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Calma AD, van den Bos M, Pavey N, Santos Silva C, Menon P, Vucic S. Physiological Biomarkers of Upper Motor Neuron Dysfunction in ALS. Brain Sci 2024; 14:760. [PMID: 39199454 PMCID: PMC11352893 DOI: 10.3390/brainsci14080760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/24/2024] [Accepted: 07/26/2024] [Indexed: 09/01/2024] Open
Abstract
Upper motor neuron (UMN) dysfunction is an important feature of amyotrophic lateral sclerosis (ALS) for the diagnosis and understanding of pathogenesis. The identification of UMN signs forms the basis of ALS diagnosis, although may be difficult to discern, especially in the setting of severe muscle weakness. Transcranial magnetic stimulation (TMS) techniques have yielded objective physiological biomarkers of UMN dysfunction in ALS, enabling the interrogation of cortical and subcortical neuronal networks with diagnostic, pathophysiological, and prognostic implications. Transcranial magnetic stimulation techniques have provided pertinent pathogenic insights and yielded novel diagnostic and prognostic biomarkers. Cortical hyperexcitability, as heralded by a reduction in short interval intracortical inhibition (SICI) and an increase in short interval intracortical facilitation (SICF), has been associated with lower motor neuron degeneration, patterns of disease evolution, as well as the development of specific ALS clinical features including the split hand phenomenon. Reduction in SICI has also emerged as a potential diagnostic aid in ALS. More recently, physiological distinct inhibitory and facilitatory cortical interneuronal circuits have been identified, which have been shown to contribute to ALS pathogenesis. The triple stimulation technique (TST) was shown to enhance the diagnostic utility of conventional TMS measures in detecting UMN dysfunction. Resting-state EEG is a novel neurophysiological technique developed for directly interrogating cortical neuronal networks in ALS, that have yielded potentially useful physiological biomarkers of UMN dysfunction. The present review discusses physiological biomarkers of UMN dysfunction in ALS, encompassing conventional and novel TMS techniques developed to interrogate the functional integrity of the corticomotoneuronal system, focusing on pathogenic, diagnostic, and prognostic utility.
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Affiliation(s)
- Aicee Dawn Calma
- Brain and Nerve Research Center, The University of Sydney, Sydney 2139, Australia (C.S.S.)
| | - Mehdi van den Bos
- Brain and Nerve Research Center, The University of Sydney, Sydney 2139, Australia (C.S.S.)
| | - Nathan Pavey
- Brain and Nerve Research Center, The University of Sydney, Sydney 2139, Australia (C.S.S.)
| | - Cláudia Santos Silva
- Brain and Nerve Research Center, The University of Sydney, Sydney 2139, Australia (C.S.S.)
- Department of Neurosciences and Mental Health, Unidade Local de Saúde de Santa Maria, 1649-028 Lisbon, Portugal
- Faculdade de Medicina-Instituto de Medicina Molecular, Centro de Estudos Egas Moniz, Universidade de Lisboa, 1649-028 Lisbon, Portugal
| | - Parvathi Menon
- Brain and Nerve Research Center, The University of Sydney, Sydney 2139, Australia (C.S.S.)
| | - Steve Vucic
- Brain and Nerve Research Center, The University of Sydney, Sydney 2139, Australia (C.S.S.)
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Dharmadasa T, Pavey N, Tu S, Menon P, Huynh W, Mahoney CJ, Timmins HC, Higashihara M, van den Bos M, Shibuya K, Kuwabara S, Grosskreutz J, Kiernan MC, Vucic S. Novel approaches to assessing upper motor neuron dysfunction in motor neuron disease/amyotrophic lateral sclerosis: IFCN handbook chapter. Clin Neurophysiol 2024; 163:68-89. [PMID: 38705104 DOI: 10.1016/j.clinph.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 02/08/2024] [Accepted: 04/14/2024] [Indexed: 05/07/2024]
Abstract
Identifying upper motor neuron (UMN) dysfunction is fundamental to the diagnosis and understanding of disease pathogenesis in motor neuron disease (MND). The clinical assessment of UMN dysfunction may be difficult, particularly in the setting of severe muscle weakness. From a physiological perspective, transcranial magnetic stimulation (TMS) techniques provide objective biomarkers of UMN dysfunction in MND and may also be useful to interrogate cortical and network function. Single, paired- and triple pulse TMS techniques have yielded novel diagnostic and prognostic biomarkers in MND, and have provided important pathogenic insights, particularly pertaining to site of disease onset. Cortical hyperexcitability, as heralded by reduced short interval intracortical inhibition (SICI) and increased short interval intracortical facilitation, has been associated with the onset of lower motor neuron degeneration, along with patterns of disease spread, development of specific clinical features such as the split hand phenomenon, and may provide an indication about the rate of disease progression. Additionally, reduction of SICI has emerged as a potential diagnostic aid in MND. The triple stimulation technique (TST) was shown to enhance the diagnostic utility of conventional TMS measures in detecting UMN dysfunction in MND. Separately, sophisticated brain imaging techniques have uncovered novel biomarkers of neurodegeneration that have bene associated with progression. The present review will discuss the utility of TMS and brain neuroimaging derived biomarkers of UMN dysfunction in MND, focusing on recently developed TMS techniques and advanced neuroimaging modalities that interrogate structural and functional integrity of the corticomotoneuronal system, with an emphasis on pathogenic, diagnostic, and prognostic utility.
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Affiliation(s)
- Thanuja Dharmadasa
- Department of Neurology, The Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia
| | - Nathan Pavey
- Brain and Nerve Research Center, The University of Sydney, Sydney, Australia
| | - Sicong Tu
- Brain and Mind Centre, The University of Sydney, and Department of Neurology, Royal Prince Alfred Hospital, Australia
| | - Parvathi Menon
- Brain and Nerve Research Center, The University of Sydney, Sydney, Australia
| | - William Huynh
- Brain and Mind Centre, The University of Sydney, and Department of Neurology, Royal Prince Alfred Hospital, Australia
| | - Colin J Mahoney
- Brain and Mind Centre, The University of Sydney, and Department of Neurology, Royal Prince Alfred Hospital, Australia
| | - Hannah C Timmins
- Brain and Mind Centre, The University of Sydney, and Department of Neurology, Royal Prince Alfred Hospital, Australia
| | - Mana Higashihara
- Department of Neurology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Mehdi van den Bos
- Brain and Nerve Research Center, The University of Sydney, Sydney, Australia
| | - Kazumoto Shibuya
- Neurology, Chiba University, Graduate School of Medicine, Chiba, Japan
| | - Satoshi Kuwabara
- Neurology, Chiba University, Graduate School of Medicine, Chiba, Japan
| | - Julian Grosskreutz
- Precision Neurology, Excellence Cluster Precision Medicine in Inflammation, University of Lübeck, University Hospital Schleswig-Holstein Campus, Lübeck, Germany
| | - Matthew C Kiernan
- Brain and Mind Centre, The University of Sydney, and Department of Neurology, Royal Prince Alfred Hospital, Australia
| | - Steve Vucic
- Brain and Nerve Research Center, The University of Sydney, Sydney, Australia.
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Snow NJ, Murphy HM, Chaves AR, Moore CS, Ploughman M. Transcranial magnetic stimulation enhances the specificity of multiple sclerosis diagnostic criteria: a critical narrative review. PeerJ 2024; 12:e17155. [PMID: 38563011 PMCID: PMC10984191 DOI: 10.7717/peerj.17155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
Background Multiple sclerosis (MS) is an immune-mediated neurodegenerative disease that involves attacks of inflammatory demyelination and axonal damage, with variable but continuous disability accumulation. Transcranial magnetic stimulation (TMS) is a noninvasive method to characterize conduction loss and axonal damage in the corticospinal tract. TMS as a technique provides indices of corticospinal tract function that may serve as putative MS biomarkers. To date, no reviews have directly addressed the diagnostic performance of TMS in MS. The authors aimed to conduct a critical narrative review on the diagnostic performance of TMS in MS. Methods The authors searched the Embase, PubMed, Scopus, and Web of Science databases for studies that reported the sensitivity and/or specificity of any reported TMS technique compared to established clinical MS diagnostic criteria. Studies were summarized and critically appraised for their quality and validity. Results Seventeen of 1,073 records were included for data extraction and critical appraisal. Markers of demyelination and axonal damage-most notably, central motor conduction time (CMCT)-were specific, but not sensitive, for MS. Thirteen (76%), two (12%), and two (12%) studies exhibited high, unclear, and low risk of bias, respectively. No study demonstrated validity for TMS techniques as diagnostic biomarkers in MS. Conclusions CMCT has the potential to: (1) enhance the specificity of clinical MS diagnostic criteria by "ruling in" true-positives, or (2) revise a diagnosis from relapsing to progressive forms of MS. However, there is presently insufficient high-quality evidence to recommend any TMS technique in the diagnostic algorithm for MS.
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Affiliation(s)
- Nicholas J. Snow
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - Hannah M. Murphy
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - Arthur R. Chaves
- Faculty of Health Sciences, Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- Neuromodulation Research Clinic, The Royal’s Institute of Mental Health Research, Ottawa, ON, Canada
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Craig S. Moore
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - Michelle Ploughman
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada
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Batzianouli ET, Caranzano L, Nguepnjo Nguissi NA, Miaz B, Herrmann FR, Benninger DH. The paired-pulse TMS paradigm of short intracortical inhibition is mediated by a reduction of repetitive motor neuron discharges. J Neurophysiol 2024; 131:541-547. [PMID: 38264793 DOI: 10.1152/jn.00346.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/19/2024] [Accepted: 01/21/2024] [Indexed: 01/25/2024] Open
Abstract
Transcranial magnetic stimulation (TMS) causes repetitive spinal motoneuron discharges (repMNDs), but the effects of short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF) on repMNDs remain unknown. Triple stimulation technique (TST) and the extended TST-protocols that include a fourth and fifth stimulation, the Quadruple (QuadS) and Quintuple (QuintS) stimulation, respectively, offer a precise estimate of cortical and spinal motor neuron discharges, including repMNDs. The objective of our study was to explore the effects of SICI and ICF on repMNDs. We explored conventional paired-pulse TMS protocols of SICI and ICF with the TMS, TST, the QuadS, and the QuintS protocols, in a randomized study design in 20 healthy volunteers. We found significantly less repMNDs in the SICI paradigm compared with a single-pulse TMS (SP-TMS). No significant difference was observed in the ICF paradigm. There was a significant inter- and intrasubject variability in both SICI and ICF. We demonstrate a significant reduction of repMNDs in SICI, which may result from the suppression of later I-waves and mediate the inhibition of motor-evoked potential (MEP). There is no increase in repMNDs in ICF suggesting another mechanism underlying facilitation. This study provides the proof that a reduction of repMNDs mediates the inhibition seen in SICI.NEW & NOTEWORTHY Significant reduction of repetitive motor neuron discharges (repMNDs) in short-interval intracortical inhibition (SICI) may result from the suppression of later I-waves and mediate the inhibition of motor-evoked potential (MEP). There is no change in the number of repMNDs in intracortical facilitation (ICF). There was a significant variability in SICI and ICF in healthy subjects.
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Affiliation(s)
- Eleni T Batzianouli
- Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- Lemanic Neuroscience Doctoral School, Faculté de Biologie et de Médecine, Université de Lausanne, Lausanne, Switzerland
| | - Leonardo Caranzano
- Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Nathalie A Nguepnjo Nguissi
- Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Baptiste Miaz
- Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - François R Herrmann
- Division of Geriatrics and rehabilitation, Department of Rehabilitation and Geriatrics, University Hospitals and University of Geneva, Geneva, Switzerland
| | - David H Benninger
- Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Sun W, Wu Q, Gao L, Zheng Z, Xiang H, Yang K, Yu B, Yao J. Advancements in Transcranial Magnetic Stimulation Research and the Path to Precision. Neuropsychiatr Dis Treat 2023; 19:1841-1851. [PMID: 37641588 PMCID: PMC10460597 DOI: 10.2147/ndt.s414782] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/02/2023] [Indexed: 08/31/2023] Open
Abstract
Transcranial magnetic stimulation (TMS) has become increasingly popular in clinical practice in recent years, and there have been significant advances in the principles and stimulation modes of TMS. With the development of multi-mode and precise stimulation technology, it is crucial to have a comprehensive understanding of TMS. The neuroregulatory effects of TMS can vary depending on the specific mode of stimulation, highlighting the importance of exploring these effects through multimodal application. Additionally, the use of precise TMS therapy can help enhance our understanding of the neural mechanisms underlying these effects, providing us with a more comprehensive perspective. This article aims to review the mechanism of action, stimulation mode, multimodal application, and precision of TMS.
