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Liang S, Wang W, Yu F, Pan L, Xu D, Hu R, Tian S, Xiang J, Zhu Y. Repetitive peripheral magnetic stimulation combined with transcranial magnetic stimulation in rehabilitation of upper extremity hemiparesis following stroke: a pilot study. J Rehabil Med 2024; 56:jrm19449. [PMID: 38298134 PMCID: PMC10847975 DOI: 10.2340/jrm.v56.19449] [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: 09/15/2023] [Accepted: 12/20/2023] [Indexed: 02/02/2024] Open
Abstract
OBJECTIVE To investigate the effect of combined repetitive peripheral magnetic stimulation and transcranial magnetic stimulation on upper extremity function in subacute stroke patients. DESIGN Pilot study. SUBJECTS Subacute stroke patients. METHODS Included patients were randomized into 3 groups: a central-associated peripheral stimulation (CPS) group, a central-stimulation-only (CS) group, and a control (C) group. The CPS group underwent a new paired associative stimulation (combined repetitive peripheral magnetic stimulation and transcranial magnetic stimulation), the CS group underwent repetitive transcranial magnetic stimulation, and the C group underwent sham stimulation. All 3 groups received physiotherapy after the stimulation or sham stimulation. The treatment comprised 20 once-daily sessions. Primary outcome was the Fugl-Meyer Assessment Upper Extremity (FMA-UE) score, and secondary outcomes were the Barthel Index and Comprehensive Functional Assessment scores, and neurophysiological assessments were mainly short-interval intracortical inhibition. A 3-group (CPS, CS, C) × 2-time (before, after intervention) repeated measures analysis of variance was conducted to determine whether changes in scores were significantly different between the 3 groups. RESULTS A total of 45 patients were included in the analysis. Between-group comparisons on the FMA-UE demonstrated a significant improvement (group × time interaction, F2,42 = 4.86; p = 0.013; C vs CS, p = 0.020; C vs CPS, p = 0.016; CS vs CPS, p = 0.955). Correlation analysis did not find any substantial positive correlation between changes in FMA-UE and short-interval intracortical inhibition variables (C, r = -0.196, p = 0.483; CS, r = -0.169, p = 0.546; CPS, r = -0.424, p = 0.115). CONCLUSION This study suggests that the real-stimulus (CS and CPS) groups had better outcomes than the control (C) group. In addition, the CPS group showed a better trend in clinical and neurophysiological assessments compared with the CS group.
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Affiliation(s)
- Sijie Liang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China; Department of Rehabilitation Medicine, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Weining Wang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Fengyun Yu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Li Pan
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Dongyan Xu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Ruiping Hu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Shan Tian
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jie Xiang
- Department of Rehabilitation Medicine, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Yulian Zhu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China.
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Lv L, Cheng X, Yang J, Chen X, Ni J. Novel role for non-invasive neuromodulation techniques in central respiratory dysfunction. Front Neurosci 2023; 17:1226660. [PMID: 37680969 PMCID: PMC10480838 DOI: 10.3389/fnins.2023.1226660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/09/2023] [Indexed: 09/09/2023] Open
Abstract
Respiration is a crucial steady-state function of human life. Central nervous system injury can damage the central respiratory pattern generator (CRPG) or interrupt its outflow, leading to central respiratory paralysis and dysfunction, which can endanger the patient's life. At present, there is no effective means to reverse this process. Commonly used non-invasive neuromodulation techniques include repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS) and so forth, which have been widely applied in nervous system diseases and their various secondary symptoms, but rarely in respiratory function. Clinical and animal studies have confirmed that TMS is also suitable for investigating the excitability and plasticity of ascending corticospinal respiratory pathways. In addition, although rTMS and tDCS differ in their respective mechanisms, both can regulate respiratory networks in healthy individuals and in diseased states. In this review, we provide an overview of the physiology of respiration, the use of TMS to assess the excitability of corticophrenic pathways in healthy individuals and in central respiratory disorders, followed by an overview of the animal and clinical studies of rTMS, tDCS and so forth in regulating respiratory circuits and the possible mechanisms behind them. It was found that the supplementary motor area (SMA) and the phrenic motor neuron (PMN) may be key regulatory areas. Finally, the challenges and future research directions of neuroregulation in respiratory function are proposed. Through understanding how neuromodulation affects the respiratory neural circuit non-invasively, we can further explore the therapeutic potential of this neuromodulation strategy, so as to promote the recovery of respiratory function after central nervous system diseases or injury.
