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Lai MH, Yu XM, Lu Y, Wang HL, Fu W, Zhou HX, Li YL, Hu J, Xia J, Hu Z, Shan CL, Wang F, Wang C. Effectiveness and brain mechanism of multi-target transcranial alternating current stimulation (tACS) on motor learning in stroke patients: study protocol for a randomized controlled trial. Trials 2024; 25:97. [PMID: 38291500 PMCID: PMC10826150 DOI: 10.1186/s13063-024-07913-4] [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: 10/20/2023] [Accepted: 01/05/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Transcranial alternating current stimulation (tACS) has proven to be an effective treatment for improving cognition, a crucial factor in motor learning. However, current studies are predominantly focused on the motor cortex, and the potential brain mechanisms responsible for the therapeutic effects are still unclear. Given the interconnected nature of motor learning within the brain network, we have proposed a novel approach known as multi-target tACS. This study aims to ascertain whether multi-target tACS is more effective than single-target stimulation in stroke patients and to further explore the potential underlying brain mechanisms by using techniques such as transcranial magnetic stimulation (TMS) and magnetic resonance imaging (MRI). METHODS This study employs a double-blind, sham-controlled, randomized controlled trial design with a 2-week intervention period. Both participants and outcome assessors will remain unaware of treatment allocation throughout the study. Thirty-nine stroke patients will be recruited and randomized into three distinct groups, including the sham tACS group (SS group), the single-target tACS group (ST group), and the multi-target tACS group (MT group), at a 1:1:1 ratio. The primary outcomes are series reaction time tests (SRTTs) combined with electroencephalograms (EEGs). The secondary outcomes include motor evoked potential (MEP), central motor conduction time (CMCT), short interval intracortical inhibition (SICI), intracortical facilitation (ICF), magnetic resonance imaging (MRI), Box and Block Test (BBT), and blood sample RNA sequencing. The tACS interventions for all three groups will be administered over a 2-week period, with outcome assessments conducted at baseline (T0) and 1 day (T1), 7 days (T2), and 14 days (T3) of the intervention phase. DISCUSSION The study's findings will determine the potential of 40-Hz tACS to improve motor learning in stroke patients. Additionally, it will compare the effectiveness of multi-target and single-target approaches, shedding light on their respective improvement effects. Through the utilization of techniques such as TMS and MRI, the study aims to uncover the underlying brain mechanisms responsible for the therapeutic impact. Furthermore, the intervention has the potential to facilitate motor learning efficiency, thereby contributing to the advancement of future stroke rehabilitation treatment. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2300073465. Registered on 11 July 2023.
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Affiliation(s)
- Ming-Hui Lai
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Datong Rd. 358, Shanghai, 200137, China
| | - Xiao-Ming Yu
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Datong Rd. 358, Shanghai, 200137, China
| | - Yan Lu
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Datong Rd. 358, Shanghai, 200137, China
| | - Hong-Lin Wang
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Datong Rd. 358, Shanghai, 200137, China
| | - Wang Fu
- Department of Neurology, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, 200137, China
| | - Huan-Xia Zhou
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Datong Rd. 358, Shanghai, 200137, China
| | - Yuan-Li Li
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Datong Rd. 358, Shanghai, 200137, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, 201203, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Jun Hu
- The Second Rehabilitation Hospital of Shanghai, Shanghai, 200435, China
| | - Jiayi Xia
- The Second Rehabilitation Hospital of Shanghai, Shanghai, 200435, China
| | - Zekai Hu
- The Second Rehabilitation Hospital of Shanghai, Shanghai, 200435, China
| | - Chun-Lei Shan
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Datong Rd. 358, Shanghai, 200137, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, 201203, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Feng Wang
- Department of Neurology, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, 200137, China
| | - Cong Wang
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Datong Rd. 358, Shanghai, 200137, China.
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, 201203, China.
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
- The Second Rehabilitation Hospital of Shanghai, Shanghai, 200435, China.
- Queensland Brain Institute, the University of Queensland, Brisbane, 4072, Australia.
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Brihmat N, Allexandre D, Bayram MB, Saleh S, Guan X, Yue GH, Zhong J, Forrest GF. Safety and effects of a therapeutic 15 Hz rTMS protocol administered at different suprathreshold intensities in able-bodied individuals. J Neurophysiol 2023; 129:56-65. [PMID: 36475885 DOI: 10.1152/jn.00268.2022] [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: 12/13/2022] Open
Abstract
High-frequency repetitive transcranial magnetic stimulation (HF-rTMS) remains a promising strategy for neurorehabilitation. The stimulation intensity (SI) influences the aftereffects observed. Here, we examined whether single sessions of a 15 Hz rTMS protocol, administered at suprathreshold SI, can be safely administered to able-bodied (AB) individuals. Six right-handed men were included in this pilot study. HF-rTMS was delivered over the right M1, in 10 trains of 75 biphasic stimuli at 15 Hz, at 105-120% of the individual resting motor threshold (RMT). To assess safety, electromyography (EMG) was monitored to control for signs of spread of excitation and brief EMG burst (BEB) after stimulation. Additionally, TMS side effects questionnaires and the numeric rating scale (NRS) were administered during each session. We assessed corticospinal excitability (CSE) and motor performance changes with measures of resting (rMEP) and active (aMEP) motor evoked potential and grip strength and box and blocks test (BBT) scores, respectively. Overall, the sessions were tolerated and feasible without any pain development. However, EMG analysis during 15 Hz rTMS administration revealed increased BEB frequency with SI. Statistical models revealed an increase of CSE at rest (rMEP) but not during active muscle contraction (aMEP). No linear relationship was observed between 15 Hz rTMS SI and rMEP increase. No significant changes were highlighted for motor performance measures. Although feasible and tolerable by the AB individuals tested, the results demonstrate that when administered at suprathreshold intensities (≥ 105% RMT) the 15 Hz rTMS protocol reveals signs of persistent excitation, suggesting that safety precautions and close monitoring of participants should be performed when testing such combinations of high-intensity and high-frequency stimulation protocols. The results also give insight into the nonlinear existent relationship between the SI and HF-rTMS effects on CSE.NEW & NOTEWORTHY The results of this pilot study show the effects of a therapeutically promising 15 Hz repetitive transcranial magnetic stimulation (rTMS) protocol, administered at different suprathreshold intensities in able-bodied individuals. Although tolerable and feasible with a neuromodulatory potential, 15 Hz rTMS might result in persistent excitability that needs to be closely monitored if administered at suprathreshold stimulation intensity. These results reaffirm the importance of feasibility studies, especially in translational animal-to-human research.
