Cervical magnetic stimulation

We stimulated the cervical region with a 9-cm-diameter magnetic coil on centered on the spinous processes in 21 normal subjects. We obtained maximal amplitudes with clockwise coil current in right-sided upper extremity muscles and counterclockwise coil current in left-sided upper extremity muscles. Optimal stimulation sites for biceps, triceps, and abductor digiti minimi were C-3 or C-4, C-4 or C-5, and C-4, C-5, or C-6, respectively. The latencies of the muscle responses varied little in the same subject in spite of marked amplitude changes due to suboptimal position of the coil or submaximal stimulator output. In abductor digiti minimi, the amplitude of the muscle response on cervical magnetic stimulation was 9 to 100% of the supramaximal amplitude on wrist electrical stimulation. We established normal values for latency, amplitude, and interside differences for the above 3 upper extremity muscles. The findings were reproducible, and the latencies obtained with large coils from different manufacturers in the same subjects were comparable. We found no advantage in bipolar recording over tendon-belly montage. Comparison of magnetic and electrical needle root stimulation in the same subjects showed that the magnetic stimulus was more proximal in biceps and triceps, and that the site of excitation was approximately the same in abductor digiti minimi. Indirect assessment of the longitudinal site of excitation based on F-wave minimal latency indicated that excitation occurred within millimeters of the emergence of axon of the peripheral motor neuron.     

The neural basis of the Enigma illusion: a transcranial magnetic stimulation study

The aim of this study was to test the role of the visual primary (V1) and the middle temporal area (V5/MT) in the illusory motion perception evoked by the Enigma figure. The Enigma figure induces a visual illusion that is characterized by apparent rotatory motion in the presence of a static figure. By means of repetitive transcranial magnetic stimulation (rTMS) we show that V5/MT is causally linked to the illusory perception of motion. When rTMS was applied bilaterally over V5/MT just prior to presentation of the Enigma figure, the perception of illusory motion was disrupted for approximately 400 ms resulting in a delayed illusion onset. In contrast, rTMS applied over V1 did not have any effect on the illusory perception of motion. These results show that V5/MT, a visual cortical area associated with real motion perception, is also important for the perception of illusory motion, while V1 appears not to be functionally involved in illusory motion perception.     

Long latency response in soleus muscle evoked by magnetic stimulation at the foramen magnum

We performed magnetic stimulation at the level of foramen magnum in healthy subjects to evaluate the long latency response in lower limb muscle. Subjects assumed an upright stance and we recorded electromyographic activities in soleus muscle. A late response at the onset latency of approximately 40 ms was elicited. The late response wasn't induced in other lower limb muscles; anterior tibial muscle, quadriceps femoris muscle, and biceps femoris muscle. Additionally, magnetic stimulation to foot motor cortex, basal occiput and cervical nerve roots did not evoke the response with latency of 40 ms. These results reveal the late response in soleus muscle that has not been previously reported. We speculate that it is involved with the long-loop reflex.     

Transcranial magnetic stimulation: role in the evaluation of disability in multiple sclerosis

BACKGROUND: In patients with multiple sclerosis (MS), transcranial magnetic stimulation (TMS) has shown significant prolongation of central motor conduction time (CMCT). Abnormal CMCT may reflect sub-clinical involvement of motor pathways and correlate with clinical motor disability. OBJECTIVE: To determine the diagnostic yield of TMS in MS and the possible correlation of TMS abnormalities with clinical disability. MATERIALS AND METHODS: Thirty patients with clinically definite MS presenting in acute relapse or with progressive disease course and 30 healthy controls were evaluated. TMS parameters evaluated included threshold intensity, motor evoked potentials (MEP) amplitudes and latencies and CMCT. Reassessment studies were done after three months. STATISTICAL ANALYSIS: Student t-test, Mann-Whitney U test and Spearman's rank correlation test were used to assess the relationships. RESULTS: Patients with MS had significantly higher threshold intensities, prolonged CMCT and reduced MEP amplitudes as compared to controls. Abnormalities in at least one parameter were observed in 86.7% of patients. When inter-side asymmetries in MEP latency and/or in CMCT were considered, the diagnostic yield increased to 96.7%. The diagnostic yield was 74.7% for visual evoked potentials, 13.3% for brainstem auditory evoked response and 10% for cerebrospinal fluid oligoclonal band. One MS patient without pyramidal or cerebellar dysfunction had prolonged CMCT. CMCT abnormalities correlated significantly with the degree of pyramidal signs, limb ataxia, intention tremor, dysdiadokokinesia and overall cerebellar score. In patients who had clinical improvement, follow-up studies showed improvement in CMCT parameters. CONCLUSION: TMS is a highly sensitive technique to evaluate cortico-spinal conduction abnormalities in MS that may have no clinical correlate and in monitoring the course of the disease. The effects of cerebellar dysfunction on TMS results need further evaluation.     

