Silent Period Research Articles

Persistent Contralateral Pain Compromises Exercise Tolerance but Does not Alter Corticomotor Responses During Repeated, Submaximal Isometric Knee Extensions to Task Failure

Muscle pain is an important determinant of exercise tolerance, but its relationship with neurophysiological responses during a submaximal exercise trial is unclear. The purpose of this study was to determine the effect of persistent contralateral pain on neurophysiological function and perceptual responses during ipsilateral isometric knee extensions to task failure. Ten participants performed a single-leg repeated submaximal isometric knee extensions with (PAIN) or without (CTRL) constant pain induced by intermittent blood flow occlusion combined with evoked muscle contraction applied to the contralateral, resting leg. Transcranial magnetic stimulation (TMS) applied over the motor cortex was used to assess corticospinal excitability (quantified as motor evoked potentials), corticospinal inhibition (quantified as silent period duration), and short interval intracortical inhibition. Maximal voluntary contractions (MVCs), coupled with femoral nerve stimulation to the exercising leg, were performed every 12 submaximal contractions to assess neuromuscular function. Perceived leg pain and effort were also assessed throughout the exercise. The experimental pain shortened the time to task failure compared to CTRL (P = 0.019). Although time effects were present, no differences appeared between conditions for MVC force, voluntary activation, or potentiated twitch force across both tasks (all P > 0.05). Additionally, no differences between CTRL and PAIN were demonstrated for any TMS-derived measures assessing corticospinal responses. Exercising leg pain was higher in CTRL (P = 0.018), as was perceived exertion (P = 0.030). Overall, when using a persistent, submaximal experimental pain intervention, it appears that although muscle pain compromises exercise tolerance, this phenomenon occurs independently of potential alterations in corticomotor mechanisms.

Evaluation of sternocleidomastoid muscle cutaneous silent period in patients with cervical dystonia

Purpose: The aim of this study to examine the in changes inhibitory interneurons of the brainstem, which are likely to be involved in pathophysiology of cervical dystonia, using the cutaneous silent period(SP) method which is an inhibitor reflex.
 Materials and Methods: SP latency and interval values were obtained from bilateral sternocleidomastoid (SCM) muscles of individuals in 20 patients with cervical dystonia and 25 healthy volunteers using superficial electrodes. SP parameters obtained were compared within and between groups. Furthermore, intra-individual correlation analysis was performed for SP parameters from bilateral SCMs of the individuals in both groups.
 Results: The mean age of the patients participating in the study was 49.3 ± 14.7, and the control group was 48.0 ± 13.7. There was no statistically significant difference between the two groups in terms of age and gender. No significant difference was found in the comparison of SP parameters both within and between groups. There was a strong intra-individual correlation between SP latencies of bilateral SCMs of both patient and control groups. It was determined that the strongly positive intra-individual correlation between SP intervals also continued in the control group, whereas at patient group disappeared.
 Conclusion: The loss of correlation between bilateral SCM SP durations in the dystonia group indicates that the abnormality in interneuron connections, which is thought to be present in dystonia, may actually be a loss of order. This “disorganization” may explain the discrepancies in the results of cutaneous SP studies in dystonia patients.

The Representation of East Asian Music in Silent Film Accompaniment Scores

The Representation of East Asian Music in Silent Film Accompaniment Scores

A History of Danish Cinema

A History of Danish Cinema

Sleep-like changes in neural processing emerge during sleep deprivation in early auditory cortex.

Insufficient sleep is commonplace in modern lifestyle and can lead to grave outcomes, yet the changes in neuronal activity accumulating over hours of extended wakefulness remain poorly understood. Specifically, which aspects of cortical processing are affected by sleep deprivation (SD), and whether they also affect early sensory regions, remain unclear. Here, we recorded spiking activity in the rat auditory cortex along with polysomnography while presenting sounds during SD followed by recovery sleep. We found that frequency tuning, onset responses, and spontaneous firing rates were largely unaffected by SD. By contrast, SD decreased entrainment to rapid (≥20Hz) click trains, increased population synchrony, and increased the prevalence of sleep-like stimulus-induced silent periods, even when ongoing activity was similar. Recovery NREM sleep was associated with similar effects as SD with even greater magnitude, while auditory processing during REM sleep was similar to vigilant wakefulness. Our results show that processes akin to those in NREM sleep invade the activity of cortical circuits during SD, even in the early sensory cortex.

