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da Silva ML, Fernandes AM, Silva VA, Galhardoni R, Felau V, de Araujo JO, Rosi J, Brock RS, Kubota GT, Teixeira MJ, Yeng LT, de Andrade DC. Motor corticospinal excitability abnormalities differ between distinct chronic low back pain syndromes. Neurophysiol Clin 2023; 53:102853. [PMID: 37018953 DOI: 10.1016/j.neucli.2023.102853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/26/2023] [Accepted: 02/26/2023] [Indexed: 04/05/2023] Open
Abstract
OBJECTIVES It is not known whether cortical plastic changes reported in low-back pain (LBP) are present in all etiologies of LBP. Here we report on the assessment of patients with three LBP conditions: non-specific-LBP (ns-LBP), failed back surgery syndrome (FBSS), and sciatica (Sc). METHODS Patients underwent a standardized assessment of clinical pain, conditioned pain modulation (CPM), and measures of motor evoked potential (MEPs)-based motor corticospinal excitability (CE) by transcranial magnetic stimulation, including short interval intracortical inhibition (SICI), and intracortical facilitation (ICF). Comparisons were also made with normative data from sex- and age-matched healthy volunteers. RESULTS 60 patients (42 women, 55.1±9.1 years old) with LBP were included (20 in each group). Pain intensity was higher in patients with neuropathic pain [FBSS (6.8±1.3), and Sc (6.4±1.4)] than in those with ns-LBP (4.7±1.0, P<0.001). The same was shown for pain interference (5.9±2.0, 5.9±1.8, 3.2±1.9, P<0.001), disability (16.4±3.3, 16.3±4.3, 10.4±4.3, P<0.001), and catastrophism (31.1±12.3, 33.0±10.4, 17.4±10.7, P<0.001) scores for FBSS, Sc, and ns-LBP groups, respectively. Patients with neuropathic pain (FBSS, Sc) had lower CPM (-14.8±1.9, -14.1±16.7, respectively) compared to ns-LBP (-25.4±16.6; P<0.02). 80.0% of the FBSS group had defective ICF compared to the other two groups (52.5% for ns-LBP, P=0.025 and 52.5% for Sc, P=0.046). MEPs (140%-rest motor threshold) were low in 50.0% of patients in the FBSS group compared to 20.0% of ns-LBP (P=0.018) and 15.0% of Sc (P=0.001) groups. Higher MEPs were correlated with mood scores (r=0.489), and with lower neuropathic pain symptom scores(r=-0.415) in FBSS. CONCLUSIONS Different types of LBP were associated with different clinical, CPM and CE profiles, which were not uniquely related to the presence of neuropathic pain. These results highlight the need to further characterize patients with LBP in psychophysics and cortical neurophysiology studies.
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Affiliation(s)
- Marcelo Luiz da Silva
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Ana Mércia Fernandes
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Valquíria A Silva
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Ricardo Galhardoni
- School of Medicine, University of City of São Paulo (UNICID), São Paulo, Brazil
| | - Valter Felau
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Joaci O de Araujo
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Jefferson Rosi
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Roger S Brock
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Gabriel T Kubota
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Manoel J Teixeira
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Lin T Yeng
- Pain Center, Institute of Orthopedics and Traumatology, University of São Paulo, São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil; Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
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Role of Cervical Spinal Magnetic Stimulation in Improving Posture and Functional Ambulation of Patients with Relapsing Remitting Multiple Sclerosis. Rehabil Res Pract 2022; 2022:6009104. [DOI: 10.1155/2022/6009104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 11/23/2022] Open
Abstract
Balance impairment is one of the hallmarks of early MS. Proprioceptive deficit was found to be one of the main causes of this imbalance. The cervical enlargement has a strong proprioceptive system, with its projections to the reticular formation and the central pattern generators, helping in rhythmic pattern generation and alternate leg movements. Repetitive trans-spinal magnetic stimulation (rTSMS) is a noninvasive technique, which can trigger massive proprioceptive afferents. Therefore, it has the potential of improving proprioceptive deficits and motor control. Objective. To determine the effectiveness of repetitive cervical magnetic stimulation in improving functional ambulation of patients with relapsing remitting multiple sclerosis (RRMS). Design. Prospective sequential clinical trial. Setting. University and academic hospital. Participants. A total of 32 participants (
