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Bao S, Kim H, Shettigar NB, Li Y, Lei Y. Personalized depth-specific neuromodulation of the human primary motor cortex via ultrasound. J Physiol 2024; 602:933-948. [PMID: 38358314 DOI: 10.1113/jp285613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/22/2024] [Indexed: 02/16/2024] Open
Abstract
Non-invasive brain stimulation has the potential to boost neuronal plasticity in the primary motor cortex (M1), but it remains unclear whether the stimulation of both superficial and deep layers of the human motor cortex can effectively promote M1 plasticity. Here, we leveraged transcranial ultrasound stimulation (TUS) to precisely target M1 circuits at depths of approximately 5 mm and 16 mm from the cortical surface. Initially, we generated computed tomography images from each participant's individual anatomical magnetic resonance images (MRI), which allowed for the generation of accurate acoustic simulations. This process ensured that personalized TUS was administered exactly to the targeted depths within M1 for each participant. Using long-term depression and long-term potentiation (LTD/LTP) theta-burst stimulation paradigms, we examined whether TUS over distinct depths of M1 could induce LTD/LTP plasticity. Our findings indicated that continuous theta-burst TUS-induced LTD-like plasticity with both superficial and deep M1 stimulation, persisting for at least 30 min. In comparison, sham TUS did not significantly alter M1 excitability. Moreover, intermittent theta-burst TUS did not result in the induction of LTP- or LTD-like plasticity with either superficial or deep M1 stimulation. These findings suggest that the induction of M1 plasticity can be achieved with ultrasound stimulation targeting distinct depths of M1, which is contingent on the characteristics of TUS. KEY POINTS: The study integrated personalized transcranial ultrasound stimulation (TUS) with electrophysiology to determine whether TUS targeting superficial and deep layers of the human motor cortex (M1) could elicit long-term depression (LTD) or long-term potentiation (LTP) plastic changes. Utilizing acoustic simulations derived from individualized pseudo-computed tomography scans, we ensured the precision of TUS delivery to the intended M1 depths for each participant. Continuous theta-burst TUS targeting both the superficial and deep layers of M1 resulted in the emergence of LTD-like plasticity, lasting for at least 30 min. Administering intermittent theta-burst TUS to both the superficial and deep layers of M1 did not lead to the induction of LTP- or LTD-like plastic changes. We suggest that theta-burst TUS targeting distinct depths of M1 can induce plasticity, but this effect is dependent on specific TUS parameters.
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Affiliation(s)
- Shancheng Bao
- Program of Motor Neuroscience, Department of Kinesiology & Sport Management, Texas A&M University, College Station, Texas, USA
| | - Hakjoo Kim
- Program of Motor Neuroscience, Department of Kinesiology & Sport Management, Texas A&M University, College Station, Texas, USA
| | - Nandan B Shettigar
- Program of Motor Neuroscience, Department of Kinesiology & Sport Management, Texas A&M University, College Station, Texas, USA
- Department of Mechanical Engineering, Texas A&M University, College Station, Texas, USA
| | - Yue Li
- Department of Neuroscience & Experimental Therapeutics, Texas A&M University, College Station, Texas, USA
| | - Yuming Lei
- Program of Motor Neuroscience, Department of Kinesiology & Sport Management, Texas A&M University, College Station, Texas, USA
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Wang Y, Huynh AT, Bao S, Buchanan JJ, Wright DL, Lei Y. Memory consolidation of sequence learning and dynamic adaptation during wakefulness. Cereb Cortex 2024; 34:bhad507. [PMID: 38185987 DOI: 10.1093/cercor/bhad507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 12/04/2023] [Accepted: 12/15/2023] [Indexed: 01/09/2024] Open
Abstract
Motor learning involves acquiring new movement sequences and adapting motor commands to novel conditions. Labile motor memories, acquired through sequence learning and dynamic adaptation, undergo a consolidation process during wakefulness after initial training. This process stabilizes the new memories, leading to long-term memory formation. However, it remains unclear if the consolidation processes underlying sequence learning and dynamic adaptation are independent and if distinct neural regions underpin memory consolidation associated with sequence learning and dynamic adaptation. Here, we first demonstrated that the initially labile memories formed during sequence learning and dynamic adaptation were stabilized against interference through time-dependent consolidation processes occurring during wakefulness. Furthermore, we found that sequence learning memory was not disrupted when immediately followed by dynamic adaptation and vice versa, indicating distinct mechanisms for sequence learning and dynamic adaptation consolidation. Finally, by applying patterned transcranial magnetic stimulation to selectively disrupt the activity in the primary motor (M1) or sensory (S1) cortices immediately after sequence learning or dynamic adaptation, we found that sequence learning consolidation depended on M1 but not S1, while dynamic adaptation consolidation relied on S1 but not M1. For the first time in a single experimental framework, this study revealed distinct neural underpinnings for sequence learning and dynamic adaptation consolidation during wakefulness, with significant implications for motor skill enhancement and rehabilitation.
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Affiliation(s)
- Yiyu Wang
- Program of Motor Neuroscience, Department of Kinesiology & Sport Management, Texas A&M University, College Station, TX 77843, United States
| | - Angelina T Huynh
- Program of Motor Neuroscience, Department of Kinesiology & Sport Management, Texas A&M University, College Station, TX 77843, United States
| | - Shancheng Bao
- Program of Motor Neuroscience, Department of Kinesiology & Sport Management, Texas A&M University, College Station, TX 77843, United States
| | - John J Buchanan
- Program of Motor Neuroscience, Department of Kinesiology & Sport Management, Texas A&M University, College Station, TX 77843, United States
| | - David L Wright
- Program of Motor Neuroscience, Department of Kinesiology & Sport Management, Texas A&M University, College Station, TX 77843, United States
| | - Yuming Lei
- Program of Motor Neuroscience, Department of Kinesiology & Sport Management, Texas A&M University, College Station, TX 77843, United States
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Lamanna J, Ferro M, Spadini S, Racchetti G, Malgaroli A. The Dysfunctional Mechanisms Throwing Tics: Structural and Functional Changes in Tourette Syndrome. Behav Sci (Basel) 2023; 13:668. [PMID: 37622808 PMCID: PMC10451670 DOI: 10.3390/bs13080668] [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: 07/11/2023] [Revised: 07/31/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023] Open
Abstract
Tourette Syndrome (TS) is a high-incidence multifactorial neuropsychiatric disorder characterized by motor and vocal tics co-occurring with several diverse comorbidities, including obsessive-compulsive disorder and attention-deficit hyperactivity disorder. The origin of TS is multifactorial, with strong genetic, perinatal, and immunological influences. Although almost all neurotransmettitorial systems have been implicated in TS pathophysiology, a comprehensive neurophysiological model explaining the dynamics of expression and inhibition of tics is still lacking. The genesis and maintenance of motor and non-motor aspects of TS are thought to arise from functional and/or structural modifications of the basal ganglia and related circuitry. This complex wiring involves several cortical and subcortical structures whose concerted activity controls the selection of the most appropriate reflexive and habitual motor, cognitive and emotional actions. Importantly, striatal circuits exhibit bidirectional forms of synaptic plasticity that differ in many respects from hippocampal and neocortical plasticity, including sensitivity to metaplastic molecules such as dopamine. Here, we review the available evidence about structural and functional anomalies in neural circuits which have been found in TS patients. Finally, considering what is known in the field of striatal plasticity, we discuss the role of exuberant plasticity in TS, including the prospect of future pharmacological and neuromodulation avenues.
