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Dharmadasa T, Pavey N, Tu S, Menon P, Huynh W, Mahoney CJ, Timmins HC, Higashihara M, van den Bos M, Shibuya K, Kuwabara S, Grosskreutz J, Kiernan MC, Vucic S. Novel approaches to assessing upper motor neuron dysfunction in motor neuron disease/amyotrophic lateral sclerosis: IFCN handbook chapter. Clin Neurophysiol 2024; 163:68-89. [PMID: 38705104 DOI: 10.1016/j.clinph.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 02/08/2024] [Accepted: 04/14/2024] [Indexed: 05/07/2024]
Abstract
Identifying upper motor neuron (UMN) dysfunction is fundamental to the diagnosis and understanding of disease pathogenesis in motor neuron disease (MND). The clinical assessment of UMN dysfunction may be difficult, particularly in the setting of severe muscle weakness. From a physiological perspective, transcranial magnetic stimulation (TMS) techniques provide objective biomarkers of UMN dysfunction in MND and may also be useful to interrogate cortical and network function. Single, paired- and triple pulse TMS techniques have yielded novel diagnostic and prognostic biomarkers in MND, and have provided important pathogenic insights, particularly pertaining to site of disease onset. Cortical hyperexcitability, as heralded by reduced short interval intracortical inhibition (SICI) and increased short interval intracortical facilitation, has been associated with the onset of lower motor neuron degeneration, along with patterns of disease spread, development of specific clinical features such as the split hand phenomenon, and may provide an indication about the rate of disease progression. Additionally, reduction of SICI has emerged as a potential diagnostic aid in MND. The triple stimulation technique (TST) was shown to enhance the diagnostic utility of conventional TMS measures in detecting UMN dysfunction in MND. Separately, sophisticated brain imaging techniques have uncovered novel biomarkers of neurodegeneration that have bene associated with progression. The present review will discuss the utility of TMS and brain neuroimaging derived biomarkers of UMN dysfunction in MND, focusing on recently developed TMS techniques and advanced neuroimaging modalities that interrogate structural and functional integrity of the corticomotoneuronal system, with an emphasis on pathogenic, diagnostic, and prognostic utility.
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Affiliation(s)
- Thanuja Dharmadasa
- Department of Neurology, The Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia
| | - Nathan Pavey
- Brain and Nerve Research Center, The University of Sydney, Sydney, Australia
| | - Sicong Tu
- Brain and Mind Centre, The University of Sydney, and Department of Neurology, Royal Prince Alfred Hospital, Australia
| | - Parvathi Menon
- Brain and Nerve Research Center, The University of Sydney, Sydney, Australia
| | - William Huynh
- Brain and Mind Centre, The University of Sydney, and Department of Neurology, Royal Prince Alfred Hospital, Australia
| | - Colin J Mahoney
- Brain and Mind Centre, The University of Sydney, and Department of Neurology, Royal Prince Alfred Hospital, Australia
| | - Hannah C Timmins
- Brain and Mind Centre, The University of Sydney, and Department of Neurology, Royal Prince Alfred Hospital, Australia
| | - Mana Higashihara
- Department of Neurology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Mehdi van den Bos
- Brain and Nerve Research Center, The University of Sydney, Sydney, Australia
| | - Kazumoto Shibuya
- Neurology, Chiba University, Graduate School of Medicine, Chiba, Japan
| | - Satoshi Kuwabara
- Neurology, Chiba University, Graduate School of Medicine, Chiba, Japan
| | - Julian Grosskreutz
- Precision Neurology, Excellence Cluster Precision Medicine in Inflammation, University of Lübeck, University Hospital Schleswig-Holstein Campus, Lübeck, Germany
| | - Matthew C Kiernan
- Brain and Mind Centre, The University of Sydney, and Department of Neurology, Royal Prince Alfred Hospital, Australia
| | - Steve Vucic
- Brain and Nerve Research Center, The University of Sydney, Sydney, Australia.
