Short-lasting impairment of tactile perception by 0.9Hz-rTMS of the sensorimotor cortex

To test whether low-frequency repetitive transcranial magnetic stimulation (rTMS) of sensorimotor cortex (SM1) has prolonged effects on somatosensory function, eight subjects were given 900 TMS pulses over the left hand SM1 (0.9Hz, 90% of the resting motor threshold) or at sites 3 cm anterior or posterior to it. Tactile threshold of the right hand was increased for a short duration after rTMS over SM1, but two-point discrimination and median nerve SEPs were unaffected after rTMS at any sites.     

Viewing the body prepares the brain for touch: effects of TMS over somatosensory cortex

Viewing the body can improve tactile perception. We investigated whether this could be due to a remodeling of somatosensory cortical areas during vision of the body. Single-pulse transcranial magnetic stimulation (TMS) was delivered over the primary and secondary somatosensory areas of subjects who showed clear visual-tactile enhancement while they performed a tactile grating discrimination task. Before the tactile stimulus, subjects viewed either their right index finger through a semisilvered mirror or an object reflected by the mirror and positioned to appear in the same location as the finger. In a first experiment we observed that TMS over primary somatosensory cortex significantly reduced subjects' accuracy whilst viewing the hand. No such reduction was found when subjects viewed a neutral object. In a second experiment, we disrupted the activity of primary and secondary somatosensory areas in different sessions. When stimulating the primary somatosensory cortex, a reduction in accuracy was again found while viewing the hand, but not a neutral object. TMS over secondary somatosensory cortex had no effect in any condition. Our results show that vision of the body may act at an early stage in stimulus elaboration and perception, allowing an anticipatory tuning of the neural circuits in primary somatosensory cortex that underlie tactile acuity.     

Homeostatic metaplasticity in the human somatosensory cortex

Long-term potentiation (LTP) and long-term depression (LTD) are regulated by homeostatic control mechanisms to maintain synaptic strength in a physiological range. Although homeostatic metaplasticity has been demonstrated in the human motor cortex, little is known to which extent it operates in other cortical areas and how it links to behavior. Here we tested homeostatic interactions between two stimulation protocols -- paired associative stimulation (PAS) followed by peripheral high-frequency stimulation (pHFS) -- on excitability in the human somatosensory cortex and tactile spatial discrimination threshold. PAS employed repeated pairs of electrical stimulation of the right median nerve followed by focal transcranial magnetic stimulation of the left somatosensory cortex at an interstimulus interval of the individual N20 latency minus 15 msec or N20 minus 2.5 msec to induce LTD- or LTP-like plasticity, respectively [Wolters, A., Schmidt, A., Schramm, A., Zeller, D., Naumann, M., Kunesch, E., et al. Timing-dependent plasticity in human primary somatosensory cortex. Journal of Physiology, 565, 1039-1052, 2005]. pHFS always consisted of 20-Hz trains of electrical stimulation of the right median nerve. Excitability in the somatosensory cortex was assessed by median nerve somatosensory evoked cortical potential amplitudes. Tactile spatial discrimination was tested by the grating orientation task. PAS had no significant effect on excitability in the somatosensory cortex or on tactile discrimination. However, the direction of effects induced by subsequent pHFS varied with the preconditioning PAS protocol: After PAS(N20-15), excitability tended to increase and tactile spatial discrimination threshold decreased. After PAS(N20-2.5), excitability decreased and discrimination threshold tended to increase. These interactions demonstrate that homeostatic metaplasticity operates in the human somatosensory cortex, controlling both cortical excitability and somatosensory skill.     

Effects of parietal TMS on somatosensory judgments challenge interhemispheric rivalry accounts

Interplay between the cerebral hemispheres is vital for coordinating perception and behavior. One influential account holds that the hemispheres engage in rivalry, each inhibiting the other. In the somatosensory domain, a seminal paper claimed to demonstrate such interhemispheric rivalry, reporting improved tactile detection sensitivity on the right hand after transcranial magnetic stimulation (TMS) to the right parietal lobe (Seyal, Ro, & Rafal, 1995). Such improvement in tactile detection ipsilateral to TMS could follow from interhemispheric rivalry, if one assumes that TMS disrupted cortical processing under the coil and thereby released the other hemisphere from inhibition. Here we extended the study by Seyal et al. (1995) to determine the effects of right parietal TMS on tactile processing for either hand, rather than only the ipsilateral hand. We performed two experiments applying TMS in the context of median-nerve stimulation; one experiment required somatosensory detection, the second somatosensory intensity discrimination. We found different TMS effects on detection versus discrimination, but neither set of results followed the prediction from hemispheric rivalry that enhanced performance for one hand should invariably be associated with impaired performance for the other hand, and vice-versa. Our results argue against a strict rivalry interpretation, instead suggesting that parietal TMS can provide a pedestal-like increment in somatosensory response.     

