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Bardel B, Créange A, Bonardet N, Bapst B, Zedet M, Wahab A, Ayache SS, Lefaucheur JP. Motor function in multiple sclerosis assessed by navigated transcranial magnetic stimulation mapping. J Neurol 2024; 271:4513-4528. [PMID: 38709305 DOI: 10.1007/s00415-024-12398-x] [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: 02/09/2024] [Revised: 04/21/2024] [Accepted: 04/22/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION Impaired motor function is a major cause of disability in multiple sclerosis (MS), involving various neuroplasticity processes typically assessed by neuroimaging. This study aimed to determine whether navigated transcranial magnetic stimulation (nTMS) could also provide biomarkers of motor cortex plasticity in patients with MS (pwMS). METHODS nTMS motor mapping was performed for hand and leg muscles bilaterally. nTMS variables included the amplitude and latency of motor evoked potentials (MEPs), corticospinal excitability measures, and the size of cortical motor maps (CMMs). Clinical assessment included disability (Expanded Disability Status Scale, EDSS), strength (MRC scale, pinch and grip), and dexterity (9-hole Pegboard Test). RESULTS nTMS motor mapping was performed in 68 pwMS. PwMS with high disability (EDSS ≥ 3) had enlarged CMMs with less dense distribution of MEPs and various MEP parameter changes compared to pwMS with low disability (EDSS < 3). Patients with progressive MS had also various MEP parameter changes compared to pwMS with relapsing remitting form. MRC score correlated positively with MEP amplitude and negatively with MEP latency, pinch strength correlated negatively with CMM volume and dexterity with MEP latency. CONCLUSIONS This is the first study to perform 4-limb cortical motor mapping in pwMS using a dedicated nTMS procedure. By quantifying the cortical surface representation of a given muscle and the variability of MEP within this representation, nTMS can provide new biomarkers of motor function impairment in pwMS. Our study opens perspectives for the use of nTMS as an objective method for assessing pwMS disability in clinical practice.
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Affiliation(s)
- Benjamin Bardel
- Excitabilité Nerveuse Et Thérapeutique (ENT), Univ Paris Est Creteil, EA 4391, 8 Rue du Général Sarrail, Créteil, 94000, France.
- Service Des Explorations Fonctionnelles Non Invasives, Department of Clinical Neurophysiology, DMU FIxIT, AP-HP, Unité de Neurophysiologie Clinique, Hôpital Universitaire Henri Mondor, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, 94000, Creteil, France.
- Centre de Ressources Et de Compétences SEP Grand-Paris Est, Hôpital Universitaire Henri Mondor, 1 Rue Gustave Eiffel, 94000, Creteil, France.
| | - Alain Créange
- Excitabilité Nerveuse Et Thérapeutique (ENT), Univ Paris Est Creteil, EA 4391, 8 Rue du Général Sarrail, Créteil, 94000, France
- Centre de Ressources Et de Compétences SEP Grand-Paris Est, Hôpital Universitaire Henri Mondor, 1 Rue Gustave Eiffel, 94000, Creteil, France
- Department of Neurology, AP-HP, Henri Mondor University Hospital, DMU Médecine, 1 Rue Gustave Eiffel, 94000, Creteil, France
| | - Nathalie Bonardet
- Excitabilité Nerveuse Et Thérapeutique (ENT), Univ Paris Est Creteil, EA 4391, 8 Rue du Général Sarrail, Créteil, 94000, France
| | - Blanche Bapst
- Excitabilité Nerveuse Et Thérapeutique (ENT), Univ Paris Est Creteil, EA 4391, 8 Rue du Général Sarrail, Créteil, 94000, France
- Centre de Ressources Et de Compétences SEP Grand-Paris Est, Hôpital Universitaire Henri Mondor, 1 Rue Gustave Eiffel, 94000, Creteil, France
- Department of Neuroradiology, AP-HP, Henri Mondor University Hospital, DMU FIxIT, 1 Rue Gustave Eiffel, 94000, Creteil, France
| | - Mickael Zedet
- Centre de Ressources Et de Compétences SEP Grand-Paris Est, Hôpital Universitaire Henri Mondor, 1 Rue Gustave Eiffel, 94000, Creteil, France
- Department of Neurology, AP-HP, Henri Mondor University Hospital, DMU Médecine, 1 Rue Gustave Eiffel, 94000, Creteil, France
| | - Abir Wahab
- Centre de Ressources Et de Compétences SEP Grand-Paris Est, Hôpital Universitaire Henri Mondor, 1 Rue Gustave Eiffel, 94000, Creteil, France
- Department of Neurology, AP-HP, Henri Mondor University Hospital, DMU Médecine, 1 Rue Gustave Eiffel, 94000, Creteil, France
| | - Samar S Ayache
- Excitabilité Nerveuse Et Thérapeutique (ENT), Univ Paris Est Creteil, EA 4391, 8 Rue du Général Sarrail, Créteil, 94000, France
- Service Des Explorations Fonctionnelles Non Invasives, Department of Clinical Neurophysiology, DMU FIxIT, AP-HP, Unité de Neurophysiologie Clinique, Hôpital Universitaire Henri Mondor, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, 94000, Creteil, France
- Centre de Ressources Et de Compétences SEP Grand-Paris Est, Hôpital Universitaire Henri Mondor, 1 Rue Gustave Eiffel, 94000, Creteil, France
- Department of Neurology, AP-HP, Henri Mondor University Hospital, DMU Médecine, 1 Rue Gustave Eiffel, 94000, Creteil, France
| | - Jean-Pascal Lefaucheur
- Excitabilité Nerveuse Et Thérapeutique (ENT), Univ Paris Est Creteil, EA 4391, 8 Rue du Général Sarrail, Créteil, 94000, France
- Service Des Explorations Fonctionnelles Non Invasives, Department of Clinical Neurophysiology, DMU FIxIT, AP-HP, Unité de Neurophysiologie Clinique, Hôpital Universitaire Henri Mondor, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, 94000, Creteil, France
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Lefaucheur JP, Nguyen JP, Delmas A, Croci S, Bredoux L, Hodaj H. Targeting Lower Limb, Upper Limb, and Face Representation in the Primary Motor Cortex for the Practice of Neuronavigated Transcranial Magnetic Stimulation. Neuromodulation 2024; 27:572-583. [PMID: 37212759 DOI: 10.1016/j.neurom.2023.04.470] [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: 01/04/2023] [Revised: 03/28/2023] [Accepted: 04/13/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE The primary motor cortex (M1) is a usual target for therapeutic application of repetitive transcranial magnetic stimulation (rTMS), especially the region of hand motor representation. However, other M1 regions can be considered as potential rTMS targets, such as the region of lower limb or face representation. In this study, we assessed the localization of all these regions on magnetic resonance imaging (MRI) with the aim of defining three standardized M1 targets for the practice of neuronavigated rTMS. MATERIALS AND METHODS A pointing task of these targets was performed by three rTMS experts on 44 healthy brain MRI data to assess interrater reliability (including the calculation of intraclass correlation coefficients [ICCs] and coefficients of variation [CoVs] and the construction of Bland-Altman plots). In addition, two "standard" brain MRI data were randomly interspersed with the other MRI data to assess intrarater reliability. A barycenter was calculated for each target (with x-y-z coordinates provided in normalized brain coordinate systems), in addition to the geodesic distance between the scalp projection of the barycenters of these different targets. RESULTS Intrarater and interrater agreement was good, according to ICCs, CoVs, or Bland-Altman plots, although interrater variability was greater for anteroposterior (y) and craniocaudal (z) coordinates, especially for the face target. The scalp projection of the barycenters between the different cortical targets ranged from 32.4 to 35.5 mm for either the lower-limb-to-upper-limb target distance or the upper-limb-to-face target distance. CONCLUSIONS This work clearly delineates three different targets for the application of motor cortex rTMS that correspond to lower limb, upper limb, and face motor representations. These three targets are sufficiently spaced to consider that their stimulation can act on distinct neural networks.
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Affiliation(s)
- Jean-Pascal Lefaucheur
- Clinical Neurophysiology Department, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France; ENT team (UR/EA-4391), Faculty of Health, Paris Est Créteil University, Créteil, France.
| | | | | | | | | | - Hasan Hodaj
- Pain Center, Anesthesiology-Critical Care Department, Grenoble Alpes University Hospital, Grenoble, France; Inserm U1216, Grenoble Institute of Neurosciences, Grenoble Alpes University, Grenoble, France
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Li L, Liu C, Pan W, Wang W, Jin W, Ren Y, Ma X. Repetitive Transcranial Magnetic Stimulation for Working Memory Deficits in Schizophrenia: A Systematic Review of Randomized Controlled Trials. Neuropsychiatr Dis Treat 2024; 20:649-662. [PMID: 38528855 PMCID: PMC10962363 DOI: 10.2147/ndt.s450303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/15/2024] [Indexed: 03/27/2024] Open
Abstract
Working memory (WM) deficits are a significant component of neurocognitive impairment in individuals with schizophrenia (SCZ). Two previous meta-analyses, conducted on randomized controlled trials (RCTs), examined the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in addressing WM deficits in individuals diagnosed with SCZ. However, the conclusions drawn from these analyses were inconsistent. Additionally, the commonly used random effects (RE) models might underestimate statistical errors, attributing a significant portion of perceived heterogeneity between studies to variations in study quality. Therefore, this review utilized both RE and quality effects (QE) models to assess relevant RCTs comparing TMS with sham intervention in terms of clinical outcomes. A comprehensive literature search was conducted using PubMed and Scopus databases, resulting in the inclusion of 13 studies for data synthesis. Overall, regardless of whether the RE or QE model was used, eligible RCTs suggested that the TMS and sham groups exhibited comparable therapeutic effects after treatment. The current state of research regarding the use of rTMS as a treatment for WM deficits in patients with SCZ remains in its preliminary phase. Furthermore, concerning the mechanism of action, the activation of brain regions focused on the dorsolateral prefrontal cortex and alterations in gamma oscillations may hold significant relevance in the therapeutic application of rTMS for addressing WM impairments. Finally, we believe that the application of closed-loop neuromodulation may contribute to the optimization of rTMS for WM impairment in patients with SCZ.
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Affiliation(s)
- Li Li
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, People’s Republic of China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, People’s Republic of China
| | - Chaomeng Liu
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, People’s Republic of China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, People’s Republic of China
| | - Weigang Pan
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, People’s Republic of China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, People’s Republic of China
| | - Wen Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, People’s Republic of China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, People’s Republic of China
| | - Wenqing Jin
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, People’s Republic of China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, People’s Republic of China
| | - Yanping Ren
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, People’s Republic of China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, People’s Republic of China
| | - Xin Ma
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, People’s Republic of China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, People’s Republic of China
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Lefaucheur JP. It is time to personalize rTMS targeting for the treatment of pain. Neurophysiol Clin 2024; 54:102950. [PMID: 38382139 DOI: 10.1016/j.neucli.2024.102950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 01/30/2024] [Indexed: 02/23/2024] Open
Affiliation(s)
- Jean-Pascal Lefaucheur
- Unité de Neurophysiologie Clinique, Hôpital Henri Mondor, AP-HP, Créteil, France; UR ENT (EA4391), Faculté de Santé, Université Paris Est Créteil, Créteil, France.
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Wang H, Cui D, Jin J, Wang X, Li Y, Liu Z, Yin T. 3D-printed helmet-type neuro-navigation approach (I-Helmet) for transcranial magnetic stimulation. Front Neurosci 2023; 17:1224800. [PMID: 37609452 PMCID: PMC10442160 DOI: 10.3389/fnins.2023.1224800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/18/2023] [Indexed: 08/24/2023] Open
Abstract
Neuro-navigation is a key technology to ensure the clinical efficacy of TMS. However, the neuro-navigation system based on positioning sensor is currently unable to be promoted and applied in clinical practice due to its time-consuming and high-cost. In the present study, we designed I-Helmet system to promote an individualized and clinically friendly neuro-navigation approach to TMS clinical application. I-Helmet system is based on C++ with a graphical user interface that allows users to design a 3D-printed helmet model for coil navigation. Besides, a dedicated coil positioning accuracy detection method was promoted based on three-dimensional (3D) printing and 3D laser scanning for evaluation. T1 images were collected from 24 subjects, and based on each image, phantom were created to simulate skin and hair. Six 3D-printed helmets with the head positioning hole enlarged by 0-5% tolerance in 1% increments were designed to evaluate the influences of skin, hair, and helmet-tolerance on the positioning accuracy and contact force of I-Helmet. Finally, I-Helmet system was evaluated by comparing its positioning accuracy with three skin hardnesses, three hair styles, three operators, and with or without landmarks. The accuracy of the proposed coil positioning accuracy detection method was about 0.30 mm in position and 0.22° in orientation. Skin and hair had significant influences on positioning accuracy (p < 0.0001), whereas different skin hardnesses, hair styles, and operators did not (p > 0.05). The tolerance of the helmet presented significant influences on positioning accuracy (p < 0.0001) and contact force (p < 0.0001). The positioning accuracy significantly increased (p < 0.0001) with landmark guided I-Helmet. 3D-printed helmet-type Neuro-navigation approach (I-Helmet) with 3% tolerance and landmarks met the positioning requirements for TMS in clinical practice with less than 5 N mean contact force, 3-5 mm positioning accuracy, 65.7 s mean operation time, and 50-yuan material cost. All the results suggest that the cost of I-Helmet system may be much less than the that of training clinical doctors to position the coil of TMS operation during short period of time.
