Rhythmic Transcranial Magnetic Stimulation Research Articles

Connectivity of EEG and fMRI network in the resting state in healthy people and patients with post-traumatic disorder of consciousness

Recovery of consciousness in patients with post-comatose unconscious states after severe traumatic brain injury and the search for their objective markers are among the urgent medical and social problems. To clarify the information content and the degree of consistency of changes in hemodynamic and bioelectrical parameters, in this work we carried out comparative studies of fMRI networks and EEG connectivity at rest in healthy subjects, as well as in patients with post-traumatic disorders of consciousness before and after therapeutic rhythmic transcranial magnetic stimulation (rTMS). It was shown that the characteristics of the functional connectivity of fMRI and EEG at rest are among the informative markers of neuroplasticity during depression of consciousness. A certain topographic correspondence between the fMRI networks and the EEG integral connectivity pattern at rest was established, regardless of the modification of the latter assessment: in the continuous recording mode or pseudo-EP. At the same time, the method of independent fMRI components more clearly reveals the features of the state of individual neural networks, and the indicators of EEG functional connectivity (range 1–15 Hz) are more informative in assessing the integral neural network characteristics and their changes during treatment.

Rhythmic transcranial magnetic stimulation in speech therapy correction in patients with autism spectrum disorder and delayed psychospeech development

The relevance of the joint use of rhythmic transcranial magnetic stimulation (rTMS) and speech therapy correction in children with autism spectrum disorder (ASD) and delayed psycho–speech development (PSRR) is associated with the high frequency of occurrence of these nosologies. The work highlights the experience of a therapeutic multidisciplinary approach in the correction of delayed psychomotor and psychorechological development in children with (ASD) and (ZPRR).The combined use of rTMS and speech therapy classes turned out to be more effective in the group of children with (ASD) in terms of reducing psycho-emotional reactions, which made it possible to achieve a greater effect in impressive speech.

Information-based rhythmic transcranial magnetic stimulation to accelerate learning during auditory working memory training: a proof-of-concept study.

Rhythmic transcranial magnetic stimulation (rhTMS) has been shown to enhance auditory working memory manipulation, specifically by boosting theta oscillatory power in the dorsal auditory pathway during task performance. It remains unclear whether these enhancements (i) persist beyond the period of stimulation, (ii) if they can accelerate learning and (iii) if they would accumulate over several days of stimulation. In the present study, we investigated the lasting behavioral and electrophysiological effects of applying rhTMS over the left intraparietal sulcus (IPS) throughout the course of seven sessions of cognitive training on an auditory working memory task. A limited sample of 14 neurologically healthy participants took part in the training protocol with an auditory working memory task while being stimulated with either theta (5 Hz) rhTMS or sham TMS. Electroencephalography (EEG) was recorded before, throughout five training sessions and after the end of training to assess to effects of rhTMS on behavioral performance and on oscillatory entrainment of the dorsal auditory network. We show that this combined approach enhances theta oscillatory activity within the fronto-parietal network and causes improvements in auditoryworking memory performance. We show that compared to individuals who received sham stimulation, cognitive training can be accelerated when combined with optimized rhTMS, and that task performance benefits can outlast the training period by ∼ 3 days. Furthermore, we show that there is increased theta oscillatory power within the recruited dorsal auditory network during training, and that sustained EEG changes can be observed ∼ 3 days following stimulation. The present study, while underpowered for definitive statistical analyses, serves to improve our understanding of the causal dynamic interactions supporting auditory working memory. Our results constitute an important proof of concept for the potential translational impact of non-invasive brain stimulation protocols and provide preliminary data for developing optimized rhTMS and training protocols that could be implemented in clinical populations.

