scholarly journals Human Theta Burst Stimulation Combined with Subsequent Electroacupuncture Increases Corticospinal Excitability

2020 ◽  
Vol 2020 ◽  
pp. 1-8 ◽  
Author(s):  
Jiali Li ◽  
Meng Ren ◽  
Wenjing Wang ◽  
Shutian Xu ◽  
Sicong Zhang ◽  
...  
Keyword(s):  
Motor Evoked Potentials ◽  
Short Interval ◽  
Silent Period ◽  
Intracortical Inhibition ◽  
Corticospinal Excitability ◽  
Conduction Time ◽  
Theta Burst Stimulation ◽  
Burst Stimulation ◽  
Clinical Trial Registry ◽  
Theta Burst

Objective. Intermittent theta burst stimulation (iTBS) is a widely used noninvasive brain stimulation for the facilitation of corticospinal excitability (CSE). Previous studies have shown that acupuncture applied to acupoints associated with motor function in healthy people can reduce the amplitude of the motor-evoked potentials (MEPs), which reflects the inhibition of CSE. In our work, we wanted to test whether the combination of iTBS and electroacupuncture (EA) would have different effects on CSE in humans. Methods. A single-blind sham-controlled crossover design study was conducted on 20 healthy subjects. Subjects received 20 minutes’ sham or real EA stimulation immediately after sham or real iTBS. MEPs, short-interval intracortical inhibition (SICI), intracortical facilitation (ICF), cortical silent period (CSP), and central motor conduction time (CMCT) were recorded before each trial, and immediately, 20 minutes, and 40 minutes after the end of stimulation. Results. In the sham iTBS group, EA produced a reduction in MEPs amplitude, lasting approximately 40 minutes, while in the real iTBS group, EA significantly increased MEPs amplitude beyond 40 minutes after the end of stimulation. In sham EA group, the recorded MEPs amplitude showed no significant trend over time compared to baseline. Among all experiments, there were no significant changes in SICI, ICF, CSP, CMCT, etc. Conclusion. These data indicate that immediate application of EA after iTBS significantly increased corticospinal excitability. This trial was registered in the Chinese Clinical Trial Registry (registration no. ChiCTR1900025348).

scholarly journals Sham-derived effects and the minimal reliability of theta burst stimulation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
P. O. Boucher ◽  
R. A. Ozdemir ◽  
D. Momi ◽  
M. J. Burke ◽  
A. Jannati ◽  
...  
Keyword(s):  
Motor Evoked Potentials ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Brain Activity ◽  
Corticospinal Excitability ◽  
Therapeutic Effects ◽  
Theta Burst Stimulation ◽  
Burst Stimulation ◽  
Similar Time ◽  
Repeat Visit ◽  
Theta Burst

AbstractTheta-burst stimulation (TBS) is a patterned form of repetitive transcranial magnetic stimulation (rTMS) that has been used to induce long-term modulation (plasticity) of corticospinal excitability in a drastically shorter duration protocol than conventional rTMS protocols. In this study we tested the reliability of the effects of two well defined TBS protocols, continuous TBS (cTBS) and intermittent TBS (iTBS), especially in relation to sham TBS, within and across the same 24 participants. All TBS protocols were repeated after approximately 1 month to assess the magnitude and reliability of the modulatory effects of each TBS protocol. Baseline and post-TBS changes in motor evoked potentials (MEP—measure of corticospinal excitability) amplitudes were compared across the cTBS, iTBS and sham TBS protocols and between the initial and retest visits. Overall, across participants, at the initial visit, iTBS facilitated MEPs as compared to baseline excitability, with sham eliciting the same effect. cTBS did not show a significant suppression of excitability compared to baseline MEPs at either visit, and even facilitated MEPs above baseline excitability at a single time point during the repeat visit. Otherwise, effects of TBS were generally diminished in the repeat visit, with iTBS and sham TBS replicating facilitation of MEPs above baseline excitability at similar time points. However, no protocol demonstrated consistent intra-individual modulation of corticospinal excitability upon retest. As the first study to test both iTBS and cTBS against sham TBS across repeat visits, our findings challenge the efficacy and reliability of TBS protocols and emphasize the importance of accounting for sham effects of TBS. Furthermore, given that therapeutic effects of TBS are hypothetically derived from consistent and repeated modulation of brain activity, the non-replicability of plasticity and sham effects call into question these basic mechanisms.