) with RRMS. Interventions. Outpatient rehabilitation. The 32 patients received 10 sessions over two weeks of 20 Hz cervical spinal magnetic stimulation (SMS). Both groups were assessed at baseline, after 2 weeks, then one month later. Patients were enrolled as a control group at first and received Sham SMS, and then a wash out period of one month was done for all the patients, followed by a baseline assessment. Second, the same 32 patients rejoined as the active group, which received real magnetic stimulation. Both groups performed an intensive physical therapy program with the spinal magnetic stimulation. Main Outcome Measures. Extended Disability status score (EDSS), Timed up and Go test (TUG), Mini-Best test, dynamic posturography sensory organization composite score, and motor composite score. Results. Thirty-two RRMS patients with EDSS range from 1.5 to 6. They showed statistically significant difference between active and control groups in Mini-Best test score. We divided our patients according to EDSS into 3 subgroups: (a) mild: ≤2.5, (b) moderate: 3-5.5, and (c) severe: ≥6. Mild cases showed significant differences in EDSS score, TUG test, Mini-Best test, and dynamic posturography sensory composite scale. The effect size between the different patient subgroups was also measured and showed highly significant improvements in all measured parameters among our mild patients, indicating that this subgroup could be the best responders to cervical repetitive high-frequency magnetic stimulation. Moderate cases showed highly significant improvement in TUG score and Mini-Best test and significant change in EDSS score and the dynamic posturography sensory composite score. Severe cases showed only significant improvements in TUG, Mini-Best test, and sensory composite score. Conclusion. Cervical repetitive magnetic stimulation can help improve balance and functional ambulation and decreases the risk of falls in RRMS patients, especially in the mild, low disability cases.
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Allen Demers F, Zangrandi A, Schneider C. Theta-Burst Stimulation of Forearm Muscles in Patients With Complex Regional Pain Syndrome: Influence on Brain and Clinical Outcomes. FRONTIERS IN PAIN RESEARCH 2021; 2:736806. [PMID: 35295471 PMCID: PMC8915654 DOI: 10.3389/fpain.2021.736806] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 08/16/2021] [Indexed: 11/30/2022] Open
Abstract
Objective: Complex regional pain syndrome (CRPS) is a common pain condition characterized by the changes in the brain that are not yet addressed by conventional treatment regimens. Repetitive peripheral magnetic stimulation (rPMS) of muscles is painless and non-invasive and can influence these changes (the induction of brain plasticity) to reduce pain and improve motricity. In patients with CRPS, this open-label pilot study tested rPMS after-effects on the pain intensity and sensorimotor control of the upper limb along with the excitability changes of the primary motor cortex (M1). Methods: Eight patients with CRPS were enrolled in a single-session program. Patients were tested at pre- and post-rPMS over the flexor digitorum superficialis (FDS) muscle. The clinical outcomes were pain intensity, proprioception, active range of motion (ROM), and grip strength. M1 excitability was tested using the single- and paired-pulse transcranial magnetic stimulation (TMS) of M1. Results: In our small sample study, rPMS reduced instant and week pain, improved proprioception and ROM, and reduced the hemispheric imbalance of several TMS outcomes. The more M1 contralateral to the CRPS side was hyperactivated at baseline, the more pain was reduced. Discussion: This open-label pilot study provided promising findings for the use of rPMS in CRPS with a focus on M1 plastic changes. Future randomized, placebo-controlled clinical trials should confirm the existence of a causal relationship between the TMS outcomes and post-rPMS decrease of pain. This will favor the development of personalized treatments of peripheral non-invasive neurostimulation in CRPS.
