Corticospinal Tract Excitability Research Articles

Motor evoked potentials in the human upper and lower limb do not increase after single 30-minute sessions of acute intermittent hypoxia.

Acute Intermittent Hypoxia (AIH) can induce sustained facilitation of motor output in people with spinal cord injury (SCI). Most studies of corticospinal tract excitability in humans have used 9% FiO2 AIH (AIH-9%), with inconsistent outcomes. We investigated the effect of single sessions of 9% FiO2 and 12% FiO2 AIH (AIH-12%) on corticospinal excitability of a hand and leg muscle in able-bodied adults. Ten naïve participants without SCI completed three sessions comprising 15 cycles of one minute of AIH-9%, AIH-12% or sham (SHAM-21%) followed by one minute of room air (21% FiO2) in a randomised crossover design. Motor evoked potentials (MEPs, n=30, ~1mV) elicited at rest by transcranial magnetic stimulation and maximal M-waves (Mmax) evoked by peripheral nerve stimulation were measured from the first dorsal interosseous (FDI) and tibialis anterior (TA) muscles at baseline and at ~0, 20, 40, and 60 minutes post-intervention. AIH-9% induced the greatest reduction in SpO2 (to 85% vs 93% and 100% in AIH-12% and SHAM-21%, respectively; p < 0.001) and the greatest increase in ventilation (by 22% vs 12% and -3% in AIH-12% and SHAM-21%, respectively (p<0.001)). There was no difference in MEP amplitudes (%Mmax) after any of the three conditions (AIH-9%, AIH-12%, SHAM-21%) for both FDI (p=0.399) and TA (p=0.582). Despite greater cardiorespiratory changes during AIH-9%, there was no evidence of corticospinal facilitation (tested with MEPs) in this study. Further studies could explore variability in response to AIH between individuals and other methods to measure motor facilitation in people with and without spinal cord injuries.

The test-retest reliability of non-navigated transcranial magnetic stimulation (TMS) measures of corticospinal pathway excitability early after stroke

Purpose Motor evoked potential (MEP) characteristics are potential biomarkers of whether rehabilitation interventions drive motor recovery after stroke. The test-retest reliability of Transcranial Magnetic Stimulation (TMS) measurements in sub-acute stroke remains unclear. This study aims to determine the test-retest reliability of upper limb MEP measures elicited by non-neuronavigated transcranial magnetic stimulation in sub-acute-stroke. Methods In two identical data collection sessions, 1–3 days apart, TMS measures assessed: motor threshold (MT), amplitude, latency (MEP-L), silent period (SP), recruitment curve slope in the biceps brachii (BB), extensor carpi radialis (ECR), and abductor pollicis brevis (APB) muscles of paretic and non-paretic upper limbs. Test-retest reliability was calculated using the intra-class correlation coefficient (ICC) and 95% confidence intervals (CI). Acceptable reliability was set at a lower 95% CI of 0.70 or above. The limits of agreement (LOA) and smallest detectable change (SDC) were calculated. Results 30 participants with sub-acute stroke were included (av 36 days post stroke) reliability was variable between poor to good for the different MEP characteristics. The SDC values differed across muscles and MEP characteristics in both paretic and less paretic limbs. Conclusions The present findings indicate there is limited evidence for acceptable test-retest reliability of non-navigated TMS outcomes when using the appropriate 95% CI for ICC, SDC and LOA values. Clinical Trial Registration Current Controlled Trials: ISCRT 19090862, http://www.controlled-trials.com

Shock waves modulate corticospinal excitability: A proof of concept for further rehabilitation purposes?

Focal extracorporeal shock wave therapy (fESWT) is a physical therapy vastly studied and used for various musculoskeletal disorders. However, the effect of fESWT on central nervous system is still to be determined. To elucidate spinal and supra-spinal mechanisms of fESWT in healthy subjects, in order to widen the spectrum of its clinical applications. In this quasi-experimental, unblinded, proof-of-concept clinical study, 10 voluntary healthy subjects underwent fESWT and were assessed immediately before (T0), immediately after (T1) and seven days after (T2) the intervention. As neurophysiological outcomes, motor evoked potentials (resting motor threshold, maximal motor evoked potential and maximal compound muscle action potential ratio, cortical silent period, total conduction motor time, direct and indirect central motor conduction time), F-waves (minimal and mean latency, persistence and temporal dispersion) and H-reflex (threshold, amplitude, maximal H reflex and maximal compound muscle action potential ratio, latency) were considered. Resting motor threshold and F-waves temporal dispersion significantly decreased, respectively, from T1 and T2 and from T0 and T2 (for both, p < 0.05). H-reflex threshold increase between T0 and T1. Analysis disclosed a strong negative correlation between Δ3 cortical silent period (i.e., T2 -T1 recordings) and Δ1 Hr threshold (i.e., T1 -T0 recordings) (r = -0.66, p < 0.05), and a positive strong relationship between Δ3 cortical silent period and Δ3 Hr threshold (r = 0.63, p < 0.05). fESWT modulates corticospinal tract excitability in healthy volunteers, possibly inducing an early inhibition followed by a later facilitation after one week.

