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Nguyen PT, Makowiecki K, Lewis TS, Fortune AJ, Clutterbuck M, Reale LA, Taylor BV, Rodger J, Cullen CL, Young KM. Low intensity repetitive transcranial magnetic stimulation enhances remyelination by newborn and surviving oligodendrocytes in the cuprizone model of toxic demyelination. Cell Mol Life Sci 2024; 81:346. [PMID: 39134808 PMCID: PMC11335270 DOI: 10.1007/s00018-024-05391-0] [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: 07/09/2023] [Revised: 07/30/2024] [Accepted: 08/01/2024] [Indexed: 08/22/2024]
Abstract
In people with multiple sclerosis (MS), newborn and surviving oligodendrocytes (OLs) can contribute to remyelination, however, current therapies are unable to enhance or sustain endogenous repair. Low intensity repetitive transcranial magnetic stimulation (LI-rTMS), delivered as an intermittent theta burst stimulation (iTBS), increases the survival and maturation of newborn OLs in the healthy adult mouse cortex, but it is unclear whether LI-rTMS can promote remyelination. To examine this possibility, we fluorescently labelled oligodendrocyte progenitor cells (OPCs; Pdgfrα-CreER transgenic mice) or mature OLs (Plp-CreER transgenic mice) in the adult mouse brain and traced the fate of each cell population over time. Daily sessions of iTBS (600 pulses; 120 mT), delivered during cuprizone (CPZ) feeding, did not alter new or pre-existing OL survival but increased the number of myelin internodes elaborated by new OLs in the primary motor cortex (M1). This resulted in each new M1 OL producing ~ 471 µm more myelin. When LI-rTMS was delivered after CPZ withdrawal (during remyelination), it significantly increased the length of the internodes elaborated by new M1 and callosal OLs, increased the number of surviving OLs that supported internodes in the corpus callosum (CC), and increased the proportion of axons that were myelinated. The ability of LI-rTMS to modify cortical neuronal activity and the behaviour of new and surviving OLs, suggests that it may be a suitable adjunct intervention to enhance remyelination in people with MS.
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Affiliation(s)
- Phuong Tram Nguyen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Kalina Makowiecki
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Thomas S Lewis
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Alastair J Fortune
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Mackenzie Clutterbuck
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Laura A Reale
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Jennifer Rodger
- School of Biological Sciences, The University of Western Australia, Crawley, WA, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
| | - Carlie L Cullen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- Mater Research Institute, The University of Queensland, Woolloongabba, QLD, Australia
| | - Kaylene M Young
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.
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Chen J, Tan B, Chen Y, Song Y, Li L, Yu L, Feng Y, Zhou Y, Jiang W. A randomized controlled trial of low-frequency repeated transcranial magnetic stimulation in patients with poststroke neurogenic bladder. Sci Rep 2024; 14:18404. [PMID: 39117697 PMCID: PMC11310514 DOI: 10.1038/s41598-024-69345-z] [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: 04/24/2024] [Accepted: 08/03/2024] [Indexed: 08/10/2024] Open
Abstract
Urinary incontinence is a common complication in stroke survivors for whom new interventions are needed. This study investigated the therapeutic effect of low-frequency (LF) repeated transcranial magnetic stimulation (rTMS) on the contralesional primary motor cortex (M1) in patients with poststroke urinary incontinence (PSI). A total of 100 patients were randomly assigned to the rTMS group or sham-rTMS group on basis of the intervention they received. Both groups underwent five treatment sessions per week for 4 weeks. Data from the urodynamic examination were used as the primary outcome. The secondary outcome measures were questionnaires and pelvic floor surface electromyography. After 4 weeks of intervention, the maximum cystometric capacity (MCC), maximum detrusor pressure (Pdet.max), residual urine output, overactive bladder score (OABSS) (including frequency, urgency, and urgency urinary incontinence), and the ICIQ-UI SF improved significantly in the rTMS group compared with those in the sham-rTMS group (P < 0.05). However, no changes in pelvic floor muscle EMG were detected in patients with PSI (both P > 0.05). Our data confirmed that 4 weeks of LF-rTMS stimulation on the contralateral M1 positively affects poststroke urinary incontinence in several aspects, such as frequency, urgency urinary incontinence, MCC, end-filling Pdet, OABSS, and ICIQ-UI SF scores.
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Affiliation(s)
- Jialu Chen
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Botao Tan
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Yuling Chen
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Yunling Song
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Lang Li
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Lehua Yu
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Yali Feng
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Yueshan Zhou
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Wei Jiang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China.
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Xiao J, Xu Y, Mi W, Hu A, Kang X. Effects of 5 Hz rTMS on post-stroke urinary retention. Brain Stimul 2024; 17:887-889. [PMID: 39069124 DOI: 10.1016/j.brs.2024.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 06/12/2024] [Accepted: 07/22/2024] [Indexed: 07/30/2024] Open
Affiliation(s)
- Juan Xiao
- Neurorehabilitation Department, Beijing Xiaotangshan Hospital, Beijing, China
| | - Yanan Xu
- Neurorehabilitation Department, Beijing Xiaotangshan Hospital, Beijing, China
| | - Wenjun Mi
- Neurorehabilitation Department, Beijing Xiaotangshan Hospital, Beijing, China
| | - Anming Hu
- Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoping Kang
- Neurorehabilitation Department, Beijing Xiaotangshan Hospital, Beijing, China.
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Nguyen PT, Zarghami A, Makowiecki K, Stevens N, Ezegbe C, Kyle K, Wang C, Ly L, De La Rue K, Hinder MR, Johnson L, Rodger J, Cooper S, Cullen CL, Barnett M, Young KM, Taylor BV. Low-intensity repetitive transcranial magnetic stimulation is safe and well tolerated by people living with MS - outcomes of the phase I randomised controlled trial (TAURUS). Mult Scler J Exp Transl Clin 2024; 10:20552173241252571. [PMID: 38756414 PMCID: PMC11097717 DOI: 10.1177/20552173241252571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 04/17/2024] [Indexed: 05/18/2024] Open
Abstract
Background Low-intensity repetitive transcranial magnetic stimulation (rTMS), delivered as a daily intermittent theta burst stimulation (iTBS) for four consecutive weeks, increased the number of new oligodendrocytes in the adult mouse brain. Therefore, rTMS holds potential as a remyelinating intervention for people with multiple sclerosis (MS). Objective Primarily to determine the safety and tolerability of our rTMS protocol in people with MS. Secondary objectives include feasibility, blinding and an exploration of changes in magnetic resonance imaging (MRI) metrics, patient-reported outcome measures (PROMs) and cognitive or motor performance. Methods A randomised (2:1), placebo controlled, single blind, parallel group, phase 1 trial of 20 rTMS sessions (600 iTBS pulses per hemisphere; 25% maximum stimulator output), delivered over 4-5 weeks. Twenty participants were randomly assigned to 'sham' (n = 7) or active rTMS (n = 13), with the coil positioned at 90° or 0°, respectively. Results Five adverse events (AEs) including one serious AE reported. None were related to treatment. Protocol compliance was high (85%) and blinding successful. Within participant MRI metrics, PROMs and cognitive or motor performance were unchanged over time. Conclusion Twenty sessions of rTMS is safe and well tolerated in a small group of people with MS. The study protocol and procedures are feasible. Improvement of sham is warranted before further investigating safety and efficacy.
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Affiliation(s)
| | | | | | | | - Chigozie Ezegbe
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Kain Kyle
- Sydney Neuroimaging Analysis Centre (SNAC), Sydney, New South Wales, Australia
| | - Chenyu Wang
- Sydney Neuroimaging Analysis Centre (SNAC), Sydney, New South Wales, Australia
- Brain & Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Linda Ly
- Sydney Neuroimaging Analysis Centre (SNAC), Sydney, New South Wales, Australia
| | - Katie De La Rue
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Mark R Hinder
- School of Psychological Sciences, University of Tasmania, Hobart, Tasmania, Australia
| | - Lewis Johnson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Jennifer Rodger
- School of Biological Sciences, The University of Western Australia, Crawley, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
| | | | - Carlie L Cullen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- Mater Research Institute, University of Queensland, Woolloongabba, Queensland, Australia
| | - Michael Barnett
- Sydney Neuroimaging Analysis Centre (SNAC), Sydney, New South Wales, Australia
- Brain & Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Kaylene M Young
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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Salazar BH, Hoffman KA, Lincoln JA, Karmonik C, Rajab H, Helekar SA, Khavari R. Evaluating noninvasive brain stimulation to treat overactive bladder in individuals with multiple sclerosis: a randomized controlled trial protocol. BMC Urol 2024; 24:20. [PMID: 38273296 PMCID: PMC10809615 DOI: 10.1186/s12894-023-01358-8] [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: 08/11/2023] [Accepted: 11/06/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Multiple Sclerosis (MS) is an often debilitating disease affecting the myelin sheath that encompasses neurons. It can be accompanied by a myriad of pathologies and adverse effects such as neurogenic lower urinary tract dysfunction (NLUTD). Current treatment modalities for resolving NLUTD focus mainly on alleviating symptoms while the source of the discomfort emanates from a disruption in brain to bladder neural circuitry. Here, we leverage functional magnetic resonance imaging (fMRI), repetitive transcranial magnetic stimulation (rTMS) protocols and the brains innate neural plasticity to aid in resolving overactive bladder (OAB) symptoms associated with NLUTD. METHODS By employing an advanced neuro-navigation technique along with processed fMRI and diffusion tensor imaging data to help locate specific targets in each participant brain, we are able to deliver tailored neuromodulation protocols and affect either an excitatory (20 min @ 10 Hz, applied to the lateral and medial pre-frontal cortex) or inhibitory (20 min @ 1 Hz, applied to the pelvic supplemental motor area) signal on neural circuitry fundamental to the micturition cycle in humans to restore or reroute autonomic and sensorimotor activity between the brain and bladder. Through a regimen of questionnaires, bladder diaries, stimulation sessions and analysis, we aim to gauge rTMS effectiveness in women with clinically stable MS. DISCUSSION Some limitations do exist with this study. In targeting the MS population, the stochastic nature of MS in general highlights difficulties in recruiting enough participants with similar symptomology to make meaningful comparisons. As well, for this neuromodulatory approach to achieve some rate of success, there must be enough intact white matter in specific brain regions to receive effective stimulation. While we understand that our results will represent only a subset of the MS community, we are confident that we will accomplish our goal of increasing the quality of life for those burdened with MS and NLUTD. TRIAL REGISTRATION This trial is registered at ClinicalTrials.gov (NCT06072703), posted on Oct 10, 2023.
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Affiliation(s)
- Betsy H Salazar
- Department of Urology, Houston Methodist Hospital, 6560 Fannin St. Suite 2100, Houston, TX, 77030, USA
| | - Kristopher A Hoffman
- Department of Urology, Houston Methodist Hospital, 6560 Fannin St. Suite 2100, Houston, TX, 77030, USA
- Translational Imaging Center, Houston Methodist Research Institute, Houston, TX, USA
| | - John A Lincoln
- Department of Neurology, The University of Texas Health Science Center, Houston, TX, USA
| | - Christof Karmonik
- Translational Imaging Center, Houston Methodist Research Institute, Houston, TX, USA
| | - Hamida Rajab
- Department of Urology, Houston Methodist Hospital, 6560 Fannin St. Suite 2100, Houston, TX, 77030, USA
| | - Santosh A Helekar
- Center for Translational Biomagnetics and Neurometry, Houston Methodist Research Institute, Houston, TX, USA
| | - Rose Khavari
- Department of Urology, Houston Methodist Hospital, 6560 Fannin St. Suite 2100, Houston, TX, 77030, USA.
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Dong L, Tao X, Gong C, Long Y, Xiao L, Luo Y, Wang M, Zhong Y. Effects of central-peripheral FMS on urinary retention after spinal cord injury: a pilot randomized controlled trial protocol. Front Neurol 2024; 14:1274203. [PMID: 38249751 PMCID: PMC10797019 DOI: 10.3389/fneur.2023.1274203] [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: 08/08/2023] [Accepted: 11/16/2023] [Indexed: 01/23/2024] Open
Abstract
Background Urinary retention is a common complication of spinal cord injury (SCI), which can seriously affect the quality of life of patients. Function magnetic stimulation (FMS) has been widely used in the recovery of neurological function in various diseases, but its application in urinary retention after SCI remains unclear. Therefore, we would like to conduct a pilot randomized controlled trial (RCT) to observe the feasible effect of FMS on urinary retention after SCI, to explore its mechanism of action. Method/design This is a single-center pilot RCT, which 60 patients with urinary retention after SCI will be selected, numbered in chronological order of hospitalization, and randomly divided into 4 groups using the random number table method, Groups A (control group), Group B, Group C, and Group D; Each group will receive the same conventional rehabilitation treatment. The whole intervention period 2 weeks and will be evaluated before and after treatment to collect data on residual bladder volume, functional near-infrared spectroscopy (fNIRS), changes in voiding condition, changes in surface electromyography (SEMG) values of pelvic floor muscle and quality of life scores (QoL). Study hypothesis We hypothesized that FMS for the treatment of urinary retention after SCI would have a significant clinical feasible effect;and that peripheral combined with central FMS would be more effective than single-site FMS for the treatment of urinary retention after SCI. Objective (1) To illustrate the clinical effectiveness of FMS in the treatment of urinary retention after SCI and to provide a new treatment modality for the patients; (2) Comparison of the differences in the efficacy of central and peripheral single FMS and combined central and peripheral FMS in the treatment of urinary retention after SCI; (3) To explore the central control mechanisms of bladder function recovery after SCI in conjunction with changes in fNIRS. Trial registration This study has been ethically approved by the Scientific and Ethics Committee of the First Affiliated Hospital of Gannan Medical university with approval number (LLSC-2022112401). It has been registered with the China Clinical Trials Registry with the registration number: ChiCTR2200067143.