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Affiliation(s)
- Lan Lv
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Rehabilitation Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Xiaoping Cheng
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jiaying Yang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xinyuan Chen
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jun Ni
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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3
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Non-invasive brain stimulation as therapeutic approach for ischemic stroke: Insights into the (sub)cellular mechanisms. Pharmacol Ther 2022; 235:108160. [PMID: 35183592 DOI: 10.1016/j.pharmthera.2022.108160] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 01/12/2023]
Abstract
Although spontaneous recovery can occur following ischemic stroke due to endogenous neuronal reorganization and neuroplastic events, the degree of functional improvement is highly variable, causing many patients to remain permanently impaired. In the last decades, non-invasive brain stimulation (NIBS) techniques have emerged as potential add-on interventions to the standard neurorehabilitation programs to improve post-stroke recovery. Due to their ability to modulate cortical excitability and to induce neuroreparative processes in the brain, multiple studies have assessed the safety, efficacy and (sub)cellular mechanisms of NIBS following ischemic stroke. In this review, an overview will be provided of the different NIBS techniques that are currently being investigated in (pre)clinical stroke studies. The NIBS therapies that will be discussed include transcranial magnetic stimulation, transcranial direct current stimulation and extremely low frequency electromagnetic stimulation. First, an overview will be given of the cellular mechanisms induced by NIBS that are associated with enhanced stroke outcome in preclinical models. Furthermore, the current knowledge on safety and efficacy of these NIBS techniques in stroke patients will be reviewed.
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4
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Chen Q, Shen W, Sun H, Zhang H, Liu C, Chen Z, Yu L, Cai X, Ke J, Li L, Zhang L, Fang Q. The effect of coupled inhibitory-facilitatory repetitive transcranial magnetic stimulation on shaping early reorganization of the motor network after stroke. Brain Res 2022; 1790:147959. [PMID: 35654120 DOI: 10.1016/j.brainres.2022.147959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 05/25/2022] [Accepted: 05/27/2022] [Indexed: 11/29/2022]
Abstract
Neural plasticity is a major factor driving cortical reorganization after stroke. This study aimed to evaluate functional connectivity (FC) changes in the cortical motor network after coupled inhibitory-facilitatory repetitive transcranial magnetic stimulation (rTMS) treatment and to assess the correlation between FC changes and functional recovery, further characterizing the neural mechanisms underlying the beneficial effects of rTMS. We randomly divided 63 patients with acute stroke into four groups: (1) Group A received coupled inhibitory-facilitatory rTMS [1 Hz over the contralesional primary motor cortex (M1) and 10 Hz over ipsilesional M1]; (2) Group B received a contralesional sham stimulation and ipsilesional 10 Hz stimulation; (3) Group C received a contralesional 1 Hz rTMS and ipsilesional sham stimulation; and (4) Group D received bilateral sham stimulation only. Standardized rehabilitation therapy was performed immediately after rTMS, and each group was treated with their respective treatment modalities for 4 weeks. Twenty-four hours before and after the intervention, participants underwent resting-state functional magnetic resonance imaging. Additional functional assessments were conducted at baseline, after treatment, and at the 3 month follow-up. The rTMS treatment significantly changed the FCs of intra- and inter-hemispheric cortical motor networks in the rTMS groups (A and B) compared with the sham group (Group D). This effect was more pronounced in Group A, which displayed a changed FC between the contralesional postcentral gyrus and contralesional superior parietal gyrus, between the contralesional precentral gyrus and contralesional postcentral gyrus, and between the ipsilesional postcentral gyrus and contralesional superior parietal gyrus, when compared with Groups B and C. Importantly, FC changes were significantly correlated with improvement of motor function. In the early stages of ischemic stroke, coupled rTMS was more conducive to motor recovery by modulating the FCs of intra-hemispheric and inter-hemispheric motor networks. Our results suggested that FC changes were related to motor function recovery for early-stage cerebral stroke patients treated with coupled rTMS. These findings could help to understand the mechanism of coupled rTMS and further the use of this therapy as an adjunct rehabilitation technique in motor recovery.
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Affiliation(s)
- Qingmei Chen
- Department of Physical Medicine &Rehabilitation, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China; Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China
| | - Wenjun Shen
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Haiwei Sun
- Department of Emergency Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China
| | - Hanjun Zhang
- Department of Physical Medicine &Rehabilitation, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China
| | - Chuandao Liu
- Department of Physical Medicine &Rehabilitation, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China
| | - Zhiguo Chen
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China
| | - Liqiang Yu
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China
| | - Xiuying Cai
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China
| | - Jun Ke
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China
| | - Li Li
- Department of Physical Medicine &Rehabilitation, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China.
| | - Lichi Zhang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, China.
| | - Qi Fang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China.