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Benussi A, Cantoni V, Grassi M, Libri I, Cotelli MS, Tarantino B, Datta A, Thomas C, Huber N, Kärkkäinen S, Herukka SK, Haapasalo A, Filosto M, Padovani A, Borroni B. Cortico-spinal tDCS in amyotrophic lateral sclerosis: A randomized, double-blind, sham-controlled trial followed by an open-label phase. Brain Stimul 2023; 16:1666-1676. [PMID: 37977335 DOI: 10.1016/j.brs.2023.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a progressive disease for which no curative treatment is currently available. OBJECTIVE This study aimed to investigate whether cortico-spinal transcranial direct current stimulation (tDCS) could mitigate symptoms in ALS patients via a randomized, double-blind, sham-controlled trial, followed by an open-label phase. METHODS Thirty-one participants were randomized into two groups for the initial controlled phase. At baseline (T0), Group 1 received placebo stimulation (sham tDCS), while Group 2 received cortico-spinal stimulation (real tDCS) for five days/week for two weeks (T1), with an 8-week (T2) follow-up (randomized, double-blind, sham-controlled phase). At the 24-week follow-up (T3), all participants (Groups 1 and 2) received a second treatment of anodal bilateral motor cortex and cathodal spinal stimulation (real tDCS) for five days/week for two weeks (T4). Follow-up evaluations were performed at 32-weeks (T5) and 48-weeks (T6) (open-label phase). At each time point, clinical assessment, blood sampling, and intracortical connectivity measures using transcranial magnetic stimulation (TMS) were evaluated. Additionally, we evaluated survival rates. RESULTS Compared to sham stimulation, cortico-spinal tDCS significantly improved global strength, caregiver burden, and quality of life scores, which correlated with the restoration of intracortical connectivity measures. Serum neurofilament light levels decreased among patients who underwent real tDCS but not in those receiving sham tDCS. The number of completed 2-week tDCS treatments significantly influenced patient survival. CONCLUSIONS Cortico-spinal tDCS may represent a promising therapeutic and rehabilitative approach for patients with ALS. Further larger-scale studies are necessary to evaluate whether tDCS could potentially impact patient survival. CLINICAL TRIAL REGISTRATION NCT04293484.
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Affiliation(s)
- Alberto Benussi
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Neurology Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Valentina Cantoni
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Mario Grassi
- Department of Brain and Behavioural Sciences, Medical and Genomic Statistics Unit, University of Pavia, Pavia, Italy
| | - Ilenia Libri
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Barbara Tarantino
- Department of Brain and Behavioural Sciences, Medical and Genomic Statistics Unit, University of Pavia, Pavia, Italy
| | - Abhishek Datta
- Research & Development, Soterix Medical, Inc., New York, USA
| | - Chris Thomas
- Research & Development, Soterix Medical, Inc., New York, USA
| | - Nadine Huber
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Sari Kärkkäinen
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
| | - Sanna-Kaisa Herukka
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland; Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Annakaisa Haapasalo
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Massimiliano Filosto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; NeMo-Brescia Clinical Center for Neuromuscular Diseases, Gussago, Brescia, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Neurology Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Barbara Borroni
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Neurology Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili di Brescia, Brescia, Italy.
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Pavey N, Menon P, van den Bos MAJ, Kiernan MC, Vucic S. Cortical inhibition and facilitation are mediated by distinct physiological processes. Neurosci Lett 2023; 803:137191. [PMID: 36924929 DOI: 10.1016/j.neulet.2023.137191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/01/2023] [Accepted: 03/11/2023] [Indexed: 03/17/2023]
Abstract
A complex interaction of inhibitory and facilitatory interneuronal processes may underlie development of cortical excitability in the human motor cortex. To determine whether distinct interneuronal processes mediated cortical excitability, threshold tracking transcranial magnetic stimulation was utilised to assess cortical excitability, with figure-of-eight coil oriented in posterior-anterior (PA), anterior-posterior (AP) and latero-medial (LM) directions. Motor evoked potential (MEP) responses were recorded over the contralateral abductor pollicis brevis. Resting motor threshold (RMT), short interval intracortical inhibition (SICI), short interval intracortical facilitation (SICF) and intracortical facilitation were recorded. Significant effects of coil orientation were evident on SICI (F = 8.560, P = 0.002) and SICF (F = 7.132, P = 0.003). SICI was greater when recorded with PA (9.7 ± 10.9%, P = 0.029) and AP (13.1 ± 7.0%, P = 0.003) compared to LM (5.2 ± 7.3%) directed currents. SICF was significantly greater with PA (-14.7 ± 8.1%, P = 0.016) and LM (-14.7 ± 8.8%, P = 0.005) compared to AP (-9.1 ± 7.2%) coil orientations. SICI recorded with LM and PA coil orientations were correlated (R = 0.7, P = 0.002), as was SICF recorded with AP vs LM (R = 0.60, P = 0.019) and LM vs PA (R = 0.69, P = 0.002) coil orientations. RMT was significantly smaller with PA compared to AP (P < 0.001) and LM (P = 0.018) stimulation. Recruitment of distinct interneuronal processes with variable cortical orientation and thresholds underlies short interval intracortical inhibition and facilitation.
