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Meng H, Houston M, Francisco GE, Zhang Y, Li S. Scalp acupuncture guidance for identifying the optimal site for transcranial electrical stimulation of the hand. Exp Brain Res 2024; 242:2083-2091. [PMID: 38963560 DOI: 10.1007/s00221-024-06883-y] [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: 03/23/2024] [Accepted: 06/21/2024] [Indexed: 07/05/2024]
Abstract
Transcranial electrical stimulation (tES) often targets the EEG-guided C3/C4 area that may not accurately represent M1 for hand muscles. This study aimed to determine if the neuroanatomy-based scalp acupuncture-guided site (AC) was a more effective spot than the C3 site for neuromodulation. Fifteen healthy subjects received one 20-minute session of high-definition transcranial alternating current stimulation (HD-tACS) intervention (20 Hz at 2 mA) at the AC or C3 sites randomly with a 1-week washout period. Subjects performed ball-squeezing exercises with the dominant hand during the HD-tACS intervention. The AC site was indiscernible from the finger flexor hotspot detected by TMS. At the baseline, the MEP amplitude from finger flexors was greater with less variability at the AC site than at the C3 site. HD-tACS intervention at the AC site significantly increased the MEP amplitude. However, no significant changes were observed after tACS was applied to the C3 site. Our results provide evidence that HD-tACS at the AC site produces better neuromodulation effects on the flexor digitorum superficialis (FDS) muscle compared to the C3 site. The AC localization approach can be used for future tES studies.
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Affiliation(s)
- Hao Meng
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
- The NeuroRecovery Research Center, TIRR Memorial Hermann Hospital, Houston, TX, 77030, USA
| | - Michael Houston
- Department of Biomedical Engineering, University of Houston, Houston, TX, 77204, USA
| | - Gerard E Francisco
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
- The NeuroRecovery Research Center, TIRR Memorial Hermann Hospital, Houston, TX, 77030, USA
| | - Yingchun Zhang
- Department of Biomedical Engineering, Miami Project to Cure Paralysis, Desai Sethi Urology Institute, University of Miami, Coral Gables, FL, 33124, USA
| | - Sheng Li
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, 77030, USA.
- The NeuroRecovery Research Center, TIRR Memorial Hermann Hospital, Houston, TX, 77030, USA.
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Wu CF, Shen C, Wang ZD, Gong Y, Zhou LH, Qian WJ, Tang T. A bibliometric analysis of transcranial alternating current stimulation. Front Neurosci 2024; 18:1409492. [PMID: 39156631 PMCID: PMC11328521 DOI: 10.3389/fnins.2024.1409492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 07/04/2024] [Indexed: 08/20/2024] Open
Abstract
Background Transcranial alternating current stimulation (tACS) can apply currents of varying intensity to the scalp, modulating cortical excitability and brain activity. tACS is a relatively new neuromodulation intervention that is now widely used in clinical practice. Many papers related to tACS have been published in various journals. However, there are no articles that objectively and directly introduce the development trend and research hotspots of tACS. Therefore, the aim of this study is to use CiteSpace to visually analyze the recent tACS-related publications, systematically and in detail summarize the current research hotspots and trends in this field, and provide valuable information for future tACS-related research. Material and methods The database Web of Science Core Collection Science Citation Index Expanded was used and searched from build to 4 August 2023. Using the CiteSpace to analyze the authors, institutions, countries, keywords, co-cited authors, journals, and references. Results A total of 677 papers were obtained. From 2008 to 2023, the number of publications shows an increasing trend, albeit with some fluctuations. The most productive country in this field was Germany. The institution with the highest number of publications is Carl von Ossietzky University of Oldenburg (n = 50). According to Bradford's law, 7 journals are considered core journals in the field. Herrmann, CS was the author with the most publications (n = 40), while Antal, A was the author with the highest number of co-citations (n = 391) and betweenness centrality (n = 0.16). Disease, neural mechanisms of the brain and electric stimulation are the major research areas in the field. The effect of tACS in different diseases, multi-site stimulation, combined treatment and evaluation are the future research hotspots and trends. Conclusion tACS has research value and research potential, and more and more researchers are paying attention to it. The findings of this bibliometric study provide the current status and trends in the clinical research of tACS and may help researchers to identify hotspots s and explore new research directions in this field.
