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Zhang X, Wang H, Guo Y, Long J. Beta rebound reduces subsequent movement preparation time by modulating of GABAA inhibition. Cereb Cortex 2024; 34:bhae037. [PMID: 38342689 DOI: 10.1093/cercor/bhae037] [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: 12/05/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/13/2024] Open
Abstract
Post-movement beta synchronization is an increase of beta power relative to baseline, which commonly used to represent the status quo of the motor system. However, its functional role to the subsequent voluntary motor output and potential electrophysiological significance remain largely unknown. Here, we examined the reaction time of a Go/No-Go task of index finger tapping which performed at the phases of power baseline and post-movement beta synchronization peak induced by index finger abduction movements at different speeds (ballistic/self-paced) in 13 healthy subjects. We found a correlation between the post-movement beta synchronization and reaction time that larger post-movement beta synchronization prolonged the reaction time during Go trials. To probe the electrophysiological significance of post-movement beta synchronization, we assessed intracortical inhibitory measures probably involving GABAB (long-interval intracortical inhibition) and GABAA (short-interval intracortical inhibition) receptors in beta baseline and post-movement beta synchronization peak induced by index finger abduction movements at different speeds. We found that short-interval intracortical inhibition but not long-interval intracortical inhibition increased in post-movement beta synchronization peak compared with that in the power baseline, and was negatively correlated with the change of post-movement beta synchronization peak value. These novel findings indicate that the post-movement beta synchronization is related to forward model updating, with high beta rebound predicting longer time for the preparation of subsequent movement by inhibitory neural pathways of GABAA.
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Affiliation(s)
- Xiangzi Zhang
- College of Information Science and Technology, Jinan University, Guangzhou 510632, China
- School of Psychology, Northwest Normal University, Lanzhou 730070, China
| | - Houmin Wang
- College of Information Science and Technology, Jinan University, Guangzhou 510632, China
| | - Yaqiu Guo
- College of Information Science and Technology, Jinan University, Guangzhou 510632, China
| | - Jinyi Long
- College of Information Science and Technology, Jinan University, Guangzhou 510632, China
- Pazhou Lab, Guangzhou 510335, China
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2
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Wang C, Nie P, Wang P, Wang Y, Zang Y, Zhang Y. The Therapeutic Effect of Transcranial Magnetic Stimulation on Post-stroke Aphasia and the Optimal Treatment Parameters: A Meta-analysis. Arch Phys Med Rehabil 2023:S0003-9993(23)00659-7. [PMID: 37984539 DOI: 10.1016/j.apmr.2023.11.006] [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: 05/22/2023] [Revised: 10/23/2023] [Accepted: 11/10/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE This meta-analysis aimed to examine the overall effectiveness of TMS on post-stroke aphasia using a meta-analysis approach, as well as examine the effect of moderating variables (eg, study design, TMS protocol) on the effectiveness of TMS. DATA SOURCES A keyword search was conducted in 5 databases: ERIC, Google Scholar, PsycINFO, MEDLINE, and ProQuest (01/1985-12/2022). The search algorithm included all possible combinations of relevant keywords. Full-text articles were thoroughly examined using forward/backward search methods. STUDY SELECTION Studies were thoroughly screened using the following inclusion criteria: patients were diagnosed with post-stroke aphasia; studies focused on the effect of TMS on post-stroke aphasia; language assessments were conducted at pretest and posttest for TMS treatment and data were reported; studies included both an experimental group (ie, a group with TMS treatment) and a control group (ie, a group without TMS treatment). DATA EXTRACTION Information was extracted from each study including authors, publication year, first language of participants, study design, stroke duration, demographics of participants, TMS protocol, stimulation site, targeting, and statistical data of language performance pre- and post-TMS treatment. DATA SYNTHESIS A total of 17 studies were included in the final review, involving 682 patients with post-stroke aphasia (348 in the experimental group, 334 in the control group). The results showed that TMS treatment has significant immediate (Hedges' g=0.37) and maintenance (Hedges' g=0.34) effects on post-stroke aphasia. Additionally, the moderating variables showed a moderation effect on the effectiveness of TMS. CONCLUSION TMS treatment can significantly improve language ability for post-stroke aphasia. Additionally, this study provides an important reference for selecting the optimal TMS treatment parameters in treating post-stroke aphasia. Specifically, administering 15 sessions of rTMS lasting 10 min over the mirror area within Broca's area may produce the best TMS treatment outcomes.
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Affiliation(s)
- Cuicui Wang
- Zhejiang Philosophy and Social Science Laboratory for Research in Early Development and Childcare, Hangzhou Normal University, Hangzhou, China; College of Education, Hangzhou Normal University, Hangzhou, China; TMS Center, Deqing Hospital of Hangzhou Normal University, China; Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Peixin Nie
- Cognitive Brain Research Unit, Faculty of Medicine, University of Helsinki, Finland; Centre of Excellence in Music, Mind, Body, and Brain, Faculty of Medicine, University of Helsinki, Finland
| | - Peng Wang
- Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China; University of Greifswald, Institute of Psychology, Greifswald, Germany
| | - Yunxia Wang
- Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Yufeng Zang
- TMS Center, Deqing Hospital of Hangzhou Normal University, China; Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China; Institute of Psychological Sciences, Hangzhou Normal University, Hangzhou, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou Normal University, Hangzhou, China
| | - Ye Zhang
- Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China; Institute of Psychological Sciences, Hangzhou Normal University, Hangzhou, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou Normal University, Hangzhou, China.
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3
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Peter J, Ferraioli F, Mathew D, George S, Chan C, Alalade T, Salcedo SA, Saed S, Tatti E, Quartarone A, Ghilardi MF. Movement-related beta ERD and ERS abnormalities in neuropsychiatric disorders. Front Neurosci 2022; 16:1045715. [PMID: 36507340 PMCID: PMC9726921 DOI: 10.3389/fnins.2022.1045715] [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: 09/15/2022] [Accepted: 10/31/2022] [Indexed: 11/24/2022] Open
Abstract
Movement-related oscillations in the beta range (from 13 to 30 Hz) have been observed over sensorimotor areas with power decrease (i.e., event-related desynchronization, ERD) during motor planning and execution followed by an increase (i.e., event-related synchronization, ERS) after the movement's end. These phenomena occur during active, passive, imaged, and observed movements. Several electrophysiology studies have used beta ERD and ERS as functional indices of sensorimotor integrity, primarily in diseases affecting the motor system. Recent literature also highlights other characteristics of beta ERD and ERS, implying their role in processes not strictly related to motor function. Here we review studies about movement-related ERD and ERS in diseases characterized by motor dysfunction, including Parkinson's disease, dystonia, stroke, amyotrophic lateral sclerosis, cerebral palsy, and multiple sclerosis. We also review changes of beta ERD and ERS reported in physiological aging, Alzheimer's disease, and schizophrenia, three conditions without overt motor symptoms. The review of these works shows that ERD and ERS abnormalities are present across the spectrum of the examined pathologies as well as development and aging. They further suggest that cognition and movement are tightly related processes that may share common mechanisms regulated by beta modulation. Future studies with a multimodal approach are warranted to understand not only the specific topographical dynamics of movement-related beta modulation but also the general meaning of beta frequency changes occurring in relation to movement and cognitive processes at large. Such an approach will provide the foundation to devise and implement novel therapeutic approaches to neuropsychiatric disorders.
