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Tăuƫan AM, Casula EP, Pellicciari MC, Borghi I, Maiella M, Bonni S, Minei M, Assogna M, Palmisano A, Smeralda C, Romanella SM, Ionescu B, Koch G, Santarnecchi E. TMS-EEG perturbation biomarkers for Alzheimer's disease patients classification. Sci Rep 2023; 13:7667. [PMID: 37169900 PMCID: PMC10175269 DOI: 10.1038/s41598-022-22978-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 10/21/2022] [Indexed: 05/13/2023] Open
Abstract
The combination of TMS and EEG has the potential to capture relevant features of Alzheimer's disease (AD) pathophysiology. We used a machine learning framework to explore time-domain features characterizing AD patients compared to age-matched healthy controls (HC). More than 150 time-domain features including some related to local and distributed evoked activity were extracted from TMS-EEG data and fed into a Random Forest (RF) classifier using a leave-one-subject out validation approach. The best classification accuracy, sensitivity, specificity and F1 score were of 92.95%, 96.15%, 87.94% and 92.03% respectively when using a balanced dataset of features computed globally across the brain. The feature importance and statistical analysis revealed that the maximum amplitude of the post-TMS signal, its Hjorth complexity and the amplitude of the TEP calculated in the window 45-80 ms after the TMS-pulse were the most relevant features differentiating AD patients from HC. TMS-EEG metrics can be used as a non-invasive tool to further understand the AD pathophysiology and possibly contribute to patients' classification as well as longitudinal disease tracking.
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Affiliation(s)
- Alexandra-Maria Tăuƫan
- Precision Neuroscience and Neuromodulation Program & Network Control Laboratory, Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- AI Multimedia Lab, Research Center CAMPUS, University Politehnica of Bucharest, 061344, Bucharest, Romania
| | - Elias P Casula
- Santa Lucia Foundation, 00179, Rome, Italy
- Department of Psychology, La Sapienza University, Via dei Marsi 78, 00185, Rome, Italy
| | | | | | | | | | | | | | - Annalisa Palmisano
- Precision Neuroscience and Neuromodulation Program & Network Control Laboratory, Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Education, Psychology and Communication, University of Bari Aldo Moro, Bari, Italy
| | - Carmelo Smeralda
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery, Neurology and Clinical Neurophysiology Section, University of Siena, Siena, Italy
| | - Sara M Romanella
- Precision Neuroscience and Neuromodulation Program & Network Control Laboratory, Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery, Neurology and Clinical Neurophysiology Section, University of Siena, Siena, Italy
| | - Bogdan Ionescu
- AI Multimedia Lab, Research Center CAMPUS, University Politehnica of Bucharest, 061344, Bucharest, Romania
| | - Giacomo Koch
- Department of Neuroscience and Rehabilitation, Section of Human Physiology, University of Ferrara, 44121, Ferrara, Italy
- Santa Lucia Foundation, 00179, Rome, Italy
| | - Emiliano Santarnecchi
- Precision Neuroscience and Neuromodulation Program & Network Control Laboratory, Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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2
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Casula EP, Pellicciari MC, Bonnì S, Borghi I, Maiella M, Assogna M, Minei M, Motta C, D'Acunto A, Porrazzini F, Pezzopane V, Mencarelli L, Roncaioli A, Rocchi L, Spampinato DA, Caltagirone C, Santarnecchi E, Martorana A, Koch G. Decreased frontal gamma activity in Alzheimer’s disease patients. Brain Stimul 2023. [DOI: 10.1016/j.brs.2023.01.596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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3
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Koch G, Casula EP, Bonnì S, Borghi I, Assogna M, Minei M, Pellicciari MC, Motta C, D’Acunto A, Porrazzini F, Maiella M, Ferrari C, Caltagirone C, Santarnecchi E, Bozzali M, Martorana A. Precuneus magnetic stimulation for Alzheimer's disease: a randomized, sham-controlled trial. Brain 2022; 145:3776-3786. [PMID: 36281767 PMCID: PMC9679166 DOI: 10.1093/brain/awac285] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [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: 03/27/2022] [Revised: 06/27/2022] [Accepted: 07/03/2022] [Indexed: 08/01/2023] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is emerging as a non-invasive therapeutic strategy in the battle against Alzheimer's disease. Alzheimer's disease patients primarily show alterations of the default mode network for which the precuneus is a key node. Here, we hypothesized that targeting the precuneus with TMS represents a promising strategy to slow down cognitive and functional decline in Alzheimer's disease patients. We performed a randomized, double-blind, sham-controlled, phase 2, 24-week trial to determine the safety and efficacy of precuneus stimulation in patients with mild-to-moderate Alzheimer's disease. Fifty Alzheimer's disease patients were randomly assigned in a 1:1 ratio to either receive precuneus or sham rTMS (mean age 73.7 years; 52% female). The trial included a 24-week treatment, with a 2-week intensive course in which rTMS (or sham) was applied daily five times per week, followed by a 22-week maintenance phase in which stimulation was applied once weekly. The Clinical Dementia Rating Scale-Sum of Boxes was selected as the primary outcome measure, in which post-treatment scores were compared to baseline. Secondary outcomes included score changes in the Alzheimer's Disease Assessment Scale-Cognitive Subscale, Mini-Mental State Examination and Alzheimer's Disease Cooperative Study-Activities of Daily Living scale. Moreover, single-pulse TMS in combination with EEG was used to assess neurophysiological changes in precuneus cortical excitability and oscillatory activity. Our findings show that patients that received precuneus repetitive magnetic stimulation presented a stable performance of the Clinical Dementia Rating Scale-Sum of Boxes score, whereas patients treated with sham showed a worsening of their score. Compared with the sham stimulation, patients in the precuneus stimulation group also showed also significantly better performances for the secondary outcome measures, including the Alzheimer's Disease Assessment Scale-Cognitive Subscale, Mini-Mental State Examination and Alzheimer's Disease Cooperative Study-Activities of Daily Living scale. Neurophysiological results showed that precuneus cortical excitability remained unchanged after 24 weeks in the precuneus stimulation group, whereas it was significantly reduced in the sham group. Finally, we found an enhancement of local gamma oscillations in the group treated with precuneus stimulation but not in patients treated with sham. We conclude that 24 weeks of precuneus rTMS may slow down cognitive and functional decline in Alzheimer's disease. Repetitive TMS targeting the default mode network could represent a novel therapeutic approach in Alzheimer's disease patients.
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Affiliation(s)
- Giacomo Koch
- Correspondence to: Prof. Giacomo Koch, MD, PhD Santa Lucia Foundation IRCCS, Via Ardeatina 306, 00179, Rome, Italy E-mail:
| | - Elias Paolo Casula
- Department of Clinical and Behavioural Neurology, Santa Lucia Foundation IRCCS, 00179, Rome, Italy
| | - Sonia Bonnì
- Department of Clinical and Behavioural Neurology, Santa Lucia Foundation IRCCS, 00179, Rome, Italy
| | - Ilaria Borghi
- Department of Clinical and Behavioural Neurology, Santa Lucia Foundation IRCCS, 00179, Rome, Italy
| | - Martina Assogna
- Department of Clinical and Behavioural Neurology, Santa Lucia Foundation IRCCS, 00179, Rome, Italy
- Memory Clinic, Department of Systems Medicine, University of Tor Vergata, 00133, Rome, Italy
| | - Marilena Minei
- Department of Clinical and Behavioural Neurology, Santa Lucia Foundation IRCCS, 00179, Rome, Italy
| | | | - Caterina Motta
- Department of Clinical and Behavioural Neurology, Santa Lucia Foundation IRCCS, 00179, Rome, Italy
| | - Alessia D’Acunto
- Department of Clinical and Behavioural Neurology, Santa Lucia Foundation IRCCS, 00179, Rome, Italy
| | - Francesco Porrazzini
- Department of Clinical and Behavioural Neurology, Santa Lucia Foundation IRCCS, 00179, Rome, Italy
| | - Michele Maiella
- Department of Clinical and Behavioural Neurology, Santa Lucia Foundation IRCCS, 00179, Rome, Italy
| | - Clarissa Ferrari
- Unit of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125, Brescia, Italy
| | - Carlo Caltagirone
- Department of Clinical and Behavioural Neurology, Santa Lucia Foundation IRCCS, 00179, Rome, Italy
| | - Emiliano Santarnecchi
- Precision Neuroscience and Neuromodulation program, Gordon Center for Medical Imaging, Massachussets General Hospital; Harvard Medical School, 02114, Boston, MA, USA
| | - Marco Bozzali
- Rita Levi Montalcini Department of Neuroscience, University of Torino, 10124, Turin, Italy
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, BN1 9PX, Brighton, UK
| | - Alessandro Martorana
- Department of Clinical and Behavioural Neurology, Santa Lucia Foundation IRCCS, 00179, Rome, Italy
- Memory Clinic, Department of Systems Medicine, University of Tor Vergata, 00133, Rome, Italy
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4
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Maiella M, Casula EP, Borghi I, Assogna M, D’Acunto A, Pezzopane V, Mencarelli L, Rocchi L, Pellicciari MC, Koch G. Simultaneous transcranial electrical and magnetic stimulation boost gamma oscillations in the dorsolateral prefrontal cortex. Sci Rep 2022; 12:19391. [PMID: 36371451 PMCID: PMC9653481 DOI: 10.1038/s41598-022-23040-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 10/25/2022] [Indexed: 11/13/2022] Open
Abstract
Neural oscillations in the gamma frequency band have been identified as a fundament for synaptic plasticity dynamics and their alterations are central in various psychiatric and neurological conditions. Transcranial magnetic stimulation (TMS) and alternating electrical stimulation (tACS) may have a strong therapeutic potential by promoting gamma oscillations expression and plasticity. Here we applied intermittent theta-burst stimulation (iTBS), an established TMS protocol known to induce LTP-like cortical plasticity, simultaneously with transcranial alternating current stimulation (tACS) at either theta (θtACS) or gamma (γtACS) frequency on the dorsolateral prefrontal cortex (DLPFC). We used TMS in combination with electroencephalography (EEG) to evaluate changes in cortical activity on both left/right DLPFC and over the vertex. We found that simultaneous iTBS with γtACS but not with θtACS resulted in an enhancement of spectral gamma power, a trend in shift of individual peak frequency towards faster oscillations and an increase of local connectivity in the gamma band. Furthermore, the response to the neuromodulatory protocol, in terms of gamma oscillations and connectivity, were directly correlated with the initial level of cortical excitability. These results were specific to the DLPFC and confined locally to the site of stimulation, not being detectable in the contralateral DLPFC. We argue that the results described here could promote a new and effective method able to induce long-lasting changes in brain plasticity useful to be clinically applied to several psychiatric and neurological conditions.
