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Neeb L, Bayer A, Bayer KE, Farmer A, Fiebach JB, Siegmund B, Volz MS. Transcranial direct current stimulation in inflammatory bowel disease patients modifies resting-state functional connectivity: A RCT. Brain Stimul 2019; 12:978-980. [PMID: 30905546 DOI: 10.1016/j.brs.2019.03.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/26/2019] [Accepted: 03/01/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Chronic pain is known to be associated with functional and structural changes in the brain. Inflammatory bowel disease (IBD) presents with chronic abdominal pain in almost 35% of all patients. This study investigates structural and functional changes in magnetic resonance imaging (MRI) after transcranial direct current stimulation (tDCS) applied to ameliorate pain in IBD. METHODS This phase-III, placebo-controlled, randomized study included 36 patients with IBD and chronic pain. MRI scans were performed before and following tDCS, which was applied for 5 days. RESULTS/CONCLUSION For the first time, this study revealed an association of changes in resting-state functional MRI and pain reduction in IBD. There was a significant increase in functional connectivity after active tDCS within the visual medial and the right frontoparietal network being connected with the amygdala, the insula, and the primary somatosensory cortex indicating central pain mechanisms in IBD. Moreover, tDCS offers a novel therapeutic strategy for abdominal pain.
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Affiliation(s)
- Lars Neeb
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Arian Bayer
- Medizinische Klinik M. S. Gastroenterologie, Infektiologie und Rheumatologie, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Kian-Elias Bayer
- Medizinische Klinik M. S. Gastroenterologie, Infektiologie und Rheumatologie, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Annabelle Farmer
- Medizinische Klinik M. S. Gastroenterologie, Infektiologie und Rheumatologie, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Jochen B Fiebach
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany.
| | - Britta Siegmund
- Medizinische Klinik M. S. Gastroenterologie, Infektiologie und Rheumatologie, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Magdalena Sarah Volz
- Medizinische Klinik M. S. Gastroenterologie, Infektiologie und Rheumatologie, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Berlin Institute of Health, 10178, Berlin, Germany.
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Lütt A, Michel K, Krüger D, Volz MS, Nassir M, Schulz E, Poralla L, Tangermann P, Bojarski C, Höltje M, Teegen B, Stöcker W, Schemann M, Siegmund B, Prüss H. High prevalence and functional effects of serum antineuronal antibodies in patients with gastrointestinal disorders. Neurogastroenterol Motil 2018; 30:e13292. [PMID: 29345029 DOI: 10.1111/nmo.13292] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 12/20/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Antineuronal antibodies can be associated with both gastrointestinal (GI) and brain disorders. For example, antibodies against the potassium channel subunit dipeptidyl-peptidase-like protein-6 (DPPX) bind to neurons in the central nervous system (CNS) and myenteric plexus and cause encephalitis, commonly preceded by severe unspecific GI symptoms. We therefore investigated the prevalence of antineuronal antibodies indicative of treatable autoimmune CNS etiologies in GI patients. METHODS Serum samples of 107 patients (Crohn's disease n = 42, ulcerative colitis n = 16, irritable bowel syndrome n = 13, others n = 36) and 44 healthy controls were screened for anti-DPPX and further antineuronal antibodies using immunofluorescence on rat brain and intestine and cell-based assays. Functional effects of high-titer reactive sera were assessed in organ bath and Ussing chamber experiments and compared to non-reactive patient sera. KEY RESULTS Twenty-one of 107 patients (19.6%) had antibodies against the enteric nervous system, and 22 (20.6%) had anti-CNS antibodies, thus significantly exceeding frequencies in healthy controls (4.5% each). Screening on cell-based assays excluded established antienteric antibodies. Antibody-positive sera were not associated with motility effects in organ bath experiments. However, they induced significant, tetrodotoxin (TTX)-insensitive secretion in Ussing chambers compared to antibody-negative sera. CONCLUSIONS & INFERENCES Antineuronal antibodies were significantly more frequent in GI patients and associated with functional effects on bowel secretion. Future studies will determine whether such antibodies indicate patients who might benefit from additional antibody-directed therapies. However, well-characterized encephalitis-related autoantibodies such as against DPPX were not detected, underlining their rarity in routine cohorts.