Determining intracortical, corticospinal and alpha motoneurone excitability in athletes with patellar tendinopathy compared to asymptomatic controls.

Lower capacity to generate knee extension maximal voluntary force (MVF) has been observed in individuals affected with patellar tendinopathy (PT) compared to asymptomatic controls. This MVF deficit is hypothesized to emanate from alterations in corticospinal excitability (CSE). The modulation of CSE is intricately linked to the excitability levels at multiple sites, encompassing neurones within the corticospinal tract (CST), intracortical neurones within the primary motor cortex (M1), and the alpha motoneurone. The aim of this investigation was to examine the excitability of intracortical neurones, CST neurones, and the alpha motoneurone, and compare these between volleyball and basketball athletes with PT and matched asymptomatic controls. Nineteen athletes with PT and 18 asymptomatic controls participated in this cross-sectional study. Transcranial magnetic stimulation was utilized to assess CST excitability, corticospinal inhibition (silent period, and short-interval cortical inhibition). Peripheral nerve stimulation was used to evaluate lumbar spine and alpha motoneurone excitability, including the evocation of lumbar-evoked potentials and maximal compound muscle action potential (MMAX ), and CSE with central activation ratio (CAR). Knee extension MVF was also assessed. Athletes with PT exhibited longer silent period duration and greater electrical stimulator output for MMAX , as well as lower MVF, compared to asymptomatic controls (p < 0.05). These findings indicate volleyball and basketball athletes with PT exhibit reduced excitability of the alpha motoneurone or the neuromuscular junction, which may be linked to lower MVF. Subtle alterations at specific sites may represent compensatory changes to excitability aiming to maintain efferent drive to the knee extensors.

Determining the Optimal Stimulation Sessions for TMS-Induced Recovery of Upper Extremity Motor Function Post Stroke: A Randomized Controlled Trial.

To find out the optimal treatment sessions of repetitive transcranial magnetic stimulation (TMS) over the primary motor cortex (M1) for upper extremity dysfunction after stroke during the 6-week treatment and to explore its mechanism using motor-evoked potentials (MEPs) and resting-state functional magnetic resonance imaging (rs-fMRI), 72 participants with upper extremity motor dysfunction after ischemic stroke were randomly divided into the control group, 10-session, 20-session, and 30-session rTMS groups. Low-frequency (1 Hz) rTMS over the contralesional M1 was applied in all rTMS groups. The motor function of the upper extremity was assessed before and after treatment. In addition, MEPs and rs-fMRI data were analyzed to detect its effect on brain reorganization. After 6 weeks of treatment, there were significant differences in the Fugl-Meyer Assessment of the upper extremity and the Wolf Motor Function Test scores between the 10-session group and the 30-session group and between the 20- and 30-session groups and the control group, while there was no significant difference between the 20-session group and the 30-session group. Meanwhile, no significant difference was found between the 10-session group and the control group. The 20-session group of rTMS decreased the excitability of the contralesional corticospinal tract represented by the amplitudes of MEPs and enhanced the functional connectivity of the ipsilesional M1 or premotor cortex with the the precentral gyrus, postcentral gyrus, and cingulate gyrus, etc. In conclusion, the 20-session of rTMS protocol is the optimal treatment sessions of TMS for upper extremity dysfunction after stroke during the 6-week treatment. The potential mechanism is related to its influence on the excitability of the corticospinal tract and the remodeling of corticomotor functional networks.

Task-dependent alteration of beta-band intermuscular coherence is associated with ipsilateral corticospinal tract excitability.

