1
|
Lanza G, Salemi M, Mogavero MP, Catania V, Galeano A, Garifoli A, Lanuzza B, Morreale M, Tripodi M, Cantone M, Cappellani F, Concerto C, Rodolico A, Pennisi M, Bella R, Ferri R. Targeting the adenosinergic system in restless legs syndrome: A pilot, "proof-of-concept" placebo-controlled TMS-based protocol. PLoS One 2024; 19:e0302829. [PMID: 38728342 PMCID: PMC11086884 DOI: 10.1371/journal.pone.0302829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/10/2024] [Indexed: 05/12/2024] Open
Abstract
Restless Legs Syndrome (RLS) is a common sleep disorder characterized by an urge to move the legs that is responsive to movement (particularly during rest), periodic leg movements during sleep, and hyperarousal. Recent evidence suggests that the involvement of the adenosine system may establish a connection between dopamine and glutamate dysfunction in RLS. Transcranial magnetic stimulation (TMS) is a non-invasive electrophysiological technique widely applied to explore brain electrophysiology and neurochemistry under different experimental conditions. In this pilot study protocol, we aim to investigate the effects of dipyridamole (a well-known enhancer of adenosinergic transmission) and caffeine (an adenosine receptor antagonist) on measures of cortical excitation and inhibition in response to TMS in patients with primary RLS. Initially, we will assess cortical excitability using both single- and paired-pulse TMS in patients with RLS. Then, based on the measures obtained, we will explore the effects of dipyridamole and caffeine, in comparison to placebo, on various TMS parameters related to cortical excitation and inhibition. Finally, we will evaluate the psycho-cognitive performance of RLS patients to screen them for cognitive impairment and/or mood-behavioral dysfunction, thus aiming to correlate psycho-cognitive findings with TMS data. Overall, this study protocol will be the first to shed lights on the neurophysiological mechanisms of RLS involving the modulation of the adenosine system, thus potentially providing a foundation for innovative "pharmaco-TMS"-based treatments. The distinctive TMS profile observed in RLS holds indeed the potential utility for both diagnosis and treatment, as well as for patient monitoring. As such, it can be considered a target for both novel pharmacological (i.e., drug) and non-pharmacological (e.g., neuromodulatory), "TMS-guided", interventions.
Collapse
Affiliation(s)
- Giuseppe Lanza
- Oasi Research Institute-IRCCS, Troina, Italy
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | | | - Maria P. Mogavero
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Neuroscience, San Raffaele Scientific Institute, Sleep Disorders Center, Milan, Italy
| | | | | | | | | | | | | | - Mariagiovanna Cantone
- Neurology Unit, Policlinico University Hospital “G. Rodolico-San Marco”, Catania, Italy
| | - Francesco Cappellani
- Ophtalomolgy Unit, Policlinico University Hospital “G. Rodolico-San Marco”, Catania, Italy
| | - Carmen Concerto
- Psychiatry Unit, Policlinico University Hospital “G. Rodolico-San Marco”, Catania, Italy
| | - Alessandro Rodolico
- Psychiatry Unit, Policlinico University Hospital “G. Rodolico-San Marco”, Catania, Italy
| | - Manuela Pennisi
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Catania, Italy
| | | |
Collapse
|
2
|
Mogavero MP, Salemi M, Lanza G, Rinaldi A, Marchese G, Ravo M, Salluzzo MG, Antoci A, DelRosso LM, Bruni O, Ferini-Strambi L, Ferri R. Unveiling the pathophysiology of restless legs syndrome through transcriptome analysis. iScience 2024; 27:109568. [PMID: 38617564 PMCID: PMC11015462 DOI: 10.1016/j.isci.2024.109568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/22/2024] [Accepted: 03/22/2024] [Indexed: 04/16/2024] Open
Abstract
The aim of this study was to analyze signaling pathways associated with differentially expressed messenger RNAs in people with restless legs syndrome (RLS). Seventeen RLS patients and 18 controls were enrolled. Coding RNA expression profiling of 12,857 gene transcripts by next-generation sequencing was performed. Enrichment analysis by pathfindR tool was carried-out, with p-adjusted ≤0.001 and fold-change ≥2.5. Nine main different network groups were significantly dysregulated in RLS: infections, inflammation, immunology, neurodegeneration, cancer, neurotransmission and biological, blood and metabolic mechanisms. Genetic predisposition plays a key role in RLS and evidence indicates its inflammatory nature; the high involvement of mainly neurotropic viruses and the TORCH complex might trigger inflammatory/immune reactions in genetically predisposed subjects and activate a series of biological pathways-especially IL-17, receptor potential channels, nuclear factor kappa-light-chain-enhancer of activated B cells, NOD-like receptor, mitogen-activated protein kinase, p53, mitophagy, and ferroptosis-involved in neurotransmitter mechanisms, synaptic plasticity, axon guidance, neurodegeneration, carcinogenesis, and metabolism.
Collapse
Affiliation(s)
- Maria P. Mogavero
- Vita-Salute San Raffaele University, 20132 Milan, Italy
- San Raffaele Scientific Institute, Division of Neuroscience, Sleep Disorders Center, 20127 Milan, Italy
| | | | - Giuseppe Lanza
- Oasi Research Institute-IRCCS, 94018 Troina, Italy
- University of Catania, Department of Surgery and Medical-Surgical Specialties, 95123 Catania, Italy
| | - Antonio Rinaldi
- Genomix4Life Srl, 84081 Baronissi, Italy
- Genome Research Center for Health-CRGS, 84081 Baronissi, Italy
| | - Giovanna Marchese
- Genomix4Life Srl, 84081 Baronissi, Italy
- Genome Research Center for Health-CRGS, 84081 Baronissi, Italy
| | - Maria Ravo
- Genomix4Life Srl, 84081 Baronissi, Italy
- Genome Research Center for Health-CRGS, 84081 Baronissi, Italy
| | | | | | | | - Oliviero Bruni
- Sapienza University of Rome, Developmental and Social Psychology, 00185 Rome, Italy
| | - Luigi Ferini-Strambi
- Vita-Salute San Raffaele University, 20132 Milan, Italy
- San Raffaele Scientific Institute, Division of Neuroscience, Sleep Disorders Center, 20127 Milan, Italy
| | | |
Collapse
|
3
|
Dirks CAH, Bachmann CG. From brain to spinal cord: neuromodulation by direct current stimulation and its promising effects as a treatment option for restless legs syndrome. Front Neurol 2024; 15:1278200. [PMID: 38333606 PMCID: PMC10850250 DOI: 10.3389/fneur.2024.1278200] [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: 08/15/2023] [Accepted: 01/09/2024] [Indexed: 02/10/2024] Open
Abstract
Neuromodulation is a fast-growing field of mostly non-invasive therapies, which includes spinal cord stimulation (SCS), transcranial direct current stimulation (tDCS), vagal nerve stimulation (VNS), peripheral nerve stimulation, transcranial magnetic stimulation (TMS) and transcutaneous spinal direct current stimulation (tsDCS). This narrative review offers an overview of the therapy options, especially of tDCS and tsDCS for chronic pain and spinal cord injury. Finally, we discuss the potential of tsDCS in Restless Legs Syndrome as a promising non-invasive, alternative therapy to medication therapy.
Collapse
|
4
|
Marinkovic K, White DR, Alderson Myers A, Parker KS, Arienzo D, Mason GF. Cortical GABA Levels Are Reduced in Post-Acute COVID-19 Syndrome. Brain Sci 2023; 13:1666. [PMID: 38137114 PMCID: PMC10741691 DOI: 10.3390/brainsci13121666] [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: 11/11/2023] [Revised: 11/28/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
After recovering from the acute COVID-19 illness, a substantial proportion of people continue experiencing post-acute sequelae of COVID-19 (PASC), also termed "long COVID". Their quality of life is adversely impacted by persistent cognitive dysfunction and affective distress, but the underlying neural mechanisms are poorly understood. The present study recruited a group of mostly young, previously healthy adults (24.4 ± 5.2 years of age) who experienced PASC for almost 6 months following a mild acute COVID-19 illness. Confirming prior evidence, they reported noticeable memory and attention deficits, brain fog, depression/anxiety, fatigue, and other symptoms potentially suggestive of excitation/inhibition imbalance. Proton magnetic resonance spectroscopy (1H-MRS) was used to examine the neurochemical aspects of cell signaling with an emphasis on GABA levels in the occipital cortex. The PASC participants were compared to a control (CNT) group matched in demographics, intelligence, and an array of other variables. Controlling for tissue composition, biological sex, and alcohol intake, the PASC group had lower GABA+/water than CNT, which correlated with depression and poor sleep quality. The mediation analysis revealed that the impact of PASC on depression was partly mediated by lower GABA+/water, indicative of cortical hyperexcitability as an underlying mechanism. In addition, N-acetylaspartate (NAA) tended to be lower in the PASC group, possibly suggesting compromised neuronal integrity. Persistent neuroinflammation may contribute to the pathogenesis of PASC-related neurocognitive dysfunction.
Collapse
Affiliation(s)
- Ksenija Marinkovic
- Spatio-Temporal Brain Imaging Lab, Department of Psychology, San Diego State University, San Diego, CA 92182, USA (A.A.M.); (D.A.)
- Department of Radiology, University of California, San Diego, CA 92093, USA
| | - David R. White
- Spatio-Temporal Brain Imaging Lab, Department of Psychology, San Diego State University, San Diego, CA 92182, USA (A.A.M.); (D.A.)
| | - Austin Alderson Myers
- Spatio-Temporal Brain Imaging Lab, Department of Psychology, San Diego State University, San Diego, CA 92182, USA (A.A.M.); (D.A.)
- Department of Psychiatry, University of California, San Diego, CA 92093, USA
| | - Katie S. Parker
- Spatio-Temporal Brain Imaging Lab, Department of Psychology, San Diego State University, San Diego, CA 92182, USA (A.A.M.); (D.A.)
| | - Donatello Arienzo
- Spatio-Temporal Brain Imaging Lab, Department of Psychology, San Diego State University, San Diego, CA 92182, USA (A.A.M.); (D.A.)
- Department of Radiology, University of California, San Diego, CA 92093, USA
| | - Graeme F. Mason
- Department of Radiology and Biomedical Imaging, Psychiatry, and Biomedical Engineering, Yale University, New Haven, CT 06520, USA;
| |
Collapse
|
5
|
Vanhanen J, Kujala J, Liljeström M, Kalso E, Virkkala J, Harno H. rTMS targeted to the secondary somatosensory cortex influences sleep in CRPS patients, as measured with the OURA ring. Brain Behav 2023; 13:e3252. [PMID: 37700567 PMCID: PMC10636402 DOI: 10.1002/brb3.3252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/31/2023] [Accepted: 09/02/2023] [Indexed: 09/14/2023] Open
Abstract
INTRODUCTION Chronic pain associates with various sleep problems. Patients with complex regional pain syndrome (CRPS) often report impaired sleep, but objective measurements of sleep in CRPS patients are scarce. Neuromodulation with repetitive transcranial magnetic stimulation (rTMS) can alleviate pain and improve sleep. Secondary somatosensory cortex (S2) is a possible rTMS target for the treatment of chronic pain, but the effect of S2-targeted rTMS on sleep is unknown. METHODS This randomized, sham-controlled trial assessed the effect of S2-targeted rTMS on sleep in patients with CRPS. Patients (n = 31) received either S2-targeted rTMS (10 Hz) or sham stimulation for 3 weeks. The effect of treatment on sleep was assessed with validated questionnaires, with a sleep and pain diary, and with a consumer-grade sleep tracker, the Oura ring. In addition to an ordinary univariate analysis of the results, we conducted multivariate testing of the Oura data using linear discriminant analysis (LDA). RESULTS S2-targeted rTMS decreased sleep restlessness that significantly differed between the rTMS and sham stimulation patient groups (p = .028). In the multivariate analysis of the Oura data, LDA classification accuracy to separate the rTMS and sham groups exceeded 95% confidence level in four out of the seven tested models. In the subjective evaluation of sleep, the effect of rTMS and sham did not differ. CONCLUSION S2-targeted rTMS influenced sleep in patients with CRPS. Improved sleep may enhance CRPS symptom alleviation and be of clinical importance. A univariate analysis could separate the rTMS and sham treatments. The multivariate analysis revealed that including multiple sleep-related parameters can be beneficial when analyzing rTMS effects on sleep. As sleep is related both to pain and quality of life, and sleep rTMS can be directly affected by rTMS, objective monitoring of sleep in various future rTMS trials could be fruitful.
