Methodological approach for assessing motor cortical excitability changes with single-pulse transcranial magnetic stimulation.

Transcranial Magnetic Stimulation (TMS) serves as a crucial tool in evaluating motor cortex excitability by applying short magnetic pulses to the skull, inducing neuron depolarization in the cerebral cortex through electromagnetic induction. This technique leads to the activation of specific skeletal muscles recorded as Motor-Evoked Potentials (MEPs) through electromyography. Although various methodologies assess cortical excitability with TMS, measuring MEP amplitudes offers a straightforward approach, especially when comparing excitability states pre- and post-interventions designed to alter cortical excitability. Despite TMS's widespread use, the absence of a standardized procedure for such measurements in existing literature hinders the comparison of results across different studies. This paper proposes a standardized procedure for assessing changes in motor cortical excitability using single-pulse TMS pre- and post-intervention. The recommended approach utilizes an intensity equating to half of the MEP's maximum amplitude, thereby ensuring equal likelihood of amplitude increase or decrease, providing a consistent basis for future studies and facilitating meaningful comparisons of results.•A method for assessing changes in motor cortical excitability using single-pulse TMS before and after a specified intervention.•We recommend using an intensity equal to half of the MEP's maximum amplitude during evaluations to objectively assess motor cortical excitability changes post-intervention.

Nitrergic neurons of the forepaw representation in the rat somatosensory and motor cortices: A quantitative study.

Nitrergic neurons (NNs) are inhibitory neurons capable of releasing nitric oxide (NO) that are labeled with nicotinamide adenine dinucleotide phosphate diaphorase histochemistry. The rat primary somatosensory (S1) and motor (M1) cortices are a favorable model to investigate NN populations by comparing their morphology, since these areas share the border of forepaw representation. The distribution of the Type I NN of the forepaw representation in the S1 and M1 cortices of the rat in different laminar compartments and the morphological parameters related to the cell body and dendritic arborization were measured and compared. We observed that the neuronal density in the S1 (130 NN/mm3 ) was higher than the neuronal density in the M1 (119 NN/mm3 ). Most NN neurons were multipolar (S1 with 58%; M1 with 69%), and a minority of the NN neurons were horizontal (S1 with 6%; M1 with 12%). NN found in S1 had a higher verticality index than NN found in M1, and no significant differences were observed for the other morphological parameters. We also demonstrated significant differences in most of the morphological parameters of the NN between different cortical compartments of S1 and M1. Our results indicate that the NN of the forepaw in S1 and M1 corresponds to a neuronal population, where the functionality is independent of the different types of sensory and motor processing. However, the morphological differences found between the cortical compartments of S1 and M1, as well as the higher density of NNs found in S1, indicate that the release of NO varies between the areas.

Impaired Cortical Cytoarchitecture and Reduced Excitability of Deep-Layer Neurons in the Offspring of Diabetic Rats.

Maternal diabetes has been related to low verbal task scores, impaired fine and gross motor skills, and poor performance in graphic and visuospatial tasks during childhood. The primary motor cortex is important for controlling motor functions, and embryos exposed to high glucose show changes in cell proliferation, migration, and differentiation during corticogenesis. However, the existing studies do not discriminate between embryos with or without neural tube defects, making it difficult to conclude whether the reported changes are related to neural tube defects or other anomalies. Furthermore, postnatal effects on central nervous system cytoarchitecture and function have been scarcely addressed. Through molecular, biochemical, morphological, and electrophysiological approaches, we provide evidence of impaired primary motor cerebral cortex lamination and neuronal function in pups from diabetic rats, showing an altered distribution of SATB2, FOXP2, and TBR1, impaired cell migration and polarity, and decreased excitability of deep-layer cortical neurons, suggesting abnormalities in cortico-cortical and extra-cortical innervation. Furthermore, phase-plot analysis of action potentials suggests changes in the activity of potassium channels. These results indicate that high-glucose insult during development promotes complex changes in migration, neurogenesis, cell polarity establishment, and dendritic arborization, which in turn lead to reduced excitability of deep-layer cortical neurons.

Differential Neuroplastic Changes in Fibromyalgia and Depression Indexed by Up-Regulation of Motor Cortex Inhibition and Disinhibition of the Descending Pain System: An Exploratory Study.

