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Matsumoto H, Ugawa Y. Central and Peripheral Motor Conduction Studies by Single-Pulse Magnetic Stimulation. J Clin Neurol 2024; 20:241-255. [PMID: 38713075 PMCID: PMC11076191 DOI: 10.3988/jcn.2023.0520] [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: 12/25/2023] [Revised: 03/08/2024] [Accepted: 03/19/2024] [Indexed: 05/08/2024] Open
Abstract
Single-pulse magnetic stimulation is the simplest type of transcranial magnetic stimulation (TMS). Muscle action potentials induced by applying TMS over the primary motor cortex are recorded with surface electromyography electrodes, and they are called motor-evoked potentials (MEPs). The amplitude and latency of MEPs are used for various analyses in clinical practice and research. The most commonly used parameter is the central motor conduction time (CMCT), which is measured using motor cortical and spinal nerve stimulation. In addition, stimulation at the foramen magnum or the conus medullaris can be combined with conventional CMCT measurements to evaluate various conduction parameters in the corticospinal tract more precisely, including the cortical-brainstem conduction time, brainstem-root conduction time, cortical-conus motor conduction time, and cauda equina conduction time. The cortical silent period is also a useful parameter for evaluating cortical excitability. Single-pulse magnetic stimulation is further used to analyze not only the central nervous system but also the peripheral nervous system, such as for detecting lesions in the proximal parts of peripheral nerves. In this review article we introduce four types of single-pulse magnetic stimulation-of the motor cortex, spinal nerve, foramen magnum, and conus medullaris-that are useful for the diagnosis, elucidation of pathophysiology, and evaluation of clinical conditions and therapeutic effects. Single-pulse magnetic stimulation is a clinically useful technique that all neurologists should learn.
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Affiliation(s)
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Fukushima, Japan
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2
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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: 44] [Impact Index Per Article: 44.0] [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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Ruiu E, Valls-Sole J. Excitatory and inhibitory responses to cervical root magnetic stimulation in healthy subjects. Clin Neurophysiol Pract 2021; 6:265-274. [PMID: 34825114 PMCID: PMC8604992 DOI: 10.1016/j.cnp.2021.10.002] [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: 07/18/2021] [Revised: 09/10/2021] [Accepted: 10/09/2021] [Indexed: 12/25/2022] Open
Abstract
We studied excitatory and inhibitory responses to cervical root magnetic stimulation. CRMS elicited direct and reflex responses in hand muscles. CRMS is painless and well tolerated and, therefore, applicable to clinical studies.
Objectives To characterize direct and reflex hand muscle responses to cervical root magnetic stimulation (CRMS) in healthy volunteers during sustained voluntary contraction. Methods In 18 healthy volunteers, we recorded from the first dorsal interosseous (FDI) muscle the responses to CRMS of progressively increasing intensity and level of muscle contraction. The compound muscle action potential (CMAP) and the silent period (SP) were compared to those obtained with plexus, midarm and wrist stimulation. Additionally, in a smaller number of subjects, we obtained the peristimulus time histogram (psth) of single motor unit firing in the FDI, examined the effects of vibration and recorded the modulation of sustained EMG activity in muscles of the lower limbs. Results Increasing CRMS intensity led to larger CMAP with no relevant changes in SP1 or SP2, except for lower amplitude of the burst interrupting the silent period (BISP). Increasing the level of muscle contraction led to reduced CMAP, shorter SP duration and increased BISP amplitude. The psth analysis showed the underlying changes in the motor unit firing frequency that corresponded to the changes seen in the CMAP and the SP with surface recordings. Progressively distal stimulation led to CMAPs of shorter latency and increased amplitude, SPs of longer latency and shorter duration, and a BISP of longer latency. Vibration led to reduction of the SP. CRMS induced SPs in muscles of the lower limb. Conclusions CRMS induces excitatory and inhibitory responses in hand muscles, fitting with the expected behavior of mixed nerve stimulation at very proximal sites. Significance Characterization of the effects of CRMS on hand muscles is of physiological and potentially clinical applicability, as it is a painless and reliable procedure.