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Affiliation(s)
- Lingyan Dong
- Gannan Medical University, Ganzhou, Jiangxi, China
| | - Xi Tao
- Gannan Medical University, Ganzhou, Jiangxi, China
| | - Cheng Gong
- Gannan Medical University, Ganzhou, Jiangxi, China
| | - Yi Long
- Gannan Medical University, Ganzhou, Jiangxi, China
| | - Li Xiao
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Yun Luo
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Maoyuan Wang
- Ganzhou Key Laboratory of Rehabilitation Medicine, Ganzhou, China
- Ganzhou Intelligent Rehabilitation Technology Innovation Center, Ganzhou, China
| | - Yanbiao Zhong
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- Ganzhou Key Laboratory of Rehabilitation Medicine, Ganzhou, China
- Ganzhou Intelligent Rehabilitation Technology Innovation Center, Ganzhou, China
- Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases, Ministry of Education, Gannan Medical University, Ganzhou, China
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Alghamdi MA, Amer KA, Aldosari AAS, Al Qahtani RF, Shar HS, Al-Tarish LM, Shawkhan RA, Alahmadi MA, Alsaleem MA, AL-Eitan LN. Assessment of the Impact of Lower Urinary Tract Dysfunction on Quality of Life in Multiple Sclerosis Patients in Saudi Arabia-A Cross-Sectional Study. Healthcare (Basel) 2023; 11:2694. [PMID: 37830731 PMCID: PMC10572286 DOI: 10.3390/healthcare11192694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/11/2023] [Accepted: 10/06/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Lower urinary tract dysfunction (LUTD) is caused by neurogenic factors that could lead to permanent injury in affected patients, and therefore result in substantial annual healthcare expenses. LUTD is very prevalent in multiple sclerosis (MS) patients and has a drastic impact on their quality of life (QOL). This study aimed to assess the effect of LUTD on the QOL of Saudi MS patients. METHODS A cross-sectional study was carried out in Saudi Arabia using a self-administered questionnaire that included the World Health Organization Quality of Life (WHOQOL-BREF) and LURN Symptom Index (LURN SI-29). Data were analyzed and presented as frequencies and percentages. RESULTS There were 428 patients who participated in this study; 270 were females and 158 were males. Most of the patients received a low score in all sections of the LURN part of the questionnaire. The highest scores (urgent need to urinate and excessive urination at night) were recorded in the urgency domain (47.20 ± 36.88) rather than the nocturia domain (44.74 ± 32.91). Meanwhile, the lowest score (complete control of bladder) was recorded in the incontinence domain (22.80 ± 26.80). For the WHOQOL-BREF score, the highest score (more social stability) was in the social domain (65.07 ± 21.16 for females, 60.41 ± 21.54 for males), and the lowest score (less psychological stability) was in the psychological domain (46.36 ± 9.84 for females, 46.20 ± 10.03 for males). However, there was no significant association between the four domains of the WHOQOL-BREF and the gender of the MS patients. CONCLUSIONS LUTD is significantly associated with a lowered quality of life. Therefore, patients are recommended to consult with and be evaluated by appropriately experienced healthcare providers and clinicians. This ensures that the patients receive the best advice, accurate and effective treatment, and long-term analysis that can lead to an improvement in their quality of life.
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Affiliation(s)
- Mansour Abdullah Alghamdi
- Department of Anatomy, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia
- Genomics and Personalized Medicine Unit, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia
| | | | | | | | - Haneen Saeed Shar
- College of Medicine, King Khalid University, Abha 62529, Saudi Arabia
| | | | | | - Mohammad Ali Alahmadi
- Department of Physical Education and Sport Sciences, College of Education, Taibah University, Madinah 42353, Saudi Arabia
| | - Mohammed Abadi Alsaleem
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia
| | - Laith Naser AL-Eitan
- Department of Applied Biological Sciences, Jordan University of Science and Technology, Irbid 22110, Jordan
- Department of Biotechnology and Genetic Engineering, Jordan University of Science and Technology, Irbid 22110, Jordan
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Wang Y, Dong T, Li X, Zhao H, Yang L, Xu R, Fu Y, Li L, Gai X, Qin D. Research progress on the application of transcranial magnetic stimulation in spinal cord injury rehabilitation: a narrative review. Front Neurol 2023; 14:1219590. [PMID: 37533475 PMCID: PMC10392830 DOI: 10.3389/fneur.2023.1219590] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/05/2023] [Indexed: 08/04/2023] Open
Abstract
Traumatic or non-traumatic spinal cord injury (SCI) can lead to severe disability and complications. The incidence of SCI is high, and the rehabilitation cycle is long, which increases the economic burden on patients and the health care system. However, there is no practical method of SCI treatment. Recently, transcranial magnetic stimulation (TMS), a non-invasive brain stimulation technique, has been shown to induce changes in plasticity in specific areas of the brain by regulating the activity of neurons in the stimulation site and its functionally connected networks. TMS is a new potential method for the rehabilitation of SCI and its complications. In addition, TMS can detect the activity of neural circuits in the central nervous system and supplement the physiological evaluation of SCI severity. This review describes the pathophysiology of SCI as well as the basic principles and classification of TMS. We mainly focused on the latest research progress of TMS in the physiological evaluation of SCI as well as the treatment of motor dysfunction, neuropathic pain, spasticity, neurogenic bladder, respiratory dysfunction, and other complications. This review provides new ideas and future directions for SCI assessment and treatment.
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Affiliation(s)
- Yuhong Wang
- Department of Rehabilitation Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Tingting Dong
- Department of Rehabilitation Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Xiahuang Li
- Department of Neurosurgery, Mengzi People’s Hospital, Mengzi, China
| | - Huiyun Zhao
- Department of Rehabilitation Medicine, Dongchuan District People’s Hospital, Kunming, China
| | - Lili Yang
- Department of Rehabilitation Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Rui Xu
- Department of Rehabilitation Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Yi Fu
- Department of Pulmonary and Critical Care Medicine, Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, China
| | - Li Li
- Department of Emergency Trauma Surgery, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Xuesong Gai
- Department of Rehabilitation Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Dongdong Qin
- Key Laboratory of Traditional Chinese Medicine for Prevention and Treatment of Neuropsychiatric Diseases, Yunnan University of Chinese Medicine, Kunming, China
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Scheinok TJ, D'Haeseleer M, Nagels G, De Bundel D, Van Schependom J. Neuronal activity and NIBS in developmental myelination and remyelination - current state of knowledge. Prog Neurobiol 2023; 226:102459. [PMID: 37127087 DOI: 10.1016/j.pneurobio.2023.102459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/06/2023] [Accepted: 04/28/2023] [Indexed: 05/03/2023]
Abstract
Oligodendrocytes are responsible for myelinating central nervous system (CNS) axons. and rapid electrical transmission through saltatory conduction of action potentials. Myelination and myelin repair rely partially on oligodendrogenesis, which comprises. oligodendrocyte precursor cell (OPC) migration, maturation, and differentiation into. oligodendrocytes (OL). In multiple sclerosis (MS), demyelination occurs due to an. inflammatory cascade with auto-reactive T-cells. When oligodendrogenesis fails, remyelination becomes aberrant and conduction impairments are no longer restored. Although current disease modifying therapies have achieved results in modulating the. faulty immune response, disease progression continues because of chronic. inflammation, neurodegeneration, and failure of remyelination. Therapies have been. tried to promote remyelination. Modulation of neuronal activity seems to be a very. promising strategy in preclinical studies. Additionally, studies in people with MS. (pwMS) have shown symptom improvement following non-invasive brain stimulation. (NIBS) techniques. The aforementioned mechanisms are yet unknown and probably. involve both the activation of neurons and glial cells. Noting neuronal activity. contributes to myelin plasticity and that NIBS modulates neuronal activity; we argue. that NIBS is a promising research horizon for demyelinating diseases. We review the. hypothesized pathways through which NIBS may affect both neuronal activity in the. CNS and how the resulting activity can affect oligodendrogenesis and myelination.
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Affiliation(s)
- Thomas J Scheinok
- AIMS Lab, Center for Neurosciences, UZ Brussel, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussel, Belgium; Department of Pharmaceutical and Pharmacological Sciences, Research Group Experimental Pharmacology (EFAR), Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium.
| | - Miguel D'Haeseleer
- Nationaal Multiple Sclerose Centrum, Vanheylenstraat 16, 1820 Melsbroek, Belgium
| | - Guy Nagels
- AIMS Lab, Center for Neurosciences, UZ Brussel, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussel, Belgium; St Edmund Hall, University of Oxford, Queen's Lane, Oxford, UK
| | - Dimitri De Bundel
- Department of Pharmaceutical and Pharmacological Sciences, Research Group Experimental Pharmacology (EFAR), Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Jeroen Van Schependom
- AIMS Lab, Center for Neurosciences, UZ Brussel, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussel, Belgium; Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussel, Belgium
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Duan H, Jing Y, Li Y, Lian Y, Li J, Li Z. Rehabilitation treatment of multiple sclerosis. Front Immunol 2023; 14:1168821. [PMID: 37090712 PMCID: PMC10117641 DOI: 10.3389/fimmu.2023.1168821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 03/27/2023] [Indexed: 04/09/2023] Open
Abstract
Multiple sclerosis is a slowly progressive disease, immunosuppressants and other drugs can delay the progression and progression of the disease, but the most patients will be left with varying degrees of neurological deficit symptoms, such as muscle weakness, muscle spasm, ataxia, sensory impairment, dysphagia, cognitive dysfunction, psychological disorders, etc. From the early stage of the disease to the stage of disease progression, professional rehabilitation treatment can reduce the functional dysfunction of multiple sclerosis patients, improve neurological function, and reduce family and social burdens. With the development of various new rehabilitation technologies such as transcranial magnetic stimulation, virtual reality technology, robot-assisted gait, telerehabilitation and transcranial direct current stimulation, the advantages of rehabilitation therapy in multiple sclerosis treatment have been further established, and more treatment means have also been provided for patients.
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Li J, Wang J, Hu Y, Jian R, Zhao Y, Li D, Wan T, Jike W, Xu F, Huang M. Effects of repetitive functional magnetic stimulation in the sacral nerve in patients with neurogenic detrusor overactivity after suprasacral spinal cord injury: a study protocol for a randomized controlled trial. Trials 2023; 24:199. [PMID: 36932375 PMCID: PMC10022156 DOI: 10.1186/s13063-023-07207-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/28/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Neurogenic detrusor overactivity (NDO) is a serious and common complication after spinal cord injury, affecting patients' quality of life seriously. Therefore, we developed this research protocol to evaluate the efficacy of repetitive functional magnetic stimulation (rFMS) in the sacral nerve in patients with neurogenic detrusor overactivity (NDO) after suprasacral spinal cord injury (SCI) and provide more options for rFMS in treating NDO after suprasacral SCI. METHODS This study is a single-center, randomized, parallel-group clinical trial. We will recruit the patients with NDO after suprasacral SCI in the Rehabilitation Department of the Affiliated Hospital of Southwest Medical University from September 2022 to August 2023. They will be assigned to the rFMS group and the sham stimulation group randomly. The sample size is 66, with 33 patients in each group. The rFMS group will receive real rFMS treatment of the sacral nerve (100% stimulation intensity, 5 Hz, 20 min each time, five times a week), and the sham group will receive sham stimulation. Both groups will receive similar treatment strategies, including medication, standard urine management, acupuncture treatment, and health education. The bladder compliance (bladder capacity/detrusor pressure) and pudendal nerve electromyography will be evaluated at baseline, 8th week of treatment. The residual volume of the bladder and bladder diary will be recorded once a week during 8 weeks of treatments. SCI-QOL and NBSS will be evaluated at baseline, the 4th and 8th week of treatment. In addition, the above assessments will be followed up at 8 weeks after the end of treatment. DISCUSSION It is expected that the bladder function, symptoms, and quality of life might be significantly improved after rFMS of the sacral nerve. TRIAL REGISTRATION The China Clinical Trials Registry has approved this study, registration number: ChiCTR2100045148. Registered on April 7, 2021.
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Affiliation(s)
- Jiyang Li
- grid.488387.8Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan People’s Republic of China
| | - Jianxiong Wang
- grid.488387.8Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan People’s Republic of China
| | - Yue Hu
- grid.488387.8Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan People’s Republic of China
| | - Rui Jian
- grid.488387.8Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan People’s Republic of China
| | - Yulu Zhao
- grid.488387.8Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan People’s Republic of China
| | - Dan Li
- grid.488387.8Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan People’s Republic of China
| | - Tenggang Wan
- grid.488387.8Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan People’s Republic of China
| | - Wuga Jike
- grid.488387.8Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan People’s Republic of China
| | - Fangyuan Xu
- grid.488387.8Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan People’s Republic of China
| | - Maomao Huang
- grid.488387.8Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan People’s Republic of China
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Su JS, Mazeaud C, Khavari R. Central Nervous Stimulation for Neurogenic Lower Urinary Tract Dysfunction: Current Application and Emergent Therapies. CURRENT BLADDER DYSFUNCTION REPORTS 2023. [DOI: 10.1007/s11884-023-00696-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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Zhao P, Zhang G, Shen Y, Wang Y, Shi L, Wang Z, Wei C, Zhai W, Sun L. Urinary dysfunction in patients with vascular cognitive impairment. Front Aging Neurosci 2023; 14:1017449. [PMID: 36742205 PMCID: PMC9889668 DOI: 10.3389/fnagi.2022.1017449] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/28/2022] [Indexed: 01/20/2023] Open
Abstract
Vascular cognitive impairment (VCI) is caused by vascular pathologies, with the spectrum of cognitive disorders ranging from subjective cognitive dysfunction to dementia. Particularly among older adults, cognitive impairment is often complicated with urinary dysfunction (UD); some patients may present with UD before cognitive impairment owing to stroke or even when there are white matter hyperintensities on imaging studies. Patients with cognitive impairment often have both language and movement dysfunction, and thus, UD in patients with VCI can often be underdiagnosed and remain untreated. UD has an impact on the quality of life of patients and caregivers, often leading to poor outcomes. Medical history is an important aspect and should be taken from both patients and their caregivers. Clinical assessment including urinalysis, voiding diary, scales on UD and cognitive impairment, post-void residual volume measurement, uroflowmetry, and (video-) urodynamics should be performed according to indication. Although studies on UD with VCI are few, most of them show that an overactive bladder (OAB) is the most common UD type, and urinary incontinence is the most common symptom. Normal urine storage and micturition in a specific environment are complex processes that require a sophisticated neural network. Although there are many studies on the brain-urinary circuit, the specific circuit involving VCI and UD remains unclear. Currently, there is no disease-modifying pharmacological treatment for cognitive impairment, and anti-acetylcholine drugs, which are commonly used to treat OAB, may cause cognitive impairment, leading to a vicious circle. Therefore, it is important to understand the complex interaction between UD and VCI and formulate individualized treatment plans. This review provides an overview of research advances in clinical features, imaging and pathological characteristics, and treatment options of UD in patients with VCI to increase subject awareness, facilitate research, and improve diagnosis and treatment rates.
