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de Albuquerque LL, Pantovic M, Wilkins EW, Morris D, Clingo M, Boss S, Riley ZA, Poston B. Exploring the Influence of Inter-Trial Interval on the Assessment of Short-Interval Intracortical Inhibition. Bioengineering (Basel) 2024; 11:645. [PMID: 39061727 PMCID: PMC11274151 DOI: 10.3390/bioengineering11070645] [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: 04/18/2024] [Revised: 06/05/2024] [Accepted: 06/17/2024] [Indexed: 07/28/2024] Open
Abstract
Short-interval intracortical inhibition (SICI) is a common paired-pulse transcranial magnetic stimulation (TMS) measure used to assess primary motor cortex (M1) interneuron activity in healthy populations and in neurological disorders. Many of the parameters of TMS stimulation to most accurately measure SICI have been determined. However, one TMS parameter that has not been investigated is the time between SICI trials (termed inter-trial interval; ITI). This is despite a series of single-pulse TMS studies which have reported that motor evoked potential (MEP) amplitude were suppressed for short, but not long ITIs in approximately the initial ten trials of a TMS block of 20-30 trials. The primary purpose was to examine the effects of ITI on the quantification of SICI at rest. A total of 23 healthy adults completed an experimental session that included four SICI trial blocks. Each block utilized a different ITI (4, 6, 8, and 10 s) and was comprised of a total of 26 SICI trials divided into three epochs. ANOVA revealed that the main effects for ITI and epoch as well as their interaction were all non-statistically significant for SICI. We conclude that the shorter (4-6 s) ITIs used in studies investigating SICI should not alter the interpretation of M1 activity, while having the advantages of being more comfortable to participants and reducing the experimental time needed to evaluate perform single and paired-pulse TMS experiments.
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Affiliation(s)
- Lidio Lima de Albuquerque
- School of Health and Applied Human Sciences, University of North Carolina Wilmington, Wilmington, NC 28403, USA;
| | - Milan Pantovic
- Health and Human Performance Department, Utah Tech University, St. George, UT 84770, USA;
| | - Erik W. Wilkins
- Department of Kinesiology and Nutrition Sciences, University of Nevada Las Vegas, Las Vegas, NV 89154, USA;
| | - Desiree Morris
- School of Medicine, University of Nevada-Las Vegas, Las Vegas, NV 89154, USA; (D.M.); (M.C.)
| | - Mitchell Clingo
- School of Medicine, University of Nevada-Las Vegas, Las Vegas, NV 89154, USA; (D.M.); (M.C.)
| | - Sage Boss
- School of Life Sciences, University of Nevada-Las Vegas, Las Vegas, NV 89154, USA;
| | - Zachary A. Riley
- Department of Kinesiology, Indiana University Purdue University Indianapolis, Indianapolis, IN 46202, USA;
| | - Brach Poston
- Department of Kinesiology and Nutrition Sciences, University of Nevada Las Vegas, Las Vegas, NV 89154, USA;
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Zhao N, Wang J, Huang S, Zhang J, Bao J, Ni H, Gao X, Zhang C. The landscape of programmed cell death-related lncRNAs in Alzheimer's disease and Parkinson's disease. Apoptosis 2024:10.1007/s10495-024-01984-z. [PMID: 38853201 DOI: 10.1007/s10495-024-01984-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 06/11/2024]
Abstract
This study delivers a thorough analysis of long non-coding RNAs (lncRNAs) in regulating programmed cell death (PCD), vital for neurodegenerative diseases like Alzheimer's disease (AD) and Parkinson's disease (PD). We propose a new framework PCDLnc, and identified 20 significant lncRNAs, including HEIH, SNHG15, and SNHG5, associated with PCD gene sets, which were known for roles in proliferation and apoptosis in neurodegenerative diseases. By using GREAT software, we identified regulatory functions of top lncRNAs in different neurodegenerative diseases. Moreover, lncRNAs cis-regulated mRNAs linked to neurodegeneration, including JAK2, AKT1, EGFR, CDC42, SNCA, and ADIPOQ, highlighting their therapeutic potential in neurodegenerative diseases. A further exploration into the differential expression of mRNA identified by PCDLnc revealed a role in apoptosis, ferroptosis and autophagy. Additionally, protein-protein interaction (PPI) network analysis exposed abnormal interactions among key genes, despite their consistent expression levels between disease and normal samples. The randomforest model effectively distinguished between disease samples, indicating a high level of accuracy. Shared gene subsets in AD and PD might serve as potential biomarkers, along with disease-specific gene sets. Besides, we also found the strong relationship between AD and immune infiltration. This research highlights the role of lncRNAs and their associated genes in PCD in neurodegenerative diseases, offering potential therapeutic targets and diagnostic markers for future study and clinical application.
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Affiliation(s)
- Ning Zhao
- College of Computer and Control Engineering, Northeast Forestry University, Harbin, Heilongjiang, China
| | - Junyi Wang
- College of Computer and Control Engineering, Northeast Forestry University, Harbin, Heilongjiang, China
| | - Shan Huang
- The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China
| | - Jingyu Zhang
- The Fourth Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China
| | - Jin Bao
- College of Computer and Control Engineering, Northeast Forestry University, Harbin, Heilongjiang, China
| | - Haisen Ni
- College of Computer and Control Engineering, Northeast Forestry University, Harbin, Heilongjiang, China
| | - Xinhang Gao
- College of Computer and Control Engineering, Northeast Forestry University, Harbin, Heilongjiang, China
| | - Chunlong Zhang
- College of Computer and Control Engineering, Northeast Forestry University, Harbin, Heilongjiang, China.
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Tan Q, Liu X, Xu S, Chen J, Li W, Zhang S, Du Y. Global trends and hotspots in research on acupuncture for neurodegenerative diseases over the last decade: a bibliometric and visualization analysis. Front Aging Neurosci 2024; 16:1390384. [PMID: 38800611 PMCID: PMC11116584 DOI: 10.3389/fnagi.2024.1390384] [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: 02/23/2024] [Accepted: 04/18/2024] [Indexed: 05/29/2024] Open
Abstract
Objectives This study aimed to explore the current status and trends of acupuncture for neurodegenerative diseases (NDs) in the last decade and provide new insights for researchers in future studies. Methods The publications concerning acupuncture treatment for NDs published between 2014 and 2023 were extracted from the Web of Science Core Collection. We used CiteSpace and VOSviewer to analyze data on numbers of annual publications, countries, institutions, cited journals, cited authors, cited references, keywords, and citation bursts about acupuncture for NDs. Results A total of 635 publications were obtained from 2014 to 2023. We identified the most prolific journals, countries, institutions, authors, patterns of authorship, and the main direction of future research in the field of acupuncture for NDs in the last decade. The country, institution, and journal with the most publications are China (389 articles), Beijing University of Chinese Medicine (56 articles), and Evidence Based Complementary and Alternative Medicine (42 articles), respectively. The high-frequency keywords focused on "Alzheimer's disease," "Parkinson's disease," "acupuncture," "dementia," and "electroacupuncture." The top five keywords in terms of centrality were "cerebral ischemia," "acupuncture stimulation," "fMRI," "apoptosis," and "deep brain stimulation." Conclusion The results from this bibliometric study provide insight into the research trends in acupuncture therapy for NDs, and the current status and trends of the past decade, which may help researchers confirm the current status, hotspots, and frontier trends in this field.
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Affiliation(s)
- Qian Tan
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine, Wuhan, China
| | - Xinyuan Liu
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine, Wuhan, China
| | - Shuyu Xu
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine, Wuhan, China
| | - Jiangmin Chen
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine, Wuhan, China
| | - Weixian Li
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine, Wuhan, China
| | - Shuai Zhang
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine, Wuhan, China
| | - Yanjun Du
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine, Wuhan, China
- Hubei Shizhen Laboratory, Wuhan, China
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Pantovic M, Boss R, Noorda KJ, Premyanov MI, Aynlender DG, Wilkins EW, Boss S, Riley ZA, Poston B. The Influence of Different Inter-Trial Intervals on the Quantification of Intracortical Facilitation in the Primary Motor Cortex. Bioengineering (Basel) 2023; 10:1278. [PMID: 38002401 PMCID: PMC10669180 DOI: 10.3390/bioengineering10111278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023] Open
Abstract
Intracortical facilitation (ICF) is a paired-pulse transcranial magnetic stimulation (TMS) measurement used to quantify interneuron activity in the primary motor cortex (M1) in healthy populations and motor disorders. Due to the prevalence of the technique, most of the stimulation parameters to optimize ICF quantification have been established. However, the underappreciated methodological issue of the time between ICF trials (inter-trial interval; ITI) has been unstandardized, and different ITIs have never been compared in a paired-pulse TMS study. This is important because single-pulse TMS studies have found motor evoked potential (MEP) amplitude reductions over time during TMS trial blocks for short, but not long ITIs. The primary purpose was to determine the influence of different ITIs on the measurement of ICF. Twenty adults completed one experimental session that involved 4 separate ICF trial blocks with each utilizing a different ITI (4, 6, 8, and 10 s). Two-way ANOVAs indicated no significant ITI main effects for test MEP amplitudes, condition-test MEP amplitudes, and therefore ICF. Accordingly, all ITIs studied provided nearly identical ICF values when averaged over entire trial blocks. Therefore, it is recommended that ITIs of 4-6 s be utilized for ICF quantification to optimize participant comfort and experiment time efficiency.
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Affiliation(s)
- Milan Pantovic
- Health and Human Performance Department, Utah Tech University, St. George, UT 84770, USA;
| | - Rhett Boss
- School of Medicine, University of Nevada-Las Vegas, Las Vegas, NV 89154, USA; (R.B.); (K.J.N.); (M.I.P.); (D.G.A.)
| | - Kevin J. Noorda
- School of Medicine, University of Nevada-Las Vegas, Las Vegas, NV 89154, USA; (R.B.); (K.J.N.); (M.I.P.); (D.G.A.)
| | - Mario I. Premyanov
- School of Medicine, University of Nevada-Las Vegas, Las Vegas, NV 89154, USA; (R.B.); (K.J.N.); (M.I.P.); (D.G.A.)
| | - Daniel G. Aynlender
- School of Medicine, University of Nevada-Las Vegas, Las Vegas, NV 89154, USA; (R.B.); (K.J.N.); (M.I.P.); (D.G.A.)
| | - Erik W. Wilkins
- Department of Kinesiology and Nutrition Sciences, University of Nevada-Las Vegas, Las Vegas, NV 89154, USA;
| | - Sage Boss
- School of Life Sciences, University of Nevada-Las Vegas, Las Vegas, NV 89154, USA;
| | - Zachary A. Riley
- Department of Kinesiology, Indiana University Purdue University Indianapolis, Indianapolis, IN 46202, USA;
| | - Brach Poston
- Department of Kinesiology and Nutrition Sciences, University of Nevada-Las Vegas, Las Vegas, NV 89154, USA;
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Desai (Kapadia) N, Marquez-Chin C, Chen R. Editorial: Non-invasive stimulation: role in neurorehabilitation. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1263530. [PMID: 37614666 PMCID: PMC10443093 DOI: 10.3389/fresc.2023.1263530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 07/25/2023] [Indexed: 08/25/2023]
Affiliation(s)
- Naaz Desai (Kapadia)
- Division of Brain, Imaging and Behaviour, Krembil Brain Institute, Toronto, ON, Canada
| | - Cesar Marquez-Chin
- CRANIA, University Health Network and University of Toronto, Toronto, ON, Canada
- The KITE Research Institute, Toronto Rehabilitation Institute—University Health Network, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Robert Chen
- Division of Brain, Imaging and Behaviour, Krembil Brain Institute, Toronto, ON, Canada
- Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON, Canada
- Divison of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
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Yan Y, Tian M, Wang T, Wang X, Wang Y, Shi J. Transcranial magnetic stimulation effects on cognitive enhancement in mild cognitive impairment and Alzheimer's disease: a systematic review and meta-analysis. Front Neurol 2023; 14:1209205. [PMID: 37528850 PMCID: PMC10389278 DOI: 10.3389/fneur.2023.1209205] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/28/2023] [Indexed: 08/03/2023] Open
Abstract
Introduction Transcranial magnetic stimulation (TMS) is a non-invasive intervention that holds promise for improving cognitive function in individuals with Alzheimer's disease (AD). However, the effectiveness of this therapy and the optimal TMS parameters has not reached a consensus. The purpose of the meta-analysis was to systematically discern the effectiveness of different components of TMS protocols on cognitive improvement in patients with mild cognitive impairment (MCI) and AD. Methods The meta-analysis was preregistered on Prospero (registration number: CRD42022345482). PubMed, Web of Science, Science Direct, and Cochrane Library databases were used to search, screen and identify eligible studies with the following keywords: Transcranial Magnetic Stimulation OR TMS OR theta burst stimulation AND Alzheimer OR Alzheimers OR Alzheimer's OR mild cognitive impairment OR MCI. Randomized controlled trials (RCTs) of participants with accepted standardized diagnostic criteria were searched by two authors independently. The risk of bias was assessed using an adapted Cochrane Risk of Bias tool. Standardized mean difference (SMD) and 95% confidence interval (CI) were calculated using the random-effects models. Subgroup analyses were performed to investigate the influential factors. Results A total of 21 studies and 25 trials were included in this meta-analysis. The findings revealed a significant overall cognition improvement of real stimulation compared with sham stimulation (short-term effects: SMD, 0.91; 95% CI 0.44-1.38; P < 0.01; long-lasting effects: SMD, 0.91; 95% CI 0.27-1.55; P < 0.01). Subgroup analysis demonstrated that stimulation of the left dorsolateral prefrontal cortex and bilateral cerebellums, as well as moderate frequency stimulation (5 Hz and 10 Hz) on mild and moderate cognitive impairment patients, were more effective than other TMS protocols. However, the additional application of cognitive training showed no significant improvement. Conclusion Cognitive improvement effect of TMS was demonstrated in MCI and AD patients in both short-term assessment and long-lasting outcomes, and the efficiency of TMS is affected by the stimulation frequency, stimulation site, and participant characteristics. Further RCTs are needed to validate the findings of our subgroup analysis. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022345482, identifier: CRD42022345482.
