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Di Lazzaro V, Ranieri F, Doretti A, Boscarino M, Maderna L, Colombo E, Soranna D, Zambon A, Ticozzi N, Musumeci G, Capone F, Silani V. Transcranial static magnetic stimulation for amyotrophic lateral sclerosis: a bicentric, randomised, double-blind placebo-controlled phase 2 trial. THE LANCET REGIONAL HEALTH. EUROPE 2024; 45:101019. [PMID: 39185360 PMCID: PMC11341967 DOI: 10.1016/j.lanepe.2024.101019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 07/16/2024] [Accepted: 07/18/2024] [Indexed: 08/27/2024]
Abstract
Background Enhanced glutamatergic transmission leading to motor neuron death is considered the major pathophysiological mechanism of amyotrophic lateral sclerosis (ALS). Motor cortex excitability can be suppressed by transcranial static magnetic stimulation (tSMS), thus tSMS can be evaluated as a potential treatment for ALS. The aim of present study was to investigate the efficacy and safety of tSMS in ALS. Methods In this phase 2 trial, we randomly assigned ALS patients to receive daily tSMS or placebo stimulation over a period of 6 months. For each participant we calculated mean disease monthly progression rate (MPR) as the variation of the total ALS Functional Rating Scale-Revised (ALSRFS-R) score, before the beginning of the treatment (over a period of at least three months) and over the six-month treatment period. The primary efficacy outcome was the difference in MPR before and after the beginning of treatment. Secondary outcomes included safety and tolerability, compliance, and changes in corticospinal output. A long-term follow-up of 18 months was performed in all patients who completed the six-month treatment considering a composite endpoint event (tracheostomy or death). Trial registered at ClinicalTrials.gov, ID: NCT04393467, status: closed. Findings Forty participants were randomly assigned to real (n = 21) or placebo stimulation (n = 19). Thirty-two participants (18 real and 14 placebo) completed the 6-month treatment. The MPR did not show statistically significant differences between the two arms during the pre-treatment (mean ± Standard deviation; Real: 1.02 ± 0.62, Sham: 1.02 ± 0.57, p-value = 1.00) and treatment period (Real: 0.90 ± 0.55, Sham: 0.94 ± 0.55, p-value = 0.83). Results for secondary clinical endpoints showed that the treatment is feasible and safe, being compliance with tSMS high. The change in corticospinal output did not differ significantly between the two groups. At the end of the long-term follow-up of 18 months, patients of real group had a statistically significant higher tracheostomy-free survival compared with patients of placebo group (Hazard Ratio = 0.27 95% Confidence interval 0.09-0.80, p-value = 0.019). Interpretation tSMS did not modify disease progression during the 6 months of treatment. However, long-term follow-up revealed a substantial increase in tracheostomy free survival in patients treated with real stimulation supporting the evaluation of tSMS in larger and more prolonged studies. Funding The "Fondazione 'Nicola Irti' per le opere di carità e di cultura", Rome, Italy, supported present study.
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Affiliation(s)
- Vincenzo Di Lazzaro
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, Roma 00128, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 21, Roma 00128, Italy
| | - Federico Ranieri
- Unit of Neurology, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, P.le L.A. Scuro 10, Verona 37134, Italy
| | - Alberto Doretti
- Istituto Auxologico Italiano IRCCS, Department of Neurology and Laboratory of Neuroscience, Piazzale Brescia 20, Milano 20149, Italy
| | - Marilisa Boscarino
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, Roma 00128, Italy
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department of the Milano Institute, Via Camaldoli 64, Milano 20138, Italy
| | - Luca Maderna
- Istituto Auxologico Italiano IRCCS, Department of Neurology and Laboratory of Neuroscience, Piazzale Brescia 20, Milano 20149, Italy
| | - Eleonora Colombo
- Istituto Auxologico Italiano IRCCS, Department of Neurology and Laboratory of Neuroscience, Piazzale Brescia 20, Milano 20149, Italy
| | - Davide Soranna
- Istituto Auxologico Italiano IRCCS, Biostatistics Unit, Milano, Italy
| | - Antonella Zambon
- Istituto Auxologico Italiano IRCCS, Biostatistics Unit, Milano, Italy
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milano 20126, Italy
