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van Midden VM, Pirtošek Z, Kojović M. The Effect of taVNS on the Cerebello-Thalamo-Cortical Pathway: a TMS Study. CEREBELLUM (LONDON, ENGLAND) 2024; 23:1013-1019. [PMID: 37639175 PMCID: PMC11102382 DOI: 10.1007/s12311-023-01595-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 08/29/2023]
Abstract
fMRI studies show activation of cerebellum during transcutaneous auricular vagal nerve stimulation (taVNS); however, there is no evidence whether taVNS induced activation of the cerebellum translates to the cerebellar closed loops involved in motor functions. We assessed the propensity of taVNS at 25 Hz (taVNS25) and 100 Hz (taVNS100) to modulate cerebello-thalamo-cortical pathways using transcranial magnetic stimulation. In our double blind within-subjects study thirty-two participants completed one visit during which cerebellar brain inhibition (CBI) was assessed at baseline (no stimulation) and in a randomized order during taVNS100, taVNS25, and sham taVNS (xVNS). Generalized linear mixed models with gamma distribution were built to assess the effect of taVNS on CBI. The estimated marginal means of linear trends during each taVNS condition were computed and compared in a pairwise fashion with Benjamini-Hochberg correction for multiple comparisons. CBI significantly increased during taVNS100 compared to taVNS25 and xVNS (p = 0.0003 and p = 0.0465, respectively). The taVNS current intensity and CBI conditioning stimulus intensity had no significant effect on CBI. taVNS has a frequency dependent propensity to modulate the cerebello-thalamo-cortical pathway. The cerebellum participates in closed-loop circuits involved in motor, cognitive, and affective operations and may serve as an entry for modulating effects of taVNS.
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Affiliation(s)
- Vesna M van Midden
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Zvezdan Pirtošek
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Maja Kojović
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
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Repetitive Transcranial Magnetic Stimulation for Neuropathic Pain and Neuropsychiatric Symptoms in Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Neural Plast 2022; 2022:2036736. [PMID: 35945967 PMCID: PMC9357260 DOI: 10.1155/2022/2036736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/05/2022] [Accepted: 07/06/2022] [Indexed: 12/12/2022] Open
Abstract
Neuropathic pain and neuropsychiatric symptoms are common complications reported by the traumatic brain injury (TBI) population. Although a growing body of research has indicated the effectiveness of repetitive transcranial magnetic stimulation (rTMS) for the management of neurological and psychiatric disorders, little evidence has been presented to support the effects of rTMS on neuropathic pain and neuropsychiatric symptoms in patients with TBI in all age groups. In addition, a better understanding of the potential factors that might influence the therapeutic effect of rTMS is necessary. The objective of this preregistered systematic review and meta-analysis was to quantify the effects of rTMS on physical and psychological symptoms in individuals with TBI. We systematically searched six databases for randomized controlled trials (RCTs) of rTMS in TBI patients reporting pain and neuropsychiatric outcomes published until March 20, 2022. The mean difference (MD) with 95% confidence intervals (CIs) was estimated separately for outcomes to understand the mean effect size. Twelve RCTs with 276 TBI patients were ultimately selected from 1605 records for systematic review, and 11 of the studies were included in the meta-analysis. Overall, five of the included studies showed a low risk of bias. The effects of rTMS on neuropathic pain were statistically significant (
, 95% CI -1.76 to -0.25,
), with high heterogeneity (
). A significant advantage of 1 Hz rTMS over the right dorsolateral prefrontal cortex (DLPFC) in improving depression (
, 95% CI -11.58 to -1.46,
) was shown, and a significant improvement was noted in the Rivermead Post-Concussion Symptoms Questionnaire-13 (RPQ-13) scores of mild TBI patients after rTMS (
, 95% CI -10.63 to -1.11,
). However, no significance was found in cognition measurement. No major adverse events related to rTMS were reported. Moderate evidence suggests that rTMS can effectively and safely improve neuropathic pain, while its effectiveness on depression, postconcussion symptoms, and cognition is limited. More trials with a larger number of participants are needed to draw firm conclusions. This trial is registered with PROSPERO (PROSPERO registration number: CRD42021242364.
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Wong PL, Yang YR, Huang SF, Fuh JL, Chiang HL, Wang RY. Transcranial Direct Current Stimulation on Different Targets to Modulate Cortical Activity and Dual-Task Walking in Individuals With Parkinson’s Disease: A Double Blinded Randomized Controlled Trial. Front Aging Neurosci 2022; 14:807151. [PMID: 35197844 PMCID: PMC8859467 DOI: 10.3389/fnagi.2022.807151] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation to modulate cortical activity for improving motor function. However, the information of tDCS stimulation on different brain regions for dual-task walking and cortical modulation in Parkinson’s disease (PD) has not yet been compared. Objective The objective of this study was to investigate the effects of different tDCS targets on dual-task gait performance and cortical activity in patients with PD. Methods A total of 36 participants were randomly assigned to primary motor cortex (M1) tDCS, dorsal lateral prefrontal cortex (DLPFC) tDCS, cerebellum tDCS, or Sham tDCS group. Each group received 20 min of tDCS stimulation, except for the Sham group. Gait performance was measured by the GAITRite system during dual-task walking and single walking. Corticomotor activity of the tibialis anterior (TA) was measured using transcranial magnetic stimulation (TMS). The functional mobility was assessed using the timed up and go (TUG) test. Results All participants showed no significant differences in baseline data. Following the one session of tDCS intervention, M1 (p = 0.048), DLPFC (p < 0.001), and cerebellum (p = 0.001) tDCS groups demonstrated significant improvements in dual-task gait speed compared with a pretest. The time × group interaction [F(3, 32) = 5.125, p = 0.005] was detected in dual-task walking speed. The post hoc Tukey’s test showed that the differences in gait speed were between the Sham tDCS group and the DLPFC tDCS group (p = 0.03). Moreover, DLPFC tDCS also increased the silent period (SP) more than M1 tDCS (p = 0.006) and Sham tDCS (p = 0.002). Conclusion The results indicate that DLPFC tDCS exerted the most beneficial effects on dual-task walking and cortical modulation in participants with PD. Clinical trial registration [http://www.thaiclinicaltrials.org/show/TCTR20200909005], Thai Clinical Trials Registry [TCTR20200909005].
