Repetitive transcranial magnetic stimulation for hypokinetic dysarthria in Parkinson's disease enhances white matter integrity of the auditory–motor loop

Background and purpose

In our previous study, repeated sessions of repetitive transcranial magnetic stimulation (rTMS) over the auditory feedback area were shown to improve hypokinetic dysarthria (HD) in Parkinson's disease (PD) and led to changes in functional connectivity within the left-sided articulatory networks. We analyzed data from this previous study and assessed the effects of rTMS for HD in PD on the diffusion parameters of the left anterior arcuate fasciculus (AAF), which connects the auditory feedback area with motor regions involved in articulation.

Methods

Patients were assigned to 10 sessions of real or sham 1-Hz stimulation over the right posterior superior temporal gyrus. Stimulation effects were evaluated using magnetic resonance diffusion tensor imaging and by a speech therapist using a validated tool (Phonetics score of the Dysarthric Profile) at baseline, immediately after 2 weeks of stimulation, and at follow-up visits at Weeks 6 and 10 after the baseline.

Results

Altogether, data from 33 patients were analyzed. A linear mixed model revealed significant time-by-group interaction (p = 0.006) for the relative changes of fractional anisotropy of the AAF; the value increases were associated with the temporal evolution of the Phonetics score (R = 0.367, p = 0.028) in the real stimulation group.

Conclusions

Real rTMS treatment for HD in PD as compared to sham stimulation led to increases of white matter integrity of the auditory–motor loop during the 2-month follow-up period. The changes were related to motor speech improvements.     

One-Hz repetitive transcranial magnetic stimulation of the premotor cortex alters reciprocal inhibition in DYT1 dystonia.

Repetitive transcranial magnetic stimulation (rTMS) can produce long-lasting effects not only underneath the site of stimulation, but also at distant connected sites. This study aimed to assess how low frequency rTMS over the premotor area might affect abnormalities in spinal motor function in patients with generalised dystonia associated with the DYT1 gene mutation. We assessed reciprocal inhibition (RI) in a group of 8 manifesting carriers of the DYT1 gene (DYT1) and 10 healthy controls. All subjects then received 20 minutes of 1 Hz rTMS over the premotor area, and RI was assessed again. Before rTMS, the second and third phases of RI were abnormal in DYT1 subjects compared to controls. After 20 minutes of 1 Hz rTMS over the premotor area, a significant increase in inhibition was noted in the third and possibly the first phase of RI in the DYT1 group. No changes in RI were observed in control subjects after rTMS. We have shown for the first time to date that reducing cortical excitability in patients with dystonia using rTMS can produce corresponding changes in abnormal spinal motor output. These findings make a case for further exploring rTMS as a tool to modulate abnormal cortical and spinal excitability in individuals with dystonia and even as a potential form of treatment for dystonic symptoms.     

低频重复经颅磁刺激治疗精神分裂症顽固性幻听的随机双盲对照研究

目的:初步探讨双背侧前额叶低频重复经颅磁刺激(rTMS)治疗精神分裂症顽固性幻听的疗效和安全性,并观察其副反应。方法:25例伴顽固性幻听的精神分裂症患者随机分为rTMS治疗组(N=12)和对照组(N=13),分别给予10次1HzrTMS真刺激和伪刺激治疗,治疗期间维持原有抗精神病药种类及剂量不变。采用阳性和阴性症状量表(Positive and Negative Syndrome Scale,PANSS)评定临床症状,采用治疗中需处理的不良反应症状量表(Treatment Emergent Symptom Scale,TESS)等检查评估副反应。结果:25例患者均完成治疗,治疗组有效率高于对照组(75%vs.31%,P0.05)。未观察到明显副反应。结论:1Hz双背侧前额叶低频重复经颅磁刺激治疗精神分裂症顽固性幻听可能有效,且安全性好,值得进一步研究。     

