1
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Collins KC, Clark AB, Pomeroy VM, Kennedy NC. The test-retest reliability of non-navigated transcranial magnetic stimulation (TMS) measures of corticospinal pathway excitability early after stroke. Disabil Rehabil 2024:1-8. [PMID: 38634228 DOI: 10.1080/09638288.2024.2337107] [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: 08/03/2021] [Accepted: 03/24/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE Motor evoked potential (MEP) characteristics are potential biomarkers of whether rehabilitation interventions drive motor recovery after stroke. The test-retest reliability of Transcranial Magnetic Stimulation (TMS) measurements in sub-acute stroke remains unclear. This study aims to determine the test-retest reliability of upper limb MEP measures elicited by non-neuronavigated transcranial magnetic stimulation in sub-acute-stroke. METHODS In two identical data collection sessions, 1-3 days apart, TMS measures assessed: motor threshold (MT), amplitude, latency (MEP-L), silent period (SP), recruitment curve slope in the biceps brachii (BB), extensor carpi radialis (ECR), and abductor pollicis brevis (APB) muscles of paretic and non-paretic upper limbs. Test-retest reliability was calculated using the intra-class correlation coefficient (ICC) and 95% confidence intervals (CI). Acceptable reliability was set at a lower 95% CI of 0.70 or above. The limits of agreement (LOA) and smallest detectable change (SDC) were calculated. RESULTS 30 participants with sub-acute stroke were included (av 36 days post stroke) reliability was variable between poor to good for the different MEP characteristics. The SDC values differed across muscles and MEP characteristics in both paretic and less paretic limbs. CONCLUSIONS The present findings indicate there is limited evidence for acceptable test-retest reliability of non-navigated TMS outcomes when using the appropriate 95% CI for ICC, SDC and LOA values. CLINICAL TRIAL REGISTRATION Current Controlled Trials: ISCRT 19090862, http://www.controlled-trials.com.
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Affiliation(s)
- Kathryn C Collins
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Allan B Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Valerie M Pomeroy
- Acquired Brain Injury Rehabilitation Alliance, School of Health Sciences, University of East Anglia, Norwich, UK
- National Institute of Health Research Brain Injury MedTech Cooperative, Cambridge, UK
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2
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Shih Y, Powers CM, Fisher BE. Reliability of a method to assess corticomotor excitability of lower limb muscles using a normalized EMG motor thresholding procedure. Sci Rep 2024; 14:2052. [PMID: 38267437 PMCID: PMC10808104 DOI: 10.1038/s41598-024-51622-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 01/08/2024] [Indexed: 01/26/2024] Open
Abstract
Given the importance of determining intervention-induced neuroplastic changes with lower extremity functional tasks, a reliable transcranial magnetic stimulation (TMS) methodology for proximal lower extremity muscles is needed. A pre-set fixed voltage value is typically used as the criterion for identifying a motor evoked potential (MEP) during the motor thresholding procedure. However, the fixed voltage value becomes problematic when the procedure is applied to proximal lower extremity muscles where active contractions are required. We sought to establish the reliability of a method measuring corticomotor excitability of gluteus maximus and vastus lateralis using normalized electromyography (EMG) as the criterion for identifying MEPs during the motor thresholding procedure. The active motor threshold for each muscle was determined using the lowest stimulator intensity required to elicit 5 MEPs that exceeded 20% maximal voluntary isometric contraction from 10 stimulations. TMS data were obtained from 10 participants on 2 separate days and compared using random-effect intra-class correlation coefficients (ICCs). Slopes from two input-output curve fitting methods as well as the maximum MEP of gluteus maximus and vastus lateralis were found to exhibit good to excellent reliability (ICCs ranging from 0.75 to 0.99). The described TMS method using EMG-normalized criteria for motor thresholding produced reliable results utilizing a relatively low number of TMS pulses.
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Affiliation(s)
- Yo Shih
- Department of Rehabilitation Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| | - Christopher M Powers
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Beth E Fisher
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
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3
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Osnabruegge M, Kanig C, Schwitzgebel F, Litschel K, Seiberl W, Mack W, Schecklmann M, Schoisswohl S. On the reliability of motor evoked potentials in hand muscles of healthy adults: a systematic review. Front Hum Neurosci 2023; 17:1237712. [PMID: 37719769 PMCID: PMC10500067 DOI: 10.3389/fnhum.2023.1237712] [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: 06/09/2023] [Accepted: 08/08/2023] [Indexed: 09/19/2023] Open
Abstract
Aims Motor evoked potentials (MEP) elicited by transcranial magnetic stimulation (TMS) over the primary motor cortex are used as a neurophysiological marker of cortical excitability in clinical and scientific practice. Though, the reliability of this outcome parameter has not been clarified. Using a systematic approach, this work reviews and critically appraises studies on the reliability of MEP outcome parameters derived from hand muscles of healthy subjects and gives a proposal for most reliable TMS practice. Methods A systematic literature research was performed in PubMed, according to the PRISMA guidelines. Articles published up to March 2023 that were written in English, conducted repeated measurements from hand muscles of healthy subjects and reliability analysis were included. The risk of publication bias was determined. Two authors conducted the literature search and rated the articles in terms of eligibility and methodological criteria with standardized instruments. Frequencies of the checklist criteria were calculated and inter-rater reliability of the rating procedure was determined. Reliability and stimulation parameters were extracted and summarized in a structured way to conclude best-practice recommendation for reliable measurements. Results A total of 28 articles were included in the systematic review. Critical appraisal of the studies revealed methodological heterogeneity and partly contradictory results regarding the reliability of outcome parameters. Inter-rater reliability of the rating procedure was almost perfect nor was there indication of publication bias. Identified studies were grouped based on the parameter investigated: number of applied stimuli, stimulation intensity, reliability of input-output curve parameters, target muscle or hemisphere, inter-trial interval, coil type or navigation and waveform. Conclusion The methodology of studies on TMS is still subject to heterogeneity, which could contribute to the partly contradictory results. According to the current knowledge, reliability of the outcome parameters can be increased by adjusting the experimental setup. Reliability of single pulse MEP measurement could be optimized by using (1) at least five stimuli per session, (2) a minimum of 110% resting motor threshold as stimulation intensity, (3) a minimum of 4 s inter-trial interval and increasing the interval up to 20 s, (4) a figure-of-eight coil and (5) a monophasic waveform. MEPs can be reliably operationalized.
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Affiliation(s)
- Mirja Osnabruegge
- Institute of Psychology, University of the Bundeswehr Munich, Neubiberg, Germany
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Carolina Kanig
- Institute of Psychology, University of the Bundeswehr Munich, Neubiberg, Germany
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Florian Schwitzgebel
- Department of Electrical Engineering, University of the Bundeswehr Munich, Neubiberg, Germany
| | - Karsten Litschel
- Department of Electrical Engineering, University of the Bundeswehr Munich, Neubiberg, Germany
| | - Wolfgang Seiberl
- Institute of Sport Science, University of the Bundeswehr Munich, Neubiberg, Germany
| | - Wolfgang Mack
- Institute of Psychology, University of the Bundeswehr Munich, Neubiberg, Germany
| | - Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Stefan Schoisswohl
- Institute of Psychology, University of the Bundeswehr Munich, Neubiberg, Germany
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
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4
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Kahl CK, Giuffre A, Wrightson JG, Zewdie E, Condliffe EG, MacMaster FP, Kirton A. Reliability of active robotic neuro-navigated transcranial magnetic stimulation motor maps. Exp Brain Res 2023; 241:355-364. [PMID: 36525072 DOI: 10.1007/s00221-022-06523-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/04/2022] [Indexed: 12/23/2022]
Abstract
Transcranial magnetic stimulation (TMS) motor mapping is a safe, non-invasive method used to study corticomotor organization and intervention-induced plasticity. Reliability of resting maps is well established, but understudied for active maps and unestablished for active maps obtained using robotic TMS techniques. The objective of this study was to determine the reliability of robotic neuro-navigated TMS motor map measures during active muscle contraction. We hypothesized that map area and volume would show excellent short- and medium-term reliability. Twenty healthy adults were tested on 3 days. Active maps of the first dorsal interosseous muscle were created using a 12 × 12 grid (7 mm spacing). Short- (24 h) and medium-term (3-5 weeks) relative (intra-class correlation coefficient) and absolute (minimal detectable change (MDC); standard error of measure) reliabilities were evaluated for map area, volume, center of gravity (CoG), and hotspot magnitude (peak-to-peak MEP amplitude at the hotspot), along with active motor threshold (AMT) and maximum voluntary contraction (MVC). This study found that AMT and MVC had good-to-excellent short- and medium-term reliability. Map CoG (x and y) were the most reliable map measures across sessions with excellent short- and medium-term reliability (p < 0.001). Map area, hotspot magnitude, and map volume followed with better reliability medium-term than short-term, with a change of 28%, 62%, and 78% needed to detect a true medium-term change, respectively. Therefore, robot-guided neuro-navigated TMS active mapping is relatively reliable but varies across measures. This, and MDC, should be considered in interventional study designs.
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Affiliation(s)
- Cynthia K Kahl
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Adrianna Giuffre
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Calgary, AB, Canada
| | - James G Wrightson
- Hotchkiss Brain Institute, Calgary, AB, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Ephrem Zewdie
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Elizabeth G Condliffe
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Calgary, AB, Canada.,Department of Pediatrics, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Frank P MacMaster
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Calgary, AB, Canada.,Department of Pediatrics, University of Calgary, Calgary, AB, Canada.,Department of Psychiatry, University of Calgary, Calgary, AB, Canada.,Addictions and Mental Health Strategic Clinical Network, Calgary, AB, Canada
| | - Adam Kirton
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Hotchkiss Brain Institute, Calgary, AB, Canada. .,Department of Pediatrics, University of Calgary, Calgary, AB, Canada. .,Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada. .,Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada.
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5
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Hardesty RL, Ellaway PH, Gritsenko V. The human motor cortex contributes to gravity compensation to maintain posture and during reaching. J Neurophysiol 2023; 129:83-101. [PMID: 36448705 PMCID: PMC9799140 DOI: 10.1152/jn.00367.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/24/2022] [Accepted: 11/17/2022] [Indexed: 12/02/2022] Open
Abstract
The neural control of posture and movement is interdependent. During voluntary movement, the neural motor command is executed by the motor cortex through the corticospinal tract and its collaterals and subcortical targets. Here we address the question of whether the control mechanism for the postural adjustments at nonmoving joints is also involved in overcoming gravity at the moving joints. We used single-pulse transcranial magnetic stimulation to measure the corticospinal excitability in humans during postural and reaching tasks. We hypothesized that the corticospinal excitability is proportional to background muscle activity and the gravity-related joint moments during both static postures and reaching movements. To test this hypothesis, we used visual targets in virtual reality to instruct five postures and three movements with or against gravity. We then measured the amplitude and gain of motor evoked potentials in multiple arm and hand muscles at several phases of the reaching motion and during static postures. The stimulation caused motor evoked potentials in all muscles that were proportional to the muscle activity. During both static postures and reaching movements, the muscle activity and the corticospinal contribution to these muscles changed in proportion with the postural moments needed to support the arm against gravity, supporting the hypothesis. Notably, these changes happened not only in antigravity muscles. Altogether, these results provide evidence that the changes in corticospinal excitability cause muscle cocontraction that modulates limb stiffness. This suggests that the motor cortex is involved in producing postural adjustments that support the arm against gravity during posture maintenance and reaching.NEW & NOTEWORTHY Animal studies suggest that the corticospinal tract and its collaterals are crucial for producing postural adjustments that accompany movement in limbs other than the moving limb. Here we provide evidence for a similar control schema for both arm posture maintenance and gravity compensation during movement of the same limb. The observed interplay between the postural and movement control signals within the corticospinal tract may help explain the underlying neural motor deficits after stroke.
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Affiliation(s)
- Russell L Hardesty
- Departments of Human Performance and Neuroscience, Rockefeller Neuroscience Center, West Virginia University, Morgantown, West Virginia
| | - Peter H Ellaway
- Department of Medicine, Imperial College London, London, United Kingdom
| | - Valeriya Gritsenko
- Departments of Human Performance and Neuroscience, Rockefeller Neuroscience Center, West Virginia University, Morgantown, West Virginia
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Hartmann M, Falconer CJ, Kaelin-Lang A, Müri RM, Mast FW. Imagined paralysis reduces motor cortex excitability. Psychophysiology 2022; 59:e14069. [PMID: 35393640 PMCID: PMC9539708 DOI: 10.1111/psyp.14069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/16/2021] [Accepted: 03/26/2022] [Indexed: 11/27/2022]
Abstract
Mental imagery is a powerful capability that engages similar neurophysiological processes that underlie real sensory and motor experiences. Previous studies show that motor cortical excitability can increase during mental imagery of actions. In this study, we focused on possible inhibitory effects of mental imagery on motor functions. We assessed whether imagined arm paralysis modulates motor cortical excitability in healthy participants, as measured by motor evoked potentials (MEPs) of the hand induced by near-threshold transcranial magnetic stimulation (TMS) over the primary motor cortex hand area. We found lower MEP amplitudes during imagined arm paralysis when compared to imagined leg paralysis or baseline stimulation without paralysis imagery. These results show that purely imagined bodily constraints can selectively inhibit basic motor corticospinal functions. The results are discussed in the context of motoric embodiment/disembodiment.