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Affiliation(s)
- Jacopo Lamanna
- Center for Behavioral Neuroscience and Communication (BNC), Vita-Salute San Raffaele University, 20132 Milan, Italy
- Faculty of Psychology, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Mattia Ferro
- Center for Behavioral Neuroscience and Communication (BNC), Vita-Salute San Raffaele University, 20132 Milan, Italy
- Department of Psychology, Sigmund Freud University, 20143 Milan, Italy
| | - Sara Spadini
- Center for Behavioral Neuroscience and Communication (BNC), Vita-Salute San Raffaele University, 20132 Milan, Italy
- Division of Neuroscience, Scientific Institute Ospedale San Raffaele, 20132 Milan, Italy
| | - Gabriella Racchetti
- Division of Neuroscience, Scientific Institute Ospedale San Raffaele, 20132 Milan, Italy
| | - Antonio Malgaroli
- Center for Behavioral Neuroscience and Communication (BNC), Vita-Salute San Raffaele University, 20132 Milan, Italy
- Faculty of Psychology, Vita-Salute San Raffaele University, 20132 Milan, Italy
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Molecular Landscape of Tourette's Disorder. Int J Mol Sci 2023; 24:ijms24021428. [PMID: 36674940 PMCID: PMC9865021 DOI: 10.3390/ijms24021428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/29/2022] [Accepted: 01/01/2023] [Indexed: 01/12/2023] Open
Abstract
Tourette's disorder (TD) is a highly heritable childhood-onset neurodevelopmental disorder and is caused by a complex interplay of multiple genetic and environmental factors. Yet, the molecular mechanisms underlying the disorder remain largely elusive. In this study, we used the available omics data to compile a list of TD candidate genes, and we subsequently conducted tissue/cell type specificity and functional enrichment analyses of this list. Using genomic data, we also investigated genetic sharing between TD and blood and cerebrospinal fluid (CSF) metabolite levels. Lastly, we built a molecular landscape of TD through integrating the results from these analyses with an extensive literature search to identify the interactions between the TD candidate genes/proteins and metabolites. We found evidence for an enriched expression of the TD candidate genes in four brain regions and the pituitary. The functional enrichment analyses implicated two pathways ('cAMP-mediated signaling' and 'Endocannabinoid Neuronal Synapse Pathway') and multiple biological functions related to brain development and synaptic transmission in TD etiology. Furthermore, we found genetic sharing between TD and the blood and CSF levels of 39 metabolites. The landscape of TD not only provides insights into the (altered) molecular processes that underlie the disease but, through the identification of potential drug targets (such as FLT3, NAALAD2, CX3CL1-CX3CR1, OPRM1, and HRH2), it also yields clues for developing novel TD treatments.
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Kahl CK, Swansburg R, Hai T, Wrightson JG, Bell T, Lemay JF, Kirton A, MacMaster FP. Differences in neurometabolites and transcranial magnetic stimulation motor maps in children with attention-deficit/hyperactivity disorder. J Psychiatry Neurosci 2022; 47:E239-E249. [PMID: 35793906 PMCID: PMC9262400 DOI: 10.1503/jpn.210186] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/01/2022] [Accepted: 03/04/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Although much is known about cognitive dysfunction in attention-deficit/hyperactivity disorder (ADHD), few studies have examined the pathophysiology of disordered motor circuitry. We explored differences in neurometabolite levels and transcranial magnetic stimulation (TMS)-derived corticomotor representations among children with ADHD and typically developing children. METHODS We used magnetic resonance spectroscopy (MRS) protocols to measure excitatory (glutamate + glutamine [Glx]) and inhibitory (γ-aminobutyric acid [GABA]) neurometabolite levels in the dominant primary motor cortex (M1) and the supplementary motor area (SMA) in children with ADHD and typically developing children. We used robotic neuronavigated TMS to measure corticospinal excitability and create corticomotor maps. RESULTS We collected data from 26 medication-free children with ADHD (aged 7-16 years) and 25 typically developing children (11-16 years). Children with ADHD had lower M1 Glx (p = 0.044, d = 0.6); their mean resting motor threshold was lower (p = 0.029, d = 0.8); their map area was smaller (p = 0.044, d = 0.7); and their hotspot density was higher (p = 0.008, d = 0.9). M1 GABA levels were associated with motor map area (p = 0.036).Limitations: Some TMS data were lost because the threshold of some children exceeded 100% of the machine output. The relatively large MRS voxel required to obtain sufficient signal-to-noise ratio and reliably measure GABA levels encompassed tissue beyond the M1, making this measure less anatomically specific. CONCLUSION The neurochemistry and neurophysiology of key nodes in the motor network may be altered in children with ADHD, and the differences appear to be related to each other. These findings suggest potentially novel neuropharmacological and neuromodulatory targets for ADHD.