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Affiliation(s)
- A Lütt
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany.,Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - K Michel
- Human Biology, Technical University of Munich, Freising, Germany
| | - D Krüger
- Human Biology, Technical University of Munich, Freising, Germany
| | - M S Volz
- Medical Department (Gastroenterology, Infectious Diseases and Rheumatology), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Nassir
- Medical Department (Gastroenterology, Infectious Diseases and Rheumatology), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - E Schulz
- Medical Department (Gastroenterology, Infectious Diseases and Rheumatology), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - L Poralla
- Medical Department (Gastroenterology, Infectious Diseases and Rheumatology), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - P Tangermann
- Medical Department (Gastroenterology, Infectious Diseases and Rheumatology), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - C Bojarski
- Medical Department (Gastroenterology, Infectious Diseases and Rheumatology), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Höltje
- Institute for Integrative Neuroanatomy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - B Teegen
- Institute for Experimental Immunology affiliated with Euroimmun, Lübeck, Germany
| | - W Stöcker
- Institute for Experimental Immunology affiliated with Euroimmun, Lübeck, Germany
| | - M Schemann
- Human Biology, Technical University of Munich, Freising, Germany
| | - B Siegmund
- Medical Department (Gastroenterology, Infectious Diseases and Rheumatology), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - H Prüss
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany.,Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Volz MS, Loddenkemper C, Morguet A, Moos V, Schneider T. Cardiac myxoma secreting interleukin-6 promotes cavitary tuberculosis: a case report. Int J Tuberc Lung Dis 2016; 19:1265-6. [PMID: 26459552 DOI: 10.5588/ijtld.15.0405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Magdalena Sarah Volz
- Department of Gastroenterology and Infectious Diseases, Charité-Universitätsmedizin Berlin, Germany
| | | | - Andreas Morguet
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Verena Moos
- Department of Gastroenterology and Infectious Diseases, Charité-Universitätsmedizin Berlin, Germany
| | - Thomas Schneider
- Department of Gastroenterology and Infectious Diseases, Charité-Universitätsmedizin Berlin, Germany
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Volz MS, Finke C, Harms L, Jurek B, Paul F, Flöel A, Prüss H. Altered paired associative stimulation-induced plasticity in NMDAR encephalitis. Ann Clin Transl Neurol 2016; 3:101-13. [PMID: 26900584 PMCID: PMC4748309 DOI: 10.1002/acn3.277] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 11/19/2015] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To determine whether neurophysiological mechanisms indicating cortical excitability, long-term potentiation (LTP)-like plasticity, GABAergic and glutamatergic function are altered in patients with anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis and whether they can be helpful as markers of diagnostic assessment, disease progression, and potentially therapy response. METHODS Neurophysiological characterizations of patients with NMDAR encephalitis (n = 34, mean age: 28 ± 11 years; 30 females) and age/gender-matched healthy controls (n = 27, 28.5 ± 10 years; 25 females) were performed using transcranial magnetic stimulation-derived protocols including resting motor threshold, recruitment curve, intracortical facilitation, short intracortical inhibition, and cortical silent period. Paired associative stimulation (PAS) was applied to assess LTP-like mechanisms which are mediated through NMDAR. Moreover, resting state functional connectivity was determined using functional magnetic resonance imaging. RESULTS PAS-induced plasticity differed significantly between groups (P = 0.0056). Cortical excitability, as assessed via motor-evoked potentials after PAS, decreased in patients, whereas it increased in controls indicating malfunctioning of NMDAR in encephalitis patients. Lower PAS-induced plasticity significantly correlated with the modified Rankin Scale (mRS) (r = -0.41; P = 0.0031) and was correlated with lower functional connectivity within the motor network in NMDAR encephalitis patients (P < 0.001, uncorrected). Other neurophysiological parameters were not significantly different between groups. Follow-up assessments were available in six patients and demonstrated parallel improvement of PAS-induced plasticity and mRS. INTERPRETATION Assessment of PAS-induced plasticity may help to determine NMDAR dysfunction and disease severity in NMDAR encephalitis, and might even aid as a sensitive, noninvasive, and well-tolerated "electrophysiological biomarker" to monitor therapy response in the future. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov: Identifier: NCT01865578.
