1
|
Vucic S, Stanley Chen KH, Kiernan MC, Hallett M, Benninger DH, Di Lazzaro V, Rossini PM, Benussi A, Berardelli A, Currà A, Krieg SM, Lefaucheur JP, Long Lo Y, Macdonell RA, Massimini M, Rosanova M, Picht T, Stinear CM, Paulus W, Ugawa Y, Ziemann U, Chen R. Clinical diagnostic utility of transcranial magnetic stimulation in neurological disorders. Updated report of an IFCN committee. Clin Neurophysiol 2023; 150:131-175. [PMID: 37068329 PMCID: PMC10192339 DOI: 10.1016/j.clinph.2023.03.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/28/2023] [Accepted: 03/09/2023] [Indexed: 03/31/2023]
Abstract
The review provides a comprehensive update (previous report: Chen R, Cros D, Curra A, Di Lazzaro V, Lefaucheur JP, Magistris MR, et al. The clinical diagnostic utility of transcranial magnetic stimulation: report of an IFCN committee. Clin Neurophysiol 2008;119(3):504-32) on clinical diagnostic utility of transcranial magnetic stimulation (TMS) in neurological diseases. Most TMS measures rely on stimulation of motor cortex and recording of motor evoked potentials. Paired-pulse TMS techniques, incorporating conventional amplitude-based and threshold tracking, have established clinical utility in neurodegenerative, movement, episodic (epilepsy, migraines), chronic pain and functional diseases. Cortical hyperexcitability has emerged as a diagnostic aid in amyotrophic lateral sclerosis. Single-pulse TMS measures are of utility in stroke, and myelopathy even in the absence of radiological changes. Short-latency afferent inhibition, related to central cholinergic transmission, is reduced in Alzheimer's disease. The triple stimulation technique (TST) may enhance diagnostic utility of conventional TMS measures to detect upper motor neuron involvement. The recording of motor evoked potentials can be used to perform functional mapping of the motor cortex or in preoperative assessment of eloquent brain regions before surgical resection of brain tumors. TMS exhibits utility in assessing lumbosacral/cervical nerve root function, especially in demyelinating neuropathies, and may be of utility in localizing the site of facial nerve palsies. TMS measures also have high sensitivity in detecting subclinical corticospinal lesions in multiple sclerosis. Abnormalities in central motor conduction time or TST correlate with motor impairment and disability in MS. Cerebellar stimulation may detect lesions in the cerebellum or cerebello-dentato-thalamo-motor cortical pathways. Combining TMS with electroencephalography, provides a novel method to measure parameters altered in neurological disorders, including cortical excitability, effective connectivity, and response complexity.
Collapse
Affiliation(s)
- Steve Vucic
- Brain, Nerve Research Center, The University of Sydney, Sydney, Australia.
| | - Kai-Hsiang Stanley Chen
- Department of Neurology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Matthew C Kiernan
- Brain and Mind Centre, The University of Sydney; and Department of Neurology, Royal Prince Alfred Hospital, Australia
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health, Bethesda, Maryland, United States
| | - David H Benninger
- Department of Neurology, University Hospital of Lausanne (CHUV), Switzerland
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Paolo M Rossini
- Department of Neurosci & Neurorehab IRCCS San Raffaele-Rome, Italy
| | - Alberto Benussi
- Centre for Neurodegenerative Disorders, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alfredo Berardelli
- IRCCS Neuromed, Pozzilli; Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Antonio Currà
- Department of Medico-Surgical Sciences and Biotechnologies, Alfredo Fiorini Hospital, Sapienza University of Rome, Terracina, LT, Italy
| | - Sandro M Krieg
- Department of Neurosurgery, Technical University Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Jean-Pascal Lefaucheur
- Univ Paris Est Creteil, EA4391, ENT, Créteil, France; Clinical Neurophysiology Unit, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Yew Long Lo
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, and Duke-NUS Medical School, Singapore
| | | | - Marcello Massimini
- Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi di Milano, Milan, Italy; Istituto Di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Mario Rosanova
- Department of Biomedical and Clinical Sciences University of Milan, Milan, Italy
| | - Thomas Picht
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Cluster of Excellence: "Matters of Activity. Image Space Material," Humboldt University, Berlin Simulation and Training Center (BeST), Charité-Universitätsmedizin Berlin, Germany
| | - Cathy M Stinear
- Department of Medicine Waipapa Taumata Rau, University of Auckland, Auckland, Aotearoa, New Zealand
| | - Walter Paulus
- Department of Neurology, Ludwig-Maximilians-Universität München, München, Germany
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Japan
| | - Ulf Ziemann
- Department of Neurology and Stroke, Eberhard Karls University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany; Hertie Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, Otfried-Müller-Straße 27, 72076 Tübingen, Germany
| | - Robert Chen
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital-UHN, Division of Neurology-University of Toronto, Toronto Canada
| |
Collapse
|
2
|
Andrade P, Lara-Valderrábano L, Manninen E, Ciszek R, Tapiala J, Ndode-Ekane XE, Pitkänen A. Seizure Susceptibility and Sleep Disturbance as Biomarkers of Epileptogenesis after Experimental TBI. Biomedicines 2022; 10:biomedicines10051138. [PMID: 35625875 PMCID: PMC9138230 DOI: 10.3390/biomedicines10051138] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 02/06/2023] Open
Abstract
Objectives: We investigated whether seizure susceptibility increases over weeks−months after experimental traumatic brain injury (TBI), and whether seizure susceptibility in rats predicts the development of post-traumatic epilepsy (PTE) or epileptiform activity. We further investigated whether rats develop chronic sleep disturbance after TBI, and whether sleep disturbance parameters—alone or in combination with pentylenetetrazol (PTZ) test parameters—could serve as novel biomarkers for the development of post-traumatic epileptogenesis. Methods: TBI was induced in adult male Sprague-Dawley rats with lateral fluid-percussion injury. Sham-operated experimental controls underwent craniectomy without exposure to an impact force. Seizure susceptibility was tested with a PTZ test (30 mg/kg, intraperitoneally) on day (D) 30, D60, D90, and D180 after TBI (n = 28) or sham operation (n = 16) under video electroencephalogram (vEEG). In the 7th post-injury month, rats underwent continuous vEEG monitoring to detect spontaneous seizures and assess sleep disturbances. At the end of the experiments, rats were perfused for brain histology. Results: In the TBI group, the percentage of rats with PTZ-induced seizures increased over time (adjusted p < 0.05 compared with D30). Combinations of three PTZ test parameters (latency to the first epileptiform discharge (ED), number of EDs, and number of PTZ-induced seizures) survived the leave-one-out validation for differentiating rats with or without epileptiform activity, indicating an area under the receiver operating curve (AUC) of 0.743 (95% CI 0.472−0.992, p = 0.05) with a misclassification rate of 36% on D90, and an AUC of 0.752 (95% CI 0.483−0.929, p < 0.05) with a misclassification rate of 32% on D180. Sleep analysis revealed that the number of transitions to N3 or rapid eye movement (REM) sleep, along with the total number of transitions, was increased in the TBI group during the lights-on period (all p < 0.05). The sleep fragmentation index during the lights-on period was greater in the TBI rats than in sham-operated rats (p < 0.05). A combination of sleep parameters showed promise as diagnostic biomarkers of prior TBI, with an AUC of 0.792 (95% CI 0.549−0.934, p < 0.01) and a misclassification rate of 28%. Rats with epilepsy or any epileptiform activity had more transitions from N3 to the awake stage (p < 0.05), and the number of N3−awake transitions differentiated rats with or without epileptiform activity, with an AUC of 0.857 (95% CI 0.651−1.063, p < 0.01). Combining sleep parameters with PTZ parameters did not improve the biomarker performance. Significance: This is the first attempt to monitor the evolution of seizure susceptibility over months in a well-described rat model of PTE. Our data suggest that assessment of seizure susceptibility and sleep disturbance can provide diagnostic biomarkers of prior TBI and prognostic biomarkers of post-traumatic epileptogenesis.