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Affiliation(s)
- Matthias Hartmann
- Department of Psychology, University of Bern, Bern, Switzerland.,Faculty of Psychology, UniDistance Suisse, Brig, Switzerland
| | - Caroline J Falconer
- Department of Psychology, University of Bern, Bern, Switzerland.,Department of Clinical Educational and Health Psychology, University College London, London, UK
| | - Alain Kaelin-Lang
- Department of Neurology, University Hospital, University of Bern, Bern, Switzerland.,Department of BioMedical Research, University Hospital, University of Bern, Bern, Switzerland.,Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - René M Müri
- Department of Neurology, University Hospital, University of Bern, Bern, Switzerland.,Department of BioMedical Research, University Hospital, University of Bern, Bern, Switzerland
| | - Fred W Mast
- Department of Psychology, University of Bern, Bern, Switzerland
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7
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Motor Cortical Plasticity Induced by Volitional Muscle Activity-Triggered Transcranial Magnetic Stimulation and Median Nerve Stimulation. Brain Sci 2021; 12:brainsci12010061. [PMID: 35053805 PMCID: PMC8774239 DOI: 10.3390/brainsci12010061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/24/2021] [Accepted: 12/28/2021] [Indexed: 11/16/2022] Open
Abstract
Bilateral motor training is a useful method for modifying corticospinal excitability. The effects of bilateral movement that are caused by artificial stimulation on corticospinal excitability have not been reported. We compared motor-evoked potentials (MEPs) of the primary motor cortex (M1) after conventional bilateral motor training and artificial bilateral movements generated by electromyogram activity of abductor pollicis brevis (APB) muscle-triggered peripheral nerve stimulation (c-MNS) and transcranial magnetic stimulation of the ipsilateral M1 (i-TMS). A total of three protocols with different interventions—bilateral finger training, APB-triggered c-MNS, and APB-triggered i-TMS—were administered to 12 healthy participants. Each protocol consisted of 360 trials of 30 min for each trial. MEPs that were induced by single-pulse TMS, short-interval intracortical inhibition (SICI), and intracortical facilitation (ICF) that were induced by paired-pulse TMS were assessed as outcome measures at baseline and at 0, 20, 40, and 60 min after intervention. MEP amplitude significantly increased up to 40 min post-intervention in all protocols compared to that at the baseline, although there were some differences in the changing pattern of ICF and SICI in each protocol. These findings suggest that artificial bilateral movement has the potential to increase the ipsilateral cortical excitability of the moving finger.
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8
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Motor Cortex Function in APOE4 Carriers and Noncarriers. J Clin Neurophysiol 2021; 38:553-557. [PMID: 32576807 DOI: 10.1097/wnp.0000000000000738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The ε4 allele of the apolipoprotein-E gene has been associated with disease activity including Alzheimer disease, multiple sclerosis, and cardiovascular disease. Individuals who possess the ε4 variant of this gene (ε4 carriers) also demonstrate higher levels of cognitive impairment and lower motor scores compared with noncarriers. The purpose of this study was to establish whether there is a difference in motor cortex function between apoε4 carriers and noncarriers. We hypothesized that carriers would have lower levels of excitability and excitatory transmitter (glutamate) and similar levels of intracortical inhibition and inhibitory neurotransmitter (gamma-aminobutyric acid) than noncarriers. METHODS Fifty-two participants provided saliva samples to determine apoε4 carrier status. Measures of motor cortex excitability and inhibition were obtained using transcranial magnetic stimulation, and measures of glutamate and gamma-aminobutyric acid concentrations were obtained using proton magnetic resonance spectroscopy. RESULTS No significant differences in transcranial magnetic stimulation (P ≥ 0.19) or proton magnetic resonance spectroscopy measures (P ≥ 0.90) were found between carriers and noncarriers. CONCLUSIONS The results from this study suggest that motor cortex function, as assessed by transcranial magnetic stimulation measures of excitability and inhibition, and MRS measures of excitatory and inhibitory neurotransmitter are similar in those who possess an apoε4 allele and those who do not.
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Roumengous T, Reutter AB, Peterson CL. Effect of low-cost transcranial magnetic stimulation navigation on hotspot targeting and motor evoked potential variability in the biceps brachii. Restor Neurol Neurosci 2021; 39:319-328. [PMID: 34657854 DOI: 10.3233/rnn-211207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) can monitor or modulate brain excitability. However, reliability of TMS outcomes depends on consistent coil placement during stimulation. Neuronavigated TMS systems can address this issue, but their cost limits their use outside of specialist research environments. OBJECTIVE The objective was to evaluate the performance of a low-cost navigated TMS approach in improving coil placement consistency and its effect on motor evoked potentials (MEPs) when targeting the biceps brachii at rest and during voluntary contractions. METHODS We implemented a navigated TMS system using a low-cost 3D camera system and open-source software environment programmed using the Unity 3D engine. MEPs were collected from the biceps brachii at rest and during voluntary contractions across two sessions in ten non-disabled individuals. Motor hotspots were recorded and targeted via two conditions: navigated and conventional. RESULTS The low-cost navigated TMS system reduced coil orientation error (pitch: 1.18°±1.2°, yaw: 1.99°±1.9°, roll: 1.18°±2.2° with navigation, versus pitch: 3.7°±5.7°, yaw: 3.11°±3.1°, roll: 3.8°±9.1° with conventional). The improvement in coil orientation had no effect on MEP amplitudes and variability. CONCLUSIONS The low-cost system is a suitable alternative to expensive systems in tracking the motor hotspot between sessions and quantifying the error in coil placement when delivering TMS. Biceps MEP variability reflects physiological variability across a range of voluntary efforts, that can be captured equally well with navigated or conventional approaches of coil locating.
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Affiliation(s)
- Thibault Roumengous
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Alec B Reutter
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Carrie L Peterson
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia, USA
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10
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Valkama AM, Rytky SO, Olsén PM. Bilateral Motor Responses to Transcranial Magnetic Stimulation in Preterm Children at 9 Years of Age. Neuropediatrics 2021; 52:268-273. [PMID: 33706405 DOI: 10.1055/s-0041-1726127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study was aimed to evaluate motor tracts integrity in nondisabled preterm-born (PT) children at 9 years of age. METHODS Overall, 18 PT and 13 term-born (T) children without motor disability were assessed by transcranial magnetic stimulation (TMS). Motor-evoked potentials (MEPs) were measured bilaterally from the abductor pollicis brevis (APB) and the tibialis anterior (TA) muscles. Muscle responses could be stimulated from all patients. RESULTS Overall, 83.3 and 23.1% of PT and T children, respectively, had mild clumsiness (p = 0.001). One PT and three T children had immediate bilateral responses in the upper extremities. Seven PT children had delayed ipsilateral APB responses after left and ten after right TMS. Three controls had delayed ipsilateral responses. Ipsilateral lower extremity responses were seen in one PT after right and two PT children and one T child after left TMS. The results did not correlate to groups, genders, clumsiness, or handedness. CONCLUSION Children of PT and T may have bilateral motor responses after TMS at 9 years of age. Ipsilateral conduction emerges immediately or more often slightly delayed and more frequently in upper than in lower extremities. SIGNIFICANCE Bilateral motor conduction reflects developmental and neurophysiological variability in children at 9 years of age. MEPs can be used as a measure of corticospinal tract integrity in PT children.
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Affiliation(s)
- A Marita Valkama
- Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Center, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Seppo O Rytky
- Department of Clinical Neurophysiology, Oulu University Hospital, Oulu, Finland
| | - Päivi M Olsén
- Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Center, University of Oulu, Oulu, Finland
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11
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Shih Y, Fisher BE, Kutch JJ, Powers CM. Corticomotor excitability of gluteus maximus and hip extensor strength: The influence of sex. Hum Mov Sci 2021; 78:102830. [PMID: 34130254 DOI: 10.1016/j.humov.2021.102830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 06/03/2021] [Accepted: 06/06/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To compare hip extensor strength and corticomotor excitability (CME) of gluteus maximus (GM) between males and females. A secondary purpose was to determine if CME of GM is predictive of hip extensor strength. METHOD Thirty-two healthy individuals participated (15 males and 17 females). CME of GM was assessed using the input-output curve (IOC) procedure acquired from transcranial magnetic stimulation (average slope). Hip extensor strength was measured by a dynamometer during a maximal voluntary isometric contraction. Independent t-tests were used to compare CME of GM and peak hip extensor torque between males and females. Linear regression analysis was used to determine whether peak hip extensor torque was predicted by CME of GM. RESULT Compared to males, females demonstrate lower peak hip extensor torque (4.42 ± 1.11 vs. 6.15 ± 1.72 Nm/kg/m2, p < 0.01) and lower CME of GM (1.36 ± 1.07 vs. 2.67 ± 1.30, p < 0.01). CME of GM was a significant predictor of peak hip extensor torque for males and females combined (r2 = 0.36, p < 0.001). CONCLUSION Our findings support the premise that corticomotor excitability plays a role in the ability of a muscle to generate torque.
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Affiliation(s)
- Yo Shih
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States of America; Department of Physical Therapy, University of Nevada, Las Vegas, NV, United States of America
| | - Beth E Fisher
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States of America
| | - Jason J Kutch
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States of America
| | - Christopher M Powers
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States of America.
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12
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Dharia AK, Gardi A, Vogel AK, Dutt-Mazumder A, Krishnan C. Evaluation of motor cortical excitability using evoked torque responses: A new tool with high reliability. J Neurosci Methods 2020; 348:108998. [PMID: 33189794 DOI: 10.1016/j.jneumeth.2020.108998] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/10/2020] [Accepted: 11/09/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation (TMS) are typically recorded via surface electromyography (EMG). However, another suitable alternative may be recording torque output associated with MEPs, especially when studying multiheaded muscles (e.g. quadriceps) for which EMG may not be ideal. METHODS We recorded the motor evoked torque elicited by TMS along with conventional EMG-based MEPs (MEPEMG) over a range of TMS intensities (100-140 % of active motor threshold [AMT]) from twenty healthy young adults on two different days. MEPs were normalized using different normalization procedures (raw, normalized to maximum voluntary isometric contraction [MVIC], and peak MEP). Additionally, motor evoked torque was normalized to TMS-evoked peripheral resting twitch torque. Intraclass correlation coefficients (ICCs) were determined for each of these variables to compute reliability. RESULTS Motor evoked torque showed good to excellent reliability (ICC: 0.65-0.90) at TMS intensities ≥ 110 % AMT, except when normalized by peak MEP. The reliability of raw MEPEMG and MVIC normalized MEPEMG was fair to excellent only at ≥ 130 % AMT (ICC: 0.42-0.82) and at ≥ 120 % AMT (ICC: 0.41-0.83), respectively. The reliability of both MEPEMG and motor evoked torque generally increased with increasing TMS intensities, with motor evoked torque normalized to the resting twitch torque yielding the best ICC scores. COMPARISON WITH EXISTING METHODS When compared with conventional MEPEMG, motor evoked torque offers superior and reliable estimates of corticospinal excitability, particularly when normalized to resting twitch torque. CONCLUSIONS TMS-induced motor evoked torque can reliably be used to measure corticospinal excitability in the quadriceps muscles.
