1
|
Wischnewski M, Edwards L, Revill KP, Drake D, Hobbs G, Buetefisch CM. Intensity-Dependent Effects of Low-Frequency Subthreshold rTMS on Primary Motor Cortex Excitability and Interhemispheric Inhibition in Elderly Participants: A Randomized Trial. Neurorehabil Neural Repair 2025; 39:58-73. [PMID: 39462433 PMCID: PMC12077577 DOI: 10.1177/15459683241292615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2024]
Abstract
BACKGROUND Low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) protocols targeting primary motor cortex (M1) are used in rehabilitation of neurological diseases for their therapeutic potential, safety, and tolerability. Although lower intensity LF-rTMS can modulate M1 neurophysiology, results are variable, and a systematic assessment of its dose effect is lacking. OBJECTIVES To determine the dose-response of LF-rTMS on stimulated and non-stimulated M1. METHODS In a sham-controlled randomized double-blind crossover study the effect of LF-TMS protocols were determined in 20 right-handed older healthy participants. In 3 sessions, 1 Hz rTMS at 80% (rTMS80), 90% (rTMS90) of motor threshold or sham stimulation were applied to left upper extremity M1. Outcome measures were curve parameters of the stimulus-response curve (maximum motor evoked potential [MEPMAX], slope and the intensity to evoke 50% MEPMAX), short-interval intracortical inhibition (SICI), and interhemispheric inhibition (IHI). RESULTS Within LF-rTMS sessions, rTMS90, increased MEPMAX in the stimulated M1. Furthermore, rTMS90, increased the slope in the non-stimulated M1. LF-rTMS effects on SICI were dependent on the participants' baseline SICI, hemisphere, and intensity of conditioning pulse. Finally, rTMS90 increased whereas rTMS80 decreased IHI, for both IHI directions. These changes were dependent on baseline IHI and hemisphere and were no longer significant when baseline IHI was accounted for. CONCLUSIONS Intensity of subthreshold LF-rTMS has differential effects on excitation and inhibition of stimulated and non-stimulated M1. The effects were small and were only demonstrated within the LF-rTMS sessions but were not different when compared to sham. rTMS related changes in SICI and IHI were dependent on baseline level. CLINICALTRIALS.GOV IDENTIFIER NCT02544503, NCT01726218.
Collapse
Affiliation(s)
- Miles Wischnewski
- Department of Neurology, Emory University, School of Medicine, Atlanta, GA, USA
- Department of Experimental Psychology, University of Groningen, Groningen, The Netherlands
| | - Lauren Edwards
- Department of Neurology, Emory University, School of Medicine, Atlanta, GA, USA
| | - Kate P Revill
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Daniel Drake
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Gerald Hobbs
- Department of Statistics, West Virginia University, Morgantown, WV, USA
| | - Cathrin M Buetefisch
- Department of Neurology, Emory University, School of Medicine, Atlanta, GA, USA
- Departments of Neurology, Rehabilitation Medicine and Radiology, School of Medicine, Emory University, Atlanta, GA, USA
| |
Collapse
|
2
|
Hung CC, Lin KH, Chang HA. Exploring Cognitive Deficits and Neuromodulation in Schizophrenia: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:2060. [PMID: 39768939 PMCID: PMC11676924 DOI: 10.3390/medicina60122060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2024] [Revised: 12/07/2024] [Accepted: 12/11/2024] [Indexed: 01/11/2025]
Abstract
Cognitive deficits are emerging as critical targets for managing schizophrenia and enhancing clinical and functional outcomes. These deficits are pervasive among individuals with schizophrenia, affecting various cognitive domains. Traditional pharmacotherapy and cognitive behavioral therapy (CBT) have limitations in effectively addressing cognitive impairments in this population. Neuromodulation techniques show promise in improving certain cognitive domains among patients with schizophrenia spectrum disorders. Understanding the mechanisms of neural circuits that underlie cognitive enhancement is essential for elucidating the pathophysiological processes of the disorder, and these insights could significantly optimize strategies for managing schizophrenia. Meanwhile, although there is an increasing body of evidence demonstrating the therapeutic effects of neuromodulation in this area, further research is still needed, particularly regarding topics such as different treatment protocols and the long-term effects of treatment.
Collapse
Affiliation(s)
- Chien-Chen Hung
- Department of Psychiatry, Tzu Chi General Hospital, Hualien 970, Taiwan;
| | - Ko-Huan Lin
- Department of Psychiatry, Tzu Chi General Hospital, Hualien 970, Taiwan;
- Non-Invasive Neuromodulation Consortium for Mental Disorders, Society of Psychophysiology, Taipei 114, Taiwan
| | - Hsin-An Chang
- Non-Invasive Neuromodulation Consortium for Mental Disorders, Society of Psychophysiology, Taipei 114, Taiwan
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei 112, Taiwan
| |
Collapse
|
3
|
Chen SY, Tsou MH, Chen KY, Liu YC, Lin MT. Impact of repetitive transcranial magnetic stimulation on cortical activity: a systematic review and meta-analysis utilizing functional near-infrared spectroscopy evaluation. J Neuroeng Rehabil 2024; 21:108. [PMID: 38915003 PMCID: PMC11194950 DOI: 10.1186/s12984-024-01407-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 06/19/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Repeated transcranial magnetic stimulation (rTMS) could induce alterations in cortical excitability and promote neuroplasticity. To precisely quantify these effects, functional near-infrared spectroscopy (fNIRS), an optical neuroimaging modality adept at detecting changes in cortical hemodynamic responses, has been employed concurrently alongside rTMS to measure and tailor the impact of diverse rTMS protocols on the brain cortex. OBJECTIVE This systematic review and meta-analysis aimed to elucidate the effects of rTMS on cortical hemodynamic responses over the primary motor cortex (M1) as detected by fNIRS. METHODS Original articles that utilized rTMS to stimulate the M1 cortex in combination with fNIRS for the assessment of cortical activity were systematically searched across the PubMed, Embase, and Scopus databases. The search encompassed records from the inception of these databases up until April, 2024. The assessment for risk of bias was also conducted. A meta-analysis was also conducted in studies with extractable raw data. RESULTS Among 312 studies, 14 articles were eligible for qualitative review. 7 studies were eligible for meta-analysis. A variety of rTMS protocols was employed on M1 cortex. In inhibitory rTMS, multiple studies observed a reduction in the concentration of oxygenated hemoglobin [HbO] at the ipsilateral M1, contrasted by an elevation at the contralateral M1. Meta-analysis also corroborated this consistent trend. Nevertheless, certain investigations unveiled diminished [HbO] in bilateral M1. Several studies also depicted intricate inhibitory or excitatory interplay among distinct cortical regions. CONCLUSION Diverse rTMS protocols led to varied patterns of cortical activity detected by fNIRS. Meta-analysis revealed a trend of increasing [HbO] in the contralateral cortices and decreasing [HbO] in the ipsilateral cortices following low frequency inhibitory rTMS. However, due to the heterogeneity between studies, further research is necessary to comprehensively understand rTMS-induced alterations in brain activity.
Collapse
Affiliation(s)
- Shao-Yu Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7 Chung-Shan South Road, Taipei City, 10002, Taiwan
| | - Meng-Hsuan Tsou
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, 3F., No.17, Xuzhou Rd., Zhongzheng Dist, Taipei City, 10002, Taiwan
| | - Kuan-Yu Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7 Chung-Shan South Road, Taipei City, 10002, Taiwan
| | - Yan-Ci Liu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, 3F., No.17, Xuzhou Rd., Zhongzheng Dist, Taipei City, 10002, Taiwan.
- Physical Therapy Center, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 1, Changde St., Zhongzheng Dist, Taipei City, 10022, Taiwan.
| | - Meng-Ting Lin
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7 Chung-Shan South Road, Taipei City, 10002, Taiwan.
| |
Collapse
|
4
|
Xia X, Wang Z, Zeng K, Nankoo JF, Darmani G, Tran S, Ding MYR, Chen R. Effects of the motor cortical theta-burst transcranial-focused ultrasound stimulation on the contralateral motor cortex. J Physiol 2024; 602:2931-2943. [PMID: 38872383 DOI: 10.1113/jp285139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 04/15/2024] [Indexed: 06/15/2024] Open
Abstract
Theta-burst transcranial ultrasound stimulation (tbTUS) increases primary motor cortex (M1) excitability for at least 30 min. However, the remote effects of focal M1 tbTUS on the excitability of other cortical areas are unknown. Here, we examined the effects of left M1 tbTUS on right M1 excitability. An 80 s train of active or sham tbTUS was delivered to the left M1 in 20 healthy subjects. Before and after the tbTUS, we measured: (1) corticospinal excitability using motor-evoked potential (MEP) amplitudes from single-pulse transcranial magnetic stimulation (TMS) of left and right M1; (2) interhemispheric inhibition (IHI) from left to right M1 and from right to left M1 using a dual-site paired-pulse TMS paradigm; and (3) intracortical circuits of the right M1 with short-interval intracortical inhibition and intracortical facilitation (ICF) using paired-pulse TMS. Left M1 tbTUS decreased right M1 excitability as shown by decreased MEP amplitudes, increased right M1 ICF and decreased short-interval IHI from left to right hemisphere at interstimulus interval (ISI) of 10 ms but not long-interval IHI at interstimulus interval of 40 ms. The study showed that left M1 tbTUS can change the excitability of remote cortical areas with decreased right M1 excitability and interhemispheric inhibition. The remote effects of tbTUS should be considered when it is used in neuroscience research and as a potential neuromodulation treatment for brain disorders. KEY POINTS: Transcranial ultrasound stimulation (TUS) is a novel non-invasive brain stimulation technique for neuromodulation with the advantages of being able to achieve high spatial resolution and target deep brain structures. A repetitive TUS protocol, with an 80 s train of theta burst patterned TUS (tbTUS), has been shown to increase primary motor cortex (M1) excitability, as well as increase alpha and beta movement-related spectral power in distinct brain regions. In this study, we examined on the effects of the motor cortical tbTUS on the excitability of contralateral M1 measured with MEPs elicited by transcranial magnetic stimulation. We showed that left M1 tbTUS decreased right M1 excitability and left-to-right M1 interhemispheric inhibition, and increased intracortical facilitation of right M1. These results lead to better understand the effects of tbTUS and can help the development of tbTUS for the treatment of neurological and psychiatric disorders and in neuroscience research.
