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Liu Q, Liu Y, Zhang Y. Effects of Cerebellar Non-Invasive Stimulation on Neurorehabilitation in Stroke Patients: An Updated Systematic Review. Biomedicines 2024; 12:1348. [PMID: 38927555 DOI: 10.3390/biomedicines12061348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/04/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
The cerebellum is emerging as a promising target for noninvasive brain stimulation (NIBS). A systematic review was conducted to evaluate the effects of cerebellar NIBS on both motor and other symptoms in stroke rehabilitation, its impact on functional ability, and potential side effects (PROSPERO number: CRD42022365697). A systematic electronic database search was performed by using PubMed Central (PMC), EMBASE, and Web of Science, with a cutoff date of November 2023. Data extracted included study details, NIBS methodology, outcome measures, and results. The risk of bias in eligible studies was also assessed. Twenty-two clinical studies involving 1016 participants were finally included, with a focus on outcomes related to post-stroke motor recovery (gait and balance, muscle spasticity, and upper limb dexterity) and other functions (dysphagia and aphasia). Positive effects were observed, especially on motor functions like gait and balance. Some efficiency was also observed in dysphagia rehabilitation. However, findings on language recovery were preliminary and inconsistent. A slight improvement in functional ability was noted, with no serious adverse effects reported. Further studies are needed to explore the effects of cerebellar NIBS on post-stroke non-motor deficits and to understand how cerebellar engagement can facilitate more precise treatment strategies for stroke rehabilitation.
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Affiliation(s)
- Qi Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Yang Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Yumei Zhang
- Department of Rehabilitation, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
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Fong PY, Rothwell JC, Rocchi L. The Past, Current and Future Research in Cerebellar TMS Evoked Responses-A Narrative Review. Brain Sci 2024; 14:432. [PMID: 38790411 PMCID: PMC11118133 DOI: 10.3390/brainsci14050432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/26/2024] Open
Abstract
Transcranial magnetic stimulation coupled with electroencephalography (TMS-EEG) is a novel technique to investigate cortical physiology in health and disease. The cerebellum has recently gained attention as a possible new hotspot in the field of TMS-EEG, with several reports published recently. However, EEG responses obtained by cerebellar stimulation vary considerably across the literature, possibly due to different experimental methods. Compared to conventional TMS-EEG, which involves stimulation of the cortex, cerebellar TMS-EEG presents some technical difficulties, including strong muscle twitches in the neck area and a loud TMS click when double-cone coils are used, resulting in contamination of responses by electromyographic activity and sensory potentials. Understanding technical difficulties and limitations is essential for the development of cerebellar TMS-EEG research. In this review, we summarize findings of cerebellar TMS-EEG studies, highlighting limitations in experimental design and potential issues that can result in discrepancies between experimental outcomes. Lastly, we propose a possible direction for academic and clinical research with cerebellar TMS-EEG.
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Affiliation(s)
- Po-Yu Fong
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK; (J.C.R.)
- Division of Movement Disorders, Department of Neurology and Neuroscience Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan
- Medical School, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - John C. Rothwell
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK; (J.C.R.)
| | - Lorenzo Rocchi
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK; (J.C.R.)
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
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Wu X, Lei Z, Wu Y, Jiang M, Luo H, Chen X, Ruan J. Dynamics of Cerebral Function in Patients with Acute Cerebellar Infarction. CEREBELLUM (LONDON, ENGLAND) 2024; 23:374-382. [PMID: 36810748 DOI: 10.1007/s12311-023-01534-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 02/24/2023]
Abstract
Few studies were devoted to investigating cerebral functional changes after acute cerebellar infarction (CI). The purpose of this study was to examine the brain functional dynamics of CI using electroencephalographic (EEG) microstate analysis. And the possible heterogenicity in neural dynamics between CI with vertigo and CI with dizziness was explored. Thirty-four CI patients and 37 age- and gender-matched healthy controls(HC) were included in the study. Each included subject underwent a 19-channel video EEG examination. Five 10-s resting-state EEG epochs were extracted after data preprocessing. Then, microstate analysis and source localization were performed using the LORETA-KEY tool. Microstate parameters such as duration, coverage, occurrence, and transition probability are all extracted. The current study showed that the duration, coverage, and occurrence of microstate(Ms) B significantly increased in CI patients, but the duration and coverage of MsA and MsD decreased. Compared CI with vertigo to dizziness, finding a decreased trend in the coverage of MsD and the transition from MsA and MsB to MsD. Taken together, our study sheds new light on the dynamics of cerebral function after CI, mainly reflecting increased activity in functional networks involved in MsB and decreased activity in functional networks involved in MsA and MsD. Vertigo and dizziness post-CI may be suggested by cerebral functional dynamics. Further longitudinal studies are needed to validate and explore the alterations in brain dynamics to what extent depict the clinical traits and their potential applications in the recovery of CI.