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Affiliation(s)
- E Ruiu
- Unit of Clinical Neurology, Department of Clinical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - J Valls-Sole
- IDIBAPS (Institut d'Investigació Biomèdica August Pi i Sunyer), Barcelona 08036, Spain
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Petrosyan H, Liang L, Tesfa A, Sisto SA, Fahmy M, Arvanian VL. Modulation of H-reflex responses and frequency-dependent depression by repetitive spinal electromagnetic stimulation: From rats to humans and back to chronic spinal cord injured rats. Eur J Neurosci 2020; 52:4875-4889. [PMID: 32594554 PMCID: PMC7818466 DOI: 10.1111/ejn.14885] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/15/2020] [Accepted: 06/12/2020] [Indexed: 11/30/2022]
Abstract
The lack of propagation of signals through survived fibers is among the major reasons for functional loss after incomplete spinal cord injury (SCI). Our recent results of animal studies demonstrate that spinal electromagnetic stimulation (SEMS) can enhance transmission in damaged spinal cord, and this type of modulation depends on the function of NMDA receptors at the neuronal networks below the injury level. Here, our pilot human study revealed that administration of repetitive SEMS induced long‐lasting modulation of H‐responses in both healthy and participants with chronic SCI. In order to understand the mechanisms underlying these effects, we have used an animal model and examined effects of SEMS on H‐responses. Effects of SEMS on H‐responses, frequency‐dependent depression (FDD) of H‐reflex, and possible underlying mechanisms have been examined in both naïve and rats with SCI. Our results demonstrate that consistent with the effects of SEMS on H‐reflex seen in humans, repetitive SEMS induced similar modulation in excitability of peripheral nerve responses in both non‐injured and rats with SCI. Importantly, our results confirmed the reduced FDD of H‐reflex in SCI animals and revealed that SEMS was able to recover FDD in rats with chronic SCI. Using intraspinal injections of the NMDA receptor blocker MK‐801, we have identified NMDA receptors as an important contributor to these SEMS‐induced effects in rats with SCI. These results identify SEMS as a novel non‐invasive technique for modulation of neuro‐muscular circuits and, importantly, modulation of spinal networks after chronic SCI.
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Affiliation(s)
- Hayk Petrosyan
- Research Services, Northport Veterans Affairs Medical Center, Northport, New York, USA.,Department of Neurobiology and Behavior, Stony Brook University, Stony Brook, New York, USA
| | - Li Liang
- Research Services, Northport Veterans Affairs Medical Center, Northport, New York, USA.,Department of Neurobiology and Behavior, Stony Brook University, Stony Brook, New York, USA
| | - Asrat Tesfa
- Research Services, Northport Veterans Affairs Medical Center, Northport, New York, USA
| | - Sue A Sisto
- Department of Physical Therapy, Division of Rehabilitation Sciences, Stony Brook University, Stony Brook, New York, USA.,Department of Rehabilitation Science, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Magda Fahmy
- Physical Medicine and Rehabilitation Services, Northport Veterans Affairs Medical Center, Northport, New York, USA
| | - Victor L Arvanian
- Research Services, Northport Veterans Affairs Medical Center, Northport, New York, USA.,Department of Neurobiology and Behavior, Stony Brook University, Stony Brook, New York, USA
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Tankisi H, Burke D, Cui L, de Carvalho M, Kuwabara S, Nandedkar SD, Rutkove S, Stålberg E, van Putten MJAM, Fuglsang-Frederiksen A. Standards of instrumentation of EMG. Clin Neurophysiol 2019; 131:243-258. [PMID: 31761717 DOI: 10.1016/j.clinph.2019.07.025] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 07/12/2019] [Accepted: 07/14/2019] [Indexed: 12/14/2022]
Abstract
Standardization of Electromyography (EMG) instrumentation is of particular importance to ensure high quality recordings. This consensus report on "Standards of Instrumentation of EMG" is an update and extension of the earlier IFCN Guidelines published in 1999. First, a panel of experts in different fields from different geographical distributions was invited to submit a section on their particular interest and expertise. Then, the merged document was circulated for comments and edits until a consensus emerged. The first sections in this document cover technical aspects such as instrumentation, EMG hardware and software including amplifiers and filters, digital signal analysis and instrumentation settings. Other sections cover the topics such as temporary storage, trigger and delay line, averaging, electrode types, stimulation techniques for optimal and standardised EMG examinations, and the artefacts electromyographers may face and safety rules they should follow. Finally, storage of data and databases, report generators and external communication are summarized.