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Affiliation(s)
- Aastha K Dharia
- NeuRRo Lab, Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
| | - Adam Gardi
- NeuRRo Lab, Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
| | - Amanda K Vogel
- NeuRRo Lab, Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
| | - Aviroop Dutt-Mazumder
- NeuRRo Lab, Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
| | - Chandramouli Krishnan
- NeuRRo Lab, Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA; Michigan Robotics Institute, University of Michigan, Ann Arbor, MI, USA; School of Kinesiology, University of Michigan, Ann Arbor, MI, USA; Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
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Giuffre A, Kahl CK, Zewdie E, Wrightson JG, Bourgeois A, Condliffe EG, Kirton A. Reliability of robotic transcranial magnetic stimulation motor mapping. J Neurophysiol 2020; 125:74-85. [PMID: 33146067 DOI: 10.1152/jn.00527.2020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Robotic transcranial magnetic stimulation (TMS) is a noninvasive and safe tool that produces cortical motor maps using neuronavigational and neuroanatomical images. Motor maps are individualized representations of the primary motor cortex (M1) topography that may reflect developmental and interventional plasticity. Results of TMS motor map reliability testing have been variable, and robotic measures are undefined. We aimed to determine the short- and long-term reliability of robotic TMS motor maps. Twenty healthy participants underwent motor mapping at baseline, 24 h, and 4 wk. A 12 × 12 grid (7-mm spacing) was placed over the left M1, centered over the hand knob area. Four suprathreshold stimulations were delivered at each grid point. First dorsal interosseous (FDI) motor-evoked potentials (MEPs) were analyzed offline to generate map characteristics of area, volume, center of gravity (COG), and hotspot magnitude. Subsets of each outcome corresponding to 75%, 50%, and 25% of each map were determined. Reliability measures including intraclass correlation coefficient (ICC), minimal detectable change (MDC), and standard error of measure (SEM) were calculated. Map volume, COG, and hotspot magnitude were the most reliable measures (good-to-excellent) over both short- and long-term sessions. Map area reliability was poor-to-moderate for short- and long-term sessions. Smaller map percentile subsets showed decreased variability but only minimal improvements in reliability. MDC for most outcomes was >50%. Procedures were well tolerated with no serious adverse events. Robotic TMS motor mapping is relatively reliable over time, but careful consideration of specific outcomes is required for this method to interrogate plasticity in the human motor system.NEW & NOTEWORTHY Robotic transcranial magnetic stimulation (TMS) is a noninvasive and safe tool that produces cortical motor maps-individualized representations of the primary motor cortex (M1) topography-that may reflect developmental and interventional plasticity. This study is the first to evaluate short- and long-term relative and absolute reliability of TMS mapping outcomes at various M1 excitability levels using novel robotic neuronavigated TMS.
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Affiliation(s)
- Adrianna Giuffre
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Alberta, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cynthia K Kahl
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ephrem Zewdie
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Alberta, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - James G Wrightson
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Anna Bourgeois
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Elizabeth G Condliffe
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Adam Kirton
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Alberta, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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14
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Welch JF, Argento PJ, Mitchell GS, Fox EJ. Reliability of diaphragmatic motor-evoked potentials induced by transcranial magnetic stimulation. J Appl Physiol (1985) 2020; 129:1393-1404. [PMID: 33031020 DOI: 10.1152/japplphysiol.00486.2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The diaphragmatic motor-evoked potential (MEP) induced by transcranial magnetic stimulation (TMS) permits electrophysiological assessment of the cortico-diaphragmatic pathway. Despite the value of TMS for investigating diaphragm motor integrity in health and disease, reliability of the technique has not been established. The study aim was to determine within- and between-session reproducibility of surface electromyogram recordings of TMS-evoked diaphragm potentials. Fifteen healthy young adults participated (6 females, age = 29 ± 7 yr). Diaphragm activation was determined by gradually increasing the stimulus intensity from 60 to 100% of maximal stimulator output (MSO). A minimum of seven stimulations were performed at each intensity. A second block of stimuli was delivered 30 min later for within-day comparisons, and a third block was performed on a separate day for between-day comparisons. Reliability of diaphragm MEPs was assessed at 100% MSO using intraclass correlation coefficients (ICC) and 95% limits of agreement (LOA). MEP latency (ICC = 0.984, P < 0.001), duration (ICC = 0.958, P < 0.001), amplitude (ICC = 0.950, P < 0.001), and area (ICC = 0.956, P < 0.001) were highly reproducible within-day. Between-day reproducibility was good to excellent for all MEP characteristics (latency ICC = 0.953, P < 0.001; duration ICC = 0.879, P = 0.002; amplitude ICC = 0.789, P = 0.019; area ICC = 0.815, P = 0.012). Data revealed less precision between-day versus within-day, as evidenced by wider LOA for all MEP characteristics. Large within- and between-subject variability in MEP amplitude and area was observed. In conclusion, TMS is a reliable means of inducing diaphragm potentials in most healthy individuals.NEW & NOTEWORTHY Transcranial magnetic stimulation (TMS) is a noninvasive technique to assess neural impulse conduction along the cortico-diaphragmatic pathway. The reliability of diaphragm motor-evoked potentials (MEP) induced by TMS is unknown. Notwithstanding large variability in MEP amplitude, we found good-to-excellent reproducibility of all MEP characteristics (latency, duration, amplitude, and area) both within- and between-day in healthy adult men and women. Our findings support the use of TMS and surface EMG to assess diaphragm activation in humans.
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Affiliation(s)
- Joseph F Welch
- Breathing Research and Therapeutics Center, Department of Physical Therapy, University of Florida, Gainesville, Florida
| | - Patrick J Argento
- Herbert Wertheim College of Engineering, University of Florida, Gainesville, Florida
| | - Gordon S Mitchell
- Breathing Research and Therapeutics Center, Department of Physical Therapy, University of Florida, Gainesville, Florida
| | - Emily J Fox
- Breathing Research and Therapeutics Center, Department of Physical Therapy, University of Florida, Gainesville, Florida.,Brooks Rehabilitation, Jacksonville, Florida
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15
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Yasen AL, Lim MM, Weymann KB, Christie AD. Excitability, Inhibition, and Neurotransmitter Levels in the Motor Cortex of Symptomatic and Asymptomatic Individuals Following Mild Traumatic Brain Injury. Front Neurol 2020; 11:683. [PMID: 32765402 PMCID: PMC7381132 DOI: 10.3389/fneur.2020.00683] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/08/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose: The purpose of this study was to determine the level of excitability and inhibition, as well as the concentrations of excitatory and inhibitory neurotransmitters, in the motor cortex of individuals with acute and chronic symptoms from mTBI. Methods: Fifty-three individuals were assigned to one of four groups: (i) without history of mTBI (Control), (ii) within 72-h of diagnosis of mTBI (Acute), (iii) with history of mTBI and no remaining symptoms (Chronic Asymptomatic), and (iv) with chronic symptoms from mTBI, lasting at least 3 months post-injury (Chronic Symptomatic). Measures of corticospinal excitability and inhibition were obtained using transcranial magnetic stimulation (TMS). On the same day, measures of glutamate and GABA concentrations were obtained from the primary motor cortex (M1) using proton magnetic resonance spectroscopy. Results: MEP amplitude and area were both significantly lower in the Chronic Symptomatic group compared to the Control and Chronic Asymptomatic groups (p ≤ 0.05). Intracortical inhibition was not significantly different among groups (p = 0.14). The concentration of glutamate in M1 was similar between groups (p = 0.93) while there was a trend for a lower concentration of GABA in the Chronic Symptomatic group compared to the Acute group (p = 0.06). Conclusions: Individuals with chronic mTBI symptoms appear to have lower corticospinal excitability compared with acutely-injured individuals and asymptomatic controls, but the absence of differences in intracortical inhibition, and concentrations of excitatory and inhibitory neurotransmitters in M1 suggests that neurotransmitter changes in the human brain post-mTBI do not follow the pattern typically seen in the animal literature.
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Affiliation(s)
- Alia L Yasen
- Department of Human Physiology, University of Oregon, Eugene, OR, United States
| | - Miranda M Lim
- Sleep Disorders Clinic, VA Portland Health Care System, Portland, OR, United States.,Departments of Neurology, Behavioral Neuroscience, Medicine, and Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, United States
| | - Kristianna B Weymann
- Sleep Disorders Clinic, VA Portland Health Care System, Portland, OR, United States.,School of Nursing, Oregon Health & Science University, Portland, OR, United States
| | - Anita D Christie
- Department of Human Physiology, University of Oregon, Eugene, OR, United States.,Faculty of Health Sciences, School of Kinesiology, Western University, London, ON, Canada
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16
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Hassanzahraee M, Zoghi M, Jaberzadeh S. Longer Transcranial Magnetic Stimulation Intertrial Interval Increases Size, Reduces Variability, and Improves the Reliability of Motor Evoked Potentials. Brain Connect 2020; 9:770-776. [PMID: 31744309 DOI: 10.1089/brain.2019.0714] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
High rates of variability in the amplitude of transcranial magnetic stimulation (TMS)-induced motor evoked potentials (MEPs), a popular method for assessing corticospinal excitability (CSE), make it essential to examine inherent reliability of the MEP amplitude. We aimed to investigate the effects of different intertrial intervals (ITIs) of single-pulse TMS on the amplitude, variability, and test-retest reliability of MEPs. Twenty-five TMS single pulses were recorded at four different ITIs of 5, 10, 15, and 20 sec from 15 healthy participants who attended two experimental sessions. Repeated measures analysis of variance (rmANOVA) and standardized z-value standard deviations (SDs) were used to investigate the effects of ITIs on MEP amplitudes and variability. Test-retest reliability of MEP amplitudes was also assessed using rmANOVA and intraclass correlation (ICC). rmANOVA revealed significantly larger MEP amplitudes following ITIs of 10, 15, and 20 sec compared with ITI 5, with no significant increases between ITIs of 15 and 20 sec. Standardized z-value SDs revealed variability rate reduction following longer ITIs with significant reductions occurring following ITIs of 10, 15, and 20 sec compared with ITI 5 with no significant difference between ITIs of 15 and 20 sec. rmANOVA showed no significant Time main effect on the MEP changes confirming within- and between-session agreement. ICCs reported significant within- and between-session reliability in all selected ITIs. The findings of the current study indicate that longer ITIs up to 15 sec can significantly induce larger MEPs with lower variability and higher reliability. The increase in ITIs not only reduces the chance of TMS-induced changes in CSE but also helps us to use this assessment tool in studies with smaller sample sizes.
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Affiliation(s)
- Maryam Hassanzahraee
- Noninvasive Brain Stimulation and Neuroplasticity Laboratory, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Australia
| | - Maryam Zoghi
- Department of Rehabilitation, Nutrition and Sport, School of Allied Health, La Trobe University, Melbourne, Australia
| | - Shapour Jaberzadeh
- Noninvasive Brain Stimulation and Neuroplasticity Laboratory, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Australia
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17
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Shih Y, Fisher BE, Smith JA, Powers CM. Corticomotor Excitability of Gluteus Maximus Is Associated with Hip Biomechanics During a Single-Leg Drop-Jump. J Mot Behav 2020; 53:40-46. [PMID: 32090700 DOI: 10.1080/00222895.2020.1723480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The purpose of this study was to determine the association between corticomotor excitability (CME) of gluteus maximus (GM) and hip biomechanics during a single-leg drop-jump task. Thirty-two healthy individuals participated. The slope of the input-output curve (IOC) obtained from transcranial magnetic stimulation was used to assess CME of GM. The average hip extensor moment and peak hip flexion angle during the stance phase of the drop jump task was calculated. The slope of the IOC of GM was found to be a predictor of the average hip extensor moment (r2 = 0.18, p = 0.016) and peak hip flexion angle (r2 = 0.20, p = 0.01). Our results demonstrate that greater functional use of the hip was associated with enhanced descending neural drive of GM.
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Affiliation(s)
- Yo Shih
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.,Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Beth E Fisher
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Jo Armour Smith
- Department of Physical Therapy, Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA, USA
| | - Christopher M Powers
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
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18
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Pearce AJ, Kidgell DJ, Frazer AK, King DA, Buckland ME, Tommerdahl M. Corticomotor correlates of somatosensory reaction time and variability in individuals with post concussion symptoms. Somatosens Mot Res 2019; 37:14-21. [PMID: 31809669 DOI: 10.1080/08990220.2019.1699045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Persistent post concussion symptoms (PPCS) describe the condition when an individual experiences chronic symptoms, particularly fatigue, beyond the expected time of recovery. The aim of this study was to quantify the effect of fatigue and related ongoing symptoms on somatosensory and corticomotor pathways using reaction time (RT) testing, and single-pulse and paired-pulse transcranial magnetic stimulation (TMS). Eighty-three participants (nine female, mean age 37.9 ± 11.5 years) were divided into two groups (persistent symptoms versus asymptomatic) following self-report based upon previously published clinical symptom scores. All participants completed somatosensory and visuomotor RT testing, as well as corticomotor excitability and inhibition measurements via TMS. Participants in the persistent symptom group (n = 38) reported greater number of previous concussions (t = 2.81, p = 0.006) and significantly higher levels of fatigue and related symptoms in the asymptomatic group (n = 45; t = 11.32, p < 0.006). Somatosensory RT showed significant slowing and increased variability in the persistent symptoms group (p < 0.001), however no significant differences were observed between groups for visuomotor RTs. Transcranial magnetic stimulation revealed differences between groups for intracortical inhibition at all stimulus intensities and paired pulse measures. The results indicate that somatosensory and corticomotor systems reflect on-going fatigue. From a practical perspective, objective and simplistic measures such as somatosensory and corticomotor measures can be used in the assessment of PPCS and gauging the efficacy of post concussion rehabilitation programmes.
