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Fong PY, Rothwell JC, Rocchi L. The Past, Current and Future Research in Cerebellar TMS Evoked Responses-A Narrative Review. Brain Sci 2024; 14:432. [PMID: 38790411 PMCID: PMC11118133 DOI: 10.3390/brainsci14050432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/26/2024] Open
Abstract
Transcranial magnetic stimulation coupled with electroencephalography (TMS-EEG) is a novel technique to investigate cortical physiology in health and disease. The cerebellum has recently gained attention as a possible new hotspot in the field of TMS-EEG, with several reports published recently. However, EEG responses obtained by cerebellar stimulation vary considerably across the literature, possibly due to different experimental methods. Compared to conventional TMS-EEG, which involves stimulation of the cortex, cerebellar TMS-EEG presents some technical difficulties, including strong muscle twitches in the neck area and a loud TMS click when double-cone coils are used, resulting in contamination of responses by electromyographic activity and sensory potentials. Understanding technical difficulties and limitations is essential for the development of cerebellar TMS-EEG research. In this review, we summarize findings of cerebellar TMS-EEG studies, highlighting limitations in experimental design and potential issues that can result in discrepancies between experimental outcomes. Lastly, we propose a possible direction for academic and clinical research with cerebellar TMS-EEG.
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Affiliation(s)
- Po-Yu Fong
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK; (J.C.R.)
- Division of Movement Disorders, Department of Neurology and Neuroscience Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan
- Medical School, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - John C. Rothwell
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK; (J.C.R.)
| | - Lorenzo Rocchi
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK; (J.C.R.)
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
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Liu W, Shen Y, Zhong Y, Sun Y, Yang J, Zhang W, Yan L, Liu W, Yu M. Levodopa improved different motor symptoms in patients with Parkinson's disease by reducing the functional connectivity of specific thalamic subregions. CNS Neurosci Ther 2024; 30:e14354. [PMID: 37452488 PMCID: PMC10848087 DOI: 10.1111/cns.14354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 05/15/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND The thalamus is an important relay station for the motor circuit of human. Levodopa can reverse the clinical manifestations by modulating the function of motor circuits, but its detailed mechanisms are still not fully understood. We aimed to explore (1) the mechanism by which levodopa modulates the functional connectivity (FC) in the subregions of the thalamus; (2) the relationship between the changed FC and the improvement of motor symptoms in Parkinson's disease (PD) patients. METHODS Resting-state functional MRI was used to scan 36 PD patients and 37 healthy controls. The FC between the subregions in the thalamus and the whole brain was measured and compared under different medication states of PD patients. The correlation between the improvement of motor symptoms and changes in FC in the thalamus subregions was examined. RESULTS The PD on state exhibited decreased FC between the right pre-motor thalamus and the right postcentral gyrus, as well as the right lateral pre-frontal thalamus and the right postcentral gyrus. These decreases were positively correlated with the improvement of resting tremor. The PD on state also exhibited decreased FC between the left lateral pre-frontal thalamus and right paracentral lobule, which was positively correlated with the improvement of bradykinesia. CONCLUSIONS This study demonstrates that levodopa treats PD by decreasing the FC between the thalamus subregions and pre/post-central cortex. Our results provide a basis for further exploration of the functional activity of thalamic subregions and offer new insights into the precision treatment in PD patients.
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Affiliation(s)
- Wan Liu
- Department of RehabilitationThe Affiliated Brain Hospital of Nanjing Medical UniversityNanjingChina
- Department of NeurologyThe Affiliated Brain Hospital of Nanjing Medical UniversityNanjingChina
| | - Yang Shen
- Department of NeurologyThe Affiliated Brain Hospital of Nanjing Medical UniversityNanjingChina
- Department of NeurologyXiaogan Hospital Affiliated to Wuhan University of Science and Technology, The Central Hospital of XiaoganXiaoganChina
| | - Yuan Zhong
- School of PsychologyNanjing Normal UniversityNanjingChina
- Jiangsu Key Laboratory of Mental Health and Cognitive ScienceNanjing Normal UniversityNanjingChina
| | - Yu Sun
- International Laboratory for Children's Medical Imaging Research, School of Biological Sciences and Medical EngineeringSoutheast UniversityNanjingChina
- Director of Joint Research Centre for University of Birmingham and Southeast UniversitySoutheast UniversityNanjingChina
| | - Jiaying Yang
- Department of Public Health, School of Medicine and Holistic Integrative MedicineNanjing University of Chinese MedicineNanjingChina
| | - Wenbin Zhang
- Department of Functional NeurosurgeryThe Affiliated Brain Hospital of Nanjing Medical UniversityNanjingChina
| | - Lei Yan
- Department of NeurologyThe Affiliated Brain Hospital of Nanjing Medical UniversityNanjingChina
| | - Weiguo Liu
- Department of NeurologyThe Affiliated Brain Hospital of Nanjing Medical UniversityNanjingChina
| | - Miao Yu
- Department of NeurologyThe Affiliated Brain Hospital of Nanjing Medical UniversityNanjingChina
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Ordás CM, Alonso-Frech F. The neural basis of somatosensory temporal discrimination threshold as a paradigm for time processing in the sub-second range: An updated review. Neurosci Biobehav Rev 2024; 156:105486. [PMID: 38040074 DOI: 10.1016/j.neubiorev.2023.105486] [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: 07/13/2023] [Revised: 11/20/2023] [Accepted: 11/27/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND AND OBJECTIVE The temporal aspect of somesthesia is a feature of any somatosensory process and a pre-requisite for the elaboration of proper behavior. Time processing in the milliseconds range is crucial for most of behaviors in everyday life. The somatosensory temporal discrimination threshold (STDT) is the ability to perceive two successive stimuli as separate in time, and deals with time processing in this temporal range. Herein, we focus on the physiology of STDT, on a background of the anatomophysiology of somesthesia and the neurobiological substrates of timing. METHODS A review of the literature through PubMed & Cochrane databases until March 2023 was performed with inclusion and exclusion criteria following PRISMA recommendations. RESULTS 1151 abstracts were identified. 4 duplicate records were discarded before screening. 957 abstracts were excluded because of redundancy, less relevant content or not English-written. 4 were added after revision. Eventually, 194 articles were included. CONCLUSIONS STDT encoding relies on intracortical inhibitory S1 function and is modulated by the basal ganglia-thalamic-cortical interplay through circuits involving the nigrostriatal dopaminergic pathway and probably the superior colliculus.