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Yang Z, Zhou Y. The repetitive transcranial magnetic stimulation in Alzheimer's disease patients with behavioral and psychological symptoms of dementia: a case report. BMC Psychiatry 2023; 23:354. [PMID: 37221495 DOI: 10.1186/s12888-023-04864-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/09/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation is a noninvasive intervention, can significantly reduce behavioral and psychological symptoms and cognitive impairment in AD patients. Only few cases have been reported the adverse reactions after the treatment. This report described the different adverse reactions after repetitive transcranial magnetic stimulation with different parameters. PATIENT PRESENTATION This article reports a patient with dementia complicated with mental behavior disorder who was treated with repetitive transcranial magnetic stimulation (rTMS) in spite of poor drug response. First, 1 Hz rTMS was initiated. After 1 month, the patient showed improved symptoms of mental behavior, decreased cognitive function and prolonged sleep duration. After switched to 10 Hz rTMS, the patient's cognitive function and mental behavior abnormalities improved, and the sleep time returned to normal. However, epilepsy occurred after one session and was changed to 0.8 Hz rTMS treatment. The patient's symptoms improved and did not have seizure. CONCLUSION Repetitive transcranial magnetic stimulation has a positive effect on cognitive function and Behavioral And Psychological Symptoms Of Dementia, and adverse reactions are inevitable. Playing personalized treatment according to the patients can reduce occurrence of adverse reactions.
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Affiliation(s)
- Zhen Yang
- University of South China, Heng Yang, 421001, China
| | - Ying Zhou
- Neurology Department, The First Hospital Of Chang Sha, Chang Sha City, 410000, China.
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Budak M, Bayraktaroglu Z, Hanoglu L. The effects of repetitive transcranial magnetic stimulation and aerobic exercise on cognition, balance and functional brain networks in patients with Alzheimer's disease. Cogn Neurodyn 2023; 17:39-61. [PMID: 36704634 PMCID: PMC9871139 DOI: 10.1007/s11571-022-09818-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 04/20/2022] [Accepted: 05/02/2022] [Indexed: 01/29/2023] Open
Abstract
The purpose of this study was to investigate the effects of high-frequency repetitive Transcranial Magnetic Stimulation (rTMS) and aerobic exercises (AE) in addition to the pharmacological therapy (PT) in Alzheimer's Disease (AD). Twenty-seven patients with AD aged ≥ 60 years were included in the study and divided into 3 groups (rTMS, AE and control). All groups received PT. rTMS group (n = 10) received 20 Hz rTMS over dorsolateral prefrontal cortex (dlPFC) bilaterally and AE group (n = 9) received the structured moderate-intensity AE for 5 consecutive days/week over 2 weeks. Control group (n = 8) only received PT. Cognition, balance, mobility, quality of life (QoL), and resting state functional brain activity were evaluated one week before and one week after the interventions. (ClinicalTrials.gov ID:NCT05102045). Significant improvements were found in executive functions, behavior, and QoL in the rTMS group, in balance and mobility in the AE group, and in the visual memory and behavior in the control group (p < 0.05). Significant differences were found in the behavior in favor of the rTMS group, and balance in favor of the AE group (p < 0.05). There was a significant increase in activation on middle temporal gyrus, intra calcarine, central opercular cortex, superior parietal lobule, and paracingulate cortex in Default Mode Network (DMN) in the rTMS group (p < 0.05). High-frequency rTMS over bilateral dlPFC may improve executive functions and behavior and lead to increased activation in DMN, structured moderate-intensity AE may improve balance and mobility, and PT may improve memory and behaviour compared to pretreatment in AD.
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Affiliation(s)
- Miray Budak
- Functional Imaging and Cognitive-Affective Neuroscience Lab (fINCAN), Research Institute for Health Sciences and Technologies (SABITA), Istanbul Medipol University, Istanbul, Turkey
- Department of Physical Therapy and Rehabilitation, Institute of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
- Department of Ergotherapy, School of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
| | - Zubeyir Bayraktaroglu
- Functional Imaging and Cognitive-Affective Neuroscience Lab (fINCAN), Research Institute for Health Sciences and Technologies (SABITA), Istanbul Medipol University, Istanbul, Turkey
- Department of Physiology, International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Lutfu Hanoglu
- Functional Imaging and Cognitive-Affective Neuroscience Lab (fINCAN), Research Institute for Health Sciences and Technologies (SABITA), Istanbul Medipol University, Istanbul, Turkey
- Department of Neurology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
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Targeting neural correlates of placebo effects. COGNITIVE, AFFECTIVE, & BEHAVIORAL NEUROSCIENCE 2022; 23:217-236. [PMID: 36517733 DOI: 10.3758/s13415-022-01039-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 12/15/2022]
Abstract
Harnessing the placebo effects would prompt critical ramifications for research and clinical practice. Noninvasive brain stimulation (NIBS) techniques, such as transcranial magnetic stimulation and multifocal transcranial electric stimulation, could manipulate the placebo response by modulating the activity and excitability of its neural correlates. To identify potential stimulation targets, we conducted a meta-analysis to investigate placebo-associated regions in healthy volunteers, including studies with emotional components and painful stimuli. Using biophysical modeling, we identified NIBS solutions to manipulate placebo effects by targeting either a single key region or multiple connected areas. Moving to a network-oriented approach, we then ran a quantitative network mapping analysis on the functional connectivity profile of clusters emerging from the meta-analysis. As a result, we suggest a multielectrode optimized montage engaging the connectivity patterns of placebo-associated functional brain networks. These NIBS solutions hope to provide a starting point to actively control, modulate or enhance placebo effects in future clinical studies and cognitive enhancement studies.
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Motor cortex excitability is reduced during freezing of upper limb movement in Parkinson's disease. NPJ Parkinsons Dis 2022; 8:161. [PMID: 36424411 PMCID: PMC9691624 DOI: 10.1038/s41531-022-00420-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 10/26/2022] [Indexed: 11/27/2022] Open
Abstract
Whilst involvement of the motor cortex in the phenomenon of freezing in Parkinson's disease has been previously suggested, few empiric studies have been conducted to date. We investigated motor cortex (M1) excitability in eleven right-handed Parkinson's disease patients (aged 69.7 ± 9.6 years, disease duration 11.2 ± 3.9 years, akinesia-rigidity type) with verified gait freezing using a single-pulse transcranial magnetic stimulation (TMS) repetitive finger tapping paradigm. We delivered single TMS pulses at 120% of the active motor threshold at the 'ascending (contraction)' and 'descending (relaxation)' slope of the tap cycle during i) regular tapping, ii) the transition period of the three taps prior to a freeze and iii) during freezing of upper limb movement. M1 excitability was modulated along the tap cycle with greater motor evoked potentials (MEPs) during 'ascending' than 'descending'. Furthermore, MEPs during the 'ascending' phase of regular tapping, but not during the transition period, were greater compared to the MEPs recorded throughout a freeze. Neither force nor EMG activity 10-110 s before the stimulus predicted MEP size. This piloting study suggests that M1 excitability is reduced during freezing and the transition period preceding a freeze. This supports that M1 excitability is critical to freezing in Parkinson's disease.
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Zhang X, Ren H, Pei Z, Lian C, Su X, Lan X, Chen C, Lei Y, Li B, Guo Y. Dual-targeted repetitive transcranial magnetic stimulation modulates brain functional network connectivity to improve cognition in mild cognitive impairment patients. Front Physiol 2022; 13:1066290. [PMID: 36467674 PMCID: PMC9716076 DOI: 10.3389/fphys.2022.1066290] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/07/2022] [Indexed: 10/15/2023] Open
Abstract
Background: Mild cognitive impairment (MCI) is a condition between normal aging and dementia; nearly 10-15% of MCI patients develop dementia annually. There are no effective interventions for MCI progression. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation technique that has attempted to improve the overall cognitive function of MCI patients. However, it does not affect episodic memory improvement. Methods: In this study, we engaged 15 clinically diagnosed MCI patients and normal controls to explore the effect of dual-targeted rTMS on progressing cognitive function, particularly episodic memory in MCI patients. Resting-state EEG recordings and neuropsychological assessments were conducted before and after the intervention. EEG features were extracted using an adaptive algorithm to calculate functional connectivity alterations in relevant brain regions and the mechanisms of altered brain functional networks in response to dual-target rTMS. Results: The study revealed that the functional brain connectivity between the right posterior cingulate gyrus (PCC) and the right dorsal caudate nucleus (DC) was significantly reduced in MCI patients compared to normal controls (p < 0.001). Dual-target rTMS increased the strength of the reduced functional connectivity (p < 0.001), which was related to cognitive enhancement (p < 0.05). Conclusion: This study provides a new stimulation protocol for rTMS intervention. Improving the functional connectivity of the right PCC to the right DC is a possible mechanism by which rTMS improves overall cognitive and memory function in MCI patients.
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Affiliation(s)
- Xinqi Zhang
- Department of Neurology, Shenzhen People’s Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Huixia Ren
- Department of Geriatrics, Shenzhen People’s Hospital (The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology), Shenzhen, China
| | - Zian Pei
- Shenzhen Bay Laboratory, Institute of Neurological Disease, Shenzhen, China
| | - Chongyuan Lian
- Shenzhen Bay Laboratory, Institute of Neurological Disease, Shenzhen, China
| | - XiaoLin Su
- Department of Neurology, Shenzhen People’s Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Xiaoyong Lan
- Shenzhen Bay Laboratory, Institute of Neurological Disease, Shenzhen, China
| | - Chanjuan Chen
- Department of Neurology, Shenzhen People’s Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - YuHua Lei
- Department of Neurology, Shenzhen People’s Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Baima Li
- Department of Neurology, Shenzhen People’s Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Yi Guo
- Department of Neurology, Shenzhen People’s Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
- Shenzhen Bay Laboratory, Institute of Neurological Disease, Shenzhen, China
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Arora T, Desai N, Kirshblum S, Chen R. Utility of transcranial magnetic stimulation in the assessment of spinal cord injury: Current status and future directions. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:1005111. [PMID: 36275924 PMCID: PMC9581184 DOI: 10.3389/fresc.2022.1005111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/16/2022] [Indexed: 11/06/2022]
Abstract
Comprehensive assessment following traumatic spinal cord injury (SCI) is needed to improve prognostication, advance the understanding of the neurophysiology and better targeting of clinical interventions. The International Standards for Neurological Classification of Spinal Cord Injury is the most common clinical examination recommended for use after a SCI. In addition, there are over 30 clinical assessment tools spanning across different domains of the International Classification of Functioning, Disability, and Health that have been validated and recommended for use in SCI. Most of these tools are subjective in nature, have limited value in predicting neurologic recovery, and do not provide insights into neurophysiological mechanisms. Transcranial magnetic stimulation (TMS) is a non-invasive neurophysiology technique that can supplement the clinical assessment in the domain of body structure and function during acute and chronic stages of SCI. TMS offers a better insight into neurophysiology and help in better detection of residual corticomotor connectivity following SCI compared to clinical assessment alone. TMS-based motor evoked potential and silent period duration allow study of excitatory and inhibitory mechanisms following SCI. Changes in muscle representations in form of displacement of TMS-based motor map center of gravity or changes in the map area can capture neuroplastic changes resulting from SCI or following rehabilitation. Paired-pulse TMS measures help understand the compensatory reorganization of the cortical circuits following SCI. In combination with peripheral stimulation, TMS can be used to study central motor conduction time and modulation of spinal reflexes, which can be used for advanced diagnostic and treatment purposes. To strengthen the utility of TMS in SCI assessment, future studies will need to standardize the assessment protocols, address population-specific concerns, and establish the psychometric properties of TMS-based measurements in the SCI population.