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Affiliation(s)
- Magdalena Sarah Volz
- Department of Gastroenterology, Infectiology and RheumatologyCharité – Universitätsmedizin BerlinGermany
| | - Carsten Finke
- Department of NeurologyCharité – Universitätsmedizin BerlinGermany
- Berlin School of Mind and BrainHumboldt – Universität zu BerlinGermany
| | - Lutz Harms
- Department of NeurologyCharité – Universitätsmedizin BerlinGermany
- Center for Autoimmune Encephalitis and Paraneoplastic Neurological SyndromesCharité – Universitätsmedizin BerlinGermany
| | - Betty Jurek
- German Center for Neurodegenerative Diseases (DZNE)BerlinGermany
| | - Friedemann Paul
- Department of NeurologyCharité – Universitätsmedizin BerlinGermany
- NeuroCure Clinical Research Center and Experimental and Clinical Research Center and Max Delbrueck Center for Molecular MedicineCharité – Universitätsmedizin BerlinGermany
| | - Agnes Flöel
- Department of NeurologyCharité – Universitätsmedizin BerlinGermany
- NeuroCure Clinical Research Center and Experimental and Clinical Research Center and Max Delbrueck Center for Molecular MedicineCharité – Universitätsmedizin BerlinGermany
- Center for Stroke Research BerlinCharité – Universitätsmedizin BerlinGermany
| | - Harald Prüss
- Department of NeurologyCharité – Universitätsmedizin BerlinGermany
- Center for Autoimmune Encephalitis and Paraneoplastic Neurological SyndromesCharité – Universitätsmedizin BerlinGermany
- German Center for Neurodegenerative Diseases (DZNE)BerlinGermany
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Volz MS, Suarez-Contreras V, Portilla ALS, Illigens B, Bermpohl F, Fregni F. Movement observation-induced modulation of pain perception and motor cortex excitability. Clin Neurophysiol 2015; 126:1204-1211. [DOI: 10.1016/j.clinph.2014.09.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 09/14/2014] [Accepted: 09/16/2014] [Indexed: 11/29/2022]
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Volz MS, Nassir M, Treese C, von Winterfeld M, Plöckinger U, Epple HJ, Siegmund B. Inflammatory bowel disease (IBD)-like disease in a case of a 33-year old man with glycogenosis 1b. BMC Gastroenterol 2015; 15:45. [PMID: 25881301 PMCID: PMC4394407 DOI: 10.1186/s12876-015-0271-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 03/20/2015] [Indexed: 02/08/2023] Open
Abstract
Background Inflammatory bowel disease (IBD)-like conditions in glycogen storage disease (GSD) type Ib have been predominantly described in children. Signs and symptoms of GSD type Ib are hypoglycemia, pancytopenia and hepatosplenomegaly. Based on few published cases, there is evidence that granulocyte-colony stimulating factor (G-CSF) in patients with glycogenosis–related pancytopenia might ameliorate the IBD-like disease through leukocyte increase. Case presentation Here we firstly describe a case of an adult 33-year-old Caucasian male patient with GSD type Ib accompanied with IBD-like disease with persistent pancytopenia despite moderate-dose G-CSF treatment. Recent vomiting and abdominal discomfort were due to a high-grade stenosis in the transverse colon. A dose increase of the G-CSF successfully normalized his leukocyte count. However, the stenosis worsened and surgical therapy was needed. Conclusion We suggest that symptomatic patients with GSD type Ib should undergo endoscopic examination in order to detect IBD-like disease and to initiate early treatment.
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Affiliation(s)
- Magdalena Sarah Volz
- Department of Medicine I (Gastroenterology, Rheumatology, Infectious Diseases), Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Mani Nassir
- Department of Medicine I (Gastroenterology, Rheumatology, Infectious Diseases), Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Christoph Treese
- Department of Medicine I (Gastroenterology, Rheumatology, Infectious Diseases), Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | | | - Ursula Plöckinger
- Interdisciplinary Center of Metabolism: Endocrinology, Diabetes and Metabolism, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Hans-Jörg Epple
- Department of Medicine I (Gastroenterology, Rheumatology, Infectious Diseases), Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Britta Siegmund
- Department of Medicine I (Gastroenterology, Rheumatology, Infectious Diseases), Charité - Universitätsmedizin Berlin, Berlin, Germany.
