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1.
Neuroimage ; 228: 117696, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33385544

RESUMO

BACKGROUND: During transcranial magnetic stimulation (TMS) a coil placed on the scalp is used to non-invasively modulate activity of targeted brain networks via a magnetically induced electric field (E-field). Ideally, the E-field induced during TMS is concentrated on a targeted cortical region of interest (ROI). Determination of the coil position and orientation that best achieve this objective presently requires a large computational effort. OBJECTIVE: To improve the accuracy of TMS we have developed a fast computational auxiliary dipole method (ADM) for determining the optimum coil position and orientation. The optimum coil placement maximizes the E-field along a predetermined direction or, alternatively, the overall E-field magnitude in the targeted ROI. Furthermore, ADM can assess E-field uncertainty resulting from precision limitations of TMS coil placement protocols. METHOD: ADM leverages the electromagnetic reciprocity principle to compute rapidly the TMS induced E-field in the ROI by using the E-field generated by a virtual constant current source residing in the ROI. The framework starts by solving for the conduction currents resulting from this ROI current source. Then, it rapidly determines the average E-field induced in the ROI for each coil position by using the conduction currents and a fast-multipole method. To further speed-up the computations, the coil is approximated using auxiliary dipoles enabling it to represent all coil orientations for a given coil position with less than 600 dipoles. RESULTS: Using ADM, the E-fields generated in an MRI-derived head model when the coil is placed at 5900 different scalp positions and 360 coil orientations per position (over 2.1 million unique configurations) can be determined in under 15 min on a standard laptop computer. This enables rapid extraction of the optimum coil position and orientation as well as the E-field variation resulting from coil positioning uncertainty. ADM is implemented in SimNIBS 3.2. CONCLUSION: ADM enables the rapid determination of coil placement that maximizes E-field delivery to a specific brain target. This method can find the optimum coil placement in under 15 min enabling its routine use for TMS. Furthermore, it enables the fast quantification of uncertainty in the induced E-field due to limited precision of TMS coil placement protocols, enabling minimization and statistical analysis of the E-field dose variability.


Assuntos
Simulação por Computador , Estimulação Magnética Transcraniana/métodos , Campos Eletromagnéticos , Humanos , Modelos Anatômicos
2.
Neuroimage ; 228: 117702, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33385558

RESUMO

The development of the organization of the motor representation areas in children and adolescents is not well-known. This cross-sectional study aimed to provide an understanding for the development of the functional motor areas of the upper extremity muscles by studying healthy right-handed children (6-9 years, n = 10), preadolescents (10-12 years, n = 13), adolescents (15-17 years, n = 12), and adults (22-34 years, n = 12). The optimal representation site and resting motor threshold (rMT) for the abductor pollicis brevis (APB) were assessed in both hemispheres using navigated transcranial magnetic stimulation (nTMS). Motor mapping was performed at 110% of the rMT while recording the EMG of six upper limb muscles in the hand and forearm. The association between the motor map and manual dexterity (box and block test, BBT) was examined. The mapping was well-tolerated and feasible in all but the youngest participant whose rMT exceeded the maximum stimulator output. The centers-of-gravity (CoG) for individual muscles were scattered to the greatest extent in the group of preadolescents and centered and became more focused with age. In preadolescents, the CoGs in the left hemisphere were located more laterally, and they shifted medially with age. The proportion of hand compared to arm representation increased with age (p = 0.001); in the right hemisphere, this was associated with greater fine motor ability. Similarly, there was less overlap between hand and forearm muscles representations in children compared to adults (p<0.001). There was a posterior-anterior shift in the APB hotspot coordinate with age, and the APB coordinate in the left hemisphere exhibited a lateral to medial shift with age from adolescence to adulthood (p = 0.006). Our results contribute to the elucidation of the developmental course in the organization of the motor cortex and its associations with fine motor skills. It was shown that nTMS motor mapping in relaxed muscles is feasible in developmental studies in children older than seven years of age.


Assuntos
Mapeamento Encefálico/métodos , Antebraço/inervação , Mãos/inervação , Córtex Motor/crescimento & desenvolvimento , Músculo Esquelético/inervação , Adolescente , Adulto , Criança , Estudos Transversais , Potencial Evocado Motor/fisiologia , Feminino , Humanos , Masculino , Estimulação Magnética Transcraniana/métodos , Adulto Jovem
3.
Neuroimage ; 227: 117655, 2021 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-33333318

RESUMO

Different cortical regions respond with distinct rhythmic patterns of neural oscillations to Transcranial Magnetic Stimulation (TMS). We investigated natural frequencies induced by TMS in left and right homologous dorsolateral prefrontal cortices (DLPFC) and related hemispheric differences. In 12 healthy young adults, single-pulse TMS was delivered in different blocks close to F3 and F4 channels to target left and right DLPFC. An occipital site near PO3 was stimulated as control. TMS-related spectral perturbation analyses were performed on recorded EEG data. A widespread unspecific increase in theta power was observed for all stimulation sites. However, occipital TMS induced greater alpha activity and a 10.58 Hz natural frequency, while TMS over the left and right DLPFC resulted in similar beta band modulations and a natural frequency of 18.77 and 18.5 Hz, respectively. In particular, TMS-related specific increase in beta activity was stronger for the right than the left DLPFC. The right DLPFC is more specifically tuned to its natural beta frequency when it is directly stimulated by TMS than with TMS over the left counterpart (or a posterior region), while the left DLPFC increases its beta activity more similarly irrespective of whether it is directly stimulated or through right homologous stimulation. These results yield important implications for both basic neuroscience research on inter-hemispheric prefrontal interactions and clinical applications.