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Affiliation(s)
- Pei-Ling Wong
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yea-Ru Yang
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Fong Huang
- Division of Nerve Repair, Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jong-Ling Fuh
- Division of General Neurology, Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Han-Lin Chiang
- Division of General Neurology, Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ray-Yau Wang
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
- *Correspondence: Ray-Yau Wang, ; orcid.org/0000-0002-8738-796X
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Motor Cortex Function in APOE4 Carriers and Noncarriers. J Clin Neurophysiol 2021; 38:553-557. [PMID: 32576807 DOI: 10.1097/wnp.0000000000000738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The ε4 allele of the apolipoprotein-E gene has been associated with disease activity including Alzheimer disease, multiple sclerosis, and cardiovascular disease. Individuals who possess the ε4 variant of this gene (ε4 carriers) also demonstrate higher levels of cognitive impairment and lower motor scores compared with noncarriers. The purpose of this study was to establish whether there is a difference in motor cortex function between apoε4 carriers and noncarriers. We hypothesized that carriers would have lower levels of excitability and excitatory transmitter (glutamate) and similar levels of intracortical inhibition and inhibitory neurotransmitter (gamma-aminobutyric acid) than noncarriers. METHODS Fifty-two participants provided saliva samples to determine apoε4 carrier status. Measures of motor cortex excitability and inhibition were obtained using transcranial magnetic stimulation, and measures of glutamate and gamma-aminobutyric acid concentrations were obtained using proton magnetic resonance spectroscopy. RESULTS No significant differences in transcranial magnetic stimulation (P ≥ 0.19) or proton magnetic resonance spectroscopy measures (P ≥ 0.90) were found between carriers and noncarriers. CONCLUSIONS The results from this study suggest that motor cortex function, as assessed by transcranial magnetic stimulation measures of excitability and inhibition, and MRS measures of excitatory and inhibitory neurotransmitter are similar in those who possess an apoε4 allele and those who do not.
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Song J, Kang W, Ohn SH, Jung KI, Bashir S, Yoo WK. An Exploration of the Neural Network of Lance-Adams Syndrome: a Case Report. BRAIN & NEUROREHABILITATION 2020; 14:e1. [PMID: 36742106 PMCID: PMC9879414 DOI: 10.12786/bn.2021.14.e1] [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: 09/22/2020] [Revised: 10/30/2020] [Accepted: 10/30/2020] [Indexed: 11/08/2022] Open
Abstract
Lance-Adams syndrome (LAS) is a rare neurological disorder that may occur after cardiopulmonary resuscitation. The LAS is usually caused by hypoxic changes. Neuroimaging studies show that the brain pathology of LAS patients is not uniform, and the pathophysiology of the myoclonus can vary from patient to patient. Our case study contributes to this etiological heterogeneity by neuroimaging and transcranial magnetic stimulation (TMS). In patients with rare brain conditions such as LAS, a combination of brain stimulation methods, such as TMS, and diffusion tensor imaging can provide insights into this condition's pathophysiology. These insights can facilitate the development of more effective therapies.
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Affiliation(s)
- Jimin Song
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Wonil Kang
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Suk Hoon Ohn
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Kwang-Ik Jung
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Shahid Bashir
- Neuroscience Center, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
| | - Woo-Kyoung Yoo
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
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Yasen AL, Lim MM, Weymann KB, Christie AD. Excitability, Inhibition, and Neurotransmitter Levels in the Motor Cortex of Symptomatic and Asymptomatic Individuals Following Mild Traumatic Brain Injury. Front Neurol 2020; 11:683. [PMID: 32765402 PMCID: PMC7381132 DOI: 10.3389/fneur.2020.00683] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/08/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose: The purpose of this study was to determine the level of excitability and inhibition, as well as the concentrations of excitatory and inhibitory neurotransmitters, in the motor cortex of individuals with acute and chronic symptoms from mTBI. Methods: Fifty-three individuals were assigned to one of four groups: (i) without history of mTBI (Control), (ii) within 72-h of diagnosis of mTBI (Acute), (iii) with history of mTBI and no remaining symptoms (Chronic Asymptomatic), and (iv) with chronic symptoms from mTBI, lasting at least 3 months post-injury (Chronic Symptomatic). Measures of corticospinal excitability and inhibition were obtained using transcranial magnetic stimulation (TMS). On the same day, measures of glutamate and GABA concentrations were obtained from the primary motor cortex (M1) using proton magnetic resonance spectroscopy. Results: MEP amplitude and area were both significantly lower in the Chronic Symptomatic group compared to the Control and Chronic Asymptomatic groups (p ≤ 0.05). Intracortical inhibition was not significantly different among groups (p = 0.14). The concentration of glutamate in M1 was similar between groups (p = 0.93) while there was a trend for a lower concentration of GABA in the Chronic Symptomatic group compared to the Acute group (p = 0.06). Conclusions: Individuals with chronic mTBI symptoms appear to have lower corticospinal excitability compared with acutely-injured individuals and asymptomatic controls, but the absence of differences in intracortical inhibition, and concentrations of excitatory and inhibitory neurotransmitters in M1 suggests that neurotransmitter changes in the human brain post-mTBI do not follow the pattern typically seen in the animal literature.