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Affiliation(s)
- Nabila Brihmat
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, New Jersey.,Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, New Jersey
| | - Didier Allexandre
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, New Jersey.,Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, New Jersey
| | - Mehmed B Bayram
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, New Jersey
| | - Soha Saleh
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, New Jersey.,Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, New Jersey
| | - Xiaofei Guan
- Burke Neurological Institute and Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, White Plains, New York
| | - Guang H Yue
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, New Jersey.,Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, New Jersey
| | - Jian Zhong
- Burke Neurological Institute and Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, White Plains, New York
| | - Gail F Forrest
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, New Jersey.,Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, New Jersey.,Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, New Jersey
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Zhang W, Deng B, Xie F, Zhou H, Guo JF, Jiang H, Sim A, Tang B, Wang Q. Efficacy of repetitive transcranial magnetic stimulation in Parkinson's disease: A systematic review and meta-analysis of randomised controlled trials. EClinicalMedicine 2022; 52:101589. [PMID: 35923424 PMCID: PMC9340539 DOI: 10.1016/j.eclinm.2022.101589] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/09/2022] [Accepted: 07/12/2022] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive form of brain stimulation that positively regulates the motor and non-motor symptoms of Parkinson's disease (PD). Although, most reviews and meta-analysis have shown that rTMS intervention is effective in treating motor symptoms and depression, very few have used randomised controlled trials (RCTs) to analyse the efficacy of this intervention in PD. We aimed to review RCTs of rTMS in patients with PD to assess the efficacy of rTMS on motor and non-motor function in patients with PD. METHODS In this systematic review and meta-analysis, we searched PubMed, MEDLINE and Web of Science databases for RCTs on rTMS in PD published between January 1, 1988 to January 1, 2022. Eligible studies included sham-controlled RCTs that used rTMS stimulation for motor or non-motor symptoms in PD. RCTs not focusing on the efficacy of rTMS in PD were excluded. Summary data were extracting from those RCTs by two investigators independently. We then calculated standardised mean difference with random-effect models. The main outcome included motor and non-motor examination of scales that were used in PD motor or non-motor assessment. This study was registered with PROSPERO, CRD42022329633. FINDINGS Fourteen studies with 469 patients met the criteria for our meta-analysis. Twelve eligible studies with 381 patients were pooled to analyse the efficacy of rTMS on motor function improvement. The effect size on motor scale scores was 0.51 (P < 0.0001) and were not distinctly heterogeneous (I2 = 29%). Five eligible studies with 202 patients were collected to evaluate antidepressant-like effects. The effect size on depression scale scores was 0.42 (P = 0.004), and were not distinctly heterogeneous (I2 = 25%), indicating a significant anti-depressive effect (P = 0.004). The results suggest that high-frequency of rTMS on primary motor cortex (M1) is effective in improving motor symptoms; while the dorsolateral prefrontal cortex (DLPFC) may be a potentially effective area in alleviating depressive symptom. INTERPRETATION The findings suggest that rTMS could be used as a possible adjuvant therapy for PD mainly to improve motor symptoms, but could have potential efficacy on depressive symptoms of PD. However, further investigation is needed. FUNDING The National Natural Science Foundation of China (NO: 81873777, 82071414), Initiated Foundation of Zhujiang Hospital (NO: 02020318005), Scientific Research Foundation of Guangzhou (NO: 202206010005), and Science and Technology Program of Guangdong of China (NO: 2020A0505100037).
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Affiliation(s)
- Wenjie Zhang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong 510282, PR China
| | - Bin Deng
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong 510282, PR China
| | - Fen Xie
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong 510282, PR China
| | - Hang Zhou
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong 510282, PR China
| | - Ji-Feng Guo
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, PR China
| | - Hong Jiang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, PR China
| | - Amy Sim
- Department of Neurology, Texas Tech University Health Sciences Centre El Paso, El Paso, TX 79905, USA
| | - Beisha Tang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, PR China
| | - Qing Wang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong 510282, PR China
- Corresponding author at: Department of Neurology, Zhujiang Hospital, Southern Medical University, Gongye Road 253, Guangzhou, Guangdong Province 510282, PR China.
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Veldema J, Gharabaghi A. Non-invasive brain stimulation for improving gait, balance, and lower limbs motor function in stroke. J Neuroeng Rehabil 2022; 19:84. [PMID: 35922846 PMCID: PMC9351139 DOI: 10.1186/s12984-022-01062-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/21/2022] [Indexed: 11/27/2022] Open
Abstract
Objectives This systematic review and meta-analysis aim to summarize and analyze the available evidence of non-invasive brain stimulation/spinal cord stimulation on gait, balance and/or lower limb motor recovery in stroke patients. Methods The PubMed database was searched from its inception through to 31/03/2021 for randomized controlled trials investigating repetitive transcranial magnetic stimulation or transcranial/trans-spinal direct current/alternating current stimulation for improving gait, balance and/or lower limb motor function in stroke patients. Results Overall, 25 appropriate studies (including 657 stroke subjects) were found. The data indicates that non-invasive brain stimulation/spinal cord stimulation is effective in supporting recovery. However, the effects are inhomogeneous across studies: (1) transcranial/trans-spinal direct current/alternating current stimulation induce greater effects than repetitive transcranial magnetic stimulation, and (2) bilateral application of non-invasive brain stimulation is superior to unilateral stimulation. Conclusions The current evidence encourages further research and suggests that more individualized approaches are necessary for increasing effect sizes in stroke patients.
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Affiliation(s)
- Jitka Veldema
- Department of Sport Science, Bielefeld University, 33 501, Bielefeld, Germany. .,Institute for Neuromodulation and Neurotechnology, University Hospital and University of Tübingen, Tübingen, Germany.
| | - Alireza Gharabaghi
- Institute for Neuromodulation and Neurotechnology, University Hospital and University of Tübingen, Tübingen, Germany
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Du Y, Wei L, Lu Y, Gao H. The effects of different frequencies of repetitive transcranial magnetic stimulation (rTMS) on patients with swallowing disorders after cerebral infarction. NeuroRehabilitation 2021; 50:115-122. [PMID: 34776422 DOI: 10.3233/nre-210176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Swallowing disorders represent one of the most common complications after cerebral infarction. OBJECTIVE To study the effects of different frequencies of repetitive transcranial magnetic stimulation (rTMS) on swallowing disorders after cerebral infarction. METHODS Ninety patients with swallowing disorder after cerebral infarction were enrolled and randomly assigned to three groups: the 10 Hz frequency rTMS group (30 patients), the 5 Hz frequency rTMS group (30 patients), and the 1 Hz frequency rTMS group (30 patients); another 90 healthy persons without swallowing disorders were included as the control group. The Kubota's water-swallow test, the video fluoroscopic swallow study (VFSS), and the Electroencephalograph (EEG) were analyzed before and after treatment; the EEG of the control group was detected as the baseline. RESULTS The Kubota's water-swallow test scores were significantly decreased while the scores of pharynx period and the aspiration degree of VFSS significantly increased in 10 Hz frequency rTMS group than before treatment (P≤0.05); the amplitudes of C3 of the EEG significantly increased in three frequency groups than before treatment (P≤0.05). CONCLUSIONS 10 Hz frequency of rTMS is effective for the treatment of swallowing disorder after cerebral infarction, the excitement of C3 area maybe the therapeutic target of rTMS on swallowing disorder after cerebral infarction.
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Affiliation(s)
- Yupeng Du
- Department of Rehabilitation, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Li Wei
- State Key Laboratory of Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Ying Lu
- Department of Rehabilitation, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Hong Gao
- Department of Rehabilitation, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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Jiang Y, Guo Z, McClure MA, He L, Mu Q. Effect of rTMS on Parkinson's cognitive function: a systematic review and meta-analysis. BMC Neurol 2020; 20:377. [PMID: 33076870 PMCID: PMC7574251 DOI: 10.1186/s12883-020-01953-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 10/05/2020] [Indexed: 12/13/2022] Open
Abstract
Background To evaluate the effects and optimal parameters of repetitive transcranial magnetic stimulation (rTMS) on cognition function of patients with Parkinson’s disease (PD) and to estimate which cognitive function may obtain more benefits from rTMS. Method The articles dealing with rTMS on cognitive function of PD patients were retrieved from the databases until April 2019. Outcomes of global cognitive function and different cognitive domains were extracted. The standardized mean differences (SMDs) with 95% confidence interval (CI) of cognitive outcome for different parameters, scales, and cognitive functions were estimated. Results Fourteen studies involving 173 subjects were included in this meta-analysis. A significant effect size was observed with the mini-mental state examination (MMSE) for the global cognitive outcome based on the evidence of four published articles. Further subtests for different cognitive domains demonstrated prominent effect for the executive function. The significant effect sizes for executive function were found with multiple sessions of high-frequency rTMS over frontal cortex; especially over dorsolateral prefrontal cortex (DLPFC). All of the other cognitive domains, which included memory, attention, and language ability, did not obtain significant effects. Conclusions Multiple sessions of high-frequency rTMS over the DLPFC may have positive effect on executive function in PD patients. Further well designed studies with large sample sizes are needed to verify our results and ascertain the long-term effects of rTMS.
