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Mustonen AM, Palviainen M, Säisänen L, Karttunen L, Tollis S, Esrafilian A, Reijonen J, Julkunen P, Siljander PRM, Kröger H, Mäki J, Arokoski J, Nieminen P. Tetraspanin profiles of serum extracellular vesicles reflect functional limitations and pain perception in knee osteoarthritis. Arthritis Res Ther 2024; 26:33. [PMID: 38254142 PMCID: PMC10801950 DOI: 10.1186/s13075-023-03234-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Emerging evidence suggests that extracellular vesicles (EVs) can play roles in inflammatory processes and joint degradation in primary osteoarthritis (OA), a common age-associated joint disease. EV subpopulations express tetraspanins and platelet markers that may reflect OA pathogenesis. The present study investigated the associations between these EV surface markers and articular cartilage degradation, subjectively and objectively assessed pain, and functional limitations in primary knee OA (KOA). METHODS Serum EVs were determined by high-sensitivity flow cytometry (large CD61+ EVs) and single particle interferometric reflectance imaging sensor (small CD41+, CD63+, CD81+, and CD9+ EVs) from end-stage KOA patients and controls (n = 8 per group). Knee pain and physical functions were assessed with several health- and pain-related questionnaires, established measurements of physical medicine, and neuromuscular examination. The obtained data were analyzed using supervised and unsupervised univariate and multivariate models. RESULTS With the combined dataset of cartilage thickness, knee function, pain, sensation, and EV molecular signatures, we identified highly correlated groups of variables and found several EV markers that were statistically significant predictors of pain, physical limitations, and other aspects of well-being for KOA patients, for instance CD41+/CD63+/CD9+ small EVs associated with the range of motion of the knee, physical performance, and pain sensitivity. CONCLUSIONS Particular serum EV subpopulations showed clear associations with KOA pain and functional limitations, suggesting that their implications in OA pathophysiology warrant further study.
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Affiliation(s)
- Anne-Mari Mustonen
- Institute of Biomedicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
- Department of Environmental and Biological Sciences, Faculty of Science, Forestry and Technology, University of Eastern Finland, Joensuu, Finland.
| | - Mari Palviainen
- EV core and EV group, Molecular and Integrative Biosciences Research Programme, Faculty of Biological and Environmental Sciences University of Helsinki, Helsinki, Finland
| | - Laura Säisänen
- Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland
- Department of Technical Physics, Faculty of Science, Forestry and Technology, University of Eastern Finland, Kuopio, Finland
| | - Lauri Karttunen
- Department of Physical and Rehabilitation Medicine, Central Finland Hospital Nova, Jyväskylä, Finland
| | - Sylvain Tollis
- Institute of Biomedicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
| | - Amir Esrafilian
- Department of Technical Physics, Faculty of Science, Forestry and Technology, University of Eastern Finland, Kuopio, Finland
| | - Jusa Reijonen
- Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland
- Department of Technical Physics, Faculty of Science, Forestry and Technology, University of Eastern Finland, Kuopio, Finland
| | - Petro Julkunen
- Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland
- Department of Technical Physics, Faculty of Science, Forestry and Technology, University of Eastern Finland, Kuopio, Finland
| | - Pia R-M Siljander
- EV core and EV group, Molecular and Integrative Biosciences Research Programme, Faculty of Biological and Environmental Sciences University of Helsinki, Helsinki, Finland
| | - Heikki Kröger
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - Jussi Mäki
- Department of Rehabilitation, Kuopio University Hospital, Kuopio, Finland
| | - Jari Arokoski
- Department of Physical and Rehabilitation Medicine, Helsinki University Hospital, Helsinki, Finland and University of Helsinki, Helsinki, Finland
| | - Petteri Nieminen
- Institute of Biomedicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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Eibl T, Schrey M, Liebert A, Ritter L, Lange R, Steiner HH, Schebesch KM. Influence of clinical and tumor-specific factors on the resting motor threshold in navigated transcranial magnetic stimulation. Neurophysiol Clin 2023; 53:102920. [PMID: 37944292 DOI: 10.1016/j.neucli.2023.102920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/27/2023] [Accepted: 10/28/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE Preoperative non-invasive mapping of motor function with navigated transcranial magnetic stimulation (nTMS) has become a widely used diagnostic procedure. Determination of the patient-individual resting motor threshold (rMT) is of great importance to achieve reliable results when conducting nTMS motor mapping. Factors which contribute to differences in rMT of brain tumor patients have not been fully investigated. METHODS We included adult patients with all types of de novo and recurrent intracranial lesions, suspicious for intra-axial brain tumors. The outcome measure was the rMT of the upper extremity, defined as the stimulation intensity eliciting motor evoked potentials with amplitudes greater than 50µV in 50 % of applied stimulations. RESULTS Eighty nTMS examinations in 75 patients (37.5 % female) aged 57.9 ± 14.9 years were evaluated. In non-parametric testing, rMT values were higher in patients with upper extremity paresis (p = 0.024) and lower in patients with high grade gliomas (HGG) (p = 0.001). rMT inversely correlated with patient age (rs=-0.28, p = 0.013) and edema volume (rs=-0.28, p = 0.012) In regression analysis, infiltration of the precentral gyrus (p<0.001) increased rMT values. Values of rMT were reduced in high grade gliomas (p<0.001), in patients taking Levetiracetam (p = 0.019) and if perilesional edema infiltrated motor eloquent brain (p<0.001). Subgroup analyses of glioma patients revealed similar results. Values of rMT did not differ between hand and forearm muscles. CONCLUSION Most factors confounding rMT in our study were specific to the lesion. These factors contributed to the variability in cortical excitability and must be considered in clinical work with nTMS to achieve reliable results with nTMS motor mapping.