| | - Nicola Ticozzi
- Istituto Auxologico Italiano IRCCS, Biostatistics Unit, Milano, Italy
- “Dino Ferrari” Center, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milano 20122, Italy
| | - Gabriella Musumeci
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, Roma 00128, Italy
| | - Fioravante Capone
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, Roma 00128, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 21, Roma 00128, Italy
| | - Vincenzo Silani
- Istituto Auxologico Italiano IRCCS, Department of Neurology and Laboratory of Neuroscience, Piazzale Brescia 20, Milano 20149, Italy
- “Dino Ferrari” Center, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milano 20122, Italy
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Tian Y, Geng S, Liu T, Wang Q, Lian J, Lin L, Li J, Gong T, Duan J, Wang D, Liu P. Unveiling MRI markers for Parkinson's Disease: GABAergic dysfunction and cortical changes. Neuroimage Clin 2024; 43:103661. [PMID: 39241547 DOI: 10.1016/j.nicl.2024.103661] [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: 05/19/2024] [Revised: 08/21/2024] [Accepted: 08/24/2024] [Indexed: 09/09/2024]
Abstract
OBJECTIVE The study aimed to investigate changes in basal levels of the inhibitory γ-aminobutyric acid (GABA) neurotransmitter in the sensorimotor cortex (SMC) and cortical gyrification in patients with Parkinson's disease (PD), which could further identify potential imaging biomarkers for PD, particularly in patients with early-onset Parkinson's disease (EOPD). METHOD Fifty patients with PD (EOPD: 10, late-onset Parkinson's disease [LOPD]: 40) and fifty-two age- and gender-matched healthy controls (HC) underwent GABA-edited 1H MRS of the SMC and high-resolution 3D T1-weighted brain imaging. GABA levels and local gyrification index (LGI) were calculated to assess GABAergic and cortical gyrification deficits in PD. RESULT The Pearson correlation coefficients revealed significant negative associations between eight indicators, including GABA/Cr level and local gyrification index (LGI) of specific cortical regions (precentral, postcentral, entorhinal, superiortemporal, posteriorcingulate, cuneus, and transversetemporal cortex), and the likelihood of Parkinson's disease (r < -0.4, p < 0.001). Additionally, GABA levels were significantly lower in the SMC region of both EOPD and LOPD patients compared to healthy controls (mean ± SD [u.i.]: EOPD=0.081 ± 0.022 vs. Young-HC=0.112 ± 0.021, p = 0.003; LOPD=0.054 ± 0.024 vs. Old-HC=0.099 ± 0.021, p < 0.001). The logistic regression model was established by using multivariate analysis, identifying two statistically significant indicators: GABA/Cr and LGI of the transversetemporal. The combined model exhibited the highest AUC values in both younger and older populations. CONCLUSION GABAergic dysfunction may play an important role in the pathogenesis of PD patients. Changes in neurotransmitter and morphological may serve as potential markers for the preclinical diagnosis and progression of PD, including EOPD.
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Affiliation(s)
- Yuan Tian
- Department of Magnetic Resonance, the First Affiliated Hospital of Harbin Medical University, Heilongjiang, Harbin 150001, PR China.
| | - Sijia Geng
- Department of Magnetic Resonance, the First Affiliated Hospital of Harbin Medical University, Heilongjiang, Harbin 150001, PR China.
| | - Tianyi Liu
- The First Department of Neurology, the First Affiliated Hospital of Harbin Medical University, Heilongjiang, Harbin 150001, PR China.
| | - Qi Wang
- Department of Magnetic Resonance, the First Affiliated Hospital of Harbin Medical University, Heilongjiang, Harbin 150001, PR China.
| | - Jianxiu Lian
- Clinical and Technical Support, Philips Healthcare, Beijing, PR China.
| | - Liangjie Lin
- Clinical and Technical Support, Philips Healthcare, Beijing, PR China.
| | - Jiayu Li
- Department of Radiology, the third People's Hospital of Chengdu, Sichuan, PR China.
| | - Tao Gong
- Departments of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, PR China.
| | - Junhong Duan
- Department of Radiology, Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Changsha 410013, Hunan, PR China.
| | - Dan Wang
- Department of Medical Imaging, The Affiliated Lihuili Hospital, Ningbo University, Ningbo, PR China.
| | - Pengfei Liu
- Department of Magnetic Resonance, the First Affiliated Hospital of Harbin Medical University, Heilongjiang, Harbin 150001, PR China.
