Bolognini, N.

Bruno, Valentina

Fossataro, Carlotta

Garbarini, Francesca

Zigiotto, L

English

Institutional Research Information System University of Turin

Most children and adolescents with ADHD are impaired in the suppressionof task irrelevant, competing stimuli (interference control) and in the in-hibition of prepotent responses. The brain region most prominentlyassociated with these aspects of inhibition control is the right inferiorfrontal gyrus (rIFG) which shows structural and functional alterations inADHD. In our talk, we will give an overview over different approachesusing transcranial direct current stimulation (tDCS) of the rIFG in healthyadults and will present findings from two of our own studies with ADHDyouth targeting the rIFG.Keywords: ADHD, executive functions, children and adolescents[0782]PILOT STUDY OF SUPPLEMENTARY MOTOR AREA RTMS FORTOURETTE'S SYNDROME IN CHILDRENC. Kahl*1, A. Kirton 1, T. Pringsheim 1, P. Croarkin 2, Q. McLellan 1, R.Swansburg 1, E. Zewdie 1, F.P. MacMaster 1. 1University of Calgary, Canada;2Mayo Clinic, USAIntroduction: Treatment options for Tourette’s Syndrome (TS) are limitedand can carry significant risk of side effects. New interventions are needed.The goal of this study is to determine the effect of fMRI-guided, low fre-quency repetitive transcranial magnetic stimulation (rTMS) on the severityof tics and underlying neurobiology in children with TS. Using low fre-quency rTMS, we inhibit activity in the supplementary motor area (SMA).We hypothesize that (1) the severity of tics will decrease with treatmentand (2) SMA GABA will increase while SMA glutamate will decrease inassociation with rTMS and clinical response.Methods: Children are recruited from a pediatric TS clinic. Inclusioncriteria include age 7-12 years and moderate to severe tics. Motor taskfMRI generates personalized maps of the SMA that are uploaded to a TMSneuronavigation system (Brainsight2). The participants, MRI, and TMSrobotic system (Axilum) are co-registered for precise targeting of SMA,allowing for motion correction. Treatment consists of 1800 low frequency(1 Hz) rTMS stimulations to the SMA at 100% resting motor threshold; 900per hemisphere. Response is defined as 30% reduction in Yale Global TicSeverity Scale (YGTSS) scores. Additional outcomes include mental healthand symptom scales, SMA spectroscopy, safety and tolerability, and roboticTMS motor mapping. All measures are completed at baseline and post-treatment.Results: The first two eleven-year-old male participants are presented.Both participants show a significant decrease in tic severity (A:30%; B:23%)and impairment (A:25%; B:50%) after treatment. Multidimensional Anxi-ety Scale for Children (MASC2) scores decreased as well (A:4%; B:42%).SMA glutamate levels also decreased (A:16.9%; B:2.2%). Procedures werewell-tolerated with no serious adverse events.Discussion: Robot-driven, personalized, neuronavigated rTMS in-terventions appear feasible and well-tolerated in children with severe TS.Treatment combined with TMS and neuroimaging may inform mecha-nisms of action and predictors of responsiveness. This study is ongoing.Keywords: TMS, Tourette's, Pediatrics, Neuroimaging[0783]CORTICAL EXCITABILITY CHANGES PARALLEL MOTOR FLUCTUATIONSIN SUBJECTS WITH PARKINSON’S DISEASE AND LEVODOPA-INDUCEDDYSKINESIAF. Turco*1, A. Canessa 1,2, C. Olivieri 1, G. Pezzoli 3, I.U. Isaias 3,4. 1 FondazioneEuropea di Ricerca Biomedica (FERB Onlus), Italy; 2University of Genoa, Italy;3Centro Parkinson ASST G. Pini-CTO Milan, Italy; 4University Hospital andJulius-Maximillian-University Wuerzburg, GermanyIntroduction: The effect of levodopa on cortical excitability in Parkinson'sdisease (PD) with levodopa-induced dyskinesia (LID) is still poorlyunderstood.Methods: We combined transcranial magnetic stimulation (TMS) andhigh-density electroencephalography (64 channels) to directly investigatelevodopa-related cortical excitability changes in 17 subjects with PD (7with LID) after overnight withdrawal of all dopaminergic drugs and at 30,60 and 180min after oral administration of 200/50mg fast-released solublelevodopa/benserazide (meds-on). We stimulated the supplementary mo-tor area (SMA) contralateral to the clinically most affected hemibody (theright side in 12 patients) and recorded TMS evoked potentials (TEPs). Wecomputed the area (immediate response area, IRA) of