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Wang YH, Gau SF, Yang LK, Chang JC, Cheong PL, Kuo HI. Acute aerobic exercise at different intensities modulates inhibitory control and cortical excitability in adults with attention-deficit hyperactivity disorder (ADHD). Asian J Psychiatr 2024; 95:103993. [PMID: 38485649 DOI: 10.1016/j.ajp.2024.103993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/30/2023] [Accepted: 03/02/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND This study aimed to investigate the effects of different aerobic exercise intensities on inhibitory control and cortical excitability in adults with attention-deficit/hyperactivity disorder (ADHD). METHODS The study was conducted in a within-subject design. Twenty-four adults with ADHD completed a stop signal task and received cortical excitability assessment by transcranial magnetic stimulation (TMS) before and after a single session of low-, moderate-, high-intensity aerobic exercise or a control intervention. RESULTS Acute moderate-, and high-intensity aerobic exercise improved inhibitory control in adults with ADHD. Moreover, the improving effect was similar between moderate-, and high-intensity aerobic exercise conditions. As shown by the brain physiology results, short interval intracortical inhibition was significantly increased following both, moderate- and high-intensity aerobic exercise intervention conditions. Additionally, the alteration of short interval intracortical inhibition and inhibitory control improvement were positively correlated. CONCLUSIONS The moderate-, and high-intensity aerobic exercise-dependent alterations of cortical excitability in adults with ADHD might partially explain the inhibitory control-improving effects of aerobic exercise in this population.
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Affiliation(s)
- Yu-Han Wang
- School and Graduate Institute of Physical Therapy, National Taiwan University, No. 17, Xu-Zhou Road, Taipei 10055, Taiwan
| | - Shur-Fen Gau
- Department of Psychiatry, National Taiwan University Hospital, No 7, Zhongshan S Road, Taipei 10055, Taiwan
| | - Li-Kuang Yang
- Department of Psychiatry, National Taiwan University Hospital, No 7, Zhongshan S Road, Taipei 10055, Taiwan
| | - Jung-Chi Chang
- Department of Psychiatry, National Taiwan University Hospital, No 7, Zhongshan S Road, Taipei 10055, Taiwan
| | - Pou-Leng Cheong
- Department of Pediatrics, National Taiwan University Hospital Hsin-Chu Hospital, No. 25, Lane 442, Section 1, Hsinchu, Taiwan; Department of Biological Science and Technology, National Yang Ming Chiao Tung University, 75 Po-Ai Street, Hsinchu 300, Taiwan
| | - Hsiao-I Kuo
- School and Graduate Institute of Physical Therapy, National Taiwan University, No. 17, Xu-Zhou Road, Taipei 10055, Taiwan.
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Phylactou P, Pham TNM, Narskhani N, Diya N, Seminowicz DA, Schabrun SM. Phosphene and motor transcranial magnetic stimulation thresholds are correlated: A meta-analytic investigation. Prog Neuropsychopharmacol Biol Psychiatry 2024; 133:111020. [PMID: 38692474 DOI: 10.1016/j.pnpbp.2024.111020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 04/22/2024] [Accepted: 04/28/2024] [Indexed: 05/03/2024]
Abstract
Transcranial magnetic stimulation (TMS) is commonly delivered at an intensity defined by the resting motor threshold (rMT), which is thought to represent cortical excitability, even if the TMS target area falls outside of the motor cortex. This approach rests on the assumption that cortical excitability, as measured through the motor cortex, represents a 'global' measure of excitability. Another common approach to measure cortical excitability relies on the phosphene threshold (PT), measured through the visual cortex of the brain. However, it remains unclear whether either estimate can serve as a singular measure to infer cortical excitability across different brain regions. If PT and rMT can indeed be used to infer cortical excitability across brain regions, they should be correlated. To test this, we systematically identified previous studies that measured PT and rMT to calculate an overall correlation between the two estimates. Our results, based on 16 effect sizes from eight studies, indicated that PT and rMT are correlated (ρ = 0.4), and thus one measure could potentially serve as a measure to infer cortical excitability across brain regions. Three exploratory meta-analyses revealed that the strength of the correlation is affected by different methodologies, and that PT intensities are higher than rMT. Evidence for a PT-rMT correlation remained robust across all analyses. Further research is necessary for an in-depth understanding of how cortical excitability is reflected through TMS.
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Affiliation(s)
- P Phylactou
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada; The Gray Centre for Mobility and Activity, Parkwood Institute, London, ON, Canada.
| | - T N M Pham
- The Gray Centre for Mobility and Activity, Parkwood Institute, London, ON, Canada
| | - N Narskhani
- The Gray Centre for Mobility and Activity, Parkwood Institute, London, ON, Canada
| | - N Diya
- The Gray Centre for Mobility and Activity, Parkwood Institute, London, ON, Canada
| | - D A Seminowicz
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada
| | - S M Schabrun
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada; The Gray Centre for Mobility and Activity, Parkwood Institute, London, ON, Canada
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Cherian A, Divya KP, Krishnan ARS. Familial adult myoclonus epilepsy: a pragmatic approach. Acta Neurol Belg 2024; 124:389-394. [PMID: 38114875 DOI: 10.1007/s13760-023-02432-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/10/2023] [Indexed: 12/21/2023]
Abstract
Familial Adult Myoclonus Epilepsy (FAME), with a prevalence of < 1/35 000, is known under different acronyms. The disease is transmitted in an autosomal dominant manner and is characterized by the occurrence of cortical myoclonic tremor, overt myoclonus, and rare bilateral tonic-clonic seizures. FAME is considered neurodegenerative, although it is relatively slow in progression. Diagnosis is based on specific neurophysiological testing, namely jerk-locked back-averaging, somatosensory evoked potentials, long latency reflex, and motor evoked potentials, among others. Imaging data, including functional magnetic resonance imaging, indicate a cortical origin of the cortical myoclonic tremor and decreased cerebellar activation. Cerebellar changes in Purkinje cells have been noted, from few neuropathology reports, in patients from isolated pedigrees. The differential diagnosis includes essential tremor, some forms of genetic generalized epilepsy, and progressive myoclonus epilepsies. Treatment is mainly symptomatic.
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Affiliation(s)
- Ajith Cherian
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Medical College P.O, Trivandrum, PIN-695011, Kerala, India
| | - K P Divya
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Medical College P.O, Trivandrum, PIN-695011, Kerala, India.
| | - A R Swathy Krishnan
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Medical College P.O, Trivandrum, PIN-695011, Kerala, India
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Deodato M, Qualizza C, Martini M, Mazzari L, Furlanis G, Buoite Stella A, Manganotti P. Efficacy of dual-task augmented reality rehabilitation in non-hospitalized adults with self-reported long COVID fatigue and cognitive impairment: a pilot study. Neurol Sci 2024; 45:1325-1333. [PMID: 38191766 DOI: 10.1007/s10072-023-07268-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/12/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Cognitive impairment and chronic fatigue represent common characteristics of the long COVID syndrome. Different non-pharmacological treatments have been proposed, and physiotherapy has been proposed to improve the symptoms. This study aimed to evaluate the effects of a dual-task augmented reality rehabilitation protocol in people with long COVID fatigue and cognitive impairment. METHODS AND MATERIALS Ten non-hospitalized adults with reported fatigue and "brain fog" symptoms after COVID (7/10 females, 50 years, range 41-58) who participated in 20 sessions of a 1-h "dual-task" training, were compared to 10 long COVID individuals with similar demographics and symptoms (9/10 females, 56 years, range 43-65), who did not participate to any rehabilitation protocol. Cognitive performance was assessed with the Trail Making Test (TMT-A and -B) and Frontal Assessment Battery (FAB), and cardiovascular and muscular fatigue were assessed with the fatigue severity scale (FSS), six-minute walking test and handgrip endurance. Finally, transcranial magnetic stimulation (TMS) investigated cortical excitability. RESULTS The mixed-factors analysis of variance found a significant interaction effect only in cognitive performance evaluation, suggesting TMT-B execution time decreased (- 15.9 s, 95% CI 7.6-24.1, P = 0.001) and FAB score improved (1.88, 95% CI 2.93-0.82, P = 0.002) only in the physiotherapy group. For the remaining outcomes, no interaction effect was found, and most parameters similarly improved in the two groups. CONCLUSION The preliminary results from this study suggest that dual-task rehabilitation could be a feasible protocol to support cognitive symptoms recovery after COVID-19 and could be helpful in those individuals suffering from persisting and invalidating symptoms.
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Affiliation(s)
- Manuela Deodato
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Via Pascoli 31, 34100, Trieste, Italy
| | - Caterina Qualizza
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Via Pascoli 31, 34100, Trieste, Italy
| | - Miriam Martini
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Via Pascoli 31, 34100, Trieste, Italy
- PhD Program in Personalized Medicine and Innovative Therapies, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada Di Fiume 447, 34149, Trieste, Italy
| | - Laura Mazzari
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Via Pascoli 31, 34100, Trieste, Italy
| | - Giovanni Furlanis
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada Di Fiume 447, 34149, Trieste, Italy
| | - Alex Buoite Stella
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Via Pascoli 31, 34100, Trieste, Italy.
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada Di Fiume 447, 34149, Trieste, Italy.
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada Di Fiume 447, 34149, Trieste, Italy.
| | - Paolo Manganotti
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Via Pascoli 31, 34100, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada Di Fiume 447, 34149, Trieste, Italy
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada Di Fiume 447, 34149, Trieste, Italy
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Choobsaz H, Ghotbi N, Ansari NN. Effects of dry needling on spasticity, cortical excitability, and range of motion in a patient with multiple sclerosis: a case report. J Med Case Rep 2024; 18:125. [PMID: 38521912 PMCID: PMC10960986 DOI: 10.1186/s13256-024-04452-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 02/08/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Dry needling is an intervention used by physiotherapists to manage muscle spasticity. We report the effects of three sessions of dry needling on ankle plantar flexor muscle spasticity and cortical excitability in a patient with multiple sclerosis. CASE PRESENTATION The patient was a 40-year-old Iranian woman with an 11-year history of multiple sclerosis. The study outcomes were measured by the modified modified Ashworth scale, transcranial magnetic stimulation parameters, and active and passive ankle range of motion. They were assessed before (T0), after three sessions of dry needling (T1), and at 2-week follow-up (T2). Our result showed: the modified modified Ashworth scale was improved at T2 from, 2 to 1. The resting motor threshold decreased from 63 to 61 and 57 at T1 and T2, respectively. The single test motor evokes potential increased from 76.2 to 78.3. The short intracortical inhibition increased from 23.6 to 35.4 at T2. The intracortical facilitation increased from 52 to 76 at T2. The ankle active and passive dorsiflexion ROM increased ~ 10° and ~ 6° at T2, respectively. CONCLUSION This case study presented a patient with multiple sclerosis who underwent dry needling of ankle plantar flexors with severe spasticity, and highlighted the successful use of dry needling in the management of spasticity, ankle dorsiflexion, and cortical excitability. Further rigorous investigations are warranted, employing randomized controlled trials with a sufficient sample of patients with multiple sclerosis. Trial registration IRCT20230206057343N1, registered 9 February 2023, https://en.irct.ir/trial/68454.
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Affiliation(s)
- Haniyeh Choobsaz
- School of Rehabilitation, Department of Physiotherapy, Tehran University of Medical Sciences, Tehran, Iran
| | - Nastaran Ghotbi
- School of Rehabilitation, Department of Physiotherapy, Tehran University of Medical Sciences, Tehran, Iran.
| | - Noureddin Nakhostin Ansari
- School of Rehabilitation, Department of Physiotherapy, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for War-Affected People, Tehran University of Medical Sciences, Tehran, Iran
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Oberman LM, Benussi A. Transcranial Magnetic Stimulation Across the Lifespan: Impact of Developmental and Degenerative Processes. Biol Psychiatry 2024; 95:581-591. [PMID: 37517703 PMCID: PMC10823041 DOI: 10.1016/j.biopsych.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/01/2023]
Abstract
Transcranial magnetic stimulation (TMS) has emerged as a pivotal noninvasive technique for investigating cortical excitability and plasticity across the lifespan, offering valuable insights into neurodevelopmental and neurodegenerative processes. In this review, we explore the impact of TMS applications on our understanding of normal development, healthy aging, neurodevelopmental disorders, and adult-onset neurodegenerative diseases. By presenting key developmental milestones and age-related changes in TMS measures, we provide a foundation for understanding the maturation of neurotransmitter systems and the trajectory of cognitive functions throughout the lifespan. Building on this foundation, the paper delves into the pathophysiology of neurodevelopmental disorders, including autism spectrum disorder, attention-deficit/hyperactivity disorder, Tourette syndrome, and adolescent depression. Highlighting recent findings on altered neurotransmitter circuits and dysfunctional cortical plasticity, we underscore the potential of TMS as a valuable tool for unraveling underlying mechanisms and informing future therapeutic interventions. We also review the emerging role of TMS in investigating and treating the most common adult-onset neurodegenerative disorders and late-onset depression. By outlining the therapeutic applications of noninvasive brain stimulation techniques in these disorders, we discuss the growing body of evidence supporting their use as therapeutic tools for symptom management and potentially slowing disease progression. The insights gained from TMS studies have advanced our understanding of the underlying mechanisms in both healthy and disease states, ultimately informing the development of more targeted diagnostic and therapeutic strategies for a wide range of neuropsychiatric conditions.
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Affiliation(s)
- Lindsay M Oberman
- National Institute of Mental Health Intramural Research Program, National Institutes of Health, Bethesda, Maryland
| | - Alberto Benussi
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
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Bhattacharya A, Stezin A, Kamble N, Bhardwaj S, Yadav R, Pal PK. Abnormal cortical excitability in patients with spinocerebellar ataxia type 12. Parkinsonism Relat Disord 2024; 120:106002. [PMID: 38219530 DOI: 10.1016/j.parkreldis.2024.106002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/27/2023] [Accepted: 01/07/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND Spinocerebellar ataxia type 12 (SCA-12) is an uncommon autosomal dominant cerebellar ataxia characterized by action tremors in the upper limbs, dysarthria, head tremor, and gait ataxia. We aimed to evaluate the motor cortical excitability in patients with SCA-12 using transcranial magnetic stimulation (TMS). METHODS The study was done in the department of Neurology at the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore. Nine patients with SCA-12 (2 females) and 10 healthy controls (2 females) were included in the study. TMS was performed in all the subjects and various parameters such as resting motor threshold (RMT), central motor conduction time (CMCT) and contralateral silent period (cSP) were recorded. The left motor cortex was stimulated and the recording was done from right first dorsal interossei muscle. The severity of ataxia was assessed using the scale for assessment and rating in ataxia (SARA). RESULTS The mean age of the patients was 58.11 ± 7.56 years mean age at onset: 51.67 ± 4.18 years. The mean duration of illness was 9.44 ± 4.88 years. The mean SARA score was 13.83 ± 3.60. Patients with SCA-12 had significantly increased RMT (88.80 ± 12.78 %) compared to HC (44.90 ± 9.40 %, p < 0.05). A significantly prolonged CMCT was observed in patients (13.70 ± 2.52 msec) compared to HC (7.31 ± 1.21 msec, p < 0.05). In addition, cSP was significantly increased in SCA-12 patients (144.43 ± 25.79 msec) compared to HC (82.14 ± 28.90 msec, p < 0.05). CONCLUSIONS Patients with SCA-12 demonstrate a reduced cortical excitability and increased cortical inhibition suggesting an increase in the GABAergic neurotransmission.
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Affiliation(s)
- Amitabh Bhattacharya
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Hosur Road, Bangalore, 560029, Karnataka, India
| | - Albert Stezin
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Hosur Road, Bangalore, 560029, Karnataka, India
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Hosur Road, Bangalore, 560029, Karnataka, India
| | - Sujas Bhardwaj
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Hosur Road, Bangalore, 560029, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Hosur Road, Bangalore, 560029, Karnataka, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Hosur Road, Bangalore, 560029, Karnataka, India.
