scholarly journals Feasibility of cerebello-cortical stimulation for intraoperative neurophysiological monitoring of cerebellar mutism

2021 ◽  
Author(s):  
Davide Giampiccolo ◽  
Federica Basaldella ◽  
Andrea Badari ◽  
Giovanna Maddalena Squintani ◽  
Luigi Cattaneo ◽  
...  
Keyword(s):  
Motor Cortex ◽  
Test Stimulus ◽  
Posterior Fossa ◽  
Motor Evoked Potentials ◽  
Significant Inhibition ◽  
Neurophysiological Monitoring ◽  
Posterior Fossa Surgery ◽  
Cerebellar Mutism ◽  
Motor Cortex Excitability ◽  
Electrical Conditioning

Abstract Background Cerebellar mutism can occur in a third of children undergoing cerebellar resections. Recent evidence proposes it may arise from uni- or bilateral damage of cerebellar efferents to the cortex along the cerebello-dento-thalamo-cortical pathway. At present, no neurophysiological procedure is available to monitor this pathway intraoperatively. Here, we specifically aimed at filling this gap. Methods We assessed 10 patients undergoing posterior fossa surgery using a conditioning-test stimulus paradigm. Electrical conditioning stimuli (cStim) were delivered to the exposed cerebellar cortex at interstimulus intervals (ISIs) of 8–24 ms prior to transcranial electric stimulation of the motor cortex, which served as test stimulus (tStim). The variation of motor-evoked potentials (MEP) to cStim + tStim compared with tStim alone was taken as a measure of cerebello-cortical connectivity. Results cStim alone did not produce any MEP. cStim preceding tStim produced a significant inhibition at 8 ms (p < 0.0001) compared with other ISIs when applied to the lobules IV-V-VI in the anterior cerebellum and the lobule VIIB in the posterior cerebellum. Mixed effects of decrease and increase in MEP amplitude were observed in these areas for longer ISIs. Conclusions The inhibition exerted by cStim at 8 ms on the motor cortex excitability is likely to be the product of activity along the cerebello-dento-thalamo-cortical pathway. We show that monitoring efferent cerebellar pathways to the motor cortex is feasible in intraoperative settings. This study has promising implications for pediatric posterior fossa surgery with the aim to preserve the cerebello-cortical pathways and thus prevent cerebellar mutism.

scholarly journals Intraoperative neurophysiological monitoring during resection of infratentorial lesions: the surgeon's view

2017 ◽  
Vol 126 (1) ◽  
pp. 281-288 ◽  
Author(s):  
Philipp J. Slotty ◽  
Amr Abdulazim ◽  
Kunihiko Kodama ◽  
Mani Javadi ◽  
Daniel Hänggi ◽  
...  
Keyword(s):  
Evoked Potentials ◽  
Posterior Fossa ◽  
Auditory Evoked Potentials ◽  
Motor Evoked Potentials ◽  
Neurological Deficits ◽  
Neurophysiological Monitoring ◽  
Posterior Fossa Surgery ◽  
Lesion Location ◽  
Crucial Information ◽  
Free Running

OBJECTIVE Methods of choice for neurophysiological intraoperative monitoring (IOM) within the infratentorial compartment mostly include early brainstem auditory evoked potentials, free-running electromyography, and direct cranial nerve (CN) stimulation. Long-tract monitoring with somatosensory evoked potentials (SEPs) and motor evoked potentials (MEPs) is rarely used. This study investigated the incidence of IOM alterations during posterior fossa surgery stratified for lesion location. METHODS Standardized CN and SEP/MEP IOM was performed in 305 patients being treated for various posterior fossa pathologies. The IOM data were correlated with lesion locations and histopathological types as well as other possible confounding factors. RESULTS Alterations in IOM were observed in 158 of 305 cases (51.8%) (CN IOM alterations in 130 of 305 [42.6%], SEP/MEP IOM alterations in 43 of 305 [14.0%]). In 15 cases (4.9%), simultaneous changes in long tracts and CNs were observed. The IOM alterations were followed by neurological sequelae in 98 of 305 cases (32.1%); 62% of IOM alterations resulted in neurological deficits. Sensitivity and specificity for detection of CN deficits were 98% and 77%, respectively, and 95% and 85%, respectively, for long-tract deficits. Regarding location, brainstem and petroclival lesions were closely associated with concurrent CN IOM and SEP/MEP alterations. CONCLUSIONS The incidence of IOM alterations during surgery in the posterior fossa varied widely between different lesion locations and histopathological types. This analysis provides crucial information on the necessity of IOM in different surgical settings. Because MEP/SEP and CN IOM alterations were commonly observed during posterior fossa surgery, the authors recommend the simultaneous use of both modalities based on lesion location.