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Affiliation(s)
- Jaime Peter
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Francesca Ferraioli
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Dave Mathew
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Shaina George
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Cameron Chan
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Tomisin Alalade
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Sheilla A. Salcedo
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Shannon Saed
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Elisa Tatti
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States,*Correspondence: Elisa Tatti,
| | - Angelo Quartarone
- IRCCS Centro Neurolesi Bonino Pulejo-Piemonte, Messina, Italy,Angelo Quartarone,
| | - M. Felice Ghilardi
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States,M. Felice Ghilardi,
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4
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Enhancement of LTD-like plasticity by associative pairing of quadripulse magnetic stimulation with peripheral nerve stimulation. Clin Neurophysiol 2022; 138:9-17. [DOI: 10.1016/j.clinph.2022.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 01/31/2022] [Accepted: 03/13/2022] [Indexed: 11/23/2022]
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5
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Kielar A, Patterson D, Chou YH. Efficacy of repetitive transcranial magnetic stimulation in treating stroke aphasia: Systematic review and meta-analysis. Clin Neurophysiol 2022; 140:196-227. [DOI: 10.1016/j.clinph.2022.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 04/11/2022] [Accepted: 04/16/2022] [Indexed: 12/12/2022]
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6
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Dose-response of intermittent theta burst stimulation of the prefrontal cortex: a TMS-EEG study. Clin Neurophysiol 2022; 136:158-172. [DOI: 10.1016/j.clinph.2021.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 12/01/2021] [Accepted: 12/26/2021] [Indexed: 01/01/2023]
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7
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Tatti E, Ferraioli F, Peter J, Alalade T, Nelson AB, Ricci S, Quartarone A, Ghilardi MF. Frontal increase of beta modulation during the practice of a motor task is enhanced by visuomotor learning. Sci Rep 2021; 11:17441. [PMID: 34465846 PMCID: PMC8408223 DOI: 10.1038/s41598-021-97004-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 08/19/2021] [Indexed: 12/12/2022] Open
Abstract
Movement is accompanied by beta power changes over frontal and sensorimotor regions: a decrease during movement (event-related desynchronization, ERD), followed by an increase (event-related synchronization, ERS) after the movement end. We previously found that enhancements of beta modulation (from ERD to ERS) during a reaching test (mov) occur over frontal and left sensorimotor regions after practice in a visuo-motor adaptation task (ROT) but not after visual learning practice. Thus, these enhancements may reflect local cumulative effects of motor learning. Here we verified whether they are triggered by the learning component inherent in ROT or simply by motor practice in a reaching task without such learning (MOT). We found that beta modulation during mov increased over frontal and left areas after three-hour practice of either ROT or MOT. However, the frontal increase was greater after ROT, while the increase over the left area was similar after the two tasks. These findings confirm that motor practice leaves local traces in beta power during a subsequent motor test. As they occur after motor tasks with and without learning, these traces likely express the cost of processes necessary for both usage and engagement of long-term potentiation mechanisms necessary for the learning required by ROT.
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Affiliation(s)
- E Tatti
- CUNY School of Medicine, 160 Convent Avenue, Harris Hall Room 008, New York, NY, 10031, USA.
| | - F Ferraioli
- CUNY School of Medicine, 160 Convent Avenue, Harris Hall Room 008, New York, NY, 10031, USA
| | - J Peter
- CUNY School of Medicine, 160 Convent Avenue, Harris Hall Room 008, New York, NY, 10031, USA
| | - T Alalade
- CUNY School of Medicine, 160 Convent Avenue, Harris Hall Room 008, New York, NY, 10031, USA
| | - A B Nelson
- CUNY School of Medicine, 160 Convent Avenue, Harris Hall Room 008, New York, NY, 10031, USA
| | - S Ricci
- CUNY School of Medicine, 160 Convent Avenue, Harris Hall Room 008, New York, NY, 10031, USA.,DIBRIS University of Genova, 16145, Genoa, Italy
| | - A Quartarone
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, 98125, Messina, Italy
| | - M F Ghilardi
- CUNY School of Medicine, 160 Convent Avenue, Harris Hall Room 008, New York, NY, 10031, USA.
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8
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Multiple Daily Rounds of Theta-Burst Stimulation for Tinnitus: Preliminary Results. ACTA ACUST UNITED AC 2021; 57:medicina57080743. [PMID: 34440949 PMCID: PMC8401076 DOI: 10.3390/medicina57080743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/21/2021] [Indexed: 11/24/2022]
Abstract
Background and Objectives: Tinnitus is a condition that negatively affects the quality of life and is difficult to treat. Theta burst stimulation (TBS), a new method of repetitive transcranial magnetic stimulation (rTMS), is a promising treatment approach because it shows stronger and more prolonged effects in a shorter time of stimulation than other rTMS protocols. However, the therapeutic effect of TBS for tinnitus was inconsistent. We hypothesized that more stimulation would be more effective. Therefore, this study aimed to explore the safety and effectiveness of multiple daily rounds of TBS over five consecutive days. Materials and Methods: The continuous TBS (cTBS) protocol is 300 pulses/day, but we applied 8 sessions of 300 pulses in a day (total 2400 pulses/day). A total of 15 patients with tinnitus were randomly assigned to treatment and sham groups. Outcome measurements were taken three times: before and after 5-day of stimulation; at a 1–3 month follow-up visit. Outcome measurements were the degree of annoyance due to ear fullness, duration of tinnitus, visual analog scales of tinnitus for annoyance, Tinnitus Handicap Inventory, pitch, loudness, minimum masking level, and residual inhibition. Results: Five-day cTBS was completed without adverse events. We did not find any significant therapeutic effect in the treatment group, but we needed to be cautious to interpret our result due to the small sample size. Conclusions: In conclusion, multiple rounds of cTBS in a day may be safe. Further research is needed in a larger sample size to determine the effectiveness and confirm the safety.