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Affiliation(s)
- Fannie Allen Demers
- Noninvasive Stimulation Laboratory (NovaStim), Quebec City, QC, Canada
- Neuroscience Division of Centre de Recherche du CHU of Québec – Université Laval, Quebec City, QC, Canada
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Andrea Zangrandi
- Noninvasive Stimulation Laboratory (NovaStim), Quebec City, QC, Canada
- Neuroscience Division of Centre de Recherche du CHU of Québec – Université Laval, Quebec City, QC, Canada
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Cyril Schneider
- Noninvasive Stimulation Laboratory (NovaStim), Quebec City, QC, Canada
- Neuroscience Division of Centre de Recherche du CHU of Québec – Université Laval, Quebec City, QC, Canada
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada
- Department of Rehabilitation, Université Laval, Quebec City, QC, Canada
- *Correspondence: Cyril Schneider
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Zangrandi A, Allen Demers F, Schneider C. Complex Regional Pain Syndrome. A Comprehensive Review on Neuroplastic Changes Supporting the Use of Non-invasive Neurostimulation in Clinical Settings. FRONTIERS IN PAIN RESEARCH 2021; 2:732343. [PMID: 35295500 PMCID: PMC8915550 DOI: 10.3389/fpain.2021.732343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Complex regional pain syndrome (CRPS) is a rare debilitating disorder characterized by severe pain affecting one or more limbs. CRPS presents a complex multifactorial physiopathology. The peripheral and sensorimotor abnormalities reflect maladaptive changes of the central nervous system. These changes of volume, connectivity, activation, metabolism, etc., could be the keys to understand chronicization, refractoriness to conventional treatment, and developing more efficient treatments. Objective: This review discusses the use of non-pharmacological, non-invasive neurostimulation techniques in CRPS, with regard to the CRPS physiopathology, brain changes underlying chronicization, conventional approaches to treat CRPS, current evidence, and mechanisms of action of peripheral and brain stimulation. Conclusion: Future work is warranted to foster the evidence of the efficacy of non-invasive neurostimulation in CRPS. It seems that the approach has to be individualized owing to the integrity of the brain and corticospinal function. Non-invasive neurostimulation of the brain or of nerve/muscles/spinal roots, alone or in combination with conventional therapy, represents a fertile ground to develop more efficient approaches for pain management in CRPS.
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Affiliation(s)
- Andrea Zangrandi
- Noninvasive Neurostimulation Laboratory (NovaStim), Quebec City, QC, Canada
- Neuroscience Division of Centre de Recherche du CHU of Québec, Université Laval, Quebec City, QC, Canada
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Fannie Allen Demers
- Noninvasive Neurostimulation Laboratory (NovaStim), Quebec City, QC, Canada
- Neuroscience Division of Centre de Recherche du CHU of Québec, Université Laval, Quebec City, QC, Canada
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Cyril Schneider
- Noninvasive Neurostimulation Laboratory (NovaStim), Quebec City, QC, Canada
- Neuroscience Division of Centre de Recherche du CHU of Québec, Université Laval, Quebec City, QC, Canada
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada
- Department Rehabilitation, Université Laval, Quebec City, QC, Canada
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Meeker TJ, Jupudi R, Lenz FA, Greenspan JD. New Developments in Non-invasive Brain Stimulation in Chronic Pain. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020; 8:280-292. [PMID: 33473332 DOI: 10.1007/s40141-020-00260-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose of Review The goal of this review is to present a summary of the recent literature of a non-invasive brain stimulation (NIBS) to alleviate pain in people with chronic pain syndromes. This article reviews the current evidence for the use of transcranial direct current (tDCS) and repetitive transcranial magnetic stimulation (rTMS) to improve outcomes in chronic pain. Finally, we introduce the reader to novel stimulation methods that may improve therapeutic outcomes in chronic pain. Recent Findings While tDCS is approved for treatment of fibromyalgia in Canada and the European Union, no NIBS method is currently approved for chronic pain in the United States. Increasing sample sizes in randomized clinical trials (RCTs) seems the most efficient way to increase confidence in initial promising results. Trends at funding agencies reveal increased interest and support for NIBS such as recent Requests for Application from the National Institutes of Health. NIBS in conjunction with cognitive behavioral therapy and physical therapy may enhance outcomes in chronic pain. Novel stimulation methods, such as transcranial ultrasound stimulation, await rigorous study in chronic pain.
