15 research outputs found
Water and Brain Function: Effects of Hydration Status on Neurostimulation and Neurorecording
Introduction: TMS and EEG are used to study normal neurophysiology, diagnose, and treat clinical neuropsychiatric conditions, but can produce variable results or fail. Both techniques depend on electrical volume conduction, and thus brain volumes. Hydration status can affect brain volumes and functions (including cognition), but effects on these techniques are unknown. We aimed to characterize the effects of hydration on TMS, EEG, and cognitive tasks. Methods: EEG and EMG were recorded during single-pulse TMS, paired-pulse TMS, and cognitive tasks from 32 human participants on dehydrated (12-hour fast/thirst) and rehydrated (1 Liter oral water ingestion in 1 hour) testing days. Hydration status was confirmed with urinalysis. MEP, ERP, and network analyses were performed to examine responses at the muscle, brain, and higher-order functioning. Results: Rehydration decreased motor threshold (increased excitability) and shifted the motor hotspot. Significant effects on TMS measures occurred despite being re-localized and re-dosed to these new parameters. Rehydration increased SICF of the MEP, magnitudes of specific TEP peaks in inhibitory protocols, specific ERP peak magnitudes and reaction time during the cognitive task. Rehydration amplified nodal inhibition around the stimulation site in inhibitory paired-pulse networks and strengthened nodes outside the stimulation site in excitatory and CSP networks. Cognitive performance was not improved by rehydration, although similar performance was achieved with generally weaker network activity. Discussion: Results highlight differences between mild dehydration and rehydration. The rehydrated brain was easier to stimulate with TMS and produced larger responses to external and internal stimuli. This is explainable by the known physiology of body water dynamics, which encompass macroscopic and microscopic volume changes. Rehydration can shift 3D cortical positioning, decrease scalp cortex distance (bringing cortex closer to stimulator/recording electrodes), and cause astrocyte swelling-induced glutamate release. Conclusions: Previously unaccounted variables like osmolarity, astrocyte and brain volumes likely affect neurostimulation/neurorecording. Controlling for and carefully manipulating hydration may reduce variability and improve therapeutic outcomes of neurostimulation. Dehydration is common and produces less excitable circuits. Rehydration should offer a mechanism to macroscopically bring target cortical areas closer to an externally applied neurostimulation device to recruit greater volumes of tissue and microscopically favor excitability in the stimulated circuits
Syndrome douloureux régional complexe : apport de la neurostimulation périphérique - Plasticité cérébrale et amélioration cliniques
MalgrĂ© des traitements spĂ©cialisĂ©s et multidisciplinaires, les personnes souffrant du syndrome douloureux rĂ©gional complexe (SDRC) peuvent conserver de la douleur et des limitations fonctionnelles qui sâexpliqueraient par des changements cĂ©rĂ©braux persistants, entre autres dans le cortex moteur primaire (M1). Ătudier les changements de fonctionnement du M1 permettrait de mieux comprendre comment utiliser la neurostimulation non invasive, comme les stimulations magnĂ©tiques rĂ©pĂ©tĂ©es en pĂ©riphĂ©rie (rPMS des muscles, connues pour influencer la plasticitĂ© cĂ©rĂ©brale), pour normaliser la fonction motrice corticale, rĂ©duire la douleur et augmenter les gains cliniques. Les objectifs de ce projet de maĂźtrise Ă©taient donc de mieux comprendre la place dans la littĂ©rature de la neurostimulation non invasive en SDRC, de tester le fonctionnement de M1en parallĂšle Ă la fonction sensorimotrice dâadultes avec SDRC au membre supĂ©rieur, ainsi que de mesurer lâeffet dâune sĂ©ance rPMS sur ces mesures et les symptĂŽmes de douleur de cette mĂȘme population. Il a Ă©tĂ© observĂ© que, indĂ©pendamment du cĂŽtĂ© atteint, lâexcitabilitĂ© du M1 Ă©tait asymĂ©trique en SDRC avec une association avec la douleur et les troubles du mouvement. Les participants avec SDRC prĂ©sentaient Ă©galement une diminution et une latĂ©ralisation altĂ©rĂ©e des mesures de fonction sensorimotrice. Les rPMS ont permis de moduler bilatĂ©ralement lâexcitabilitĂ© des M1 (diminution du dĂ©balancement) et, chez les personnes prĂ©sentant avant la sĂ©ance rPMS une hyperexcitabilitĂ© du M1 controlatĂ©ral au membre atteint, de diminuer leur douleur. Les rPMS ont Ă©galement permis une amĂ©lioration de la fonction sensorimotrice et des changements centraux reliĂ©s Ă la plasticitĂ© cĂ©rĂ©brale ont Ă©tĂ© mesurĂ©s dans lâhĂ©misphĂšre ipsilatĂ©ral au membre avec SDRC. Les rPMS seules ou comme adjuvant aux thĂ©rapies conventionnelles de rĂ©adaptation reprĂ©sentent donc une approche prometteuse pour dĂ©passer les gains cliniques en SDRC.Despite specialized and multidisciplinary treatments, people suffering from complex regional pain syndrome (CRPS) can present with persistent pain and functional limitations likely due to brain changes such as in the primary motor cortex (M1). Studying the changes of M1 functioning would permit to better understand how to use noninvasive neurostimulation, as repetitive peripheral magnetic stimulation (rPMS of muscles, known to influence brain plasticity) in CRPS to enable the normalization of cortical motor function, the reduction of pain and to go beyond gains already reached. The