Bilateral Primary Motor Cortex Research Articles

Dynamics of sleep spindles and coupling to slow oscillations following motor learning in adult mice.

Sleep spindles have been implicated in motor learning in human subjects, but their occurrence, timing in relation to cortical slow oscillations, and relationship to offline gains in motor learning have not been examined in animal models. In this study, we recorded EEG over bilateral primary motor cortex in conjunction with EMG for 24 h following a period of either baseline handling or following rotarod motor learning to monitor sleep. We measured several biophysical properties of sleep spindles and their temporal coupling with cortical slow oscillations (SO, <1 Hz) and cortical delta waves (1-4 Hz). Following motor learning, we found an increase in spindles during an early period of NREM sleep (1-4 h) without changes to biophysical properties such as spindle power, peak frequency and coherence. In this same period of early NREM sleep, both SO and delta power increased after motor learning. Notably, a vast majority of spindles were associated with minimal SO power, but in the subset that were associated with significant SO power (>1 z-score above the population mean), spindle-associated SO power was greater in spindles following motor learning compared to baseline sleep. Also, we did not observe a group-level preferred phase in spindle-SO or spindle-delta coupling. While SO power alone was not predictive of motor performance in early NREM sleep, both spindle density and the difference in the magnitude of the mean resultant vector length of the phase angle for SO-associated spindles, a measure of its coupling precision, were positively correlated with offline change in motor performance. These findings support a role for sleep spindles and their coupling to slow oscillations in motor learning and establish a model in which spindle timing and the brain circuits that support offline plasticity can be mechanistically explored.

Modulation of Cortical Activity by High-Frequency Whole-Body Vibration Exercise: An fNIRS Study.

Whole-body vibration (WBV) has shown many positive effects on the human body in rehabilitation and clinical settings in which vibration has been used to elicit muscle contractions in spastic and paretic muscles. The purpose of this study was to investigate whether WBV exercise (WBVe) differently modulates the cortical activity associated with motor and prefrontal function based on its frequency. A total of 18 healthy male adults (mean age: 25.3 [2.4]y) participated in this study and performed WBVe (Galileo Advanced plus; Novotec Medical, Pforzheim, Germany) under 3 different vibration frequency conditions (4-mm amplitude with 10-, 20-, and 27-Hz frequencies) and a control condition (0-mm amplitude with 0-Hz frequency). Each condition consisted of 2 alternating tasks (squatting and standing) every 30 seconds for 5 repetitions. All subjects performed the 4 conditions in a randomized order. Cortical activation during WBVe was measured by relative changes in oxygenated hemoglobin concentration over the primary motor cortex, premotor cortex, supplementary motor area, and prefrontal and somatosensory cortices using functional near-infrared spectroscopy. Oxygenated hemoglobin concentration was higher during the 27-Hz vibration condition than the control and 10-Hz vibration conditions. Specifically, these changes were pronounced in the bilateral primary motor cortex (P < .05) and right prefrontal cortex (P < .05). In contrast, no significant changes in oxygenated hemoglobin concentration were observed in any of the cortical areas during the 10-Hz vibration condition compared with the control condition. This study provides evidence that the motor network and prefrontal cortical areas of healthy adult males can be activated by 27-Hz WBVe. However, WBVe at lower frequencies did not induce significant changes in cortical activation.

Enhanced Effective Connectivity From Ipsilesional to Contralesional M1 in Well-Recovered Subcortical Stroke Patients.