Collapse
Affiliation(s)
- Xue Xia
- School of Social Development and Health Management, University of Health and Rehabilitation Sciences, Qingdao, China
- Krembil Research Institute, University Health Network, Toronto, Canada
| | - Zhen Wang
- Krembil Research Institute, University Health Network, Toronto, Canada
- School of Sport and Health Science, Xi'an Physical Education University, Xi'an, China
| | - Ke Zeng
- Krembil Research Institute, University Health Network, Toronto, Canada
- Department of Psychology, Faculty of Arts and Sciences, Beijing Normal University at Zhuhai, Zhuhai, China
| | | | - Ghazaleh Darmani
- Krembil Research Institute, University Health Network, Toronto, Canada
| | - Stephanie Tran
- Krembil Research Institute, University Health Network, Toronto, Canada
| | | | - Robert Chen
- Krembil Research Institute, University Health Network, Toronto, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada
| |
Collapse
|
5
|
Huang XL, Wu MY, Wu CC, Yan LC, He MH, Chen YC, Tsai ST. Neuromodulation techniques in poststroke motor impairment recovery: Efficacy, challenges, and future directions. Tzu Chi Med J 2024; 36:136-141. [PMID: 38645790 PMCID: PMC11025597 DOI: 10.4103/tcmj.tcmj_247_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/16/2023] [Accepted: 12/19/2023] [Indexed: 04/23/2024] Open
Abstract
Cerebrovascular accidents, also known as strokes, represent a major global public health challenge and contribute to substantial mortality, disability, and socioeconomic burden. Multidisciplinary approaches for poststroke therapies are crucial for recovering lost functions and adapting to new limitations. This review discusses the potential of neuromodulation techniques, repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation, spinal cord stimulation (SCS), vagus nerve stimulation (VNS), and deep brain stimulation (DBS), as innovative strategies for facilitating poststroke recovery. Neuromodulation is an emerging adjunct to conventional therapies that target neural plasticity to restore lost function and compensate for damaged brain areas. The techniques discussed in this review have different efficacies in enhancing neural plasticity, optimizing motor recovery, and mitigating poststroke impairments. Specifically, rTMS has shown significant promise in enhancing motor function, whereas SCS has shown potential in improving limb movement and reducing disability. Similarly, VNS, typically used to treat epilepsy, has shown promise in enhancing poststroke motor recovery, while DBS may be used to improve poststroke motor recovery and symptom mitigation. Further studies with standardized protocols are warranted to elucidate the efficacy of these methods and integrate them into mainstream clinical practice to optimize poststroke care.
Collapse
Affiliation(s)
- Xiang-Ling Huang
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- Department of Nursing, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Ming-Yung Wu
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Ciou-Chan Wu
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Lian-Cing Yan
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Mei-Huei He
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Yu-Chen Chen
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- Department of Medical Informatics, Tzu Chi University, Hualien, Taiwan
| | - Sheng-Tzung Tsai
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| |
Collapse
|
6
|
Billot A, Kiran S. Disentangling neuroplasticity mechanisms in post-stroke language recovery. BRAIN AND LANGUAGE 2024; 251:105381. [PMID: 38401381 PMCID: PMC10981555 DOI: 10.1016/j.bandl.2024.105381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/28/2023] [Accepted: 01/12/2024] [Indexed: 02/26/2024]
Abstract
A major objective in post-stroke aphasia research is to gain a deeper understanding of neuroplastic mechanisms that drive language recovery, with the ultimate goal of enhancing treatment outcomes. Subsequent to recent advances in neuroimaging techniques, we now have the ability to examine more closely how neural activity patterns change after a stroke. However, the way these neural activity changes relate to language impairments and language recovery is still debated. The aim of this review is to provide a theoretical framework to better investigate and interpret neuroplasticity mechanisms underlying language recovery in post-stroke aphasia. We detail two sets of neuroplasticity mechanisms observed at the synaptic level that may explain functional neuroimaging findings in post-stroke aphasia recovery at the network level: feedback-based homeostatic plasticity and associative Hebbian plasticity. In conjunction with these plasticity mechanisms, higher-order cognitive control processes dynamically modulate neural activity in other regions to meet communication demands, despite reduced neural resources. This work provides a network-level neurobiological framework for understanding neural changes observed in post-stroke aphasia and can be used to define guidelines for personalized treatment development.
Collapse
Affiliation(s)
- Anne Billot
- Center for Brain Recovery, Boston University, Boston, USA; Department of Psychology, Center for Brain Science, Harvard University, Cambridge, Massachusetts, USA; Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Swathi Kiran
- Center for Brain Recovery, Boston University, Boston, USA.
| |
Collapse
|
7
|
Xu R, Zhang H, Liu S, Meng L, Ming D. cTBS over primary motor cortex increased contralateral corticomuscular coupling and interhemispheric functional connection. J Neural Eng 2024; 21:016012. [PMID: 38211343 DOI: 10.1088/1741-2552/ad1dc4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 01/11/2024] [Indexed: 01/13/2024]
Abstract
Objective.Transcranial magnetic stimulation is a non-invasive brain stimulation technique that changes the activity of the cerebral cortex. Contralesional continuous theta burst stimulation (cTBS) has been proposed and verified beneficial to stroke motor recovery. However, the underlying mechanism is still unclear.Approach.20 healthy right-handed subjects were recruited in this study, receiving real-cTBS over their left primary motor cortex or sham-cTBS. We designed the finger tapping task (FTT) before and after stimulation and recorded the accuracy and reaction time (RT) of the task. The electroencephalogram and surface electromyogram signals were recorded during the left finger pinching task (FPT) before and after stimulation. We calculated cortico-muscular coherence (CMC) in the contralateral hemisphere and cortico-cortical coherence (CCC) in the bilateral hemisphere. The two-way repeated measures analysis of variance was used to analyze the effect of cTBS.Main results.In the FTT, there was a significant main effect of 'time' on RT (F(1, 38) = 24.739,p< 0.001). In the FPT, the results showed that there was a significant interaction effect on the CMC peak and area in the beta band (peak:F(1, 38) = 8.562,p= 0.006; area:F(1, 38) = 5.273,p= 0.027), on the CCC peak in the alpha band (F(1, 38) = 4.815,p= 0.034) and area in the beta band (F(1, 38) = 4.822,p= 0.034). The post hoc tests showed that the CMC peak (W= 20,p= 0.002), the CMC area (W= 13,p= 0.003) and the CCC peak (t= -2.696,p= 0.014) increased significantly after real-cTBS. However, there was no significant decrease or increase after sham-cTBS.Significance.Our study found that cTBS can improve CMC of contralateral hemisphere and CCC of bilateral hemisphere, indicating that cTBS can strengthen cortico-muscular and cortico-cortical coupling.
Collapse
Affiliation(s)
- Rui Xu
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin 300072, People's Republic of China
| | - Haichao Zhang
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin 300072, People's Republic of China
| | - Shizhong Liu
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin 300072, People's Republic of China
- Department of Rehabilitation, Tianjin Medical University General Hospital, Tianjin 300052, People's Republic of China
| | - Lin Meng
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin 300072, People's Republic of China
| | - Dong Ming
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin 300072, People's Republic of China
| |
Collapse
|
8
|
Guan M, Xie Y, Li C, Zhang T, Ma C, Wang Z, Ma Z, Wang H, Fang P. Rich-club reorganization of white matter structural network in schizophrenia patients with auditory verbal hallucinations following 1 Hz rTMS treatment. Neuroimage Clin 2023; 40:103546. [PMID: 37988997 PMCID: PMC10701084 DOI: 10.1016/j.nicl.2023.103546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 11/23/2023]
Abstract
The human brain comprises a large-scale structural network of regions and interregional pathways, including a selectively defined set of highly central and interconnected hub regions, often referred to as the "rich club", which may play a pivotal role in the integrative processes of the brain. A quintessential symptom of schizophrenia, auditory verbal hallucinations (AVH) have shown a decrease in severity following low-frequency repetitive transcranial magnetic stimulation (rTMS). However, the underlying mechanism of rTMS in treating AVH remains elusive. This study investigated the effect of low-frequency rTMS on the rich-club organization within the brain in patients diagnosed with schizophrenia who experience AVH using diffusion tensor imaging data. Through by constructing structural connectivity networks, we identified several critical rich hub nodes, which constituted a rich-club subnetwork, predominantly located in the prefrontal cortices. Notably, our findings revealed enhanced connection strength and density within the rich-club subnetwork following rTMS treatment. Furthermore, we found that the decreased connectivity within the subnetwork components, including the rich-club subnetwork, was notably enhanced in patients following rTMS treatment. In particular, the increased connectivity strength of the right median superior frontal gyrus, which functions as a critical local bridge, with the right postcentral gyrus exhibited a significant correlation with improvements in both positive symptoms and AVH. These findings provide valuable insights into the role of rTMS in inducing reorganizational changes within the rich-club structural network in schizophrenia and shed light on potential mechanisms through which rTMS may alleviate AVH.
Collapse
Affiliation(s)
- Muzhen Guan
- Department of Mental Health, Xi'an Medical College, Xi'an, China.
| | - Yuanjun Xie
- Military Medical Psychology School, Fourth Military Medical University, Xi'an, China; Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
| | - Chenxi Li
- Military Medical Psychology School, Fourth Military Medical University, Xi'an, China
| | - Tian Zhang
- Military Medical Psychology School, Fourth Military Medical University, Xi'an, China
| | - Chaozong Ma
- Military Medical Psychology School, Fourth Military Medical University, Xi'an, China
| | - Zhongheng Wang
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Zhujing Ma
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Huaning Wang
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
| | - Peng Fang
- Military Medical Psychology School, Fourth Military Medical University, Xi'an, China.
| |
Collapse
|
9
|
Kim E, Van Reet J, Yoo SS. Cerebrospinal fluid solute transport associated with sensorimotor brain activity in rodents. Sci Rep 2023; 13:17002. [PMID: 37813871 PMCID: PMC10562378 DOI: 10.1038/s41598-023-43920-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/29/2023] [Indexed: 10/11/2023] Open
Abstract
Cerebrospinal fluid (CSF) is crucial for maintaining neuronal homeostasis, providing nutrition, and removing metabolic waste from the brain. However, the relationship between neuronal activity and CSF solute transport remains poorly understood. To investigate the effect of regional neuronal activity on CSF solute transport, Sprague-Dawley rats (all male, n = 30) under anesthesia received an intracisternal injection of a fluorescent tracer (Texas Red ovalbumin) and were subjected to unilateral electrical stimulation of a forelimb. Two groups (n = 10 each) underwent two different types of stimulation protocols for 90 min, one including intermittent 7.5-s resting periods and the other without rest. The control group was not stimulated. Compared to the control, the stimulation without resting periods led to increased transport across most of the cortical areas, including the ventricles. The group that received intermittent stimulation showed an elevated level of solute uptake in limited areas, i.e., near/within the ventricles and on the ventral brain surface. Interhemispheric differences in CSF solute transport were also found in the cortical regions that overlap with the forelimb sensorimotor area. These findings suggest that neuronal activity may trigger local and brain-wide increases in CSF solute transport, contributing to waste clearance.
Collapse
Affiliation(s)
- Evgenii Kim
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Jared Van Reet
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Seung-Schik Yoo
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| |
Collapse
|
10
|
Tian D, Izumi SI. Different effects of I-wave periodicity repetitive TMS on motor cortex interhemispheric interaction. Front Neurosci 2023; 17:1079432. [PMID: 37457007 PMCID: PMC10349661 DOI: 10.3389/fnins.2023.1079432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Background Activity of the neural circuits in the human motor cortex can be probed using transcranial magnetic stimulation (TMS). Changing TMS-induced current direction recruits different cortical neural circuits. I-wave periodicity repetitive TMS (iTMS) substantially modulates motor cortex excitability through neural plasticity, yet its effect on interhemispheric interaction remains unclear. Objective To explore the modulation of interhemispheric interaction by iTMS applied in different current directions. Materials and Methods Twenty right-handed healthy young volunteers (aged 27.5 ± 5.0 years) participated in this study with three visits. On each visit, iTMS in posterior-anterior/anterior-posterior direction (PA-/AP-iTMS) or sham-iTMS was applied to the right hemisphere, with corticospinal excitability and intracortical facilitation of the non-stimulated left hemisphere evaluated at four timepoints. Ipsilateral silent period was also measured at each timepoint probing interhemispheric inhibition (IHI). Results PA- and AP-iTMS potentiated cortical excitability concurrently in the stimulated right hemisphere. Corticospinal excitability of the non-stimulated left hemisphere increased 10 min after both PA- and AP-iTMS intervention, with a decrease in short-interval intracortical facilitation (SICF) observed in AP-iTMS only. Immediately after the intervention, PA-iTMS tilted the IHI balance toward inhibiting the non-stimulated hemisphere, while AP-iTMS shifted the balance toward the opposite direction. Conclusions Our findings provide systematic evidence on the plastic modulation of interhemispheric interaction by PA- and AP-iTMS. We show that iTMS induces an interhemispheric facilitatory effect, and that PA- and AP-iTMS differs in modulating interhemispheric inhibition.