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Volz MS, Suarez-Contreras V, Portilla ALS, Fregni F. Mental imagery-induced attention modulates pain perception and cortical excitability. BMC Neurosci 2015; 16:15. [PMID: 25887060 PMCID: PMC4387598 DOI: 10.1186/s12868-015-0146-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 02/18/2015] [Indexed: 11/19/2022] Open
Abstract
Background Mental imagery is a powerful method of altering brain activity and behavioral outcomes, such as performance of cognition and motor skills. Further, attention and distraction can modulate pain-related neuronal networks and the perception of pain. This exploratory study examined the effects of mental imagery-induced attention on pressure pain threshold and cortical plasticity using transcranial magnetic stimulation (TMS). This blinded, randomized, and parallel-design trial comprised 30 healthy right-handed male subjects. Exploratory statistical analyses were performed using ANOVA and t-tests for pain and TMS assessments. Pearson’s correlation was used to analyze the association between changes in pain threshold and cortical excitability. Results In the analysis of pain outcomes, there was no significant interaction effect on pain between group versus time. In an exploratory analysis, we only observed a significant effect of group for the targeted left hand (ANOVA with pain threshold as the dependent variable and time and group as independent variables). Although there was only a within-group effect of mental imagery on pain, further analyses showed a significant positive correlation of changes in pain threshold and cortical excitability (motor-evoked potentials via TMS). Conclusions Mental imagery has a minor effect on pain modulation in healthy subjects. Its effects appear to differ compared with chronic pain, leading to a small decrease in pain threshold. Assessments of cortical excitability confirmed that these effects are related to the modulation of pain-related cortical circuits. These exploratory findings suggest that neuronal plasticity is influenced by pain and that the mental imagery effects on pain depend on the state of central sensitization.
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Affiliation(s)
- Magdalena Sarah Volz
- Laboratory of Neuromodulation, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, 125 Nashua Street #727, Boston, 02114, MA, USA. .,Charité - Universitätsmedizin, Berlin, Germany.
| | - Vanessa Suarez-Contreras
- Laboratory of Neuromodulation, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, 125 Nashua Street #727, Boston, 02114, MA, USA.
| | - Andrea L Santos Portilla
- Laboratory of Neuromodulation, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, 125 Nashua Street #727, Boston, 02114, MA, USA.
| | - Felipe Fregni
- Laboratory of Neuromodulation, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, 125 Nashua Street #727, Boston, 02114, MA, USA. .,Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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Wang QM, Cui H, Han SJ, Black-Schaffer R, Volz MS, Lee YT, Herman S, Latif LA, Zafonte R, Fregni F. Combination of transcranial direct current stimulation and methylphenidate in subacute stroke. Neurosci Lett 2014; 569:6-11. [PMID: 24631567 DOI: 10.1016/j.neulet.2014.03.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/01/2014] [Accepted: 03/05/2014] [Indexed: 01/23/2023]
Abstract
Noninvasive transcranial direct current stimulation (tDCS) and methylphenidate (MP) are associated with motor recovery after stroke. Based on the potentially complementary mechanisms of these interventions, we examined whether there is an interactive effect between MP and tDCS. In this preliminary study, we randomized subacute stroke subjects to receive tDCS alone, MP alone or combination of tDCS and MP. A blinded rater measured safety, hand function, and cortical excitability before and after treatment. None of the treatments caused any major or severe adverse effects or induced significant differences in cortical excitability. Analysis of variance of gain score, as measured by Purdue pegboard test, showed a significant between-group difference (F(2,6)=12.167, p=0.008). Post hoc analysis showed that the combination treatment effected greater Purdue pegboard gain scores than tDCS alone (p=0.017) or MP alone (p=0.01). Our preliminary data with nine subjects shows an interesting dissociation between motor function improvement and lack of motor corticospinal plasticity changes as indexed by transcranial magnetic stimulation in subacute stroke subjects.