Collapse
|
3
|
The Effect of Epilepsy and Antiepileptic Drugs on Cortical Motor Excitability in Patients With Temporal Lobe Epilepsy. Clin Neuropharmacol 2021; 43:175-184. [PMID: 32969972 DOI: 10.1097/wnf.0000000000000412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Transcranial magnetic stimulation (TMS) has been used to assess cortical disinhibition/excitation with epilepsy and determine the degree of patients' response to antiepileptic drugs (AEDs). However, the results of studies are variable and conflicting. We assessed cortical motor excitability in adults with temporal lobe epilepsy (TLE). METHODS The TMS parameters used for assessment were: resting (RMT) and active (AMT) motor thresholds, cortical silent period (CSP), and central motor conduction time (CMCT). RESULTS AND CONCLUSIONS This study included 40 adults (males, 22; females, 18) with TLE with impaired awareness or to bilateral tonic clonic seizures (mean age, 32.50 ± 3.38 years; duration of illness, 6.15 ± 2.02 years) and on treatment with AEDs (valproate, 15; carbamazepine, 15; levetiracetam, 10]. The majority (62.5%) were seizure-free for ≥1 year on AEDs before TMS testing. All had normal brain magnetic resonance imaging except two, who had mesial temporal sclerosis. Comparing the entire patients with controls, patients had significantly bihemispheric higher RMT and AMT particularly over the epileptic hemisphere and shorter CSP and CMCT in the epileptic hemisphere. Shorter CSP and CMCT were observed in patients on valproate or carbamazepine and those who were uncontrolled on medications but not with levetiracetam. Significant correlations were identified between RMT and AMT (P = 0.01) and between CSP and CMCT (P = 0.001). We conclude that chronic TLE had increased cortical disinhibition in the epileptic hemisphere which can spread outside the epileptogenic zone despite the apparent control on AEDs. The TMS studies using CSP and CMCT may help future prediction of pharmacoresistance and, therefore, the need of combined AEDs with multiple mechanisms of action.
Collapse
|
4
|
Antidepressant effect of repetitive transcranial magnetic stimulation is not impaired by intake of lithium or antiepileptic drugs. Eur Arch Psychiatry Clin Neurosci 2021; 271:1245-1253. [PMID: 34218305 PMCID: PMC8429361 DOI: 10.1007/s00406-021-01287-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 06/21/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The effect of concomitant medication on repetitive transcranial magnetic stimulation (rTMS) outcomes in depression remains understudied. Recent analyses show attenuation of rTMS effects by antipsychotic medication and benzodiazepines, but data on the effects of antiepileptic drugs and lithium used as mood stabilizers or augmenting agents are sparse despite clinical relevance. Preclinical electrophysiological studies suggest relevant impact of the medication on treatment, but this might not translate into clinical practice. We aimed to investigate the role of lithium (Li), lamotrigine (LTG) and valproic acid (VPA) by analyzing rTMS treatment outcomes in depressed patients. METHODS 299 patients with uni- and bipolar depression treated with rTMS were selected for analysis in respect to intake of lithium, lamotrigine and valproic acid. The majority (n = 251) were treated with high-frequency (10-20 Hz) rTMS of the lDLPFC for an average of 17 treatment sessions with a figure-of-8 coil with a MagVenture system aiming for 110% resting motor threshold, and smaller groups of patients were being treated with other protocols including intermittent theta-burst stimulation and bilateral prefrontal and medial prefrontal protocols. For group comparisons, we used analysis of variance with the between-subjects factor group or Chi-Square Test of Independence depending on the scales of measurement. For post-hoc tests, we used least significant difference (LSD). For differences in treatment effects between groups, we used an ANOVA with the between-subjects factor group (groups: no mood stabilizer, Li, LTG, VPA, Li + LTG) the within-subjects factor treatment (pre vs. post treatment with rTMS) and also Chi-Square Tests of independence for response and remission. RESULTS Overall, patients showed an amelioration of symptoms with no significant differences for the main effect of group and for the interaction effect treatment by group. Based on direct comparisons between the single groups taking mood stabilizers against the group taking no mood stabilizers, we see a superior effect of lamotrigine, valproic acid and combination of lithium and lamotrigine for the response and remission rates. Motor threshold was significantly and markedly higher for patients taking valproic acid. CONCLUSION Being treated with lithium, lamotrigine and valproic acid had no relevant influence on rTMS treatment outcome. The results suggest there is no reason for clinicians to withhold or withdraw these types of medication from patients who are about to undergo a course of rTMS. Prospective controlled work on the subject is encouraged.
Collapse
|
5
|
Hamed SA. Cortical excitability in epilepsy and the impact of antiepileptic drugs: transcranial magnetic stimulation applications. Expert Rev Neurother 2020; 20:707-723. [PMID: 3251028 DOI: 10.1080/14737175.2020.1780122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Epileptic conditions are characterized by impaired cortical excitation/inhibition balance and interneuronal disinhibition. Transcranial magnetic stimulation (TMS) is a neurophysiological method that assesses brain excitation/inhibition. AREA COVERED This review was written after a detailed search in PubMed, EMBASE, ISI web of science, SciELO, Scopus, and Cochrane Controlled Trials databases from 1990 to 2020. It summarizes TMS applications for diagnostic and therapeutic purposes in epilepsy. TMS studies help to distinguish different epilepsy conditions and explore the antiepileptic drugs' (AEDs') effects on neuronal microcircuits and plasticity mechanisms. Repetitive TMS studies showed that low-frequency rTMS (0.33-1 Hz) can reduce seizures' frequency in refractory epilepsy or pause ongoing seizures; however, there is no current approval for its use in such patients as adjunctive treatment to AEDs. EXPERT OPINION There are variable and conflicting TMS results which reflect the distinct pathogenic mechanisms of each epilepsy condition, the dynamic epileptogenic process over the long disease course resulting in the development of recurrent spontaneous seizures and/or progression of epilepsy after it is established, and the differential effect of AEDs on cortical excitability. Future epilepsy research should focus on combined TMS/functional connectivity studies that explore the complex cortical excitability circuits and networks using different TMS parameters and techniques.
