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ID 243 – Enhancement of cortical excitability in stroke patients after combined repetitive transcranial and peripheral magnetic stimulation
Abstracts / Clinical Neurophysiology 127 (2016) e18–e132
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ID 232 – Assessment of the impact of segmental magnetic stimulation on different parts of the nervous system—V. Blokhina a, S. Nikolaev b, A. Kuznetsov a, N. Smirnov c, E. Melikyan a (a Neurology Department, National Medical-Surgical Center named by N.I. Pirogov, Moscow, Russia, b Medical Company Elf Ltd, Vladimir, Russia, c Ivanovo State Medical University, Ivanovo, Russia)
ID 248 – Therapeutic role of repetitive peripheral magnetic stimulation in carpal tunnel syndrome—A. El Gohary a, H. Raafat a, M. Basheer a, S. Ahmed b, M. Shalaby a (a Clinical Neurophysiology Unit, Faculty of Medicine, Cairo University, Cairo, Egypt, b Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt)
Objective: Segmental magnetic stimulation is an innovative approach in treatment of lumbal pain. The aim of this study was the assessment of the intensity of pulsed magnetic stimulus required to affect different parts of nervous system such as spinal roots and terminal motor nerve branches. Methods: 27 healthy subjects were enrolled in the study. The threshold of motor evoked potential (MEP) was used to evaluate the excitability of spinal root, whereas the excitability of terminal motor nerve branches was assessed by the contraction of m. trapezius and the subjective feeling as a ‘‘push”. Results: All healthy individuals, except two, had registered the subjective threshold on the intensity of magnetic stimulus less than the threshold of muscle contraction and MEP. In 51.8% of cases the threshold of muscle contraction was equal or higher than MEP’s threshold. Conclusions: Based on the results of previous studies and our data, we suppose that the subjective threshold is an indicator of the excitability of terminal motor nerve branches. The threshold of MEP indicates the excitability of the spinal root. Key message: Our data can have potential clinical applicability for designing an optimum algorithm of repetitive peripheral magnetic stimulation in management of patients with vertebral pathology.
Background: Carpal tunnel syndrome (CTS) is one of the most common causes of upper limb neuropathic pain and tends to increase in severity as the disease progresses. It can significantly affect motor performance and different activities of daily living. Appropriate management should be implemented from the time of its symptoms onset. Many non-surgical treatment procedures were previously researched. However, repetitive peripheral magnetic stimulation (RPMS) for the treatment of carpal tunnel syndrome is not in such lists. Objectives: To evaluate the therapeutic effects of RPMS in carpal tunnel syndrome. Methods: twenty participants were enrolled. Nerve conduction studies, Visual Analogue-pain-Scale (VAS) and RPMS were performed. Results: significant pain reduction was found among patients with early CTS for up to a month after RPMS. Conclusions: RPMS can be considered as a noninvasive therapeutic tool for pain reduction in early CTS patients. doi:10.1016/j.clinph.2015.11.411
doi:10.1016/j.clinph.2015.11.409
ID 243 – Enhancement of cortical excitability in stroke patients after combined repetitive transcranial and peripheral magnetic stimulation—S. Kuznietsova, N. Skachkova, O. Semonova (Neurology, Institution of Gerontology of NAMS of Ukraine, Kiev, Ukraine) Objective: To determine the effect of combined repetitive transcranial magnetic stimulation (rTMS) and repetitive peripheral magnetic stimulation (rPMS) on cortical excitability in stroke patients. Methods: 77 patients (mean age – 63.02 ± 1.21 years) with ischemic stroke were randomized to receive 1 Hz real or sham rTMS and rPMS for 10 consecutive days. Motor function was evaluated by the Motor Club Assessment Scale (MCAS). Motor evoked potential (MEP) and resting motor threshold (RMT) of the affected abductor digiti minimi and abductor hallucis were measured as parameters of cortical excitability with single-pulse TMS methods. Results: The improvement of motor function was greater in the real stimulation group (40.4% in MCAS) when compared to the sham group (17.1% in MCAS). The MEPs in the real stimulation group became shorter in latency and higher in amplitude and area after intervention in comparison with the sham group. The RMT in the real stimulation group became lower after treatment in comparison with the sham group. Conclusion: Combined rTMS and rPMS improved motor functions and increased cortical excitability of the affected hemisphere in stroke patients. Key message: Combined rTMS and rPMS may potentiate cerebral adaptive processes that facilitate motor recovery after stroke.