objectives of this masterâs project were thus to better understand the place in the literature of the noninvasive neurostimulation in SDRC, to test the functioning of M1 concurrent with the sensorimotor function of adults with CRPS of the upper limb, and to measure the effect of one rPMS session on these measures and pain symptoms of this same population. It has been measured that M1 excitability was asymmetrical in CRPS, regardless of the impaired side, with an association to pain and movement disorders. Participants with CRPS also exhibited a decreased and an altered lateralization of the measures of sensorimotor function. rPMS influenced bilateral M1 excitability (decrease of the imbalance) and, with people presenting before the rPMS session hyperactivity of M1 contralateral to the impaired limb, reduced pain. rPMS also improved sensorimotor function and central changes related to brain plasticity were measured in the hemisphere ipsilateral to the CRPS limb. rPMS alone or as adjuvant to conventional rehabilitation therapies thus represent a promising approach to overcome clinical gains in CRPS
Clinical Pathways in Stroke Rehabilitation
This open access book focuses on practical clinical problems that are frequently encountered in stroke rehabilitation. Consequences of diseases, e.g. impairments and activity limitations, are addressed in rehabilitation with the overall goal to reduce disability and promote participation. Based on the available best external evidence, clinical pathways are described for stroke rehabilitation bridging the gap between clinical evidence and clinical decision-making. The clinical pathways answer the questions which rehabilitation treatment options are beneficial to overcome specific impairment constellations and activity limitations and are well acceptable to stroke survivors, as well as when and in which settings to provide rehabilitation over the course of recovery post stroke. Each chapter starts with a description of the clinical problem encountered. This is followed by a systematic, but concise review of the evidence (RCTs, systematic reviews and meta-analyses) that is relevant for clinical decision-making, and comments on assessment, therapy (training, technology, medication), and the use of technical aids as appropriate. Based on these summaries, clinical algorithms / pathways are provided and the main clinical-decision situations are portrayed. The book is invaluable for all neurorehabilitation team members, clinicians, nurses, and therapists in neurology, physical medicine and rehabilitation, and related fields. It is a World Federation for NeuroRehabilitation (WFNR) educational initiative, bridging the gap between the rapidly expanding clinical research in stroke rehabilitation and clinical practice across societies and continents. It can be used for both clinical decision-making for individuals and as well as clinical background knowledge for stroke rehabilitation service development initiatives. ; Provides evidence-based clinical practice guidelines for stroke rehabilitation Discusses clinical problems and evidence, comments on assessment, therapy and technical aids Written by experienced experts with a background in clinical practic
A Systematic Review and Meta-Analysis of the Incidence of Injury in Professional Female Soccer
The epidemiology of injury in male professional football is well documented and has been used as a basis to monitor injury trends and implement injury prevention strategies. There are no systematic reviews that have investigated injury incidence in womenâs professional football. Therefore, the extent of injury burden in womenâs professional football remains unknown. PURPOSE: The primary aim of this study was to calculate an overall incidence rate of injury in senior female professional soccer. The secondary aims were to provide an incidence rate for training and match play. METHODS: PubMed, Discover, EBSCO, Embase and ScienceDirect electronic databases were searched from inception to September 2018. Two reviewers independently assessed study quality using the Strengthening the Reporting of Observational Studies in Epidemiology statement using a 22-item STROBE checklist. Seven prospective studies (n=1137 professional players) were combined in a pooled analysis of injury incidence using a mixed effects model. Heterogeneity was evaluated using the Cochrane Q statistic and I2. RESULTS: The epidemiological incidence proportion over one season was 0.62 (95% CI 0.59 - 0.64). Mean total incidence of injury was 3.15 (95% CI 1.54 - 4.75) injuries per 1000 hours. The mean incidence of injury during match play was 10.72 (95% CI 9.11 - 12.33) and during training was 2.21 (95% CI 0.96 - 3.45). Data analysis found a significant level of heterogeneity (total Incidence, X2 = 16.57 P < 0.05; I2 = 63.8%) and during subsequent sub group analyses in those studies reviewed (match incidence, X2 = 76.4 (d.f. = 7), P <0.05; I2 = 90.8%, training incidence, X2 = 16.97 (d.f. = 7), P < 0.05; I2 = 58.8%). Appraisal of the study methodologies revealed inconsistency in the use of injury terminology, data collection procedures and calculation of exposure by researchers. Such inconsistencies likely contribute to the large variance in the incidence and prevalence of injury reported. CONCLUSIONS: The estimated risk of sustaining at least one injury over one football season is 62%. Continued reporting of heterogeneous results in population samples limits meaningful comparison of studies. Standardising the criteria used to attribute injury and activity coupled with more accurate methods of calculating exposure will overcome such limitations