Collapse
Affiliation(s)
- Sherifa Ahmed Hamed
- Department of Neurology and Psychiatry, Assiut University Hospital , Assiut, Egypt
| |
Collapse
|
6
|
Cortical Excitability, Synaptic Plasticity, and Cognition in Benign Epilepsy With Centrotemporal Spikes: A Pilot TMS-EMG-EEG Study. J Clin Neurophysiol 2020; 37:170-180. [PMID: 32142025 DOI: 10.1097/wnp.0000000000000662] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Children with benign epilepsy with centrotemporal spikes have rare seizures emerging from the motor cortex, which they outgrow in adolescence, and additionally may have language deficits of unclear etiology. We piloted the use of transcranial magnetic stimulation paired with EMG and EEG (TMS-EMG, TMS-EEG) to test the hypotheses that net cortical excitability decreases with age and that use-dependent plasticity predicts learning. METHODS We assessed language and motor learning in 14 right-handed children with benign epilepsy with centrotemporal spikes. We quantified two TMS metrics of left motor cortex excitability: the resting motor threshold (measure of neuronal membrane excitability) and amplitude of the N100-evoked potential (an EEG measure of GABAergic tone). To test plasticity, we applied 1 Hz repetitive TMS to the motor cortex to induce long-term depression-like changes in EMG- and EEG-evoked potentials. RESULTS Children with benign epilepsy with centrotemporal spikes tolerate TMS; no seizures were provoked. Resting motor threshold decreases with age but is elevated above maximal stimulator output for half the group. N100 amplitude decreases with age after controlling for resting motor threshold. Motor cortex plasticity correlates significantly with language learning and at a trend level with motor learning. CONCLUSIONS Transcranial magnetic stimulation is safe and feasible for children with benign epilepsy with centrotemporal spikes, and TMS-EEG provides more reliable outcome measures than TMS-EMG in this group because many children have unmeasurably high resting motor thresholds. Net cortical excitability decreases with age, and motor cortex plasticity predicts not only motor learning but also language learning, suggesting a mechanism by which motor cortex seizures may interact with language development.
Collapse
|
7
|
Julkunen P, Löfberg O, Kallioniemi E, Hyppönen J, Kälviäinen R, Mervaala E. Abnormal motor cortical adaptation to external stimulus in Unverricht-Lundborg disease (progressive myoclonus type 1, EPM1). J Neurophysiol 2018; 120:617-623. [PMID: 29742025 DOI: 10.1152/jn.00063.2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Unverricht-Lundborg disease (EPM1) is associated with progressive functional and anatomic changes in the thalamus and motor cortex. The neurophysiological mechanisms behind the impaired thalamocortical system were studied through short-term adaptation of the motor cortex to transcranial magnetic stimulation (TMS) via repetition suppression (RS) phenomenon. RS is considered to be related to neural processing of external stimuli. We hypothesized that this neural processing is progressively impaired in EPM1 from adolescence to adulthood. Eight adult patients with EPM1 (age: 40 ± 13 yr), six adolescent patients with EPM1 (age: 16 ± 1 yr), and ten adult controls (age: 35 ± 12 yr) were studied using navigated TMS and RS study protocol including trains of four repeated stimuli with intertrain interval of 20 s and interstimulus interval of 1 s. Changes in RS were investigated from adolescence to adulthood in EPM1 by comparing with adult controls. In controls, the RS was seen as 50-55% reduction in motor response amplitudes to TMS after the first stimulus. RS was mild or missing in EPM1. RS from first to second stimulus within the stimulus trains was significantly stronger in adolescent patients than in adult patients ( P = 0.046). Abnormal RS correlated with the myoclonus severity of the patients. In agreement with our hypothesis, neural processing of external stimuli is progressively impaired in EPM1 possibly due to anatomically impaired thalamocortical system or inhibitory tonus preventing sufficient adaptive reactiveness to stimuli. Our results suggest that RS abnormality might be used as a biomarker in the therapeutic trials for myoclonus. NEW & NOTEWORTHY Unverricht-Lundborg disease (EPM1) is associated with impaired thalamocortical function, which we studied in 8 adult and 6 adolescent patients and in 10 adult controls through repetition suppression (RS) of the motor cortex. We hypothesized that neural processing is progressively impaired in EPM1 from adolescence to adulthood. RS was normal in controls, whereas it was mild or missing in EPM1. Stronger RS was seen in adolescent patients than in adult patients correlating with the myoclonus severity.
Collapse
Affiliation(s)
- Petro Julkunen
- Department of Clinical Neurophysiology, Kuopio University Hospital , Kuopio , Finland.,Department of Applied Physics, University of Eastern Finland , Kuopio , Finland
| | - Olli Löfberg
- Department of Clinical Neurophysiology, Kuopio University Hospital , Kuopio , Finland
| | - Elisa Kallioniemi
- Department of Clinical Neurophysiology, Kuopio University Hospital , Kuopio , Finland.,Department of Clinical Radiology, Kuopio University Hospital , Kuopio , Finland
| | - Jelena Hyppönen
- Department of Clinical Neurophysiology, Kuopio University Hospital , Kuopio , Finland
| | - Reetta Kälviäinen
- Department of Neurology, Kuopio Epilepsy Center, Kuopio University Hospital , Kuopio , Finland.,Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland , Kuopio , Finland
| | - Esa Mervaala
- Department of Clinical Neurophysiology, Kuopio University Hospital , Kuopio , Finland.,Department of Clinical Neurophysiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| |
Collapse
|
8
|
ter Braack EM, Koopman AWE, van Putten MJ. Early TMS evoked potentials in epilepsy: A pilot study. Clin Neurophysiol 2016; 127:3025-3032. [DOI: 10.1016/j.clinph.2016.06.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 05/31/2016] [Accepted: 06/03/2016] [Indexed: 11/16/2022]
|
9
|
Single and paired pulse transcranial magnetic stimulation in drug naïve epilepsy. Clin Neurophysiol 2016; 127:3140-3155. [DOI: 10.1016/j.clinph.2016.06.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 06/03/2016] [Accepted: 06/26/2016] [Indexed: 01/06/2023]
|
10
|
Ossemann M, de Fays K, Bihin B, Vandermeeren Y. Effect of a single dose of retigabine in cortical excitability parameters: A cross-over, double-blind placebo-controlled TMS study. Epilepsy Res 2016; 126:78-82. [PMID: 27448328 DOI: 10.1016/j.eplepsyres.2016.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 06/01/2016] [Accepted: 06/24/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Antiepileptic drugs (AEDs) decrease the occurrence of epileptic seizures and modulate cortical excitability through several mechanisms that likely interact. The modulation of brain excitability by AEDs is believed to reflect their antiepileptic action(s) and could be used as a surrogate marker of their efficacy. Transcranial magnetic stimulation (TMS) is one of the best noninvasive methods to study cortical excitability in human subjects. Specific TMS parameters can be used to quantify the various mechanisms of action of AEDs. A new AED called retigabine increases potassium efflux by changing the conformation of KCNQ 2-5 potassium channels, which leads to neuronal hyperpolarisation and a decrease in excitability. HYPOTHESIS The purpose of this study is to investigate the effect of retigabine on cortical excitability. Based on the known mechanisms of action of retigabine, we hypothesized that the oral intake of retigabine would increase the resting motor threshold (RMT). METHODS Fifteen healthy individuals participated in a placebo-controlled, double-blind, randomised, clinical trial (RCT). The primary outcome measure was the RMT quantified before and after oral intake of retigabine. Several secondary TMS outcome measures were acquired. RESULTS The mean RMT, active motor threshold (AMT) and intensity to obtain a 1mV peak-to-peak amplitude potential (SI1mV) were significantly increased after retigabine intake compared to placebo (RMT: P=0.039; AMT: P=0.014; SI1mV: P=0.019). No significant differences were found for short-interval intracortical inhibition/intracortical facilitation (SICI/ICF), long-interval intracortical inhibition (LICI) or short-interval intracortical facilitation (SICF). CONCLUSION A single dose of retigabine increased the RMT, AMT and S1mV in healthy individuals. No modulating intracortical facilitation or inhibition was observed. This study provides the first in vivo demonstration of the modulating effects of retigabine on the excitability of the human brain, and the results are consistent with the data showing that retigabine hyperpolarizes neurons mainly by increasing potassium conductance.
