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P76-S Therapeutic possibilities of transcranial magnetic stimulation in patients after traumatic brain injury (updated report)
Abstracts / Clinical Neurophysiology 130 (2019) e21–e116
P76-S Therapeutic possibilities of transcranial magnetic stimulation in patients after traumatic brain injury (updated report)— Miroslav Kopachka a,*, Elena Sharova b, Evgenija Alexandrova a, Elena Troshina a, Oleg Zaitsev a, Marina Chelyapina b, Lubov Oknina b (a Federal State Autonomous Institution ‘‘n.n. Burdenko National Scientific And Practical Center For Neurosurgery”, Moscow, Russian Federation, b Institute of Higher Nervous Activity and Neurophysiology of RAS, Moscow, Russian Federation) ⇑
Corresponding author.
Objectives: The purpose of this study is to estimate the therapeutic potential of transcranial magnetic stimulation (TMS) in patients after traumatic brain injury (TBI) with impaired consciousness and motor activity. Methods: Observation groups: (1)19 patients after TBI at the age of 16–50 with a prolonged (from 60 to 360 days) unconscious state in which the rhythmic TMS was performed; (2) Control group: 6 healthy men aged 22–28. Changes of neurological status, indicators of the memory and attention, and N100, N200 and P300 components of auditory ERP hour before and hour after stimulation, the dynamics of diagnostic TMS and bimodal (somatosensory and short latency auditory) EP’s were estimated. Results: Therapeutic rTMS of the sagittal premotor cortex areas in both groups concurred with improvement of any attention and normalization of amplitude and latency of all ERP components, especially for P300. rTMS of the frontal lobes facilitated positive clinical dynamics, while rTMS of the parietal lobes did not prove any clear positive effects. Conclusions: The obtained data proposes the availability of using rTMS for therapeutic purposes in patients with PUS. The most promising targets for stimulation at the moment seems to be the frontal and sagittal premotor areas of the brain. Further research is required to clarify the areas and parameters of stimulation. Supported by: RFFI N 16-29-08304. doi:10.1016/j.clinph.2019.04.604
P77-S Early results of rTMS application in the recovery of motor function in the iSCI subjects—Wojciech Fortuna a,b,*, Juliusz Huber c, Agnieszka Wincek c, Jagoda Łukaszek d, Stefan Okurowski d, Paweł Tabakow a (a Regenerative and Functional Neurosurgery Unit, Department of Neurosurgery, Wroclaw Medical University, Wroclaw, Poland, b Bacteriophage Laboratory, Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland, c Department of Pathophysiology of Locomotors Organs, University of Medical Sciences, Poznan, Poland, d Neurorehabilitation Center for Treatment of Spinal Cord Injuries AKSON, Wroclaw, Poland) ⇑
Corresponding author.
Background: Patients with incomplete spinal cord injuries (iSCI) present impairment of motor and sensory functions associated with increased spasticity. The repetitive transcranial magnetic stimulation (rTMS) becomes widely used to potentiate the effects of longlasting physical rehabilitation in the iSCI subjects. The purpose of this study was ascertaining the early changes in activity of motor muscles units and spinal cord efferent transmission studied with surface electromyography (sEMG) and motor evoked potentials (MEPs) recordings after five repeated sessions of rTMS applied every month to the iSCI subjects along with rehabilitation.
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Material and methods: Twenty-eight subjects with iSCI at C2-Th12 levels were subjected to twenty sessions of rTMS for five months (three to four sessions every month). Subjects received 800 biphasic pulses (20 Hz, 2s trains, 28s ITI, 36–38% MSO) per day bilaterally over the primary motor cortex areas (MagVenture). sEMG at rest and during attempts of maximal contraction lasting five seconds and MEPs recordings from five observation periods were analyzed before and after rTMS. Results: After five rTMS meetings a significant decrease in sEMG amplitudes recorded at rest and increase of mean sEMG amplitudes recorded during maximal contraction were observed. A moderate increase of mean MEPs amplitudes was observed on certain observation period. Conclusions: rTMS provided decrease of spasticity as evaluated in sEMG recordings at rest and evoked simultaneous improvement of muscle’s motor units’ contractions as well as the efferent transmission in spinal pathways in the iSCI subjects. The study was supported by the Nicholls Spinal Injury Foundation, UK. doi:10.1016/j.clinph.2019.04.605
P78-S Transcranial direct current stimulation in chronic motor stroke: Preliminary results of a four-arm controlled study— Ilya Bakulin *, Alexandra Poydasheva, Dmitry Lagoda, Artem Kotov-Smolenskiy, Anastasia Butkovskaya, Natalia Suponeva, Michael Piradov (Research Center of Neurology, Moscow, Russian Federation) ⇑
Corresponding author.
