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Lanza G, Salemi M, Mogavero MP, Catania V, Galeano A, Garifoli A, Lanuzza B, Morreale M, Tripodi M, Cantone M, Cappellani F, Concerto C, Rodolico A, Pennisi M, Bella R, Ferri R. Targeting the adenosinergic system in restless legs syndrome: A pilot, "proof-of-concept" placebo-controlled TMS-based protocol. PLoS One 2024; 19:e0302829. [PMID: 38728342 PMCID: PMC11086884 DOI: 10.1371/journal.pone.0302829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/10/2024] [Indexed: 05/12/2024] Open
Abstract
Restless Legs Syndrome (RLS) is a common sleep disorder characterized by an urge to move the legs that is responsive to movement (particularly during rest), periodic leg movements during sleep, and hyperarousal. Recent evidence suggests that the involvement of the adenosine system may establish a connection between dopamine and glutamate dysfunction in RLS. Transcranial magnetic stimulation (TMS) is a non-invasive electrophysiological technique widely applied to explore brain electrophysiology and neurochemistry under different experimental conditions. In this pilot study protocol, we aim to investigate the effects of dipyridamole (a well-known enhancer of adenosinergic transmission) and caffeine (an adenosine receptor antagonist) on measures of cortical excitation and inhibition in response to TMS in patients with primary RLS. Initially, we will assess cortical excitability using both single- and paired-pulse TMS in patients with RLS. Then, based on the measures obtained, we will explore the effects of dipyridamole and caffeine, in comparison to placebo, on various TMS parameters related to cortical excitation and inhibition. Finally, we will evaluate the psycho-cognitive performance of RLS patients to screen them for cognitive impairment and/or mood-behavioral dysfunction, thus aiming to correlate psycho-cognitive findings with TMS data. Overall, this study protocol will be the first to shed lights on the neurophysiological mechanisms of RLS involving the modulation of the adenosine system, thus potentially providing a foundation for innovative "pharmaco-TMS"-based treatments. The distinctive TMS profile observed in RLS holds indeed the potential utility for both diagnosis and treatment, as well as for patient monitoring. As such, it can be considered a target for both novel pharmacological (i.e., drug) and non-pharmacological (e.g., neuromodulatory), "TMS-guided", interventions.
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Affiliation(s)
- Giuseppe Lanza
- Oasi Research Institute-IRCCS, Troina, Italy
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | | | - Maria P. Mogavero
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Neuroscience, San Raffaele Scientific Institute, Sleep Disorders Center, Milan, Italy
| | | | | | | | | | | | | | - Mariagiovanna Cantone
- Neurology Unit, Policlinico University Hospital “G. Rodolico-San Marco”, Catania, Italy
| | - Francesco Cappellani
- Ophtalomolgy Unit, Policlinico University Hospital “G. Rodolico-San Marco”, Catania, Italy
| | - Carmen Concerto
- Psychiatry Unit, Policlinico University Hospital “G. Rodolico-San Marco”, Catania, Italy
| | - Alessandro Rodolico
- Psychiatry Unit, Policlinico University Hospital “G. Rodolico-San Marco”, Catania, Italy
| | - Manuela Pennisi
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Catania, Italy
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Remahi S, Mabika M, Côté S, Iorio-Morin C, Near J, Hui SCN, Edden RAE, Théoret H, Whittingstall K, Lepage JF. Neurotransmitter levels in the basal ganglia are associated with intracortical circuit activity of the primary motor cortex in healthy humans. Prog Neuropsychopharmacol Biol Psychiatry 2024; 129:110892. [PMID: 37952692 DOI: 10.1016/j.pnpbp.2023.110892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/10/2023] [Accepted: 11/01/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND The basal ganglia are strongly connected to the primary motor cortex (M1) and play a crucial role in movement control. Interestingly, several disorders showing abnormal neurotransmitter levels in basal ganglia also present concomitant anomalies in intracortical function within M1. OBJECTIVE/HYPOTHESIS The main aim of this study was to clarify the relationship between neurotransmitter content in the basal ganglia and intracortical function at M1 in healthy individuals. We hypothesized that neurotransmitter content of the basal ganglia would be significant predictors of M1 intracortical function. METHODS We combined magnetic resonance spectroscopy (MRS) and transcranial magnetic stimulation (TMS) to test this hypothesis in 20 healthy adults. An extensive TMS battery probing common measures of intracortical, and corticospinal excitability was administered, and GABA and glutamate-glutamine levels were assessed from voxels placed over the basal ganglia and the occipital cortex (control region). RESULTS Regression models using metabolite concentration as predictor and TMS metrics as outcome measures showed that glutamate level in the basal ganglia significantly predicted short interval intracortical inhibition (SICI) and intracortical facilitation (ICF), while GABA content did not. No model using metabolite measures from the occipital control voxel was significant. CONCLUSIONS Taken together, these results converge with those obtained in clinical populations and suggest that intracortical circuits in human M1 are associated with the neurotransmitter content of connected but distal subcortical structures crucial for motor function.
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Affiliation(s)
- Sarah Remahi
- Sherbrooke University Hospital Research Center, Sherbrooke, Canada; Department of Pediatrics, Faculty of Medicine and Health Sciences, Sherbrooke University, Sherbrooke, Canada
| | - Madora Mabika
- University of Galway, School of Medicine, Galway, Ireland
| | - Samantha Côté
- Sherbrooke University Hospital Research Center, Sherbrooke, Canada; Department of Pediatrics, Faculty of Medicine and Health Sciences, Sherbrooke University, Sherbrooke, Canada; Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Sciences, Sherbrooke University, Sherbrooke, Canada
| | - Christian Iorio-Morin
- Sherbrooke University Hospital Research Center, Sherbrooke, Canada; Department of Surgery, Faculty of Medicine and Health Sciences, Sherbrooke University, Sherbrooke, Canada
| | - Jamie Near
- Physical Sciences Platform, SunnyBrook Health Sciences Center, Toronto, Canada
| | - Steve C N Hui
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Richard A E Edden
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Hugo Théoret
- Department of Psychology, Faculty of Arts and Sciences, Université de Montréal, Montréal, Canada
| | - Kevin Whittingstall
- Sherbrooke University Hospital Research Center, Sherbrooke, Canada; Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Sciences, Sherbrooke University, Sherbrooke, Canada
| | - Jean-François Lepage
- Sherbrooke University Hospital Research Center, Sherbrooke, Canada; Department of Pediatrics, Faculty of Medicine and Health Sciences, Sherbrooke University, Sherbrooke, Canada.
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Paparella G, De Riggi M, Cannavacciuolo A, Costa D, Birreci D, Passaretti M, Angelini L, Colella D, Guerra A, Berardelli A, Bologna M. Interhemispheric imbalance and bradykinesia features in Parkinson's disease. Brain Commun 2024; 6:fcae020. [PMID: 38370448 PMCID: PMC10873583 DOI: 10.1093/braincomms/fcae020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/14/2023] [Accepted: 01/25/2024] [Indexed: 02/20/2024] Open
Abstract
In patients with Parkinson's disease, the connectivity between the two primary motor cortices may be altered. However, the correlation between asymmetries of abnormal interhemispheric connections and bradykinesia features has not been investigated. Furthermore, the potential effects of dopaminergic medications on this issue remain largely unclear. The aim of the present study is to investigate the interhemispheric connections in Parkinson's disease by transcranial magnetic stimulation and explore the potential relationship between interhemispheric inhibition and bradykinesia feature asymmetry in patients. Additionally, we examined the impact of dopaminergic therapy on neurophysiological and motor characteristics. Short- and long-latency interhemispheric inhibition was measured in 18 Parkinson's disease patients and 18 healthy controls, bilaterally. We also assessed the corticospinal and intracortical excitability of both primary motor cortices. We conducted an objective analysis of finger-tapping from both hands. Correlation analyses were performed to explore potential relationships among clinical, transcranial magnetic stimulation and kinematic data in patients. We found that short- and long-latency interhemispheric inhibition was reduced (less inhibition) from both hemispheres in patients than controls. Compared to controls, finger-tapping movements in patients were slower, more irregular, of smaller amplitudes and characterized by a progressive amplitude reduction during movement repetition (sequence effect). Among Parkinson's disease patients, the degree of short-latency interhemispheric inhibition imbalance towards the less affected primary motor cortex correlated with the global clinical motor scores, as well as with the sequence effect on the most affected hand. The greater the interhemispheric inhibition imbalance towards the less affected hemisphere (i.e. less inhibition from the less to the most affected primary motor cortex than that measured from the most to the less affected primary motor cortex), the more severe the bradykinesia in patients. In conclusion, the inhibitory connections between the two primary motor cortices in Parkinson's disease are reduced. The interhemispheric disinhibition of the primary motor cortex may have a role in the pathophysiology of specific bradykinesia features in patients, i.e. the sequence effect.
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Affiliation(s)
- Giulia Paparella
- IRCCS Neuromed, Pozzilli, IS 86077, Italy
- Department of Human Neurosciences, Sapienza, University of Rome, Rome 00185, Italy
| | - Martina De Riggi
- Department of Human Neurosciences, Sapienza, University of Rome, Rome 00185, Italy
| | | | - Davide Costa
- Department of Human Neurosciences, Sapienza, University of Rome, Rome 00185, Italy
| | - Daniele Birreci
- Department of Human Neurosciences, Sapienza, University of Rome, Rome 00185, Italy
| | | | | | - Donato Colella
- Department of Human Neurosciences, Sapienza, University of Rome, Rome 00185, Italy
| | - Andrea Guerra
- Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua 35121, Italy
- Padova Neuroscience Center (PNC), University of Padua, Padua 35131, Italy
| | - Alfredo Berardelli
- IRCCS Neuromed, Pozzilli, IS 86077, Italy
- Department of Human Neurosciences, Sapienza, University of Rome, Rome 00185, Italy
| | - Matteo Bologna
- IRCCS Neuromed, Pozzilli, IS 86077, Italy
- Department of Human Neurosciences, Sapienza, University of Rome, Rome 00185, Italy
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Pantovic M, Boss R, Noorda KJ, Premyanov MI, Aynlender DG, Wilkins EW, Boss S, Riley ZA, Poston B. The Influence of Different Inter-Trial Intervals on the Quantification of Intracortical Facilitation in the Primary Motor Cortex. Bioengineering (Basel) 2023; 10:1278. [PMID: 38002401 PMCID: PMC10669180 DOI: 10.3390/bioengineering10111278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023] Open
Abstract
Intracortical facilitation (ICF) is a paired-pulse transcranial magnetic stimulation (TMS) measurement used to quantify interneuron activity in the primary motor cortex (M1) in healthy populations and motor disorders. Due to the prevalence of the technique, most of the stimulation parameters to optimize ICF quantification have been established. However, the underappreciated methodological issue of the time between ICF trials (inter-trial interval; ITI) has been unstandardized, and different ITIs have never been compared in a paired-pulse TMS study. This is important because single-pulse TMS studies have found motor evoked potential (MEP) amplitude reductions over time during TMS trial blocks for short, but not long ITIs. The primary purpose was to determine the influence of different ITIs on the measurement of ICF. Twenty adults completed one experimental session that involved 4 separate ICF trial blocks with each utilizing a different ITI (4, 6, 8, and 10 s). Two-way ANOVAs indicated no significant ITI main effects for test MEP amplitudes, condition-test MEP amplitudes, and therefore ICF. Accordingly, all ITIs studied provided nearly identical ICF values when averaged over entire trial blocks. Therefore, it is recommended that ITIs of 4-6 s be utilized for ICF quantification to optimize participant comfort and experiment time efficiency.