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Affiliation(s)
- Thomas Eibl
- Department of Neurosurgery, Paracelsus Medical University Nuremberg, Germany.
| | - Michael Schrey
- Department of Neurosurgery, Paracelsus Medical University Nuremberg, Germany
| | - Adrian Liebert
- Department of Neurosurgery, Paracelsus Medical University Nuremberg, Germany
| | - Leonard Ritter
- Department of Neurosurgery, Paracelsus Medical University Nuremberg, Germany
| | - Rüdiger Lange
- Department of Neurology, Paracelsus Medical University Nuremberg, Germany
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Nguyen DTA, Julkunen P, Säisänen L, Määttä S, Rissanen SM, Lintu N, Könönen M, Lakka T, Karjalainen PA. Developmental models of motor-evoked potential features by transcranial magnetic stimulation across age groups from childhood to adulthood. Sci Rep 2023; 13:10604. [PMID: 37391521 PMCID: PMC10313665 DOI: 10.1038/s41598-023-37775-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 06/27/2023] [Indexed: 07/02/2023] Open
Abstract
To derive the maturation of neurophysiological processes from childhood to adulthood reflected by the change of motor-evoked potential (MEP) features. 38 participants were recruited from four groups (age mean in years [SD in months], number (males)): children (7.3 [4.2], 7(4)), preadolescents (10.3 [6.9], 10(5)), adolescents (15.3 [9.8], 11(5)), and adults (26.9 [46.2], 10(5)). The navigated transcranial magnetic stimulation was performed on both hemispheres at seven stimulation intensity (SI) levels from sub- to supra-threshold and targeted to the representative cortical area of abductor pollicis brevis muscle. MEPs were measured from three hand- and two forearm-muscles. The input-output (I/O) curves of MEP features across age groups were constructed using linear mixed-effect models. Age and SI significantly affected MEP features, whereas the stimulated side had a minor impact. MEP size and duration increased from childhood to adulthood. MEP onset- and peak-latency dropped in adolescence, particularly in hand muscles. Children had the smallest MEPs with the highest polyphasia, whereas I/O curves were similar among preadolescents, adolescents, and adults. This study illustrates some of the changing patterns of MEP features across the ages, suggesting developing patterns of neurophysiological processes activated by TMS, and to motivate studies with larger sample size.
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Affiliation(s)
- Dao T A Nguyen
- Department of Technical Physics, University of Eastern Finland, POB 1627, 70211, Kuopio, Finland.