Background and Purpose: Interhemispheric imbalance may provide a framework for developing new strategies to facilitate post-stroke motor recovery especially for patients in chronic stage. Using effective connectivity analysis, we aimed to investigate interactions between the bilateral primary motor cortices (M1) and their correlations with motor function and M1-related structural and functional changes in well-recovered patients with chronic subcortical ischemic stroke.Methods: Twenty subcortical stroke patients and 20 normal controls underwent multimodal magnetic resonance imaging (MRI) examinations. During the movement of the affected hand, functional MRI was used to calculate the M1 activation and M1-M1 effective connectivity. Diffusion tensor imaging was used to compute the fractional anisotropy (FA) of the affected corticospinal tract (CST) and M1-M1 anatomical connection. After intergroup comparisons, we tested whether the altered M1-M1 effective connectivity was correlated with the motor function, M1 activation and FA of the affected CST and M1-M1 anatomical connection in patients.Results: Compared to normal controls, stroke patients exhibited increased excitatory effective connectivity from ipsilesional to contralesional M1 and increased ipsilesional M1 activation; however, they showed reduced FA values in the affected CST and M1-M1 anatomical connection. The increased effective connectivity was positively correlated with motor score and the FA of the M1-M1 anatomical connection, but not with the M1 activation or the FA of the affected CST in these patients.Conclusions: These findings suggest that the enhancement of M1-M1 effective connectivity from ipsilesional to contralesional hemisphere depends on the integrity of the underlying M1-M1 anatomical connection (i.e., less deficits of the M1-M1 anatomical connection, greater enhancement of the corresponding effective connectivity), and such M1-M1 effective connectivity enhancement plays a supportive role in motor function in chronic subcortical stroke.

Time course of bilateral corticospinal tract excitability in the motor-learning process

Although it is known that motor learning changes the corticospinal tract excitability, the time course of bilateral corticospinal tract excitability in the motor-learning process has not been clarified. The study aimed to investigate the time course of bilateral corticospinal tract excitability during the motor-learning process. Sixteen subjects performed 10 trials of the visuomotor tracking task by using their right index finger for one minute. The movement intensity of the visuomotor tracking task ranged from 5%–17% of the maximum index finger abduction force and the movement frequency was 0.5 Hz. To assess bilateral corticospinal excitability, we stimulated the bilateral primary motor cortex with transcranial magnetic stimulation between each trial and measured motor-evoked potential (MEP) from the bilateral first dorsal interosseous (FDI) muscle. Motor performance improved rapidly to the sixth trial (P < 0.05), and motor performance did not change from the seventh to the tenth trial. The MEP amplitude of the right FDI increased significantly from the fifth to the ninth trial relative to that before the task (P < 0.05). Conversely, the MEP amplitude of the left FDI did not change during the motor-learning process. This study revealed that primary motor cortex excitability on the contralateral side to the exercising muscle increased in the late motor learning stage and that primary motor cortex excitability on the ipsilateral side to the exercising muscle did not change in the motor-learning process.

Different Brain Connectivity between Responders and Nonresponders to Dual-Mode Noninvasive Brain Stimulation over Bilateral Primary Motor Cortices in Stroke Patients.

Noninvasive brain stimulation (NBS), such as repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS), has been used in stroke patients with motor impairment. NBS can help recovery from brain damage by modulating cortical excitability. However, the efficacy of NBS varies among individuals. To obtain insights of responsiveness to the efficacy of NBS, we investigated characteristic changes of the motor network in responders and nonresponders of NBS over the primary motor cortex (M1). A total of 21 patients with subacute stroke (13 males, mean age 59.6 ± 11.5 years) received NBS in the same manner: 1 Hz rTMS on the contralesional M1 and anodal tDCS on the ipsilesional M1. Participants were classified into responders and nonresponders based on the functional improvement of the affected upper extremity after applying NBS. Twelve age-matched healthy controls (8 males, mean age 56.1 ± 14.3 years) were also recruited. Motor networks were constructed using resting-state functional magnetic resonance imaging. M1 intrahemispheric connectivity, interhemispheric connectivity, and network efficiency were measured to investigate differences in network characteristics between groups. The motor network characteristics were found to differ between both groups. Specifically, M1 intrahemispheric connectivity in responders showed a noticeable imbalance between affected and unaffected hemispheres, which was markedly restored after NBS. The responders also showed greater interhemispheric connectivity and higher efficiency of the motor network than the nonresponders. These results may provide insight on patient-specific NBS treatment based on the brain network characteristics in neurorehabilitation of patients with stroke. This trial is registered with trial registration number NCT03390192.