Assuntos
Córtex Pré-Frontal/fisiologia , Estimulação Magnética Transcraniana/métodos , Adulto , Feminino , Humanos , Masculino , Adulto Jovem
4.
Neuroimage ; 227: 117680, 2021 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-33359345

RESUMO

Whether antagonistic brain states constitute a fundamental principle of human brain organization has been debated over the past decade. Some argue that intrinsically anti-correlated brain networks in resting-state functional connectivity are an artifact of preprocessing. Others argue that anti-correlations are biologically meaningful predictors of how the brain will respond to different stimuli. Here, we investigated the co-activation patterns across the whole brain in various tasks and test whether brain regions demonstrate anti-correlated activity similar to those observed at rest. We examined brain activity in 47 task contrasts from the Human Connectome Project (N = 680) and found robust antagonistic interactions between networks. Regions of the default network exhibited the highest degree of cortex-wide negative connectivity. The negative co-activation patterns across tasks showed good correspondence to that derived from resting-state data processed with global signal regression (GSR). Interestingly, GSR-processed resting-state data was a significantly better predictor of task-induced modulation than data processed without GSR. Finally, in a cohort of 25 patients with depression, we found that task-based anti-correlations between the dorsolateral prefrontal cortex (DLPFC) and subgenual anterior cingulate cortex were associated with clinical efficacy of transcranial magnetic stimulation therapy targeting the DLPFC. Overall, our findings indicate that anti-correlations are a biologically meaningful phenomenon and may reflect an important principle of functional brain organization.


Assuntos
Encéfalo/fisiologia , Rede Nervosa/fisiologia , Adulto , Idoso , Conectoma/métodos , Feminino , Humanos , Processamento de Imagem Assistida por Computador/métodos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Descanso/fisiologia , Estimulação Magnética Transcraniana/métodos
5.
Nat Protoc ; 15(11): 3595-3614, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33005039

RESUMO

Transcranial magnetic stimulation (TMS) is a noninvasive method to stimulate the cerebral cortex that has applications in psychiatry, such as in the treatment of depression and anxiety. Although many TMS targeting methods that use figure-8 coils exist, many do not account for individual differences in anatomy or are not generalizable across target sites. This protocol combines functional magnetic resonance imaging (fMRI) and iterative electric-field (E-field) modeling in a generalized approach to subject-specific TMS targeting that is capable of optimizing the stimulation site and TMS coil orientation. To apply this protocol, the user should (i) operationally define a region of interest (ROI), (ii) generate the head model from the structural MRI data, (iii) preprocess the functional MRI data, (iv) identify the single-subject stimulation site within the ROI, and (iv) conduct E-field modeling to identify the optimal coil orientation. In comparison with standard targeting methods, this approach demonstrates (i) reduced variability in the stimulation site across subjects, (ii) reduced scalp-to-cortical-target distance, and (iii) reduced variability in optimal coil orientation. Execution of this protocol requires intermediate-level skills in structural and functional MRI processing. This protocol takes ~24 h to complete and demonstrates how constrained fMRI targeting combined with iterative E-field modeling can be used as a general method to optimize both the TMS coil site and its orientation.


Assuntos
Mapeamento Encefálico/métodos , Encéfalo/fisiologia , Imagem por Ressonância Magnética/métodos , Estimulação Magnética Transcraniana/métodos , Encéfalo/diagnóstico por imagem , Humanos , Fluxo de Trabalho
6.
Fisioterapia (Madr., Ed. impr.) ; 42(5): 267-276, sept.-oct. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-195143

