Este estudo foi apoiado por uma bolsa (A101901) a partir da Coreia do Healthcare Tecnologia R &amp; D Project, Ministério da Saúde e Bem-Estar, República da Coreia. Agradecemos Dr. Ji-Young Lee para a prestação de assistência técnica em todo o processo.

declaração de ética: Este estudo foi aprovado pelo conselho de revisão institucional de um hospital cego. 1. Materiais a preparação de (Tabela 1) <ol><li> Usar equipamento TMS com uma potência máxima de 3,0 Tesla e uma fonte de alimentação de 200-240 Vac 50/60 Hz 5A em uma largura de pulso de 350 ms. </li><li> Adquirir descansando limiar motor (RMT) em cada disciplina por meio da eletromiografia (EMG) para determinar o potencial evocado motor (MEP) usando o sistema TMS e o eletrodo ativo (veja o passo 3.1 para mais detalhes). Definir o RMT como intensidade individual para o protocolo de estudo TMS real (Figura 1). Nota: O sistema neuronavigational inclui uma tela de computador, perseguidor subjetiva, perseguidor bobina, ponteiro, bloco de calibração, câmera, e cadeira TMS sistema de assento. (Figuras 2 - 4) </li><li> Use o programa SuperLab para configurar a nomeação de figuras tarefa e apresentar o estímulo para os assuntos para testar o grau de virtu induzidaal afasia. </li><li> tempo de reacção é registado para cada imagem utilizando um sistema de gravação de voz, descrito em mais pormenor no passo 4. </li><li> Analisar a latência e a duração da resposta de nomeação por um sistema de análise de voz, descrito em mais pormenor no passo 4. </li></ol> 2. Verificar o Desenho do Estudo <ol><li> Use EMTr para induzir Virtual afasia. <ol><li> Peça ao sujeito para executar a tarefa de nomeação, descrito em mais pormenor no passo 4. imagem da tarefa de nomenclatura. </li><li> Aplicar quer EMTr guiada por neuronavegação (MNT) ou EMTr convencionais (CTMs) durante a tarefa de nomeação de figuras. Os detalhes de CTMs estão descritos nos passos 5.3.2 e 5.5. </li></ol></li><li> Medir o tempo de reacção e taxa de erro de nomeação e comparar os resultados sob ambas as condições, tal como descrito em mais pormenor no passo 4. </li></ol> 3. Preparação do Protocolo TMS <ol><li> determinar RMT <ol><li> Coloque o eletrodo ativo na primeira dorsal esquerda naterosseous (IED) muscular. </li><li> Entregar 10 estimulações consecutivas para a área M1 direito a um intervalo interstimulus 4-6 segundos, verificando a contração do músculo IED esquerda. </li><li> Determinar RMT do sujeito utilizando o mínimo de intensidade de TMS em que uma amplitude de MEP pico-a-pico de 50 uV maior do que é produzido, pelo menos, cinco vezes. </li></ol></li><li> Mapeamento TMS <ol><li> Obter uma alta resolução de ressonância magnética ponderada em T1 (MR) imagens anatômicas usando um scanner de ressonância magnética 3-T do assunto para o uso do sistema neuronavigational. Os parâmetros para o exame de MRI estão resumidos na Tabela 1. Nota: Transfira as imagens do cérebro de RM para o programa neuronavegação, que reconstrói a curvilínea cérebro e da pele de cada indivíduo usando a orientação anatômica da comissura anterior (AC) e comissura posterior (PC), como mostrado na Figura 5. <ol><li> Reconstruir a estrutura da pele <ol><li> Obter o arquivo de MR cérebro do sujeitoimagem na norma Digital Imaging e Comunicações em Medicina (DICOM). formato. Converter a imagem MR, selecionando &quot;estudo converso&quot;. Defina o diretório de pesquisa a partir do qual o arquivo é transferido para o computador neuronavegação. Converter tipo deve ser seleccionada por tipo DICOM para ser utilizado no programa neuronavegação. </li><li> Transferir o ficheiro DICOM para o computador em que o programa é instalado neuronavegação. Implementar o programa de navegação. O ícone padrão é &quot;Anatomical.&quot; Para um novo registro do paciente, selecione um dos arquivos de imagem DICOM. </li><li> Clique em &quot;espaços Atlas&quot;. Este passo é definir o ponto de referência para reconstruir cada imagem. Pressione &quot;novo&quot; na caixa de depósito e definir a estrutura anatômica de referência, clicando em &quot;manual (caixa de AC-PC)&quot;. </li><li> Encontrar AC do paciente do corpo caloso, apenas a linha média dos dois hemisférios colocados em frente das colunas do fórnice. Mark AC na imagem MR e clique em &quot;definir AC&quot;. </li><li> Encontrar o PC do paciente, a linha média dos dois hemisférios do aspecto dorsal da extremidade superior do aqueduto cerebral. Mark PC na imagem MR e clique em &quot;PC set&quot;. </li><li> Clique em &quot;Reconstruções&quot; para fazer a estrutura da pele. Pressione &quot;novo&quot; na caixa de depósito para selecionar &quot;Skin&quot;. Defina o intervalo para a reconstrução nas imagens de RM. Certifique-se de incluir todo o crânio com a ponta nasal e ambas as orelhas. </li><li> Clique em &quot;pele de computação&quot; na nova estrutura. Aguarde até que o processo é feito. Após a conclusão da construção de pele, a morfologia da pele deve ser exibida. </li></ol></li><li> Selecione &quot;curvilínea completa do cérebro&quot; na seção &quot;Reconstrução&quot; para reconstruir o cérebro seguinte curvilínea 3.2.1.1. Semelhante à etapa anterior, defina o intervalo para a reconstrução nas imagens de RM contendo a ponta nasal. Clique em &quot;curvilínea de computação&quot;. curvilínea cérebro cheia deve ser exibido após a construção seja concluída. </li></ol></li><li> Marque a nasion, ponta nasal, e ambos trago para registrar os pontos anatômicos. Este passo é para coincidir com o ponto anatómica entre o paciente e a estrutura da pele reconstruída para a configuração da posição relativa do alvo sobre o córtex cerebral (Figura 6). <ol><li> Clique no ícone &quot;Landmark&quot;. Para configurar o local de interesse, marcar o nasion (ponto entre o nariz na testa, na junção dos ossos nasais) sobre a estrutura da pele computadorizada. Registre-lo clicando em &quot;novo&quot; e armazená-lo como &quot;Landmark 1&quot; </li><li> Mark a ponta nasal após registrar nasion como marco 1. Registre a ponta nasal, clicando em &quot;novo&quot; e armazená-lo como &quot;Landmark 2&quot; </li><li> Marcar cada trago sobre a estrutura da pele. O tragus é a pequena eminência pontas da orelha externa, situado em frente à concha. Registar cada trago após a