Collapse
Affiliation(s)
- Jukka Vanhanen
- HUS Diagnostic Center, Clinical Neurophysiology, Clinical NeurosciencesHelsinki University Hospital and University of HelsinkiHelsinkiFinland
- BioMag Laboratory, HUS Diagnostic CenterHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Jan Kujala
- Department of PsychologyUniversity of JyväskyläJyväskyläFinland
| | - Mia Liljeström
- BioMag Laboratory, HUS Diagnostic CenterHelsinki University Hospital and University of HelsinkiHelsinkiFinland
- Department of Neuroscience and Biomedical EngineeringAalto UniversityEspooFinland
| | - Eija Kalso
- Department of Anaesthesiology, Intensive Care and Pain MedicineHelsinki University Hospital and University of HelsinkiHelsinkiFinland
- SleepWell Research ProgramUniversity of HelsinkiHelsinkiFinland
| | - Jussi Virkkala
- HUS Diagnostic Center, Clinical Neurophysiology, Clinical NeurosciencesHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Hanna Harno
- Department of Anaesthesiology, Intensive Care and Pain MedicineHelsinki University Hospital and University of HelsinkiHelsinkiFinland
- SleepWell Research ProgramUniversity of HelsinkiHelsinkiFinland
- Clinical Neurosciences, NeurologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| |
Collapse
|
6
|
Xu M, Wang Q, Li B, Qian S, Wang S, Wang Y, Chen C, Liu Z, Ji Y, Liu K, Xin K, Niu Y. Cerebellum and hippocampus abnormalities in patients with insomnia comorbid depression: a study on cerebral blood perfusion and functional connectivity. Front Neurosci 2023; 17:1202514. [PMID: 37397441 PMCID: PMC10311636 DOI: 10.3389/fnins.2023.1202514] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 05/29/2023] [Indexed: 07/04/2023] Open
Abstract
Chronic insomnia disorder and major depressive disorder are highly-occurred mental diseases with extensive social harm. The comorbidity of these two diseases is commonly seen in clinical practice, but the mechanism remains unclear. To observe the characteristics of cerebral blood perfusion and functional connectivity in patients, so as to explore the potential pathogenesis and biological imaging markers, thereby improving the understanding of their comorbidity mechanism. 44 patients with chronic insomnia disorder comorbid major depressive disorder and 43 healthy controls were recruited in this study. The severity of insomnia and depression were assessed by questionnaire. The cerebral blood perfusion and functional connectivity values of participants were obtained to, analyze their correlation with questionnaire scores. The cerebral blood flow in cerebellum, vermis, right hippocampus, left parahippocampal gyrus of patients were reduced, which was negatively related to the severity of insomnia or depression. The connectivities of left cerebellum-right putamen and right hippocampus-left inferior frontal gyrus were increased, showing positive correlations with the severity of insomnia and depression. Decreased connectivities of left cerebellum-left fusiform gyrus, left cerebellum-left occipital lobe, right hippocampus-right paracentral lobule, right hippocampus-right precentral gyrus were partially associated with insomnia or depression. The connectivity of right hippocampus-left inferior frontal gyrus may mediate between insomnia and depression. Insomnia and depression can cause changes in cerebral blood flow and brain function. Changes in the cerebellar and hippocampal regions are the result of insomnia and depression. They reflect abnormalities in sleep and emotion regulation. That may be involved in the pathogenesis of comorbidity.
Collapse
Affiliation(s)
- Minghe Xu
- Postgraduate Training Base of the 960th Hospital of People's Liberation Army Joint Logistic Support Force, Jinzhou Medical University, Jinan, China
| | - Qian Wang
- Department of Radiology, Qingdao Hospital of Traditional Chinese Medicine (Qingdao Hiser hospital), Qingdao, China
| | - Bo Li
- Department of Radiology, The 960th Hospital of People's Liberation Army Joint Logistic Support Force, Jinan, China
| | - Shaowen Qian
- Department of Radiology, The 960th Hospital of People's Liberation Army Joint Logistic Support Force, Jinan, China
| | - Shuang Wang
- Department of Radiology, The 960th Hospital of People's Liberation Army Joint Logistic Support Force, Jinan, China
| | - Yu Wang
- Department of Radiology, The 960th Hospital of People's Liberation Army Joint Logistic Support Force, Jinan, China
| | - Chunlian Chen
- Department of Radiology, The 960th Hospital of People's Liberation Army Joint Logistic Support Force, Jinan, China
| | - Zhe Liu
- Department of Radiology, The 960th Hospital of People's Liberation Army Joint Logistic Support Force, Jinan, China
| | - Yuqing Ji
- Department of Radiology, The 960th Hospital of People's Liberation Army Joint Logistic Support Force, Jinan, China
| | - Kai Liu
- Department of Radiology, The 960th Hospital of People's Liberation Army Joint Logistic Support Force, Jinan, China
| | - Kuolin Xin
- Sleep Clinic, The 960th Hospital of People's Liberation Army Joint Logistic Support Force, Jinan, China
| | - Yujun Niu
- Department of Radiology, First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| |
Collapse
|
7
|
Lanza G, Fisicaro F, Cantone M, Pennisi M, Cosentino FII, Lanuzza B, Tripodi M, Bella R, Paulus W, Ferri R. Repetitive transcranial magnetic stimulation in primary sleep disorders. Sleep Med Rev 2023; 67:101735. [PMID: 36563570 DOI: 10.1016/j.smrv.2022.101735] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/13/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a widely used non-invasive neuromodulatory technique. When applied in sleep medicine, the main hypothesis explaining its effects concerns the modulation of synaptic plasticity and the strength of connections between the brain areas involved in sleep disorders. Recently, there has been a significant increase in the publication of rTMS studies in primary sleep disorders. A multi-database-based search converges on the evidence that rTMS is safe and feasible in chronic insomnia, obstructive sleep apnea syndrome (OSAS), restless legs syndrome (RLS), and sleep deprivation-related cognitive deficits, whereas limited or no data are available for narcolepsy, sleep bruxism, and REM sleep behavior disorder. Regarding efficacy, the stimulation of the dorsolateral prefrontal cortex bilaterally, right parietal cortex, and dominant primary motor cortex (M1) in insomnia, as well as the stimulation of M1 leg area bilaterally, left primary somatosensory cortex, and left M1 in RLS reduced subjective symptoms and severity scale scores, with effects lasting for up to weeks; conversely, no relevant effect was observed in OSAS and narcolepsy. Nevertheless, several limitations especially regarding the stimulation protocols need to be considered. This review should be viewed as a step towards the further contribution of individually tailored neuromodulatory techniques for sleep disorders.
Collapse
Affiliation(s)
- Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy; Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS, Troina, Italy.
| | - Francesco Fisicaro
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Mariagiovanna Cantone
- Neurology Unit, University Hospital Policlinico "G. Rodolico-San Marco", Catania, Italy; Department of Neurology, Sant'Elia Hospital, ASP Caltanissetta, Caltanissetta, Italy
| | - Manuela Pennisi
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | | | - Bartolo Lanuzza
- Department of Neurology IC and Sleep Research Centre, Oasi Research Institute-IRCCS, Troina, Italy
| | - Mariangela Tripodi
- Department of Neurology IC and Sleep Research Centre, Oasi Research Institute-IRCCS, Troina, Italy
| | - Rita Bella
- Department of Medical and Surgical Science and Advanced Technologies, University of Catania, Catania, Italy
| | - Walter Paulus
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
| | - Raffaele Ferri
- Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS, Troina, Italy
| |
Collapse
|
8
|
Zhu L, Dang G, Wu W, Zhou J, Shi X, Su X, Ren H, Pei Z, Lan X, Lian C, Xie P, Guo Y. Functional connectivity changes are correlated with sleep improvement in chronic insomnia patients after rTMS treatment. Front Neurosci 2023; 17:1135995. [PMID: 37139515 PMCID: PMC10149758 DOI: 10.3389/fnins.2023.1135995] [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: 01/02/2023] [Accepted: 03/28/2023] [Indexed: 05/05/2023] Open
Abstract
Background Repetitive transcranial magnetic stimulation (rTMS) has been increasingly used as a treatment modality for chronic insomnia disorder (CID). However, our understanding of the mechanisms underlying the efficacy of rTMS is limited. Objective This study aimed to investigate rTMS-induced alterations in resting-state functional connectivity and to find potential connectivity biomarkers for predicting and tracking clinical outcomes after rTMS. Methods Thirty-seven patients with CID received a 10-session low frequency rTMS treatment applied to the right dorsolateral prefrontal cortex. Before and after treatment, the patients underwent resting-state electroencephalography recordings and a sleep quality assessment using the Pittsburgh Sleep Quality Index (PSQI). Results After treatment, rTMS significantly increased the connectivity of 34 connectomes in the lower alpha frequency band (8-10 Hz). Additionally, alterations in functional connectivity between the left insula and the left inferior eye junction, as well as between the left insula and medial prefrontal cortex, were associated with a decrease in PSQI score. Further, the correlation between the functional connectivity and PSQI persisted 1 month after the completion of rTMS as evidenced by subsequent electroencephalography (EEG) recordings and the PSQI assessment. Conclusion Based on these results, we established a link between alterations in functional connectivity and clinical outcomes of rTMS, which suggested that EEG-derived functional connectivity changes were associated with clinical improvement of rTMS in treating CID. These findings provide preliminary evidence that rTMS may improve insomnia symptoms by modifying functional connectivity, which can be used to inform prospective clinical trials and potentially for treatment optimization.
Collapse
Affiliation(s)
- Lin Zhu
- Department of Neurology, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Ge Dang
- Department of Neurology, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Wei Wu
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Junhong Zhou
- Hebrew Seniorlife, Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School, Boston, MA, United States
| | - Xue Shi
- Department of Neurology, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Xiaolin Su
- Department of Neurology, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Huixia Ren
- Department of Geriatrics, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Zian Pei
- Shenzhen Bay Laboratory, Shenzhen, Guangdong, China
| | - Xiaoyong Lan
- Shenzhen Bay Laboratory, Shenzhen, Guangdong, China
| | | | - Peng Xie
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yi Guo
- Department of Neurology, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
- Shenzhen Bay Laboratory, Shenzhen, Guangdong, China
- *Correspondence: Yi Guo,
| |
Collapse
|
9
|
Silvani A, Ghorayeb I, Manconi M, Li Y, Clemens S. Putative Animal Models of Restless Legs Syndrome: A Systematic Review and Evaluation of Their Face and Construct Validity. Neurotherapeutics 2023; 20:154-178. [PMID: 36536233 PMCID: PMC10119375 DOI: 10.1007/s13311-022-01334-4] [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] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Restless legs syndrome (RLS) is a sensorimotor disorder that severely affects sleep. It is characterized by an urge to move the legs, which is often accompanied by periodic limb movements during sleep. RLS has a high prevalence in the population and is usually a life-long condition. While its origins remain unclear, RLS is initially highly responsive to treatment with dopaminergic agonists that target D2-like receptors, in particular D2 and D3, but the long-term response is often unsatisfactory. Over the years, several putative animal models for RLS have been developed, mainly based on the epidemiological and neurochemical link with iron deficiency, treatment efficacy of D2-like dopaminergic agonists, or genome-wide association studies that identified risk factors in the patient population. Here, we present the first systematic review of putative animal models of RLS, provide information about their face and construct validity, and report their role in deciphering the underlying pathophysiological mechanisms that may cause or contribute to RLS. We propose that identifying the causal links between genetic risk factors, altered organ functions, and changes to molecular pathways in neural circuitry will eventually lead to more effective new treatment options that bypass the side effects of the currently used therapeutics in RLS, especially for long-term therapy.
Collapse
Affiliation(s)
- Alessandro Silvani
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Ravenna Campus, Ravenna, Italy
| | - Imad Ghorayeb
- Département de Neurophysiologie Clinique, Pôle Neurosciences Cliniques, CHU de Bordeaux, Bordeaux, France
- Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, UMR 5287, Université de Bordeaux, Bordeaux, France
- Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, UMR 5287, CNRS, Bordeaux, France
| | - Mauro Manconi
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, EOC, Ospedale Civico, Lugano, Switzerland
- Department of Neurology, University Hospital, Inselspital, Bern, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Yuqing Li
- Department of Neurology, College of Medicine, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Stefan Clemens
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, USA.
| |
Collapse
|
10
|
Li Y, Chen K, Wang J, Lu H, Li X, Yang L, Zhang W, Ning S, Wang J, Sun Y, Song Y, Zhang M, Hou J, Shi H. Research progress on transcranial magnetic stimulation for post-stroke dysphagia. Front Behav Neurosci 2022; 16:995614. [PMID: 36062260 PMCID: PMC9434690 DOI: 10.3389/fnbeh.2022.995614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
Dysphagia is one of the most common manifestations of stroke, which can affect as many as 50–81% of acute stroke patients. Despite the development of diverse treatment approaches, the precise mechanisms underlying therapeutic efficacy remain controversial. Earlier studies have revealed that the onset of dysphagia is associated with neurological damage. Neuroplasticity-based transcranial magnetic stimulation (TMS), a recently introduced technique, is widely used in the treatment of post-stroke dysphagia (PSD) by increasing changes in neurological pathways through synaptogenesis, reorganization, network strengthening, and inhibition. The main objective of this review is to discuss the effectiveness, mechanisms, potential limitations, and prospects of TMS for clinical application in PSD rehabilitation, with a view to provide a reference for future research and clinical practice.