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Pagge C, Caballero-Insaurriaga J, Oliviero A, Foffani G, Ammann C. Transcranial static magnetic field stimulation of the supplementary motor area decreases corticospinal excitability in the motor cortex: a pilot study. Sci Rep 2024; 14:6597. [PMID: 38504094 PMCID: PMC10951294 DOI: 10.1038/s41598-024-57030-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/13/2024] [Indexed: 03/21/2024] Open
Abstract
Transcranial static magnetic field stimulation (tSMS) is a non-invasive brain stimulation technique that is portable and easy to use. Long-term, home-based treatments with tSMS of the supplementary motor area (SMA) are promising for movement disorders and other brain diseases. The aim of the present work was to investigate the potential of SMA-tSMS for reducing corticospinal excitability. We completed an open pilot study in which twenty right-handed healthy subjects (8 females; age: 31.3 ± 5.4 years) completed two 30-min sessions (at least one week apart) of SMA-tSMS. We assessed corticospinal excitability by applying transcranial magnetic stimulation (TMS) over the primary motor cortex, recording 30 motor evoked potentials (MEPs) from either the left or right first dorsal interosseous (FDI, 'hotspot' muscle) and extensor carpi radialis (ECR, 'offspot' muscle) in each session before and after (up to 30 min) tSMS. We observed moderate-to-extreme level of Bayesian evidence for a reduction of MEP amplitude after 30 min of tSMS over SMA compared to baseline. Thus, tSMS applied over SMA may reduce corticospinal excitability. These findings, if confirmed with double-blind, placebo-controlled experiments, support the potential of targeting the SMA for neuromodulating a large motor network in future therapeutic applications of tSMS.
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Affiliation(s)
- Cristina Pagge
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
- PhD Program in Neuroscience, Autonoma de Madrid University-Cajal Institute, Madrid, Spain, 28029
| | - Jaime Caballero-Insaurriaga
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
- Escuela Técnica Superior de Ingenieros de Telecomunicación, Universidad Politécnica de Madrid, 28040, Madrid, Spain
- Champalimaud Research, Champalimaud Foundation, Lisbon, Portugal
| | | | - Guglielmo Foffani
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain.
- Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain.
- CIBERNED, Instituto de Salud Carlos III, Madrid, Spain.
| | - Claudia Ammann
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain.
- Faculty of Health Sciences - HM Hospitales, University Camilo José Cela, Villanueva de la Cañada, 28682, Madrid, Spain.
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Di Lazzaro V, Ranieri F, Bączyk M, de Carvalho M, Dileone M, Dubbioso R, Fernandes S, Kozak G, Motolese F, Ziemann U. Novel approaches to motoneuron disease/ALS treatment using non-invasive brain and spinal stimulation: IFCN handbook chapter. Clin Neurophysiol 2024; 158:114-136. [PMID: 38218077 DOI: 10.1016/j.clinph.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/28/2023] [Accepted: 12/17/2023] [Indexed: 01/15/2024]
Abstract
Non-invasive brain stimulation techniques have been exploited in motor neuron disease (MND) with multifold objectives: to support the diagnosis, to get insights in the pathophysiology of these disorders and, more recently, to slow down disease progression. In this review, we consider how neuromodulation can now be employed to treat MND, with specific attention to amyotrophic lateral sclerosis (ALS), the most common form with upper motoneuron (UMN) involvement, taking into account electrophysiological abnormalities revealed by human and animal studies that can be targeted by neuromodulation techniques. This review article encompasses repetitive transcranial magnetic stimulation methods (including low-frequency, high-frequency, and pattern stimulation paradigms), transcranial direct current stimulation as well as experimental findings with the newer approach of trans-spinal direct current stimulation. We also survey and discuss the trials that have been performed, and future perspectives.
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Affiliation(s)
- Vincenzo Di Lazzaro
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy.
| | - Federico Ranieri
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, P.Le L.A. Scuro 10, 37134 Verona, Italy
| | - Marcin Bączyk
- Department of Neurobiology, Poznań University of Physical Education, Królowej Jadwigi Street 27/39, 61-871 Poznań, Poland
| | - Mamede de Carvalho
- Institute of Physiology, Institute of Molecular Medicine-JLA, Egas Moniz Study Centre, Faculty of Medicine, University of Lisbon, Lisbon 1649-028, Portugal; Department of Neurosciences and Mental Health, CHULN, Lisbon, Portugal
| | - Michele Dileone
- Faculty of Health Sciences, UCLM Talavera de la Reina, Toledo, Spain; Neurology Department, Hospital Nuestra Señora del Prado, Talavera de la Reina, Toledo, Spain
| | - Raffaele Dubbioso
- Neurophysiology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Napoli, Italy
| | - Sofia Fernandes
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016-Lisboa, Portugal
| | - Gabor Kozak
- Department of Neurology and Stroke, University of Tübingen, Tübingen, Germany; Hertie-Institute of Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Francesco Motolese
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Ulf Ziemann
- Department of Neurology and Stroke, University of Tübingen, Tübingen, Germany; Hertie-Institute of Clinical Brain Research, University of Tübingen, Tübingen, Germany.