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Affiliation(s)
- Xin Wu
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
- Laboratory of Neurological Diseases and Brain Function, Luzhou, 646000, China
| | - Ziye Lei
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
- Laboratory of Neurological Diseases and Brain Function, Luzhou, 646000, China
| | - Yusi Wu
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
- Laboratory of Neurological Diseases and Brain Function, Luzhou, 646000, China
| | - Mingqing Jiang
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
- Laboratory of Neurological Diseases and Brain Function, Luzhou, 646000, China
| | - Hua Luo
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
- Laboratory of Neurological Diseases and Brain Function, Luzhou, 646000, China
| | - Xiu Chen
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
- Laboratory of Neurological Diseases and Brain Function, Luzhou, 646000, China
| | - Jianghai Ruan
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China.
- Laboratory of Neurological Diseases and Brain Function, Luzhou, 646000, China.
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Zhang H, Yang X, Yao L, Liu Q, Lu Y, Chen X, Wang T. EEG microstates analysis after TMS in patients with subacute stroke during the resting state. Cereb Cortex 2024; 34:bhad480. [PMID: 38112223 PMCID: PMC10793572 DOI: 10.1093/cercor/bhad480] [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: 09/01/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 12/21/2023] Open
Abstract
To investigate whether intermittent theta burst stimulation over the cerebellum induces changes in resting-state electroencephalography microstates in patients with subacute stroke and its correlation with cognitive and emotional function. Twenty-four stroke patients and 17 healthy controls were included in this study. Patients and healthy controls were assessed at baseline, including resting-state electroencephalography and neuropsychological scales. Fifteen patients received lateral cerebellar intermittent theta burst stimulation as well as routine rehabilitation training (intermittent theta burst stimulation-RRT group), whereas 9 patients received only conventional rehabilitation training (routine rehabilitation training group). After 2 wk, baseline data were recorded again in both groups. Stroke patients exhibited reduced parameters in microstate D and increased parameters in microstate C compared with healthy controls. However, after the administration of intermittent theta burst stimulation over the lateral cerebellum, significant alterations were observed in the majority of metrics for both microstates D and C. Lateral cerebellar intermittent theta burst stimulation combined with conventional rehabilitation has a stronger tendency to improve emotional and cognitive function in patients with subacute stroke than conventional rehabilitation. The improvement of mood and cognitive function was significantly associated with microstates C and D. We identified electroencephalography microstate spatiotemporal dynamics associated with clinical improvement following a course of intermittent theta burst stimulation therapy.
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Affiliation(s)
- Hongmei Zhang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan, China
| | - Xue Yang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan, China
| | - Liqing Yao
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan, China
| | - Qian Liu
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan, China
| | - Yihuan Lu
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan, China
| | - Xueting Chen
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan, China
| | - Tianling Wang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan, China
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Gaßmann L, Gordon PC, Ziemann U. Reflecting the causes of variability of EEG responses elicited by cerebellar TMS. Neuroimage 2023; 281:120368. [PMID: 37696424 DOI: 10.1016/j.neuroimage.2023.120368] [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: 06/30/2023] [Accepted: 09/07/2023] [Indexed: 09/13/2023] Open
Abstract
Recently, Fong et al. published EEG responses in cerebral cortex elicited by cerebellar TMS (cbTMS) (Fong et al., 2023), which differ from our recently identified cbTMS-EEG responses (Gassmann et al., 2022). Fong et al. argued that this discrepancy is due to coil placement unsuitable for eliciting cerebellar brain inhibition (CBI) in our study. However, we reliably elicited CBI in our subjects. Consequently, this leads to a compelling discussion on possible reasons for the observed discrepancies in cbTMS-evoked EEG responses. Reliably measuring cbTMS-evoked EEG responses could become an important neurophysiological tool to test effective cerebellum-to-cortex connectivity.