marcação e clicando em &quot;novos&quot; pontos de referência. Para este protocolo, o trago direito é regregis- como &quot;Landmark 3&quot; e à esquerda é registrado como &quot;Landmark 4&quot;. </li></ol></li><li> Coloque a cinta de cabeça com o tracker subjetiva sobre a cabeça do participante. Calibrar o rastreador da bobina com o bloco de calibração do sistema de assento de navegação em todas as sessões para cada sujeito. Certifique-se os detecta câmera de navegação e exibe todos o sistema de rastreamento do assunto, a cadeira, a bobina, e o ponteiro na tela do computador antes de prosseguir. <ol><li> Calibrar a bobina com o sistema de assento. <ol><li> Calibrar o rastreador da bobina antes de cada estimulação MNT. No menu principal do computador, selecione &quot;Janela&quot;. Clique em &quot;calibração bobina TMS&quot; no dropbox. Clique em &quot;nova calibração&quot;. Na segunda sessão, selecione o nome da bobina usada pela primeira vez e clique em &quot;recalibrar&quot;. </li><li> Coloque a bobina TMS na posterior ponto padrão de bloco de calibração. Certifique-se a bobina é colocada horizontalmente. Verifique se ocâmera está detectando tanto o bloco de calibração e rastreador bobina (mostrado em verde). Em seguida, clique em &quot;Começar a contagem regressiva de calibração&quot;, e a 5 seg de contagem regressiva vai começar. Segure a bobina ainda durante a contagem regressiva. </li></ol></li></ol></li></ol></li></ol> 4. Imagem Naming Task <ol><li> Definir o programa de nomeação para apresentar cada estímulo para 3.000 ms antes de avançar automaticamente para a próxima imagem. </li><li> Peça ao participante para nomear a imagem apresentada como com precisão e rapidez possível. </li><li> Medir o tempo de reação (latência de pop-up do estímulo na tela para o primeiro som feito pelo participante) para cada imagem ao detectar o som feito pelo sujeito através do microfone fone de ouvido usando o programa de análise de voz gratuito. <ol><li> Quarenta imagens combinadas de comprimento e segmentos de dois nome a três do banco de dados de imagem da versão coreana do Boston Naming Test (K-BNT) são apresentados no ecrãpré e pós estimulação, assim como no estudo por Kim et ai., (2014). </li></ol></li></ol> 5. TMS Mapping Protocol <ol><li> estimulação Hz Deliver1 a uma intensidade de 90% de RMT durante 10 minutos, com um total de 600 pulsos de TMS. </li><li> Segurar o tangencialmente bobina em forma de oito com o crânio com a bobina orientada perpendicularmente ao alvo. </li><li> Mapeamento de TMS (Figura 7) <ol><li> Identificar o giro anatómicas frontal inferior (IFG), com base na superfície do cérebro, normalizada para MNT. <ol><li> Registre o IFG como o alvo MNT. <ol><li> Clique em &quot;Target&quot; e pressione &quot;alvos Configurar&quot;. Marcar o IFG na janela que exibe o curvilínea cérebro. o estabelecimento de metas detalhadas é conseguido através da segmentação cada transversais e sagital imagens de RM. Salvar o ponto como &quot;Trajetória&quot;. </li></ol></li><li> Registre marcos com o couro cabeludo assuntos. <ol><li> Clique &quot;sessões&quot; para o mapeamento. Criouma nova sessão, selecionando &quot;sessão on-line&quot; na nova caixa de depósito. Uma janela &quot;Sessão 1&quot; é criado, no âmbito do qual o ícone padrão é &quot;alvos&quot;. Selecione o nome de destino salvo na etapa 3.2.2.2. (Selecione &quot;Trajetória 1&quot;). Clique no botão &quot;Adicionar&quot;, e passar para a próxima etapa. </li><li> Clique em &quot;Registro&quot;. Este passo é para combinar o curvilínea cérebro reconstruída com o assunto. O marco registrado no passo 3.2.2.1. é usado para combinar o ponto anatômico com a estrutura anatômica real. </li><li> Verifique se a câmera identifica o ponteiro e o rastreador assunto, exibido na cor verde. Apontam para nasion do sujeito com o ponteiro. Clique em &quot;Amostra% Ir para a próxima Landmark&quot;. Ponto a ponta nasal do sujeito e provar isso. Repita até que todos os quatro pontos de referência são correspondidos. </li></ol></li></ol></li><li> Coloque a bobina na F3 do sistema 10-20 EEG internacional 7 para CTMs. </li></ol></li><li>Olhar para a tela para assegurar a bobina está no alvo desejado e é mantido durante todo o procedimento MNT. A tela deve exibir superfície do sujeito cérebro, alvo pretendido, e a bobina, bem como a gama de erro, como a bobina se move para longe do alvo mostrado pelo olho-de-boi (Figura 8). Referindo-se ao ecrã, o operador ajusta a bobina sobre o alvo, uma vez que é afastado. <ol><li> Execute NTMS sobre o alvo registrada <ol><li> Clique em &quot;Executar&quot; na tela depois de registrar marcos das pessoas, conforme descrito no passo 5.3.1.1. Para alterar a configuração padrão da câmera para detectar o ponteiro, escolha o nome da bobina salvo durante a etapa 3.2.3.1. na parte inferior da caixa de depósito &quot;Driver&quot;. Verifique se a câmera identifica o rastreador assunto e rastreador bobina. </li><li> Verifique se a tela exibe a distância relativa e ângulo da bobina TMS do alvo registado (IFG). Se a bobina se move para longe do alvo, odistância está marcado em vermelho, enquanto ele é marcado em verde quando a bobina está dentro do intervalo alvo pretendido. Tente obter o ângulo entre a bobina e o destino como um olho de boi, tanto quanto possível. </li></ol></li></ol></li><li> Virar a tela longe do operador para o procedimento de CTMs para entregar cegamente o TMS. A bobina é mantida tal como foi no início da sessão. </li></ol> 6. Aquisição de Dados Topographic <ol><li> localização bobina de registro por estimulação premindo manualmente o botão &quot;record&quot; no controle remoto. </li><li> Após a gravação de cada estimulação, adquire coordenadas Taliarach em x, y, z para o alvo real e designada área de estimulada. </li><li> Retratam as coordenadas em um único cérebro normalizada usando o programa de processamento de imagem de freeware (MRIcro, http://www.mccauslandcenter.sc.edu/mricro/mricro/index.html). </li><li> Adquirir áreas cerebrais anatômicas correspondentes, incluindo a área de Brodmann, o gyrus, lobo, e região hemisfério etiquetas para a Talairach coordenadas usando um programa de rotulagem gratuito (Talairachclient, http://www.talairach.org/client.html). </li></ol>

