1
|
Rosenow F, Baier H, Bien C, Bösebeck F, Dümpelmann M, Hamer H, Kellinghaus C, Knake S, Schreiber M, Surges R, Staack A, Tergau F, von Podewils F, Weber Y, Wehner T, Winter Y, Zöllner J, Strzelczyk A, Willems L. P 67 Satisfaction with and reliability of in-hospital video-electroencephalography monitoring systems in epilepsy diagnosis among German epilepsy centers. Clin Neurophysiol 2022. [DOI: 10.1016/j.clinph.2022.01.098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
2
|
Noachtar S, Bast T, Happe S, Lerche H, Pogarell O, Steinhoff B, Tergau F. EEG zum Irreversibilitätsnachweis der klinischen Ausfallssymptome des Gehirns. KLIN NEUROPHYSIOL 2016. [DOI: 10.1055/s-0041-111359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- S. Noachtar
- Klinikum der Universität München – Großhadern, Neurologische Klinik, München
| | - T. Bast
- Epilepsiezentrum Kork, Klinik für Kinder und Jugendliche, Kehl
| | - S. Happe
- Klinik Maria Frieden, Klinik für Neurologie, Telgte
| | - H. Lerche
- Uniklinik Tübingen, Neurologische Klinik, Tübingen
| | - O. Pogarell
- Klinikum der Universität München – Innenstadt, Psychiatrische Klinik, München
| | - B. Steinhoff
- Epilepsiezentrum Kork, Klinik für Erwachsene, Kehl
| | - F. Tergau
- St. Bernward Krankenhaus, Neurologie, Hildesheim
| |
Collapse
|
3
|
Lang N, Rothkegel H, Reiber H, Hasan A, Sueske E, Tergau F, Ehrenreich H, Wuttke W, Paulus W. Circadian Modulation of GABA-Mediated Cortical Inhibition. Cereb Cortex 2011; 21:2299-306. [DOI: 10.1093/cercor/bhr003] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
|
4
|
Heise CA, Wanschura V, Albrecht B, Uebel H, Roessner V, Himpel S, Paulus W, Rothenberger A, Tergau F. Voluntary motor drive: possible reduction in Tourette syndrome. J Neural Transm (Vienna) 2008; 115:857-61. [PMID: 18196201 PMCID: PMC2440945 DOI: 10.1007/s00702-007-0010-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Accepted: 11/15/2007] [Indexed: 11/03/2022]
Abstract
Electrophysiologically, Tourette syndrome (TS) is characterized by shortened cortical silent period (CSP), reflecting decreased motor inhibition. However, voluntary versus involuntary aspects of inhibitory functions in TS are not well understood. Hence, investigating voluntary motor drive (VMD) could help to elucidate this issue. A group of 14 healthy adolescents was compared with subjects of same age suffering from TS with (N = 6) and without (N = 6) presence of distal tics. Basic resting and active motor thresholds (RMT and AMT, respectively) as well as suprathreshold transcranial magnetic stimulation-conditioned RMT and AMT were determined during the CSP. The difference between AMT and RMT was considered as VMD quantum. No group-differences were found in RMT or AMT. Subjects with distal tics showed reduced VMD compared to healthy controls while patients without distal tics did not differ from controls. In the second half of CSP, patients with distal tics showed also diminished VMD compared to tic-patients without distal tics. The findings support the notion, that TS shows possible reduction of VMD and is associated with central motor threshold alterations confined to the very motor networks related to the tics observed.
Collapse
Affiliation(s)
- C A Heise
- Child and Adolescent Psychiatry, University of Göttingen, Göttingen, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Kurth C, Gaida-Hommernick B, Hagemann G, Kerling F, Kowalik A, Tergau F. Stellenwert der niedrig dosierten Topiramat-Monotherapie von Epilepsien im Erwachsenenalter mit fokalen und generalisierten Anfällen. Akt Neurol 2007. [DOI: 10.1055/s-2007-970890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
6
|
Nitsche M, Seeber A, Frommann K, Klein C, Rochford C, Nitsche M, Fricke K, Liebetanz D, Lang N, Antal A, Tergau F, Paulus W. Modulating parameters of excitability during and after transcranial direct current stimulation of the human motor cortex. Clin Neurophysiol 2007. [DOI: 10.1016/j.clinph.2006.11.185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
7
|
Nitsche MA, Doemkes S, Karaköse T, Antal A, Liebetanz D, Lang N, Tergau F, Paulus W. Shaping the Effects of Transcranial Direct Current Stimulation of the Human Motor Cortex. J Neurophysiol 2007; 97:3109-17. [PMID: 17251360 DOI: 10.1152/jn.01312.2006] [Citation(s) in RCA: 519] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Transcranial DC stimulation (tDCS) induces stimulation polarity-dependent neuroplastic excitability shifts in the human brain. Because it accomplishes long-lasting effects and its application is simple, it is used increasingly. However, one drawback is its low focality, caused by 1) the large stimulation electrode and 2) the functionally effective reference electrode, which is also situated on the scalp. We aimed to increase the focality of tDCS, which might improve the interpretation of the functional effects of stimulation because it will restrict its effects to more clearly defined cortical areas. Moreover, it will avoid unwanted reversed effects of tDCS under the reference electrode, which is of special importance in clinical settings, when a homogeneous shift of cortical excitability is needed. Because current density (current strength/electrode size) determines the efficacy of tDCS, increased focality should be accomplished by 1) reducing stimulation electrode size, but keeping current density constant; or 2) increasing reference electrode size under constant current strength. We tested these hypotheses for motor cortex tDCS. The results show that reducing the size of the motor cortex DC-stimulation electrode focalized the respective tDCS-induced excitability changes. Increasing the size of the frontopolar reference electrode rendered stimulation over this cortex functionally inefficient, but did not compromise the tDCS-generated motor cortical excitability shifts. Thus tDCS-generated modulations of cortical excitability can be focused by reducing the size of the stimulation electrode and by increasing the size of the reference electrode. For future applications of tDCS, such paradigms may help to achieve more selective tDCS effects.
