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Kamel DM, Hassan M, Elsawy NA, Hashad D, Fayed AA, Elhabashy AM, Abdel-Fattah YH. Serum brain-derived neurotrophic factor level in patients with disc induced lumbosacral radiculopathy: Relation to pain severity and functional disability. J Clin Neurosci 2024; 128:110773. [PMID: 39137713 DOI: 10.1016/j.jocn.2024.110773] [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: 06/15/2024] [Revised: 07/31/2024] [Accepted: 08/01/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND Pain is the major cause of disability in disc induced lumbosacral radiculopathy (LSR) and is related to neurotrophins mainly brain derived neurotrophic factor (BDNF). However, to our knowledge evaluating serum BDNF in disc induced LSR has not been reported before. This study was done to investigate serum BDNF in LSR patients and its relation to pain severity and functional disability. METHODS This case-control study included 40 disc induced LSR patients and 40 age and sex matched healthy subjects. All patients were subjected to neurological examination, electrophysiological evaluation, pain severity assessment using numerical rating scale (NRS) and functional disability assessment using Modified Oswestry Low Back Pain Disability Index (ODI) and Maine-Seattle Back Questionnaire (MSBQ). According to Douleur neuropathique 4 (DN4) questionnaire, patients were divided into those with neuropathic pain and those with non-neuropathic pain. Serum BDNF was measured by enzyme-linked immunosorbent assay in all participants. RESULTS Serum BDNF was significantly higher in LSR patients than in healthy controls (U=272.5, P<0.001). Moreover, serum BDNF was significantly higher in those with neuropathic pain compared to those with non-neuropathic pain (U=35, P=0.03). Serum BDNF had a significant positive correlation with NRS score among those with acute pain (rs=0.537, P=0.026), however there was no significant correlation among those with chronic pain. Furthermore, BDNF had no significant correlation with modified ODI and MSBQ. CONCLUSION Increased serum BDNF may be associated with neuropathic pain and acute pain severity in disc induced LSR. However, it may not be related to chronic pain severity or functional disability.
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Affiliation(s)
- Dina Mansour Kamel
- Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, University of Alexandria, Egypt.
| | - Marwa Hassan
- Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, University of Alexandria, Egypt.
| | - Noha A Elsawy
- Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, University of Alexandria, Egypt
| | - Doaa Hashad
- Clinical and Chemical Pathology, Faculty of Medicine, University of Alexandria, Egypt
| | | | | | - Yousra Hisham Abdel-Fattah
- Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, University of Alexandria, Egypt
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2
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Xiong HY, Hendrix J, Schabrun S, Wyns A, Campenhout JV, Nijs J, Polli A. The Role of the Brain-Derived Neurotrophic Factor in Chronic Pain: Links to Central Sensitization and Neuroinflammation. Biomolecules 2024; 14:71. [PMID: 38254671 PMCID: PMC10813479 DOI: 10.3390/biom14010071] [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: 11/30/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
Chronic pain is sustained, in part, through the intricate process of central sensitization (CS), marked by maladaptive neuroplasticity and neuronal hyperexcitability within central pain pathways. Accumulating evidence suggests that CS is also driven by neuroinflammation in the peripheral and central nervous system. In any chronic disease, the search for perpetuating factors is crucial in identifying therapeutic targets and developing primary preventive strategies. The brain-derived neurotrophic factor (BDNF) emerges as a critical regulator of synaptic plasticity, serving as both a neurotransmitter and neuromodulator. Mounting evidence supports BDNF's pro-nociceptive role, spanning from its pain-sensitizing capacity across multiple levels of nociceptive pathways to its intricate involvement in CS and neuroinflammation. Moreover, consistently elevated BDNF levels are observed in various chronic pain disorders. To comprehensively understand the profound impact of BDNF in chronic pain, we delve into its key characteristics, focusing on its role in underlying molecular mechanisms contributing to chronic pain. Additionally, we also explore the potential utility of BDNF as an objective biomarker for chronic pain. This discussion encompasses emerging therapeutic approaches aimed at modulating BDNF expression, offering insights into addressing the intricate complexities of chronic pain.
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Affiliation(s)
- Huan-Yu Xiong
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (H.-Y.X.); (J.H.); (A.W.); (J.V.C.); (A.P.)
| | - Jolien Hendrix
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (H.-Y.X.); (J.H.); (A.W.); (J.V.C.); (A.P.)
- Department of Public Health and Primary Care, Centre for Environment & Health, KU Leuven, 3000 Leuven, Belgium
- Research Foundation—Flanders (FWO), 1000 Brussels, Belgium
| | - Siobhan Schabrun
- The School of Physical Therapy, University of Western Ontario, London, ON N6A 3K7, Canada;
- The Gray Centre for Mobility and Activity, Parkwood Institute, London, ON N6A 4V2, Canada
| | - Arne Wyns
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (H.-Y.X.); (J.H.); (A.W.); (J.V.C.); (A.P.)
| | - Jente Van Campenhout
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (H.-Y.X.); (J.H.); (A.W.); (J.V.C.); (A.P.)
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (H.-Y.X.); (J.H.); (A.W.); (J.V.C.); (A.P.)
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 41390 Göterbog, Sweden
| | - Andrea Polli
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (H.-Y.X.); (J.H.); (A.W.); (J.V.C.); (A.P.)
- Department of Public Health and Primary Care, Centre for Environment & Health, KU Leuven, 3000 Leuven, Belgium
- Research Foundation—Flanders (FWO), 1000 Brussels, Belgium
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3
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Guidetti M, Maria Bianchi A, Parazzini M, Maiorana N, Bonato M, Ferrara R, Libelli G, Montemagno K, Ferrucci R, Priori A, Bocci T. Monopolar tDCS might affect brainstem reflexes: A computational and neurophysiological study. Clin Neurophysiol 2023; 155:44-54. [PMID: 37690391 DOI: 10.1016/j.clinph.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/04/2023] [Accepted: 08/12/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE To assess whether monopolar multi-electrode transcranial direct current stimulation (tDCS) montages might selectively affect deep brain structures through computational predictions and neurophysiological assessment. METHODS Electric field distribution in deep brain structures (i.e., thalamus and midbrain) were estimated through computational models simulating tDCS with two monopolar and two monopolar multi-electrode montages. Monopolar multi-electrode tDCS was then applied to healthy subject, and effects on pontine and medullary circuitries was evaluated studying changes in blink reflex (BR) and masseter inhibitory reflex (MIR). RESULTS Computational results suggest that tDCS with monopolar multi-electrode montages might induce electric field intensities in deep brain structure comparable to those in grey matter, while neurophysiological results disclosed that BR and MIR were selectively modulated by tDCS only when cathode was placed over the right deltoid. CONCLUSIONS Multi-electrode tDCS (anodes over motor cortices, cathode over right deltoid) could induce significant electric fields in the thalamus and midbrain, and selectively affect brainstem neural circuits. SIGNIFICANCE Multi-electrode tDCS (anodes over motor cortices, cathode over right deltoid) might be further explored to affect brainstem activity, also in the context of non-invasive deep brain stimulation.
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Affiliation(s)
- Matteo Guidetti
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy; Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci, 32, 20133 Milan, Italy
| | - Anna Maria Bianchi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci, 32, 20133 Milan, Italy
| | - Marta Parazzini
- Institute of Electronics, Computer and Telecommunication Engineering (IEIIT), CNR, 20133 Milan, Italy
| | - Natale Maiorana
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy
| | - Marta Bonato
- Institute of Electronics, Computer and Telecommunication Engineering (IEIIT), CNR, 20133 Milan, Italy
| | - Rosanna Ferrara
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy
| | - Giorgia Libelli
- Neurology Unit, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Kora Montemagno
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy
| | - Roberta Ferrucci
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy; Clinical Neurology Unit, "Azienda Socio-Sanitaria Territoriale Santi Paolo E Carlo", Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy
| | - Alberto Priori
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy; Clinical Neurology Unit, "Azienda Socio-Sanitaria Territoriale Santi Paolo E Carlo", Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy
| | - Tommaso Bocci
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy; Clinical Neurology Unit, "Azienda Socio-Sanitaria Territoriale Santi Paolo E Carlo", Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy.
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Marangolo P, Vasta S, Manfredini A, Caltagirone C. What Else Can Be Done by the Spinal Cord? A Review on the Effectiveness of Transpinal Direct Current Stimulation (tsDCS) in Stroke Recovery. Int J Mol Sci 2023; 24:10173. [PMID: 37373323 DOI: 10.3390/ijms241210173] [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: 05/10/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Since the spinal cord has traditionally been considered a bundle of long fibers connecting the brain to all parts of the body, the study of its role has long been limited to peripheral sensory and motor control. However, in recent years, new studies have challenged this view pointing to the spinal cord's involvement not only in the acquisition and maintenance of new motor skills but also in the modulation of motor and cognitive functions dependent on cortical motor regions. Indeed, several reports to date, which have combined neurophysiological techniques with transpinal direct current stimulation (tsDCS), have shown that tsDCS is effective in promoting local and cortical neuroplasticity changes in animals and humans through the activation of ascending corticospinal pathways that modulate the sensorimotor cortical networks. The aim of this paper is first to report the most prominent tsDCS studies on neuroplasticity and its influence at the cortical level. Then, a comprehensive review of tsDCS literature on motor improvement in animals and healthy subjects and on motor and cognitive recovery in post-stroke populations is presented. We believe that these findings might have an important impact in the future making tsDCS a potential suitable adjunctive approach for post-stroke recovery.
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Affiliation(s)
- Paola Marangolo
- Department of Humanities Studies, University Federico II, 80133 Naples, Italy
| | - Simona Vasta
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy
| | - Alessio Manfredini
- Department of Humanities Studies, University Federico II, 80133 Naples, Italy
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Guidetti M, Giannoni-Luza S, Bocci T, Pacheco-Barrios K, Bianchi AM, Parazzini M, Ionta S, Ferrucci R, Maiorana NV, Verde F, Ticozzi N, Silani V, Priori A. Modeling Electric Fields in Transcutaneous Spinal Direct Current Stimulation: A Clinical Perspective. Biomedicines 2023; 11:1283. [PMID: 37238953 PMCID: PMC10216237 DOI: 10.3390/biomedicines11051283] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/12/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
Clinical findings suggest that transcutaneous spinal direct current stimulation (tsDCS) can modulate ascending sensitive, descending corticospinal, and segmental pathways in the spinal cord (SC). However, several aspects of the stimulation have not been completely understood, and realistic computational models based on MRI are the gold standard to predict the interaction between tsDCS-induced electric fields and anatomy. Here, we review the electric fields distribution in the SC during tsDCS as predicted by MRI-based realistic models, compare such knowledge with clinical findings, and define the role of computational knowledge in optimizing tsDCS protocols. tsDCS-induced electric fields are predicted to be safe and induce both transient and neuroplastic changes. This could support the possibility to explore new clinical applications, such as spinal cord injury. For the most applied protocol (2-3 mA for 20-30 min, active electrode over T10-T12 and the reference on the right shoulder), similar electric field intensities are generated in both ventral and dorsal horns of the SC at the same height. This was confirmed by human studies, in which both motor and sensitive effects were found. Lastly, electric fields are strongly dependent on anatomy and electrodes' placement. Regardless of the montage, inter-individual hotspots of higher values of electric fields were predicted, which could change when the subjects move from a position to another (e.g., from the supine to the lateral position). These characteristics underlines the need for individualized and patient-tailored MRI-based computational models to optimize the stimulation protocol. A detailed modeling approach of the electric field distribution might contribute to optimizing stimulation protocols, tailoring electrodes' configuration, intensities, and duration to the clinical outcome.
