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Romero JP, Moreno-Verdú M, Arroyo-Ferrer A, Serrano JI, Herreros-Rodríguez J, García-Caldentey J, Rocon de Lima E, Del Castillo MD. Clinical and neurophysiological effects of bilateral repetitive transcranial magnetic stimulation and EEG-guided neurofeedback in Parkinson's disease: a randomized, four-arm controlled trial. J Neuroeng Rehabil 2024; 21:135. [PMID: 39103947 DOI: 10.1186/s12984-024-01427-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 07/17/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Repetitive Transcranial Magnetic Stimulation (rTMS) and EEG-guided neurofeedback techniques can reduce motor symptoms in Parkinson's disease (PD). However, the effects of their combination are unknown. Our objective was to determine the immediate and short-term effects on motor and non-motor symptoms, and neurophysiological measures, of rTMS and EEG-guided neurofeedback, alone or combined, compared to no intervention, in people with PD. METHODS A randomized, single-blinded controlled trial with 4 arms was conducted. Group A received eight bilateral, high-frequency (10 Hz) rTMS sessions over the Primary Motor Cortices; Group B received eight 30-minute EEG-guided neurofeedback sessions focused on reducing average bilateral alpha and beta bands; Group C received a combination of A and B; Group D did not receive any therapy. The primary outcome measure was the UPDRS-III at post-intervention and two weeks later. Secondary outcomes were functional mobility, limits of stability, depression, health-related quality-of-life and cortical silent periods. Treatment effects were obtained by longitudinal analysis of covariance mixed-effects models. RESULTS Forty people with PD participated (27 males, age = 63 ± 8.26 years, baseline UPDRS-III = 15.63 ± 6.99 points, H&Y = 1-3). Group C showed the largest effect on motor symptoms, health-related quality-of-life and cortical silent periods, followed by Group A and Group B. Negligible differences between Groups A-C and Group D for functional mobility or limits of stability were found. CONCLUSIONS The combination of rTMS and EEG-guided neurofeedback diminished overall motor symptoms and increased quality-of-life, but this was not reflected by changes in functional mobility, postural stability or depression levels. TRIAL REGISTRATION NCT04017481.
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Affiliation(s)
- Juan Pablo Romero
- Brain Injury and Movement Disorders Neurorehabilitation Group (GINDAT), Institute of Life Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Spain
- Facultad de Ciencias Experimentales, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Spain
- Brain Damage Unit, Hospital Beata María Ana, Madrid, Spain
| | - Marcos Moreno-Verdú
- Brain Injury and Movement Disorders Neurorehabilitation Group (GINDAT), Institute of Life Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Spain.
- Brain, Action, and Skill Laboratory (BAS-Lab), Institute of Neuroscience (Cognition and Systems Division), UC Louvain, Av. Mounier 54 (Claude Bernard), Floor +2, Office 0430, Woluwe-Saint-Lambert, 1200, Belgium.
| | - Aida Arroyo-Ferrer
- Brain Injury and Movement Disorders Neurorehabilitation Group (GINDAT), Institute of Life Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Spain
- Facultad de Ciencias Experimentales, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Spain
| | - J Ignacio Serrano
- Neural and Cognitive Engineering Group, Centre for Automation and Robotics, Spanish National Research Council, Madrid, Spain
| | | | | | - Eduardo Rocon de Lima
- Neural and Cognitive Engineering Group, Centre for Automation and Robotics, Spanish National Research Council, Madrid, Spain
| | - María Dolores Del Castillo
- Neural and Cognitive Engineering Group, Centre for Automation and Robotics, Spanish National Research Council, Madrid, Spain
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Chen R, Wang S, Hu Q, Kang N, Xie H, Liu M, Shan H, Long Y, Hao Y, Qin B, Su H, Zhuang Y, Li L, Li W, Sun W, Wu D, Cao W, Mai X, Chen G, Wang D, Zou Q. Exercise intervention in middle-aged and elderly individuals with insomnia improves sleep and restores connectivity in the motor network. Transl Psychiatry 2024; 14:159. [PMID: 38519470 PMCID: PMC10959941 DOI: 10.1038/s41398-024-02875-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 03/09/2024] [Accepted: 03/13/2024] [Indexed: 03/25/2024] Open
Abstract
Exercise is a potential treatment to improve sleep quality in middle-aged and elderly individuals. Understanding exercise-induced changes in functional plasticity of brain circuits that underlie improvements in sleep among middle-aged and older adults can inform treatment of sleep problems. The aim of the study is to identify the effects of a 12-week exercise program on sleep quality and brain functional connectivity in middle-aged and older adults with insomnia. The trial was registered with Chinese Clinical Trial Register (ChiCTR2000033652). We recruited 84 healthy sleepers and 85 individuals with insomnia. Participants with insomnia were assigned to receive either a 12-week exercise intervention or were placed in a 12-week waitlist control condition. Thirty-seven middle-aged and older adults in the exercise group and 30 in the waitlist group completed both baseline and week 12 assessments. We found that middle-aged and older adults with insomnia showed significantly worse sleep quality than healthy sleepers. At the brain circuit level, insomnia patients showed decreased connectivity in the widespread motor network. After exercise intervention, self-reported sleep was increased in the exercise group (P < 0.001) compared to that in the waitlist group. We also found increased functional connectivity of the motor network with the cerebellum in the exercise group (P < 0.001). Moreover, we observed significant correlations between improvement in subjective sleep indices and connectivity changes within the motor network. We highlight exercise-induced improvement in sleep quality and functional plasticity of the aging brain.