Collapse
Affiliation(s)
- Michel Ossemann
- Université catholique de Louvain (UCL), CHU UCL Namur, Department of Neurology, Avenue Dr G. Thérasse, B5530 Yvoir, Belgium; Université catholique de Louvain (UCL), Institute of NeuroSciences (IoNS), Avenue Hippocrate, 54 Bte 54.10, 1200 Brussels, Belgium.
| | - Katalin de Fays
- Université catholique de Louvain (UCL), CHU UCL Namur, Department of Neurology, Avenue Dr G. Thérasse, B5530 Yvoir, Belgium; Université catholique de Louvain (UCL), Institute of NeuroSciences (IoNS), Avenue Hippocrate, 54 Bte 54.10, 1200 Brussels, Belgium
| | - Benoit Bihin
- Université catholique de Louvain (UCL), CHU UCL Namur, Scientific Support Unit Avenue Dr G. Thérasse, 5530 Yvoir, Belgium
| | - Yves Vandermeeren
- Université catholique de Louvain (UCL), CHU UCL Namur, Department of Neurology, Avenue Dr G. Thérasse, B5530 Yvoir, Belgium; Université catholique de Louvain (UCL), Institute of NeuroSciences (IoNS), Avenue Hippocrate, 54 Bte 54.10, 1200 Brussels, Belgium
| |
Collapse
|
11
|
Vidal-Dourado M, Nunes KF, Guaranha MSB, Giuliano LMP, Yacubian EMT, Manzano GM. Expression of praxis induction on cortical excitability in juvenile myoclonic epilepsy. Clin Neurophysiol 2016; 127:2551-60. [PMID: 27291873 DOI: 10.1016/j.clinph.2016.03.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 03/23/2016] [Accepted: 03/25/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to evaluate the effects of praxis induction on sensorimotor cortical and transcallosal excitability in juvenile myoclonic epilepsy (JME). METHODS A total of 36 subjects (18-62years) were included. The JME group was screened by video-electroencephalography neuropsychological protocol and divided into JME without praxis induction [JME-WI (n=12)], JME with praxis-induced seizures or epileptiform discharges [JME-PI (n=10)], and healthy controls (n=14). Motor and somatosensory cortical excitability and transcallosal pathways were evaluated through single-pulse transcranial magnetic stimulation (sTMS) and somatosensory evoked potentials (SEPs). RESULTS Motor and transcallosal excitabilities tested with sTMS were not different in the motor-dominant or non-dominant hemisphere among groups. Significant differences were found in cortical SEP amplitudes in the P27 component of the non-dominant hemisphere (p=0.03, Cohen's d=0.98), N35 in the dominant hemisphere (p=0.04, Cohen's d=0.96), and P27-35 interpeak amplitude in both somatosensory cortices of the JME-PI group (p=0.03, Cohen's d=0.96; p=0.02, Cohen's d=1.05) when compared with healthy controls. Giant SEPs were observed in two (16.7%) and five (50%) patients of the JME-WI and JME-PI groups, respectively. Cortical latencies did not reveal differences. CONCLUSIONS Praxis induction was associated with enhanced excitability in the somatosensory cortex of JME patients. SIGNIFICANCE These findings may help clarifying the less favorable therapeutic response in the JME-PI group and indicate identifying praxis induction as an important determinant in differentiating between JME patients.
Collapse
Affiliation(s)
- Marcos Vidal-Dourado
- Department of Neurology and Neurosurgery, Division of Neurology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
| | - Karlo Faria Nunes
- Department of Neurology and Neurosurgery, Division of Neurology, Section of Clinical Neurophysiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | | | - Lydia Maria Pereira Giuliano
- Department of Neurology and Neurosurgery, Division of Neurology, Section of Clinical Neurophysiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Elza Márcia Targas Yacubian
- Department of Neurology and Neurosurgery, Division of Neurology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Gilberto Mastrocola Manzano
- Department of Neurology and Neurosurgery, Division of Neurology, Section of Clinical Neurophysiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| |
Collapse
|
12
|
Strigaro G, Falletta L, Varrasi C, Rothwell JC, Cantello R. Overactive visuomotor connections underlie the photoparoxysmal response. A TMS study. Epilepsia 2015; 56:1828-35. [DOI: 10.1111/epi.13190] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Gionata Strigaro
- Department of Translational Medicine; Section of Neurology; University of Piemonte Orientale; Novara Italy
| | - Lina Falletta
- Department of Translational Medicine; Section of Neurology; University of Piemonte Orientale; Novara Italy
| | - Claudia Varrasi
- Department of Translational Medicine; Section of Neurology; University of Piemonte Orientale; Novara Italy
| | - John C. Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders; University College London Institute of Neurology; London United Kingdom
| | - Roberto Cantello
- Department of Translational Medicine; Section of Neurology; University of Piemonte Orientale; Novara Italy
| |
Collapse
|
13
|
Cincotta M, Giovannelli F, Borgheresi A, Tramacere L, Viggiano MP, Zaccara G. A Meta-analysis of the Cortical Silent Period in Epilepsies. Brain Stimul 2015; 8:693-701. [PMID: 25981158 DOI: 10.1016/j.brs.2015.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 03/24/2015] [Accepted: 04/19/2015] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The cortical silent period (CSP) following transcranial magnetic stimulation reflects GABAB-mediated inhibition in the primary motor cortex (M1) and could contribute to understand the pathophysiological substrates of epileptic conditions. Increased CSP duration has been reported in idiopathic generalized epilepsy (IGE) and in partial epilepsy (PE) involving the M1, although other studies yielded discordant findings. We used meta-analysis to systematically assess the consistency of CSP changes in untreated patients with epilepsies. METHODS Databases were searched for controlled studies evaluating the CSP in drug-naïve or drug-free patients with IGE or PE. For each study, the mean difference with 95% confidence intervals (CIs) between CSP duration obtained in patients and controls was calculated. The effect of motor threshold (MT) on the CSP duration has also been explored by meta-analysis and meta-regression. RESULTS Fourteen studies (267 patients and 234 controls) were included. A significant mean difference (14.16 ms, 95% CI, 1.20, 27.11 ms) was found, with longer CSP in patients than in controls. The mean difference was still greater (18.05 ms) if only the 202 IGE patients were analyzed. No MT difference emerged between patients and controls. Meta-regression showed no relationship between MT and CSP duration. CONCLUSION Meta-analysis confirms CSP modifications in epilepsies, with enhancement of this cortical inhibitory measure at least in most IGE patients. This provides rationale for further investigations aiming to verify the hypotheses that increased CSP reflects compensatory neural phenomena counteracting transition from the interictal to ictal state and that CSP variability reflects the pathophysiological heterogeneity of epileptic syndromes.
