Restorative Neurology and Neuroscience - Volume 34, issue 2

Authors: Schecklmann, Martin | Giani, Anette | Tupak, Sara | Langguth, Berthold | Raab, Vincent | Polak, Thomas | Várallyay, Csanád | Großmann, Wilma | Herrmann, Martin J. | Fallgatter, Andreas J.

Article Type: Research Article

Abstract: Purpose: Clinical effects of repetitive transcranial magnetic stimulation (rTMS) in chronic tinnitus are moderate. More precise coil localisation strategies, innovative stimulation protocols, and identification of predictors for treatment response were proposed as promising attempts to enhance treatment efficacy. In this pilot study we investigated neuronavigated continuous theta burst TMS (cTBS). Methods: Twenty-three patients received neuronavigated cTBS over the left primary auditory cortex in a randomized sham-controlled trial (verum = 12; sham = 11). Treatment response was evaluated with tinnitus questionnaires and numeric rating scales. Immediate change in numeric rating scales during the first session was used as predictor for treatment response. …Results: Tinnitus was significantly reduced after treatment, but there were no superior effects between verum vs. sham treatment. Immediate change in the first treatment session predicted the response to treatment only in the verum group. Conclusions: In our study, verum cTBS was not superior to sham which highlights the persistent need for improving non-invasive brain stimulation techniques for the treatment of tinnitus. Future research should focus on the transfer of positive single session effects to daily treatment trials. Show more

Keywords: Transcranial magnetic stimulation, TMS, theta burst stimulation, TBS, ringing in the ears, tinnitus, neuronavigation, auditory cortex

DOI: 10.3233/RNN-150518

Citation: Restorative Neurology and Neuroscience, vol. 34, no. 2, pp. 165-175, 2016

Authors: Guo, Yi | He, Yitao | Tang, Bingshan | Ma, Kefu | Cai, Zhili | Zeng, Siling | Zhang, Ying | Jiang, Xin

Article Type: Research Article

Abstract: Purpose: To evaluate the effect of using fluoxetine at different time intervals after ischemic stroke on neurological functional prognosis in China. Methods: The patients enrolled were randomly allocated to three groups. Group A received fluoxetine 20 mg/day immediately; group B received fluoxetine 20 mg/day 7 days after enrollment; and group C did not receive fluoxetine. The therapeutic duration of fluoxetine was 90 days and the follow-up period was 180 days. Results: The mean NIHSS score at day 90 was significantly lower in group A than group C (P  = 0.005), while at day 180, the mean score in …group A was significantly lower than groups B and C (P  = 0.035, P  = 0.000), respectively. The mean BI score at day 90 was significantly higher in group A than group C (P  = 0.001), while at day 180, the mean score in group A was significantly higher than groups B and C (P  = 0.036, P  = 0.000), respectively. Regression analysis indicated that lower NIHSS score and higher BI score at day 180 were attributed to the early administration of fluoxetine. Conclusions: In patients with ischemic stroke, early administration of fluoxetine may improve the neurological functional prognosis. Show more

Keywords: Fluoxetine, ischemic stroke, neurological functional prognosis, time intervals

DOI: 10.3233/RNN-150535

Citation: Restorative Neurology and Neuroscience, vol. 34, no. 2, pp. 177-187, 2016

Authors: Palm, Ulrich | Chalah, Moussa A. | Padberg, Frank | Al-Ani, Tarik | Abdellaoui, Mohamed | Sorel, Marc | Dimitri, Dalia | Créange, Alain | Lefaucheur, Jean-Pascal | Ayache, Samar S.

Article Type: Research Article

Abstract: Purpose: Pain and cognitive impairment are frequent symptoms in patients with multiple sclerosis (MS). Neglecting experimental pain and paying attention to demanding tasks is reported to decrease the pain intensity. Little is known about the interaction between chronic neuropathic pain and attention disorders in MS. Recently, transcranial direct current stimulation (tDCS) was used to modulate various cognitive and motor symptoms in MS. We aimed to study the effects of transcranial random noise stimulation (tRNS), a form of transcranial electric stimulation, over the left dorsolateral prefrontal cortex (DLPFC) on attention and neuropathic pain in MS patients. Methods: 16 …MS patients were included in a randomized, sham-controlled, cross-over study. Each patient randomly received two tRNS blocks, separated by three weeks of washout interval. Each block consisted of three consecutive daily sessions of either active or sham tRNS. The patients were evaluated for pain, attention and mood and further underwent an electrophysiological evaluation. Results: Compared to sham, tRNS showed a trend to decrease the N2-P2 amplitudes of pain related evoked potentials and improve pain ratings. Attention performance and mood scales did not change after stimulations. Conclusions: This study suggests the role of tRNS in pain modulation, which could have been more evident with longer stimulation protocols. Show more