Obesity and the nervous system

The article discusses certain aspects of the relationship between neurological diseases and metabolic disorders that are extremely relevant in connection with the pandemic spread of obesity. The pathogenesis of damage to the nervous system (NS) is considered in detail. The influence of the main metabolic factors on the development of cerebrovascular diseases (CVD), incl. neuroinflammation, changes in hemostasis, etc. is demonstrated. The problem of the development of cognitive dysfunction against the background of obesity due to the formation of atrophic processes in brain structures is highlighted. Modern possibilities of evaluation and modulation of eating behavior due to brain stimulation using functional magnetic resonance imaging (fMRI) and navigational rhythmic transcranial magnetic stimulation (rTMS) are described.The problem of cerebrometabolic health is presented as a continuum of metabolic and cerebral disturbances. The mechanisms of interaction between the two most important systems of the body allow us to consider the changes that occur in them as an integral neuroendocrine alteration.

Internal Representations Are Prioritized by Frontoparietal Theta Connectivity and Suppressed by alpha Oscillation Dynamics: Evidence from Concurrent Transcranial Magnetic Stimulation EEG and Invasive EEG.

Control over internal representations requires the prioritization of relevant information and suppression of irrelevant information. The frontoparietal network exhibits prominent neural oscillations during these distinct cognitive processes. Yet, the causal role of this network-scale activity is unclear. Here, we targeted theta-frequency frontoparietal coherence and dynamic alpha oscillations in the posterior parietal cortex using online rhythmic transcranial magnetic stimulation (TMS) in women and men while they prioritized or suppressed internally maintained working memory (WM) representations. Using concurrent high-density EEG, we provided evidence that we acutely drove the targeted neural oscillation and TMS improved WM capacity only when the evoked activity corresponded with the desired cognitive process. To suppress an internal representation, we increased the amplitude of lateralized alpha oscillations in the posterior parietal cortex contralateral to the irrelevant visual field. For prioritization, we found that TMS to the prefrontal cortex increased theta-frequency connectivity in the prefrontoparietal network contralateral to the relevant visual field. To understand the spatial specificity of these effects, we administered the WM task to participants with implanted electrodes. We found that theta connectivity during prioritization was directed from the lateral prefrontal to the superior posterior parietal cortex. Together, these findings provide causal evidence in support of a model where a frontoparietal theta network prioritizes internally maintained representations and alpha oscillations in the posterior parietal cortex suppress irrelevant representations.

Transcranial magnetic stimulation effects support an oscillatory model of ERP genesis

Whether prestimulus oscillatory brain activity contributes to the generation of post-stimulus-evoked neural responses has long been debated, but findings remain inconclusive. We first investigated the hypothesized relationship via EEG recordings during a perceptual task with this correlational evidence causally probed subsequently by means of online rhythmic transcranial magnetic stimulation. Both approaches revealed a close link between prestimulus individual alpha frequency (IAF) and P1 latency, with faster IAF being related to shorter latencies, best explained via phase-reset mechanisms. Moreover, prestimulus alpha amplitude predicted P3 size, best explained via additive (correlational and causal evidence) and baseline shift mechanisms (correlational evidence), each with distinct prestimulus alpha contributors. Finally, in terms of performance, faster prestimulus IAF and shorter P1 latencies were both associated with higher task accuracy, while lower prestimulus alpha amplitudes and higher P3 amplitudes were associated with higher confidence ratings. Our results are in favor of the oscillatory model of ERP genesis and modulation, shedding new light on the mechanistic relationship between prestimulus oscillations and functionally relevant evoked components.

