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Zhang JJ, Sui Y, Sack AT, Bai Z, Kwong PWH, Sanchez Vidana DI, Xiong L, Fong KNK. Theta burst stimulation for enhancing upper extremity motor functions after stroke: a systematic review of clinical and mechanistic evidence. Rev Neurosci 2024; 35:679-695. [PMID: 38671584 DOI: 10.1515/revneuro-2024-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024]
Abstract
This systematic review aimed to evaluate the effects of different theta burst stimulation (TBS) protocols on improving upper extremity motor functions in patients with stroke, their associated modulators of efficacy, and the underlying neural mechanisms. We conducted a meta-analytic review of 29 controlled trials published from January 1, 2000, to August 29, 2023, which investigated the effects of TBS on upper extremity motor, neurophysiological, and neuroimaging outcomes in poststroke patients. TBS significantly improved upper extremity motor impairment (Hedge's g = 0.646, p = 0.003) and functional activity (Hedge's g = 0.500, p < 0.001) compared to controls. Meta-regression revealed a significant relationship between the percentage of patients with subcortical stroke and the effect sizes of motor impairment (p = 0.015) and functional activity (p = 0.018). Subgroup analysis revealed a significant difference in the improvement of upper extremity motor impairment between studies using 600-pulse and 1200-pulse TBS (p = 0.002). Neurophysiological studies have consistently found that intermittent TBS increases ipsilesional corticomotor excitability. However, evidence to support the regional effects of continuous TBS, as well as the remote and network effects of TBS, is still mixed and relatively insufficient. In conclusion, TBS is effective in enhancing poststroke upper extremity motor function. Patients with preserved cortices may respond better to TBS. Novel TBS protocols with a higher dose may lead to superior efficacy compared with the conventional 600-pulse protocol. The mechanisms of poststroke recovery facilitated by TBS can be primarily attributed to the modulation of corticomotor excitability and is possibly caused by the recruitment of corticomotor networks connected to the ipsilesional motor cortex.
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Affiliation(s)
- Jack Jiaqi Zhang
- Department of Rehabilitation Sciences, 26680 The Hong Kong Polytechnic University , Hong Kong SAR, China
| | - Youxin Sui
- Department of Rehabilitation Sciences, 26680 The Hong Kong Polytechnic University , Hong Kong SAR, China
| | - Alexander T Sack
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Zhongfei Bai
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Centre), School of Medicine, Tongji University, Shanghai, China
| | - Patrick W H Kwong
- Department of Rehabilitation Sciences, 26680 The Hong Kong Polytechnic University , Hong Kong SAR, China
| | | | - Li Xiong
- Clinical Trials Centre, 26469 The Eighth Affiliated Hospital of Sun Yat-Sen University , Shenzhen, China
| | - Kenneth N K Fong
- Department of Rehabilitation Sciences, 26680 The Hong Kong Polytechnic University , Hong Kong SAR, China
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2
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Huang Y, Zelmann R, Hadar P, Dezha-Peralta J, Richardson RM, Williams ZM, Cash SS, Keller CJ, Paulk AC. Theta-burst direct electrical stimulation remodels human brain networks. Nat Commun 2024; 15:6982. [PMID: 39143083 PMCID: PMC11324911 DOI: 10.1038/s41467-024-51443-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 08/07/2024] [Indexed: 08/16/2024] Open
Abstract
Theta-burst stimulation (TBS), a patterned brain stimulation technique that mimics rhythmic bursts of 3-8 Hz endogenous brain rhythms, has emerged as a promising therapeutic approach for treating a wide range of brain disorders, though the neural mechanism of TBS action remains poorly understood. We investigated the neural effects of TBS using intracranial EEG (iEEG) in 10 pre-surgical epilepsy participants undergoing intracranial monitoring. Here we show that individual bursts of direct electrical TBS at 29 frontal and temporal sites evoked strong neural responses spanning broad cortical regions. These responses exhibited dynamic local field potential voltage changes over the course of stimulation presentations, including either increasing or decreasing responses, suggestive of short-term plasticity. Stronger stimulation augmented the mean TBS response amplitude and spread with more recording sites demonstrating short-term plasticity. TBS responses were stimulation site-specific with stronger TBS responses observed in regions with strong baseline stimulation effective (cortico-cortical evoked potentials) and functional (low frequency phase locking) connectivity. Further, we could use these measures to predict stable and varying (e.g. short-term plasticity) TBS response locations. Future work may integrate pre-treatment connectivity alongside other biophysical factors to personalize stimulation parameters, thereby optimizing induction of neuroplasticity within disease-relevant brain networks.
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Affiliation(s)
- Yuhao Huang
- Department of Neurosurgery, Stanford University, Palo Alto, CA, USA
| | - Rina Zelmann
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Peter Hadar
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jaquelin Dezha-Peralta
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - R Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ziv M Williams
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Sydney S Cash
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Corey J Keller
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA.
- Wu Tsai Neurosciences Institute, Stanford University, Palo Alto, CA, USA.
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, USA.
| | - Angelique C Paulk
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
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Ebrahimi S, van der Voort B, Ostry DJ. The Consolidation of Newly Learned Movements Depends upon the Somatosensory Cortex in Humans. J Neurosci 2024; 44:e0629242024. [PMID: 38871461 PMCID: PMC11308319 DOI: 10.1523/jneurosci.0629-24.2024] [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: 04/03/2024] [Revised: 05/26/2024] [Accepted: 05/30/2024] [Indexed: 06/15/2024] Open
Abstract
Studies using magnetic brain stimulation indicate the involvement of somatosensory regions in the acquisition and retention of newly learned movements. Recent work found an impairment in motor memory when retention was tested shortly after the application of continuous theta-burst stimulation (cTBS) to the primary somatosensory cortex, compared with stimulation of the primary motor cortex or a control zone. This finding that the somatosensory cortex is involved in motor memory retention whereas the motor cortex is not, if confirmed, could alter our understanding of human motor learning. It would indicate that plasticity in sensory systems underlies newly learned movements, which is different than the commonly held view that adaptation learning involves updates to a motor controller. Here we test this idea. Participants were trained in a visuomotor adaptation task, with visual feedback gradually shifted. Following adaptation, cTBS was applied either to M1, S1, or an occipital cortex control area. Participants were tested for retention 24 h later. It was observed that S1 stimulation led to reduced retention of prior learning, compared with stimulation of M1 or the control area (with no significant difference between M1 and control). In a further control, cTBS was applied to S1 following training with unrotated feedback, in which no learning occurred. This had no effect on movement in the retention test indicating the effects of S1 stimulation on movement are learning specific. The findings are consistent with the S1 participation in the encoding of learning-related changes to movements and in the retention of human motor memory.
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Affiliation(s)
- Shahryar Ebrahimi
- Department of Psychology, McGill University, Montreal, Quebec H3A1G1, Canada
| | - Bram van der Voort
- Department of Psychology and Educational Sciences, KU Leuven, Leuven, Flemish Brabant 3000, Belgium
| | - David J Ostry
- Department of Psychology, McGill University, Montreal, Quebec H3A1G1, Canada
- Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut 06511
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Hodkinson DJ, Drabek MM, Jung J, Lankappa ST, Auer DP. Theta Burst Stimulation of the Human Motor Cortex Modulates Secondary Hyperalgesia to Punctate Mechanical Stimuli. Neuromodulation 2024; 27:812-823. [PMID: 37952136 DOI: 10.1016/j.neurom.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/19/2023] [Accepted: 10/03/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES Many chronic pain conditions show evidence of dysregulated synaptic plasticity, including the development and maintenance of central sensitization. This provides a strong rationale for neuromodulation therapies for the relief of chronic pain. However, variability in responses and low fidelity across studies remain an issue for both clinical trials and pain management, demonstrating insufficient mechanistic understanding of effective treatment protocols. MATERIALS AND METHODS In a randomized counterbalanced crossover designed study, we evaluated two forms of patterned repetitive transcranial magnetic stimulation, known as continuous theta burst stimulation (TBS) and intermittent TBS, during normal and central sensitization states. Secondary hyperalgesia (a form of use-dependent central sensitization) was induced using a well-established injury-free pain model and assessed by standardized quantitative sensory testing involving light touch and pinprick pain thresholds in addition to stimulus-response functions. RESULTS We found that continuous TBS of the human motor cortex has a facilitatory (pronociceptive) effect on the magnitude of perceived pain to secondary hyperalgesia, which may rely on induction and expression of neural plasticity through heterosynaptic long-term potentiation-like mechanisms. CONCLUSIONS By defining the underlying mechanisms of TBS-driven synaptic plasticity in the nociceptive system, we offer new insight into disease mechanisms and provide targets for promoting functional recovery and repair in chronic pain. For clinical applications, this knowledge is critical for development of more efficacious and mechanisms-based neuromodulation protocols, which are urgently needed to address the chronic pain and opioid epidemics.
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Affiliation(s)
- Duncan J Hodkinson
- Division of Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK; Sir Peter Mansfield Imaging Center, School of Medicine, University of Nottingham, Nottingham, UK; National Institute for Health Research, Nottingham Biomedical Research Center, Queens Medical Center, Nottingham, UK.
| | - Marianne M Drabek
- Division of Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK; Sir Peter Mansfield Imaging Center, School of Medicine, University of Nottingham, Nottingham, UK; National Institute for Health Research, Nottingham Biomedical Research Center, Queens Medical Center, Nottingham, UK
| | - JeYoung Jung
- School of Psychology, University of Nottingham, Nottingham, UK
| | - Sudheer T Lankappa
- Nottinghamshire Healthcare National Health Service Foundation Trust, Nottingham, UK
| | - Dorothee P Auer
- Division of Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK; Sir Peter Mansfield Imaging Center, School of Medicine, University of Nottingham, Nottingham, UK; National Institute for Health Research, Nottingham Biomedical Research Center, Queens Medical Center, Nottingham, UK
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Lin H, Liang J, Wang Q, Shao Y, Song P, Li S, Bai Y. Effects of accelerated intermittent theta-burst stimulation in modulating brain of Alzheimer's disease. Cereb Cortex 2024; 34:bhae106. [PMID: 38517175 DOI: 10.1093/cercor/bhae106] [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: 09/20/2023] [Revised: 01/27/2024] [Accepted: 02/16/2024] [Indexed: 03/23/2024] Open
Abstract
Intermittent theta-burst stimulation (iTBS) is emerging as a noninvasive therapeutic strategy for Alzheimer's disease (AD). Recent advances highlighted a new accelerated iTBS (aiTBS) protocol, consisting of multiple sessions per day and higher overall pulse doses, in brain modulation. To examine the possibility of applying the aiTBS in treating AD patients, we enrolled 45 patients in AD at early clinical stages, and they were randomly assigned to either receive real or sham aiTBS. Neuropsychological scores were evaluated before and after treatment. Moreover, we detected cortical excitability and oscillatory activity changes in AD, by the single-pulse TMS in combination with EEG (TMS-EEG). Real stimulation showed markedly better performances in the group average of Auditory Verbal Learning Test scores compared to baseline. TMS-EEG revealed that aiTBS has reinforced this memory-related cortical mechanism by increasing cortical excitability and beta oscillatory activity underlying TMS target. We also found an enhancement of local natural frequency after aiTBS treatment. The novel findings implicated that high-dose aiTBS targeting left DLPFC is rapid-acting, safe, and tolerable in AD patients. Furthermore, TMS-related increase of specific neural oscillation elucidates the mechanisms of the AD cognitive impairment ameliorated by aiTBS.