Developing a BrainâBased, NonâInvasive Treatment for Pain
Chronic pain cost society more than $500 billion each year and contributes to the ongoing opioid overdose crisis. Substantial risks and low efficacy are associated with opiate usage for chronic pain. This dissertation seeks to fill the urgent need for a new pain treatment using a neural-circuit based approach in healthy controls and chronic pain patients. First, we performed a single-blind study examining the causal effects of transcranial magnetic stimulation (TMS), compared to a well-matched control condition. Using interleaved TMS/fMRI we explored brain activation in response to dorsolateral prefrontal cortex (DLPFC) stimulation in 20 healthy controls. This study tested the hypothesis that the TMS evoked responses would be in frontostriatal locations. Consistent with this hypothesis active TMS, compared to the control, led to significantly greater activity in the caudate, thalamus and anterior cingulate cortex (ACC). Building on these findings, we developed a single-blind, sham-controlled study examining two TMS strategies for analgesia in 45 healthy controls. We completed an fMRI thermal pain paradigm before and after modulatory repetitive TMS at either the DLPFC or the medial prefrontal cortex (MPFC). Despite a role in pain processing, the MPFC has not yet been explored as a target for analgesia. Only MPFC stimulation significantly improved behavioral pain measures. These effects were associated with increased motor and parietal cortex activity during the pain task. We then supplement these findings by testing the hypothesis that chronic pain patients who use opioids (n=14) would have elevated brain responses to thermal pain relative to healthy controls (n=14). Despite indistinguishable self-report measures, we found increased brain activity in the ACC and sensory areas in patients which were positively correlated with opioid dose. We conclude by evaluating the feasibility of these approaches in chronic pain patients, reporting preliminary findings from a pilot study examining the two treatment strategies tested previously in controls. Collectively, our findings support a circuits-first approach to pain treatment. Though MPFC stimulation was effective in reducing pain in healthy controls, further work is required to confirm these results in a chronic pain population, as chronic pain and opioid usage alter how the brain processes the pain experience
Neuroplasticity of Ipsilateral Cortical Motor Representations, Training Effects and Role in Stroke Recovery
This thesis examines the contribution of the ipsilateral hemisphere to motor control with the aim of evaluating the potential of the contralesional hemisphere to contribute to motor recovery after stroke. Predictive algorithms based on neurobiological principles emphasize integrity of the ipsilesional corticospinal tract as the strongest prognostic indicator of good motor recovery. In contrast, extensive lesions placing reliance on alternative contralesional ipsilateral motor pathways are associated with poor recovery. Within the predictive algorithms are elements of motor control that rely on contributions from ipsilateral motor pathways, suggesting that balanced, parallel contralesional contributions can be beneficial. Current therapeutic approaches have focussed on the maladaptive potential of the contralesional hemisphere and sought to inhibit its activity with neuromodulation. Using Transcranial Magnetic Stimulation I seek examples of beneficial plasticity in ipsilateral cortical motor representations of expert performers, who have accumulated vast amounts of deliberate practise training skilled bilateral activation of muscles habitually under ipsilateral control. I demonstrate that ipsilateral cortical motor representations reorganize in response to training to acquisition of skilled motor performance. Features of this reorganization are compatible with evidence suggesting ipsilateral importance in synergy representations, controlled through corticoreticulopropriospinal pathways. I demonstrate that ipsilateral plasticity can associate positively with motor recovery after stroke. Features of plastic change in ipsilateral cortical representations are shown in response to robotic training of chronic stroke patients. These findings have implications for the individualization of motor rehabilitation after stroke, and prompt reappraisal of the approach to therapeutic intervention in the chronic phase of stroke
Low intensity transcranial magnetic stimulation modulates skilled motor learning in adult mice
Repetitive transcranial magnetic stimulation (rTMS) is commonly used to modulate cortical plasticity in clinical and non-clinical populations. Clinically, rTMS is delivered to targeted regions of the cortex at high intensities (>1 T). We have previously shown that even at low intensities, rTMS induces structural and molecular plasticity in the rodent cortex. To determine whether low intensity rTMS (LI-rTMS) alters behavioural performance, daily intermittent theta burst LI-rTMS (120 mT) or sham was delivered as a priming or consolidating stimulus to mice completing 10 consecutive days of skilled reaching training. Relative to sham, priming LI-rTMS (before each training session), increased skill accuracy (~9%) but did not alter the rate of learning over time. In contrast, consolidating LI-rTMS (after each training session), resulted in a small increase in the rate of learning (an additional ~1.6% each day) but did not alter the daily skill accuracy. Changes in behaviour with LI-rTMS were not accompanied with long lasting changes in brain-derived neurotrophic factor (BDNF) expression or in the expression of plasticity markers at excitatory and inhibitory synapses for either priming or consolidation groups. These results suggest that LI-rTMS can alter specific aspects of skilled motor learning in a manner dependent on the timing of intervention