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Affiliation(s)
- Alia L Yasen
- Department of Human Physiology, University of Oregon, Eugene, OR, United States
| | - Miranda M Lim
- Sleep Disorders Clinic, VA Portland Health Care System, Portland, OR, United States.,Departments of Neurology, Behavioral Neuroscience, Medicine, and Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, United States
| | - Kristianna B Weymann
- Sleep Disorders Clinic, VA Portland Health Care System, Portland, OR, United States.,School of Nursing, Oregon Health & Science University, Portland, OR, United States
| | - Anita D Christie
- Department of Human Physiology, University of Oregon, Eugene, OR, United States.,Faculty of Health Sciences, School of Kinesiology, Western University, London, ON, Canada
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7
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Kang JI, Kim DY, Lee CI, Kim CH, Kim SJ. Changes of motor cortical excitability and response inhibition in patients with obsessive–compulsive disorder. J Psychiatry Neurosci 2019; 44:261-268. [PMID: 30758161 PMCID: PMC6606423 DOI: 10.1503/jpn.180064] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Deficits in cortical inhibitory processes have been suggested as underlying pathophysiological mechanisms of obsessive–compulsive disorder (OCD). We examined whether patients with OCD have altered cortical excitability using paired-pulse transcranial magnetic stimulation (TMS). We also tested associations between TMS indices and OCD-related characteristics, including age of onset and response inhibition in the go/no-go paradigm, to examine whether altered cortical excitability contributes to symptom formation and behavioural inhibition deficit in patients with OCD. METHODS We assessed motor cortex excitability using paired-pulse TMS in 51 patients with OCD and 39 age-matched healthy controls. We also assessed clinical symptoms and response inhibition in the go/nogo task. All patients were undergoing treatment with serotonin reuptake inhibitors. We performed repeated-measures multivariate analysis of covariance to compare TMS indices between patients with OCD and controls. RESULTS Compared to controls, patients with OCD showed a shorter cortical silent period and decreased intracortical facilitation. However, we found no significant difference between groups for resting motor threshold or short-interval intracortical inhibition. In the OCD group, the shortened cortical silent period was associated with a prompt reaction time in the go/no-go task and with early onset of OCD. LIMITATIONS We could not exclude the influence of medications on motor cortex excitability. CONCLUSION These findings suggest abnormal cortical excitability in patients with OCD. The associations between cortical silent period and response inhibition and age of onset further indicate that altered cortical excitability may play an important role in the development of OCD.
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Affiliation(s)
- Jee In Kang
- From the Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea (Kang, C. Kim, S.J. Kim); the Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea (D.Y. Kim); and the Yonsei Phil Neuropsychiatric Clinic, Seoul, South Korea (Lee)
| | - Deog Young Kim
- From the Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea (Kang, C. Kim, S.J. Kim); the Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea (D.Y. Kim); and the Yonsei Phil Neuropsychiatric Clinic, Seoul, South Korea (Lee)
| | - Chang-il Lee
- From the Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea (Kang, C. Kim, S.J. Kim); the Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea (D.Y. Kim); and the Yonsei Phil Neuropsychiatric Clinic, Seoul, South Korea (Lee)
| | - Chan-Hyung Kim
- From the Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea (Kang, C. Kim, S.J. Kim); the Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea (D.Y. Kim); and the Yonsei Phil Neuropsychiatric Clinic, Seoul, South Korea (Lee)
| | - Se Joo Kim
- From the Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea (Kang, C. Kim, S.J. Kim); the Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea (D.Y. Kim); and the Yonsei Phil Neuropsychiatric Clinic, Seoul, South Korea (Lee)
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Miyauchi E, Ide M, Tachikawa H, Nemoto K, Arai T, Kawasaki M. A novel approach for assessing neuromodulation using phase-locked information measured with TMS-EEG. Sci Rep 2019; 9:428. [PMID: 30674902 PMCID: PMC6344580 DOI: 10.1038/s41598-018-36317-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 08/23/2018] [Indexed: 02/05/2023] Open
Abstract
Neuromodulation therapies such as electroconvulsive therapy (ECT) are used to treat several neuropsychiatric disorders, including major depressive disorder (MDD). Recent work has highlighted the use of combined transcranial magnetic stimulation and electroencephalography (TMS-EEG) to evaluate the therapeutic effects of neuromodulation; particularly, the phase locking factor (PLF) and phase locking value (PLV) can reportedly assess neuromodulation-induced functional changes in cortical networks. To examine changes in TMS-induced PLV and PLF before and after ECT, and their relationship with depression severity in patients with MDD, TMS-EEG and the Montgomery–Åsberg Depression Rating Scale (MADRS; depression severity) were implemented before and after ECT in 10 patients with MDD. Single-pulse TMS was applied to the visual and motor areas to induce phase propagation in the visuo-motor network at rest. Functional changes were assessed using PLF and PLV data. Pre-ECT TMS-induced alpha band (9–12 Hz) PLV was negatively correlated with depression severity, and increments of post-ECT from pre-ECT TMS-induced alpha band PLV were positively correlated with the reduction in depression severity. Moreover, we found a negative correlation between pre-ECT TMS-induced PLF at TMS-destination and depression severity. Finally, differences in post-ECT TMS-induced PLF peak latencies between visual and motor areas were positively correlated with depression severity. TMS-EEG-based PLV and PLF may be used to assess the therapeutic effects of neuromodulation and depressive states, respectively. Furthermore, our results provide new insights about the neural mechanisms of ECT and depression.
