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EP 21. Neurophysiological, psychological and behavioural correlates of rTMS treatment in alcohol dependence
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Abstracts / Clinical Neurophysiology 127 (2016) e210–e303
Conclusions: Cathodal tDCS is slightly more effective than dualtDCS in reducing distal UL spasticity in chronic post-stroke subjects. A modulation of spinal inhibitory mechanisms, as demonstrated by H reflex modifications, supports this finding. doi:10.1016/j.clinph.2016.05.075
Fig. 1.
EP 21. Neurophysiological, psychological and behavioural correlates of rTMS treatment in alcohol dependence—A. Del Felice a,*, E. Bellamoli b, E. Formaggio a,c, P. Manganotti d,c, S. Masiero a, G. Cuoghi e, C. Rimondo f, B. Genetti g, M. Sperotto g, F. Corso h, G. Brunetto h, F. Bricolo h, M. Gomma h, G. Serpelloni h (a University of Padua, Department of Neuroscience, Section of Rehabilitation, Padova, Italy, b University of Verona, Department of Neurological and Movement Sciences, Section of Neurology, Verona, Italy, c Foundation IRCCS San Camillo Hospital, Department of Neurophysiology, Venezia-Lido, Italy, d University Hospital Trieste, Neurology department, Trieste Italy, e Institute of Constructivist
Abstracts / Clinical Neurophysiology 127 (2016) e210–e303
Psychology, Padua Italy, f National Coordination Centre for NIDA Collaborations, Verona Italy, g Explora – Centro di Ricerca e Analisi Statistica, Padua Italy, h Addiction Department, ULSS 20, Verona Italy) ⇑
Corresponding author.
Background: Dependence is associated with dorso-lateral prefrontal cortex (DLPFC) dysfunction and altered brain-oscillations. High frequency repetitive transcranial magnetic stimulation (HFrTMS) over DLPFC reportedly reduces drug craving. Its effects on neuropsychological, behavioural and neurophysiological are unclear. Methods: We assessed psychological, behavioural and neurophysiological effects of 4 sessions of 10-minutes adjunctive HFrTMS over the left DLPFC during two weeks during a residential programme for alcohol detoxification. Participants were randomized to active HFrTMS (10 Hz, 100%motor threshold) or sham. Immediately before the first and after last session, 32-channels EEG was recorded and Alcohol craving Visual Analogue Scale, Symptom Check List-90-R, Numeric Stroop task and Go/No-go task administered. Tests were repeated at 1-month follow-up. Results: 17 subjects (mean age 44.7 y, 4 F) were assessed. Active rTMS subjects performed better at Stroop test at end of treatment (p = 0.036) and follow up (p = 0.004) and at Go-NoGo at end of treatment (p = 0.05) and follow up (p = 0.015). Depressive symptoms decreased at end of active treatment (p = 0.036). Active-TMS showed an overall decrease of fast EEG frequencies after treatment compared to sham (p = 0.026). No significant modifications over time or group emerged for craving and number of drinks at follow up. Conclusion: 4 HFrTMS sessions over two weeks on the left DLPFC can improve inhibitory control task and selective attention and reduce depressive symptoms. An overall reduction of faster EEG frequencies was observed. Nonetheless, this schedule is ineffective in reducing craving and alcohol intake.
doi:10.1016/j.clinph.2016.05.076
EP 22. A sleep surgery of language eloquent brain lesions purely based on rTMS language mapping—S. Ille a,b,*, N. Sollmann a,b, B. Meyer a, F. Ringel a, S.M. Krieg a,b (a Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Germany, b TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, München, Germany) ⇑
Corresponding author.
Objective: The resection of left-sided perisylvian brain lesions harbors the risk of postoperative language impairment. Hence, neurosurgeons determine the individual patient’s language distribution by using intraoperative direct cortical stimulation (DCS) during awake surgery. Yet, not all patients qualify for awake surgery. Since non-invasive language mapping by repetitive navigated transcranial magnetic stimulation (rTMS) has frequently shown a high correlation in comparison with the results of DCS language mapping in terms of language-negative brain regions, the present study analyzes oncological and functional outcome of patients who underwent left-sided perisylvian resection of brain lesions purely based on the results of rTMS language mapping.