Exploratory genome-wide analyses of cortical inhibition, facilitation, and plasticity in late-life depression

Late-life depression (LLD) is a heterogenous mood disorder influenced by genetic factors. Cortical physiological processes such as cortical inhibition, facilitation, and plasticity may be markers of illness that are more strongly associated with genetic factors than the clinical phenotype. Thus, exploring the relationship between genetic factors and these physiological processes may help to characterize the biological mechanisms underlying LLD and improve diagnosis and treatment selection. Transcranial magnetic stimulation (TMS) combined with electromyography was used to measure short interval intracortical inhibition (SICI), cortical silent period (CSP), intracortical facilitation (ICF), and paired associative stimulation (PAS) in 79 participants with LLD. We used exploratory genome-wide association and gene-based analyses to assess for genetic correlations of these TMS measures. MARK4 (which encodes microtubule affinity-regulating kinase 4) and PPP1R37 (which encodes protein phosphatase 1 regulatory subunit 37) showed genome-wide significant association with SICI. EGFLAM (which encodes EGF-like fibronectin type III and laminin G domain) showed genome-wide significant association with CSP. No genes met genome-wide significant association with ICF or PAS. We observed genetic influences on cortical inhibition in older adults with LLD. Replication with larger sample sizes, exploration of clinical phenotype subgroups, and functional analysis of relevant genotypes is warranted to better characterize genetic influences on cortical physiology in LLD. This work is needed to determine whether cortical inhibition may serve as a biomarker to improve diagnostic precision and guide treatment selection in LLD.

Different effects of I-wave periodicity repetitive TMS on motor cortex interhemispheric interaction.

Activity of the neural circuits in the human motor cortex can be probed using transcranial magnetic stimulation (TMS). Changing TMS-induced current direction recruits different cortical neural circuits. I-wave periodicity repetitive TMS (iTMS) substantially modulates motor cortex excitability through neural plasticity, yet its effect on interhemispheric interaction remains unclear. To explore the modulation of interhemispheric interaction by iTMS applied in different current directions. Twenty right-handed healthy young volunteers (aged 27.5 ± 5.0 years) participated in this study with three visits. On each visit, iTMS in posterior-anterior/anterior-posterior direction (PA-/AP-iTMS) or sham-iTMS was applied to the right hemisphere, with corticospinal excitability and intracortical facilitation of the non-stimulated left hemisphere evaluated at four timepoints. Ipsilateral silent period was also measured at each timepoint probing interhemispheric inhibition (IHI). PA- and AP-iTMS potentiated cortical excitability concurrently in the stimulated right hemisphere. Corticospinal excitability of the non-stimulated left hemisphere increased 10 min after both PA- and AP-iTMS intervention, with a decrease in short-interval intracortical facilitation (SICF) observed in AP-iTMS only. Immediately after the intervention, PA-iTMS tilted the IHI balance toward inhibiting the non-stimulated hemisphere, while AP-iTMS shifted the balance toward the opposite direction. Our findings provide systematic evidence on the plastic modulation of interhemispheric interaction by PA- and AP-iTMS. We show that iTMS induces an interhemispheric facilitatory effect, and that PA- and AP-iTMS differs in modulating interhemispheric inhibition.

Non-paretic leg movements can facilitate cortical drive to the paretic leg in individuals post stroke with severe motor impairment: Implications for motor priming.

