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Oberman LM, Benussi A. Transcranial Magnetic Stimulation Across the Lifespan: Impact of Developmental and Degenerative Processes. Biol Psychiatry 2024; 95:581-591. [PMID: 37517703 PMCID: PMC10823041 DOI: 10.1016/j.biopsych.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/01/2023]
Abstract
Transcranial magnetic stimulation (TMS) has emerged as a pivotal noninvasive technique for investigating cortical excitability and plasticity across the lifespan, offering valuable insights into neurodevelopmental and neurodegenerative processes. In this review, we explore the impact of TMS applications on our understanding of normal development, healthy aging, neurodevelopmental disorders, and adult-onset neurodegenerative diseases. By presenting key developmental milestones and age-related changes in TMS measures, we provide a foundation for understanding the maturation of neurotransmitter systems and the trajectory of cognitive functions throughout the lifespan. Building on this foundation, the paper delves into the pathophysiology of neurodevelopmental disorders, including autism spectrum disorder, attention-deficit/hyperactivity disorder, Tourette syndrome, and adolescent depression. Highlighting recent findings on altered neurotransmitter circuits and dysfunctional cortical plasticity, we underscore the potential of TMS as a valuable tool for unraveling underlying mechanisms and informing future therapeutic interventions. We also review the emerging role of TMS in investigating and treating the most common adult-onset neurodegenerative disorders and late-onset depression. By outlining the therapeutic applications of noninvasive brain stimulation techniques in these disorders, we discuss the growing body of evidence supporting their use as therapeutic tools for symptom management and potentially slowing disease progression. The insights gained from TMS studies have advanced our understanding of the underlying mechanisms in both healthy and disease states, ultimately informing the development of more targeted diagnostic and therapeutic strategies for a wide range of neuropsychiatric conditions.
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Affiliation(s)
- Lindsay M Oberman
- National Institute of Mental Health Intramural Research Program, National Institutes of Health, Bethesda, Maryland
| | - Alberto Benussi
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
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Moreno-Roco J, del Valle L, Jiménez D, Acosta I, Castillo JL, Dharmadasa T, Kiernan MC, Matamala JM. Diagnostic utility of transcranial magnetic stimulation for neurodegenerative disease: a critical review. Dement Neuropsychol 2024; 17:e20230048. [PMID: 38189033 PMCID: PMC10768644 DOI: 10.1590/1980-5764-dn-2023-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/13/2023] [Accepted: 09/24/2023] [Indexed: 01/09/2024] Open
Abstract
Neurodegenerative diseases pose significant challenges due to their impact on brain structure, function, and cognition. As life expectancy rises, the prevalence of these disorders is rapidly increasing, resulting in substantial personal, familial, and societal burdens. Efforts have been made to optimize the diagnostic and therapeutic processes, primarily focusing on clinical, cognitive, and imaging characterization. However, the emergence of non-invasive brain stimulation techniques, specifically transcranial magnetic stimulation (TMS), offers unique functional insights and diagnostic potential. TMS allows direct evaluation of brain function, providing valuable information inaccessible through other methods. This review aims to summarize the current and potential diagnostic utility of TMS in investigating neurodegenerative diseases, highlighting its relevance to the field of cognitive neuroscience. The findings presented herein contribute to the growing body of research focused on improving our understanding and management of these debilitating conditions, particularly in regions with limited resources and a pressing need for innovative approaches.
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Affiliation(s)
- Javier Moreno-Roco
- Universidad de Chile, Facultad de Medicina, Laboratorio de Neurología y Neurofisiología Traslacional, Santiago, Chile
- Universidad de Chile, Facultad de Medicina, Centro de Investigación Clínica Avanzado (CICA) Oriente, Santiago, Chile
- Universidad de Chile, Facultad de Medicina, Departamento de Ciencias Neurológicas Oriente, Santiago, Chile
| | - Lucía del Valle
- Universidad de Chile, Facultad de Medicina, Laboratorio de Neurología y Neurofisiología Traslacional, Santiago, Chile
- Universidad de Chile, Facultad de Medicina, Centro de Investigación Clínica Avanzado (CICA) Oriente, Santiago, Chile
- Universidad de Chile, Facultad de Medicina, Departamento de Ciencias Neurológicas Oriente, Santiago, Chile
| | - Daniel Jiménez
- Universidad de Chile, Facultad de Medicina, Laboratorio de Neurología y Neurofisiología Traslacional, Santiago, Chile
- Universidad de Chile, Facultad de Medicina, Centro de Investigación Clínica Avanzado (CICA) Oriente, Santiago, Chile
- Universidad de Chile, Facultad de Medicina, Departamento de Ciencias Neurológicas Oriente, Santiago, Chile
- Hospital del Salvador, Servicio de Neurología, Santiago, Chile
| | - Ignacio Acosta
- Universidad de Chile, Facultad de Medicina, Laboratorio de Neurología y Neurofisiología Traslacional, Santiago, Chile
- Universidad de Chile, Facultad de Medicina, Centro de Investigación Clínica Avanzado (CICA) Oriente, Santiago, Chile
- Universidad de Chile, Facultad de Medicina, Departamento de Ciencias Neurológicas Oriente, Santiago, Chile
- Hospital del Salvador, Servicio de Neurología, Santiago, Chile
| | - José Luis Castillo
- Universidad de Chile, Facultad de Medicina, Laboratorio de Neurología y Neurofisiología Traslacional, Santiago, Chile
- Universidad de Chile, Facultad de Medicina, Departamento de Ciencias Neurológicas Oriente, Santiago, Chile
| | - Thanuja Dharmadasa
- University of Melbourne, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
- The Royal Melbourne Hospital, Department of Neurology, Parkville, Victoria, Australia
- University of Sydney, Brain and Mind Centre, Sydney, Australia
| | - Matthew C. Kiernan
- University of Sydney, Brain and Mind Centre, Sydney, Australia
- Royal Prince Alfred Hospital, Department of Neurology, Sydney, AustraliaArgento
| | - José Manuel Matamala
- Universidad de Chile, Facultad de Medicina, Laboratorio de Neurología y Neurofisiología Traslacional, Santiago, Chile
- Universidad de Chile, Facultad de Medicina, Centro de Investigación Clínica Avanzado (CICA) Oriente, Santiago, Chile
- Universidad de Chile, Facultad de Medicina, Departamento de Ciencias Neurológicas Oriente, Santiago, Chile
- Universidad de Chile, Facultad de Medicina, Departamento de Neurociencias, Santiago, Chile
- Universidad de Chile, Facultad de Medicina, Instituto de Neurociencia Biomédica (BNI), Santiago, Chile
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Li S, Lan X, Liu Y, Zhou J, Pei Z, Su X, Guo Y. Unlocking the Potential of Repetitive Transcranial Magnetic Stimulation in Alzheimer's Disease: A Meta-Analysis of Randomized Clinical Trials to Optimize Intervention Strategies. J Alzheimers Dis 2024; 98:481-503. [PMID: 38427480 DOI: 10.3233/jad-231031] [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] [Indexed: 03/03/2024]
Abstract
Background Repetitive transcranial magnetic stimulation (rTMS) is an advanced and noninvasive technology that uses pulse stimulation to treat cognitive impairment. However, its specific effects have always been mixed with those of cognitive training, and the optimal parameter for Alzheimer's disease (AD) intervention is still ambiguous. Objective This study aimed to summarize the therapeutic effects of pure rTMS on AD, excluding the influence of cognitive training, and to develop a preliminary rTMS treatment plan. Methods Between 1 January 2010 and 28 February 2023, we screened randomized controlled clinical trials from five databases (PubMed, Web of Science, Embase, Cochrane, and ClinicalTrials. gov). We conducted a meta-analysis and systematic review of treatment outcomes and rTMS treatment parameters. Result A total of 4,606 articles were retrieved. After applying the inclusion and exclusion criteria, 16 articles, comprising 655 participants (308 males and 337 females), were included in the final analysis. The findings revealed that rTMS significantly enhances both global cognitive ability (p = 0.0002, SMD = 0.43, 95% CI = 0.20-0.66) and memory (p = 0.009, SMD = 0.37, 95% CI = 0.09-0.65). Based on follow-up periods of at least 6 weeks, the following stimulation protocols have demonstrated efficacy for AD: stimulation sites (single or multiple targets), frequency (20 Hz), stimulation time (1-2 s), interval (20-30 s), single pulses (≤2500), total pulses (>20000), duration (≥3 weeks), and sessions (≥20). Conclusions This study suggests that rTMS may be an effective treatment option for patients with AD, and its potential therapeutic capabilities should be further developed in the future.
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Affiliation(s)
- Sha Li
- Institute of Neurological and Psychiatric Diseases, Shenzhen Bay Laboratory, Shenzhen, Guangdong, China
| | - Xiaoyong Lan
- Institute of Neurological and Psychiatric Diseases, Shenzhen Bay Laboratory, Shenzhen, Guangdong, China
| | - Yumei Liu
- Institute of Neurological and Psychiatric Diseases, Shenzhen Bay Laboratory, Shenzhen, Guangdong, China
| | - Junhong Zhou
- Hebrew Seniorlife Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School, Boston, MA, USA
| | - Zian Pei
- Institute of Neurological and Psychiatric Diseases, Shenzhen Bay Laboratory, Shenzhen, Guangdong, China
| | - Xiaolin Su
- Department of Neurology, Shenzhen People's Hospital (The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University), Shenzhen, Guangdong, China
| | - Yi Guo
- Institute of Neurological and Psychiatric Diseases, Shenzhen Bay Laboratory, Shenzhen, Guangdong, China
- Department of Neurology, Shenzhen People's Hospital (The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University), Shenzhen, Guangdong, China
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Mimura Y, Tobari Y, Nakahara K, Nakajima S, Yoshida K, Mimura M, Noda Y. Transcranial magnetic stimulation neurophysiology in patients with non-Alzheimer's neurodegenerative diseases: A systematic review and meta-analysis. Neurosci Biobehav Rev 2023; 155:105451. [PMID: 37926239 DOI: 10.1016/j.neubiorev.2023.105451] [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: 07/12/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/07/2023]
Abstract
Non-Alzheimer's dementia (NAD) accounts for 30% of all neurodegenerative conditions and is characterized by cognitive decline beyond mere memory dysfunction. Diagnosing NAD remains challenging due to the lack of established biomarkers. Transcranial magnetic stimulation (TMS) is a non-invasive neurophysiological tool that enables the investigation of cortical excitability in the human brain. Paired-pulse TMS paradigms include short- and long-interval intracortical inhibition (SICI/LICI), intracortical facilitation (ICF), and short-latency afferent inhibition (SAI), which can assess neurophysiological functions of GABAergic, glutamatergic, and cholinergic neural circuits, respectively. We conducted the first systematic review and meta-analysis to compare these TMS indices among patients with NAD and healthy controls. Our meta-analyses indicated that TMS neurophysiological examinations revealed decreased glutamatergic function in patients with frontotemporal dementia (FTD) and decreased GABAergic function in patients with FTD, progressive supranuclear palsy, Huntington's disease, cortico-basal syndrome, and multiple system atrophy-parkinsonian type. In addition, decreased cholinergic function was found in dementia with Lewy body and vascular dementia. These results suggest the potential of TMS as an additional diagnostic tool to differentiate NAD.
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Affiliation(s)
- Yu Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Yui Tobari
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Kazuho Nakahara
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Shinichiro Nakajima
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
| | - Kazunari Yoshida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Pharmacogenetics Research Clinic, Centre for Addiction and Mental Health, Toronto, ON, Canada; Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Yoshihiro Noda
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
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Antonioni A, Raho EM, Lopriore P, Pace AP, Latino RR, Assogna M, Mancuso M, Gragnaniello D, Granieri E, Pugliatti M, Di Lorenzo F, Koch G. Frontotemporal Dementia, Where Do We Stand? A Narrative Review. Int J Mol Sci 2023; 24:11732. [PMID: 37511491 PMCID: PMC10380352 DOI: 10.3390/ijms241411732] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
Frontotemporal dementia (FTD) is a neurodegenerative disease of growing interest, since it accounts for up to 10% of middle-age-onset dementias and entails a social, economic, and emotional burden for the patients and caregivers. It is characterised by a (at least initially) selective degeneration of the frontal and/or temporal lobe, generally leading to behavioural alterations, speech disorders, and psychiatric symptoms. Despite the recent advances, given its extreme heterogeneity, an overview that can bring together all the data currently available is still lacking. Here, we aim to provide a state of the art on the pathogenesis of this disease, starting with established findings and integrating them with more recent ones. In particular, advances in the genetics field will be examined, assessing them in relation to both the clinical manifestations and histopathological findings, as well as considering the link with other diseases, such as amyotrophic lateral sclerosis (ALS). Furthermore, the current diagnostic criteria will be explored, including neuroimaging methods, nuclear medicine investigations, and biomarkers on biological fluids. Of note, the promising information provided by neurophysiological investigations, i.e., electroencephalography and non-invasive brain stimulation techniques, concerning the alterations in brain networks and neurotransmitter systems will be reviewed. Finally, current and experimental therapies will be considered.
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Affiliation(s)
- Annibale Antonioni
- Unit of Clinical Neurology, Neurosciences and Rehabilitation Department, University of Ferrara, 44121 Ferrara, Italy
- Doctoral Program in Translational Neurosciences and Neurotechnologies, University of Ferrara, 44121 Ferrara, Italy
| | - Emanuela Maria Raho
- Unit of Clinical Neurology, Neurosciences and Rehabilitation Department, University of Ferrara, 44121 Ferrara, Italy
| | - Piervito Lopriore
- Neurological Institute, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Antonia Pia Pace
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, Azienda Sanitaria-Universitaria Friuli Centrale, 33100 Udine, Italy
| | - Raffaela Rita Latino
- Complex Structure of Neurology, Emergency Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
| | - Martina Assogna
- Centro Demenze, Policlinico Tor Vergata, University of Rome 'Tor Vergata', 00133 Rome, Italy
- Non Invasive Brain Stimulation Unit, Istituto di Ricovero e Cura a Carattere Scientifico Santa Lucia, 00179 Rome, Italy
| | - Michelangelo Mancuso
- Neurological Institute, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Daniela Gragnaniello
- Nuerology Unit, Neurosciences and Rehabilitation Department, Ferrara University Hospital, 44124 Ferrara, Italy
| | - Enrico Granieri
- Unit of Clinical Neurology, Neurosciences and Rehabilitation Department, University of Ferrara, 44121 Ferrara, Italy
| | - Maura Pugliatti
- Unit of Clinical Neurology, Neurosciences and Rehabilitation Department, University of Ferrara, 44121 Ferrara, Italy
| | - Francesco Di Lorenzo
- Non Invasive Brain Stimulation Unit, Istituto di Ricovero e Cura a Carattere Scientifico Santa Lucia, 00179 Rome, Italy
| | - Giacomo Koch
- Non Invasive Brain Stimulation Unit, Istituto di Ricovero e Cura a Carattere Scientifico Santa Lucia, 00179 Rome, Italy
- Iit@Unife Center for Translational Neurophysiology, Istituto Italiano di Tecnologia, 44121 Ferrara, Italy
- Section of Human Physiology, Neurosciences and Rehabilitation Department, University of Ferrara, 44121 Ferrara, Italy
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Vucic S, Stanley Chen KH, Kiernan MC, Hallett M, Benninger D, Di Lazzaro V, Rossini PM, Benussi A, Berardelli A, Currà A, Krieg SM, Lefaucheur JP, Long Lo Y, Macdonell RA, Massimini M, Rosanova M, Picht T, Stinear CM, Paulus W, Ugawa Y, Ziemann U, Chen R. Clinical diagnostic utility of transcranial magnetic stimulation in neurological disorders. Updated report of an IFCN committee. Clin Neurophysiol 2023; 150:131-175. [PMID: 37068329 DOI: 10.1016/j.clinph.2023.03.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/28/2023] [Accepted: 03/09/2023] [Indexed: 03/31/2023]
Abstract
The review provides a comprehensive update (previous report: Chen R, Cros D, Curra A, Di Lazzaro V, Lefaucheur JP, Magistris MR, et al. The clinical diagnostic utility of transcranial magnetic stimulation: report of an IFCN committee. Clin Neurophysiol 2008;119(3):504-32) on clinical diagnostic utility of transcranial magnetic stimulation (TMS) in neurological diseases. Most TMS measures rely on stimulation of motor cortex and recording of motor evoked potentials. Paired-pulse TMS techniques, incorporating conventional amplitude-based and threshold tracking, have established clinical utility in neurodegenerative, movement, episodic (epilepsy, migraines), chronic pain and functional diseases. Cortical hyperexcitability has emerged as a diagnostic aid in amyotrophic lateral sclerosis. Single-pulse TMS measures are of utility in stroke, and myelopathy even in the absence of radiological changes. Short-latency afferent inhibition, related to central cholinergic transmission, is reduced in Alzheimer's disease. The triple stimulation technique (TST) may enhance diagnostic utility of conventional TMS measures to detect upper motor neuron involvement. The recording of motor evoked potentials can be used to perform functional mapping of the motor cortex or in preoperative assessment of eloquent brain regions before surgical resection of brain tumors. TMS exhibits utility in assessing lumbosacral/cervical nerve root function, especially in demyelinating neuropathies, and may be of utility in localizing the site of facial nerve palsies. TMS measures also have high sensitivity in detecting subclinical corticospinal lesions in multiple sclerosis. Abnormalities in central motor conduction time or TST correlate with motor impairment and disability in MS. Cerebellar stimulation may detect lesions in the cerebellum or cerebello-dentato-thalamo-motor cortical pathways. Combining TMS with electroencephalography, provides a novel method to measure parameters altered in neurological disorders, including cortical excitability, effective connectivity, and response complexity.
