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Kuo YL, Chen M, Kimberley TJ. Probing the inhibitory motor circuits in adductor laryngeal dystonia during a dystonia-unrelated task. Parkinsonism Relat Disord 2023; 115:105812. [PMID: 37651926 PMCID: PMC10592018 DOI: 10.1016/j.parkreldis.2023.105812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/04/2023] [Accepted: 08/13/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND The pathophysiology of adductor laryngeal dystonia (AdLD) remains unknown; however, there is growing evidence that dystonia is associated with disruptions in the inhibitory regulation of sensorimotor cortical areas. Using functional MRI (fMRI) and transcranial magnetic stimulation (TMS) complementarily, we previously demonstrated an overly activated laryngeal motor cortex and revealed correlations between blood-oxygen-level dependent (BOLD) activation and intracortical inhibition in a phonation (dystonia-related) task in adductor laryngeal dystonia (AdLD). OBJECTIVE Here, we aimed to characterize the brain-based findings in the primary motor cortex (M1) during a dystonia-unrelated (finger tapping) task in AdLD and controls (CTL). METHODS We examined the between-group differences in task-dependent BOLD activation and intracortical inhibition, measured by the TMS-evoked cortical silent period (cSP), in the M1. The correlations between fMRI and TMS responses were assessed. RESULTS There is more broadly dispersed BOLD activation, not confined to the hand motor cortex, and reduced intracortical inhibition in AdLD compared to CTL. Further, there are more positive correlations between cSP and BOLD activation in a task unrelated to dystonic symptoms in AdLD compared with CTL. This is in contrast to our previous work that demonstrated fewer positive correlations in AdLD during a dystonic phonation task. CONCLUSIONS In unaffected musculature activation, there is dispersed BOLD activation that is correlated with intracortical inhibition suggesting a possible compensatory strategy in the non-dystonic muscles.
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Affiliation(s)
- Yi-Ling Kuo
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA.
| | - Mo Chen
- Neuroscience Research Program, Gillette Children's Specialty Healthcare, St. Paul, MN, USA; Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA.
| | - Teresa J Kimberley
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA; Department of Physical Therapy, MGH Institute of Health Professions, Boston, MA, USA.
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Gómez-Feria J, Martín-Rodríguez JF, Mir P. Corticospinal adaptations following resistance training and its relationship with strength: A systematic review and multivariate meta-analysis. Neurosci Biobehav Rev 2023; 152:105289. [PMID: 37353049 DOI: 10.1016/j.neubiorev.2023.105289] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 05/21/2023] [Accepted: 06/18/2023] [Indexed: 06/25/2023]
Abstract
Neural adaptations to resistance training (RT) and their correlation with muscle strength remain partially understood. We conducted a systematic review and multivariate meta-analysis to examine the effects of metronome-paced (MP), self-paced (SP), and isometric (IM) training on M1 and corticospinal pathway activity. Following MP RT, a significant increase in corticospinal excitability was observed, correlating with increased strength. Conversely, no significant relationship was found after SP or IM training. RT also reduced the duration of the cortical silent period, but this change did not predict strength changes and was not specific to any training modality. No significant effects were found for short-interval intracortical inhibition. Our findings suggest that changes in corticospinal excitability may contribute to strength gains after RT. Furthermore, the relationship between these adaptations and strength appears dependent on the type of training performed.
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Affiliation(s)
- José Gómez-Feria
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Juan Francisco Martín-Rodríguez
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Departamento de Psicología Experimental, Facultad de Psicología, Universidad de Sevilla, Seville, Spain.
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Sevilla, Seville, Spain.
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Boček V, Krbec M, Vaško P, Brabec K, Pavlíková M, Štětkářová I. Alteration of cortical but not spinal inhibitory circuits in idiopathic scoliosis. J Spinal Cord Med 2022; 45:186-193. [PMID: 32202478 PMCID: PMC8986185 DOI: 10.1080/10790268.2020.1739893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Background: The pathogenesis of adolescent idiopathic scoliosis (AIS), including the role of brain and spinal inhibitory circuits, is still poorly elucidated. The aim of this study was to identify which central inhibitory mechanisms are involved in the pathogenesis of AIS.Design: A prospective neurophysiological study, using a battery of neurophysiological tests, such as cutaneous (CuSP) and cortical (CoSP) silent periods, motor evoked potentials (MEP) and paired-pulse transcranial magnetic stimulation (ppTMS).Settings: Neurophysiological laboratory.Participants: Sixteen patients with AIS (14 females, median age 14.4) and healthy controls.Outcome measures: MEPs were obtained after transcranial magnetic stimulation (TMS) and recorded from the abductor pollicis muscle (APB). ppTMS was obtained at interval ratios (ISI) of 1, 2, 3, 6, 10, 15 and 20 ms. The cortical silent period (CoSP) was recorded from the APB. The cutaneous silent period (CuSP) was measured after painful stimuli delivered to the thumb while the subjects maintained voluntary contraction of the intrinsic hand muscles. The data were analyzed and compared with those from healthy subjects.Results: The CoSP duration was significantly prolonged in AIS patients. A significantly higher amplitude of ppTMS for ISI was found in all AIS patients, without remarkable left-right side differences. No significant difference in MEP latency or amplitude nor in the CuSP duration was obtained.Conclusion: Our observation demonstrates evidence of central nervous system involvement in adolescent idiopathic scoliosis (AIS). Lower intracortical inhibition, higher motor cortex excitability, and preserved spinal inhibitory circuits are the main findings of this study. A possible explanation of these changes could be attributed to impaired sensorimotor integration predominantly at the cortical level.
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Affiliation(s)
- Václav Boček
- Department of Neurology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic,Correspondence to: Václav Boček, Department of Neurology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Ruska 87, 100 00Prague 10, Czech Republic.
| | - Martin Krbec
- Department of Orthopedics and Traumatology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Peter Vaško
- Department of Neurology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Karel Brabec
- Department of Neurology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic,Department of Orthopedics and Traumatology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Markéta Pavlíková
- Department of Probability and Mathematical Statistics, Faculty of Mathematics and Physics, Charles University, Prague, Czech Republic
| | - Ivana Štětkářová
- Department of Neurology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
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Hanson MR, Swanson CW, Whittier TT, Fling BW. Inhibitory signaling as a predictor of leg force control in young and older adults. Exp Brain Res 2022; 240:1005-1016. [PMID: 35171308 DOI: 10.1007/s00221-022-06321-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/29/2022] [Indexed: 11/04/2022]
Abstract
As the populations of the United States and developed nations age, motor control performance is adversely impacted, resulting in functional impairments that can diminish quality of life. Generally, force control in the lower limb worsens with age, with older adults (OA) displaying more variable and less accurate submaximal forces. Corticospinal inhibitory signaling may influence force control, with those OA who maintain corticospinal inhibitory signaling capacity achieving steadier forces. This study aimed to assess the relationships between lower limb force control and transcranial magnetic stimulation (TMS) measures of corticospinal inhibition (i.e., cortical silent period (cSP) duration and depth). 15 OA and 14 young adults (YA) were recruited for this study. All subjects underwent a TMS protocol to elicit the cSP while maintaining 15% of their maximal force in their knee extensor muscles. OA and YA did not display differences in force control metrics or corticospinal inhibitory measures. However, in OA, maximal cSP depth (%dSP max) was associated with lower force variability. No other significant relationships existed in the YA or OA groups. Future studies will benefit from evaluating a range of target forces and target muscles to assess potential relationships between sensorimotor inhibitory capacity and control of muscle force output.