ID 278 – Motor cortical disinhibition is more pronounced in Progressive Supranuclear Palsy than in Parkinson’s disease: Evidence from TMS—M. Fichera, E. Houdayer, F. Avantaggiato, R. Chieffo, G. Comi, M.A. Volonté, L. Leocani (Scientific Institute University Hospital San Raffaele, Institute of Experimental Neurology, Milan, Italy) Objective: Progressive Supranuclear Palsy-PSP is the second most common parkinsonian syndrome after Parkinson’s disease-PD. Non-invasive neurophysiological techniques, such as transcranial magnetic stimulation-TMS, could prove useful to gain insight into these pathologies and for differential diagnosis. Methods: Seventeen PD, 13 PSP and 11 healthy controls-CT were included in this study. TMS evaluation included resting motor threshold-RMT, motor evoked potentials-MEP amplitude, response to inhibitory-SICI and facilitating-ICF conditioning stimuli, corticalCSP and ipsilateral silent period-iSP. Statistical analysis was performed using either parametric or non-parametric ANOVA and post-hoc tests according to data distribution. Results: PSP and PD groups did not significantly differ in UPDRS. RMT distributed differently across groups (p.008), with PSP patients showing highest values and PD lowest (PSPvs.PD p.002). Group also affected iSP duration (p.016), being longest in PSP and lowest in HC (PSPvs.CT p.005). On paired-pulse inhibition and facilitation, a significant effect for inter-stimulus interval-ISI (p < .001) and group (p.035) but not interaction was found, with lower SICI and higher ICF in PSP vs. PD (p.017) and CT (p.032). Conclusions: This study suggests that TMS can help differentiate PD and PSP. PSP patients displayed different response to the perturbation induced by conditioning stimuli and iSP elongation, probably due to impairment of GABA-mediated neurotransmission. doi:10.1016/j.clinph.2015.11.412
doi:10.1016/j.clinph.2015.11.410
e121
ID 232 – Assessment of the impact of segmental magnetic stimulation on different parts of the nervous system—V. Blokhina a, S. Nikolaev b, A. Kuznetsov a, N. Smirnov c, E. Melikyan a (a Neurology Department, National Medical-Surgical Center named by N.I. Pirogov, Moscow, Russia, b Medical Company Elf Ltd, Vladimir, Russia, c Ivanovo State Medical University, Ivanovo, Russia)
ID 248 – Therapeutic role of repetitive peripheral magnetic stimulation in carpal tunnel syndrome—A. El Gohary a, H. Raafat a, M. Basheer a, S. Ahmed b, M. Shalaby a (a Clinical Neurophysiology Unit, Faculty of Medicine, Cairo University, Cairo, Egypt, b Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt)
Objective: Segmental magnetic stimulation is an innovative approach in treatment of lumbal pain. The aim of this study was the assessment of the intensity of pulsed magnetic stimulus required to affect different parts of nervous system such as spinal roots and terminal motor nerve branches. Methods: 27 healthy subjects were enrolled in the study. The threshold of motor evoked potential (MEP) was used to evaluate the excitability of spinal root, whereas the excitability of terminal motor nerve branches was assessed by the contraction of m. trapezius and the subjective feeling as a ‘‘push”. Results: All healthy individuals, except two, had registered the subjective threshold on the intensity of magnetic stimulus less than the threshold of muscle contraction and MEP. In 51.8% of cases the threshold of muscle contraction was equal or higher than MEP’s threshold. Conclusions: Based on the results of previous studies and our data, we suppose that the subjective threshold is an indicator of the excitability of terminal motor nerve branches. The threshold of MEP indicates the excitability of the spinal root. Key message: Our data can have potential clinical applicability for designing an optimum algorithm of repetitive peripheral magnetic stimulation in management of patients with vertebral pathology.
