/ALS, Research Center, Columbia University, New York, NY, USA
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