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Edwards M, Koens L, Liepert J, Nonnekes J, Schwingenschuh P, van de Stouwe A, Morgante F. Clinical neurophysiology of functional motor disorders: IFCN Handbook Chapter. Clin Neurophysiol Pract 2024; 9:69-77. [PMID: 38352251 PMCID: PMC10862411 DOI: 10.1016/j.cnp.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/18/2023] [Accepted: 12/27/2023] [Indexed: 02/16/2024] Open
Abstract
Functional Motor Disorders are common and disabling. Clinical diagnosis has moved from one of exclusion of other causes for symptoms to one where positive clinical features on history and examination are used to make a "rule in" diagnosis wherever possible. Clinical neurophysiological assessments have developed increasing importance in assisting with this positive diagnosis, not being used simply to demonstrate normal sensory-motor pathways, but instead to demonstrate specific abnormalities that help to positively diagnose these disorders. Here we provide a practical review of these techniques, their application, interpretation and pitfalls. We also highlight particular areas where such tests are currently lacking in sensitivity and specificity, for example in people with functional dystonia and functional tic-like movements.
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Affiliation(s)
- M.J. Edwards
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
- Department of Neuropsychiatry, Maudsley Hospital, London, UK
| | - L.H. Koens
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Neurology and Clinical Neurophysiology, Martini Ziekenhuis, Groningen, the Netherlands
| | - J. Liepert
- Kliniken Schmieder Allensbach, Allensbach, Germany
| | - J. Nonnekes
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
- Center of Expertise for Parkinson & Movement Disorders, Department of Rehabilitation, Nijmegen, the Netherlands
- Department of Rehabilitation, Sint Maartenskliniek, Ubbergen, the Netherlands
| | | | - A.M.M. van de Stouwe
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Neurology, Ommelander Ziekenhuis, Scheemda, the Netherlands
| | - F. Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
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Nguyen DTA, Julkunen P, Säisänen L, Määttä S, Rissanen SM, Lintu N, Könönen M, Lakka T, Karjalainen PA. Developmental models of motor-evoked potential features by transcranial magnetic stimulation across age groups from childhood to adulthood. Sci Rep 2023; 13:10604. [PMID: 37391521 PMCID: PMC10313665 DOI: 10.1038/s41598-023-37775-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 06/27/2023] [Indexed: 07/02/2023] Open
Abstract
To derive the maturation of neurophysiological processes from childhood to adulthood reflected by the change of motor-evoked potential (MEP) features. 38 participants were recruited from four groups (age mean in years [SD in months], number (males)): children (7.3 [4.2], 7(4)), preadolescents (10.3 [6.9], 10(5)), adolescents (15.3 [9.8], 11(5)), and adults (26.9 [46.2], 10(5)). The navigated transcranial magnetic stimulation was performed on both hemispheres at seven stimulation intensity (SI) levels from sub- to supra-threshold and targeted to the representative cortical area of abductor pollicis brevis muscle. MEPs were measured from three hand- and two forearm-muscles. The input-output (I/O) curves of MEP features across age groups were constructed using linear mixed-effect models. Age and SI significantly affected MEP features, whereas the stimulated side had a minor impact. MEP size and duration increased from childhood to adulthood. MEP onset- and peak-latency dropped in adolescence, particularly in hand muscles. Children had the smallest MEPs with the highest polyphasia, whereas I/O curves were similar among preadolescents, adolescents, and adults. This study illustrates some of the changing patterns of MEP features across the ages, suggesting developing patterns of neurophysiological processes activated by TMS, and to motivate studies with larger sample size.
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Affiliation(s)
- Dao T A Nguyen
- Department of Technical Physics, University of Eastern Finland, POB 1627, 70211, Kuopio, Finland.
| | - Petro Julkunen
- Department of Technical Physics, University of Eastern Finland, POB 1627, 70211, Kuopio, Finland
- Department of Clinical Neurophysiology, Kuopio University Hospital, POB 100, 70029 KYS, Kuopio, Finland
| | - Laura Säisänen
- Department of Technical Physics, University of Eastern Finland, POB 1627, 70211, Kuopio, Finland
- Department of Clinical Neurophysiology, Kuopio University Hospital, POB 100, 70029 KYS, Kuopio, Finland
| | - Sara Määttä
- Department of Clinical Neurophysiology, Kuopio University Hospital, POB 100, 70029 KYS, Kuopio, Finland
| | - Saara M Rissanen
- Department of Technical Physics, University of Eastern Finland, POB 1627, 70211, Kuopio, Finland
| | - Niina Lintu
- Institute of Biomedicine, University of Eastern Finland, POB 162, 70211, Kuopio, Finland
| | - Mervi Könönen
- Department of Technical Physics, University of Eastern Finland, POB 1627, 70211, Kuopio, Finland
| | - Timo Lakka
- Institute of Biomedicine, University of Eastern Finland, POB 162, 70211, Kuopio, Finland
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, POB 100, 70029 KYS, Kuopio, Finland
- Foundation for Research in Health Exercise and Nutrition, Kuopio Research Institute of Exercise Medicine, Haapaniementie 16, 70100, Kuopio, Finland
| | - Pasi A Karjalainen
- Department of Technical Physics, University of Eastern Finland, POB 1627, 70211, Kuopio, Finland
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Shraim MA, Massé-Alarie H, Salomoni SE, Hodges PW. The effect of skilled motor training on corticomotor control of back muscles in different presentations of low back pain. J Electromyogr Kinesiol 2023; 71:102782. [PMID: 37290203 DOI: 10.1016/j.jelekin.2023.102782] [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: 03/18/2023] [Revised: 05/11/2023] [Accepted: 05/17/2023] [Indexed: 06/10/2023] Open
Abstract
Transcranial magnetic stimulation (TMS) has revealed differences in the motor cortex (M1) between people with and without low back pain (LBP). There is potential to reverse these changes using motor skill training, but it remains unclear whether changes can be induced in people with LBP or whether this differs between LBP presentations. This study (1) compared TMS measures of M1 (single and paired-pulse) and performance of a motor task (lumbopelvic tilting) between individuals with LBP of predominant nociceptive (n = 9) or nociplastic presentation (n = 9) and pain-free individuals (n = 16); (2) compared these measures pre- and post-training; and (3) explored correlations between TMS measures, motor performance, and clinical features. TMS measures did not differ between groups at baseline. The nociplastic group undershot the target in the motor task. Despite improved motor performance for all groups, only MEP amplitudes increased across the recruitment curve and only for the pain-free and nociplastic groups. TMS measures did not correlate with motor performance or clinical features. Some elements of motor task performance and changes in corticomotor excitability differed between LBP groups. Absence of changes in intra-cortical TMS measures suggests regions other than M1 are likely to be involved in skill learning of back muscles.
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Affiliation(s)
- Muath A Shraim
- The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, QLD 4072, Australia
| | - Hugo Massé-Alarie
- The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, QLD 4072, Australia; Centre interdisciplinaire de recherche en réadaptation et integration sociale (CIRRIS), Université Laval, Québec, QC G1V 0A6, Canada
| | - Sauro E Salomoni
- The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, QLD 4072, Australia
| | - Paul W Hodges
- The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, QLD 4072, Australia.
