Posts Tagged Transcranial magnetic stimulation

[ARTICLE] Effects of High-Frequency Repetitive Transcranial Magnetic Stimulation Combined with Task-Oriented Mirror Therapy Training on Hand Rehabilitation of Acute Stroke Patients – Full Text PDF

BACKGROUND: Impairments of hand function make it difficult to perform daily life activities and to return to work. The aim of this study was to investigate the effect of high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) combined with task-oriented mirror therapy (TOMT) on hand rehabilitation in acute stroke patients.
MATERIAL AND METHODS: Twenty subacute stroke patients in the initial stages (<3 months) participated in the study. Subjects were allocated to 2 groups: the experimental group received HF-rTMS + TOMT and the control group received HF-rTMS. TOMT training was conducted in 10 sessions over 2 weeks for 30 min. rTMS was applied at a 20 Hz frequency over the hand motor area in the cortex of the affected hemisphere for 15 min. Outcomes, including motor-evoked potential (MEP), pinch grip, hand grip, and box and block test, were measured before and after training.
RESULTS: Significant improvements in the MEP and hand function variables were observed in both groups (p<0.05). In particular, hand functions (pinch grip and box and block test) were significantly different between the 2 groups (p<0.05).
CONCLUSIONS: HF-rTMS combined with TOMT had a positive effect on hand function and can be used for the rehabilitation of precise hand movements in acute stroke patients.

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[Abstract] Long-lasting effects of transcranial static magnetic field stimulation on motor cortex excitability

Abstract

Background

Transcranial static magnetic field stimulation (tSMS) was recently added to the family of inhibitory non-invasive brain stimulation techniques. However, the application of tSMS for 10–20 min over the motor cortex (M1) induces only short-lasting effects that revert within few minutes.

Objective

We examined whether increasing the duration of tSMS to 30 min leads to long-lasting changes in cortical excitability, which is critical for translating tSMS toward clinical applications.

Methods

The study comprised 5 experiments in 45 healthy subjects. We assessed the impact of 30-min-tSMS over M1 on corticospinal excitability, as measured by the amplitude of motor evoked potentials (MEPs) and resting motor thresholds (RMTs) to single-pulse transcranial magnetic stimulation (TMS) (experiments 1–2). We then assessed the impact of 30-min-tSMS on intracortical excitability, as measured by short-interval intracortical facilitation (SICF) and short-interval intracortical inhibition (SICI) using paired-pulse TMS protocols (experiments 2–4). We finally assessed the impact of 10-min-tSMS on SICF and SICI.

Results

30-min-tSMS decreased MEP amplitude compared to sham for at least 30 min after the end of the stimulation. This long-lasting effect was associated with increased SICF and reduced SICI. 10-min-tSMS –previously reported to induce a short-lasting decrease in MEP amplitude– produced the opposite changes in intracortical excitability, decreasing SICF while increasing SICI.

Conclusions

These results suggest a dissociation of intracortical changes in the consolidation from short-lasting to long-lasting decrease of corticospinal excitability induced by tSMS. The long-lasting effects of 30-min-tSMS open the way to the translation of this simple, portable and low-cost technique toward clinical trials.

via Long-lasting effects of transcranial static magnetic field stimulation on motor cortex excitability – Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation

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[WEB SITE] How Doctors Are Using Brain Imaging to Treat Depression

Typically, depression is diagnosed based on what a patient describes about their emotional and mental state. People who suffer from depression often state that they’re sad more often than not and that things they used to enjoy are no longer enjoyable.

The biggest hurdle in diagnosing depression is overcoming the stigma and embarrassment of possibly having a mental health disorder. It’s hard to talk about such raw, emotional, and personal details. Another issue is the fact that depression manifests itself in different ways. Some patients stop eating, others gain weight and suffer from anxiety. There’s no one-size-fits-all when it comes to depression symptoms.

While there aren’t many biological indicators that can be used to diagnose someone with depression, brain imaging has proven to be useful in diagnosing and helping to shape a treatment plan.

What Does Brain Imaging Show?