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Affiliation(s)
- Eri Miyauchi
- Department of Intelligent Interaction Technology, Graduate School of Systems and Information Engineering, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8573, Japan
| | - Masayuki Ide
- Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Hirokazu Tachikawa
- Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Kiyotaka Nemoto
- Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tetsuaki Arai
- Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Masahiro Kawasaki
- Department of Intelligent Interaction Technology, Graduate School of Systems and Information Engineering, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8573, Japan.
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Kumar S, Zomorrodi R, Ghazala Z, Goodman MS, Blumberger DM, Cheam A, Fischer C, Daskalakis ZJ, Mulsant BH, Pollock BG, Rajji TK. Extent of Dorsolateral Prefrontal Cortex Plasticity and Its Association With Working Memory in Patients With Alzheimer Disease. JAMA Psychiatry 2017; 74:1266-1274. [PMID: 29071355 PMCID: PMC6583382 DOI: 10.1001/jamapsychiatry.2017.3292] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The extent of dorsolateral prefrontal cortex (DLPFC) plasticity in Alzheimer disease (AD) and its association with working memory are not known. OBJECTIVES To determine whether participants with AD had impaired DLPFC plasticity compared with healthy control participants, to compare working memory between participants with AD and controls, and to determine whether DLPFC plasticity was associated with working memory. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included 32 participants with AD who were 65 years or older and met diagnostic criteria for dementia due to probable AD with a score of at least 17 on the Mini-Mental State Examination and 16 age-matched control participants. Participants were recruited from a university teaching hospital from May 2013 to October 2016. MAIN OUTCOMES AND MEASURES Plasticity of the DLPFC measured as potentiation of cortical-evoked activity using paired associative stimulation (a combination of peripheral nerve electrical stimulation and transcranial magnetic stimulation) combined with electroencephalography. Working memory was assessed with the n-back task (1- and 2-back) and measured using the A' statistic. RESULTS Among the 32 participants with AD, 17 were women and 15 were men (mean [SD] age, 76.3 [6.3] years); among the 16 controls, 8 were men and 8 were women (mean [SD] age, 76.4 [5.1] years). Participants with AD had impaired DLPFC plasticity (mean [SD] potentiation, 1.18 [0.25]) compared with controls (mean [SD] potentiation, 1.40 [0.35]; F1,44 = 5.90; P = .02; between-group comparison, Cohen d = 0.77; P = .01). Participants with AD also had impaired performances on the 1-back condition (mean [SD] A' = 0.47 [0.30]) compared with controls (mean [SD] A' = 0.96 [0.01]; Cohen d = 1.86; P < .001), with similar findings for participants with AD on the 2-back condition (mean [SD] A' = 0.29 [0.2]) compared with controls (mean [SD], A' = 0.85 [0.18]; Cohen d = 2.83; P < .001). Plasticity of DLPFC was positively associated with working memory performance on the 1-back A' (parameter estimate B [SE] = 0.32 [0.13]; standardized β = 0.29; P = .02) and 2-back A' (B [SE] = 0.43 [0.15]; β = 0.39; P = .006) across both groups after controlling for age, education, and attention. CONCLUSIONS AND RELEVANCE This study demonstrated impaired in vivo DLPFC plasticity in patients with AD. The findings support the use of DLPFC plasticity as a measure of DLPFC function and a potential treatment target to enhance DLPFC function and working memory in patients with AD.
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Affiliation(s)
- Sanjeev Kumar
- Centre for Addiction and Mental Health, Geriatric Psychiatry Division, Toronto, Ontario, Canada,Campbell Family Research Institute, Toronto, Ontario, Canada
| | - Reza Zomorrodi
- Centre for Addiction and Mental Health, Geriatric Psychiatry Division, Toronto, Ontario, Canada
| | - Zaid Ghazala
- Centre for Addiction and Mental Health, Geriatric Psychiatry Division, Toronto, Ontario, Canada,Campbell Family Research Institute, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Michelle S. Goodman
- Centre for Addiction and Mental Health, Geriatric Psychiatry Division, Toronto, Ontario, Canada,Campbell Family Research Institute, Toronto, Ontario, Canada
| | - Daniel M. Blumberger
- Centre for Addiction and Mental Health, Geriatric Psychiatry Division, Toronto, Ontario, Canada,Campbell Family Research Institute, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Amay Cheam
- Centre for Addiction and Mental Health, Geriatric Psychiatry Division, Toronto, Ontario, Canada,Campbell Family Research Institute, Toronto, Ontario, Canada
| | - Corinne Fischer
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada,Keenan Research Centre for Biomedical Research, the Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Zafiris J. Daskalakis
- Centre for Addiction and Mental Health, Geriatric Psychiatry Division, Toronto, Ontario, Canada,Campbell Family Research Institute, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Benoit H. Mulsant
- Centre for Addiction and Mental Health, Geriatric Psychiatry Division, Toronto, Ontario, Canada,Campbell Family Research Institute, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Bruce G. Pollock
- Centre for Addiction and Mental Health, Geriatric Psychiatry Division, Toronto, Ontario, Canada,Campbell Family Research Institute, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Tarek K. Rajji
- Centre for Addiction and Mental Health, Geriatric Psychiatry Division, Toronto, Ontario, Canada,Campbell Family Research Institute, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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10