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Affiliation(s)
- Moriah R Hanson
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO, USA
| | - Clayton W Swanson
- Department of Health & Exercise Science, Colorado State University, 1582 Campus Delivery, Moby B-201A, Fort Collins, CO, 80523, USA
| | - Tyler T Whittier
- Department of Health & Exercise Science, Colorado State University, 1582 Campus Delivery, Moby B-201A, Fort Collins, CO, 80523, USA
| | - Brett W Fling
- Department of Health & Exercise Science, Colorado State University, 1582 Campus Delivery, Moby B-201A, Fort Collins, CO, 80523, USA. .,Molecular, Cellular, and Integrative Neuroscience Program, Colorado State University, Fort Collins, CO, USA.
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Prudente CN, Chen M, Stipancic KL, Marks KL, Samargia-Grivette S, Goding GS, Green JR, Kimberley TJ. Effects of low-frequency repetitive transcranial magnetic stimulation in adductor laryngeal dystonia: a safety, feasibility, and pilot study. Exp Brain Res 2022; 240:561-574. [PMID: 34859288 PMCID: PMC8858301 DOI: 10.1007/s00221-021-06277-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/13/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE The effects of neuromodulation are virtually unexplored in adductor laryngeal dystonia (AdLD), a disorder characterized by involuntary contraction of intrinsic laryngeal muscles. Recent findings indicated that intracortical inhibition is reduced in people with AdLD. Low-frequency repetitive transcranial magnetic stimulation (rTMS) induces prolonged intracortical inhibition, but the effects in AdLD are unexplored. This pilot and feasibility study aimed to examine the safety, feasibility, and effects of a single session 1 Hz rTMS over the laryngeal motor cortex (LMC) in people with AdLD and healthy individuals. METHODS The stimulation location was individualized and determined through TMS-evoked responses in the thyroarytenoid muscles using fine-wire electrodes. 1200 pulses of 1 Hz rTMS were delivered to the left LMC in two groups: Control (n = 6) and AdLD (n = 7). Tolerance, adverse effects, intracortical inhibition, and voice recordings were collected immediately before and after rTMS. Voice quality was assessed with acoustic-based and auditory-perceptual measures. RESULTS All participants tolerated the procedures, with no unexpected adverse events or worsening of symptoms. No significant effects on intracortical inhibition were observed. In the AdLD group, there was a large-effect size after rTMS in vocal perturbation measures and a small-effect size in decreased phonatory breaks. CONCLUSIONS One rTMS session over the LMC is safe and feasible, and demonstrated trends of beneficial effects on voice quality and phonatory function in AdLD. These preliminary findings support further investigation to assess clinical benefits in a future randomized sham-controlled trial. CLINICALTRIALS.GOV: NCT02957942, registered on November 8, 2016.
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Affiliation(s)
- Cecília N Prudente
- Divisions of Physical Therapy and Rehabilitation Science, Department of Rehabilitation Medicine, School of Medicine, University of Minnesota, Minneapolis, MN, USA
- MicroTransponder Inc., Austin, TX, USA
| | - Mo Chen
- Non-Invasive Neuromodulation Laboratory, MnDRIVE Initiative, University of Minnesota, Minneapolis, MN, USA
- Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Kaila L Stipancic
- Department of Communication Sciences and Disorders, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
- Department of Communicative Sciences and Disorders, University at Buffalo, Buffalo, NY, USA
| | - Katherine L Marks
- Department of Communication Sciences and Disorders, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
- Department of Speech Language Hearing Sciences, Boston University, Boston, MA, USA
| | - Sharyl Samargia-Grivette
- Department of Communication Sciences and Disorders, University of Minnesota-Duluth, Duluth, MN, USA
| | - George S Goding
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Jordan R Green
- Department of Communication Sciences and Disorders, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
| | - Teresa J Kimberley
- Divisions of Physical Therapy and Rehabilitation Science, Department of Rehabilitation Medicine, School of Medicine, University of Minnesota, Minneapolis, MN, USA.
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, 36 First Ave, Boston, MA, 02129, USA.
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Stipancic KL, Kuo YL, Miller A, Ventresca HM, Sternad D, Kimberley TJ, Green JR. The effects of continuous oromotor activity on speech motor learning: speech biomechanics and neurophysiologic correlates. Exp Brain Res 2021; 239:3487-3505. [PMID: 34524491 PMCID: PMC8599312 DOI: 10.1007/s00221-021-06206-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/25/2021] [Indexed: 11/26/2022]
Abstract
Sustained limb motor activity has been used as a therapeutic tool for improving rehabilitation outcomes and is thought to be mediated by neuroplastic changes associated with activity-induced cortical excitability. Although prior research has reported enhancing effects of continuous chewing and swallowing activity on learning, the potential beneficial effects of sustained oromotor activity on speech improvements is not well-documented. This exploratory study was designed to examine the effects of continuous oromotor activity on subsequent speech learning. Twenty neurologically healthy young adults engaged in periods of continuous chewing and speech after which they completed a novel speech motor learning task. The motor learning task was designed to elicit improvements in accuracy and efficiency of speech performance across repetitions of eight-syllable nonwords. In addition, transcranial magnetic stimulation was used to measure the cortical silent period (cSP) of the lip motor cortex before and after the periods of continuous oromotor behaviors. All repetitions of the nonword task were recorded acoustically and kinematically using a three-dimensional motion capture system. Productions were analyzed for accuracy and duration, as well as lip movement distance and speed. A control condition estimated baseline improvement rates in speech performance. Results revealed improved speech performance following 10 min of chewing. In contrast, speech performance following 10 min of continuous speech was degraded. There was no change in the cSP as a result of either oromotor activity. The clinical implications of these findings are discussed in the context of speech rehabilitation and neuromodulation.
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Affiliation(s)
- Kaila L Stipancic
- Department of Communicative Disorders and Sciences, University at Buffalo, Buffalo, NY, USA
| | - Yi-Ling Kuo
- Department of Physical Therapy, Upstate Medical University, Syracuse, NY, USA
| | - Amanda Miller
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA, USA
| | - Hayden M Ventresca
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Building 79/96, 2nd Floor 13th Street, Boston, MA, 02129, USA
| | - Dagmar Sternad
- Department of Biology, Northeastern University, Boston, MA, USA
| | - Teresa J Kimberley
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Building 79/96, 2nd Floor 13th Street, Boston, MA, 02129, USA
| | - Jordan R Green
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Building 79/96, 2nd Floor 13th Street, Boston, MA, 02129, USA.
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Matsumoto H, Uchio N, Hao A, Haga M, Abe C, Sakamoto Y, Ugawa Y. Prominent Prolongation of Cortical Silent Period Induced by Transcranial Magnetic Stimulation in Creutzfeldt-Jakob Disease. Case Rep Neurol 2020; 12:447-451. [PMID: 33362525 PMCID: PMC7747086 DOI: 10.1159/000510395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/21/2020] [Indexed: 11/22/2022] Open
Abstract
The cortical silent period (CSP) induced by transcranial magnetic stimulation (TMS) has been reported to be prolonged in 2 Creutzfeldt-Jakob disease (CJD) patients who presented with periodic myoclonus. Herein, we will show a prominent prolongation of TMS-induced CSP in a patient with CJD who did not have periodic myoclonus. The patient was a 66-year-old woman who developed rapidly progressive dementia. No myoclonic jerks were observed. Brain magnetic resonance imaging showed high-intensity lesions in the cerebral cortex, basal ganglia, and thalamus on diffusion-weighted images. Electroencephalography (EEG) showed diffuse and continuous slow waves, but no periodic synchronous discharges (PSDs). A TMS study revealed that the duration of CSP was prominently prolonged: the duration of CSP (370 ms) equaled that of the mean + 6.5 SD of the normal value. One month after admission, the patient exhibited akinetic mutism and developed periodic myoclonus in her limbs. The clinical course was compatible with CJD. To date, CSP has been measured in only 2 CJD patients. The common findings in both cases were marked prolongation of CSP, periodic myoclonus, and PSD on EEG. In short, we demonstrated that TMS-induced CSP was prominently prolonged even at the early stage of CJD without periodic myoclonus or PSD. In other disorders, the CSP has not been reported to be comparably prolonged to that of CJD patients. Therefore, we conclude that TMS-induced CSP could be prominently prolonged even in the early stage of CJD. The marked prolongation of the CSP might be an early biomarker of CJD.
