Auditory cortex hyperconnectivity before rTMS is correlated with tinnitus improvement.

INTRODUCTION: Repetitive transcranial magnetic stimulation (rTMS) has been used as a potential treatment for tinnitus; however, its effectiveness is variable and unpredictable. We hypothesized that resting-state functional connectivity before rTMS may be correlated with rTMS treatment effectiveness. METHODS: We applied 1-Hz rTMS to the left primary auditory (A1) and dorsolateral prefrontal cortices (DLPFC) of 10 individuals with tinnitus and 10 age-matched controls. Resting-state functional magnetic resonance imaging (fMRI) studies were performed approximately one week before rTMS. Seed-based connectivity analyses were conducted for each individual, with seed regions as rTMS target areas. RESULTS: Compared to controls, the left superior temporal areas showed significantly increased positive connectivity with the left A1 and negative connectivity with the left DLPFC in the tinnitus group. The left frontoparietal and right cerebellar areas showed significantly increased negative connectivity with the left A1 and positive connectivity with the left DLPFC. Seed-based hyperconnectivity was correlated with tinnitus improvement (pre-rTMS vs. 2-week post-rTMS Tinnitus Handicap Inventory scores). Tinnitus improvement was significantly correlated with left A1 hyperconnectivity; however, no correlation was observed with left DLPFC connectivity. Positive rTMS outcomes were associated with significantly increased positive connectivity in bilateral superior temporal areas and significantly increased negative connectivity in bilateral frontal areas. CONCLUSIONS: Our results suggest that oversynchronisation of left A1 connectivity before rTMS of the left A1 and DLPFC is associated with treatment effectiveness.

Auditory cortex hyperconnectivity before rTMS is correlated with tinnitus improvement / Correlación entre hiperconectividad de la corteza auditiva antes del tratamiento con estimulación magnética transcraneal repetitiva y mejoría de los acúfenos

Introduction: Repetitive transcranial magnetic stimulation (rTMS) has been used as a potential treatment for tinnitus; however, its effectiveness is variable and unpredictable. We hypothesized that resting-state functional connectivity before rTMS may be correlated with rTMS treatment effectiveness. Methods: We applied 1-Hz rTMS to the left primary auditory (A1) and dorsolateral prefrontal cortices (DLPFC) of 10 individuals with tinnitus and 10 age-matched controls. Resting-state functional magnetic resonance imaging (fMRI) studies were performed approximately one week before rTMS. Seed-based connectivity analyses were conducted for each individual, with seed regions as rTMS target areas. Results: Compared to controls, the left superior temporal areas showed significantly increased positive connectivity with the left A1 and negative connectivity with the left DLPFC in the tinnitus group. The left frontoparietal and right cerebellar areas showed significantly increased negative connectivity with the left A1 and positive connectivity with the left DLPFC. Seed-based hyperconnectivity was correlated with tinnitus improvement (pre-rTMS vs. 2-week post-rTMS Tinnitus Handicap Inventory scores). Tinnitus improvement was significantly correlated with left A1 hyperconnectivity; however, no correlation was observed with left DLPFC connectivity. Positive rTMS outcomes were associated with significantly increased positive connectivity in bilateral superior temporal areas and significantly increased negative connectivity in bilateral frontal areas. Conclusions: Our results suggest that oversynchronisation of left A1 connectivity before rTMS of the left A1 and DLPFC is associated with treatment effectiveness.(AU)

Introducción: La estimulación magnética transcraneal repetitiva (EMTr) se ha utilizado como posible tratamiento para los acúfenos, aunque su efectividad es variable e impredecible. Planteamos la hipótesis de que existe una correlación entre la conectividad funcional en estado de reposo antes de aplicar EMTr y la efectividad de dicho tratamiento. Métodos: Aplicamos EMTr a 1 Hz sobre la corteza auditiva primaria (A1) y la corteza prefrontal dorsolateral (CPFDL) izquierdas de 10 pacientes con acúfenos y 10 controles del mismo rango de edad. Se realizaron estudios de resonancia magnética funcional (RMF) en estado de reposo de todos los pacientes aproximadamente una semana antes de la EMTr. En cada caso, se construyó un mapa de conectividad basado en las ROIs, en el que las ROIs eran las áreas que se tratarían con la EMTr. Resultados: La región temporal superior izquierda mostró una conectividad positiva significativamente mayor con el área A1 izquierda y mayor conectividad negativa con la CPFDL izquierda en los pacientes con acúfenos que en los controles. Además, las áreas frontoparietal izquierda y cerebelar derecha mostraron una conectividad negativa significativamente superior con el área A1 izquierda y mayor conectividad positiva con la CPFDL izquierda. La hiperconectividad de las ROIs se correlacionó con mejoría de los acúfenos según las puntuaciones pre-EMTr y 2 semanas post-EMTr en la escala Tinnitus Handicap Inventory. La mejoría de los acúfenos se correlacionó de manera significativa con la hiperconectividad del área A1 izquierda; sin embargo, no se encontró correlación con la conectividad de la CPFDL izquierda. El resultado favorable del tratamiento con EMTr se asocia con una mayor conectividad positiva en áreas temporales superiores de ambos hemisferios y con mayor conectividad negativa en áreas frontales bilaterales...(AU)

