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Spampinato DA, Ibanez J, Rocchi L, Rothwell J. Motor potentials evoked by transcranial magnetic stimulation: interpreting a simple measure of a complex system. J Physiol 2023; 601:2827-2851. [PMID: 37254441 PMCID: PMC10952180 DOI: 10.1113/jp281885] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 05/18/2023] [Indexed: 06/01/2023] Open
Abstract
Transcranial magnetic stimulation (TMS) is a non-invasive technique that is increasingly used to study the human brain. One of the principal outcome measures is the motor-evoked potential (MEP) elicited in a muscle following TMS over the primary motor cortex (M1), where it is used to estimate changes in corticospinal excitability. However, multiple elements play a role in MEP generation, so even apparently simple measures such as peak-to-peak amplitude have a complex interpretation. Here, we summarize what is currently known regarding the neural pathways and circuits that contribute to the MEP and discuss the factors that should be considered when interpreting MEP amplitude measured at rest in the context of motor processing and patients with neurological conditions. In the last part of this work, we also discuss how emerging technological approaches can be combined with TMS to improve our understanding of neural substrates that can influence MEPs. Overall, this review aims to highlight the capabilities and limitations of TMS that are important to recognize when attempting to disentangle sources that contribute to the physiological state-related changes in corticomotor excitability.
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Affiliation(s)
- Danny Adrian Spampinato
- Department of Clinical and Movement NeurosciencesUniversity College LondonLondonUK
- Department of Human NeurosciencesSapienza University of RomeRomeItaly
- Department of Clinical and Behavioral NeurologyIRCCS Santa Lucia FoundationRomeItaly
| | - Jaime Ibanez
- Department of Clinical and Movement NeurosciencesUniversity College LondonLondonUK
- BSICoS group, I3A Institute and IIS AragónUniversity of ZaragozaZaragozaSpain
- Department of Bioengineering, Centre for NeurotechnologiesImperial College LondonLondonUK
| | - Lorenzo Rocchi
- Department of Clinical and Movement NeurosciencesUniversity College LondonLondonUK
- Department of Medical Sciences and Public HealthUniversity of CagliariCagliariItaly
| | - John Rothwell
- Department of Clinical and Movement NeurosciencesUniversity College LondonLondonUK
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Cirillo G, Pepe R, Siciliano M, Ippolito D, Ricciardi D, de Stefano M, Buonanno D, Atripaldi D, Abbadessa S, Perfetto B, Sharbafshaaer M, Sepe G, Bonavita S, Iavarone A, Todisco V, Papa M, Tedeschi G, Esposito S, Trojsi F. Long-Term Neuromodulatory Effects of Repetitive Transcranial Magnetic Stimulation (rTMS) on Plasmatic Matrix Metalloproteinases (MMPs) Levels and Visuospatial Abilities in Mild Cognitive Impairment (MCI). Int J Mol Sci 2023; 24:ijms24043231. [PMID: 36834642 PMCID: PMC9961904 DOI: 10.3390/ijms24043231] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/25/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation technique that is used against cognitive impairment in mild cognitive impairment (MCI) and Alzheimer's disease (AD). However, the neurobiological mechanisms underlying the rTMS therapeutic effects are still only partially investigated. Maladaptive plasticity, glial activation, and neuroinflammation, including metalloproteases (MMPs) activation, might represent new potential targets of the neurodegenerative process and progression from MCI to AD. In this study, we aimed to evaluate the effects of bilateral rTMS over the dorsolateral prefrontal cortex (DLPFC) on plasmatic levels of MMP1, -2, -9, and -10; MMPs-related tissue inhibitors TIMP1 and TIMP2; and cognitive performances in MCI patients. Patients received high-frequency (10 Hz) rTMS (MCI-TMS, n = 9) or sham stimulation (MCI-C, n = 9) daily for four weeks, and they were monitored for six months after TMS. The plasmatic levels of MMPs and TIMPs and the cognitive and behavioral scores, based on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Beck Depression Inventory II, Beck Anxiety Inventory, and Apathy Evaluation Scale, were assessed at baseline (T0) and after 1 month (T1) and 6 months (T2) since rTMS. In the MCI-TMS group, at T2, plasmatic levels of MMP1, -9, and -10 were reduced and paralleled by increased plasmatic levels of TIMP1 and TIMP2 and improvement of visuospatial performances. In conclusion, our findings suggest that targeting DLPFC by rTMS might result in the long-term modulation of the MMPs/TIMPs system in MCI patients and the neurobiological mechanisms associated with MCI progression to dementia.