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Loonen ICM, Voskuyl RA, Schenke M, van Heiningen SH, van den Maagdenberg AMJM, Tolner EA. Spontaneous and optogenetically induced cortical spreading depolarization in familial hemiplegic migraine type 1 mutant mice. Neurobiol Dis 2024; 192:106405. [PMID: 38211710 DOI: 10.1016/j.nbd.2024.106405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/15/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024] Open
Abstract
Mechanisms underlying the migraine aura are incompletely understood, which to large extent is related to a lack of models in which cortical spreading depolarization (CSD), the correlate of the aura, occurs spontaneously. Here, we investigated electrophysiological and behavioural CSD features in freely behaving mice expressing mutant CaV2.1 Ca2+ channels, either with the milder R192Q or the severer S218L missense mutation in the α1 subunit, known to cause familial hemiplegic migraine type 1 (FHM1) in patients. Very rarely, spontaneous CSDs were observed in mutant but never in wildtype mice. In homozygous Cacna1aR192Q mice exclusively single-wave CSDs were observed whereas heterozygous Cacna1aS218L mice displayed multiple-wave events, seemingly in line with the more severe clinical phenotype associated with the S218L mutation. Spontaneous CSDs were associated with body stretching, one-directional slow head turning, and rotating movement of the body. Spontaneous CSD events were compared with those induced in a controlled manner using minimally invasive optogenetics. Also in the optogenetic experiments single-wave CSDs were observed in Cacna1aR192Q and Cacna1aS218L mice (whereas the latter also showed multiple-wave events) with movements similar to those observed with spontaneous events. Compared to wildtype mice, FHM1 mutant mice exhibited a reduced threshold and an increased propagation speed for optogenetically induced CSD with a more profound CSD-associated dysfunction, as indicated by a prolonged suppression of transcallosal evoked potentials and a reduction of unilateral forepaw grip performance. When induced during sleep, the optogenetic CSD threshold was particularly lowered, which may explain why spontaneous CSD events predominantly occurred during sleep. In conclusion, our data show that key neurophysiological and behavioural features of optogenetically induced CSDs mimic those of rare spontaneous events in FHM1 R192Q and S218L mutant mice with differences in severity in line with FHM1 clinical phenotypes seen with these mutations.
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Affiliation(s)
- Inge C M Loonen
- Department of Human Genetics, Leiden University Medical Center, Leiden 2333 RC, the Netherlands
| | - Rob A Voskuyl
- Department of Human Genetics, Leiden University Medical Center, Leiden 2333 RC, the Netherlands
| | - Maarten Schenke
- Department of Human Genetics, Leiden University Medical Center, Leiden 2333 RC, the Netherlands
| | - Sandra H van Heiningen
- Department of Human Genetics, Leiden University Medical Center, Leiden 2333 RC, the Netherlands
| | - Arn M J M van den Maagdenberg
- Department of Human Genetics, Leiden University Medical Center, Leiden 2333 RC, the Netherlands; Department of Neurology, Leiden University Medical Center, Leiden 2333 RC, the Netherlands
| | - Else A Tolner
- Department of Human Genetics, Leiden University Medical Center, Leiden 2333 RC, the Netherlands; Department of Neurology, Leiden University Medical Center, Leiden 2333 RC, the Netherlands.
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Herrero Babiloni A, Jodoin M, Provost C, Charlebois-Plante C, De Koninck BP, Apinis-Deshaies A, Lavigne GJ, De Beaumont L. Females with painful temporomandibular disorders present higher intracortical facilitation relative to pain-free controls. Clin Oral Investig 2023; 28:12. [PMID: 38129743 DOI: 10.1007/s00784-023-05412-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES This study aimed to investigate cortical excitability differences in the primary motor cortex (M1) hand representation between individuals with temporomandibular disorders (TMD) and healthy controls. We assessed resting motor thresholds, motor-evoked potentials (MEPs), intracortical inhibition, and intracortical facilitation and explored potential associations with clinical and psychosocial characteristics in the TMD group. MATERIALS AND METHODS We recruited 36 female participants with TMD and 17 pain-free controls. Transcranial magnetic stimulation (TMS) was used to assess M1 cortical excitability. Correlations between clinical and psychosocial factors and cortical excitability measures were also evaluated. RESULTS Patients with TMD showed significantly higher intracortical facilitation at 12 ms (z = 1.98, p = 0.048) and 15 ms (z = 2.65, p = 0.008) when compared to controls. Correlations revealed associations between intracortical facilitation and pain interference, sleep quality, depressive symptoms, and pain catastrophizing in the TMD group. CONCLUSIONS Females with TMD exhibit heightened motor cortex intracortical facilitation in the hand representation, potentially indicating altered cortical excitability beyond the motor face area. This suggests a role for cortical excitability in TMD pathophysiology, influenced by psychosocial factors. CLINICAL RELEVANCE Understanding cortical excitability in TMD may inform targeted interventions. Psychosocial variables may play a role in cortical excitability, emphasizing the multidimensional nature of TMD-related pain. Further research is needed to confirm and expand upon these findings, with potential implications for the management of TMD and related pain conditions.
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Affiliation(s)
- Alberto Herrero Babiloni
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada.
- Sacre-Coeur Hospital, CIUSSS NIM Research Center, CEAMS, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada.
| | - Marianne Jodoin
- Sacre-Coeur Hospital, CIUSSS NIM Research Center, CEAMS, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Catherine Provost
- Sacre-Coeur Hospital, CIUSSS NIM Research Center, CEAMS, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada
| | - Camille Charlebois-Plante
- Sacre-Coeur Hospital, CIUSSS NIM Research Center, CEAMS, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Beatrice P De Koninck
- Sacre-Coeur Hospital, CIUSSS NIM Research Center, CEAMS, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Amelie Apinis-Deshaies
- Sacre-Coeur Hospital, CIUSSS NIM Research Center, CEAMS, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada
| | - Gilles J Lavigne
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
- Sacre-Coeur Hospital, CIUSSS NIM Research Center, CEAMS, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada
- Faculty of Dental Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Louis De Beaumont
- Sacre-Coeur Hospital, CIUSSS NIM Research Center, CEAMS, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
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Prei K, Kanig C, Osnabruegge M, Langguth B, Mack W, Abdelnaim M, Schecklmann M, Schoisswohl S. Limited evidence for reliability of low and high frequency rTMS over the motor cortex. Brain Res 2023; 1820:148534. [PMID: 37586677 DOI: 10.1016/j.brainres.2023.148534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/07/2023] [Accepted: 08/12/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the reliability of low-frequency and high-frequency repetitive transcranial magnetic stimulation (rTMS) on healthy individuals over the motor cortex. A secondary outcome was the assessment if low-frequency rTMS results in inhibition and high-frequency rTMS results in facilitation. METHODS In this experiment, 30 healthy participants received on four consecutive days one session each with application of 1 Hz or 20 Hz rTMS over the left motor cortex. 1 Hz and 20 Hz were applied in alternating order, whereby the starting frequency was randomized. Motor evoked potentials (MEPs) were measured before and after each session. Reliability measures were intraclass and Pearson's correlation coefficient (ICC and r). RESULTS ICCs and r values were low to moderate. Notably, within subgroups of less confounded measures, we found good r values for 20 Hz rTMS. The group-level analysis did not demonstrate a clear low-frequency inhibition and high-frequency facilitation pattern. At the single-subject level, only one participant exhibited significant changes consistent with the expected pattern, with concurrent decreases in MEPs following 1 Hz sessions and increases following 20 Hz sessions. CONCLUSION The investigated neuromodulatory protocols show low to moderate reliability. Results are questioning the low-frequency inhibition and high-frequency facilitation pattern. SIGNIFICANCE Methodological improvements for the usage of rTMS are necessary to increase validity and reliability of non-invasive brain stimulation.
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Affiliation(s)
- Kilian Prei
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitätsstraße 84, 93053 Regensburg, Germany
| | - Carolina Kanig
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitätsstraße 84, 93053 Regensburg, Germany; Department of Human Sciences, University of the Bundeswehr Munich, Werner-Heisenberg-Weg 39, 85577 Neubiberg, Germany.
| | - Mirja Osnabruegge
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitätsstraße 84, 93053 Regensburg, Germany; Department of Human Sciences, University of the Bundeswehr Munich, Werner-Heisenberg-Weg 39, 85577 Neubiberg, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitätsstraße 84, 93053 Regensburg, Germany
| | - Wolfgang Mack
- Department of Human Sciences, University of the Bundeswehr Munich, Werner-Heisenberg-Weg 39, 85577 Neubiberg, Germany
| | - Mohamed Abdelnaim
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitätsstraße 84, 93053 Regensburg, Germany
| | - Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitätsstraße 84, 93053 Regensburg, Germany
| | - Stefan Schoisswohl
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitätsstraße 84, 93053 Regensburg, Germany; Department of Human Sciences, University of the Bundeswehr Munich, Werner-Heisenberg-Weg 39, 85577 Neubiberg, Germany
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11
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Gimeno-Ferrer F, Eitner A, Bauer R, Lehmenkühler A, Schaible HG, Richter F. Cortical spreading depolarization is a potential target for rat brain excitability modulation by Galanin. Exp Neurol 2023; 370:114569. [PMID: 37827229 DOI: 10.1016/j.expneurol.2023.114569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 08/24/2023] [Accepted: 10/09/2023] [Indexed: 10/14/2023]
Abstract
The inhibitory neuropeptide Galanin (Gal) has been shown to mediate anticonvulsion and neuroprotection. Here we investigated whether Gal affects cortical spreading depolarization (CSD). CSD is considered the pathophysiological neuronal mechanism of migraine aura, and a neuronal mechanism aggravating brain damage upon afflictions of the brain. Immunohistochemistry localized Gal and the Gal receptors 1-3 (GalR1-3) in native rat cortex and evaluated microglial morphology after exposure to Gal. In anesthetized rats, Gal was applied alone and together with the GalR antagonists M40, M871, or SNAP 37889 locally to the exposed cortex. The spontaneous electrocorticogram and CSDs evoked by remote KCl pressure microinjection were measured. In rat cortex, Gal was present in all neurons of all cortical layers, but not in astrocytes, microglia and vessels. GalR2 and GalR3 were expressed throughout all neurons, whereas GalR1 was preponderantly located at neurons in layers IV and V, but only in about half of the neurons. In susceptible rats, topical application of Gal on cortex decreased CSD amplitude, slowed CSD propagation velocity, and increased the threshold for KCl to ignite CSD. In some rats, washout of previously applied Gal induced periods of epileptiform patterns in the electrocorticogram. Blockade of GalR2 by M871 robustly prevented all Gal effects on CSD, whereas blockade of GalR1 or GalR3 was less effective. Although microglia did not express GalRs, topical application of Gal changed microglial morphology indicating microglial activation. This effect of Gal on microglia was prevented by blocking neuronal GalR2. In conclusion, Gal has the potential to ameliorate CSD thus reducing pathophysiological neuronal events caused by or associated with CSD.
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Affiliation(s)
- Fátima Gimeno-Ferrer
- Institute of Physiology 1/Neurophysiology, Jena University Hospital, Jena D-07740, Germany
| | - Annett Eitner
- Department of Trauma, Hand and Reconstructive Surgery, Experimental Trauma Surgery, Jena University Hospital, Jena D-07740, Germany
| | - Reinhard Bauer
- Institute of Molecular Cell Biology, CMB-Center for Molecular Biomedicine, Jena University Hospital, Jena D-07740, Germany
| | | | - Hans-Georg Schaible
- Institute of Physiology 1/Neurophysiology, Jena University Hospital, Jena D-07740, Germany
| | - Frank Richter
- Institute of Physiology 1/Neurophysiology, Jena University Hospital, Jena D-07740, Germany.
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12
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Ortega-Robles E, Cantillo-Negrete J, Carino-Escobar RI, Arias-Carrión O. Methodological approach for assessing motor cortical excitability changes with single-pulse transcranial magnetic stimulation. MethodsX 2023; 11:102451. [PMID: 38023316 PMCID: PMC10630640 DOI: 10.1016/j.mex.2023.102451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Transcranial Magnetic Stimulation (TMS) serves as a crucial tool in evaluating motor cortex excitability by applying short magnetic pulses to the skull, inducing neuron depolarization in the cerebral cortex through electromagnetic induction. This technique leads to the activation of specific skeletal muscles recorded as Motor-Evoked Potentials (MEPs) through electromyography. Although various methodologies assess cortical excitability with TMS, measuring MEP amplitudes offers a straightforward approach, especially when comparing excitability states pre- and post-interventions designed to alter cortical excitability. Despite TMS's widespread use, the absence of a standardized procedure for such measurements in existing literature hinders the comparison of results across different studies. This paper proposes a standardized procedure for assessing changes in motor cortical excitability using single-pulse TMS pre- and post-intervention. The recommended approach utilizes an intensity equating to half of the MEP's maximum amplitude, thereby ensuring equal likelihood of amplitude increase or decrease, providing a consistent basis for future studies and facilitating meaningful comparisons of results.•A method for assessing changes in motor cortical excitability using single-pulse TMS before and after a specified intervention.•We recommend using an intensity equal to half of the MEP's maximum amplitude during evaluations to objectively assess motor cortical excitability changes post-intervention.
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Affiliation(s)
- Emmanuel Ortega-Robles
- Unidad de Trastornos del Movimiento y Sueño, Hospital General Dr. Manuel Gea González, Mexico City 14080, Mexico
| | - Jessica Cantillo-Negrete
- División de Investigación en Neurociencias Clínica, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City 14389, Mexico
| | - Ruben I. Carino-Escobar
- División de Investigación en Neurociencias Clínica, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City 14389, Mexico
| | - Oscar Arias-Carrión
- Unidad de Trastornos del Movimiento y Sueño, Hospital General Dr. Manuel Gea González, Mexico City 14080, Mexico
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Nalborczyk L, Longcamp M, Bonnard M, Serveau V, Spieser L, Alario FX. Distinct neural mechanisms support inner speaking and inner hearing. Cortex 2023; 169:161-173. [PMID: 37922641 DOI: 10.1016/j.cortex.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 11/07/2023]
Abstract
Humans have the ability to mentally examine speech. This covert form of speech production is often accompanied by sensory (e.g., auditory) percepts. However, the cognitive and neural mechanisms that generate these percepts are still debated. According to a prominent proposal, inner speech has at least two distinct phenomenological components: inner speaking and inner hearing. We used transcranial magnetic stimulation to test whether these two phenomenologically distinct processes are supported by distinct neural mechanisms. We hypothesised that inner speaking relies more strongly on an online motor-to-sensory simulation that constructs a multisensory experience, whereas inner hearing relies more strongly on a memory-retrieval process, where the multisensory experience is reconstructed from stored motor-to-sensory associations. Accordingly, we predicted that the speech motor system will be involved more strongly during inner speaking than inner hearing. This would be revealed by modulations of TMS evoked responses at muscle level following stimulation of the lip primary motor cortex. Overall, data collected from 31 participants corroborated this prediction, showing that inner speaking increases the excitability of the primary motor cortex more than inner hearing. Moreover, this effect was more pronounced during the inner production of a syllable that strongly recruits the lips (vs. a syllable that recruits the lips to a lesser extent). These results are compatible with models assuming that the primary motor cortex is involved during inner speech and contribute to clarify the neural implementation of the fundamental ability of silently speaking in one's mind.
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Affiliation(s)
- Ladislas Nalborczyk
- Aix Marseille Univ, CNRS, LPC, Marseille, France; Aix Marseille Univ, CNRS, LNC, Marseille, France.