Collapse
Affiliation(s)
- M A Nitsche
- Department for Clinical Neurophysiology, Georg-August-University, Goettingen, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
8
|
Hasan A, Reiber H, Sueske E, Wuttke W, Ehrenreich H, Tergau F, Paulus W, Lang N. Hormonelle Untersuchungen zu zirkadianen Veränderungen der Exzitabilität des menschlichen Motorkortex. KLIN NEUROPHYSIOL 2007. [DOI: 10.1055/s-2007-976424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
9
|
Nitsche MA, Dömkes S, Karaköse T, Antal A, Liebetanz D, Lang N, Tergau F, Paulus W. Möglichkeiten der Fokussierung der Effekte der transkraniellen Gleichstromstimulation. KLIN NEUROPHYSIOL 2007. [DOI: 10.1055/s-2007-976472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
10
|
Nitsche MA, Roth A, Kuo MF, Fischer AK, Antal A, Liebetanz D, Lang N, Tergau F, Paulus W. Modulation of associative plasticity by general network excitability in the human motor cortex. Akt Neurol 2007. [DOI: 10.1055/s-2007-987444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
11
|
Nitsche M, Lampe C, Antal A, Liebetanz D, Lang N, Tergau F, Paulus W. Dopaminergic modulation of long-lasting direct current-induced cortical excitability changes in the human motor cortex. Akt Neurol 2006. [DOI: 10.1055/s-2006-952984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
12
|
Henning S, Tings T, Schmidt H, Tergau F, Wolf S, Scholz K, Knauth M, Buchner H, Gold R, Paulus W. A case of cerebral Whipple's disease initially presenting with isolated focal myoclonus. Eur J Neurol 2006; 13:659-61. [PMID: 16796592 DOI: 10.1111/j.1468-1331.2006.01396.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Neurological manifestations in Whipple's disease are highly variable and tend to occur at later stages of the disease. However, isolated, focal neurological symptoms are reported to be rare. Here we describe the successful treatment of a case of cerebral Whipple's disease initially presenting solely with isolated myoclonic jerks of the left hand and forearm evolving to a segmental myoclonus at a later stage. Additionally, we present - to our knowledge - a novel treatment by administration of immunomodulatory therapy (IVIg) in addition to established antibiotics.
Collapse
Affiliation(s)
- S Henning
- Department of Clinical Neurophysiology, Georg-August University, Göttingen, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Lang N, Reiber H, Ehrenreich H, Wuttke W, Tergau F, Paulus W. P37.15 Circadian changes in human motor cortex inhibition. Clin Neurophysiol 2006. [DOI: 10.1016/j.clinph.2006.06.669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
14
|
Nitsche MA, Seeber A, Frommann K, Klein C, Rochford C, Nitsche MS, Fricke K, Liebetanz D, Lang N, Antal A, Tergau F, Paulus W. Modulating parameters of excitability during and after transcranial direct current stimulation of the human motor cortex. KLIN NEUROPHYSIOL 2006. [DOI: 10.1055/s-2006-939247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
15
|
Nitsche M, Liebetanz D, Paulus W, Tergau F. Pharmacological Characterisation and Modulation of Neuroplasticity in Humans. Curr Neuropharmacol 2005. [DOI: 10.2174/1570159054368268] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
16
|
Nitsche MA, Grundey J, Jaussi W, Liebetanz D, Lang N, Tergau F, Paulus W. Pharmacological Consolidation of Motor Cortical Neuroplasticity in Humans. KLIN NEUROPHYSIOL 2004. [DOI: 10.1055/s-2004-832111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
17
|
Nitsche MA, Antal A, Liebetanz D, Lang N, Tergau F, Paulus W. Erzeugung und Modulation von Neuroplastizität durch transkranielle Gleichstromstimulation beim Menschen. KLIN NEUROPHYSIOL 2004. [DOI: 10.1055/s-2003-814948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
18
|
Sommer M, Lang N, Tings T, Tergau F, Paulus W. Corticospinal inhibition evoked by 1Hz repetitive transcranial magnetic stimulation depends on current direction and pulse waveform. Akt Neurol 2004. [DOI: 10.1055/s-2004-833054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
19
|
Tings T, Lang N, Tergau F, Paulus W, Sommer M. Corticospinal facilitation during 5Hz repetitive transcranial magnetic stimulation depends on current direction and pulse waveform. Akt Neurol 2004. [DOI: 10.1055/s-2004-833055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
20
|
Nitsche MA, Grundey J, Liebetanz D, Lang N, Tergau F, Paulus W. Catecholaminergic consolidation of motor cortical neuroplasticity in humans. Akt Neurol 2004. [DOI: 10.1055/s-2004-833022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
21
|
Nitsche MA, Fricke K, Henschke U, Schlitterlau A, Liebetanz D, Lang N, Henning S, Tergau F, Paulus W. Pharmacological modulation of cortical excitability shifts induced by transcranial direct current stimulation in humans. J Physiol 2003; 553:293-301. [PMID: 12949224 PMCID: PMC2343495 DOI: 10.1113/jphysiol.2003.049916] [Citation(s) in RCA: 1020] [Impact Index Per Article: 48.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) of the human motor cortex results in polarity-specific shifts of cortical excitability during and after stimulation. Anodal tDCS enhances and cathodal stimulation reduces excitability. Animal experiments have demonstrated that the effect of anodal tDCS is caused by neuronal depolarisation, while cathodal tDCS hyperpolarises cortical neurones. However, not much is known about the ion channels and receptors involved in these effects. Thus, the impact of the sodium channel blocker carbamazepine, the calcium channel blocker flunarizine and the NMDA receptor antagonist dextromethorphane on tDCS-elicited motor cortical excitability changes of healthy human subjects were tested. tDCS-protocols inducing excitability alterations (1) only during tDCS and (2) eliciting long-lasting after-effects were applied after drug administration. Carbamazepine selectively eliminated the excitability enhancement induced by anodal stimulation during and after tDCS. Flunarizine resulted in similar changes. Antagonising NMDA receptors did not alter current-generated excitability changes during a short stimulation, which elicits no after-effects, but prevented the induction of long-lasting after-effects independent of their direction. These results suggest that, like in other animals, cortical excitability shifts induced during tDCS in humans also depend on membrane polarisation, thus modulating the conductance of sodium and calcium channels. Moreover, they suggest that the after-effects may be NMDA receptor dependent. Since NMDA receptors are involved in neuroplastic changes, the results suggest a possible application of tDCS in the modulation or induction of these processes in a clinical setting. The selective elimination of tDCS-driven excitability enhancements by carbamazepine proposes a role for this drug in focussing the effects of cathodal tDCS, which may have important future clinical applications.