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Affiliation(s)
- Milan Pantovic
- Health and Human Performance Department, Utah Tech University, St. George, UT 84770, USA;
| | - Rhett Boss
- School of Medicine, University of Nevada-Las Vegas, Las Vegas, NV 89154, USA; (R.B.); (K.J.N.); (M.I.P.); (D.G.A.)
| | - Kevin J. Noorda
- School of Medicine, University of Nevada-Las Vegas, Las Vegas, NV 89154, USA; (R.B.); (K.J.N.); (M.I.P.); (D.G.A.)
| | - Mario I. Premyanov
- School of Medicine, University of Nevada-Las Vegas, Las Vegas, NV 89154, USA; (R.B.); (K.J.N.); (M.I.P.); (D.G.A.)
| | - Daniel G. Aynlender
- School of Medicine, University of Nevada-Las Vegas, Las Vegas, NV 89154, USA; (R.B.); (K.J.N.); (M.I.P.); (D.G.A.)
| | - Erik W. Wilkins
- Department of Kinesiology and Nutrition Sciences, University of Nevada-Las Vegas, Las Vegas, NV 89154, USA;
| | - Sage Boss
- School of Life Sciences, University of Nevada-Las Vegas, Las Vegas, NV 89154, USA;
| | - Zachary A. Riley
- Department of Kinesiology, Indiana University Purdue University Indianapolis, Indianapolis, IN 46202, USA;
| | - Brach Poston
- Department of Kinesiology and Nutrition Sciences, University of Nevada-Las Vegas, Las Vegas, NV 89154, USA;
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Sun H, Gan C, Wang L, Ji M, Cao X, Yuan Y, Zhang H, Shan A, Gao M, Zhang K. Cortical Disinhibition Drives Freezing of Gait in Parkinson's Disease and an Exploratory Repetitive Transcranial Magnetic Stimulation Study. Mov Disord 2023; 38:2072-2083. [PMID: 37646183 DOI: 10.1002/mds.29595] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/14/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Dysfunction of the primary motor cortex, participating in regulation of posture and gait, is implicated in freezing of gait (FOG) in Parkinson's disease (PD). OBJECTIVE The aim was to reveal the mechanisms of "OFF-period" FOG (OFF-FOG) and "levodopa-unresponsive" FOG (ONOFF-FOG) in PD. METHODS We measured the transcranial magnetic stimulation (TMS) indicators and gait parameters in 21 healthy controls (HCs), 15 PD patients with ONOFF-FOG, 15 PD patients with OFF-FOG, and 15 PD patients without FOG (Non-FOG) in "ON" and "OFF" medication conditions. Difference of TMS indicators in the four groups and two conditions and its correlations with gait parameters were explored. Additionally, we explored the effect of 10 Hz repetitive TMS on gait and TMS indicators in ONOFF-FOG patients. RESULTS In "OFF" condition, short interval intracortical inhibition (SICI) exhibited remarkable attenuation in FOG patients (both ONOFF-FOG and OFF-FOG) compared to Non-FOG patients and HCs. The weakening of SICI correlated with impaired gait characteristics in FOG. However, in "ON" condition, SICI in ONOFF-FOG patients reduced compared to OFF-FOG patients. Pharmacological treatment significantly improved SICI and gait in OFF-FOG patients, and high-frequency repetitive TMS distinctly improved gait in ONOFF-FOG patients, accompanied by enhanced SICI. CONCLUSIONS Motor cortex disinhibition, represented by decreased SICI, is related to FOG in PD. Refractory freezing in ONOFF-FOG patients correlated with the their reduced SICI insensitive to dopaminergic medication. SICI can serve as an indicator of the severity of impaired gait characteristics in FOG and reflect treatments efficacy for FOG in PD patients. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Huimin Sun
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Caiting Gan
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lina Wang
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Min Ji
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xingyue Cao
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yongsheng Yuan
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Heng Zhang
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Aidi Shan
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Mengxi Gao
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Kezhong Zhang
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
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Batschelett MA, Huddleston DA, Crocetti D, Horn PS, Mostofsky SH, Gilbert DL. Biomarkers of tic severity in children with Tourette syndrome: Motor cortex inhibition measured with transcranial magnetic stimulation. Dev Med Child Neurol 2023; 65:1321-1331. [PMID: 36938698 PMCID: PMC10509315 DOI: 10.1111/dmcn.15578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/21/2023]
Abstract
AIM To compare transcranial magnetic stimulation (TMS)-derived measures of primary motor cortex (M1) physiology between children with and without Tourette syndrome, and to dimensionally analyze TMS measures with Tourette syndrome-related symptom severity. METHOD We used a cross-sectional experimental design. Sixty 8- to 12-year-old children participated (30 with Tourette syndrome: three females, mean age 10 years 10 months, standard deviation [SD] 1 year 3 months; 30 typically developing children: seven females, mean age 10 years 7 months, SD 1 year 3 months). In the group with Tourette syndrome, 15 (one female, mean age 10 years 11 months, SD 1 year 3 months) had comorbid attention-deficit/hyperactivity disorder (ADHD), rated with the Conners, Third Edition and the parent-reported ADHD rating scales. Tic severity was rated with the Yale Global Tic Severity Scale and urge severity with the Individualized Premonitory Urge for Tics Scale. M1 short-interval cortical inhibition (SICI) and intracortical facilitation were compared between diagnostic groups and, within the group with Tourette syndrome, correlated with symptom severity using linear mixed-effects models for repeated measures. RESULTS Accounting for ADHD, we found no difference in SICI or intracortical facilitation in those with Tourette syndrome versus typically developing children (p > 0.1). In the group with Tourette syndrome, reduced M1 SICI predicted greater total (p = 0.012) and global (p = 0.002) tic severity. There were no associations with urge severity (p > 0.5). INTERPRETATION Reduced M1 SICI is robustly associated with increased tic, but not urge, severity. WHAT THIS PAPER ADDS Increased tic severity is associated with reduced motor cortex short-interval cortical inhibition (SICI). Children with Tourette syndrome with increased urge severity also show increased tic severity. However, reduced motor cortex SICI is associated with tic, but not urge, severity.
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Affiliation(s)
- Mitchell A Batschelett
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, MD, USA
| | - David A Huddleston
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Deana Crocetti
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Paul S Horn
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Stewart H Mostofsky
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Donald L Gilbert
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
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Ginatempo F, Manzo N, Loi N, Belvisi D, Cutrona C, Conte A, Berardelli A, Deriu F. Abnormalities in the face primary motor cortex in oromandibular dystonia. Clin Neurophysiol 2023; 151:151-160. [PMID: 37150654 DOI: 10.1016/j.clinph.2023.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/17/2023] [Accepted: 04/15/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To comprehensively investigate excitability in face and hand M1 and sensorimotor integration in oromandibular dystonia (OMD) patients. METHODS Short-interval intracortical inhibition (SICI), intracortical facilitation (ICF), short (SAI) and long (LAI) afferent inhibition were investigated in face and hand M1 using transcranial magnetic stimulation protocols in 10 OMD patients. Data were compared with those obtained in 10 patients with focal hand dystonia (FHD), in 10 patients with blepharospasm (BSP), and 10 matched healthy subjects (HS). RESULTS Results demonstrated that in OMD patients SICI was reduced in face M1 (p < 0.001), but not in hand M1, compared to HS. In FHD, SICI was significantly impaired in hand M1 (p = 0.029), but not in face M1. In BSP, SICI was normal in both face and hand M1 while ICF and LAI were normal in all patient groups and cortical area tested. SAI was significantly reduced (p = 0.003) only in the face M1 of OMD patients. CONCLUSIONS In OMD, SICI and SAI were significantly reduced. These abnormalities are specific to the motor cortical area innervating the muscular district involved in focal dystonia. SIGNIFICANCE In OMD, the integration between sensory inflow and motor output seem to be disrupted at cortical level with topographic specificity.
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Affiliation(s)
| | - Nicoletta Manzo
- Department of Human Neurosciences, Sapienza, University of Rome, Viale Dell' Università 30, 00185 Rome, Italy; IRCCS San Camillo Hospital, Via Alberoni 70, Venice 30126, Italy
| | - Nicola Loi
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Daniele Belvisi
- Department of Human Neurosciences, Sapienza, University of Rome, Viale Dell' Università 30, 00185 Rome, Italy; IRCCS NEUROMED, Via Atinense, 18, 86077 Pozzilli, IS, Italy
| | - Carolina Cutrona
- Department of Human Neurosciences, Sapienza, University of Rome, Viale Dell' Università 30, 00185 Rome, Italy
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza, University of Rome, Viale Dell' Università 30, 00185 Rome, Italy; IRCCS NEUROMED, Via Atinense, 18, 86077 Pozzilli, IS, Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza, University of Rome, Viale Dell' Università 30, 00185 Rome, Italy; IRCCS NEUROMED, Via Atinense, 18, 86077 Pozzilli, IS, Italy
| | - Franca Deriu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy; Unit of Endocrinology, Nutritional and Metabolic Disorders, AOU Sassari, Sassari, Italy.
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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: 32] [Impact Index Per Article: 32.0] [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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9
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Turrini S, Fiori F, Chiappini E, Lucero B, Santarnecchi E, Avenanti A. Cortico-cortical paired associative stimulation (ccPAS) over premotor-motor areas affects local circuitries in the human motor cortex via Hebbian plasticity. Neuroimage 2023; 271:120027. [PMID: 36925088 DOI: 10.1016/j.neuroimage.2023.120027] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 03/09/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Transcranial magnetic stimulation (TMS) studies have shown that cortico-cortical paired associative stimulation (ccPAS) can strengthen connectivity between the ventral premotor cortex (PMv) and the primary motor cortex (M1) by modulating convergent input over M1 via Hebbian spike-timing-dependent plasticity (STDP). However, whether ccPAS locally affects M1 activity remains unclear. We tested 60 right-handed young healthy humans in two studies, using a combination of dual coil TMS and ccPAS over the left PMv and M1 to probe and manipulate PMv-to-M1 connectivity, and single- and paired-pulse TMS to assess neural activity within M1. We provide convergent evidence that ccPAS, relying on repeated activations of excitatory PMv-to-M1 connections, acts locally over M1. During ccPAS, motor-evoked potentials (MEPs) induced by paired PMv-M1 stimulation gradually increased. Following ccPAS, the threshold for inducing MEPs of different amplitudes decreased, and the input-output curve (IO) slope increased, highlighting increased M1 corticospinal excitability. Moreover, ccPAS reduced the magnitude of short-interval intracortical inhibition (SICI), reflecting suppression of GABA-ergic interneuronal mechanisms within M1, without affecting intracortical facilitation (ICF). These changes were specific to ccPAS Hebbian strengthening of PMv-to-M1 connectivity, as no modulations were observed when reversing the order of the PMv-M1 stimulation during a control ccPAS protocol. These findings expand prior ccPAS research that focused on the malleability of cortico-cortical connectivity at the network-level, and highlight local changes in the area of convergent activation (i.e., M1) during plasticity induction. These findings provide new mechanistic insights into the physiological basis of ccPAS that are relevant for protocol optimization.
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Affiliation(s)
- Sonia Turrini
- Centro studi e Ricerche in Neuroscienze Cognitive, Dipartimento di Psicologia "Renzo Canestrari", Alma Mater Studiorum Università di Bologna, Cesena Campus, Cesena 47521, Italy; Precision Neuroscience & Neuromodulation Program, Gordon Center for Medical Imaging, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, United States.
| | - Francesca Fiori
- Centro studi e Ricerche in Neuroscienze Cognitive, Dipartimento di Psicologia "Renzo Canestrari", Alma Mater Studiorum Università di Bologna, Cesena Campus, Cesena 47521, Italy; NeXT: Neurophysiology and Neuro-Engineering of Human-Technology Interaction Research Unit, Campus Bio-Medico University, Rome 00128, Italy
| | - Emilio Chiappini
- Centro studi e Ricerche in Neuroscienze Cognitive, Dipartimento di Psicologia "Renzo Canestrari", Alma Mater Studiorum Università di Bologna, Cesena Campus, Cesena 47521, Italy; Institut für Klinische und Gesundheitspsychologie, Universität Wien, Vienna 1010, Austria
| | - Boris Lucero
- Centro de Investigación en Neuropsicología y Neurociencias Cognitivas (CINPSI Neurocog), Universidad Católica Del Maule, Talca 346000, Chile
| | - Emiliano Santarnecchi
- Precision Neuroscience & Neuromodulation Program, Gordon Center for Medical Imaging, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, United States
| | - Alessio Avenanti
- Centro studi e Ricerche in Neuroscienze Cognitive, Dipartimento di Psicologia "Renzo Canestrari", Alma Mater Studiorum Università di Bologna, Cesena Campus, Cesena 47521, Italy; Centro de Investigación en Neuropsicología y Neurociencias Cognitivas (CINPSI Neurocog), Universidad Católica Del Maule, Talca 346000, Chile.
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10
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Ewers SP, Dreier TM, Al-Bas S, Schwenkreis P, Pleger B. Classical conditioning of faciliatory paired-pulse TMS. Sci Rep 2023; 13:6192. [PMID: 37062779 PMCID: PMC10106457 DOI: 10.1038/s41598-023-32894-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 04/04/2023] [Indexed: 04/18/2023] Open
Abstract
In this proof-of-concept study, we questioned whether the influence of TMS on cortical excitability can be applied to classical conditioning. More specifically, we investigated whether the faciliatory influence of paired-pulse TMS on the excitability of the human motor cortex can be transferred to a simultaneously presented auditory stimulus through conditioning. During the conditioning phase, 75 healthy young participants received 170 faciliatory paired TMS pulses (1st pulse at 95% resting motor threshold, 2nd at 130%, interstimulus interval 12 ms), always presented simultaneously with one out of two acoustic stimuli. In the test phase, 20 min later, we pseudorandomly applied 100 single TMS pulses (at 130% MT), 50 paired with the conditioned tone-50 paired with a control tone. Using the Wilcoxon-Signed Rank test, we found significantly enhanced median amplitudes of motor evoked potentials (MEPs) paired with the conditioned tone as compared to the control tone, suggesting successful conditioning (p = 0.031, responder rate 55%, small effect size of r = - 0.248). The same comparison in only those participants with a paired-pulse amplitude < 2 mV in the conditioning phase, increased the responder rate to 61% (n = 38) and effect size to moderate (r = - 0.389). If we considered only those participants with a median paired-pulse amplitude < 1 mV, responder rate increased further to 79% (n = 14) and effect size to r = - 0.727 (i.e., large effect). These findings suggest increasingly stronger conditioning effects for smaller MEP amplitudes during paired-pulse TMS conditioning. These proof-of-concept findings extend the scope of classical conditioning to faciliatory paired-pulse TMS.
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Affiliation(s)
- Stefan P Ewers
- Department of Neurology, BG University Clinic Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Timo M Dreier
- Department of Neurology, BG University Clinic Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Siham Al-Bas
- Department of Neurology, BG University Clinic Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Peter Schwenkreis
- Department of Neurology, BG University Clinic Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Burkhard Pleger
- Department of Neurology, BG University Clinic Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany.