<ol>
	<li>Barker, A. T., Jalinous, R., Freeston, I. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Non-invasive+magnetic+stimulation+of+human+motor+cortex.">Non-invasive magnetic stimulation of human motor cortex.</a> Lancet. 11 (1), 1106-1107 (1985).</li><li>Pape, T. L., Rosenow, J., Lewis, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transcranial+magnetic+stimulation:+a+possible+treatment+for+TBI.">Transcranial magnetic stimulation: a possible treatment for TBI.</a> J Head Trauma Rehabil. 21 (5), 437-451 (2006).</li><li>Ruohonen, J., Karhu, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Navigated+transcranial+magnetic+stimulation.">Navigated transcranial magnetic stimulation.</a> Neurophysiol Clin. 40 (1), 7-17 (2010).</li><li>Dell'Osso, B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Augmentative+repetitive+navigated+transcranial+magnetic+stimulation+(rTMS)+in+drug-resistant+bipolar+depression.">Augmentative repetitive navigated transcranial magnetic stimulation (rTMS) in drug-resistant bipolar depression.</a> Bipolar Disord. 11 (1), 76-81 (2009).</li><li>Herbsman, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=More+lateral+and+anterior+prefrontal+coil+location+is+associated+with+better+repetitive+transcranial+magnetic+stimulation+antidepressant+response.">More lateral and anterior prefrontal coil location is associated with better repetitive transcranial magnetic stimulation antidepressant response.</a> Biol Psychiatry. 66 (5), 509-515 (2009).</li><li>Schuhmann, T., Schiller, N. O., Goebel, R., Sack, A. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+temporal+characteristics+of+functional+activation+in+Broca's+area+during+overt+picture+naming.">The temporal characteristics of functional activation in Broca's area during overt picture naming.</a> Cortex. 45 (9), 1111-1116 (2009).</li><li>Danner, N., Julkunen, P., Kononen, M., Saisanen, L., Nurkkala, J., Karhu, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Navigated+transcranial+magnetic+stimulation+and+computed+electric+field+strength+reduce+stimulator-dependent+differences+in+the+motor+threshold.">Navigated transcranial magnetic stimulation and computed electric field strength reduce stimulator-dependent differences in the motor threshold.</a> J Neurosci Methods. 174 (1), 116-122 (2008).</li><li>Bashir, S., Edwards, D., Pascual-Leone, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Neuronavigation+increases+the+physiologic+and+behavioral+effects+of+low-frequency+rTMS+of+primary+motor+cortex+in+healthy+subjects.">Neuronavigation increases the physiologic and behavioral effects of low-frequency rTMS of primary motor cortex in healthy subjects.</a> Brain Topogr. 24 (1), 54-64 (2011).</li><li>Kim, W. J., Min, Y. S., Yang, E. J., Paik, N. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Neuronavigated+vs.+conventional+repetitive+transcranial+magnetic+stimulation+method+for+virtual+lesioning+on+the+Broca's+area.">Neuronavigated vs. conventional repetitive transcranial magnetic stimulation method for virtual lesioning on the Broca's area.</a> Neuromodulation. 17 (1), 16-21 (2014).</li><li>Lioumis, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+novel+approach+for+documenting+naming+errors+induced+by+navigated+transcranial+magnetic+stimulation.">A novel approach for documenting naming errors induced by navigated transcranial magnetic stimulation.</a> J Neurosci Methods. 204 (2), 349-354 (2012).</li><li>Hamilton, R. H., Chrysikou, E. G., Coslett, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mechanisms+of+aphasia+recovery+after+stroke+and+the+role+of+noninvasive+brain+stimulation.">Mechanisms of aphasia recovery after stroke and the role of noninvasive brain stimulation.</a> Brain Lang. 118 (1-2), 40-50 (2011).</li><li>Pascual-Leone, A., Walsh, V., Rothwell, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transcranial+magnetic+stimulation+in+cognitive+neuroscience--virtual+lesion,+chronometry,+and+functional+connectivity.">Transcranial magnetic stimulation in cognitive neuroscience--virtual lesion, chronometry, and functional connectivity.</a> Curr Opin Neurobiol. 10 (2), 232-237 (2000).</li><li>Julkunen, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+navigated+and+non-navigated+transcranial+magnetic+stimulation+for+motor+cortex+mapping,+motor+threshold+and+motor+evoked+potentials.">Comparison of navigated and non-navigated transcranial magnetic stimulation for motor cortex mapping, motor threshold and motor evoked potentials.</a> Neuroimage. 44 (3), 790-795 (2009).</li><li>Chrysikou, E. G., Hamilton, R. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Noninvasive+brain+stimulation+in+the+treatment+of+aphasia:+exploring+interhemispheric+relationships+and+their+implications+for+neurorehabilitation.">Noninvasive brain stimulation in the treatment of aphasia: exploring interhemispheric relationships and their implications for neurorehabilitation.</a> Restor Neurol Neurosci. 29 (6), 375-394 (2011).</li></ol>