Collapse
Affiliation(s)
- M A Nitsche
- Department of Clinical Neurophysiology, Georg-August-University, Goettingen, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Nitsche M, Schauenburg A, Exner C, Lang N, Tergau F, Paulus W. Transkranielle Gleichstromstimulation des motorischen Kortex verbessert implizites motorisches Lernen. KLIN NEUROPHYSIOL 2003. [DOI: 10.1055/s-2003-816500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
23
|
Kellinghaus C, Loddenkemper T, Möddel G, Tergau F, Lüders J, Lüdemann P, Nair DR, Lüders HO. [Electric brain stimulation for epilepsy therapy]. Nervenarzt 2003; 74:664-76. [PMID: 12904868 DOI: 10.1007/s00115-003-1541-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Attempts to control epileptic seizures by electrical brain stimulation have been performed for 50 years. Many different stimulation targets and methods have been investigated. Vagal nerve stimulation (VNS) is now approved for the treatment of refractory epilepsies by several governmental authorities in Europe and North America. However, it is mainly used as a palliative method when patients do not respond to medical treatment and epilepsy surgery is not possible. Numerous studies of the effect of deep brain stimulation (DBS) on epileptic seizures have been performed and almost invariably report remarkable success. However, a limited number of controlled studies failed to show a significant effect. Repetitive transcranial magnetic stimulation (rTMS) also was effective in open studies, and controlled studies are now being carried out. In addition, several uncontrolled reports describe successful treatment of refractory status epilepticus with electroconvulsive therapy (ECT). In summary, with the targets and stimulation parameters investigated so far, the effects of electrical brain stimulation on seizure frequency have been moderate at best. In the animal laboratory, we are now testing high-intensity, low-frequency stimulation of white matter tracts directly connected to the epileptogenic zone (e.g., fornix, corpus callosum) as a new methodology to increase the efficacy of DBS ("overdrive method").
Collapse
Affiliation(s)
- C Kellinghaus
- Department of Neurology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA.
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Stiasny-Kolster K, Haeske H, Tergau F, Müller HH, Braune HJ, Oertel WH. Chapter 38 Cortical silent period is shortened in restless legs syndrome independently from circadian rhythm. Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation, Proceedings of the 2nd International Transcranial Magnetic Stimulation (TMS) and Transcranial Direct Current Stimulation (tDCS) Symposium 2003; 56:381-9. [PMID: 14677414 DOI: 10.1016/s1567-424x(09)70241-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- K Stiasny-Kolster
- Department of Neurology, Center of Nervous Diseases, Philipps-University of Marburg, Rudolf-Bultmann-Strasse 8, D-35033 Marburg, Germany.
| | | | | | | | | | | |
Collapse
|
25
|
Abstract
Modulation of cerebral excitability is thought to be one mechanism underlying the pharmacological treatment of neuropsychiatric diseases such as epilepsy, depression, and dystonia. Repetitive transcranial magnetic stimulation (rTMS) has been tested for several years as a nonpharmacological, noninvasive method of directly influencing patients' cortical functions. We present an overview of the more easily performed transcranial direct current stimulation (tDCS) with weak current, which produces distinctly more pronounced changes in excitability than rTMS. The basic underlying mechanism is a shift in the resting membrane potential towards either hyper- or depolarisation, depending on stimulation polarity. This in turn leads to changes in the excitability of cortical neurons. Anodic stimulation increases cortical excitability, while cathodic stimulation decreases it. These changes persist after the end of stimulation if the stimulation lasts long enough, i.e., at least several minutes. The duration of this aftereffect can be controlled through the duration and intensity of the stimulation. Transcranial direct current stimulation essentially allows a focal, selective, reversible, pain-free, and noninvasive induction of changes in cortical excitability, the therapeutic potential of which must be evaluated in clinical studies, once possible risk factors have been assessed.
Collapse
Affiliation(s)
- M A Nitsche
- Abteilung Klinische Neurophysiolgie, Georg-August-Universität Göttingen.
| | | | | | | |
Collapse
|
26
|
Abstract
OBJECTIVES Repetitive transcranial magnetic stimulation (rTMS) can modify cortical excitability and is widely used for clinical and research purposes. We sought to determine the intra- and interindividual variability of its effects on motor cortex excitability, and whether repeated paired-pulses yield less variability than repeated single-pulses. METHODS We investigated rTMS over the left motor cortex of 6 healthy subjects and recorded motor evoked potentials (MEPs) from the right abductor digiti minimi muscle. Eighty single suprathreshold stimuli or conditioning-test pairs of stimuli were delivered at 2Hz frequency. The pairs consisted of a subthreshold pulse followed by a suprathreshold pulse after 2, 5 or 10ms. In each subject we studied all types of rTMS 5 times on separate days. Single suprathreshold pulses at 0.17Hz preceded rTMS for baseline determination. RESULTS The day-to-day variability of MEPs during either type of rTMS was small compared to the subject-to-subject variability. MEPs increased during all types of rTMS except for interstimulus interval (ISI) 2ms. Paired-pulses yielded less variability than single-pulse rTMS. CONCLUSIONS Motor responses to rTMS show a high interindividual, but a low intraindividual variability. Repeated paired-pulses yield less variability than repeated single-pulses.