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Affiliation(s)
| | - Naohiro Uchio
- Department of Neurology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Akihito Hao
- Department of Neurology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Mari Haga
- Department of Clinical Laboratory, Mitsui Memorial Hospital, Tokyo, Japan
| | - Chiaki Abe
- Department of Clinical Laboratory, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yuuri Sakamoto
- Department of Clinical Laboratory, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Fukushima, Japan
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Hupfeld KE, Swanson CW, Fling BW, Seidler RD. TMS-induced silent periods: A review of methods and call for consistency. J Neurosci Methods 2020; 346:108950. [PMID: 32971133 PMCID: PMC8276277 DOI: 10.1016/j.jneumeth.2020.108950] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/24/2020] [Accepted: 09/15/2020] [Indexed: 12/31/2022]
Abstract
Transcranial magnetic stimulation (TMS)-induced silent periods provide an in vivo measure of human motor cortical inhibitory function. Cortical silent periods (cSP, also sometimes referred to as contralateral silent periods) and ipsilateral silent periods (iSP) may change with advancing age and disease and can provide insight into cortical control of the motor system. The majority of past silent period work has implemented largely varying methodology, sometimes including subjective analyses and incomplete methods descriptions. This limits reproducibility of silent period work and hampers comparisons of silent period measures across studies. Here, we discuss methodological differences in past silent period work, highlighting how these choices affect silent period outcome measures. We also outline challenges and possible solutions for measuring silent periods in the unique case of the lower limbs. Finally, we provide comprehensive recommendations for collection, analysis, and reporting of future silent period studies.
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Affiliation(s)
- K E Hupfeld
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - C W Swanson
- Department of Health & Exercise Science, Colorado State University, Fort Collins, CO, USA
| | - B W Fling
- Department of Health & Exercise Science, Colorado State University, Fort Collins, CO, USA; Molecular, Cellular, and Integrative Neuroscience Program, Colorado State University, Fort Collins, CO, USA
| | - R D Seidler
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA; Department of Neurology, University of Florida, Gainesville, FL, USA.
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Khedr EM, Elserogy Y, Fawzy M, Abdelrahman AA, Galal AM, Noaman MM. Effect of psychotropic drugs on cortical excitability of patients with major depressive disorders: A transcranial magnetic stimulation study. Psychiatry Res 2020; 291:113287. [PMID: 32763548 DOI: 10.1016/j.psychres.2020.113287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/11/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 11/24/2022]
Abstract
Transcranial magnetic stimulation (TMS) can be used to evaluate the effects of pharmacological interventions. The aim of this study was to assess the impact of the selective serotonin reuptake inhibitor, sertraline, and the atypical antipsychotic drugs quetiapine and olanzapine, on cortical excitability in unmedicated patients with major depressive disorder (MDD). The study included 45 medication-free MDD patients diagnosed according to DSM V. They were divided randomly into three groups who received a single oral dose of one of the three drugs sertraline (50 mg), quetiapine (100 mg) and olanzapine (10 mg). Psychological evaluation was conducted using the Mini-Mental State Examination (MMSE) and Beck Depression Inventory Scale (BDI). Resting and active motor thresholds (rMT and aMT) together with contralateral and ipsilateral cortical silent periods (cSP, and iSP) were measured for each participant before and at the time of maximum concentration of drug intake. There was significant increase in excitability of motor cortex after sertraline without changes in GABAB neurotransmission. Quetiapine and olanzapine potentiated inhibitory GABAB neurotransmission (prolongation of cSP); olanzapine additionally prolonged the iSP. Thus TMS can differentiate between the impact of different psychotropic drugs on excitatory and inhibitory transmission in motor cortex.
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Affiliation(s)
- Eman M Khedr
- Neuropsychiatry Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
| | - Yasser Elserogy
- Neuropsychiatry Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed Fawzy
- Neuropsychiatry Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed A Abdelrahman
- Neuropsychiatry Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Amr M Galal
- Neuropsychiatry Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mostafa M Noaman
- Neuropsychiatry Department, Faculty of Medicine, Assiut University, Assiut, Egypt
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Chen M, Summers RLS, Prudente CN, Goding GS, Samargia-Grivette S, Ludlow CL, Kimberley TJ. Transcranial magnetic stimulation and functional magnet resonance imaging evaluation of adductor spasmodic dysphonia during phonation. Brain Stimul 2020; 13:908-915. [PMID: 32289724 PMCID: PMC7213049 DOI: 10.1016/j.brs.2020.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 03/04/2020] [Accepted: 03/06/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Reduced intracortical inhibition is a neurophysiologic finding in focal dystonia that suggests a broader problem of impaired cortical excitability within the brain. A robust understanding of the neurophysiology in dystonia is essential to elucidate the pathophysiology of the disorder and develop new treatments. The cortical silent period (cSP) is a reliable, non-invasive method to measure intracortical inhibition in the primary motor cortex associated with a muscle of interest. In adductor spasmodic dysphonia (AdSD), cSP of the laryngeal motor cortex (LMC) which directly corresponds to the affected musculature, the thyroarytenoid (TA), has not been examined. OBJECTIVE This work evaluated the cSP of the LMC and the relationship between cSP and functional magnetic resonance imaging (fMRI) blood-oxygen-level dependent (BOLD) activation in people with AdSD (n = 12) compared to healthy controls (CTL, n = 14). RESULTS Shortened LMC cSP were observed bilaterally in people with AdSD vs CTL (F(1, 99) = 19.5226, p < 0.0001), with a large effect size (η2 = 0.1834). Between-group fMRI analysis revealed greater activation in bilateral LMC in the AdSD > CTL contrast as compared to CTL > AdSD contrast. Correlation analysis showed that people with AdSD have positive correlation of left LMC BOLD activation and the cSP. Further, the right LMC cSP lacks either positive or negative associations with BOLD activation. CTL individuals displayed both positive and negative correlations between cSP and BOLD activation in the left LMC. In CTL, the LMC cSP and BOLD activation showed exclusively negative correlations in both hemispheres. CONCLUSION In AdSD, the cortical activation during phonation may not be efficiently or effectively associated with inhibitory processes, leading to muscular dysfunction. These findings may give insight into the maladaptive cortical control during phonation in people with AdSD.