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Affiliation(s)
- Matteo Guidetti
- Aldo Ravelli Research Center for Neurotechnology and Experimental Neurotherapeutics, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (M.G.); (T.B.); (N.V.M.)
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy;
| | - Stefano Giannoni-Luza
- Sensory-Motor Lab (SeMoLa), Department of Ophthalmology—University of Lausanne, Jules Gonin Eye Hospital/Fondation Asile des Aveugles, 1015 Lausanne, Switzerland; (S.G.-L.); (S.I.)
| | - Tommaso Bocci
- Aldo Ravelli Research Center for Neurotechnology and Experimental Neurotherapeutics, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (M.G.); (T.B.); (N.V.M.)
- III Neurology Clinic, ASST-Santi Paolo e Carlo University Hospital, 20142 Milan, Italy;
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, MA 02129, USA;
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Lima 15024, Peru
| | - Anna Maria Bianchi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy;
| | - Marta Parazzini
- Istituto di Elettronica e di Ingegneria Dell’Informazione e delle Telecomunicazioni (IEIIT), Consiglio Nazionale delle Ricerche (CNR), 10129 Milan, Italy;
| | - Silvio Ionta
- Sensory-Motor Lab (SeMoLa), Department of Ophthalmology—University of Lausanne, Jules Gonin Eye Hospital/Fondation Asile des Aveugles, 1015 Lausanne, Switzerland; (S.G.-L.); (S.I.)
| | - Roberta Ferrucci
- III Neurology Clinic, ASST-Santi Paolo e Carlo University Hospital, 20142 Milan, Italy;
- Department of Oncology and Hematology, University of Milan, 20122 Milan, Italy
| | - Natale Vincenzo Maiorana
- Aldo Ravelli Research Center for Neurotechnology and Experimental Neurotherapeutics, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (M.G.); (T.B.); (N.V.M.)
| | - Federico Verde
- Department of Neurology, Istituto Auxologico Italiano IRCCS, 20149 Milan, Italy; (F.V.); (N.T.); (V.S.)
- Department of Pathophysiology and Transplantation, ‘Dino Ferrari’ Center, Università degli Studi di Milano, 20122 Milan, Italy
| | - Nicola Ticozzi
- Department of Neurology, Istituto Auxologico Italiano IRCCS, 20149 Milan, Italy; (F.V.); (N.T.); (V.S.)
- Department of Pathophysiology and Transplantation, ‘Dino Ferrari’ Center, Università degli Studi di Milano, 20122 Milan, Italy
| | - Vincenzo Silani
- Department of Neurology, Istituto Auxologico Italiano IRCCS, 20149 Milan, Italy; (F.V.); (N.T.); (V.S.)
- Department of Pathophysiology and Transplantation, ‘Dino Ferrari’ Center, Università degli Studi di Milano, 20122 Milan, Italy
| | - Alberto Priori
- Aldo Ravelli Research Center for Neurotechnology and Experimental Neurotherapeutics, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (M.G.); (T.B.); (N.V.M.)
- III Neurology Clinic, ASST-Santi Paolo e Carlo University Hospital, 20142 Milan, Italy;
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Effect of Transcutaneous Spinal Direct Current Stimulation in Patients with Painful Polyneuropathy and Influence of Possible Predictors of Efficacy including BDNF Polymorphism: A Randomized, Sham-Controlled Crossover Study. Brain Sci 2023; 13:brainsci13020229. [PMID: 36831772 PMCID: PMC9953758 DOI: 10.3390/brainsci13020229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/20/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
Introduction: The neuromodulating effects of transcutaneous-spinal Direct Current Stimulation (tsDCS) have been reported to block pain signaling. For patients with chronic pain, tsDCS could be a potential treatment option. To approach this, we studied the effect of anodal tsDCS on patients with neuropathic pain approaching an optimal paradigm including the investigation of different outcome predictors. Methods: In this randomized, double-blinded, sham-controlled crossover study we recruited twenty patients with neurophysiologically evaluated neuropathic pain due to polyneuropathy (PNP). Variables (VAS; pain and sleep quality) were reported daily, one week prior to, and one week after the stimulation/sham period. Anodal tsDCS (2.5 mA, 20 min) was given once daily for three days during one week. BDNF-polymorphism, pharmacological treatment, and body mass index (BMI) of all the patients were investigated. Results: Comparing the effects of sham and real stimulation at the group level, there was a tendency towards reduced pain, but no significant effects were found. However, for sleep quality a significant improvement was seen. At the individual level, 30 and 35% of the subjects had a clinically significant improvement of pain level and sleep quality, respectively, the first day after the stimulation. Both effects were reduced over the coming week and these changes were negatively correlated. The BDNF polymorphism Val66Met was carried by 35% of the patients and this group was found to have a lower general level of pain but there was no significant difference in the tsDCS response effect. Neither pharmacologic treatment or BMI influenced the treatment effect. Conclusions: Short-term and sparse anodal thoracic tsDCS reduces pain and improves sleep with large inter-individual differences. Roughly 30% will benefit in a clinically meaningful way. The BDNF genotype seems to influence the level of pain that PNP produces. Individualized and intensified tsDCS may be a treatment option for neuropathic pain due to PNP.
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Fava de Lima F, Silva CR, Kohn AF. Transcutaneous spinal direct current stimulation (tsDCS) does not affect postural sway of young and healthy subjects during quiet upright standing. PLoS One 2022; 17:e0267718. [PMID: 35482798 PMCID: PMC9049532 DOI: 10.1371/journal.pone.0267718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 04/13/2022] [Indexed: 12/02/2022] Open
Abstract
Transcutaneous spinal direct current stimulation (tsDCS) is an effective non-invasive spinal cord electrical stimulation technique to induce neuromodulation of local and distal neural circuits of the central nervous system (CNS). Applied to the spinal cord lumbosacral region, tsDCS changes electrophysiological responses of the motor, proprioceptive and nociceptive pathways, alters the performance of some lower limb motor tasks and can even modulate the behavior of supramedullary neuronal networks. In this study an experimental protocol was conducted to verify if tsDCS (5 mA, 20 minutes) of two different polarizations, applied over the lumbosacral region (tenth thoracic vertebrae (T10)), can induce changes in postural sway oscillations of young healthy individuals during quiet standing. A novel initialization of the electrical stimulation was developed to improve subject blinding to the different stimulus conditions including the sham trials. Measures of postural sway, both global and structural, were computed before, during and following the DC stimulation period. The results indicated that, for the adopted conditions, tsDCS did not induce statistically significant changes in postural sway of young healthy individuals during quiet standing.
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Affiliation(s)
- Felipe Fava de Lima
- Biomedical Engineering Laboratory, Escola Politécnica, University of São Paulo, São Paulo, Brazil
- * E-mail:
| | - Cristiano Rocha Silva
- Biomedical Engineering Laboratory, Escola Politécnica, University of São Paulo, São Paulo, Brazil
| | - Andre Fabio Kohn
- Biomedical Engineering Laboratory, Escola Politécnica, University of São Paulo, São Paulo, Brazil
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Dubbioso R, Pellegrino G, Ranieri F, Di Pino G, Capone F, Dileone M, Iodice R, Ruggiero L, Tozza S, Uncini A, Manganelli F, Di Lazzaro V. BDNF polymorphism and inter hemispheric balance of motor cortex excitability: a preliminary study. J Neurophysiol 2021; 127:204-212. [PMID: 34936818 DOI: 10.1152/jn.00268.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Preclinical studies have demonstrated that Brain-Derived Neurotrophic Factor (BDNF) plays a crucial role in the homeostatic regulation of cortical excitability and excitation/inhibition balance. Using transcranial magnetic stimulation (TMS) techniques we investigated whether BDNF polymorphism could influence cortical excitability of the left and right primary motor cortex in healthy humans. Twenty-nine participants were recruited and genotyped for the presence of the BDNF Val66Met polymorphism, namely homozygous for the valine allele (Val/Val), heterozygotes (Val/Met), and homozygous for the methionine allele (Met/Met). Blinded to the latter, we evaluated inhibitory and facilitatory circuits of the left (LH) and right motor cortex (RH) by measuring resting (RMT) and active motor threshold (AMT), short interval intracortical inhibition (SICI) and intracortical facilitation (ICF). For each neurophysiological metric we also considered the inter-hemispheric balance expressed by the Laterality Index (LI). Val/Val participants (n= 21) exhibited an overall higher excitability of the LH compared to the RH, as probed by lower motor thresholds, lower SICI and higher ICF. Val/Val participants displayed positive LI, especially for AMT and ICF (all p< 0.05), indicating higher LH excitability and more pronounced inter-hemispheric excitability imbalance as compared to Met carriers. Our preliminary results suggest that BDNF Val66Met polymorphism might influence interhemispheric balance of motor cortex excitability.
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Affiliation(s)
- Raffaele Dubbioso
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Giovanni Pellegrino
- Neurology and Neurosurgery Department, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Federico Ranieri
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giovanni Di Pino
- Research Unit of Neurophysiology and Neuroengineering of Human-Technology Interaction (NeXTlab), Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Fioravante Capone
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Michele Dileone
- Faculty of Health Sciences, University of Castilla La Mancha, Talavera de la Reina, Spain
| | - Rosa Iodice
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Lucia Ruggiero
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Stefano Tozza
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Antonino Uncini
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti-Pescara, Italy
| | - Fiore Manganelli
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
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Jogia T, Kopp MA, Schwab JM, Ruitenberg MJ. Peripheral white blood cell responses as emerging biomarkers for patient stratification and prognosis in acute spinal cord injury. Curr Opin Neurol 2021; 34:796-803. [PMID: 34608075 PMCID: PMC8631147 DOI: 10.1097/wco.0000000000000995] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW To date, prognostication of patients after acute traumatic spinal cord injury (SCI) mostly relies on the neurological assessment of residual function attributed to lesion characteristics. With emerging treatment candidates awaiting to be tested in early clinical trials, there is a need for wholistic high-yield prognostic biomarkers that integrate both neurogenic and nonneurogenic SCI pathophysiology as well as premorbid patient characteristics. RECENT FINDINGS It is becoming clearer that effective prognostication after acute SCI would benefit from integrating an assessment of pathophysiological changes on a systemic level, and with that, extend from a lesion-centric approach. Immunological markers mirror tissue injury as well as host immune function and are easily accessible through routine blood sampling. New studies have highlighted the value of circulating white blood cells, neutrophils and lymphocytes in particular, as prognostic systemic indicators of SCI severity and outcomes. SUMMARY We survey recent advances in methods and approaches that may allow for a more refined diagnosis and better prognostication after acute SCI, discuss how these may help deepen our understanding of SCI pathophysiology, and be of use in clinical trials.
