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She X, Nix KC, Cline CC, Qi W, Tugin S, He Z, Baumer FM. Stability of transcranial magnetic stimulation electroencephalogram evoked potentials in pediatric epilepsy. Sci Rep 2024; 14:9045. [PMID: 38641629 PMCID: PMC11031596 DOI: 10.1038/s41598-024-59468-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/11/2024] [Indexed: 04/21/2024] Open
Abstract
Transcranial magnetic stimulation paired with electroencephalography (TMS-EEG) can measure local excitability and functional connectivity. To address trial-to-trial variability, responses to multiple TMS pulses are recorded to obtain an average TMS evoked potential (TEP). Balancing adequate data acquisition to establish stable TEPs with feasible experimental duration is critical when applying TMS-EEG to clinical populations. Here we aim to investigate the minimum number of pulses (MNP) required to achieve stable TEPs in children with epilepsy. Eighteen children with Self-Limited Epilepsy with Centrotemporal Spikes, a common epilepsy arising from the motor cortices, underwent multiple 100-pulse blocks of TMS to both motor cortices over two days. TMS was applied at 120% of resting motor threshold (rMT) up to a maximum of 100% maximum stimulator output. The average of all 100 pulses was used as a "gold-standard" TEP to which we compared "candidate" TEPs obtained by averaging subsets of pulses. We defined TEP stability as the MNP needed to achieve a concordance correlation coefficient of 80% between the candidate and "gold-standard" TEP. We additionally assessed whether experimental or clinical factors affected TEP stability. Results show that stable TEPs can be derived from fewer than 100 pulses, a number typically used for designing TMS-EEG experiments. The early segment (15-80 ms) of the TEP was less stable than the later segment (80-350 ms). Global mean field amplitude derived from all channels was less stable than local TEP derived from channels overlying the stimulated site. TEP stability did not differ depending on stimulated hemisphere, block order, or antiseizure medication use, but was greater in older children. Stimulation administered with an intensity above the rMT yielded more stable local TEPs. Studies of TMS-EEG in pediatrics have been limited by the complexity of experimental set-up and time course. This study serves as a critical starting point, demonstrating the feasibility of designing efficient TMS-EEG studies that use a relatively small number of pulses to study pediatric epilepsy and potentially other pediatric groups.
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Affiliation(s)
- Xiwei She
- Department of Neurology, Stanford University, Stanford, CA, USA
| | - Kerry C Nix
- Department of Neurology, Stanford University, Stanford, CA, USA
| | - Christopher C Cline
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Wendy Qi
- Department of Neurology, Stanford University, Stanford, CA, USA
| | - Sergei Tugin
- Department of Neurology, Stanford University, Stanford, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Zihuai He
- Department of Neurology, Stanford University, Stanford, CA, USA
| | - Fiona M Baumer
- Department of Neurology, Stanford University, Stanford, CA, USA.
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Schoisswohl S, Kanig C, Osnabruegge M, Agboada D, Langguth B, Rethwilm R, Hebel T, Abdelnaim MA, Mack W, Seiberl W, Kuder M, Schecklmann M. Monitoring Changes in TMS-Evoked EEG and EMG Activity During 1 Hz rTMS of the Healthy Motor Cortex. eNeuro 2024; 11:ENEURO.0309-23.2024. [PMID: 38565296 PMCID: PMC11015949 DOI: 10.1523/eneuro.0309-23.2024] [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: 08/18/2023] [Revised: 12/13/2023] [Accepted: 01/08/2024] [Indexed: 04/04/2024] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation technique capable of inducing neuroplasticity as measured by changes in peripheral muscle electromyography (EMG) or electroencephalography (EEG) from pre-to-post stimulation. However, temporal courses of neuromodulation during ongoing rTMS are unclear. Monitoring cortical dynamics via TMS-evoked responses using EMG (motor-evoked potentials; MEPs) and EEG (transcranial-evoked potentials; TEPs) during rTMS might provide further essential insights into its mode of action - temporal course of potential modulations. The objective of this study was to first evaluate the validity of online rTMS-EEG and rTMS-EMG analyses, and second to scrutinize the temporal changes of TEPs and MEPs during rTMS. As rTMS is subject to high inter-individual effect variability, we aimed for single-subject analyses of EEG changes during rTMS. Ten healthy human participants were stimulated with 1,000 pulses of 1 Hz rTMS over the motor cortex, while EEG and EMG were recorded continuously. Validity of MEPs and TEPs measured during rTMS was assessed in sensor and source space. Electrophysiological changes during rTMS were evaluated with model fitting approaches on a group- and single-subject level. TEPs and MEPs appearance during rTMS was consistent with past findings of single pulse experiments. Heterogeneous temporal progressions, fluctuations or saturation effects of brain activity were observed during rTMS depending on the TEP component. Overall, global brain activity increased over the course of stimulation. Single-subject analysis revealed inter-individual temporal courses of global brain activity. The present findings are in favor of dose-response considerations and attempts in personalization of rTMS protocols.
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Affiliation(s)
- Stefan Schoisswohl
- Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany
- Department of Human Sciences, Institute of Psychology, Universität der Bundeswehr München, 85579 Neubiberg, Germany
| | - Carolina Kanig
- Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany
- Department of Human Sciences, Institute of Psychology, Universität der Bundeswehr München, 85579 Neubiberg, Germany
| | - Mirja Osnabruegge
- Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany
- Department of Human Sciences, Institute of Psychology, Universität der Bundeswehr München, 85579 Neubiberg, Germany
| | - Desmond Agboada
- Department of Human Sciences, Institute of Psychology, Universität der Bundeswehr München, 85579 Neubiberg, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany
| | - Roman Rethwilm
- Department of Human Sciences, Institute of Sport Science, Universität der Bundeswehr München, 85579 Neubiberg, Germany
| | - Tobias Hebel
- Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany
| | - Mohamed A Abdelnaim
- Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany
| | - Wolfgang Mack
- Department of Human Sciences, Institute of Psychology, Universität der Bundeswehr München, 85579 Neubiberg, Germany
| | - Wolfgang Seiberl
- Department of Human Sciences, Institute of Sport Science, Universität der Bundeswehr München, 85579 Neubiberg, Germany
| | - Manuel Kuder
- Department of Electrical Engineering, Universität der Bundeswehr München, 85579 Neubiberg, Germany
| | - Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany
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Oberman LM, Benussi A. Transcranial Magnetic Stimulation Across the Lifespan: Impact of Developmental and Degenerative Processes. Biol Psychiatry 2024; 95:581-591. [PMID: 37517703 PMCID: PMC10823041 DOI: 10.1016/j.biopsych.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/01/2023]
Abstract
Transcranial magnetic stimulation (TMS) has emerged as a pivotal noninvasive technique for investigating cortical excitability and plasticity across the lifespan, offering valuable insights into neurodevelopmental and neurodegenerative processes. In this review, we explore the impact of TMS applications on our understanding of normal development, healthy aging, neurodevelopmental disorders, and adult-onset neurodegenerative diseases. By presenting key developmental milestones and age-related changes in TMS measures, we provide a foundation for understanding the maturation of neurotransmitter systems and the trajectory of cognitive functions throughout the lifespan. Building on this foundation, the paper delves into the pathophysiology of neurodevelopmental disorders, including autism spectrum disorder, attention-deficit/hyperactivity disorder, Tourette syndrome, and adolescent depression. Highlighting recent findings on altered neurotransmitter circuits and dysfunctional cortical plasticity, we underscore the potential of TMS as a valuable tool for unraveling underlying mechanisms and informing future therapeutic interventions. We also review the emerging role of TMS in investigating and treating the most common adult-onset neurodegenerative disorders and late-onset depression. By outlining the therapeutic applications of noninvasive brain stimulation techniques in these disorders, we discuss the growing body of evidence supporting their use as therapeutic tools for symptom management and potentially slowing disease progression. The insights gained from TMS studies have advanced our understanding of the underlying mechanisms in both healthy and disease states, ultimately informing the development of more targeted diagnostic and therapeutic strategies for a wide range of neuropsychiatric conditions.
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Affiliation(s)
- Lindsay M Oberman
- National Institute of Mental Health Intramural Research Program, National Institutes of Health, Bethesda, Maryland
| | - Alberto Benussi
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
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Farzan F. Transcranial Magnetic Stimulation-Electroencephalography for Biomarker Discovery in Psychiatry. Biol Psychiatry 2024; 95:564-580. [PMID: 38142721 DOI: 10.1016/j.biopsych.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 12/08/2023] [Accepted: 12/15/2023] [Indexed: 12/26/2023]
Abstract
Current diagnosis and treatment of psychiatric illnesses are still based on behavioral observations and self-reports, commonly leading to prolonged untreated illness. Biological markers (biomarkers) may offer an opportunity to revolutionize clinical psychiatry practice by helping provide faster and potentially more effective therapies. Transcranial magnetic stimulation concurrent with electroencephalography (TMS-EEG) is a noninvasive brain mapping methodology that can assess the functions and dynamics of specific brain circuitries in awake humans and aid in biomarker discovery. This article provides an overview of TMS-EEG-based biomarkers that may hold potential in psychiatry. The methodological readiness of the TMS-EEG approach and steps in the validation of TMS-EEG biomarkers for clinical utility are discussed. Biomarker discovery with TMS-EEG is in the early stages, and several validation steps are still required before clinical implementations are realized. Thus far, TMS-EEG predictors of response to magnetic brain stimulation treatments in particular have shown promise for translation to clinical practice. Larger-scale studies can confirm validation followed by biomarker-informed trials to assess added value compared to existing practice.