Background: Major depressive disorder (MDD) and fibromyalgia (FM) present overlapped symptoms. Although the connection between these two disorders has not been elucidated yet, the disruption of neuroplastic processes that mediate the equilibrium in the inhibitory systems stands out as a possible mechanism. Thus, the purpose of this cross-sectional exploratory study was: (i) to compare the motor cortex inhibition indexed by transcranial magnetic stimulation (TMS) measures [short intracortical inhibition (SICI) and intracortical facilitation (ICF)], as well as the function of descending pain modulatory systems (DPMS) among FM, MDD, and healthy subjects (HS); (ii) to compare SICI, ICF, and the role of DPMS evaluated by the change on Numerical Pain Scale (NPS) during the conditioned pain modulation test (CPM-test) between FM and MDD considering the BDNF-adjusted index; (iii) to assess the relationship between the role of DPMS and the BDNF-adjusted index, despite clinical diagnosis. Patients and Methods: A cohort of 63 women, aged 18 to 75 years [FM (n = 18), MDD (n = 19), and HC (n = 29)]. Results: The MANCOVA analysis revealed that the mean of SICI was 53.40% larger in FM compared to MDD [1.03 (0.50) vs. 0.55 (0.43)] and 66.99% larger compared to HC [1.03 (0.50) vs. 0.34 (0.19)], respectively. The inhibitory potency of the DPMS assessed by the change on the NPS during CPM-test was 112.29 % lower in the FM compared to MDD [0.22 (1.37) vs. -0.87 (1.49)]. The mean of BDNF from FM compared to MDD was 35.70% higher [49.82 (16.31) vs. 14.12 (8.86)]. In FM, the Spearman's coefficient between the change in the NPS during CPM-test with the SICI was Rho = -0.49, [confidence interval (CI) 95%; -0.78 to -0.03]. The BDNF-adjusted index was positively correlated with the disinhibition of the DPMS. Conclusion: These findings support the hypothesis that in FM a deteriorated function of cortical inhibition, indexed by a higher SICI parameter, a lower function of the DPMS, together with a higher level of BDNF indicate that FM has different pathological substrates from depression. They suggest that an up-regulation phenomenon of intracortical inhibitory networks associated with a disruption of the DPMS function occurs in FM.

The primary motor cortex is associated with learning the absolute, but not relative, timing dimension of a task: A tDCS study.

The functional role of the primary motor cortex (M1) in the production of movement parameters, such as length, direction and force, is well known; however, whether M1 is associated with the parametric adjustments in the absolute timing dimension of the task remains unknown. Previous studies have not applied tasks and analyses that could separate the absolute (variant) and relative (invariant) dimensions. We applied transcranial direct current stimulation (tDCS) to M1 before motor practice to facilitate motor learning. A sequential key-pressing task was practiced with two goals: learning the relative timing dimension and learning the absolute timing dimension. All effects of the stimulation of M1 were observed only in the absolute dimension of the task. Mainly, the stimulation was associated with better performance in the transfer test in the absolute dimension. Taken together, our results indicate that M1 is an important area for learning the absolute timing dimension of a motor sequence.

Is the omega sign a reliable landmark for the neurosurgical team? An anatomical study about the central sulcus region / O sinal do ômega é um reparo anatômico confiável para a equipe neurocirúrgica? Estudo anatômico sobre a regiāo do sulco central

ABSTRACTThe central sulcus region is an eloquent area situated between the frontal and parietal lobes. During neurosurgical procedures, it is sometimes difficult to understand the cortical anatomy of this region.Objective Find alternative ways to anatomically navigate in this region during neurosurgical procedures.Method We analyzed eighty two human hemispheres using a surgical microscope and completed a review of the literature about central sulcus region.Results In 68/82 hemispheres, the central sulcus did not reach the posterior ramus of the lateral sulcus. A knob on the second curve of the precentral gyrus was reliably identified in only 64/82 hemispheres.Conclusion The morphometric data presented in this article can be useful as supplementary method to identify the central sulcus region landmarks.

RESUMOA região do sulco central é uma área eloquente posicionada entre os lobos frontal e parietal. Durante procedimentos neurocirúrgicos, em algumas ocasiões, torna-se difícil compreender a anatomia cortical desta região.Objetivo Encontrar métodos alternativos para uma navegaçāo anatômica desta regiāo durante procedimentos neurocirúrgicos.Método Analisamos oitenta e dois hemisférios humanos usando um microscópio cirúrgico, além de fazer uma revisão da literatura.Resultados Em 68/82 hemisférios, o sulco central não atingiu o ramo posterior do sulco lateral. Uma dilatação na segunda curva do giro precentral foi encontrada em apenas 64/82 hemisférios.Conclusão Os dados morfométricos apresentados neste artigo podem ser úteis como método suplementar para identificação dos reparos anatômicos na região do sulco central.