A recent study that was published in Nature Medicine discuss biological markers that can be used to distinguish different types of depression. To get a better look at the brain, functional magnetic resonance imaging was used to measure the connection strength between the brain and neural circuits. From these images researchers were able to pinpoint four types of depression.

While further research is needed to confirm initial findings, the potential of using biological indicators paves the way for clearer diagnoses and more personalized and effective therapies that treat the brain.

Based on the research, it was observed that certain patients experienced higher levels of fatigue while others discussed a lack of pleasure. In the future there is hope that certain treatment types can be matched to a type of depression. For example, those who report a lack of pleasure may benefit from a treatment known as transcranial magnetic stimulation (TMS). Because TMS uses a magnet to create small electric currents in the brain, the under-functioning reasons can be restored through TMS therapy.

The Next Steps

Though several studies have been conducted to compare depressed brains to those who don’t have the condition, it will take some time before brain imaging becomes a fool-proof way of diagnosing depression. Doctors and researchers will need to find common ground and patterns between the various types of depression so there is one unified method of determining if a patient has depression and the type.

In the future, it’s hoped that brain imaging can not only be used to diagnose depression but also to:

  • Determine treatment options
  • Determine the success rate of treatment
  • Understand other mental health disorders
  • Diagnose other conditions that may impact depression symptoms

While there is still a way to go in using brain imaging to diagnose and treat depression, the future is bright in this health arena.

Treatment Options

There are several forms of brain treatment that can be used to treat depression. The top two options include electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS).

Electroconvulsive Therapy (ECT)

The use of ECT dates back hundreds of years. In fact, ECT is the most commonly used brain treatment for those who suffer from depression. When undergoing ECT treatment, an electric current is formed in the brain that creates a spurt of energy. This causes the patient to have a seizure. Though seizures can be quite scary to experience and even scarier to watch, patients are given anesthesia and a muscle relaxant to avoid the convulsions that are often seen in someone who is having a seizure.

The biggest drawback to ECT is memory loss. Patients often have a hard time remembering past memories so doctors encourage people to create new memories to get that functionality in the brain back up and running.

Transcranial Magnetic Stimulation (TMS)

While electroconvulsive therapy (ECT) is often the go-to procedure for those with severe, long-term, or treatment resistant depression, TMS has proven to be an effective brain treatment for depression. As we better understand how depression impacts regions of the brain, especially the prefrontal cortex, doctors will be able to pinpoint which treatment of combination thereof will produce the best results for a patient.

TMS is beneficial in that it is safe, non-invasive, has minimal side effects, and is designed to target and restore those abnormal connections in the brain. Unlike ECT and other forms of brain treatment options, TMS typically produces minimal to no side effects. Some patients have complained of headache and scalp discomfort but nothing as serious as the memory loss that is often found in those who undergo ECT.

Conclusion

As it stands physical symptoms are the best indicators of whether or not someone has depression. But, with the continued research of using brain imaging to diagnose and determine treatment brings new hope and ideas into the mental health realm.

via How Doctors Are Using Brain Imaging to Treat Depression

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[Abstract] Decreased short-interval intracortical inhibition correlates with better pinch strength in patients with stroke and good motor recovery

Abstract

Background

Deeper short-interval intracortical inhibition (SICI), a marker of GABAA activity, correlates with better motor performance in patients with moderate to severe hand impairments in the chronic phase after stroke.

Objectives

We evaluated the correlation between SICI in the affected hemisphere and pinch force of the paretic hand in well-recovered patients. We also investigated the correlation between SICI and pinch force in controls.

Methods

Twenty-two subjects were included in the study. SICI was measured with a paired-pulse paradigm. The correlation between lateral pinch strength and SICI was assessed with Spearman’s rho.

Results

There was a significant correlation (rho = 0.69, p = 0.014) between SICI and pinch strength in patients, but not in controls. SICI was significantly deeper in patients with greater hand weakness.