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Matsumoto T, Watanabe T, Ito K, Horinouchi T, Shibata S, Kurumadani H, Sunagawa T, Mima T, Kirimoto H. Effect of transcranial static magnetic stimulation over unilateral or bilateral motor association cortex on performance of simple and choice reaction time tasks. Front Hum Neurosci 2023; 17:1298761. [PMID: 38111674 PMCID: PMC10725921 DOI: 10.3389/fnhum.2023.1298761] [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: 09/22/2023] [Accepted: 11/14/2023] [Indexed: 12/20/2023] Open
Abstract
Background Transcranial static magnetic stimulation (tSMS) is a non-invasive brain stimulation technique that place a strong neodymium magnet on scalp to reduce cortical excitability. We have recently developed a new tSMS device with three magnets placed close to each other (triple tSMS) and confirmed that this new device can produce a stronger and broader static magnetic field than the conventional single tSMS. The aim of the present study was to investigate the effect of the conventional single tSMS as well as triple tSMS over the unilateral or bilateral motor association cortex (MAC) on simple and choice reaction time (SRT and CRT) task performance. Methods There were two experiments: one involved the conventional tSMS, and the other involved the triple tSMS. In both experiments, right-handed healthy participants received each of the following stimulations for 20 min on different days: tSMS over the unilateral (left) MAC, tSMS over the bilateral MAC, and sham stimulation. The center of the stimulation device was set at the premotor cortex. The participants performed SRT and CRT tasks before, immediately after, and 15 min after the stimulation (Pre, Post 0, and Post 15). We evaluated RT, standard deviation (SD) of RT, and accuracy (error rate). Simulation was also performed to determine the spatial distribution of magnetic field induced by tSMS over the bilateral MAC. Results The spatial distribution of induced magnetic field was centered around the PMd for both tSMS systems, and the magnetic field reached multiple regions of the MAC as well as the sensorimotor cortices for triple tSMS. SD of CRT was significantly larger at Post 0 as compared to Pre when triple tSMS was applied to the bilateral MAC. No significant findings were noted for the other conditions or variables. Discussion We found that single tSMS over the unilateral or bilateral MAC did not affect performance of RT tasks, whereas triple tSMS over the bilateral MAC but not over the unilateral MAC increased variability of CRT. Our finding suggests that RT task performance can be modulated using triple tSMS.
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Affiliation(s)
- Takuya Matsumoto
- Faculty of Health Sciences, Tokyo Kasei University, Saitama, Japan
| | - Tatsunori Watanabe
- Faculty of Health Sciences, Aomori University of Health and Welfare, Aomori, Japan
| | | | - Takayuki Horinouchi
- Department of Sensorimotor Neuroscience, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Japan Society for the Promotion of Science, Tokyo, Japan
| | - Sumiya Shibata
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Hiroshi Kurumadani
- Department of Analysis and Control of Upper Extremity Function, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Toru Sunagawa
- Department of Analysis and Control of Upper Extremity Function, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tatsuya Mima
- Graduate School of Core Ethics and Frontier Sciences, Ritsumeikan University, Kyoto, Japan
| | - Hikari Kirimoto
- Department of Sensorimotor Neuroscience, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Chen XY, Feng SN, Bao Y, Zhou YX, Ba F. Identification of Clec7a as the therapeutic target of rTMS in alleviating Parkinson's disease: targeting neuroinflammation. Biochim Biophys Acta Mol Basis Dis 2023; 1869:166814. [PMID: 37495085 DOI: 10.1016/j.bbadis.2023.166814] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/25/2023] [Accepted: 07/20/2023] [Indexed: 07/28/2023]
Abstract
Parkinson's disease (PD) is a neurodegenerative disease. Repetitive transcranial magnetic stimulation (rTMS) is a therapeutic tool in PD. High-throughput sequencing was performed to screen potential therapeutic targets in unilaterally 6-hydroxydopamine (6-OHDA)-lesioned rats. The candidate gene, Clec7a, was screened out and validated. Clec7a is a pattern recognition receptor involved in neuroinflammation. The higher expression of Clec7a was observed in the substantia nigra (SN) and striatum of PD rats with dopaminergic neurons damage and was mainly localized in the microglial. Adeno-associated virus (AAV)-mediated specific knockdown of Clec7a in microglial alleviated 6-OHDA induced motor deficits and nigrostriatal dopaminergic neuron damage of rats, as evidenced by the increase of tyrosine hydroxylase (TH) -positive neurons in SN, as well as dopaminergic nerve fibers in the striatum. Clec7a knockdown restrained the neuroinflammation by suppressing inflammatory factors (IFN-γ, TNF-α, IL-1β, IL-18, and IL-6) release in SN, which might result from enhanced Arg-1 expression (M2 polarization) and defective inducible nitric oxide synthase (iNOS) expression (M1 polarization). The same phenomena were also observed in the LPS inflammatory rat model of PD. In vitro, α-synuclein fibrils induced upregulation of Clec7a expression and microglia polarization to a pro-inflammatory state of BV2 cells, leading to increased release of cytokines. However, Clec7a knockdown reversed those changes and induced a shift to an anti-inflammatory phenotype in BV2 cells. In conclusion, our study suggested that Clec7a was involved in PD pathogenesis, and its inhibition might protect rats from PD by depressing neuroinflammation through microglial polarization.