scholarly journals Intermittent theta burst stimulation facilitates functional connectivity from the dorsal premotor cortex to primary motor cortex

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e9253
Author(s):  
Hai-Jiang Meng ◽  
Na Cao ◽  
Jian Zhang ◽  
Yan-Ling Pi
Keyword(s):  
Motor Cortex ◽  
Primary Motor Cortex ◽  
Premotor Cortex ◽  
Intracortical Inhibition ◽  
Corticospinal Excitability ◽  
Dorsal Premotor Cortex ◽  
Theta Burst Stimulation ◽  
Burst Stimulation ◽  
Intracortical Facilitation ◽  
Theta Burst

Background Motor information in the brain is transmitted from the dorsal premotor cortex (PMd) to the primary motor cortex (M1), where it is further processed and relayed to the spinal cord to eventually generate muscle movement. However, how information from the PMd affects M1 processing and the final output is unclear. Here, we applied intermittent theta burst stimulation (iTBS) to the PMd to alter cortical excitability not only at the application site but also at the PMd projection site of M1. We aimed to determine how PMd iTBS–altered information changed M1 processing and the corticospinal output. Methods In total, 16 young, healthy participants underwent PMd iTBS with 600 pulses (iTBS600) or sham-iTBS600. Corticospinal excitability, short-interval intracortical inhibition (SICI), and intracortical facilitation (ICF) were measured using transcranial magnetic stimulation before and up to 60 min after stimulation. Results Corticospinal excitability in M1 was significantly greater 15 min after PMd iTBS600 than that after sham-iTBS600 (p = 0.012). Compared with that after sham-iTBS600, at 0 (p = 0.014) and 15 (p = 0.037) min after iTBS600, SICI in M1 was significantly decreased, whereas 15 min after iTBS600, ICF in M1 was significantly increased (p = 0.033). Conclusion Our results suggested that projections from the PMd to M1 facilitated M1 corticospinal output and that this facilitation may be attributable in part to decreased intracortical inhibition and increased intracortical facilitation in M1. Such a facilitatory network may inform future understanding of the allocation of resources to achieve optimal motion output.

Theta Burst Stimulation of Human Primary Motor Cortex Degrades Selective Muscle Activation in the Ipsilateral Arm

2010 ◽  
Vol 104 (5) ◽  
pp. 2594-2602 ◽  
Author(s):  
Lynley V. Bradnam ◽  
Cathy M. Stinear ◽  
Winston D. Byblow
Keyword(s):  
Upper Limb ◽  
Muscle Activation ◽  
Primary Motor Cortex ◽  
Biceps Brachii ◽  
Motor Evoked Potentials ◽  
Short Interval ◽  
Relative Size ◽  
Theta Burst Stimulation ◽  
Burst Stimulation ◽  
Theta Burst

This study investigated whether repetitive transcranial magnetic stimulation (TMS) delivered as continuous theta burst stimulation (cTBS) to left M1 degraded selective muscle activation in the contralateral and ipsilateral upper limb in healthy participants. Contralateral motor-evoked potentials (cMEPs) were elicited in left and right biceps brachii (BB) before either elbow flexion or forearm pronation. A neurophysiological index, the excitability ratio (ER), was computed from the relative size of BB cMEPs before each type of movement. Short interval intracortical inhibition (SICI) was assessed in cMEPs of right BB with paired-pulse TMS of left M1. Ipsilateral MEPs (iMEPs) and silent periods (iSPs) were measured in left BB with single-pulse TMS of left M1. Low-intensity cTBS was expected to suppress corticospinal output from left M1. A sham condition was also included. Real but not sham cTBS caused increases in BB ER bilaterally. In the right arm, ER increased because BB cMEPs before flexion were less facilitated, whereas cMEPs in the pronation task were unaffected. This was accompanied by an increase in left M1 SICI. In the left arm, ER increased because BB cMEPs before pronation were facilitated but were unaffected in the flexion task. There was also facilitation of left BB iMEPs. These changes in the left arm are consistent with inappropriate facilitation of left BB α-motoneurons (αMNs) before pronation. This is the first demonstration that cTBS of M1 can alter excitability of neurons controlling ipsilateral proximal musculature and degrade ipsilateral upper limb motor control, providing evidence that ipsilateral and contralateral M1 shape the spatial and temporal characteristics of proximal muscle activation appropriate for the task at hand.