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Affiliation(s)
- Yi Jiang
- Department of Radiology and Institute of Rehabilitation and Imaging of Brain Function, The Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, NO. 97 South Renmin Road, Shunqing District, Nanchong, 637000, Sichuan, China
| | - Zhiwei Guo
- Department of Radiology and Institute of Rehabilitation and Imaging of Brain Function, The Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, NO. 97 South Renmin Road, Shunqing District, Nanchong, 637000, Sichuan, China
| | - Morgan A McClure
- Department of Radiology and Institute of Rehabilitation and Imaging of Brain Function, The Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, NO. 97 South Renmin Road, Shunqing District, Nanchong, 637000, Sichuan, China
| | - Lin He
- Department of Radiology and Institute of Rehabilitation and Imaging of Brain Function, The Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, NO. 97 South Renmin Road, Shunqing District, Nanchong, 637000, Sichuan, China
| | - Qiwen Mu
- Department of Radiology and Institute of Rehabilitation and Imaging of Brain Function, The Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, NO. 97 South Renmin Road, Shunqing District, Nanchong, 637000, Sichuan, China. .,Department of Radiology, Peking University Third Hospital, Beijing, China.
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Madrid J, Benninger DH. Non-invasive brain stimulation for Parkinson's disease: Clinical evidence, latest concepts and future goals: A systematic review. J Neurosci Methods 2020; 347:108957. [PMID: 33017643 DOI: 10.1016/j.jneumeth.2020.108957] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 08/27/2020] [Accepted: 09/18/2020] [Indexed: 12/16/2022]
Abstract
Parkinson's disease (PD) is becoming a major public-health issue in an aging population. Available approaches to treat advanced PD still have limitations; new therapies are needed. The non-invasive brain stimulation (NIBS) may offer a complementary approach to treat advanced PD by personalized stimulation. Although NIBS is not as effective as the gold-standard levodopa, recent randomized controlled trials show promising outcomes in the treatment of PD symptoms. Nevertheless, only a few NIBS-stimulation paradigms have shown to improve PD's symptoms. Current clinical recommendations based on the level of evidence are reported in Table 1 through Table 3. Furthermore, novel technological advances hold promise and may soon enable the non-invasive stimulation of deeper brain structures for longer periods.
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Affiliation(s)
- Julian Madrid
- Service of Neurology, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
| | - David H Benninger
- Service of Neurology, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
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Wang J, Meng HJ, Ji GJ, Jing Y, Wang HX, Deng XP, Feng ZJ, Zhao N, Zang YF, Zhang J. Finger Tapping Task Activation vs. TMS Hotspot: Different Locations and Networks. Brain Topogr 2019; 33:123-134. [PMID: 31691912 PMCID: PMC6943404 DOI: 10.1007/s10548-019-00741-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 10/22/2019] [Indexed: 12/15/2022]
Abstract
Both functional magnetic resonance imaging (fMRI) and transcranial magnetic stimulation (TMS) have been used to non-invasively localize the human motor functional area. These locations can be clinically used as stimulation target of TMS treatment. However, it has been reported that the finger tapping fMRI activation and TMS hotspot were not well-overlapped. The aim of the current study was to measure the distance between the finger tapping fMRI activation and the TMS hotspot, and more importantly, to compare the network difference by using resting-state fMRI. Thirty healthy participants underwent resting-state fMRI, task fMRI, and then TMS hotspot localization. We found significant difference of locations between finger tapping fMRI activation and TMS hotspot. Specifically, the finger tapping fMRI activation was more lateral than the TMS hotspot in the premotor area. The fMRI activation peak and TMS hotspot were taken as seeds for resting-state functional connectivity analyses. Compared with TMS hotspot, finger tapping fMRI activation peak showed more intensive functional connectivity with, e.g., the bilateral premotor, insula, putamen, and right globus pallidus. The findings more intensive networks of finger tapping activation than TMS hotspot suggest that TMS treatment targeting on the fMRI activation area might result in more remote effects and would be more helpful for TMS treatment on movement disorders.
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Affiliation(s)
- Jue Wang
- School of Psychology, Shanghai University of Sport, Shanghai, 200438, China
| | - Hai-Jiang Meng
- School of Psychology, Shanghai University of Sport, Shanghai, 200438, China
| | - Gong-Jun Ji
- Department of Medical Psychology, Chaohu Clinical Medical College, Anhui Medical University, Hefei, 230032, China.,Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental Health, Hefei, 230032, Anhui, China
| | - Ying Jing
- Institutes of Psychological Sciences, Hangzhou Normal University, Hangzhou, 311121, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, 311121, China.,Center for Cognition and Brain Disorders and the Affiliated Hospital, Hangzhou Normal University, Hangzhou, 310015, China
| | - Hong-Xiao Wang
- Institutes of Psychological Sciences, Hangzhou Normal University, Hangzhou, 311121, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, 311121, China.,Center for Cognition and Brain Disorders and the Affiliated Hospital, Hangzhou Normal University, Hangzhou, 310015, China
| | - Xin-Ping Deng
- Institutes of Psychological Sciences, Hangzhou Normal University, Hangzhou, 311121, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, 311121, China.,Center for Cognition and Brain Disorders and the Affiliated Hospital, Hangzhou Normal University, Hangzhou, 310015, China
| | - Zi-Jian Feng
- Institutes of Psychological Sciences, Hangzhou Normal University, Hangzhou, 311121, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, 311121, China.,Center for Cognition and Brain Disorders and the Affiliated Hospital, Hangzhou Normal University, Hangzhou, 310015, China
| | - Na Zhao
- Institutes of Psychological Sciences, Hangzhou Normal University, Hangzhou, 311121, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, 311121, China.,Center for Cognition and Brain Disorders and the Affiliated Hospital, Hangzhou Normal University, Hangzhou, 310015, China
| | - Yu-Feng Zang
- Institutes of Psychological Sciences, Hangzhou Normal University, Hangzhou, 311121, China. .,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, 311121, China. .,Center for Cognition and Brain Disorders and the Affiliated Hospital, Hangzhou Normal University, Hangzhou, 310015, China.
| | - Jian Zhang
- School of Psychology, Shanghai University of Sport, Shanghai, 200438, China.