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Affiliation(s)
- Hatice Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital & Dept of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - David Burke
- Royal Prince Alfred Hospital and University of Sydney, Australia
| | - Liying Cui
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Mamede de Carvalho
- Faculdade de Medicina-iMM, Universidade de Lisboa, Lisbon, Portugal; Department of Neurosciences, Centro Hospitalar Universitário de Lisboa, Portugal
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
| | | | | | - Erik Stålberg
- Department Clin Neurophysiology, Inst Neurosciences, Uppsala University, Sweden
| | | | - Anders Fuglsang-Frederiksen
- Department of Clinical Neurophysiology, Aarhus University Hospital & Dept of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Frazer AK, Pearce AJ, Howatson G, Thomas K, Goodall S, Kidgell DJ. Determining the potential sites of neural adaptation to cross-education: implications for the cross-education of muscle strength. Eur J Appl Physiol 2018; 118:1751-1772. [PMID: 29995227 DOI: 10.1007/s00421-018-3937-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/05/2018] [Indexed: 12/11/2022]
Abstract
Cross-education describes the strength gain in the opposite, untrained limb following a unilateral strength training program. Since its discovery in 1894, several studies now confirm the existence of cross-education in contexts that involve voluntary dynamic contractions, eccentric contraction, electrical stimulation, whole-body vibration and, more recently, following mirror feedback training. Although many aspects of cross-education have been established, the mediating neural mechanisms remain unclear. Overall, the findings of this review show that the neural adaptations to cross-education of muscle strength most likely represent a continuum of change within the central nervous system that involves both structural and functional changes within cortical motor and non-motor regions. Such changes are likely to be the result of more subtle changes along the entire neuroaxis which include, increased corticospinal excitability, reduced cortical inhibition, reduced interhemispheric inhibition, changes in voluntary activation and new regions of cortical activation. However, there is a need to widen the breadth of research by employing several neurophysiological techniques (together) to better understand the potential mechanisms mediating cross-education. This fundamental step is required in order to better prescribe targeted and effective guidelines for the clinical practice of cross-education. There is a need to determine whether similar cortical responses also occur in clinical populations where, perhaps, the benefits of cross-education could be best observed.
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Affiliation(s)
- Ashlyn K Frazer
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University, PO Box 527, Frankston, Melbourne, VIC, 3199, Australia.
| | - Alan J Pearce
- Discipline of Exercise Science, School of Allied Health, La Trobe University, Melbourne, Australia
| | - Glyn Howatson
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, UK.,Water Research Group, School of Biological Sciences, North West University, Potchefstroom, South Africa
| | - Kevin Thomas
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, UK
| | - Stuart Goodall
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, UK
| | - Dawson J Kidgell
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University, PO Box 527, Frankston, Melbourne, VIC, 3199, Australia
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Matsumoto H, Ugawa Y. A pitfall in magnetic stimulation for measuring central motor conduction time. Clin Neurophysiol 2017; 128:2332-2333. [PMID: 28918969 DOI: 10.1016/j.clinph.2017.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 07/27/2017] [Accepted: 08/12/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Hideyuki Matsumoto
- Department of Neurology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan.
| | - Yoshikazu Ugawa
- Department of Neurology, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan.