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Covariation of the amplitude and latency of motor evoked potentials elicited by transcranial magnetic stimulation in a resting hand muscle. Exp Brain Res 2023; 241:927-936. [PMID: 36811686 PMCID: PMC9985579 DOI: 10.1007/s00221-023-06575-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 02/13/2023] [Indexed: 02/24/2023]
Abstract
Transcranial magnetic stimulation (TMS) is a non-invasive brain stimulation technique used to study human neurophysiology. A single TMS pulse delivered to the primary motor cortex can elicit a motor evoked potential (MEP) in a target muscle. MEP amplitude is a measure of corticospinal excitability and MEP latency is a measure of the time taken for intracortical processing, corticofugal conduction, spinal processing, and neuromuscular transmission. Although MEP amplitude is known to vary across trials with constant stimulus intensity, little is known about MEP latency variation. To investigate MEP amplitude and latency variation at the individual level, we scored single-pulse MEP amplitude and latency in a resting hand muscle from two datasets. MEP latency varied from trial to trial in individual participants with a median range of 3.9 ms. Shorter MEP latencies were associated with larger MEP amplitudes for most individuals (median r = - 0.47), showing that latency and amplitude are jointly determined by the excitability of the corticospinal system when TMS is delivered. TMS delivered during heightened excitability could discharge a greater number of cortico-cortical and corticospinal cells, increasing the amplitude and, by recurrent activation of corticospinal cells, the number of descending indirect waves. An increase in the amplitude and number of indirect waves would progressively recruit larger spinal motor neurons with large-diameter fast-conducting fibers, which would shorten MEP onset latency and increase MEP amplitude. In addition to MEP amplitude variability, understanding MEP latency variability is important given that these parameters are used to help characterize pathophysiology of movement disorders.
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Li J, Chen C, Zhu S, Niu X, Yu X, Ren J, Shen M. Evaluating the Effects of 5-Hz Repetitive Transcranial Magnetic Stimulation With and Without Wrist-Ankle Acupuncture on Improving Spasticity and Motor Function in Children With Cerebral Palsy: A Randomized Controlled Trial. Front Neurosci 2022; 15:771064. [PMID: 34975377 PMCID: PMC8714760 DOI: 10.3389/fnins.2021.771064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 11/03/2021] [Indexed: 11/29/2022] Open
Abstract
Objective: The goal of this study is to explore the effect of wrist-ankle acupuncture combined with 5-Hz repetitive transcranial magnetic stimulation (rTMS) on improving spastic state and motor function of children with spastic cerebral palsy by measuring electrophysiological parameters and behaviors. Methods: Twenty-five children with spastic cerebral palsy were enrolled in a single-blind and randomized controlled trial. The control group received 20 sessions of 5-Hz rTMS over the affected hemisphere with 1,000 pulses. The experimental group was given wrist-ankle acupuncture on the basis of the control group. Gross motor function measure (GMFM-66), muscle tension, and electrophysiological parameters of the two groups were assessed at baseline and after intervention. Results: After treatment, the GMFM-66 scores in the same groups were significantly improved (p < 0.001). Besides, the R-value of soleus, gastrocnemius, and hamstring muscle decreased (p < 0.05), and the results showed a trend of shortening MEP latency, increasing amplitude and duration (p < 0.05). Compared to the controlled group, the experimental group displayed more excellent changes in the GMFM-66 scores and motor evoked potential (MEP) latency. The statistical results showed that the increase of GMFM-66 score and the shortening of MEP latency in the experimental group were greater than that in the control group (p < 0.05). However, no significant differences were found in the assessment of muscle tension, amplitude, and duration of MEPs between two groups (p > 0.05). Conclusion: Wrist-ankle acupuncture combined with 5-Hz rTMS is optimal to improve gross motor function and enhance the conductivity of corticospinal tract in children with cerebral palsy but cannot highlight its clinical superiority in improving spasticity. Clinical Trial Registration: [http://www.chictr.org.cn/index.aspx], identifier [chictr2000039495].
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Affiliation(s)
- Jiamin Li
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China.,School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Shanghai Taiping Rehabilitation Hospital, Shanghai, China
| | - Cen Chen
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Shenyu Zhu
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Xiulian Niu
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Xidan Yu
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Jie Ren
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Min Shen
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China.,School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Ito S, Sakai Y, Harada A, Ando K, Kobayashi K, Nakashima H, Machino M, Kambara S, Inoue T, Hida T, Ito K, Ishiguro N, Imagama S. Evaluation of the Association between Neck Pain and the Trapezius Muscles in Patients with Cervical Myelopathy Using Motor Evoked Potential: A Retrospective Study. Asian Spine J 2021; 15:604-610. [PMID: 33059431 PMCID: PMC8561161 DOI: 10.31616/asj.2020.0186] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN Retrospective study. PURPOSE We aimed to use motor evoked potentials (MEPs) to examine the association of electrophysiological assessment of the trapezius muscle with neck pain. OVERVIEW OF LITERATURE Previous reports on the association of neck pain with the trapezius muscle have focused on surface electromyograms and muscle oxygenation; however, to our knowledge, none of these studies included detailed data on MEPs. METHODS The study included 100 patients with cervical myelopathy who underwent surgery at the National Center for Geriatrics and Gerontology in Obu, Japan from June 2010 to March 2013. Before the surgery, neck pain was evaluated using a Visual Analog Scale (a score ≥50 indicated neck pain and a score <50 indicated no neck pain). The preoperative cross-sectional areas of the trapezius muscles were measured with cervical magnetic resonance imaging sagittal T2-weighted images. Cranial stimulation under general anesthesia was used to derive the MEPs, enabling the measurement of latency and amplitude, using preoperative MEPs of the trapezius muscles. RESULTS The MEP of the trapezius muscle in patients with neck pain had significantly shorter latencies than those in patients who did not have neck pain. However, there was no significant difference in the amplitude between patients with and without neck pain. However, this tended to be greater in patients with neck pain as compared to that in those without neck pain. The cross-sectional area of the trapezius muscle in patients with neck pain was significantly smaller than that in those who did not have neck pain. CONCLUSIONS MEPs revealed electrophysiological abnormalities of the trapezius muscles in patients with neck pain, supporting a relationship of neck pain with the trapezius muscles.