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Affiliation(s)
- He Wang
- Institute of Biomedical Engineering, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China
| | - Dong Cui
- School of Radiology, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong, China
| | - Jingna Jin
- Institute of Biomedical Engineering, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China
| | - Xin Wang
- Institute of Biomedical Engineering, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China
| | - Ying Li
- Institute of Biomedical Engineering, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China
| | - Zhipeng Liu
- Institute of Biomedical Engineering, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China
| | - Tao Yin
- Institute of Biomedical Engineering, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China
- Neuroscience Center, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
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Vucic S, Stanley Chen KH, Kiernan MC, Hallett M, Benninger DH, Di Lazzaro V, Rossini PM, Benussi A, Berardelli A, Currà A, Krieg SM, Lefaucheur JP, Long Lo Y, Macdonell RA, Massimini M, Rosanova M, Picht T, Stinear CM, Paulus W, Ugawa Y, Ziemann U, Chen R. Clinical diagnostic utility of transcranial magnetic stimulation in neurological disorders. Updated report of an IFCN committee. Clin Neurophysiol 2023; 150:131-175. [PMID: 37068329 PMCID: PMC10192339 DOI: 10.1016/j.clinph.2023.03.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/28/2023] [Accepted: 03/09/2023] [Indexed: 03/31/2023]
Abstract
The review provides a comprehensive update (previous report: Chen R, Cros D, Curra A, Di Lazzaro V, Lefaucheur JP, Magistris MR, et al. The clinical diagnostic utility of transcranial magnetic stimulation: report of an IFCN committee. Clin Neurophysiol 2008;119(3):504-32) on clinical diagnostic utility of transcranial magnetic stimulation (TMS) in neurological diseases. Most TMS measures rely on stimulation of motor cortex and recording of motor evoked potentials. Paired-pulse TMS techniques, incorporating conventional amplitude-based and threshold tracking, have established clinical utility in neurodegenerative, movement, episodic (epilepsy, migraines), chronic pain and functional diseases. Cortical hyperexcitability has emerged as a diagnostic aid in amyotrophic lateral sclerosis. Single-pulse TMS measures are of utility in stroke, and myelopathy even in the absence of radiological changes. Short-latency afferent inhibition, related to central cholinergic transmission, is reduced in Alzheimer's disease. The triple stimulation technique (TST) may enhance diagnostic utility of conventional TMS measures to detect upper motor neuron involvement. The recording of motor evoked potentials can be used to perform functional mapping of the motor cortex or in preoperative assessment of eloquent brain regions before surgical resection of brain tumors. TMS exhibits utility in assessing lumbosacral/cervical nerve root function, especially in demyelinating neuropathies, and may be of utility in localizing the site of facial nerve palsies. TMS measures also have high sensitivity in detecting subclinical corticospinal lesions in multiple sclerosis. Abnormalities in central motor conduction time or TST correlate with motor impairment and disability in MS. Cerebellar stimulation may detect lesions in the cerebellum or cerebello-dentato-thalamo-motor cortical pathways. Combining TMS with electroencephalography, provides a novel method to measure parameters altered in neurological disorders, including cortical excitability, effective connectivity, and response complexity.
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Affiliation(s)
- Steve Vucic
- Brain, Nerve Research Center, The University of Sydney, Sydney, Australia.
| | - Kai-Hsiang Stanley Chen
- Department of Neurology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Matthew C Kiernan
- Brain and Mind Centre, The University of Sydney; and Department of Neurology, Royal Prince Alfred Hospital, Australia
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health, Bethesda, Maryland, United States
| | - David H Benninger
- Department of Neurology, University Hospital of Lausanne (CHUV), Switzerland
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Paolo M Rossini
- Department of Neurosci & Neurorehab IRCCS San Raffaele-Rome, Italy
| | - Alberto Benussi
- Centre for Neurodegenerative Disorders, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alfredo Berardelli
- IRCCS Neuromed, Pozzilli; Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Antonio Currà
- Department of Medico-Surgical Sciences and Biotechnologies, Alfredo Fiorini Hospital, Sapienza University of Rome, Terracina, LT, Italy
| | - Sandro M Krieg
- Department of Neurosurgery, Technical University Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Jean-Pascal Lefaucheur
- Univ Paris Est Creteil, EA4391, ENT, Créteil, France; Clinical Neurophysiology Unit, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Yew Long Lo
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, and Duke-NUS Medical School, Singapore
| | | | - Marcello Massimini
- Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi di Milano, Milan, Italy; Istituto Di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Mario Rosanova
- Department of Biomedical and Clinical Sciences University of Milan, Milan, Italy
| | - Thomas Picht
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Cluster of Excellence: "Matters of Activity. Image Space Material," Humboldt University, Berlin Simulation and Training Center (BeST), Charité-Universitätsmedizin Berlin, Germany
| | - Cathy M Stinear
- Department of Medicine Waipapa Taumata Rau, University of Auckland, Auckland, Aotearoa, New Zealand
| | - Walter Paulus
- Department of Neurology, Ludwig-Maximilians-Universität München, München, Germany
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Japan
| | - Ulf Ziemann
- Department of Neurology and Stroke, Eberhard Karls University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany; Hertie Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, Otfried-Müller-Straße 27, 72076 Tübingen, Germany
| | - Robert Chen
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital-UHN, Division of Neurology-University of Toronto, Toronto Canada
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Matsuda RH, Souza VH, Kirsten PN, Ilmoniemi RJ, Baffa O. MarLe: Markerless estimation of head pose for navigated transcranial magnetic stimulation. Phys Eng Sci Med 2023; 46:887-896. [PMID: 37166586 DOI: 10.1007/s13246-023-01263-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/16/2023] [Indexed: 05/12/2023]
Abstract
Navigated transcranial magnetic stimulation (nTMS) is a valuable tool for non-invasive brain stimulation. Currently, nTMS requires fixing of markers on the patient's head. Head marker displacements lead to changes in coil placement and brain stimulation inaccuracy. A markerless neuronavigation method is needed to increase the reliability of nTMS and simplify the nTMS protocol. In this study, we introduce and release MarLe, a Python markerless head tracker neuronavigation software for TMS. This novel software uses computer-vision techniques combined with low-cost cameras to estimate the head pose for neuronavigation. A coregistration algorithm, based on a closed-form solution, was designed to track the patient's head and the TMS coil referenced to the individual's brain image. We show that MarLe can estimate head pose based on real-time video processing. An intuitive pipeline was developed to connect the MarLe and nTMS neuronavigation software. MarLe achieved acceptable accuracy and stability in a mockup nTMS experiment. MarLe allows real-time tracking of the patient's head without any markers. The combination of face detection and a coregistration algorithm can overcome nTMS head marker displacement concerns. MarLe can improve reliability, simplify, and reduce the protocol time of brain intervention techniques such as nTMS.
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Affiliation(s)
- Renan H Matsuda
- Department of Physics, Faculty of Philosophy Sciences and Letters of Ribeirão Preto, University of São Paulo, Av. Bandeirantes, Ribeirão Preto, 3900, 14040-901, SP, Brazil.
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Rakentajanaukio 2, Espoo, 02150, Finland.
| | - Victor H Souza
- Department of Physics, Faculty of Philosophy Sciences and Letters of Ribeirão Preto, University of São Paulo, Av. Bandeirantes, Ribeirão Preto, 3900, 14040-901, SP, Brazil
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Rakentajanaukio 2, Espoo, 02150, Finland
- School of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora - MG, Cascatinha, Brazil
| | - Petrus N Kirsten
- Department of Physics, Faculty of Philosophy Sciences and Letters of Ribeirão Preto, University of São Paulo, Av. Bandeirantes, Ribeirão Preto, 3900, 14040-901, SP, Brazil
| | - Risto J Ilmoniemi
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Rakentajanaukio 2, Espoo, 02150, Finland
| | - Oswaldo Baffa
- Department of Physics, Faculty of Philosophy Sciences and Letters of Ribeirão Preto, University of São Paulo, Av. Bandeirantes, Ribeirão Preto, 3900, 14040-901, SP, Brazil
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Huntley JH, Rezvani Habibabadi R, Vaishnavi S, Khoshpouri P, Kraut MA, Yousem DM. Transcranial Magnetic Stimulation and its Imaging Features in Patients With Depression, Post-traumatic Stress Disorder, and Traumatic Brain Injury. Acad Radiol 2023; 30:103-112. [PMID: 35437218 DOI: 10.1016/j.acra.2022.03.016] [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: 01/11/2022] [Revised: 03/07/2022] [Accepted: 03/18/2022] [Indexed: 11/01/2022]
Abstract
Transcranial magnetic stimulation (TMS) is a type of noninvasive neurostimulation used increasingly often in clinical medicine. While most studies to date have focused on TMS's ability to treat major depressive disorder, it has shown promise in several other conditions including post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI). As different treatment protocols are often used across studies, the ability to predict patient outcomes and evaluate immediate and long-term changes using imaging becomes increasingly important. Several imaging features, such as thickness, connectedness, and baseline activity of a variety of cortical and subcortical areas, have been found to be correlated with a greater response to TMS therapy. Intrastimulation imaging can reveal in real time how TMS applied to superficial areas activates or inhibits activity in deeper brain regions. Functional imaging performed weeks to months after treatment can offer an understanding of how long-term effects on brain activity relate to clinical improvement. Further work should be done to expand our knowledge of imaging features relevant to TMS therapy and how they vary across patients with different neurological and psychiatric conditions.
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Affiliation(s)
- Joseph H Huntley
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland.
| | - Roya Rezvani Habibabadi
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Sandeep Vaishnavi
- MindPath Care Centers Clinical Research Institute, Raleigh, North Carolina
| | - Parisa Khoshpouri
- Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, BC, Canada
| | - Michael A Kraut
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - David M Yousem
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Nieminen AE, Nieminen JO, Stenroos M, Novikov P, Nazarova M, Vaalto S, Nikulin V, Ilmoniemi RJ. Accuracy and precision of navigated transcranial magnetic stimulation. J Neural Eng 2022; 19. [PMID: 36541458 DOI: 10.1088/1741-2552/aca71a] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 11/29/2022] [Indexed: 12/02/2022]
Abstract
Objective.Transcranial magnetic stimulation (TMS) induces an electric field (E-field) in the cortex. To facilitate stimulation targeting, image-guided neuronavigation systems have been introduced. Such systems track the placement of the coil with respect to the head and visualize the estimated cortical stimulation location on an anatomical brain image in real time. The accuracy and precision of the neuronavigation is affected by multiple factors. Our aim was to analyze how different factors in TMS neuronavigation affect the accuracy and precision of the coil-head coregistration and the estimated E-field.Approach.By performing simulations, we estimated navigation errors due to distortions in magnetic resonance images (MRIs), head-to-MRI registration (landmark- and surface-based registrations), localization and movement of the head tracker, and localization of the coil tracker. We analyzed the effect of these errors on coil and head coregistration and on the induced E-field as determined with simplistic and realistic head models.Main results.Average total coregistration accuracies were in the range of 2.2-3.6 mm and 1°; precision values were about half of the accuracy values. The coregistration errors were mainly due to head-to-MRI registration with average accuracies 1.5-1.9 mm/0.2-0.4° and precisions 0.5-0.8 mm/0.1-0.2° better with surface-based registration. The other major source of error was the movement of the head tracker with average accuracy of 1.5 mm and precision of 1.1 mm. When assessed within an E-field method, the average accuracies of the peak E-field location, orientation, and magnitude ranged between 1.5 and 5.0 mm, 0.9 and 4.8°, and 4.4 and 8.5% across the E-field models studied. The largest errors were obtained with the landmark-based registration. When computing another accuracy measure with the most realistic E-field model as a reference, the accuracies tended to improve from about 10 mm/15°/25% to about 2 mm/2°/5% when increasing realism of the E-field model.Significance.The results of this comprehensive analysis help TMS operators to recognize the main sources of error in TMS navigation and that the coregistration errors and their effect in the E-field estimation depend on the methods applied. To ensure reliable TMS navigation, we recommend surface-based head-to-MRI registration and realistic models for E-field computations.