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9
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Ghilardi MF, Tatti E, Quartarone A. Beta power and movement-related beta modulation as hallmarks of energy for plasticity induction: Implications for Parkinson's disease. Parkinsonism Relat Disord 2021; 88:136-139. [PMID: 34144879 DOI: 10.1016/j.parkreldis.2021.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 04/10/2021] [Accepted: 05/17/2021] [Indexed: 11/29/2022]
Abstract
Extensive work on movement-related beta oscillations (~13-30 Hz) over the sensorimotor areas in both humans and animals has demonstrated that sensorimotor beta power decreases during movement and transiently increases after movement. This beta power modulation has been interpreted as reflecting interactions between sensory and motor cortical areas with attenuation of sensory afferents during movement and their subsequent re-activation for internal models updating. More recent studies in neurologically normal subjects have demonstrated that this movement-related modulation as well as mean beta power at rest increase with practice and that previous motor learning enhances such increases. Conversely, patients with Parkinson's disease (PD) do not show such practice-related increases. Interestingly, a 2-h inactivity period without sleep can restore beta power values to baseline in normal subjects. Based on these results and on those of biochemical and electrophysiological studies in animals, we expand the current interpretation of beta activity and propose that the practice-related increases of beta power over sensorimotor areas are local indices of energy used for engaging plasticity-related activity. This paper provides some preliminary evidence in this respect linking findings of biochemical and electrophysiological studies in both humans and animals. This novel interpretation may explain the high level of beta power at rest, the deficient modulation during movement as well as the decreased skill formation in PD as resulting from deficiency in energy consumption, availability and regulation that are altered in this disease.
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Affiliation(s)
| | | | - Angelo Quartarone
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Messina, Italy.
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10
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Determining the optimal pulse number for theta burst induced change in cortical excitability. Sci Rep 2021; 11:8726. [PMID: 33888752 PMCID: PMC8062542 DOI: 10.1038/s41598-021-87916-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/06/2021] [Indexed: 12/19/2022] Open
Abstract
Theta-burst stimulation (TBS) is a form of non-invasive neuromodulation which is delivered in an intermittent (iTBS) or continuous (cTBS) manner. Although 600 pulses is the most common dose, the goal of these experiments was to evaluate the effect of higher per-dose pulse numbers on cortical excitability. Sixty individuals were recruited for 2 experiments. In Experiment 1, participants received 600, 1200, 1800, or sham (600) iTBS (4 visits, counterbalanced, left motor cortex, 80% active threshold). In Experiment 2, participants received 600, 1200, 1800, 3600, or sham (600) cTBS (5 visits, counterbalanced). Motor evoked potentials (MEP) were measured in 10-min increments for 60 min. For iTBS, there was a significant interaction between dose and time (F = 3.8296, p = 0.01), driven by iTBS (1200) which decreased excitability for up to 50 min (t = 3.1267, p = 0.001). For cTBS, there was no overall interaction between dose and time (F = 1.1513, p = 0.33). Relative to sham, cTBS (3600) increased excitability for up to 60 min (t = 2.0880, p = 0.04). There were no other significant effects of dose relative to sham in either experiment. Secondary analyses revealed high within and between subject variability. These results suggest that iTBS (1200) and cTBS (3600) are, respectively, the most effective doses for decreasing and increasing cortical excitability.
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11
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Wang XQ, Wang DQ, Bao YP, Liu JJ, Chen J, Wu SW, Luk HN, Yu L, Sun W, Yang Y, Wang XH, Lu L, Deng JH, Li SX. Preliminary Study on Changes of Sleep EEG Power and Plasma Melatonin in Male Patients With Major Depressive Disorder After 8 Weeks Treatment. Front Psychiatry 2021; 12:736318. [PMID: 34867527 PMCID: PMC8632954 DOI: 10.3389/fpsyt.2021.736318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/29/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To clarify the effects of escitalopram on sleep EEG power in patients with Major depressive disorder (MDD). Method: Polysomnography (PSG) was detected overnight, and blood samples were collected at 4 h intervals over 24 h from 13 male healthy controls and 13 male MDD patients before and after treatment with escitalopram for 8 weeks. The outcome measures included plasma melatonin levels, sleep architecture, and the sleep EEG power ratio. Results: Compared with healthy controls, MDD patients presented abnormalities in the diurnal rhythm of melatonin secretion, including peak phase delayed 3 h and a decrease in plasma melatonin levels at night and an increase at daytime, accompanied by sleep disturbances, a decrease in low-frequency bands and an increase in high-frequency bands, and the dominant right-side brain activity. Several of these abnormalities (abnormalities in the diurnal rhythm of melatonin secretion, partial sleep architecture parameters) persisted for at least the 8-week testing period. Conclusions: Eight weeks of treatment with escitalopram significantly improved subjective sleep perception and depressive symptoms of patients with MDD, and partially improved objective sleep parameters, while the improvement of circadian rhythm of melatonin was limited.
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Affiliation(s)
- Xue-Qin Wang
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
| | - De-Quan Wang
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Yan-Ping Bao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Jia-Jia Liu
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
| | - Jie Chen
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
| | - Shao-Wei Wu
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China.,Key Laboratory of Molecular Cardiovascular Sciences, Peking University, Ministry of Education, Beijing, China
| | - Hsuan-Nu Luk
- Peking University Health Science Center, Beijing, China
| | - Ling Yu
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
| | - Wei Sun
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
| | - Yong Yang
- School of Automation, Hangzhou Dianzi University, Hangzhou, China
| | | | - Lin Lu
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Institute of Mental Health, Peking University Sixth Hospital, Beijing, China.,National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China.,Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
| | - Jia-Hui Deng
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
| | - Su-Xia Li
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China.,Department of Pharmacology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
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12
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Pal A, Pegwal N, Behari M, Sharma R. High delta and gamma EEG power in resting state characterise dementia in Parkinson’s patients. Biomark Neuropsychiatry 2020. [DOI: 10.1016/j.bionps.2020.100027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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13
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Tiksnadi A, Murakami T, Wiratman W, Matsumoto H, Ugawa Y. Direct comparison of efficacy of the motor cortical plasticity induction and the interindividual variability between TBS and QPS. Brain Stimul 2020; 13:1824-1833. [PMID: 33144269 DOI: 10.1016/j.brs.2020.10.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/04/2020] [Accepted: 10/23/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Theta burst stimulation (TBS) and quadripulse stimulation (QPS) are known to induce synaptic plasticity in humans. There have been no head-to-head comparisons of the efficacy and variability between TBS and QPS. OBJECTIVE To compare the efficacy and interindividual variability between the original TBS and QPS protocols. We hypothesized that QPS would be more effective and less variable than TBS. METHODS Forty-six healthy subjects participated in this study. Thirty subjects participated in the main comparison experiment, and the other sixteen subjects participated in the experiment to obtain natural variation in motor-evoked potentials. The facilitatory effects were compared between intermittent TBS (iTBS) and QPS5, and the inhibitory effects were compared between continuous TBS (cTBS) and QPS50. The motor-evoked potential amplitudes elicited by transcranial magnetic stimulation over the primary motor cortex were measured before the intervention and every 5 min after the intervention for 1 h. To investigate the interindividual variability, the responder/nonresponder/opposite-responder rates were also analyzed. RESULTS The facilitatory effects of QPS5 were greater than those of iTBS, and the inhibitory effects of QPS50 were much stronger than those of cTBS. The responder rate of QPS was significantly higher than that of TBS. QPS had a smaller number of opposite responders than TBS. CONCLUSION QPS is more effective and stable for synaptic plasticity induction than TBS.