Collapse
Affiliation(s)
- Massimo Cincotta
- Unit of Neurology, Azienda Sanitaria di Firenze, Florence, Italy.
| | - Fabio Giovannelli
- Unit of Neurology, Azienda Sanitaria di Firenze, Florence, Italy; Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | | | | | - Maria Pia Viggiano
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Gaetano Zaccara
- Unit of Neurology, Azienda Sanitaria di Firenze, Florence, Italy
| |
Collapse
|
14
|
Hsu WY, Kuo YF, Liao KK, Yu HY, Lin YY. Widespread inter-ictal excitability changes in patients with temporal lobe epilepsy: A TMS/MEG study. Epilepsy Res 2015; 111:61-71. [DOI: 10.1016/j.eplepsyres.2015.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 12/31/2014] [Accepted: 01/18/2015] [Indexed: 11/15/2022]
|
15
|
Ziemann U, Reis J, Schwenkreis P, Rosanova M, Strafella A, Badawy R, Müller-Dahlhaus F. TMS and drugs revisited 2014. Clin Neurophysiol 2014; 126:1847-68. [PMID: 25534482 DOI: 10.1016/j.clinph.2014.08.028] [Citation(s) in RCA: 450] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 08/03/2014] [Accepted: 08/24/2014] [Indexed: 12/18/2022]
Abstract
The combination of pharmacology and transcranial magnetic stimulation to study the effects of drugs on TMS-evoked EMG responses (pharmaco-TMS-EMG) has considerably improved our understanding of the effects of TMS on the human brain. Ten years have elapsed since an influential review on this topic has been published in this journal (Ziemann, 2004). Since then, several major developments have taken place: TMS has been combined with EEG to measure TMS evoked responses directly from brain activity rather than by motor evoked potentials in a muscle, and pharmacological characterization of the TMS-evoked EEG potentials, although still in its infancy, has started (pharmaco-TMS-EEG). Furthermore, the knowledge from pharmaco-TMS-EMG that has been primarily obtained in healthy subjects is now applied to clinical settings, for instance, to monitor or even predict clinical drug responses in neurological or psychiatric patients. Finally, pharmaco-TMS-EMG has been applied to understand the effects of CNS active drugs on non-invasive brain stimulation induced long-term potentiation-like and long-term depression-like plasticity. This is a new field that may help to develop rationales of pharmacological treatment for enhancement of recovery and re-learning after CNS lesions. This up-dated review will highlight important knowledge and recent advances in the contribution of pharmaco-TMS-EMG and pharmaco-TMS-EEG to our understanding of normal and dysfunctional excitability, connectivity and plasticity of the human brain.
Collapse
Affiliation(s)
- Ulf Ziemann
- Department of Neurology & Stroke, and Hertie Institute for Clinical Brain Research, Eberhard-Karls-University Tübingen, Tübingen, Germany.
| | - Janine Reis
- Department of Neurology, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Peter Schwenkreis
- Department of Neurology, BG-University Hospital Bergmannsheil Bochum, Bochum, Germany
| | - Mario Rosanova
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy; Fondazione Europea di Ricerca Biomedica, FERB Onlus, Milan, Italy
| | - Antonio Strafella
- Morton and Gloria Shulman Movement Disorder Unit & E.J. Safra Parkinson Disease Program, Toronto Western Hospital, UHN, University of Toronto, Ontario, Canada; Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada
| | - Radwa Badawy
- Department of Neurology, Saint Vincent's Hospital, Fitzroy, The University of Melbourne, Parkville, Victoria, Australia; Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Florian Müller-Dahlhaus
- Department of Neurology & Stroke, and Hertie Institute for Clinical Brain Research, Eberhard-Karls-University Tübingen, Tübingen, Germany
| |
Collapse
|
16
|
Brain Stimulation for Epilepsy – Local and Remote Modulation of Network Excitability. Brain Stimul 2014; 7:350-8. [DOI: 10.1016/j.brs.2014.02.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 01/28/2014] [Accepted: 02/05/2014] [Indexed: 01/13/2023] Open
|
17
|
Pallanti S, Grassi G, Antonini S, Quercioli L, Salvadori E, Hollander E. rTMS in resistant mixed states: an exploratory study. J Affect Disord 2014; 157:66-71. [PMID: 24581830 DOI: 10.1016/j.jad.2013.12.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 12/12/2013] [Accepted: 12/13/2013] [Indexed: 01/21/2023]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) has shown efficacy in resistant unipolar depression, but its efficacy in bipolar disorders has not yet been extensively investigated. Mixed episodes are reported in up to 40% of acute bipolar admissions and are associated with severe psychopathology, comorbidity, high risk of suicide and poor treatment response. Right low-frequency rTMS (LF-rTMS) as an augmentation treatment might be effective for mixed states. METHODS Forty patients were treated during a 4-week period with a mood stabilizer and subsequent rTMS (low frequency stimulation - 1Hz - applied to the right Dorso-Lateral Prefrontal Cortex (DLPFC)) as add-on treatment for 3 weeks. Response to LF-rTMS was assessed by the Hamilton Depression Rating Scale (HAM-D), the Young Mania Rating Scale (YMRS) and the Clinical Global Impressions-Bipolar Version (CGIBP) subscales. ANOVA with repeated measures performed on HAM-D, YMRS and CGI-BP subscales "change from the preceding phase" and "severity of illness" showed a statistically significant time effect from the baseline to the endpoint. RESULTS For the HAM-D there was a 46.6% responder rate, of which 28.6% was remitted, while for the YMRS there was a 15% responder rate, all of which was remitted. LIMITATIONS The open label-design of our study and the lack of a sham-controlled group represent a methodological limitation. CONCLUSIONS The results suggest that LF-rTMS on the right DLFC might be a potential augmentation strategy in the treatment of both depressive and manic symptoms in mixed states.