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Affiliation(s)
- Aino E Nieminen
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland.,AMI Centre, Aalto NeuroImaging, Aalto University School of Science, Espoo, Finland
| | - Jaakko O Nieminen
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland
| | - Matti Stenroos
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland
| | - Pavel Novikov
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland.,Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, National Research University Higher School of Economics, Moscow, Russia
| | - Maria Nazarova
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland.,Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, National Research University Higher School of Economics, Moscow, Russia.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States of America
| | - Selja Vaalto
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland.,HUS Diagnostic Center, Clinical Neurophysiology, Clinical Neurosciences, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Vadim Nikulin
- Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, National Research University Higher School of Economics, Moscow, Russia.,Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Risto J Ilmoniemi
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland
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10
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Wu XS, Yan TC, Wang XY, Cao Y, Liu XF, Fu YF, Wu L, Jin YC, Yin H, Cui LB. Magnetic Resonance Imaging-Guided and Navigated Individualized Repetitive Transcranial Magnetic Stimulation for Cognitive Impairment in Schizophrenia. Neurosci Bull 2021; 37:1365-1369. [PMID: 34145549 DOI: 10.1007/s12264-021-00727-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 04/12/2021] [Indexed: 12/21/2022] Open
Affiliation(s)
- Xu-Sha Wu
- School of Medical Technology, Shaanxi University of Chinese Medicine, Xianyang, 712046, China
- Department of Clinical Psychology, School of Medical Psychology, Fourth Military Medical University, Xi'an, 710032, China
| | - Tian-Cai Yan
- School of Medical Imaging, Mudanjiang Medical University, Mudanjiang, 157011, China
| | - Xian-Yang Wang
- Department of Clinical Psychology, School of Medical Psychology, Fourth Military Medical University, Xi'an, 710032, China
| | - Yang Cao
- Department of Clinical Psychology, School of Medical Psychology, Fourth Military Medical University, Xi'an, 710032, China
| | - Xiao-Fan Liu
- School of Medical Technology, Shaanxi University of Chinese Medicine, Xianyang, 712046, China
- Department of Clinical Psychology, School of Medical Psychology, Fourth Military Medical University, Xi'an, 710032, China
| | - Yu-Fei Fu
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Lin Wu
- Department of Clinical Psychology, School of Medical Psychology, Fourth Military Medical University, Xi'an, 710032, China
| | - Yin-Chuan Jin
- Department of Clinical Psychology, School of Medical Psychology, Fourth Military Medical University, Xi'an, 710032, China
| | - Hong Yin
- School of Medical Technology, Shaanxi University of Chinese Medicine, Xianyang, 712046, China.
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China.
| | - Long-Biao Cui
- Department of Clinical Psychology, School of Medical Psychology, Fourth Military Medical University, Xi'an, 710032, China.
- Department of Radiology, The Second Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
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11
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Neville IS, Gomes Dos Santos A, Almeida CC, Hayashi CY, Solla DJF, Galhardoni R, de Andrade DC, Brunoni AR, Teixeira MJ, Paiva WS. Evaluation of Changes in Preoperative Cortical Excitability by Navigated Transcranial Magnetic Stimulation in Patients With Brain Tumor. Front Neurol 2021; 11:582262. [PMID: 33551949 PMCID: PMC7863982 DOI: 10.3389/fneur.2020.582262] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 12/14/2020] [Indexed: 01/09/2023] Open
Abstract
Background: This prospective study aimed to evaluate the cortical excitability (CE) of patients with brain tumors surrounding or directly involving the corticospinal tract (CST) using navigated transcranial magnetic stimulation (nTMS). Methods: We recruited 40 patients with a single brain tumor surrounding or directly involving the CST as well as 82 age- and sex-matched healthy controls. The patients underwent standard nTMS and CE evaluations. Single and paired pulses were applied to the primary motor area (M1) of both affected and unaffected cerebral hemispheres 1 week before surgery. The CE parameters included resting motor threshold (RMT), motor evoked potential (MEP) ratio for 140 and 120% stimulus (MEP 140/120 ratio), short-interval intracortical inhibition (SICI), and intracortical facilitation (ICF). Motor outcome was evaluated on hospital discharge and on 30-day and 90-day postoperative follow-up. Results: In the affected hemispheres of patients, SICI and ICF were significantly higher than in the unaffected hemispheres (p=0.002 and p=0.009, respectively). The 140/120 MEP ratio of patients' unaffected hemispheres was lower than that in controls (p=0.001). Patients with glioblastomas (GBM) had a higher interhemispheric RMT ratio than patients with grade II and III gliomas (p = 0.018). A weak correlation was observed among the RMT ratio and the preoperative motor score (R2 = 0.118, p = 0.017) and the 90-day follow-up (R2 = 0.227, p = 0.016). Conclusion: Using preoperative nTMS, we found that brain hemispheres affected by tumors had abnormal CE and that patients with GBM had a distinct pattern of CE. These findings suggest that tumor biological behavior might play a role in CE changes.
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Affiliation(s)
- Iuri Santana Neville
- Instituto do Cancer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,LIM-62/Division of Neurosurgery, Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Service of Interdisciplinary Neuromodulation, Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Alexandra Gomes Dos Santos
- LIM-62/Division of Neurosurgery, Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Cesar Cimonari Almeida
- LIM-62/Division of Neurosurgery, Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Service of Interdisciplinary Neuromodulation, Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Cintya Yukie Hayashi
- LIM-62/Division of Neurosurgery, Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Service of Interdisciplinary Neuromodulation, Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Davi Jorge Fontoura Solla
- LIM-62/Division of Neurosurgery, Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ricardo Galhardoni
- LIM-62/Division of Neurosurgery, Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Service of Interdisciplinary Neuromodulation, Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,School of Medicine - Universidade da Cidade de São Paulo UNICID, São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- Instituto do Cancer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,LIM-62/Division of Neurosurgery, Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Service of Interdisciplinary Neuromodulation, Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Andre Russowsky Brunoni
- Service of Interdisciplinary Neuromodulation, Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Manoel Jacobsen Teixeira
- LIM-62/Division of Neurosurgery, Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Wellingson Silva Paiva
- LIM-62/Division of Neurosurgery, Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Service of Interdisciplinary Neuromodulation, Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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12
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Rossi S, Antal A, Bestmann S, Bikson M, Brewer C, Brockmöller J, Carpenter LL, Cincotta M, Chen R, Daskalakis JD, Di Lazzaro V, Fox MD, George MS, Gilbert D, Kimiskidis VK, Koch G, Ilmoniemi RJ, Lefaucheur JP, Leocani L, Lisanby SH, Miniussi C, Padberg F, Pascual-Leone A, Paulus W, Peterchev AV, Quartarone A, Rotenberg A, Rothwell J, Rossini PM, Santarnecchi E, Shafi MM, Siebner HR, Ugawa Y, Wassermann EM, Zangen A, Ziemann U, Hallett M. Safety and recommendations for TMS use in healthy subjects and patient populations, with updates on training, ethical and regulatory issues: Expert Guidelines. Clin Neurophysiol 2021; 132:269-306. [PMID: 33243615 PMCID: PMC9094636 DOI: 10.1016/j.clinph.2020.10.003] [Citation(s) in RCA: 505] [Impact Index Per Article: 168.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 12/11/2022]
Abstract
This article is based on a consensus conference, promoted and supported by the International Federation of Clinical Neurophysiology (IFCN), which took place in Siena (Italy) in October 2018. The meeting intended to update the ten-year-old safety guidelines for the application of transcranial magnetic stimulation (TMS) in research and clinical settings (Rossi et al., 2009). Therefore, only emerging and new issues are covered in detail, leaving still valid the 2009 recommendations regarding the description of conventional or patterned TMS protocols, the screening of subjects/patients, the need of neurophysiological monitoring for new protocols, the utilization of reference thresholds of stimulation, the managing of seizures and the list of minor side effects. New issues discussed in detail from the meeting up to April 2020 are safety issues of recently developed stimulation devices and pulse configurations; duties and responsibility of device makers; novel scenarios of TMS applications such as in the neuroimaging context or imaging-guided and robot-guided TMS; TMS interleaved with transcranial electrical stimulation; safety during paired associative stimulation interventions; and risks of using TMS to induce therapeutic seizures (magnetic seizure therapy). An update on the possible induction of seizures, theoretically the most serious risk of TMS, is provided. It has become apparent that such a risk is low, even in patients taking drugs acting on the central nervous system, at least with the use of traditional stimulation parameters and focal coils for which large data sets are available. Finally, new operational guidelines are provided for safety in planning future trials based on traditional and patterned TMS protocols, as well as a summary of the minimal training requirements for operators, and a note on ethics of neuroenhancement.
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Affiliation(s)
- Simone Rossi
- Department of Scienze Mediche, Chirurgiche e Neuroscienze, Unit of Neurology and Clinical Neurophysiology, Brain Investigation and Neuromodulation Lab (SI-BIN Lab), University of Siena, Italy.
| | - Andrea Antal
- Department of Clinical Neurophysiology, University Medical Center, Georg-August University of Goettingen, Germany; Institue of Medical Psychology, Otto-Guericke University Magdeburg, Germany
| | - Sven Bestmann
- Department of Movement and Clinical Neurosciences, UCL Queen Square Institute of Neurology, London, UK and Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, UK
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York, New York, NY, USA
| | - Carmen Brewer
- National Institute on Deafness and Other Communication Disorders, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Jürgen Brockmöller
- Department of Clinical Pharmacology, University Medical Center, Georg-August University of Goettingen, Germany
| | - Linda L Carpenter
- Butler Hospital, Brown University Department of Psychiatry and Human Behavior, Providence, RI, USA
| | - Massimo Cincotta
- Unit of Neurology of Florence - Central Tuscany Local Health Authority, Florence, Italy
| | - Robert Chen
- Krembil Research Institute and Division of Neurology, Department of Medicine, University of Toronto, Canada
| | - Jeff D Daskalakis
- Center for Addiction and Mental Health (CAMH), University of Toronto, Canada
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico, Roma, Italy
| | - Michael D Fox
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Mark S George
- Medical University of South Carolina, Charleston, SC, USA
| | - Donald Gilbert
- Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Vasilios K Kimiskidis
- Laboratory of Clinical Neurophysiology, Aristotle University of Thessaloniki, AHEPA University Hospital, Greece
| | | | - Risto J Ilmoniemi
- Department of Neuroscience and Biomedical Engineering (NBE), Aalto University School of Science, Aalto, Finland
| | - Jean Pascal Lefaucheur
- EA 4391, ENT Team, Faculty of Medicine, Paris Est Creteil University (UPEC), Créteil, France; Clinical Neurophysiology Unit, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, (APHP), Créteil, France
| | - Letizia Leocani
- Department of Neurology, Institute of Experimental Neurology (INSPE), IRCCS-San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
| | - Sarah H Lisanby
- National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Bethesda, MD, USA; Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Carlo Miniussi
- Center for Mind/Brain Sciences - CIMeC, University of Trento, Rovereto, Italy
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research and Center for Memory Health, Hebrew SeniorLife, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA; Guttmann Brain Health Institut, Institut Guttmann, Universitat Autonoma Barcelona, Spain
| | - Walter Paulus
- Department of Clinical Neurophysiology, University Medical Center, Georg-August University of Goettingen, Germany
| | - Angel V Peterchev
- Departments of Psychiatry & Behavioral Sciences, Biomedical Engineering, Electrical & Computer Engineering, and Neurosurgery, Duke University, Durham, NC, USA
| | - Angelo Quartarone
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Alexander Rotenberg
- Department of Neurology, Division of Epilepsy and Clinical Neurophysiology, Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - John Rothwell
- Department of Movement and Clinical Neurosciences, UCL Queen Square Institute of Neurology, London, UK and Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, UK
| | - Paolo M Rossini
- Department of Neuroscience and Rehabilitation, IRCCS San Raffaele-Pisana, Roma, Italy
| | - Emiliano Santarnecchi
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Mouhsin M Shafi
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Hartwig R Siebner
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark; Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark; Institute for Clinical Medicine, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Yoshikatzu Ugawa
- Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Eric M Wassermann
- National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Abraham Zangen
- Zlotowski Center of Neuroscience, Ben Gurion University, Beer Sheva, Israel
| | - Ulf Ziemann
- Department of Neurology & Stroke, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Germany
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA.
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13
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Sorkhabi MM, Wendt K, Denison T. Temporally Interfering TMS: Focal and Dynamic Stimulation Location. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:3537-3543. [PMID: 33018767 DOI: 10.1109/embc44109.2020.9176249] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In this study, we present a temporal interference (TI) concept to achieve focal and steerable stimulation in the targeted brain area through transcranial magnetic stimulation (TMS). This method works by inducing two high-frequency electric fields with a slight frequency difference via two independent coils. The intrinsic nonlinear nature of the nerve membrane, which acts as a low-pass filter, does not allow the nerve to engage at high frequencies. Instead, neurons at the intersection of two electric fields can follow the frequency difference of the two fields. For 3D MRI-derived head models, the finite element method is used to compute the electric field induced by the time-varying magnetic field along with the electric field penetration depth and the activated volume for the specific coil parameters. A deeper stimulation with an acceptable spatial spread can be obtained by controlling the intersection of the fields by finding the optimal position and orientation of the two coils. Moreover, by changing the voltage ratio of the coils, and not their mechanical orientation, the intended area can be dynamically driven. The computational results show that the TI technique is an efficient approach to resolve the electric field depth-focality trade-off, which can be a reasonable alternative to complex coil designs. The system proposed in this paper shows a great promise for a more dynamic and focused magnetic stimulation.