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Affiliation(s)
- Timothy J Meeker
- Dept. of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.,Dept. of Neural and Pain Sciences, School of Dentistry, and Center to Advance Chronic Pain Research, Univ. of Maryland Baltimore, Baltimore, MD, USA
| | - Rithvic Jupudi
- Dept. of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - Frederik A Lenz
- Dept. of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - Joel D Greenspan
- Dept. of Neural and Pain Sciences, School of Dentistry, and Center to Advance Chronic Pain Research, Univ. of Maryland Baltimore, Baltimore, MD, USA
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CRPS Is Not Associated with Altered Sensorimotor Cortex GABA or Glutamate. eNeuro 2020; 7:ENEURO.0389-19.2020. [PMID: 31980452 PMCID: PMC7029188 DOI: 10.1523/eneuro.0389-19.2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 12/18/2022] Open
Abstract
Complex regional pain syndrome (CRPS) is a debilitating chronic pain disorder typically in the upper or lower limbs. While CRPS usually develops from a peripheral event, it is likely maintained by CNS changes. Indeed, CRPS is reported to be associated with sensorimotor cortex changes, or functional “reorganization,” as well as deficits such as poor tactile acuity. While the mechanisms underpinning cortical reorganization in CRPS are unknown, some have hypothesized that it involves disinhibition (i.e., a reduction in GABA activity). In this study, we addressed this hypothesis by using edited magnetic resonance spectroscopy to determine sensorimotor GABA and glutamate concentrations in 16 humans with CRPS and 30 matched control subjects and the relationship of these concentrations with tactile acuity. We found that individuals with upper limb CRPS displayed reduced tactile acuity in the painful hand, compared with the nonpainful hand and pain-free control subjects. Despite this acuity deficit, CRPS was not associated with altered GABA or glutamate concentrations within the sensorimotor cortex on either the side that represents the affected or unaffected hand. Furthermore, there was no significant relationship between sensorimotor GABA or glutamate concentrations and tactile acuity in CRPS subjects or control subjects. Although our sample was small, these data suggest that CRPS is not associated with altered total sensorimotor GABA or glutamate concentrations. While these results are at odds with the sensorimotor cortex disinhibition hypothesis, it is possible that GABAergic mechanisms other than total GABA concentration may contribute to such disinhibition.
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Molina-Rueda F, Navarro-Fernández C, Cuesta-Gómez A, Alguacil-Diego IM, Molero-Sánchez A, Carratalá-Tejada M. Neuroplasticity Modifications Following a Lower-Limb Amputation: A Systematic Review. PM R 2019; 11:1326-1334. [PMID: 30989836 DOI: 10.1002/pmrj.12167] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 04/07/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Although there are studies that have examined brain functional reorganization following upper-limb amputation, understanding of the brain changes that occur in people with lower-limb amputation is limited. OBJECTIVE To investigate modifications in the brain following lower-limb amputation. METHODS We included case-control studies that evaluate neuroplasticity in the central nervous system using neuroimaging techniques. A literature search was conducted using MEDLINE, CINAHL, Web of Science, Scopus, and Cochrane. RESULTS Eleven articles were included (total n = 204 people with unilateral lower-limb amputation). These studies showed an increase in cerebellar gray matter volume in prosthesis users, as well as a decrease in thickness of the premotor cortex, orbitofrontal cortex, temporo-occipital junction, precentral gyrus, visual areas, and somatosensory cortex. Regarding white matter, the trials observed a decrease in the integrity at the corona radiata, the connections between the premotor areas, the fronto-occipital fasciculus and the corpus callosum. In addition, a decreased functional connectivity between cortical and subcortical areas has been described. CONCLUSIONS Lower-limb amputation causes changes in several brain structures that may occur in the absence of pain and regardless of prosthesis use. The modifications observed include thinning or loss of gray matter volume, decrease in the integrity of the white matter connections between brain structures and changes in the functional connectivity between cortical and subcortical areas. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Francisco Molina-Rueda
- Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain
| | - Cristian Navarro-Fernández
- Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain
| | - Alicia Cuesta-Gómez
- Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain
| | - Isabel M Alguacil-Diego
- Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain
| | - Alberto Molero-Sánchez
- Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain
| | - María Carratalá-Tejada
- Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain
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Chang WJ, O'Connell NE, Beckenkamp PR, Alhassani G, Liston MB, Schabrun SM. Altered Primary Motor Cortex Structure, Organization, and Function in Chronic Pain: A Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2018; 19:341-359. [DOI: 10.1016/j.jpain.2017.10.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 10/15/2017] [Accepted: 10/19/2017] [Indexed: 01/14/2023]
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The Association Between Corticomotor Excitability and Motor Skill Learning in People With Painful Hand Arthritis. Clin J Pain 2017; 33:222-230. [PMID: 27258992 DOI: 10.1097/ajp.0000000000000392] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Previous studies have shown a tendency for reduced motor cortex inhibition in chronic pain populations. People with chronic pain also routinely demonstrate motor deficiencies, including skill learning. The goals of the current study were to (1) provide a thorough analysis of corticomotor and intracortical excitability in people with chronic arthritic hand pain, and (2) examine the relationship between these measures and performance on a motor skill learning task. METHODS Twenty-three people with arthritic hand pain and 20 pain-free controls participated in a cross-sectional study. Transcranial magnetic stimulation was used to assess corticomotor and intracortical excitability of the first dorsal interosseus muscle. Participants then completed a 30-minute motor skill training task involving the index finger of the same hand. RESULTS Hand arthritis participants showed evidence of reduced intracortical inhibition and enhanced facilitation, which correlated with duration of hand pain. Arthritis participants were initially poorer at the motor skill task but over the total training time performance was equivalent between groups. There were no associations found between measures of intracortical excitability and motor skill learning. DISCUSSION Our findings are the first to provide evidence of cortical disinhibition in people with painful arthritis, as previously demonstrated in other chronic pain populations. Cortical excitability changes may progress the longer pain persists, with increased pain duration being associated with greater cortical disinhibition. There was no evidence that these changes in cortical excitability are related to impaired motor function or skill learning.