Collapse
Affiliation(s)
- Dongting Tian
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shin-Ichi Izumi
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan
- Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
| |
Collapse
|
11
|
El Saied AM, ELWishy AA, Mansour WT, Rehab NI, El Zanaty MY, Abd El-Hakim AAEM, Abdelaleem RE, Youssef TM. Effect of transcranial magnetic stimulation on functional outcome in patients with incomplete spinal cord injury: A randomized controlled study. FIZJOTERAPIA POLSKA 2023; 23:34-40. [DOI: 10.56984/8zg0df2f4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Background. Incomplete spinal cord injury is a common disorder leading to sensory or motor function loss.
Objective. This study aimed to investigate the effect of repetitive transcranial magnetic stimulation therapy (rTMS) on functional outcome in patients with incomplete spinal cord injury.
Design. A prospective randomized controlled trial. Setting. Agouza Rehabilitation Hospital Out clinic.
Methods. Forty male patients with chronic traumatic incomplete spinal cord injury aging from 25 to 45years. Patients were randomly divided into two equal groups (group A and group B).Group A was the study group that received rTMS in addition to designed physical therapy program including BWST training and Group B was the control group that received the same designed physical therapy program including BWST training. The functional gait was assessed using walking index for spinal cord injury (WISCI II) and gait speed was assessed using 10 m walk test. Measurements were performed before and after treatment and three months after end of the treatment as follow up.
Results. There was a statistically significant improvement in WISCI II and 10m walk test at post treatment and follow up compared with that pre-treatment in study group (P < 0.05). There was no statistically significant improvement in all outcome variables at post treatment and follow up compared with that pretreatment in control group (P > 0.05).There was a statistically significant improvement in patients who received rTMS with BWST compared with patients received BWST only in WISCI II and 10 m walk test at post treatment (p = 0.01 and p = 0.001 respectively) compared to pre treatment. The gained effect was lost at follow up measurement compared to post treatment in WISCI II and the gained effect was maintained at follow up measurement compared to post treatment in 10m walk test score.
Conclusion. It was proven that rTMS add a valuable effect for restoring function in patients with incomplete spinal cord injury, particularly in cases when the effect of BWST has reached a plateau.
Collapse
Affiliation(s)
- Ahmed M. El Saied
- Department of Physical Therapy for Neurology, Cairo university,Egypt
| | - Abeer A. ELWishy
- Department of Physical Therapy for Neurology, Cairo university,Egypt
| | | | | | | | | | | | - Tarek M. Youssef
- Department of Physiotherapy, Faculty of Allied Medical Science, Middle East University, Amman, Jordan
| |
Collapse
|
12
|
Champagne PL, Blanchette AK, Schneider C. Continuous, and not intermittent, theta-burst stimulation of the unlesioned hemisphere improved brain and hand function in chronic stroke: A case study. BRAIN DISORDERS 2023. [DOI: 10.1016/j.dscb.2022.100062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
|
13
|
The Perturbational Map of Low Frequency Repetitive Transcranial Magnetic Stimulation of Primary Motor Cortex in Movement Disorders. BRAIN DISORDERS 2023. [DOI: 10.1016/j.dscb.2023.100071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
|
14
|
Xu C, Wu W, Zheng X, Liang Q, Huang X, Zhong H, Xiao Q, Lan Y, Bai Y, Xie Q. Repetitive transcranial magnetic stimulation over the posterior parietal cortex improves functional recovery in nonresponsive patients: A crossover, randomized, double-blind, sham-controlled study. Front Neurol 2023; 14:1059789. [PMID: 36873436 PMCID: PMC9978157 DOI: 10.3389/fneur.2023.1059789] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 01/18/2023] [Indexed: 02/19/2023] Open
Abstract
Background Recent studies have shown that patients with disorders of consciousness (DoC) can benefit from repetitive transcranial magnetic stimulation (rTMS) therapy. The posterior parietal cortex (PPC) is becoming increasingly important in neuroscience research and clinical treatment for DoC as it plays a crucial role in the formation of human consciousness. However, the effect of rTMS on the PPC in improving consciousness recovery remains to be studied. Method We conducted a crossover, randomized, double-blind, sham-controlled clinical study to assess the efficacy and safety of 10 Hz rTMS over the left PPC in unresponsive patients. Twenty patients with unresponsive wakefulness syndrome were recruited. The participants were randomly divided into two groups: one group received active rTMS treatment for 10 consecutive days (n = 10) and the other group received sham treatment for the same period (n = 10). After a 10-day washout period, the groups crossed over and received the opposite treatment. The rTMS protocol involved the delivery of 2000 pulses/day at a frequency of 10 Hz, targeting the left PPC (P3 electrode sites) at 90% of the resting motor threshold. The primary outcome measure was the JFK Coma Recovery Scele-Revised (CRS-R), and evaluations were conducted blindly. EEG power spectrum assessments were also conducted simultaneously before and after each stage of the intervention. Result rTMS-active treatment resulted in a significant improvement in the CRS-R total score (F = 8.443, p = 0.009) and the relative alpha power (F = 11.166, p = 0.004) compared to sham treatment. Furthermore, 8 out of 20 patients classified as rTMS responders showed improvement and evolved to a minimally conscious state (MCS) as a result of active rTMS. The relative alpha power also significantly improved in responders (F = 26.372, p = 0.002) but not in non-responders (F = 0.704, p = 0.421). No adverse effects related to rTMS were reported in the study. Conclusions This study suggests that 10 Hz rTMS over the left PPC can significantly improve functional recovery in unresponsive patients with DoC, with no reported side effects. Clinical trial registration www.ClinicalTrials.gov, identifier: NCT05187000.
Collapse
Affiliation(s)
- Chengwei Xu
- Department of Rehabilitation Medicine, Joint Research Centre for Disorders of Consciousness, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Wanchun Wu
- Department of Rehabilitation Medicine, Joint Research Centre for Disorders of Consciousness, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Xiaochun Zheng
- Department of Rehabilitation Medicine, Joint Research Centre for Disorders of Consciousness, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Qimei Liang
- Department of Rehabilitation Medicine, Joint Research Centre for Disorders of Consciousness, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Xiyan Huang
- Department of Rehabilitation Medicine, Joint Research Centre for Disorders of Consciousness, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Haili Zhong
- Department of Rehabilitation Medicine, Joint Research Centre for Disorders of Consciousness, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Qiuyi Xiao
- Department of Rehabilitation Medicine, Joint Research Centre for Disorders of Consciousness, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Yue Lan
- Department of Rehabilitation Medicine, Joint Research Centre for Disorders of Consciousness, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Yang Bai
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China.,School of Basic Medical Sciences, Hangzhou Normal University, Hangzhou, China
| | - Qiuyou Xie
- Department of Rehabilitation Medicine, Joint Research Centre for Disorders of Consciousness, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| |
Collapse
|
15
|
3D-mapping of TMS effects with automatic robotic placement improved reliability and the risk of spurious correlation. J Neurosci Methods 2022; 381:109689. [PMID: 35987214 DOI: 10.1016/j.jneumeth.2022.109689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/19/2022] [Accepted: 08/16/2022] [Indexed: 12/14/2022]
|
16
|
Jangwan NS, Ashraf GM, Ram V, Singh V, Alghamdi BS, Abuzenadah AM, Singh MF. Brain augmentation and neuroscience technologies: current applications, challenges, ethics and future prospects. Front Syst Neurosci 2022; 16:1000495. [PMID: 36211589 PMCID: PMC9538357 DOI: 10.3389/fnsys.2022.1000495] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 08/31/2022] [Indexed: 12/02/2022] Open
Abstract
Ever since the dawn of antiquity, people have strived to improve their cognitive abilities. From the advent of the wheel to the development of artificial intelligence, technology has had a profound leverage on civilization. Cognitive enhancement or augmentation of brain functions has become a trending topic both in academic and public debates in improving physical and mental abilities. The last years have seen a plethora of suggestions for boosting cognitive functions and biochemical, physical, and behavioral strategies are being explored in the field of cognitive enhancement. Despite expansion of behavioral and biochemical approaches, various physical strategies are known to boost mental abilities in diseased and healthy individuals. Clinical applications of neuroscience technologies offer alternatives to pharmaceutical approaches and devices for diseases that have been fatal, so far. Importantly, the distinctive aspect of these technologies, which shapes their existing and anticipated participation in brain augmentations, is used to compare and contrast them. As a preview of the next two decades of progress in brain augmentation, this article presents a plausible estimation of the many neuroscience technologies, their virtues, demerits, and applications. The review also focuses on the ethical implications and challenges linked to modern neuroscientific technology. There are times when it looks as if ethics discussions are more concerned with the hypothetical than with the factual. We conclude by providing recommendations for potential future studies and development areas, taking into account future advancements in neuroscience innovation for brain enhancement, analyzing historical patterns, considering neuroethics and looking at other related forecasts.
Collapse
Affiliation(s)
- Nitish Singh Jangwan
- Department of Pharmacology, School of Pharmaceutical Sciences and Technology, Sardar Bhagwan Singh University, Balawala, India
| | - Ghulam Md Ashraf
- Pre-Clinical Research Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Veerma Ram
- Department of Pharmacology, School of Pharmaceutical Sciences and Technology, Sardar Bhagwan Singh University, Balawala, India
| | - Vinod Singh
- Prabha Harji Lal College of Pharmacy and Paraclinical Sciences, University of Jammu, Jammu, India
| | - Badrah S. Alghamdi
- Pre-Clinical Research Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Physiology, Neuroscience Unit, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Adel Mohammad Abuzenadah
- Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mamta F. Singh
- Department of Pharmacology, School of Pharmaceutical Sciences and Technology, Sardar Bhagwan Singh University, Balawala, India
| |
Collapse
|
17
|
Interhemispheric Facilitatory Effect of High-Frequency rTMS: Perspective from Intracortical Facilitation and Inhibition. Brain Sci 2022; 12:brainsci12080970. [PMID: 35892411 PMCID: PMC9332419 DOI: 10.3390/brainsci12080970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 02/04/2023] Open
Abstract
The activity of excitatory and inhibitory neural circuits in the motor cortex can be probed and modified by transcranial magnetic stimulation (TMS) and repetitive TMS (rTMS), noninvasively. At present, not only has a consensus regarding the interhemispheric effect of high frequency rTMS not been reached, but the attributes of these TMS-related circuits are also poorly understood. To address this question comprehensively, we integrated a single- and paired-pulse TMS evaluation with excitatory 20-Hz rTMS intervention in order to probe the interhemispheric effect on the intracortical circuits by high-frequency rTMS. In the rest state, after 20-Hz rTMS, a significant increase of single-pulse MEP and paired-pulse intracortical facilitation (ICF) in the non-stimulated hemisphere was observed with good test–retest reliability. Intracortical inhibition (measured by the cortical silent period) in the unstimulated hemisphere also increased after rTMS. No significant time–course change was observed in the sham-rTMS group. The results provide the evidence that 20-Hz rTMS induced a reliable interhemispheric facilitatory effect. Findings from the present study suggest that the glutamatergic facilitatory system and the GABAergic inhibitory system may vary synchronously.