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Affiliation(s)
- Amanda Tiksnadi
- Department of Neurology, Fukushima Medical University, Fukushima, Japan; Department of Neurology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
| | - Takenobu Murakami
- Department of Neurology, Fukushima Medical University, Fukushima, Japan; Department of Neurology, Tottori Prefectural Kousei Hospital, Tottori, Japan
| | - Winnugroho Wiratman
- Department of Neurology, Fukushima Medical University, Fukushima, Japan; Department of Neurology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | | | - Yoshikazu Ugawa
- Department of Neurology, Fukushima Medical University, Fukushima, Japan; Department of Human Neurophysiology, Fukushima Medical University, Fukushima, Japan
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14
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Tatti E, Ricci S, Nelson AB, Mathew D, Chen H, Quartarone A, Cirelli C, Tononi G, Ghilardi MF. Prior Practice Affects Movement-Related Beta Modulation and Quiet Wake Restores It to Baseline. Front Syst Neurosci 2020; 14:61. [PMID: 33013332 PMCID: PMC7462015 DOI: 10.3389/fnsys.2020.00061] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/24/2020] [Indexed: 12/30/2022] Open
Abstract
Beta oscillations (13.5−25 Hz) over the sensorimotor areas are characterized by a power decrease during movement execution (event-related desynchronization, ERD) and a sharp rebound after the movement end (event-related synchronization, ERS). In previous studies, we demonstrated that movement-related beta modulation depth (peak ERS-ERD) during reaching increases within 1-h practice. This increase may represent plasticity processes within the sensorimotor network. If so, beta modulation during a reaching test should be affected by previous learning activity that engages the sensorimotor system but not by learning involving other systems. We thus recorded high-density EEG activity in a group of healthy subjects performing three 45-min blocks of motor adaptation task to a visually rotated display (ROT) and in another performing three blocks of visual sequence-learning (VSEQ). Each block of either ROT or VSEQ was followed by a simple reaching test (mov) without rotation. We found that beta modulation depth increased with practice across mov tests. However, such an increase was greater in the group performing ROT over both the left and frontal areas previously involved in ROT. Importantly, beta modulation values returned to baseline values after a 90-min of either nap or quiet wake. These results show that previous practice leaves a trace in movement-related beta modulation and therefore such increases are cumulative. Furthermore, as sleep is not necessary to bring beta modulation values to baseline, they could reflect local increases of neuronal activity and decrease of energy and supplies.
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Affiliation(s)
- Elisa Tatti
- CUNY School of Medicine, The City University of New York, New York, NY, United States
| | - Serena Ricci
- CUNY School of Medicine, The City University of New York, New York, NY, United States
| | - Aaron B Nelson
- CUNY School of Medicine, The City University of New York, New York, NY, United States
| | - Dave Mathew
- CUNY School of Medicine, The City University of New York, New York, NY, United States
| | - Henry Chen
- CUNY School of Medicine, The City University of New York, New York, NY, United States
| | - Angelo Quartarone
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Messina, Italy
| | - Chiara Cirelli
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, United States
| | - Giulio Tononi
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, United States
| | - Maria Felice Ghilardi
- CUNY School of Medicine, The City University of New York, New York, NY, United States
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15
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Theta burst stimulation in humans: a need for better understanding effects of brain stimulation in health and disease. Exp Brain Res 2020; 238:1707-1714. [PMID: 32671422 DOI: 10.1007/s00221-020-05880-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 06/30/2020] [Indexed: 12/17/2022]
Abstract
Repetitive transcranial stimulation (rTMS) paradigms have been used to induce lasting changes in brain activity and excitability. Previous methods of stimulation were long, often ineffective and produced short-lived and variable results. A new non-invasive brain stimulation technique was developed in John Rothwell's laboratory in the early 2000s, which was named 'theta burst stimulation' (TBS). This used rTMS applied in burst patterns of newly acquired 50 Hz rTMS machines, which emulated long-term potentiation/depression-like effects in brain slices. This stimulation paradigm created long-lasting changes in brain excitability, using efficient, very rapid stimulation, which would affect behaviour, with the aim to influence neurological diseases in humans. We describe the development of this technique, including findings and limitations identified since then. We discuss how pitfalls facing TBS reflect those involving both older and newer, non-invasive stimulation techniques, with suggestions of how to overcome these, using personalised, 'closed loop' stimulation methods. The challenge in most non-invasive stimulation techniques remains in identifying their exact mechanisms of action in the context of neurological disease models. The development of TBS provides the backdrop for describing John's contribution to the field, inspiring our own scientific endeavour thanks to his unconditional support, and unfailing kindness.
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16
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Yu F, Tang X, Hu R, Liang S, Wang W, Tian S, Wu Y, Yuan TF, Zhu Y. The After-Effect of Accelerated Intermittent Theta Burst Stimulation at Different Session Intervals. Front Neurosci 2020; 14:576. [PMID: 32670006 PMCID: PMC7330092 DOI: 10.3389/fnins.2020.00576] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/11/2020] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE The study aims to investigate the after-effect of three sessions of intermittent theta-burst stimulation (iTBS) on motor cortical excitability. The iTBS was induced over the primary motor cortex (M1) at different time intervals. METHODS The study has a crossover design. Sixteen participants were assigned to three groups and received different accelerated iTBS (aiTBS) protocols during each visit: (1) three continuous sessions with no interval (iTBS18000); (2) three iTBS sessions with 10-min intervals (iTBS600 × 3∗10); and (3) three iTBS sessions with 30-min intervals (iTBS600 × 3∗30). As washout period, each visit is separated by at least 7 days. We measured the motor cortical excitability changes and intracortical inhibition. RESULTS A dose of 1,800 pulses of aiTBS per day is tolerable. The iTBS1800 led to a reduced cortical excitability; whereas iTBS600 × 3∗10 and iTBS600 × 3∗30 enhanced cortical excitability to a differential extent. After a total dose of 1,800 pulses, iTBS600 × 3∗30 exhibited the longer effect and highest percentage of individuals with enhanced cortical excitability. CONCLUSION The results suggest that aiTBS protocols at different time intervals result in different motor cortical excitability after-effects.