重复经颅磁刺激治疗脊髓损伤的临床疗效

目的：观察重复经颅磁刺激（rTMS）治疗对脊髓损伤（SCI）的临床疗效。方法：对26例SCI患者进行rTMS治疗,并与20例健康志愿者对照分析,观察治疗前后运动诱发电位（MEP）波幅及潜伏期的变化。结果：26例SCI患者治疗前MEP潜伏期延迟,波幅降低,治疗后均有明显变化,表现为MEP潜伏期明显缩短,波幅明显增高,治疗前后比较,差异有统计学意义。结论：rTMS治疗SCI具有一定疗效。     

开窍通络针刺法配合重复经颅磁刺激治疗脑卒中后手功能障碍临床应用研究

ObjectiveTo observe the clinical improvement of Kāiqiàotōngluò(induce resuscitation and remove obstruction in meridians) acupuncture combined with repetitive transcranial magnetic stimulation (rTMS) in patients with hand dysfunction after stroke, and to provide evidence for its extensive application in the future.MethodsSixty patients with the problem of hand dysfunction were divided into the observation group and the control group randomly. The two groups of patients were treated with the basic treatment, the observation group received Kāiqiàotōngluò acupuncture combined with rTMS, and the control group only received the rTMS treatment. Broetz hand function scale, hemiplegic hand function grading, and modified Barthel index were used to evaluate the hand function of the patients in two groups before and after treatment.ResultsAfter treatment, Broetz score of the patients in observation group and control group were significantly lower than that before treatment, and Broetz score of the patients in observation group was lower than that of control group (all P < 0.05); As for the hemiplegic hand function grading, 24 cases in the observation group improved, the improvement rate was 80.0%, and 8 cases in the control group improved, the improvement rate was only 26.7%. The improvement rate of observation group was significantly better than that of control group (P < 0.01); the Barthel index scores of the observation group and the control group were significantly improved after treatment, and the observation group was better than the control group (both P < 0.05).ConclusionThe Kāiqiàotōngluò acupuncture combined with rTMS can improve the hand dysfunction of patients after stroke, and it is worthy of clinical application.     

低频重复经颅磁刺激治疗焦虑症状的临床疗效观察

目的：探讨低频重复经颅磁刺激（rTMS）时带有焦虑症状患者的治疗效果。方法：把41例进行rTMS（1Hz）治疗的焦虑患者分为两组,一组合并使用抗抑郁药物治疗,另一绑单独使用rTMS治疗,然后对两组患者疗效进行比较。结果：两组治疗效果比较差异无统计学意义（P〉O．05）o结论：单独使用低频rTMS治疗可能改善患者的焦虑症状。     

A randomized controlled feasibility and safety study of deep transcranial magnetic stimulation

OBJECTIVE: The H-coils are a new development in transcranial magnetic stimulation (TMS) research, allowing direct stimulation of deeper neuronal pathways than does standard TMS. This study assessed possible health risks, and some cognitive and emotional effects, of two H-coil versions designed to stimulate deep portions of the prefrontal cortex, using several stimulation frequencies. METHODS: Healthy volunteers (n=32) were randomly assigned to one of four groups: each of two H-coil designs (H1/H2), standard figure-8 coil, and sham-coil control. Subjects were tested in a pre-post design, during three increasing (single pulses, 10 Hz, and 20 Hz) stimulation sessions, as well as 24-36 h after the last stimulation. RESULTS: The major finding of the present study is that stimulation with the novel H-coils was well tolerated, with no adverse physical or neurological outcomes. Computerized cognitive tests found no deterioration in cognitive functions, except for a transient short-term effect of the H1-coil on spatial recognition memory on the first day of rTMS (but not in the following treatment days). On the other hand, spatial working memory was transiently improved by the H2-coil treatment. Finally, the questionnaires showed no significant emotional or mood alterations, except for reports on 'detachment' experienced by subjects treated with the H1-coil. CONCLUSIONS: This study provides additional evidence for the feasibility and safety of the two H-coil designs (H1/H2). SIGNIFICANCE: The H-coils offer a safe new tool with potential for both research and clinical applications for psychiatric and neurological disorders associated with dysfunctions of deep brain regions.     

Repetitive transcranial magnetic stimulation reveals abnormal plastic response to premotor cortex stimulation in schizophrenia.