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Affiliation(s)
- Cheng-Fan Wu
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Chao Shen
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Zhao-Di Wang
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Yan Gong
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Lu-Han Zhou
- The Fourth Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Wen-Jun Qian
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Tong Tang
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
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Lefaucheur JP, Moro E, Shirota Y, Ugawa Y, Grippe T, Chen R, Benninger DH, Jabbari B, Attaripour S, Hallett M, Paulus W. Clinical neurophysiology in the treatment of movement disorders: IFCN handbook chapter. Clin Neurophysiol 2024; 164:57-99. [PMID: 38852434 PMCID: PMC11418354 DOI: 10.1016/j.clinph.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 03/02/2024] [Accepted: 05/15/2024] [Indexed: 06/11/2024]
Abstract
In this review, different aspects of the use of clinical neurophysiology techniques for the treatment of movement disorders are addressed. First of all, these techniques can be used to guide neuromodulation techniques or to perform therapeutic neuromodulation as such. Neuromodulation includes invasive techniques based on the surgical implantation of electrodes and a pulse generator, such as deep brain stimulation (DBS) or spinal cord stimulation (SCS) on the one hand, and non-invasive techniques aimed at modulating or even lesioning neural structures by transcranial application. Movement disorders are one of the main areas of indication for the various neuromodulation techniques. This review focuses on the following techniques: DBS, repetitive transcranial magnetic stimulation (rTMS), low-intensity transcranial electrical stimulation, including transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS), and focused ultrasound (FUS), including high-intensity magnetic resonance-guided FUS (MRgFUS), and pulsed mode low-intensity transcranial FUS stimulation (TUS). The main clinical conditions in which neuromodulation has proven its efficacy are Parkinson's disease, dystonia, and essential tremor, mainly using DBS or MRgFUS. There is also some evidence for Tourette syndrome (DBS), Huntington's disease (DBS), cerebellar ataxia (tDCS), and axial signs (SCS) and depression (rTMS) in PD. The development of non-invasive transcranial neuromodulation techniques is limited by the short-term clinical impact of these techniques, especially rTMS, in the context of very chronic diseases. However, at-home use (tDCS) or current advances in the design of closed-loop stimulation (tACS) may open new perspectives for the application of these techniques in patients, favored by their easier use and lower rate of adverse effects compared to invasive or lesioning methods. Finally, this review summarizes the evidence for keeping the use of electromyography to optimize the identification of muscles to be treated with botulinum toxin injection, which is indicated and widely performed for the treatment of various movement disorders.
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Affiliation(s)
- Jean-Pascal Lefaucheur
- Clinical Neurophysiology Unit, Henri Mondor University Hospital, AP-HP, Créteil, France; EA 4391, ENT Team, Paris-Est Créteil University, Créteil, France.