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5
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Poh EZ, Green C, Agostinelli L, Penrose-Menz M, Karl AK, Harvey AR, Rodger J. Manipulating the Level of Sensorimotor Stimulation during LI-rTMS Can Improve Visual Circuit Reorganisation in Adult Ephrin-A2A5 -/- Mice. Int J Mol Sci 2022; 23:ijms23052418. [PMID: 35269561 PMCID: PMC8910719 DOI: 10.3390/ijms23052418] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/16/2022] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation technique that has the potential to treat a variety of neurologic and psychiatric disorders. The extent of rTMS-induced neuroplasticity may be dependent on a subject's brain state at the time of stimulation. Chronic low intensity rTMS (LI-rTMS) has previously been shown to induce beneficial structural and functional reorganisation within the abnormal visual circuits of ephrin-A2A5-/- mice in ambient lighting. Here, we administered chronic LI-rTMS in adult ephrin-A2A5-/- mice either in a dark environment or concurrently with voluntary locomotion. One day after the last stimulation session, optokinetic responses were assessed and fluorescent tracers were injected to map corticotectal and geniculocortical projections. We found that LI-rTMS in either treatment condition refined the geniculocortical map. Corticotectal projections were improved in locomotion+LI-rTMS subjects, but not in dark + LI-rTMS and sham groups. Visuomotor behaviour was not improved in any condition. Our results suggest that the beneficial reorganisation of abnormal visual circuits by rTMS can be significantly influenced by simultaneous, ambient visual input and is enhanced by concomitant physical exercise. Furthermore, the observed pathway-specific effects suggest that regional molecular changes and/or the relative proximity of terminals to the induced electric fields influence the outcomes of LI-rTMS on abnormal circuitry.
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Affiliation(s)
- Eugenia Z. Poh
- School of Biological Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (E.Z.P.); (M.P.-M.); (A.-K.K.)
- School of Human Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (C.G.); (L.A.); (A.R.H.)
- Perron Institute for Neurological and Translational Research, 8 Verdun St, Nedlands, WA 6009, Australia
- Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, 1105 BA Amsterdam, The Netherlands
| | - Courtney Green
- School of Human Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (C.G.); (L.A.); (A.R.H.)
| | - Luca Agostinelli
- School of Human Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (C.G.); (L.A.); (A.R.H.)
| | - Marissa Penrose-Menz
- School of Biological Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (E.Z.P.); (M.P.-M.); (A.-K.K.)
| | - Ann-Kathrin Karl
- School of Biological Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (E.Z.P.); (M.P.-M.); (A.-K.K.)
- Department of Neurology, University Hospital of Würzburg, Josef-Schneider-Strasse 11, 97080 Würzburg, Germany
| | - Alan R. Harvey
- School of Human Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (C.G.); (L.A.); (A.R.H.)
- Perron Institute for Neurological and Translational Research, 8 Verdun St, Nedlands, WA 6009, Australia
| | - Jennifer Rodger
- School of Biological Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (E.Z.P.); (M.P.-M.); (A.-K.K.)
- Perron Institute for Neurological and Translational Research, 8 Verdun St, Nedlands, WA 6009, Australia
- Correspondence: ; Tel.: +61-8-6488-2245
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6
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Chou TY, Wang JC, Lin MY, Tsai PY. Low-Frequency vs. Theta Burst Transcranial Magnetic Stimulation for the Treatment of Chronic Non-fluent Aphasia in Stroke: A Proof-of-Concept Study. Front Aging Neurosci 2022; 13:800377. [PMID: 35095477 PMCID: PMC8795082 DOI: 10.3389/fnagi.2021.800377] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/27/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Although low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) has shown promise in the treatment of poststroke aphasia, the efficacy of high-frequency rTMS (HF-rTMS) has yet to be determined. PURPOSE We investigated the efficacy of intermittent theta burst stimulation (iTBS) in ameliorating chronic non-fluent aphasia and compared it with that of LF-rTMS. METHODS We randomly assigned patients with poststroke non-fluent aphasia to an ipsilesional iTBS (n = 29), contralesional 1-Hz rTMS (n = 27), or sham (n = 29) group. Each group received the rTMS protocol executed in 10 daily sessions over 2 weeks. We evaluated language function before and after the intervention by using the Concise Chinese Aphasia Test (CCAT). RESULTS Compared with the sham group, the iTBS group exhibited significant improvements in conversation, description, and expression scores (P = 0.0004-0.031), which characterize verbal production, as well as in auditory comprehension, reading comprehension, and matching scores (P < 0.01), which characterize language perception. The 1-Hz group exhibited superior improvements in expression, reading comprehension, and imitation writing scores compared with the sham group (P < 0.05). The iTBS group had significantly superior results in CCAT total score, matching and auditory comprehension (P < 0.05) relative to the 1-Hz group. CONCLUSION Our study findings contribute to a growing body of evidence that ipsilesional iTBS enhances the language recovery of patients with non-fluent aphasia after a chronic stroke. Auditory comprehension was more preferentially enhanced by iTBS compared with the 1-Hz protocol. Our findings highlight the importance of ipsilesional modulation through excitatory rTMS for the recovery of non-fluent aphasia in patients with chronic stroke. CLINICAL TRIAL REGISTRATION [www.ClinicalTrials.gov], identifier [NCT03059225].