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Affiliation(s)
- Qing Mei Wang
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, United States
| | - Huashun Cui
- Department of Acupuncture, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, China; Laboratory of Neuromodulation, Spaulding Rehabilitation Hospital, Harvard Medical School, United States
| | - Soo Jeong Han
- Laboratory of Neuromodulation, Spaulding Rehabilitation Hospital, Harvard Medical School, United States; Department of Rehabilitation Medicine, School of Medicine, Ewha Womans University, Republic of Korea
| | - Randie Black-Schaffer
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, United States
| | - Magdalena Sarah Volz
- Laboratory of Neuromodulation, Spaulding Rehabilitation Hospital, Harvard Medical School, United States; Charité - Universitätsmedizin Berlin, Medical Department I Gastroenterology, Infectiology and Rheumatology, Berlin, Germany
| | - Yong-Tae Lee
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, United States
| | - Seth Herman
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, United States
| | - Lydia Abul Latif
- Laboratory of Neuromodulation, Spaulding Rehabilitation Hospital, Harvard Medical School, United States; Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Malaysia
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, United States
| | - Felipe Fregni
- Laboratory of Neuromodulation, Spaulding Rehabilitation Hospital, Harvard Medical School, United States.
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Villamar MF, Volz MS, Bikson M, Datta A, Dasilva AF, Fregni F. Technique and considerations in the use of 4x1 ring high-definition transcranial direct current stimulation (HD-tDCS). J Vis Exp 2013:e50309. [PMID: 23893039 PMCID: PMC3735368 DOI: 10.3791/50309] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
High-definition transcranial direct current stimulation (HD-tDCS) has recently been developed as a noninvasive brain stimulation approach that increases the accuracy of current delivery to the brain by using arrays of smaller "high-definition" electrodes, instead of the larger pad-electrodes of conventional tDCS. Targeting is achieved by energizing electrodes placed in predetermined configurations. One of these is the 4x1-ring configuration. In this approach, a center ring electrode (anode or cathode) overlying the target cortical region is surrounded by four return electrodes, which help circumscribe the area of stimulation. Delivery of 4x1-ring HD-tDCS is capable of inducing significant neurophysiological and clinical effects in both healthy subjects and patients. Furthermore, its tolerability is supported by studies using intensities as high as 2.0 milliamperes for up to twenty minutes. Even though 4x1 HD-tDCS is simple to perform, correct electrode positioning is important in order to accurately stimulate target cortical regions and exert its neuromodulatory effects. The use of electrodes and hardware that have specifically been tested for HD-tDCS is critical for safety and tolerability. Given that most published studies on 4x1 HD-tDCS have targeted the primary motor cortex (M1), particularly for pain-related outcomes, the purpose of this article is to systematically describe its use for M1 stimulation, as well as the considerations to be taken for safe and effective stimulation. However, the methods outlined here can be adapted for other HD-tDCS configurations and cortical targets.
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Affiliation(s)
- Mauricio F Villamar
- Laboratory of Neuromodulation, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, USA
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Volz MS, Medeiros LF, Tarragô MDG, Vidor LP, Dall'Agnol L, Deitos A, Brietzke A, Rozisky JR, Razzolini B, Torres ILS, Fregni F, Caumo W. The relationship between cortical excitability and pain catastrophizing in myofascial pain. J Pain 2013; 14:1140-7. [PMID: 23810270 DOI: 10.1016/j.jpain.2013.04.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 04/16/2013] [Accepted: 04/22/2013] [Indexed: 10/26/2022]
Abstract
UNLABELLED Pain catastrophizing regularly occurs in chronic pain patients. It has been suggested that pain catastrophizing is a stable, person-based construct. These findings highlight the importance of investigating catastrophizing in conceptualizing specific approaches for pain management. One important area of investigation is the mechanism underlying pain catastrophizing. Therefore, this study explored the relationship between a neurophysiological marker of cortical excitability, as assessed by transcranial magnetic stimulation, and catastrophizing, as assessed by the Brazilian Portuguese Pain Catastrophizing Scale, in patients with chronic myofascial pain syndrome. The Pain Catastrophizing Scale is a robust questionnaire used to examine rumination, magnification and helplessness that are associated with the experience of pain. We include 24 women with myofascial pain syndrome. The Brazilian Portuguese Pain Catastrophizing Scale and cortical excitability were assessed. Functional and behavioral aspects of pain were evaluated with a version of the Profile of Chronic Pain scale and by multiple pain measurements (eg, pain intensity, pressure pain threshold, and other quantitative sensory measurements). Intracortical facilitation was found to be significantly associated with pain catastrophizing (β = .63, P = .001). Our results did not suggest that these findings were influenced by other factors, such as age or medication use. Furthermore, short intracortical inhibition showed a significant association with pressure pain threshold (β = .44, P = .04). This study elaborates on previous findings indicating a relationship between cortical excitability and catastrophizing. The present findings suggest that glutamatergic activity may be associated with mechanisms underlying pain catastrophizing; thus, the results highlight the need to further investigate the neurophysiological mechanisms associated with pain and catastrophizing. PERSPECTIVE This study highlights the relationship between cortical excitability and catastrophizing. Cortical measures may illuminate how catastrophizing responses may be related to neurophysiological mechanisms associated with chronic pain.