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Affiliation(s)
- Wei Sun
- Department of Psychiatry, the Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang City, Sichuan Province, People’s Republic of China
| | - Qiao Wu
- Department of Psychiatry, the Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang City, Sichuan Province, People’s Republic of China
| | - Li Gao
- Department of Neurology, The Third People’s Hospital of Chengdu, Chengdu Institute of Neurological Diseases, Chengdu City, Sichuan Province, People’s Republic of China
| | - Zhong Zheng
- Neurobiological Detection Center, West China Hospital Affiliated to Sichuan University, Chengdu City, Sichuan Province, People’s Republic of China
| | - Hu Xiang
- Department of Psychiatry, the Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang City, Sichuan Province, People’s Republic of China
| | - Kun Yang
- Department of Psychiatry, the Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang City, Sichuan Province, People’s Republic of China
| | - Bo Yu
- Department of Psychiatry, the Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang City, Sichuan Province, People’s Republic of China
| | - Jing Yao
- Department of Psychiatry, the Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang City, Sichuan Province, People’s Republic of China
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Vucic S, Stanley Chen KH, Kiernan MC, Hallett M, Benninger DH, Di Lazzaro V, Rossini PM, Benussi A, Berardelli A, Currà A, Krieg SM, Lefaucheur JP, Long Lo Y, Macdonell RA, Massimini M, Rosanova M, Picht T, Stinear CM, Paulus W, Ugawa Y, Ziemann U, Chen R. Clinical diagnostic utility of transcranial magnetic stimulation in neurological disorders. Updated report of an IFCN committee. Clin Neurophysiol 2023; 150:131-175. [PMID: 37068329 PMCID: PMC10192339 DOI: 10.1016/j.clinph.2023.03.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/28/2023] [Accepted: 03/09/2023] [Indexed: 03/31/2023]
Abstract
The review provides a comprehensive update (previous report: Chen R, Cros D, Curra A, Di Lazzaro V, Lefaucheur JP, Magistris MR, et al. The clinical diagnostic utility of transcranial magnetic stimulation: report of an IFCN committee. Clin Neurophysiol 2008;119(3):504-32) on clinical diagnostic utility of transcranial magnetic stimulation (TMS) in neurological diseases. Most TMS measures rely on stimulation of motor cortex and recording of motor evoked potentials. Paired-pulse TMS techniques, incorporating conventional amplitude-based and threshold tracking, have established clinical utility in neurodegenerative, movement, episodic (epilepsy, migraines), chronic pain and functional diseases. Cortical hyperexcitability has emerged as a diagnostic aid in amyotrophic lateral sclerosis. Single-pulse TMS measures are of utility in stroke, and myelopathy even in the absence of radiological changes. Short-latency afferent inhibition, related to central cholinergic transmission, is reduced in Alzheimer's disease. The triple stimulation technique (TST) may enhance diagnostic utility of conventional TMS measures to detect upper motor neuron involvement. The recording of motor evoked potentials can be used to perform functional mapping of the motor cortex or in preoperative assessment of eloquent brain regions before surgical resection of brain tumors. TMS exhibits utility in assessing lumbosacral/cervical nerve root function, especially in demyelinating neuropathies, and may be of utility in localizing the site of facial nerve palsies. TMS measures also have high sensitivity in detecting subclinical corticospinal lesions in multiple sclerosis. Abnormalities in central motor conduction time or TST correlate with motor impairment and disability in MS. Cerebellar stimulation may detect lesions in the cerebellum or cerebello-dentato-thalamo-motor cortical pathways. Combining TMS with electroencephalography, provides a novel method to measure parameters altered in neurological disorders, including cortical excitability, effective connectivity, and response complexity.
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Affiliation(s)
- Steve Vucic
- Brain, Nerve Research Center, The University of Sydney, Sydney, Australia.
| | - Kai-Hsiang Stanley Chen
- Department of Neurology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Matthew C Kiernan
- Brain and Mind Centre, The University of Sydney; and Department of Neurology, Royal Prince Alfred Hospital, Australia
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health, Bethesda, Maryland, United States
| | - David H Benninger
- Department of Neurology, University Hospital of Lausanne (CHUV), Switzerland
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Paolo M Rossini
- Department of Neurosci & Neurorehab IRCCS San Raffaele-Rome, Italy
| | - Alberto Benussi
- Centre for Neurodegenerative Disorders, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alfredo Berardelli
- IRCCS Neuromed, Pozzilli; Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Antonio Currà
- Department of Medico-Surgical Sciences and Biotechnologies, Alfredo Fiorini Hospital, Sapienza University of Rome, Terracina, LT, Italy
| | - Sandro M Krieg
- Department of Neurosurgery, Technical University Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Jean-Pascal Lefaucheur
- Univ Paris Est Creteil, EA4391, ENT, Créteil, France; Clinical Neurophysiology Unit, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Yew Long Lo
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, and Duke-NUS Medical School, Singapore
| | | | - Marcello Massimini
- Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi di Milano, Milan, Italy; Istituto Di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Mario Rosanova
- Department of Biomedical and Clinical Sciences University of Milan, Milan, Italy
| | - Thomas Picht
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Cluster of Excellence: "Matters of Activity. Image Space Material," Humboldt University, Berlin Simulation and Training Center (BeST), Charité-Universitätsmedizin Berlin, Germany
| | - Cathy M Stinear
- Department of Medicine Waipapa Taumata Rau, University of Auckland, Auckland, Aotearoa, New Zealand
| | - Walter Paulus
- Department of Neurology, Ludwig-Maximilians-Universität München, München, Germany
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Japan
| | - Ulf Ziemann
- Department of Neurology and Stroke, Eberhard Karls University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany; Hertie Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, Otfried-Müller-Straße 27, 72076 Tübingen, Germany
| | - Robert Chen
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital-UHN, Division of Neurology-University of Toronto, Toronto Canada
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Dietmann A, Blanquet M, Rösler KM, Scheidegger O. Effects of high resistance muscle training on corticospinal output during motor fatigue assessed by transcranial magnetic stimulation. Front Physiol 2023; 14:1125974. [PMID: 36969602 PMCID: PMC10036808 DOI: 10.3389/fphys.2023.1125974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/27/2023] [Indexed: 03/12/2023] Open
Abstract
Introduction: Central fatigue refers to a reduced drive of motor cortical output during exercise, and performance can be enhanced after training. However, the effects of training on central fatigue remain unclear. Changes in cortical output can be addressed non-invasively using transcranial magnetic stimulation (TMS). The aim of the study was to compare responses to TMS during a fatiguing exercise before and after a 3 weeks lasting resistance training, in healthy subjects.Methods: The triple stimulation technique (TST) was used to quantify a central conduction index (CCI = amplitude ratio of central conduction response and peripheral nerve response) to the abductor digiti minimi muscle (ADM) in 15 subjects. The training consisted of repetitive isometric maximal voluntary contractions (MVC) of ADM for 2 min twice a day. Before and after this training, TST recordings were obtained every 15 s during an 2 min exercise of MVC of the ADM, where subjects performed repetitive contractions of the ADM, and repeatedly during a recovery period of 7 min.Results: There was a consistent decrease of force to approximately 40% of MVC in all experiments and in all subjects, both before and after training. In all subjects, CCI decreased during exercise. While before training, theCCI decreased to 49% (SD 23.7%) after 2 min of exercise, it decreased after training onlyto 79% (SD 26.4%) after exercise (p < 0.01).Discussion: The training regimen increased the proportion of target motor units that could be activated by TMS during a fatiguing exercise. The results point to a reduced intracortical inhibition, which may be a transient physiological response to facilitate the motor task. Possible underlying mechanisms at spinal and supraspinal sites are discussed.
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Affiliation(s)
- Anelia Dietmann
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland, Bern, Switzerland
| | - Marisa Blanquet
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland, Bern, Switzerland
| | - Kai Michael Rösler
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland, Bern, Switzerland
- Neurozentrum Basel, Bellevue Medical Group, Basel, Switzerland
| | - Olivier Scheidegger
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland, Bern, Switzerland
- Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- *Correspondence: Olivier Scheidegger ,
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Truffert A, Sukockienė E, Desmaison A, Ališauskienė M, Iancu Ferfoglia R, Guy N. Combined tendon reflex and motor evoked potential recordings in amyotrophic lateral sclerosis. Clin Neurophysiol 2023; 147:88-98. [PMID: 36753809 DOI: 10.1016/j.clinph.2022.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 12/13/2022] [Accepted: 12/18/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVE This retrospective (case-control) collaborative study evaluates tendon reflex recordings combined with transcranial magnetic stimulation motor evoked potentials recordings (T-MEPs) at lower limbs in amyotrophic lateral sclerosis (ALS). METHODS T-MEPs were recorded in 97 ALS patients distinguished according to their patellar reflex briskness. Patients' electrophysiological data were compared with values measured in 60 control patients matched for age and height. Correlations studies between parameters or with some patients' clinical characteristics were also performed. RESULTS The central motor conduction time yields the highest sensitivity (82%) and specificity (93%), allowing twice more upper motor neuron (UMN) dysfunction detection than clinical examination, and being more altered in late stages of the disease. The T response to MEP response amplitude ratio (T/MEP ar) is nearly as sensitive to detect ALS and better identifies abnormal hyperreflexia. It is not correlated with evolutive stage, contrarily to conduction time-related parameters. In addition, T-MEPs detect asymmetries escaping clinical examination. CONCLUSIONS The corticospinal conduction to lower limbs is slowed in ALS. The T/MEP ar helps deciding when patellar reflexes are abnormal in a given patient suspected of ALS. SIGNIFICANCE The T-MEP technique provide powerful electrophysiological biomarkers of UMN involvement in ALS. This simple and painless procedure introduces the clinically useful concept of electrophysiological hyperreflexia and might be expanded to future exploration of proximal upper limbs and bulbar territories.
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Affiliation(s)
- André Truffert
- University of Geneva, Faculty of Medicine, Department of Clinical Neurosciences, Geneva, Switzerland.
| | - Eglė Sukockienė
- Division of Neurology, Geneva University Hospitals, Geneva, Switzerland
| | - Annaïck Desmaison
- CRCSLA et maladies du neurone moteur, Department of Neurology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Miglė Ališauskienė
- Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Nathalie Guy
- CRCSLA et maladies du neurone moteur, Department of Neurology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France; Université Clermont Auvergne, Inserm Neuro-Dol U1107, Clermont-Ferrand, France
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Madsen MAJ, Wiggermann V, Marques MFM, Lundell H, Cerri S, Puonti O, Blinkenberg M, Christensen JR, Sellebjerg F, Siebner HR. Linking lesions in sensorimotor cortex to contralateral hand function in multiple sclerosis: a 7 T MRI study. Brain 2022; 145:3522-3535. [PMID: 35653498 PMCID: PMC9586550 DOI: 10.1093/brain/awac203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/17/2022] [Accepted: 05/20/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Cortical lesions constitute a key manifestation of multiple sclerosis and contribute to clinical disability and cognitive impairment. Yet it is unknown whether local cortical lesions and cortical lesion subtypes contribute to domain-specific impairments attributable to the function of the lesioned cortex.
In this cross-sectional study, we assessed how cortical lesions in the primary sensorimotor hand area (SM1-HAND) relate to corticomotor physiology and sensorimotor function of the contralateral hand. 50 relapse-free patients with relapsing-remitting or secondary-progressive multiple sclerosis and 28 healthy age- and sex-matched participants underwent whole-brain 7 T MRI to map cortical lesions. Brain scans were also used to estimate normalized brain volume, pericentral cortical thickness, white matter lesion fraction of the corticospinal tract, infratentorial lesion volume and the cross-sectional area of the upper cervical spinal cord. We tested sensorimotor hand function and calculated a motor and sensory composite score for each hand. In 37 patients and 20 healthy controls, we measured maximal motor evoked potential (MEP) amplitude, resting motor threshold and corticomotor conduction time with transcranial magnetic stimulation (TMS) and the N20 latency from somatosensory evoked potentials (SSEPs).
Patients showed at least one cortical lesion in the SM1-HAND in 47 of 100 hemispheres. The presence of a lesion was associated with worse contralateral sensory (P = 0.014) and motor (P = 0.009) composite scores. TMS of a lesion-positive SM1-HAND revealed a decreased maximal MEP amplitude (P < 0.001) and delayed corticomotor conduction (P = 0.002) relative to a lesion-negative SM1-HAND. Stepwise mixed linear regressions showed that the presence of an SM1-HAND lesion, higher white-matter lesion fraction of the corticospinal tract, reduced spinal cord cross-sectional area and higher infratentorial lesion volume were associated with reduced contralateral motor hand function. Cortical lesions in SM1-HAND, spinal cord cross-sectional area and normalized brain volume were also associated with smaller maximal MEP amplitude and longer corticomotor conduction times. The effect of cortical lesions on sensory function was no longer significant when controlling for MRI-based covariates. Lastly, we found that intracortical and subpial lesions had the largest effect on reduced motor hand function, intracortical lesions on reduced MEP amplitude and leukocortical lesions on delayed corticomotor conduction.
