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Hernandez-Pavon JC, Schneider-Garces N, Begnoche JP, Miller LE, Raij T. Targeted Modulation of Human Brain Interregional Effective Connectivity With Spike-Timing Dependent Plasticity. Neuromodulation 2023; 26:745-754. [PMID: 36404214 PMCID: PMC10188658 DOI: 10.1016/j.neurom.2022.10.045] [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: 06/15/2022] [Revised: 09/23/2022] [Accepted: 10/04/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The ability to selectively up- or downregulate interregional brain connectivity would be useful for research and clinical purposes. Toward this aim, cortico-cortical paired associative stimulation (ccPAS) protocols have been developed in which two areas are repeatedly stimulated with a millisecond-level asynchrony. However, ccPAS results in humans using bifocal transcranial magnetic stimulation (TMS) have been variable, and the mechanisms remain unproven. In this study, our goal was to test whether ccPAS mechanism is spike-timing-dependent plasticity (STDP). MATERIALS AND METHODS Eleven healthy participants received ccPAS to the left primary motor cortex (M1) → right M1 with three different asynchronies (5 milliseconds shorter, equal to, or 5 milliseconds longer than the 9-millisecond transcallosal conduction delay) in separate sessions. To observe the neurophysiological effects, single-pulse TMS was delivered to the left M1 before and after ccPAS while cortico-cortical evoked responses were extracted from the contralateral M1 using source-resolved electroencephalography. RESULTS Consistent with STDP mechanisms, the effects on synaptic strengths flipped depending on the asynchrony. Further implicating STDP, control experiments suggested that the effects were unidirectional and selective to the targeted connection. CONCLUSION The results support the idea that ccPAS induces STDP and may selectively up- or downregulate effective connectivity between targeted regions in the human brain.
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Affiliation(s)
- Julio C Hernandez-Pavon
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Center for Brain Stimulation, Shirley Ryan AbilityLab, Chicago, IL, USA; Legs + Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA
| | | | | | - Lee E Miller
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, USA; Limb Motor Control Lab, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Tommi Raij
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Center for Brain Stimulation, Shirley Ryan AbilityLab, Chicago, IL, USA; Department of Neurobiology, Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL, USA.
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Wecht JR, Savage WM, Famodimu GO, Mendez GA, Levine JM, Maher MT, Weir JP, Wecht JM, Carmel JB, Wu YK, Harel NY. Posteroanterior Cervical Transcutaneous Spinal Cord Stimulation: Interactions with Cortical and Peripheral Nerve Stimulation. J Clin Med 2021; 10:jcm10225304. [PMID: 34830584 PMCID: PMC8623612 DOI: 10.3390/jcm10225304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/06/2021] [Accepted: 11/09/2021] [Indexed: 12/27/2022] Open
Abstract
Transcutaneous spinal cord stimulation (TSCS) has demonstrated potential to beneficially modulate spinal cord motor and autonomic circuitry. We are interested in pairing cervical TSCS with other forms of nervous system stimulation to enhance synaptic plasticity in circuits serving hand function. We use a novel configuration for cervical TSCS in which the anode is placed anteriorly over ~C4–C5 and the cathode posteriorly over ~T2–T4. We measured the effects of single pulses of TSCS paired with single pulses of motor cortex or median nerve stimulation timed to arrive at the cervical spinal cord at varying intervals. In 13 participants with and 15 participants without chronic cervical spinal cord injury, we observed that subthreshold TSCS facilitates hand muscle responses to motor cortex stimulation, with a tendency toward greater facilitation when TSCS is timed to arrive at cervical synapses simultaneously or up to 10 milliseconds after cortical stimulus arrival. Single pulses of subthreshold TSCS had no effect on the amplitudes of median H-reflex responses or F-wave responses. These findings support a model in which TSCS paired with appropriately timed cortical stimulation has the potential to facilitate convergent transmission between descending motor circuits, segmental afferents, and spinal motor neurons serving the hand. Studies with larger numbers of participants and repetitively paired cortical and spinal stimulation are needed.
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Affiliation(s)
- Jaclyn R. Wecht
- James J. Peters VA Medical Center, Bronx, NY 10468, USA; (J.R.W.); (W.M.S.); (G.O.F.); (G.A.M.); (J.M.L.); (M.T.M.); (J.M.W.); (Y.-K.W.)
| | - William M. Savage
- James J. Peters VA Medical Center, Bronx, NY 10468, USA; (J.R.W.); (W.M.S.); (G.O.F.); (G.A.M.); (J.M.L.); (M.T.M.); (J.M.W.); (Y.-K.W.)
| | - Grace O. Famodimu
- James J. Peters VA Medical Center, Bronx, NY 10468, USA; (J.R.W.); (W.M.S.); (G.O.F.); (G.A.M.); (J.M.L.); (M.T.M.); (J.M.W.); (Y.-K.W.)
| | - Gregory A. Mendez
- James J. Peters VA Medical Center, Bronx, NY 10468, USA; (J.R.W.); (W.M.S.); (G.O.F.); (G.A.M.); (J.M.L.); (M.T.M.); (J.M.W.); (Y.-K.W.)
| | - Jonah M. Levine
- James J. Peters VA Medical Center, Bronx, NY 10468, USA; (J.R.W.); (W.M.S.); (G.O.F.); (G.A.M.); (J.M.L.); (M.T.M.); (J.M.W.); (Y.-K.W.)
| | - Matthew T. Maher
- James J. Peters VA Medical Center, Bronx, NY 10468, USA; (J.R.W.); (W.M.S.); (G.O.F.); (G.A.M.); (J.M.L.); (M.T.M.); (J.M.W.); (Y.-K.W.)
| | - Joseph P. Weir
- Department of Health, Sport & Exercise Sciences, University of Kansas, Lawrence, KS 66045, USA;
| | - Jill M. Wecht
- James J. Peters VA Medical Center, Bronx, NY 10468, USA; (J.R.W.); (W.M.S.); (G.O.F.); (G.A.M.); (J.M.L.); (M.T.M.); (J.M.W.); (Y.-K.W.)