Effect of theta burst stimulation over the human sensorimotor cortex on motor and somatosensory evoked potentials.

OBJECTIVE: To study the after-effect of theta burst stimulation (TBS) over the left sensorimotor cortex on the size of somatosensory as well as motor evoked potentials evoked from both hemispheres in healthy human subjects. METHODS: We used a continuous TBS paradigm for 40 s (600 pulses) in which a burst of 3 transcranial magnetic stimuli at 50 Hz is repeated at 5 Hz [Huang YZ, Edwards MJ, Rounis E, Bhatia KP, Rothwell JC. Theta burst stimulation of the human motor cortex. Neuron 2005;45:201-6]. Somatosensory evoked potentials (SEPs) following electrical stimulation of right or left median nerve and motor evoked potentials (MEPs) in the right or left first dorsal interosseous (FDI) muscles were recorded before and after TBS over the left motor cortex (M1) or a point 2 cm posterior to left M1. RESULTS: Amplitudes of P25/N33 (parietal components) following right median nerve stimulation were significantly increased for at least 53 min after TBS over the left M1, whereas this component was suppressed for 13 min after TBS over a point 2 cm posterior. MEPs in right as well as left FDI muscles were suppressed with a similar time course after TBS over the left M1. CONCLUSIONS: A single-session of TBS over the sensorimotor cortex can induce a short-lasting change in the size of ipsilateral cortical components of SEPs as well as MEPs evoked from both hemispheres. SIGNIFICANCE: TBS is an interventional tool that can induce rapid reorganization within cortical somatosensory as well as motor networks in humans.     

Suppression of vibrotactile discrimination by transcranial magnetic stimulation of primary somatosensory cortex

A number of human and animal studies have reported a differential representation of the frequency of vibrotactile stimuli in the somatosensory cortices: neurons in the primary somatosensory cortex (SI) are predominantly responsive to lower frequencies of tactile vibration, and those in the secondary somatosensory cortex (SII) are predominantly responsive to higher frequencies. We employed transcranial magnetic stimulation (TMS) over SI in human subjects to investigate the extent to which the inactivation of SI disrupted the discrimination of vibrotactile stimulation at frequencies that give rise to the tactile sensations of flutter (30 Hz) and vibration (200 Hz). Frequency discrimination around the 30-Hz standard following application of TMS to SI was reduced in seven of the eight subjects, and around the 200-Hz standard was reduced in all eight subjects. The average change in discrimination following TMS was about 20% for both low and high frequencies of vibrotactile stimulation. These data suggest that disruption of SI: (1) has a direct effect on the discrimination of both low and high frequencies of vibrotactile stimuli, consistent with a serial model of processing, or (2) has a direct effect on low-frequency vibrotactile stimuli and an indirect effect on the processing of high-frequency vibrotactile stimuli by SII via cortico-cortical connections between the two regions.     

Sensory perception changes induced by transcranial magnetic stimulation over the primary somatosensory cortex in Parkinson's disease