Conclusions

These preliminary findings suggest that decreased GABAA activity in M1AH correlates with better hand motor performance in well-recovered subjects with stroke in the chronic phase.

via Decreased short-interval intracortical inhibition correlates with better pinch strength in patients with stroke and good motor recovery – Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation

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[PINTEREST Board] transcranial Direct Current Stimulation (tDCS), Transcranial Magnetic Stimulation (TMS)

 

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[WEB SITE] Insights from TMS into recovery after stroke

Posted in Clinical Review Article on 11th Dec 2017

Transcranial Magnetic Stimulation (TMS) is a non-invasive technique whereby an electro-magnetic coil held over the scalp is used to induce a brief electrical current in the cortex of the underlying brain. TMS may be used in a number of ways to gain in vivo insights into brain physiology and has provided a window into the cascade of physiological changes that occur following stroke. When stimulating the primary motor cortex in a healthy subject stimuli of an intensity above the motor threshold will give rise to a detectable evoked potential in a peripheral muscle. As the stimulus intensity is gradually increased the evoked potentials increase in amplitude up to a maximum, giving rise to a measurable recruitment curve. The motor threshold and the recruitment curve both provide measures of the excitability of the corticospinal tract. This incorporates the excitability of axons within the motor cortex, synaptic inputs onto pyramidal cells and the spinal alpha motor neuron pool. In paired pulse TMS a sub-threshold pulse is delivered a few milliseconds before a second suprathreshold pulse, both through the same coil. The first pulse conditions the response to the second, resulting in inhibition or facilitation depending upon the inter-stimulus interval and reflecting the activity in intracortical regulatory circuits. If two separate TMS coils are used then one may use a similar test-conditioning approach to explore inter-regional interactions, such as interhemispheric inhibition between the two primary motor cortices (Figure 1). Alternatively pulses may be delivered during a motor task, and the resulting effect on behaviour used to infer the stimulated region’s role in task performance, for example during a simple reaction time or movement selection task. See Reis et al1 for a summary of these techniques and their physiological basis.

Figure 1. TMS measures of motor cortical physiology. a) Eliciting a Motor Evoked Potential (MEP) from the primary motor cortex, b) Measures of corticospinal tract excitability, c) Using paired pulse stimulation to measure Intracortical inhibition, d) Using two TMS coils to measure Interhemispheric Inhibition.

Strokes that cause hemiparesis usually disrupt the corticospinal tract, and when testing the stroke hemisphere this may manifest as increased motor thresholds, flattened recruitment curves, or alternatively as the inability to elicit an evoked potential at all. An absent evoked potential in the acute post-stroke period is a poor prognostic indicator for motor recovery2,3 and at that stage these markers of corticospinal excitability, when obtainable, correlate strongly with clinical measures of motor performance.4 If these corticospinal excitability measures improve then they usually do so over the early weeks post-stroke, presumably reflecting spontaneous biological recovery around the infarct, and the physiological change is reflected in clinical improvement in this group. It has been a fairly consistent finding that the correlation between corticospinal excitability and clinical status declines with time, which may reflect reduced reliance on the original corticospinal projection once the network generating the motor output has reorganised. Some studies have shown hyper-excitability of the corticospinal tract from the non-stroke hemisphere during the acute phase in more severely affected patients, which is interpreted by some as a form of diaschisis.

Paired pulse measures have fairly reliably shown reduced inhibitory activity in the intracortical circuits after stroke. Such apparent disinhibition is hard to interpret in the stroke hemisphere, as these measures depend upon an unconditioned evoked potential of reasonable amplitude which may not be available or may require high stimulus intensities. However no such technical issue affects the intact hemisphere, and the absence or reduction of inhibition when tested in the contralesional primary motor cortex suggests a reduction in the tonic level of GABA-ergic inhibitory activity in intracortical circuits that extends far beyond the site of the stroke. In one study such intracortical disinhibition of the non-stroke hemisphere was seen in patients with cortical but not subcortical infarction,5 suggesting that this phenomenon may relate to interruption of the transcallosal projection between the motor cortices. Few longitudinal studies of intra-cortical excitability have been performed but on the basis of the data available it seems that in the acute period disinhibition is seen regardless of clinical status, but that by three months it has resolved in those patients with a better clinical outcome, such that a clinical–physiological correlation emerges at around that time.6 A recent meta-analysis of TMS studies has shown no overall abnormality of excitability in the intact hemisphere:7however if disinhibition were seen only in more severely affected patients then one may see clinical correlation without a group effect.