Background: Transcranial direct current stimulation (tDCS) is a promising method for motor recovery in patients with stroke. At present different electrodes montages are used in motor stroke, but their comparative efficacy remains unclear. The aim of this study was to evaluate efficacy of different tDCS montages in chronic motor stroke. Materials and methods: In this four-arm sham-controlled study 29 patients with chronic motor stroke were randomized into 4 groups: anodal tDCS over primary motor cortex (M1) of the lesional hemisphere (n = 7); cathodal tDCS over M1 of the contralesional hemisphere (n = 7); simultaneous bilateral stimulation (n = 8) and sham-stimulation (n = 7). Each patient received five stimulation sessions (20 min, 2 mA in active groups, one session per day) in combination with a course of standard physical rehabilitation. Participants were evaluated before and after stimulation with the upper extremity section of the Fugl-Meyer Assessment Scale (FM-UE) and the Modified Ashworth Scale (MAS) of muscle spasticity. Results: The groups were not significantly different at baseline on age, duration after stroke, FM-UE and MAS scores. FM-UE score significantly improved after cathodal and bilateral tDCS, but not after anodal and sham-stimulation. There were no significant changes in MAS score in all groups. The effect of tDCS on motor function did not depend on baseline FM-UE score. Conclusions: Our findings suggest that cathodal and bihemispheric stimulation improve motor function recovery in chronic stroke. Further studies are needed to determine predictors and compare efficacy of different tDCS protocols in chronic motor stroke. doi:10.1016/j.clinph.2019.04.606
P76-S Therapeutic possibilities of transcranial magnetic stimulation in patients after traumatic brain injury (updated report)— Miroslav Kopachka a,*, Elena Sharova b, Evgenija Alexandrova a, Elena Troshina a, Oleg Zaitsev a, Marina Chelyapina b, Lubov Oknina b (a Federal State Autonomous Institution ‘‘n.n. Burdenko National Scientific And Practical Center For Neurosurgery”, Moscow, Russian Federation, b Institute of Higher Nervous Activity and Neurophysiology of RAS, Moscow, Russian Federation) ⇑
Corresponding author.
Objectives: The purpose of this study is to estimate the therapeutic potential of transcranial magnetic stimulation (TMS) in patients after traumatic brain injury (TBI) with impaired consciousness and motor activity. Methods: Observation groups: (1)19 patients after TBI at the age of 16–50 with a prolonged (from 60 to 360 days) unconscious state in which the rhythmic TMS was performed; (2) Control group: 6 healthy men aged 22–28. Changes of neurological status, indicators of the memory and attention, and N100, N200 and P300 components of auditory ERP hour before and hour after stimulation, the dynamics of diagnostic TMS and bimodal (somatosensory and short latency auditory) EP’s were estimated. Results: Therapeutic rTMS of the sagittal premotor cortex areas in both groups concurred with improvement of any attention and normalization of amplitude and latency of all ERP components, especially for P300. rTMS of the frontal lobes facilitated positive clinical dynamics, while rTMS of the parietal lobes did not prove any clear positive effects. Conclusions: The obtained data proposes the availability of using rTMS for therapeutic purposes in patients with PUS. The most promising targets for stimulation at the moment seems to be the frontal and sagittal premotor areas of the brain. Further research is required to clarify the areas and parameters of stimulation. Supported by: RFFI N 16-29-08304. doi:10.1016/j.clinph.2019.04.604
P77-S Early results of rTMS application in the recovery of motor function in the iSCI subjects—Wojciech Fortuna a,b,*, Juliusz Huber c, Agnieszka Wincek c, Jagoda Łukaszek d, Stefan Okurowski d, Paweł Tabakow a (a Regenerative and Functional Neurosurgery Unit, Department of Neurosurgery, Wroclaw Medical University, Wroclaw, Poland, b Bacteriophage Laboratory, Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland, c Department of Pathophysiology of Locomotors Organs, University of Medical Sciences, Poznan, Poland, d Neurorehabilitation Center for Treatment of Spinal Cord Injuries AKSON, Wroclaw, Poland) ⇑
Corresponding author.