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Affiliation(s)
- Michele Maiella
- grid.417778.a0000 0001 0692 3437Department of Behavioural and Clinical Neurology, Santa Lucia Foundation IRCCS, Via Ardeatina, 306, 00179 Rome, Italy
| | - Elias Paolo Casula
- grid.417778.a0000 0001 0692 3437Department of Behavioural and Clinical Neurology, Santa Lucia Foundation IRCCS, Via Ardeatina, 306, 00179 Rome, Italy ,grid.7841.aDepartment of Psychology, La Sapienza University, Rome, Italy
| | - Ilaria Borghi
- grid.417778.a0000 0001 0692 3437Department of Behavioural and Clinical Neurology, Santa Lucia Foundation IRCCS, Via Ardeatina, 306, 00179 Rome, Italy ,grid.25786.3e0000 0004 1764 2907Center for Translational Neurophysiology of Speech and Communication, Istituto Italiano di Tecnologia (IIT), Ferrara, Italy
| | - Martina Assogna
- grid.417778.a0000 0001 0692 3437Department of Behavioural and Clinical Neurology, Santa Lucia Foundation IRCCS, Via Ardeatina, 306, 00179 Rome, Italy
| | - Alessia D’Acunto
- grid.417778.a0000 0001 0692 3437Department of Behavioural and Clinical Neurology, Santa Lucia Foundation IRCCS, Via Ardeatina, 306, 00179 Rome, Italy
| | - Valentina Pezzopane
- grid.417778.a0000 0001 0692 3437Department of Behavioural and Clinical Neurology, Santa Lucia Foundation IRCCS, Via Ardeatina, 306, 00179 Rome, Italy
| | - Lucia Mencarelli
- grid.417778.a0000 0001 0692 3437Department of Behavioural and Clinical Neurology, Santa Lucia Foundation IRCCS, Via Ardeatina, 306, 00179 Rome, Italy
| | - Lorenzo Rocchi
- grid.7763.50000 0004 1755 3242Department of Medical Sciences and Public Health, Institute of Neurology, University of Cagliari, Cagliari, Italy
| | - Maria Concetta Pellicciari
- grid.417778.a0000 0001 0692 3437Department of Behavioural and Clinical Neurology, Santa Lucia Foundation IRCCS, Via Ardeatina, 306, 00179 Rome, Italy
| | - Giacomo Koch
- grid.417778.a0000 0001 0692 3437Department of Behavioural and Clinical Neurology, Santa Lucia Foundation IRCCS, Via Ardeatina, 306, 00179 Rome, Italy ,grid.8484.00000 0004 1757 2064Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
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5
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Casula E, Concetta Pellicciari M, Bonnì S, Borghi I, Maiella M, Assogna M, Minei M, Motta C, D'Acunto A, Porrazzini F, Pezzopane V, Picazio S, Spampinato D, Caltagirone C, Santarnecchi E, Martorana A, Koch G. TU-143. Decreased frontal gamma activity in Alzheimer’s disease patients. Clin Neurophysiol 2022. [DOI: 10.1016/j.clinph.2022.07.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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6
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Miraglia F, Vecchio F, Concetta Pellicciari M, Cespon J, Cotelli M, Pappalettera C, Nucci L, Paolo Maria R. TU-116. Brain networks modulation in young and old subjects during transcranial direct current stimulation applied on prefrontal and parietal cortex. Clin Neurophysiol 2022. [DOI: 10.1016/j.clinph.2022.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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7
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Miraglia F, Vecchio F, Pellicciari MC, Cespon J, Rossini PM. Brain Networks Modulation in Young and Old Subjects During Transcranial Direct Current Stimulation Applied on Prefrontal and Parietal Cortex. Int J Neural Syst 2021; 32:2150056. [PMID: 34651550 DOI: 10.1142/s0129065721500568] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Evidence indicates that the transcranial direct current stimulation (tDCS) has the potential to transiently modulate cognitive function, including age-related changes in brain performance. Only a small number of studies have explored the interaction between the stimulation sites on the scalp, task performance, and brain network connectivity within the frame of physiological aging. We aimed to evaluate the spread of brain activation in both young and older adults in response to anodal tDCS applied to two different scalp stimulation sites: Prefrontal cortex (PFC) and posterior parietal cortex (PPC). EEG data were recorded during tDCS stimulation and evaluated using the Small World (SW) index as a graph theory metric. Before and after tDCS, participants performed a behavioral task; a performance accuracy index was computed and correlated with the SW index. Results showed that the SW index increased during tDCS of the PPC compared to the PFC at higher EEG frequencies only in young participants. tDCS at the PPC site did not exert significant effects on the performance, while tDCS at the PFC site appeared to influence task reaction times in the same direction in both young and older participants. In conclusion, studies using tDCS to modulate functional connectivity and influence behavior can help identify suitable protocols for the aging brain.
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Affiliation(s)
- Francesca Miraglia
- Brain Connectivity Laboratory, Department of Neuroscience and Neurorehabilitation, IRCCS San Raffaele Roma Rome, Italy
| | - Fabrizio Vecchio
- Brain Connectivity Laboratory, Department of Neuroscience and Neurorehabilitation, IRCCS San Raffaele Roma Rome, Italy.,eCampus University, Novedrate (Como), Italy
| | | | - Jesus Cespon
- Basque Center on Cognition, Brain and Language, San Sebastian, Spain
| | - Paolo Maria Rossini
- Brain Connectivity Laboratory, Department of Neuroscience and Neurorehabilitation, IRCCS San Raffaele Roma Rome, Italy
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Rodella C, Cespón J, Repetto C, Pellicciari MC. Customized Application of tDCS for Clinical Rehabilitation in Alzheimer's Disease. Front Hum Neurosci 2021; 15:687968. [PMID: 34393740 PMCID: PMC8358653 DOI: 10.3389/fnhum.2021.687968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/30/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Claudia Rodella
- Department of Psychology, Catholic University of Sacred Heart, Milan, Italy
| | - Jesús Cespón
- Basque Center on Cognition, Brain and Language, San Sebastian, Spain
| | - Claudia Repetto
- Department of Psychology, Catholic University of Sacred Heart, Milan, Italy
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Invitto S, Romano D, Garbarini F, Bruno V, Urgesi C, Curcio G, Grasso A, Pellicciari MC, Koch G, Betti V, Fiorio M, Ricciardi E, de Tommaso M, Valeriani M. Corrigendum: Major Stress-Related Symptoms During the Lockdown: A Study by the Italian Society of Psychophysiology and Cognitive Neuroscience. Front Public Health 2021; 9:711132. [PMID: 34178938 PMCID: PMC8232049 DOI: 10.3389/fpubh.2021.711132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 12/05/2022] Open
Affiliation(s)
- Sara Invitto
- INSPIRE LAB - Laboratory of Cognitive and Psychophysiological Olfactory Processes, Department of Biological and Environmental Sciences and Technologies, University of Salento, Lecce, Italy
| | - Daniele Romano
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | | | - Valentina Bruno
- Manibus Lab, Department of Psychology, University of Torino, Torino, Italy
| | - Cosimo Urgesi
- Department of Languages and Literatures, Communication, Education, and Society, University of Udine, Udine, Italy
| | - Giuseppe Curcio
- Dipartimento di Scienze Cliniche Applicate e Biotecnologiche, Università Degli Studi Dell'Aquila, L'Aquila, Italy
| | - Alberto Grasso
- INSPIRE LAB - Laboratory of Cognitive and Psychophysiological Olfactory Processes, Department of Biological and Environmental Sciences and Technologies, University of Salento, Lecce, Italy
| | | | - Giacomo Koch
- Fondazione Santa Lucia IRCCS, Rome, Italy.,Dipartimento di Neuroscienze e Riabilitazione, Università di Ferrara, Ferrara, Italy
| | - Viviana Betti
- Fondazione Santa Lucia IRCCS, Rome, Italy.,Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Mirta Fiorio
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Marina de Tommaso
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
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Vecchio F, Miraglia F, Alù F, Judica E, Cotelli M, Pellicciari MC, Rossini PM. Human brain networks in physiological and pathological aging: reproducibility of EEG graph theoretical analysis in cortical connectivity. Brain Connect 2021; 12:41-51. [PMID: 33797981 DOI: 10.1089/brain.2020.0824] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Physiological and pathological brain aging plays a central role in brain networks modulation. The aim of the present paper was to assess the stability of a proposed method for the evaluation of Small World (SW) characteristics for the study of Human Connectome. METHODS 80 subjects were recruited: 36 young healthy controls, 32 elderly healthy controls, and 12 patients affected by Alzheimer's disease. Electroencephalograms (EEG) were recorded during six separate sessions (480 recordings) at an average inter-session interval of 3.8±0.2 days. Graph theory functions were applied to the undirected and weighted networks obtained by the lagged linear coherence evaluated by exact Low Resolution Electromagnetic Tomography (eLORETA). Were explored the following frequency bands: delta (2-4Hz), theta (4-8Hz), alpha1 (8-10.5Hz), alpha2 (10.5-13Hz), beta1 (13-20Hz), beta2 (20-30Hz) and gamma (30-40Hz). RESULTS The proposed method for the evaluation of Small World (SW) characteristics showed good reproducibility and stability. Furthermore, the results showed the pattern Young>Elderly>AD in low frequency delta and theta bands and vice versa in the higher alpha band. Finally, the correlation with age was confirmed in healthy subjects showing that older the age higher the SW values for alpha2. DISCUSSION Evidences from the present study confirm the stability of the Small World index and suggest that graph theory can support the analysis of connectivity patterns estimated from EEG. The proposed method for the evaluation of the characteristics of the Small World (SW) has shown good reproducibility and stability and applied to patient data, this technique could provide more information on the pathophysiological processes underlying the age-related brain disconnection, as well as on the administration of rehabilitation treatments at the right time that could allow to avoid unnecessary interventions.