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Affiliation(s)
- Trisha Jogia
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Marcel A. Kopp
- Spinal Cord Injury Research (Neuroparaplegiology), Department of Neurology and Experimental Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Jan M. Schwab
- Spinal Cord Injury Research (Neuroparaplegiology), Department of Neurology and Experimental Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Belford Center for Spinal Cord Injury, Departments of Neuroscience and Physical Medicine and Rehabilitation, The Neurological Institute, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
| | - Marc J. Ruitenberg
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Ciccone AB, Fry AC, Emerson DM, Gallagher PM, Herda TJ, Weir JP. Effects of Transspinal Direct Current Stimulation on Cycling Perception of Effort and Time to Exhaustion. J Strength Cond Res 2021; 35:347-352. [PMID: 33306592 DOI: 10.1519/jsc.0000000000003876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Ciccone, AB, Fry, AC, Emerson, DM, Gallagher, PM, Herda, TJ, and Weir, JP. Effects of transspinal direct current stimulation on cycling perception of effort and time to exhaustion. J Strength Cond Res 35(2): 347-352, 2021-In the past decade, researchers have investigated the efficacy of transspinal direct current stimulation (tsDCS) on the central nervous system and afferent neuron function in humans. Recently, data have suggested it may be possible for such tsDCS-induced changes in neuromuscular function to enhance performance. This study used noninvasive thoracic spine tsDCS to determine if cycling performance and perception of effort could be modulated by tsDCS. In 3 different stimulation conditions, anodal, cathodal, and sham, subjects cycled at 80% of their maximal aerobic capacity until exhaustion and reported their rating of perceived exertion (RPE) every minute. From this period, we compared the RPE responses over the first 3 minutes and time to exhaustion. There was no significant difference in time to exhaustion between anodal (408 ± 121 seconds), cathodal (413 ± 168 seconds), and sham (440 ± 189 seconds) conditions (p = 0.58). There was no significant difference in RPE from minutes 1-3 (collapsed across time) between anodal (12.9 ± 2.4 arbitrary units (AUs)), cathodal (13.3 ± 2.2 AUs), and sham (12.9 ± 2.1 AUs) conditions (p = 0.51). These data suggest tsDCS condition did not influence cycling performance or perception of effort during high-intensity cycling. Therefore, thoracic spine and lower abdominal montage delivering a current density of 0.071 mA·cm-2 for 20 minutes likely does not substantially improve high-intensity cycling work capacity. Therefore, more research is needed to investigate the efficacy of tsDCS and which stimulation methods may and may not enhance human performance.
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Affiliation(s)
- Anthony B Ciccone
- Department of Exercise Science and Outdoor Recreation, Utah Valley University, Orem, Utah; and
| | - Andrew C Fry
- Osness Human Performance Laboratories, Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, Kansas
| | - Dawn M Emerson
- Osness Human Performance Laboratories, Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, Kansas
| | - Philip M Gallagher
- Osness Human Performance Laboratories, Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, Kansas
| | - Trent J Herda
- Osness Human Performance Laboratories, Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, Kansas
| | - Joseph P Weir
- Osness Human Performance Laboratories, Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, Kansas
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Transcutaneous spinal direct current stimulation shows no effect on paired stimulation suppression of the somatosensory cortex. Sci Rep 2020; 10:22010. [PMID: 33319846 PMCID: PMC7738485 DOI: 10.1038/s41598-020-79131-2] [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: 06/17/2020] [Accepted: 12/03/2020] [Indexed: 11/08/2022] Open
Abstract
Transcutaneous spinal direct current stimulation (tsDCS) is a safe and convenient method of neuromodulation. It has been proven to alter sensory processing at cervicomedullary level by amplitude changes of the P30 response of tibial nerve somatosensory evoked potentials (TN SEPs). With knowledge that tsDCS affects cortical circuits, we hypothesized that tsDCS may also affect intracortical excitability of the somatosensory cortex assessed by paired stimulation suppression (PSS). Fourteen healthy men were included in this prospective, single-blinded, placebo-controlled crossover study. Single (SS) and paired stimulation (PS) TN SEPs were recorded over the scalp before, immediately as well as 30 and 60 min after applying 15 min of tsDCS over the twelfth thoracic vertebra. Each volunteer underwent three independent and randomized sessions of either cathodal, anodal or sham stimulation. tsDCS showed no effect on peak-to-peak amplitudes or latencies of cortical P40-N50 response after SS. Furthermore, tsDCS failed to induce significant changes on amplitude ratios of PSS, thus showing no impact on intracortical excitability of the somatosensory cortex in healthy subjects. Further research is required to reveal the different mechanisms and to strengthen clinical use of this promising technique.
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12
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Zheng Y, Mao YR, Yuan TF, Xu DS, Cheng LM. Multimodal treatment for spinal cord injury: a sword of neuroregeneration upon neuromodulation. Neural Regen Res 2020; 15:1437-1450. [PMID: 31997803 PMCID: PMC7059565 DOI: 10.4103/1673-5374.274332] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 04/28/2019] [Accepted: 07/08/2019] [Indexed: 12/25/2022] Open
Abstract
Spinal cord injury is linked to the interruption of neural pathways, which results in irreversible neural dysfunction. Neural repair and neuroregeneration are critical goals and issues for rehabilitation in spinal cord injury, which require neural stem cell repair and multimodal neuromodulation techniques involving personalized rehabilitation strategies. Besides the involvement of endogenous stem cells in neurogenesis and neural repair, exogenous neural stem cell transplantation is an emerging effective method for repairing and replacing damaged tissues in central nervous system diseases. However, to ensure that endogenous or exogenous neural stem cells truly participate in neural repair following spinal cord injury, appropriate interventional measures (e.g., neuromodulation) should be adopted. Neuromodulation techniques, such as noninvasive magnetic stimulation and electrical stimulation, have been safely applied in many neuropsychiatric diseases. There is increasing evidence to suggest that neuromagnetic/electrical modulation promotes neuroregeneration and neural repair by affecting signaling in the nervous system; namely, by exciting, inhibiting, or regulating neuronal and neural network activities to improve motor function and motor learning following spinal cord injury. Several studies have indicated that fine motor skill rehabilitation training makes use of residual nerve fibers for collateral growth, encourages the formation of new synaptic connections to promote neural plasticity, and improves motor function recovery in patients with spinal cord injury. With the development of biomaterial technology and biomechanical engineering, several emerging treatments have been developed, such as robots, brain-computer interfaces, and nanomaterials. These treatments have the potential to help millions of patients suffering from motor dysfunction caused by spinal cord injury. However, large-scale clinical trials need to be conducted to validate their efficacy. This review evaluated the efficacy of neural stem cells and magnetic or electrical stimulation combined with rehabilitation training and intelligent therapies for spinal cord injury according to existing evidence, to build up a multimodal treatment strategy of spinal cord injury to enhance nerve repair and regeneration.
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Affiliation(s)
- Ya Zheng
- Rehabilitation Section, Spine Surgery Division of Department of Orthopedics, Tongji Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Ye-Ran Mao
- Rehabilitation Section, Spine Surgery Division of Department of Orthopedics, Tongji Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Ti-Fei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu Province, China
| | - Dong-Sheng Xu
- Rehabilitation Section, Spine Surgery Division of Department of Orthopedics, Tongji Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education of the People's Republic of China, Tongji University, Shanghai, China
| | - Li-Ming Cheng
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education of the People's Republic of China, Tongji University, Shanghai, China
- Spine Surgery Division of Department of Orthopedics, Tongji Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
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13
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Effect of transspinal direct current stimulation on afferent pain signalling in humans. J Clin Neurosci 2020; 77:163-167. [DOI: 10.1016/j.jocn.2020.04.116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/24/2020] [Accepted: 04/26/2020] [Indexed: 02/03/2023]
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Tan AQ, Barth S, Trumbower RD. Acute intermittent hypoxia as a potential adjuvant to improve walking following spinal cord injury: evidence, challenges, and future directions. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020; 8:188-198. [PMID: 33738145 DOI: 10.1007/s40141-020-00270-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Purpose of Review The reacquisition and preservation of walking ability are highly valued goals in spinal cord injury (SCI) rehabilitation. Recurrent episodes of breathing low oxygen (i.e., acute intermittent hypoxia, AIH) is a potential therapy to promote walking recovery after incomplete SCI via endogenous mechanisms of neuroplasticity. Here, we report on the progress of AIH, alone or paired with other treatments, on walking recovery in persons with incomplete SCI. We evaluate the evidence of AIH as a therapy ready for clinical and home use and the real and perceived challenges that may interfere with this possibility. Recent Findings Repetitive AIH is a safe and an efficacious treatment to enhance strength, walking speed and endurance, as well as, dynamic balance in persons with chronic, incomplete SCI. Summary The potential for AIH as a treatment for SCI remains high, but further research is necessary to understand treatment targets and effectiveness in a large cohort of persons with SCI.
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Affiliation(s)
- Andrew Quesada Tan
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA. USA
- Spaulding Rehabilitation Hospital, Boston MA
| | - Stella Barth
- Spaulding Rehabilitation Hospital, Boston MA
- Harvard University, Cambridge MA
| | - Randy D Trumbower
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA. USA
- Spaulding Rehabilitation Hospital, Boston MA
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Gogeascoechea A, Kuck A, van Asseldonk E, Negro F, Buitenweg JR, Yavuz US, Sartori M. Interfacing With Alpha Motor Neurons in Spinal Cord Injury Patients Receiving Trans-spinal Electrical Stimulation. Front Neurol 2020; 11:493. [PMID: 32582012 PMCID: PMC7296155 DOI: 10.3389/fneur.2020.00493] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/05/2020] [Indexed: 12/22/2022] Open
Abstract
Trans-spinal direct current stimulation (tsDCS) provides a non-invasive, clinically viable approach to potentially restore physiological neuromuscular function after neurological impairment, e.g., spinal cord injury (SCI). Use of tsDCS has been hampered by the inability of delivering stimulation patterns based on the activity of neural targets responsible to motor function, i.e., α-motor neurons (α-MNs). State of the art modeling and experimental techniques do not provide information about how individual α-MNs respond to electrical fields. This is a major element hindering the development of neuro-modulative technologies highly tailored to an individual patient. For the first time, we propose the use of a signal-based approach to infer tsDCS effects on large α-MNs pools in four incomplete SCI individuals. We employ leg muscles spatial sampling and deconvolution of high-density fiber electrical activity to decode accurate α-MNs discharges across multiple lumbosacral segments during isometric plantar flexion sub-maximal contractions. This is done before, immediately after and 30 min after sub-threshold cathodal stimulation. We deliver sham tsDCS as a control measure. First, we propose a new algorithm for removing compromised information from decomposed α-MNs spike trains, thereby enabling robust decomposition and frequency-domain analysis. Second, we propose the analysis of α-MNs spike trains coherence (i.e., frequency-domain) as an indicator of spinal response to tsDCS. Results showed that α-MNs spike trains coherence analysis sensibly varied across stimulation phases. Coherence analyses results suggested that the common synaptic input to α-MNs pools decreased immediately after cathodal tsDCS with a persistent effect after 30 min. Our proposed non-invasive decoding of individual α-MNs behavior may open up new avenues for the design of real-time closed-loop control applications including both transcutaneous and epidural spinal electrical stimulation where stimulation parameters are adjusted on-the-fly.