Cross-education, a phenomenon where unilateral strength (or skill) training enhances strength (or skill) in the contralateral untrained limb, has been well studied in able-bodied individuals. Cross-education effect accompanies bilateral changes of corticomotor activity in the motor cortex (M1). Recent reports demonstrated greater cross-education effect in stroke survivors compared to healthy individuals, however, corticomotor responses to cross-education in stroke remains unclear. This study aimed to determine the effects of non-paretic leg movements on corticomotor excitability (CME) and reaction time of the paretic leg in severely impaired stroke survivors. Seventeen post stroke individuals with severe leg motor impairment (Fugl-Meyer lower extremity score less than 21 and absence of motor evoked potential in the paretic leg) performed three 20-min motor trainings using their non-paretic ankle: skill (targeted dynamic movements), strength (isometric resistance) and sham (sub-threshold electrical nerve stimulation). During training, verbal instructions were given to the participants to limit their movement to the non-paretic leg and this was confirmed with visual observation of the paretic leg. Transcranial magnetic stimulation measured CME of the contralateral pathways from the non-lesioned M1 to the non-paretic tibialis anterior (TA) muscle, ipsilateral pathways to the paretic TA and transcallosal inhibition (TCI) from the non-lesioned to lesioned M1. Paretic ankle reaction time was measured using a reaction time paradigm. All outcomes were measured before, immediately post, 30-min post and 60-min post priming. CME of the non-paretic TA increased after skill (.08 ± .10 mV) and strength (.06 ± .05 mV) training (p < .01). Ipsilateral CME of the paretic TA (.02 ± .01 mV) and TCI (.01 ± .01 s, ipsilateral silent period; more inhibition to the lesioned M1) increased after skill (p < .05) but not strength training. Reaction time of the paretic ankle improved after skill and strength training (-.11 ± .2 and -.13 ± .20 s, respectively; p < .05) and was sustained at 60 min. No changes were observed during the sham condition. Our findings may inform future studies for using non-paretic leg movements as a priming modality, especially for those who are contraindicated to other priming paradigms (e.g., brain stimulation) or unable to perform paretic leg movements. Conclusion: Non-paretic leg movements can be used as a priming modality, especially for those who are contraindicated to other priming paradigms (e.g., brain stimulation) or unable to perform paretic leg movements.

ENGLISH STUDENTS’ STRATEGIES TO SPEAK ENGLISH (A CASE STUDY OF SIXTH SEMESTER STUDENTS OF ENGLISH EDUCATION DEPARTMENT) THE STATE INSTITUTE FOR ISLAMIC STUDIES SULTHAN THAHA SAIFUDDIN JAMBI

This study aimed to discuss about English students’ strategies to speak English of sixth semester English Education Department of The State Institute for Islamic Studies Sulthan Thaha Saifuddin Jambi. The design of the study is Qualitative Method with a case study approach. Subjects of the study are the Sixth Semester Students of English Education Department and Faculty of Education and Teacher Training of The State Institute for Islamic Studies Sulthan Thaha Saifuddin Jambi. In the collecting of data, the researcher used Observation and Interview. The analyzing technique is the data reduction, data display and conclusion drawing. The results of the research show that most of English students have strategies applied to increase their ability to speak English. They use learning strategies from watching movies, absorb the structure of English through Silent Period and Improving Fluency. Researchers did not find the learning strategies of Native Speakers applied by English students because very difficult to find native speakers in their areas. Researchers also find difficulties faced by English students to speak English such as Pronunciation, Vocabulary and Meaning and Grammar. But researchers have also found the other difficulties faced by English students which are fearful or nervous and the lack friends / partners who want to speak English with them to increase their speaking skills.

