1
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Tedeschi R. Neuroplastic training-movement therapy: managing dystonia. Neurol Sci 2024:10.1007/s10072-024-07680-9. [PMID: 38977628 DOI: 10.1007/s10072-024-07680-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 06/28/2024] [Indexed: 07/10/2024]
Affiliation(s)
- Roberto Tedeschi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Via Zamboni 33, Bologna, 40126, Italy.
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2
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Frey J, Ramirez-Zamora A, Wagle Shukla A. Applications of Transcranial Magnetic Stimulation for Understanding and Treating Dystonia. ADVANCES IN NEUROBIOLOGY 2023; 31:119-139. [PMID: 37338699 DOI: 10.1007/978-3-031-26220-3_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Transcranial magnetic stimulation (TMS)-based studies have led to an advanced understanding of the pathophysiology of dystonia. This narrative review summarizes the TMS data contributed to the literature so far. Many studies have shown that increased motor cortex excitability, excessive sensorimotor plasticity, and abnormal sensorimotor integration are the core pathophysiological substrates for dystonia. However, an increasing body of evidence supports a more widespread network dysfunction involving many other brain regions. Repetitive TMS pulses (rTMS) in dystonia have therapeutic potential as they can induce local and network-wide effects through modulation of excitability and plasticity. The bulk of rTMS studies has targeted the premotor cortex with some promising results in focal hand dystonia. Some studies have targeted the cerebellum for cervical dystonia and the anterior cingulate cortex for blepharospasm. We believe that therapeutic potential could be leveraged better when rTMS is implemented in conjunction with standard-of-care pharmacological treatments. However, due to several limitations in the studies conducted to date, including small samples, heterogeneous populations, variability in the target sites, and inconsistencies in the study design and control arm, it is hard to draw a definite conclusion. Further studies are warranted to determine optimal targets and protocols yielding the most beneficial outcomes that will translate into meaningful clinical changes.
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Affiliation(s)
- Jessica Frey
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Adolfo Ramirez-Zamora
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Aparna Wagle Shukla
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA.
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3
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Somaa FA, de Graaf TA, Sack AT. Transcranial Magnetic Stimulation in the Treatment of Neurological Diseases. Front Neurol 2022; 13:793253. [PMID: 35669870 PMCID: PMC9163300 DOI: 10.3389/fneur.2022.793253] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/25/2022] [Indexed: 12/16/2022] Open
Abstract
Transcranial Magnetic Stimulation (TMS) has widespread use in research and clinical application. For psychiatric applications, such as depression or OCD, repetitive TMS protocols (rTMS) are an established and globally applied treatment option. While promising, rTMS is not yet as common in treating neurological diseases, except for neurorehabilitation after (motor) stroke and neuropathic pain treatment. This may soon change. New clinical studies testing the potential of rTMS in various other neurological conditions appear at a rapid pace. This can prove challenging for both practitioners and clinical researchers. Although most of these neurological applications have not yet received the same level of scientific/empirical scrutiny as motor stroke and neuropathic pain, the results are encouraging, opening new doors for TMS in neurology. We here review the latest clinical evidence for rTMS in pioneering neurological applications including movement disorders, Alzheimer's disease/mild cognitive impairment, epilepsy, multiple sclerosis, and disorders of consciousness.