Influence of a comprehensive method of rehabilitation includes transcranial magnetic stimulation and balance therapy on the severity of neurological disorders, gate function and balance in patients with diabetic neuropathy

Objective. To evaluate the effectiveness of a new method of rehabilitation of patients with diabetic polyneuropathy using balance therapy and transcranial magnetic stimulation against the background of a basic rehabilitation program to reduce neurological symptoms and improve the function of movement and balance. Material and methods. The study sample consisted of 34 patients with type 2 diabetes mellitus and with a severe degree of diabetic neuropathy, distal sensorimotor form, from which 2 groups were formed by randomization: the main group (n=17) and the control group (n=17). Patients of the main group received a new rehabilitation method, including rhythmic transcranial magnetic stimulation, No. 10, balance therapy on a simulator with biofeedback, No. 10, whirlpool baths for the lower extremities, No. 10, physical therapy, No. 10, and massage of the lower extremities, No. 10. The rehabilitation method for the control group included magnetic therapy for the lower extremities, No. 10, whirlpool baths for the lower extremities, No. 10, physical therapy, No. 10, and massage of the lower extremities, No. 10. Results. There were revealed a decrease in NSS scale values by 33.3% (from 6.0 [4.0; 7.0] to 4.0 [3.0; 6.0] points, p=0.029) and DN4 questionnaire scores – by 36.4% (from 5.5 [3.0; 7.0] to 3.5 [2.5.0; 5.0] points, p=0.034, p=0.045 in comparison with control), increase in walking speed by 10.7% (from 75.0 [59.0; 88.0] to 83.0 [68.0; 103.0] steps per minute, p = 0.047), decrease in time performing the “Up and go test” from 12.0 [7.0; 15.0] to 10.0 [5.0; 11.0] sec (p=0.039) and an increase in the time of maintaining balance in the “One leg standing test” with eyes closed on the right leg from 2.0 [1.0; 3.5] to 3.5 [1.5; 6.0] sec (p=0.041, p=0.022 compared with control) in patients of the main group, after completion of rehabilitation,. In the control group, there were no reliably significant changes in any of the studied indicators (p>0.05). Conclusion. A new rehabilitation complex, including transcranial magnetic stimulation and balance therapy with biofeedback against the background of standard therapy, helps to significantly reduce the severity of symptoms of distal diabetic polyneuropathy, increase walking speed and improve static balance.

Transcranial Magnetic and Transcutaneous Spinal Cord Electrical Stimulation a Stroke-Patients Walking Correction: Blinded Clinical Randomised Study

INTRODUCTION. The impairment of motor system function due to stroke often leads to patients’ dependence on external assistance. The technique of rhythmic transcranial magnetic stimulation (rTMS) is now widely used in the restoration of impaired central nervous system (CNS) function. In recent years, there has been information about the use of transcutaneous electrical spinal cord stimulation (TSCS) in the correction of motor functions in CNS disorders of various genesis.
 AIM. To evaluate the possibilities of combined use of transcranial magnetic and transcutaneous electrical stimulation of the spinal cord in the correction of locomotor functions in patients after ischemic stroke.
 MATERIALS AND METHODS. The conducted blind clinical randomized study involved patients who had an ischemic stroke. Study participants were randomly divided into control (n = 12) and experimental (n = 9) groups. Patients in the control group received standardized neurorehabilitation techniques. The participants of the experimental group were offered standardized neurorehabilitation techniques combined with rTMS and TSCS. High-frequency rTMS was performed in the projection of the sensory-motor cortex on the side of the lesion, in the area of innervation of the lower limb. During TSCS, a stimulating electrode was placed between Th11–Th12, indifferent electrodes were placed in the region of the iliac crests, and the lumbar enlargement of the spinal cord was stimulated. The dynamics of neurological deficit was assessed using the rehabilitation routing scale, the Rivermead mobility index, the Berg balance scale, and a six-point scale for assessing muscle strength. The excitability of the neural networks of the spinal cord was determined using TSCS at the T11–T12 level, with electromyographic recording of the evoked motor responses of the muscles of the lower extremities.
 RESULTS AND DISCUSSION. The combined use of rTMS and TSCS in the rehabilitation of patients in the acute period after ischemic stroke leads to an increase in the excitability of neuronal networks of the lumbar thickening of the spinal cord, a decrease in the activation thresholds of the RF, BF, TA and GM muscles of the affected limb (by 7.7 ma, 18.3 ma, 24.8 ma and 14.2 ma, respectively). Inclusion of rTMS and TSCS in the rehabilitation course leads to a significant improvement in the rehabilitation routing scale (by 2 points), Rivermead mobility index (by 5.8 points), statokinetic control functions (balance-Berg by 12 points) and an increase in lower limb muscle strength (flexors by 5.1 points, extensors by 6.2 points).
 CONCLUSION. The use of rTMS and TSCS can be used as an additional effect within the framework of rehabilitation measures in the acute period after ischemic stroke.