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Affiliation(s)
- Carlos M Ordás
- Universidad Rey Juan Carlos, Móstoles, Madrid, Spain; Department of Neurology, Hospital Rey Juan Carlos, Móstoles, Madrid, Spain.
| | - Fernando Alonso-Frech
- Department of Neurology, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Spain
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Permezel F, Alty J, Harding IH, Thyagarajan D. Brain Networks Involved in Sensory Perception in Parkinson's Disease: A Scoping Review. Brain Sci 2023; 13:1552. [PMID: 38002513 PMCID: PMC10669548 DOI: 10.3390/brainsci13111552] [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: 10/12/2023] [Revised: 10/26/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023] Open
Abstract
Parkinson's Disease (PD) has historically been considered a disorder of motor dysfunction. However, a growing number of studies have demonstrated sensory abnormalities in PD across the modalities of proprioceptive, tactile, visual, auditory and temporal perception. A better understanding of these may inform future drug and neuromodulation therapy. We analysed these studies using a scoping review. In total, 101 studies comprising 2853 human participants (88 studies) and 125 animals (13 studies), published between 1982 and 2022, were included. These highlighted the importance of the basal ganglia in sensory perception across all modalities, with an additional role for the integration of multiple simultaneous sensation types. Numerous studies concluded that sensory abnormalities in PD result from increased noise in the basal ganglia and increased neuronal receptive field size. There is evidence that sensory changes in PD and impaired sensorimotor integration may contribute to motor abnormalities.
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Affiliation(s)
- Fiona Permezel
- Department of Neuroscience, Monash University, Melbourne 3004, Australia; (F.P.); (I.H.H.)
- Department of Neurology, Mayo Clinic, Rochester, MN 55901, USA
| | - Jane Alty
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart 7001, Australia;
| | - Ian H. Harding
- Department of Neuroscience, Monash University, Melbourne 3004, Australia; (F.P.); (I.H.H.)
| | - Dominic Thyagarajan
- Department of Neuroscience, Monash University, Melbourne 3004, Australia; (F.P.); (I.H.H.)
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Fong PY, Spampinato D, Michell K, Mancuso M, Brown K, Ibáñez J, Santo AD, Latorre A, Bhatia K, Rothwell JC, Rocchi L. EEG responses induced by cerebellar TMS at rest and during visuomotor adaptation. Neuroimage 2023; 275:120188. [PMID: 37230209 DOI: 10.1016/j.neuroimage.2023.120188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Connections between the cerebellum and the cortex play a critical role in learning and executing complex behaviours. Dual-coil transcranial magnetic stimulation (TMS) can be used non-invasively to probe connectivity changes between the lateral cerebellum and motor cortex (M1) using the motor evoked potential as an outcome measure (cerebellar-brain inhibition, CBI). However, it gives no information about cerebellar connections to other parts of cortex. OBJECTIVES We used electroencephalography (EEG) to investigate whether it was possible to detect activity evoked in any areas of cortex by single-pulse TMS of the cerebellum (cerebellar TMS evoked potentials, cbTEPs). A second experiment tested if these responses were influenced by the performance of a cerebellar-dependent motor learning paradigm. METHODS In the first series of experiments, TMS was applied over either the right or left cerebellar cortex, and scalp EEG was recorded simultaneously. Control conditions that mimicked auditory and somatosensory inputs associated with cerebellar TMS were included to identify responses due to non-cerebellar sensory stimulation. We conducted a follow-up experiment that evaluated whether cbTEPs are behaviourally sensitive by assessing individuals before and after learning a visuomotor reach adaptation task. RESULTS A TMS pulse over the lateral cerebellum evoked EEG responses that could be distinguished from those caused by auditory and sensory artefacts. Significant positive (P80) and negative peaks (N110) over the contralateral frontal cerebral area were identified with a mirrored scalp distribution after left vs. right cerebellar stimulation. The P80 and N110 peaks were replicated in the cerebellar motor learning experiment and changed amplitude at different stages of learning. The change in amplitude of the P80 peak was associated with the degree of learning that individuals retained following adaptation. Due to overlap with sensory responses, the N110 should be interpreted with caution. CONCLUSIONS Cerebral potentials evoked by TMS of the lateral cerebellum provide a neurophysiological probe of cerebellar function that complements the existing CBI method. They may provide novel insight into mechanisms of visuomotor adaptation and other cognitive processes.
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Affiliation(s)
- Po-Yu Fong
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK; Division of Movement Disorders, Department of Neurology and Neuroscience Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan; Medical School, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Danny Spampinato
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK; Non-invasive Brain Stimulation Unit, IRCCS Santa Lucia Foundation, Via Ardeatina 306/354, 00142, Rome, Italy
| | - Kevin Michell
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Marco Mancuso
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Katlyn Brown
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Jaime Ibáñez
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK; BSICoS group, I3A Institute, University of Zaragoza, IIS Aragón, Zaragoza, Spain; Department of Bioengineering, Imperial College, London, UK
| | - Alessandro Di Santo
- NEuroMuscular Omnicentre (NEMO), Serena Onlus, AOS Monaldi, Naples, Italy; Unit of Neurology, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
| | - Anna Latorre
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Kailash Bhatia
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - John C Rothwell
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Lorenzo Rocchi
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK; Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Miyawaki EK. Review: Subjective Time Perception, Dopamine Signaling, and Parkinsonian Slowness. Front Neurol 2022; 13:927160. [PMID: 35899266 PMCID: PMC9311331 DOI: 10.3389/fneur.2022.927160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 06/16/2022] [Indexed: 11/25/2022] Open
Abstract
The association between idiopathic Parkinson's disease, a paradigmatic dopamine-deficiency syndrome, and problems in the estimation of time has been studied experimentally for decades. I review that literature, which raises a question about whether and if dopamine deficiency relates not only to the motor slowness that is an objective and cardinal parkinsonian sign, but also to a compromised neural substrate for time perception. Why does a clinically (motorically) significant deficiency in dopamine play a role in the subjective perception of time's passage? After a discussion of a classical conception of basal ganglionic control of movement under the influence of dopamine, I describe recent work in healthy mice using optogenetics; the methodology visualizes dopaminergic neuronal firing in very short time intervals, then allows for correlation with motor behaviors in trained tasks. Moment-to-moment neuronal activity is both highly dynamic and variable, as assessed by photometry of genetically defined dopaminergic neurons. I use those animal data as context to review a large experimental experience in humans, spanning decades, that has examined subjective time perception mainly in Parkinson's disease, but also in other movement disorders. Although the human data are mixed in their findings, I argue that loss of dynamic variability in dopaminergic neuronal activity over very short intervals may be a fundamental sensory aspect in the pathophysiology of parkinsonism. An important implication is that therapeutic response in Parkinson's disease needs to be understood in terms of short-term alterations in dynamic neuronal firing, as has already been examined in novel ways—for example, in the study of real-time changes in neuronal network oscillations across very short time intervals. A finer analysis of a treatment's network effects might aid in any effort to augment clinical response to either medications or functional neurosurgical interventions in Parkinson's disease.