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11
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D’Onofrio V, Manzo N, Guerra A, Landi A, Baro V, Määttä S, Weis L, Porcaro C, Corbetta M, Antonini A, Ferreri F. Combining Transcranial Magnetic Stimulation and Deep Brain Stimulation: Current Knowledge, Relevance and Future Perspectives. Brain Sci 2023; 13:brainsci13020349. [PMID: 36831892 PMCID: PMC9954740 DOI: 10.3390/brainsci13020349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
Deep brain stimulation (DBS) has emerged as an invasive neuromodulation technique for the treatment of several neurological disorders, but the mechanisms underlying its effects remain partially elusive. In this context, the application of Transcranial Magnetic Stimulation (TMS) in patients treated with DBS represents an intriguing approach to investigate the neurophysiology of cortico-basal networks. Experimental studies combining TMS and DBS that have been performed so far have mainly aimed to evaluate the effects of DBS on the cerebral cortex and thus to provide insights into DBS's mechanisms of action. The modulation of cortical excitability and plasticity by DBS is emerging as a potential contributor to its therapeutic effects. Moreover, pairing DBS and TMS stimuli could represent a method to induce cortical synaptic plasticity, the therapeutic potential of which is still unexplored. Furthermore, the advent of new DBS technologies and novel treatment targets will present new research opportunities and prospects to investigate brain networks. However, the application of the combined TMS-DBS approach is currently limited by safety concerns. In this review, we sought to present an overview of studies performed by combining TMS and DBS in neurological disorders, as well as available evidence and recommendations on the safety of their combination. Additionally, we outline perspectives for future research by highlighting knowledge gaps and possible novel applications of this approach.
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Affiliation(s)
| | - Nicoletta Manzo
- IRCCS San Camillo Hospital, Via Alberoni 70, 0126 Venice, Italy
| | - Andrea Guerra
- IRCCS Neuromed, 86077 Pozzilli, Italy
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Andrea Landi
- Academic Neurosurgery, Department of Neurosciences, University of Padova, 35128 Padova, Italy
| | - Valentina Baro
- Academic Neurosurgery, Department of Neurosciences, University of Padova, 35128 Padova, Italy
| | - Sara Määttä
- Department of Clinical Neurophysiology, Kuopio University Hospital, University of Eastern Finland, 70211 Kuopio, Finland
| | - Luca Weis
- Parkinson’s Disease and Movement Disorders Unit, Department of Neuroscience, Centre for Rare Neurological Diseases (ERN-RND), University of Padova, 35128 Padova, Italy
| | - Camillo Porcaro
- Padova Neuroscience Center (PNC), University of Padova, 35129 Padova, Italy
- Department of Neuroscience, University of Padova, 35128 Padova, Italy
- Institute of Cognitive Sciences, and Technologies (ISTC)-National Research Council (CNR), 00185 Rome, Italy
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham B15 2TT, UK
| | - Maurizio Corbetta
- Padova Neuroscience Center (PNC), University of Padova, 35129 Padova, Italy
- Unit of Neurology, Unit of Clinical Neurophysiology, Study Center of Neurodegeneration (CESNE), Department of Neuroscience, University of Padova, 35128 Padova, Italy
- Venetian Institute of Molecular Medicine, 35129 Padova, Italy
| | - Angelo Antonini
- Parkinson’s Disease and Movement Disorders Unit, Department of Neuroscience, Centre for Rare Neurological Diseases (ERN-RND), University of Padova, 35128 Padova, Italy
- Unit of Neurology, Unit of Clinical Neurophysiology, Study Center of Neurodegeneration (CESNE), Department of Neuroscience, University of Padova, 35128 Padova, Italy
- Department of Neurology, Washington University, St. Louis, MO 63108, USA
- Department of Neuroscience, Washington University, St. Louis, MO 63108, USA
- Correspondence: (A.A.); (F.F.)
| | - Florinda Ferreri
- Department of Clinical Neurophysiology, Kuopio University Hospital, University of Eastern Finland, 70211 Kuopio, Finland
- Unit of Neurology, Unit of Clinical Neurophysiology, Study Center of Neurodegeneration (CESNE), Department of Neuroscience, University of Padova, 35128 Padova, Italy
- Correspondence: (A.A.); (F.F.)
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12
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Guerra A, D'Onofrio V, Asci F, Ferreri F, Fabbrini G, Berardelli A, Bologna M. Assessing the interaction between L-dopa and γ-transcranial alternating current stimulation effects on primary motor cortex plasticity in Parkinson's disease. Eur J Neurosci 2023; 57:201-212. [PMID: 36382537 PMCID: PMC10100043 DOI: 10.1111/ejn.15867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/18/2022] [Accepted: 11/08/2022] [Indexed: 11/17/2022]
Abstract
L-dopa variably influences transcranial magnetic stimulation (TMS) parameters of motor cortex (M1) excitability and plasticity in Parkinson's disease (PD). In patients OFF dopaminergic medication, impaired M1 plasticity and defective GABA-A-ergic inhibition can be restored by boosting gamma (γ) oscillations via transcranial alternating current stimulation (tACS) during intermittent theta-burst stimulation (iTBS). However, it is unknown whether L-dopa modifies the beneficial effects of iTBS-γ-tACS on M1 in PD. In this study, a PD patients group underwent combined iTBS-γ-tACS and iTBS-sham-tACS, each performed both OFF and ON dopaminergic therapy (four sessions in total). Motor evoked potentials (MEPs) elicited by single TMS pulses and short-interval intracortical inhibition (SICI) were assessed before and after iTBS-tACS. We also evaluated possible SICI changes during γ-tACS delivered alone in OFF and ON conditions. The amplitude of MEP elicited by single TMS pulses and the degree of SICI inhibition significantly increased after iTBS-γ-tACS. The amount of change produced by iTBS-γ-tACS was similar in patients OFF and ON therapy. Finally, γ-tACS (delivered alone) modulated SICI during stimulation and this effect did not depend on the dopaminergic condition of patients. In conclusion, boosting cortical γ oscillatory activity via tACS during iTBS improved M1 plasticity and enhanced GABA-A-ergic transmission in PD patients to the same extent regardless of dopaminergic state. These results suggest a lack of interaction between L-dopa and γ-tACS effects at the M1 level. The possible neural substrate underlying iTBS-γ tACS effects, that is, γ-resonant GABA-A-ergic interneurons activity, may explain our findings.
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Affiliation(s)
| | - Valentina D'Onofrio
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.,Unit of Neurology, Unit of Clinical Neurophysiology and Study Center for Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
| | | | - Florinda Ferreri
- Unit of Neurology, Unit of Clinical Neurophysiology and Study Center for Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua, Italy.,Department of Clinical Neurophysiology, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Giovanni Fabbrini
- IRCCS Neuromed, Pozzilli, Italy.,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Alfredo Berardelli
- IRCCS Neuromed, Pozzilli, Italy.,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Matteo Bologna
- IRCCS Neuromed, Pozzilli, Italy.,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
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13
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Wilhelm E, Quoilin C, Derosiere G, Paço S, Jeanjean A, Duque J. Corticospinal Suppression Underlying Intact Movement Preparation Fades in Parkinson's Disease. Mov Disord 2022; 37:2396-2406. [PMID: 36121426 DOI: 10.1002/mds.29214] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/11/2022] [Accepted: 08/17/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND In Parkinson's disease (PD), neurophysiological abnormalities within the primary motor cortex (M1) have been shown to contribute to bradykinesia, but exact modalities are still uncertain. We propose that such motor slowness could involve alterations in mechanisms underlying movement preparation, especially the suppression of corticospinal excitability-called "preparatory suppression"-which is considered to propel movement execution by increasing motor neural gain in healthy individuals. METHODS On two consecutive days, 29 PD patients (on and off medication) and 29 matched healthy controls (HCs) underwent transcranial magnetic stimulation over M1, eliciting motor-evoked potentials (MEPs) in targeted hand muscles, while they were either at rest or preparing a left- or right-hand response in an instructed-delay choice reaction time task. Preparatory suppression was assessed by expressing MEP amplitudes during movement preparation relative to rest. RESULTS Contrary to HCs, PD patients showed a lack of preparatory suppression when the side of the responding hand was analyzed, especially when the latter was the most affected one. This deficit, which did not depend on dopamine medication, increased with disease duration and also tended to correlate with motor impairment, as measured by the Movement Disorder Society Unified Parkinson's Disease Rating Scale, Part III (both total and bradykinesia scores). CONCLUSIONS Our novel findings indicate that preparatory suppression fades in PD, in parallel with worsening motor symptoms, including bradykinesia. Such results suggest that an alteration in this marker of intact movement preparation could indeed cause motor slowness and support its use in future studies on the relation between M1 alterations and motor impairment in PD. © 2022 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Emmanuelle Wilhelm
- CoActions Lab, Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.,Department of Adult Neurology, Saint-Luc University Hospital, Brussels, Belgium
| | - Caroline Quoilin
- CoActions Lab, Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Gerard Derosiere
- CoActions Lab, Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Susana Paço
- NOVA IMS, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Anne Jeanjean
- Department of Adult Neurology, Saint-Luc University Hospital, Brussels, Belgium
| | - Julie Duque
- CoActions Lab, Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
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14
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Herzog R, Berger TM, Pauly MG, Xue H, Rueckert E, Münchau A, Bäumer T, Weissbach A. Cerebellar transcranial current stimulation – An intraindividual comparison of different techniques. Front Neurosci 2022; 16:987472. [PMID: 36188449 PMCID: PMC9521312 DOI: 10.3389/fnins.2022.987472] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Transcranial current stimulation (tCS) techniques have been shown to induce cortical plasticity. As an important relay in the motor system, the cerebellum is an interesting target for plasticity induction using tCS, aiming to modulate its excitability and connectivity. However, until now it remains unclear, which is the most effective tCS method for inducing plasticity in the cerebellum. Thus, in this study, the effects of anodal transcranial direct current stimulation (tDCS), 50 Hz transcranial alternating current stimulation (50 Hz tACS), and high frequency transcranial random noise stimulation (tRNS) were compared with sham stimulation in 20 healthy subjects in a within-subject design. tCS was applied targeting the cerebellar lobe VIIIA using neuronavigation. We measured corticospinal excitability, short-interval intracortical inhibition (SICI), short-latency afferent inhibition (SAI), and cerebellar brain inhibition (CBI) and performed a sensor-based movement analysis at baseline and three times after the intervention (post1 = 15 min; post2 = 55 min; post3 = 95 min). Corticospinal excitability increased following cerebellar tACS and tRNS compared to sham stimulation. This effect was most pronounced directly after stimulation but lasted for at least 55 min after tACS. Cortico-cortical and cerebello-cortical conditioning protocols, as well as sensor-based movement analyses, did not change. Our findings suggest that cerebellar 50 Hz tACS is the most effective protocol to change corticospinal excitability.
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Affiliation(s)
- Rebecca Herzog
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
- Department of Neurology, University Hospital Schleswig Holstein, Lübeck, Germany
| | - Till M. Berger
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Martje G. Pauly
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
- Department of Neurology, University Hospital Schleswig Holstein, Lübeck, Germany
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Honghu Xue
- Institute for Robotics and Cognitive Systems, University of Lübeck, Lübeck, Germany
| | | | - Alexander Münchau
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Tobias Bäumer
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Anne Weissbach
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
- *Correspondence: Anne Weissbach,
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15
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Neurophysiological assessment of juvenile parkinsonism due to primary monoamine neurotransmitter disorders. J Neural Transm (Vienna) 2022; 129:1011-1021. [PMID: 35829818 PMCID: PMC9300560 DOI: 10.1007/s00702-022-02527-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 06/27/2022] [Indexed: 11/10/2022]
Abstract
No studies have investigated voluntary movement abnormalities and their neurophysiological correlates in patients with parkinsonism due to inherited primary monoamine neurotransmitter (NT) disorders. Nine NT disorders patients and 16 healthy controls (HCs) were enrolled. Objective measurements of repetitive finger tapping were obtained using a motion analysis system. Primary motor cortex (M1) excitability was assessed by recording the input/output (I/O) curve of motor-evoked potentials (MEP) and using a conditioning test paradigm for short-interval intracortical inhibition (SICI) assessment. M1 plasticity-like mechanisms were indexed according to MEPs amplitude changes after the paired associative stimulation protocol. Patient values were considered abnormal if they were greater or lower than two standard deviations from the average HCs value. Patients with aromatic amino acid decarboxylase, tyrosine hydroxylase, and 6-pyruvoyl-tetrahydropterin synthase defects showed markedly reduced velocity (5/5 patients), reduced movement amplitude, and irregular rhythm (4/5 patients). Conversely, only 1 out of 3 patients with autosomal-dominant GTPCH deficiency showed abnormal movement parameters. Interestingly, none of the patients had a progressive reduction in movement amplitude or velocity during the tapping sequence (no sequence effect). Reduced SICI was the most prominent neurophysiological abnormality in patients (5/9 patients). Finally, the I/O curve slope correlated with movement velocity and rhythm in patients. We provided an objective assessment of finger tapping abnormalities in monoamine NT disorders. We also demonstrated M1 excitability changes possibly related to alterations in motor execution. Our results may contribute to a better understanding of the pathophysiology of juvenile parkinsonism due to dopamine deficiency.