| | - Elena Moro
- Grenoble Alpes University, Division of Neurology, CHU of Grenoble, Grenoble Institute of Neuroscience, Grenoble, France
| | - Yuichiro Shirota
- Department of Neurology, Division of Neuroscience, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Talyta Grippe
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Neuroscience Graduate Program, Federal University of Minas Gerais, Belo Horizonte, Brazil; Krembil Brain Institute, Toronto, Ontario, Canada
| | - Robert Chen
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Krembil Brain Institute, Toronto, Ontario, Canada
| | - David H Benninger
- Service of Neurology, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Bahman Jabbari
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Sanaz Attaripour
- Department of Neurology, University of California, Irvine, CA, USA
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Walter Paulus
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
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Birreci D, De Riggi M, Costa D, Angelini L, Cannavacciuolo A, Passaretti M, Paparella G, Guerra A, Bologna M. The Role of Non-Invasive Brain Modulation in Identifying Disease Biomarkers for Diagnostic and Therapeutic Purposes in Parkinsonism. Brain Sci 2024; 14:695. [PMID: 39061435 PMCID: PMC11274666 DOI: 10.3390/brainsci14070695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/05/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
Over the past three decades, substantial advancements have occurred in non-invasive brain stimulation (NIBS). These developments encompass various non-invasive techniques aimed at modulating brain function. Among the most widely utilized methods today are transcranial magnetic stimulation (TMS) and transcranial electrical stimulation (TES), which include direct- or alternating-current transcranial stimulation (tDCS/tACS). In addition to these established techniques, newer modalities have emerged, broadening the scope of non-invasive neuromodulation approaches available for research and clinical applications in movement disorders, particularly for Parkinson's disease (PD) and, to a lesser extent, atypical Parkinsonism (AP). All NIBS techniques offer the opportunity to explore a wide range of neurophysiological mechanisms and exert influence over distinct brain regions implicated in the pathophysiology of Parkinsonism. This paper's first aim is to provide a brief overview of the historical background and underlying physiological principles of primary NIBS techniques, focusing on their translational relevance. It aims to shed light on the potential identification of biomarkers for diagnostic and therapeutic purposes, by summarising available experimental data on individuals with Parkinsonism. To date, despite promising findings indicating the potential utility of NIBS techniques in Parkinsonism, their integration into clinical routine for diagnostic or therapeutic protocols remains a subject of ongoing investigation and scientific debate. In this context, this paper addresses current unsolved issues and methodological challenges concerning the use of NIBS, focusing on the importance of future research endeavours for maximizing the efficacy and relevance of NIBS strategies for individuals with Parkinsonism.
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Affiliation(s)
- Daniele Birreci
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università, 30, 00185 Rome, Italy; (D.B.); (M.D.R.); (M.P.); (G.P.)
| | - Martina De Riggi
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università, 30, 00185 Rome, Italy; (D.B.); (M.D.R.); (M.P.); (G.P.)
| | - Davide Costa
- IRCCS Neuromed, Via Atinense, 18, 86077 Pozzilli, IS, Italy; (D.C.); (L.A.); (A.C.)
| | - Luca Angelini
- IRCCS Neuromed, Via Atinense, 18, 86077 Pozzilli, IS, Italy; (D.C.); (L.A.); (A.C.)
| | | | - Massimiliano Passaretti
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università, 30, 00185 Rome, Italy; (D.B.); (M.D.R.); (M.P.); (G.P.)
- Department of Clinical Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Giulia Paparella
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università, 30, 00185 Rome, Italy; (D.B.); (M.D.R.); (M.P.); (G.P.)
- IRCCS Neuromed, Via Atinense, 18, 86077 Pozzilli, IS, Italy; (D.C.); (L.A.); (A.C.)
| | - Andrea Guerra
- Parkinson and Movement Disorders Unit, Study Centre on Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, 35121 Padua, Italy;
- Padova Neuroscience Centre (PNC), University of Padua, 35121 Padua, Italy
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università, 30, 00185 Rome, Italy; (D.B.); (M.D.R.); (M.P.); (G.P.)
- IRCCS Neuromed, Via Atinense, 18, 86077 Pozzilli, IS, Italy; (D.C.); (L.A.); (A.C.)
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Chu HY, Smith Y, Lytton WW, Grafton S, Villalba R, Masilamoni G, Wichmann T. Dysfunction of motor cortices in Parkinson's disease. Cereb Cortex 2024; 34:bhae294. [PMID: 39066504 PMCID: PMC11281850 DOI: 10.1093/cercor/bhae294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 06/26/2024] [Accepted: 07/19/2024] [Indexed: 07/28/2024] Open
Abstract
The cerebral cortex has long been thought to be involved in the pathophysiology of motor symptoms of Parkinson's disease. The impaired cortical function is believed to be a direct and immediate effect of pathologically patterned basal ganglia output, mediated to the cerebral cortex by way of the ventral motor thalamus. However, recent studies in humans with Parkinson's disease and in animal models of the disease have provided strong evidence suggesting that the involvement of the cerebral cortex is much broader than merely serving as a passive conduit for subcortical disturbances. In the present review, we discuss Parkinson's disease-related changes in frontal cortical motor regions, focusing on neuropathology, plasticity, changes in neurotransmission, and altered network interactions. We will also examine recent studies exploring the cortical circuits as potential targets for neuromodulation to treat Parkinson's disease.