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Affiliation(s)
- Edison K. Miyawaki
- Department of Neurology, Mass General Brigham, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- *Correspondence: Edison K. Miyawaki
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7
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Manto M, Argyropoulos GPD, Bocci T, Celnik PA, Corben LA, Guidetti M, Koch G, Priori A, Rothwell JC, Sadnicka A, Spampinato D, Ugawa Y, Wessel MJ, Ferrucci R. Consensus Paper: Novel Directions and Next Steps of Non-invasive Brain Stimulation of the Cerebellum in Health and Disease. CEREBELLUM (LONDON, ENGLAND) 2021; 21:1092-1122. [PMID: 34813040 DOI: 10.1007/s12311-021-01344-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 12/11/2022]
Abstract
The cerebellum is involved in multiple closed-loops circuitry which connect the cerebellar modules with the motor cortex, prefrontal, temporal, and parietal cortical areas, and contribute to motor control, cognitive processes, emotional processing, and behavior. Among them, the cerebello-thalamo-cortical pathway represents the anatomical substratum of cerebellum-motor cortex inhibition (CBI). However, the cerebellum is also connected with basal ganglia by disynaptic pathways, and cerebellar involvement in disorders commonly associated with basal ganglia dysfunction (e.g., Parkinson's disease and dystonia) has been suggested. Lately, cerebellar activity has been targeted by non-invasive brain stimulation (NIBS) techniques including transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) to indirectly affect and tune dysfunctional circuitry in the brain. Although the results are promising, several questions remain still unsolved. Here, a panel of experts from different specialties (neurophysiology, neurology, neurosurgery, neuropsychology) reviews the current results on cerebellar NIBS with the aim to derive the future steps and directions needed. We discuss the effects of TMS in the field of cerebellar neurophysiology, the potentials of cerebellar tDCS, the role of animal models in cerebellar NIBS applications, and the possible application of cerebellar NIBS in motor learning, stroke recovery, speech and language functions, neuropsychiatric and movement disorders.
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Affiliation(s)
- Mario Manto
- Service de Neurologie, CHU-Charleroi, 6000, Charleroi, Belgium.,Service Des Neurosciences, UMons, 7000, Mons, Belgium
| | - Georgios P D Argyropoulos
- Division of Psychology, Faculty of Natural Sciences, Faculty of Natural Sciences, University of Stirling, Stirling, FK9 4LA, UK
| | - Tommaso Bocci
- Aldo Ravelli Research Center for Neurotechnology and Experimental Neurotherapeutics, Department of Health Sciences, University of Milan, 20142, Milan, Italy.,ASST Santi Paolo E Carlo, Via di Rudinì, 8, 20142, Milan, Italy
| | - Pablo A Celnik
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Louise A Corben
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Department of Paediatrics, University of Melbourne, Parkville. Victoria, Australia
| | - Matteo Guidetti
- Aldo Ravelli Research Center for Neurotechnology and Experimental Neurotherapeutics, Department of Health Sciences, University of Milan, 20142, Milan, Italy.,Department of Electronics, Information and Bioengineering, Politecnico Di Milano, 20133, Milan, Italy
| | - Giacomo Koch
- Fondazione Santa Lucia IRCCS, via Ardeatina 306, 00179, Rome, Italy
| | - Alberto Priori
- Aldo Ravelli Research Center for Neurotechnology and Experimental Neurotherapeutics, Department of Health Sciences, University of Milan, 20142, Milan, Italy.,ASST Santi Paolo E Carlo, Via di Rudinì, 8, 20142, Milan, Italy
| | - John C Rothwell
- Department of Clinical and Movement Neuroscience, UCL Queen Square Institute of Neurology, London, UK
| | - Anna Sadnicka
- Motor Control and Movement Disorders Group, St George's University of London, London, UK.,Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Danny Spampinato
- Fondazione Santa Lucia IRCCS, via Ardeatina 306, 00179, Rome, Italy
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, Fukushima Medical University, Fukushima, Japan
| | - 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, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL Valais), Clinique Romande de Réadaptation, Sion, Switzerland
| | - Roberta Ferrucci
- Aldo Ravelli Research Center for Neurotechnology and Experimental Neurotherapeutics, Department of Health Sciences, University of Milan, 20142, Milan, Italy. .,ASST Santi Paolo E Carlo, Via di Rudinì, 8, 20142, Milan, Italy.