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Affiliation(s)
- Nathan Pavey
- Brain and Nerve Research Centre, Concord Clinical School, University of Sydney, Concord Hospital, Sydney, NSW, Australia
| | - Parvathi Menon
- Brain and Nerve Research Centre, Concord Clinical School, University of Sydney, Concord Hospital, Sydney, NSW, Australia
| | - Mehdi A J van den Bos
- Brain and Nerve Research Centre, Concord Clinical School, University of Sydney, Concord Hospital, Sydney, NSW, Australia
| | | | - Steve Vucic
- Brain and Nerve Research Centre, Concord Clinical School, University of Sydney, Concord Hospital, Sydney, NSW, Australia.
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Kamble N, Bhattacharya A, Hegde S, Vidya N, Gothwal M, Yadav R, Pal PK. Cortical excitability changes as a marker of cognitive impairment in Parkinson's disease. Behav Brain Res 2022; 422:113733. [PMID: 34998797 DOI: 10.1016/j.bbr.2022.113733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 12/23/2021] [Accepted: 01/01/2022] [Indexed: 12/12/2022]
Abstract
Cognitive impairment of different severity with eventual progression to dementia in Parkinson's disease (PD) appears during the course of the disease. In this study, transcranial magnetic stimulation (TMS) was used to assess cortical excitability changes in PD patients with varying cognitive impairment. We aimed to identify the TMS parameters that could serve as a non-invasive marker of cognitive impairment in patients with PD. Consecutive PD patients were recruited in the study. Detailed neuropsychological assessment was carried out to identify PD without cognitive impairment (PD-nC), PD with mild cognitive impairment (PD-MCI) and PD with dementia (PDD). Twenty patients of PDD (2 females and 18 males), 20 PD-MCI (4 females and 16 males), 18 PD-nC (5 females, 13 males) and 18 healthy controls (4 females, and 14 males) were included in the study. All the participants underwent TMS with recording of resting motor threshold, central motor conduction time, silent period, short interval intracortical inhibition (SICI) and intracortical facilitation (ICF). All the groups were age matched. The SICI was present in all; however, significantly greater inhibition was noted in PDD (Mean±SD; 0.11±0.08) followed by PD-MCI (0.31±0.17), PD-nC (0.49±0.26) and controls (0.61±0.23; p<0.001). The ICF was significantly reduced in PDD (Mean±SD; 0.15±0.18), PD-MCI (0.55±0.31), PD-nC (0.96±0.59), when compared to healthy controls (1.81±0.83; p<0.001). Patients with PD-nC, PD-MCI and PDD had graded reduction in ICF and increasing intracortical inhibition as the disease progressed from PD-nC through PD-MCI to PDD. This suggests progressive overactivity of GABAergic transmission, glutaminergic deficiency with consequent reduction of cholinergic transmission leading to dementia.
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Affiliation(s)
- Nitish Kamble
- Departments of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore 560029, Karnataka, India
| | - Amitabh Bhattacharya
- Departments of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore 560029, Karnataka, India
| | - Shantala Hegde
- Clinical Psychology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore 560029, Karnataka, India
| | - N Vidya
- Clinical Psychology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore 560029, Karnataka, India
| | - Mohit Gothwal
- Clinical Psychology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore 560029, Karnataka, India
| | - Ravi Yadav
- Departments of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore 560029, Karnataka, India
| | - Pramod Kumar Pal
- Departments of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore 560029, Karnataka, India.
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Bhattacharya A, Kamble N, Yadav R, Stezin A, Pal PK. Abnormal Intracortical Functions in Parkinson's Disease with Rapid Eye Movement Sleep Behaviour Disorder. Can J Neurol Sci 2021;:1-6. [PMID: 34470683 DOI: 10.1017/cjn.2021.206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Rapid eye movement sleep behaviour disorder (RBD) is considered to be one of the most frequent and important prodromal symptoms of Parkinson's disease (PD). We aimed to study the neurophysiological abnormalities in patients of PD-RBD and PD without RBD (PD-nRBD) using transcranial magnetic stimulation (TMS). METHODS Twenty patients each of PD-RBD and PD-nRBD were included in the study in addition to 20 age and gender-matched healthy controls. RBD was identified using the RBD screening questionnaire (RBDSQ). All the subjects were evaluated with single and paired-pulse TMS and parameters such as resting motor threshold (RMT), central motor conduction time (CMCT), silent period (SP), short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF) were recorded. RESULTS The mean age of the controls and PD patients with and without RBD was comparable. There were no significant differences in RMT, CMCT and silent period between the two patient groups. SICI was present in all the three groups with significant inhibition noted in PD-RBD group (p < 0.001). ICF was absent in patients of PD-RBD (0.19 ± 0.11) and PD-nRBD (0.7 ± 0.5) when compared to controls (1.88 ± 1.02) with profound impairment in patients with PD-RBD (p < 0.001). The mean MoCA score was found to be significantly different in all the three groups with a worse score in patients with RBD (23.10 ± 2.55; p < 0.001). CONCLUSIONS PD-RBD patients have significantly greater inhibition and reduced intracortical facilitation suggesting enhanced GABAergic and reduced glutaminergic transmission. These abnormalities may underlie the different pathophysiological process observed in these patients.