Comparison between conventional and neuronavigated strategies to assess corticospinal responsiveness in unfatigued and fatigued knee-extensor muscles

In studying neuromuscular fatigability, researchers commonly use functional criteria to position and hold the transcranial magnetic stimulation (TMS) coil during testing sessions. This could influence the magnitude of corticospinal excitability and inhibition responses due to imprecise and unsteady positions of the coil. To reduce coil position and orientation variability, neuronavigated TMS (nTMS) could be used. We evaluated the accuracy of nTMS and a standardized function-guided procedure for maintaining TMS coil position both in unfatigued and fatigued knee extensors. Eighteen participants (10F/8M) volunteered in two identical and randomized sessions. Maximal and submaximal neuromuscular evaluations were performed with TMS three times before (PRE_1) and three times after (PRE_2) a 2 min resting session and one time immediately after (POST) a 2-min sustained maximal voluntary isometric contraction (MVIC). The located “hotspot” [the location that evoked the largest motor-evoked potential (MEP) responses in the rectus femoris] was maintained either with or without nTMS. MEP, silent period (SP) and the distance between the “hotspot” and the actual coil position were recorded. A time × contraction intensity × testing session × muscle interaction was not observed for MEP, SP, and distance. Bland-Altman plots presented adequate agreements for MEP and SP. Spatial accuracy of TMS coil position over the motor cortex did not influence corticospinal excitability and inhibition in unfatigued and fatigued knee extensors. The variability in MEP and SP responses may be due to spontaneous fluctuations in corticospinal excitability and inhibition, and it is not altered by the spatial stability of the stimulation point.

Rapid thalamocortical network switching mediated by cortical synchronization underlies propofol-induced EEG signatures: a biophysical model.

Propofol-mediated unconsciousness elicits strong alpha/low-beta and slow oscillations in the electroencephalogram (EEG) of patients. As anesthetic dose increases, the EEG signal changes in ways that give clues to the level of unconsciousness; the network mechanisms of these changes are only partially understood. Here, we construct a biophysical thalamocortical network involving brain stem influences that reproduces transitions in dynamics seen in the EEG involving the evolution of the power and frequency of alpha/low-beta and slow rhythm, as well as their interactions. Our model suggests that propofol engages thalamic spindle and cortical sleep mechanisms to elicit persistent alpha/low-beta and slow rhythms, respectively. The thalamocortical network fluctuates between two mutually exclusive states on the timescale of seconds. One state is characterized by continuous alpha/low-beta-frequency spiking in thalamus (C-state), whereas in the other, thalamic alpha spiking is interrupted by periods of co-occurring thalamic and cortical silence (I-state). In the I-state, alpha colocalizes to the peak of the slow oscillation; in the C-state, there is a variable relationship between an alpha/beta rhythm and the slow oscillation. The C-state predominates near loss of consciousness; with increasing dose, the proportion of time spent in the I-state increases, recapitulating EEG phenomenology. Cortical synchrony drives the switch to the I-state by changing the nature of the thalamocortical feedback. Brain stem influence on the strength of thalamocortical feedback mediates the amount of cortical synchrony. Our model implicates loss of low-beta, cortical synchrony, and coordinated thalamocortical silent periods as contributing to the unconscious state.NEW & NOTEWORTHY GABAergic anesthetics induce alpha/low-beta and slow oscillations in the EEG, which interact in dose-dependent ways. We constructed a thalamocortical model to investigate how these interdependent oscillations change with propofol dose. We find two dynamic states of thalamocortical coordination, which change on the timescale of seconds and dose-dependently mirror known changes in EEG. Thalamocortical feedback determines the oscillatory coupling and power seen in each state, and this is primarily driven by cortical synchrony and brain stem neuromodulation.

Sex-Specific Reliability of Lower-Limb Corticospinal Excitability and Silent Periods.