Keywords: Transcranial random noise stimulation, tRNS, multiple sclerosis, fatigue, pain, depression, attention

DOI: 10.3233/RNN-150557

Citation: Restorative Neurology and Neuroscience, vol. 34, no. 2, pp. 189-199, 2016

Authors: Lee, Hae In | Park, Jung Hwa | Park, Min Young | Kim, Nam Gyun | Park, Kyoung-Jun | Choi, Byung Tae | Shin, Yong-II | Shin, Hwa Kyoung

Article Type: Research Article

Abstract: Purpose: Transcranial low-level light therapy (LLLT) has gained interest as a non-invasive, inexpensive and safe method of modulating neurological and psychological functions in recent years. This study was designed to examine the preventive effects of LLLT via visible light source against cerebral ischemia at the behavioral, structural and neurochemical levels. Methods: The mice received LLLT twice a day for 2 days prior to photothrombotic cortical ischemia. Results: LLLT significantly reduced infarct size and edema and improved neurological and motor function 24 h after ischemic injury. In addition, LLLT markedly inhibited Iba-1- and GFAP-positive cells, which was …accompanied by a reduction in the expression of inflammatory mediators and inhibition of MAPK activation and NF-κ B translocation in the ischemic cortex. Concomitantly, LLLT significantly attenuated leukocyte accumulation and infiltration into the infarct perifocal region. LLLT also prevented BBB disruption after ischemic events, as indicated by a reduction of Evans blue leakage and water content. These findings were corroborated by immunofluorescence staining of the tight junction-related proteins in the ischemic cortex in response to LLLT. Conclusions: Non-invasive intervention of LLLT in ischemic brain injury may provide a significant functional benefit with an underlying mechanism possibly being suppression of neuroinflammation and reduction of BBB disruption. Show more

Keywords: Low-level light therapy, focal cerebral ischemia, blood-brain barrier, neuroinflammation

DOI: 10.3233/RNN-150559

Citation: Restorative Neurology and Neuroscience, vol. 34, no. 2, pp. 201-214, 2016

Authors: Costanzo, Floriana | Varuzza, Cristiana | Rossi, Serena | Sdoia, Stefano | Varvara, Pamela | Oliveri, Massimiliano | Giacomo, Koch | Vicari, Stefano | Menghini, Deny

Article Type: Research Article

Abstract: Purpose: There is evidence that non-invasive brain stimulation transitorily modulates reading by facilitating the neural pathways underactive in individuals with dyslexia. The study aimed at investigating whether multiple sessions of transcranial direct current stimulation (tDCS) would enhance reading abilities of children and adolescents with dyslexia and whether the effect is long-lasting. Methods: Eighteen children and adolescents with dyslexia received three 20-minute sessions a week for 6 weeks (18 sessions) of left anodal/right cathodal tDCS set at 1 mA over parieto-temporal regions combined with a cognitive training. The participants were randomly assigned to the active or the sham treatment; …reading tasks (text, high and low frequency words, non-words) were used as outcome measures and collected before treatment, after treatment and one month after the end of treatment. The tolerability of tDCS was evaluated. Results: The active group showed reduced low frequency word reading errors and non-word reading times. These positive effects were stable even one month after the end of treatment. None reported adverse effects. Conclusions: The study shows preliminary evidence of tDCS feasibility and efficacy in improving non-words and low frequency words reading of children and adolescents with dyslexia and it opens new rehabilitative perspectives for the remediation of dyslexia. Show more

Keywords: Brain stimulation, parieto-temporal regions, cognitive training

DOI: 10.3233/RNN-150561

Citation: Restorative Neurology and Neuroscience, vol. 34, no. 2, pp. 215-226, 2016

Authors: Roosink, Meyke | Robitaille, Nicolas | Jackson, Philip L. | Bouyer, Laurent J. | Mercier, Catherine