Sensory symptoms are common nonmotor manifestations of Parkinson's disease. It has been hypothesized that abnormal central processing of sensory signals occurs in Parkinson's disease and is related to dopaminergic treatment. The objective of this study was to investigate the alterations in sensory perception induced by transcranial magnetic stimulation of the primary somatosensory cortex in patients with Parkinson's disease and the modulatory effects of dopaminergic treatment. Fourteen patients with Parkinson's disease with and without dopaminergic treatment and 13 control subjects were included. Twenty milliseconds after peripheral electrical tactile stimuli in the contralateral thumb, paired‐pulse transcranial magnetic stimulation over the right primary somatosensory cortex was delivered. We evaluated the perception of peripheral electrical tactile stimuli at 2 conditioning stimulus intensities, set at 70% and 90% of the right resting motor threshold, using different interstimulus intervals. At 70% of the resting motor threshold, paired‐pulse transcranial magnetic stimulation over the right primary somatosensory cortex induced an increase in positive responses at short interstimulus intervals (1–7 ms) in controls but not in patients with dopaminergic treatment. At 90% of the resting motor threshold, controls and patients showed similar transcranial magnetic stimulation effects. Changes in peripheral electrical tactile stimuli perception after paired‐pulse transcranial magnetic stimulation over the primary somatosensory cortex are altered in patients with Parkinson's disease with dopaminergic treatment compared with controls. These findings suggest that primary somatosensory cortex excitability could be involved in changes in somatosensory integration in Parkinson's disease with dopaminergic treatment. © 2011 Movement Disorder Society     

Improvement of spatial tactile acuity by transcranial direct current stimulation.

OBJECTIVE: Non-invasive brain stimulation such as transcranial direct current stimulation (tDCS) has been successfully used to induce polarity-specific excitability changes in the brain. However, it is still unknown if anodal tDCS (tDCS(anodal)) applied to the primary somatosensory cortex (S1) can lead to behavioral changes in performance of tactile discriminative tasks. METHODS: Using an accurate tactile discrimination task (grating orientation task: GOT) we tested the hypothesis that application of 1mA of tDCS(anodal) (current density at the electrodes of 0.04mA/cm2) over the left S1 can lead to an improved tactile spatial acuity in the contralateral index-finger (IF). RESULTS: Performance in the GOT task with the contralateral IF but not with the ipsilateral IF was enhanced for about 40min after a 20min application of tDCS(anodal) in the absence of changes with sham stimulation. CONCLUSIONS: These results provide the first evidence that tDCS(anodal) over S1 improves performance in a complex somatosensory task beyond the period of stimulation. SIGNIFICANCE: The ability to induce performance improvement in the somatosensory domain with tDCS applied over S1 could be used to promote functional recovery in patients with diminished tactile perception.     

Changes of muscle excitability of the hand contralateral to a task performing one: a transcranial magnetic stimulation study]

It used to be considered that unilateral movements of distal limb parts are associated only with contralateral motor cortical activity. Recent neuroimaging studies, however, suggest that the motor cortex ipsilateral to a task-performing hand is also activated, and that motor patterns in one hand affect the degree of the activity of the ipsilateral motor cortex. If so, muscles of the hand contralateral to a task-performing one may change those excitability depending on types of tasks. We studied eight subjects who performed three different finger tasks by one hand: (a) pinch, (b) sequential finger opposition, and (c) tactile discrimination. Transcranial magnetic stimulation was delivered by a figure eight coil over the hemisphere ipsilateral to a task-performing hand. Motor evoked potentials and background electromyographic activities were recorded from the opponens pollicis muscle contralateral to the stimulated hemisphere. On average, the motor evoked potentials were larger during tactile discrimination task than those at rest in either hand (p < 0.01). Background electromyographic activities in the left hand increased significantly during right hand tactile discrimination task (p < 0.01), whilst those in the right hand did not change during the left hand performance (p > 0.05). These findings suggest the followings: (1) the hand muscle contralateral to a task performing one changes its excitability depending on types of tasks; and (2) increment of excitability of the left hand muscle associated with right hand tactile discrimination is greater than that of the right hand one in association with the same task by the left hand, thus supporting the idea that there is a functional asymmetry between the right and left motor cortex in respect of motor performance.     

Transcranial magnetic stimulation to the parietal lobes reduces detection of contralateral somatosensory stimuli

OBJECTIVES: Neglect has been described in patients with lesions of the parietal cortex and has been interpreted as a disorder of the allocation of spatial attention. The persistence of neglect has been linked to poor rehabilitation outcome in patients suffering from acute stroke. Transcranial magnetic stimulation (TMS) applied to the parietal cortex has been shown to induce changes in the perception of stimuli including tactile stimulation of the fingers contra- and ipsilateral to the stimulated hemisphere. MATERIAL AND METHODS: In the current study, eleven normal young subjects performed a detection task for cutaneous electrical stimuli to the left or right forearm that had been precued by a preceding visual warning stimulus. To investigate the role of the parietal cortical areas for attentional processes TMS was applied to frontal and parietal scalp sites of each hemisphere in the cue-target interval before the somatosensory stimulus. RESULTS: Right and left parietal stimulation led to reduced detection sensitivity for near threshold stimuli to the forearm contralateral to the stimulated hemisphere without hemispheric differences. Ipsilateral tactile perception was not influenced by parietal TMS and there was no change in perception after frontal stimulation to left or right scalp sites. CONCLUSION: This pattern of results is consistent with a role of the right and left parietal lobe in the distribution of spatial attention and provides an experimental basis for possible therapeutical application of TMS to improve attentional deficits in stroke patients.     