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Veltsista D, Chroni E. Usefulness of cervical root magnetic stimulation in assessing proximal motor nerve conduction. J Electromyogr Kinesiol 2015. [PMID: 26216867 DOI: 10.1016/j.jelekin.2015.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES To evaluate the reliability and utility of cervical root magnetic stimulation in exploring proximal motor conduction. METHODS In 20 patients with demyelinating polyneuropathy (DPN), 20 patients with amyotrophic lateral sclerosis (ALS) and 25 healthy subjects, evoked compound muscle action potentials (CMAPs) were recorded from abductor digiti minimi muscle in response to electrical stimulation up to Erb's point and magnetic stimulation up to the cervical roots. RESULTS In all healthy and ALS subjects, magnetic root stimulation confirmed the absence of conduction abnormalities, including those in whom supramaximal responses at Erb's point were not achieved. In the DPN group, conduction block and/or temporal dispersion was revealed by magnetic root stimulation in 9 out of 20 patients (45%), 3 more than those detected at Erb's point. CONCLUSIONS Cervical root stimulation allowed clear distinction between motor neuronopathy and DPN. It is recommended as part of the routine evaluation of patients suspected of having DPN, especially when distal nerve studies are inconclusive.
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Affiliation(s)
- Dimitra Veltsista
- Department of Neurology, School of Medicine, University of Patras, Patras, Greece
| | - Elisabeth Chroni
- Department of Neurology, School of Medicine, University of Patras, Patras, Greece.
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Matsumoto H, Ugawa Y. Conduction block in thoracic outlet syndrome? The need for motor root stimulation. Clin Neurophysiol 2015; 127:26-27. [PMID: 25971724 DOI: 10.1016/j.clinph.2015.04.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 04/20/2015] [Accepted: 04/21/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Hideyuki Matsumoto
- Department of Neurology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan.
| | - Yoshikazu Ugawa
- Department of Neurology, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan.
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Rossini PM, Burke D, Chen R, Cohen LG, Daskalakis Z, Di Iorio R, Di Lazzaro V, Ferreri F, Fitzgerald PB, George MS, Hallett M, Lefaucheur JP, Langguth B, Matsumoto H, Miniussi C, Nitsche MA, Pascual-Leone A, Paulus W, Rossi S, Rothwell JC, Siebner HR, Ugawa Y, Walsh V, Ziemann U. Non-invasive electrical and magnetic stimulation of the brain, spinal cord, roots and peripheral nerves: Basic principles and procedures for routine clinical and research application. An updated report from an I.F.C.N. Committee. Clin Neurophysiol 2015; 126:1071-1107. [PMID: 25797650 PMCID: PMC6350257 DOI: 10.1016/j.clinph.2015.02.001] [Citation(s) in RCA: 1726] [Impact Index Per Article: 191.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 01/22/2015] [Accepted: 02/01/2015] [Indexed: 12/14/2022]
Abstract
These guidelines provide an up-date of previous IFCN report on “Non-invasive electrical and magnetic stimulation of the brain, spinal cord and roots: basic principles and procedures for routine clinical application” (Rossini et al., 1994). A new Committee, composed of international experts, some of whom were in the panel of the 1994 “Report”, was selected to produce a current state-of-the-art review of non-invasive stimulation both for clinical application and research in neuroscience. Since 1994, the international scientific community has seen a rapid increase in non-invasive brain stimulation in studying cognition, brain–behavior relationship and pathophysiology of various neurologic and psychiatric disorders. New paradigms of stimulation and new techniques have been developed. Furthermore, a large number of studies and clinical trials have demonstrated potential therapeutic applications of non-invasive brain stimulation, especially for TMS. Recent guidelines can be found in the literature covering specific aspects of non-invasive brain stimulation, such as safety (Rossi et al., 2009), methodology (Groppa et al., 2012) and therapeutic applications (Lefaucheur et al., 2014). This up-dated review covers theoretical, physiological and practical aspects of non-invasive stimulation of brain, spinal cord, nerve roots and peripheral nerves in the light of more updated knowledge, and include some recent extensions and developments.