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Affiliation(s)
- Alan J Pearce
- College of Health Science and Engineering, La Trobe University, Melbourne, Australia
| | - Dawson J Kidgell
- Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia
| | - Ashlyn K Frazer
- Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia
| | - Doug A King
- Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand
| | - Michael E Buckland
- Department of Neuropathology, Royal Prince Alfred Hospital, Sydney, Australia.,Brain and Mind Centre, University Sydney, Camperdown, Australia
| | - Mark Tommerdahl
- Cortical Metrics, USA.,Department of Biomedical Engineering, University of North Carolina, NC, USA
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19
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Labruna L, Stark-Inbar A, Breska A, Dabit M, Vanderschelden B, Nitsche MA, Ivry RB. Individual differences in TMS sensitivity influence the efficacy of tDCS in facilitating sensorimotor adaptation. Brain Stimul 2019; 12:992-1000. [PMID: 30930208 PMCID: PMC6592723 DOI: 10.1016/j.brs.2019.03.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 03/07/2019] [Accepted: 03/07/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) can enhance cognitive function in healthy individuals, with promising applications as a therapeutic intervention. Despite this potential, variability in the efficacy of tDCS has been a considerable concern. OBJECTIVE /Hypothesis: Given that tDCS is always applied at a set intensity, we examined whether individual differences in sensitivity to brain stimulation might be one variable that modulates the efficacy of tDCS in a motor learning task. METHODS In the first part of the experiment, single-pulse transcranial magnetic stimulation (TMS) over primary motor cortex (M1) was used to determine each participant's resting motor threshold (rMT). This measure was used as a proxy of individual sensitivity to brain stimulation. In an experimental group of 28 participants, 2 mA tDCS was then applied during a motor learning task with the anodal electrode positioned over left M1. Another 14 participants received sham stimulation. RESULTS M1-Anodal tDCS facilitated learning relative to participants who received sham stimulation. Of primary interest was a within-group analysis of the experimental group, showing that the rate of learning was positively correlated with rMT: Participants who were more sensitive to brain stimulation as operationalized by our TMS proxy (low rMT), showed faster adaptation. CONCLUSIONS Methodologically, the results indicate that TMS sensitivity can predict tDCS efficacy in a behavioral task, providing insight into one source of variability that may contribute to replication problems with tDCS. Theoretically, the results provide further evidence of a role of sensorimotor cortex in adaptation, with the boost from tDCS observed during acquisition.
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Affiliation(s)
- L Labruna
- Department of Psychology, University of California, 94704, Berkeley, CA, USA; Helen Wills Neuroscience Institute, University of California, 94704, Berkeley, CA, USA.
| | - A Stark-Inbar
- Department of Psychology, University of California, 94704, Berkeley, CA, USA; Helen Wills Neuroscience Institute, University of California, 94704, Berkeley, CA, USA
| | - A Breska
- Department of Psychology, University of California, 94704, Berkeley, CA, USA; Helen Wills Neuroscience Institute, University of California, 94704, Berkeley, CA, USA
| | - M Dabit
- Department of Psychology, University of California, 94704, Berkeley, CA, USA
| | - B Vanderschelden
- Department of Psychology, University of California, 94704, Berkeley, CA, USA
| | - M A Nitsche
- Leibniz Research Center for Working Environment and Human Factors, 44139, Dortmund, Germany
| | - R B Ivry
- Department of Psychology, University of California, 94704, Berkeley, CA, USA; Helen Wills Neuroscience Institute, University of California, 94704, Berkeley, CA, USA
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20
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Jannati A, Fried PJ, Block G, Oberman LM, Rotenberg A, Pascual-Leone A. Test-Retest Reliability of the Effects of Continuous Theta-Burst Stimulation. Front Neurosci 2019; 13:447. [PMID: 31156361 PMCID: PMC6533847 DOI: 10.3389/fnins.2019.00447] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 04/18/2019] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES The utility of continuous theta-burst stimulation (cTBS) as index of cortical plasticity is limited by inadequate characterization of its test-retest reliability. We thus evaluated the reliability of cTBS aftereffects, and explored the roles of age and common single-nucleotide polymorphisms in the brain-derived neurotrophic factor (BDNF) and apolipoprotein E (APOE) genes. METHODS Twenty-eight healthy adults (age range 21-65) underwent two identical cTBS sessions (median interval = 9.5 days) targeting the motor cortex. Intraclass correlation coefficients (ICCs) of the log-transformed, baseline-corrected amplitude of motor evoked potentials (ΔMEP) at 5-60 min post-cTBS (T5-T60) were calculated. Adjusted effect sizes for cTBS aftereffects were then calculated by taking into account the reliability of each cTBS measure. RESULTS ΔMEP at T50 was the most-reliable cTBS measure in the whole sample (ICC = 0.53). Area under-the-curve (AUC) of ΔMEPs was most reliable when calculated over the full 60 min post-cTBS (ICC = 0.40). cTBS measures were substantially more reliable in younger participants (< 35 years) and in those with BDNF Val66Val and APOE ε4- genotypes. CONCLUSION cTBS aftereffects are most reliable when assessed 50 min post-cTBS, or when cumulative ΔMEP measures are calculated over 30-60 min post-cTBS. Reliability of cTBS aftereffects is influenced by age, and BDNF and APOE polymorphisms. Reliability coefficients are used to adjust effect-size calculations for interpretation and planning of cTBS studies.
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Affiliation(s)
- Ali Jannati
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Peter J. Fried
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Gabrielle Block
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Lindsay M. Oberman
- Neuroplasticity and Autism Spectrum Disorder Program, Department of Psychiatry and Human Behavior, E.P. Bradley Hospital, Warren Alpert Medical School, Brown University, East Providence, RI, United States
| | - Alexander Rotenberg
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
- Neuromodulation Program and Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
- Institut Guttman de Neurorehabilitació, Universitat Autónoma de Barcelona, Barcelona, Spain
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21
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Wehrman JJ, Sowman P. Time in the motor cortex: Motor evoked potentials track foreperiod duration without concurrent movement. Neurosci Lett 2019; 698:85-89. [PMID: 30630059 DOI: 10.1016/j.neulet.2019.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/30/2018] [Accepted: 01/06/2019] [Indexed: 11/26/2022]
Abstract
Transcranial magnetic stimulation (TMS) allows for the monitoring of motor cortex dynamics in preparation for response. Using this method, it has previously been shown that motor evoked potentials (MEPs) are suppressed as a response approaches. In the current article, we applied TMS while participants either relaxed or contracted their first dorsal interosseous muscle. We varied the time at which TMS was applied, however, unlike previous studies, no participant response was required. Using this method, we provide evidence that MEPs systematically decrease with the duration of the trial, while inhibition is not similarly affected. Further, we found some evidence that MEPs are inversely proportional to the duration of the prior trial. These findings have ramifications for other research interested in the application of TMS, especially when used across multiple possible points in a trial. Further, this finding shows a role for the motor cortex in timing more broadly.
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Affiliation(s)
- Jordan J Wehrman
- Macquarie University Cognitive Science Department, Sydney, Australia.
| | - Paul Sowman
- Macquarie University Cognitive Science Department, Sydney, Australia
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22
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Pellegrini M, Zoghi M, Jaberzadeh S. The effect of transcranial magnetic stimulation test intensity on the amplitude, variability and reliability of motor evoked potentials. Brain Res 2018; 1700:190-198. [DOI: 10.1016/j.brainres.2018.09.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/14/2018] [Accepted: 09/04/2018] [Indexed: 10/28/2022]
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23
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Davila-Pérez P, Jannati A, Fried PJ, Cudeiro Mazaira J, Pascual-Leone A. The Effects of Waveform and Current Direction on the Efficacy and Test-Retest Reliability of Transcranial Magnetic Stimulation. Neuroscience 2018; 393:97-109. [PMID: 30300705 PMCID: PMC6291364 DOI: 10.1016/j.neuroscience.2018.09.044] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 09/26/2018] [Accepted: 09/28/2018] [Indexed: 12/31/2022]
Abstract
The pulse waveform and current direction of transcranial magnetic stimulation (TMS) influence its interactions with the neural substrate; however, their role in the efficacy and reliability of single- and paired-pulse TMS measures is not fully understood. We investigated how pulse waveform and current direction affect the efficacy and test-retest reliability of navigated, single- and paired-pulse TMS measures. 23 healthy adults (aged 18-35 years) completed two identical TMS sessions, assessing resting motor threshold (RMT), motor-evoked potentials (MEPs), cortical silent period (cSP), short- and long-interval intra-cortical inhibition (SICI and LICI), and intracortical facilitation (ICF) using either monophasic posterior-anterior (monoPA; n = 9), monophasic anterior-posterior (monoAP; n = 7), or biphasic (biAP-PA; n = 7) pulses. Averages of each TMS measure were compared across the three groups and intraclass correlation coefficients were calculated to assess test-retest reliability. RMT was the lowest and cSP was the longest with biAP-PA pulses, whereas MEP latency was the shortest with monoPA pulses. SICI and LICI had the largest effect with monoPA pulses, whereas only monoAP and biAP-PA pulses resulted in significant ICF. MEP amplitude was more reliable with either monoPA or monoAP than with biAP-PA pulses. LICI was the most reliable with monoAP pulses, whereas ICF was the most reliable with biAP-PA pulses. Waveform/current direction influenced RMT, MEP latency, cSP, SICI, LICI, and ICF, as well as the reliability of MEP amplitude, LICI, and ICF. These results show the importance of considering TMS pulse parameters for optimizing the efficacy and reliability of TMS neurophysiologic measures.
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Affiliation(s)
- Paula Davila-Pérez
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Neuroscience and Motor Control Group (NEUROcom), Institute for Biomedical Research (INIBIC), Universidade da Coruña, A Coruña, Spain.
| | - Ali Jannati
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Peter J Fried
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Javier Cudeiro Mazaira
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Neuroscience and Motor Control Group (NEUROcom), Institute for Biomedical Research (INIBIC), Universidade da Coruña, A Coruña, Spain; Centro de Estimulación Cerebral de Galicia, A Coruña, Spain
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Institut Guttman de Neurorehabilitació, Universitat Autónoma de Barcelona, Badalona, Barcelona, Spain.
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24
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Su D, Li D, Wang S, Qiao H, Li P, Wang B, Wan H, Schumacher M, Liu S. Hypoglossal-facial nerve "side-to-side" neurorrhaphy for facial paralysis resulting from closed temporal bone fractures. Restor Neurol Neurosci 2018; 36:443-457. [PMID: 29889081 DOI: 10.3233/rnn-170794] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Closed temporal bone fractures due to cranial trauma often result in facial nerve injury, frequently inducing incomplete facial paralysis. Conventional hypoglossal-facial nerve end-to-end neurorrhaphy may not be suitable for these injuries because sacrifice of the lesioned facial nerve for neurorrhaphy destroys the remnant axons and/or potential spontaneous innervation. OBJECTIVE we modified the classical method by hypoglossal-facial nerve "side-to-side" neurorrhaphy using an interpositional predegenerated nerve graft to treat these injuries. METHODS Five patients who experienced facial paralysis resulting from closed temporal bone fractures due to cranial trauma were treated with the "side-to-side" neurorrhaphy. An additional 4 patients did not receive the neurorrhaphy and served as controls. RESULTS Before treatment, all patients had suffered House-Brackmann (H-B) grade V or VI facial paralysis for a mean of 5 months. During the 12-30 months of follow-up period, no further detectable deficits were observed, but an improvement in facial nerve function was evidenced over time in the 5 neurorrhaphy-treated patients. At the end of follow-up, the improved facial function reached H-B grade II in 3, grade III in 1 and grade IV in 1 of the 5 patients, consistent with the electrophysiological examinations. In the control group, two patients showed slightly spontaneous innervation with facial function improved from H-B grade VI to V, and the other patients remained unchanged at H-B grade V or VI. CONCLUSIONS We concluded that the hypoglossal-facial nerve "side-to-side" neurorrhaphy can preserve the injured facial nerve and is suitable for treating significant incomplete facial paralysis resulting from closed temporal bone fractures, providing an evident beneficial effect. Moreover, this treatment may be performed earlier after the onset of facial paralysis in order to reduce the unfavorable changes to the injured facial nerve and atrophy of its target muscles due to long-term denervation and allow axonal regrowth in a rich supportive environment.