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Affiliation(s)
- Sadayuki Ito
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshihito Sakai
- Department of Orthopedic Surgery, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Atsushi Harada
- Department of Orthopedic Surgery, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaaki Machino
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shunsuke Kambara
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taro Inoue
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tetsuro Hida
- Department of Orthopedic Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Kenyu Ito
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Naoki Ishiguro
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Miget G, Hentzen C, Turmel N, Chesnel C, Le Breton F, Ismael SS, Kerdraon J, Amarenco G. Assessment of sacral spinal excitability using stimulus-response curves of the bulbocavernosus reflex. Clin Neurophysiol 2021; 132:2123-2129. [PMID: 34284247 DOI: 10.1016/j.clinph.2021.06.006] [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: 05/24/2020] [Revised: 05/25/2021] [Accepted: 06/08/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To analyze and quantify sacral spinal excitability through bulbocavernosus reflex (BCR) stimulus-response curves. METHODS Thirty subjects with upper motor neuron lesions (UMN) and nine controls were included in this prospective, monocentric study. Sacral spinal excitability was assessed using stimulus-response curves of the BCR, modeled at different bladder filling volumes relative to the desire to void (as defined by the International Continence Society) during a cystometry. Variations in α (i.e. the slope of the stimulus-response curve) were considered as an indicator of the modulation of sacral spinal excitability. RESULTS In all subjects, α increased during bladder filling suggesting the modulation of spinal sacral excitability during the filling phase. This increase was over 30% in 96.7% of neurological subjects and 88.9% of controls. The increase was higher before the first sensation to void in the neurological population (163.15%), compared to controls, (29.91%), p < 0.001. CONCLUSIONS We showed the possibility of using BCR stimulus-response curves to characterize sacral spinal response with an amplification of this response during bladder filling as well as a difference in this response amplification in patients with UMN in comparison with a control group. SIGNIFICANCE BCR, through stimulus-response curves, might be an indicator of pelvic-perineal exaggerated reflex response and possibly a tool for evaluating treatment effectiveness.
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Affiliation(s)
- Gabriel Miget
- Sorbonne Université, GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Department of Neuro-urology, Tenon Hospital, AP-HP, 4, rue de la Chine, 75020 Paris, France.
| | - Claire Hentzen
- Sorbonne Université, GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Department of Neuro-urology, Tenon Hospital, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - Nicolas Turmel
- Sorbonne Université, GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Department of Neuro-urology, Tenon Hospital, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - Camille Chesnel
- Sorbonne Université, GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Department of Neuro-urology, Tenon Hospital, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - Frédérique Le Breton
- Sorbonne Université, GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Department of Neuro-urology, Tenon Hospital, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - Samer Sheikh Ismael
- Sorbonne Université, GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Department of Neuro-urology, Tenon Hospital, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - Jacques Kerdraon
- Sorbonne Université, GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Department of Neuro-urology, Tenon Hospital, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - Gérard Amarenco
- Sorbonne Université, GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Department of Neuro-urology, Tenon Hospital, AP-HP, 4, rue de la Chine, 75020 Paris, France
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Cleland BT, Sisel E, Madhavan S. Motor evoked potential latency and duration from tibialis anterior in individuals with chronic stroke. Exp Brain Res 2021; 239:2251-2260. [PMID: 34059935 DOI: 10.1007/s00221-021-06144-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/26/2021] [Indexed: 11/26/2022]
Abstract
Ipsilateral motor pathways from the contralesional hemisphere to the paretic limbs may be upregulated to compensate for impaired function after stroke. Onset latency and duration of motor evoked potentials (MEPs) evoked by transcranial magnetic stimulation (TMS) provide insight into compensatory pathways but have been understudied in the lower limb. This study assessed MEP onset latency and duration in the lower limb after stroke, and compared ipsilateral and contralateral MEPs in the paretic and non-paretic limb. We hypothesized that: (1) onset latency would be longer for ipsilateral than contralateral MEPs and longer for the paretic than the non-paretic limb, and (2) duration would be shorter for ipsilateral than contralateral MEPs and longer for the paretic than the non-paretic limb. Data were collected as a part of a pre-test of a randomized controlled trial. TMS was applied to the ipsilateral and contralateral hemisphere of the paretic and non-paretic limb. MEP onset latency and duration were calculated from the tibialis anterior. Thirty-five participants with chronic stroke were included in the final analysis. Onset latency was longer in the paretic than the non-paretic limb (~ 6.0 ms) and longer after ipsilateral than contralateral stimulation (~ 1.8 ms). Duration was longer in the paretic than the non-paretic limb (~ 9.2 ms) and longer after contralateral than ipsilateral stimulation (~ 5.2 ms). Ipsilateral MEPs may be elicited through ipsilateral pathways with fewer fibers with a higher activation threshold and/or greater spinal branching. MEPs from the paretic limb may reflect slower central motor conduction, peripheral changes, or changes in motor pathway.
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Affiliation(s)
- Brice T Cleland
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W. Taylor St., Chicago, IL, 60612, USA
| | - Emily Sisel
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Sangeetha Madhavan
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W. Taylor St., Chicago, IL, 60612, USA.
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Intracortical and Intercortical Motor Disinhibition to Transcranial Magnetic Stimulation in Newly Diagnosed Celiac Disease Patients. Nutrients 2021. [PMID: 34062843 DOI: 10.3390/nu13051530.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Celiac disease (CD) may present or be complicated by neurological and neuropsychiatric manifestations. Transcranial magnetic stimulation (TMS) probes brain excitability non-invasively, also preclinically. We previously demonstrated an intracortical motor disinhibition and hyperfacilitation in de novo CD patients, which revert back after a long-term gluten-free diet (GFD). In this cross-sectional study, we explored the interhemispheric excitability by transcallosal inhibition, which has never been investigated in CD. METHODS A total of 15 right-handed de novo, neurologically asymptomatic, CD patients and 15 age-matched healthy controls were screened for cognitive and depressive symptoms to the Montreal Cognitive Assessment (MoCA) and the 17-item Hamilton Depression Rating Scale (HDRS), respectively. TMS consisted of resting motor threshold, amplitude, latency, and duration of the motor evoked potentials, duration and latency of the contralateral silent period (cSP). Transcallosal inhibition was evaluated as duration and latency of the ipsilateral silent period (iSP). RESULTS MoCA and HDRS scored significantly worse in patients. The iSP and cSP were significantly shorter in duration in patients, with a positive correlation between the MoCA and iSP. CONCLUSIONS An intracortical and interhemispheric motor disinhibition was observed in CD, suggesting the involvement of GABA-mediated cortical and callosal circuitries. Further studies correlating clinical, TMS, and neuroimaging data are needed.
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Fisicaro F, Lanza G, D’Agate CC, Ferri R, Cantone M, Falzone L, Pennisi G, Bella R, Pennisi M. Intracortical and Intercortical Motor Disinhibition to Transcranial Magnetic Stimulation in Newly Diagnosed Celiac Disease Patients. Nutrients 2021; 13:nu13051530. [PMID: 34062843 PMCID: PMC8147364 DOI: 10.3390/nu13051530] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/24/2021] [Accepted: 04/28/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Celiac disease (CD) may present or be complicated by neurological and neuropsychiatric manifestations. Transcranial magnetic stimulation (TMS) probes brain excitability non-invasively, also preclinically. We previously demonstrated an intracortical motor disinhibition and hyperfacilitation in de novo CD patients, which revert back after a long-term gluten-free diet (GFD). In this cross-sectional study, we explored the interhemispheric excitability by transcallosal inhibition, which has never been investigated in CD. METHODS A total of 15 right-handed de novo, neurologically asymptomatic, CD patients and 15 age-matched healthy controls were screened for cognitive and depressive symptoms to the Montreal Cognitive Assessment (MoCA) and the 17-item Hamilton Depression Rating Scale (HDRS), respectively. TMS consisted of resting motor threshold, amplitude, latency, and duration of the motor evoked potentials, duration and latency of the contralateral silent period (cSP). Transcallosal inhibition was evaluated as duration and latency of the ipsilateral silent period (iSP). RESULTS MoCA and HDRS scored significantly worse in patients. The iSP and cSP were significantly shorter in duration in patients, with a positive correlation between the MoCA and iSP. CONCLUSIONS An intracortical and interhemispheric motor disinhibition was observed in CD, suggesting the involvement of GABA-mediated cortical and callosal circuitries. Further studies correlating clinical, TMS, and neuroimaging data are needed.
