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Heemels RE, Ademi S, Hehl M. Test-retest reliability of intrahemispheric dorsal premotor and primary motor cortex dual-site TMS connectivity measures. Clin Neurophysiol 2024; 165:64-75. [PMID: 38959537 DOI: 10.1016/j.clinph.2024.06.006] [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: 03/14/2024] [Revised: 05/23/2024] [Accepted: 06/02/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVE Investigating the optimal interstimulus interval (ISI) and the 24-hour test-retest reliability for intrahemispheric dorsal premotor cortex (PMd) - primary motor cortex (M1) connectivity using dual-site transcranial magnetic stimulation (dsTMS). METHODS In 21 right-handed adults, left intrahemispheric PMd-M1 connectivity has been investigated with a stacked-coil dsTMS setup (conditioning stimulus: 75% of resting motor threshold; test stimulus: eliciting MEPs of 1-1.5 mV) at ISIs of 3, 5-8, and 10 ms. Additionally, M1-M1 short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF) were investigated to assess comparability to standard paired-pulse setups. RESULTS Conditioning PMd led to significant inhibition of M1 output at ISIs of 3 and 5 ms, whereas 10 ms resulted in facilitation (all, p < 0.001), with a fair test-retest reliability for 3 (ICC: 0.47) and 6 ms (ICC: 0.44) ISIs. Replication of SICI (p < 0.001) and ICF (p = 0.017) was successful, with excellent test-retest reliability for SICI (ICC: 0.81). CONCLUSION This dsTMS setup can probe the inhibitory and facilitatory PMd-M1 connections, as well as reliably replicate SICI and ICF paradigms. SIGNIFICANCE The stacked-coil dsTMS setup for investigating intrahemispheric PMd-M1 connectivity offers promising possibilities to better understand motor control.
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Affiliation(s)
- Robin E Heemels
- Movement Control & Neuroplasticity Research Group, Department of Movement Sciences, Group Biomedical Sciences, KU Leuven, Heverlee, Belgium; KU Leuven, Leuven Brain Institute (LBI), Leuven, Belgium
| | - Sian Ademi
- Movement Control & Neuroplasticity Research Group, Department of Movement Sciences, Group Biomedical Sciences, KU Leuven, Heverlee, Belgium; KU Leuven, Leuven Brain Institute (LBI), Leuven, Belgium
| | - Melina Hehl
- Movement Control & Neuroplasticity Research Group, Department of Movement Sciences, Group Biomedical Sciences, KU Leuven, Heverlee, Belgium; KU Leuven, Leuven Brain Institute (LBI), Leuven, Belgium; Neuroplasticity and Movement Control Research Group, Rehabilitation Research Institute (REVAL), Hasselt University, Diepenbeek, Belgium.
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2
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Hehl M, Van Malderen S, Geraerts M, Meesen RLJ, Rothwell JC, Swinnen SP, Cuypers K. Probing intrahemispheric interactions with a novel dual-site TMS setup. Clin Neurophysiol 2024; 158:180-195. [PMID: 38232610 DOI: 10.1016/j.clinph.2023.12.128] [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: 10/24/2023] [Revised: 12/02/2023] [Accepted: 12/19/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVE Using dual-site transcranial magnetic stimulation (dsTMS), the effective connectivity between the primary motor cortex (M1) and adjacent brain areas such as the dorsal premotor cortex (PMd) can be investigated. However, stimulating two brain regions in close proximity (e.g., ±2.3 cm for intrahemispheric PMd-M1) is subject to considerable spatial restrictions that potentially can be overcome by combining two standard figure-of-eight coils in a novel dsTMS setup. METHODS After a technical evaluation of its induced electric fields, the dsTMS setup was tested in vivo (n = 23) by applying a short-interval intracortical inhibition (SICI) protocol. Additionally, the intrahemispheric PMd-M1 interaction was probed. E-field modelling was performed using SimNIBS. RESULTS The technical evaluation yielded no major alterations of the induced electric fields due to coil overlap. In vivo, the setup reliably elicited SICI. Investigating intrahemispheric PMd-M1 interactions was feasible (inter-stimulus interval 6 ms), resulting in modulation of M1 output. CONCLUSIONS The presented dsTMS setup provides a novel way to stimulate two adjacent brain regions with fewer technical and spatial limitations than previous attempts. SIGNIFICANCE This dsTMS setup enables more accurate and repeatable targeting of brain regions in close proximity and can facilitate innovation in the field of effective connectivity.