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Affiliation(s)
- Diya Su
- Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China
| | - Dezhi Li
- Department of Neurosurgery and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shiwei Wang
- U 1195, INSERM and Université Paris-Sud and Université Paris-Saclay, 94276 Le Kremlin-Bicêtre, France
| | - Hui Qiao
- Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China
| | - Ping Li
- Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China
| | - Binbin Wang
- Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China
| | - Hong Wan
- Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China
| | - Michael Schumacher
- U 1195, INSERM and Université Paris-Sud and Université Paris-Saclay, 94276 Le Kremlin-Bicêtre, France
| | - Song Liu
- Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China.,Department of Neurosurgery and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,U 1195, INSERM and Université Paris-Sud and Université Paris-Saclay, 94276 Le Kremlin-Bicêtre, France
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25
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Leung H, Latella C, Lamon S, Hendy AM. The Reliability of Neurological Measurement in the Vastus Medialis: Implications for Research and Practice. Front Psychol 2018; 9:1857. [PMID: 30327634 PMCID: PMC6174212 DOI: 10.3389/fpsyg.2018.01857] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 09/11/2018] [Indexed: 11/21/2022] Open
Abstract
The integrity of the corticomotor pathway is paramount in the optimal functioning of skeletal muscle. However, variability of neurophysiological assessment via peripheral nerve and transcranial magnetic stimulation can render interpretation difficult. Seldom evidence exists regarding the reliability of such measurements in the leg extensors, which have important locomotive and functional roles. This study aimed to assess the test-retest reliability of peripheral, corticospinal and intracortical responses in the vastus medialis. Transcranial magnetic and direct current electrical nerve stimulation were delivered to sixteen healthy young adults (8M and 8F) on two separate occasions. The Hoffmann reflex, maximal compound wave, motor evoked potential, corticospinal silent period, intracortical facilitation, and short-interval intracortical inhibition were recorded from the vastus medialis at rest, and during controlled submaximal voluntary contraction. Relative reliability was quantified using intra-class correlation coefficient (ICC2,1). Absolute reliability was quantified using standard error of measurement (SEm) and minimal detectable change (MDC). Corticospinal silent period, corticospinal silent period/motor evoked potential ratio, active motor evoked potential, maximal Hoffman reflex, and passive short-interval intracortical inhibition demonstrated “good to excellent” relative reliability (ICC ≥ 0.643). Intracortical facilitation demonstrated the lowest relative reliability (ICC = 0.420–0.908). Corticospinal silent period displayed the lowest absolute reliability (SEm ≤ 18.68%). Good reliability of the maximal compound wave, Hoffman reflex, motor evoked potential, and corticospinal silent period allow for reliable neurological evaluation of peripheral and corticospinal pathways in the vastus medialis. Future research should investigate reliability of the intracortical (short-interval intracortical inhibition and intracortical facilitation) measures by using different paired-pulse stimulus parameters. These findings hold important implications for neurophysiological assessment conducted in the leg extensor group.
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Affiliation(s)
- Hans Leung
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Christopher Latella
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Séverine Lamon
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Ashlee M Hendy
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
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26
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Dissanayaka T, Zoghi M, Farrell M, Egan G, Jaberzadeh S. Comparison of Rossini-Rothwell and adaptive threshold-hunting methods on the stability of TMS induced motor evoked potentials amplitudes. J Neurosci Res 2018; 96:1758-1765. [DOI: 10.1002/jnr.24319] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 07/31/2018] [Accepted: 07/31/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Thusharika Dissanayaka
- Faculty of Medicine, Nursing and Health Sciences, Department of Physiotherapy, School of Primary and Allied Health Care; Monash University; Melbourne Victoria Australia
| | - Maryam Zoghi
- Department of Rehabilitation, Nutrition and Sport, School of Allied health; La Trobe University; Melbourne Victoria Australia
| | - Michael Farrell
- Monash Biomedical Imaging; Monash University; Melbourne Victoria Australia
- Biomedicine Discovery Institute and Department of Medical Imaging and Radiation Sciences; Monash University; Clayton Victoria Australia
| | - Gary Egan
- Monash Biomedical Imaging; Monash University; Melbourne Victoria Australia
| | - Shapour Jaberzadeh
- Faculty of Medicine, Nursing and Health Sciences, Department of Physiotherapy, School of Primary and Allied Health Care; Monash University; Melbourne Victoria Australia
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27
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Lee KM, Joo MC, Yu YM, Kim MS. Mylohyoid motor evoked potentials can effectively predict persistent dysphagia 3 months poststroke. Neurogastroenterol Motil 2018. [PMID: 29532576 DOI: 10.1111/nmo.13323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the association between mylohyoid motor-evoked potentials (MH-MEP) and swallowing function and determine the value of MH-MEP for predicting aspiration 3 months poststroke. METHODS Subacute patients within a month of their first stroke were enrolled up for 2 consecutive years. Videofluoroscopic swallowing studies (VFSS) were performed twice. Patients were evaluated during VFSS using the penetration aspiration scale (PAS) and videofluoroscopic dysphagia scale (VDS). MH-MEP was recorded in the mylohyoid muscles. The active electrode was positioned submentally, 2 cm lateral to midline. Magnetic stimulation was performed on the contralateral motor cortex, 2-4 cm anterior and 4-6 cm lateral to the cranial vertex. The resting motor threshold (rMT), latency, and amplitude stimulation at 120% (amp120) and 150% (amp150) of the rMT were assessed. The ratio of each parameter was also estimated. The relationship between MH-MEP and VFSS findings was analyzed. KEY RESULTS Sixty-eight patients completed the study. On VFSS at 3 months poststroke, 24 (35.3%) patients showed aspiration. The rMT, rMT ratio, amp120 and amp120 ratio were significantly correlated with the PAS and VDS (P < .05). The rMT ratio (OR = 1.208, P = .001) and amp120 ratio (OR = 0.821, P = .002) were independent predictors of aspiration at 3 months. The optimal cut-off value of the rMT ratio was 126.1 (AUC = 0.94, sensitivity = 0.92, specificity = 0.89); that of the amp120 ratio was 66.5 (AUC = 0.89, sensitivity = 0.88, specificity = 0.86). CONCLUSIONS AND INFERENCES MH-MEP was well-correlated with dysphagia severity assessed by VFSS. The rMT ratio and amplitude ratio of MH-MEP can effectively predict persistent dysphagia 3 months poststroke.
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Affiliation(s)
- K M Lee
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - M C Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Y M Yu
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - M-S Kim
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Korea
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28
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Tedesco Triccas L, Hughes AM, Burridge JH, Din AE, Warner M, Brown S, Desikan M, Rothwell J, Verheyden G. Measurement of motor-evoked potential resting threshold and amplitude of proximal and distal arm muscles in healthy adults. A reliability study. J Rehabil Assist Technol Eng 2018; 5:2055668318765406. [PMID: 31191932 PMCID: PMC6453085 DOI: 10.1177/2055668318765406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 02/19/2018] [Indexed: 12/04/2022] Open
Abstract
Purpose Reliability of motor-evoked potential threshold and amplitude measurement of
upper limb muscles is important when detecting changes in cortical
excitability. The objective of this study was to investigate intra-rater,
test–retest reliability and minimal detectable change of resting motor
threshold and amplitude of a proximal and distal upper limb muscles,
anterior deltoid and distal extensor digitorum communis in healthy
adults. Method To measure motor-evoked potential responses, transcranial magnetic
stimulation was interfaced with electromyography and neuronavigation
equipment. Two measurements were conducted on day 1 and a third measurement
three days later. Reliability was analysed using intraclass correlation
coefficients. Results Twenty participants completed the study. Excellent intra-rater (intraclass
correlation coefficient = 0.91 (extensor digitorum), 0.94 (anterior
deltoid)) and good to excellent test–retest reliability (intraclass
correlation coefficient = 0.69 (anterior deltoid), 0.84 (extensor
digitorum)) was found for resting motor threshold. Minimal detectable change
for resting motor threshold was found at 10.95% (extensor digitorum) and
16.35% (anterior deltoid) between first and third measurements. Motor-evoked
potential amplitude of extensor digitorum communis had fair to good
intra-rater (intraclass correlation coefficient = 0.50) and test–retest
reliability (intraclass correlation coefficient = 0.65). Conclusions Our results suggest that resting motor threshold is a reliable
neurophysiological measure even for proximal shoulder muscles. Future
research should further explore the reliability of motor-evoked potential
amplitude before integration into neurological rehabilitation.
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Affiliation(s)
- Lisa Tedesco Triccas
- 1Faculty of Health Sciences, University of Southampton, Southampton, UK.,Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Ann-Marie Hughes
- 1Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Jane H Burridge
- 1Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Amy E Din
- 1Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Martin Warner
- 1Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Simon Brown
- 1Faculty of Health Sciences, University of Southampton, Southampton, UK
| | | | - John Rothwell
- Institute of Neurology, Queen Square, University College London, London, UK
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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29
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Brown KE, Lohse KR, Mayer IMS, Strigaro G, Desikan M, Casula EP, Meunier S, Popa T, Lamy JC, Odish O, Leavitt BR, Durr A, Roos RAC, Tabrizi SJ, Rothwell JC, Boyd LA, Orth M. The reliability of commonly used electrophysiology measures. Brain Stimul 2017; 10:1102-1111. [PMID: 28807846 DOI: 10.1016/j.brs.2017.07.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/27/2017] [Accepted: 07/27/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Electrophysiological measures can help understand brain function both in healthy individuals and in the context of a disease. Given the amount of information that can be extracted from these measures and their frequent use, it is essential to know more about their inherent reliability. OBJECTIVE/HYPOTHESIS To understand the reliability of electrophysiology measures in healthy individuals. We hypothesized that measures of threshold and latency would be the most reliable and least susceptible to methodological differences between study sites. METHODS Somatosensory evoked potentials from 112 control participants; long-latency reflexes, transcranial magnetic stimulation with resting and active motor thresholds, motor evoked potential latencies, input/output curves, and short-latency sensory afferent inhibition and facilitation from 84 controls were collected at 3 visits over 24 months at 4 Track-On HD study sites. Reliability was assessed using intra-class correlation coefficients for absolute agreement, and the effects of reliability on statistical power are demonstrated for different sample sizes and study designs. RESULTS Measures quantifying latencies, thresholds, and evoked responses at high stimulator intensities had the highest reliability, and required the smallest sample sizes to adequately power a study. Very few between-site differences were detected. CONCLUSIONS Reliability and susceptibility to between-site differences should be evaluated for electrophysiological measures before including them in study designs. Levels of reliability vary substantially across electrophysiological measures, though there are few between-site differences. To address this, reliability should be used in conjunction with theoretical calculations to inform sample size and ensure studies are adequately powered to detect true change in measures of interest.
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Affiliation(s)
- K E Brown
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - K R Lohse
- College of Health, University of Utah, Salt Lake City, UT, USA
| | - I M S Mayer
- Department of Neurology, Ulm University Hospital, Ulm, Germany; Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
| | - G Strigaro
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
| | - M Desikan
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
| | - E P Casula
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
| | - S Meunier
- APHP Department of Genetics, Groupe Hospitalier Pitié-Salpêtrière, Institut du Cerveau et de la Moelle, INSERM U1127, CNRS UMR7225, Sorbonne Universités - UPMC Université Paris VI UMR_S1127, Paris, France
| | - T Popa
- APHP Department of Genetics, Groupe Hospitalier Pitié-Salpêtrière, Institut du Cerveau et de la Moelle, INSERM U1127, CNRS UMR7225, Sorbonne Universités - UPMC Université Paris VI UMR_S1127, Paris, France
| | - J-C Lamy
- APHP Department of Genetics, Groupe Hospitalier Pitié-Salpêtrière, Institut du Cerveau et de la Moelle, INSERM U1127, CNRS UMR7225, Sorbonne Universités - UPMC Université Paris VI UMR_S1127, Paris, France
| | - O Odish
- Department of Neurology, Leiden University Medical Centre, 2300RC Leiden, The Netherlands
| | - B R Leavitt
- Centre for Molecular Medicine and Therapeutics, Department of Medical Genetics, University of British Columbia, 950 West 28th Avenue, Vancouver, BC V5Z 4H4, Canada
| | - A Durr
- APHP Department of Genetics, Groupe Hospitalier Pitié-Salpêtrière, Institut du Cerveau et de la Moelle, INSERM U1127, CNRS UMR7225, Sorbonne Universités - UPMC Université Paris VI UMR_S1127, Paris, France
| | - R A C Roos
- Department of Neurology, Leiden University Medical Centre, 2300RC Leiden, The Netherlands
| | - S J Tabrizi
- Huntington's Disease Research Centre, UCL Institute of Neurology, London, UK
| | - J C Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
| | - L A Boyd
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - M Orth
- Department of Neurology, Ulm University Hospital, Ulm, Germany.