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Kumru H, Albu S, Rothwell J, Leon D, Flores C, Opisso E, Tormos JM, Valls-Sole J. Modulation of motor cortex excitability by paired peripheral and transcranial magnetic stimulation. Clin Neurophysiol 2017; 128:2043-2047. [DOI: 10.1016/j.clinph.2017.06.041] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 05/29/2017] [Accepted: 06/18/2017] [Indexed: 10/19/2022]
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Massé-Alarie H, Beaulieu LD, Preuss R, Schneider C. Repetitive peripheral magnetic neurostimulation of multifidus muscles combined with motor training influences spine motor control and chronic low back pain. Clin Neurophysiol 2017; 128:442-453. [DOI: 10.1016/j.clinph.2016.12.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 12/15/2016] [Accepted: 12/21/2016] [Indexed: 12/15/2022]
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Parker RS, Lewis GN, Rice DA, McNair PJ. Is Motor Cortical Excitability Altered in People with Chronic Pain? A Systematic Review and Meta-Analysis. Brain Stimul 2016; 9:488-500. [DOI: 10.1016/j.brs.2016.03.020] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 03/02/2016] [Accepted: 03/30/2016] [Indexed: 01/18/2023] Open
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Repetitive peripheral magnetic stimulation to reduce pain or improve sensorimotor impairments: A literature review on parameters of application and afferents recruitment. Neurophysiol Clin 2015; 45:223-37. [DOI: 10.1016/j.neucli.2015.08.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 08/06/2015] [Accepted: 08/06/2015] [Indexed: 11/22/2022] Open
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Beaulieu LD, Massé-Alarie H, Brouwer B, Schneider C. Noninvasive neurostimulation in chronic stroke: a double-blind randomized sham-controlled testing of clinical and corticomotor effects. Top Stroke Rehabil 2015; 22:8-17. [PMID: 25776116 DOI: 10.1179/1074935714z.0000000032] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Repetitive peripheral magnetic stimulation (RPMS) is a painless and noninvasive method to produce afferents via the depolarization of the peripheral nervous system. A few studies tested RPMS after-effects on cerebral plasticity and motor recovery in stroke individuals, but evidences remain limited. OBJECTIVES This study aimed to explore whether RPMS could mediate improvements in corticomotor and clinical outcomes associated with ankle impairments in chronic stroke. METHODS Eighteen subjects with chronic stroke were randomly allocated to RPMS or sham group and compared to 14 healthy subjects. Stimulation was applied over the paretic tibialis anterior (TA). Ankle impairments on the paretic side and ipsilesional TA cortical motor representation were tested clinically and by transcranial magnetic stimulation (TMS), respectively. RESULTS In the RPMS group, ankle dorsiflexion mobility and maximal isometric strength increased and resistance to plantar flexor stretch decreased. The magnitude of change seemed to be related to cortical and corticospinal integrity. Sham stimulation yielded no effect. Changes in TMS outcome and their relationships with clinical improvements were limited. CONCLUSIONS RPMS improved ankle impairments in chronic stroke likely by a dynamic influence of sensory inputs on synaptic plasticity. The neurophysiological mechanisms potentially underlying the clinical effects are unclear. More studies are warranted to test the spinal and hemispheric changes responsible for the clinical improvements with emphasis on circuits spared by the lesion.