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Affiliation(s)
- Faranak Farzan
- eBrain Lab, School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
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Wang M, Wang T, Li X, Yuan Y. Low-intensity ultrasound stimulation modulates cortical neurovascular coupling in an attention deficit hyperactivity disorder rat model. Cereb Cortex 2023; 33:11646-11655. [PMID: 37874023 DOI: 10.1093/cercor/bhad398] [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: 06/21/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/25/2023] Open
Abstract
Attention deficit hyperactivity disorder is accompanied by changes in cranial nerve function and cerebral blood flow (CBF). Low-intensity ultrasound stimulation can modulate brain neural activity in attention deficit hyperactivity disorder. However, to date, the modulatory effects of low-intensity ultrasound stimulation on CBF and neurovascular coupling in attention deficit hyperactivity disorder have not been reported. To address this question, Sprague-Dawley, Wistar-Kyoto, and spontaneously hypertensive (attention deficit hyperactivity disorder (ADHD) rat model) rats were divided into the control and low-intensity ultrasound stimulation (LIUS) groups. Cortical electrical stimulation was used to induce cortical excitability in different types of rats, and a penetrable laser speckle contrast imaging (LSCI) system and electrodes were used to evaluate the electrical stimulation-induced CBF, cortical excitability, and neurovascular coupling in free-moving rats. The CBF, cortical excitability, and neurovascular coupling (NVC) under cortical electrical stimulation in the attention deficit hyperactivity disorder rats were significantly different from those in the Sprague-Dawley and Wistar-Kyoto rats. We also found that low-intensity ultrasound stimulation significantly interfered with the cortical excitability and neurovascular coupling induced by cortical electrical stimulation in rats with attention deficit hyperactivity disorder. Our findings suggest that neurovascular coupling is a potential biomarker for attention deficit hyperactivity disorder. Furthermore, low-intensity ultrasound stimulation can improve abnormal brain function in attention deficit hyperactivity disorder and lay a research foundation for its application in the clinical treatment of attention deficit hyperactivity disorder.
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Affiliation(s)
- Mengran Wang
- School of Electrical Engineering, Yanshan University, Qinhuangdao 066004, China
- Key Laboratory of Intelligent Rehabilitation and Neuromodulation of Hebei Province, Yanshan University, Qinhuangdao 066004, China
| | - Teng Wang
- School of Electrical Engineering, Yanshan University, Qinhuangdao 066004, China
- Key Laboratory of Intelligent Rehabilitation and Neuromodulation of Hebei Province, Yanshan University, Qinhuangdao 066004, China
| | - Xin Li
- School of Electrical Engineering, Yanshan University, Qinhuangdao 066004, China
| | - Yi Yuan
- School of Electrical Engineering, Yanshan University, Qinhuangdao 066004, China
- Key Laboratory of Intelligent Rehabilitation and Neuromodulation of Hebei Province, Yanshan University, Qinhuangdao 066004, China
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Wang M, Wang T, Ji H, Yan J, Wang X, Zhang X, Li X, Yuan Y. Modulation effect of non-invasive transcranial ultrasound stimulation in an ADHD rat model. J Neural Eng 2023; 20. [PMID: 36599159 DOI: 10.1088/1741-2552/acb014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/04/2023] [Indexed: 01/05/2023]
Abstract
Objective.Previous studies have demonstrated that transcranial ultrasound stimulation (TUS) with noninvasive high penetration and high spatial resolution has an effective neuromodulatory effect on neurological diseases. Attention deficit hyperactivity disorder (ADHD) is a persistent neurodevelopmental disorder that severely affects child health. However, the neuromodulatory effects of TUS on ADHD have not been reported to date. This study aimed to investigate the neuromodulatory effects of TUS on ADHD.Approach.TUS was performed in ADHD model rats for two consecutive weeks, and the behavioral improvement of ADHD, neural activity of ADHD from neurons and neural oscillation levels, and the plasma membrane dopamine transporter and brain-derived neurotrophic factor (BDNF) in the brains of ADHD rats were evaluated.Main results.TUS can improve cognitive behavior in ADHD rats, and TUS altered neuronal firing patterns and modulated the relative power and sample entropy of local field potentials in the ADHD rats. In addition, TUS can also enhance BDNF expression in the brain tissues.Significance. TUS has an effective neuromodulatory effect on ADHD and thus has the potential to clinically improve cognitive dysfunction in ADHD.
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Affiliation(s)
- Mengran Wang
- School of Electrical Engineering, Yanshan University, Qinhuangdao 066004, People's Republic of China
| | - Teng Wang
- School of Electrical Engineering, Yanshan University, Qinhuangdao 066004, People's Republic of China.,Key Laboratory of Intelligent Rehabilitation and Neuromodulation of Hebei Province, Yanshan University, Qinhuangdao 066004, People's Republic of China
| | - Hui Ji
- Department of Neurology, Hebei Key Laboratory of Vascular Homeostasis and Hebei Collaborative Innovation Center for Cardio-cerebrovascular Disease, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, People's Republic of China
| | - Jiaqing Yan
- College of Electrical and Control Engineering, North China University of Technology, Beijing 100041, People's Republic of China
| | - Xingran Wang
- School of Electrical Engineering, Yanshan University, Qinhuangdao 066004, People's Republic of China.,Key Laboratory of Intelligent Rehabilitation and Neuromodulation of Hebei Province, Yanshan University, Qinhuangdao 066004, People's Republic of China
| | - Xiangjian Zhang
- Department of Neurology, Hebei Key Laboratory of Vascular Homeostasis and Hebei Collaborative Innovation Center for Cardio-cerebrovascular Disease, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, People's Republic of China
| | - Xin Li
- School of Electrical Engineering, Yanshan University, Qinhuangdao 066004, People's Republic of China
| | - Yi Yuan
- School of Electrical Engineering, Yanshan University, Qinhuangdao 066004, People's Republic of China.,Key Laboratory of Intelligent Rehabilitation and Neuromodulation of Hebei Province, Yanshan University, Qinhuangdao 066004, People's Republic of China
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Chowdhury NS, Chang WJ, Millard SK, Skippen P, Bilska K, Seminowicz DA, Schabrun SM. The Effect of Acute and Sustained Pain on Corticomotor Excitability: A Systematic Review and Meta-Analysis of Group and Individual Level Data. THE JOURNAL OF PAIN 2022; 23:1680-1696. [PMID: 35605763 DOI: 10.1016/j.jpain.2022.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/12/2022] [Accepted: 04/15/2022] [Indexed: 06/15/2023]
Abstract
Pain alters motor function. This is supported by studies showing reduced corticomotor excitability in response to experimental pain lasting <90 minutes. Whether similar reductions in corticomotor excitability are present with pain of longer durations or whether alterations in corticomotor excitability are associated with pain severity is unknown. Here we evaluated the evidence for altered corticomotor excitability in response to experimental pain of differing durations in healthy individuals. Databases were systematically searched for eligible studies. Measures of corticomotor excitability and pain were extracted. Meta-analyses were performed to examine: (1) group-level effect of pain on corticomotor excitability, and (2) individual-level associations between corticomotor excitability and pain severity. 49 studies were included. Corticomotor excitability was reduced when pain lasted milliseconds-seconds (hedges g's = -1.26 to -1.55) and minutes-hours (g's = -0.55 to -0.9). When pain lasted minutes-hours, a greater reduction in corticomotor excitability was associated with lower pain severity (g = -0.24). For pain lasting days-weeks, there were no group level effects (g = -0.18 to 0.27). However, a greater reduction in corticomotor excitability was associated with higher pain severity (g = 0.229). In otherwise healthy individuals, suppression of corticomotor excitability may be a beneficial short-term strategy with long-term consequences. PERSPECTIVE: This systematic review synthesised the evidence for altered corticomotor excitability in response to experimentally induced pain. Reduced corticomotor excitability was associated with lower acute pain severity but higher sustained pain severity, suggesting suppression of corticomotor excitability may be a beneficial short-term adaptation with long-term consequences.
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Affiliation(s)
- Nahian S Chowdhury
- Center for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia
| | - Wei-Ju Chang
- Center for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Samantha K Millard
- Center for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia
| | - Patrick Skippen
- Center for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Katarzyna Bilska
- Center for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia
| | - David A Seminowicz
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, Maryland; Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, Maryland
| | - Siobhan M Schabrun
- Center for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia.
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Jivraj J, Ameis SH. Is Repetitive Transcranial Magnetic Stimulation (rTMS) Ready for Clinical Use as a Treatment Tool for Mental Health Targets in Children and Youth? JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2022; 31:93-99. [PMID: 35614951 PMCID: PMC9084373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 03/10/2022] [Indexed: 06/15/2023]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation tool with potential for broad application in individuals with neuropsychiatric conditions. As in adults, most rTMS research in youth has focused on treatment-resistant depression. A limited number of rTMS studies have also been conducted in children and youth with primary diagnoses of Autism Spectrum Disorder (ASD), Attention-Deficit/Hyperactivity Disorder (ADHD) or Tourette's syndrome. Across the available rTMS literature, rTMS appears to be well tolerated with few adverse effects reported when applied to child and youth research samples. However, the potential efficacy of rTMS treatment for a variety of targets in children and youth remains unclear, due in part to limitations of the current literature, including studies using diverse protocols, potential for bias in existing clinical trial designs, variability in the research samples, and the use of heterogenous outcome measures. While rTMS is unlikely to take the place of more accessible treatments (e.g., psychopharmacological, psychosocial, psychotherapeutic), rTMS may provide a valuable alternative treatment option, particularly for those individuals where conventional treatments are inaccessible, poorly tolerated, or ineffective. A more robust body of well-designed, controlled trials, is needed in order to clarify rTMS treatment efficacy across relevant neuropsychiatric conditions, optimize treatment protocols, and meet the critical need for novel mental health interventions in children and youth.