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Affiliation(s)
- Hong-Yuan Chu
- Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD 20815, United States
- Department of Pharmacology and Physiology, Georgetown University Medical Center, 3900 Reservoir Rd N.W., Washington D.C. 20007, United States
| | - Yoland Smith
- Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD 20815, United States
- Department of Neurology, School of Medicine, Emory University, 12 Executive Drive N.E., Atlanta, GA 30329, United States
- Emory National Primate Research Center, 954 Gatewood Road N.E., Emory University, Atlanta, GA 30329, United States
| | - William W Lytton
- Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD 20815, United States
- Department of Physiology & Pharmacology, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, United States
- Department of Neurology, Kings County Hospital, 451 Clarkson Avenue,Brooklyn, NY 11203, United States
| | - Scott Grafton
- Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD 20815, United States
- Department of Psychological and Brain Sciences, University of California, 551 UCEN Road, Santa Barbara, CA 93106, United States
| | - Rosa Villalba
- Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD 20815, United States
- Emory National Primate Research Center, 954 Gatewood Road N.E., Emory University, Atlanta, GA 30329, United States
| | - Gunasingh Masilamoni
- Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD 20815, United States
- Emory National Primate Research Center, 954 Gatewood Road N.E., Emory University, Atlanta, GA 30329, United States
| | - Thomas Wichmann
- Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD 20815, United States
- Department of Neurology, School of Medicine, Emory University, 12 Executive Drive N.E., Atlanta, GA 30329, United States
- Emory National Primate Research Center, 954 Gatewood Road N.E., Emory University, Atlanta, GA 30329, United States
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Liu Y, Luo Y, Zhang N, Zhang X, Liu S. A scientometric review of the growing trends in transcranial alternating current stimulation (tACS). Front Hum Neurosci 2024; 18:1362593. [PMID: 38510513 PMCID: PMC10950919 DOI: 10.3389/fnhum.2024.1362593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/19/2024] [Indexed: 03/22/2024] Open
Abstract
Objective The aim of the current study was to provide a comprehensive picture of tACS-related research in the last decade through a bibliometric approach in order to systematically analyze the current status and cutting-edge trends in this field. Methods Articles and review articles related to tACS from 2013 to 2022 were searched on the Web of Science platform. A bibliometric analysis of authors, journals, countries, institutions, references, and keywords was performed using CiteSpace (6.2.R2), VOSviewer (1.6.19), Scimago Graphica (1.0.30), and Bibliometrix (4.2.2). Results A total of 602 papers were included. There was an overall increase in annual relevant publications in the last decade. The most contributing author was Christoph S. Herrmann. Brain Stimulation was the most prolific journal. The most prolific countries and institutions were Germany and Harvard University, respectively. Conclusion The findings reveal the development prospects and future directions of tACS and provide valuable references for researchers in the field. In recent years, the keywords "gamma," "transcranial direct current simulation," and "Alzheimer's disease" that have erupted, as well as many references cited in the outbreak, have provided certain clues for the mining of research prefaces. This will act as a guide for future researchers in determining the path of tACS research.
