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Strigaro G, Gori B, Varrasi C, Fleetwood T, Cantello G, Cantello R. Flash-evoked high-frequency EEG oscillations in photosensitive epilepsies. Epilepsy Res 2021; 172:106597. [PMID: 33714866 DOI: 10.1016/j.eplepsyres.2021.106597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 02/03/2021] [Accepted: 02/27/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine the feasibility of measuring scalp-recorded, flash-evoked, high-frequency EEG oscillations (F-HFOs) using a relatively simple technique. Furthermore, to assess whether F-HFOs are enhanced in photosensitive epileptic patients and if they might be proposed as a putative non-provocative biomarker of photosensitivity. METHODS We studied 19 photosensitive patients with idiopathic generalized epilepsy, and 22 controls matched for demographic features. We extracted F-HFOs from the broadband scalp flash-visual evoked potential (b F-VEP) through appropriate filtering. We measured F-HFO amplitude, number and latency. Also, we carried out a time-frequency domain spectral F-HFO analysis. Inter-group statistics was performed. Within-groups, F-HFO features were correlated to the b F-VEP. RESULTS The N3-N3I wave of the b F-VEP was significantly (p = 0.01) larger in patients compared to controls. The same was true for the inter-group F-HFO amplitude (p = 0.01). F-HFOs showed two main spectral peaks (∼88 and ∼125 Hz), whose power was greater (p = 0.001) in patients than in controls. The ∼88 Hz peak power exceeded the upper normal range in 15/19 patients. Patients showed a significant (p = 0.04) correlation between the ∼88 Hz peak power and the size of the N3-N3I wave. SIGNIFICANCE A simplified F-HFO measurement proved feasible. In patients, F-HFOs were enhanced in terms of both size and spectral power, suggesting a role in the generation of the photoparoxysmal response. Some spectral features of the F-HFOs may be proposed as a putative non-provocative marker of epileptic photosensitivity.
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Affiliation(s)
- Gionata Strigaro
- Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, Azienda Ospedaliero-Universitaria "Maggiore della Carità", Novara, Italy.
| | - Benedetta Gori
- Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, Azienda Ospedaliero-Universitaria "Maggiore della Carità", Novara, Italy
| | - Claudia Varrasi
- Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, Azienda Ospedaliero-Universitaria "Maggiore della Carità", Novara, Italy
| | - Thomas Fleetwood
- Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, Azienda Ospedaliero-Universitaria "Maggiore della Carità", Novara, Italy
| | - Giorgio Cantello
- Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, Azienda Ospedaliero-Universitaria "Maggiore della Carità", Novara, Italy
| | - Roberto Cantello
- Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, Azienda Ospedaliero-Universitaria "Maggiore della Carità", Novara, Italy
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Karabanov AN, Saturnino GB, Thielscher A, Siebner HR. Can Transcranial Electrical Stimulation Localize Brain Function? Front Psychol 2019; 10:213. [PMID: 30837911 PMCID: PMC6389710 DOI: 10.3389/fpsyg.2019.00213] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 01/22/2019] [Indexed: 11/13/2022] Open
Abstract
Transcranial electrical stimulation (TES) uses constant (TDCS) or alternating currents (TACS) to modulate brain activity. Most TES studies apply low-intensity currents through scalp electrodes (≤2 mA) using bipolar electrode arrangements, producing weak electrical fields in the brain (<1 V/m). Low-intensity TES has been employed in humans to induce changes in task performance during or after stimulation. In analogy to focal transcranial magnetic stimulation, TES-induced behavioral effects have often been taken as evidence for a causal involvement of the brain region underlying one of the two stimulation electrodes, often referred to as the active electrode. Here, we critically review the utility of bipolar low-intensity TES to localize human brain function. We summarize physiological substrates that constitute peripheral targets for TES and may mediate subliminal or overtly perceived peripheral stimulation during TES. We argue that peripheral co-stimulation may contribute to the behavioral effects of TES and should be controlled for by "sham" TES. We discuss biophysical properties of TES, which need to be considered, if one wishes to make realistic assumptions about which brain regions were preferentially targeted by TES. Using results from electric field calculations, we evaluate the validity of different strategies that have been used for selective spatial targeting. Finally, we comment on the challenge of adjusting the dose of TES considering dose-response relationships between the weak tissue currents and the physiological effects in targeted cortical areas. These considerations call for caution when attributing behavioral effects during or after low-intensity TES studies to a specific brain region and may facilitate the selection of best practices for future TES studies.