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Affiliation(s)
- Tarun Arora
- Krembil Research Institute, University Health Network, Toronto, ON, Canada,Correspondence: Tarun Arora Robert Chen
| | - Naaz Desai
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Steven Kirshblum
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States,Kessler Institute for Rehabilitation, West Orange, NJ, United States,Kessler Foundation, West Orange, NJ, United States,Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Robert Chen
- Krembil Research Institute, University Health Network, Toronto, ON, Canada,Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON, Canada,Division of Neurology, University of Toronto, Toronto, ON, Canada,Correspondence: Tarun Arora Robert Chen
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13
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Chou YH, Sundman M, Ton That V, Green J, Trapani C. Cortical excitability and plasticity in Alzheimer's disease and mild cognitive impairment: A systematic review and meta-analysis of transcranial magnetic stimulation studies. Ageing Res Rev 2022; 79:101660. [PMID: 35680080 DOI: 10.1016/j.arr.2022.101660] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 05/13/2022] [Accepted: 05/30/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) is a non-invasive neuromodulation technique. When stimulation is applied over the primary motor cortex and coupled with electromyography measures, TMS can probe functions of cortical excitability and plasticity in vivo. The purpose of this meta-analysis is to evaluate the utility of TMS-derived measures for differentiating patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI) from cognitively normal older adults (CN). METHODS Databases searched included PubMed, Embase, APA PsycInfo, Medline, and CINAHL Plus from inception to July 2021. RESULTS Sixty-one studies with a total of 2728 participants (1454 patients with AD, 163 patients with MCI, and 1111 CN) were included. Patients with AD showed significantly higher cortical excitability, lower cortical inhibition, and impaired cortical plasticity compared to the CN cohorts. Patients with MCI exhibited increased cortical excitability and reduced plasticity compared to the CN cohort. Additionally, lower cognitive performance was significantly associated with higher cortical excitability and lower inhibition. No seizure events due to TMS were reported, and the mild adverse response rate is approximately 3/1000 (i.e., 9/2728). CONCLUSIONS Findings of our meta-analysis demonstrate the potential of using TMS-derived cortical excitability and plasticity measures as diagnostic biomarkers and therapeutic targets for AD and MCI.
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Affiliation(s)
- Ying-Hui Chou
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, Tucson, USA; Evelyn F McKnight Brain Institute, Arizona Center on Aging, and BIO5 Institute, University of Arizona, Tucson, USA.
| | - Mark Sundman
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, Tucson, USA
| | - Viet Ton That
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, Tucson, USA
| | - Jacob Green
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, Tucson, USA
| | - Chrisopher Trapani
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, Tucson, USA
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14
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Caparelli EC, Schleyer B, Zhai T, Gu H, Abulseoud OA, Yang Y. High-Frequency Transcranial Magnetic Stimulation Combined With Functional Magnetic Resonance Imaging Reveals Distinct Activation Patterns Associated With Different Dorsolateral Prefrontal Cortex Stimulation Sites. Neuromodulation 2022; 25:633-643. [PMID: 35418339 DOI: 10.1016/j.neurom.2022.03.002] [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: 09/08/2021] [Revised: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Transcranial magnetic stimulation (TMS) has been extensively used for the treatment of depression, obsessive-compulsive disorder, and certain neurologic disorders. Despite having promising treatment efficacy, the fundamental neural mechanisms of TMS remain understudied. MATERIALS AND METHODS In this study, 15 healthy adult participants received simultaneous TMS and functional magnetic resonance imaging to map the modulatory effect of TMS when it was applied over three different sites in the dorsolateral prefrontal cortex. Independent component analysis (ICA) was used to identify the networks affected by TMS when applied over the different sites. The standard general linear model (GLM) analysis was used for comparison. RESULTS ICA showed that TMS affected the stimulation sites as well as remote brain areas, some areas/networks common across all TMS sites, and other areas/networks specific to each TMS site. In particular, TMS site and laterality differences were observed at the left executive control network. In addition, laterality differences also were observed at the dorsal anterior cingulate cortex and dorsolateral/dorsomedial prefrontal cortex. In contrast with the ICA findings, the GLM-based results mainly showed activation of auditory cortices regardless of the TMS sites. CONCLUSIONS Our findings support the notion that TMS could act through a top-down mechanism, indirectly modulating deep subcortical nodes by directly stimulating cortical regions. CLINICAL TRIAL REGISTRATION The Clinicaltrials.gov registration number for the study is NCT03394066.
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Affiliation(s)
- Elisabeth C Caparelli
- Neuroimaging Research Branch, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA.
| | - Brooke Schleyer
- Neuroimaging Research Branch, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA; Department of Psychology, College of Liberal Arts, Temple University, Philadelphia, PA, USA
| | - Tianye Zhai
- Neuroimaging Research Branch, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA
| | - Hong Gu
- Neuroimaging Research Branch, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA
| | - Osama A Abulseoud
- Neuroimaging Research Branch, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA; Department of Psychiatry and Psychology, Mayo Clinic, Phoenix, AZ, USA
| | - Yihong Yang
- Neuroimaging Research Branch, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA
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15
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Toward noninvasive brain stimulation 2.0 in Alzheimer's disease. Ageing Res Rev 2022; 75:101555. [PMID: 34973457 PMCID: PMC8858588 DOI: 10.1016/j.arr.2021.101555] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 12/01/2021] [Accepted: 12/27/2021] [Indexed: 12/13/2022]
Abstract
Noninvasive brain stimulation techniques (NiBS) have gathered substantial interest in the study of dementia, considered their possible role in help defining diagnostic biomarkers of altered neural activity for early disease detection and monitoring of its pathophysiological course, as well as for their therapeutic potential of boosting residual cognitive functions. Nevertheless, current approaches suffer from some limitations. In this study, we review and discuss experimental NiBS applications that might help improve the efficacy of future NiBS uses in Alzheimer's Disease (AD), including perturbation-based biomarkers for early diagnosis and disease tracking, solutions to enhance synchronization of oscillatory electroencephalographic activity across brain networks, enhancement of sleep-related memory consolidation, image-guided stimulation for connectome control, protocols targeting interneuron pathology and protein clearance, and finally hybrid-brain models for in-silico modeling of AD pathology and personalized target selection. The present work aims to stress the importance of multidisciplinary, translational, model-driven interventions for precision medicine approaches in AD.
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16
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Cheng B, Zhu T, Zhao W, Sun L, Shen Y, Xiao W, Zhang S. Effect of Theta Burst Stimulation-Patterned rTMS on Motor and Nonmotor Dysfunction of Parkinson's Disease: A Systematic Review and Metaanalysis. Front Neurol 2022; 12:762100. [PMID: 35095722 PMCID: PMC8790062 DOI: 10.3389/fneur.2021.762100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 12/10/2021] [Indexed: 01/27/2023] Open
Abstract
Background: Theta burst stimulation (TBS), a type of patterned repetitive transcranial magnetic stimulation (rTMS), has several advantages, such as short time of single treatment and low stimulation intensity compared with traditional rTMS. Since the efficacy of TBS on the symptoms of Parkinson's disease (PD) was inconsistent among different studies, we systematically searched these studies and quantitatively analyzed the therapeutic effect of TBS for patients with PD. Methods: We followed the recommended PRISMA guidelines for systematic reviews. Studies from PubMed, EMBASE, CENTRAL, and ClinicalTrials.gov from January 1, 2005 of each database to September 30, 2021 were analyzed. We also manually retrieved studies of reference. Results: Eight eligible studies with 189 participants (received real TBS and/or sham TBS) were included. This metaanalysis found that TBS did not significantly improve Unified Parkinson's Disease Rating Scale part III (UPDRS-III) score in the “on” medicine state (SMD = −0.06; 95% CI, −0.37 to 0.25; p = 0.69; I2 = 0%), while, it brought significant improvement of UPDRS-III scores in the “off” medicine state (SMD = −0.37; 95% CI, −0.65 to −0.09; p < 0.01; I2 = 19%). Subgroup analysis found that merely continuous TBS (cTBS) over the supplementary motor area (SMA) brought significant improvement of UPDRS-III score (SMD = −0.63; 95% CI, −1.02 to −0.25; p < 0.01). TBS had insignificant effectiveness for upper limb movement disorder both in the “on” and “off” medicine status (SMD = −0.07; 95% CI, −0.36 to 0.22; p = 0.64; I2 = 0%; SMD = −0.21; 95% CI, −0.57 to 0.15; p = 0.26; I2 = 0%; respectively). TBS significantly improved slowing of gait in the “off” medicine status (SMD = −0.37; 95% CI, −0.71 to −0.03; p = 0.03; I2 = 0%). Subgroup analysis suggested that only intermittent TBS (iTBS) over the primary motor cortex (M1) + dorsolateral prefrontal cortex (DLPFC) had significant difference (SMD = −0.57; 95% CI, −1.13 to −0.01; p = 0.04). Additionally, iTBS over the M1+ DLPFC had a short-term (within 2 weeks) therapeutic effect on PD depression (MD = −2.93; 95% CI, −5.52 to −0.33; p = 0.03). Conclusion: Our study demonstrated that cTBS over the SMA could significantly improve the UPDRS-III score for PD patients in the “off,” not in the “on,” medicine state. TBS could not bring significant improvement of upper limb movement dysfunction. ITBS over the M1+DLPFC could significantly improve the slowing of gait in the “off” medicine status. Additionally, iTBS over the M1+DLPFC has a short-term (within 2 weeks) therapeutic effect on PD depression. Further RCTs of a large sample, and excellent design are needed to confirm our conclusions.
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Affiliation(s)
- Bo Cheng
- Department of Neurology, Affiliated Hospital of Medical College, North Sichuan Medical College (University), Nanchong, China
| | - Tao Zhu
- Department of Preventive Medicine, North Sichuan Medical College (University), Nanchong, China
| | - Wenhao Zhao
- Department of Neurology, Affiliated Hospital of Medical College, North Sichuan Medical College (University), Nanchong, China
| | - Ling Sun
- Department of Neurology, Affiliated Hospital of Medical College, North Sichuan Medical College (University), Nanchong, China
| | - Yao Shen
- Department of Neurology, Affiliated Hospital of Medical College, North Sichuan Medical College (University), Nanchong, China
| | - Wei Xiao
- Department of Neurology, Affiliated Hospital of Medical College, North Sichuan Medical College (University), Nanchong, China
| | - Shushan Zhang
- Department of Neurology, Affiliated Hospital of Medical College, North Sichuan Medical College (University), Nanchong, China
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17
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Queiroz SAL, Ton AMM, Pereira TMC, Campagnaro BP, Martinelli L, Picos A, Campos-Toimil M, Vasquez EC. The Gut Microbiota-Brain Axis: A New Frontier on Neuropsychiatric Disorders. Front Psychiatry 2022; 13:872594. [PMID: 35722583 PMCID: PMC9198224 DOI: 10.3389/fpsyt.2022.872594] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
Alzheimer's disease (AD) is a progressive and incurable neurodegenerative disorder of integrative areas of the brain, characterized by cognitive decline and disability resulting in negative impacts on the family of the patients and the health care services worldwide. AD involves oxidative stress, neuroinflammation and accelerated apoptosis, accompanied by deposition of amyloid-β peptide plaques and tau protein-based neurofibrillary tangles in the central nervous system. Among the multiple factors that contribute to the onset and evolution of this disease, aging stands out. That is why the prevalence of this disease has increased due to the constant increase in life expectancy. In the hope of finding new, more effective methods to slow the progression of this disease, over the last two decades, researchers have promoted "omics"-based approaches that include the gut microbiota and their reciprocal interactions with different targets in the body. This scientific advance has also led to a better understanding of brain compartments and the mechanisms that affect the integrity of the blood-brain barrier. This review aims to discuss recent advances related to the gut-brain-microbiota axis in AD. Furthermore, considering that AD involves psychiatric symptoms, this review also focuses on the psychiatric factors that interact with this axis (an issue that has not yet been sufficiently addressed in the literature).