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jason B. Carmel
- Department of Orthopedic Surgery, Columbia University, New York, NY 10032, USA;
| | - Yu-Kuang Wu
- James J. Peters VA Medical Center, Bronx, NY 10468, USA; (J.R.W.); (W.M.S.); (G.O.F.); (G.A.M.); (J.M.L.); (M.T.M.); (J.M.W.); (Y.-K.W.)
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Noam Y. Harel
- James J. Peters VA Medical Center, Bronx, NY 10468, USA; (J.R.W.); (W.M.S.); (G.O.F.); (G.A.M.); (J.M.L.); (M.T.M.); (J.M.W.); (Y.-K.W.)
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Correspondence:
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Bonizzato M, Martinez M. An intracortical neuroprosthesis immediately alleviates walking deficits and improves recovery of leg control after spinal cord injury. Sci Transl Med 2021; 13:13/586/eabb4422. [PMID: 33762436 DOI: 10.1126/scitranslmed.abb4422] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 01/09/2021] [Indexed: 12/18/2022]
Abstract
Most rehabilitation interventions after spinal cord injury (SCI) only target the sublesional spinal networks, peripheral nerves, and muscles. However, mammalian locomotion is not a mere act of rhythmic pattern generation. Recovery of cortical control is essential for voluntary movement and modulation of gait. We developed an intracortical neuroprosthetic intervention to SCI, with the goal to condition cortical locomotor control. Neurostimulation delivered in phase coherence with ongoing locomotion immediately alleviated primary SCI deficits, such as leg dragging, in rats with incomplete SCI. Cortical neurostimulation achieved high fidelity and markedly proportional online control of leg trajectories in both healthy and SCI rats. Long-term neuroprosthetic training lastingly improved cortical control of locomotion, whereas short training held transient improvements. We performed longitudinal awake cortical motor mapping, unveiling that recovery of cortico-spinal transmission tightly parallels return of locomotor function in rats. These results advocate directly targeting the motor cortex in clinical neuroprosthetic approaches.
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Affiliation(s)
- Marco Bonizzato
- Department of Neurosciences and Groupe de recherche sur le système nerveux central (GRSNC), Université de Montréal, Montréal, Québec H3T 1N8, Canada.,CIUSSS du Nord-de-l'Île-de-Montréal, Montréal, Québec H4J 1C5, Canada
| | - Marina Martinez
- Department of Neurosciences and Groupe de recherche sur le système nerveux central (GRSNC), Université de Montréal, Montréal, Québec H3T 1N8, Canada. .,CIUSSS du Nord-de-l'Île-de-Montréal, Montréal, Québec H4J 1C5, Canada
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Ting WKC, Fadul FAR, Fecteau S, Ethier C. Neurostimulation for Stroke Rehabilitation. Front Neurosci 2021; 15:649459. [PMID: 34054410 PMCID: PMC8160247 DOI: 10.3389/fnins.2021.649459] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/26/2021] [Indexed: 01/08/2023] Open
Abstract
Neurological injuries such as strokes can lead to important loss in motor function. Thanks to neuronal plasticity, some of the lost functionality may be recovered over time. However, the recovery process is often slow and incomplete, despite the most effective conventional rehabilitation therapies. As we improve our understanding of the rules governing activity-dependent plasticity, neuromodulation interventions are being developed to harness neural plasticity to achieve faster and more complete recovery. Here, we review the principles underlying stimulation-driven plasticity as well as the most commonly used stimulation techniques and approaches. We argue that increased spatiotemporal precision is an important factor to improve the efficacy of neurostimulation and drive a more useful neuronal reorganization. Consequently, closed-loop systems and optogenetic stimulation hold theoretical promise as interventions to promote brain repair after stroke.
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Affiliation(s)
- Windsor Kwan-Chun Ting
- Département de Psychiatrie et de Neurosciences, Centre de Recherche CERVO, Université Laval, Québec City, QC, Canada
| | - Faïza Abdou-Rahaman Fadul
- Département de Psychiatrie et de Neurosciences, Centre de Recherche CERVO, Université Laval, Québec City, QC, Canada
| | - Shirley Fecteau
- Département de Psychiatrie et de Neurosciences, Centre de Recherche CERVO, Université Laval, Québec City, QC, Canada
| | - Christian Ethier
- Département de Psychiatrie et de Neurosciences, Centre de Recherche CERVO, Université Laval, Québec City, QC, Canada
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Huot-Lavoie M, Ethier C, Ting W, Burns D. Assessment of Corticospinal Excitability in Awake Rodents Using EMG-Controlled Intracortical Stimulation. Bio Protoc 2021; 11:e4267. [DOI: 10.21769/bioprotoc.4267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/18/2021] [Accepted: 07/29/2021] [Indexed: 11/02/2022] Open
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