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Affiliation(s)
- Fengyun Yu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Xinwei Tang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Ruiping Hu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Sijie Liang
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Weining Wang
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Shan Tian
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yi Wu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Ti-Fei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Co-innovation Center of Neuroregeneration, Nantong University, Nantong, China
| | - Yulian Zhu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
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17
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Aging Does Not Affect Beta Modulation during Reaching Movements. Neural Plast 2019; 2019:1619290. [PMID: 31223306 PMCID: PMC6541950 DOI: 10.1155/2019/1619290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/09/2019] [Accepted: 04/17/2019] [Indexed: 12/24/2022] Open
Abstract
During movement, modulation of beta power occurs over the sensorimotor areas, with a decrease just before its start (event-related desynchronization, ERD) and a rebound after its end (event-related synchronization, ERS). We have recently found that the depth of ERD-to-ERS modulation increases during practice in a reaching task and the following day decreases to baseline levels. Importantly, the magnitude of the beta modulation increase during practice is highly correlated with the retention of motor skill tested the following day. Together with other evidence, this suggests that the increase of practice-related modulation depth may be the expression of sensorimotor cortex's plasticity. Here, we determine whether the practice-related increase of beta modulation depth is equally present in a group of younger and a group of older subjects during the performance of a 30-minute block of reaching movements. We focused our analyses on two regions of interest (ROIs): the left sensorimotor and the frontal region. Performance indices were significantly different in the two groups, with the movements of older subjects being slower and less accurate. Importantly, both groups presented a similar increase of the practice-related beta modulation depth in both ROIs in the course of the task. Peak latency analysis revealed a progressive delay of the ERS peak that correlated with the total movement time. Altogether, these findings support the notion that the depth of beta modulation in a reaching movement task does not depend on age and confirm previous findings that only ERS peak latency but not ERS magnitude is related to performance indices.
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18
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Chen YJ, Huang YZ, Chen CY, Chen CL, Chen HC, Wu CY, Lin KC, Chang TL. Intermittent theta burst stimulation enhances upper limb motor function in patients with chronic stroke: a pilot randomized controlled trial. BMC Neurol 2019; 19:69. [PMID: 31023258 PMCID: PMC6485156 DOI: 10.1186/s12883-019-1302-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 04/11/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Intermittent theta burst stimulation (iTBS) is a form of repetitive transcranial stimulation that has been used to enhance upper limb (UL) motor recovery. However, only limited studies have examined its efficacy in patients with chronic stroke and therefore it remains controversial. METHODS This was a randomized controlled trial that enrolled patients from a rehabilitation department. Twenty-two patients with first-ever chronic and unilateral cerebral stroke, aged 30-70 years, were randomly assigned to the iTBS or control group. All patients received 1 session per day for 10 days of either iTBS or sham stimulation over the ipsilesional primary motor cortex in addition to conventional neurorehabilitation. Outcome measures were assessed before and immediately after the intervention period: Modified Ashworth Scale (MAS), Fugl-Meyer Assessment Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), Box and Block test (BBT), and Motor Activity Log (MAL). Analysis of covariance was adopted to compare the treatment effects between groups. RESULTS The iTBS group had greater improvement in the MAS and FMA than the control group (η2 = 0.151-0.233; p < 0.05), as well as in the ARAT and BBT (η2 = 0.161-0.460; p < 0.05) with large effect size. Both groups showed an improvement in the BBT, and there were no significant between-group differences in MAL changes. CONCLUSIONS The iTBS induced greater gains in spasticity decrease and UL function improvement, especially in fine motor function, than sham TBS. This is a promising finding because patients with chronic stroke have a relatively low potential for fine motor function recovery. Overall, iTBS may be a beneficial adjunct therapy to neurorehabilitation for enhancing UL function. Further larger-scale study is warranted to confirm the findings and its long-term effect. TRIAL REGISTRATION This trial was registered under ClinicalTrials.gov ID No. NCT01947413 on September 20, 2013.
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Affiliation(s)
- Yu-Jen Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, 5, Fushing Street, Kuei-Shan District, Taoyuan City, 33305, Taiwan
| | - Ying-Zu Huang
- Neuroscience Research Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou, Taiwan.,Institute of Cognitive Neuroscience, National Central University, Taoyuan, Taiwan.,Medical School, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Yao Chen
- Medical School, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chia-Ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, 5, Fushing Street, Kuei-Shan District, Taoyuan City, 33305, Taiwan. .,Graduate Institute of Early Intervention, Chang Gung University, Taoyuan, Taiwan.
| | - Hsieh-Ching Chen
- Department of Industrial and Management, National Taipei University of Technology, Taipei, Taiwan
| | - Ching-Yi Wu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, 5, Fushing Street, Kuei-Shan District, Taoyuan City, 33305, Taiwan.,Department of Occupational Therapy, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Keh-Chung Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Tzu-Ling Chang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, 5, Fushing Street, Kuei-Shan District, Taoyuan City, 33305, Taiwan
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19
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Tatti E, Ricci S, Mehraram R, Lin N, George S, Nelson AB, Ghilardi MF. Beta Modulation Depth Is Not Linked to Movement Features. Front Behav Neurosci 2019; 13:49. [PMID: 30923498 PMCID: PMC6426772 DOI: 10.3389/fnbeh.2019.00049] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 02/26/2019] [Indexed: 11/17/2022] Open
Abstract
Beta power over the sensorimotor areas starts decreasing just before movement execution (event-related desynchronization, ERD) and increases post-movement (event-related synchronization, ERS). In this study, we determined whether the magnitude of beta ERD, ERS and modulation depth are linked to movement characteristics, such as movement length and velocity. Brain activity was recorded with a 256-channels EEG system in 35 healthy subjects performing fast, uncorrected reaching movements to targets located at three distances. We found that the temporal profiles of velocity were bell-shaped and scaled to the appropriate target distance. However, the magnitude of beta ERD, ERS and modulation depth, as well as their timing, did not significantly change and were not related to movement features.
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Affiliation(s)
- Elisa Tatti
- CUNY School of Medicine, New York City, NY, United States
| | - Serena Ricci
- CUNY School of Medicine, New York City, NY, United States.,Dipartimento di Informatica, Bioingegneria, Robotica e Ingegneria dei Sistemi (DIBRIS), University of Genova, Genoa, Italy
| | - Ramtin Mehraram
- CUNY School of Medicine, New York City, NY, United States.,Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Nancy Lin
- CUNY School of Medicine, New York City, NY, United States
| | - Shaina George
- CUNY School of Medicine, New York City, NY, United States
| | - Aaron B Nelson
- CUNY School of Medicine, New York City, NY, United States
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20
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Estévez-Báez M, Machado C, García-Sánchez B, Rodríguez V, Alvarez-Santana R, Leisman G, Carrera JME, Schiavi A, Montes-Brown J, Arrufat-Pié E. Autonomic impairment of patients in coma with different Glasgow coma score assessed with heart rate variability. Brain Inj 2019; 33:496-516. [PMID: 30755043 DOI: 10.1080/02699052.2018.1553312] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PRIMARY OBJECTIVE The objective of this study is to assess the functional state of the autonomic nervous system in healthy individuals and in individuals in coma using measures of heart rate variability (HRV) and to evaluate its efficiency in predicting mortality. DESIGN AND METHODS Retrospective group comparison study of patients in coma classified into two subgroups, according to their Glasgow coma score, with a healthy control group. HRV indices were calculated from 7 min of artefact-free electrocardiograms using the Hilbert-Huang method in the spectral range 0.02-0.6 Hz. A special procedure was applied to avoid confounding factors. Stepwise multiple regression logistic analysis (SMLRA) and ROC analysis evaluated predictions. RESULTS Progressive reduction of HRV was confirmed and was associated with deepening of coma and a mortality score model that included three spectral HRV indices of absolute power values of very low, low and very high frequency bands (0.4-0.6 Hz). The SMLRA model showed sensitivity of 95.65%, specificity of 95.83%, positive predictive value of 95.65%, and overall efficiency of 95.74%. CONCLUSIONS HRV is a reliable method to assess the integrity of the neural control of the caudal brainstem centres on the hearts of patients in coma and to predict patient mortality.