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Affiliation(s)
- Mo Chen
- Divisions of Physical Therapy and Rehabilitation Science, Department of Rehabilitation Medicine, School of Medicine, University of Minnesota. 426 Church St. SE, Minneapolis, MN, 55455, USA; Non-invasive Neuromodulation Laboratory, MnDRIVE Initiative, University of Minnesota. 247, 717 Delaware St. SE, Minneapolis, MN, 55414, USA
| | - Rebekah L S Summers
- Divisions of Physical Therapy and Rehabilitation Science, Department of Rehabilitation Medicine, School of Medicine, University of Minnesota. 426 Church St. SE, Minneapolis, MN, 55455, USA; Department of Neurology, School of Medicine, University of Minnesota, 717 Delaware St., SE. Minneapolis, MN, 55414, USA
| | - Cecília N Prudente
- Divisions of Physical Therapy and Rehabilitation Science, Department of Rehabilitation Medicine, School of Medicine, University of Minnesota. 426 Church St. SE, Minneapolis, MN, 55455, USA
| | - George S Goding
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Phillips Wangensteen Building, 516 Delaware Street SE, Minneapolis, MN, 55455, USA
| | - Sharyl Samargia-Grivette
- Department of Communication Sciences and Disorders, University of Wisconsin River Falls Campus. 220 Wyman Teacher Education Bldg, 410 South Third Street, River Falls, WI, 54022, USA
| | - Christy L Ludlow
- Department of Communication Sciences and Disorders, James Madison University, MSC 4304, MLK Drive, Harrisonburg, VA, 22807, USA
| | - Teresa J Kimberley
- Divisions of Physical Therapy and Rehabilitation Science, Department of Rehabilitation Medicine, School of Medicine, University of Minnesota. 426 Church St. SE, Minneapolis, MN, 55455, USA; School of Health and Rehabilitation Sciences, Department of Physical Therapy, Massachusetts General Hospital, Institute of Health Professions, 36 First Ave, Boston, MA, 02129, USA.
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Summers RLS, Chen M, MacKinnon CD, Kimberley TJ. Evidence for normal intracortical inhibitory recruitment properties in cervical dystonia. Clin Neurophysiol 2020; 131:1272-1279. [PMID: 32304844 DOI: 10.1016/j.clinph.2020.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/17/2020] [Accepted: 03/22/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Dystonia is associated with reduced intracortical inhibition as measured by the cortical silent period (cSP); however, this may be due to abnormal cSP threshold or input-output properties. This study evaluated cSP recruitment properties in people with cervical dystonia (CD). METHODS Bilateral electromyographic recordings were collected in the upper trapezius muscle in response to transcranial magnetic stimulation of the left and right primary motor cortex in a group with CD (n = 19) and controls (n = 21). cSP threshold, cSP input-output properties at stimulation intensities from 1 to 1.4x the cSP threshold, ipsilateral silent period duration (iSP) and timing and magnitude of the contralateral and ipsilateral motor evoked potential (MEP) were assessed. RESULTS The cSP threshold, input-output properties, and contralateral MEP magnitude were not significantly different between groups (all p > 0.07). Hemispheric symmetry was present in the control group while the CD group had reduced iSP (p < 0.01) and a trend for reduced ipsilateral MEP response (p = 0.053) in the left hemisphere. CONCLUSIONS Recruitment properties of intracortical inhibition are similar between control and CD groups. Transcallosal inhibition is asymmetric between hemispheres in people with CD. SIGNIFICANCE Evidence of normal intracortical inhibition recruitment properties challenge the commonly held view that cortical inhibition is reduced in dystonia.
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Affiliation(s)
- Rebekah L S Summers
- Divisions of Physical Therapy and Rehabilitation Science, Department of Rehabilitation Medicine, School of Medicine, University of Minnesota, 426 Church St. SE, Minneapolis, MN 55455, USA; Department of Neurology, School of Medicine, University of Minnesota, 717 Delaware St. SE, Minneapolis, MN 55414, USA.
| | - Mo Chen
- Divisions of Physical Therapy and Rehabilitation Science, Department of Rehabilitation Medicine, School of Medicine, University of Minnesota, 426 Church St. SE, Minneapolis, MN 55455, USA; Non-invasive Neuromodulation Laboratory, MnDRIVE Initiative, University of Minnesota, 247, 717 Delaware St. SE, Minneapolis, MN 55414, USA
| | - Colum D MacKinnon
- Department of Neurology, School of Medicine, University of Minnesota, 717 Delaware St. SE, Minneapolis, MN 55414, USA
| | - Teresa J Kimberley
- Divisions of Physical Therapy and Rehabilitation Science, Department of Rehabilitation Medicine, School of Medicine, University of Minnesota, 426 Church St. SE, Minneapolis, MN 55455, USA; School of Health and Rehabilitation Sciences, Department of Physical Therapy, Massachusetts General Hospital, Institute of Health Professions, 36 First Ave, Boston, MA 02129, USA
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12
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Khedr EM, Elserogy Y, Fawzy M, Elnoaman M, Galal AM. Global cortical hypoexcitability of the dominant hemisphere in major depressive disorder: A transcranial magnetic stimulation study. Neurophysiol Clin 2020; 50:175-183. [PMID: 32169427 DOI: 10.1016/j.neucli.2020.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 01/07/2020] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Accumulating evidence suggests that major depressive disorders (MDD) are associated with an imbalance of excitation-inhibition within the prefrontal cortex (PFC), generated by a deficit of inhibitory synaptic transmission onto glutamatergic principal neurons. Transcranial magnetic stimulation (TMS) protocols can be used to measure neuronal excitability and GABAergic inhibition and thus provide additional evidence to evaluate this theory. OBJECTIVE In the present study, TMS protocols were used to compare GABAergic function and cortical excitability of dominant hemisphere in unmedicated patients with MDD versus a control group of healthy individuals. METHODS The study included 43 MDD patients according to DSM-V and 20 age- and sex- matched healthy volunteers. Psychological evaluation was conducted using the Beck Depression Inventory (BDI). Resting and active motor thresholds (rMT and aMT) together with contralateral and ipsilateral cortical silent periods (cSP, and iSP) were measured for each participant. RESULTS rMT and aMT were higher in MDD patients compared with the control group, while cSP and iSP were significantly shorter in duration. There were significant positive correlations between the BDI score and rMT, aMT (P=0.001 and 0.002 respectively), and a negative correlation with cSP duration (P=0.001). CONCLUSION Global hypoexcitability of both pyramidal cortical neurons (elevated MTs) and GABAergic controls (shortened SPs) was evidenced within the left/dominant motor cortex in MDD. These results are consistent with previous reports of abnormal glutamate and GABA function in frontal cortex.
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Affiliation(s)
- Eman M Khedr
- Neuropsychiatry Department, Faculty of Medicine, Assiut University Hospital, 71511 Assiut, Egypt.
| | - Yasser Elserogy
- Neuropsychiatry Department, Faculty of Medicine, Assiut University Hospital, 71511 Assiut, Egypt
| | - Mohamed Fawzy
- Neuropsychiatry Department, Faculty of Medicine, Assiut University Hospital, 71511 Assiut, Egypt
| | - Mostafa Elnoaman
- Neuropsychiatry Department, Faculty of Medicine, Assiut University Hospital, 71511 Assiut, Egypt
| | - Amr M Galal
- Neuropsychiatry Department, Faculty of Medicine, Assiut University Hospital, 71511 Assiut, Egypt
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Wehrman JJ, Sowman P. Time in the motor cortex: Motor evoked potentials track foreperiod duration without concurrent movement. Neurosci Lett 2019; 698:85-89. [PMID: 30630059 DOI: 10.1016/j.neulet.2019.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/08/2018] [Revised: 12/30/2018] [Accepted: 01/06/2019] [Indexed: 11/26/2022]
Abstract
Transcranial magnetic stimulation (TMS) allows for the monitoring of motor cortex dynamics in preparation for response. Using this method, it has previously been shown that motor evoked potentials (MEPs) are suppressed as a response approaches. In the current article, we applied TMS while participants either relaxed or contracted their first dorsal interosseous muscle. We varied the time at which TMS was applied, however, unlike previous studies, no participant response was required. Using this method, we provide evidence that MEPs systematically decrease with the duration of the trial, while inhibition is not similarly affected. Further, we found some evidence that MEPs are inversely proportional to the duration of the prior trial. These findings have ramifications for other research interested in the application of TMS, especially when used across multiple possible points in a trial. Further, this finding shows a role for the motor cortex in timing more broadly.