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Affiliation(s)
- Yuanli Liu
- Department of Psychology, School of Humanities and Social Sciences, Anhui Agricultural University, Hefei, China
| | - Yulin Luo
- Department of Psychology, School of Humanities and Social Sciences, Anhui Agricultural University, Hefei, China
| | - Na Zhang
- Department of Information Management, Anhui Vocational College of Police Officers, Hefei, China
| | - Xiaochu Zhang
- Department of Psychology, School of Humanities & Social Science, University of Science & Technology of China, Hefei, Anhui, China
- Hefei National Research Center for Physical Sciences at the Microscale, and Department of Radiology, the First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science & Technology of China, Hefei, China
- Application Technology Center of Physical Therapy to Brain Disorders, Institute of Advanced Technology, University of Science & Technology of China, Hefei, China
- Key Laboratory of Brain-Machine Intelligence for Information Behavior (Ministry of Education and Shanghai), School of Business and Management, Shanghai International Studies University, Shanghai, China
| | - Shen Liu
- Department of Psychology, School of Humanities and Social Sciences, Anhui Agricultural University, Hefei, China
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Sohn MN, Brown JC, Sharma P, Ziemann U, McGirr A. Pharmacological adjuncts and transcranial magnetic stimulation-induced synaptic plasticity: a systematic review. J Psychiatry Neurosci 2024; 49:E59-E76. [PMID: 38359933 PMCID: PMC10890793 DOI: 10.1503/jpn.230090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/23/2023] [Accepted: 11/08/2023] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) is a noninvasive neurostimulation modality that has been used to study human synaptic plasticity. Leveraging work in ex vivo preparations, mechanistically informed pharmacological adjuncts to TMS have been used to improve our fundamental understanding of TMS-induced synaptic plasticity. METHODS We systematically reviewed the literature pairing pharmacological adjuncts with TMS plasticity-induction protocols in humans. We searched MEDLINE, PsycINFO, and Embase from 2013 to Mar. 10, 2023. Studies published before 2013 were extracted from a previous systematic review. We included studies using repetitive TMS, theta-burst stimulation, paired associative stimulation, and quadripulse stimulation paradigms in healthy and clinical populations. RESULTS Thirty-six studies met our inclusion criteria (28 in healthy and 8 in clinical populations). Most pharmacological agents have targeted the glutamatergic N-methyl-d-aspartate (NMDA; 15 studies) or dopamine receptors (13 studies). The NMDA receptor is necessary for TMS-induced plasticity; however, sufficiency has not been shown across protocols. Dopaminergic modulation of TMS-induced plasticity appears to be dose-dependent. The GABAergic, cholinergic, noradrenergic, and serotonergic neurotransmitter systems have small evidence bases supporting modulation of TMS-induced plasticity, as do voltage-gated calcium and sodium channels. Studies in clinical populations suggest that pharmacological adjuncts to TMS may rescue motor cortex plasticity, with implications for therapeutic applications of TMS and a promising clinical trial in depression. LIMITATIONS This review is limited by the predominance in the literature of studies with small sample sizes and crossover designs. CONCLUSION Pharmacologically enhanced TMS largely parallels findings from ex vivo preparations. As this area expands and novel targets are tested, adequately powered samples in healthy and clinical populations will inform the mechanisms of TMS-induced plasticity in health and disease.
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Affiliation(s)
- Myren N Sohn
- From the Hotchkiss Brain Institute, University of Calgary, Calgary, Alta., Canada (Sohn, McGirr); the Department of Psychiatry, University of Calgary, Alta., Canada (Sohn, McGirr); the Mathison Centre for Mental Health Research and Education, Calgary, Alta., Canada (Sohn, McGirr); the McLean Hospital, Division of Neurotherapeutics, Belmont, Mass., USA (Brown, Sharma); the Department of Psychiatry, Harvard Medical School, Boston, Mass., USA (Brown); the Department of Neurology & Stroke, Eberhard-Karls University, Tübingen, Germany (Ziemann); and the Hertie-Institute for Clinical Brain Research, Eberhard-Karls University, Tübingen, Germany (Ziemann)