It is recognised that in healthy humans there is tonic inhibition of each hemisphere by its opposite, a situation that is likely to be important in the generation of unimanual versus bimanual movements. When this inter-hemispheric interaction is measured at rest with two TMS coils using a paired pulse conditioning approach there is robust inhibition. When tested in healthy subjects during a reaction time paradigm the baseline inhibition disappears or reverses as the onset of movement approaches. Murase and colleagues8found that such switching-off of interhemispheric inhibition was impaired in stroke patients, and that the extent of residual interhemispheric inhibition was greater in more severely affected patients. This result has been interpreted as suggesting that after stroke there is an imbalance of such interhemispheric interactions, with pathological inhibition of the recovering stroke hemisphere by the non-stroke hemisphere.

Interpretation of the physiological changes observed after stroke remains a matter of debate. TMS as a technique operates at the level of the whole system, drawing inferences from the effect of manipulations on the overall corticospinal output, but the pathological changes observed may be the result of dysfunction at one or more of several levels. These may include the effects of cytotoxic changes on local neurochemistry, altered inhibitory vs excitatory synaptic activity, or diaschisis due to disruption of inter-regional tracts. The TMS finding of wide- spread intracortical disinhibition is in keeping with MR Spectroscopy studies that show reduced cortical GABA content during this period after stroke.9 A rapid reduction in GABA is also seen in healthy humans as a response to motor training or to experimental deafferentation of one arm by ischaemic nerve block, which likewise causes intracortical disinhibition as assessed by TMS. In those contexts it is felt that such disinhibition creates a more favourable environment for synaptic plasticity to occur, and it is tempting to conclude that the same is occurring in the post-stroke period as a way of driving reorganisation of the motor output. It is also conceivable that disinhibition allows cortical regions that are disconnected from their usual corticospinal output projection to access instead the horizontal cortico-cortical connections that are prevalent in cortical layers 2 and 3, thereby reaching an alternative output projection. Such a phenomenon would allow for the shifts in cortical motor output maps that are well documented after stroke.10 In one longitudinal study the correlation between disinhibition and clinical status was strong at three months but then became weaker in the chronic phase.6 We interpreted this as suggesting that ongoing disinhibition becomes less important for motor function as the reorganised motor network becomes better established with time. Direct evidence for such a process is lacking however, and some would argue that disinhibition is an epiphenomenon rather than an adaptive response to injury. This alternative conclusion would be supported by the observation that reduced intracortical inhibition as measured by paired pulse TMS may be observed in other pathological states, including dystonia and Attention Deficit Hyperactivity Disorder.

The concept of an imbalance between the two hemispheres and of excessive interhemispheric inhibition of the stroke hemisphere has gained a lot of traction and has provided the rationale for therapeutic approaches that aim to redress it. Non-invasive brain stimulation, either by repetitive TMS or transcranial direct current stimulation (tDCS), can induce measurable changes in cortical excitability that outlast the period of stimulation. Depending on the stimulation paradigm used one can induce either increases or reductions lasting minutes or in some cases hours. The most common approaches are either to apply excitatory stimulation to the stroke hemisphere or alternatively inhibitory stimulation to the non-stroke hemisphere (Figure 2), the aim being to enhance the response to conventional therapy by stimulating either before or during treatment. The concept of an overactive non-stroke hemisphere resonates with the widely reproduced functional imaging finding of increased movement-related brain activation on that side in more severely affected patients, which may normalise as clinical recovery progresses.6

 

Figure 2. The interhemispheric rivalry model, whereby the intact hemisphere exerts a pathological degree of interhemispheric inhibition on the stroke hemisphere and hinders motor function in the paretic limb. This has given rise to the therapeutic strategies of either increasing excitability in the stroke hemisphere or reducing it in the intact hemisphere.