Collapse
Affiliation(s)
- M Sommer
- Department of Clinical Neurophysiology, University of Goettingen, P.O. Box 3742, D-37070, Goettingen, Germany
| | | | | | | |
Collapse
|
27
|
Baudewig J, Siebner HR, Bestmann S, Tergau F, Tings T, Paulus W, Frahm J. Functional MRI of cortical activations induced by transcranial magnetic stimulation (TMS). Neuroreport 2001; 12:3543-8. [PMID: 11733708 DOI: 10.1097/00001756-200111160-00034] [Citation(s) in RCA: 145] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The effects of repetitive transcranial magnetic stimulation (rTMS) on human brain activity and associated hemodynamics were investigated by blood-oxygenation-level-dependent (BOLD) MRI using echo-planar imaging at 2.0 T. Apart from bilateral activation of the auditory cortex by the audible rTMS discharges (23 bursts, 1 s duration, 10 Hz, 10-20 s interstimulus intervals), BOLD responses were restricted to cortical representations of actual finger movements performed either voluntarily or evoked by suprathreshold rTMS of the motor cortex. Neither subthreshold rTMS of the motor cortex nor suprathreshold rTMS of the lateral premotor cortex induced a detectable BOLD response. These findings suggest that neuronal depolarization as induced by rTMS modulates the spiking output of a brain area but does not automatically alter cerebral blood flow and oxygenation. The observation of BOLD MRI activations probably reflects the afferent intracortical processing of real movements.
Collapse
Affiliation(s)
- J Baudewig
- Biomedizinische NMR Forschungs GmbH am Max-Planck-Institut für biophysikalische Chemie, 37070 Göttingen, Germany
| | | | | | | | | | | | | |
Collapse
|
28
|
Abstract
In nine healthy humans we modulated corticospinal excitability by using conditioning-test paired-pulse transcranial magnetic stimulation in a repetitive mode (rTMS), and we compared its effect to conventional single-pulse rTMS. We applied 80 single pulses or 80 paired pulses to the motor cortex at frequencies ranging from 0.17 to 5 Hz. The conditioning-test intervals were 2, 5, or 10 ms. Motor evoked potential (MEP) amplitudes from the abductor digiti minimi (ADM) as target muscle and extensor carpi radialis (ECR) indicated the excitability changes during and after rTMS. During paired-pulse rTMS at a facilitatory conditioning-test interval of 10 ms, we observed a facilitation of MEPs at 1, 2, and 5 Hz. A similar facilitation was found during single-pulse rTMS, when stimulus intensity was adjusted to evoke MEPs of comparable size. Using an inhibitory conditioning-test interval of 2 ms, paired-pulse rTMS at frequencies of 1 and 2 Hz caused no change in MEP size during the train. However, paired-pulse rTMS at 5 Hz caused a strong enhancement of MEP size, indicating a loss of paired-pulse inhibition during the rTMS train. Since no facilitatory effect was observed during single-pulse rTMS with an adjusted stimulus intensity, the MEP enhancement during 5 Hz rTMS was specific for "inhibitory" paired-pulse rTMS. After 5 Hz rTMS MEPs were facilitated for 1 min, and this effect was not substantially different between paired-pulse rTMS and single-pulse rTMS. The correlation between ADM and ECR was most pronounced at 5 Hz rTMS. We conclude that paired-pulse rTMS is a suitable tool to study changes in corticospinal excitability during the course of rTMS. In addition, our data suggest that short trains of paired-pulse rTMS are not superior to single-pulse rTMS in inducing lasting inhibition or facilitation.
Collapse
Affiliation(s)
- M Sommer
- Department of Clinical Neurophysiology, University of Göttingen, Germany.
| | | | | | | |
Collapse
|
29
|
Abstract
An open pilot study with the dopamine agonist alpha-dihydroergocryptine (DHEC) was conducted in 16 patients with idiopathic restless legs syndrome (RLS) over a period of 5 weeks. Following a drug-free interval of 1 week, the patients were treated with daily doses of 10 to 40 mg DHEC. As compared to baseline values, treatment led to a statistically significant reduction of subjective RLS symptoms. Overall complaints at night decreased significantly by 63.9 +/- 38.1% as measured by a visual analogue scale. Detailed evaluation of sensory discomfort, motor restlessness, involuntary movements, as well as sleep quality also showed significant improvement. Side effects were mostly mild and affected mainly the gastrointestinal tract. Five patients needed domperidone for treatment of concomitant nausea. One patient stopped the study due to nausea. In conclusion, the results of this open study suggest a role for DHEC in the treatment of RLS.
Collapse
Affiliation(s)
- F Tergau
- Department of Clinical Neurophysiology, Georg-August University Göttingen, Germany
| | | | | | | |
Collapse
|
30
|
Abstract
Repetitive transcranial magnetic stimulation (rTMS) has been introduced as a new antidepressive treatment strategy. The mode of action by which the antidepressive effect is brought about is not yet clear. Other antidepressive treatment strategies such as sleep deprivation are associated with an increase of plasma thyroid-stimulating hormone (TSH) levels that correlate with clinical improvement. In the present study, the effect of left prefrontal suprathreshold (120% of motor threshold) rTMS on TSH plasma levels of 19 healthy male subjects was investigated in comparison with subthreshold (80% of motor threshold) and sham stimulation. Suprathreshold rTMS was followed by a significant relative increase of TSH levels 10 and 60 minutes after stimulation in comparison with subthreshold and sham stimulation. The more pronounced effect of suprathreshold rTMS on TSH plasma levels might be important for the determination of optimal stimulation parameters in the treatment of depressed patients.