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Latorre A, Rocchi L, Berardelli A, Bhatia KP, Rothwell JC. The use of transcranial magnetic stimulation as a treatment for movement disorders: A critical review. Mov Disord 2019; 34:769-782. [PMID: 31034682 DOI: 10.1002/mds.27705] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 04/04/2019] [Accepted: 04/07/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Transcranial magnetic stimulation is a safe and painless non-invasive brain stimulation technique that has been largely used in the past 30 years to explore cortical function in healthy participants and, inter alia, the pathophysiology of movement disorders. During the years, its use has evolved from primarily research purposes to treatment of a large variety of neurological and psychiatric diseases. In this article, we illustrate the basic principles on which the therapeutic use of transcranial magnetic stimulation is based and review the clinical trials that have been performed in patients with movement disorders. METHODS A search of the PubMed database for research and review articles was performed on therapeutic applications of transcranial magnetic stimulation in movement disorders. The search included the following conditions: Parkinson's disease, dystonia, Tourette syndrome and other chronic tic disorders, Huntington's disease and choreas, and essential tremor. The results of the studies and possible mechanistic explanations for the relatively minor effects of transcranial magnetic stimulation are discussed. Possible ways to improve the methodology and achieve greater therapeutic efficacy are discussed. CONCLUSION Despite the promising and robust rationales for the use of transcranial magnetic stimulations as a treatment tool in movement disorders, the results taken as a whole are not as successful as were initially expected. There is encouraging evidence that transcranial magnetic stimulation may improve motor symptoms and depression in Parkinson's disease, but the efficacy in other movement disorders is unclear. Possible improvements in methodology are on the horizon but have yet to be implemented in large clinical studies. © 2019 International Parkinson and Movement Disorder Society © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Anna Latorre
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology University College London, London, UK
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Lorenzo Rocchi
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology University College London, London, UK
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed Institute, Pozzilli, Isernia, Italy
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology University College London, London, UK
| | - John C Rothwell
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology University College London, London, UK
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Lawrence BJ, Gasson N, Bucks RS, Troeung L, Loftus AM. Cognitive Training and Noninvasive Brain Stimulation for Cognition in Parkinson's Disease: A Meta-analysis. Neurorehabil Neural Repair 2017; 31:597-608. [PMID: 28583011 DOI: 10.1177/1545968317712468] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Many people with Parkinson's disease (PD) experience cognitive decline. It is not known whether cognitive training or noninvasive brain stimulation are effective at alleviating cognitive deficits in PD. OBJECTIVE To examine cognitive training and non-invasive brain stimulation interventions for cognition in PD. METHODS An extensive search was conducted of published and unpublished studies in online databases. Studies were selected if they were controlled trials examining standard (not individualized) or tailored (individualized) cognitive training, repetitive transcranial magnetic stimulation (rTMS), or transcranial direct current stimulation (tDCS) in PD, with outcomes measured by standardized neuropsychological tests. RESULTS Fourteen controlled trials met inclusion criteria. For executive function, the pooled effect size (Hedges' g) for cognitive training (standard and tailored combined) was small ( g = 0.42) but statistically significant (95% CI 0.15-0.68). The pooled effect for standard cognitive training (alone) was medium ( g = 0.51) and significant (95% CI 0.16-0.85). For attention/working memory, small pooled effect sizes were found when combining standard and tailored cognitive training ( g = 0.23; 95% CI 0.02-0.44) and for standard cognitive training alone ( g = 0.29; 95% CI 0.04-0.53), both significant. For memory, small but significant pooled effect sizes were also found when combining standard and tailored cognitive training and for standard cognitive training alone. CONCLUSIONS The results suggest that standard and tailored cognitive training may improve executive function, attention/working memory, and memory in PD. Future studies must adopt randomized controlled trial designs to explore the therapeutic potential of these interventions.
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Affiliation(s)
| | - Natalie Gasson
- 1 Curtin University, Bentley, Western Australia, Australia
| | - Romola S Bucks
- 2 The University of Western Australia, Perth, Western Australia, Australia
| | - Lakkhina Troeung
- 2 The University of Western Australia, Perth, Western Australia, Australia.,3 The University of Notre Dame Australia, Fremantle, Western Australia, Australia
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11
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Schabrun SM, Lamont RM, Brauer SG. Transcranial Direct Current Stimulation to Enhance Dual-Task Gait Training in Parkinson's Disease: A Pilot RCT. PLoS One 2016; 11:e0158497. [PMID: 27359338 PMCID: PMC4928827 DOI: 10.1371/journal.pone.0158497] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 06/15/2016] [Indexed: 11/22/2022] Open
Abstract
Objective To investigate the feasibility and safety of a combined anodal transcranial direct current stimulation (tDCS) and dual task gait training intervention in people with Parkinson’s Disease (PD) and to provide data to support a sample size calculation for a fully powered trial should trends of effectiveness be present. Design A pilot, randomized, double-blind, sham-controlled parallel group trial with 12 week follow-up. Setting A university physiotherapy department. Interventions Sixteen participants diagnosed with PD received nine dual task gait training sessions over 3 weeks. Participants were randomized to receive either active or sham tDCS applied for the first 20 minutes of each session. Main Measures The primary outcome was gait speed while undertaking concurrent cognitive tasks (word lists, counting, conversation). Secondary measures included step length, cadence, Timed Up and Go, bradykinesia and motor speed. Results Gait speed, step length and cadence improved in both groups, under all dual task conditions. This effect was maintained at follow-up. There was no difference between the active and sham tDCS groups. Time taken to perform the TUGwords also improved, with no difference between groups. The active tDCS group did however increase their correct cognitive response rate during the TUGwords and TUGcount. Bradykinesia improved after training in both groups. Conclusion Three weeks of dual task gait training resulted in improved gait under dual task conditions, and bradykinesia, immediately following training and at 12 weeks follow-up. The only parameter enhanced by tDCS was the number of correct responses while performing the dual task TUG. tDCS applied to M1 may not be an effective adjunct to dual task gait training in PD. Trial Registration Australia-New Zealand Clinical Trials Registry ACTRN12613001093774
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Affiliation(s)
- Siobhan M. Schabrun
- Brain Rehabilitation and Neuroplasticity unit, School of Science and Health, Western Sydney University, Penrith, NSW, Australia
- * E-mail:
| | - Robyn M. Lamont
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane, Queensland, Australia
| | - Sandra G. Brauer
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane, Queensland, Australia
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12
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Bologna M, Suppa A, Conte A, Latorre A, Rothwell JC, Berardelli A. Are studies of motor cortex plasticity relevant in human patients with Parkinson’s disease? Clin Neurophysiol 2016; 127:50-59. [DOI: 10.1016/j.clinph.2015.02.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 02/08/2015] [Accepted: 02/11/2015] [Indexed: 10/23/2022]
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13
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Wagle Shukla A, Shuster JJ, Chung JW, Vaillancourt DE, Patten C, Ostrem J, Okun MS. Repetitive Transcranial Magnetic Stimulation (rTMS) Therapy in Parkinson Disease: A Meta-Analysis. PM R 2015; 8:356-366. [PMID: 26314233 DOI: 10.1016/j.pmrj.2015.08.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 08/11/2015] [Accepted: 08/13/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Several studies have reported repetitive transcranial magnetic stimulation (rTMS) therapy as an effective treatment for the control of motor symptoms in Parkinson disease. The objective of the study is to quantify the overall efficacy of this treatment. TYPES Systematic review and meta-analysis. LITERATURE SURVEY We reviewed the literature on clinical rTMS trials in Parkinson disease since the technique was introduced in 1980. We used the following databases: MEDLINE, Web of Science, Cochrane, and CINAHL. METHODOLOGY PATIENTS AND SETTING Patients with Parkinson disease who were participating in prospective clinical trials that included an active arm and a control arm and change in motor scores on Unified Parkinson's Disease Rating Scale as the primary outcome. We pooled data from 21 studies that met these criteria. We then analyzed separately the effects of low- and high-frequency rTMS on clinical motor improvements. SYNTHESIS The overall pooled mean difference between treatment and control groups in the Unified Parkinson's Disease Rating Scale motor score was significant (4.0 points, 95% confidence interval, 1.5, 6.7; P = .005). rTMS therapy was effective when low-frequency stimulation (≤ 1 Hz) was used with a pooled mean difference of 3.3 points (95% confidence interval 1.6, 5.0; P = .005). There was a trend for significance when high-frequency stimulation (≥ 5 Hz) studies were evaluated with a pooled mean difference of 3.9 points (95% confidence interval, -0.7, 8.5; P = .08). rTMS therapy demonstrated benefits at short-term follow-up (immediately after a treatment protocol) with a pooled mean difference of 3.4 points (95% confidence interval, 0.3, 6.6; P = .03) as well as at long-term follow-up (average follow-up 6 weeks) with mean difference of 4.1 points (95% confidence interval, -0.15, 8.4; P = .05). There were insufficient data to statistically analyze the effects of rTMS when we specifically examined bradykinesia, gait, and levodopa-induced dyskinesia using quantitative methods. CONCLUSION rTMS therapy in patients with Parkinson disease results in mild-to-moderate motor improvements and has the potential to be used as an adjunct therapy for the treatment of Parkinson disease. Future large, sample studies should be designed to isolate the specific clinical features of Parkinson disease that respond well to rTMS therapy.