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Affiliation(s)
- Jamil Jivraj
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Stephanie H Ameis
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario
- The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario
- Centre for Brain and Mental Health, Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario
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9
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TMS-EEG responses across the lifespan: Measurement, methods for characterisation and identified responses. J Neurosci Methods 2022; 366:109430. [PMID: 34856320 DOI: 10.1016/j.jneumeth.2021.109430] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/02/2021] [Accepted: 11/25/2021] [Indexed: 01/29/2023]
Abstract
The combination of transcranial magnetic stimulation (TMS) and electroencephalography (EEG) allows probing of the neurophysiology of any neocortical brain area in vivo with millisecond accuracy. TMS-EEG is particularly unique compared with other available neurophysiological methods, as it can measure the state and dynamics of excitatory and inhibitory systems separately. Because of these capabilities, TMS-EEG responses are sensitive to the brain state, and the responses are influenced by brain maturation and ageing, making TMS-EEG a suitable method to study age-specific pathophysiology. In this review, we outline the TMS-EEG measurement procedure, the existing methods used for characterising TMS-EEG responses and the challenges associated with identifying the responses. We also summarise the findings thus far on how TMS-EEG responses change across the lifespan and the TMS-EEG features that separate typical and atypical brain maturation and ageing. Finally, we give an overview of the gaps in current knowledge to provide directions for future studies.
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10
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Maidan I, Zifman N, Hausdorff JM, Giladi N, Levy-Lamdan O, Mirelman A. A multimodal approach using TMS and EEG reveals neurophysiological changes in Parkinson's disease. Parkinsonism Relat Disord 2021; 89:28-33. [PMID: 34216938 DOI: 10.1016/j.parkreldis.2021.06.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Alterations in large scale neural networks leading to neurophysiological changes have been described in Parkinson's disease (PD). The combination of transcranial magnetic stimulation (TMS) and electroencephalography (EEG) has been suggested as a promising tool to identify and quantify neurophysiological mechanisms. The aim of this study was to investigate specific changes in electrical brain activity in response to stimulation of four brain areas in patients with PD. METHODS 21 healthy controls and 32 patients with PD underwent a combined TMS-EEG assessment that included stimulation of four brain areas: left M1, right M1, left dorso-lateral prefrontal cortex (DLPFC), and right DLPFC. Six measures were calculated to characterize the TMS evoked potentials (TEP) using EEG: (1) wave form adherence (WFA), (2) late phase deflection (LPD), (3) early phase deflection (EPD), (4) short-term plasticity (STP), (5) inter-trial adherence, and (6) connectivity between right and left M1 and DLPFC. A Linear mixed-model was used to compare these measures between groups and areas stimulated. RESULTS Patients with PD showed lower WFA (p = 0.052), lower EPD (p = 0.009), lower inter-trial adherence (p < 0.001), and lower connectivity between homologs areas (p = 0.050), compared to healthy controls. LPD and STP measures were not different between the groups. In addition, lower inter-trial adherence correlated with longer disease duration (r = -0.355, p = 0.050). CONCLUSIONS Our findings provide evidence to various alterations in neurophysiological measures in patients with PD. The higher cortical excitability along with increased variability and lower widespread of the evoked potentials in PD can elucidate different aspects related to the pathophysiology of the disease.
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Affiliation(s)
- Inbal Maidan
- Laboratory of Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Department of Neurology, Sackler School of Medicine, Tel Aviv University, Israel.
| | - Noa Zifman
- QuantalX Neuroscience, 'Beer-Yaacov', Israel
| | - Jeffrey M Hausdorff
- Laboratory of Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Israel; Rush Alzheimer's Disease Center and Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Nir Giladi
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Department of Neurology, Sackler School of Medicine, Tel Aviv University, Israel
| | | | - Anat Mirelman
- Laboratory of Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Department of Neurology, Sackler School of Medicine, Tel Aviv University, Israel
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11
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Cao KX, Ma ML, Wang CZ, Iqbal J, Si JJ, Xue YX, Yang JL. TMS-EEG: An emerging tool to study the neurophysiologic biomarkers of psychiatric disorders. Neuropharmacology 2021; 197:108574. [PMID: 33894219 DOI: 10.1016/j.neuropharm.2021.108574] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 03/08/2021] [Accepted: 04/15/2021] [Indexed: 01/02/2023]
Abstract
The etiology of psychiatric disorders remains largely unknown. The exploration of the neurobiological mechanisms of mental illness helps improve diagnostic efficacy and develop new therapies. This review focuses on the application of concurrent transcranial magnetic stimulation and electroencephalography (TMS-EEG) in various mental diseases, including major depressive disorder, bipolar disorder, schizophrenia, autism spectrum disorder, attention-deficit/hyperactivity disorder, substance use disorder, and insomnia. First, we summarize the commonly used protocols and output measures of TMS-EEG; then, we review the literature exploring the alterations in neural patterns, particularly cortical excitability, plasticity, and connectivity alterations, and studies that predict treatment responses and clinical states in mental disorders using TMS-EEG. Finally, we discuss the potential mechanisms underlying TMS-EEG in establishing biomarkers for psychiatric disorders and future research directions.
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Affiliation(s)
- Ke-Xin Cao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Mao-Liang Ma
- Department of Clinical Psychology, Tianjin Medical University General Hospital Airport Site, Tianjin, China
| | - Cheng-Zhan Wang
- Department of Clinical Psychology, Tianjin Medical University General Hospital, Tianjin, China
| | - Javed Iqbal
- School of Psychology, Shaanxi Normal University and Key Laboratory for Behavior and Cognitive Neuroscience of Shaanxi Province, Xi'an, China
| | - Ji-Jian Si
- Department of Clinical Psychology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yan-Xue Xue
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China; Key Laboratory for Neuroscience of Ministry of Education and Neuroscience, National Health and Family Planning Commission, Peking University, Beijing, China.
| | - Jian-Li Yang
- Department of Clinical Psychology, Tianjin Medical University General Hospital, Tianjin, China.
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12
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Goldsworthy MR, Hordacre B, Rothwell JC, Ridding MC. Effects of rTMS on the brain: is there value in variability? Cortex 2021; 139:43-59. [PMID: 33827037 DOI: 10.1016/j.cortex.2021.02.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/16/2021] [Accepted: 02/26/2021] [Indexed: 01/02/2023]
Abstract
The ability of repetitive transcranial magnetic stimulation (rTMS) to non-invasively induce neuroplasticity in the human cortex has opened exciting possibilities for its application in both basic and clinical research. Changes in the amplitude of motor evoked potentials (MEPs) elicited by single-pulse transcranial magnetic stimulation has so far provided a convenient model for exploring the neurophysiology of rTMS effects on the brain, influencing the ways in which these stimulation protocols have been applied therapeutically. However, a growing number of studies have reported large inter-individual variability in the mean MEP response to rTMS, raising legitimate questions about the usefulness of this model for guiding therapy. Although the increasing application of different neuroimaging approaches has made it possible to probe rTMS-induced neuroplasticity outside the motor cortex to measure changes in neural activity that impact other aspects of human behaviour, the high variability of rTMS effects on these measurements remains an important issue for the field to address. In this review, we seek to move away from the conventional facilitation/inhibition dichotomy that permeates much of the rTMS literature, presenting a non-standard approach for measuring rTMS-induced neuroplasticity. We consider the evidence that rTMS is able to modulate an individual's moment-to-moment variability of neural activity, and whether this could have implications for guiding the therapeutic application of rTMS.
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Affiliation(s)
- Mitchell R Goldsworthy
- Lifespan Human Neurophysiology Group, Adelaide Medical School, University of Adelaide, Adelaide, Australia; Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Discipline of Psychiatry, Adelaide Medical School, University of Adelaide, Adelaide, Australia.
| | - Brenton Hordacre
- Innovation, IMPlementation and Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide, Australia
| | - John C Rothwell
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Michael C Ridding
- Innovation, IMPlementation and Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide, Australia
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13
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Jarczok TA, Roebruck F, Pokorny L, Biermann L, Roessner V, Klein C, Bender S. Single-Pulse TMS to the Temporo-Occipital and Dorsolateral Prefrontal Cortex Evokes Lateralized Long Latency EEG Responses at the Stimulation Site. Front Neurosci 2021; 15:616667. [PMID: 33790732 PMCID: PMC8006291 DOI: 10.3389/fnins.2021.616667] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/12/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Transcranial magnetic stimulation (TMS)–evoked potentials (TEPs) allow for probing cortical functions in health and pathology. However, there is uncertainty whether long-latency TMS-evoked potentials reflect functioning of the targeted cortical area. It has been suggested that components such as the TMS-evoked N100 are stereotypical and related to nonspecific sensory processes rather than transcranial effects of the changing magnetic field. In contrast, TEPs that vary according to the targeted brain region and are systematically lateralized toward the stimulated hemisphere can be considered to reflect activity in the stimulated brain region resulting from transcranial electromagnetic induction. Methods TMS with concurrent 64-channel electroencephalography (EEG) was sequentially performed in homologous areas of both hemispheres. One sample of healthy adults received TMS to the dorsolateral prefrontal cortex; another sample received TMS to the temporo-occipital cortex. We analyzed late negative TEP deflections corresponding to the N100 component in motor cortex stimulation. Results TEP topography varied according to the stimulation target site. Long-latency negative TEP deflections were systematically lateralized (higher in ipsilateral compared to contralateral electrodes) in electrodes over the stimulated brain region. A calculation that removes evoked components that are not systematically lateralized relative to the stimulated hemisphere revealed negative maxima located around the respective target sites. Conclusion TEPs contain long-latency negative components that are lateralized toward the stimulated hemisphere and have their topographic maxima at the respective stimulation sites. They can be differentiated from co-occurring components that are invariable across different stimulation sites (probably reflecting coactivation of peripheral sensory afferences) according to their spatiotemporal patterns. Lateralized long-latency TEP components located at the stimulation site likely reflect activity evoked in the targeted cortex region by direct transcranial effects and are therefore suitable for assessing cortical functions.