The effects of motor imagery training and conventional therapy on the functioning of stroke survivors: A resting-state fMRI study

Objective To measure the efficacy of combining motor imagery training (MIT) with conventional therapy in improving stroke patients′ upper-extremity function. And to seek a cortical reorganization mechanism associated with the improvement using resting-state functional magnetic resonance imaging (rs-fMRI). Methods Ten stroke survivors were selected as an experimental group. They were given motor imagery training for four weeks (30 minutes a day, 5 days a week) and conventional rehabilitation therapy (40 minutes a day, 5 days a week). Another 10 healthy counterparts were the control group. Before and after the four weeks of treatment, both groups were assessed using the upper extremity Fugl-Meyer assessment (FMA-UE) and the modified Barthel index (MBI). Moreover, rs-fMRI was conducted to assess functional connectivity between cortical regions and the ipsilesional primary motor cortex (M1) before and after the intervention. The laterality index (LI) of the primary motor or sensory cortex was also calculated. Results After the intervention, the average FMA-UE and MBI scores of the experimental group had increased significantly. After MIT and conventional therapy there was increased functional connectivity between the ipsilesional and contralesional M1 areas, and between the ipsilesional M1 and contralesional primary sensory cortex (S1) and frontal lobe, the functional connection between the ipsilesional M1 and the ipsilesional paracentral lobule and the anterior cingutate was also increased. More specifically, the LI relating M1 and S1 decreased after the intervention, tending toward the normal level. LIMI decreased significantly. Conclusion The 4-week regimen of motor imagery training and conventional therapy resulted in functional improvement in the upper limbs and greater ability in the activities of daily living. The observed improvements may be due to cortical reorganization, including better functional connectivity between the bilateral M1 areas and increased connectivity between the ipsilesional M1 area and some non-motor areas. There is some recovery of symmetry in the bilateral primary motor cortex. Key words: Resting-state functional magnetic resonance imaging; Functional magnetic resonance imaging; Motor imagery training; Stroke; Cortical reorganization

Selective atrophy of the connected deepest cortical layers following small subcortical infarct.

To explore whether in patients with chronic small subcortical infarct the cortical layers of the connected cortex are differentially affected and whether these differences correlate with clinical symptomatology. Twenty patients with a history of chronic small subcortical infarct affecting the corticospinal tracts and 15 healthy controls were included. Connected primary motor cortex was identified with tractography starting from infarct. T1-component probability maps were calculated from T1 relaxation 3T MRI, dividing the cortex into 5 laminar gaussian classes. Focal cortical thinning was observed in the connected cortex and specifically only in its deepest laminar class compared to the nonaffected mirrored cortex (p < 0.001). There was loss of microstructural integrity of the affected corticospinal tract with increased mean diffusivity and decreased fractional anisotropy compared to the contralateral nonaffected tract (p ≤ 0.002). Clinical scores were correlated with microstructural damage of the corticospinal tracts and with thinning of the cortex and specifically only its deepest laminar class (p < 0.001). No differences were found in the laminar thickness pattern of the bilateral primary motor cortices or in the microstructural integrity of the bilateral corticospinal tracts in the healthy controls. Our results support the concept of secondary neurodegeneration of connected primary motor cortex after a small subcortical infarct affecting the corticospinal tract, with observations that the main cortical thinning occurs in the deepest cortex and that the clinical symptomatology is correlated with this cortical atrophy pattern. Our findings may contribute to a better understanding of structural reorganization and functional outcomes after stroke.

The Shared Genetic Basis of Educational Attainment and Cerebral Cortical Morphology.

Individual differences in educational attainment are linked to differences in intelligence, and predict important social, economic, and health outcomes. Previous studies have found common genetic factors that influence educational achievement, cognitive performance and total brain volume (i.e., brain size). Here, in a large sample of participants from the UK Biobank, we investigate the shared genetic basis between educational attainment and fine-grained cerebral cortical morphological features, and associate this genetic variation with a related aspect of cognitive ability. Importantly, we execute novel statistical methods that enable high-dimensional genetic correlation analysis, and compute high-resolution surface maps for the genetic correlations between educational attainment and vertex-wise morphological measurements. We conduct secondary analyses, using the UK Biobank verbal-numerical reasoning score, to confirm that variation in educational attainment that is genetically correlated with cortical morphology is related to differences in cognitive performance. Our analyses relate the genetic overlap between cognitive ability and cortical thickness measurements to bilateral primary motor cortex as well as predominantly left superior temporal cortex and proximal regions. These findings extend our understanding of the neurobiology that connects genetic variation to individual differences in educational attainment and cognitive performance.

Altered Gamma Oscillations during Motor Control in Children with Autism Spectrum Disorder.