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Affiliation(s)
- Sarha A L Queiroz
- Laboratory of Translational Physiology and Pharmacology, Pharmaceutical Sciences Graduate Program, Vila Velha University, Vila Velha, Brazil
| | - Alyne M M Ton
- Laboratory of Translational Physiology and Pharmacology, Pharmaceutical Sciences Graduate Program, Vila Velha University, Vila Velha, Brazil
| | - Thiago M C Pereira
- Laboratory of Translational Physiology and Pharmacology, Pharmaceutical Sciences Graduate Program, Vila Velha University, Vila Velha, Brazil.,Federal Institute of Education, Science and Technology (IFES), Vila Velha, Brazil
| | - Bianca P Campagnaro
- Laboratory of Translational Physiology and Pharmacology, Pharmaceutical Sciences Graduate Program, Vila Velha University, Vila Velha, Brazil
| | - Larissa Martinelli
- Laboratory of Translational Physiology and Pharmacology, Pharmaceutical Sciences Graduate Program, Vila Velha University, Vila Velha, Brazil
| | - Aitor Picos
- Physiology and Pharmacology of Chronic Diseases (FIFAEC), Center for Research in Molecular Medicine and Chronic Diseases (CIMUS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Manuel Campos-Toimil
- Physiology and Pharmacology of Chronic Diseases (FIFAEC), Center for Research in Molecular Medicine and Chronic Diseases (CIMUS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Elisardo C Vasquez
- Laboratory of Translational Physiology and Pharmacology, Pharmaceutical Sciences Graduate Program, Vila Velha University, Vila Velha, Brazil
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18
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Filipović SR, Kačar A, Milanović S, Ljubisavljević MR. Neurophysiological Predictors of Response to Medication in Parkinson's Disease. Front Neurol 2021; 12:763911. [PMID: 34867748 PMCID: PMC8635106 DOI: 10.3389/fneur.2021.763911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Although dopaminergic medication has been the foundation of Parkinson's disease (PD) therapy for decades, sensitive and specific therapeutic response biomarkers that allow for better treatment optimization are lacking. Objective: We tested whether the features of Transcranial Magnetic Stimulation-based neurophysiological measures taken off-medication are associated with dopaminergic medication-induced clinical effects. Method: Motor cortex excitability [short-latency intracortical inhibition (SICI), intracortical facilitation (ICF), short-latency afferent inhibition (SAI), and input-output (IO) curve], and plasticity [paired associative stimulation (PAS) protocol] neurophysiological measures were examined in 23 PD patients off-medication. Clinical features were quantified by the motor section of the Unified Parkinson's Disease Scale (total score and lateralized total, bradykinesia, and rigidity sub-scores), and the differences between measures off-medication and on-medication (following the usual morning dose), were determined. Total daily dopaminergic medication dose (expressed as levodopa equivalent daily dose-LEDD), was also determined. Results: SICI significantly correlated with changes in lateralized UPDRS motor and bradykinesia sub-scores, suggesting that patients with stronger basal intracortical inhibition benefit more from dopaminergic treatment than patients with weaker intracortical inhibition. Also, ICF significantly negatively correlated with LEDD, suggesting that patients with stronger intracortical facilitation require less dopaminergic medication to achieve optimal therapeutic benefit. Both associations were independent of disease severity and duration. Conclusions: The results suggest variability of (patho) physiological phenotypes related to intracortical inhibitory and facilitatory mechanisms determining clinical response to dopaminergic medication in PD. Measures of intracortical excitability may help predict patients' response to dopaminergic therapy, thus potentially providing a background for developing personalized therapy in PD.
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Affiliation(s)
- Saša R. Filipović
- Department for Human Neuroscience, Institute for Medical Research, University of Belgrade, Belgrade, Serbia
| | - Aleksandra Kačar
- Department for Human Neuroscience, Institute for Medical Research, University of Belgrade, Belgrade, Serbia
- Department of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sladjan Milanović
- Department for Human Neuroscience, Institute for Medical Research, University of Belgrade, Belgrade, Serbia
| | - Miloš R. Ljubisavljević
- Department for Human Neuroscience, Institute for Medical Research, University of Belgrade, Belgrade, Serbia
- Department of Physiology, College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates
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19
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Zhang X, Lan X, Chen C, Ren H, Guo Y. Effects of Repetitive Transcranial Magnetic Stimulation in Patients With Mild Cognitive Impairment: A Meta-Analysis of Randomized Controlled Trials. Front Hum Neurosci 2021; 15:723715. [PMID: 34764859 PMCID: PMC8576192 DOI: 10.3389/fnhum.2021.723715] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/30/2021] [Indexed: 01/14/2023] Open
Abstract
Background: Mild cognitive impairment (MCI) is an intermediary state between normal aging and dementia. It has a high risk of progression in patients with Alzheimer's disease (AD). Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation technique used to improve cognitive deficits in patients with MCI and AD. Although previous meta-analyses included studies carried on patients with MCI and AD, few studies have analyzed patients with MCI independently. This meta-analysis aimed to evaluate the effects and safety of rTMS on cognition function in patients with MCI and factors that may influence such effects. Methods: Data used in this study were searched and screened from different databases, including PubMed, Web of Science, Embase, the Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), Chinese Technical Periodicals (VIP), Wanfang Database, and China BioMedical Literature Database (SinoMed). The retrieved studies were carefully reviewed, data were extracted, and the quality of data was assessed. Results: A total of 12 studies involving 329 patients with MCI were included in the present meta-analysis. The analyses results revealed that rTMS improved cognitive function [standardized mean difference (SMD) = 0.83, 95% confidence interval (CI) = 0.44-1.22, p = 0.0009] and memory function (SMD = 0.73, 95% CI = 0.48-0.97, p < 0.00001) in the MCI + rTMS active group when compared to the sham stimulation group. The showed that: (1) cognitive improvement was more pronounced under high-frequency rTMS stimulation of multiple sites, such as the bilateral dorsolateral prefrontal cortex and (2) more than 10 rTMS stimulation sessions produced higher improvement on cognition function in patients with MCI. Conclusions: This study shows that rTMS can improve cognitive function in patients with MCI, especially when applied at high frequency, multi-site, and for a prolonged period. However, further studies are required to validate these findings and explore more effective stimulation protocols and targets. Systematic Review Registration: [http://www.crd.york.ac.uk/PROSPERO/], identifier: CRD 42021238708.
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Affiliation(s)
- Xinqi Zhang
- Department of Neurology, Shenzhen People's Hospital (The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University), Shenzhen, China
| | - Xiaoyong Lan
- Department of Neurology, Shenzhen People's Hospital (The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University), Shenzhen, China
| | - Chanjuan Chen
- Department of Neurology, Shenzhen People's Hospital (The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University), Shenzhen, China
| | - Huixia Ren
- Department of Neurology, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen, China.,The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Yi Guo
- Department of Neurology, Shenzhen People's Hospital (The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University), Shenzhen, China
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20
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Are there differences in cortical excitability between akinetic-rigid and tremor-dominant subtypes of Parkinson's disease? Neurophysiol Clin 2021; 51:443-453. [PMID: 34588134 DOI: 10.1016/j.neucli.2021.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/25/2021] [Accepted: 08/25/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To assess by transcranial magnetic stimulation (TMS) the excitability of various cortical circuits in akinetic-rigid and tremor-dominant subtypes of Parkinson's disease (PD). METHODS The study included 92 patients with PD according to UK Brain Bank criteria, with akinetic-rigid (n = 64) or tremor-dominant (n = 28) subtype. Cortical excitability study, including resting and active motor thresholds (rMT and aMT), input-output curve of motor evoked potentials, contralateral and ipsilateral silent periods (cSP and iSP), short and long-interval intracortical inhibition (SICI and LICI), and intracortical facilitation (ICF) were measured. The results obtained were compared to a control group of 30 age- and sex-matched healthy subjects. RESULTS The patients in the tremor group had significantly lower rMT and aMT compared to controls and akinetic-rigid patients and significantly shorter iSP duration compared to akinetic-rigid patients, while iSP latency tended to be longer in akinetic-rigid patients compared to controls. There were no significant differences between the two PD subgroups regarding other cortical excitability parameters, including paired-pulse TMS parameters. CONCLUSIONS Only subtle differences of cortical excitability were found between patients with akinetic-rigid vs. tremor-dominant subtype of PD. SIGNIFICANCE The clinical heterogeneity of PD patients probably has an impact on cortical excitability measures, far beyond the akinetic-rigid versus tremor-dominant profile.
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21
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Hutny M, Hofman J, Klimkowicz-Mrowiec A, Gorzkowska A. Current Knowledge on the Background, Pathophysiology and Treatment of Levodopa-Induced Dyskinesia-Literature Review. J Clin Med 2021; 10:jcm10194377. [PMID: 34640395 PMCID: PMC8509231 DOI: 10.3390/jcm10194377] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/02/2021] [Accepted: 09/22/2021] [Indexed: 02/07/2023] Open
Abstract
Levodopa remains the primary drug for controlling motor symptoms in Parkinson’s disease through the whole course, but over time, complications develop in the form of dyskinesias, which gradually become more frequent and severe. These abnormal, involuntary, hyperkinetic movements are mainly characteristic of the ON phase and are triggered by excess exogenous levodopa. They may also occur during the OFF phase, or in both phases. Over the past 10 years, the issue of levodopa-induced dyskinesia has been the subject of research into both the substrate of this pathology and potential remedial strategies. The purpose of the present study was to review the results of recent research on the background and treatment of dyskinesia. To this end, databases were reviewed using a search strategy that included both relevant keywords related to the topic and appropriate filters to limit results to English language literature published since 2010. Based on the selected papers, the current state of knowledge on the morphological, functional, genetic and clinical features of levodopa-induced dyskinesia, as well as pharmacological, genetic treatment and other therapies such as deep brain stimulation, are described.
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Affiliation(s)
- Michał Hutny
- Students’ Scientific Society, Department of Neurorehabilitation, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
- Correspondence:
| | - Jagoda Hofman
- Students’ Scientific Society, Department of Neurorehabilitation, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
| | - Aleksandra Klimkowicz-Mrowiec
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Medical College, Jagiellonian University, 30-688 Kraków, Poland;
| | - Agnieszka Gorzkowska
- Department of Neurorehabilitation, Faculty of Medical Sciences, School of Medicine, Medical University of Silesia, 40-752 Katowice, Poland;
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22
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Huang H, Du X, He Z, Yan Z, Han W. Nanoparticles for Stem Cell Tracking and the Potential Treatment of Cardiovascular Diseases. Front Cell Dev Biol 2021; 9:662406. [PMID: 34277609 PMCID: PMC8283769 DOI: 10.3389/fcell.2021.662406] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/12/2021] [Indexed: 01/15/2023] Open
Abstract
Stem cell-based therapies have been shown potential in regenerative medicine. In these cells, mesenchymal stem cells (MSCs) have the ability of self-renewal and being differentiated into different types of cells, such as cardiovascular cells. Moreover, MSCs have low immunogenicity and immunomodulatory properties, and can protect the myocardium, which are ideal qualities for cardiovascular repair. Transplanting mesenchymal stem cells has demonstrated improved outcomes for treating cardiovascular diseases in preclinical trials. However, there still are some challenges, such as their low rate of migration to the ischemic myocardium, low tissue retention, and low survival rate after the transplantation. To solve these problems, an ideal method should be developed to precisely and quantitatively monitor the viability of the transplanted cells in vivo for providing the guidance of clinical translation. Cell imaging is an ideal method, but requires a suitable contrast agent to label and track the cells. This article reviews the uses of nanoparticles as contrast agents for tracking MSCs and the challenges of clinical use of MSCs in the potential treatment of cardiovascular diseases.
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Affiliation(s)
- Huihua Huang
- Emergency Department, Shenzhen University General Hospital, Shenzhen University, Shenzhen, China
- Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Shenzhen University, Health Science Center, Shenzhen, China
| | - Xuejun Du
- Emergency Department, Shenzhen University General Hospital, Shenzhen University, Shenzhen, China
| | - Zhiguo He
- Advanced Materials Institute, Graduate School at Shenzhen, Tsinghua University, Shenzhen, China
| | - Zifeng Yan
- Advanced Materials Institute, Graduate School at Shenzhen, Tsinghua University, Shenzhen, China
| | - Wei Han
- Emergency Department, Shenzhen University General Hospital, Shenzhen University, Shenzhen, China
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23
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Billeri L, Naro A. A narrative review on non-invasive stimulation of the cerebellum in neurological diseases. Neurol Sci 2021; 42:2191-2209. [PMID: 33759055 DOI: 10.1007/s10072-021-05187-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 03/15/2021] [Indexed: 12/26/2022]
Abstract
IMPORTANCE The cerebellum plays an important role in motor, cognitive, and affective functions owing to its dense interconnections with basal ganglia and cerebral cortex. This review aimed at summarizing the non-invasive cerebellar stimulation (NICS) approaches used to modulate cerebellar output and treat cerebellar dysfunction in the motor domain. OBSERVATION The utility of NICS in the treatment of cerebellar and non-cerebellar neurological diseases (including Parkinson's disease, dementia, cerebellar ataxia, and stroke) is discussed. NICS induces meaningful clinical effects from repeated sessions alone in both cerebellar and non-cerebellar diseases. However, there are no conclusive data on this issue and several concerns need to be still addressed before NICS could be considered a valuable, standard therapeutic tool. CONCLUSIONS AND RELEVANCE Even though some challenges must be overcome to adopt NICS in a wider clinical setting, this tool might become a useful strategy to help patients with lesions in the cerebellum and cerebral areas that are connected with the cerebellum whether one could enhance cerebellar activity with the intention of facilitating the cerebellum and the entire, related network, rather than attempting to facilitate a partially damaged cortical region or inhibiting the homologs' contralateral area. The different outcome of each approach would depend on the residual functional reserve of the cerebellum, which is confirmed as a critical element to be probed preliminary in order to define the best patient-tailored NICS.