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Moscatelli F, Monda V, Limone P, Marsala G, Mancini N, Monda M, Messina A, De Maria A, Scarinci A, Monda A, Polito R, Messina G. Acute non invasive brain stimulation improves performances in volleyball players. Physiol Behav 2023; 271:114356. [PMID: 37769861 DOI: 10.1016/j.physbeh.2023.114356] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/12/2023] [Accepted: 09/20/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVES The ability to redirect one's attention in response to various environmental situations is a crucial aspect of selective attention in team sports. Thus, the aim of this study was to investigate whether repetitive transcranial magnetic stimulation (rTMS) in volleyball players can improve Posner test response and cortical excitability. This study had a double-blinded (participant and evaluator) matched-pair experimental design. METHODS Twenty right-handed female volleyball players were recruited for the study and randomly assigned to either the active rTMS group (n = 10) or the sham stimulation group (n = 10). The stimulation was performed in one session with 10 Hz, 80% of the resting motor threshold (RMT), 5 s of stimulation, and 15 s of rest, for a total of 1,500 pulses. Before and after stimulation, the Posner test and cortical excitability were evaluated. RESULTS The significant finding of this paper was that 10 Hz rTMS to the DLPFC seemed to improve Posner test response, and also resulted in a significantly decreased RMT and MEP latency of the ipsilateral motor cortex. After stimulation, the active group showed a significant decrease in the percentage of errors in the Posner test. Moreover, active group showed faster RT after rTMS, suggesting that HF stimulation could enhance performance. Additionally, significant differences in RMT emerged in the active rTMS group after stimulation, while no differences were observed in MEP latency and MEP amplitude. CONCLUSION In conclusion, we believe that these results may be of great interest to the scientific community and could have practical implications in the future.
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Affiliation(s)
- Fiorenzo Moscatelli
- Faculty of Human Sciences, Education and Sport, Pegaso Telematic University, Napoli, Italy
| | - Vincenzo Monda
- Department of Movement Sciences and Wellbeing, University of Naples "Parthenope", Naples, Italy
| | - Pierpaolo Limone
- Faculty of Human Sciences, Education and Sport, Pegaso Telematic University, Napoli, Italy
| | | | - Nicola Mancini
- Faculty of Physical Education and Sports, "Babes Bolyai" University, Cluj-Napoca, Romania
| | - Marcellino Monda
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetics and Sports Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonietta Messina
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetics and Sports Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonella De Maria
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetics and Sports Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Alessia Scarinci
- Department of Education Sciences, Psychology, Communication, University of Bari, 70121 Bari, Italy
| | - Antonietta Monda
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetics and Sports Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Rita Polito
- Department of Clinical and Experimental Medicine, University of Fogia, Foggia, Italy.
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of Fogia, Foggia, Italy
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Cengiz B, Koçak ÖK, Erdoğan T, Yanık E, Pek G, Savrun Y, Evren Boran H, Reha Kuruoğlu H. Excitability of somatosensory cortex is increased in ALS: A SEP recovery function study. Clin Neurophysiol 2023; 155:58-64. [PMID: 37734132 DOI: 10.1016/j.clinph.2023.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/04/2023] [Revised: 07/28/2023] [Accepted: 08/14/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE Neuronal loss in the somatosensory, as well as the motor cortex in amyotrophic lateral sclerosis (ALS), indicative of a structural abnormality has been reported. Previously we have shown that afferent inhibition was impaired in ALS, suggestive of sensory involvement. In this study, we aimed to evaluate excitability changes in the somatosensory cortex of ALS patients. METHODS ALS patients underwent a paired pulse somatosensory evoked potential (SEP) paradigm at various interstimulus intervals (ISI). The amplitude ratio obtained by dividing the amplitude of paired pulse SEP stimulation S2 (paired pulse stimulation) to S1 (the single pulse stimulation) was considered the somatosensory cortex excitability parameter. Findings were compared to the results obtained from healthy controls. Resting motor threshold (RMT) was also assessed in the ALS group. RESULTS An increased S2/S1 ratio was found in the ALS group in every ISI examined. Additionally, the reduced inhibition correlated negatively with forced vital capacity, Medical Research Council sum score, median nerve compound muscle action potential amplitude, while there was a positive association with Penn upper motor neuron score and sural nerve conduction velocity. No correlation existed with RMT. CONCLUSIONS Our findings demonstrated increased somatosensory cortical excitability in ALS, which was associated with clinical parameters such as reduced pulmonary function and motor strength. SIGNIFICANCE Somatosensory cortical excitability is impaired in ALS. Whether this is associated with increased motor cortical excitability requires further studies.
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Affiliation(s)
- Bülent Cengiz
- Department of Neurology, Faculty of Medicine, Gazi University, Ankara, Turkey; Department of Neurology, Section of Clinical Neurophysiology, Faculty of Medicine, Gazi University, Ankara, Turkey; Neuroscience and Neurotechnology Center of Excellence, Ankara, Turkey.
| | - Özlem Kurtkaya Koçak
- Department of Neurology, Faculty of Medicine, Gazi University, Ankara, Turkey; Department of Neurology, Section of Clinical Neurophysiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Tuğba Erdoğan
- Department of Neurology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ece Yanık
- Department of Neurology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Gökhan Pek
- Department of Neurology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Yusuf Savrun
- Department of Neurology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - H Evren Boran
- Department of Neurology, Faculty of Medicine, Gazi University, Ankara, Turkey; Department of Neurology, Section of Clinical Neurophysiology, Faculty of Medicine, Gazi University, Ankara, Turkey; Neuroscience and Neurotechnology Center of Excellence, Ankara, Turkey
| | - H Reha Kuruoğlu
- Department of Neurology, Faculty of Medicine, Gazi University, Ankara, Turkey; Department of Neurology, Section of Clinical Neurophysiology, Faculty of Medicine, Gazi University, Ankara, Turkey
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Agrawal A, Bhattacharya A, Kamble N, Mailankody P, Yadav R, Pal PK. Cortical excitability changes in patients of vascular parkinsonism with cognitive impairment. Parkinsonism Relat Disord 2023; 116:105869. [PMID: 37783026 DOI: 10.1016/j.parkreldis.2023.105869] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/25/2023] [Accepted: 09/25/2023] [Indexed: 10/04/2023]
Abstract
INTRODUCTION Vascular parkinsonism (VaP), type of lower body parkinsonism, occurs in relation to ischemic cerebrovascular disease. It can be associated with cognitive impairment. We aimed to study the cortical excitability changes in these patients using transcranial magnetic stimulation (TMS). METHODS We included 20 patients with VaP and 22 healthy controls (HC). All subjects underwent TMS over left motor cortex with recording of resting motor threshold (RMT), central motor conduction time (CMCT), short-interval intracortical inhibition (SICI), intracortical facilitation (ICF), contralateral and ipsilateral silent period (SP) along with RMT and CMCT in the contralateral lower limb. Cognitive assessments were done using Montreal cognitive assessment (MoCA) and Addenbrooke's cognitive evaluation III (ACE III). RESULTS Mean age of patients (63.90 ± 7.36 years) was comparable with controls (59.77 ± 6.94 years; p = 0.07). Duration of disease was 2.58 ± 2.57 years. The upper and lower limb RMT of patients (32.45 ± 4.81%; 57.20 ± 11.54%) was significantly low compared to HC (43.64 ± 7.73%; 69.18 ± 14.27%; p < 0.001). There was a significant reduction in SICI in patients (1.87 ± 2.03) compared to HC (0.38 ± 0.29; p < 0.001). In addition, there was a significant prolongation of ipsilateral SP in patients (48.49 ± 24.49) compared to controls (32.04 ± 12.26, p = 0.01). However, there was no significant difference in contralateral SP (p = 0.66) and ICF (p = 0.25) between the two groups. There was a significant prolongation of lower limb CMCT in patients (p < 0.01). There was a positive correlation of SICI with MoCA (r = 0.45, p < 0.05) and ACE-III (r = 0.33, p < 0.05) scores. CONCLUSION Reduction in RMT and SICI in patients with VaP suggests abnormalities in GABAergic neurotransmission that may underlie cognitive impairment observed in them.
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Affiliation(s)
- Aakash Agrawal
- Department of Neurology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Hosur Road, Bangalore, 560029, Karnataka, India
| | - Amitabh Bhattacharya
- Department of Neurology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Hosur Road, Bangalore, 560029, Karnataka, India
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Hosur Road, Bangalore, 560029, Karnataka, India
| | - Pooja Mailankody
- Department of Neurology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Hosur Road, Bangalore, 560029, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Hosur Road, Bangalore, 560029, Karnataka, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Hosur Road, Bangalore, 560029, Karnataka, India.
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Alaee E, Pachenari N, Khani F, Semnanian S, Shojaei A, Azizi H. Enhancement of neuronal excitability in the medial prefrontal cortex following prenatal morphine exposure. Brain Res Bull 2023; 204:110803. [PMID: 37913849 DOI: 10.1016/j.brainresbull.2023.110803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 11/03/2023]
Abstract
The clinical use and abuse of opioids during human pregnancy have been widely reported. Several studies have demonstrated that opioids cross the placenta in rats during late gestation, and prenatal morphine exposure has been shown to have negative outcomes in cognitive function. The medial prefrontal cortex (mPFC) is believed to play a crucial role in cognitive processes, motivation, and emotion, integrating neural information from several brain areas and sending converted information to other structures. Dysfunctions in this area have been observed in numerous psychiatric and neurological disorders, including addiction. This current study aimed to compare the electrophysiological properties of mPFC neurons in rat offspring prenatally exposed to morphine. Pregnant rats were injected with morphine or saline twice a day from gestational days 11-18. Whole-cell patch-clamp recordings were performed in male offspring on postnatal days 14-18. All recordings were obtained in current-clamp configuration from mPFC pyramidal neurons to assess their electrophysiological properties. The results revealed that prenatal exposure to morphine shifted the resting membrane potential (RMP) to less negative voltages and increased input resistance and duration of action potentials. However, the amplitude, rise slope, and afterhyperpolarization (AHP) amplitude of the first elicited action potentials were significantly decreased in rats prenatally exposed to morphine. Moreover, the sag voltage ratio was significantly decreased in the prenatal morphine group. Our results suggest that the changes observed in the electrophysiological properties of mPFC neurons indicate an elevation in neuronal excitability following prenatal exposure to morphine.
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Affiliation(s)
- Elham Alaee
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Narges Pachenari
- School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
| | - Fatemeh Khani
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Saeed Semnanian
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran; Institute for Brain Sciences and Cognition, Tarbiat Modares University, Tehran, Iran
| | - Amir Shojaei
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran; Institute for Brain Sciences and Cognition, Tarbiat Modares University, Tehran, Iran
| | - Hossein Azizi
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran; Institute for Brain Sciences and Cognition, Tarbiat Modares University, Tehran, Iran.
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Huang Y, Lin R, Li H, Xu Y, Tian F, Ma L, Liu X, Ma S, Li X, Lai Z, Bai C, He W, Ma Q, Wang J, Zhu N. Protocol for a single-blind randomized clinical trial to test the efficacy of bilateral transcranial magnetic stimulation on upper extremity motor function in patients recovering from stroke. Trials 2023; 24:601. [PMID: 37735708 PMCID: PMC10515042 DOI: 10.1186/s13063-023-07584-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/14/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND No consensus currently exists regarding the optimal protocol for repetitive transcranial magnetic stimulation (rTMS) treatment of upper-extremity motor dysfunction after stroke. Studies have shown that combined low- and high-frequency stimulation (LF-HF-rTMS) of the bilateral cerebral hemispheres is more effective than sham stimulation or stimulation of one cerebral hemisphere alone in treating motor dysfunction in the subacute stage of stroke. The efficacy of this protocol in the convalescence phase of stroke has rarely been reported, and its mechanism of action has not been clarified. In this study, we designed a prospective, single-blind, randomized controlled trial to investigate the efficacy and safety of different stimulation regimens for the treatment of upper extremity motor disorders in patients with convalescent stage stroke and aimed to explore the underlying mechanisms based on biomarkers such as brain-derived neurotrophic factor (BDNF). METHODS Seventy-six subjects will be randomly divided into combined, low-frequency, high-frequency, and control groups based on the proportion of 1:1:1:1, with 19 cases in each group. All groups will have conventional rehabilitation, on top of which the combined group will receive 1 Hz rTMS in the unaffected hemisphere and 10 Hz rTMS in the affected hemisphere. The low-frequency group will be administered 1 Hz rTMS in the unaffected hemisphere and sham stimulation in the contralateral hemisphere. The high-frequency group will be administered 10 Hz rTMS in the affected hemisphere and contralateral sham stimulation. The control group will receive bilateral sham stimulation. Assessments will be performed at baseline, after 2 weeks of treatment, and at post-treatment follow-up at week 6. The primary outcomes are FMA-UE (Fugl-Meyer assessment-upper extremity), latency, and serum BDNF levels. The secondary outcomes are the National Institute of Health Stroke Scale (NIHSS), Brunnstrom staging (BS), modified Ashworth scale (MAS), Modified Barthel Index (MBI), central motor conduction time (CMCT), precursor proteins of mature BDNF (proBDNF), and matrix metalloproteinase-9 (MMP-9) levels. Adverse events, such as headaches and seizures, will be recorded throughout the study. DISCUSSION The findings of this study will help develop optimal stimulation protocols for motor recovery in stroke patients and identify biomarkers that respond to post-stroke motor rehabilitation, for better guidance of clinical treatment. TRIAL REGISTRATION The study protocol was passed by the Medical Research Ethics Committee of the General Hospital of Ningxia Medical University on January 1, 2022 (no. KYLL-2021-1082). It was registered into the Chinese Clinical Trials Registry on May 22, 2022 (no. ChiCTR2200060201). This study is currently in progress.
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Affiliation(s)
- Yuan Huang
- Department of Rehabilitation Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Ruizhu Lin
- Department of Rehabilitation Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Hongyu Li
- Department of Rehabilitation Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Yujuan Xu
- Department of Rehabilitation Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Fubao Tian
- Department of Rehabilitation Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Liangchen Ma
- Department of Rehabilitation Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Xiaoli Liu
- Department of Rehabilitation Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Shuming Ma
- Department of Rehabilitation Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Xiaolong Li
- Department of Rehabilitation Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Zheying Lai
- Department of Rehabilitation Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Chuanping Bai
- Department of Rehabilitation Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Weichun He
- Department of Rehabilitation Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Qi Ma
- Department of Rehabilitation Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Jingkai Wang
- Department of Rehabilitation Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Ning Zhu
- Department of Rehabilitation Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China.
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Parreira RB, Oliveira CS. Improvement of motor control in neurological patients through motor evoked potential changes induced by transcranial direct current stimulation therapy: A meta-analysis study. Gait Posture 2023; 106:53-64. [PMID: 37660514 DOI: 10.1016/j.gaitpost.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 06/14/2023] [Accepted: 08/24/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) seems to facilitate and/or inhibit neural activity and improve motor function in neurological patients. However, it is important to confirm such improvements as well as determine the association between neurophysiological changes and the enhancement of motor control. RESEARCH QUESTION Does the improvement of motor control in neurological patients after transcranial direct current stimulation translate into changes in the motor evoked potential? METHODS A systematic electronic search strategy was employed to identify studies indexed in the PubMed, BIREME, and COCHRANE databases using a combination of search terms adapted to each database: transcranial direct current stimulation; evoked potential motor; and motor control. Relevant data was extracted from each selected article and methodological quality was assessed using the PEDro scale. Standard mean differences with 95% confidence intervals were pooled using a random-effects model. Moreover, standard methods were employed for assessment of the heterogeneity of the studies. RESULTS Thirteen articles were included in this review. Anodal tDCS was found to increase the amplitude and diminish the latency of the MEP, which correlated positively with improvements in motor control. However, the improvement in MEP did not persist over time. SIGNIFICANCE Despite the paucity of studies, positive effects are found when combining anodal tDCS and a therapeutic intervention, such as an improvement in MEP and better motor control in neurological patients. Future studies should include neurophysiological measures other than MEP and consider a homogenous analysis.
