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Robert Chen and Kaviraja Udupa

Several techniques that involve transcranial magnetic stimulation (TMS) can be used to measure brain plasticity noninvasively in humans. These include paired-associative stimulation (PAS), repetitive transcranial magnetic stimulation (rTMS) and theta burst stimulation (TBS). Some of these techniques are based the principle of use dependent plasticity or are designed to mimic protocols used to induce long-term potentiation or depression in animal studies. These studies have been applied to certain neurological and psychiatric disorders to investigate their pathophysiology. For example, PAS induced plasticity is enhanced in dystonia and stroke but is reduced in Huntington’s disease and schizophrenia. Furthermore, TMS may be used to modulate brain plasticity and has therapeutic potential in neurological and psychiatric disorders such as stroke, Parkinson’s disease, dystonia and depression.

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Abbey C. Thomas, Brian G. Pietrosimone, and Carter J. Bayer

Context: Transcranial magnetic stimulation (TMS) may provide important information regarding the corticospinal mechanisms that may contribute to the neuromuscular activation impairments. Paired-pulse TMS testing is a reliable method for measuring intracortical facilitation and inhibition; however, little evidence exists regarding agreement of these measures in the quadriceps. Objective: To determine the between-sessions and interrater agreement of intracortical excitability (short- and long-interval intracortical inhibition [SICI, LICI] and intracortical facilitation [ICF]) in the dominant-limb quadriceps. Design: Reliability study. Setting: Research laboratory. Participants: 13 healthy volunteers (n = 6 women; age 24.7 ± 2.1 y; height 1.7 ± 0.1 m; mass 77.1 ± 17.4 kg). Intervention: Participants completed 2 TMS sessions separated by 1 wk. Main Outcome Measures: Two investigators measured quadriceps SICI, LICI, and ICF at rest and actively (5% of maximal voluntary isometric contraction). All participants were seated in a dynamometer with the knee flexed to 90°. Intracortical-excitability paradigm and investigator order were randomized. Bland-Altman analyses were used to establish agreement. Results: Agreement was stronger between sessions within a single investigator than between investigators and for active than resting measures. Agreement was strongest for resting SICI and active ICF and LICI between sessions for each investigator. Conclusions: Quadriceps intracortical excitability may be measured longitudinally by a single investigator, though active muscle contraction should be elicited during testing.

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Y.L. Lo, H.H. Zhang, C.C. Wang, Z.Y. Chin, S. Fook-Chong, C. Gabriel, and C.T. Guan

In overt reading and singing tasks, actual vocalization of words in a rhythmic fashion is performed. During execution of these tasks, the role of underlying vascular processes in relation to cortical excitability changes in a spatial manner is uncertain. Our objective was to investigate cortical excitability changes during reading and singing with transcranial magnetic stimulation (TMS), as well as vascular changes with nearinfrared spectroscopy (NIRS). Findings with TMS and NIRS were correlated. TMS and NIRS recordings were performed in 5 normal subjects while they performed reading and singing tasks separately. TMS was applied over the left motor cortex at 9 positions 2.5 cm apart. NIRS recordings were made over these identical positions. Although both TMS and NIRS showed significant mean cortical excitability and hemodynamic changes from baseline during vocalization tasks, there was no significant spatial correlation of these changes evaluated with the 2 techniques over the left motor cortex. Our findings suggest that increased left-sided cortical excitability from overt vocalization tasks in the corresponding “hand area” were the result of “functional connectivity,” rather than an underlying “vascular overflow mechanism” from the adjacent speech processing or face/mouth areas. Our findings also imply that functional neurophysiological and vascular methods may evaluate separate underlying processes, although subjects performed identical vocalization tasks. Future research combining similar methodologies should embrace this aspect and harness their separate capabilities.

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Christopher A. Knight

Column-editor : Thomas W. Kaminski

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János Négyesi, Menno P. Veldman, Kelly M.M. Berghuis, Marie Javet, József Tihanyi, and Tibor Hortobágyi

transfer-receiving hand. We supplemented the behavioral data with transcranial magnetic stimulation (TMS) measures to examine the potential underlying mechanisms involved in skill acquisition and its intermanual transfer. Materials and Methods Participants In total, 34 right-handed healthy adults (age 22

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Stephen P. Bailey, Julie Hibbard, Darrin La Forge, Madison Mitchell, Bart Roelands, G. Keith Harris, and Stephen Folger

improvement in performance is unclear; however, it is believed that the CHO MR enhances the excitability of the motor cortex via oral CHO receptors. Gant et al 3 provided supportive evidence for this premise when they found that the motor-evoked potential (MEP) response to transcranial magnetic stimulation

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Katherine G. Holste, Alia L. Yasen, Matthew J. Hill, and Anita D. Christie