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Affiliation(s)
- Hua Lin
- Department of Neurology, Xuanwu Hospital, Capital Medical University, 45th, Changchun Street, Beijing 100053, China
| | - Junhua Liang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, 45th, Changchun Street, Beijing 100053, China
| | - Qianqian Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, 45th, Changchun Street, Beijing 100053, China
| | - Yuxuan Shao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, 45th, Changchun Street, Beijing 100053, China
| | - Penghui Song
- Department of Neurology, Xuanwu Hospital, Capital Medical University, 45th, Changchun Street, Beijing 100053, China
| | - Siran Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, 45th, Changchun Street, Beijing 100053, China
| | - Yang Bai
- Affiliated Rehabilitation Hospital, Jiangxi Medical College, Nanchang University, 133th, south road of square Street, Nanchang 330006, Jiangxi, China
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Ebrahimi S, Ostry DJ. The human somatosensory cortex contributes to the encoding of newly learned movements. Proc Natl Acad Sci U S A 2024; 121:e2316294121. [PMID: 38285945 PMCID: PMC10861869 DOI: 10.1073/pnas.2316294121] [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: 09/20/2023] [Accepted: 12/28/2023] [Indexed: 01/31/2024] Open
Abstract
Recent studies have indicated somatosensory cortex involvement in motor learning and retention. However, the nature of its contribution is unknown. One possibility is that the somatosensory cortex is transiently engaged during movement. Alternatively, there may be durable learning-related changes which would indicate sensory participation in the encoding of learned movements. These possibilities are dissociated by disrupting the somatosensory cortex following learning, thus targeting learning-related changes which may have occurred. If changes to the somatosensory cortex contribute to retention, which, in effect, means aspects of newly learned movements are encoded there, disruption of this area once learning is complete should lead to an impairment. Participants were trained to make movements while receiving rotated visual feedback. The primary motor cortex (M1) and the primary somatosensory cortex (S1) were targeted for continuous theta-burst stimulation, while stimulation over the occipital cortex served as a control. Retention was assessed using active movement reproduction, or recognition testing, which involved passive movements produced by a robot. Disruption of the somatosensory cortex resulted in impaired motor memory in both tests. Suppression of the motor cortex had no impact on retention as indicated by comparable retention levels in control and motor cortex conditions. The effects were learning specific. When stimulation was applied to S1 following training with unrotated feedback, movement direction, the main dependent variable, was unaltered. Thus, the somatosensory cortex is part of a circuit that contributes to retention, consistent with the idea that aspects of newly learned movements, possibly learning-updated sensory states (new sensory targets) which serve to guide movement, may be encoded there.
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Affiliation(s)
- Shahryar Ebrahimi
- Department of Psychology, McGill University, Montreal, QC H3A1G1, Canada
| | - David J Ostry
- Department of Psychology, McGill University, Montreal, QC H3A1G1, Canada
- Yale Child Study Center, Yale School of Medicine, New Haven, CT 06519
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7
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Austin D, Rothwell J. Test-retest reliability of spaced continuous theta-burst stimulation over six months. Clin Neurophysiol 2023; 156:140-142. [PMID: 37948947 DOI: 10.1016/j.clinph.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 10/22/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Duncan Austin
- Monash University - Central Clinical School, Alfred Centre, 99 Commercial Road, Melbourne, Victoria, Australia; UCL Queen Square Institute of Neurology, 33 Queen Square, London, UK.
| | - John Rothwell
- UCL Queen Square Institute of Neurology, 33 Queen Square, London, UK
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Darainy M, Manning TF, Ostry DJ. Disruption of somatosensory cortex impairs motor learning and retention. J Neurophysiol 2023; 130:1521-1528. [PMID: 37964765 DOI: 10.1152/jn.00231.2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 11/16/2023] Open
Abstract
This study tests for a function of the somatosensory cortex, that, in addition to its role in processing somatic afferent information, somatosensory cortex contributes both to motor learning and the stabilization of motor memory. Continuous theta-burst magnetic stimulation (cTBS) was applied, before force-field training to disrupt activity in either the primary somatosensory cortex, primary motor cortex, or a control zone over the occipital lobe. Tests for retention and relearning were conducted after a 24 h delay. Analysis of movement kinematic measures and force-channel trials found that cTBS to somatosensory cortex disrupted both learning and subsequent retention, whereas cTBS to motor cortex had little effect on learning but possibly impaired retention. Basic movement variables are unaffected by cTBS suggesting that the stimulation does not interfere with movement but instead disrupts changes in the cortex that are necessary for learning. In all experimental conditions, relearning in an abruptly introduced force field, which followed retention testing, showed extensive savings, which is consistent with previous work suggesting that more cognitive aspects of learning and retention are not dependent on either of the cortical zones under test. Taken together, the findings are consistent with the idea that motor learning is dependent on learning-related activity in the somatosensory cortex.NEW & NOTEWORTHY This study uses noninvasive transcranial magnetic stimulation to test the contribution of somatosensory and motor cortex to human motor learning and retention. Continuous theta-burst stimulation is applied before learning; participants return 24 h later to assess retention. Disruption of the somatosensory cortex is found to impair both learning and retention, whereas disruption of the motor cortex has no effect on learning. The findings are consistent with the idea that motor learning is dependent upon learning-related plasticity in somatosensory cortex.
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Affiliation(s)
- Mohammad Darainy
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Timothy F Manning
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - David J Ostry
- Department of Psychology, McGill University, Montreal, Quebec, Canada
- Child Study Center, Yale School of Medicine, Yale University, New Haven, Connecticut, United States
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Joseph JT, Jammigumpula A, Praharaj SK, Purohit AN, Shenoy S. Tolerability of Accelerated Theta Burst Stimulation for Treatment-Resistant Obsessive-Compulsive Disorder: A Case Report. J ECT 2023; 39:e1-e2. [PMID: 36897119 DOI: 10.1097/yct.0000000000000904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
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10
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Wrightson JG, Cole J, Sohn MN, McGirr A. The effects of D-Cycloserine on corticospinal excitability after repeated spaced intermittent theta-burst transcranial magnetic stimulation: A randomized controlled trial in healthy individuals. Neuropsychopharmacology 2023; 48:1217-1224. [PMID: 37041205 PMCID: PMC10267195 DOI: 10.1038/s41386-023-01575-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 04/13/2023]
Abstract
Repeated spaced TMS protocols, also termed accelerated TMS protocols, are of increasing therapeutic interest. The long-term potentiation (LTP)-like effects of repeated spaced intermittent theta-burst transcranial magnetic stimulation (iTBS) are presumed to be N-Methyl-D-Aspartate receptor (NMDA-R) dependent; however, this has not been tested. We tested whether the LTP-like effects of repeated spaced iTBS are influenced by low-dose D-Cycloserine (100 mg), an NMDA-R partial-agonist. We conducted a randomized, double-blind, placebo-controlled crossover trial in 20 healthy adults from August 2021-Feb 2022. Participants received repeated spaced iTBS, consisting of two iTBS sessions 60 minutes apart, to the primary motor cortex. The peak-to-peak amplitude of the motor evoked potentials (MEP) at 120% resting motor threshold (RMT) was measured after each iTBS. The TMS stimulus-response (TMS-SR; 100-150% RMT) was measured at baseline, +30 min, and +60 min after each iTBS. We found evidence for a significant Drug*iTBS effect in MEP amplitude, revealing that D-Cycloserine enhanced MEP amplitudes relative to the placebo. When examining TMS-SR, pairing iTBS with D-Cycloserine increased the TMS-SR slope relative to placebo after both iTBS tetani, and this was due to an increase in the upper bound of the TMS-SR. This indicates that LTP-like and metaplastic effects of repeated-spaced iTBS involve NMDA-R, as revealed by two measures of corticospinal excitability, and that low-dose D-Cycloserine facilitates the physiological effects of repeated spaced iTBS. However, extension of these findings to clinical populations and therapeutic protocols targeting non-motor regions of cortex requires empirical validation.
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Affiliation(s)
- James G Wrightson
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Jaeden Cole
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Mathison Centre for Mental Health Research and Education, Calgary, AB, Canada
| | - Maya N Sohn
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Mathison Centre for Mental Health Research and Education, Calgary, AB, Canada
| | - Alexander McGirr
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Mathison Centre for Mental Health Research and Education, Calgary, AB, Canada.
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Champagne PL, Blanchette AK, Schneider C. Continuous, and not intermittent, theta-burst stimulation of the unlesioned hemisphere improved brain and hand function in chronic stroke: A case study. BRAIN DISORDERS 2023. [DOI: 10.1016/j.dscb.2022.100062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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12
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Liu Y, Lim K, Sundman MH, Ugonna C, Ton That V, Cowen S, Chou YH. Association Between Responsiveness to Transcranial Magnetic Stimulation and Interhemispheric Functional Connectivity of Sensorimotor Cortex in Older Adults. Brain Connect 2023; 13:39-50. [PMID: 35620910 PMCID: PMC9942174 DOI: 10.1089/brain.2021.0180] [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] [Indexed: 11/13/2022] Open
Abstract
Introduction: Repetitive transcranial magnetic stimulation (rTMS) is a promising therapeutic technique, and is believed to accomplish its effect by influencing the stimulated and remotely connected areas. However, responsiveness to rTMS shows high interindividual variability, and this intersubject variability is particularly high in older adults. It remains unclear whether baseline resting-state functional connectivity (rsFC) contributes to this variability in older adults. The aims of this study are to (1) examine rTMS effects over the primary motor cortex (M1) in older adults, and (2) identify baseline network properties that may contribute to the interindividual variability. Methods: We tested response to intermittent theta burst stimulation (iTBS), an effective rTMS protocol, over M1 by using both electromyography and resting-state functional magnetic resonance imaging in older adults. Outcome measures included motor-evoked potential (MEP) elicited by single-pulse transcranial magnetic stimulation and rsFC before and after an iTBS session. Results: iTBS significantly increased MEP amplitudes and rsFC between the stimulation site, sensorimotor cortex, and supplementary motor area (SMA) in older adults. iTBS-induced changes in MEP amplitude were positively correlated with increases in interhemispheric rsFC after iTBS. Furthermore, older adults with lower baseline interhemispheric rsFC between sensorimotor cortex and SMA exhibited stronger MEP response after iTBS. Discussion: Findings of the study suggest that different levels of interhemispheric communication during resting state might contribute to the response heterogeneity to iTBS in older adults. Interhemispheric rsFC may have great potential serving as a useful marker for predicting iTBS responsiveness in older adults. ClinicalTrials.gov ID: 1707654427 Impact statement Factors contributing to interindividual variability of the responsive to repetitive transcranial magnetic stimulation (rTMS) in older adults remain poorly understood. In this study, we examined the effects of rTMS over the primary motor cortex in older adults, and found that response to rTMS is associated with prestimulation interhemispheric connectivity in the sensorimotor and premotor areas. Findings of the study have great potential to be translated into a connectivity-based strategy for identification of responders for rTMS in older adults.