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Affiliation(s)
- Fabrizio Vecchio
- IRCCS San Raffaele Pisana, 46729, Via di Val Cannuta, 247, 00166 Roma RM, Roma, Italy, 00163;
| | | | - Francesca Alù
- IRCCS San Raffaele Pisana, 46729, Roma, Lazio, Italy;
| | - Elda Judica
- Casa di Cura del Policlinico SpA, 390725, Milano, Lombardia, Italy;
| | - Maria Cotelli
- IRCCS Centro San Giovanni di Dio Fatebenefratelli, 18518, Brescia, Lombardia, Italy;
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11
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Invitto S, Romano D, Garbarini F, Bruno V, Urgesi C, Curcio G, Grasso A, Pellicciari MC, Kock G, Betti V, Fiorio M, Ricciardi E, de Tommaso M, Valeriani M. Major Stress-Related Symptoms During the Lockdown: A Study by the Italian Society of Psychophysiology and Cognitive Neuroscience. Front Public Health 2021; 9:636089. [PMID: 33842419 PMCID: PMC8032941 DOI: 10.3389/fpubh.2021.636089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/26/2021] [Indexed: 12/20/2022] Open
Abstract
The clinical effects of the Covid-19 pandemic are now the subject of numerous studies worldwide. But what are the effects of the quarantine imposed by the states that implemented the measures of lockdown? The present research aims to explore, in a preliminary way, the major stress-related symptoms during the lockdown, due to Covid-19, in the Italian population. Subjects were asked to fill out a survey, that traced a line identifying the most relevant psychophysiological symptoms that took into account factors such as perceived stress, body perception, perceived pain, quality of sleep, perceptive variations (i.e., olfactory, gustatory, visual, acoustic, and haptic perception). A network approach formulating a hypothesis-generating exploratory analysis was adopted. Main results of the network analysis showed that the beliefs of having had the Covid-19 was related to individual variables (i.e., gender, working in presence, sleep quality, anxiety symptoms), while the familiarity of Covid-19 disease was related to contextual factors (e.g., number of recorded cases in the Region, working in presence). The self-perception of olfactory and perceptive alterations highlighted a great sensorial cross-modality, additionally, the olfactory impairment was related to the belief of having had the Covid-19. Compared to general network data, BAI, perceived stress, anxiety and chronic pain were in relation to daily sleep disturbance. Main study's results show how the management of the Covid-19 stressful representation, in its cognitive aspects, can modulate the psychophysiological responses.
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Affiliation(s)
- Sara Invitto
- INSPIRE LAB - Laboratory of Cognitive and Psychophysiological Olfactory Processes, Department of Biological and Environmental Sciences and Technologies, University of Salento, Lecce, Italy
| | - Daniele Romano
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | | | - Valentina Bruno
- Manibus Lab, Department of Psychology, University of Torino, Torino, Italy
| | - Cosimo Urgesi
- Department of Languages and Literatures, Communication, Education, and Society, University of Udine, Udine, Italy
| | - Giuseppe Curcio
- Dipartimento di Scienze Cliniche Applicate e Biotecnologiche, Università Degli Studi Dell'Aquila, L'Aquila, Italy
| | - Alberto Grasso
- INSPIRE LAB - Laboratory of Cognitive and Psychophysiological Olfactory Processes, Department of Biological and Environmental Sciences and Technologies, University of Salento, Lecce, Italy
| | | | - Giacomo Kock
- Dipartimento di Neuroscienze, Policlinico Tor Vergata, Rome, Italy
| | - Viviana Betti
- Department of Psychology, Sapienza University of Roma, Roma, Italy.,IRCSS Fondazione Santa Lucia, Roma, Italy
| | - Mirta Fiorio
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Marina de Tommaso
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
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12
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Casula EP, Pellicciari MC, Bonnì S, Spanò B, Ponzo V, Salsano I, Giulietti G, Martino Cinnera A, Maiella M, Borghi I, Rocchi L, Bozzali M, Sallustio F, Caltagirone C, Koch G. Evidence for interhemispheric imbalance in stroke patients as revealed by combining transcranial magnetic stimulation and electroencephalography. Hum Brain Mapp 2021; 42:1343-1358. [PMID: 33439537 PMCID: PMC7927297 DOI: 10.1002/hbm.25297] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 10/28/2020] [Accepted: 10/28/2020] [Indexed: 01/13/2023] Open
Abstract
Interhemispheric interactions in stroke patients are frequently characterized by abnormalities, in terms of balance and inhibition. Previous results showed an impressive variability, mostly given to the instability of motor-evoked potentials when evoked from the affected hemisphere. We aim to find reliable interhemispheric measures in stroke patients with a not-evocable motor-evoked potential from the affected hemisphere, by combining transcranial magnetic stimulation (TMS) and electroencephalography. Ninteen stroke patients (seven females; 61.26 ± 9.8 years) were studied for 6 months after a first-ever stroke in the middle cerebral artery territory. Patients underwent four evaluations: clinical, cortical, corticospinal, and structural. To test the reliability of our measures, the evaluations were repeated after 3 weeks. To test the sensitivity, 14 age-matched healthy controls were compared to stroke patients. In stroke patients, stimulation of the affected hemisphere did not result in any inhibition onto the unaffected. The stimulation of the unaffected hemisphere revealed a preservation of the inhibition mechanism onto the affected. This resulted in a remarkable interhemispheric imbalance, whereas this mechanism was steadily symmetric in healthy controls. This result was stable when cortical evaluation was repeated after 3 weeks. Importantly, patients with a better recovery of the affected hand strength were the ones with a more stable interhemispheric balance. Finally, we found an association between microstructural integrity of callosal fibers, suppression of interhemispheric TMS-evoked activity and interhemispheric connectivity. We provide direct and sensitive cortical measures of interhemispheric imbalance in stroke patients. These measures offer a reliable means of distinguishing healthy and pathological interhemispheric dynamics.
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Affiliation(s)
- Elias Paolo Casula
- Non‐Invasive Brain Stimulation Unit/Department of Behavioral and Clinical NeurologySanta Lucia FoundationRomeItaly
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of Neurology, University College LondonLondonUK
| | - Maria Concetta Pellicciari
- Non‐Invasive Brain Stimulation Unit/Department of Behavioral and Clinical NeurologySanta Lucia FoundationRomeItaly
| | - Sonia Bonnì
- Non‐Invasive Brain Stimulation Unit/Department of Behavioral and Clinical NeurologySanta Lucia FoundationRomeItaly
| | - Barbara Spanò
- Neuroimaging LaboratorySanta Lucia FoundationRomeItaly
| | - Viviana Ponzo
- Non‐Invasive Brain Stimulation Unit/Department of Behavioral and Clinical NeurologySanta Lucia FoundationRomeItaly
| | | | | | - Alex Martino Cinnera
- Non‐Invasive Brain Stimulation Unit/Department of Behavioral and Clinical NeurologySanta Lucia FoundationRomeItaly
| | - Michele Maiella
- Non‐Invasive Brain Stimulation Unit/Department of Behavioral and Clinical NeurologySanta Lucia FoundationRomeItaly
| | - Ilaria Borghi
- Non‐Invasive Brain Stimulation Unit/Department of Behavioral and Clinical NeurologySanta Lucia FoundationRomeItaly
| | - Lorenzo Rocchi
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of Neurology, University College LondonLondonUK
| | - Marco Bozzali
- Neuroimaging LaboratorySanta Lucia FoundationRomeItaly
- Brighton and Sussex Medical School, University of SussexBrightonUK
| | | | - Carlo Caltagirone
- Non‐Invasive Brain Stimulation Unit/Department of Behavioral and Clinical NeurologySanta Lucia FoundationRomeItaly
| | - Giacomo Koch
- Non‐Invasive Brain Stimulation Unit/Department of Behavioral and Clinical NeurologySanta Lucia FoundationRomeItaly
- Stroke Unit, Department of NeuroscienceTor Vergata PolyclinicRomeItaly
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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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14
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Galli G, Miniussi C, Pellicciari MC. Transcranial electric stimulation as a neural interface to gain insight on human brain functions: current knowledge and future perspective. Soc Cogn Affect Neurosci 2020; 17:4-14. [PMID: 32756871 DOI: 10.1093/scan/nsaa099] [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: 01/10/2020] [Revised: 05/12/2020] [Accepted: 07/11/2020] [Indexed: 11/12/2022] Open
Abstract
The use of brain-stimulation approaches in social and affective science has greatly increased over the last two decades. The interest in social factors has grown along with technological advances in brain research. Transcranial electric stimulation (tES) is a research tool that allows scientists to establish contributory causality between brain functioning and social behaviour, therefore deepening our understanding of the social mind. Preliminary evidence is also starting to demonstrate that tES, either alone or in combination with pharmacological or behavioural interventions, can alleviate the symptomatology of individuals with affective or social cognition disorders. This review offers an overview of the application of tES in the field of social and affective neuroscience. We discuss issues and challenges related to this application and suggest avenue for future basic and translational research.
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Affiliation(s)
- Giulia Galli
- Department of Psychology, Kingston University, Penrhyn Road, Kingston Upon Thames, KT1 2EE, United Kingdom
| | - Carlo Miniussi
- Center for Mind/Brain Sciences - CIMeC, University of Trento, Corso Bettini, 31, 38068 Rovereto, TN Italy
| | - Maria Concetta Pellicciari
- UniCamillus - Saint Camillus International University of Health Sciences, via di Sant'Alessandro 8, 00131, Rome, Italy
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15
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Koch G, Motta C, Bonnì S, Pellicciari MC, Picazio S, Casula EP, Maiella M, Di Lorenzo F, Ponzo V, Ferrari C, Scaricamazza E, Caltagirone C, Martorana A. Effect of Rotigotine vs Placebo on Cognitive Functions Among Patients With Mild to Moderate Alzheimer Disease: A Randomized Clinical Trial. JAMA Netw Open 2020; 3:e2010372. [PMID: 32667654 PMCID: PMC7364345 DOI: 10.1001/jamanetworkopen.2020.10372] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE Impairment of dopaminergic transmission may contribute to cognitive dysfunction in Alzheimer disease (AD). OBJECTIVE To investigate whether therapy with dopaminergic agonists may affect cognitive functions in patients with AD. DESIGN, SETTING, AND PARTICIPANTS This phase 2, monocentric, randomized, double-blind, placebo-controlled trial was conducted in Italy. Patients with mild to moderate AD were enrolled between September 1, 2017, and December 31, 2018. Data were analyzed from July 1 to September 1, 2019. INTERVENTIONS A rotigotine 2 mg transdermal patch for 1 week followed by a 4 mg patch for 23 weeks (n = 47) or a placebo transdermal patch for 24 weeks (n = 47). MAIN OUTCOMES AND MEASURES The primary end point was change from baseline on the Alzheimer Disease Assessment Scale-Cognitive Subscale. Secondary end points were changes in Frontal Assessment Battery, Alzheimer Disease Cooperative Study-Activities of Daily Living, and Neuropsychiatric Inventory scores. Prefrontal cortex activity was evaluated by transcranial magnetic stimulation combined with electroencephalography. RESULTS Among 94 patients randomized (mean [SD] age, 73.9 [5.6] years; 58 [62%] women), 78 (83%) completed the study. Rotigotine, as compared with placebo, had no significant effect on the primary end point: estimated mean change in Alzheimer Disease Assessment Scale-Cognitive Subscale score was 2.92 (95% CI, 2.51-3.33) for the rotigotine group and 2.66 (95% CI, 2.31-3.01) for the placebo group. For the secondary outcomes, there were significant estimated mean changes between groups for Alzheimer Disease Cooperative Study-Activities of Daily Living score (-3.32 [95% CI, -4.02 to -2.62] for rotigotine and -7.24 [95% CI, -7.84 to -6.64] for placebo) and Frontal Assessment Battery score (0.48 [95% CI, 0.31 to 0.65] for rotigotine and -0.66 [95% CI, -0.80 to -0.52] for placebo). There was no longitudinal change in Neuropsychiatric Inventory scores (1.64 [95% CI, 1.06-2.22] for rotigotine and 1.26 [95% CI, 0.77-1.75] for placebo group). Neurophysiological analysis of electroencephalography results indicated that prefrontal cortical activity increased in rotigotine but not in the placebo group. Adverse events were more common in the rotigotine group, with 11 patients dropping out compared with 5 in the placebo group. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, rotigotine treatment did not significantly affect global cognition in patients with mild to moderate AD; however, improvement was observed in cognitive functions highly associated with the frontal lobe and in activities of daily living. These findings suggest that treatment with the dopaminergic agonist rotigotine may reduce symptoms associated with frontal lobe cognitive dysfunction and thus may delay the impairment of activities of daily living. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03250741.