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Affiliation(s)
- Aparna Wagle Shukla
- Department of Neurology and Center for Movement Disorders and Neurorestoration, University of Florida, 3450 Hull Road, Gainesville, FL 32607(∗).
| | - Jonathan J Shuster
- Department of Health Outcomes and Policy, Clinical and Translational Science Institute, University of Florida, Gainesville, FL(†)
| | - Jae Woo Chung
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL(‡)
| | - David E Vaillancourt
- Department of Neurology and Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL; Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL(§)
| | - Carolynn Patten
- Brain Rehabilitation Research Center of Excellence and Department of Physical Therapy, University of Florida, Gainesville, FL(‖)
| | - Jill Ostrem
- Department of Neurology and Surgical Movement Disorders, University of California, San Francisco, CA(¶)
| | - Michael S Okun
- Department of Neurology and Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL(#)
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14
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Benninger DH, Hallett M. Non-invasive brain stimulation for Parkinson’s disease: Current concepts and outlook 2015. NeuroRehabilitation 2015; 37:11-24. [DOI: 10.3233/nre-151237] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- David H. Benninger
- Service de Neurologie, Départment des Neurosciences Cliniques, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Mark Hallett
- Medical Neurology Branch, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA
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15
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Zheng CJ, Liao WJ, Xia WG. Effect of combined low-frequency repetitive transcranial magnetic stimulation and virtual reality training on upper limb function in subacute stroke: a double-blind randomized controlled trail. ACTA ACUST UNITED AC 2015; 35:248-254. [DOI: 10.1007/s11596-015-1419-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 03/13/2015] [Indexed: 02/01/2023]
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16
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Therapeutic applications of repetitive transcranial magnetic stimulation (rTMS) in movement disorders: A review. Parkinsonism Relat Disord 2014; 20:695-707. [DOI: 10.1016/j.parkreldis.2014.03.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 03/10/2014] [Accepted: 03/18/2014] [Indexed: 11/19/2022]
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17
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Lefaucheur JP, André-Obadia N, Antal A, Ayache SS, Baeken C, Benninger DH, Cantello RM, Cincotta M, de Carvalho M, De Ridder D, Devanne H, Di Lazzaro V, Filipović SR, Hummel FC, Jääskeläinen SK, Kimiskidis VK, Koch G, Langguth B, Nyffeler T, Oliviero A, Padberg F, Poulet E, Rossi S, Rossini PM, Rothwell JC, Schönfeldt-Lecuona C, Siebner HR, Slotema CW, Stagg CJ, Valls-Sole J, Ziemann U, Paulus W, Garcia-Larrea L. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS). Clin Neurophysiol 2014; 125:2150-2206. [PMID: 25034472 DOI: 10.1016/j.clinph.2014.05.021] [Citation(s) in RCA: 1255] [Impact Index Per Article: 125.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 05/09/2014] [Accepted: 05/13/2014] [Indexed: 12/11/2022]
Abstract
A group of European experts was commissioned to establish guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS) from evidence published up until March 2014, regarding pain, movement disorders, stroke, amyotrophic lateral sclerosis, multiple sclerosis, epilepsy, consciousness disorders, tinnitus, depression, anxiety disorders, obsessive-compulsive disorder, schizophrenia, craving/addiction, and conversion. Despite unavoidable inhomogeneities, there is a sufficient body of evidence to accept with level A (definite efficacy) the analgesic effect of high-frequency (HF) rTMS of the primary motor cortex (M1) contralateral to the pain and the antidepressant effect of HF-rTMS of the left dorsolateral prefrontal cortex (DLPFC). A Level B recommendation (probable efficacy) is proposed for the antidepressant effect of low-frequency (LF) rTMS of the right DLPFC, HF-rTMS of the left DLPFC for the negative symptoms of schizophrenia, and LF-rTMS of contralesional M1 in chronic motor stroke. The effects of rTMS in a number of indications reach level C (possible efficacy), including LF-rTMS of the left temporoparietal cortex in tinnitus and auditory hallucinations. It remains to determine how to optimize rTMS protocols and techniques to give them relevance in routine clinical practice. In addition, professionals carrying out rTMS protocols should undergo rigorous training to ensure the quality of the technical realization, guarantee the proper care of patients, and maximize the chances of success. Under these conditions, the therapeutic use of rTMS should be able to develop in the coming years.
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Affiliation(s)
- Jean-Pascal 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.
| | - Nathalie André-Obadia
- Neurophysiology and Epilepsy Unit, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, Bron, France; Inserm U 1028, NeuroPain Team, Neuroscience Research Center of Lyon (CRNL), Lyon-1 University, Bron, France
| | - Andrea Antal
- Department of Clinical Neurophysiology, Georg-August University, Göttingen, Germany
| | - Samar S Ayache
- 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
| | - Chris Baeken
- Department of Psychiatry and Medical Psychology, Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium; Department of Psychiatry, University Hospital (UZBrussel), Brussels, Belgium
| | - David H Benninger
- Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Roberto M Cantello
- Department of Translational Medicine, Section of Neurology, University of Piemonte Orientale "A. Avogadro", Novara, Italy
| | | | - Mamede de Carvalho
- Institute of Physiology, Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, Portugal
| | - Dirk De Ridder
- Brai(2)n, Tinnitus Research Initiative Clinic Antwerp, Belgium; Department of Neurosurgery, University Hospital Antwerp, Belgium
| | - Hervé Devanne
- Department of Clinical Neurophysiology, Lille University Hospital, Lille, France; ULCO, Lille-Nord de France University, Lille, France
| | - Vincenzo Di Lazzaro
- Department of Neurosciences, Institute of Neurology, Campus Bio-Medico University, Rome, Italy
| | - Saša R Filipović
- Department of Neurophysiology, Institute for Medical Research, University of Belgrade, Beograd, Serbia
| | - Friedhelm C Hummel
- Brain Imaging and Neurostimulation (BINS) Laboratory, Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Satu K Jääskeläinen
- Department of Clinical Neurophysiology, Turku University Hospital, University of Turku, Turku, Finland
| | - Vasilios K Kimiskidis
- Laboratory of Clinical Neurophysiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Giacomo Koch
- Non-Invasive Brain Stimulation Unit, Neurologia Clinica e Comportamentale, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Thomas Nyffeler
- Perception and Eye Movement Laboratory, Department of Neurology, University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Antonio Oliviero
- FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Emmanuel Poulet
- Department of Emergency Psychiatry, CHU Lyon, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France; EAM 4615, Lyon-1 University, Bron, France
| | - Simone Rossi
- Brain Investigation & Neuromodulation Lab, Unit of Neurology and Clinical Neurophysiology, Department of Neuroscience, University of Siena, Siena, Italy
| | - Paolo Maria Rossini
- Brain Connectivity Laboratory, IRCCS San Raffaele Pisana, Rome, Italy; Institute of Neurology, Catholic University, Rome, Italy
| | - John C Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
| | | | - Hartwig 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
| | | | - Charlotte J Stagg
- Oxford Centre for Functional MRI of the Brain (FMRIB), Department of Clinical Neurosciences, University of Oxford, United Kingdom
| | - Josep Valls-Sole
- EMG Unit, Neurology Service, Hospital Clinic, Department of Medicine, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Ulf Ziemann
- Department of Neurology & Stroke, and Hertie Institute for Clinical Brain Research, Eberhard Karls University, Tübingen, Germany
| | - Walter Paulus
- Department of Clinical Neurophysiology, Georg-August University, Göttingen, Germany
| | - Luis Garcia-Larrea
- Inserm U 1028, NeuroPain Team, Neuroscience Research Center of Lyon (CRNL), Lyon-1 University, Bron, France; Pain Unit, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, Bron, France
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18
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Koch G. Do studies on cortical plasticity provide a rationale for using non-invasive brain stimulation as a treatment for Parkinson's disease patients? Front Neurol 2013; 4:180. [PMID: 24223573 PMCID: PMC3818583 DOI: 10.3389/fneur.2013.00180] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 10/24/2013] [Indexed: 12/04/2022] Open
Abstract
Animal models of Parkinson’s disease (PD) have shown that key mechanisms of cortical plasticity such as long-term potentiation (LTP) and long-term depression (LTD) can be impaired by the PD pathology. In humans protocols of non-invasive brain stimulation, such as paired associative stimulation (PAS) and theta-burst stimulation (TBS), can be used to investigate cortical plasticity of the primary motor cortex. Through the amplitude of the motor evoked potential these transcranial magnetic stimulation methods allow to measure both LTP-like and LTD-like mechanisms of cortical plasticity. So far these protocols have reported some controversial findings when tested in PD patients. While various studies described evidence for reduced LTP- and LTD-like plasticity, others showed different results, demonstrating increased LTP-like and normal LTD-like plasticity. Recent evidence provided support to the hypothesis that these different patterns of cortical plasticity likely depend on the stage of the disease and on the concomitant administration of l-DOPA. However, it is still unclear how and if these altered mechanisms of cortical plasticity can be taken as a reliable model to build appropriate protocols aimed at treating PD symptoms by applying repetitive sessions of repetitive TMS (rTMS) or transcranial direct current stimulation (tDCS). The current article will provide an up-to-date overview of these issues together with some reflections on future studies in the field.