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Thibaut A, Zeng D, Caumo W, Liu J, Fregni F. Corticospinal excitability as a biomarker of myofascial pain syndrome. Pain Rep 2017; 2:e594. [PMID: 29392210 PMCID: PMC5741300 DOI: 10.1097/pr9.0000000000000594] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 03/09/2017] [Accepted: 03/10/2017] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Myofascial pain syndrome (MPS) is a common chronic pain disorder that lacks effective diagnostic criteria. To better understand neurophysiological changes in chronic pain, several trials exploring corticospinal excitability in different populations of patients with chronic pain have been performed. OBJECTIVES In this systematic review, we aimed to investigate the current literature on MPS and intracortical disinhibition, by means of increased intracortical facilitation and decreased intracortical inhibition (ICI). METHODS We performed a search on PubMed to identify clinical trials on MPS and transcranial magnetic stimulation measurements. We then applied the Harford Hill criteria to the identified studies to assess the possible causal relationship between intracortical disinhibition measurements and MPS. Finally, we compared our findings on MPS with other chronic pain conditions. RESULTS Four studies assessing corticospinal excitability in patients with MPS were found. Although the amount of trials available is limited, all the reported studies indicated an increased intracortical disinhibition in patients with MPS. Importantly, these measurements were also correlated with psychological factors, such as pain catastrophism, or anxiety. However, based on the Harford Hill criteria, we could not assert a strong causal relationship between these markers and MPS. Although intracortical disinhibition has been consistently found in patients having MPS, this lack of cortical inhibition was not only observed in this specific chronic pain syndrome but also in fibromyalgia and neuropathic pain conditions. CONCLUSION Intracortical disinhibition seems to be a marker that has been consistently observed in MPS. Future prospective cohort studies could provide new insights in the development of neoplastic and maladaptive changes occurring in chronic pain syndromes and help the development of new therapeutic options.
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Affiliation(s)
- Aurore Thibaut
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Dian Zeng
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
- Guangdong Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wolnei Caumo
- Laboratory of Pain and Neuromodulation, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Jianhua Liu
- Guangdong Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Felipe Fregni
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
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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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12
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Abstract
Current data suggest that transcranial magnetic stimulation (TMS) has the potential to be an effective and complimentary treatment modality for patients with chronic neuropathic pain syndromes. The success of TMS for pain relief depends on the parameters of the stimulation delivered, the location of neural target, and duration of treatment. TMS can be used to excite or inhibit underlying neural tissue that depends on long-term potentiation and long-term depression, respectively. Long-term randomized controlled studies are warranted to establish the efficacy of repetitive TMS in patients with various chronic pain syndromes.
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Affiliation(s)
- Nicole A Young
- Department of Neuroscience, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, 480 Medical Center Drive, Columbus, OH 43210, USA
| | - Mayur Sharma
- Department of Neurosurgery, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, 480 Medical Center Drive, Columbus, OH 43210, USA
| | - Milind Deogaonkar
- Department of Neurosurgery, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, 480 Medical Center Drive, Columbus, OH 43210, USA.
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13
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Macrae PR, Jones RD, Huckabee ML. The effect of swallowing treatments on corticobulbar excitability: a review of transcranial magnetic stimulation induced motor evoked potentials. J Neurosci Methods 2014; 233:89-98. [PMID: 24932964 DOI: 10.1016/j.jneumeth.2014.06.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 06/07/2014] [Accepted: 06/09/2014] [Indexed: 10/25/2022]
Abstract
Transcranial magnetic stimulation (TMS) has been used extensively as a method of investigating the corticomotor physiology of many motor tasks, including healthy and disordered swallowing. Changes in excitability of cortical projections to various swallowing muscles have been documented in response to treatments with TMS induced motor evoked potentials (MEPs). These studies have provided valuable insight into CNS response to swallowing impairment, and more importantly, the adaptations associated with functional recovery. However, unique obstacles are presented when investigating corticobulbar neurophysiology associated with the complex task of swallowing. Stringent methodological control and supplementary outcome measures are required to ensure robust and clinically applicable findings. This article offers a tutorial for the researcher who may be considering the use of TMS for investigating changes in cortical excitability associated with various swallowing paradigms. Included is a review of the mechanisms of TMS and what can be measured with this technique, a summary of existing research using MEPs to investigate swallowing, a review of methodological factors that may influence outcomes, and proposed directions for new areas of research.
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Affiliation(s)
- Phoebe R Macrae
- New Zealand Brain Research Institute, 66 Stewart Street, Christchurch, New Zealand; Department of Communication Disorders, University of Canterbury, Private Bag 4800, Christchurch, New Zealand.
| | - Richard D Jones
- New Zealand Brain Research Institute, 66 Stewart Street, Christchurch, New Zealand; Department of Communication Disorders, University of Canterbury, Private Bag 4800, Christchurch, New Zealand; Department of Medicine, University of Otago, Private Bag 4710, Christchurch, New Zealand; Department of Medical Physics and Bioengineering, Canterbury District Health Board, Private Bag 4710, Christchurch, New Zealand.
| | - Maggie-Lee Huckabee
- New Zealand Brain Research Institute, 66 Stewart Street, Christchurch, New Zealand; Department of Communication Disorders, University of Canterbury, Private Bag 4800, Christchurch, New Zealand.