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Affiliation(s)
- Antonio Gogeascoechea
- Department of Biomechanical Engineering, University of Twente, Enschede, Netherlands
| | - Alexander Kuck
- Department of Biomechanical Engineering, University of Twente, Enschede, Netherlands
| | - Edwin van Asseldonk
- Department of Biomechanical Engineering, University of Twente, Enschede, Netherlands
| | - Francesco Negro
- Department of Clinical and Experimental Sciences, Università degli Studi di Brescia, Brescia, Italy
| | - Jan R Buitenweg
- Biomedical Signals and Systems Group, University of Twente, Enschede, Netherlands
| | - Utku S Yavuz
- Biomedical Signals and Systems Group, University of Twente, Enschede, Netherlands
| | - Massimo Sartori
- Department of Biomechanical Engineering, University of Twente, Enschede, Netherlands
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16
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Morya E, Monte-Silva K, Bikson M, Esmaeilpour Z, Biazoli CE, Fonseca A, Bocci T, Farzan F, Chatterjee R, Hausdorff JM, da Silva Machado DG, Brunoni AR, Mezger E, Moscaleski LA, Pegado R, Sato JR, Caetano MS, Sá KN, Tanaka C, Li LM, Baptista AF, Okano AH. Beyond the target area: an integrative view of tDCS-induced motor cortex modulation in patients and athletes. J Neuroeng Rehabil 2019; 16:141. [PMID: 31730494 PMCID: PMC6858746 DOI: 10.1186/s12984-019-0581-1] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 08/19/2019] [Indexed: 02/07/2023] Open
Abstract
Transcranial Direct Current Stimulation (tDCS) is a non-invasive technique used to modulate neural tissue. Neuromodulation apparently improves cognitive functions in several neurologic diseases treatment and sports performance. In this study, we present a comprehensive, integrative review of tDCS for motor rehabilitation and motor learning in healthy individuals, athletes and multiple neurologic and neuropsychiatric conditions. We also report on neuromodulation mechanisms, main applications, current knowledge including areas such as language, embodied cognition, functional and social aspects, and future directions. We present the use and perspectives of new developments in tDCS technology, namely high-definition tDCS (HD-tDCS) which promises to overcome one of the main tDCS limitation (i.e., low focality) and its application for neurological disease, pain relief, and motor learning/rehabilitation. Finally, we provided information regarding the Transcutaneous Spinal Direct Current Stimulation (tsDCS) in clinical applications, Cerebellar tDCS (ctDCS) and its influence on motor learning, and TMS combined with electroencephalography (EEG) as a tool to evaluate tDCS effects on brain function.
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Affiliation(s)
- Edgard Morya
- Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaíba, Rio Grande do Norte Brazil
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
| | - Kátia Monte-Silva
- Universidade Federal de Pernambuco, Recife, Pernambuco Brazil
- Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN), Universidade Federal do ABC (UFABC)/Universidade de São Paulo (USP)/Universidade Cidade de São Paulo (UNICID)/Universidade Federal de Pernambuco (UFPE), Escola Bahiana de Medicina e Saúde Pública (EBMSP), Santo André, Brazil
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, NY USA
| | - Zeinab Esmaeilpour
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, NY USA
| | - Claudinei Eduardo Biazoli
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
| | - Andre Fonseca
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
| | - Tommaso Bocci
- Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, International Medical School, University of Milan, Milan, Italy
| | - Faranak Farzan
- School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia Canada
| | - Raaj Chatterjee
- School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia Canada
| | - Jeffrey M. Hausdorff
- Department of Physical Therapy, Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Eva Mezger
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Luciane Aparecida Moscaleski
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
| | - Rodrigo Pegado
- Graduate Program in Rehabilitation Science, Universidade Federal do Rio Grande do Norte, Santa Cruz, Rio Grande do Norte Brazil
| | - João Ricardo Sato
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
| | - Marcelo Salvador Caetano
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
| | - Kátia Nunes Sá
- Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN), Universidade Federal do ABC (UFABC)/Universidade de São Paulo (USP)/Universidade Cidade de São Paulo (UNICID)/Universidade Federal de Pernambuco (UFPE), Escola Bahiana de Medicina e Saúde Pública (EBMSP), Santo André, Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia Brazil
| | - Clarice Tanaka
- Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN), Universidade Federal do ABC (UFABC)/Universidade de São Paulo (USP)/Universidade Cidade de São Paulo (UNICID)/Universidade Federal de Pernambuco (UFPE), Escola Bahiana de Medicina e Saúde Pública (EBMSP), Santo André, Brazil
- Laboratório de Investigações Médicas-54, Universidade de São Paulo, São Paulo, São Paulo Brazil
| | - Li Min Li
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
| | - Abrahão Fontes Baptista
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
- Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN), Universidade Federal do ABC (UFABC)/Universidade de São Paulo (USP)/Universidade Cidade de São Paulo (UNICID)/Universidade Federal de Pernambuco (UFPE), Escola Bahiana de Medicina e Saúde Pública (EBMSP), Santo André, Brazil
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia Brazil
- Laboratório de Investigações Médicas-54, Universidade de São Paulo, São Paulo, São Paulo Brazil
| | - Alexandre Hideki Okano
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
- Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN), Universidade Federal do ABC (UFABC)/Universidade de São Paulo (USP)/Universidade Cidade de São Paulo (UNICID)/Universidade Federal de Pernambuco (UFPE), Escola Bahiana de Medicina e Saúde Pública (EBMSP), Santo André, Brazil
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
- Graduate Program in Physical Education. State University of Londrina, Londrina, Paraná, Brazil
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Giarratana AO, Teng S, Reddi S, Zheng C, Adler D, Thakker-Varia S, Alder J. BDNF Val66Met Genetic Polymorphism Results in Poor Recovery Following Repeated Mild Traumatic Brain Injury in a Mouse Model and Treatment With AAV-BDNF Improves Outcomes. Front Neurol 2019; 10:1175. [PMID: 31787925 PMCID: PMC6854037 DOI: 10.3389/fneur.2019.01175] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/21/2019] [Indexed: 01/23/2023] Open
Abstract
Clinicians have long noticed that some Traumatic Brain Injury (TBI) patients have worse symptoms and take a longer time to recover than others, for reasons unexplained by known factors. Identifying what makes some individuals more susceptible is critical to understanding the underlying mechanisms through which TBI causes deleterious effects. We have sought to determine the effect of a single nucleotide polymorphism (SNP) in Brain-derived neurotrophic factor (BDNF) at amino acid 66 (rs6265) on recovery after TBI. There is controversy from human studies as to whether the BDNF Val66Val or Val66Met allele is the risk factor for worse outcomes after brain trauma. We therefore investigated cellular and behavioral outcomes in genetically engineered mice following repeated mild TBI (rmTBI) using a lateral fluid percussion (LFP) injury model. We found that relative to injured Val66Val carriers, injured Val66Met carriers had a larger inflammation volume and increased levels of neurodegeneration, apoptosis, p-tau, activated microglia, and gliosis in the cortex and/or hippocampus at 1 and/or 21 days post-injury (DPI). We therefore concluded that the Val66Met genetic polymorphism is a risk factor for poor outcomes after rmTBI. In order to determine the mechanism for these differences, we investigated levels of the apoptotic-inducing pro BDNF and survival-inducing mature BDNF isoforms and found that Met carriers had less total BDNF in the cortex and a higher pro/mature ratio of BDNF in the hippocampus. We then developed a personalized approach to treating genetically susceptible individuals by overexpressing wildtype BDNF in injured Val66Met mice using an AAV-BDNF virus. This intervention improved cellular, motor, and cognitive behavior outcomes at 21 DPI and increased levels of mature BDNF and phosphorylation of mature BDNF's receptor trkB. This study lays the groundwork for further investigation into the genetics that play a role in the extent of injury after rmTBI and highlights how personalized therapeutics may be targeted for recovery in susceptible individuals.
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Affiliation(s)
- Anna O Giarratana
- Department of Neuroscience and Cell Biology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, United States
| | - Shavonne Teng
- Department of Neuroscience and Cell Biology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, United States
| | - Sahithi Reddi
- Department of Neuroscience and Cell Biology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, United States
| | - Cynthia Zheng
- Department of Neuroscience and Cell Biology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, United States
| | - Derek Adler
- Department of Neuroscience and Cell Biology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, United States
| | - Smita Thakker-Varia
- Department of Neuroscience and Cell Biology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, United States
| | - Janet Alder
- Department of Neuroscience and Cell Biology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, United States
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18
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Murray LM, Knikou M. Repeated cathodal transspinal pulse and direct current stimulation modulate cortical and corticospinal excitability differently in healthy humans. Exp Brain Res 2019; 237:1841-1852. [DOI: 10.1007/s00221-019-05559-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 05/08/2019] [Indexed: 10/26/2022]
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19
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Choi YA, Kim Y, Shin HI. Pilot study of feasibility and effect of anodal transcutaneous spinal direct current stimulation on chronic neuropathic pain after spinal cord injury. Spinal Cord 2019; 57:461-470. [PMID: 30700853 DOI: 10.1038/s41393-019-0244-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/03/2019] [Accepted: 01/14/2019] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN A single-blind crossover study. OBJECTIVES This study aimed to evaluate neuropathic pain in persons with spinal cord injury (SCI) after the application of transcutaneous spinal direct current stimulation (tsDCS). SETTING Outpatient Clinic of the Rehabilitation Department, Seoul National University Hospital. METHODS The effect of single sessions of both anodal and sham tsDCS (2 mA, 20 min) on chronic neuropathic pain in ten volunteers with complete motor cervical SCI was assessed. The active electrode was placed over the spinal process of the tenth thoracic vertebra and the reference electrode, at the top of the head. Pre- to post-tsDCS intervention changes in pain intensity (numeric rating scale, NRS), patient global assessment, and present pain intensity (PPI) were assessed before and after the tsDCS session (immediately post stimulation, and at 1 and 2 h post stimulation). RESULTS All participants underwent the stimulation procedure without dropout. Our results showed no significant pre- to post-treatment difference in pain intensity between the active and sham tsDCS groups. Only in the sham tsDCS stimulation, NRS and PPI scores were reduced after the stimulation session. Furthermore, in the mixed effect model analysis, the response in the second period appeared to be more favorable. CONCLUSION The results suggest that a single session of anodal tsDCS with the montage used in this study is feasible but does not have a significant analgesic effect in individuals with chronic cervical SCI. SPONSORSHIP The study was funded by Seoul National University Hospital (No. 0420160470) and Korea Workers' Compensation & Welfare Service.
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Affiliation(s)
- Young-Ah Choi
- Department of Rehabilitation Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Yale Kim
- Department of Rehabilitation Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Hyung-Ik Shin
- Department of Rehabilitation Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea.