Collapse
Affiliation(s)
- Yi Li
- Department of Rehabilitation Medicine, Third People’s Hospital of Yunnan Province, Kunming, China
| | - Kerong Chen
- Department of Rehabilitation Medicine, Third People’s Hospital of Yunnan Province, Kunming, China
| | - Jiapu Wang
- Department of Rehabilitation Medicine, Third People’s Hospital of Yunnan Province, Kunming, China
| | - Hanmei Lu
- Department of Rehabilitation Medicine, Third People’s Hospital of Yunnan Province, Kunming, China
| | - Xiaoyu Li
- Department of Rehabilitation Medicine, Third People’s Hospital of Yunnan Province, Kunming, China
| | - Lei Yang
- Department of Rehabilitation Medicine, Third People’s Hospital of Yunnan Province, Kunming, China
| | - Wenlu Zhang
- Department of Rehabilitation Medicine, Third People’s Hospital of Yunnan Province, Kunming, China
| | - Shujuan Ning
- Department of Rehabilitation Medicine, Third People’s Hospital of Yunnan Province, Kunming, China
| | - Juan Wang
- Department of Rehabilitation Medicine, Third People’s Hospital of Yunnan Province, Kunming, China
| | - Yi Sun
- Department of Rehabilitation Medicine, Third People’s Hospital of Yunnan Province, Kunming, China
| | - Yu Song
- Department of Rehabilitation Medicine, Third People’s Hospital of Yunnan Province, Kunming, China
| | - Mei Zhang
- Department of Rehabilitation Medicine, Third People’s Hospital of Yunnan Province, Kunming, China
- Mei Zhang,
| | - Jianhong Hou
- Department of Orthopedics, Third People’s Hospital of Yunnan Province, Kunming, China
- Jianhong Hou,
| | - Hongling Shi
- Department of Rehabilitation Medicine, Third People’s Hospital of Yunnan Province, Kunming, China
- *Correspondence: Hongling Shi,
| |
Collapse
|
11
|
Lu Q, Zhang W, Yan H, Mansouri N, Tanglay O, Osipowicz K, Joyce AW, Young IM, Zhang X, Doyen S, Sughrue ME, He C. Connectomic disturbances underlying insomnia disorder and predictors of treatment response. Front Hum Neurosci 2022; 16:960350. [PMID: 36034119 PMCID: PMC9399490 DOI: 10.3389/fnhum.2022.960350] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/19/2022] [Indexed: 01/23/2023] Open
Abstract
ObjectiveDespite its prevalence, insomnia disorder (ID) remains poorly understood. In this study, we used machine learning to analyze the functional connectivity (FC) disturbances underlying ID, and identify potential predictors of treatment response through recurrent transcranial magnetic stimulation (rTMS) and pharmacotherapy.Materials and methods51 adult patients with chronic insomnia and 42 healthy age and education matched controls underwent baseline anatomical T1 magnetic resonance imaging (MRI), resting-stage functional MRI (rsfMRI), and diffusion weighted imaging (DWI). Imaging was repeated for 24 ID patients following four weeks of treatment with pharmacotherapy, with or without rTMS. A recently developed machine learning technique, Hollow Tree Super (HoTS) was used to classify subjects into ID and control groups based on their FC, and derive network and parcel-based FC features contributing to each model. The number of FC anomalies within each network was also compared between responders and non-responders using median absolute deviation at baseline and follow-up.ResultsSubjects were classified into ID and control with an area under the receiver operating characteristic curve (AUC-ROC) of 0.828. Baseline FC anomaly counts were higher in responders than non-responders. Response as measured by the Insomnia Severity Index (ISI) was associated with a decrease in anomaly counts across all networks, while all networks showed an increase in anomaly counts when response was measured using the Pittsburgh Sleep Quality Index. Overall, responders also showed greater change in all networks, with the Default Mode Network demonstrating the greatest change.ConclusionMachine learning analysis into the functional connectome in ID may provide useful insight into diagnostic and therapeutic targets.
Collapse
Affiliation(s)
- Qian Lu
- Department of Rehabilitation Medicine, The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University, Suzhou, China
| | - Wentong Zhang
- Department of Rehabilitation Medicine, The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University, Suzhou, China
| | - Hailang Yan
- Department of Radiology, The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University, Suzhou, China
| | | | - Onur Tanglay
- Omniscient Neurotechnology, Sydney, NSW, Australia
| | | | | | | | - Xia Zhang
- International Joint Research Center on Precision Brain Medicine, XD Group Hospital, Xi’an, China
- Shenzhen Xijia Medical Technology Company, Shenzhen, China
| | | | - Michael E. Sughrue
- Omniscient Neurotechnology, Sydney, NSW, Australia
- International Joint Research Center on Precision Brain Medicine, XD Group Hospital, Xi’an, China
- Michael E. Sughrue,
| | - Chuan He
- Department of Rehabilitation Medicine, The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University, Suzhou, China
- *Correspondence: Chuan He,
| |
Collapse
|
12
|
Salminen AV, Clemens S, García-Borreguero D, Ghorayeb I, Li Y, Manconi M, Ondo W, Rye D, Siegel JM, Silvani A, Winkelman JW, Allen RP, Ferré S. Consensus guidelines on the construct validity of rodent models of restless legs syndrome. Dis Model Mech 2022; 15:dmm049615. [PMID: 35946581 PMCID: PMC9393041 DOI: 10.1242/dmm.049615] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/10/2022] [Indexed: 12/16/2022] Open
Abstract
Our understanding of the causes and natural course of restless legs syndrome (RLS) is incomplete. The lack of objective diagnostic biomarkers remains a challenge for clinical research and for the development of valid animal models. As a task force of preclinical and clinical scientists, we have previously defined face validity parameters for rodent models of RLS. In this article, we establish new guidelines for the construct validity of RLS rodent models. To do so, we first determined and agreed on the risk, and triggering factors and pathophysiological mechanisms that influence RLS expressivity. We then selected 20 items considered to have sufficient support in the literature, which we grouped by sex and genetic factors, iron-related mechanisms, electrophysiological mechanisms, dopaminergic mechanisms, exposure to medications active in the central nervous system, and others. These factors and biological mechanisms were then translated into rodent bioequivalents deemed to be most appropriate for a rodent model of RLS. We also identified parameters by which to assess and quantify these bioequivalents. Investigating these factors, both individually and in combination, will help to identify their specific roles in the expression of rodent RLS-like phenotypes, which should provide significant translational implications for the diagnosis and treatment of RLS.
Collapse
Affiliation(s)
- Aaro V. Salminen
- Institute of Neurogenomics, Helmholtz Zentrum München GmbH - German Research Center for Environmental Health, 85764 Neuherberg, Germany
- Institute of Human Genetics, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Stefan Clemens
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA
| | | | - Imad Ghorayeb
- Département de Neurophysiologie Clinique, Pôle Neurosciences Cliniques, CHU de Bordeaux, 33076 Bordeaux, France
- Université de Bordeaux, Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, UMR 5287, 33076 Bordeaux, France
- CNRS, Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, UMR 5287, 33076 Bordeaux, France
| | - Yuqing Li
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Mauro Manconi
- Sleep Medicine Unit, Regional Hospital of Lugano, Neurocenter of Southern Switzerland, 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
- Department of Neurology, University Hospital Inselspital, 3010 Bern, Switzerland
| | - William Ondo
- Houston Methodist Hospital Neurological Institute, Weill Cornell Medical School, Houston, TX 77070, USA
| | - David Rye
- Department of Neurology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Jerome M. Siegel
- Neuropsychiatric Institute and Brain Research Institute, University of California, Los Angeles, CA 90095, USA
- Neurobiology Research, Veterans Administration Greater Los Angeles Healthcare System, North Hills, CA 91343, USA
| | - Alessandro Silvani
- Department of Biomedical and Neuromotor Sciences Alma Mater Studiorum, Università di Bologna, 48121 Ravenna Campus, Ravenna, Italy
| | - John W. Winkelman
- Departments of Psychiatry and Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Richard P. Allen
- Department of Neurology, Johns Hopkins University, Baltimore, MD 21224, USA
| | - Sergi Ferré
- Integrative Neurobiology Section, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD 21224, USA
| | | |
Collapse
|
13
|
Pickersgill JW, Turco CV, Ramdeo K, Rehsi RS, Foglia SD, Nelson AJ. The Combined Influences of Exercise, Diet and Sleep on Neuroplasticity. Front Psychol 2022; 13:831819. [PMID: 35558719 PMCID: PMC9090458 DOI: 10.3389/fpsyg.2022.831819] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/25/2022] [Indexed: 12/11/2022] Open
Abstract
Neuroplasticity refers to the brain’s ability to undergo structural and functional adaptations in response to experience, and this process is associated with learning, memory and improvements in cognitive function. The brain’s propensity for neuroplasticity is influenced by lifestyle factors including exercise, diet and sleep. This review gathers evidence from molecular, systems and behavioral neuroscience to explain how these three key lifestyle factors influence neuroplasticity alone and in combination with one another. This review collected results from human studies as well as animal models. This information will have implications for research, educational, fitness and neurorehabilitation settings.
Collapse
Affiliation(s)
| | - Claudia V Turco
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Karishma Ramdeo
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Ravjot S Rehsi
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Stevie D Foglia
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
| | - Aimee J Nelson
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
14
|
Jiao Y, Li G, Dai Y. Clinical effect of repetitive transcranial magnetic stimulation on dysphagia due to stroke. Neurol Sci 2022; 43:3139-3144. [PMID: 35000011 DOI: 10.1007/s10072-021-05799-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 12/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rT) could change the excitability of the cerebral cortex, and control the neurotransmitter release, with the therapeutic effect depending on stimulation intensity and position. In this study, we used 3 Hz rTMS to stimulate the pharyngeal cortical area of the lesioned hemisphere and to explore its clinical significance in the treatment of dysphagia after acute cerebral infarction. METHODS A total of 61 in-patients with acute dysphagia caused by cerebral infarction hospitalized in the department of neurology of our hospital were included in this study and were assigned into the control and rTMS group. Patients in the control group only accepted the basic treatment of rehabilitation training, while patients in the rTMS group received additional rTMS (3 Hz) stimulation. The levels of the water swallowing test (WST) 14 days before and after the treatment of rTMS (3 Hz) would be recorded. RESULTS After different therapies in two groups, 9 patients of the control group showed excellent curative effect, with a recovery rate of 31.0%. However, in the rTMS group, the swallowing function of 21 patients was significantly improved, with a recovery rate of 65.6%. Comparison results showed that the recovery rate of the rTMS group was much better than the control group (P < 0.05), indicating an effective therapeutic effect of 3 Hz rTMS on patients with dysphagia after acute cerebral infarction. CONCLUSION Stimulating the target cortical representation areas of pharyngeal of the lesioned hemisphere with cerebral infarction by the rTMS (3 Hz) could improve the patients' function.
Collapse
Affiliation(s)
- Yonggang Jiao
- Department of Neurology, Guangdong Second Provincial General Hospital, Haizhu District, No. 466, Xingang Middle Road, Guangzhou, 510317, Guangdong, China.
| | - Guocai Li
- Department of Anesthesiology, Shenzhen Hospital (Fu Tian) of Guangzhou University of Chinese Medicine, Shenzhen, 518034, Guangdong, China
| | - Yingyi Dai
- Department of Neurology, Guangdong Second Provincial General Hospital, Haizhu District, No. 466, Xingang Middle Road, Guangzhou, 510317, Guangdong, China
| |
Collapse
|
15
|
Lanza G, Cosentino FII, Lanuzza B, Tripodi M, Aricò D, Figorilli M, Puligheddu M, Fisicaro F, Bella R, Ferri R, Pennisi M. Reduced Intracortical Facilitation to TMS in Both Isolated REM Sleep Behavior Disorder (RBD) and Early Parkinson's Disease with RBD. J Clin Med 2022; 11:jcm11092291. [PMID: 35566417 PMCID: PMC9104430 DOI: 10.3390/jcm11092291] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/06/2022] [Accepted: 04/18/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND a reduced intracortical facilitation (ICF), a transcranial magnetic stimulation (TMS) measure largely mediated by glutamatergic neurotransmission, was observed in subjects affected by isolated REM sleep behavior disorder (iRBD). However, direct comparison between iRBD and Parkinson's disease (PD) with RBD is currently lacking. METHODS resting motor threshold, contralateral cortical silent period, amplitude and latency of motor evoked potentials, short-interval intracortical inhibition, and intracortical facilitation (ICF) were recorded from 15 drug-naïve iRBD patients, 15 drug-naïve PD with RBD patients, and 15 healthy participants from the right First Dorsal Interosseous muscle. REM sleep atonia index (RAI), Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS), and Epworth Sleepiness Scale (ESS) were assessed. RESULTS Groups were similar for sex, age, education, and patients for RBD duration and RAI. Neurological examination, MMSE, ESS, and GDS were normal in iRBD patients and controls; ESS scored worse in PD patients, but with no difference between groups at post hoc analysis. Compared to controls, both patient groups exhibited a significantly decreased ICF, without difference between them. CONCLUSIONS iRBD and PD with RBD shared a reduced ICF, thus suggesting the involvement of glutamatergic transmission both in subjects at risk for degeneration and in those with an overt α-synucleinopathy.