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14
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Julkunen P, Kallioniemi E, Könönen M, Säisänen L. Feasibility of automated analysis and inter-examiner variability of cortical silent period induced by transcranial magnetic stimulation. J Neurosci Methods 2013; 217:75-81. [PMID: 23660523 DOI: 10.1016/j.jneumeth.2013.04.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 04/17/2013] [Accepted: 04/28/2013] [Indexed: 10/26/2022]
Abstract
Cortical silent period (cSP) is a short interruption in electromyography (EMG) during active muscle contraction induced with transcranial magnetic stimulation (TMS). The cSP is a measure of cortical inhibition and is believed to represent inhibitory interneuron effects on excited motor cortical areas. Several pathological conditions and pharmacological manipulations induce changes to cSP duration indicating alterations in intracortical inhibition. At present, it is common to manually analyse the cSP duration from measured EMG. However, to avoid inter-examiner effects on cSP interpretation and detection, as well as to allow for quick measurement online, automated routine would be preferable. In this study, we evaluate the feasibility of a straight-forward cSP detection routine based on analysing the rectified first derivative of the EMG signal following TMS. Previously measured cSPs of 54 healthy subjects were reanalysed manually by two of the authors and using the automated routine. Furthermore, we recruited one subject for whom the cSPs were induced with several stimulation intensities, and those cSPs were analysed manually by two of the authors as well as using the automated routine. We found that cSPs were detected correctly by the automated cSP detection routine, and agreement with manually analysed subject-specific mean cSPs was excellent (ICC=0.992, p<0.001). The inter-examiner variability was similar to the variability between manual and automated analysis. Hence, we believe the introduced cSP detection routine would be feasible for online cSP detection, in such a way that is presently used to detect the motor evoked potentials.
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Affiliation(s)
- Petro Julkunen
- Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland.
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15
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Farzan F, Barr MS, Hoppenbrouwers SS, Fitzgerald PB, Chen R, Pascual-Leone A, Daskalakis ZJ. The EEG correlates of the TMS-induced EMG silent period in humans. Neuroimage 2013; 83:120-34. [PMID: 23800790 DOI: 10.1016/j.neuroimage.2013.06.059] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 06/13/2013] [Accepted: 06/16/2013] [Indexed: 12/14/2022] Open
Abstract
Application of magnetic or electrical stimulation to the motor cortex can result in a period of electromyography (EMG) silence in a tonically active peripheral muscle. This period of EMG silence is referred to as the silent period (SP). The duration of SP shows intersubject variability and reflects the integrity of cortical and corticospinal pathways. A non-invasive technique for assessing the duration of SP is the combination of Transcranial Magnetic Stimulation (TMS) with EMG. Utilizing TMS-EMG, several studies have reported on the shortening or lengthening of SP in neuropsychiatric disorders such as schizophrenia, bipolar disorder, depression, obsessive compulsive disorder, epilepsy, Parkinson's disease, and stroke. However, cortical, corticospinal and peripheral components are difficult to disentangle from EMG alone. Here, we use the multimodal neuroimaging technique of TMS-EMG combined with concurrent electroencephalography (EEG) recording to further examine the cortical origin of SP and the cortical oscillatory activity that underlies SP genesis. We demonstrate that the duration of SP is related to the temporal characteristics of the cortical reactivity and the power of delta to alpha oscillations in both local and remote areas ipsilateral and contralateral to the stimulation site, and beta oscillations locally. We illustrate that, compared to EMG, the EEG indices of the SP provide additional information about the brain dynamics and propose that the EEG measures of SP may be used in future clinical and research investigations to more precisely delineate the mechanisms underlying inhibitory impairments.
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Affiliation(s)
- Faranak Farzan
- Berenson-Allen Center for Non-invasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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16
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Évaluation électrophysiologique de l’excitabilité corticale dans la migraine. Rev Neurol (Paris) 2013; 169:427-35. [DOI: 10.1016/j.neurol.2013.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Revised: 02/20/2013] [Accepted: 02/26/2013] [Indexed: 11/21/2022]
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Voineskos D, Rogasch NC, Rajji TK, Fitzgerald PB, Daskalakis ZJ. A review of evidence linking disrupted neural plasticity to schizophrenia. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2013; 58:86-92. [PMID: 23442895 DOI: 10.1177/070674371305800205] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The adaptations resulting from neural plasticity lead to changes in cognition and behaviour, which are strengthened through repeated exposure to the novel environment or stimulus. Learning and memory have been hypothesized to occur through modifications of the strength of neural circuits, particularly in the hippocampus and cortex. Cognitive deficits, specifically in executive functioning and negative symptoms, may be a corollary to deficits in neural plasticity. Moreover, the main excitatory and inhibitory neurotransmitters associated with neural plasticity have also been extensively investigated for their role in the cognitive deficits associated with schizophrenia. Transcranial magnetic stimulation (TMS) represents some of the most promising approaches to directly explore the physiological manifestations of neural plasticity in the human brain. Three TMS paradigms (use-dependent plasticity, paired associative stimulation, and repetitive TMS) have been used to evaluate neurophysiological measures of neural plasticity in the healthy brain and in patients with schizophrenia, and to examine the brain's responses to such stimulation. In schizophrenia, deficits in neural plasticity have been consistently shown which parallel the molecular evidence appearing to be entwined with this debilitating disorder. Such pathophysiology may underlie the learning and memory deficits that are key symptoms of this disorder and may even be a key mechanism involved in treatment with antipsychotics.