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Affiliation(s)
- Giacomo Koch
- Department of Behavioral and Clinical Neurology, Santa Lucia Foundation Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Section of Human Physiology, University of Ferrara, Italy
| | - Caterina Motta
- Department of Behavioral and Clinical Neurology, Santa Lucia Foundation Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Sonia Bonnì
- Department of Behavioral and Clinical Neurology, Santa Lucia Foundation Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Maria Concetta Pellicciari
- Department of Behavioral and Clinical Neurology, Santa Lucia Foundation Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Silvia Picazio
- Department of Behavioral and Clinical Neurology, Santa Lucia Foundation Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Elias Paolo Casula
- Department of Behavioral and Clinical Neurology, Santa Lucia Foundation Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Michele Maiella
- Department of Behavioral and Clinical Neurology, Santa Lucia Foundation Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Francesco Di Lorenzo
- Department of Behavioral and Clinical Neurology, Santa Lucia Foundation Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Unit of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Viviana Ponzo
- Department of Behavioral and Clinical Neurology, Santa Lucia Foundation Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Clarissa Ferrari
- Unit of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | | | - Carlo Caltagirone
- Department of Behavioral and Clinical Neurology, Santa Lucia Foundation Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Alessandro Martorana
- Department of Behavioral and Clinical Neurology, Santa Lucia Foundation Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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16
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de Tommaso M, Betti V, Bocci T, Bolognini N, Di Russo F, Fattapposta F, Ferri R, Invitto S, Koch G, Miniussi C, Piccione F, Ragazzoni A, Sartucci F, Rossi S, Arcara G, Berchicci M, Bianco V, Delussi M, Gentile E, Giovannelli F, Mannarelli D, Marino M, Mussini E, Pauletti C, Pellicciari MC, Pisoni A, Raggi A, Valeriani M. Pearls and pitfalls in brain functional analysis by event-related potentials: a narrative review by the Italian Psychophysiology and Cognitive Neuroscience Society on methodological limits and clinical reliability-part I. Neurol Sci 2020; 41:2711-2735. [PMID: 32388645 DOI: 10.1007/s10072-020-04420-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 11/02/2019] [Accepted: 04/13/2020] [Indexed: 12/14/2022]
Abstract
Event-related potentials (ERPs) are obtained from the electroencephalogram (EEG) or the magnetoencephalogram (MEG, event-related fields (ERF)), extracting the activity that is time-locked to an event. Despite the potential utility of ERP/ERF in cognitive domain, the clinical standardization of their use is presently undefined for most of procedures. The aim of the present review is to establish limits and reliability of ERP medical application, summarize main methodological issues, and present evidence of clinical application and future improvement. The present section of the review focuses on well-standardized ERP methods, including P300, Contingent Negative Variation (CNV), Mismatch Negativity (MMN), and N400, with a chapter dedicated to laser-evoked potentials (LEPs). One section is dedicated to proactive preparatory brain activity as the Bereitschaftspotential and the prefrontal negativity (BP and pN). The P300 and the MMN potentials have a limited but recognized role in the diagnosis of cognitive impairment and consciousness disorders. LEPs have a well-documented usefulness in the diagnosis of neuropathic pain, with low application in clinical assessment of psychophysiological basis of pain. The other ERP components mentioned here, though largely applied in normal and pathological cases and well standardized, are still confined to the research field. CNV, BP, and pN deserve to be largely tested in movement disorders, just to explain possible functional changes in motor preparation circuits subtending different clinical pictures and responses to treatments.
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Affiliation(s)
- Marina de Tommaso
- Applied Neurophysiology and Pain Unit-AnpLab-University of Bari Aldo Moro, Bari, Italy
| | - Viviana Betti
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,IRCCS Fondazione Santa Lucia (Santa Lucia Foundation), Rome, Italy
| | - Tommaso Bocci
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Nadia Bolognini
- Department of Psychology & NeuroMi, University of Milano Bicocca, Milan, Italy.,Laboratory of Neuropsychology, IRCCS Istituto Auxologico, Milan, Italy
| | - Francesco Di Russo
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | | | | | - Sara Invitto
- INSPIRE - Laboratory of Cognitive and Psychophysiological Olfactory Processes, University of Salento, Lecce, Italy
| | - Giacomo Koch
- IRCCS Fondazione Santa Lucia (Santa Lucia Foundation), Rome, Italy.,Department of Neuroscience, Policlinico Tor Vergata, Rome, Italy
| | - Carlo Miniussi
- Center for Mind/Brain Sciences - CIMeC, University of Trento, Rovereto, Italy.,Cognitive Neuroscience Section, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Francesco Piccione
- Brain Imaging and Neural Dynamics Research Group, IRCCS San Camillo Hospital, Venice, Italy
| | - Aldo Ragazzoni
- Unit of Neurology and Clinical Neurophysiology, Fondazione PAS, Scandicci, Florence, Italy
| | - Ferdinando Sartucci
- Section of Neurophysiopathology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,CNR Institute of Neuroscience, Pisa, Italy
| | - Simone Rossi
- Department of Medicine, Surgery and Neuroscience Siena Brain Investigation and Neuromodulation Lab (SI-BIN Lab), University of Siena, Siena, Italy
| | - Giorgio Arcara
- Brain Imaging and Neural Dynamics Research Group, IRCCS San Camillo Hospital, Venice, Italy
| | - Marika Berchicci
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Valentina Bianco
- IRCCS Fondazione Santa Lucia (Santa Lucia Foundation), Rome, Italy.,Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Marianna Delussi
- Applied Neurophysiology and Pain Unit-AnpLab-University of Bari Aldo Moro, Bari, Italy
| | - Eleonora Gentile
- Applied Neurophysiology and Pain Unit-AnpLab-University of Bari Aldo Moro, Bari, Italy
| | - Fabio Giovannelli
- Section of Psychology - Department of Neuroscience, Psychology, Drug Research, Child Health, University of Florence, Florence, Italy
| | - Daniela Mannarelli
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Marco Marino
- Brain Imaging and Neural Dynamics Research Group, IRCCS San Camillo Hospital, Venice, Italy
| | - Elena Mussini
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Caterina Pauletti
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | | | - Alberto Pisoni
- Department of Psychology & NeuroMi, University of Milano Bicocca, Milan, Italy
| | - Alberto Raggi
- Unit of Neurology, G.B. Morgagni - L. Pierantoni Hospital, Forlì, Italy
| | - Massimiliano Valeriani
- Neurology Ward Unit, Bambino Gesù Hospital, Rome, Italy. .,Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark.
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Martino Cinnera A, Bonnì S, Pellicciari MC, Giorgi F, Caltagirone C, Koch G. Health-related quality of life (HRQoL) after stroke: Positive relationship between lower extremity and balance recovery. Top Stroke Rehabil 2020; 27:534-540. [PMID: 32041495 DOI: 10.1080/10749357.2020.1726070] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Stroke survivors have poor long-term quality of life (QoL), especially in the dimensions of mobility and daily activities. Objectives: We aimed to investigate how clinical variables influence QoL during subacute stroke rehabilitation. Methods: We assessed the evolution of the health-related QoL (HRQoL), the balance skills, the sensory-motor functions, and the ability in the activity of daily living in 25 hospitalized patients (60.6 ± 11.14 years old; 32% female) during a period of 2 months of stroke rehabilitation. We used the Stroke-Specific Quality of Life scale (SSQoL) to assess the HRQoL; the Berg Balance Scale to assess gait and balance functions; the Fugl-Meyer Assessment scale for sensory-motor functions of upper (UE) and lower limb (LE); and the Barthel Index for activity of daily living. All data have been investigated with the repeated-measures analysis of variance before and after normalization. Multiple Regression Analysis (MRA) has been performed on the normalized data and between the normalized data and the demographic characteristics (Gender; Age; Lesion side). Results: A significant improvement was found in all the assessed scales during the time of observation. MRA shows a positive regression between HRQoL and the motor recovery of LE and between HRQoL and the balance skills in 60 days from the stroke (MR = 0.88; respectively: p = 0.004 and p = 0.02). Conclusions: Our result shows that LE motor recovery impacts the QoL more than motor recovery of UE after 60 days of neurorehabilitation. This finding is strengthened by a positive regression between balance skills and QoL.