Autism is hypothesized to result in a cortical excitatory and inhibitory imbalance driven by inhibitory interneuron dysfunction, which is associated with the generation of gamma oscillations. On the other hand, impaired motor control has been widely reported in autism. However, no study has focused on the gamma oscillations during motor control in autism. In the present study, we investigated the motor-related gamma oscillations in autism using magnetoencephalography. Magnetoencephalographic signals were recorded from 14 right-handed human children with autism (5 female), aged 5–7 years, and age- and IQ-matched 15 typically developing children during a motor task using their right index finger. Consistent with previous studies, the autism group showed a significantly longer button response time and reduced amplitude of motor-evoked magnetic fields. We observed that the autism group exhibited a low peak frequency of motor-related gamma oscillations from the contralateral primary motor cortex, and these were associated with the severity of autism symptoms. The autism group showed a reduced power of motor-related gamma oscillations in the bilateral primary motor cortex. A linear discriminant analysis using the button response time and gamma oscillations showed a high classification performance (86.2% accuracy). The alterations of the gamma oscillations in autism might reflect the cortical excitatory and inhibitory imbalance. Our findings provide an important clue into the behavioral and neurophysiological alterations in autism and a potential biomarker for autism.SIGNIFICANCE STATEMENT Currently, the diagnosis of autism has been based on behavioral assessments, and a crucial issue in the diagnosis of autism is to identify objective and quantifiable clinical biomarkers. A key hypothesis of the neurophysiology of autism is an excitatory and inhibitory imbalance in the brain, which is associated with the generation of gamma oscillations. On the other hand, motor deficits have also been widely reported in autism. This is the first study to demonstrate low motor performance and altered motor-related gamma oscillations in autism, reflecting a brain excitatory and inhibitory imbalance. Using these behavioral and neurophysiological parameters, we classified autism and control group with good accuracy. This work provides important information on behavioral and neurophysiological alterations in patients with autism.

Anodal Transcranial Direct Current Stimulation (tDCS) Over the Right Primary Motor Cortex (M1) Impairs Implicit Motor Sequence Learning of the Ipsilateral Hand.

Motor sequence learning is associated with the activation of bilateral primary motor cortices (M1). While previous data support the hypothesis that the contralateral M1 is causally involved in the acquisition as well as early consolidation of a motor sequence, the functional significance of the ipsilateral M1 has yet to be solved. Transcranial direct current stimulation (tDCS) allows the non-invasive modulation of cortical excitability. Anodal tDCS applied to the left M1 has been shown to facilitate implicit motor sequence learning of the right hand most likely due to increased excitability. The present study aims at characterizing the functional contribution of the ipsilateral (right) M1 on implicit motor sequence learning of the right hand. To this end, 24 healthy, right-handed subjects received anodal and sham tDCS to the right M1 in a counterbalanced order. Stimulation started 8 min prior to training on a variant of the serial reaction time task (SRTT) with the right hand and persists over the entire training period. The SRTT comprised a fixed eight-digit sequence. A random pattern served as control condition. Reaction times were assessed before and at the end of the acquisition (EoA) immediately after training on the SRTT. The analysis revealed significantly faster reaction times of both hands independent of tDCS condition in sequential trials. However, the gain of reaction times was significantly smaller following anodal as compared to sham tDCS. The data suggest that anodal tDCS applied to the right M1 impairs implicit motor sequence learning of both hands. The underlying mechanism likely involves alterations of the interaction between bilateral M1.

Differential Bilateral Primary Motor Cortex tDCS Fails to Modulate Choice Bias and Readiness in Perceptual Decision Making.

One of the critical factors that guide choice behavior is the prior bias of the decision-maker with respect to different options, namely, the relative readiness by which the decision-maker opts for a specific choice. Although previous neuroimaging work has shown decision bias related activity in the orbitofrontal cortex, intraparietal sulcus (IPS) and dorsolateral prefrontal cortex, in a recent work by Javadi et al. (2015), primary motor cortex was also implicated. By applying transcranial direct current stimulation (tDCS), they have revealed a causal role of the primary motor cortex excitability in the induction of response time (RT) differences and decision bias in the form of choice probability. The current study aimed to replicate these recent findings with an experimental design that contained a sham group to increase experimental control and an additional testing phase to investigate the possible after-effects of tDCS. The conventional decision outputs such as choice proportion and RT were analyzed along with the theory-driven estimates of choice bias and non-decision related components of RTs (e.g., motor implementation speed of choices made). None of the statistical comparisons favored the alternative hypotheses over the null hypotheses. Consequently, previous findings regarding the effect of primary motor cortex excitability on choice bias and response times could not be replicated with a more controlled experimental design that is recommended for tDCS studies (Horvath et al., 2015). This empirical discrepancy between the two studies adds to the evidence demonstrating inconsistent effects of tDCS in establishing causal relationships between cortical excitability and motor behavior.