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Affiliation(s)
- Rodolfo Borges Parreira
- Health Sciences Program, Faculty of Medical Sciences of Santa Casa de Sao Paulo, Doutor Cesário Motta Júnior st. #61, zip code 01221-020, São Paulo, SP, Brazil; PostureLab, 20 rue du rendez-vous, 75012 Paris, France; Universidade Evangelica de Goias, Universitária av. 3,5 - Cidade Universitária, zip code: 75083-515, Anápolis, GO, Brazil.
| | - Claudia Santos Oliveira
- Health Sciences Program, Faculty of Medical Sciences of Santa Casa de Sao Paulo, Doutor Cesário Motta Júnior st. #61, zip code 01221-020, São Paulo, SP, Brazil; Universidade Evangelica de Goias, Universitária av. 3,5 - Cidade Universitária, zip code: 75083-515, Anápolis, GO, Brazil.
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Vogel A, Ueberbach T, Wilken-Schmitz A, Hahnefeld L, Franck L, Weyer MP, Jungenitz T, Schmid T, Buchmann G, Freudenberg F, Brandes RP, Gurke R, Schwarzacher SW, Geisslinger G, Mittmann T, Tegeder I. Repetitive and compulsive behavior after Early-Life-Pain associated with reduced long-chain sphingolipid species. Cell Biosci 2023; 13:155. [PMID: 37635256 PMCID: PMC10463951 DOI: 10.1186/s13578-023-01106-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/13/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Pain in early life may impact on development and risk of chronic pain. We developed an optogenetic Cre/loxP mouse model of "early-life-pain" (ELP) using mice with transgenic expression of channelrhodopsin-2 (ChR2) under control of the Advillin (Avil) promoter, which drives expression of transgenes predominantly in isolectin B4 positive non-peptidergic nociceptors in postnatal mice. Avil-ChR2 (Cre +) and ChR2-flfl control mice were exposed to blue light in a chamber once daily from P1-P5 together with their Cre-negative mother. RESULTS ELP caused cortical hyperexcitability at P8-9 as assessed via multi-electrode array recordings that coincided with reduced expression of synaptic genes (RNAseq) including Grin2b, neurexins, piccolo and voltage gated calcium and sodium channels. Young adult (8-16 wks) Avil-ChR2 mice presented with nociceptive hypersensitivity upon heat or mechanical stimulation, which did not resolve up until one year of age. The persistent hypersensitivy to nociceptive stimuli was reflected by increased calcium fluxes in primary sensory neurons of aged mice (1 year) upon capsaicin stimulation. Avil-ChR2 mice behaved like controls in maze tests of anxiety, social interaction, and spatial memory but IntelliCage behavioral studies revealed repetitive nosepokes and corner visits and compulsive lickings. Compulsiveness at the behavioral level was associated with a reduction of sphingomyelin species in brain and plasma lipidomic studies. Behavioral studies were done with female mice. CONCLUSION The results suggest that ELP may predispose to chronic "pain" and compulsive psychopathology in part mediated by alterations of sphingolipid metabolism, which have been previously described in the context of addiction and psychiatric diseases.
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Affiliation(s)
- Alexandra Vogel
- Institute of Clinical Pharmacology, Faculty of Medicine, Goethe-University, Frankfurt, Germany
| | - Timo Ueberbach
- Institute of Physiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Annett Wilken-Schmitz
- Institute of Clinical Pharmacology, Faculty of Medicine, Goethe-University, Frankfurt, Germany
| | - Lisa Hahnefeld
- Institute of Clinical Pharmacology, Faculty of Medicine, Goethe-University, Frankfurt, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, 60596, Frankfurt, Germany
- Fraunhofer Cluster of Excellence for Immune Mediated Diseases (CIMD), 60596, Frankfurt, Germany
| | - Luisa Franck
- Institute of Clinical Pharmacology, Faculty of Medicine, Goethe-University, Frankfurt, Germany
| | - Marc-Philipp Weyer
- Institute of Clinical Pharmacology, Faculty of Medicine, Goethe-University, Frankfurt, Germany
| | - Tassilo Jungenitz
- Institute of Clinical Neuroanatomy, Neuroscience Center, Goethe University, Frankfurt, Germany
| | - Tobias Schmid
- Institute of Biochemistry I, Faculty of Medicine, Goethe-University, Frankfurt, Germany
- Partner Site Frankfurt, German Cancer Consortium (DKTK), Frankfurt, Germany
| | - Giulia Buchmann
- Institute of Cardiovascular Physiology, Faculty of Medicine, Goethe-University, Frankfurt, Germany
| | - Florian Freudenberg
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe-University Hospital, Frankfurt, Germany
| | - Ralf P Brandes
- Institute of Cardiovascular Physiology, Faculty of Medicine, Goethe-University, Frankfurt, Germany
| | - Robert Gurke
- Institute of Clinical Pharmacology, Faculty of Medicine, Goethe-University, Frankfurt, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, 60596, Frankfurt, Germany
- Fraunhofer Cluster of Excellence for Immune Mediated Diseases (CIMD), 60596, Frankfurt, Germany
| | - Stephan W Schwarzacher
- Institute of Clinical Neuroanatomy, Neuroscience Center, Goethe University, Frankfurt, Germany
| | - Gerd Geisslinger
- Institute of Clinical Pharmacology, Faculty of Medicine, Goethe-University, Frankfurt, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, 60596, Frankfurt, Germany
- Fraunhofer Cluster of Excellence for Immune Mediated Diseases (CIMD), 60596, Frankfurt, Germany
| | - Thomas Mittmann
- Institute of Physiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Irmgard Tegeder
- Institute of Clinical Pharmacology, Faculty of Medicine, Goethe-University, Frankfurt, Germany.
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21
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Marti-Marca A, Vilà-Balló A, Cerda-Company X, Ikumi N, Torres-Ferrus M, Caronna E, Gallardo VJ, Alpuente A, Torralba Cuello M, Soto-Faraco S, Pozo-Rosich P. Exploring sensory sensitivity, cortical excitability, and habituation in episodic migraine, as a function of age and disease severity, using the pattern-reversal task. J Headache Pain 2023; 24:104. [PMID: 37545005 PMCID: PMC10405481 DOI: 10.1186/s10194-023-01618-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/20/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Migraine is a cyclic, neurosensory disorder characterized by recurrent headaches and altered sensory processing. The latter is manifested in hypersensitivity to visual stimuli, measured with questionnaires and sensory thresholds, as well as in abnormal cortical excitability and a lack of habituation, assessed with visual evoked potentials elicited by pattern-reversal stimulation. Here, the goal was to determine whether factors such as age and/or disease severity may exert a modulatory influence on sensory sensitivity, cortical excitability, and habituation. METHODS Two similar experiments were carried out, the first comparing 24 young, episodic migraine patients and 28 healthy age- and gender-matched controls and the second 36 middle-aged, episodic migraine patients and 30 healthy age- and gender-matched controls. A neurologist confirmed the diagnoses. Migraine phases were obtained using eDiaries. Sensory sensitivity was assessed with the Sensory Perception Quotient and group comparisons were carried out. We obtained pattern-reversal visual evoked potentials and calculated the N1-P1 Peak-to-Peak amplitude. Two linear mixed-effects models were fitted to these data. The first model had Block (first block, last block) and Group (patients, controls) as fixed factors, whereas the second model had Trial (all trials) and Group as fixed factors. Participant was included as a random factor in both. N1-P1 first block amplitude was used to assess cortical excitability and habituation was defined as a decrease of N1-P1 amplitude across Blocks/Trials. Both experiments were performed interictally. RESULTS The final samples consisted of 18 patients with episodic migraine and 27 headache-free controls (first experiment) and 19 patients and 29 controls (second experiment). In both experiments, patients reported increased visual hypersensitivity on the Sensory Perception Quotient as compared to controls. Regarding N1-P1 peak-to-peak data, there was no main effect of Group, indicating no differences in cortical excitability between groups. Finally, significant main effects of both Block and Trial were found indicating habituation in both groups, regardless of age and headache frequency. CONCLUSIONS The results of this study yielded evidence for significant hypersensitivity in patients but no significant differences in either habituation or cortical excitability, as compared to headache-free controls. Although the alterations in patients may be less pronounced than originally anticipated they demonstrate the need for the definition and standardization of optimal methodological parameters.
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Affiliation(s)
- Angela Marti-Marca
- Headache and Neurological Pain Research Group, Vall d'Hebron Institute of Research (VHIR), Department of Medicine, Universitat Autonoma Barcelona, Barcelona, Spain
| | - Adrià Vilà-Balló
- Headache and Neurological Pain Research Group, Vall d'Hebron Institute of Research (VHIR), Department of Medicine, Universitat Autonoma Barcelona, Barcelona, Spain
| | - Xim Cerda-Company
- Headache and Neurological Pain Research Group, Vall d'Hebron Institute of Research (VHIR), Department of Medicine, Universitat Autonoma Barcelona, Barcelona, Spain
| | - Nara Ikumi
- Headache and Neurological Pain Research Group, Vall d'Hebron Institute of Research (VHIR), Department of Medicine, Universitat Autonoma Barcelona, Barcelona, Spain
| | - Marta Torres-Ferrus
- Headache and Neurological Pain Research Group, Vall d'Hebron Institute of Research (VHIR), Department of Medicine, Universitat Autonoma Barcelona, Barcelona, Spain
- Headache Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Edoardo Caronna
- Headache and Neurological Pain Research Group, Vall d'Hebron Institute of Research (VHIR), Department of Medicine, Universitat Autonoma Barcelona, Barcelona, Spain
| | - Victor J Gallardo
- Headache and Neurological Pain Research Group, Vall d'Hebron Institute of Research (VHIR), Department of Medicine, Universitat Autonoma Barcelona, Barcelona, Spain
| | - Alicia Alpuente
- Headache and Neurological Pain Research Group, Vall d'Hebron Institute of Research (VHIR), Department of Medicine, Universitat Autonoma Barcelona, Barcelona, Spain
- Headache Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Mireia Torralba Cuello
- Multisensory Research Group, Center for Brain and Cognition, Pompeu Fabra University, 08005, Barcelona, Spain
| | - Salvador Soto-Faraco
- Multisensory Research Group, Center for Brain and Cognition, Pompeu Fabra University, 08005, Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), 08010, Barcelona, Spain
| | - Patricia Pozo-Rosich
- Headache and Neurological Pain Research Group, Vall d'Hebron Institute of Research (VHIR), Department of Medicine, Universitat Autonoma Barcelona, Barcelona, Spain.
- Headache Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
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22
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Bai Z, Zhang JJ, Fong KNK. Intracortical and intercortical networks in patients after stroke: a concurrent TMS-EEG study. J Neuroeng Rehabil 2023; 20:100. [PMID: 37533093 PMCID: PMC10398934 DOI: 10.1186/s12984-023-01223-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 07/21/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Concurrent transcranial magnetic stimulation and electroencephalography (TMS-EEG) recording provides information on both intracortical reorganization and networking, and that information could yield new insights into post-stroke neuroplasticity. However, a comprehensive investigation using both concurrent TMS-EEG and motor-evoked potential-based outcomes has not been carried out in patients with chronic stroke. Therefore, this study sought to investigate the intracortical and network neurophysiological features of patients with chronic stroke, using concurrent TMS-EEG and motor-evoked potential-based outcomes. METHODS A battery of motor-evoked potential-based measures and concurrent TMS-EEG recording were performed in 23 patients with chronic stroke and 21 age-matched healthy controls. RESULTS The ipsilesional primary motor cortex (M1) of the patients with stroke showed significantly higher resting motor threshold (P = 0.002), reduced active motor-evoked potential amplitudes (P = 0.001) and a prolonged cortical silent period (P = 0.007), compared with their contralesional M1. The ipsilesional stimulation also produced a reduction in N100 amplitude of TMS-evoked potentials around the stimulated M1 (P = 0.007), which was significantly correlated with the ipsilesional resting motor threshold (P = 0.011) and motor-evoked potential amplitudes (P = 0.020). In addition, TMS-related oscillatory power was significantly reduced over the ipsilesional midline-prefrontal and parietal regions. Both intra/interhemispheric connectivity and network measures in the theta band were significantly reduced in the ipsilesional hemisphere compared with those in the contralesional hemisphere. CONCLUSIONS The ipsilesional M1 demonstrated impaired GABA-B receptor-mediated intracortical inhibition characterized by reduced duration, but reduced magnitude. The N100 of TMS-evoked potentials appears to be a useful biomarker of post-stroke recovery.
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Affiliation(s)
- Zhongfei Bai
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR
- Department of Rehabilitation, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Centre), School of Medicine, Tongji University, Shanghai, China
| | - Jack Jiaqi Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR
| | - Kenneth N. K. Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR
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Barbosa LM, Valerio F, da Silva VA, Rodrigues ALDL, Galhardoni R, Yeng LT, Junior JR, Conforto AB, Lucato LT, Teixeira MJ, de Andrade DC. Corticomotor excitability is altered in central neuropathic pain compared with non-neuropathic pain or pain-free patients. Neurophysiol Clin 2023; 53:102845. [PMID: 36822032 DOI: 10.1016/j.neucli.2023.102845] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVES Central neuropathic pain (CNP) is associated with altered corticomotor excitability (CE), which can potentially provide insights into its mechanisms. The objective of this study is to describe the CE changes that are specifically related to CNP. METHODS We evaluated CNP associated with brain injury after stroke or spinal cord injury (SCI) due to neuromyelitis optica through a battery of CE measurements and comprehensive pain, neurological, functional, and quality of life assessments. CNP was compared to two groups of patients with the same disease: i. with non-neuropathic pain and ii. without chronic pain, matched by sex and lesion location. RESULTS We included 163 patients (stroke=93; SCI=70: 74 had CNP, 43 had non-neuropathic pain, and 46 were pain-free). Stroke patients with CNP had lower motor evoked potential (MEP) in both affected and unaffected hemispheres compared to non- neuropathic pain and no-pain patients. Patients with CNP had lower amplitudes of MEPs (366 μV ±464 μV) than non-neuropathic (478 ±489) and no-pain (765 μV ± 880 μV) patients, p < 0.001. Short-interval intracortical inhibition (SICI) was defective (less inhibited) in patients with CNP (2.6±11.6) compared to no-pain (0.8±0.7), p = 0.021. MEPs negatively correlated with mechanical and cold-induced allodynia. Furthermore, classifying patients' results according to normative data revealed that at least 75% of patients had abnormalities in some CE parameters and confirmed MEP findings based on group analyses. DISCUSSION CNP is associated with decreased MEPs and SICI compared to non-neuropathic pain and no-pain patients. Corticomotor excitability changes may be helpful as neurophysiological markers of the development and persistence of pain after CNS injury, as they are likely to provide insights into global CE plasticity changes occurring after CNS lesions associated with CNP.
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Affiliation(s)
- Luciana Mendonça Barbosa
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil; Department of Neurology, University of São Paulo, 05403-900, São Paulo, Brazil
| | - Fernanda Valerio
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
| | | | | | - Ricardo Galhardoni
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
| | - Lin Tchia Yeng
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
| | - Jefferson Rosi Junior
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
| | | | | | - Manoel Jacobsen Teixeira
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil; Department of Neurology, University of São Paulo, 05403-900, São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- Department of Neurology, University of São Paulo, 05403-900, São Paulo, Brazil; Center for Neuroplasticity and Pain, Department of Health Sciences and Technology, Faculty of Medicine, Aalborg University, DK-9220, Aalborg, Denmark.