Efectos de la estimulación transcraneal por corriente directa y de la estimulación magnética transcraneal en pacientes con fibromialgia. Revisión sistemática / Effects of transcranial direct current stimulation and transcranial magnetic stimulation in patients with fibromyalgia. A systematic review

ntroducción: La fibromialgia (FM) es una patología crónica caracterizada por la presenciade dolor musculoesquelético generalizado que se asocia a trastornos psicológicos que afectana la calidad de vida. En los últimos a˜nos, la estimulación transcraneal con corriente directa(tDCS) y la estimulación magnética transcraneal (TMS) se han estudiado para el abordaje deldolor crónico. El objetivo de esta revisión es determinar los efectos de la tDCS y la TMS en lossíntomas característicos de los pacientes con FM.Desarrollo: Se realizó una revisión sistemática acorde a los criterios PRISMA. Se realizaronbúsquedas en las bases de datos Medline, Scopus, PEDro y Cochrane Library. Se seleccionaronensayos clínicos aleatorizados que analizaran los efectos de estas intervenciones en el dolor, elumbral de dolor a la presión, la fatiga, la ansiedad y depresión, el catastrofismo y la calidad devida en pacientes con FM. Se incluyeron 14 estudios.Conclusiones: La aplicación de tDCS en el córtex motor es la única intervención que ha mos-trado disminuir el dolor a corto y medio plazo en pacientes con FM. La aplicación de ambasintervenciones ha mostrado mejoras en el umbral de dolor a la presión, el catastrofismo y lacalidad de vida cuando se aplica en el córtex motor, y de la fatiga cuando se aplica en la cortezadorsolateral prefrontal. Los efectos de estas intervenciones en la ansiedad y depresión no sonconcluyentes.(AU)

Introduction: Fibromyalgia syndrome (FM) is a chronic pathology characterized by widespreadpain commonly associated with psychological distress affecting quality of life. In recent years,transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS) havebeen investigated to treat chronic pain. The aim of the current review is to determine theeffects of tDCS and TMS on the main symptoms of patients with FM.Development: A systematic review based on PRISMA guidelines was carried out. The searchstrategy was performed in Medline, Scopus, PEDro and Cochrane Library. Randomized controlledtrials based on the effects of tDCS and TMS on pain, pressure pain threshold, fatigue, anxietyand depression, catastrophizing and quality of life in patients with FM were analysed. Fourteenstudies were included.Conclusions: The application of tDCS to the motor cortex is the only intervention shown todecrease pain in the short and medium-term in patients with FM. The application of bothinterventions showed improvements in pressure pain threshold, catastrophizing and quality oflife when applied to the motor cortex, and in fatigue when applied to the dorsolateral prefrontalcortex. The effects of these interventions on anxiety and depression are unclear.(AU)

Historia y principios básicos de la estimulación magnética transcraneal

La estimulación magnética transcraneal (EMT) es una técnica no invasiva que consiste en la utilización de campos magnéticos para estimular a las neuronas de la corteza cerebral. Si bien la electricidad se ha pretendido emplear previamente en el campo de la medicina, la historia de la EMT se remonta al descubrimiento de la inducción electromagnética, por Faraday, en el siglo XIX. Sin embargo, no fue hasta la década de 1980 cuando Anthony Barker, en la Universidad de Sheffield, desarrolló el primer dispositivo de EMT. La EMT funciona mediante una bobina colocada en el cuero cabelludo, la cual produce un campo magnético que puede atravesar el cráneo y estimular las neuronas corticales. La intensidad y la frecuencia del campo magnético pueden ajustarse para dirigirse a zonas específicas del cerebro y producir efectos excitatorios e inhibitorios. Los principios de la EMT se basan en el concepto de neuroplasticidad, que se refiere a la capacidad del cerebro para cambiar y adaptarse en respuesta a nuevas experiencias y estímulos. Al estimular las neuronas del cerebro con la EMT, es posible inducir cambios en la actividad neuronal y la conectividad, lo que a su vez puede provocar cambios cognitivos y en el estado de ánimo.

Transcranial magnetic stimulation (TMS) is a noninvasive technique that uses magnetic fields to stimulate neurons in the cerebral cortex. While electricity has previously been intended to be used in the medical field, the history of TMS dates back to the discovery of electromagnetic induction by Faraday in the 19th century. However, it was not until the 1980s when Anthony Barker developed the first TMS device at the University of Sheffield. TMS works by means of a coil placed against the scalp, thereby producing a magnetic field. This magnetic field can pass through the skull and stimulate cortical neurons. The intensity and frequency of the magnetic field can be adjusted to target specific areas of the brain and produce excitatory and inhibitory effects. The principles of TMS are based on the concept of neuroplasticity, which refers to the brain's ability to change and adapt in response to new experiences and stimuli. By stimulating neurons in the brain with TMS, it is possible to cause changes in neuronal activity and connectivity, which in turn can lead to cognitive and mood changes.

Effects of transcranial direct current stimulation and transcranial magnetic stimulation in patients with fibromyalgia. A systematic review.