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Affiliation(s)
- Yilin Liu
- Department of Psychology and University of Arizona, Tucson, Arizona, USA
| | - Koeun Lim
- Department of Psychology and University of Arizona, Tucson, Arizona, USA
| | - Mark H. Sundman
- Department of Psychology and University of Arizona, Tucson, Arizona, USA
| | - Chidi Ugonna
- Department of Psychology and University of Arizona, Tucson, Arizona, USA
- Department of Biomedical Engineering, University of Arizona, Tucson, Arizona, USA
| | - Viet Ton That
- Department of Psychology and University of Arizona, Tucson, Arizona, USA
| | - Stephen Cowen
- Department of Psychology and University of Arizona, Tucson, Arizona, USA
- Evelyn F McKnight Brain Institute, Arizona Center on Aging, and BIO5 Institute, University of Arizona, Tucson, Arizona, USA
| | - Ying-hui Chou
- Department of Psychology and University of Arizona, Tucson, Arizona, USA
- Evelyn F McKnight Brain Institute, Arizona Center on Aging, and BIO5 Institute, University of Arizona, Tucson, Arizona, USA
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Ni HC, Chao YP, Tseng RY, Wu CT, Cocchi L, Chou TL, Chen RS, Gau SSF, Yeh CH, Lin HY. Lack of effects of four-week theta burst stimulation on white matter macro/microstructure in children and adolescents with autism. Neuroimage Clin 2023; 37:103324. [PMID: 36638598 PMCID: PMC9852693 DOI: 10.1016/j.nicl.2023.103324] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 12/18/2022] [Accepted: 01/05/2023] [Indexed: 01/09/2023]
Abstract
Following the published behavioral and cognitive results of this single-blind parallel sham-controlled randomized clinical trial, the current study aimed to explore the impact of intermittent theta burst stimulation (iTBS), a variant of excitatory transcranial magnetic stimulation, over the bilateral posterior superior temporal sulci (pSTS) on white matter macro/microstructure in intellectually able children and adolescents with autism. Participants were randomized and blindly received active or sham iTBS for 4 weeks (the single-blind sham-controlled phase). Then, all participants continued to receive active iTBS for another 4 weeks (the open-label phase). The clinical results were published elsewhere. Here, we present diffusion magnetic resonance imaging data on potential changes in white matter measures after iTBS. Twenty-two participants in Active-Active group and 27 participants in Sham-Active group underwent multi-shell high angular resolution diffusion imaging (64-direction for b = 2000 & 1000 s/mm2, respectively) at baseline, week 4, and week 8. With longitudinal fixel-based analysis, we found no white matter changes following iTBS from baseline to week 4 (a null treatment by time interaction and a null within-group paired comparison in the Active-Active group), nor from baseline to week 8 (null within-group paired comparisons in both Active-Active and Sham-Active groups). As for the brain-symptoms relationship, we did not find baseline white matter metrics associated with symptom changes at week 4 in either group. Our results raise the question of what the minimal cumulative stimulation dose required to induce the white matter plasticity is.
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Affiliation(s)
- Hsing-Chang Ni
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yi-Ping Chao
- Deparment of Computer Science and Information Engineering, Chang Gung University, Taoyuan, Taiwan; Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Rung-Yu Tseng
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Institute for Radiological Research, Chang Gung University, Taoyuan, Taiwan
| | - Chen-Te Wu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Luca Cocchi
- Clinical Brain Networks Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Tai-Li Chou
- Department of Psychology, National Taiwan University, Taipei, Taiwan; Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan; Neurobiology and Cognitive Science Center, National Taiwan University, Taipei, Taiwan
| | - Rou-Shayn Chen
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Susan Shur-Fen Gau
- Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Chun-Hung Yeh
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Institute for Radiological Research, Chang Gung University, Taoyuan, Taiwan.
| | - Hsiang-Yuan Lin
- Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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14
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Brunelin J, Galvao F, Mondino M. Twice daily low frequency rTMS for treatment-resistant auditory hallucinations. Int J Clin Health Psychol 2023; 23:100344. [PMID: 36299491 PMCID: PMC9577245 DOI: 10.1016/j.ijchp.2022.100344] [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: 07/21/2022] [Accepted: 09/29/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) has emerged as a therapeutic solution in patients with treatment-resistant auditory verbal hallucinations. However, the optimal stimulation parameters remain unclear, especially for patients with clozapine-resistant symptoms. METHOD In an open label retrospective study, we investigated whether parameters of stimulation that were useful in patients with major depressive disorder would help schizophrenia patients with treatment-resistant auditory verbal hallucinations. Fourteen participants, including 9 under clozapine, received 30 sessions of 1 Hz rTMS over 3 weeks (360 pulses per sessions delivered with 60 s 'on' and 30 s 'off' at 110% of the resting motor threshold, 2 sessions per day). Stimulations were applied over the left temporoparietal junction (T3-P3 according to 10/20 system). RESULTS After rTMS, a significant decrease of auditory verbal hallucinations was observed (-38.7% ± 31.8, p = 0.003) on the Auditory Hallucination Rating Scale. The beneficial effects were also significant in the 9 patients who were also receiving clozapine (-34.9% ± 28.4, p = 0.01). CONCLUSIONS Low frequency rTMS, 30 sessions over 3 weeks, appears to be a suitable approach to decrease treatment-resistant auditory verbal hallucinations, including in patients with clozapine-resistant symptoms. Results from the current retrospective study in the clinical settings need to be confirmed by large-scale randomized sham-controlled trials.
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Affiliation(s)
- Jérôme Brunelin
- Pôle Est, Centre Hospitalier Le Vinatier, F69500 Bron, France,PSYR2 Team, Lyon Neuroscience Research Center, INSERM, U1028, CNRS, UMR5292, F-69000 Lyon, France,Université Lyon 1, Lyon University, F-69100 Villeurbanne, France,Corresponding author at: CH le Vinatier, PSYR2 team, bat 416 – 1st floor, 95 boulevard Pinel, 69678, BRON Cedex BP 30039, France.
| | - Filipe Galvao
- Pôle Est, Centre Hospitalier Le Vinatier, F69500 Bron, France,PSYR2 Team, Lyon Neuroscience Research Center, INSERM, U1028, CNRS, UMR5292, F-69000 Lyon, France,Université Lyon 1, Lyon University, F-69100 Villeurbanne, France
| | - Marine Mondino
- Pôle Est, Centre Hospitalier Le Vinatier, F69500 Bron, France,PSYR2 Team, Lyon Neuroscience Research Center, INSERM, U1028, CNRS, UMR5292, F-69000 Lyon, France,Université Lyon 1, Lyon University, F-69100 Villeurbanne, France
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15
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Romero MC, Merken L, Janssen P, Davare M. Neural effects of continuous theta-burst stimulation in macaque parietal neurons. eLife 2022; 11:e65536. [PMID: 36097816 PMCID: PMC9470151 DOI: 10.7554/elife.65536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
Theta-burst transcranial magnetic stimulation (TBS) has become a standard non-invasive technique to induce offline changes in cortical excitability in human volunteers. Yet, TBS suffers from a high variability across subjects. A better knowledge about how TBS affects neural activity in vivo could uncover its mechanisms of action and ultimately allow its mainstream use in basic science and clinical applications. To address this issue, we applied continuous TBS (cTBS, 300 pulses) in awake behaving rhesus monkeys and quantified its after-effects on neuronal activity. Overall, we observed a pronounced, long-lasting, and highly reproducible reduction in neuronal excitability after cTBS in individual parietal neurons, with some neurons also exhibiting periods of hyperexcitability during the recovery phase. These results provide the first experimental evidence of the effects of cTBS on single neurons in awake behaving monkeys, shedding new light on the reasons underlying cTBS variability.
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Affiliation(s)
- Maria C Romero
- Laboratorium voor Neuro- en Psychofysiologie, The Leuven Brain InstituteLeuvenBelgium
| | - Lara Merken
- Laboratorium voor Neuro- en Psychofysiologie, The Leuven Brain InstituteLeuvenBelgium
| | - Peter Janssen
- Laboratorium voor Neuro- en Psychofysiologie, The Leuven Brain InstituteLeuvenBelgium
| | - Marco Davare
- Faculty of Life Sciences and Medicine, King's College LondonLondonUnited Kingdom
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16
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Mukherjee A, Kumre PK, Goyal N, Khanra S. Adjunctive neuronavigated accelerated continuous theta-burst stimulation in obsessive-compulsive disorder: a randomized sham-controlled study. CNS Spectr 2022; 28:1-10. [PMID: 36059099 DOI: 10.1017/s1092852922000980] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Approximately 40% of patients treated for obsessive-compulsive disorder (OCD) do not respond to standard and second-line augmentation treatments leading to the exploration of alternate biological treatments. Continuous theta burst stimulation (cTBS) is a form of repetitive transcranial magnetic stimulation inducing more rapid and longer-lasting effects on synaptic plasticity than the latter. To the best of our knowledge, only one recent study and a case report investigated the effect of cTBS at the supplementary motor area (SMA) in OCD. OBJECTIVE This study aimed to examine the effect of accelerated robotized neuronavigated cTBS over SMA in patients with OCD. METHODS A total of 32 patients with OCD were enrolled and randomized into active and sham cTBS groups. For active cTBS stimulation, an accelerated protocol was used. Bursts of three stimuli at 50 Hz, at 80% of MT, repeated at 5 Hz were used. Daily 2 sessions of 900 pulses each, for a total of 30 sessions over 3 wk (weekly 10 sessions), were given. Yale-Brown Obsessive-Compulsive Rating Scale (YBOCS), Clinical Global Impressions scale (CGI), Hamilton Depression Rating Scale (HAM-D), and Hamilton Anxiety Rating Scale (HAM-A) were administered at baseline and at end of weeks 3 and 8. RESULTS A total of 26 patients completed the study. Active cTBS group showed significant group × time effect in YBOCS obsession (P < .001, η2 = 0.288), compulsion (P = .004, η2 = 0.207), YBOCS total (P < .001, η2 = 0.288), CGI-S (P = .010, η2 = 0.248), CGI-C (P = .010, η2 = 0.248), HAM-D (P = .014, η2 = 0.224) than sham cTBS group. CONCLUSIONS Findings from our study suggest that adjunctive accelerated cTBS significantly improves psychopathology, severity of illness, and depression among patients with OCD. Future studies with larger sample sizes will add to our knowledge.
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Affiliation(s)
- Aniruddha Mukherjee
- Centre for Cognitive Neuroscience, Central Institute of Psychiatry, Ranchi, India
| | - Pramod Kumar Kumre
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, India
| | - Nishant Goyal
- Centre for Cognitive Neuroscience, Central Institute of Psychiatry, Ranchi, India
| | - Sourav Khanra
- Centre for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi, India
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17
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Neurochemical profiles of the anterior temporal lobe predict response of repetitive transcranial magnetic stimulation on semantic processing. Neuroimage 2022; 258:119386. [PMID: 35709948 DOI: 10.1016/j.neuroimage.2022.119386] [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: 01/24/2022] [Revised: 05/23/2022] [Accepted: 06/12/2022] [Indexed: 10/18/2022] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive technique used to modulate cortical excitability in the human brain. However, one major challenge with rTMS is that the responses to stimulation are highly variable across individuals. The underlying reasons why responses to rTMS are highly variable between individuals still remain unclear. Here, we investigated whether the response to continuous theta-burst stimulation (cTBS) - an effective rTMS protocol for decreasing cortical excitability - is related to individual differences in glutamate and GABA neurotransmission. We acquired resting-state magnetic resonance spectroscopy (MRS) and functional magnetic resonance imaging (fMRI) during semantic processing. Then, we applied cTBS over the anterior temporal lobe (ATL), a hub for semantic representation, to explore the relationship between the baseline neurochemical profiles in this region and the response to cTBS. We found that the baseline excitation-inhibition balance (glutamate + glutamine/GABA ratio) in the ATL was associated with individual cTBS responsiveness during semantic processing. Specifically, individuals with lower excitation-inhibition balance showed stronger inhibitory effect - poorer semantic performance. Our results revealed that non-responders (subjects who did not show an inhibitory effect of cTBS on subsequent semantic performance) had higher excitatory-inhibitory balance in the ATL, which led to up-regulated task-induced regional activity as well as increased ATL-connectivity with other semantic regions compared to responders. These results disclose that the baseline neurochemical state of a cortical region can be a significant factor in predicting responses to cTBS.
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18
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Bakulin I, Zabirova A, Sinitsyn D, Poydasheva A, Lagoda D, Suponeva N, Piradov M. Adding a Second iTBS Block in 15 or 60 Min Time Interval Does Not Increase iTBS Effects on Motor Cortex Excitability and the Responder Rates. Brain Sci 2022; 12:brainsci12081064. [PMID: 36009127 PMCID: PMC9405900 DOI: 10.3390/brainsci12081064] [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: 07/13/2022] [Revised: 08/06/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
The use of metaplasticity-based intermittent theta-burst stimulation (iTBS) protocols including several stimulation blocks could be a possible approach to increasing stimulation effectiveness. Our aim was to investigate the neurophysiological effects of two protocols with a short and a long interval between blocks. Seventeen healthy volunteers received four protocols in a pseudorandomized order: iTBS 0-15 (two blocks of active iTBS of primary motor cortex (M1) separated by 15 min and a control stimulation block of the vertex in 60 min from the first block); iTBS 0-60 (active iTBS, a control block in 15 min, and an active block in 60 min); iTBS 0 (active iTBS and two control blocks with the same intervals); and Control (three control blocks). The motor evoked potentials (MEPs) were measured before the first and after the second and third blocks. We have shown no significant differences between the effects of the protocols on both the motor cortex excitability and the responder rates. No significant changes of MEPs were observed after all the protocols. The reliability for the responsiveness to a single block between two sessions was insignificant. Our data confirm low reproducibility of the response to iTBS and suggest that the use of repeated protocols does not increase the responder rates or neurophysiological effects of iTBS.