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Affiliation(s)
- Giacomo Koch
- Non-Invasive Brain Stimulation Unit, Neurologia Clinica e Comportamentale, Fondazione Santa Lucia IRCCS , Rome , Italy ; Stroke Unit, Policlinico Tor Vergata , Rome , Italy
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19
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Sung WH, Wang CP, Chou CL, Chen YC, Chang YC, Tsai PY. Efficacy of Coupling Inhibitory and Facilitatory Repetitive Transcranial Magnetic Stimulation to Enhance Motor Recovery in Hemiplegic Stroke Patients. Stroke 2013; 44:1375-82. [DOI: 10.1161/strokeaha.111.000522] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Although there has been extensive research on the effectiveness of repetitive transcranial magnetic stimulation (rTMS) to improve patients’ motor performance after experiencing chronic stroke, explicit findings on the coupling of different rTMS protocols are meager. We designed this sham-controlled randomized study to investigate the potential for a consecutive suppressive-facilitatory TMS protocol to improve motor outcomes after chronic stroke.
Methods—
Fifty-four chronic hemiplegic stroke patients were allocated across 4 groups to undergo 20 daily sessions of (1) 1 Hz rTMS over the contralesional primary motor cortex (M1) and then intermittent theta burst stimulation over the ipsilesional M1 (group A); (2) contralesional sham stimulation and then ipsilesional real intermittent theta burst stimulation (group B); (3) contralesional real 1 Hz rTMS and then ipsilesional sham stimulation (group C); or (4) bilateral sham-control procedures (group D). We tested cortical excitability and motor activity assessments at the baseline, postpriming rTMS, and postconsequent rTMS periods.
Results—
At post, group A showed greater muscle strength, Fugl-Meyer Assessment (FMA), Wolf Motor Function test, and reaction time improvement in comparison with group B (
P
<0.001≈0.003) and group C (
P
=0.001≈0.003). Correlation analyses in group A revealed a close relation between contralesional map area decrement and Wolf Motor Function test gain (
P
=0.005;
r
=−0.75), and also revealed ipsilesional map area increment and reaction time decrement (
P
=0.02;
r
=−0.87). We detected no such relations in the other 3 groups.
Conclusions—
Our clinical trials established an extended timeframe during which conditioning could be safely continued and produced more favorable outcomes in facilitating motor performance and ameliorating interhemispheric imbalance than those obtained from single-course rTMS modulation alone.
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Affiliation(s)
- Wen-Hsu Sung
- From the Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan (W.-H.S.); Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan (C.-P.W.); Department of Mathematics, Tamkang University; Taipei, Taiwan (Y.-C. Chang); and Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, National Yang-Ming University, School of Medicine, Taipei, Taiwan (C.-L.C., Y.-C. Chen, P.-Y.T.)
| | - Chih-Pin Wang
- From the Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan (W.-H.S.); Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan (C.-P.W.); Department of Mathematics, Tamkang University; Taipei, Taiwan (Y.-C. Chang); and Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, National Yang-Ming University, School of Medicine, Taipei, Taiwan (C.-L.C., Y.-C. Chen, P.-Y.T.)
| | - Chen-Liang Chou
- From the Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan (W.-H.S.); Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan (C.-P.W.); Department of Mathematics, Tamkang University; Taipei, Taiwan (Y.-C. Chang); and Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, National Yang-Ming University, School of Medicine, Taipei, Taiwan (C.-L.C., Y.-C. Chen, P.-Y.T.)
| | - Yi-Cheng Chen
- From the Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan (W.-H.S.); Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan (C.-P.W.); Department of Mathematics, Tamkang University; Taipei, Taiwan (Y.-C. Chang); and Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, National Yang-Ming University, School of Medicine, Taipei, Taiwan (C.-L.C., Y.-C. Chen, P.-Y.T.)
| | - Yue-Cune Chang
- From the Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan (W.-H.S.); Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan (C.-P.W.); Department of Mathematics, Tamkang University; Taipei, Taiwan (Y.-C. Chang); and Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, National Yang-Ming University, School of Medicine, Taipei, Taiwan (C.-L.C., Y.-C. Chen, P.-Y.T.)
| | - Po-Yi Tsai
- From the Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan (W.-H.S.); Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan (C.-P.W.); Department of Mathematics, Tamkang University; Taipei, Taiwan (Y.-C. Chang); and Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, National Yang-Ming University, School of Medicine, Taipei, Taiwan (C.-L.C., Y.-C. Chen, P.-Y.T.)
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Vonloh M, Chen R, Kluger B. Safety of transcranial magnetic stimulation in Parkinson's disease: a review of the literature. Parkinsonism Relat Disord 2013; 19:573-85. [PMID: 23473718 DOI: 10.1016/j.parkreldis.2013.01.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 12/18/2012] [Accepted: 01/13/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) has been used in both physiological studies and, more recently, the therapy of Parkinson's disease (PD). Prior TMS studies in healthy subjects and other patient populations demonstrate a slight risk of seizures and other adverse events. Our goal was to estimate these risks and document other safety concerns specific to PD patients. METHODS We performed an English-Language literature search through PudMed to review all TMS studies involving PD patients. We documented any seizures or other adverse events associated with these studies. Crude risks were calculated per subject and per session of TMS. RESULTS We identified 84 single pulse (spTMS) and/or paired-pulse (ppTMS) TMS studies involving 1091 patients and 77 repetitive TMS (rTMS) studies involving 1137 patients. Risk of adverse events was low in all protocols. spTMS and ppTMS risk per patient for any adverse event was 0.0018 (95% CI: 0.0002-0.0066) per patient and no seizures were encountered. Risk of an adverse event from rTMS was 0.040 (95% CI: 0.029-0.053) per patient and no seizures were reported. Other adverse events included transient headaches, scalp pain, tinnitus, nausea, increase in pre-existing pain, and muscle jerks. Transient worsening of Parkinsonian symptoms was noted in one study involving rTMS of the supplementary motor area (SMA). CONCLUSION We conclude that current TMS and rTMS protocols do not pose significant risks to PD patients. We would recommend that TMS users in this population follow the most recent safety guidelines but do not warrant additional precautions.