Collapse
|
18
|
Parkinson's disease: Alterations of motor plasticity and motor learning. HANDBOOK OF CLINICAL NEUROLOGY 2022; 184:135-151. [PMID: 35034730 DOI: 10.1016/b978-0-12-819410-2.00007-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This chapter reviews the alterations in motor learning and motor cortical plasticity in Parkinson's disease (PD), the most common movement disorder. Impairments in motor learning, which is a hallmark of basal ganglia disorders, influence the performance of motor learning-related behavioral tasks and have clinical implications for the management of disturbance in gait and posture, and for rehabilitative management of PD. Although plasticity is classically induced and assessed in sliced preparation in animal models, in this review we have concentrated on the results from non-invasive brain stimulation techniques such as transcranial magnetic stimulation (TMS), transcranial alternating current stimulation (tACS) and transcranial direct current stimulation (tDCS) in patients with PD, in addition to a few animal electrophysiologic studies. The chapter summarizes the results from different cortical and subcortical plasticity investigations. Plasticity induction protocols reveal deficient plasticity in PD and these plasticity measures are modulated by medications and deep brain stimulation. There is considerable variability in these measures that are related to inter-individual variations, different disease characteristics and methodological considerations. Nevertheless, these pathophysiologic studies expand our knowledge of cortical excitability, plasticity and the effects of different treatments in PD. These tools of modulating plasticity and motor learning improve our understanding of PD pathophysiology and help to develop new treatments for this disabling condition.
Collapse
|
19
|
New Treatment Strategy Using Repetitive Transcranial Magnetic Stimulation for Post-Stroke Aphasia. Diagnostics (Basel) 2021; 11:diagnostics11101853. [PMID: 34679550 PMCID: PMC8534572 DOI: 10.3390/diagnostics11101853] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) for post-stroke aphasia (PSA) has been suggested to promote improvement of language function when used in combination with rehabilitation. However, many challenges remain. In some reports examined by category of language function, only naming has good evidence of improvement, and the improvement effect on other language modalities is low. Therefore, it is necessary to establish methods that contribute to the improvement of language functions other than naming. Therapeutic methods for PSA based on the mechanism of rTMS are mainly inhibitory stimulation methods for language homologous areas. However, the mechanisms of these methods are controversial when inferred from the process of recovery of language function. Low-frequency rTMS applied to the right hemisphere has been shown to be effective in the chronic phase of PSA, but recent studies of the recovery process of language function indicate that this method is unclear. Therefore, it has been suggested that evaluating brain activity using neuroimaging contributes to confirming the effect of rTMS on PSA and the elucidation of the mechanism of functional improvement. In addition, neuroimaging-based stimulation methods (imaging-based rTMS) may lead to further improvements in language function. Few studies have examined neuroimaging and imaging-based rTMS in PSA, and further research is required. In addition, the stimulation site and stimulation parameters of rTMS are likely to depend on the time from onset to intervention. However, there are no reports of studies in patients between 90 and 180 days after onset. Therefore, research during this period is required. New stimulation methods, such as multiple target methods and the latest neuroimaging methods, may contribute to the establishment of new knowledge and new treatment methods in this field.
Collapse
|
20
|
Perinatal stroke: mapping and modulating developmental plasticity. Nat Rev Neurol 2021; 17:415-432. [PMID: 34127850 DOI: 10.1038/s41582-021-00503-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2021] [Indexed: 02/04/2023]
Abstract
Most cases of hemiparetic cerebral palsy are caused by perinatal stroke, resulting in lifelong disability for millions of people. However, our understanding of how the motor system develops following such early unilateral brain injury is increasing. Tools such as neuroimaging and brain stimulation are generating informed maps of the unique motor networks that emerge following perinatal stroke. As a focal injury of defined timing in an otherwise healthy brain, perinatal stroke represents an ideal human model of developmental plasticity. Here, we provide an introduction to perinatal stroke epidemiology and outcomes, before reviewing models of developmental plasticity after perinatal stroke. We then examine existing therapeutic approaches, including constraint, bimanual and other occupational therapies, and their potential synergy with non-invasive neurostimulation. We end by discussing the promise of exciting new therapies, including novel neurostimulation, brain-computer interfaces and robotics, all focused on improving outcomes after perinatal stroke.
Collapse
|
21
|
Transcranial static magnetic stimulation over the motor cortex can facilitate the contralateral cortical excitability in human. Sci Rep 2021; 11:5370. [PMID: 33686102 PMCID: PMC7940605 DOI: 10.1038/s41598-021-84823-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 02/19/2021] [Indexed: 01/27/2023] Open
Abstract
Transcranial static magnetic stimulation (tSMS) has been focused as a new non-invasive brain stimulation, which can suppress the human cortical excitability just below the magnet. However, the non-regional effects of tSMS via brain network have been rarely studied so far. We investigated whether tSMS over the left primary motor cortex (M1) can facilitate the right M1 in healthy subjects, based on the hypothesis that the functional suppression of M1 can cause the paradoxical functional facilitation of the contralateral M1 via the reduction of interhemispheric inhibition (IHI) between the bilateral M1. This study was double-blind crossover trial. We measured the corticospinal excitability in both M1 and IHI from the left to right M1 by recording motor evoked potentials from first dorsal interosseous muscles using single-pulse and paired-pulse transcranial magnetic stimulation before and after the tSMS intervention for 30 min. We found that the corticospinal excitability of the left M1 decreased, while that of the right M1 increased after tSMS. Moreover, the evaluation of IHI revealed the reduced inhibition from the left to the right M1. Our findings provide new insights on the mechanistic understanding of neuromodulatory effects of tSMS in human.
Collapse
|
22
|
Ghazwani Y, Patay Z, Sadighi ZS, Sparrow J, Upadhyaya S, Boop F, Gajjar A, Qaddoumi I. Handedness switching as a presenting sign for pediatric low-grade gliomas: An insight into brain plasticity from a short case series. J Pediatr Rehabil Med 2021; 14:31-36. [PMID: 33386828 DOI: 10.3233/prm-190637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To describe clinical data, rehabilitation services, and outcomes of children with handedness switching as their presenting symptom before low-grade glioma (LGG) diagnosis. METHODS A retrospective chart review was performed for five patients (four female and four white) with LGG and confirmed handedness switching before LGG diagnosis. RESULTS All children were less than 8 years at diagnosis, and two patients were less than 3 years. All children were initially right-handed and experienced loss of motor function, ranging from weakness to paresis, in their dominant hand. The median time from switching handedness to diagnosis was 1 month (range: 0.75-60 months). Rehabilitation was offered for three patients, and motor function deficits in the initial dominant hand were resolved in two of the total cohort. At long-term follow-up, hand dominance returned to the initial hand in three patients. CONCLUSIONS Handedness switching should be acknowledged as a potential sign of LGG in children, and early long-term rehabilitation services should be offered for these children.
Collapse
Affiliation(s)
- Yahya Ghazwani
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Zoltan Patay
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Zsila S Sadighi
- Department of Neurology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jessica Sparrow
- Department of Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Santhosh Upadhyaya
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Frederick Boop
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Amar Gajjar
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ibrahim Qaddoumi
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| |
Collapse
|
23
|
Gröhn H, Gillick BT, Tkáč I, Bednařík P, Mascali D, Deelchand DK, Michaeli S, Meekins GD, Leffler-McCabe MJ, MacKinnon CD, Eberly LE, Mangia S. Influence of Repetitive Transcranial Magnetic Stimulation on Human Neurochemistry and Functional Connectivity: A Pilot MRI/MRS Study at 7 T. Front Neurosci 2019; 13:1260. [PMID: 31827419 PMCID: PMC6890551 DOI: 10.3389/fnins.2019.01260] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 11/06/2019] [Indexed: 12/13/2022] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation method commonly used in the disciplines of neuroscience, neurology, and neuropsychiatry to examine or modulate brain function. Low frequency rTMS (e.g., 1 Hz) is associated with a net suppression of cortical excitability, whereas higher frequencies (e.g., 5 Hz) purportedly increase excitability. Magnetic resonance spectroscopy (MRS) and resting-state functional MRI (rsfMRI) allow investigation of neurochemistry and functional connectivity, respectively, and can assess the influence of rTMS in these domains. This pilot study investigated the effects of rTMS on the primary motor cortex using pre and post MRS and rsfMRI assessments at 7 T. Seven right-handed males (age 27 ± 7 y.o.) underwent single-voxel MRS and rsfMRI before and about 30-min after rTMS was administered outside the scanner for 20-min over the primary motor cortex of the left (dominant) hemisphere. All participants received 1-Hz rTMS; one participant additionally received 5-Hz rTMS in a separate session. Concentrations of 17 neurochemicals were quantified in left and right motor cortices. Connectivity metrics included fractional amplitude of low-frequency fluctuations (fALFF) and regional homogeneity (ReHo) of both motor cortices, strength of related brain networks, and inter-hemispheric connectivity. The group-analysis revealed few trends (i.e., uncorrected for multiple comparisons), including a mean increase in the concentration of the inhibitory neurotransmitter γ-aminobutyric acid (GABA) after the inhibitory rTMS protocol as compared to baseline in the stimulated (left) motor cortex (+8%, p = 0.043), along with a slight increase of total creatine (+2%, p = 0.018), and decrease of aspartate (-18%, p = 0.016). Additionally, GABA tended to decrease in the contralateral hemisphere (-6%, p = 0.033). No other changes of metabolite concentrations were found. Whereas functional connectivity outcomes did not exhibit trends of significant changes induced by rTMS, the percent changes of few connectivity metrics in both hemispheres were negatively correlated with GABA changes in the contralateral hemisphere. While studies in larger cohorts are needed to confirm these preliminary findings, our results indicate the safety and feasibility of detecting changes in key metabolites associated with neurotransmission after a single 1-Hz rTMS session, establishing the construct for future exploration of the neurochemical, and connectivity mechanisms of cortical responses to neuromodulation.
Collapse
Affiliation(s)
- Heidi Gröhn
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, United States.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Bernadette T Gillick
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Ivan Tkáč
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, United States
| | - Petr Bednařík
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, United States.,Department of Biomedical Imaging and Image-guided Therapy, High Field MR Centre, Medical University of Vienna, Vienna, Austria
| | - Daniele Mascali
- Museo Storico della Fisica e Centro Studi e Ricerche "Enrico Fermi", Rome, Italy
| | - Dinesh K Deelchand
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, United States
| | - Shalom Michaeli
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, United States
| | - Gregg D Meekins
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | | | - Colum D MacKinnon
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - Lynn E Eberly
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Silvia Mangia
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, United States
| |
Collapse
|
24
|
Jin JN, Wang X, Li Y, Wang H, Liu ZP, Yin T. rTMS combined with motor training changed the inter-hemispheric lateralization. Exp Brain Res 2019; 237:2735-2746. [PMID: 31435692 DOI: 10.1007/s00221-019-05621-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 08/06/2019] [Indexed: 01/10/2023]
Abstract
Repetitive transcranial magnetic stimulation combined with motor training (rTMS-MT) can be an effective method for enhancing motor function. However, the effects of rTMS-MT on inter-hemispheric lateralization remain unclear. Nineteen healthy volunteers were recruited. The volunteers were randomized to receive 2 weeks of rTMS-MT or MT to improve the motor function of the nondominant hand. Hand dexterity was tested by the Nine-Hole Peg Test. Resting motor threshold (RMT), motor evoked potentials (MEP) and electroencephalography (EEG) in the resting state with eyes closed were recorded, to calculate inter-hemispheric lateralization before and after rTMS-MT or MT. rTMS-MT and MT improved the dexterity and MEP amplitude of the nondominant hand. Furthermore, there were significant changes in the lateralization of not only power spectral density, but also information transmission efficiency between regions following rTMS-MT, especially between the central cortices of both hemispheres. However, although the lateralization change of the power spectral density between the central cortices was observed following MT, there was no such change for information transmission efficiency between any cortices. These results suggested that rTMS-MT could modulate inter-hemispheric lateralization. Changes in inter-hemispheric lateralization might be an important neural mechanism by which rTMS-MT improves motor function. These results could be helpful for understanding the brain mechanism of rTMS-MT.