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Affiliation(s)
- Luana Billeri
- IRCCS Centro Neurolesi Bonino Pulejo, via Palermo, SS113, Ctr. Casazza, 98124, Messina, Italy
| | - Antonino Naro
- IRCCS Centro Neurolesi Bonino Pulejo, via Palermo, SS113, Ctr. Casazza, 98124, Messina, Italy.
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Chaves AR, Snow NJ, Alcock LR, Ploughman M. Probing the Brain-Body Connection Using Transcranial Magnetic Stimulation (TMS): Validating a Promising Tool to Provide Biomarkers of Neuroplasticity and Central Nervous System Function. Brain Sci 2021; 11:384. [PMID: 33803028 PMCID: PMC8002717 DOI: 10.3390/brainsci11030384] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 01/18/2023] Open
Abstract
Transcranial magnetic stimulation (TMS) is a non-invasive method used to investigate neurophysiological integrity of the human neuromotor system. We describe in detail, the methodology of a single pulse TMS protocol that was performed in a large cohort of people (n = 110) with multiple sclerosis (MS). The aim was to establish and validate a core-set of TMS variables that predicted typical MS clinical outcomes: walking speed, hand dexterity, fatigue, and cognitive processing speed. We provide a brief and simple methodological pipeline to examine excitatory and inhibitory corticospinal mechanisms in MS that map to clinical status. Delayed and longer ipsilateral silent period (a measure of transcallosal inhibition; the influence of one brain hemisphere's activity over the other), longer cortical silent period (suggestive of greater corticospinal inhibition via GABA) and higher resting motor threshold (lower corticospinal excitability) most strongly related to clinical outcomes, especially when measured in the hemisphere corresponding to the weaker hand. Greater interhemispheric asymmetry (imbalance between hemispheres) correlated with poorer performance in the greatest number of clinical outcomes. We also show, not surprisingly, that TMS variables related more strongly to motor outcomes than non-motor outcomes. As it was validated in a large sample of patients with varying severities of central nervous system dysfunction, the protocol described herein can be used by investigators and clinicians alike to investigate the role of TMS as a biomarker in MS and other central nervous system disorders.
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Affiliation(s)
| | | | | | - Michelle Ploughman
- L.A. Miller Centre, Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1A 1E5, Canada; (A.R.C.); (N.J.S.); (L.R.A.)
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25
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Yang J, Liang R, Wang L, Zheng C, Xiao X, Ming D. Repetitive Transcranial Magnetic Stimulation (rTMS) Improves the Gait Disorders of Rats Under Simulated Microgravity Conditions Associated With the Regulation of Motor Cortex. Front Physiol 2021; 12:587515. [PMID: 33613305 PMCID: PMC7890125 DOI: 10.3389/fphys.2021.587515] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 01/15/2021] [Indexed: 11/25/2022] Open
Abstract
In previous studies, it has been proved that repetitive transcranial magnetic stimulation (rTMS) improves dyskinesia induced by conditions such as spinal cord injury, Parkinson diseases and cerebral ischemia. However, it is still unknown whether it can be used as a countermeasure for gait disorders in astronauts during space flight. In this study, we evaluated the effects of rTMS on the rat gait function under simulated microgravity (SM) conditions. The SM procedure continued for consecutive 21 days in male Wistar rats. Meanwhile, the high-frequency rTMS (10 Hz) was applied for 14 days from the eighth day of SM procedure. The behavioral results showed that SM could cause gait disorders such as decreased walking ability and contralateral limb imbalance in rats, which could be reversed by rTMS. Furthermore, rTMS affected the neural oscillations of motor cortex, enhancing in δ (2–4 Hz) band, suppressing in θ (4–7 Hz), and α (7–12 Hz) bands. Additionally, rTMS could activate mTOR in the motor cortex. These data suggests that the improvement effects of rTMS on gait disorders in rats under SM conditions might be associated with its regulation on neural oscillations in the cerebral motor cortex and the expression of some motor-related proteins which may enhance the control of nervous system on muscle function. Based on our results, rTMS can be used as an potential effective supplement in the field of clinical and rehabilitation research to reduce gait disorders caused by the space environment.
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Affiliation(s)
- Jiajia Yang
- Institute of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China.,School of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Tianjin, China.,Tianjin Key Laboratory of Brain Science and Neural Engineering, Tianjin University, Tianjin, China
| | - Rong Liang
- Institute of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Ling Wang
- School of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Tianjin, China
| | - Chenguang Zheng
- School of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Tianjin, China.,Tianjin Key Laboratory of Brain Science and Neural Engineering, Tianjin University, Tianjin, China
| | - Xi Xiao
- Institute of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China.,Tianjin Key Laboratory of Brain Science and Neural Engineering, Tianjin University, Tianjin, China
| | - Dong Ming
- Institute of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China.,School of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Tianjin, China.,Tianjin Key Laboratory of Brain Science and Neural Engineering, Tianjin University, Tianjin, China
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26
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Velioglu HA, Hanoglu L, Bayraktaroglu Z, Toprak G, Guler EM, Bektay MY, Mutlu-Burnaz O, Yulug B. Left lateral parietal rTMS improves cognition and modulates resting brain connectivity in patients with Alzheimer's disease: Possible role of BDNF and oxidative stress. Neurobiol Learn Mem 2021; 180:107410. [PMID: 33610772 DOI: 10.1016/j.nlm.2021.107410] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 01/11/2021] [Accepted: 02/14/2021] [Indexed: 12/22/2022]
Abstract
Repetitive Transcranial Magnetic Stimulation (rTMS) is a non-invasive neuromodulation technique which is increasingly used for cognitive impairment in Alzheimer's Disease (AD). Although rTMS has been shown to modify Brain-Derived Neurotrophic Factor (BDNF) and oxidative stress levels in many neurological and psychiatric diseases, there is still no study evaluating the relationship between memory performance, BDNF, oxidative stress, and resting brain connectivity following rTMS in Alzheimer's patients. Furthermore, there are increasing clinical data showing that the stimulation of strategic brain regions may lead to more robust improvements in memory functions compared to conventional rTMS. In this study, we aimed to evaluate the possible disease-modifying effects of rTMS on the lateral parietal cortex in AD patients who have the highest connectivity with the hippocampus. To fill the mentioned research gaps, we have evaluated the relationships between resting-state Functional Magnetic Resonance Imaging (fMRI), cognitive scores, blood BDNF levels, and total oxidative/antioxidant status to explain the therapeutic and potential disease-modifying effects of rTMS which has been applied at 20 Hz frequencies for two weeks. Our results showed significantly increased visual recognition memory functions and clock drawing test scores which were associated with elevated peripheral BDNF levels, and decreased oxidant status after two weeks of left lateral parietal TMS stimulation. Clinically our findings suggest that the left parietal region targeted rTMS application leads to significant improvement in familiarity-based cognition associated with the network connections between the left parietal region and the hippocampus.
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Affiliation(s)
- Halil Aziz Velioglu
- Istanbul Medipol University, Health Sciences and Technology Research Institute (SABITA), Regenerative and Restorative Medicine Research Center (REMER), functional Imaging and Cognitive-Affective Neuroscience Lab (fINCAN), Istanbul, Turkey
| | - Lutfu Hanoglu
- Istanbul Medipol University, Health Sciences and Technology Research Institute (SABITA), Regenerative and Restorative Medicine Research Center (REMER), functional Imaging and Cognitive-Affective Neuroscience Lab (fINCAN), Istanbul, Turkey; Istanbul Medipol University School of Medicine, Department of Neurology, Istanbul, Turkey
| | - Zubeyir Bayraktaroglu
- Istanbul Medipol University, Health Sciences and Technology Research Institute (SABITA), Regenerative and Restorative Medicine Research Center (REMER), functional Imaging and Cognitive-Affective Neuroscience Lab (fINCAN), Istanbul, Turkey; Istanbul Medipol University, International School of Medicine Department of Physiology, Istanbul, Turkey
| | - Guven Toprak
- Istanbul Medipol University, Health Sciences and Technology Research Institute (SABITA), Regenerative and Restorative Medicine Research Center (REMER), functional Imaging and Cognitive-Affective Neuroscience Lab (fINCAN), Istanbul, Turkey
| | - Eray Metin Guler
- University of Health Sciences Hamidiye School of Medicine, Department of Medical Biochemistry, Istanbul, Turkey; University of Health Sciences, Haydarpasa Numune Health Application and Research Center, Department of Medical Biochemistry, Istanbul, Turkey
| | - Muhammed Yunus Bektay
- Bezmialem Vakif University School of Pharmacy, Department of Clinical Pharmacy, Istanbul, Turkey; Marmara University School of Pharmacy, Department of Clinical Pharmacy, Istanbul, Turkey
| | - Ozlem Mutlu-Burnaz
- Istanbul Medipol University, Health Sciences and Technology Research Institute (SABITA), Regenerative and Restorative Medicine Research Center (REMER), functional Imaging and Cognitive-Affective Neuroscience Lab (fINCAN), Istanbul, Turkey
| | - Burak Yulug
- Alanya Alaaddin Keykubat University School of Medicine, Department of Neurology, Alanya/Antalya, Turkey.
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27
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Pang Y, Shi M. Repetitive Transcranial Magnetic Stimulation Improves Mild Cognitive Impairment Associated with Alzheimer's Disease in Mice by Modulating the miR-567/NEUROD2/PSD95 Axis. Neuropsychiatr Dis Treat 2021; 17:2151-2161. [PMID: 34239303 PMCID: PMC8259939 DOI: 10.2147/ndt.s311183] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/17/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Mild cognitive impairment (MCI) is a typical symptom of early Alzheimer's disease (AD) and is driven by the dysfunction of microRNAs (miRs). Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive technique for handling neuropsychiatric disorders and has universally effects on the functions of miRs. In the current study, the improvement effects of rTMS on MCI associated with AD were explored by focusing on miR-567/NEUROD2/PSD95 axis. METHODS MCI was induced in mice using scopolamine and was treated with rTMS of two frequencies (1 Hz and 10 Hz). The changes in cognitive function, brain structure, neurotrophic factor levels, and activity of miR-567/NEUROD2/PSD95 axis were assessed. The interaction between rTMS and miR-567 was further verified by inducing the level of miR-567 in AD mice. RESULTS The administrations of rTMS improved the cognitive function of AD mice and attenuated brain tissue destruction, which were associated with the restored production of BDNF and NGF. Additionally, rTMS administrations suppressed the expression of miR-567 and up-regulated the expressions of NEUROD2 and PSD95, which contributed to the improved condition in central nerve system. With the induced level of miR-567, the effects of rTMS were counteracted: the learning and memorizing abilities of mice were impaired, the brain neuron viability was suppressed, and the production of neurotrophic factors was suppressed even under the administration of rTMS. The changes in brain function and tissues were associated with the inhibited expressions of NEUROD2 and PSD95. CONCLUSION The findings outlined in the current study demonstrated that rTMS treatment could protect brain against AD-induced MCI without significant side effects, and the function depended on the inhibition of miR-567.