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Affiliation(s)
- Lukas Gaßmann
- Department of Neurology & Stroke, University of Tübingen, Germany; Hertie Institute for Clinical Brain Research, University of Tübingen, Germany
| | - Pedro Caldana Gordon
- Department of Neurology & Stroke, University of Tübingen, Germany; Hertie Institute for Clinical Brain Research, University of Tübingen, Germany
| | - Ulf Ziemann
- Department of Neurology & Stroke, University of Tübingen, Germany; Hertie Institute for Clinical Brain Research, University of Tübingen, Germany.
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Fong PY, Spampinato D, Michell K, Mancuso M, Brown K, Ibáñez J, Di Santo A, Latorre A, Bhatia K, Rothwell JC, Rocchi L. Reply to: "Reflecting the causes of variability of EEG responses elicited by cerebellar TMS". Neuroimage 2023; 281:120392. [PMID: 37769927 DOI: 10.1016/j.neuroimage.2023.120392] [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: 09/12/2023] [Accepted: 09/25/2023] [Indexed: 10/01/2023] Open
Abstract
In their commentary on our recently published paper about electroencephalographic responses induced by cerebellar transcranial magnetic stimulation (Fong et al., 2023), Gassmann and colleagues (Gassmann et al., 2023b) try to explain the differences between our results and their own previous work on the same topic. We agree with them that many of the differences arise from our use of a different magnetic stimulation coil. However, two unresolved questions remain. (1) Which method is most likely to achieve optimal activation of cerebellar output? (2) To what extent are the evoked cerebellar responses contaminated by concomitant sensory input? We highlight the role of careful experimental design and of combining electrophysiological and behavioural data to obtain reliable TMS-EEG data.
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Affiliation(s)
- Po-Yu Fong
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK; Division of Movement Disorders, Department of Neurology and Neuroscience Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Medical School, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Danny Spampinato
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK; Non-Invasive Brain Stimulation Unit, IRCCS Santa Lucia Foundation, Via Ardeatina 306/354, Rome 00142, Italy
| | - Kevin Michell
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Marco Mancuso
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Katlyn Brown
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Jaime Ibáñez
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK; BSICoS Group, I3A Institute, University of Zaragoza, IIS Aragón, Zaragoza, Spain; Department of Bioengineering, Imperial College, London, UK
| | - Alessandro Di Santo
- NEuroMuscular Omnicentre (NEMO), Serena Onlus, AOS Monaldi, Naples, Italy; Unit of Neurology, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
| | - Anna Latorre
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Kailash Bhatia
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - John C Rothwell
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Lorenzo Rocchi
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK; Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Dale M, Mancini M, Stevens A, Brumbach B, Prewitt A, Harker G, Silva-Batista C, Ragothaman A, Folmer R, Quinn J, Horak F. C-STIM: Protocol for a randomized, single-blind, crossover study of cerebellar repetitive transcranial magnetic stimulation (rTMS) for postural instability in people with progressive supranuclear palsy (PSP). Contemp Clin Trials Commun 2023; 35:101165. [PMID: 37538197 PMCID: PMC10393598 DOI: 10.1016/j.conctc.2023.101165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/12/2023] [Accepted: 06/18/2023] [Indexed: 08/05/2023] Open
Abstract
Background Methods for modulating the cerebellum with transcranial magnetic stimulation (TMS) are well established, and preliminary data from our group and others has shown evidence of transient improvements in balance after cerebellar repetitive transcranial magnetic stimulation (rTMS) in progressive suprancuclear palsy (PSP). This study examines extensive posturography measures before and after 10 sessions of cerebellar rTMS and sham TMS in PSP. Methods Thirty subjects with PSP and postural instability will undergo cerebellar active and sham rTMS in a single-blind, crossover design with a randomized order of a 10-day intervention. Primary outcomes will be changes in sway area and medio-lateral range of sway with eyes open while standing on a stationary force-plate, and safety, tolerability, and blindedness. Secondary outcomes will include posturography and gait analysis with body-worn, triaxial inertial sensors, clinical balance scales and questionnaires, and a bedside test of vestibular function. Exploratory outcomes are changes in functional near infrared spectroscopy (fNIRS) signal over the prefrontal, supplementary motor, and primary motor cortices while standing and walking, and speech samples for future analysis. Discussion The C-STIM crossover intervention study adds a longer duration of stimulation and extensive posturography measures to more finely measure the improvements in balance and exploratory functional near-infrared spectroscopy (fNIRS) over the prefronal, supplementary motor, and primary motor cortices during balance assessments before and after 10 sessions of cerebellar rTMS and 10 sessions of sham cerebellar TMS. This project will improve our understanding of the importance of the cerebellum for control of postural stability in PSP.