BACKGROUND: Fibromyalgia syndrome (FM) is a chronic pathology characterised by widespread pain commonly associated with psychological distress affecting quality of life. In recent years, transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS) have been investigated to treat chronic pain. The aim of the current review is to determine the effects of tDCS and TMS on the main symptoms of patients with FM. DEVELOPMENT: A systematic review based on PRISMA guidelines was carried out. The search strategy was performed in MEDLINE, SCOPUS, PEDro and Cochrane Library. Randomised controlled trials based on the effects of tDCS and TMS on pain, pressure pain threshold (PPT), fatigue, anxiety and depression, catastrophising and quality of life in patients with FM were analysed. Fourteen studies were included. CONCLUSIONS: The application of tDCS to the motor cortex is the only intervention shown to decrease pain in the short and medium-term in patients with FM. The application of both interventions showed improvements in PPT, catastrophising and quality of life when applied to the motor cortex, and in fatigue when applied to the dorsolateral prefrontal cortex. The effects of these interventions on anxiety and depression are unclear.

Effects of neuromodulation on executive functions and food desires in individuals with obesity: a systematic review / Efectos de la neuromodulación sobre las funciones ejecutivas y los deseos alimentarios en pacientes con obesidad: revisión sistemática

Objective: to describe the effects of neuromodulation on the performance of executive functions in overweight and/or individuals with obesity. Methods: articles published in PubMed, ScienceDirect, BIREME, and Web of Science databases were selected using the following combination of descriptors: (“problem solving” OR “executive function” OR memory) AND (tDCS OR TMS) AND obesity. After applying the selection criteria, 08 articles were included for analysis. Results: the articles included had an average of 30.1 participants per study, with a minimum of 12 and a maximum of 76. The overall nutritional status ranged from underweight to grade 3 obesity, and the general mean body mass index was 28,1 kg/m2. Regarding the instruments used to assess executive functions, the most frequent were: the flanker paradigm; binocular rivalry for Continuous Flash Suppression (bCFS/NoCFS); Stroop task; Go/No-Go task; and N-back task. The primary outcomes were dependent on the neuromodulation target site. Reduced food craving and improved performance in the active group were observed from decreased response time and increased precision in cognitive tasks. Conclusion: neuromodulation can generate changes in executive functions, reducing food cravings in overweight and individuals with obesity. (AU)

Objetivo: describir los efectos de la neuromodulación en el desempeño de funciones ejecutivas en pacientes con sobrepeso y/o obesidad. Métodos: se seleccionaron artículos publicados en las bases de datos PubMed, ScienceDirect, BIREME y Web of Science utilizando la siguiente combinación de descriptores: (“resolución de problemas” O “función ejecutiva” O memoria) Y (tDCS O TMS) Y obesidad. Después de aplicar los criterios de selección, 08 artículos fueron incluidos para el análisis. Resultados: los artículos incluidos tuvieron un promedio de 30,1 participantes por estudio, con un mínimo de 12 y un máximo de 76. El estado nutricional general osciló entre bajo peso y obesidad grado 3, y el índice de masa corporal promedio general fue de 28,1 kg/m2. En cuanto a los instrumentos utilizados para evaluar las funciones ejecutivas, los más frecuentes fueron: paradigma del flanqueador; rivalidad binocular para la supresión continua de flash (bCFS/NoCFS); tarea de Stroop; Tarea Go/No-Go; y tarea N-back. Los resultados primarios dependieron del sitio objetivo de la neuromodulación. Se observó una reducción del antojo de alimentos y un mejor rendimiento en el grupo activo debido a la disminución del tiempo de respuesta y al aumento de la precisión en las tareas cognitivas.Conclusión: la neuromodulación puede generar cambios en las funciones ejecutivas, reduciendo el antojo de alimentos en personas con sobrepeso y obesidad. (AU)

Effects of neuromodulation on executive functions and food desires in individuals with obesity: a systematic review.

Introduction: Objective: to describe the effects of neuromodulation on the performance of executive functions in overweight and/or individuals with obesity. Methods: articles published in PubMed, ScienceDirect, BIREME, and Web of Science databases were selected using the following combination of descriptors: ("problem solving" OR "executive function" OR memory) AND (tDCS OR TMS) AND obesity. After applying the selection criteria, 08 articles were included for analysis. Results: the articles included had an average of 30.1 participants per study, with a minimum of 12 and a maximum of 76. The overall nutritional status ranged from underweight to grade 3 obesity, and the general mean body mass index was 28,1 kg/m2. Regarding the instruments used to assess executive functions, the most frequent were: the flanker paradigm; binocular rivalry for Continuous Flash Suppression (bCFS/NoCFS); Stroop task; Go/No-Go task; and N-back task. The primary outcomes were dependent on the neuromodulation target site. Reduced food craving and improved performance in the active group were observed from decreased response time and increased precision in cognitive tasks. Conclusion: neuromodulation can generate changes in executive functions, reducing food cravings in overweight and individuals with obesity.