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19
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Boccuni L, Marinelli L, Trompetto C, Pascual-Leone A, Tormos Muñoz JM. Time to reconcile research findings and clinical practice on upper limb neurorehabilitation. Front Neurol 2022; 13:939748. [PMID: 35928130 PMCID: PMC9343948 DOI: 10.3389/fneur.2022.939748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
The problemIn the field of upper limb neurorehabilitation, the translation from research findings to clinical practice remains troublesome. Patients are not receiving treatments based on the best available evidence. There are certainly multiple reasons to account for this issue, including the power of habit over innovation, subjective beliefs over objective results. We need to take a step forward, by looking at most important results from randomized controlled trials, and then identify key active ingredients that determined the success of interventions. On the other hand, we need to recognize those specific categories of patients having the greatest benefit from each intervention, and why. The aim is to reach the ability to design a neurorehabilitation program based on motor learning principles with established clinical efficacy and tailored for specific patient's needs.Proposed solutionsThe objective of the present manuscript is to facilitate the translation of research findings to clinical practice. Starting from a literature review of selected neurorehabilitation approaches, for each intervention the following elements were highlighted: definition of active ingredients; identification of underlying motor learning principles and neural mechanisms of recovery; inferences from research findings; and recommendations for clinical practice. Furthermore, we included a dedicated chapter on the importance of a comprehensive assessment (objective impairments and patient's perspective) to design personalized and effective neurorehabilitation interventions.ConclusionsIt's time to reconcile research findings with clinical practice. Evidence from literature is consistently showing that neurological patients improve upper limb function, when core strategies based on motor learning principles are applied. To this end, practical take-home messages in the concluding section are provided, focusing on the importance of graded task practice, high number of repetitions, interventions tailored to patient's goals and expectations, solutions to increase and distribute therapy beyond the formal patient-therapist session, and how to integrate different interventions to maximize upper limb motor outcomes. We hope that this manuscript will serve as starting point to fill the gap between theory and practice in upper limb neurorehabilitation, and as a practical tool to leverage the positive impact of clinicians on patients' recovery.
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Affiliation(s)
- Leonardo Boccuni
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
- *Correspondence: Leonardo Boccuni
| | - Lucio Marinelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Department of Neuroscience, Division of Clinical Neurophysiology, Genova, Italy
| | - Carlo Trompetto
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Department of Neuroscience, Division of Neurorehabilitation, Genova, Italy
| | - Alvaro Pascual-Leone
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Spain
- Hinda and Arthur Marcus Institute for Aging Research and Deanna and Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Boston, MA, United States
- Department of Neurology and Harvard Medical School, Boston, MA, United States
| | - José María Tormos Muñoz
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
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20
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Priming the pump? Evaluating the effect of multiple intermittent theta burst sessions on cortical excitability in a nonhuman primate model. Brain Stimul 2022; 15:676-677. [DOI: 10.1016/j.brs.2022.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/31/2022] [Accepted: 04/02/2022] [Indexed: 11/18/2022] Open
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21
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Suppa A, Asci F, Guerra A. Transcranial magnetic stimulation as a tool to induce and explore plasticity in humans. HANDBOOK OF CLINICAL NEUROLOGY 2022; 184:73-89. [PMID: 35034759 DOI: 10.1016/b978-0-12-819410-2.00005-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Activity-dependent synaptic plasticity is the main theoretical framework to explain mechanisms of learning and memory. Synaptic plasticity can be explored experimentally in animals through various standardized protocols for eliciting long-term potentiation and long-term depression in hippocampal and cortical slices. In humans, several non-invasive protocols of repetitive transcranial magnetic stimulation and transcranial direct current stimulation have been designed and applied to probe synaptic plasticity in the primary motor cortex, as reflected by long-term changes in motor evoked potential amplitudes. These protocols mimic those normally used in animal studies for assessing long-term potentiation and long-term depression. In this chapter, we first discuss the physiologic basis of theta-burst stimulation, paired associative stimulation, and transcranial direct current stimulation. We describe the current biophysical and theoretical models underlying the molecular mechanisms of synaptic plasticity and metaplasticity, defined as activity-dependent changes in neural functions that modulate subsequent synaptic plasticity such as long-term potentiation (LTP) and long-term depression (LTD), in the human motor cortex including calcium-dependent plasticity, spike-timing-dependent plasticity, the role of N-methyl-d-aspartate-related transmission and gamma-aminobutyric-acid interneuronal activity. We also review the putative microcircuits responsible for synaptic plasticity in the human motor cortex. We critically readdress the issue of variability in studies investigating synaptic plasticity and propose available solutions. Finally, we speculate about the utility of future studies with more advanced experimental approaches.
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Affiliation(s)
- Antonio Suppa
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed Institute, Pozzilli (IS), Italy.
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22
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Repetitive Transcranial Magnetic Stimulation for Comorbid Major Depressive Disorder and Alcohol Use Disorder. Brain Sci 2021; 12:brainsci12010048. [PMID: 35053792 PMCID: PMC8773947 DOI: 10.3390/brainsci12010048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 12/24/2022] Open
Abstract
Major depressive disorder (MDD) and alcohol use disorder (AUD) are leading causes of disability, and patients are frequently affected by both conditions. This comorbidity is known to confer worse outcomes and greater illness severity. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation method that has demonstrated antidepressant effects. However, the study of rTMS for patients with MDD and commonly associated comorbidities, such as AUD, has been largely overlooked, despite significant overlap in clinical presentation and neurobiological mechanisms. This narrative review aims to highlight the interrelated aspects of the literature on rTMS for MDD and rTMS for AUD. First, we summarize the available evidence on the effectiveness of rTMS for each condition, both most studied through stimulation of the dorsolateral prefrontal cortex (DLPFC). Second, we describe common symptom constructs that can be modulated by rTMS, such as executive dysfunction, that are transdiagnostic across these disorders. Lastly, we describe promising approaches in the personalization and optimization of rTMS that may be applicable to both AUD and MDD. By bridging the gap between research efforts in MDD and AUD, rTMS is well positioned to be developed as a treatment for the many patients who have both conditions concurrently.
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23
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Janssens SEW, Sack AT. Spontaneous Fluctuations in Oscillatory Brain State Cause Differences in Transcranial Magnetic Stimulation Effects Within and Between Individuals. Front Hum Neurosci 2021; 15:802244. [PMID: 34924982 PMCID: PMC8674306 DOI: 10.3389/fnhum.2021.802244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 11/16/2021] [Indexed: 01/01/2023] Open
Abstract
Transcranial magnetic stimulation (TMS) can cause measurable effects on neural activity and behavioral performance in healthy volunteers. In addition, TMS is increasingly used in clinical practice for treating various neuropsychiatric disorders. Unfortunately, TMS-induced effects show large intra- and inter-subject variability, hindering its reliability, and efficacy. One possible source of this variability may be the spontaneous fluctuations of neuronal oscillations. We present recent studies using multimodal TMS including TMS-EMG (electromyography), TMS-tACS (transcranial alternating current stimulation), and concurrent TMS-EEG-fMRI (electroencephalography, functional magnetic resonance imaging), to evaluate how individual oscillatory brain state affects TMS signal propagation within targeted networks. We demonstrate how the spontaneous oscillatory state at the time of TMS influences both immediate and longer-lasting TMS effects. These findings indicate that at least part of the variability in TMS efficacy may be attributable to the current practice of ignoring (spontaneous) oscillatory fluctuations during TMS. Ignoring this state-dependent spread of activity may cause great individual variability which so far is poorly understood and has proven impossible to control. We therefore also compare two technical solutions to directly account for oscillatory state during TMS, namely, to use (a) tACS to externally control these oscillatory states and then apply TMS at the optimal (controlled) brain state, or (b) oscillatory state-triggered TMS (closed-loop TMS). The described multimodal TMS approaches are paramount for establishing more robust TMS effects, and to allow enhanced control over the individual outcome of TMS interventions aimed at modulating information flow in the brain to achieve desirable changes in cognition, mood, and behavior.
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Affiliation(s)
- Shanice E. W. Janssens
- Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
- Maastricht Brain Imaging Centre (MBIC), Maastricht, Netherlands
| | - Alexander T. Sack
- Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
- Maastricht Brain Imaging Centre (MBIC), Maastricht, Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Brain + Nerve Centre, Maastricht University Medical Centre+ (MUMC+), Maastricht, Netherlands
- Centre for Integrative Neuroscience (CIN), Maastricht University, Maastricht, Netherlands
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24
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Pastore-Wapp M, Lehnick D, Nef T, Bohlhalter S, Vanbellingen T. Combining Repetitive Transcranial Magnetic Stimulation and Video Game-Based Training to Improve Dexterity in Parkinson's Disease: Study Protocol of a Randomized Controlled Trial. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:777981. [PMID: 36188867 PMCID: PMC9397672 DOI: 10.3389/fresc.2021.777981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 10/08/2021] [Indexed: 11/28/2022]
Abstract
Introduction: Patients with Parkinson's disease (PD) often exhibit difficulties with dexterity during the performance of activities of daily living (ADL) due to dysfunctional supplementary motor area (SMA). The aim of this clinical trial protocol work is to describe how the effectiveness of a combined repetitive transcranial magnetic stimulation (rTMS) over SMA and video-game-based skill training (VBT) in PD will be evaluated. The short and long-term benefits are assessed. Methods and analysis: A single-blind (patients) stratified (based on Hoehn & Yahr) parallel randomized sham-controlled rTMS-VBT study with a baseline and two follow-up measurements (3 and 12 weeks) is being conducted. These measurements include the dexterity questionnaire 24 (DextQ-24) as a primary outcome, and nine hole peg test and coin rotation task as main secondary dexterity outcomes. Further secondary outcomes will be the subscale II of the movement disorders society unified PD rating scale (MDS-UPDRS) to assess improvements on overall ADL and the Parkinson's Disease Questionnaire-39 to assess quality of life. Thirty-six outpatients (from one neurorehabilitation center) with PD (diagnosis based on brain bank criteria) will be recruited who report difficulties with dexterity in performing ADL. All PD patients will receive a 45-min VBT three times a week for 3 weeks. The PD patients randomized in the experimental group will receive VBT preceded by real rTMS, being intermittent theta burst (iTBS) stimulation sessions. The PD patients randomized to the control group receive a VBT with sham rTMS. Discussion: The study will provide evidence to determine whether a combined iTBS and VBT skill intervention is more effective than a VBT intervention alone to improve dexterity in PD. Ethics and dissemination: The study was approved by the Ethics Committee for Northwest and Central Switzerland (EKNZ), Switzerland 2019–00433. The study will be conducted in accordance with the Helsinki Declaration and the Guidelines of Good Clinical Practice. Informed consent will be signed prior to subject enrolment. Dissemination will include submission to international peer-reviewed professional journals and presentation at international congresses. The study protocol has been registered in the clinicaltrials.gov registry with the identification code: NCT04699149.