scholarly journals The value of corticospinal excitability and intracortical inhibition in predicting motor skill improvement driven by action observation

2021 ◽  
Author(s):  
Arturo Nuara ◽  
Maria Chiara Bazzini ◽  
Pasquale Cardellicchio ◽  
Emilia Scalona ◽  
Doriana De Marco ◽  
...  
Keyword(s):  
Motor Skill ◽  
Motor Evoked Potentials ◽  
Action Observation ◽  
Short Interval ◽  
Silent Period ◽  
Intracortical Inhibition ◽  
Corticospinal Excitability ◽  
Two Phase ◽  
Rehabilitative Treatment ◽  
Skill Improvement

BACKGROUND AND OBJECTIVE: Action observation can sustain motor skill improvement. At the neurophysiological level, action observation affects the excitability of the motor cortices, as measured by transcranial magnetic stimulation. However, whether the cortical modulations induced by action observation may explain the amount of motor improvement driven by action observation training (AOT) remains to be addressed. METHODS: We conducted a two-phase study involving 40 volunteers. First, we assessed the effect of action observation on corticospinal excitability (amplitude of motor evoked potentials), short-interval intracortical inhibition, and transcallosal inhibition (ipsilateral silent period). Subsequently, a randomized-controlled design was applied, with AOT participants asked to observe and then execute, as quickly as possible, a right-hand dexterity task six consecutive times, whereas controls had to observe a no-action video before performing the same task. RESULTS: AOT participants showed greater performance improvement relative to controls. The amount of improvement in the AOT group was predicted by the amplitude of corticospinal modulation during action observation and even more by the amount of intracortical inhibition induced by action observation. Importantly, these relations were found specifically for the AOT group and not for the controls. CONCLUSIONS: In this study, we identified the neurophysiological signatures associated with, and potentially sustaining, the outcome of AOT. Intracortical inhibition driven by action observation plays a major role. These findings elucidate the cortical mechanisms underlying AOT efficacy and open to predictive assessments for the identification of potential responders to AOT, informing the rehabilitative treatment individualization.

scholarly journals Interindividual Variability and Intraindividual Reliability of Intermittent Theta Burst Stimulation-induced Neuroplasticity Mechanisms in the Healthy Brain

2017 ◽  
Vol 29 (6) ◽  
pp. 1022-1032 ◽  
Author(s):  
Lukas Schilberg ◽  
Teresa Schuhmann ◽  
Alexander T. Sack
Keyword(s):  
Interindividual Variability ◽  
Motor Evoked Potentials ◽  
Long Term Potentiation ◽  
Corticospinal Excitability ◽  
Theta Burst Stimulation ◽  
Burst Stimulation ◽  
Assessment Visit ◽  
Term Potentiation ◽  
Theta Burst

We combined patterned TMS with EMG in several sessions of a within-subject design to assess and characterize intraindividual reliability and interindividual variability of TMS-induced neuroplasticity mechanisms in the healthy brain. Intermittent theta burst stimulation (iTBS) was applied over M1 to induce long-term potentiation-like mechanisms as assessed by changes in corticospinal excitability. Furthermore, we investigated the association between the observed iTBS effects and individual differences in prolonged measures of corticospinal excitability. Our results show that iTBS-induced measures of neuroplasticity suffer from high variability between individuals within a single assessment visit and from low reliability within individuals across two assessment visits. This indicates that both group and individual effects of iTBS on corticospinal excitability cannot be assumed to be reliable and therefore need to be interpreted with caution, at least when measured by changes in the amplitudes of motor-evoked potentials.

scholarly journals Determining the optimal pulse number for theta burst induced change in cortical excitability

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Daniel M. McCalley ◽  
Daniel H. Lench ◽  
Jade D. Doolittle ◽  
Julia P. Imperatore ◽  
Michaela Hoffman ◽  
...  
Keyword(s):  
Cortical Excitability ◽  
Motor Evoked Potentials ◽  
Pulse Number ◽  
Theta Burst Stimulation ◽  
Burst Stimulation ◽  
Non Invasive ◽  
Subject Variability ◽  
Secondary Analyses ◽  
Effective Doses ◽  
Theta Burst