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Affiliation(s)
- Matthew Vonloh
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
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Ullrich H, Kranaster L, Sigges E, Andrich J, Sartorius A. Ultra-high-frequency left prefrontal transcranial magnetic stimulation as augmentation in severely ill patients with depression: a naturalistic sham-controlled, double-blind, randomized trial. Neuropsychobiology 2013; 66:141-8. [PMID: 22948250 DOI: 10.1159/000339561] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 05/21/2012] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND AIM Repetitive transcranial magnetic stimulation (rTMS) is supposed to be not as effective in severe depression as it is in medium depression. We evaluated the treatment response to an ultra-high-frequency (UHF; 30 Hz) approach, which was used to maximize the rTMS efficacy in severely ill patients. METHODS 43 severely depressed patients were included in the randomized, double-blind study and received either rTMS with 30 Hz over the left dorsolateral prefrontal cortex or sham condition for 3 weeks as an add-on therapy to stable antidepressant medication. Hamilton Depression Rating Scale (HDRS) and cognitive performance were evaluated before and after the intervention. RESULTS In the active UHF group, the HRDS score was reduced by about 7.2, whereas the sham condition showed a smaller reduction of the HDRS score with 3.9. However, lithium as a covariant was responsible for the outcome difference, not the group of stimulation. No adverse events were reported. Comparing the differences of both groups in the pre- and post-study performance in a trail-making test, a group effect for the UHF group that was not influenced by the lithium intake was observed. CONCLUSION A 30-Hz left prefrontal rTMS in severely depressed patients was safe and no adverse events occurred. Due to a strong effect of lithium as a covariate, we could not demonstrate favorable antidepressant effects of the UHF stimulation compared to sham. However, we found an improvement of processing speed performance in the UHF group, which covaried with improvement of psychomotor retardation.
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Affiliation(s)
- Heiko Ullrich
- Department of Psychiatry and Psychotherapy, Kreisklinikum Siegen GmbH, Siegen, Germany
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Abstract
In advanced Parkinson's disease (PD), the emergence of symptoms refractory to conventional therapy poses therapeutic challenges. The success of deep brain stimulation (DBS) and advances in the understanding of the pathophysiology of PD have raised interest in noninvasive brain stimulation as an alternative therapeutic tool. The rationale for its use draws from the concept that reversing abnormalities in brain activity and physiology thought to cause the clinical deficits may restore normal functioning. Currently the best evidence in support of this concept comes from DBS, which improves motor deficits, and modulates brain activity and motor cortex physiology, although whether a causal interaction exists remains largely undetermined. Most trials of noninvasive brain stimulation in PD have applied repetitive transcranial magnetic stimulation (rTMS), targeting the motor cortex. Current studies suggest a possible therapeutic potential for rTMS and transcranial direct current stimulation (tDCS), but clinical effects so far have been small and negligible with regard to functional independence and quality of life. Approaches to potentiate the efficacy of rTMS include increasing stimulation intensity and novel stimulation parameters that derive their rationale from studies on brain physiology. These novel parameters are intended to simulate normal firing patterns or to act on the hypothesized role of oscillatory activity in the motor cortex and basal ganglia with regard to motor control and its contribution to the pathogenesis of motor disorders. Noninvasive brain stimulation studies will enhance our understanding of PD pathophysiology and might provide further evidence for potential therapeutic applications.
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Affiliation(s)
- David H Benninger
- Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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Pilato F, Profice P, Ranieri F, Capone F, Di Iorio R, Florio L, Di Lazzaro V. Synaptic plasticity in neurodegenerative diseases evaluated and modulated by in vivo neurophysiological techniques. Mol Neurobiol 2012; 46:563-71. [PMID: 22821187 DOI: 10.1007/s12035-012-8302-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 07/09/2012] [Indexed: 12/12/2022]
Abstract
Several studies demonstrated in experimental models and in humans synaptic plasticity impairment in some neurodegenerative and neuropsychiatric diseases such as Parkinson's disease, Alzheimer's disease, Huntington's disease, and schizophrenia. Recently new neurophysiological tools, such as repetitive transcranial magnetic stimulation and transcranial direct current stimulation, have been introduced in experimental and clinical settings for studying physiology of the brain and modulating cortical activity. These techniques use noninvasive transcranial electrical or magnetic stimulation to modulate neurons activity in the human brain. Cortical stimulation might enhance or inhibit the activity of cortico-subcortical networks, depending on stimulus frequency and intensity, current polarity, and other stimulation parameters such as the configuration of the induced electric field and stimulation protocols. On this basis, in the last two decades, these techniques have rapidly become valuable tools to investigate physiology of the human brain and have been applied to treat drug-resistant neurological and psychiatric diseases. Here we describe these techniques and discuss the mechanisms that may explain these effects.
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Affiliation(s)
- F Pilato
- Department of Neurosciences, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Rome, Italy.
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Degardin A, Devos D, Defebvre L, Destée A, Plomhause L, Derambure P, Devanne H. Effect of intermittent theta-burst stimulation on akinesia and sensorimotor integration in patients with Parkinson’s disease. Eur J Neurosci 2012; 36:2669-78. [DOI: 10.1111/j.1460-9568.2012.08158.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Schulz R, Gerloff C, Hummel FC. Non-invasive brain stimulation in neurological diseases. Neuropharmacology 2012; 64:579-87. [PMID: 22687520 DOI: 10.1016/j.neuropharm.2012.05.016] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Revised: 05/11/2012] [Accepted: 05/13/2012] [Indexed: 11/30/2022]
Abstract
Non-invasive brain stimulation has shown its potential to modulate brain plasticity in humans. Endeavour has been made to utilize brain stimulation in neurological diseases to enhance adaptive processes and prevent potential maladaptive ones. In stroke for instance both sensorimotor and higher cognitive impairment, such as aphasia and neglect, has been addressed to facilitate functional recovery. In Parkinson's disease, brain stimulation has been evaluated to improve motor and non-motor symptoms. In the present review we provide an update of the field of transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) as non-invasive brain stimulation techniques to improve motor and higher cognitive functions in patients suffering from stroke and Parkinson's disease. Rather than attempting to be comprehensive in regard of the reviewed scientific field, this article may be considered as a present day's framework of the application of non-invasive brain stimulation on selected examples of common neurological diseases. At the end we will briefly discuss open controversies and future directions of the field which has to be addressed in upcoming studies. This article is part of a Special Issue entitled 'Cognitive Enhancers'.
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Affiliation(s)
- Robert Schulz
- Brain Imaging and Neurostimulation (BINS) Laboratory, Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
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Benninger DH, Iseki K, Kranick S, Luckenbaugh DA, Houdayer E, Hallett M. Controlled study of 50-Hz repetitive transcranial magnetic stimulation for the treatment of Parkinson disease. Neurorehabil Neural Repair 2012; 26:1096-105. [PMID: 22593114 DOI: 10.1177/1545968312445636] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the safety and efficacy of 50-Hz repetitive transcranial magnetic stimulation (rTMS) in the treatment of motor symptoms in Parkinson disease (PD). BACKGROUND Progression of PD is characterized by the emergence of motor deficits that gradually respond less to dopaminergic therapy. rTMS has shown promising results in improving gait, a major cause of disability, and may provide a therapeutic alternative. Prior controlled studies suggest that an increase in stimulation frequency might enhance therapeutic efficacy. METHODS In this randomized, double blind, sham-controlled study, the authors investigated the safety and efficacy of 50-Hz rTMS of the motor cortices in 8 sessions over 2 weeks. Assessment of safety and clinical efficacy over a 1-month period included timed tests of gait and bradykinesia, Unified Parkinson's Disease Rating Scale (UPDRS), and additional clinical, neurophysiological, and neuropsychological parameters. In addition, the safety of 50-Hz rTMS was tested with electromyography-electroencephalogram (EMG-EEG) monitoring during and after stimulation. RESULTS The authors investigated 26 patients with mild to moderate PD: 13 received 50-Hz rTMS and 13 sham stimulation. The 50-Hz rTMS did not improve gait, bradykinesia, and global and motor UPDRS, but there appeared a short-lived "on"-state improvement in activities of daily living (UPDRS II). The 50-Hz rTMS lengthened the cortical silent period, but other neurophysiological and neuropsychological measures remained unchanged. EMG/EEG recorded no pathological increase of cortical excitability or epileptic activity. There were no adverse effects. CONCLUSION It appears that 50-Hz rTMS of the motor cortices is safe, but it fails to improve motor performance and functional status in PD. Prolonged stimulation or other techniques with rTMS might be more efficacious but need to be established in future research.
