TMS of the left primary motor cortex improves tremor intensity and postural control in primary orthostatic tremor.

A ponto-cerebello-thalamo-cortical network is the pathophysiological correlate of primary orthostatic tremor. Affected patients often do not respond satisfactorily to pharmacological treatment. Consequently, the objective of the current study was to examine the effects of a non-invasive neuromodulation by theta burst repetitive transcranial magnetic stimulation (rTMS) of the left primary motor cortex (M1) and dorsal medial frontal cortex (dMFC) on tremor frequency, intensity, sway path and subjective postural stability in primary orthostatic tremor. In a cross-over design, eight patients (mean age 70.2 ± 5.4 years, 4 female) with a primary orthostatic tremor received either rTMS of the left M1 leg area or the dMFC at the first study session, followed by the other condition (dMFC or M1 respectively) at the second study session 30 days later. Tremor frequency and intensity were quantified by surface electromyography of lower leg muscles and total sway path by posturography (foam rubber with eyes open) before and after each rTMS session. Patients subjectively rated postural stability on the posturography platform following each rTMS treatment. We found that tremor frequency did not change significantly with M1- or dMFC-stimulation. However, tremor intensity was lower after M1- but not dMFC-stimulation (p = 0.033/ p = 0.339). The sway path decreased markedly after M1-stimulation (p = 0.0005) and dMFC-stimulation (p = 0.023) compared to baseline. Accordingly, patients indicated a better subjective feeling of postural stability both with M1-rTMS (p = 0.007) and dMFC-rTMS (p = 0.01). In conclusion, non-invasive neuromodulation particularly of the M1 area can improve postural control and tremor intensity in primary orthostatic tremor by interference with the tremor network.

Synthesis, characterization, and reactivity of group 13 hydride complexes based on amido-amine ligands.

The preparation of group 13 hydride complexes supported by N,N',N'-substituted 1,2-ethanediamines is reported. Dihydridoalanes LAlH2, for which the aggregation behaviour in solution and in the solid state is modulated by the steric bulk of the aryl substituent, readily react with elemental sulphur affording dinuclear aluminium sulphide complexes. Chloridohydrido trielanes LEHCl (E = B, Al, Ga) have been synthesized as well starting from the hydrochloride salts of the protio-ligands and the chlorido substituent within LAlHCl is readily replaced using Li[N(SiMe3)2]. Depending on the steric bulk of the ligand, the chloridohydrido gallane gives rise to a dinuclear gallium(ii) complex upon heating. All twelve complexes reported in here have been fully characterized and the solid-state structure of eleven complexes has been examined by means of single-crystal X-ray diffraction analysis.