Introducción: Objetivo: describir los efectos de la neuromodulación en el desempeño de funciones ejecutivas en pacientes con sobrepeso y/o obesidad. Métodos: se seleccionaron artículos publicados en las bases de datos PubMed, ScienceDirect, BIREME y Web of Science utilizando la siguiente combinación de descriptores: ("resolución de problemas" O "función ejecutiva" O memoria) Y (tDCS O TMS) Y obesidad. Después de aplicar los criterios de selección, 08 artículos fueron incluidos para el análisis. Resultados: los artículos incluidos tuvieron un promedio de 30,1 participantes por estudio, con un mínimo de 12 y un máximo de 76. El estado nutricional general osciló entre bajo peso y obesidad grado 3, y el índice de masa corporal promedio general fue de 28,1 kg/m2. En cuanto a los instrumentos utilizados para evaluar las funciones ejecutivas, los más frecuentes fueron: paradigma del flanqueador; rivalidad binocular para la supresión continua de flash (bCFS/NoCFS); tarea de Stroop; Tarea Go/No-Go; y tarea N-back. Los resultados primarios dependieron del sitio objetivo de la neuromodulación. Se observó una reducción del antojo de alimentos y un mejor rendimiento en el grupo activo debido a la disminución del tiempo de respuesta y al aumento de la precisión en las tareas cognitivas. Conclusión: la neuromodulación puede generar cambios en las funciones ejecutivas, reduciendo el antojo de alimentos en personas con sobrepeso y obesidad.

The ontogenetic model for CVA rehabilitation with transcranial stimulation

Currently, transcranial stimulation for CVA treatment is based on the interhemispheric rivalry model. This model has proven to have many anomalies, necessitating a new paradigm. Spontaneous recovery from post-CVA hemiplegia has an ontogenetic pattern. We reanalyzed the 2008 longitudinal London study and found that cortical disinhibition is the mechanism for ontogenetic CVA recovery. We propose that transcranial stimulation with 10 Hz rTMS or anode electrical microstimulation can produce CVA recovery similar to spontaneous recovery. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2466).

Actualmente la aplicación de la estimulación transcraneal para el tratamiento del ACV se realiza con base en el modelo de rivalidad interhemisférica. Este modelo ha mostrado muchas anomalías que hacen necesario un nuevo paradigma. La recuperación espontánea de la hemiplejia post-ACV tiene patrón ontogénico. Reanalizamos el estudio longitudinal de Londres 2008 y encontramos que su propuesta corresponde al mecanismo de recuperación ontogénica del ACV. Planteamos que la estimulación transcraneal, utilizando EMTr a 10 Hz o microestimulación eléctrica anódica, podría recuperar el ACV de manera similar a la recuperación espontánea. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2466).

Stroke improvement with magnetic stimulation recapitulates ontogeny / Mejoría del ACV con estimulación magnética recapitula la ontogenia

Abstract A patient with chronic brainstem CVA sequelae received one cycle of magnetic stimulation to treat her dysphagia and serendipitously obtained a minimal improvement in her axial movement. Two additional cycles gave her improved postural control and then distal movement, preceded by a display of ipsilateral and contralateral motor evoked potentials, respectively. Magnetic stimulation at 10 Hertz produces cortical disinhibition and reopens the critical neurodevelop ment periods. The ontogenic pattern of hemiplegia recovery in this patient may be explained by an increased and rejuvenated brain plasticity due to critical period reopening through cortical disinhibition. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2253).

Resumen Una paciente con secuelas crónicas de un ACV del tallo cerebral recibió un ciclo de estimulación magnética para el manejo de la disfagia y, por serendipia obtuvo mejoría leve del movimiento axial. Dos ciclos adicionales le permitieron mejoría del control postural y luego la aparición de movimiento distal, precedidos por la visualización de los potenciales evocados motores ipsilateral y contralateral, respectivamente. La estimulación magnética a 10 Hertz produce desinhibición cortical y reabre los periodos críticos del neurodesarrollo. Es posible, que el patrón ontogénico de recuperación de la hemiplejía en esta paciente se explique por el incremento y rejuvenecimiento de la plasticidad cerebral debido a la reapertura de los periodos críticos, por medio de la desinhibición cortical. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2253).

Current evidence on the potential therapeutic applications of transcranial magnetic stimulation in multiple sclerosis: a systematic review of the literature.

INTRODUCTION: A growing number of studies have evaluated the effects of transcranial magnetic stimulation (TMS) for the symptomatic treatment of multiple sclerosis (MS). METHODS: We performed a PubMed search for articles, recent books, and recommendations from the most relevant clinical practice guidelines and scientific societies regarding the use of TMS as symptomatic treatment in MS. CONCLUSIONS: Excitatory electromagnetic pulses applied to the affected cerebral hemisphere allow us to optimise functional brain activity, including the transmission of nerve impulses through the demyelinated corticospinal pathway. Various studies into TMS have safely shown statistically significant improvements in spasticity, fatigue, lower urinary tract dysfunction, manual dexterity, gait, and cognitive deficits related to working memory in patients with MS; however, the exact level of evidence has not been defined as the results have not been replicated in a sufficient number of controlled studies. Further well-designed, randomised, controlled clinical trials involving a greater number of patients are warranted to attain a higher level of evidence in order to recommend the appropriate use of TMS in MS patients across the board. TMS acts as an adjuvant with other symptomatic and immunomodulatory treatments. Additional studies should specifically investigate the effect of conventional repetitive TMS on fatigue in these patients, something that has yet to see the light of day.