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van den Bos MAJ, Menon P, Vucic S. Cortical hyperexcitability and plasticity in Alzheimer's disease: developments in understanding and management. Expert Rev Neurother 2022; 22:981-993. [PMID: 36683586 DOI: 10.1080/14737175.2022.2170784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Transcranial magnetic stimulation (TMS) is a non-invasive neurophysiological tool that provides important insights into Alzheimer's Disease (AD). A significant body of work utilizing TMS techniques has explored the pathophysiological relevance of cortical hyperexcitability and plasticity in AD and their modulation in novel therapies. AREAS COVERED This review examines the technique of TMS, the use of TMS to examine specific features of cortical excitability and the use of TMS techniques to modulate cortical function. A search was performed utilizing the PubMed database to identify key studies utilizing TMS to examine cortical hyperexcitability and plasticity in Alzheimer's dementia. We then translate this understanding to the study of Alzheimer's disease pathophysiology, examining the underlying neurophysiologic links contributing to these twin signatures, cortical hyperexcitability and abnormal plasticity, in the cortical dysfunction characterizing AD. Finally, we examine utilization of TMS excitability to guide targeted therapies and, through the use of repetitive TMS (rTMS), modulate cortical plasticity. EXPERT OPINION The examination of cortical hyperexcitability and plasticity with TMS has potential to optimize and expand the window of therapeutic interventions in AD, though remains at relatively early stage of development.
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Affiliation(s)
- Mehdi A J van den Bos
- Brain and Nerve Research Centre, Concord Repatriation General Hospital, Sydney, Australia
| | - Parvathi Menon
- Brain and Nerve Research Centre, Concord Repatriation General Hospital, Sydney, Australia
| | - Steve Vucic
- Brain and Nerve Research Centre, Concord Repatriation General Hospital, Sydney, Australia
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Benussi A, Cantoni V, Rivolta J, Archetti S, Micheli A, Ashton N, Zetterberg H, Blennow K, Borroni B. Classification accuracy of blood-based and neurophysiological markers in the differential diagnosis of Alzheimer's disease and frontotemporal lobar degeneration. Alzheimers Res Ther 2022; 14:155. [PMID: 36229847 PMCID: PMC9558959 DOI: 10.1186/s13195-022-01094-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 09/22/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND In the last decade, non-invasive blood-based and neurophysiological biomarkers have shown great potential for the discrimination of several neurodegenerative disorders. However, in the clinical workup of patients with cognitive impairment, it will be highly unlikely that any biomarker will achieve the highest potential predictive accuracy on its own, owing to the multifactorial nature of Alzheimer's disease (AD) and frontotemporal lobar degeneration (FTLD). METHODS In this retrospective study, performed on 202 participants, we analysed plasma neurofilament light (NfL), glial fibrillary acidic protein (GFAP), and tau phosphorylated at amino acid 181 (p-Tau181) concentrations, as well as amyloid β42 to 40 ratio (Aβ1-42/1-40) ratio, using the ultrasensitive single-molecule array (Simoa) technique, and neurophysiological measures obtained by transcranial magnetic stimulation (TMS), including short-interval intracortical inhibition (SICI), intracortical facilitation (ICF), long-interval intracortical inhibition (LICI), and short-latency afferent inhibition (SAI). We assessed the diagnostic accuracy of combinations of both plasma and neurophysiological biomarkers in the differential diagnosis between healthy ageing, AD, and FTLD. RESULTS We observed significant differences in plasma NfL, GFAP, and p-Tau181 levels between the groups, but not for the Aβ1-42/Aβ1-40 ratio. For the evaluation of diagnostic accuracy, we adopted a two-step process which reflects the clinical judgement on clinical grounds. In the first step, the best single biomarker to classify "cases" vs "controls" was NfL (AUC 0.94, p < 0.001), whilst in the second step, the best single biomarker to classify AD vs FTLD was SAI (AUC 0.96, p < 0.001). The combination of multiple biomarkers significantly increased diagnostic accuracy. The best model for classifying "cases" vs "controls" included the predictors p-Tau181, GFAP, NfL, SICI, ICF, and SAI, resulting in an AUC of 0.99 (p < 0.001). For the second step, classifying AD from FTD, the best model included the combination of Aβ1-42/Aβ1-40 ratio, p-Tau181, SICI, ICF, and SAI, resulting in an AUC of 0.98 (p < 0.001). CONCLUSIONS The combined assessment of plasma and neurophysiological measures may greatly improve the differential diagnosis of AD and FTLD.
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Affiliation(s)
- Alberto Benussi
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy
- Neurology Unit, ASST Spedali Civili Brescia, Brescia, Italy
| | - Valentina Cantoni
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Jasmine Rivolta
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy
| | - Silvana Archetti
- Biotechnology Laboratory and Department of Diagnostics, Civic Hospital of Brescia, Brescia, Italy
| | | | - Nicholas Ashton
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Mölndal, Sweden
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Maurice Wohl Clinical Neuroscience Institute, London, UK
- NIHR Biomedical Research Centre for Mental Health & Biomedical Research Unit for Dementia at South London & Maudsley NHS Foundation, London, UK
| | - Henrik Zetterberg
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- UK Dementia Research Institute at UCL, London, UK
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
| | - Kaj Blennow
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Barbara Borroni
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy.
- Neurology Unit, ASST Spedali Civili Brescia, Brescia, Italy.
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9
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Lanza G, Fisicaro F, Dubbioso R, Ranieri F, Chistyakov AV, Cantone M, Pennisi M, Grasso AA, Bella R, Di Lazzaro V. A comprehensive review of transcranial magnetic stimulation in secondary dementia. Front Aging Neurosci 2022; 14:995000. [PMID: 36225892 PMCID: PMC9549917 DOI: 10.3389/fnagi.2022.995000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Although primary degenerative diseases are the main cause of dementia, a non-negligible proportion of patients is affected by a secondary and potentially treatable cognitive disorder. Therefore, diagnostic tools able to early identify and monitor them and to predict the response to treatment are needed. Transcranial magnetic stimulation (TMS) is a non-invasive neurophysiological technique capable of evaluating in vivo and in “real time” the motor areas, the cortico-spinal tract, and the neurotransmission pathways in several neurological and neuropsychiatric disorders, including cognitive impairment and dementia. While consistent evidence has been accumulated for Alzheimer’s disease, other degenerative cognitive disorders, and vascular dementia, to date a comprehensive review of TMS studies available in other secondary dementias is lacking. These conditions include, among others, normal-pressure hydrocephalus, multiple sclerosis, celiac disease and other immunologically mediated diseases, as well as a number of inflammatory, infective, metabolic, toxic, nutritional, endocrine, sleep-related, and rare genetic disorders. Overall, we observed that, while in degenerative dementia neurophysiological alterations might mirror specific, and possibly primary, neuropathological changes (and hence be used as early biomarkers), this pathogenic link appears to be weaker for most secondary forms of dementia, in which neurotransmitter dysfunction is more likely related to a systemic or diffuse neural damage. In these cases, therefore, an effort toward the understanding of pathological mechanisms of cognitive impairment should be made, also by investigating the relationship between functional alterations of brain circuits and the specific mechanisms of neuronal damage triggered by the causative disease. Neurophysiologically, although no distinctive TMS pattern can be identified that might be used to predict the occurrence or progression of cognitive decline in a specific condition, some TMS-associated measures of cortical function and plasticity (such as the short-latency afferent inhibition, the short-interval intracortical inhibition, and the cortical silent period) might add useful information in most of secondary dementia, especially in combination with suggestive clinical features and other diagnostic tests. The possibility to detect dysfunctional cortical circuits, to monitor the disease course, to probe the response to treatment, and to design novel neuromodulatory interventions in secondary dementia still represents a gap in the literature that needs to be explored.
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Affiliation(s)
- Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
- Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS, Troina, Italy
- *Correspondence: Giuseppe Lanza,
| | - Francesco Fisicaro
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Raffaele Dubbioso
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, Naples, Italy
| | - Federico Ranieri
- Unit of Neurology, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Mariagiovanna Cantone
- Neurology Unit, Policlinico University Hospital “G. Rodolico – San Marco”, Catania, Italy
- Neurology Unit, Sant’Elia Hospital, ASP Caltanissetta, Caltanissetta, Italy
| | - Manuela Pennisi
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Alfio Antonio Grasso
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Catania, Italy
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology and Neurobiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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10
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Sun L, Hui L, Li Y, Chen X, Liu R, Ma J. Pathogenesis and research progress in leukoaraiosis. Front Hum Neurosci 2022; 16:902731. [PMID: 36061509 PMCID: PMC9437627 DOI: 10.3389/fnhum.2022.902731] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 08/02/2022] [Indexed: 12/02/2022] Open
Abstract
Leukoaraiosis is a common imaging marker of cerebral small vessel disease. In recent years, with the continuous advances in brain imaging technology, the detection rate of leukoaraiosis is higher and its clinical subtypes are gradually gaining attention. Although leukoaraiosis has long been considered an incidental finding with no therapeutic necessity, there is now growing evidence linking it to, among other things, cognitive impairment and a high risk of death after stroke. Due to different research methods, some of the findings are inconsistent and even contradictory. Therefore, a comprehensive and in-depth study of risk factors for leukoaraiosis is of great clinical significance. In this review, we summarize the literature on leukoaraiosis in recent years with the aim of elucidating the disease in terms of various aspects (including pathogenesis, imaging features, and clinical features, etc.).
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Affiliation(s)
- Lingqi Sun
- Department of Medical Oncology, West China Hospital, Sichuan University, Chengdu, China
- Department of Neurology, Air Force Hospital of the Western Theater of the Chinese People's Liberation Army, Chengdu, China
| | - Lin Hui
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yi Li
- Department of Ultrasound Medicine, Air Force Hospital of the Western Theater of the Chinese People's Liberation Army, Chengdu, China
| | - Xian Chen
- Department of Neurology, Air Force Hospital of the Western Theater of the Chinese People's Liberation Army, Chengdu, China
| | - Rong Liu
- Department of Neurology, Air Force Hospital of the Western Theater of the Chinese People's Liberation Army, Chengdu, China
| | - Ji Ma
- Department of Medical Oncology, West China Hospital, Sichuan University, Chengdu, China
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11
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Chou YH, Sundman M, Ton That V, Green J, Trapani C. Cortical excitability and plasticity in Alzheimer's disease and mild cognitive impairment: A systematic review and meta-analysis of transcranial magnetic stimulation studies. Ageing Res Rev 2022; 79:101660. [PMID: 35680080 DOI: 10.1016/j.arr.2022.101660] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 05/13/2022] [Accepted: 05/30/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) is a non-invasive neuromodulation technique. When stimulation is applied over the primary motor cortex and coupled with electromyography measures, TMS can probe functions of cortical excitability and plasticity in vivo. The purpose of this meta-analysis is to evaluate the utility of TMS-derived measures for differentiating patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI) from cognitively normal older adults (CN). METHODS Databases searched included PubMed, Embase, APA PsycInfo, Medline, and CINAHL Plus from inception to July 2021. RESULTS Sixty-one studies with a total of 2728 participants (1454 patients with AD, 163 patients with MCI, and 1111 CN) were included. Patients with AD showed significantly higher cortical excitability, lower cortical inhibition, and impaired cortical plasticity compared to the CN cohorts. Patients with MCI exhibited increased cortical excitability and reduced plasticity compared to the CN cohort. Additionally, lower cognitive performance was significantly associated with higher cortical excitability and lower inhibition. No seizure events due to TMS were reported, and the mild adverse response rate is approximately 3/1000 (i.e., 9/2728). CONCLUSIONS Findings of our meta-analysis demonstrate the potential of using TMS-derived cortical excitability and plasticity measures as diagnostic biomarkers and therapeutic targets for AD and MCI.
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Affiliation(s)
- Ying-Hui Chou
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, Tucson, USA; Evelyn F McKnight Brain Institute, Arizona Center on Aging, and BIO5 Institute, University of Arizona, Tucson, USA.
| | - Mark Sundman
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, Tucson, USA
| | - Viet Ton That
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, Tucson, USA
| | - Jacob Green
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, Tucson, USA
| | - Chrisopher Trapani
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, Tucson, USA
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12
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Cengiz B, Boran HE, Alaydın HC, Tankisi H, Samusyte G, Howells J, Koltzenburg M, Bostock H. Short latency afferent inhibition: comparison between threshold-tracking and conventional amplitude recording methods. Exp Brain Res 2022; 240:1241-1247. [PMID: 35192042 DOI: 10.1007/s00221-022-06327-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 02/05/2022] [Indexed: 11/04/2022]
Abstract
Short-latency afferent inhibition (SAI), which is conventionally measured as a reduction in motor evoked potential amplitude (A-SAI), is of clinical interest as a potential biomarker for cognitive impairment. Since threshold-tracking has some advantages for clinical studies of short-interval cortical inhibition, we have compared A-SAI with a threshold-tracking alternative method (T-SAI). In the T-SAI method, inhibition was calculated by tracking the required TMS intensity for the targeted MEP amplitude (200 uV) both for the test (TMS only) and paired (TMS and peripheral stimulation) stimuli. A-SAI and T-SAI were recorded from 31 healthy subjects using ten stimuli at each of 12 inter-stimulus intervals, once in the morning and again in the afternoon. There were no differences between morning and afternoon recordings. When A-SAI was normalized by log conversion it was closely related to T-SAI. Between subjects, variability was similar for the two techniques, but within-subject variability was significantly smaller for normalized A-SAI. Conventional amplitude measurements appear more sensitive for detecting changes within-subjects, such as in interventional studies, but threshold-tracking may be as sensitive as detecting abnormal SAI in a patient.