Collapse
Affiliation(s)
- Jing-Na Jin
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300192, China
| | - Xin Wang
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300192, China
| | - Ying Li
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300192, China
| | - He Wang
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300192, China
| | - Zhi-Peng Liu
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300192, China.
| | - Tao Yin
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300192, China.
- Neuroscience Center, Chinese Academy of Medical Sciences, Beijing, 100730, China.
| |
Collapse
|
25
|
Different Brain Connectivity between Responders and Nonresponders to Dual-Mode Noninvasive Brain Stimulation over Bilateral Primary Motor Cortices in Stroke Patients. Neural Plast 2019; 2019:3826495. [PMID: 31093270 PMCID: PMC6476041 DOI: 10.1155/2019/3826495] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/23/2019] [Accepted: 02/18/2019] [Indexed: 12/16/2022] Open
Abstract
Noninvasive brain stimulation (NBS), such as repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS), has been used in stroke patients with motor impairment. NBS can help recovery from brain damage by modulating cortical excitability. However, the efficacy of NBS varies among individuals. To obtain insights of responsiveness to the efficacy of NBS, we investigated characteristic changes of the motor network in responders and nonresponders of NBS over the primary motor cortex (M1). A total of 21 patients with subacute stroke (13 males, mean age 59.6 ± 11.5 years) received NBS in the same manner: 1 Hz rTMS on the contralesional M1 and anodal tDCS on the ipsilesional M1. Participants were classified into responders and nonresponders based on the functional improvement of the affected upper extremity after applying NBS. Twelve age-matched healthy controls (8 males, mean age 56.1 ± 14.3 years) were also recruited. Motor networks were constructed using resting-state functional magnetic resonance imaging. M1 intrahemispheric connectivity, interhemispheric connectivity, and network efficiency were measured to investigate differences in network characteristics between groups. The motor network characteristics were found to differ between both groups. Specifically, M1 intrahemispheric connectivity in responders showed a noticeable imbalance between affected and unaffected hemispheres, which was markedly restored after NBS. The responders also showed greater interhemispheric connectivity and higher efficiency of the motor network than the nonresponders. These results may provide insight on patient-specific NBS treatment based on the brain network characteristics in neurorehabilitation of patients with stroke. This trial is registered with trial registration number NCT03390192.
Collapse
|
26
|
Phase Synchronicity of μ-Rhythm Determines Efficacy of Interhemispheric Communication Between Human Motor Cortices. J Neurosci 2018; 38:10525-10534. [PMID: 30355634 DOI: 10.1523/jneurosci.1470-18.2018] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 10/14/2018] [Accepted: 10/15/2018] [Indexed: 12/13/2022] Open
Abstract
The theory of communication through coherence predicts that effective connectivity between nodes in a distributed oscillating neuronal network depends on their instantaneous excitability state and phase synchronicity (Fries, 2005). Here, we tested this prediction by using state-dependent millisecond-resolved real-time electroencephalography-triggered dual-coil transcranial magnetic stimulation (EEG-TMS) (Zrenner et al., 2018) to target the EEG-negative (high-excitability state) versus EEG-positive peak (low-excitability state) of the sensorimotor μ-rhythm in the left (conditioning) and right (test) motor cortex (M1) of 16 healthy human subjects (9 female, 7 male). Effective connectivity was tested by short-interval interhemispheric inhibition (SIHI); that is, the inhibitory effect of the conditioning TMS pulse given 10-12 ms before the test pulse on the test motor-evoked potential. We compared the four possible combinations of excitability states (negative peak, positive peak) and phase relations (in-phase, out-of-phase) of the μ-rhythm in the conditioning and test M1 and a random phase condition. Strongest SIHI was found when the two M1 were in phase for the high-excitability state (negative peak of the μ-rhythm), whereas the weakest SIHI occurred when they were out of phase and the conditioning M1 was in the low-excitability state (positive peak). Phase synchronicity contributed significantly to SIHI variation, with stronger SIHI in the in-phase than out-of-phase conditions. These findings are in exact accord with the predictions of the theory of communication through coherence. They open a translational route for highly effective modification of brain connections by repetitive stimulation at instants in time when nodes in the network are phase synchronized and excitable.SIGNIFICANCE STATEMENT The theory of communication through coherence predicts that effective connectivity between nodes in distributed oscillating brain networks depends on their instantaneous excitability and phase relation. We tested this hypothesis in healthy human subjects by real-time analysis of brain states by electroencephalography in combination with transcranial magnetic stimulation of left and right motor cortex. We found that short-interval interhemispheric inhibition, a marker of interhemispheric effective connectivity, was maximally expressed when the two motor cortices were in phase for a high-excitability state (the trough of the sensorimotor μ-rhythm). We conclude that findings are consistent with the theory of communication through coherence. They open a translational route to highly effectively modify brain connections by repetitive stimulation at instants in time of phase-synchronized high-excitability states.
Collapse
|
27
|
Keitel A, Øfsteng H, Krause V, Pollok B. Anodal Transcranial Direct Current Stimulation (tDCS) Over the Right Primary Motor Cortex (M1) Impairs Implicit Motor Sequence Learning of the Ipsilateral Hand. Front Hum Neurosci 2018; 12:289. [PMID: 30072884 PMCID: PMC6060306 DOI: 10.3389/fnhum.2018.00289] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 06/28/2018] [Indexed: 11/19/2022] Open
Abstract
Motor sequence learning is associated with the activation of bilateral primary motor cortices (M1). While previous data support the hypothesis that the contralateral M1 is causally involved in the acquisition as well as early consolidation of a motor sequence, the functional significance of the ipsilateral M1 has yet to be solved. Transcranial direct current stimulation (tDCS) allows the non-invasive modulation of cortical excitability. Anodal tDCS applied to the left M1 has been shown to facilitate implicit motor sequence learning of the right hand most likely due to increased excitability. The present study aims at characterizing the functional contribution of the ipsilateral (right) M1 on implicit motor sequence learning of the right hand. To this end, 24 healthy, right-handed subjects received anodal and sham tDCS to the right M1 in a counterbalanced order. Stimulation started 8 min prior to training on a variant of the serial reaction time task (SRTT) with the right hand and persists over the entire training period. The SRTT comprised a fixed eight-digit sequence. A random pattern served as control condition. Reaction times were assessed before and at the end of the acquisition (EoA) immediately after training on the SRTT. The analysis revealed significantly faster reaction times of both hands independent of tDCS condition in sequential trials. However, the gain of reaction times was significantly smaller following anodal as compared to sham tDCS. The data suggest that anodal tDCS applied to the right M1 impairs implicit motor sequence learning of both hands. The underlying mechanism likely involves alterations of the interaction between bilateral M1.
Collapse
Affiliation(s)
- Ariane Keitel
- Medical Faculty, Institute of Clinical Neuroscience and Medical Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Henning Øfsteng
- Medical Faculty, Institute of Clinical Neuroscience and Medical Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Vanessa Krause
- Medical Faculty, Institute of Clinical Neuroscience and Medical Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Bettina Pollok
- Medical Faculty, Institute of Clinical Neuroscience and Medical Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| |
Collapse
|
28
|
BDNF Val66Met polymorphism is associated with altered activity-dependent modulation of short-interval intracortical inhibition in bilateral M1. PLoS One 2018; 13:e0197505. [PMID: 29856758 PMCID: PMC5983496 DOI: 10.1371/journal.pone.0197505] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 05/03/2018] [Indexed: 11/19/2022] Open
Abstract
The BDNF Val66Met polymorphism is associated with impaired short-term plasticity in the motor cortex, short-term motor learning, and intermanual transfer of a procedural motor skill. Here, we investigated the impact of the Val66Met polymorphism on the modulation of cortical excitability and interhemispheric inhibition through sensorimotor practice of simple dynamic skills with the right and left first dorsal interosseous (FDI) muscles. To that end, we compared motor evoked potentials (MEP) amplitudes and short-interval intracortical inhibition (SICI) in the bilateral representations of the FDI muscle in the primary motor cortex (M1), and interhemispheric inhibition (IHI) from the left to right M1, before and after right and left FDI muscle training in an alternated sequence. Val66Met participants did not differ from their Val66Val counterparts on motor performance at baseline and following motor training, or on measures of MEP amplitude and IHI. However, while the Val66Val group displayed significant SICI reduction in the bilateral M1 in response to motor training, SICI remained unchanged in the Val66Met group. Further, Val66Val group's SICI decrease in the left M1, which was also observed following unimanual training with the right hand in the Control Right group, was correlated with motor improvement with the left hand. The potential interaction between left and right M1 activity during bimanual training and the implications of altered activity-dependent cortical excitability on short-term motor learning in Val66Met carriers are discussed.
Collapse
|
29
|
Bashir S, Vernet M, Najib U, Perez J, Alonso-Alonso M, Knobel M, Yoo WK, Edwards D, Pascual-Leone A. Enhanced motor function and its neurophysiological correlates after navigated low-frequency repetitive transcranial magnetic stimulation over the contralesional motor cortex in stroke. Restor Neurol Neurosci 2018; 34:677-89. [PMID: 27567763 DOI: 10.3233/rnn-140460] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The net effect of altered interhemispheric interactions between homologous motor cortical areas after unilateral stroke has been previously reported to contribute to residual hemiparesis. Using this framework, we hypothesized that navigated 1 Hz repetitive transcranial magnetic stimulation (rTMS) over the contralesional hemisphere would induce a stronger physiological and behavioural response in patients with residual motor deficit than in healthy subjects, because an imbalance in interhemispheric excitability may underlie motor dysfunction. METHODS Navigated rTMS was conducted in 8 chronic stroke patients (67.50±13.77 years) and in 8 comparable normal subjects (57.38±9.61 years). We evaluated motor function (Finger tapping, Nine Hole Peg test, Strength Index and Reaction Time) as well as the excitatory and inhibitory function (resting motor threshold, motor evoked potential amplitude, intra-cortical inhibition and facilitation, and silent period) of the stimulated and non-stimulated motor cortex before and after navigated rTMS. RESULTS rTMS induced an increase in excitability in the ipsilesional (non-stimulated) motor cortex and led to improved performance in the finger tapping task and pinch force task. These physiological and behavioral effects were more prominent (or robust) in the group of stroke patients than in the control group. CONCLUSION Navigated low-frequency rTMS involving precise and consistent targeting of the contralesional hemisphere in stroke patients enhanced the cortical excitability of the ipsilesional hemisphere and the motor response of the hemiparetic hand.