Beta-band (15-30 Hz) synchronization between the EMG signals of active limb muscles can serve as a non-invasive assay of corticospinal tract integrity. Tasks engaging a single limb often primarily utilize one corticospinal pathway, although bilateral neural circuits can participate in goal-directed actions involving multi-muscle coordination and utilization of feedback. Suboptimal utilization of such circuits after CNS injury can result in unintended mirror movements and activation of pathological synergies. Accordingly, it is important to understand how the actions of one limb (e.g., a less-affected limb after strokes) influence the opposite corticospinal pathway for the rehabilitation target. Certain unimanual actions decrease the excitability of the "unengaged" corticospinal tract, presumably to prevent mirror movement, but there is no direct way to predict the extent to which this will occur. In this study, we tested the hypothesis that task-dependent changes in beta-band drives to muscles of one hand will inversely correlate with changes in the opposite corticospinal tract excitability. Ten participants completed spring pinching tasks known to induce differential 15-30 Hz drive to muscles. During compressions, transcranial magnetic stimulation single pulses to the ipsilateral M1 were delivered to generate motor-evoked potentials in the unengaged hand. The task-induced changes in ipsilateral corticospinal excitability were inversely correlated with associated changes in EMG-EMG coherence of the task hand. These results demonstrate a novel connection between intermuscular coherence and the excitability of the "unengaged" corticospinal tract and provide a springboard for further mechanistic studies of unimanual tasks of varying difficulty and their effects on neural pathways relevant to rehabilitation.

Two weeks of arm cycling sprint interval training enhances spinal excitability to the biceps brachii.

The present study aimed to investigate whether a 2-wk arm cycling sprint interval training (SIT) program modulated corticospinal pathway excitability in healthy, neurologically intact participants. We employed a pre-post study design with two groups: 1) an experimental SIT group and 2) a nonexercising control group. Transcranial magnetic stimulation (TMS) of the motor cortex and transmastoid electrical stimulation (TMES) of corticospinal axons were used at baseline and post-training to provide indices of corticospinal and spinal excitability, respectively. Stimulus-response curves (SRCs) recorded from the biceps brachii were elicited for each stimulation type during two submaximal arm cycling conditions [25 watts (W) and 30% peak power output (PPO)]. All stimulations were delivered during the mid-elbow flexion phase of cycling. Compared with baseline, performance on the time-to-exhaustion (TTE) test at post-testing was improved for members of the SIT group but was not altered for controls, suggesting that SIT improved exercise performance. There were no changes in the area under the curve (AUC) for TMS-elicited SRCs for either group. However, the AUC for TMES-elicited cervicomedullary motor-evoked potential SRCs were significantly larger at post-testing in the SIT group only (25 W: P = 0.012, d = 0.870; 30% PPO: P = 0.016, d = 0.825). This data shows that overall corticospinal excitability is unchanged following SIT, whereas spinal excitability is enhanced. Although the precise mechanisms underlying these findings during arm cycling at post-SIT are unknown, it is suggested that the enhanced spinal excitability may represent a neural adaptation to training.NEW & NOTEWORTHY Two weeks of arm cycling sprint interval training (SIT) improves subsequent aerobic exercise performance and induces changes within the descending corticospinal pathway. Specifically, spinal excitability is enhanced following training, whereas overall corticospinal excitability does not change. These results suggest that the enhanced spinal excitability may represent a neural adaptation to training. Future work is required to discern the precise neurophysiological mechanisms underlying these observations.

Relationship between Corticospinal Excitability While Gazing at the Mirror and Motor Imagery Ability

Mirror therapy (MT) helps stroke survivors recover motor function. Previous studies have reported that an individual's motor imagery ability is related to the areas of brain activity during motor imagery and the effectiveness of motor imagery training. However, the relationship between MT and motor imagery ability and between corticospinal tract excitability during mirror gazing, an important component of MT, and motor imagery ability is unclear. This study determined whether the motor-evoked potential (MEP) amplitude while gazing at the mirror relates to participants' motor imagery abilities. Twenty-four healthy right-handed adults (seven males) were recruited. Transcranial magnetic stimulation was performed while gazing at the mirror, and MEP of the first dorsal interosseous muscle of the right hand were measured. Motor imagery ability was measured using the Kinesthetic and Visual Imagery Questionnaire (KVIQ), which assesses the vividness of motor imagery ability. Additionally, a mental chronometry (MC) task was used to assess time aspects. The results showed a significant moderate correlation between changes in MEP amplitude values while gazing at the mirror, as compared with resting conditions, and assessment scores of KVIQ. This study shows that corticospinal excitability because of mirror gazing may be related to the vividness of motor imagery ability.