the first artifact-freecomponent of the TEPs of the channels over a Region Of Interest (ROI)showing the highest activity (z-score>2). Patients were evaluated with theUnified Parkinson’s Disease Rating Scale motor section (UPDRS) and theAbnormal Involuntary Movement Scale (AIMS). IRA and UPDRS valueswere calculated as percentage change from the grand mean of all mea-surements in meds-on state (e.g. IRAD%30_MEAN) or as maximum changefrom meds-off state (IRAD%MAX_OFF).Results: PDLID had longer disease duration (PD:7.0±2.1, PDLID:10.7±3.0,p<0.05), but matched for age (PD:64.5±8.5, PDLID:61.4±6.2), motorimpairment (UPDRSOFF PD:21.1±11.2, PDLID:29.3±8.5), benefit from levo-dopa (UPDRS30 PD:13.4±8.7, PDLID:16.4±5.8; UPDRS60 PD:11.6±7.2,PDLID:14.1±6.3; UPDRS180 PD:15.2±7.7, PDLID:18.0±6.0) and levodopa-equivalent daily dose (PD:597.3±210.6, PDLID:768.6±360.1mg). At 30 and60min after levodopa intake, PDLID showed mild to moderate LID (AIMSscore:7.4±4.5). Clinical improvement was paralleled by increased corticalexcitability in both groups (Figure). In comparison to non-dyskinetic pa-tients, PDLID showed a higher IRAD%MAX_OFF (PD:223.5±132.7;PDLID:671.3±328.9, p<0.01), which led to a steeper reduction of corticalexcitability to baseline level (meds-off) at 180min evaluation.Discussion: We showed that levodopa directly modulates cortical excit-ability changes, which correlatewith motor performance. PD patients withLID displayed an immediate hypersensitivity of SMA, possibly sustainingdyskinetic movements.Keywords: TMS, EEG, Parkinson's disease, DyskinesiaĂ[0784]THE ROLE OF PARIETAL CORTEX DURING MONITORING OFINVOLUNTARY MOVEMENT: A COMBINED TMS AND TDCS STUDYF. Garbarini*1, V. Bruno 1, C. Fossataro 1, L. Zigiotto 2,3, N.Bolognini 2,3. 1Dipartimento di Psicologia, Universita di Torino, Italy;2Department of Psychology, University of Milano Bicocca, Italy; 3Universityof Turin, ItalyRecent studies, involving both brain-damaged patients affected by anosog-nosia for hemiplegia and non-invasive brain stimulation in normal subjects,show that the right premotor cortex (PMC) is involved in the motor moni-toring of voluntary movements. In the present study, we asked whether thePMC is involved in the motor monitoring of involuntary movements, exter-nally triggered. We take advantage from the transcranial Direct CurrentStimulation (tDCS), in order to investigate if cortical excitability shifts in thisarea interferes with the motor monitoring of an involuntary hand twitchAbstracts / Brain Stimulation 10 (2017) 346e540 531induced by a single pulse of Transcranial Magnetic Stimulation (sTMS) overthe hand area of the primary motor cortex (M1). If PMC has a role in motormonitoring irrespective of the voluntary component of the movement, amodulation of the subjects’motormonitoring capacities after tDCSover PMCshould emerge. Twelve right-handed healthy subjects participated in thestudy. Theexperimental design comprised threeconditions: a) cathodal tDCSover the right PMC; b) cathodal tDCS over the right posterior parietal cortex(PPC); c) sham tDCS over PMC or PPC. At the end of the tDCS, participantsperformed the motor monitoring task: while being blindfolded, they had todetect and verbally report hand twitches induced by sTMS. The resultsshowed that stimulation of the right PMC does not affect the monitoring ofinvoluntary movements. Rather, it was the cathodal tDCS of the right PPC toaffect motor monitoring abilities. In particular, after PPC stimulation, wefound a significant increase of the false alarms rate (the subjects reported amuscle twitch, although nomovement was triggered by the sTMS of M1), ascompared to both PMC or sham tDCS. This finding is supports by previousevidence that intracranial stimulation of the parietal cortex during awakebrain surgery generates a non-veridical feeling of movement.Keywords: Motor monitoring, Involuntary actions, tDCS, TMS[0786]EFFECT OF REPETITIVE HIGH FREQUENCY TRANSCRANIAL MAGNETICSTIMULATION ON TRIGEMINAL NEURALGIAJ. Lopez-Trigo Mateu*1, J. Lopez-Trigo Picho 2, J. Escudero 2, P.Ortiz 2. 