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Affiliation(s)
- Jordan J Wehrman
- Macquarie University Cognitive Science Department, Sydney, Australia.
| | - Paul Sowman
- Macquarie University Cognitive Science Department, Sydney, Australia
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Chaves AR, Kelly LP, Moore CS, Stefanelli M, Ploughman M. Prolonged cortical silent period is related to poor fitness and fatigue, but not tumor necrosis factor, in Multiple Sclerosis. Clin Neurophysiol 2019; 130:474-83. [PMID: 30771724 DOI: 10.1016/j.clinph.2018.12.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/08/2018] [Accepted: 12/21/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Poor fitness among people with Multiple Sclerosis (MS) aggravates disease symptoms. Whether low fitness levels accompany brain functioning changes is unknown. METHODS MS patients (n = 82) completed a graded maximal exercise test, blood was drawn, and transcranial magnetic stimulation determined resting and active motor thresholds, motor evoked potential latency, and cortical silent period (CSP). RESULTS Sixty-two percent of participants had fitness levels ranked below 10th percentile. Fitness was not associated with disability measured using the Expanded Disability Status Scale (EDSS). Regression analyses revealed that, cardiorespiratory fitness, when controlling for disease demographics, contributed 23.7% (p < 0.001) to the model explaining variance in CSP. Regression analysis using cardiorespiratory fitness and CSP as predictors showed that CSP alone explained 19.9% of variance in subjective fatigue (p = 0.002). Tumor necrosis factor was not associated with any variable. CONCLUSION Low fitness was associated with longer CSP in MS. Longer CSP was, in turn, related to greater MS fatigue. SIGNIFICANCE MS patients had extremely low levels of cardiorespiratory fitness. Poor fitness predicted longer CSP, a marker of greater intracortical inhibition, which was linked to MS fatigue. Future research should examine whether aerobic training could shorten CSP and potentially lessen inhibition of cortical networks.
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Abstract
PURPOSE The contribution of gamma-aminobutyric acidergic inhibitory neural circuits in the primary motor cortex, as estimated by the cortical silent period, during weak and strong force output has not been defined. The aim of this study was to investigate whether cortical silent period is modulated with change from weak to strong force control. MATERIALS AND METHODS Eleven healthy right-handed adults participated in this study. With the aid of visual feedback, participants were asked to control the force of abduction of the right index finger to 10%, 20%, 40%, 60%, 80%, and 100% of the maximum voluntary contraction. Single pulse transcranial magnetic stimulation was delivered to the left primary motor cortex region during force control tasks. The averaged actual force output level, background electromyography amplitude, and cortical silent period duration were compared between conditions, and correlation analysis was conducted. RESULTS There were significant main effects of target force on background electromyography, and cortical silent period duration; with increased force, the actual force output level and background electromyography gradually increased, while cortical silent period duration gradually decreased. There were significant negative correlations between cortical silent period and force and cortical silent period and background electromyography. CONCLUSIONS These findings indicate that the excitability of gamma-aminobutyric acidergic inhibitory neural circuits in primary motor cortex decreases in response to increased force output, mediated via increased corticospinal and motoneuron excitability. These results may facilitate understanding of the role of the gamma-aminobutyric acidergic circuit in primary motor cortex in force control, as well as of the mechanism underlying motor dysfunction in stroke-induced palsy, dystonia, and cerebellar ataxia.
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Affiliation(s)
- Akiyoshi Matsugi
- a Faculty of Rehabilitation , Shijonawate Gakuen University , Daitou City , Japan
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16
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Haavik H, Niazi IK, Jochumsen M, Uginčius P, Sebik O, Yılmaz G, Navid MS, Özyurt MG, Türker KS. Chiropractic spinal manipulation alters TMS induced I-wave excitability and shortens the cortical silent period. J Electromyogr Kinesiol 2018; 42:24-35. [PMID: 29936314 DOI: 10.1016/j.jelekin.2018.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/12/2018] [Accepted: 06/14/2018] [Indexed: 12/30/2022] Open
Abstract
The objective of this study was to construct peristimulus time histogram (PSTH) and peristimulus frequencygram (PSF) using single motor unit recordings to further characterize the previously documented immediate sensorimotor effects of spinal manipulation. Single pulse transcranial magnetic stimulation (TMS) via a double cone coil over the tibialis anterior (TA) motor area during weak isometric dorsiflexion of the foot was used on two different days in random order; pre/post spinal manipulation (in eighteen subjects) and pre/post a control (in twelve subjects) condition. TA electromyography (EMG) was recorded with surface and intramuscular fine wire electrodes. Three subjects also received sham double cone coil TMS pre and post a spinal manipulation intervention. From the averaged surface EMG data cortical silent periods (CSP) were constructed and analysed. Twenty-one single motor units were identified for the spinal manipulation intervention and twelve single motor units were identified for the control intervention. Following spinal manipulations there was a shortening of the silent period and an increase in the single unit I-wave amplitude. No changes were observed following the control condition. The results provide evidence that spinal manipulation reduces the TMS-induced cortical silent period and increases low threshold motoneurone excitability in the lower limb muscle. These finding may have important clinical implications as they provide support that spinal manipulation can be used to strengthen muscles. This could be followed up on populations that have reduced muscle strength, such as stroke victims.
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de Paiva JPQ, Magalhães SC, do Prado GF, Eckeli AL, Kaelin-Lang A, Conforto AB. The duration of the cortical silent period is not abnormal in Restless Legs Syndrome/Willis-Ekbom Disease. J Neurol Sci 2017; 375:35-42. [PMID: 28320166 DOI: 10.1016/j.jns.2016.12.066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/28/2016] [Accepted: 12/28/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To compare the duration of the cortical silent period (CSP) measured in a hand muscle in subjects with primary Restless Legs Syndrome (RLS/WED) and controls, using four different methods of analysis. METHODS The CSP to transcranial magnetic stimulation of the dominant motor cortex was assessed in the abductor digiti minimi of 33 subjects with RLS/WED and 24 controls. CSP duration was measured by an automated and three visually-guided methods. RESULTS There were significant differences between absolute values of CSP duration according to the method of analysis. However, irrespectively of the method used for CSP assessment, no differences were found between measurements performed in subjects with RLS/WED and subjects from the control group. CONCLUSIONS Absolute values of CSP durations analyzed by different methods should not be directly compared, because significantly different results can be obtained from the same data set. SIGNIFICANCE The CSP assessed from a hand muscle is unlikely to be a biomarker of primary RLS/WED. Our results highlight the importance of standardizing the definition of CSP onset and offset, as well as of describing in detail the methodology chosen to record and measure CSP duration, in order to enable comparisons between studies.
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Affiliation(s)
- Joselisa Péres Queiroz de Paiva
- Hospital Israelita Albert Einstein, Edifício Josef Féher (Bloco A), 2° subsolo, Av. Albert Einstein, 627/701, São Paulo, SP, Brazil CEP: 05652-900.
| | - Samir Câmara Magalhães
- Hospital Israelita Albert Einstein, Edifício Josef Féher (Bloco A), 2° subsolo, Av. Albert Einstein, 627/701, São Paulo, SP, Brazil CEP: 05652-900.
| | - Gilmar Fernandes do Prado
- Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, Rua Claúdio Rossi, 394, São Paulo, SP, Brazil CEP: 01547-000.
| | - Alan Luiz Eckeli
- Hospital das Clínicas da Faculdade de Medicina, Departamento de Neurociências e Ciências do Comportamento, Divisão de Neurologia, Hospital das Clinicas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil CEP: 14.048-900.
| | - Alain Kaelin-Lang
- Neurocenter of Southern Switzerland, LBN - Laboratory for Biomedical Neurosciences, 6900 Lugano, Switzerland.
| | - Adriana Bastos Conforto
- Hospital Israelita Albert Einstein, Edifício Josef Féher (Bloco A), 2° subsolo, Av. Albert Einstein, 627/701, São Paulo, SP, Brazil CEP: 05652-900; Hospital das Clínicas da Faculdade de Medicina, Departamento de Neurologia e Núcleo de Apoio à Pesquisa em Neurociência Aplicada (NAPNA), Universidade de São Paulo, São Paulo, SP, Brazil CEP: 05403-010.
