scholarly journals Role of Growth Factors & Neurophysiological Markers In Evaluation of Neuroplasticity Using 1Hz rTMS With Physical Therapy In Ischemic Stroke: A Double Blind, Parallel Group, Sham Controlled Randomized Trial

2021 ◽  
Author(s):  
Hina Sharma ◽  
Nand Kumar ◽  
Sreenivas Vishnubhatla ◽  
Rajeswari MR ◽  
M.V. Padma Srivast
Keyword(s):  
Ischemic Stroke ◽  
Growth Factors ◽  
Physical Therapy ◽  
Evoked Potential ◽  
Premotor Cortex ◽  
Surrogate Marker ◽  
Motor Evoked Potential ◽  
Secondary Outcome ◽  
Therapeutic Benefits ◽  
Resting Motor Threshold

Abstract Background: The therapeutic benefits of repetitive trans cranial magnetic stimulation along with physical therapy to study the neuroplasticity and neurogenesis in ischemic stroke patients has not been fully elucidated. The aim of this study is to determine the neuroplasticity using serum growth factors as a surrogate marker, using 1Hz rTMS with conventional physiotherapy in patients with sub acute ischemic stroke.Methods: In this study, participants with first ever ischemic stroke (N = 96), onset within 15 days were randomized after a run-in period of 75 ± 7 days along with standard physical therapy to receive 10 sessions of real 1Hz rTMS (N = 47) on contralesional premotor cortex or to sham stimulation (N = 49) for 2 weeks. Participants, investigators and outcome assessors were blinded. The primary efficacy outcome was change in the level of peripheral serum growth factors VEGF & BDNF at third month. The secondary outcome was measurement of neurophysiological parameters and their correlation with growth factors levels.Results: Modified intention to treat analysis showed significant up regulation in the mean level of serum VEGF & BDNF from pre to post rTMS in Real rTMS Group. Trend of decrease in Resting Motor Threshold and increase in Motor Evoked Potential in the affected hand was seen. Statistically significant negative correlation between motor evoked potential and mean VEGF (rho = -1.000, P<0.001) in the affected hand in Real rTMS Group was seen.Conclusion: Total ten sessions of 1Hz rTMS plus physical therapy on contralateral hemisphere resulted in up regulation of serum growth factors possible reflecting improved neuroplasticity. Trial funded by Indian Council of Medical Research (ICMR), India, CTRI/2016/02/006620. Retrospectively registered. Note: As this is not a regulatory trial, therefore under Indian regulatory authorities, ICMR, any trial registered before 1st April 2018 was registered as retrospective study. Ethics committee approval for this study was taken in 2012.

scholarly journals Measurement of Motor Evoked Potential in Acute Ischemic Stroke: Based on Latency, Amplitude, Central Motoric Conduction Time and Resting Motor Threshold

2016 ◽  
Vol 8 (3) ◽  
pp. 157 ◽  
Author(s):  
Tugas Ratmono ◽  
Andi Wijaya ◽  
Cahyono Kaelan ◽  
Andi Asadul Islam ◽  
Ferry Sandra
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Conduction Time ◽  
Size Measurement ◽  
Motor Threshold ◽  
Dynamic Changes ◽  
Resting Motor Threshold ◽  
Function Impairment

BACKGROUND: After stroke, there are dynamic changes of motor evoked potential (MEP), including latency, amplitude, central motoric conduction time (CMCT) and resting motor threshold (RMT) in cerebral. However, latency, CMCT, amplitude and RMT have not been clearly shown in acute ischemic stroke patients with motoric function impairment based on Modified Motoric Research Council Scale (MRCs).METHODS: Patients with motoric function impairment after acute ischemic stroke were recruited, scored based on MRCs and grouped. Latency, amplitude, CMCT and RMT (% intensity) was measured using transcranial magnetic stimulation (TMS). Latency, amplitude, CMCT and RMT of subjects based on affected hemisphere (AH) and unaffected hemisphere (UH); stroke onset; and motoric severity; were analyzed and compared statistically.RESULTS: Thirty-seven subjects with complete assessments were selected. Results of MEP size measurement between AH and UH showed that latency, amplitude, CMCT and RMT of AH and UH were significantly different (p<0.05). In accordance to AH and UH results, latency, amplitude, CMCT and RMT of mild, moderate and severe groups based on motoric severity, showed that latency and CMCT were prolonged, RMT was increased, while amplitude was decreased along with severity increment. The amplitude and RMT among the groups were significantly different with p=0.034 and p=0.029, respectively.CONCLUSION: MEP size measurement including latency, amplitude, CMCT and RMT have significant different in AH and UH. In addition, amplitude and RMT were significantly different in MRCs groups, therefore the MEP size measurement could be suggested as prognostic tool.KEYWORDS: MEP, latency, amplitude, CMCT, RMT

scholarly journals Evidence for a Window of Enhanced Plasticity in the Human Motor Cortex Following Ischemic Stroke

