Non-invasive Stimulation of the Cerebellum in Health and Disease

The cerebellum is linked to motor, cognitive and affective functions. Anatomically, the cerebellum is part of an interconnected network including a wide range of other brain structures. This chapter reviews ways in which non-invasive stimulation has been used to activate or inhibit these circuits and how this has contributed to our understanding of cerebellar function in both motor and non-motor domains. The utility of non-invasive stimulation of the cerebellum in the treatment of neurological and psychiatric diseases (Parkinson’s disease, cerebellar ataxia, stroke, depression and schizophrenia) is discussed. The chapter concludes with consideration of the challenges that must be overcome if non-invasive cerebellar stimulation is to be adopted in a wider clinical setting

Cerebellum: an explanation for dystonia?

Dystonia is a movement disorder that is characterized by involuntary muscle contractions, abnormal movements and postures, as well as by non-motor symptoms, and is due to abnormalities in different brain areas. In this article, we focus on the growing number of experimental studies aimed at explaining the pathophysiological role of the cerebellum in dystonia. Lastly, we highlight gaps in current knowledge and issues that future research studies should focus on as well as some of the potential applications of this research avenue. Clarifying the pathophysiological role of cerebellum in dystonia is an important concern given the increasing availability of invasive and non-invasive stimulation techniques and their potential therapeutic role in this condition

Non-invasive stimulation of the social brain: the methodological challenges

Use of non-invasive brain stimulation methods (NIBS) has become a common approach to study social processing in addition to behavioural, imaging and lesion studies. However, research using NIBS to investigate social processing faces challenges. Overcoming these is important to allow valid and reliable interpretation of findings in neurotypical cohorts, but also to allow us to tailor NIBS protocols to atypical groups with social difficulties. In this review, we consider the utility of brain stimulation as a technique to study and modulate social processing. We also discuss challenges that face researchers using NIBS to study social processing in neurotypical adults with a view to highlighting potential solutions. Finally, we discuss additional challenges that face researchers using NIBS to study and modulate social processing in atypical groups. These are important to consider given that NIBS protocols are rarely tailored to atypical groups before use. Instead, many rely on protocols designed for neurotypical adults despite differences in brain function that are likely to impact response to NIBS

Modulation of laser-evoked pain perception and event-related potentials with non-invasive stimulation of the motor cortex

In the last two decades new techniques of non-invasive brain stimulation have been introduced that enable relatively long-lasting and reversible facilitation or inhibition of distinct cortical areas by modulating the excitability of underlying neurons. Among these methods, repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are the most widespread ones. To date, both have been successfully used to modulate various perceptual, cognitive and motor functions in healthy subjects and several diseases, including chronic pain. Their efficacy regarding acute pain perception in healthy subjects, however, is still not well-established. The aims of our studies were to investigate the effects of a novel rTMS paradigm, called continuous theta-burst stimulation (cTBS), and tDCS on laser-induced acute pain perception and laser-evoked potentials (LEPs) when applied to the motor cortex of healthy adult volunteers. In two psychophysical and two electrophysiological experiments, we have compared the effects of real cTBS and two tDCS protocols (anodal and cathodal) to those of sham stimulations. We have shown for the first time that cTBS over the motor cortex significantly alleviated laser-induced pain on both hands, accentuating on the con tralateral limb. The effect of cTBS was accompanied by reduced N2-P2 LEP amplitudes in the case of medium intensity pain. In the tDCS experiments, cathodal stimulation of the motor cortex reduced mild pain contralateral to the side of stimulation. Moreover, cathodal tDCS attenuated N2-P2 LEP components, without modulating thresholds of medium intensity pain. On the contrary, anodal tDCS facilitated laser-induced warm sensation contralateral to the side of tDCS, without affecting either pain sensation or LEPs. Our results indicate that non-invasive stimulation of the motor cortex causes antinociceptive effects that depend on the parameters of stimulation and are probably due to excitability changes in remote pain-related areas such as the operculoinsular region and the anterior cingulate cortex. These findings further strengthen the application of cTBS and tDCS in pain research, which might contribute to a more efficient manipulation of brain plasticity for therapeutic purposes

Non-invasive electrical and magnetic stimulation of the brain, spinal cord, roots and peripheral nerves: Basic principles and procedures for routine clinical and research application. An updated report from an I.F.C.N. Committee

These guidelines provide an up-date of previous IFCN report on "Non-invasive electrical and magnetic stimulation of the brain, spinal cord and roots: basic principles and procedures for routine clinical application" (Rossini et al., 1994). A new Committee, composed of international experts, some of whom were in the panel of the 1994 "Report", was selected to produce a current state-of-the-art review of non-invasive stimulation both for clinical application and research in neuroscience. Since 1994, the international scientific community has seen a rapid increase in non-invasive brain stimulation in studying cognition, brain-behavior relationship and pathophysiology of various neurologic and psychiatric disorders. New paradigms of stimulation and new techniques have been developed. Furthermore, a large number of studies and clinical trials have demonstrated potential therapeutic applications of non-invasive brain stimulation, especially for TMS. Recent guidelines can be found in the literature covering specific aspects of non-invasive brain stimulation, such as safety (Rossi et al., 2009), methodology (Groppa et al., 2012) and therapeutic applications (Lefaucheur et al., 2014). This up-dated review covers theoretical, physiological and practical aspects of non-invasive stimulation of brain, spinal cord, nerve roots and peripheral nerves in the light of more updated knowledge, and include some recent extensions and developments

Non-invasive stimulation techniques to relieve abdominal/pelvic pain: is more always better?

Chronic abdominal and pelvic pain is a common condition that has significant impact on quality of life, and causes billions of dollars in direct and indirect costs. Emerging data suggest that transcranial direct current stimulation (tDCS), alone or in combination with transcutaneous electrical nerve stimulation TENS), could be a promising therapeutic avenue to reduce chronic pain. The encouraging results coming from these studies prompted us to try combining TENS and tDCS in 4 of our patients who suffered from chronic abdominal/pelvic pain and to compare the effect with 5 other patients who received TENS alone. Pain intensity was assessed with a visual analog scale before, during and after the stimulation. We observed that there was a slight decrease in pain which was similar in both patient groups (TENS alone and TENS combined with tDCS). These observations suggest that combining TENS and tDCS in patients suffering from chronic pelvic and/or abdominal pain produces no additional benefit, compared to TENS alone. Future studies, looking at the effect of several/consecutive TENS and tDCS sessions should be conducted

Brain rhythms: enhancing memories

Summary: A new study shows that different processes are responsible for maintaining relevant and suppressing irrelevant information. By promoting the suppression of irrelevant information, memories may be enhanced