RESUMO

OBJETIVO: Realizar una revisión sistemática actualizada y crítica sobre los estudios clínicos que han utilizado la combinación de estimulación magnética transcraneal repetitiva (EMTr) con fisioterapia en pacientes con secuelas de enfermedad vascular cerebral (EVC) para conocer si existen efectos sinérgicos de ambas terapias sobre la función motora. ESTRATEGIA DE BÚSQUEDA Y SELECCIÓN DE ESTUDIOS: Revisión sistemática de estudios clínicos con grupo control. La búsqueda se realizó en las siguientes bases de datos: PubMed, MedLine, DynaMed, EBSCO, Science Direct y Latindex, de 2009 a 2019. Se encontró un total de 184 artículos, y basado en los criterios de inclusión se seleccionó un total de 10 estudios que combinaron fisioterapia con EMTr. SÍNTESIS DE RESULTADOS: Existen pocos estudios en donde se haya combinado la aplicación de EMTr con fisioterapia para la recuperación motora en EVC. Se encontraron diversos puntos de variabilidad en el diseño de los estudios, lo cual dificulta su comparación: número de participantes, tipo de fisioterapia aplicada, parámetros de estimulación, variables de desenlace, etc. Seis estudios demostraron efectos sinérgicos de la EMT + fisioterapia en la función motora en EVC. CONCLUSIONES: Se observaron múltiples puntos de variabilidad metodológica que pueden afectar la comparación entre los estudios. La evidencia disponible parece sugerir un efecto sinérgico de la combinación de EMTr + fisioterapia en la función motora en EVC


OBJECTIVE: To perform an updated and critical systematic review of the clinical studies that have used the combination of repetitive Transcranial Magnetic Stimulation (rTMS) and physiotherapy in patients with sequelae of stroke to establish whether there are synergistic effects of both therapies on motor function SEARCH STRATEGY AND STUDY SELECTION: Systematic review of clinical studies with control group. The search was carried out in the following databases: PubMed, MedLine, DynaMed, EBSCO, Science Direct and Latindex from 2009 to 2019. A total of 184 articles were found and, based on the inclusion criteria, a total of 10 studies were selected who combined physiotherapy with rTMS. SYNTHESIS OF RESULTS: There are few studies where rTMS has been combined with physiotherapy for motor recovery in stroke. Several points of variability were found in the design of the studies, which makes comparison difficult: number of participants, type of physiotherapy applied, stimulation parameters, outcome variables, etc. Six studies showed a synergistic effect of rTMS + physiotherapy on motor function in stroke. CONCLUSIONS: There are several points of methodological variability between studies but the available evidence suggests a possible synergistic effect of rTMS+physiotherapy


Assuntos
Humanos , Transtornos Cerebrovasculares/reabilitação , Transtornos Cerebrovasculares/terapia , Estimulação Magnética Transcraniana/instrumentação , Modalidades de Fisioterapia , Estimulação Magnética Transcraniana/métodos , Plasticidade Neuronal/fisiologia
7.
Am J Geriatr Psychiatry ; 28(10): 1025-1029, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32753340

RESUMO

OBJECTIVE: Electroconvulsive therapy (ECT) is an essential psychiatric service with an important role in treating older adults with severe or treatment-resistant depression. During the COVID-19 pandemic, ECT services have be constrained by infection control measures. We report a case of a 66-year-old female patient with a severe major depressive episode who had previously responded to right unilateral ECT and was treated with two modified accelerated intermittent theta-burst stimulation (aiTBS) protocols. METHODS: The two aiTBS courses consisted of eight daily sessions over five consecutive days, followed by gradual tapering, using 1,800 pulses per session pre-COVID-19 (first course), and 600 pulses per session during the pandemic (second course). RESULTS: Moderate to severe baseline depressive symptoms reached remission levels after both courses. CONCLUSION: The 600-pulses aiTBS treatment protocol reported here warrants further study and evaluation, but may be a potential option in cases where older adults with severe depressive symptoms cannot access ECT during the COVID-19 pandemic.


Assuntos
Transtorno Depressivo Maior/terapia , Transtorno Depressivo Resistente a Tratamento/terapia , Estimulação Magnética Transcraniana/métodos , Idoso , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Transtorno Depressivo Maior/psicologia , Transtorno Depressivo Resistente a Tratamento/psicologia , Eletroconvulsoterapia , Feminino , Acesso aos Serviços de Saúde , Humanos , Pandemias , Questionário de Saúde do Paciente , Pneumonia Viral/epidemiologia , Resultado do Tratamento
8.
BMC Neurol ; 20(1): 311, 2020 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-32819321

RESUMO

BACKGROUND: Prefrontal repetitive transcranial magnetic stimulation is an established add-on treatment for major depressive disorder and is increasingly feasible with protocols of short duration, such as intermittent theta burst stimulation (iTBS). The most common and limiting side effect is pain at the site of application. Our objective was to investigate how pain develops over time in patients with depression receiving iTBS compared to sham stimulation. METHODS: This is a subsample from a randomized clinical trial. Patients received daily sessions of 2400 pulses of dorsomedial prefrontal iTBS or sham stimulation with transcutaneous electric stimulation during 2 to 3 weeks. After unmasking of treatment allocation, patients receiving sham treatment were offered active iTBS in an open phase. Patients rated pain on a scale from 0 to 10 after the last train of stimulation on the first, fifth and final treatment day. A Mann-Whitney U-test was conducted to test for group differences and related-samples Friedman's tests to analyze changes in pain ratings over time. RESULTS: The scalp pain in the group receiving iTBS was rated higher than sham treatment on the first (U = 263.5, p = 0.035) and fifth day (U = 271.0, p = 0.020) but not on the final day (U = 210.5, p = 0.121). The pain decreased mainly during the first 5 days of treatment (χ2 = 0.875, p = 0.040). In the open phase the pain decreased from the first day to the final day (χ2 = 1.194, p = 0.001). CONCLUSIONS: The subjective pain perception of active dorsomedial iTBS was higher than sham treatment but decreased over time, indicating an analgesic effect, or habituation. The result from this study can be used to inform patients about what to expect regarding pain during an iTBS treatment course. TRIAL REGISTRATION: Clinicaltrials.gov, NCT02905604 . Registered 19 September 2016.