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Affiliation(s)
- Daphne Voineskos
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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18
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Zunhammer M, Eichhammer P, Franz J, Hajak G, Busch V. Effects of acupuncture needle penetration on motor system excitability. Neurophysiol Clin 2012; 42:225-30. [PMID: 22632870 DOI: 10.1016/j.neucli.2012.02.134] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 01/16/2012] [Accepted: 02/12/2012] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Transcranial magnetic stimulation (TMS) studies reported changes in motor evoked potential amplitude after acupuncture needling both at traditional acupoints and non-acupoints. However, the effects of needle penetration per se have not yet been investigated with TMS. The present study aimed at exploring effects of deep manual acupuncture needling compared to a state-of-the-art, non-penetrating control condition on several standard TMS measures of motor system excitability. METHODS Twenty healthy volunteers received both verum and sham acupuncture applied at the acupoint GB 34 near the right knee, using a crossover design. A needle with a retractable tip ("Streitberger needle") was used as sham condition to minimize non-specific effects. TMS parameters (resting motor threshold, active motor threshold, cortical silent period, short intracortical inhibition, and intracortical facilitation) were calculated from the abductor digiti minimi (ADM) of both hands 15 min before and after needling by a researcher blind to the treatment condition. RESULTS Verum compared to sham acupuncture significantly increased resting motor threshold. No significant treatment effect was found for any other measure, though cortical silent period and intracortical facilitation showed trends to increase in the hemisphere contralateral to the needling site after verum acupuncture. CONCLUSIONS These results suggest a subtle but specific inhibitory effect of acupuncture needle penetration at acupoint GB 34 on motor system excitability. Further investigations should be performed with a particular emphasis on the measurements of resting motor threshold, cortical silent periods and intracortical facilitation.
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Affiliation(s)
- M Zunhammer
- Department of Psychiatry, University of Regensburg, Universitaetsstrae 84, 93053 Regensburg, Germany.
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19
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Malsert J, Guyader N, Chauvin A, Polosan M, Szekely D, Bougerol T, Marendaz C. Saccadic performance and cortical excitability as trait-markers and state-markers in rapid cycling bipolar disorder: a two-case follow-up study. Front Psychiatry 2012; 3:112. [PMID: 23293609 PMCID: PMC3537079 DOI: 10.3389/fpsyt.2012.00112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 12/14/2012] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The understanding of physiopathology and cognitive impairments in mood disorders requires finding objective markers. Mood disorders have often been linked to hypometabolism in the prefrontal dorsolateral cortex, and to GABAergic and glutamatergic neurotransmission dysfunction. The present study aimed to discover whether saccadic tasks (involving DPLFC activity), and cortical excitability (involving GABA/Glutamate neurotransmission) could provide neuropsychophysical markers for mood disorders, and/or of its phases, in patients with rapid cycling bipolar disorders (rcBD). METHODS Two rcBD patients were followed for a cycle, and were compared to nine healthy controls. A saccade task, mixing prosaccades, antisaccades, and nosaccades, and an evaluation of cortical excitability using transcranial magnetic stimulation were performed. RESULTS We observed a deficit in antisaccade in patients independently of thymic phase, and in nosaccade in the manic phase only. Cortical excitability data revealed global intracortical deficits in all phases, switching according to cerebral hemisphere and thymic phase. CONCLUSION Specific patterns of performance in saccade tasks and cortical excitability could characterize mood disorders (trait-markers) and its phases (state-markers). Moreover, a functional relationship between oculometric performance and cortical excitability is discussed.
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Affiliation(s)
- Jennifer Malsert
- CNRS, UMR 5105, Psychology and NeuroCognition Laboratory Grenoble, France
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20
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Wassermann EM, Zimmermann T. Transcranial magnetic brain stimulation: therapeutic promises and scientific gaps. Pharmacol Ther 2011; 133:98-107. [PMID: 21924290 DOI: 10.1016/j.pharmthera.2011.09.003] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 08/12/2011] [Indexed: 01/19/2023]
Abstract
Since its commercial advent in 1985, transcranial magnetic stimulation (TMS), a technique for stimulating neurons in the cerebral cortex through the scalp, safely and with minimal discomfort, has captured the imaginations of scientists, clinicians and lay observers. Initially a laboratory tool for neurophysiologists studying the human motor system, TMS now has a growing list of applications in clinical and basic neuroscience. Although we understand many of its effects at the system level, detailed knowledge of its actions, particularly as a modulator of neural activity, has lagged, due mainly to the lack of suitable non-human models. Nevertheless, these gaps have not blocked the therapeutic application of TMS in brain disorders. Moderate success has been achieved in treating disorders such as depression, where the U.S. Food and Drug Administration has cleared a TMS system for therapeutic use. In addition, there are small, but promising, bodies of data on the treatment of schizophrenic auditory hallucinations, tinnitus, anxiety disorders, neurodegenerative diseases, hemiparesis, and pain syndromes. Some other nascent areas of study also exist. While the fate of TMS as a therapeutic modality depends on continued innovation and experimentation, economic and other factors may be decisive.
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Affiliation(s)
- Eric M Wassermann
- Behavioral Neurology Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
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21
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Zunhammer M, Langguth B, Landgrebe M, Frank E, Müller S, Burger J, Sand PG, Eichhammer P, Hajak G. Modulation of human motor cortex excitability by valproate. Psychopharmacology (Berl) 2011; 215:277-80. [PMID: 21161183 DOI: 10.1007/s00213-010-2126-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Accepted: 12/01/2010] [Indexed: 11/26/2022]
Abstract
RATIONALE Valproate is widely used in the treatment of epilepsy, bipolar disorder, and chronic pain disorders, but its exact mechanisms of action is still incompletely understood. OBJECTIVES Here we used transcranial magnetic stimulation to explore effects of a single dose of 800 mg valproate on motor cortex excitability in healthy volunteers. METHODS Motor threshold, peripheral maximum M-wave, cortical silent period short intracortical inhibition, intracortical facilitation, and motor evoked potential recruitment were assessed before and 1.5 h after the administration of valproate in 15 (eight male, seven female) healthy volunteers. RESULTS None of the measures of cortical excitability were found to be altered significantly after valproate. CONCLUSION These results are in line with previous findings of unaffected intracortical excitability after a single dose of valproate, suggesting that valproate's immediate in vivo actions do not resemble the effects of classic GABAergic compounds.
