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Lefaucheur JP, Moro E, Shirota Y, Ugawa Y, Grippe T, Chen R, Benninger DH, Jabbari B, Attaripour S, Hallett M, Paulus W. Clinical neurophysiology in the treatment of movement disorders: IFCN handbook chapter. Clin Neurophysiol 2024; 164:57-99. [PMID: 38852434 DOI: 10.1016/j.clinph.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 03/02/2024] [Accepted: 05/15/2024] [Indexed: 06/11/2024]
Abstract
In this review, different aspects of the use of clinical neurophysiology techniques for the treatment of movement disorders are addressed. First of all, these techniques can be used to guide neuromodulation techniques or to perform therapeutic neuromodulation as such. Neuromodulation includes invasive techniques based on the surgical implantation of electrodes and a pulse generator, such as deep brain stimulation (DBS) or spinal cord stimulation (SCS) on the one hand, and non-invasive techniques aimed at modulating or even lesioning neural structures by transcranial application. Movement disorders are one of the main areas of indication for the various neuromodulation techniques. This review focuses on the following techniques: DBS, repetitive transcranial magnetic stimulation (rTMS), low-intensity transcranial electrical stimulation, including transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS), and focused ultrasound (FUS), including high-intensity magnetic resonance-guided FUS (MRgFUS), and pulsed mode low-intensity transcranial FUS stimulation (TUS). The main clinical conditions in which neuromodulation has proven its efficacy are Parkinson's disease, dystonia, and essential tremor, mainly using DBS or MRgFUS. There is also some evidence for Tourette syndrome (DBS), Huntington's disease (DBS), cerebellar ataxia (tDCS), and axial signs (SCS) and depression (rTMS) in PD. The development of non-invasive transcranial neuromodulation techniques is limited by the short-term clinical impact of these techniques, especially rTMS, in the context of very chronic diseases. However, at-home use (tDCS) or current advances in the design of closed-loop stimulation (tACS) may open new perspectives for the application of these techniques in patients, favored by their easier use and lower rate of adverse effects compared to invasive or lesioning methods. Finally, this review summarizes the evidence for keeping the use of electromyography to optimize the identification of muscles to be treated with botulinum toxin injection, which is indicated and widely performed for the treatment of various movement disorders.
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Affiliation(s)
- Jean-Pascal Lefaucheur
- Clinical Neurophysiology Unit, Henri Mondor University Hospital, AP-HP, Créteil, France; EA 4391, ENT Team, Paris-Est Créteil University, Créteil, France.
| | - Elena Moro
- Grenoble Alpes University, Division of Neurology, CHU of Grenoble, Grenoble Institute of Neuroscience, Grenoble, France
| | - Yuichiro Shirota
- Department of Neurology, Division of Neuroscience, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Talyta Grippe
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Neuroscience Graduate Program, Federal University of Minas Gerais, Belo Horizonte, Brazil; Krembil Brain Institute, Toronto, Ontario, Canada
| | - Robert Chen
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Krembil Brain Institute, Toronto, Ontario, Canada
| | - David H Benninger
- Service of Neurology, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Bahman Jabbari
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Sanaz Attaripour
- Department of Neurology, University of California, Irvine, CA, USA
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Walter Paulus
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
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Shin W, Lee Y, Lim J, Lee Y, Lah JD, Lee S, Lee JU, Yu R, Lee PH, Lee JH, Kwak M, Cheon J. Nanoscale Magneto-mechanical-genetics of Deep Brain Neurons Reversing Motor Deficits in Parkinsonian Mice. NANO LETTERS 2024; 24:270-278. [PMID: 38157214 DOI: 10.1021/acs.nanolett.3c03899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Here, we introduce the magneto-mechanical-genetic (MMG)-driven wireless deep brain stimulation (DBS) using magnetic nanostructures for therapeutic benefits in the mouse model of Parkinson's disease (PD). Electrical DBS of the subthalamic nucleus (STN) is an effective therapy for mitigating Parkinson's motor symptoms. However, its broader application is hampered by the requirement for implanted electrodes and the lack of anatomical and cellular specificity. Using the nanoscale magnetic force actuators (m-Torquer), which deliver torque force under rotating magnetic fields to activate pre-encoded Piezo1 ion channels on target neurons, our system enables wireless and STN-specific DBS without implants, addressing key unmet challenges in the DBS field. In both late- and early-stage PD mice, MMG-DBS significantly improved locomotor activity and motor balance by 2-fold compared to untreated PD mice. Moreover, MMG-DBS enabled sustained therapeutic effects. This approach provides a non-invasive and implant-free DBS with cellular targeting capability for the effective treatment of Parkinsonian symptoms.