| | - Joshua C Brown
- From the Hotchkiss Brain Institute, University of Calgary, Calgary, Alta., Canada (Sohn, McGirr); the Department of Psychiatry, University of Calgary, Alta., Canada (Sohn, McGirr); the Mathison Centre for Mental Health Research and Education, Calgary, Alta., Canada (Sohn, McGirr); the McLean Hospital, Division of Neurotherapeutics, Belmont, Mass., USA (Brown, Sharma); the Department of Psychiatry, Harvard Medical School, Boston, Mass., USA (Brown); the Department of Neurology & Stroke, Eberhard-Karls University, Tübingen, Germany (Ziemann); and the Hertie-Institute for Clinical Brain Research, Eberhard-Karls University, Tübingen, Germany (Ziemann)
| | - Prayushi Sharma
- From the Hotchkiss Brain Institute, University of Calgary, Calgary, Alta., Canada (Sohn, McGirr); the Department of Psychiatry, University of Calgary, Alta., Canada (Sohn, McGirr); the Mathison Centre for Mental Health Research and Education, Calgary, Alta., Canada (Sohn, McGirr); the McLean Hospital, Division of Neurotherapeutics, Belmont, Mass., USA (Brown, Sharma); the Department of Psychiatry, Harvard Medical School, Boston, Mass., USA (Brown); the Department of Neurology & Stroke, Eberhard-Karls University, Tübingen, Germany (Ziemann); and the Hertie-Institute for Clinical Brain Research, Eberhard-Karls University, Tübingen, Germany (Ziemann)
| | - Ulf Ziemann
- From the Hotchkiss Brain Institute, University of Calgary, Calgary, Alta., Canada (Sohn, McGirr); the Department of Psychiatry, University of Calgary, Alta., Canada (Sohn, McGirr); the Mathison Centre for Mental Health Research and Education, Calgary, Alta., Canada (Sohn, McGirr); the McLean Hospital, Division of Neurotherapeutics, Belmont, Mass., USA (Brown, Sharma); the Department of Psychiatry, Harvard Medical School, Boston, Mass., USA (Brown); the Department of Neurology & Stroke, Eberhard-Karls University, Tübingen, Germany (Ziemann); and the Hertie-Institute for Clinical Brain Research, Eberhard-Karls University, Tübingen, Germany (Ziemann)
| | - Alexander McGirr
- From the Hotchkiss Brain Institute, University of Calgary, Calgary, Alta., Canada (Sohn, McGirr); the Department of Psychiatry, University of Calgary, Alta., Canada (Sohn, McGirr); the Mathison Centre for Mental Health Research and Education, Calgary, Alta., Canada (Sohn, McGirr); the McLean Hospital, Division of Neurotherapeutics, Belmont, Mass., USA (Brown, Sharma); the Department of Psychiatry, Harvard Medical School, Boston, Mass., USA (Brown); the Department of Neurology & Stroke, Eberhard-Karls University, Tübingen, Germany (Ziemann); and the Hertie-Institute for Clinical Brain Research, Eberhard-Karls University, Tübingen, Germany (Ziemann)
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8
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Sun H, Gan C, Wang L, Ji M, Cao X, Yuan Y, Zhang H, Shan A, Gao M, Zhang K. Cortical Disinhibition Drives Freezing of Gait in Parkinson's Disease and an Exploratory Repetitive Transcranial Magnetic Stimulation Study. Mov Disord 2023; 38:2072-2083. [PMID: 37646183 DOI: 10.1002/mds.29595] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/14/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Dysfunction of the primary motor cortex, participating in regulation of posture and gait, is implicated in freezing of gait (FOG) in Parkinson's disease (PD). OBJECTIVE The aim was to reveal the mechanisms of "OFF-period" FOG (OFF-FOG) and "levodopa-unresponsive" FOG (ONOFF-FOG) in PD. METHODS We measured the transcranial magnetic stimulation (TMS) indicators and gait parameters in 21 healthy controls (HCs), 15 PD patients with ONOFF-FOG, 15 PD patients with OFF-FOG, and 15 PD patients without FOG (Non-FOG) in "ON" and "OFF" medication conditions. Difference of TMS indicators in the four groups and two conditions and its correlations with gait parameters were explored. Additionally, we explored the effect of 10 Hz repetitive TMS on gait and TMS indicators in ONOFF-FOG patients. RESULTS In "OFF" condition, short interval intracortical inhibition (SICI) exhibited remarkable attenuation in FOG patients (both ONOFF-FOG and OFF-FOG) compared to Non-FOG patients and HCs. The weakening of SICI correlated with impaired gait characteristics in FOG. However, in "ON" condition, SICI in ONOFF-FOG patients reduced compared to OFF-FOG patients. Pharmacological treatment significantly improved SICI and gait in OFF-FOG patients, and high-frequency repetitive TMS distinctly improved gait in ONOFF-FOG patients, accompanied by enhanced SICI. CONCLUSIONS Motor cortex disinhibition, represented by decreased SICI, is related to FOG in PD. Refractory freezing in ONOFF-FOG patients correlated with the their reduced SICI insensitive to dopaminergic medication. SICI can serve as an indicator of the severity of impaired gait characteristics in FOG and reflect treatments efficacy for FOG in PD patients. