Intermittent theta burst stimulation over ipsilesional primary motor cortex of subacute ischemic stroke patients: A pilot study

Hsu, Yi‐Cheng; Huang, Ying Zu; Lin, Yung Yang; Tang, Chih‐Wei; Liao, Kwong‐Kum; Lee, Po-Lei; Tsai, Yun-An; Cheng, Hsien-Lin; Cheng, Henrich; Chern, Chang‐Ming; Lee, I‐Hui

doi:10.1016/j.brs.2012.04.007

Cited by 59 publications

(73 citation statements)

References 56 publications

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“…iTBS shows promise for clinical application (Hsu et al, 2013). TMS studies in rodents have been essential for elucidating mechanism (Benali et al , 2011; Wang et al, 2011).…”

Section: Discussionmentioning

confidence: 99%

Combined motor cortex and spinal cord neuromodulation promotes corticospinal system functional and structural plasticity and motor function after injury

Song

Amer

Ryan

et al. 2016

Experimental Neurology

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An important strategy for promoting voluntary movements after motor system injury is to harness activity-dependent corticospinal tract (CST) plasticity. We combine forelimb motor cortex (M1) activation with co-activation of its cervical spinal targets in rats to promote CST sprouting and skilled limb movement after pyramidal tract lesion (PTX). We used a two-step experimental design in which we first established the optimal combined stimulation protocol in intact rats and then used the optimal protocol in injured animals to promote CST repair and motor recovery. M1 was activated epidurally using an electrical analog of intermittent theta burst stimulation (iTBS). The cervical spinal cord was co-activated by trans-spinal direct current stimulation (tsDCS) that was targeted to the cervical enlargement, simulated from finite element method. In intact rats, forelimb motor evoked potentials (MEPs) were strongly facilitated during iTBS and for 10 minutes after cessation of stimulation. Cathodal, not anodal, tsDCS alone facilitated MEPs and also produced a facilitatory aftereffect that peaked at 10 minutes. Combined iTBS and cathodal tsDCS (c-tsDCS) produced further MEP enhancement during stimulation, but without further aftereffect enhancement. Correlations between forelimb M1 local field potentials and forelimb electromyogram (EMG) during locomotion increased after electrical iTBS alone and further increased with combined stimulation (iTBS + c-tsDCS). This optimized combined stimulation was then used to promote function after PTX because it enhanced functional connections between M1 and spinal circuits and greater M1 engagement in muscle contraction than either stimulation alone. Daily application of combined M1 iTBS on the intact side and c-tsDCS after PTX (10 days, 27 minutes/day) significantly restored skilled movements during horizontal ladder walking. Stimulation produced a 5.4-fold increase in spared ipsilateral CST terminations. Combined neuromodulation achieves optimal motor recovery and substantial CST outgrowth with only 27 minutes of daily stimulation compared with 6 hours, as in our prior study, making it a potential therapy for humans with spinal cord injury.

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“…iTBS shows promise for clinical application (Hsu et al, 2013). TMS studies in rodents have been essential for elucidating mechanism (Benali et al , 2011; Wang et al, 2011).…”

Section: Discussionmentioning

confidence: 99%

Combined motor cortex and spinal cord neuromodulation promotes corticospinal system functional and structural plasticity and motor function after injury

Song

Amer

Ryan

et al. 2016

Experimental Neurology

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“…In support of this, two studies in individuals with perinatal stroke showed improvements in MA hand function after constraint-induced movement therapy that were associated with concurrent increases in IL corticospinal excitability (Juenger et al, 2007; Walther et al, 2009). Another technique to increase IL corticospinal excitability is intermittent theta burst transcranial magnetic stimulation (TMS), which was shown to be related to improvements in clinical scales of neurologic deficits and function in a pilot study in adults with subacute MCA stroke (Hsu et al, 2013). Consequently, future rehabilitative efforts in childhood stroke would likely benefit from methods that can improve IL sensorimotor cortical activation during hand movement.…”

Section: Discussionmentioning

confidence: 99%

Cortical activation and inter-hemispheric sensorimotor coherence in individuals with arm dystonia due to childhood stroke