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Moscatelli F, Toto GA, Valenzano A, Cibelli G, Monda V, Limone P, Mancini N, Messina A, Marsala G, Messina G, Polito R. High frequencies (HF) repetitive transcranial magnetic stimulation (rTMS) increase motor coordination performances in volleyball players. BMC Neurosci 2023; 24:30. [PMID: 37161411 PMCID: PMC10170826 DOI: 10.1186/s12868-023-00796-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/09/2022] [Accepted: 03/31/2023] [Indexed: 05/11/2023] Open
Abstract
INTRODUCTION It is widely demonstrated that high frequency (HF) repetitive transcranial magnetic stimulation (rTMS) has facilitative effects and is therefore capable to inducing changes in motor responses. One of the most investigated areas is the dorsolateral prefrontal cortex (DLPFC) as it plays a special executive attention role in actively preserving access to stimulus representations and objectives in environments with plenty of distraction such as those of team sports. Volleyball is a team sport in which the attention and coordination components are essential for achieving performance. Thus, the aim of this study was to investigate if HF rTMS at DLPFC in volleyball players can improve homolateral motor coordination and cortical excitability. RESULTS This study was a double-blinded (participant and evaluator) matched-pair experimental design. Twenty right-handed female volleyball players were recruited for the study and were randomly assigned either the active rTMS (n = 10) or the sham stimulation group (n = 10). The stimulation was performed in one session with 10 Hz, 80% of the resting motor threshold (RMT) of the right first dorsal interosseous muscle, 5 s of stimulation, and 15 s of rest, for a total of 1500 pulses. Before and after stimulation, the coordination and the cortical excitability were evaluated. The significant finding of this paper was that HF-rTMS of the DLPFC improved performance in terms of the homolateral interlimb coordination, with a significantly decreased in resting motor threshold and MEP latency of the ipsilateral motor cortex. It seem that HF-rTMS could increase coordination performances when the velocity of the execution is higher (120 bpm and 180 bpm). CONCLUSION Moreover, in active rTMS group significant differences emerged after stimulation in RMT and in MEP latency, while no differences emerged after stimulation in MEP amplitude. In conclusion we believe that these results may be of great interest to the scientific community and may also have practical implications in the future.
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Affiliation(s)
- Fiorenzo Moscatelli
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Giusi Antonia Toto
- Learning Science Hub, Department of Humanistic Studies, University of Foggia, Foggia, Italy
| | - Anna Valenzano
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Giuseppe Cibelli
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Vincenzo Monda
- Department of Movement Sciences and Wellbeing, University of Naples "Parthenope", Naples, Italy
| | - Pierpaolo Limone
- Department of Human Sciences, Telematic University Pegaso, Naples, Italy
| | - Nicola Mancini
- Faculty of Physical Education and Sports, "Babes Bolyai" University, Cluj-Napoca, Romania
| | - Antonietta Messina
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetics and Sports Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Gabriella Marsala
- Struttura Complessa di Farmacia, Azienda Ospedaliero-Universitaria di Foggia, Foggia, Italy
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy.
| | - Rita Polito
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy.
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25
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Maccora S, Bolognini N, Mannina C, Torrente A, Agnello L, Lo Sasso B, Ciaccio M, Sireci G, Brighina F. The effects of estradiol levels on crossmodal perception: a study on the sound induced flash illusion in healthy and menstrually related migraine individuals. Neurol Sci 2023. [PMID: 36920571 DOI: 10.1007/s10072-023-06744-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/08/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE The sound-induced flash illusion (SIFI) is a valid paradigm to study multisensorial perception. In the "fission" SIFI, multiple flashes are perceived when observing a single flash paired with two or more beeps. SIFI is largely dependent on visual and acoustic cortex excitability; in migraine, dysfunctional cortical excitability affects SIFI perception. Since estrogen peak occurring during ovulation can increase neuronal excitability, the present study aims to verify whether cortical excitability shifts linked to the menstrual cycle could influence SIFI. METHODS In a comparative prospective study, we tested the effect of estrogens on crossmodal perception using the SIFI. We recruited 27 females in reproductive age, including 16 healthy and 11 menstrually related migraine females, testing their proneness to SIFI on day 14 (high estradiol) and day 27 (low estradiol) of menstrual cycle. RESULTS Women on day 14 reported less flashes than on day 27 (p = 0.02) in the fission illusion, suggesting a pro-excitatory effect of estradiol on visual cortex excitability during ovulation. Moreover, we confirmed that migraine women perceived less flashes (p = 0.001) than controls, independently from cycle phase. Non-migraineurs women significantly reported more flashes on day 27 than on day 14 (p = 0.04). CONCLUSIONS This study suggests that estradiol may influence the multisensory perception due to changes of visual cortex excitability, with high estradiol peak leading to increased visual cortical sensitivity during ovulation in non-migraineurs. Visual cortex hyperresponsiveness, here reflected by reduced SIFI, is not influenced by estradiol fluctuations in migraine women, as shown by reduced fission effects on day 14 and 27.
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Helling RM, Perenboom MJL, Bauer PR, Carpay JA, Sander JW, Ferrari MD, Visser GH, Tolner EA. TMS-evoked EEG potentials demonstrate altered cortical excitability in migraine with aura. Brain Topogr 2023; 36:269-281. [PMID: 36781512 PMCID: PMC10014725 DOI: 10.1007/s10548-023-00943-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/25/2023] [Indexed: 02/15/2023]
Abstract
Migraine is associated with altered sensory processing, that may be evident as changes in cortical responsivity due to altered excitability, especially in migraine with aura. Cortical excitability can be directly assessed by combining transcranial magnetic stimulation with electroencephalography (TMS-EEG). We measured TMS evoked potential (TEP) amplitude and response consistency as these measures have been linked to cortical excitability but were not yet reported in migraine.We recorded 64-channel EEG during single-pulse TMS on the vertex interictally in 10 people with migraine with aura and 10 healthy controls matched for age, sex and resting motor threshold. On average 160 pulses around resting motor threshold were delivered through a circular coil in clockwise and counterclockwise direction. Trial-averaged TEP responses, frequency spectra and phase clustering (over the entire scalp as well as in frontal, central and occipital midline electrode clusters) were compared between groups, including comparison to sham-stimulation evoked responses.Migraine and control groups had a similar distribution of TEP waveforms over the scalp. In migraine with aura, TEP responses showed reduced amplitude around the frontal and occipital N100 peaks. For the migraine and control groups, responses over the scalp were affected by current direction for the primary motor cortex, somatosensory cortex and sensory association areas, but not for frontal, central or occipital midline clusters.This study provides evidence of altered TEP responses in-between attacks in migraine with aura. Decreased TEP responses around the N100 peak may be indicative of reduced cortical GABA-mediated inhibition and expand observations on enhanced cortical excitability from earlier migraine studies using more indirect measurements.
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Affiliation(s)
- Robert M Helling
- Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 5, 2103 SW, Heemstede, The Netherlands
| | - Matthijs J L Perenboom
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Prisca R Bauer
- Department of Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, University of Freiburg, Hauptstraße 8, 79104, Freiburg, Germany
| | - Johannes A Carpay
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.,Department of Neurology, Tergooi Hospitals, Van Riebeeckweg 212, 1213 XZ, Hilversum, The Netherlands
| | - Josemir W Sander
- Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 5, 2103 SW, Heemstede, The Netherlands.,Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, WC1N 3BG, London, UK
| | - Michel D Ferrari
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Gerhard H Visser
- Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 5, 2103 SW, Heemstede, The Netherlands
| | - Else A Tolner
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands. .,Department of Human Genetics, Leiden University Medical Centre, Postal Zone S4-P, PO Box 9600, Leiden, The Netherlands.
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27
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Lanza G, Fisicaro F, Cantone M, Pennisi M, Cosentino FII, Lanuzza B, Tripodi M, Bella R, Paulus W, Ferri R. Repetitive transcranial magnetic stimulation in primary sleep disorders. Sleep Med Rev 2023; 67:101735. [PMID: 36563570 DOI: 10.1016/j.smrv.2022.101735] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [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: 06/30/2022] [Revised: 09/13/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a widely used non-invasive neuromodulatory technique. When applied in sleep medicine, the main hypothesis explaining its effects concerns the modulation of synaptic plasticity and the strength of connections between the brain areas involved in sleep disorders. Recently, there has been a significant increase in the publication of rTMS studies in primary sleep disorders. A multi-database-based search converges on the evidence that rTMS is safe and feasible in chronic insomnia, obstructive sleep apnea syndrome (OSAS), restless legs syndrome (RLS), and sleep deprivation-related cognitive deficits, whereas limited or no data are available for narcolepsy, sleep bruxism, and REM sleep behavior disorder. Regarding efficacy, the stimulation of the dorsolateral prefrontal cortex bilaterally, right parietal cortex, and dominant primary motor cortex (M1) in insomnia, as well as the stimulation of M1 leg area bilaterally, left primary somatosensory cortex, and left M1 in RLS reduced subjective symptoms and severity scale scores, with effects lasting for up to weeks; conversely, no relevant effect was observed in OSAS and narcolepsy. Nevertheless, several limitations especially regarding the stimulation protocols need to be considered. This review should be viewed as a step towards the further contribution of individually tailored neuromodulatory techniques for sleep disorders.
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Affiliation(s)
- Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy; Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS, Troina, Italy.
| | - Francesco Fisicaro
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Mariagiovanna Cantone
- Neurology Unit, University Hospital Policlinico "G. Rodolico-San Marco", Catania, Italy; Department of Neurology, Sant'Elia Hospital, ASP Caltanissetta, Caltanissetta, Italy
| | - Manuela Pennisi
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | | | - Bartolo Lanuzza
- Department of Neurology IC and Sleep Research Centre, Oasi Research Institute-IRCCS, Troina, Italy
| | - Mariangela Tripodi
- Department of Neurology IC and Sleep Research Centre, Oasi Research Institute-IRCCS, Troina, Italy
| | - Rita Bella
- Department of Medical and Surgical Science and Advanced Technologies, University of Catania, Catania, Italy
| | - Walter Paulus
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
| | - Raffaele Ferri
- Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS, Troina, Italy
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Isis S, Armele D, Paulo GL, Raylene A, Luam D, Marina BR, Adriana B, Katia MS. The effect of tDCS on improving physical performance and attenuating effort perception during maximal dynamic exercise in non-athletes. Neurosci Lett 2023; 794:136991. [PMID: 36455695 DOI: 10.1016/j.neulet.2022.136991] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to test the effects of transcranial direct current stimulation (tDCS), using different electrode positioning and montages, on physical performance in maximum incremental tests of healthy non-athlete subjects. DESIGN A double-blinded, crossover, sham-controlled study. METHOD Fifteen subjects (aged 25.8 ± 5 years, nine women) received one of five different tDCS protocols: (i) anodal tDCS on the primary motor cortex (M1) (a-tDCS/M1), (ii) anodal tDCS on the left temporal cortex (T3) (a-tDCS/T3), (iii) cathodal tDCS on M1 (c-tDCS/M1), (iv) cathodal on T3 (c-tDCS/T3), or (v) sham tDCS. The protocols were assigned in a random order in separate sessions. After tDCS, the volunteers performed the maximal incremental exercise test (MIT) on a cycle ergometer in each session. The following measures were used to evaluate physical performance (primary outcome) during MIT: time to exhaustion (TE), maximum power (MAX-P), and Borg Rating of Perceived Exertion (RPE) scale. In addition, as a secondary outcome measure, we assessed the lower-limb corticospinal excitability and electrical muscular activity. RESULTS tDCS applied over T3 or M1 did not influence electrical muscular activity or increase physical performance during MIT in healthy non-athlete subjects. However, our data confirmed that a-tDCS on the M1 increases lower-limb cortical excitability. CONCLUSIONS Our results suggest that tDCS is not effective in improving performance during maximal dynamic exercise in non-athletes. However, we confirmed that the a-tDCS M1 protocol used in this study might increase cortical excitability in the lower limb motor cortex.
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Affiliation(s)
- Suruagy Isis
- Applied Neuroscience Laboratory, Universidade Federal de Pernambuco, Recife, Brazil; Department of Physical Therapy, Universidade Federal de Pernambuco, Brazil
| | - Dornelas Armele
- Department of Physical Therapy, Universidade Federal de Pernambuco, Brazil
| | - Gomes Luis Paulo
- Bioscience of Human Movement Laboratory, Universidade Tiradentes, Aracaju, Sergipe, Brazil
| | - Araújo Raylene
- Applied Neuroscience Laboratory, Universidade Federal de Pernambuco, Recife, Brazil
| | - Diniz Luam
- Applied Neuroscience Laboratory, Universidade Federal de Pernambuco, Recife, Brazil; Department of Physical Therapy, Universidade Federal de Pernambuco, Brazil
| | - Berenguer-Rocha Marina
- Applied Neuroscience Laboratory, Universidade Federal de Pernambuco, Recife, Brazil; Department of Physical Therapy, Universidade Federal de Pernambuco, Brazil
| | - Baltar Adriana
- Applied Neuroscience Laboratory, Universidade Federal de Pernambuco, Recife, Brazil; Department of Physical Therapy, Universidade Federal de Pernambuco, Brazil
| | - Monte-Silva Katia
- Applied Neuroscience Laboratory, Universidade Federal de Pernambuco, Recife, Brazil; Department of Physical Therapy, Universidade Federal de Pernambuco, Brazil.
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Rodriguez KM, Palmieri-Smith RM, Krishnan C. Quadriceps motor evoked torque is a reliable measure of corticospinal excitability in individuals with anterior cruciate ligament reconstruction. J Electromyogr Kinesiol 2022; 67:102700. [PMID: 36063566 DOI: 10.1016/j.jelekin.2022.102700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/01/2022] [Accepted: 08/26/2022] [Indexed: 12/14/2022] Open
Abstract
This study comprehensively evaluated the test-retest reliability of raw and normalized quadriceps motor evoked responses elicited by transcranial magnetic stimulation (TMS) in individuals with anterior cruciate ligament (ACL) reconstruction. Fifteen participants were tested on three different days that were separated at least by 24 h. Motor evoked responses were collected during a small background contraction on the reconstructed leg across a range of TMS intensities using torque (MEPTORQUE) and electromyographic (MEPEMG) responses. MEPTORQUE and MEPEMG were evaluated using different normalization procedures (raw, normalized to maximum voluntary isometric contraction [MVIC], peak MEP, and background contraction). MEPTORQUE was also normalized to the magnetically-evoked peripheral resting twitch torque. The area under the recruitment curve was computed for both raw and normalized MEPs. Intraclass correlation coefficients (ICCs) were determined to assess test-retest reliability. Results indicated that MEPTORQUE generally showed greater reliability than MEPEMG for all normalization procedures. Vastus medialis MEPEMG generally showed greater reliability than rectus femoris MEPEMG. Finally, both MEPTORQUE and MEPEMG exhibited good reliability, even when not normalized. These findings indicate that MEPTORQUE and MEPEMG offer reliable measures of corticospinal function and suggest that MEPTORQUE is a suitable alternative to MEPEMG for measuring quadriceps corticospinal excitability in individuals with ACL reconstruction.
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Hermann JK, Borseth A, Pucci FG, Toth C, Hogue O, Chan HH, Machado AG, Baker KB. Changes in somatosensory evoked potentials elicited by lateral cerebellar nucleus deep brain stimulation in the naïve rodent. Neurosci Lett 2022; 786:136800. [PMID: 35842210 DOI: 10.1016/j.neulet.2022.136800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 07/02/2022] [Accepted: 07/11/2022] [Indexed: 11/17/2022]
Abstract
Deep brain stimulation (DBS) of the deep cerebellar nuclei has been shown to enhance perilesional cortical excitability and promote motor rehabilitation in preclinical models of cortical ischemia and is currently being evaluated in patients with chronic, post-stroke deficits. Understanding the effects of cerebellar DBS on contralateral sensorimotor cortex may be key to developing approaches to optimize stimulation delivery and treatment outcomes. Using the naïve rat model, we characterized the effects of DBS of the lateral cerebellar nucleus (LCN) on somatosensory evoked potentials (SSEPs) and evaluated their potential use as a surrogate index of cortical excitability. SSEPs were recorded concurrently with continuous 30 Hz or 100 Hz LCN DBS and compared to the DBS OFF condition. Ratios of SSEP peak to peak amplitude during 100 Hz LCN DBS to DBS OFF at longer latency peaks were significantly>1, suggesting that cortical excitability was enhanced as a result of LCN DBS. Although changes in SSEP peak to peak amplitudes were observed, they were modest in relation to previously reported effects on motor cortical excitability. Overall, our findings suggest that LCN output influences thalamocortical somatosensory pathways, however further work is need to better understand the potential role of SSEPs in optimizing therapy.
