1,721,138 research outputs found
Author response: Cerebello-spinal tDCS in ataxia: A randomized, double-blind, sham-controlled, crossover trial
No full textCerebellar Stimulation: Lighting the Way
No full textThe cerebellum plays a fundamental role in motor control in humans, contributing to coordination, precision of movements, and accurate timing of muscle activities. It receives sensory inputs from the spinal cord and integrates these inputs to fine-tune motor activity via multiple loops with the cerebral cortex and brainstem. The two main afferent paths to the cerebellum are the mossy fibers and the climbing fibers, which both project to the cerebellar cortex and nuclei. The activation of Purkinje cells results in inhibition of cerebellar nuclei, consequently reducing excitatory input on the motor cortex via the dentato-thalamo-cortical pathway. The facilitatory/disfacilitatory effect of cerebellar nuclei upon remote targets is an essential mode of action of the cerebellar circuitry
Emergent technologies and applications of TMS and TMS-EEG in clinical neurophysiology for early and differential diagnosis: IFCN handbook chapter
Full text linkThis chapter examines how emerging neurophysiological technologies are transforming the early and differential diagnosis of neurological disorders. While imaging and fluid biomarkers have greatly advanced the field, they remain limited by cost, invasiveness, and their inability to directly capture dynamic brain activity. Neurophysiological techniques, particularly transcranial magnetic stimulation (TMS) and TMS combined with EEG, offer a unique, non-invasive means of probing cortical excitability, connectivity, and plasticity with millisecond precision. Recent technological and analytical breakthroughs are moving these approaches from research laboratories into clinical practice. By detecting subtle network dysfunctions that precede structural degeneration, they open the possibility of identifying disease in its prodromal or even presymptomatic stages, when interventions may be most effective. This chapter outlines the principles of advanced TMS paradigms and TMS-EEG and explores their application across a range of conditions, including amyotrophic lateral sclerosis, dementias, and movement disorders. It also highlights how integrating neurophysiological measures with blood-based biomarkers and computational tools, such as machine learning, can enhance diagnostic accuracy and guide individualized treatment strategies. Together, these innovations establish neurophysiology as a cornerstone of precision neurology, linking mechanistic insights to clinical decision-making and enabling earlier diagnosis, improved patient stratification, and more targeted therapeutic interventions
Brain Stimulation in Alzheimer's Disease Trials
No full textAlzheimer's disease (AD) continues to lack definitive curative therapies, necessitating an urgent exploration of innovative approaches. This review provides a comprehensive analysis of recent clinical trials focusing on invasive and non-invasive brain stimulation techniques as potential interventions for AD. Deep brain stimulation (DBS), repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), and transcranial alternating current stimulation (tACS) are evaluated for their therapeutic efficacy, safety, and applicability. DBS, though invasive, has shown promising results in mitigating cognitive decline, but concerns over surgical risks and long-term effects persist. On the other hand, non-invasive methods like rTMS, tDCS, and tACS have demonstrated potential in enhancing cognitive performance and delaying disease progression, with minimal side effects, but with varied consistency. The evidence hints towards an individualized, patient-centric approach to brain stimulation, considering factors such as disease stage, genetic traits, and stimulation parameters. The review also highlights emerging technologies and potential future directions, emphasizing the need for larger, multi-center trials to confirm preliminary findings and establish robust clinical guidelines. In conclusion, while brain stimulation techniques present a promising avenue in AD therapy, further research is imperative for more comprehensive understanding and successful clinical implementation. Through this review, we aim to catalyze the scientific discourse and stimulate further investigation into these novel interventions for AD
Editorial: Recording and modulating neural activity in neurodegenerative diseases: Pathophysiological and therapeutic implications.