Biophysical modeling of neural plasticity induced by transcranial magnetic stimulation

Transcranial magnetic stimulation (TMS) is a widely used noninvasive brain stimulation method capable of inducing plastic reorganisation of cortical circuits in humans. Changes in neural activity following TMS are often attributed to synaptic plasticity via process of long-term potentiation and depression (LTP/LTD). However, the precise way in which synaptic processes such as LTP/LTD modulate the activity of large populations of neurons, as stimulated en masse by TMS, are unclear. The recent development of biophysical models, which incorporate the physiological properties of TMS-induced plasticity mathematically, provide an excellent framework for reconciling synaptic and macroscopic plasticity. This article overviews the TMS paradigms used to induce plasticity, and their limitations. It then describes the development of biophysically-based numerical models of the mechanisms underlying LTP/LTD on population-level neuronal activity, and the application of these models to TMS plasticity paradigms, including theta burst and paired associative stimulation. Finally, it outlines how modeling can complement experimental work to improve mechanistic understandings and optimize outcomes of TMS-induced plasticity.     

The role of cutaneous inputs during magnetic transcranial stimulation

Latency and amplitude characteristics of motor evoked potentials (MEPs) from abductor digiti minimi (ADM) and first dorsal interosseus (FDI) muscles were evaluated in 7 healthy volunteers via magnetic transcranial stimulation of the hemiscalp overlying contralateral motor areas. MEPs in complete relaxation and during contraction were recorded in two different experimental conditions: before and following anesthesia of median (sensory + motor) and radial (sensory) nerve fibers at wrist. This procedure induced a complete loss of skin sensation from dorsal and palmar aspects of the hand area “enveloping” the FDI muscle. On the other hand, the skin overlying the ADM muscle, as well as the strength of ulnar nerve-supplied muscles were spared. This selective sensory deprivation lead to the following short-term changes: the physiological latency “jump” toward shorter values in contracted MEPs vs. relaxation was partially lost in the FDI (3.0 ± 1.4 ms in basal condition, 1.8 ± 1.1 ms after anesthesia, P = 0.028), while it was still clearly evident in the ADM (3.7 ± 0.9 ms and 3.3 ± 1.0 ms, respectively). Moreover, minor amplitude changes of MEPs during active contraction in the two muscles were detected: MEPs recorded from the FDI muscle were less potentiated during voluntary contraction than those recorded from the ADM muscle. The role of the cutaneous input in governing latency/amplitude characteristics of MEPs is discussed. © 1996 John Wiley & Sons, Inc.     

The neural correlates of phonological short-term memory: a repetitive transcranial magnetic stimulation study

Neuropsychological reports and activation studies by means of positron emission tomography and functional magnetic resonance imaging have suggested that the neural correlates of phonological short-term memory are located in the left hemisphere, with Brodmann's area (BA) 40 being responsible for short-term storage, and BA 44 for articulatory rehearsal. However, a careful review of the literature on the role of left BA 40 shows that the data are equivocal. We tested these hypotheses by means of repetitive transcranial magnetic stimulation (rTMS). Participants performed four tasks: two phonological judgements, thought to require only articulatory rehearsal without the contribution of short-term storage; a digit span, which involves both, short-term storage and articulatory rehearsal; and a pattern span, this last being the control task. The sites of stimulation were left BA 40, left BA 44 and the electrode location v(tx), plus a baseline without TMS. Reaction times increased and accuracy decreased in the case of the phonological judgements and digit span after stimulation of both left sites, suggesting that BA 40, in addition to BA 44, is involved in phonological judgements. Possible explanations are discussed, namely, the possibility that (i) the neural correlates of rehearsal are not limited to BA 44 and (ii) phonological judgements involve processes other than rehearsal. We also consider the effects of using different tasks and responses to resolve some of the discrepancies in the literature.     