Using guitar learning to probe the Action Observation Network's response to visuomotor familiarity
Watching other people move elicits engagement of a collection of sensorimotor brain regions collectively termed the Action Observation Network (AON). An extensive literature documents more robust AON responses when observing or executing familiar compared to unfamiliar actions, as well as a positive correlation between amplitude of AON response and an observer's familiarity with an observed or executed movement. On the other hand, emerging evidence shows patterns of AON activity counter to these findings, whereby in some circumstances, unfamiliar actions lead to greater AON engagement than familiar actions. In an attempt to reconcile these conflicting findings, some have proposed that the relationship between AON response amplitude and action familiarity is nonlinear in nature. In the present study, we used an elaborate guitar training intervention to probe the relationship between movement familiarity and AON engagement during action execution and action observation tasks. Participants underwent fMRI scanning while executing one set of guitar sequences with a scanner-compatible bass guitar and observing a second set of sequences. Participants then acquired further physical practice or observational experience with half of these stimuli outside the scanner across 3 days. Participants then returned for an identical scanning session, wherein they executed and observed equal numbers of familiar (trained) and unfamiliar (untrained) guitar sequences. Via region of interest analyses, we extracted activity within AON regions engaged during both scanning sessions, and then fit linear, quadratic and cubic regression models to these data. The data best support the cubic regression models, suggesting that the response profile within key sensorimotor brain regions associated with the AON respond to action familiarity in a nonlinear manner. Moreover, by probing the subjective nature of the prediction error signal, we show results consistent with a predictive coding account of AON engagement during action observation and execution that also takes into account effects of changes in neural efficiency
Resting state fMRI study of brain activation using rTMS in rats
Background and purpose: Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation technique used to treat many neurological and psychiatric conditions. However, not much is known about the mechanisms underlying its efficacy because human rTMS studies are mostly non-invasive while most animal studies are invasive. Invasive animal studies allow for cellular and molecular changes to be detected and hence, have been able to show that rTMS may alter synaptic plasticity in the form of long-term potentiation. This is the first rodent study using non-invasive resting state functional magnetic resonance imaging (rs-fMRI) to examine the effects of low-intensity rTMS (LI-rTMS) in order to provide a more direct comparison to human studies.
Methods: rs-fMRI data were acquired before and after 10 minutes of LI-rTMS intervention at one of four frequenciesâ1 Hz, 10 Hz, biomimetic high frequency stimulation (BHFS) and continuous theta burst stimulation (cTBS)âin addition to sham. We used independent component analysis to uncover changes in the default mode network (DMN) induced by each rTMS protocol.
Results: There were considerable rTMS-related changes in the DMN. Specifically, (1) the synchrony of resting activity of the somatosensory cortex was decreased ipsilaterally following 10 Hz stimulation, increased ipsilaterally following cTBS, and decreased bilaterally following 1 Hz stimulation and BHFS; (2) the motor cortex showed bilateral changes following 1 Hz and 10 Hz stimulation, an ipsilateral increase in synchrony of resting activity following cTBS, and a contralateral decrease following BHFS; and (3) in the hippocampus, 10 Hz stimulation caused an ipsilateral decrease while 1 Hz and BHFS caused a bilateral decrease in synchrony. There was no change in the correlation of the hippocampus induced by cTBS.
Conclusion: The present findings suggest that LI-rTMS can modulate functional links within the DMN of rats. LI-rTMS can induce changes in the cortex, as well as in remote brain regions such as the hippocampus when applied to anaesthetised rats and the pattern of these changes depends on the frequency used, with 10 Hz stimulation, BHFS and cTBS causing mostly ipsilateral changes in synchrony of activity in the DMN and 1 Hz stimulation causing bilateral changes in synchrony, with the contralateral changes being more prominent than ipsilateral changes. Hence, combined rTMS-fMRI emerges as a powerful tool to visualise rTMS-induced cortical connectivity changes at a high spatio-temporal resolution and help unravel the physiological processes underlying these changes in the cortex and interconnected brain regions