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Affiliation(s)
- Alex Martino Cinnera
- Non Invasive Brain Stimulation Unit (NIBSU), IRCCS Santa Lucia Foundation , Rome, Italy
| | - Sonia Bonnì
- Non Invasive Brain Stimulation Unit (NIBSU), IRCCS Santa Lucia Foundation , Rome, Italy
| | | | - Francesco Giorgi
- Non Invasive Brain Stimulation Unit (NIBSU), IRCCS Santa Lucia Foundation , Rome, Italy
| | - Carlo Caltagirone
- Non Invasive Brain Stimulation Unit (NIBSU), IRCCS Santa Lucia Foundation , Rome, Italy
| | - Giacomo Koch
- Non Invasive Brain Stimulation Unit (NIBSU), IRCCS Santa Lucia Foundation , Rome, Italy.,Department of Psychology, "eCampus" University , Novedrate, Italy
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18
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Casula EP, Maiella M, Pellicciari MC, Porrazzini F, D'Acunto A, Rocchi L, Koch G. Novel TMS-EEG indexes to investigate interhemispheric dynamics in humans. Clin Neurophysiol 2020; 131:70-77. [DOI: 10.1016/j.clinph.2019.09.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 09/03/2019] [Accepted: 09/15/2019] [Indexed: 10/25/2022]
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19
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Koch G, Bonnì S, Casula EP, Iosa M, Paolucci S, Pellicciari MC, Cinnera AM, Ponzo V, Maiella M, Picazio S, Sallustio F, Caltagirone C. Effect of Cerebellar Stimulation on Gait and Balance Recovery in Patients With Hemiparetic Stroke: A Randomized Clinical Trial. JAMA Neurol 2019; 76:170-178. [PMID: 30476999 DOI: 10.1001/jamaneurol.2018.3639] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Gait and balance impairment is associated with poorer functional recovery after stroke. The cerebellum is known to be strongly implicated in the functional reorganization of motor networks in patients with stroke, especially for gait and balance functions. Objective To determine whether cerebellar intermittent θ-burst stimulation (CRB-iTBS) can improve balance and gait functions in patients with hemiparesis due to stroke. Design, Setting, Participants This randomized, double-blind, sham-controlled phase IIa trial investigated efficacy and safety of a 3-week treatment of CRB-iTBS coupled with physiotherapy in promoting gait and balance recovery in patients with stroke. Thirty-six patients with consecutive ischemic chronic stroke in the territory of the contralateral middle cerebral artery with hemiparesis were recruited from a neuro-rehabilitation hospital. Participants were screened and enrolled from March 2013 to June 2017. Intention-to-treat analysis was performed. Interventions Patients were randomly assigned to treatment with CRB-iTBS or sham iTBS applied over the cerebellar hemisphere ipsilateral to the affected body side immediately before physiotherapy daily during 3 weeks. Main Outcomes and Measures The primary outcome was the between-group difference in change from baseline in the Berg Balance Scale. Secondary exploratory measures included the between-group difference in change from baseline in Fugl-Meyer Assessment scale, Barthel Index, and locomotion assessment with gait analysis and cortical activity measured by transcranial magnetic stimulation in combination with electroencephalogram. Results A total of 34 patients (mean [SD] age, 64 [11.3] years; 13 women [38.2%]) completed the study. Patients treated with CRB-iTBS, but not with sham iTBS, showed an improvement of gait and balance functions, as revealed by a pronounced increase in the mean (SE) Berg Balance Scale score (baseline: 34.5 [3.4]; 3 weeks after treatment: 43.4 [2.6]; 3 weeks after the end of treatment: 47.5 [1.8]; P < .001). No overall treatment-associated differences were noted in the Fugl-Meyer Assessment (mean [SE], baseline: 163.8 [6.8]; 3 weeks after treatment: 171.1 [7.2]; 3 weeks after the end of treatment: 173.5 [6.9]; P > .05) and Barthel Index scores (mean [SE], baseline: 71.1 [4.92]; 3 weeks after treatment: 88.8 [2.1]; 3 weeks after the end of treatment: 92.2 [2.4]; P > .05). Patients treated with CRB-iTBS, but not sham iTBS, showed a reduction of step width at the gait analysis (mean [SE], baseline: 16.8 [4.8] cm; 3 weeks after treatment: 14.3 [6.2] cm; P < .05) and an increase of neural activity over the posterior parietal cortex. Conclusions and Relevance Cerebellar intermittent θ-burst stimulation promotes gait and balance recovery in patients with stroke by acting on cerebello-cortical plasticity. These results are important to increase the level of independent walking and reduce the risk of falling. Trial Registration ClinicalTrials.gov Identifier: NCT03456362.
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Affiliation(s)
- Giacomo Koch
- Non Invasive Brain Stimulation Unit/Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy.,Stroke Unit, Department of Neuroscience, Tor Vergata Policlinic, Rome, Italy
| | - Sonia Bonnì
- Non Invasive Brain Stimulation Unit/Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Elias Paolo Casula
- Non Invasive Brain Stimulation Unit/Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Marco Iosa
- Clinical Laboratory of Experimental Neurorehabilitation, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Stefano Paolucci
- Clinical Laboratory of Experimental Neurorehabilitation, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Maria Concetta Pellicciari
- Non Invasive Brain Stimulation Unit/Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Alex Martino Cinnera
- Non Invasive Brain Stimulation Unit/Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Viviana Ponzo
- Non Invasive Brain Stimulation Unit/Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Michele Maiella
- Non Invasive Brain Stimulation Unit/Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Silvia Picazio
- Non Invasive Brain Stimulation Unit/Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Fabrizio Sallustio
- Stroke Unit, Department of Neuroscience, Tor Vergata Policlinic, Rome, Italy
| | - Carlo Caltagirone
- Non Invasive Brain Stimulation Unit/Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy.,Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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Cespón J, Rodella C, Miniussi C, Pellicciari MC. Behavioural and electrophysiological modulations induced by transcranial direct current stimulation in healthy elderly and Alzheimer's disease patients: A pilot study. Clin Neurophysiol 2019; 130:2038-2052. [PMID: 31541981 DOI: 10.1016/j.clinph.2019.08.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 12/30/2018] [Revised: 06/28/2019] [Accepted: 08/14/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate whether anodal and cathodal transcranial direct current stimulation (tDCS) can modify cognitive performance and neural activity in healthy elderly and Alzheimer's disease (AD) patients. METHODS Fourteen healthy elderly and twelve AD patients performed a working memory task during an electroencephalogram recording before and after receiving anodal, cathodal, and sham tDCS over the left dorsolateral prefrontal cortex. Behavioural performance, event-related potentials (P200, P300) and evoked cortical oscillations were studied as correlates of working memory. RESULTS Anodal tDCS increased P200 and P300 amplitudes in healthy elderly. Cathodal tDCS increased P200 amplitude and frontal theta activity between 150 and 300 ms in AD patients. Improved working memory after anodal tDCS correlated with increased P300 in healthy elderly. In AD patients, slight tendencies between enhanced working memory and increased P200 after cathodal tDCS were observed. CONCLUSIONS Functional neural modulations were promoted by anodal tDCS in healthy elderly and by cathodal tDCS in AD patients. SIGNIFICANCE Interaction between tDCS polarity and the neural state (e.g., hyper-excitability exhibited by AD patients) suggests that appropriate tDCS parameters (in terms of tDCS polarity) to induce behavioural improvements should be chosen based on the participant's characteristics. Future studies using higher sample sizes should confirm and extend the present findings.
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Affiliation(s)
- J Cespón
- Cognitive Neuroscience Section, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; BCBL, Basque Center on Cognition, Brain, and Language, Donostia/San Sebastián, Spain.
| | - C Rodella
- Cognitive Neuroscience Section, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - C Miniussi
- Center for Mind/Brain Sciences - CIMeC, University of Trento, Rovereto, TN, Italy; Cognitive Neuroscience Section, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - M C Pellicciari
- Cognitive Neuroscience Section, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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Tremblay S, Rogasch NC, Premoli I, Blumberger DM, Casarotto S, Chen R, Di Lazzaro V, Farzan F, Ferrarelli F, Fitzgerald PB, Hui J, Ilmoniemi RJ, Kimiskidis VK, Kugiumtzis D, Lioumis P, Pascual-Leone A, Pellicciari MC, Rajji T, Thut G, Zomorrodi R, Ziemann U, Daskalakis ZJ. Clinical utility and prospective of TMS–EEG. Clin Neurophysiol 2019; 130:802-844. [DOI: 10.1016/j.clinph.2019.01.001] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 01/07/2019] [Accepted: 01/08/2019] [Indexed: 12/15/2022]
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22
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Motta C, Di Lorenzo F, Ponzo V, Pellicciari MC, Bonnì S, Picazio S, Mercuri NB, Caltagirone C, Martorana A, Koch G. Transcranial magnetic stimulation predicts cognitive decline in patients with Alzheimer's disease. J Neurol Neurosurg Psychiatry 2018; 89:1237-1242. [PMID: 30464028 DOI: 10.1136/jnnp-2017-317879] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 06/14/2018] [Accepted: 06/27/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the ability of transcranial magnetic stimulation (TMS) in detecting synaptic impairment in patients with Alzheimer's disease (AD) and predicting cognitive decline since the early phases of the disease. METHODS We used TMS-based parameters to evaluate long-term potentiation (LTP)-like cortical plasticity and cholinergic activity as measured by short afferent inhibition (SAI) in 60 newly diagnosed patients with AD and 30 healthy age-matched subjects (HS). Receiver operating characteristic (ROC) curves were used to assess TMS ability in discriminating patients with AD from HS. Regression analyses examined the association between TMS-based parameters and cognitive decline. Multivariable regression model revealed the best parameters able to predict disease progression. RESULTS Area under the ROC curve was 0.90 for LTP-like cortical plasticity, indicating an excellent accuracy of this parameter in detecting AD pathology. In contrast, area under the curve was only 0.64 for SAI, indicating a poor diagnostic accuracy. Notably, LTP-like cortical plasticity was a significant predictor of disease progression (p=0.02), while no other neurophysiological, neuropsychological and demographic parameters were associated with cognitive decline. Multivariable analysis then promoted LTP-like cortical plasticity as the best significant predictor of cognitive decline (p=0.01). Finally, LTP-like cortical plasticity was found to be strongly associated with the probability of rapid cognitive decline (delta Mini-Mental State Examination score ≤-4 points at 18 months) (p=0.04); patients with AD with lower LTP-like cortical plasticity values showed faster disease progression. CONCLUSIONS TMS-based assessment of LTP-like cortical plasticity could be a viable biomarker to assess synaptic impairment and predict subsequent cognitive decline progression in patients with ADs.
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Affiliation(s)
- Caterina Motta
- Non Invasive Brain Stimulation Unit, Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy.,Department of Systems Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Francesco Di Lorenzo
- Non Invasive Brain Stimulation Unit, Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy.,Department of Systems Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Viviana Ponzo
- Non Invasive Brain Stimulation Unit, Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Maria Concetta Pellicciari
- Non Invasive Brain Stimulation Unit, Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Sonia Bonnì
- Non Invasive Brain Stimulation Unit, Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Silvia Picazio
- Non Invasive Brain Stimulation Unit, Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | | | - Carlo Caltagirone
- Non Invasive Brain Stimulation Unit, Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy.,Department of Systems Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Alessandro Martorana
- Non Invasive Brain Stimulation Unit, Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy.,Department of Systems Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Giacomo Koch
- Non Invasive Brain Stimulation Unit, Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy .,Stroke Unit, Tor Vergata Policlinic, Rome, Italy
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Pellicciari MC, Bonnì S, Ponzo V, Cinnera AM, Mancini M, Casula EP, Sallustio F, Paolucci S, Caltagirone C, Koch G. Dynamic reorganization of TMS-evoked activity in subcortical stroke patients. Neuroimage 2018; 175:365-378. [DOI: 10.1016/j.neuroimage.2018.04.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 04/04/2018] [Accepted: 04/06/2018] [Indexed: 12/21/2022] Open
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Cespón J, Miniussi C, Pellicciari MC. Interventional programmes to improve cognition during healthy and pathological ageing: Cortical modulations and evidence for brain plasticity. Ageing Res Rev 2018. [PMID: 29522820 DOI: 10.1016/j.arr.2018.03.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [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] [Indexed: 11/17/2022]
Abstract
A growing body of evidence suggests that healthy elderly individuals and patients with Alzheimer's disease retain an important potential for neuroplasticity. This review summarizes studies investigating the modulation of neural activity and structural brain integrity in response to interventions involving cognitive training, physical exercise and non-invasive brain stimulation in healthy elderly and cognitively impaired subjects (including patients with mild cognitive impairment (MCI) and Alzheimer's disease). Moreover, given the clinical relevance of neuroplasticity, we discuss how evidence for neuroplasticity can be inferred from the functional and structural brain changes observed after implementing these interventions. We emphasize that multimodal programmes, which combine several types of interventions, improve cognitive function to a greater extent than programmes that use a single interventional approach. We suggest specific methods for weighting the relative importance of cognitive training, physical exercise and non-invasive brain stimulation according to the functional and structural state of the brain of the targeted subject to maximize the cognitive improvements induced by multimodal programmes.