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Affiliation(s)
- Bülent Cengiz
- Department of Neurology, Gazi University Faculty of Medicine, Beşevler, 06500, Ankara, Turkey.
| | - H Evren Boran
- Department of Neurology, Gazi University Faculty of Medicine, Beşevler, 06500, Ankara, Turkey
| | - Halil Can Alaydın
- Department of Neurology, Gazi University Faculty of Medicine, Beşevler, 06500, Ankara, Turkey
| | - Hatice Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - Gintaute Samusyte
- Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - James Howells
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Martin Koltzenburg
- Department of Clinical and Movement Neuroscience, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK.,Department of Clinical Neurophysiology, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - Hugh Bostock
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
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13
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Assogna M, Motta C, Bonnì S, Borghi I, Casula EP, Martorana A, Koch G. Isolated Amyloid-β Pathology Is Associated with Preserved Cortical Plasticity in APOE4 Alzheimer's Disease Patients. J Alzheimers Dis 2022; 86:773-778. [PMID: 35124643 DOI: 10.3233/jad-215218] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Long-term potentiation (LTP) like-cortical plasticity impairment and cholinergic neurotransmission deficits have been widely demonstrated in Alzheimer's disease (AD) patients. OBJECTIVE In this study we aim to investigate the neurophysiological features underlying cognitive decline in AD patients according to the National Institute on Aging-Alzheimer's Association (NIA-AA) classification and APOE genotype. METHODS 65 newly diagnosed AD patients were enrolled. APOE genotype and lumbar puncture for the analysis of cerebrospinal fluid biomarkers were performed for diagnostic purposes. Patients were subdivided upon NIA-AA criteria, according to the presence of biomarkers of Aβ amyloid deposition (A) and fibrillar tau (T), in four groups: A+/T-E4 (n = 9), A+/T-E3 (n = 18), A+/T+ E4 (n = 21), and A+/T+ E3 (n = 17). We applied intermittent theta burst stimulation over the primary motor cortex to assess LTP-like cortical plasticity and short latency afferent inhibition (SAI) protocol to investigate central cholinergic activity. Patients were followed over 24 months. Cognitive decline was evaluated considering changes in Mini-Mental State Examination scores respect to the baseline. RESULTS A+/T-E4 patients showed preserved LTP-like cortical plasticity as compared to A+/T-E3 and to A+/T+ patients independently from genotype (p < 0.001). In addition, A+/T-E4 patients showed a slower cognitive decline with respect to A+/T+ E4 (-0.5±2.12 versus -6.05±4.95; post-hoc p = 0.004) and to A+/T+ E3 patients (-4.12±4.14; post-hoc p = 0.028). No differences were found for SAI protocol (p > 0.05). CONCLUSION Our results suggest that APOE4 in patients with isolated amyloid pathology could exert positive effects on LTP-like cortical plasticity with a consequent slower cognitive decline.
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Affiliation(s)
- Martina Assogna
- Experimental Neuropsychophysiology Lab, Santa Lucia Foundation, IRCCS, Rome, Italy.,UOSD Centro Demenze, Policlinico Tor Vergata, Rome, Italy
| | - Caterina Motta
- Experimental Neuropsychophysiology Lab, Santa Lucia Foundation, IRCCS, Rome, Italy
| | - Sonia Bonnì
- Experimental Neuropsychophysiology Lab, Santa Lucia Foundation, IRCCS, Rome, Italy
| | - Ilaria Borghi
- Experimental Neuropsychophysiology Lab, Santa Lucia Foundation, IRCCS, Rome, Italy
| | - Elias P Casula
- Experimental Neuropsychophysiology Lab, Santa Lucia Foundation, IRCCS, Rome, Italy
| | | | - Giacomo Koch
- Experimental Neuropsychophysiology Lab, Santa Lucia Foundation, IRCCS, Rome, Italy.,Department on Neuroscience and Rehabilitation, Section of Human Physiology, University of Ferrara, Italy
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14
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Biological sex differences in afferent-mediated inhibition of motor responses evoked by TMS. Brain Res 2021; 1771:147657. [PMID: 34509460 DOI: 10.1016/j.brainres.2021.147657] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/02/2021] [Accepted: 09/04/2021] [Indexed: 12/14/2022]
Abstract
Sensorimotor integration can be assessed by pairing electrical peripheral nerve stimulation with transcranial magnetic stimulation (TMS). The resulting afferent inhibition is observed when TMS precedes nerve stimulation by ∼ 20-25 ms, termed short-latency afferent inhibition (SAI), or by 200 ms, termed long-latency afferent inhibition (LAI). The purpose of this study was to determine whether biological sex influences the magnitude of SAI or LAI. SAI and LAI were assessed in fifteen males (21.5 ± 2.7 years) and fifteen females (20.2 ± 2.3 years). TMS was delivered to the primary motor cortex (M1) following stimulation of the contralateral median nerve at the wrist or digital nerve of the index finger, and motor-evoked potentials (MEPs) were obtained from the right first dorsal interosseous (FDI) muscle. SAI evoked by median and digital nerve stimulation, and LAI evoked by median nerve stimulation, were not different between males and females. LAI evoked by digital nerve stimulation was increased in females compared to males, but this difference between sexes was no longer present following the removal of datapoints where inhibition was not observed. This study is the first to investigate biological sex differences in afferent inhibition.
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15
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Di Lazzaro V, Bella R, Benussi A, Bologna M, Borroni B, Capone F, Chen KHS, Chen R, Chistyakov AV, Classen J, Kiernan MC, Koch G, Lanza G, Lefaucheur JP, Matsumoto H, Nguyen JP, Orth M, Pascual-Leone A, Rektorova I, Simko P, Taylor JP, Tremblay S, Ugawa Y, Dubbioso R, Ranieri F. Diagnostic contribution and therapeutic perspectives of transcranial magnetic stimulation in dementia. Clin Neurophysiol 2021; 132:2568-2607. [PMID: 34482205 DOI: 10.1016/j.clinph.2021.05.035] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 04/22/2021] [Accepted: 05/28/2021] [Indexed: 02/07/2023]
Abstract
Transcranial magnetic stimulation (TMS) is a powerful tool to probe in vivo brain circuits, as it allows to assess several cortical properties such asexcitability, plasticity and connectivity in humans. In the last 20 years, TMS has been applied to patients with dementia, enabling the identification of potential markers of thepathophysiology and predictors of cognitive decline; moreover, applied repetitively, TMS holds promise as a potential therapeutic intervention. The objective of this paper is to present a comprehensive review of studies that have employed TMS in dementia and to discuss potential clinical applications, from the diagnosis to the treatment. To provide a technical and theoretical framework, we first present an overview of the basic physiological mechanisms of the application of TMS to assess cortical excitability, excitation and inhibition balance, mechanisms of plasticity and cortico-cortical connectivity in the human brain. We then review the insights gained by TMS techniques into the pathophysiology and predictors of progression and response to treatment in dementias, including Alzheimer's disease (AD)-related dementias and secondary dementias. We show that while a single TMS measure offers low specificity, the use of a panel of measures and/or neurophysiological index can support the clinical diagnosis and predict progression. In the last part of the article, we discuss the therapeutic uses of TMS. So far, only repetitive TMS (rTMS) over the left dorsolateral prefrontal cortex and multisite rTMS associated with cognitive training have been shown to be, respectively, possibly (Level C of evidence) and probably (Level B of evidence) effective to improve cognition, apathy, memory, and language in AD patients, especially at a mild/early stage of the disease. The clinical use of this type of treatment warrants the combination of brain imaging techniques and/or electrophysiological tools to elucidate neurobiological effects of neurostimulation and to optimally tailor rTMS treatment protocols in individual patients or specific patient subgroups with dementia or mild cognitive impairment.
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Affiliation(s)
- Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy.
| | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced Technologies, Section of Neurosciences, University of Catania, Catania, Italy
| | - Alberto Benussi
- Centre for Neurodegenerative Disorders, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy
| | - Barbara Borroni
- Centre for Neurodegenerative Disorders, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Fioravante Capone
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Kai-Hsiang S Chen
- Department of Neurology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Robert Chen
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada; Division of Brain, Imaging& Behaviour, Krembil Brain Institute, Toronto, Canada
| | | | - Joseph Classen
- Department of Neurology, University Hospital Leipzig, Leipzig University Medical Center, Germany
| | - Matthew C Kiernan
- Department of Neurology, Royal Prince Alfred Hospital, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Giacomo Koch
- Non Invasive Brain Stimulation Unit/Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy; Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy; Department of Neurology IC, Oasi Research Institute-IRCCS, Troina, Italy
| | - Jean-Pascal Lefaucheur
- ENT Team, EA4391, Faculty of Medicine, Paris Est Créteil University, Créteil, France; Clinical Neurophysiology Unit, Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | | | - Jean-Paul Nguyen
- Pain Center, clinique Bretéché, groupe ELSAN, Multidisciplinary Pain, Palliative and Supportive care Center, UIC 22/CAT2 and Laboratoire de Thérapeutique (EA3826), University Hospital, Nantes, France
| | - Michael Orth
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Swiss Huntington's Disease Centre, Siloah, Bern, Switzerland
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research, Center for Memory Health, Hebrew SeniorLife, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA; Guttmann Brain Health Institute, Universitat Autonoma Barcelona, Spain
| | - Irena Rektorova
- Applied Neuroscience Research Group, Central European Institute of Technology, Masaryk University (CEITEC MU), Brno, Czech Republic; Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Patrik Simko
- Applied Neuroscience Research Group, Central European Institute of Technology, Masaryk University (CEITEC MU), Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sara Tremblay
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, ON, Canada; Royal Ottawa Institute of Mental Health Research, Ottawa, ON, Canada
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Raffaele Dubbioso
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Federico Ranieri
- Unit of Neurology, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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16
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Martini DN, Morris R, Madhyastha TM, Grabowski TJ, Oakley J, Hu SC, Zabetian CP, Edwards KL, Hiller A, Chung K, Ramsey K, Lapidus JA, Cholerton B, Montine TJ, Quinn JF, Horak FB. Relationships Between Sensorimotor Inhibition and Mobility in Older Adults With and Without Parkinson's Disease. J Gerontol A Biol Sci Med Sci 2021; 76:630-637. [PMID: 33252618 DOI: 10.1093/gerona/glaa300] [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: 02/04/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Reduced cortical sensorimotor inhibition is associated with mobility and cognitive impairments in people with Parkinson's disease (PD) and older adults (OAs). However, there is a lack of clarity regarding the relationships among sensorimotor, cognitive, and mobility impairments. The purpose of this study was to determine how cortical sensorimotor inhibition relates to impairments in mobility and cognition in people with PD and OAs. METHOD Cortical sensorimotor inhibition was characterized with short-latency afferent inhibition (SAI) in 81 people with PD and 69 OAs. Six inertial sensors recorded single- and dual-task gait and postural sway characteristics during a 2-minute walk and a 1-minute quiet stance. Cognition was assessed across the memory, visuospatial, executive function, attention, and language domains. RESULTS SAI was significantly impaired in the PD compared to the OA group. The PD group preformed significantly worse across all gait and postural sway tasks. In PD, SAI significantly correlated with single-task foot strike angle and stride length variability, sway area, and jerkiness of sway in the coronal and sagittal planes. In OAs, SAI significantly related to single-task gait speed and stride length, dual-task stride length, and immediate recall (memory domain). No relationship among mobility, cognition, and SAI was observed. CONCLUSIONS Impaired SAI related to slower gait in OA and to increased gait variability and postural sway in people with PD, all of which have been shown to be related to increased fall risk.
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Affiliation(s)
- Douglas N Martini
- Department of Neurology, Oregon Health and Science University, Portland.,Department of Kinesiology, University of Massachusetts Amherst
| | - Rosie Morris
- Department of Neurology, Oregon Health and Science University, Portland
| | - Tara M Madhyastha
- Department of Radiology, University of Washington School of Medicine, Seattle
| | - Thomas J Grabowski
- Department of Radiology, University of Washington School of Medicine, Seattle
| | - John Oakley
- Department of Neurology, University of Washington School of Medicine, Seattle
| | - Shu-Ching Hu
- Department of Neurology, University of Washington School of Medicine, Seattle.,Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Cyrus P Zabetian
- Department of Neurology, University of Washington School of Medicine, Seattle.,Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Karen L Edwards
- Department of Epidemiology, University of California, Irvine
| | - Amie Hiller
- Department of Neurology, Oregon Health and Science University, Portland.,Portland Veterans Affairs Health Care System, Oregon
| | - Kathryn Chung
- Department of Neurology, Oregon Health and Science University, Portland.,Portland Veterans Affairs Health Care System, Oregon
| | - Katrina Ramsey
- Biostatistics & Design Program, Oregon Health and Science University, Portland
| | - Jodi A Lapidus
- Biostatistics & Design Program, Oregon Health and Science University, Portland.,School of Public Health, Oregon Health and Science University, Portland
| | - Brenna Cholerton
- Department of Pathology, Stanford University School of Medicine, Palo Alto, California
| | - Thomas J Montine
- Department of Pathology, Stanford University School of Medicine, Palo Alto, California
| | - Joseph F Quinn
- Department of Neurology, Oregon Health and Science University, Portland.,Portland Veterans Affairs Health Care System, Oregon
| | - Fay B Horak
- Department of Neurology, Oregon Health and Science University, Portland.,Portland Veterans Affairs Health Care System, Oregon
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17
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Joseph S, Patterson R, Wang W, Blumberger DM, Rajji T, Kumar S. Quantitative Assessment of Cortical Excitability in Alzheimer's Dementia and Its Association with Clinical Symptoms: A Systematic Review and Meta-Analyses. J Alzheimers Dis 2021; 88:867-891. [PMID: 34219724 DOI: 10.3233/jad-210311] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Alzheimer's disease (AD) is characterized by cognitive and neuropsychiatric symptoms (NPS) due to underlying neurodegenerative pathology. Some studies using electroencephalography (EEG) have shown increased epileptiform and epileptic activity in AD. OBJECTIVE This review and meta-analyses aims to synthesize the existing evidence for quantitative abnormalities of cortical excitability in AD and their relationship with clinical symptoms. METHODS We systematically searched and reviewed publications that quantitatively assessed cortical excitability, using transcranial magnetic stimulation (TMS) resting motor threshold (rMT), active motor threshold (aMT), motor evoked potential (MEP) or directly from the cortex using TMS-EEG via TMS-evoked potential (TEP). We meta-analyzed studies that assessed rMT and aMT using random effects model. RESULTS We identified 895 publications out of which 37 were included in the qualitative review and 30 studies using rMT or aMT were included in the meta-analyses. The AD group had reduced rMT (Hedges' g = -0.99, 95%CI [-1.29, -0.68], p < 0.00001) and aMT (Hedges' g = -0.87, 95%CI [-1.50, -0.24], p < 0.00001) as compared with control groups, indicative of higher cortical excitability. Qualitative review found some evidence of increased MEP amplitude, whereas findings related to TEP were inconsistent. There was some evidence supporting an inverse association between cortical excitability and global cognition. No publications reported on the relationship between cortical excitability and NPS. CONCLUSION There is strong evidence of increased motor cortex excitability in AD and some evidence of an inverse association between excitability and cognition. Future studies should assess cortical excitability from non-motor areas using TMS-EEG and examine its relationship with cognition and NPS.
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Affiliation(s)
- Shaylyn Joseph
- Centre for Addiction and Mental Health, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Rachel Patterson
- Centre for Addiction and Mental Health, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Wei Wang
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Daniel M Blumberger
- Centre for Addiction and Mental Health, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Tarek Rajji
- Centre for Addiction and Mental Health, Toronto, Canada.,University of Toronto, Toronto, Canada.,Toronto Dementia Research Alliance, Toronto, Canada
| | - Sanjeev Kumar
- Centre for Addiction and Mental Health, Toronto, Canada.,University of Toronto, Toronto, Canada
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18
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Antczak J, Rusin G, Słowik A. Transcranial Magnetic Stimulation as a Diagnostic and Therapeutic Tool in Various Types of Dementia. J Clin Med 2021; 10:jcm10132875. [PMID: 34203558 PMCID: PMC8267667 DOI: 10.3390/jcm10132875] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 02/03/2023] Open
Abstract
Dementia is recognized as a healthcare and social burden and remains challenging in terms of proper diagnosis and treatment. Transcranial magnetic stimulation (TMS) is a diagnostic and therapeutic tool in various neurological diseases that noninvasively investigates cortical excitability and connectivity and can induce brain plasticity. This article reviews findings on TMS in common dementia types as well as therapeutic results. Alzheimer’s disease (AD) is characterized by increased cortical excitability and reduced cortical inhibition, especially as mediated by cholinergic neurons and as documented by impairment of short latency inhibition (SAI). In vascular dementia, excitability is also increased. SAI may have various outcomes, which probably reflects its frequent overlap with AD. Dementia with Lewy bodies (DLB) is associated with SAI decrease. Motor cortical excitability is usually normal, reflecting the lack of corticospinal tract involvement. DLB and other dementia types are also characterized by impairment of short interval intracortical inhibition. In frontotemporal dementia, cortical excitability is increased, but SAI is normal. Repetitive transcranial magnetic stimulation has the potential to improve cognitive function. It has been extensively studied in AD, showing promising results after multisite stimulation. TMS with electroencephalography recording opens new possibilities for improving diagnostic accuracy; however, more studies are needed to support the existing data.
