Transcranial cortico-cortical paired associative stimulation (ccPAS) over ventral premotor-motor pathways enhances action performance and corticomotor excitability in young adults more than in elderly adults

Transcranial magnetic stimulation (TMS) methods such as cortico-cortical paired associative stimulation (ccPAS) can increase the strength of functional connectivity between ventral premotor cortex (PMv) and primary motor cortex (M1) via spike timing-dependent plasticity (STDP), leading to enhanced motor functions in young adults. However, whether this STDP-inducing protocol is effective in the aging brain remains unclear. In two groups of young and elderly healthy adults, we evaluated manual dexterity with the 9-hole peg task before and after ccPAS of the left PMv-M1 circuit. We observed that ccPAS enhanced dexterity in young adults, and this effect was anticipated by a progressive increase in motor-evoked potentials (MEPs) during ccPAS administration. No similar effects were observed in elderly individuals or in a control task. Across age groups, we observed that the magnitude of MEP changes predicted larger behavioral improvements. These findings demonstrate that left PMv-to-M1 ccPAS induces functionally specific improvements in young adults' manual dexterity and an increase in corticomotor excitability, but altered plasticity prevents the effectiveness of ccPAS in the elderly

Neurophysiological Markers of Premotor–Motor Network Plasticity Predict Motor Performance in Young and Older Adults

Aging is commonly associated with a decline in motor control and neural plasticity. Tuning cortico–cortical interactions between premotor and motor areas is essential for controlling fine manual movements. However, whether plasticity in premotor–motor circuits predicts hand motor abilities in young and elderly humans remains unclear. Here, we administered transcranial magnetic stimulation (TMS) over the ventral premotor cortex (PMv) and primary motor cortex (M1) using the cortico–cortical paired-associative stimulation (ccPAS) protocol to manipulate the strength of PMv-to-M1 connectivity in 14 young and 14 elderly healthy adults. We assessed changes in motor-evoked potentials (MEPs) during ccPAS as an index of PMv-M1 network plasticity. We tested whether the magnitude of MEP changes might predict interindividual differences in performance in two motor tasks that rely on premotor-motor circuits, i.e., the nine-hole pegboard test and a choice reaction task. Results show lower motor performance and decreased PMv-M1 network plasticity in elderly adults. Critically, the slope of MEP changes during ccPAS accurately predicted performance at the two tasks across age groups, with larger slopes (i.e., MEP increase) predicting better motor performance at baseline in both young and elderly participants. These findings suggest that physiological indices of PMv-M1 plasticity could provide a neurophysiological marker of fine motor control across age-groups

Empowering Reentrant Projections from V5 to V1 Boosts Sensitivity to Motion

Evidence from macaques [1] and humans [2, 3] has shown that back projections from extrastriate areas to the primary visual area (V1) determine whether visual awareness will arise. For example, reentrant projections from the visual motion area (V5) to V1 are considered to be critical for awareness of motion [2, 3]. If these projections are also instrumental to functional processing of moving stimuli [4–8], then increasing synaptic efficacy in V5-V1 connections should induce functionally relevant short-term plastic changes, resulting in enhanced perception of visual motion. Using transcranial magnetic stimulation (TMS), we applied a novel cortico-cortical paired associative stimulation (ccPAS) protocol to transiently enhance visual motion sensitivity and demonstrate both the functional relevance of V5-V1 reentrant projections to motion perception and their plasticity. Specifically, we found that ccPAS aimed at strengthening reentrant connectivity from V5 to V1 (but not in the opposite direction) enhanced the human ability to perceive coherent visual motion. This perceptual enhancement followed the temporal profile of Hebbian plasticity [9–18] and was observed only when an optimal timing of 20 ms between TMS pulses [2, 3, 5, 6] was used, not when TMS pulses were delivered synchronously. Thus, plastic change is critically dependent on both the direction and timing of connectivity; if either of these requirements was not met, perceptual enhancement did not take place. We therefore provide novel causal evidence that V5-V1 back projections, instrumental to motion perception, are functionally malleable. These findings have implications for theoretical models of visual awareness and for the rehabilitation of visual deficits

Induction of Hebbian associative plasticity through paired non-invasive brain stimulation of premotor-motor areas to elucidate the network's functional role