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Affiliation(s)
- Cynthia K Kahl
- From the Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kahl, Swansburg, MacMaster); the Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kahl, Swansburg, Lemay, Kirton, MacMaster); the Hotchkiss Brain Institute, University of Calgary, Calgary, Alta. (Kahl, Wrightson, Bell, Kirton, MacMaster); the Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alta. (Kahl, Bell, Kirton, MacMaster); the Department of Educational Psychology, University of Alberta, Edmonton, Alta. (Hai); the Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Bell); the Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kirton); and the Strategic Clinical Network for Addictions and Mental Health, Calgary, Alta. (MacMaster)
| | - Rose Swansburg
- From the Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kahl, Swansburg, MacMaster); the Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kahl, Swansburg, Lemay, Kirton, MacMaster); the Hotchkiss Brain Institute, University of Calgary, Calgary, Alta. (Kahl, Wrightson, Bell, Kirton, MacMaster); the Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alta. (Kahl, Bell, Kirton, MacMaster); the Department of Educational Psychology, University of Alberta, Edmonton, Alta. (Hai); the Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Bell); the Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kirton); and the Strategic Clinical Network for Addictions and Mental Health, Calgary, Alta. (MacMaster)
| | - Tasmia Hai
- From the Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kahl, Swansburg, MacMaster); the Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kahl, Swansburg, Lemay, Kirton, MacMaster); the Hotchkiss Brain Institute, University of Calgary, Calgary, Alta. (Kahl, Wrightson, Bell, Kirton, MacMaster); the Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alta. (Kahl, Bell, Kirton, MacMaster); the Department of Educational Psychology, University of Alberta, Edmonton, Alta. (Hai); the Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Bell); the Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kirton); and the Strategic Clinical Network for Addictions and Mental Health, Calgary, Alta. (MacMaster)
| | - James G Wrightson
- From the Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kahl, Swansburg, MacMaster); the Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kahl, Swansburg, Lemay, Kirton, MacMaster); the Hotchkiss Brain Institute, University of Calgary, Calgary, Alta. (Kahl, Wrightson, Bell, Kirton, MacMaster); the Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alta. (Kahl, Bell, Kirton, MacMaster); the Department of Educational Psychology, University of Alberta, Edmonton, Alta. (Hai); the Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Bell); the Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kirton); and the Strategic Clinical Network for Addictions and Mental Health, Calgary, Alta. (MacMaster)
| | - Tiffany Bell
- From the Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kahl, Swansburg, MacMaster); the Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kahl, Swansburg, Lemay, Kirton, MacMaster); the Hotchkiss Brain Institute, University of Calgary, Calgary, Alta. (Kahl, Wrightson, Bell, Kirton, MacMaster); the Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alta. (Kahl, Bell, Kirton, MacMaster); the Department of Educational Psychology, University of Alberta, Edmonton, Alta. (Hai); the Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Bell); the Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kirton); and the Strategic Clinical Network for Addictions and Mental Health, Calgary, Alta. (MacMaster)
| | - Jean-François Lemay
- From the Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kahl, Swansburg, MacMaster); the Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kahl, Swansburg, Lemay, Kirton, MacMaster); the Hotchkiss Brain Institute, University of Calgary, Calgary, Alta. (Kahl, Wrightson, Bell, Kirton, MacMaster); the Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alta. (Kahl, Bell, Kirton, MacMaster); the Department of Educational Psychology, University of Alberta, Edmonton, Alta. (Hai); the Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Bell); the Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kirton); and the Strategic Clinical Network for Addictions and Mental Health, Calgary, Alta. (MacMaster)
| | - Adam Kirton
- From the Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kahl, Swansburg, MacMaster); the Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kahl, Swansburg, Lemay, Kirton, MacMaster); the Hotchkiss Brain Institute, University of Calgary, Calgary, Alta. (Kahl, Wrightson, Bell, Kirton, MacMaster); the Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alta. (Kahl, Bell, Kirton, MacMaster); the Department of Educational Psychology, University of Alberta, Edmonton, Alta. (Hai); the Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Bell); the Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kirton); and the Strategic Clinical Network for Addictions and Mental Health, Calgary, Alta. (MacMaster)
| | - Frank P MacMaster
- From the Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kahl, Swansburg, MacMaster); the Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kahl, Swansburg, Lemay, Kirton, MacMaster); the Hotchkiss Brain Institute, University of Calgary, Calgary, Alta. (Kahl, Wrightson, Bell, Kirton, MacMaster); the Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alta. (Kahl, Bell, Kirton, MacMaster); the Department of Educational Psychology, University of Alberta, Edmonton, Alta. (Hai); the Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Bell); the Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Kirton); and the Strategic Clinical Network for Addictions and Mental Health, Calgary, Alta. (MacMaster)
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Elmaghraby R, Sun Q, Ozger C, Shekunov J, Romanowicz M, Croarkin PE. A Systematic Review of the Safety and Tolerability of Theta Burst Stimulation in Children and Adolescents. Neuromodulation 2022; 25:494-503. [PMID: 35670061 PMCID: PMC8617062 DOI: 10.1111/ner.13455] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/04/2021] [Accepted: 04/19/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Theta burst stimulation (TBS) is often used in clinical practice and research protocols for adults with neuropsychiatric disorders. There are substantial knowledge gaps related to the application of TBS in children and adolescents. This systematic review examined the safety and tolerability of TBS in children and adolescents. MATERIALS AND METHODS A systematic review of human TBS studies in children and adolescents was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following inclusion criteria were applied: 1) articles in English language only; 2) studies that included child and adolescent participants (up to 21 years of age); 3) studies that administered intermittent TBS or continuous TBS or both to participants; 4) studies that had an outcome measure; and 5) availability of full text material. The primary outcome measures were tolerability and safety. When feasible, the clinical effects were reviewed. RESULTS Twenty relevant articles met the criteria for inclusion. The reported adverse events were mild and similar to what is noted in adult studies. The most common symptom was headache. One case report described a seizure induced by TBS. Collectively, the studies were heterogeneous but the methodologic quality of randomized trials was high. CONCLUSIONS TBS interventions in children may have similar safety, tolerability, and feasibility as compared to adults. However, long-term, follow-up studies of TBS are lacking. Future dose-ranging studies with systematic assessment of adverse events will be important in the translation of findings with TBS from adults to youth.
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Affiliation(s)
- Rana Elmaghraby
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Qi Sun
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Can Ozger
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Julia Shekunov
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Magdalena Romanowicz
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
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Jannati A, Ryan MA, Kaye HL, Tsuboyama M, Rotenberg A. Biomarkers Obtained by Transcranial Magnetic Stimulation in Neurodevelopmental Disorders. J Clin Neurophysiol 2022; 39:135-148. [PMID: 34366399 PMCID: PMC8810902 DOI: 10.1097/wnp.0000000000000784] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
SUMMARY Transcranial magnetic stimulation (TMS) is a method for focal brain stimulation that is based on the principle of electromagnetic induction where small intracranial electric currents are generated by a powerful fluctuating magnetic field. Over the past three decades, TMS has shown promise in the diagnosis, monitoring, and treatment of neurological and psychiatric disorders in adults. However, the use of TMS in children has been more limited. We provide a brief introduction to the TMS technique; common TMS protocols including single-pulse TMS, paired-pulse TMS, paired associative stimulation, and repetitive TMS; and relevant TMS-derived neurophysiological measurements including resting and active motor threshold, cortical silent period, paired-pulse TMS measures of intracortical inhibition and facilitation, and plasticity metrics after repetitive TMS. We then discuss the biomarker applications of TMS in a few representative neurodevelopmental disorders including autism spectrum disorder, fragile X syndrome, attention-deficit hyperactivity disorder, Tourette syndrome, and developmental stuttering.
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Affiliation(s)
- Ali Jannati
- Neuromodulation Program and Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Mary A. Ryan
- Neuromodulation Program and Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Harper Lee Kaye
- Behavioral Neuroscience Program, Division of Medical Sciences, Boston University School of Medicine, Boston, USA
| | - Melissa Tsuboyama
- Neuromodulation Program and Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexander Rotenberg
- Neuromodulation Program and Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
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Pateraki G, Anargyros K, Aloizou AM, Siokas V, Bakirtzis C, Liampas I, Tsouris Z, Ziogka P, Sgantzos M, Folia V, Peristeri E, Dardiotis E. Therapeutic application of rTMS in neurodegenerative and movement disorders: A review. J Electromyogr Kinesiol 2021; 62:102622. [PMID: 34890834 DOI: 10.1016/j.jelekin.2021.102622] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 11/08/2021] [Accepted: 11/22/2021] [Indexed: 12/11/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) is a non-invasive form of brain stimulation that makes use of the magnetic field generated when an electric current passes through a magnetic coil placed over the scalp. It can be applied as a single stimulus at a time, in pairs of stimuli, or repetitively in trains of stimuli (repetitive TMS, rTMS). RTMS can induce changes in brain activity, whose after-effects reflect the processes of long-term potentiation and long-term depression, as certain protocols, namely those using low frequencies (≤1 Hz) seem to suppress cortical excitability, while those using high frequencies (>1 Hz) seem to enhance it. It is a technique with very few and mostly mild side-effects, whose effects can persist for long time periods, and as such, it has been studied as a potential treatment option in a multitude of neurodegenerative diseases, including those affecting movement. Although rTMS has received approval as a treatment strategy of only a few aspects in movement disorders in the latest guidelines, its further use seems to also be promising in their context. In this review, we gathered the available literature on the therapeutic application of rTMS in movement disorders, namely Parkinson's disease, Amyotrophic Lateral Sclerosis, Huntington's disease, Dystonia, Tic disorders and Essential Tremor.