Collapse
Affiliation(s)
- Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy
- Clinical Neurophysiology Research Unit, Oasi Research Institute—IRCCS, Via Conte Ruggero 73, 94018 Troina, Italy;
- Correspondence: ; Tel.: +39-095-3782448
| | - Filomena Irene Ilaria Cosentino
- Department of Neurology IC and Sleep Research Center, Oasi Research Institute—IRCCS, Via Conte Ruggero 73, 94018 Troina, Italy; (F.I.I.C.); (B.L.); (M.T.); (D.A.)
| | - Bartolo Lanuzza
- Department of Neurology IC and Sleep Research Center, Oasi Research Institute—IRCCS, Via Conte Ruggero 73, 94018 Troina, Italy; (F.I.I.C.); (B.L.); (M.T.); (D.A.)
| | - Mariangela Tripodi
- Department of Neurology IC and Sleep Research Center, Oasi Research Institute—IRCCS, Via Conte Ruggero 73, 94018 Troina, Italy; (F.I.I.C.); (B.L.); (M.T.); (D.A.)
| | - Debora Aricò
- Department of Neurology IC and Sleep Research Center, Oasi Research Institute—IRCCS, Via Conte Ruggero 73, 94018 Troina, Italy; (F.I.I.C.); (B.L.); (M.T.); (D.A.)
| | - Michela Figorilli
- Neurology Unit, Department of Medical Sciences and Public Health, University of Cagliari and AOU Cagliari, Asse Didattico E., SS 554 Bivio Sestu, Monserrato, 09042 Cagliari, Italy; (M.F.); (M.P.)
- Sleep Disorders Center, Department of Medical Sciences and Public Health, University of Cagliari, Asse Didattico E., SS 554 Bivio Sestu, Monserrato, 09042 Cagliari, Italy
| | - Monica Puligheddu
- Neurology Unit, Department of Medical Sciences and Public Health, University of Cagliari and AOU Cagliari, Asse Didattico E., SS 554 Bivio Sestu, Monserrato, 09042 Cagliari, Italy; (M.F.); (M.P.)
- Sleep Disorders Center, Department of Medical Sciences and Public Health, University of Cagliari, Asse Didattico E., SS 554 Bivio Sestu, Monserrato, 09042 Cagliari, Italy
| | - Francesco Fisicaro
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (F.F.); (M.P.)
| | - Rita Bella
- Department of Medical and Surgical Science and Advanced Technologies, University of Catania, Via Santa Sofia 78, 95125 Catania, Italy;
| | - Raffaele Ferri
- Clinical Neurophysiology Research Unit, Oasi Research Institute—IRCCS, Via Conte Ruggero 73, 94018 Troina, Italy;
| | - Manuela Pennisi
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (F.F.); (M.P.)
| |
Collapse
|
16
|
Zhang H, Huang X, Wang C, Liang K. Alteration of gamma-aminobutyric acid in the left dorsolateral prefrontal cortex of individuals with chronic insomnia: a combined transcranial magnetic stimulation-magnetic resonance spectroscopy study. Sleep Med 2022; 92:34-40. [DOI: 10.1016/j.sleep.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/23/2022] [Accepted: 03/02/2022] [Indexed: 11/29/2022]
|
17
|
Rodrigues MS, Ferreira SG, Quiroz C, Earley CJ, García-Borreguero D, Cunha RA, Ciruela F, Köfalvi A, Ferré S. Brain Iron Deficiency Changes the Stoichiometry of Adenosine Receptor Subtypes in Cortico-Striatal Terminals: Implications for Restless Legs Syndrome. Molecules 2022; 27:molecules27051489. [PMID: 35268590 PMCID: PMC8911604 DOI: 10.3390/molecules27051489] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/19/2022] [Accepted: 02/21/2022] [Indexed: 01/01/2023] Open
Abstract
Brain iron deficiency (BID) constitutes a primary pathophysiological mechanism in restless legs syndrome (RLS). BID in rodents has been widely used as an animal model of RLS, since it recapitulates key neurochemical changes reported in RLS patients and shows an RLS-like behavioral phenotype. Previous studies with the BID-rodent model of RLS demonstrated increased sensitivity of cortical pyramidal cells to release glutamate from their striatal nerve terminals driving striatal circuits, a correlative finding of the cortical motor hyperexcitability of RLS patients. It was also found that BID in rodents leads to changes in the adenosinergic system, a downregulation of the inhibitory adenosine A1 receptors (A1Rs) and upregulation of the excitatory adenosine A2A receptors (A2ARs). It was then hypothesized, but not proven, that the BID-induced increased sensitivity of cortico-striatal glutamatergic terminals could be induced by a change in A1R/A2AR stoichiometry in favor of A2ARs. Here, we used a newly developed FACS-based synaptometric analysis to compare the relative abundance on A1Rs and A2ARs in cortico-striatal and thalamo-striatal glutamatergic terminals (labeled with vesicular glutamate transporters VGLUT1 and VGLUT2, respectively) of control and BID rats. It could be demonstrated that BID (determined by measuring transferrin receptor density in the brain) is associated with a selective decrease in the A1R/A2AR ratio in VGLUT1 positive-striatal terminals.
Collapse
Affiliation(s)
- Matilde S. Rodrigues
- CNC-Center for Neuroscience and Cell Biology of Coimbra, University of Coimbra, 3004-504 Coimbra, Portugal; (M.S.R.); (S.G.F.); (R.A.C.); (A.K.)
| | - Samira G. Ferreira
- CNC-Center for Neuroscience and Cell Biology of Coimbra, University of Coimbra, 3004-504 Coimbra, Portugal; (M.S.R.); (S.G.F.); (R.A.C.); (A.K.)
| | - César Quiroz
- Integrative Neurobiology Section, National Institute on Drug Abuse, Baltimore, MD 21224, USA;
| | | | | | - Rodrigo A. Cunha
- CNC-Center for Neuroscience and Cell Biology of Coimbra, University of Coimbra, 3004-504 Coimbra, Portugal; (M.S.R.); (S.G.F.); (R.A.C.); (A.K.)
- Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal
| | - Francisco Ciruela
- Pharmacology Unit, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, 08907 L’Hospitalet de Llobregat, Spain;
- Neuropharmacology and Pain Group, Neuroscience Program, Institut d’Investigació Biomèdica de Belvitge, Idibell, 08907 L’Hospitalet de Llobregat, Spain
| | - Attila Köfalvi
- CNC-Center for Neuroscience and Cell Biology of Coimbra, University of Coimbra, 3004-504 Coimbra, Portugal; (M.S.R.); (S.G.F.); (R.A.C.); (A.K.)
| | - Sergi Ferré
- Integrative Neurobiology Section, National Institute on Drug Abuse, Baltimore, MD 21224, USA;
- Correspondence:
| |
Collapse
|
18
|
Abstract
Sleep homeostasis is a complex neurobiologic phenomenon involving a number of molecular pathways, neurotransmitter release, synaptic activity, and factors modulating neural networks. Sleep plasticity allows for homeostatic optimization of neural networks and the replay-based consolidation of specific circuits, especially important for cognition, behavior, and information processing. Furthermore, research is currently moving from an essentially brain-focused to a more comprehensive view involving other systems, such as the immune system, hormonal status, and metabolic pathways. When dysfunctional, these systems contribute to sleep loss and fragmentation as well as to sleep need. In this chapter, the implications of neural plasticity and sleep homeostasis for the diagnosis and treatment of some major sleep disorders, such as insomnia and sleep deprivation, obstructive sleep apnea syndrome, restless legs syndrome, REM sleep behavior disorder, and narcolepsy are discussed in detail with their therapeutical implications. This chapter highlights that sleep is necessary for the maintenance of an optimal brain function and is sensitive to both genetic background and environmental enrichment. Even in pathologic conditions, sleep acts as a resilient plastic state that consolidates prior information and prioritizes network activity for efficient brain functioning.
Collapse
|
19
|
Restless Legs Syndrome: Known Knowns and Known Unknowns. Brain Sci 2022; 12:brainsci12010118. [PMID: 35053861 PMCID: PMC8773543 DOI: 10.3390/brainsci12010118] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/09/2022] [Accepted: 01/12/2022] [Indexed: 02/06/2023] Open
Abstract
Although restless legs syndrome (RLS) is a common neurological disorder, it remains poorly understood from both clinical and pathophysiological perspectives. RLS is classified among sleep-related movement disorders, namely, conditions characterized by simple, often stereotyped movements occurring during sleep. However, several clinical, neurophysiological and neuroimaging observations question this view. The aim of the present review is to summarize and query some of the current concepts (known knowns) and to identify open questions (known unknowns) on RLS pathophysiology. Based on several lines of evidence, we propose that RLS should be viewed as a disorder of sensorimotor interaction with a typical circadian pattern of occurrence, possibly arising from neurochemical dysfunction and abnormal excitability in different brain structures.
Collapse
|
20
|
Jiao J, Tan L, Zhang Y, Li T, Tang X. Repetitive transcranial magnetic stimulation for insomnia in patients with autism spectrum disorder: Study protocol for a randomized, double-blind, and sham-controlled clinical trial. Front Psychiatry 2022; 13:977341. [PMID: 36245883 PMCID: PMC9554245 DOI: 10.3389/fpsyt.2022.977341] [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: 06/24/2022] [Accepted: 09/06/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Insomnia is the most common comorbidity in children with autism spectrum disorder (ASD) and seriously affects their rehabilitation and prognosis. Thus, an intervention targeting insomnia in ASD seems warranted. Repetitive transcranial magnetic stimulation (rTMS), a potentially effective treatment for improving sleep quality and optimizing sleep structure, has already been demonstrated to alleviate insomnia symptoms and sleep disturbance in different neurological and neuropsychiatric conditions. This trial aims to investigate the effects of rTMS on insomnia in patients with ASD. METHOD This study is designed to be a double-blind, randomized, and sham-controlled trial with a target sample size of 30 participants (aged 3-13 years) diagnosed with ASD comorbid with insomnia. The intervention phase will comprise 20 sessions of rTMS or sham rTMS applied over the right dorsolateral prefrontal cortex (DLPFC) within four consecutive weeks. The effect of rTMS on insomnia and other symptoms of ASD will be investigated through home-PSG (two consecutive overnights), sleep diary, CSHQ, CARS, ABC, SRS, RBS-R, and metabolomics analysis at baseline and posttreatment. A follow-up assessment 1 month after the intervention will examine the long-term effects. DISCUSSION The results of this study may address an important knowledge gap and may provide evidence for the use of rTMS to treat insomnia in ASD. Furthermore, it will elucidate the potential mechanism and link between sleep disorders and clinical symptoms. CLINICAL TRIAL REGISTRATION The study is ongoing and has been registered at the Chinese Clinical Trial Registry (ChiCTR2100049266) on 28/07/2021.
Collapse
Affiliation(s)
- Jian Jiao
- Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
| | - Lu Tan
- Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ye Zhang
- Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
| | - Taomei Li
- Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiangdong Tang
- Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
21
|
Shi X, Guo Y, Zhu L, Wu W, Hordacre B, Su X, Wang Q, Chen X, Lan X, Dang G. Electroencephalographic connectivity predicts clinical response to repetitive transcranial magnetic stimulation in patients with insomnia disorder. Sleep Med 2021; 88:171-179. [PMID: 34773788 DOI: 10.1016/j.sleep.2021.10.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/10/2021] [Accepted: 10/12/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Accumulating evidence suggests that low frequency repetitive transcranial magnetic stimulation (rTMS), which generally decreases cortical excitability and remodels plastic connectivity, improves sleep quality in patients with insomnia disorder. However, the effects of rTMS vary substantially across individuals and treatment is sometimes unsatisfactory, calling for biomarkers for predicting clinical outcomes. OBJECTIVE This study aimed to investigate whether functional connectivity of the target network in electroencephalography is associated with the clinical response to low frequency rTMS in patients with insomnia disorder. METHODS Twenty-five patients with insomnia disorder were subjected to 10 sessions of treatment with 1 Hz rTMS over the right dorsolateral prefrontal cortex. Resting-state electroencephalography was collected before rTMS. Pittsburgh Sleep Quality Index, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, and Mini-Mental State Exam were performed before and after rTMS treatment, with a follow-up after one month. Electroencephalographic connectivity was measured by the power envelope connectivity at the source level. Partial least squares regression identified models of connectivity that maximally accounted for the rTMS response. RESULTS Scores of Pittsburgh Sleep Quality Index, Hamilton Depression Rating Scale, and Hamilton Anxiety Rating Scale were decreased after rTMS and one-month later. Baseline weaker connectivity of a network in the beta and alpha bands between a brain region approximating the stimulated right dorsolateral prefrontal cortex and areas located in the frontal, insular, and limbic cortices was associated with a greater change in Pittsburgh Sleep Quality Index and Hamilton Depression Rating Scale following rTMS. CONCLUSIONS Low frequency rTMS could improve sleep quality and depressive moods in patients with insomnia disorder. Moreover, electroencephalographic functional connectivity would potentially be a robust biomarker for predicting the therapeutic effects.