Background: Carpal tunnel syndrome (CTS) is one of the most common causes of upper limb neuropathic pain and tends to increase in severity as the disease progresses. It can significantly affect motor performance and different activities of daily living. Appropriate management should be implemented from the time of its symptoms onset. Many non-surgical treatment procedures were previously researched. However, repetitive peripheral magnetic stimulation (RPMS) for the treatment of carpal tunnel syndrome is not in such lists. Objectives: To evaluate the therapeutic effects of RPMS in carpal tunnel syndrome. Methods: twenty participants were enrolled. Nerve conduction studies, Visual Analogue-pain-Scale (VAS) and RPMS were performed. Results: significant pain reduction was found among patients with early CTS for up to a month after RPMS. Conclusions: RPMS can be considered as a noninvasive therapeutic tool for pain reduction in early CTS patients. doi:10.1016/j.clinph.2015.11.411
doi:10.1016/j.clinph.2015.11.409
ID 243 – Enhancement of cortical excitability in stroke patients after combined repetitive transcranial and peripheral magnetic stimulation—S. Kuznietsova, N. Skachkova, O. Semonova (Neurology, Institution of Gerontology of NAMS of Ukraine, Kiev, Ukraine) Objective: To determine the effect of combined repetitive transcranial magnetic stimulation (rTMS) and repetitive peripheral magnetic stimulation (rPMS) on cortical excitability in stroke patients. Methods: 77 patients (mean age – 63.02 ± 1.21 years) with ischemic stroke were randomized to receive 1 Hz real or sham rTMS and rPMS for 10 consecutive days. Motor function was evaluated by the Motor Club Assessment Scale (MCAS). Motor evoked potential (MEP) and resting motor threshold (RMT) of the affected abductor digiti minimi and abductor hallucis were measured as parameters of cortical excitability with single-pulse TMS methods. Results: The improvement of motor function was greater in the real stimulation group (40.4% in MCAS) when compared to the sham group (17.1% in MCAS). The MEPs in the real stimulation group became shorter in latency and higher in amplitude and area after intervention in comparison with the sham group. The RMT in the real stimulation group became lower after treatment in comparison with the sham group. Conclusion: Combined rTMS and rPMS improved motor functions and increased cortical excitability of the affected hemisphere in stroke patients. Key message: Combined rTMS and rPMS may potentiate cerebral adaptive processes that facilitate motor recovery after stroke.
ID 278 – Motor cortical disinhibition is more pronounced in Progressive Supranuclear Palsy than in Parkinson’s disease: Evidence from TMS—M. Fichera, E. Houdayer, F. Avantaggiato, R. Chieffo, G. Comi, M.A. Volonté, L. Leocani (Scientific Institute University Hospital San Raffaele, Institute of Experimental Neurology, Milan, Italy) Objective: Progressive Supranuclear Palsy-PSP is the second most common parkinsonian syndrome after Parkinson’s disease-PD. Non-invasive neurophysiological techniques, such as transcranial magnetic stimulation-TMS, could prove useful to gain insight into these pathologies and for differential diagnosis. Methods: Seventeen PD, 13 PSP and 11 healthy controls-CT were included in this study. TMS evaluation included resting motor threshold-RMT, motor evoked potentials-MEP amplitude, response to inhibitory-SICI and facilitating-ICF conditioning stimuli, corticalCSP and ipsilateral silent period-iSP. Statistical analysis was performed using either parametric or non-parametric ANOVA and post-hoc tests according to data distribution. Results: PSP and PD groups did not significantly differ in UPDRS. RMT distributed differently across groups (p.008), with PSP patients showing highest values and PD lowest (PSPvs.PD p.002). Group also affected iSP duration (p.016), being longest in PSP and lowest in HC (PSPvs.CT p.005). On paired-pulse inhibition and facilitation, a significant effect for inter-stimulus interval-ISI (p < .001) and group (p.035) but not interaction was found, with lower SICI and higher ICF in PSP vs. PD (p.017) and CT (p.032). Conclusions: This study suggests that TMS can help differentiate PD and PSP. PSP patients displayed different response to the perturbation induced by conditioning stimuli and iSP elongation, probably due to impairment of GABA-mediated neurotransmission. doi:10.1016/j.clinph.2015.11.412
doi:10.1016/j.clinph.2015.11.410