Collapse
Affiliation(s)
- Stefano Pallanti
- Department of Psychiatry and Behavioral Medicine, University of California, Davis, USA; Department of Neurofarba, University of Florence, Via delle Gore 2H, 50100 Florence, Italy; Institute of Neuroscience, Florence, Italy; Deprtament of Psychiatry, Icahn School of Medicine, NY, USA.
| | - Giacomo Grassi
- Department of Neurofarba, University of Florence, Via delle Gore 2H, 50100 Florence, Italy
| | | | | | - Emilia Salvadori
- Department of Neurofarba, University of Florence, Via delle Gore 2H, 50100 Florence, Italy
| | - Eric Hollander
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, NY, USA
| |
Collapse
|
18
|
TMS, cortical excitability and epilepsy: The clinical impact. Epilepsy Res 2014; 108:153-61. [DOI: 10.1016/j.eplepsyres.2013.11.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 10/22/2013] [Accepted: 11/12/2013] [Indexed: 01/07/2023]
|
19
|
BAUER PRISCAR, KALITZIN STILIYAN, ZIJLMANS MAEIKE, SANDER JOSEMIRW, VISSER GERHARDH. CORTICAL EXCITABILITY AS A POTENTIAL CLINICAL MARKER OF EPILEPSY: A REVIEW OF THE CLINICAL APPLICATION OF TRANSCRANIAL MAGNETIC STIMULATION. Int J Neural Syst 2014; 24:1430001. [DOI: 10.1142/s0129065714300010] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Transcranial magnetic stimulation (TMS) can be used for safe, noninvasive probing of cortical excitability (CE). We review 50 studies that measured CE in people with epilepsy. Most showed cortical hyperexcitability, which can be corrected with anti-epileptic drug treatment. Several studies showed that decrease of CE after epilepsy surgery is predictive of good seizure outcome. CE is a potential biomarker for epilepsy. Clinical application may include outcome prediction of drug treatment and epilepsy surgery.
Collapse
Affiliation(s)
- PRISCA R. BAUER
- SEIN - Epilepsy Institute in the Netherlands Foundation, Heemstede, The Netherlands, P.O. Box 540, 2130 AM Hoofddorp, The Netherlands
| | - STILIYAN KALITZIN
- SEIN - Epilepsy Institute in the Netherlands Foundation, Heemstede, The Netherlands, P.O. Box 540, 2130 AM Hoofddorp, The Netherlands
| | - MAEIKE ZIJLMANS
- SEIN - Epilepsy Institute in the Netherlands Foundation, Heemstede, The Netherlands, P.O. Box 540, 2130 AM Hoofddorp, The Netherlands
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - JOSEMIR W. SANDER
- SEIN - Epilepsy Institute in the Netherlands Foundation, Heemstede, The Netherlands, P.O. Box 540, 2130 AM Hoofddorp, The Netherlands
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom
- Epilepsy Society, Chalfont St Peter, SL9 0RJ, United Kingdom
| | - GERHARD H. VISSER
- SEIN - Epilepsy Institute in the Netherlands Foundation, Heemstede, The Netherlands, P.O. Box 540, 2130 AM Hoofddorp, The Netherlands
| |
Collapse
|
20
|
Danner N, Julkunen P, Hyppönen J, Niskanen E, Säisänen L, Könönen M, Koskenkorva P, Vanninen R, Kälviäinen R, Mervaala E. Alterations of motor cortical excitability and anatomy in Unverricht-Lundborg disease. Mov Disord 2013; 28:1860-7. [DOI: 10.1002/mds.25615] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 06/08/2013] [Accepted: 06/25/2013] [Indexed: 11/09/2022] Open
Affiliation(s)
- Nils Danner
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences; University of Eastern Finland; Kuopio Finland
- Department of Clinical Neurophysiology; Kuopio University Hospital; Kuopio Finland
| | - Petro Julkunen
- Department of Clinical Neurophysiology; Kuopio University Hospital; Kuopio Finland
| | - Jelena Hyppönen
- Department of Clinical Neurophysiology; Kuopio University Hospital; Kuopio Finland
| | - Eini Niskanen
- Department of Clinical Radiology; Kuopio University Hospital; Kuopio Finland
- Department of Applied Physics; University of Eastern Finland; Kuopio Finland
| | - Laura Säisänen
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences; University of Eastern Finland; Kuopio Finland
- Department of Clinical Neurophysiology; Kuopio University Hospital; Kuopio Finland
| | - Mervi Könönen
- Department of Clinical Neurophysiology; Kuopio University Hospital; Kuopio Finland
- Department of Clinical Radiology; Kuopio University Hospital; Kuopio Finland
| | - Päivi Koskenkorva
- Department of Clinical Radiology; Kuopio University Hospital; Kuopio Finland
| | - Ritva Vanninen
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences; University of Eastern Finland; Kuopio Finland
- Department of Clinical Radiology; Kuopio University Hospital; Kuopio Finland
| | - Reetta Kälviäinen
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences; University of Eastern Finland; Kuopio Finland
- Department of Neurology; Kuopio University Hospital; Kuopio Finland
| | - Esa Mervaala
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences; University of Eastern Finland; Kuopio Finland
- Department of Clinical Neurophysiology; Kuopio University Hospital; Kuopio Finland
| |
Collapse
|
21
|
Spampinato C, Aguglia E, Concerto C, Pennisi M, Lanza G, Bella R, Cantone M, Pennisi G, Kavasidis I, Giordano D. Transcranial magnetic stimulation in the assessment of motor cortex excitability and treatment of drug-resistant major depression. IEEE Trans Neural Syst Rehabil Eng 2013; 21:391-403. [PMID: 23559064 DOI: 10.1109/tnsre.2013.2256432] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Major depression is one of the leading causes of disabling condition worldwide and its treatment is often challenging and unsatisfactory, since many patients become refractory to pharmacological therapies. Transcranial magnetic stimulation (TMS) is a noninvasive neurophysiological investigation mainly used to study the integrity of the primary motor cortex excitability and of the cortico-spinal tract. The development of paired-pulse and repetitive TMS (rTMS) paradigms has allowed investigators to explore the pathophysiology of depressive disorders and other neuropsychiatric diseases linked to brain excitability dysfunctions. Repetitive transcranial magnetic stimulation has also therapeutic and rehabilitative capabilities since it is able to induce changes in the excitability of inhibitory and excitatory neuronal networks that may persist in time. However, the therapeutic effects of rTMS on major depression have been demonstrated by analyzing only the improvement of neuropsychological performance. The aim of this study was to investigate cortical excitability changes on 12 chronically-medicated depressed patients (test group) after rTMS treatment and to correlate neurophysiological findings to neuropsychological outcomes. In detail, we assessed different parameters of cortical excitability before and after active rTMS in the test group, then compared to those of 10 age-matched depressed patients (control group) who underwent sham rTMS. In line with previous studies, at baseline both groups exhibited a significant interhemispheric difference of motor cortex excitability. This neurophysiological imbalance was then reduced in the patients treated with active rTMS, resulting also in a clinical benefit as demonstrated by the improvement in neuropsychological test scores. On the contrary, after sham rTMS, the interhemispheric difference was still evident in the control group. The reported clinical benefits in the test group might be related to the plastic remodeling of synaptic connection induced by rTMS treatment.