Je pense donc je fais: transcranial direct current stimulation modulates brain oscillations associated with motor imagery and movement observation.

Motor system neural networks are activated during movement imagery, observation and execution, with a neural signature characterized by suppression of the Mu rhythm. In order to investigate the origin of this neurophysiological marker, we tested whether transcranial direct current stimulation (tDCS) modifies Mu rhythm oscillations during tasks involving observation and imagery of biological and non-biological movements. We applied tDCS (anodal, cathodal, and sham) in 21 male participants (mean age 23.8 ± 3.06), over the left M1 with a current of 2 mA for 20 min. Following this, we recorded the EEG at C3, C4, and Cz and surrounding C3 and C4 electrodes. Analyses of C3 and C4 showed significant effects for biological vs. non-biological movement (p = 0.005), and differential hemisphere effects according to the type of stimulation (p = 0.04) and type of movement (p = 0.02). Analyses of surrounding electrodes revealed significant interaction effects considering type of stimulation and imagery or observation of biological or non-biological movement (p = 0.03). The main findings of this study were (1) Mu desynchronization during biological movement of the hand region in the contralateral hemisphere after sham tDCS; (2) polarity-dependent modulation effects of tDCS on the Mu rhythm, i.e., anodal tDCS led to Mu synchronization while cathodal tDCS led to Mu desynchronization during movement observation and imagery (3) specific focal and opposite inter-hemispheric effects, i.e., contrary effects for the surrounding electrodes during imagery condition and also for inter-hemispheric electrodes (C3 vs. C4). These findings provide insights into the cortical oscillations during movement observation and imagery. Furthermore, it shows that tDCS can be highly focal when guided by a behavioral task.

Low frequency (0.5Hz) rTMS over the right (non-dominant) motor cortex does not affect ipsilateral hand performance in healthy humans / A inibição do córtex motor não-dominante por meio da estimulação magnética transcraniana a 0, 5Hz não interfere no desempenho manual ipsilateral de sujeitos hígidos

Reduction of excitability of the dominant primary motor cortex (M1) improves ipsilateral hand function in healthy subjects. In analogy, inhibition of non-dominant M1 should also improve ipsilateral performance. In order to investigate this hypothesis, we have used slow repetitive transcranial magnetic stimulation (rTMS) and the Purdue Pegboard test. Twenty-eight volunteers underwent 10 minutes of either 0.5Hz rTMS over right M1 or sham rTMS (coil perpendicular to scalp). The motor task was performed before, immediately after, and 20 minutes after rTMS. In both groups, motor performance improved significantly throughout the sessions. rTMS inhibition of the non-dominant M1 had no significant influence over ipsilateral or contralateral manual dexterity, even though the results were limited by unequal performance between groups at baseline. This is in contrast to an improvement in left hand function previously described following slow rTMS over left M1, and suggests a less prominent physiological transcallosal inhibition from right to left M1.

A redução da excitabilidade do córtex motor primário (M1) dominante melhora o desempenho manual ipsilateral: a inibição do M1 não-dominante poderia, analogamente, aprimorar a função manual direita. Para investigar esta hipótese, utilizou-se a estimulação magnética transcraniana repetitiva (EMTr) de baixa frequência e o teste Purdue Pegboard. Submetemos 28 voluntários a 10 minutos de EMTr sobre o M1 direito (0,5 Hz) ou a EMTr placebo (bobina perpendicular ao escalpo). O teste foi executado antes, imediatamente após e 20 minutos após a EMTr. Nos dois grupos, o desempenho manual mostrou significativa melhora entre as sessões. A inibição do M1 não-dominante não influenciou significativamente a destreza motora ipsi ou contralateral, apesar da conclusão limitada pelo desempenho discrepante dos grupos na primeira sessão. Este resultado contrasta com a melhora da função manual esquerda descrita após a EMTr sobre o M1 esquerdo e sugere uma inibição transcalosa fisiológica menos intensa do M1 direito para o esquerdo.