A New Paired Associative Stimulation Protocol with High-Frequency Peripheral Component and High-Intensity 20 Hz Repetitive Transcranial Magnetic Stimulation—A Pilot Study

Paired associative stimulation (PAS) is a stimulation technique combining transcranial magnetic stimulation (TMS) and peripheral nerve stimulation (PNS) that can induce plastic changes in the human motor system. A PAS protocol consisting of a high-intensity single TMS pulse given at 100% of stimulat...

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Autores principales:	Sabin Sathyan, Aleksandra Tolmacheva, Sergei Tugin, Jyrki P. Mäkelä, Anastasia Shulga, Pantelis Lioumis
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	corticospinal tract long interval cortical inhibition neuroplasticity paired associative stimulation peripheral nerve stimulation primary motor cortex Medicine R
Acceso en línea:	https://doaj.org/article/75933447b049426cbf580c67a90c2eff
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spelling	oai:doaj.org-article:75933447b049426cbf580c67a90c2eff2021-11-11T16:22:37ZA New Paired Associative Stimulation Protocol with High-Frequency Peripheral Component and High-Intensity 20 Hz Repetitive Transcranial Magnetic Stimulation—A Pilot Study10.3390/ijerph1821112241660-46011661-7827https://doaj.org/article/75933447b049426cbf580c67a90c2eff2021-10-01T00:00:00Zhttps://www.mdpi.com/1660-4601/18/21/11224https://doaj.org/toc/1661-7827https://doaj.org/toc/1660-4601Paired associative stimulation (PAS) is a stimulation technique combining transcranial magnetic stimulation (TMS) and peripheral nerve stimulation (PNS) that can induce plastic changes in the human motor system. A PAS protocol consisting of a high-intensity single TMS pulse given at 100% of stimulator output (SO) and high-frequency 100-Hz PNS train, or “the high-PAS” was designed to promote corticomotoneuronal synapses. Such PAS, applied as a long-term intervention, has demonstrated therapeutic efficacy in spinal cord injury (SCI) patients. Adding a second TMS pulse, however, rendered this protocol inhibitory. The current study sought for more effective PAS parameters. Here, we added a third TMS pulse, i.e., a 20-Hz rTMS (three pulses at 96% SO) combined with high-frequency PNS (six pulses at 100 Hz). We examined the ability of the proposed stimulation paradigm to induce the potentiation of motor-evoked potentials (MEPs) in five human subjects and described the safety and tolerability of the new protocol in these subjects. In this study, rTMS alone was used as a control. In addition, we compared the efficacy of the new protocol in five subjects with two PAS protocols consisting of PNS trains of six pulses at 100 Hz combined with (a) single 100% SO TMS pulses (high-PAS) and (b) a 20-Hz rTMS at a lower intensity (three pulses at 120% RMT). The MEPs were measured immediately after, and 30 and 60 min after the stimulation. Although at 0 and 30 min there was no significant difference in the induced MEP potentiation between the new PAS protocol and the rTMS control, the MEP potentiation remained significantly higher at 60 min after the new PAS than after rTMS alone. At 60 min, the new protocol was also more effective than the two other PAS protocols. The new protocol caused strong involuntary twitches in three subjects and, therefore, its further characterization is needed before introducing it for clinical research. Additionally, its mechanism plausibly differs from PAS with high-frequency PNS that has been used in SCI patients.Sabin SathyanAleksandra TolmachevaSergei TuginJyrki P. MäkeläAnastasia ShulgaPantelis LioumisMDPI AGarticlecorticospinal tractlong interval cortical inhibitionneuroplasticitypaired associative stimulationperipheral nerve stimulationprimary motor cortexMedicineRENInternational Journal of Environmental Research and Public Health, Vol 18, Iss 11224, p 11224 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	corticospinal tract long interval cortical inhibition neuroplasticity paired associative stimulation peripheral nerve stimulation primary motor cortex Medicine R