Collapse
Affiliation(s)
- C Spampinato
- Department of Electrical, Electronic and Computer Engineering, University of Catania, 95125 Catania, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Brigo F, Storti M, Benedetti MD, Rossini F, Nardone R, Tezzon F, Fiaschi A, Bongiovanni LG, Manganotti P. Resting motor threshold in idiopathic generalized epilepsies: a systematic review with meta-analysis. Epilepsy Res 2012; 101:3-13. [PMID: 22542570 DOI: 10.1016/j.eplepsyres.2012.03.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 03/13/2012] [Accepted: 03/28/2012] [Indexed: 12/24/2022]
Abstract
Resting motor threshold (rMT) assessed by means of Transcranial Magnetic Stimulation (TMS) is thought to reflect trans-synaptic excitability of cortico-spinal neurons. TMS studies reporting rMT in idiopathic generalized epilepsies (IGEs) yielded discrepant results, so that it is difficult to draw a definitive conclusion on cortico-spinal excitability in IGEs by simple summation of previous results regarding this measure. Our purpose was to carry out a systematic review and a meta-analysis of studies evaluating rMT values obtained during single-pulse TMS in patients with IGEs. Controlled studies measuring rMT by single-pulse TMS in drug-naive patients older than 12 years affected by IGEs were systematically reviewed. rMT values were assessed calculating mean difference and odds ratio with 95% confidence intervals (CI). Fourteen trials (265 epileptic patients and 424 controls) were included. Patients with juvenile myoclonic epilepsy (JME) have a statistically significant lower rMT compared with controls (mean difference: -6.78; 95% CI -10.55 to -3.00); when considering all subtypes of IGEs and IGEs other than JME no statistically significant differences were found. Overall considered, the results are indicative of a cortico-spinal hyper-excitability in JME, providing not enough evidence for motor hyper-excitability in other subtypes of IGE. The considerable variability across studies probably reflects the presence of relevant clinical and methodological heterogeneity, and higher temporal variability among rMT measurements over time, related to unstable cortical excitability in these patients.
Collapse
Affiliation(s)
- Francesco Brigo
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences, Section of Clinical Neurology, University of Verona, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Kikuchi T, Matsumoto R, Mikuni N, Yokoyama Y, Matsumoto A, Ikeda A, Fukuyama H, Miyamoto S, Hashimoto N. Asymmetric bilateral effect of the supplementary motor area proper in the human motor system. Clin Neurophysiol 2012; 123:324-34. [DOI: 10.1016/j.clinph.2011.06.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Revised: 05/28/2011] [Accepted: 06/11/2011] [Indexed: 12/01/2022]
|
24
|
Re: Modulation of human motor cortex excitability by valproate. Psychopharmacology (Berl) 2011; 216:145-6. [PMID: 21336578 DOI: 10.1007/s00213-011-2195-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 01/17/2011] [Indexed: 10/18/2022]
|
25
|
Danner N, Säisänen L, Määttä S, Julkunen P, Hukkanen T, Könönen M, Hyppönen J, Kälviäinen R, Mervaala E. Motor cortical plasticity is impaired in Unverricht-Lundborg disease. Mov Disord 2011; 26:2095-100. [DOI: 10.1002/mds.23813] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 04/01/2011] [Accepted: 05/08/2011] [Indexed: 01/07/2023] Open
|
26
|
Hanajima R, Terao Y, Nakatani-Enomoto S, Okabe S, Shirota Y, Oominami S, Matsumoto H, Tsuji S, Ugawa Y. Triad stimulation frequency for cortical facilitation in cortical myoclonus. Mov Disord 2011; 26:685-90. [PMID: 21328618 DOI: 10.1002/mds.23539] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 10/21/2010] [Accepted: 10/25/2010] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Abnormally enhanced cortical rhythmic activities have been reported in patients with cortical myoclonus. We recently reported a new triad-conditioning transcranial magnetic stimulation (TMS) method to detect the intrinsic rhythms of the primary motor cortex (M1). Triad-conditioning TMS revealed a 40-Hz intrinsic rhythm of M1 in normal subjects. In this investigation, we study the motor cortical facilitation induced by rhythmic triple TMS pulses (triad-conditioning TMS) in patients with cortical myoclonus. METHODS Subjects were 7 patients with cortical myoclonus (28-74 years old) and 13 healthy volunteers (30-71 years old). Three conditioning stimuli over M1 at the intensity of 110% active motor threshold preceded the test TMS at various interstimulus intervals corresponding to 10-200 Hz. The resulting amplitudes of conditioned motor evoked potentials recorded from the contralateral hand muscle were compared with those evoked by the test stimulus alone. RESULTS The facilitation at 25 ms (40 Hz) observed in normal subjects was absent in patients with cortical myoclonus. Instead, triad-conditioning TMS induced facilitation at a 40 ms interval (25 Hz) in cortical myoclonus. DISCUSSIONS This change in the timing of facilitation may be explained by a shift of the most preferential intrinsic rhythm of M1, or by some dysfunction in the interneuronal network in cortical myoclonus.