Together, this comprehensive multi-level assessment of sensorimotor brain damage shows that the presence of a cortical lesion in SM1-HAND is associated with impaired corticomotor function of the hand, after accounting for damage at the subcortical level. The results also provide preliminary evidence that cortical lesion types may affect the various facets of corticomotor function differentially.
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Affiliation(s)
- Mads A. J. Madsen
- Copenhagen University Hospital - Amager & Hvidovre Danish Research Centre for Magnetic Resonance, , 2650 Hvidovre, Denmark
| | - Vanessa Wiggermann
- Copenhagen University Hospital - Amager & Hvidovre Danish Research Centre for Magnetic Resonance, , 2650 Hvidovre, Denmark
| | - Marta F. M. Marques
- Copenhagen University Hospital - Amager & Hvidovre Danish Research Centre for Magnetic Resonance, , 2650 Hvidovre, Denmark
| | - Henrik Lundell
- Copenhagen University Hospital - Amager & Hvidovre Danish Research Centre for Magnetic Resonance, , 2650 Hvidovre, Denmark
| | - Stefano Cerri
- Copenhagen University Hospital - Amager & Hvidovre Danish Research Centre for Magnetic Resonance, , 2650 Hvidovre, Denmark
- Technical University of Denmark Department of Health Technology, , 2800 Kgs. Lyngby, Denmark
| | - Oula Puonti
- Copenhagen University Hospital - Amager & Hvidovre Danish Research Centre for Magnetic Resonance, , 2650 Hvidovre, Denmark
| | - Morten Blinkenberg
- Copenhagen University Hospital – Rigshospitalet Danish Multiple Sclerosis Center, Department of Neurology, , 2600 Glostrup, Denmark
| | - Jeppe Romme Christensen
- Copenhagen University Hospital – Rigshospitalet Danish Multiple Sclerosis Center, Department of Neurology, , 2600 Glostrup, Denmark
| | - Finn Sellebjerg
- Copenhagen University Hospital – Rigshospitalet Danish Multiple Sclerosis Center, Department of Neurology, , 2600 Glostrup, Denmark
- University of Copenhagen Department of Clinical Medicine, , 2200 Copenhagen, Denmark
| | - Hartwig R. Siebner
- Copenhagen University Hospital - Amager & Hvidovre Danish Research Centre for Magnetic Resonance, , 2650 Hvidovre, Denmark
- Copenhagen University Hospital - Bispebjerg & Frederiksberg Department of Neurology, , 2400 Copenhagen, Denmark
- University of Copenhagen Department of Clinical Medicine, , 2200 Copenhagen, Denmark
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10
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A New Paired Associative Stimulation Protocol with High-Frequency Peripheral Component and High-Intensity 20 Hz Repetitive Transcranial Magnetic Stimulation-A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111224. [PMID: 34769744 PMCID: PMC8583447 DOI: 10.3390/ijerph182111224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/12/2021] [Accepted: 10/21/2021] [Indexed: 11/16/2022]
Abstract
Paired associative stimulation (PAS) is a stimulation technique combining transcranial magnetic stimulation (TMS) and peripheral nerve stimulation (PNS) that can induce plastic changes in the human motor system. A PAS protocol consisting of a high-intensity single TMS pulse given at 100% of stimulator output (SO) and high-frequency 100-Hz PNS train, or "the high-PAS" was designed to promote corticomotoneuronal synapses. Such PAS, applied as a long-term intervention, has demonstrated therapeutic efficacy in spinal cord injury (SCI) patients. Adding a second TMS pulse, however, rendered this protocol inhibitory. The current study sought for more effective PAS parameters. Here, we added a third TMS pulse, i.e., a 20-Hz rTMS (three pulses at 96% SO) combined with high-frequency PNS (six pulses at 100 Hz). We examined the ability of the proposed stimulation paradigm to induce the potentiation of motor-evoked potentials (MEPs) in five human subjects and described the safety and tolerability of the new protocol in these subjects. In this study, rTMS alone was used as a control. In addition, we compared the efficacy of the new protocol in five subjects with two PAS protocols consisting of PNS trains of six pulses at 100 Hz combined with (a) single 100% SO TMS pulses (high-PAS) and (b) a 20-Hz rTMS at a lower intensity (three pulses at 120% RMT). The MEPs were measured immediately after, and 30 and 60 min after the stimulation. Although at 0 and 30 min there was no significant difference in the induced MEP potentiation between the new PAS protocol and the rTMS control, the MEP potentiation remained significantly higher at 60 min after the new PAS than after rTMS alone. At 60 min, the new protocol was also more effective than the two other PAS protocols. The new protocol caused strong involuntary twitches in three subjects and, therefore, its further characterization is needed before introducing it for clinical research. Additionally, its mechanism plausibly differs from PAS with high-frequency PNS that has been used in SCI patients.
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11
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Metsomaa J, Belardinelli P, Ermolova M, Ziemann U, Zrenner C. Causal decoding of individual cortical excitability states. Neuroimage 2021; 245:118652. [PMID: 34687858 DOI: 10.1016/j.neuroimage.2021.118652] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/30/2021] [Accepted: 10/11/2021] [Indexed: 10/20/2022] Open
Abstract
Brain responsiveness to stimulation fluctuates with rapidly shifting cortical excitability state, as reflected by oscillations in the electroencephalogram (EEG). For example, the amplitude of motor-evoked potentials (MEPs) elicited by transcranial magnetic stimulation (TMS) of motor cortex changes from trial to trial. To date, individual estimation of the cortical processes leading to this excitability fluctuation has not been possible. Here, we propose a data-driven method to derive individually optimized EEG classifiers in healthy humans using a supervised learning approach that relates pre-TMS EEG activity dynamics to MEP amplitude. Our approach enables considering multiple brain regions and frequency bands, without defining them a priori, whose compound phase-pattern information determines the excitability. The individualized classifier leads to an increased classification accuracy of cortical excitability states from 57% to 67% when compared to μ-oscillation phase extracted by standard fixed spatial filters. Results show that, for the used TMS protocol, excitability fluctuates predominantly in the μ-oscillation range, and relevant cortical areas cluster around the stimulated motor cortex, but between subjects there is variability in relevant power spectra, phases, and cortical regions. This novel decoding method allows causal investigation of the cortical excitability state, which is critical also for individualizing therapeutic brain stimulation.
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Affiliation(s)
- J Metsomaa
- Department of Neurology & Stroke, University of Tübingen, Tübingen, Germany; Hertie Institute for Clinical Brain Research, University of Tübingen
| | - P Belardinelli
- Department of Neurology & Stroke, University of Tübingen, Tübingen, Germany; Hertie Institute for Clinical Brain Research, University of Tübingen; CIMeC, Center for Mind-Brain Sciences, University of Trento, Italy
| | - M Ermolova
- Department of Neurology & Stroke, University of Tübingen, Tübingen, Germany; Hertie Institute for Clinical Brain Research, University of Tübingen
| | - U Ziemann
- Department of Neurology & Stroke, University of Tübingen, Tübingen, Germany; Hertie Institute for Clinical Brain Research, University of Tübingen.
| | - C Zrenner
- Department of Neurology & Stroke, University of Tübingen, Tübingen, Germany; Hertie Institute for Clinical Brain Research, University of Tübingen; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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12
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Floeter MK, Warden D, Lange D, Wymer J, Paganoni S, Mitsumoto H. Clinical care and therapeutic trials in PLS. Amyotroph Lateral Scler Frontotemporal Degener 2021; 21:67-73. [PMID: 33602017 DOI: 10.1080/21678421.2020.1837180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Primary lateral sclerosis (PLS) is an extremely rare central nervous system degenerative disorder characterized by slowly progressive upper motor neuron loss leading to severe limb and bulbar dysfunction and disability. Although not necessarily life-shortening, PLS disease burden is substantial and improved symptomatic treatments are a major unmet need, especially for the often refractory spasticity that is a core feature of the syndrome. In Section 1, we describe clinical care needs and emphasize a highly personalized approach that can be best attained through multidisciplinary management. In Section 2, we describe progress in clinical trials in PLS that includes advances in symptomatic treatment, disease-modifying therapy, and emerging innovative trials.
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Affiliation(s)
- Mary Kay Floeter
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Deborah Warden
- Departments of Neurology and Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Dale Lange
- Department of Neurology, Hospital for Special Surgery, Weill Cornell School of Medicine, New York, NY, USA
| | - James Wymer
- Department of Neurology, University of Florida, Gainesville, FL, USA
| | - Sabrina Paganoni
- Healey Center for ALS at Mass General, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA, and
| | - Hiroshi Mitsumoto
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
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13
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Grapperon AM, Verschueren A, Jouve E, Morizot-Koutlidis R, Lenglet T, Pradat PF, Salachas F, Bernard E, Delstanche S, Maertens de Noordhout A, Guy N, Danel V, Delval A, Delmont E, Rolland AS, Pulse Study Group, Jomir L, Devos D, Wang F, Attarian S. Assessing the upper motor neuron in amyotrophic lateral sclerosis using the triple stimulation technique: A multicenter prospective study. Clin Neurophysiol 2021; 132:2551-2557. [PMID: 34455313 DOI: 10.1016/j.clinph.2021.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/16/2021] [Accepted: 08/07/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the relevance of transcranial magnetic stimulation (TMS) using triple stimulation technique (TST) to assess corticospinal function in amyotrophic lateral sclerosis (ALS) in a large-scale multicenter study. METHODS Six ALS centers performed TST and conventional TMS in upper limbs in 98 ALS patients during their first visit to the center. Clinical evaluation of patients included the revised ALS Functional Rating Scale (ALSFRS-R) and upper motor neuron (UMN) score. RESULTS TST amplitude ratio was decreased in 62% of patients whereas conventional TMS amplitude ratio was decreased in 25% of patients and central motor conduction time was increased in 16% of patients. TST amplitude ratio was correlated with ALSFRS-R and UMN score. TST amplitude ratio results were not different between the centers. CONCLUSIONS TST is a TMS technique applicable in daily clinical practice in ALS centers for the detection of UMN dysfunction, more sensitive than conventional TMS and related to the clinical condition of the patients. SIGNIFICANCE This multicenter study shows that TST can be a routine clinical tool to evaluate UMN dysfunction at the diagnostic assessment of ALS patients.
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Affiliation(s)
- Aude-Marie Grapperon
- APHM, Timone University Hospital, Referral Center for Neuromuscular Diseases and ALS, ERN Euro-NMD Center, Marseille, France
| | - Annie Verschueren
- APHM, Timone University Hospital, Referral Center for Neuromuscular Diseases and ALS, ERN Euro-NMD Center, Marseille, France
| | - Elisabeth Jouve
- Aix Marseille Univ, APHM, INSERM, Inst Neurosci Syst, Department of Clinical Pharmacology and Pharmacovigilance, CIC-CPCET, Marseille, France
| | | | - Timothée Lenglet
- Department of Neurophysiology, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | | | - François Salachas
- Referral Center for ALS, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Emilien Bernard
- Service des pathologies neuromusculaires et du motoneurone, Hospices Civils de Lyon, France
| | - Stéphanie Delstanche
- University of Liège, Centre Hospitalier Régional de la Citadelle, Department of Neurology, Liège, Belgium
| | | | - Nathalie Guy
- CRC SLA et maladie du neurone moteur, U1107-neurodol-UCA, CHU de Clermont-Ferrand, France
| | - Véronique Danel
- University of Lille, Expert center for ALS, CHU-Lille, Lille Neuroscience & Cognition, INSERM, UMR-S1172, LICEND, ACT4ALS-MND network, France
| | - Arnaud Delval
- Department of Clinical Neurophysiology, CHU-Lille, U1172 Lille Neuroscience & Cognition, University of Lille, France
| | - Emilien Delmont
- APHM, Timone University Hospital, Referral Center for Neuromuscular Diseases and ALS, ERN Euro-NMD Center, Marseille, France
| | - Anne-Sophie Rolland
- University of Lille, Expert center for ALS, CHU-Lille, Lille Neuroscience & Cognition, INSERM, UMR-S1172, LICEND, ACT4ALS-MND network, France
| | | | - Laurent Jomir
- Service des pathologies neuromusculaires et du motoneurone, Hospices Civils de Lyon, France
| | - David Devos
- University of Lille, Expert center for ALS, CHU-Lille, Lille Neuroscience & Cognition, INSERM, UMR-S1172, LICEND, ACT4ALS-MND network, France
| | - François Wang
- CHU de Liège, Department of Clinical Neurophysiology, Liège, Belgium
| | - Shahram Attarian
- APHM, Timone University Hospital, Referral Center for Neuromuscular Diseases and ALS, ERN Euro-NMD Center, Marseille, France.