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Affiliation(s)
- David H Benninger
- Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
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Adeyemo BO, Simis M, Macea DD, Fregni F. Systematic review of parameters of stimulation, clinical trial design characteristics, and motor outcomes in non-invasive brain stimulation in stroke. Front Psychiatry 2012; 3:88. [PMID: 23162477 PMCID: PMC3495265 DOI: 10.3389/fpsyt.2012.00088] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 09/22/2012] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION/OBJECTIVES Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation are two powerful non-invasive neuromodulatory therapies that have the potential to alter and evaluate the integrity of the corticospinal tract. Moreover, recent evidence has shown that brain stimulation might be beneficial in stroke recovery. Therefore, investigating and investing in innovative therapies that may improve neurorehabilitative stroke recovery are next steps in research and development. Participants/Materials and Methods: This article presents an up-to-date systematic review of the treatment effects of rTMS and tDCS on motor function. A literary search was conducted, utilizing search terms "stroke" and "transcranial stimulation." Items were excluded if they failed to: (1) include stroke patients, (2) study motor outcomes, or (3) include rTMS/tDCS as treatments. Other exclusions included: (1) reviews, editorials, and letters, (2) animal or pediatric populations, (3) case reports or sample sizes ≤2 patients, and (4) primary outcomes of dysphagia, dysarthria, neglect, or swallowing. RESULTS Investigation of PubMed English Database prior to 01/01/2012 produced 695 applicable results. Studies were excluded based on the aforementioned criteria, resulting in 50 remaining studies. They included 1314 participants (1282 stroke patients and 32 healthy subjects) evaluated by motor function pre- and post-tDCS or rTMS. Heterogeneity among studies' motor assessments was high and could not be accounted for by individual comparison. Pooled effect sizes for the impact of post-treatment improvement revealed consistently demonstrable improvements after tDCS and rTMS therapeutic stimulation. Most studies provided limited follow-up for long-term effects. CONCLUSION It is apparent from the available studies that non-invasive stimulation may enhance motor recovery and may lead to clinically meaningful functional improvements in the stroke population. Only mild to no adverse events have been reported. Though results have been positive results, the large heterogeneity across articles precludes firm conclusions.
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Affiliation(s)
- Bamidele O Adeyemo
- Laboratory of Neuromodulation, Spaulding Rehabilitation Hospital, Harvard Medical School Boston, MA, USA ; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School Boston, MA, USA
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Wassermann EM, Zimmermann T. Transcranial magnetic brain stimulation: therapeutic promises and scientific gaps. Pharmacol Ther 2011; 133:98-107. [PMID: 21924290 DOI: 10.1016/j.pharmthera.2011.09.003] [Citation(s) in RCA: 136] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 08/12/2011] [Indexed: 01/19/2023]
Abstract
Since its commercial advent in 1985, transcranial magnetic stimulation (TMS), a technique for stimulating neurons in the cerebral cortex through the scalp, safely and with minimal discomfort, has captured the imaginations of scientists, clinicians and lay observers. Initially a laboratory tool for neurophysiologists studying the human motor system, TMS now has a growing list of applications in clinical and basic neuroscience. Although we understand many of its effects at the system level, detailed knowledge of its actions, particularly as a modulator of neural activity, has lagged, due mainly to the lack of suitable non-human models. Nevertheless, these gaps have not blocked the therapeutic application of TMS in brain disorders. Moderate success has been achieved in treating disorders such as depression, where the U.S. Food and Drug Administration has cleared a TMS system for therapeutic use. In addition, there are small, but promising, bodies of data on the treatment of schizophrenic auditory hallucinations, tinnitus, anxiety disorders, neurodegenerative diseases, hemiparesis, and pain syndromes. Some other nascent areas of study also exist. While the fate of TMS as a therapeutic modality depends on continued innovation and experimentation, economic and other factors may be decisive.
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Affiliation(s)
- Eric M Wassermann
- Behavioral Neurology Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
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Benninger DH, Berman BD, Houdayer E, Pal N, Luckenbaugh DA, Schneider L, Miranda S, Hallett M. Intermittent theta-burst transcranial magnetic stimulation for treatment of Parkinson disease. Neurology 2011; 76:601-9. [PMID: 21321333 DOI: 10.1212/wnl.0b013e31820ce6bb] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the safety and efficacy of intermittent theta-burst stimulation (iTBS) in the treatment of motor symptoms in Parkinson disease (PD). BACKGROUND Progression of PD is characterized by the emergence of motor deficits, which eventually respond less to dopaminergic therapy and pose a therapeutic challenge. Repetitive transcranial magnetic stimulation (rTMS) has shown promising results in improving gait, a major cause of disability, and may provide a therapeutic alternative. iTBS is a novel type of rTMS that may be more efficacious than conventional rTMS. METHODS In this randomized, double-blind, sham-controlled study, we investigated safety and efficacy of iTBS of the motor and dorsolateral prefrontal cortices in 8 sessions over 2 weeks (evidence Class I). Assessment of safety and clinical efficacy over a 1-month period included timed tests of gait and bradykinesia, Unified Parkinson's Disease Rating Scale (UPDRS), and additional clinical, neuropsychological, and neurophysiologic measures. RESULTS We investigated 26 patients with mild to moderate PD: 13 received iTBS and 13 sham stimulation. We found beneficial effects of iTBS on mood, but no improvement of gait, bradykinesia, UPDRS, and other measures. EEG/EMG monitoring recorded no pathologic increase of cortical excitability or epileptic activity. Few reported discomfort or pain and one experienced tinnitus during real stimulation. CONCLUSION iTBS of the motor and prefrontal cortices appears safe and improves mood, but failed to improve motor performance and functional status in PD. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that iTBS was not effective for gait, upper extremity bradykinesia, or other motor symptoms in PD.
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Affiliation(s)
- D H Benninger
- Department of Neurology, University Hospital of Basel, Petersgraben 4, 4051 Basel, Switzerland.
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Benninger DH, Lomarev M, Lopez G, Wassermann EM, Li X, Considine E, Hallett M. Transcranial direct current stimulation for the treatment of Parkinson's disease. J Neurol Neurosurg Psychiatry 2010; 81:1105-11. [PMID: 20870863 PMCID: PMC4162743 DOI: 10.1136/jnnp.2009.202556] [Citation(s) in RCA: 220] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Progression of Parkinson's disease (PD) is characterised by motor deficits which eventually respond less to dopaminergic therapy and thus pose a therapeutic challenge. Deep brain stimulation has proven efficacy but carries risks and is not possible in all patients. Non-invasive brain stimulation has shown promising results and may provide a therapeutic alternative. OBJECTIVE To investigate the efficacy of transcranial direct current stimulation (tDCS) in the treatment of PD. DESIGN Randomised, double blind, sham controlled study. SETTING Research institution. METHODS The efficacy of anodal tDCS applied to the motor and prefrontal cortices was investigated in eight sessions over 2.5 weeks. Assessment over a 3 month period included timed tests of gait (primary outcome measure) and bradykinesia in the upper extremities, Unified Parkinson's Disease Rating Scale (UPDRS), Serial Reaction Time Task, Beck Depression Inventory, Health Survey and self-assessment of mobility. RESULTS Twenty-five PD patients were investigated, 13 receiving tDCS and 12 sham stimulation. tDCS improved gait by some measures for a short time and improved bradykinesia in both the on and off states for longer than 3 months. Changes in UPDRS, reaction time, physical and mental well being, and self-assessed mobility did not differ between the tDCS and sham interventions. CONCLUSION tDCS of the motor and prefrontal cortices may have therapeutic potential in PD but better stimulation parameters need to be established to make the technique clinically viable. This study was publicly registered (clinicaltrials.org: NCT00082342).
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Affiliation(s)
- David H Benninger
- Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892, USA.
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Liang X, Liu K, Guo L. Repetitive transcranial magnetic stimulation (rTMS): A possible novel therapeutic approach to dementia with Lewy bodies. Med Hypotheses 2010; 74:877-9. [DOI: 10.1016/j.mehy.2009.11.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Accepted: 11/18/2009] [Indexed: 11/16/2022]
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