It is by no means clear however that this contralesional activity is the same phenomenon as that which generates pathological inhibition of the recovering hemisphere, or that it is necessarily maladaptive. There is evidence that at least some regions on the non-stroke side may support movement of the paretic side, such as the contralesional dorsal premotor cortex which displays increased functional connectivity to the primary motor cortex of the stroke in more affected patients and appears to support hand movement.11,12Furthermore a recent study suggested that reducing intact hemisphere excitability may in fact be detrimental to upper limb function in more impaired patients.3

As the role of contralesional brain regions in movement appears to differ depending upon factors such as clinical severity, extent of corticospinal tract disruption and possibly stroke location it would seem that reducing excitability on that side equally in all stroke patients may represent rather a blunt therapeutic approach. This is especially true of tDCS, whose effects incorporate most of the stimulated hemisphere. However, positive studies may be found in the literature for both repetitive TMS and tDCS when applied to either side of the brain (sometimes both), and although a comprehensive review of the outcomes is beyond the scope of this article the most promising approach appears to be inhibition of the non-stroke hemisphere by tDCS.13 Non-invasive brain stimulation has not as yet entered routine clinical practice however, and there are a number of reasons why this may be, such as the large number of stimulation protocols available and uncertainty regarding the optimal time to apply stimulation. However, for the reasons discussed above it is important to consider the heterogeneity of the clinical syndrome when designing further trials. Opinions differ as to whether progress will be made using a ‘one size fits all’ design, the hope being that larger sample sizes will take care of heterogeneity, or alternatively whether targeting stimulation according to clinical and physiological factors would have a greater chance of success. This is likely to be worth getting right, as a large negative study would present an obstacle to further investigation in this field. It is likely to be the case that applying brain stimulation to the right patients could significantly enhance the outcome of post-stroke rehabilitation, with a clinically meaningful reduction in resulting impairment and disability.

References

  1. Reis J, Swayne OB, Vandermeeren Y, Camus M, Dimyan MA, Harris-Love M, Perez MA, Ragert P, Rothwell JC, Cohen LG. Contribution of transcranial magnetic stimulation to the understanding of cortical mechanisms involved in motor control. J Physiol 2008; 586(2):325-51.
  2. Stinear CM, Barber PA, Smale PR, Coxon JP, Fleming MK, Byblow WD. Functional Potential in chronic stroke patients depends on corticospinal tract integrity. Brain 2007;130:170-180.
  3. Bradnam LV, Stinear CM, Barber PA, Byblow WD. Contralesional hemisphere control of the proximal paretic upper limb following stroke. Cereb Cortex. 2012 Nov;22(11):2662-71.
  4. Traversa R, Cicinelli P, Pasqualetti P, Filippi M, Rossini PM. Follow-up of interhemispheric differences of motor evoked potentials from the ‘affected’ and ‘unaffected’ hemispheres in human stroke. Brain Research 1998; 803:1-8.
  5. Manganotti P, Patuzzo S, Cortese F, Palermo A, Smania N, Fiaschi A. Motor disinhibition in affected and unaffected hemisphere in the early period of recovery after stroke. Clin Neurophysiol 2002; 113:936-943.
  6. Swayne OB, Rothwell JC, Ward NS, Greenwood RJ. Stages of Motor Output Reorganization after Hemispheric Stroke Suggested by Longitudinal Studies of Cortical Physiology. Cereb Cortex 2008; 18:1909- 1922.
  7. McDonnell MN, Stinear CM. TMS measures of motor cortex function after stroke: A meta-analysis. Brain Stimul. 2017 Jul – Aug;10(4):721-734.
  8. Murase N, Duque J, Mazzocchio R, Cohen LG. Influence of interhemispheric interactions on motor function in chronic stroke. Ann Neurol 2004; 55:400-409.
  9. Blicher JU, Near J, Næss-Schmidt E, Stagg CJ, Johansen-Berg H, Nielsen JF, Østergaard L, Ho YC. GABA levels are decreased after stroke and GABA changes during rehabilitation correlate with motor improvement. Neurorehabil Neural Repair 2015 Mar-Apr;29(3):278-86.
  10. Delvaux V, Alagona G, Gerard P, De Pasqua V, Pennisi G, de Noordhout AM. Post-stroke reorganization of hand motor area: a 1-year prospective follow-up with focal transcranial magnetic stimulation. Clin Neurophysiol 2003; 114:1217-1225
  11. Bestmann S, Swayne O, Blankenburg F, Ruff CC, Teo J, Weiskopf N, Driver J, Rothwell JC, Ward NS. The role of contralesional dorsal premotor cortex after stroke as studied with concurrent TMS-fMRI. J Neurosci 2010; 30(36):11926-37.
  12. Johansen-Berg H, Rushworth MF, Bogdanovic MD, Kischka U, Wimalaratna S, Matthews PM. The role of ipsilateral premotor cortex in hand movement after stroke. Proc Natl Acad Sci U S A 2002; 99:14518- 14523.
  13. Kang N, Summers JJ, Cauraugh JH. Transcranial direct current stimulation facilitates motor learning post- stroke: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. 2016 Apr;87(4):345-55.