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19
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Turco CV, Toepp SL, Foglia SD, Dans PW, Nelson AJ. Association of short- and long-latency afferent inhibition with human behavior. Clin Neurophysiol 2021; 132:1462-1480. [PMID: 34030051 DOI: 10.1016/j.clinph.2021.02.402] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/26/2021] [Accepted: 02/12/2021] [Indexed: 01/04/2023]
Abstract
Transcranial magnetic stimulation (TMS) paired with nerve stimulation evokes short-latency afferent inhibition (SAI) and long-latency afferent inhibition (LAI), which are non-invasive assessments of the excitability of the sensorimotor system. SAI and LAI are abnormally reduced in various special populations in comparison to healthy controls. However, the relationship between afferent inhibition and human behavior remains unclear. The purpose of this review is to survey the current literature and synthesize observations and patterns that affect the interpretation of SAI and LAI in the context of human behavior. We discuss human behaviour across the motor and cognitive domains, and in special and control populations. Further, we discuss future considerations for research in this field and the potential for clinical applications. By understanding how human behavior is mediated by changes in SAI and LAI, this can allow us to better understand the neurophysiological underpinnings of human motor control.
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Affiliation(s)
- Claudia V Turco
- Department of Kinesiology, McMaster University, Hamilton, ON L8S 4K1, Canada.
| | - Stephen L Toepp
- Department of Kinesiology, McMaster University, Hamilton, ON L8S 4K1, Canada.
| | - Stevie D Foglia
- School of Biomedical Engineering, McMaster University, Hamilton, ON L8S 4K1, Canada.
| | - Patrick W Dans
- Department of Kinesiology, McMaster University, Hamilton, ON L8S 4K1, Canada.
| | - Aimee J Nelson
- Department of Kinesiology, McMaster University, Hamilton, ON L8S 4K1, Canada.
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20
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Mimura Y, Nishida H, Nakajima S, Tsugawa S, Morita S, Yoshida K, Tarumi R, Ogyu K, Wada M, Kurose S, Miyazaki T, Blumberger DM, Daskalakis ZJ, Chen R, Mimura M, Noda Y. Neurophysiological biomarkers using transcranial magnetic stimulation in Alzheimer's disease and mild cognitive impairment: A systematic review and meta-analysis. Neurosci Biobehav Rev 2020; 121:47-59. [PMID: 33307047 DOI: 10.1016/j.neubiorev.2020.12.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/08/2020] [Accepted: 12/03/2020] [Indexed: 12/19/2022]
Abstract
Transcranial magnetic stimulation (TMS) is a non-invasive neurophysiological tool that enables the investigation of cortical excitability in the human brain. Paired-pulse TMS paradigms include short- and long-interval intracortical inhibition (SICI/LICI), intracortical facilitation (ICF), and short-latency afferent inhibition (SAI), which can assess neurophysiological functions of GABAergic, glutamatergic, and cholinergic neural circuits, respectively. We conducted the first systematic review and meta-analysis to compare these TMS indices among patients with AD, mild cognitive impairment (MCI), and healthy controls (HC). Our meta-analyses indicated that RMT, SAI, SICI, and LICI were significantly lower in patients with AD, while ICF did not show a difference in patients with AD compared with HC. In patients with MCI, RMT and SAI were significantly lower than in HC. In conclusion, motor cortical excitability was increased, while cholinergic function was decreased in AD and MCI in comparison with HC and patients with AD had decreased GABAergic and glutamatergic functions compared with HC. Our results warrant further studies to differentiate AD, MCI, and HC, employing multimodal TMS neurophysiology.
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Affiliation(s)
- Yu Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Hana Nishida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Shinichiro Nakajima
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.
| | - Sakiko Tsugawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Shinji Morita
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Kazunari Yoshida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Pharmacogenetics Research Clinic, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Ryosuke Tarumi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Kamiyu Ogyu
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Masataka Wada
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Shin Kurose
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Takahiro Miyazaki
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Robert Chen
- Division of Neurology, Department of Medicine, University of Toronto, Division of Brain, Imaging and Behaviour - Systems Neuroscience, Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Yoshihiro Noda
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
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21
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Evaluation and Treatment of Vascular Cognitive Impairment by Transcranial Magnetic Stimulation. Neural Plast 2020. [PMID: 33193753 DOI: 10.1155/2020/8820881.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The exact relationship between cognitive functioning, cortical excitability, and synaptic plasticity in dementia is not completely understood. Vascular cognitive impairment (VCI) is deemed to be the most common cognitive disorder in the elderly since it encompasses any degree of vascular-based cognitive decline. In different cognitive disorders, including VCI, transcranial magnetic stimulation (TMS) can be exploited as a noninvasive tool able to evaluate in vivo the cortical excitability, the propension to undergo neural plastic phenomena, and the underlying transmission pathways. Overall, TMS in VCI revealed enhanced cortical excitability and synaptic plasticity that seem to correlate with the disease process and progression. In some patients, such plasticity may be considered as an adaptive response to disease progression, thus allowing the preservation of motor programming and execution. Recent findings also point out the possibility to employ TMS to predict cognitive deterioration in the so-called "brains at risk" for dementia, which may be those patients who benefit more of disease-modifying drugs and rehabilitative or neuromodulatory approaches, such as those based on repetitive TMS (rTMS). Finally, TMS can be exploited to select the responders to specific drugs in the attempt to maximize the response and to restore maladaptive plasticity. While no single TMS index owns enough specificity, a panel of TMS-derived measures can support VCI diagnosis and identify early markers of progression into dementia. This work reviews all TMS and rTMS studies on VCI. The aim is to evaluate how cortical excitability, plasticity, and connectivity interact in the pathophysiology of the impairment and to provide a translational perspective towards novel treatments of these patients. Current pitfalls and limitations of both studies and techniques are also discussed, together with possible solutions and future research agenda.
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22
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Martini DN, Morris R, Kelly VE, Hiller A, Chung KA, Hu SC, Zabetian CP, Oakley J, Poston K, Mata IF, Edwards KL, Lapidus JA, Grabowski TJ, Montine TJ, Quinn JF, Horak F. Sensorimotor Inhibition and Mobility in Genetic Subgroups of Parkinson's Disease. Front Neurol 2020; 11:893. [PMID: 33013627 PMCID: PMC7498564 DOI: 10.3389/fneur.2020.00893] [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: 05/22/2020] [Accepted: 07/13/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Mobility and sensorimotor inhibition impairments are heterogeneous in Parkinson's disease (PD). Genetics may contribute to this heterogeneity since the apolipoprotein (APOE) ε4 allele and glucocerebrosidase (GBA) gene variants have been related to mobility impairments in otherwise healthy older adult (OA) and PD cohorts. The purpose of this study is to determine if APOE or GBA genetic status affects sensorimotor inhibition and whether the relationship between sensorimotor inhibition and mobility differs in genetic sub-groups of PD. Methods: Ninety-three participants with idiopathic PD (53 non-carriers; 23 ε4 carriers; 17 GBA variants) and 72 OA (45 non-carriers; 27 ε4 carriers) had sensorimotor inhibition characterized by short-latency afferent inhibition. Mobility was assessed in four gait domains (pace/turning, rhythm, trunk, variability) and two postural sway domains (area/jerkiness and velocity) using inertial sensors. Results: Sensorimotor inhibition was worse in the PD than OA group, with no effect of genetic status. Gait pace/turning was slower and variability was higher (p < 0.01) in PD compared to OA. Postural sway area/jerkiness (p < 0.01) and velocity (p < 0.01) were also worse in the PD than OA group. Genetic status was not significantly related to any gait or postural sway domain. Sensorimotor inhibition was significantly correlated with gait variability (r = 0.27; p = 0.02) and trunk movement (r = 0.23; p = 0.045) in the PD group. In PD non-carriers, sensorimotor inhibition related to variability (r = 0.35; p = 0.010) and trunk movement (r = 0.31; p = 0.025). In the PD ε4 group, sensorimotor inhibition only related to rhythm (r = 0.47; p = 0.024), while sensorimotor inhibition related to pace/turning (r = -0.49; p = 0.046) and rhythm (r = 0.59; p = 0.013) in the PD GBA group. Sensorimotor inhibition was significantly correlated with gait pace/turning (r = -0.27; p = 0.04) in the OA group. There was no relationship between sensorimotor inhibition and postural sway. Conclusion: ε4 and GBA genetic status did not affect sensorimotor inhibition or mobility impairments in this PD cohort. However, worse sensorimotor inhibition was associated with gait variability in PD non-carriers, but with gait rhythm in PD ε4 carriers and with gait rhythm and pace in PD with GBA variants. Impaired sensorimotor inhibition had a larger effect on mobility in people with PD than OA and affected different domains of mobility depending on genetic status.
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Affiliation(s)
- Douglas N Martini
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
| | - Rosie Morris
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
| | - Valerie E Kelly
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Amie Hiller
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States.,Portland Veterans Affairs Health Care System, Portland, OR, United States
| | - Kathryn A Chung
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States.,Portland Veterans Affairs Health Care System, Portland, OR, United States
| | - Shu-Ching Hu
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, United States.,Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
| | - Cyrus P Zabetian
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, United States.,Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
| | - John Oakley
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, United States
| | - Kathleen Poston
- Department of Neurology and Neurological Sciences, Stanford School of Medicine, Palo Alto, CA, United States
| | - Ignacio F Mata
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, United States.,Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States.,Lerner Research Institute, Genomic Medicine, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Karen L Edwards
- Department of Epidemiology, University of California, Irvine, Irvine, CA, United States
| | - Jodi A Lapidus
- Biostatistics & Design Program, Oregon Health and Science University, Portland, OR, United States
| | - Thomas J Grabowski
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States
| | - Thomas J Montine
- Department of Pathology, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Joseph F Quinn
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States.,Portland Veterans Affairs Health Care System, Portland, OR, United States
| | - Fay Horak
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
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23
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Stampanoni Bassi M, Buttari F, Gilio L, De Paolis N, Fresegna D, Centonze D, Iezzi E. Inflammation and Corticospinal Functioning in Multiple Sclerosis: A TMS Perspective. Front Neurol 2020; 11:566. [PMID: 32733354 PMCID: PMC7358546 DOI: 10.3389/fneur.2020.00566] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/19/2020] [Indexed: 12/13/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) has been employed in multiple sclerosis (MS) to assess the integrity of the corticospinal tract and the corpus callosum and to explore some physiological properties of the motor cortex. Specific alterations of TMS measures have been strongly associated to different pathophysiological mechanisms, particularly to demyelination and neuronal loss. Moreover, TMS has contributed to investigate the neurophysiological basis of MS symptoms, particularly those not completely explained by conventional structural damage, such as fatigue. However, variability existing between studies suggests that alternative mechanisms should be involved. Knowledge of MS pathophysiology has been enriched by experimental studies in animal models (i.e., experimental autoimmune encephalomyelitis) demonstrating that inflammation alters synaptic transmission, promoting hyperexcitability and neuronal damage. Accordingly, TMS studies have demonstrated an imbalance between cortical excitation and inhibition in MS. In particular, cerebrospinal fluid concentrations of different proinflammatory and anti-inflammatory molecules have been associated to corticospinal hyperexcitability, highlighting that inflammatory synaptopathy may represent a key pathophysiological mechanism in MS. In this perspective article, we discuss whether corticospinal excitability alterations assessed with TMS in MS patients could be useful to explain the pathophysiological correlates and their relationships with specific MS clinical characteristics and symptoms. Furthermore, we discuss evidence indicating that, in MS patients, inflammatory synaptopathy could be present since the early phases, could specifically characterize relapses, and could progressively increase during the disease course.
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Affiliation(s)
| | - Fabio Buttari
- Unit of Neurology & Neurorehabilitation, IRCCS Neuromed, Pozzilli, Italy
| | - Luana Gilio
- Unit of Neurology & Neurorehabilitation, IRCCS Neuromed, Pozzilli, Italy
| | - Nicla De Paolis
- Unit of Neurology & Neurorehabilitation, IRCCS Neuromed, Pozzilli, Italy
| | - Diego Fresegna
- Laboratory of Synaptic Immunopathology, IRCCS San Raffaele Pisana, Rome, Italy
| | - Diego Centonze
- Unit of Neurology & Neurorehabilitation, IRCCS Neuromed, Pozzilli, Italy.,Laboratory of Synaptic Immunopathology, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Ennio Iezzi
- Unit of Neurology & Neurorehabilitation, IRCCS Neuromed, Pozzilli, Italy
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24
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Martin-Rodriguez JF, Mir P. Short-afferent inhibition and cognitive impairment in Parkinson's disease: A quantitative review and challenges. Neurosci Lett 2020; 719:133679. [DOI: 10.1016/j.neulet.2018.06.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 06/19/2018] [Accepted: 06/26/2018] [Indexed: 10/28/2022]
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25
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Benussi A, Grassi M, Palluzzi F, Koch G, Di Lazzaro V, Nardone R, Cantoni V, Dell'Era V, Premi E, Martorana A, Lorenzo F, Bonnì S, Ranieri F, Capone F, Musumeci G, Cotelli MS, Padovani A, Borroni B. Classification Accuracy of Transcranial Magnetic Stimulation for the Diagnosis of Neurodegenerative Dementias. Ann Neurol 2020; 87:394-404. [DOI: 10.1002/ana.25677] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 12/21/2019] [Accepted: 01/05/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Alberto Benussi
- Department of Clinical and Experimental Sciences, Center for Neurodegenerative Disorders, Neurology UnitUniversity of Brescia Brescia Italy
| | - Mario Grassi
- Department of Brain and Behavioral Sciences, Medical and Genomic Statistics UnitUniversity of Pavia Pavia Italy
| | - Fernando Palluzzi
- Department of Brain and Behavioral Sciences, Medical and Genomic Statistics UnitUniversity of Pavia Pavia Italy
| | - Giacomo Koch
- Noninvasive Brain Stimulation Unit, Scientific Institute for Research, Hospitalisation and Health Care Santa Lucia Foundation Rome Italy
- Stroke Unit, Tor Vergata Polyclinic Rome Italy
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, and Neurobiology, Department of MedicineCampus Bio‐Medico University Rome Italy
| | - Raffaele Nardone
- Department of NeurologyFranz Tappeiner Hospital Merano Italy
- Department of NeurologyChristian Doppler Clinic, Paracelsus Medical University Salzburg Austria
| | - Valentina Cantoni
- Department of Clinical and Experimental Sciences, Center for Neurodegenerative Disorders, Neurology UnitUniversity of Brescia Brescia Italy
| | - Valentina Dell'Era
- Department of Clinical and Experimental Sciences, Center for Neurodegenerative Disorders, Neurology UnitUniversity of Brescia Brescia Italy
| | - Enrico Premi
- Department of Clinical and Experimental Sciences, Center for Neurodegenerative Disorders, Neurology UnitUniversity of Brescia Brescia Italy
| | - Alessandro Martorana
- Noninvasive Brain Stimulation Unit, Scientific Institute for Research, Hospitalisation and Health Care Santa Lucia Foundation Rome Italy
- Neurology Unit, Department of System MedicineUniversity of Tor Vergata Rome Italy
| | - Francesco Lorenzo
- Noninvasive Brain Stimulation Unit, Scientific Institute for Research, Hospitalisation and Health Care Santa Lucia Foundation Rome Italy
| | - Sonia Bonnì
- Noninvasive Brain Stimulation Unit, Scientific Institute for Research, Hospitalisation and Health Care Santa Lucia Foundation Rome Italy
| | - Federico Ranieri
- Department of Neuroscience, Biomedicine, and Movement SciencesUniversity of Verona Verona Italy
| | - Fioravante Capone
- Unit of Neurology, Neurophysiology, and Neurobiology, Department of MedicineCampus Bio‐Medico University Rome Italy
| | - Gabriella Musumeci
- Unit of Neurology, Neurophysiology, and Neurobiology, Department of MedicineCampus Bio‐Medico University Rome Italy
| | | | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, Center for Neurodegenerative Disorders, Neurology UnitUniversity of Brescia Brescia Italy
| | - Barbara Borroni
- Department of Clinical and Experimental Sciences, Center for Neurodegenerative Disorders, Neurology UnitUniversity of Brescia Brescia Italy
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26
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Cantone M, Lanza G, Fisicaro F, Pennisi M, Bella R, Di Lazzaro V, Di Pino G. Evaluation and Treatment of Vascular Cognitive Impairment by Transcranial Magnetic Stimulation. Neural Plast 2020; 2020:8820881. [PMID: 33193753 PMCID: PMC7641667 DOI: 10.1155/2020/8820881] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/23/2020] [Accepted: 10/12/2020] [Indexed: 02/07/2023] Open
Abstract
The exact relationship between cognitive functioning, cortical excitability, and synaptic plasticity in dementia is not completely understood. Vascular cognitive impairment (VCI) is deemed to be the most common cognitive disorder in the elderly since it encompasses any degree of vascular-based cognitive decline. In different cognitive disorders, including VCI, transcranial magnetic stimulation (TMS) can be exploited as a noninvasive tool able to evaluate in vivo the cortical excitability, the propension to undergo neural plastic phenomena, and the underlying transmission pathways. Overall, TMS in VCI revealed enhanced cortical excitability and synaptic plasticity that seem to correlate with the disease process and progression. In some patients, such plasticity may be considered as an adaptive response to disease progression, thus allowing the preservation of motor programming and execution. Recent findings also point out the possibility to employ TMS to predict cognitive deterioration in the so-called "brains at risk" for dementia, which may be those patients who benefit more of disease-modifying drugs and rehabilitative or neuromodulatory approaches, such as those based on repetitive TMS (rTMS). Finally, TMS can be exploited to select the responders to specific drugs in the attempt to maximize the response and to restore maladaptive plasticity. While no single TMS index owns enough specificity, a panel of TMS-derived measures can support VCI diagnosis and identify early markers of progression into dementia. This work reviews all TMS and rTMS studies on VCI. The aim is to evaluate how cortical excitability, plasticity, and connectivity interact in the pathophysiology of the impairment and to provide a translational perspective towards novel treatments of these patients. Current pitfalls and limitations of both studies and techniques are also discussed, together with possible solutions and future research agenda.