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Affiliation(s)
- Fahad A. Somaa
- Department of Occupational Therapy, Faculty of Medical Rehabilitation, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Tom A. de Graaf
- Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
- Center of Integrative Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Alexander T. Sack
- Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
- Center of Integrative Neuroscience, Maastricht University, Maastricht, Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Brain + Nerve Centre, Maastricht University Medical Centre+, Maastricht, Netherlands
- *Correspondence: Alexander T. Sack
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4
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Ferrazzoli D, Ortelli P, Iansek R, Volpe D. Rehabilitation in movement disorders: From basic mechanisms to clinical strategies. HANDBOOK OF CLINICAL NEUROLOGY 2022; 184:341-355. [PMID: 35034747 DOI: 10.1016/b978-0-12-819410-2.00019-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Movement disorders encompass a variety of conditions affecting the nervous system at multiple levels. The pathologic processes underlying movement disorders alter the normal neural functions and could lead to aberrant neuroplastic changes and to clinical phenomenology that is not expressed only through mere motor symptoms. Given this complexity, the responsiveness to pharmacologic and surgical therapies is often disappointing. Growing evidence supports the efficacy of neurorehabilitation for the treatment of movement disorders. Specific form of training involving both goal-based practice and aerobic training could drive and modulate neuroplasticity in order to restore the circuitries dysfunctions and to achieve behavioral gains. This chapter provides an overview of the alterations expressed in some movement disorders in terms of clinical signs and symptoms and plasticity, and suggests which ones and why tailored rehabilitation strategies should be adopted for the management of the different movement disorders.
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Affiliation(s)
- Davide Ferrazzoli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy; Department of Parkinson's Disease, Fresco Parkinson Center, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital-Gravedona ed Uniti, Como, Italy
| | - Paola Ortelli
- Department of Parkinson's Disease, Fresco Parkinson Center, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital-Gravedona ed Uniti, Como, Italy; Department of Parkinson's Disease, Fresco Parkinson Center, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital-Gravedona ed Uniti, Como, Italy
| | - Robert Iansek
- Clinical Research Centre for Movement Disorders and Gait, National Parkinson Foundation Center of Excellence, Monash Health, Cheltenham, VIC, Australia; School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Daniele Volpe
- Department of Rehabilitation, Fresco Parkinson Center, Villa Margherita, S. Stefano Riabilitazione, Vicenza, Italy
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5
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Ortelli P, Ferrazzoli D, Maestri R, Saltuari L, Kofler M, Alibardi A, Koch G, Spampinato D, Castagna A, Sebastianelli L, Versace V. Experimental Protocol to Test Explicit Motor Learning–Cerebellar Theta Burst Stimulation. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:720184. [PMID: 36188833 PMCID: PMC9397715 DOI: 10.3389/fresc.2021.720184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/05/2021] [Indexed: 11/13/2022]
Abstract
Implicit and explicit motor learning processes work interactively in everyday life to promote the creation of highly automatized motor behaviors. The cerebellum is crucial for motor sequence learning and adaptation, as it contributes to the error correction and to sensorimotor integration of on-going actions. A non-invasive cerebellar stimulation has been demonstrated to modulate implicit motor learning and adaptation. The present study aimed to explore the potential role of cerebellar theta burst stimulation (TBS) in modulating explicit motor learning and adaptation, in healthy subjects. Cerebellar TBS will be applied immediately before the learning phase of a computerized task based on a modified Serial Reaction Time Task (SRTT) paradigm. Here, we present a study protocol aimed at evaluating the behavioral effects of continuous (cTBS), intermittent TBS (iTBS), or sham Theta Burst Stimulation (TBS) on four different conditions: learning, adaptation, delayed recall and re-adaptation of SRTT. We are confident to find modulation of SRTT performance induced by cerebellar TBS, in particular, processing acceleration and reduction of error in all the conditions induced by cerebellar iTBS, as already known for implicit processes. On the other hand, we expect that cerebellar cTBS could induce opposite effects. Results from this protocol are supposed to advance the knowledge about the role of non-invasive cerebellar modulation in neurorehabilitation, providing clinicians with useful data for further exploiting this technique in different clinical conditions.