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Affiliation(s)
- Francesco Fisicaro
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via Santa Sofia 97, 95123 Catania, Italy; (F.F.); (M.P.)
| | - Giuseppe Lanza
- Department of Surgery and Medical-Surgery Specialties, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy;
- Department of Neurology IC, Oasi Research Institute-IRCCS, Via Conte Ruggero 73, 94018 Troina, Italy;
- Correspondence: ; Tel.: +39-095-3782448
| | - Carmela Cinzia D’Agate
- Gastroenterology and Endoscopy Unit, University Hospital “Policlinico G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy;
| | - Raffaele Ferri
- Department of Neurology IC, Oasi Research Institute-IRCCS, Via Conte Ruggero 73, 94018 Troina, Italy;
| | - Mariagiovanna Cantone
- Department of Neurology, Sant’Elia Hospital, ASP Caltanissetta, Via Luigi Russo 6, 93100 Caltanissetta, Italy;
| | - Luca Falzone
- Epidemiology and Biostatistics Unit, Instituto Nazionale Tumori-IRCCS “Fondazione G. Pascale”, Via Mariano Semmola 53, 80131 Napoli, Italy;
| | - Giovanni Pennisi
- Department of Surgery and Medical-Surgery Specialties, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy;
| | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Via Santa Sofia 87, 95123 Catania, Italy;
| | - Manuela Pennisi
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via Santa Sofia 97, 95123 Catania, Italy; (F.F.); (M.P.)
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11
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Non-invasive brain stimulation to assess neurophysiologic underpinnings of lower limb motor impairment in multiple sclerosis. J Neurosci Methods 2021; 356:109143. [PMID: 33757762 DOI: 10.1016/j.jneumeth.2021.109143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/20/2021] [Accepted: 03/10/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a neuroinflammatory disease resulting in axonal demyelination and an amalgamation of symptoms which commonly result in decreased quality of life due to mobility dysfunction and limited participation in meaningful activities. NEW METHOD The use of non-invasive brain stimulation (NIBS) techniques, specifically transcranial magnetic and transcranial direct current stimulation, have been essential in understanding the pathophysiological decrements related to disease progression, particularly with regard to motor impairments. Although the research in this area has primarily focused on the upper extremities, new interest has arisen in understanding the neurophysiological underpinnings of lower limb impairment. Therefore, the purpose of this review is to: first, provide an overview of common NIBS techniques used to explore sensorimotor neurophysiology; second, summarize lower limb neuromuscular and mobility impairments typically observed in PwMS; third, review the current knowledge regarding interactions between TMS-assessed neurophysiology and lower limb impairments in PwMS; and fourth, provide recommendations for future NIBS studies based on current gaps in the literature. RESULTS PwMS exhibit reduced excitability and increased inhibitory neurophysiologic function which has been related to disease severity and lower limb motor impairments. Comparison with existing methods: Moreover, promising results indicate that the use of repetitive stimulation and transcranial direct current stimulation may prime neural adaptability and prove useful as a therapeutic tool in ameliorating lower limb impairments. CONCLUSIONS While these studies are both informative and promising, additional studies are necessary to be conclusive. As such, studies assessing objective measures of lower limb impairments associated with neurophysiological adaptations need further evaluation.
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12
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Proessl F, Canino MC, Beckner ME, Sinnott AM, Eagle SR, LaGoy AD, Conkright WR, Sterczala AJ, Connaboy C, Ferrarelli F, Germain A, Nindl BC, Flanagan SD. Characterizing off-target corticospinal responses to double-cone transcranial magnetic stimulation. Exp Brain Res 2021; 239:1099-1110. [PMID: 33547521 DOI: 10.1007/s00221-021-06044-5] [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: 10/07/2020] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The double-cone coil (D-CONE) is frequently used in transcranial magnetic stimulation (TMS) experiments that target the motor cortex (M1) lower-limb representation. Anecdotal evidence and modeling studies have shed light on the off-target effects of D-CONE TMS but the physiological extent remains undetermined. PURPOSE To characterize the off-target effects of D-CONE TMS based on bilateral corticospinal responses in the legs and hands. METHODS Thirty (N = 30) participants (9 women, age: 26 ± 5yrs) completed a stimulus-response curve procedure with D-CONE TMS applied to the dominant vastus lateralis (cVL) and motor-evoked potentials (MEPs) recorded in each active VL and resting first dorsal interosseous (FDI). As a positive control (CON), the dominant FDI was directly targeted with a figure-of-eight coil and MEPs were similarly recorded in each active FDI and resting VL. MEPMAX, V50 and MEP latencies were compared with repeated-measures ANOVAs or mixed-effects analysis and Bonferroni-corrected pairwise comparisons. RESULTS Off-target responses were evident in all muscles, with similar MEPMAX in the target (cVL) and off-target (iVL) leg (p = 0.99) and cFDI compared with CON (p = 0.99). cFDI and CON MEPMAX were greater than iFDI (p < 0.01). A main effect of target (p < 0.001) indicated that latencies were shorter with CON but similar in all muscles with D-CONE. DISCUSSION Concurrent MEP recordings in bilateral upper- and lower-extremity muscles confirm that lower-limb D-CONE TMS produces substantial distance-dependent off-target effects. In addition to monitoring corticospinal responses in off-target muscles to improve targeting accuracy in real-time, future studies may incorporate off-target information into statistical models post-hoc.
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Affiliation(s)
- F Proessl
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, 3860 South Water St, Pittsburgh, PA, 15203, USA
| | - M C Canino
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, 3860 South Water St, Pittsburgh, PA, 15203, USA
| | - M E Beckner
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, 3860 South Water St, Pittsburgh, PA, 15203, USA
| | - A M Sinnott
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, 3860 South Water St, Pittsburgh, PA, 15203, USA
| | - S R Eagle
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, 3860 South Water St, Pittsburgh, PA, 15203, USA
| | - A D LaGoy
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, 3860 South Water St, Pittsburgh, PA, 15203, USA.,Department of Psychiatry, University of Pittsburgh Medical School, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - W R Conkright
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, 3860 South Water St, Pittsburgh, PA, 15203, USA
| | - A J Sterczala
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, 3860 South Water St, Pittsburgh, PA, 15203, USA
| | - C Connaboy
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, 3860 South Water St, Pittsburgh, PA, 15203, USA
| | - F Ferrarelli
- Department of Psychiatry, University of Pittsburgh Medical School, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - A Germain
- Department of Psychiatry, University of Pittsburgh Medical School, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - B C Nindl
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, 3860 South Water St, Pittsburgh, PA, 15203, USA
| | - S D Flanagan
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, 3860 South Water St, Pittsburgh, PA, 15203, USA.