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14
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Geevasinga N, Van den Bos M, Menon P, Vucic S. Utility of Transcranial Magnetic Simulation in Studying Upper Motor Neuron Dysfunction in Amyotrophic Lateral Sclerosis. Brain Sci 2021; 11:brainsci11070906. [PMID: 34356140 PMCID: PMC8304017 DOI: 10.3390/brainsci11070906] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/01/2021] [Accepted: 07/05/2021] [Indexed: 11/16/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is characterised by progressive dysfunction of the upper and lower motor neurons. The disease can evolve over time from focal limb or bulbar onset to involvement of other regions. There is some clinical heterogeneity in ALS with various phenotypes of the disease described, from primary lateral sclerosis, progressive muscular atrophy and flail arm/leg phenotypes. Whilst the majority of ALS patients are sporadic in nature, recent advances have highlighted genetic forms of the disease. Given the close relationship between ALS and frontotemporal dementia, the importance of cortical dysfunction has gained prominence. Transcranial magnetic stimulation (TMS) is a noninvasive neurophysiological tool to explore the function of the motor cortex and thereby cortical excitability. In this review, we highlight the utility of TMS and explore cortical excitability in ALS diagnosis, pathogenesis and insights gained from genetic and variant forms of the disease.
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15
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Xu Y, Chen J, Zhang S, Fan D. Upper Motor Neuron Signs in the Cervical Region of Patients With Flail Arm Syndrome. Front Neurol 2021; 12:610786. [PMID: 33658977 PMCID: PMC7917109 DOI: 10.3389/fneur.2021.610786] [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: 09/28/2020] [Accepted: 01/27/2021] [Indexed: 11/30/2022] Open
Abstract
Objective: We investigated upper motor neuron (UMN) signs in the cervical region in a Chinese clinic-based cohort of patients with flail arm syndrome (FAS) by clinical examination and neurophysiological tests such as triple stimulation technique (TST) and pectoralis tendon reflex testing. Methods: A total of 130 consecutive FAS patients from Peking University Third Hospital underwent physical examination and neurophysiological tests at baseline and 3 months, 6 months, 9 months, and 12 months later. Pyramidal signs, pectoralis tendon reflex and TST results were evaluated to estimate the function of cervical spinal UMNs. Results: At the first visit, weakness of the bilateral proximal upper limbs was found in 99 patients, while weakness of a single proximal upper limb was found in 31 patients. There were 49 patients with tendon hyperreflexia, 42 patients with tendon hyporeflexia and 39 patients with tendon areflexia. All except 4 of the patients had brisk pectoralis tendon reflex. The UMN score of the cervical region was 1.7 ± 0.4, and the lower motor neuron score of that region was 3.5 ± 0.3. The TSTtest/TSTcontrol amplitude ratio was 65.7 ± 7.5%. The latency of quantitative detection of the pectoralis tendon reflex was 7.7 ± 1.2 ms. In the follow-up study, the UMN score and the TSTtest/TSTcontrol amplitude ratio decreased, while the lower motor neuron score increased, and the latency of quantitative detection of the pectoralis tendon reflex remained steady. Conclusion: Although the signs of cervical spinal UMN dysfunction in patients with FAS were often concealed by muscle atrophy in the progression of the disease, TST and pectoralis tendon reflex could reveal it.
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Affiliation(s)
- Yingsheng Xu
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Junyi Chen
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Shuo Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Dongsheng Fan
- Department of Neurology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Peking University Third Hospital, Beijing, China
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16
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Xu D, Ding Q, Wang H. Corticospinal Tract Impairment of Patients With Parkinson’s Disease: Triple Stimulation Technique Findings. Front Aging Neurosci 2020; 12:588085. [PMID: 33328966 PMCID: PMC7673408 DOI: 10.3389/fnagi.2020.588085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/09/2020] [Indexed: 11/13/2022] Open
Abstract
Background Methods Results Conclusion
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17
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Caranzano L, Stephan MA, Bedulli M, Herrmann FR, Benninger DH. Peripheral stimulation affects subthreshold Triple Stimulation Technique. J Neurosci Methods 2020; 347:108959. [PMID: 33002507 DOI: 10.1016/j.jneumeth.2020.108959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 08/27/2020] [Accepted: 09/23/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Compared to conventional transcranial magnetic stimulation (TMS), the triple stimulation technique (TST) strongly decrease the effects of desynchronization of descending discharges and accompanying phase cancellation that follow TMS and offers a more sensitive method to quantify motor evoked potentials (MEPs). NEW METHOD Using the TST, we explored as to whether sub-threshold TMS evokes peripheral motor neuron discharges (MNs). We compared the number of MEPs elicited by TMS and by TST in fifteen healthy participants. We used the subthreshold intensity of 80 % resting motor threshold. To control the TST assessment of the corticospinal tract, we included a peripheral stimulation control condition, which consisted of peripheral stimulation alone, in a subgroup of five volunteers. RESULTS Compared to TMS, TST at sub-threshold intensities did not detect significantly more responses unequivocally attributable to the cortical stimulation. In contrast, the peripheral supra-maximal stimuli produced confounding effects in the TST condition that were, in part, indistinguishable from cortical responses. COMPARISON WITH EXISTING METHODS At subthreshold TMS intensities, the TST does not detect more discharges of spinal MNs than conventional TMS and, in addition, it is confounded by effects from peripheral stimulation. CONCLUSION The TST can be useful in assessing the integrity of the MN pool and of the corticospinal tract. However, if used at near threshold intensity, the confounding effects of peripheral stimulation need to be considered; for instance, in paired-pulse stimulation paradigms assessing the cortical physiology.
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Affiliation(s)
- L Caranzano
- Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Faculté de Biologie et de Médecine, Doctoral School, Université de Lausanne, Lausanne, Switzerland.
| | - M A Stephan
- Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
| | - M Bedulli
- Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
| | - F R Herrmann
- Division of Geriatrics, Department of Rehabilitation and Geriatrics, University Hospitals and University of Geneva, Geneva, Switzerland.
| | - D H Benninger
- Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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18
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Zhao C, Lange DJ, Wymer JP. Management of Primary Lateral Sclerosis. Curr Treat Options Neurol 2020. [DOI: 10.1007/s11940-020-00640-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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19
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Electrodiagnosis of Amyotrophic Lateral Sclerosis: A Review of Existing Guidelines. J Clin Neurophysiol 2020; 37:294-298. [DOI: 10.1097/wnp.0000000000000682] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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20
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Bashir S, Ahmad S, Alatefi M, Hamza A, Sharaf M, Fecteau S, Yoo WK. Effects of anodal transcranial direct current stimulation on motor evoked potentials variability in humans. Physiol Rep 2020; 7:e14087. [PMID: 31301123 PMCID: PMC6640590 DOI: 10.14814/phy2.14087] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 12/24/2022] Open
Abstract
Motor evoked potentials (MEPs) obtained from transcranial magnetic stimulation (TMS) allow corticospinal excitability (CSE) to be measured in the human primary motor cortex (M1). CSE responses to transcranial direct current stimulation (tDCS) protocols are highly variable. Here, we tested the reproducibility and reliability of individual MEPs following a common anodal tDCS protocol. In this study, 32 healthy subjects received anodal tDCS stimulation over the left M1 for three durations (tDCS‐T5, tDCS‐T10, and tDCS‐T20 min) on separate days in a crossover‐randomized order. After the resting motor threshold (RMT) was determined for the contralateral first dorsal interosseous muscle, 15 single pulses 4–8 sec apart at an intensity of 120% RMT were delivered to the left M1 to determine the baseline MEP amplitude at T0, T5, T10, T20, T30, T40, T50, and T60 min after stimulation for each durations. During TMS delivery, 3D images of the participant's cortex and hot spot were visualized for obtaining MEPs from same position. Our findings revealed that there was a significant MEPs improvement at T0 (P = 0.01) after 10 min of anodal stimulation. After the 20‐min stimulation duration, MEPs differed specifically at T0, T5, T30 min (P < 0.05). This indicates that tDCS is a promising tool to improve MEPs. Our observed variability in response to the tDCS protocol is consistent with other noninvasive brain stimulation studies.
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Affiliation(s)
- Shahid Bashir
- Neuroscience Center, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
| | - Shafiq Ahmad
- Department of Industrial Engineering, College of Engineering, King Saud University, Riyadh, Saudi Arabia
| | - Moath Alatefi
- Department of Industrial Engineering, College of Engineering, King Saud University, Riyadh, Saudi Arabia
| | - Ali Hamza
- Department of Electrical Engineering, National University of Computer and Emerging Sciences, Lahore, Pakistan
| | - Mohamed Sharaf
- Department of Industrial Engineering, College of Engineering, King Saud University, Riyadh, Saudi Arabia
| | | | - Woo Kyoung Yoo
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Anyang, South Korea.,Hallym Institute for Translational Genomics & Bioinformatics, Hallym University Sacred Heart Hospital, Anyang, South Korea
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21
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Bashir S, Aisha D, Hamza A, Al-Hussain F, Yoo WK. Effects of transcranial direct current stimulation on cortex modulation by stimulation of the primary motor cortex and parietal cortex in humans. Int J Neurosci 2020; 131:1107-1114. [PMID: 32462947 DOI: 10.1080/00207454.2020.1775594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AIM OF THE STUDY Transcranial magnetic stimulation (TMS) is used to measure corticospinal excitability (CSE) from the primary motor cortex (M1) in humans through motor-evoked potentials (MEPs). The variability of CSE responses to transcranial direct current stimulation (tDCS) protocols is high and needs to be reproduced in the healthy population. The M1 and posterior parietal cortex (PPC) are anatomically and functionally connected and could play a role in understanding the variability in CSE responses. We tested the individual MEPs following a common cathodal (ctDCS) protocol over the M1 and PPC. MATERIALS AND METHODS Twenty-eight healthy subjects were randomized for a ctDCS stimulation over the left M1 and PPC for 20 min on a separate days. The first dorsal interosseous muscle (FDI) contralateral stimulation of the left M1 was used as the resting motor threshold (RMT), while 15 single pulses 4-8 s apart at an intensity of 120% RMT were used to determine the baseline MEP amplitude and at T0, 5, 10, 20, 30, 40, 50, and 60 min after ctDCS stimulation in both sessions. RESULTS A 20 min duration of ctDCS stimulation significantly deceased the CSE only at T0 (p = 0.046 at M1, p = 0.010 at PPC). CONCLUSION Our results suggested that PPC stimulation can modulate M1 excitability and PPC-M1 connectivity, but a significant effect is only observed immediately post ctDCS. The tDCS showed variability in response to the tDCS protocol is consistent with other non-invasive brain stimulation studies.
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Affiliation(s)
- Shahid Bashir
- Neuroscience Center, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
| | - Dowihi Aisha
- Neuroscience Center, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
| | - Ali Hamza
- Department of Electrical Engineering, National University of Computer and Emerging Sciences, Lahore, Pakistan
| | - Fawaz Al-Hussain
- Division of Neurology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Woo-Kyoung Yoo
- Department of Physical Medicine and Rehabilitation, Hallym University College of Medicine, Anyang, South Korea.,Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
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Oguz Akarsu E, Sirin NG, Kocasoy Orhan E, Erbas B, Dede HO, Baslo MB, Idrisoglu HA, Oge AE. Repeater F-waves in amyotrophic lateral sclerosis: Electrophysiologic indicators of upper or lower motor neuron involvement? Clin Neurophysiol 2019; 131:96-105. [PMID: 31760213 DOI: 10.1016/j.clinph.2019.09.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 09/08/2019] [Accepted: 09/25/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To extract insight about the mechanism of repeater F-waves (Frep) by exploring their correlation with electrophysiologic markers of upper and lower motor neuron dysfunction in amyotrophic lateral sclerosis (ALS). METHODS The correlations of Frep parameters with clinical scores and the results of neurophysiological index (NI), MScanfit MUNE, F/M amplitude ratio (F/M%), single and paired-pulse transcranial magnetic stimulation (TMS), and triple stimulation technique (TST) studies, recorded from abductor digiti minimi (ADM) and abductor pollicis brevis (APB) muscles of 35 patients with ALS were investigated. RESULTS Frep parameters were correlated with NI and MScanfit MUNE in ADM muscle and F/M% in both muscles. None of the Frep parameters were correlated with clinical scores or TST and TMS measures. While the CMAP amplitudes were similar in the two recording muscles, there was a more pronounced decrease of F-wave persistence in APB, probably heralding the subsequent split hand phenomenon. CONCLUSION Our findings suggest that the presence and density of Freps are primarily related to the degree of lower motor neuron loss and show no correlation with any of the relatively extensive set of parameters for upper motor neuron dysfunction. SIGNIFICANCE Freps are primarily related to lower motor neuron loss in ALS.