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Affiliation(s)
- Mario Estévez-Báez
- a Department of Clinical Neurophysiology , Institute of Neurology and Neurosurgery , Havana , Cuba
| | - Calixto Machado
- a Department of Clinical Neurophysiology , Institute of Neurology and Neurosurgery , Havana , Cuba
| | | | | | | | - Gerry Leisman
- d Faculty of Health Sciences , University of Haifa , Haifa , Israel
| | | | - Adam Schiavi
- e Anesthesiology and Critical Care Medicine, Neurosciences Critical Care Division , Johns Hopkins Hospital , Baltimore , MD , USA
| | - Julio Montes-Brown
- f Department of Medicine & Health Science , University of Sonora , Sonora , Mexico
| | - Eduardo Arrufat-Pié
- g Institute of Basic and Preclinical Sciences, "Victoria de Girón" , Havana , Cuba
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21
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Wilson MT, Fulcher BD, Fung PK, Robinson P, Fornito A, Rogasch NC. Biophysical modeling of neural plasticity induced by transcranial magnetic stimulation. Clin Neurophysiol 2018; 129:1230-1241. [DOI: 10.1016/j.clinph.2018.03.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/28/2018] [Accepted: 03/14/2018] [Indexed: 10/17/2022]
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22
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The effect of single and repeated prefrontal intermittent theta burst stimulation on cortical reactivity and working memory. Brain Stimul 2018; 11:566-574. [DOI: 10.1016/j.brs.2018.01.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/18/2017] [Accepted: 01/04/2018] [Indexed: 01/26/2023] Open
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23
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Nelson AB, Moisello C, Lin J, Panday P, Ricci S, Canessa A, Di Rocco A, Quartarone A, Frazzitta G, Isaias IU, Tononi G, Cirelli C, Ghilardi MF. Beta Oscillatory Changes and Retention of Motor Skills during Practice in Healthy Subjects and in Patients with Parkinson's Disease. Front Hum Neurosci 2017; 11:104. [PMID: 28326029 PMCID: PMC5339296 DOI: 10.3389/fnhum.2017.00104] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/20/2017] [Indexed: 11/20/2022] Open
Abstract
Recently we found that modulation depth of beta power during movement increases with practice over sensory-motor areas in normal subjects but not in patients with Parkinson's disease (PD). As such changes might reflect use-dependent modifications, we concluded that reduction of beta enhancement in PD represents saturation of cortical plasticity. A few questions remained open: What is the relation between these EEG changes and retention of motor skills? Would a second task exposure restore beta modulation enhancement in PD? Do practice-induced increases of beta modulation occur within each block? We thus recorded EEG in patients with PD and age-matched controls in two consecutive days during a 40-min reaching task divided in fifteen blocks of 56 movements each. The results confirmed that, with practice, beta modulation depth over the contralateral sensory-motor area significantly increased across blocks in controls but not in PD, while performance improved in both groups without significant correlations between behavioral and EEG data. The same changes were seen the following day in both groups. Also, beta modulation increased within each block with similar values in both groups and such increases were partially transferred to the successive block in controls, but not in PD. Retention of performance improvement was present in the controls but not in the patients and correlated with the increase in day 1 modulation depth. Therefore, the lack of practice-related increase beta modulation in PD is likely due to deficient potentiation mechanisms that permit between-block saving of beta power enhancement and trigger mechanisms of memory formation.
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Affiliation(s)
- Aaron B Nelson
- Department of Physiology, Pharmacology and Neuroscience, City University of New York School of Medicine New York, NY, USA
| | - Clara Moisello
- Department of Physiology, Pharmacology and Neuroscience, City University of New York School of Medicine New York, NY, USA
| | - Jing Lin
- Department of Physiology, Pharmacology and Neuroscience, City University of New York School of Medicine New York, NY, USA
| | - Priya Panday
- Department of Physiology, Pharmacology and Neuroscience, City University of New York School of Medicine New York, NY, USA
| | - Serena Ricci
- Department of Physiology, Pharmacology and Neuroscience, City University of New York School of MedicineNew York, NY, USA; Department of Informatics, Bioengineering, Robotics and System Engineering, University of GenoaGenoa, Italy
| | - Andrea Canessa
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of GenoaGenoa, Italy; Fondazione Europea di Ricerca BiomedicaCernusco sul Naviglio, Milan, Italy
| | - Alessandro Di Rocco
- The Fresco Institute at New York University School of Medicine New York, NY, USA
| | - Angelo Quartarone
- The Fresco Institute at New York University School of MedicineNew York, NY, USA; Centro Neurolesi, University of MessinaMessina, Italy
| | | | - Ioannis U Isaias
- The Fresco Institute at New York University School of MedicineNew York, NY, USA; Department of Neurology, University Hospital and Julius-Maximillian-UniversityWuerzburg, Germany; Parkinson Institute ASST Gaetano Pini-CTOMilan, Italy
| | - Giulio Tononi
- Department of Psychiatry, University of Wisconsin-Madison Madison, WI, USA
| | - Chiara Cirelli
- Department of Psychiatry, University of Wisconsin-Madison Madison, WI, USA
| | - M Felice Ghilardi
- Department of Physiology, Pharmacology and Neuroscience, City University of New York School of MedicineNew York, NY, USA; The Fresco Institute at New York University School of MedicineNew York, NY, USA
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24
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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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25
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Moisello C, Blanco D, Lin J, Panday P, Kelly SP, Quartarone A, Di Rocco A, Cirelli C, Tononi G, Ghilardi MF. Practice changes beta power at rest and its modulation during movement in healthy subjects but not in patients with Parkinson's disease. Brain Behav 2015; 5:e00374. [PMID: 26516609 PMCID: PMC4614055 DOI: 10.1002/brb3.374] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 07/22/2015] [Accepted: 07/24/2015] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND PD (Parkinson's disease) is characterized by impairments in cortical plasticity, in beta frequency at rest and in beta power modulation during movement (i.e., event-related ERS [synchronization] and ERD [desynchronization]). Recent results with experimental protocols inducing long-term potentiation in healthy subjects suggest that cortical plasticity phenomena might be reflected by changes of beta power recorded with EEG during rest. Here, we determined whether motor practice produces changes in beta power at rest and during movements in both healthy subjects and patients with PD. We hypothesized that such changes would be reduced in PD. METHODS We thus recorded EEG in patients with PD and age-matched controls before, during and after a 40-minute reaching task. We determined posttask changes of beta power at rest and assessed the progressive changes of beta ERD and ERS during the task over frontal and sensorimotor regions. RESULTS We found that beta ERS and ERD changed significantly with practice in controls but not in PD. In PD compared to controls, beta power at rest was greater over frontal sensors but posttask changes, like those during movements, were far less evident. In both groups, kinematic characteristics improved with practice; however, there was no correlation between such improvements and the changes in beta power. CONCLUSIONS We conclude that prolonged practice in a motor task produces use-dependent modifications that are reflected in changes of beta power at rest and during movement. In PD, such changes are significantly reduced; such a reduction might represent, at least partially, impairment of cortical plasticity.