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Jono Y, Iwata Y, Mizusawa H, Hiraoka K. Change in Excitability of Corticospinal Pathway and GABA-Mediated Inhibitory Circuits of Primary Motor Cortex Induced by Contraction of Adjacent Hand Muscle. Brain Topogr 2016; 29:834-846. [PMID: 27251710 DOI: 10.1007/s10548-016-0499-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 02/28/2016] [Accepted: 05/24/2016] [Indexed: 11/29/2022]
Abstract
The present study examined whether the excitability of the corticospinal pathway and the GABA-mediated inhibitory circuits of the primary motor cortex that project onto the corticospinal neurons in the tonically contracting hand muscle are changed by tonic contraction of the adjacent hand muscle. The motor evoked potential (MEP) and cortical silent period (CSP) in the tonically contracting hand muscle were obtained while the adjacent hand muscle was either tonically contracting or at rest. The MEP and CSP of the first dorsal interosseous (FDI) muscle elicited across the scalp sites where the MEP is predominantly elicited in the FDI muscle were decreased by tonic contraction of the abductor digiti minimi (ADM) muscle. The centers of the area of the MEP and the duration of the CSP in the FDI muscle elicited across the sites where the MEP is predominantly elicited in the FDI muscle were lateral to those in the FDI muscle elicited across the sites where the MEP is elicited in both the FDI and ADM muscles. They were also lateral to those in the ADM muscle elicited either across the sites where the MEP is predominantly elicited in the ADM muscle, or across the sites where the MEP is elicited in both the FDI and ADM muscles. The decrease in the corticospinal excitability and the excitability of the GABA-mediated inhibitory circuits of the primary motor cortex that project onto the corticospinal neurons in the FDI muscle may be due either to (1) the interaction between the activity of the lateral area of the FDI representation and the descending drive to the ADM muscle, or (2) the decreased susceptibility of the primary motor area that predominantly projects onto the corticospinal neurons in the FDI muscle, which also plays a role in independent finger movement when both the FDI and ADM muscles act together as synergists.
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Affiliation(s)
- Yasutomo Jono
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, 3-7-30 Habikino, Habikino, Osaka, 583-8555, Japan
| | - Yasuyuki Iwata
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, 3-7-30 Habikino, Habikino, Osaka, 583-8555, Japan
| | - Hiroki Mizusawa
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, 3-7-30 Habikino, Habikino, Osaka, 583-8555, Japan
| | - Koichi Hiraoka
- College of Health and Human Sciences, Osaka Prefecture University, Habikino, Osaka, Japan.
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Khedr EM, Elbeh KAM, Elserogy Y, Khalifa HE, Ahmed MA, Hafez MH, Ali AM, Elfetoh NA. Motor cortical excitability in obsessive-compulsive disorder: Transcranial magnetic stimulation study. Neurophysiol Clin 2016; 46:135-43. [PMID: 27016878 DOI: 10.1016/j.neucli.2016.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 07/24/2015] [Revised: 01/28/2016] [Accepted: 02/15/2016] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES Transcranial magnetic stimulation is a non-invasive method of stimulating the brain that is increasingly being used in neuropsychiatric research. Previous work has suggested that the pathophysiology of obsessive-compulsive disorder (OCD) may involve dysfunction of excitatory and/or inhibitory brain function. This study aimed to extend those findings. METHODS The study included 45 OCD patients and 15 age- and sex-matched healthy volunteers. Clinical evaluation was conducted using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Hamilton Anxiety Rating Scale (HAM-A), and Clinical Global Impression rating scale (CGI). Physiological measures were resting and active motor thresholds (RMT and AMT), motor evoked potential (MEP) amplitude, cortical silent period (CSP) and transcallosal inhibition (TCI) durations, short-interval intracortical inhibition (SICI), and intracortical facilitation. RESULTS RMT and AMT were significantly lower in patients than in the control group. The mean duration of the CSP and TCI were also significantly shorter. Obsessive trait was associated with significant reduction of TCI duration compared to compulsive trait. There was significant reduction in SICI in OCD patients compared to controls. There were no significant correlations between the Y-BOCS, HAM-A and CGI scores and the cortical excitability parameters. CONCLUSION These results provide further evidence for inhibitory deficits or increased facilitation in cortical circuits of patients with OCD.
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Affiliation(s)
- Eman M Khedr
- Department of neuropsychiatry, faculty of medicine, Assiut university hospital, 71511 Assiut, Egypt.
| | - Khaled A M Elbeh
- Department of neuropsychiatry, faculty of medicine, Assiut university hospital, 71511 Assiut, Egypt
| | - Yasser Elserogy
- Department of neuropsychiatry, faculty of medicine, Assiut university hospital, 71511 Assiut, Egypt
| | - Hossam E Khalifa
- Department of neuropsychiatry, faculty of medicine, Assiut university hospital, 71511 Assiut, Egypt
| | - Mohamed A Ahmed
- Department of neuropsychiatry, faculty of medicine, Assiut university hospital, 71511 Assiut, Egypt
| | - Mahmoud H Hafez
- Department of neuropsychiatry, faculty of medicine, Assiut university hospital, 71511 Assiut, Egypt
| | - Anwar M Ali
- Department of neuropsychiatry, faculty of medicine, Assiut university hospital, 71511 Assiut, Egypt
| | - Noha A Elfetoh
- Department of neuropsychiatry, faculty of medicine, Assiut university hospital, 71511 Assiut, Egypt
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Golaszewski S, Schwenker K, Bergmann J, Brigo F, Christova M, Trinka E, Nardone R. Abnormal short-latency synaptic plasticity in the motor cortex of subjects with Becker muscular dystrophy: a rTMS study. Neurosci Lett 2016; 610:218-22. [PMID: 26562314 DOI: 10.1016/j.neulet.2015.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 11/03/2015] [Accepted: 11/05/2015] [Indexed: 11/28/2022]
Abstract
We used repetitive transcranial magnetic stimulation (rTMS) to further investigate motor cortex excitability in 13 patients with Becker muscular dystrophy (BMD), six of them with slight mental retardation. RTMS delivered at 5Hz frequency and suprathreshold intensity progressively increases the size of motor evoked potentials (MEPs) in healthy subjects; the rTMS-induced facilitation of MEPs was significantly reduced in the BMD patients mentally retarded or classified as borderline when compared with age-matched control subjects and the BMD patients with normal intelligence. The increase in the duration of the cortical silent period was similar in both patient groups and controls. These findings suggest an altered cortical short-term synaptic plasticity in glutamate-dependent excitatory circuits within the motor cortex in BMD patients with intellectual disabilities. RTMS studies may shed new light on the physiological mechanisms of cortical involvement in dystrophinopathies.