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Alaydin HC, Cengiz B. Body ownership, sensorimotor integration and motor cortical excitability: A TMS study about rubber hand illusion. Neuropsychologia 2021; 161:107992. [PMID: 34391807 DOI: 10.1016/j.neuropsychologia.2021.107992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 08/02/2021] [Accepted: 08/10/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The Rubber Hand Illusion (RHI) manipulates body ownership experimentally and helps investigate the related neurophysiological processes. This study aimed to evaluate motor cortex excitability that hypothesized changed due to illusion. METHOD Twenty-one healthy (twelve male, nine female), right-handed volunteers aged between 25 and 50 years were recruited to the study. Short-Latency Afferent Inhibition (SAI) was evaluated by transcranial magnetic stimulation (TMS) given with a figure-of-eight-shaped coil from the left motor cortex, 21 ms after peripheral electrical stimulation. Short-Interval Intracortical Inhibition (SICI) and Intracortical Facilitation (ICF) were investigated using a paired-pulse TMS at interstimulus intervals (ISI) of 1, 2.5, 3 ms and 15, 20, 25 ms, respectively. We used custom-made illusion setups for TMS paradigms. SAI, SICI and ICF was evaluated before, during and 15 min after the RHI. RESULTS Results of the study revealed significantly high SAI during illusion compared to pre-illusion, but no difference was found between post-illusion 15th minutes and control measurements. Significantly reduced SICI at 2.5 and 3 ms ISI obtained during illusion, while RHI did not affect SICI at 1 ms ISI and ICF. SIGNIFICANCE Body ownership illusion modulates the motor cortex excitability, possibly through altered sensory processing and sensorimotor integration.
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Affiliation(s)
- Halil Can Alaydin
- - Department of Neurology, Gazi University Faculty of Medicine, Ankara, Turkey; - Department of Neurology, Clinical Neurophysiology Division, Gazi University Faculty of Medicine, Ankara, Turkey.
| | - Bülent Cengiz
- - Department of Neurology, Gazi University Faculty of Medicine, Ankara, Turkey; - Department of Neurology, Clinical Neurophysiology Division, Gazi University Faculty of Medicine, Ankara, Turkey
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Ørskov S, Bostock H, Howells J, Pugdahl K, Fuglsang-Frederiksen A, Nielsen CSZ, Cengiz B, Samusyte G, Koltzenburg M, Tankisi H. Comparison of figure-of-8 and circular coils for threshold tracking transcranial magnetic stimulation measurements. Neurophysiol Clin 2021; 51:153-160. [PMID: 33468370 DOI: 10.1016/j.neucli.2021.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/05/2021] [Accepted: 01/05/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The transcranial magnetic stimulation (TMS) technique of threshold-tracking short-interval intracortical inhibition (T-SICI) has been proposed as a diagnostic tool for amyotrophic lateral sclerosis (ALS). Most of these studies have used a circular coil, whereas a figure-of-8 coil is usually recommended for paired-pulse TMS measurements. The aim of this study was to compare figure-of-8 and circular coils for T-SICI in the upper limb, with special attention to reproducibility, and the pain or discomfort experienced by the subjects. METHODS Twenty healthy subjects (aged: 45.5 ± 6.7, mean ± SD, 9 females, 11 males) underwent two examinations with each coil, in morning and afternoon sessions on the same day, with T-SICI measured at interstimulus intervals (ISIs) from 1-7 ms. After each examination the subjects rated degree of pain/discomfort from 0 to 10 using a numerical rating scale (NRS). RESULTS Mean T-SICI was higher for the figure-of-8 than for the circular coil at ISI of 2 ms (p < 0.05) but did not differ at other ISIs. Intra-subject variability did not differ between coils, but mean inhibition from 1-3.5 ms was less variable between subjects with the figure-of-8 coil (SD 7.2% vs. 11.2% RMT, p < 0.05), and no such recordings were without inhibition (vs. 6 with the circular coil). The subjects experienced less pain/discomfort with the figure-of-8 coil (mean NRS: 1.9 ± 1.28 vs 2.8 ± 1.60, p < 0.005). DISCUSSION The figure-of-8 coil may have better applicability in patients, due to the lower incidence of lack of inhibition in healthy subjects, and the lower experience of pain or discomfort.