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Affiliation(s)
- Emel Oguz Akarsu
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey.
| | - Nermin Gorkem Sirin
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Elif Kocasoy Orhan
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Bahar Erbas
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey; Demiroglu Bilim University, Faculty of Medicine, Department of Pharmacology, Istanbul, Turkey
| | - Hava Ozlem Dede
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Mehmet Baris Baslo
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Halil Atilla Idrisoglu
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Ali Emre Oge
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
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Franques J. [Chronic inflammatory demyelinating polyneuropathy: Diagnosis and therapeutic update]. Rev Med Interne 2019; 40:808-815. [PMID: 31677862 DOI: 10.1016/j.revmed.2019.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 06/19/2019] [Accepted: 07/17/2019] [Indexed: 10/25/2022]
Abstract
Chronic inflammatory demyelinating polyradiculoneuropathies are acquired demyelinating neuropathies belonging to the group of autoimmune neuropathies. Since specific biological markers are present in less than 10% of cases, the diagnosis is based on the clinical and electrophysiological analysis of each patient. Furthermore, a decision-making algorithm ranking all other available paraclinical tools will guide the physician to the diagnosis of atypical forms. In nearly 80% of cases, these dysimmune neuropathies are responsive to first-line treatments, namely intravenous immunoglobulins, corticosteroids and plasma exchanges. A second line treatment may be proposed in case of no response, intolerance or inaccessibility to the three reference treatments. While some immunosuppressants or monoclonal antibodies can sometimes be very effective, there is currently no predictive marker or recommendation available to determine which treatment will be most appropriate for which patient.
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Affiliation(s)
- J Franques
- Hôpital européen, 6, rue Désirée-Clary, 13003 Marseille, France; Hôpital La Casamance, 33, boulevard des Farigoules, 13400 Aubagne, France.
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24
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Snow NJ, Wadden KP, Chaves AR, Ploughman M. Transcranial Magnetic Stimulation as a Potential Biomarker in Multiple Sclerosis: A Systematic Review with Recommendations for Future Research. Neural Plast 2019; 2019:6430596. [PMID: 31636661 PMCID: PMC6766108 DOI: 10.1155/2019/6430596] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 08/31/2019] [Indexed: 12/23/2022] Open
Abstract
Multiple sclerosis (MS) is a demyelinating disorder of the central nervous system. Disease progression is variable and unpredictable, warranting the development of biomarkers of disease status. Transcranial magnetic stimulation (TMS) is a noninvasive method used to study the human motor system, which has shown potential in MS research. However, few reviews have summarized the use of TMS combined with clinical measures of MS and no work has comprehensively assessed study quality. This review explored the viability of TMS as a biomarker in studies of MS examining disease severity, cognitive impairment, motor impairment, or fatigue. Methodological quality and risk of bias were evaluated in studies meeting selection criteria. After screening 1603 records, 30 were included for review. All studies showed high risk of bias, attributed largely to issues surrounding sample size justification, experimenter blinding, and failure to account for key potential confounding variables. Central motor conduction time and motor-evoked potentials were the most commonly used TMS techniques and showed relationships with disease severity, motor impairment, and fatigue. Short-latency afferent inhibition was the only outcome related to cognitive impairment. Although there is insufficient evidence for TMS in clinical assessments of MS, this review serves as a template to inform future research.
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Affiliation(s)
- Nicholas J. Snow
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Katie P. Wadden
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Arthur R. Chaves
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Michelle Ploughman
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
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Abstract
PURPOSE To identify upper motor neuron (UMN) dysfunction using the triple stimulation technique (TST) in amyotrophic lateral sclerosis (ALS). METHODS Fifty ALS and 42 non-ALS patients were examined clinically, using conventional transcranial magnetic stimulation and TST. RESULTS For ALS patients presenting with UMN in tested limb, the TST amplitude ratio was abnormal in 25 of 28 patients (89.3%). For ALS patients without UMN signs, 6 of 22 patients (27.3%) had an abnormal TST ratio. When clinical signs were not present, both abnormal resting motor threshold and TST indicated a UMN involvement. In non-ALS patients with central motor conduction disorders, the percentage of patients with an abnormal TST was higher for those presenting with clinical UMN signs (9/12, 75.0%) than for those without these signs (1/8, 12.5%). CONCLUSIONS Triple stimulation technique appears to be an accurate, early measure for detecting clinical and subclinical UMN abnormalities in ALS. Triple stimulation technique could also be useful to investigate central motor conduction abnormalities in other disorders.
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26
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Chouteau R, Combès B, Bannier E, Snoussi H, Ferré JC, Barillot C, Edan G, Sauleau P, Kerbrat A. Joint assessment of brain and spinal cord motor tract damage in patients with early RRMS: predominant impact of spinal cord lesions on motor function. J Neurol 2019; 266:2294-2303. [PMID: 31175433 DOI: 10.1007/s00415-019-09419-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/30/2019] [Accepted: 06/01/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND In patients with MS, the effect of structural damage to the corticospinal tract (CST) has been separately evaluated in the brain and spinal cord (SC), even though a cumulative impact is suspected. OBJECTIVE To evaluate CST damages on both the cortex and cervical SC, and examine their relative associations with motor function, measured both clinically and by electrophysiology. METHODS We included 43 patients with early relapsing-remitting MS. Lesions were manually segmented on SC (axial T2*) and brain (3D FLAIR) scans. The CST was automatically segmented using an atlas (SC) or tractography (brain). Lesion volume fractions and diffusion parameters were calculated for SC, brain and CST. Central motor conduction time (CMCT) and triple stimulation technique amplitude ratio were measured for 42 upper limbs, from 22 patients. RESULTS Mean lesion volume fractions were 5.2% in the SC portion of the CST and 0.9% in the brain portion. We did not find a significant correlation between brain and SC lesion volume fraction (r = 0.06, p = 0.68). The pyramidal EDSS score and CMCT were both significantly correlated with the lesion fraction in the SC CST (r = 0.39, p = 0.01 and r = 0.33, p = 0.03), but not in the brain CST. CONCLUSION Our results highlight the major contribution of SC lesions to CST damage and motor function abnormalities.
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Affiliation(s)
- Raphaël Chouteau
- Neurology Department, CHU Rennes, Rennes, France.,Univ Rennes, CHU Rennes, CNRS, Inria, Inserm, IRISA UMR 6074, VISAGES (Vision, Action Et Gestion Des Informations en santé), ERL U 1228, 35000, Rennes, France
| | - Benoit Combès
- Univ Rennes, CHU Rennes, CNRS, Inria, Inserm, IRISA UMR 6074, VISAGES (Vision, Action Et Gestion Des Informations en santé), ERL U 1228, 35000, Rennes, France
| | - Elise Bannier
- Univ Rennes, CHU Rennes, CNRS, Inria, Inserm, IRISA UMR 6074, VISAGES (Vision, Action Et Gestion Des Informations en santé), ERL U 1228, 35000, Rennes, France.,Radiology Department, CHU Rennes, Rennes, France
| | - Haykel Snoussi
- Univ Rennes, CHU Rennes, CNRS, Inria, Inserm, IRISA UMR 6074, VISAGES (Vision, Action Et Gestion Des Informations en santé), ERL U 1228, 35000, Rennes, France
| | - Jean-Christophe Ferré
- Univ Rennes, CHU Rennes, CNRS, Inria, Inserm, IRISA UMR 6074, VISAGES (Vision, Action Et Gestion Des Informations en santé), ERL U 1228, 35000, Rennes, France.,Radiology Department, CHU Rennes, Rennes, France
| | - Christian Barillot
- Univ Rennes, CHU Rennes, CNRS, Inria, Inserm, IRISA UMR 6074, VISAGES (Vision, Action Et Gestion Des Informations en santé), ERL U 1228, 35000, Rennes, France
| | - Gilles Edan
- Neurology Department, CHU Rennes, Rennes, France.,Univ Rennes, CHU Rennes, CNRS, Inria, Inserm, IRISA UMR 6074, VISAGES (Vision, Action Et Gestion Des Informations en santé), ERL U 1228, 35000, Rennes, France.,Plurithematic Clinical Investigation Center (CIC-P 1414), INSERM, Rennes, France
| | - Paul Sauleau
- Neurophysiology Department, CHU Rennes, Rennes, France.,Behavior and Basal Ganglia Research Unit (EA4712), Rennes 1 University, Rennes, France
| | - Anne Kerbrat
- Neurology Department, CHU Rennes, Rennes, France. .,Univ Rennes, CHU Rennes, CNRS, Inria, Inserm, IRISA UMR 6074, VISAGES (Vision, Action Et Gestion Des Informations en santé), ERL U 1228, 35000, Rennes, France.
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Giffroy X, Dive D, Kaux JF, Maes N, Albert A, Göbels C, Wang F. Is the triple stimulation technique a better quantification tool of motor dysfunction than motor evoked potentials in multiple sclerosis? Acta Neurol Belg 2019; 119:47-54. [PMID: 30136146 DOI: 10.1007/s13760-018-1001-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/13/2018] [Indexed: 01/07/2023]
Abstract
The triple stimulation technique (TST) was rarely used in multiple sclerosis (MS). This study aimed to compare TST and motor evoked potentials (MEP) for the quantification of motor dysfunction. Central motor conduction based on MEP (four limbs) and TST (upper limbs) was assessed in 28 MS patients with a median Expanded Disability Status Scale (EDSS) of 4. EDSS, timed 25-foot walk (T25FW), grasping strength and motor components of the MS functional composite were evaluated. Regression analysis was used to assess the relationship between MEP, TST and clinical findings. TST was negatively correlated with EDSS (r = - 0.74, p < 0.0001) and to a lesser extent with T25FW (r = - 0.47, p < 0.05), and grasping strength (r = - 0.43, p < 0.05). A multiple regression analysis underlined the better correlation between clinical data and TST (R2 = 0.56, p < 0.0005) than with MEP (0.03 < R2 < 0.22, p > 0.05). This study evidenced the value of TST as a quantification tool of motor dysfunction. TST appeared to reflect a global disability since it was correlated not only to hand function but also to walking capacity.
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28
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Cao D, Guo X, Yuan T, Hao J. Diagnosing chronic inflammatory demyelinating polyradiculoneuropathy with triple stimulation technique. J Neurol 2018; 265:1916-1921. [PMID: 29926221 DOI: 10.1007/s00415-018-8929-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 06/04/2018] [Accepted: 06/05/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the value of triple stimulation technique (TST) for diagnose of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). METHODS Seven clinically suspected CIDP patients who did not fulfill EFNS/PNS electrodiagnostic criteria for demyelinating neuropathy were enrolled in our study. Routine nerve conduction studies, lumbar puncture, spinal cord magnetic resonance imaging and TST were detected. The patients were being treated with oral prednisone starting at 1 mg/kg daily. The overall disability sum score was performed to evaluate the effect of corticosteroids. RESULTS Twenty-eight motor nerves were tested with TST, two conduction blocks (CBs) were detected between the root emergence and the Erb point in six patients respectively and one CB was detected in one patient. Symptoms of all seven patients improved after treatment with oral prednisone. CONCLUSION TST can detect CBs located between the root emergence and the Erb point. TST is useful for early diagnosis of CIDP.
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Affiliation(s)
- Du Cao
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Friendship Road, Yuanjiagang, Yuzhong District, Chongqing, 400016, China
| | - Xiuming Guo
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Friendship Road, Yuanjiagang, Yuzhong District, Chongqing, 400016, China.
| | - Ting Yuan
- Department of Neurology, 363 Hospital, Chengdu, China
| | - Jie Hao
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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29
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Rodríguez-Labrada R, Velázquez-Pérez L, Ziemann U. Transcranial magnetic stimulation in hereditary ataxias: Diagnostic utility, pathophysiological insight and treatment. Clin Neurophysiol 2018; 129:1688-1698. [PMID: 29940480 DOI: 10.1016/j.clinph.2018.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 05/10/2018] [Accepted: 06/04/2018] [Indexed: 12/28/2022]
Abstract
Transcranial magnetic stimulation (TMS) is a valuable technique to assess and modulate human brain function in normal and pathological conditions. This critical review surveys the contributions of TMS to the diagnosis, insight into pathophysiology and treatment of genetically confirmed hereditary ataxias, a heterogeneous group of neurodegenerative disorders that can affect motor cortex and the corticospinal tract. Most studies were conducted on small sample sizes and focused on diagnostic approaches. The available data demonstrate early involvement of the corticospinal tract and motor cortex circuitry, and support the possible efficacy of cerebellar repetitive TMS (rTMS) as therapeutic approach. Further TMS-based studies are warranted, to establish biomarkers for early diagnosis and disease monitoring, explore the involvement of the cerebello-dentato-thalamo-cortical projection, study the effects of rTMS-induced plasticity, and utilize rTMS for treatment.