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Affiliation(s)
- P M Rossini
- Institute of Neurology, Department of Geriatrics, Neuroscience and Orthopedics, Catholic University, Policlinic A. Gemelli, Rome, Italy
| | - D Burke
- Department of Neurology, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - R Chen
- Division of Neurology, Toronto Western Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - L G Cohen
- Human Cortical Physiology and Neurorehabilitation Section, NINDS, NIH, Bethesda, MD, USA
| | - Z Daskalakis
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - R Di Iorio
- Institute of Neurology, Department of Geriatrics, Neuroscience and Orthopedics, Catholic University, Policlinic A. Gemelli, Rome, Italy.
| | - V Di Lazzaro
- Department of Neurology, University Campus Bio-medico, Rome, Italy
| | - F Ferreri
- Department of Neurology, University Campus Bio-medico, Rome, Italy; Department of Clinical Neurophysiology, University of Eastern Finland, Kuopio, Finland
| | - P B Fitzgerald
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred, Melbourne, Australia
| | - M S George
- Medical University of South Carolina, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - M Hallett
- Human Motor Control Section, Medical Neurology Branch, NINDS, NIH, Bethesda, MD, USA
| | - J P Lefaucheur
- Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France; EA 4391, Nerve Excitability and Therapeutic Team, Faculty of Medicine, Paris Est Créteil University, Créteil, France
| | - B Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - H Matsumoto
- Department of Neurology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - C Miniussi
- Department of Clinical and Experimental Sciences University of Brescia, Brescia, Italy; IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - M A Nitsche
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Georg-August-University, Göttingen, Germany
| | - A Pascual-Leone
- Berenson-Allen Center for Non-invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - W Paulus
- Department of Clinical Neurophysiology, Georg-August University, Göttingen, Germany
| | - S Rossi
- Brain Investigation & Neuromodulation Lab, Unit of Neurology and Clinical Neurophysiology, Department of Neuroscience, University of Siena, Siena, Italy
| | - J C Rothwell
- Institute of Neurology, University College London, London, United Kingdom
| | - H R Siebner
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark; Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Y Ugawa
- Department of Neurology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - V Walsh
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom
| | - U Ziemann
- Department of Neurology & Stroke, and Hertie Institute for Clinical Brain Research, Eberhard Karls University, Tübingen, Germany
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Does trans-spinal direct current stimulation alter phrenic motoneurons and respiratory neuromechanical outputs in humans? A double-blind, sham-controlled, randomized, crossover study. J Neurosci 2015; 34:14420-9. [PMID: 25339753 DOI: 10.1523/jneurosci.1288-14.2014] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Although compelling evidence has demonstrated considerable neuroplasticity in the respiratory control system, few studies have explored the possibility of altering descending projections to phrenic motoneurons (PMNs) using noninvasive stimulation protocols. The present study was designed to investigate the immediate and long-lasting effects of a single session of transcutaneous spinal direct current stimulation (tsDCS), a promising technique for modulating spinal cord functions, on descending ventilatory commands in healthy humans. Using a double-blind, controlled, randomized, crossover approach, we examined the effects of anodal, cathodal, and sham tsDCS delivered to the C3-C5 level on (1) diaphragm motor-evoked potentials (DiMEPs) elicited by transcranial magnetic stimulation and (2) spontaneous ventilation, as measured by respiratory inductance plethysmography. Both anodal and cathodal tsDCS induced a progressive increase in DiMEP amplitude during stimulation that persisted for at least 15 min after current offset. Interestingly, cathodal, but not anodal, tsDCS induced a persistent increase in tidal volume. In addition, (1) short-interval intracortical inhibition, (2) nonlinear complexity of the tidal volume signal (related to medullary ventilatory command), (3) autonomic function, and (4) compound muscle action potentials evoked by cervical magnetic stimulation were unaffected by tsDCS. This suggests that tsDCS-induced aftereffects did not occur at brainstem or cortical levels and were likely not attributable to direct polarization of cranial nerves or ventral roots. Instead, we argue that tsDCS could induce sustained changes in PMN output. Increased tidal volume after cathodal tsDCS opens up the perspective of harnessing respiratory neuroplasticity as a therapeutic tool for the management of several respiratory disorders.