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Affiliation(s)
- Søren Ørskov
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hugh Bostock
- Department of Clinical Neurophysiology, National Hospital for Neurology and Neurosurgery, Queen Square, WC1N 3BG, London, United Kingdom
| | - James Howells
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Kirsten Pugdahl
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Bülent Cengiz
- Department of Neurology, Gazi University Faculty of Medicine, Beşevler, 06500, Ankara, Turkey
| | - Gintaute Samusyte
- Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Martin Koltzenburg
- Department of Clinical Neurophysiology, National Hospital for Neurology and Neurosurgery, Queen Square, WC1N 3BG, London, United Kingdom; Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, WC1N 3BG, London, United Kingdom
| | - Hatice Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark.
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Benussi A, Grassi M, Palluzzi F, Cantoni V, Cotelli MS, Premi E, Di Lorenzo F, Pellicciari MC, Ranieri F, Musumeci G, Marra C, Manganotti P, Nardone R, Di Lazzaro V, Koch G, Borroni B. Classification accuracy of TMS for the diagnosis of mild cognitive impairment. Brain Stimul 2021; 14:241-249. [PMID: 33453454 DOI: 10.1016/j.brs.2021.01.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/17/2020] [Accepted: 01/08/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To evaluate the performance of a Random Forest (RF) classifier on Transcranial Magnetic Stimulation (TMS) measures in patients with Mild Cognitive Impairment (MCI). METHODS We applied a RF classifier on TMS measures obtained from a multicenter cohort of patients with MCI, including MCI-Alzheimer's Disease (MCI-AD), MCI-frontotemporal dementia (MCI-FTD), MCI-dementia with Lewy bodies (MCI-DLB), and healthy controls (HC). All patients underwent TMS assessment at recruitment (index test), with application of reference clinical criteria, to predict different neurodegenerative disorders. The primary outcome measures were the classification accuracy, precision, recall and F1-score of TMS in differentiating each disorder. RESULTS 160 participants were included, namely 64 patients diagnosed as MCI-AD, 28 as MCI-FTD, 14 as MCI-DLB, and 47 as healthy controls (HC). A series of 3 binary classifiers was employed, and the prediction model exhibited high classification accuracy (ranging from 0.72 to 0.86), high precision (0.72-0.90), high recall (0.75-0.98), and high F1-scores (0.78-0.92), in differentiating each neurodegenerative disorder. By computing a new classifier, trained and validated on the current cohort of MCI patients, classification indices showed even higher accuracy (ranging from 0.83 to 0.93), precision (0.87-0.89), recall (0.83-1.00), and F1-scores (0.85-0.94). CONCLUSIONS TMS may be considered a useful additional screening tool to be used in clinical practice in the prodromal stages of neurodegenerative dementias.
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Affiliation(s)
- Alberto Benussi
- Neurology Unit, Department of Clinial and Experimental Sciences, University of Brescia, Italy
| | - Mario Grassi
- Department of Brain and Behavioural Sciences, Medical and Genomic Statistics Unit, University of Pavia, Pavia, Italy
| | - Fernando Palluzzi
- Department of Brain and Behavioural Sciences, Medical and Genomic Statistics Unit, University of Pavia, Pavia, Italy
| | - Valentina Cantoni
- Neurology Unit, Department of Clinial and Experimental Sciences, University of Brescia, Italy
| | | | - Enrico Premi
- Neurology Unit, Department of Clinial and Experimental Sciences, University of Brescia, Italy
| | | | | | - Federico Ranieri
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Gabriella Musumeci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Camillo Marra
- Department of Neuroscience, Catholic University of Sacred Heart, Rome, Italy
| | | | - Raffaele Nardone
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy; Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Giacomo Koch
- Non Invasive Brain Stimulation Unit, IRCCS Santa Lucia Foundation, Rome, Italy; Stroke Unit, Policlinico Tor Vergata, Rome, Italy
| | - Barbara Borroni
- Neurology Unit, Department of Clinial and Experimental Sciences, University of Brescia, Italy.
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