Assuntos
Transtorno Depressivo Maior/terapia , Dor/etiologia , Estimulação Magnética Transcraniana/efeitos adversos , Adulto , Método Duplo-Cego , Feminino , Humanos , Masculino , Córtex Pré-Frontal/fisiologia , Estimulação Magnética Transcraniana/métodos , Adulto Jovem
9.
Medicine (Baltimore) ; 99(32): e21493, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769884

RESUMO

BACKGROUND: Depression, a common psychiatric disorder in elderly, serves as a remarkable precipitating factor for suicide among the elderly people. Here, a randomized double-blinded study was performed to investigate the efficacy of repetitive transcranial magnetic stimulation (rTMS) on improving the clinical symptoms and reducing suicidal ideation in elderly patients with depression. METHODS: In this study, 103 elderly patients with depression and suicidal ideation were randomly divided into 2 groups, 48 cases in the rTMS group and 55 cases in the control group (sham rTMS). Both groups received routine drug therapy with rTMS or sham rTMS. The patients received evaluation by Hamilton depression scale and self-rating idea of suicide scale before treatment and after 2 and 4 weeks of treatment, respectively. RESULTS: The measurement from the present study demonstrated that Hamilton depression scale and self-rating idea of suicide scale scores decreased to varying degrees in the 2 groups after treatment, and the decrease was more significant in rTMS group. The rate of marked effectiveness was much higher in rTMS group after 2 weeks of treatment compared with the control group. Furthermore, the rate of moderate effectiveness at 4 weeks after treatment was significantly higher in rTMS group compared with the control group. CONCLUSION: Together, the present study shows that rTMS with routine drug therapy exhibited effect with quick onset to improve the clinical symptoms and reduce suicidal ideation in elderly patients with depression.


Assuntos
Antidepressivos/uso terapêutico , Depressão/terapia , Ideação Suicida , Estimulação Magnética Transcraniana/métodos , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Depressão/psicologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Resultado do Tratamento
10.
Medicine (Baltimore) ; 99(30): e21292, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791711

RESUMO

BACKGROUND: Insomnia is a common, recurrent, and tenacious sleep problem, especially the chronic insomnia. Repetitive transcranial magnetic stimulation (rTMS) at right dorsolateral prefrontal cortex (r-DLPFC) is used in chronic insomnia, and repetitive magnetic stimulation (rMS) at Shenmen (HT7) acupoint may be an alternative approach. However, the efficacy and mechanism of rMS at HT7 acupoint for chronic insomnia has not been confirmed. METHODS/DESIGN: This is a 3-armed randomized positive-controlled noninferiority clinical trial. We will allocate 45 subjects aged between 18 and 65 years old, diagnosed with initial chronic insomnia over 3 months to 3 groups randomly in a ratio of 1:1:1. Patients in the experimental group will be treated with rMS at HT7 acupoint while the others in the control group will be treated with rTMS at r-DLPFC or waiting treatment. All will be given rMS at HT7 or rTMS at r-DLPFC or no treatment for 10 days, and then received 20-day follow-up. Patients will be evaluated with the insomnia severity index and Pittsburgh sleep quality index for sleep state, Beck Depression Inventory-2nd edition scores for the depression state, Beck anxiety inventory scores for the anxiety state, and Montreal Cognitive Assessment scores for the cognition state before and the 10th day of treatment, 30th day of follow-up; study on mechanisms of rMS will be revealed through the resting motor threshold diversity of the motor cortex before and the 10th day of treatment, 30th day of follow-up. Baseline characteristics of patients will be summarized by groups and compared with Chi-squared for categorical variables, and analysis of variance or Kruskal-Wallis test for the continuous variables. Primary and secondary outcomes according to the measurement times are applicable to univariate repetitive measurement deviation analysis or analysis of variance, or Kruskal-Wallis test. CONCLUSION: The present study is designed to preliminarily investigate short-term efficacy and mechanism of rMS at HT7 acupoint therapy on chronic insomnia, also to explore the correlation between motor cortex excitability and chronic insomnia. With this research, we are looking forward to find out an appropriate alternative and easy therapy for chronic insomnia individuals compared with rTMS at r-DLPFC. TRIAL REGISTRATION: The trial was registered on Chinese Clinical Trial Registry (http://www.chictr.org.cn/index.aspx) with the ID ChiCTR1900026844 on October 24, 2019.