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Affiliation(s)
- Paola Ortelli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
- *Correspondence: Paola Ortelli
| | - Davide Ferrazzoli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Roberto Maestri
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Leopold Saltuari
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Markus Kofler
- Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - Alessia Alibardi
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Giacomo Koch
- Non-invasive Brain Stimulation Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Danny Spampinato
- Non-invasive Brain Stimulation Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
- Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, London, United Kingdom
| | - Anna Castagna
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Luca Sebastianelli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Viviana Versace
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
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Ferrazzoli D, Ortelli P, Volpe D, Cucca A, Versace V, Nardone R, Saltuari L, Sebastianelli L. The Ties That Bind: Aberrant Plasticity and Networks Dysfunction in Movement Disorders-Implications for Rehabilitation. Brain Connect 2021; 11:278-296. [PMID: 33403893 DOI: 10.1089/brain.2020.0971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Movement disorders encompass various conditions affecting the nervous system. The pathological processes underlying movement disorders lead to aberrant synaptic plastic changes, which in turn alter the functioning of large-scale brain networks. Therefore, clinical phenomenology does not only entail motor symptoms but also cognitive and motivational disturbances. The result is the disruption of motor learning and motor behavior. Due to this complexity, the responsiveness to standard therapies could be disappointing. Specific forms of rehabilitation entailing goal-based practice, aerobic training, and the use of noninvasive brain stimulation techniques could "restore" neuroplasticity at motor-cognitive circuitries, leading to clinical gains. This is probably associated with modulations occurring at both molecular (synaptic) and circuitry levels (networks). Several gaps remain in our understanding of the relationships among plasticity and neural networks and how neurorehabilitation could promote clinical gains is still unclear. Purposes: In this review, we outline first the networks involved in motor learning and behavior and analyze which mechanisms link the pathological synaptic plastic changes with these networks' disruption in movement disorders. Therefore, we provide theoretical and practical bases to be applied for treatment in rehabilitation.
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Affiliation(s)
- Davide Ferrazzoli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Paola Ortelli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Daniele Volpe
- Fresco Parkinson Center, Villa Margherita, S. Stefano Riabilitazione, Vicenza, Italy
| | - Alberto Cucca
- Fresco Parkinson Center, Villa Margherita, S. Stefano Riabilitazione, Vicenza, Italy.,Department of Neurology, The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, NYU School of Medicine, New York, New York, USA.,Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Viviana Versace
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Raffaele Nardone
- Department of Neurology, Franz Tappeiner Hospital (SABES-ASDAA), Merano-Meran, Italy.,Department of Neurology, Christian Doppler Medical Center, Paracelsus University Salzburg, Salzburg, Austria
| | - Leopold Saltuari
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Luca Sebastianelli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
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7
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Poydasheva AG, Semenova OV, Suponeva NA, Timerbaeva SL, Piradov MA. [Issues of diagnostic and therapeutic use of transcranial magnetic stimulation in patients with writing cramp]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 120:49-56. [PMID: 33459541 DOI: 10.17116/jnevro202012012149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To study diagnostic and therapeutic values of transcranial magnetic stimulation (TMS) in writing cramp (WC). MATERIAL AND METHODS Twelve right-handed patients with WC were enrolled in the study. All patients underwent low-frequency repetitive TMS (rTMS) of the premotor cortex of contralateral to affected hand hemisphere. The clinical efficacy was assessed using the Writer's Cramp Rating Scale (WCRS) and the Medical Outcomes Study-Short Form (MOS-SF-36). Before and after last rTMS session, motor mapping of Abductor pollicis brevis muscle (APB) was performed using navigated TMS (nTMS). Localization, area, and amplitude-weighted area of the APB muscle cortical representations were compared with the healthy controls. After the rTMS course, the dynamics of the studied parameters was assessed. RESULTS Ten sessions of low-frequency rTMS of premotor cortex reduced the severity of WS clinical symptoms with a duration of effect of at least 1 month (p<0.05). There was no statistically significant difference between the area and the weighted area of cortical muscle representations between patients and healthy controls or in patients before and after rTMS. When assessing the localization of cortical muscle representations, two trends were noted: in 4 patients, the localization remained stable, with a shift in the center of gravity of less than 4 mm; in the other 8 patients, a shift in the center of mass of more than 5 mm was noted. No significant correlation between the stability of the cortical muscle representations (the magnitude of the shift in the center of gravity) and the improvement on the WCRS were found. CONCLUSION The low-frequency rTMS of the premotor cortex of the contralateral to affected hand hemisphere can be used as an adjuvant therapy for WC. The TMS-motor mapping study did not show its diagnostic value.