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Affiliation(s)
- Giovanni Cirillo
- Neuronal Networks Morphology & Systems Biology Lab, Division of Human Anatomy, Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
- Correspondence:
| | - Roberta Pepe
- First Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Mattia Siciliano
- First Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Domenico Ippolito
- First Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
- Neurologic Unit, Centro Traumatologico Ortopedico (CTO) Hospital, Azienda Ospedaliera di Rilievo Nazionale (AORN) “Ospedali Dei Colli”, 80138 Naples, Italy
| | - Dario Ricciardi
- First Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Manuela de Stefano
- First Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Daniela Buonanno
- First Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Danilo Atripaldi
- First Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Salvatore Abbadessa
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Brunella Perfetto
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Minoo Sharbafshaaer
- First Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Giovanna Sepe
- Neuronal Networks Morphology & Systems Biology Lab, Division of Human Anatomy, Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Simona Bonavita
- First Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Alessandro Iavarone
- Neurologic Unit, Centro Traumatologico Ortopedico (CTO) Hospital, Azienda Ospedaliera di Rilievo Nazionale (AORN) “Ospedali Dei Colli”, 80138 Naples, Italy
| | - Vincenzo Todisco
- First Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Michele Papa
- Neuronal Networks Morphology & Systems Biology Lab, Division of Human Anatomy, Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Gioacchino Tedeschi
- First Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Sabrina Esposito
- First Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Francesca Trojsi
- First Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
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Esposito S, Trojsi F, Cirillo G, de Stefano M, Di Nardo F, Siciliano M, Caiazzo G, Ippolito D, Ricciardi D, Buonanno D, Atripaldi D, Pepe R, D’Alvano G, Mangione A, Bonavita S, Santangelo G, Iavarone A, Cirillo M, Esposito F, Sorbi S, Tedeschi G. Repetitive Transcranial Magnetic Stimulation (rTMS) of Dorsolateral Prefrontal Cortex May Influence Semantic Fluency and Functional Connectivity in Fronto-Parietal Network in Mild Cognitive Impairment (MCI). Biomedicines 2022; 10:biomedicines10050994. [PMID: 35625731 PMCID: PMC9138229 DOI: 10.3390/biomedicines10050994] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/17/2022] [Accepted: 04/20/2022] [Indexed: 12/28/2022] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive neuromodulation technique that is increasingly used as a nonpharmacological intervention against cognitive impairment in Alzheimer’s disease (AD) and other dementias. Although rTMS has been shown to modify cognitive performances and brain functional connectivity (FC) in many neurological and psychiatric diseases, there is still no evidence about the possible relationship between executive performances and resting-state brain FC following rTMS in patients with mild cognitive impairment (MCI). In this preliminary study, we aimed to evaluate the possible effects of rTMS of the bilateral dorsolateral prefrontal cortex (DLPFC) in 27 MCI patients randomly assigned to two groups: one group received high-frequency (10 Hz) rTMS (HF-rTMS) for four weeks (n = 11), and the other received sham stimulation (n = 16). Cognitive and psycho-behavior scores, based on the Repeatable Battery for the Assessment of Neuropsychological Status, Beck Depression Inventory-II, Beck Anxiety Inventory, Apathy Evaluation Scale, and brain FC, evaluated by independent component analysis of resting state functional MRI (RS-fMRI) networks, together with the assessment of regional atrophy measures, evaluated by whole-brain voxel-based morphometry (VBM), were measured at baseline, after five weeks, and six months after rTMS stimulation. Our results showed significantly increased semantic fluency (p = 0.026) and visuo-spatial (p = 0.014) performances and increased FC within the salience network (p ≤ 0.05, cluster-level corrected) at the short-term timepoint, and increased FC within the left fronto-parietal network (p ≤ 0.05, cluster-level corrected) at the long-term timepoint, in the treated group but not in the sham group. Conversely, regional atrophy measures did not show significant longitudinal changes between the two groups across six months. Our preliminary findings suggest that targeting DLPFC by rTMS application may lead to a significant long-term increase in FC in MCI patients in a RS network associated with executive functions, and this process might counteract the progressive cortical dysfunction affecting this domain.