Assuntos
Distúrbios do Início e da Manutenção do Sono/terapia , Estimulação Magnética Transcraniana/métodos , Pontos de Acupuntura , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Punho
11.
Ned Tijdschr Geneeskd ; 1642020 06 11.
Artigo em Holandês | MEDLINE | ID: mdl-32608923

RESUMO

There is increasing interest in the use of non-invasive neurostimulation in the treatment of depressive disorder. A recent meta-analysis compared different forms of neurostimulation, and concluded that the effectiveness of different forms of this therapy, for example repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS), was similar to electroconvulsive therapy (ECT). In this comment we discuss these different techniques; we also stress that an unfair comparison has been made between the different forms of neurostimulation. In daily practice, techniques such as ECT, rTMS, and tDCS are used in different patient groups. ECT, in particular, is highly effective in patients suffering from a major depressive disorder with psychotic features, but this patient group has not been sufficiently included in the studies incorporated with a consequent negative bias towards ECT in this meta-analysis.


Assuntos
Transtorno Depressivo Maior/terapia , Eletroconvulsoterapia/métodos , Avaliação de Resultados em Cuidados de Saúde/métodos , Estimulação Transcraniana por Corrente Contínua/métodos , Estimulação Magnética Transcraniana/métodos , Feminino , Humanos , Masculino , Metanálise como Assunto , Resultado do Tratamento
12.
Cogn Behav Neurol ; 33(2): 145-153, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32496300

RESUMO

This manuscript presents the case of an adult, male patient with mal de debarquement syndrome (MdDS); results from his experimental treatment with repetitive transcranial magnetic stimulation (rTMS) are also provided. Additionally, we included a review of literature related to the neurophysiology of MdDS and its treatment with rTMS. A 41-year-old man had been experiencing symptoms of MdDS, which initially emerged following a car ride, for 11 to 12 years. Pharmacologic approaches had failed to provide symptom relief; thus, we investigated an intervention using low-frequency (1 Hz) rTMS unilaterally for 2 consecutive weeks. The outcome measures included a standardized, computerized dynamic posturography test to quantify the patient's balance and identify abnormalities in his use of the sensory systems contributing to postural control, as well as the Hospital Anxiety and Depression Scale (HADS) to measure his anxiety and depression. An rTMS treatment log was created to document any adverse events. Following rTMS, the patient's balance scores improved significantly; these improvements were mostly related to the patient's increased reliance on the visual and vestibular systems. Our patient's HADS Anxiety and Depression subscores also showed improvement post-rTMS. The presented case study provides preliminary evidence that rTMS may be a noninvasive treatment option for improving balance, specifically in individuals with MdDS. This evidence can be used to further therapeutic research on, and provide strategies for treating, MdDS.


Assuntos
Estimulação Magnética Transcraniana/métodos , Doença Relacionada a Viagens , Adulto , Humanos , Masculino , Resultado do Tratamento
13.
J Electromyogr Kinesiol ; 53: 102436, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32505988

RESUMO

This systematic review and meta-analysis examined differences in lower extremity neural excitability between ankles with and without chronic ankle instability (CAI). We searched the literature for studies that compared corticomotor or spinal reflexive excitability between a CAI group and controls or copers, or between limbs of a CAI group. Random effects meta-analyses calculated pooled effect sizes for each outcome. Nineteen studies were included. Meta-analyses of motor thresholds of the fibularis longus (Z = 1.17, P = 0.24) and soleus (Z = 0.47, P = 0.64) exhibited no differences between ankles with and without CAI. Pooled data indicate that ankles with CAI had reduced soleus spinal reflexive excitability (Z = 2.18, P = 0.03) and significantly less modulation of the soleus (Z = 6.96, P < 0.01) and fibularis longus (Z = 4.75, P < 0.01) spinal reflexive excitability when transitioning to more challenging stances. Pre-synaptic inhibition was facilitated in ankles with CAI (Z = 4.05, P < 0.01), but no difference in recurrent inhibition existed (Z = 1.50, P = 0.13). Soleus spinal reflexive activity is reduced in those with CAI. Reduced ability of ankles with CAI to modulate soleus and fibularis longus reflexive activity may contribute to impaired balance.