Rhythmic TMS as a Feasible Tool to Uncover the Oscillatory Signatures of Audiovisual Integration.

Multisensory integration is quintessential to adaptive behavior, with clinical populations showing significant impairments in this domain, most notably hallucinatory reports. Interestingly, altered cross-modal interactions have also been reported in healthy individuals when engaged in tasks such as the Sound-Induced Flash-Illusion (SIFI). The temporal dynamics of the SIFI have been recently tied to the speed of occipital alpha rhythms (IAF), with faster oscillations entailing reduced temporal windows within which the illusion is experienced. In this regard, entrainment-based protocols have not yet implemented rhythmic transcranial magnetic stimulation (rhTMS) to causally test for this relationship. It thus remains to be evaluated whether rhTMS-induced acoustic and somatosensory sensations may not specifically interfere with the illusion. Here, we addressed this issue by asking 27 volunteers to perform a SIFI paradigm under different Sham and active rhTMS protocols, delivered over the occipital pole at the IAF. Although TMS has been proven to act upon brain tissues excitability, results show that the SIFI occurred for both Sham and active rhTMS, with the illusory rate not being significantly different between baseline and stimulation conditions. This aligns with the discrete sampling hypothesis, for which alpha amplitude modulation, known to reflect changes in cortical excitability, should not account for changes in the illusory rate. Moreover, these findings highlight the viability of rhTMS-based interventions as a means to probe the neuroelectric signatures of illusory and hallucinatory audiovisual experiences, in healthy and neuropsychiatric populations.

Evaluation of the effectiveness of migraine therapy using functional resting MRI with course rhythmic transcranial magnetic stimulation

Introduction. In the context of the search for new migraine therapy options, strict control of their eff ectiveness by means of objective examination methods is required.Objective. Objective assessment of the eff ectiveness of TMS in patients with migraine on the basis of functional magnetic resonance imaging (fMRI) data.Material and methods. Resting-state fMRI before and after a fi ve-day course of TMS of the junction of the inferior frontal and temporal lobes bilaterally was performed in 19 patients with migraine. Changes in functional connectivity (FC) of the main neuronal networks of the brain, as well as clinical parameters of pain and quality of life of the patients were assessed before and after the course of TMS.Results. A decrease in pain intensity and anxiety scores, as well as a decrease in the number of acute pain medications taken, was observed against the background of the therapy. Changes in FC aff ected three main networks: the default mode network, the salience and visual networks. At the same time, decreased effi cacy of therapy was noted in patients with higher severity of depressive symptoms and presence of neuroimaging criteria of depression.Conclusion. The study suggests the effi cacy of TMS in patients with migraine based on neuroimaging criteria. It is worth paying special attention to the presence of depressive symptoms in migraine patients.