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14
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Draaisma LR, Wessel MJ, Hummel FC. Neurotechnologies as tools for cognitive rehabilitation in stroke patients. Expert Rev Neurother 2020; 20:1249-1261. [DOI: 10.1080/14737175.2020.1820324] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Laurijn R. Draaisma
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Clinique Romande de Réadaptation, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI, Swiss Federal Institute of Technology (EPFL Valais), Sion, Switzerland
| | - Maximilian J. Wessel
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Clinique Romande de Réadaptation, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI, Swiss Federal Institute of Technology (EPFL Valais), Sion, Switzerland
| | - Friedhelm C. Hummel
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Clinique Romande de Réadaptation, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI, Swiss Federal Institute of Technology (EPFL Valais), Sion, Switzerland
- Clinical Neuroscience, University of Geneva Medical School, Geneva, Switzerland
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15
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Xiu MH, Guan HY, Zhao JM, Wang KQ, Pan YF, Su XR, Wang YH, Guo JM, Jiang L, Liu HY, Sun SG, Wu HR, Geng HS, Liu XW, Yu HJ, Wei BC, Li XP, Trinh T, Tan SP, Zhang XY. Cognitive Enhancing Effect of High-Frequency Neuronavigated rTMS in Chronic Schizophrenia Patients With Predominant Negative Symptoms: A Double-Blind Controlled 32-Week Follow-up Study. Schizophr Bull 2020; 46:1219-1230. [PMID: 32185388 PMCID: PMC7505170 DOI: 10.1093/schbul/sbaa035] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Accumulating studies have shown that high-frequency (HF) repetitive transcranial magnetic stimulation (rTMS) may improve cognitive dysfunction of the patients with schizophrenia (SCZ), but with inconsistent results. The present study aims to assess the efficacy of different frequencies of neuronavigated rTMS in ameliorating cognitive impairments and alleviating the psychotic symptoms. A total of 120 patients were randomly assigned to 3 groups: 20 Hz rTMS (n = 40), 10 Hz rTMS (n = 40), or sham stimulation (n = 40) for 8 weeks, and then followed up at week 32. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was performed to assess the cognitive functions of the patients at baseline, at the end of week 8, and week 32 follow-up. Psychotic symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS) at baseline and at the end of week 2, week 4, week 6, week 8, and week 32 follow-up. Our results demonstrated that 20 Hz rTMS treatment produced an effective therapeutic benefit on immediate memory of patients with chronic SCZ at week 8, but not in the 10 Hz group. Interestingly, both 10 Hz and 20 Hz rTMS treatments produced delayed effects on cognitive functions at the 6-month follow-up. Moreover, in both 10 Hz rTMS and 20 Hz rTMS, the improvements in RBANS total score were positively correlated with the reduction of PANSS positive subscore at the 6-month follow-up. Stepwise regression analysis identified that the visuospatial/constructional index, immediate memory index, and prolactin at baseline were predictors for the improvement of cognitive impairments in the patients. Our results suggest that add-on HF rTMS could be an effective treatment for cognitive impairments in patients with chronic SCZ, with a delayed effect. Trial registration: clinicaltrials.gov identifier-NCT03774927.
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Affiliation(s)
- Mei Hong Xiu
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China
| | - Heng Yong Guan
- Department of Psychiatry, Hebei Province Rong-Jun hospital, Baoding, China
| | - Jian Min Zhao
- Department of Psychiatry, Hebei Province Rong-Jun hospital, Baoding, China
| | - Ke Qiang Wang
- Department of Psychiatry, Hebei Province Rong-Jun hospital, Baoding, China
| | - Yan Fen Pan
- Department of Psychiatry, Hebei Province Rong-Jun hospital, Baoding, China
| | - Xiu Ru Su
- Department of Psychiatry, Hebei Province Rong-Jun hospital, Baoding, China
| | - Yu Hong Wang
- Department of Psychiatry, Hebei Province Rong-Jun hospital, Baoding, China
| | - Jin Ming Guo
- Department of Psychiatry, Hebei Province Rong-Jun hospital, Baoding, China
| | - Long Jiang
- Department of Psychiatry, Hebei Province Rong-Jun hospital, Baoding, China
| | - Hong Yu Liu
- Department of Psychiatry, Hebei Province Rong-Jun hospital, Baoding, China
| | - Shi Guang Sun
- Department of Psychiatry, Hebei Province Rong-Jun hospital, Baoding, China
| | - Hao Ran Wu
- Department of Psychiatry, Hebei Province Rong-Jun hospital, Baoding, China
| | - Han Song Geng
- Department of Psychiatry, Hebei Province Rong-Jun hospital, Baoding, China
| | - Xiao Wen Liu
- Department of Psychiatry, Hebei Province Rong-Jun hospital, Baoding, China
| | - Hui Jing Yu
- Department of Psychiatry, Hebei Province Rong-Jun hospital, Baoding, China
| | - Bao Chun Wei
- Department of Psychiatry, Hebei Province Rong-Jun hospital, Baoding, China
| | - Xi Po Li
- Department of Psychiatry, Hebei Province Rong-Jun hospital, Baoding, China
| | - Tammy Trinh
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX
| | - Shu Ping Tan
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China
| | - Xiang Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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16
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Ngetich R, Zhou J, Zhang J, Jin Z, Li L. Assessing the Effects of Continuous Theta Burst Stimulation Over the Dorsolateral Prefrontal Cortex on Human Cognition: A Systematic Review. Front Integr Neurosci 2020; 14:35. [PMID: 32848648 PMCID: PMC7417340 DOI: 10.3389/fnint.2020.00035] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/03/2020] [Indexed: 01/11/2023] Open
Abstract
Theta burst stimulation is increasingly growing in popularity as a non-invasive method of moderating corticospinal networks. Theta burst stimulation uses gamma frequency trains applied at the rhythm of theta, thus, mimicking theta–gamma coupling involved in cognitive processes. The dorsolateral prefrontal cortex has been found to play a crucial role in numerous cognitive processes. Here, we include 25 studies for review to determine the cognitive effects of continuous theta burst stimulation over the dorsolateral prefrontal cortex; 20 of these studies are healthy participant and five are patient (pharmacotherapy-resistant depression) studies. Due to the heterogeneous nature of the included studies, only a descriptive approach is used and meta-analytics ruled out. The cognitive effect is measured on various cognitive domains: attention, working memory, planning, language, decision making, executive function, and inhibitory and cognitive control. We conclude that continuous theta burst stimulation over the dorsolateral prefrontal cortex mainly inhibits cognitive performance. However, in some instances, it can lead to improved performance by inhibiting the effect of distractors or other competing irrelevant cognitive processes. To be precise, continuous theta burst stimulation over the right dorsolateral prefrontal cortex impaired attention, inhibitory control, planning, and goal-directed behavior in decision making but also improved decision making by reducing impulsivity. Conversely, continuous theta burst stimulation over the left dorsolateral prefrontal cortex impaired executive function, working, auditory feedback regulation, and cognitive control but accelerated the planning, decision-making process. These findings constitute a useful contribution to the literature on the cognitive effects of continuous theta burst stimulation over the dorsolateral prefrontal cortex.
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Affiliation(s)
- Ronald Ngetich
- Key Laboratory for Neuroinformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Jing Zhou
- Key Laboratory for Neuroinformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Junjun Zhang
- Key Laboratory for Neuroinformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhenlan Jin
- Key Laboratory for Neuroinformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Ling Li
- Key Laboratory for Neuroinformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
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17
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Leung A, Shirvalkar P, Chen R, Kuluva J, Vaninetti M, Bermudes R, Poree L, Wassermann EM, Kopell B, Levy R. Transcranial Magnetic Stimulation for Pain, Headache, and Comorbid Depression: INS-NANS Expert Consensus Panel Review and Recommendation. Neuromodulation 2020; 23:267-290. [PMID: 32212288 DOI: 10.1111/ner.13094] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/27/2019] [Accepted: 11/25/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND While transcranial magnetic stimulation (TMS) has been studied for the treatment of psychiatric disorders, emerging evidence supports its use for pain and headache by stimulating either motor cortex (M1) or dorsolateral prefrontal cortex (DLPFC). However, its clinical implementation is hindered due to a lack of consensus in the quality of clinical evidence and treatment recommendation/guideline(s). Thus, working collaboratively, this multinational multidisciplinary expert panel aims to: 1) assess and rate the existing outcome evidence of TMS in various pain/headache conditions; 2) provide TMS treatment recommendation/guidelines for the evaluated conditions and comorbid depression; and 3) assess the cost-effectiveness and technical issues relevant to the long-term clinical implementation of TMS for pain and headache. METHODS Seven task groups were formed under the guidance of a 5-member steering committee with four task groups assessing the utilization of TMS in the treatment of Neuropathic Pain (NP), Acute Pain, Primary Headache Disorders, and Posttraumatic Brain Injury related Headaches (PTBI-HA), and remaining three assessing the treatment for both pain and comorbid depression, and the cost-effectiveness and technological issues relevant to the treatment. RESULTS The panel rated the overall level of evidence and recommendability for clinical implementation of TMS as: 1) high and extremely/strongly for both NP and PTBI-HA respectively; 2) moderate for postoperative pain and migraine prevention, and recommendable for migraine prevention. While the use of TMS for treating both pain and depression in one setting is clinically and financially sound, more studies are required to fully assess the long-term benefit of the treatment for the two highly comorbid conditions, especially with neuronavigation. CONCLUSIONS After extensive literature review, the panel provided recommendations and treatment guidelines for TMS in managing neuropathic pain and headaches. In addition, the panel also recommended more outcome and cost-effectiveness studies to assess the feasibility of the long-term clinical implementation of the treatment.
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Affiliation(s)
- Albert Leung
- Professor of Anesthesiology and Pain Medicine, Department of Anesthesiology, Center for Pain Medicine, University of California, San Diego, School of Medicine, La Jolla, CA, USA.,Director, Center for Pain and Headache Research, VA San Diego Healthcare System, La Jolla, CA, USA
| | - Prasad Shirvalkar
- Assistant Professor, Departments of Anesthesiology (Pain Management), Neurology, and Neurosurgery, UCSF School of Medicine, USA
| | - Robert Chen
- Catherine Manson Chair in Movement Disorders, Professor of Medicine (Neurology), University of Toronto, Toronto, Ontario, Canada
| | - Joshua Kuluva
- Neurologist and Psychiatrist, TMS Health Solution, San Francisco, CA, USA
| | - Michael Vaninetti
- Assistant Clinical Professor, Anesthesiology and Pain Medicine, UCSD School of Medicine, La Jolla, CA, USA
| | - Richard Bermudes
- Chief Medical Officer, TMS Health Solutions, Assistant Clinical Professor- Volunteer, Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Lawrence Poree
- Professor of Anesthesiology, Director, Neuromodulation Service, Division of Pain Medicine, University of California, San Francisco, School of Medicine, San Francisco, CA, USA
| | - Eric M Wassermann
- Director, Behavioral Neurology Unit, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Brian Kopell
- Professor of Neurosurgery, Mount Sinai Center for Neuromodulation, New York, NY, USA
| | - Robert Levy
- President of International Neuromodulation Society, Editor-in-Chief, Neuromodulation, Boca Raton, FL, USA
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- See Appendix for Complete List of Task Group Members
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18
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Bakulin I, Zabirova A, Lagoda D, Poydasheva A, Cherkasova A, Pavlov N, Kopnin P, Sinitsyn D, Kremneva E, Fedorov M, Gnedovskaya E, Suponeva N, Piradov M. Combining HF rTMS over the Left DLPFC with Concurrent Cognitive Activity for the Offline Modulation of Working Memory in Healthy Volunteers: A Proof-of-Concept Study. Brain Sci 2020; 10:brainsci10020083. [PMID: 32033106 PMCID: PMC7071618 DOI: 10.3390/brainsci10020083] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/31/2020] [Accepted: 02/03/2020] [Indexed: 01/28/2023] Open
Abstract
It has been proposed that the effectiveness of non-invasive brain stimulation (NIBS) as a cognitive enhancement technique may be enhanced by combining the stimulation with concurrent cognitive activity. However, the benefits of such a combination in comparison to protocols without ongoing cognitive activity have not yet been studied. In the present study, we investigate the effects of fMRI-guided high-frequency repetitive transcranial magnetic stimulation (HF rTMS) over the left dorsolateral prefrontal cortex (DLPFC) on working memory (WM) in healthy volunteers, using an n-back task with spatial and verbal stimuli and a spatial span task. In two combined protocols (TMS + WM + (maintenance) and TMS + WM + (rest)) trains of stimuli were applied in the maintenance and rest periods of the modified Sternberg task, respectively. We compared them to HF rTMS without a cognitive load (TMS + WM −) and control stimulation (TMS − WM + (maintenance)). No serious adverse effects appeared in this study. Among all protocols, significant effects on WM were shown only for the TMS + WM − with oppositely directed influences of this protocol on storage and manipulation in spatial WM. Moreover, there was a significant difference between the effects of TMS + WM − and TMS + WM + (maintenance), suggesting that simultaneous cognitive activity does not necessarily lead to an increase in TMS effects.