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20
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Van Acker GM, Vrabec TL, Bhadra N, Chae J, Kilgore KL, Bhadra N. Block of motor nerve conduction via transcutaneous application of direct current. BIOELECTRONICS IN MEDICINE 2018; 1:107-116. [PMID: 39301195 PMCID: PMC11412303 DOI: 10.2217/bem-2017-0011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/09/2018] [Indexed: 09/22/2024]
Abstract
Aims Nerve conduction block using implanted electrodes is being used increasingly for clinical applications. Alternatively, non-invasive electrical nerve block would be beneficial for applications including pain block and muscle spasticity. Here we developed a novel means of non-invasive electrical nerve conduction blockade - transcutaneous direct current block (tDCB) - that produces direct block of nerve conduction. Materials & Methods In an in vivo rodent model, tDCB produced stable neuromotor blockade of sciatic nerve branches, dependent on stimulus parameters and electrode geometry. Results Partial-to-complete neuromotor block was achieved in all subjects using tDCB amplitudes at or below 20 mA, and complete block was achieved at amplitudes as low as 6 mA. Conclusions Our results reveal that neuromotor activity can be rapidly, reliably and reversibly blocked using tDCB.
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Affiliation(s)
- Gustaf M Van Acker
- MetroHealth Rehabilitation Institute of Ohio, The MetroHealth System & Case Western Reserve University, Cleveland, OH 44109, USA
- Cleveland Functional Electrical Stimulation Center, Cleveland, OH 44106, USA
| | - Tina L Vrabec
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
- Cleveland Functional Electrical Stimulation Center, Cleveland, OH 44106, USA
| | - Narendra Bhadra
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
- Cleveland Functional Electrical Stimulation Center, Cleveland, OH 44106, USA
| | - John Chae
- MetroHealth Rehabilitation Institute of Ohio, The MetroHealth System & Case Western Reserve University, Cleveland, OH 44109, USA
- Cleveland Functional Electrical Stimulation Center, Cleveland, OH 44106, USA
| | - Kevin L Kilgore
- Department of Orthopedics, The MetroHealth System, Cleveland, OH 44109, USA
- Cleveland Functional Electrical Stimulation Center, Cleveland, OH 44106, USA
| | - Niloy Bhadra
- MetroHealth Rehabilitation Institute of Ohio, The MetroHealth System & Case Western Reserve University, Cleveland, OH 44109, USA
- Cleveland Functional Electrical Stimulation Center, Cleveland, OH 44106, USA
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21
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Kuck A, Stegeman DF, van der Kooij H, van Asseldonk EHF. Changes in H-Reflex Recruitment After Trans-Spinal Direct Current Stimulation With Multiple Electrode Configurations. Front Neurosci 2018; 12:151. [PMID: 29643759 PMCID: PMC5882846 DOI: 10.3389/fnins.2018.00151] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 02/26/2018] [Indexed: 01/11/2023] Open
Abstract
Trans-spinal direct current stimulation (tsDCS) is an electro-modulatory tool with possible application in the rehabilitation of spinal cord injury. TsDCS generates a small electric field, aiming to induce lasting, functional neuromodulation in the targeted neuronal networks. Earlier studies have shown significant modulatory effects after application of lumbar tsDCS. However, for clinical application, a better understanding of application specific factors is required. Our goal was to investigate the effect of different electrode configurations using lumbar spinal tsDCS on spinal excitability. We applied tsDCS (2.5 mA, 15 min) in 10 healthy subjects with three different electrode configurations: (1) Anode and cathode placed over vertebra T11, and the posterior left shoulder respectively (LSC-S) (one polarity), and (2) Both electrodes placed in equal distance (ED) (7 cm) above and below vertebra T11, investigated for two polarities (ED-Anodal/Cathodal). The soleus H-Reflex is measured before, during and after tsDCS in either electrode configuration or a sham condition. To account for genetic predispositions in response to direct current stimulation, subject BDNF genotype was assessed. Stimulation in configuration ED-Cathodal induced an amplitude reduction of the H-reflex, 30 min after tsDCS with respect to baseline, whereas none of the other configurations led to significant post intervention effects. BDNF genotype did not correlate with post intervention effects. Furthermore, we failed to replicate effects shown by a previous study, which highlights the need for a better understanding of methodological and subject specific influences on tsDCS outcome. The H-reflex depression after tsDCS (Config. ED-Cathodal) provides new insights and may foster our understanding of the working mechanism of tsDCS.
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Affiliation(s)
- Alexander Kuck
- Laboratory of Biomechanical Engineering, Department of Engineering Technology, University of Twente, Enschede, Netherlands.,Neuronal Rhythms in Movement Unit, Okinawa Institute of Science and Technology Graduate University, Onna-son, Japan
| | - Dick F Stegeman
- Department of Neurology/Clinical Neurophysiology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, Netherlands
| | - Herman van der Kooij
- Laboratory of Biomechanical Engineering, Department of Engineering Technology, University of Twente, Enschede, Netherlands.,Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, Netherlands
| | - Edwin H F van Asseldonk
- Laboratory of Biomechanical Engineering, Department of Engineering Technology, University of Twente, Enschede, Netherlands
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22
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Kim MS, Koo H, Han SW, Paulus W, Nitsche MA, Kim YH, Yoon JA, Shin YI. Repeated anodal transcranial direct current stimulation induces neural plasticity-associated gene expression in the rat cortex and hippocampus. Restor Neurol Neurosci 2018; 35:137-146. [PMID: 28059801 DOI: 10.3233/rnn-160689] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Anodal transcranial direct current stimulation (A-tDCS) induces a long-lasting increase in cortical excitability that can increase gene transcription in the brain. OBJECTIVE The purpose of this study was to evaluate the expression of genes related to activity-dependent neuronal plasticity in the sensorimotor cortex and hippocampus of young Sprague-Dawley rats following A-tDCS. METHODS We applied A-tDCS over the right sensorimotor cortex epicranially with a circular electrode (3 mm diameter) at 250 μA for 20 min per day for 7 consecutive days. Levels of mRNA for brain-derived neurotrophic factor (BDNF), cAMP response element-binding protein (CREB), synapsin I, Ca2+/calmodulin-dependent protein kinase II (CaMKII), activity-regulated cytoskeleton-associated protein (Arc), and c-Fos were analyzed using SYBR Green quantitative real-time polymerase chain reaction (PCR). RESULTS We found that 7 days of unilateral A-tDCS resulted in significant increases in transcription of all plasticity-related genes tested in the ipsilateral cortex. Daily A-tDCS also resulted in a significant increase in c-Fos mRNA in the ipsilateral hippocampus. CONCLUSION These results indicate that altered expression of plasticity-associated genes in the cortex and hippocampus is a molecular substrate of A-tDCS-induced neural plasticity.
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Affiliation(s)
- Min Sun Kim
- Department of Physiology, Wonkwang University College of Medicine, Iksan, South Korea
| | - Ho Koo
- Department of Physiology, Wonkwang University College of Medicine, Iksan, South Korea
| | - Sang Who Han
- Department of Physiology, Wonkwang University College of Medicine, Iksan, South Korea
| | - Walter Paulus
- Department of Clinical Neurophysiology, University Medical Center, Georg-August-University, Goettingen, Germany
| | - Michael A Nitsche
- Department of Clinical Neurophysiology, University Medical Center, Georg-August-University, Goettingen, Germany.,Leibniz Research Center for Working Environment and Human Factors, Dortmund, Germany.,Department of Neurology, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Germany
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jin A Yoon
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
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23
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Dongés SC, Bai S, Taylor JL. Concurrent electrical cervicomedullary stimulation and cervical transcutaneous spinal direct current stimulation result in a stimulus interaction. Exp Physiol 2017; 102:1309-1320. [PMID: 28730695 DOI: 10.1113/ep086360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 07/03/2017] [Indexed: 01/19/2023]
Abstract
NEW FINDINGS What is the central question of this study? We previously showed that the motor pathway is not modified after cervical transcutaneous spinal direct current stimulation (tsDCS) applied using anterior-posterior electrodes. Here, we examine the motor pathway during stimulation. What is the main finding and its importance? We show that electrically elicited muscle responses to cervicomedullary stimulation are modified during tsDCS, whereas magnetically elicited responses are not. Modelling reveals electrical field modifications during concurrent tsDCS and electrical cervicomedullary stimulation. Changes in muscle response probably result from electrical field modifications rather than physiological changes. Care should be taken when applying electrical stimuli simultaneously. Transcutaneous spinal direct current stimulation (tsDCS) can modulate neuronal excitability within the human spinal cord; however, few studies have used tsDCS at a cervical level. This study aimed to characterize cervical tsDCS further by observing its acute effects on motor responses to transcranial magnetic stimulation and cervicomedullary stimulation. In both studies 1 and 2, participants (study 1, n = 8, four female; and study 2, n = 8, three female) received two periods of 10 min, 3 mA cervical tsDCS on the same day through electrodes placed in an anterior-posterior configuration over the neck; one period with the cathode posterior (c-tsDCS) and the other with the anode posterior (a-tsDCS). In study 1, electrically elicited cervicomedullary motor evoked potentials (eCMEPs) and transcranial magnetic stimulation-elicited motor evoked potentials (MEPs) were measured in biceps brachii and flexor carpi radialis before, during and after each tsDCS period. In study 2, eCMEPs and magnetically elicited CMEPs (mCMEPs) were measured before, during and after each tsDCS period. For study 3, computational modelling was used to observe possible interactions of cervical tsDCS and electrical cervicomedullary stimulation. Studies 1 and 2 revealed that eCMEPs were larger during c-tsDCS and smaller during a-tsDCS compared with those elicited when tsDCS was off (P < 0.05), with no changes in MEPs or mCMEPs. Modelling revealed that eCMEP changes might result from modifications of the electrical field direction and magnitude when combined with cervical tsDCS. Bidirectional eCMEP changes are likely to be caused by an interaction between cervical tsDCS and electrical cervicomedullary stimulation; therefore, care should be taken when combining such electrical stimuli in close proximity.
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Affiliation(s)
- Siobhan C Dongés
- Neuroscience Research Australia, Barker Street, Randwick, NSW, 2031, Australia.,University of New South Wales, Sydney, NSW, 2052, Australia
| | - Siwei Bai
- University of New South Wales, Sydney, NSW, 2052, Australia.,Faculty of Electrical and Computer Engineering, Technical University of Munich, Garching, Germany
| | - Janet L Taylor
- Neuroscience Research Australia, Barker Street, Randwick, NSW, 2031, Australia.,University of New South Wales, Sydney, NSW, 2052, Australia.,Edith Cowan University, Joondalup, WA, 6027, Australia
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24
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Schweizer L, Meyer-Frießem CH, Zahn PK, Tegenthoff M, Schmidt-Wilcke T. Transcutaneous Spinal Direct Current Stimulation Alters Resting-State Functional Connectivity. Brain Connect 2017; 7:357-365. [DOI: 10.1089/brain.2017.0505] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lauren Schweizer
- Department of Neurology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Christine H. Meyer-Frießem
- Department of Anesthesiology, Intensive Care Medicine, Palliative Care Medicine and Pain Management, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH Bochum, Medical Faculty of Ruhr-University Bochum, Bochum, Germany
| | - Peter K. Zahn
- Department of Anesthesiology, Intensive Care Medicine, Palliative Care Medicine and Pain Management, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH Bochum, Medical Faculty of Ruhr-University Bochum, Bochum, Germany
| | - Martin Tegenthoff
- Department of Neurology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Tobias Schmidt-Wilcke
- Department of Neurology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH Bochum, Ruhr-University Bochum, Bochum, Germany
- Department of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
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25
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Kuck A, Stegeman DF, van Asseldonk EHF. Modeling trans-spinal direct current stimulation for the modulation of the lumbar spinal motor pathways. J Neural Eng 2017. [PMID: 28631619 DOI: 10.1088/1741-2552/aa7960] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Trans-spinal direct current stimulation (tsDCS) is a potential new technique for the treatment of spinal cord injury (SCI). TsDCS aims to facilitate plastic changes in the neural pathways of the spinal cord with a positive effect on SCI recovery. To establish tsDCS as a possible treatment option for SCI, it is essential to gain a better understanding of its cause and effects. We seek to understand the acute effect of tsDCS, including the generated electric field (EF) and its polarization effect on the spinal circuits, to determine a cellular target. We further ask how these findings can be interpreted to explain published experimental results. APPROACH We use a realistic full body finite element volume conductor model to calculate the EF of a 2.5 mA direct current for three different electrode configurations. We apply the calculated electric field to realistic motoneuron models to investigate static changes in membrane resting potential. The results are combined with existing knowledge about the theoretical effect on a neuronal level and implemented into an existing lumbar spinal network model to simulate the resulting changes on a network level. MAIN RESULTS Across electrode configurations, the maximum EF inside the spinal cord ranged from 0.47 V m-1 to 0.82 V m-1. Axon terminal polarization was identified to be the dominant cellular target. Also, differences in electrode placement have a large influence on axon terminal polarization. Comparison between the simulated acute effects and the electrophysiological long-term changes observed in human tsDCS studies suggest an inverse relationship between the two. SIGNIFICANCE We provide methods and knowledge for better understanding the effects of tsDCS and serve as a basis for a more targeted and optimized application of tsDCS.