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30
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Kidgell DJ, Bonanno DR, Frazer AK, Howatson G, Pearce AJ. Corticospinal responses following strength training: a systematic review and meta-analysis. Eur J Neurosci 2017; 46:2648-2661. [DOI: 10.1111/ejn.13710] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 08/27/2017] [Accepted: 08/31/2017] [Indexed: 01/21/2023]
Affiliation(s)
- Dawson J. Kidgell
- Department of Physiotherapy; School of Primary and Allied Health Care; Faculty of Medicine, Nursing and Health Science; Monash University; Melbourne Vic. 3199 Australia
| | - Daniel R. Bonanno
- Discipline of Podiatry; School of Allied Health; La Trobe University; Melbourne Vic. Australia
- La Trobe Sport and Exercise Medicine Research Centre; School of Allied Health; La Trobe University; Melbourne Vic. Australia
| | - Ashlyn K. Frazer
- Department of Physiotherapy; School of Primary and Allied Health Care; Faculty of Medicine, Nursing and Health Science; Monash University; Melbourne Vic. 3199 Australia
| | - Glyn Howatson
- Faculty of Health and Life Sciences; Northumbria University; Newcastle-upon-Tyne UK
- Water Research Group; School of Environmental Sciences and Development; Northwest University; Potchefstroom South Africa
| | - Alan J. Pearce
- Discipline of Exercise Science; School of Allied Health; La Trobe University; Melbourne Vic. Australia
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31
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Wörsching J, Padberg F, Helbich K, Hasan A, Koch L, Goerigk S, Stoecklein S, Ertl-Wagner B, Keeser D. Test-retest reliability of prefrontal transcranial Direct Current Stimulation (tDCS) effects on functional MRI connectivity in healthy subjects. Neuroimage 2017; 155:187-201. [PMID: 28450138 DOI: 10.1016/j.neuroimage.2017.04.052] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 04/22/2017] [Indexed: 01/01/2023] Open
Abstract
Transcranial Direct Current Stimulation (tDCS) of the prefrontal cortex (PFC) can be used for probing functional brain connectivity and meets general interest as novel therapeutic intervention in psychiatric and neurological disorders. Along with a more extensive use, it is important to understand the interplay between neural systems and stimulation protocols requiring basic methodological work. Here, we examined the test-retest (TRT) characteristics of tDCS-induced modulations in resting-state functional-connectivity MRI (RS fcMRI). Twenty healthy subjects received 20minutes of either active or sham tDCS of the dorsolateral PFC (2mA, anode over F3 and cathode over F4, international 10-20 system), preceded and ensued by a RS fcMRI (10minutes each). All subject underwent three tDCS sessions with one-week intervals in between. Effects of tDCS on RS fcMRI were determined at an individual as well as at a group level using both ROI-based and independent-component analyses (ICA). To evaluate the TRT reliability of individual active-tDCS and sham effects on RS fcMRI, voxel-wise intra-class correlation coefficients (ICC) of post-tDCS maps between testing sessions were calculated. For both approaches, results revealed low reliability of RS fcMRI after active tDCS (ICC(2,1) = -0.09 - 0.16). Reliability of RS fcMRI (baselines only) was low to moderate for ROI-derived (ICC(2,1) = 0.13 - 0.50) and low for ICA-derived connectivity (ICC(2,1) = 0.19 - 0.34). Thus, for ROI-based analyses, the distribution of voxel-wise ICC was shifted to lower TRT reliability after active, but not after sham tDCS, for which the distribution was similar to baseline. The intra-individual variation observed here resembles variability of tDCS effects in motor regions and may be one reason why in this study robust tDCS effects at a group level were missing. The data can be used for appropriately designing large scale studies investigating methodological issues such as sources of variability and localisation of tDCS effects.
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Affiliation(s)
- Jana Wörsching
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany.
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Konstantin Helbich
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Lena Koch
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Stephan Goerigk
- Department of Psychological Methodology and Assessment, Ludwig-Maximilians-University, Munich, Germany
| | - Sophia Stoecklein
- Institute for Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany
| | - Birgit Ertl-Wagner
- Institute for Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany; Institute for Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany
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32
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Response variability of different anodal transcranial direct current stimulation intensities across multiple sessions. Brain Stimul 2017; 10:757-763. [PMID: 28420581 DOI: 10.1016/j.brs.2017.04.003] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 02/01/2017] [Accepted: 04/07/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND It is well known that transcranial direct current stimulation (tDCS) is capable of modulating corticomotor excitability. However, a source of growing concern has been the observed inter- and intra-individual variability of tDCS-responses. Recent studies have assessed whether individuals respond in a predictable manner across repeated sessions of anodal tDCS (atDCS). The findings of these investigations have been inconsistent, and their methods have some limitations (i.e. lack of sham condition or testing only one tDCS intensity). OBJECTIVE To study inter- and intra-individual variability of atDCS effects at two different intensities on primary motor cortex (M1) excitability. METHODS Twelve subjects participated in a crossover study testing 7-min atDCS over M1 in three separate conditions (2 mA, 1 mA, sham) each repeated three times separated by 48 h. Motor evoked potentials were recorded before and after stimulation (up to 30min). Time of testing was maintained consistent within participants. To estimate the reliability of tDCS effects across sessions, we calculated the Intra-class Correlation Coefficient (ICC). RESULTS AtDCS at 2 mA, but not 1 mA, significantly increased cortical excitability at the group level in all sessions. The overall ICC revealed fair to high reliability of tDCS effects for multiple sessions. Given that the distribution of responses showed important variability in the sham condition, we established a Sham Variability-Based Threshold to classify responses and to track individual changes across sessions. Using this threshold an intra-individual consistent response pattern was then observed only for the 2 mA condition. CONCLUSION 2 mA anodal tDCS results in consistent intra- and inter-individual increases of M1 excitability.
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33
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Cavaleri R, Schabrun SM, Chipchase LS. The number of stimuli required to reliably assess corticomotor excitability and primary motor cortical representations using transcranial magnetic stimulation (TMS): a systematic review and meta-analysis. Syst Rev 2017; 6:48. [PMID: 28264713 PMCID: PMC5340029 DOI: 10.1186/s13643-017-0440-8] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 02/22/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) is a non-invasive means by which to assess the structure and function of the central nervous system. Current practices involve the administration of multiple stimuli over target areas of a participant's scalp. Decreasing the number of stimuli delivered during TMS assessments would improve time efficiency and decrease participant demand. However, doing so may also compromise the within- or between-session reliability of the technique. The aim of this review was therefore to determine the minimum number of TMS stimuli required to reliably measure (i) corticomotor excitability of a target muscle at a single cranial site and (ii) topography of the primary motor cortical representation of a target muscle across multiple cranial sites. METHODS Database searches were performed to identify diagnostic reliability studies published before May 2015. Two independent reviewers extracted data from studies employing single-pulse TMS to measure (i) the corticomotor excitability at a single cranial site or (ii) the topographic cortical organisation of a target muscle across a number of cranial sites. Outcome measures included motor evoked potential amplitude, map volume, number of active map sites and location of the map centre of gravity. RESULTS Only studies comparing the reliability of varying numbers of stimuli delivered to a single cranial site were identified. Five was the lowest number of stimuli that could be delivered to produce excellent within-session motor evoked potential (MEP) amplitude reliability (intraclass correlation coefficient (ICC) = 0.92, 95% CI 0.87 to 0.95). Ten stimuli were required to achieve consistent between-session MEP amplitudes among healthy participants (ICC = 0.89, 95% CI 0.76 to 0.95). However, between-session reliability was influenced by participant characteristics, intersession intervals and target musculature. CONCLUSIONS Further exploration of the reliability of multi-site TMS mapping is required. Five stimuli produce reliable MEP recordings during single-site TMS investigations involving one session. For single-site analyses involving multiple sessions, ten stimuli are recommended when investigating corticomotor excitability in healthy participants or the upper limb musculature. However, greater numbers of stimuli may be required for clinical populations or assessments involving the lower limb. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015024579.
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Affiliation(s)
- Rocco Cavaleri
- Brain Rehabilitation and Neuroplasticity Unit, School of Science and Health, Western Sydney University, Sydney, NSW, 2560, Australia
| | - Siobhan M Schabrun
- Brain Rehabilitation and Neuroplasticity Unit, School of Science and Health, Western Sydney University, Sydney, NSW, 2560, Australia
| | - Lucy S Chipchase
- Brain Rehabilitation and Neuroplasticity Unit, School of Science and Health, Western Sydney University, Sydney, NSW, 2560, Australia.
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Individual Differences in Resting Corticospinal Excitability Are Correlated with Reaction Time and GABA Content in Motor Cortex. J Neurosci 2017; 37:2686-2696. [PMID: 28179557 DOI: 10.1523/jneurosci.3129-16.2017] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 01/04/2017] [Accepted: 01/31/2017] [Indexed: 01/14/2023] Open
Abstract
Individuals differ in the intrinsic excitability of their corticospinal pathways and, perhaps more generally, their entire nervous system. At present, we have little understanding of the mechanisms underlying these differences and how variation in intrinsic excitability relates to behavior. Here, we examined the relationship between individual differences in intrinsic corticospinal excitability, local cortical GABA levels, and reaction time (RT) in a group of 20 healthy human adults. We measured corticospinal excitability at rest with transcranial magnetic stimulation, local concentrations of basal GABA with magnetic resonance spectroscopy, and RT with a behavioral task. All measurements were repeated in two separate sessions, and tests of reliability confirmed the presence of stable individual differences. There was a negative correlation between corticospinal excitability and RT, such that larger motor-evoked potentials (MEPs) measured at rest were associated with faster RTs. Interestingly, larger MEPs were associated with higher levels of GABA in M1, but not in three other cortical regions. Together, these results suggest that individuals with more excitable corticospinal pathways are faster to initiate planned responses and have higher levels of GABA within M1, possibly to compensate for a more excitable motor system.SIGNIFICANCE STATEMENT This study brings together physiological, behavioral, and neurochemical evidence to examine variability in the excitability of the human motor system. Previous work has focused on state-based factors (e.g., preparedness, uncertainty), with little attention given to the influence of inherent stable characteristics. Here, we examined how the excitability of the motor system relates to reaction time and the regional content of the inhibitory neurotransmitter GABA. Importantly, motor pathway excitability and GABA concentrations were measured at rest, outside a task context, providing assays of intrinsic properties of the individuals. Individuals with more excitable motor pathways had faster reaction times and, paradoxically, higher concentrations of GABA. We propose that greater GABA capacity in the motor cortex counteracts an intrinsically more excitable motor system.
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Hashemirad F, Zoghi M, Fitzgerald PB, Jaberzadeh S. Reliability of Motor Evoked Potentials Induced by Transcranial Magnetic Stimulation: The Effects of Initial Motor Evoked Potentials Removal. Basic Clin Neurosci 2017; 8:43-50. [PMID: 28446949 PMCID: PMC5396172 DOI: 10.15412/j.bcn.03080106] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Transcranial magnetic stimulation (TMS) is a useful tool for assessment of corticospinal excitability (CSE) changes in both healthy individuals and patients with brain disorders. The usefulness of TMS-elicited motor evoked potentials (MEPs) for the assessment of CSE in a clinical context depends on their intra-and inter-session reliability. This study aimed to evaluate if removal of initial MEPs elicited by using two types of TMS techniques influences the reliability scores and whether this effect is different in blocks with variable number of MEPs. METHODS Twenty-three healthy participants were recruited in this study. The stimulus intensity was set at 120% of resting motor threshold (RMT) for one group while the stimulus intensity was adjusted to record MEPs up to 1 mV for the other group. Twenty MEPs were recorded at 3 time points on 2 separate days. An intra-class correlation coefficient (ICC) reliability with absolute agreement and analysis of variance model were used to assess reliability of the MEP amplitudes for blocks with variable number of MEPs. RESULTS A decrease in ICC values was observed with removal of 3 or 5 MEPs in both techniques when compared to all MEP responses in any given block. Therefore, removal of the first 3 or 5 MEPs failed to further increase the reliability of MEP responses. CONCLUSION Our findings revealed that a greater number of trials involving averaged MEPs can influence TMS reliability more than removal of the first trials.
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Affiliation(s)
- Fahimeh Hashemirad
- Department of Physiotherapy, School of Primary Health Care, Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Maryam Zoghi
- Department of Medicine at Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Paul B Fitzgerald
- Monash Alfred Psychiatry Research Centre, Alfred and Monash University Central Clinical School, Melbourne, Australia
| | - Shapour Jaberzadeh
- Department of Physiotherapy, School of Primary Health Care, Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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Haavik H, Niazi IK, Jochumsen M, Sherwin D, Flavel S, Türker KS. Impact of Spinal Manipulation on Cortical Drive to Upper and Lower Limb Muscles. Brain Sci 2016; 7:brainsci7010002. [PMID: 28025542 PMCID: PMC5297291 DOI: 10.3390/brainsci7010002] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/19/2016] [Accepted: 12/21/2016] [Indexed: 10/29/2022] Open
Abstract
This study investigates whether spinal manipulation leads to changes in motor control by measuring the recruitment pattern of motor units in both an upper and lower limb muscle and to see whether such changes may at least in part occur at the cortical level by recording movement related cortical potential (MRCP) amplitudes. In experiment one, transcranial magnetic stimulation input-output (TMS I/O) curves for an upper limb muscle (abductor pollicus brevis; APB) were recorded, along with F waves before and after either spinal manipulation or a control intervention for the same subjects on two different days. During two separate days, lower limb TMS I/O curves and MRCPs were recorded from tibialis anterior muscle (TA) pre and post spinal manipulation. Dependent measures were compared with repeated measures analysis of variance, with p set at 0.05. Spinal manipulation resulted in a 54.5% ± 93.1% increase in maximum motor evoked potential (MEPmax) for APB and a 44.6% ± 69.6% increase in MEPmax for TA. For the MRCP data following spinal manipulation there were significant difference for amplitude of early bereitschafts-potential (EBP), late bereitschafts potential (LBP) and also for peak negativity (PN). The results of this study show that spinal manipulation leads to changes in cortical excitability, as measured by significantly larger MEPmax for TMS induced input-output curves for both an upper and lower limb muscle, and with larger amplitudes of MRCP component post manipulation. No changes in spinal measures (i.e., F wave amplitudes or persistence) were observed, and no changes were shown following the control condition. These results are consistent with previous findings that have suggested increases in strength following spinal manipulation were due to descending cortical drive and could not be explained by changes at the level of the spinal cord. Spinal manipulation may therefore be indicated for the patients who have lost tonus of their muscle and/or are recovering from muscle degrading dysfunctions such as stroke or orthopaedic operations and/or may also be of interest to sports performers. These findings should be followed up in the relevant populations.