All authors declare no conflict of interest.

TMS é amplamente utilizado tanto na prática clínica e pesquisa básica. 10 efeitos terapêuticos valiosos são oferecidos pela influência fisiológica da EMTr, incluindo um efeito neuromodulador inibitória sobre a excitabilidade cortical com EMTr de baixa frequência para o tratamento de afasia. 11 interrupção transitória de processamento neural ou virtual a lesão induzida pela rTMS pode alterar o desempenho comportamental. 12 no entanto, o efeito desejado de a rTMS pode ser dil...

Estimulação magnética transcraniana repetitiva (EMTr) de forma não invasiva ativa circuitos neuronais no sistema nervoso central e periférico. 1 EMTr modula a excitabilidade cerebral 2 e tem efeitos terapêuticos potenciais em diversas condições psiquiátricas e neurológicas, tais como fraqueza motora, afasia, negligência e dor . 3 os sítios-alvo para fins que não o córtex motor são convencionalmente identificados utilizando o sistema internacional 10-20 EEG EMTr ou medindo as distâncias de certos pontos de referência externos. No entanto, as diferenças inter-individuais no tamanho, anatomia e morfologia do córtex cerebral não são tomadas em consideração, tornando localização óptima alvo desafiador. 3 Um outro problema crítico para aplicações rTMS é a discordância entre a colocação da bobina magnética e a região cortical estimulação pretendido. Opticamente rastreados neurocirurgia navegação tem expaplicações de TI ANDed para abranger o campo da neurociência cognitiva, incluindo a EMTr de orientação da bobina magnética. O sistema neuronavigational auxilia na identificação das estruturas alvo óptimas para a rTMS 4,5. Tal divergência no posicionamento da bobina na área alvo ocorre frequentemente com o método convencional, que adopta o sistema de EEG 10-20, e este é esperado para ser superada por neuronavegação. Este protocolo de estudo demonstra um método para induzir a afasia virtual em indivíduos saudáveis ​​por EMTr neuronavigational segmentação área de Broca, utilizando o mapeamento anatômico individual. O grau de afasia virtual em termos de mudança de tempo de reacção a nomenclatura imagem é medido e comparado com os do método de estimulação convencional. O método guiada por neuronavegação tem maior precisão para a entrega de impulsos magnéticos ao cérebro, e é, portanto, espera-se que demonstram maior mudança clínica do que a do método convencional. O objetivo deste parafuso prisioneiroy foi a introdução de um método mais preciso e eficaz de estimulação para pacientes com afasia em ambiente clínico.

<table><tbody><tr><td>Medtronic MagPro X100</td><td>MagVenture</td><td>9016E0711</td><td></td></tr><tr><td>MCF-B65 Butterfly coil</td><td>MagVenture</td><td>9016E042</td><td></td></tr><tr><td>Brainsight TMS Navigation</td><td>Rogue Research</td><td>&lt;br/&gt; KITBSF1003&amp;nbsp;</td><td></td></tr></tbody></table>

neuronavigation-guided repetitive transcranial magnetic stimulation for aphasia

estimulação magnética transcraniana repetitiva (EMTr) é amplamente utilizado para várias condições neurológicas, como ele ganhou reconhecimento por seus potenciais efeitos terapêuticos. Cérebro excitabilidade é modulada de forma não invasiva por EMTr e EMTr para as áreas de linguagem provou seus potenciais efeitos sobre tratamento de afasia. Em nosso protocolo, pretendemos induzir artificialmente afasia virtual em indivíduos saudáveis ​​inibindo área de Brodmann 44 e 45 usando neuronavigational TMS (MNT) e F3 do Sistema Internacional 10-20 EEG para TMS convencional (CTMs). Para medir o grau de afasia, alterações no tempo de reação a uma nomeação de figuras pré-tarefa e pós-estimulação são medidos e comparar o atraso no tempo de reação entre NTMS e CTMs. Precisão dos dois métodos de estimulação TMS é comparada a média da Talairach coordenadas do alvo eo estímulo real. Consistência de estimulação é demonstrada pela gama de erro a partir do alvo. O objectivo da presente Study é demonstrar uso de MNT e descrever os benefícios e limitações das MNT em comparação com aqueles de CTMs.