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Affiliation(s)
- Tomasz A Jarczok
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Friederike Roebruck
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lena Pokorny
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lea Biermann
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Christoph Klein
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Clinic for Child and Adolescent Psychiatry, Medical Faculty, University of Freiburg, Freiburg, Germany.,Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stephan Bender
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Roos D, Biermann L, Jarczok TA, Bender S. Local Differences in Cortical Excitability - A Systematic Mapping Study of the TMS-Evoked N100 Component. Front Neurosci 2021; 15:623692. [PMID: 33732105 PMCID: PMC7959732 DOI: 10.3389/fnins.2021.623692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/19/2021] [Indexed: 11/13/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) with simultaneous electroencephalography applied to the primary motor cortex provides two parameters for cortical excitability: motor evoked potentials (MEPs) and TMS-evoked potentials (TEPs). This study aimed to evaluate the effects of systematic coil shifts on both the TEP N100 component and MEPs in addition to the relationship between both parameters. In 12 healthy adults, the center of a standardized grid was fixed above the hot spot of the target muscle of the left primary motor cortex. Twelve additional positions were arranged in a quadratic grid with positions between 5 and 10 mm from the hot spot. At each of the 13 positions, TMS single pulses were applied. The topographical maximum of the resulting N100 was located ipsilateral and slightly posterior to the stimulation site. A source analysis revealed an equivalent dipole localized more deeply than standard motor cortex coordinates that could not be explained by a single seeded primary motor cortex dipole. The N100 topography might not only reflect primary motor cortex activation, but also sum activation of the surrounding cortex. N100 amplitude and latency decreased significantly during stimulation anterior-medial to the hot spot although MEP amplitudes were smaller at all other stimulation sites. Therefore, N100 amplitudes might be suitable for detecting differences in local cortical excitability. The N100 topography, with its maximum located posterior to the stimulation site, possibly depends on both anatomical characteristics of the stimulated cortex and differences in local excitability of surrounding cortical areas. The less excitable anterior cortex might contribute to a more posterior maximum. There was no correlation between N100 and MEP amplitudes, but a single-trial analysis revealed a trend toward larger N100 amplitudes in trials with larger MEPs. Thus, functionally efficient cortical excitation might increase the probability of higher N100 amplitudes, but TEPs are also generated in the absence of MEPs.
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Affiliation(s)
- Daniela Roos
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lea Biermann
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Tomasz A Jarczok
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephan Bender
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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15
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Goldsworthy MR, Rogasch NC, Ballinger S, Graetz L, Van Dam JM, Harris R, Yu S, Pitcher JB, Baune BT, Ridding MC. Age-related decline of neuroplasticity to intermittent theta burst stimulation of the lateral prefrontal cortex and its relationship with late-life memory performance. Clin Neurophysiol 2020; 131:2181-2191. [DOI: 10.1016/j.clinph.2020.06.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 04/09/2020] [Accepted: 06/01/2020] [Indexed: 01/08/2023]
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16
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Cortical Excitability, Synaptic Plasticity, and Cognition in Benign Epilepsy With Centrotemporal Spikes: A Pilot TMS-EMG-EEG Study. J Clin Neurophysiol 2020; 37:170-180. [PMID: 32142025 DOI: 10.1097/wnp.0000000000000662] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Children with benign epilepsy with centrotemporal spikes have rare seizures emerging from the motor cortex, which they outgrow in adolescence, and additionally may have language deficits of unclear etiology. We piloted the use of transcranial magnetic stimulation paired with EMG and EEG (TMS-EMG, TMS-EEG) to test the hypotheses that net cortical excitability decreases with age and that use-dependent plasticity predicts learning. METHODS We assessed language and motor learning in 14 right-handed children with benign epilepsy with centrotemporal spikes. We quantified two TMS metrics of left motor cortex excitability: the resting motor threshold (measure of neuronal membrane excitability) and amplitude of the N100-evoked potential (an EEG measure of GABAergic tone). To test plasticity, we applied 1 Hz repetitive TMS to the motor cortex to induce long-term depression-like changes in EMG- and EEG-evoked potentials. RESULTS Children with benign epilepsy with centrotemporal spikes tolerate TMS; no seizures were provoked. Resting motor threshold decreases with age but is elevated above maximal stimulator output for half the group. N100 amplitude decreases with age after controlling for resting motor threshold. Motor cortex plasticity correlates significantly with language learning and at a trend level with motor learning. CONCLUSIONS Transcranial magnetic stimulation is safe and feasible for children with benign epilepsy with centrotemporal spikes, and TMS-EEG provides more reliable outcome measures than TMS-EMG in this group because many children have unmeasurably high resting motor thresholds. Net cortical excitability decreases with age, and motor cortex plasticity predicts not only motor learning but also language learning, suggesting a mechanism by which motor cortex seizures may interact with language development.
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17
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Määttä S, Säisänen L, Kallioniemi E, Lakka TA, Lintu N, Haapala EA, Koskenkorva P, Niskanen E, Ferreri F, Könönen M. Maturation changes the excitability and effective connectivity of the frontal lobe: A developmental TMS-EEG study. Hum Brain Mapp 2019; 40:2320-2335. [PMID: 30648321 DOI: 10.1002/hbm.24525] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 12/07/2018] [Accepted: 01/07/2019] [Indexed: 12/22/2022] Open
Abstract
The combination of transcranial magnetic stimulation with simultaneous electroencephalography (TMS-EEG) offers direct neurophysiological insight into excitability and connectivity within neural circuits. However, there have been few developmental TMS-EEG studies to date, and they all have focused on primary motor cortex stimulation. In the present study, we used navigated high-density TMS-EEG to investigate the maturation of the superior frontal cortex (dorsal premotor cortex [PMd]), which is involved in a broad range of motor and cognitive functions known to develop with age. We demonstrated that reactivity to frontal cortex TMS decreases with development. We also showed that although frontal cortex TMS elicits an equally complex TEP waveform in all age groups, the statistically significant between-group differences in the topography of the TMS-evoked peaks and differences in current density maps suggest changes in effective connectivity of the right PMd with maturation. More generally, our results indicate that direct study of the brain's excitability and effective connectivity via TMS-EEG co-registration can also be applied to pediatric populations outside the primary motor cortex, and may provide useful information for developmental studies and studies on developmental neuropsychiatric disorders.
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Affiliation(s)
- Sara Määttä
- Faculty of Health Sciences, Department of Clinical Neurophysiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio Campus, Finland.,Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland
| | - Laura Säisänen
- Faculty of Health Sciences, Department of Clinical Neurophysiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio Campus, Finland.,Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland
| | - Elisa Kallioniemi
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas
| | - Timo A Lakka
- Faculty of Health Sciences, Institute of Biomedicine, University of Eastern Finland, Kuopio Campus, Finland.,Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland.,Foundation for Research in Health Exercise and Nutrition, Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
| | - Niina Lintu
- Faculty of Health Sciences, Institute of Biomedicine, University of Eastern Finland, Kuopio Campus, Finland
| | - Eero A Haapala
- Faculty of Health Sciences, Institute of Biomedicine, University of Eastern Finland, Kuopio Campus, Finland.,Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Päivi Koskenkorva
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Eini Niskanen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Florinda Ferreri
- Department of Neuroscience, Unit of Neurology and Neurophysiology, University of Padua, Padua, Italy
| | - Mervi Könönen
- Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland.,Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
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18
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Tremblay S, Rogasch NC, Premoli I, Blumberger DM, Casarotto S, Chen R, Di Lazzaro V, Farzan F, Ferrarelli F, Fitzgerald PB, Hui J, Ilmoniemi RJ, Kimiskidis VK, Kugiumtzis D, Lioumis P, Pascual-Leone A, Pellicciari MC, Rajji T, Thut G, Zomorrodi R, Ziemann U, Daskalakis ZJ. Clinical utility and prospective of TMS–EEG. Clin Neurophysiol 2019; 130:802-844. [DOI: 10.1016/j.clinph.2019.01.001] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 01/07/2019] [Accepted: 01/08/2019] [Indexed: 12/15/2022]
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19
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Abd Elghany SE, Al Ashkar DS, El-Barbary AM, El Khouly RM, Aboelhawa MA, Nada DW, Darwish NF, Hussein MS, Rageh ES, Abo-Zaid MH, Eldesoky IF, Afifi S. Regenerative injection therapy and repetitive transcranial magnetic stimulation in primary fibromyalgia treatment: A comparative study. J Back Musculoskelet Rehabil 2019; 32:55-62. [PMID: 30149440 DOI: 10.3233/bmr-181127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study compared the effectiveness of regenerative injection therapy (RIT), i.e. prolotherapy, and repetitive transcranial magnetic stimulation (rTMS) in the treatment of fibromyalgia syndrome. PATIENTS AND METHODS This study included 120 female, age-matched fibromyalgia patients. All patients underwent a clinical examination, pain assessment by VAS, assessment of tender points, psychiatric and functional assessment using the Beck Depression Inventory (BDI), Fibromyalgia Impact Questionnaire Revised (RFIQ), and measurement of cortical auditory evoked potentials CAEPs elicited at 1000 Hz. Patients were divided into two equal groups; Group 1 received prolotherapy three times, two weeks apart, and Group 2 received rTMS sessions every other day for one month. Assessment was performed before treatment, immediately after treatment, and one month later. RESULTS A significant improvement of pain measured by the mean score of VAS was remarked in Group 1 compared to Group 2 immediately after treatment and one month later. There was statistically significant difference of mean scores for the number of tender points in Group 1 compared to Group 2 after treatment and one month later. The patients improved functionally, with a statistically significant difference in mean score of RFIQ, in Group 1 compared to Group 2 one month after treatment. However, there was a significant difference in mean score of BDI in Group 2 compared to Group 1 after treatment and one month later. Further, CAEPs showed better improvement, with a significant difference in Group 2, one month after treatment. CONCLUSION RIT had the advantage in clinical and functional improvement in fibromyalgia patients, while rTMS had better results regarding depression and the cortical component of AEPs. These results might draw attention to the evaluability of a combination of both techniques for a better therapeutic response.