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Predictors for outcomes of noninvasive, individualized transcranial magnetic neuromodulation in multiple sclerosis women with neurogenic voiding dysfunction. CONTINENCE (AMSTERDAM, NETHERLANDS) 2022; 4:100517. [PMID: 36568960 PMCID: PMC9788803 DOI: 10.1016/j.cont.2022.100517] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Purpose Multiple sclerosis (MS) is a multifocal demyelinating disease that affects the central nervous system (CNS) and commonly leads to neurogenic lower urinary tract dysfunction (NLUTD). Proper storage and release of urine relies on synchronized activity of the LUT, which is meticulously regulated by supraspinal circuits, making it vulnerable to diseases such as MS. NLUTD, characterized by voiding dysfunction (VD), storage issues, or a combination of both is a common occurrence in MS. Unfortunately, there are limited treatment options for NLUTD, making the search for alternative treatments such as transcranial rotating permanent magnet stimulation (TRPMS) of utmost importance. To assess effectiveness of treatment we also need to understand underlying factors that may affect outcomes, which we addressed here. Methods Ten MS subjects with VD and median age of 54.5 years received daily TRPMS sessions for two weeks. Five pre-determined regions of interest (ROIs) known to be involved in the micturition cycle were modulated (stimulated or inhibited) using TRPMS. Clinical data (non-instrumented uroflow and urodynamics parameters, PVR, bladder symptom questionnaires) and neuro-imaging data were collected at baseline and following TRPMS via 7-Tesla Siemens MAGNETOM Terra magnetic resonance imaging (MRI) scanner. Each participant underwent functional MRI (fMRI) concurrently with a repeated urodynamic study (UDS). Baseline data of each arm was evaluated to determine any indicators of successful response to treatment.
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15
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Atak Çakir P, Mutluay F, Hanoğlu L, Güzelburç V. Effect of transcutaneous posterior tibial nerve stimulation and repetitive transcranial magnetic stimulation on neurogenic overactive bladder symptoms in female patients with multiple sclerosis: The study protocol of a randomized controlled study. Front Neurol 2022; 13:1011502. [PMID: 36388236 PMCID: PMC9650967 DOI: 10.3389/fneur.2022.1011502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/28/2022] [Indexed: 10/23/2023] Open
Abstract
INTRODUCTION Neurogenic bladder is frequently seen in patients with multiple sclerosis (MS). Electrical stimulation methods (neuromodulation) can be used for patients that have persistent symptoms despite pharmacological treatment. This study aims to compare the effects of two different neuromodulation techniques used in the treatment of neurogenic bladder. METHODS AND ANALYSIS This is a single-center randomized controlled trial for MS patients with neurogenic bladder. Patients determined to be eligible according to the study criteria will be randomized into two treatment groups: the transcutaneous posterior tibial nerve stimulation (PTNS) and repetitive transcranial magnetic stimulation (rTMS) groups. Each group will include eight patients. The patients will be treated for a total of 10 sessions for two consecutive weeks. The pressure-flow study will be used to compare the initial and final urodynamic results as the primary outcome. All the participants will fill in a 3-day bladder diary before and after the treatments in each group. Patients will also be asked to complete specific questionnaires for incontinence and quality of life (QOL): Overactive Bladder Questionnaire-V8 score (OAB-V8), Incontinence Severity Index (ISI), Incontinence Quality of Life Scale score (I-QOL), International Incontinence Questionnaire (ICIQ-SF) score, and International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) score) as the secondary outcomes. ETHICS AND DISSEMINATION An ethical approval number was obtained from the Non-Invasive Clinical Research Ethics Committee of Istanbul Medipol University (ethical approval number: 768). Support was received within the scope of the Istanbul Medipol University Scientific Research Project with project number 2020-2017. The result of this study will be published in a peer-reviewed journal. TRIAL REGISTRATION NCT05312138.
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Affiliation(s)
- Pinar Atak Çakir
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
| | - Fatma Mutluay
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
| | - Lütfü Hanoğlu
- Neurology Department, Istanbul Medipol University, Istanbul, Turkey
| | - Vahit Güzelburç
- Urology Department, Istanbul Medipol University Hospital, Istanbul, Turkey
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16
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Jiang W, Tang W, Song Y, Feng Y, Zhou Y, Li L, Tan B. Effectiveness of repetitive transcranial magnetic stimulation against poststroke urinary incontinence: a study protocol for a randomized controlled trial. Trials 2022; 23:650. [PMID: 35964135 PMCID: PMC9375329 DOI: 10.1186/s13063-022-06535-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/11/2022] [Indexed: 11/19/2022] Open
Abstract
Background and purpose Poststroke urinary incontinence (PSI) is prevalent in stroke survivors, and high-quality evidence is required to guide clinical practice. Previous studies have demonstrated the curative effect of repetitive transcranial magnetic stimulation (rTMS) for urinary incontinence in individuals with multiple sclerosis (MS), Parkinson’s disease (PD), and spinal cord injury (SCI). Here, we describe the protocol for a randomized controlled trial to evaluate the efficacy and safety of low-frequency rTMS on the contralesional primary motor cortex (M1) for the treatment of PSI. Methods and analysis In this single-centre randomized controlled trial for poststroke urinary incontinence, a total of 140 eligible patients will be randomly allocated into two groups. The rTMS group (n = 70) will receive low-frequency rTMS at the M1 along with routine medical care, while the control group will receive sham rTMS along with routine medical care. All participants will undergo 20 treatment sessions, five times a week for 4 weeks. The primary outcome measures will be the changes in the urodynamic test at baseline versus 4 weeks after intervention. The secondary outcomes include the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF), Overactive Bladder Symptom Score (OABSS), and pelvic floor muscle function. Ethics and dissemination The Institutional Review Board and Hospital Research Ethics Committee of the Second Affiliated Hospital of Chongqing Medical University approved this trial, and the approval number is No. 2020-153. All methods will be carried out in accordance with the principles of the Declaration of Helsinki and relevant ethical guidelines covering informed consent, confidentiality, and data storage. After the study had been thoroughly described to the participants by a physician, all participants will provide written informed consent indicating their willingness to participate. The results will be disseminated to most of the population, including participants, researchers, healthcare providers, and sponsors. Trial registration URL: https://www.chictr.org.cn; Unique identifier: ChiCTR2100042688. Date of Registration: 2021-01-26. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06535-y.
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Affiliation(s)
- Wei Jiang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Linjiang Road, Chongqing, 40010, China
| | - Wen Tang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Linjiang Road, Chongqing, 40010, China
| | - Yunling Song
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Linjiang Road, Chongqing, 40010, China
| | - Yali Feng
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Linjiang Road, Chongqing, 40010, China
| | - Yuesan Zhou
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Linjiang Road, Chongqing, 40010, China
| | - Lang Li
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Linjiang Road, Chongqing, 40010, China
| | - Botao Tan
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Linjiang Road, Chongqing, 40010, China.
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17
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Tomeh A, Yusof Khan AHK, Inche Mat LN, Basri H, Wan Sulaiman WA. Repetitive Transcranial Magnetic Stimulation of the Primary Motor Cortex beyond Motor Rehabilitation: A Review of the Current Evidence. Brain Sci 2022; 12:brainsci12060761. [PMID: 35741646 PMCID: PMC9221422 DOI: 10.3390/brainsci12060761] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 02/01/2023] Open
Abstract
Transcranial magnetic stimulation (TMS) has emerged as a novel technique to stimulate the human brain through the scalp. Over the years, identifying the optimal brain region and stimulation parameters has been a subject of debate in the literature on therapeutic uses of repetitive TMS (rTMS). Nevertheless, the primary motor cortex (M1) has been a conventional target for rTMS to treat motor symptoms, such as hemiplegia and spasticity, as it controls the voluntary movement of the body. However, with an expanding knowledge base of the M1 cortical and subcortical connections, M1-rTMS has shown a therapeutic efficacy that goes beyond the conventional motor rehabilitation to involve pain, headache, fatigue, dysphagia, speech and voice impairments, sleep disorders, cognitive dysfunction, disorders of consciousness, anxiety, depression, and bladder dysfunction. In this review, we summarize the latest evidence on using M1-rTMS to treat non-motor symptoms of diverse etiologies and discuss the potential mechanistic rationale behind the management of each of these symptoms.
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Affiliation(s)
- Abdulhameed Tomeh
- Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia; (A.T.); (A.H.K.Y.K.); (L.N.I.M.); (H.B.)
| | - Abdul Hanif Khan Yusof Khan
- Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia; (A.T.); (A.H.K.Y.K.); (L.N.I.M.); (H.B.)
- Malaysian Research Institute on Ageing (MyAgeingTM), Universiti Putra Malaysia, Serdang 43400, Malaysia
| | - Liyana Najwa Inche Mat
- Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia; (A.T.); (A.H.K.Y.K.); (L.N.I.M.); (H.B.)
| | - Hamidon Basri
- Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia; (A.T.); (A.H.K.Y.K.); (L.N.I.M.); (H.B.)
| | - Wan Aliaa Wan Sulaiman
- Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia; (A.T.); (A.H.K.Y.K.); (L.N.I.M.); (H.B.)
- Malaysian Research Institute on Ageing (MyAgeingTM), Universiti Putra Malaysia, Serdang 43400, Malaysia
- Correspondence: ; Tel.: +60-3-9769-5560
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Somaa FA, de Graaf TA, Sack AT. Transcranial Magnetic Stimulation in the Treatment of Neurological Diseases. Front Neurol 2022; 13:793253. [PMID: 35669870 PMCID: PMC9163300 DOI: 10.3389/fneur.2022.793253] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/25/2022] [Indexed: 12/16/2022] Open
Abstract
Transcranial Magnetic Stimulation (TMS) has widespread use in research and clinical application. For psychiatric applications, such as depression or OCD, repetitive TMS protocols (rTMS) are an established and globally applied treatment option. While promising, rTMS is not yet as common in treating neurological diseases, except for neurorehabilitation after (motor) stroke and neuropathic pain treatment. This may soon change. New clinical studies testing the potential of rTMS in various other neurological conditions appear at a rapid pace. This can prove challenging for both practitioners and clinical researchers. Although most of these neurological applications have not yet received the same level of scientific/empirical scrutiny as motor stroke and neuropathic pain, the results are encouraging, opening new doors for TMS in neurology. We here review the latest clinical evidence for rTMS in pioneering neurological applications including movement disorders, Alzheimer's disease/mild cognitive impairment, epilepsy, multiple sclerosis, and disorders of consciousness.
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Affiliation(s)
- Fahad A. Somaa
- Department of Occupational Therapy, Faculty of Medical Rehabilitation, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Tom A. de Graaf
- Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
- Center of Integrative Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Alexander T. Sack
- Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
- Center of Integrative Neuroscience, Maastricht University, Maastricht, Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Brain + Nerve Centre, Maastricht University Medical Centre+, Maastricht, Netherlands
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León Ruiz M, Sospedra M, Arce Arce S, Tejeiro-Martínez J, Benito-León J. Current evidence on the potential therapeutic applications of transcranial magnetic stimulation in multiple sclerosis: a systematic review of the literature. NEUROLOGÍA (ENGLISH EDITION) 2022; 37:199-215. [PMID: 35465914 DOI: 10.1016/j.nrleng.2020.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 03/29/2018] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION A growing number of studies have evaluated the effects of transcranial magnetic stimulation (TMS) for the symptomatic treatment of multiple sclerosis (MS). METHODS We performed a PubMed search for articles, recent books, and recommendations from the most relevant clinical practice guidelines and scientific societies regarding the use of TMS as symptomatic treatment in MS. CONCLUSIONS Excitatory electromagnetic pulses applied to the affected cerebral hemisphere allow us to optimise functional brain activity, including the transmission of nerve impulses through the demyelinated corticospinal pathway. Various studies into TMS have safely shown statistically significant improvements in spasticity, fatigue, lower urinary tract dysfunction, manual dexterity, gait, and cognitive deficits related to working memory in patients with MS; however, the exact level of evidence has not been defined as the results have not been replicated in a sufficient number of controlled studies. Further well-designed, randomised, controlled clinical trials involving a greater number of patients are warranted to attain a higher level of evidence in order to recommend the appropriate use of TMS in MS patients across the board. TMS acts as an adjuvant with other symptomatic and immunomodulatory treatments. Additional studies should specifically investigate the effect of conventional repetitive TMS on fatigue in these patients, something that has yet to see the light of day.