Collapse
Affiliation(s)
- Xue Shi
- Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, 518020, Guangdong, China
| | - Yi Guo
- Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, 518020, Guangdong, China; Shenzhen Bay Laboratory, Shenzhen, 518020, Guangdong, China
| | - Lin Zhu
- Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, 518020, Guangdong, China
| | - Wei Wu
- School of Automation Science and Engineering, South China University of Technology, Guangzhou, 510641, China
| | - Brenton Hordacre
- Innovation, Implementation and Clinical Translation (IIMPACT) in Health, Allied Health and Human Performance, University of South Australia, Australia
| | - Xiaolin Su
- Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, 518020, Guangdong, China
| | - Qian Wang
- Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, 518020, Guangdong, China
| | - Xiaoxia Chen
- Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, 518020, Guangdong, China
| | - Xiaoyong Lan
- Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, 518020, Guangdong, China
| | - Ge Dang
- Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, 518020, Guangdong, China.
| |
Collapse
|
22
|
Di Lazzaro V, Bella R, Benussi A, Bologna M, Borroni B, Capone F, Chen KHS, Chen R, Chistyakov AV, Classen J, Kiernan MC, Koch G, Lanza G, Lefaucheur JP, Matsumoto H, Nguyen JP, Orth M, Pascual-Leone A, Rektorova I, Simko P, Taylor JP, Tremblay S, Ugawa Y, Dubbioso R, Ranieri F. Diagnostic contribution and therapeutic perspectives of transcranial magnetic stimulation in dementia. Clin Neurophysiol 2021; 132:2568-2607. [PMID: 34482205 DOI: 10.1016/j.clinph.2021.05.035] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 04/22/2021] [Accepted: 05/28/2021] [Indexed: 02/07/2023]
Abstract
Transcranial magnetic stimulation (TMS) is a powerful tool to probe in vivo brain circuits, as it allows to assess several cortical properties such asexcitability, plasticity and connectivity in humans. In the last 20 years, TMS has been applied to patients with dementia, enabling the identification of potential markers of thepathophysiology and predictors of cognitive decline; moreover, applied repetitively, TMS holds promise as a potential therapeutic intervention. The objective of this paper is to present a comprehensive review of studies that have employed TMS in dementia and to discuss potential clinical applications, from the diagnosis to the treatment. To provide a technical and theoretical framework, we first present an overview of the basic physiological mechanisms of the application of TMS to assess cortical excitability, excitation and inhibition balance, mechanisms of plasticity and cortico-cortical connectivity in the human brain. We then review the insights gained by TMS techniques into the pathophysiology and predictors of progression and response to treatment in dementias, including Alzheimer's disease (AD)-related dementias and secondary dementias. We show that while a single TMS measure offers low specificity, the use of a panel of measures and/or neurophysiological index can support the clinical diagnosis and predict progression. In the last part of the article, we discuss the therapeutic uses of TMS. So far, only repetitive TMS (rTMS) over the left dorsolateral prefrontal cortex and multisite rTMS associated with cognitive training have been shown to be, respectively, possibly (Level C of evidence) and probably (Level B of evidence) effective to improve cognition, apathy, memory, and language in AD patients, especially at a mild/early stage of the disease. The clinical use of this type of treatment warrants the combination of brain imaging techniques and/or electrophysiological tools to elucidate neurobiological effects of neurostimulation and to optimally tailor rTMS treatment protocols in individual patients or specific patient subgroups with dementia or mild cognitive impairment.
Collapse
Affiliation(s)
- Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy.
| | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced Technologies, Section of Neurosciences, University of Catania, Catania, Italy
| | - Alberto Benussi
- Centre for Neurodegenerative Disorders, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy
| | - Barbara Borroni
- Centre for Neurodegenerative Disorders, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Fioravante Capone
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Kai-Hsiang S Chen
- Department of Neurology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Robert Chen
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada; Division of Brain, Imaging& Behaviour, Krembil Brain Institute, Toronto, Canada
| | | | - Joseph Classen
- Department of Neurology, University Hospital Leipzig, Leipzig University Medical Center, Germany
| | - Matthew C Kiernan
- Department of Neurology, Royal Prince Alfred Hospital, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Giacomo Koch
- Non Invasive Brain Stimulation Unit/Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy; Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy; Department of Neurology IC, Oasi Research Institute-IRCCS, Troina, Italy
| | - 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
| | | | - Jean-Paul Nguyen
- Pain Center, clinique Bretéché, groupe ELSAN, Multidisciplinary Pain, Palliative and Supportive care Center, UIC 22/CAT2 and Laboratoire de Thérapeutique (EA3826), University Hospital, Nantes, France
| | - Michael Orth
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Swiss Huntington's Disease Centre, Siloah, Bern, Switzerland
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research, Center for Memory Health, Hebrew SeniorLife, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA; Guttmann Brain Health Institute, Universitat Autonoma Barcelona, Spain
| | - Irena Rektorova
- Applied Neuroscience Research Group, Central European Institute of Technology, Masaryk University (CEITEC MU), Brno, Czech Republic; Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Patrik Simko
- Applied Neuroscience Research Group, Central European Institute of Technology, Masaryk University (CEITEC MU), Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sara Tremblay
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, ON, Canada; Royal Ottawa Institute of Mental Health Research, Ottawa, ON, Canada
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Raffaele Dubbioso
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Federico Ranieri
- Unit of Neurology, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| |
Collapse
|
23
|
Oroz R, Kung S, Croarkin PE, Cheung J. Transcranial magnetic stimulation therapeutic applications on sleep and insomnia: a review. SLEEP SCIENCE AND PRACTICE 2021. [DOI: 10.1186/s41606-020-00057-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AbstractRepetitive transcranial magnetic stimulation (rTMS) is a neuromodulatory technique approved by the US Food and Drug Administration for use in treatment-resistant major depressive disorder. It works by generating localized magnetic fields that create depolarizing electrical currents in neurons a few centimeters below the scalp. This localized effect is believed to stimulate neural plasticity, activate compensatory processes, and influence cortical excitability. Additionally, rTMS has been used in a variety of clinical trials for neurological and psychiatric conditions such as anxiety, post-traumatic stress disorder and epilepsy. Beneficial effects in sleep parameters have been documented in these trials, as well as in major depressive disorder, and have led to an interest in using rTMS in the field of sleep medicine for specific disorders such as insomnia, hypersomnia, and restless legs syndrome. It is unknown whether rTMS has intrinsically beneficial properties when applied to primary sleep disorders, or if it only acts on sleep through mood disorders. This narrative review sought to examine available literature regarding the application of rTMS for sleep disorder to identify knowledge gaps and inform future study design. The literature in this area remains scarce, with few randomized clinical trials on rTMS and insomnia. Available studies have found mixed results, with some studies reporting subjective sleep improvement while objective improvement is less consistent. Due to the heterogeneity of results and the variations in rTMS protocols, no definitive conclusions have been reached, signaling the need for further research.
Collapse
|
24
|
Cheng JX, Zhao X, Qiu J, Jiang Y, Ren J, Sun S, Wang R, Su C. Effects of transcranial direct current stimulation on performance and recovery sleep during acute sleep deprivation: a pilot study. Sleep Med 2021; 79:124-133. [PMID: 33524838 DOI: 10.1016/j.sleep.2021.01.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Previous studies claimed that transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex (DLPFC) improves cognition in neuropsychiatric patients with cognitive impairment, schizophrenia, organic hypersomnia, etc, but few studies evaluated the effects of tDCS on cognitive improvement following sleep deprivation. The objective of this study was to determine whether tDCS (anode on the left DLPFC and cathode on the right DLPFC with a 2-mA current for 30 min) improves cognition following sleep deprivation. METHODS Seven participants received active tDCS and eight participants received sham tDCS when their cognition declined during at least 30 h of sleep deprivation. All participants completed the psychomotor vigilance task, Trail Making Tests A and B, digit cancellation test, Stroop color word test, the Brief Visuospatial Memory Test-Revised and a procedural game every 2 h during the sleep deprivation and after recovery sleep. RESULTS Compared to the sham stimulation, active tDCS (anode on the left DLPFC and cathode on the right DLPFC at a 2-mA current for 30 min) had beneficial effects on attention, memory, executive function, processing speed, and the ability to inhibit cognitive interference, and improved in subjective drowsiness and fatigue following sleep deprivation. The lasting effect of a single tDCS on cognition during sleep deprivation was greater than 2 h. In all participants, tDCS did not disturb recovery sleep, and cognitive performance recovered to the baseline levels after recovery sleep. CONCLUSIONS The study results indicate that tDCS can improve cognition following sleep deprivation and does not disturb recovery sleep or cognitive performance after recovery sleep. The possible pathophysiological mechanisms might be related to the modulation of the corticothalamic pathway. We believe that tDCS can be applied in the treatment of sleep disorders involving sleepiness. TRIAL REGISTRATION NUMBER ChiCTR2000029420. DATE OF REGISTRATION 2020-1-31.
Collapse
Affiliation(s)
- Jin-Xiang Cheng
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, Shaanxi Province, China.
| | - Xianchao Zhao
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, Shaanxi Province, China
| | - Jian Qiu
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, Shaanxi Province, China
| | - Yingcong Jiang
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, Shaanxi Province, China
| | - Jiafeng Ren
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, Shaanxi Province, China
| | - Shuyu Sun
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, Shaanxi Province, China
| | - Rong Wang
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, Shaanxi Province, China
| | - Changjun Su
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, Shaanxi Province, China.
| |
Collapse
|
25
|
Affiliation(s)
- Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania. Via Santa Sofia, 78 - 95125, Catania, Italy; Department of Neurology IC, Oasi Research Institute - IRCCS, Via Conte Ruggero, 73 - 94018, Troina, Italy.
| |
Collapse
|
26
|
Gong L, Xu R, Qin M, Liu D, Zhang B, Bi Y, Xi C. New potential stimulation targets for noninvasive brain stimulation treatment of chronic insomnia. Sleep Med 2020; 75:380-387. [PMID: 32950883 DOI: 10.1016/j.sleep.2020.08.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/11/2020] [Accepted: 08/19/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Noninvasive brain stimulation (NIBS) was recently used as a therapeutic application in patients with insomnia. Most of the previous NIBS treatments for insomnia directly selected the dorsolateral prefrontal cortex (DLPFC) as the stimulation site. As the NIBS target is an important factor in the efficacy of NIBS, it is necessary to detect more potential cortical sites for NIBS in insomnia. METHODS A neuroimaging study-based meta-analysis was used to examine sleep-related brain regions. A sleep-associated brain region-based functional connectivity (FC) map was constructed in 50 patients with chronic insomnia disorder (CID) without any comorbidity. We also combined the meta-analysis and FC results to examine the potential surface targets for NIBS for CID. RESULTS The results identified the bilateral supplementary motor area (SMA), left superior temporal gyrus (STG), bilateral DLPFC, precentral lobule, supramarginal gyrus, angular gyrus, superior frontal gyrus, middle temporal gyrus and middle occipital gyrus as potential brain stimulation targets for insomnia treatment. Notably, the bilateral SMA, right DLPFC and left STG were identified in the FC and meta-analyses. In addition, the SMA and DLPFC were positively and STG was negatively connected with other sleep related brain regions, which indicated inhibitory and excitatory stimulation for NIBS treatment for CID, respectively. CONCLUSION Our study suggests the SMA, DLPFC and STG as preferentially selected brain targets of NIBS for CID treatment. We recommend an inhibitory stimulation over SMA and DLPFC, and an excitatory stimulation over STG for NIBS treatment. Future studies should test these new targets using NIBS treatment for insomnia.