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[ARTICLE] Low-Frequency Repetitive Transcranial Magnetic Stimulation for Stroke-Induced Upper Limb Motor Deficit: A Meta-Analysis – Full Text

Abstract

Background and Purpose. This meta-analysis aimed to evaluate the therapeutic potential of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) over the contralesional hemisphere on upper limb motor recovery and cortex plasticity after stroke. Methods. Databases of PubMed, Medline, ScienceDirect, Cochrane, and Embase were searched for randomized controlled trials published before Jun 31, 2017. The effect size was evaluated by using the standardized mean difference (SMD) and a 95% confidence interval (CI). Resting motor threshold (rMT) and motor-evoked potential (MEP) were also examined. Results. Twenty-two studies of 1 Hz LF-rTMS over the contralesional hemisphere were included. Significant efficacy was found on finger flexibility (SMD = 0.75), hand strength (SMD = 0.49), and activity dexterity (SMD = 0.32), but not on body function (SMD = 0.29). The positive changes of rMT (SMD = 0.38 for the affected hemisphere and SMD = −0.83 for the unaffected hemisphere) and MEP (SMD = −1.00 for the affected hemisphere and SMD = 0.57 for the unaffected hemisphere) were also significant. Conclusions. LF-rTMS as an add-on therapy significantly improved upper limb functional recovery especially the hand after stroke, probably through rebalanced cortical excitability of both hemispheres. Future studies should determine if LF-rTMS alone or in conjunction with practice/training would be more effective. Clinical Trial Registration Information. This trial is registered with unique identifier CRD42016042181.

1. Introduction

Stroke is a global disease with high rates of long-term disability [1]. Around the world, 25%–74% of stroke survivors require different levels of assistance for daily living mainly due to upper limb hemiplegia [2]. In search for better therapies, scientists have been trying to understand the relationship between stroke motor recovery and cortical reorganization [3]. The equilibrium of cortical excitability between the two hemispheres is often disrupted after stroke. In the affected hemisphere, both the cortical excitability and the homonymous motor representation of the affected hemisphere decrease; whereas the excitability in the unaffected hemisphere increases [4].

Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive stimulation to induce electrical currents in the brain tissues. Currently, rTMS is being explored as a novel therapy in modulating cortical excitability to improve motor functions in stroke patients [5]. Of the two forms of rTMS, high-frequency rTMS (HF-rTMS > 1.0 Hz), applied over the ipsilesional hemisphere, facilitates cortical excitability [6], whereas, low-frequency rTMS (LF-rTMS ≤ 1.0 Hz), applied over the contralesional hemisphere, decreases cortical excitability [7].

The effect of rTMS is primarily determined by the stimulation frequency [8] and targeted region [3]. Although both LF-rTMS and HF-rTMS could treat motor dysfunction in poststroke patients, LF-rTMS is considered safer and superior to HF-rTMS in motor function recovery [912]. Lomarev et al. [13] reported increased risk for seizures by HF-rTMS of 20–25 Hz. To date, the majority of rTMS trials on motor recovery after stroke used the protocol of LF-rTMS with 1 Hz. In comparison, the HF-rTMS studies involved only a small number of trials and applied varied frequency protocols (3 Hz to 25 Hz). According to Cho et al. [14], the primary motor cortex (M1) forms a main part of the motor cortices and contributes to the high order control of motor behaviors. Until now, most studies about the efficacy of LF-rTMS on functional rehabilitation have focused on the M1. In healthy subjects, LF-rTMS applied over the M1 increased the resting motor threshold (rMT) and decreased the motor-evoked potential (MEP) size of the ipsilateral hemisphere, suggesting a suppressive effect of LF-rTMS in the intact M1 [15].