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13
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Santamaria AJ, Benavides FD, Saraiva PM, Anderson KD, Khan A, Levi AD, Dietrich WD, Guest JD. Neurophysiological Changes in the First Year After Cell Transplantation in Sub-acute Complete Paraplegia. Front Neurol 2021; 11:514181. [PMID: 33536992 PMCID: PMC7848788 DOI: 10.3389/fneur.2020.514181] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 11/05/2020] [Indexed: 12/15/2022] Open
Abstract
Neurophysiological testing can provide quantitative information about motor, sensory, and autonomic system connectivity following spinal cord injury (SCI). The clinical examination may be insufficiently sensitive and specific to reveal evolving changes in neural circuits after severe injury. Neurophysiologic data may provide otherwise imperceptible circuit information that has rarely been acquired in biologics clinical trials in SCI. We reported a Phase 1 study of autologous purified Schwann cell suspension transplantation into the injury epicenter of participants with complete subacute thoracic SCI, observing no clinical improvements. Here, we report longitudinal electrophysiological assessments conducted during the trial. Six participants underwent neurophysiology screening pre-transplantation with three post-transplantation neurophysiological assessments, focused on the thoracoabdominal region and lower limbs, including MEPs, SSEPs, voluntarily triggered EMG, and changes in GSR. We found several notable signals not detectable by clinical exam. In all six participants, thoracoabdominal motor connectivity was detected below the clinically assigned neurological level defined by sensory preservation. Additionally, small voluntary activations of leg and foot muscles or positive lower extremity MEPs were detected in all participants. Voluntary EMG was most sensitive to detect leg motor function. The recorded MEP amplitudes and latencies indicated a more caudal thoracic level above which amplitude recovery over time was observed. In contrast, further below, amplitudes showed less improvement, and latencies were increased. Intercostal spasms observed with EMG may also indicate this thoracic “motor level.” Galvanic skin testing revealed autonomic dysfunction in the hands above the injury levels. As an open-label study, we can establish no clear link between these observations and cell transplantation. This neurophysiological characterization may be of value to detect therapeutic effects in future controlled studies.
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Affiliation(s)
- Andrea J Santamaria
- The Miami Project to Cure Paralysis, Miller School of Medicine, The University of Miami, Miami, FL, United States
| | - Francisco D Benavides
- The Miami Project to Cure Paralysis, Miller School of Medicine, The University of Miami, Miami, FL, United States
| | - Pedro M Saraiva
- The Miami Project to Cure Paralysis, Miller School of Medicine, The University of Miami, Miami, FL, United States
| | - Kimberly D Anderson
- The Miami Project to Cure Paralysis, Miller School of Medicine, The University of Miami, Miami, FL, United States.,The Department of Neurological Surgery, Miller School of Medicine, The University of Miami, Miami, FL, United States
| | - Aisha Khan
- The Miami Project to Cure Paralysis, Miller School of Medicine, The University of Miami, Miami, FL, United States.,Miller School of Medicine, The Interdisciplinary Stem Cell Institute, The University of Miami, Miami, FL, United States
| | - Allan D Levi
- The Miami Project to Cure Paralysis, Miller School of Medicine, The University of Miami, Miami, FL, United States.,The Department of Neurological Surgery, Miller School of Medicine, The University of Miami, Miami, FL, United States
| | - W Dalton Dietrich
- The Miami Project to Cure Paralysis, Miller School of Medicine, The University of Miami, Miami, FL, United States.,The Department of Neurological Surgery, Miller School of Medicine, The University of Miami, Miami, FL, United States
| | - James D Guest
- The Miami Project to Cure Paralysis, Miller School of Medicine, The University of Miami, Miami, FL, United States.,The Department of Neurological Surgery, Miller School of Medicine, The University of Miami, Miami, FL, United States
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14
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Gomez IN, Ormiston K, Greenhouse I. Response preparation involves a release of intracortical inhibition in task-irrelevant muscles. J Neurophysiol 2020; 125:523-532. [PMID: 33356901 DOI: 10.1152/jn.00390.2020] [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: 11/22/2022] Open
Abstract
Action preparation involves widespread modulation of motor system excitability, but the precise mechanisms are unknown. In this study, we investigated whether intracortical inhibition changes in task-irrelevant muscle representations during action preparation. We used transcranial magnetic stimulation (TMS) combined with electromyography in healthy human adults to measure motor-evoked potentials (MEPs) and cortical silent periods (CSPs) in task-irrelevant muscles during the preparatory period of simple delayed response tasks. In experiment 1, participants responded with the left index finger in one task condition and the right index finger in another task condition, whereas MEPs and CSPs were measured from the contralateral nonresponding and tonically contracted index finger. During experiment 2, participants responded with the right pinky finger whereas MEPs and CSPs were measured from the tonically contracted left index finger. In both experiments, MEPs and CSPs were compared between the task preparatory period and a resting intertrial baseline. The CSP duration during response preparation decreased from baseline in every case. A laterality difference was also observed in experiment 1, with a greater CSP reduction during the preparation of left finger responses compared to right finger responses. Despite reductions in CSP duration, consistent with a release of intracortical inhibition, MEP amplitudes were smaller during action preparation when accounting for background levels of muscle activity, consistent with earlier studies that reported decreased corticospinal excitability. These findings indicate that intracortical inhibition associated with task-irrelevant muscles is transiently released during action preparation and implicate a novel mechanism for the controlled and coordinated release of motor cortex inhibition.NEW & NOTEWORTHY In this study, we observed the first evidence of a release of intracortical inhibition in task-irrelevant muscle representations during response preparation. We applied transcranial magnetic stimulation to elicit cortical silent periods in task-irrelevant muscles during response preparation, and observed a consistent decrease in the silent period duration relative to a resting baseline. These findings address the question of whether cortical mechanisms underlie widespread modulation in motor excitability during response preparation.
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Affiliation(s)
- Isaac N Gomez
- Department of Human Physiology, University of Oregon, Eugene, Oregon
| | - Kara Ormiston
- Department of Human Physiology, University of Oregon, Eugene, Oregon
| | - Ian Greenhouse
- Department of Human Physiology, University of Oregon, Eugene, Oregon
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15
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Lopez AJ, Xu J, Hoque MM, McMullen C, Kesar TM, Borich MR. Integration of Convergent Sensorimotor Inputs Within Spinal Reflex Circuits in Healthy Adults. Front Hum Neurosci 2020; 14:592013. [PMID: 33324184 PMCID: PMC7725688 DOI: 10.3389/fnhum.2020.592013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/03/2020] [Indexed: 11/25/2022] Open
Abstract
The output from motor neuron pools is influenced by the integration of synaptic inputs originating from descending corticomotor and spinal reflex pathways. In this study, using paired non-invasive brain and peripheral nerve stimulation, we investigated how descending corticomotor pathways influence the physiologic recruitment order of the soleus Hoffmann (H-) reflex. Eleven neurologically unimpaired adults (9 females; mean age 25 ± 3 years) completed an assessment of transcranial magnetic stimulation (TMS)-conditioning of the soleus H-reflex over a range of peripheral nerve stimulation (PNS) intensities. Unconditioned H-reflex recruitment curves were obtained by delivering PNS pulses to the posterior tibial nerve. Subsequently, TMS-conditioned H-reflex recruitment curves were obtained by pairing PNS with subthreshold TMS at short (−1.5 ms) and long (+10 ms) intervals. We evaluated unconditioned and TMS-conditioned H-reflex amplitudes along the ascending limb, peak, and descending limb of the H-reflex recruitment curve. Our results revealed that, for long-interval facilitation, TMS-conditioned H-reflex amplitudes were significantly larger than unconditioned H-reflex amplitudes along the ascending limb and peak of the H-reflex recruitment curve. Additionally, significantly lower PNS intensities were needed to elicit peak H-reflex amplitude (Hmax) for long-interval facilitation compared to unconditioned. These findings suggest that the influence of descending corticomotor pathways, particularly those mediating long-interval facilitation, contribute to changing the recruitment gain of the motor neuron pool, and can inform future methodological protocols for TMS-conditioning of H-reflexes. By characterizing and inducing short-term plasticity in circuitry mediating short- and long-interval TMS-conditioning of H-reflex amplitudes, future studies can investigate supraspinal and spinal circuit contributions to abnormal motor control, as well as develop novel therapeutic targets for neuromodulation.