Effects of motor stimulation of the tibial nerve on corticospinal excitability of abductor hallucis and pelvic floor muscles.

Peripheral nerve stimulation can modulate the excitability of corticospinal pathways of muscles in the upper and lower limbs. Further, the pattern of peripheral nerve stimulation (continuous vs. intermittent) may be an important factor determining the modulation of this corticospinal excitability. The pelvic floor muscles (PFM) are crucial for maintaining urinary continence in humans, and share spinal segmental innervation with the tibial nerve. We explored the idea of whether the neuromodulatory effects of tibial nerve stimulation (TibNS) could induce effects on somatic pathways to the PFM. We evaluated the effects of two patterns of stimulation (intermittent vs. continuous) on corticospinal excitability of the PFM compared to its effect on the abductor hallucis (AH) muscle (which is directly innervated by the tibial nerve). We hypothesized that intermittent TibNS would increase, while continuous stimulation would decrease, the excitability of both AH and PFM. Twenty able-bodied adults (20-33 years of age) enrolled in this study. TibNS was delivered either intermittently (1 ms pulses delivered at 30Hz with an on:off duty cycle of 600:400 ms, for 60 min), or continuously (1 ms pulses delivered at 30Hz for 36 min) just above the motor threshold of the AH. We randomized the order of the stimulation pattern and tested them on separate days. We used surface electromyography (EMG) to record motor-evoked responses (MEP) in the PFM and AH following transcranial magnetic stimulation (TMS). We generated stimulus-response (SR) curves to quantify the changes in peak-to-peak MEP amplitude relative to TMS intensity to assess changes in corticospinal excitability pre- and post-stimulation. We found that TibNS increased corticospinal excitability only to AH, with no effects in PFM. There was no difference in responses to continuous vs. intermittent stimulation. Our results indicate a lack of effect of TibNS on descending somatic pathways to the PFM, but further investigation is required to explore other stimulation parameters and whether neuromodulatory effects may be spinal in origin.

Isolating two sources of variability of subcortical stimulation to quantify fluctuations of corticospinal tract excitability

ObjectiveInvestigate the variability previously found with cortical stimulation and handheld transcranial magnetic stimulation (TMS) coils, criticized for its high potential of coil position fluctuations, bypassing the cortex using deep brain electrical stimulation (DBS) of the corticospinal tract with fixed electrodes where both latent variations of the coil position of TMS are eliminated and cortical excitation fluctuations should be absent. MethodsTen input–output curves were recorded from five anesthetized cats with implanted DBS electrodes targeting the corticospinal tract. Goodness of fit of regressions with a conventional single variability source as well as a dual variability source model was quantified using a Schwarz Bayesian Information approach to avoid overfitting. ResultsMotor evoked potentials (MEPs) through DBS of the corticospinal tract revealed short-term fluctuations in excitability of the targeted neuron pathway reflecting endogenous input-side variability at similar magnitude as TMS despite bypassing cortical networks. ConclusionInput-side variability, i.e., variability resulting in changing MEP amplitudes as if the stimulation strength was modulated, also emerges in electrical stimulation at a similar degree and is not primarily a result of varying stimulation, such as minor coil movements in TMS. More importantly, this variability component is present, although the cortex is bypassed. Thus, it may be of spinal origin, which can include cortical input from spinal projections. Further, the nonlinearity of the compound variability entails complex heteroscedastic non-Gaussian distributions and typically does not allow simple linear averages in statistical analysis of MEPs. As the average is dominated by outliers, it risks bias. With appropriate regression, the net effects of excitatory and inhibitory inputs to the targeted neuron pathways become noninvasively observable and quantifiable. SignificanceThe neural responses evoked by artificial stimulation in the cerebral cortex are variable. For example, MEPs in response to repeated presentations of the same stimulus can vary from no response to saturation across trials. Several sources of such variability have been suggested, and most of them may be technical in nature, but localization is missing.