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Affiliation(s)
- Ting-Yu Chou
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jia-Chi Wang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Mu-Yun Lin
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Po-Yi Tsai
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Szaflarski JP, Nenert R, Allendorfer JB, Martin AN, Amara AW, Griffis JC, Dietz A, Mark VW, Sung VW, Walker HC, Zhou X, Lindsell CJ. Intermittent Theta Burst Stimulation (iTBS) for Treatment of Chronic Post-Stroke Aphasia: Results of a Pilot Randomized, Double-Blind, Sham-Controlled Trial. Med Sci Monit 2021; 27:e931468. [PMID: 34183640 PMCID: PMC8254416 DOI: 10.12659/msm.931468] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Research indicates intermittent theta burst stimulation (iTBS) is a potential treatment of post-stroke aphasia. Material/Methods In this double-blind, sham-controlled trial (NCT 01512264) participants were randomized to receive 3 weeks of sham (G0), 1 week of iTBS/2 weeks of sham (G1), 2 weeks of iTBS/1 week of sham (G2), or 3 weeks of iTBS (G3). FMRI localized residual language function in the left hemisphere; iTBS was applied to the maximum fMRI activation in the residual language cortex in the left frontal lobe. FMRI and aphasia testing were conducted pre-treatment, at ≤1 week after completing treatment, and at 3 months follow-up. Results 27/36 participants completed the trial. We compared G0 to each of the individual treatment group and to all iTBS treatment groups combined (G1–3). In individual groups, participants gained (of moderate or large effect sizes; some significant at P<0.05) on the Boston Naming Test (BNT), the Semantic Fluency Test (SFT), and the Aphasia Quotient of the Western Aphasia Battery-Revised (WAB-R AQ). In G1–3, BNT, and SFT improved immediately after treatment, while the WAB-R AQ improved at 3 months. Compared to G0, the other groups showed greater fMRI activation in both hemispheres and non-significant increases in language lateralization to the left hemisphere. Changes in IFG connectivity were noted with iTBS, showing differences between time-points, with some of them correlating with the behavioral measures. Conclusions The results of this pilot trial support the hypothesis that iTBS applied to the ipsilesional hemisphere can improve aphasia and result in cortical plasticity.
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Affiliation(s)
- Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rodolphe Nenert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amber N Martin
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amy W Amara
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joseph C Griffis
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Aimee Dietz
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Victor W Mark
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Victor W Sung
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Harrison C Walker
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Xiaohua Zhou
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
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8
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Bao SC, Khan A, Song R, Kai-yu Tong R. Rewiring the Lesioned Brain: Electrical Stimulation for Post-Stroke Motor Restoration. J Stroke 2020; 22:47-63. [PMID: 32027791 PMCID: PMC7005350 DOI: 10.5853/jos.2019.03027] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/03/2020] [Accepted: 01/06/2020] [Indexed: 02/06/2023] Open
Abstract
Electrical stimulation has been extensively applied in post-stroke motor restoration, but its treatment mechanisms are not fully understood. Stimulation of neuromotor control system at multiple levels manipulates the corresponding neuronal circuits and results in neuroplasticity changes of stroke survivors. This rewires the lesioned brain and advances functional improvement. This review addresses the therapeutic mechanisms of different stimulation modalities, such as noninvasive brain stimulation, peripheral electrical stimulation, and other emerging techniques. The existing applications, the latest progress, and future directions are discussed. The use of electrical stimulation to facilitate post-stroke motor recovery presents great opportunities in terms of targeted intervention and easy applicability. Further technical improvements and clinical studies are required to reveal the neuromodulatory mechanisms and to enhance rehabilitation therapy efficiency in stroke survivors and people with other movement disorders.
