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Samejima S, Caskey CD, Inanici F, Shrivastav SR, Brighton LN, Pradarelli J, Martinez V, Steele KM, Saigal R, Moritz CT. Multisite Transcutaneous Spinal Stimulation for Walking and Autonomic Recovery in Motor-Incomplete Tetraplegia: A Single-Subject Design. Phys Ther 2022; 102:6514473. [PMID: 35076067 PMCID: PMC8788019 DOI: 10.1093/ptj/pzab228] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 06/07/2021] [Accepted: 08/23/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This study investigated the effect of cervical and lumbar transcutaneous spinal cord stimulation (tSCS) combined with intensive training to improve walking and autonomic function after chronic spinal cord injury (SCI). METHODS Two 64-year-old men with chronic motor incomplete cervical SCI participated in this single-subject design study. They each underwent 2 months of intensive locomotor training and 2 months of multisite cervical and lumbosacral tSCS paired with intensive locomotor training. RESULTS The improvement in 6-Minute Walk Test distance after 2 months of tSCS with intensive training was threefold greater than after locomotor training alone. Both participants improved balance ability measured by the Berg Balance Scale and increased their ability to engage in daily home exercises. Gait analysis demonstrated increased step length for each individual. Both participants experienced improved sensation and bowel function, and 1 participant eliminated the need for intermittent catheterization after the stimulation phase of the study. CONCLUSION These results suggest that noninvasive spinal cord stimulation might promote recovery of locomotor and autonomic functions beyond traditional gait training in people with chronic incomplete cervical SCI. IMPACT Multisite transcutaneous spinal stimulation may induce neuroplasticity of the spinal networks and confer functional benefits following chronic cervical SCI.
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Affiliation(s)
- Soshi Samejima
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA,Center for Neurotechnology, University of Washington, Seattle, Washington, USA,Department of Electrical and Computer Engineering, University of Washington, Seattle, Washington, USA
| | - Charlotte D Caskey
- Department of Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Fatma Inanici
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA,Center for Neurotechnology, University of Washington, Seattle, Washington, USA,Department of Electrical and Computer Engineering, University of Washington, Seattle, Washington, USA
| | - Siddhi R Shrivastav
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA,Center for Neurotechnology, University of Washington, Seattle, Washington, USA,Department of Electrical and Computer Engineering, University of Washington, Seattle, Washington, USA
| | - Lorie N Brighton
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Jared Pradarelli
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Vincente Martinez
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Katherine M Steele
- Department of Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Rajiv Saigal
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Chet T Moritz
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA,Center for Neurotechnology, University of Washington, Seattle, Washington, USA,Department of Electrical and Computer Engineering, University of Washington, Seattle, Washington, USA,Department of Physiology and Biophysics, University of Washington, Seattle, Washington, USA,Address all correspondence to Dr Moritz at:
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Lamy JC, Varriale P, Apartis E, Mehdi S, Blancher-Meinadier A, Kosutzka Z, Degos B, Frismand S, Simonetta-Moreau M, Meunier S, Roze E, Vidailhet M. Trans-Spinal Direct Current Stimulation for Managing Primary Orthostatic Tremor. Mov Disord 2021; 36:1835-1842. [PMID: 33772851 DOI: 10.1002/mds.28581] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/19/2021] [Accepted: 03/01/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Primary orthostatic tremor (POT) is a rare disorder, characterized by 13 to 18 Hz tremor in the legs when standing and is often refractory to medical treatment. Epidural spinal cord stimulation has been proposed as an alternative treatment. However, this approach is invasive, which limits its application. OBJECTIVE Trans-spinal direct current stimulation (tsDCS) is a non-invasive method to modulate spinal cord circuits. The aim of this proof-of-concept study was to investigate the potential beneficial effect of tsDCS in POT. METHODS We conducted a double-blind, sham-controlled study in 16 patients with POT. In two separate visits, patients received sham tsDCS first followed by active (either cathodal or anodal) tsDCS. The