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16
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Bologna M, Valls-Solè J, Kamble N, Pal PK, Conte A, Guerra A, Belvisi D, Berardelli A. Dystonia, chorea, hemiballismus and other dyskinesias. Clin Neurophysiol 2022; 140:110-125. [PMID: 35785630 DOI: 10.1016/j.clinph.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/12/2022] [Accepted: 05/24/2022] [Indexed: 11/30/2022]
Abstract
Hyperkinesias are heterogeneous involuntary movements that significantly differ in terms of clinical and semeiological manifestations, including rhythm, regularity, speed, duration, and other factors that determine their appearance or suppression. Hyperkinesias are due to complex, variable, and largely undefined pathophysiological mechanisms that may involve different brain areas. In this chapter, we specifically focus on dystonia, chorea and hemiballismus, and other dyskinesias, specifically, levodopa-induced, tardive, and cranial dyskinesia. We address the role of neurophysiological studies aimed at explaining the pathophysiology of these conditions. We mainly refer to human studies using surface and invasive in-depth recordings, as well as spinal, brainstem, and transcortical reflexology and non-invasive brain stimulation techniques. We discuss the extent to which the neurophysiological abnormalities observed in hyperkinesias may be explained by pathophysiological models. We highlight the most relevant issues that deserve future research efforts. The potential role of neurophysiological assessment in the clinical context of hyperkinesia is also discussed.
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Affiliation(s)
- Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy
| | - Josep Valls-Solè
- Institut d'Investigació Biomèdica August Pi I Sunyer, Villarroel, 170, Barcelona, Spain
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, India
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy
| | | | - Daniele Belvisi
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy.
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17
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Guerra A, Bologna M. Low-Intensity Transcranial Ultrasound Stimulation: Mechanisms of Action and Rationale for Future Applications in Movement Disorders. Brain Sci 2022; 12:brainsci12050611. [PMID: 35624998 PMCID: PMC9139935 DOI: 10.3390/brainsci12050611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/29/2022] [Accepted: 05/05/2022] [Indexed: 02/01/2023] Open
Abstract
Low-intensity transcranial ultrasound stimulation (TUS) is a novel non-invasive brain stimulation technique that uses acoustic energy to induce changes in neuronal activity. However, although low-intensity TUS is a promising neuromodulation tool, it has been poorly studied as compared to other methods, i.e., transcranial magnetic and electrical stimulation. In this article, we first focus on experimental studies in animals and humans aimed at explaining its mechanisms of action. We then highlight possible applications of TUS in movement disorders, particularly in patients with parkinsonism, dystonia, and tremor. Finally, we highlight the knowledge gaps and possible limitations that currently limit potential TUS applications in movement disorders. Clarifying the potential role of TUS in movement disorders may further promote studies with therapeutic perspectives in this field.
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Affiliation(s)
| | - Matteo Bologna
- IRCCS Neuromed, 86077 Pozzilli, Italy;
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- Correspondence:
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18
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Kolmančič K, Zupančič NK, Trošt M, Flisar D, Kramberger MG, Pirtošek Z, Kojović M. Continuous Dopaminergic Stimulation Improves Cortical Maladaptive Changes in Advanced Parkinson's Disease. Mov Disord 2022; 37:1465-1473. [PMID: 35436354 DOI: 10.1002/mds.29028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/10/2022] [Accepted: 03/27/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND With the progression of Parkinson's disease (PD), pulsatile treatment with oral levodopa causes maladaptive changes within basal ganglia-thalamo-cortical circuits, which are clinically expressed as motor fluctuations and dyskinesias. At the level of the motor cortex, these changes may be detected using transcranial magnetic stimulation (TMS), as abnormal corticospinal and intracortical excitability and absent response to plasticity protocols. OBJECTIVE We investigated the effect of continuous dopaminergic stimulation on cortical maladaptive changes related to oral levodopa treatment. METHODS Twenty patients with advanced PD were tested using TMS within 1 week before and again 6 months after the introduction of levodopa-carbidopa intestinal gel. We measured resting and active motor thresholds, input/output curve, short interval intracortical inhibition curve, cortical silent period, and response to intermittent theta burst stimulation. Patients were clinically assessed with Part III and Part IV of the Movement Disorders Society Unified Parkinson's Disease Rating Scale. RESULTS Six months after the introduction of levodopa-carbidopa intestinal gel, motor fluctuations scores (P = 0.001) and dyskinesias scores (P < 0.001) were reduced. Resting and active motor threshold (P = 0.012 and P = 0.015) and x-intercept of input/output curve (P = 0.005) were also decreased, while short-interval intracortical inhibition and response to intermittent theta bust stimulation were improved (P = 0.026 and P = 0.031, respectively). Changes in these parameters correlated with clinical improvement. CONCLUSIONS In patients with advanced PD, switching from intermittent to continuous levodopa delivery increased corticospinal excitability and improved deficient intracortical inhibition and abnormal motor cortex plasticity, along with amelioration of motor fluctuations and dyskinesias. Continuous dopaminergic stimulation ameliorates maladaptive changes inflicted by chronic pulsatile dopaminergic stimulation. © 2022 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Kaja Kolmančič
- Department of Nuclear Medicine, University Clinical Centre, Ljubljana, Slovenia.,Department of Neurology, University Clinical Centre, Ljubljana, Slovenia
| | - Nina K Zupančič
- Department of Neurology, University Clinical Centre, Ljubljana, Slovenia
| | - Maja Trošt
- Department of Neurology, University Clinical Centre, Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Dušan Flisar
- Department of Neurology, University Clinical Centre, Ljubljana, Slovenia
| | - Milica G Kramberger
- Department of Neurology, University Clinical Centre, Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Zvezdan Pirtošek
- Department of Neurology, University Clinical Centre, Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Maja Kojović
- Department of Neurology, University Clinical Centre, Ljubljana, Slovenia
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19
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Boček V, Krbec M, Vaško P, Brabec K, Pavlíková M, Štětkářová I. Alteration of cortical but not spinal inhibitory circuits in idiopathic scoliosis. J Spinal Cord Med 2022; 45:186-193. [PMID: 32202478 PMCID: PMC8986185 DOI: 10.1080/10790268.2020.1739893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Background: The pathogenesis of adolescent idiopathic scoliosis (AIS), including the role of brain and spinal inhibitory circuits, is still poorly elucidated. The aim of this study was to identify which central inhibitory mechanisms are involved in the pathogenesis of AIS.Design: A prospective neurophysiological study, using a battery of neurophysiological tests, such as cutaneous (CuSP) and cortical (CoSP) silent periods, motor evoked potentials (MEP) and paired-pulse transcranial magnetic stimulation (ppTMS).Settings: Neurophysiological laboratory.Participants: Sixteen patients with AIS (14 females, median age 14.4) and healthy controls.Outcome measures: MEPs were obtained after transcranial magnetic stimulation (TMS) and recorded from the abductor pollicis muscle (APB). ppTMS was obtained at interval ratios (ISI) of 1, 2, 3, 6, 10, 15 and 20 ms. The cortical silent period (CoSP) was recorded from the APB. The cutaneous silent period (CuSP) was measured after painful stimuli delivered to the thumb while the subjects maintained voluntary contraction of the intrinsic hand muscles. The data were analyzed and compared with those from healthy subjects.Results: The CoSP duration was significantly prolonged in AIS patients. A significantly higher amplitude of ppTMS for ISI was found in all AIS patients, without remarkable left-right side differences. No significant difference in MEP latency or amplitude nor in the CuSP duration was obtained.Conclusion: Our observation demonstrates evidence of central nervous system involvement in adolescent idiopathic scoliosis (AIS). Lower intracortical inhibition, higher motor cortex excitability, and preserved spinal inhibitory circuits are the main findings of this study. A possible explanation of these changes could be attributed to impaired sensorimotor integration predominantly at the cortical level.
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Affiliation(s)
- Václav Boček
- Department of Neurology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic,Correspondence to: Václav Boček, Department of Neurology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Ruska 87, 100 00Prague 10, Czech Republic.
| | - Martin Krbec
- Department of Orthopedics and Traumatology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Peter Vaško
- Department of Neurology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Karel Brabec
- Department of Neurology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic,Department of Orthopedics and Traumatology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Markéta Pavlíková
- Department of Probability and Mathematical Statistics, Faculty of Mathematics and Physics, Charles University, Prague, Czech Republic
| | - Ivana Štětkářová
- Department of Neurology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
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20
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Aceves-Serrano L, Neva JL, Doudet DJ. Insight Into the Effects of Clinical Repetitive Transcranial Magnetic Stimulation on the Brain From Positron Emission Tomography and Magnetic Resonance Imaging Studies: A Narrative Review. Front Neurosci 2022; 16:787403. [PMID: 35264923 PMCID: PMC8899094 DOI: 10.3389/fnins.2022.787403] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/01/2022] [Indexed: 12/14/2022] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) has been proposed as a therapeutic tool to alleviate symptoms for neurological and psychiatric diseases such as chronic pain, stroke, Parkinson’s disease, major depressive disorder, and others. Although the therapeutic potential of rTMS has been widely explored, the neurological basis of its effects is still not fully understood. Fortunately, the continuous development of imaging techniques has advanced our understanding of rTMS neurobiological underpinnings on the healthy and diseased brain. The objective of the current work is to summarize relevant findings from positron emission tomography (PET) and magnetic resonance imaging (MRI) techniques evaluating rTMS effects. We included studies that investigated the modulation of neurotransmission (evaluated with PET and magnetic resonance spectroscopy), brain activity (evaluated with PET), resting-state connectivity (evaluated with resting-state functional MRI), and microstructure (diffusion tensor imaging). Overall, results from imaging studies suggest that the effects of rTMS are complex and involve multiple neurotransmission systems, regions, and networks. The effects of stimulation seem to not only be dependent in the frequency used, but also in the participants characteristics such as disease progression. In patient populations, pre-stimulation evaluation was reported to predict responsiveness to stimulation, while post-stimulation neuroimaging measurements showed to be correlated with symptomatic improvement. These studies demonstrate the complexity of rTMS effects and highlight the relevance of imaging techniques.
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Affiliation(s)
- Lucero Aceves-Serrano
- Department of Medicine/Neurology, University of British Columbia, Vancouver, BC, Canada
- *Correspondence: Lucero Aceves-Serrano,
| | - Jason L. Neva
- École de Kinésiologie et des Sciences de l’Activité Physique, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche de l’Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
| | - Doris J. Doudet
- Department of Medicine/Neurology, University of British Columbia, Vancouver, BC, Canada
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21
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Are Neurophysiological Biomarkers Able to Discriminate Multiple Sclerosis Clinical Subtypes? Biomedicines 2022; 10:biomedicines10020231. [PMID: 35203440 PMCID: PMC8869727 DOI: 10.3390/biomedicines10020231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 11/26/2022] Open
Abstract
Secondary progressive multiple sclerosis (SPMS) subtype is retrospectively diagnosed, and biomarkers of the SPMS are not available. We aimed to identify possible neurophysiological markers exploring grey matter structures that could be used in clinical practice to better identify SPMS. Fifty-five people with MS and 31 healthy controls underwent a transcranial magnetic stimulation protocol to test intracortical interneuron excitability in the primary motor cortex and somatosensory temporal discrimination threshold (STDT) to test sensory function encoded in cortical and deep grey matter nuclei. A logistic regression model was used to identify a combined neurophysiological index associated with the SP subtype. We observed that short intracortical inhibition (SICI) and STDT were the only variables that differentiated the RR from the SP subtype. The logistic regression model provided a formula to compute the probability of a subject being assigned to an SP subtype based on age and combined SICI and STDT values. While only STDT correlated with disability level at baseline evaluation, both SICI and STDT were associated with disability at follow-up. SICI and STDT abnormalities reflect age-dependent grey matter neurodegenerative processes that likely play a role in SPMS pathophysiology and may represent easily accessible neurophysiological biomarkers for the SPMS subtype.
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22
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Wu Y, Cao XB, Zeng WQ, Zhai H, Zhang XQ, Yang XM, Cheng C, Wang JL, Yang XM, Xu Y. Transcranial Magnetic Stimulation Alleviates Levodopa-Induced Dyskinesia in Parkinson's Disease and the Related Mechanisms: A Mini-Review. Front Neurol 2021; 12:758345. [PMID: 34858315 PMCID: PMC8631751 DOI: 10.3389/fneur.2021.758345] [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: 08/13/2021] [Accepted: 10/04/2021] [Indexed: 01/28/2023] Open
Abstract
After long-term use of levodopa, Parkinson's patients almost inevitably develop dyskinesia, a kind of drug side effect manifesting as uncontrollable choreic movements and dystonia, which could be crippling yet have limited therapeutic options. Transcranial magnetic stimulation is the most widely studied non-invasive neuromodulation technology to treat levodopa-induced dyskinesia. Many studies have shown that transcranial magnetic stimulation has beneficial effects on levodopa-induced dyskinesia and is patient-tolerable, barely with reported adverse effects. Changes in brain connectivity, neuroplasticity, neurotransmitter, neurorestoration, and blood flow modulation could play crucial roles in the efficacy of transcranial magnetic stimulation for levodopa-induced dyskinesia. The appearance of new modes and application for emerging targets are possible solutions for transcranial magnetic stimulation to achieve sustained efficacy. Since the sample size in all available studies is small, more randomized double-blind controlled studies are needed to elucidate the specific treatment mechanisms and optimize treatment parameters.