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Affiliation(s)
- Wookjin Shin
- Center for Nanomedicine, Institute for Basic Science, Seoul 03722, Republic of Korea
| | - Yeongdo Lee
- Center for Nanomedicine, Institute for Basic Science, Seoul 03722, Republic of Korea
- Department of Nano Biomedical Engineering, Advanced Science Institute, Yonsei University, Seoul 03722, Republic of Korea
| | - Jueun Lim
- Center for Nanomedicine, Institute for Basic Science, Seoul 03722, Republic of Korea
- Department of Nano Biomedical Engineering, Advanced Science Institute, Yonsei University, Seoul 03722, Republic of Korea
| | - Youbin Lee
- Center for Nanomedicine, Institute for Basic Science, Seoul 03722, Republic of Korea
- Department of Nano Biomedical Engineering, Advanced Science Institute, Yonsei University, Seoul 03722, Republic of Korea
| | - Jungsu David Lah
- Center for Nanomedicine, Institute for Basic Science, Seoul 03722, Republic of Korea
- Department of Nano Biomedical Engineering, Advanced Science Institute, Yonsei University, Seoul 03722, Republic of Korea
| | - Somin Lee
- Center for Nanomedicine, Institute for Basic Science, Seoul 03722, Republic of Korea
- Department of Nano Biomedical Engineering, Advanced Science Institute, Yonsei University, Seoul 03722, Republic of Korea
| | - Jung-Uk Lee
- Center for Nanomedicine, Institute for Basic Science, Seoul 03722, Republic of Korea
| | - Ri Yu
- Center for Nanomedicine, Institute for Basic Science, Seoul 03722, Republic of Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul 03722, South Korea
- Department of Biomedical Science, Yonsei University College of Medicine, Seoul 03722, South Korea
| | - Jae-Hyun Lee
- Center for Nanomedicine, Institute for Basic Science, Seoul 03722, Republic of Korea
- Department of Nano Biomedical Engineering, Advanced Science Institute, Yonsei University, Seoul 03722, Republic of Korea
| | - Minsuk Kwak
- Center for Nanomedicine, Institute for Basic Science, Seoul 03722, Republic of Korea
- Department of Nano Biomedical Engineering, Advanced Science Institute, Yonsei University, Seoul 03722, Republic of Korea
| | - Jinwoo Cheon
- Center for Nanomedicine, Institute for Basic Science, Seoul 03722, Republic of Korea
- Department of Nano Biomedical Engineering, Advanced Science Institute, Yonsei University, Seoul 03722, Republic of Korea
- Department of Chemistry, Yonsei University, Seoul 03722, Republic of Korea
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Brancucci A, Rivolta D, Nitsche MA, Manippa V. The effects of transcranial random noise stimulation on motor function: A comprehensive review of the literature. Physiol Behav 2023; 261:114073. [PMID: 36608913 DOI: 10.1016/j.physbeh.2023.114073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/23/2022] [Accepted: 01/01/2023] [Indexed: 01/05/2023]
Abstract
The present review considers all papers published on the topic up to the end of the year 2022. Transcranial random noise stimulation (tRNS) is a non-invasive neuromodulation technique introduced about 15 years ago whose use is becoming increasingly widespread in neuroscience. It consists of the application over the scalp of a weak, white noise-like current, through electrodes having a surface of several square centimetres, for a duration ranging from seconds to minutes. Despite its relatively low spatial and temporal resolution, tRNS has well defined effects on central motor excitability, which critically depend on stimulation parameters. These effects seem to be chiefly based on an effect on neuronal membrane sodium channels and can last much longer than the stimulation itself. While the effects at the cellular level in the motor cortex are becoming progressively clear, much more studies are needed to understand the effects of tRNS on motor behaviour and performance, where initial research results are nevertheless promising, in both basic and applied research.
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Affiliation(s)
- Alfredo Brancucci
- Dipartimento di Scienze Motorie, Umane e della Salute, Università di Roma "Foro Italico", Italy.