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Affiliation(s)
- Yongfeng Pang
- Department of Rehabilitation, Tiantai People's Hospital of Zhejiang Province, Zhengjiang, 317200, People's Republic of China
| | - Mingfei Shi
- Department of Rehabilitation, Tiantai People's Hospital of Zhejiang Province, Zhengjiang, 317200, People's Republic of China
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28
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Nikolov P, Zimmermann JV, Hassan SS, Albrecht P, Schnitzler A, Groiss SJ. Impact of the number of conditioning pulses on motor cortex excitability: a transcranial magnetic stimulation study. Exp Brain Res 2020; 239:583-589. [PMID: 33373012 PMCID: PMC7936961 DOI: 10.1007/s00221-020-06010-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/07/2020] [Indexed: 12/03/2022]
Abstract
Conditioning transcranial magnetic stimulation (TMS) with subthreshold conditioning stimulus followed by supra-threshold test stimulus at inter-stimulus intervals (ISI) of 1–5 ms results in inhibition (SICI), while ISI at 10–15 ms results in facilitation (ICF). One concerning issue, applying ICF/SICI protocols on patients is the substantial protocol variability. Here, we hypothesized that increasing the number of CS could result in more robust ICF/SICI protocols. Twenty healthy subjects participated in the study. Motor-evoked potentials (MEP) were obtained from conditioning TMS with a varying number of conditioning stimuli in 3, 4, 10, and 15 ms ISI over the primary motor cortex. MEP amplitudes were then compared to examine excitability. TMS with 3, 5, and 7 conditioning stimuli but not with one conditioning stimulus induced ICF. Moreover, 10 ms ISI produced stronger ICF than 15 ms ISI. Significant SICI was only induced with one conditioning stimulus. Besides, 3 ms ISI resulted in stronger SICI than 4 ms ISI. Only a train of conditioning stimuli induced stable ICF and may be more advantageous than the classical paired pulse ICF paradigm.
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Affiliation(s)
- Petyo Nikolov
- Institute of Clinical Neuroscience and Medical Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Johanna V Zimmermann
- Institute of Clinical Neuroscience and Medical Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Shady S Hassan
- Department of Neurology, Medical Faculty, Assiut University Hospital, Assiut, Egypt
| | - Philipp Albrecht
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Alfons Schnitzler
- Institute of Clinical Neuroscience and Medical Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Stefan J Groiss
- Institute of Clinical Neuroscience and Medical Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
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29
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Romanella SM, Sprugnoli G, Ruffini G, Seyedmadani K, Rossi S, Santarnecchi E. Noninvasive Brain Stimulation & Space Exploration: Opportunities and Challenges. Neurosci Biobehav Rev 2020; 119:294-319. [PMID: 32937115 PMCID: PMC8361862 DOI: 10.1016/j.neubiorev.2020.09.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/22/2020] [Accepted: 09/03/2020] [Indexed: 01/11/2023]
Abstract
As NASA prepares for longer space missions aiming for the Moon and Mars, astronauts' health and performance are becoming a central concern due to the threats associated with galactic cosmic radiation, unnatural gravity fields, and life in extreme environments. In space, the human brain undergoes functional and structural changes related to fluid shift and changes in intracranial pressure. Behavioral abnormalities, such as cognitive deficits, sleep disruption, and visuomotor difficulties, as well as psychological effects, are also an issue. We discuss opportunities and challenges of noninvasive brain stimulation (NiBS) methods - including transcranial magnetic stimulation (TMS) and transcranial electrical stimulation (tES) - to support space exploration in several ways. NiBS includes safe and portable techniques already applied in a wide range of cognitive and motor domains, as well as therapeutically. NiBS could be used to enhance in-flight performance, supporting astronauts during pre-flight Earth-based training, as well as to identify biomarkers of post-flight brain changes for optimization of rehabilitation/compensatory strategies. We review these NiBS techniques and their effects on brain physiology, psychology, and cognition.
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Affiliation(s)
- S M Romanella
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, University of Siena, Italy
| | - G Sprugnoli
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Radiology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - G Ruffini
- Neuroelectrics Corporation, Cambridge, MA, USA
| | - K Seyedmadani
- University Space Research Association NASA Johnson Space Center, Houston, TX, USA; Ann and H.J. Smead Aerospace Engineering Sciences, University of Colorado, Boulder, CO, USA
| | - S Rossi
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, University of Siena, Italy; Human Physiology Section, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - E Santarnecchi
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, University of Siena, Italy; Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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30
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Rane S, Koh N, Oakley J, Caso C, Zabetian CP, Cholerton B, Montine TJ, Grabowski T. Arterial spin labeling detects perfusion patterns related to motor symptoms in Parkinson's disease. Parkinsonism Relat Disord 2020; 76:21-28. [PMID: 32559629 PMCID: PMC7554132 DOI: 10.1016/j.parkreldis.2020.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/25/2020] [Accepted: 05/08/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Imaging neurovascular disturbances in Parkinson's disease (PD) is an excellent measure of disease severity. Indeed, a disease-specific regional pattern of abnormal metabolism has been identified using positron emission tomography. Only a handful of studies, however, have applied perfusion MRI to detect this disease pattern. Our goal was to replicate the evaluation of a PD-related perfusion pattern using scaled subprofile modeling/principal component analysis (SSM-PCA). METHODS We applied arterial spin labeling (ASL) MRI for this purpose. Uniquely, we assessed this pattern separately in PD individuals ON and OFF dopamine medications. We further compared the existence of these patterns and their strength in each individual with their Movement Disorder Society-Unified Parkinson's Disease Rating Scale motor (MDS-UPDRS) scores, cholinergic tone as indexed by short-term afferent inhibition (SAI), and other neuropsychiatric tests. RESULTS We observed a PD-related perfusion pattern that was similar to previous studies. The patterns were observed in both ON and OFF states but only the pattern in the OFF condition could significantly (AUC=0.72) differentiate between PD and healthy subjects. In the ON condition, PD subjects were similar to controls from a CBF standpoint (AUC=0.45). The OFF pattern prominently included the posterior cingulate, precentral region, precuneus, and the subcallosal cortex. Individual principal components from the ON and OFF states were strongly associated with MDS-UPDRS scores, SAI amplitude and latency. CONCLUSION Using ASL, our study identified patterns of abnormal perfusion in PD and were associated with disease symptoms.
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Affiliation(s)
- Swati Rane
- Integrated Brain Imaging Center, Radiology, University of Washington Medical Center, Seattle, WA, USA.
| | - Natalie Koh
- Integrated Brain Imaging Center, Radiology, University of Washington Medical Center, Seattle, WA, USA
| | - John Oakley
- Department of Neurology, University of Washington Medical Center, Seattle, WA, USA
| | - Christina Caso
- Integrated Brain Imaging Center, Radiology, University of Washington Medical Center, Seattle, WA, USA
| | - Cyrus P Zabetian
- Department of Neurology, University of Washington Medical Center, Seattle, WA, USA; Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Brenna Cholerton
- Department of Pathology, Stanford University, Stanford, CA, 94305, USA
| | - Thomas J Montine
- Department of Pathology, Stanford University, Stanford, CA, 94305, USA
| | - Thomas Grabowski
- Integrated Brain Imaging Center, Radiology, University of Washington Medical Center, Seattle, WA, USA
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31
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Lee YY, Li MH, Tai CH, Luh JJ. Corticomotor Excitability Changes Associated With Freezing of Gait in People With Parkinson Disease. Front Hum Neurosci 2020; 14:190. [PMID: 32508609 PMCID: PMC7253638 DOI: 10.3389/fnhum.2020.00190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 04/28/2020] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose Freezing of gait (FOG) is a debilitating gait disorder in people with Parkinson’s disease (PD). While various neuroimaging techniques have been used to investigate the pathophysiology of FOG, changes in corticomotor excitability associated with FOG have yet to be determined. Research to date has not concluded if changes in corticomotor excitability are associated with gait disturbances in this patient population. This study aimed to use transcranial magnetic stimulation (TMS) to investigate corticomotor excitability changes associated with FOG. Furthermore, the relationship between corticomotor excitability and gait performances would be determined. Methods Eighteen participants with PD and FOG (PD + FOG), 15 without FOG (PD − FOG), and 15 non-disabled adults (Control) were recruited for this study. Single and paired-pulse TMS paradigms were used to assess corticospinal and intracortical excitability, respectively. Gait performance was measured by the 10-Meter-Walk test. Correlation analysis was performed to evaluate relationships between TMS outcomes and gait parameters. Results Compared with the Control group, the PD + FOG group showed a significantly lower resting motor threshold and reduced short intracortical inhibition (SICI). Correlation analysis revealed a relationship between resting motor evoked potential and step length, and between SICI and walking velocity in the Control group. While the silent period correlated with step length in the PD − FOG group, no significant relationship was observed in the PD + FOG group. Discussion and Conclusion Compared to the Control group, the PD + FOG group exhibited reduced corticomotor inhibition. Distinct correlations observed among the three groups suggest that the function of the corticomotor system plays an important role in mediating walking ability in non-disabled adults and people with PD − FOG, while people with PD + FOG may rely on neural networks other than the corticomotor system to control gait.
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Affiliation(s)
- Ya-Yun Lee
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Min-Hao Li
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-Hwei Tai
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Jer-Junn Luh
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,College of Education, Fu-Jen Catholic University, Taipei, Taiwan
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Akbar N, Yarossi M, Martinez-Gost M, Sommer MA, Dannhauer M, Rampersad S, Brooks D, Tunik E, Erdoğmuş D. Mapping Motor Cortex Stimulation to Muscle Responses: A Deep Neural Network Modeling Approach. THE ... INTERNATIONAL CONFERENCE ON PERVASIVE TECHNOLOGIES RELATED TO ASSISTIVE ENVIRONMENTS : PETRA ... INTERNATIONAL CONFERENCE ON PERVASIVE TECHNOLOGIES RELATED TO ASSISTIVE ENVIRONMENTS 2020; 2020:15. [PMID: 32818205 PMCID: PMC7430758 DOI: 10.1145/3389189.3389203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A deep neural network (DNN) that can reliably model muscle responses from corresponding brain stimulation has the potential to increase knowledge of coordinated motor control for numerous basic science and applied use cases. Such cases include the understanding of abnormal movement patterns due to neurological injury from stroke, and stimulation based interventions for neurological recovery such as paired associative stimulation. In this work, potential DNN models are explored and the one with the minimum squared errors is recommended for the optimal performance of the M2M-Net, a network that maps transcranial magnetic stimulation of the motor cortex to corresponding muscle responses, using: a finite element simulation, an empirical neural response profile, a convolutional autoencoder, a separate deep network mapper, and recordings of multi-muscle activation. We discuss the rationale behind the different modeling approaches and architectures, and contrast their results. Additionally, to obtain a comparative insight of the trade-o between complexity and performance analysis, we explore different techniques, including the extension of two classical information criteria for M2M-Net. Finally, we find that the model analogous to mapping the motor cortex stimulation to a combination of direct and synergistic connection to the muscles performs the best, when the neural response profile is used at the input.
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33
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Wang X, Mao Z, Yu X. The role of noninvasive brain stimulation for behavioral and psychological symptoms of dementia: a systematic review and meta-analysis. Neurol Sci 2020; 41:1063-1074. [PMID: 31925612 DOI: 10.1007/s10072-020-04245-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 01/07/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This meta-analysis aimed at evaluating and comparing the efficacy of noninvasive brain stimulation (NIBS) techniques on the behavioral and psychological symptoms of dementia (BPSD). METHODS An exhaustive literature retrieval was performed on PubMed, Embase, Cochrane Library, and Web of Science until October 2019. The primary outcome was the relative changes in BPSD severity scores immediately after NIBS and at the last follow-up visit. Subgroup analyses were conducted to compare the efficacy of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS). Changes in the severity scores after NIBS were also analyzed with restriction to patients with Alzheimer's disease (AD). RESULTS Ten studies with 324 patients were included, out of which 7 studies involved patients with AD. The analysis results indicated that NIBS significantly improved the BPSD outcome immediately after stimulation (SMD, 0.31; 95% CI, 0.10-0.52; P = 0.005), but not at the last follow-up visit (0.15; - 0.11-0.41; 0.25). Our subgroup analyses suggested that the favorable effects of rTMS remained significant at the last follow-up visit (0.57; 0.18-0.96; 0.004). This discrepancy maybe caused by the continuously insignificant outcomes of tDCS on the whole data. The results for AD patients immediately after stimulation (0.37; 0.12-0.61; 0.003) and at the last follow-up visit (0.29; - 0.19-0.76; 0.24) were both largely similar to those in the whole patient group with dementia. CONCLUSIONS rTMS, rather than tDCS, was capable of persistently improving the BPSD at an early stage after treatment. More trials are warranted to confirm our results before the establishment of final conclusions.
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Affiliation(s)
- Xin Wang
- School of Medicine, Nankai University, Tianjin, China
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Zhiqi Mao
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Xinguang Yu
- School of Medicine, Nankai University, Tianjin, China.
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China.