Collapse
Affiliation(s)
- Shahid Bashir
- Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Brookline Avenue KS, Boston, MA, USA.,Faculty of Medicine, Department of Physiology, King Saud University, Riyadh, Saudi Arabia
| | - Marine Vernet
- Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Brookline Avenue KS, Boston, MA, USA
| | - Umer Najib
- Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Brookline Avenue KS, Boston, MA, USA
| | - Jennifer Perez
- Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Brookline Avenue KS, Boston, MA, USA
| | - Miguel Alonso-Alonso
- Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Brookline Avenue KS, Boston, MA, USA
| | - Mark Knobel
- Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Brookline Avenue KS, Boston, MA, USA
| | - Woo-Kyoung Yoo
- Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Brookline Avenue KS, Boston, MA, USA
| | - Dylan Edwards
- Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Brookline Avenue KS, Boston, MA, USA.,Department of Neurology and The Burke Medical Research Institute, Weill Cornell Medical College, NY, USA
| | - Alvaro Pascual-Leone
- Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Brookline Avenue KS, Boston, MA, USA.,Institut Universitari de Neurorehabilitació Guttmann, Universidad Autónoma de Barcelona, Barcelona, Spain
| |
Collapse
|
30
|
Eng D, Zewdie E, Ciechanski P, Damji O, Kirton A. Interhemispheric motor interactions in hemiparetic children with perinatal stroke: Clinical correlates and effects of neuromodulation therapy. Clin Neurophysiol 2017; 129:397-405. [PMID: 29289841 DOI: 10.1016/j.clinph.2017.11.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 11/10/2017] [Accepted: 11/17/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Brain stimulation and constraint therapy may enhance function after perinatal stroke but mechanisms are unknown. We characterized interhemispheric interactions (IHI) in hemiparetic children and explored their relationship to motor function and neuromodulation. METHODS Forty-five hemiparetic perinatal stroke subjects aged 6-19 years completed a clinical trial of repetitive-transcranial magnetic stimulation (rTMS) and constraint therapy. Paired-pulse TMS measured IHI in cases and normal controls. Suprathreshold conditioning stimuli preceded contralateral test stimuli bidirectionally: stroke to non-stroke (SNS) and non-stroke to stroke (NSS). Primary outcome was the interhemispheric ratio (IHR) between conditioned and test only MEP amplitudes X100 (<100 implied inhibition). Motor outcomes at baseline and post-intervention were compared to IHR. RESULTS Procedures were well tolerated. IHI occurred bidirectionally in controls. Eighteen stroke participants had complete data. IHR were increased in stroke participants in both directions. SNS IHR was >100 (facilitation) in 39% of measurements and correlated with better motor function. NSS IHR correlated with poorer motor function. Intervention-induced clinical change was not associated with IHR. CONCLUSIONS Interhemispheric interactions are altered and related to clinical function, but not necessarily neuromodulation, in children with perinatal stroke. SIGNIFICANCE Adding interhemispheric interactions to evolving models of developmental plasticity following early injury may advance neuromodulation strategies.
Collapse
Affiliation(s)
- Derek Eng
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Alberta T3B6A8, Canada; Department of Neurosciences, University of Calgary, Calgary, Alberta T2N1N4, Canada
| | - Ephrem Zewdie
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Alberta T3B6A8, Canada
| | - Patrick Ciechanski
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Alberta T3B6A8, Canada; Department of Neurosciences, University of Calgary, Calgary, Alberta T2N1N4, Canada
| | - Omar Damji
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Alberta T3B6A8, Canada; Department of Neurosciences, University of Calgary, Calgary, Alberta T2N1N4, Canada
| | - Adam Kirton
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Alberta T3B6A8, Canada; Departments of Pediatrics and Clinical Neurosciences, Alberta Children's Hospital, Calgary, Alberta T3B6A8, Canada; Department of Neurosciences, University of Calgary, Calgary, Alberta T2N1N4, Canada; Alberta Children's Hospital Research Institute, Calgary, Alberta T3B6A8, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta T2N1N4, Canada; Cumming School of Medicine, University of Calgary, Calgary, Alberta T2N1N4, Canada.
| |
Collapse
|
31
|
Spasticity Management: The Current State of Transcranial Neuromodulation. PM R 2017; 9:1020-1029. [DOI: 10.1016/j.pmrj.2017.03.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 03/20/2017] [Accepted: 03/31/2017] [Indexed: 12/18/2022]
|
32
|
Targeting interhemispheric inhibition with neuromodulation to enhance stroke rehabilitation. Brain Stimul 2017; 10:214-222. [DOI: 10.1016/j.brs.2017.01.006] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 12/10/2016] [Accepted: 01/10/2017] [Indexed: 12/13/2022] Open
|
33
|
Kirton A. Advancing non-invasive neuromodulation clinical trials in children: Lessons from perinatal stroke. Eur J Paediatr Neurol 2017; 21:75-103. [PMID: 27470654 DOI: 10.1016/j.ejpn.2016.07.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 06/21/2016] [Accepted: 07/02/2016] [Indexed: 12/18/2022]
Abstract
Applications of non-invasive brain stimulation including therapeutic neuromodulation are expanding at an alarming rate. Increasingly established scientific principles, including directional modulation of well-informed cortical targets, are advancing clinical trial development. However, high levels of disease burden coupled with zealous enthusiasm may be getting ahead of rational research and evidence. Experience is limited in the developing brain where additional issues must be considered. Properly designed and meticulously executed clinical trials are essential and required to advance and optimize the potential of non-invasive neuromodulation without risking the well-being of children and families. Perinatal stroke causes most hemiplegic cerebral palsy and, as a focal injury of defined timing in an otherwise healthy brain, is an ideal human model of developmental plasticity. Advanced models of how the motor systems of young brains develop following early stroke are affording novel windows of opportunity for neuromodulation clinical trials, possibly directing neuroplasticity toward better outcomes. Reviewing the principles of clinical trial design relevant to neuromodulation and using perinatal stroke as a model, this article reviews the current and future issues of advancing such trials in children.
Collapse
Affiliation(s)
- Adam Kirton
- Departments of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, 2888 Shaganappi Trail NW, Calgary, AB T3B6A8, Canada.
| |
Collapse
|
34
|
Rjosk V, Kaminski E, Hoff M, Gundlach C, Villringer A, Sehm B, Ragert P. Transcranial Alternating Current Stimulation at Beta Frequency: Lack of Immediate Effects on Excitation and Interhemispheric Inhibition of the Human Motor Cortex. Front Hum Neurosci 2016; 10:560. [PMID: 27857687 PMCID: PMC5093129 DOI: 10.3389/fnhum.2016.00560] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 10/21/2016] [Indexed: 11/13/2022] Open
Abstract
Transcranial alternating current stimulation (tACS) is a form of noninvasive brain stimulation and is capable of influencing brain oscillations and cortical networks. In humans, the endogenous oscillation frequency in sensorimotor areas peaks at 20 Hz. This beta-band typically occurs during maintenance of tonic motor output and seems to play a role in interhemispheric coordination of movements. Previous studies showed that tACS applied in specific frequency bands over primary motor cortex (M1) or the visual cortex modulates cortical excitability within the stimulated hemisphere. However, the particular impact remains controversial because effects of tACS were shown to be frequency, duration and location specific. Furthermore, the potential of tACS to modulate cortical interhemispheric processing, like interhemispheric inhibition (IHI), remains elusive. Transcranial magnetic stimulation (TMS) is a noninvasive and well-tolerated method of directly activating neurons in superficial areas of the human brain and thereby a useful tool for evaluating the functional state of motor pathways. The aim of the present study was to elucidate the immediate effect of 10 min tACS in the β-frequency band (20 Hz) over left M1 on IHI between M1s in 19 young, healthy, right-handed participants. A series of TMS measurements (motor evoked potential (MEP) size, resting motor threshold (RMT), IHI from left to right M1 and vice versa) was performed before and immediately after tACS or sham using a double-blinded, cross-over design. We did not find any significant tACS-induced modulations of intracortical excitation (as assessed by MEP size and RMT) and/or IHI. These results indicate that 10 min of 20 Hz tACS over left M1 seems incapable of modulating immediate brain activity or inhibition. Further studies are needed to elucidate potential aftereffects of 20 Hz tACS as well as frequency-specific effects of tACS on intracortical excitation and IHI.
Collapse
Affiliation(s)
- Viola Rjosk
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences Leipzig, Germany
| | - Elisabeth Kaminski
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences Leipzig, Germany
| | - Maike Hoff
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences Leipzig, Germany
| | - Christopher Gundlach
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain SciencesLeipzig, Germany; Institute of Psychology, University of LeipzigLeipzig, Germany
| | - Arno Villringer
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain SciencesLeipzig, Germany; Mind and Brain Institute, Charité and Humboldt UniversityBerlin, Germany
| | - Bernhard Sehm
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences Leipzig, Germany
| | - Patrick Ragert
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain SciencesLeipzig, Germany; Institute for General Kinesiology and Exercise Science, University of LeipzigLeipzig, Germany
| |
Collapse
|
35
|
Derosiere G, Zénon A, Alamia A, Duque J. Primary motor cortex contributes to the implementation of implicit value-based rules during motor decisions. Neuroimage 2016; 146:1115-1127. [PMID: 27742597 DOI: 10.1016/j.neuroimage.2016.10.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 09/14/2016] [Accepted: 10/05/2016] [Indexed: 11/18/2022] Open
Abstract
In the present study, we investigated the functional contribution of the human primary motor cortex (M1) to motor decisions. Continuous theta burst stimulation (cTBS) was used to alter M1 activity while participants performed a decision-making task in which the reward associated with the subjects' responses (right hand finger movements) depended on explicit and implicit value-based rules. Subjects performed the task over two consecutive days and cTBS occurred in the middle of Day 2, once the subjects were just about to implement implicit rules, in addition to the explicit instructions, to choose their responses, as evident in the control group (cTBS over the right somatosensory cortex). Interestingly, cTBS over the left M1 prevented subjects from implementing the implicit value-based rule while its implementation was enhanced in the group receiving cTBS over the right M1. Hence, cTBS had opposite effects depending on whether it was applied on the contralateral or ipsilateral M1. The use of the explicit value-based rule was unaffected by cTBS in the three groups of subject. Overall, the present study provides evidence for a functional contribution of M1 to the implementation of freshly acquired implicit rules, possibly through its involvement in a cortico-subcortical network controlling value-based motor decisions.
Collapse
Affiliation(s)
- Gerard Derosiere
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.
| | - Alexandre Zénon
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Andrea Alamia
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Julie Duque
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| |
Collapse
|
36
|
Ongoing cumulative effects of single TMS pulses on corticospinal excitability: An intra- and inter-block investigation. Clin Neurophysiol 2016; 127:621-628. [DOI: 10.1016/j.clinph.2015.03.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 03/04/2015] [Accepted: 03/09/2015] [Indexed: 11/20/2022]
|
37
|
Improvement in Paretic Arm Reach-to-Grasp following Low Frequency Repetitive Transcranial Magnetic Stimulation Depends on Object Size: A Pilot Study. Stroke Res Treat 2015; 2015:498169. [PMID: 26664827 PMCID: PMC4664821 DOI: 10.1155/2015/498169] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/19/2015] [Accepted: 10/21/2015] [Indexed: 11/17/2022] Open
Abstract
Introduction. Low frequency repetitive transcranial magnetic stimulation (LF-rTMS) delivered to the nonlesioned hemisphere has been shown to improve limited function of the paretic upper extremity (UE) following stroke. The outcome measures have largely included clinical assessments with little investigation on changes in kinematics and coordination. To date, there is no study investigating how the effects of LF-rTMS are modulated by the sizes of an object to be grasped. Objective. To investigate the effect of LF-rTMS on kinematics and coordination of the paretic hand reach-to-grasp (RTG) for two object sizes in chronic stroke. Methods. Nine participants received two TMS conditions: real rTMS and sham rTMS conditions. Before and after the rTMS conditions, cortico-motor excitability (CE) of the nonlesioned hemisphere, RTG kinematics, and coordination was evaluated. Object sizes were 1.2 and 7.2 cm in diameter. Results. Compared to sham rTMS, real rTMS significantly reduced CE of the non-lesioned M1. While rTMS had no effect on RTG action for the larger object, real rTMS significantly improved movement time, aperture opening, and RTG coordination for the smaller object. Conclusions. LF-rTMS improves RTG action for only the smaller object in chronic stroke. The findings suggest a dissociation between effects of rTMS on M1 and task difficulty for this complex skill.