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Affiliation(s)
- M.L. Dale
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | - M. Mancini
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | - A. Stevens
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR, USA
| | - B.H. Brumbach
- OHSU-PSU School of Public Health, Biostatistics and Design Program, Oregon Health & Science University, Portland, OR, USA
| | - A. Prewitt
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | - G. Harker
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | - C. Silva-Batista
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | - A. Ragothaman
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | - R.L. Folmer
- National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Medical Center, Portland, OR, USA
- Department of Otolaryngology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | - J.F. Quinn
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | - F.B. Horak
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
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Spampinato DA, Casula EP, Koch G. The Cerebellum and the Motor Cortex: Multiple Networks Controlling Multiple Aspects of Behavior. Neuroscientist 2023:10738584231189435. [PMID: 37649430 DOI: 10.1177/10738584231189435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
The cerebellum and its thalamic projections to the primary motor cortex (M1) are well known to play an essential role in executing daily actions. Anatomic investigations in animals and postmortem humans have established the reciprocal connections between these regions; however, how these pathways can shape cortical activity in behavioral contexts and help promote recovery in neuropathological conditions remains not well understood. The present review aims to provide a comprehensive description of these pathways in animals and humans and discuss how novel noninvasive brain stimulation (NIBS) methods can be used to gain a deeper understanding of the cerebellar-M1 connections. In the first section, we focus on recent animal literature that details how information sent from the cerebellum and thalamus is integrated into an broad network of cortical motor neurons. We then discuss how NIBS approaches in humans can be used to reliably assess the connectivity between the cerebellum and M1. Moreover, we provide the latest perspectives on using advanced NIBS approaches to investigate and modulate multiple cerebellar-cortical networks involved in movement behavior and plasticity. Finally, we discuss how these emerging methods have been used in translation research to produce long-lasting modifications of cerebellar-thalamic-M1 to restore cortical activity and motor function in neurologic patients.
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Gassmann L, Gordon PC, Roy O, Kaut O, Hömberg V, Ziemann U. Cerebellar TMS-EEG in a chronic stroke patient with connectional diaschisis of the dentato-thalamo-cortical tract. Clin Neurophysiol 2023; 152:68-70. [PMID: 37329656 DOI: 10.1016/j.clinph.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/14/2023] [Accepted: 05/19/2023] [Indexed: 06/19/2023]
Affiliation(s)
- Lukas Gassmann
- Department of Neurology & Stroke, University of Tübingen, Germany; Hertie Institute for Clinical Brain Research, University of Tübingen, Germany
| | - Pedro Caldana Gordon
- Department of Neurology & Stroke, University of Tübingen, Germany; Hertie Institute for Clinical Brain Research, University of Tübingen, Germany
| | - Olivier Roy
- Department of Neurology & Stroke, University of Tübingen, Germany; Hertie Institute for Clinical Brain Research, University of Tübingen, Germany; CERVO Brain Research Centre, Quebec, Canada; Department of Psychiatry and Neurosciences, Université Laval, Quebec, Canada
| | - Oliver Kaut
- SRH Gesundheitszentrum Bad Wimpfen GmbH, Bei der alten Saline 2, 74206 Bad Wimpfen, Germany
| | - Volker Hömberg
- SRH Gesundheitszentrum Bad Wimpfen GmbH, Bei der alten Saline 2, 74206 Bad Wimpfen, Germany
| | - Ulf Ziemann
- Department of Neurology & Stroke, University of Tübingen, Germany; Hertie Institute for Clinical Brain Research, University of Tübingen, Germany.