Перспективы применения терапевтической транскраниальной магнитной стимуляции при диабетической полинейропатии

This article examines promising areas of therapeutic transcranial magnetic stimulation (TMS) for the treatment of diabetic polyneuropathy (DPN) — a common complication of diabetes mellitus, which significantly reduces the life quality of patients. Conservative therapy of this condition is not always effective; therefore, the article discusses alternative treatment methods, including TMS — a method in which magnetic induction is used to affect the brain structures. TMS use for the DPN treatment has shown certain positive results. The article discusses various aspects of the TMS use, including protocols, treatment duration, dosage and safety. A review of existing Russian and foreign studies with recommendations on the TMS use in clinical practice for the DPN treatment is being conducted. These studies demonstrate the potential of using TMS as an additional treatment method of DPN. However, there is a need in further clinical studies for a deeper understanding of the TMS efficacy and mechanisms of action in this disease. TMS use in the DPN treatment may represent a new direction in the field of therapeutic methods that contribute to improving the patient lives with diabetes mellitus. KEYWORDS: diabetes mellitus, complications, diabetic polyneuropathy, neuropathic pain, rhythmic transcranial magnetic stimulation, conservative therapy FOR CITATION: Bobrov M.P., Ekusheva E.V., Voitenkov V.B., Khozhenko E.V. Prospects for the use of therapeutic transcranial magnetic stimulation in diabetic polyneuropathy. Russian Medical Inquiry. 2023;7(10):625–629 (in Russ.). DOI: 10.32364/2587-6821-2023-7-10-3.

Неинвазивная нейромодуляция как метод обезболивания в комплексной терапии хронической боли в нижней части спины

Aim: To describe the Russian and foreign experience in the use of non-invasive neuromodulation for pain management in patients with chronic lower back pain (LBP); to present various neuromodulation techniques and other rehabilitation methods which can be used in combination with neuromodulation in patients with LBP; to describe neuromodulation parameters and programs for an optimal analgesic effect. Key points. LBP is a common (affecting 7.5 % of the world population) and socially significant condition (one of the leading causes of disability worldwide). The efficiency of drug pain management in chronic LBP is approximately 40 %, therefore, non-drug treatment options are required. The neuropathic component of chronic LBP is associated with reorganization in cortex brain structures Hence, neural stimulation is a most promising approach to chronic LBP management, while transcranial direct current electrotherapy stimulation (TEdC) and rhythmic transcranial magnetic stimulation (rTMS) are the most efficient and safest neural stimulation methods. rTMS is an efficient and safe approach to the management both of nociceptive and neuropathic pain, which is a common component of chronic conditions, in particular of LBP. The main area of exposure is motor cortex areas (М1). As compared to TEdC, rTMS is better tolerated by patients and demonstrates better pain management results. Conclusion. Pain syndrome is a significant limitation to rehabilitation in patients with LBP, and drug pain management is inefficient. We suggest that anaesthetic neuromodulation be included into a complex therapy of such patients. The most widely used and efficient neuromodulation techniques are TEdC and rTMS. Keywords: lower back pain, rehabilitation, transcranial magnetic stimulation, neuropathic pain.

Experience of using rhythmic transcranial magnetic stimulation, extracorporeal shock wave therapy and botulinotherapy in individual motor recovery programs in patients with spastic paresis of the lower limb

Walking disorder is one of the most frequent consequences of stroke and traumatic brain injury, occurring in 80% of cases. Spastic paresis of the muscles of the lower extremity is the cause formed in 20-40% of patients within a few weeks after brain damage. In this case, a complex of symptoms occurs: motor deficiency (muscle paresis), increased muscle tone (spasticity), biomechanical changes in muscles, joints and surrounding tissues, contractures. Recovery of walking is a difficult task due to the peculiarities of its organization in the norm. At the same time, changes occurring in the muscles of the lower limb after a stroke, their modular reorganization, the formation of various pathological patterns, violation of the regulation of movements by the central nervous system, rapidly occurring changes in muscles, ligaments, complicate this process. Improving walking is one of the most important priorities of rehabilitation. Already at the second (stationary) stage of rehabilitation, patients have a lack of proper support on the lower limb, which inevitably leads to excessive load on the second limb, a change in the body scheme, incorrect foot placement, violation of the mechanics of walking (moving from heel to toe) due to plantar flexion / turn of the foot, etc. All this makes patients dependent on outside help, and walking unsafe, increases the risk of falls and complications (arthropathy, contracture, etc.). In this regard, it is important to timely diagnose the totality of changes in the lower limb and create optimal comprehensive rehabilitation programs using highly effective treatment methods aimed at reducing the severity of the motor defect, reducing spasticity and preventing complications. The article discusses the place of rhythmic transcranial magnetic stimulation, extracorporeal shock wave therapy and botulinum therapy during rehabilitation in patients with spastic paresis of the lower limb after a stroke. The results of the protocol of clinical approbation «Complex rehabilitation of patients with lower limb spasticity after focal brain damage at the second stage of medical rehabilitation» are presented.