A study on the immediate effects of neuromuscular electrical stimulation on the corticospinal tract excitability of the infraspinatus muscle

Rotator cuff muscles are structurally and functionally different from other upper-limb muscles because they are responsible for glenohumeral joint stability. Neuromuscular electrical stimulation (NMES) induces excitability changes (increase or decrease) of the corticospinal tract (CST) in the peripheral muscles, such as those of the finger. However, it remains unclear whether similar results are obtained when targeting the infraspinatus muscle, which has properties that differ from other muscles, in healthy subjects. We investigated the immediate effects of NMES on the corticospinal excitability of the infraspinatus muscle, a rotator cuff muscle, in healthy subjects. Thirteen healthy right-handed men (mean age: 26.77 ± 2.08 years) participated in this study. The motor evoked potentials (MEPs) and the maximum compound muscle action potential (Mmax) were recorded before NMES to the right infraspinatus and within 15 minutes after the end of the NMES. NMES on the infraspinatus muscle significantly increased its MEP amplitude (Pre: 0.45 mV [0.33-0.48]; Post: 0.54mV [0.46-0.60] (median [lower quartile to higher quartile]); p= 0.005) but had no effect on Mmax (Pre: 2.95 mV [2.59-4.71]; Post: 3.35 mV [2.76-4.72]; p= 0.753). NMES application to the infraspinatus muscle increases CST excitability without producing immediate changes in the neuromuscular junction or muscle hypertrophy.

Determinants of Neural Plastic Changes Induced by Motor Practice.

Short-term motor practice leads to plasticity in the primary motor cortex (M1). The purpose of this study is to investigate the factors that determine the increase in corticospinal tract (CST) excitability after motor practice, with special focus on two factors; “the level of muscle activity” and “the presence/absence of a goal of keeping the activity level constant.” Fifteen healthy subjects performed four types of rapid thumb adduction in separate sessions. In the “comfortable task” (C) and “forceful task” (F), the subjects adducted their thumb using comfortable and strong forces. In the “comfortable with a goal task” (CG) and “forceful with a goal task” (FG), subjects controlled the muscle activity at the same level as in the C and F, respectively, by adjusting the peak electromyographic amplitude within the target ranges. Paired associative stimulation (PAS), which combines peripheral nerve (median nerve) stimulation and transcranial magnetic stimulation (TMS), with an inter-stimulus interval of 25 ms (PAS25) was also done. Before and after the motor tasks and PAS25, TMS was applied to the M1. None of the four tasks showed any temporary changes in behavior, meaning no learning occurred. Motor-evoked potential (MEP) amplitude increased only after the FG and it exhibited a positive correlation with the MEP increase after PAS25, suggesting that FG and PAS25 share at least similar plasticity mechanisms in the M1. Resting motor threshold (RMT) decreased only after FG, suggesting that FG would also be associated with the membrane depolarization of M1 neurons. These results suggest task-dependent plasticity from the synergistic effect of forceful muscle activity and of setting a goal of keeping the activity level constant.

Altered Motor Excitability in Patients With Diffuse Gliomas Involving Motor Eloquent Areas: The Impact of Tumor Grading.

Diffuse gliomas have an increased biological aggressivenessacross the World Health Organization (WHO) grading system. The implications of glioma grading on the primary motor cortex (M1)-corticospinal tract (CST) excitability is unknown. To assess the excitability of the motor pathway with navigated transcranial magnetic stimulation (nTMS). Retrospective cohort study of patients admitted for surgery with diffuse gliomas within motor eloquent areas.Demographic, clinical, andnTMS-related variables were collected. The Cortical Excitability Score (CES 0 to 2 according to the number of abnormalinterhemispheric resting motor threshold (RMT) ratios) was calculated for patients where bilateral upper and lower limb mapping was performed. A total of 45 patients were included: 9 patients had a low-grade glioma and 36 patients had a high-grade glioma.The unadjusted analysis revealed an increase in the latency of the motor evoked potential of the lower limb with an increase of the WHO grade (P=.038). The adjusted analysis confirmed this finding (P=.013) and showed a relation between the increase in the WHO and a decreased RMT (P=.037) of the motor evoked responses in the lower limb. When CES was calculated, an increase in the score was related with an increase in the WHO grade (unadjusted analysis-P=.0001; adjusted analysis-P=.001) and in isocitrate dehydrogenase (IDH) wild-type tumors (unadjusted analysis-P=.020). An increase in the WHO grading system and IDH wild-type tumors are associated with an abnormal excitability of the motor eloquent areas in patients with diffuse gliomas.