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Affiliation(s)
- Anke Ninija Karabanov
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Guilherme Bicalho Saturnino
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Department of Electrical Engineering, Technical University of Denmark, Copenhagen, Denmark
| | - Axel Thielscher
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Department of Electrical Engineering, Technical University of Denmark, Copenhagen, Denmark
| | - Hartwig Roman Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
- Institute for Clinical Medicine, Faculty of Health Sciences and Medicine, University of Copenhagen, Copenhagen, Denmark
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The topographical distribution of epileptic spikes in juvenile myoclonic epilepsy with and without photosensitivity. Clin Neurophysiol 2017; 128:176-182. [DOI: 10.1016/j.clinph.2016.10.098] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 09/01/2016] [Accepted: 10/08/2016] [Indexed: 11/17/2022]
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Strigaro G, Matino E, Falletta L, Pizzamiglio C, Tondo G, Badawy R, Cantello R. Defective interhemispheric inhibition in drug-treated focal epilepsies. Brain Stimul 2016; 10:579-587. [PMID: 28017318 DOI: 10.1016/j.brs.2016.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 10/22/2016] [Accepted: 12/03/2016] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Focal epilepsies (FEs) arise from a lateralized network, while in generalized epilepsies (GEs) there is a bilateral involvement from the outset. Intuitively, the corpus callosum is the anatomical substrate for interhemispheric spread. OBJECTIVE We used transcranial magnetic stimulation (TMS) to explore whether there are any physiological differences in the corpus callosum of drug-treated patients with FE and those with genetic GE (GGE), compared to healthy subjects (HS). METHODS TMS was used to measure the interhemispheric inhibition (IHI) from right-to-left primary motor cortex (M1) and viceversa in 16 patients with FE, 17 patients with GGE and 17 HS. A conditioning stimulus (CS) was given to one M1 10 and 50 ms before a test stimulus delivered to the contralateral M1. Motor evoked potentials (MEPs) were analysed both as a function of the side of stimulation and of the epileptic focus (left-right). RESULTS In HS, IHI was reproducible with suppression of MEPs at ISIs of 10 and 50 ms. Similar effects occurred in GGE patients. FE patients behaved differently, since IHI was significantly reduced bilaterally. When FE patients were stratified according to the side of their epileptic focus, the long-ISI IHI (=50 ms) appeared to be defective only when the CS was applied over the "focal" hemisphere. CONCLUSIONS FE patients had a defective inhibitory response of contralateral M1 to inputs travelling from the "focal" hemisphere that was residual to the drug action. Whilst IHI changes would not be crucial for the GGE pathophysiology, they may represent one key factor for the contralateral spread of focal discharges, and seizure generalization.
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Affiliation(s)
- Gionata Strigaro
- Department of Translational Medicine, Section of Neurology, University of Piemonte Orientale, Novara, Italy; CRRF Mons. L. Novarese, Moncrivello, VC, Italy.