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Affiliation(s)
- M León Ruiz
- Servicio de Neurología, Clínica San Vicente, Madrid, Spain; Servicio de Neurología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.
| | - M Sospedra
- Sección de Neuroinmunología y de Investigación en Esclerosis Múltiple, Departamento de Neurología, Hospital Universitario de Zúrich, Zurich, Switzerland
| | - S Arce Arce
- Servicio de Psiquiatría, Clínica San Vicente, Madrid, Spain; Departamento de Dirección Médica, Clínica San Vicente, Madrid, Spain
| | - J Tejeiro-Martínez
- Servicio de Neurología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - J Benito-León
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
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20
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León Ruiz M, Sospedra M, Arce Arce S, Tejeiro-Martínez J, Benito-León J. Current evidence on the potential therapeutic applications of transcranial magnetic stimulation in multiple sclerosis: A systematic review of the literature. Neurologia 2022; 37:199-215. [PMID: 29898858 DOI: 10.1016/j.nrl.2018.03.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 03/03/2018] [Accepted: 03/29/2018] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION A growing number of studies have evaluated the effects of transcranial magnetic stimulation (TMS) for the symptomatic treatment of multiple sclerosis (MS). METHODS We performed a PubMed search for articles, recent books, and recommendations from the most relevant clinical practice guidelines and scientific societies regarding the use of TMS as symptomatic treatment in MS. CONCLUSIONS Excitatory electromagnetic pulses applied to the affected cerebral hemisphere allow us to optimise functional brain activity, including the transmission of nerve impulses through the demyelinated corticospinal pathway. Various studies into TMS have safely shown statistically significant improvements in spasticity, fatigue, lower urinary tract dysfunction, manual dexterity, gait, and cognitive deficits related to working memory in patients with MS; however, the exact level of evidence has not been defined as the results have not been replicated in a sufficient number of controlled studies. Further well-designed, randomised, controlled clinical trials involving a greater number of patients are warranted to attain a higher level of evidence in order to recommend the appropriate use of TMS in MS patients across the board. TMS acts as an adjuvant with other symptomatic and immunomodulatory treatments. Additional studies should specifically investigate the effect of conventional repetitive TMS on fatigue in these patients, something that has yet to see the light of day.
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Affiliation(s)
- M León Ruiz
- Servicio de Neurología, Clínica San Vicente, Madrid, España; Servicio de Neurología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España.
| | - M Sospedra
- Sección de Neuroinmunología y de Investigación en Esclerosis Múltiple, Departamento de Neurología, Hospital Universitario de Zúrich, Zúrich, Suiza
| | - S Arce Arce
- Servicio de Psiquiatría, Clínica San Vicente, Madrid, España; Departamento de Dirección Médica, Clínica San Vicente, Madrid, España
| | - J Tejeiro-Martínez
- Servicio de Neurología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - J Benito-León
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, España; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, España
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Ali MU, Fong KNK, Kannan P, Bello UM, Kranz G. Effects of nonsurgical, minimally or noninvasive therapies for urinary incontinence due to neurogenic bladder: a systematic review and meta-analysis. Ther Adv Chronic Dis 2022; 13:20406223211063059. [PMID: 35321402 PMCID: PMC8935404 DOI: 10.1177/20406223211063059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/10/2021] [Indexed: 12/18/2022] Open
Abstract
Objective To determine the effects of nonsurgical, minimally or noninvasive therapies on urge urinary incontinence (UUI) symptoms and quality of life (QoL) in individuals with neurogenic bladder (NGB). Data Sources Cochrane library, EMBASE, MEDLINE, PEDro, Scopus, and Web of Science databases were searched from inception to September 2021. Review Methods Randomized controlled trials that compared therapies such as intravaginal electrical stimulation (IVES), transcutaneous electrical nerve stimulation (TENS), neuromuscular electrical stimulation (NMES), transcutaneous tibial nerve stimulation (TTNS), pelvic floor muscle training (PFMT), and behavioural therapy (BT) to control were included. Study screening, data extraction, and study quality assessments were performed by two independent authors. Results Fourteen trials with 804 participants were included in the study after screening of 4281 potentially relevant articles. Meta-analyses revealed a significant effect of electrical stimulation on UUI due to multiple sclerosis (standardized mean difference (SMD): -0.614; 95% confidence interval (CI): -1.023, -0.206; p = 0.003) and stroke (SMD: -2.639; 95% CI: -3.804, -1.474; p = 0.000). The pooled analyses of TTNS (weighted mean difference (WMD): -12.406; 95% CI: -16.015, -8.797; p = 0.000) and BT (WMD: -9.117; 95% CI: -14.746, -3.487; p = 0.002) revealed significant effects of these interventions on QoL in people with Parkinson's disease. However, meta-analyses revealed nonsignificant effects for PFMT (WMD: -0.751; 95% CI: -2.426, 0.924; p = 0.380) and BT (WMD: -0.597; 95% CI: -1.278, 0.083; p = 0.085) on UUI due to Parkinson's disease. Conclusions Our meta-analyses found electrical stimulation to be beneficial for improving the symptoms of UUI among people with multiple sclerosis and those with stroke. Our review also revealed that TTNS and BT might improve QoL for people with NGB due to Parkinson's disease, although the effects of PFMT and BT on UUI warrant further investigation.
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Affiliation(s)
- Mohammed Usman Ali
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong Department of Medical Rehabilitation (Physiotherapy), University of Maiduguri, Maiduguri, Nigeria
| | - Kenneth Nai-Kuen Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Priya Kannan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Umar Muhammad Bello
- Centre for Eye and Vision Research (CEVR) Limited, Hong Kong, China; Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong Department of Physiotherapy, Yobe State University Teaching Hospital, Damaturu, Nigeria
| | - Georg Kranz
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
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22
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Stampanoni Bassi M, Iezzi E, Centonze D. Multiple sclerosis: Inflammation, autoimmunity and plasticity. HANDBOOK OF CLINICAL NEUROLOGY 2022; 184:457-470. [PMID: 35034754 DOI: 10.1016/b978-0-12-819410-2.00024-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In recent years, experimental studies have clarified that immune system influences the functioning of the central nervous system (CNS) in both physiologic and pathologic conditions. The neuro-immune crosstalk plays a crucial role in neuronal development and may be critically involved in mediating CNS response to neuronal damage. Multiple sclerosis (MS) represents a good model to investigate how the immune system regulates neuronal activity. Accordingly, a growing body of evidence has demonstrated that increased levels of pro-inflammatory mediators may significantly impact synaptic mechanisms, influencing overall neuronal excitability and synaptic plasticity expression. In this chapter, we provide an overview of preclinical data and clinical studies exploring synaptic functioning noninvasively with transcranial magnetic stimulation (TMS) in patients with MS. Moreover, we examine how inflammation-driven synaptic dysfunction could affect synaptic plasticity expression, negatively influencing the MS course. Contrasting CSF inflammation together with pharmacologic enhancement of synaptic plasticity and application of noninvasive brain stimulation, alone or in combination with rehabilitative treatments, could improve the clinical compensation and prevent the accumulating deterioration in MS.
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Affiliation(s)
| | - Ennio Iezzi
- Unit of Neurology & Neurorehabilitation, IRCCS Neuromed, Pozzilli, Italy
| | - Diego Centonze
- Unit of Neurology & Neurorehabilitation, IRCCS Neuromed, Pozzilli, Italy; Laboratory of Synaptic Immunopathology, Department of Systems Medicine, Tor Vergata University, Rome, Italy.
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Pan S, Chan JR. Clinical Applications of Myelin Plasticity for Remyelinating Therapies in Multiple Sclerosis. Ann Neurol 2021; 90:558-567. [PMID: 34402546 PMCID: PMC8555870 DOI: 10.1002/ana.26196] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 12/12/2022]
Abstract
Central nervous system demyelination in multiple sclerosis (MS) and subsequent axonal degeneration represent a major cause of clinical morbidity. Learning, salient experiences, and stimulation of neuronal activity induce new myelin formation in rodents, and in animal models of demyelination, remyelination can be enhanced via experience- and activity-dependent mechanisms. Furthermore, preliminary studies in MS patients support the use of neuromodulation and rehabilitation exercises for symptomatic improvement, suggesting that these interventions may represent nonpharmacological strategies for promoting remyelination. Here, we review the literature on myelin plasticity processes and assess the potential to leverage these mechanisms to develop remyelinating therapies. ANN NEUROL 2021;90:558-567.
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Affiliation(s)
- Simon Pan
- Department of Neurology, Weill Institute for Neuroscience, University of California, San Francisco
| | - Jonah R. Chan
- Department of Neurology, Weill Institute for Neuroscience, University of California, San Francisco
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Pericolini M, Miget G, Hentzen C, Finazzi Agrò E, Chesnel C, Lagnau P, Haddad R, Grasland M, Amarenco G. Cortical, Spinal, Sacral, and Peripheral Neuromodulations as Therapeutic Approaches for the Treatment of Lower Urinary Tract Symptoms in Multiple Sclerosis Patients: A Review. Neuromodulation 2021; 25:1065-1075. [PMID: 34496454 DOI: 10.1111/ner.13525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/30/2021] [Accepted: 07/28/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Multiple sclerosis (MS) is often associated with urological disorders, mainly urinary incontinence and retention, the management of which being necessary to improve patient's quality of life (QOL) and to reduce potential urological complications. Besides the classical treatments based mainly on anticholinergics and/or self-catheterization, several neuromodulation techniques have been tried in recent years to improve these urinary disorders. By this review, we aim at providing an overview of neuromodulation and electrostimulation approaches to manage urinary symptoms in MS patients. MATERIALS AND METHODS A literature search using MEDLINE was performed. Only papers in English, and describing the effects of neuromodulation in MS patients, were considered. RESULTS A total of 18 studies met inclusion criteria and were reviewed. Of them, four related to sacral neuromodulation (SNM), seven to percutaneous tibial nerve stimulation (PTNS), six to spinal cord stimulation (SCS), and one to transcranial magnetic stimulation (TMS). DISCUSSION PTNS and SNM seem to be effective and safe therapeutic options for treating lower urinary tract symptoms in MS patients principally in case of overactive bladder (OAB) symptoms. Similarly, also SCS and TMS have been shown to be effective, despite the very limited number of patients and the small number of studies found in the literature. Interestingly, these techniques are effective even in patients who do not respond well to conservative therapies, such as anticholinergics. Furthermore, given their safety and efficacy, stimulations such as PTNS could be considered as a first-line treatment for OAB in MS patients, also considering that they are often preferred by patients to other commonly used treatments.
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Affiliation(s)
- Martina Pericolini
- Urology Department, Policlinico Tor Vergata, Università Degli Studi di Roma, Rome, Italy.,GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, Hôpital Tenon, Sorbonne Université, Paris, AP-HP, France
| | - Gabriel Miget
- GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, Hôpital Tenon, Sorbonne Université, Paris, AP-HP, France
| | - Claire Hentzen
- GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, Hôpital Tenon, Sorbonne Université, Paris, AP-HP, France
| | - Enrico Finazzi Agrò
- Urology Department, Policlinico Tor Vergata, Università Degli Studi di Roma, Rome, Italy
| | - Camille Chesnel
- GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, Hôpital Tenon, Sorbonne Université, Paris, AP-HP, France
| | - Philippe Lagnau
- GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, Hôpital Tenon, Sorbonne Université, Paris, AP-HP, France
| | - Rebecca Haddad
- GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, Hôpital Tenon, Sorbonne Université, Paris, AP-HP, France
| | - Matthieu Grasland
- GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, Hôpital Tenon, Sorbonne Université, Paris, AP-HP, France
| | - Gerard Amarenco
- GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, Hôpital Tenon, Sorbonne Université, Paris, AP-HP, France
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Dragić M, Zeljković M, Stevanović I, Adžić M, Stekić A, Mihajlović K, Grković I, Ilić N, Ilić TV, Nedeljković N, Ninković M. Downregulation of CD73/A 2AR-Mediated Adenosine Signaling as a Potential Mechanism of Neuroprotective Effects of Theta-Burst Transcranial Magnetic Stimulation in Acute Experimental Autoimmune Encephalomyelitis. Brain Sci 2021; 11:brainsci11060736. [PMID: 34205965 PMCID: PMC8227256 DOI: 10.3390/brainsci11060736] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/12/2021] [Accepted: 05/17/2021] [Indexed: 12/11/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic neurodegenerative disease caused by autoimmune-mediated inflammation in the central nervous system. Purinergic signaling is critically involved in MS-associated neuroinflammation and its most widely applied animal model—experimental autoimmune encephalomyelitis (EAE). A promising but poorly understood approach in the treatment of MS is repetitive transcranial magnetic stimulation. In the present study, we aimed to investigate the effect of continuous theta-burst stimulation (CTBS), applied over frontal cranial bone, on the adenosine-mediated signaling system in EAE, particularly on CD73/A2AR/A1R in the context of neuroinflammatory activation of glial cells. EAE was induced in two-month-old female DA rats and in the disease peak treated with CTBS protocol for ten consecutive days. Lumbosacral spinal cord was analyzed immunohistochemically for adenosine-mediated signaling components and pro- and anti-inflammatory factors. We found downregulated IL-1β and NF- κB-ir and upregulated IL-10 pointing towards a reduction in the neuroinflammatory process in EAE animals after CTBS treatment. Furthermore, CTBS attenuated EAE-induced glial eN/CD73 expression and activity, while inducing a shift in A2AR expression from glia to neurons, contrary to EAE, where tight coupling of eN/CD73 and A2AR on glial cells is observed. Finally, increased glial A1R expression following CTBS supports anti-inflammatory adenosine actions and potentially contributes to the overall neuroprotective effect observed in EAE animals after CTBS treatment.
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Affiliation(s)
- Milorad Dragić
- Department for General Physiology and Biophysics, Faculty of Biology, University of Belgrade, 11000 Belgrade, Serbia; (M.Z.); (M.A.); (A.S.); (K.M.); (N.N.)
- Correspondence:
| | - Milica Zeljković
- Department for General Physiology and Biophysics, Faculty of Biology, University of Belgrade, 11000 Belgrade, Serbia; (M.Z.); (M.A.); (A.S.); (K.M.); (N.N.)
| | - Ivana Stevanović
- Institute for Medical Research, Military Medical Academy, 11000 Belgrade, Serbia; (I.S.); (M.N.)