Collapse
Affiliation(s)
- Liang Gong
- Department of Neurology, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China
| | - Ronghua Xu
- Department of Neurology, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China
| | - Minhuang Qin
- Department of Neurology, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China
| | - Duan Liu
- Department of Neurology, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China
| | - Bei Zhang
- Department of Neurology, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China
| | - Youcai Bi
- Department of Neurology, Zigong Fourth People's Hospital, Zigong, Sichuan, 643000, China.
| | - Chunhua Xi
- Department of Neurology, The Third Affiliated Hospital of Anhui Medical University, Heifei, Anhui, 230061, China.
| |
Collapse
|
27
|
Kocar TD, Müller HP, Kassubek J. Differential functional connectivity in thalamic and dopaminergic pathways in restless legs syndrome: a meta-analysis. Ther Adv Neurol Disord 2020; 13:1756286420941670. [PMID: 32821291 PMCID: PMC7412904 DOI: 10.1177/1756286420941670] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/22/2020] [Indexed: 12/13/2022] Open
Abstract
Objective: Restless legs syndrome (RLS) is a sensorimotor disorder with alterations in somatosensory processing in association with a dysfunctional cerebral network, involving the basal ganglia, limbic network, and sensorimotor pathways. Resting state functional magnetic resonance imaging (MRI) is a powerful tool to provide in vivo insight into functional processing and as such is of special interest in RLS considering the widespread pattern of networks involved in this disorder. In this meta-analysis of resting state functional MRI studies, we analyzed the preponderance of functional connectivity changes associated with RLS and discussed possible links to sensorimotor dysfunction and somatosensory processing. Methods: A systematic research using the online library PubMed was conducted and a total of seven studies passed the inclusion criteria of the meta-analysis. The results of these studies were merged and a statistical probability map was generated that indicated the likelihood of functional connectivity changes within the combined cohort, both for increased and decreased connectivity. Results: The meta-analysis demonstrated decreased functional connectivity within the dopaminergic network in participants with RLS compared with healthy controls, including the nigrostriatal, mesolimbic, and mesocortical pathways. Increased functional connectivity was observed bilaterally in the thalamus, including its ventral lateral, ventral anterior, and ventral posterior lateral nuclei, and the pulvinar. Discussion: Sensorimotor dysfunction in RLS seems to be reflected by decreased functional connectivity within the dopaminergic pathways. Network extension in the thalamus can be regarded as an adaptation to somatosensory dysfunction in RLS. This differential functional connectivity pattern extends prior findings on cerebral somatosensory processing in RLS and offers an explanation for the efficacy of dopaminergic treatment.
Collapse
Affiliation(s)
| | | | - Jan Kassubek
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, Ulm, 89081, Germany
| |
Collapse
|
28
|
Nardone R, Golaszewski S, Frey V, Brigo F, Versace V, Sebastianelli L, Saltuari L, Höller Y. Altered response to repetitive transcranial magnetic stimulation in patients with chronic primary insomnia. Sleep Med 2020; 72:126-129. [PMID: 32615461 DOI: 10.1016/j.sleep.2020.03.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/17/2020] [Accepted: 03/26/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND We aimed at evaluating the amplitude changes of the motor evoked potentials (MEPs) induced by of low-frequency (LF) repetitive transcranial magnetic stimulation (rTMS) over the primary motor cortex (M1) in10 patients with primary insomnia (PI) and in 10 age-matched healthy controls. METHODS Median peak-to-peak MEP amplitudes were assessed in all subjects at three times: at baseline (T0), after the first train of a single rTMS session (T1), and after the whole rTMS procedure (T2). This consists of 20 trains of 1 Hz stimulation with 50 stimuli per train and an intertrain interval of 30 s. RESULTS Resting motor threshold (RMT) and MEPs amplitude did not differ between the two groups at T0. A reduction of MEP size was observed at both T1 and T2 in all subjects, but this was significantly less pronounced in patients than in control subjects. CONCLUSIONS The lack of MEP inhibition reflects an altered response to LF rTMS in patients with PI. These rTMS findings are indicative of an altered cortical plasticity in inhibitory circuits within M1 in PI. Subjects with PI exhibited an impairment of the LTD-like mechanisms induced by inhibitory rTMS, thus providing further support to the involvement of GABA neurotransmission in the pathophysiology of PI.
Collapse
Affiliation(s)
- Raffaele Nardone
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy; Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria.
| | - Stefan Golaszewski
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria
| | - Vanessa Frey
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
| | - Francesco Brigo
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy; Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Italy
| | - Viviana Versace
- Department of Neurorehabilitation, Hospital of Vipiteno, Italy; Research Department for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Luca Sebastianelli
- Department of Neurorehabilitation, Hospital of Vipiteno, Italy; Research Department for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Leopold Saltuari
- Department of Neurorehabilitation, Hospital of Vipiteno, Italy; Research Department for Neurorehabilitation South Tyrol, Bolzano, Italy; Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - Yvonne Höller
- Department of Psychology, University of Akureyri, Iceland
| |
Collapse
|
29
|
Nardone R, Sebastianelli L, Versace V, Brigo F, Golaszewski S, Pucks-Faes E, Saltuari L, Trinka E. Contribution of transcranial magnetic stimulation in restless legs syndrome: pathophysiological insights and therapeutical approaches. Sleep Med 2020; 71:124-134. [PMID: 32088150 DOI: 10.1016/j.sleep.2019.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 12/10/2019] [Accepted: 12/11/2019] [Indexed: 01/06/2023]
Abstract
Transcranial magnetic stimulation (TMS) may offer a reliable means to characterize significant pathophysiologic and neurochemical aspects of restless legs syndrome (RLS). Namely, TMS has revealed specific patterns of changes in cortical excitability and plasticity, in particular dysfunctional inhibitory mechanisms and sensorimotor integration, which are thought to be part of the pathophysiological mechanisms of RLS rather than reflect a non-specific consequence of sleep architecture alteration. If delivered repetitively, TMS is able to transiently modulate the neural activity of the stimulated and connected areas. Some studies have begun to therapeutically use repetitive TMS (rTMS) to improve sensory and motor disturbances in RLS. High-frequency rTMS applied over the primary motor cortex or the supplementary motor cortex, as well as low-frequency rTMS over the primary somatosensory cortex, seem to have transient beneficial effects. However, further studies with larger patient samples, repeated sessions, an optimized rTMS setup, and clinical follow-up are needed in order to corroborate preliminary results. Thus, we performed a systematic search of all the studies that have used TMS and rTMS techniques in patients with RLS.
Collapse
Affiliation(s)
- Raffaele Nardone
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy; Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Austria; Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria.
| | - Luca Sebastianelli
- Department of Neurorehabilitation, Hospital of Vipiteno, Vipiteno, Italy; Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Viviana Versace
- Department of Neurorehabilitation, Hospital of Vipiteno, Vipiteno, Italy; Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Francesco Brigo
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy; Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Italy
| | - Stefan Golaszewski
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria
| | | | - Leopold Saltuari
- Department of Neurorehabilitation, Hospital of Vipiteno, Vipiteno, Italy; Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy; Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Centre for Cognitive Neurosciences Salzburg, Salzburg, Austria; University for Medical Informatics and Health Technology, UMIT, Hall in Tirol, Austria
| |
Collapse
|
30
|
Affiliation(s)
- Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia, 78, 95125, Catania, Italy; Department of Neurology IC, Oasi Research Institute - IRCCS, Via Conte Ruggero, 73, 94018, Troina, Italy.
| |
Collapse
|
31
|
Affiliation(s)
- Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia, 78, 95125, Catania, Italy; Department of Neurology IC, Oasi Research Institute - IRCCS, Via Conte Ruggero, 73, 94018, Troina, Italy.
| | - Anna Scalise
- Clinical Neurology Unit, Department of Neurosciences, University Hospital of Udine, P.le Santa Maria della Misericordia, 15, 33100, Udine, Italy.
| |
Collapse
|
32
|
Effects of repetitive transcranial magnetic stimulation in subjects with sleep disorders. Sleep Med 2020; 71:113-121. [DOI: 10.1016/j.sleep.2020.01.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 01/06/2020] [Accepted: 01/31/2020] [Indexed: 01/08/2023]
|
33
|
Li S, Zhou H, Yu Y, Lyu H, Mou T, Shi G, Hu S, Huang M, Hu J, Xu Y. Effect of repetitive transcranial magnetic stimulation on the cognitive impairment induced by sleep deprivation: a randomized trial. Sleep Med 2020; 77:270-278. [PMID: 32843299 DOI: 10.1016/j.sleep.2020.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/08/2020] [Accepted: 06/11/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Currently, an efficient method for improving cognitive impairment due to sleep deprivation (SD) is lacking. The aim of this study is to evaluate the effect of high-frequency repetitive transcranial magnetic stimulation (rTMS) during SD on reversing the adverse effects of SD. METHODS A total of 66 healthy people were randomized into the rTMS group and sham group. Both groups were deprived of sleep for 24 h. During SD, participants were asked to complete several cognitive tasks and underwent mood assessments. Saliva cortisol levels, plasma concentrations of brain-derived neurotrophic factor (BDNF), precursor BDNF (proBDNF), and tissue-type plasminogen activator (tPA), and frontal blood activation were detected before and after SD. The rTMS group received real rTMS stimulation for 2 sessions of 10 Hz rTMS (40 trains of 50 pulses with a 20-second intertrain interval) to the left dorsolateral prefrontal cortex and the sham group received sham stimulation during SD. RESULTS Twenty-four hours of SD induced a reduced accuracy in the n-back task, increases in both anxiety and depression, increased cortisol levels, decreased frontal blood activation and decreased BDNF levels in healthy people. Notably, rTMS improved the hyperactivity of the hypothalamic-pituitary-adrenal axis and decreased frontal blood activation induced by SD, and reduced the consumption of plasma proBDNF. CONCLUSIONS Twenty-four hours of SD induced a cognitive impairment. The administration of high-frequency rTMS during sleep deprivation exerted positive effects on HPA axis and frontal activation and might help alleviate cognitive impairment in the long term.
Collapse
Affiliation(s)
- Shangda Li
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; The Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou, China
| | - Hetong Zhou
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; The Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou, China
| | - Yueran Yu
- Department of Infectious Diseases, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Hailong Lyu
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; The Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou, China
| | - Tingting Mou
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; The Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou, China
| | - Gongde Shi
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; The Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou, China
| | - Shaohua Hu
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; The Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou, China
| | - Manli Huang
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; The Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou, China
| | - Jianbo Hu
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; The Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou, China
| | - Yi Xu
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; The Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou, China; Brain Research Institute of Zhejiang University, Hangzhou, China; Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, China.
| |
Collapse
|
34
|
Sun N, He Y, Wang Z, Zou W, Liu X. The effect of repetitive transcranial magnetic stimulation for insomnia: a systematic review and meta-analysis. Sleep Med 2020; 77:226-237. [PMID: 32830052 DOI: 10.1016/j.sleep.2020.05.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/03/2020] [Accepted: 05/12/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) might be a promising technique in treating insomnia. A comprehensive meta-analysis of the available literature is conducted to offer evidence. OBJECTIVE To evaluate the efficacy and safety of rTMS for insomnia, either as monotherapy or as a complementary strategy. METHODS CENTRAL, PubMed, EMBASE, PsycINFO, CINAHL, PEDro, CBM, CNKI, WANFANG, and VIP were searched from earliest record to August 2019. Randomized control trials (RCTs) published in English and Chinese examining effects of rTMS on patients with insomnia were included. Two authors independently completed the article selection, data extraction and rating. Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality of the included studies. The RevMan software was used for meta-analysis. The quality of the evidence was assessed by Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS A total of 36 trials from 28 eligible studies were included, involving a total of 2357 adult participants (mean age, 48.80 years; 45.33% males). Compared with sham rTMS, rTMS was associated with improved PSQI total score (SMD -2.31, 95% CI -2.95 to -1.66; Z = 7.01, P < 0.00001) and scores of seven subscales. Compared to other treatment, rTMS as an adjunct to other treatment was associated with improved PSQI total score (SMD -1.44, 95% CI -2.00 to -0.88; Z = 5.01, P < 0.00001), and may have effects on scores of seven subscales. Compared with other treatment, rTMS was associated with improved Pittsburgh sleep quality index (PSQI) total score (SMD -0.63, 95% CI -1.22 to -0.04; Z = 2.08, P = 0.04), and may have a better score in sleep latency, sleep disturbance and hypnotic using of seven subscales. In the three pair of comparisons, the results for polysomnography (PSG) outcomes were varied. In general, rTMS may improve sleep quality through increasing slow wave and rapid eye movement (REM) sleep. The rTMS group was more prone to headache than the sham or blank control group (RR 1.71, 95% CI 1.03 to 2.85; Z = 2.07, P = 0.04). No severe adverse events were reported. Reporting biases and low and very low grade of some evidences should be considered when interpreting the results of this meta-analysis. CONCLUSIONS Our findings indicate that rTMS may be a safe and effective option for insomnia. Further international, multicenter, high-quality RCTs with more objective, quality of life related and follow-up assessments are needed.