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Affiliation(s)
- Georgia Pateraki
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Konstantinos Anargyros
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Athina-Maria Aloizou
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Vasileios Siokas
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Christos Bakirtzis
- B' Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Liampas
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Zisis Tsouris
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Pinelopi Ziogka
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Markos Sgantzos
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Vasiliki Folia
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Eleni Peristeri
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Efthimios Dardiotis
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece.
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Dyke K, Jackson G, Jackson S. Non-invasive brain stimulation as therapy: systematic review and recommendations with a focus on the treatment of Tourette syndrome. Exp Brain Res 2021; 240:341-363. [PMID: 34643763 PMCID: PMC8858270 DOI: 10.1007/s00221-021-06229-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 09/18/2021] [Indexed: 01/06/2023]
Abstract
Tourette syndrome (TS) is a neurodevelopmental condition characterised by tics, which are stereotyped movements and/or vocalisations. Tics often cause difficulties in daily life and many with TS express a desire to reduce and/or gain control over them. No singular effective treatment exists for TS, and while pharmacological and behavioural interventions can be effective, the results are variable, and issues relating to access, availability and side effects can be barriers to treatment. Consequently, over the past decade, there has been increasing interest into the potential benefits of non-invasive brain stimulation (NIBS) approaches. This systematic review highlights work exploring NIBS as a potential treatment for TS. On balance, the results tentatively suggest that multiple sessions of stimulation applied over the supplementary motor area (SMA) may help to reduce tics. However, a number of methodological and theoretical issues limit the strength of this conclusion, with the most problematic being the lack of large-scale sham-controlled studies. In this review, methodological and theoretical issues are discussed, unanswered questions highlighted and suggestions for future work put forward.
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Affiliation(s)
- Katherine Dyke
- School of Psychology, University of Nottingham, Nottingham, UK.
| | - Georgina Jackson
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK.,School of Medicine, The University of Nottingham, Nottingham, UK
| | - Stephen Jackson
- School of Psychology, University of Nottingham, Nottingham, UK.,Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
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10
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Marufa SA, Hsieh TH, Liou JC, Chen HY, Peng CW. Neuromodulatory effects of repetitive transcranial magnetic stimulation on neural plasticity and motor functions in rats with an incomplete spinal cord injury: A preliminary study. PLoS One 2021; 16:e0252965. [PMID: 34086836 PMCID: PMC8177618 DOI: 10.1371/journal.pone.0252965] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/26/2021] [Indexed: 11/18/2022] Open
Abstract
We investigated the effects of intermittent theta-burst stimulation (iTBS) on locomotor function, motor plasticity, and axonal regeneration in an animal model of incomplete spinal cord injury (SCI). Aneurysm clips with different compression forces were applied extradurally around the spinal cord at T10. Motor plasticity was evaluated by examining the motor evoked potentials (MEPs). Long-term iTBS treatment was given at the post-SCI 5th week and continued for 2 weeks (5 consecutive days/week). Time-course changes in locomotor function and the axonal regeneration level were measured by the Basso Beattie Bresnahan (BBB) scale, and growth-associated protein (GAP)-43 expression was detected in brain and spinal cord tissues. iTBS-induced potentiation was reduced at post-1-week SCI lesion and had recovered by 4 weeks post-SCI lesion, except in the severe group. Multiple sessions of iTBS treatment enhanced the motor plasticity in all SCI rats. The locomotor function revealed no significant changes between pre- and post-iTBS treatment in SCI rats. The GAP-43 expression level in the spinal cord increased following 2 weeks of iTBS treatment compared to the sham-treatment group. This preclinical model may provide a translational platform to further investigate therapeutic mechanisms of transcranial magnetic stimulation and enhance the possibility of the potential use of TMS with the iTBS scheme for treating SCIs.
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Affiliation(s)
- Siti Ainun Marufa
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
- Physical Therapy Department, Faculty of Health Science, University of Muhammadiyah Malang, Indonesia
| | - Tsung-Hsun Hsieh
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, Chang Gung University, Taoyuan, Taiwan
- Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Jian-Chiun Liou
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Hsin-Yung Chen
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Wei Peng
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
- International PhD Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan
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11
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Ganos C, Neumann WJ, Müller-Vahl KR, Bhatia KP, Hallett M, Haggard P, Rothwell J. The Phenomenon of Exquisite Motor Control in Tic Disorders and its Pathophysiological Implications. Mov Disord 2021; 36:1308-1315. [PMID: 33739492 DOI: 10.1002/mds.28557] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/21/2021] [Accepted: 02/16/2021] [Indexed: 12/28/2022] Open
Abstract
The unifying characteristic of movement disorders is the phenotypic presentation of abnormal motor outputs, either as isolated phenomena or in association with further clinical, often neuropsychiatric, features. However, the possibility of a movement disorder also characterized by supranormal or enhanced volitional motor control has not received attention. Based on clinical observations and cases collected over a number of years, we here describe the intriguing clinical phenomenon that people with tic disorders are often able to control specific muscle contractions as part of their tic behaviors to a degree that most humans typically cannot. Examples are given in accompanying video documentation. We explore medical literature on this topic and draw analogies with early research of fine motor control physiology in healthy humans. By systematically analyzing the probable sources of this unusual capacity, and focusing on neuroscientific accounts of voluntary motor control, sensory feedback, and the role of motor learning in tic disorders, we provide a novel pathophysiological account explaining both the presence of exquisite control over motor output and that of overall tic behaviors. We finally comment on key questions for future research on the topic and provide concluding remarks on the complex movement disorder of tic behaviors. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Christos Ganos
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Wolf-Julian Neumann
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Kirsten R Müller-Vahl
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Mark Hallett
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Patrick Haggard
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom
| | - John Rothwell
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
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12
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Versace V, Campostrini S, Sebastianelli L, Soda M, Saltuari L, Lun S, Nardone R, Kofler M. Adult-Onset Gilles de la Tourette Syndrome: Psychogenic or Organic? The Challenge of Abnormal Neurophysiological Findings. Front Neurol 2019; 10:461. [PMID: 31130912 PMCID: PMC6509948 DOI: 10.3389/fneur.2019.00461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/16/2019] [Indexed: 11/13/2022] Open
Abstract
Gilles de la Tourette syndrome (GTS) is characterized by multiple motor and vocal tics. Adult-onset cases are rare and may be due to "reactivation" of childhood tics, or secondary to psychiatric or genetic diseases, or due to central nervous system lesions of different etiologies. Late-onset psychogenic motor/vocal tics resembling GTS have been described. Neurophysiology may serve to differentiate organic from functional GTS. Altered blink reflex pre-pulse inhibition (BR-PPI), blink reflex excitability recovery (BR-ERC), and short-interval intracortical inhibition (SICI) have been described in GTS. We report a 48-years-old male, who developed numerous motor/vocal tics 2 months after sustaining non-commotional craniofacial trauma in a car accident. Both his father and brother had died earlier in car crashes. He presented with blepharospasm-like forced lid closure, forceful lip pursing, noisy suction movements, and deep moaning sounds, occurring in variable combinations, without warning symptoms or internal "urge." Tics showed low distractibility and these increased with attention. Standard magnetic resonance imaging, electroencephalography, and evoked potentials were unremarkable. Neuropsychology diagnosed moderately impaired intellect, attention, and executive functions. Psychiatric assessment revealed somatization disorder and generalized anxiety. BR-PPI was unremarkable, while BR-ERC was enhanced, even showing facilitation at short intervals. SICI was markedly reduced at 1 and 3 ms and intracortical facilitation (ICF) was enhanced at 10 ms. The patient fulfilled Fahn and Williams' diagnostic criteria for a psychogenic movement disorder. Neurophysiology, however, documented hyperexcitability of motor cortex and brainstem. We suggest that-similar to what has been reported in psychogenic dystonia-a pre-existing predisposition may have led to the functional hyperkinetic disorder in response to severe psychic stress.