Comprehensive analysis of area-specific and time-dependent changes in gene expression in the motor cortex of macaque monkeys during recovery from spinal cord injury.

The present study aimed to assess the molecular bases of cortical compensatory mechanisms following spinal cord injury in primates. To accomplish this, comprehensive changes in gene expression were investigated in the bilateral primary motor cortex (M1), dorsal premotor cortex (PMd), and ventral premotor cortex (PMv) after a unilateral lesion of the lateral corticospinal tract (l-CST). At 2 weeks after the lesion, a large number of genes exhibited altered expression levels in the contralesional M1, which is directly linked to the lesioned l-CST. Gene ontology and network analyses indicated that these changes in gene expression are involved in the atrophy and plasticity changes observed in neurons. Orchestrated gene expression changes were present when behavioral recovery was attained 3 months after the lesion, particularly among the bilateral premotor areas, and a large number of these genes are involved in plasticity. Moreover, several genes abundantly expressed in M1 of intact monkeys were upregulated in both the PMd and PMv after the l-CST lesion. These area-specific and time-dependent changes in gene expression may underlie the molecular mechanisms of functional recovery following a lesion of the l-CST.

Modulating Brain Connectivity by Simultaneous Dual-Mode Stimulation over Bilateral Primary Motor Cortices in Subacute Stroke Patients.

Repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS) has been used for the modulation of stroke patients' motor function. Recently, more challenging approaches have been studied. In this study, simultaneous stimulation using both rTMS and tDCS (dual-mode stimulation) over bilateral primary motor cortices (M1s) was investigated to compare its modulatory effects with single rTMS stimulation over the ipsilesional M1 in subacute stroke patients. Twenty-four patients participated; 12 participants were assigned to the dual-mode stimulation group while the other 12 participants were assigned to the rTMS-only group. We assessed each patient's motor function using the Fugl-Meyer assessment score and acquired their resting-state fMRI data at two times: prior to stimulation and 2 months after stimulation. Twelve healthy subjects were also recruited as the control group. The interhemispheric connectivity of the contralesional M1, interhemispheric connectivity between bilateral hemispheres, and global efficiency of the motor network noticeably increased in the dual-mode stimulation group compared to the rTMS-only group. Contrary to the dual-mode stimulation group, there was no significant change in the rTMS-only group. These data suggested that simultaneous dual-mode stimulation contributed to the recovery of interhemispheric interaction than rTMS only in subacute stroke patients. This trial is registered with NCT03279640.

P 16 The implementation of Near-Infrared-Spectroscopy (NIRS) in sports science – a verification of suitability using the compound movement squat