Kukke

Campos

Damiano

et al. 2015

Clinical Neurophysiology

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Objective Dystonia is a disabling motor disorder often without effective therapies. To better understand the genesis of dystonia after childhood stroke, we analyzed electroencephalographic (EEG) recordings in this population. Methods Resting spectral power of EEG signals over bilateral sensorimotor cortices (Powrest), resting inter-hemispheric sensorimotor coherence (Cohrest), and task-related changes in power (TRPow) and coherence (TRCoh) during wrist extension were analyzed in individuals with dystonia (age 20±3 years) and healthy volunteers (age 17±5 years). Results Ipsilesional TRPow decrease was significantly lower in patients than controls during the more affected wrist task. Force deficits of the affected wrist correlated with reduced alpha TRPow decrease on the ipsilesional and not the contralesional hemisphere. Cohrest was significantly lower in patients than controls, and correlated with more severe dystonia and poorer hand function. Powrest and TRCoh were similar between groups. Conclusions The association between weakness and cortical activation during wrist extension highlights the importance of ipsilesional sensorimotor activation on function. Reduction of Cohrest in patients reflects a loss of inter-hemispheric connectivity that may result from structural changes and neuroplasticity, potentially contributing to the development of dystonia. Significance Cortical and motor dysfunction are correlated in patients with childhood stroke and may in part explain the genesis of dystonia.

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“…The duration of each epoch was set at 20 s, since it was demonstrated in a previous work that this time interval is sufficient for extracting the synchronization degree in a robust way (Gudmundsson et al, 2007; Hsu et al, 2012; Frantzidis et al, 2014). Aiming to avoid methodological and sampling errors, the epoch selection was performed in a completely randomized way.…”

Section: Methodsmentioning

confidence: 99%

Functional disorganization of small-world brain networks in mild Alzheimer's Disease and amnestic Mild Cognitive Impairment: an EEG study using Relative Wavelet Entropy (RWE)

Frantzidιs

Vivas²,

Tsolaki

et al. 2014

Front. Aging Neurosci.

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Previous neuroscientific findings have linked Alzheimer's Disease (AD) with less efficient information processing and brain network disorganization. However, pathological alterations of the brain networks during the preclinical phase of amnestic Mild Cognitive Impairment (aMCI) remain largely unknown. The present study aimed at comparing patterns of the detection of functional disorganization in MCI relative to Mild Dementia (MD). Participants consisted of 23 cognitively healthy adults, 17 aMCI and 24 mild AD patients who underwent electroencephalographic (EEG) data acquisition during a resting-state condition. Synchronization analysis through the Orthogonal Discrete Wavelet Transform (ODWT), and directional brain network analysis were applied on the EEG data. This computational model was performed for networks that have the same number of edges (N = 500, 600, 700, 800 edges) across all participants and groups (fixed density values). All groups exhibited a small-world (SW) brain architecture. However, we found a significant reduction in the SW brain architecture in both aMCI and MD patients relative to the group of Healthy controls. This functional disorganization was also correlated with the participant's generic cognitive status. The deterioration of the network's organization was caused mainly by deficient local information processing as quantified by the mean cluster coefficient value. Functional hubs were identified through the normalized betweenness centrality metric. Analysis of the local characteristics showed relative hub preservation even with statistically significant reduced strength. Compensatory phenomena were also evident through the formation of additional hubs on left frontal and parietal regions. Our results indicate a declined functional network organization even during the prodromal phase. Degeneration is evident even in the preclinical phase and coexists with transient network reorganization due to compensation.

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Intermittent theta burst stimulation over ipsilesional primary motor cortex of subacute ischemic stroke patients: A pilot study

Cited by 59 publications

References 56 publications

Combined motor cortex and spinal cord neuromodulation promotes corticospinal system functional and structural plasticity and motor function after injury

Combined motor cortex and spinal cord neuromodulation promotes corticospinal system functional and structural plasticity and motor function after injury

Cortical activation and inter-hemispheric sensorimotor coherence in individuals with arm dystonia due to childhood stroke

Functional disorganization of small-world brain networks in mild Alzheimer's Disease and amnestic Mild Cognitive Impairment: an EEG study using Relative Wavelet Entropy (RWE)

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