2021 ◽  
pp. 154596832199233
Author(s):  
Brenton Hordacre ◽  
Duncan Austin ◽  
Katlyn E. Brown ◽  
Lynton Graetz ◽  
Isabel Pareés ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Synaptic Plasticity ◽  
Motor Cortex ◽  
Human Brain ◽  
Evoked Potential ◽  
Cortical Excitability ◽  
Motor Evoked Potential ◽  
Stroke Survivors ◽  
Behavioral Training ◽  
Human Motor Cortex

Background In preclinical models, behavioral training early after stroke produces larger gains compared with delayed training. The effects are thought to be mediated by increased and widespread reorganization of synaptic connections in the brain. It is viewed as a period of spontaneous biological recovery during which synaptic plasticity is increased. Objective To look for evidence of a similar change in synaptic plasticity in the human brain in the weeks and months after ischemic stroke. Methods We used continuous theta burst stimulation (cTBS) to activate synapses repeatedly in the motor cortex. This initiates early stages of synaptic plasticity that temporarily reduces cortical excitability and motor-evoked potential amplitude. Thus, the greater the effect of cTBS on the motor-evoked potential, the greater the inferred level of synaptic plasticity. Data were collected from separate cohorts (Australia and UK). In each cohort, serial measurements were made in the weeks to months following stroke. Data were obtained for the ipsilesional motor cortex in 31 stroke survivors (Australia, 66.6 ± 17.8 years) over 12 months and the contralesional motor cortex in 29 stroke survivors (UK, 68.2 ± 9.8 years) over 6 months. Results Depression of cortical excitability by cTBS was most prominent shortly after stroke in the contralesional hemisphere and diminished over subsequent sessions ( P = .030). cTBS response did not differ across the 12-month follow-up period in the ipsilesional hemisphere ( P = .903). Conclusions Our results provide the first neurophysiological evidence consistent with a period of enhanced synaptic plasticity in the human brain after stroke. Behavioral training given during this period may be especially effective in supporting poststroke recovery.

scholarly journals Evidence of Neuroplasticity: A Robotic Hand Exoskeleton Study for Post-Stroke Rehabilitation

2020 ◽  
Author(s):  
Neha Singh ◽  
Megha Saini ◽  
Nand Kumar ◽  
M.V. Padma Srivast ◽  
Amit Mehndiratta
Keyword(s):  
Evoked Potential ◽  
Cortical Excitability ◽  
Motor Evoked Potential ◽  
Clinical Scales ◽  
Robotic Therapy ◽  
Active Range Of Motion ◽  
Modified Ashworth Scale ◽  
Resting Motor Threshold ◽  
Motor Outcomes ◽  
Ashworth Scale

Abstract Background: A novel electromechanical robotic-exoskeleton was designed in-house for rehabilitation of wrist joint and Metacarpophalangeal (MCP) joint. Objective: The objective was to compare the rehabilitation effectiveness (clinical-scales and neurophysiological-measures) of robotic-therapy training-sessions with dose-matched control in patients with stroke. Methods: An observational pilot study was designed with patients within 2 years of chronicity. Patients received an intervention of 20 sessions of 45-minutes each, five days a week for four-weeks) in Robotic-therapy Group (RG) (n=12) and conventional upper-limb rehabilitation in Control-Group (CG) (n=11). Clinical-scales– Modified Ashworth Scale, Active Range of Motion, Barthel-Index, Brunstrom-stage and Fugl-Meyer scale (Shoulder/Elbow and Wrist/Hand component), and neurophysiological-measures of cortical-excitability (using Transcranial Magnetic Stimulation) –Motor Evoked Potential and Resting Motor-threshold, were acquired pre and post-therapy. Results: RG and CG showed significant improvement in all clinical motor-outcomes (p<0.05) except Modified Ashworth Scale in CG. RG showed significantly higher improvement over CG in Modified Ashworth Scale, Active Range of Motion and Fugl-Meyer (FM) scale and FM Wrist-/Hand component) (p<0.05). Increase in cortical-excitability in ipsilesional-hemisphere was found to be statistically significant in RG over CG, as indexed by decrease in Resting Motor-Threshold and increase in amplitude of Motor Evoked Potential (p<0.05). No significant changes were shown by the contralesional-hemisphere. Interhemispheric RMT-asymmetry evidenced significant changes in RG over CG (p<0.05) indicating increased cortical-excitability in ipsilesional-hemisphere along with interhemispheric changes.Conclusion: Neurophysiological-changes in RG could be most likely a consequence of plastic-reorganization and use-dependent plasticity. Robotic-exoskeleton training could significantly improve motor-outcomes and cortical-excitability in patients with stroke.Registry number: IEC/NP-99/13.03.2015

scholarly journals Duration and reliability of the silent period in individuals with spinal cord injury