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Affiliation(s)
- Melina Hehl
- Movement Control & Neuroplasticity Research Group, Department of Movement Sciences, Group Biomedical Sciences, KU Leuven, 3001 Heverlee, Belgium; KU Leuven, Leuven Brain Institute (LBI), Leuven, Belgium; Neuroplasticity and Movement Control Research Group, Rehabilitation Research Institute (REVAL), Hasselt University, Diepenbeek, Belgium
| | - Shanti Van Malderen
- Movement Control & Neuroplasticity Research Group, Department of Movement Sciences, Group Biomedical Sciences, KU Leuven, 3001 Heverlee, Belgium; KU Leuven, Leuven Brain Institute (LBI), Leuven, Belgium; Neuroplasticity and Movement Control Research Group, Rehabilitation Research Institute (REVAL), Hasselt University, Diepenbeek, Belgium
| | - Marc Geraerts
- Neuroplasticity and Movement Control Research Group, Rehabilitation Research Institute (REVAL), Hasselt University, Diepenbeek, Belgium
| | - Raf L J Meesen
- Movement Control & Neuroplasticity Research Group, Department of Movement Sciences, Group Biomedical Sciences, KU Leuven, 3001 Heverlee, Belgium; Neuroplasticity and Movement Control Research Group, Rehabilitation Research Institute (REVAL), Hasselt University, Diepenbeek, Belgium
| | - John C Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
| | - Stephan P Swinnen
- Movement Control & Neuroplasticity Research Group, Department of Movement Sciences, Group Biomedical Sciences, KU Leuven, 3001 Heverlee, Belgium; KU Leuven, Leuven Brain Institute (LBI), Leuven, Belgium
| | - Koen Cuypers
- Movement Control & Neuroplasticity Research Group, Department of Movement Sciences, Group Biomedical Sciences, KU Leuven, 3001 Heverlee, Belgium; KU Leuven, Leuven Brain Institute (LBI), Leuven, Belgium; Neuroplasticity and Movement Control Research Group, Rehabilitation Research Institute (REVAL), Hasselt University, Diepenbeek, Belgium.
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3
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Hehl M, Swinnen SP, Van Malderen S, Cuypers K. No evidence for a difference in lateralization and distinctiveness level of transcranial magnetic stimulation-derived cortical motor representations over the adult lifespan. Front Aging Neurosci 2022; 14:971858. [PMID: 36313026 PMCID: PMC9608504 DOI: 10.3389/fnagi.2022.971858] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/15/2022] [Indexed: 11/30/2022] Open
Abstract
This study aimed to investigate the presence and patterns of age-related differences in TMS-based measures of lateralization and distinctiveness of the cortical motor representations of two different hand muscles. In a sample of seventy-three right-handed healthy participants over the adult lifespan, the first dorsal interosseus (FDI) and abductor digiti minimi (ADM) cortical motor representations of both hemispheres were acquired using transcranial magnetic stimulation (TMS). In addition, dexterity and maximum force levels were measured. Lateralization quotients were calculated for homolog behavioral and TMS measures, whereas the distinctiveness between the FDI and ADM representation within one hemisphere was quantified by the center of gravity (CoG) distance and cosine similarity. The presence and patterns of age-related changes were examined using linear, polynomial, and piecewise linear regression. No age-related differences could be identified for the lateralization quotient of behavior or cortical motor representations of both intrinsic hand muscles. Furthermore, no evidence for a change in the distinctiveness of the FDI and ADM representation with advancing age was found. In conclusion this work showed that lateralization and distinctiveness of cortical motor representations, as determined by means of TMS-based measures, remain stable over the adult lifespan.