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34
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Hui J, Lioumis P, Blumberger DM, Daskalakis ZJ. Non-invasive Central Neuromodulation with Transcranial Magnetic Stimulation. Stereotact Funct Neurosurg 2020. [DOI: 10.1007/978-3-030-34906-6_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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35
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Wang X, Mao Z, Ling Z, Yu X. Repetitive transcranial magnetic stimulation for cognitive impairment in Alzheimer's disease: a meta-analysis of randomized controlled trials. J Neurol 2019; 267:791-801. [PMID: 31760522 DOI: 10.1007/s00415-019-09644-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/16/2019] [Accepted: 11/18/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive brain stimulation technique for Alzheimer's disease (AD). rTMS, with high- or low-frequency, is thought to enhance or inhibit the cortical activities, respectively. This meta-analysis of randomized controlled trials (RCTs) was to summarize the efficacy of the rTMS on the cognition of AD patients and to identify its potential influential factors. METHODS Literature from the Pubmed, Embase, Cochrane Library and Web of Science were searched and screened to identify eligible studies. Standardized mean difference (SMD) and 95% confidence interval were used to evaluate the therapeutic effects of rTMS. Subgroup analyses were performed to investigate the influential factors. RESULTS Ten studies with 15 trials involving 240 patients were included. Compared with sham stimulation, rTMS could significantly improve cognition in AD (SMD, 0.42; 95% CI 0.18-0.67; P = 0.0006). Subgroup analysis suggested significant cognitive enhancement in participants receiving rTMS on multiple sites rather than on single site, and in patients receiving rTMS of more than 10 sessions, but not ≤ 10 sessions. Compared with rTMS as the single therapeutic method, rTMS with concurrent cognitive training seemed to produce greater improvement. Moreover, 20 Hz rTMS, seemed to be more effective than 10 Hz or 1 Hz rTMS. Furthermore, patients with higher education, or with mild-to-moderate AD were more likely to benefit from rTMS than patients with lower education, or with severe dementia, respectively. CONCLUSIONS Based on the current evidence, rTMS was an effective therapy for cognitive impairment in AD. Large RCTs are warranted to further validate the results of our subgroup analyses.
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Affiliation(s)
- Xin Wang
- School of Medicine, Nankai University, Tianjin, China.,Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Zhiqi Mao
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Zhipei Ling
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Xinguang Yu
- School of Medicine, Nankai University, Tianjin, China. .,Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China.
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Broeder S, Nackaerts E, Cuypers K, Meesen R, Verheyden G, Nieuwboer A. tDCS-Enhanced Consolidation of Writing Skills and Its Associations With Cortical Excitability in Parkinson Disease: A Pilot Study. Neurorehabil Neural Repair 2019; 33:1050-1060. [DOI: 10.1177/1545968319887684] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background. Learning processes of writing skills involve the re-engagement of previously established motor programs affected by Parkinson disease (PD). To counteract the known problems with consolidation in PD, transcranial direct current stimulation (tDCS) could be imperative to achieve a lasting regeneration of habitual motor skills. Objective. To examine tDCS-enhanced learning of writing and explore alterations in cortical excitability after stimulation in PD compared with healthy controls (HCs). Methods. Ten patients and 10 HCs received 2 training sessions combined with 20 minutes of 1-mA anodal tDCS or sham on the left primary motor cortex in a randomized crossover design. Writing skills on a tablet and paper were assessed at baseline, after training, and after 1 week of follow-up. Before and immediately after the intervention, cortical excitability and inhibition were measured during rest and activity. Results. Writing amplitude and velocity improved when practice was tDCS supplemented compared with sham in PD. Benefits were sustained at retention for trained and untrained tasks on the tablet as well as for writing on paper. No improvements were found for HCs. Reduced resting motor thresholds after tDCS indicated tDCS-enhanced cortical excitability. Additionally, increments in motor-evoked potential amplitudes correlated with improved writing in PD, whereas HCs showed the opposite pattern. Conclusion. Our results endorse the usefulness of tDCS-boosted learning in PD, at least when applied to improving writing capacity. Although further confirmatory studies are needed, these novel findings are striking because tDCS-mediated consolidation was found for learning a motor task directly affected by PD.
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Affiliation(s)
| | | | - Koen Cuypers
- KU Leuven, Leuven, Belgium
- Hasselt University, Diepenbeek, Belgium
| | - Raf Meesen
- KU Leuven, Leuven, Belgium
- Hasselt University, Diepenbeek, Belgium
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Zifman N, Levy-Lamdan O, Suzin G, Efrati S, Tanne D, Fogel H, Dolev I. Introducing a Novel Approach for Evaluation and Monitoring of Brain Health Across Life Span Using Direct Non-invasive Brain Network Electrophysiology. Front Aging Neurosci 2019; 11:248. [PMID: 31551761 PMCID: PMC6745309 DOI: 10.3389/fnagi.2019.00248] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 08/21/2019] [Indexed: 12/17/2022] Open
Abstract
Objective Evaluation and monitoring of brain health throughout aging by direct electrophysiological imaging (DELPHI) which analyzes TMS (transcranial magnetic stimulation) evoked potentials. Methods Transcranial magnetic stimulation evoked potentials formation, coherence and history dependency, measured using electroencephalogram (EEG), was extracted from 80 healthy subjects in different age groups, 25–85 years old, and 20 subjects diagnosed with mild dementia (MD), over 70 years old. Subjects brain health was evaluated using MRI scans, neurocognitive evaluation, and computerized testing and compared to DELPHI analysis of brain network functionality. Results A significant decrease in signal coherence is observed with age in connectivity maps, mostly in inter-hemispheric temporal, and parietal areas. MD patients display a pronounced decrease in global and inter-hemispheric frontal connectivity compared to healthy controls. Early and late signal slope ratio also display a significant, age dependent, change with pronounced early slope, phase shift, between normal healthy aging, and MD. History dependent analysis demonstrates a binary step function classification of healthy brain vs. abnormal aging subjects mostly for late slope. DELPHI measures demonstrate high reproducibility with reliability coefficients of around 0.9. Conclusion These results indicate that features of evoked response, as charge transfer, slopes of response, and plasticity are altered during abnormal aging and that these fundamental properties of network functionality can be directly evaluated and monitored using DELPHI.
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Affiliation(s)
- Noa Zifman
- QuantalX Neuroscience, Tel Aviv-Yafo, Israel
| | | | - Gil Suzin
- Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Ramle, Israel
| | - Shai Efrati
- Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Ramle, Israel.,Sackler School of Medicine and Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - David Tanne
- Sackler School of Medicine and Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv-Yafo, Israel.,Stroke and Cognition Institute, Rambam Healthcare Campus, Haifa, Israel
| | - Hilla Fogel
- QuantalX Neuroscience, Tel Aviv-Yafo, Israel
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Pain in amyotrophic lateral sclerosis. КЛИНИЧЕСКАЯ ПРАКТИКА 2019. [DOI: 10.17816/clinpract10266-73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
In this review, we discuss different aspects of pain syndrome in patients with amyotrophic lateral sclerosis: etiology, incidence, pathophysiology and main clinical features. Also we review the modern approaches to the treatment of pain in amyotrophic lateral sclerosis. Pain is actually not rare in this condition: it appears in 80% of patients, affecting their quality of life and functional activity, leading to the development of depressive and anxiety disorders. Pain in amyotrophic lateral sclerosis is often overlooked by clinicians, since their attention may focus on the motor symptoms of the disease. Thus, a more careful approach is needed to diagnose and treat pain in amyotrophic lateral sclerosis.
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Repetitive Transcranial Magnetic Stimulation Does Not Improve the Sequence Effect in Freezing of Gait. PARKINSONS DISEASE 2019; 2019:2196195. [PMID: 31275542 PMCID: PMC6589230 DOI: 10.1155/2019/2196195] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/17/2019] [Accepted: 04/28/2019] [Indexed: 11/18/2022]
Abstract
Introduction The sequence effect (SE) is a reason contributing to freezing of gait (FOG) in Parkinson's disease (PD) patients. There is no effective treatment for the SE. The objective of the current study is to investigate the effect of repetitive transcranial magnetic stimulation (rTMS) on the SE in PD patients with FOG. Methods 28 PD patients with FOG received either real or sham 10-Hz rTMS over the supplementary motor area (SMA). The effects of rTMS on the SE, FOG, and some gait parameters were evaluated. Results rTMS did not improve the SE. Real rTMS had beneficial effects on FOG and some gait parameters, and this effect lasted for at least four weeks. Conclusions High-frequency rTMS over the SMA cannot alleviate the SE in PD patients with FOG. rTMS has a long-lasting beneficial effect on FOG; however, this effect is not achieved by improving the SE but may be through improving some other gait parameters.
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Tremblay S, Rogasch NC, Premoli I, Blumberger DM, Casarotto S, Chen R, Di Lazzaro V, Farzan F, Ferrarelli F, Fitzgerald PB, Hui J, Ilmoniemi RJ, Kimiskidis VK, Kugiumtzis D, Lioumis P, Pascual-Leone A, Pellicciari MC, Rajji T, Thut G, Zomorrodi R, Ziemann U, Daskalakis ZJ. Clinical utility and prospective of TMS–EEG. Clin Neurophysiol 2019; 130:802-844. [DOI: 10.1016/j.clinph.2019.01.001] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 01/07/2019] [Accepted: 01/08/2019] [Indexed: 12/15/2022]
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Ba F, Zhou Y, Zhou J, Chen X. Repetitive transcranial magnetic stimulation protects mice against 6-OHDA-induced Parkinson’s disease symptoms by regulating brain amyloid β1–42 level. Mol Cell Biochem 2019; 458:71-78. [DOI: 10.1007/s11010-019-03531-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 04/10/2019] [Indexed: 01/08/2023]
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42
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Lin YC, Wang YP. Status of Noninvasive Brain Stimulation in the Therapy of Alzheimer's Disease. Chin Med J (Engl) 2019; 131:2899-2903. [PMID: 30539900 PMCID: PMC6302656 DOI: 10.4103/0366-6999.247217] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Yi-Cong Lin
- Department of Neurology, Xuanwu Hospital, Capital Medical University; Beijing Key Laboratory of Neuromodulation, Beijing 100053, China
| | - Yu-Ping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University; Beijing Key Laboratory of Neuromodulation, Beijing 100053; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing 100069, China
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Administration of Repetitive Transcranial Magnetic Stimulation Attenuates A β 1-42-Induced Alzheimer's Disease in Mice by Activating β-Catenin Signaling. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1431760. [PMID: 30949496 PMCID: PMC6425292 DOI: 10.1155/2019/1431760] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/31/2019] [Indexed: 12/11/2022]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive and painless technique that has been applied for the treatments of diverse neurodegenerative disorders. In the current study, its anti-Alzheimer's disease (AD) effect was assessed and the mechanism driving the effect was explored. The AD symptoms were induced via the intracranial injection of Aβ1-42 in mice and then treated with rTMS of 1 Hz or 10 Hz. The anti-AD effect of rTMS was assessed by Morris water maze (MWM), histological staining and western blotting. The results showed that rTMS administrations of both frequencies improved the cognitive function and suppressed neuron apoptosis in AD mice. Moreover, the treatment also increased the brain BDNF, NGF, and doublecortin levels, which represented the increased viability of neurons by rTMS. The injection of Aβ1-42 also increased the expressions of p-GSK-3β, p-Tau, and p-β-catenin and suppressed the level of total β-catenin. After the treatments of rTMS, the level of β-catenin was restored, indicating the activation of β-catenin signaling. In conclusion, the findings outlined in the current study demonstrated that the anti-AD effect of rTMS was associated with the activation of β-catenin, which would promote the survival of neurons.
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Chaves AR, Wallack EM, Kelly LP, Pretty RW, Wiseman HD, Chen A, Moore CS, Stefanelli M, Ploughman M. Asymmetry of Brain Excitability: A New Biomarker that Predicts Objective and Subjective Symptoms in Multiple Sclerosis. Behav Brain Res 2019; 359:281-291. [DOI: 10.1016/j.bbr.2018.11.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 10/24/2018] [Accepted: 11/05/2018] [Indexed: 12/13/2022]
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The role of repetitive transcranial magnetic stimulation (rTMS) in the treatment of cognitive impairment in patients with Alzheimer's disease: A systematic review and meta-analysis. J Neurol Sci 2019; 398:184-191. [PMID: 30735817 DOI: 10.1016/j.jns.2019.01.038] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 01/01/2019] [Accepted: 01/22/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although repetitive transcranial magnetic stimulation (rTMS) has been considered a potentially effective treatment for cognitive impairment in patients with Alzheimer's disease (AD), previous studies have produced inconsistent results. The objective of this meta-analysis was to evaluate the effects of rTMS on cognitive function in patients with AD. METHODS PubMed, EMBASE, Web of Science, MEDLINE and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for relevant terms. Abstracts of all papers were carefully reviewed, followed by data extraction, quality assessment, data synthesis and subgroup analyses. RESULT A total of 12 studies with 231 patients were included, with 8 randomized controlled studies and 4 self-controlled studies. Eleven studies used high frequency rTMS (≥ 5 Hz), but only one study directly compared the difference between low-frequency (1 Hz) and high-frequency (20 Hz). Random-effects analysis revealed that rTMS could significantly improve cognition compared with sham-rTMS (SMD: 0.60, 95% CI: 0.35-0.85, P < .0001). In subgroup analyses, the effect for stimulation at a single target was 0.13 (95% CI: -0.35-0.62) and multiple targets 0.86 (95% CI: 0.18-1.54). Treatment for ≤3 sessions produced an effect of 0.29 (95% CI: -1.04-1.62), whereas treatment for ≥5 sessions produced an effect of 2.77 (95% CI: 2.22-3.32). No differences were found for rTMS combined with medication or cognitive training. CONCLUSIONS rTMS can significantly improve cognitive ability in patients with mild to moderate AD. Stimulation of multiple sites and long-term treatment are better at improving AD-associated cognitive performance. Furthermore, some novel interventional targets, like precuneus (PC), may be a more effective therapeutic site to improve memory in AD.