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8
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Billeri L, Naro A. A narrative review on non-invasive stimulation of the cerebellum in neurological diseases. Neurol Sci 2021; 42:2191-2209. [PMID: 33759055 DOI: 10.1007/s10072-021-05187-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 03/15/2021] [Indexed: 12/26/2022]
Abstract
IMPORTANCE The cerebellum plays an important role in motor, cognitive, and affective functions owing to its dense interconnections with basal ganglia and cerebral cortex. This review aimed at summarizing the non-invasive cerebellar stimulation (NICS) approaches used to modulate cerebellar output and treat cerebellar dysfunction in the motor domain. OBSERVATION The utility of NICS in the treatment of cerebellar and non-cerebellar neurological diseases (including Parkinson's disease, dementia, cerebellar ataxia, and stroke) is discussed. NICS induces meaningful clinical effects from repeated sessions alone in both cerebellar and non-cerebellar diseases. However, there are no conclusive data on this issue and several concerns need to be still addressed before NICS could be considered a valuable, standard therapeutic tool. CONCLUSIONS AND RELEVANCE Even though some challenges must be overcome to adopt NICS in a wider clinical setting, this tool might become a useful strategy to help patients with lesions in the cerebellum and cerebral areas that are connected with the cerebellum whether one could enhance cerebellar activity with the intention of facilitating the cerebellum and the entire, related network, rather than attempting to facilitate a partially damaged cortical region or inhibiting the homologs' contralateral area. The different outcome of each approach would depend on the residual functional reserve of the cerebellum, which is confirmed as a critical element to be probed preliminary in order to define the best patient-tailored NICS.
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Affiliation(s)
- Luana Billeri
- IRCCS Centro Neurolesi Bonino Pulejo, via Palermo, SS113, Ctr. Casazza, 98124, Messina, Italy
| | - Antonino Naro
- IRCCS Centro Neurolesi Bonino Pulejo, via Palermo, SS113, Ctr. Casazza, 98124, Messina, Italy.
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9
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Latorre A, Rocchi L, Magrinelli F, Mulroy E, Berardelli A, Rothwell JC, Bhatia KP. Unravelling the enigma of cortical tremor and other forms of cortical myoclonus. Brain 2021; 143:2653-2663. [PMID: 32417917 DOI: 10.1093/brain/awaa129] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/11/2020] [Accepted: 02/27/2020] [Indexed: 12/21/2022] Open
Abstract
Cortical tremor is a fine rhythmic oscillation involving distal upper limbs, linked to increased sensorimotor cortex excitability, as seen in cortical myoclonus. Cortical tremor is the hallmark feature of autosomal dominant familial cortical myoclonic tremor and epilepsy (FCMTE), a syndrome not yet officially recognized and characterized by clinical and genetic heterogeneity. Non-coding repeat expansions in different genes have been recently recognized to play an essential role in its pathogenesis. Cortical tremor is considered a rhythmic variant of cortical myoclonus and is part of the 'spectrum of cortical myoclonus', i.e. a wide range of clinical motor phenomena, from reflex myoclonus to myoclonic epilepsy, caused by abnormal sensorimotor cortical discharges. The aim of this update is to provide a detailed analysis of the mechanisms defining cortical tremor, as seen in FCMTE. After reviewing the clinical and genetic features of FCMTE, we discuss the possible mechanisms generating the distinct elements of the cortical myoclonus spectrum, and how cortical tremor fits into it. We propose that the spectrum is due to the evolution from a spatially limited focus of excitability to recruitment of more complex mechanisms capable of sustaining repetitive activity, overcoming inhibitory mechanisms that restrict excitatory bursts, and engaging wide areas of cortex. Finally, we provide evidence for a possible common denominator of the elements of the spectrum, i.e. the cerebellum, and discuss its role in FCMTE, according to recent genetic findings.
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Affiliation(s)
- Anna Latorre
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, UK
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Lorenzo Rocchi
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, UK
| | - Francesca Magrinelli
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, UK
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Eoin Mulroy
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, UK
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, IS, Italy
| | - John C Rothwell
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, UK
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, UK
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10
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Transcranial Evoked Potentials Can Be Reliably Recorded with Active Electrodes. Brain Sci 2021; 11:brainsci11020145. [PMID: 33499330 PMCID: PMC7912161 DOI: 10.3390/brainsci11020145] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/14/2021] [Accepted: 01/19/2021] [Indexed: 01/11/2023] Open
Abstract
Electroencephalographic (EEG) signals evoked by transcranial magnetic stimulation (TMS) are usually recorded with passive electrodes (PE). Active electrode (AE) systems have recently become widely available; compared to PE, they allow for easier electrode preparation and a higher-quality signal, due to the preamplification at the electrode stage, which reduces electrical line noise. The performance between the AE and PE can differ, especially with fast EEG voltage changes, which can easily occur with TMS-EEG; however, a systematic comparison in the TMS-EEG setting has not been made. Therefore, we recorded TMS-evoked EEG potentials (TEPs) in a group of healthy subjects in two sessions, one using PE and the other using AE. We stimulated the left primary motor cortex and right medial prefrontal cortex and used two different approaches to remove early TMS artefacts, Independent Component Analysis and Signal Space Projection—Source Informed Recovery. We assessed statistical differences in amplitude and topography of TEPs, and their similarity, by means of the concordance correlation coefficient (CCC). We also tested the capability of each system to approximate the final TEP waveform with a reduced number of trials. The results showed that TEPs recorded with AE and PE do not differ in amplitude and topography, and only few electrodes showed a lower-than-expected CCC between the two methods of amplification. We conclude that AE are a viable solution for TMS-EEG recording.
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11
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Rawji V, Latorre A, Sharma N, Rothwell JC, Rocchi L. On the Use of TMS to Investigate the Pathophysiology of Neurodegenerative Diseases. Front Neurol 2020; 11:584664. [PMID: 33224098 PMCID: PMC7669623 DOI: 10.3389/fneur.2020.584664] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/05/2020] [Indexed: 12/22/2022] Open
Abstract
Neurodegenerative diseases are a collection of disorders that result in the progressive degeneration and death of neurons. They are clinically heterogenous and can present as deficits in movement, cognition, executive function, memory, visuospatial awareness and language. Transcranial magnetic stimulation (TMS) is a non-invasive brain stimulation tool that allows for the assessment of cortical function in vivo. We review how TMS has been used for the investigation of three neurodegenerative diseases that differ in their neuroanatomical axes: (1) Motor cortex-corticospinal tract (motor neuron diseases), (2) Non-motor cortical areas (dementias), and (3) Subcortical structures (parkinsonisms). We also make four recommendations that we hope will benefit the use of TMS in neurodegenerative diseases. Firstly, TMS has traditionally been limited by the lack of an objective output and so has been confined to stimulation of the motor cortex; this limitation can be overcome by the use of concurrent neuroimaging methods such as EEG. Given that neurodegenerative diseases progress over time, TMS measures should aim to track longitudinal changes, especially when the aim of the study is to look at disease progression and symptomatology. The lack of gold-standard diagnostic confirmation undermines the validity of findings in clinical populations. Consequently, diagnostic certainty should be maximized through a variety of methods including multiple, independent clinical assessments, imaging and fluids biomarkers, and post-mortem pathological confirmation where possible. There is great interest in understanding the mechanisms by which symptoms arise in neurodegenerative disorders. However, TMS assessments in patients are usually carried out during resting conditions, when the brain network engaged during these symptoms is not expressed. Rather, a context-appropriate form of TMS would be more suitable in probing the physiology driving clinical symptoms. In all, we hope that the recommendations made here will help to further understand the pathophysiology of neurodegenerative diseases.
