The paired-pulse TMS paradigm of short intracortical inhibition is mediated by a reduction of repetitive motor neuron discharges.

Transcranial magnetic stimulation (TMS) causes repetitive spinal motoneuron discharges (repMNDs), but the effects of short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF) on repMNDs remain unknown. Triple stimulation technique (TST) and the extended TST-protocols that include a fourth and fifth stimulation, the Quadruple (QuadS) and Quintuple (QuintS) stimulation, respectively, offer a precise estimate of cortical and spinal motor neuron discharges, including repMNDs. The objective of our study was to explore the effects of SICI and ICF on repMNDs. We explored conventional paired-pulse TMS protocols of SICI and ICF with the TMS, TST, the QuadS, and the QuintS protocols, in a randomized study design in 20 healthy volunteers. We found significantly less repMNDs in the SICI paradigm compared with a single-pulse TMS (SP-TMS). No significant difference was observed in the ICF paradigm. There was a significant inter- and intrasubject variability in both SICI and ICF. We demonstrate a significant reduction of repMNDs in SICI, which may result from the suppression of later I-waves and mediate the inhibition of motor-evoked potential (MEP). There is no increase in repMNDs in ICF suggesting another mechanism underlying facilitation. This study provides the proof that a reduction of repMNDs mediates the inhibition seen in SICI.NEW & NOTEWORTHY Significant reduction of repetitive motor neuron discharges (repMNDs) in short-interval intracortical inhibition (SICI) may result from the suppression of later I-waves and mediate the inhibition of motor-evoked potential (MEP). There is no change in the number of repMNDs in intracortical facilitation (ICF). There was a significant variability in SICI and ICF in healthy subjects.

[Polypharmacy : the method and tools for medication review]. / Polypharmacie : la démarche et les outils de revue médicamenteuse.

Polypharmacy and Potentially Inappropriate Medication (PIM) are major public health concerns. They are associated with higher morbi-mortality and a socio-economic burden. The medication review is a solution to limit PIM, especially in the elderly, and in cases of poly-morbidity. Many tools are available to support medication review. We will introduce here the Beers criteria, the PRISCUS list, the STOPP/START criteria, the MAI (Medication Appropriateness Index) and the Good-Palliative-Geriatric Practice Algorithm.

La polypharmacie et la prescription médicamenteuse inappropriée (PMI) sont des problèmes majeurs de santé publique. Elles sont associées à une augmentation de la morbimortalité et représentent un fardeau socio-économique. La révision médicamenteuse est une solution pour limiter les PMI qui sont présentes majoritairement chez le patient âgé et polymorbide. De nombreux outils sont disponibles dans le processus de revue médicamenteuse. Nous présenterons ici les critères de Beers, la liste PRISCUS, les critères STOPP/START (Screening Tool of Older Persons' Potentially Inappropriate Prescriptions/Screening Tool to Alert Doctors to the Right Treatment), le MAI (Medication Appropriatness Index) et l'algorithme GP-GP (Good-Palliative-Geriatric Practice).