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Affiliation(s)
- Ilya Bakulin
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.Z.); (D.L.); (A.P.); (A.C.); (N.P.); (P.K.); (D.S.); (E.K.); (E.G.); (N.S.); (M.P.)
- Correspondence: ; Tel.: +7-495-490-2010
| | - Alfiia Zabirova
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.Z.); (D.L.); (A.P.); (A.C.); (N.P.); (P.K.); (D.S.); (E.K.); (E.G.); (N.S.); (M.P.)
| | - Dmitry Lagoda
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.Z.); (D.L.); (A.P.); (A.C.); (N.P.); (P.K.); (D.S.); (E.K.); (E.G.); (N.S.); (M.P.)
| | - Alexandra Poydasheva
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.Z.); (D.L.); (A.P.); (A.C.); (N.P.); (P.K.); (D.S.); (E.K.); (E.G.); (N.S.); (M.P.)
| | - Anastasiia Cherkasova
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.Z.); (D.L.); (A.P.); (A.C.); (N.P.); (P.K.); (D.S.); (E.K.); (E.G.); (N.S.); (M.P.)
| | - Nikolay Pavlov
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.Z.); (D.L.); (A.P.); (A.C.); (N.P.); (P.K.); (D.S.); (E.K.); (E.G.); (N.S.); (M.P.)
| | - Peter Kopnin
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.Z.); (D.L.); (A.P.); (A.C.); (N.P.); (P.K.); (D.S.); (E.K.); (E.G.); (N.S.); (M.P.)
| | - Dmitry Sinitsyn
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.Z.); (D.L.); (A.P.); (A.C.); (N.P.); (P.K.); (D.S.); (E.K.); (E.G.); (N.S.); (M.P.)
| | - Elena Kremneva
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.Z.); (D.L.); (A.P.); (A.C.); (N.P.); (P.K.); (D.S.); (E.K.); (E.G.); (N.S.); (M.P.)
| | - Maxim Fedorov
- Skolkovo Institute of Science and Technology, Bolshoy Boulevard, 30, bld. 1, Territory of Innovation Center «Skolkovo», Moscow 121205, Russia;
| | - Elena Gnedovskaya
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.Z.); (D.L.); (A.P.); (A.C.); (N.P.); (P.K.); (D.S.); (E.K.); (E.G.); (N.S.); (M.P.)
- Skolkovo Institute of Science and Technology, Bolshoy Boulevard, 30, bld. 1, Territory of Innovation Center «Skolkovo», Moscow 121205, Russia;
| | - Natalia Suponeva
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.Z.); (D.L.); (A.P.); (A.C.); (N.P.); (P.K.); (D.S.); (E.K.); (E.G.); (N.S.); (M.P.)
| | - Michael Piradov
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.Z.); (D.L.); (A.P.); (A.C.); (N.P.); (P.K.); (D.S.); (E.K.); (E.G.); (N.S.); (M.P.)
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19
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Yang X, Zhang K. Navigated transcranial magnetic stimulation brain mapping: Achievements, opportunities, and prospects. GLIOMA 2020. [DOI: 10.4103/glioma.glioma_13_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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20
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Lefaucheur JP, Aleman A, Baeken C, Benninger DH, Brunelin J, Di Lazzaro V, Filipović SR, Grefkes C, Hasan A, Hummel FC, Jääskeläinen SK, Langguth B, Leocani L, Londero A, Nardone R, Nguyen JP, Nyffeler T, Oliveira-Maia AJ, Oliviero A, Padberg F, Palm U, Paulus W, Poulet E, Quartarone A, Rachid F, Rektorová I, Rossi S, Sahlsten H, Schecklmann M, Szekely D, Ziemann U. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): An update (2014-2018). Clin Neurophysiol 2020; 131:474-528. [PMID: 31901449 DOI: 10.1016/j.clinph.2019.11.002] [Citation(s) in RCA: 907] [Impact Index Per Article: 226.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 10/21/2019] [Accepted: 11/02/2019] [Indexed: 02/08/2023]
Abstract
A group of European experts reappraised the guidelines on the therapeutic efficacy of repetitive transcranial magnetic stimulation (rTMS) previously published in 2014 [Lefaucheur et al., Clin Neurophysiol 2014;125:2150-206]. These updated recommendations take into account all rTMS publications, including data prior to 2014, as well as currently reviewed literature until the end of 2018. Level A evidence (definite efficacy) was reached for: high-frequency (HF) rTMS of the primary motor cortex (M1) contralateral to the painful side for neuropathic pain; HF-rTMS of the left dorsolateral prefrontal cortex (DLPFC) using a figure-of-8 or a H1-coil for depression; low-frequency (LF) rTMS of contralesional M1 for hand motor recovery in the post-acute stage of stroke. Level B evidence (probable efficacy) was reached for: HF-rTMS of the left M1 or DLPFC for improving quality of life or pain, respectively, in fibromyalgia; HF-rTMS of bilateral M1 regions or the left DLPFC for improving motor impairment or depression, respectively, in Parkinson's disease; HF-rTMS of ipsilesional M1 for promoting motor recovery at the post-acute stage of stroke; intermittent theta burst stimulation targeted to the leg motor cortex for lower limb spasticity in multiple sclerosis; HF-rTMS of the right DLPFC in posttraumatic stress disorder; LF-rTMS of the right inferior frontal gyrus in chronic post-stroke non-fluent aphasia; LF-rTMS of the right DLPFC in depression; and bihemispheric stimulation of the DLPFC combining right-sided LF-rTMS (or continuous theta burst stimulation) and left-sided HF-rTMS (or intermittent theta burst stimulation) in depression. Level A/B evidence is not reached concerning efficacy of rTMS in any other condition. The current recommendations are based on the differences reached in therapeutic efficacy of real vs. sham rTMS protocols, replicated in a sufficient number of independent studies. This does not mean that the benefit produced by rTMS inevitably reaches a level of clinical relevance.
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Affiliation(s)
- Jean-Pascal Lefaucheur
- ENT Team, EA4391, Faculty of Medicine, Paris Est Créteil University, Créteil, France; Clinical Neurophysiology Unit, Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France.
| | - André Aleman
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - 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; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - David H Benninger
- Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Jérôme Brunelin
- PsyR2 Team, U1028, INSERM and UMR5292, CNRS, Center for Neuroscience Research of Lyon (CRNL), Centre Hospitalier Le Vinatier, Lyon-1 University, Bron, France
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Saša R Filipović
- Department of Human Neuroscience, Institute for Medical Research, University of Belgrade, Belgrade, Serbia
| | - Christian Grefkes
- Department of Neurology, Cologne University Hospital, Cologne, Germany; Institute of Neurosciences and Medicine (INM3), Jülich Research Centre, Jülich, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Friedhelm C Hummel
- Defitech Chair in Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland; Defitech Chair in Clinical Neuroengineering, Swiss Federal Institute of Technology (EPFL) Valais and Clinique Romande de Réadaptation, Sion, Switzerland; Clinical Neuroscience, University of Geneva Medical School, Geneva, Switzerland
| | - Satu K Jääskeläinen
- Department of Clinical Neurophysiology, Turku University Hospital and University of Turku, Turku, Finland
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Letizia Leocani
- Department of Neurorehabilitation and Experimental Neurophysiology Unit, Institute of Experimental Neurology (INSPE), IRCCS San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Alain Londero
- Department of Otorhinolaryngology - Head and Neck Surgery, Université Paris Descartes Sorbonne Paris Cité, Hôpital Européen Georges Pompidou, Paris, France
| | - Raffaele Nardone
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy; Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria; Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria
| | - Jean-Paul Nguyen
- Multidisciplinary Pain Center, Clinique Bretéché, ELSAN, Nantes, France; Multidisciplinary Pain, Palliative and Supportive Care Center, UIC22-CAT2-EA3826, University Hospital, CHU Nord-Laënnec, Nantes, France
| | - Thomas Nyffeler
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland; Perception and Eye Movement Laboratory, Department of Neurology, University of Bern, Bern, Switzerland; Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Albino J Oliveira-Maia
- Champalimaud Research & Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal; Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Antonio Oliviero
- FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Ulrich Palm
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Medical Park Chiemseeblick, Bernau, Germany
| | - Walter Paulus
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Göttingen, Germany
| | - Emmanuel Poulet
- PsyR2 Team, U1028, INSERM and UMR5292, CNRS, Center for Neuroscience Research of Lyon (CRNL), Centre Hospitalier Le Vinatier, Lyon-1 University, Bron, France; Department of Emergency Psychiatry, Edouard Herriot Hospital, Groupement Hospitalier Centre, Hospices Civils de Lyon, Lyon, France
| | - Angelo Quartarone
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | | | - Irena Rektorová
- Applied Neuroscience Research Group, Central European Institute of Technology, CEITEC MU, Masaryk University, Brno, Czech Republic; First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Simone Rossi
- Department of Medicine, Surgery and Neuroscience, Si-BIN Lab Human Physiology Section, Neurology and Clinical Neurophysiology Unit, University of Siena, Siena, Italy
| | - Hanna Sahlsten
- ENT Clinic, Mehiläinen and University of Turku, Turku, Finland
| | - Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - David Szekely
- Department of Psychiatry, Princess Grace Hospital, Monaco
| | - Ulf Ziemann
- Department of Neurology and Stroke, and Hertie Institute for Clinical Brain Research, Eberhard Karls University, Tübingen, Germany
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21
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Moisset X, Lanteri-Minet M, Fontaine D. Neurostimulation methods in the treatment of chronic pain. J Neural Transm (Vienna) 2019; 127:673-686. [PMID: 31637517 DOI: 10.1007/s00702-019-02092-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 10/06/2019] [Indexed: 02/07/2023]
Abstract
The goal of this narrative review was to give an up-to-date overview of the peripheral and central neurostimulation methods that can be used to treat chronic pain. Special focus has been given to three pain conditions: neuropathic pain, nociplastic pain and primary headaches. Both non-invasive and invasive techniques are briefly presented together with their pain relief potentials. For non-invasive stimulation techniques, data concerning transcutaneous electrical nerve stimulation (TENS), transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), remote electrical neuromodulation (REN) and vagus nerve stimulation (VNS) are provided. Concerning invasive stimulation techniques, occipital nerve stimulation (ONS), vagus nerve stimulation (VNS), epidural motor cortex stimulation (EMCS), spinal cord stimulation (SCS) and deep brain stimulation (DBS) are presented. The action mode of all these techniques is only partly understood but can be very different from one technique to the other. Patients' selection is still a challenge. Recent consensus-based guidelines for clinical practice are presented when available. The development of closed-loop devices could be of interest in the future, although the clinical benefit over open loop is not proven yet.
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Affiliation(s)
- X Moisset
- Service de Neurologie, Université Clermont-Auvergne, INSERM, Neuro-Dol, CHU Clermont-Ferrand, Clermont-Ferrand, France.
| | - M Lanteri-Minet
- Pain Department, CHU Nice, FHU InovPain Côte Azur University, Nice, France
- Université Clermont-Auvergne, INSERM, Neuro-Dol, Clermont-Ferrand, France
| | - D Fontaine
- Department of Neurosurgery, Université Côte Azur University, CHU de Nice, FHU InovPain, Nice, France
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22
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Lefaucheur JP, Nguyen JP. A practical algorithm for using rTMS to treat patients with chronic pain. Neurophysiol Clin 2019; 49:301-307. [PMID: 31375381 DOI: 10.1016/j.neucli.2019.07.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 07/10/2019] [Accepted: 07/12/2019] [Indexed: 12/12/2022] Open
Abstract
High-frequency repetitive transcranial magnetic stimulation (rTMS) of the primary motor cortex has a good level of evidence of efficacy as a method for providing analgesic effects in patients with chronic pain. However, there is still no consensus regarding the parameters of stimulation to use and the detailed protocol to apply for therapeutic practice. In this article, we review the main technical points to address, and we propose a practical algorithm of how to use rTMS for chronic pain treatment in daily clinical practice.