Augmentation therapy of resistant schizophrenia with rhythmic transcranial magnetic stimulation

To identify the clinical efficacy of rhythmic transcranial magnetic stimulation (rTMS) in resistant schizophrenia. The study included 44 male patients with resistant schizophrenia, divided into 4 groups: with depressive (group 1; n=11, 25.0%), with hallucinatory (group 2; n=12, 27.3%), with negative (group 3; n=11, 25.0%) and with delusional symptoms (group 4; n=10, 22.7%). Patients received rTMS, the parameters of which were determined depending on the typological variety, for 3 weeks (15 sessions). Psychometric assessment was carried with PANSS, CGI-S, CGI-I, SANS, CDSS, AHRS when included in the study (0 day), after stimulation (21 days) and by the end of the study (42 day) that allowed evaluation of both the severity of the therapeutic effect and its duration. By the end of the course of stimulation, patients of the first three groups developed a distinct positive effect corresponding to a significant reduction in the total PANSS score: group 1 - 24.4% (p=0.002), group 2 - 8.3% (p=0.02), group 3 - 11.7% (p=0.001), which remained stable by day 42 in patients of the first (p=0.001) and second (p=0.005) groups. In patients with delusional symptoms (group 4), a subpsychotic state developed with a corresponding increase in the total PANSS score by 9.7% (p=0.007) requiring a course of relief therapy, which showed effectiveness by the end of the observation (day 42), indicating that resistance was overcome. The study demonstrated the validity of rTMS as an adjuvant method of treatment in the resistant schizophrenia. To implement the potential of rTMS, it is necessary first of all to take into account the structural features of the condition, as well as to continue improving the stimulation technique itself (increasing the duration of the course, developing supportive courses).

Impact of cerebellar beta entrainment using non-invasive brain stimulation: Insights from an ongoing rhythmic TMS—EEG study in healthy human participants

Abstract Oscillations play a pivotal role in shaping cerebellar local activity and its communication with neocortical areas involved in learning motor skills. Previous studies have emphasized the presence and the potentially important role of beta (15-30 Hz) cerebellar oscillations in such processes. Yet, the distribution and causal nature of local and interregional synchronization patterns at such frequencies remain elusive. The present study aims to better understand the functional mechanisms by which the cerebellum synchronizes with widespread cortical regions. This will pave the way to identify and better modulate the specific electrophysiological properties of these networks. To this end, we sought to entrain beta frequency cerebellar oscillations with transcranial magnetic stimulation (TMS) and to characterize the cerebello-cortical synchronization patterns in the sensory-motor networks. A cohort of 20 healthy adult participants received trial-by-trial blocks of 4-pulses bursts of either rhythmic (20 Hz, experimental condition) or arrhythmic (control condition) TMS delivered over the right cerebellum, while EEG was also recorded. The stimulation of a right occipital/parietal cortical site performed in separate blocks served to assess the specificity of cerebellar stimulation. After cleaning and pre-processing, we computed and averaged the power and the inter-trial coherence of EEG signals elicited by TMS in frontal, central and parietal areas. Current interim analyses support the tolerability and feasibility of cerebellar TMS—EEG recordings, and our ability to assess signs of beta-induced entrainment while ruling out unspecific effects (artifacts triggered by the TMS clicking-sound, scalp-tapping, etc). This is the first study overcoming the limitations of ‘offline’ repetitive TMS approaches assessing effective connectivity between cerebellar and cerebral systems using TMS—EEG approaches. The outcome of this study will characterize the neurophysiological properties of cerebello-cortical communication based on frequency-specific synchronization mechanisms, which would ultimately influence learning processes. Research Category and Technology and Methods Basic Research: 10. Transcranial Magnetic Stimulation (TMS) Keywords: Cerebellum, Oscillations, Entrainment, TMS-EEG