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Wang Y, Fang K, He S, Fan Y, Yu J, Zhang X. Effects of repetitive magnetic stimulation on the growth of primarily cultured hippocampus neurons in vitro and their expression of iron-containing enzymes. Neuropsychiatr Dis Treat 2019; 15:927-934. [PMID: 31114204 PMCID: PMC6489628 DOI: 10.2147/ndt.s199328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 03/05/2019] [Indexed: 12/22/2022] Open
Abstract
Background: The mechanism of action of repetitive transcranial magnetic stimulation (rTMS) involves the generation of neuronal and action potentials utilizing induced currents in time-varying magnetic fields. However, the long-lasting and effective biological impact of magnetic stimulation does not appear to be completely explained by the transient magnetic field pulses. In this context, we hypothesized magnetic stimulation may affect the expression of iron-containing enzymes in neurons, mediating the long-lasting biological effects associated with this stimulus. Methods: Primarily cultured hippocampus neurons from SD rats were used as the cell model in this study. These were randomly divided into control, sham, and magnetic stimulation groups to probe into the effect of the magnetic field directly. The latter group received 40%, 60%, and 100% maximal stimulator output Tesla (1.68, 2.52, and 4.2 T) with low-frequency rTMS (1 Hz). The expression of iron-containing enzymes (catalase and aconitase) and non-ferrous enzymes (protein kinase A) was measured with Western blotting and ELISA. Results: The survival rates of neurons in the 40%T and 60%T groups were significantly increased in comparison to the controls (P<0.05), while those in the 100%T group showed cell damage, with slightly disturbed neurite connections and decreased survival rate. Furthermore, catalase and aconitase expression was higher in all of the stimulated groups in comparison to controls (P<0.05). On the other hand, the expression of the iron-containing enzymes decreased in the 100%T group in comparison with the 40%T and 60%T groups (P<0.05). Meanwhile, the expression of protein kinase A was not significantly increased in the groups which underwent magnetic stimulation. Conclusion: rTMS may increase the expression of ferrous enzymes but does not have a strong effect on non-ferrous enzymes. Excessive intensity of magnetic stimulation may reduce neuronal survival rate and affect the expression of iron-containing enzymes. The mechanism underlying the lasting effect of rTMS may be related to the increase of ferriferous expression induced by magnetic stimulation, with a clear correlation with stimulation intensity.
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Affiliation(s)
- Yirong Wang
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Sichuan, People's Republic of China
| | - Kewei Fang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Sichuan, People's Republic of China
| | - Shijia He
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Sichuan, People's Republic of China
| | - Yang Fan
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Sichuan, People's Republic of China
| | - Juming Yu
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Sichuan, People's Republic of China
| | - Xiaodong Zhang
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Sichuan, People's Republic of China
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de Goede AA, Ter Braack EM, van Putten MJAM. Accurate Coil Positioning is Important for Single and Paired Pulse TMS on the Subject Level. Brain Topogr 2018; 31:917-930. [PMID: 29943242 PMCID: PMC6182440 DOI: 10.1007/s10548-018-0655-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 06/07/2018] [Indexed: 12/04/2022]
Abstract
Function-guided navigation is commonly used when assessing cortical excitability using transcranial magnetic stimulation (TMS). However, the required accuracy, stability and the effect of a change in coil positioning are not entirely known. This study investigates the accuracy of function-guided navigation for determining the hotspot. Furthermore, it evaluates the effect of a change in coil location on the single and paired pulse excitability measures: motor evoked potential (MEP) amplitude, TMS evoked potential (TEP) and long intracortical inhibition (LICI), and of a change in coil orientation on LICI. Eight healthy subjects participated in the single pulse study, and ten in the paired pulse study. A robot-guided navigation system was used to ensure accurate and stable coil positioning at the motor hotspot as determined using function-guided navigation. In addition, we targeted four locations at 2 mm and four at 5 mm distance around the initially defined hotspot, and we increased and decreased the coil orientation by 10°. In none of the subjects, the largest MEP amplitudes were evoked at the originally determined hotspot, resulting in a poor accuracy of function-guided navigation. At the group level, a change in coil location had no significant effect on the MEP amplitude, TEP, or LICI, and a change in coil orientation did not significantly affected LICI. However, at the subject level significant effects on MEP amplitude, TEP, and LICI were found for changes in coil location or orientation, although absolute differences were relatively small and did not show a consistent pattern. This study indicates that a high accuracy in coil positioning is especially required to measure cortical excitability reliably in individual subjects using single or paired pulse TMS.
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Affiliation(s)
- Annika A de Goede
- Department of Clinical Neurophysiology, Technical Medical Centre, University of Twente, Carré 3.714, P.O. Box 217, 7500 AE, Enschede, The Netherlands.
| | - Esther M Ter Braack
- Department of Clinical Neurophysiology, Technical Medical Centre, University of Twente, Carré 3.714, P.O. Box 217, 7500 AE, Enschede, The Netherlands
| | - Michel J A M van Putten
- Department of Clinical Neurophysiology, Technical Medical Centre, University of Twente, Carré 3.714, P.O. Box 217, 7500 AE, Enschede, The Netherlands
- Department of Neurology and Clinical Neurophysiology, Medisch Spectrum Twente, Enschede, The Netherlands
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Schilberg L, Engelen T, ten Oever S, Schuhmann T, de Gelder B, de Graaf TA, Sack AT. Phase of beta-frequency tACS over primary motor cortex modulates corticospinal excitability. Cortex 2018; 103:142-152. [DOI: 10.1016/j.cortex.2018.03.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 01/11/2018] [Accepted: 03/01/2018] [Indexed: 01/26/2023]
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Schwartz L, Lafitte O, da Veiga Moreira J. Toward a Reasoned Classification of Diseases Using Physico-Chemical Based Phenotypes. Front Physiol 2018. [PMID: 29541031 PMCID: PMC5835834 DOI: 10.3389/fphys.2018.00094] [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] [Indexed: 11/13/2022] Open
Abstract
Background: Diseases and health conditions have been classified according to anatomical site, etiological, and clinical criteria. Physico-chemical mechanisms underlying the biology of diseases, such as the flow of energy through cells and tissues, have been often overlooked in classification systems. Objective: We propose a conceptual framework toward the development of an energy-oriented classification of diseases, based on the principles of physical chemistry. Methods: A review of literature on the physical chemistry of biological interactions in a number of diseases is traced from the point of view of the fluid and solid mechanics, electricity, and chemistry. Results: We found consistent evidence in literature of decreased and/or increased physical and chemical forces intertwined with biological processes of numerous diseases, which allowed the identification of mechanical, electric and chemical phenotypes of diseases. Discussion: Biological mechanisms of diseases need to be evaluated and integrated into more comprehensive theories that should account with principles of physics and chemistry. A hypothetical model is proposed relating the natural history of diseases to mechanical stress, electric field, and chemical equilibria (ATP) changes. The present perspective toward an innovative disease classification may improve drug-repurposing strategies in the future.
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Affiliation(s)
| | - Olivier Lafitte
- LAGA, UMR 7539, Paris 13 University, Sorbonne Paris Cité, Villetaneuse, France
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50
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Kumar S, Zomorrodi R, Ghazala Z, Goodman MS, Blumberger DM, Cheam A, Fischer C, Daskalakis ZJ, Mulsant BH, Pollock BG, Rajji TK. Extent of Dorsolateral Prefrontal Cortex Plasticity and Its Association With Working Memory in Patients With Alzheimer Disease. JAMA Psychiatry 2017; 74:1266-1274. [PMID: 29071355 PMCID: PMC6583382 DOI: 10.1001/jamapsychiatry.2017.3292] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The extent of dorsolateral prefrontal cortex (DLPFC) plasticity in Alzheimer disease (AD) and its association with working memory are not known. OBJECTIVES To determine whether participants with AD had impaired DLPFC plasticity compared with healthy control participants, to compare working memory between participants with AD and controls, and to determine whether DLPFC plasticity was associated with working memory. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included 32 participants with AD who were 65 years or older and met diagnostic criteria for dementia due to probable AD with a score of at least 17 on the Mini-Mental State Examination and 16 age-matched control participants. Participants were recruited from a university teaching hospital from May 2013 to October 2016. MAIN OUTCOMES AND MEASURES Plasticity of the DLPFC measured as potentiation of cortical-evoked activity using paired associative stimulation (a combination of peripheral nerve electrical stimulation and transcranial magnetic stimulation) combined with electroencephalography. Working memory was assessed with the n-back task (1- and 2-back) and measured using the A' statistic. RESULTS Among the 32 participants with AD, 17 were women and 15 were men (mean [SD] age, 76.3 [6.3] years); among the 16 controls, 8 were men and 8 were women (mean [SD] age, 76.4 [5.1] years). Participants with AD had impaired DLPFC plasticity (mean [SD] potentiation, 1.18 [0.25]) compared with controls (mean [SD] potentiation, 1.40 [0.35]; F1,44 = 5.90; P = .02; between-group comparison, Cohen d = 0.77; P = .01). Participants with AD also had impaired performances on the 1-back condition (mean [SD] A' = 0.47 [0.30]) compared with controls (mean [SD] A' = 0.96 [0.01]; Cohen d = 1.86; P < .001), with similar findings for participants with AD on the 2-back condition (mean [SD] A' = 0.29 [0.2]) compared with controls (mean [SD], A' = 0.85 [0.18]; Cohen d = 2.83; P < .001). Plasticity of DLPFC was positively associated with working memory performance on the 1-back A' (parameter estimate B [SE] = 0.32 [0.13]; standardized β = 0.29; P = .02) and 2-back A' (B [SE] = 0.43 [0.15]; β = 0.39; P = .006) across both groups after controlling for age, education, and attention. CONCLUSIONS AND RELEVANCE This study demonstrated impaired in vivo DLPFC plasticity in patients with AD. The findings support the use of DLPFC plasticity as a measure of DLPFC function and a potential treatment target to enhance DLPFC function and working memory in patients with AD.
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Affiliation(s)
- Sanjeev Kumar
- Centre for Addiction and Mental Health, Geriatric Psychiatry Division, Toronto, Ontario, Canada,Campbell Family Research Institute, Toronto, Ontario, Canada
| | - Reza Zomorrodi
- Centre for Addiction and Mental Health, Geriatric Psychiatry Division, Toronto, Ontario, Canada
| | - Zaid Ghazala
- Centre for Addiction and Mental Health, Geriatric Psychiatry Division, Toronto, Ontario, Canada,Campbell Family Research Institute, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Michelle S. Goodman
- Centre for Addiction and Mental Health, Geriatric Psychiatry Division, Toronto, Ontario, Canada,Campbell Family Research Institute, Toronto, Ontario, Canada
| | - Daniel M. Blumberger
- Centre for Addiction and Mental Health, Geriatric Psychiatry Division, Toronto, Ontario, Canada,Campbell Family Research Institute, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Amay Cheam
- Centre for Addiction and Mental Health, Geriatric Psychiatry Division, Toronto, Ontario, Canada,Campbell Family Research Institute, Toronto, Ontario, Canada
| | - Corinne Fischer
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada,Keenan Research Centre for Biomedical Research, the Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Zafiris J. Daskalakis
- Centre for Addiction and Mental Health, Geriatric Psychiatry Division, Toronto, Ontario, Canada,Campbell Family Research Institute, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Benoit H. Mulsant
- Centre for Addiction and Mental Health, Geriatric Psychiatry Division, Toronto, Ontario, Canada,Campbell Family Research Institute, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Bruce G. Pollock
- Centre for Addiction and Mental Health, Geriatric Psychiatry Division, Toronto, Ontario, Canada,Campbell Family Research Institute, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Tarek K. Rajji
- Centre for Addiction and Mental Health, Geriatric Psychiatry Division, Toronto, Ontario, Canada,Campbell Family Research Institute, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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