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Affiliation(s)
- John K Hermann
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States
| | - Ashley Borseth
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States
| | - Francesco G Pucci
- Center for Neurologic Restoration, Neurological Institute, Cleveland Clinic, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States; Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States
| | - Carmen Toth
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States
| | - Olivia Hogue
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States
| | - Hugh H Chan
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States
| | - Andre G Machado
- Center for Neurologic Restoration, Neurological Institute, Cleveland Clinic, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States; Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States
| | - Kenneth B Baker
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States.
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Kennouche D, Varesco G, Espeit L, Féasson L, Souron R, Rozand V, Millet GY, Lapole T. Acute effects of quadriceps muscle versus tendon prolonged local vibration on force production capacities and central nervous system excitability. Eur J Appl Physiol 2022; 122:2451-2461. [PMID: 36001143 DOI: 10.1007/s00421-022-05028-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/17/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE The present study aimed to directly compare the effects of 30 min muscle (VIBmuscle) vs. tendon (VIBtendon) local vibration (LV) to the quadriceps on maximal voluntary isometric contraction (MVIC) and rate of torque development (RTD) as well as on central nervous system excitability (i.e. motoneuron and cortical excitability). METHODS Before (PRE) and immediately after (POST) LV applied to the quadriceps muscle or its tendon, we investigated MVIC and RTD (STUDY #1; n = 20) or vastus lateralis (VL), vastus medialis (VM) and rectus femoris (RF) electromyography responses to thoracic electrical stimulation (TMEPs; motoneuron excitability) and transcranial magnetic stimulation (MEPs; corticospinal excitability) (STUDY #2; n = 17). MEP/TMEP ratios were further calculated to quantify changes in cortical excitability. RESULTS MVIC decreased at POST (P = 0.017) without any difference between VIBtendon and VIBmuscle, while RTD decreased for VIBtendon (P = 0.013) but not VIBmuscle. TMEP amplitudes were significantly decreased for all muscles (P = 0.014, P < 0.001 and P = 0.004 for VL, VM and RF, respectively) for both LV sites. While no changes were observed for MEP amplitude, MEP/TMEP ratios increased at POST for VM and RF muscles (P = 0.009 and P = 0.013, respectively) for both VIBtendon and VIBmuscle. CONCLUSION The present results suggest that prolonged muscle and tendon LV are similarly effective in modulating central nervous system excitability and decreasing maximal force. Yet, altered explosive performance after tendon but not muscle LV suggests greater neural alterations when tendons are vibrated.
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Affiliation(s)
- Djahid Kennouche
- Univ Lyon, UJM-Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, F-42023, Saint-Etienne, France
| | - Giorgio Varesco
- Univ Lyon, UJM-Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, F-42023, Saint-Etienne, France
| | - Loïc Espeit
- Univ Lyon, UJM-Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, F-42023, Saint-Etienne, France
| | - Léonard Féasson
- Univ Lyon, UJM-Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, F-42023, Saint-Etienne, France.,Unité de Myologie, Centre Référent Maladies Neuromusculaires - Euro-NMD, Centre Hospitalier Universitaire de Saint-Etienne, 42055, Saint Etienne, France
| | - Robin Souron
- Univ Lyon, UJM-Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, F-42023, Saint-Etienne, France.,UFR STAPS de Toulon, Unité de Recherche IAPS (N°201723207F), UFR STAPS de Toulon, Toulon, France
| | - Vianney Rozand
- Univ Lyon, UJM-Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, F-42023, Saint-Etienne, France
| | - Guillaume Y Millet
- Univ Lyon, UJM-Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, F-42023, Saint-Etienne, France.,Institut Universitaire de France (IUF), Paris, France
| | - Thomas Lapole
- Univ Lyon, UJM-Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, F-42023, Saint-Etienne, France.
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Therrien-Blanchet JM, Ferland MC, Rousseau MA, Badri M, Boucher E, Merabtine A, Hofmann LH, Théoret H. Stability and test-retest reliability of neuronavigated TMS measures of corticospinal and intra cortical excitability. Brain Res 2022; 1794:148057. [PMID: 35987284 DOI: 10.1016/j.brainres.2022.148057] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 07/08/2022] [Accepted: 08/15/2022] [Indexed: 11/22/2022]
Abstract
The present study aimed at investigating the long-term stability and test-retest reliability of neuronavigated transcranial magnetic stimulation (nTMS) measures of cortical excitability, inhibition, and facilitation in the primary motor cortex. To fulfill these aims, thirty-one healthy adults underwent four nTMS sessions, over an average one-month period. Stability and test-retest reliability statistics were computed and analyzed to produce smallest real difference statistics, which indicate the absolute variation in a measurement that is likely to be the result of error (randomness). Excellent reliability was found for resting motor thresholds, which reflect baseline neuronal excitability. Good reliability statistics were found for input/output curve measurements, which reflect the excitability of a highly plastic neuronal population. Using the slope of mean amplitudes throughout the input/output curve or the stimulator intensity required to elicit motor evoked potentials of 1 mV presented good to excellent measurement reliability for global cortical excitability indexing, compared to mean MEP at a given intensity. Overall, this methodological study provides useful and novel information on transcranial magnetic stimulation interventions by providing smallest real difference statistics that inform on potential response thresholds across time, contributing to the validation of these measurements as clinical monitoring tools across time.
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Helekar SA, Thonhoff J, John BS, Nguyen L, Rosenfield DB, Appel SH. Modulation of spontaneous motor unit potentials by a new motor cortical magnetic stimulation method in amyotrophic lateral sclerosis. J Neurol 2022; 269:5487-5496. [PMID: 35704101 DOI: 10.1007/s00415-022-11214-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/28/2022] [Accepted: 06/03/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Patients with amyotrophic lateral sclerosis (ALS) show altered cortical excitability. In this study, we measure modulation of spontaneous motor unit potentials (sMUPs) in hand muscles by multifocal cortical stimulation with a newly developed wearable transcranial rotating permanent magnet stimulator (TRPMS). METHODS We conducted cross-sectional and longitudinal electromyographic assessments in 40 and 20 ALS patients, respectively, of the stimulation-induced peak increase in the count of sMUPs in two hand muscles modulated by unilateral TRPMS stimulation of the primary motor cortex. We measured peak sMUP counts during several short sessions consisting of 10 stimuli over 60 s and 30 s post-stimulation periods. The longitudinal component involved an initial assessment at an early stage of the disease and up to five follow-up assessments at least 3 months apart. RESULTS TRPMS stimulation produced no device-related adverse effects. It showed an inverted V-shaped modulation of the peak sMUP counts as a function of ALS functional rating scale revised scores. The ratios of ALS subjects showing peak sMUP count increases between early and intermediate stages (χ2 = 4.086, df = 1, p = 0.043) and intermediate and late stages (χ2 = 4.29, df = 1, p = 0.038) in cross-sectional data were significantly different. Longitudinal assessment also produced a significant (z = 2.31, p = 0.021) result, with all subjects showing a post-initial visit increase in peak sMUP counts. CONCLUSIONS These results are consistent with delayed onset of upper motor neuronal dysfunction with respect to onset of clinical features. However, the above results need to be confirmed in a larger sample of patients and with multiple lines of evidence.
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Affiliation(s)
- Santosh A Helekar
- Stanley H. Appel Department of Neurology, Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, TX, 77030, USA. .,Weill Cornell Medical College, New York, NY, 10065, USA.
| | - Jason Thonhoff
- Stanley H. Appel Department of Neurology, Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Blessy S John
- Stanley H. Appel Department of Neurology, Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Lisa Nguyen
- Stanley H. Appel Department of Neurology, Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - David B Rosenfield
- Stanley H. Appel Department of Neurology, Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, TX, 77030, USA.,Weill Cornell Medical College, New York, NY, 10065, USA
| | - Stanley H Appel
- Stanley H. Appel Department of Neurology, Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, TX, 77030, USA.,Weill Cornell Medical College, New York, NY, 10065, USA
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Chou YH, Sundman M, Ton That V, Green J, Trapani C. Cortical excitability and plasticity in Alzheimer's disease and mild cognitive impairment: A systematic review and meta-analysis of transcranial magnetic stimulation studies. Ageing Res Rev 2022; 79:101660. [PMID: 35680080 DOI: 10.1016/j.arr.2022.101660] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 09/29/2021] [Revised: 05/13/2022] [Accepted: 05/30/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) is a non-invasive neuromodulation technique. When stimulation is applied over the primary motor cortex and coupled with electromyography measures, TMS can probe functions of cortical excitability and plasticity in vivo. The purpose of this meta-analysis is to evaluate the utility of TMS-derived measures for differentiating patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI) from cognitively normal older adults (CN). METHODS Databases searched included PubMed, Embase, APA PsycInfo, Medline, and CINAHL Plus from inception to July 2021. RESULTS Sixty-one studies with a total of 2728 participants (1454 patients with AD, 163 patients with MCI, and 1111 CN) were included. Patients with AD showed significantly higher cortical excitability, lower cortical inhibition, and impaired cortical plasticity compared to the CN cohorts. Patients with MCI exhibited increased cortical excitability and reduced plasticity compared to the CN cohort. Additionally, lower cognitive performance was significantly associated with higher cortical excitability and lower inhibition. No seizure events due to TMS were reported, and the mild adverse response rate is approximately 3/1000 (i.e., 9/2728). CONCLUSIONS Findings of our meta-analysis demonstrate the potential of using TMS-derived cortical excitability and plasticity measures as diagnostic biomarkers and therapeutic targets for AD and MCI.
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Affiliation(s)
- Ying-Hui Chou
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, Tucson, USA; Evelyn F McKnight Brain Institute, Arizona Center on Aging, and BIO5 Institute, University of Arizona, Tucson, USA.
| | - Mark Sundman
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, Tucson, USA
| | - Viet Ton That
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, Tucson, USA
| | - Jacob Green
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, Tucson, USA
| | - Chrisopher Trapani
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, Tucson, USA
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Dubbioso R, Bove M, Boccia D, D'Ambrosio V, Nolano M, Manganelli F, Iodice R. Neurophysiological and behavioural correlates of ocrelizumab therapy on manual dexterity in patients with primary progressive multiple sclerosis. J Neurol 2022; 269:4791-4801. [PMID: 35419681 PMCID: PMC9363320 DOI: 10.1007/s00415-022-11114-x] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 12/20/2022]
Abstract
Background Hand dexterity impairment is a key feature of disability in people with primary progressive multiple sclerosis (PPMS). So far, ocrelizumab, a recombinant humanized monoclonal antibody that selectively depletes CD20-expressing B cells, is the only therapy approved for PPMS and recent analysis reported its ability to reduce the risk of upper limb disability progression. However, the neural mechanisms underlying hand impairment in PPMS and the brain networks behind the effect of ocrelizumab on manual dexterity are not fully understood. Objective Main aims of our study were: (i) to investigate neurophysiological and behavioural correlates of hand function impairment in subjects with PPMS, and (ii) to use neurophysiologic and behavioural measures to track the effects of ocrelizumab therapy on manual dexterity. Methods Seventeen PPMS patients and 17 healthy-controls underwent routine neurophysiological protocols assessing the integrity of cortico-spinal and somatosensory pathways and advanced transcranial magnetic stimulation (TMS) protocols evaluating inhibitory (short and long interval intracortical inhibition, short-latency afferent inhibition) and facilitatory (motor thresholds, intracortical facilitation, short-interval intracortical facilitation) circuits in the primary motor cortex. All subjects also underwent behavioural analysis of hand dexterity by means of nine-hole peg test and finger movement analysis, and hand strength with handgrip and three-point pinch test. Neurophysiological and clinical assessments of hand functionality were also performed after 1 year of ocrelizumab therapy. Results At baseline PPMS patients displayed a significant impairment of hand dexterity and strength compared to healthy controls (all p < 0.03). Neurophysiological study disclosed prolonged latencies of standard somatosensory and motor evoked potentials (all p < 0.025) and an overall reduction of intracortical excitability at TMS protocols, involving both excitatory and inhibitory circuits. Importantly, hand dexterity impairment, indexed by delayed 9HPT, correlated with TMS protocols investigating cortical sensorimotor integration (short-latency afferent inhibition, SAI), p = 0.009. Both parameters, 9HPT (p = 0.01) and SAI (p = 0.01), displayed a significant improvement after 1 year of therapy with ocrelizumab. Conclusion Intracortical sensorimotor networks are involved in hand dexterity dysfunction of PPMS. Ocrelizumab therapy displays a beneficial effect on hand dexterity impairment most likely through intracortical networks implicated in fast sensorimotor integration.
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Affiliation(s)
- Raffaele Dubbioso
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Via Sergio Pansini, 5. 80131, Napoli, Italy.
| | - Marco Bove
- IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Section of Human Physiology, Department of Experimental Medicine, Università Degli Studi Di Genova, 16132, Genoa, Italy
| | - Daniele Boccia
- IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Neuroscience Genetics, Maternal and Child Health (DINOGMI)Center of Excellence for Biomedical Research (CEBR), University of Genoa, RehabilitationGenoa, Ophthalmology, Italy
| | - Vincenzo D'Ambrosio
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Maria Nolano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Via Sergio Pansini, 5. 80131, Napoli, Italy.,Department of Neurology, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy
| | - Fiore Manganelli
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Via Sergio Pansini, 5. 80131, Napoli, Italy
| | - Rosa Iodice
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Via Sergio Pansini, 5. 80131, Napoli, Italy
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Bringman CL, Shields RK, DeJong SL. Corticospinal modulation of vibration-induced H-reflex depression. Exp Brain Res 2022; 240:803-12. [PMID: 35044475 DOI: 10.1007/s00221-022-06306-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 01/04/2022] [Indexed: 11/04/2022]
Abstract
The purpose of this study was to examine corticospinal modulation of spinal reflex excitability, by determining the effect of transcranial magnetic stimulation (TMS) on soleus H-reflexes while they were almost completely suppressed by lower extremity vibration. In 15 healthy adults, a novel method of single-limb vibration (0.6 g, 30 Hz, 0.33 mm displacement) was applied to the non-dominant leg. Soleus muscle responses were examined in six stimulation conditions: (1) H-reflex elicited by tibial nerve stimulation, (2) tibial nerve stimulation during vibration, (3) subthreshold TMS, (4) subthreshold TMS during vibration, (5) tibial nerve stimulation 10 ms after a subthreshold TMS pulse, and (6) tibial nerve stimulation 10 ms after a subthreshold TMS pulse, during vibration. With or without vibration, subthreshold TMS produced no motor evoked potentials and had no effect on soleus electromyography (p > 0.05). In the absence of vibration, H-reflex amplitudes were not affected by subthreshold TMS conditioning (median (md) 35, interquartile range (IQ) 18-56 vs. md 46, IQ 22-59% of the maximal M wave (Mmax), p > 0.05). During vibration, however, unconditioned H-reflexes were nearly abolished, and a TMS conditioning pulse increased the H-reflex more than fourfold (md 0.3, IQ 0.1-0.7 vs. md 2, IQ 0.9-5.0% of Mmax, p < 0.008). Limb vibration alone had no significant effect on corticospinal excitability. In the absence of vibration, a subthreshold TMS pulse did not influence the soleus H-reflex. During limb vibration, however, while the H-reflex was almost completely suppressed, a subthreshold TMS pulse partially restored the H-reflex. This disinhibition of the H-reflex by a corticospinal signal may represent a mechanism involved in the control of voluntary movement. Corticospinal signals that carry the descending motor command may also reduce presynaptic inhibition, temporarily increasing the impact of sensory inputs on motoneuron activation.