| | - Erica Matino
- Department of Translational Medicine, Section of Neurology, University of Piemonte Orientale, Novara, Italy
| | - Lina Falletta
- Department of Translational Medicine, Section of Neurology, University of Piemonte Orientale, Novara, Italy
| | - Chiara Pizzamiglio
- Department of Translational Medicine, Section of Neurology, University of Piemonte Orientale, Novara, Italy
| | - Giacomo Tondo
- Department of Translational Medicine, Section of Neurology, University of Piemonte Orientale, Novara, Italy
| | - Radwa Badawy
- Department of Medicine, Melbourne University, Victoria, Australia; Tamayoz Clinic, Cairo, Egypt
| | - Roberto Cantello
- Department of Translational Medicine, Section of Neurology, University of Piemonte Orientale, Novara, Italy
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Ákos Szabó C, Salinas FS, Li K, Franklin C, Leland MM, Fox PT, Laird AR, Narayana S. Modeling the effective connectivity of the visual network in healthy and photosensitive, epileptic baboons. Brain Struct Funct 2016; 221:2023-33. [PMID: 25749860 PMCID: PMC5558201 DOI: 10.1007/s00429-015-1022-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 02/27/2015] [Indexed: 12/13/2022]
Abstract
The baboon provides a model of photosensitive, generalized epilepsy. This study compares cerebral blood flow responses during intermittent light stimulation (ILS) between photosensitive (PS) and healthy control (CTL) baboons using H 2 (15) O-PET. We examined effective connectivity associated with visual stimulation in both groups using structural equation modeling (SEM). Eight PS and six CTL baboons, matched for age, gender and weight, were classified on the basis of scalp EEG findings performed during the neuroimaging studies. Five H 2 (15) O-PET studies were acquired alternating between resting and activation (ILS at 25 Hz) scans. PET images were acquired in 3D mode and co-registered with MRI. SEM demonstrated differences in neural connectivity between PS and CTL groups during ILS that were not previously identified using traditional activation analyses. First-level pathways consisted of similar posterior-to-anterior projections in both groups. While second-level pathways were mainly lateralized to the left hemisphere in the CTL group, they consisted of bilateral anterior-to-posterior projections in the PS baboons. Third- and fourth-level pathways were only evident in PS baboons. This is the first functional neuroimaging study used to model the photoparoxysmal response (PPR) using a primate model of photosensitive, generalized epilepsy. Evidence of increased interhemispheric connectivity and bidirectional feedback loops in the PS baboons represents electrophysiological synchronization associated with the generation of epileptic discharges. PS baboons demonstrated decreased model stability compared to controls, which may be attributed to greater variability in the driving response or PPRs, or to the influence of regions not included in the model.
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Affiliation(s)
- C Ákos Szabó
- Department of Neurology, South Texas Comprehensive Epilepsy Center, University of Texas Health Science Center San Antonio, 8300 Floyd Curl Drive, San Antonio, TX, 78229-7883, USA.
| | - Felipe S Salinas
- Research Imaging Institute, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Karl Li
- Research Imaging Institute, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Crystal Franklin
- Research Imaging Institute, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - M Michelle Leland
- Laboratory Animal Research, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Peter T Fox
- Research Imaging Institute, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
- South Texas Veterans Administration Medical Center, San Antonio, TX, USA
| | - Angela R Laird
- Department of Physics, Florida International University, Miami, FL, USA
| | - Shalini Narayana
- Department of Pediatrics, Le Bonheur's Children's Hospital, University of Tennessee, Memphis, TN, USA
- Neuroscience Institute, Le Bonheur's Children's Hospital, Memphis, TN, USA
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Gomceli YB, Dogan B, Genc F, Uygur E, Turgut Coban D, Erdal A, Kazım Erol M. Optical coherence tomography parameters in patients with photosensitive juvenile myoclonic epilepsy. Seizure 2016; 35:36-40. [DOI: 10.1016/j.seizure.2015.12.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 12/23/2015] [Accepted: 12/25/2015] [Indexed: 11/29/2022] Open
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Koepp MJ, Caciagli L, Pressler RM, Lehnertz K, Beniczky S. Reflex seizures, traits, and epilepsies: from physiology to pathology. Lancet Neurol 2015; 15:92-105. [PMID: 26627365 DOI: 10.1016/s1474-4422(15)00219-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 08/11/2015] [Accepted: 08/13/2015] [Indexed: 10/22/2022]
Abstract
Epileptic seizures are generally unpredictable and arise spontaneously. Patients often report non-specific triggers such as stress or sleep deprivation, but only rarely do seizures occur as a reflex event, in which they are objectively and consistently modulated, precipitated, or inhibited by external sensory stimuli or specific cognitive processes. The seizures triggered by such stimuli and processes in susceptible individuals can have different latencies. Once seizure-suppressing mechanisms fail and a critical mass (the so-called tipping point) of cortical activation is reached, reflex seizures stereotypically manifest with common motor features independent of the physiological network involved. The complexity of stimuli increases from simple sensory to complex cognitive-emotional with increasing age of onset. The topography of physiological networks involved follows the posterior-to-anterior trajectory of brain development, reflecting age-related changes in brain excitability. Reflex seizures and traits probably represent the extremes of a continuum, and understanding of their underlying mechanisms might help to elucidate the transition of normal physiological function to paroxysmal epileptic activity.
