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

Developing a Brain‐Based, Non‐Invasive 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

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 frequencies—1 Hz, 10 Hz, biomimetic high frequency stimulation (BHFS) and continuous theta burst stimulation (cTBS)—in 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

Effects of dance therapy on balance, gait and neuro-psychological performances in patients with Parkinson's disease and postural instability

Postural Instability (PI) is a core feature of Parkinson’s Disease (PD) and a major cause of falls and disabilities. Impairment of executive functions has been called as an aggravating factor on motor performances. Dance therapy has been shown effective for improving gait and has been suggested as an alternative rehabilitative method. To evaluate gait performance, spatial-temporal (S-T) gait parameters and cognitive performances in a cohort of patients with PD and PI modifications in balance after a cycle of dance therapy

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

Syndrome douloureux régional complexe : apport de la neurostimulation périphérique - Plasticité cérébrale et amélioration cliniques

Malgré des traitements spécialisés et multidisciplinaires, les personnes souffrant du syndrome douloureux régional complexe (SDRC) peuvent conserver de la douleur et des limitations fonctionnelles qui s’expliqueraient par des changements cérébraux persistants, entre autres dans le cortex moteur primaire (M1). Étudier les changements de fonctionnement du M1 permettrait de mieux comprendre comment utiliser la neurostimulation non invasive, comme les stimulations magnétiques répétées en périphérie (rPMS des muscles, connues pour influencer la plasticité cérébrale), pour normaliser la fonction motrice corticale, réduire la douleur et augmenter les gains cliniques. Les objectifs de ce projet de maîtrise étaient donc de mieux comprendre la place dans la littérature de la neurostimulation non invasive en SDRC, de tester le fonctionnement de M1en parallèle à la fonction sensorimotrice d’adultes avec SDRC au membre supérieur, ainsi que de mesurer l’effet d’une séance rPMS sur ces mesures et les symptômes de douleur de cette même population. Il a été observé que, indépendamment du côté atteint, l’excitabilité du M1 était asymétrique en SDRC avec une association avec la douleur et les troubles du mouvement. Les participants avec SDRC présentaient également une diminution et une latéralisation altérée des mesures de fonction sensorimotrice. Les rPMS ont permis de moduler bilatéralement l’excitabilité des M1 (diminution du débalancement) et, chez les personnes présentant avant la séance rPMS une hyperexcitabilité du M1 controlatéral au membre atteint, de diminuer leur douleur. Les rPMS ont également permis une amélioration de la fonction sensorimotrice et des changements centraux reliés àla plasticité cérébrale ont été mesurés dans l’hémisphère ipsilatéral au membre avec SDRC. Les rPMS seules ou comme adjuvant aux thérapies conventionnelles de réadaptation représentent donc une approche prometteuse pour dépasser 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 master’s 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

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