Modeling motor-evoked potentials from neural field simulations of transcranial magnetic stimulation

ObjectiveTo develop a population-based biophysical model of motor-evoked potentials (MEPs) following transcranial magnetic stimulation (TMS).MethodsWe combined an existing MEP model with population-based cortical modeling. Layer 2/3 excitatory and inhibitory neural populations, modeled with neural-field theory, are stimulated with TMS and feed layer 5 corticospinal neurons, which also couple directly but weakly to the TMS pulse. The layer 5 output controls mean motoneuron responses, which generate a series of single motor-unit action potentials that are summed to estimate a MEP.ResultsA MEP waveform was generated comparable to those observed experimentally. The model captured TMS phenomena including a sigmoidal input–output curve, common paired pulse effects (short interval intracortical inhibition, intracortical facilitation, long interval intracortical inhibition) including responses to pharmacological interventions, and a cortical silent period. Changes in MEP amplitude following theta burst paradigms were observed including variability in outcome direction.ConclusionsThe model reproduces effects seen in common TMS paradigms.SignificanceThe model allows population-based modeling of changes in cortical dynamics due to TMS protocols to be assessed in terms of changes in MEPs, thus allowing a clear comparison between population-based modeling predictions and typical experimental outcome measures.     

The role of magnetic stimulation in the diagnosis of multiple sclerosis.

Magnetic stimulation was used to measure motor conduction time (MCT) between head and neck, and head and lumbar region, as well as amplitude of the motor evoked potential (MEP) in normal subjects and patients with multiple sclerosis (MS). Patients with definite MS had significantly longer MCTs and smaller amplitude MEPs than normal subjects when recording from arm and leg muscles. In a comparison with visual evoked potential (VEP) recordings, head to neck MCTs were abnormal less often than VEPs, and VEPs detected more silent lesions. Recording from leg as well as arm muscles significantly increased the yield of abnormal MCT measurements. The detection of silent lesions in the patients with definite MS was improved, but there was no improvement in the non-definite cases. Amplitude measurements provided very little extra diagnostic information over MCT measurements alone and did not improve the detection of silent lesions. Interside MCT differences yielded extra abnormalities when recording from the arms but not the legs. Interside MCT abnormalities increased the detection of silent lesions in both the definite and non-definite categories. It was concluded that the majority of useful diagnostic information in patients with MS should be obtainable from bilateral MCT (head to neck) measurements, together with estimation of interside MCT differences. However, VEP recording is a better diagnostic test for MS than MEP recording as more silent lesions are detected. This may be because MCT abnormalities tend to reflect the degree of pyramidal disability.     

Cerebellar transcranial magnetic stimulation: The role of coil type from distinct manufacturers

BackgroundStimulating the cerebellum with transcranial magnetic stimulation is often perceived as uncomfortable. No study has systematically tested which coil design can effectively trigger a cerebellar response with the least discomfort.ObjectiveTo determine the relationship between perceived discomfort and effectiveness of cerebellar stimulation using different coils: MagStim (70 mm, 110 mm-coated, 110-uncoated), MagVenture and Deymed.MethodsUsing the cerebellar-brain inhibition (CBI) protocol, we conducted a CBI recruitment curve with respect to each participant’s maximum tolerated-stimulus intensity (MTI) to assess how effective each coil was at activating the cerebellum.ResultsOnly the Deymed double-cone coil elicited CBI at low intensities (−20% MTI). At the MTI, the MagStim (110 mm coated/uncoated) and Deymed coils produced reliable CBI, whereas no CBI was found with the MagVenture coil.Conclusions: The Deymed double-cone coil was most effective at cerebellar stimulation at tolerable intensities. These results can guide coil selection and stimulation parameters when designing cerebellar TMS studies.     

Treatment refractory depression in the elderly: A possible role for repetitive transcranial magnetic stimulation

Older patients with depression often have a limited response to antidepressant medications. Electroconvulsive therapy (ECT) is effective for treatment refractory depression in late life, but the side effects and risks of ECT often limit its use. Repetitive transcranial magnetic stimulation (TMS) is an emerging, noninvasive treatment for depression that has shown antidepressant effects in younger patients with treatment refractory depression. Results to date in the elderly have been mixed, but TMS is likely to develop as a useful treatment adjunct for at least some older patients with treatment refractory depression.     