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Affiliation(s)
| | | | | | | | - Lorenzo Rocchi
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
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12
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Jung JH, Kim BH, Chung SJ, Yoo HS, Lee YH, Baik K, Ye BS, Sohn YH, Lee JM, Lee PH. Motor Cerebellar Connectivity and Future Development of Freezing of Gait in De Novo Parkinson's Disease. Mov Disord 2020; 35:2240-2249. [PMID: 32926481 DOI: 10.1002/mds.28243] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To investigate the role of motor cerebellar connectivity in future development of freezing of gait, because it is a complex network disorder in Parkinson's disease (PD). METHODS We recruited 26 de novo patients with PD who experienced freezing of gait within 5 years from magnetic resonance imaging acquisition (vulnerable PD group), 61 patients with PD who had not experienced freezing of gait within 5 years (resistant PD group), and 27 healthy control subjects. We compared the resting state functional connectivity between the motor cerebellum and the whole brain between the groups. In addition, we evaluated the relationship between motor cerebellar connectivity and freezing of gait latency. RESULTS The vulnerable PD group had increased functional connectivity between the motor cerebellum and parieto-occipito-temporal association cortices compared with the control group or the resistant PD group. Connectivity between lobule VI and the right superior parietal lobule, right fusiform gyrus, and left inferior temporal gyrus; between lobule VIIb and the right superior parietal lobule, right hippocampus, and right middle temporal gyrus; and between lobule VIIIb and the bilateral fusiform gyri, right middle occipital gyrus, and bilateral parietal lobes was inversely proportional to freezing of gait latency. The freezing of gait latency-related cortical functional connectivity from the motor cerebellum was also significantly higher in the vulnerable PD group compared with the control group, as well as the resistant PD group. CONCLUSIONS The data suggest that the motor cerebellar functional connectivity with the posterior cortical areas play an important role in future development of freezing of gait in PD. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Jin Ho Jung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Bo-Hyun Kim
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - Han Soo Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Yang Hyun Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyoungwon Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Byoung Seok Ye
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong-Min Lee
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
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13
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Hurtado-Puerto AM, Nestor K, Eldaief M, Camprodon JA. Safety Considerations for Cerebellar Theta Burst Stimulation. Clin Ther 2020; 42:1169-1190.e1. [PMID: 32674957 DOI: 10.1016/j.clinthera.2020.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE The cerebellum is an intricate neural structure that orchestrates various cognitive and behavioral functions. In recent years, there has been an increasing interest in neuromodulation of the cerebellum with transcranial magnetic stimulation (TMS) for therapeutic and basic science applications. Theta burst stimulation (TBS) is an efficient and powerful TMS protocol that is able to induce longer-lasting effects with shorter stimulation times compared with traditional TMS. Parameters for cerebellar TBS are traditionally framed in the bounds of TBS to the cerebral cortex, even when the 2 have distinct histologic, anatomical, and functional characteristics. Tolerability limits have not been systematically explored in the literature for this specific application. Therefore, we aimed to determine the stimulation parameters that have been used for cerebellar. TBS to date and evaluate adverse events and adverse effects related to stimulation parameters. METHODS We used PubMed to perform a critical review of the literature based on a systematic review of original research studies published between September 2008 and November 2019 that reported on cerebellar TBS. We recovered information from these publications and communication with authors about the stimulation parameters used and the occurrence of adverse events. FINDINGS We identified 61 research articles on interventions of TBS to the cerebellum. These articles described 3176 active sessions of cerebellar TBS in 1203 individuals, including healthy participants and patients with various neurologic conditions, including brain injuries. Some studies used substantial doses (eg, pulse intensity and number of pulses) in short periods. No serious adverse events were reported. The specific number of patients who experienced adverse events was established for 48 studies. The risk of an adverse event in this population (n = 885) was 4.1%. Adverse events consisted mostly of discomfort attributable to involuntary muscle contractions. Authors used a variety of methods for calculating stimulation dosages, ranging from the long-established reference of electromyography of a hand muscle to techniques that atone for some of the differences between cerebrum and cerebellum. IMPLICATIONS No serious adverse events have been reported for cerebellar TBS. There is no substantial evidence of a tolerable maximal-efficacy stimulation dose in humans. There is no assurance of equivalence in the translation of cortical excitability and stimulation intensities from the cerebral cortex to cerebellar regions. Further research for the stimulation dose in cerebellar TBS is warranted, along with consistent report of adverse events. © 2020 Elsevier HS Journals, Inc.