The purpose of this study was to assess the effect of a cognitive task on motor cortex excitability and inhibition. Transcranial magnetic stimulation of the motor cortex was performed on 20 healthy individuals (18–24 years; 9 females) to measure motor evoked potentials (MEPs) and cortical silent periods at baseline, during, and following a secondary cognitive task. The MEP amplitude increased from 0.50 ± 0.09–0.87 ± 0.50 mV during a secondary cognitive task (p = .04), and returned to baseline (0.48 ± 0.31 mV; p = .90) posttask. The CSP duration also increased from 93.48 ± 28.76–113.6 ± 33.68 ms (p = .001) during the cognitive task, and returned to baseline posttask (89.0 ± 6.9 ms; p = .88). In the presence of a cognitive task, motor cortex excitability and inhibition were both increased relative to baseline. The increase in inhibition may help to explain the motor deficits experienced while performing a secondary cognitive task.

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Alex V. Nowicky, Alison H. McGregor, and Nick J. Davey

We used transcranial magnetic stimulation (TMS) to study corticospinal excitability to erector Spinae (ES) muscles during graded voluntary contractions in bilateral trunk extension (BTE) and forced expiratory breath holding (FEBH) in normal individuals. Motor evoked potentials (MEPs) could be produced in all subjects in the absence of voluntary activation. At maximum voluntary contraction, levels of surface electromyographic (EMG) activity were 4 times greater during BTE than FEBH. When EMG was normalized to maximum. MEP amplitudes increased in proportion to contraction in both tasks. MEPs in FEBH were compared with extrapolated values at similar EMG levels in BTE and were found to be larger. EMG and MEPs in left and right ES were symmetrical throughout the range of contractions in both tasks. ES muscles have a facilitation pattern similar to that previously shown in leg muscles, but subtle differences at low levels of EMG suggest that the facilitation is dependent on the task.

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Francesca Wightman, Suzanne Delves, Caroline M. Alexander, and Paul H. Strutton

Descending bilateral control of external oblique (EO) and latissimus dorsi (LD) was investigated using transcranial magnetic stimulation. Contralateral (CL) motor evoked potential (MEP) thresholds were lower and latencies were shorter than for ipsilateral (IL) MEPs. Hotspots for EO were symmetrical; this was not the case for LD. The volumes of drive to the left and right muscles were not different. The laterality index was not different between the left and right muscles. The average index for the EO muscles was closer to zero than that for LD, suggesting a stronger IL drive to EO. The symmetry of drive to each muscle did not differ; however, the symmetry of drive varies within a subject for different muscles and between subjects for the same muscle. The findings may be useful in understanding a number of clinical conditions relating to the trunk and also for predicting the outcome of rehabilitative strategies.

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Ashley Stern, Chris Kuenze, Daniel Herman, Lindsay D. Sauer, and Joseph M. Hart

Context:

Central and peripheral muscle fatigue during exercise may exacerbate neuromuscular factors that increase risk for noncontact anterior cruciate ligament injury.

Objective:

To compare lower extremity motor-evoked potentials (MEPs), muscle strength, and electromyography (EMG) activation after an exercise protocol.

Design:

Pretest, posttest group comparison.

Setting:

University laboratory.

Participants:

34 healthy volunteers (17 female, age = 21.9 ± 2.3 years, weight = 77.8 ± 3.0 kg, height = 171.1 ± 6.6 cm, and 17 male, age = 23.4 ± 6.5 years, weight = 81.6 ± 3.3 kg, height = 179.6 ± 7.3 cm).

Intervention:

A standardized 30-min exercise protocol that involved 5 repeated cycles of uphill walking, body-weight squatting, and step-ups.

Main Outcome Measures:

Quadriceps and hamstring MEP amplitude (mV) and transmission velocity normalized to subject height (m/s) were elicited via transcranial magnetic stimulation and measured via surface EMG. Quadriceps and hamstring peak EMG activation (% MVIC) and peak torque (Nm/kg) were measured during MVICs. Separate ANCOVAs were used to compare groups after exercise while controlling for baseline measurement.

Results:

At baseline, males exhibited significantly greater knee-extension torques (males = 2.47 ± 0.68 Nm/kg, females = 1.95 ± 0.53 Nm/kg; P = .036) and significantly higher hamstring MEP amplitudes (males = 223.5 ± 134.0 mV, females = 89.3 ± 77.6 mV; P = .007). Males exhibited greater quadriceps MEP amplitude after exercise than females (males = 127.2 ± 112.7 mV, females = 32.3 ± 34.9 mV; P = .016).

Conclusions:

Males experienced greater peripheral neuromuscular changes manifested as more pronounced reductions in quadriceps torque after exercise. Females experienced greater central neuromuscular changes manifested as more pronounced reduction in quadriceps MEP amplitude. Reduced central neural drive of the quadriceps coupled with knee-extension torque preservation after exercise may increase risk of knee injury in females.