Article Type: Research Article

Abstract: Purpose: Motor imagery can improve motor function and reduce pain. This is relevant to individuals with spinal cord injury (SCI) in whom motor dysfunction and neuropathic pain are prevalent. However, therapy efficacy could be dependent on motor imagery ability, and a clear understanding of how motor imagery might be facilitated is currently lacking. Thus, the aim of the present study was to assess the immediate effects of interactive virtual feedback on motor imagery performance after SCI. Methods: Nine individuals with a traumatic SCI participated in the experiment. Motor imagery tasks consisted of forward (i.e. simpler) and backward …(i.e. more complex) walking while receiving interactive versus static virtual feedback. Motor imagery performance (vividness, effort and speed), neuropathic pain intensity and feasibility (immersion, distraction, side-effects) were assessed. Results: During interactive feedback trials, motor imagery vividness and speed were significantly higher and effort was significantly lower as compared static feedback trials. No change in neuropathic pain was observed. Adverse effects were minor, and immersion was reported to be good. Conclusions: This exploratory study showed that interactive virtual walking was feasible and facilitated motor imagery performance. The response to motor imagery interventions after SCI might be improved by using interactive virtual feedback. Show more

Keywords: Spinal cord injury, visual feedback, virtual reality therapy, gait, chronic pain

DOI: 10.3233/RNN-150563

Citation: Restorative Neurology and Neuroscience, vol. 34, no. 2, pp. 227-235, 2016

Authors: Duret, Christophe | Courtial, Ophélie | Grosmaire, Anne Gaelle

Article Type: Research Article

Abstract: Purpose: Kinematic assessments are increasingly used as motor outcome measures during upper limb robot-assisted training, in addition to clinical scales. However, their relevance has not been evaluated much. Methods: Thirty-eight patients with severe sub-acute stroke (age 56 ± 17 [19–87] years; time since stroke, 55 ± 22 days) carried out 16 sessions (average 3/week, 35 ± 15 days) of upper limb robot-assisted training combined with standard therapy. Pre/post motor performance was evaluated using the Fugl-Meyer Assessment scale, Motor Status Scale (MSS) and kinematic measures. Motor outcomes were compared and relationships between clinical and kinematic outcomes were analyzed. …Results: All clinical and kinematic outcomes improved after training (p  <  0.01). FM score increased from 17.7 ± 10.0 to 28.6 ± 15.4. All baseline kinematic measures were strongly correlated with clinical scores. Correlations between clinical and kinematic changes were moderate (r  = –0.65 for change in FM Proximal score and change in accuracy measure). However, smoothness and accuracy indicators were shown to be responsive measures. Conclusion: This study demonstrated that baseline kinematic measures and their pre/post training changes were significantly correlated with clinical motor outcome measures. However, even if kinematic measures are valid for the evaluation of motor impairment we cannot propose to substitute common clinical measures of motor function which also evaluate functional abilities of the upper limb. Show more

Keywords: Hemiparesis, upper limb, sub-acute stroke, robotic therapy, kinematics

DOI: 10.3233/RNN-150565

Citation: Restorative Neurology and Neuroscience, vol. 34, no. 2, pp. 237-245, 2016

Authors: Fusco, Augusto | Gallotta, Maria Chiara | Iosa, Marco | Morone, Giovanni | Iasevoli, Luigi | Trifoglio, Domenica | Saraceni, Vincenzo Maria | Paolucci, Stefano | Baldari, Carlo | Guidetti, Laura

Article Type: Research Article

Abstract: Purpose: Recently, Motor Imagery (MI) has been associated with the execution of movements miming in part the mentally represented action (dynamic MI, dMI). Preliminary studies have reported as dMI may improve trainings in sport, with imagery timing close to the physical execution one. This study was aimed to investigate time and spatial parameters of dMI with actual locomotion in people with stroke. Methods: Twelve patients (stroke group, SG) were compared with twelve healthy elderly (elderly group, EG) and twenty young adults (young group, YG). Subjects performed mental representations of different walking (forward, FW; lateral, LW, backward, BW), …accompanied or not by movements imitating walking (dMI and static MI, sMI). Then, they performed actual locomotion (AL). Outcome measures were related to the time and the number of steps spent for completing the tasks for all the given locomotor conditions. Results: Significant differences were found in patients with respect to healthy subjects, with time in sMI significantly shorter than in dMI (p  < 0.004) and AL (p  < 0.002), but not between dMI and AL in FW (p  = 0.806). In patients, times obtained in sMI and dMI was significantly shorter with respect to those of AL in LW and BW. Patients performed imagery tasks with similar times in all locomotion. Healthy groups did not reveal differences among tasks in BW, while significant differences were found in LW. Analogous results were found in terms of number of performed steps. Conclusions: In patients with stroke, a spatiotemporal functional equivalence with AL was found only for dMI, and not for sMI, in forward walking. This could be due to familiarity with this task. These results might have implications for the rehabilitative techniques based on MI. Show more