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Affiliation(s)
- Viviana Versace
- Department of Neurorehabilitation, Hospital of Vipiteno, Vipiteno, Italy.,Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Stefania Campostrini
- Department of Neurorehabilitation, Hospital of Vipiteno, Vipiteno, Italy.,Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Luca Sebastianelli
- Department of Neurorehabilitation, Hospital of Vipiteno, Vipiteno, Italy.,Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Mirco Soda
- Department of Neuropsychology, Hospital of Bressanone, Bressanone, Italy
| | - Leopold Saltuari
- Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy.,Department of Neurology, State Hospital Hochzirl, Zirl, Austria
| | - Sigrid Lun
- Department of Psychiatry, Hospital of Bressanone, Bressanone, Italy
| | - Raffaele Nardone
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy.,Department of Neurology, Christian Doppler Medical Center, Paracelsus Private Medical University of Salzburg, Salzburg, Austria
| | - Markus Kofler
- Department of Neurology, State Hospital Hochzirl, Zirl, Austria
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13
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Sharp AN, Singer HS. Standard, Complementary, and Future Treatment Options for Tics. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2018. [DOI: 10.1007/s40474-018-0138-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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14
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Suppa A, Quartarone A, Siebner H, Chen R, Di Lazzaro V, Del Giudice P, Paulus W, Rothwell J, Ziemann U, Classen J. The associative brain at work: Evidence from paired associative stimulation studies in humans. Clin Neurophysiol 2017; 128:2140-2164. [DOI: 10.1016/j.clinph.2017.08.003] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 07/20/2017] [Accepted: 08/03/2017] [Indexed: 12/25/2022]
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15
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Fassett HJ, Turco CV, El-Sayes J, Lulic T, Baker S, Richardson B, Nelson AJ. Transcranial Magnetic Stimulation with Intermittent Theta Burst Stimulation Alters Corticospinal Output in Patients with Chronic Incomplete Spinal Cord Injury. Front Neurol 2017; 8:380. [PMID: 28824536 PMCID: PMC5543286 DOI: 10.3389/fneur.2017.00380] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 07/18/2017] [Indexed: 12/02/2022] Open
Abstract
Intermittent theta burst stimulation (iTBS) is intended primarily to alter corticospinal excitability, creating an attractive opportunity to alter neural output following incomplete spinal cord injury (SCI). This study is the first to assess the effects of iTBS in SCI. Eight individuals with chronic incomplete SCI were studied. Sham or real iTBS was delivered (to each participant) over primary motor and somatosensory cortices in separate sessions. Motor-evoked potential (MEP) recruitment curves were obtained from the flexor carpi radialis muscle before and after iTBS. Results indicate similar responses for iTBS to both motor and somatosensory cortex and reduced MEPs in 56.25% and increased MEPs in 25% of instances. Sham stimulation exceeded real iTBS effects in the remaining 18.25%. It is our opinion that observing short-term neuroplasticity in corticospinal output in chronic SCI is an important advance and should be tested in future studies as an opportunity to improve function in this population. We emphasize the need to re-consider the importance of the direction of MEP change following a single session of iTBS since the relationship between MEP direction and motor function is unknown and multiple sessions of iTBS may yield very different directional results. Furthermore, we highlight the importance of including sham control in the experimental design. The fundamental point from this pilot research is that a single session of iTBS is often capable of creating short-term change in SCI. Future sham-controlled randomized trials may consider repeat iTBS sessions to promote long-term changes in corticospinal excitability.
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Affiliation(s)
- Hunter J Fassett
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Claudia V Turco
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Jenin El-Sayes
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Tea Lulic
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Steve Baker
- Division of Physical Medicine and Rehabilitation, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Brian Richardson
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Aimee J Nelson
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
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16
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Marsili L, Suppa A, Di Stasio F, Belvisi D, Upadhyay N, Berardelli I, Pasquini M, Petrucci S, Ginevrino M, Fabbrini G, Cardona F, Defazio G, Berardelli A. BDNF and LTP-/LTD-like plasticity of the primary motor cortex in Gilles de la Tourette syndrome. Exp Brain Res 2016; 235:841-850. [DOI: 10.1007/s00221-016-4847-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 11/24/2016] [Indexed: 01/13/2023]
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17
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Chung SW, Hill AT, Rogasch NC, Hoy KE, Fitzgerald PB. Use of theta-burst stimulation in changing excitability of motor cortex: A systematic review and meta-analysis. Neurosci Biobehav Rev 2016; 63:43-64. [PMID: 26850210 DOI: 10.1016/j.neubiorev.2016.01.008] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 12/30/2015] [Accepted: 01/26/2016] [Indexed: 12/13/2022]
Abstract
Noninvasive brain stimulation has been demonstrated to modulate cortical activity in humans. In particular, theta burst stimulation (TBS) has gained notable attention due to its ability to induce lasting physiological changes after short stimulation durations. The present study aimed to provide a comprehensive meta-analytic review of the efficacy of two TBS paradigms; intermittent (iTBS) and continuous (cTBS), on corticospinal excitability in healthy individuals. Literature searches yielded a total of 87 studies adhering to the inclusion criteria. iTBS yielded moderately large MEP increases lasting up to 30 min with a pooled SMD of 0.71 (p<0.00001). cTBS produced a reduction in MEP amplitudes lasting up to 60 min, with the largest effect size seen at 5 min post stimulation (SMD=-0.9, P<0.00001). The collected studies were of heterogeneous nature, and a series of tests conducted indicated a degree of publication bias. No significant change in SICI and ICF was observed, with exception to decrease in SICI with cTBS at the early time point (SMD=0.42, P=0.00036). The results also highlight several factors contributing to TBS efficacy, including the number of pulses, frequency of stimulation and BDNF polymorphisms. Further research investigating optimal TBS stimulation parameters, particularly for iTBS, is needed in order for these paradigms to be successfully translated into clinical settings.