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Affiliation(s)
- Aura M Hurtado-Puerto
- Laboratory of Neuropsychiatry and Neuromodulation, Massachusetts General Hospital, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA; Centro de Estudios Cerebrales, Facultad de Ciencias, Universidad del Valle, Cali, Colombia.
| | - Kimberly Nestor
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Mark Eldaief
- Laboratory of Neuropsychiatry and Neuromodulation, Massachusetts General Hospital, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Joan A Camprodon
- Laboratory of Neuropsychiatry and Neuromodulation, Massachusetts General Hospital, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
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14
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Odorfer TM, Wind T, Zeller D. Temporal Discrimination Thresholds and Proprioceptive Performance: Impact of Age and Nerve Conduction. Front Neurosci 2019; 13:1241. [PMID: 31803012 PMCID: PMC6877661 DOI: 10.3389/fnins.2019.01241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/04/2019] [Indexed: 11/25/2022] Open
Abstract
Background Increasing attention is payed to the contribution of somatosensory processing in motor control. In particular, temporal somatosensory discrimination has been found to be altered differentially in common movement disorders. To date, there have only been speculations as to how impaired temporal discrimination and clinical motor signs may relate to each other. Prior to disentangling this relationship, potential confounders of temporal discrimination, in particular age and peripheral nerve conduction, should be assessed, and a quantifiable measure of proprioceptive performance should be established. Objective To assess the influence of age and polyneuropathy (PNP) on somatosensory temporal discrimination threshold (STDT), temporal discrimination movement threshold (TDMT), and behavioral measures of proprioception of upper and lower limbs. Methods STDT and TDMT were assessed in 79 subjects (54 healthy, 25 with PNP; age 30–79 years). STDT was tested with surface electrodes over the thenar or dorsal foot region. TDMT was probed with needle electrodes in flexor carpi radialis (FCR) and tibialis anterior (TA) muscle. Goniometer-based devices were used to assess limb proprioception during (i) active pointing to LED markers, (ii) active movements in response to variable visual cues, and (iii) estimation of limb position following passive movements. Pointing (or estimation) error was taken as a measure of proprioceptive performance. Results In healthy subjects, higher age was associated with higher STDT and TDMT at upper and lower extremities, while age did not correlate with proprioceptive performance. Patients with PNP showed higher STDT and TDMT values and decreased proprioceptive performance in active pointing tasks compared to matched healthy subjects. As an additional finding, there was a significant correlation between performance in active pointing tasks and temporal discrimination thresholds. Conclusion Given their notable impact on measures of temporal discrimination, age and peripheral nerve conduction need to be accounted for if STDT and TDMT are applied in patients with movement disorders. As a side observation, the correlation between measures of proprioception and temporal discrimination may prompt further studies on the presumptive link between these two domains.
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Affiliation(s)
| | - Teresa Wind
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Daniel Zeller
- Department of Neurology, University of Würzburg, Würzburg, Germany
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15
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Gövert F, Becktepe J, Balint B, Rocchi L, Brugger F, Garrido A, Walter T, Hannah R, Rothwell J, Elble R, Deuschl G, Bhatia K. Temporal discrimination is altered in patients with isolated asymmetric and jerky upper limb tremor. Mov Disord 2019; 35:306-315. [PMID: 31724777 DOI: 10.1002/mds.27880] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 09/01/2019] [Accepted: 09/16/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Unilateral or very asymmetric upper limb tremors with a jerky appearance are poorly investigated. Their clinical classification is an unsolved problem because their classification as essential tremor versus dystonic tremor is uncertain. To avoid misclassification as essential tremor or premature classification as dystonic tremor, the term indeterminate tremor was suggested. OBJECTIVES The aim of this study was to characterize this tremor subgroup electrophysiologically and evaluate whether diagnostically meaningful electrophysiological differences exist compared to patients with essential tremor and dystonic tremor. METHODS We enrolled 29 healthy subjects and 64 patients with tremor: 26 with dystonic tremor, 23 with essential tremor, and 15 patients with upper limb tremor resembling essential tremor but was unusually asymmetric and jerky (indeterminate tremor). We investigated the somatosensory temporal discrimination threshold, the short-interval intracortical inhibition, and the cortical plasticity by paired associative stimulation. RESULTS Somatosensory temporal discrimination threshold was significantly increased in patients with dystonic tremor and indeterminate tremor, but it was normal in the essential tremor patients and healthy controls. Significant differences in short-interval intracortical inhibition and paired associative stimulation were not found among the three patient groups and controls. CONCLUSION These results indicate that indeterminate tremor, as defined in this study, shares electrophysiological similarities with dystonic tremor rather than essential tremor. Therefore, we propose that indeterminate tremor should be considered as a separate clinical entity from essential tremor and that it might be dystonic in nature. Somatosensory temporal discrimination appears to be a useful tool in tremor classification. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Felix Gövert
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany.,Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Jos Becktepe
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Bettina Balint
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, United Kingdom.,Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Lorenzo Rocchi
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Florian Brugger
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, United Kingdom.,Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Alicia Garrido
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, United Kingdom.,Movement Disorders Unit, Neurology Service, Hospital Clínic, Institut d'investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Tim Walter
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Ricci Hannah
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - John Rothwell
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Rodger Elble
- Department of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Günther Deuschl
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Kailash Bhatia
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, United Kingdom
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16
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Behrangrad S, Zoghi M, Kidgell D, Jaberzadeh S. Does cerebellar non-invasive brain stimulation affect corticospinal excitability in healthy individuals? A systematic review of literature and meta-analysis. Neurosci Lett 2019; 706:128-139. [PMID: 31102706 DOI: 10.1016/j.neulet.2019.05.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/12/2019] [Accepted: 05/14/2019] [Indexed: 10/26/2022]
Abstract
Numerous studies have indicated that non-invasive brain stimulation (NIBS) of the cerebellum could modulate corticospinal excitability (CSE) in young healthy individuals. However, there is no systematic review and meta-analysis that clarifies the effects of cerebellar NIBS on CSE. The aim of this study was to provide a meta-analytic summary of the effects of cerebellar NIBS on CSE. Seven search engines were used to identify any trial evaluating CSE before and after one session of cerebellar NIBS in healthy individuals up to June 2018. Twenty-six studies investigating the corticospinal responses following cerebellar NIBS were included. Meta-analysis was used to pool the findings from included studies. Effects were expressed as mean differences (MD) and the standard deviation (SD). Risk of bias was assessed with the Cochrane tool. Meta-analysis found that paired associative stimulation (PAS) with 2 ms interval, a combination of PAS with 21.5 ms interval and anodal transcranial direct current stimulation, and repetitive transcranial magnetic stimulation with a frequency of < 5 Hz increase CSE (P PAS2 < 0.00001, P PAS21.5 +a-tDCS = 0.02, P rTMS = 0.04). However, continuous theta burst stimulation, a combination of PAS with 25 ms interval and anodal transcranial direct current stimulation, and PAS with a 6 ms interval decreased CSE (P PAS6 < 0.00001, P cTBS < 0.00001, P PAS25 +a-tDCS = 0.003). The results of this review show that cerebellar NIBS techniques are a promising tool for increasing CSE.