- Medical Faculty of Military Medical Academy, University of Defense, 11000 Belgrade, Serbia;
| | - Marija Adžić
- Department for General Physiology and Biophysics, Faculty of Biology, University of Belgrade, 11000 Belgrade, Serbia; (M.Z.); (M.A.); (A.S.); (K.M.); (N.N.)
| | - Andjela Stekić
- Department for General Physiology and Biophysics, Faculty of Biology, University of Belgrade, 11000 Belgrade, Serbia; (M.Z.); (M.A.); (A.S.); (K.M.); (N.N.)
| | - Katarina Mihajlović
- Department for General Physiology and Biophysics, Faculty of Biology, University of Belgrade, 11000 Belgrade, Serbia; (M.Z.); (M.A.); (A.S.); (K.M.); (N.N.)
| | - Ivana Grković
- Department of Molecular Biology and Endocrinology, Vinča Institute of Nuclear Sciences-National Institute of the Republic of Serbia, University of Belgrade, 11000 Belgrade, Serbia;
| | - Nela Ilić
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia;
- Clinic of Physical Medicine and Rehabilitation, Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Tihomir V. Ilić
- Medical Faculty of Military Medical Academy, University of Defense, 11000 Belgrade, Serbia;
| | - Nadežda Nedeljković
- Department for General Physiology and Biophysics, Faculty of Biology, University of Belgrade, 11000 Belgrade, Serbia; (M.Z.); (M.A.); (A.S.); (K.M.); (N.N.)
| | - Milica Ninković
- Institute for Medical Research, Military Medical Academy, 11000 Belgrade, Serbia; (I.S.); (M.N.)
- Medical Faculty of Military Medical Academy, University of Defense, 11000 Belgrade, Serbia;
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Tran K, Shi Z, Karmonik C, John B, Rajab H, Helekar SA, Boone T, Khavari R. Therapeutic effects of non-invasive, individualized, transcranial neuromodulation treatment for voiding dysfunction in multiple sclerosis patients: study protocol for a pilot clinical trial. Pilot Feasibility Stud 2021; 7:83. [PMID: 33757581 PMCID: PMC7989407 DOI: 10.1186/s40814-021-00825-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/15/2021] [Indexed: 11/21/2022] Open
Abstract
Background Voiding dysfunction (VD) is a common neurogenic lower urinary tract dysfunction (NLUTD) in multiple sclerosis (MS) patients. Currently, the only effective management for VD and urinary retention in MS patients is catheterization, prompting us to look for novel therapeutic options beyond the bladder, such as the brain. Transcranial rotating permanent magnet stimulator (TRPMS) is a non-invasive, portable, multifocal neuromodulator that simultaneously modulates multiple cortical regions, enhancing or attenuating strengths of functional connections between these regions. The objective of this pilot clinical trial is to evaluate the feasibility of a TRPMS trial to address lower urinary tract symptoms in MS patients, through investigating the therapeutic effects of TRPMS in modulating brain regions during voiding initiation and mitigating VD in female MS individuals. Methods Ten adult female MS patients with VD (defined as having %post-void residual/bladder capacity (%PVR/BC) ≥ 40% or Liverpool nomogram percentile < 10%) will be recruited for this study. Concurrent urodynamic and functional MRI evaluation with a bladder filling/emptying task repeated three to four times will be performed at baseline and post-treatment. Predetermined regions of interest and their blood-oxygen-level-dependent (BOLD) activation at voiding initiation will be identified on each patient’s baseline anatomical and functional MRI scan, corresponding to the microstimulators placement on their individualized TRPMS treatment cap to either stimulate or inhibit these regions. Patients will receive 10 40-min treatment sessions. Non-instrumented uroflow and validated questionnaires will also be collected at baseline and post-treatment to evaluate clinical improvement. Discussion Despite the crucial role of the central nervous system in urinary control and its sensitivity to MS, there has been no treatment for urinary dysfunction targeting the brain centers that are involved in proper bladder function. This trial, to our knowledge, will be the first of its kind in humans to consider non-invasive and individualized cortical modulation for treating VD in MS patients. Results from this study will provide a better understanding of the brain control of neurogenic bladders and lay the foundation for a potential alternative therapy for VD in MS patients and other NLUTD in a larger neurogenic population in the future. Trial registration This trial is registered at ClinicalTrials.Gov (NCT03574610, 2 July 2018.) and Houston Methodist Research Institute IRB (PRO00019329)
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Affiliation(s)
- Khue Tran
- Department of Urology, Houston Methodist Hospital, 6560 Fannin St. Suite 2100, Houston, TX, 77030, USA
| | - Zhaoyue Shi
- Translational Imaging Center, Houston Methodist Research Institute, Houston, TX, USA
| | - Christof Karmonik
- Translational Imaging Center, Houston Methodist Research Institute, Houston, TX, USA
| | - Blessy John
- Department of Neurology, Houston Methodist Hospital, Houston, TX, USA
| | - Hamida Rajab
- Department of Urology, Houston Methodist Hospital, 6560 Fannin St. Suite 2100, Houston, TX, 77030, USA
| | - Santosh A Helekar
- Department of Neurosurgery, Houston Methodist Hospital, Houston, TX, USA
| | - Timothy Boone
- Department of Urology, Houston Methodist Hospital, 6560 Fannin St. Suite 2100, Houston, TX, 77030, USA
| | - Rose Khavari
- Department of Urology, Houston Methodist Hospital, 6560 Fannin St. Suite 2100, Houston, TX, 77030, USA.
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Choi EH, Nwakalor C, Brown NJ, Lee J, Oh MY, Yang IH. Therapeutic potential of neuromodulation for demyelinating diseases. Neural Regen Res 2021; 16:214-217. [PMID: 32859766 PMCID: PMC7896214 DOI: 10.4103/1673-5374.290876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Neuromodulation represents a cutting edge class of both invasive and non-invasive therapeutic methods which alter the activity of neurons. Currently, several different techniques have been developed - or are currently being investigated – to treat a wide variety of neurological and neuropsychiatric disorders. Recently, in vivo and in vitro studies have revealed that neuromodulation can also induce myelination, meaning that it could hold potential as a therapy for various demyelinating diseases including multiple sclerosis and progressive multifocal leukencepalopathy. These findings come on the heels of a paradigm shift in the view of myelin’s role within the nervous system from a static structure to an active co-regulator of central nervous system plasticity and participant in neuron-mediated modulation. In the present review, we highlight several of the recent findings regarding the role of neural activity in altering myelination including several soluble and contact-dependent factors that seem to mediate neural activity-dependent myelination. We also highlight several considerations for neuromodulatory techniques, including the need for further research into spatiotemporal precision, dosage, and the safety and efficacy of transcranial focused ultrasound stimulation, an emerging neuromodulation technology. As the field of neuromodulation continues to evolve, it could potentially bring forth methods for the treatment of demyelinating diseases, and as such, further investigation into the mechanisms of neuron-dependent myelination as well as neuro-imaging modalities that can monitor myelination activity is warranted.
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Affiliation(s)
- Elliot H Choi
- Department of Pharmacology, School of Medicine, Case Western Reserve University, Cleveland, OH; Department of Ophthalmology, Gavin Herbert Eye Institute, School of Medicine, University of California; Department of Neurological Surgery, University of California, Irvine, CA, USA
| | - Chioma Nwakalor
- Department of Mechanical Engineering and Engineering Science, Center for Biomedical Engineering and Science, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Nolan J Brown
- Department of Neurological Surgery, University of California, Irvine, CA, USA
| | - Joonho Lee
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Michael Y Oh
- Department of Neurological Surgery, University of California, Irvine, CA, USA
| | - In Hong Yang
- Department of Mechanical Engineering and Engineering Science, Center for Biomedical Engineering and Science, University of North Carolina at Charlotte, Charlotte, NC, USA
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Abstract
The function of the lower urinary tract is mainly storage and voiding of urine, which is coordinated by the nervous system. Various diseases of the nervous system may cause neuro-urological symptoms. Neuro-urological symptoms depend on the localization of the disease and the extension of the neurological lesion. About 80% of multiple sclerosis (MS) patients have neuro-urological symptoms within 10 years after diagnosis. In addition, 10% of MS patients may even present with voiding dysfunction at disease onset. In this review, different types of neuromodulation are discussed. The available studies suggest that sacral neuromodulation (SNM) and percutaneous tibial nerve stimulation (PTNS) may be helpful in the neuromodulation of MS-related overactive bladder symptoms. These techniques may not only decrease the severity of symptoms but also significantly improve the quality of life of affected patients. Exploring the role of implantable tibial nerve stimulation devices in patients with MS could open new doors in the management of urgency and urgency incontinence in this patient group.
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Affiliation(s)
- Mohammad Sajjad Rahnama'i
- Department of Urology, Uniklinik RWTH Aachen, Aachen, Germany/Society of Urological Research and Education (SURE), Heerlen, The Netherlands
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30
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Transcranial magnetic stimulation and bladder function: A systematic review. Clin Neurophysiol 2019; 130:2032-2037. [PMID: 31541980 DOI: 10.1016/j.clinph.2019.08.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 08/10/2019] [Accepted: 08/22/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We aimed at assessing the usefulness of motor evoked potentials (MEPs) for exploring the integrity of striated sphincters and pelvic floor motor innervation in normal subjects and of repetitive transcranial magnetic stimulation TMS (rTMS) in patients with neurogenic bladder dysfunction. METHODS A systematic literature search was conducted using PubMed and Embase. RESULTS We identified, reviewed and discussed 11 articles matching the inclusion criteria. CONCLUSIONS The assessment of MEPs could represent a useful tool in the investigation of patients with urologic disorders. High frequency rTMS can improve detrusor contraction and/or urethral sphincter relaxation in patients with multiple sclerosis and bladder dysfunction. Low frequency (LF) rTMS seems to be an effective treatment of neurogenic lower urinary tract dysfunctions in subjects with Parkinson's disease and possibly other neurodegenerative disorders. Furthermore, rTMS might have the potential to restore bladder and bowel sphincter function after incomplete spinal cord injury. LF rTMS could also relieve some symptoms of bladder pain syndrome and chronic pelvic pain. SIGNIFICANCE The clinical applicability of MEPs appears to be questionable, since a poor reproducibility was detected for all pelvic floor muscles. The use of rTMS in this field is emerging and the results of a few preliminary studies should be replicated in controlled, randomized studies with larger sample sizes.
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Coolen RL, Groen J, Blok B. Electrical stimulation in the treatment of bladder dysfunction: technology update. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2019; 12:337-345. [PMID: 31572023 PMCID: PMC6750158 DOI: 10.2147/mder.s179898] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/24/2019] [Indexed: 01/24/2023] Open
Abstract
The urinary bladder has two functions: urine storage and voiding. Clinically, two major categories of lower urinary tract symptoms can be defined: storage symptoms such as incontinence and urgency, and voiding symptoms such as feeling of incomplete bladder emptying and slow urinary stream. Urgency to void with or without incontinence is called overactive bladder (OAB). Slow urinary stream, hesitancy, and straining to void with the feeling of incomplete bladder emptying are often called underactive bladder (UAB). The underlying causes of OAB or UAB can be either non-neurogenic (also referred to as idiopathic) and neurogenic, for example due to spinal cord injury or multiple sclerosis. OAB and UAB can be treated conservatively by lifestyle intervention or medication. In the case that conservative treatment does not provide sufficient benefit, electrical stimulation can be used. Sacral neurostimulation or neuromodulation (SNM) is offered as a third-line therapy to patients with non-neurogenic OAB or UAB. In SNM, the third or fourth sacral nerve root is stimulated and after a test period, a neuromodulator is implanted in the buttock. Until recently only a non-rechargeable neuromodulator was approved for clinical use. However, nowadays, a rechargeable sacral neuromodulator is also on the market, with similar safety and effectiveness to the non-rechargeable SNM system. The rechargeable device was approved for full body 1.5T and 3T MRI in Europe in February 2019. Regarding neurogenic lower urinary tract dysfunction, electrical stimulation only seems to benefit a selected group of patients.
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Affiliation(s)
- R L Coolen
- Department of Urology, Erasmus Medical Center, Rotterdam 3015 GD, The Netherlands
| | - J Groen
- Department of Urology, Erasmus Medical Center, Rotterdam 3015 GD, The Netherlands
| | - Bfm Blok
- Department of Urology, Erasmus Medical Center, Rotterdam 3015 GD, The Netherlands
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Leocani L, Chieffo R, Gentile A, Centonze D. Beyond rehabilitation in MS: Insights from non-invasive brain stimulation. Mult Scler 2019; 25:1363-1371. [PMID: 31469356 DOI: 10.1177/1352458519865734] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Although the number of disease-modifying treatments for people with multiple sclerosis (pwMS) has meaningfully increased in the past years, targeting repair or compensation for central nervous system damage associated with the disease process remains an important clinical goal. With this aim, neurorehabilitation is a powerful approach targeting central nervous system plasticity. Another driver of brain plasticity is non-invasive brain stimulation (NIBS), receiving recent attention in neurology, particularly for its potential synergy with neurorehabilitation and as add-on treatment for several neurological conditions, from pain to fatigue to sensorimotor and cognitive deficits. In this review, we will resume the evidence exploring the neurobiological basis of NIBS and its applications to MS-related conditions.
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Affiliation(s)
- Letizia Leocani
- Neurorehabilitation Unit and INSPE-Institute of Experimental Neurology, San Raffaele Hospital, Milan, Italy/Vita-Salute San Raffaele University, Milan, Italy
| | - Raffaella Chieffo
- Neurorehabilitation Unit and INSPE-Institute of Experimental Neurology, San Raffaele Hospital, Milan, Italy
| | - Antonietta Gentile
- Synaptic Immunopathology Lab, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Diego Centonze
- Synaptic Immunopathology Lab, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy/Neurology Unit, IRCCS Neuromed, Pozzilli, Italy
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[Interest of transcranial stimulation in pelvic and perineal disorders]. Prog Urol 2019; 29:349-359. [PMID: 31036483 DOI: 10.1016/j.purol.2019.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/26/2019] [Accepted: 03/08/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this article was to describe the diagnostic and therapeutic value of transcranial stimulation in pelvic and perineal disorders. METHODS A literature review (Medline database and Google scholar) with no time limit was performed using keywords: "transcranial direct stimulation", "transcranial magnetic stimulation", "neurogenic bladder", "urinary incontinence", "Parkinson disease", "multiple sclerosis", "stroke", "muscle spasticity", "pelvic pain", "visceral pain". RESULTS Twelve articles have been selected. Transcranial magnetic or electrical stimulation is a noninvasive neuromodulation technique widely used to establish brain maps to highlight causal relationships between brain and function. Regarding pelvic-perineal disorders, repeated transcranial stimulation has shown significant effects for the treatment of overactive bladder in Parkinson's disease (P<0.05) and multiple sclerosis, but also for the treatment of refractory chronic pelvic pain (P=0.026). Finally, therapeutic effects have also been demonstrated in irritable bowel syndrome. No evidence of efficacy was found on genito-sexual disorders. CONCLUSION Data from the literature suggest that transcranial stimulation is a noninvasive treatment that may have a role in the management of pelvic and perineal disorders. Its promising field of action would require prospective and randomized studies on a larger scale.