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Affiliation(s)
| | - Doaa S Al Ashkar
- Physical Medicine, Rheumatology and Rehabilitation Department, Tanta University, Tanta, Egypt
| | - Amal M El-Barbary
- Physical Medicine, Rheumatology and Rehabilitation Department, Tanta University, Tanta, Egypt
| | - Radwa M El Khouly
- Physical Medicine, Rheumatology and Rehabilitation Department, Tanta University, Tanta, Egypt
| | - Marwa A Aboelhawa
- Physical Medicine, Rheumatology and Rehabilitation Department, Tanta University, Tanta, Egypt
| | - Doaa W Nada
- Physical Medicine, Rheumatology and Rehabilitation Department, Tanta University, Tanta, Egypt
| | - Nivine F Darwish
- Physical Medicine, Rheumatology and Rehabilitation Department, Tanta University, Tanta, Egypt
| | - Manal S Hussein
- Physical Medicine, Rheumatology and Rehabilitation Department, Tanta University, Tanta, Egypt
| | - El Sayed Rageh
- Physical Medicine, Rheumatology and Rehabilitation Department, Tanta University, Tanta, Egypt
| | - Mohamed H Abo-Zaid
- Physical Medicine, Rheumatology and Rehabilitation Department, Tanta University, Tanta, Egypt
| | - Islam F Eldesoky
- Neurology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Samah Afifi
- Neurology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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20
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Finisguerra A, Borgatti R, Urgesi C. Non-invasive Brain Stimulation for the Rehabilitation of Children and Adolescents With Neurodevelopmental Disorders: A Systematic Review. Front Psychol 2019; 10:135. [PMID: 30787895 PMCID: PMC6373438 DOI: 10.3389/fpsyg.2019.00135] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 01/15/2019] [Indexed: 12/18/2022] Open
Abstract
In the last years, there has been a growing interest in the application of different non-invasive brain stimulation techniques to induce neuroplasticity and to modulate cognition and behavior in adults. Very recently, different attempts have been made to induce functional plastic changes also in pediatric populations. Importantly, not only sensorimotor processing, but also higher-level functions have been addressed, with the aim to boost rehabilitation in different neurodevelopmental disorders. However, efficacy and safety of using these techniques in pediatric population is still debated. The current article aims to review the non-invasive brain stimulation studies conducted in pediatric populations using Transcranial Magnetic Stimulation or transcranial Direct Current Stimulation. Specifically, the available proofs concerning the efficacy and safety of these techniques on Autism Spectrum Disorder, Attention-deficit/hyperactivity disorder, Dyslexia, Tourette syndrome, and tic disorders are systematically reviewed and discussed. The article also aims to provide an overview about other possible applications of these and other stimulation techniques for rehabilitative purposes in children and adolescents.
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Affiliation(s)
| | - Renato Borgatti
- Child Neuropsychiatry and Neurorehabilitation Unit, Scientific Institute, IRCCS E. Medea, Bosisio Parini, Italy
| | - Cosimo Urgesi
- Scientific Institute, IRCCS E. Medea, Pasian di Prato, Udine, Italy.,Child Neuropsychiatry and Neurorehabilitation Unit, Scientific Institute, IRCCS E. Medea, Bosisio Parini, Italy.,Laboratory of Cognitive Neuroscience, Department of Languages, Literatures, Communication, Education and Society, University of Udine, Udine, Italy
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21
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TMS evoked N100 reflects local GABA and glutamate balance. Brain Stimul 2018; 11:1071-1079. [PMID: 29759942 DOI: 10.1016/j.brs.2018.05.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 03/11/2017] [Accepted: 05/02/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Animal studies suggest that synchronized electrical activities in the brain are regulated by the primary inhibitory and excitatory neurotransmitters gamma-aminobutyric acid (GABA) and glutamate, respectively. Identifying direct evidence that this same basic chemical-electrical neuroscience principle operates in the human brains is critical for translation of neuroscience to pathological research. OBJECTIVE/HYPOTHESIS We hypothesize that the background neurochemical concentrations may affect the cortical excitability probed by transcranial magnetic stimulation (TMS). METHODS We used TMS with simultaneous evoked potential recording to probe the cortical excitability and determined how background frontal cortical GABA and glutamate levels measured using magnetic resonance spectroscopy (MRS) modulate frontal electrical activities. RESULTS We found that TMS-evoked N100 reflects a balance between GABA-inhibitory and glutamate-excitatory levels. About 46% of individual variances in frontal N100 can be explained by their glutamate/GABA ratio (r = -0.68, p = 0.001). Both glutamate (r = -0.51, p = 0.019) and GABA (r = 0.55, p = 0.01) significantly contributed to this relationship but in opposite directions. CONCLUSION The current finding encourages additional mechanistic studies to develop TMS evoked N100 as a potential electrophysiological biomarker for translating the known inhibitory GABAergic vs. excitatory glutamatergic chemical-electrical principle from animal brain studies to human brain studies.
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22
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Moliadze V, Lyzhko E, Schmanke T, Andreas S, Freitag CM, Siniatchkin M. 1 mA cathodal tDCS shows excitatory effects in children and adolescents: Insights from TMS evoked N100 potential. Brain Res Bull 2018; 140:43-51. [PMID: 29625151 DOI: 10.1016/j.brainresbull.2018.03.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 03/19/2018] [Accepted: 03/30/2018] [Indexed: 11/16/2022]
Abstract
In children and adolescents, 1 mA transcranial direct current stimulation (tDCS) may cause "paradoxical" effects compared with adults: both 1 mA anodal and cathodal tDCS increase amplitude of the motor evoked potential (MEP) as revealed by a single pulse transcranial magnetic stimulation (TMS) of the motor cortex. Here, EEG based evoked potentials induced by a single pulse TMS, particularly the N100 component as marker of motor cortex inhibition, were investigated in order to explain effects of tDCS on the developing brain. In nineteen children and adolescents (11-16 years old), 1 mA anodal, cathodal, or sham tDCS was applied over the left primary motor cortex for 10 min. The TMS-evoked N100 was measured by 64-channel EEG before and immediately after stimulation as well as every 10 min after tDCS for one hour. 1 mA Cathodal stimulation suppressed the N100 amplitude compared with sham stimulation. In contrast, anodal tDCS did not modify the N100 amplitude. It seems likely that the increase of the motor cortex activity under cathodal tDCS in children and adolescents as shown in previous studies can be attributed to a reduce inhibition. Based on TMS evoked N100, the study provides an insight into neuromodulatory effects of tDCS on the developing brain.
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Affiliation(s)
- Vera Moliadze
- Institute of Medical Psychology and Medical Sociology, University Hospital of Schleswig-Holstein (UKSH), Campus Kiel, Christian-Albrechts-University Kiel, Preußerstrasse 1-9, 24105, Kiel, Germany; Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy Goethe-University, Deutschordenstr, 50, D-60528, Frankfurt am Main, Germany.