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Affiliation(s)
- Shabnam Behrangrad
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, P.O. Box 527, Australia.
| | - Maryam Zoghi
- Department of Rehabilitation, Nutrition and Sport, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
| | - Dawson Kidgell
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, P.O. Box 527, Australia
| | - Shapour Jaberzadeh
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, P.O. Box 527, Australia
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17
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Narasimham S, McGovern EM, Quinlivan B, Killian O, Beck R, O'Riordan S, Hutchinson M, Reilly RB. Neural Correlates of Abnormal Temporal Discrimination in Unaffected Relatives of Cervical Dystonia Patients. Front Integr Neurosci 2019; 13:8. [PMID: 30914929 PMCID: PMC6423170 DOI: 10.3389/fnint.2019.00008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 02/25/2019] [Indexed: 12/27/2022] Open
Abstract
Background: An abnormal temporal discrimination threshold in cervical dystonia (CD) is considered to be a mediational endophenotype; in unaffected relatives it is hypothesized to indicate non-manifesting gene carriage. The pathogenesis underlying this condition remains unknown. Investigation of the neural networks involved in disordered temporal discrimination may highlight its pathomechanisms. Objective: To examine resting state brain function in unaffected relatives of CD patients with normal and abnormal temporal discrimination. We hypothesized that the endophenotype, an abnormal temporal discrimination, would manifest as altered connectivity in relatives in regions associated with CD, thereby illuminating the neural substrates of the link between temporal discrimination and CD. Methods: Rs-fMRI data was analyzed from two sex- and age-matched cohorts: 16 unaffected relatives of CD patients with normal temporal discrimination and 16 with abnormal temporal discrimination. Regional and whole brain functional connectivity measures were extracted via Independent Component Analysis (ICA), Regional Homogeneity (ReHo), and Amplitude of Low Frequency (ALFF) analyses. Results: Our ICA analysis revealed increased connectivity within both the executive control and cerebellar networks and decreased connectivity within the sensorimotor network in relatives with abnormal temporal discrimination when compared to relatives with normal temporal discrimination. The ReHo and ALFF analyses complimented these results and demonstrated connectivity differences in areas corresponding to motor planning, movement coordination, visual information processing, and eye movements in unaffected relatives with abnormal temporal discrimination. Conclusion: Disordered connectivity in unaffected relatives with abnormal temporal discrimination illuminates neural substrates underlying endophenotype expression and supports the hypothesis that genetically determined aberrant connectivity, when later coupled with unknown environmental triggers, may lead to disease penetrance.
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Affiliation(s)
- Shruti Narasimham
- Trinity Centre for Bioengineering, Trinity College Dublin, University of Dublin, Dublin, Ireland.,School of Engineering, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Eavan M McGovern
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.,Department of Neurology, St. Vincent's University Hospital, Dublin, Ireland
| | - Brendan Quinlivan
- Trinity Centre for Bioengineering, Trinity College Dublin, University of Dublin, Dublin, Ireland.,School of Engineering, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Owen Killian
- Trinity Centre for Bioengineering, Trinity College Dublin, University of Dublin, Dublin, Ireland.,School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Rebecca Beck
- Trinity Centre for Bioengineering, Trinity College Dublin, University of Dublin, Dublin, Ireland.,School of Engineering, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Sean O'Riordan
- Department of Neurology, St. Vincent's University Hospital, Dublin, Ireland
| | - Michael Hutchinson
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.,Department of Neurology, St. Vincent's University Hospital, Dublin, Ireland
| | - Richard B Reilly
- Trinity Centre for Bioengineering, Trinity College Dublin, University of Dublin, Dublin, Ireland.,School of Engineering, Trinity College Dublin, University of Dublin, Dublin, Ireland.,School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland
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18
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Cerebellar Theta-Burst Stimulation Impairs Memory Consolidation in Eyeblink Classical Conditioning. Neural Plast 2018; 2018:6856475. [PMID: 30402087 PMCID: PMC6198564 DOI: 10.1155/2018/6856475] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 07/29/2018] [Accepted: 08/29/2018] [Indexed: 11/17/2022] Open
Abstract
Associative learning of sensorimotor contingences, as it occurs in eyeblink classical conditioning (EBCC), is known to involve the cerebellum, but its mechanism remains controversial. EBCC involves a sequence of learning processes which are thought to occur in the cerebellar cortex and deep cerebellar nuclei. Recently, the extinction phase of EBCC has been shown to be modulated after one week by cerebellar continuous theta-burst stimulation (cTBS). Here, we asked whether cerebellar cTBS could affect retention and reacquisition of conditioned responses (CRs) tested immediately after conditioning. We also investigated a possible lateralized cerebellar control of EBCC by applying cTBS on both the right and left cerebellar hemispheres. Both right and left cerebellar cTBSs induced a statistically significant impairment in retention and new acquisition of conditioned responses (CRs), the disruption effect being marginally more effective when the left cerebellar hemisphere was stimulated. These data support a model in which cTBS impairs retention and reacquisition of CR in the cerebellum, possibly by interfering with the transfer of memory to the deep cerebellar nuclei.