Collapse
|
38
|
Turkeltaub PE. Brain Stimulation and the Role of the Right Hemisphere in Aphasia Recovery. Curr Neurol Neurosci Rep 2015; 15:72. [PMID: 26396038 DOI: 10.1007/s11910-015-0593-6] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
39
|
|
40
|
Zénon A, Klein PA, Alamia A, Boursoit F, Wilhelm E, Duque J. Increased Reliance on Value-based Decision Processes Following Motor Cortex Disruption. Brain Stimul 2015; 8:957-64. [PMID: 26279406 DOI: 10.1016/j.brs.2015.05.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 05/13/2015] [Accepted: 05/22/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND During motor decision making, the neural activity in primary motor cortex (M1) encodes dynamically the competition occurring between potential action plans. A common view is that M1 represents the unfolding of the outcome of a decision process taking place upstream. Yet, M1 could also be directly involved in the decision process. OBJECTIVE Here we tested this hypothesis by assessing the effect of M1 disruption on a motor decision-making task. METHODS We applied continuous theta burst stimulation (cTBS) to inhibit either left or right M1 in different groups of subjects and included a third control group with no stimulation. Following cTBS, participants performed a task that required them to choose between two finger key-presses with the right hand according to both perceptual and value-based information. Effects were assessed by means of generalized linear mixed models and computational simulations. RESULTS In all three groups, subjects relied both on perceptual (P < 0.0001) and value-based information (P = 0.003) to reach a decision. Yet, left M1 disruption led to an increased reliance on value-based information (P = 0.03). This result was confirmed by a computational model showing an increased weight of the valued-based process on the right hand finger choices following left M1 cTBS (P < 0.01). CONCLUSION These results indicate that M1 is involved in motor decision making, possibly by weighting the final integration of multiple sources of evidence driving motor behaviors.
Collapse
Affiliation(s)
- Alexandre Zénon
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
| | | | - Andrea Alamia
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
| | - François Boursoit
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
| | - Emmanuelle Wilhelm
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
| | - Julie Duque
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium.
| |
Collapse
|
41
|
Chieffo R, Comi G, Leocani L. Noninvasive Neuromodulation in Poststroke Gait Disorders. Neurorehabil Neural Repair 2015; 30:71-82. [DOI: 10.1177/1545968315586464] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Walking rehabilitation is one of the primary goals in stroke survivors because of its great potential for recovery and its functional relevance in daily living activities. Although 70% to 80% of people in the chronic poststroke phases are able to walk, impairment of gait often persists, involving speed, endurance, and stability. Walking involves several brain regions, such as the sensorimotor cortex, supplementary motor area, cerebellum, and brainstem, which are approachable by the application of noninvasive brain stimulation (NIBS). NIBS techniques, such as repetitive transcranial magnetic stimulation and transcranial direct current stimulation, have been reported to modulate neural activity beyond the period of stimulation, facilitating neuroplasticity. NIBS methods have been largely applied for improving paretic hand motor function and stroke-associated cognitive deficits. Recent studies suggest a possible effectiveness of these techniques also in the recovery of poststroke gait disturbance. This article is a selective review about functional investigations addressing the mechanisms of lower-limb motor system reorganization after stroke and the application of NIBS for neurorehabilitation.
Collapse
Affiliation(s)
- Raffaella Chieffo
- Scientific Institute Vita-Salute University San Raffaele, Milan, Italy
| | - Giancarlo Comi
- Scientific Institute Vita-Salute University San Raffaele, Milan, Italy
| | - Letizia Leocani
- Scientific Institute Vita-Salute University San Raffaele, Milan, Italy
| |
Collapse
|
42
|
Pan L, Zhang D, Sheng X, Zhu X. Improving Myoelectric Control for Amputees through Transcranial Direct Current Stimulation. IEEE Trans Biomed Eng 2015; 62:1927-36. [PMID: 25730820 DOI: 10.1109/tbme.2015.2407491] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Most prosthetic myoelectric control studies have shown good performance for unimpaired subjects. However, performance is generally unacceptable for amputees. The primary problem is the poor quality of electromyography (EMG) signals of amputees compared with healthy individuals. To improve clinical performance of myoelectric control, this study explored transcranial direct current stimulation (tDCS) to modulate brain activity and enhance EMG quality. We tested six unilateral transradial amputees by applying active and sham anodal tDCS separately on two different days. Surface EMG signals were acquired from the affected and intact sides for 11 hand and wrist motions in the pre-tDCS and post-tDCS sessions. Autoregression coefficients and linear discriminant analysis classifiers were used to process the EMG data for pattern recognition of the 11 motions. For the affected side, active anodal tDCS significantly reduced the average classification error rate (CER) by 10.1%, while sham tDCS had no such effect. For the intact side, the average CER did not change on the day of sham tDCS but increased on the day of active tDCS. These results demonstrated that tDCS could modulate brain function and improve EMG-based classification performance for amputees. It has great potential in dramatically reducing the length of learning process of amputees for effectively using myoelectrically controlled multifunctional prostheses.
Collapse
|
43
|
Matsuura R, Ogata T. Effects of fatiguing unilateral plantar flexions on corticospinal and transcallosal inhibition in the primary motor hand area. J Physiol Anthropol 2015; 34:4. [PMID: 25857538 PMCID: PMC4340114 DOI: 10.1186/s40101-015-0042-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 01/16/2015] [Indexed: 12/02/2022] Open
Abstract
Background Corticospinal excitability of the primary motor cortex (M1) representing the hand muscle is depressed by bilateral lower limb muscle fatigue. The effects of fatiguing unilateral lower limb contraction on corticospinal excitability and transcallosal inhibition in the M1 hand areas remain unclear. The purpose of this study was to determine the effects of fatiguing unilateral plantar flexions on corticospinal excitability in the M1 hand areas and transcallosal inhibition originated from the M1 hand area contralateral to the fatigued ankle. Methods Ten healthy volunteers (26.2 ± 3.8 years) participated in the study. Using transcranial magnetic stimulation, we examined motor evoked potentials (MEPs) and interhemispheric inhibition (IHI) recorded from resting first dorsal interosseous (FDI) muscles before, immediately after, and 10 min after fatiguing unilateral lower limb muscle contraction, which was consisted of 40 unilateral maximal isometric plantar flexions intermittently with a 2-s contraction followed by 1 s of rest. Results We demonstrated no significant changes in MEPs in the FDI muscle ipsilateral to the fatigued ankle and decrease in IHI from the M1 hand area contralateral to the fatigued ankle to the ipsilateral M1 hand area after the fatiguing contraction. MEPs in the FDI muscle contralateral to the fatigued ankle were increased after the fatiguing contraction. Conclusions These results suggest that fatiguing unilateral lower limb muscle contraction differently influences corticospinal excitability of the contralateral M1 hand area and IHI from the contralateral M1 hand area to the ipsilateral M1 hand area. Although fatiguing unilateral lower limb muscle contraction increases corticospinal excitability of the ipsilateral M1 hand area, the increased corticospinal excitability is not associated with the decreased IHI.
Collapse
|
44
|
Tazoe T, Endoh T, Kitamura T, Ogata T. Polarity specific effects of transcranial direct current stimulation on interhemispheric inhibition. PLoS One 2014; 9:e114244. [PMID: 25478912 PMCID: PMC4257682 DOI: 10.1371/journal.pone.0114244] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 11/05/2014] [Indexed: 11/19/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) has been used as a useful interventional brain stimulation technique to improve unilateral upper-limb motor function in healthy humans, as well as in stroke patients. Although tDCS applications are supposed to modify the interhemispheric balance between the motor cortices, the tDCS after-effects on interhemispheric interactions are still poorly understood. To address this issue, we investigated the tDCS after-effects on interhemispheric inhibition (IHI) between the primary motor cortices (M1) in healthy humans. Three types of tDCS electrode montage were tested on separate days; anodal tDCS over the right M1, cathodal tDCS over the left M1, bilateral tDCS with anode over the right M1 and cathode over the left M1. Single-pulse and paired-pulse transcranial magnetic stimulations were given to the left M1 and right M1 before and after tDCS to assess the bilateral corticospinal excitabilities and mutual direction of IHI. Regardless of the electrode montages, corticospinal excitability was increased on the same side of anodal stimulation and decreased on the same side of cathodal stimulation. However, neither unilateral tDCS changed the corticospinal excitability at the unstimulated side. Unilateral anodal tDCS increased IHI from the facilitated side M1 to the unchanged side M1, but it did not change IHI in the other direction. Unilateral cathodal tDCS suppressed IHI both from the inhibited side M1 to the unchanged side M1 and from the unchanged side M1 to the inhibited side M1. Bilateral tDCS increased IHI from the facilitated side M1 to the inhibited side M1 and attenuated IHI in the opposite direction. Sham-tDCS affected neither corticospinal excitability nor IHI. These findings indicate that tDCS produced polarity-specific after-effects on the interhemispheric interactions between M1 and that those after-effects on interhemispheric interactions were mainly dependent on whether tDCS resulted in the facilitation or inhibition of the M1 sending interhemispheric volleys.