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Affiliation(s)
- Rongrong Chen
- Department of Psychology, Renmin University of China, Beijing, China
| | - Shilei Wang
- Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
- Beijing City Key Lab for Medical Physics and Engineering, Institution of Heavy Ion Physics, School of Physics, Peking University, Beijing, China
- Center for Magnetic Resonance Imaging Research & Key Laboratory of Applied Brain and Cognitive Sciences, School of Business and Management, Shanghai International Studies University, Shanghai, China
| | - Qinzi Hu
- Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
- Beijing City Key Lab for Medical Physics and Engineering, Institution of Heavy Ion Physics, School of Physics, Peking University, Beijing, China
| | - Ning Kang
- Institute of Population Research, Peking University, Beijing, China
| | - Haijiang Xie
- Department of Physical Education, Peking University, Beijing, China
| | - Meng Liu
- Sports Coaching College, Beijing Sports University, Beijing, China
| | - Hongyu Shan
- Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
- Beijing City Key Lab for Medical Physics and Engineering, Institution of Heavy Ion Physics, School of Physics, Peking University, Beijing, China
| | - Yujie Long
- Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
- Beijing City Key Lab for Medical Physics and Engineering, Institution of Heavy Ion Physics, School of Physics, Peking University, Beijing, China
| | - Yizhe Hao
- Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
- Beijing City Key Lab for Medical Physics and Engineering, Institution of Heavy Ion Physics, School of Physics, Peking University, Beijing, China
| | - Bolin Qin
- Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
- Beijing City Key Lab for Medical Physics and Engineering, Institution of Heavy Ion Physics, School of Physics, Peking University, Beijing, China
| | - Hao Su
- The School of Sports Science, Beijing Sport University, Beijing, China
| | | | - Li Li
- Peking University Hospital, Beijing, China
| | - Weiju Li
- Peking University Hospital, Beijing, China
| | - Wei Sun
- National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Dong Wu
- China Wushu School, Beijing Sport University, Beijing, China
| | - Wentian Cao
- Beijing City Key Lab for Medical Physics and Engineering, Institution of Heavy Ion Physics, School of Physics, Peking University, Beijing, China
| | - Xiaoqin Mai
- Department of Psychology, Renmin University of China, Beijing, China
| | - Gong Chen
- Institute of Population Research, Peking University, Beijing, China
| | - Dongmin Wang
- Department of Physical Education, Peking University, Beijing, China.
| | - Qihong Zou
- Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China.
- Beijing City Key Lab for Medical Physics and Engineering, Institution of Heavy Ion Physics, School of Physics, Peking University, Beijing, China.