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Affiliation(s)
- Manuela Pastore-Wapp
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland
- ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
| | - Dirk Lehnick
- Biostatistics and Methodology, Clinical Trials Unit Central Switzerland, Lucerne, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Tobias Nef
- ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
| | - Stephan Bohlhalter
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Tim Vanbellingen
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland
- ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
- *Correspondence: Tim Vanbellingen ;
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Gonsalvez I, Spagnolo P, Dworetzky B, Baslet G. Neurostimulation for the treatment of functional neurological disorder: A systematic review. Epilepsy Behav Rep 2021; 16:100501. [PMID: 34950864 PMCID: PMC8671519 DOI: 10.1016/j.ebr.2021.100501] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/28/2021] [Accepted: 11/04/2021] [Indexed: 01/02/2023] Open
Abstract
Functional Neurological Disorder (FND), also known as conversion disorder, is characterized by neurological symptoms that are incompatible with any known structural disorder and best explained by a biopsychosocial model. Evidence-based treatments for FND are limited, with cognitive behavioral therapy (CBT) and physiotherapy being the most effective interventions [1]. In recent years, functional neuroimaging studies have provided robust evidence of alterations in activity and connectivity in multiple brain networks in FND. This body of evidence suggests that neurocircuitry-based interventions, such as non-invasive brain stimulation techniques (NIBS), may also represent an effective therapeutic option for patients with FND. In this systematic review, we outline the current state of knowledge of NIBS in FND, and discuss limitations and future directions that may help establish the efficacy of NIBS as a therapeutic option for FND.
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Affiliation(s)
- Irene Gonsalvez
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Primavera Spagnolo
- Mary Horrigan Connors Center for Women's Health & Gender Biology, Department of Psychiatry, Brigham and Women Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Barbara Dworetzky
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Gaston Baslet
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Herrero JL, Smith A, Mishra A, Markowitz N, Mehta AD, Bickel S. Inducing neuroplasticity through intracranial θ-burst stimulation in the human sensorimotor cortex. J Neurophysiol 2021; 126:1723-1739. [PMID: 34644179 PMCID: PMC8782667 DOI: 10.1152/jn.00320.2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/20/2021] [Accepted: 10/08/2021] [Indexed: 01/04/2023] Open
Abstract
The progress of therapeutic neuromodulation greatly depends on improving stimulation parameters to most efficiently induce neuroplasticity effects. Intermittent θ-burst stimulation (iTBS), a form of electrical stimulation that mimics natural brain activity patterns, has proved to efficiently induce such effects in animal studies and rhythmic transcranial magnetic stimulation studies in humans. However, little is known about the potential neuroplasticity effects of iTBS applied through intracranial electrodes in humans. This study characterizes the physiological effects of intracranial iTBS in humans and compare them with α-frequency stimulation, another frequently used neuromodulatory pattern. We applied these two stimulation patterns to well-defined regions in the sensorimotor cortex, which elicited contralateral hand muscle contractions during clinical mapping, in patients with epilepsy implanted with intracranial electrodes. Treatment effects were evaluated using oscillatory coherence across areas connected to the treatment site, as defined with corticocortical-evoked potentials. Our results show that iTBS increases coherence in the β-frequency band within the sensorimotor network indicating a potential neuroplasticity effect. The effect is specific to the sensorimotor system, the β band, and the stimulation pattern and outlasted the stimulation period by ∼3 min. The effect occurred in four out of seven subjects depending on the buildup of the effect during iTBS treatment and other patterns of oscillatory activity related to ceiling effects within the β band and to preexistent coherence within the α band. By characterizing the neurophysiological effects of iTBS within well-defined cortical networks, we hope to provide an electrophysiological framework that allows clinicians/researchers to optimize brain stimulation protocols which may have translational value.NEW & NOTEWORTHY θ-Burst stimulation (TBS) protocols in transcranial magnetic stimulation studies have shown improved treatment efficacy in a variety of neuropsychiatric disorders. The optimal protocol to induce neuroplasticity in invasive direct electrical stimulation approaches is not known. We report that intracranial TBS applied in human sensorimotor cortex increases local coherence of preexistent β rhythms. The effect is specific to the stimulation frequency and the stimulated network and outlasts the stimulation period by ∼3 min.
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Affiliation(s)
- Jose L Herrero
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Alexander Smith
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Akash Mishra
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Noah Markowitz
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Ashesh D Mehta
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Stephan Bickel
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
- Department of Neurology, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
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Mariner J, Loetscher T, Hordacre B. Parietal Cortex Connectivity as a Marker of Shift in Spatial Attention Following Continuous Theta Burst Stimulation. Front Hum Neurosci 2021; 15:718662. [PMID: 34566602 PMCID: PMC8455944 DOI: 10.3389/fnhum.2021.718662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/17/2021] [Indexed: 11/13/2022] Open
Abstract
Non-invasive brain stimulation is a useful tool to probe brain function and provide therapeutic treatments in disease. When applied to the right posterior parietal cortex (PPC) of healthy participants, it is possible to temporarily shift spatial attention and mimic symptoms of spatial neglect. However, the field of brain stimulation is plagued by issues of high response variability. The aim of this study was to investigate baseline functional connectivity as a predictor of response to an inhibitory brain stimulation paradigm applied to the right PPC. In fourteen healthy adults (9 female, aged 24.8 ± 4.0 years) we applied continuous theta burst stimulation (cTBS) to suppress activity in the right PPC. Resting state functional connectivity was quantified by recording electroencephalography and assessing phase consistency. Spatial attention was assessed before and after cTBS with the Landmark Task. Finally, known determinants of response to brain stimulation were controlled for to enable robust investigation of the influence of resting state connectivity on cTBS response. We observed significant inter-individual variability in the behavioral response to cTBS with 53.8% of participants demonstrating the expected rightward shift in spatial attention. Baseline high beta connectivity between the right PPC, dorsomedial pre-motor region and left temporal-parietal region was strongly associated with cTBS response (R2 = 0.51). Regression analysis combining known cTBS determinants (age, sex, motor threshold, physical activity, stress) found connectivity between the right PPC and left temporal-parietal region was the only significant variable (p = 0.011). These results suggest baseline resting state functional connectivity is a strong predictor of a shift in spatial attention following cTBS. Findings from this study help further understand the mechanism by which cTBS modifies cortical function and could be used to improve the reliability of brain stimulation protocols.
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Affiliation(s)
- Jessica Mariner
- Innovation, IMPlementation And Clinical Translation in Health (IIMPACT in Health), Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Tobias Loetscher
- Behavior-Brain-Body Research Center, Justice and Society, University of South Australia, Adelaide, SA, Australia
| | - Brenton Hordacre
- Innovation, IMPlementation And Clinical Translation in Health (IIMPACT in Health), Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
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Wittkopf PG, Larsen DB, Graven-Nielsen T. Protocols for inducing homeostatic plasticity reflected in the corticospinal excitability in healthy human participants: A systematic review and meta-analysis. Eur J Neurosci 2021; 54:5444-5461. [PMID: 34251703 DOI: 10.1111/ejn.15389] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 11/26/2022]
Abstract
Homeostatic plasticity complements synaptic plasticity by stabilising neural activity within a physiological range. In humans, homeostatic plasticity is investigated using two blocks of non-invasive brain stimulation (NIBS) with an interval without stimulation between blocks. The aim of this systematic review and meta-analysis was to investigate the effect of homeostatic plasticity induction protocols on motor evoked potentials (MEP) in healthy participants. Four databases were searched (Medline, Scopus, Embase and Cochrane library). Studies describing the application of two blocks of NIBS of the primary motor cortex with an interval of no stimulation between blocks reporting changes in corticospinal excitability by MEP amplitude were included. Thirty-seven reports with 55 experiments (700 participants) were included. Study quality was considered poor overall, with heterogeneity in study size, sample and designs. Two blocks of excitatory stimulation at the primary motor cortex produced a homeostatic response (decreased MEP) between 0 and 30 min post-protocols, when compared with a single stimulation block. Two blocks of inhibitory stimulation at the primary motor cortex using interval duration of 10 min or less produced a homeostatic response (increased MEP) between 0 and 30 min post-protocols, when compared with a single stimulation block. There were no differences in MEPs when compared with baseline MEPs. In conclusion, homeostatic plasticity induction using two blocks of NIBS with an interval of 10 min or less without stimulation between blocks produces a homeostatic response up to 30 min post-protocol. Improvements in participant selection, sample sizes and protocols of NIBS techniques are needed.
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Affiliation(s)
- Priscilla G Wittkopf
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Dennis B Larsen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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29
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Zito GA, Worbe Y, Lamy JC, Kälin J, Bühler J, Weber S, Müri RM, Aybek S. Behavioral Differences Across Theta Burst Stimulation Protocols. A Study on the Sense of Agency in Healthy Humans. Front Neurosci 2021; 15:658688. [PMID: 34305515 PMCID: PMC8299722 DOI: 10.3389/fnins.2021.658688] [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: 01/26/2021] [Accepted: 04/09/2021] [Indexed: 11/27/2022] Open
Abstract
Background Theta burst stimulation (TBS) is a non-invasive brain stimulation method. Various stimulation protocols have been proposed, for instance, stimulation at 50 Hz with pattern at 5 Hz, or at 30 Hz with pattern at 6 Hz. To identify better stimulation parameters for behavioral applications, we investigated the effects of 50-Hz continuous TBS (cTBS) on the sense of agency (SoA), and compared them with a previously published study with 30-Hz cTBS. Methods Based on power analysis from a previous sample using two applications of 30-Hz cTBS, we recruited 20 healthy subjects in a single-blind, Vertex-controlled, randomized, crossover trial. Participants were stimulated with one application of 50-Hz cTBS over the right posterior parietal cortex (rPPC), a key area for agency processing, and the vertex, in a random order. A behavioral task targeting the SoA was done before and after stimulation. After controlling for baseline differences across samples, we studied the effect of stimulation in the two protocols separately. Results Compared to the previously published 30-Hz protocol, 50-Hz cTBS over the rPPC did not reveal significant changes in the SoA, similar to sham Vertex stimulation. Conclusion One application of 50-Hz cTBS was not sufficient to elicit behavioral effects, compared to two applications of 30-Hz cTBS, as previously described. This may be due to a mechanism of synaptic plasticity, consolidated through consecutive stimulation cycles. Our results are relevant for future studies aiming at modulating activity of the rPPC in cognitive domains other than agency, and in patients affected by abnormal agency, who could benefit from treatment options based on TBS.
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Affiliation(s)
- Giuseppe A Zito
- Movement Investigation and Therapeutics Team, ICM, Inserm U1127, CNRS UMR 7225, UM75, Sorbonne University, Paris, France
| | - Yulia Worbe
- Movement Investigation and Therapeutics Team, ICM, Inserm U1127, CNRS UMR 7225, UM75, Sorbonne University, Paris, France.,Department of Neurophysiology, Saint-Antoine Hospital, APHP.6 - Sorbonne University, Paris, France
| | - Jean-Charles Lamy
- Movement Investigation and Therapeutics Team, ICM, Inserm U1127, CNRS UMR 7225, UM75, Sorbonne University, Paris, France
| | - Joel Kälin
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Janine Bühler
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Samantha Weber
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - René M Müri
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Perception and Eye Movement Laboratory, Department of Neurology and Biomedical Research, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Selma Aybek
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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30
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Comparative Study of a Continuous Train of Theta-Burst Stimulation for a Duration of 20 s (cTBS 300) versus a Duration of 40 s (cTBS 600) in a Pre-Stimulation Relaxed Condition in Healthy Volunteers. Brain Sci 2021; 11:brainsci11060737. [PMID: 34205963 PMCID: PMC8230207 DOI: 10.3390/brainsci11060737] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 11/16/2022] Open
Abstract
As variable after effects have been observed following phasic muscle contraction prior to continuous theta-burst stimulation (cTBS), we here investigated two cTBS protocols (cTBS300 and cTBS600) in 20 healthy participants employing a pre-relaxed muscle condition including visual feedback on idle peripheral surface EMG activity. Furthermore, we assessed corticospinal excitability measures also from a pre-relaxed state to better understand the potential impact of these proposed contributors to TBS. Motor-evoked potential (MEP) magnitude changes were assessed for 30 min. The linear model computed across both experimental paradigms (cTBS300 and cTBS600) revealed a main effect of TIME COURSE (p = 0.044). Separate exploratory analysis for cTBS300 revealed a main effect of TIME COURSE (p = 0.031), which did not maintain significance after Greenhouse-Geisser correction (p = 0.073). For cTBS600, no main effects were observed. An exploratory analysis revealed a correlation between relative SICF at 2.0 ms (p = 0.006) and after effects (relative mean change) of cTBS600, which did not survive correction for multiple testing. Our findings thereby do not support the hypothesis of a specific excitability modulating effect of cTBS applied to the human motor-cortex in setups with pre-relaxed muscle conditions.