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Affiliation(s)
- Mariagiovanna Cantone
- 1Department of Neurology, Sant'Elia Hospital, ASP Caltanissetta, Caltanissetta 93100, Italy
| | - Giuseppe Lanza
- 2Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania 95123, Italy
- 3Department of Neurology IC, Oasi Research Institute–IRCCS, Troina 94108, Italy
| | - Francesco Fisicaro
- 4Department of Biomedical and Biotechnological Sciences, University of Catania, Catania 95123, Italy
| | - Manuela Pennisi
- 4Department of Biomedical and Biotechnological Sciences, University of Catania, Catania 95123, Italy
| | - Rita Bella
- 5Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Catania 95123, Italy
| | - Vincenzo Di Lazzaro
- 6Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome 00128, Italy
| | - Giovanni Di Pino
- 7Research Unit of Neurophysiology and Neuroengineering of Human-Technology Interaction (NeXTlab), Università Campus Bio-Medico di Roma, Rome 00128, Italy
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27
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Esposito M, Dubbioso R, Tozza S, Iodice R, Aiello M, Nicolai E, Cavaliere C, Salvatore M, Santoro L, Manganelli F. In vivo evidence of cortical amyloid deposition in the adult form of Niemann Pick type C. Heliyon 2019; 5:e02776. [PMID: 31844711 PMCID: PMC6895717 DOI: 10.1016/j.heliyon.2019.e02776] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 09/25/2019] [Accepted: 10/29/2019] [Indexed: 11/24/2022] Open
Abstract
Background Niemann Pick disease type C (NPC) is a lysosomal lipid storage disorder presenting visceral and neurological impairment with cognitive decline. Neurodegeneration in NPC is associated to deposition of amyloid-β and abnormal tau aggregations likewise Alzheimer disease (AD). Dementia is also related to intracortical circuiting abnormalities that can be detected by neurophysiological procedures both in NPC and in AD. Aim of this study is to find the in vivo evidence of amyloid deposition in NPC patients with cognitive impairment and to investigate the pathophysiology of dementia according to similarities with AD. Methods Two sisters affected by NPC and cognitive decline underwent neuropsychological tests, PET scans with 18F- Florbetaben and neurophysiological protocols to assess cortex excitability by means of transcranial magnetic stimulation (TMS), such as short-latency afferent inhibition (SAI), short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF). Results Both patients presented a multidomain cognitive impairment. 18F- Florbetaben uptake was detected in brain frontal areas, while SAI and SICI were abnormal in both patients. Discussion Cognitive impairment in NPC is associated to cortical amyloid deposition as revealed by 18F- Florbetaben PET scan. Amyloid imaging data, together with specific abnormalities found at TMS studies, suggest similar mechanisms underlying NPC and AD dementia.
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Affiliation(s)
- Marcello Esposito
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Italy
| | - Raffaele Dubbioso
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Italy
- Corresponding author.
| | - Stefano Tozza
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Italy
| | - Rosa Iodice
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Italy
| | - Marco Aiello
- IRCCS SDN, Via Emanuele Gianturco 113, 80143, Napoli, Italy
| | | | | | | | - Lucio Santoro
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Italy
| | - Fiore Manganelli
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Italy
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28
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Nicoletti CG, Landi D, Monteleone F, Mataluni G, Albanese M, Lauretti B, Rocchi C, Simonelli I, Boffa L, Buttari F, Mercuri NB, Centonze D, Marfia GA. Treatment with Dimethyl Fumarate Enhances Cholinergic Transmission in Multiple Sclerosis. CNS Drugs 2019; 33:1133-1139. [PMID: 31650471 DOI: 10.1007/s40263-019-00676-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dimethyl fumarate (DMF) exerts anti-inflammatory effects in multiple sclerosis by activating the Nrf2 antioxidant pathway, which is also stimulated by acetylcholine via alpha-7 nicotinic acetylcholine receptors. In animal models, Nrf2 potentiates cholinergic synaptic plasticity. OBJECTIVE The aim of this study was to test whether treatment with DMF modulates cholinergic pathways in relapsing-remitting multiple sclerosis (RRMS). METHODS Patients starting DMF (20) or IFN-β 1a (20) and healthy subjects (20) were enrolled. Short-latency afferent inhibition (SAI), which is a transcranial stimulation measure of central cholinergic transmission, was recorded in patients and controls at baseline and, in patients only, after 6 months of treatment. Patients treated with DMF also underwent autonomic function testing to further explore peripheral and central cholinergic tone. RESULTS At baseline, SAI was similar in patients and in controls (p = 0.983). Treatment with DMF significantly increased SAI (p = 0.01), while IFNβ had no effect (p = 0.80). In the cold face test, DMF treatment also increased reflex bradycardia (p = 0.013), and reduced diastolic blood pressure variation (p = 0.010), further indicating its ability to stimulate cholinergic transmission. CONCLUSIONS Treatment of MS patients with DMF results in increased cholinergic stimulation, with possible implications for neuroinflammation and neuroprotection.
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Affiliation(s)
- Carolina Gabri Nicoletti
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University and Hospital, Via Montpellier 1, 00133, Rome, Italy
| | - Doriana Landi
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University and Hospital, Via Montpellier 1, 00133, Rome, Italy
| | - Fabrizia Monteleone
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University and Hospital, Via Montpellier 1, 00133, Rome, Italy
| | - Giorgia Mataluni
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University and Hospital, Via Montpellier 1, 00133, Rome, Italy
| | - Maria Albanese
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University and Hospital, Via Montpellier 1, 00133, Rome, Italy
| | - Benedetta Lauretti
- Neurology Unit, Department of Systems Medicine, Tor Vergata University and Hospital, Via Montpellier 1, 00133, Rome, Italy
| | - Camilla Rocchi
- Neurology Unit, Department of Systems Medicine, Tor Vergata University and Hospital, Via Montpellier 1, 00133, Rome, Italy
| | - Ilaria Simonelli
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University and Hospital, Via Montpellier 1, 00133, Rome, Italy.,Service of Medical Statistics and Information Technology, Fondazione Fatebenefratelli per la Ricerca e la Formazione Sanitaria e Sociale, Lungotevere de' Cenci 5, 00186, Rome, Italy
| | - Laura Boffa
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University and Hospital, Via Montpellier 1, 00133, Rome, Italy
| | - Fabio Buttari
- Neurology and Neurorehabilitation Units, IRCCS NEUROMED, Via Atinense 18, 86077, Pozzilli, IS, Italy
| | - Nicola Biagio Mercuri
- Neurology Unit, Department of Systems Medicine, Tor Vergata University and Hospital, Via Montpellier 1, 00133, Rome, Italy.,Laboratory of Experimental Neurology, IRCCS Fondazione Santa Lucia, Via del Fosso di Fiorano 64, 00143, Rome, Italy
| | - Diego Centonze
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University and Hospital, Via Montpellier 1, 00133, Rome, Italy. .,Neurology and Neurorehabilitation Units, IRCCS NEUROMED, Via Atinense 18, 86077, Pozzilli, IS, Italy.
| | - Girolama Alessandra Marfia
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University and Hospital, Via Montpellier 1, 00133, Rome, Italy.,Neurology and Neurorehabilitation Units, IRCCS NEUROMED, Via Atinense 18, 86077, Pozzilli, IS, Italy
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29
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Dubbioso R, Manganelli F, Siebner HR, Di Lazzaro V. Fast Intracortical Sensory-Motor Integration: A Window Into the Pathophysiology of Parkinson's Disease. Front Hum Neurosci 2019; 13:111. [PMID: 31024277 PMCID: PMC6463734 DOI: 10.3389/fnhum.2019.00111] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 03/13/2019] [Indexed: 01/09/2023] Open
Abstract
Parkinson's Disease (PD) is a prototypical basal ganglia disorder. Nigrostriatal dopaminergic denervation leads to progressive dysfunction of the cortico-basal ganglia-thalamo-cortical sensorimotor loops, causing the classical motor symptoms. Although the basal ganglia do not receive direct sensory input, they are important for sensorimotor integration. Therefore, the basal ganglia dysfunction in PD may profoundly affect sensory-motor interaction in the cortex. Cortical sensorimotor integration can be probed with transcranial magnetic stimulation (TMS) using a well-established conditioning-test paradigm, called short-latency afferent inhibition (SAI). SAI probes the fast-inhibitory effect of a conditioning peripheral electrical stimulus on the motor response evoked by a TMS test pulse given to the contralateral primary motor cortex (M1). Since SAI occurs at latencies that match the peaks of early cortical somatosensory potentials, the cortical circuitry generating SAI may play an important role in rapid online adjustments of cortical motor output to changes in somatosensory inputs. Here we review the existing studies that have used SAI to examine how PD affects fast cortical sensory-motor integration. Studies of SAI in PD have yielded variable results, showing reduced, normal or even enhanced levels of SAI. This variability may be attributed to the fact that the strength of SAI is influenced by several factors, such as differences in dopaminergic treatment or the clinical phenotype of PD. Inter-individual differences in the expression of SAI has been shown to scale with individual motor impairment as revealed by UPDRS motor score and thus, may reflect the magnitude of dopaminergic neurodegeneration. The magnitude of SAI has also been linked to cognitive dysfunction, and it has been suggested that SAI also reflects cholinergic denervation at the cortical level. Together, the results indicate that SAI is a useful marker of disease-related alterations in fast cortical sensory-motor integration driven by subcortical changes in the dopaminergic and cholinergic system. Since a multitude of neurobiological factors contribute to the magnitude of inhibition, any mechanistic interpretation of SAI changes in PD needs to consider the group characteristics in terms of phenotypical spectrum, disease stage, and medication.
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Affiliation(s)
- Raffaele Dubbioso
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Napoli, Italy
| | - Fiore Manganelli
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Napoli, Italy
| | - 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 and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, Rome, Italy
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Cengiz B, Fidanci H, Kiyak Keçeli Y, Baltaci H, KuruoĞlu R. Impaired short‐ and long‐latency afferent inhibition in amyotrophic lateral sclerosis. Muscle Nerve 2019; 59:699-704. [DOI: 10.1002/mus.26464] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 03/03/2019] [Accepted: 03/05/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Bülent Cengiz
- Department of NeurologyGazi University Faculty of Medicine Beşevler, 06500, Ankara Turkey
- Clinical Neurophysiology Division of the Department of NeurologyGazi University Faculty of Medicine Ankara Turkey
| | - Halit Fidanci
- Clinical Neurophysiology Division of the Department of NeurologyGazi University Faculty of Medicine Ankara Turkey
| | - Yeliz Kiyak Keçeli
- Department of NeurologyGazi University Faculty of Medicine Beşevler, 06500, Ankara Turkey
| | - Hande Baltaci
- Department of NeurologyGazi University Faculty of Medicine Beşevler, 06500, Ankara Turkey
| | - Reha KuruoĞlu
- Department of NeurologyGazi University Faculty of Medicine Beşevler, 06500, Ankara Turkey
- Clinical Neurophysiology Division of the Department of NeurologyGazi University Faculty of Medicine Ankara Turkey
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31
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Agarwal S, Koch G, Hillis AE, Huynh W, Ward NS, Vucic S, Kiernan MC. Interrogating cortical function with transcranial magnetic stimulation: insights from neurodegenerative disease and stroke. J Neurol Neurosurg Psychiatry 2019; 90:47-57. [PMID: 29866706 DOI: 10.1136/jnnp-2017-317371] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 05/07/2018] [Accepted: 05/07/2018] [Indexed: 12/11/2022]
Abstract
Transcranial magnetic stimulation (TMS) is an accessible, non-invasive technique to study cortical function in vivo. TMS studies have provided important pathophysiological insights across a range of neurodegenerative disorders and enhanced our understanding of brain reorganisation after stroke. In neurodegenerative disease, TMS has provided novel insights into the function of cortical output cells and the related intracortical interneuronal networks. Characterisation of cortical hyperexcitability in amyotrophic lateral sclerosis and altered motor cortical function in frontotemporal dementia, demonstration of cholinergic deficits in Alzheimer's disease and Parkinson's disease are key examples where TMS has led to advances in understanding of disease pathophysiology and potential mechanisms of propagation, with the potential for diagnostic applications. In stroke, TMS methodology has facilitated the understanding of cortical reorganisation that underlie functional recovery. These insights are critical to the development of effective and targeted rehabilitation strategies in stroke. The present review will provide an overview of cortical function measures obtained using TMS and how such measures may provide insight into brain function. Through an improved understanding of cortical function across a range of neurodegenerative disorders, and identification of changes in neural structure and function associated with stroke that underlie clinical recovery, more targeted therapeutic approaches may now be developed in an evolving era of precision medicine.