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Affiliation(s)
- Jesús Cespón
- Cognitive Neuroscience Section, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; BCBL, Basque Center on Cognition, Brain and Language, Spain.
| | - Carlo Miniussi
- Cognitive Neuroscience Section, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Center for Mind/Brain Sciences - CIMeC, University of Trento, Rovereto, TN, Italy
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25
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Koch G, Bonnì S, Pellicciari MC, Casula EP, Mancini M, Esposito R, Ponzo V, Picazio S, Di Lorenzo F, Serra L, Motta C, Maiella M, Marra C, Cercignani M, Martorana A, Caltagirone C, Bozzali M. Transcranial magnetic stimulation of the precuneus enhances memory and neural activity in prodromal Alzheimer's disease. Neuroimage 2018; 169:302-311. [DOI: 10.1016/j.neuroimage.2017.12.048] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 12/11/2017] [Accepted: 12/14/2017] [Indexed: 02/08/2023] Open
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26
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Mancini M, Pellicciari MC, Brignani D, Mauri P, De Marchis C, Miniussi C, Conforto S. Automatic artifact suppression in simultaneous tDCS-EEG using adaptive filtering. Annu Int Conf IEEE Eng Med Biol Soc 2018; 2015:2729-32. [PMID: 26736856 DOI: 10.1109/embc.2015.7318956] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation method that can be used in cognitive and clinical protocols in order to modulate neural activity. Although some macro effects are known, the underlying mechanisms are still not clear. tDCS in combination with electroencephalography (EEG) could help to understand these mechanisms from a neural point of view. However, simultaneous tDCS-EEG still remains challenging because of the artifacts that affect the recorded signals. In this paper, an automated artifact cancellation method based on adaptive filtering is proposed. Using independent component analysis (ICA), the artifacts were characterized using data from both a phantom and a group of healthy subjects. The resulting filter can successfully remove tDCS-related artifacts during anodal and cathodal stimulations.
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DI Lorenzo F, Motta C, Pellicciari MC, Ponzo V, Bonnı̀ S, Caltagirone C, Martorana A, Koch G. O176 LTP-like cortical plasticity in ad patients: A novel biomarker of disease progression. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.07.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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28
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Di Lorenzo F, Bonnì S, Picazio S, Ponzo V, Pellicciari MC, Casula E, Serra L, Mancini M, Caltagirone C, Martorana A, Bozzali M, Koch G. Repetitive TMS of the default mode network: a randomized, double-blinded, cross-over study trial in MCI patients. Brain Stimul 2017. [DOI: 10.1016/j.brs.2017.01.543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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29
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Pellicciari MC, Veniero D, Miniussi C. Characterizing the Cortical Oscillatory Response to TMS Pulse. Front Cell Neurosci 2017; 11:38. [PMID: 28289376 PMCID: PMC5326778 DOI: 10.3389/fncel.2017.00038] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 02/07/2017] [Indexed: 12/15/2022] Open
Affiliation(s)
| | - Domenica Veniero
- Centre for Cognitive Neuroimaging, Institute of Neuroscience and Psychology, University of GlasgowGlasgow, UK
| | - Carlo Miniussi
- Cognitive Neuroscience Section, IRCCS Centro San Giovanni di Dio FatebenefratelliBrescia, Italy
- Center for Mind/Brain Sciences - CIMeC, University of TrentoRovereto, Italy
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30
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Casula EP, Pellicciari MC, Ponzo V, Stampanoni Bassi M, Veniero D, Caltagirone C, Koch G. Cerebellar theta burst stimulation modulates the neural activity of interconnected parietal and motor areas. Sci Rep 2016; 6:36191. [PMID: 27796359 PMCID: PMC5086958 DOI: 10.1038/srep36191] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 10/12/2016] [Indexed: 12/24/2022] Open
Abstract
Voluntary movement control and execution are regulated by the influence of the cerebellar output over different interconnected cortical areas, through dentato-thalamo connections. In the present study we applied transcranial magnetic stimulation (TMS) and electroencephalography (EEG) to directly assess the effects of cerebellar theta-burst stimulation (TBS) over the controlateral primary motor cortex (M1) and posterior parietal cortex (PPC) in a group of healthy volunteers. We found a TBS-dependent bidirectional modulation over TMS-evoked activity; specifically, cTBS increased whereas iTBS decreased activity between 100 and 200 ms after TMS, in a similar manner over both M1 and PPC areas. On the oscillatory domain, TBS induced specific changes over M1 natural frequencies of oscillation: TMS-evoked alpha activity was decreased by cTBS whereas beta activity was enhanced by iTBS. No effects were observed after sham stimulation. Our data provide novel evidence showing that the cerebellum exerts its control on the cortex likely by impinging on specific set of interneurons dependent on GABA-ergic activity. We show that cerebellar TBS modulates cortical excitability of distant interconnected cortical areas by acting through common temporal, spatial and frequency domains.
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Affiliation(s)
- Elias Paolo Casula
- Non Invasive Brain Stimulation Unit, Department of Behavioural and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Maria Concetta Pellicciari
- Non Invasive Brain Stimulation Unit, Department of Behavioural and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Viviana Ponzo
- Non Invasive Brain Stimulation Unit, Department of Behavioural and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | | | - Domenica Veniero
- Non Invasive Brain Stimulation Unit, Department of Behavioural and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Carlo Caltagirone
- Non Invasive Brain Stimulation Unit, Department of Behavioural and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
- Department of System Medicine, Tor Vergata University, Rome, Italy
| | - Giacomo Koch
- Non Invasive Brain Stimulation Unit, Department of Behavioural and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
- Stroke Unit, Tor Vergata Policlinic, Rome, Italy
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31
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Casula EP, Stampanoni Bassi M, Pellicciari MC, Ponzo V, Veniero D, Peppe A, Brusa L, Stanzione P, Caltagirone C, Stefani A, Koch G. Subthalamic stimulation and levodopa modulate cortical reactivity in Parkinson's patients. Parkinsonism Relat Disord 2016; 34:31-37. [PMID: 27771287 DOI: 10.1016/j.parkreldis.2016.10.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 09/05/2016] [Accepted: 10/14/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND The effects of deep brain stimulation of the subthalamic nucleus (DBS-STN) and L-dopa (LD) on cortical activity in Parkinson's disease (PD) are poorly understood. OBJECTIVES By combining transcranial magnetic stimulation (TMS) and electroencephalography (EEG) we explored the effects of STN-DBS, either alone or in combination with L-Dopa (LD), on TMS-evoked cortical activity in a sample of implanted PD patients. METHODS PD patients were tested in three clinical conditions: i) LD therapy with STN-DBS turned on (ON/ON condition); ii) without LD therapy with STN-DBS turned on (OFF/ON condition); iii) without LD therapy with STN-DBS turned off (OFF/OFF condition). TMS pulses were delivered over left M1 while simultaneously acquiring EEG. Eight age-matched healthy volunteers (HC) were tested as a control group. RESULTS STN-DBS enhanced early global TMS-evoked activity (∼45-80ms) and high-alpha TMS-evoked oscillations (11-13 Hz) as compared to OFF/OFF condition, independently from concomitant LD therapy. LD intake (ON/ON condition) produced a further increase of late TMS-evoked activity (∼80-130ms) and beta TMS-evoked oscillations (13-30 Hz), as compared to OFF/OFF and OFF/ON conditions, that normalized reactivity as compared to HC range of values. CONCLUSIONS Our data reveal that bilateral STN-DBS and LD therapy induce a modulation of specific cortical components and specific ranges of frequency. These findings demonstrate that STN-DBS and LD therapy may have synergistic effects on motor cortical activity.
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Affiliation(s)
- Elias Paolo Casula
- Non-Invasive Brain Stimulation Unit, Neurologia Clinica e Comportamentale, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Mario Stampanoni Bassi
- Non-Invasive Brain Stimulation Unit, Neurologia Clinica e Comportamentale, Fondazione Santa Lucia IRCCS, Rome, Italy; Department of System Medicine, Policlinico di Tor Vergata, Rome, Italy
| | - Maria Concetta Pellicciari
- Non-Invasive Brain Stimulation Unit, Neurologia Clinica e Comportamentale, Fondazione Santa Lucia IRCCS, Rome, Italy; Cognitive Neuroscience Section, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Viviana Ponzo
- Non-Invasive Brain Stimulation Unit, Neurologia Clinica e Comportamentale, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Domenica Veniero
- Non-Invasive Brain Stimulation Unit, Neurologia Clinica e Comportamentale, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Antonella Peppe
- Non-Invasive Brain Stimulation Unit, Neurologia Clinica e Comportamentale, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Livia Brusa
- Department of Neurology, Sant'Eugenio Hospital, Rome, Italy
| | - Paolo Stanzione
- Department of Neurology, Sant'Eugenio Hospital, Rome, Italy; Stroke Unit, Policlinico Tor Vergata, Rome, Italy
| | - Carlo Caltagirone
- Non-Invasive Brain Stimulation Unit, Neurologia Clinica e Comportamentale, Fondazione Santa Lucia IRCCS, Rome, Italy; Department of System Medicine, Policlinico di Tor Vergata, Rome, Italy; Department of Neurology, Sant'Eugenio Hospital, Rome, Italy
| | | | - Giacomo Koch
- Non-Invasive Brain Stimulation Unit, Neurologia Clinica e Comportamentale, Fondazione Santa Lucia IRCCS, Rome, Italy; Department of System Medicine, Policlinico di Tor Vergata, Rome, Italy; Stroke Unit, Policlinico Tor Vergata, Rome, Italy.