Pagan, JI, Harmon, KK, Girts, RM, MacLennan, RJ, Beausejour, JP, Hernandez-Sarabia, JA, Coker, NA, Carr, JC, Ye, X, DeFreitas, JM, and Stock, MS. Sex-specific reliability of lower-limb corticospinal excitability and silent periods. J Strength Cond Res 37(9): 1882-1887, 2023-Transcranial magnetic stimulation (TMS) is a research tool that has potential to provide new insights into strength training-induced adaptations. However, using TMS to study the lower limbs is challenging, and sex-specific reliability has yet to be reported. We examined the reliability of corticospinal excitability and silent periods for the rectus femoris, vastus lateralis, and biceps femoris in both sexes. Thirteen males and 14 females reported to the laboratory twice. During both trials, a double cone coil was used to deliver 20 pulses to the rectus femoris hotspot with a stimulator output of 130% of active motor threshold. Motor-evoked potential peak-to-peak amplitude, which reflects corticospinal excitability, and silent period duration were quantified. Our results offer 4 novel findings. First, corticospinal excitability and silent period demonstrated higher reliability for the females. Second, regardless of sex and muscle, the silent period was more reliable than corticospinal excitability. Third, reliability was highest for our target muscle (rectus femoris), with lower reliability for the vastus lateralis and biceps femoris, suggesting that these methods cannot be used to study coactivation. Fourth, active motor threshold showed less variability than corticospinal excitability and silent period but increased at trial 2 in females. Many of the intraclass correlation coefficients were excellent (≥0.90), although we attribute this finding to variability between subjects. Reliability of lower-limb TMS measures may be sex, muscle, and variable dependent. Our findings suggest that both males and females should be included in lower-limb TMS research, although combining data between sexes should be approached cautiously.

A Silent Disco: Differential Effects of Beat-based and Pattern-based Temporal Expectations on Persistent Entrainment of Low-frequency Neural Oscillations.

The brain uses temporal structure in the environment, like rhythm in music and speech, to predict the timing of events, thereby optimizing their processing and perception. Temporal expectations can be grounded in different aspects of the input structure, such as a regular beat or a predictable pattern. One influential account posits that a generic mechanism underlies beat-based and pattern-based expectations, namely, entrainment of low-frequency neural oscillations to rhythmic input, whereas other accounts assume different underlying neural mechanisms. Here, we addressed this outstanding issue by examining EEG activity and behavioral responses during silent periods following rhythmic auditory sequences. We measured responses outlasting the rhythms both to avoid confounding the EEG analyses with evoked responses, and to directly test whether beat-based and pattern-based expectations persist beyond stimulation, as predicted by entrainment theories. To properly disentangle beat-based and pattern-based expectations, which often occur simultaneously, we used non-isochronous rhythms with a beat, a predictable pattern, or random timing. In Experiment 1 (n = 32), beat-based expectations affected behavioral ratings of probe events for two beat-cycles after the end of the rhythm. The effects of pattern-based expectations reflected expectations for one interval. In Experiment 2 (n = 27), using EEG, we found enhanced spectral power at the beat frequency for beat-based sequences both during listening and silence. For pattern-based sequences, enhanced power at a pattern-specific frequency was present during listening, but not silence. Moreover, we found a difference in the evoked signal following pattern-based and beat-based sequences. Finally, we show how multivariate pattern decoding and multiscale entropy-measures sensitive to non-oscillatory components of the signal-can be used to probe temporal expectations. Together, our results suggest that the input structure used to form temporal expectations may affect the associated neural mechanisms. We suggest climbing activity and low-frequency oscillations may be differentially associated with pattern-based and beat-based expectations.

Negative myoclonus causes locomotory disability in progressive myoclonus epilepsy type EPM1- Unverricht-Lundborg disease.

Patients with Unverricht-Lundborg disease/EPM1 develop increasing locomotory disability or ataxia in the course of their disease. To test our hypothesis that negative myoclonus is the reason for this increasing ataxia, we investigated a possible correlation over time. In 15 patients with EPM1who were confirmed to have a mutation in the CSTB gene, polygraphic video-EEG-EMG recordings were performed in freely moving or standing patients. The criterion for the duration of the negative myoclonus was the measured length of the silent periods on the EMG. All 15 patients had documented negative myoclonus when standing and walking. The mean duration of silent periods significantly increased from 100 (SD: 19.1) ms at time point T1 to 128 (SD: 26.6) ms at T2 in seven of eight patients, based on two recordings and a mean interval of 12.8 (SD: 4.9) years. Using a cross-sectional approach, all 15 patients were classified based on whether they were ambulatory, could walk with aid, or needed a wheelchair. Ambulatory patients had a mean duration of 97.3 (SD: 16.5) ms, patients who could walk with aid had a mean duration of 106.7 (SD: 16) ms, and patients who were wheelchair-bound had a mean duration of 138 (SD: 23.6) ms. In addition to the prolongation of the silent periods, there was an observed increase in frequency of the negative myoclonus, becoming more continuous and tremulous. Using simultaneous EEG/EMG recordings in freely moving or standing patients, we have shown that the locomotor disability or ataxia is due to negative myoclonus in voluntary innervated muscles. The reason for the progression is the prolongation of the silent periods as measured by the duration of the negative myoclonus and their increase in frequency.