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Affiliation(s)
- Smriti Agarwal
- Brain and Mind Centre, University of Sydney, and Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Giacomo Koch
- Non-Invasive Brain Stimulation Unit, Neurologia Clinica e Comportamentale, Fondazione Santa Lucia IRCCS, Rome, Italy.,Stroke Unit, Department of Neuroscience, Policlinico Tor Vergata, Rome, Italy
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Cognitive Science, Johns Hopkins University, Baltimore, Maryland, USA
| | - William Huynh
- Brain and Mind Centre, University of Sydney, and Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Nick S Ward
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, University College London, London, UK.,UCL Partners Centre for Neurorehabilitation, UCL Institute of Neurology, University College London, London, UK.,The National Hospital for Neurology and Neurosurgery, London, UK
| | - Steve Vucic
- Westmead Clinical School, University of Sydney, Sydney, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, University of Sydney, and Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Motta C, Di Lorenzo F, Ponzo V, Pellicciari MC, Bonnì S, Picazio S, Mercuri NB, Caltagirone C, Martorana A, Koch G. Transcranial magnetic stimulation predicts cognitive decline in patients with Alzheimer's disease. J Neurol Neurosurg Psychiatry 2018; 89:1237-1242. [PMID: 30464028 DOI: 10.1136/jnnp-2017-317879] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 06/14/2018] [Accepted: 06/27/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the ability of transcranial magnetic stimulation (TMS) in detecting synaptic impairment in patients with Alzheimer's disease (AD) and predicting cognitive decline since the early phases of the disease. METHODS We used TMS-based parameters to evaluate long-term potentiation (LTP)-like cortical plasticity and cholinergic activity as measured by short afferent inhibition (SAI) in 60 newly diagnosed patients with AD and 30 healthy age-matched subjects (HS). Receiver operating characteristic (ROC) curves were used to assess TMS ability in discriminating patients with AD from HS. Regression analyses examined the association between TMS-based parameters and cognitive decline. Multivariable regression model revealed the best parameters able to predict disease progression. RESULTS Area under the ROC curve was 0.90 for LTP-like cortical plasticity, indicating an excellent accuracy of this parameter in detecting AD pathology. In contrast, area under the curve was only 0.64 for SAI, indicating a poor diagnostic accuracy. Notably, LTP-like cortical plasticity was a significant predictor of disease progression (p=0.02), while no other neurophysiological, neuropsychological and demographic parameters were associated with cognitive decline. Multivariable analysis then promoted LTP-like cortical plasticity as the best significant predictor of cognitive decline (p=0.01). Finally, LTP-like cortical plasticity was found to be strongly associated with the probability of rapid cognitive decline (delta Mini-Mental State Examination score ≤-4 points at 18 months) (p=0.04); patients with AD with lower LTP-like cortical plasticity values showed faster disease progression. CONCLUSIONS TMS-based assessment of LTP-like cortical plasticity could be a viable biomarker to assess synaptic impairment and predict subsequent cognitive decline progression in patients with ADs.
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Affiliation(s)
- Caterina Motta
- Non Invasive Brain Stimulation Unit, Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy.,Department of Systems Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Francesco Di Lorenzo
- Non Invasive Brain Stimulation Unit, Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy.,Department of Systems Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Viviana Ponzo
- Non Invasive Brain Stimulation Unit, Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Maria Concetta Pellicciari
- Non Invasive Brain Stimulation Unit, Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Sonia Bonnì
- Non Invasive Brain Stimulation Unit, Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Silvia Picazio
- Non Invasive Brain Stimulation Unit, Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | | | - Carlo Caltagirone
- Non Invasive Brain Stimulation Unit, Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy.,Department of Systems Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Alessandro Martorana
- Non Invasive Brain Stimulation Unit, Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy.,Department of Systems Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Giacomo Koch
- Non Invasive Brain Stimulation Unit, Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy .,Stroke Unit, Tor Vergata Policlinic, Rome, Italy
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Turco CV, El-Sayes J, Locke MB, Chen R, Baker S, Nelson AJ. Effects of lorazepam and baclofen on short- and long-latency afferent inhibition. J Physiol 2018; 596:5267-5280. [PMID: 30192388 DOI: 10.1113/jp276710] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 09/06/2018] [Indexed: 01/23/2023] Open
Abstract
KEY POINTS Short-latency afferent inhibition (SAI) is modulated by GABAA receptor activity, whereas the pharmacological origin of long-latency afferent inhibition remains unknown. This is the first study to report that long-latency afferent inhibition (LAI) is reduced by the GABAA positive allosteric modulator lorazepam, and that both SAI and LAI are not modulated by the GABAB agonist baclofen. These findings advance our understanding of the neural mechanisms underlying afferent inhibition. ABSTRACT The afferent volley evoked by peripheral nerve stimulation has an inhibitory influence on transcranial magnetic stimulation induced motor evoked potentials. This phenomenon, known as afferent inhibition, occurs in two phases: short-latency afferent inhibition (SAI) and long-latency afferent inhibition (LAI). SAI exerts its inhibitory influence via cholinergic and GABAergic activity. The neurotransmitter receptors that mediate LAI remain unclear. The present study aimed to determine whether LAI is contributed by GABAA and/or GABAB receptor activity. In a double-blinded, placebo-controlled study, 2.5 mg of lorazepam (GABAA agonist), 20 mg of baclofen (GABAB agonist) and placebo were administered to 14 males (mean age 22.7 ± 1.9 years) in three separate sessions. SAI and LAI, evoked by stimulation of the median nerve and recorded from the first dorsal interosseous muscle, were quantified before and at the peak plasma concentration following drug ingestion. Results indicate that lorazepam reduced LAI by ∼40% and, in support of previous work, reduced SAI by ∼19%. However, neither SAI, nor LAI were altered by baclofen. In a follow-up double-blinded, placebo-controlled study, 10 returning participants received placebo or 40 mg of baclofen (double the dosage used in Experiment 1). The results obtained indicate that SAI and LAI were unchanged by baclofen. This is the first study to show that LAI is modulated by GABAA receptor activity, similar to SAI, and that afferent inhibition does not appear to be a GABAB mediated process.
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Affiliation(s)
- Claudia V Turco
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Jenin El-Sayes
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Mitchell B Locke
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Robert Chen
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Steven Baker
- Division of Physical Medicine and Rehabilitation, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Aimee J Nelson
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
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34
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Discrimination of atypical parkinsonisms with transcranial magnetic stimulation. Brain Stimul 2018; 11:366-373. [DOI: 10.1016/j.brs.2017.11.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/16/2017] [Accepted: 11/18/2017] [Indexed: 12/12/2022] Open
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Borroni B, Benussi A, Premi E, Alberici A, Marcello E, Gardoni F, Di Luca M, Padovani A. Biological, Neuroimaging, and Neurophysiological Markers in Frontotemporal Dementia: Three Faces of the Same Coin. J Alzheimers Dis 2018; 62:1113-1123. [PMID: 29171998 PMCID: PMC5870000 DOI: 10.3233/jad-170584] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2017] [Indexed: 12/12/2022]
Abstract
Frontotemporal dementia (FTD) is a heterogeneous clinical, genetic, and neuropathological disorder. Clinical diagnosis and prediction of neuropathological substrates are hampered by heterogeneous pictures. Diagnostic markers are key in clinical trials to differentiate FTD from other neurodegenerative dementias. In the same view, identifying the neuropathological hallmarks of the disease is key in light of future disease-modifying treatments. The aim of the present review is to unravel the progress in biomarker discovery, discussing the potential applications of available biological, imaging, and neurophysiological markers.
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Affiliation(s)
- Barbara Borroni
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
| | - Alberto Benussi
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
| | - Enrico Premi
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
| | - Antonella Alberici
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
| | - Elena Marcello
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Fabrizio Gardoni
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Monica Di Luca
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
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Turco CV, El-Sayes J, Savoie MJ, Fassett HJ, Locke MB, Nelson AJ. Short- and long-latency afferent inhibition; uses, mechanisms and influencing factors. Brain Stimul 2018; 11:59-74. [DOI: 10.1016/j.brs.2017.09.009] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 08/28/2017] [Accepted: 09/14/2017] [Indexed: 12/11/2022] Open
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Neurophysiological studies on atypical parkinsonian syndromes. Parkinsonism Relat Disord 2017; 42:12-21. [DOI: 10.1016/j.parkreldis.2017.06.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 06/14/2017] [Accepted: 06/24/2017] [Indexed: 01/31/2023]
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Kuo HI, Paulus W, Batsikadze G, Jamil A, Kuo MF, Nitsche MA. Acute and Chronic Noradrenergic Effects on Cortical Excitability in Healthy Humans. Int J Neuropsychopharmacol 2017; 20:634-643. [PMID: 28430976 PMCID: PMC5574667 DOI: 10.1093/ijnp/pyx026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/05/2017] [Accepted: 04/18/2017] [Indexed: 11/16/2022] Open
Abstract
Background Noradrenaline is a major neuromodulator in the central nervous system, and it is involved in the pathophysiology of diverse neuropsychiatric diseases. Previous transcranial magnetic stimulation studies suggested that acute application of selective noradrenaline reuptake inhibitors enhances cortical excitability in the human brain. However, other, such like clinical effects, usually require prolonged noradrenaline reuptake inhibitor treatment, which might go along with different physiological effects. Methods The purpose of this study was to investigate the acute and chronic effects of the selective noradrenaline reuptake inhibitor reboxetine on cortical excitability in healthy humans in a double-blind, placebo-controlled, randomized crossover study. Sixteen subjects were assessed with different transcranial magnetic stimulation measurements: motor thresholds, input-output curve, short-latency intracortical inhibition and intracortical facilitation, I-wave facilitation, and short-interval afferent inhibition before and after placebo or reboxetine (8 mg) single-dose administration. Afterwards, the same subjects took reboxetine (8 mg/d) consecutively for 21 days. During this period (subjects underwent 2 experimental sessions with identical transcranial magnetic stimulation measures under placebo or reboxetine), transcranial magnetic stimulation measurements were assessed before and after drug intake. Results Both single-dose and chronic administration of reboxetine increased cortical excitability; increased the slope of the input-output curve, intracortical facilitation, and I-wave facilitation; but decreased short-latency intracortical inhibition and short-interval afferent inhibition. Moreover, chronic reboxetine showed a larger enhancement of intracortical facilitation and I-wave facilitation compared with single-dose application. Conclusions The results show physiological mechanisms of noradrenergic enhancement possibly underlying the functional effects of reboxetine regarding acute and chronic application.
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Affiliation(s)
- Hsiao-I Kuo
- Department of Clinical Neurophysiology, University Medical Center, Georg-August-University, Göttingen, Germany (Ms H.-I. Kuo, Paulus, Mr Jamil, and Nitsche); Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany (Ms H.-I. Kuo, Mr Jamil, M.-F. Kuo, and Nitsche); Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany (Dr Nitsche); Department of Neurology, Essen University Hospital, University of Duisburg-Essen, Germany (Dr Batsikadze)
| | - Walter Paulus
- Department of Clinical Neurophysiology, University Medical Center, Georg-August-University, Göttingen, Germany (Ms H.-I. Kuo, Paulus, Mr Jamil, and Nitsche); Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany (Ms H.-I. Kuo, Mr Jamil, M.-F. Kuo, and Nitsche); Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany (Dr Nitsche); Department of Neurology, Essen University Hospital, University of Duisburg-Essen, Germany (Dr Batsikadze)
| | - Giorgi Batsikadze
- Department of Clinical Neurophysiology, University Medical Center, Georg-August-University, Göttingen, Germany (Ms H.-I. Kuo, Paulus, Mr Jamil, and Nitsche); Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany (Ms H.-I. Kuo, Mr Jamil, M.-F. Kuo, and Nitsche); Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany (Dr Nitsche); Department of Neurology, Essen University Hospital, University of Duisburg-Essen, Germany (Dr Batsikadze)
| | - Asif Jamil
- Department of Clinical Neurophysiology, University Medical Center, Georg-August-University, Göttingen, Germany (Ms H.-I. Kuo, Paulus, Mr Jamil, and Nitsche); Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany (Ms H.-I. Kuo, Mr Jamil, M.-F. Kuo, and Nitsche); Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany (Dr Nitsche); Department of Neurology, Essen University Hospital, University of Duisburg-Essen, Germany (Dr Batsikadze)
| | - Min-Fang Kuo
- Department of Clinical Neurophysiology, University Medical Center, Georg-August-University, Göttingen, Germany (Ms H.-I. Kuo, Paulus, Mr Jamil, and Nitsche); Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany (Ms H.-I. Kuo, Mr Jamil, M.-F. Kuo, and Nitsche); Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany (Dr Nitsche); Department of Neurology, Essen University Hospital, University of Duisburg-Essen, Germany (Dr Batsikadze)
| | - Michael A Nitsche
- Department of Clinical Neurophysiology, University Medical Center, Georg-August-University, Göttingen, Germany (Ms H.-I. Kuo, Paulus, Mr Jamil, and Nitsche); Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany (Ms H.-I. Kuo, Mr Jamil, M.-F. Kuo, and Nitsche); Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany (Dr Nitsche); Department of Neurology, Essen University Hospital, University of Duisburg-Essen, Germany (Dr Batsikadze)
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Benussi A, Di Lorenzo F, Dell'Era V, Cosseddu M, Alberici A, Caratozzolo S, Cotelli MS, Micheli A, Rozzini L, Depari A, Flammini A, Ponzo V, Martorana A, Caltagirone C, Padovani A, Koch G, Borroni B. Transcranial magnetic stimulation distinguishes Alzheimer disease from frontotemporal dementia. Neurology 2017; 89:665-672. [PMID: 28747446 DOI: 10.1212/wnl.0000000000004232] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 05/19/2017] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To determine whether a transcranial magnetic stimulation (TMS) multiparadigm approach can be used to distinguish Alzheimer disease (AD) from frontotemporal dementia (FTD). METHODS Paired-pulse TMS was used to investigate short-interval intracortical inhibition (SICI) and facilitation (ICF), long-interval intracortical inhibition, and short-latency afferent inhibition (SAI) to measure the activity of different intracortical circuits in patients with AD, patients with FTD, and healthy controls (HC). The primary outcome measures were sensitivity and specificity of TMS measures, derived from receiver operating curve analysis. RESULTS A total of 175 participants met the inclusion criteria. We diagnosed 79 patients with AD, 64 patients with FTD, and 32 HC. We found that while patients with AD are characterized by a specific impairment of SAI, FTD shows a remarkable dysfunction of SICI-ICF intracortical circuits. With the use of the best indexes, TMS differentiated FTD from AD with a sensitivity of 91.8% and specificity of 88.6%, AD from HC with a sensitivity of 84.8% and specificity of 90.6%, and FTD from HC with a sensitivity of 90.2% and specificity of 78.1%. These results were confirmed in patients with mild disease. CONCLUSIONS TMS is a noninvasive procedure that reliably distinguishes AD from FTD and HC and, if these findings are replicated in larger studies, could represent a useful additional diagnostic tool for clinical practice. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that TMS measures can distinguish patients with AD from those with FTD.