1Univerisdad Cardenal Herrera CEU, Spain; 2Hospital GeneralUniversitario de Valencia, SpainIntroduction: The aim of this study is to analyze the efficacy and safety ofrepetitive TMS in patients with refractory trigeminal neuralgia, and also toevaluate the maintenance of the effect.Methods: We studied 20 patients with a placebo-active rTMS trial. A total of1000 stimulus in 10minutes per sessionwith an intensity of 80%handmotorthreshold, stimulating in M1 point (facial area, contralateral pain site).We applied, at first, 5 consecutive days sessions of placebo stimulation, fol-lowed by a resting week to 24 patients, 4 were discarded by placebo effect(decrease of three points or more in VAS scale).The remaining 20 patients had a 5 days session of active stimulationapplied with a subsequent resting week. We applied a third week of activestimulation in order to evaluate the maintenance of the effect.All patients filled a visual pain scale (VAS), a verbal pain scale (VPS) and ananxiety and depression scale (HADS). We registered pain scales beforestimulationperiod (P0), atfinalplaceboweek (P1),final restingplaceboweek(P2),finalfirst activeweek (P3),final active restingweek (P4)andfinallyafterthe second active week (P5). The HADS was registered only in P0 and P5.We applied Friedman test and Wilcoxon signed-rank test for the statisticalanalysis.Results: The TMS showed significant reduction of pain (VAS and VPS) incomparison to the placebo, between P1 and P3 (p<0.05 in Friedman Test).Although the reduction of pain decreased at the end of the first activestimulation period (P3), kept stable and smaller than the placebo restingperiod (P2). We obtained again a positive effect after second active stim-ulation week (P5 with P4). Only one patient quitted the trial becausesuffered moderate headache.Discussion: Like others studies we observe that repetitive TMS is effectivein reduction of pain intensity on refractory trigeminal neuralgia. Themaintenance of TMS effect was prolonged by a second active week stim-ulation period, lasting around oneweekmore. Further studies with a largerduration and sample are needed to confirm these results.Keywords: Trigeminal neuralgia, Transcranial magnetic stimulation, Pla-cebo, Motor cortex[0787]NIRS OBSERVATION OF CHANGES IN BRAIN ACTIVITY FOLLOWING LOWFIELD MAGNETIC STIMULATIONM.L. Rohan*, R.T. Yamamoto, K. Ohashi, Y. Tong, L.M. Hocke, B.B.Frederick, B.M. Cohan. McLean Hospital, USAIntroduction: Low Field Magnetic Stimulation (LFMS) is a novel electro-magnetic treatment for depression. We propose that LFMS acts on animmediate depressed state rather than on deficits specific to particulardiagnoses, and that physiologic effects from the fields of LFMS may bepresent for all subjects but will only be associated with change in mood insubjects that have active mood dysregulation.Methods: Nine healthy controls were recruited to participate in this ran-domized, sham controlled, single blinded study. Subjects received eitheractive or sham LFMS on two separate occasions within twoweeks. Subjectswere fitted with a 12 optode cap providing 9 channels of data in bilateralpre-frontal regions. An additional infrared plethysmograph was places onthe left forefinger to record the pulse for use in the removal of physiologicconfounds. Data was then acquired in the resting state for 5 minutes,during LFMS (active or sham) for 20 minutes, and in the resting state for 5additional minutes in a continuous experiment.Standard artefact detection and timeseries analysis was performed todetect post-pre change in absolute deoxy- and oxy-hemoglobin levels forall channels as a global measure of change. Repeatedmeasures ANOVAwasused, within the FSL software package, to provide a group result.Results: We observed a significant decrease in global deoxy-hemoglobinconcentration (-0.44 +/- 0.25 mM, p<0.04) and a corresponding, trending,increase in oxy-hemoglobin concentration (+1.08 +/- 0.75 mM, p<0.8)associated with LFMS.Figure 9 Change in deoxy-hemoglpbin (blue negative, red positive).Discussion: The electric fields that LFMS induces have a global corticaldistribution. Our hypothesis is that this global stimulation results inregional responses that are translated into change in mood. These obser-vations are consistent with this.Keywords: NIRS, LFMS, Electrical, DepressionĂAbstracts / Brain Stimulation 10 (2017) 346e540532

The role of parietal cortex during monitoring of involuntary movement: a combined TMS and tDCS study.

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The role of parietal cortex during monitoring of involuntary movement: a combined TMS and tDCS study.

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