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Affiliation(s)
- Jean-Pascal Lefaucheur
- UPEC, EA4391, Clinical Neurophysiology Department, Henri-Mondor University Hospital, Faculty of Medicine, 94010 Créteil, France.
| | - Jean-Paul Nguyen
- Multidisciplinary Pain, Palliative and Supportive care Center, UIC 22/CAT2 and Laboratoire de Thérapeutique (EA3826), University Hospital, 44000 Nantes, France; Multidisciplinary Pain Center, groupe ELSAN, clinique Bretéché, 44000 Nantes, France
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23
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Personalized repetitive transcranial magnetic stimulation temporarily alters default mode network in healthy subjects. Sci Rep 2019; 9:5631. [PMID: 30948765 PMCID: PMC6449366 DOI: 10.1038/s41598-019-42067-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 03/19/2019] [Indexed: 12/27/2022] Open
Abstract
High frequency repetitive transcranial magnetic stimulation (HF-rTMS) delivered to the left dorsolateral prefrontal cortex (DLPFC) is an effective treatment option for treatment resistant depression. However, the underlying mechanisms of a full session of HF-rTMS in healthy volunteers have not yet been described. Here we investigated, with a personalized selection of DLPFC stimulation sites, the effects driven by HF-rTMS in healthy volunteers (n = 23) over the default mode network (DMN) in multiple time windows. After a complete 10 Hz rTMS (3000 pulses) session, we observe a decrease of functional connectivity between the DMN and the subgenual Anterior Cingulate Cortex (sgACC), as well as the ventral striatum (vStr). A negative correlation between the magnitude of this decrease in the right sgACC and the harm avoidance domain measure from the Temperament and Character Inventory was observed. Moreover, we identify that coupling strength of right vStr with the DMN post-stimulation was proportional to a decrease in self-reports of negative mood from the Positive and Negative Affect Schedule. This shows HF-rTMS attenuates perception of negative mood in healthy recipients in agreement with the expected effects in patients. Our study, by using a personalized selection of DLPFC stimulation sites, contributes understanding the effects of a full session of rTMS approved for clinical use in depression over related brain regions in healthy volunteers.
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Charalambous CC, Liang JN, Kautz SA, George MS, Bowden MG. Bilateral Assessment of the Corticospinal Pathways of the Ankle Muscles Using Navigated Transcranial Magnetic Stimulation. J Vis Exp 2019. [PMID: 30855569 DOI: 10.3791/58944] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Distal leg muscles receive neural input from motor cortical areas via the corticospinal tract, which is one of the main motor descending pathway in humans and can be assessed using transcranial magnetic stimulation (TMS). Given the role of distal leg muscles in upright postural and dynamic tasks, such as walking, a growing research interest in the assessment and modulation of the corticospinal tracts relative to the function of these muscles has emerged in the last decade. However, methodological parameters used in previous work have varied across studies making the interpretation of results from cross-sectional and longitudinal studies less robust. Therefore, use of a standardized TMS protocol specific to the assessment of leg muscles' corticomotor response (CMR) will allow for direct comparison of results across studies and cohorts. The objective of this paper is to present a protocol that provides the flexibility to simultaneously assess the bilateral CMR of two main ankle antagonistic muscles, the tibialis anterior and soleus, using single pulse TMS with a neuronavigation system. The present protocol is applicable while the examined muscle is either fully relaxed or isometrically contracted at a defined percentage of maximum isometric voluntary contraction. Using each subject's structural MRI with the neuronavigation system ensures accurate and precise positioning of the coil over the leg cortical representations during assessment. Given the inconsistency in CMR derived measures, this protocol also describes a standardized calculation of these measures using automated algorithms. Though this protocol is not conducted during upright postural or dynamic tasks, it can be used to assess bilaterally any pair of leg muscles, either antagonistic or synergistic, in both neurologically intact and impaired subjects.
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Affiliation(s)
- Charalambos C Charalambous
- Department of Neurology, New York University School of Medicine; Department of Health Sciences and Research, Medical University of South Carolina;
| | - Jing Nong Liang
- Department of Physical Therapy, University of Nevada Las Vegas; Department of Health Professions, Medical University of South Carolina
| | - Steve A Kautz
- Department of Health Sciences and Research, Medical University of South Carolina; Ralph H. Johnson VA Medical Center
| | - Mark S George
- Ralph H. Johnson VA Medical Center; Department of Psychiatry, Medical University of South Carolina
| | - Mark G Bowden
- Department of Health Sciences and Research, Medical University of South Carolina; Ralph H. Johnson VA Medical Center; Division of Physical Therapy, Medical University of South Carolina
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Moisset X, Lefaucheur JP. Non pharmacological treatment for neuropathic pain: Invasive and non-invasive cortical stimulation. Rev Neurol (Paris) 2018; 175:51-58. [PMID: 30322590 DOI: 10.1016/j.neurol.2018.09.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 09/10/2018] [Indexed: 01/10/2023]
Abstract
The use of medications in chronic neuropathic pain may be limited with regard to efficacy and tolerance. Therefore, non-pharmacological approaches, using electrical stimulation of the cortex has been proposed as an alternative. First, in the early nineties, surgically-implanted epidural motor cortex stimulation (EMCS) was proven to be effective to relieve refractory neuropathic pain. Later, non-invasive stimulation techniques were found to produce similar analgesic effects, at least by means of repetitive transcranial magnetic stimulation (rTMS) targeting the primary motor cortex (M1). Following "high-frequency" rTMS (e.g., stimulation frequency ranging from 5 to 20Hz) delivered to the precentral gyrus (e.g., M1 region), it is possible to obtain an analgesic effect via the modulation of several remote brain regions involved in nociceptive information processing or control. This pain reduction can last for weeks beyond the time of the stimulation, especially if repeated sessions are performed, probably related to processes of long-term synaptic plasticity. Transcranial direct current stimulation (tDCS), another form of transcranial stimulation, using low-intensity electrical currents, generally delivered by a pair of large electrodes, has also shown some efficacy to improve patients with chronic pain syndromes. The mechanism of action of tDCS differs from that of EMCS and rTMS, but the cortical target is the same, which is M1. Although the level of evidence of therapeutic efficacy in the context of neuropathic pain is lower for tDCS than for rTMS, interesting perspectives are opened by using at-home tDCS protocols for long-term management. Now, there is a scientific basis for recommending both EMCS and rTMS of M1 to treat refractory chronic neuropathic pain, but their application in clinical practice remains limited due to practical and regulatory issues.
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Affiliation(s)
- X Moisset
- Inserm, service de neurologie Clermont-Ferrand, université Clermont-Auvergne, Neuro-Dol, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France.
| | - J-P Lefaucheur
- Service de physiologie, explorations fonctionnelles, EA 4391, faculté de médecine, université Paris Est Créteil, 94000 Créteil, France; Hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, 94000 Créteil, France
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A reappraisal of pain-paired associative stimulation suggesting motor inhibition at spinal level. Neurophysiol Clin 2018; 48:295-302. [DOI: 10.1016/j.neucli.2018.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/15/2018] [Accepted: 04/24/2018] [Indexed: 01/17/2023] Open
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de Goede AA, Ter Braack EM, van Putten MJAM. Accurate Coil Positioning is Important for Single and Paired Pulse TMS on the Subject Level. Brain Topogr 2018; 31:917-930. [PMID: 29943242 PMCID: PMC6182440 DOI: 10.1007/s10548-018-0655-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 06/07/2018] [Indexed: 12/04/2022]
Abstract
Function-guided navigation is commonly used when assessing cortical excitability using transcranial magnetic stimulation (TMS). However, the required accuracy, stability and the effect of a change in coil positioning are not entirely known. This study investigates the accuracy of function-guided navigation for determining the hotspot. Furthermore, it evaluates the effect of a change in coil location on the single and paired pulse excitability measures: motor evoked potential (MEP) amplitude, TMS evoked potential (TEP) and long intracortical inhibition (LICI), and of a change in coil orientation on LICI. Eight healthy subjects participated in the single pulse study, and ten in the paired pulse study. A robot-guided navigation system was used to ensure accurate and stable coil positioning at the motor hotspot as determined using function-guided navigation. In addition, we targeted four locations at 2 mm and four at 5 mm distance around the initially defined hotspot, and we increased and decreased the coil orientation by 10°. In none of the subjects, the largest MEP amplitudes were evoked at the originally determined hotspot, resulting in a poor accuracy of function-guided navigation. At the group level, a change in coil location had no significant effect on the MEP amplitude, TEP, or LICI, and a change in coil orientation did not significantly affected LICI. However, at the subject level significant effects on MEP amplitude, TEP, and LICI were found for changes in coil location or orientation, although absolute differences were relatively small and did not show a consistent pattern. This study indicates that a high accuracy in coil positioning is especially required to measure cortical excitability reliably in individual subjects using single or paired pulse TMS.
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Affiliation(s)
- Annika A de Goede
- Department of Clinical Neurophysiology, Technical Medical Centre, University of Twente, Carré 3.714, P.O. Box 217, 7500 AE, Enschede, The Netherlands.
| | - Esther M Ter Braack
- Department of Clinical Neurophysiology, Technical Medical Centre, University of Twente, Carré 3.714, P.O. Box 217, 7500 AE, Enschede, The Netherlands
| | - Michel J A M van Putten
- Department of Clinical Neurophysiology, Technical Medical Centre, University of Twente, Carré 3.714, P.O. Box 217, 7500 AE, Enschede, The Netherlands
- Department of Neurology and Clinical Neurophysiology, Medisch Spectrum Twente, Enschede, The Netherlands
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Huberfeld G, Trébuchon A, Capelle L, Badier JM, Chen S, Lefaucheur JP, Gavaret M. Preoperative and intraoperative neurophysiological investigations for surgical resections in functional areas. Neurochirurgie 2017; 63:142-149. [DOI: 10.1016/j.neuchi.2016.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 10/17/2016] [Accepted: 10/31/2016] [Indexed: 01/23/2023]
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Lefaucheur JP. Stimolazione magnetica ed elettrica della corteccia cerebrale. Neurologia 2017. [DOI: 10.1016/s1634-7072(16)81782-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Pommier B, Vassal F, Boutet C, Jeannin S, Peyron R, Faillenot I. Easy methods to make the neuronavigated targeting of DLPFC accurate and routinely accessible for rTMS. Neurophysiol Clin 2017; 47:35-46. [DOI: 10.1016/j.neucli.2017.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 01/03/2017] [Indexed: 12/22/2022] Open
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de Goede AA, van Putten MJAM. Repeatability of long intracortical inhibition in healthy subjects. Clin Neurophysiol Pract 2016; 2:26-34. [PMID: 30214967 PMCID: PMC6123853 DOI: 10.1016/j.cnp.2016.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 11/13/2016] [Accepted: 12/07/2016] [Indexed: 12/04/2022] Open
Abstract
LICI repeatability showed a large variation at the subject level and ISI level. Good repeatability at group level decreased when including inter-subject variation. Added value of robot-guided coil positioning seems limited for paired pulse TMS.
Objectives Transcranial magnetic stimulation (TMS) is widely used to assess cortical excitability. To detect changes in excitability with longitudinal studies, it is important to validate the repeatability of excitability measures within a subject between different sessions. Repeatability studies on long intracortical inhibition (LICI) are limited and reported agreement ranges from poor to good. This study aims to evaluate the repeatability of LICI in healthy subjects using paired pulse TMS. In addition, it investigates whether LICI repeatability differs for manual and robot-guided coil positioning. Methods Thirty healthy subjects (10 males, mean age 28.4 ± 8.2 years) were studied twice, approximately one week apart. Both motor cortices were stimulated with 50 paired pulses (intensity 120% of resting motor threshold) at interstimulus intervals (ISIs): 50, 100, 150, 200, 250 and 300 ms. In twenty subjects a figure-of-eight coil was positioned and held in place manually during both sessions, while in ten subjects a robot-navigated arm was used. LICI repeatability was assessed using the intraclass correlation coefficient (ICC). Results For manual and robot-guided coil positioning we found a large variation in repeatability at the subject level and ISI level, ranging from poor to good agreement. On a group level, we found good repeatability for averaged LICI curves (manual: ICC = 0.91, robot-guided: ICC = 0.95), which decreased when individual curves were correlated between sessions (manual: ICC = 0.76, robot-guided: ICC = 0.84). Conclusion For a correct interpretation of longitudinal study outcomes it is important to know the subject specific LICI repeatability and to analyze each ISI individually. Furthermore, the added value of robot-guided coil positioning for paired pulse TMS seems limited. Significance The large variation in LICI repeatability at the subject level and ISI level should be taken into account in longitudinal studies, while robot-guided coil positioning seems unnecessary.