Keywords: Walking, dynamic motor imagery, locomotor body schema, locomotion, task-dependent activity

DOI: 10.3233/RNN-150573

Citation: Restorative Neurology and Neuroscience, vol. 34, no. 2, pp. 247-256, 2016

Authors: Caudle, Krista L. | Lu, Xi-Chun M. | Mountney, Andrea | Shear, Deborah A. | Tortella, Frank C.

Article Type: Research Article

Abstract: Purpose: We assessed the therapeutic efficacy of FDA-approved anti-epileptic drug Levetiracetam (LEV) to reduce post-traumatic nonconvulsive seizure (NCS) activity and promote neurobehavioral recovery following 10% frontal penetrating ballistic-like brain injury (PBBI) in male Sprague-Dawley rats. Methods: Experiment 1 anti-seizure study: 50 mg/kg LEV (25 mg/kg maintenance doses) was given twice daily for 3 days (LEV3D ) following PBBI; outcome measures included seizures incidence, frequency, duration, and onset. Experiment 2 neuroprotection studies: 50 mg/kg LEV was given twice daily for either 3 (LEV3D ) or 10 days (LEV10D ) post-injury; outcome measures include motor (rotarod) and cognitive (water maze) functions. …Results: LEV3D treatment attenuated seizure activity with significant reductions in NCS incidence (54%), frequency, duration, and delayed latency to seizure onset compared to vehicle treatment. LEV3D treatment failed to improve cognitive or motor performance; however extending the dosing regimen through 10 days post-injury afforded significant neuroprotective benefit. Animals treated with the extended LEV10D dosing regimen showed a twofold improvement in rotarod task latency to fall as well as significantly improved spatial learning performance (24%) in the MWM task. Conclusions: These findings support the dual anti- seizure and neuroprotective role of LEV, but more importantly identify the importance of an extended dosing protocol which was specific to the therapeutic targets studied. Show more

Keywords: Traumatic brain injury, post-traumatic seizures, neuroprotection, motor, cognitive function, rat

DOI: 10.3233/RNN-150580

Citation: Restorative Neurology and Neuroscience, vol. 34, no. 2, pp. 257-270, 2016

Authors: Platz, Thomas | Schüttauf, Johannes | Aschenbach, Julia | Mengdehl, Christine | Lotze, Martin

Article Type: Research Article

Abstract: Purpose and methods: The study sought to alter visual spatial attention in young healthy subjects by a neuronavigated inhibitory rTMS protocol (cTBS-600) to right brain areas thought to be involved in visual attentional processes, i.e. the temporoparietal junction (TPJ) and the posterior middle frontal gyrus (pMFG), and to test the reversibility of effects by an additional consecutive cTBS to the homologue left brain cortical areas. Results: Healthy subjects showed a leftward bias of the egocentric perspective for both visual-perceptive and visual-exploratory tasks specifically for items presented in the left hemifield. cTBS to the right TPJ, and less …systematically to the right pMFG reduced this bias for visuo-spatial and exploratory visuo-motor behaviour. Further, a consecutive cTBS to the left TPJ changed the bias again towards the left for a visual-perceptive task. Conclusions: The evidence supports the notion of an involvement of the right TPJ (and pMFG) in spatial visual attention. The observations further indicate that inhibitory non-invasive brain stimulation (cTBS) to the left TPJ has a potential for reversing a rightward bias of spatial attention when the right TPJ is dysfunctional. Accordingly, the findings could have implications for therapeutic rTMS development for right brain damaged patients with visual neglect. Show more

Keywords: Neglect, cortex, transcranial magnetic stimulation, spatial attention, exploration, egocentric, allocentric, temporoparietal junction, TPJ, middle frontal gyrus, MFG

DOI: 10.3233/RNN-150582

Citation: Restorative Neurology and Neuroscience, vol. 34, no. 2, pp. 271-285, 2016