| | - Ekaterina Lyzhko
- Institute of Medical Psychology and Medical Sociology, University Hospital of Schleswig-Holstein (UKSH), Campus Kiel, Christian-Albrechts-University Kiel, Preußerstrasse 1-9, 24105, Kiel, Germany
| | - Till Schmanke
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy Goethe-University, Deutschordenstr, 50, D-60528, Frankfurt am Main, Germany
| | - Saskia Andreas
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy Goethe-University, Deutschordenstr, 50, D-60528, Frankfurt am Main, Germany
| | - Christine M Freitag
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy Goethe-University, Deutschordenstr, 50, D-60528, Frankfurt am Main, Germany
| | - Michael Siniatchkin
- Institute of Medical Psychology and Medical Sociology, University Hospital of Schleswig-Holstein (UKSH), Campus Kiel, Christian-Albrechts-University Kiel, Preußerstrasse 1-9, 24105, Kiel, Germany; Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy Goethe-University, Deutschordenstr, 50, D-60528, Frankfurt am Main, Germany
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23
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Kaskie RE, Ferrarelli F. Investigating the neurobiology of schizophrenia and other major psychiatric disorders with Transcranial Magnetic Stimulation. Schizophr Res 2018; 192:30-38. [PMID: 28478887 DOI: 10.1016/j.schres.2017.04.045] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 04/24/2017] [Accepted: 04/26/2017] [Indexed: 11/16/2022]
Abstract
Characterizing the neurobiology of schizophrenia and other major psychiatric disorders is one of the main challenges of the current research in psychiatry. The availability of Transcranial Magnetic Stimulation (TMS) allows to directly probe virtually any cortical areas, thus providing a unique way to assess the neurophysiological properties of cortical neurons. This article presents a review of studies employing TMS in combination with Motor Evoked Potentials (TMS/MEPs) and high density Electroencephalogram (TMS/hd-EEG) in schizophrenia and other major psychiatric disorders. Studies were identified by conducting a PubMed search using the following search item: "transcranial magnetic stimulation and (Schizophrenia or OCD or MDD or ADHD)". Studies that utilized TMS/MEP and/or TMS/hd-EEG measures to characterize cortical excitability, inhibition, oscillatory activity, and/or connectivity in psychiatric patients were selected. Across disorders, patients displayed a pattern of reduced cortical inhibition, and to a lesser extent increased excitability, in the motor cortex, which was most consistently established in Schizophrenia. Furthermore, psychiatric patients showed abnormalities in a number of TMS-evoked EEG oscillations, which was most prominent in the prefrontal cortex of Schizophrenia relative to healthy comparison subjects. Overall, results from this review point to significant impairments in cortical excitability, inhibition, and oscillatory activity, especially in frontal areas, in several major psychiatric disorders. Building on these findings, future studies employing TMS-based experimental paradigms may help elucidating the neurobiology of these psychiatric disorders, and may assess the contribution of TMS-related measures in monitoring and possibly maximizing the effectiveness of treatment interventions in psychiatric populations.
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Beck RW, Laugharne J, Laugharne R, Woldman W, McLean B, Mastropasqua C, Jorge R, Shankar R. Abnormal cortical asymmetry as a target for neuromodulation in neuropsychiatric disorders: A narrative review and concept proposal. Neurosci Biobehav Rev 2017; 83:21-31. [PMID: 28958599 DOI: 10.1016/j.neubiorev.2017.09.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 09/17/2017] [Accepted: 09/25/2017] [Indexed: 12/20/2022]
Abstract
Recent advances in knowledge relating to the organization of neural circuitry in the human brain have increased understanding of disorders involving brain circuit asymmetry. These asymmetries, which can be measured and identified utilizing EEG and LORETA analysis techniques, may be a factor in mental disorders. New treatments involving non-invasive brain stimulation (NIBS), including trans-cranial magnetic stimulation, direct current stimulation and vagal nerve stimulation, have emerged in recent years. We propose that EEG identification of circuit asymmetry geometries can direct non-invasive brain stimulation more specifically for treatments of mental disorders. We describe as a narrative review new NIBS therapies that have been developed and delivered, and suggest that they are proving effective in certain patient groups. A brief narrative of influence of classical and operant conditioning of neurofeedback on EEG coherence, phase, abnormalities and Loreta's significance is provided. We also discuss the role of Heart rate variability and biofeedback in influencing EEG co-relates. Clinical evidence is at an early stage, but the basic science evidence and early case studies suggest that this may be a promising new modality for treating mental disorders and merits further research.
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Affiliation(s)
- Randy W Beck
- Institute of Functional Neuroscience, Perth, Australia
| | - Jonathan Laugharne
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia
| | - Richard Laugharne
- Cornwall Partnership NHS Foundation Trust and Hon, University of Exeter Medical School, Exeter, United Kingdom
| | - Wessel Woldman
- Living Systems Institute, University of Exeter, Exeter EX4 4QD, United Kingdom; Wellcome Trust Centre for Biomedical Modelling and Analysis, University of Exeter, Exeter EX4 4QD, United Kingdom; EPSRC Centre for Predictive Modelling in Healthcare, University of Exeter, Exeter EX4 4QD, United Kingdom
| | - Brendan McLean
- The Royal Cornwall Hospitals NHS Trust, Treliske, Truro, Cornwall, United Kingdom
| | - Chiara Mastropasqua
- Institute of Functional Neuroscience, Sydney, Australia; Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Via Ardeatina 306, 00179 Rome, Italy
| | - Ricardo Jorge
- Institute of Functional Neuroscience, Perth, Australia
| | - Rohit Shankar
- Cornwall Partnership NHS Foundation Trust, University of Exeter Medical School, Exeter, United Kingdom.
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25
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Määttä S, Könönen M, Kallioniemi E, Lakka T, Lintu N, Lindi V, Ferreri F, Ponzo D, Säisänen L. Development of cortical motor circuits between childhood and adulthood: A navigated TMS-HdEEG study. Hum Brain Mapp 2017; 38:2599-2615. [PMID: 28218489 PMCID: PMC6866783 DOI: 10.1002/hbm.23545] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 02/08/2017] [Accepted: 02/09/2017] [Indexed: 12/18/2022] Open
Abstract
Motor functions improve during childhood and adolescence, but little is still known about the development of cortical motor circuits during early life. To elucidate the neurophysiological hallmarks of motor cortex development, we investigated the differences in motor cortical excitability and connectivity between healthy children, adolescents, and adults by means of navigated suprathreshold motor cortex transcranial magnetic stimulation (TMS) combined with high-density electroencephalography (EEG). We demonstrated that with development, the excitability of the motor system increases, the TMS-evoked EEG waveform increases in complexity, the magnitude of induced activation decreases, and signal spreading increases. Furthermore, the phase of the oscillatory response to TMS becomes less consistent with age. These changes parallel an improvement in manual dexterity and may reflect developmental changes in functional connectivity. Hum Brain Mapp 38:2599-2615, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Sara Määttä
- Department of Clinical NeurophysiologyInstitute of Clinical Medicine, Faculty of Health Sciences, University of Eastern FinlandKuopioFinland
- Department of Clinical NeurophysiologyKuopio University HospitalKuopioFinland
| | - Mervi Könönen
- Department of Clinical NeurophysiologyKuopio University HospitalKuopioFinland
- Department of Clinical RadiologyKuopio University HospitalKuopioFinland
| | - Elisa Kallioniemi
- Department of Clinical NeurophysiologyKuopio University HospitalKuopioFinland
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
| | - Timo Lakka
- Institute of Biomedicine, Faculty of Health Sciences, University of Eastern FinlandKuopioFinland
- Department of Clinical Physiology and Nuclear MedicineKuopio University HospitalKuopioFinland
- Kuopio Research Institute of Exercise MedicineKuopioFinland
| | - Niina Lintu
- Institute of Biomedicine, Faculty of Health Sciences, University of Eastern FinlandKuopioFinland
| | - Virpi Lindi
- Institute of Biomedicine, Faculty of Health Sciences, University of Eastern FinlandKuopioFinland
| | - Florinda Ferreri
- Department of Clinical NeurophysiologyInstitute of Clinical Medicine, Faculty of Health Sciences, University of Eastern FinlandKuopioFinland
- Department of NeurologyUniversity Campus BiomedicoRomeItaly
| | - David Ponzo
- Department of NeurologyUniversity Campus BiomedicoRomeItaly
| | - Laura Säisänen
- Department of Clinical NeurophysiologyInstitute of Clinical Medicine, Faculty of Health Sciences, University of Eastern FinlandKuopioFinland
- Department of Clinical NeurophysiologyKuopio University HospitalKuopioFinland
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26
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Safety of Transcranial Magnetic Stimulation in Children: A Systematic Review of the Literature. Pediatr Neurol 2017; 68:3-17. [PMID: 28216033 PMCID: PMC5346461 DOI: 10.1016/j.pediatrneurol.2016.12.009] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 12/02/2016] [Accepted: 12/19/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Data and best practice recommendations for transcranial magnetic stimulation (TMS) use in adults are largely available. Although there are fewer data in pediatric populations and no published guidelines, its practice in children continues to grow. METHODS We performed a literature search through PubMed to review all TMS studies from 1985 to 2016 involving children and documented any adverse events. Crude risks were calculated per session. RESULTS Following data screening we identified 42 single-pulse and/or paired-pulse TMS studies involving 639 healthy children, 482 children with central nervous system disorders, and 84 children with epilepsy. Adverse events occurred at rates of 3.42%, 5.97%, and 4.55% respective to population and number of sessions. We also report 23 repetitive TMS studies involving 230 central nervous system and 24 children with epilepsy with adverse event rates of 3.78% and 0.0%, respectively. We finally identified three theta-burst stimulation studies involving 90 healthy children, 40 children with central nervous system disorder, and no epileptic children, with adverse event rates of 9.78% and 10.11%, respectively. Three seizures were found to have occurred in central nervous system disorder individuals during repetitive TMS, with a risk of 0.14% per session. There was no significant difference in frequency of adverse events by group (P = 0.988) or modality (P = 0.928). CONCLUSIONS Available data suggest that risk from TMS/theta-burst stimulation in children is similar to adults. We recommend that TMS users in this population follow the most recent adult safety guidelines until sufficient data are available for pediatric specific guidelines. We also encourage continued surveillance through surveys and assessments on a session basis.