Nota clínica: Efecto antidepresivo de la EMTrdurante el embarazo en un caso de Depresión Mayor Resistente al Tratamiento Farmacológico / Clinical note: Antidepressant effect of rTMS during pregnancy in a case of drug-resistant major depression. during pregnancy in a case of Medication-Resistant Major Depression

El trastorno depresivo mayor (TDM) constituye una complicación común del embarazo y el período posparto. Aproximadamente un 5% de mujeres que presentan un TDM durante la gestación o el periodo postparto cumplen criterios paradepresión resistente, asociándose con un incremento de lamorbilidad tanto en el recién nacido como en la propia gestante. En la actualidad disponemos de diferentes opcionesterapéuticas para el tratamiento del TDM durante el embarazo si bien en los casos de resistencia durante el embarazolos criterios de tratamiento no se encuentran tan bien establecidos.Presentamos el caso de una mujer de 36 años de edadque desarrolló un episodio de depresión mayor resistente altratamiento farmacológico. Durante el episodio actual y trascuatro ciclos de tratamiento farmacológico fallido se quedóembarazada. A las 16 semanas de gestación fue tratada conestimulación magnética transcraneal repetitiva (EMTr) debaja frecuencia. Tras 30 sesiones de tratamiento, con buenatolerancia, la paciente presentó una recuperación completade la sintomatología depresiva, dando a luz a un recién nacido sano. La EMTr constituye una buena alternativa frente a laTerapia Electroconvulsiva en algunos casos de TDM resistentedurante la gestación. A pesar de estos hallazgos prometedores, se requiere de un mayor número de estudios controlados,doble ciego que incluyan muestras amplias de pacientes embarazadas, con parámetros EMTr bien diseñados, e inclusoestudios prospectivos (siguiendo a mujeres embarazadas ysus descendientes) para confirmar la ausencia de efectos secundarios a largo plazo. (AU)

Major depressive disorder (MDD) is a common complication of pregnancy and the postpartum period. Approximately 5% of women who have MDD during pregnancy orthe postpartum period meet criteria for resistant depression,associated with increased morbidity in both the newbornand the pregnant woman. Currently we have different therapeutic options for the treatment of MDD during pregnancy,although in cases of resistance during that period the treatment criteria are not that well established.We set out the case of a 36-year-old woman who presents an episode of major depression resistant to pharmacotherapy. During the current episode and after four cycles offailed pharmacological treatment she became pregnant. Inthe 16th week of gestation, she was treated with low-frequency repetitive transcranial magnetic stimulation (rTMS).After 30 treatment sessions, with good tolerance, the patient presented a complete recovery from the depressivesymptoms, giving birth to a healthy newborn. rTMS is a goodalternative to Electroconvulsive Therapy in some cases ofresistant MDD during pregnancy. Despite these promisingfindings, further double-blind controlled studies with broadsamples of pregnant women are required, with well-designed rTMS parameters, and even prospective studies (following pregnant women and their offspring) to confirm theabsence of long-term side effects. (AU)

¿Desempeña un papel decisivo la excitabilidad corticoespinal ipsilateral en el efecto cruzado provocado por el entrenamiento de fuerza unilateral? Una revisión sistemática / Does ipsilateral corticospinal excitability play a decisive role in the cross-education effect caused by unilateral resistance training? A systematic review

Introducción: El entrenamiento de fuerza unilateral ha demostrado provocar aumentos de fuerza tanto en la extremidad entrenada como en la no entrenada. Una de las teorías actuales más aceptadas defiende que el origen de dicho aumento de rendimiento se encuentra en adaptaciones en el sistema nervioso, concretamente en la corteza motora primaria, siendo los aumentos en la excitabilidad corticoespinal (EC) medida con estimulación magnética transcraneal una de las principales adaptaciones observadas tras periodos crónicos de entrenamiento. Por ello, el principal objetivo es hacer un análisis de la literatura actual para determinar el grado de adaptación que se da en la EC y su posible relación funcional con el aumento de fuerza de la extremidad no entrenada.DesarrolloSe llevó a cabo una búsqueda sistemática en la literatura existente entre enero de 1970 hasta diciembre de 2016 en las bases de datos online Medline (vía PubMed), Ovid, Web of Science y Science Direct con la siguiente estrategia de búsqueda: (Transcranial magnetic stimulation OR excitability) Y (strength training OR resistance training or force) Y (cross transfer OR contralateral limb OR cross education). Finalmente se incluyeron un total de 10 artículos.ConclusionesExiste cierta inconsistencia en los resultados referentes al aumento de la EC. Aunque no se puede descartar que dicha inconsistencia se deba a aspectos metodológicos, los resultados parecen indicar que el aumento de fuerza y el incremento en la EC podrían no estar funcionalmente relacionados. (AU)

Introduction: Unilateral resistance training has been shown to improve muscle strength in both the trained and the untrained limb. One of the most widely accepted theories is that this improved performance is due to nervous system adaptations, specifically in the primary motor cortex. According to this hypothesis, increased corticospinal excitability (CSE), measured with transcranial magnetic stimulation, is one of the main adaptations observed following prolonged periods of training. The principal aim of this review is to determine the degree of adaptation of CSE and its possible functional association with increased strength in the untrained limb.DevelopmentWe performed a systematic literature review of studies published between January 1970 and December 2016, extracted from Medline (via PubMed), Ovid, Web of Science, and Science Direct online databases. The search terms were as follows: (transcranial magnetic stimulation OR excitability) AND (strength training OR resistance training OR force) AND (cross transfer OR contralateral limb OR cross education). A total of 10 articles were found.ConclusionResults regarding increased CSE were inconsistent. Although the possibility that the methodology had a role in this inconsistency cannot be ruled out, the results appear to suggest that there may not be a functional association between increases in muscle strength and in CSE. (AU)

Auditory cortex hyperconnectivity before rTMS is correlated with tinnitus improvement.