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Affiliation(s)
- Shi-chun Bao
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong, China
| | - Ahsan Khan
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong, China
| | - Rong Song
- School of Biomedical Engineering, Sun Yat-Sen University, Guangzhou, China
| | - Raymond Kai-yu Tong
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong, China
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9
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Clarke D, Penrose MA, Penstone T, Fuller-Carter PI, Hool LC, Harvey AR, Rodger J, Bates KA. Frequency-specific effects of repetitive magnetic stimulation on primary astrocyte cultures. Restor Neurol Neurosci 2018; 35:557-569. [PMID: 29172007 DOI: 10.3233/rnn-160708] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive technique that uses magnetic pulses over the cranium to induce electrical currents in underlying cortical tissue. Although rTMS has shown clinical utility for a number of neurological conditions, we have only limited understanding of how rTMS influences cellular function and cell-cell interactions. OBJECTIVE In this study, we sought to investigate whether repeated magnetic stimulation (rMS) can influence astrocyte biology in vitro. METHOD We tested four different rMS frequencies and measured the calcium response in primary neonatal astrocyte cultures. We also tested the effect of rMS on astrocyte migration and proliferation in vitro. We tested 3 to 4 culture replicates and 17 to 34 cells for each rMS frequency (sham, 1 Hz, cTBS, 10 Hz and biomemetic high frequency stimulation - BHFS). RESULTS Of all frequencies tested, 1 Hz stimulation resulted in a statistically significant rise in intracellular calcium in the cytoplasmic and nuclear compartments of the cultured astrocytes. This calcium rise did not affect migration or proliferation in the scratch assay, though astrocyte hypertrophy was reduced in response to 1 Hz rMS, 24 hours post scratch injury. CONCLUSION Our results provide preliminary evidence that rMS can influence astrocyte physiology, indicating the potential for a novel mechanism by which rTMS can influence brain activity.
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Affiliation(s)
- Darren Clarke
- School of Biological Sciences, The University of Western Australia, Perth, Crawley, WA, Australia.,School of Human Sciences, The University of Western Australia, Perth, Crawley, WA, Australia
| | - Marissa A Penrose
- School of Biological Sciences, The University of Western Australia, Perth, Crawley, WA, Australia
| | - Tamasin Penstone
- School of Biological Sciences, The University of Western Australia, Perth, Crawley, WA, Australia
| | - Paula I Fuller-Carter
- School of Biological Sciences, The University of Western Australia, Perth, Crawley, WA, Australia
| | - Livia C Hool
- School of Human Sciences, The University of Western Australia, Perth, Crawley, WA, Australia.,Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
| | - Alan R Harvey
- School of Human Sciences, The University of Western Australia, Perth, Crawley, WA, Australia.,Perron Institute for Neurological and Translational Science, Perth, WA, Australia
| | - Jennifer Rodger
- School of Biological Sciences, The University of Western Australia, Perth, Crawley, WA, Australia.,Perron Institute for Neurological and Translational Science, Perth, WA, Australia
| | - Kristyn A Bates
- School of Biological Sciences, The University of Western Australia, Perth, Crawley, WA, Australia
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10
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Cha HG, Kim MK. Effects of strengthening exercise integrated repetitive transcranial magnetic stimulation on motor function recovery in subacute stroke patients: A randomized controlled trial. Technol Health Care 2018; 25:521-529. [PMID: 28106573 DOI: 10.3233/thc-171294] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the effects of strengthening exercise integrated repetitive transcranial magnetic stimulation (rTMS) on motor function recovery in subacute stroke patients. SUBJECTS AND METHODS Thirty subacute stroke patients were randomly assigned to three groups: an ankle strengthening exercise group (group I), ankle strengthening exercise integrated rTMS group (group II), or an rTMS group (control group (CG)). Study subjects received therapy five days per week for eight weeks. Motor-evoked potential testing, peak torque at the ankle joint, and 10 m walk test were performed before and after the eight-week treatment period. RESULTS Subjects in group II showed significantly higher amplitude of MEP, plantarflexor and dorsiflexor of peak torque, 10 m walk test than groups I and CG (p < 0.05). Subjects in groups I and II differed significantly in the pre- and post-test for all variables, (p < 0.05). In the CG group, the pre- and post-test scores for the amplitude of MEP, dorsiflexor, and 10-walk test differed significantly (p < 0.05). CONCLUSIONS Strengthening exercise integrated rTMS has positive effects on motor function recovery in subacute stroke patients.