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31
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Chen YH, Chen CL, Huang YZ, Chen HC, Chen CY, Wu CY, Lin KC. Augmented efficacy of intermittent theta burst stimulation on the virtual reality-based cycling training for upper limb function in patients with stroke: a double-blinded, randomized controlled trial. J Neuroeng Rehabil 2021; 18:91. [PMID: 34059090 PMCID: PMC8166006 DOI: 10.1186/s12984-021-00885-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 05/25/2021] [Indexed: 11/11/2022] Open
Abstract
Background Virtual reality and arm cycling have been reported as effective treatments for improving upper limb motor recovery in patients with stroke. Intermittent theta burst stimulation (iTBS) can increase ipsilesional cortical excitability, and has been increasingly used in patients with stroke. However, few studies examined the augmented effect of iTBS on neurorehabilitation program. In this study, we investigated the augmented effect of iTBS on virtual reality-based cycling training (VCT) for upper limb function in patients with stroke. Methods In this randomized controlled trial, 23 patients with stroke were recruited. Each patient received either 15 sessions of iTBS or sham stimulation in addition to VCT on the same day. Outcome measures were assessed before and after the intervention. Primary outcome measures for the improvement of upper limb motor function and spasticity were Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and Modified Ashworth Scale Upper-Extremity (MAS-UE). Secondary outcome measures for activity and participation were Action Research Arm Test (ARAT), Nine Hole Peg Test (NHPT), Box and Block Test (BBT) and Motor Activity Log (MAL), and Stroke Impact Scale (SIS). Wilcoxon signed-rank tests were performed to evaluate the effectiveness after the intervention and Mann–Whitney U tests were conducted to compare the therapeutic effects between two groups. Results At post-treatment, both groups showed significant improvement in FMA-UE and ARAT, while only the iTBS + VCT group demonstrated significant improvement in MAS-UE, BBT, NHPT, MAL and SIS. The Mann–Whitney U tests revealed that the iTBS + VCT group has presented greater improvement than the sham group significantly in MAS-UE, MAL-AOU and SIS. However, there were no significant differences in the changes of the FMA-UE, ARAT, BBT, NHPT and MAL-QOM between groups. Conclusions Intermittent TBS showed augmented efficacy on VCT for reducing spasticity, increasing actual use of the affected upper limb, and improving participation in daily life in stroke patients. This study provided an integrated innovative intervention, which may be a promising therapy to improve upper limb function recovery in stroke rehabilitation. However, this study has a small sample size, and thus a further larger-scale study is warranted to confirm the treatment efficacy. Trial registration This trial was registered under ClinicalTrials.gov ID No. NCT03350087, retrospectively registered, on November 22, 2017
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Affiliation(s)
- Yu-Hsin Chen
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan. .,Graduate Institute of Early Intervention, Chang Gung University, Taoyuan, Taiwan.
| | - Ying-Zu Huang
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Neuroscience Research Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou, Taiwan.,Institute of Cognitive Neuroscience, National Central University, Taoyuan, Taiwan
| | - Hsieh-Ching Chen
- Department of Industrial and Management, National Taipei University of Technology, Taipei, Taiwan
| | - Chung-Yao Chen
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Ching-Yi Wu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Occupational Therapy, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Keh-Chung Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
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Hordacre B, Goldsworthy MR, Graetz L, Ridding MC. Motor network connectivity predicts neuroplastic response following theta burst stimulation in healthy adults. Brain Struct Funct 2021; 226:1893-1907. [PMID: 34043076 DOI: 10.1007/s00429-021-02299-4] [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] [Received: 08/07/2019] [Accepted: 05/10/2021] [Indexed: 01/17/2023]
Abstract
A patterned repetitive transcranial magnetic stimulation protocol, known as continuous theta burst stimulation (cTBS), can suppress corticospinal excitability via mechanisms that appear similar to long-term depression synaptic plasticity. Despite much potential, this technique is currently limited by substantial response variability. The purpose of this study was to investigate whether baseline resting state functional connectivity is a determinant of response to cTBS. Eighteen healthy young adults participated in up to three experimental sessions. Single-pulse transcranial magnetic stimulation was used to quantify change in corticospinal excitability following cTBS. Three minutes of resting electroencephalographic activity was recorded, and functional connectivity was estimated using the debiased weighted phase lag index across different frequency bands. Partial least squares regression identified models of connectivity between a seed region (C3) and the whole scalp that maximally accounted for variance in cTBS responses. There was no group-level effect of a single cTBS train or spaced cTBS trains on corticospinal excitability (p = 0.092). A low beta frequency band model of connectivity accounted for the largest proportion of variance in spaced cTBS response (R2 = 0.50). Based on the low beta frequency model, a-priori regions of interest were identified and predicted 39% of variance in response to spaced cTBS at a subsequent session. Importantly, weaker connectivity between the seed electrode (C3) and a cluster approximating a frontocentral region was associated with greater spaced cTBS response (p = 0.02). It appears M1-frontocentral networks may have an important role in determining the effects of cTBS on corticospinal excitability.
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Affiliation(s)
- Brenton Hordacre
- Innovation, Implementation and Clinical Translation (IIMPACT) in Health, University of South Australia, City East Campus, GPO Box 2471, Adelaide, South, 5001, Australia.
| | - Mitchell R Goldsworthy
- Lifespan Human Neurophysiology Group, Adelaide Medical School, The University of Adelaide, Adelaide, 5005, Australia.,Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia.,Discipline of Psychiatry, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Lynton Graetz
- Lifespan Human Neurophysiology Group, Adelaide Medical School, The University of Adelaide, Adelaide, 5005, Australia.,Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Michael C Ridding
- Innovation, Implementation and Clinical Translation (IIMPACT) in Health, University of South Australia, City East Campus, GPO Box 2471, Adelaide, South, 5001, Australia
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Hordacre B, Austin D, Brown KE, Graetz L, Parees I, De Trane S, Vallence AM, Koblar S, Kleinig T, McDonnell MN, Greenwood R, Ridding MC, Rothwell JC. Evidence for a Window of Enhanced Plasticity in the Human Motor Cortex Following Ischemic Stroke. Neurorehabil Neural Repair 2021; 35:307-320. [PMID: 33576318 PMCID: PMC7610679 DOI: 10.1177/1545968321992330] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND In preclinical models, behavioral training early after stroke produces larger gains compared with delayed training. The effects are thought to be mediated by increased and widespread reorganization of synaptic connections in the brain. It is viewed as a period of spontaneous biological recovery during which synaptic plasticity is increased. OBJECTIVE To look for evidence of a similar change in synaptic plasticity in the human brain in the weeks and months after ischemic stroke. METHODS We used continuous theta burst stimulation (cTBS) to activate synapses repeatedly in the motor cortex. This initiates early stages of synaptic plasticity that temporarily reduces cortical excitability and motor-evoked potential amplitude. Thus, the greater the effect of cTBS on the motor-evoked potential, the greater the inferred level of synaptic plasticity. Data were collected from separate cohorts (Australia and UK). In each cohort, serial measurements were made in the weeks to months following stroke. Data were obtained for the ipsilesional motor cortex in 31 stroke survivors (Australia, 66.6 ± 17.8 years) over 12 months and the contralesional motor cortex in 29 stroke survivors (UK, 68.2 ± 9.8 years) over 6 months. RESULTS Depression of cortical excitability by cTBS was most prominent shortly after stroke in the contralesional hemisphere and diminished over subsequent sessions (P = .030). cTBS response did not differ across the 12-month follow-up period in the ipsilesional hemisphere (P = .903). CONCLUSIONS Our results provide the first neurophysiological evidence consistent with a period of enhanced synaptic plasticity in the human brain after stroke. Behavioral training given during this period may be especially effective in supporting poststroke recovery.
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Affiliation(s)
- Brenton Hordacre
- University of South Australia, IIMPACT in Health, Adelaide,
Australia
| | - Duncan Austin
- UCL Institute of Neurology, Queen Square, London, UK
| | | | - Lynton Graetz
- Lifespan Human Neurophysiology group, Adelaide Medical
School, The University of Adelaide, Australia
| | - Isabel Parees
- Servicio de Neurologia, Hospital Universitario Ramón
y Cajal, Madrid, Spain
- Servicio de Neurología, Hospital Ruber
Internacional, Madrid, Spain
| | - Stefania De Trane
- The Blizard Institute, Barts and The London School of
Medicine & Dentistry, Queen Mary University of London, London, UK
- Clinical Board: Medicine (Neuroscience), The Royal London
Hospital, Barts Health NHS Trust, London, UK
- National Hospital for Neurology and Neurosurgery, Queen
Square, London, UK
| | - Ann-Maree Vallence
- Discipline of Psychology, College of Science, Health,
Engineering and Education, Murdoch University, Western Australia, Australia
| | - Simon Koblar
- Department of Medicine, The University of Adelaide,
Adelaide, Australia
- Department of Neurology, Royal Adelaide Hospital,
Adelaide, Australia
| | - Timothy Kleinig
- Department of Medicine, The University of Adelaide,
Adelaide, Australia
- Department of Neurology, Royal Adelaide Hospital,
Adelaide, Australia
| | | | - Richard Greenwood
- National Hospital for Neurology and Neurosurgery, Queen
Square, London, UK
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Goldsworthy MR, Hordacre B, Rothwell JC, Ridding MC. Effects of rTMS on the brain: is there value in variability? Cortex 2021; 139:43-59. [PMID: 33827037 DOI: 10.1016/j.cortex.2021.02.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/16/2021] [Accepted: 02/26/2021] [Indexed: 01/02/2023]
Abstract
The ability of repetitive transcranial magnetic stimulation (rTMS) to non-invasively induce neuroplasticity in the human cortex has opened exciting possibilities for its application in both basic and clinical research. Changes in the amplitude of motor evoked potentials (MEPs) elicited by single-pulse transcranial magnetic stimulation has so far provided a convenient model for exploring the neurophysiology of rTMS effects on the brain, influencing the ways in which these stimulation protocols have been applied therapeutically. However, a growing number of studies have reported large inter-individual variability in the mean MEP response to rTMS, raising legitimate questions about the usefulness of this model for guiding therapy. Although the increasing application of different neuroimaging approaches has made it possible to probe rTMS-induced neuroplasticity outside the motor cortex to measure changes in neural activity that impact other aspects of human behaviour, the high variability of rTMS effects on these measurements remains an important issue for the field to address. In this review, we seek to move away from the conventional facilitation/inhibition dichotomy that permeates much of the rTMS literature, presenting a non-standard approach for measuring rTMS-induced neuroplasticity. We consider the evidence that rTMS is able to modulate an individual's moment-to-moment variability of neural activity, and whether this could have implications for guiding the therapeutic application of rTMS.