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Mancini M, Brignani D, Conforto S, Mauri P, Miniussi C, Pellicciari MC. Assessing cortical synchronization during transcranial direct current stimulation: A graph-theoretical analysis. Neuroimage 2016; 140:57-65. [DOI: 10.1016/j.neuroimage.2016.06.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 06/01/2016] [Accepted: 06/02/2016] [Indexed: 01/22/2023] Open
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Polimanti R, Simonelli I, Zappasodi F, Ventriglia M, Pellicciari MC, Benussi L, Squitti R, Rossini PM, Tecchio F. Biological factors and age-dependence of primary motor cortex experimental plasticity. Neurol Sci 2015; 37:211-8. [PMID: 26445942 DOI: 10.1007/s10072-015-2388-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 05/30/2015] [Accepted: 09/25/2015] [Indexed: 12/23/2022]
Abstract
To evaluate whether the age-dependence of brain plasticity correlates with the levels of proteins involved in hormone and brain functions we executed a paired associative stimulation (PAS) protocol and blood tests. We measured the PAS-induced plasticity in the primary motor cortex. Blood levels of the brain-derived neurotrophic factor (BDNF), estradiol, the insulin-like growth factor (IGF)-1, the insulin-like growth factor binding protein (IGFBP)-3, progesterone, sex hormone-binding globulin (SHBG), testosterone, and the transforming growth factor beta 1 (TGF-β1) were determined in 15 healthy men and 20 healthy women. We observed an age-related reduction of PAS-induced plasticity in females that it is not present in males. In females, PAS-induced plasticity displayed a correlation with testosterone (p = 0.006) that became a trend after the adjustment for the age effect (p = 0.078). In males, IGF-1 showed a nominally significant correlation with the PAS-induced plasticity (p = 0.043). In conclusion, we observed that hormone blood levels (testosterone in females and IGF-1 in males) may be involved in the age-dependence of brain plasticity.
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Affiliation(s)
- Renato Polimanti
- Department of Biology, University of Rome "Tor Vergata", Rome, Italy
- Department of Psychiatry, Yale University School of Medicine, West Haven, CT, USA
| | - Ilaria Simonelli
- Department of Imaging and Neurodegeneration Laboratory, IRCCS San Raffaele Pisana, Rome, Italy
- Medical Statistics and Information Technology and Department of Neuroscience, Fatebenefratelli Foundation, AFaR Division, Fatebenefratelli Hospital-Isola Tiberina, Rome, Italy
| | - Filippo Zappasodi
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy
- Institute of Advanced Biomedical Technologies, University "G. d'Annunzio", Chieti, Italy
| | - Mariacarla Ventriglia
- Medical Statistics and Information Technology and Department of Neuroscience, Fatebenefratelli Foundation, AFaR Division, Fatebenefratelli Hospital-Isola Tiberina, Rome, Italy
| | - Maria Concetta Pellicciari
- Cognitive Neuroscience Section and Molecular Markers Laboratory, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Luisa Benussi
- Cognitive Neuroscience Section and Molecular Markers Laboratory, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Rosanna Squitti
- Department of Imaging and Neurodegeneration Laboratory, IRCCS San Raffaele Pisana, Rome, Italy
- Medical Statistics and Information Technology and Department of Neuroscience, Fatebenefratelli Foundation, AFaR Division, Fatebenefratelli Hospital-Isola Tiberina, Rome, Italy
| | - Paolo Maria Rossini
- Department of Imaging and Neurodegeneration Laboratory, IRCCS San Raffaele Pisana, Rome, Italy
- Institute of Neurology, Catholic University, Rome, Italy
| | - Franca Tecchio
- Department of Imaging and Neurodegeneration Laboratory, IRCCS San Raffaele Pisana, Rome, Italy.
- Laboratory of Electrophysiology for Translational neuroScience (LET'S), Institute of Cognitive Sciences and Technologies (ISTC), National Research Council (CNR), Rome, Italy.
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Pellicciari MC, Cordone S, Marzano C, Bignotti S, Gazzoli A, Miniussi C, De Gennaro L. Dorsolateral prefrontal transcranial magnetic stimulation in patients with major depression locally affects alpha power of REM sleep. Front Hum Neurosci 2013; 7:433. [PMID: 23935577 PMCID: PMC3731627 DOI: 10.3389/fnhum.2013.00433] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 07/16/2013] [Indexed: 02/05/2023] Open
Abstract
Sleep alterations are among the most important disabling manifestation symptoms of Major Depression Disorder (MDD). A critical role of sleep importance is also underlined by the fact that its adjustment has been proposed as an objective marker of clinical remission in MDD. Repetitive transcranial magnetic stimulation (rTMS) represents a relatively novel therapeutic tool for the treatment of drug-resistant depression. Nevertheless, besides clinical evaluation of the mood improvement after rTMS, we have no clear understanding of what are the neurophysiological correlates of such treatment. One possible marker underlying the clinical outcome of rTMS in MDD could be cortical changes on wakefulness and sleep activity. The aim of this open-label study was to evaluate the efficacy of a sequential bilateral rTMS treatment over the dorsolateral prefrontal cortex (DLPFC) to improve the mood in MDD patients, and to determine if rTMS can induce changes on the sleep structure, and if those changes can be used as a surrogate marker of the clinical state of the patient. Ten drug-resistant depressed patients participated to ten daily sessions of sequential bilateral rTMS with a low-frequency TMS (1 Hz) over right-DLPFC and a subsequent high-frequency (10 Hz) TMS over left-DLPFC. The clinical and neurophysiological effects induced by rTMS were evaluated, respectively by means of the Hamilton Depression Rating Scale (HDRS), and by comparing the sleep pattern modulations and the spatial changes of EEG frequency bands during both NREM and REM sleep, before and after the real rTMS treatment. The sequential bilateral rTMS treatment over the DLPFC induced topographical-specific decrease of the alpha activity during REM sleep over left-DLPFC, which is significantly associated to the clinical outcome. In line with the notion of a left frontal hypoactivation in MDD patients, the observed local decrease of alpha activity after rTMS treatment during the REM sleep suggests that alpha frequency reduction could be considered as a marker of up-regulation of cortical activity induced by rTMS, as well as a surrogate neurophysiological correlate of the clinical outcome.
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Affiliation(s)
| | - Susanna Cordone
- Department of Psychology, University of Rome SapienzaRome, Italy
| | - Cristina Marzano
- Department of Psychology, University of Rome SapienzaRome, Italy
| | - Stefano Bignotti
- Cognitive Neuroscience Section, IRCCS Centro San Giovanni di Dio FatebenefratelliBrescia, Italy
| | - Anna Gazzoli
- Cognitive Neuroscience Section, IRCCS Centro San Giovanni di Dio FatebenefratelliBrescia, Italy
| | - Carlo Miniussi
- Cognitive Neuroscience Section, IRCCS Centro San Giovanni di Dio FatebenefratelliBrescia, Italy
- Department of Clinical and Experimental Sciences, National Institute of Neuroscience, University of BresciaBrescia, Italy
| | - Luigi De Gennaro
- Department of Psychology, University of Rome SapienzaRome, Italy
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Pellicciari MC, Brignani D, Miniussi C. Excitability modulation of the motor system induced by transcranial direct current stimulation: a multimodal approach. Neuroimage 2013; 83:569-80. [PMID: 23845429 DOI: 10.1016/j.neuroimage.2013.06.076] [Citation(s) in RCA: 136] [Impact Index Per Article: 12.4] [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: 04/23/2013] [Revised: 06/12/2013] [Accepted: 06/29/2013] [Indexed: 11/19/2022] Open
Abstract
Anodal and cathodal transcranial direct current stimulations (tDCS) are both established techniques to induce cortical excitability changes. Typically, in the human motor system, such cortical modulations are inferred through changes in the amplitude of the motor evoked potentials (MEPs). However, it is now possible to directly evaluate tDCS-induced changes at the cortical level by recording the transcranial magnetic stimulation evoked potentials (TEPs) using electroencephalography (EEG). The present study investigated the modulation induced by the tDCS on the motor system. The study evaluates changes in the MEPs, in the amplitude and distribution of the TEPs, in resting state oscillatory brain activity and in behavioral performance in a simple manual response task. Both the short- and long-term tDCS effects were investigated by evaluating their time course at ~0 and 30min after tDCS. Anodal tDCS over the left primary motor cortex (M1) induced an enhancement of corticospinal excitability, whereas cathodal stimulation produced a reduction. These changes in excitability were indexed by changes in MEP amplitude. More interestingly, tDCS modulated the cortical reactivity, which is the neuronal activity evoked by TMS, in a polarity-dependent and site-specific manner. Cortical reactivity increased after anodal stimulation over the left M1, whereas it decreased with cathodal stimulation. These effects were partially present also at long term evaluation. No polarity-specific effect was found either on behavioral measures or on oscillatory brain activity. The latter showed a general increase in the power density of low frequency oscillations (theta and alpha) at both stimulation polarities. Our results suggest that tDCS is able to modulate motor cortical reactivity in a polarity-specific manner, inducing a complex pattern of direct and indirect cortical activations or inhibitions of the motor system-related network, which might be related to changes in synaptic efficacy of the motor cortex.
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Cacciari C, Bolognini N, Senna I, Pellicciari MC, Miniussi C, Papagno C. Literal, fictive and metaphorical motion sentences preserve the motion component of the verb: a TMS study. Brain Lang 2011; 119:149-157. [PMID: 21684590 DOI: 10.1016/j.bandl.2011.05.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 05/09/2011] [Accepted: 05/23/2011] [Indexed: 05/30/2023]
Abstract
We used Transcranial Magnetic Stimulation (TMS) to assess whether reading literal, non-literal (i.e., metaphorical, idiomatic) and fictive motion sentences modulates the activity of the motor system. Sentences were divided into three segments visually presented one at a time: the noun phrase, the verb and the final part of the sentence. Single pulse-TMS was delivered at the end of the sentence over the leg motor area in the left hemisphere and motor evoked potentials (MEPs) were recorded from the right gastrocnemius and tibialis anterior muscles. MEPs were larger when participants were presented with literal, fictive and metaphorical motion sentences than with idiomatic motion or mental sentences. These results suggest that the excitability of the motor system is modulated by the motor component of the verb, which is preserved in fictive and metaphorical motion sentences.