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Affiliation(s)
- Alejandro J Lopez
- Neural Plasticity Research Laboratory, Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, United States.,Motion Analysis Laboratory, Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, United States
| | - Jiang Xu
- Neural Plasticity Research Laboratory, Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, United States.,Motion Analysis Laboratory, Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, United States.,Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Maruf M Hoque
- Neural Plasticity Research Laboratory, Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, United States.,Motion Analysis Laboratory, Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, United States
| | - Carly McMullen
- Neural Plasticity Research Laboratory, Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, United States.,Motion Analysis Laboratory, Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, United States
| | - Trisha M Kesar
- Motion Analysis Laboratory, Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, United States
| | - Michael R Borich
- Neural Plasticity Research Laboratory, Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, United States
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16
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Sundman MH, Lim K, Ton That V, Mizell JM, Ugonna C, Rodriguez R, Chen NK, Fuglevand AJ, Liu Y, Wilson RC, Fellous JM, Rapcsak S, Chou YH. Transcranial magnetic stimulation reveals diminished homoeostatic metaplasticity in cognitively impaired adults. Brain Commun 2020; 2:fcaa203. [PMID: 33376989 PMCID: PMC7750948 DOI: 10.1093/braincomms/fcaa203] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 09/22/2020] [Accepted: 10/13/2020] [Indexed: 12/13/2022] Open
Abstract
Homoeostatic metaplasticity is a neuroprotective physiological feature that counterbalances Hebbian forms of plasticity to prevent network destabilization and hyperexcitability. Recent animal models highlight dysfunctional homoeostatic metaplasticity in the pathogenesis of Alzheimer's disease. However, the association between homoeostatic metaplasticity and cognitive status has not been systematically characterized in either demented or non-demented human populations, and the potential value of homoeostatic metaplasticity as an early biomarker of cognitive impairment has not been explored in humans. Here, we report that, through pre-conditioning the synaptic activity prior to non-invasive brain stimulation, the association between homoeostatic metaplasticity and cognitive status could be established in a population of non-demented human subjects (older adults across cognitive spectrums; all within the non-demented range). All participants (n = 40; age range, 65-74, 47.5% female) underwent a standardized neuropsychological battery, magnetic resonance imaging and a transcranial magnetic stimulation protocol. Specifically, we sampled motor-evoked potentials with an input/output curve immediately before and after repetitive transcranial magnetic stimulation to assess neural plasticity with two experimental paradigms: one with voluntary muscle contraction (i.e. modulated synaptic activity history) to deliberately introduce homoeostatic interference, and one without to serve as a control condition. From comparing neuroplastic responses across these experimental paradigms and across cohorts grouped by cognitive status, we found that (i) homoeostatic metaplasticity is diminished in our cohort of cognitively impaired older adults and (ii) this neuroprotective feature remains intact in cognitively normal participants. This novel finding suggests that (i) future studies should expand their scope beyond just Hebbian forms of plasticity that are traditionally assessed when using non-invasive brain stimulation to investigate cognitive ageing and (ii) the potential value of homoeostatic metaplasticity in serving as a biomarker for cognitive impairment should be further explored.
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Affiliation(s)
- Mark H Sundman
- Department of Psychology, University of Arizona, Tucson, AZ 85721, USA
| | - Koeun Lim
- Department of Psychology, University of Arizona, Tucson, AZ 85721, USA
| | - Viet Ton That
- Department of Psychology, University of Arizona, Tucson, AZ 85721, USA
| | | | - Chidi Ugonna
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ 85721, USA
- Department of Medical Imaging, University of Arizona, Tucson, AZ 85721, USA
| | - Rudolph Rodriguez
- Department of Psychology, University of Arizona, Tucson, AZ 85721, USA
| | - Nan-Kuei Chen
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ 85721, USA
- Department of Medical Imaging, University of Arizona, Tucson, AZ 85721, USA
| | - Andrew J Fuglevand
- Department of Physiology, College of Medicine, University of Arizona, Tucson, AZ 85721, USA
- Department of Neuroscience, College of Medicine, University of Arizona, Tucson, AZ 85721, USA
| | - Yilin Liu
- Department of Psychology, University of Arizona, Tucson, AZ 85721, USA
| | - Robert C Wilson
- Department of Psychology, University of Arizona, Tucson, AZ 85721, USA
| | - Jean-Marc Fellous
- Department of Psychology, University of Arizona, Tucson, AZ 85721, USA
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ 85721, USA
| | - Steven Rapcsak
- Department of Psychology, University of Arizona, Tucson, AZ 85721, USA
- Department of Neurology, University of Arizona, Tucson, AZ 85721, USA
| | - Ying-Hui Chou
- Department of Psychology, University of Arizona, Tucson, AZ 85721, USA
- Evelyn F. McKnight Brain Institute, Arizona Center on Aging, and BIO5 Institute, University of Arizona, Tucson, AZ 85721, USA
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17
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Influence of preceding muscle activity on movement-related cortical potential during superimposed ballistic contraction. Neurosci Lett 2020; 735:135193. [PMID: 32565221 DOI: 10.1016/j.neulet.2020.135193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/28/2020] [Accepted: 06/17/2020] [Indexed: 11/24/2022]
Abstract
The purpose of current study was to clarify the influence of preceding muscle activity on the force production and movement-related cortical potential (MRCP) during superimposed ballistic contractions. The participants performed the ballistic force production at 40 % of maximum voluntary contraction (MVC) using the isometric abduction force of the metacarpophalangeal joint of the index finger. They were asked to match the peak of force curve with a horizontal target line displayed on the computer monitor. We compared the MRCP amplitude during force exertion detected from Fz, C4, C3, Cz and Pz electrodes during ballistic force production with (active condition) and without (resting condition) preceding muscle activity. The results showed that the MRCP amplitudes of Fz, C4, C3 and Cz electrodes were significantly smaller for the active condition than the resting condition. This was the case even though the peak force values during both conditions were identical. This result suggests that the facilitation of spinal motoneuron excitability by preceding muscle activity could reduce the required central motor command to produce the identical force level. In addition, we examined the MRCP amplitude during ballistic force production of the active condition without a visually displayed target. In this condition, the participants had to perform the force production based on aiming point of target force level (40 %MVC). As a result, the mean of peak force without a visual target was 54 %MVC, which overshot the aiming force level. However, the MRCP amplitudes of five electrodes during the 54 %MVC force production in the active condition were equivalent to the case of the 40 %MVC force production in the resting condition. These results suggest that the MRCP amplitude is consistent with participants' sense of effort involved in the force production, rather than the actual produced force level.