scholarly journals Effect of opposing needling on motor cortex excitability in healthy participants and in patients with post-stroke hemiplegia: study protocol for a single-blind, randomised controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Mindong Xu ◽  
Yinyu Zi ◽  
Jianlu Wu ◽  
Nenggui Xu ◽  
Liming Lu ◽  
...  
Keyword(s):  
Motor Cortex ◽  
Primary Motor Cortex ◽  
Motor Evoked Potentials ◽  
Controlled Trial ◽  
Secondary Outcome ◽  
Post Stroke ◽  
Motor Cortex Excitability ◽  
Opposing Needling ◽  
Single Blind ◽  
Healthy Participants

Abstract Background Opposing needling has an obvious curative effect in the treatment of post-stroke hemiplegia; however, the mechanism of the opposing needling in the treatment of post-stroke hemiplegia is still not clear. The purpose of this study is to investigate the effect of opposing needling on the excitability of primary motor cortex (M1) of healthy participants and patients with post-stroke hemiplegia, which may provide insight into the mechanisms of opposing needling in treating post-stroke hemiplegia. Methods This will be a single-blind, randomised, sham-controlled trial in which 80 healthy participants and 40 patients with post-stroke hemiplegia will be recruited. Healthy participants will be randomised 1:1:1:1 to the 2-Hz, 50-Hz, 100-Hz, and sham electroacupuncture groups. Patients with post-stroke hemiplegia will be randomised 1:1 to the opposing needling or conventional treatment groups. The M1 will be located in all groups by using neuroimaging-based navigation. The stimulator coil of transcranial magnetic stimulation (TMS) will be moved over the left and right M1 in order to identify the TMS hotspot, followed by a recording of resting motor thresholds (RMTs) and motor-evoked potentials (MEPs) of the thenar muscles induced by TMS before and after the intervention. The primary outcome measure will be the percent change in the RMTs of the thenar muscles at baseline and after the intervention. The secondary outcome measures will be the amplitude (μV) and latency (ms) of the MEPs of the thenar muscles at baseline and after the intervention. Discussion The aim of this trial is to explore the effect of opposing needling on the excitability of M1 of healthy participants and patients with post-stroke hemiplegia. Trial registration Chinese Clinical Trial Registry ChiCTR1900028138. Registered on 13 December 2019.

scholarly journals Comparison of repeated transcranial stimulation and transcranial direct-current stimulation on primary motor cortex excitability and inhibition: A pilot study

2018 ◽  
pp. 59-67 ◽  
Author(s):  
Vincent Cabibel ◽  
Makii Muthalib ◽  
Jérôme Froger ◽  
Stéphane Perrey
Keyword(s):  
Pilot Study ◽  
Motor Cortex ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Primary Motor Cortex ◽  
Motor Evoked Potentials ◽  
High Definition ◽  
Direct Current Stimulation ◽  
Motor Cortex Excitability ◽  
The Right