Opposite modulations of corticospinal excitability by intermittent and continuous peripheral electrical stimulation in healthy subjects

Peripheral electrical stimulation (PES) modulates the excitability of the corticospinal tract (CST). This modulation of CST excitability depends on the PES intensity, defined by the amplitude and the width of each pulse, the total pulse number, the stimulation frequency, and the intervention duration. Another key PES parameter is the stimulation pattern; little is known about how PES pattern affects CST excitability, as previous studies did not control other PES parameters. Here, we investigated the effect of the net difference in PES pattern on CST excitability. We use three controlled PESs, intermittent PES (30 Hz) (stimulation trains at 30 Hz with pauses), continuous PES (12 Hz) (constant stimulation at 12 Hz without pauses), and continuous PES (30 Hz) with the same stimulation frequency as the intermittent PES (30 Hz), to compare the effect of the stimulation frequency. The motor evoked potentials (MEPs) and somatosensory evoked potentials (SEPs) of healthy subjects were recorded before and after these three types of PESs in separate sessions. We found that intermittent PES (30 Hz) increased MEP amplitudes, whereas continuous PES (12 and 30 Hz) decreased amplitudes. A significant change in subcortical SEP component occurred during continuous PES (12 and 30 Hz), but not intermittent PES (30 Hz), whereas cortical SEP components showed similar behavior in three types of PESs. We conclude that (1) opposing modulations of CST excitability were induced by the differences in the PES pattern, and (2) these modulations appear to be mediated through different processes in the sensorimotor system. Our findings suggest the possibility that it may be preferable to select the PES pattern in therapeutic interventions based on the putative desired effect and the neural structure being targeted.

Altered Corticospinal Tract Structure And Excitability In Patients With Anterior Cruciate Ligament Reconstruction

Underlying neural factors contribute to poor outcomes following anterior cruciate ligament reconstruction (ACLR). Neurophysiological adaptations have been identified in motor cortex activation and corticospinal tract excitability, however limited evidence exists on neurostructural changes that may influence motor recovery in ACLR patients. PURPOSE: To 1) quantify hemispheric differences in structural properties of the corticospinal tract in patients with a history of ACLR, and 2) assess the relationship between excitability and corticospinal tract structure. METHODS: Ten ACLR participants (age: 22.6 ± 1.9yrs; height: 166.3 ± 7.5cm; mass: 65.4 ± 12.6kg, months from surgery: 70.0 ± 23.6) volunteered for this cross-sectional study. Corticospinal tract structure (volume; fractional anisotropy [FA]; axial diffusivity [AD]; radial diffusivity [RD]; mean diffusivity [MD]) was assessed using diffusion tensor imaging, and excitability was assessed using transcranial magnetic stimulation (motor evoked potentials [MEP]) for each hemisphere. Hemispheric differences were evaluated using paired samples t-tests. Pearson product moment correlational analyses were conducted on structural and excitability outcomes. Alpha level was set at p ≤ 0.05. RESULTS: The hemisphere of the ACLR injured limb demonstrated lower volume (567.1 ± 75.3voxels; p = 0.005), lower FA (0.49 ± 0.01; p = 0.02), higher MD (7.58 x10-4 ± 0.35 x10-4; p = 0.01), and smaller MEPs (0.013 ± 0.007; p = 0.04) compared to the hemisphere of the non-injured limb (659.7 ± 64.3voxels; 0.53 ± 0.02; 7.23 x10-4 ± 0.10 x10-4; 0.028 ± 0.010), indicating disrupted white matter structure and a reduction in excitability of the corticospinal tract. Correlation analyses revealed a strong, positive correlation between corticospinal tract volume and MEP of the ACLR injured limb (r=0.890; p=0.001). CONCLUSIONS: ACLR patients demonstrated asymmetry in structural properties of the corticospinal tract that may influence the recovery of motor function following surgical reconstruction. More research is warranted to establish the influence of neurostructural measures on patient outcomes and response to treatment in ACLR populations.