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Affiliation(s)
- A Kuck
- University of Twente, Drienerlolaan 5, 7522 NB Enschede, Netherlands
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26
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Berry HR, Tate RJ, Conway BA. Transcutaneous spinal direct current stimulation induces lasting fatigue resistance and enhances explosive vertical jump performance. PLoS One 2017; 12:e0173846. [PMID: 28379980 PMCID: PMC5381869 DOI: 10.1371/journal.pone.0173846] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 02/27/2017] [Indexed: 01/05/2023] Open
Abstract
Transcutaneous spinal direct current stimulation (tsDCS) is a non-invasive neuromodulatory intervention that has been shown to modify excitability in spinal and supraspinal circuits in animals and humans. Our objective in this study was to explore the functional neuromodulatory potential of tsDCS by examining its immediate and lasting effects over the repeated performance of a whole body maximal exercise in healthy volunteers. Using a double-blind, randomized, crossover, sham-controlled design we investigated the effects of 15 min of anodal tsDCS on repeated vertical countermovement jump (VCJ) performance at 0, 20, 60, and 180 minutes post-stimulation. Measurements of peak and take-off velocity, vertical displacement, peak power and work done during countermovement and push-off VCJ phases were derived from changes in vertical ground reaction force (12 performance parameters) in 12 healthy participants. The magnitude and direction of change in VCJ performance from pre- to post-stimulation differed significantly between sham and active tsDCS for 7 of the 12 VCJ performance measures (P < 0.05). These differences comprised of a post-sham fatigue in VCJ displacement/work done, peak to peak power and take-off velocity, and a resilience to this fatigue effect post-active tsDCS. In addition there was also an enhancement of countermovement performance and total work done (P < 0.05). These changes did not vary across repeated VCJ performances over time post-tsDCS (P > 0.05). Our original findings demonstrate that one single session of anodal tsDCS in healthy subjects can prevent fatigue and maintain or enhance different aspects of whole body explosive motor power over repeated sets of VCJs performed over a period of three hours. The observed effects are discussed in relation to alterations in central fatigue mechanisms, muscle contraction mode during jump execution and changes in spinal cord excitability. These findings have important implications for power endurance sport performance and for neuromotor rehabilitation.
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Affiliation(s)
- Helen R. Berry
- Centre for Excellence in Rehabilitation Research, Department of Biomedical Engineering, University of Strathclyde, Glasgow, United Kingdom
- * E-mail:
| | - Rothwelle J. Tate
- Strathclyde Institute for Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Bernard A. Conway
- Centre for Excellence in Rehabilitation Research, Department of Biomedical Engineering, University of Strathclyde, Glasgow, United Kingdom
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27
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Dongés SC, D’Amico JM, Butler JE, Taylor JL. The effects of cervical transcutaneous spinal direct current stimulation on motor pathways supplying the upper limb in humans. PLoS One 2017; 12:e0172333. [PMID: 28225813 PMCID: PMC5321432 DOI: 10.1371/journal.pone.0172333] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 01/08/2017] [Indexed: 12/29/2022] Open
Abstract
Non-invasive, weak direct current stimulation can induce changes in excitability of underlying neural tissue. Many studies have used transcranial direct current stimulation to induce changes in the brain, however more recently a number of studies have used transcutaneous spinal direct current stimulation to induce changes in the spinal cord. This study further characterises the effects following cervical transcutaneous spinal direct current stimulation on motor pathways supplying the upper limb. In Study 1, on two separate days, participants (n = 12, 5 F) received 20 minutes of either real or sham direct current stimulation at 3 mA through electrodes placed in an anterior-posterior configuration over the neck (anode anterior). Biceps brachii, flexor carpi radialis and first dorsal interosseous responses to transcranial magnetic stimulation (motor evoked potentials) and cervicomedullary stimulation (cervicomedullary motor evoked potentials) were measured before and after real or sham stimulation. In Study 2, on two separate days, participants (n = 12, 7 F) received either real or sham direct current stimulation in the same way as for Study 1. Before and after real or sham stimulation, median nerve stimulation elicited M waves and H reflexes in the flexor carpi radialis. H-reflex recruitment curves and homosynaptic depression of the H reflex were assessed. Results show that the effects of real and sham direct current stimulation did not differ for motor evoked potentials or cervicomedullary motor evoked potentials for any muscle, nor for H-reflex recruitment curve parameters or homosynaptic depression. Cervical transcutaneous spinal direct current stimulation with the parameters described here does not modify motor responses to corticospinal stimulation nor does it modify H reflexes of the upper limb. These results are important for the emerging field of transcutaneous spinal direct current stimulation.
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Affiliation(s)
- Siobhan C. Dongés
- Neuroscience Research Australia, Barker Street, Randwick, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Jessica M. D’Amico
- Neuroscience Research Australia, Barker Street, Randwick, New South Wales, Australia
| | - Jane E. Butler
- Neuroscience Research Australia, Barker Street, Randwick, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Janet L. Taylor
- Neuroscience Research Australia, Barker Street, Randwick, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
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28
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Leech KA, Hornby TG. High-Intensity Locomotor Exercise Increases Brain-Derived Neurotrophic Factor in Individuals with Incomplete Spinal Cord Injury. J Neurotrauma 2017; 34:1240-1248. [PMID: 27526567 DOI: 10.1089/neu.2016.4532] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
High-intensity locomotor exercise is suggested to contribute to improved recovery of locomotor function after neurological injury. This may be secondary to exercise-intensity-dependent increases in neurotrophin expression demonstrated previously in control subjects. However, rigorous examination of intensity-dependent changes in neurotrophin levels is lacking in individuals with motor incomplete spinal cord injury (SCI). Therefore, the primary aim of this study was to evaluate the effect of locomotor exercise intensity on peripheral levels of brain-derived neurotrophic factor (BDNF) in individuals with incomplete SCI. We also explored the impact of the Val66Met single-nucleotide polymorphism (SNP) on the BDNF gene on intensity-dependent changes. Serum concentrations of BDNF and insulin-like growth factor-1 (IGF-1), as well as measures of cardiorespiratory dynamics, were evaluated across different levels of exercise intensity achieved during a graded-intensity, locomotor exercise paradigm in 11 individuals with incomplete SCI. Our results demonstrate a significant increase in serum BDNF at high, as compared to moderate, exercise intensities (p = 0.01) and 15 and 30 min post-exercise (p < 0.01 for both), with comparison to changes at low intensity approaching significance (p = 0.05). Serum IGF-1 demonstrated no intensity-dependent changes. Significant correlations were observed between changes in BDNF and specific indicators of exercise intensity (e.g., rating of perceived exertion; R = 0.43; p = 0.02). Additionally, the data suggest that Val66Met SNP carriers may not exhibit intensity-dependent changes in serum BDNF concentration. Given the known role of BDNF in experience-dependent neuroplasticity, these preliminary results suggest that exercise intensity modulates serum BDNF concentrations and may be an important parameter of physical rehabilitation interventions after neurological injury.
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Affiliation(s)
- Kristan A Leech
- 1 Center Motion Studies, Kennedy Krieger Institute , Baltimore, Maryland.,2 Department of Neuroscience, Johns Hopkins University , Baltimore, Maryland.,3 Sensory Motor Performance Program, Rehabilitation Institute of Chicago , Chicago, Illinois
| | - T George Hornby
- 3 Sensory Motor Performance Program, Rehabilitation Institute of Chicago , Chicago, Illinois.,4 Department of Physical Medicine and Rehabilitation, Northwestern University , Chicago, Illinois.,5 Departments of Physical Medicine and Rehabilitation, Indiana University School of Medicine , Indianapolis, Indiana
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29
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Saghazadeh A, Esfahani SA, Rezaei N. Genetic polymorphisms and the adequacy of brain stimulation: state of the art. Expert Rev Neurother 2016; 16:1043-54. [PMID: 27228124 DOI: 10.1080/14737175.2016.1194202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Heterogeneity of therapeutic response to brain stimulation techniques has inspired scientists to uncover the secrets to success or failure of these projects. Genetic polymorphisms are one of the major causes of this heterogeneity. AREAS COVERED More than twenty genetic variants within more than ten genes (e.g. BDNF, COMT, DRD2, TRPV1, 5-HT1A, 5-HHT, P2RX7, VEGF, TPH1, TPH2, ACE, APOE, GNB3, NET, NMDA receptors, and RGS4) have been investigated, among which the BDNF gene and its polymorphism, Val66Met, is the best documented variant. We review the genotypic combinations, which are reported to interact with the work of brain stimulation, of which the DRD2 C957T polymorphism is the most prominent type. Finally, implications of transcranial magnetic stimulation in deciphering the interaction between genetic background (e.g. SCN1A and 5-HTT) and drugs (e.g. carbamazepine and citalopram) at the cortical excitability level is explained. Expert commentary: Studies are ongoing to find missing factors responsible for heterogeneity of response to brain stimulation techniques. Further knowledge about genetic factors affecting the therapeutic response to brain stimulation techniques might provide helpful guidelines for choosing ideal candidates for treatment.