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Affiliation(s)
- Matthias Zunhammer
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Regensburg, Universitaetsstraße 84, 93053 Regensburg, Germany
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Mhalla A, Baudic S, de Andrade DC, Gautron M, Perrot S, Teixeira MJ, Attal N, Bouhassira D. Long-term maintenance of the analgesic effects of transcranial magnetic stimulation in fibromyalgia. Pain 2011; 152:1478-1485. [PMID: 21397400 DOI: 10.1016/j.pain.2011.01.034] [Citation(s) in RCA: 180] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 01/10/2011] [Accepted: 01/18/2011] [Indexed: 12/18/2022]
Abstract
We assessed for the first time the long-term maintenance of repetitive transcranial magnetic stimulation (rTMS)-induced analgesia in patients with chronic widespread pain due to fibromyalgia. Forty consecutive patients were randomly assigned, in a double-blind fashion, to 2 groups: one receiving active rTMS (n=20) and the other, sham stimulation (n=20), applied to the left primary motor cortex. The stimulation protocol consisted of 14 sessions: an "induction phase" of 5 daily sessions followed by a "maintenance phase" of 3 sessions a week apart, 3 sessions a fortnight apart, and 3 sessions a month apart. The primary outcome was average pain intensity over the last 24 hours, measured before each stimulation from day 1 to week 21 and at week 25 (1 month after the last stimulation). Other outcomes measured included quality of life, mood and anxiety, and several parameters of motor cortical excitability. Thirty patients completed the study (14 in the sham stimulation group and 16 in the active stimulation group). Active rTMS significantly reduced pain intensity from day 5 to week 25. These analgesic effects were associated with a long-term improvement in items related to quality of life (including fatigue, morning tiredness, general activity, walking, and sleep) and were directly correlated with changes in intracortical inhibition. In conclusion, these results suggest that TMS may be a valuable and safe new therapeutic option in patients with fibromyalgia.
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Affiliation(s)
- Alaa Mhalla
- INSERM U-987, CHU Ambroise Paré, Assistance Publique Hôpitaux de Paris, Boulogne-Billancourt F-92100, France Department of Neurology, Hospital das Clinicas, University of São Paulo, Brazil CHU Hôtel Dieu, Assistance Publique Hôpitaux de Paris, Paris F-75001, France Université Paris Descartes, Paris F-75005, France
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23
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Short- and intermediate-interval cortical inhibition and facilitation assessed by navigated transcranial magnetic stimulation. J Neurosci Methods 2011; 195:241-8. [DOI: 10.1016/j.jneumeth.2010.11.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 11/19/2010] [Accepted: 11/28/2010] [Indexed: 11/21/2022]
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Alteration of cortical excitability in patients with fibromyalgia. Pain 2010; 149:495-500. [PMID: 20356675 DOI: 10.1016/j.pain.2010.03.009] [Citation(s) in RCA: 133] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Revised: 02/04/2010] [Accepted: 03/10/2010] [Indexed: 01/07/2023]
Abstract
We assessed cortical excitability and intracortical modulation systematically, by transcranial magnetic stimulation (TMS) of the motor cortex, in patients with fibromyalgia. In total 46 female patients with fibromyalgia and 21 normal female subjects, matched for age, were included in this study. TMS was applied to the hand motor area of both hemispheres and motor evoked potentials (MEPs) were recorded for the first interosseous muscle of the contralateral hand. Single-pulse stimulation was used for measurements of the rest motor threshold (RMT) and suprathreshold MEP. Paired-pulse stimulation was used to assess short intracortical inhibition (SICI) and intracortical facilitation (ICF). Putative correlations were sought between changes in electrophysiological parameters and major clinical features of fibromyalgia, such as pain, fatigue, anxiety, depression and catastrophizing. The RMT on both sides was significantly increased in patients with fibromyalgia and suprathreshold MEP was significantly decreased bilaterally. However, these alterations, suggesting a global decrease in corticospinal excitability, were not correlated with clinical features. Patients with fibromyalgia also had lower ICF and SICI on both sides, than controls, these lower values being correlated with fatigue, catastrophizing and depression. These neurophysiological alterations were not linked to medication, as similar changes were observed in patients with or without psychotropic treatment. In conclusion, fibromyalgia is associated with deficits in intracortical modulation involving both GABAergic and glutamatergic mechanisms, possibly related to certain aspects of the pathophysiology of this chronic pain syndrome. Our data add to the growing body of evidence for objective and quantifiable changes in brain function in fibromyalgia.
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Fitzsimons L, Disner SG, Bress JN. Effective utilization and future directions for repetitive transcranial magnetic stimulation: a guide for psychiatric nurses. J Am Psychiatr Nurses Assoc 2009; 15:314-24. [PMID: 21659243 DOI: 10.1177/1078390309346845] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) and magnetic seizure therapy (MST) represent new and promising avenues for treating mild and severe treatment-resistant depression, respectively. A further understanding of these modalities and the contribution of psychiatric nurses in the emerging field of brain stimulation would be of great use to the nursing community. This article serves as a primer for those who are interested in participating in or referring patients for research or treatment with rTMS or MST. Of particular emphasis is the role of certified psychiatric nurses as clinical rater, patient liaison, and evidence-based practitioner:
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