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Affiliation(s)
| | - O V Semenova
- Vorokhobov City Clinical Hospital No. 67, Moscow, Russia
| | | | | | - M A Piradov
- Research Center of Neurology, Moscow, Russia
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8
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Lefaucheur JP, Damier P, Nizard J, Nguyen JP. The value of non-invasive brain stimulation techniques in treating focal dystonia. Neurophysiol Clin 2020; 50:309-313. [PMID: 33172759 DOI: 10.1016/j.neucli.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/03/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- Jean-Pascal Lefaucheur
- EA4391, Faculté de Santé, UPEC, Créteil, France; Unité de Neurophysiologie Clinique, Hôpital Henri Mondor, APHP, Créteil, France
| | | | - Julien Nizard
- EA4391, Faculté de Santé, UPEC, Créteil, France; Service Douleur, Soins Palliatifs et Support, Ethique Clinique et Laboratoire de Thérapeutique, CHU Nantes, Nantes, France
| | - Jean-Paul Nguyen
- Service Douleur, Soins Palliatifs et Support, Ethique Clinique et Laboratoire de Thérapeutique, CHU Nantes, Nantes, France; Unité de Stimulation Magnétique, Centre d'évaluation et de Traitement de la Douleur, Clinique Bretéché, Groupe Elsan, Nantes, France
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Mantel T, Dresel C, Welte M, Meindl T, Jochim A, Zimmer C, Haslinger B. Altered sensory system activity and connectivity patterns in adductor spasmodic dysphonia. Sci Rep 2020; 10:10179. [PMID: 32576918 PMCID: PMC7311401 DOI: 10.1038/s41598-020-67295-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 05/26/2020] [Indexed: 12/19/2022] Open
Abstract
Adductor-type spasmodic dysphonia (ADSD) manifests in effortful speech temporarily relievable by botulinum neurotoxin type A (BoNT-A). Previously, abnormal structure, phonation-related and resting-state sensorimotor abnormalities as well as peripheral tactile thresholds in ADSD were described. This study aimed at assessing abnormal central tactile processing patterns, their spatial relation with dysfunctional resting-state connectivity, and their BoNT-A responsiveness. Functional MRI in 14/12 ADSD patients before/under BoNT-A effect and 15 controls was performed (i) during automatized tactile stimulus application to face/hand, and (ii) at rest. Between-group differential stimulation-induced activation and resting-state connectivity (regional homogeneity, connectivity strength within selected sensory(motor) networks), as well as within-patient BoNT-A effects on these differences were investigated. Contralateral-to-stimulation overactivity in ADSD before BoNT-A involved primary and secondary somatosensory representations, along with abnormalities in higher-order parietal, insular, temporal or premotor cortices. Dysphonic impairment in ADSD positively associated with left-hemispheric temporal activity. Connectivity was increased within right premotor (sensorimotor network), left primary auditory cortex (auditory network), and regionally reduced at the temporoparietal junction. Activation/connectivity before/after BoNT-A within-patients did not significantly differ. Abnormal ADSD central somatosensory processing supports its significance as common pathophysiologic focal dystonia trait. Abnormal temporal cortex tactile processing and resting-state connectivity might hint at abnormal cross-modal sensory interactions.
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Affiliation(s)
- Tobias Mantel
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse, 22, Munich, Germany
| | - Christian Dresel
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse, 22, Munich, Germany.,Department of Neurology, Johannes Gutenberg University, Langenbeckstrasse, 1, Mainz, Germany
| | - Michael Welte
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse, 22, Munich, Germany
| | - Tobias Meindl
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse, 22, Munich, Germany
| | - Angela Jochim
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse, 22, Munich, Germany
| | - Claus Zimmer
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse, 22, Munich, Germany
| | - Bernhard Haslinger
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse, 22, Munich, Germany.