Assuntos
Articulação do Tornozelo/fisiologia , Potencial Evocado Motor/fisiologia , Instabilidade Articular/fisiopatologia , Extremidade Inferior/fisiologia , Músculo Esquelético/fisiologia , Traumatismos do Tornozelo/diagnóstico , Traumatismos do Tornozelo/fisiopatologia , Estudos de Casos e Controles , Humanos , Instabilidade Articular/diagnóstico , Reflexo/fisiologia , Estimulação Magnética Transcraniana/métodos
14.
J Neuroeng Rehabil ; 17(1): 72, 2020 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-32527268

RESUMO

BACKGROUND: Dual transcranial direct current stimulation (tDCS) to the bilateral primary motor cortices (M1s) has potential benefits in chronic stroke, but its effects in subacute stroke, when behavioural effects might be expected to be greater, have been relatively unexplored. Here, we examined the neurophysiological effects and the factors influencing responsiveness of dual-tDCS in subacute stroke survivors. METHODS: We conducted a randomized sham-controlled crossover study in 18 survivors with first-ever, unilateral subcortical ischaemic stroke 2-4 weeks after stroke onset and 14 matched healthy controls. Participants had real dual-tDCS (with an ipsilesional [right for controls] M1 anode and a contralesional M1 [left for controls] cathode; 2 mA for 20mins) and sham dual-tDCS on separate days, with concurrent paretic [left for controls] hand exercise. Using transcranial magnetic stimulation (TMS) and magnetoencephalography (MEG), we recorded motor evoked potentials (MEPs), the ipsilateral silent period (iSP), short-interval intracortical inhibition, and finger movement-related cortical oscillations before and immediately after tDCS. RESULTS: Stroke survivors had decreased excitability in ipsilesional M1 with a relatively excessive transcallosal inhibition from the contralesional to ipsilesional hemisphere at baseline compared with controls, as quantified by decreased MEPs and increased iSP duration. Dual-tDCS led to increased MEPs and decreased iSP duration in ipsilesional M1. The magnitude of the tDCS-induced MEP increase in stroke survivors was predicted by baseline contralesional-to-ipsilesional transcallosal inhibition (iSP) ratio. Baseline post-movement synchronization in α-band activity in ipsilesional M1 was decreased after stroke compared with controls, and its tDCS-induced increase correlated with upper limb score in stroke survivors. No significant adverse effects were observed during or after dual-tDCS. CONCLUSIONS: Task-concurrent dual-tDCS in subacute stroke can safely and effectively modulate bilateral M1 excitability and inter-hemispheric imbalance and also movement-related α-activity.


Assuntos
Córtex Motor/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Estimulação Transcraniana por Corrente Contínua/métodos , Adulto , Idoso , Estudos Cross-Over , Potencial Evocado Motor/fisiologia , Feminino , Humanos , Magnetoencefalografia/métodos , Masculino , Pessoa de Meia-Idade , Movimento/fisiologia , Estimulação Magnética Transcraniana/métodos , Extremidade Superior
15.
Medicine (Baltimore) ; 99(21): e20170, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481286

RESUMO

BACKGROUND: Numerous studies have reported that transcranial magnetic stimulation (TMS) and fluoxetine is used in the treatment of postpartum depression (PPD). Currently, no study has systematically investigated the efficacy and safety of TMS and fluoxetine for the treatment of patients with PPD. Thus, this study will assess the efficacy and safety of TMS and fluoxetine for treating PPD. METHODS: Relevant studies involving TMS and fluoxetine for the treatment of patients with PPD will be comprehensively searched from the electronic databases from inception to the February 1, 2020: Cochrane Library, EMBASE, MEDILINE, CINAHL, AMED, WANGFANG, VIP, and CNKI databases. No language and publication time restrictions will be applied. RevMan 5.3 software will be utilized for data pooling, data analysis, and risk of bias evaluation. If necessary, we will also assess reporting bias using funnel plot and Egger test. RESULTS: This study will comprehensively summarize the existing evidence to assess the efficacy and safety of TMS and fluoxetine for treating PPD. CONCLUSION: The findings of this study may help to establish a better approach to treat PPD using TMS and fluoxetine. DISSEMINATION AND ETHICS: This study will be disseminated through a peer-reviewed journal. This study does not need ethical approval as no primary patient data will be used. SYSTEMATIC REVIEW REGISTRATION: INPLASY202040017.


Assuntos
Depressão Pós-Parto/terapia , Fluoxetina/uso terapêutico , Inibidores de Captação de Serotonina/uso terapêutico , Estimulação Magnética Transcraniana/métodos , Adulto , Terapia Combinada/métodos , Depressão Pós-Parto/epidemiologia , Feminino , Fluoxetina/administração & dosagem , Humanos , Inibidores de Captação de Serotonina/administração & dosagem , Resultado do Tratamento
16.
Medicine (Baltimore) ; 99(22): e20282, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481397