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Affiliation(s)
- Hyun Gyu Cha
- Department of Physical Therapy, College of Tourism and Health Science, Joongbu University, Chungnam, Keumsan, Korea
| | - Myoung Kwon Kim
- Department of Physical Therapy, College of Rehabilitation Sciences, Daegu University, Jillyang, Gyeongsan, Gyeongbuk, Korea
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11
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Lee YJ, Seo TH, Lee S, Jang W, Kim MJ, Sung JS. Neuronal differentiation of human mesenchymal stem cells in response to the domain size of graphene substrates. J Biomed Mater Res A 2017; 106:43-51. [DOI: 10.1002/jbm.a.36215] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 08/10/2017] [Accepted: 08/24/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Yoo-Jung Lee
- Department of Life Science; Dongguk University; Goyang Gyeonggi-do 10326 Republic of Korea
| | - Tae Hoon Seo
- Applied Quantum Composites Research Center; Korea Institute of Science and Technology; Jeonbuk 565-905 Republic of Korea
| | - Seula Lee
- Applied Quantum Composites Research Center; Korea Institute of Science and Technology; Jeonbuk 565-905 Republic of Korea
| | - Wonhee Jang
- Department of Life Science; Dongguk University; Goyang Gyeonggi-do 10326 Republic of Korea
| | - Myung Jong Kim
- Applied Quantum Composites Research Center; Korea Institute of Science and Technology; Jeonbuk 565-905 Republic of Korea
| | - Jung-Suk Sung
- Department of Life Science; Dongguk University; Goyang Gyeonggi-do 10326 Republic of Korea
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12
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Kremer KL, Smith AE, Sandeman L, Inglis JM, Ridding MC, Koblar SA. Transcranial Magnetic Stimulation of Human Adult Stem Cells in the Mammalian Brain. Front Neural Circuits 2016; 10:17. [PMID: 27013982 PMCID: PMC4794489 DOI: 10.3389/fncir.2016.00017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 03/07/2016] [Indexed: 01/09/2023] Open
Abstract
Introduction: The burden of stroke on the community is growing, and therefore, so is the need for a therapy to overcome the disability following stroke. Cellular-based therapies are being actively investigated at a pre-clinical and clinical level. Studies have reported the beneficial effects of exogenous stem cell implantation, however, these benefits are also associated with limited survival of implanted stem cells. This exploratory study investigated the use of transcranial magnetic stimulation (TMS) as a complementary therapy to increase stem cell survival following implantation of human dental pulp stem cells (DPSC) in the rodent cortex. Methods: Sprague-Dawley rats were anesthetized and injected with 6 × 105 DPSC or control media via an intracranial injection, and then received real TMS (TMS0.2 Hz) or sham TMS (TMSsham) every 2nd day beginning on day 3 post DPSC injection for 2 weeks. Brain sections were analyzed for the survival, migration and differentiation characteristics of the implanted cells. Results: In animals treated with DPSC and TMS0.2 Hz there were significantly less implanted DPSC and those that survived remained in the original cerebral hemisphere compared to animals that received TMSsham. The surviving implanted DPSC in TMS0.2 Hz were also found to express the apoptotic marker Caspase-3. Conclusions: We suggest that TMS at this intensity may cause an increase in glutamate levels, which promotes an unfavorable environment for stem cell implantation, proliferation and differentiation. It should be noted that only one paradigm of TMS was tested as this was conducted as a exploratory study, and further TMS paradigms should be investigated in the future.
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Affiliation(s)
- Karlea L Kremer
- School of Paediatrics and Reproductive Health, The Robinson Research Institute, The University of AdelaideAdelaide, SA, Australia; School of Medicine, The Stroke Research Programme, The University of AdelaideAdelaide, SA, Australia
| | - Ashleigh E Smith
- School of Paediatrics and Reproductive Health, The Robinson Research Institute, The University of AdelaideAdelaide, SA, Australia; Alliance for Research in Exercise Nutrition and Activity (ARENA), School of Health Science, Sansom Institute for Health Research, University of South AustraliaAdelaide, SA, Australia
| | - Lauren Sandeman
- School of Paediatrics and Reproductive Health, The Robinson Research Institute, The University of AdelaideAdelaide, SA, Australia; School of Medicine, The Stroke Research Programme, The University of AdelaideAdelaide, SA, Australia
| | - Joshua M Inglis
- School of Paediatrics and Reproductive Health, The Robinson Research Institute, The University of AdelaideAdelaide, SA, Australia; School of Medicine, The Stroke Research Programme, The University of AdelaideAdelaide, SA, Australia
| | - Michael C Ridding
- School of Paediatrics and Reproductive Health, The Robinson Research Institute, The University of Adelaide Adelaide, SA, Australia
| | - Simon A Koblar
- School of Paediatrics and Reproductive Health, The Robinson Research Institute, The University of AdelaideAdelaide, SA, Australia; School of Medicine, The Stroke Research Programme, The University of AdelaideAdelaide, SA, Australia