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Affiliation(s)
- Clara Moisello
- Department of Physiology, Pharmacology and Neuroscience CUNY Medical School New York New York 10031
| | - Daniella Blanco
- Department of Physiology, Pharmacology and Neuroscience CUNY Medical School New York New York 10031
| | - Jing Lin
- Department of Physiology, Pharmacology and Neuroscience CUNY Medical School New York New York 10031
| | - Priya Panday
- Department of Physiology, Pharmacology and Neuroscience CUNY Medical School New York New York 10031
| | - Simon P Kelly
- Department of Biomedical Engineering CCNY New York New York 10031
| | - Angelo Quartarone
- Department of Physiology, Pharmacology and Neuroscience CUNY Medical School New York New York 10031 ; Department of Neurosciences, Psychiatry and Anaesthesiological Sciences University of Messina Messina 98125 Italy ; The Fresco Institute for Parkinson's and Movement Disorders NYU-Langone School of Medicine New York New York 10016
| | - Alessandro Di Rocco
- The Fresco Institute for Parkinson's and Movement Disorders NYU-Langone School of Medicine New York New York 10016
| | - Chiara Cirelli
- Department of Psychiatry University of Madison Madison Wisconsin 53719
| | - Giulio Tononi
- Department of Psychiatry University of Madison Madison Wisconsin 53719
| | - M Felice Ghilardi
- Department of Physiology, Pharmacology and Neuroscience CUNY Medical School New York New York 10031 ; The Fresco Institute for Parkinson's and Movement Disorders NYU-Langone School of Medicine New York New York 10016
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26
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Cortical Excitability Measured with nTMS and MEG during Stroke Recovery. Neural Plast 2015; 2015:309546. [PMID: 26491569 PMCID: PMC4600492 DOI: 10.1155/2015/309546] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 05/05/2015] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Stroke alters cortical excitability both in the lesioned and in the nonlesioned hemisphere. Stroke recovery has been studied using transcranial magnetic stimulation (TMS). Spontaneous brain oscillations and somatosensory evoked fields (SEFs) measured by magnetoencephalography (MEG) are modified in stroke patients during recovery. METHODS We recorded SEFs and spontaneous MEG activity and motor threshold (MT) short intracortical inhibition (SICI) and intracortical facilitation (ICF) with navigated TMS (nTMS) at one and three months after first-ever hemispheric ischemic strokes. Changes of MEG and nTMS parameters attributed to gamma-aminobutyrate and glutamate transmission were compared. RESULTS ICF correlated with the strength and extent of SEF source areas depicted by MEG at three months. The nTMS MT and event-related desynchronization (ERD) of beta-band MEG activity and SICI and the beta-band MEG event-related synchronization (ERS) were correlated, but less strongly. CONCLUSIONS This first report using sequential nTMS and MEG in stroke recovery found intra- and interhemispheric correlations of nTMS and MEG estimates of cortical excitability. ICF and SEF parameters, MT and the ERD of the lesioned hemisphere, and SICI and ERS of the nonlesioned hemisphere were correlated. Covarying excitability in the lesioned and nonlesioned hemispheres emphasizes the importance of the hemispheric balance of the excitability of the sensorimotor system.
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27
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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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Intensity sensitive modulation effect of theta burst form of median nerve stimulation on the monosynaptic spinal reflex. Neural Plast 2015; 2015:704849. [PMID: 25821603 PMCID: PMC4364050 DOI: 10.1155/2015/704849] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 02/22/2015] [Indexed: 01/05/2023] Open
Abstract
The effects of electrical stimulation of median nerve with a continuous theta burst pattern (EcTBS) on the spinal H-reflex were studied. Different intensities and durations of EcTBS were given to the median nerve to 11 healthy individuals. The amplitude ratio of the H-reflex to maximum M wave (H/M ratio), corticospinal excitability and inhibition measured using motor evoked potentials (MEPs), short-interval intracortical inhibition and facilitation (SICI/ICF), spinal reciprocal inhibition (RI), and postactivation depression (PAD) were measured before and after EcTBS. In result, the H/M ratio was reduced followed by EcTBS at 90% H-reflex threshold, and the effect lasted longer after 1200 pulses than after 600 pulses of EcTBS. In contrast, EcTBS at 110% threshold facilitated the H/M ratio, while at 80% threshold it had no effect. Maximum M wave, MEPs, SICI/ICF, RI, and PAD all remained unchanged after EcTBS. In conclusion, EcTBS produced lasting effects purely on the H-reflex, probably, through effects on postsynaptic plasticity. The effect of EcTBS depends on the intensity and duration of stimulation. EcTBS is beneficial to research on mechanisms of human plasticity. Moreover, its ability to modulate spinal excitability is expected to have therapeutic benefits on neurological disorders involving spinal cord dysfunction.
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Jeggo R, Zhao FY, Spanswick D. Electrophysiological Techniques for Studying Synaptic Activity In Vivo. CURRENT PROTOCOLS IN PHARMACOLOGY 2014; 64:11.11.1-17. [PMID: 26344209 DOI: 10.1002/0471141755.ph1111s64] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Understanding the physiology, pharmacology, and plasticity associated with synaptic function is a key goal of neuroscience research and is fundamental to identifying the processes involved in the development and manifestation of neurological disease. A diverse range of electrophysiological methodologies are used to study synaptic function. Described in this unit is a technique for recording electrical activity from a single component of the central nervous system that is used to investigate pre- and post-synaptic elements of synaptic function. A strength of this technique is that it can be used on live animals, although the effect of anesthesia must be taken into consideration when interpreting the results. This methodology can be employed not only in naïve animals for studying normal physiological synaptic function, but also in a variety of disease models, including transgenic animals, to examine dysfunctional synaptic plasticity associated with neurological pathologies.