Kim et al., Demonstraram um efeito mais superior de TMS com orientação sistema neuronavigational em comparação com o método convencional não-navegado por menor dispersão de estímulo e estimulação mais focal para a área M1 direita, 8, como mostrado na Figura 9. Evidência adicional para apoiar a incorporação o sistema neuronavigational com TMS é demonstrada por um experimento randomizado cruzado para induzir a afasia virtual em indivíduo...

Watch this Scientific Journal Video about Neuronavigation-guided Repetitive Transcranial Magnetic Stimulation for Aphasia at JoVE.com

Neuronavigation-guided Repetitive Transcranial Magnetic Stimulation for Aphasia

This study is designed to test the hypothesis that neuronavigational system-guided transcranial magnetic stimulation has higher accuracy for targeting the intended target as demonstrated by eliciting a greater degree of virtual aphasia in healthy subjects, measured by delay in reaction time to picture naming.

Repetitiva Estimulação Magnética Transcraniana guiada por neuronavegação para a afasia

Repetitive transcranial magnetic stimulation (rTMS) is widely used for several neurological conditions, as it has gained acknowledgement for its potential ...

neuronavigation-guided-repetitive-transcranial-magnetic-stimulation

Universidad de Cartagena UDEC

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JoVE Journal

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12.0K visualizações.  Inje University of Medicine, Haeundae Paik Hospital. This study is designed to test the hypothesis that neuronavigational system-guided transcranial magnetic stimulation has higher accuracy for targeting the intended target as demonstrated by eliciting a greater degree of virtual aphasia in healthy subjects, measured by delay in reaction time to picture naming.

Vídeo: Neuronavigation-guided Repetitive Transcranial Magnetic Stimulation for Aphasia

Functional Magnetic Resonance Imaging (fMRI) with Auditory Stimulation in Songbirds

The neurobiology of birdsong, as a model for human speech, is a pronounced area of research in behavioral neuroscience. Whereas electrophysiology and molecular approaches allow the investigation of either different stimuli on few neurons, or one stimulus in large parts of the brain, blood oxygenation level dependent (BOLD) functional Magnetic Resonance Imaging (fMRI) allows combining both advantages, i.e. compare the neural activation induced by different stimuli in the entire brain at once. fMRI in songbirds is challenging because of the small size of their brains and because their bones and especially their skull comprise numerous air cavities, inducing important susceptibility artifacts. Gradient-echo (GE) BOLD fMRI has been successfully applied to songbirds 1-5 (for a review, see 6). These studies focused on the primary and secondary auditory brain areas, which are regions free of susceptibility artifacts. However, because processes of interest may occur beyond these regions, whole brain BOLD fMRI is required using an MRI sequence less susceptible to these artifacts. This can be achieved by using spin-echo (SE) BOLD fMRI 7,8 . In this article, we describe how to use this technique in zebra finches (Taeniopygia guttata), which are small songbirds with a bodyweight of 15-25 g extensively studied in behavioral neurosciences of birdsong. The main topic of fMRI studies on songbirds is song perception and song learning. The auditory nature of the stimuli combined with the weak BOLD sensitivity of SE (compared to GE) based fMRI sequences makes the implementation of this technique very challenging.

Functional Magnetic Resonance Imaging fMRI with Auditory Stimulation in Songbirds

This article shows an optimized procedure for imaging of the neural substrates of auditory stimulation in the songbird brain using functional Magnetic Resonance Imaging (fMRI). It describes the preparation of the sound stimuli, the positioning of the subject and the acquisition and subsequent analysis of the fMRI data.

Ressonância Magnética Funcional (fMRI), com estimulação auditiva em aves canoras

The neurobiology of birdsong, as a model for human speech, is a pronounced area of research in behavioral neuroscience. Whereas electrophysiology and ...

Comportamento

Stimulating the Lip Motor Cortex with Transcranial Magnetic Stimulation

Transcranial magnetic stimulation (TMS) has proven to be a useful tool in investigating the role of the articulatory motor cortex in speech perception. Researchers have used single-pulse and repetitive TMS to stimulate the lip representation in the motor cortex. The excitability of the lip motor representation can be investigated by applying single TMS pulses over this cortical area and recording TMS-induced motor evoked potentials (MEPs) via electrodes attached to the lip muscles (electromyography; EMG). Larger MEPs reflect increased cortical excitability. Studies have shown that excitability increases during listening to speech as well as during&#160;viewing speech-related movements. TMS can be used also to disrupt the lip motor representation. A 15-min train of low-frequency sub-threshold repetitive stimulation has been shown to suppress motor excitability for a further 15-20 min. This TMS-induced disruption of the motor lip representation impairs subsequent performance in demanding speech perception tasks and modulates auditory-cortex responses to speech sounds. These findings are consistent with the suggestion that the motor cortex contributes to speech perception. This article describes how to localize the lip representation in the motor cortex and how to define the appropriate stimulation intensity for carrying out both single-pulse and repetitive TMS experiments.