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Affiliation(s)
- Magdalena Sarah Volz
- Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts; Charité - Universitätsmedizin Berlin, Berlin, Germany
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Volz MS, Suarez-Contreras V, Mendonca ME, Pinheiro FS, Merabet LB, Fregni F. Effects of sensory behavioral tasks on pain threshold and cortical excitability. PLoS One 2013; 8:e52968. [PMID: 23301010 PMCID: PMC3536816 DOI: 10.1371/journal.pone.0052968] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 11/23/2012] [Indexed: 11/25/2022] Open
Abstract
Background/Objective Transcutaneous electrical stimulation has been proven to modulate nervous system activity, leading to changes in pain perception, via the peripheral sensory system, in a bottom up approach. We tested whether different sensory behavioral tasks induce significant effects in pain processing and whether these changes correlate with cortical plasticity. Methodology/Principal Findings This randomized parallel designed experiment included forty healthy right-handed males. Three different somatosensory tasks, including learning tasks with and without visual feedback and simple somatosensory input, were tested on pressure pain threshold and motor cortex excitability using transcranial magnetic stimulation (TMS). Sensory tasks induced hand-specific pain modulation effects. They increased pain thresholds of the left hand (which was the target to the sensory tasks) and decreased them in the right hand. TMS showed that somatosensory input decreased cortical excitability, as indexed by reduced MEP amplitudes and increased SICI. Although somatosensory tasks similarly altered pain thresholds and cortical excitability, there was no significant correlation between these variables and only the visual feedback task showed significant somatosensory learning. Conclusions/Significance Lack of correlation between cortical excitability and pain thresholds and lack of differential effects across tasks, but significant changes in pain thresholds suggest that analgesic effects of somatosensory tasks are not primarily associated with motor cortical neural mechanisms, thus, suggesting that subcortical neural circuits and/or spinal cord are involved with the observed effects. Identifying the neural mechanisms of somatosensory stimulation on pain may open novel possibilities for combining different targeted therapies for pain control.
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Affiliation(s)
- Magdalena Sarah Volz
- Laboratory of Neuromodulation, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Charité Center for Neurology, Neurosurgery and Psychiatry, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Vanessa Suarez-Contreras
- Laboratory of Neuromodulation, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Mariana E. Mendonca
- Laboratory of Neuromodulation, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Fernando Santos Pinheiro
- Laboratory of Neuromodulation, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Lotfi B. Merabet
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Felipe Fregni
- Laboratory of Neuromodulation, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
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Volz MS, Volz TS, Brunoni AR, de Oliveira JPVTR, Fregni F. Analgesic effects of noninvasive brain stimulation in rodent animal models: a systematic review of translational findings. Neuromodulation 2012; 15:283-95. [PMID: 22759345 DOI: 10.1111/j.1525-1403.2012.00478.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Noninvasive brain stimulation (NIBS) interventions have demonstrated promising results in the clinical treatment of pain, according to several preliminary trials, although the results have been mixed. The limitations of clinical research on NIBS are the insufficient understanding of its mechanisms of action, a lack of adequate safety data, and several disparities with regard to stimulation parameters, which have hindered the generalizability of such studies. Thus, experimental animal research that allows the use of more invasive interventions and creates additional control of independent variables and confounders is desirable. To this end, we systematically reviewed animal studies investigating the analgesic effects of NIBS. In addition, we also explored the investigation of NIBS in animal models of stroke as to compare these findings with NIBS animal pain research. METHODS Of 1916 articles that were found initially, we identified 15 studies (stroke and pain studies) per our eligibility criteria that used NIBS methods, such as transcranial direct current stimulation, paired associative stimulation, transcranial magnetic stimulation, and transcranial electrostimulation. We extracted the main outcomes on stroke and pain, as well as the methods and electrical parameters of each technique. RESULTS NIBS techniques are effective in alleviating pain. Similar beneficial clinical effects are observed in stroke. The main insights from these animal studies are the following: 1) combination of NIBS with analgesic drugs has a synergistic effect; 2) effects are dependent on the parameters of stimulation, and in fact, not necessarily the strongest stimulation parameter (i.e., the largest intensity of stimulation) is associated with the largest benefit; 3) pain studies show an overall good quality as indexed by Animals in Research: Reporting In Vivo Experiments guidelines of the reporting of animal experiments, but insufficient with regard to the reporting of safety data for brain stimulation; 4) these studies suggest that NIBS techniques have a primary effect on synaptic plasticity, but they also suggest other mechanisms of action such as via neurovascular modulation. CONCLUSIONS We found a limited number of animal studies for both pain and stroke NIBS experimental research. There is a lack of safety data in animal studies in these two topics and results from these studies have not been yet fully tested and translated to human research. We discuss the challenges and limitations of translating experimental animal research on NIBS into clinical studies.