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27
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Farzan F, Vernet M, Shafi MMD, Rotenberg A, Daskalakis ZJ, Pascual-Leone A. Characterizing and Modulating Brain Circuitry through Transcranial Magnetic Stimulation Combined with Electroencephalography. Front Neural Circuits 2016; 10:73. [PMID: 27713691 PMCID: PMC5031704 DOI: 10.3389/fncir.2016.00073] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 09/07/2016] [Indexed: 12/18/2022] Open
Abstract
The concurrent combination of transcranial magnetic stimulation (TMS) with electroencephalography (TMS-EEG) is a powerful technology for characterizing and modulating brain networks across developmental, behavioral, and disease states. Given the global initiatives in mapping the human brain, recognition of the utility of this technique is growing across neuroscience disciplines. Importantly, TMS-EEG offers translational biomarkers that can be applied in health and disease, across the lifespan, and in humans and animals, bridging the gap between animal models and human studies. However, to utilize the full potential of TMS-EEG methodology, standardization of TMS-EEG study protocols is needed. In this article, we review the principles of TMS-EEG methodology, factors impacting TMS-EEG outcome measures, and the techniques for preventing and correcting artifacts in TMS-EEG data. To promote the standardization of this technique, we provide comprehensive guides for designing TMS-EEG studies and conducting TMS-EEG experiments. We conclude by reviewing the application of TMS-EEG in basic, cognitive and clinical neurosciences, and evaluate the potential of this emerging technology in brain research.
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Affiliation(s)
- Faranak Farzan
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto Toronto, ON, Canada
| | - Marine Vernet
- Berenson-Allen Center for Non-invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School Boston, MA, USA
| | - Mouhsin M D Shafi
- Berenson-Allen Center for Non-invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School Boston, MA, USA
| | - Alexander Rotenberg
- Berenson-Allen Center for Non-invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical SchoolBoston, MA, USA; Neuromodulation Program, Department of Neurology, Boston Children's Hospital, Harvard Medical SchoolBoston, MA, USA
| | - Zafiris J Daskalakis
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto Toronto, ON, Canada
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Non-invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School Boston, MA, USA
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28
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N100 as a generic cortical electrophysiological marker based on decomposition of TMS-evoked potentials across five anatomic locations. Exp Brain Res 2016; 235:69-81. [PMID: 27628235 DOI: 10.1007/s00221-016-4773-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 09/06/2016] [Indexed: 12/25/2022]
Abstract
N100, the negative peak of electrical response occurring around 100 ms, is present in diverse functional paradigms including auditory, visual, somatic, behavioral and cognitive tasks. We hypothesized that the presence of the N100 across different paradigms may be indicative of a more general property of the cerebral cortex regardless of functional or anatomic specificity. To test this hypothesis, we combined transcranial magnetic stimulation (TMS) and electroencephalography (EEG) to measure cortical excitability by TMS across cortical regions without relying on specific sensory, cognitive or behavioral modalities. The five stimulated regions included left prefrontal, left motor, left primary auditory cortices, the vertex and posterior cerebellum with stimulations performed using supra- and subthreshold intensities. EEG responses produced by TMS stimulation at the five locations all generated N100s that peaked at the vertex. The amplitudes of the N100s elicited by these five diverse cortical origins were statistically not significantly different (all uncorrected p > 0.05). No other EEG response components were found to have this global property of N100. Our findings suggest that anatomy- and modality-specific interpretation of N100 should be carefully evaluated, and N100 by TMS may be used as a biomarker for evaluating local versus general cortical properties across the brain.
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29
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Muldoon SF, Pasqualetti F, Gu S, Cieslak M, Grafton ST, Vettel JM, Bassett DS. Stimulation-Based Control of Dynamic Brain Networks. PLoS Comput Biol 2016; 12:e1005076. [PMID: 27611328 PMCID: PMC5017638 DOI: 10.1371/journal.pcbi.1005076] [Citation(s) in RCA: 154] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 07/23/2016] [Indexed: 11/30/2022] Open
Abstract
The ability to modulate brain states using targeted stimulation is increasingly being employed to treat neurological disorders and to enhance human performance. Despite the growing interest in brain stimulation as a form of neuromodulation, much remains unknown about the network-level impact of these focal perturbations. To study the system wide impact of regional stimulation, we employ a data-driven computational model of nonlinear brain dynamics to systematically explore the effects of targeted stimulation. Validating predictions from network control theory, we uncover the relationship between regional controllability and the focal versus global impact of stimulation, and we relate these findings to differences in the underlying network architecture. Finally, by mapping brain regions to cognitive systems, we observe that the default mode system imparts large global change despite being highly constrained by structural connectivity. This work forms an important step towards the development of personalized stimulation protocols for medical treatment or performance enhancement. Brain stimulation is increasingly used in clinical settings to treat neurological disorders, but much remains unknown about how stimulation to a single brain region impacts large-scale, brain network activity. Using structural neuroimaging scans, we create computational models of brain dynamics for eight participants to explore how structure-function relationships constrain the effect of stimulation to a single region on the brain as a whole. Our results show that network control theory can be used to predict if the effects of stimulation remain focal or spread globally, and structural connectivity differentially constrains the effects of regional stimulation. Additionally, we study how stimulation of different cognitive systems spreads throughout the brain and find that stimulation of regions within the default mode network provide a mechanism to impart large change in overall brain dynamics through a densely connected structural network. By revealing how the stimulation of different brain regions and cognitive systems spreads differently through the brain, we provide a modeling framework to develop stimulation protocols to personalize medical treatments, enable performance enhancements, and facilitate cortical plasticity.
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Affiliation(s)
- Sarah Feldt Muldoon
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- US Army Research Laboratory, Aberdeen Proving Ground, Maryland, United States of America
- Department of Mathematics and Computational and Data-Enabled Science and Engineering Program, University at Buffalo, SUNY, Buffalo, New York, United States of America
| | - Fabio Pasqualetti
- Department of Mechanical Engineering, University of California, Riverside, Riverside, California, United States of America
| | - Shi Gu
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Applied Mathematics and Computational Science Graduate Program, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Matthew Cieslak
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, Santa Barbara, California, United States of America
| | - Scott T. Grafton
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, Santa Barbara, California, United States of America
| | - Jean M. Vettel
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- US Army Research Laboratory, Aberdeen Proving Ground, Maryland, United States of America
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, Santa Barbara, California, United States of America
| | - Danielle S. Bassett
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Department of Electrical and Systems Engineering, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- * E-mail:
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30
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Rubio B, Boes AD, Laganiere S, Rotenberg A, Jeurissen D, Pascual-Leone A. Noninvasive Brain Stimulation in Pediatric Attention-Deficit Hyperactivity Disorder (ADHD): A Review. J Child Neurol 2016; 31:784-96. [PMID: 26661481 PMCID: PMC4833526 DOI: 10.1177/0883073815615672] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 07/10/2015] [Indexed: 01/08/2023]
Abstract
Attention-deficit hyperactivity disorder (ADHD) is one of the most prevalent neurodevelopmental disorders in the pediatric population. The clinical management of ADHD is currently limited by a lack of reliable diagnostic biomarkers and inadequate therapy for a minority of patients who do not respond to standard pharmacotherapy. There is optimism that noninvasive brain stimulation may help to address these limitations. Transcranial magnetic stimulation and transcranial direct current stimulation are 2 methods of noninvasive brain stimulation that modulate cortical excitability and brain network activity. Transcranial magnetic stimulation can be used diagnostically to probe cortical neurophysiology, whereas daily use of repetitive transcranial magnetic stimulation or transcranial direct current stimulation can induce long-lasting and potentially therapeutic changes in targeted networks. In this review, we highlight research showing the potential diagnostic and therapeutic applications of transcranial magnetic stimulation and transcranial direct current stimulation in pediatric ADHD. We also discuss the safety and ethics of using these tools in the pediatric population.
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Affiliation(s)
- Belen Rubio
- Child and Adolescent Psychiatry Department, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain Both are co-primary authors
| | - Aaron D Boes
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA Harvard Medical School, Department of Pediatric Neurology, Massachusetts General Hospital, Boston, MA, USA Both are co-primary authors.
| | - Simon Laganiere
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Alexander Rotenberg
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA Pediatric Neuromodulation Program, Division of Epilepsy and Neurophysiology, Department of Neurology, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA
| | - Danique Jeurissen
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA Department of Vision and Cognition, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA
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31
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Hill AT, Rogasch NC, Fitzgerald PB, Hoy KE. TMS-EEG: A window into the neurophysiological effects of transcranial electrical stimulation in non-motor brain regions. Neurosci Biobehav Rev 2016; 64:175-84. [DOI: 10.1016/j.neubiorev.2016.03.006] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 03/03/2016] [Accepted: 03/04/2016] [Indexed: 01/10/2023]
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32
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Harrington A, Hammond-Tooke GD. Theta Burst Stimulation of the Cerebellum Modifies the TMS-Evoked N100 Potential, a Marker of GABA Inhibition. PLoS One 2015; 10:e0141284. [PMID: 26529225 PMCID: PMC4631469 DOI: 10.1371/journal.pone.0141284] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 10/05/2015] [Indexed: 01/07/2023] Open
Abstract
Theta burst stimulation (TBS) of the cerebellum, a potential therapy for neurological disease, can modulate corticospinal excitability via the dentato-thalamo-cortical pathway, but it is uncertain whether its effects are mediated via inhibitory or facilitatory networks. The aim of this study was to investigate the effects of 30Hz cerebellar TBS on the N100 waveform of the TMS-evoked potential (TEP), a marker of intracortical GABAB-mediated inhibition. 16 healthy participants (aged 18–30 years; 13 right handed and 3 left handed) received 30Hz intermittent TBS (iTBS), continuous TBS (cTBS) or sham stimulation over the right cerebellum, in three separate sessions. The first 8 participants received TBS at a stimulus intensity of 80% of active motor threshold (AMT), while the remainder received 90% of AMT. Motor evoked potentials (MEP) and TEP were recorded before and after each treatment, by stimulating the first dorsal interosseus area of the left motor cortex. Analysis of the 13 right handed participants showed that iTBS at 90% of AMT increased the N100 amplitude compared to sham and cTBS, without significantly altering MEP amplitude. cTBS at 80% of active motor threshold decreased the N100 amplitude and cTBS overall reduced resting MEP amplitude. The study demonstrates effects of 30Hz cerebellar TBS on inhibitory cortical networks that may be useful for treatment of neurological conditions associated with dysfunctional intracortical inhibition.