Collapse
Affiliation(s)
- S Cohrs
- Department of Psychiatry and Psychotherapy, Georg-August University, Göttingen, Germany
| | | | | | | | | |
Collapse
|
31
|
Abstract
OBJECTIVE To investigate by means of transcranial magnetic stimulation (TMS) the effect of a single oral dose of the GABA derivate piracetam on intracortical facilitatory I-wave interaction. METHODS The study was performed in 8 healthy volunteers. Before, 1, 3, 6, and 24 h after intake of 4000 mg piracetam, MEPs in the relaxed abductor digiti minimi muscle were elicited by a recently introduced double pulse TMS technique with a suprathreshold first and a subthreshold second stimulus. From interstimulus intervals of 0.5-5.1 ms 3 periods were observed in which MEP facilitation showed maxima - so-called peaks of I-wave interaction - and which were separated by two troughs with no facilitation. We studied the changes in timing and size of the peaks over time. RESULTS With piracetam, I-wave peaks showed a reduction in size as well as a shortening of the latencies at which the peaks occurred. Both changes were significant at 6 h after drug intake compared to baseline. The effects were partially reversible after 24 h. CONCLUSIONS The mode of action of piracetam within the nervous system is almost unknown. The peak size reduction was similar to effects that were seen under GABAergic drugs, although GABAergic properties of piracetam have not been observed so far. Shortening of the I-wave peak latencies is a new phenomenon. The results are discussed on the basis of the known therapeutic effects of piracetam in cortical myoclonus and as nootropic agent.
Collapse
Affiliation(s)
- S Wischer
- Department of Clinical Neurophysiology, University of Goettingen, Robert-Koch-Strasse 40, D-37075, Goettingen, Germany
| | | | | | | |
Collapse
|
32
|
Rosenkranz K, Nitsche MA, Tergau F, Paulus W. Diminution of training-induced transient motor cortex plasticity by weak transcranial direct current stimulation in the human. Neurosci Lett 2000; 296:61-3. [PMID: 11099834 DOI: 10.1016/s0304-3940(00)01621-9] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Training of a thumb movement in the opposite direction of a twitch in response to transcranial magnetic stimulation (TMS) induces a transient directional change of post-training TMS-evoked movements towards the trained direction. Functional synaptic mechanisms seem to underlie this rapid training-induced plasticity. Transcranial direct current stimulation (tDCS) induces outlasting changes of cerebral excitability, thus presenting as promising tool for neuroplasticity research. We studied the influence of tDCS, applied over the motorcortex during training, on angular deviation of post-training to pre-training TMS-evoked thumb movements. With tDCS of anodal and cathodal polarity the training-induced directional change of thumb movements was significantly reduced during a 10 min post-training interval, indicating an interference of tDCS with mechanisms of rapid training-induced plasticity.
Collapse
Affiliation(s)
- K Rosenkranz
- Department of Clinical Neurophysiology, University of Goettingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
| | | | | | | |
Collapse
|
33
|
Abstract
PURPOSE Besides peripheral mechanisms, central fatigue is an important factor limiting the performance of exhausting exercise in sport. The mechanisms responsible are still in discussion. Using noninvasive transcranial magnetic stimulation (TMS) in a double-pulse technique, we sought to assess fatigue of the motor cortex after exhaustive anaerobic strain. METHODS 23 male subjects (22-52 yr) taking part in the study were requested to accomplish as many pull-ups as possible until exhaustion. The amount of physical lifting work was recorded. Before and immediately after the task, intracortical inhibition (ICI) and facilitation (ICF) were measured by a conditioned-test double-pulse TMS method for the right brachioradialis (BR) and abductor pollicis brevis muscle (APB). RESULTS After exercise, ICF was significantly reduced in the BR but not in the APB. ICI was not altered. Changes tended to normalize within 8 min after the task. The amount of lifting work accomplished showed significant correlation to the values of ICF reduction (r = 0.73). Moreover, the baseline values of ICF before exercise were also significantly correlated to the lifting work (r = 0.63). CONCLUSIONS Because double-pulse TMS gives access to the motor cortex independently of spinal or peripheral mechanisms, reduced ICF reflects decreased excitability of interneuronal circuits within the motor cortex. We suggest that ICF measures motor cortex fatigue after exhausting strain specifically for the muscles performing the task. Gamma-aminobutyric acid (GABA)-ergic neurotransmission is possibly involved in the mechanisms mediating central fatigue. Double-pulse TMS may be a useful tool in the control of training in sports as well as in the detection of pathological central fatigue in overreaching and in the prevention of overtraining.
Collapse
Affiliation(s)
- F Tergau
- Department of Clinical Neurophysiology, University of Göttingen, Germany.
| | | | | | | | | | | |
Collapse
|
34
|
Abstract
OBJECTIVES To study the time course of the changes of the inhibitory network of the human motor system, we investigated the silent period (SP) in 7 healthy subjects by double suprathreshold transcranial magnetic stimulation (TMS). METHODS SPs and motor evoked potentials (MEPs) were recorded from the voluntarily activated right abductor digiti minimi muscle. Conditioning and test stimuli were delivered with equal intensity, which was set to yield a baseline SP duration of 130 ms by a single pulse, and with various interstimulus intervals (ISIs). In addition, a control experiment with adjustment of the intensity of single stimuli was performed. RESULTS At ISIs of 20 and 30 ms the test pulse SP duration was prolonged, without increasing the MEP amplitude. The SP duration shortened at longer ISIs and showed a significant depression between ISIs of 60-110 ms. The shortened SP was accompanied by a diminished MEP. The control experiment revealed that the SPs evoked by the adjusted pulses were significantly shorter than the test pulse SPs. CONCLUSIONS A conditioning stimulus can prolong and shorten the test pulse SP duration at different ISIs. The prolongation is probably cortically generated, whereas the shortening is likely to occur at a cortical and spinal level.