Transcranial magnetic stimulation (TMS) has proven to be a useful tool in investigating the role of the articulatory motor cortex in speech perception.&#160; This article describes how to record motor evoked potentials (MEPs) from the lip muscles and how to disrupt the motor lip representation using repetitive TMS.

Estimular o Lip Motor Cortex com Estimulação Magnética Transcraniana

Transcranial magnetic stimulation (TMS) has proven to be a useful tool in investigating the role of the articulatory motor cortex in speech perception. ...

Utilizing Transcranial Magnetic Stimulation to Study the Human Neuromuscular System

Transcranial magnetic stimulation (TMS) has been in use for more than 20 years 1, and has grown exponentially in popularity over the past decade. While the use of TMS has expanded to the study of many systems and processes during this time, the original application and perhaps one of the most common uses of TMS involves studying the physiology, plasticity and function of the human neuromuscular system. Single pulse TMS applied to the motor cortex excites pyramidal neurons transsynaptically 2 (Figure 1) and results in a measurable electromyographic response that can be used to study and evaluate the integrity and excitability of the corticospinal tract in humans 3. Additionally, recent advances in magnetic stimulation now allows for partitioning of cortical versus spinal excitability 4,5. For example, paired-pulse TMS can be used to assess intracortical facilitatory and inhibitory properties by combining a conditioning stimulus and a test stimulus at different interstimulus intervals 3,4,6-8. In this video article we will demonstrate the methodological and technical aspects of these techniques. Specifically, we will demonstrate single-pulse and paired-pulse TMS techniques as applied to the flexor carpi radialis (FCR) muscle as well as the erector spinae (ES) musculature. Our laboratory studies the FCR muscle as it is of interest to our research on the effects of wrist-hand cast immobilization on reduced muscle performance6,9, and we study the ES muscles due to these muscles clinical relevance as it relates to low back pain8. With this stated, we should note that TMS has been used to study many muscles of the hand, arm and legs, and should iterate that our demonstrations in the FCR and ES muscle groups are only selected examples of TMS being used to study the human neuromuscular system.

Transcranial magnetic stimulation (TMS) is a non-invasive tool to gain insight on the physiology and function of the human nervous system. Here, we present our TMS techniques to study cortical excitability of the upper limb and lumbar musculature.

Utilizando Estimulação Magnética Transcraniana para o Estudo do sistema neuromuscular humano

Transcranial magnetic stimulation (TMS) has been in use for more than 20 years 1, and has grown exponentially in popularity over the past decade.  While ...

Medicina

Repetitive Transcranial Magnetic Stimulation to the Unilateral Hemisphere of Rat Brain

Previous rodent models of repetitive transcranial magnetic stimulation (rTMS) adopted whole-brain stimulation instead of unilateral hemispheric rTMS, which is unlike the protocols used for human subjects. We report a successful application of rTMS to the unilateral hemisphere of rat brain. The rTMS was delivered with a low-frequency (1 Hz), high-frequency (20 Hz), or sham stimulation protocol to one side of the brain by using a small 25-mm figure-8 coil. We placed the center of the coil 1 cm lateral to the vertex on the biauricular line and angulated the coil 45&#176; to the ground to minimize a potential direct effect of rTMS on the contralateral cortex. We also used an in-house water cooling system to enable repetitive magnetic stimulation for more than 20 min, even at a 20-Hz stimulation frequency. Increases in the transcriptions of immediate early genes (Arc, Junb, and Egr2) were greater after rTMS than after sham stimulation. After 5 consecutive days of 20-min 1-Hz rTMS, bdnf mRNA expression was significantly higher in stimulated cortex than in contralateral side. The model presented herein will elucidate the molecular mechanisms of rTMS by allowing analysis of the inter-hemispheric difference in its effect.

We applied repetitive transcranial magnetic stimulation (rTMS) to the unilateral hemisphere of rat brain, by placing a 25-mm figure-8 coil 1 cm lateral to the vertex on the biauricular line and angulating the coil by 45&#176;. An in-house water cooling system was used for rTMS for more than 20 min.

Estimulação Magnética Transcraniana repetitiva para o Hemisfério unilateral do cérebro de rato

Previous rodent models of repetitive transcranial magnetic stimulation (rTMS) adopted whole-brain stimulation instead of unilateral hemispheric rTMS, ...

Utilizing Repetitive Transcranial Magnetic Stimulation to Improve Language Function in Stroke Patients with Chronic Non-fluent Aphasia

Transcranial magnetic stimulation (TMS) has been shown to significantly improve language function in patients with non-fluent aphasia1. In this experiment, we demonstrate the administration of low-frequency repetitive TMS (rTMS) to an optimal stimulation site in the right hemisphere in patients with chronic non-fluent aphasia. A battery of standardized language measures is administered in order to assess baseline performance. Patients are subsequently randomized to either receive real rTMS or initial sham stimulation. Patients in the real stimulation undergo a site-finding phase, comprised of a series of six rTMS sessions administered over five days; stimulation is delivered to a different site in the right frontal lobe during each of these sessions. Each site-finding session consists of 600 pulses of 1 Hz rTMS, preceded and followed by a picture-naming task. By comparing the degree of transient change in naming ability elicited by stimulation of candidate sites, we are able to locate the area of optimal response for each individual patient. We then administer rTMS to this site during the treatment phase. During treatment, patients undergo a total of ten days of stimulation over the span of two weeks; each session is comprised of 20 min of 1 Hz rTMS delivered at 90% resting motor threshold. Stimulation is paired with an fMRI-naming task on the first and last days of treatment. After the treatment phase is complete, the language battery obtained at baseline is repeated two and six months following stimulation in order to identify rTMS-induced changes in performance. The fMRI-naming task is also repeated two and six months following treatment. Patients who are randomized to the sham arm of the study undergo sham site-finding, sham treatment, fMRI-naming studies, and repeat language testing two months after completing sham treatment. Sham patients then cross over into the real stimulation arm, completing real site-finding, real treatment, fMRI, and two- and six-month post-stimulation language testing.