Collapse
Affiliation(s)
- R Hanajima
- Department of Neurology, Division of Neuroscience, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Primary motor cortex alterations in a compound heterozygous form of Unverricht–Lundborg disease (EPM1). Seizure 2011; 20:65-71. [DOI: 10.1016/j.seizure.2010.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 10/07/2010] [Accepted: 10/15/2010] [Indexed: 11/22/2022] Open
|
28
|
Badawy RAB, Macdonell RAL, Berkovic SF, Newton MR, Jackson GD. Predicting seizure control: Cortical excitability and antiepileptic medication. Ann Neurol 2010; 67:64-73. [DOI: 10.1002/ana.21806] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
29
|
Palermo A, Fierro B, Giglia G, Cosentino G, Puma AR, Brighina F. Modulation of visual cortex excitability in migraine with aura: Effects of valproate therapy. Neurosci Lett 2009; 467:26-9. [DOI: 10.1016/j.neulet.2009.09.054] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 09/03/2009] [Accepted: 09/27/2009] [Indexed: 10/20/2022]
|
30
|
Altered cortical inhibition in Unverricht–Lundborg type progressive myoclonus epilepsy (EPM1). Epilepsy Res 2009; 85:81-8. [DOI: 10.1016/j.eplepsyres.2009.02.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Revised: 02/14/2009] [Accepted: 02/16/2009] [Indexed: 11/20/2022]
|
31
|
Lamotrigine and valproic acid have different effects on motorcortical neuronal excitability. J Neural Transm (Vienna) 2009; 116:423-9. [PMID: 19238517 DOI: 10.1007/s00702-009-0195-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2008] [Accepted: 02/03/2009] [Indexed: 10/21/2022]
Abstract
To investigate different cortical effects of lamotrigine and valproic acid, 30 paid healthy adult men were given, in a randomized/blinded fashion on three separate days (separated by a week), either a single dose of lamotrigine 325 mg, or a single dose of valproic acid 1,250 mg, or placebo. Resting motor threshold (RMT), cortical silent period (CSP) and motor evoked potential recruitment curves (RC) were assessed at baseline and 3 h after administration of each medication (or placebo). Lamotrigine caused a significant increase (63.32 vs. 69.25) in the RMT, compared with an insignificant increase following valproic acid (62.50 vs. 63.35), and a decrease (62.60 vs. 62.36) following placebo (F (2,26) = 18.58, P < 0.0001). No significant difference in CSP was found between placebo and drugs (F (2,26) = 0.119, P > 0.05). RCs were significantly suppressed by lamotrigine (t = 2.07, P < 0.05) and enhanced by valproic acid (t = 2.39, P < 0.05). Lamotrigine and valproic acid have different effects on cortical neuronal excitability as demonstrated by TMS.
Collapse
|
32
|
Paulus W, Classen J, Cohen LG, Large CH, Di Lazzaro V, Nitsche M, Pascual-Leone A, Rosenow F, Rothwell JC, Ziemann U. State of the art: Pharmacologic effects on cortical excitability measures tested by transcranial magnetic stimulation. Brain Stimul 2008; 1:151-63. [PMID: 20633382 DOI: 10.1016/j.brs.2008.06.002] [Citation(s) in RCA: 309] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Revised: 06/02/2008] [Accepted: 06/06/2008] [Indexed: 11/19/2022] Open
Abstract
The combination of brain stimulation techniques like transcranial magnetic stimulation (TMS) with CNS active drugs in humans now offers a unique opportunity to explore the physiologic effects of these substances in vivo in the human brain. Motor threshold, motor evoked potential size, motor evoked potential intensity curves, cortical silent period, short-interval intracortical inhibition, intracortical facilitation, short-interval intracortical facilitation, long-interval intracortical inhibition and short latency afferent inhibition represent the repertoire for investigating drug effects on motor cortical excitability by TMS. Here we present an updated overview on the pharmacophysiologic mechanisms with special emphasis on methodologic pitfalls and possible future developments or requirements.
Collapse
Affiliation(s)
- Walter Paulus
- Department of Clinical Neurophysiology, University of Göttingen, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Huang YZ, Lai SC, Lu CS, Weng YH, Chuang WL, Chen RS. Abnormal cortical excitability with preserved brainstem and spinal reflexes in sialidosis type I. Clin Neurophysiol 2008; 119:1042-50. [PMID: 18343720 DOI: 10.1016/j.clinph.2008.01.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2007] [Revised: 01/14/2008] [Accepted: 01/28/2008] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine neurophysiological evidence of functional involvement of the brainstem and spinal cord and motor cortical excitability in sialidosis type I, a rare inherited neurodegenerative disorder caused by mutations in the NEU1 gene. METHODS We investigated particular pathways in the brainstem, spinal cord and motor cortex in 12 genetically proven cases of sialidosis type I by assessing blink reflex recovery cycle (BR), spinal reciprocal inhibition (RI), input-output curves (I/O), short interval intracortical inhibition (SICI), intracortical facilitation (ICF) and silent period (SP). RESULTS The BR and RI were normal. The slope of I/O was significantly increased, and SICI and the duration of SP were reduced in sialidosis patients. CONCLUSIONS Despite reports of pathology involving brainstem and anterior horn neurones, there were no obvious abnormalities in spinal and brainstem reflexes in the present patients, suggesting that the major clinical effects may be caused by changes at a level above the brainstem. SIGNIFICANCE For the first time, the integrity of certain brainstem and spinal cord reflexes in addition to motor cortical facilitatory and inhibitory circuits has been assessed in genetically proven type I sialidosis. This provides new data to aid in understanding of the pathophysiology of motor system dysfunction in this condition.
Collapse
Affiliation(s)
- Ying-Zu Huang
- Department of Neurology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 199, Dunhwa North Road, Taipei 10507, Taiwan
| | | | | | | | | | | |
Collapse
|
34
|
Matsumoto Y, Motoki T, Kubota S, Takigawa M, Tsubouchi H, Gohda E. Inhibition of tumor-stromal interaction through HGF/Met signaling by valproic acid. Biochem Biophys Res Commun 2007; 366:110-6. [PMID: 18053801 DOI: 10.1016/j.bbrc.2007.11.089] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Accepted: 11/19/2007] [Indexed: 11/18/2022]
Abstract
Hepatocyte growth factor (HGF), which is produced by surrounding stromal cells, including fibroblasts and endothelial cells, has been shown to be a significant factor responsible for cancer cell invasion mediated by tumor-stromal interactions. We found in this study that the anti-tumor agent valproic acid (VPA), a histone deacetylase (HDAC) inhibitor, strongly inhibited tumor-stromal interaction. VPA inhibited HGF production in fibroblasts induced by epidermal growth factor (EGF), platelet-derived growth factor, basic fibroblast growth factor, phorbol 12-myristate 13-acetate (PMA) and prostaglandin E(2) without any appreciable cytotoxic effect. Other HDAC inhibitors, including butyric acid and trichostatin A (TSA), showed similar inhibitory effects on HGF production stimulated by various inducers. Up-regulations of HGF gene expression induced by PMA and EGF were also suppressed by VPA and TSA. Furthermore, VPA significantly inhibited HGF-induced invasion of HepG2 hepatocellular carcinoma cells. VPA, however, did not affect the increases in phosphorylation of MAPK and Akt in HGF-treated HepG2 cells. These results demonstrated that VPA inhibited two critical processes of tumor-stromal interaction, induction of fibroblastic HGF production and HGF-induced invasion of HepG2 cells, and suggest that those activities serve for other anti-tumor mechanisms of VPA besides causing proliferation arrest, differentiation, and/or apoptosis of tumor cells.
Collapse
Affiliation(s)
- Yohsuke Matsumoto
- Department of Immunochemistry, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 1-1-1, Tsushima-naka, Okayama 700-8530, Japan
| | | | | | | | | | | |
Collapse
|