Repeated transcranial magnetic stimulation (rTMS) is a well-known clinical neuromodulation technique, but transcranial direct-current stimulation (tDCS) is rapidly growing interest for neurorehabilitation applications. Both methods (contralesional hemisphere inhibitory low-frequency: LF-rTMS or lesional hemisphere excitatory anodal: a-tDCS) have been employed to modify the interhemispheric imbalance following stroke. The aim of this pilot study was to compare aHD-tDCS (anodal high-definition tDCS) of the left M1 (2 mA, 20 min) and LF-rTMS of the right M1 (1 Hz, 20 min) to enhance excitability and reduce inhibition of the left primary motor cortex (M1) in five healthy subjects. Single-pulse TMS was used to elicit resting and active (low level muscle contraction, 5% of maximal electromyographic signal) motor-evoked potentials (MEPs) and cortical silent periods (CSPs) from the right and left extensor carpi radialis muscles at Baseline, immediately and 20 min (Post-Stim-20) after the end of each stimulation protocol. LF-rTMS or aHD-tDCS significantly increased right M1 resting and active MEP amplitude at Post-Stim-20 without any CSP modulation and with no difference between methods. In conclusion, this pilot study reported unexpected M1 excitability changes, which most likely stems from variability, which is a major concern in the field to consider.

scholarly journals Cerebellar Mutism after Posterior Fossa Surgery in the Child : A Case Report

1998 ◽  
Vol 7 (9) ◽  
pp. 591-595
Author(s):  
Toshihiro Ishibashi ◽  
Hiroyasu Nagahima ◽  
Kohichi Takahashi ◽  
Saroshi Sawauchi ◽  
Shigeyuki Murakami ◽  
...  
Keyword(s):  
Case Report ◽  
Posterior Fossa ◽  
Posterior Fossa Surgery ◽  
Cerebellar Mutism

scholarly journals Expanding the parameter space of anodal transcranial direct current stimulation of the primary motor cortex

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Desmond Agboada ◽  
Mohsen Mosayebi Samani ◽  
Asif Jamil ◽  
Min-Fang Kuo ◽  
Michael A. Nitsche
Keyword(s):  
Motor Cortex ◽  
Parameter Space ◽  
Primary Motor Cortex ◽  
Cortical Excitability ◽  
Motor Evoked Potentials ◽  
Anodal Tdcs ◽  
Stimulation Parameters ◽  
Motor Cortex Excitability ◽  
The Impact ◽  
Motor Cortex Plasticity

AbstractSize and duration of the neuroplastic effects of tDCS depend on stimulation parameters, including stimulation duration and intensity of current. The impact of stimulation parameters on physiological effects is partially non-linear. To improve the utility of this intervention, it is critical to gather information about the impact of stimulation duration and intensity on neuroplasticity, while expanding the parameter space to improve efficacy. Anodal tDCS of 1–3 mA current intensity was applied for 15–30 minutes to study motor cortex plasticity. Sixteen healthy right-handed non-smoking volunteers participated in 10 sessions (intensity-duration pairs) of stimulation in a randomized cross-over design. Transcranial magnetic stimulation (TMS)-induced motor-evoked potentials (MEP) were recorded as outcome measures of tDCS effects until next evening after tDCS. All active stimulation conditions enhanced motor cortex excitability within the first 2 hours after stimulation. We observed no significant differences between the three stimulation intensities and durations on cortical excitability. A trend for larger cortical excitability enhancements was however observed for higher current intensities (1 vs 3 mA). These results add information about intensified tDCS protocols and suggest that the impact of anodal tDCS on neuroplasticity is relatively robust with respect to gradual alterations of stimulation intensity, and duration.

scholarly journals Primary Motor Cortex Excitability Is Modulated During the Mental Simulation of Hand Movement

2017 ◽  
Vol 23 (2) ◽  
pp. 185-193 ◽  
Author(s):  
Christian Hyde ◽  
Ian Fuelscher ◽  
Jarrad A.G. Lum ◽  
Jacqueline Williams ◽  
Jason He ◽  
...  
Keyword(s):  
Motor Cortex ◽  
Primary Motor Cortex ◽  
Motor Evoked Potentials ◽  
Hand Movement ◽  
Single Pulse ◽  
Stimulus Presentation ◽  
Mental Simulation ◽  
Right Hand ◽  
Hand Laterality ◽  
Motor Cortex Excitability