N°126 – Clinical application of cortical silent period

N°126 – Clinical application of cortical silent period

The distribution of transcallosal inhibition to upper extremity muscles is altered in chronic stroke

ObjectiveTo determine if the distribution of transcallosal inhibition (TI) acting on proximal and distal upper extremity muscles is altered in chronic stroke. MethodsWe examined thirteen healthy controls and sixteen mildly to moderately impaired chronic stroke patients. We used transcranial magnetic stimulation (TMS) to probe TI from the contralesional onto ipsilesional hemisphere (assigned in controls). We recorded the ipsilateral silent period in the paretic biceps (BIC) and first dorsal interosseous (FDI). We measured TI strength, distribution gradient (TI difference between muscles), and motor impairment (Fugl-Meyer Assessment). ResultsBoth groups had stronger TI acting on their FDIs than BICs (p < 0.001). However, stroke patients also had stronger TI acting on their BICs than controls (p = 0.034), resulting in a flatter distribution of inhibition (p = 0.028). In patients, stronger FDI inhibition correlated with less hand impairment (p = 0.031); BIC inhibition was not correlated to impairment. ConclusionTI is more evenly distributed to the paretic FDI and BIC in chronic stroke. The relative increase in proximal inhibition does not relate to better function, as it does distally. SignificanceThe results expand our knowledge about segment-specific neurophysiology and its relevance to impairment after stroke.

The Cortical Silent Period in the Cricothyroid Muscle as a Neurophysiologic Feature for Dystonia Observation: E-Field-Navigated Transcranial Magnetic (TMS) Study.

The cortical silent period (cSP) is a period of electrical silence following a motor-evoked potential (MEP) in the electromyographic signal recorded from a muscle. The MEP can be elicited by transcranial magnetic stimulation (TMS) over the primary motor cortex site corresponding with the muscle. The cSP reflects the intracortical inhibitory process mediated by GABAA and GABAB receptors. The study aimed to investigate the cSP in the cricothyroid (CT) muscle after applying e-field-navigated TMS over the laryngeal motor cortex (LMC) in healthy subjects. Then, a cSP as a neurophysiologic feature for laryngeal dystonia was observed. We applied a single-pulse e-field-navigated TMS to the LMC over both hemispheres with hook-wire electrodes positioned in the CT muscle in nineteen healthy participants, which triggered the elicitation of contralateral and ipsilateral corticobulbar MEPs. The subjects were engaged in a vocalization task, and then we assessed the following metrics: LMC intensity, peak-to-peak MEP amplitude in the CT muscle, and cSP duration. The results showed that the cSP duration from the contralateral CT muscle was distributed from 40 ms to 60.83 ms, and from the ipsilateral CT muscle, from 40 ms to 65.58 ms. Also, no significant difference was found between the contralateral and ipsilateral cSP duration (t(30) = 0.85, p = 0.40), MEP amplitude in the CT muscle (t(30) = 0.91, p = 0.36), and LMC intensity (t(30) = 1.20, p = 0.23). To conclude, the applied research protocol showed the feasibility of recording LMC corticobulbar MEPs and observing the cSP during vocalization in healthy participants. Furthermore, an understanding of neurophysiologic cSP features can be used to study the pathophysiology of neurological disorders that affect laryngeal muscles, such as laryngeal dystonia.