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Affiliation(s)
- Sung Wook Chung
- Monash Alfred Psychiatry Research Centre, Central Clinical School, The Alfred and Monash University, Melbourne, Australia.
| | - Aron T Hill
- Monash Alfred Psychiatry Research Centre, Central Clinical School, The Alfred and Monash University, Melbourne, Australia
| | - Nigel C Rogasch
- Brain and Mental Health Laboratory, School of Psychological Sciences and Monash Biomedical Imaging, Monash University, Melbourne, Australia
| | - Kate E Hoy
- Monash Alfred Psychiatry Research Centre, Central Clinical School, The Alfred and Monash University, Melbourne, Australia
| | - Paul B Fitzgerald
- Monash Alfred Psychiatry Research Centre, Central Clinical School, The Alfred and Monash University, Melbourne, Australia
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18
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Wischnewski M, Schutter DJLG. Efficacy and Time Course of Theta Burst Stimulation in Healthy Humans. Brain Stimul 2015; 8:685-92. [PMID: 26014214 DOI: 10.1016/j.brs.2015.03.004] [Citation(s) in RCA: 174] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 03/12/2015] [Accepted: 03/20/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In the past decade research has shown that continuous (cTBS) and intermittent theta burst stimulation (iTBS) alter neuronal excitability levels in the primary motor cortex. OBJECTIVE Quantitatively review the magnitude and time course on cortical excitability of cTBS and iTBS. METHODS Sixty-four TBS studies published between January 2005 and October 2014 were retrieved from the scientific search engine PubMED and included for analyses. The main inclusion criteria involved stimulation of the primary motor cortex in healthy volunteers with no motor practice prior to intervention and motor evoked potentials as primary outcome measure. RESULTS ITBS applied for 190 s significantly increases cortical excitability up to 60 min with a mean maximum potentiation of 35.54 ± 3.32%. CTBS applied for 40 s decreases cortical excitability up to 50 min with a mean maximum depression of -22.81 ± 2.86%, while cTBS applied for 20 s decreases cortical excitability (mean maximum -27.84 ± 4.15%) for 20 min. CONCLUSION The present findings offer normative insights into the magnitude and time course of TBS-induced changes in cortical excitability levels.
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Affiliation(s)
- Miles Wischnewski
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, the Netherlands.
| | - Dennis J L G Schutter
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, the Netherlands
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19
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Pedapati EV, Gilbert DL, Horn PS, Huddleston DA, Laue CS, Shahana N, Wu SW. Effect of 30 Hz theta burst transcranial magnetic stimulation on the primary motor cortex in children and adolescents. Front Hum Neurosci 2015; 9:91. [PMID: 25762919 PMCID: PMC4340218 DOI: 10.3389/fnhum.2015.00091] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 02/04/2015] [Indexed: 01/01/2023] Open
Abstract
Fourteen healthy children (13.8 ± 2.2 years, range 10–16; M:F = 5:9) received 30 Hz intermittent theta burst transcranial magnetic stimulation (iTBS) with a stimulation intensity of 70% of resting motor threshold (RMT) with a total of 300 (iTBS300) pulses. All volunteers were free of neurologic, psychiatric and serious medical illnesses, not taking any neuropsychiatric medications, and did not have any contraindications to transcranial magnetic stimulation. Changes in the mean amplitudes of motor-evoked potentials from baseline following iTBS were expressed as a ratio and assessed from 1 to 10 min (BLOCK1) and 1–30 min (BLOCK2) using repeated-measures analysis of variance. All 14 subjects completed iTBS300 over the dominant primary motor cortex (M1) without any clinically reported adverse events. ITBS300 produced significant M1 facilitation [F(5, 65) = 3.165, p = 0.01] at BLOCK1 and trend level M1 facilitation at BLOCK2 [F(10, 129) = 1.69, p = 0.089]. Although iTBS300 (stimulation duration of 92 s at 70% RMT) delivered over M1 in typically developed children was well-tolerated and produced on average significant facilitatory changes in cortical excitability, the post-iTBS300 neurophysiologic response was variable in our small sample. ITBS300-induced changes may represent a potential neuroplastic biomarker in healthy children and those with neuro-genetic or neuro-psychiatric disorders. However, a larger sample size is needed to address safety and concerns of response variability.
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Affiliation(s)
- Ernest V Pedapati
- Division of Neurology, Cincinnati Children's Hospital Medical Center Cincinnati, OH, USA ; Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center Cincinnati, OH, USA
| | - Donald L Gilbert
- Division of Neurology, Cincinnati Children's Hospital Medical Center Cincinnati, OH, USA
| | - Paul S Horn
- Division of Neurology, Cincinnati Children's Hospital Medical Center Cincinnati, OH, USA ; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center Cincinnati, OH, USA
| | - David A Huddleston
- Division of Neurology, Cincinnati Children's Hospital Medical Center Cincinnati, OH, USA
| | - Cameron S Laue
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center Cincinnati, OH, USA
| | - Nasrin Shahana
- Division of Neurology, Cincinnati Children's Hospital Medical Center Cincinnati, OH, USA
| | - Steve W Wu
- Division of Neurology, Cincinnati Children's Hospital Medical Center Cincinnati, OH, USA
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20
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Martín‐Rodríguez JF, Ruiz‐Rodríguez MA, Palomar FJ, Cáceres‐Redondo MT, Vargas L, Porcacchia P, Gómez‐Crespo M, Huertas‐Fernández I, Carrillo F, Madruga‐Garrido M, Mir P. Aberrant cortical associative plasticity associated with severe adult Tourette syndrome. Mov Disord 2015; 30:431-5. [DOI: 10.1002/mds.26151] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 12/04/2014] [Accepted: 12/10/2014] [Indexed: 11/08/2022] Open
Affiliation(s)
- Juan Francisco Martín‐Rodríguez
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de SevillaSeville Spain
| | - María Adilia Ruiz‐Rodríguez
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de SevillaSeville Spain
| | - Francisco J. Palomar
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de SevillaSeville Spain
| | - María Teresa Cáceres‐Redondo
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de SevillaSeville Spain
| | - Laura Vargas
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de SevillaSeville Spain
| | - Paolo Porcacchia
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de SevillaSeville Spain
| | - Mercedes Gómez‐Crespo
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de SevillaSeville Spain
| | - Ismael Huertas‐Fernández
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de SevillaSeville Spain
| | - Fátima Carrillo
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de SevillaSeville Spain
| | - Marcos Madruga‐Garrido
- Sección de Neuropediatría, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de SevillaSeville Spain
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de SevillaSeville Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) Spain
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21
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Landeros-Weisenberger A, Mantovani A, Motlagh MG, de Alvarenga PG, Katsovich L, Leckman JF, Lisanby SH. Randomized Sham Controlled Double-blind Trial of Repetitive Transcranial Magnetic Stimulation for Adults With Severe Tourette Syndrome. Brain Stimul 2014; 8:574-81. [PMID: 25912296 DOI: 10.1016/j.brs.2014.11.015] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 11/04/2014] [Accepted: 11/29/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND A small proportion of individuals with Tourette syndrome (TS) have a lifelong course of illness that fails to respond to conventional treatments. Open label studies have suggested that low frequency (1-Hz) repetitive transcranial magnetic stimulation (rTMS) targeting the supplementary motor area (SMA) may be effective in reducing tic severity. OBJECTIVE/HYPOTHESIS To examine the efficacy of rTMS over the SMA for TS in a randomized double-blind sham-controlled trial (RCT). METHODS We conducted a two-site RCT-rTMS with 20 adults with severe TS for 3 weeks. Treatment consisted of 15 sessions (1-Hz; 30 min; 1800 pulses per day) of active or sham rTMS at 110% of the motor threshold over the SMA. A subsequent 3 week course of active rTMS treatment was offered. RESULTS Of the 20 patients (16 males; mean age of 33.7 ± 12.2 years), 9 received active and 11 received sham rTMS. After 3 weeks, patients receiving active rTMS showed on average a 17.3% reduction in the YGTSS total tic score compared to a 13.2% reduction in those receiving sham rTMS, resulting in no statistically significant reduction in tic severity (P = 0.27). An additional 3 week open label active treatment for those patients (n = 7) initially randomized to active rTMS resulted in a significant overall 29.7% reduction in tic severity compared to baseline (P = 0.04). CONCLUSION This RCT did not demonstrate efficacy of 3-week SMA-targeted low frequency rTMS in the treatment of severe adult TS. Further studies using longer or alternative stimulation protocols are warranted.
