Intermittent Cerebellar Theta Burst Stimulation Improves Visuo-motor Learning in Stroke Patients: a Pilot Study
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Intermittent Cerebellar Theta Burst Stimulation Improves Visuo-motor Learning in Stroke Patients: a Pilot Study Sonia Bonnì 1 & Caterina Motta 1 & Maria Concetta Pellicciari 1 & Elias Paolo Casula 1 & Alex Martino Cinnera 1 & Michele Maiella 1 & Silvia Picazio 1 & Marco Tramontano 1 & Fabrizio Sallustio 2 & Giacomo Koch 1,3,4
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The cerebellum plays a critical role in promoting learning of new motor tasks, which is an essential function for motor recovery. Repetitive transcranial magnetic stimulation (rTMS) of the cerebellum can be used to enhance learning. In this study, we investigated the effects of cerebellar intermittent theta burst stimulation (c-iTBS), a high-frequency rTMS protocol, on visuomotor learning in a sample of hemiparetic patients due to recent stroke in the territory of the contralateral middle cerebral artery. Eight stroke patients were enrolled for the purposes of the study in the chronic stage of recovery (i.e., at least 6 months after stroke). In two sessions, Patients were randomly assigned to treatment with real or sham c-iTBS applied over the cerebellar hemisphere ipsilateral to the affected body side. c-iTBS was applied immediately before the learning phase of a visuo-motor adaptation task. Real, but not sham, c-iTBS improved visuo-motor learning as revealed by an increased performance in of the learning phase of the visuo-moto adaptation task. Moreover, we also found that real but not sham c-iTBS induced a sustained improvement in the re-adaptation of the recently learned skill (i.e., when patients were re-tested after 30 min). Taken together, these data point to c-iTBS as a potential novel strategy to promote motor learning in patients with stroke. Keywords Motor learning . Cerebellum . TMS/EEG . TBS . Stroke
Abbreviations TBS Theta burst stimulation VAT Visuo-motor adaptation task iTBS Intermittent theta burst stimulation cTBS Continuous theta burst stimulation TMS Transcranial magnetic stimulation LTP Long-term potentiation LTD Long-term depression CTC Cerebello-thalamo-cortical network AMT Active motor threshold Sonia Bonnì and Caterina Motta contributed equally to this work. * Giacomo Koch [email protected] 1
Non Invasive Brain Stimulation Unit/Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
2
Comprehensive Stroke Center, Department of Systems Medicine, University of Tor Vergata, Rome, Italy
3
Section of Human Physiology, eCampus University, Novedrate, Italy
4
Experimental Neuropsychophysiology Lab, IRCCS Fondazione S. Lucia, Via Ardeatina, 306, 00179 Rome, Italy
RMT EEG TEP TRSP
Resting motor threshold Electroencephalography TMS-evoked potential TMS-related spectral perturbation.
Introduction Stroke is the major cause of severe adult disability worldwide. Several neurological functions can be affected by stroke, but the most common is the motor system. In particular, the presence of motor impairment due to limb deficit after stroke is
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