primary outcome was the change in time in standing position. Secondary outcomes comprised quantitative assessment of tremor, measurement of corticospinal excitability including short-latency afferent inhibition, and clinical global impression-improvement (CGI-I). Measurements were made at baseline, after sham tsDCS, 0-30 min, and 30-60 min after active conditions. RESULTS Cathodal-tsDCS reduced tremor amplitude and frequency and lowered corticospinal excitability whereas anodal-tsDCS reduced tremor frequency only. CGI-I scores positively correlated with the time in standing position after both active tsDCS conditions. CONCLUSION A single session of tsDCS can improve instability in POT. This opens a new vista for experimental treatment options using multiple sessions of spinal DC stimulation. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Jean-Charles Lamy
- Institut du Cerveau / Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, CNRS UMR 7225, Inserm U 1127, Sorbonne Université UM75, Paris, France
| | - Pasquale Varriale
- Institut du Cerveau / Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, CNRS UMR 7225, Inserm U 1127, Sorbonne Université UM75, Paris, France
| | - Emmanuelle Apartis
- Institut du Cerveau / Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, CNRS UMR 7225, Inserm U 1127, Sorbonne Université UM75, Paris, France.,Department of Neurophysiology, Saint-Antoine Hospital, Assistance Publique - Hopitaux de Paris (AP-HP), Paris, France
| | - Sophien Mehdi
- Institut du Cerveau / Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, CNRS UMR 7225, Inserm U 1127, Sorbonne Université UM75, Paris, France
| | - Anne Blancher-Meinadier
- Department of Neurophysiology, Saint-Antoine Hospital, Assistance Publique - Hopitaux de Paris (AP-HP), Paris, France
| | - Zuzana Kosutzka
- Institut du Cerveau / Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, CNRS UMR 7225, Inserm U 1127, Sorbonne Université UM75, Paris, France.,2nd Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Bertrand Degos
- Department of Neurology, Avicenne Hospital, Assistance Publique - Hopitaux de Paris (AP-HP), Sorbonne Paris Nord, Bobigny, France.,Dynamics and Pathophysiology of Neuronal Networks Team, Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR7241/INSERM U1050, Université PSL, Paris, France
| | - Solène Frismand
- Department of Neurology, University Hospital of Nancy, Nancy, France
| | - Marion Simonetta-Moreau
- Department of Neurology Toulouse Hospital, Toulouse NeuroImaging Center (ToNIC), INSERM, University Paul Sabatier, UPS, Toulouse, France
| | - Sabine Meunier
- Institut du Cerveau / Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, CNRS UMR 7225, Inserm U 1127, Sorbonne Université UM75, Paris, France
| | - Emmanuel Roze
- Institut du Cerveau / Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, CNRS UMR 7225, Inserm U 1127, Sorbonne Université UM75, Paris, France.,Department of Neurology, Pitié-Salpêtrière Hospital, Assistance Publique - Hopitaux de Paris (AP-HP), Paris, France
| | - Marie Vidailhet
- Institut du Cerveau / Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, CNRS UMR 7225, Inserm U 1127, Sorbonne Université UM75, Paris, France.,Department of Neurology, Pitié-Salpêtrière Hospital, Assistance Publique - Hopitaux de Paris (AP-HP), Paris, France
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The Potential of Corticospinal-Motoneuronal Plasticity for Recovery after Spinal Cord Injury. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020; 8:293-298. [PMID: 33777502 DOI: 10.1007/s40141-020-00272-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Purpose of review This review focuses on a relatively new neuromodulation method where transcranial magnetic stimulation over the primary motor cortex is paired with transcutaneous electrical stimulation over a peripheral nerve to induce plasticity at corticospinal-motoneuronal synapses. Recent findings Recovery of sensorimotor function after spinal cord injury largely depends on transmission in the corticospinal pathway. Significantly damaged corticospinal axons fail to regenerate and participate in functional recovery. Transmission in residual corticospinal axons can be assessed using non-invasive transcranial magnetic stimulation which combined with transcutaneous electrical stimulation can be used to improve voluntary motor output, as was recently demonstrated in clinical studies in humans with chronic incomplete spinal cord injury. These two stimuli are applied at precise inter-stimulus intervals to reinforce corticospinal synaptic transmission using principles of spike-timing dependent plasticity. Summary We discuss the neural mechanisms and application of this neuromodulation technique and its potential therapeutic effect on recovery of function in humans with chronic spinal cord injury.