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Affiliation(s)
- C Cacciari
- Department of Biomedical Sciences, University of Modena & Reggio-Emilia, Italy
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37
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De Gennaro L, Marzano C, Fratello F, Moroni F, Pellicciari MC, Ferlazzo F, Costa S, Couyoumdjian A, Curcio G, Sforza E, Malafosse A, Finelli LA, Pasqualetti P, Ferrara M, Bertini M, Rossini PM. The electroencephalographic fingerprint of sleep is genetically determined: A twin study. Ann Neurol 2008; 64:455-60. [PMID: 18688819 DOI: 10.1002/ana.21434] [Citation(s) in RCA: 170] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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38
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Tecchio F, Zappasodi F, Pasqualetti P, Gennaro LD, Pellicciari MC, Ercolani M, Squitti R, Rossini PM. Age dependence of primary motor cortex plasticity induced by paired associative stimulation. Clin Neurophysiol 2008; 119:675-682. [PMID: 18178522 DOI: 10.1016/j.clinph.2007.10.023] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Revised: 09/26/2007] [Accepted: 10/31/2007] [Indexed: 02/05/2023]
Affiliation(s)
- F Tecchio
- ISTC-CNR, Franca Tecchio, Unità MEG, Fatebenefratelli Hospital, Isola Tiberina, 00186 Roma, Italy; Casa di Cura San Raffaele Cassino e IRCCS San Raffaele Pisana, Italy.
| | - F Zappasodi
- ISTC-CNR, Franca Tecchio, Unità MEG, Fatebenefratelli Hospital, Isola Tiberina, 00186 Roma, Italy; AFaR, Fatebenefratelli Hospital, Isola Tiberina, Roma, Italy
| | - P Pasqualetti
- AFaR, Fatebenefratelli Hospital, Isola Tiberina, Roma, Italy; Casa di Cura San Raffaele Cassino e IRCCS San Raffaele Pisana, Italy
| | - L De Gennaro
- Department of Psychology, University 'Sapienza', Roma, Italy
| | - M C Pellicciari
- Cognitive Neuroscience Unit, IRCCS "Centro San Giovanni di Dio - FBF", Brescia, Italy
| | - M Ercolani
- AFaR, Fatebenefratelli Hospital, Isola Tiberina, Roma, Italy
| | - R Squitti
- AFaR, Fatebenefratelli Hospital, Isola Tiberina, Roma, Italy
| | - P M Rossini
- Department of Neurology, 'Campus Bio-Medico' University, Roma, Italy; AFaR, Fatebenefratelli Hospital, Isola Tiberina, Roma, Italy; Cognitive Neuroscience Unit, IRCCS "Centro San Giovanni di Dio - FBF", Brescia, Italy
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Marzano C, Fratello F, Moroni F, Pellicciari MC, Curcio G, Ferrara M, Ferlazzo F, De Gennaro L. Slow eye movements and subjective estimates of sleepiness predict EEG power changes during sleep deprivation. Sleep 2007; 30:610-6. [PMID: 17552376 DOI: 10.1093/sleep/30.5.610] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE The aim of the present study was to assess, intraindividually, the relationship among slow eye movements, electroencephalogram (EEG) power, and subjective measures of sleepiness during a 40-hour sleep deprivation comparing 2 experimental conditions: eyes-open and eyes-closed. METHODS Nineteen normal subjects participated in a sleep-deprivation protocol with recordings of the waking Cz-A1-2 EEG in 36 sessions at 1-hour intervals starting at 10:00 AM. Each session consisted of a 2-minute eyes-closed period, followed by a 4-minute eyes-open period. Electrooculogram, self-ratings (Karolinska Sleepiness Scale and Visual Analog Scale for Global Vigor), and tympanic temperature were also recorded. RESULTS Changes in sleepiness and alertness are paralleled by increases in slow eye movements and theta and delta EEG power. The beginning of the rise of delta, theta, and slow eye movement activity corresponded to the nadir of temperature, peaking at 7:00AM. Cross-correlational analyses showed that changes in slow eye movements were strictly phase locked to those in slow-frequency EEG bands and in subjective measures. The comparison of time intervals that were equivalent with respect to circadian phase confirms the effects of the increased sleepiness on slow eye movement activity and on the other measures. The temporal concordance of the different physiologic and subjective measures is also reflected in the individual time courses. Individual and group analyses converged in indicating that slow eye movements can be considered reliable indexes of sleepiness but only in the eyes-closed condition. CONCLUSIONS Results suggest that subjective and EEG changes associated with higher sleepiness are paralleled by an increase in slow eye movement activity, but this relationship exists almost exclusively with the eyes closed. Hence, its use in practical and operational contexts seems limited.
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Affiliation(s)
- Cristina Marzano
- Department of Psychology, University of Rome "La Sapienza," Rome, Italy
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De Gennaro L, Marzano C, Veniero D, Moroni F, Fratello F, Curcio G, Ferrara M, Ferlazzo F, Novelli L, Concetta Pellicciari M, Bertini M, Rossini PM. Neurophysiological correlates of sleepiness: A combined TMS and EEG study. Neuroimage 2007; 36:1277-87. [PMID: 17524675 DOI: 10.1016/j.neuroimage.2007.04.013] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2007] [Revised: 04/02/2007] [Accepted: 04/06/2007] [Indexed: 02/08/2023] Open
Abstract
Changes of cortical and corticospinal excitability as a function of sleep deprivation have been studied, using EEG power maps and several TMS measures in 33 normal subjects before and after a 40-h sleep deprivation (SD). The effects of SD were independently assessed by subjective and EEG measures of sleepiness, the latter being represented in terms of cortical maps for different frequency bands. Short intracortical facilitation (SICF) and inhibition (SICI) were measured by the paired-pulse TMS technique with different inter-stimulus intervals. Besides standardized motor threshold (MT), lower threshold (LT) and upper threshold (UT) were also determined. Subjective sleepiness severely increased as a consequence of SD, paralleled by a drastic decrease of alertness. EEG topography showed large increases in delta and theta activity, mainly evident at fronto-central areas. Standard MTs, as well as LTs and UTs, all increased as a consequence of SD. SICF also showed a significant increase as compared to pre-deprivation values, but only in females. The increase of theta activity was strongly associated in the left frontal and prefrontal cortex to a smaller decrease of corticospinal excitability, expressed by MTs, and a larger increase of intracortical facilitation, expressed by SICF. TMS and EEG measures converge in indicating that SD has severe effects on both cortical and corticospinal excitability, as shown respectively by the increases of slow-frequency EEG power and MTs. The SICF enhancement in females and the results of the combined topographical analysis of EEG and TMS changes are coherent with the hypothesis that cortical TMS-evoked responses are higher as a consequence of a longer wakefulness. However, the lack of an increase in cortical excitability after prolonged wakefulness in males suggests some caution in the generalization of these effects, that deserve further investigation.
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Affiliation(s)
- Luigi De Gennaro
- Department of Psychology, University of Rome La Sapienza, Rome, Italy.
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Fratello F, Veniero D, Curcio G, Ferrara M, Marzano C, Moroni F, Pellicciari MC, Bertini M, Rossini PM, De Gennaro L. Modulation of corticospinal excitability by paired associative stimulation: Reproducibility of effects and intraindividual reliability. Clin Neurophysiol 2006; 117:2667-74. [PMID: 17011821 DOI: 10.1016/j.clinph.2006.07.315] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Revised: 07/19/2006] [Accepted: 07/28/2006] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Electrical stimulation of the median nerve followed by a magnetic pulse on the primary motor cortex (M1) is effective to cause an increase in the amplitude of motor evoked potential (MEP) registered in the target muscle with the interstimulus interval (ISI) at 25ms (paired associative stimulation, PAS). The aim of this study is to evaluate the reproducibility of PAS with ISI 25 (PAS25), assessed in two separate sessions. Intraindividual reliability of TMS measures was also evaluated. METHODS Motor threshold of abductor pollicis brevis (APB), assessed at rest, and MEP amplitude of APB and abductor digiti minimi (ADM) were assessed before and after PAS25 in 18 healthy volunteers (nine males and nine females). RESULTS Data showed a significant increase of MEP amplitude in the target muscle (APB) after PAS25 and a reproducibility of group effect in the two sessions, as assessed by ANOVA, but a lack of intraindividual reliability, as assessed by intraclass correlation coefficients (ICC). CONCLUSIONS The results underline the reproducibility of mean effects and the need to be careful when comparing the same subject on different days. SIGNIFICANCE Electrical stimulation of the median nerve followed by a magnetic pulse delivered on M1 after 25ms causes a reproducible increase in MEP amplitude, without showing an acceptable intraindividual reliability.
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Affiliation(s)
- Fabiana Fratello
- Department of Psychology, University of Rome, La Sapienza, Rome, Italy
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Ferrara M, Curcio G, Fratello F, Moroni F, Marzano C, Pellicciari MC, Gennaro LD. The electroencephalographic substratum of the awakening. Behav Brain Res 2006; 167:237-44. [PMID: 16242789 DOI: 10.1016/j.bbr.2005.09.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2005] [Revised: 09/09/2005] [Accepted: 09/12/2005] [Indexed: 02/05/2023]
Abstract
The aim of the present study was to characterize the regional electroencephalographic substratum of the awakening process by means of a Hz-by-Hz EEG spectral power analysis. For this purpose, we recorded a group of 25 female subjects who slept for at least two consecutive nights in the laboratory. The post-sleep waking EEG was compared to the one recorded during the presleep wakefulness from four midline derivations (Fz-A1, Cz-A1, Pz-A1, Oz-A1). Results indicated that the first 10 min after awakening are characterized by an increase of EEG power in the low-frequency range (1-9 Hz) compared to the corresponding presleep waking period, and by a significant decrease of EEG power in the beta range (18-24 Hz). As regards topographic differences, the increase of EEG power upon awakening in the delta-theta range showed a parieto-occipital prevalence. Moreover, the occipital derivation showed a larger decrease of power in the beta range as compared to the other derivations. In conclusion, the EEG substratum of the sleep offset period is characterized by a pattern of increased EEG power in the delta-theta and low-alpha bands, and of decreased power in the beta range. This pattern could be considered as the spectral EEG signature of the sleep inertia phenomenon. The state of post-sleep EEG hypo-arousal does not subside in the first 10-min period after awakening considered in the present analysis. Finally, according to our results, the more posterior scalp locations show stronger EEG signs of sleep inertia, and could be the last ones to properly wake up.
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Affiliation(s)
- Michele Ferrara
- Department of Internal Medicine and Public Health, University of L'Aquila, Via Vetoio, I-67100 L'Aquila, Italy.
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Abstract
OBJECTIVE To assess the effects of total sleep deprivation on sleep spindle and K-complex (KC) density. METHODS Eight healthy male subjects (mean age=23.4 years) participated in the experiment: they slept in the laboratory for 3 nights (one adaptation, one baseline, one recovery); baseline and recovery night were separated by a period of 40 h of continuous wake. RESULTS One night of total sleep deprivation caused a doubling of slow-wave sleep (SWS) amount, an increase of sleep efficiency and a reduction of the latencies of non-rapid eye movement (NREM) sleep stages during the recovery night. These effects were accompanied by a significant reduction in spindle density in the first sleep cycle of the recovery night. Mean KC density did not change as a result of total sleep deprivation, while KC density and inter-KC intervals showed linear trends across the first 4 sleep cycles, respectively decreasing and increasing. Finally, a clear evidence of an antagonist relationship between spindle and KC changes across sleep cycles was provided. CONCLUSIONS The present study further supports the existence of a reciprocal relationship between SWS and sleep spindles, but fails to show an increase of KC density after total sleep deprivation. The opposite time courses of spindle and KC density across sleep cycles points to an antagonist relation between the two main phasic events of NREM sleep. The latter result, together with the increase of inter-KC distance and the decrease of KC density across subsequent sleep cycles, is consistent with the hypothesis of a role of the spontaneous KC as the "forerunner" of delta waves.
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Affiliation(s)
- Giuseppe Curcio
- Laboratorio di Psicofisiologia del Sonno, Department of Psychology, University of Rome La Sapienza, Via dei Marsi, 78; 00185 Rome, Italy.
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