INTRODUCTION: Repetitive transcranial magnetic stimulation (rTMS) has been used as a potential treatment for tinnitus; however, its effectiveness is variable and unpredictable. We hypothesized that resting-state functional connectivity before rTMS may be correlated with rTMS treatment effectiveness. METHODS: We applied 1-Hz rTMS to the left primary auditory (A1) and dorsolateral prefrontal cortices (DLPFC) of 10 individuals with tinnitus and 10 age-matched controls. Resting-state functional magnetic resonance imaging (fMRI) studies were performed approximately one week before rTMS. Seed-based connectivity analyses were conducted for each individual, with seed regions as rTMS target areas. RESULTS: Compared to controls, the left superior temporal areas showed significantly increased positive connectivity with the left A1 and negative connectivity with the left DLPFC in the tinnitus group. The left frontoparietal and right cerebellar areas showed significantly increased negative connectivity with the left A1 and positive connectivity with the left DLPFC. Seed-based hyperconnectivity was correlated with tinnitus improvement (pre-rTMS vs. 2-week post-rTMS Tinnitus Handicap Inventory scores). Tinnitus improvement was significantly correlated with left A1 hyperconnectivity; however, no correlation was observed with left DLPFC connectivity. Positive rTMS outcomes were associated with significantly increased positive connectivity in bilateral superior temporal areas and significantly increased negative connectivity in bilateral frontal areas. CONCLUSIONS: Our results suggest that oversynchronisation of left A1 connectivity before rTMS of the left A1 and DLPFC is associated with treatment effectiveness.

Does ipsilateral corticospinal excitability play a decisive role in the cross-education effect caused by unilateral resistance training? A systematic review. / ¿Desempeña un papel decisivo la excitabilidad corticoespinal ipsilateral en el efecto cruzado provocado por el entrenamiento de fuerza unilateral? Una revisión sistemática.

INTRODUCTION: Unilateral resistance training has been shown to improve muscle strength in both the trained and the untrained limb. One of the most widely accepted theories is that this improved performance is due to nervous system adaptations, specifically in the primary motor cortex. According to this hypothesis, increased corticospinal excitability (CSE), measured with transcranial magnetic stimulation, is one of the main adaptations observed following prolonged periods of training. The principal aim of this review is to determine the degree of adaptation of CSE and its possible functional association with increased strength in the untrained limb. DEVELOPMENT: We performed a systematic literature review of studies published between January 1970 and December 2016, extracted from Medline (via PubMed), Ovid, Web of Science, and Science Direct online databases. The search terms were as follows: (transcranial magnetic stimulation OR excitability) AND (strength training OR resistance training OR force) AND (cross transfer OR contralateral limb OR cross education). A total of 10 articles were found. CONCLUSION: Results regarding increased CSE were inconsistent. Although the possibility that the methodology had a role in this inconsistency cannot be ruled out, the results appear to suggest that there may not be a functional association between increases in muscle strength and in CSE.

Propuesta de asignatura Generalidades de la Estimulación Magnética Transcraneal para técnicos superiores de Neurofisiología Clínica / Course proposal Generalities of Transcranial Magnetic Stimulation for senior technicians of Clinical Neurophysiology

Introducción: Recientemente se inició la formación de profesionales en una nueva modalidad de Programas Técnico Superior de Ciclo Corto, en la especialidad de Neurofisiología Clínica. Esto responde a la necesidad de la formación de profesionales de la salud en el estudio de las enfermedades neurológicas. La estimulación magnética transcraneal constituye una herramienta importante en el diagnóstico y tratamiento de estas enfermedades. Sin embargo, se carece de un programa para la formación de los estudiantes en el estudio y aplicación de esta técnica. Objetivo: Diseñar un programa de curso propio sobre generalidades de la estimulación magnética transcraneal, para estudiantes de primer año de Neurofisiología Clínica. Métodos: Se realizó una investigación didáctica metodológica utilizando los métodos empíricos y teóricos observación, histórico lógico, estudio documental y bibliográfico, dialéctico, análisis y síntesis, inducción y deducción. Resultados: Se propuso un programa para curso propio que se estructuró en siete temas, con carácter presencial y duración de 32 horas. Se presentaron los contenidos por temas, objetivos, conocimientos esenciales a adquirir, habilidades principales a dominar y sistema de evaluación. Conclusiones: La aplicación de este programa contribuye al desarrollo de habilidades y el desempeño exitoso de los profesionales en formación, en el campo del conocimiento de la técnica de estimulación magnética transcraneal para el diagnóstico y tratamiento de las enfermedades neurológicas(AU)

Introduction: Recently began the training of professionals in a new modality of short-cycle Higher Technical Programs, in the specialty of Clinical Neurophysiology. This responds to the need of training health professionals in the study of neurological diseases, whose incidence rates have increased in recent years. Transcranial magnetic stimulation is an important tool in the diagnosis and treatment of these diseases. However, there is a lack of a program for the training of students in the study and application of this technique. Objective: Tto design an own course program on the generalities of transcranial magnetic stimulation, for first-year students of Clinical Neurophysiology. Method: A methodological didactic research was carried out using the empirical and theoretical methods, observation, logical historical, documentary and bibliographic study, dialectic, analysis and synthesis, induction and deduction. Results: A program for the course was proposed, structured in seven topics, with a face-to-face character and a duration of 32 hours. The contents were presented by topics, objectives, essential knowledge to acquire, main skills to master and an evaluation system. Conclusions: The application of this program contributes to the development of skills and the successful performance of professionals in training, in the field of knowledge of the transcranial magnetic stimulation technique for the diagnosis and treatment of neurological diseases(AU)

