Restoration of motor inhibition through an abnormal premotor-motor connection in dystonia
Identifieur interne : 000220 ( Pmc/Curation ); précédent : 000219; suivant : 000221Restoration of motor inhibition through an abnormal premotor-motor connection in dystonia
Auteurs : Ying-Zu Huang [Taïwan] ; John C. Rothwell [Royaume-Uni] ; Chin-Song Lu [Taïwan] ; Jiunjie Wang [Taïwan] ; Rou-Shayn Chen [Taïwan]Source :
- Movement disorders : official journal of the Movement Disorder Society [ 0885-3185 ] ; 2010.
Abstract
To clarify the rationale for using rTMS of dorsal premotor cortex (PMd) to treat dystonia, we examined how the motor system reacts to an inhibitory form of rTMS applied to the PMd in healthy subjects and in a group of patients with focal hand dystonia and DYT1 gene carriers. Continuous theta burst transcranial magnetic stimulation (cTBS) with 300 and 600 pulses (cTBS300 and cTBS600) was applied to PMd and its after-effects were quantified by measuring the amplitude of MEPs evoked by single pulse transcranial magnetic stimulation (TMS) over the primary motor cortex (M1), short interval intracortical inhibition/facilitation (SICI/ICF) within M1, the third phase of spinal reciprocal inhibition (RI) and writing tests. In addition, in DYT1 gene carriers, the effects of cTBS300 over M1 and PMd on MEPs were studied in separate experiments. In healthy subjects cTBS300 and cTBS600 over PMd suppressed MEPs for 30min or more and cTBS600 decreased SICI and RI. In contrast, neither form of cTBS over PMd had any significant effect on MEPs, while cTBS600 increased effectiveness of SICI and RI and improved writing in patients with writer's cramp. NMDYT1 had a normal response to cTBS300 over left PMd. We suggest that the reduced PMd to M1 interaction in dystonic patients is likely to be due to reduced excitability of PMd-M1 connections. The possible therapeutic effects of premotor rTMS may therefore involve indirect effects of PMd on SICI and RI, which this study has shown can be normalised by cTBS.
Url:
DOI: 10.1002/mds.22814
PubMed: 20309999
PubMed Central: 3000921
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<front><div type="abstract" xml:lang="en"><p id="P1">To clarify the rationale for using rTMS of dorsal premotor cortex (PMd) to treat dystonia, we examined how the motor system reacts to an inhibitory form of rTMS applied to the PMd in healthy subjects and in a group of patients with focal hand dystonia and DYT1 gene carriers. Continuous theta burst transcranial magnetic stimulation (cTBS) with 300 and 600 pulses (cTBS300 and cTBS600) was applied to PMd and its after-effects were quantified by measuring the amplitude of MEPs evoked by single pulse transcranial magnetic stimulation (TMS) over the primary motor cortex (M1), short interval intracortical inhibition/facilitation (SICI/ICF) within M1, the third phase of spinal reciprocal inhibition (RI) and writing tests. In addition, in DYT1 gene carriers, the effects of cTBS300 over M1 and PMd on MEPs were studied in separate experiments. In healthy subjects cTBS300 and cTBS600 over PMd suppressed MEPs for 30min or more and cTBS600 decreased SICI and RI. In contrast, neither form of cTBS over PMd had any significant effect on MEPs, while cTBS600 increased effectiveness of SICI and RI and improved writing in patients with writer's cramp. NMDYT1 had a normal response to cTBS300 over left PMd. We suggest that the reduced PMd to M1 interaction in dystonic patients is likely to be due to reduced excitability of PMd-M1 connections. The possible therapeutic effects of premotor rTMS may therefore involve indirect effects of PMd on SICI and RI, which this study has shown can be normalised by cTBS.</p>
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<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">8610688</journal-id>
<journal-id journal-id-type="pubmed-jr-id">5937</journal-id>
<journal-id journal-id-type="nlm-ta">Mov Disord</journal-id>
<journal-id journal-id-type="iso-abbrev">Mov. Disord.</journal-id>
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<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
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<title-group><article-title>Restoration of motor inhibition through an abnormal premotor-motor connection in dystonia</article-title>
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<contrib-group><contrib contrib-type="author"><name><surname>Huang</surname>
<given-names>Ying-Zu</given-names>
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<xref ref-type="aff" rid="A1">1</xref>
