Theta Burst Stimulation Modulates Cerebellar-Cortical Connectivity in Patients with Progressive Supranuclear Palsy |
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| Affiliation: | 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 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, 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. Neuromed Institute IRCCS, Pozzilli, IS, Italy;2. Department of Neurology and Psychiatry, Sapienza University of Rome, Italy;1. Danish Research Center for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark;2. Department of Applied Mathematics and Computer Science, Technical University of Denmark, Denmark;3. Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark;4. Institute for Clinical Medicine, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark |
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| Abstract: | BackgroundProgressive Supranuclear Palsy (PSP) is an atypical degenerative Parkinsonism characterized by postural instability, supranuclear gaze palsy and frontal deficits. Recent imaging studies revealed that the volume of cerebellar peduncles and midbrain were reduced in PSP. Transcranial magnetic stimulation (TMS) studies demonstrated a cerebellar involvement in PSP showing an impairment of functional connectivity between the cerebellar hemisphere (Cb) and the contralateral primary motor cortex (M1) (cerebellar brain inhibition-CBI).ObjectiveTo investigate the plasticity of the cerebello-thalamo-cortical circuits in ten PSP patients after two-week course of cerebellar intermittent theta burst stimulation (iTBS), a form of repetitive TMS.MethodsBefore and after the iTBS sessions we measured functional connectivity between Cb and contralateral M1 (CBI), short intracortical inhibition (SICI) and intracortical facilitation (ICF) and short latency afferent inhibition (SLAI) in contralateral M1. We also performed resting state functional magnetic resonance (rs-fMRI) and we administered clinical rating scale (PSP-RS).ResultsAt baseline PSP patients had decreased efficiency of CBI, SICI and SLAI in comparison to PD patients and healthy subjects. Cerebellar iTBS increased the deficient functional cerebellar-motor connectivity as assessed by CBI. No effect was seen for SICI/ICF and SLAI circuits. Following iTBS there was an increased signal in the head of the caudate nucleus bilaterally as shown by rs-fMRI. Moreover, PSP-RS showed an improvement of dysarthria in all patients.ConclusionsiTBS enhanced functional connectivity between the cerebellar hemisphere, the caudate nucleus and the cortex, that was paralleled by some clinical improvement. Future randomized, sham-stimulation controlled studies are warranted to support the clinical efficacy of this technique. |
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| Keywords: | Theta burst stimulation Progressive Supranuclear Palsy Cerebellar brain inhibition |
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