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13
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Volz LJ, Rehme AK, Michely J, Nettekoven C, Eickhoff SB, Fink GR, Grefkes C. Shaping Early Reorganization of Neural Networks Promotes Motor Function after Stroke. Cereb Cortex 2016; 26:2882-2894. [PMID: 26980614 PMCID: PMC4869817 DOI: 10.1093/cercor/bhw034] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Neural plasticity is a major factor driving cortical reorganization after stroke. We here tested whether repetitively enhancing motor cortex plasticity by means of intermittent theta-burst stimulation (iTBS) prior to physiotherapy might promote recovery of function early after stroke. Functional magnetic resonance imaging (fMRI) was used to elucidate underlying neural mechanisms. Twenty-six hospitalized, first-ever stroke patients (time since stroke: 1–16 days) with hand motor deficits were enrolled in a sham-controlled design and pseudo-randomized into 2 groups. iTBS was administered prior to physiotherapy on 5 consecutive days either over ipsilesional primary motor cortex (M1-stimulation group) or parieto-occipital vertex (control-stimulation group). Hand motor function, cortical excitability, and resting-state fMRI were assessed 1 day prior to the first stimulation and 1 day after the last stimulation. Recovery of grip strength was significantly stronger in the M1-stimulation compared to the control-stimulation group. Higher levels of motor network connectivity were associated with better motor outcome. Consistently, control-stimulated patients featured a decrease in intra- and interhemispheric connectivity of the motor network, which was absent in the M1-stimulation group. Hence, adding iTBS to prime physiotherapy in recovering stroke patients seems to interfere with motor network degradation, possibly reflecting alleviation of post-stroke diaschisis.
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Affiliation(s)
- L J Volz
- Department of Neurology, University Hospital Cologne, Cologne, Germany.,Department of Psychological and Brain Sciences, University of California, Santa Barbara, CA, USA.,Max Planck Institute for Neurological Research, Cologne, Germany
| | - A K Rehme
- Department of Neurology, University Hospital Cologne, Cologne, Germany.,Max Planck Institute for Neurological Research, Cologne, Germany
| | - J Michely
- Department of Neurology, University Hospital Cologne, Cologne, Germany.,Max Planck Institute for Neurological Research, Cologne, Germany
| | - C Nettekoven
- Max Planck Institute for Neurological Research, Cologne, Germany.,Institute of Neurosciences and Medicine (INM-1, INM-3), Juelich Research Centre, Germany
| | - S B Eickhoff
- Institute of Neurosciences and Medicine (INM-1, INM-3), Juelich Research Centre, Germany.,Institute for Clinical Neuroscience, Heinrich-Heine-University, Duesseldorf, Germany
| | - G R Fink
- Department of Neurology, University Hospital Cologne, Cologne, Germany.,Institute of Neurosciences and Medicine (INM-1, INM-3), Juelich Research Centre, Germany
| | - C Grefkes
- Department of Neurology, University Hospital Cologne, Cologne, Germany.,Max Planck Institute for Neurological Research, Cologne, Germany.,Institute of Neurosciences and Medicine (INM-1, INM-3), Juelich Research Centre, Germany
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14
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Abstract
Stroke is a dramatic event and is associated with potentially severe consequences, including disability, mortality, and social costs. Stroke may occur at any age; however, most strokes occur in individuals aged 65 years and older. Previous research has found that stroke increases suicide risk, especially among women and younger patients. The aim of the current review is to investigate the relationship between suicide and stroke in order to determine which stroke patients are at elevated risk for suicide. Moreover, we review the literature in order to provide pharmacological treatment strategies for stroke patients at high risk of suicide. We performed a careful search to identify articles and book chapters focused on this issue, selecting only English-language articles published from 1990 to 2014 that addressed the issue of suicide after stroke and its pharmacological management. We found 12 clinical trials that explored the relationship between stroke and suicidal ideation and/or suicidal plans and 11 investigating suicide as the cause of death after stroke. We identified stroke as a significant risk factor for both suicide and suicidal ideation, especially among younger adult depressed patients in all articles, providing further support for the association between post-stroke and suicidality. Suicide risk is particularly high in the first 5 years following stroke. Depression, previous mood disorder, prior history of stroke, and cognitive impairment were found to be the most important risk factors for suicide. Selective serotonin reuptake inhibitors (SSRIs) represent the treatment of choice for stroke survivors with suicide risk, and studies in rats have suggested that carbolithium is a promising treatment in these patients. Early identification and treatment of post-stroke depression may significantly reduce suicide risk in stroke patients.