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Affiliation(s)
- Matthias J Koepp
- Department of Clinical and Experimental Epilepsy, University College London (UCL) Institute of Neurology, London, UK; National Hospital for Neurology and Neurosurgery, Queen Square, UK.
| | - Lorenzo Caciagli
- Department of Clinical and Experimental Epilepsy, University College London (UCL) Institute of Neurology, London, UK; National Hospital for Neurology and Neurosurgery, Queen Square, UK
| | - Ronit M Pressler
- Department of Clinical Neurophysiology, Great Ormond Street Hospital, London, UK; Clinical Neuroscience, UCL Institute of Child Health, London, UK
| | - Klaus Lehnertz
- Department of Epileptology, University Hospital of Bonn, Bonn, Germany
| | - Sándor Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark; Department of Clinical Neurophysiology, Aarhus University, Aarhus, Denmark
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Suppa A, Rocchi L, Li Voti P, Papazachariadis O, Casciato S, Di Bonaventura C, Giallonardo A, Berardelli A. The Photoparoxysmal Response Reflects Abnormal Early Visuomotor Integration in the Human Motor Cortex. Brain Stimul 2015; 8:1151-61. [DOI: 10.1016/j.brs.2015.05.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 04/23/2015] [Accepted: 05/22/2015] [Indexed: 11/29/2022] Open
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Schutter DJLG. Cutaneous retinal activation and neural entrainment in transcranial alternating current stimulation: A systematic review. Neuroimage 2015; 140:83-8. [PMID: 26453929 DOI: 10.1016/j.neuroimage.2015.09.067] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 09/25/2015] [Accepted: 09/30/2015] [Indexed: 01/21/2023] Open
Abstract
Transcranial alternating current stimulation (tACS) applies exogenous oscillatory electric field potentials to entrain neural rhythms and is used to investigate brain-function relationships and its potential to enhance perceptual and cognitive performance. However, due to current spread tACS can cause cutaneous activation of the retina and phosphenes. Several lines of evidence suggest that retinal phosphenes are capable of inducing neural entrainment, making the contributions of central and peripheral stimulation to the effects in the brain difficult to disentangle. In this literature review, the importance of this issue is further illustrated by the fact that photic stimulation can have a direct impact on perceptual and cognitive performance. This leaves open the possibility that peripheral photic stimulation can at least in part explain the central effects that are attributed to tACS. The extent to which phosphene perception contributes to the effects of exogenous oscillatory electric fields in the brain and influence perception and cognitive performance needs to be examined to understand the working mechanisms of tACS in neurophysiology and behaviour.
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Affiliation(s)
- Dennis J L G Schutter
- Radboud University, Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Montessorilaan 3, 6525 HR Nijmegen, The Netherlands.