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Affiliation(s)
| | - Antonio Mantovani
- Department of Physiology, Pharmacology & Neuroscience, Sophie Davis School of Biomedical Education, City University of New York, NY, USA; Division of Experimental Therapeutics, Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York, NY, USA
| | - Maria G Motlagh
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Pedro Gomes de Alvarenga
- Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Liliya Katsovich
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - James F Leckman
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA.
| | - Sarah H Lisanby
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
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22
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Suppa A, Marsili L, Di Stasio F, Berardelli I, Roselli V, Pasquini M, Cardona F, Berardelli A. Cortical and brainstem plasticity in Tourette syndrome and obsessive-compulsive disorder. Mov Disord 2014; 29:1523-31. [PMID: 24996148 DOI: 10.1002/mds.25960] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 05/12/2014] [Accepted: 06/02/2014] [Indexed: 11/09/2022] Open
Abstract
Gilles de la Tourette syndrome is characterized by motor/vocal tics commonly associated with psychiatric disorders, including obsessive-compulsive disorder. We investigated primary motor cortex and brainstem plasticity in Tourette patients, exposed and unexposed to chronic drug treatment, with and without psychiatric disturbances. We also investigated primary motor cortex and brainstem plasticity in obsessive-compulsive disorder. We studied 20 Tourette patients with and without psychiatric disturbances, 15 with obsessive-compulsive disorder, and 20 healthy subjects. All groups included drug-naïve patients. We conditioned the left primary motor cortex with intermittent/continuous theta-burst stimulation and recorded motor evoked potentials. We conditioned the supraorbital nerve with facilitatory/inhibitory high-frequency stimulation and recorded the blink reflex late response area. In healthy subjects, intermittent theta-burst increased and continuous theta-burst stimulation decreased motor evoked potentials. Differently, intermittent theta-burst failed to increase and continuous theta-burst stimulation failed to decrease motor evoked potentials in Tourette patients, with and without psychiatric disturbances. In obsessive-compulsive disorder, intermittent/continuous theta-burst stimulation elicited normal responses. In healthy subjects and in subjects with obsessive-compulsive disorder, the blink reflex late response area increased after facilitatory high-frequency and decreased after inhibitory high-frequency stimulation. Conversely, in Tourette patients, with and without psychiatric disturbances, facilitatory/inhibitory high-frequency stimulation left the blink reflex late response area unchanged. Theta-burst and high-frequency stimulation elicited similar responses in drug-naïve and chronically treated patients. Tourette patients have reduced plasticity regardless of psychiatric disturbances. These findings suggest that abnormal plasticity contributes to the pathophysiology of Gilles de la Tourette syndrome. However, obsessive-compulsive disorder patients have normal cortical and brainstem plasticity.
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Affiliation(s)
- Antonio Suppa
- Neuromed Institute, "Sapienza" University of Rome, Italy
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23
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Brandt VC, Niessen E, Ganos C, Kahl U, Bäumer T, Münchau A. Altered synaptic plasticity in Tourette's syndrome and its relationship to motor skill learning. PLoS One 2014; 9:e98417. [PMID: 24878665 PMCID: PMC4039486 DOI: 10.1371/journal.pone.0098417] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 05/02/2014] [Indexed: 11/25/2022] Open
Abstract
Gilles de la Tourette syndrome is a neuropsychiatric disorder characterized by motor and phonic tics that can be considered motor responses to preceding inner urges. It has been shown that Tourette patients have inferior performance in some motor learning tasks and reduced synaptic plasticity induced by transcranial magnetic stimulation. However, it has not been investigated whether altered synaptic plasticity is directly linked to impaired motor skill acquisition in Tourette patients. In this study, cortical plasticity was assessed by measuring motor-evoked potentials before and after paired associative stimulation in 14 Tourette patients (13 male; age 18–39) and 15 healthy controls (12 male; age 18–33). Tic and urge severity were assessed using the Yale Global Tic Severity Scale and the Premonitory Urges for Tics Scale. Motor learning was assessed 45 minutes after inducing synaptic plasticity and 9 months later, using the rotary pursuit task. On average, long-term potentiation-like effects in response to the paired associative stimulation were present in healthy controls but not in patients. In Tourette patients, long-term potentiation-like effects were associated with more and long-term depression-like effects with less severe urges and tics. While motor learning did not differ between patients and healthy controls 45 minutes after inducing synaptic plasticity, the learning curve of the healthy controls started at a significantly higher level than the Tourette patients' 9 months later. Induced synaptic plasticity correlated positively with motor skills in healthy controls 9 months later. The present study confirms previously found long-term improvement in motor performance after paired associative stimulation in healthy controls but not in Tourette patients. Tourette patients did not show long-term potentiation in response to PAS and also showed reduced levels of motor skill consolidation after 9 months compared to healthy controls. Moreover, synaptic plasticity appears to be related to symptom severity.