The effectiveness of rhythmic transcranial magnetic stimulation in relation to the severity of cervical dystonia, quality of life, levels of anxiety and depression

The effectiveness of rhythmic transcranial magnetic stimulation in relation to the severity of cervical dystonia, quality of life, levels of anxiety and depression

Evaluation of the effect of low-intensity rhythmic transcranial magnetic stimulation on motor and non-motor manifestations of Parkinson's disease

BACKGROUND: The use of repetitive transcranial magnetic stimulation as a method of non-drug therapy of Parkinson's disease has been actively studied over the past decades. The prevailing number of repetitive transcranial magnetic stimulation protocols in Parkinson's disease use a high intensity of stimulation (80120% of the value of the threshold of the evoked motor threshold from the muscles of the hand), while the choice of the stimulation intensity parameter was carried out empirically.
 AIM: to study the effectiveness of low-intensity unilateral repetitive transcranial magnetic stimulation on motor and non-motor symptoms of Parkinson's disease.
 MATERIAL AND METHODS:An open prospective non-randomized clinical trial included 37 patients with stage IIII Parkinson's disease according to HoehnYahr (1967), akinetic-rigid and mixed (akinetic-rigid-tremor) forms. All patients underwent repetitive transcranial magnetic stimulation according to the protocol: M1 stimulation zone, frequency 5 Hz, intensity 40% of the cortical motor threshold, on 6s, off 8s, total number of pulses per session 3000. The course of treatment is 10 procedures with 2 days (weekend) off.
 RESULTS: All patients completed the study in accordance with the protocol. When analyzing the results of the UPDRS scale (Unified Parkinson's disease rating scale), positive dynamics was noted in all parts of the questionnaire: part I ― from 2 (0; 3) to 0 (0; 1) points, p 0.05; part II ― from 9 (5.5; 12.5) to 4 (2; 6.5) points, p 0.05; part III ― with 11 (7; 14.5) to 6 (2; 7.5) points, p 0.05; part IV (Schwab and England scale) ― from 80% (70; 95) to 90% (85; 100), p 0.05. There was also a selective effect on non-motor symptoms.
 CONCLUSION: Low-intensity exposure (40% of the motor threshold) has a significant clinical effect on motor and non-motor symptoms of Parkinson's disease; stimulation of the primary motor cortex can have an antidepressant effect; repetitive transcranial magnetic stimulation has a selective effect on non-motor symptoms of Parkinson's disease: a predominant effect has been demonstrated with respect to olfactory, emotional, cognitive disorders, sleep disorders and hypersalivation; when assessing the dynamics of motor disorders, a more pronounced effect was noted with respect to rigidity, postural disorders, walking speed, and to a lesser extent, the effect on tremor was noted.

Navigated transcranial magnetic stimulation: Question of accuracy

In this literature review and our own data, we provide information about navigational transcranial magnetic stimulation (TMS). At present, a significant amount of knowledge has been accumulated about the use of TMS, both diagnostic and therapeutic, in real clinical practice. Diagnostic TMS has been studied and developed maximally. Nevertheless, despite the undoubted clinical effect of therapeutic TMS, the question of the need for the most accurate target designation for the greatest effectiveness of treatment remains controversial. A number of publications emphasize and justify the need for such target designation, but others report a positive clinical effect of stimulation regardless of the exact location of the inductor. This undoubtedly makes further research in this area relevant with an assessment of the comparative effectiveness of the most accurate rhythmic TMS with other protocols for its use.