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Affiliation(s)
- Stefan Golaszewski
- Department of Neurology and Neuroscience Institute, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria; TMS & fMRI Lab, Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria.
| | - Kerstin Schwenker
- Department of Neurology and Neuroscience Institute, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria; TMS & fMRI Lab, Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Jürgen Bergmann
- Department of Neurology and Neuroscience Institute, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Francesco Brigo
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy; Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Italy
| | - Monica Christova
- Department of Physiology, Medical University of Graz, Graz, Austria
| | - Eugen Trinka
- Department of Neurology and Neuroscience Institute, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Raffaele Nardone
- Department of Neurology and Neuroscience Institute, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria; Department of Neurology, Franz Tappeiner Hospital, Merano, Italy
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Lee JH, Joo EY, Seo DW, Hong SB. Lateralizing Cortical Excitability in Drug Naïve Patients with Generalized or Focal Epilepsy. J Epilepsy Res 2015; 5:75-83. [PMID: 26819939 PMCID: PMC4724855 DOI: 10.14581/jer.15013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 12/10/2015] [Indexed: 11/08/2022] Open
Abstract
Background and Purpose: Numerous transcranial magnetic stimulation (TMS) studies have defined the characteristic features of TMS in epilepsy. TME parameters were expected to classify the epilepsy syndrome or drug responses. However, the results such as cortical silent periods (CSP) are variable according to conditions of patients. Here, we investigate whether specific TMS parameters have localizing or lateralizing values in drug-naïve epilepsy patients. Methods: We recruited 148 consecutive untreated patients with epilepsy (idiopathic generalized epilepsy (IGE) 38, focal epilepsy (FE) 110, mean age 31.4 years) and 38 age- and gender-matched normal subjects. We obtained resting motor threshold (RMT), motor-evoked potential (MEP), CSP, short interval intracortical inhibition (SICI, inter-stimuli interval 2–5 ms), and intracortical facilitation (ICF, inter-stimuli interval 10–20 ms). TMS were performed during a seizure-free state of more than 48 h. Results: In IGE, no interhemispheric difference in CSP was found (p > 0.05). However, the mean CSP was longer in IGE patients than in normal controls at all stimulus intensities (p < 0.05). The mean CSP in ipsilateral hemisphere (IH) of FE was significantly longer at all stimulus intensities than that in normal controls (p < 0.001). The CSP in IH was longer than that in the contralateral hemisphere of FE. There was no significant difference in CSP between FE and IGE. SICI was significantly reduced only in the IH of FE versus normal subjects. RMT, MEP amplitudes, and ICF did not differ among IGE, FE, and normal controls. Conclusions: We found that prolonged CSP and reduced SICI in FE indicate asymmetrically increased cortical inhibition and excitation in the epileptic hemispheres. It suggests that CSP among TMS parameters has a crucial role to lateralize the epileptic hemisphere in FE.
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Affiliation(s)
- Jung Hwa Lee
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine and Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul; Korea; Department of Neurology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Eun Yeon Joo
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine and Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul; Korea
| | - Dae Won Seo
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine and Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul; Korea
| | - Seung Bong Hong
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine and Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul; Korea
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Bradnam L, Shanahan EM, Hendy K, Reed A, Skipworth T, Visser A, Lennon S. Afferent inhibition and cortical silent periods in shoulder primary motor cortex and effect of a suprascapular nerve block in people experiencing chronic shoulder pain. Clin Neurophysiol 2015; 127:769-778. [PMID: 25900020 DOI: 10.1016/j.clinph.2015.03.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 12/18/2014] [Revised: 03/16/2015] [Accepted: 03/23/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To characterise short afferent inhibition (SAI) and the cortical silent period (CSP) in the primary motor cortex representations of the infraspinatus muscle in healthy adults and people experiencing chronic shoulder pain, to determine the impact of a suprascapular nerve block (SSNB). METHODS Neurophysiological measures were obtained in 18 controls and 8 patients with chronic shoulder pain, pre and post SSNB and 1 week later. Pain intensity was assessed by a visual analogue scale. RESULTS SAI was apparent in controls (all P<0.03) and a CSP was observed which reduced in the presence of SAI (all P<0.0001). Compared to controls, shoulder pain patients demonstrated higher active motor threshold (P=0.046), less SAI (P=0.044), a longer CSP (P=0.048) and less modulation of the CSP by SAI (P=0.045). Higher motor thresholds were related to higher pain scores (P=0.009). The SSNB immediately restored SAI (P=0.013), with a positive relationship between increased SAI and reduced pain (P=0.031). The SSNB further reduced modulation of CSP by SAI at 1 week post injection (P=0.006). CONCLUSIONS SAI and the CSP were present and demonstrated robust interaction in controls, which was aberrant in patients. The SSNB transiently restored SAI but had no effect on the CSP; however CSP modulation by SAI was further attenuated 1 week post injection. SIGNIFICANCE The current findings improve understanding of the neurophysiology of the shoulder motor cortex and its modulation by chronic pain. The effect of SSNB in shoulder pain patients should be interpreted with caution until proven in a larger population. Interventions that target intracortical inhibition might increase efficacy in people with chronic shoulder pain.
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Affiliation(s)
- Lynley Bradnam
- Discipline of Physiotherapy, School of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Flinders University, South Australia, Australia; Applied Brain Research Laboratory, Centre for Neuroscience, School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Flinders University, South Australia, Australia.
| | - E Michael Shanahan
- Department of Rheumatology, Repatriation General Hospital, Adelaide, South Australia, Australia; School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Flinders University, South Australia, Australia
| | - Kirsty Hendy
- Discipline of Physiotherapy, School of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Flinders University, South Australia, Australia
| | - Amalia Reed
- Discipline of Physiotherapy, School of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Flinders University, South Australia, Australia
| | - Tegan Skipworth
- Discipline of Physiotherapy, School of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Flinders University, South Australia, Australia
| | - Anri Visser
- Discipline of Physiotherapy, School of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Flinders University, South Australia, Australia
| | - Sheila Lennon
- Discipline of Physiotherapy, School of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Flinders University, South Australia, Australia
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Tang Y, Zhang T, Edelman B, Zeng B, Zhao S, Li C, Zhuo K, Qian Z, Li H, Guo Q, Cui H, Zhu Y, Jiang L, Li C, Yu D, Wang J. Prolonged cortical silent period among drug-naive subjects at ultra-high risk of psychosis. Schizophr Res 2014; 160:124-30. [PMID: 25458861 DOI: 10.1016/j.schres.2014.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 09/09/2014] [Accepted: 10/07/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Deficits in gamma-aminobutyric acid (GABA) inhibitory neurotransmission have been associated with pathophysiological mechanisms underlying schizophrenia. However, little is known about whether these deficits occur before or after the onset of psychosis. METHOD We recruited 16 drug-naive subjects at ultra-high risk of psychosis (UHR), 17 schizophrenia patients and 28 healthy controls. Cortical inhibition was determined using transcranial magnetic stimulation (TMS) over the left primary motor cortex. TMS markers such as short-interval cortical inhibition (SICI), cortical silent period (CSP) and intracortical facilitation (ICF) were obtained from each subject. While SICI can reflect GABA type A (GABAA) mediated inhibition, CSP is thought to indicate GABA type B (GABAB) mediated inhibitory circuits. RESULTS As compared with healthy controls, UHR subjects showed a prolonged CSP with no change in SICI, whereas schizophrenia patients demonstrated both a prolonged CSP and a reduced SICI. No group differences were found for ICF. CSP in schizophrenia patients also had a positive correlation with positive symptom score of the positive and negative symptom scale (PANSS). CONCLUSIONS Cortical inhibitory deficits among UHR subjects were relatively limited compared to those among schizophrenia patients. Alterations might occur in some subgroup of GABA-mediated neurotransmitter systems before the onset of psychosis, while alterations in both GABAA and GABAB networks might contribute to full-blown psychosis.