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Affiliation(s)
- Heidi Haavik
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand.
| | - Imran Khan Niazi
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand.
- Centre for Sensory-Motor Interaction, Department of Health Science and Technology, Aalborg University, Aalborg 9220, Denmark.
| | - Mads Jochumsen
- Centre for Sensory-Motor Interaction, Department of Health Science and Technology, Aalborg University, Aalborg 9220, Denmark.
| | - Diane Sherwin
- Chirofit (Private Practice), 32a Normanby Rd, Mt Eden Auckland, Auckland 1024, New Zealand.
| | - Stanley Flavel
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand.
| | - Kemal S Türker
- School of Medicine, Koç University, Rumelifeneri Yolu, Sariyer, Istanbul 34450, Turkey.
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Beaulieu LD, Flamand VH, Massé-Alarie H, Schneider C. Reliability and minimal detectable change of transcranial magnetic stimulation outcomes in healthy adults: A systematic review. Brain Stimul 2016; 10:196-213. [PMID: 28031148 DOI: 10.1016/j.brs.2016.12.008] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 12/12/2016] [Accepted: 12/16/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) is used worldwide for noninvasively testing human motor systems but its psychometric properties remain unclear. OBJECTIVE/HYPOTHESIS This work systematically reviewed studies on the reliability of TMS outcome measures of primary motor cortex (M1) excitability in healthy humans, with an emphasis on retrieving minimal detectable changes (MDC). METHODS The literature search was performed in three databases (Pubmed, CINAHL, Embase) up to June 2016 and additional studies were identified through hand-searching. French and English-written studies had to report the reliability of at least one TMS outcome of M1 in healthy humans. Two independent raters assessed the eligibility of potential studies, and eligible articles were reviewed using a structured data extraction form and two critical appraisal scales. RESULTS A total of 34 articles met the selection criteria, which tested the intra- and inter-rater reliability (relative and absolute subtypes) of several TMS outcomes. However, our critical appraisal of studies raised concerns on the applicability and generalization of results because of methodological and statistical pitfalls. Importantly, MDC were generally large and likely affected by various factors, especially time elapsed between sessions and number of stimuli delivered. CONCLUSIONS This systematic review underlined that the evidence about the reliability of TMS outcomes is scarce and affected by several methodological and statistical problems. Data and knowledge of the review provided however relevant insights on the ability of TMS outcomes to track plastic changes within an individual or within a group, and recommendations were made to level up the quality of future work in the field.
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Affiliation(s)
- Louis-David Beaulieu
- Clinical Neuroscience and Neurostimulation Laboratory, CHU de Québec Research Center - Neuroscience Division, Quebec City, Qc, Canada; Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Qc, Canada.
| | - Véronique H Flamand
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Qc, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Qc, Canada
| | - Hugo Massé-Alarie
- Clinical Neuroscience and Neurostimulation Laboratory, CHU de Québec Research Center - Neuroscience Division, Quebec City, Qc, Canada; Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Qc, Canada
| | - Cyril Schneider
- Clinical Neuroscience and Neurostimulation Laboratory, CHU de Québec Research Center - Neuroscience Division, Quebec City, Qc, Canada; Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Qc, Canada
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Vaseghi B, Zoghi M, Jaberzadeh S. Unihemispheric concurrent dual-site cathodal transcranial direct current stimulation: the effects on corticospinal excitability. Eur J Neurosci 2016; 43:1161-72. [PMID: 26946332 DOI: 10.1111/ejn.13229] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 02/20/2016] [Accepted: 03/01/2016] [Indexed: 11/30/2022]
Abstract
We aimed to assess the effects of concurrent cathodal transcranial direct current stimulation (c-tDCS) of two targets in a hemisphere, termed unihemispheric concurrent dual-site cathodal tDCS (c-tDCSUHCDS ), on the size of M1 corticospinal excitability and its lasting effect. Secondary aims were to identify the mechanisms behind the efficacy of c-tDCSUHCDS and to evaluate the side effects of this new technique. Twelve healthy volunteers received 20 min c-tDCS under five conditions in a random order: M1 c-tDCS, c-tDCSUHCDS of M1-dorsolateral prefrontal cortex (DLPFC), M1-primary sensory cortex (S1), M1-primary visual cortex (V1) and sham. The M1 corticospinal excitability of the first dorsal interossei muscle was assessed before, immediately after, and 30 min, 60 min and 24 h after the interventions. Short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF) were also assessed, using a paired-pulse paradigm. Compared to conventional M1 c-tDCS, corticospinal excitability significantly increased following c-tDCSUHCDS of M1-DLPFC and M1-V1 for up to 24 h (P = 0.001). Significant increases in ICF were observed following c-tDCSUHCDS of M1-DLPFC (P = 0.005) and M1-V1 (P = 0.002). Compared to baseline values, ICF and SICI increased significantly at T60 (P < 0.001) and T24 h (P < 0.001) following the concurrent c-tDCS of M1 and V1. Sham c-tDCSUHCDS did not induce any significant alteration. The corticospinal excitability increase was mainly accompanied by ICF increase, which indirectly indicates the activity of glutamergic mechanisms. The findings may help us to more fully understand the brain function and develop future motor learning studies. No significant excitability change induced by sham c-tDCSUHCDS suggests that there is no placebo effect associated with this new tDCS technique.
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Affiliation(s)
- Bita Vaseghi
- Department of Physiotherapy, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Building B, Frankston 3199, Melbourne, Vic., Australia
| | - Maryam Zoghi
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Vic., Australia
| | - Shapour Jaberzadeh
- Department of Physiotherapy, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Building B, Frankston 3199, Melbourne, Vic., Australia
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Ongoing cumulative effects of single TMS pulses on corticospinal excitability: An intra- and inter-block investigation. Clin Neurophysiol 2016; 127:621-628. [DOI: 10.1016/j.clinph.2015.03.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 03/04/2015] [Accepted: 03/09/2015] [Indexed: 11/20/2022]
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Schambra HM, Ogden RT, Martínez-Hernández IE, Lin X, Chang YB, Rahman A, Edwards DJ, Krakauer JW. The reliability of repeated TMS measures in older adults and in patients with subacute and chronic stroke. Front Cell Neurosci 2015; 9:335. [PMID: 26388729 PMCID: PMC4555014 DOI: 10.3389/fncel.2015.00335] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 08/10/2015] [Indexed: 11/21/2022] Open
Abstract
The reliability of transcranial magnetic stimulation (TMS) measures in healthy older adults and stroke patients has been insufficiently characterized. We determined whether common TMS measures could reliably evaluate change in individuals and in groups using the smallest detectable change (SDC), or could tell subjects apart using the intraclass correlation coefficient (ICC). We used a single-rater test-retest design in older healthy, subacute stroke, and chronic stroke subjects. At twice daily sessions on two consecutive days, we recorded resting motor threshold, test stimulus intensity, recruitment curves, short-interval intracortical inhibition, and facilitation, and long-interval intracortical inhibition. Using variances estimated from a random effects model, we calculated the SDC and ICC for each TMS measure. For all TMS measures in all groups, SDCs for single subjects were large; only with modest group sizes did the SDCs become low. Thus, while these TMS measures cannot be reliably used as a biomarker to detect individual change, they can reliably detect change exceeding measurement noise in moderate-sized groups. For several of the TMS measures, ICCs were universally high, suggesting that they can reliably discriminate between subjects. TMS measures should be used based on their reliability in particular contexts. More work establishing their validity, responsiveness, and clinical relevance is still needed.
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Affiliation(s)
- Heidi M Schambra
- Motor Performance Laboratory, Department of Rehabilitation and Regenerative Medicine, Columbia University New York, NY, USA
| | - R Todd Ogden
- Department of Biostatistics, Columbia University New York, NY, USA
| | - Isis E Martínez-Hernández
- Motor Performance Laboratory, Department of Rehabilitation and Regenerative Medicine, Columbia University New York, NY, USA
| | - Xuejing Lin
- Department of Biostatistics, Columbia University New York, NY, USA
| | - Y Brenda Chang
- Department of Biostatistics, Columbia University New York, NY, USA
| | - Asif Rahman
- Neural Engineering Group, Department of Biomedical Engineering, City College of New York NY, USA
| | - Dylan J Edwards
- Non-Invasive Brain Stimulation and Human Motor Control Laboratory, Burke-Cornell Medical Research Institute White Plains, NY, USA
| | - John W Krakauer
- Brain, Learning, Animation, and Movement Lab, Department of Neurology, Johns Hopkins University Baltimore, MD, USA
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O'Leary TJ, Morris MG, Collett J, Howells K. Reliability of single and paired-pulse transcranial magnetic stimulation in the vastus lateralis muscle. Muscle Nerve 2015; 52:605-15. [PMID: 25620286 DOI: 10.1002/mus.24584] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 01/14/2015] [Accepted: 01/19/2015] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Transcranial magnetic stimulation (TMS) is an important tool to examine neurological pathologies, movement disorders, and central nervous system responses to exercise, fatigue, and training. The reliability has not been examined in a functional locomotor knee extensor muscle. METHODS Within- (n = 10) and between-day (n = 16) reliability of single and paired-paired pulse TMS was examined from the active vastus lateralis. RESULTS Motor evoked potential amplitude and cortical silent period duration showed good within- and between-day reliability (intraclass correlation coefficient [ICC] ≥ 0.82). Short- and long-interval intracortical inhibition (SICI and LICI, respectively) demonstrated good within-day reliability (ICC ≥ 0.84). SICI had moderate to good between-day reliability (ICC ≥ 0.67), but LICI was not repeatable (ICC = 0.47). Intracortical facilitation showed moderate to good within-day reliability (ICC ≥ 0.73) but poor to moderate reliability between days (ICC ≥ 0.51). CONCLUSIONS TMS can reliably assess cortical function in a knee extensor muscle. This may be useful to examine neurological disorders that affect locomotion.
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Affiliation(s)
- Thomas J O'Leary
- Department of Sport and Health Sciences, Oxford Brookes University, Gipsy Lane, Oxford, Oxon, OX3 0BP, United Kingdom
| | - Martyn G Morris
- Department of Sport and Health Sciences, Oxford Brookes University, Gipsy Lane, Oxford, Oxon, OX3 0BP, United Kingdom
| | - Johnny Collett
- Department of Sport and Health Sciences, Oxford Brookes University, Gipsy Lane, Oxford, Oxon, OX3 0BP, United Kingdom
| | - Ken Howells
- Department of Sport and Health Sciences, Oxford Brookes University, Gipsy Lane, Oxford, Oxon, OX3 0BP, United Kingdom
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Cavaleri R, Schabrun SM, Chipchase LS. Determining the number of stimuli required to reliably assess corticomotor excitability and primary motor cortical representations using transcranial magnetic stimulation (TMS): a protocol for a systematic review and meta-analysis. Syst Rev 2015; 4:107. [PMID: 26260518 PMCID: PMC4531429 DOI: 10.1186/s13643-015-0095-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 07/24/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) is a technique that can be used to assess corticospinal plasticity. Current TMS practices involve the administration of multiple stimuli over target areas of the participant's scalp. However, these procedures require 1 to 2 h per assessment. Decreasing the number of stimuli delivered during TMS assessments would improve time efficiency and decrease participant demand. Thus, the aim of this review is to determine the number of TMS stimuli required to reliably measure (1) corticomotor excitability to a target muscle at a single cranial site and (2) the topography of the primary motor cortical representation for a target muscle across multiple cranial sites (termed 'mapping'). METHODS/DESIGN A systematic review and meta-analysis will be conducted. Electronic databases will be searched using pre-determined search terms to identify relevant studies and evaluate the studies for inclusion and risks of bias. Two independent reviewers will extract the data. Any disagreements will be resolved by a third reviewer. Studies employing single-pulse TMS to measure (1) corticomotor excitability at a single cranial site or (2) the topographic cortical organisation of a target muscle across a number of cranial sites, published before May 2015, will be included if they meet the eligibility criteria. Outcomes will include motor-evoked potential amplitude, map volume, number of active map sites, location of the map centre of gravity, and distance between the centres of gravity of the target muscle and one or more neighbouring muscles. DISCUSSION To our knowledge, this review will be the first to systematically explore the number of TMS stimuli required to reliably measure both corticomotor excitability and the topography of primary motor cortical representations. This research has the capacity to improve the efficiency of TMS, decrease participant demand, and facilitate the use of TMS as an outcome measurement tool in clinical populations. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015024579.