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Strigaro G, Falletta L, Varrasi C, Rothwell JC, Cantello R. Overactive visuomotor connections underlie the photoparoxysmal response. A TMS study. Epilepsia 2015; 56:1828-35. [DOI: 10.1111/epi.13190] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Gionata Strigaro
- Department of Translational Medicine; Section of Neurology; University of Piemonte Orientale; Novara Italy
| | - Lina Falletta
- Department of Translational Medicine; Section of Neurology; University of Piemonte Orientale; Novara Italy
| | - Claudia Varrasi
- Department of Translational Medicine; Section of Neurology; University of Piemonte Orientale; Novara Italy
| | - John C. Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders; University College London Institute of Neurology; London United Kingdom
| | - Roberto Cantello
- Department of Translational Medicine; Section of Neurology; University of Piemonte Orientale; Novara Italy
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Strigaro G, Falletta L, Cerino A, Pizzamiglio C, Tondo G, Varrasi C, Cantello R. Abnormal motor cortex plasticity in juvenile myoclonic epilepsy. Seizure 2015. [DOI: 10.1016/j.seizure.2015.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Strigaro G, Ruge D, Chen JC, Marshall L, Desikan M, Cantello R, Rothwell JC. Interaction between visual and motor cortex: a transcranial magnetic stimulation study. J Physiol 2015; 593:2365-77. [PMID: 25762215 DOI: 10.1113/jp270135] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 03/04/2015] [Indexed: 11/08/2022] Open
Abstract
The major link between the visual and motor systems is via the dorsal stream pathways from visual to parietal and frontal areas of the cortex. Although the pathway appears to be indirect, there is evidence that visual input can reach the motor cortex at relatively short latency. To shed some light on its neural basis, we studied the visuomotor interaction using paired transcranial magnetic stimulation (TMS). Motor-evoked potentials (MEPs) were recorded from the right first dorsal interosseous in sixteen healthy volunteers. A conditioning stimulus (CS) was applied over the phosphene hotspot of the visual cortex, followed by a test stimulus over the left primary motor cortex (M1) with a random interstimulus interval (ISI) in range 12-40 ms. The effects of paired stimulation were retested during visual and auditory reaction-time tasks (RT). Finally, we measured the effects of a CS on short-interval intracortical inhibition (SICI). At rest, a CS over the occiput significantly (P < 0.001) suppressed test MEPs with an ISI in the range 18-40 ms. In the visual RT, inhibition with an ISI of 40 ms (but not 18 ms) was replaced by a time-specific facilitation (P < 0.001), whereas, in the auditory RT, the CS no longer had any effect on MEPs. Finally, an occipital CS facilitated SICI with an ISI of 40 ms (P < 0.01). We conclude that it is possible to study separate functional connections from visual to motor cortices using paired-TMS with an ISI in the range 18-40 ms. The connections are inhibitory at rest and possibly mediated by inhibitory interneurones in the motor cortex. The effect with an ISI of 40 ms reverses into facilitation during a visuomotor RT but not an audiomotor RT. This suggests that it plays a role in visuomotor integration.
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Affiliation(s)
- Gionata Strigaro
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London Institute of Neurology, London, UK.,Department of Translational Medicine, Section of Neurology, University of Piemonte Orientale 'A. Avogadro', Novara, Italy
| | - Diane Ruge
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London Institute of Neurology, London, UK
| | - Jui-Cheng Chen
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London Institute of Neurology, London, UK.,Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
| | - Louise Marshall
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London Institute of Neurology, London, UK
| | - Mahalekshmi Desikan
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London Institute of Neurology, London, UK
| | - Roberto Cantello
- Department of Translational Medicine, Section of Neurology, University of Piemonte Orientale 'A. Avogadro', Novara, Italy
| | - John C Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London Institute of Neurology, London, UK
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Bartolini E, Pesaresi I, Fabbri S, Cecchi P, Giorgi FS, Sartucci F, Bonuccelli U, Cosottini M. Abnormal response to photic stimulation in Juvenile Myoclonic Epilepsy: An EEG-fMRI study. Epilepsia 2014; 55:1038-47. [DOI: 10.1111/epi.12634] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Emanuele Bartolini
- Department of Clinical and Experimental Medicine; University of Pisa; Italy
| | | | - Serena Fabbri
- Department of Clinical and Experimental Medicine; University of Pisa; Italy
| | - Paolo Cecchi
- Department of Clinical and Experimental Medicine; University of Pisa; Italy
| | | | | | - Ubaldo Bonuccelli
- Department of Clinical and Experimental Medicine; University of Pisa; Italy
| | - Mirco Cosottini
- Department of Translational Research and New Technologies in Medicine and Surgery; University of Pisa; Pisa Italy
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15
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TMS, cortical excitability and epilepsy: The clinical impact. Epilepsy Res 2014; 108:153-61. [DOI: 10.1016/j.eplepsyres.2013.11.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 10/22/2013] [Accepted: 11/12/2013] [Indexed: 01/07/2023]
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