Effects of Rhythmic Transcranial Magnetic Stimulation in the Alpha-Band on Visual Perception Depend on Deviation From Alpha-Peak Frequency: Faster Relative Transcranial Magnetic Stimulation Alpha-Pace Improves Performance.

Alpha-band oscillatory activity over occipito-parietal areas is involved in shaping perceptual and cognitive processes, with a growing body of electroencephalographic (EEG) evidence indicating that pre-stimulus alpha-band amplitude relates to the subjective perceptual experience, but not to objective measures of visual task performance (discrimination accuracy). The primary aim of the present transcranial magnetic stimulation (TMS) study was to investigate whether causality can be established for this relationship, using rhythmic (alpha-band) TMS entrainment protocols. It was anticipated that pre-stimulus 10 Hz-TMS would induce changes in subjective awareness ratings but not accuracy, in the visual hemifield contralateral to TMS. To test this, we administered 10 Hz-TMS over the right intraparietal sulcus prior to visual stimulus presentation in 17 participants, while measuring their objective performance and subjective awareness in a visual discrimination task. Arrhythmic and 10 Hz sham-TMS served as control conditions (within-participant design). Resting EEG was used to record individual alpha frequency (IAF). A study conducted in parallel to ours with a similar design but reported after we completed data collection informed further, secondary analyses for a causal relationship between pre-stimulus alpha-frequency and discrimination accuracy. This was explored through a regression analysis between rhythmic-TMS alpha-pace relative to IAF and performance measures. Our results revealed that contrary to our primary expectation, pre-stimulus 10 Hz-TMS did not affect subjective measures of performance, nor accuracy, relative to control-TMS. This null result is in accord with a recent finding showing that for influencing subjective measures of performance, alpha-TMS needs to be applied post-stimulus. In addition, our secondary analysis showed that IAF was positively correlated with task accuracy across participants, and that 10 Hz-TMS effects on accuracy—but not awareness ratings—depended on IAF: The slower (or faster) the IAF, relative to the fixed 10 Hz TMS frequency, the stronger the TMS-induced performance improvement (or worsening), indicating that 10 Hz-TMS produced a gain (or a loss) in individual performance, directly depending on TMS-pace relative to IAF. In support of recent reports, this is evidence for alpha-frequency playing a causal role in perceptual sensitivity likely through regulating the speed of sensory sampling.

Changes in Resting fMRI Networks in Patients with Severe Traumatic Brain Injury During Therapeutic Rhythmic Transcranial Magnetic Stimulation (Case Report)

Severe traumatic brain injury (TBI) accompanied by impaired consciousness manifesting as prolonged postcoma unawareness (PCU) is one of the current medical and social problems causing high morbidity and mortality worldwide. Difficult recovery of such patients necessitates the development of additional neurorehabilitation approaches, including neuromodulation methods, as well as the search for objective markers of treatment efficacy. Aim of the study: to evaluate the effect of therapeutic rhythmic transcranial magnetic stimulation (rTMS) on fMRI resting state networks (RSN) in PCU after severe TBI. Materials and Methods. We analyzed individual fMRI RSN in three patients with PCU before and after a course of rTMS performed at different timepoints after severe TBI and with different efficacy of treatment. We assessed the topography and quantitative characteristics of the networks (DMN, sensorimotor, control functions, left and right fronto-parietal, auditory, and speech) known to be most significant for recovery of consciousness. Results. We found a trend toward normalization of RSN topography as well as an increase in the integral index of network intensity in two of three patients with a distinct increase in consciousness after a course of rTMS. Conclusion. Using case observations, we have demonstrated the therapeutic efficacy of rTMS and feasibility of using fMRI RSN as a reliable diagnostic approach in PCU following severe TBI.