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19
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Somatosensory temporal discrimination in Parkinson’s disease, dystonia and essential tremor: Pathophysiological and clinical implications. Clin Neurophysiol 2018; 129:1849-1853. [DOI: 10.1016/j.clinph.2018.05.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/23/2018] [Accepted: 05/15/2018] [Indexed: 12/18/2022]
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20
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Rocchi L, Ibáñez J, Benussi A, Hannah R, Rawji V, Casula E, Rothwell J. Variability and Predictors of Response to Continuous Theta Burst Stimulation: A TMS-EEG Study. Front Neurosci 2018; 12:400. [PMID: 29946234 PMCID: PMC6006718 DOI: 10.3389/fnins.2018.00400] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 05/24/2018] [Indexed: 12/23/2022] Open
Abstract
Continuous theta-burst stimulation (cTBS) is a repetitive transcranial magnetic stimulation paradigm reported to decrease the excitability of the stimulated cortical area and which is thought to reflect a form of inhibitory synaptic plasticity. However, since its introduction, the effect of cTBS has shown a remarkable variability in its effects, which are often quantified by measuring the amplitude of motor evoked potentials (MEPs). Part of this inconsistency in experimental results might be due to an intrinsic variability of TMS effects caused by genetic or neurophysiologic factors. However, it is also possible that MEP only reflect the excitability of a sub-population of output neurons; resting EEG power and measures combining TMS and electroencephalography (TMS-EEG) might represent a more thorough reflection of cortical excitability. The aim of the present study was to verify the robustness of several predictors of cTBS response, such as I wave recruitment and baseline MEP amplitude, and to test cTBS after-effects on multiple neurophysiologic measurements such as MEP, resting EEG power, local mean field power (LMFP), TMS-related spectral perturbation (TRSP), and inter-trial phase clustering (ITPC). As a result, we were not able to confirm either the expected decrease of MEP amplitude after cTBS or the ability of I wave recruitment and MEP amplitude to predict the response to cTBS. Resting EEG power, LMFP, TRSP, and ITPC showed a more consistent trend toward a decrease after cTBS. Overall, our data suggest that the effect of cTBS on corticospinal excitability is variable and difficult to predict with common electrophysiologic markers, while its effect might be clearer when probed with combined TMS and EEG.
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Affiliation(s)
- Lorenzo Rocchi
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
| | - Jaime Ibáñez
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
| | - Alberto Benussi
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Ricci Hannah
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
| | - Vishal Rawji
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
| | - Elias Casula
- Non-invasive Brain Stimulation Unit, IRCCS Santa Lucia Foundation, Rome, Italy
| | - John Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
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21
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Lee MS, Lee MJ, Conte A, Berardelli A. Abnormal somatosensory temporal discrimination in Parkinson’s disease: Pathophysiological correlates and role in motor control deficits. Clin Neurophysiol 2018; 129:442-447. [DOI: 10.1016/j.clinph.2017.11.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 11/13/2017] [Accepted: 11/21/2017] [Indexed: 12/14/2022]
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22
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Rastogi A, Cash R, Dunlop K, Vesia M, Kucyi A, Ghahremani A, Downar J, Chen J, Chen R. Modulation of cognitive cerebello-cerebral functional connectivity by lateral cerebellar continuous theta burst stimulation. Neuroimage 2017; 158:48-57. [DOI: 10.1016/j.neuroimage.2017.06.048] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/27/2017] [Accepted: 06/20/2017] [Indexed: 11/17/2022] Open
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23
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Tremblay S, Austin D, Hannah R, Rothwell JC. Non-invasive brain stimulation as a tool to study cerebellar-M1 interactions in humans. CEREBELLUM & ATAXIAS 2016; 3:19. [PMID: 27895926 PMCID: PMC5111316 DOI: 10.1186/s40673-016-0057-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 11/01/2016] [Indexed: 12/29/2022]
Abstract
The recent development of non-invasive brain stimulation techniques such as transcranial magnetic stimulation (TMS) has allowed the non-invasive assessment of cerebellar function in humans. Early studies showed that cerebellar activity, as reflected in the excitability of the dentate-thalamo-cortical pathway, can be assessed with paired stimulation of the cerebellum and the primary motor cortex (M1) (cerebellar inhibition of motor cortex, CBI). Following this, many attempts have been made, using techniques such as repetitive TMS and transcranial electrical stimulation (TES), to modulate the activity of the cerebellum and the dentate-thalamo-cortical output, and measure their impact on M1 activity. The present article reviews literature concerned with the impact of non-invasive stimulation of cerebellum on M1 measures of excitability and "plasticity" in both healthy and clinical populations. The main conclusion from the 27 reviewed articles is that the effects of cerebellar "plasticity" protocols on M1 activity are generally inconsistent. Nevertheless, two measurements showed relatively reproducible effects in healthy individuals: reduced response of M1 to sensorimotor "plasticity" (paired-associative stimulation, PAS) and reduced CBI following repetitive TMS and TES. We discuss current challenges, such as the low power of reviewed studies, variability in stimulation parameters employed and lack of understanding of physiological mechanisms underlying CBI.
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Affiliation(s)
- Sara Tremblay
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, WC1N 3BG UK
| | - Duncan Austin
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, WC1N 3BG UK
| | - Ricci Hannah
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, WC1N 3BG UK
| | - John C Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, WC1N 3BG UK
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24
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Temporal discrimination threshold with healthy aging. Neurobiol Aging 2016; 43:174-9. [PMID: 27255827 DOI: 10.1016/j.neurobiolaging.2016.04.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 02/10/2016] [Accepted: 04/13/2016] [Indexed: 01/16/2023]
Abstract
The temporal discrimination threshold (TDT) is the shortest interstimulus interval at which a subject can perceive successive stimuli as separate. To investigate the effects of aging on TDT, we studied tactile TDT using the method of limits with 120% of sensory threshold in each hand for each of 100 healthy volunteers, equally divided among men and women, across 10 age groups, from 18 to 79 years. Linear regression analysis showed that age was significantly related to left-hand mean, right-hand mean, and mean of 2 hands with R-square equal to 0.08, 0.164, and 0.132, respectively. Reliability analysis indicated that the 3 measures had fair-to-good reliability (intraclass correlation coefficient: 0.4-0.8). We conclude that TDT is affected by age and has fair-to-good reproducibility using our technique.
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25
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Mirdamadi JL. Cerebellar role in Parkinson's disease. J Neurophysiol 2016; 116:917-9. [PMID: 26792889 DOI: 10.1152/jn.01132.2015] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 01/20/2016] [Indexed: 11/22/2022] Open
Abstract
Parkinson's disease (PD) is a common neurodegenerative disorder associated with motor and cognitive impairments. The mechanisms underlying the pathophysiology and treatments have traditionally focused on basal ganglia-thalamo-cortical pathways due to striatal dopamine loss, but more recent evidence has highlighted the role of the cerebellum. In this Neuro Forum article, I review evidence from neuroimaging and noninvasive brain stimulation that demonstrates altered cerebellar activity in PD may be both a pathophysiological and compensatory mechanism depending on dopaminergic medication and symptoms.
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Affiliation(s)
- Jasmine L Mirdamadi
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
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