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Priori A, Ciocca M, Parazzini M, Vergari M, Ferrucci R. Transcranial cerebellar direct current stimulation and transcutaneous spinal cord direct current stimulation as innovative tools for neuroscientists. J Physiol 2014; 592:3345-69. [PMID: 24907311 PMCID: PMC4229333 DOI: 10.1113/jphysiol.2013.270280] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 05/30/2014] [Indexed: 12/26/2022] Open
Abstract
Two neuromodulatory techniques based on applying direct current (DC) non-invasively through the skin, transcranial cerebellar direct current stimulation (tDCS) and transcutaneous spinal DCS, can induce prolonged functional changes consistent with a direct influence on the human cerebellum and spinal cord. In this article we review the major experimental works on cerebellar tDCS and on spinal tDCS, and their preliminary clinical applications. Cerebellar tDCS modulates cerebellar motor cortical inhibition, gait adaptation, motor behaviour, and cognition (learning, language, memory, attention). Spinal tDCS influences the ascending and descending spinal pathways, and spinal reflex excitability. In the anaesthetised mouse, DC stimulation applied under the skin along the entire spinal cord may affect GABAergic and glutamatergic systems. Preliminary clinical studies in patients with cerebellar disorders, and in animals and patients with spinal cord injuries, have reported beneficial effects. Overall the available data show that cerebellar tDCS and spinal tDCS are two novel approaches for inducing prolonged functional changes and neuroplasticity in the human cerebellum and spinal cord, and both are new tools for experimental and clinical neuroscientists.
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Affiliation(s)
- Alberto Priori
- Centro Clinico per la Neurostimolazione, le Neurotecnologie e i Disordini del Movimento, Fondazione IRCCS Ca' Granda, Milan, Italy Dipartimento di Fisiopatologia Medico Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - Matteo Ciocca
- Centro Clinico per la Neurostimolazione, le Neurotecnologie e i Disordini del Movimento, Fondazione IRCCS Ca' Granda, Milan, Italy Dipartimento di Fisiopatologia Medico Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - Marta Parazzini
- Consiglio Nazionale delle Ricerche, Istituto di Elettronica e di Ingegneria dell'Informazione e delle Telecomunicazioni, Milan, Italy
| | - Maurizio Vergari
- Centro Clinico per la Neurostimolazione, le Neurotecnologie e i Disordini del Movimento, Fondazione IRCCS Ca' Granda, Milan, Italy
| | - Roberta Ferrucci
- Centro Clinico per la Neurostimolazione, le Neurotecnologie e i Disordini del Movimento, Fondazione IRCCS Ca' Granda, Milan, Italy Dipartimento di Fisiopatologia Medico Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
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Flamand VH, Schneider C. Noninvasive and painless magnetic stimulation of nerves improved brain motor function and mobility in a cerebral palsy case. Arch Phys Med Rehabil 2014; 95:1984-90. [PMID: 24907638 DOI: 10.1016/j.apmr.2014.05.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 05/06/2014] [Accepted: 05/17/2014] [Indexed: 10/25/2022]
Abstract
Motor deficits in cerebral palsy disturb functional independence. This study tested whether noninvasive and painless repetitive peripheral magnetic stimulation could improve motor function in a 7-year-old boy with spastic hemiparetic cerebral palsy. Stimulation was applied over different nerves of the lower limbs for 5 sessions. We measured the concurrent aftereffects of this intervention on ankle motor control, gait (walking velocity, stride length, cadence, cycle duration), and function of brain motor pathways. We observed a decrease of ankle plantar flexors resistance to stretch, an increase of active dorsiflexion range of movement, and improvements of corticospinal control of ankle dorsiflexors. Joint mobility changes were still present 15 days after the end of stimulation, when all gait parameters were also improved. Resistance to stretch was still lower than prestimulation values 45 days after the end of stimulation. This case illustrates the sustained effects of repetitive peripheral magnetic stimulation on brain plasticity, motor function, and gait. It suggests a potential impact for physical rehabilitation in cerebral palsy.