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Affiliation(s)
- Xue-Yun Chen
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning, China
| | - Si-Ning Feng
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning, China
| | - Yin Bao
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning, China
| | - Yu-Xin Zhou
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning, China
| | - Fang Ba
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning, China.
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Caballero-Insaurriaga J, Pineda-Pardo JA, Obeso I, Oliviero A, Foffani G. Noninvasive modulation of human corticostriatal activity. Proc Natl Acad Sci U S A 2023; 120:e2219693120. [PMID: 37023134 PMCID: PMC10104491 DOI: 10.1073/pnas.2219693120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/25/2023] [Indexed: 04/07/2023] Open
Abstract
Corticostriatal activity is an appealing target for nonpharmacological treatments of brain disorders. In humans, corticostriatal activity may be modulated with noninvasive brain stimulation (NIBS). However, a NIBS protocol with a sound neuroimaging measure demonstrating a change in corticostriatal activity is currently lacking. Here, we combine transcranial static magnetic field stimulation (tSMS) with resting-state functional MRI (fMRI). We first present and validate the ISAAC analysis, a well-principled framework that disambiguates functional connectivity between regions from local activity within regions. All measures of the framework suggested that the region along the medial cortex displaying greater functional connectivity with the striatum is the supplementary motor area (SMA), where we applied tSMS. We then use a data-driven version of the framework to show that tSMS of the SMA modulates the local activity in the SMA proper, in the adjacent sensorimotor cortex, and in the motor striatum. We finally use a model-driven version of the framework to clarify that the tSMS-induced modulation of striatal activity can be primarily explained by a change in the shared activity between the modulated motor cortical areas and the motor striatum. These results suggest that corticostriatal activity can be targeted, monitored, and modulated noninvasively in humans.
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Affiliation(s)
- Jaime Caballero-Insaurriaga
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid28938, Spain
- Escuela Técnica Superior de Ingenieros de Telecomunicación, Universidad Politécnica de Madrid, Madrid28040, Spain
| | - José A. Pineda-Pardo
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid28938, Spain
| | - Ignacio Obeso
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid28938, Spain
| | | | - Guglielmo Foffani
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid28938, Spain
- Hospital Nacional de Parapléjicos, Toledo45004, Spain
- CIBERNED, Instituto de Salud Carlos III, Madrid28031, Spain
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Watanabe T, Chen X, Yunoki K, Matsumoto T, Horinouchi T, Ito K, Ishida H, Sunagawa T, Mima T, Kirimoto H. Differential Effects of Transcranial Static Magnetic Stimulation Over Left and Right Dorsolateral Prefrontal Cortex on Brain Oscillatory Responses During a Working Memory Task. Neuroscience 2023; 517:50-60. [PMID: 36907432 DOI: 10.1016/j.neuroscience.2023.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 03/01/2023] [Accepted: 03/06/2023] [Indexed: 03/13/2023]
Abstract
Transcranial static magnetic stimulation (tSMS) is known to influence behavioral and neural activities. However, although the left and right dorsolateral prefrontal cortex (DLPFC) are associated with different cognitive functions, there remains a lack of knowledge on a difference in the effects of tSMS on cognitive performance and related brain activity between left and right DLPFC stimulations. To address this knowledge gap, we examined how differently tSMS over the left and right DLPFC altered working memory performance and electroencephalographic oscillatory responses using a 2-back task, in which subjects monitor a sequence of stimuli and decide whether a presented stimulus matches the stimulus presented two trials previously. Fourteen healthy adults (five females) performed the 2-back task before, during (20 min after the start of stimulation), immediately after, and 15 min after three different stimulation conditions: tSMS over the left DLPFC, tSMS over the right DLPFC, and sham stimulation. Our preliminary results revealed that while tSMS over the left and right DLPFC impaired working memory performance to a similar extent, the impacts of tSMS on brain oscillatory responses were different between the left and right DLPFC stimulations. Specifically, tSMS over the left DLPFC increased the event-related synchronization in beta band whereas tSMS over the right DLPFC did not show such an effect. These findings support evidence that the left and right DLPFC play different roles in working memory and suggest that the neural mechanism underlying the impairment of working memory by tSMS can be different between left and right DLPFC stimulations.