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Smith AT, Gorassini MA. Hyperexcitability of brain stem pathways in cerebral palsy. J Neurophysiol 2018; 120:1428-1437. [DOI: 10.1152/jn.00185.2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Individuals with cerebral palsy (CP) experience impairments in the control of head and neck movements, suggesting dysfunction in brain stem circuitry. To examine if brain stem circuitry is altered in CP, we compared reflexes evoked in the sternocleidomastoid (SCM) muscle by trigeminal nerve stimulation in adults with CP and in age/sex-matched controls. Increasing the intensity of trigeminal nerve stimulation produced progressive increases in the long-latency suppression of ongoing SCM electromyography in controls. In contrast, participants with CP showed progressively increased facilitation around the same reflex window, suggesting heightened excitability of brain stem pathways. We also examined if there was altered activation of cortico-brain stem pathways in response to prenatal injury of the brain. Motor-evoked potentials (MEPs) in the SCM that were conditioned by a prior trigeminal afferent stimulation were more facilitated in CP compared with controls, especially in ipsilateral MEPs that are likely mediated by corticoreticulospinal pathways. In some participants with CP, but not in controls, a combined trigeminal nerve and cortical stimulation near threshold intensities produced large, long-lasting responses in both the SCM and biceps brachii muscles. We propose that the enhanced excitatory responses evoked from trigeminal and cortical inputs in CP are produced by heightened excitability of brain stem circuits, resulting in the augmented activation of reticulospinal pathways. Enhanced activation of reticulospinal pathways in response to early injury of the corticospinal tract may provide a compensated activation of the spinal cord or, alternatively, contribute to impairments in the precise control of head and neck functions. NEW & NOTEWORTHY This is the first study to show that in adults with spastic cerebral palsy, activation of brain stem circuits by cortical and/or trigeminal afferents produces excitatory responses in anterior neck muscles compared with inhibitory responses in age/sex-matched controls. This may reflect a more excitable reticulospinal tract in response to early brain injury to provide a compensated activation of postural muscles. On the other hand, a hyperexcitable brain stem may contribute to impairments in the precise control of head and neck functions.
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Affiliation(s)
- A. T. Smith
- Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - M. A. Gorassini
- Department of Biomedical Engineering, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Yamaguchi T, Fujiwara T, Lin SC, Takahashi Y, Hatori K, Liu M, Huang YZ. Priming With Intermittent Theta Burst Transcranial Magnetic Stimulation Promotes Spinal Plasticity Induced by Peripheral Patterned Electrical Stimulation. Front Neurosci 2018; 12:508. [PMID: 30087593 PMCID: PMC6066516 DOI: 10.3389/fnins.2018.00508] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 07/05/2018] [Indexed: 01/04/2023] Open
Abstract
This study explored the effect of corticospinal activity on spinal plasticity by examining the interactions between intermittent theta burst transcranial magnetic stimulation (iTBS) of the motor cortex and peripheral patterned electrical stimulation (PES) of the common peroneal nerve (CPN). Healthy volunteers (n = 10) received iTBS to the tibialis anterior (TA) muscle zone of the motor cortex and PES of the CPN in three separate sessions: (1) iTBS-before-PES, (2) iTBS-after-PES, and (3) sham iTBS-before-PES. The PES protocol used 10 100-Hz pulses every 2 s for 20 min. Reciprocal inhibition (RI) from the TA to soleus muscle and motor cortical excitability of the TA and soleus muscles were assessed at baseline, before PES, and 0, 15, 30, and 45 min after PES. When compared to the other protocols, iTBS-before-PES significantly increased changes in disynaptic RI for 15 min and altered long-loop presynaptic inhibition immediately after PES. Moreover, the iTBS-induced cortical excitability changes in the TA before PES were correlated with the enhancement of disynaptic RI immediately after PES. These results demonstrate that spinal plasticity can be modified by altering cortical excitability. This study provides insight into the interactions between modulation of corticospinal excitability and spinal RI, which may help in developing new rehabilitation strategies.