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Methods: Four patients (astrocytoma WHO grade III of the superior temporal gyrus, astrocytoma WHO grade III of the middle and inferior temporal gyrus, glioblastoma WHO IV of the opercular part of the frontal gyrus, and cavernoma of the insular lobe) underwent rTMS language mapping prior to surgery and data of rTMS language mapping were transferred to the intraoperative neuronavigation system. Preoperatively, 5 days after surgery (=POD5), and 3 months after surgery (=POM3) clinical follow-up was performed. Results: No patient suffered from a new surgery-related aphasia. Three patients underwent complete resection immediately, while one patient required a second resection some days later. Conclusion: Despite only presenting 4 patients, we could show the feasibility of successfully resecting language-eloquent brain lesions purely based on rTMS language mapping data as a rescue strategy in selected cases in which awake surgery is impossible. No patient was harmed and the extent of resection was oncologically optimal. doi:10.1016/j.clinph.2016.05.077
EP 23. Cortical language mapping by rTMS compared to fMRI in healthy volunteers—N. Sollmann a,b,c, S. Ille a,b,*, C. Zimmer c, B. Meyer a, F. Ringel a, S.M. Krieg a,b (a Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Germany, b TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, München, Germany, c Abteilung für Neuroradiologie, Institut für Radiologie, Klinikum rechts der Isar, Technische Universität München, München, Germany) ⇑
Corresponding author.
Objective: While functional magnetic resonance imaging (fMRI) was considered to be the standard for non-invasive language mapping for a long time, repetitive navigated transcranial magnetic stimulation (rTMS) is an upcoming method. However, most current language models refer to fMRI language mapping data. We therefore compared both modalities for language mapping in healthy subjects. Methods: We performed rTMS and fMRI language mapping in 40 healthy subjects. After assigning language-positive regions to a cortical parcellation system (CPS), we calculated rTMS error rates (ER = errors per stimulations) and fMRI activation rates (AR = bloodoxygen-level-dependent-positive regions per patients) for each CPS region. We defined different error rate thresholds (ERT = ER at which a CPS region was defined as language-positive in terms of rTMS), and used Cohen’s kappa coefficient for the comparison of the two techniques. Results: The overall kappa for all regions was 0.05 ± 0.06 (mean ± SD). We found the best agreement for both techniques when using the 2-out-of-3 rule (CPS region was defined as language-positive in terms of rTMS if at least 2 out of 3 stimulations led to a language error). However, kappa value for this agreement was only 0.24, describing a fair agreement. Conclusion: Mapping data by fMRI and rTMS differed significantly and we need to be careful to call one of the two techniques as the true one. However, current language models referring to fMRI data should be reconsidered, and new models should combine data of both techniques. doi:10.1016/j.clinph.2016.05.078
Abstracts / Clinical Neurophysiology 127 (2016) e210–e303
Conclusions: Cathodal tDCS is slightly more effective than dualtDCS in reducing distal UL spasticity in chronic post-stroke subjects. A modulation of spinal inhibitory mechanisms, as demonstrated by H reflex modifications, supports this finding. doi:10.1016/j.clinph.2016.05.075
Fig. 1.
EP 21. Neurophysiological, psychological and behavioural correlates of rTMS treatment in alcohol dependence—A. Del Felice a,*, E. Bellamoli b, E. Formaggio a,c, P. Manganotti d,c, S. Masiero a, G. Cuoghi e, C. Rimondo f, B. Genetti g, M. Sperotto g, F. Corso h, G. Brunetto h, F. Bricolo h, M. Gomma h, G. Serpelloni h (a University of Padua, Department of Neuroscience, Section of Rehabilitation, Padova, Italy, b University of Verona, Department of Neurological and Movement Sciences, Section of Neurology, Verona, Italy, c Foundation IRCCS San Camillo Hospital, Department of Neurophysiology, Venezia-Lido, Italy, d University Hospital Trieste, Neurology department, Trieste Italy, e Institute of Constructivist
Abstracts / Clinical Neurophysiology 127 (2016) e210–e303
Psychology, Padua Italy, f National Coordination Centre for NIDA Collaborations, Verona Italy, g Explora – Centro di Ricerca e Analisi Statistica, Padua Italy, h Addiction Department, ULSS 20, Verona Italy) ⇑
Corresponding author.