The ventral premotor cortex (PMv) is believed to play a pivotal role in a multitude of visuomotor behaviors, such as sensory-guided goal-directed visuomotor transformations, arbitrary visuomotor mapping, and hyper-learnt visuomotor associations underlying automatic imitative tendencies. All these functions are likely carried out through the copious projections connecting PMv to the primary motor cortex (M1). Yet, causal evidence investigating the functional relevance of the PMv-M1 network remains elusive and scarce. In the studies reported in this thesis we addressed this issue using a transcranial magnetic stimulation (TMS) protocol called cortico-cortical paired associative stimulation (ccPAS), which relies on multisite stimulation to induce Hebbian spike-timing dependent plasticity (STDP) by repeatedly stimulating the pathway connecting two target areas to manipulate their connectivity. Firstly, we show that ccPAS protocols informed by both short- and long-latency PMv-M1 interactions effectively modulate connectivity between the two nodes. Then, by pre-activating the network to apply ccPAS in a state-dependent manner, we were able to selectively target specific functional visuo-motor pathways, demonstrating the relevance of PMv-M1 connectivity to arbitrary visuomotor mapping. Subsequently, we addressed the PMv-to-M1 role in automatic imitation, and demonstrated that its connectivity manipulation has a corresponding impact on automatic imitative tendencies. Finally, by combining dual-coil TMS connectivity assessments and ccPAS in young and elderly individuals, we traced effective connectivity of premotor-motor networks and tested their plasticity and relevance to manual dexterity and force in healthy ageing. Our findings provide unprecedent causal evidence of the functional role of the PMv-to-M1 network in young and elderly individuals. The studies presented in this thesis suggest that ccPAS can effectively modulate the strength of connectivity between targeted areas, and coherently manipulate a networks’ behavioral output. Results open new research prospects into the causal role of cortico-cortical connectivity, and provide necessary information to the development of clinical interventions based on connectivity manipulation

TMS highlights the functional relevance and malleability of cortico-cortical connections to motion and action perception

In social environments the human brain evolves systems to make sense of others’ actions and behaviours, allowing the development of social interactions and reactions. Influential theories posit that the understanding of others’ actions is realised through the activation of one’s motor system that internally simulates the kinematics of the ongoing action and predicts its sensorial outcome. This process engages an action observation network (AON) that encompasses temporal-occipital visual and parietal-frontal motor regions. The flowing visual information is coupled with motor representations through recursive bidirectional fronto-temporal interactions that are modelled by sensorimotor experience allegedly via Hebbian plastic mechanisms. However, to date there is no direct evidence on the role that connectivity plays in carrying crucial information for the AON functioning. Recent studies demonstrated the efficacy of a TMS protocol, named cortico-cortical paired associative stimulation (ccPAS), able to induce transient Hebbian-like plastic potentiation in motor neural circuits. For a mechanistic understanding of AON connections relevance for simulative processes and action prediction, we used ccPAS with the aim of empowering the synaptic efficacy of the connections between the nodes of the system. ccPAS impact on behaviour and neurophysiological responses was evaluated. On motor behaviour, a ccPAS to empower premotor-motor connectivity led to improved dexterity (Study I) revealing the circuit’s functional malleability. On low-level perception, ccPAS, boosting the re-entrant connectivity of visual cortices revealed changes in motion perception and in specific features of it (Studies II-III). We then demonstrated that premotor-motor circuit conveys crucial information for the motor simulation of observed movements (Study IV), and finally, that empowering feedback connectivity in the AON enhances action prediction accuracy (Study V). We therefore provided evidence on the functional relevance of AON connectivity that supports theoretical models, and we developed an innovative tool able to promote AON functionality by inducing plastic changes in its connections

Changing connectivity between premotor and motor cortex changes inter-areal communication in the human brain.

The ventral premotor cortex (PMv) is an important component of cortico-cortical pathways mediating prefrontal control over primary motor cortex (M1) function. Paired associative stimulation (ccPAS) is known to change PMv influence over M1 in humans, which manifests differently depending on the behavioural context. Here we show that these changes in influence are functionally linked to PMv-M1 phase synchrony changes induced by repeated paired stimulation of the two areas. PMv-to-M1 ccPAS leads to increased phase synchrony in alpha and beta bands, while reversed order M1-to-PMv ccPAS leads to decreased theta phase synchrony. These changes are visible at rest but are predictive of changes in oscillatory power in the same frequencies during movement execution and inhibition, respectively. The results unveil a link between the physiology of the motor network and the resonant frequencies mediating its interactions and provide a putative mechanism underpinning the relationship between synaptic efficacy and brain oscillations

Selective enhancement of motor cortical plasticity by observed mirror-matched actions