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Ortiz FC, Habermacher C, Graciarena M, Houry PY, Nishiyama A, Oumesmar BN, Angulo MC. Neuronal activity in vivo enhances functional myelin repair. JCI Insight 2019; 5:123434. [PMID: 30896448 PMCID: PMC6538342 DOI: 10.1172/jci.insight.123434] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 03/19/2019] [Indexed: 11/17/2022] Open
Abstract
In demyelinating diseases such as Multiple Sclerosis (MS), demyelination of neuronal fibers impairs impulse conduction and causes axon degeneration. While neuronal activity stimulates oligodendrocyte production and myelination in normal conditions, it remains unclear whether the activity of demyelinated axons restores their loss-of-function in a harmful environment. To investigate this question, we established a model to induce a moderate optogenetic stimulation of demyelinated axons in the corpus callosum at the level of the motor cortex in which cortical circuit activation and locomotor effects were reduced in adult freely moving mice. We demonstrate that a moderate activation of demyelinated axons enhances the differentiation of oligodendrocyte precursor cells onto mature oligodendrocytes, but only under a repeated stimulation paradigm. This activity-dependent increase in the oligodendrocyte pool promotes an extensive remyelination and functional restoration of conduction, as revealed by ultrastructural analyses and compound action potential recordings. Our findings reveal the need of preserving an appropriate neuronal activity in the damaged tissue to promote oligodendrocyte differentiation and remyelination, likely by enhancing axon-oligodendroglia interactions. Our results provide new perspectives for translational research using neuromodulation in demyelinating diseases.
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Affiliation(s)
- Fernando C. Ortiz
- INSERM U1128, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Instituto de Ciencias Biomédicas, Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Santiago, Chile
| | - Chloé Habermacher
- INSERM U1128, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France
| | - Mariana Graciarena
- Institut du Cerveau et de la Moelle épinière, Sorbonne Université, INSERM U1127, CNRS UMR 7225, Paris, France
| | - Pierre-Yves Houry
- INSERM U1128, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Akiko Nishiyama
- Department of Physiology and Neurobiology, University of Connecticut, Storrs, Connecticut, USA
| | - Brahim Nait Oumesmar
- Institut du Cerveau et de la Moelle épinière, Sorbonne Université, INSERM U1127, CNRS UMR 7225, Paris, France
| | - María Cecilia Angulo
- INSERM U1128, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France
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Abstract
PURPOSE OF REVIEW Voiding dysfunction (VD) is morbid, costly, and leads to urinary tract infections, stones, sepsis, and permanent renal failure. Evaluation and diagnosis of VD in non-obstructed patients can be challenging. Potential diagnostic and therapeutic options beyond the bladder, such as brain centers involved in voiding have been proposed as promising targets. This review focuses on current and future applications of functional neuroimaging in human in voiding and in patients with VD. RECENT FINDINGS The current understanding of brain centers, and their roles in initiating, maintaining and/or modulating voiding, is rudimentary in humans and in patients with VD. With the advent and advancement in functional neuroimaging we are gaining more insight into specific brain regions involved in the voiding phase of micturition. In healthy individuals, right dorsomedial pontine tegmentum, periaqueductal grey, hypothalamus, and the inferior, medial and superior frontal gyrus have been identified as regions of interest in voiding. SUMMARY Functional neuroimaging could suggest new diagnostic methods and provides crucial steps towards therapeutic options for the morbid and intractable VD condition, in patients with neurogenic (e.g. MS or Strokes) or non-neurogenic VD (e.g. underactive bladder or Fowler's syndrome).
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Affiliation(s)
- Rose Khavari
- Department of Urology, Houston Methodist Hospital, 6560 Fannin St. Suite 2100, Houston, TX, 77030
| | - Timothy B. Boone
- Department of Urology, Houston Methodist Hospital, 6560 Fannin St. Suite 2100, Houston, TX, 77030
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Şan AU, Yılmaz B, Kesikburun S. The Effect of Repetitive Transcranial Magnetic Stimulation on Spasticity in Patients with Multiple Sclerosis. J Clin Neurol 2019; 15:461-467. [PMID: 31591833 PMCID: PMC6785483 DOI: 10.3988/jcn.2019.15.4.461] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/02/2019] [Accepted: 04/02/2019] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose This randomized controlled study examined the effect of repetitive transcranial magnetic stimulation (rTMS) on spasticity in patients with multiple sclerosis (MS). Methods This study included 16 patients with a history of MS and spasticity in the adductor hip muscles according to the Modified Ashworth Scale (MAS). The participants were randomized into the active group (n=10) and control group (n=6), in which active rTMS and sham rTMS were applied in 10 sessions, respectively. A physical therapy and rehabilitation program was applied along with rTMS sessions in both groups. The evaluation parameters were assessed at baseline and then 1 week and 1 month after applying rTMS. Results Statistical analyses with post-hoc correction revealed statistically significant improvements in the active group compared to the control group in the bilateral MAS score, Penn Spasm Frequency Scale score, patient satisfaction, amount of urine leakage, actual health status, perceived health status, energy and fatigue, role limitations due to physical problems, social function, overall quality of life, cognitive functioning, physical health composite score, mental health composite score, and total score on the Multiple Sclerosis Quality of Life-54 (MSQOL-54) (p<0.05). Statistically significant changes were detected in the MSQOL-54 social function and physical health composite scores of patients in the control group (p<0.05). Conclusions Active rTMS combined with a physical therapy program reduced spasticity in MS patients compared to the control group that received only physical therapy. Further comprehensive and more advanced studies are needed to confirm the present findings.
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Affiliation(s)
- Ayça Uran Şan
- Department of Physical Rehabilitation Medicine, Karabuk University Karabuk Training and Research Hospital, Karabuk, Turkey.
| | - Bilge Yılmaz
- Department of Physical Rehabilitation Medicine, Health Sciences University, Gulhane School of Medicine, Ankara, Turkey
| | - Serdar Kesikburun
- Department of Physical Rehabilitation Medicine, Health Sciences University, Gulhane School of Medicine, Ankara, Turkey
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Abstract
Neuromodulation, or the utilization of advanced technology for targeted electrical or chemical neuronal stimulation or inhibition, has been expanding in several neurological subspecialties. In the past decades, immune-modulating therapy has been the main focus of multiple sclerosis (MS) research with little attention to neuromodulation. However, with the recent advances in disease-modifying therapies, it is time to shift the focus of MS research to neuromodulation and restoration of function as with other neurological subspecialties. Preliminary research supports the value of intrathecal baclofen pump and functional electrical stimulation in improving spasticity and motor function in MS patients. Deep brain stimulation can improve MS-related tremor and trigeminal neuralgia. Spinal cord stimulation has been shown to be effective against MS-related pain and bladder dysfunction. Bladder overactivity also responds to sacral neuromodulation and posterior tibial nerve stimulation. Despite limited data in MS, transcranial magnetic stimulation and brain-computer interface are promising neuromodulatory techniques for symptom mitigation and neurorehabilitation of MS patients. In this review, we provide an overview of the available neuromodulatory techniques and the evidence for their use in MS.
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Affiliation(s)
- Hesham Abboud
- Multiple Sclerosis and Neuroimmunology Program, University Hospitals of Cleveland, Cleveland, OH, USA/School of Medicine, Case Western Reserve University, Cleveland, OH, USA/Neurology Department, Alexandria University, Alexandria, Egypt
| | - Eddie Hill
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Junaid Siddiqui
- Movement Disorders, University of Missouri- School of Medicine, Columbia, MO, USA
| | - Alessandro Serra
- Multiple Sclerosis and Neuroimmunology Program, University Hospitals of Cleveland, Cleveland, OH, USA/School of Medicine, Case Western Reserve University, Cleveland, OH, USA/Multiple Sclerosis Center of Excellence, Cleveland VA Medical Center Hub Site, East Cleveland, OH, USA
| | - Benjamin Walter
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA/Parkinson's and Movement Disorders Center, University Hospitals of Cleveland, Cleveland, OH, USA
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Iodice R, Manganelli F, Dubbioso R. The therapeutic use of non-invasive brain stimulation in multiple sclerosis - a review. Restor Neurol Neurosci 2018; 35:497-509. [PMID: 28984619 DOI: 10.3233/rnn-170735] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system and a leading cause of disability in young adults. Many disabling symptoms in MS, such as spasticity, pain, depression and cognitive deficits are not fully controlled by drug treatment. Non-invasive brain stimulation (NIBS) techniques can be used as tools for modulating altered cortical excitability and plasticity MS patients, providing an improvement in disabling symptoms affecting such patients. OBJECTIVE This review reported and summarized some of the most interesting and promising recent achievements regarding the therapeutic use of NIBS in MS patients. METHODS We reviewed the clinical application of transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), emphasizing their effect on clinical symptoms and signs that are commonly involved in MS patients. In addition, we shortly described new NIBS protocols, such as transcranial alternating current stimulation and transcranial focused ultrasound stimulation as potential and innovative therapeutic options to be applied in future studies in MS patients. RESULTS We reviewed twenty-one studies covering six main clinical domains. Most of such studies focused on fatigues (33.3%), motor performance (19%) and spasticity (19%), sparse results were about pain (9.5%), cognitive abilities (9.5%), sensory deficit (4.8%) and bladder function (4.8%). The most promising results have been published for the improvement of motor (i.e. hand dexterity) and cognitive performances (i.e. attention and working memory) by applying rTMS or tDCS alone or in association with motor/cognitive training, for pain's treatment by using tDCS. CONCLUSION There are still no official recommendations for the therapeutic use of tDCS or rTMS in MS. The huge inter-individual variability of NIBS efficacy is still a big challenge which needs to be solved. However, well-designed studies, deeper knowledge about pathomechanisms underlying MS, and the combination of such techniques with motor and cognitive rehabilitation might results in higher effectiveness of NIBS.
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Affiliation(s)
- Rosa Iodice
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Italy
| | - Fiore Manganelli
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Italy
| | - Raffaele Dubbioso
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Italy
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Cervigni M, Onesti E, Ceccanti M, Gori MC, Tartaglia G, Campagna G, Panico G, Vacca L, Cambieri C, Libonati L, Inghilleri M. Repetitive transcranial magnetic stimulation for chronic neuropathic pain in patients with bladder pain syndrome/interstitial cystitis. Neurourol Urodyn 2018; 37:2678-2687. [DOI: 10.1002/nau.23718] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 05/06/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Mauro Cervigni
- Department of Women's Health and Newborns; Interstitial Cystitis Referral Center; University Hospital Foundation A. Gemelli; Rome Italy
| | - Emanuela Onesti
- Department of Human Neuroscience; Rare Neuromuscular Diseases Centre; Sapienza University; Rome Italy
| | - Marco Ceccanti
- Department of Human Neuroscience; Rare Neuromuscular Diseases Centre; Sapienza University; Rome Italy
| | - Maria C. Gori
- Department of Human Neuroscience; Rare Neuromuscular Diseases Centre; Sapienza University; Rome Italy
| | - Giorgio Tartaglia
- Department of Human Neuroscience; Rare Neuromuscular Diseases Centre; Sapienza University; Rome Italy
| | - Giuseppe Campagna
- Department of Women's Health and Newborns; Interstitial Cystitis Referral Center; University Hospital Foundation A. Gemelli; Rome Italy
| | - Giovanni Panico
- Department of Women's Health and Newborns; Interstitial Cystitis Referral Center; University Hospital Foundation A. Gemelli; Rome Italy
| | - Lorenzo Vacca
- Department of Women's Health and Newborns; Interstitial Cystitis Referral Center; University Hospital Foundation A. Gemelli; Rome Italy
| | - Chiara Cambieri
- Department of Human Neuroscience; Rare Neuromuscular Diseases Centre; Sapienza University; Rome Italy
| | - Laura Libonati
- Department of Human Neuroscience; Rare Neuromuscular Diseases Centre; Sapienza University; Rome Italy
| | - Maurizio Inghilleri
- Department of Human Neuroscience; Rare Neuromuscular Diseases Centre; Sapienza University; Rome Italy
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Abstract
Depressive disorders are common in patients with multiple sclerosis, influencing their quality of life and adherence to treatments, as well as becoming more frequent with the progression of the disease and in the secondary progressive form of multiple sclerosis. Patients with multiple sclerosis often experience a typical cluster of symptoms in association with depression, such as fatigue, pain and cognitive impairment. However, the pathogenesis of multiple sclerosis-related depression remains partially unclear, even though genetic, immune-inflammatory and psychosocial factors might be seen to play a role, in addition to the brain structural alterations documented by magnetic resonance imaging studies. The high incidence and burden of depression in people affected with multiple sclerosis are matters of crucial importance. Despite such importance, the efficacy of pharmacologic treatments has been poorly studied and, for the most part, the access to non-pharmacological treatments is partially dependent on the local health system availability. It has been determined that interferon-beta and glatiramer acetate do not cause depressive symptoms; however, no definitive data in this regard are avaible for the newer disease-modifyng medications. In this review, we discuss the diagnosis, prevalence, pathogenesis, clinical aspects, magnetic resonance imaging findings and treatments available in patients experiencing multiple sclerosis-related depression.