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Affiliation(s)
- Yi Wu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xue-Bing Cao
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei-Qi Zeng
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Heng Zhai
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao-Qian Zhang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao-Man Yang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chi Cheng
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jia-Ling Wang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao-Mei Yang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Xu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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23
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Guerra A, Asci F, Zampogna A, D'Onofrio V, Suppa A, Fabbrini G, Berardelli A. Long-term changes in short-interval intracortical facilitation modulate motor cortex plasticity and L-dopa-induced dyskinesia in Parkinson's disease. Brain Stimul 2021; 15:99-108. [PMID: 34823038 DOI: 10.1016/j.brs.2021.11.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Abnormal glutamatergic neurotransmission in the primary motor cortex (M1) contributes to Parkinson's disease (PD) pathophysiology and is related to l-dopa-induced dyskinesia (LID). We previously showed that short-term treatment with safinamide, a monoamine oxidase type-B inhibitor with anti-glutamatergic properties, improves abnormally enhanced short-interval intracortical facilitation (SICF) in PD patients. OBJECTIVE To examine whether a long-term SICF modulation has beneficial effects on clinical measures, including LID severity, and whether these changes parallel improvement in cortical plasticity mechanisms in PD. METHODS We tested SICF in patients with and without LID before (S0) and after short- (14 days - S1) and long-term (12 months - S2) treatment with safinamide 100 mg/day. Possible changes in M1 plasticity were assessed using intermittent theta-burst stimulation (iTBS). Finally, we correlated safinamide-related neurophysiological changes with modifications in clinical scores. RESULTS SICF was enhanced at S0, and prominently in patients with LID. Safinamide normalized SICF at S1, and this effect persisted at S2. Impaired iTBS-induced plasticity was present at S0 and safinamide restored this alteration at S2. There was a significant correlation between the degree of SICF and the amount of iTBS-induced plasticity at S0 and S2. In patients with LID, the degree of SICF at S0 and S2 correlated with long-term changes in LID severity. CONCLUSIONS Altered SICF contributes to M1 plasticity impairment in PD. Both SICF and M1 plasticity improve after long-term treatment with safinamide. The abnormality in SICF-related glutamatergic circuits plays a role in LID pathophysiology, and its long-term modulation may prevent LID worsening over time.
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Affiliation(s)
| | | | | | | | - Antonio Suppa
- IRCCS Neuromed, Pozzilli, IS, Italy; Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Giovanni Fabbrini
- IRCCS Neuromed, Pozzilli, IS, Italy; Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Alfredo Berardelli
- IRCCS Neuromed, Pozzilli, IS, Italy; Department of Human Neurosciences, Sapienza University of Rome, Italy.
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24
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Filipović SR, Kačar A, Milanović S, Ljubisavljević MR. Neurophysiological Predictors of Response to Medication in Parkinson's Disease. Front Neurol 2021; 12:763911. [PMID: 34867748 PMCID: PMC8635106 DOI: 10.3389/fneur.2021.763911] [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: 08/24/2021] [Accepted: 10/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Although dopaminergic medication has been the foundation of Parkinson's disease (PD) therapy for decades, sensitive and specific therapeutic response biomarkers that allow for better treatment optimization are lacking. Objective: We tested whether the features of Transcranial Magnetic Stimulation-based neurophysiological measures taken off-medication are associated with dopaminergic medication-induced clinical effects. Method: Motor cortex excitability [short-latency intracortical inhibition (SICI), intracortical facilitation (ICF), short-latency afferent inhibition (SAI), and input-output (IO) curve], and plasticity [paired associative stimulation (PAS) protocol] neurophysiological measures were examined in 23 PD patients off-medication. Clinical features were quantified by the motor section of the Unified Parkinson's Disease Scale (total score and lateralized total, bradykinesia, and rigidity sub-scores), and the differences between measures off-medication and on-medication (following the usual morning dose), were determined. Total daily dopaminergic medication dose (expressed as levodopa equivalent daily dose-LEDD), was also determined. Results: SICI significantly correlated with changes in lateralized UPDRS motor and bradykinesia sub-scores, suggesting that patients with stronger basal intracortical inhibition benefit more from dopaminergic treatment than patients with weaker intracortical inhibition. Also, ICF significantly negatively correlated with LEDD, suggesting that patients with stronger intracortical facilitation require less dopaminergic medication to achieve optimal therapeutic benefit. Both associations were independent of disease severity and duration. Conclusions: The results suggest variability of (patho) physiological phenotypes related to intracortical inhibitory and facilitatory mechanisms determining clinical response to dopaminergic medication in PD. Measures of intracortical excitability may help predict patients' response to dopaminergic therapy, thus potentially providing a background for developing personalized therapy in PD.
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Affiliation(s)
- Saša R. Filipović
- Department for Human Neuroscience, Institute for Medical Research, University of Belgrade, Belgrade, Serbia
| | - Aleksandra Kačar
- Department for Human Neuroscience, Institute for Medical Research, University of Belgrade, Belgrade, Serbia
- Department of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sladjan Milanović
- Department for Human Neuroscience, Institute for Medical Research, University of Belgrade, Belgrade, Serbia
| | - Miloš R. Ljubisavljević
- Department for Human Neuroscience, Institute for Medical Research, University of Belgrade, Belgrade, Serbia
- Department of Physiology, College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates
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25
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Samotus O, Chen R, Jog M. Changes in Cortical Excitability and Parkinson Tremor After Botulinum Toxin Therapy. Neurology 2021; 97:e1413-e1424. [PMID: 34497068 DOI: 10.1212/wnl.0000000000012662] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 07/16/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To investigate the relationship between botulinum toxin type A (BoNT-A) administration, tremor amplitude, and modulation of intracortical excitability and sensorimotor processing using paired-pulse transcranial magnetic stimulation (pp-TMS) in patients with early, tremor-dominant Parkinson disease (PD). METHODS Twelve de novo (naive to anti-PD medications) and 7 l-dopa (optimized on levodopa) participants with PD with tremor affecting one arm were recruited. All participants received 4 serial BoNT-A treatments for tremor every 12 weeks and peak effect was assessed 6 weeks posttreatment, totaling 8 visits over 42 weeks. Injection measures were based on kinematic tremor analysis. Short interval intracortical inhibition (SICI), intracortical facilitation (ICF), long interval intracortical inhibition (LICI), and measures of sensorimotor interaction (short-latency afferent [SAI] and long-latency afferent [LAI] stimulation) were assessed in both hemispheres using pp-TMS paradigms at each time point. Linear mixed models analyzed the effect of each pp-TMS measure and tremor severity within each cohort and the association between pp-TMS and tremor severity in the de novo cohort over 42 weeks. t Tests compared pp-TMS measures between hemispheres per time point. RESULTS Baseline SICI, LICI, and SAI was reduced (higher motor evoked potential [MEP] ratio) on the tremulous/treated side compared to the nontremulous side in de novo participants. On the treated side in the de novo cohort, BoNT-A treatment significantly reduced ICF and increased LICI, SAI, and LAI (lower MEP ratio) at peak BoNT-A time points. The change in tremor severity was significantly associated with changes in SICI, LICI, and LAI. DISCUSSION Our findings suggest that tremor severity in early PD may be related to impaired intracortical inhibition and defective sensorimotor integration.
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Affiliation(s)
- Olivia Samotus
- From the Department of Clinical Neurological Sciences (O.S., M.J.), Lawson Health Research Institute, London Health Sciences Centre; Schulich School of Medicine and Dentistry (O.S., M.J.), University of Western Ontario, London; Krembil Research Institute (R.C.), University Health Network; and Division of Neurology, Department of Medicine (R.C.), University of Toronto, Canada
| | - Robert Chen
- From the Department of Clinical Neurological Sciences (O.S., M.J.), Lawson Health Research Institute, London Health Sciences Centre; Schulich School of Medicine and Dentistry (O.S., M.J.), University of Western Ontario, London; Krembil Research Institute (R.C.), University Health Network; and Division of Neurology, Department of Medicine (R.C.), University of Toronto, Canada
| | - Mandar Jog
- From the Department of Clinical Neurological Sciences (O.S., M.J.), Lawson Health Research Institute, London Health Sciences Centre; Schulich School of Medicine and Dentistry (O.S., M.J.), University of Western Ontario, London; Krembil Research Institute (R.C.), University Health Network; and Division of Neurology, Department of Medicine (R.C.), University of Toronto, Canada.
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26
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Guerra A, Belvisi D, Berardelli A. The importance of assessing interactions between different circuits in primary motor cortex in Parkinson's disease. Clin Neurophysiol 2021; 132:2668-2670. [PMID: 34364745 DOI: 10.1016/j.clinph.2021.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/18/2021] [Indexed: 01/01/2023]
Affiliation(s)
| | - Daniele Belvisi
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy.
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27
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Guerra A, Colella D, Giangrosso M, Cannavacciuolo A, Paparella G, Fabbrini G, Suppa A, Berardelli A, Bologna M. Driving motor cortex oscillations modulates bradykinesia in Parkinson's disease. Brain 2021; 145:224-236. [PMID: 34245244 DOI: 10.1093/brain/awab257] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/13/2022] Open
Abstract
In Parkinson's disease (PD) patients, beta (β) and gamma (γ) oscillations are altered in the basal ganglia, and this abnormality contributes to the pathophysiology of bradykinesia. However, it is unclear whether β and γ rhythms at the primary motor cortex (M1) level influence bradykinesia. Transcranial alternating current stimulation (tACS) can modulate cortical rhythms by entraining endogenous oscillations. We tested whether β- and γ-tACS on M1 modulate bradykinesia in PD patients by analyzing the kinematic features of repetitive finger tapping, including movement amplitude, velocity, and sequence effect, recorded during β-, γ-, and sham tACS. We also verified whether possible tACS-induced bradykinesia changes depended on modifications in specific M1 circuits, as assessed by short-interval intracortical inhibition (SICI) and short-latency afferent inhibition (SAI). Patients were studied OFF and ON dopaminergic therapy. Results were compared to those obtained in a group of healthy subjects (HS). In patients, movement velocity significantly worsened during β-tACS and movement amplitude improved during γ-tACS, while the sequence effect did not change. In addition, SAI decreased (reduced inhibition) during β-tACS and SICI decreased during both γ- and β-tACS in PD. The effects of tACS were comparable between OFF and ON sessions. In patients OFF therapy, the degree of SICI modulation during β- and γ-tACS correlated with movement velocity and amplitude changes. Moreover, there was a positive correlation between the effect of γ-tACS on movement amplitude and motor symptoms severity. Our results show that cortical β and γ oscillations are relevant in the pathophysiology of bradykinesia in PD and that changes in inhibitory GABA-A-ergic interneuronal activity may reflect compensatory M1 mechanisms to counteract bradykinesia. In conclusion, abnormal oscillations at the M1 level of the basal ganglia-thalamo-cortical network play a relevant role in the pathophysiology of bradykinesia in PD.
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Affiliation(s)
| | - Donato Colella
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | | | | | | | - Giovanni Fabbrini
- IRCCS Neuromed, Pozzilli (IS), Italy.,Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Antonio Suppa
- IRCCS Neuromed, Pozzilli (IS), Italy.,Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Alfredo Berardelli
- IRCCS Neuromed, Pozzilli (IS), Italy.,Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Matteo Bologna
- IRCCS Neuromed, Pozzilli (IS), Italy.,Department of Human Neurosciences, Sapienza University of Rome, Italy
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28
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Saravanamuttu J, Radhu N, Udupa K, Baarbé J, Gunraj C, Chen R. Impaired motor cortical facilitatory-inhibitory circuit interaction in Parkinson's disease. Clin Neurophysiol 2021; 132:2685-2692. [PMID: 34284974 DOI: 10.1016/j.clinph.2021.05.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/18/2021] [Accepted: 05/25/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Motor cortical (M1) inhibition and facilitation can be studied with short-interval intracortical inhibition (SICI) and short-interval intracortical facilitation (SICF). These circuits are altered in Parkinson's disease (PD). The sensorimotor measure short latency afferent inhibition (SAI) is possibly altered in PD. The aim was to determine if the manner in which these circuits interact with each other is abnormal in PD. METHODS Fifteen PD patients were studied at rest in ON and OFF medication states, and were compared to 16 age-matched controls. A triple-stimulus transcranial magnetic stimulation paradigm was used to elicit a circuit of interest in the presence of another circuit. RESULTS SICF was increased in PD OFF and PD ON conditions compared to controls. SICI facilitated SICF in controls and PD ON, but not in PD OFF. SICF in the presence of SICI negatively correlated with UPDRS-III scores in OFF and ON medication conditions. SAI showed similar inhibition of SICI in controls, PD OFF and PD ON conditions. CONCLUSIONS The facilitatory effect of SICI on SICF is absent in PD OFF, but is restored with dopaminergic medication. SIGNIFICANCE Impaired interaction between M1 circuits is a pathophysiological feature of PD.
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Affiliation(s)
- James Saravanamuttu
- Division of Neurology, Department of Medicine, University of Toronto and Division of Brain, Imaging & Behaviour - Systems Neuroscience, Krembil Brain Institute, University Health Network, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada
| | - Natasha Radhu
- Division of Neurology, Department of Medicine, University of Toronto and Division of Brain, Imaging & Behaviour - Systems Neuroscience, Krembil Brain Institute, University Health Network, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada
| | - Kaviraja Udupa
- Division of Neurology, Department of Medicine, University of Toronto and Division of Brain, Imaging & Behaviour - Systems Neuroscience, Krembil Brain Institute, University Health Network, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada; Department of Neurophysiology, National Institute of Mental Health and NeuroSciences, Hosur Road, Bangalore, India
| | - Julianne Baarbé
- Division of Neurology, Department of Medicine, University of Toronto and Division of Brain, Imaging & Behaviour - Systems Neuroscience, Krembil Brain Institute, University Health Network, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada
| | - Carolyn Gunraj
- Division of Neurology, Department of Medicine, University of Toronto and Division of Brain, Imaging & Behaviour - Systems Neuroscience, Krembil Brain Institute, University Health Network, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada
| | - Robert Chen
- Division of Neurology, Department of Medicine, University of Toronto and Division of Brain, Imaging & Behaviour - Systems Neuroscience, Krembil Brain Institute, University Health Network, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada.