Collapse
Affiliation(s)
- T Wu
- Department of Clinical Neurophysiology, Georg August University, Robert-Koch-Street 40, D-37075, Göttingen, Germany
| | | | | | | |
Collapse
|
35
|
Abstract
We studied the effects of a train of 30 pulses of repetitive transcranial magnetic stimulation (rTMS) at frequencies of 5 and 15 Hz and at an intensity of 120% of resting motor threshold on human motor cortex excitability. Intracortical inhibition (ICI) and intracortical facilitation (ICF) after rTMS were tested by a conditioning-test designed paired-pulse paradigm. After 15 Hz rTMS, ICI was significantly reduced for 3.2 min, ICF was enhanced for 1.5 min, muscle evoked potentials from single TMS were increased in the first 30 s only. After 5 Hz rTMS ICI was significantly reduced in the first 32 s. We conclude that high-frequency suprathreshold rTMS transiently suppresses the activity of the intracortical inhibitory circuitry and, with a different time course, increases the excitability of the excitatory circuitry.
Collapse
Affiliation(s)
- T Wu
- Department of Clinical Neurophysiology, Georg August University, Robert-Koch-Strasse 40, D-37077, Göttingen, Germany
| | | | | | | |
Collapse
|
36
|
Moll GH, Heinrich H, Wischer S, Tergau F, Paulus W, Rothenberger A. Motor system excitability in healthy children: developmental aspects from transcranial magnetic stimulation. Electroencephalogr Clin Neurophysiol Suppl 1999; 51:243-9. [PMID: 10590956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Affiliation(s)
- G H Moll
- University of Göttingen, Germany
| | | | | | | | | | | |
Collapse
|
37
|
Hajak G, Cohrs S, Tergau F, Ziemann U, Paulus W, Rüther E. Sleep and rTMS. Investigating the link between transcranial magnetic stimulation, sleep, and depression. Electroencephalogr Clin Neurophysiol Suppl 1999; 51:315-21. [PMID: 10590965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Affiliation(s)
- G Hajak
- Department of Psychiatry, Georg-August University, Göttingen, Germany
| | | | | | | | | | | |
Collapse
|
38
|
Paulus W, Korinth S, Wischer S, Tergau F. Differentiation of parvo- and magnocellular pathways by TMS at the occipital cortex. Electroencephalogr Clin Neurophysiol Suppl 1999; 51:351-60. [PMID: 10590968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Affiliation(s)
- W Paulus
- Department of Clinical Neurophysiology, University of Göttingen, Germany
| | | | | | | |
Collapse
|
39
|
Sommer M, Tergau F, Wischer S, Reimers CD, Beuche W, Paulus W. Riluzole does not have an acute effect on motor thresholds and the intracortical excitability in amyotrophic lateral sclerosis. J Neurol 1999; 246 Suppl 3:III22-6. [PMID: 10631657 DOI: 10.1007/bf03161086] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Intracortical excitability in amyotrophic lateral sclerosis (ALS) is impaired. The effectiveness of the glutamate antagonist riluzole (Rilutek, Rhône-Poulenc Rorer) in ALS has been shown in clinical studies. In healthy subjects it modifies intracortical excitability in a frequently used double-stimulus paradigm of transcranial magnetic stimulation (TMS). Under riluzole intracortical inhibition is enhanced in healthy individuals, although not always significantly, whereas intracortical facilitation has been described as reduced [10, 11]. We wanted to find out whether riluzole affects and potentially rebalances impaired intracortical excitability in ALS. We, therefore, enrolled 13 patients with clinically and electromyographically confirmed ALS into this study. Five patients had to be excluded because motor thresholds were too high to get reliable motor evoked potentials (MEPs). In the remaining 8 patients, mean age was 59.9 +/- 11.9 years (+/- standard deviation) and mean symptom duration 9.6 +/- 2.5 months. Intracortical excitability was assessed before and 1.5 hours after the first intake of a loading dose of 100 mg of riluzole using a conventional paired-pulse TMS paradigm with interstimulus intervals (ISI) ranging from 1-30 ms and intensities adjusted to yield MEPs of 1.0 mV for test pulses and of 90% active motor threshold for conditioning pulses. Patients' baseline results were compared to those of 9 age-matched, healthy control subjects. Before drug intake, motor thresholds did not differ between groups, but there was significantly less intracortical inhibition in the ALS patient group. Riluzole intake did not significantly alter motor thresholds or intracortical excitability in the ALS patients. We conclude that riluzole does not immediately influence intracortical excitability in ALS. Our results are in contrast to the findings of Stefan et al (1998) [14] where a partial normalization of intracortical inhibition in ALS was observed after at least 5 days of drug intake. The difference between that study and our result may indicate a delayed onset of riluzole's influence on intracortical excitability.
Collapse
Affiliation(s)
- M Sommer
- Department of Clinical Neurophysiology, University of Goettingen, Germany
| | | | | | | | | | | |
Collapse
|
40
|
Moll GH, Wischer S, Heinrich H, Tergau F, Paulus W, Rothenberger A. Deficient motor control in children with tic disorder: evidence from transcranial magnetic stimulation. Neurosci Lett 1999; 272:37-40. [PMID: 10507537 DOI: 10.1016/s0304-3940(99)00575-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Decreased motor inhibition was reported in adult patients with tic disorder (TD) using the technique of transcranial magnetic stimulation. Since tics usually begin during childhood, motor threshold, cortical silent period (CSP) and intracortical inhibition/facilitation were measured in 21 TD children and 25 healthy children aged 10-16 years. In TD children motor threshold was normal. The CSP was significantly shortened compared to healthy controls but did not depend on tic localization. Intracortical inhibition and facilitation did not differ between the two groups. This study confirms that the finding of decreased motor control in adult patients also holds true for children wherever the tics in the latter group were located.