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10
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de Oliveira Souza C, Goulardins J, Coelho DB, Casagrande S, Conti J, Limongi JCP, Barbosa ER, Monte-Silva K, Tanaka C. Non-invasive brain stimulation and kinesiotherapy for treatment of focal dystonia: Instrumental analysis of three cases. J Clin Neurosci 2020; 76:208-210. [PMID: 32284289 DOI: 10.1016/j.jocn.2020.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/04/2020] [Indexed: 12/31/2022]
Abstract
Dystonia is a disabling movement disorder characterized by co-contraction of antagonist and agonist muscles, leading to abnormal sustained postures and impaired motor control. Cervical Dystonia (CD) and Hand Focal Dystonia (HFD) have been the most common forms of focal dystonia (FD). Do Non-Invasive Brain Neuromodulation (NIBS) such as Transcranial Direct Current Stimulation (tDCS) and repetitive Transcranial Magnetic Stimulation (rTMS) modulate the excitability of the connections between the motor cortical areas and may represent a therapeutic alternative for focal dystonia? Herein, we reported three cases of focal dystonia, two of them with cervical dystonia (CD) and one with hand focal dystonia (HFD), treated with NIBS combined to kinesiotherapy. The patients were daily submitted to 15 sessions of NIBS combined simultaneously with kinesiotherapy. CD patients were treated with tDCS (2 mA, 20 min, over the primary motor cortex), and HFD patient with rTMS (1 Hz, 1200 pulses, 80% of resting motor threshold, over the premotor cortex). For the CD patient's assessment, the Modified Toronto Scale for Cervical Dystonia Assessment (MTS), quiet balance test, and visual postural assessment were applied to observe the therapeutic effects. Quality handwriting analysis, tremor acceleration amplitudes, and the Wrinter's Cramp Rating Scale (WCRS) were used to assess the NIBS effect on HFD symptoms. Patients were evaluated before (pretest), immediately after (posttest), and three months after treatment (retention). NIBS associated with kinesiotherapy produced a long-term improvement of dystonia symptoms in all three patients. rTMS and tDCS associated with kinesiotherapy showed to be useful and safe to relief the dystonia symptoms in individuals with different types of focal dystonia with distinct functional disorders. SIGNIFICANCE: The combined use of these intervention strategies seems to optimize and anticipate satisfactory clinical results in these neurological conditions, characterized by its difficult clinical management.
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Affiliation(s)
- Carolina de Oliveira Souza
- Ambulatório de Neuromodulação da Divisão de Fisioterapia do Instituto Central do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Brazil; Department of Neurology, Hospital das Clínicas, School of Medicine, University of São Paulo, Brazil
| | - Juliana Goulardins
- Ambulatório de Neuromodulação da Divisão de Fisioterapia do Instituto Central do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Brazil; Universidade Nove de Julho, Brazil
| | | | - Sara Casagrande
- Department of Neurology, Hospital das Clínicas, School of Medicine, University of São Paulo, Brazil
| | - Juliana Conti
- Department of Neurology, Hospital das Clínicas, School of Medicine, University of São Paulo, Brazil
| | | | - Egberto Reis Barbosa
- Department of Neurology, Hospital das Clínicas, School of Medicine, University of São Paulo, Brazil
| | - Katia Monte-Silva
- Applied Neuroscience Laboratory, Department of Physical Therapy, Federal University of Pernambuco, Brazil
| | - Clarice Tanaka
- Ambulatório de Neuromodulação da Divisão de Fisioterapia do Instituto Central do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Brazil; Physical Therapy Department, School of Medicine, University of São Paulo, Brazil
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11
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Abstract
The dystonias are a large and heterogenous group of disorders characterized by excessive muscle contractions leading to abnormal postures and/or repetitive movements. Their clinical manifestations vary widely, and there are many potential causes. Despite the heterogeneity, helpful treatments are available for the vast majority of patients. Symptom-based therapies include oral medications, botulinum toxins, and surgical interventions. For some subtypes of dystonia, specific mechanism-based treatments are available. Advances in understanding the biological basis for many types of dystonia have led to numerous recent clinical trials, so additional treatments are likely to become available in the very near future.