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Affiliation(s)
- Rocco Cavaleri
- Brain Rehabilitation and Neuroplasticity Unit, School of Science and Health, The University of Western Sydney, Sydney, New South Wales, 2560, Australia.
| | - Siobhan M Schabrun
- Brain Rehabilitation and Neuroplasticity Unit, School of Science and Health, The University of Western Sydney, Sydney, New South Wales, 2560, Australia.
| | - Lucy S Chipchase
- Brain Rehabilitation and Neuroplasticity Unit, School of Science and Health, The University of Western Sydney, Sydney, New South Wales, 2560, Australia.
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Zhang L, Li D, Wan H, Hao S, Wang S, Wu Z, Zhang J, Qiao H, Li P, Wang M, Su D, Schumacher M, Liu S. Hypoglossal-facial nerve 'side'-to-side neurorrhaphy using a predegenerated nerve autograft for facial palsy after removal of acoustic tumours at the cerebellopontine angle. J Neurol Neurosurg Psychiatry 2015; 86:865-72. [PMID: 25228445 DOI: 10.1136/jnnp-2014-308465] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 08/28/2014] [Indexed: 01/10/2023]
Abstract
TRIAL DESIGN Hypoglossal-facial nerve (HN-FN) neurorrhaphy is a method commonly used to treat facial palsy when the proximal stump of the injured FN is unavailable. Since the classic HN-FN neurorrhaphy method that needs to section the injured FN is not suitable for incomplete facial palsy, we investigated a modified method that consists of HN-FN 'side'-to-side neurorrhaphy, retaining the remaining or spontaneously regenerated FN axons while preserving hemihypoglossal function. METHODS To improve axonal regeneration, we used for the first time a predegenerated sural autograft for performing HN-FN 'side'-to-side neurorrhaphy followed by postoperative facial exercise. We treated 12 patients who had experienced FN injury for 1-18 months as a result of acoustic tumour removal. All patients experienced facial grade V-VI paralysis according to the House-Brackmann scale, but their FN was anatomically preserved. No spontaneous facial reinnervation was detected before repair. RESULTS Although we did not perform fresh nerve grafts and HN-FN 'side'-to-end neurorrhaphy as controls for ethical reasons, the reparative outcomes after nerve reconstruction were remarkable: functional improvements were detected as soon as 3 months after repair, House-Brackmann grade II or III FN functions were achieved in five and four patients, respectively, and there were no apparent signs of synkinesis. The three patients who experienced less satisfactory outcomes had exhibited facial palsy for more than 1 year accompanied by muscle atrophy, consistent with a need for rapid surgical intervention. CONCLUSIONS Based on fundamental concepts and our experimental results, this new surgical method represents a major advance in the rehabilitation of FN injury. TRIAL REGISTRATION NUMBER JS2013-001-02.
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Affiliation(s)
- Liwei Zhang
- Department of Neurosurgery and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dezhi Li
- Department of Neurosurgery and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hong Wan
- Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China
| | - Shuyu Hao
- Department of Neurosurgery and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shiwei Wang
- Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China
| | - Zhen Wu
- Department of Neurosurgery and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Junting Zhang
- Department of Neurosurgery and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hui Qiao
- Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China
| | - Ping Li
- Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China
| | - Mingran Wang
- Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China
| | - Diya Su
- Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China
| | | | - Song Liu
- Department of Neurosurgery and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China UMR 788, INSERM and Université Paris-Sud, Le Kremlin-Bicêtre, France
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Sankarasubramanian V, Roelle SM, Bonnett CE, Janini D, Varnerin NM, Cunningham DA, Sharma JS, Potter-Baker KA, Wang X, Yue GH, Plow EB. Reproducibility of transcranial magnetic stimulation metrics in the study of proximal upper limb muscles. J Electromyogr Kinesiol 2015; 25:754-64. [PMID: 26111434 DOI: 10.1016/j.jelekin.2015.05.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 05/11/2015] [Accepted: 05/29/2015] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Reproducibility of transcranial magnetic stimulation (TMS) metrics is essential in accurately tracking recovery and disease. However, majority of evidence pertains to reproducibility of metrics for distal upper limb muscles. We investigate for the first time, reliability of corticospinal physiology for a large proximal muscle - the biceps brachii and relate how varying statistical analyses can influence interpretations. METHODS 14 young right-handed healthy participants completed two sessions assessing resting motor threshold (RMT), motor evoked potentials (MEPs), motor map and intra-cortical inhibition (ICI) from the left biceps brachii. Analyses included paired t-tests, Pearson's, intra-class (ICC) and concordance correlation coefficients (CCC) and Bland-Altman plots. RESULTS Unlike paired t-tests, ICC, CCC and Pearson's were >0.6 indicating good reliability for RMTs, MEP intensities and locations of map; however values were <0.3 for MEP responses and ICI. CONCLUSIONS Corticospinal physiology, defining excitability and output in terms of intensity of the TMS device, and spatial loci are the most reliable metrics for the biceps. MEPs and variables based on MEPs are less reliable since biceps receives fewer cortico-motor-neuronal projections. Statistical tests of agreement and associations are more powerful reliability indices than inferential tests. SIGNIFICANCE Reliable metrics of proximal muscles when translated to a larger number of participants would serve to sensitively track and prognosticate function in neurological disorders such as stroke where proximal recovery precedes distal.
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Affiliation(s)
| | - Sarah M Roelle
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, United States
| | - Corin E Bonnett
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, United States
| | - Daniel Janini
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, United States
| | - Nicole M Varnerin
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, United States
| | - David A Cunningham
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, United States
| | - Jennifer S Sharma
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, United States
| | - Kelsey A Potter-Baker
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, United States
| | - Xiaofeng Wang
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, United States
| | - Guang H Yue
- Human Performance and Engineering Research, Kessler Foundation, West Orange, NJ, United States
| | - Ela B Plow
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, United States; Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH, United States; Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, United States.
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Intrasession Reliability of Single and Paired Pulse TMS Evoked From the Biceps Brachii Representation of the Human Motor Cortex. Brain Stimul 2015; 8:660-1. [DOI: 10.1016/j.brs.2015.01.402] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 01/12/2015] [Accepted: 01/13/2015] [Indexed: 11/20/2022] Open
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Excitability of the infraspinatus, but not the middle deltoid, is affected by shoulder elevation angle. Exp Brain Res 2015; 233:1837-43. [DOI: 10.1007/s00221-015-4255-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 03/11/2015] [Indexed: 11/26/2022]
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Fractional anisotropy in corpus callosum is associated with facilitation of motor representation during ipsilateral hand movements. PLoS One 2014; 9:e104218. [PMID: 25118828 PMCID: PMC4131905 DOI: 10.1371/journal.pone.0104218] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 07/10/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Coactivation of primary motor cortex ipsilateral to a unilateral movement (M1(ipsilateral)) has been observed, and the magnitude of activation is influenced by the contracting muscles. It has been suggested that the microstructural integrity of the callosal motor fibers (CMFs) connecting M1 regions may reflect the observed response. However, the association between the structural connectivity of CMFs and functional changes in M1(ipsilateral) remains unclear. The purpose of this study was to investigate the relationship between functional changes within M1(ipsilateral) during unilateral arm or leg movements and the microstructure of the CMFs connecting both homotopic representations (arm or leg). METHODS Transcranial magnetic stimulation was used to assess changes in motor evoked potentials (MEP) in an arm muscle during unilateral movements compared to rest in fifteen healthy adults. Functional magnetic resonance imaging was then used to identify regions of M1 associated with either arm or leg movements. Diffusion-weighted imaging data was acquired to generate CMFs for arm and leg areas using the areas of activation from the functional imaging as seed masks. Individual values of regional fractional anisotropy (FA) of arm and leg CMFs was then calculated by examining the overlap between CMFs and a standard atlas of corpus callosum. RESULTS The change in the MEP was significantly larger in the arm movement compared to the leg movement. Additionally, regression analysis revealed that FA in the arm CMFs was positively correlated with the change in MEP during arm movement, whereas a negative correlation was observed during the leg movement. However, there was no significant relationship between FA in the leg CMF and the change in MEP during the movements. CONCLUSIONS These findings suggest that individual differences in interhemispheric structural connectivity may be used to explain a homologous muscle-dominant effect within M1(ipsilateral) hand representation during unilateral movement with topographical specificity.
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Liu H, Au-Yeung SSY. Reliability of transcranial magnetic stimulation induced corticomotor excitability measurements for a hand muscle in healthy and chronic stroke subjects. J Neurol Sci 2014; 341:105-9. [PMID: 24792099 DOI: 10.1016/j.jns.2014.04.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 04/07/2014] [Accepted: 04/08/2014] [Indexed: 11/30/2022]
Abstract
Transcranial magnetic stimulation (TMS) has been used to evaluate neuroplastic changes in the brain in clinical trials. The purpose of this study was to establish the test-retest reliability of 4 TMS measures of corticomotor excitability - (1) resting motor threshold, (2) slope of input-output curve, (3) peak motor evoked potential amplitude, and (4) cortical silent period duration for the corticospinal projections to the first dorsal interosseous of the contralateral hand. Fourteen healthy subjects (mean age 27.4 years) and 27 subjects with stroke-induced upper limb hemiparesis (mean age 61.3 years) completed 2 repeated sessions of assessment of 1 week apart. Good to excellent test-retest reliability of the TMS measurements was confirmed in the stroke subjects for both hemispheres with the ICC ≥ 0.88. Measurement reliability was good (ICC ≥ 0.75) for the 4 outcome measures in healthy subjects. Contrary to the similarity in standard error of measurements in both hemispheres for outcome measures (1) to (3) in the stroke subjects, that of the cortical silent period duration was larger in magnitude in the lesioned hemisphere. The test-retest reliability coefficients determined for the four corticomotor excitability measurements allowed the estimation of 95% minimal detectable changes of these outcome variables for the respective subject group in future clinical trials.
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Affiliation(s)
- Hao Liu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong; Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, China
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Lewis GN, Signal N, Taylor D. Reliability of lower limb motor evoked potentials in stroke and healthy populations: How many responses are needed? Clin Neurophysiol 2014; 125:748-754. [DOI: 10.1016/j.clinph.2013.07.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 07/08/2013] [Accepted: 07/11/2013] [Indexed: 10/26/2022]
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Choi TW, Jang SG, Yang SN, Pyun SB. Factors affecting the motor evoked potential responsiveness and parameters in patients with supratentorial stroke. Ann Rehabil Med 2014; 38:19-28. [PMID: 24639922 PMCID: PMC3953359 DOI: 10.5535/arm.2014.38.1.19] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 09/24/2013] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the factors which affect the motor evoked potential (MEP) responsiveness and parameters and to find the correlation between the function of the upper extremities and the combined study of MEP with a diffusion tensor tractography (DTT) in patients with stroke. METHODS A retrospective study design was used by analyzing medical records and neuroimaging data of 70 stroke patients who underwent a MEP test between June 2011 and March 2013. MEP parameters which were recorded from the abductor pollicis brevis muscle were the resting motor threshold, latency, amplitude, and their ratios. Functional variables, Brunnstrom stage of hand, upper extremity subscore of Fugl-Meyer assessment, Manual Function Test, and the Korean version of Modified Barthel Index (K-MBI) were collected together with the biographical and neurological data. The DTT parameters were fiber number, fractional anisotropy value and their ratios of affected corticospinal tract. The data were compared between two groups, built up according to the presence (MEP-P) or absence (MEP-N) of MEP on the affected hand. RESULTS Functional and DTT variables were significantly different between MEP-P and MEP-N groups (p<0.001). Among the MEP-P group, the amplitude ratio (unaffected/affected) was significantly correlated with the Brunnstrom stage of hand (r=-0.427, p=0.013), K-MBI (r=-0.380, p=0.029) and the time post-onset (r=-0.401, p=0.021). The functional scores were significantly better when both MEP response and DTT were present and decreased if one or both of the two studies were absent. CONCLUSION This study indicates MEP responsiveness and amplitude ratio are significantly associated with the upper extremity function and the activities of daily living performance, and the combined study of MEP and DTT provides useful information.
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Affiliation(s)
- Tae Woong Choi
- Department of Physical Medicine and Rehabilitation, Korea University Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seung Gul Jang
- Department of Physical Medicine and Rehabilitation, Korea University Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seung Nam Yang
- Department of Physical Medicine and Rehabilitation, Korea University Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sung-Bom Pyun
- Department of Physical Medicine and Rehabilitation, Korea University Hospital, Korea University College of Medicine, Seoul, Korea
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