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Affiliation(s)
- Melina Hehl
- Movement Control & Neuroplasticity Research Group, Department of Movement Sciences, Group Biomedical Sciences, KU Leuven, Heverlee, Belgium
- Neuroplasticity and Movement Control Research Group, Rehabilitation Research Institute (REVAL), Hasselt University, Diepenbeek, Belgium
| | - Stephan P. Swinnen
- Movement Control & Neuroplasticity Research Group, Department of Movement Sciences, Group Biomedical Sciences, KU Leuven, Heverlee, Belgium
- Leuven Brain Institute (LBI), KU Leuven, Leuven, Belgium
| | - Shanti Van Malderen
- Movement Control & Neuroplasticity Research Group, Department of Movement Sciences, Group Biomedical Sciences, KU Leuven, Heverlee, Belgium
- Neuroplasticity and Movement Control Research Group, Rehabilitation Research Institute (REVAL), Hasselt University, Diepenbeek, Belgium
| | - Koen Cuypers
- Movement Control & Neuroplasticity Research Group, Department of Movement Sciences, Group Biomedical Sciences, KU Leuven, Heverlee, Belgium
- Neuroplasticity and Movement Control Research Group, Rehabilitation Research Institute (REVAL), Hasselt University, Diepenbeek, Belgium
- Leuven Brain Institute (LBI), KU Leuven, Leuven, Belgium
- *Correspondence: Koen Cuypers,
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4
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Rurak BK, Rodrigues JP, Power BD, Drummond PD, Vallence AM. Reduced SMA-M1 connectivity in older than younger adults measured using dual-site TMS. Eur J Neurosci 2021; 54:6533-6552. [PMID: 34470079 DOI: 10.1111/ejn.15438] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 08/18/2021] [Indexed: 12/29/2022]
Abstract
With advancing age comes a decline in voluntary movement control. Growing evidence suggests that an age-related decline in effective connectivity between the supplementary motor area and primary motor cortex (SMA-M1) might play a role in an age-related decline of bilateral motor control. Dual-site transcranial magnetic stimulation (TMS) can be used to measure SMA-M1 effective connectivity. In the current study, we aimed to (1) replicate previous dual-site TMS research showing reduced SMA-M1 connectivity in older than younger adults and (2) examine whether SMA-M1 connectivity is associated with bilateral motor control in independent samples of younger (n = 30) and older adults (n = 30). SMA-M1 connectivity was measured using dual-site TMS with interstimulus intervals of 6, 7 and 8 ms, and bilateral motor control was measured using the Purdue Pegboard, Four Square Step Test and the Timed Up and Go task. Findings from this study showed that SMA-M1 connectivity was reduced in older than in younger adults, suggesting that the direct excitatory connections between SMA and M1 had reduced efficacy in older than younger adults. Furthermore, greater SMA-M1 connectivity was associated with better bimanual motor control in older adults. Thus, SMA-M1 connectivity in older adults might underpin, in part, the age-related decline in bilateral motor control. These findings contribute to our understanding of age-related declines in motor control and provide a physiological basis for the development of interventions to improve bimanual and bilateral motor control.
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Affiliation(s)
- Brittany K Rurak
- Discipline of Psychology, College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Western Australia, Australia.,Centre for Healthy Ageing, Health Futures Institute, Murdoch University, Murdoch, Western Australia, Australia
| | | | - Brian D Power
- Hollywood Private Hospital, Nedlands, Western Australia, Australia.,School of Medicine Fremantle, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Peter D Drummond
- Discipline of Psychology, College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Western Australia, Australia.,Centre for Healthy Ageing, Health Futures Institute, Murdoch University, Murdoch, Western Australia, Australia
| | - Ann-Maree Vallence
- Discipline of Psychology, College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Western Australia, Australia.,Centre for Healthy Ageing, Health Futures Institute, Murdoch University, Murdoch, Western Australia, Australia.,Centre for Molecular Medicine and Innovative Therapeutics, Murdoch, Western Australia, Australia
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5
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Seer C, Sidlauskaite J, Lange F, Rodríguez-Nieto G, Swinnen SP. Cognition and action: a latent variable approach to study contributions of executive functions to motor control in older adults. Aging (Albany NY) 2021; 13:15942-15963. [PMID: 34166223 PMCID: PMC8266336 DOI: 10.18632/aging.203239] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/03/2021] [Indexed: 12/23/2022]
Abstract
Aging is associated with profound alterations in motor control that may be exacerbated by age-related executive functioning decline. Executive functions span multiple facets including inhibition (suppressing unwanted response tendencies), shifting (switching between cognitive operations), and updating (managing working memory content). However, comprehensive studies regarding the contributions of single facets of executive functioning to movement control in older adults are still lacking. A battery of nine neuropsychological tasks was administered to n = 92 older adults in order to derive latent factors for inhibition, shifting, and updating by structural equation modeling. A bimanual task was used to assess complex motor control. A sample of n = 26 young adults served as a control group to verify age-related performance differences. In older adults, structural equation models revealed that performance on the most challenging condition of the complex motor task was best predicted by the updating factor and by general executive functioning performance. These data suggest a central role for working memory updating in complex motor performance and contribute to our understanding of how individual differences in executive functioning relate to movement control in older adults.