Continuous theta-burst rTMS over primary somatosensory cortex modulates tactile perception on the hand

ObjectiveTheta-burst stimulation (TBS) over the primary somatosensory cortex (SI) alters cortical excitability, and in its intermittent form (iTBS) improves tactile spatial acuity. The effects of continuous TBS (cTBS) on tactile acuity remain unknown. The present study examined the influence of cTBS over SI on temporal and spatial tactile acuity on the contralateral hand.MethodsIn separate experiments, temporal discrimination threshold (TDT) and spatial amplitude discrimination threshold (SDT) were obtained from the right hand before and for up to 34 min following real and sham cTBS (600 pulses) over left-hemisphere SI.ResultsCTBS reduced temporal and spatial tactile acuity for up to 18 min following real cTBS. Tactile acuity was unaltered in the groups receiving sham cTBS.ConclusionsCTBS over SI impairs both temporal and spatial domains of tactile acuity for a similar duration.SignificanceCTBS over SI appears to decrease neural activity within targeted cortex and has potential utility in reducing excessive sensory processing.     

Convergence of human brain mapping tools: neuronavigated TMS parameters and fMRI activity in the hand motor area

Functional magnetic resonance imaging (fMRI) and transcranial magnetic stimulation (TMS) are well-established tools for investigating the human motor system in-vivo. We here studied the relationship between movement-related fMRI signal changes in the primary motor cortex (M1) and electrophysiological properties of the hand motor area assessed with neuronavigated TMS in 17 healthy subjects. The voxel showing the highest task-related BOLD response in the left hand motor area during right hand movements was identified for each individual subject. This fMRI peak voxel in M1 served as spatial target for coil positioning during neuronavigated TMS. We performed correlation analyses between TMS parameters, BOLD signal estimates and effective connectivity parameters of M1 assessed with dynamic causal modeling (DCM). The results showed a negative correlation between the movement-related BOLD signal in left M1 and resting as well as active motor threshold (MT) obtained for left M1. The DCM analysis revealed that higher excitability of left M1 was associated with a stronger coupling between left supplementary motor area (SMA) and M1. Furthermore, BOLD activity in left M1 correlated with ipsilateral silent period (ISP), i.e. the stronger the task-related BOLD response in left M1, the higher interhemispheric inhibition effects targeting right M1. DCM analyses revealed a positive correlation between the coupling of left SMA with left M1 and the duration of ISP. The data show that TMS parameters assessed for the hand area of M1 do not only reflect the intrinsic properties at the stimulation site but also interactions with remote areas in the human motor system.     

Specific forms of neural activity associated with tactile space awareness

Left tactile extinction, in which a left tactile stimulus fails to access consciousness only when a right stimulus is presented simultaneously, offers a model for studying tactile awareness from its transitory absence. Pairs of transcranial magnetic stimuli (TMS) on the parietal cortex inhibit contralateral tactile perception when separated by an interval of 1 ms. We have applied this technique on the left parietal cortex of right brain damaged (RBD) patients and normal subjects and have shown a selective lack of paired TMS inhibitory effects on right tactile perception of patients during bimanual stimulation. TMS effects were normal during unimanual right stimulation. These results suggest the presence of a specific pattern of inhibitory/excitatory interactions in parietal brain areas as critical for tactile awareness.     

Influence of task-related ipsilateral hand movement on motor cortex excitability.