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Affiliation(s)
- Amene Saghazadeh
- a Research Center for Immunodeficiencies, Children's Medical Center , Tehran University of Medical Sciences , Tehran , Iran.,b NeuroImmunology Research Association (NIRA) , Universal Scientific Education and Research Network (USERN) , Tehran , Iran
| | - Shadi A Esfahani
- c Department of Radiology, Massachusetts General Hospital , Harvard Medical School , Boston , MA , USA.,d Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA) , Universal Scientific Education and Research Network (USERN) , Boston , MA , USA
| | - Nima Rezaei
- a Research Center for Immunodeficiencies, Children's Medical Center , Tehran University of Medical Sciences , Tehran , Iran.,e Department of Immunology, School of Medicine , Tehran University of Medical Sciences , Tehran , Iran.,f Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA) , Universal Scientific Education and Research Network (USERN) , Tehran , Iran
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30
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Marceglia S, Mrakic-Sposta S, Rosa M, Ferrucci R, Mameli F, Vergari M, Arlotti M, Ruggiero F, Scarpini E, Galimberti D, Barbieri S, Priori A. Transcranial Direct Current Stimulation Modulates Cortical Neuronal Activity in Alzheimer's Disease. Front Neurosci 2016; 10:134. [PMID: 27065792 PMCID: PMC4814712 DOI: 10.3389/fnins.2016.00134] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 03/16/2016] [Indexed: 02/02/2023] Open
Abstract
Quantitative electroencephalography (qEEG) showed that Alzheimer's disease (AD) is characterized by increased theta power, decreased alpha and beta power, and decreased coherence in the alpha and theta band in posterior regions. These abnormalities are thought to be associated with functional disconnections among cortical areas, death of cortical neurons, axonal pathology, and cholinergic deficits. Since transcranial Direct Current Stimulation (tDCS) over the temporo-parietal area is thought to have beneficial effects in patients with AD, in this study we aimed to investigate whether tDCS benefits are related to tDCS-induced changes in cortical activity, as represented by qEEG. A weak anodal current (1.5 mA, 15 min) was delivered bilaterally over the temporal-parietal lobe to seven subjects with probable AD (Mini-Mental State Examination, MMSE score >20). EEG (21 electrodes, 10–20 international system) was recorded for 5 min with eyes closed before (baseline, t0) and 30 min after anodal and cathodal tDCS ended (t1). At the same time points, patients performed a Word Recognition Task (WRT) to assess working memory functions. The spectral power and the inter- and intra-hemispheric EEG coherence in different frequency bands (e.g., low frequencies, including delta and theta; high frequencies, including alpha and beta) were calculated for each subject at t0 and t1. tDCS-induced changes in EEG neurophysiological markers were correlated with the performance of patients at the WRT. At baseline, qEEG features in AD patients confirmed that the decreased high frequency power was correlated with lower MMSE. After anodal tDCS, we observed an increase in the high-frequency power in the temporo-parietal area and an increase in the temporo-parieto-occipital coherence that correlated with the improvement at the WRT. In addition, cathodal tDCS produced a non-specific effect of decreased theta power all over the scalp that was not correlated with the clinical observation at the WRT. Our findings disclosed that tDCS induces significant modulations in the cortical EEG activity in AD patients. The abnormal pattern of EEG activity observed in AD during memory processing is partially reversed by applying anodal tDCS, suggesting that anodal tDCS benefits in AD patients during working memory tasks are supported by the modulation of cortical activity.
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Affiliation(s)
- Sara Marceglia
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Clinical Center for Neurostimulation, Neurotechnology, and Movement DisordersMilano, Italia; Dipartimento di Ingegneria e Architettura, Università degli Studi di TriesteTrieste, Italia
| | - Simona Mrakic-Sposta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Clinical Center for Neurostimulation, Neurotechnology, and Movement DisordersMilano, Italia; Istituto di Bioimmagini e di Fisiologia Molecolare, Consiglio Nazionale delle RicercheSegrate, Italia
| | - Manuela Rosa
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Clinical Center for Neurostimulation, Neurotechnology, and Movement Disorders Milano, Italia
| | - Roberta Ferrucci
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Clinical Center for Neurostimulation, Neurotechnology, and Movement Disorders Milano, Italia
| | - Francesca Mameli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Clinical Center for Neurostimulation, Neurotechnology, and Movement Disorders Milano, Italia
| | - Maurizio Vergari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Clinical Center for Neurostimulation, Neurotechnology, and Movement Disorders Milano, Italia
| | - Mattia Arlotti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Clinical Center for Neurostimulation, Neurotechnology, and Movement DisordersMilano, Italia; Dipartimento di Ingegneria Elettrica e dell'Informazione "Guglielmo Marconi," Università di BolognaCesena, Italia
| | - Fabiana Ruggiero
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Clinical Center for Neurostimulation, Neurotechnology, and Movement Disorders Milano, Italia
| | - Elio Scarpini
- Unità di Neurologia, Dipartimento di Fisiologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Italia
| | - Daniela Galimberti
- Unità di Neurologia, Dipartimento di Fisiologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Italia
| | - Sergio Barbieri
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Clinical Center for Neurostimulation, Neurotechnology, and Movement Disorders Milano, Italia
| | - Alberto Priori
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Clinical Center for Neurostimulation, Neurotechnology, and Movement DisordersMilano, Italia; Dipartimento di Scienze della Salute, Università degli Studi di Milano, Polo Ospedaliero San PaoloMilano, Italia
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31
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Sabatier MJ, English AW. Pathways Mediating Activity-Induced Enhancement of Recovery From Peripheral Nerve Injury. Exerc Sport Sci Rev 2015; 43:163-71. [PMID: 25906422 DOI: 10.1249/jes.0000000000000047] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This article outlines the novel hypothesis that exercise promotes axon regeneration after peripheral nerve injury through neuronal brain-derived neurotrophic factor (BDNF), and there are three required means of promoting BDNF expression: 1) increased signaling through androgen receptors, 2) increased cAMP-responsive element-binding protein expression, and 3) increased expression of the transcription factor SRY-box containing gene 11.
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Affiliation(s)
- Manning J Sabatier
- 1Departments of Rehabilitation Medicine and 2Cell Biology, Emory University School of Medicine, Atlanta, GA
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Astrocytes Protect against Isoflurane Neurotoxicity by Buffering pro-brain-derived Neurotrophic Factor. Anesthesiology 2015; 123:810-9. [PMID: 26270940 DOI: 10.1097/aln.0000000000000824] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Isoflurane induces cell death in neurons undergoing synaptogenesis via increased production of pro-brain-derived neurotrophic factor (proBDNF) and activation of postsynaptic p75 neurotrophin receptor (p75). Astrocytes express p75, but their role in neuronal p75-mediated cell death remains unclear. The authors investigated whether astrocytes have the capacity to buffer increases in proBDNF and protect against isoflurane/p75 neurotoxicity. METHODS Cell death was assessed in day in vitro (DIV) 7 mouse primary neuronal cultures alone or in co-culture with age-matched or DIV 21 astrocytes with propidium iodide 24 h after 1 h exposure to 2% isoflurane or recombinant proBDNF. Astrocyte-targeted knockdown of p75 in co-culture was achieved with small-interfering RNA and astrocyte-specific transfection reagent and verified with immunofluorescence microscopy. proBDNF levels were assessed by enzyme-linked immunosorbent assay. Each experiment used six to eight replicate cultures/condition and was repeated at least three times. RESULTS Exposure to isoflurane significantly (P < 0.05) increased neuronal cell death in primary neuronal cultures (1.5 ± 0.7 fold, mean ± SD) but not in co-culture with DIV 7 (1.0 ± 0.5 fold) or DIV 21 astrocytes (1.2 ± 1.2 fold). Exogenous proBDNF dose dependently induced neuronal cell death in both primary neuronal and co-cultures, an effect enhanced by astrocyte p75 inhibition. Astrocyte-targeted p75 knockdown in co-cultures increased media proBDNF (1.2 ± 0.1 fold) and augmented isoflurane-induced neuronal cell death (3.8 ± 3.1 fold). CONCLUSIONS The presence of astrocytes provides protection to growing neurons by buffering increased levels of proBDNF induced by isoflurane. These findings may hold clinical significance for the neonatal and injured brain where increased levels of proBDNF impair neurogenesis.
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Nardone R, Höller Y, Taylor A, Thomschewski A, Orioli A, Frey V, Trinka E, Brigo F. Noninvasive Spinal Cord Stimulation: Technical Aspects and Therapeutic Applications. Neuromodulation 2015; 18:580-91; discussion 590-1. [DOI: 10.1111/ner.12332] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 05/23/2015] [Accepted: 06/03/2015] [Indexed: 12/31/2022]
Affiliation(s)
- Raffaele Nardone
- Department of Neurology; Christian Doppler Klinik, Paracelsus Medical University and Centre for Cognitive Neuroscience; Salzburg Austria
- Department of Neurology; Franz Tappeiner Hospital; Merano Italy
- Spinal Cord Injury and Tissue Regeneration Center; Paracelsus Medical University; Salzburg Austria
| | - Yvonne Höller
- Department of Neurology; Christian Doppler Klinik, Paracelsus Medical University and Centre for Cognitive Neuroscience; Salzburg Austria
- Spinal Cord Injury and Tissue Regeneration Center; Paracelsus Medical University; Salzburg Austria
| | - Alexandra Taylor
- Department of Neurology; Christian Doppler Klinik, Paracelsus Medical University and Centre for Cognitive Neuroscience; Salzburg Austria
- Spinal Cord Injury and Tissue Regeneration Center; Paracelsus Medical University; Salzburg Austria
| | - Aljoscha Thomschewski
- Department of Neurology; Christian Doppler Klinik, Paracelsus Medical University and Centre for Cognitive Neuroscience; Salzburg Austria
- Spinal Cord Injury and Tissue Regeneration Center; Paracelsus Medical University; Salzburg Austria
| | - Andrea Orioli
- Department of Neurology; Franz Tappeiner Hospital; Merano Italy
| | - Vanessa Frey
- Department of Neurology; Christian Doppler Klinik, Paracelsus Medical University and Centre for Cognitive Neuroscience; Salzburg Austria
- Spinal Cord Injury and Tissue Regeneration Center; Paracelsus Medical University; Salzburg Austria
| | - Eugen Trinka
- Department of Neurology; Christian Doppler Klinik, Paracelsus Medical University and Centre for Cognitive Neuroscience; Salzburg Austria
- Spinal Cord Injury and Tissue Regeneration Center; Paracelsus Medical University; Salzburg Austria
| | - Francesco Brigo
- Department of Neurology; Franz Tappeiner Hospital; Merano Italy
- Department of Neurological and Movement Sciences. Section of Clinical Neurology; University of Verona; Verona Italy
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Bocci T, Marceglia S, Vergari M, Cognetto V, Cogiamanian F, Sartucci F, Priori A. Transcutaneous spinal direct current stimulation modulates human corticospinal system excitability. J Neurophysiol 2015; 114:440-6. [PMID: 25925328 DOI: 10.1152/jn.00490.2014] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 04/24/2015] [Indexed: 12/14/2022] Open
Abstract
This study aimed to assess the effects of thoracic anodal and cathodal transcutaneous spinal direct current stimulation (tsDCS) on upper and lower limb corticospinal excitability. Although there have been studies assessing how thoracic tsDCS influences the spinal ascending tract and reflexes, none has assessed the effects of this technique over upper and lower limb corticomotor neuronal connections. In 14 healthy subjects we recorded motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation (TMS) from abductor hallucis (AH) and hand abductor digiti minimi (ADM) muscles before (baseline) and at different time points (0 and 30 min) after anodal or cathodal tsDCS (2.5 mA, 20 min, T9-T11 level). In 8 of the 14 subjects we also tested the soleus H reflex and the F waves from AH and ADM before and after tsDCS. Both anodal and cathodal tsDCS left the upper limb MEPs and F wave unchanged. Conversely, while leaving lower limb H reflex unchanged, they oppositely affected lower limb MEPs: whereas anodal tsDCS increased resting motor threshold [(mean ± SE) 107.33 ± 3.3% increase immediately after tsDCS and 108.37 ± 3.2% increase 30 min after tsDCS compared with baseline] and had no effects on MEP area and latency, cathodal tsDCS increased MEP area (139.71 ± 12.9% increase immediately after tsDCS and 132.74 ± 22.0% increase 30 min after tsDCS compared with baseline) without affecting resting motor threshold and MEP latency. Our results show that tsDCS induces polarity-specific changes in corticospinal excitability that last for >30 min after tsDCS offset and selectively affect responses in lower limb muscles innervated by lumbar and sacral motor neurons.