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Affiliation(s)
- Roberto Rodríguez-Labrada
- Centre for the Research and Rehabilitation of Hereditary Ataxias, Holguín, Cuba; School of Physical Culture and Sport, University of Holguin, Holguin, Cuba
| | - Luis Velázquez-Pérez
- Centre for the Research and Rehabilitation of Hereditary Ataxias, Holguín, Cuba; School of Physical Culture and Sport, University of Holguin, Holguin, Cuba; Cuban Academy of Science, Havana, Cuba.
| | - Ulf Ziemann
- Department of Neurology & Stroke, and Hertie Institute for Clinical Brain Research, University Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany.
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30
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Scheidegger O, Kamber N, Rösler KM. Estimation of voluntary elicited motor neuron discharge using a peripheral nerve collision technique at different contraction strengths. Clin Neurophysiol 2018; 129:1579-1587. [PMID: 29885647 DOI: 10.1016/j.clinph.2018.04.751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/24/2018] [Accepted: 04/25/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate non-invasively the amount, recruitment pattern and discharge frequency of spinal motor neurons (MN) at contraction strength >20% of maximal voluntary contraction (MVC) of small hand muscles. METHODS A peripheral collision technique was used and consisted of supramaximal electrical stimuli at Erb's point and at the wrist, synchronizing descending volleys of action potential during voluntary isometric contractions of the abductor digiti minimi muscle at 20-80% of MVC strength and 1-8 s of contraction duration. Responses of 13 healthy volunteers were quantified and analysed using a recently described model of MN behaviour. RESULTS A linear relationship between MN discharge and force generation was noticed with R2 = 0.996, and was confirmed using the simulation results (R2 = 0.997) for contraction durations up to 8 s. For each investigated force level, discharge frequency and recruitment pattern were calculated for individual MN. CONCLUSIONS Using this method, MN discharge properties during voluntary activity can be estimated non-invasively. SIGNIFICANCE This method provides new opportunities for the non-invasive study of MN behaviour, and could be expanded to patients with conduction failure and during fatigue.
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Affiliation(s)
- Olivier Scheidegger
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland.
| | - Nicole Kamber
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Kai Michael Rösler
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
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31
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Li C, Liu F, Peng H, Huang Y, Song X, Xie Q, Li Y, Liu Y. The positive effect of venlafaxine on central motor conduction. Clin Neurol Neurosurg 2018; 167:65-69. [PMID: 29454182 DOI: 10.1016/j.clineuro.2018.02.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/02/2018] [Accepted: 02/11/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Using the triple stimulation technique (TST) and conventional transcranial magnetic stimulation (TMS), this study was designed to investigate the effect of venlafaxine on central motor conduction in healthy adults. PATIENTS AND METHODS In this crossover, self-controlled trial, eight healthy adult volunteers were randomly divided into groups A and B. In group A, the volunteers were administered 1 venlafaxine capsule once daily for 7 consecutive days, followed by a 3-day break. Next, volunteers in this group received 1 placebo capsule once daily for 7 consecutive days. Group B received the treatments in the opposite order. The index finger tapping test, grip strength test, TST and conventional TMS examination for each hand were recorded before and one week after the administration of venlafaxine or placebo. RESULTS Compared to the placebo stage, in the venlafaxine stage, the number of index finger taps was significantly increased for both hands, and the TST amplitude and area ratios were significantly increased. The improvement in the TST amplitude ratio was significantly and positively correlated with the improvements in performance on the index finger tapping test. CONCLUSION Venlafaxine positively regulates central motor conduction in healthy adults.
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Affiliation(s)
- Chunyong Li
- Dept. Cerebral Vascular Disease, The General Hospital of Guangzhou Military Command of PLA, No. 111, Liuhua Avenue, Yuexiu District, Guangzhou, 510010, PR China.
| | - Fuda Liu
- Area 2, Department of Neurology, Jiangmen Central Hospital, No.23, Haibang Street, Beijie, Jiangmen City, Guangdong Province, PR China.
| | - Haiyan Peng
- Dept. Neurology, The General Hospital of Guangzhou Military Command of PLA, No.111, Liuhua Avenue, Yuexiu District, Guangzhou, 510010, PR China.
| | - Yongjun Huang
- Dept. Neurology, The General Hospital of Guangzhou Military Command of PLA, No.111, Liuhua Avenue, Yuexiu District, Guangzhou, 510010, PR China.
| | - Xuezhu Song
- Dept. of Neurology, Shunde Guizhou Hospital, Fushan, Guangdong, PR China.
| | - Qi Xie
- Dept. of Rehabilitation Medicine, The General Hospital of Guangzhou Military Command of PLA, No.111, Liuhua Avenue, Yuexiu, Guangzhou, 510010, PR China.
| | - Yingkai Li
- Dept. of Neurology, The Second People's Hospital of Zhuhai, No. 208, Yuehua Avenue, Zhuhai, Guangdong Province, 510260, PR China.
| | - Yan Liu
- Dept. Cerebral Vascular Disease, The General Hospital of Guangzhou Military Command of PLA, No. 111, Liuhua Avenue, Yuexiu District, Guangzhou, 510010, PR China.
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32
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Sevy A, Grapperon AM, Salort Campana E, Delmont E, Attarian S. Detection of proximal conduction blocks using a triple stimulation technique improves the early diagnosis of Guillain-Barré syndrome. Clin Neurophysiol 2017; 129:127-132. [PMID: 29182914 DOI: 10.1016/j.clinph.2017.10.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 10/05/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Current diagnostic electrophysiological criteria can miss the early stages of Guillain-Barré syndrome (GBS). We evaluated the diagnostic efficiency of the triple stimulation technique (TST) in highlighting proximal conduction blocks (CBs) in patients who do not meet the electrophysiological criteria for GBS. METHODS All patients with a diagnosis of clinical GBS referred to our center between September 2014 and January 2016 were included in the study. For patients who did not fulfill the electrophysiological criteria of GBS, we performed the TST examination. RESULTS Among the 44 included patients, 86% fulfilled the electrophysiological criteria of GBS during the initial nerve conduction study (NCS). The six remaining patients had proximal CBs revealed by TST examination. Therefore, a combination of a conventional NCS and the TST allowed 100% of the patients to be electrophysiologically diagnosed. CONCLUSIONS TST is useful for the diagnosis of GBS in association with NCS, particularly in the early stages of the disease. SIGNIFICANCE TST is a useful tool for GBS diagnosis at the early stages of the disease.
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Affiliation(s)
- Amandine Sevy
- Reference Center for Neuromuscular Diseases and ALS, La Timone University Hospital, Aix-Marseille University, France; Aix Marseille University, INSERM, GMGF, Marseille, France
| | - Aude-Marie Grapperon
- Reference Center for Neuromuscular Diseases and ALS, La Timone University Hospital, Aix-Marseille University, France
| | - Emmanuelle Salort Campana
- Reference Center for Neuromuscular Diseases and ALS, La Timone University Hospital, Aix-Marseille University, France
| | - Emilien Delmont
- Reference Center for Neuromuscular Diseases and ALS, La Timone University Hospital, Aix-Marseille University, France; Aix-Marseille University, UMR 7286, Marseille, France
| | - Shahram Attarian
- Reference Center for Neuromuscular Diseases and ALS, La Timone University Hospital, Aix-Marseille University, France; Aix Marseille University, INSERM, GMGF, Marseille, France.
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Hassanlouei H, Sundberg CW, Smith AE, Kuplic A, Hunter SK. Physical activity modulates corticospinal excitability of the lower limb in young and old adults. J Appl Physiol (1985) 2017; 123:364-374. [PMID: 28495848 PMCID: PMC5614787 DOI: 10.1152/japplphysiol.01078.2016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 04/11/2017] [Accepted: 05/04/2017] [Indexed: 11/22/2022] Open
Abstract
Aging is associated with reduced neuromuscular function, which may be due in part to altered corticospinal excitability. Regular physical activity (PA) may ameliorate these age-related declines, but the influence of PA on corticospinal excitability is unknown. The purpose of this study was to determine the influence of age, sex, and PA on corticospinal excitability by comparing the stimulus-response curves of motor evoked potentials (MEP) in 28 young (22.4 ± 2.2 yr; 14 women and 14 men) and 50 old adults (70.2 ± 6.1 yr; 22 women and 28 men) who varied in activity levels. Transcranial magnetic stimulation was used to elicit MEPs in the active vastus lateralis muscle (10% maximal voluntary contraction) with 5% increments in stimulator intensity until the maximum MEP amplitude. Stimulus-response curves of MEP amplitudes were fit with a four-parameter sigmoidal curve and the maximal slope calculated (slopemax). Habitual PA was assessed with tri-axial accelerometry and participants categorized into either those meeting the recommended PA guidelines for optimal health benefits (>10,000 steps/day, high-PA; n = 21) or those not meeting the guidelines (<10,000 steps/day, low-PA; n = 41). The MEP amplitudes and slopemax were greater in the low-PA compared with the high-PA group (P < 0.05). Neither age nor sex influenced the stimulus-response curve parameters (P > 0.05), suggesting that habitual PA influenced the excitability of the corticospinal tract projecting to the lower limb similarly in both young and old adults. These findings provide evidence that achieving the recommended PA guidelines for optimal health may mediate its effects on the nervous system by decreasing corticospinal excitability.NEW & NOTEWORTHY Transcranial magnetic stimulation was used to determine whether achieving the recommended 10,000 steps/day for optimal health influenced the excitability of the corticospinal tract projecting to the knee extensor muscles. Irrespective of age and sex, individuals who achieved >10,000 steps/day had lower corticospinal excitability than those who performed <10,000 steps/day, possibly representing greater control of inhibitory and excitatory networks. Physical activity involving >10,000 steps/day may mediate its effects on the nervous system by decreasing corticospinal excitability.
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Affiliation(s)
- Hamidollah Hassanlouei
- Exercise Science Program, Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin
| | - Christopher W Sundberg
- Exercise Science Program, Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin
- Clinical and Translational Rehabilitation Health Sciences Program, Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin; and
| | - Ashleigh E Smith
- Alliance for Research in Exercise Nutrition and Activity, Sansom Institute for Health Research, School of Health Science, University of South Australia, Adelaide, South Australia, Australia
| | - Andrew Kuplic
- Exercise Science Program, Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin
- Clinical and Translational Rehabilitation Health Sciences Program, Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin; and
| | - Sandra K Hunter
- Exercise Science Program, Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin;
- Clinical and Translational Rehabilitation Health Sciences Program, Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin; and
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34
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Goetz SM, Deng ZD. The development and modelling of devices and paradigms for transcranial magnetic stimulation. Int Rev Psychiatry 2017; 29:115-145. [PMID: 28443696 PMCID: PMC5484089 DOI: 10.1080/09540261.2017.1305949] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 03/03/2017] [Accepted: 03/09/2017] [Indexed: 12/20/2022]
Abstract
Magnetic stimulation is a non-invasive neurostimulation technique that can evoke action potentials and modulate neural circuits through induced electric fields. Biophysical models of magnetic stimulation have become a major driver for technological developments and the understanding of the mechanisms of magnetic neurostimulation and neuromodulation. Major technological developments involve stimulation coils with different spatial characteristics and pulse sources to control the pulse waveform. While early technological developments were the result of manual design and invention processes, there is a trend in both stimulation coil and pulse source design to mathematically optimize parameters with the help of computational models. To date, macroscopically highly realistic spatial models of the brain, as well as peripheral targets, and user-friendly software packages enable researchers and practitioners to simulate the treatment-specific and induced electric field distribution in the brains of individual subjects and patients. Neuron models further introduce the microscopic level of neural activation to understand the influence of activation dynamics in response to different pulse shapes. A number of models that were designed for online calibration to extract otherwise covert information and biomarkers from the neural system recently form a third branch of modelling.