OBJECTIVE: The time course of the right motor cortex excitability in relation to a task-related voluntary right thumb twitch was studied using sub-threshold transcranial magnetic stimulation (TMS) to the right motor cortex. METHODS: Motor excitability was studied in 8 adult subjects who made a brief right thumb twitch to the predictable omission of every fifth tone in a series of tones 2.5 s apart. This paradigm avoided an overt sensory cue, while allowing experimental control of TMS timing relative to both movement and the cue to move. Motor excitability was characterized by several measures of motor evoked potentials (MEPs) recorded from the left thenar eminence in response to TMS over the right scalp with a 9 cm coil: probability of eliciting MEPs, incidence of MEPs and amplitude of MEPs. RESULTS: All subjects showed suppression of motor excitability immediately following a voluntary right thumb twitch (ipsilateral response), and up to 1 s after it. However, two distinctly different effects on motor excitability were observed before the response: two subjects showed excitation, beginning about 500 ms before response until 300 ms after it, followed by the post-movement suppression; 6 subjects displayed pre-movement suppression, beginning about 600 ms before the response and persisting for the duration. CONCLUSIONS: The net effect of an ipsilateral response on motor cortex can be either inhibitory or excitatory, changing with time relative to the response. These findings are compatible with two separate processes, inhibitory and excitatory, which interact to determine motor excitability ipsilateral to the responding hand.     

Analysis of stimuli triggering attacks of paroxysmal dystonia induced by exertion

In a patient with a familial form of paroxysmal exertion induced dyskinesia (PED), the efficacy of different stimuli and manoeuvres in triggering dystonic attacks in the arm was studied. As a new approach, transcranial magnetic stimulation (TMS) of the motor cortex was used to trigger motor paroxysms and to monitor cortical excitability during attacks. Motor paroxysms could be provoked by muscle vibration, passive movements, TMS, magnetic stimulation of the brachial plexus, and electrical nerve stimulation. Sham stimulation over the motor cortex and thermal and tactile cutaneous stimuli were ineffective in triggering attacks. It is concluded that dystonic attacks are triggered by proprioceptive afferents rather than cutaneous stimuli or the descending motor command itself. Outside the attacks, motor cortical excitatory and inhibitory neuronal mechanisms as assessed by TMS (response threshold and amplitudes, duration of the contralateral and ipsilateral silent period, corticocortical inhibition, and facilitation) were normal, which underlines the paroxysmal character of the disorder.     

Somatosensory Discrimination of Shape: Tactile Exploration and Cerebral Activation

This study of somatosensory discrimination of rectangular parallelepipeda with the right hand had three purposes: (i) to describe the exploratory finger movements; (ii) to reveal the anatomical brain structures specifically engaged in the production of exploratory finger movements; and (iii) to reveal the anatomical structures specifically engaged in the discrimination of tactually sensed shape. The thumb was the most active finger, moving with a mean exploration frequency of 2.4 Hz, as evident from videotape records of the exploratory finger movements. The cerebral structures activated during somatosensory discrimination were mapped by measurements of regional cerebral blood flow (rCBF) in six healthy male volunteers with positron emission tomography (PET) and the use of the computerized brain atlas of Greitz et al. (1991, J. Comp. Ass. Tomogr., 15, 26 - 38). The rCBF changes caused by somatosensory discrimination were compared point-to-point to a PET-study on right-hand finger movements and a PET-study on vibration stimulation of the right hand. From these results the following conclusions were drawn. The rCBF increase in the left superior parietal lobule indicated the site engaged in the analysis of shape. The rCBF increases in the left supplementary sensory area, bilaterally in premotor areas, in the left putamen, the right dentate nucleus and bilaterally in the posterior cerebellum were related to the control of the tactile exploratory finger movements. The rCBF increases in the right homologue of Broca's area, bilaterally in the superior prefrontal cortex and in the right midfrontal cortex probably resulted from working memory, the direction of attention, and the discrimination process.     

Transcranial direct current stimulation disrupts tactile perception

The excitability of the cerebral cortex can be modulated by various transcranial stimulation techniques. Transcranial direct current stimulation (tDCS) offers the advantage of portable equipment and could, therefore, be used for ambulatory modulation of brain excitability. However, modulation of cortical excitability by tDCS has so far mostly been shown by indirect measures. Therefore, we examined whether tDCS has a direct behavioral/perceptional effect. We compared tactile discrimination of vibratory stimuli to the left ring finger prior to, during and after tDCS applied for 7 min at 1-mA current intensity in 13 subjects. Stimulation was pseudorandomized into cathodal, anodal and sham conditions in a within-subject design. The active electrode was placed over the corresponding somatosensory cortex at C4 according to the 10-20 EEG system and the reference electrode at the forehead above the contralateral orbita. Cathodal stimulation compared with sham induced a prolonged decrease of tactile discrimination, while anodal and sham stimulation did not. Thus, cortical processing can be modulated in a behaviorally/perceptually meaningful way by weak transcranial current stimulation applied through portable technology. This finding offers a new perspective for the treatment of conditions characterized by alterations of cortical excitability.     