Collapse
Affiliation(s)
- Nianyi Sun
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China; Department of Physical Medicine and Rehabilitation, The Second Clinical College, China Medical University, Shenyang, People's Republic of China
| | - Yu He
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China; Department of Physical Medicine and Rehabilitation, The Second Clinical College, China Medical University, Shenyang, People's Republic of China
| | - Zhiqiang Wang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China; Department of Physical Medicine and Rehabilitation, The Second Clinical College, China Medical University, Shenyang, People's Republic of China
| | - Wenchen Zou
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Xueyong Liu
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China; Department of Physical Medicine and Rehabilitation, The Second Clinical College, China Medical University, Shenyang, People's Republic of China.
| |
Collapse
|
35
|
Vinciguerra L, Lanza G, Puglisi V, Fisicaro F, Pennisi M, Bella R, Cantone M. Update on the Neurobiology of Vascular Cognitive Impairment: From Lab to Clinic. Int J Mol Sci 2020; 21:ijms21082977. [PMID: 32340195 PMCID: PMC7215552 DOI: 10.3390/ijms21082977] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 02/07/2023] Open
Abstract
In the last years, there has been a significant growth in the literature exploring the pathophysiology of vascular cognitive impairment (VCI). As an "umbrella term" encompassing any degree of vascular-related cognitive decline, VCI is deemed to be the most common cognitive disorder in the elderly, with a significant impact on social and healthcare expenses. Interestingly, some of the molecular, biochemical, and electrophysiological abnormalities detected in VCI seem to correlate with disease process and progression, eventually promoting an adaptive plasticity in some patients and a maladaptive, dysfunctional response in others. However, the exact relationships between vascular lesion, cognition, and neuroplasticity are not completely understood. Recent findings point out also the possibility to identify a panel of markers able to predict cognitive deterioration in the so-called "brain at risk" for vascular or mixed dementia. This will be of pivotal importance when designing trials of disease-modifying drugs or non-pharmacological approaches, including non-invasive neuromodulatory techniques. Taken together, these advances could make VCI a potentially preventable cause of both vascular and degenerative dementia in late life. This review provides a timely update on the recent serological, cerebrospinal fluid, histopathological, imaging, and neurophysiological studies on this "cutting-edge" topic, including the limitations, future perspectives and translational implications in the diagnosis and management of VCI patients.
Collapse
Affiliation(s)
- Luisa Vinciguerra
- Department of Neurology and Stroke Unit, ASST Cremona, 26100 Cremona, Italy; (L.V.); (V.P.)
| | - Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, 95123 Catania, Italy
- Department of Neurology IC, Oasi Research Institute – IRCCS, 94018 Troina, Italy
- Correspondence: ; Tel.: +39-095-3782448
| | - Valentina Puglisi
- Department of Neurology and Stroke Unit, ASST Cremona, 26100 Cremona, Italy; (L.V.); (V.P.)
| | - Francesco Fisicaro
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (F.F.); (M.P.)
| | - Manuela Pennisi
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (F.F.); (M.P.)
| | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, 95123 Catania, Italy;
| | - Mariagiovanna Cantone
- Department of Neurology, Sant’Elia Hospital, ASP Caltanissetta, 93100 Caltanissetta, Italy;
| |
Collapse
|
36
|
Update on the Neurobiology of Vascular Cognitive Impairment: From Lab to Clinic. Int J Mol Sci 2020. [PMID: 32340195 DOI: 10.3390/ijms21082977.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In the last years, there has been a significant growth in the literature exploring the pathophysiology of vascular cognitive impairment (VCI). As an "umbrella term" encompassing any degree of vascular-related cognitive decline, VCI is deemed to be the most common cognitive disorder in the elderly, with a significant impact on social and healthcare expenses. Interestingly, some of the molecular, biochemical, and electrophysiological abnormalities detected in VCI seem to correlate with disease process and progression, eventually promoting an adaptive plasticity in some patients and a maladaptive, dysfunctional response in others. However, the exact relationships between vascular lesion, cognition, and neuroplasticity are not completely understood. Recent findings point out also the possibility to identify a panel of markers able to predict cognitive deterioration in the so-called "brain at risk" for vascular or mixed dementia. This will be of pivotal importance when designing trials of disease-modifying drugs or non-pharmacological approaches, including non-invasive neuromodulatory techniques. Taken together, these advances could make VCI a potentially preventable cause of both vascular and degenerative dementia in late life. This review provides a timely update on the recent serological, cerebrospinal fluid, histopathological, imaging, and neurophysiological studies on this "cutting-edge" topic, including the limitations, future perspectives and translational implications in the diagnosis and management of VCI patients.
Collapse
|
37
|
Lanza G, Aricò D, Lanuzza B, Cosentino FII, Tripodi M, Giardina F, Bella R, Puligheddu M, Pennisi G, Ferri R, Pennisi M. Facilitatory/inhibitory intracortical imbalance in REM sleep behavior disorder: early electrophysiological marker of neurodegeneration? Sleep 2020; 43:5584903. [PMID: 31599326 DOI: 10.1093/sleep/zsz242] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 09/27/2019] [Indexed: 02/07/2023] Open
Abstract
STUDY OBJECTIVES Previous studies found an early impairment of the short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF) to transcranial magnetic stimulation (TMS) in Parkinson's disease. However, very little is known on the TMS correlates of rapid eye movement (REM) sleep behavior disorder (RBD), which can precede the onset of a α-synucleinopathy. METHODS The following TMS measures were obtained from 14 de novo patients with isolated RBD and 14 age-matched healthy controls: resting motor threshold, cortical silent period, latency and amplitude of the motor evoked potentials, SICI, and ICF. A cognitive screening and a quantification of subjective sleepiness (Epworth Sleepiness Scale [ESS]) and depressive symptoms were also performed. RESULTS Neurological examination, global cognitive functioning, and mood status were normal in all participants. ESS score was higher in patients, although not suggestive of diurnal sleepiness. Compared to controls, patients exhibited a significant decrease of ICF (median 0.8, range 0.5-1.4 vs. 1.9, range 1.4-2.3; p < 0.01) and a clear trend, though not significant, towards a reduction of SICI (median 0.55, range 0.1-1.4 vs. 0.25, range 0.1-0.3), with a large effect size (Cohen's d: -0.848). REM Sleep Atonia Index significantly correlated with SICI. CONCLUSIONS In still asymptomatic patients for a parkinsonian syndrome or neurodegenerative disorder, changes of ICF and, to a lesser extent, SICI (which are largely mediated by glutamatergic and GABAergic transmission, respectively) might precede the onset of a future neurodegeneration. SICI was correlated with the muscle tone alteration, possibly supporting the proposed RBD model of retrograde influence on the cortex from the brainstem.
Collapse
Affiliation(s)
- Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
- Sleep Research Center, Department of Neurology IC, Oasi Research Institute - IRCCS, Troina, Italy
| | - Debora Aricò
- Sleep Research Center, Department of Neurology IC, Oasi Research Institute - IRCCS, Troina, Italy
| | - Bartolo Lanuzza
- Sleep Research Center, Department of Neurology IC, Oasi Research Institute - IRCCS, Troina, Italy
| | | | - Mariangela Tripodi
- Sleep Research Center, Department of Neurology IC, Oasi Research Institute - IRCCS, Troina, Italy
| | - Floriana Giardina
- Sleep Research Center, Department of Neurology IC, Oasi Research Institute - IRCCS, Troina, Italy
| | - Rita Bella
- Department of Medical and Surgical Science and Advanced Technologies, University of Catania, Catania, Italy
| | - Monica Puligheddu
- Sleep Disorder Research Center, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Giovanni Pennisi
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Raffaele Ferri
- Sleep Research Center, Department of Neurology IC, Oasi Research Institute - IRCCS, Troina, Italy
| | - Manuela Pennisi
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| |
Collapse
|
38
|
Türkoglu ŞA, Bolac ES, Yildiz S, Kalaycioglu O, Yildiz N. Presynaptic inhibition in restless legs syndrome. Int J Neurosci 2020; 131:213-219. [PMID: 32108535 DOI: 10.1080/00207454.2020.1737048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Restless legs syndrome (RLS) is a condition that particularly urges at night in resting and causes the need to move the legs. Although the pathophysiology has not yet been clarified, dopamine and iron metabolism and spinal cord pathologies are blamed for causing the condition. There are few studies on spinal reflex mechanisms on RLS. In the present study, we aimed to investigate the role of presynaptic inhibition (PreI) in the spinal cord in RLS.Methods: Fourteen patients with RLS and 14 controls with similar demographic characteristics were included in the study. Soleus muscle H-reflex (Ht) investigation was performed for subjects whose electrophysiologic investigation was normal. The Ht response was conditioned to the stimulation of the common peroneal nerve (CPN) (Hc). The test and conditioned stimulation intervals were kept between 10 ms, 20 ms, 30 ms, 40 ms, 50 ms, 75 ms, 100 ms, 150 ms and 200 ms. In each inter-stimulus interval, nonparametric repeat measurement evaluations were conducted with the percentage value of Hc/Ht. The Hc/Ht values of the study and control groups in the same intervals were compared separately.Results: A significant decrease was detected in Hc values in the control group in the repeat measurement values at 20 ms and 100 ms inter-stimulus intervals; however, there was not decrease in any intervals in the patient's group.Conclusion: The absence of any decrease in Hc reflexes for 20-100 ms intervals revealed that discernible PreI was vanished in RLS patients.
Collapse
Affiliation(s)
- Şule Aydin Türkoglu
- Department of Neurology, Abant İzzet Baysal University Faculty of Medicine, Bolu, Turkey
| | - Elif Sultan Bolac
- Department of Neurology, Abant İzzet Baysal University Faculty of Medicine, Bolu, Turkey
| | - Serpil Yildiz
- Department of Neurology, Abant İzzet Baysal University Faculty of Medicine, Bolu, Turkey
| | - Oya Kalaycioglu
- Biostatistics Unit, Abant İzzet Baysal University Faculty of Medicine, Bolu, Turkey
| | - Nebil Yildiz
- Department of Neurology, Abant İzzet Baysal University Faculty of Medicine, Bolu, Turkey
| |
Collapse
|
39
|
Elnemr R, Sweed RA, Shafiek H. Diaphragmatic motor cortex hyperexcitability in patients with chronic obstructive pulmonary disease. PLoS One 2019; 14:e0217886. [PMID: 31851669 PMCID: PMC6919588 DOI: 10.1371/journal.pone.0217886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 11/18/2019] [Indexed: 12/02/2022] Open
Abstract
Background and objectives Respiratory muscles dysfunction has been reported in COPD. Transcranial magnetic stimulation (TMS) has been used for assessing the respiratory corticospinal pathways particularly of diaphragm. We aimed to study the cortico-diaphragmatic motor system changes in COPD using TMS and to correlate the findings with the pulmonary function. Methods A case control study recruited 30 stable COPD from the out-patient respiratory clinic of Main Alexandria University hospital- Egypt and 17 healthy control subjects who were subjected to spirometry. Cortical conduction of the diaphragm was performed by TMS to all participants followed by cervical magnetic stimulation of the phrenic nerve roots. Diaphragmatic resting motor threshold (DRMT), cortical motor evoked potential latency (CMEPL), CMEP amplitude (CMEPA), peripheral motor evoked potential latency (PMEPL), PMEP amplitude (PMEPA) and central motor conduction time (CMCT) were measured. Results 66.7% of COPD patients had severe and very severe COPD with median age of 59 (55–63) years. There was statistically significant bilateral decrease in DRMT, CMEPA and PMEPA in COPD group versus healthy subjects and significant increase in CMEPL and PMEPL (p <0.01). Left CMCT was significantly prolonged in COPD group versus healthy subjects (p <0.0001) but not right CMCT. Further, there was significant increase in CMEPL and CMCT of left versus right diaphragm in COPD group (p = 0.003 and 0.001 respectively) that inversely correlated with FEV1% and FVC% predicted. Right and left DRMT were insignificantly different in COPD group (p >0.05) but positively correlated with FEV1/FVC, FEV1% and FVC% predicted. Conclusion Central cortico-diaphragmatic motor system is affected in COPD patients with heterogeneity of both sides that is correlated with pulmonary function. Significance Coticospinal pathway affection could be a factor for development of diaphragmatic dysfunction in COPD patients accordingly its evaluation could help in personalization of COPD management especially pulmonary rehabilitation programs.