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Affiliation(s)
- Mitchell R Goldsworthy
- Lifespan Human Neurophysiology Group, Adelaide Medical School, University of Adelaide, Adelaide, Australia; Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Discipline of Psychiatry, Adelaide Medical School, University of Adelaide, Adelaide, Australia.
| | - Brenton Hordacre
- Innovation, IMPlementation and Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide, Australia
| | - John C Rothwell
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Michael C Ridding
- Innovation, IMPlementation and Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide, Australia
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Smith AE, Dumuid D, Goldsworthy MR, Graetz L, Hodyl N, Thornton NLR, Ridding MC. Daily activities are associated with non-invasive measures of neuroplasticity in older adults. Clin Neurophysiol 2021; 132:984-992. [PMID: 33639453 DOI: 10.1016/j.clinph.2021.01.016] [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: 08/31/2020] [Revised: 12/22/2020] [Accepted: 01/11/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE We aimed to determine the association between daily activities (sleep, sedentary behavior and physical activities) and neuroplasticity in older adults by measuring motor evoked potential amplitudes (MEPs) elicited after a single and spaced continuous theta burst stimulation (cTBS) paradigm, targeting the primary motor cortex. METHODS MEPs were recorded from the right first dorsal interosseous muscle of 34 older adults (66.9 ± 4.5 years) by delivering single-pulse TMS before, between and at 0, 10, 20, 40 and 60 min after the application of spaced-cTBS separated by 10 min. Habitual activity was assessed by accelerometry for 24 h/day over 7-days. Multiple linear regression models determined if the time-use composition (sleep, sedentary behavior and physical activities) was associated with neuroplasticity response. RESULTS More physical activity at the equal expense of sleep and sedentary behaviors was associated with greater motor cortical neuroplasticity. Associations appeared to be driven by more time spent in light- but not moderate-to-vigorous- physical activities. CONCLUSIONS Engaging in light physical activity at the expense of sleep and sedentary behavior was associated with greater LTD-like motor cortex neuroplasticity (as measured with cTBS) in older adults. SIGNIFICANCE These findings suggest the promotion of physical activity among older adults to support brain neuroplasticity.
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Affiliation(s)
- Ashleigh E Smith
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, City East Campus, Australia.
| | - Dorothea Dumuid
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, City East Campus, Australia
| | - Mitchell R Goldsworthy
- Lifespan Human Neurophysiology Group, Adelaide Medical School, University of Adelaide, Australia; Lifelong Health, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Discipline of Psychiatry, Adelaide Medical School, The University of Adelaide, Australia
| | - Lynton Graetz
- Lifespan Human Neurophysiology Group, Adelaide Medical School, University of Adelaide, Australia; Lifelong Health, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Discipline of Psychiatry, Adelaide Medical School, The University of Adelaide, Australia
| | - Nicolette Hodyl
- Lifespan Human Neurophysiology Group, Adelaide Medical School, University of Adelaide, Australia
| | - Nicollette L R Thornton
- Lifespan Human Neurophysiology Group, Adelaide Medical School, University of Adelaide, Australia
| | - Michael C Ridding
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, City East Campus, Australia
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Zhang JJ, Fong KNK. The Effects of Priming Intermittent Theta Burst Stimulation on Movement-Related and Mirror Visual Feedback-Induced Sensorimotor Desynchronization. Front Hum Neurosci 2021; 15:626887. [PMID: 33584232 PMCID: PMC7878678 DOI: 10.3389/fnhum.2021.626887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 01/06/2021] [Indexed: 11/24/2022] Open
Abstract
The potential benefits of priming intermittent theta burst stimulation (iTBS) with continuous theta burst stimulation (cTBS) have not been examined in regard to sensorimotor oscillatory activities recorded in electroencephalography (EEG). The objective of this study was to investigate the modulatory effect of priming iTBS (cTBS followed by iTBS) delivered to the motor cortex on movement-related and mirror visual feedback (MVF)-induced sensorimotor event-related desynchronization (ERD), compared with iTBS alone, on healthy adults. Twenty participants were randomly allocated into Group 1: priming iTBS—cTBS followed by iTBS, and Group 2: non-priming iTBS—sham cTBS followed by iTBS. The stimulation was delivered to the right primary motor cortex daily for 4 consecutive days. EEG was measured before and after 4 sessions of stimulation. Movement-related ERD was evaluated during left-index finger tapping and MVF-induced sensorimotor ERD was evaluated by comparing the difference between right-index finger tapping with and without MVF. After stimulation, both protocols increased movement-related ERD and MVF-induced sensorimotor ERD in high mu and low beta bands, indicated by significant time effects. A significant interaction effect favoring Group 1 in enhancing movement-related ERD was observed in the high mu band [F(1,18) = 4.47, p = 0.049], compared with Group 2. Our experiment suggests that among healthy adults priming iTBS with cTBS delivered to the motor cortex yields similar effects with iTBS alone on enhancing ERD induced by MVF-based observation, while movement-related ERD was more enhanced in the priming iTBS condition, specifically in the high mu band.
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Affiliation(s)
- Jack Jiaqi Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Kenneth N K Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Whife CJ, Vallence AM, Edgar DW, Wood FM. Decreased neuroplasticity in minor burn injury survivors compared to non-injured adults: A pilot study in burn injury survivors aged 45 years and older. Burns 2020; 47:327-337. [PMID: 33288329 DOI: 10.1016/j.burns.2020.10.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/22/2020] [Accepted: 10/29/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Neuroplasticity is the capacity of the brain to change or adapt with experience: brain changes occur with use, disuse, and injury. Repetitive transcranial magnetic stimulation (rTMS) can be used to induce neuroplasticity in the human brain. Here, we examined rTMS-induced neuroplasticity in the primary motor cortex in burns survivors and controls without injury, and whether neuroplasticity is associated with functional recovery in burns survivors. METHODS Sixteen burn injury survivors (total body surface area of burn injury <15%) and 13 non-injured control participants were tested. Repetitive TMS (specifically, spaced continuous theta-burst stimulation[cTBS]) was applied to induce neuroplasticity 6 and 12 weeks after injury in burn survivors and in two sessions separated by 6 weeks in controls. Motor evoked potentials (MEPs) elicited by single-pulse TMS were measured before and after rTMS to measure neuroplasticity. Burns survivors completed a functional assessment 12 weeks after injury. RESULTS Non-injured controls showed decreased MEP amplitude 15-30 min after spaced cTBS in both experimental sessions. Burn survivors showed a smaller change in MEP amplitude after spaced cTBS compared to controls 6 weeks after burn injury but no difference compared to controls 12 weeks after burn injury. In burn survivors, there was a significant positive association between general health outcome (Short-Form Health Survey) and the change in MEP amplitude after spaced cTBS 12 weeks after injury (r=.73, p = .01). CONCLUSIONS The current findings suggest that burn survivors have a reduced capacity for neuroplasticity early in the recovery period (6 weeks after injury), which normalizes later in the recovery period (12 weeks after injury). Furthermore, the results provide preliminary evidence to suggest that burn survivors with normalized neuroplasticity 12 weeks after injury recover faster after burn injury.
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Affiliation(s)
- Casey J Whife
- Burn Injury Research Unit, School of Surgery, University of Western Australia, Crawley, Western Australia, Australia
| | - Ann-Maree Vallence
- Psychology, Murdoch University, Western Australia, Australia; Centre for Healthy Ageing, Health Futures Institute, Murdoch University, Western Australia, Australia; Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Western Australia, Australia.
| | - Dale W Edgar
- Burn Injury Research Unit, School of Surgery, University of Western Australia, Crawley, Western Australia, Australia; Burn Injury Research Node, The University of Notre Dame Australia, Fremantle, Western Australia, Australia; Burns Service of Western Australia, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Fiona M Wood
- Burn Injury Research Unit, School of Surgery, University of Western Australia, Crawley, Western Australia, Australia; Burns Service of Western Australia, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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Goldsworthy MR, Rogasch NC, Ballinger S, Graetz L, Van Dam JM, Harris R, Yu S, Pitcher JB, Baune BT, Ridding MC. Age-related decline of neuroplasticity to intermittent theta burst stimulation of the lateral prefrontal cortex and its relationship with late-life memory performance. Clin Neurophysiol 2020; 131:2181-2191. [DOI: 10.1016/j.clinph.2020.06.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 04/09/2020] [Accepted: 06/01/2020] [Indexed: 01/08/2023]
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Obesity is Associated with Reduced Plasticity of the Human Motor Cortex. Brain Sci 2020; 10:brainsci10090579. [PMID: 32839377 PMCID: PMC7564681 DOI: 10.3390/brainsci10090579] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/13/2020] [Accepted: 08/17/2020] [Indexed: 01/06/2023] Open
Abstract
Obesity is characterised by excessive body fat and is associated with several detrimental health conditions, including cardiovascular disease and diabetes. There is some evidence that people who are obese have structural and functional brain alterations and cognitive deficits. It may be that these neurophysiological and behavioural consequences are underpinned by altered plasticity. This study investigated the relationship between obesity and plasticity of the motor cortex in people who were considered obese (n = 14, nine males, aged 35.4 ± 14.3 years) or healthy weight (n = 16, seven males, aged 26.3 ± 8.5 years). A brain stimulation protocol known as continuous theta burst transcranial magnetic stimulation was applied to the motor cortex to induce a brief suppression of cortical excitability. The suppression of cortical excitability was quantified using single-pulse transcranial magnetic stimulation to record and measure the amplitude of the motor evoked potential in a peripheral hand muscle. Therefore, the magnitude of suppression of the motor evoked potential by continuous theta burst stimulation was used as a measure of the capacity for plasticity of the motor cortex. Our results demonstrate that the healthy-weight group had a significant suppression of cortical excitability following continuous theta burst stimulation (cTBS), but there was no change in excitability for the obese group. Comparing the response to cTBS between groups demonstrated that there was an impaired plasticity response for the obese group when compared to the healthy-weight group. This might suggest that the capacity for plasticity is reduced in people who are obese. Given the importance of plasticity for human behaviour, our results add further emphasis to the potentially detrimental health effects of obesity.
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Cole EJ, Stimpson KH, Bentzley BS, Gulser M, Cherian K, Tischler C, Nejad R, Pankow H, Choi E, Aaron H, Espil FM, Pannu J, Xiao X, Duvio D, Solvason HB, Hawkins J, Guerra A, Jo B, Raj KS, Phillips AL, Barmak F, Bishop JH, Coetzee JP, DeBattista C, Keller J, Schatzberg AF, Sudheimer KD, Williams NR. Stanford Accelerated Intelligent Neuromodulation Therapy for Treatment-Resistant Depression. Am J Psychiatry 2020; 177:716-726. [PMID: 32252538 DOI: 10.1176/appi.ajp.2019.19070720] [Citation(s) in RCA: 314] [Impact Index Per Article: 78.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE New antidepressant treatments are needed that are effective, rapid acting, safe, and tolerable. Intermittent theta-burst stimulation (iTBS) is a noninvasive brain stimulation treatment that has been approved by the U.S. Food and Drug Administration for treatment-resistant depression. Recent methodological advances suggest that the current iTBS protocol might be improved through 1) treating patients with multiple sessions per day at optimally spaced intervals, 2) applying a higher overall pulse dose of stimulation, and 3) precision targeting of the left dorsolateral prefrontal cortex (DLPFC) to subgenual anterior cingulate cortex (sgACC) circuit. The authors examined the feasibility, tolerability, and preliminary efficacy of Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT), an accelerated, high-dose resting-state functional connectivity MRI (fcMRI)-guided iTBS protocol for treatment-resistant depression. METHODS Twenty-two participants with treatment-resistant depression received open-label SAINT. fcMRI was used to individually target the region of the left DLPFC most anticorrelated with sgACC in each participant. Fifty iTBS sessions (1,800 pulses per session, 50-minute intersession interval) were delivered as 10 daily sessions over 5 consecutive days at 90% resting motor threshold (adjusted for cortical depth). Neuropsychological testing was conducted before and after SAINT. RESULTS One participant withdrew, leaving a sample size of 21. Nineteen of 21 participants (90.5%) met remission criteria (defined as a score <11 on the Montgomery-Åsberg Depression Rating Scale). In the intent-to-treat analysis, 19 of 22 participants (86.4%) met remission criteria. Neuropsychological testing demonstrated no negative cognitive side effects. CONCLUSIONS SAINT, an accelerated, high-dose, iTBS protocol with fcMRI-guided targeting, was well tolerated and safe. Double-blinded sham-controlled trials are needed to confirm the remission rate observed in this initial study.