AbstractTheta-burst stimulation (TBS) is a form of non-invasive neuromodulation which is delivered in an intermittent (iTBS) or continuous (cTBS) manner. Although 600 pulses is the most common dose, the goal of these experiments was to evaluate the effect of higher per-dose pulse numbers on cortical excitability. Sixty individuals were recruited for 2 experiments. In Experiment 1, participants received 600, 1200, 1800, or sham (600) iTBS (4 visits, counterbalanced, left motor cortex, 80% active threshold). In Experiment 2, participants received 600, 1200, 1800, 3600, or sham (600) cTBS (5 visits, counterbalanced). Motor evoked potentials (MEP) were measured in 10-min increments for 60 min. For iTBS, there was a significant interaction between dose and time (F = 3.8296, p = 0.01), driven by iTBS (1200) which decreased excitability for up to 50 min (t = 3.1267, p = 0.001). For cTBS, there was no overall interaction between dose and time (F = 1.1513, p = 0.33). Relative to sham, cTBS (3600) increased excitability for up to 60 min (t = 2.0880, p = 0.04). There were no other significant effects of dose relative to sham in either experiment. Secondary analyses revealed high within and between subject variability. These results suggest that iTBS (1200) and cTBS (3600) are, respectively, the most effective doses for decreasing and increasing cortical excitability.

The effects of 30 Hz, 50 Hz AND 100 Hz continuous theta burst stimulation via transcranial magnetic stimulation on the electrophysiological parameters in healthy individuals

2021 ◽  
Vol 74 (1-2) ◽  
pp. 41-49
Author(s):  
Zeynep Ozdemir ◽  
Erkan Acar ◽  
Aysun Soysal
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Short Interval ◽  
Motor Evoked Potential ◽  
Individual Variability ◽  
Theta Burst Stimulation ◽  
Burst Stimulation ◽  
Resting Motor Threshold ◽  
Theta Burst ◽  
Continuous Theta Burst Stimulation

Transcranial magnetic stimulation is a non-invasive procedure that uses robust magnetic fields to create an electrical current in the cerebral cortex. Dual stimulation consists of administering subthre­shold conditioning stimulation (CS), then suprathreshold test stimulation (TS). When the interstimulus interval (ISI) is 1-6 msec, the motor evoked potential (MEP) decreases in amplitude; this decrease is termed “short interval intracortical inhibition” (SICI); when the ISI is 7-30 msec, an increase in MEP amplitude occurs, termed “short interval intracortical facilitation” (SICF). Continuous theta burst stimulation (cTBS), often applied at a frequency of 50 Hz, has been shown to decrease cortical excitability. The primary objective is to determine which duration of cTBS achieves better inhibition or excitation. The secondary objective is to compare 50 Hz cTBS to 30 Hz and 100 Hz cTBS. The resting motor threshold (rMT), MEP, SICI, and SICF were studied in 30 healthy volunteers. CS and TS were administered at 80%-120% and 70%-140% of rMT at 2 and 3-millisecond (msec) intervals for SICI, and 10- and 12-msec intervals for SICF. Ten individuals in each group received 30, 50, or 100 Hz, followed by administration of rMT, MT-MEP, SICI, SICF immediately and at 30 minutes. Greater inhibition was achieved with 3 msec than 2 msec in SICI, whereas better facilitation occurred at 12 msec than 10 msec in SICF. At 30 Hz, cTBS augmented inhibition and suppressed facilitation, while 50 Hz yielded less inhibition and greater inter-individual variability. At 100 Hz, cTBS provided slight facilitation in MEP amplitudes with less interindividual variability. SICI and SICF did not differ significantly between 50 Hz and 100 Hz cTBS. Our results suggest that performing SICI and SICF for 3 and 12 msec, respectively, and CS and TS at 80%-120% of rMT, demonstrate safer inhibition and facilitation. Recently, TBS has been used in the treatment of various neurological diseases, and we recommend preferentially 30 Hz over 50 Hz cTBS for better inhibition with greater safety and less inter-individual variability.

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