The role of the cerebellum in subsecond time perception: evidence from repetitive transcranial magnetic stimulation

In three experiments, we investigated the role of the cerebellum in sub- and suprasecond time perception by using repetitive transcranial magnetic stimulation (rTMS). In Experiment 1, subjects underwent four 8-min 1-Hz rTMS sessions in a within-subject design. rTMS sites were the medial cerebellum (real and sham rTMS), left lateral cerebellum, and right lateral cerebellum. Following each rTMS session, subjects completed a subsecond temporal bisection task (stimuli in the range 400-800 msec). Compared with sham rTMS, rTMS applied over the right lateral or medial cerebellum induced a leftward shift of the psychophysical function (perceived lengthening of time). In Experiment 2, a separate sample of subjects underwent the identical rTMS procedure and completed a suprasecond bisection task (stimuli in the 1000-2000 msec range). In this experiment, rTMS to the cerebellar sites did not produce any significant changes compared with sham rTMS. Experiment 3 employed a within-subject design to replicate findings from Experiments 1 and 2. Subjects underwent four rTMS conditions (sub- and suprabisection tasks following medial cerebellar and sham rTMS). rTMS induced a significant leftward shift of psychophysical function in the subsecond bisection, but not in the suprasecond bisection. In this study, we have demonstrated that transient cerebellar stimulation can differently affect the ability to estimate time intervals below and above a duration of 1 sec. The results of this study provide direct evidence for the role of the cerebellum in processing subsecond time intervals. This study further suggests that the perception of sub- and suprasecond intervals is likely to depend upon distinct neural systems.     

The role of transcranial magnetic stimulation in the study of cerebellar cognitive function

Transcranial magnetic stimulation (TMS) allows non-invasive stimulation of brain structures. This technique can be used either for stimulating the motor cortex, recording motor evoked potentials from peripheral muscles, or for modulating the excitability of other non-motor areas in order to establish their necessity for a given task. TMS of the cerebellum can give interesting insights on the cerebellar functions. Paired-TMS techniques, delivering stimuli over the cerebellum followed at various interstimulus intervals by stimuli over the motor cortex, allow studying the pattern of connectivity between the cerebellum and the contralateral motor cortex in physiological as well as in pathological conditions. Repetitive TMS, delivering trains of stimuli at different frequencies, allows interfering with the function of cerebellar circuits during the execution of cognitive tasks. This application complements neuropsychological and neuroimaging studies in the study of the cerebellar involvement in a number of cognitive operations, ranging from procedural memory, working memory and learning through observation.     

经颅磁刺激的频率与位点对帕金森病的作用

帕金森病(Parkinsondisease,PD)是中老年人常见的一种慢性进行性中枢神经系统变性疾病,随着年龄的增长,患病率也在不断升高,目前仍以药物治疗为主.据文献统计,左旋多巴制剂是我国治疗PD使用率较高、最有效的药物,药物治疗临床总有效率77.2%[1].同时,PD外科治疗也经历了苍白球毁损术及其复兴,丘脑腹外侧核毁损术等多个发展历程.     

The role of the dorsolateral prefrontal cortex in bimodal divided attention: two transcranial magnetic stimulation studies

The neural processes underlying the ability to divide attention between multiple sensory modalities remain poorly understood. To investigate the role of the dorsolateral prefrontal cortex (DLPFC) in bimodal divided attention, we completed two repetitive transcranial magnetic stimulation (rTMS) studies. We tested the hypothesis that the DLPFC is necessary in the ability to divide attention across modalities. This hypothesis originated as a result of a previous fMRI study in which the posterior DLPFC was active during a bimodal divided attention condition [Johnson, J. A., & Zatorre, R. J. Neural substrates for dividing and focusing attention between simultaneous auditory and visual events. Neuroimage, 2006]. In the current experiments, two separate groups of subjects underwent 10 min of slow rTMS to temporarily disrupt function of the DLPFC. In both groups, the ability to divide attention between unrelated auditory and visual stimuli decreased following DLPFC disruption compared to control site stimulation. Specifically, the ability to divide attention between modalities was hindered, leading to a pattern of behavior similar to bimodal selective attention (ability to attend to one or the other modality but not both). We discuss possible roles of the posterior DLPFC in bimodal divided attention and conclude that the area may be functioning to support the increased working memory load associated with divided, compared to selective attention.     

The role of the right dorsal premotor cortex in visuomotor learning: a transcranial magnetic stimulation study

To study the role of the right dorsal premotor cortex in visuomotor association learning (association of four visual stimuli to four buttons), transcranial magnetic stimulation was applied to this area to interfere with the ongoing learning processes. Two transcranial magnetic stimulation pulses to the right dorsal premotor cortex at 150 and 200 ms after onset of the imperative stimulus resulted in the abolishing of reaction time decreases during learning. Transcranial magnetic stimulation applied to a control region revealed no influence on reaction time decreases. During both conditions, however, there were similar increases of accuracy scores. We conclude that the right dorsal premotor cortex is not directly involved in associating visual with motor cues. We suggest that this area is intimately involved in selection and preparation of forthcoming movements.