Watching others learn a motor task can enhance an observer's own later performance when learning the same motor task. This is thought to be due to activation of the action observation (or mirror neuron) network. Here we show that the effectiveness of plasticity induced in human motor cortex (M1) is also significantly influenced by the nature of prior action observation. In separate sessions, 17 participants watched a video showing repeated goal-directed movements (action observation) involving either the right hand (congruent condition) or the same video mirror-reversed to simulate the left hand (incongruent condition). Participants then received pulses of transcranial magnetic stimulation over the hand area of left M1 paired with median nerve stimulation of the right hand (paired associative stimulation; PAS). The resting motor-evoked potential (MEP) in right abductor pollicis brevis (APB) increased significantly 20. minutes after PAS, but only when participants had previously watched the congruent video. In this condition, all participants showed an increase in MEP amplitude at 20. minutes post-PAS. There was no change in MEP amplitude following PAS when participants watched the incongruent video. We conclude that prior action observation is a potent modulator of subsequent PAS-induced neuroplasticity, which may have important therapeutic applications

Information-Based Approaches of Noninvasive Transcranial Brain Stimulation

Progress in cognitive neuroscience relies on methodological developments to increase the specificity of knowledge obtained regarding brain function. For example, in functional neuroimaging the current trend is to study the type of information carried by brain regions rather than simply compare activation levels induced by task manipulations. In this context noninvasive transcranial brain stimulation (NTBS) in the study of cognitive functions may appear coarse and old fashioned in its conventional uses. However, in their multitude of parameters, and by coupling them with behavioral manipulations, NTBS protocols can reach the specificity of imaging techniques. Here we review the different paradigms that have aimed to accomplish this in both basic science and clinical settings and follow the general philosophy of information-based approach

Increasing and decreasing interregional brain coupling increases and decreases oscillatory activity in the human brain

The origins of oscillatory activity in the brain are currently debated, but common to many hypotheses is the notion that they reflect interactions between brain areas. Here, we examine this possibility by manipulating the strength of coupling between two human brain regions, ventral premotor cortex (PMv) and primary motor cortex (M1), and examine the impact on oscillatory activity in the motor system measurable in the electroencephalogram. We either increased or decreased the strength of coupling while holding the impact on each component area in the pathway constant. This was achieved by stimulating PMv and M1 with paired pulses of transcranial magnetic stimulation using two different patterns, only one of which increases the influence exerted by PMv over M1. While the stimulation protocols differed in their temporal patterning, they were comprised of identical numbers of pulses to M1 and PMv. We measured the impact on activity in alpha, beta, and theta bands during a motor task in which participants either made a preprepared action (Go) or withheld it (No-Go). Augmenting cortical connectivity between PMv and M1, by evoking synchronous pre- and postsynaptic activity in the PMv–M1 pathway, enhanced oscillatory beta and theta rhythms in Go and No-Go trials, respectively. Little change was observed in the alpha rhythm. By contrast, diminishing the influence of PMv over M1 decreased oscillatory beta and theta rhythms in Go and No-Go trials, respectively. This suggests that corticocortical communication frequencies in the PMv–M1 pathway can be manipulated following Hebbian spike-timing–dependent plasticity

Seeing emotions in others: Improving cognitive and neuronal mechanisms of facial expression processing

In the conceptual framework of affective neuroscience, this thesis intends to advance the understanding of the plasticity mechanisms of other’s emotional facial expression representations. Chapter 1 outlines a description of the neurophysiological bases of Hebbian plasticity, reviews influential studies that adopted paired associative stimulation procedures, and introduces new lines of research where the impact of cortico-cortical paired associative stimulation protocols on higher order cognitive functions is investigated. The experiments in Chapter 2 aimed to test the modulatory influence of a perceptual-motor training, based on the execution of emotional expressions, on the subsequent emotion intensity judgements of others’ high (i.e., full visible) and low-intensity (i.e., masked) emotional expressions. As a result of the training-induced learning, participants showed a significant congruence effect, as indicated by relatively higher expression intensity ratings for the same emotion as the one that was previously trained. Interestingly, although judged as overall less emotionally intense, surgical facemasks did not prevent the emotion-specific effects of the training to occur, suggesting that covering the lower part of other’s face do not interact with the training-induced congruence effect. In Chapter 3 it was implemented a transcranial magnetic stimulation study targeting neural pathways involving re-entrant input from higher order brain regions into lower levels of the visual processing hierarchy. We focused on cortical visual networks within the temporo-occipital stream underpinning the processing of emotional faces and susceptible to plastic adaptations. Importantly, we tested the plasticity-induced effects in a state dependent manner, by administering ccPAS while presenting different facial expressions yet afferent to a specific emotion. Results indicated that the discrimination accuracy of emotion-specific expressions is enhanced following the ccPAS treatment, suggesting that a multi-coil TMS intervention might represent a suitable tool to drive brain remodeling at a neural network level, and consequently influence a specific behavior