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Affiliation(s)
- Annika A de Goede
- Department of Clinical Neurophysiology, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands
| | - Michel J A M van Putten
- Department of Clinical Neurophysiology, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands.,Department of Neurology and Clinical Neurophysiology, Medisch Spectrum Twente, P.O. Box 50000, 7500 KA Enschede, The Netherlands
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Lage C, Wiles K, Shergill SS, Tracy DK. A systematic review of the effects of low-frequency repetitive transcranial magnetic stimulation on cognition. J Neural Transm (Vienna) 2016; 123:1479-1490. [PMID: 27503083 PMCID: PMC5110586 DOI: 10.1007/s00702-016-1592-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 06/29/2016] [Indexed: 01/18/2023]
Abstract
rTMS is increasingly used for a variety of neuropsychiatric conditions. There are data to support 'fast' rTMS (≥10 Hz) having some positive effects on cognitive functioning, but a dearth of research looking at any such effects of 'slow' rTMS. This question is important as cognitive dysfunction accompanies many neuropsychiatric conditions and neuromodulation that potentially enhances or hinders such functioning has important clinical consequences. To determine cognitive effects of slow (≤1 Hz) rTMS, a systematic review of randomized control trials assayed cognition in neurological, psychiatric, and healthy volunteer ≤1 Hz rTMS paradigms. Both active (fast rTMS) and placebo comparators were included. 497 Records were initially obtained; 20 met inclusion criteria for evaluation. Four major categories emerged: mood disorders; psychotic disorders; cerebrovascular accidents; and 'other' (PTSD, OCD, epilepsy, anxiety, and tinnitus). Cognitive effects were measured across several domains: attention, executive functioning, learning, and psychomotor speed. Variability of study paradigms and reporting precluded meta-analytical analysis. No statistically significant improvement or deterioration was consistently found in any cognitive domain or illness category. These data support the overall safety of rTMS in not adversely affecting cognitive functioning. There are some data indicating that rTMS might have cognitive enhancing potential, but these are too limited at this time to make any firm conclusions, and the literature is marked by considerable heterogeneity in study parameters that hinder interpretation. Greater consensus is required in future studies in cognitive markers, and particularly in reporting of protocols. Future work should evaluate the effects of rTMS on cognitive training.
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Affiliation(s)
- Claudia Lage
- Cognition, Schizophrenia and Imaging Laboratory, The Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | - Sukhwinder S. Shergill
- Cognition, Schizophrenia and Imaging Laboratory, The Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Derek K. Tracy
- Cognition, Schizophrenia and Imaging Laboratory, The Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Oxleas NHS Foundation Trust, London, UK
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Cortical neurostimulation for neuropathic pain: state of the art and perspectives. Pain 2016; 157 Suppl 1:S81-S89. [PMID: 26785160 DOI: 10.1097/j.pain.0000000000000401] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The treatment of neuropathic pain by neuromodulation is an objective for more than 40 years in modern clinical practice. With respect to spinal cord and deep brain structures, the cerebral cortex is the most recently evaluated target of invasive neuromodulation therapy for pain. In the early 90s, the first successes of invasive epidural motor cortex stimulation (EMCS) were published. A few years later was developed repetitive transcranial magnetic stimulation (rTMS), a noninvasive stimulation technique. Then, electrical transcranial stimulation returned valid and is currently in full development, with transcranial direct current stimulation (tDCS). Regarding transcranial approaches, the main studied and validated target was still the motor cortex, but other cortical targets are under investigation. The mechanisms of action of these techniques share similarities, especially between EMCS and rTMS, but they also have differences that could justify specific indications and applications. It is therefore important to know the principles and to assess the merit of these techniques on the basis of a rigorous assessment of the results, to avoid fad. Various types of chronic neuropathic pain syndromes can be significantly relieved by EMCS or repeated daily sessions of high-frequency (5-20 Hz) rTMS or anodal tDCS over weeks, at least when pain is lateralized and stimulation is applied to the motor cortex contralateral to pain side. However, cortical stimulation therapy remains to be optimized, especially by improving EMCS electrode design, rTMS targeting, or tDCS montage, to reduce the rate of nonresponders, who do not experience clinically relevant effects of these techniques.
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Uglem M, Omland P, Engstrøm M, Gravdahl G, Linde M, Hagen K, Sand T. Non-invasive cortical modulation of experimental pain in migraine. Clin Neurophysiol 2016; 127:2362-9. [DOI: 10.1016/j.clinph.2016.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/10/2016] [Accepted: 03/12/2016] [Indexed: 11/29/2022]
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The value of preoperative functional cortical mapping using navigated TMS. Neurophysiol Clin 2016; 46:125-33. [PMID: 27229765 DOI: 10.1016/j.neucli.2016.05.001] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 05/02/2016] [Indexed: 01/29/2023] Open
Abstract
The surgical removal of brain tumours in so-called eloquent regions is frequently associated with a high risk of causing disabling postoperative deficits. Among the preoperative techniques proposed to help neurosurgical planning and procedure, navigated transcranial magnetic stimulation (nTMS) is increasingly performed. A high level of evidence is now available in the literature regarding the anatomical and functional accuracy of this mapping technique. This article presents the principles and facts demonstrating the value of using nTMS in clinical practice to preserve motor or language functions from deleterious lesions secondary to brain tumour resection or epilepsy surgery.
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Abstract
Recognizing that electrically stimulating the motor cortex could relieve chronic pain sparked development of noninvasive technologies. In transcranial magnetic stimulation (TMS), electromagnetic coils held against the scalp influence underlying cortical firing. Multiday repetitive transcranial magnetic stimulation (rTMS) can induce long-lasting, potentially therapeutic brain plasticity. Nearby ferromagnetic or electronic implants are contraindications. Adverse effects are minimal, primarily headaches. Single provoked seizures are very rare. Transcranial magnetic stimulation devices are marketed for depression and migraine in the United States and for various indications elsewhere. Although multiple studies report that high-frequency rTMS of the motor cortex reduces neuropathic pain, their quality has been insufficient to support Food and Drug Administration application. Harvard's Radcliffe Institute therefore sponsored a workshop to solicit advice from experts in TMS, pain research, and clinical trials. They recommended that researchers standardize and document all TMS parameters and improve strategies for sham and double blinding. Subjects should have common well-characterized pain conditions amenable to motor cortex rTMS and studies should be adequately powered. They recommended standardized assessment tools (eg, NIH's PROMIS) plus validated condition-specific instruments and consensus-recommended metrics (eg, IMMPACT). Outcomes should include pain intensity and qualities, patient and clinician impression of change, and proportions achieving 30% and 50% pain relief. Secondary outcomes could include function, mood, sleep, and/or quality of life. Minimum required elements include sample sources, sizes, and demographics, recruitment methods, inclusion and exclusion criteria, baseline and posttreatment means and SD, adverse effects, safety concerns, discontinuations, and medication-usage records. Outcomes should be monitored for at least 3 months after initiation with prespecified statistical analyses. Multigroup collaborations or registry studies may be needed for pivotal trials.
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Analgesic effects of navigated motor cortex rTMS in patients with chronic neuropathic pain. Eur J Pain 2016; 20:1413-22. [DOI: 10.1002/ejp.864] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2016] [Indexed: 12/12/2022]
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Ahdab R, Ayache SS, Brugières P, Farhat WH, Lefaucheur JP. The Hand Motor Hotspot is not Always Located in the Hand Knob: A Neuronavigated Transcranial Magnetic Stimulation Study. Brain Topogr 2016; 29:590-7. [PMID: 26980192 DOI: 10.1007/s10548-016-0486-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/10/2016] [Indexed: 10/22/2022]
Abstract
The hand motor hot spot (hMHS) is one of the most salient parameters in transcranial magnetic stimulation (TMS) practice, notably used for targeting. It is commonly accepted that the hMHS corresponds to the hand representation within the primary motor cortex (M1). Anatomical and imaging studies locate this representation in a region of the central sulcus called the "hand knob". The aim of this study was to determine if the hMHS location corresponds to its expected location at the hand knob. Twelve healthy volunteers and eleven patients with chronic neuropathic pain of various origins, but not related to a brain lesion, were enrolled. Morphological magnetic resonance imaging of the brain was normal in all participants. Both hemispheres were studied in all participants except four (two patients and two healthy subjects). Cortical mapping of the hand motor area was conducted using a TMS-dedicated navigation system and recording motor evoked potentials (MEPs) in the contralateral first dorsal interosseous (FDI) muscle. We then determined the anatomical position of the hMHS, defined as the stimulation site providing the largest FDI-MEPs. In 45 % of hemispheres of normal subjects and 25 % of hemispheres of pain patients, the hMHS was located over the central sulcus, most frequently at the level of the hand knob. However, in the other cases, the hMHS was located outside M1, most frequently anteriorly over the precentral or middle frontal gyrus. This study shows that the hMHS does not always correspond to the hand knob and M1 location in healthy subjects or patients. Therefore, image-guided navigation is needed to improve the anatomical accuracy of TMS targeting, even for M1.
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Affiliation(s)
- Rechdi Ahdab
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France.,Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, 51 avenue de Lattre de Tassigny, 94010, Créteil, France.,Neurology Division, University Medical Center Rizk Hospital, Beirut, Lebanon
| | - Samar S Ayache
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France. .,Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, 51 avenue de Lattre de Tassigny, 94010, Créteil, France. .,Neurology Division, University Medical Center Rizk Hospital, Beirut, Lebanon.
| | - Pierre Brugières
- Service de Neuroradiologie, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - Wassim H Farhat
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France.,Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, 51 avenue de Lattre de Tassigny, 94010, Créteil, France
| | - Jean-Pascal Lefaucheur
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France.,Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, 51 avenue de Lattre de Tassigny, 94010, Créteil, France
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Chalah MA, Riachi N, Ahdab R, Créange A, Lefaucheur JP, Ayache SS. Fatigue in Multiple Sclerosis: Neural Correlates and the Role of Non-Invasive Brain Stimulation. Front Cell Neurosci 2015; 9:460. [PMID: 26648845 PMCID: PMC4663273 DOI: 10.3389/fncel.2015.00460] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 11/11/2015] [Indexed: 12/21/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic progressive inflammatory disease of the central nervous system (CNS) and the major cause of non-traumatic disability in young adults. Fatigue is a frequent symptom reported by the majority of MS patients during their disease course and drastically affects their quality of life. Despite its significant prevalence and impact, the underlying pathophysiological mechanisms are not well elucidated. MS fatigue is still considered the result of multifactorial and complex constellations, and is commonly classified into “primary” fatigue related to the pathological changes of the disease itself, and “secondary” fatigue attributed to mimicking symptoms, comorbid sleep and mood disorders, and medications side effects. Radiological, physiological, and endocrine data have raised hypotheses regarding the origin of this symptom, some of which have succeeded in identifying an association between MS fatigue and structural or functional abnormalities within various brain networks. Hence, the aim of this work is to reappraise the neural correlates of MS fatigue and to discuss the rationale for the emergent use of noninvasive brain stimulation (NIBS) techniques as potential treatments. This will include a presentation of the various NIBS modalities and a suggestion of their potential mechanisms of action in this context. Specific issues related to the value of transcranial direct current stimulation (tDCS) will be addressed.
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Affiliation(s)
- Moussa A Chalah
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil Créteil, France ; Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris Créteil, France
| | - Naji Riachi
- Neurology Division, University Medical Center Rizk Hospital Beirut, Lebanon
| | - Rechdi Ahdab
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil Créteil, France ; Neurology Division, University Medical Center Rizk Hospital Beirut, Lebanon
| | - Alain Créange
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil Créteil, France ; Service de Neurologie, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris Créteil, France
| | - Jean-Pascal Lefaucheur
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil Créteil, France ; Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris Créteil, France
| | - Samar S Ayache
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil Créteil, France ; Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris Créteil, France
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Chalah MA, Lefaucheur JP, Ayache SS. Non-invasive Central and Peripheral Stimulation: New Hope for Essential Tremor? Front Neurosci 2015; 9:440. [PMID: 26635516 PMCID: PMC4649015 DOI: 10.3389/fnins.2015.00440] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 11/01/2015] [Indexed: 12/31/2022] Open
Abstract
Essential tremor (ET) is among the most frequent movement disorders. It usually manifests as a postural and kinematic tremor of the arms, but may also involve the head, voice, lower limbs, and trunk. An oscillatory network has been proposed as a neural correlate of ET, and is mainly composed of the olivocerebellar system, thalamus, and motor cortex. Since pharmacological agents have limited benefits, surgical interventions like deep brain stimulation are the last-line treatment options for the most severe cases. Non-invasive brain stimulation techniques, particularly transcranial magnetic or direct current stimulation, are used to ameliorate ET. Their non-invasiveness, along with their side effects profile, makes them an appealing treatment option. In addition, peripheral stimulation has been applied in the same perspective. Hence, the aim of the present review is to shed light on the emergent use of non-invasive central and peripheral stimulation techniques in this interesting context.