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Affiliation(s)
- Tommaso Bocci
- Fondazione IRCCS "Ca' Granda" Ospedale Maggiore di Milano, Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Milan, Italy; Unità Operativa di Neurologia, Dipartimento di Neuroscienze, Università di Pisa, Pisa, Italy
| | - Sara Marceglia
- Fondazione IRCCS "Ca' Granda" Ospedale Maggiore di Milano, Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Milan, Italy; Dipartimento di Ingegneria e Architettura, Università degli Studi di Trieste, Trieste, Italy; and
| | - Maurizio Vergari
- Fondazione IRCCS "Ca' Granda" Ospedale Maggiore di Milano, Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Milan, Italy
| | - Valeria Cognetto
- Fondazione IRCCS "Ca' Granda" Ospedale Maggiore di Milano, Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Milan, Italy
| | - Filippo Cogiamanian
- Fondazione IRCCS "Ca' Granda" Ospedale Maggiore di Milano, Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Milan, Italy
| | - Ferdinando Sartucci
- Unità Operativa di Neurologia, Dipartimento di Neuroscienze, Università di Pisa, Pisa, Italy; Istituto di Neuroscienze, Consiglio Nazionale delle Ricerche, Pisa, Italy
| | - Alberto Priori
- Fondazione IRCCS "Ca' Granda" Ospedale Maggiore di Milano, Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Milan, Italy;
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Pelletier SJ, Cicchetti F. Cellular and molecular mechanisms of action of transcranial direct current stimulation: evidence from in vitro and in vivo models. Int J Neuropsychopharmacol 2015; 18:pyu047. [PMID: 25522391 PMCID: PMC4368894 DOI: 10.1093/ijnp/pyu047] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Transcranial direct current stimulation is a noninvasive technique that has been experimentally tested for a number of psychiatric and neurological conditions. Preliminary observations suggest that this approach can indeed influence a number of cellular and molecular pathways that may be disease relevant. However, the mechanisms of action underlying its beneficial effects are largely unknown and need to be better understood to allow this therapy to be used optimally. In this review, we summarize the physiological responses observed in vitro and in vivo, with a particular emphasis on cellular and molecular cascades associated with inflammation, angiogenesis, neurogenesis, and neuroplasticity recruited by direct current stimulation, a topic that has been largely neglected in the literature. A better understanding of the neural responses to transcranial direct current stimulation is critical if this therapy is to be used in large-scale clinical trials with a view of being routinely offered to patients suffering from various conditions affecting the central nervous system.
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Affiliation(s)
| | - Francesca Cicchetti
- Centre Hospitalier Universitaire de Québec, Axe Neuroscience, Québec, QC, Canada (Mr Pelletier and Dr Cicchetti); Département de Psychiatrie et Neurosciences, Université Laval, Québec, QC, Canada (Mr Pelletier and Dr Cicchetti).
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Transcutaneous spinal DC stimulation reduces pain sensitivity in humans. Neurosci Lett 2015; 589:153-8. [PMID: 25596439 DOI: 10.1016/j.neulet.2015.01.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 01/02/2015] [Accepted: 01/09/2015] [Indexed: 01/10/2023]
Abstract
Non-invasive approaches to pain management are needed to manage patient pain escalation and to providing sufficient pain relief. Here, we evaluate the potential of transcutaneous spinal direct current stimulation (tsDCS) to modulate pain sensitivity to electrical stimuli and mechanical pinpricks in 24 healthy subjects in a sham-controlled, single-blind study. Pain ratings to mechanical pinpricks and electrical stimuli were recorded prior to and at three time points (0, 30, and 60min) following 15min of anodal tsDCS (2.5mA, "active" electrode centered over the T11 spinous process, return electrode on the left posterior shoulder). Pain ratings to the pinpricks of the highest forces tested (128, 256, 512mN) were reduced at 30min and 60min following anodal tsDCS. These findings demonstrate that pain sensitivity in healthy subjects can be suppressed by anodal tsDCS and suggest that tsDCS may provide a non-invasive tool to manage mechanically-induced pain.
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Nijs J, Meeus M, Versijpt J, Moens M, Bos I, Knaepen K, Meeusen R. Brain-derived neurotrophic factor as a driving force behind neuroplasticity in neuropathic and central sensitization pain: a new therapeutic target? Expert Opin Ther Targets 2014; 19:565-76. [PMID: 25519921 DOI: 10.1517/14728222.2014.994506] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Central sensitization is a form of maladaptive neuroplasticity underlying many chronic pain disorders, including neuropathic pain, fibromyalgia, whiplash, headache, chronic pelvic pain syndrome and some forms of osteoarthritis, low back pain, epicondylitis, shoulder pain and cancer pain. Brain-derived neurotrophic factor (BDNF) is a driving force behind neuroplasticity, and it is therefore crucial for neural maintenance and repair. However, BDNF also contributes to sensitization of pain pathways, making it an interesting novel therapeutic target. AREAS COVERED An overview of BDNF's sensitizing capacity at every level of the pain pathways is presented, including the peripheral nociceptors, dorsal root ganglia, spinal dorsal horn neurons, and brain descending inhibitory and facilitatory pathways. This is followed by the presentation of several potential therapeutic options, ranging from indirect influencing of BDNF levels (using exercise therapy, anti-inflammatory drugs, melatonin, repetitive transcranial magnetic stimulation) to more specific targeting of BDNF's receptors and signaling pathways (blocking the proteinase-activated receptors 2-NK-κβ signaling pathway, administration of phencyclidine for antagonizing NMDA receptors, or blockade of the adenosine A2A receptor). EXPERT OPINION This section focuses on combining pharmacotherapy with multimodal rehabilitation for balancing the deleterious and therapeutic effects of BNDF treatment in chronic pain patients, as well as accounting for the complex and biopsychosocial nature of chronic pain.
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Affiliation(s)
- Jo Nijs
- Pain in Motion international research group
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Smith PA. BDNF: No gain without pain? Neuroscience 2014; 283:107-23. [DOI: 10.1016/j.neuroscience.2014.05.044] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 05/16/2014] [Accepted: 05/21/2014] [Indexed: 12/22/2022]
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Priori A, Ciocca M, Parazzini M, Vergari M, Ferrucci R. Transcranial cerebellar direct current stimulation and transcutaneous spinal cord direct current stimulation as innovative tools for neuroscientists. J Physiol 2014; 592:3345-69. [PMID: 24907311 PMCID: PMC4229333 DOI: 10.1113/jphysiol.2013.270280] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 05/30/2014] [Indexed: 12/26/2022] Open
Abstract
Two neuromodulatory techniques based on applying direct current (DC) non-invasively through the skin, transcranial cerebellar direct current stimulation (tDCS) and transcutaneous spinal DCS, can induce prolonged functional changes consistent with a direct influence on the human cerebellum and spinal cord. In this article we review the major experimental works on cerebellar tDCS and on spinal tDCS, and their preliminary clinical applications. Cerebellar tDCS modulates cerebellar motor cortical inhibition, gait adaptation, motor behaviour, and cognition (learning, language, memory, attention). Spinal tDCS influences the ascending and descending spinal pathways, and spinal reflex excitability. In the anaesthetised mouse, DC stimulation applied under the skin along the entire spinal cord may affect GABAergic and glutamatergic systems. Preliminary clinical studies in patients with cerebellar disorders, and in animals and patients with spinal cord injuries, have reported beneficial effects. Overall the available data show that cerebellar tDCS and spinal tDCS are two novel approaches for inducing prolonged functional changes and neuroplasticity in the human cerebellum and spinal cord, and both are new tools for experimental and clinical neuroscientists.
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Affiliation(s)
- Alberto Priori
- Centro Clinico per la Neurostimolazione, le Neurotecnologie e i Disordini del Movimento, Fondazione IRCCS Ca' Granda, Milan, Italy Dipartimento di Fisiopatologia Medico Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - Matteo Ciocca
- Centro Clinico per la Neurostimolazione, le Neurotecnologie e i Disordini del Movimento, Fondazione IRCCS Ca' Granda, Milan, Italy Dipartimento di Fisiopatologia Medico Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - Marta Parazzini
- Consiglio Nazionale delle Ricerche, Istituto di Elettronica e di Ingegneria dell'Informazione e delle Telecomunicazioni, Milan, Italy
| | - Maurizio Vergari
- Centro Clinico per la Neurostimolazione, le Neurotecnologie e i Disordini del Movimento, Fondazione IRCCS Ca' Granda, Milan, Italy
| | - Roberta Ferrucci
- Centro Clinico per la Neurostimolazione, le Neurotecnologie e i Disordini del Movimento, Fondazione IRCCS Ca' Granda, Milan, Italy Dipartimento di Fisiopatologia Medico Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
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Effects of cathodal trans-spinal direct current stimulation on mouse spinal network and complex multijoint movements. J Neurosci 2013; 33:14949-57. [PMID: 24027294 DOI: 10.1523/jneurosci.2793-13.2013] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Cathodal trans-spinal direct current (c-tsDC) stimulation is a powerful technique to modulate spinal excitability. However, the manner in which c-tsDC stimulation modulates cortically evoked simple single-joint and complex multijoint movements is unknown. To address this issue, anesthetized mice were suspended with the hindlimb allowed to move freely in space. Simple and complex multijoint movements were elicited with short and prolonged trains of electrical stimulation, respectively, delivered to the area of primary motor cortex representing the hindlimb. In addition, spinal cord burst generators are known to be involved in a variety of motor activities, including locomotion, postural control, and voluntary movements. Therefore, to shed light into the mechanisms underlying movements modulated by c-tsDC stimulation, spinal circuit activity was induced using GABA and glycine receptor blockers, which produced three rates of spinal bursting activity: fast, intermediate, and slow. Characteristics of bursting activity were assessed during c-tsDC stimulation. During c-tsDC stimulation, significant increases were observed in (1) ankle dorsiflexion amplitude and speed; (2) ankle plantarflexion amplitude, speed, and duration; and (3) complex multijoint movement amplitude, speed, and duration. However, complex multijoint movement tracing showed that c-tsDC did not change the form of movements. In addition, spinal bursting activity was significantly modulated during c-tsDC stimulation: (1) fast bursting activity showed increased rate, amplitude, and duration; (2) intermediate bursting activity showed increased rate and duration, but decreased amplitude; and (3) slow bursting activity showed increased rate, but decreased duration and amplitude. These results suggest that c-tsDC stimulation amplifies cortically evoked movements through spinal mechanisms.
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