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Lissemore JI, Mulsant BH, Bonner AJ, Butters MA, Chen R, Downar J, Karp JF, Lenze EJ, Rajji TK, Reynolds CF 3rd, Zomorrodi R, Daskalakis ZJ, Blumberger DM. Transcranial Magnetic Stimulation Indices of Cortical Excitability Enhance the Prediction of Response to Pharmacotherapy in Late-Life Depression. Biol Psychiatry Cogn Neurosci Neuroimaging 2022; 7:265-75. [PMID: 34311121 DOI: 10.1016/j.bpsc.2021.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/16/2021] [Accepted: 07/14/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Older adults with late-life depression (LLD) often experience incomplete or lack of response to first-line pharmacotherapy. The treatment of LLD could be improved using objective biological measures to predict response. Transcranial magnetic stimulation (TMS) can be used to measure cortical excitability, inhibition, and plasticity, which have been implicated in LLD pathophysiology and associated with brain stimulation treatment outcomes in younger adults with depression. TMS measures have not yet been investigated as predictors of treatment outcomes in LLD or pharmacotherapy outcomes in adults of any age with depression. METHODS We assessed whether pretreatment single-pulse and paired-pulse TMS measures, combined with clinical and demographic measures, predict venlafaxine treatment response in 76 outpatients with LLD. We compared the predictive performance of machine learning models including or excluding TMS predictors. RESULTS Two single-pulse TMS measures predicted venlafaxine response: cortical excitability (neuronal membrane excitability) and the variability of cortical excitability (dynamic fluctuations in excitability levels). In cross-validation, models using a combination of these TMS predictors, clinical markers of treatment resistance, and age classified patients with 73% ± 11% balanced accuracy (average correct classification rate of responders and nonresponders; permutation testing, p < .005); these models significantly outperformed (corrected t test, p = .025) models using clinical and demographic predictors alone (60% ± 10% balanced accuracy). CONCLUSIONS These preliminary findings suggest that single-pulse TMS measures of cortical excitability may be useful predictors of response to pharmacotherapy in LLD. Future studies are needed to confirm these findings and determine whether combining TMS predictors with other biomarkers further improves the accuracy of predicting LLD treatment outcome.
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Bai Z, Zhang J, Fong KNK. Effects of transcranial magnetic stimulation in modulating cortical excitability in patients with stroke: a systematic review and meta-analysis. J Neuroeng Rehabil 2022; 19:24. [PMID: 35193624 PMCID: PMC8862292 DOI: 10.1186/s12984-022-00999-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [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: 08/10/2021] [Accepted: 01/28/2022] [Indexed: 12/13/2022] Open
Abstract
Background Transcranial magnetic stimulation (TMS) has attracted plenty of attention as it has been proved to be effective in facilitating motor recovery in patients with stroke. The aim of this study was to systematically review the effects of repetitive TMS (rTMS) and theta burst stimulation (TBS) protocols in modulating cortical excitability after stroke. Methods A literature search was carried out using PubMed, Medline, EMBASE, CINAHL, and PEDro, to identify studies that investigated the effects of four rTMS protocols—low and high frequency rTMS, intermittent and continuous TBS, on TMS measures of cortical excitability in stroke. A random-effects model was used for all meta-analyses. Results Sixty-one studies were included in the current review. Low frequency rTMS was effective in decreasing individuals’ resting motor threshold and increasing the motor-evoked potential of the non-stimulated M1 (affected M1), while opposite effects occurred in the stimulated M1 (unaffected M1). High frequency rTMS enhanced the cortical excitability of the affected M1 alone. Intermittent TBS also showed superior effects in rebalancing bilateral excitability through increasing and decreasing excitability within the affected and unaffected M1, respectively. Due to the limited number of studies found, the effects of continuous TBS remained inconclusive. Motor impairment was significantly correlated with various forms of TMS measures. Conclusions Except for continuous TBS, it is evident that these protocols are effective in modulating cortical excitability in stroke. Current evidence does support the effects of inhibitory stimulation in enhancing the cortical excitability of the affected M1. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-022-00999-4.
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Affiliation(s)
- Zhongfei Bai
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China.,Department of Occupational Therapy, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Shanghai, China.,Department of Rehabilitation Sciences, Tongji University School of Medicine, Shanghai, China
| | - Jiaqi Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Kenneth N K Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China.
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Abstract
Sleep homeostasis is a complex neurobiologic phenomenon involving a number of molecular pathways, neurotransmitter release, synaptic activity, and factors modulating neural networks. Sleep plasticity allows for homeostatic optimization of neural networks and the replay-based consolidation of specific circuits, especially important for cognition, behavior, and information processing. Furthermore, research is currently moving from an essentially brain-focused to a more comprehensive view involving other systems, such as the immune system, hormonal status, and metabolic pathways. When dysfunctional, these systems contribute to sleep loss and fragmentation as well as to sleep need. In this chapter, the implications of neural plasticity and sleep homeostasis for the diagnosis and treatment of some major sleep disorders, such as insomnia and sleep deprivation, obstructive sleep apnea syndrome, restless legs syndrome, REM sleep behavior disorder, and narcolepsy are discussed in detail with their therapeutical implications. This chapter highlights that sleep is necessary for the maintenance of an optimal brain function and is sensitive to both genetic background and environmental enrichment. Even in pathologic conditions, sleep acts as a resilient plastic state that consolidates prior information and prioritizes network activity for efficient brain functioning.
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Lanza G, DelRosso LM, Ferri R. Sleep and homeostatic control of plasticity. Handb Clin Neurol 2022. [PMID: 35034758 DOI: 10.1016/b978-0-12-819410-2.00004-7.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Sleep homeostasis is a complex neurobiologic phenomenon involving a number of molecular pathways, neurotransmitter release, synaptic activity, and factors modulating neural networks. Sleep plasticity allows for homeostatic optimization of neural networks and the replay-based consolidation of specific circuits, especially important for cognition, behavior, and information processing. Furthermore, research is currently moving from an essentially brain-focused to a more comprehensive view involving other systems, such as the immune system, hormonal status, and metabolic pathways. When dysfunctional, these systems contribute to sleep loss and fragmentation as well as to sleep need. In this chapter, the implications of neural plasticity and sleep homeostasis for the diagnosis and treatment of some major sleep disorders, such as insomnia and sleep deprivation, obstructive sleep apnea syndrome, restless legs syndrome, REM sleep behavior disorder, and narcolepsy are discussed in detail with their therapeutical implications. This chapter highlights that sleep is necessary for the maintenance of an optimal brain function and is sensitive to both genetic background and environmental enrichment. Even in pathologic conditions, sleep acts as a resilient plastic state that consolidates prior information and prioritizes network activity for efficient brain functioning.
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Affiliation(s)
- Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy; Sleep Research Centre, Oasi Research Institute - IRCCS, Troina, Italy
| | - Lourdes M DelRosso
- Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, United States
| | - Raffaele Ferri
- Sleep Research Centre, Oasi Research Institute - IRCCS, Troina, Italy.
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Chiang MC, Hsueh HW, Yeh TY, Cheng YY, Kao YH, Chang KC, Feng FP, Chao CC, Hsieh ST. Maladaptive motor cortical excitability and connectivity in polyneuropathy with neuropathic pain. Eur J Neurol 2022; 29:1465-1476. [PMID: 35020255 DOI: 10.1111/ene.15247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/06/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sensory symptoms, especially neuropathic pain, are common in polyneuropathy. Conventional diagnostic tools can evaluate structural or functional impairment of nerves but cannot reveal mechanisms of neuropathic pain. Changes in the brain after polyneuropathy may play roles in the genesis of neuropathic pain. METHODS This cross-sectional study investigated changes of cortical excitability within left primary motor cortex (M1) by measuring resting motor thresholds, short-interval intracortical inhibition (SICI), intracortical facilitation (ICF), and afferent inhibition between polyneuropathy patients and controls, and investigated the correlates of these parameters with neuropathic pain and the M1 structural and functional connectivity assessed by diffusion tractography imaging and functional MRI. RESULTS Thirty-three painful and 15 non-painful neuropathic patients and 21 controls were enrolled. There were no differences in intraepidermal nerve fiber density, nerve conduction study, thermal thresholds, or autonomic functional tests between patients with and without neuropathic pain. Compared to controls, neuropathic patients exhibited similar resting motor thresholds or afferent inhibition, but attenuated SICI and augmented ICF, especially in painful patients. Changes of intracortical excitability in neuropathic patients were correlated with intensities of neuropathic pain, and different presentations of SICI and ICF were noted between patients with and without thermal paresthesia. Additionally, short latency afferent inhibition at interstimulus intervals of 20 ms was associated with structural connectivity of left M1 with brain areas associated with pain perception. CONCLUSIONS Maladaptive cortical excitability with altered structural connectivity in left M1 developed after peripheral nerve degeneration and was associated with neuropathic pain and sensory symptoms in polyneuropathy.
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Affiliation(s)
- Ming-Chang Chiang
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsueh-Wen Hsueh
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ti-Yen Yeh
- Department of Anatomy and Cell Biology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ya-Yin Cheng
- Department of Anatomy and Cell Biology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Hui Kao
- Department of Neurology, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Kai-Chieh Chang
- Department of Neurology, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Fang-Ping Feng
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Chao Chao
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Sung-Tsang Hsieh
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Anatomy and Cell Biology, National Taiwan University College of Medicine, Taipei, Taiwan.,Graduate Institute of Brain and Mind Sciences.,Graduate Institute of Clinical Medicine.,Center of Precision Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
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Kamble N, Bhattacharya A, Hegde S, Vidya N, Gothwal M, Yadav R, Pal PK. Cortical excitability changes as a marker of cognitive impairment in Parkinson's disease. Behav Brain Res 2022; 422:113733. [PMID: 34998797 DOI: 10.1016/j.bbr.2022.113733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 12/23/2021] [Accepted: 01/01/2022] [Indexed: 12/12/2022]
Abstract
Cognitive impairment of different severity with eventual progression to dementia in Parkinson's disease (PD) appears during the course of the disease. In this study, transcranial magnetic stimulation (TMS) was used to assess cortical excitability changes in PD patients with varying cognitive impairment. We aimed to identify the TMS parameters that could serve as a non-invasive marker of cognitive impairment in patients with PD. Consecutive PD patients were recruited in the study. Detailed neuropsychological assessment was carried out to identify PD without cognitive impairment (PD-nC), PD with mild cognitive impairment (PD-MCI) and PD with dementia (PDD). Twenty patients of PDD (2 females and 18 males), 20 PD-MCI (4 females and 16 males), 18 PD-nC (5 females, 13 males) and 18 healthy controls (4 females, and 14 males) were included in the study. All the participants underwent TMS with recording of resting motor threshold, central motor conduction time, silent period, short interval intracortical inhibition (SICI) and intracortical facilitation (ICF). All the groups were age matched. The SICI was present in all; however, significantly greater inhibition was noted in PDD (Mean±SD; 0.11±0.08) followed by PD-MCI (0.31±0.17), PD-nC (0.49±0.26) and controls (0.61±0.23; p<0.001). The ICF was significantly reduced in PDD (Mean±SD; 0.15±0.18), PD-MCI (0.55±0.31), PD-nC (0.96±0.59), when compared to healthy controls (1.81±0.83; p<0.001). Patients with PD-nC, PD-MCI and PDD had graded reduction in ICF and increasing intracortical inhibition as the disease progressed from PD-nC through PD-MCI to PDD. This suggests progressive overactivity of GABAergic transmission, glutaminergic deficiency with consequent reduction of cholinergic transmission leading to dementia.
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Affiliation(s)
- Nitish Kamble
- Departments of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore 560029, Karnataka, India
| | - Amitabh Bhattacharya
- Departments of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore 560029, Karnataka, India
| | - Shantala Hegde
- Clinical Psychology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore 560029, Karnataka, India
| | - N Vidya
- Clinical Psychology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore 560029, Karnataka, India
| | - Mohit Gothwal
- Clinical Psychology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore 560029, Karnataka, India
| | - Ravi Yadav
- Departments of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore 560029, Karnataka, India
| | - Pramod Kumar Pal
- Departments of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore 560029, Karnataka, India.
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Cosentino G, Todisco M, Blandini F. Noninvasive neuromodulation in Parkinson's disease: Neuroplasticity implication and therapeutic perspectives. Handb Clin Neurol 2022; 184:185-198. [PMID: 35034733 DOI: 10.1016/b978-0-12-819410-2.00010-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Noninvasive brain stimulation techniques can be used to study in vivo the changes of cortical activity and plasticity in subjects with Parkinson's disease (PD). Also, an increasing number of studies have suggested a potential therapeutic effect of these techniques. High-frequency repetitive transcranial magnetic stimulation (rTMS) and anodal transcranial direct current stimulation (tDCS) represent the most used stimulation paradigms to treat motor and nonmotor symptoms of PD. Both techniques can enhance cortical activity, compensating for its reduction related to subcortical dysfunction in PD. However, the use of suboptimal stimulation parameters can lead to therapeutic failure. Clinical studies are warranted to clarify in PD the additional effects of these stimulation techniques on pharmacologic and neurorehabilitation treatments.
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Affiliation(s)
- Giuseppe Cosentino
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Massimiliano Todisco
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Movement Disorders Research Center, IRCCS Mondino Foundation, Pavia, Italy.
| | - Fabio Blandini
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Movement Disorders Research Center, IRCCS Mondino Foundation, Pavia, Italy
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Udupa K, Bhattacharya A, Chen R. Exploring the connections between basal ganglia and cortex revealed by transcranial magnetic stimulation, evoked potential and deep brain stimulation in dystonia. Eur J Paediatr Neurol 2022; 36:69-77. [PMID: 34922163 DOI: 10.1016/j.ejpn.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 10/30/2021] [Accepted: 12/01/2021] [Indexed: 12/30/2022]
Abstract
We review the findings for motor cortical excitability, plasticity and evoked potentials in dystonia. Plasticity can be induced and assessed in cortical areas by non-invasive brain stimulation techniques such as transcranial magnetic stimulation (TMS) and the invasive technique of deep brain stimulation (DBS), which allows access to deep brain structures. Single-pulse TMS measures have been widely studied in dystonia and consistently showed reduced silent period duration. Paired pulse TMS measures showed reduced short and long interval intracortical inhibition, interhemispheric inhibition, long-latency afferent inhibition and increased intracortical facilitation in dystonia. Repetitive transcranial magnetic stimulation (rTMS) of the premotor cortex improved handwriting with prolongation of the silent period in focal hand dystonia patients. Continuous theta-burst stimulation (cTBS) of the cerebellum or cTBS of the dorsal premotor cortex improved dystonia in some studies. Plasticity induction protocols in dystonia demonstrated excessive motor cortical plasticity with the reduction in cortico-motor topographic specificity. Bilateral DBS of the globus pallidus internus (GPi) improves dystonia, associated pain and functional disability. Local field potentials recordings in dystonia patients suggested that there is increased power in the low-frequency band (4-12 Hz) in the GPi. Cortical evoked potentials at peak latencies of 10 and 25 ms can be recorded with GPi stimulation in dystonia. Plasticity induction protocols based on the principles of spike timing dependent plasticity that involved repeated pairing of GPi-DBS and motor cortical TMS at latencies of cortical evoked potentials induced motor cortical plasticity. These studies expanded our knowledge of the pathophysiology of dystonia and how cortical excitability and plasticity are altered with different treatments such as DBS.