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Affiliation(s)
- Valerie Cathérine Brandt
- Institute of Neurogenetics, University of Lübeck, Lübeck, Schleswig-Holstein, Germany
- Department of Neurology, University Clinic Hamburg-Eppendorf, Hamburg, Hamburg, Germany
- * E-mail:
| | - Eva Niessen
- Institute of Neuroscience & Medicine, Research Centre Jülich, Jülich, Nordrhein-Westfalen, Germany
| | - Christos Ganos
- Institute of Neurogenetics, University of Lübeck, Lübeck, Schleswig-Holstein, Germany
- Department of Neurology, University Clinic Hamburg-Eppendorf, Hamburg, Hamburg, Germany
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London, London, United Kingdom
| | - Ursula Kahl
- Department of Neurology, University Clinic Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Tobias Bäumer
- Institute of Neurogenetics, University of Lübeck, Lübeck, Schleswig-Holstein, Germany
| | - Alexander Münchau
- Institute of Neurogenetics, University of Lübeck, Lübeck, Schleswig-Holstein, Germany
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24
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Wu SW, Maloney T, Gilbert DL, Dixon SG, Horn PS, Huddleston DA, Eaton K, Vannest J. Functional MRI-navigated repetitive transcranial magnetic stimulation over supplementary motor area in chronic tic disorders. Brain Stimul 2013; 7:212-8. [PMID: 24268723 DOI: 10.1016/j.brs.2013.10.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 10/12/2013] [Accepted: 10/24/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Open label studies have shown repetitive transcranial magnetic stimulation to be effective in reducing tics. OBJECTIVES To determine whether 8 sessions of continuous theta burst stimulation (cTBS) over supplementary motor area (SMA) given over 2 days may reduce tics and motor cortical network activity in Tourette syndrome/chronic tic disorders. METHODS This was a randomized (1:1), double-blind, sham-controlled trial of functional MRI (fMRI)-navigated, 30 Hz cTBS at 90% of resting motor threshold (RMT) over SMA in 12 patients ages 10-22 years. Comorbid ADHD (n = 8), OCD (n = 8), and stable concurrent medications (n = 9) were permitted. Neuro-navigation utilized each individual's event-related fMRI signal. Primary clinical and cortical outcomes were: 1) Yale Global Tic Severity Scale (YGTSS) at one week; 2) fMRI event-related signal in SMA and primary motor cortex (M1) during a finger-tapping motor task. RESULT Baseline characteristics were not statistically different between groups (age, current tic/OCD/ADHD severities, tic-years, number of prior medication trials, RMT). Mean YGTSS scores decreased in both active (27.5 ± 7.4 to 23.2 ± 9.8) and sham (26.8 ± 4.8 to 21.7 ± 7.7) groups. However, no significant difference in video-based tic severity rating was detected between the two groups. Two-day post-treatment fMRI activation during finger tapping decreased significantly in active vs. sham groups for SMA (P = 0.02), left M1 (P = 0.0004), and right M1 (P < 0.0001). No serious adverse events occurred. CONCLUSION Active, fMRI-navigated cTBS administered in 8 sessions over 2 days to the SMA induced significant inhibition in the motor network (SMA, bilateral M1). However, both groups on average experienced tic reduction at 7 days. Larger sample size and protocol modifications may be needed to produce clinically significant tic reduction beyond placebo effect.
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Affiliation(s)
- Steve W Wu
- Cincinnati Children's Hospital Medical Center, Division of Neurology, 3333 Burnet Ave., MLC 2015, Cincinnati, OH 45229, USA.
| | - Thomas Maloney
- Cincinnati Children's Hospital Medical Center, Division of Radiology, 3333 Burnet Ave., MLC 5033, Cincinnati, OH 45229, USA
| | - Donald L Gilbert
- Cincinnati Children's Hospital Medical Center, Division of Neurology, 3333 Burnet Ave., MLC 2015, Cincinnati, OH 45229, USA
| | - Stephan G Dixon
- Cincinnati Children's Hospital Medical Center, Division of Neurology, 3333 Burnet Ave., MLC 2015, Cincinnati, OH 45229, USA
| | - Paul S Horn
- Cincinnati Children's Hospital Medical Center, Division of Neurology, 3333 Burnet Ave., MLC 2015, Cincinnati, OH 45229, USA
| | - David A Huddleston
- Cincinnati Children's Hospital Medical Center, Division of Neurology, 3333 Burnet Ave., MLC 2015, Cincinnati, OH 45229, USA
| | - Kenneth Eaton
- Cincinnati Children's Hospital Medical Center, Division of Radiology, 3333 Burnet Ave., MLC 5033, Cincinnati, OH 45229, USA
| | - Jennifer Vannest
- Cincinnati Children's Hospital Medical Center, Division of Neurology, 3333 Burnet Ave., MLC 2015, Cincinnati, OH 45229, USA; Cincinnati Children's Hospital Medical Center, Division of Radiology, 3333 Burnet Ave., MLC 5033, Cincinnati, OH 45229, USA
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25
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Wu SW, Shahana N, Huddleston DA, Lewis AN, Gilbert DL. Safety and tolerability of theta-burst transcranial magnetic stimulation in children. Dev Med Child Neurol 2012; 54:636-9. [PMID: 22515662 DOI: 10.1111/j.1469-8749.2012.04300.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Theta-burst stimulation (TBS) is a lower intensity, high-frequency repetitive transcranial magnetic stimulation technique developed recently for quantifying and modulating cerebral cortical function. Nearly all published studies have involved adults. The aim of this study was to obtain safety data as a basis for evaluating potential risks versus benefits of TBS research in children. METHOD Forty participants under 18 years: 16 with Tourette syndrome (five females, 11 males; mean age 12y, SD 2y 10mo) and 24 typically developing children (12 females, 12 males; mean age 12y 11mo, SD 2y 10mo) underwent intermittent or continuous TBS over the left motor cortex. Open questions, a structured 16-question review of systems, and visual analog mood scale (VAMS) were administered before and after TBS. A Wilcoxon signed-rank sum test was used to analyze differences in VAMS scores before and after TBS. RESULTS There were no serious adverse events. Five of the 40 children reported mild, self-limited adverse events: a subjective sensation of finger twitching (n=1), neck stiffness (n=1), and mild headache (n=3). The total adverse event rate was 11.6%. There was no significant change in VAMS score in either group after one session of TBS. INTERPRETATION A single session of TBS in children appears to be safe and well tolerated.
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Affiliation(s)
- Steve W Wu
- Division of Pediatric Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.
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26
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Wu SW, Shahana N, Huddleston DA, Gilbert DL. Effects of 30Hz θ burst transcranial magnetic stimulation on the primary motor cortex. J Neurosci Methods 2012; 208:161-4. [PMID: 22627376 DOI: 10.1016/j.jneumeth.2012.05.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 05/02/2012] [Accepted: 05/14/2012] [Indexed: 11/17/2022]
Abstract
Theta Burst Stimulation (TBS) is a relatively new form of repetitive Transcranial Magnetic Stimulation (TMS) used to probe neuroplasticity in the human cortex. Thirty-Hz TBS, a variation of the originally described 50Hz TBS, has been shown to induce cortical changes in several nonmotor regions. However, its effects over the primary motor cortex have not been examined. Due to TMS device mechanical properties, 30Hz TBS is advantageous over 50Hz TBS in that it can be delivered at higher stimulation intensities. The goal of this pilot study is to examine the neurophysiologic effects of 30Hz TBS on the primary motor cortex (M1) of healthy adults. Eighteen right-handed adults (33±9.0 years; M:F=8:10) completed intermittent TBS (iTBS) or continuous TBS (cTBS) over left M1. TBS was performed with Magstim® SuperRapid2 with stimulation bursts (3 pulses at 30Hz) repeating every 200ms. For iTBS, each 2-s stimulation train was separated by 8s but there was no pause between trains for cTBS. Each TBS consisted of a total of 600 pulses delivered at an intensity of 90%*Resting Motor Threshold. Motor-Evoked Potentials (MEP) in the right first dorsal interosseous muscle were measured before, and one and ten minutes after TBS. Pre/post-TBS MEP amplitudes were compared using repeated-measures ANOVA. MEP amplitudes increased after 30Hz iTBS and decreased after 30Hz cTBS (TBS-Type*Time effect p=0.009). In conclusion, 30Hz TBS induced similar neurophysiologic effects over M1 as conventional 50Hz TBS.
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Affiliation(s)
- Steve W Wu
- Division of Pediatric Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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