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Affiliation(s)
- Caroline Seer
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Flanders, Belgium.,KU Leuven Brain Institute (LBI), KU Leuven, Flanders, Belgium
| | - Justina Sidlauskaite
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Flanders, Belgium.,KU Leuven Brain Institute (LBI), KU Leuven, Flanders, Belgium
| | - Florian Lange
- Behavioral Engineering Research Group, KU Leuven, Flanders, Belgium
| | - Geraldine Rodríguez-Nieto
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Flanders, Belgium.,KU Leuven Brain Institute (LBI), KU Leuven, Flanders, Belgium
| | - Stephan P Swinnen
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Flanders, Belgium.,KU Leuven Brain Institute (LBI), KU Leuven, Flanders, Belgium
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Van Hoornweder S, Debeuf R, Verstraelen S, Meesen R, Cuypers K. Unravelling Ipsilateral Interactions Between Left Dorsal Premotor and Primary Motor Cortex: A Proof of Concept Study. Neuroscience 2021; 466:36-46. [PMID: 33971265 DOI: 10.1016/j.neuroscience.2021.04.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 11/16/2022]
Abstract
Few studies have identified the intrahemispheric functional connectivity between the ipsilateral dorsal premotor cortex (PMd) and the primary motor hand area (M1hand) due to technical limitations. In this proof-of-concept study, a novel neuronavigated dsTMS set-up was employed, combining stimulation over left PMd and left M1hand using the edge of a butterfly coil and a small cooled-coil. This arrangement was warranted because coil (over)heating and inter coil distance are limiting factors when investigating connectivity between stimulation targets in close proximity and over a longer duration. The proposed set-up was designed to deal with these limitations. Specifically, the effect of four dual-site transcranial magnetic stimulation (dsTMS) protocols on twenty-eight right-handed participants (12 males) was evaluated. These protocols differed in stimulus order, interstimulus interval and current direction induced in PMd. A structural scan with electric (E-)field modeling was obtained from seven participants prior to dsTMS, demonstrating that PMd and M1hand were effectively stimulated. Results indicate that one protocol, in which a latero-medial current was induced in PMd 2.8 ms prior to stimulation over M1hand, induced a sex-mediated effect. In males, significant inhibition of motor-evoked potentials was identified, whereas females demonstrated a facilitatory effect that did not survive correction for multiple comparisons. E-field simulations revealed that the E-field induced by the coil targeting PMd was maximal in PMd, with weaker E-field strengths extending to regions beyond PMd. Summarizing, the current dsTMS set-up enabled stimulating at an inter-target distance of 35 mm without any indications of coil-overheating.
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Affiliation(s)
- Sybren Van Hoornweder
- Neuroplasticity and Movement Control Research Group, Rehabilitation Research Institute (REVAL), Hasselt University, Diepenbeek, Belgium; Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, Group Biomedical Sciences, KU Leuven, Heverlee, Belgium
| | - Ruben Debeuf
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, Group Biomedical Sciences, KU Leuven, Heverlee, Belgium; Rehabilitation Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Stefanie Verstraelen
- Neuroplasticity and Movement Control Research Group, Rehabilitation Research Institute (REVAL), Hasselt University, Diepenbeek, Belgium
| | - Raf Meesen
- Neuroplasticity and Movement Control Research Group, Rehabilitation Research Institute (REVAL), Hasselt University, Diepenbeek, Belgium
| | - Koen Cuypers
- Neuroplasticity and Movement Control Research Group, Rehabilitation Research Institute (REVAL), Hasselt University, Diepenbeek, Belgium; Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, Group Biomedical Sciences, KU Leuven, Heverlee, Belgium.