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15
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Interhemispheric Plasticity following Intermittent Theta Burst Stimulation in Chronic Poststroke Aphasia. Neural Plast 2016; 2016:4796906. [PMID: 26881111 PMCID: PMC4736997 DOI: 10.1155/2016/4796906] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 11/01/2015] [Accepted: 11/10/2015] [Indexed: 12/31/2022] Open
Abstract
The effects of noninvasive neurostimulation on brain structure and function in chronic poststroke aphasia are poorly understood. We investigated the effects of intermittent theta burst stimulation (iTBS) applied to residual language-responsive cortex in chronic patients using functional and anatomical MRI data acquired before and after iTBS. Lateralization index (LI) analyses, along with comparisons of inferior frontal gyrus (IFG) activation and connectivity during covert verb generation, were used to assess changes in cortical language function. Voxel-based morphometry (VBM) was used to assess effects on regional grey matter (GM). LI analyses revealed a leftward shift in IFG activity after treatment. While left IFG activation increased, right IFG activation decreased. Changes in right to left IFG connectivity during covert verb generation also decreased after iTBS. Behavioral correlations revealed a negative relationship between changes in right IFG activation and improvements in fluency. While anatomical analyses did not reveal statistically significant changes in grey matter volume, the fMRI results provide evidence for changes in right and left IFG function after iTBS. The negative relationship between post-iTBS changes in right IFG activity during covert verb generation and improvements in fluency suggests that iTBS applied to residual left-hemispheric language areas may reduce contralateral responses related to language production and facilitate recruitment of residual language areas after stroke.
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16
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Ljubisavljevic MR, Javid A, Oommen J, Parekh K, Nagelkerke N, Shehab S, Adrian TE. The Effects of Different Repetitive Transcranial Magnetic Stimulation (rTMS) Protocols on Cortical Gene Expression in a Rat Model of Cerebral Ischemic-Reperfusion Injury. PLoS One 2015; 10:e0139892. [PMID: 26431529 PMCID: PMC4592250 DOI: 10.1371/journal.pone.0139892] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 09/18/2015] [Indexed: 02/01/2023] Open
Abstract
Although repetitive Transcranial Magnetic Stimulation (rTMS) in treatment of stroke in humans has been explored over the past decade the data remain controversial in terms of optimal stimulation parameters and the mechanisms of rTMS long-term effects. This study aimed to explore the potential of different rTMS protocols to induce changes in gene expression in rat cortices after acute ischemic-reperfusion brain injury. The stroke was induced by middle cerebral artery occlusion (MCAO) with subsequent reperfusion. Changes in the expression of 96 genes were examined using low-density expression arrays after MCAO alone and after MCAO combined with 1Hz, 5Hz, continuous (cTBS) and intermittent (iTBS) theta-burst rTMS. rTMS over the lesioned hemisphere was given for two weeks (with a 2-day pause) in a single daily session and a total of 2400 pulses. MCAO alone induced significant upregulation in the expression of 44 genes and downregulation in 10. Two weeks of iTBS induced significant increase in the expression of 52 genes. There were no downregulated genes. 1Hz and 5Hz had no significant effects on gene expression, while cTBS effects were negligible. Upregulated genes included those involved in angiogenesis, inflammation, injury response and cellular repair, structural remodeling, neuroprotection, neurotransmission and neuronal plasticity. The results show that long-term rTMS in acute ischemic-reperfusion brain injury induces complex changes in gene expression that span multiple pathways, which generally promote the recovery. They also demonstrate that induced changes primarily depend on the rTMS frequency (1Hz and 5Hz vs. iTBS) and pattern (cTBS vs. iTBS). The results further underlines the premise that one of the benefits of rTMS application in stroke may be to prime the brain, enhancing its potential to cope with the injury and to rewire. This could further augment its potential to favorably respond to rehabilitation, and to restore some of the loss functions.
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Affiliation(s)
- Milos R. Ljubisavljevic
- Department of Physiology, College of Medicine and Health Sciences, UAE University, Al Ain, UAE
- * E-mail:
| | - Asma Javid
- Department of Physiology, College of Medicine and Health Sciences, UAE University, Al Ain, UAE
| | - Joji Oommen
- Department of Physiology, College of Medicine and Health Sciences, UAE University, Al Ain, UAE
| | - Khatija Parekh
- Department of Physiology, College of Medicine and Health Sciences, UAE University, Al Ain, UAE
| | - Nico Nagelkerke
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, College of Medicine, Blantyre, Malawi
- Department of Community Medicine, College of Medicine and Health Sciences, UAE University, Al Ain, UAE
| | - Safa Shehab
- Department of Anatomy, College of Medicine and Health Sciences, UAE University, Al Ain, UAE
| | - Thomas E. Adrian
- Department of Physiology, College of Medicine and Health Sciences, UAE University, Al Ain, UAE
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