AbstractObjectives:It is unclear whether the primary motor cortex (PMC) is involved in the mental simulation of movement [i.e., motor imagery (MI)]. The present study aimed to clarify PMC involvement using a highly novel adaptation of the hand laterality task (HLT).Methods:Participants were administered single-pulse transcranial magnetic stimulation (TMS) to the hand area of the left PMC (hPMC) at either 50 ms, 400 ms, or 650 ms post stimulus presentation. Motor-evoked potentials (MEPs) were recorded from the right first dorsal interosseous via electromyography. To avoid the confound of gross motor response, participant response (indicating left or right hand) was recorded via eye tracking. Participants were 22 healthy adults (18 to 36 years), 16 whose behavioral profile on the HLT was consistent with the use of a MI strategy (MI users).Results:hPMC excitability increased significantly during HLT performance for MI users, evidenced by significantly larger right hand MEPs following single-pulse TMS 50 ms, 400 ms, and 650 ms post stimulus presentation relative to baseline. Subsequent analysis showed that hPMC excitability was greater for more complex simulated hand movements, where hand MEPs at 50 ms were larger for biomechanically awkward movements (i.e., hands requiring lateral rotation) compared to simpler movements (i.e., hands requiring medial rotation).Conclusions:These findings provide support for the modulation of PMC excitability during the HLT attributable to MI, and may indicate a role for the PMC during MI. (JINS, 2017,23, 185–193)

scholarly journals NS-01PEDIATRIC INTRAOPERATIVE NEUROPHYSIOLOGICAL MONITORING IN POSTERIOR FOSSA SURGERY

2016 ◽  
Vol 18 (suppl 3) ◽  
pp. iii127.1-iii127
Author(s):  
Franco Randi ◽  
Andrea Carai ◽  
Gionatan Amante ◽  
Alessandro De Benedictis ◽  
Raffaella Messina ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Intraoperative Neurophysiological Monitoring ◽  
Neurophysiological Monitoring ◽  
Posterior Fossa Surgery

scholarly journals Response inhibition activates distinct motor cortical inhibitory processes

2018 ◽  
Vol 119 (3) ◽  
pp. 877-886 ◽  
Author(s):  
John Cirillo ◽  
Matthew J. Cowie ◽  
Hayley J. MacDonald ◽  
Winston D. Byblow
Keyword(s):  
Motor Cortex ◽  
Response Inhibition ◽  
Primary Motor Cortex ◽  
Motor Evoked Potentials ◽  
Short Interval ◽  
Left Hand ◽  
Motor Cortex Excitability ◽  
Motor Cortical ◽  
Inhibitory Tone ◽  
Inhibitory Networks

We routinely cancel preplanned movements that are no longer required. If stopping is forewarned, proactive processes are engaged to selectively decrease motor cortex excitability. However, without advance information there is a nonselective reduction in motor cortical excitability. In this study we examined modulation of human primary motor cortex inhibitory networks during response inhibition tasks with informative and uninformative cues using paired-pulse transcranial magnetic stimulation. Long- (LICI) and short-interval intracortical inhibition (SICI), indicative of GABAB- and GABAA-receptor mediated inhibition, respectively, were examined from motor evoked potentials obtained in task-relevant and task-irrelevant hand muscles when response inhibition was preceded by informative and uninformative cues. When the participants (10 men and 8 women) were cued to stop only a subcomponent of the bimanual response, the remaining response was delayed, and the extent of delay was greatest in the more reactive context, when cues were uninformative. For LICI, inhibition was reduced in both muscles during all types of response inhibition trials compared with the pre-task resting baseline. When cues were uninformative and left-hand responses were suddenly canceled, task-relevant LICI positively correlated with response times of the responding right hand. In trials where left-hand responding was highly probable or known (informative cues), task-relevant SICI was reduced compared with that when cued to rest, revealing a motor set indicative of responding. These novel findings indicate that the GABAB-receptor-mediated pathway may set a default inhibitory tone according to task context, whereas the GABAA-receptor-mediated pathways are recruited proactively with response certainty. NEW & NOTEWORTHY We examined how informative and uninformative cues that trigger both proactive and reactive processes modulate GABAergic inhibitory networks within human primary motor cortex. We show that GABAB inhibition was released during the task regardless of cue type, whereas GABAA inhibition was reduced when responding was highly probable or known compared with rest. GABAB-receptor-mediated inhibition may set a default inhibitory tone, whereas GABAA circuits may be modulated proactively according to response certainty.

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