| | - Davide Rivolta
- Dipartimento di Scienze della Formazione, Psicologia, Comunicazione, Università degli studi di Bari "Aldo Moro", Italy
| | - Michael A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany; Bielefeld University, University Hospital OWL, Protestant Hospital of Bethel Foundation, University Clinic of Psychiatry and Psychotherapy and University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Germany
| | - Valerio Manippa
- Dipartimento di Scienze della Formazione, Psicologia, Comunicazione, Università degli studi di Bari "Aldo Moro", Italy; Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
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Brak IV, Filimonova E, Zakhariya O, Khasanov R, Stepanyan I. Transcranial Current Stimulation as a Tool of Neuromodulation of Cognitive Functions in Parkinson’s Disease. Front Neurosci 2022; 16:781488. [PMID: 35903808 PMCID: PMC9314857 DOI: 10.3389/fnins.2022.781488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Abstract
Decrease in cognitive function is one of the most common causes of poor life quality and early disability in patients with Parkinson’s disease (PD). Existing methods of treatment are aimed at both correction of motor and non-motor symptoms. Methods of adjuvant therapy (or complementary therapy) for maintaining cognitive functions in patients with PD are of interest. A promising subject of research in this regard is the method of transcranial electric current stimulation (tES). Here we reviewed the current understanding of the pathogenesis of cognitive impairment in PD and of the effects of transcranial direct current stimulation and transcranial alternating current stimulation on the cognitive function of patients with PD-MCI (Parkinson’s Disease–Mild Cognitive Impairment).
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Affiliation(s)
- Ivan V. Brak
- Laboratory of Comprehensive Problems of Risk Assessment to Population and Workers’ Health, Federal State Budgetary Scientific Institution “Izmerov Research Institute of Occupational Health”, Moscow, Russia
- “Engiwiki” Scientific and Engineering Projects Laboratory, Department of Information Technologies, Novosibirsk State University, Novosibirsk, Russia
- *Correspondence: Ivan V. Brak,
| | | | - Oleg Zakhariya
- Faculty of Philosophy, Lomonosov Moscow State University, Moscow, Russia
| | - Rustam Khasanov
- Faculty of Philosophy, Lomonosov Moscow State University, Moscow, Russia
- Independent Researcher, Novosibirsk, Russia
| | - Ivan Stepanyan
- Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
- Mechanical Engineering Research Institute of the Russian Academy of Sciences, Moscow, Russia
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Ni R, Yuan Y, Yang L, Meng Q, Zhu Y, Zhong Y, Cao Z, Zhang S, Yao W, Lv D, Chen X, Chen X, Bu J. Novel Non-invasive Transcranial Electrical Stimulation for Parkinson's Disease. Front Aging Neurosci 2022; 14:880897. [PMID: 35493922 PMCID: PMC9039727 DOI: 10.3389/fnagi.2022.880897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/15/2022] [Indexed: 11/25/2022] Open
Abstract
Conventional transcranial electrical stimulation (tES) is a non-invasive method to modulate brain activity and has been extensively used in the treatment of Parkinson's disease (PD). Despite promising prospects, the efficacy of conventional tES in PD treatment is highly variable across different studies. Therefore, many have tried to optimize tES for an improved therapeutic efficacy by developing novel tES intervention strategies. Until now, these novel clinical interventions have not been discussed or reviewed in the context of PD therapy. In this review, we focused on the efficacy of these novel strategies in PD mitigation, classified them into three categories based on their distinct technical approach to circumvent conventional tES problems. The first category has novel stimulation modes to target different modulating mechanisms, expanding the rang of stimulation choices hence enabling the ability to modulate complex brain circuit or functional networks. The second category applies tES as a supplementary intervention for PD hence amplifies neurological or behavioral improvements. Lastly, the closed loop tES stimulation can provide self-adaptive individualized stimulation, which enables a more specialized intervention. In summary, these novel tES have validated potential in both alleviating PD symptoms and improving understanding of the pathophysiological mechanisms of PD. However, to assure wide clinical used of tES therapy for PD patients, further large-scale trials are required.