Introdução: Iniciou recentemente a formação de profissionais numa nova modalidade de Cursos Técnicos Superiores de Ciclo Curto, na especialidade de Neurofisiologia Clínica. Isso responde à necessidade de formação de profissionais de saúde no estudo das doenças neurológicas. A estimulação magnética transcraniana é uma ferramenta importante no diagnóstico e tratamento dessas doenças. No entanto, falta um programa de treinamento dos alunos no estudo e aplicação desta técnica. Objetivo: Desenhar um programa próprio sobre as generalidades da estimulação magnética transcraniana, para alunos do primeiro ano de Neurofisiologia Clínica. Método: Realizou-se uma investigação metodológica didática utilizando os métodos empírico e teórico de observação, histórico lógico, estudo documental e bibliográfico, dialética, análise e síntese, indução e dedução. Resultados: Foi proposto um programa de curso próprio, estruturado em sete temas, com caráter presencial e duração de 32 horas. Os conteúdos foram apresentados por tópicos, objetivos, conhecimentos essenciais a adquirir, competências principais a dominar e um sistema de avaliação. Conclusões: A aplicação deste programa contribui para o desenvolvimento de competências e o desempenho bem sucedido de profissionais em formação, no domínio do conhecimento da técnica de estimulação magnética transcraniana para o diagnóstico e tratamento de doenças neurológicas(AU)

Effects of transcranial direct current stimulation and transcranial magnetic stimulation in patients with fibromyalgia. A systematic review. / Efectos de la estimulación transcraneal por corriente directa y de la estimulación magnética transcraneal en pacientes con fibromialgia. Revisión sistemática.

INTRODUCTION: Fibromyalgia syndrome (FM) is a chronic pathology characterized by widespread pain commonly associated with psychological distress affecting quality of life. In recent years, transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS) have been investigated to treat chronic pain. The aim of the current review is to determine the effects of tDCS and TMS on the main symptoms of patients with FM. DEVELOPMENT: A systematic review based on PRISMA guidelines was carried out. The search strategy was performed in Medline, Scopus, PEDro and Cochrane Library. Randomized controlled trials based on the effects of tDCS and TMS on pain, pressure pain threshold, fatigue, anxiety and depression, catastrophizing and quality of life in patients with FM were analysed. Fourteen studies were included. CONCLUSIONS: The application of tDCS to the motor cortex is the only intervention shown to decrease pain in the short and medium-term in patients with FM. The application of both interventions showed improvements in pressure pain threshold, catastrophizing and quality of life when applied to the motor cortex, and in fatigue when applied to the dorsolateral prefrontal cortex. The effects of these interventions on anxiety and depression are unclear.

Terapia Electroconvulsiva y Estimulación Magnética Transcraneal Repetitiva en pacientes con esquizofrenia: una revisión sistemática / Electroconvulsive Therapy and Repetitive Transcranial Magnetic Stimulation in patients with schizophrenia: a systematic review

Cuando la esquizofrenia no responde satisfactoriamente a tratamiento farmacológico, alcanzar una terapia efectiva para el paciente es una tarea bastante frustrante para el médico psiquiatra. Es en este contexto que la terapia electroconvulsiva y la estimulación magnética transcraneal repetitiva han tomado fuerza en la investigación clínica, a pesar de los grandes cuestionamientos sobre su efectividad y mala reputación. Se realizó una revisión sistemática de la literatura en las principales bases de datos disponibles. Concluyendo que ambas terapias demuestran ser herramientas útiles en el tratamiento de la esquizofrenia resistente a tratamiento farmacológico, así como también complementarias a los antipsicóticos

When schizophrenia does not respond satisfactorily to pharmacological treatment, achieving effective therapy for the patient is quite a frustrating task for the psychiatrist. It is in this context that electroconvulsive therapy and repetitive transcranial magnetic stimulation have gained strength in clinical research, despite huge questions about its success and bad reputation. A systematic review of the literature was conducted in the main available databases. Concluding that both specific therapies will be useful tools in the treatment of schizophrenia resistant to pharmacological treatment, as well as complementary to antipsychotics.

Estimulación Magnética Trascraneal "Theta-Burst Intermitente" en un paciente con Trastorno del Espectro Autista: Reporte de un caso / Intermittent Theta-Burst Transcranial Magnetic Stimulation in a Patient with Autism Spectrum Disorder: A Case Report