Multiple studies have investigated the therapeutic effect of LF-rTMS after stroke [81619], with the outcomes of pinch force [1922], grip force [102225], finger tapping [892629], and overall function [153034]. Other studies also explored the impact of rTMS on cortical excitability [10181926]. However, inconsistent reports exist regarding the benefits of LF-rTMS: Some studies showed no beneficial effect of LF-rTMS [162329] and one study reported worsening effects of LF-rTMS such as decreased finger-tapping speed; [35] other investigators proposed that inhibition of the contralesional motor areas may lead to deterioration of the function of the unaffected hand [2426]. Although a few previous meta-analyses had investigated the therapeutic effect of rTMS after stroke [113638], they focused on the mixed effect of combined LF-rTMS and HF-rTMS interventions or on the combined outcomes of varying motor measurements. So far, there is a lack of in-depth systematic meta-analysis about the efficacy of LF-rTMS on upper limb function recovery.

The primary objective of this study was to evaluate the effects of LF-rTMS on upper limb motor recovery after stroke in several aspects: “finger flexibility,” “hand strength,” “activity dexterity,” and “body function level.” The effects of LF-rTMS on motor cortex excitability which were represented by MEP and rMTin poststroke patients were also evaluated. […]

Continue —>  Low-Frequency Repetitive Transcranial Magnetic Stimulation for Stroke-Induced Upper Limb Motor Deficit: A Meta-Analysis

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[Abstract+References] Non-invasive Cerebellar Stimulation: a Promising Approach for Stroke Recovery?

Abstract

Non-invasive brain stimulation (NIBS) combined with behavioral training is a promising strategy to augment recovery after stroke. Current research efforts have been mainly focusing on primary motor cortex (M1) stimulation. However, the translation from proof-of-principle to clinical applications is not yet satisfactory. Possible reasons are the heterogeneous properties of stroke, generalization of the stimulation protocols, and hence the lack of patient stratification. One strategy to overcome these limitations could be the evaluation of alternative stimulation targets, like the cerebellum. In this regard, first studies provided evidence that non-invasive cerebellar stimulation can modulate cerebellar processing and linked behavior in healthy subjects. The cerebellum provides unique plasticity mechanisms and has vast connections to interact with neocortical areas. Moreover, the cerebellum could serve as a non-lesioned entry to the motor or cognitive system in supratentorial stroke. In the current article, we review mechanisms of plasticity in the cortico-cerebellar system after stroke, methods for non-invasive cerebellar stimulation, and possible target symptoms in stroke, like fine motor deficits, gait disturbance, or cognitive impairments, and discuss strategies for multi-focal stimulation.

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via Non-invasive Cerebellar Stimulation: a Promising Approach for Stroke Recovery? | SpringerLink

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[WEB SITE] Magnetic brain stimulation helps “unlearn” crippling fear of heights

 

New research suggests a little magnetic brain stimulation prior to being exposed to your greatest fear...

New research suggests a little magnetic brain stimulation prior to being exposed to your greatest fear in a VR headset could help you “unlearn” your anxiety response(Credit: DanRoss/Depositphotos)

Advances in technology over the last decade have led to a swift rise in the volume of research surrounding transcranial magnetic stimulation (TMS) and its therapeutic effects. A team from the Würzburg University Hospital in Germany has just published a new study demonstrating how TMS, in conjunction with a virtual reality experience, can help alleviate anxiety disorders and essentially help people “unlearn” fears.

Transcranial magnetic stimulation works by directing a targeted magnetic field toward specific areas in the brain. Depending on the frequencies delivered this can either stimulate or inhibit the brain activity of the targeted area. Initially conceived as a research tool allowing scientists to understand exactly what roles certain areas of the brain play, TMS has more recently been explored as a potential new tool for treating an assortment of problems.

TMS devices have already been approved to treat migraines and some major depressive disorders, but other research is looking into its uses as a learning aid and a way to help visually-impaired people navigate the world.