Collapse
Affiliation(s)
- Rehab Elnemr
- Physical Medicine, Rheumatology and Rehabilitation Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- * E-mail:
| | - Rania Ahmad Sweed
- Chest Diseases Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hanaa Shafiek
- Chest Diseases Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| |
Collapse
|
40
|
Jiang B, He D, Guo Z, Mu Q, Zhang L. Efficacy and placebo response of repetitive transcranial magnetic stimulation for primary insomnia. Sleep Med 2019; 63:9-13. [DOI: 10.1016/j.sleep.2019.05.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/26/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
|
41
|
Magalhães SC, Queiroz de Paiva JP, Kaelin-Lang A, Sterr A, Eckeli AL, Winkler AM, Fernandes do Prado G, Amaro E, Conforto AB. Short-interval intracortical inhibition is decreased in restless legs syndrome across a range of severity. Sleep Med 2019; 62:34-42. [PMID: 31539846 DOI: 10.1016/j.sleep.2019.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/10/2019] [Accepted: 03/12/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Decreased short-interval intracortical inhibition (SICI) to transcranial magnetic stimulation (TMS) of the primary motor cortex was described in subjects with restless legs syndrome/Willis-Ekbom disease (RLS/WED). It remained to be determined whether the magnitude of SICI decrease would be similar across levels of RLS/WED severity. Moreover, it was unknown whether, in addition to decreases in SICI, changes in cortical thickness or area could be detected in subjects with RLS/WED compared to controls. The objective of this study was to compare SICI, cortical thickness, and cortical area in subjects with idiopathic mild to moderate RLS/WED, severe to very severe RLS/WED, and controls. METHODS The severity of RLS/WED was assessed by the International Restless Legs Syndrome Severity Scale (IRLSS). SICI and 3T magnetic resonance imaging (MRI) data of subjects with RLS/WED and controls were compared. A receiver operating characteristic curve for SICI was designed for discrimination of participants with RLS/WED from controls. Cortical thickness and area were assessed by automated surface-based analysis. RESULTS SICI was significantly reduced in patients with mild to moderate and severe to very severe RLS/WED, compared to controls (one-way analysis of variance: F = 9.62, p < 0.001). Receiver operating characteristic curve analysis predicted RLS/WED when SICI was above 35% (area under the curve = 0.79, 95% CI 0.67-0.91, p < 0.001). Analyses of the whole brain and of regions of interest did not reveal differences in gray matter thickness or area between controls and subjects with RLS/WED. CONCLUSION SICI is an accurate cortical biomarker that can support the diagnosis of RLS/WED even in subjects with mild symptoms, but cortical thickness and area were not useful for discriminating subjects with this condition from controls.
Collapse
Affiliation(s)
- Samir Câmara Magalhães
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; Universidade de Fortaleza, Unifor, Fortaleza, CE, Brazil.
| | | | | | - Annette Sterr
- Department of Psychology, University of Surrey, Guildford, Surrey, UK
| | - Alan Luiz Eckeli
- Departamento de Neurociências e Ciências do Comportamento, Divisão de Neurologia, Hospital das Clínicas da Faculdade de Medicina da USP-Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | | | | | - Edson Amaro
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; Departamento de Radiologia, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Adriana Bastos Conforto
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; Departamento de Neurologia, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
42
|
Stefani A, Mitterling T, Heidbreder A, Steiger R, Kremser C, Frauscher B, Gizewski ER, Poewe W, Högl B, Scherfler C. Multimodal Magnetic Resonance Imaging reveals alterations of sensorimotor circuits in restless legs syndrome. Sleep 2019; 42:5539066. [DOI: 10.1093/sleep/zsz171] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/22/2019] [Indexed: 01/18/2023] Open
Abstract
AbstractStudy ObjectivesIntegrated information on brain microstructural integrity and iron storage and its impact on the morphometric profile is not available in restless legs syndrome (RLS). We applied multimodal magnetic resonance imaging (MRI) including diffusion tensor imaging, the transverse relaxation rate (R2*), a marker for iron storage, as well as gray and white matter volume measures to characterize RLS-related MRI signal distribution patterns and to analyze their associations with clinical parameters.MethodsEighty-seven patients with RLS (mean age 51, range 20–72 years; disease duration, mean 13 years, range 1–46 years, of those untreated n = 30) and 87 healthy control subjects, individually matched for age and gender, were investigated with multimodal 3T MRI.ResultsVolume of the white matter compartment adjacent to the post- and precentral cortex and fractional anisotropy (FA) of the frontopontine tract were both significantly reduced in RLS compared to healthy controls, and these alterations were associated with disease duration (r = 0.25, p = 0.025 and r = 0.23, p = 0.037, respectively). Corresponding gray matter volume increases of the right primary motor cortex in RLS (p < 0.001) were negatively correlated with the right FA signal of the frontopontine tract (r = −0.22; p < 0.05). Iron content evaluated with R2* was reduced in the putamen as well as in temporal and occipital compartments of the RLS cohort compared to the control group (p < 0.01).ConclusionsMultimodal MRI identified progressing white matter decline of key somatosensory circuits that may underlie the perception of sensory leg discomfort. Increases of gray matter volume of the premotor cortex are likely to be a consequence of functional neuronal reorganization.
Collapse
Affiliation(s)
- Ambra Stefani
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Thomas Mitterling
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Anna Heidbreder
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Ruth Steiger
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
- Department of Neuroradiology, Medical University Innsbruck, Innsbruck, Austria
| | - Christian Kremser
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Birgit Frauscher
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Elke R Gizewski
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
- Department of Neuroradiology, Medical University Innsbruck, Innsbruck, Austria
| | - Werner Poewe
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Christoph Scherfler
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
43
|
He Y, Sun N, Wang Z, Zou W. Effect of repetitive transcranial magnetic stimulation (rTMS) for insomnia: a protocol for a systematic review. BMJ Open 2019; 9:e029206. [PMID: 31315870 PMCID: PMC6661550 DOI: 10.1136/bmjopen-2019-029206] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Repetitive transcranial magnetic stimulation (rTMS), a non-invasive brain stimulation approach, might be a promising technique in the management of insomnia. A systematic review of the available literature on this topic is warranted. The systematic review described in this protocol aims to investigate the efficacy of rTMS as a physical therapy in patients with insomnia. METHODS AND ANALYSIS This protocol was developed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. We will retrieve relevant literatures across the following electronic bibliographic databases: CENTRAL, PubMed, EMBASE, PsycINFO, CINAHL, PEDro, CBM, CNKI, WANFANG and VIP. A manual search of the reference lists of all relevant articles will be performed for any additional studies. We will include randomised controlled trials published in English and Chinese examining efficacy of rTMS on patients with insomnia. Two reviewers will independently complete the article selection, data extraction and rating. PEDro scale will be used to assess the methodological quality of the included studies. Narrative and quantitative synthesis will be done accordingly. ETHICS AND DISSEMINATION Ethical approval will not be required for this review. The results of this review will be disseminated in a peer-review journal. PROSPERO REGISTRATION NUMBER CRD42018115033.
Collapse
Affiliation(s)
- Yu He
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, China
- Department of Physical Medicine and Rehabilitation, The Second Clinical College, China Medical University, Shenyang, China
| | - Nianyi Sun
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, China
- Department of Physical Medicine and Rehabilitation, The Second Clinical College, China Medical University, Shenyang, China
| | - Zhiqiang Wang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, China
- Department of Physical Medicine and Rehabilitation, The Second Clinical College, China Medical University, Shenyang, China
| | - Wenchen Zou
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, China
| |
Collapse
|
44
|
Candido S, Lupo G, Pennisi M, Basile MS, Anfuso CD, Petralia MC, Gattuso G, Vivarelli S, Spandidos DA, Libra M, Falzone L. The analysis of miRNA expression profiling datasets reveals inverse microRNA patterns in glioblastoma and Alzheimer's disease. Oncol Rep 2019; 42:911-922. [PMID: 31322245 PMCID: PMC6682788 DOI: 10.3892/or.2019.7215] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 06/25/2019] [Indexed: 02/07/2023] Open
Abstract
There is recent evidence to indicate the existence of an inverse association between the incidence of neurological disorders and cancer development. Concurrently, the transcriptional pathways responsible for the onset of glioblastoma multiforme (GBM) and Alzheimer's disease (AD) have been found to be mutually exclusive between the two pathologies. Despite advancements being made concerning the knowledge of the molecular mechanisms responsible for the development of GBM and AD, little is known about the identity of the microRNA (miRNAs or miRs) involved in the development and progression of these two pathologies and their possible inverse expression patterns. On these bases, the aim of the present study was to identify a set of miRNAs significantly de-regulated in both GBM and AD, and hence to determine whether the identified miRNAs exhibit an inverse association within the two pathologies. For this purpose, miRNA expression profiling datasets derived from the Gene Expression Omnibus (GEO) DataSets and relative to GBM and AD were used. Once the miRNAs significantly de-regulated in both pathologies were identified, DIANA-mirPath pathway prediction and STRING Gene Ontology enrichment analyses were performed to establish their functional roles in each of the pathologies. The results allowed the identification of a set of miRNAs found de-regulated in both GBM and AD, whose expression levels were inversely associated in the two pathologies. In particular, a strong negative association was observed between the expression levels of miRNAs in GBM compared to AD, suggesting that although the molecular pathways behind the development of these two pathologies are the same, they appear to be inversely regulated by miRNAs. Despite the identification of this set of miRNAs which may be used for diagnostic, prognostic and therapeutic purposes, further functional in vitro and in vivo evaluations are warranted in order to validate the diagnostic and therapeutic potential of the identified miRNAs, as well as their involvement in the development of GBM and AD.
Collapse
Affiliation(s)
- Saverio Candido
- Department of Biomedical and Biotechnological Sciences, University of Catania, I‑95123 Catania, Italy
| | - Gabriella Lupo
- Department of Biomedical and Biotechnological Sciences, University of Catania, I‑95123 Catania, Italy
| | - Manuela Pennisi
- Department of Biomedical and Biotechnological Sciences, University of Catania, I‑95123 Catania, Italy
| | - Maria S Basile
- Department of Biomedical and Biotechnological Sciences, University of Catania, I‑95123 Catania, Italy
| | - Carmelina D Anfuso
- Department of Biomedical and Biotechnological Sciences, University of Catania, I‑95123 Catania, Italy
| | - Maria C Petralia
- Department of Biomedical and Biotechnological Sciences, University of Catania, I‑95123 Catania, Italy
| | - Giuseppe Gattuso
- Department of Biomedical and Biotechnological Sciences, University of Catania, I‑95123 Catania, Italy
| | - Silvia Vivarelli
- Department of Biomedical and Biotechnological Sciences, University of Catania, I‑95123 Catania, Italy
| | - Demetrios A Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Massimo Libra
- Department of Biomedical and Biotechnological Sciences, University of Catania, I‑95123 Catania, Italy
| | - Luca Falzone
- Department of Biomedical and Biotechnological Sciences, University of Catania, I‑95123 Catania, Italy
| |
Collapse
|
45
|
|
46
|
Jiménez-Jiménez FJ, Alonso-Navarro H, García-Martín E, Agúndez JA. Neurochemical features of idiopathic restless legs syndrome. Sleep Med Rev 2019; 45:70-87. [DOI: 10.1016/j.smrv.2019.03.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 03/08/2019] [Accepted: 03/15/2019] [Indexed: 11/26/2022]
|
47
|
Lin J, Liu X, Li H, Yu L, Shen M, Lou Y, Xie S, Chen J, Zhang R, Yuan TF. Chronic repetitive transcranial magnetic stimulation (rTMS) on sleeping quality and mood status in drug dependent male inpatients during abstinence. Sleep Med 2019; 58:7-12. [DOI: 10.1016/j.sleep.2019.01.052] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 01/04/2019] [Accepted: 01/31/2019] [Indexed: 11/30/2022]
|
48
|
Madeo G, Bonci A. Rewiring the Addicted Brain: Circuits-Based Treatment for Addiction. COLD SPRING HARBOR SYMPOSIA ON QUANTITATIVE BIOLOGY 2019; 83:173-184. [PMID: 31097615 DOI: 10.1101/sqb.2018.83.038158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The advent of the noninvasive brain stimulation (NIBS) technique has paved the way for neural circuit-based treatments for addiction. Recently, evidence from both preclinical and clinical studies has evaluated the use of transcranial magnetic stimulation (TMS) as a safe and cost-effective therapeutic tool for substance use disorders (SUDs). Indeed, repetitive TMS impacts on neural activity inducing short- and long-term effects involving neuroplasticity mechanisms locally within the target area of stimulation and the network level throughout the brain. Here, we provide an integrated view of evidence highlighting the mechanisms of TMS-induced effects on modulating the maladaptive brain circuitry of addiction. We then review the preclinical and clinical findings suggesting rTMS as an effective interventional tool for the treatment of SUDs.
Collapse
Affiliation(s)
- Graziella Madeo
- Novella Fronda Foundation, Human Science and Brain Research Piazza Castello, 16-35141 Padua, Italy.,Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland 21224, USA
| | - Antonello Bonci
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland 21224, USA.,Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
| |
Collapse
|
49
|
Song P, Lin H, Li S, Wang L, Liu J, Li N, Wang Y. Repetitive transcranial magnetic stimulation (rTMS) modulates time-varying electroencephalography (EEG) network in primary insomnia patients: a TMS-EEG study. Sleep Med 2019; 56:157-163. [DOI: 10.1016/j.sleep.2019.01.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/04/2018] [Accepted: 01/07/2019] [Indexed: 12/11/2022]
|
50
|
Affiliation(s)
- Sergi Ferré
- Editor in Chief of the Journal of Caffeine and Adenosine Research
- Integrative Neurobiology Section, National Institute on Drug Abuse, IRP, NIH, DHHS, Baltimore, Maryland
| |
Collapse
|