RESUMO

INTRODUCTION: The aberrant pyramidal tract (APT) refers to the collateral pathway of the pyramidal tract (PT) descending through the medial lemniscus in the midbrain and pons. We report on a patient who showed changes of the APT from the early stage to the chronic stage concurrent with motor recovery following an infarct in the cerebral peduncle. PATIENT CONCERNS: An 84-year-old female patient presented with moderate motor weakness of her upper and lower extremities (2/2) due to cerebral infarct on the right cerebral peduncle of midbrain. One week after her stroke, her motor weakness was similar to that at the onset (2/2). During 5 weeks' rehabilitation, her motor weakness recovered to the point that she was able to move upper and lower extremities against gravity with some resistance (4/4). DIAGNOSIS: Cerebral infarct on the right cerebral peduncle of midbrain INTERVENTIONS:: She participated in a comprehensive rehabilitative management program, including movement therapy, neurotrophic drugs, and neuromuscular electrical stimulation therapy of the left finger extensor and ankle dorsiflexor muscles. OUTCOMES: On 1-week and 6-week diffusion tensor tractographys (DTTs), the right PT was not reconstructed, but the right APT, which descended through the medial lemniscus pathway at the midbrain and pons and the pyramid at the medulla, was observed. The right APT became thicker on six-week DTT compared with 1-week DTT. On 1-week transcranial magnetic stimulation study, an motor evoked potential with delayed latency and decreased amplitude was evoked from the affected (right) hemisphere (latency: 24.4 msec and amplitude: 0.2uV). In contrast, its latency was decreased and amplitude was increased on six-week transcranial magnetic stimulation study (latency: 21.8 msec, amplitude: 0.8 uV) CONCLUSIONS:: We demonstrated changes in the APT from the early stage to the chronic stage concurrent with motor recovery in a patient with an infarct in the cerebral peduncle. Our findings have important implications that a spared APT could contribute to the motor recovery in patients with cerebral infarct when the PTis completely injured at the onset of cerebral infarct,.


Assuntos
Infarto Cerebral/reabilitação , Tratos Piramidais/fisiopatologia , Recuperação de Função Fisiológica/fisiologia , Estimulação Magnética Transcraniana/métodos , Idoso de 80 Anos ou mais , Imagem de Tensor de Difusão , Feminino , Humanos
17.
Brain Stimul ; 13(4): 1124-1149, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32413554

RESUMO

BACKGROUND: The COVID-19 pandemic has broadly disrupted biomedical treatment and research including non-invasive brain stimulation (NIBS). Moreover, the rapid onset of societal disruption and evolving regulatory restrictions may not have allowed for systematic planning of how clinical and research work may continue throughout the pandemic or be restarted as restrictions are abated. The urgency to provide and develop NIBS as an intervention for diverse neurological and mental health indications, and as a catalyst of fundamental brain research, is not dampened by the parallel efforts to address the most life-threatening aspects of COVID-19; rather in many cases the need for NIBS is heightened including the potential to mitigate mental health consequences related to COVID-19. OBJECTIVE: To facilitate the re-establishment of access to NIBS clinical services and research operations during the current COVID-19 pandemic and possible future outbreaks, we develop and discuss a framework for balancing the importance of NIBS operations with safety considerations, while addressing the needs of all stakeholders. We focus on Transcranial Magnetic Stimulation (TMS) and low intensity transcranial Electrical Stimulation (tES) - including transcranial Direct Current Stimulation (tDCS) and transcranial Alternating Current Stimulation (tACS). METHODS: The present consensus paper provides guidelines and good practices for managing and reopening NIBS clinics and laboratories through the immediate and ongoing stages of COVID-19. The document reflects the analysis of experts with domain-relevant expertise spanning NIBS technology, clinical services, and basic and clinical research - with an international perspective. We outline regulatory aspects, human resources, NIBS optimization, as well as accommodations for specific demographics. RESULTS: A model based on three phases (early COVID-19 impact, current practices, and future preparation) with an 11-step checklist (spanning removing or streamlining in-person protocols, incorporating telemedicine, and addressing COVID-19-associated adverse events) is proposed. Recommendations on implementing social distancing and sterilization of NIBS related equipment, specific considerations of COVID-19 positive populations including mental health comorbidities, as well as considerations regarding regulatory and human resource in the era of COVID-19 are outlined. We discuss COVID-19 considerations specifically for clinical (sub-)populations including pediatric, stroke, addiction, and the elderly. Numerous case-examples across the world are described. CONCLUSION: There is an evident, and in cases urgent, need to maintain NIBS operations through the COVID-19 pandemic, including anticipating future pandemic waves and addressing effects of COVID-19 on brain and mind. The proposed robust and structured strategy aims to address the current and anticipated future challenges while maintaining scientific rigor and managing risk.


Assuntos
Pesquisa Biomédica/métodos , Assistência à Saúde/métodos , Doenças do Sistema Nervoso/terapia , Telemedicina/métodos , Estimulação Transcraniana por Corrente Contínua/métodos , Estimulação Magnética Transcraniana/métodos , Idoso , Comportamento Aditivo/terapia , Betacoronavirus , Encéfalo/fisiologia , Criança , Ensaios Clínicos como Assunto , Infecções por Coronavirus/epidemiologia , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Acidente Vascular Cerebral/terapia , Transtornos Relacionados ao Uso de Substâncias/terapia
18.
Psychiatry Res ; 288: 112974, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32353694