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Affiliation(s)
- Sabrina Esposito
- First Division of Neurology, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy; (S.E.); (M.d.S.); (D.I.); (D.R.); (D.B.); (G.D.); (G.T.)
| | - Francesca Trojsi
- First Division of Neurology, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy; (S.E.); (M.d.S.); (D.I.); (D.R.); (D.B.); (G.D.); (G.T.)
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy; (F.D.N.); (M.S.); (G.C.); (D.A.); (R.P.); (A.M.); (S.B.); (M.C.); (F.E.)
- Correspondence: ; Tel.: +39-08-1566-5659
| | - Giovanni Cirillo
- Division of Human Anatomy, Laboratory of Morphology of Neuronal Networks & Systems Biology, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, 80138 Naples, Italy;
| | - Manuela de Stefano
- First Division of Neurology, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy; (S.E.); (M.d.S.); (D.I.); (D.R.); (D.B.); (G.D.); (G.T.)
| | - Federica Di Nardo
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy; (F.D.N.); (M.S.); (G.C.); (D.A.); (R.P.); (A.M.); (S.B.); (M.C.); (F.E.)
| | - Mattia Siciliano
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy; (F.D.N.); (M.S.); (G.C.); (D.A.); (R.P.); (A.M.); (S.B.); (M.C.); (F.E.)
| | - Giuseppina Caiazzo
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy; (F.D.N.); (M.S.); (G.C.); (D.A.); (R.P.); (A.M.); (S.B.); (M.C.); (F.E.)
| | - Domenico Ippolito
- First Division of Neurology, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy; (S.E.); (M.d.S.); (D.I.); (D.R.); (D.B.); (G.D.); (G.T.)
| | - Dario Ricciardi
- First Division of Neurology, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy; (S.E.); (M.d.S.); (D.I.); (D.R.); (D.B.); (G.D.); (G.T.)
| | - Daniela Buonanno
- First Division of Neurology, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy; (S.E.); (M.d.S.); (D.I.); (D.R.); (D.B.); (G.D.); (G.T.)
| | - Danilo Atripaldi
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy; (F.D.N.); (M.S.); (G.C.); (D.A.); (R.P.); (A.M.); (S.B.); (M.C.); (F.E.)
| | - Roberta Pepe
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy; (F.D.N.); (M.S.); (G.C.); (D.A.); (R.P.); (A.M.); (S.B.); (M.C.); (F.E.)
| | - Giulia D’Alvano
- First Division of Neurology, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy; (S.E.); (M.d.S.); (D.I.); (D.R.); (D.B.); (G.D.); (G.T.)
| | - Antonella Mangione
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy; (F.D.N.); (M.S.); (G.C.); (D.A.); (R.P.); (A.M.); (S.B.); (M.C.); (F.E.)
| | - Simona Bonavita
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy; (F.D.N.); (M.S.); (G.C.); (D.A.); (R.P.); (A.M.); (S.B.); (M.C.); (F.E.)
| | - Gabriella Santangelo
- Department of Psychology, University of Campania Luigi Vanvitelli, 81100 Caserta, Italy;
| | - Alessandro Iavarone
- Neurological Unit, CTO Hospital, AORN Ospedali Dei Colli, 80131 Naples, Italy;
| | - Mario Cirillo
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy; (F.D.N.); (M.S.); (G.C.); (D.A.); (R.P.); (A.M.); (S.B.); (M.C.); (F.E.)
| | - Fabrizio Esposito
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy; (F.D.N.); (M.S.); (G.C.); (D.A.); (R.P.); (A.M.); (S.B.); (M.C.); (F.E.)
| | - Sandro Sorbi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy;
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, 50134 Florence, Italy
| | - Gioacchino Tedeschi
- First Division of Neurology, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy; (S.E.); (M.d.S.); (D.I.); (D.R.); (D.B.); (G.D.); (G.T.)
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy; (F.D.N.); (M.S.); (G.C.); (D.A.); (R.P.); (A.M.); (S.B.); (M.C.); (F.E.)
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