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12
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Poydasheva AG, Semenova OV, Suponeva NA, Timerbaeva SL, Piradov MA. [Diagnostic and therapeutic issues of using transcranial magnetic stimulation in patients with writer's cramp]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:22-29. [PMID: 31793539 DOI: 10.17116/jnevro201911910122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To assess diagnostic and therapeutic values of transcranial magnetic stimulation (TMS) in patients with writer's cramp (WC). MATERIAL AND METHODS Twelve right-handed patients with WC were enrolled in the study. All patients underwent low-frequency repetitive TMS (rTMS) over the premotor cortex of the hemisphere contralateral to the affected hand. The clinical efficacy was assessed using the Writer's Cramp Rating Scale (WCRS) and the Medical Outcomes Study-Short Form (MOS-SF-36). Before and after the last rTMS session, motor mapping of abductor pollicis brevis muscle (APB) was performed using navigated TMS (nTMS). Localization, area, and amplitude-weighted area of the APB muscle cortical representations were compared with the healthy controls. The dynamics of the mentioned above parameters after the rTMS course was assessed. RESULTS Ten sessions of low-frequency rTMS over premotor cortex reduced the severity of WC clinical symptoms, with a duration of effect of at least 1 month (p<0.05). There was no significant difference between the area and the weighted area of cortical muscle representations between patients and healthy controls or in patients before and after rTMS. When assessing the localization of cortical muscle representations, two trends were noted: in 4 patients, the localization remained stable, with a shift in the center of gravity of less than 4 mm; in the other 8 patients, a shift in the center of gravity of more than 5 mm was noted. No significant correlations between the stability of the cortical muscle representations (the magnitude of the shift in the center of gravity) and the improvement on the WCRS scale were found. CONCLUSION The low-frequency rTMS over the premotor cortex of the hemisphere contralateral to the affected hand can be used as an adjuvant therapy for WC. The TMS-motor mapping study did not show its diagnostic value.
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Affiliation(s)
| | - O V Semenova
- Vorokhobov City Clinical Hospital #67, Moscow, Russia
| | | | - S L Timerbaeva
- Federal State Hospital for Treatment and Rehabilitation, Moscow, Russia
| | - M A Piradov
- Research Center of Neurology, Moscow, Russia
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13
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Naro A, Billeri L, Portaro S, Bramanti P, Calabrò RS. Lasting Effects of Low-Frequency Repetitive Transcranial Magnetic Stimulation in Writer's Cramp: A Case Report. Front Hum Neurosci 2019; 13:314. [PMID: 31619978 PMCID: PMC6759570 DOI: 10.3389/fnhum.2019.00314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/22/2019] [Indexed: 12/14/2022] Open
Abstract
The treatment of writer’s cramp (W’sC) is essentially based on the use of botulinum toxin. However, additional treatments are sometime required to prolong the effects of the toxin, compensate for its progressive loss of efficacy in some subjects, and re-educate handwriting (e.g., rehabilitation strategies). Low-frequency repetitive transcranial magnetic stimulation (rTMS) has been employed to improve W’sC, but with short-lasting and controversial outcomes. We report on the effects of a long-lasting low-frequency rTMS paradigm on W’sC symptoms. A 25-year-old male with a diagnosis of simple W’sC was enrolled in the study. He underwent an objective assessment using the Writer’s Cramp Rating Scale (WCRS) and the 1-min writing test. Further, we recorded muscle activation of the upper limb during handwriting using an EMG wireless system. The patient was provided with 1,200 biphasic magnetic pulses delivered at 1 Hz over the left premotor cortex (PMC), 15 times scheduled every 2 days, thus covering a period of 5 weeks, followed by 10 days of rest. This block of stimulations was practiced other four times, for a period of 6 months. The patient showed a gradual clinical improvement with the progression of the treatments. W’sC symptoms totally disappeared and all the clinical scores showed a significant improvement after rTMS completion. Such improvement lasted up to 1 year after the end of the treatment. Moreover, we detected a long-lasting improvement in sensorimotor plasticity as measured by a paired associative stimulation protocol. Our case suggests that the long-lasting application of 1 Hz rTMS to PMC is a safe and potentially valuable tool to improve W’sC symptoms enduringly, probably by reverting maladaptive plasticity mechanisms within the sensory-motor areas of the hemisphere contralateral to the dystonic hand.