Behavioral significance of input-dependent plasticity of human somatosensory cortex

Training and learning induce powerful cortical reorganizational changes, which are referred to as use- or experience-dependent plasticity. Using MEG, we investigated how rapid reorganization of human somatosensory cortex induced by tactile stimulation leads to improved spatial discrimination performance. Plastic changes were induced by several hours of tactile co-activation in separated receptive fields on the right index finger. Subjects did not attend the stimulation but performed their daily work. We found a 20% decrease in spatial two-point discrimination thresholds paralleled by a dipole shift in medio-lateral direction along the central sulcus. We conclude that reorganization of primary somatosensory cortex induced by purely passive tactile co-activation is sufficient to improve tactile discrimination performance without training, attention or reinforcement.     

High frequency somatosensory stimulation increases sensori-motor inhibition and leads to perceptual improvement in healthy subjects

ObjectiveHigh frequency repetitive somatosensory stimulation (HF-RSS), which is a patterned electric stimulation applied to the skin through surface electrodes, improves two-point discrimination, somatosensory temporal discrimination threshold (STDT) and motor performance in humans. However, the mechanisms which underlie these changes are still unknown. In particular, we hypothesize that refinement of inhibition might be responsible for the improvement in spatial and temporal perception.MethodsFifteen healthy subjects underwent 45 min of HF-RSS. Before and after the intervention several measures of inhibition in the primary somatosensory area (S1), such as paired-pulse somatosensory evoked potentials (pp-SEP), high-frequency oscillations (HFO), and STDT were tested, as well as tactile spatial acuity and short intracortical inhibition (SICI).ResultsHF-RSS increased inhibition in S1 tested by pp-SEP and HFO; these changes were correlated with improvement in STDT. HF-RSS also enhanced bumps detection, while there was no change in grating orientation test. Finally there was an increase in SICI, suggesting widespread changes in cortical sensorimotor interactions.ConclusionsThese findings suggest that HF-RSS can improve spatial and temporal tactile abilities by increasing the effectiveness of inhibitory interactions in the somatosensory system. Moreover, HF-RSS induces changes in cortical sensorimotor interaction.SignificanceHF-RSS is a repetitive electric stimulation technique able to modify the effectiveness of inhibitory circuitry in the somatosensory system and primary motor cortex.     

LTP-like changes induced by paired associative stimulation of the primary somatosensory cortex in humans: source analysis and associated changes in behaviour

Paired associative stimulation (PAS), which combines repetitive peripheral nerve stimulation with transcranial magnetic stimulation (TMS), may induce neuroplastic changes in somatosensory cortex (S1), possibly by long-term potentiation-like mechanisms. We used multichannel median nerve somatosensory evoked potential (MN-SSEP) recordings and two-point tactile discrimination testing to examine the location and behavioural significance of these changes. When TMS was applied to S1 near-synchronously to an afferent signal containing mechanoreceptive information, MN-SSEP changes (significant at 21-31 ms) could be explained by a change in a tangential source located in Brodmann area 3b, with their timing and polarity suggesting modification of upper cortical layers. PAS-induced MN-SSEP changes between 28 and 32 ms were linearly correlated with changes in tactile discrimination. Conversely, when the near-synchronous afferent signal contained predominantly proprioceptive information, PAS-induced MN-SSEP changes (20-29 ms) were shifted medially, and tactile performance remained stable. With near-synchronous mechanoreceptive stimulation subtle differences in the timing of the two interacting signals tended to influence the direction of tactile performance changes. PAS performed with TMS delivered asynchronously to the afferent pulse did not change MN-SSEPs. Hebbian interaction of mechanoreceptive afferent signals with TMS-evoked activity may modify synaptic efficacy in superficial cortical layers of Brodmann area 3b and is associated with timing-dependent and qualitatively congruent behavioural changes.