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Affiliation(s)
| | - Graeme David Hammond-Tooke
- Department of Medicine, University of Otago, Dunedin, New Zealand
- Department of Neurology, Dunedin Hospital, Dunedin, New Zealand
- * E-mail:
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33
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Measuring Brain Stimulation Induced Changes in Cortical Properties Using TMS-EEG. Brain Stimul 2015; 8:1010-20. [DOI: 10.1016/j.brs.2015.07.029] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/10/2015] [Accepted: 07/13/2015] [Indexed: 11/19/2022] Open
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34
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Sato S, Bergmann TO, Borich MR. Opportunities for concurrent transcranial magnetic stimulation and electroencephalography to characterize cortical activity in stroke. Front Hum Neurosci 2015; 9:250. [PMID: 25999839 PMCID: PMC4419720 DOI: 10.3389/fnhum.2015.00250] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 04/17/2015] [Indexed: 11/13/2022] Open
Abstract
Stroke is the leading cause of disability in the United States. Despite the high incidence and mortality of stroke, sensitive and specific brain-based biomarkers predicting persisting disabilities are lacking. Both neuroimaging techniques like electroencephalography (EEG) and non-invasive brain stimulation (NIBS) techniques such as transcranial magnetic stimulation (TMS) have proven useful in predicting prognosis, recovery trajectories and response to rehabilitation in individuals with stroke. We propose, however, that additional synergetic effects can be achieved by simultaneously combining both approaches. Combined TMS-EEG is able to activate discrete cortical regions and directly assess local cortical reactivity and effective connectivity within the network independent of the integrity of descending fiber pathways and also outside the motor system. Studying cortical reactivity and connectivity in patients with stroke TMS-EEG may identify salient neural mechanisms underlying motor disabilities and lead to novel biomarkers of stroke pathophysiology which can then be used to assess, monitor, and refine rehabilitation approaches for individuals with significant disability to improve outcomes and quality of life after stroke.
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Affiliation(s)
- Sumire Sato
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine Atlanta, GA, USA
| | - Til Ole Bergmann
- Institute of Psychology, Christian-Albrechts University Kiel Kiel, Germany
| | - Michael R Borich
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine Atlanta, GA, USA
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35
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Krishnan C, Santos L, Peterson MD, Ehinger M. Safety of noninvasive brain stimulation in children and adolescents. Brain Stimul 2014; 8:76-87. [PMID: 25499471 DOI: 10.1016/j.brs.2014.10.012] [Citation(s) in RCA: 160] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 10/03/2014] [Accepted: 10/21/2014] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Noninvasive brain stimulation (NIBS) techniques such as transcranial magnetic stimulation (TMS) and transcranial current stimulation (tCS) have the potential to mitigate a variety of symptoms associated with neurological and psychiatric conditions, including stroke, cerebral palsy, autism, depression, and Tourette syndrome. While the safety of these modalities has been established in adults, there is a paucity of research assessing the safety of NIBS among children. OBJECTIVE To examine the existing literature regarding the safety of NIBS techniques in children and adolescents with neurologic and neuropsychiatric disorders. METHODS An electronic search was performed on online databases for studies using NIBS in individuals less than 18 years of age. Non-English publications, diagnostic studies, electroconvulsive therapy, single/dual pulse TMS studies, and reviews were excluded. Adverse events reported in the studies were carefully examined and synthesized to understand the safety and tolerability of NIBS among children and adolescents. RESULTS The data from 48 studies involving more than 513 children/adolescents (2.5-17.8 years of age) indicate that the side effects of NIBS were, in general, mild and transient [TMS: headache (11.5%), scalp discomfort (2.5%), twitching (1.2%), mood changes (1.2%), fatigue (0.9%), tinnitus (0.6%); tCS: tingling (11.5%), itching (5.8%), redness (4.7%), scalp discomfort (3.1%)] with relatively few serious adverse events. CONCLUSION Our findings indicate that both repetitive TMS and tCS are safe modalities in children and adolescents with various neurological conditions, especially when safety guidelines are followed. The incidence of adverse events appears to be similar to that observed in adults; however, further studies with longer treatment and follow-up periods are needed to better understand the benefits and tolerance of long-term use of NIBS in children.
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Affiliation(s)
- Chandramouli Krishnan
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Luciana Santos
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Mark D Peterson
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Margaret Ehinger
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, USA
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36
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Casula EP, Tarantino V, Basso D, Arcara G, Marino G, Toffolo GM, Rothwell JC, Bisiacchi PS. Low-frequency rTMS inhibitory effects in the primary motor cortex: Insights from TMS-evoked potentials. Neuroimage 2014; 98:225-32. [DOI: 10.1016/j.neuroimage.2014.04.065] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 04/14/2014] [Accepted: 04/24/2014] [Indexed: 10/25/2022] Open
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37
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Grammer G, Green V, Amin R, Alampay M. The Role of rTMS in the Treatment of Psychiatric Disorders Other than Major Depression. Psychiatr Ann 2014. [DOI: 10.3928/00485713-20140609-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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38
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Sung WH, Wang CP, Chou CL, Chen YC, Chang YC, Tsai PY. Efficacy of Coupling Inhibitory and Facilitatory Repetitive Transcranial Magnetic Stimulation to Enhance Motor Recovery in Hemiplegic Stroke Patients. Stroke 2013; 44:1375-82. [DOI: 10.1161/strokeaha.111.000522] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Although there has been extensive research on the effectiveness of repetitive transcranial magnetic stimulation (rTMS) to improve patients’ motor performance after experiencing chronic stroke, explicit findings on the coupling of different rTMS protocols are meager. We designed this sham-controlled randomized study to investigate the potential for a consecutive suppressive-facilitatory TMS protocol to improve motor outcomes after chronic stroke.
Methods—
Fifty-four chronic hemiplegic stroke patients were allocated across 4 groups to undergo 20 daily sessions of (1) 1 Hz rTMS over the contralesional primary motor cortex (M1) and then intermittent theta burst stimulation over the ipsilesional M1 (group A); (2) contralesional sham stimulation and then ipsilesional real intermittent theta burst stimulation (group B); (3) contralesional real 1 Hz rTMS and then ipsilesional sham stimulation (group C); or (4) bilateral sham-control procedures (group D). We tested cortical excitability and motor activity assessments at the baseline, postpriming rTMS, and postconsequent rTMS periods.
Results—
At post, group A showed greater muscle strength, Fugl-Meyer Assessment (FMA), Wolf Motor Function test, and reaction time improvement in comparison with group B (
P
<0.001≈0.003) and group C (
P
=0.001≈0.003). Correlation analyses in group A revealed a close relation between contralesional map area decrement and Wolf Motor Function test gain (
P
=0.005;
r
=−0.75), and also revealed ipsilesional map area increment and reaction time decrement (
P
=0.02;
r
=−0.87). We detected no such relations in the other 3 groups.
Conclusions—
Our clinical trials established an extended timeframe during which conditioning could be safely continued and produced more favorable outcomes in facilitating motor performance and ameliorating interhemispheric imbalance than those obtained from single-course rTMS modulation alone.
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Affiliation(s)
- Wen-Hsu Sung
- From the Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan (W.-H.S.); Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan (C.-P.W.); Department of Mathematics, Tamkang University; Taipei, Taiwan (Y.-C. Chang); and Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, National Yang-Ming University, School of Medicine, Taipei, Taiwan (C.-L.C., Y.-C. Chen, P.-Y.T.)
| | - Chih-Pin Wang
- From the Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan (W.-H.S.); Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan (C.-P.W.); Department of Mathematics, Tamkang University; Taipei, Taiwan (Y.-C. Chang); and Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, National Yang-Ming University, School of Medicine, Taipei, Taiwan (C.-L.C., Y.-C. Chen, P.-Y.T.)
| | - Chen-Liang Chou
- From the Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan (W.-H.S.); Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan (C.-P.W.); Department of Mathematics, Tamkang University; Taipei, Taiwan (Y.-C. Chang); and Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, National Yang-Ming University, School of Medicine, Taipei, Taiwan (C.-L.C., Y.-C. Chen, P.-Y.T.)
| | - Yi-Cheng Chen
- From the Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan (W.-H.S.); Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan (C.-P.W.); Department of Mathematics, Tamkang University; Taipei, Taiwan (Y.-C. Chang); and Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, National Yang-Ming University, School of Medicine, Taipei, Taiwan (C.-L.C., Y.-C. Chen, P.-Y.T.)
| | - Yue-Cune Chang
- From the Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan (W.-H.S.); Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan (C.-P.W.); Department of Mathematics, Tamkang University; Taipei, Taiwan (Y.-C. Chang); and Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, National Yang-Ming University, School of Medicine, Taipei, Taiwan (C.-L.C., Y.-C. Chen, P.-Y.T.)
| | - Po-Yi Tsai
- From the Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan (W.-H.S.); Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan (C.-P.W.); Department of Mathematics, Tamkang University; Taipei, Taiwan (Y.-C. Chang); and Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, National Yang-Ming University, School of Medicine, Taipei, Taiwan (C.-L.C., Y.-C. Chen, P.-Y.T.)
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