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Zhao CG, Sun W, Ju F, Jiang S, Wang H, Sun XL, Mou X, Yuan H. Analgesic Effects of Navigated Repetitive Transcranial Magnetic Stimulation in Patients With Acute Central Poststroke Pain. Pain Ther 2021; 10:1085-100. [PMID: 33866522 DOI: 10.1007/s40122-021-00261-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 03/30/2021] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Central poststroke pain (CPSP) develops commonly after stroke, which impairs the quality of life, mood, and social functioning. Current pharmacological approaches for the treatment of CPSP are not satisfactory. Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive technique which has been recommended for the treatment of chronic CPSP. However, few studies have evaluated the analgesic effects of rTMS in patients with acute neuropathic pain after stroke. METHODS We evaluated the analgesic effects of rTMS applied over the upper extremity area of the motor cortex (M1) in patients with acute CPSP. Forty patients were randomized to receive either rTMS (10 Hz, 2000 stimuli) (n = 20) or a sham intervention (n = 20) for 3 weeks. The Numeric Rating Scale (NRS), Short-form McGill Pain Questionnaire-2 (SF-MPQ-2, Chinese version), Hamilton Anxiety Scale (HAM-A), Hamilton Depression Scale (HAM-D), brain-derived neurotrophic factor (BDNF) levels, and motor-evoked potentials (MEP) were analyzed at baseline, 3 days, 1 week, 2 weeks, and 3 weeks. RESULTS Significant treatment-time interactions were found for pain intensity. Compared with the sham group, the NRS and SF-MPQ-2 scores were significantly lower on the seventh day of treatment in the rTMS group (P < 0.001, Cohen's d = 1.302) (P = 0.003, Cohen's d = 0.771), and this effect lasted until the third week (P = 0.001, Cohen's d = 0.860) (P = 0.027, Cohen's d = 0.550). The HAM-A and HAM-D scores did not change in the rTMS group when compared with the sham group (P = 0.341, Cohen's d = 0.224) (P = 0.356, Cohen's d = 0.217). The serum BDNF levels were significantly higher in the treated group (P = 0.048, Cohen's d = -0.487), and the resting motor threshold (RMT) decreased by 163.65%. CONCLUSION Our findings indicate that rTMS applied over the upper extremity area of the motor cortex can effectively alleviate acute CPSP, possibly by influencing cortical excitability and serum BDNF secretion. TRIAL REGISTRATION This trial is registered with Clinical Trial Registry of China: Reg. No. ChiCTR-INR-17012880.
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Chang PW, Lu CF, Chang ST, Tsai PY. Functional Near-Infrared Spectroscopy as a Target Navigator for rTMS Modulation in Patients with Hemiplegia: A Randomized Control Study. Neurol Ther 2021; 11:103-121. [PMID: 34773596 PMCID: PMC8857363 DOI: 10.1007/s40120-021-00300-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/01/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Although repetitive transcranial magnetic stimulation (rTMS) is efficacious for motor neuromodulation in stroke survivors, high interindividual variability for responsiveness remains a concern. Target probing on the skull using a proper brain-mapping technique may help overcome this challenge. This study assessed the feasibility of functional near-infrared spectroscopy (fNIRS) as a target navigator in rTMS treatment for motor facilitation in patients with stroke. Methods Fifty-one patients with stroke were enrolled in this randomized controlled study. The patients were assigned to three groups: fNIRS-guided rTMS treatment (fNIRS group, n = 20), motor evoked potential (MEP)-guided rTMS treatment (MEP group, n = 16), and sham (n = 15) group. Motor assessments, including Fugl–Meyer Assessment (FMA), Wolf Motor Function Test (WMFT), and muscle strength, were conducted at baseline and after the 10-session rTMS treatment. Results The fNIRS-guided hotspot (fNIRS-HS) was obtained for each patient, even those for whom the MEP-guided hotspot was undetectable. Both intervention groups exhibited significant improvements in muscle strength, FMA, and WMFT scores (P < 0.001) compared with the sham group. The fNIRS group achieved significantly greater improvement in elbow function (P = 0.001) than the MEP group. Conclusion fNIRS can be a reliable tool for hotspot navigation for motor neuromodulation in patients with stroke. With high sensitivity to cortical oxygenation changes, this navigation system achieved a superior outcome to the traditional MEP-based method in patients with stroke. fNIRS-based systems may also facilitate the integration of machine learning, thus enabling precision medicine for neuromodulation. Trial Registration https://clinicaltrials.gov; Unique identifier: NCT02006615. Supplementary Information The online version contains supplementary material available at 10.1007/s40120-021-00300-0.
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Affiliation(s)
- Pang-Wei Chang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Feng Lu
- Department of Biomedical Imaging and Radiological Sciences, School of Biomedical Science and Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Biophotonics, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shin-Tsu Chang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Po-Yi Tsai
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan. .,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Di Lazzaro V, Bella R, Benussi A, Bologna M, Borroni B, Capone F, Chen KHS, Chen R, Chistyakov AV, Classen J, Kiernan MC, Koch G, Lanza G, Lefaucheur JP, Matsumoto H, Nguyen JP, Orth M, Pascual-Leone A, Rektorova I, Simko P, Taylor JP, Tremblay S, Ugawa Y, Dubbioso R, Ranieri F. Diagnostic contribution and therapeutic perspectives of transcranial magnetic stimulation in dementia. Clin Neurophysiol 2021; 132:2568-2607. [PMID: 34482205 DOI: 10.1016/j.clinph.2021.05.035] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 04/22/2021] [Accepted: 05/28/2021] [Indexed: 02/07/2023]
Abstract
Transcranial magnetic stimulation (TMS) is a powerful tool to probe in vivo brain circuits, as it allows to assess several cortical properties such asexcitability, plasticity and connectivity in humans. In the last 20 years, TMS has been applied to patients with dementia, enabling the identification of potential markers of thepathophysiology and predictors of cognitive decline; moreover, applied repetitively, TMS holds promise as a potential therapeutic intervention. The objective of this paper is to present a comprehensive review of studies that have employed TMS in dementia and to discuss potential clinical applications, from the diagnosis to the treatment. To provide a technical and theoretical framework, we first present an overview of the basic physiological mechanisms of the application of TMS to assess cortical excitability, excitation and inhibition balance, mechanisms of plasticity and cortico-cortical connectivity in the human brain. We then review the insights gained by TMS techniques into the pathophysiology and predictors of progression and response to treatment in dementias, including Alzheimer's disease (AD)-related dementias and secondary dementias. We show that while a single TMS measure offers low specificity, the use of a panel of measures and/or neurophysiological index can support the clinical diagnosis and predict progression. In the last part of the article, we discuss the therapeutic uses of TMS. So far, only repetitive TMS (rTMS) over the left dorsolateral prefrontal cortex and multisite rTMS associated with cognitive training have been shown to be, respectively, possibly (Level C of evidence) and probably (Level B of evidence) effective to improve cognition, apathy, memory, and language in AD patients, especially at a mild/early stage of the disease. The clinical use of this type of treatment warrants the combination of brain imaging techniques and/or electrophysiological tools to elucidate neurobiological effects of neurostimulation and to optimally tailor rTMS treatment protocols in individual patients or specific patient subgroups with dementia or mild cognitive impairment.
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Affiliation(s)
- Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy.
| | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced Technologies, Section of Neurosciences, University of Catania, Catania, Italy
| | - Alberto Benussi
- Centre for Neurodegenerative Disorders, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy
| | - Barbara Borroni
- Centre for Neurodegenerative Disorders, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Fioravante Capone
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Kai-Hsiang S Chen
- Department of Neurology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Robert Chen
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada; Division of Brain, Imaging& Behaviour, Krembil Brain Institute, Toronto, Canada
| | | | - Joseph Classen
- Department of Neurology, University Hospital Leipzig, Leipzig University Medical Center, Germany
| | - Matthew C Kiernan
- Department of Neurology, Royal Prince Alfred Hospital, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Giacomo Koch
- Non Invasive Brain Stimulation Unit/Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy; Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy; Department of Neurology IC, Oasi Research Institute-IRCCS, Troina, Italy
| | - Jean-Pascal Lefaucheur
- ENT Team, EA4391, Faculty of Medicine, Paris Est Créteil University, Créteil, France; Clinical Neurophysiology Unit, Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | | | - Jean-Paul Nguyen
- Pain Center, clinique Bretéché, groupe ELSAN, Multidisciplinary Pain, Palliative and Supportive care Center, UIC 22/CAT2 and Laboratoire de Thérapeutique (EA3826), University Hospital, Nantes, France
| | - Michael Orth
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Swiss Huntington's Disease Centre, Siloah, Bern, Switzerland
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research, Center for Memory Health, Hebrew SeniorLife, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA; Guttmann Brain Health Institute, Universitat Autonoma Barcelona, Spain
| | - Irena Rektorova
- Applied Neuroscience Research Group, Central European Institute of Technology, Masaryk University (CEITEC MU), Brno, Czech Republic; Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Patrik Simko
- Applied Neuroscience Research Group, Central European Institute of Technology, Masaryk University (CEITEC MU), Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sara Tremblay
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, ON, Canada; Royal Ottawa Institute of Mental Health Research, Ottawa, ON, Canada
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Raffaele Dubbioso
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Federico Ranieri
- Unit of Neurology, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Khedr EM, Lefaucheur JP, Hasan AM, Osama K. Are there differences in cortical excitability between akinetic-rigid and tremor-dominant subtypes of Parkinson's disease? Neurophysiol Clin 2021; 51:443-53. [PMID: 34588134 DOI: 10.1016/j.neucli.2021.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/25/2021] [Accepted: 08/25/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To assess by transcranial magnetic stimulation (TMS) the excitability of various cortical circuits in akinetic-rigid and tremor-dominant subtypes of Parkinson's disease (PD). METHODS The study included 92 patients with PD according to UK Brain Bank criteria, with akinetic-rigid (n = 64) or tremor-dominant (n = 28) subtype. Cortical excitability study, including resting and active motor thresholds (rMT and aMT), input-output curve of motor evoked potentials, contralateral and ipsilateral silent periods (cSP and iSP), short and long-interval intracortical inhibition (SICI and LICI), and intracortical facilitation (ICF) were measured. The results obtained were compared to a control group of 30 age- and sex-matched healthy subjects. RESULTS The patients in the tremor group had significantly lower rMT and aMT compared to controls and akinetic-rigid patients and significantly shorter iSP duration compared to akinetic-rigid patients, while iSP latency tended to be longer in akinetic-rigid patients compared to controls. There were no significant differences between the two PD subgroups regarding other cortical excitability parameters, including paired-pulse TMS parameters. CONCLUSIONS Only subtle differences of cortical excitability were found between patients with akinetic-rigid vs. tremor-dominant subtype of PD. SIGNIFICANCE The clinical heterogeneity of PD patients probably has an impact on cortical excitability measures, far beyond the akinetic-rigid versus tremor-dominant profile.
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Hu Y, Wu J, Zhang X, Tian J, Lu Y, Guo T. Effects of Paired Associative Stimulation on Metabolites in Ischemia Stroke Rats Model as Studied by Nuclear Magnetic Resonance Spectrum. Neurochem Res 2021; 46:2495-2504. [PMID: 34231112 DOI: 10.1007/s11064-021-03388-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/16/2021] [Revised: 06/10/2021] [Accepted: 06/23/2021] [Indexed: 11/30/2022]
Abstract
Paired associated stimulation (PAS) has been confirmed to play a role in motor recovery after stroke, but the underlying mechanism has not been fully elucidated. In this study, we employed a comprehensive battery of measurements, including behavioral test, electrophysiology and 1H-NMR approaches, to investigate the therapeutic effects of PAS in rat model of cerebral ischemia and its underlying mechanism. Rats were randomly divided into a transient middle cerebral artery occlusion group (tMCAO group), a tMCAO + PAS group (PAS group), and a sham group. PAS was applied over 7 consecutive days in PAS group. The behavioral function of rats was evaluated by modified Garcia Scores and Rota-rod test. Electrophysiological changes were measured by motor evoked potentials (MEP). Metabolic changes of ischemic penumbra were detected by 1H-NMR. After PAS intervention, the performances on Rota-rod test and Garcia test improved and the amplitude of MEP increased significantly. The gamma-aminobutyric acid (GABA) in penumbra cortex was decreased significantly, whereas the glutamate showed the opposite changes. The results suggested that post-stroke recovery promoted by PAS may be related to the metabolites alteration in ischemic penumbra and also regulate the excitability of motor cortex.
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Affiliation(s)
- Yan Hu
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, No. 1095, Jiefang Avenue, Qiaokou District, Wuhan City, 430000, Hubei Province, China
| | - Jinfeng Wu
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, 430071, China
| | - Xiangyu Zhang
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, No. 1095, Jiefang Avenue, Qiaokou District, Wuhan City, 430000, Hubei Province, China
| | - Jun Tian
- Department of Rehabilitation Medicine, Zhongnan Hospital, Wuhan University, Wuhan, 430000, China
| | - Yinshan Lu
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, No. 1095, Jiefang Avenue, Qiaokou District, Wuhan City, 430000, Hubei Province, China
| | - Tiecheng Guo
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, No. 1095, Jiefang Avenue, Qiaokou District, Wuhan City, 430000, Hubei Province, China.
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50
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Proteau-Lemieux M, Lacroix A, Galarneau L, Corbin F, Lepage JF, Çaku A. The safety and efficacy of metformin in fragile X syndrome: An open-label study. Prog Neuropsychopharmacol Biol Psychiatry 2021; 110:110307. [PMID: 33757860 DOI: 10.1016/j.pnpbp.2021.110307] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 03/03/2021] [Accepted: 03/16/2021] [Indexed: 11/18/2022]
Abstract
Fragile X syndrome (FXS) is a rare genetic disorder characterized by a deficit of the fragile X mental retardation protein (FMRP), encoded by the fragile X mental retardation gene (FMR1) on the X chromosome. It has been hypothesized that the absence of FRMP leads to higher levels of Insulin-like Growth Factor 1 (IGF-1) in the brain, possibly contributing to the intellectual impairment characteristic of the disorder. Preclinical studies have shown that metformin downregulates the insulin/IGF-1 signaling pathway, corrects dendritic defects, and improves repetitive behavior in Fmr1 knockout mice. Here, we conducted an open-label study to evaluate: (1) the safety of metformin in normoglycemic individuals with FXS; and (2) the efficacy of metformin to improve aberrant behavior, attention, and to modulate cortical functioning. Fifteen patients with FXS, aged from 17 to 44, received 500 mg of metformin twice/daily over a 9-week treatment period. The primary outcome measures were: (1) the incidence of adverse events (AE); (2) the decrease in IGF-1 levels; and (3) the global score of the Aberrant Behavior Checklist-Community, Fragile X. The secondary outcomes were: (1) the Test of Attentional Performance for children (KiTAP); and (2) the Transcranial Magnetic Stimulation (TMS) parameters measuring cortical excitability. The metformin treatment was well tolerated, with no significant related AE. The TMS data showed an increase in corticospinal inhibition mediated by GABAA and GABAB mechanisms. This study demonstrates the safety of metformin in normoglycemic patients with FXS, and suggests the potential of this medication in modifying GABA-mediated inhibition, a hallmark of FXS pathophysiology. Implications for future clinical trials are discussed.
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Affiliation(s)
- Mélodie Proteau-Lemieux
- Sherbrooke University Hospital Research Center, Sherbrooke, Canada; Department of Pediatrics, Faculty of Medicine and Health Sciences, Sherbrooke University, Sherbrooke, Canada
| | - Angélina Lacroix
- Sherbrooke University Hospital Research Center, Sherbrooke, Canada; Department of Pharmacology, Faculty of Medicine and Health Sciences, Sherbrooke University, Sherbrooke, Canada
| | - Luc Galarneau
- Sherbrooke University Hospital Research Center, Sherbrooke, Canada; Department of Biochemistry, Faculty of Medicine and Health Sciences, Sherbrooke University, Sherbrooke, Canada
| | - François Corbin
- Sherbrooke University Hospital Research Center, Sherbrooke, Canada; Department of Biochemistry, Faculty of Medicine and Health Sciences, Sherbrooke University, Sherbrooke, Canada
| | - Jean-François Lepage
- Sherbrooke University Hospital Research Center, Sherbrooke, Canada; Department of Pediatrics, Faculty of Medicine and Health Sciences, Sherbrooke University, Sherbrooke, Canada.
| | - Artuela Çaku
- Sherbrooke University Hospital Research Center, Sherbrooke, Canada; Department of Biochemistry, Faculty of Medicine and Health Sciences, Sherbrooke University, Sherbrooke, Canada
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