Resumen Introducción: La estimulación magnética transcraneal (EMT) es una opción potencial de tratamiento para la sintomatología de trastorno del espectro autista. Objetivos: Determinar la eficacia de la EMT en modalidad theta-burst intermitente (ETBi) sobre la corteza pre frontal dorso lateral izquierda (CDLPF) en el manejo de comportamientos patológicos asociados con TEA. Pacientes y Métodos: Paciente masculino de 10 años de edad diagnosticado con TEA con (ADOS) Autistic Diagnostic Observation Schedule, presenta una historia familiar de una hermana menor con TEA. Tanto el estudio de Resonancia Magnética encéfalo (IRM) y IRM funcional (IRMf) con paradigma emocionales se efectuaron antes del tratamiento de ETBi, inmediatamente después de tratamiento ETBi, y después de 6 meses de tratamiento con ETBi. Resultados: La prueba de ATEC reporto mejoría en las escalas de comunicación, cognición, social y comportamiento, 83%,81%,72% y 52% respectivamente. La puntuación total mejoro un 66% inmediatamente después de tratamiento y 55% en un periodo de 6 meses. La IRMf revelo la activación de la corteza frontal, parietal y occipital antes del tratamiento con ETBi y persistiendo la mejoría por 6 meses. Conclusión: ETBi una técnica de neuromodulación no invasiva bien tolerado que requiere un tiempo de administración menor que el tratamiento estándar.

Abstract Background: Transcranial magnetic stimulation (TMS) is a potential treatment option for autism spectrum disorder (ASD) symptomatology. Objectives: To determine the efficacy of the TMS intermittent theta-burst stimulation (iTBS) protocol over the left dorsolateral prefrontal cortex (DLPFC) in the management of pathological behaviors associated with ASD. Patient/Methods: A 10-year-old male diagnosed with ASD by the Autism Diagnostic Observation Schedule (ADOS) presented with a family history of ASD with a younger sister diagnosed with the same disorder. Both magnetic resonance imaging (MRI) and functional MRI (fMRI) scans for emotional paradigms were performed before the iTBS treatment, immediately after the iTBS treatment, and after 6 months of iTBS treatment. Results: The ATEC reports revealed improvement in communication, cognition, sociability, and behavior scales by 83%, 81%, 72%, and 52%, respectively. The overall score improved by 66% immediately after the treatment and by 55% lasting over a 6-month period. The fMRI revealed the activation of the frontal, parietal, and occipital cortex before iTBS treatment, and a better integration and activation of the frontal, temporal, and occipital cortex after iTBS treatment and persisted after 6 months. Conclusions: iTBS is a well-tolerated, non-invasive neuromodulation technique that requires relatively less administration than the standard treatment.

Current evidence on the potential therapeutic applications of transcranial magnetic stimulation in multiple sclerosis: A systematic review of the literature. / Evidencias actuales sobre las potenciales aplicaciones terapéuticas de la estimulación magnética transcraneal en la esclerosis múltiple: revisión sistemática de la literatura.

INTRODUCTION: A growing number of studies have evaluated the effects of transcranial magnetic stimulation (TMS) for the symptomatic treatment of multiple sclerosis (MS). METHODS: We performed a PubMed search for articles, recent books, and recommendations from the most relevant clinical practice guidelines and scientific societies regarding the use of TMS as symptomatic treatment in MS. CONCLUSIONS: Excitatory electromagnetic pulses applied to the affected cerebral hemisphere allow us to optimise functional brain activity, including the transmission of nerve impulses through the demyelinated corticospinal pathway. Various studies into TMS have shown statistically significant improvements in spasticity, fatigue, lower urinary tract dysfunction, manual dexterity, gait, and cognitive deficits related to working memory in patients with MS; however, the exact level of evidence has not been defined as the results have not been replicated in a sufficient number of controlled studies. Further well-designed, randomised, controlled clinical trials involving a greater number of patients are warranted to attain a higher level of evidence in order to recommend the appropriate use of TMS in MS patients across the board. TMS acts as an adjuvant with other symptomatic and immunomodulatory treatments. Additional studies should specifically investigate the effect of conventional repetitive TMS on fatigue in these patients, something that has yet to see the light of day.

Current evidence on transcranial magnetic stimulation and its potential usefulness in post-stroke neurorehabilitation: Opening new doors to the treatment of cerebrovascular disease. / Evidencias actuales sobre la estimulación magnética transcraneal y su utilidad potencial en la neurorrehabilitación postictus: Ampliando horizontes en el tratamiento de la enfermedad cerebrovascular.

INTRODUCTION: Repetitive transcranial magnetic stimulation (rTMS) is a therapeutic reality in post-stroke rehabilitation. It has a neuroprotective effect on the modulation of neuroplasticity, improving the brain's capacity to retrain neural circuits and promoting restoration and acquisition of new compensatory skills. DEVELOPMENT: We conducted a literature search on PubMed and also gathered the latest books, clinical practice guidelines, and recommendations published by the most prominent scientific societies concerning the therapeutic use of rTMS in the rehabilitation of stroke patients. The criteria of the International Federation of Clinical Neurophysiology (2014) were followed regarding the inclusion of all evidence and recommendations. CONCLUSIONS: Identifying stroke patients who are eligible for rTMS is essential to accelerate their recovery. rTMS has proven to be safe and effective for treating stroke complications. Functional brain activity can be optimised by applying excitatory or inhibitory electromagnetic pulses to the hemisphere ipsilateral or contralateral to the lesion, respectively, as well as at the level of the transcallosal pathway to regulate interhemispheric communication. Different studies of rTMS in these patients have resulted in improvements in motor disorders, aphasia, dysarthria, oropharyngeal dysphagia, depression, and perceptual-cognitive deficits. However, further well-designed randomized controlled clinical trials with larger sample size are needed to recommend with a higher level of evidence, proper implementation of rTMS use in stroke subjects on a widespread basis.