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Affiliation(s)
- Tatsunori Watanabe
- Faculty of Health Sciences, Aomori University of Health and Welfare, Aomori, Japan; Department of Sensorimotor Neuroscience, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Xiaoxiao Chen
- Department of Sensorimotor Neuroscience, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; College of Physical Education and Sports Rehabilitation, Jinzhou Medical University, Jinzhou, China
| | - Keisuke Yunoki
- Department of Sensorimotor Neuroscience, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takuya Matsumoto
- Department of Sensorimotor Neuroscience, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Faculty of Health Sciences, Tokyo Kasei University, Saitama, Japan
| | - Takayuki Horinouchi
- Department of Sensorimotor Neuroscience, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kanami Ito
- Department of Sensorimotor Neuroscience, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Haruki Ishida
- Department of Sensorimotor Neuroscience, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Toru Sunagawa
- Department of Analysis and Control of Upper Extremity Function, Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Tatsuya Mima
- Graduate School of Core Ethics and Frontier Sciences, Ritsumeikan University, Kyoto, Japan
| | - Hikari Kirimoto
- Department of Sensorimotor Neuroscience, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
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Gao B, Wang Y, Zhang D, Wang Z, Wang Z. Intermittent theta-burst stimulation with physical exercise improves poststroke motor function: A systemic review and meta-analysis. Front Neurol 2022; 13:964627. [PMID: 36110393 PMCID: PMC9468864 DOI: 10.3389/fneur.2022.964627] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Intermittent theta-burst stimulation (iTBS) is an optimized rTMS modality that could modulate the excitability of neural structures. Several studies have been conducted to investigate the efficacy of iTBS in improving the motor function of stroke patients. However, the specific role of iTBS in motor function recovery after stroke is unclear. Hence, in our study, we performed a meta-analysis to investigate the efficacy of iTBS for the motor function improvement of stroke patients. Methods MEDLINE, Embase, and Cochrane Library were searched until May 2022 for randomized controlled trials (RCTs). Results Thirteen RCTs with 334 patients were finally included in our study. The primary endpoints were the Fugl-Meyer assessment scale (FMA) and Motor Assessment Scale (MAS) change from baseline. We found that iTBS led to a significant reduction in FMA score (P = 0.002) but not in MAS score (P = 0.24) compared with the sham group. Moreover, standard 600-pulse stimulation showed a better effect on motor function improvement than the sham group (P = 0.004), however, 1200-pulse iTBS showed no effect on motor function improvement after stroke (P = 0.23). The effect of iTBS for improving motor function only exists in chronic stroke patients (P = 0.02) but not in subacute patients (P = 0.27). Conclusion This study supports that iTBS has good efficacy for improving motor function in stroke patients. Therefore, standard 600-pulse stimulation iTBS therapy is proper management and treatment for chronic stroke.
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Affiliation(s)
- Bixi Gao
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Stroke Research, Soochow University, Suzhou, China
| | - Yunjiang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Stroke Research, Soochow University, Suzhou, China
- Department of Neurosurgery, Yancheng Third People's Hospital, Yancheng, China
| | - Dingding Zhang
- Department of Anesthesia, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zongqi Wang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Stroke Research, Soochow University, Suzhou, China
- *Correspondence: Zongqi Wang
| | - Zhong Wang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Stroke Research, Soochow University, Suzhou, China
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