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Affiliation(s)
- Antonino Naro
- Behavioral and Robotic Neurorehabilitation Unit, IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | - Luana Billeri
- Behavioral and Robotic Neurorehabilitation Unit, IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | - Simona Portaro
- Behavioral and Robotic Neurorehabilitation Unit, IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | - Placido Bramanti
- Behavioral and Robotic Neurorehabilitation Unit, IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | - Rocco Salvatore Calabrò
- Behavioral and Robotic Neurorehabilitation Unit, IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
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Motor and Perceptual Recovery in Adult Patients with Mild Intellectual Disability. Neural Plast 2018. [PMID: 29849555 DOI: 10.1155/2018/3273246.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction The relationship between intellectual disability (ID) and hand motor coordination and speed-accuracy, as well as the effect of aging on fine motor performance in patients with ID, has been previously investigated. However, only a few data are available on the impact of the nonpharmacological interventions in adult patients with long-term hand motor deficit. Methods Fifty adults with mild ID were enrolled. A group of thirty patients underwent a two-month intensive ergotherapic treatment that included hand motor rehabilitation and visual-perceptual treatment (group A); twenty patients performing conventional motor rehabilitation alone (group B) served as a control group. Data on attention, perceptual abilities, hand dexterity, and functional independence were collected by a blind operator, both at entry and at the end of the study. Results After the interventions, group A showed significantly better performance than group B in all measures related to hand movement from both sides and to independence in activities of daily living. Discussion Multimodal integrated interventions targeting visual-perceptual abilities and motor skills are an effective neurorehabilitative approach in adult patients with mild ID. Motor learning and memory-mediated mechanisms of neural plasticity might underlie the observed recovery, suggesting the presence of plastic adaptive changes even in the adult brain with ID.
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Cantone M, Catalano MA, Lanza G, La Delfa G, Ferri R, Pennisi M, Bella R, Pennisi G, Bramanti A. Motor and Perceptual Recovery in Adult Patients with Mild Intellectual Disability. Neural Plast 2018; 2018:3273246. [PMID: 29849555 PMCID: PMC5937379 DOI: 10.1155/2018/3273246] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/02/2018] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The relationship between intellectual disability (ID) and hand motor coordination and speed-accuracy, as well as the effect of aging on fine motor performance in patients with ID, has been previously investigated. However, only a few data are available on the impact of the nonpharmacological interventions in adult patients with long-term hand motor deficit. METHODS Fifty adults with mild ID were enrolled. A group of thirty patients underwent a two-month intensive ergotherapic treatment that included hand motor rehabilitation and visual-perceptual treatment (group A); twenty patients performing conventional motor rehabilitation alone (group B) served as a control group. Data on attention, perceptual abilities, hand dexterity, and functional independence were collected by a blind operator, both at entry and at the end of the study. RESULTS After the interventions, group A showed significantly better performance than group B in all measures related to hand movement from both sides and to independence in activities of daily living. DISCUSSION Multimodal integrated interventions targeting visual-perceptual abilities and motor skills are an effective neurorehabilitative approach in adult patients with mild ID. Motor learning and memory-mediated mechanisms of neural plasticity might underlie the observed recovery, suggesting the presence of plastic adaptive changes even in the adult brain with ID.