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Caux-Dedeystère A, Allart E, Morel P, Kreisler A, Derambure P, Devanne H. Late cortical disinhibition in focal hand dystonia. Eur J Neurosci 2021; 54:4712-4720. [PMID: 34061422 DOI: 10.1111/ejn.15333] [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: 01/14/2021] [Revised: 05/20/2021] [Accepted: 05/23/2021] [Indexed: 11/30/2022]
Abstract
In writer's cramp (WC), a form of focal hand dystonia, cortical GABAergic inhibitory mechanisms are altered and may cause involuntary tonic contractions while writing. The objective of this study was to explore the time course of long-interval intracortical inhibition (LICI) that involves gamma-amino butyric acid (GABA)-B transmission and late cortical disinhibition (LCD) (that combines GABA-A and GABA-B mechanisms) in patients with WC and in control subjects. A double pulse transcranial magnetic stimulation protocol was used to evoke LICI and LCD while the subjects either gripped a cylinder between their thumb and index fingers or relaxed all their upper limb muscles. We measured the ratio between primed and unprimed motor evoked potential in the first dorsal interosseous at interstimulus intervals ranging between 60 and 300 ms. Though the cortical silent period was not different between the groups, LICI lasted longer in patients with WC, that is, LCD was delayed for more than 30 ms and reached a higher level. In addition to the alteration of inhibitory mechanism mediated by GABA-B transmission, LCD which probably involves presynaptic inhibition is also modified in patients with WC with possible consequences on the activity of primary motor cortex inhibitory and excitatory circuits which control the hand muscles.caus.
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Affiliation(s)
- Alexandre Caux-Dedeystère
- ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Univ Littoral Côte d'Opale, Univ Lille, Univ Artois, Calais, France
| | - Etienne Allart
- Rééducation Neurologique Cérébrolésion, CHU de Lille, Hôpital Pierre Swynghedauw, Lille, France.,univ Lille, UMR-S-1172 lilncog, Lille, France
| | - Pierre Morel
- ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Univ Littoral Côte d'Opale, Univ Lille, Univ Artois, Calais, France
| | - Alexandre Kreisler
- Neurologie & Pathologie du Mouvement, CHU de Lille, Hôpital Roger Salengro, Lille, France
| | - Philippe Derambure
- univ Lille, UMR-S-1172 lilncog, Lille, France.,Neurophysiologie Clinique, CHU de Lille, Hôpital Roger Salengro, Lille, France
| | - Hervé Devanne
- ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Univ Littoral Côte d'Opale, Univ Lille, Univ Artois, Calais, France.,Neurophysiologie Clinique, CHU de Lille, Hôpital Roger Salengro, Lille, France
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30
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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: 15] [Impact Index Per Article: 5.0] [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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31
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Teixeira PEP, Pacheco-Barrios K, Gunduz ME, Gianlorenço AC, Castelo-Branco L, Fregni F. Understanding intracortical excitability in phantom limb pain: A multivariate analysis from a multicenter randomized clinical trial. Neurophysiol Clin 2021; 51:161-173. [PMID: 33648819 DOI: 10.1016/j.neucli.2020.12.006] [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] [Received: 09/23/2020] [Revised: 12/30/2020] [Accepted: 12/31/2020] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES To explore associations of intracortical excitability with clinical characteristics in a large sample of subjects with phantom limb pain (PLP). METHODS Ancillary study using baseline and longitudinal data from a large multicenter randomized trial that investigated the effects of non-invasive brain stimulation combined with sensorimotor training on PLP. Multivariate regression modeling analyses were used to investigate the association of intracortical excitability, measured by percentages of intracortical inhibition (ICI) and facilitation (ICF) with clinical variables. RESULTS Ninety-eight subjects were included. Phantom sensation of itching was positively associated with ICI changes and at baseline in the affected hemisphere (contralateral to PLP). However, in the non-affected hemisphere (ipsilateral to PLP), the phantom sensation of warmth and PLP intensity were negatively associated with ICI (both models). For the ICF, PLP intensity (baseline model only) and age (longitudinal model) were negatively associated, while time since amputation and amputation level (both for longitudinal model only) were positively associated in the affected hemisphere. Additionally, use of antidepressants led to lower ICF in the non-affected hemisphere for the baseline model while higher amputation level also led to less changes in the ICF. CONCLUSION Results revealed clear associations of clinical variables and cortical excitability in a large chronic pain sample. ICI and ICF changes appear not to be mainly explained by PLP intensity. Instead, other variables associated with duration of neuroplasticity changes (such as age and duration of amputation) and compensatory mechanisms (such as itching and phantom limb sensation) seem to be more important in explaining these variables.
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Affiliation(s)
- Paulo E P Teixeira
- Neuromodulation and Clinical Research Learning Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA; MGH Institute of Health Professions, Boston, MA, USA; Instituto Wilson Mello, Campinas, SP, Brazil.
| | - Kevin Pacheco-Barrios
- Neuromodulation and Clinical Research Learning Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA; Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
| | - Muhammed Enes Gunduz
- Neuromodulation and Clinical Research Learning Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Anna Carolyna Gianlorenço
- Neuromodulation and Clinical Research Learning Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA; Laboratory of neuroscience, Department of Physical Therapy, Federal University of Sao Carlos, SP, Brazil
| | - Luis Castelo-Branco
- Neuromodulation and Clinical Research Learning Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Felipe Fregni
- Neuromodulation and Clinical Research Learning Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA; Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Kaňovský P, Rosales R, Otruba P, Nevrlý M, Hvizdošová L, Opavský R, Kaiserová M, Hok P, Menšíková K, Hluštík P, Bareš M. Contemporary clinical neurophysiology applications in dystonia. J Neural Transm (Vienna) 2021; 128:509-519. [PMID: 33591454 DOI: 10.1007/s00702-021-02310-6] [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: 11/23/2020] [Accepted: 01/18/2021] [Indexed: 12/25/2022]
Abstract
The complex phenomenological understanding of dystonia has transcended from the clinics to genetics, imaging and neurophysiology. One way in which electrophysiology will impact into the clinics are cases wherein a dystonic clinical presentation may not be typical or a "forme fruste" of the disorder. Indeed, the physiological imprints of dystonia are present regardless of its clinical manifestation. Underpinnings in the understanding of dystonia span from the peripheral, segmental and suprasegmental levels to the cortex, and various electrophysiological tests have been applied in the course of time to elucidate the origin of dystonia pathophysiology. While loss of inhibition remains to be the key finding in this regard, intricacies and variabilities exist, thus leading to a notion that perhaps dystonia should best be gleaned as network disorder. Interestingly, the complex process has now spanned towards the understanding in terms of networks related to the cerebellar circuitry and the neuroplasticity. What is evolving towards a better and cohesive view will be neurophysiology attributes combined with structural dynamic imaging. Such a sound approach will significantly lead to better therapeutic modalities in the future.
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Affiliation(s)
- Petr Kaňovský
- Department of Neurology, Faculty of Medicine and Dentistry, University Hospital, Palacky University, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic.
| | - Raymond Rosales
- Department of Neurology, Faculty of Medicine and Dentistry, University Hospital, Palacky University, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic.,Department of Neurology and Psychiatry, The Neuroscience Institute, University of Santo Tomás Hospital, Manila, Philippines
| | - Pavel Otruba
- Department of Neurology, Faculty of Medicine and Dentistry, University Hospital, Palacky University, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic
| | - Martin Nevrlý
- Department of Neurology, Faculty of Medicine and Dentistry, University Hospital, Palacky University, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic
| | - Lenka Hvizdošová
- Department of Neurology, Faculty of Medicine and Dentistry, University Hospital, Palacky University, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic
| | - Robert Opavský
- Department of Neurology, Faculty of Medicine and Dentistry, University Hospital, Palacky University, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic
| | - Michaela Kaiserová
- Department of Neurology, Faculty of Medicine and Dentistry, University Hospital, Palacky University, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic
| | - Pavel Hok
- Department of Neurology, Faculty of Medicine and Dentistry, University Hospital, Palacky University, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic
| | - Kateřina Menšíková
- Department of Neurology, Faculty of Medicine and Dentistry, University Hospital, Palacky University, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic
| | - Petr Hluštík
- Department of Neurology, Faculty of Medicine and Dentistry, University Hospital, Palacky University, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic
| | - Martin Bareš
- 1st Department of Neurology, Masaryk University Medical School and St. Anne University Hospital, Brno, Czech Republic
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Colella D, Guerra A, Paparella G, Cioffi E, Di Vita A, Trebbastoni A, Berardelli A, Bologna M. Motor dysfunction in mild cognitive impairment as tested by kinematic analysis and transcranial magnetic stimulation. Clin Neurophysiol 2021; 132:315-322. [DOI: 10.1016/j.clinph.2020.10.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/16/2020] [Accepted: 10/24/2020] [Indexed: 01/07/2023]
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Nikolov P, Zimmermann JV, Hassan SS, Albrecht P, Schnitzler A, Groiss SJ. Impact of the number of conditioning pulses on motor cortex excitability: a transcranial magnetic stimulation study. Exp Brain Res 2020; 239:583-589. [PMID: 33373012 PMCID: PMC7936961 DOI: 10.1007/s00221-020-06010-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/07/2020] [Indexed: 12/03/2022]
Abstract
Conditioning transcranial magnetic stimulation (TMS) with subthreshold conditioning stimulus followed by supra-threshold test stimulus at inter-stimulus intervals (ISI) of 1–5 ms results in inhibition (SICI), while ISI at 10–15 ms results in facilitation (ICF). One concerning issue, applying ICF/SICI protocols on patients is the substantial protocol variability. Here, we hypothesized that increasing the number of CS could result in more robust ICF/SICI protocols. Twenty healthy subjects participated in the study. Motor-evoked potentials (MEP) were obtained from conditioning TMS with a varying number of conditioning stimuli in 3, 4, 10, and 15 ms ISI over the primary motor cortex. MEP amplitudes were then compared to examine excitability. TMS with 3, 5, and 7 conditioning stimuli but not with one conditioning stimulus induced ICF. Moreover, 10 ms ISI produced stronger ICF than 15 ms ISI. Significant SICI was only induced with one conditioning stimulus. Besides, 3 ms ISI resulted in stronger SICI than 4 ms ISI. Only a train of conditioning stimuli induced stable ICF and may be more advantageous than the classical paired pulse ICF paradigm.
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Affiliation(s)
- Petyo Nikolov
- Institute of Clinical Neuroscience and Medical Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Johanna V Zimmermann
- Institute of Clinical Neuroscience and Medical Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Shady S Hassan
- Department of Neurology, Medical Faculty, Assiut University Hospital, Assiut, Egypt
| | - Philipp Albrecht
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Alfons Schnitzler
- Institute of Clinical Neuroscience and Medical Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Stefan J Groiss
- Institute of Clinical Neuroscience and Medical Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
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Opie GM, Semmler JG. Preferential Activation of Unique Motor Cortical Networks With Transcranial Magnetic Stimulation: A Review of the Physiological, Functional, and Clinical Evidence. Neuromodulation 2020; 24:813-828. [PMID: 33295685 DOI: 10.1111/ner.13314] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/30/2020] [Accepted: 10/19/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The corticospinal volley produced by application of transcranial magnetic stimulation (TMS) over primary motor cortex consists of a number of waves generated by trans-synaptic input from interneuronal circuits. These indirect (I)-waves mediate the sensitivity of TMS to cortical plasticity and intracortical excitability and can be assessed by altering the direction of cortical current induced by TMS. While this methodological approach has been conventionally viewed as preferentially recruiting early or late I-wave inputs from a given populations of neurons, growing evidence suggests recruitment of different neuronal populations, and this would strongly influence interpretation and application of these measures. The aim of this review is therefore to consider the physiological, functional, and clinical evidence for the independence of the neuronal circuits activated by different current directions. MATERIALS AND METHODS To provide the relevant context, we begin with an overview of TMS methodology, focusing on the different techniques used to quantify I-waves. We then comprehensively review the literature that has used variations in coil orientation to investigate the I-wave circuits, grouping studies based on the neurophysiological, functional, and clinical relevance of their outcomes. RESULTS Review of the existing literature reveals significant evidence supporting the idea that varying current direction can recruit different neuronal populations having unique functionally and clinically relevant characteristics. CONCLUSIONS Further research providing greater characterization of the I-wave circuits activated with different current directions is required. This will facilitate the development of interventions that are able to modulate specific intracortical circuits, which will be an important application of TMS.
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Affiliation(s)
- George M Opie
- Discipline of Physiology, Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - John G Semmler
- Discipline of Physiology, Adelaide Medical School, The University of Adelaide, Adelaide, Australia
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36
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Primary motor cortex in Parkinson's disease: Functional changes and opportunities for neurostimulation. Neurobiol Dis 2020; 147:105159. [PMID: 33152506 DOI: 10.1016/j.nbd.2020.105159] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/30/2020] [Accepted: 10/31/2020] [Indexed: 02/07/2023] Open
Abstract
Movement abnormalities of Parkinson's disease (PD) arise from disordered neural activity in multiple interconnected brain structures. The planning and execution of movement requires recruitment of a heterogeneous collection of pyramidal projection neurons in the primary motor cortex (M1). The neural representations of movement in M1 single-cell and field potential recordings are directly and indirectly influenced by the midbrain dopaminergic neurons that degenerate in PD. This review examines M1 functional alterations in PD as uncovered by electrophysiological recordings and neurostimulation studies in patients and experimental animal models. Dysfunction of the parkinsonian M1 depends on the severity and/or duration of dopamine-depletion and the species examined, and is expressed as alterations in movement-related firing dynamics; functional reorganisation of local circuits; and changes in field potential beta oscillations. Neurostimulation methods that modulate M1 activity directly (e.g., transcranial magnetic stimulation) or indirectly (subthalamic nucleus deep brain stimulation) improve motor function in PD patients, showing that targeted neuromodulation of M1 is a realistic therapy. We argue that the therapeutic profile of M1 neurostimulation is likely to be greatly enhanced with alternative technologies that permit cell-type specific control and incorporate feedback from electrophysiological biomarkers measured locally.