| | - Petro Julkunen
- Department of Technical Physics, University of Eastern Finland, POB 1627, 70211, Kuopio, Finland
- Department of Clinical Neurophysiology, Kuopio University Hospital, POB 100, 70029 KYS, Kuopio, Finland
| | - Laura Säisänen
- Department of Technical Physics, University of Eastern Finland, POB 1627, 70211, Kuopio, Finland
- Department of Clinical Neurophysiology, Kuopio University Hospital, POB 100, 70029 KYS, Kuopio, Finland
| | - Sara Määttä
- Department of Clinical Neurophysiology, Kuopio University Hospital, POB 100, 70029 KYS, Kuopio, Finland
| | - Saara M Rissanen
- Department of Technical Physics, University of Eastern Finland, POB 1627, 70211, Kuopio, Finland
| | - Niina Lintu
- Institute of Biomedicine, University of Eastern Finland, POB 162, 70211, Kuopio, Finland
| | - Mervi Könönen
- Department of Technical Physics, University of Eastern Finland, POB 1627, 70211, Kuopio, Finland
| | - Timo Lakka
- Institute of Biomedicine, University of Eastern Finland, POB 162, 70211, Kuopio, Finland
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, POB 100, 70029 KYS, Kuopio, Finland
- Foundation for Research in Health Exercise and Nutrition, Kuopio Research Institute of Exercise Medicine, Haapaniementie 16, 70100, Kuopio, Finland
| | - Pasi A Karjalainen
- Department of Technical Physics, University of Eastern Finland, POB 1627, 70211, Kuopio, Finland
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Passera B, Chauvin A, Raffin E, Bougerol T, David O, Harquel S. Exploring the spatial resolution of TMS-EEG coupling on the sensorimotor region. Neuroimage 2022; 259:119419. [PMID: 35777633 DOI: 10.1016/j.neuroimage.2022.119419] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 04/12/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
The use of TMS-EEG coupling as a neuroimaging tool for the functional exploration of the human brain recently gained strong interest. If this tool directly inherits the fine temporal resolution from EEG, its spatial counterpart remains unknown. In this study, we explored the spatial resolution of TMS-EEG coupling by evaluating the minimal distance between two stimulated cortical sites that would significantly evoke different response dynamics. TMS evoked responses were mapped on the sensorimotor region in twenty participants. The stimulation grid was composed of nine targets separated between 10 and 15 mm on average. The dynamical signatures of TMS evoked activity were extracted and compared between sites using both local and remote linear regression scores and spatial generalized mixed models. We found a significant effect of the distance between stimulated sites on their dynamical signatures, neighboring sites showing differentiable response dynamics. Besides, common dynamical signatures were also found between sites up to 25-30 mm from each other. This overlap in dynamical properties decreased with distance and was stronger between sites within the same Brodmann area. Our results suggest that the spatial resolution of TMS-EEG coupling might be at least as high as 10 mm. Furthermore, our results reveal an anisotropic spatial resolution that was higher across than within the same Brodmann areas, in accordance with the TMS induced E-field modeling. Common cytoarchitectonic leading to shared dynamical properties within the same Brodmann area could also explain this anisotropy. Overall, these findings suggest that TMS-EEG benefits from the spatial resolution of TMS, which makes it an accurate technique for meso-scale brain mapping.
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Affiliation(s)
- Brice Passera
- Univ. Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France; Univ. Grenoble Alpes, CNRS, UMR5105, Laboratoire Psychologie et NeuroCognition, LPNC, F-38000 Grenoble, France; Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Alan Chauvin
- Univ. Grenoble Alpes, CNRS, UMR5105, Laboratoire Psychologie et NeuroCognition, LPNC, F-38000 Grenoble, France
| | - Estelle Raffin
- Univ. Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France; Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL Valais), Clinique Romande de Réadaptation, Sion, Switzerland
| | - Thierry Bougerol
- Univ. Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France; Centre Hospitalier Univ. Grenoble Alpes, Service de Psychiatrie, F-38000 Grenoble, France
| | - Olivier David
- Univ. Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France; Aix Marseille Univ, Inserm, U1106, INS, Institut de Neurosciences des Systèmes, Marseille, France
| | - Sylvain Harquel
- Univ. Grenoble Alpes, CNRS, UMR5105, Laboratoire Psychologie et NeuroCognition, LPNC, F-38000 Grenoble, France; Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL Valais), Clinique Romande de Réadaptation, Sion, Switzerland.