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Affiliation(s)
- Mariagiovanna Cantone
- 1IRCCS Centro Neurolesi Bonino Pulejo, Via Provinciale Palermo, Contrada Casazza, 98124 Messina, Italy
| | - Maria A. Catalano
- 2Associazione Assistenziale Villa Sandra, Via per Aci Bonaccorsi 16, San Giovanni La Punta, 95037 Catania, Italy
| | - Giuseppe Lanza
- 3Oasi Research Institute-IRCCS, Via Conte Ruggero 73, Troina, 94018 Enna, Italy
| | - Gaetano La Delfa
- 2Associazione Assistenziale Villa Sandra, Via per Aci Bonaccorsi 16, San Giovanni La Punta, 95037 Catania, Italy
| | - Raffaele Ferri
- 3Oasi Research Institute-IRCCS, Via Conte Ruggero 73, Troina, 94018 Enna, Italy
| | - Manuela Pennisi
- 4Spinal Unit, Emergency Hospital “Cannizzaro”, Via Messina 829, 95126 Catania, Italy
| | - Rita Bella
- 5Department of Medical and Surgical Sciences and Advanced Technologies, Section of Neurosciences, University of Catania, Via S. Sofia 78, 95123 Catania, Italy
| | - Giovanni Pennisi
- 6Department of Surgery and Medical-Surgical Specialties, University of Catania, Via S. Sofia 78, 95123 Catania, Italy
| | - Alessia Bramanti
- 1IRCCS Centro Neurolesi Bonino Pulejo, Via Provinciale Palermo, Contrada Casazza, 98124 Messina, Italy
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Jinnah HA, Neychev V, Hess EJ. The Anatomical Basis for Dystonia: The Motor Network Model. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2017; 7:506. [PMID: 29123945 PMCID: PMC5673689 DOI: 10.7916/d8v69x3s] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 09/25/2017] [Indexed: 01/27/2023]
Abstract
Background The dystonias include a clinically and etiologically very diverse group of disorders. There are both degenerative and non-degenerative subtypes resulting from genetic or acquired causes. Traditionally, all dystonias have been viewed as disorders of the basal ganglia. However, there has been increasing appreciation for involvement of other brain regions including the cerebellum, thalamus, midbrain, and cortex. Much of the early evidence for these other brain regions has come from studies of animals, but multiple recent studies have been done with humans, in an effort to confirm or refute involvement of these other regions. The purpose of this article is to review the new evidence from animals and humans regarding the motor network model, and to address the issues important to translational neuroscience. Methods The English literature was reviewed for articles relating to the neuroanatomical basis for various types of dystonia in both animals and humans. Results There is evidence from both animals and humans that multiple brain regions play an important role in various types of dystonia. The most direct evidence for specific brain regions comes from animal studies using pharmacological, lesion, or genetic methods. In these studies, experimental manipulations of specific brain regions provide direct evidence for involvement of the basal ganglia, cerebellum, thalamus and other regions. Additional evidence also comes from human studies using neuropathological, neuroimaging, non-invasive brain stimulation, and surgical interventions. In these studies, the evidence is less conclusive, because discriminating the regions that cause dystonia from those that reflect secondary responses to abnormal movements is more challenging. Discussion Overall, the evidence from both animals and humans suggests that different regions may play important roles in different subtypes of dystonia. The evidence so far provides strong support for the motor network model. There are obvious challenges, but also advantages, of attempting to translate knowledge gained from animals into a more complete understanding of human dystonia and novel therapeutic strategies.
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Affiliation(s)
- H A Jinnah
- Departments of Neurology, Human Genetics and Pediatrics, Emory University, Atlanta, GA, USA
| | - Vladimir Neychev
- Department of Surgery, University Multiprofile Hospital for Active Treatment "Alexandrovska", Medical University of Sofia, Sofia, Bulgaria
| | - Ellen J Hess
- Departments of Pharmacology and Neurology, Emory University, Atlanta, GA, USA
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