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18
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McCambridge AB, Hay K, Levin K, Philpott K, Wood K, Bradnam LV. Neck rotation modulates motor-evoked potential duration of proximal muscle cortical representations in healthy adults. Exp Brain Res 2020; 238:2531-2538. [PMID: 32862278 DOI: 10.1007/s00221-020-05887-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
Abstract
Transcranial magnetic stimulation (TMS) produces motor-evoked potentials (MEP) used to infer changes in corticomotor excitability. In humans, neck rotation can probe reticulospinal input on corticomotor output. This study investigated the effect of neck rotation on MEP duration in a proximal and distal upper limb muscle and compared responses between rest and preactivation. Single-pulse TMS to motor cortex was used to evoke MEPs at two stimulus intensities in 18 healthy adults (20-40 years). Surface electromyography recorded MEPs from the non-dominant biceps brachii (BB) and first dorsal interosseous (FDI). Participants were seated with the target muscle at rest or 10% preactivated, and head rotated ipsilateral, contralateral, or in neutral position. The primary outcome was MEP tail, defined as the mean difference in MEP duration between active and rest trials. Secondary outcomes were MEP duration and amplitude. MEP tail was modulated by neck rotation in the proximal BB (P = 0.03) but not distal FDI (P > 0.19), with shorter duration during ipsilateral or contralateral rotation relative to neutral. In a neutral neck position, MEP duration was prolonged by muscle preactivation and higher TMS intensities in the FDI and BB (P < 0.03). Neck rotation attenuated the prolongation of MEP duration during preactivation in the BB, but not the FDI. Neck rotation had no effect on MEP amplitude for either muscle (P > 0.05). Modulation of the late portion of the MEP by rotation of the neck could indicate subcortical projections to alpha-motoneuron pools are stronger in proximal than distal upper limb muscles. These findings may have relevance for using MEP duration as a neural biomarker in neurological diseases.
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Affiliation(s)
- Alana B McCambridge
- Graduate School of Health, Discipline of Physiotherapy, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia.
| | - Kayla Hay
- Graduate School of Health, Discipline of Physiotherapy, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia
| | - Kumbelin Levin
- Graduate School of Health, Discipline of Physiotherapy, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia
| | - Kirsty Philpott
- Graduate School of Health, Discipline of Physiotherapy, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia
| | - Kunal Wood
- Graduate School of Health, Discipline of Physiotherapy, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia
| | - Lynley V Bradnam
- Department of Exercise Sciences, University of Auckland, Auckland, New Zealand.,Centre for Brain Research, University of Auckland, Auckland, New Zealand
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19
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Sato D, Yamazaki Y, Yamashiro K, Onishi H, Baba Y, Ikarashi K, Maruyama A. Elite competitive swimmers exhibit higher motor cortical inhibition and superior sensorimotor skills in a water environment. Behav Brain Res 2020; 395:112835. [PMID: 32750463 DOI: 10.1016/j.bbr.2020.112835] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 07/11/2020] [Accepted: 07/23/2020] [Indexed: 01/24/2023]
Abstract
Motor skill learning leads to task-related contextual behavioral changes that are underpinned by neuroplastic cortical reorganization. Short-term training induces environment-related contextual behavioral changes and neuroplastic changes in the primary motor cortex (M1). However, it is unclear whether environment-related contextual behavioral changes persist after long-term training and how cortical plastic changes are involved in behavior. To address these issues, we examined 14 elite competitive swimmers and 14 novices. We hypothesized that the sensorimotor skills of swimmers would be higher in a water environment than those of novices, and the recruitment of corticospinal and intracortical projections would be different between swimmers and novices. We assessed joint angle modulation performance as a behavioral measure and motor cortical excitation and inhibition using transcranial magnetic stimulation (TMS) at rest and during the tasks that were performed before, during, and after water immersion (WI). Motor cortical inhibition was measured with short-interval intracortical inhibition and long-interval intracortical inhibition by a paired-pulse TMS paradigm. We found that 1) the sensorimotor skills of swimmers who underwent long-term training in a water environment were superior and robustly unchanged compared with those of novices with respect to baseline on land, during WI, on land post-WI and 2) intracortical inhibition in water environments was increased in swimmers but was decreased in non-swimmers at rest compared to that on land; however, the latter alterations in intracortical inhibition in water environment were insufficient to account for the superior sensorimotor skills of swimmers. In conclusion, we demonstrate that environment-related contextual behavioral and neural changes occur even with long-term training experience.
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Affiliation(s)
- Daisuke Sato
- Department of Health and Sports, Niigata University of Health and Welfare, Japan; Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Japan.
| | - Yudai Yamazaki
- Research Fellow of Japan Society for the Promotion of Science, Japan; Laboratory of Exercise Biochemistry and Neuroendocrinology, Faculty of Health and Sport Sciences, University of Tsukuba, Japan; Sports Neuroscience Division, Advanced Research Initiative for Human High Performance (ARIHHP), Faculty of Health and Sport Sciences, University of Tsukuba, Japan
| | - Koya Yamashiro
- Department of Health and Sports, Niigata University of Health and Welfare, Japan; Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Japan
| | - Hideaki Onishi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Japan; Department of Physical Therapy, Niigata University of Health and Welfare, Japan
| | - Yasuhiro Baba
- Department of Health and Sports, Niigata University of Health and Welfare, Japan
| | - Koyuki Ikarashi
- Field of Health and Sports, Graduate School of Niigata University of Health and Welfare, Japan
| | - Atsuo Maruyama
- Department of Rehabilitation Medicine, Kagoshima University, Japan
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Miyamoto T, Kizuka T, Ono S. Influence of preceding muscle activity on perceptually guided force production during superimposed ballistic contraction. Physiol Behav 2020; 222:112933. [PMID: 32376328 DOI: 10.1016/j.physbeh.2020.112933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/21/2020] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
Abstract
Current study attempted to clarify whether preceding muscle activity influences the perceptually guided force production during superimposed ballistic contractions using isometric abduction of index finger. Subjects were verbally asked to produce ballistic force at requested percentages of their MVC with and without preceding muscle activity at 10% and 20%MVC. Our results showed that the ballistic force and EMG activity were increased significantly with preceding muscle activity at 20%MVC, but no change for 10%MVC. These results suggest that preceding muscle activity at sufficient intensity facilitates spinal motoneuron excitability, which could alter the relationship between the produced force and sense of effort.