BACKGROUND: Schizophrenia may be characterized by abnormal plastic modulation in cortical neuronal circuits. Activation of premotor cortex using repetitive transcranial magnetic stimulation (rTMS) produces suppression of cortical excitability in primary motor cortex. We hypothesized that premotor rTMS would cause less suppression of motor cortical excitability in patients with schizophrenia than in control subjects. METHODS: Twelve patients diagnosed with schizophrenia and twelve healthy control subjects underwent subthreshold rTMS to the premotor area in a 15-min conditioning train. Measurements of primary motor cortical excitability (motor evoked potential; MEP), the resting motor threshold (RMT), and cortical inhibition (CI) were taken before and after the rTMS. RESULTS: There was no difference in RMT between groups at baseline, although the patient group had less CI than the control group at baseline. Following rTMS, the change in both MEP size and RMT between groups was significant. After rTMS, MEP size was suppressed in the control group and increased in the patient group, whereas RMT increased in the normal control group and decreased in the patient group. CONCLUSIONS: Patients with schizophrenia demonstrate abnormal brain responses to rTMS applied to the premotor cortex that appear to relate to reduced motor cortical inhibition.     

High frequency repetitive transcranial magnetic stimulation (rTMS) is effective in migraine prophylaxis: an open labeled study

Abstract

Objective: To evaluate the effect of high rate repetitive transcranial magnetic stimulation (rTMS) in migraine prophylaxis in medically refractory patients.

Methods: Migraine patients above 15 years of age, having more than 7 attacks/month and refractory to at least two prophylactic drugs were included. The patients were evaluated for migraine frequency, severity, functional disability, number of rescue medications and migraine index. Three sessions of alternate day 10 Hz rTMS comprising of 600 pulses in 10 trains were delivered to left frontal cortex. The response was evaluated at the end of session and weekly for 4 weeks.

Results: Fifty-one patients aged 16–61 years and 45 females were treated. Fifty (98%) patients had more than 50% reduction of headache frequency at the end and 1 week after rTMS and the improvement persisted till the fourth week in 80·4% patients. The headache frequency, severity, functional disability, migraine index, and rescue medications significantly reduced at all time points, but the maximum benefit was observed in the first 2 weeks. There were no serious adverse events.

Conclusion: High rate rTMS in left frontal cortex is effective and well tolerated for migraine prophylaxis.     

重复经颅磁刺激对慢性精神分裂症患者认知功能及血清 C 反应蛋白的影响

目的 探索重复经颅磁刺激(rTMS)治疗对住院慢性精神分裂症患者认知功能的改善作用以及对患者血清C反应蛋白(CRP)水平的影响,初步探索rTMS影响患者认知功能的潜在机制.方法 选取2013年1月~2016年1月在天津市精神卫生中心住院治疗的精神分裂症患者60例,按照病情、性别、年龄等因素进行配对,随机分配每对患者接受rTMS真刺激治疗(治疗组)和伪刺激治疗(对照组)4周,应用阳性与阴性症状量表(PANSS)和可重复的成套神经心理状态测量(RBANS)在治疗前后评估患者的精神症状及认知功能.所有患者治疗前后均检测血清CRP水平.结果 (1)治疗后,治疗组患者的血清CRP水平明显下降,差异有统计学意义(P<0.05),而对照组无变化;(2)治疗组治疗后PANSS总分及阴性症状因子分较治疗前均有下降,差异有统计学意义(P<0.05),而对照组无变化;(3)治疗后,治疗组RBANS总分、视觉广度分、注意分、延时记忆分较前均有升高,差异有统计学意义(P<0.05),对照组RBANS总分及各因子分较治疗前差异均无统计学意义;(4)治疗组患者治疗前后PANSS总分差值与即刻记忆分差值、阴性量表分差值与RBANS总分差值及延时记忆分差值均呈负相关(P<0.05);(5)治疗组患者的血清CRP变化值与RBANS总分差值、即刻记忆、注意和延时记忆各因子差值均呈负相关(P<0.05).结论 rTMS可以有效改善慢性精神分裂症患者的认知功能,其机制可能与rTMS治疗缓解炎性反应有关.