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Affiliation(s)
- Ross Jeggo
- Neurosolutions Limited, University of Warwick Medical School, Coventry, United Kingdom
| | - Fei-Yue Zhao
- Neurosolutions Limited, University of Warwick Medical School, Coventry, United Kingdom
| | - David Spanswick
- The Institute For Genomic Research, Rockville, Maryland.,Department of Physiology, Monash University, Clayton, Victoria, Australia.,University of Warwick Medical School, Coventry, United Kingdom
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30
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Lynch G, Gall CM. Mechanism based approaches for rescuing and enhancing cognition. Front Neurosci 2013; 7:143. [PMID: 23966908 PMCID: PMC3744010 DOI: 10.3389/fnins.2013.00143] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 05/23/2013] [Indexed: 01/24/2023] Open
Abstract
Progress toward pharmacological means for enhancing memory and cognition has been retarded by the widely discussed failure of behavioral studies in animals to predict human outcomes. As a result, a number of groups have targeted cognition-related neurobiological mechanisms in animal models, with the assumption that these basic processes are highly conserved across mammals. Here we survey one such approach that begins with a form of synaptic plasticity intimately related to memory encoding in animals and likely operative in humans. An initial section will describe a detailed hypothesis concerning the signaling and structural events (a “substrate map”) that convert learning associated patterns of afferent activity into extremely stable increases in fast, excitatory transmission. We next describe results suggesting that all instances of intellectual impairment so far tested in rodent models involve a common endpoint failure in the substrate map. This will be followed by a clinically plausible proposal for obviating the ultimate defect in these models. We then take up the question of whether it is reasonable to expect, from either general principles or a very limited set of experimental results, that enhancing memory will expand the cognitive capabilities of high functioning brains. The final section makes several suggestions about how to improve translation of behavioral results from animals to humans. Collectively, the material covered here points to the following: (1) enhancement, in the sense of rescue, is not an unrealistic possibility for a broad array of neuropsychiatric disorders; (2) serendipity aside, developing means for improving memory in normals will likely require integration of information about mechanisms with new behavioral testing strategies; (3) a shift in emphasis from synapses to networks is a next, logical step in the evolution of the cognition enhancement field.
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Affiliation(s)
- Gary Lynch
- Department of Psychiatry and Human Behavior, University of California Irvine, CA, USA ; Department of Anatomy and Neurobiology, University of California Irvine, CA, USA
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Oscillatory beta activity mediates neuroplastic effects of motor cortex stimulation in humans. J Neurosci 2013; 33:7919-27. [PMID: 23637183 DOI: 10.1523/jneurosci.5624-12.2013] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Continuous theta burst stimulation (cTBS) is a repetitive transcranial magnetic stimulation protocol that can inhibit human motor cortex (M1) excitability and impair movement for ≤ 1 h. While offering valuable insights into brain function and potential therapeutic benefits, these neuroplastic effects are highly variable between individuals. The source of this variability, and the electrophysiological mechanisms underlying the inhibitory after-effects, are largely unknown. In this regard, oscillatory activity at beta frequency (15-35 Hz) is of particular interest as it is elevated in motor disorders such as Parkinson's disease and modulated during the generation of movements. Here, we used a source-level magnetoencephalography approach to investigate the hypothesis that the presence of neuroplastic effects following cTBS is associated with concurrent changes in oscillatory M1 beta activity. M1 cortices were localized with a synthetic aperture magnetometry beamforming analysis of visually cued index finger movements. Virtual electrode analysis was used to reconstruct the spontaneous and movement-related oscillatory activity in bilateral M1 cortices, before and from 10 to 45 min after cTBS. We demonstrate that 40 s of cTBS applied over left M1 reduced corticospinal excitability in the right index finger of 8/16 participants. In these responder participants only, cTBS increased the power of the spontaneous beta oscillations in stimulated M1 and delayed reaction times in the contralateral index finger. No further changes were observed in the latency or power of movement-related beta oscillations. These data provide insights into the electrophysiological mechanisms underlying cTBS-mediated impairment of motor function and demonstrate the association between spontaneous oscillatory beta activity in M1 and the inhibition of motor function.
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Hsu YF, Huang YZ, Lin YY, Tang CW, Liao KK, Lee PL, Tsai YA, Cheng HL, Cheng H, Chern CM, Lee IH. Intermittent theta burst stimulation over ipsilesional primary motor cortex of subacute ischemic stroke patients: A pilot study. Brain Stimul 2013; 6:166-74. [PMID: 22659021 DOI: 10.1016/j.brs.2012.04.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 04/15/2012] [Accepted: 04/19/2012] [Indexed: 01/24/2023] Open
Affiliation(s)
- Ya-Fang Hsu
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
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Magnetoencephalography and neuromodulation. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2012. [PMID: 23206680 DOI: 10.1016/b978-0-12-404706-8.00007-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Magnetoencephalography (MEG) is a noninvasive method which allows recordings of human brain activity with excellent temporal and good spatial resolution. In this chapter, we review applications of MEG in neuromodulation. We provide an overview of studies which used MEG to optimize parameters for neuromodulation and to characterize the electrophysiological effects of brain stimulation. In particular, we discuss how MEG may be employed to study deep brain stimulation. In this context, we describe the problems arising from stimulation artifacts and present approaches to solve them.
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Pichiorri F, Vicenzini E, Gilio F, Giacomelli E, Frasca V, Cambieri C, Ceccanti M, Di Piero V, Inghilleri M. Effects of intermittent theta burst stimulation on cerebral blood flow and cerebral vasomotor reactivity. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:1159-1167. [PMID: 22837279 DOI: 10.7863/jum.2012.31.8.1159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To determine whether intermittent theta burst stimulation influences cerebral hemodynamics, we investigated changes induced by intermittent theta burst stimulation on the middle cerebral artery cerebral blood flow velocity and vasomotor reactivity to carbon dioxide (CO(2)) in healthy participants. The middle cerebral artery flow velocity and vasomotor reactivity were monitored by continuous transcranial Doppler sonography. Changes in cortical excitability were tested by transcranial magnetic stimulation. METHODS In 11 healthy participants, before and immediately after delivering intermittent theta burst stimulation, we tested cortical excitability measured by the resting motor threshold and motor evoked potential amplitude over the stimulated hemisphere and vasomotor reactivity to CO(2) bilaterally. The blood flow velocity was monitored in both middle cerebral arteries throughout the experimental session. In a separate session, we tested the effects of sham stimulation under the same experimental conditions. RESULTS Whereas the resting motor threshold remained unchanged before and after stimulation, motor evoked potential amplitudes increased significantly (P = .04). During and after stimulation, middle cerebral artery blood flow velocities also remained bilaterally unchanged, whereas vasomotor reactivity to CO(2) increased bilaterally (P = .04). The sham stimulation left all variables unchanged. CONCLUSIONS The expected intermittent theta burst stimulation-induced changes in cortical excitability were not accompanied by changes in cerebral blood flow velocities; however, the bilateral increased vasomotor reactivity suggests that intermittent theta burst stimulation influences the cerebral microcirculation, possibly involving subcortical structures. These findings provide useful information on hemodynamic phenomena accompanying intermittent theta burst stimulation, which should be considered in research aimed at developing this noninvasive, low-intensity stimulation technique for safe therapeutic applications.
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Affiliation(s)
- Floriana Pichiorri
- Department of Neurology and Psychiatry, Sapienza University, Viale Dell'Università 30, 00185 Rome, Italy
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Hamada M, Murase N, Hasan A, Balaratnam M, Rothwell JC. The Role of Interneuron Networks in Driving Human Motor Cortical Plasticity. Cereb Cortex 2012; 23:1593-605. [DOI: 10.1093/cercor/bhs147] [Citation(s) in RCA: 540] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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