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Affiliation(s)
- Stefan M Goetz
- a Department of Psychiatry & Behavioral Sciences, Division for Brain Stimulation & Neurophysiology , Duke University , Durham , NC , USA
- b Department of Electrical & Computer Engineering , Duke University , Durham , NC , USA
- c Department of Neurosurgery , Duke University , Durham , NC , USA
| | - Zhi-De Deng
- a Department of Psychiatry & Behavioral Sciences, Division for Brain Stimulation & Neurophysiology , Duke University , Durham , NC , USA
- d Intramural Research Program, Experimental Therapeutics & Pathophysiology Branch, Noninvasive Neuromodulation Unit , National Institutes of Health, National Institute of Mental Health , Bethesda , MD , USA
- e Duke Institute for Brain Sciences , Duke University , Durham , NC , USA
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Do evoked potentials contribute to the functional follow-up and clinical prognosis of multiple sclerosis? Acta Neurol Belg 2017; 117:53-59. [PMID: 27194163 DOI: 10.1007/s13760-016-0650-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 05/10/2016] [Indexed: 10/21/2022]
Abstract
The clinical variability and complexity of multiple sclerosis (MS) challenges the individual clinical course prognostication. This study aimed to find out whether multimodal evoked potentials (EP) correlate with the motor components of multiple sclerosis functional composite (MSFCm) and predict clinically relevant motor functional deterioration. One hundred MS patients were assessed at baseline (T 0) and about 7.5 years later (T 1), with visual, somatosensory and motor EP and rated on the Expanded Disability Status Scale (EDSS) and the MSFCm, including the 9 Hole Peg Test and the Timed 25 Foot Walk (T25FW). The Spearman correlation coefficient (r S) was used to evaluate the cross-sectional and longitudinal relationship between EP Z scores and clinical findings. The predictive value of baseline electrophysiological data for clinical worsening (EDSS, 9-HPT, T25FW, MSFCm) during follow-up was assessed by logistic regression analysis. Unlike longitudinal correlations, cross-sectional correlations between EP Z scores and clinical outcomes were all significant and ranged between 0.22 and 0.67 (p < 0.05). The global EP Z score was systematically predictive of EDSS and MSFCm worsening over time (all p < 0.05). EP latency was a better predictor than amplitude, although weaker than latency and amplitude aggregation in the global EP Z score. The study demonstrates that EP numerical scores can be used for motor function monitoring and outcome prediction in patients with MS.
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Caranzano L, Stephan MA, Herrmann FR, Benninger DH. Desynchronization does not contribute to intracortical inhibition and facilitation: a paired-pulse paradigm study combined with TST. J Neurophysiol 2016; 117:1052-1056. [PMID: 27974446 DOI: 10.1152/jn.00381.2016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 12/13/2016] [Accepted: 12/13/2016] [Indexed: 12/14/2022] Open
Abstract
The paired-pulse (PP) transcranial magnetic stimulation (TMS) paradigms allow the exploration of the motor cortex physiology. The triple stimulation technique (TST) improves conventional TMS by reducing effects of desynchronization of motor neuron discharges allowing a precise evaluation of the corticospinal conduction. The objective of our study was to explore PP TMS paradigms combined with the TST to study whether the desynchronization contributes to these phenomena and whether the combined TMS-TST protocol could improve the consistency of responses. We investigated the PP paradigms of short intracortical inhibition (SICI) with 2 ms interstimulus interval (ISI) and of intracortical facilitation (ICF) with 10 ms ISI in 22 healthy subjects applying either conventional TMS alone or combined with the TST protocol. The results of the PP paradigms combined with the TST of SICI and ICF do not differ from those with conventional TMS. However, combining the PP paradigm with the TST reduces their variability. These results speak against a contribution of the desynchronization of motor neuron discharges to the PP paradigms of SICI and ICF. Combining the PP TMS paradigm with the TST may improve their consistency, but the interindividual variability remains such that it precludes their utility for clinical practice.NEW & NOTEWORTHY Combining the triple stimulation technique with the paired-pulse stimulation paradigm improves the consistency of short intracortical inhibition and facilitation and could be useful in research, but the interindividual variability precludes their utility for clinical practice. Our findings do not suggest that desynchronization of descending discharges following transcranial magnetic stimulation contributes to short intracortical inhibition or intracortical facilitation.
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Affiliation(s)
- L Caranzano
- Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.,Faculté de Biologie et de Médecine, Doctoral School, Université de Lausanne, Lausanne, Switzerland; and
| | - M A Stephan
- Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - F R Herrmann
- Division of Geriatrics, Department of Internal Medicine, Rehabilitation, and Geriatrics, University Hospitals and University of Geneva, Geneva, Switzerland
| | - D H Benninger
- Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland;
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New insights into the clinical neurophysiological assessment of ALS. Neurophysiol Clin 2016; 46:157-63. [PMID: 27364772 DOI: 10.1016/j.neucli.2016.05.070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 05/25/2016] [Accepted: 05/25/2016] [Indexed: 12/11/2022] Open
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Assessment of the upper motor neuron in amyotrophic lateral sclerosis. Clin Neurophysiol 2016; 127:2643-60. [PMID: 27291884 DOI: 10.1016/j.clinph.2016.04.025] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 04/22/2016] [Accepted: 04/27/2016] [Indexed: 02/07/2023]
Abstract
Clinical signs of upper motor neuron (UMN) involvement are an important component in supporting the diagnosis of amyotrophic lateral sclerosis (ALS), but are often not easily appreciated in a limb that is concurrently affected by muscle wasting and lower motor neuron degeneration, particularly in the early symptomatic stages of ALS. Whilst recent criteria have been proposed to facilitate improved detection of lower motor neuron impairment through electrophysiological features that have improved diagnostic sensitivity, assessment of upper motor neuron involvement remains essentially clinical. As a result, there is often a significant diagnostic delay that in turn may impact institution of disease-modifying therapy and access to other optimal patient management. Biomarkers of pathological UMN involvement are also required to ensure patients with suspected ALS have timely access to appropriate therapeutic trials. The present review provides an analysis of current and recently developed assessment techniques, including novel imaging and electrophysiological approaches used to study corticomotoneuronal pathology in ALS.
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Goldsworthy M, Hordacre B, Ridding M. Minimum number of trials required for within- and between-session reliability of TMS measures of corticospinal excitability. Neuroscience 2016; 320:205-9. [DOI: 10.1016/j.neuroscience.2016.02.012] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 02/02/2016] [Accepted: 02/02/2016] [Indexed: 11/30/2022]
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Feng JT, Zhu Y, Hua XY, Zhu Y, Gu YD, Xu JG, Xu WD. Diagnosing neurogenic thoracic outlet syndrome with the triple stimulation technique. Clin Neurophysiol 2016; 127:886-891. [DOI: 10.1016/j.clinph.2015.04.065] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 03/22/2015] [Accepted: 04/08/2015] [Indexed: 11/26/2022]
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41
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Simpson M, Macdonell R. The use of transcranial magnetic stimulation in diagnosis, prognostication and treatment evaluation in multiple sclerosis. Mult Scler Relat Disord 2015; 4:430-436. [PMID: 26346791 DOI: 10.1016/j.msard.2015.06.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 06/10/2015] [Accepted: 06/22/2015] [Indexed: 11/26/2022]
Abstract
Despite advances in brain imaging which have revolutionised the diagnosis and monitoring of patients with Multiple Sclerosis (MS), current imaging techniques have limitations, including poor correlation with clinical disability and prognosis. There is growing evidence that electrophysiological techniques may provide complementary functional information which can aid in diagnosis, prognostication and perhaps even monitoring of treatment response in patients with MS. Transcranial magnetic stimulation (TMS) is an underutilised technique with potential to assist diagnosis, predict prognosis and provide an objective surrogate marker of clinical progress and treatment response. This review explores the existing body of evidence relating to the use of TMS in patients with MS, outlines the practical aspects and scope of TMS testing and reviews the current evidence relating to the use of TMS in diagnosis, disease classification, prognostication and response to symptomatic and disease-modifying therapies.
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Affiliation(s)
- Marion Simpson
- Department of Neurology, Austin Health and Faculty of Medicine, The University of Melbourne, Melbourne, Vic, Australia.
| | - Richard Macdonell
- Department of Neurology, Austin Health and Faculty of Medicine, The University of Melbourne, Melbourne, Vic, Australia
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Matsumoto H, Ugawa Y. Conduction block in thoracic outlet syndrome? The need for motor root stimulation. Clin Neurophysiol 2015; 127:26-27. [PMID: 25971724 DOI: 10.1016/j.clinph.2015.04.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 04/20/2015] [Accepted: 04/21/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Hideyuki Matsumoto
- Department of Neurology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan.
| | - Yoshikazu Ugawa
- Department of Neurology, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan.
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Rossini PM, Burke D, Chen R, Cohen LG, Daskalakis Z, Di Iorio R, Di Lazzaro V, Ferreri F, Fitzgerald PB, George MS, Hallett M, Lefaucheur JP, Langguth B, Matsumoto H, Miniussi C, Nitsche MA, Pascual-Leone A, Paulus W, Rossi S, Rothwell JC, Siebner HR, Ugawa Y, Walsh V, Ziemann U. Non-invasive electrical and magnetic stimulation of the brain, spinal cord, roots and peripheral nerves: Basic principles and procedures for routine clinical and research application. An updated report from an I.F.C.N. Committee. Clin Neurophysiol 2015; 126:1071-1107. [PMID: 25797650 PMCID: PMC6350257 DOI: 10.1016/j.clinph.2015.02.001] [Citation(s) in RCA: 1772] [Impact Index Per Article: 196.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 01/22/2015] [Accepted: 02/01/2015] [Indexed: 12/14/2022]
Abstract
These guidelines provide an up-date of previous IFCN report on “Non-invasive electrical and magnetic stimulation of the brain, spinal cord and roots: basic principles and procedures for routine clinical application” (Rossini et al., 1994). A new Committee, composed of international experts, some of whom were in the panel of the 1994 “Report”, was selected to produce a current state-of-the-art review of non-invasive stimulation both for clinical application and research in neuroscience. Since 1994, the international scientific community has seen a rapid increase in non-invasive brain stimulation in studying cognition, brain–behavior relationship and pathophysiology of various neurologic and psychiatric disorders. New paradigms of stimulation and new techniques have been developed. Furthermore, a large number of studies and clinical trials have demonstrated potential therapeutic applications of non-invasive brain stimulation, especially for TMS. Recent guidelines can be found in the literature covering specific aspects of non-invasive brain stimulation, such as safety (Rossi et al., 2009), methodology (Groppa et al., 2012) and therapeutic applications (Lefaucheur et al., 2014). This up-dated review covers theoretical, physiological and practical aspects of non-invasive stimulation of brain, spinal cord, nerve roots and peripheral nerves in the light of more updated knowledge, and include some recent extensions and developments.
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Affiliation(s)
- P M Rossini
- Institute of Neurology, Department of Geriatrics, Neuroscience and Orthopedics, Catholic University, Policlinic A. Gemelli, Rome, Italy
| | - D Burke
- Department of Neurology, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - R Chen
- Division of Neurology, Toronto Western Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - L G Cohen
- Human Cortical Physiology and Neurorehabilitation Section, NINDS, NIH, Bethesda, MD, USA
| | - Z Daskalakis
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - R Di Iorio
- Institute of Neurology, Department of Geriatrics, Neuroscience and Orthopedics, Catholic University, Policlinic A. Gemelli, Rome, Italy.