Collapse
Affiliation(s)
- G H Moll
- Child and Adolescent Psychiatry, University of Göttingen, Germany
| | | | | | | | | | | |
Collapse
|
41
|
|
42
|
Paulus W, Korinth S, Wischer S, Tergau F. Differential inhibition of chromatic and achromatic perception by transcranial magnetic stimulation of the human visual cortex. Neuroreport 1999; 10:1245-8. [PMID: 10363933 DOI: 10.1097/00001756-199904260-00017] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The magnocellular visual pathway is devoted to low-contrast achromatic and motion perception whereas the parvocellular pathway deals with chromatic and high resolution spatial vision. To specifically separate perception mediated by these pathways we have used low-contrast Gaussian filtered black-white or coloured visual stimuli. By use of transcranial magnetic stimulation (TMS) over the visual cortex inhibition of magnocellular stimuli was achieved distinctly earlier by about 40 ms compared with parvocellular information. A nonspecific inhibition of all stimuli could be seen peaking at 75-90 ms, significantly higher for magnocellular stimuli. The particular vulnerability of magnocellular stimuli to TMS is correlated with distinct physiological properties of this pathway such as faster conduction velocity and non-linear stimulus encoding.
Collapse
Affiliation(s)
- W Paulus
- Department of Clinical Neurophysiology, University of Göttingen, Germany
| | | | | | | |
Collapse
|
43
|
Abstract
In 18 patients with idiopathic restless legs syndrome (RLS), intracortical inhibition by paired transcranial magnetic stimulation (TMS) was significantly reduced for both foot and hand muscles, suggesting that the entire motor cortex is disinhibited in RLS. Decreased intracortical facilitation in the foot muscle but not in the hand muscle may be due to subliminal activation of the symptomatic lower limbs. Motor excitability measurements of single TMS were not altered. These results support a subcortical origin of RLS.
Collapse
Affiliation(s)
- F Tergau
- Department of Clinical Neurophysiology, University of Göttingen, Germany
| | | | | |
Collapse
|
44
|
Tergau F, Wanschura V, Canelo M, Wischer S, Wassermann EM, Ziemann U, Paulus W. Complete suppression of voluntary motor drive during the silent period after transcranial magnetic stimulation. Exp Brain Res 1999; 124:447-54. [PMID: 10090656 DOI: 10.1007/s002210050640] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
To evaluate changes in the motor system during the silent period (SP) induced by transcranial magnetic stimulation (TMS) of the motor cortex, we investigated motor thresholds as parameters of the excitability of the cortico-muscular pathway after a suprathreshold conditioning stimulus in the abductor digiti minimi muscle (ADM) of normal humans. Since the unconditioned motor threshold was lower during voluntary tonic contraction than at rest (31.9+/-5.4% vs. 45.6+/-7.5%), it is suggested that the difference between active and resting motor threshold indicates the magnitude of the voluntary drive on the cortico-muscular pathway. Therefore, we compared conditioned resting and active motor threshold (cRMT and cAMT) during the SP. cRMT showed an intensity-dependent period of elevation of more than 200 ms in duration and approximately 17% of the maximum stimulator output above the unconditioned threshold, due to decreased excitability of the cortico-muscular pathway after the conditioning stimulus. Some 3040 ms after the conditioning stimulus, cAMT approximated cRMT, indicating complete suppression of the voluntary motor drive. This suppression did not start directly after the conditioning stimulus since cAMT was still significantly lower than the cRMT within the first 30-40 ms. Threshold elevation was significantly longer than the SP (220+/-41 vs. 151+/-28 ms). Recovery of the voluntary motor drive started late in the SP and was nearly complete at the end of the SP, although thresholds were still significantly elevated. We conclude that the SP is largely due to a suppression of voluntary motor drive, while the threshold elevation is a different inhibitory phenomenon that is of less importance for the generation of the SP, at least in its late part. It is argued that the pathway of fast cortico-spinal fibers activated by TMS is partially different from the pathway involved in the maintenance of tonic voluntary muscle activation.
Collapse
Affiliation(s)
- F Tergau
- Department of Clinical Neurophysiology, University of Göttingen, Germany.
| | | | | | | | | | | | | |
Collapse
|
45
|
Tergau F, Wassermann EM, Paulus W, Ziemann U. Lack of clinical improvement in patients with Parkinson's disease after low and high frequency repetitive transcranial magnetic stimulation. Electroencephalogr Clin Neurophysiol Suppl 1999; 51:281-8. [PMID: 10590961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Affiliation(s)
- F Tergau
- Department of Clinical Neurophysiology, University of Göttingen, Germany
| | | | | | | |
Collapse
|
46
|
Ziemann U, Winter M, Reimers CD, Reimers K, Tergau F, Paulus W. Impaired motor cortex inhibition in patients with ALS: Evidence from paired transcranial magnetic stimulation. Neurology 1998. [DOI: 10.1212/wnl.51.6.1771-a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
47
|
Cohrs S, Tergau F, Riech S, Kastner S, Paulus W, Ziemann U, Rüther E, Hajak G. High-frequency repetitive transcranial magnetic stimulation delays rapid eye movement sleep. Neuroreport 1998; 9:3439-43. [PMID: 9855295 DOI: 10.1097/00001756-199810260-00019] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a promising new treatment for patients with major depression. However, the mechanisms underlying the antidepressive action of rTMS are widely unclear. Rapid eye movement (REM) sleep has been shown to play an important role in the pathophysiology of depression. In the present study we demonstrate that rTMS delays the first REM sleep epoch on average by 17 min (102.6 +/-22.5 min vs 85.7+/-18.8 min; p < 0.02) and prolongs the nonREM-REM cycle length (109.1+/-11.4 min vs 101.8+/-13.2min, p< 0.012). These rTMS-induced changes in REM sleep variables correspond to findings observed after pharmacological and electroconvulsive treatment of depression. Therefore, it is likely that the capability of rTMS to affect circadian and ultradian biological rhythms contributes to its antidepressive action.