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Matsumoto H, Saito K, Konoma Y, Okabe S, Ugawa Y, Ishibashi Y. Motor cortical excitability in peritoneal dialysis: a single-pulse TMS study. J Physiol Sci 2015; 65:113-9. [PMID: 25376928 PMCID: PMC10717939 DOI: 10.1007/s12576-014-0347-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 10/23/2014] [Indexed: 10/24/2022]
Abstract
The aim of this paper is to investigate cortical excitability in patients with end-stage renal disease receiving peritoneal dialysis (PD) without any symptoms suggestive of uremic encephalopathy. We performed transcranial magnetic stimulation for 52 PD patients and 28 normal subjects. We compared the active motor threshold (AMT), resting motor threshold (RMT), root latency, central motor conduction time (CMCT), and cortical silent period (CSP) in PD patients to those in normal subjects. AMT, RMT, CMCT, and CSP were not significantly different between PD patients and normal subjects. However, root latency was significantly prolonged in PD patients compared to normal subjects. The root latency correlated linearly with HbA1c or duration of PD in the patients. The results suggest that the corticospinal tract and the cortical and spinal excitabilities are preserved but the peripheral nerves are disturbed in PD patients. The severity of peripheral neuropathy corresponds to the severity of DM and the duration of PD. We uncovered no evidence suggestive of any subclinical abnormality of the motor cortical excitability in PD patients.
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Affiliation(s)
- Hideyuki Matsumoto
- Department of Neurology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan,
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A conduction block in sciatic nerves can be detected by magnetic motor root stimulation. J Neurol Sci 2013; 331:174-6. [DOI: 10.1016/j.jns.2013.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 06/02/2013] [Accepted: 06/06/2013] [Indexed: 11/17/2022]
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Matsumoto H, Tokushige SI, Hashida H, Hanajima R, Terao Y, Ugawa Y. Focal Lesion in Upper Part of Brachial Plexus can be Detected by Magnetic Cervical Motor Root Stimulation. Brain Stimul 2013; 6:538-40. [DOI: 10.1016/j.brs.2012.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 08/22/2012] [Accepted: 09/21/2012] [Indexed: 11/24/2022] Open
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Matsumoto H, Hanajima R, Terao Y, Ugawa Y. Magnetic-motor-root stimulation: Review. Clin Neurophysiol 2013; 124:1055-67. [DOI: 10.1016/j.clinph.2012.12.049] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 12/18/2012] [Accepted: 12/28/2012] [Indexed: 12/13/2022]
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Hemmi S, Kurokawa K, Nagai T, Izawa N, Murakami T, Sunada Y. [Acute fulminant brachial plexopathy with good recovery: electrophysiological features]. Rinsho Shinkeigaku 2012; 52:436-438. [PMID: 22790808 DOI: 10.5692/clinicalneurol.52.436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We report a case of fulminant brachial plexopathy with radicular involvement. A 25-year-old man developed acute total monoplegia in the left upper limb. Needle electromyography showed extensive acute denervation in the C5-T1 spinal segments, and peripheral sensory nerve conduction was normal, mimicking a pre-ganglionic lesion. However, left median somatosensory evoked potentials revealed abnormal Erb's point potential, suggesting a brachial plexus lesion. Corticosteroid treatment resulted in good recovery. These findings suggest that the primary pathophysiology was conduction block and this can explain the good clinical recovery in this patient.
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Affiliation(s)
- Shoji Hemmi
- Department of Neurology, Kawasaki Medical School, Kurashiki, Okayama, Japan
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Shirota Y, Hanajima R, Hamada M, Terao Y, Matsumoto H, Tsutsumi R, Ohminami S, Furubayashi T, Ugawa Y. Inter-individual variation in the efficient stimulation site for magnetic brainstem stimulation. Clin Neurophysiol 2011; 122:2044-8. [DOI: 10.1016/j.clinph.2011.03.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 03/16/2011] [Accepted: 03/18/2011] [Indexed: 11/28/2022]
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Matsumoto H, Hanajima R, Shirota Y, Hamada M, Terao Y, Ohminami S, Furubayashi T, Nakatani-Enomoto S, Ugawa Y. Cortico-conus motor conduction time (CCCT) for leg muscles. Clin Neurophysiol 2010; 121:1930-3. [DOI: 10.1016/j.clinph.2010.04.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Revised: 04/17/2010] [Accepted: 04/19/2010] [Indexed: 11/29/2022]
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