| | - V Di Lazzaro
- Department of Neurology, University Campus Bio-medico, Rome, Italy
| | - F Ferreri
- Department of Neurology, University Campus Bio-medico, Rome, Italy; Department of Clinical Neurophysiology, University of Eastern Finland, Kuopio, Finland
| | - P B Fitzgerald
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred, Melbourne, Australia
| | - M S George
- Medical University of South Carolina, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - M Hallett
- Human Motor Control Section, Medical Neurology Branch, NINDS, NIH, Bethesda, MD, USA
| | - J P Lefaucheur
- Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France; EA 4391, Nerve Excitability and Therapeutic Team, Faculty of Medicine, Paris Est Créteil University, Créteil, France
| | - B Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - H Matsumoto
- Department of Neurology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - C Miniussi
- Department of Clinical and Experimental Sciences University of Brescia, Brescia, Italy; IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - M A Nitsche
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Georg-August-University, Göttingen, Germany
| | - A Pascual-Leone
- Berenson-Allen Center for Non-invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - W Paulus
- Department of Clinical Neurophysiology, Georg-August University, Göttingen, Germany
| | - S Rossi
- Brain Investigation & Neuromodulation Lab, Unit of Neurology and Clinical Neurophysiology, Department of Neuroscience, University of Siena, Siena, Italy
| | - J C Rothwell
- Institute of Neurology, University College London, London, United Kingdom
| | - H R Siebner
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark; Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Y Ugawa
- Department of Neurology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - V Walsh
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom
| | - U Ziemann
- Department of Neurology & Stroke, and Hertie Institute for Clinical Brain Research, Eberhard Karls University, Tübingen, Germany
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Attarian S, Franques J, Elisabeth J, Trébuchon A, Duclos Y, Wybrecht D, Verschueren A, Salort-Campana E, Pouget J. Triple-stimulation technique improves the diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy. Muscle Nerve 2015; 51:541-8. [DOI: 10.1002/mus.24352] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Shahram Attarian
- Reference Centre for Neuromuscular Diseases and ALS; Department of Neurology and Neuromuscular Diseases; Centre Hospitalier Universitaire La Timone; 264 rue Saint-Pierre 13385 Marseille France
- Inserm UMR_S 910 Medical Genetics and Functional Genomics; Aix-Marseille University; Marseilles France
| | - Jérôme Franques
- Reference Centre for Neuromuscular Diseases and ALS; Department of Neurology and Neuromuscular Diseases; Centre Hospitalier Universitaire La Timone; 264 rue Saint-Pierre 13385 Marseille France
| | - Jouve Elisabeth
- CIC-UPCET, Clinical Pharmacology, Centre Hospitalier Universitaire La Timone; Marseilles France
| | - Agnes Trébuchon
- Department of Clinical Neurology; Centre Hospitalier Universitaire La Timone; Marseilles France
| | - Yann Duclos
- Reference Centre for Neuromuscular Diseases and ALS; Department of Neurology and Neuromuscular Diseases; Centre Hospitalier Universitaire La Timone; 264 rue Saint-Pierre 13385 Marseille France
| | - Délphine Wybrecht
- Department of Neurologie; HIA Sainte Anne; BP 20545, 83041 Toulon France
| | - Annie Verschueren
- Reference Centre for Neuromuscular Diseases and ALS; Department of Neurology and Neuromuscular Diseases; Centre Hospitalier Universitaire La Timone; 264 rue Saint-Pierre 13385 Marseille France
| | - Emmanuelle Salort-Campana
- Reference Centre for Neuromuscular Diseases and ALS; Department of Neurology and Neuromuscular Diseases; Centre Hospitalier Universitaire La Timone; 264 rue Saint-Pierre 13385 Marseille France
| | - Jean Pouget
- Reference Centre for Neuromuscular Diseases and ALS; Department of Neurology and Neuromuscular Diseases; Centre Hospitalier Universitaire La Timone; 264 rue Saint-Pierre 13385 Marseille France
- Inserm UMR_S 910 Medical Genetics and Functional Genomics; Aix-Marseille University; Marseilles France
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Fuhr P, Schindler C. Clinical Neurophysiology in multiple sclerosis – From diagnostic tool to biomarker. Clin Neurophysiol 2015; 126:7-9. [DOI: 10.1016/j.clinph.2014.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 06/03/2014] [Accepted: 06/07/2014] [Indexed: 11/16/2022]
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Hofstadt-van Oy U, Keune PM, Muenssinger J, Hagenburger D, Oschmann P. Normative data and long-term test-retest reliability of the triple stimulation technique (TST) in multiple sclerosis. Clin Neurophysiol 2014; 126:356-64. [PMID: 25027641 DOI: 10.1016/j.clinph.2014.05.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 05/19/2014] [Accepted: 05/20/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Transcranial magnetic stimulation is useful for the assessment of cortico-spinal tract integrity in multiple sclerosis (MS). An advanced approach is the triple stimulation technique (TST), utilizing a combination of central and peripheral stimuli, reducing individual response variability. Although TST measures have been implemented in longitudinal studies, basic methodological data on temporal properties of abnormal TST values in MS are sparse. METHODS Normative TST data were obtained from 48 healthy participants. Longitudinal measures were derived from 17 MS-patients (relapsing-remitting: N=10; clinically isolated syndrome: N=7) prior to, three and twelve months following therapy initiation. Intraclass correlations were used to examine test-retest reliability. Complementary, patient ambulation and cognition were assessed. RESULTS Patient TST parameters were abnormal, involving excellent test-retest reliability and stable mean values. Cognitive and motor performance improved. CONCLUSIONS Results are the first to show that abnormal TST values in MS, reflecting diagnostic utility, are highly reliable in a long-term follow-up. Methodological properties are adequate for a longitudinal implementation of TST. Parameters were insensitive to alterations in cognitive/motor functioning. Sensitivity may be verified in subgroups with different treatment regimes. SIGNIFICANCE Results provide new normative data, support diagnostic utility of TST measures in MS, and confirm their long-term robustness.
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Affiliation(s)
| | - P M Keune
- Department of Neurology, Klinikum Bayreuth, Bayreuth, Germany; Department of Physiological Psychology, Otto-Friedrich-University of Bamberg, Bamberg, Germany.
| | - J Muenssinger
- Department of Neurology, Klinikum Bayreuth, Bayreuth, Germany
| | - D Hagenburger
- Department of Neurology, Klinikum Bayreuth, Bayreuth, Germany
| | - P Oschmann
- Department of Neurology, Klinikum Bayreuth, Bayreuth, Germany
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Camdessanché JP, Lenglet T. Place des explorations électrophysiologiques dans la sclérose latérale amyotrophique. Presse Med 2014; 43:563-8. [DOI: 10.1016/j.lpm.2014.03.003] [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: 02/28/2014] [Revised: 03/21/2014] [Accepted: 03/24/2014] [Indexed: 10/25/2022] Open
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Baudry S, Penzer F, Duchateau J. Input-output characteristics of soleus homonymous Ia afferents and corticospinal pathways during upright standing differ between young and elderly adults. Acta Physiol (Oxf) 2014; 210:667-77. [PMID: 24433254 DOI: 10.1111/apha.12233] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 12/03/2013] [Accepted: 01/09/2014] [Indexed: 11/28/2022]
Abstract
AIM This study investigated the effects of ageing on the excitability of soleus homonymous Ia afferents and corticospinal pathways during bipedal upright standing. METHODS The input-output relations for the Hoffmann (H) reflex and motor-evoked potential (MEP) were computed for the soleus in response to electrical nerve stimulation and transcranial magnetic stimulation, respectively, in young (n = 16) and elderly (n = 16) adults. In subsets of subjects, the input-output relations were compared between normal and supported upright standing, and corticomotoneuronal excitability was assessed during upright standing with an H-reflex conditioning method. For the H-reflex and MEP threshold, maximal amplitude (Hmax , MEPmax ) and the slope of the input-output relation (Hslope , MEPslope ) were measured and normalized to the corresponding M-wave value. RESULTS In normal standing, the Hmax /Mmax [mean (SD); young: 48.3 (14.2)%; elderly: 17.3 (6.4)%] and Hslope /Mslope were significantly (P < 0.05) lower in elderly than in young adults, whereas the MEPmax /Mmax [young: 13.6 (7.5)%; elderly: 24.5 (12.8)%] and MEPslope /Mslope were greater in elderly adults (P < 0.05). The Hslope /Mslope and MEPslope /Mslope decreased and increased, respectively, from supported to normal standing for both age groups but more so in elderly adults. Furthermore, the conditioned H reflex was greater (P < 0.05) in elderly [175.1 (34.3)%] than in young adults [141.8 (29.8)%] during normal standing. CONCLUSION This is the first study that clearly indicates lower efficacy of Ia afferents to discharge spinal motor neurones accompanied by greater corticospinal excitability in elderly adults, suggesting an increased contribution of the descending drive in controlling soleus activity during upright standing with ageing.
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Affiliation(s)
- S. Baudry
- Laboratory of Applied Biology; ULB Neuroscience Institute (UNI); Université Libre de Bruxelles (ULB); Brussels Belgium
| | - F. Penzer
- Laboratory of Applied Biology; ULB Neuroscience Institute (UNI); Université Libre de Bruxelles (ULB); Brussels Belgium
| | - J. Duchateau
- Laboratory of Applied Biology; ULB Neuroscience Institute (UNI); Université Libre de Bruxelles (ULB); Brussels Belgium
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49
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Grapperon AM, Verschueren A, Duclos Y, Confort-Gouny S, Soulier E, Loundou AD, Guye M, Cozzone PJ, Pouget J, Ranjeva JP, Attarian S. Association between structural and functional corticospinal involvement in amyotrophic lateral sclerosis assessed by diffusion tensor MRI and triple stimulation technique. Muscle Nerve 2014; 49:551-7. [DOI: 10.1002/mus.23957] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 06/15/2013] [Accepted: 07/09/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Aude-Marie Grapperon
- Department of Neurology and Neuromuscular Diseases; CHU La Timone; 264 rue Saint-Pierre 13385 Marseille France
| | - Annie Verschueren
- Department of Neurology and Neuromuscular Diseases; CHU La Timone; 264 rue Saint-Pierre 13385 Marseille France
| | - Yann Duclos
- Department of Neurology and Neuromuscular Diseases; CHU La Timone; 264 rue Saint-Pierre 13385 Marseille France
| | - Sylviane Confort-Gouny
- Biological and Medical Magnetic Resonance Center (CRMBM) and Center for Metabolic Exploration using Magnetic Resonance (CEMEREM) (UMR 7339); CHU La Timone; Marseilles France
| | - Elisabeth Soulier
- Biological and Medical Magnetic Resonance Center (CRMBM) and Center for Metabolic Exploration using Magnetic Resonance (CEMEREM) (UMR 7339); CHU La Timone; Marseilles France
| | - Anderson D. Loundou
- Department of Methodological Aid to Clinical Research; CHU La Timone; Marseilles France
| | - Maxime Guye
- Biological and Medical Magnetic Resonance Center (CRMBM) and Center for Metabolic Exploration using Magnetic Resonance (CEMEREM) (UMR 7339); CHU La Timone; Marseilles France
| | - Patrick J. Cozzone
- Biological and Medical Magnetic Resonance Center (CRMBM) and Center for Metabolic Exploration using Magnetic Resonance (CEMEREM) (UMR 7339); CHU La Timone; Marseilles France
| | - Jean Pouget
- Department of Neurology and Neuromuscular Diseases; CHU La Timone; 264 rue Saint-Pierre 13385 Marseille France
| | - Jean-Philippe Ranjeva
- Biological and Medical Magnetic Resonance Center (CRMBM) and Center for Metabolic Exploration using Magnetic Resonance (CEMEREM) (UMR 7339); CHU La Timone; Marseilles France
| | - Shahram Attarian
- Department of Neurology and Neuromuscular Diseases; CHU La Timone; 264 rue Saint-Pierre 13385 Marseille France
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50
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Cuypers K, Thijs H, Meesen RLJ. Optimization of the transcranial magnetic stimulation protocol by defining a reliable estimate for corticospinal excitability. PLoS One 2014; 9:e86380. [PMID: 24475111 PMCID: PMC3901672 DOI: 10.1371/journal.pone.0086380] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 12/11/2013] [Indexed: 11/19/2022] Open
Abstract
The goal of this study was to optimize the transcranial magnetic stimulation (TMS) protocol for acquiring a reliable estimate of corticospinal excitability (CSE) using single-pulse TMS. Moreover, the minimal number of stimuli required to obtain a reliable estimate of CSE was investigated. In addition, the effect of two frequently used stimulation intensities [110% relative to the resting motor threshold (rMT) and 120% rMT] and gender was evaluated. Thirty-six healthy young subjects (18 males and 18 females) participated in a double-blind crossover procedure. They received 2 blocks of 40 consecutive TMS stimuli at either 110% rMT or 120% rMT in a randomized order. Based upon our data, we advise that at least 30 consecutive stimuli are required to obtain the most reliable estimate for CSE. Stimulation intensity and gender had no significant influence on CSE estimation. In addition, our results revealed that for subjects with a higher rMT, fewer consecutive stimuli were required to reach a stable estimate of CSE. The current findings can be used to optimize the design of similar TMS experiments.
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Affiliation(s)
- Koen Cuypers
- REVAL Rehabilitation Research Centre, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- Motor Control Laboratory, Research Center for Movement Control and Neuroplasticity, Department of Biomedical Kinesiology, Group Biomedical Sciences, K.U. Leuven, Heverlee, Belgium
| | - Herbert Thijs
- I-BioStat, Interuniversity Institute for Biostatistics and statistical Bioinformatics, Hasselt University, Diepenbeek, Belgium
- I-BioStat, Interuniversity Institute for Biostatistics and statistical Bioinformatics, Leuven University, Leuven, Belgium
| | - Raf L. J. Meesen
- REVAL Rehabilitation Research Centre, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- Motor Control Laboratory, Research Center for Movement Control and Neuroplasticity, Department of Biomedical Kinesiology, Group Biomedical Sciences, K.U. Leuven, Heverlee, Belgium
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