spellingShingle	corticospinal tract long interval cortical inhibition neuroplasticity paired associative stimulation peripheral nerve stimulation primary motor cortex Medicine R Sabin Sathyan Aleksandra Tolmacheva Sergei Tugin Jyrki P. Mäkelä Anastasia Shulga Pantelis Lioumis A New Paired Associative Stimulation Protocol with High-Frequency Peripheral Component and High-Intensity 20 Hz Repetitive Transcranial Magnetic Stimulation—A Pilot Study
description	Paired associative stimulation (PAS) is a stimulation technique combining transcranial magnetic stimulation (TMS) and peripheral nerve stimulation (PNS) that can induce plastic changes in the human motor system. A PAS protocol consisting of a high-intensity single TMS pulse given at 100% of stimulator output (SO) and high-frequency 100-Hz PNS train, or “the high-PAS” was designed to promote corticomotoneuronal synapses. Such PAS, applied as a long-term intervention, has demonstrated therapeutic efficacy in spinal cord injury (SCI) patients. Adding a second TMS pulse, however, rendered this protocol inhibitory. The current study sought for more effective PAS parameters. Here, we added a third TMS pulse, i.e., a 20-Hz rTMS (three pulses at 96% SO) combined with high-frequency PNS (six pulses at 100 Hz). We examined the ability of the proposed stimulation paradigm to induce the potentiation of motor-evoked potentials (MEPs) in five human subjects and described the safety and tolerability of the new protocol in these subjects. In this study, rTMS alone was used as a control. In addition, we compared the efficacy of the new protocol in five subjects with two PAS protocols consisting of PNS trains of six pulses at 100 Hz combined with (a) single 100% SO TMS pulses (high-PAS) and (b) a 20-Hz rTMS at a lower intensity (three pulses at 120% RMT). The MEPs were measured immediately after, and 30 and 60 min after the stimulation. Although at 0 and 30 min there was no significant difference in the induced MEP potentiation between the new PAS protocol and the rTMS control, the MEP potentiation remained significantly higher at 60 min after the new PAS than after rTMS alone. At 60 min, the new protocol was also more effective than the two other PAS protocols. The new protocol caused strong involuntary twitches in three subjects and, therefore, its further characterization is needed before introducing it for clinical research. Additionally, its mechanism plausibly differs from PAS with high-frequency PNS that has been used in SCI patients.
format	article
author	Sabin Sathyan Aleksandra Tolmacheva Sergei Tugin Jyrki P. Mäkelä Anastasia Shulga Pantelis Lioumis
author_facet	Sabin Sathyan Aleksandra Tolmacheva Sergei Tugin Jyrki P. Mäkelä Anastasia Shulga Pantelis Lioumis
author_sort	Sabin Sathyan
title	A New Paired Associative Stimulation Protocol with High-Frequency Peripheral Component and High-Intensity 20 Hz Repetitive Transcranial Magnetic Stimulation—A Pilot Study
title_short	A New Paired Associative Stimulation Protocol with High-Frequency Peripheral Component and High-Intensity 20 Hz Repetitive Transcranial Magnetic Stimulation—A Pilot Study
title_full	A New Paired Associative Stimulation Protocol with High-Frequency Peripheral Component and High-Intensity 20 Hz Repetitive Transcranial Magnetic Stimulation—A Pilot Study
title_fullStr	A New Paired Associative Stimulation Protocol with High-Frequency Peripheral Component and High-Intensity 20 Hz Repetitive Transcranial Magnetic Stimulation—A Pilot Study
title_full_unstemmed	A New Paired Associative Stimulation Protocol with High-Frequency Peripheral Component and High-Intensity 20 Hz Repetitive Transcranial Magnetic Stimulation—A Pilot Study
title_sort	new paired associative stimulation protocol with high-frequency peripheral component and high-intensity 20 hz repetitive transcranial magnetic stimulation—a pilot study
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/75933447b049426cbf580c67a90c2eff
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A New Paired Associative Stimulation Protocol with High-Frequency Peripheral Component and High-Intensity 20 Hz Repetitive Transcranial Magnetic Stimulation—A Pilot Study

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