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Affiliation(s)
- Véronique H Flamand
- Neuroscience Division, CHU de Québec Research Center, Québec, QC, Canada; Faculty of Medicine, Université Laval, Québec, QC, Canada.
| | - Cyril Schneider
- Neuroscience Division, CHU de Québec Research Center, Québec, QC, Canada; Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec, QC, Canada
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Di Pietro F, McAuley JH, Parkitny L, Lotze M, Wand BM, Moseley GL, Stanton TR. Primary Motor Cortex Function in Complex Regional Pain Syndrome: A Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2013; 14:1270-88. [DOI: 10.1016/j.jpain.2013.07.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 06/25/2013] [Accepted: 07/02/2013] [Indexed: 02/09/2023]
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Beaulieu L, Schneider C. Effects of repetitive peripheral magnetic stimulation on normal or impaired motor control. A review. Neurophysiol Clin 2013; 43:251-60. [DOI: 10.1016/j.neucli.2013.05.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Revised: 05/16/2013] [Accepted: 05/16/2013] [Indexed: 11/26/2022] Open
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Kirveskari E, Vartiainen NV, Gockel M, Forss N. Motor cortex dysfunction in complex regional pain syndrome. Clin Neurophysiol 2010; 121:1085-91. [PMID: 20185362 DOI: 10.1016/j.clinph.2010.01.032] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2009] [Revised: 01/25/2010] [Accepted: 01/27/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Most patients with complex regional pain syndrome (CRPS) exhibit debilitating motor symptoms. The effect of continuous pain on motor system in CRPS, however, is not well known. We searched for signs of motor cortex dysfunction in chronic CRPS type 1 patients with motor impairment. METHODS We recorded rhythmic brain activity with magnetoencephalography (MEG) during noxious thulium-laser stimulation of both hands in eight CRPS patients and eight control subjects. We measured excitability of the motor cortex by monitoring the reactivity of the approximately 20-Hz motor cortex rhythm to laser stimuli. The reactivity was defined as a sum of the stimulus-induced suppression and the subsequent rebound of the approximately 20-Hz rhythm. RESULTS In CRPS, the reactivity of the approximately 20-Hz rhythm in the hemisphere contralateral to the painful hand was significantly weaker than in control subjects. The reactivity correlated with the mean level of the spontaneous pain (r=-0.64, P=0.04). Suppression of the approximately 20-Hz rhythm correlated with the grip strength in the painful hand (r=0.66, P=0.04). CONCLUSION Continuous pain in CRPS is associated with attenuated motor cortex reactivity. SIGNIFICANCE Abnormal motor cortex reactivity may be linked with motor dysfunction of the affected hand in CRPS.
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Affiliation(s)
- Erika Kirveskari
- Brain Research Unit, Low Temperature Laboratory, Aalto University, School of Science and Technology, Finland.
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Affiliation(s)
- Marissa de Mos
- Erasmus University Medical Center, Pharmaco-epidemiology Unit, Departments of Medical Informatics and Epidemiology & Biostatistics, Rotterdam, The Netherlands.
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Krause P, Straube A. Peripheral repetitive magnetic stimulation induces intracortical inhibition in healthy subjects. Neurol Res 2008; 30:690-4. [PMID: 18498680 DOI: 10.1179/174313208x297959] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE Repetitive magnetic stimulation (rMS) is mainly used in transcranial applications. Only a few works have described its potential peripheral use. The aim of this investigation was to determine if conditioning peripheral (paravertebral) rMS of the cervical nerve roots in a group of healthy subjects induces changes in motor cortical excitability. METHODS This was measured by means of motor evoked potentials (MEP), motor recruitment curves (RC), intracortical inhibition (ICI) and facilitation, as well as the cortical silent period (CSP) before and after repetitive stimulation. rMS was carried out by applying ten series of stimulation at 120% of resting motor threshold, each lasting 10 seconds with a frequency of 20 Hz. The nerve roots (C7/C8) of the right hand innervating the target muscles (the first dorsal interosseous) were systematically stimulated. RESULTS This conditioning rMS caused a significantly longer CSP (p=0.001), increased MEP amplitudes (with a tendency to significance of p=0.06) and raised ICI (p<0.05). These changes were absent on the contralateral side, as well as in the course of RC. In conclusion, previously published results that described a prolonged CSP and increased MEP amplitudes led us to speculate that conditioning peripheral rMS is, like electrical stimulation, capable of influencing motor cortical excitability. SIGNIFICANCE rMS might therefore be used in rehabilitative strategies for spasticity, pain or central paresis.
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Affiliation(s)
- Phillip Krause
- Department of Neurology, University of Munich, Klinikum Grosshadern, Munich, Germany.
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