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Affiliation(s)
- Alberto Benussi
- From the Neurology Unit (A.B., V.D., M.C., A.A., S.C., L.R., A.P., B.B.), Department of Clinical and Experimental Sciences, University of Brescia; Non-Invasive Brain Stimulation Unit (F.D.L., V.P., A. Martorana, C.C., G.K.), IRCCS Santa Lucia Foundation; Stroke Unit (G.K.), Policlinico Tor Vergata, Rome; Neurology Unit (M.S.C.), Valle Camonica Hospital, Brescia; Casa di Cura San Francesco (A. Micheli), Bergamo; Dipartimento di ingegneria dell'Informazione (A.D., A.F.), University of Brescia; and Neurology Unit (A. Martorana, C.C.), Department of System Medicine, University of Tor Vergata, Rome, Italy
| | - Francesco Di Lorenzo
- From the Neurology Unit (A.B., V.D., M.C., A.A., S.C., L.R., A.P., B.B.), Department of Clinical and Experimental Sciences, University of Brescia; Non-Invasive Brain Stimulation Unit (F.D.L., V.P., A. Martorana, C.C., G.K.), IRCCS Santa Lucia Foundation; Stroke Unit (G.K.), Policlinico Tor Vergata, Rome; Neurology Unit (M.S.C.), Valle Camonica Hospital, Brescia; Casa di Cura San Francesco (A. Micheli), Bergamo; Dipartimento di ingegneria dell'Informazione (A.D., A.F.), University of Brescia; and Neurology Unit (A. Martorana, C.C.), Department of System Medicine, University of Tor Vergata, Rome, Italy
| | - Valentina Dell'Era
- From the Neurology Unit (A.B., V.D., M.C., A.A., S.C., L.R., A.P., B.B.), Department of Clinical and Experimental Sciences, University of Brescia; Non-Invasive Brain Stimulation Unit (F.D.L., V.P., A. Martorana, C.C., G.K.), IRCCS Santa Lucia Foundation; Stroke Unit (G.K.), Policlinico Tor Vergata, Rome; Neurology Unit (M.S.C.), Valle Camonica Hospital, Brescia; Casa di Cura San Francesco (A. Micheli), Bergamo; Dipartimento di ingegneria dell'Informazione (A.D., A.F.), University of Brescia; and Neurology Unit (A. Martorana, C.C.), Department of System Medicine, University of Tor Vergata, Rome, Italy
| | - Maura Cosseddu
- From the Neurology Unit (A.B., V.D., M.C., A.A., S.C., L.R., A.P., B.B.), Department of Clinical and Experimental Sciences, University of Brescia; Non-Invasive Brain Stimulation Unit (F.D.L., V.P., A. Martorana, C.C., G.K.), IRCCS Santa Lucia Foundation; Stroke Unit (G.K.), Policlinico Tor Vergata, Rome; Neurology Unit (M.S.C.), Valle Camonica Hospital, Brescia; Casa di Cura San Francesco (A. Micheli), Bergamo; Dipartimento di ingegneria dell'Informazione (A.D., A.F.), University of Brescia; and Neurology Unit (A. Martorana, C.C.), Department of System Medicine, University of Tor Vergata, Rome, Italy
| | - Antonella Alberici
- From the Neurology Unit (A.B., V.D., M.C., A.A., S.C., L.R., A.P., B.B.), Department of Clinical and Experimental Sciences, University of Brescia; Non-Invasive Brain Stimulation Unit (F.D.L., V.P., A. Martorana, C.C., G.K.), IRCCS Santa Lucia Foundation; Stroke Unit (G.K.), Policlinico Tor Vergata, Rome; Neurology Unit (M.S.C.), Valle Camonica Hospital, Brescia; Casa di Cura San Francesco (A. Micheli), Bergamo; Dipartimento di ingegneria dell'Informazione (A.D., A.F.), University of Brescia; and Neurology Unit (A. Martorana, C.C.), Department of System Medicine, University of Tor Vergata, Rome, Italy
| | - Salvatore Caratozzolo
- From the Neurology Unit (A.B., V.D., M.C., A.A., S.C., L.R., A.P., B.B.), Department of Clinical and Experimental Sciences, University of Brescia; Non-Invasive Brain Stimulation Unit (F.D.L., V.P., A. Martorana, C.C., G.K.), IRCCS Santa Lucia Foundation; Stroke Unit (G.K.), Policlinico Tor Vergata, Rome; Neurology Unit (M.S.C.), Valle Camonica Hospital, Brescia; Casa di Cura San Francesco (A. Micheli), Bergamo; Dipartimento di ingegneria dell'Informazione (A.D., A.F.), University of Brescia; and Neurology Unit (A. Martorana, C.C.), Department of System Medicine, University of Tor Vergata, Rome, Italy
| | - Maria Sofia Cotelli
- From the Neurology Unit (A.B., V.D., M.C., A.A., S.C., L.R., A.P., B.B.), Department of Clinical and Experimental Sciences, University of Brescia; Non-Invasive Brain Stimulation Unit (F.D.L., V.P., A. Martorana, C.C., G.K.), IRCCS Santa Lucia Foundation; Stroke Unit (G.K.), Policlinico Tor Vergata, Rome; Neurology Unit (M.S.C.), Valle Camonica Hospital, Brescia; Casa di Cura San Francesco (A. Micheli), Bergamo; Dipartimento di ingegneria dell'Informazione (A.D., A.F.), University of Brescia; and Neurology Unit (A. Martorana, C.C.), Department of System Medicine, University of Tor Vergata, Rome, Italy
| | - Anna Micheli
- From the Neurology Unit (A.B., V.D., M.C., A.A., S.C., L.R., A.P., B.B.), Department of Clinical and Experimental Sciences, University of Brescia; Non-Invasive Brain Stimulation Unit (F.D.L., V.P., A. Martorana, C.C., G.K.), IRCCS Santa Lucia Foundation; Stroke Unit (G.K.), Policlinico Tor Vergata, Rome; Neurology Unit (M.S.C.), Valle Camonica Hospital, Brescia; Casa di Cura San Francesco (A. Micheli), Bergamo; Dipartimento di ingegneria dell'Informazione (A.D., A.F.), University of Brescia; and Neurology Unit (A. Martorana, C.C.), Department of System Medicine, University of Tor Vergata, Rome, Italy
| | - Luca Rozzini
- From the Neurology Unit (A.B., V.D., M.C., A.A., S.C., L.R., A.P., B.B.), Department of Clinical and Experimental Sciences, University of Brescia; Non-Invasive Brain Stimulation Unit (F.D.L., V.P., A. Martorana, C.C., G.K.), IRCCS Santa Lucia Foundation; Stroke Unit (G.K.), Policlinico Tor Vergata, Rome; Neurology Unit (M.S.C.), Valle Camonica Hospital, Brescia; Casa di Cura San Francesco (A. Micheli), Bergamo; Dipartimento di ingegneria dell'Informazione (A.D., A.F.), University of Brescia; and Neurology Unit (A. Martorana, C.C.), Department of System Medicine, University of Tor Vergata, Rome, Italy
| | - Alessandro Depari
- From the Neurology Unit (A.B., V.D., M.C., A.A., S.C., L.R., A.P., B.B.), Department of Clinical and Experimental Sciences, University of Brescia; Non-Invasive Brain Stimulation Unit (F.D.L., V.P., A. Martorana, C.C., G.K.), IRCCS Santa Lucia Foundation; Stroke Unit (G.K.), Policlinico Tor Vergata, Rome; Neurology Unit (M.S.C.), Valle Camonica Hospital, Brescia; Casa di Cura San Francesco (A. Micheli), Bergamo; Dipartimento di ingegneria dell'Informazione (A.D., A.F.), University of Brescia; and Neurology Unit (A. Martorana, C.C.), Department of System Medicine, University of Tor Vergata, Rome, Italy
| | - Alessandra Flammini
- From the Neurology Unit (A.B., V.D., M.C., A.A., S.C., L.R., A.P., B.B.), Department of Clinical and Experimental Sciences, University of Brescia; Non-Invasive Brain Stimulation Unit (F.D.L., V.P., A. Martorana, C.C., G.K.), IRCCS Santa Lucia Foundation; Stroke Unit (G.K.), Policlinico Tor Vergata, Rome; Neurology Unit (M.S.C.), Valle Camonica Hospital, Brescia; Casa di Cura San Francesco (A. Micheli), Bergamo; Dipartimento di ingegneria dell'Informazione (A.D., A.F.), University of Brescia; and Neurology Unit (A. Martorana, C.C.), Department of System Medicine, University of Tor Vergata, Rome, Italy
| | - Viviana Ponzo
- From the Neurology Unit (A.B., V.D., M.C., A.A., S.C., L.R., A.P., B.B.), Department of Clinical and Experimental Sciences, University of Brescia; Non-Invasive Brain Stimulation Unit (F.D.L., V.P., A. Martorana, C.C., G.K.), IRCCS Santa Lucia Foundation; Stroke Unit (G.K.), Policlinico Tor Vergata, Rome; Neurology Unit (M.S.C.), Valle Camonica Hospital, Brescia; Casa di Cura San Francesco (A. Micheli), Bergamo; Dipartimento di ingegneria dell'Informazione (A.D., A.F.), University of Brescia; and Neurology Unit (A. Martorana, C.C.), Department of System Medicine, University of Tor Vergata, Rome, Italy
| | - Alessandro Martorana
- From the Neurology Unit (A.B., V.D., M.C., A.A., S.C., L.R., A.P., B.B.), Department of Clinical and Experimental Sciences, University of Brescia; Non-Invasive Brain Stimulation Unit (F.D.L., V.P., A. Martorana, C.C., G.K.), IRCCS Santa Lucia Foundation; Stroke Unit (G.K.), Policlinico Tor Vergata, Rome; Neurology Unit (M.S.C.), Valle Camonica Hospital, Brescia; Casa di Cura San Francesco (A. Micheli), Bergamo; Dipartimento di ingegneria dell'Informazione (A.D., A.F.), University of Brescia; and Neurology Unit (A. Martorana, C.C.), Department of System Medicine, University of Tor Vergata, Rome, Italy
| | - Carlo Caltagirone
- From the Neurology Unit (A.B., V.D., M.C., A.A., S.C., L.R., A.P., B.B.), Department of Clinical and Experimental Sciences, University of Brescia; Non-Invasive Brain Stimulation Unit (F.D.L., V.P., A. Martorana, C.C., G.K.), IRCCS Santa Lucia Foundation; Stroke Unit (G.K.), Policlinico Tor Vergata, Rome; Neurology Unit (M.S.C.), Valle Camonica Hospital, Brescia; Casa di Cura San Francesco (A. Micheli), Bergamo; Dipartimento di ingegneria dell'Informazione (A.D., A.F.), University of Brescia; and Neurology Unit (A. Martorana, C.C.), Department of System Medicine, University of Tor Vergata, Rome, Italy
| | - Alessandro Padovani
- From the Neurology Unit (A.B., V.D., M.C., A.A., S.C., L.R., A.P., B.B.), Department of Clinical and Experimental Sciences, University of Brescia; Non-Invasive Brain Stimulation Unit (F.D.L., V.P., A. Martorana, C.C., G.K.), IRCCS Santa Lucia Foundation; Stroke Unit (G.K.), Policlinico Tor Vergata, Rome; Neurology Unit (M.S.C.), Valle Camonica Hospital, Brescia; Casa di Cura San Francesco (A. Micheli), Bergamo; Dipartimento di ingegneria dell'Informazione (A.D., A.F.), University of Brescia; and Neurology Unit (A. Martorana, C.C.), Department of System Medicine, University of Tor Vergata, Rome, Italy
| | - Giacomo Koch
- From the Neurology Unit (A.B., V.D., M.C., A.A., S.C., L.R., A.P., B.B.), Department of Clinical and Experimental Sciences, University of Brescia; Non-Invasive Brain Stimulation Unit (F.D.L., V.P., A. Martorana, C.C., G.K.), IRCCS Santa Lucia Foundation; Stroke Unit (G.K.), Policlinico Tor Vergata, Rome; Neurology Unit (M.S.C.), Valle Camonica Hospital, Brescia; Casa di Cura San Francesco (A. Micheli), Bergamo; Dipartimento di ingegneria dell'Informazione (A.D., A.F.), University of Brescia; and Neurology Unit (A. Martorana, C.C.), Department of System Medicine, University of Tor Vergata, Rome, Italy.
| | - Barbara Borroni
- From the Neurology Unit (A.B., V.D., M.C., A.A., S.C., L.R., A.P., B.B.), Department of Clinical and Experimental Sciences, University of Brescia; Non-Invasive Brain Stimulation Unit (F.D.L., V.P., A. Martorana, C.C., G.K.), IRCCS Santa Lucia Foundation; Stroke Unit (G.K.), Policlinico Tor Vergata, Rome; Neurology Unit (M.S.C.), Valle Camonica Hospital, Brescia; Casa di Cura San Francesco (A. Micheli), Bergamo; Dipartimento di ingegneria dell'Informazione (A.D., A.F.), University of Brescia; and Neurology Unit (A. Martorana, C.C.), Department of System Medicine, University of Tor Vergata, Rome, Italy.
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Abstract
Chorea-acanthocytosis (Ch-Ac) is an autosomal recessive neurodegenerative disorder characterized by adult-onset chorea, acanthocytes in the peripheral blood, and Huntington's disease-like neuropsychiatric symptoms. Animal studies have shown mutation-related dysregulated cortical gamma-aminobutyric acid (GABA)ergic inhibitory networks in its pathophysiology. Herein we found that in patients with Ch-Ac there is a striking alteration of intracortical inhibitory circuits detected by using paired pulse transcranial magnetic stimulation protocols. Our findings show in vivo the functional disruption of GABA(A)-mediated networks in humans with Ch-Ac supporting the existing data in mice models with this condition.
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Versace V, Langthaler PB, Sebastianelli L, Höller Y, Brigo F, Orioli A, Saltuari L, Nardone R. Impaired cholinergic transmission in patients with Parkinson's disease and olfactory dysfunction. J Neurol Sci 2017; 377:55-61. [PMID: 28477708 DOI: 10.1016/j.jns.2017.03.049] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 03/25/2017] [Accepted: 03/29/2017] [Indexed: 10/19/2022]
Abstract
Olfactory dysfunction represents a frequent and disturbing non-motor manifestation of Parkinson's disease (PD). The pathophysiology of olfactory dysfunction in PD is still poorly understood. Experimental evidence suggests that olfactory impairment could be related to central cholinergic dysfunction. Short latency afferent inhibition (SAI) technique gives the opportunity to test an inhibitory cholinergic circuit in the human cerebral motor cortex. The objective of the study was to assess the cholinergic function, as measured by SAI, in PD patients with different degrees of olfactory dysfunction. We applied SAI technique in 31 patients with PD. These patients also underwent Olfactory Event-Related Potentials (OERPs) studies to objectively evaluate the olfactory system and a battery of neuropsychological tests to assess the cognitive functions. Absent OERPs indicated a severe olfactory dysfunction in 13 subjects. The presence of OERPs with an alteration in latency and/or amplitude can be considered as a borderline condition of slight alteration of smell and was found in other 15 patients. Only 3 patients showed normal OERPs. SAI was significantly reduced in the PD patients with absent OERPs compared with those with present but abnormal OERPs. Neuropsychological examination showed a mild cognitive impairment in 12 out of 13 PD patients with severe olfactory dysfunction, and in 3 out of the 15 patients with borderline olfactory dysfunction. SAI abnormalities and presence of severe olfactory impairment strongly support the hypothesis of cholinergic dysfunction in some patients with PD, who will probably develop a dementia. Longitudinal studies are required to verify whether SAI abnormalities in PD patients with olfactory dysfunction can predict a future severe cognitive decline.
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Affiliation(s)
- Viviana Versace
- Department of Neurorehabilitation, Hospital of Vipiteno, Italy; Research Unit for Neurorehabilitation of South Tyrol, Italy
| | - Patrick B Langthaler
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Department of Mathematics, Paris Lodron University of Salzburg, Austria
| | - Luca Sebastianelli
- Department of Neurorehabilitation, Hospital of Vipiteno, Italy; Research Unit for Neurorehabilitation of South Tyrol, Italy
| | - Yvonne Höller
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
| | - Francesco Brigo
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy; Department of Neurological and Movement Sciences, University of Verona, Italy
| | - Andrea Orioli
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy
| | - Leopold Saltuari
- Department of Neurology, Hochzirl Hospital, Zirl, Austria; Research Unit for Neurorehabilitation of South Tyrol, Italy
| | - Raffaele Nardone
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Department of Neurology, Franz Tappeiner Hospital, Merano, Italy.