RESUMO

Schizophrenia is characterised by delusions, hallucinations, anhedonia and apathy; while impairments in social cognition are often less recognised. Poor social cognition can lead to difficulties in obtaining and maintaining employment, academic progression, interpersonal relationships, and community functioning. Current interventions are highly intensive, require significant resources and have only modest effects on functional outcomes. Virtual reality (VR) and non-invasive brain stimulation (NIBS) may have a role in addressing these limitations. VR allows treatments that are potentially more accessible, less delivery intensive, and have higher ecological validity. While NIBS is able to directly modulate activity in social brain areas in order to promote neuroplasticity, strengthen neural connections and enhance brain function related to social cognitive behaviours. Therefore, the combination of VR and NIBS may allow for more efficient and transferrable interventions than those currently available. This review will explore the potential role of these technologies in the treatment of social cognitive impairment.


Assuntos
Cognição/fisiologia , Esquizofrenia/terapia , Comportamento Social , Estimulação Transcraniana por Corrente Contínua/métodos , Estimulação Magnética Transcraniana/métodos , Terapia de Exposição à Realidade Virtual/métodos , Encéfalo/fisiopatologia , Humanos , Relações Interpessoais , Esquizofrenia/fisiopatologia
19.
Medicine (Baltimore) ; 99(18): e19642, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358345

RESUMO

BACKGROUND: Clinical symptoms of Parkinson disease (PD) included both motor and nonmotor symptoms. Previous studies indicated inconsistent results for the therapeutic effects of repetitive transcranial magnetic stimulation (rTMS) on motor and depression in PD. The study aimed to assess the therapeutic effect of rTMS with different mode on motor and depression in PD using a meta-analysis. METHODS: Articles published before July 2019 were searched based on the following databases (PubMed, Web of Science, Medline, Embase, and Google Scholar). The therapeutic effects were assessed by computing the standard mean difference (SMD) and a 95% confidence interval (CI). RESULTS: The present study indicated that rTMS showed significant therapeutic effects on motor in PD (SMD 2.05, 95% CI 1.57-2.53, I = 93.0%, P < .001). Both high-frequency (HF)-rTMS and low-frequency rTMS showed therapeutic effects on motor; stimulation over primary motor cortex (M1), supplementary motor area, dorsal lateral prefrontal cortex (DLPFC) or M1+DLPFC showed therapeutic effects; stimulation during "on" and "off" states showed therapeutic effects; the study showed long-term effect of rTMS on motor in PD. In addition, the study indicated that rTMS showed significant therapeutic effects on depression in PD (SMD 0.80, 95% CI 0.31-1.29, I = 89.1%, P < .001). Stimulation over left DLPFC showed significant therapeutic effects on depression in PD; only HF-rTMS showed therapeutic effects; ages, disease durations, numbers of pulses, and session durations displayed influence on the therapeutic effects of rTMS on depression in PD; the therapeutic effects on depression was long term. However, no significant difference in therapeutic effects on depression were showed between rTMS and oral Fluoxetine (SMD 0.74, 95% CI -0.83 to 2.31, I = 92.5%, P < .001). CONCLUSION: The rTMS showed significant therapeutic effects on motor in PD. HF-rTMS showed a significant positive antidepressive effect in PD only over DLPFC.


Assuntos
Depressão/terapia , Doença de Parkinson/terapia , Estimulação Magnética Transcraniana/métodos , Idoso , Depressão/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/psicologia , Desempenho Psicomotor , Recuperação de Função Fisiológica , Resultado do Tratamento
20.
PLoS One ; 15(5): e0233614, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32453767

RESUMO

Recently, modulatory effects of static magnetic field stimulation (tSMS) on excitability of the motor cortex have been reported. In our previous study we failed to replicate these results. It was suggested that the lack of modulatory effects was due to the use of an auditory oddball task in our study. Thus, we aimed to evaluate the role of an oddball task on the effects of tSMS on motor cortex excitability. In a within-subject-design we compared 10 minutes tSMS with and without oddball task. In one of the two sessions subjects had to solve an auditory oddball task during the exposure to the magnet, whereas there was no task during exposure in the other session. Motor cortex excitability was measured before and after tSMS. No modulation was observed in any condition. However, when data were pooled regarding the order of the sessions, a trend for an increase of excitability was observed in the first session compared to the second session. We now can rule out that the auditory oddball task destroys tSMS effects, as postulated. Our results rather suggest that fluctuations in the amplitudes of single pulse motor evoked potentials may possibly mask weak modulatory effects but may also lead to false positive results if the number of subjects in a study is too low. In addition, there might be a habituation effect to the whole procedure, resulting in less variability when subjects underwent the same experiment twice.


Assuntos
Potencial Evocado Motor/efeitos da radiação , Córtex Motor/efeitos da radiação , Estimulação Magnética Transcraniana/métodos , Adulto , Feminino , Humanos , Campos Magnéticos/efeitos adversos , Masculino , Córtex Motor/fisiopatologia , Estimulação Magnética Transcraniana/efeitos adversos
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