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Affiliation(s)
- Magdalena Sarah Volz
- Laboratory of Neuromodulation, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Medeiros LF, de Souza ICC, Vidor LP, de Souza A, Deitos A, Volz MS, Fregni F, Caumo W, Torres ILS. Neurobiological effects of transcranial direct current stimulation: a review. Front Psychiatry 2012; 3:110. [PMID: 23293607 PMCID: PMC3531595 DOI: 10.3389/fpsyt.2012.00110] [Citation(s) in RCA: 165] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 12/04/2012] [Indexed: 12/20/2022] Open
Abstract
Transcranial Direct Current Stimulation (tDCS) is a non-invasive brain stimulation technique that is affordable and easy to operate compared to other neuromodulation techniques. Anodal stimulation increases cortical excitability, while the cathodal stimulation decreases it. Although tDCS is a promising treatment approach for chronic pain as well as for neuropsychiatric diseases and other neurological disorders, several complex neurobiological mechanisms that are not well understood are involved in its effect. The purpose of this systematic review is to summarize the current knowledge regarding the neurobiological mechanisms involved in the effects of tDCS. The initial search resulted in 171 articles. After applying inclusion and exclusion criteria, we screened 32 full-text articles to extract findings about the neurobiology of tDCS effects including investigation of cortical excitability parameters. Overall, these findings show that tDCS involves a cascade of events at the cellular and molecular levels. Moreover, tDCS is associated with glutamatergic, GABAergic, dopaminergic, serotonergic, and cholinergic activity modulation. Though these studies provide important advancements toward the understanding of mechanisms underlying tDCS effects, further studies are needed to integrate these mechanisms as to optimize clinical development of tDCS.
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Affiliation(s)
- Liciane Fernandes Medeiros
- Post-Graduate Program in Biological Sciences, Department of Physiology, Universidade Federal do Rio Grande do Sul Porto Alegre, Brazil ; Pharmacology Department, Institute of Basic Health Science, Universidade Federal do Rio Grande do Sul Porto Alegre, Brazil ; Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre Porto Alegre, Brazil
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DaSilva AF, Volz MS, Bikson M, Fregni F. Electrode Positioning and Montage in Transcranial Direct Current Stimulation. J Vis Exp 2011. [DOI: 10.3791/2744-v] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
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Abstract
Transcranial direct current stimulation (tDCS) is a technique that has been intensively investigated in the past decade as this method offers a non-invasive and safe alternative to change cortical excitability2. The effects of one session of tDCS can last for several minutes, and its effects depend on polarity of stimulation, such as that cathodal stimulation induces a decrease in cortical excitability, and anodal stimulation induces an increase in cortical excitability that may last beyond the duration of stimulation6. These effects have been explored in cognitive neuroscience and also clinically in a variety of neuropsychiatric disorders – especially when applied over several consecutive sessions4. One area that has been attracting attention of neuroscientists and clinicians is the use of tDCS for modulation of pain-related neural networks3,5. Modulation of two main cortical areas in pain research has been explored: primary motor cortex and dorsolateral prefrontal cortex7. Due to the critical role of electrode montage, in this article, we show different alternatives for electrode placement for tDCS clinical trials on pain; discussing advantages and disadvantages of each method of stimulation.
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Affiliation(s)
- Alexandre F DaSilva
- Headache & Orofacial Pain Effort, Biologic & Material Sciences, School of Dentistry, University of Michigan, USA.
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