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Affiliation(s)
- Rui Ni
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Anhui Medical University, Hefei, China
- Department of Life Sciences, Imperial College London, London, United Kingdom
| | - Ye Yuan
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Anhui Medical University, Hefei, China
| | - Li Yang
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Anhui Medical University, Hefei, China
| | - Qiujian Meng
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Anhui Medical University, Hefei, China
| | - Ying Zhu
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Anhui Medical University, Hefei, China
| | - Yiya Zhong
- Department of Life Sciences, Imperial College London, London, United Kingdom
| | - Zhenqian Cao
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Anhui Medical University, Hefei, China
| | - Shengzhao Zhang
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Anhui Medical University, Hefei, China
| | - Wenjun Yao
- Department of Radiology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Daping Lv
- Department of Neurology, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xin Chen
- Department of Neurology, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xianwen Chen
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Junjie Bu
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Anhui Medical University, Hefei, China
- Department of Neurosurgery, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, China
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Oh E, Park J, Youn J, Jang W. Anodal Transcranial Direct Current Stimulation Could Modulate Cortical Excitability and the Central Cholinergic System in Akinetic Rigid-Type Parkinson's Disease: Pilot Study. Front Neurol 2022; 13:830976. [PMID: 35401397 PMCID: PMC8987019 DOI: 10.3389/fneur.2022.830976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/11/2022] [Indexed: 12/12/2022] Open
Abstract
Background Transcranial direct current stimulation (tDCS) is a non-invasive technique that has been widely studied as an alternative treatment for Parkinson's disease (PD). However, its clinical benefit remains unclear. In this study, we aimed to investigate the effect of tDCS on the central cholinergic system and cortical excitability in mainly akinetic rigid-type patients with PD. Methods In total, 18 patients with PD were prospectively enrolled and underwent 5 sessions of anodal tDCS on the M1 area, which is on the contralateral side of the dominant hand. We excluded patients with PD who had evident resting tremor of the hand to reduce the artifact of electrophysiologic findings. We compared clinical scales reflecting motor, cognitive, and mood symptoms between pre- and post-tDCS. Additionally, we investigated the changes in electrophysiologic parameters, such as short latency afferent inhibition (SAI) (%), which reflects the central cholinergic system. Results The United Parkinson's Disease Rating Scale Part 3 (UPDRS-III), the Korean-Montreal Cognitive Assessment (MoCA-K), and Beck Depression Inventory (BDI) scores were significantly improved after anodal tDCS (p < 0.01, p < 0.01, and p < 0.01). Moreover, motor evoked potential amplitude ratio (MEPAR) (%) and integrated SAI showed significant improvement after tDCS (p < 0.01 and p < 0.01). The mean values of the change in integrated SAI (%) were significantly correlated with the changes in UPDRS-III scores; however, the MoCA-K and BDI scores did not show differences. Conclusions Anodal tDCS could influence the central cholinergic system, such as frontal cortical excitability and depression in PD. This mechanism could underlie the clinical benefit of tDCS in patients with PD.
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Affiliation(s)
- Eungseok Oh
- Department of Neurology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Jinse Park
- Department of Neurology, Haeundae Paik Hospital, Inje University, Busan, South Korea
| | - Jinyoung Youn
- Department of Neurology, Samsung Medical Center, Seoul, South Korea
| | - Wooyoung Jang
- Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, South Korea
- *Correspondence: Wooyoung Jang
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Schneider JS, Kortagere S. Current concepts in treating mild cognitive impairment in Parkinson's disease. Neuropharmacology 2022; 203:108880. [PMID: 34774549 DOI: 10.1016/j.neuropharm.2021.108880] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 12/15/2022]
Abstract
Impairment in various aspects of cognition is recognized as an important non-motor symptom of Parkinson's disease (PD). Mild cognitive impairment in PD (PD-MCI) is common in non-demented PD patients and is often associated with severity of motor symptoms, disease duration and increasing age. Further, PD-MCI can have a significant negative effect on performance of daily life activities and may be a harbinger of development of PD dementia. Thus, there is significant interest in developing therapeutic strategies to ameliorate cognitive deficits in PD and improve cognitive functioning of PD patients. However, due to significant questions that remain regarding the pathophysiology of cognitive dysfunction in PD, remediation of cognitive dysfunction in PD has proven difficult. In this paper, we will focus on PD-MCI and will review some of the current therapeutic approaches being taken to try to improve cognitive functioning in patients with PD-MCI.
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Affiliation(s)
- Jay S Schneider
- Dept. of Pathology, Anatomy and Cell Biology, Thomas Jefferson University, Philadelphia, PA 19107, USA.
| | - Sandhya Kortagere
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA 19129, USA
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New Horizons on Non-invasive Brain Stimulation of the Social and Affective Cerebellum. THE CEREBELLUM 2021; 21:482-496. [PMID: 34270081 DOI: 10.1007/s12311-021-01300-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 10/20/2022]
Abstract
The cerebellum is increasingly attracting scientists interested in basic and clinical research of neuromodulation. Here, we review available studies that used either transcranial magnetic stimulation (TMS) or transcranial direct current stimulation (tDCS) to examine the role of the posterior cerebellum in different aspects of social and affective cognition, from mood regulation to emotion discrimination, and from the ability to identify biological motion to higher-level social inferences (mentalizing). We discuss how at the functional level the role of the posterior cerebellum in these different processes may be explained by a generic prediction mechanism and how the posterior cerebellum may exert this function within different cortico-cerebellar and cerebellar limbic networks involved in social cognition. Furthermore, we suggest to deepen our understanding of the cerebro-cerebellar circuits involved in different aspects of social cognition by employing promising stimulation approaches that have so far been primarily used to study cortical functions and networks, such as paired-pulse TMS, frequency-tuned stimulation, state-dependent protocols, and chronometric TMS. The ability to modulate cerebro-cerebellar connectivity opens up possible clinical applications for improving impairments in social and affective skills associated with cerebellar abnormalities.
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