Background: Dependence is associated with dorso-lateral prefrontal cortex (DLPFC) dysfunction and altered brain-oscillations. High frequency repetitive transcranial magnetic stimulation (HFrTMS) over DLPFC reportedly reduces drug craving. Its effects on neuropsychological, behavioural and neurophysiological are unclear. Methods: We assessed psychological, behavioural and neurophysiological effects of 4 sessions of 10-minutes adjunctive HFrTMS over the left DLPFC during two weeks during a residential programme for alcohol detoxification. Participants were randomized to active HFrTMS (10 Hz, 100%motor threshold) or sham. Immediately before the first and after last session, 32-channels EEG was recorded and Alcohol craving Visual Analogue Scale, Symptom Check List-90-R, Numeric Stroop task and Go/No-go task administered. Tests were repeated at 1-month follow-up. Results: 17 subjects (mean age 44.7 y, 4 F) were assessed. Active rTMS subjects performed better at Stroop test at end of treatment (p = 0.036) and follow up (p = 0.004) and at Go-NoGo at end of treatment (p = 0.05) and follow up (p = 0.015). Depressive symptoms decreased at end of active treatment (p = 0.036). Active-TMS showed an overall decrease of fast EEG frequencies after treatment compared to sham (p = 0.026). No significant modifications over time or group emerged for craving and number of drinks at follow up. Conclusion: 4 HFrTMS sessions over two weeks on the left DLPFC can improve inhibitory control task and selective attention and reduce depressive symptoms. An overall reduction of faster EEG frequencies was observed. Nonetheless, this schedule is ineffective in reducing craving and alcohol intake.
doi:10.1016/j.clinph.2016.05.076
EP 22. A sleep surgery of language eloquent brain lesions purely based on rTMS language mapping—S. Ille a,b,*, N. Sollmann a,b, B. Meyer a, F. Ringel a, S.M. Krieg a,b (a Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Germany, b TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, München, Germany) ⇑
Corresponding author.
Objective: The resection of left-sided perisylvian brain lesions harbors the risk of postoperative language impairment. Hence, neurosurgeons determine the individual patient’s language distribution by using intraoperative direct cortical stimulation (DCS) during awake surgery. Yet, not all patients qualify for awake surgery. Since non-invasive language mapping by repetitive navigated transcranial magnetic stimulation (rTMS) has frequently shown a high correlation in comparison with the results of DCS language mapping in terms of language-negative brain regions, the present study analyzes oncological and functional outcome of patients who underwent left-sided perisylvian resection of brain lesions purely based on the results of rTMS language mapping.
e243
Methods: Four patients (astrocytoma WHO grade III of the superior temporal gyrus, astrocytoma WHO grade III of the middle and inferior temporal gyrus, glioblastoma WHO IV of the opercular part of the frontal gyrus, and cavernoma of the insular lobe) underwent rTMS language mapping prior to surgery and data of rTMS language mapping were transferred to the intraoperative neuronavigation system. Preoperatively, 5 days after surgery (=POD5), and 3 months after surgery (=POM3) clinical follow-up was performed. Results: No patient suffered from a new surgery-related aphasia. Three patients underwent complete resection immediately, while one patient required a second resection some days later. Conclusion: Despite only presenting 4 patients, we could show the feasibility of successfully resecting language-eloquent brain lesions purely based on rTMS language mapping data as a rescue strategy in selected cases in which awake surgery is impossible. No patient was harmed and the extent of resection was oncologically optimal. doi:10.1016/j.clinph.2016.05.077
EP 23. Cortical language mapping by rTMS compared to fMRI in healthy volunteers—N. Sollmann a,b,c, S. Ille a,b,*, C. Zimmer c, B. Meyer a, F. Ringel a, S.M. Krieg a,b (a Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Germany, b TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, München, Germany, c Abteilung für Neuroradiologie, Institut für Radiologie, Klinikum rechts der Isar, Technische Universität München, München, Germany) ⇑
Corresponding author.
Objective: While functional magnetic resonance imaging (fMRI) was considered to be the standard for non-invasive language mapping for a long time, repetitive navigated transcranial magnetic stimulation (rTMS) is an upcoming method. However, most current language models refer to fMRI language mapping data. We therefore compared both modalities for language mapping in healthy subjects. Methods: We performed rTMS and fMRI language mapping in 40 healthy subjects. After assigning language-positive regions to a cortical parcellation system (CPS), we calculated rTMS error rates (ER = errors per stimulations) and fMRI activation rates (AR = bloodoxygen-level-dependent-positive regions per patients) for each CPS region. We defined different error rate thresholds (ERT = ER at which a CPS region was defined as language-positive in terms of rTMS), and used Cohen’s kappa coefficient for the comparison of the two techniques. Results: The overall kappa for all regions was 0.05 ± 0.06 (mean ± SD). We found the best agreement for both techniques when using the 2-out-of-3 rule (CPS region was defined as language-positive in terms of rTMS if at least 2 out of 3 stimulations led to a language error). However, kappa value for this agreement was only 0.24, describing a fair agreement. Conclusion: Mapping data by fMRI and rTMS differed significantly and we need to be careful to call one of the two techniques as the true one. However, current language models referring to fMRI data should be reconsidered, and new models should combine data of both techniques. doi:10.1016/j.clinph.2016.05.078