Introduction Near - Infrared Spectroscopy (NIRS) serves as a promising tool to examine cortical activity in a sports-scientific context. The associated feasibility of said method remains to be validated as exercise - induced confounders such as increases in extracerebral blood flow have been postulated ( Tachtsidis and Scholkmann, 2016 ). Additionally, the relationship between force and cortical activity is yet to be investigated in compound movements. Both parameters show a linear relationship in isolated movements ( Shibuya et al., 2014 ) yet it remains unclear whether this relationship applies to compound movements. Here we assessed the feasibility of NIRS for the compound movement barbell squat (BS). Complementarily the relationship between force levels and cortical activity during the squat was examined. We hypothesized that the extracerebral blood flow superimposes the signal and can be eliminated. Furthermore, we hypothesized a linear relationship between force during BS and cortical activity in the leg area of bilateral primary motor cortex (M1). Methods Ten healthy young adults participated in this study (n = 10; age: 25.7 ± 2.214 years). All subjects performed the BS task, five 90° squats per activity block, on three separate days with varying NIRS - configurations to control for and eliminate extracerebral effects. The experimental setup corresponds to a block design with varying force levels (L0%, L20%, L40%) which were individually adjusted in succession to Maximum Strength Tests. Our standard NIRS - configuration (A) covered the cortical motor system. The second configuration (B) additionally covered bilateral auditory cortices, frontopolar areas, as well as primary visual cortex. A third configuration incorporated a short - distance - channel to use this channel in a short separation regression (C). Cortical activation was assumed to be reflected by increased oxyhemoglobin (HbO2) and a corresponding decline or unchanged deoxyhemoglobin (HHb). Results For (A) and (B), HbO2showed a significant increase in the entire detection range when comparing the varying force levels during BS ( p 0.0023 ). For (C), HbO2 showed a significant increase in bilateral superior parietal lobule (SPL) (L20%, L40%) when compared to L0% ( p 0.01 ). HbO2 showed no significant increase when comparing the different force levels to baseline values. HHb showed no regionally consistent, significant decline for all comparisons. Discussion Short separation regression potentially enables the disentanglement of extracerebral blood flow from cerebral blood flow. There is a relationship between force and cortical activity in the squat when comparing force levels, although in bilateral SPL as opposed to M1 as seen in isolated movements. This implies a different modulator for compound movements compared to isolated movements.

Response Inhibition Deficits and Altered Motor Network Connectivity in the Chronic Phase of Pediatric Traumatic Brain Injury.

Poor response inhibition is a hallmark of pediatric traumatic brain injury (TBI). We assessed motor response inhibition by measuring commission error rates on Simple (minimized cognitive demands) and Motivation (monetary reward) Go/No-Go tasks, comparing 17 children with chronic TBI (>1 year post-injury) and 14 matched, uninjured peers. Using resting state functional magnetic resonance imaging (fMRI), we examined between-group differences in whole-brain intrinsic connectivity of the motor network as derived from the averaged time course of bilateral primary motor cortex seeds, to identify regions of interest (ROIs) for brain-behavior correlations. Independent sample t tests compared Go/No-Go performance and connectivity at the ROI level. Pearson correlations examined relationships between intrinsic connectivity at the ROI level and Go/No-Go performance. Adolescents with TBI showed poorer performance on Simple and Motivation Go/No-Go tasks compared with controls. In whole-brain contrasts, adolescents with TBI showed significantly reduced functional connectivity between the motor network and voxels within the left caudate. Furthermore, in ROI analyses, the group with TBI had significantly lower connectivity between the motor network and left caudate and numerically lower connectivity between the motor network and right caudate. In adolescents with TBI, lower motor network to left caudate connectivity correlated with poorer Simple task performance; lower motor network to right caudate connectivity correlated with poorer Simple and Motivation task performance. No significant brain-behavior relationships existed among controls. These results are consistent with previous pediatric TBI literature and suggest that disrupted intrinsic connectivity of a corticostriatal motor network may contribute to response inhibition deficits.

Enhanced Functional Connectivity between the Bilateral Primary Motor Cortices after Acupuncture at Yanglingquan (GB34) in Right-Hemispheric Subcortical Stroke Patients: A Resting-State fMRI Study.

Increasing neuroimaging researches in stroke rehabilitation had revealed the neural mechanisms of rehabilitation therapy. However, little was known about the neural mechanisms of acupuncture therapy in subcortical stroke patients. The aim of this study was to investigate the changes of functional connectivity (FC) between the bilateral primary motor cortices (M1s) after acupuncture intervention in right subcortical stroke patients. Twenty right-hemispheric subcortical stroke patients and 20 healthy subjects were recruited to undergo one functional magnetic resonance imaging (fMRI) scanning. The scanning consisted of resting-state fMRI before and after needling at Yanglinquan (GB34), and task-evoked fMRI. The most significant active point during the left passive thumb-to-index task was chosen as the seed point. The seed-based FC analysis of the bilateral M1s was performed. Stroke patients revealed decreased FC between the bilateral M1s compared with healthy subjects, and the decreased FC was significantly enhanced after acupuncture at GB34. Acupuncture could increase the intrinsically decreased FC between the bilateral M1s which provided further insight into the neural mechanisms of acupuncture for motor function recovery in stroke patients.

Dual-mode noninvasive brain stimulation over the bilateral primary motor cortices in stroke patients.