Collapse
Affiliation(s)
- Toshiki Tazoe
- Department of Rehabilitation for Movement Functions, Research Institute, National Rehabilitation Center for Persons with Disabilities, Tokorozawa, Japan
- Japan Society for the Promotion of Science, Tokyo, Japan
- * E-mail:
| | - Takashi Endoh
- Department of Rehabilitation for Movement Functions, Research Institute, National Rehabilitation Center for Persons with Disabilities, Tokorozawa, Japan
- Faculty of Child Development and Education, Uekusa Gakuen University, Chiba, Japan
| | - Taku Kitamura
- Department of Rehabilitation for Movement Functions, Research Institute, National Rehabilitation Center for Persons with Disabilities, Tokorozawa, Japan
- Division of Functional Control Systems, Graduate School of Engineering and Science, Shibaura Institute of Technology, Saitama, Japan
| | - Toru Ogata
- Department of Rehabilitation for Movement Functions, Research Institute, National Rehabilitation Center for Persons with Disabilities, Tokorozawa, Japan
| |
Collapse
|
45
|
Takarada Y, Mima T, Abe M, Nakatsuka M, Taira M. Inhibition of the primary motor cortex can alter one's “sense of effort”: Effects of low-frequency rTMS. Neurosci Res 2014; 89:54-60. [DOI: 10.1016/j.neures.2014.09.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 08/30/2014] [Accepted: 09/16/2014] [Indexed: 11/25/2022]
|
46
|
Li H, Wang J, Li C, Xiao Z, Cochrane Common Mental Disorders Group. Repetitive transcranial magnetic stimulation (rTMS) for panic disorder in adults. Cochrane Database Syst Rev 2014; 2014:CD009083. [PMID: 25230088 PMCID: PMC6885044 DOI: 10.1002/14651858.cd009083.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Panic disorder (PD) is a common type of anxiety disorder, characterized by unexpected and repeated panic attacks or fear of future panic attacks, or both. Individuals with PD are often resistant to pharmacological or psychological treatments and this can lead to the disorder becoming a chronic and disabling illness. Repetitive transcranial magnetic stimulation (rTMS) can deliver sustained and spatially selective current to suppress or induce cortical excitability, and its therapeutic effect on pathological neuronal activity in people with PD has already been examined in case studies and clinical trials. However, a systematic review is necessary to assess the efficacy and safety of rTMS for PD. OBJECTIVES To assess the effects of repetitive transcranial magnetic stimulation (rTMS) for panic disorder (PD) in adults aged 18 to 65 years, either as a monotherapy or as an augmentation strategy. SEARCH METHODS An electronic search of the Cochrane Depression, Anxiety and Neurosis Review Group Controlled Trials Register (CCDANCTR) was conducted to 19 February 2014. The CCDANCTR includes reports of relevant randomised controlled trials (RCTs) from MEDLINE (1950 to date), EMBASE (1974 to date), PsycINFO (1967 to date) and the Cochrane Central Register of Controlled Trials (CENTRAL) (all years). Additional searches were conducted in Psyndex and the main Chinese medical databases. SELECTION CRITERIA RCTs or quasi-randomised trials evaluating rTMS for PD in people aged between 18 and 65 years, either as a monotherapy or as an augmentation strategy. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies and extracted data and verified the data by cross-checking. Disagreements were resolved by discussion. For binary data, we calculated fixed-effect model risk ratio (RR) and its 95% confidence interval (CI). For continuous data, we calculated fixed-effect model standardized mean difference (SMD) and its 95% CI. MAIN RESULTS Two RCTs (n = 40) were included in this review. The included trials compared rTMS with sham rTMS; no trials comparing rTMS with active treatments (electroconvulsive therapy (ECT), pharmacotherapy, psychotherapy) met our inclusion criteria. Both included studies used 1 Hz rTMS over the right dorso-lateral prefrontal cortex (DLPFC) for two or four weeks as an augmentation treatment for PD. However, in both studies the data for the primary outcome, panic symptoms as measured by the Panic Disorder Severity Scale (PDSS), were skewed and could not be pooled for a quantitative analysis. For this primary outcome one trial with 25 participants reported a superior effect of rTMS in reducing panic symptoms compared with sham rTMS (t = 3.04, df = 16.57, P = 0.007), but this trial had a 16% dropout rate and so was deemed as having a high risk of attrition bias. The other trial found that all 15 participants exhibited a reduction in panic symptoms but there was no significant difference between rTMS and sham rTMS (Mann Whitney U test, P > 0.05). Regarding the acceptability of rTMS, no significant difference was found between rTMS and sham rTMS in dropout rates or in reports of side effects. The quality of evidence contributing to this review was assessed as very low. Assessments of the risk of bias for the two studies were hampered by the lack of information provided in the reports, especially on methods of sequence generation and whether allocation concealment had been applied. Of the remaining sources of bias, we considered one of the studies to have been at risk of attrition bias. AUTHORS' CONCLUSIONS Only two RCTs of rTMS were available and their sample sizes were small. The available data were insufficient for us to draw any conclusions about the efficacy of rTMS for PD. Further trials with large sample sizes and adequate methodology are needed to confirm the effectiveness of rTMS for PD.
Collapse
Affiliation(s)
- Hui Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of MedicineShanghai Key Laboratory of Psychotic Disorders600 Wanping Nan RoadShanghaiChina200030
| | - Jijun Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of MedicineDepartment of EEG Source ImagingShanghaiShanghaiChina200030
| | - Chunbo Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of MedicineShanghai Key Laboratory of Psychotic Disorders600 Wanping Nan RoadShanghaiChina200030
| | - Zeping Xiao
- Shanghai Jiao Tong University School of MedicineDepartment of Psychosomatic Medicine, Shanghai Mental Health Center600 Wan Ping Nan RoadShanghaiChina200030
| | | |
Collapse
|
47
|
Does inhibitory repetitive transcranial magnetic stimulation augment functional task practice to improve arm recovery in chronic stroke? Stroke Res Treat 2014; 2014:305236. [PMID: 25197611 PMCID: PMC4147256 DOI: 10.1155/2014/305236] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 06/25/2014] [Indexed: 11/18/2022] Open
Abstract
Introduction. Restoration of upper extremity (UE) functional use remains a challenge for individuals following stroke. Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive modality that modulates cortical excitability and is being explored as a means to potentially ameliorate these deficits. The purpose of this study was to evaluate, in the presence of chronic stroke, the effects of low-frequency rTMS to the contralesional hemisphere as an adjuvant to functional task practice (FTP), to improve UE functional ability. Methods. Twenty-two individuals with chronic stroke and subsequent moderate UE deficits were randomized to receive 16 sessions (4 times/week for 4 weeks) of either real-rTMS or sham-rTMS followed by 1-hour of paretic UE FTP. Results. No differences in UE outcomes were revealed between the real-rTMS and sham-rTMS intervention groups. After adjusting for baseline differences, no differences were revealed in contralesional cortical excitability postintervention. In a secondary analysis, data pooled across both groups revealed small, but statistically significant, improvements in UE behavioral measures. Conclusions. rTMS did not augment changes in UE motor ability in this population of individuals with chronic stroke. The chronicity of our participant cohort and their degree of UE motor impairment may have contributed to inability to produce marked effects using rTMS.
Collapse
|
48
|
Ren J, Li H, Palaniyappan L, Liu H, Wang J, Li C, Rossini PM. Repetitive transcranial magnetic stimulation versus electroconvulsive therapy for major depression: a systematic review and meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2014; 51:181-9. [PMID: 24556538 DOI: 10.1016/j.pnpbp.2014.02.004] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 02/12/2014] [Accepted: 02/12/2014] [Indexed: 01/29/2023]
Abstract
Electroconvulsive therapy (ECT) is the most effective treatment of depression. During the last decades repetitive transcranial magnetic stimulation (rTMS), an alternative method using electric stimulation of the brain, has revealed possible alternative to ECT in the treatment of depression. There are some clinical trials comparing their efficacies and safeties but without clear conclusions, mainly due to their small sample sizes. In the present study, a meta-analysis had been carried out to gain statistical power. Outcomes were response, remission, acceptability and cognitive effects in depression. Following a comprehensive literature search that included both English and Chinese language databases, we identified all randomized controlled trials that directly compared rTMS and ECT for major depression. 10 articles (9 trials) with a total of 425 patients were identified. Methodological quality, heterogeneity, sensitivity and publication bias were systematically evaluated. ECT was superior to high frequency rTMS in terms of response (64.4% vs. 48.7%, RR = 1.41, p = 0.03), remission (52.9% vs. 33.6%, RR = 1.38, p = 0.006) while discontinuation was not significantly different between the two treatments (8.3% vs. 9.4%, RR = 1.11, p = 0.80). According to the subgroup analysis, the superiority of ECT was more apparent in those with psychotic depression, while high frequency rTMS was as effective as ECT in those with non-psychotic depression. The same results were obtained in the comparison of ECT with low frequency rTMS. ECT had a non-significant advantage over high frequency rTMS on the overall improvement in HAMD scores (p = 0.11). There was insufficient data on medium or long term efficacy. Both rTMS and ECT were well tolerated with only minor side effects reported. Results based on 3 studies suggested that specific cognitive domains such as visual memory and verbal fluency were more impaired in patients receiving ECT. In conclusion, ECT seemed more effective than and at least as acceptable as rTMS in the short term, especially in the presence of psychotic depression. This review identified the lack of good quality trials comparing the long-term outcome and cognitive effects of rTMS and ECT, especially using approaches to optimize stimulus delivery and reduce clinical heterogeneity.
Collapse
Affiliation(s)
- Juanjuan Ren
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Hui Li
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; Department of EEG Source Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Lena Palaniyappan
- Centre for Translational Neuroimaging in Mental Health, Institute of Mental Health, Nottingham, UK; Division of Psychiatry & Applied Psychology, University of Nottingham, UK
| | - Hongmei Liu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Jijun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; Department of EEG Source Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China.
| | - Chunbo Li
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China.
| | - Paolo Maria Rossini
- Department of Geriatrics, Neuroscience and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| |
Collapse
|
49
|
Cognitive effects of repetitive transcranial magnetic stimulation in patients with neurodegenerative diseases - clinician's perspective. J Neurol Sci 2014; 339:15-25. [PMID: 24530170 DOI: 10.1016/j.jns.2014.01.037] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Revised: 12/23/2013] [Accepted: 01/27/2014] [Indexed: 02/06/2023]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) represents a promising tool for studying and influencing cognition in people with neurodegenerative diseases. This procedure is noninvasive and painless, and it does not require the use of anesthesia or pharmacological substances. In this systematic critical review we report outcomes from research focused on behavioral cognitive effects induced by rTMS in patients with Alzheimer's disease (AD), Parkinson's disease (PD), and mild cognitive impairment (MCI) preceding AD. There are still major limitations to rTMS use, such as a poor understanding of its after-effects and inter-individual variability in their magnitude, discrepancies in stimulation protocols and study designs, varied selection of the specific stimulated areas and control procedures, and neuropsychological methods for assessment of after-effects; hence, the results of the present research can only be considered preliminary. The future directions are discussed.
Collapse
|
50
|
Tsutsumi R, Hanajima R, Terao Y, Shirota Y, Ohminami S, Shimizu T, Tanaka N, Ugawa Y. Effects of the motor cortical quadripulse transcranial magnetic stimulation (QPS) on the contralateral motor cortex and interhemispheric interactions. J Neurophysiol 2014; 111:26-35. [DOI: 10.1152/jn.00515.2013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Corpus callosum connects the bilateral primary motor cortices (M1s) and plays an important role in motor control. Using the paired-pulse transcranial magnetic stimulation (TMS) paradigm, we can measure interhemispheric inhibition (IHI) and interhemispheric facilitation (IHF) as indexes of the interhemispheric interactions in humans. We investigated how quadripulse transcranial magnetic stimulation (QPS), one form of repetitive TMS (rTMS), on M1 affects the contralateral M1 and the interhemispheric interactions. QPS is able to induce bidirectional plastic changes in M1 depending on the interstimulus intervals (ISIs) of TMS pulses: long-term potentiation (LTP)-like effect by QPS-5 protocol, and long-term depression-like effect by QPS-50, whose numbers indicate the ISI (ms). Twelve healthy subjects were enrolled. We applied QPS over the left M1 and recorded several parameters before and 30 min after QPS. QPS-5, which increased motor-evoked potentials (MEPs) induced by left M1 activation, also increased MEPs induced by right M1 activation. Meanwhile, QPS-50, which decreased MEPs elicited by left M1 activation, did not induce any significant changes in MEPs elicited by right M1 activation. None of the resting motor threshold, active motor threshold, short-interval intracortical inhibition, long-interval intracortical inhibition, intracortical facilitation, and short-interval intracortical inhibition in right M1 were affected by QPS. IHI and IHF from left to right M1 significantly increased after left M1 QPS-5. The degree of left first dorsal interosseous MEP amplitude change by QPS-5 significantly correlated with the degree of IHF change. We suppose that the LTP-like effect on the contralateral M1 may be produced by some interhemispheric interactions through the corpus callosum.
Collapse
Affiliation(s)
- Ryosuke Tsutsumi
- Department of Neurology, Division of Neuroscience, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; and
| | - Ritsuko Hanajima
- Department of Neurology, Division of Neuroscience, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; and
| | - Yasuo Terao
- Department of Neurology, Division of Neuroscience, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; and
| | - Yuichiro Shirota
- Department of Neurology, Division of Neuroscience, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; and
| | - Shinya Ohminami
- Department of Neurology, Division of Neuroscience, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; and
| | - Takahiro Shimizu
- Department of Neurology, Division of Neuroscience, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; and
| | - Nobuyuki Tanaka
- Department of Neurology, Division of Neuroscience, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; and
| | - Yoshikazu Ugawa
- Department of Neurology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| |
Collapse
|