2020 ◽  
Author(s):  
Hannah Sfreddo ◽  
Jaclyn R. Wecht ◽  
Ola Alsalman ◽  
Yu-Kuang Wu ◽  
Noam Y. Harel
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Silent Period ◽  
List Type ◽  
Abductor Pollicis Brevis ◽  
Resting Motor Threshold ◽  
Cord Injury ◽  
Period Duration

ObjectiveWe aim to better understand the silent period (SP), an inhibitory counterpart to the well-known motor evoked potential (MEP) elicited by transcranial magnetic stimulation (TMS), in individuals with spinal cord injury (SCI).MethodsElectromyographic responses were measured in the target abductor pollicis brevis at rest (TMS at 120% of resting motor threshold (RMT)) and during maximal effort (TMS at 110% of RMT). Participants with chronic cervical SCI (n=9) and able-bodied volunteers (n=12) underwent between 3-7 sessions of stimulation on separate days. The primary outcomes were the magnitude and reliability of SP duration, resting and active MEP amplitudes, and RMT.ResultsSCI participants showed significantly increased RMT, decreased MEP amplitudes, and non-significantly longer SP duration compared to AB participants. In contrast to high inter-participant variability, SP duration demonstrated reduced intra-participant variability within and across sessions compared with resting and active MEP amplitudes. SCI participants also demonstrated a higher prevalence of SP ‘interruptions’ compared to AB participants.ConclusionsSP reflects a balance between corticospinal excitatory and inhibitory processes. SP duration is more reliable within and across multiple sessions than MEP amplitude.SignificanceThe higher reliability of SP duration may make it a useful outcome measure for future trials of SCI interventions.HighlightsWe compared characteristics of the silent period between individuals with spinal cord injury and able-bodied volunteers.Silent period duration was insignificantly longer in spinal cord injury individuals.Silent period duration was found to be a more reliable within-subject metric than motor evoked potential amplitude.

scholarly journals Diaphragmatic Central Motor Conduction Changes In Chronic Obstructive Pulmonary Disease

2019 ◽  
Author(s):  
Rehab Abdelaal El-Nemr ◽  
Rania Ahmad Sweed ◽  
Hanaa Shafiek
Keyword(s):  
Pulmonary Function ◽  
Healthy Subjects ◽  
Magnetic Stimulation ◽  
Motor System ◽  
Evoked Potential ◽  
Group Versus ◽  
Motor Evoked Potential ◽  
Conduction Time ◽  
Copd Patients ◽  
Resting Motor Threshold

AbstractBackground and objectivesRespiratory muscles dysfunction has been reported in COPD. Transcranial magnetic stimulation (TMS) is easy non-invasive that has been used for assessing the respiratory corticospinal pathways particularly of diaphragm. We aimed to study the cortico-diaphragmatic motor system changes in COPD using TMS and to correlate the findings with the pulmonary function.MethodsA case control study recruited 30 stable COPD from the out-patient respiratory clinic of Main Alexandria University hospital-Egypt and 17 healthy control subjects who were subjected to spirometry. Cortical conduction of the diaphragm was performed by TMS to all participants followed by cervical magnetic stimulation of the phrenic nerve roots. Diaphragmatic resting motor threshold (DRMT), cortical motor evoked potential latency (CMEPL), CMEP amplitude (CMEPA), peripheral motor evoked potential latency (PMEPL), PMEP amplitude (PMEPA) and central motor conduction time (CMCT) were measured.Results66.7% of COPD patients had severe and very severe COPD with median age of 59 (55-63) years. There was statistically significant bilateral decrease in DRMT, CMEPA and PMEPA in COPD group versus healthy subjects and significant increase in CMEPL and PMEPL (p <0.01). Left CMCT was significantly prolonged in COPD group versus healthy subjects (p <0.0001) but not right CMCT. Further, there was significant increase in CMEPL and CMCT of left versus right diaphragm in COPD group (p= 0.003 and 0.001 respectively) that inversely correlated with FEV1% and FVC% predicted.ConclusionCentral cortico-diaphragmatic motor system is affected in COPD patients with heterogeneity of both sides that is correlated with pulmonary function.SignificanceCoticospinal pathway affection could be a factor for development of diaphragmatic dysfunction in COPD patients accordingly its evaluation could help in personalization of COPD management especially pulmonary rehabilitation programs

Fibers from the dorsal premotor cortex elicit motor-evoked potential in a cortical dysplasia

NeuroImage ◽  
2007 ◽  
Vol 34 (1) ◽  
pp. 12-18 ◽  
Author(s):  
Nobuhiro Mikuni ◽  
Tsutomu Okada ◽  
Junya Taki ◽  
Riki Matsumoto ◽  
Namiko Nishida ◽  
...  
Keyword(s):  
Evoked Potential ◽  
Premotor Cortex ◽  
Motor Evoked Potential ◽  
Cortical Dysplasia ◽  
Dorsal Premotor Cortex
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