Noninvasive brain stimulation (NBS) using repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS) has recently been adopted for modulating motor function in stroke patients. We investigated the effect of simultaneous dual-mode stimulation using rTMS and tDCS over the bilateral primary motor cortices (M1) to assess its efficacy as compared to single stimulation using rTMS for the recovery of motor function in subacute stroke patients. Thirty subacute stroke patients were recruited in this study. In the dual-mode stimulation group, 10 Hz rTMS (90% of resting motor threshold, 1,000 pulses) was applied over the ipsilesional M1 for 20 minutes with the simultaneous application of cathodal tDCS (2 mA) on the contralesional M1. The single stimulation group underwent 10 Hz rTMS without tDCS. Ten daily sessions were conducted for two consecutive weeks. The total Fugl-Meyer (FMA-T), upper limb (FMA-UL), and lower limb (FMA-LL) scores were measured before, after, and two months later. The FMA-T and FMA- UL were significantly improved over time in both the dual and single stimulation group (p < 0.05). However, there were significant group and time interaction effects in both the FMA-T and FMA-UL (p < 0.05). Post-hoc analysis showed that the mean changes in the FMA-T and FMA-UL were significantly better in the dual-mode stimulation group. Dual-mode NBS with the simultaneous application of 10 Hz rTMS and cathodal tDCS over the bilateral M1s was safe and superior to 10 Hz rTMS alone for improving motor function in subacute stroke patients.

The aging brain and changes in GABA concentrations

The aging brain and changes in GABA concentrations

Neural Correlates of Motor Recovery Measured by SPECT at Six Months After Basal Ganglia Stroke.

ObjectiveTo investigate neural correlates associated with recovery of motor function over 6 months in patients with basal ganglia (BG) stroke using acetazolamide (ACZ) stress brain-perfusion single-photon emission computed tomography (SPECT).MethodsMedical records of 22 patients presenting first-ever BG stroke were retrospectively reviewed. Regional cerebral blood flow (CBF) and cerebrovascular reserve (CVR) were measured for 9 regions in each cerebral hemisphere (primary motor cortex, supplementary motor area, premotor cortex, prefrontal cortex, temporal lobe, parietal lobe, occipital lobe, BG, and thalamus). The Fugl-Meyer Assessment (FMA) motor score was used to assess motor function.ResultsAfter ACZ injection, CBF of all regions of interest (ROIs) increased compared with baseline. Baseline CBF of all ROIs was not significantly correlated with changes in FMA upper or lower motor score. However, multivariate analysis revealed CVR was significantly associated with change in FMA upper score in the ipsilateral primary motor cortex (R2=0.216, p=0.017), the ipsilateral parietal lobe (R2=0.135, p=0.029), and the contralateral primary motor cortex (R2=0.210, p=0.041).ConclusionCVR in the bilateral primary motor cortex and ipsilateral parietal lobe was associated with restoration of upper motor function 6 months after BG stroke. SPECT is a readily available imaging modality useful in studying brain residual function in patients with BG stroke.

Neuroplasticity Changes on Human Motor Cortex Induced by Acupuncture Therapy: A Preliminary Study.

While neuroplasticity changes measured by transcranial magnetic stimulation have been proved to be highly correlated to motor recovery and have been tested in various forms of interventions, it has not been applied to investigate the neurophysiologic mechanism of acupuncture therapy. The aim of this study is to investigate neuroplasticity changes induced by a single session of acupuncture therapy in healthy adults, regarding the excitability change on bilateral primary motor cortex and interhemispheric inhibition. Ten subjects took a 30-minute acupuncture therapy and the same length relaxing phase in separate days. Transcranial magnetic stimulation measures, including resting motor threshold, amplitudes of motor-evoked potential, and interhemispheric inhibition, were assessed before and 10 minutes after intervention. Acupuncture treatment showed significant changes on potential amplitude from both ipsilateral and contralateral hemispheres to acupuncture compared to baseline. Also, interhemispheric inhibition from the contralateral motor cortex to the opposite showed a significant decline. The results indicated that corticomotoneuronal excitability and interhemispheric competition could be modulated by acupuncture therapy on healthy subjects. The following question about whether these changes will be observed in the same way on stroke patients and whether they correlate with the therapeutic effect on movement need to be answered by following studies. This trial is registered with ISRCTN13074245.