Full text linkNeurodegenerative diseases encompass different conditions characterized by progressive degeneration of neurons and networks and accumulation of misfolded proteins in the brain. Recent research employing invasive and non-invasive neurophysiological techniques provided new insights into pathological mechanisms responsible for symptom development. This set the foundation for the translation of advanced therapeutic neuromodulation strategies that hold promise to optimize symptom control and potentially modify disease course in the future. In this Research Topic, we aimed to investigate the role of specific neurophysiological abnormalities in neurodegenerative diseases that serve as electrophysiological target for invasive and non-invasive neuromodulation techniques, such as deep brain stimulation (DBS; Tinkhauser et al., 2017; Bocci et al., 2021) and transcranial alternating current stimulation (tACS; Benussi et al., 2022; Guerra et al., 2022). Parkinson's disease (PD) is an exemplary condition for targeting brain oscillatory activities for therapeutic purposes. Indeed, PD can be considered an oscillopathy, as abnormal oscillations at specific frequency bands in the basal ganglia-thalamo-cortical network play a relevant role in motor symptoms pathophysiology (Oswal et al., 2013). Not only the suppression of exaggerated oscillatory beta activity using DBS (Tinkhauser et al., 2017), but also driving the pro-kinetic high-gamma rhythm at the cortical level using non-invasive tACS may attenuate bradykinesia (Guerra et al., 2022)
Transcranial Magnetic Stimulation in Alzheimer's Disease and Cortical Dementias
No full textTranscranial magnetic stimulation (TMS) has become a safe, noninvasive, and promising tool to assess speci c cortical circuits in the central nervous system. Since its introduction, the use of TMS in clinical neurophysiology, neurology, neuroscience, and psychiatry has spread widely, leading to important ndings on cortical function in physiological and pathological conditions. Indeed, numerous studies have described abnormalities in speci c cortical circuits using particular TMS stimulation paradigms, which allow the indirect assessment of inhibitory and excitatory interneuronal activity, mainly dependent on GABA receptors, of central cholinergic activity, and of cortical plasticity. The objective of the present work is to examine the utility of TMS as a means to support and predict the clinical diagnosis of Alzheimer ’s disease and other cortical dementias, in a setting where our understanding of neurodegenerative diseases is far from adequate
Advances in the treatment and management of frontotemporal dementia
No full textIntroduction: Frontotemporal dementia (FTD) is a complex neurodegenerative disorder, characterized by a wide range of pathological conditions associated with the buildup of proteins such as tau and TDP-43. With a strong hereditary component, FTD often results from genetic variants in three genes - MAPT, GRN, and C9orf72. Areas covered: In this review, the authors explore abnormal protein accumulation in FTD and forthcoming treatments, providing a detailed analysis of new diagnostic advancements, including innovative markers. They analyze how these discoveries have influenced therapeutic strategies, particularly disease-modifying treatments, which could potentially transform FTD management. This comprehensive exploration of FTD from its molecular underpinnings to its therapeutic prospects offers a compelling overview of the current state of FTD research. Expert opinion: Notable challenges in FTD management involve identifying reliable biomarkers for early diagnosis and response monitoring. Genetic forms of FTD, particularly those linked to C9orf72 and GRN, show promise, with targeted therapies resulting in substantial progress in disease-modifying strategies. The potential of neuromodulation techniques, like tDCS and rTMS, is being explored, requiring further study. Ongoing trials and multi-disciplinary care highlight the continued push toward effective FTD treatments. With increasing understanding of FTD's molecular and clinical intricacies, the hope for developing effective interventions grows
Transcranial Magnetic Stimulation Across the Lifespan: Impact of Developmental and Degenerative Processes
Full text linkTranscranial magnetic stimulation (TMS) has emerged as a pivotal noninvasive technique for investigating cortical excitability and plasticity across the lifespan, offering valuable insights into neurodevelopmental and neurodegenerative processes. In this review, we explore the impact of TMS applications on our understanding of normal development, healthy aging, neurodevelopmental disorders, and adult-onset neurodegenerative diseases. By presenting key developmental milestones and age-related changes in TMS measures, we provide a foundation for understanding the maturation of neurotransmitter systems and the trajectory of cognitive functions throughout the lifespan. Building on this foundation, the paper delves into the pathophysiology of neurodevelopmental disorders, including autism spectrum disorder, attention-deficit/hyperactivity disorder, Tourette syndrome, and adolescent depression. Highlighting recent findings on altered neurotransmitter circuits and dysfunctional cortical plasticity, we underscore the potential of TMS as a valuable tool for unraveling underlying mechanisms and informing future therapeutic interventions. We also review the emerging role of TMS in investigating and treating the most common adult-onset neurodegenerative disorders and late-onset depression. By outlining the therapeutic applications of noninvasive brain stimulation techniques in these disorders, we discuss the growing body of evidence supporting their use as therapeutic tools for symptom management and potentially slowing disease progression. The insights gained from TMS studies have advanced our understanding of the underlying mechanisms in both healthy and disease states, ultimately informing the development of more targeted diagnostic and therapeutic strategies for a wide range of neuropsychiatric conditions
Cerebellar transcranial direct current stimulation in patients with ataxia: A double-blind, randomized, sham-controlled study
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