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<contrib contrib-type="author"><name><surname>Rothwell</surname>
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<contrib contrib-type="author"><name><surname>Lu</surname>
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<contrib contrib-type="author"><name><surname>Wang</surname>
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<xref ref-type="aff" rid="A3">3</xref>
<xref ref-type="aff" rid="A4">4</xref>
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<contrib contrib-type="author"><name><surname>Chen</surname>
<given-names>Rou-Shayn</given-names>
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<xref ref-type="aff" rid="A1">1</xref>
<xref ref-type="corresp" rid="CR1">*</xref>
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<aff id="A1"><label>1</label>
Department of Neurology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taipei, Taiwan</aff>
<aff id="A2"><label>2</label>
Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, Queen Square, London, UK</aff>
<aff id="A3"><label>3</label>
Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan</aff>
<aff id="A4"><label>4</label>
Magnetic Resonance Imaging Centre, Chang Gung Memorial Hospital, Taoyuan, Taiwan</aff>
<author-notes><corresp id="CR1"><label>*</label>
Address for Correspondence: Rou-Shayn Chen, MD Department of Neurology, Chang Gung Memorial Hospital 199, Dunhwa North Road, Taipei 10507, Taiwan Tel: +886 3 3281200 ext 8423; Fax: +886 3 3287226 <email>cerebrum@adm.cgmh.org.tw</email>
</corresp>
<fn id="FN3"><p id="P34"><bold>AUTHOR ROLES</bold>
</p>
<p id="P35">Ying-Zu Huang: Research project conception and execution; statistic analysis design and execution; manuscript writing of the first draft. John C Rothwell: Research project conception; statistical analysis review and critique; manuscript review and critique. Chin-Song Lu: Research project conception; manuscript review and critique. JiunJie Wang: Research project organization; statistical analysis review and critique; manuscript review and critique. Rou-Shayn Chen: Research project conception and execution; statistical analysis review and critique; manuscript review and critique</p>
</fn>
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<pub-date pub-type="nihms-submitted"><day>29</day>
<month>11</month>
<year>2010</year>
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<pub-date pub-type="ppub"><day>30</day>
<month>4</month>
<year>2010</year>
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<pub-date pub-type="pmc-release"><day>11</day>
<month>12</month>
<year>2010</year>
</pub-date>
<volume>25</volume>
<issue>6</issue>
<fpage>696</fpage>
<lpage>703</lpage>
<abstract><p id="P1">To clarify the rationale for using rTMS of dorsal premotor cortex (PMd) to treat dystonia, we examined how the motor system reacts to an inhibitory form of rTMS applied to the PMd in healthy subjects and in a group of patients with focal hand dystonia and DYT1 gene carriers. Continuous theta burst transcranial magnetic stimulation (cTBS) with 300 and 600 pulses (cTBS300 and cTBS600) was applied to PMd and its after-effects were quantified by measuring the amplitude of MEPs evoked by single pulse transcranial magnetic stimulation (TMS) over the primary motor cortex (M1), short interval intracortical inhibition/facilitation (SICI/ICF) within M1, the third phase of spinal reciprocal inhibition (RI) and writing tests. In addition, in DYT1 gene carriers, the effects of cTBS300 over M1 and PMd on MEPs were studied in separate experiments. In healthy subjects cTBS300 and cTBS600 over PMd suppressed MEPs for 30min or more and cTBS600 decreased SICI and RI. In contrast, neither form of cTBS over PMd had any significant effect on MEPs, while cTBS600 increased effectiveness of SICI and RI and improved writing in patients with writer's cramp. NMDYT1 had a normal response to cTBS300 over left PMd. We suggest that the reduced PMd to M1 interaction in dystonic patients is likely to be due to reduced excitability of PMd-M1 connections. The possible therapeutic effects of premotor rTMS may therefore involve indirect effects of PMd on SICI and RI, which this study has shown can be normalised by cTBS.</p>
</abstract>
<kwd-group><kwd>Premotor</kwd>
<kwd>rTMS</kwd>
<kwd>dystonia</kwd>
<kwd>theta burst</kwd>
<kwd>TBS</kwd>
</kwd-group>
<funding-group><award-group><funding-source country="United Kingdom">Medical Research Council : </funding-source>
<award-id>G0500258(74086) || MRC_</award-id>
</award-group>
</funding-group>
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</front>
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