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Repetitive Transcranial Magnetic Stimulation, Cognition, and Multiple Sclerosis: An Overview. Behav Neurol 2018; 2018:8584653. [PMID: 29568339 PMCID: PMC5822759 DOI: 10.1155/2018/8584653] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 12/07/2017] [Indexed: 11/30/2022] Open
Abstract
Multiple sclerosis (MS) affects cognition in the majority of patients. A major aspect of the disease is brain volume loss (BVL), present in all phases and types (relapsing and progressive) of the disease and linked to both motor and cognitive disabilities. Due to the lack of effective pharmacological treatments for cognition, cognitive rehabilitation and other nonpharmacological interventions such as repetitive transcranial magnetic stimulation (rTMS) have recently emerged and their potential role in functional connectivity is studied. With recently developed advanced neuroimaging and neurophysiological techniques, changes related to alterations of the brain's functional connectivity can be detected. In this overview, we focus on the brain's functional reorganization in MS, theoretical and practical aspects of rTMS utilization in humans, and its potential therapeutic role in treating cognitively impaired MS patients.
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Stampanoni Bassi M, Gilio L, Buttari F, Maffei P, Marfia GA, Restivo DA, Centonze D, Iezzi E. Remodeling Functional Connectivity in Multiple Sclerosis: A Challenging Therapeutic Approach. Front Neurosci 2017; 11:710. [PMID: 29321723 PMCID: PMC5733539 DOI: 10.3389/fnins.2017.00710] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 12/04/2017] [Indexed: 11/13/2022] Open
Abstract
Neurons in the central nervous system are organized in functional units interconnected to form complex networks. Acute and chronic brain damage disrupts brain connectivity producing neurological signs and/or symptoms. In several neurological diseases, particularly in Multiple Sclerosis (MS), structural imaging studies cannot always demonstrate a clear association between lesion site and clinical disability, originating the "clinico-radiological paradox." The discrepancy between structural damage and disability can be explained by a complex network perspective. Both brain networks architecture and synaptic plasticity may play important roles in modulating brain networks efficiency after brain damage. In particular, long-term potentiation (LTP) may occur in surviving neurons to compensate network disconnection. In MS, inflammatory cytokines dramatically interfere with synaptic transmission and plasticity. Importantly, in addition to acute and chronic structural damage, inflammation could contribute to reduce brain networks efficiency in MS leading to worse clinical recovery after a relapse and worse disease progression. These evidence suggest that removing inflammation should represent the main therapeutic target in MS; moreover, as synaptic plasticity is particularly altered by inflammation, specific strategies aimed at promoting LTP mechanisms could be effective for enhancing clinical recovery. Modulation of plasticity with different non-invasive brain stimulation (NIBS) techniques has been used to promote recovery of MS symptoms. Better knowledge of features inducing brain disconnection in MS is crucial to design specific strategies to promote recovery and use NIBS with an increasingly tailored approach.
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Affiliation(s)
- Mario Stampanoni Bassi
- Unit of Neurology & Unit of Neurorehabilitation, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy.,Multiple Sclerosis Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Luana Gilio
- Unit of Neurology & Unit of Neurorehabilitation, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy.,Multiple Sclerosis Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Fabio Buttari
- Unit of Neurology & Unit of Neurorehabilitation, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy.,Multiple Sclerosis Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Pierpaolo Maffei
- Unit of Neurology & Unit of Neurorehabilitation, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
| | - Girolama A Marfia
- Multiple Sclerosis Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | | | - Diego Centonze
- Unit of Neurology & Unit of Neurorehabilitation, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy.,Multiple Sclerosis Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Ennio Iezzi
- Unit of Neurology & Unit of Neurorehabilitation, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
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Gaede G, Tiede M, Lorenz I, Brandt AU, Pfueller C, Dörr J, Bellmann-Strobl J, Piper SK, Roth Y, Zangen A, Schippling S, Paul F. Safety and preliminary efficacy of deep transcranial magnetic stimulation in MS-related fatigue. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2017; 5:e423. [PMID: 29259998 PMCID: PMC5730816 DOI: 10.1212/nxi.0000000000000423] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 09/06/2017] [Indexed: 11/23/2022]
Abstract
Objective: To conduct a randomized, sham-controlled phase I/IIa study to evaluate the safety and preliminary efficacy of deep brain H-coil repetitive transcranial magnetic stimulation (rTMS) over the prefrontal cortex (PFC) and the primary motor cortex (MC) in patients with MS with fatigue or depression (NCT01106365). Methods: Thirty-three patients with MS were recruited to undergo 18 consecutive rTMS sessions over 6 weeks, followed by follow-up (FU) assessments over 6 weeks. Patients were randomized to receive high-frequency stimulation of the left PFC, MC, or sham stimulation. Primary end point was the safety of stimulation. Preliminary efficacy was assessed based on changes in Fatigue Severity Scale (FSS) and Beck Depression Inventory scores. Randomization allowed only analysis of preliminary efficacy for fatigue. Results: No serious adverse events were observed. Five patients terminated participation during treatment due to mild side effects. Treatment resulted in a significant median FSS decrease of 1.0 point (95%CI [0.45,1.65]), which was sustained during FU. Conclusions: H-coil rTMS is safe and well tolerated in patients with MS. The observed sustained reduction in fatigue after subthreshold MC stimulation warrants further investigation. ClinicalTrials.gov identifier: NCT01106365. Classification of evidence: This study provides Class III evidence that rTMS of the prefrontal or primary MC is not associated with serious adverse effects, although this study is underpowered to state this with any precision.
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Affiliation(s)
- Gunnar Gaede
- NeuroCure Clinical Research Center (G.G., A.U.B., C.P., J.D., J.B.-S., S.K.P., F.P.), Center for Stroke Research Berlin (CSB) (S.K.P.), Experimental and Clinical Research Center (J.B.-S., F.P.), and Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité-Universitätsmedizin Berlin, Germany; Institute of Neuroimmunology and Multiple Sclerosis (M.T., I.L., S.S.), University Medical Centre Hamburg-Eppendorf, Germany; Department of Life Sciences (Y.R., A.Z.), Ben-Gurion University, Beer-Sheva, Israel; and Max-Delbrück Center for Molecular Medicine (F.P.), Berlin, Germany. G.G. and C.P. are now with St. Joseph Krankenhaus-Berlin-Weissensee, Germany. S.S. is now with Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland
| | - Marina Tiede
- NeuroCure Clinical Research Center (G.G., A.U.B., C.P., J.D., J.B.-S., S.K.P., F.P.), Center for Stroke Research Berlin (CSB) (S.K.P.), Experimental and Clinical Research Center (J.B.-S., F.P.), and Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité-Universitätsmedizin Berlin, Germany; Institute of Neuroimmunology and Multiple Sclerosis (M.T., I.L., S.S.), University Medical Centre Hamburg-Eppendorf, Germany; Department of Life Sciences (Y.R., A.Z.), Ben-Gurion University, Beer-Sheva, Israel; and Max-Delbrück Center for Molecular Medicine (F.P.), Berlin, Germany. G.G. and C.P. are now with St. Joseph Krankenhaus-Berlin-Weissensee, Germany. S.S. is now with Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland
| | - Ina Lorenz
- NeuroCure Clinical Research Center (G.G., A.U.B., C.P., J.D., J.B.-S., S.K.P., F.P.), Center for Stroke Research Berlin (CSB) (S.K.P.), Experimental and Clinical Research Center (J.B.-S., F.P.), and Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité-Universitätsmedizin Berlin, Germany; Institute of Neuroimmunology and Multiple Sclerosis (M.T., I.L., S.S.), University Medical Centre Hamburg-Eppendorf, Germany; Department of Life Sciences (Y.R., A.Z.), Ben-Gurion University, Beer-Sheva, Israel; and Max-Delbrück Center for Molecular Medicine (F.P.), Berlin, Germany. G.G. and C.P. are now with St. Joseph Krankenhaus-Berlin-Weissensee, Germany. S.S. is now with Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland
| | - Alexander U Brandt
- NeuroCure Clinical Research Center (G.G., A.U.B., C.P., J.D., J.B.-S., S.K.P., F.P.), Center for Stroke Research Berlin (CSB) (S.K.P.), Experimental and Clinical Research Center (J.B.-S., F.P.), and Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité-Universitätsmedizin Berlin, Germany; Institute of Neuroimmunology and Multiple Sclerosis (M.T., I.L., S.S.), University Medical Centre Hamburg-Eppendorf, Germany; Department of Life Sciences (Y.R., A.Z.), Ben-Gurion University, Beer-Sheva, Israel; and Max-Delbrück Center for Molecular Medicine (F.P.), Berlin, Germany. G.G. and C.P. are now with St. Joseph Krankenhaus-Berlin-Weissensee, Germany. S.S. is now with Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland
| | - Caspar Pfueller
- NeuroCure Clinical Research Center (G.G., A.U.B., C.P., J.D., J.B.-S., S.K.P., F.P.), Center for Stroke Research Berlin (CSB) (S.K.P.), Experimental and Clinical Research Center (J.B.-S., F.P.), and Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité-Universitätsmedizin Berlin, Germany; Institute of Neuroimmunology and Multiple Sclerosis (M.T., I.L., S.S.), University Medical Centre Hamburg-Eppendorf, Germany; Department of Life Sciences (Y.R., A.Z.), Ben-Gurion University, Beer-Sheva, Israel; and Max-Delbrück Center for Molecular Medicine (F.P.), Berlin, Germany. G.G. and C.P. are now with St. Joseph Krankenhaus-Berlin-Weissensee, Germany. S.S. is now with Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland
| | - Jan Dörr
- NeuroCure Clinical Research Center (G.G., A.U.B., C.P., J.D., J.B.-S., S.K.P., F.P.), Center for Stroke Research Berlin (CSB) (S.K.P.), Experimental and Clinical Research Center (J.B.-S., F.P.), and Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité-Universitätsmedizin Berlin, Germany; Institute of Neuroimmunology and Multiple Sclerosis (M.T., I.L., S.S.), University Medical Centre Hamburg-Eppendorf, Germany; Department of Life Sciences (Y.R., A.Z.), Ben-Gurion University, Beer-Sheva, Israel; and Max-Delbrück Center for Molecular Medicine (F.P.), Berlin, Germany. G.G. and C.P. are now with St. Joseph Krankenhaus-Berlin-Weissensee, Germany. S.S. is now with Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland
| | - Judith Bellmann-Strobl
- NeuroCure Clinical Research Center (G.G., A.U.B., C.P., J.D., J.B.-S., S.K.P., F.P.), Center for Stroke Research Berlin (CSB) (S.K.P.), Experimental and Clinical Research Center (J.B.-S., F.P.), and Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité-Universitätsmedizin Berlin, Germany; Institute of Neuroimmunology and Multiple Sclerosis (M.T., I.L., S.S.), University Medical Centre Hamburg-Eppendorf, Germany; Department of Life Sciences (Y.R., A.Z.), Ben-Gurion University, Beer-Sheva, Israel; and Max-Delbrück Center for Molecular Medicine (F.P.), Berlin, Germany. G.G. and C.P. are now with St. Joseph Krankenhaus-Berlin-Weissensee, Germany. S.S. is now with Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland
| | - Sophie K Piper
- NeuroCure Clinical Research Center (G.G., A.U.B., C.P., J.D., J.B.-S., S.K.P., F.P.), Center for Stroke Research Berlin (CSB) (S.K.P.), Experimental and Clinical Research Center (J.B.-S., F.P.), and Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité-Universitätsmedizin Berlin, Germany; Institute of Neuroimmunology and Multiple Sclerosis (M.T., I.L., S.S.), University Medical Centre Hamburg-Eppendorf, Germany; Department of Life Sciences (Y.R., A.Z.), Ben-Gurion University, Beer-Sheva, Israel; and Max-Delbrück Center for Molecular Medicine (F.P.), Berlin, Germany. G.G. and C.P. are now with St. Joseph Krankenhaus-Berlin-Weissensee, Germany. S.S. is now with Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland
| | - Yiftach Roth
- NeuroCure Clinical Research Center (G.G., A.U.B., C.P., J.D., J.B.-S., S.K.P., F.P.), Center for Stroke Research Berlin (CSB) (S.K.P.), Experimental and Clinical Research Center (J.B.-S., F.P.), and Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité-Universitätsmedizin Berlin, Germany; Institute of Neuroimmunology and Multiple Sclerosis (M.T., I.L., S.S.), University Medical Centre Hamburg-Eppendorf, Germany; Department of Life Sciences (Y.R., A.Z.), Ben-Gurion University, Beer-Sheva, Israel; and Max-Delbrück Center for Molecular Medicine (F.P.), Berlin, Germany. G.G. and C.P. are now with St. Joseph Krankenhaus-Berlin-Weissensee, Germany. S.S. is now with Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland
| | - Abraham Zangen
- NeuroCure Clinical Research Center (G.G., A.U.B., C.P., J.D., J.B.-S., S.K.P., F.P.), Center for Stroke Research Berlin (CSB) (S.K.P.), Experimental and Clinical Research Center (J.B.-S., F.P.), and Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité-Universitätsmedizin Berlin, Germany; Institute of Neuroimmunology and Multiple Sclerosis (M.T., I.L., S.S.), University Medical Centre Hamburg-Eppendorf, Germany; Department of Life Sciences (Y.R., A.Z.), Ben-Gurion University, Beer-Sheva, Israel; and Max-Delbrück Center for Molecular Medicine (F.P.), Berlin, Germany. G.G. and C.P. are now with St. Joseph Krankenhaus-Berlin-Weissensee, Germany. S.S. is now with Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland
| | - Sven Schippling
- NeuroCure Clinical Research Center (G.G., A.U.B., C.P., J.D., J.B.-S., S.K.P., F.P.), Center for Stroke Research Berlin (CSB) (S.K.P.), Experimental and Clinical Research Center (J.B.-S., F.P.), and Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité-Universitätsmedizin Berlin, Germany; Institute of Neuroimmunology and Multiple Sclerosis (M.T., I.L., S.S.), University Medical Centre Hamburg-Eppendorf, Germany; Department of Life Sciences (Y.R., A.Z.), Ben-Gurion University, Beer-Sheva, Israel; and Max-Delbrück Center for Molecular Medicine (F.P.), Berlin, Germany. G.G. and C.P. are now with St. Joseph Krankenhaus-Berlin-Weissensee, Germany. S.S. is now with Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland
| | - Friedemann Paul
- NeuroCure Clinical Research Center (G.G., A.U.B., C.P., J.D., J.B.-S., S.K.P., F.P.), Center for Stroke Research Berlin (CSB) (S.K.P.), Experimental and Clinical Research Center (J.B.-S., F.P.), and Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité-Universitätsmedizin Berlin, Germany; Institute of Neuroimmunology and Multiple Sclerosis (M.T., I.L., S.S.), University Medical Centre Hamburg-Eppendorf, Germany; Department of Life Sciences (Y.R., A.Z.), Ben-Gurion University, Beer-Sheva, Israel; and Max-Delbrück Center for Molecular Medicine (F.P.), Berlin, Germany. G.G. and C.P. are now with St. Joseph Krankenhaus-Berlin-Weissensee, Germany. S.S. is now with Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland
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Azin M, Zangiabadi N, Iranmanesh F, Baneshi MR, Banihashem S. Effects of Intermittent Theta Burst Stimulation on Manual Dexterity and Motor Imagery in Patients with Multiple Sclerosis: A Quasi-Experimental Controlled Study. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e27056. [PMID: 28180015 PMCID: PMC5285577 DOI: 10.5812/ircmj.27056] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 02/07/2015] [Accepted: 02/09/2015] [Indexed: 11/23/2022]
Abstract
Background Intermittent theta burst stimulation (iTBS) is a repetitive transcranial magnetic stimulation (rTMS) protocol that influences cortical excitability and motor function recovery. Objectives This study aimed to investigate the effects of iTBS on manual dexterity and hand motor imagery in multiple sclerosis (MS) patients. Methods Thirty-six MS patients were non-randomly assigned into sham (control) or iTBS groups. Then, iTBS was delivered to the primary motor cortex for ten days over two consecutive weeks. The patients’ manual dexterity was assessed using the nine-hole peg test (9HPT) and the Box and Block Test (BBT), while the hand motor imagery was assessed with the hand mental rotation task (HMRT). Results iTBS group showed a reduction in the time required to complete the 9HPT (mean difference = -3.05, P = 0.002), and an increase in the number of blocks transferred in one minute in the BBT (mean difference = 8.9, P = 0.001) when compared to the control group. Furthermore, there was no significant difference between the two groups in terms of the reaction time (P = 0.761) and response accuracy rate (P = 0.482) in the HMRT. Conclusions When iTBS was applied over the primary motor cortex, it significantly improved manual dexterity, but had no significant effect on the hand motor imagery ability in MS patients.