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Affiliation(s)
- Eleanor J Cole
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Katy H Stimpson
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Brandon S Bentzley
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Merve Gulser
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Kirsten Cherian
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Claudia Tischler
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Romina Nejad
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Heather Pankow
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Elizabeth Choi
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Haley Aaron
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Flint M Espil
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Jaspreet Pannu
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Xiaoqian Xiao
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Dalton Duvio
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Hugh B Solvason
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Jessica Hawkins
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Austin Guerra
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Booil Jo
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Kristin S Raj
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Angela L Phillips
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Fahim Barmak
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - James H Bishop
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - John P Coetzee
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Charles DeBattista
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Jennifer Keller
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Alan F Schatzberg
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Keith D Sudheimer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Nolan R Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
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Theta burst stimulation in humans: a need for better understanding effects of brain stimulation in health and disease. Exp Brain Res 2020; 238:1707-1714. [PMID: 32671422 DOI: 10.1007/s00221-020-05880-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 06/30/2020] [Indexed: 12/17/2022]
Abstract
Repetitive transcranial stimulation (rTMS) paradigms have been used to induce lasting changes in brain activity and excitability. Previous methods of stimulation were long, often ineffective and produced short-lived and variable results. A new non-invasive brain stimulation technique was developed in John Rothwell's laboratory in the early 2000s, which was named 'theta burst stimulation' (TBS). This used rTMS applied in burst patterns of newly acquired 50 Hz rTMS machines, which emulated long-term potentiation/depression-like effects in brain slices. This stimulation paradigm created long-lasting changes in brain excitability, using efficient, very rapid stimulation, which would affect behaviour, with the aim to influence neurological diseases in humans. We describe the development of this technique, including findings and limitations identified since then. We discuss how pitfalls facing TBS reflect those involving both older and newer, non-invasive stimulation techniques, with suggestions of how to overcome these, using personalised, 'closed loop' stimulation methods. The challenge in most non-invasive stimulation techniques remains in identifying their exact mechanisms of action in the context of neurological disease models. The development of TBS provides the backdrop for describing John's contribution to the field, inspiring our own scientific endeavour thanks to his unconditional support, and unfailing kindness.
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Investigating the influence of paired-associative stimulation on multi-session skill acquisition and retention in older adults. Clin Neurophysiol 2020; 131:1497-1507. [DOI: 10.1016/j.clinph.2020.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/19/2020] [Accepted: 04/13/2020] [Indexed: 12/26/2022]
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Palaus M, Viejo-Sobera R, Redolar-Ripoll D, Marrón EM. Cognitive Enhancement via Neuromodulation and Video Games: Synergistic Effects? Front Hum Neurosci 2020; 14:235. [PMID: 32636739 PMCID: PMC7319101 DOI: 10.3389/fnhum.2020.00235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/28/2020] [Indexed: 12/18/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) is a non-invasive brain stimulation technique able to modulate cortical excitability. This modulation may influence areas and networks responsible for specific cognitive processes, and the repetition of the induced temporary changes can produce long-lasting effects. TMS effectiveness may be enhanced when used in conjunction with cognitive training focused on specific cognitive functions. Playing video games can be an optimal cognitive training since it involves different cognitive components and high levels of engagement and motivation. The goal of this study is to assess the synergistic effects of TMS and video game training to enhance cognition, specifically, working memory and executive functions. We conducted a randomized 2 × 3 repeated measures (stimulation × time) study, randomly assigning 27 healthy volunteers to an active intermittent theta-burst stimulation or a sham stimulation group. Participants were assessed using a comprehensive neuropsychological battery before, immediately after, and 15 days after finishing the video game+TMS training. The training consisted of 10 sessions where participants played a 3D platform video game for 1.5 h. After each gaming session, TMS was applied over the right dorsolateral prefrontal cortex (DLPFC). All participants improved their video gaming performance, but we did not find a synergistic effect of stimulation and video game training. Neither had we found cognitive improvements related to the stimulation. We explored possible confounding variables such as age, gender, and early video gaming experience through linear regression. The early video gaming experience was related to improvements in working memory and inhibitory control. This result, although exploratory, highlights the influence of individual variables and previous experiences on brain plasticity.
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Affiliation(s)
| | - Raquel Viejo-Sobera
- Cognitive NeuroLab, Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
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Jannati A, Block G, Ryan MA, Kaye HL, Kayarian FB, Bashir S, Oberman LM, Pascual-Leone A, Rotenberg A. Continuous Theta-Burst Stimulation in Children With High-Functioning Autism Spectrum Disorder and Typically Developing Children. Front Integr Neurosci 2020; 14:13. [PMID: 32231523 PMCID: PMC7083078 DOI: 10.3389/fnint.2020.00013] [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: 06/30/2019] [Accepted: 02/25/2020] [Indexed: 01/03/2023] Open
Abstract
Objectives: A neurophysiologic biomarker for autism spectrum disorder (ASD) is highly desirable and can improve diagnosis, monitoring, and assessment of therapeutic response among children with ASD. We investigated the utility of continuous theta-burst stimulation (cTBS) applied to the motor cortex (M1) as a biomarker for children and adolescents with high-functioning (HF) ASD compared to their age- and gender-matched typically developing (TD) controls. We also compared the developmental trajectory of long-term depression- (LTD-) like plasticity in the two groups. Finally, we explored the influence of a common brain-derived neurotrophic factor (BDNF) polymorphism on cTBS aftereffects in a subset of the ASD group. Methods: Twenty-nine children and adolescents (age range 10-16) in ASD (n = 11) and TD (n = 18) groups underwent M1 cTBS. Changes in MEP amplitude at 5-60 min post-cTBS and their cumulative measures in each group were calculated. We also assessed the relationship between age and maximum cTBS-induced MEP suppression (ΔMEPMax) in each group. Finally, we compared cTBS aftereffects in BDNF Val/Val (n = 4) and Val/Met (n = 4) ASD participants. Results: Cumulative cTBS aftereffects were significantly more facilitatory in the ASD group than in the TD group (P FDR's < 0.03). ΔMEPMax was negatively correlated with age in the ASD group (r = -0.67, P = 0.025), but not in the TD group (r = -0.12, P = 0.65). Cumulative cTBS aftereffects were not significantly different between the two BDNF subgroups (P-values > 0.18). Conclusions: The results support the utility of cTBS measures of cortical plasticity as a biomarker for children and adolescents with HF-ASD and an aberrant developmental trajectory of LTD-like plasticity in ASD.
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Affiliation(s)
- Ali Jannati
- Neuromodulation Program and Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.,Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Gabrielle Block
- Neuromodulation Program and Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.,Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Mary A Ryan
- Neuromodulation Program and Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.,Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Harper L Kaye
- Neuromodulation Program and Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Fae B Kayarian
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Shahid Bashir
- Neuroscience Center, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
| | - Lindsay M Oberman
- Neuroplasticity and Autism Spectrum Disorder Program, Department of Psychiatry and Human Behavior, E. P. Bradley Hospital, Warren Alpert Medical School, Brown University, East Providence, RI, United States
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.,Institut Guttman de Neurorehabilitació, Universitat Autónoma de Barcelona, Badalona, Spain
| | - Alexander Rotenberg
- Neuromodulation Program and Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.,Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
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Guerra A, López-Alonso V, Cheeran B, Suppa A. Solutions for managing variability in non-invasive brain stimulation studies. Neurosci Lett 2020; 719:133332. [DOI: 10.1016/j.neulet.2017.12.060] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/18/2017] [Accepted: 12/27/2017] [Indexed: 12/22/2022]
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Fitzgerald PB, Hoy KE, Reynolds J, Singh A, Gunewardene R, Slack C, Ibrahim S, Daskalakis ZJ. A pragmatic randomized controlled trial exploring the relationship between pulse number and response to repetitive transcranial magnetic stimulation treatment in depression. Brain Stimul 2020; 13:145-152. [DOI: 10.1016/j.brs.2019.09.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/28/2019] [Accepted: 09/03/2019] [Indexed: 01/29/2023] Open
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Mosayebi Samani M, Agboada D, Kuo MF, Nitsche MA. Probing the relevance of repeated cathodal transcranial direct current stimulation over the primary motor cortex for prolongation of after-effects. J Physiol 2019; 598:805-816. [PMID: 31714998 DOI: 10.1113/jp278857] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/11/2019] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS To explore the capability of cathodal transcranial direct current stimulation (tDCS) to induce late-phase long-term depression (LTD) via repeated stimulation. Conventional (1 mA for 15 min) and intensified (3 mA for 20 min) protocols with short (20 min) and long (24 h) intervals were tested. Late-phase plasticity was not induced by a single repetition of stimulation. Repetition reduced the efficacy of stimulation protocols with higher intensities. ABSTRACT Transcranial direct current stimulation (tDCS) has shown promising results in pilot studies as a therapeutic intervention in disorders of the central nervous system, but more sustained effects are required for clinical application. To address this issue, one possible solution is the use of repeated stimulation protocols. Previous studies indicated the possibility of extending the after-effects of single intervention cathodal tDCS by repeating the tDCS, with relatively short intervals between repetitions being most effective. In this study, we thus investigated the effects of repeated stimulation protocols at short and long intervals, for a conventional tDCS protocol (1 mA for 15 min) and a newly developed optimized protocol (3 mA for 20 min). In 16 healthy participants, we compared single interventions of conventional and optimized protocols, repeated application of these protocols at intervals of 20 min and 24 h, and a sham tDCS session. tDCS-induced neuroplastic after-effects were then monitored with transcranial magnetic stimulation (TMS)-induced motor evoked potentials (MEPs) until the following evening after stimulation. The results revealed that the duration of the after-effects of repeated conventional and optimized protocols with short intervals remained nearly unchanged compared to the respective single intervention protocols. For the long-interval (24 h) protocol, stimulation with the conventional protocol did not significantly alter respective after-effects, while it reduced the efficacy of the optimized protocol, compared with respective single interventions. Thus late-phase plasticity could not be induced by a single repetition of stimulation in this study, but repetition reduced the efficacy of stimulation protocols with higher intensities. This study provides further insights into the dependency of tDCS-induced neuroplasticity on stimulation parameters, and therefore delivers crucial information for future tDCS applications.
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Affiliation(s)
- Mohsen Mosayebi Samani
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany.,Institute of Biomedical Engineering and Informatics, Ilmenau University of Technology, Ilmenau, Germany
| | - Desmond Agboada
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany.,International Graduate School of Neuroscience, IGSN, Ruhr University Bochum, Bochum, Germany
| | - Min-Fang Kuo
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Michael A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany.,Department of Neurology, University Hospital Bergmannsheil, Bochum, Germany
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Sessions of Prolonged Continuous Theta Burst Stimulation or High-frequency 10 Hz Stimulation to Left Dorsolateral Prefrontal Cortex for 3 Days Decreased Pain Sensitivity by Modulation of the Efficacy of Conditioned Pain Modulation. THE JOURNAL OF PAIN 2019; 20:1459-1469. [DOI: 10.1016/j.jpain.2019.05.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/29/2019] [Accepted: 05/22/2019] [Indexed: 12/16/2022]
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49
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Harika-Germaneau G, Rachid F, Chatard A, Lafay-Chebassier C, Solinas M, Thirioux B, Millet B, Langbour N, Jaafari N. Continuous theta burst stimulation over the supplementary motor area in refractory obsessive-compulsive disorder treatment: A randomized sham-controlled trial. Brain Stimul 2019; 12:1565-1571. [DOI: 10.1016/j.brs.2019.07.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 06/28/2019] [Accepted: 07/23/2019] [Indexed: 11/26/2022] Open
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50
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The dorsomedial prefrontal cortex as a flexible hub mediating behavioral as well as local and distributed neural effects of social support context on pain: A Theta Burst Stimulation and TMS-EEG study. Neuroimage 2019; 201:116053. [DOI: 10.1016/j.neuroimage.2019.116053] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 07/18/2019] [Accepted: 07/23/2019] [Indexed: 11/19/2022] Open
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