We explore the use of repetitive transcranial magnetic stimulation (rTMS) to improve language abilities in patients with chronic stroke and non-fluent aphasia. After identifying a site in the right frontal gyrus for each patient that responds optimally to stimulation, we target this site during ten days of rTMS treatment.

Utilizando estimulação magnética transcraniana repetitiva para melhorar a função da linguagem em pacientes com AVC crônico com afasia não-fluente

Transcranial magnetic stimulation (TMS) has been shown to significantly improve language function in patients with non-fluent aphasia1. In this ...

Individualized rTMS Treatment for Depression using an fMRI-Based Targeting Method

To achieve greater clinical efficacy, a revolution in treatment for major depressive disorder (MDD) is highly anticipated. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive and safe neuromodulation technique that immediately changes brain activity. Despite its wide application in the treatment for MDD, the treatment response remains different among individuals, which may be attributable to the inaccurate positioning of the stimulation target. Our study aims to examine whether the functional magnetic resonance imaging (fMRI)-assisted positioning improves the efficacy of rTMS in treating depression. We intend to identify and stimulate the subregion of dorsolateral prefrontal cortex (DLPFC) in MDD with strongest anti-correlation with the subgenual anterior cingulate cortex (sgACC), and to conduct a comparative investigation of this novel method and the traditional 5-cm rule. To achieve more precise stimulation, both methods were applied under the guidance of neuronavigation system. We expected that the TMS treatment with individualized positioning based on resting state functional connectivity may show better clinical efficacy than the 5-cm method.

The present protocol describes the application of repetitive transcranial magnetic stimulation (rTMS), where a subregion of the dorsolateral prefrontal cortex (DLPFC) with the strongest functional anticorrelation with the subgenual anterior cingulate cortex (sgACC) was located as the stimulation target under the assistance of a fMRI-based neuronavigation system.

Tratamento individualizado de rTMS para depressão usando um método de segmentação baseado em fMRI

To achieve greater clinical efficacy, a revolution in treatment for major depressive disorder (MDD) is highly anticipated. Repetitive transcranial ...

MRI-guided dmPFC-rTMS as a Treatment for Treatment-resistant Major Depressive Disorder

Here we outline the protocol for magnetic resonance imaging (MRI) guided repetitive transcranial magnetic stimulation (rTMS) to the dorsal medial prefrontal cortex (dmPFC) in patients with major depressive disorder (MDD). Technicians used a neuronavigation system to process patient MRIs to generate a 3-dimensional head model. The head model was subsequently used to identify patient-specific stimulatory targets. The dmPFC was stimulated daily for 20 sessions. Stimulation intensity was titrated to address scalp pain associated with rTMS. Weekly assessments were conducted on the patients using the Hamilton Rating Scale for Depression (HamD17) and Beck Depression Index II (BDI-II). Treatment-resistant MDD patients achieved significant improvements on both HAMD and BDI-II. Of note, angled, double-cone coil rTMS at 120% resting motor threshold allows for optimal stimulation of deeper midline prefrontal regions, which results in a possible therapeutic application for MDD. One major limitation of the rTMS field is the heterogeneity of treatment parameters across studies, including duty cycle, number of pulses per session and intensity. Further work should be done to clarify the effect of stimulation parameters on outcome. Future dmPFC-rTMS work should include sham-controlled studies to confirm its clinical efficacy in MDD.

Here we outline the procedure for MRI-guided repetitive transcranial magnetic stimulation to the dorsomedial prefrontal cortex as an experimental treatment for major depressive disorder.

Guiada por MRI dmPFC-EMTr como um tratamento para o Transtorno Depressivo Maior resistente ao tratamento

Here we outline the protocol for magnetic resonance imaging (MRI) guided repetitive transcranial magnetic stimulation (rTMS) to the dorsal medial ...

Combined Transcranial Magnetic Stimulation and Electroencephalography of the Dorsolateral Prefrontal Cortex

Transcranial magnetic stimulation (TMS) is a non-invasive method that produces neural excitation in the cortex by means of brief, time-varying magnetic field pulses. The initiation of cortical activation or its modulation depends on the background activation of the neurons of the cortical region activated, the characteristics of the coil, its position and its orientation with respect to the head. TMS combined with simultaneous electrocephalography (EEG) and neuronavigation (nTMS-EEG) allows for the assessment of cortico-cortical excitability and connectivity in almost all cortical areas in a reproducible manner. This advance makes nTMS-EEG a powerful tool that can accurately assess brain dynamics and neurophysiology in test-retest paradigms that are required for clinical trials. Limitations of this method include artifacts that cover the initial brain reactivity to stimulation. Thus, the process of removing artifacts may also extract valuable information. Moreover, the optimal parameters for dorsolateral prefrontal (DLPFC) stimulation are not fully known and current protocols utilize variations from the motor cortex (M1) stimulation paradigms. However, evolving nTMS-EEG designs hope to address these issues. The protocol presented here introduces some standard practices for assessing neurophysiological functioning from stimulation to the DLPFC that can be applied in patients with treatment resistant psychiatric disorders that receive treatment such as transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), magnetic seizure therapy (MST) or electroconvulsive therapy (ECT).