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Paparella G, Rocchi L, Bologna M, Berardelli A, Rothwell J. Differential effects of motor skill acquisition on the primary motor and sensory cortices in healthy humans. J Physiol 2020; 598:4031-4045. [DOI: 10.1113/jp279966] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/02/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
| | - Lorenzo Rocchi
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology University College London London United Kingdom
| | - Matteo Bologna
- IRCCS Neuromed Via Atinense 18 Pozzilli IS 86077 Italy
- Department of Human Neurosciences Sapienza University of Rome Italy
| | - Alfredo Berardelli
- IRCCS Neuromed Via Atinense 18 Pozzilli IS 86077 Italy
- Department of Human Neurosciences Sapienza University of Rome Italy
| | - John Rothwell
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology University College London London United Kingdom
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Defazio G, Ercoli T, Erro R, Pellicciari R, Mascia MM, Fabbrini G, Albanese A, Lalli S, Eleopra R, Barone P, Marchese R, Ceravolo R, Scaglione C, Liguori R, Esposito M, Bentivoglio AR, Bertolasi L, Altavista MC, Bono F, Pisani A, Girlanda P, Berardelli A, Cimino P, Ferrazzano G, Devigili G, Scannapieco S, Di Biasio F, Mazzucchi S, Habetswallner F, Petracca M, Zivelonghi C, Polidori L, Manzo L, Di Lazzaro G, Terranova C, Cotelli MS, Castagna A, Minafra B, Misceo S, Magistrelli L, Zibetti M, Cossu G, Coletti Moja M. Idiopathic
Non‐task‐Specific
Upper Limb Dystonia, a Neglected Form of Dystonia. Mov Disord 2020; 35:2038-2045. [DOI: 10.1002/mds.28199] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/30/2020] [Accepted: 06/17/2020] [Indexed: 12/16/2022] Open
Affiliation(s)
- Giovanni Defazio
- Department of Medical Science and Public Health Institute of Neurology, University of Cagliari Cagliari Italy
| | - Tommaso Ercoli
- Department of Medical Science and Public Health Institute of Neurology, University of Cagliari Cagliari Italy
| | - Roberto Erro
- Department of Medicine Surgery and Dentistry "Scuola Medica Salernitana," University of Salerno Baronissi (SA) Italy
| | - Roberta Pellicciari
- Department of Basic Science, Neuroscience and Sense Organs Aldo Moro University of Bari Bari Italy
| | - Marcello Mario Mascia
- Department of Medical Science and Public Health Institute of Neurology, University of Cagliari Cagliari Italy
| | - Giovanni Fabbrini
- Department of Human Neurosciences Sapienza University of Rome Rome Italy
- IRCSS Neuromed Pozzili Italy
| | - Alberto Albanese
- Department of Neurology IRCCS Istituto Clinico Humanitas Rozzano, Milan Italy
| | - Stefania Lalli
- Department of Neurology IRCCS Istituto Clinico Humanitas Rozzano, Milan Italy
| | | | - Paolo Barone
- Department of Medicine Surgery and Dentistry "Scuola Medica Salernitana," University of Salerno Baronissi (SA) Italy
| | | | - Roberto Ceravolo
- Department of Clinical and Experimental Medicine University of Pisa Pisa Italy
| | - Cesa Scaglione
- IRCCS ‐ Institute of Neurological Sciences Bologna Italy
| | - Rocco Liguori
- IRCCS ‐ Institute of Neurological Sciences Bologna Italy
| | | | - Anna Rita Bentivoglio
- Gemelli University Hospital ‐ IRCCS Rome Italy
- Institute of Neurology, Università Cattolica del Sacro Cuore Rome Italy
| | | | | | - Francesco Bono
- Center for Botulinum Toxin Therapy, Neurologic Unit Mater Domini University Hospital Catanzaro Italy
| | - Antonio Pisani
- Department of Systems Medicine University of Rome Tor Vergata Rome Italy
| | - Paolo Girlanda
- Department of Clinical and Experimental Medicine University of Messina Messina Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences Sapienza University of Rome Rome Italy
- IRCSS Neuromed Pozzili Italy
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Advanced TMS approaches to probe corticospinal excitability during action preparation. Neuroimage 2020; 213:116746. [DOI: 10.1016/j.neuroimage.2020.116746] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/02/2020] [Accepted: 03/13/2020] [Indexed: 12/13/2022] Open
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Stephan M, Volkmann P, Rossner MJ. Assessing behavior and cognition in rodents, nonhuman primates, and humans: where are the limits of translation?
. DIALOGUES IN CLINICAL NEUROSCIENCE 2020; 21:249-259. [PMID: 31749649 PMCID: PMC6829167 DOI: 10.31887/dcns.2019.21.3/mrossner] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
New psychopharmacological treatments are needed for affective and nonaffective
psychoses, especially for the associated negative and cognitive symptoms. Earlier
developments mostly failed, probably partly because of limitations in behavioral models
used for validation. Now, deeper understanding of the genetics underlying disease
pathogenesis and progress in genetic engineering will generate many rodent models with
increased construct validity. To improve these models’ translational value, we need
complementary data from nonhuman primates. We also have to improve and streamline
behavioral test systems to cope with increased demand. Here, we propose a comprehensive
neurocognitive test battery that should overcome the disadvantages of single tests and
yield cognitive/behavioral profiles for modeling subsets of patient symptoms. Further,
we delineate a concept for classifying disease-relevant cognitive endophenotypes to
balance between face and construct validity and clinical diagnostics. In summary, this
review discusses new concepts and the limitations and future potential of translational
research on cognition in psychiatry.
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Affiliation(s)
- Marius Stephan
- Molecular and Behavioural Neurobiology, Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Germany; International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Paul Volkmann
- Molecular and Behavioural Neurobiology, Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Germany
| | - Moritz J Rossner
- Molecular and Behavioural Neurobiology, Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Germany
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Enhancing Gamma Oscillations Restores Primary Motor Cortex Plasticity in Parkinson's Disease. J Neurosci 2020; 40:4788-4796. [PMID: 32430296 DOI: 10.1523/jneurosci.0357-20.2020] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/26/2020] [Accepted: 04/26/2020] [Indexed: 11/21/2022] Open
Abstract
In humans, γ oscillations in cortical motor areas reflect asynchronous synaptic activity and contribute to plasticity processes. In Parkinson's disease (PD), γ oscillatory activity in the basal ganglia-thalamo-cortical network is altered and the LTP-like plasticity elicited by intermittent theta burst stimulation (iTBS) is reduced in the primary motor cortex (M1). In this study, we tested whether transcranial alternating current stimulation (tACS) delivered at γ frequency promotes iTBS-induced LTP-like plasticity in M1 in PD patients. Sixteen patients (OFF condition) and 16 healthy subjects (HSs) underwent iTBS during γ-tACS (iTBS-γ tACS) and during sham-tACS (iTBS-sham tACS) in two sessions. Motor-evoked potentials (MEPs) evoked by single-pulse transcranial magnetic stimulation and short-interval intracortical inhibition (SICI) were recorded before and after the costimulation. A subgroup of patients also underwent iTBS during β tACS. iTBS-sham tACS facilitated single-pulse MEPs in HSs, but not in patients. iTBS-γ tACS induced a larger MEP facilitation than iTBS-sham tACS in both groups, with similar values in patients and HSs. In patients, SICI improved after iTBS-γ tACS. The effect produced by iTBS-γ tACS on single-pulse MEPs correlated with disease duration, while changes in SICI correlated with Unified Parkinson's Disease Rating Scale Part III scores. The effect of iTBS-β tACS on both single-pulse MEPs and SICI was similar to that obtained in the iTBS-sham tACS session. Our data suggest that γ oscillations have a role in the pathophysiology of the abnormal LTP-like plasticity in PD. Entraining M1 neurons at the γ rhythm through tACS may be an effective method to restore impaired plasticity.SIGNIFICANCE STATEMENT In Parkinson's disease, the LTP-like plasticity of the primary motor cortex is impaired, and γ oscillations are altered in the basal ganglia-thalamo-cortical network. Using a combined transcranial magnetic stimulation-transcranial alternating current stimulation approach (iTBS-γ tACS costimulation), we demonstrate that driving γ oscillations restores the LTP-like plasticity in patients with Parkinson's disease. The effects correlate with clinical characteristics of patients, being more evident in less affected patients and weaker in patients with longer disease duration. These findings suggest that cortical γ oscillations play a beneficial role in modulating the LTP-like plasticity of M1 in Parkinson's disease. The iTBS-γ tACS approach may be potentially useful in rehabilitative settings in patients.
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Bradykinesia in Alzheimer’s disease and its neurophysiological substrates. Clin Neurophysiol 2020; 131:850-858. [DOI: 10.1016/j.clinph.2019.12.413] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/11/2019] [Accepted: 12/29/2019] [Indexed: 01/15/2023]
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Lanza G, Aricò D, Lanuzza B, Cosentino FII, Tripodi M, Giardina F, Bella R, Puligheddu M, Pennisi G, Ferri R, Pennisi M. Facilitatory/inhibitory intracortical imbalance in REM sleep behavior disorder: early electrophysiological marker of neurodegeneration? Sleep 2020; 43:5584903. [PMID: 31599326 DOI: 10.1093/sleep/zsz242] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 09/27/2019] [Indexed: 02/07/2023] Open
Abstract
STUDY OBJECTIVES Previous studies found an early impairment of the short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF) to transcranial magnetic stimulation (TMS) in Parkinson's disease. However, very little is known on the TMS correlates of rapid eye movement (REM) sleep behavior disorder (RBD), which can precede the onset of a α-synucleinopathy. METHODS The following TMS measures were obtained from 14 de novo patients with isolated RBD and 14 age-matched healthy controls: resting motor threshold, cortical silent period, latency and amplitude of the motor evoked potentials, SICI, and ICF. A cognitive screening and a quantification of subjective sleepiness (Epworth Sleepiness Scale [ESS]) and depressive symptoms were also performed. RESULTS Neurological examination, global cognitive functioning, and mood status were normal in all participants. ESS score was higher in patients, although not suggestive of diurnal sleepiness. Compared to controls, patients exhibited a significant decrease of ICF (median 0.8, range 0.5-1.4 vs. 1.9, range 1.4-2.3; p < 0.01) and a clear trend, though not significant, towards a reduction of SICI (median 0.55, range 0.1-1.4 vs. 0.25, range 0.1-0.3), with a large effect size (Cohen's d: -0.848). REM Sleep Atonia Index significantly correlated with SICI. CONCLUSIONS In still asymptomatic patients for a parkinsonian syndrome or neurodegenerative disorder, changes of ICF and, to a lesser extent, SICI (which are largely mediated by glutamatergic and GABAergic transmission, respectively) might precede the onset of a future neurodegeneration. SICI was correlated with the muscle tone alteration, possibly supporting the proposed RBD model of retrograde influence on the cortex from the brainstem.
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Affiliation(s)
- Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
- Sleep Research Center, Department of Neurology IC, Oasi Research Institute - IRCCS, Troina, Italy
| | - Debora Aricò
- Sleep Research Center, Department of Neurology IC, Oasi Research Institute - IRCCS, Troina, Italy
| | - Bartolo Lanuzza
- Sleep Research Center, Department of Neurology IC, Oasi Research Institute - IRCCS, Troina, Italy
| | | | - Mariangela Tripodi
- Sleep Research Center, Department of Neurology IC, Oasi Research Institute - IRCCS, Troina, Italy
| | - Floriana Giardina
- Sleep Research Center, Department of Neurology IC, Oasi Research Institute - IRCCS, Troina, Italy
| | - Rita Bella
- Department of Medical and Surgical Science and Advanced Technologies, University of Catania, Catania, Italy
| | - Monica Puligheddu
- Sleep Disorder Research Center, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Giovanni Pennisi
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Raffaele Ferri
- Sleep Research Center, Department of Neurology IC, Oasi Research Institute - IRCCS, Troina, Italy
| | - Manuela Pennisi
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
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Ibáñez J, Spampinato DA, Paraneetharan V, Rothwell JC. SICI during changing brain states: Differences in methodology can lead to different conclusions. Brain Stimul 2020; 13:353-356. [PMID: 31711879 PMCID: PMC7790761 DOI: 10.1016/j.brs.2019.11.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/30/2019] [Accepted: 11/01/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Short-latency intracortical inhibition (SICI) is extensively used to probe GABAergic inhibitory mechanisms in M1. Task-related changes in SICI are presumed to reflect changes in the central excitability of GABAergic pathways. Usually, the level of SICI is evaluated using a single intensity of conditioning stimulus so that inhibition can be compared in different brain states. OBJECTIVE Here, we show that this approach may sometimes be inadequate since distinct conclusions can be drawn if a different CS intensity is used. METHODS We measured SICI using a range of CS intensities at rest and during a warned simple reaction time task. CONCLUSIONS Our results show that SICI changes that occurred during the task could be either larger or smaller than at rest depending on the intensity of the CS. These findings indicate that careful interpretation of results are needed when a single intensity of CS is used to measure task-related physiological changes.