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Affiliation(s)
- Mahdieh Azin
- Kerman Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, IR Iran
| | - Nasser Zangiabadi
- Kerman Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, IR Iran
- Corresponding Author: Nasser Zangiabadi, Kerman Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, P. O. Box: 76175-113, Kerman, IR Iran. Tel: +98-9131404398, E-mail:
| | - Farhad Iranmanesh
- Neurology Research Center, Kerman University of Medical Sciences, Kerman, IR Iran
| | - Mohammad Reza Baneshi
- Modeling in Health Research Center Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, IR Iran
| | - Seyedshahab Banihashem
- Psychosomatic Department, Taleghani Hospital , Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
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Chalah MA, Riachi N, Ahdab R, Créange A, Lefaucheur JP, Ayache SS. Fatigue in Multiple Sclerosis: Neural Correlates and the Role of Non-Invasive Brain Stimulation. Front Cell Neurosci 2015; 9:460. [PMID: 26648845 PMCID: PMC4663273 DOI: 10.3389/fncel.2015.00460] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 11/11/2015] [Indexed: 12/21/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic progressive inflammatory disease of the central nervous system (CNS) and the major cause of non-traumatic disability in young adults. Fatigue is a frequent symptom reported by the majority of MS patients during their disease course and drastically affects their quality of life. Despite its significant prevalence and impact, the underlying pathophysiological mechanisms are not well elucidated. MS fatigue is still considered the result of multifactorial and complex constellations, and is commonly classified into “primary” fatigue related to the pathological changes of the disease itself, and “secondary” fatigue attributed to mimicking symptoms, comorbid sleep and mood disorders, and medications side effects. Radiological, physiological, and endocrine data have raised hypotheses regarding the origin of this symptom, some of which have succeeded in identifying an association between MS fatigue and structural or functional abnormalities within various brain networks. Hence, the aim of this work is to reappraise the neural correlates of MS fatigue and to discuss the rationale for the emergent use of noninvasive brain stimulation (NIBS) techniques as potential treatments. This will include a presentation of the various NIBS modalities and a suggestion of their potential mechanisms of action in this context. Specific issues related to the value of transcranial direct current stimulation (tDCS) will be addressed.
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Affiliation(s)
- Moussa A Chalah
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil Créteil, France ; Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris Créteil, France
| | - Naji Riachi
- Neurology Division, University Medical Center Rizk Hospital Beirut, Lebanon
| | - Rechdi Ahdab
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil Créteil, France ; Neurology Division, University Medical Center Rizk Hospital Beirut, Lebanon
| | - Alain Créange
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil Créteil, France ; Service de Neurologie, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris Créteil, France
| | - Jean-Pascal Lefaucheur
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil Créteil, France ; Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris Créteil, France
| | - Samar S Ayache
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil Créteil, France ; Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris Créteil, France
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Zwolińska J, Kwolek A, Gąsior M. The effectiveness of physical factors used in the treatment of patients with Multiple Sclerosis. Literature review. ADVANCES IN REHABILITATION 2015. [DOI: 10.1515/rehab-2015-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractIntroduction: Multiple Sclerosis (MS) is a chronic progressive disease of the nervous system which etiology is still unknown. Environmental factors, genetic predisposition and complex autoimmune reactions play a significant role in its pathogenesis. MS is not a fatal disease, but patients often require constant medical care and complex social welfare. Physiotherapy conducted at every stage of the disease depends on the current state of a patient and their functional capability and gradually occurring disorders and dysfunctions. Physical therapy is an important element of the therapy.Aim: To evaluate the usefulness of physical treatments used in the treatment of the MS patients.Material and methods: An analysis of domestic and foreign literature published between 2004 and 2014. The following databases were searched: PubMed, Science Direct, Termedia, Polish Medical Bibliography, Cochrane. The papers concerning the use of physical treatment as monotherapy and combination therapy were included.Summary and conclusions: Numerous research confirm both safety and efficacy of physical methods used in treatment of the MS patients. The implementation of research on the mechanism of action and effectiveness of physical factors, which are well-designed in terms of methodology, allows for the selection of the optimal physical procedure. Modern equipment and current methods of physiotherapy change views on the previously used treatments, their methodology and application.
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Joussain C, Denys P. Electrical management of neurogenic lower urinary tract disorders. Ann Phys Rehabil Med 2015; 58:245-250. [PMID: 26321622 DOI: 10.1016/j.rehab.2015.07.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 07/07/2015] [Accepted: 07/07/2015] [Indexed: 11/16/2022]
Abstract
Management of lower urinary tract dysfunction (LUTD) in neurological diseases remains a priority because it leads to many complications such as incontinence, renal failure and decreased quality of life. A pharmacological approach remains the first-line treatment for patients with neurogenic LUTD, but electrical stimulation is a well-validated and recommended second-line treatment. However, clinicians must be aware of the indications, advantages and side effects of the therapy. This report provides an update on the 2 main electrical stimulation therapies for neurogenic LUTD - inducing direct bladder contraction with the Brindley procedure and modulating LUT physiology (sacral neuromodulation, tibial posterior nerve stimulation or pudendal nerve stimulation). We also describe the indications of these therapies for neurogenic LUTD, following international guidelines, as illustrated by their efficacy in patients with neurologic disorders. Electrical stimulation could be proposed for neurogenic LUTD as second-line treatment after failure of oral pharmacologic approaches. Nevertheless, further investigations are needed for a better understanding of the mechanisms of action of these techniques and to confirm their efficacy. Other electrical investigations, such as deep-brain stimulation and repetitive transcranial magnetic stimulation, or improved sacral anterior root stimulation, which could be associated with non-invasive and highly specific deafferentation of posterior roots, may open new fields in the management of neurogenic LUTD.
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Affiliation(s)
- C Joussain
- Medical School Paris Île-de-France Ouest, Inserm U1179, Versailles Saint-Quentin University, Versailles, France.
| | - P Denys
- Department of Physical Medicine and Rehabilitation, Raymond-Poincaré Hospital, Medical School Paris Île-de-France Ouest, Inserm U1179 Versailles Saint-Quentin University, Versailles, France
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Drake MJ. Management and rehabilitation of neurologic patients with lower urinary tract dysfunction. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:451-68. [PMID: 26003260 DOI: 10.1016/b978-0-444-63247-0.00026-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Diverse lower urinary tract problems arise in neurologic disease, caused by dysfunctions of the bladder and outlet, both during urine storage and voiding. Most neurologic diseases cause some lower urinary tract dysfunction (LUTD), and the type of dysfunction is related to the location of the nervous system lesion. Clinical evaluation requires identification of risk factors for major morbidity, particularly renal dysfunction, and mechanisms underlying symptoms. A holistic approach is needed to cover influential aspects (e.g., cognitive function, mobility, and urinary tract infections) and related issues (e.g., sexual function, bowel function, and autonomic dysreflexia), requiring a multidisciplinary team. Comprehensive history and examination are supported by a bladder diary, urinalysis, and renal assessment, supplemented by urodynamic tests. The simplest classification of neurogenic LUTD describes both bladder and sphincter function, cataloging each structure as normal, overactive, or underactive. Treatment aims to protect life expectancy and improve quality of life, noting the possibility of neurologic disease progression and comorbid disorders. Conservative measures include fluid advice and assessment of suitable containment products. Urine storage can be improved with antimuscarinic medications, bladder injections with botulinum neurotoxin A, and less established methods such as nerve stimulation, intravesical instillations, and beta-3 agonist. For severe storage dysfunction, sacral neuromodulation or surgery to improve reservoir function, increase outlet resistance, or divert the urinary tract may be needed. Voiding is usually replaced by intermittent or indwelling catheterization, which has largely superseded triggered reflex voiding, bladder expression, or sphincterotomy. Treatment selection is hampered by a limited, low-quality evidence base.
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Reti IM, Schwarz N, Bower A, Tibbs M, Rao V. Transcranial magnetic stimulation: A potential new treatment for depression associated with traumatic brain injury. Brain Inj 2015; 29:789-97. [PMID: 25950260 DOI: 10.3109/02699052.2015.1009168] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Each year, more than 1.7 million Americans suffer a traumatic brain injury (TBI) and the lifetime prevalence of major depressive disorder following TBI is between 25-50%. There are no validated established strategies to treat TBI depression. Repetitive transcranial magnetic stimulation (rTMS) is a novel putative treatment option for post-TBI depression, which, compared with standard pharmacological agents, may provide a more targeted treatment with fewer side-effects. However, TBI is associated with an increased risk of both early and late spontaneous seizures, a significant consideration in evaluating rTMS as a potential treatment for TBI depression. Whilst the risk of seizure from rTMS is low, underlying neuropathology may somewhat increase that risk. REVIEW This review focuses on the safety aspects of rTMS in TBI patients. The authors review why low frequency rTMS might be less likely to trigger a seizure than high frequency rTMS and propose low frequency rTMS as a safer option in TBI patients. Because there is little data on the safety of rTMS in TBI, the authors also review the safety of rTMS in patients with other brain pathology. CONCLUSION It is concluded that pilot safety and tolerability studies should be first conducted in persons with TBI and neuropsychiatric comorbidities. These results could be used to help design larger randomized controlled trials.
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Affiliation(s)
- Irving M Reti
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University , Baltimore, MD , USA
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Sakakibara R. Lower urinary tract dysfunction in patients with brain lesions. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:269-87. [PMID: 26003249 DOI: 10.1016/b978-0-444-63247-0.00015-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Stroke and brain tumor are well-known brain diseases. The incidence of lower urinary tract dysfunction (LUTD) in these patients ranges from 14% to 53%, mostly overactive bladder (OAB), and is higher when the frontal cortex is involved. This presumably reflects damage at the prefrontal cortex, cingulate cortex, and other areas that regulate (mainly inhibit) the micturition reflex. White-matter disease (WMD) is a chronic, bilateral form of cerebrovascular disease, leading to a high prevalence of OAB (up to 90%). Since WMD is particularly common in the elderly, WMD may be one of the anatomic substrates for elderly OAB. Traumatic brain injury and normal-pressure hydrocephalus are rather diffuse brain diseases, which cause OAB with a prevalence rate of 60-95%. Recent neuroimaging studies have shown a relationship between LUTD and the frontal cortex in these diseases. Data on other brain diseases, particularly affecting deep brain structures, are limited. Small infarctions, tumors, or inflammatory diseases affecting the basal ganglia, hypothalamus, and cerebellum lead to mainly OAB. In contrast, similar diseases affecting the brainstem lead to either OAB or urinary retention. The latter reflects damage at the periaqueductal gray and the pontine micturition center that directly relay and modulate the micturition reflex. Urinary incontinence (UI) in brain disease can be divided into two types: neurogenic UI (due to OAB) and functional UI (immobility and loss of initiative/cognition). These two types of UI may occur together, but management differs significantly. Management of neurogenic UI includes anticholinergic drugs that do not penetrate the blood-brain barrier easily. Management of functional UI includes behavioral therapy (timed/prompted voiding with physical assistance and bladder/pelvic floor training) and drugs to treat gait as well as cognition that facilitate continence. These treatments will maximize the quality of life in patients with brain diseases.
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Affiliation(s)
- Ryuji Sakakibara
- Department of Neurology, Sakura Medical Center, Toho University, Sakura, Japan.
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