The influence of different characteristics of isotonic contraction on motor cortex and corticospinal tract excitability

The influence of different characteristics of isotonic contraction on motor cortex and corticospinal tract excitability

Upregulating excitability of corticospinal pathways in stroke patients using TMS neurofeedback; A pilot study

Upper limb weakness following a stroke affects 80% of survivors and is a key factor in preventing their return to independence. State-of-the art approaches to rehabilitation often require that the patient can generate some activity in the paretic limb, which is not possible for many patients in the early period following stroke. Approaches that enable more patients to engage with upper limb therapy earlier are urgently needed.Motor imagery has shown promise as a potential means to maintain activity in the brain’s motor network, when the patient is incapable of generating functional movement. However, as imagery is a hidden mental process, it is impossible for individuals to gauge what impact this is having upon their neural activity.Here we used a novel brain-computer interface (BCI) approach allowing patients to gain an insight into the effect of motor imagery on their brain-muscle pathways, in real-time. Seven patients 2–26 weeks post stroke were provided with neurofeedback (NF) of their corticospinal excitability measured by the size of motor evoked potentials (MEP) in response to transcranial magnetic stimulation (TMS). The aim was to train patients to use motor imagery to increase the size of MEPs, using the BCI with a computer game displaying neurofeedback.Patients training finger muscles learned to elevate MEP amplitudes above their resting baseline values for the first dorsal interosseous (FDI) and abductor digiti minimi (ADM) muscles. By day 3 for ADM and day 4 for FDI, MEP amplitudes were sustained above baseline in all three NF blocks.Here we have described the first clinical implementation of TMS NF in a population of sub-acute stroke patients. The results show that in the context of severe upper limb paralysis, patients are capable of using neurofeedback to elevate corticospinal excitability in the affected muscles. This may provide a new training modality for early intervention following stroke.

Corticospinal tract structure and excitability in patients with anterior cruciate ligament reconstruction: A DTI and TMS study.

Underlying neural factors contribute to poor outcomes following anterior cruciate ligament reconstruction (ACLR). Neurophysiological adaptations have been identified in corticospinal tract excitability, however limited evidence exists on neurostructural changes that may influence motor recovery in ACLR patients. To 1) quantify hemispheric differences in structural properties of the corticospinal tract in patients with a history of ACLR, and 2) assess the relationship between excitability and corticospinal tract structure. Ten participants with ACLR (age: 22.6±1.9yrs; height: 166.3±7.5cm; mass: 65.4±12.6kg, months from surgery: 70.0±23.6) volunteered for this cross-sectional study. Corticospinal tract structure (volume; fractional anisotropy [FA]; axial diffusivity [AD]; radial diffusivity [RD]; mean diffusivity [MD]) was assessed using diffusion tensor imaging, and excitability was assessed using transcranial magnetic stimulation (motor evoked potentials normalized to maximal muscle response [MEP]) for each hemisphere. Hemispheric differences were evaluated using paired samples t-tests. Correlational analyses were conducted on structural and excitability outcomes. The hemisphere of the ACLR injured limb (i.e. hemisphere contralateral to the ACLR injured limb) demonstrated lower volume, lower FA, higher MD, and smaller MEPs compared to the hemisphere of the non-injured limb, indicating disrupted white matter structure and a reduction in excitability of the corticospinal tract. Greater corticospinal tract excitability was associated with larger corticospinal tract volume. ACLR patients demonstrated asymmetry in structural properties of the corticospinal tract that may influence the recovery of motor function following surgical reconstruction. More research is warranted to establish the influence of neurostructural measures on patient outcomes and response to treatment in ACLR populations.

Exercise-Induced Fatigue in One Leg Does Not Impair the Neuromuscular Performance in the Contralateral Leg but Improves the Excitability of the Ipsilateral Corticospinal Pathway.

To investigate the influence of pre-induced fatigue in one leg on neuromuscular performance and corticospinal responses of the contralateral homologous muscles, three experiments were conducted with different exercise protocols; A (n = 12): a 60 s rest vs. time-matched sustained left leg knee extension maximum voluntary contraction (MVC), B (n = 12): a 60 s rest vs. time-matched left leg MVC immediately followed by 60 s right leg MVC, and C (n = 9): a similar protocol to experiment B, but with blood flow occluded in the left leg while the right leg was performing the 60 s MVC. The neuromuscular assessment included 5 s knee extensions at 100%, 75%, and 50% of MVC. At each force level, transcranial magnetic and peripheral nerve stimuli were elicited to investigate the influence of different protocols on the right (tested) knee extensors’ maximal force output, voluntary activation, corticospinal excitability, and inhibition. The pre-induced fatigue in the left leg did not alter the performance nor the neuromuscular responses recorded from the right leg in the three experiments (all p > 0.3). However, enhanced corticospinal pathway excitability was evident in the tested knee extensors (p = 0.002). These results suggest that the pre-induced fatigue and muscle ischemia in one leg did not compromise the central and peripheral components of the neuromuscular function in the tested contralateral leg.

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.