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Affiliation(s)
- Jaime Ibáñez
- Department for Clinical and Movement Neurosciences, Institute of Neurology, University College London, United Kingdom; Department of Bioengineering, Imperial College, London, United Kingdom.
| | - Danny A Spampinato
- Department for Clinical and Movement Neurosciences, Institute of Neurology, University College London, United Kingdom
| | - Varshini Paraneetharan
- Department for Clinical and Movement Neurosciences, Institute of Neurology, University College London, United Kingdom
| | - John C Rothwell
- Department for Clinical and Movement Neurosciences, Institute of Neurology, University College London, United Kingdom
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Guerra A, Suppa A, D'Onofrio V, Di Stasio F, Asci F, Fabbrini G, Berardelli A. Abnormal cortical facilitation and L-dopa-induced dyskinesia in Parkinson's disease. Brain Stimul 2019; 12:1517-1525. [DOI: 10.1016/j.brs.2019.06.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/05/2019] [Accepted: 06/07/2019] [Indexed: 10/26/2022] Open
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Voluntary and involuntary movements: A proposal from a clinician. Neurosci Res 2019; 156:80-87. [PMID: 31634500 DOI: 10.1016/j.neures.2019.10.001] [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: 04/25/2019] [Revised: 07/08/2019] [Accepted: 07/28/2019] [Indexed: 11/23/2022]
Abstract
In this communication, I first summarize the mechanisms underlying human voluntary movements and define the involuntary movements (medical term). CLASSIFICATION OF HUMAN MOVEMENTS Human movements are classified into two main kinds: intentional movements and non-intentional movements in which the involuntary movements are included. Non-intentional movements have many kinds of movement: normal non-intentional movements (associate movements, mirror movements or juggling knees etc.), several reflexes (spinal tendon, spinal flexion, spino-bulbo-spinal, cortical reflexes and startle response) and pathological non-intentional movements which should be treated (so called "involuntary movements" in clinical practice, medical term of involuntary movement). VOLUNTARY MOVEMENTS The final motor commands for movements are mediated by several descending motor pathways. These final pathways are modified, regulated by two main loops (basal ganglia loop and cerebellar loop). INVOLUNTARY MOVEMENTS (MEDICAL TERM) The involuntary movements are produced by a non-intentional, pathological activation anywhere within the final common pathways or the above two loops. I would like to personally divide those into four major groups. TREMOR Some oscillation mechanisms may produce tremor: one site oscillation or loop oscillation. MYOCLONUS Sudden, brief, shock-like involuntary movements arising from anywhere from the cortex to the muscle. CHOREA/BALLISM Suddenly appearing, irregular, phasic movements which are usually mimicked by normal subjects. DYSTONIA/ATHETOSIS Sustained, long duration muscle contraction sometimes associated with torsion components.
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Conte A, Rocchi L, Latorre A, Belvisi D, Rothwell JC, Berardelli A. Ten‐Year Reflections on the Neurophysiological Abnormalities of Focal Dystonias in Humans. Mov Disord 2019; 34:1616-1628. [DOI: 10.1002/mds.27859] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/20/2019] [Accepted: 08/23/2019] [Indexed: 12/12/2022] Open
Affiliation(s)
- Antonella Conte
- Department of Human Neurosciences Sapienza, University of Rome Rome Italy
- IRCCS Neuromed Pozzilli (IS) Italy
| | - Lorenzo Rocchi
- Department of Clinical and Movement Neurosciences UCL Queen Square Institute of Neurology London UK
| | - Anna Latorre
- Department of Human Neurosciences Sapienza, University of Rome Rome Italy
- Department of Clinical and Movement Neurosciences UCL Queen Square Institute of Neurology London UK
| | | | - John C. Rothwell
- Department of Clinical and Movement Neurosciences UCL Queen Square Institute of Neurology London UK
| | - Alfredo Berardelli
- Department of Human Neurosciences Sapienza, University of Rome Rome Italy
- IRCCS Neuromed Pozzilli (IS) Italy
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Tang SC, Lee LJH, Jeng JS, Hsieh ST, Chiang MC, Yeh SJ, Hsueh HW, Chao CC. Pathophysiology of Central Poststroke Pain. Stroke 2019; 50:2851-2857. [DOI: 10.1161/strokeaha.119.025692] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background and Purpose—
Central poststroke pain (CPSP) is a disabling condition in stroke patients, and evidence suggests that altered corticospinal and motor intracortical excitability occurs in neuropathic pain. The objective of this study was to investigate changes in motor cortex excitability and sensorimotor interaction and their correlates with clinical manifestations and alterations in somatosensory systems in CPSP patients.
Methods—
Fourteen patients with CPSP but no motor weakness were compared with age- and sex-matched healthy controls for motor cortex excitability and sensorimotor interaction assessed by transcranial magnetic stimulation to measure resting motor thresholds, short-interval intracortical inhibition, intracortical facilitation, and afferent inhibitions. The sensory pathway was evaluated by quantitative sensory testing, contact heat evoked potential, and somatosensory evoked potentials. Clinical pain and quality of life were assessed with validated tools.
Results—
The duration of CPSP was 3.3±3.0 years (ranging 0.5–10 years), and pain significantly impaired quality of life. Compared with the unaffected hemisphere, the stroke hemisphere had higher thermal thresholds, lower contact heat evoked potential amplitudes, and prolonged cortical somatosensory evoked potential latencies. There was no difference in resting motor thresholds between the stroke and unaffected hemisphere or between patients and controls. CPSP patients had a reduction in short-interval intracortical inhibition in the stroke hemisphere compared with that in the unaffected hemispheres of patients and controls. No changes were noted in afferent inhibitions between the stroke and unaffected hemispheres. The short-interval intracortical inhibition of the stroke hemisphere was negatively correlated with self-rated health on a visual analog scale and positively correlated with cortical somatosensory evoked potential latencies.
Conclusions—
CPSP patients with intact corticospinal tracts showed reduced motor intracortical inhibition in the stroke hemisphere, suggesting defective gamma-aminobutyric acid-ergic inhibition. This disinhibition was associated with impaired quality of life and was related to dorsal column–medial lemniscus pathway dysfunction.
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Affiliation(s)
- Sung-Chun Tang
- From the Department of Neurology, National Taiwan University Hospital, Taipei (S.-C.T., L.J.-H.L., J.-S.J., S.-T.H., S.-J.Y., H.-W.H., C.-C.C.)
| | - Lukas Jyuhn-Hsiarn Lee
- From the Department of Neurology, National Taiwan University Hospital, Taipei (S.-C.T., L.J.-H.L., J.-S.J., S.-T.H., S.-J.Y., H.-W.H., C.-C.C.)
- National Institute of Environmental Medicine Sciences, National Health Research Institutes, Taiwan (L.J.-H.L.)
- Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei (L.J.-H.L.)
| | - Jiann-Shing Jeng
- From the Department of Neurology, National Taiwan University Hospital, Taipei (S.-C.T., L.J.-H.L., J.-S.J., S.-T.H., S.-J.Y., H.-W.H., C.-C.C.)
| | - Sung-Tsang Hsieh
- From the Department of Neurology, National Taiwan University Hospital, Taipei (S.-C.T., L.J.-H.L., J.-S.J., S.-T.H., S.-J.Y., H.-W.H., C.-C.C.)
- Department of Anatomy and Cell Biology (S.-T.H.), National Taiwan University College of Medicine, Taipei
- Graduate Institute of Brain and Mind Sciences (S.-T.H.), National Taiwan University College of Medicine, Taipei
- Graduate Institute of Clinical Medicine (S.-T.H.), National Taiwan University College of Medicine, Taipei
| | - Ming-Chang Chiang
- Department of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan (M.-C.C.)
| | - Shin-Joe Yeh
- From the Department of Neurology, National Taiwan University Hospital, Taipei (S.-C.T., L.J.-H.L., J.-S.J., S.-T.H., S.-J.Y., H.-W.H., C.-C.C.)
| | - Hsueh-Wen Hsueh
- From the Department of Neurology, National Taiwan University Hospital, Taipei (S.-C.T., L.J.-H.L., J.-S.J., S.-T.H., S.-J.Y., H.-W.H., C.-C.C.)
| | - Chi-Chao Chao
- From the Department of Neurology, National Taiwan University Hospital, Taipei (S.-C.T., L.J.-H.L., J.-S.J., S.-T.H., S.-J.Y., H.-W.H., C.-C.C.)
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Magalhães SC, Queiroz de Paiva JP, Kaelin-Lang A, Sterr A, Eckeli AL, Winkler AM, Fernandes do Prado G, Amaro E, Conforto AB. Short-interval intracortical inhibition is decreased in restless legs syndrome across a range of severity. Sleep Med 2019; 62:34-42. [PMID: 31539846 DOI: 10.1016/j.sleep.2019.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/10/2019] [Accepted: 03/12/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Decreased short-interval intracortical inhibition (SICI) to transcranial magnetic stimulation (TMS) of the primary motor cortex was described in subjects with restless legs syndrome/Willis-Ekbom disease (RLS/WED). It remained to be determined whether the magnitude of SICI decrease would be similar across levels of RLS/WED severity. Moreover, it was unknown whether, in addition to decreases in SICI, changes in cortical thickness or area could be detected in subjects with RLS/WED compared to controls. The objective of this study was to compare SICI, cortical thickness, and cortical area in subjects with idiopathic mild to moderate RLS/WED, severe to very severe RLS/WED, and controls. METHODS The severity of RLS/WED was assessed by the International Restless Legs Syndrome Severity Scale (IRLSS). SICI and 3T magnetic resonance imaging (MRI) data of subjects with RLS/WED and controls were compared. A receiver operating characteristic curve for SICI was designed for discrimination of participants with RLS/WED from controls. Cortical thickness and area were assessed by automated surface-based analysis. RESULTS SICI was significantly reduced in patients with mild to moderate and severe to very severe RLS/WED, compared to controls (one-way analysis of variance: F = 9.62, p < 0.001). Receiver operating characteristic curve analysis predicted RLS/WED when SICI was above 35% (area under the curve = 0.79, 95% CI 0.67-0.91, p < 0.001). Analyses of the whole brain and of regions of interest did not reveal differences in gray matter thickness or area between controls and subjects with RLS/WED. CONCLUSION SICI is an accurate cortical biomarker that can support the diagnosis of RLS/WED even in subjects with mild symptoms, but cortical thickness and area were not useful for discriminating subjects with this condition from controls.
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Affiliation(s)
- Samir Câmara Magalhães
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; Universidade de Fortaleza, Unifor, Fortaleza, CE, Brazil.
| | | | | | - Annette Sterr
- Department of Psychology, University of Surrey, Guildford, Surrey, UK
| | - Alan Luiz Eckeli
- Departamento de Neurociências e Ciências do Comportamento, Divisão de Neurologia, Hospital das Clínicas da Faculdade de Medicina da USP-Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | | | | | - Edson Amaro
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; Departamento de Radiologia, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Adriana Bastos Conforto
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; Departamento de Neurologia, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
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Guerra A, Suppa A, Asci F, De Marco G, D'Onofrio V, Bologna M, Di Lazzaro V, Berardelli A. LTD-like plasticity of the human primary motor cortex can be reversed by γ-tACS. Brain Stimul 2019; 12:1490-1499. [PMID: 31289014 DOI: 10.1016/j.brs.2019.06.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 06/19/2019] [Accepted: 06/28/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Cortical oscillatory activities play a role in regulating several brain functions in humans. However, whether motor resonant oscillations (i.e. β and γ) modulate long-term depression (LTD)-like plasticity of the primary motor cortex (M1) is still unclear. OBJECTIVE To address this issue, we combined transcranial alternating current stimulation (tACS), a technique able to entrain cortical oscillations, with continuous theta burst stimulation (cTBS), a transcranial magnetic stimulation (TMS) protocol commonly used to induce LTD-like plasticity in M1. METHODS Motor evoked potentials (MEPs) elicited by single-pulse TMS, short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF) were evaluated before and 5, 15 and 30 min after cTBS alone or cTBS delivered during β-tACS (cTBS-β) or γ-tACS (cTBS-γ). Moreover, we tested the effects of β-tACS (alone) on short-latency afferent inhibition (SAI) and γ-tACS on SICI in order to verify whether tACS-related interneuronal modulation contributes to the effects of tACS-cTBS co-stimulation. RESULTS cTBS-γ turned the expected after-effects of cTBS from inhibition to facilitation. By contrast, responses to cTBS-β were similar to those induced by cTBS alone. β- and γ-tACS did not change MEPs evoked by single-pulse TMS. β-tACS reduced SAI and γ-tACS reduced SICI. However, the degree of γ-tACS-induced modulation of SICI did not correlate with the effects of cTBS-γ. CONCLUSION γ-tACS reverses cTBS-induced plasticity of the human M1. γ-oscillations may therefore regulate LTD-like plasticity mechanisms.
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Affiliation(s)
- Andrea Guerra
- IRCCS Neuromed, Via Atinense 18, 86077, Pozzilli (IS), 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
| | - Francesco Asci
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy
| | - Giovanna De Marco
- 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
| | - Matteo Bologna
- IRCCS Neuromed, Via Atinense 18, 86077, Pozzilli (IS), Italy; Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, Via Álvaro Del Portillo 21, 00128, 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.
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