Effects of Two Weeks of Cerebellar Theta Burst Stimulation in Cervical Dystonia Patients |
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| Institution: | 1. Non-invasive Brain Stimulation Unit, Santa Lucia Foundation IRCCS, Via Ardeatina 306, 00179 Rome, Italy;2. University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy;3. Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain;4. UOC Neurologia, Ospedale S. Eugenio, P.le dell''Umanesimo 10, 00144 Rome, Italy;5. Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Spain;1. Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA;2. Behavioural Brain Sciences, School of Psychology, University of Birmingham, Birmingham, UK;1. UOC Neurologia, Ospedale S. Eugenio, P.le dell''Umanesimo 10, 00144 Rome, Italy;2. Non-invasive Brain Stimulation Unit, Santa Lucia Foundation IRCCS, Via Ardeatina 306, 00179 Rome, Italy;3. Neuroimaging Laboratory, Santa Lucia Foundation IRCCS, Via Ardeatina 306, 00179 Rome, Italy;4. Department of Neuroscience, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy;1. Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK;2. Division of Movement Disorders, Department of Neurology and Neuroscience Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan;3. Medical School, College of Medicine, Chang Gung University, Taoyuan, Taiwan;4. Non-invasive Brain Stimulation Unit, IRCCS Santa Lucia Foundation, Via Ardeatina 306/354, 00142, Rome, Italy;5. Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy;6. Department of Psychology, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA;7. Division of Biosciences, University College London, London, UK;8. Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy;9. Department of Neurology, Heliopolis and Al Azhar University Hospitals, Cairo, Egypt;1. Department of Rehabilitation, Baba Memorial Hospital, Nishiku Hamaderahunaotyohigashi 4-244, Sakai City, Osaka, 592-8555, Japan;2. Faculty of Rehabilitation, Shijonawate Gakuen University, Hojo 5-11-10, Daito City, Osaka, 574-0011, Japan;3. Faculty of Health Science, Kio University, 4-2-2 Umami-naka, Koryo-cho, Kitakatsuragi-gun, Nara, 635-0832, Japan;4. Neurorehabilitation Research Center of Kio University, Koryo-cho, Kitakatsuragi-gun, Nara, 635-0832, Japan;1. Non Invasive Brain Stimulation Unit/Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy;2. Stroke Unit, Department of Neuroscience, Tor Vergata Policlinic, Rome, Italy;3. Center for Mind/Brain Sciences - Cimec, University of Trento, Rovereto, TN, Italy |
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| Abstract: | Dystonia is generally regarded as a disorder of the basal ganglia and their efferent connections to the thalamus and brainstem, but an important role of cerebellar-thalamo-cortical (CTC) circuits in the pathophysiology of dystonia has been invoked. Here in a sham controlled trial, we tested the effects of two-weeks of cerebellar continuous theta burst stimulation (cTBS) in a sample of cervical dystonia (CD) patients. Clinical evaluations were performed by administering the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) and the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS). We used TMS to measure the inhibitory connectivity between the cerebellum and the contralateral motor cortex (cerebellar brain inhibition CBI]), and the excitability of the contralateral primary motor cortex assessing intracortical inhibition (SICI), intracortical facilitation (ICF) and cortical silent period (CSP). Paired associative stimulation (PAS) was tested to evaluate the level and the topographical specificity of cortical plasticity, which is abnormally enhanced and non-focal in CD patients. Two weeks of cerebellar stimulation resulted in a small but significant clinical improvement as measured by the TWSTRS of approximately 15%. Cerebellar stimulation modified the CBI circuits and reduced the heterotopic PAS potentiation, leading to a normal pattern of topographic specific induced plasticity. These data provide novel evidence CTC circuits could be a potential target to partially control some dystonic symptoms in patients with cervical dystonia. |
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| Keywords: | Cerebellar-thalamo-cortical circuits Cervical dystonia cerebellar theta burst stimulation Paired associative stimulation |
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