Hemispheric Differences of 1 Hz rTMS over Motor and Premotor Cortex in Modulation of Neural Processing and Hand Function.

Non-invasive brain stimulation can modulate both neural processing and behavioral performance. Its effects may be influenced by the stimulated area and hemisphere. In this study (EC no. 09083), repetitive transcranial magnetic stimulation (rTMS) was applied to the primary motor cortex (M1) or dorsal premotor cortex (dPMC) of either the right or left hemisphere, while evaluating cortical neurophysiology and hand function. Fifteen healthy subjects participated in this placebo-controlled crossover study. Four sessions of real 1 Hz rTMS (110% of rMT, 900 pulses) over (i) left M1, (ii) right M1, (iii) left dPMC, (iv) right dPMC, and one session of (v) placebo 1 Hz rTMS (0% of rMT, 900 pulses) over the left M1 were applied in randomized order. Motor function of both hands (Jebsen-Taylor Hand Function Test (JTHFT)) and neural processing within both hemispheres (motor evoked potentials (MEPs), cortical silent period (CSP), and ipsilateral silent period (ISP)) were evaluated prior and after each intervention session. A lengthening of CSP and ISP durations within the right hemisphere was induced by 1 Hz rTMS over both areas and hemispheres. No such intervention-induced neurophysiological changes were detected within the left hemisphere. Regarding JTHFT and MEP, no intervention-induced changes ensued. Changes of hand function correlated with neurophysiological changes within both hemispheres, more often for the left than the right hand. Effects of 1 Hz rTMS can be better captured by neurophysiological than behavioral measures. Hemispheric differences need to be considered for this intervention.

Abstract #1396724: Cryptic Catecholamines

The textbook presentation of a pheochromocytoma is the pentad of severe headache, palpitations, significant perspiration, hypertension (HTN), and pallor. However, many patients present with subclinical findings, adding to the challenge for physicians to make this diagnosis. The following case is unusual in the patient’s history of three procedures under general anesthesia, with one being an ablation in 2019. A review of previous CT images showed an adrenal adenoma from 2019. This demonstrates that pheochromocytomas may have biochemically silent periods further complicating the diagnosis and management of pheochromocytoma. 78-year-old female presents s/p elective ablation with atrial tachycardia. PMH is remarkable for T2D, HTN, hypothyroidism, CAD, and atrial fibrillation/AVNRT. In 2019 patient had the first ablation without any complications related to blood pressure fluctuations. Due to unknown reasons, the patient had persistent atypical atrial fibrillation with dyspnea, with a plan to redo ablation for worsening symptoms of shortness of breath. Then in 2022 patient underwent a second ablation and developed labile blood pressure with initial findings of 77/48 with signs of cardiogenic shock and subsequent pulmonary edema. Due to the patient’s presentation of hypovolemia secondary to the development of cardiogenic shock, the patient required vasopressors. The patient was started on a beta-blockade in response to vasopressor treatment, which caused her blood pressure to increase significantly, with systolic pressures ranging between 230-240. The metoprolol was stopped, and the patient was transitioned to doxazosin, due to high suspicion of a pheochromocytoma. Initial stabilization of BP was achieved after starting an alpha blockade. BP remained somewhat labile but continued a downward trend with doxazosin. CT was later ordered and appreciable for a left adrenal mass. Past imaging records showed the mass had been present since 2019. Metanephrine labs were collected and found to be 6332 pg/ml, confirming the diagnosis of a pheochromocytoma. The patient was further stabilized with doxazosin and adequate volume resuscitation then transitioned to metoprolol with tight control of blood pressure. Her hospital course proved to be difficult due to prior comorbidities and age, but she was ultimately stabilized and discharged after a three-week hospital stay. A vast majority of patients with AFib have chronic HTN. There are many different etiologies of secondary HTN, including a more uncommon cause, pheochromocytomas. Common subclinical symptoms are as follows: headache, palpitations, sweating, HTN, and anxiety, which are also common presentations of AFib. Long-term management for pheochromocytomas would improve significantly if screenings were done in a patient presenting with symptomatic Afib and history of HTN. Positive screening would initiate early treatment, consisting of a short alpha blockade followed by a chronic, low-dose beta blockade. In this patient, the pheochromocytoma might have contributed to the failure of ablation treatments and the persistence of atrial fibrillation.