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Affiliation(s)
- Yingying Tang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China; Department of EEG and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China
| | - Tianhong Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China; Department of EEG and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China
| | - Bradley Edelman
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Botao Zeng
- Department of EEG and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China
| | - Shanshan Zhao
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China
| | - Chunyan Li
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China
| | - Kaiming Zhuo
- Department of EEG and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China
| | - Zhenying Qian
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China
| | - Hui Li
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China
| | - Qian Guo
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China
| | - Huiru Cui
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China
| | - Yikang Zhu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China
| | - Lijuan Jiang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China
| | - Chunbo Li
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China; Department of EEG and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China
| | - Dehua Yu
- Department of Psychiatry, Yangpu Hospital, Medical School of Tongji University, Shanghai 200090, PR China.
| | - Jijun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China; Department of EEG and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China.
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24
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Frank E, Landgrebe M, Poeppl TB, Schecklmann M, Kreuzer PM, Prasser J, Rupprecht R, Eichhammer P, Hajak G, Langguth B. Antipsychotic treatment with quetiapine increases the cortical silent period. Schizophr Res 2014; 156:128-32. [PMID: 24794881 DOI: 10.1016/j.schres.2014.03.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [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: 11/26/2013] [Revised: 02/12/2014] [Accepted: 03/28/2014] [Indexed: 10/25/2022]
Abstract
RATIONALE Measurement of motor cortex excitability with single and paired pulse transcranial magnetic stimulation has become an established method for in vivo characterization of the effects of central-acting drugs. The comparison of drug-free and medicated patients with schizophrenia suggests an association of neuroleptics intake and prolongation of the cortical silent period (CSP). However all available data come from cross-sectional non-randomized studies. Thus it is not clear whether the observed difference is an effect of medication or reflects differences in disease severity or both. OBJECTIVES We aimed to investigate whether the CSP or other parameters of cortical excitability change, when cortical excitability is measured in drug-free patients with acute psychosis before and after 3week intake of the atypical neuroleptic quetiapine. METHODS Different parameters of cortical excitability were studied in 24 drug-free patients with acute psychosis before and after 3weeks of treatment with a mean dose of 352±199mg quetiapine. RESULTS We observed a significant prolongation of the cortical silent period (CSP) after three week treatment with quetiapine. Other parameters of cortical excitability such as motor threshold (MT), short intracortical inhibition (SICI) and intracortical facilitation (ICF) remained unaffected. There was a significant improvement in clinical parameters (PANS, GAF) but no significant correlation between clinical improvement and changes in cortical excitability. CONCLUSIONS These longitudinal data are in line with previous reports from cross-sectional studies. The excitability changes induced by three-week intake of quetiapine in acute psychotic patients confirm the notion that neuroleptic treatment is associated with an increase in CSP.
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Affiliation(s)
- Elmar Frank
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, D-93053 Regensburg, Germany
| | - Michael Landgrebe
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, D-93053 Regensburg, Germany; Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Social Foundation, Bamberg, Bamberg, Germany; Department of Psychiatry, Psychosomatics and Psychotherapy, kbo-Lech-Mangfall-Klinik Agatharied, Germany
| | - Timm B Poeppl
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, D-93053 Regensburg, Germany
| | - Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, D-93053 Regensburg, Germany
| | - Peter M Kreuzer
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, D-93053 Regensburg, Germany
| | - Julia Prasser
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, D-93053 Regensburg, Germany
| | - Rainer Rupprecht
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, D-93053 Regensburg, Germany
| | - Peter Eichhammer
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, D-93053 Regensburg, Germany
| | - Göran Hajak
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, D-93053 Regensburg, Germany; Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Social Foundation, Bamberg, Bamberg, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, D-93053 Regensburg, Germany.
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25
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Mantovani A, Rossi S, Bassi BD, Simpson HB, Fallon BA, Lisanby SH. Modulation of motor cortex excitability in obsessive-compulsive disorder: an exploratory study on the relations of neurophysiology measures with clinical outcome. Psychiatry Res 2013; 210:1026-32. [PMID: 24064461 PMCID: PMC7325264 DOI: 10.1016/j.psychres.2013.08.054] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [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: 01/11/2013] [Revised: 07/03/2013] [Accepted: 08/29/2013] [Indexed: 12/19/2022]
Abstract
Low-frequency repetitive transcranial magnetic stimulation (rTMS) to supplementary motor area (SMA) showed clinical benefit in obsessive-compulsive disorder (OCD). Here we tested whether clinical improvement was associated with enhanced cortical inhibition as measured by single and paired-pulse TMS variables. In 18 OCD patients receiving 4 weeks of either active or sham rTMS in a double-blind randomized trial, we assessed bilateral resting and active motor thresholds (RMT and AMT), cortical silent period (CSP), short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF). We tested correlations between changes in Yale-Brown Obsessive Compulsive Scale-Self-report (Y-BOCS-SR), Clinical Global Impression-Severity subscale (CGI-S) and cortical excitability measures. Active rTMS increased right hemisphere RMT whose change correlated with Y-BOCS-SR improvement. Baseline RMT hemispheric asymmetry, defined as the difference between left and right hemispheres RMT, and its normalization after active rTMS correlated with Y-BOCS-SR and CGI-S improvements. Active rTMS also increased right hemisphere SICI whose change correlated with Y-BOCS-SR and CGI-S at week 4, and with normalization of baseline RMT hemispheric asymmetry. Treatment-induced changes in cortical excitability measures are consistent with an inhibitory action of SMA rTMS on dysfunctional motor circuits in OCD. Correlations of neurophysiology measures with therapeutic outcome are supportive of the role of SMA in the modulation of OCD symptoms.
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Affiliation(s)
- Antonio Mantovani
- Division of Experimental Therapeutics, Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York, NY, USA; Division of Psychiatry, Department of Neuroscience, Siena University, Siena, Italy.
| | - Simone Rossi
- Department of Neurological and Neurosensorial Sciences, Neurology and Clinical Neurophysiology Section, Siena University, Siena, Italy
| | - Bruce D. Bassi
- University of Michigan, Medical School, Ann Arbor, MI, USA
| | - Helen B. Simpson
- Anxiety Disorders Clinic, Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York, NY, USA
| | - Brian A. Fallon
- Anxiety Disorders Clinic, Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York, NY, USA
| | - Sarah H. Lisanby
- Department of Psychiatry & Behavioral Sciences, Duke University, Durham, NC, USA
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26
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Samargia S, Schmidt R, Kimberley TJ. Shortened cortical silent period in adductor spasmodic dysphonia: evidence for widespread cortical excitability. Neurosci Lett 2014; 560:12-5. [PMID: 24333913 DOI: 10.1016/j.neulet.2013.12.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 11/27/2013] [Accepted: 12/04/2013] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to compare cortical inhibition in the hand region of the primary motor cortex between subjects with focal hand dystonia (FHD), adductor spasmodic dysphonia (AdSD), and healthy controls. Data from 28 subjects were analyzed (FHD n=11, 53.25 ± 8.74 y; AdSD: n=8, 56.38 ± 7.5 y; and healthy controls: n=941.67 ± 10.85 y). All subjects received single pulse TMS to the left motor cortex to measure cortical silent period (CSP) in the right first dorsal interosseus (FDI) muscle. Duration of the CSP was measured and compared across groups. A one-way ANCOVA with age as a covariate revealed a significant group effect (p<0.001). Post hoc analysis revealed significantly longer CSP duration in the healthy group vs. AdSD group (p<0.001) and FHD group (p<0.001). These results suggest impaired intracortical inhibition is a neurophysiologic characteristic of FHD and AdSD. In addition, the shortened CSP in AdSD provides evidence to support a widespread decrease in cortical inhibition in areas of the motor cortex that represent an asymptomatic region of the body. These findings may inform future investigations of differential diagnosis as well as alternative treatments for focal dystonias.
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