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Affiliation(s)
- Takeshi Miyamoto
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki 305-8574, Japan
| | - Tomohiro Kizuka
- Faculty of Health and Sport Sciences, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki 305-8574, Japan
| | - Seiji Ono
- Faculty of Health and Sport Sciences, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki 305-8574, Japan.
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Neige C, Grosprêtre S, Martin A, Lebon F. Influence of Voluntary Contraction Level, Test Stimulus Intensity and Normalization Procedures on the Evaluation of Short-Interval Intracortical Inhibition. Brain Sci 2020; 10:brainsci10070433. [PMID: 32650395 PMCID: PMC7407177 DOI: 10.3390/brainsci10070433] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/02/2020] [Accepted: 07/06/2020] [Indexed: 12/13/2022] Open
Abstract
Short-interval intracortical inhibition (SICI) represents an inhibitory phenomenon acting at the cortical level. However, SICI estimation is based on the amplitude of a motor-evoked potential (MEP), which depends on the discharge of spinal motoneurones and the generation of compound muscle action potential (M-wave). In this study, we underpin the importance of taking into account the proportion of spinal motoneurones that are activated or not when investigating the SICI of the right flexor carpi radialis (normalization with maximal M-wave (Mmax) and MEPtest, respectively), in 15 healthy subjects. We probed SICI changes according to various MEPtest amplitudes that were modulated actively (four levels of muscle contraction: rest, 10%, 20% and 30% of maximal voluntary contraction (MVC)) and passively (two intensities of test transcranial magnetic stimulation (TMS): 120 and 130% of motor thresholds). When normalized to MEPtest, SICI remained unchanged by stimulation intensity and only decreased at 30% of MVC when compared with rest. However, when normalized to Mmax, we provided the first evidence of a strong individual relationship between SICI and MEPtest, which was ultimately independent from experimental conditions (muscle states and TMS intensities). Under similar experimental conditions, it is thus possible to predict SICI individually from a specific level of corticospinal excitability in healthy subjects.
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Affiliation(s)
- Cécilia Neige
- INSERM UMR1093-CAPS, Université Bourgogne Franche-Comté, UFR des Sciences du Sport, F-21078 Dijon, France; (A.M.); (F.L.)
- Correspondence: ; Tel.: +33-3-8039-6761
| | - Sidney Grosprêtre
- EA4660-C3S Laboratory—Culture, Sport, Health and Society, Université Bourgogne Franche-Comté, 25000 Besançon, France;
| | - Alain Martin
- INSERM UMR1093-CAPS, Université Bourgogne Franche-Comté, UFR des Sciences du Sport, F-21078 Dijon, France; (A.M.); (F.L.)
| | - Florent Lebon
- INSERM UMR1093-CAPS, Université Bourgogne Franche-Comté, UFR des Sciences du Sport, F-21078 Dijon, France; (A.M.); (F.L.)
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Higashihara M, Van den Bos MA, Menon P, Kiernan MC, Vucic S. Interneuronal networks mediate cortical inhibition and facilitation. Clin Neurophysiol 2020; 131:1000-1010. [DOI: 10.1016/j.clinph.2020.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 01/23/2020] [Accepted: 02/04/2020] [Indexed: 12/13/2022]
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Motor corticospinal excitability: a novel facet of pain modulation? Pain Rep 2019; 4:e725. [PMID: 31041424 PMCID: PMC6455687 DOI: 10.1097/pr9.0000000000000725] [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: 05/27/2018] [Revised: 01/20/2019] [Accepted: 01/30/2019] [Indexed: 12/13/2022] Open
Abstract
Introduction Increase in excitability of the primary motor cortex (M1) is associated with pain inhibition by analgesics, which is, in turn, associated with the psychophysical antinociceptive pain modulation profile. However, the relationship between neurophysiological M1 excitability and psychophysical pain modulation has not yet been explored. Objectives We aim to study these relationships in healthy subjects. Methods Forty-one young healthy subjects (22 women) underwent a wide battery of psychophysical testing that included conditioned pain modulation (CPM) and pain temporal summation, and a transcranial magnetic stimulation neurophysiological assessment of the motor corticospinal excitability, including resting motor threshold, motor-evoked potentials (MEPs), and cortical silent period. Results Increased motor corticospinal excitability in 2 parameters was associated with more efficient CPM: (1) higher MEP amplitude (r = -0.574; P _Bonferroni = 0.02) and (2) longer MEP duration (r = -0.543; P _Bonferroni = 0.02). The latter also correlated with the lower temporal summation magnitude (r = -0.421; P = 0.007); however, on multiplicity adjustment, significance was lost. Conclusions Increased corticospinal excitability of the primary motor cortex is associated with more efficient inhibitory pain modulation as assessed by CPM, in healthy subjects. Motor-evoked potential amplitude and duration may be considered as an additional, objective and easy to measure parameter to allow for better individual assessment of pain modulation profile.
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Menon P, Kiernan MC, Vucic S. Cortical excitability varies across different muscles. J Neurophysiol 2018; 120:1397-1403. [PMID: 29975162 DOI: 10.1152/jn.00148.2018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The aim of the present study was to determine whether significant differences in cortical excitability were evident across different body regions in healthy humans. Threshold tracking transcranial magnetic stimulation (TMS) was undertaken in 28 healthy controls. Short-interval intracortical inhibition [SICI between interstimulus intervals (ISI) 1-7 ms], intracortical facilitation (ICF, between ISI 10-30 ms), resting motor threshold (RMT), cortical silent period (CSP) duration (generated at stimulus intensity 150% RMT), and motor evoked potential amplitude were recorded from the abductor pollicis brevis (APB), tibialis anterior (TA), and trapezius muscles. These muscles were selected as they are frequently affected in neurodegenerative diseases, such as amyotrophic lateral sclerosis. SICI and ICF are measured as a percentage difference between conditioned and an unconditioned test response. SICI was significantly greater when recorded over the APB (9.9 ± 1.5%) and TA (8.6 ± 1.4%) muscles compared with the trapezius (4.5 ± 1.9%, P < 0.05). The CSP duration was significantly shorter (CSPtrapezius, 131.0 ± 6.3 ms; CSPTA, 175.7 ± 9.9 ms; CSPAPB, 188.3 ± 4.0 ms; P < 0.001) and ICF greater ( P < 0.01) in the trapezius muscle. There were no significant correlations between inhibitory and facilitatory processes recorded across the three muscles. The present study established significant differences in cortical excitability across three body regions, with evidence of more prominent inhibition and less facilitation in the limb muscles. NEW & NOTEWORTHY Cortical excitability of muscles with differing motor functions was assessed using threshold tracking transcranial magnetic stimulation. Significantly greater intracortical inhibition and less facilitation were evident over the limb muscles. These findings could relate to differences in the functional organization of the corticomotoneuronal system innervating different muscle regions.
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Affiliation(s)
- Parvathi Menon
- Western Clinical School, University of Sydney , Sydney , Australia.,Westmead Hospital, University of Sydney , Sydney , Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, University of Sydney and Royal Prince Alfred Hospital , Sydney , Australia
| | - Steve Vucic
- Western Clinical School, University of Sydney , Sydney , Australia.,Westmead Hospital, University of Sydney , Sydney , Australia
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