Background: Patients with incomplete spinal cord injuries (iSCI) present impairment of motor and sensory functions associated with increased spasticity. The repetitive transcranial magnetic stimulation (rTMS) becomes widely used to potentiate the effects of longlasting physical rehabilitation in the iSCI subjects. The purpose of this study was ascertaining the early changes in activity of motor muscles units and spinal cord efferent transmission studied with surface electromyography (sEMG) and motor evoked potentials (MEPs) recordings after five repeated sessions of rTMS applied every month to the iSCI subjects along with rehabilitation.
e115
Material and methods: Twenty-eight subjects with iSCI at C2-Th12 levels were subjected to twenty sessions of rTMS for five months (three to four sessions every month). Subjects received 800 biphasic pulses (20 Hz, 2s trains, 28s ITI, 36–38% MSO) per day bilaterally over the primary motor cortex areas (MagVenture). sEMG at rest and during attempts of maximal contraction lasting five seconds and MEPs recordings from five observation periods were analyzed before and after rTMS. Results: After five rTMS meetings a significant decrease in sEMG amplitudes recorded at rest and increase of mean sEMG amplitudes recorded during maximal contraction were observed. A moderate increase of mean MEPs amplitudes was observed on certain observation period. Conclusions: rTMS provided decrease of spasticity as evaluated in sEMG recordings at rest and evoked simultaneous improvement of muscle’s motor units’ contractions as well as the efferent transmission in spinal pathways in the iSCI subjects. The study was supported by the Nicholls Spinal Injury Foundation, UK. doi:10.1016/j.clinph.2019.04.605
P78-S Transcranial direct current stimulation in chronic motor stroke: Preliminary results of a four-arm controlled study— Ilya Bakulin *, Alexandra Poydasheva, Dmitry Lagoda, Artem Kotov-Smolenskiy, Anastasia Butkovskaya, Natalia Suponeva, Michael Piradov (Research Center of Neurology, Moscow, Russian Federation) ⇑
Corresponding author.
Background: Transcranial direct current stimulation (tDCS) is a promising method for motor recovery in patients with stroke. At present different electrodes montages are used in motor stroke, but their comparative efficacy remains unclear. The aim of this study was to evaluate efficacy of different tDCS montages in chronic motor stroke. Materials and methods: In this four-arm sham-controlled study 29 patients with chronic motor stroke were randomized into 4 groups: anodal tDCS over primary motor cortex (M1) of the lesional hemisphere (n = 7); cathodal tDCS over M1 of the contralesional hemisphere (n = 7); simultaneous bilateral stimulation (n = 8) and sham-stimulation (n = 7). Each patient received five stimulation sessions (20 min, 2 mA in active groups, one session per day) in combination with a course of standard physical rehabilitation. Participants were evaluated before and after stimulation with the upper extremity section of the Fugl-Meyer Assessment Scale (FM-UE) and the Modified Ashworth Scale (MAS) of muscle spasticity. Results: The groups were not significantly different at baseline on age, duration after stroke, FM-UE and MAS scores. FM-UE score significantly improved after cathodal and bilateral tDCS, but not after anodal and sham-stimulation. There were no significant changes in MAS score in all groups. The effect of tDCS on motor function did not depend on baseline FM-UE score. Conclusions: Our findings suggest that cathodal and bihemispheric stimulation improve motor function recovery in chronic stroke. Further studies are needed to determine predictors and compare efficacy of different tDCS protocols in chronic motor stroke. doi:10.1016/j.clinph.2019.04.606