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Affiliation(s)
- Moussa A Chalah
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil Créteil, France ; Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris Créteil, France
| | - Jean-Pascal Lefaucheur
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil Créteil, France ; Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris Créteil, France
| | - Samar S Ayache
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil Créteil, France ; Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris Créteil, France ; Neurology Division, University Medical Center Rizk Hospital Beirut, Lebanon
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Rossini PM, Burke D, Chen R, Cohen LG, Daskalakis Z, Di Iorio R, Di Lazzaro V, Ferreri F, Fitzgerald PB, George MS, Hallett M, Lefaucheur JP, Langguth B, Matsumoto H, Miniussi C, Nitsche MA, Pascual-Leone A, Paulus W, Rossi S, Rothwell JC, Siebner HR, Ugawa Y, Walsh V, Ziemann U. Non-invasive electrical and magnetic stimulation of the brain, spinal cord, roots and peripheral nerves: Basic principles and procedures for routine clinical and research application. An updated report from an I.F.C.N. Committee. Clin Neurophysiol 2015; 126:1071-1107. [PMID: 25797650 PMCID: PMC6350257 DOI: 10.1016/j.clinph.2015.02.001] [Citation(s) in RCA: 1726] [Impact Index Per Article: 191.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 01/22/2015] [Accepted: 02/01/2015] [Indexed: 12/14/2022]
Abstract
These guidelines provide an up-date of previous IFCN report on “Non-invasive electrical and magnetic stimulation of the brain, spinal cord and roots: basic principles and procedures for routine clinical application” (Rossini et al., 1994). A new Committee, composed of international experts, some of whom were in the panel of the 1994 “Report”, was selected to produce a current state-of-the-art review of non-invasive stimulation both for clinical application and research in neuroscience. Since 1994, the international scientific community has seen a rapid increase in non-invasive brain stimulation in studying cognition, brain–behavior relationship and pathophysiology of various neurologic and psychiatric disorders. New paradigms of stimulation and new techniques have been developed. Furthermore, a large number of studies and clinical trials have demonstrated potential therapeutic applications of non-invasive brain stimulation, especially for TMS. Recent guidelines can be found in the literature covering specific aspects of non-invasive brain stimulation, such as safety (Rossi et al., 2009), methodology (Groppa et al., 2012) and therapeutic applications (Lefaucheur et al., 2014). This up-dated review covers theoretical, physiological and practical aspects of non-invasive stimulation of brain, spinal cord, nerve roots and peripheral nerves in the light of more updated knowledge, and include some recent extensions and developments.
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Affiliation(s)
- P M Rossini
- Institute of Neurology, Department of Geriatrics, Neuroscience and Orthopedics, Catholic University, Policlinic A. Gemelli, Rome, Italy
| | - D Burke
- Department of Neurology, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - R Chen
- Division of Neurology, Toronto Western Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - L G Cohen
- Human Cortical Physiology and Neurorehabilitation Section, NINDS, NIH, Bethesda, MD, USA
| | - Z Daskalakis
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - R Di Iorio
- Institute of Neurology, Department of Geriatrics, Neuroscience and Orthopedics, Catholic University, Policlinic A. Gemelli, Rome, Italy.
| | - V Di Lazzaro
- Department of Neurology, University Campus Bio-medico, Rome, Italy
| | - F Ferreri
- Department of Neurology, University Campus Bio-medico, Rome, Italy; Department of Clinical Neurophysiology, University of Eastern Finland, Kuopio, Finland
| | - P B Fitzgerald
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred, Melbourne, Australia
| | - M S George
- Medical University of South Carolina, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - M Hallett
- Human Motor Control Section, Medical Neurology Branch, NINDS, NIH, Bethesda, MD, USA
| | - J P Lefaucheur
- Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France; EA 4391, Nerve Excitability and Therapeutic Team, Faculty of Medicine, Paris Est Créteil University, Créteil, France
| | - B Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - H Matsumoto
- Department of Neurology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - C Miniussi
- Department of Clinical and Experimental Sciences University of Brescia, Brescia, Italy; IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - M A Nitsche
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Georg-August-University, Göttingen, Germany
| | - A Pascual-Leone
- Berenson-Allen Center for Non-invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - W Paulus
- Department of Clinical Neurophysiology, Georg-August University, Göttingen, Germany
| | - S Rossi
- Brain Investigation & Neuromodulation Lab, Unit of Neurology and Clinical Neurophysiology, Department of Neuroscience, University of Siena, Siena, Italy
| | - J C Rothwell
- Institute of Neurology, University College London, London, United Kingdom
| | - H R Siebner
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark; Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Y Ugawa
- Department of Neurology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - V Walsh
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom
| | - U Ziemann
- Department of Neurology & Stroke, and Hertie Institute for Clinical Brain Research, Eberhard Karls University, Tübingen, Germany
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Treatment of Chronic Facial Pain Including Cluster Headache by Repetitive Transcranial Magnetic Stimulation of the Motor Cortex With Maintenance Sessions: A Naturalistic Study. Brain Stimul 2015; 8:801-7. [PMID: 25979838 DOI: 10.1016/j.brs.2015.01.416] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 01/24/2015] [Accepted: 01/31/2015] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To assess the long-term maintenance of analgesia induced by high-frequency repetitive transcranial magnetic stimulation (rTMS) of the motor cortex contralateral to pain in a naturalistic study of patients with chronic refractory facial pain. METHODS 55 patients were included (cluster headache, n = 19; trigeminal neuropathic pain, n = 21; atypical facial pain, n = 15). The rTMS protocol consisted of an "induction phase" of one daily rTMS session for five days per week during two consecutive weeks, followed by a "maintenance phase" of two sessions during one week, then one session in weeks 4 and 6, and a monthly session for the next five months. In a subset of patients, navigated targeting was performed and session duration was shortened from 20-min to 10-min (with the same number of 2000 pulses per session). The analgesic effect of rTMS was assessed on a 0-10 visual numerical scale from 15 to 180 days after treatment initiation. RESULTS All pain measures significantly decreased from baseline to D15: the intensity of permanent pain (5.2 ± 1.6 to 3.2 ± 1.9) and paroxysmal pain (8.6 ± 1.5 to 4.5 ± 3.4), as well as the daily number of painful attacks (5.6 ± 3.1 to 2.3 ± 3.1). The percentage of responders (defined as pain score decrease ≥30%) was 73% at D15 and dropped to 40% at D180. The analgesic effect was similar regardless of the type of pain and was significantly lower when session duration was shortened, irrespective of the number of pulses. CONCLUSION This long-term maintenance rTMS protocol can be a therapeutic option in the clinical management of patients with chronic refractory facial pain, including cluster headache. However, only part of the patients respond to this technique and session duration should not be reduced.
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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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Mylius V, Zouari HG, Ayache SS, Farhat WH, Lefaucheur JP. Stroke rehabilitation using noninvasive cortical stimulation: aphasia. Expert Rev Neurother 2014; 12:973-82. [DOI: 10.1586/ern.12.76] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ayache SS, Farhat WH, Zouari HG, Hosseini H, Mylius V, Lefaucheur JP. Stroke rehabilitation using noninvasive cortical stimulation: motor deficit. Expert Rev Neurother 2014; 12:949-72. [DOI: 10.1586/ern.12.83] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ahdab R, Ayache SS, Farhat WH, Mylius V, Schmidt S, Brugières P, Lefaucheur JP. Reappraisal of the anatomical landmarks of motor and premotor cortical regions for image-guided brain navigation in TMS practice. Hum Brain Mapp 2013; 35:2435-47. [PMID: 24038518 DOI: 10.1002/hbm.22339] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 04/14/2013] [Accepted: 05/20/2013] [Indexed: 11/11/2022] Open
Abstract
Image-guided navigation systems dedicated to transcranial magnetic stimulation (TMS) have been recently developed and offer the possibility to visualize directly the anatomical structure to be stimulated. Performing navigated TMS requires a perfect knowledge of cortical anatomy, which is very variable between subjects. This study aimed at providing a detailed description of sulcal and gyral anatomy of motor cortical regions with special interest to the inter-individual variability of sulci. We attempted to identify the most stable structures, which can serve as anatomical landmarks for motor cortex mapping in navigated TMS practice. We analyzed the 3D reconstruction of 50 consecutive healthy adult brains (100 hemispheres). Different variants were identified regarding sulcal morphology, but several anatomical structures were found to be remarkably stable (four on dorsoventral axis and five on rostrocaudal axis). These landmarks were used to define a grid of 12 squares, which covered motor cortical regions. This grid was used to perform motor cortical mapping with navigated TMS in 12 healthy subjects from our cohort. The stereotactic coordinates (x-y-z) of the center of each of the 12 squares of the mapping grid were expressed into the standard Talairach space to determine the corresponding functional areas. We found that the regions whose stimulation produced almost constantly motor evoked potentials mainly correspond to the primary motor cortex, with rostral extension to premotor cortex and caudal extension to posterior parietal cortex. Our anatomy-based approach should facilitate the expression and the comparison of the results obtained in motor mapping studies using navigated TMS.
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Affiliation(s)
- Rechdi Ahdab
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France; Service de Physiologie-Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France; Neuroscience Department, University Medical Center Rizk Hospital, Beirut, Lebanon
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Mylius V, Ayache SS, Ahdab R, Farhat WH, Zouari HG, Belke M, Brugières P, Wehrmann E, Krakow K, Timmesfeld N, Schmidt S, Oertel WH, Knake S, Lefaucheur JP. Definition of DLPFC and M1 according to anatomical landmarks for navigated brain stimulation: inter-rater reliability, accuracy, and influence of gender and age. Neuroimage 2013; 78:224-32. [PMID: 23567888 DOI: 10.1016/j.neuroimage.2013.03.061] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 03/06/2013] [Accepted: 03/25/2013] [Indexed: 11/29/2022] Open
Abstract
The optimization of the targeting of a defined cortical region is a challenge in the current practice of transcranial magnetic stimulation (TMS). The dorsolateral prefrontal cortex (DLPFC) and the primary motor cortex (M1) are among the most usual TMS targets, particularly in its "therapeutic" application. This study describes a practical algorithm to determine the anatomical location of the DLPFC and M1 using a three-dimensional (3D) brain reconstruction provided by a TMS-dedicated navigation system from individual magnetic resonance imaging (MRI) data. The coordinates of the right and left DLPFC and M1 were determined in 50 normal brains (100 hemispheres) by five different investigators using a standardized procedure. Inter-rater reliability was good, with 95% limits of agreement ranging between 7 and 16 mm for the different coordinates. As expressed in the Talairach space and compared with anatomical or imaging data from the literature, the coordinates of the DLPFC defined by our algorithm corresponded to the junction between BA9 and BA46, while M1 coordinates corresponded to the posterior border of hand representation. Finally, we found an influence of gender and possibly of age on some coordinates on both rostrocaudal and dorsoventral axes. Our algorithm only requires a short training and can be used to provide a reliable targeting of DLPFC and M1 between various TMS investigators. This method, based on an image-guided navigation system using individual MRI data, should be helpful to a variety of TMS studies, especially to standardize the procedure of stimulation in multicenter "therapeutic" studies.
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Affiliation(s)
- V Mylius
- EA 4391, Faculté de Médecine, Université Paris Est Créteil, and Service de Physiologie-Explorations Fonctionnelles, Hôpital Henri-Mondor, AP-HP, Créteil, France.
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Liu S, Shi L, Wang D, Chen J, Jiang Z, Wang W, Chu WCW, Wang T, Ahuja AT. MRI-GUIDED NAVIGATION AND POSITIONING SOLUTION FOR REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION. BIOMEDICAL ENGINEERING-APPLICATIONS BASIS COMMUNICATIONS 2013. [DOI: 10.4015/s1016237213500129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A MRI-guided navigation solution for repetitive transcranial magnetic stimulation (rTMS)was designed in this study which integrates optical positioning system to perform positioning and tracking of the magnetic stimulation coil in real-time. The system includes the following procedures: segmentation and 3D reconstruction of brain anatomy from T1-weighted (T1W) MRI, coil calibration and localization, spatial registration between the subject's head and the MRI data and 2D/3D navigation. The 2D/3D navigation provides the spatial relationship between actual sites of the coils and the cortical surface quantitively and allows visualization of the location and orientation of the coil over the brain/head. Verified through the experiments using a phantom human skull model and the head MRI data from a healthy human subject, the proposed navigation system was demonstrated to be flexible, safe, accurate and time efficient.
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Affiliation(s)
- Shangping Liu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, N. T., Hong Kong
- College of Bioengineering, Chongqing University, Chongqing, P. R. China
| | - Lin Shi
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, N. T., Hong Kong
| | - Defeng Wang
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, N. T., Hong Kong
| | - Ji Chen
- College of Bioengineering, Chongqing University, Chongqing, P. R. China
| | - Zhimin Jiang
- School of Electronics Engineering and Computer Science, Peking University, Beijing, P. R. China
| | - Weimin Wang
- School of Electronics Engineering and Computer Science, Peking University, Beijing, P. R. China
| | - Winnie CW Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, N. T., Hong Kong
| | - Tianfu Wang
- Shenzhen Key Lab of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen, Guangdong, P. R. China
| | - A. T. Ahuja
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, N. T., Hong Kong
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