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Affiliation(s)
- Tomofumi Yamaguchi
- Department of Physical Therapy, Yamagata Prefectural University of Health Sciences, Yamagata, Japan.,Department of Rehabilitation Medicine, Keio University School of Medicine, Keio University, Tokyo, Japan.,Postdoctoral Fellow for Research Abroad (JSPS), Tokyo, Japan.,Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - Toshiyuki Fujiwara
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Su-Chuan Lin
- Neuroscience Research Center and Department of Neurology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yoko Takahashi
- Department of Rehabilitation Medicine, Keio University School of Medicine, Keio University, Tokyo, Japan
| | - Kozo Hatori
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Meigen Liu
- Department of Rehabilitation Medicine, Keio University School of Medicine, Keio University, Tokyo, Japan
| | - Ying-Zu Huang
- Neuroscience Research Center and Department of Neurology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.,Institute of Cognitive Neuroscience, National Central University, Taoyuan, Taiwan
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Urbin MA, Ozdemir RA, Tazoe T, Perez MA. Spike-timing-dependent plasticity in lower-limb motoneurons after human spinal cord injury. J Neurophysiol 2017; 118:2171-2180. [PMID: 28468994 DOI: 10.1152/jn.00111.2017] [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] [Received: 02/16/2017] [Revised: 04/24/2017] [Accepted: 04/24/2017] [Indexed: 01/20/2023] Open
Abstract
Recovery of lower-limb function after spinal cord injury (SCI) likely depends on transmission in the corticospinal pathway. Here, we examined whether paired corticospinal-motoneuronal stimulation (PCMS) changes transmission at spinal synapses of lower-limb motoneurons in humans with chronic incomplete SCI and aged-matched controls. We used 200 pairs of stimuli where corticospinal volleys evoked by transcranial magnetic stimulation (TMS) over the leg representation of the motor cortex were timed to arrive at corticospinal-motoneuronal synapses of the tibialis anterior (TA) muscle 2 ms before antidromic potentials evoked in motoneurons by electrical stimulation of the common peroneal nerve (PCMS+) or when antidromic potentials arrived 15 or 28 ms before corticospinal volleys (PCMS-) on separate days. Motor evoked potentials (MEPs) elicited by TMS and electrical stimulation were measured in the TA muscle before and after each stimulation protocol. After PCMS+, the size of MEPs elicited by TMS and electrical stimulation increased for up to 30 min in control and SCI participants. Notably, this was accompanied by increases in TA electromyographic activity and ankle dorsiflexion force in both groups, suggesting that this plasticity has functional implications. After PCMS-, MEPs elicited by TMS and electrical stimulation were suppressed if afferent input from the common peroneal nerve reduced TA MEP size during paired stimulation in both groups. In conclusion, PCMS elicits spike-timing-dependent changes at spinal synapses of lower-limb motoneurons in humans and has potential to improve lower-limb motor output following SCI.NEW & NOTEWORTHY Approaches that aim to enhance corticospinal transmission to lower-limb muscles following spinal cord injury (SCI) are needed. We demonstrate that paired corticomotoneuronal stimulation (PCMS) can enhance plasticity at spinal synapses of lower-limb motoneurons in humans with and without SCI. We propose that PCMS has potential for improving motor output in leg muscles in individuals with damage to the corticospinal tract.
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Affiliation(s)
- M A Urbin
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami, Miami, Florida; and Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida
| | - Recep A Ozdemir
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami, Miami, Florida; and Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida
| | - Toshiki Tazoe
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami, Miami, Florida; and Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida
| | - Monica A Perez
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami, Miami, Florida; and Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida
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Facilitation of descending excitatory and spinal inhibitory networks from training of endurance and precision walking in participants with incomplete spinal cord injury. PROGRESS IN BRAIN RESEARCH 2015; 218:127-55. [DOI: 10.1016/bs.pbr.2014.12.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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