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Cirillo G, Di Pino G, Capone F, Ranieri F, Florio L, Todisco V, Tedeschi G, Funke K, Di Lazzaro V. Neurobiological after-effects of non-invasive brain stimulation. Brain Stimul 2017; 10:1-18. [DOI: 10.1016/j.brs.2016.11.009] [Citation(s) in RCA: 196] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 11/14/2016] [Accepted: 11/15/2016] [Indexed: 01/05/2023] Open
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Cortical afferent inhibition reflects cognitive impairment in obstructive sleep apnea syndrome: a TMS study. Sleep Med 2016; 24:51-56. [DOI: 10.1016/j.sleep.2016.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/16/2016] [Accepted: 08/02/2016] [Indexed: 12/31/2022]
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Schanz O, Bageac D, Braun L, Traynor BJ, Lehky TJ, Floeter MK. Cortical hyperexcitability in patients with C9ORF72 mutations: Relationship to phenotype. Muscle Nerve 2016; 54:264-9. [PMID: 26799151 DOI: 10.1002/mus.25047] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 01/05/2016] [Accepted: 01/12/2016] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Patients with mutations in C9orf72 can have amyotrophic lateral sclerosis (ALS), frontotemporal dementia (FTD), or ALS-FTD. The goals were to establish whether cortical hyperexcitability occurs in C9orf72 patients with different clinical presentations. METHODS Cortical thresholds and silent periods were measured in thenar muscles in 19 participants with C9orf72 expansions and 21 healthy controls using transcranial magnetic stimulation (TMS). El Escorial and Rascovsky criteria were used to diagnose ALS and FTD. Fourteen participants with C9orf72 expansions were re-tested 6 months later. Correlations with finger-tapping speed, timed peg test, the ALS functional rating scale, and Dementia Rating Scale were examined. RESULTS Most participants with C9orf72 expansions had normal or low cortical thresholds. Among them, ALS patients had the lowest thresholds and significantly shorter silent periods. Thresholds correlated with timed peg-test scores. TMS did not correlate with the Dementia Rating Scale. CONCLUSIONS TMS measures of cortical excitability may serve as noninvasive biomarkers of ALS disease activity. Muscle Nerve, 2016 Muscle Nerve 54: 264-269, 2016.
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Affiliation(s)
- Olivia Schanz
- Motor Neuron Disorders Unit, National Institutes of Health, Bethesda, Maryland, USA
| | - Devin Bageac
- Motor Neuron Disorders Unit, National Institutes of Health, Bethesda, Maryland, USA
| | - Laura Braun
- Motor Neuron Disorders Unit, National Institutes of Health, Bethesda, Maryland, USA
| | - Bryan J Traynor
- Neurogenetics of Neuromuscular Disease Section, National Institute of Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Tanya J Lehky
- EMG section, National Institute of Neurological Disorders, National Institutes of Health, Bethesda, Maryland, USA
| | - Mary Kay Floeter
- Motor Neuron Disorders Unit, National Institutes of Health, Bethesda, Maryland, USA
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Bella R, Cantone M, Lanza G, Ferri R, Vinciguerra L, Puglisi V, Pennisi M, Ricceri R, Di Lazzaro V, Pennisi G. Cholinergic circuitry functioning in patients with vascular cognitive impairment--no dementia. Brain Stimul 2016; 9:225-33. [PMID: 26515786 DOI: 10.1016/j.brs.2015.09.013] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 09/29/2015] [Accepted: 09/30/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND An impairment of central cholinergic activity, as evaluated non-invasively by the short-latency afferent inhibition (SAI) of motor responses evoked by transcranial magnetic stimulation (TMS), was observed in patients with Alzheimer's disease (AD) and amnestic Mild Cognitive Impairment. Conversely, the involvement of central cholinergic neurotransmission in vascular dementia (VaD) is still under debate and data on Vascular Cognitive Impairment--No Dementia (VCI-ND) at risk for future VaD are lacking. OBJECTIVE To test for the first time SAI in patients with VCI-ND. METHODS Single-pulse TMS measures of cortical excitability and SAI were evaluated in 25 VCI-ND patients with subcortical ischemic lesions and 20 age-matched healthy controls. Functional status, neuropsychological tests evaluating frontal lobe abilities, and white matter lesions (WMLs) load were assessed. RESULTS A significant difference was found between patients and controls for the mean SAI, although this result did not resist after the Bonferroni correction. In the whole group of patients and controls, SAI showed a correlation with worse scores at the Montreal Cognitive Assessment (r = 0.376, p < 0.01). SAI also positively correlated with the total vascular burden (r = 0.345, p < 0.05) but not with the WML severity. CONCLUSIONS Central cholinergic pathway does not seem to be involved in VCI-ND, and the current results differ from those reported in primary cholinergic forms of dementia, such as AD. SAI might represent a valuable additional tool in the differential diagnosis of the dementing processes and in identifying potential responders to cholinergic agents.
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Affiliation(s)
- Rita Bella
- Department of Medical and Surgical Sciences and Advanced Technologies, Section of Neurosciences, University of Catania, Catania, Italy
| | - Mariagiovanna Cantone
- Department of Neurology I.C., "Oasi" Institute for Research on Mental Retardation and Brain Aging (I.R.C.C.S.), Troina (EN), Italy
| | - Giuseppe Lanza
- Department of Neurology I.C., "Oasi" Institute for Research on Mental Retardation and Brain Aging (I.R.C.C.S.), Troina (EN), Italy
| | - Raffaele Ferri
- Department of Neurology I.C., "Oasi" Institute for Research on Mental Retardation and Brain Aging (I.R.C.C.S.), Troina (EN), Italy
| | - Luisa Vinciguerra
- Department of Medical and Surgical Sciences and Advanced Technologies, Section of Neurosciences, University of Catania, Catania, Italy
| | - Valentina Puglisi
- Department of Medical and Surgical Sciences and Advanced Technologies, Section of Neurosciences, University of Catania, Catania, Italy
| | - Manuela Pennisi
- Spinal Unit, Emergency Hospital "Cannizzaro", Catania, Italy
| | - Riccardo Ricceri
- Department of Medical and Surgical Sciences and Advanced Technologies, Section of Neurosciences, University of Catania, Catania, Italy
| | | | - Giovanni Pennisi
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy.
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Trebbastoni A, Pichiorri F, D’Antonio F, Campanelli A, Onesti E, Ceccanti M, de Lena C, Inghilleri M. Altered Cortical Synaptic Plasticity in Response to 5-Hz Repetitive Transcranial Magnetic Stimulation as a New Electrophysiological Finding in Amnestic Mild Cognitive Impairment Converting to Alzheimer's Disease: Results from a 4-year Prospective Cohort Study. Front Aging Neurosci 2016; 7:253. [PMID: 26793103 PMCID: PMC4709411 DOI: 10.3389/fnagi.2015.00253] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 12/21/2015] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION To investigate cortical excitability and synaptic plasticity in amnestic mild cognitive impairment (aMCI) using 5 Hz repetitive transcranial magnetic stimulation (5 Hz-rTMS) and to assess whether specific TMS parameters predict conversion time to Alzheimer's disease (AD). MATERIALS AND METHODS Forty aMCI patients (single- and multi-domain) and 20 healthy controls underwent, at baseline, a neuropsychological examination and 5 Hz-rTMS delivered in trains of 10 stimuli and 120% of resting motor threshold (rMT) intensity over the dominant motor area. The rMT and the ratio between amplitude of the 1st and the 10th motor-evoked potential elicited by the train (X/I-MEP ratio) were calculated as measures of cortical excitability and synaptic plasticity, respectively. Patients were followed up annually over a period of 48 months. Analysis of variance for repeated measures was used to compare TMS parameters in patients with those in controls. Spearman's correlation was performed by considering demographic variables, aMCI subtype, neuropsychological test scores, TMS parameters, and conversion time. RESULTS Thirty-five aMCI subjects completed the study; 60% of these converted to AD. The baseline rMT and X/I-MEP ratio were significantly lower in patients than in controls (p = 0.04 and p = 0.01). Spearman's analysis showed that conversion time correlated with the rMT (0.40) and X/I-MEP ratio (0.51). DISCUSSION aMCI patients displayed cortical hyperexcitability and altered synaptic plasticity to 5 Hz-rTMS when compared with healthy subjects. The extent of these changes correlated with conversion time. These alterations, which have previously been observed in AD, are thus present in the early stages of disease and may be considered as potential neurophysiological markers of conversion from aMCI to AD.
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Affiliation(s)
| | - Floriana Pichiorri
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
- Neuroelectrical Imaging and Brain Computer Interface Laboratory, Fondazione Santa Lucia – Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Fabrizia D’Antonio
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | | | - Emanuela Onesti
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Marco Ceccanti
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Carlo de Lena
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Maurizio Inghilleri
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
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Picillo M, Dubbioso R, Iodice R, Iavarone A, Pisciotta C, Spina E, Santoro L, Barone P, Amboni M, Manganelli F. Short-latency afferent inhibition in patients with Parkinson’s disease and freezing of gait. J Neural Transm (Vienna) 2015; 122:1533-40. [DOI: 10.1007/s00702-015-1428-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 07/14/2015] [Indexed: 10/23/2022]
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Cromarty RA, Elder GJ, Graziadio S, Baker M, Bonanni L, Onofrj M, O'Brien JT, Taylor JP. Neurophysiological biomarkers for Lewy body dementias. Clin Neurophysiol 2015; 127:349-359. [PMID: 26183755 PMCID: PMC4727506 DOI: 10.1016/j.clinph.2015.06.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 06/05/2015] [Accepted: 06/23/2015] [Indexed: 11/07/2022]
Abstract
Biomarkers are needed to improve Lewy body dementia (LBD) diagnosis and measure treatment response. There is substantial heterogeneity in neurophysiology biomarker methodologies limiting comparison. However, there is tentative evidence to suggest neurophysiological approaches may show promise as potential biomarkers of LBD.
Objective Lewy body dementias (LBD) include both dementia with Lewy bodies (DLB) and Parkinson’s disease with dementia (PDD), and the differentiation of LBD from other neurodegenerative dementias can be difficult. Currently, there are few biomarkers which might assist early diagnosis, map onto LBD symptom severity, and provide metrics of treatment response. Traditionally, biomarkers in LBD have focussed on neuroimaging modalities; however, as biomarkers need to be simple, inexpensive and non-invasive, neurophysiological approaches might also be useful as LBD biomarkers. Methods In this review, we searched PubMED and PsycINFO databases in a semi-systematic manner in order to identify potential neurophysiological biomarkers in the LBDs. Results We identified 1491 studies; of these, 37 studies specifically examined neurophysiological biomarkers in LBD patients. We found that there was substantial heterogeneity with respect to methodologies and patient cohorts. Conclusion Generally, many of the findings have yet to be replicated, although preliminary findings reinforce the potential utility of approaches such as quantitative electroencephalography and motor cortical stimulation paradigms. Significance Various neurophysiological techniques have the potential to be useful biomarkers in the LBDs. We recommend that future studies focus on maximising the diagnostic specificity and sensitivity of the most promising neurophysiological biomarkers.
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Affiliation(s)
- Ruth A Cromarty
- Institute of Neuroscience, Campus for Aging and Vitality, Newcastle University, Newcastle upon Tyne NE4 5PL, UK.
| | - Greg J Elder
- Institute of Neuroscience, Campus for Aging and Vitality, Newcastle University, Newcastle upon Tyne NE4 5PL, UK
| | - Sara Graziadio
- Institute of Neuroscience, Framlington Place, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Mark Baker
- Institute of Neuroscience, Framlington Place, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Laura Bonanni
- Clinica Neurologica, Dipartimento di Neuroscienze e Imaging, Università "G.D'Annunzio" Chieti-Pescara, Italy
| | - Marco Onofrj
- Clinica Neurologica, Dipartimento di Neuroscienze e Imaging, Università "G.D'Annunzio" Chieti-Pescara, Italy
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0SP, UK
| | - John-Paul Taylor
- Institute of Neuroscience, Campus for Aging and Vitality, Newcastle University, Newcastle upon Tyne NE4 5PL, UK
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Stern AL, Naidoo N. Wake-active neurons across aging and neurodegeneration: a potential role for sleep disturbances in promoting disease. SPRINGERPLUS 2015; 4:25. [PMID: 25635245 PMCID: PMC4306674 DOI: 10.1186/s40064-014-0777-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 12/23/2014] [Indexed: 12/13/2022]
Abstract
Sleep/wake disturbance is a feature of almost all common age-related neurodegenerative diseases. Although the reason for this is unknown, it is likely that this inability to maintain sleep and wake states is in large part due to declines in the number and function of wake-active neurons, populations of cells that fire only during waking and are silent during sleep. Consistent with this, many of the brain regions that are most susceptible to neurodegeneration are those that are necessary for wake maintenance and alertness. In the present review, these wake-active populations are systematically assessed in terms of their observed pathology across aging and several neurodegenerative diseases, with implications for future research relating sleep and wake disturbances to aging and age-related neurodegeneration.
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Affiliation(s)
- Anna L Stern
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Nirinjini Naidoo
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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Guerra A, Petrichella S, Vollero L, Ponzo D, Pasqualetti P, Määttä S, Mervaala E, Könönen M, Bressi F, Iannello G, Rossini PM, Ferreri F. Neurophysiological features of motor cortex excitability and plasticity in Subcortical Ischemic Vascular Dementia: a TMS mapping study. Clin Neurophysiol 2014; 126:906-13. [PMID: 25262646 DOI: 10.1016/j.clinph.2014.07.036] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 07/11/2014] [Accepted: 07/13/2014] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate neurophysiological features of M1 excitability and plasticity in Subcortical Ischemic Vascular Dementia (SIVD), by means of a TMS mapping study. METHODS Seven SIVD and nine AD patients, along with nine control subjects were tested. The M1 excitability was studied by resting thresholds, area and volume of active cortical sites for forearm and hand's examined muscles. For M1 plasticity, coordinates of the hot-spot and the center of gravity (CoG) were evaluated. The correlation between the degree of hyperexcitability and the amount of M1 plastic rearrangement was also calculated. RESULTS Multivariate analysis of excitability measures demonstrated similarly enhanced cortical excitability in AD and SIVD patients with respect to controls. SIVD patients showed a medial and frontal shift of CoG from the hot-spot, not statistically different from that observed in AD. A significant direct correlation was seen between parameters related to cortical excitability and those related to cortical plasticity. CONCLUSIONS The results suggest the existence of common compensatory mechanisms in different kind of dementing diseases supporting the idea that cortical hyperexcitability can promote cortical plasticity. SIGNIFICANCE This study characterizes neurophysiological features of motor cortex excitability and plasticity in SIVD, providing new insights on the correlation between cortical excitability and plasticity.
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Affiliation(s)
- Andrea Guerra
- Department of Neurology, University Campus Bio-Medico, Rome, Italy
| | - Sara Petrichella
- Department of Computer Science and Computer Engineering, University Campus Bio-Medico, Rome, Italy
| | - Luca Vollero
- Department of Computer Science and Computer Engineering, University Campus Bio-Medico, Rome, Italy
| | - David Ponzo
- Department of Neurology, University Campus Bio-Medico, Rome, Italy; Department of Clinical Neurophysiology, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Patrizio Pasqualetti
- Service of Medical Statistics and Information Technology, Fatebenefratelli Foundation for Health Research and Education, AFaR Division, Rome, Italy
| | - Sara Määttä
- Department of Clinical Neurophysiology, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Esa Mervaala
- Department of Clinical Neurophysiology, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Mervi Könönen
- Department of Clinical Neurophysiology, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland; Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Federica Bressi
- Department of Physical Medicine and Rehabilitation, University Campus Biomedico, Rome, Italy
| | - Giulio Iannello
- Department of Computer Science and Computer Engineering, University Campus Bio-Medico, Rome, Italy
| | - Paolo Maria Rossini
- Institute of Neurology, Dept. Geriatrics, Neurosciences, Orthopaedics, Policlinic A. Gemelli, Catholic University, Rome, Italy; IRCCS S. Raffaele-Pisana, Rome, Italy
| | - Florinda Ferreri
- Department of Neurology, University Campus Bio-Medico, Rome, Italy; Department of Clinical Neurophysiology, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland.
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