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Perucca L, Scarano S, Russo G, Robecchi Majnardi A, Caronni A. Fatigue may improve equally after balance and endurance training in multiple sclerosis: a randomised, crossover clinical trial. Front Neurol 2024; 15:1274809. [PMID: 38385033 PMCID: PMC10880192 DOI: 10.3389/fneur.2024.1274809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/02/2024] [Indexed: 02/23/2024] Open
Abstract
Introduction Fatigue and poor balance are frequent and severe problems in multiple sclerosis (MS) that may interact. Endurance training is known to be effective on fatigue. This study aims to test if balance training is more effective against MS fatigue. Methods A randomised crossover trial was run, recruiting 31 MS people (21 women; median age: 46 years, range: 30-64; median EDSS: 4, range: 2.5-5). Participants received balance and endurance training alternately (15 one-to-one sessions, 5 days/week) and were assessed before (T0), after (T1), and 30 days after treatment ended (T2). The Modified Fatigue Impact Scale (MFIS) with scores linearised through Rasch analysis was the primary outcome (the lower the measure, the better the condition, i.e., the lower the fatigue symptoms). The Equiscale balance scale and posturography (EquiTest) were used to assess balance. Linear mixed-effects models with ANOVA were used for significance testing. Results Thirteen participants had no carryover effect and were included in the primary analysis. Fatigue significantly changed across the three time points (F2,58 = 16.0; p < 0.001), but no difference across treatments was found. Altogether, both treatments significantly improved the MFIS measure at T1 (95%CI: -1.24 logits; mean: -1.67 to -0.81 logits) and T2 (95%CI: -1.04; mean: -1.49 to -0.60) compared to T0 (95%CI: -0.51; mean: -0.95 to -0.08; p ≤ 0.001). Equiscale and posturography highlighted balance improvement after balance training but not after endurance training. Conclusion Balance and endurance training could similarly reduce fatigue in MS patients in the short term. However, only balance training also improved balance in MS.
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Affiliation(s)
- Laura Perucca
- IRCCS Istituto Auxologico Italiano, Department of Neurorehabilitation Sciences, Ospedale San Luca, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Stefano Scarano
- IRCCS Istituto Auxologico Italiano, Department of Neurorehabilitation Sciences, Ospedale San Luca, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Giovanna Russo
- IRCCS Istituto Auxologico Italiano, Department of Neurorehabilitation Sciences, Ospedale San Luca, Milan, Italy
| | - Antonio Robecchi Majnardi
- IRCCS Istituto Auxologico Italiano, Department of Neurorehabilitation Sciences, Ospedale San Luca, Milan, Italy
| | - Antonio Caronni
- IRCCS Istituto Auxologico Italiano, Department of Neurorehabilitation Sciences, Ospedale San Luca, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
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Application of Repetitive Transcranial Magnetic Stimulation in Neuropathic Pain: A Narrative Review. Life (Basel) 2023; 13:life13020258. [PMID: 36836613 PMCID: PMC9962564 DOI: 10.3390/life13020258] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/08/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
Neuropathic pain, affecting 6.9-10% of the general population, has a negative impact on patients' quality of life and potentially leads to functional impairment and disability. Repetitive transcranial magnetic stimulation (rTMS)-a safe, indirect and non-invasive technique-has been increasingly applied for treating neuropathic pain. The mechanism underlying rTMS is not yet well understood, and the analgesic effects of rTMS have been inconsistent with respect to different settings/parameters, causing insufficient evidence to determine its efficacy in patients with neuropathic pain. This narrative review aimed to provide an up-to-date overview of rTMS for treating neuropathic pain as well as to summarize the treatment protocols and related adverse effects from existing clinical trials. Current evidence supports the use of 10 Hz HF-rTMS of the primary motor cortex to reduce neuropathic pain, especially in patients with spinal cord injury, diabetic neuropathy and post-herpetic neuralgia. However, the lack of standardized protocols impedes the universal use of rTMS for neuropathic pain. rTMS was hypothesized to achieve analgesic effects by upregulating the pain threshold, inhibiting pain impulse, modulating the brain cortex, altering imbalanced functional connectivity, regulating neurotrophin and increasing endogenous opioid and anti-inflammatory cytokines. Further studies are warranted to explore the differences in the parameters/settings of rTMS for treating neuropathic pain due to different disease types.
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Traikapi A, Phylactou P, Konstantinou N. Repetitive transcranial magnetic stimulation of the human motor cortex in the gamma band reduces cortical excitability. Neurophysiol Clin 2022; 52:407-409. [PMID: 36210255 DOI: 10.1016/j.neucli.2022.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 09/19/2022] [Accepted: 09/19/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Artemis Traikapi
- Department of Rehabilitation Sciences, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus.
| | - Phivos Phylactou
- Department of Rehabilitation Sciences, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Nikos Konstantinou
- Department of Rehabilitation Sciences, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
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