This new study looks at how the technology could improve a patient’s response when used in conjunction with a more traditional treatment method. Anxiety disorders are incredibly debilitating for many, from social phobias to more specific problems such as a fear of heights. Classically, the treatment for people with these disorders has been a type of cognitive behavioral therapy where one is exposed to the source of their anxiety under the supervision of a psychologist.

The team at the Würzburg University Hospital decided to examine whether this kind of classic therapy could be improved using TMS. Previous studies have shown that by targeting the frontal lobe with magnetic stimulation an anxiety response can be reduced, but the new research looks at how this could be incorporated into a specific treatment method for a targeted anxiety.

Even though the subject knows it is fake, exposure to great heights in a virtual reality...

Even though the subject knows it is fake, exposure to great heights in a virtual reality headset still triggers an anxiety response in sufferers(Credit: VTplus)

Thirty-nine subjects with an active fear of heights were split into two groups, including a control group which received fake TMS. The groups received 20 minutes of either real or fake TMS directed at the ventral medial prefrontal cortex, followed by virtual reality exposure to a dizzying height. After two sessions the group treated with the TMS prior to VR exposure exhibited reduced anxiety and avoidance symptoms compared to the control group that didn’t receive the TMS.

“The findings demonstrate that all participants benefit considerably from the therapy in virtual reality and the positive effects of the intervention are still clearly visible even after three months,” explains Professor Martin J. Herrmann, one of the researchers working on the study.

The researchers suggest that adding TMS and VR to an already well-proven treatment process increases the overall efficacy and essentially helps the brain “unlearn” its anxiety responses. The next phase for the study is to look at other forms of anxiety and see if the process is equally effective.

And the next fear that is being tackled? Arachnophobia.

The research was published in the journal Brain Stimulation.

Source: Würzburg University Hospital

Source: Magnetic brain stimulation helps “unlearn” crippling fear of heights

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[WEB SITE] Magnetic Therapy Can Provide Alternative Treatment For Depression

Depression is a leading cause of poor health, disability and suicide — and medications only help some depression patients.

Many also cannot take the side effects.

But as CBS2’s Dr. Max Gomez reported, magnets might offer relief by rewiring the patient’s brain.

Each year, Americans spend billions of dollars on antidepressants. But studies show they can be ineffective in up to 40 percent of all patients.

Bob Holmes was one of them.

“They tried to adjust my medication, but the medication had side effects that weren’t desirable,” Holmes said.

Holmes is among the 16 million people in the U.S. who suffer major depressive episodes each year — a number that has increased 18 percent over the last decade. For that reason, some doctors at UCLA are taking a different approach.

Doctors beam magnetic pulses deep inside patients’ brains to change the way depression symptoms are perceived.

“We are used to thinking of the brain as a chemical organ, but it’s also an electrical organ,” said Dr. Andrew Leuchter of UCLA Health.

“The idea that by using non-chemical means, we can change the brain and how it functions,” said Dr. Ian Cook of UCLA Health.

It is called transcranial magnetic stimulation, or TMS. It is currently approved by the Food and Drug Administration only to treat depression, but doctors say it may prove helpful in a wide range of conditions by rewiring a network of signals in the brain.

“What TMS is doing is changing how that network functions, really rebooting the network to improve symptoms of mood, anxiety and chronic pain,” Leuchter said.

That may be why patients treated for depression also say it helps relieve their pain, raising provocative questions about whether TMS could one day become a viable alternative to opioids.

“This is a really transformative kind of therapy,” Cook said.

But for now, it has made a dramatic difference in Holmes’ depression.

“It provided that kind of jolt to get my brain to start work again normally,” he said.

Reportedly, TMS can feel a bit uncomfortable at first — but many patients quickly get used to it. They report substantial relief from their symptoms of depression within a few weeks.

Even though the NeuroStar system has been approved for depression since 2008, it is only recently that doctors have realized its effectiveness for everything from post-traumatic stress disorder to obsessive-compulsive disorder.

Source: https://medium.com/@pemfindia/magnetic-therapy-can-provide-alternative-treatment-for-depression-941a687a79f

Source: Magnetic Therapy Can Provide Alternative Treatment For Depression | Samir Singhal | Pulse | LinkedIn

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