The Transcallosal Highway: The ipsilateral silent period as a neural biomarker for impaired corpus callosum communication in multiple sclerosis

Multiple sclerosis is a neurodegenerative disease that damages myelin sheath within the central nervous system. This axonal demyelination impacts communication between the brain's hemispheres in persons with multiple sclerosis (PwMS). Changes in transcallosal communication impairs the coordination of movements requiring precise temporal and spatial components such as lower extremity function during gait. These bilateral movements require constant communication across the corpus callosum to excite and inhibit specific muscle groups. The ipsilateral silent period (iSP) is an indirect marker of the magnitude for transcallosal inhibition. We hypothesize that the iSP may also serve as a neural biomarker for transcallosal impairments originating from the more affected hemisphere and highlight underlying mechanisms for gait asymmetries in PwMS. Our ongoing study utilizes transcranial magnetic stimulation to assess the inhibitory capacity between the brain's hemispheres (i.e., iSPs). A focal magnetic pulse is delivered to the first dorsal interosseous resulting in a suppression of muscle activity, thus reflecting inhibitory transcallosal communication. There is a lack of research analyzing directionality data between the more and less affected hemisphere in PwMS. Therefore, we evaluate outcome metrics dependent upon the individual's more affected hemisphere. Twenty-three PwMS completed the ongoing protocol and inhibitory metrics such as depth iSP% average, duration, depth iSP% max, transcallosal conduction time, and onset latency were collected. No statistically significant differences have been found between the two hemispheres in PwMS. However, beyond directionality data, our study is investigating gait coordination with overall inhibitory capacity. Walking coordination is quantified using a metric called phase coordination index (PCI). A greater PCI value reflects poorer gait coordination. We hypothesize those who demonstrate better gait coordination (lower PCI values), will have a greater iSP. These findings will determine the potential of iSPs as a neural biomarker to address gait asymmetries and stratify participants into individualized mobility rehabilitation protocols. Multiple sclerosis is a neurodegenerative disease that damages myelin sheath within the central nervous system. This axonal demyelination impacts communication between the brain's hemispheres in persons with multiple sclerosis (PwMS). Changes in transcallosal communication impairs the coordination of movements requiring precise temporal and spatial components such as lower extremity function during gait. These bilateral movements require constant communication across the corpus callosum to excite and inhibit specific muscle groups. The ipsilateral silent period (iSP) is an indirect marker of the magnitude for transcallosal inhibition. We hypothesize that the iSP may also serve as a neural biomarker for transcallosal impairments originating from the more affected hemisphere and highlight underlying mechanisms for gait asymmetries in PwMS. Our ongoing study utilizes transcranial magnetic stimulation to assess the inhibitory capacity between the brain's hemispheres (i.e., iSPs). A focal magnetic pulse is delivered to the first dorsal interosseous resulting in a suppression of muscle activity, thus reflecting inhibitory transcallosal communication. There is a lack of research analyzing directionality data between the more and less affected hemisphere in PwMS. Therefore, we evaluate outcome metrics dependent upon the individual's more affected hemisphere. Twenty-three PwMS completed the ongoing protocol and inhibitory metrics such as depth iSP% average, duration, depth iSP% max, transcallosal conduction time, and onset latency were collected. No statistically significant differences have been found between the two hemispheres in PwMS. However, beyond directionality data, our study is investigating gait coordination with overall inhibitory capacity. Walking coordination is quantified using a metric called phase coordination index (PCI). A greater PCI value reflects poorer gait coordination. We hypothesize those who demonstrate better gait coordination (lower PCI values), will have a greater iSP. These findings will determine the potential of iSPs as a neural biomarker to address gait asymmetries and stratify participants into individualized mobility rehabilitation protocols.