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Fong PY, Spampinato D, Michell K, Mancuso M, Brown K, Ibáñez J, Santo AD, Latorre A, Bhatia K, Rothwell JC, Rocchi L. EEG responses induced by cerebellar TMS at rest and during visuomotor adaptation. Neuroimage 2023; 275:120188. [PMID: 37230209 DOI: 10.1016/j.neuroimage.2023.120188] [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: 01/10/2023] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Connections between the cerebellum and the cortex play a critical role in learning and executing complex behaviours. Dual-coil transcranial magnetic stimulation (TMS) can be used non-invasively to probe connectivity changes between the lateral cerebellum and motor cortex (M1) using the motor evoked potential as an outcome measure (cerebellar-brain inhibition, CBI). However, it gives no information about cerebellar connections to other parts of cortex. OBJECTIVES We used electroencephalography (EEG) to investigate whether it was possible to detect activity evoked in any areas of cortex by single-pulse TMS of the cerebellum (cerebellar TMS evoked potentials, cbTEPs). A second experiment tested if these responses were influenced by the performance of a cerebellar-dependent motor learning paradigm. METHODS In the first series of experiments, TMS was applied over either the right or left cerebellar cortex, and scalp EEG was recorded simultaneously. Control conditions that mimicked auditory and somatosensory inputs associated with cerebellar TMS were included to identify responses due to non-cerebellar sensory stimulation. We conducted a follow-up experiment that evaluated whether cbTEPs are behaviourally sensitive by assessing individuals before and after learning a visuomotor reach adaptation task. RESULTS A TMS pulse over the lateral cerebellum evoked EEG responses that could be distinguished from those caused by auditory and sensory artefacts. Significant positive (P80) and negative peaks (N110) over the contralateral frontal cerebral area were identified with a mirrored scalp distribution after left vs. right cerebellar stimulation. The P80 and N110 peaks were replicated in the cerebellar motor learning experiment and changed amplitude at different stages of learning. The change in amplitude of the P80 peak was associated with the degree of learning that individuals retained following adaptation. Due to overlap with sensory responses, the N110 should be interpreted with caution. CONCLUSIONS Cerebral potentials evoked by TMS of the lateral cerebellum provide a neurophysiological probe of cerebellar function that complements the existing CBI method. They may provide novel insight into mechanisms of visuomotor adaptation and other cognitive processes.
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Affiliation(s)
- Po-Yu Fong
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK; Division of Movement Disorders, Department of Neurology and Neuroscience Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan; Medical School, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Danny Spampinato
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK; Non-invasive Brain Stimulation Unit, IRCCS Santa Lucia Foundation, Via Ardeatina 306/354, 00142, Rome, Italy
| | - Kevin Michell
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Marco Mancuso
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Katlyn Brown
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Jaime Ibáñez
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK; BSICoS group, I3A Institute, University of Zaragoza, IIS Aragón, Zaragoza, Spain; Department of Bioengineering, Imperial College, London, UK
| | - Alessandro Di Santo
- NEuroMuscular Omnicentre (NEMO), Serena Onlus, AOS Monaldi, Naples, Italy; Unit of Neurology, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
| | - Anna Latorre
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Kailash Bhatia
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - John C Rothwell
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Lorenzo Rocchi
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK; Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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