Collapse
Affiliation(s)
- S Cohrs
- Department of Psychiatry, Georg-August University, Göttingen, Germany
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Ziemann U, Tergau F, Wassermann EM, Wischer S, Hildebrandt J, Paulus W. Demonstration of facilitatory I wave interaction in the human motor cortex by paired transcranial magnetic stimulation. J Physiol 1998; 511 ( Pt 1):181-90. [PMID: 9679173 PMCID: PMC2231091 DOI: 10.1111/j.1469-7793.1998.181bi.x] [Citation(s) in RCA: 333] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/1997] [Accepted: 05/08/1998] [Indexed: 11/30/2022] Open
Abstract
1. Transcranial magnetic stimulation (TMS) of the human motor cortex results in multiple discharges (D and I waves) in the corticospinal tract. We tested whether these volleys can be explored non-invasively with paired TMS. The intensity of the first stimulus (S1) was set to produce a motor-evoked potential (MEP) of 1 mV in the resting contralateral abductor digiti minimi (ADM) muscle; the second stimulus (S2) was set to 90 % of the resting motor threshold. At interstimulus intervals of 1.1-1.5, 2.3-2.9 and 4.1-4.4 ms the MEP elicited by S1 plus S2 was larger than that produced by S1 alone. 2. Varying the S1 intensity between 70 and 130 % resting motor threshold with S2 held constant at 90 % resting motor threshold showed that the threshold for the first MEP peak was <= 70 % resting motor threshold. The second and third MEP peaks appeared only at higher S1 intensities. The latency of all peaks decreased with increasing S1 intensity. 3. Varying the S2 intensity with S1 held constant to produce a MEP of 1 mV on its own showed that the amplitude of all MEP peaks increased with S2 intensity, but that their timing remained unchanged. 4. Paired TMS in the active ADM (S1 clearly suprathreshold, S2 just above threshold; interstimulus interval, 1 ms) produced strong MEP facilitation. The onset of this facilitation occurred later by about 1.5 ms than the onset of the MEP evoked by S2 alone. No MEP facilitation was seen if the magnetic S2 was replaced by anodal or cathodal transcranial electrical stimulation. 5. It is concluded that the MEP facilitation after paired TMS, at least for the first MEP peak, is due to facilitatory interaction between I waves, and takes place in the motor cortex at or upstream from the corticospinal neurone.
Collapse
Affiliation(s)
- U Ziemann
- Department of Clinical Neurophysiology, University of Gottingen, Human Motor Control Section, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA.
| | | | | | | | | | | |
Collapse
|
49
|
Ziemann U, Tergau F, Wischer S, Hildebrandt J, Paulus W. Pharmacological control of facilitatory I-wave interaction in the human motor cortex. A paired transcranial magnetic stimulation study. Electroencephalogr Clin Neurophysiol 1998; 109:321-30. [PMID: 9751295 DOI: 10.1016/s0924-980x(98)00023-x] [Citation(s) in RCA: 139] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
A novel paired transcranial magnetic stimulation (TMS) paradigm with a suprathreshold first and a subthreshold second stimulus was used in healthy volunteers to investigate the acute effects of a single oral dose of various CNS-active drugs on short-interval motor evoked potential (MEP) facilitation. MEPs were recorded from the relaxed abductor digiti muscle. Three peaks of MEP facilitation were consistently observed at interstimulus intervals of 1.1-1.5 ms, 2.3-2.7 ms, and 3.9-4.5 ms. The size of these MEP peaks was transiently suppressed by drugs which enhance gamma-aminobutyric acid (GABA) function in the neocortex (lorazepam, vigabatrin, phenobarbital, ethanol), while the GABA-B receptor agonist baclofen, anti-glutamate drugs (gabapentin, memantine), and sodium channel blockers (carbamazepine, lamotrigine) had no effect. The interstimulus intervals effective for the production of the MEP peaks remained unaffected by all drugs. The MEP peaks are thought to be due to a facilitatory interaction of I-(indirect) waves in the motor cortex. Therefore, the present results indicate that the production of I-waves is primarily controlled by GABA related neuronal circuits. The potential relevance of this non-invasive paired TMS protocol for the investigation of I-waves in patients with neurological disease will be discussed.
Collapse
Affiliation(s)
- U Ziemann
- Department of Clinical Neurophysiology, University of Göttingen, Germany.
| | | | | | | | | |
Collapse
|
50
|
Abstract
This paper reviews the current role of transcranial magnetic stimulation (TMS) in epilepsy research. After a brief introduction to the technical principles, the physiology and the safety aspects of TMS, emphasis is put on how human cortex excitability can be assessed by TMS and how this may improve our understanding of pathophysiological mechanisms in epilepsy and the mode of action of antiepileptic drugs (AEDs). Also, potential therapeutical applications of TMS are reviewed. For all aspects of this paper, a clear distinction was made between single-/paired-pulse TMS and repetitive TMS, since these two techniques have fundamentally different scopes and applications.
Collapse
Affiliation(s)
- U Ziemann
- Department of Clinical Neurophysiology, University of Gottingen, Germany
| | | | | | | |
Collapse
|