The protocol presented here is for TMS-EEG studies utilizing intracortical excitability test-retest design paradigms. The intent of the protocol is to produce reliable and reproducible cortical excitability measures for assessing neurophysiological functioning related to therapeutic interventions in the treatment of neuropsychiatric diseases such as major depression.

Estimulação magnética transcraniana combinada e Eletroencefalografia do córtex pré-frontal Dorsolateral

Transcranial magnetic stimulation (TMS) is a non-invasive method that produces neural excitation in the cortex by means of brief, time-varying magnetic ...

Neurociência

Study Design for Navigated Repetitive Transcranial Magnetic Stimulation for Speech Cortical Mapping

The cortical areas involved in human speech should be characterized reliably prior to surgery for brain tumors or drug-resistant epilepsy. The functional mapping of language areas for surgical decision-making is usually done invasively by electrical direct cortical stimulation (DCS), which is used to identify the organization of the crucial cortical and subcortical structures within each patient. Accurate preoperative non-invasive mapping aids surgical planning, reduces time, costs, and risks in the operating room, and provides an alternative for patients not suitable for awake craniotomy. Non-invasive imaging methods like MRI, fMRI, MEG, and PET are currently applied in presurgical design and planning. Although anatomical and functional imaging can identify the brain regions involved in speech, they cannot determine whether these regions are critical for speech. Transcranial magnetic stimulation (TMS) non-invasively excites the cortical neuronal populations by means of electric field induction in the brain. When applied in its repetitive mode (rTMS) to stimulate a speech-related cortical site, it can produce speech-related errors analogous to those induced by intraoperative DCS. rTMS combined with neuronavigation (nrTMS) enables neurosurgeons to preoperatively assess where these errors occur and to plan the DCS and the operation to preserve the language function. A detailed protocol is provided here for non-invasive speech cortical mapping (SCM) using nrTMS. The proposed protocol can be modified to best fit the patient- and site-specific demands. It can also be applied to language cortical network studies in healthy subjects or in patients with diseases that are not amenable to surgery.

Navigated repetitive transcranial magnetic stimulation is a highly efficient non-invasive tool for mapping speech-related cortical areas. It helps in designing brain surgery and speeds up the direct cortical stimulation conducted during the surgery. This report describes how to perform speech cortical mapping reliably for preoperative evaluation and research.

Desenho de Estudo para Estimulação Magnética Transcraniana Repetitiva Navegada para Mapeamento Cortical de Fala

The cortical areas involved in human speech should be characterized reliably prior to surgery for brain tumors or drug-resistant epilepsy. The functional ...

Treinamento de Intervenção Combinada para Crianças com Paralisia Cerebral Espástica 

Repeated Transcranial Magnetic Stimulation Combined with Action Observation Training in Children with Spastic Cerebral Palsy

This study presents the results of a randomized controlled trial utilizing a 2 x 2 factorial design, comparing the effects of repeated transcranial magnetic stimulation (rTMS) and action observation training (AOT) intervention methods on spasticity, balance function, and motor function in children with spastic cerebral palsy (SCP). The study aimed to investigate whether the combination of the two interventions produces greater improvement than either treatment alone or conventional treatment.
Subject children in this study, in accordance with the random number table, were randomly divided into four groups: conventional group, rTMS group, AOT group, and combined intervention group. All the children in the four groups received conventional rehabilitation treatment, on the basis of which they were given different therapeutic programs of rehabilitation measures. The conventional group had no other treatment while the rTMS group received rTMS, the AOT group received AOT and the combined intervention group was given a combined intervention of rTMS and AOT. They were trained five days per week for 12 weeks. Changes in scores of spasticity, balance function, walking ability, and gross motor function were assessed at the onset of the training program and upon completion of 12 weeks of treatment.
A total of 64 Children with SCP completed the study, and their results were analyzed. The total gross motor function efficiency of 87.50% in the experimental group was significantly higher than that of 25.00% in the conventional group, 62.50% in the rTMS group, and 68.75% in the AOT group. The preliminary results showed that combined intervention of rTMS and AOT could effectively improve the balance function and motor function of children, and the therapeutic effect of the combined intervention was better than that of conventional treatment, rTMS or AOT alone. Finally, clinical efficacy and optimal treatment parameters of the combined intervention were clarified to provide a clinical basis for therapists to conduct lower limb function rehabilitation for children with SCP.

Autor em destaque: Estimulação magnética transcraniana repetitiva combinada com observação de movimento na paralisia cerebral

Children with spastic cerebral palsy (SCP) have limb spasticity, movement disorders, and abnormal posture due to injury to the cerebral cortex motor area, resulting in inability to stand and walk normally. Therefore, alleviating limb spasticity and enhancing gross motor function in children with SCP have become important therapeutic goals.

Estimulação Magnética Transcraniana Repetida Combinada com Treinamento de Observação de Ação em Crianças com Paralisia Cerebral Espástica

This study presents the results of a randomized controlled trial utilizing a 2 x 2 factorial design, comparing the effects of repeated transcranial ...