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Shavlovskaya O. Hand motor dexterity as one of neurological status assessing indicators. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:121-128. [DOI: 10.17116/jnevro2022122101121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Giuffre A, Zewdie E, Wrightson JG, Cole L, Carlson HL, Kuo HC, Babwani A, Kirton A. Effects of Transcranial Direct Current Stimulation and High-Definition Transcranial Direct Current Stimulation Enhanced Motor Learning on Robotic Transcranial Magnetic Stimulation Motor Maps in Children. Front Hum Neurosci 2021; 15:747840. [PMID: 34690726 PMCID: PMC8526891 DOI: 10.3389/fnhum.2021.747840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/16/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Conventional transcranial direct current stimulation (tDCS) and high-definition tDCS (HD-tDCS) may improve motor learning in children. Mechanisms are not understood. Neuronavigated robotic transcranial magnetic stimulation (TMS) can produce individualised maps of primary motor cortex (M1) topography. We aimed to determine the effects of tDCS- and HD-tDCS-enhanced motor learning on motor maps. Methods: Typically developing children aged 12-18 years were randomised to right M1 anodal tDCS, HD-tDCS, or Sham during training of their left-hand on the Purdue Pegboard Task (PPT) over 5 days. Bilateral motor mapping was performed at baseline (pre), day 5 (post), and 6-weeks retention time (RT). Primary muscle was the first dorsal interosseous (FDI) with secondary muscles of abductor pollicis brevis (APB) and adductor digiti minimi (ADM). Primary mapping outcomes were volume (mm2/mV) and area (mm2). Secondary outcomes were centre of gravity (COG, mm) and hotspot magnitude (mV). Linear mixed-effects modelling was employed to investigate effects of time and stimulation type (tDCS, HD-tDCS, Sham) on motor map characteristics. Results: Twenty-four right-handed participants (median age 15.5 years, 52% female) completed the study with no serious adverse events or dropouts. Quality maps could not be obtained in two participants. No effect of time or group were observed on map area or volume. LFDI COG (mm) differed in the medial-lateral plane (x-axis) between tDCS and Sham (p = 0.038) from pre-to-post mapping sessions. Shifts in map COG were also observed for secondary left-hand muscles. Map metrics did not correlate with behavioural changes. Conclusion: Robotic TMS mapping can safely assess motor cortex neurophysiology in children undergoing motor learning and neuromodulation interventions. Large effects on map area and volume were not observed while changes in COG may occur. Larger controlled studies are required to understand the role of motor maps in interventional neuroplasticity in children.
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Affiliation(s)
- Adrianna Giuffre
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ephrem Zewdie
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - James G Wrightson
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lauran Cole
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada
| | - Helen L Carlson
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Hsing-Ching Kuo
- Department of Physical Medicine & Rehabilitation, University of California, Davis, Sacramento, CA, United States
| | - Ali Babwani
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada
| | - Adam Kirton
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Sollmann N, Krieg SM, Säisänen L, Julkunen P. Mapping of Motor Function with Neuronavigated Transcranial Magnetic Stimulation: A Review on Clinical Application in Brain Tumors and Methods for Ensuring Feasible Accuracy. Brain Sci 2021; 11:brainsci11070897. [PMID: 34356131 PMCID: PMC8305823 DOI: 10.3390/brainsci11070897] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/29/2021] [Accepted: 07/02/2021] [Indexed: 12/15/2022] Open
Abstract
Navigated transcranial magnetic stimulation (nTMS) has developed into a reliable non-invasive clinical and scientific tool over the past decade. Specifically, it has undergone several validating clinical trials that demonstrated high agreement with intraoperative direct electrical stimulation (DES), which paved the way for increasing application for the purpose of motor mapping in patients harboring motor-eloquent intracranial neoplasms. Based on this clinical use case of the technique, in this article we review the evidence for the feasibility of motor mapping and derived models (risk stratification and prediction, nTMS-based fiber tracking, improvement of clinical outcome, and assessment of functional plasticity), and provide collected sets of evidence for the applicability of quantitative mapping with nTMS. In addition, we provide evidence-based demonstrations on factors that ensure methodological feasibility and accuracy of the motor mapping procedure. We demonstrate that selection of the stimulation intensity (SI) for nTMS and spatial density of stimuli are crucial factors for applying motor mapping accurately, while also demonstrating the effect on the motor maps. We conclude that while the application of nTMS motor mapping has been impressively spread over the past decade, there are still variations in the applied protocols and parameters, which could be optimized for the purpose of reliable quantitative mapping.
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Affiliation(s)
- Nico Sollmann
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany;
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, San Francisco, CA 94143, USA
- Correspondence:
| | - Sandro M. Krieg
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany;
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Laura Säisänen
- Department of Clinical Neurophysiology, Kuopio University Hospital, 70029 Kuopio, Finland; (L.S.); (P.J.)
- Department of Applied Physics, University of Eastern Finland, 70211 Kuopio, Finland
| | - Petro Julkunen
- Department of Clinical Neurophysiology, Kuopio University Hospital, 70029 Kuopio, Finland; (L.S.); (P.J.)
- Department of Applied Physics, University of Eastern Finland, 70211 Kuopio, Finland
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