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7
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Xu X, Xu DS. Prospects for the application of transcranial magnetic stimulation in diabetic neuropathy. Neural Regen Res 2021; 16:955-962. [PMID: 33229735 PMCID: PMC8178790 DOI: 10.4103/1673-5374.297062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Encouraging results have been reported for the use of transcranial magnetic stimulation-based nerve stimulation in studies of the mechanisms of neurological regulation, nerve injury repair, and nerve localization. However, to date, there are only a few reviews on the use of transcranial magnetic stimulation for diabetic neuropathy. Patients with diabetic neuropathy vary in disease progression and show neuropathy in the early stage of the disease with mild symptoms, making it difficult to screen and identify. In the later stage of the disease, irreversible neurological damage occurs, resulting in treatment difficulties. In this review, we summarize the current state of diabetic neuropathy research and the prospects for the application of transcranial magnetic stimulation in diabetic neuropathy. We review significant studies on the beneficial effects of transcranial magnetic stimulation in diabetic neuropathy treatment, based on the outcomes of its use to treat neurodegeneration, pain, blood flow change, autonomic nervous disorders, vascular endothelial injury, and depression. Collectively, the studies suggest that transcranial magnetic stimulation can produce excitatory/inhibitory stimulation of the cerebral cortex or local areas, promote the remodeling of the nervous system, and that it has good application prospects for the localization of the injury, neuroprotection, and the promotion of nerve regeneration. Therefore, transcranial magnetic stimulation is useful for the screening and early treatment of diabetic neuropathy. Transcranial magnetic stimulation can also alleviate pain symptoms by changing the cortical threshold and inhibiting the conduction of sensory information in the thalamo-spinal pathway, and therefore it has therapeutic potential for the treatment of pain and pain-related depressive symptoms in patients with diabetic neuropathy. Additionally, based on the effect of transcranial magnetic stimulation on local blood flow and its ability to change heart rate and urine protein content, transcranial magnetic stimulation has potential in the treatment of autonomic nerve dysfunction and vascular injury in diabetic neuropathy. Furthermore, oxidative stress and the inflammatory response are involved in the process of diabetic neuropathy, and transcranial magnetic stimulation can reduce oxidative damage. The pathological mechanisms of diabetic neuropathy should be further studied in combination with transcranial magnetic stimulation technology.
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Affiliation(s)
- Xi Xu
- Department of Rehabilitation Medicine, Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, China
| | - Dong-Sheng Xu
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine; School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Age-related GABAergic differences in the primary sensorimotor cortex: A multimodal approach combining PET, MRS and TMS. Neuroimage 2020; 226:117536. [PMID: 33186716 PMCID: PMC7894275 DOI: 10.1016/j.neuroimage.2020.117536] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 10/10/2020] [Accepted: 10/28/2020] [Indexed: 01/15/2023] Open
Abstract
Healthy aging is associated with mechanistic changes in gamma-aminobutyric acid (GABA), the most abundant inhibitory neurotransmitter in the human brain. While previous work mainly focused on magnetic resonance spectroscopy (MRS)-based GABA+ levels and transcranial magnetic stimulation (TMS)-based GABAA receptor (GABAAR) activity in the primary sensorimotor (SM1) cortex, the aim of the current study was to identify age-related differences in positron emission tomography (PET)-based GABAAR availability and its relationship with GABA+ levels (i.e. GABA with the contribution of macromolecules) and GABAAR activity. For this purpose, fifteen young (aged 20–28 years) and fifteen older (aged 65–80 years) participants were recruited. PET and MRS images were acquired using simultaneous time-of-flight PET/MR to evaluate age-related differences in GABAAR availability (distribution volume ratio with pons as reference region) and GABA+ levels. TMS was applied to identify age-related differences in GABAAR activity by measuring short-interval intracortical inhibition (SICI). Whereas GABAAR availability was significantly higher in the SM cortex of older as compared to young adults (18.5%), there were neither age-related differences in GABA+ levels nor SICI. A correlation analysis revealed no significant associations between GABAAR availability, GABAAR activity and GABA+ levels. Although the exact mechanisms need to be further elucidated, it is possible that a higher GABAAR availability in older adults is a compensatory mechanism to ensure optimal inhibitory functionality during the aging process.
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