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Huimin Sun
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Caiting Gan
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lina Wang
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Min Ji
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xingyue Cao
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yongsheng Yuan
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Heng Zhang
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Aidi Shan
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Mengxi Gao
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Kezhong Zhang
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
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Guerra A, Colella D, Cannavacciuolo A, Giangrosso M, Paparella G, Fabbrini G, Berardelli A, Bologna M. Short-term plasticity of the motor cortex compensates for bradykinesia in Parkinson's disease. Neurobiol Dis 2023; 182:106137. [PMID: 37120094 DOI: 10.1016/j.nbd.2023.106137] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/14/2023] [Accepted: 04/24/2023] [Indexed: 05/01/2023] Open
Abstract
Patients with Parkinson's disease (PD) show impaired short-term potentiation (STP) mechanisms in the primary motor cortex (M1). However, the role played by this neurophysiological abnormality in bradykinesia pathophysiology is unknown. In this study, we used a multimodal neuromodulation approach to test whether defective STP contributes to bradykinesia. We evaluated STP by measuring motor-evoked potential facilitation during 5 Hz-repetitive transcranial magnetic stimulation (rTMS) and assessed repetitive finger tapping movements through kinematic techniques. Also, we used transcranial alternating current stimulation (tACS) to drive M1 oscillations and experimentally modulate bradykinesia. STP was assessed during tACS delivered at beta (β) and gamma (γ) frequency, and during sham-tACS. Data were compared to those recorded in a group of healthy subjects. In PD, we found that STP was impaired during sham- and γ-tACS, while it was restored during β-tACS. Importantly, the degree of STP impairment was associated with the severity of movement slowness and amplitude reduction. Moreover, β-tACS-related improvements in STP were linked to changes in movement slowness and intracortical GABA-A-ergic inhibition during stimulation, as assessed by short-interval intracortical inhibition (SICI). Patients with prominent STP amelioration had greater SICI reduction (cortical disinhibition) and less slowness worsening during β-tACS. Dopaminergic medications did not modify β-tACS effects. These data demonstrate that abnormal STP processes are involved in bradykinesia pathophysiology and return to normal levels when β oscillations increase. STP changes are likely mediated by modifications in GABA-A-ergic intracortical circuits and may represent a compensatory mechanism against β-induced bradykinesia in PD.
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Affiliation(s)
- Andrea Guerra
- IRCCS Neuromed, Pozzilli, IS 86077, Italy; Department of Human Neurosciences, Sapienza University of Rome, Rome 00185, Italy
| | - Donato Colella
- Department of Human Neurosciences, Sapienza University of Rome, Rome 00185, Italy
| | | | | | | | - Giovanni Fabbrini
- IRCCS Neuromed, Pozzilli, IS 86077, Italy; Department of Human Neurosciences, Sapienza University of Rome, Rome 00185, Italy
| | - Alfredo Berardelli
- IRCCS Neuromed, Pozzilli, IS 86077, Italy; Department of Human Neurosciences, Sapienza University of Rome, Rome 00185, Italy
| | - Matteo Bologna
- IRCCS Neuromed, Pozzilli, IS 86077, Italy; Department of Human Neurosciences, Sapienza University of Rome, Rome 00185, Italy.
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