Cyril Schneider

Neural mechanisms involved in the functional linking of motor cortical points.

We sought to understand the basic neural processes involved in the functional linking of motor cortical points. We asked which of the two basic neural mechanisms, excitation or inhibition, is required to functionally link motor cortical points. In the ketamineanaesthetized cat, a microstimulation electrode was positioned at a point (control point) that was identified by the following three characteristics of the EMG responses: the muscle(s) activated at threshold, any additional muscles recruited by supra-threshold stimulation, and their relative latency. A second distinct point (test point) producing activation of a muscle at a different joint was then identified. At this test cortical point the GABAA receptor antagonist bicuculline was ejected iontophoretically, while stimulating the control point near threshold. A combined response was elicited consisting of the response normally elicited at the control point plus that elicited at the test point. Thus, an artificial muscle synergy was produced following disinhibition of the test point. This was never the case when glutamate was ejected at the test point, even when supra-threshold stimuli were used at the control point. Therefore, simply increasing the excitability of a cortical point was not sufficient to release the muscle(s) represented at that point into a muscle synergy. Kynurenate, a broadly acting excitatory amino acid receptor antagonist, ejected at the bicuculline point reversed the effect of bicuculline. This shows that the release phenomenon was mediated synaptically and was not due to spread of the stimulating current. We suggest that release from inhibition may be one of the neural mechanisms involved in functionally linking motor cortical points. This functional linking may be part of the ensemble of motor cortical mechanisms involved in recruitment of muscle synergies.

Corticomotor control of deep abdominal muscles in chronic low back pain and anticipatory postural adjustments.

Contralateral transversus abdominis muscle (cTrA) is known to be anticipatory to rapid focal movement. The activation of ipsilateral TrA (iTrA) follows cTrA, but their anticipatory interaction in healthy subjects seems to be delayed in low back pain (LBP) patients. TrA delay in LBP is linked with reorganization of the primary motor cortex (M1), thus supporting that cortical changes underlie the altered postural control. Our study tested whether differences in postural adjustments were present in LBP for TrA onsets and co-activation, and whether these differences were paralleled by cortical motor changes. Thirteen chronic LBP patients and 9 healthy Controls were enrolled. Surface recordings of cTrA/internal oblique (IO) and iTrA/IO were collected during a rapid shoulder flexion task while standing. Transcranial magnetic stimulation of M1 tested TrA/IO corticospinal excitability, active motor threshold and short-interval intracortical inhibition (SICI). In LBP compared to Controls, iTrA/IO activation was delayed, co-activation was absent, timing between TrA/IO onsets was impaired, and SICI was missing. Between-outcomes correlations observed in one group were not significant in the other. Delay of iTrA/IO and the lacking co-activation were not explained by between-group differences of transcranial magnetic stimulation outcomes. TrA/IO co-activation is present during rapid focal movement in healthy subjects only. LBP patients displayed an important alteration of the control of spine stability that can be explained by altered mechanisms of M1 motor programming.

Cerebral motor function in very premature-at-birth adolescents: a brain stimulation exploration of kangaroo mother care effects.

Aim:  Given that prematurity has deleterious effects on brain networking development beyond childhood, the study explored whether an early intervention such as Kangaroo Mother Care (KMC) in very preterm preemies could have influenced brain motor function up to adolescence.

Enhancement of episodic memory in young and healthy adults: a paired-pulse TMS study on encoding and retrieval performance.

Transcranial magnetic stimulation (TMS) is a neurophysiological tool that can transiently influence brain excitability and improve cognitive performance. Facilitation effects induced by low frequency repetitive TMS on memory functions have been shown in a few studies in young and healthy participants [29] and in older individuals with memory complaints [40]. However, regions specifically involved in encoding and retrieval were not always systematically targeted. We thus aimed to facilitate episodic memory with online TMS systematically applied over the left or right dorsolateral prefrontal cortex (DLPFC) while participants were performing a recognition task. We applied online paired-pulse TMS (ppTMS) (15 ms inter-stimulus interval) either during encoding or retrieving of verbal or non-verbal material. Participants were 11 right-handed young individuals (21.33 ± 2.27 years old). Repeated measures ANOVA showed shorter reaction time when ppTMS are applied over the left DLPFC during encoding as compared to right homologous stimulation or to Sham condition. In contrast, ppTMS over the right DLPFC during retrieval was associated with shorter reaction times compared to left homologous stimulation. Overall, our data support for the first time that online ppTMS over the DLPFCs is capable of hastening memory processes in young and healthy individuals.

Paired-pulse transcranial magnetic stimulation over the dorsolateral prefrontal cortex interferes with episodic encoding and retrieval for both verbal and non-verbal materials

Neuroimaging studies report that encoding and retrieval processes of episodic memory constantly activate the left and right prefrontal cortex, even in the simplest memory tasks. Conversely, individuals with frontal lesions displayed impaired memory performance mainly in the most complex memory tasks. This discrepancy regarding the involvement of dorsolateral prefrontal cortex (DLPFC) may be explained by methodological divergences. Our goal was to study the critical role of the DLPFC in episodic encoding and retrieval processes according to the nature of the material (verbal or non-verbal) by using transcranial magnetic stimulation (TMS). Eighteen healthy adults performed a recognition task with words or random shapes. Paired-pulse TMS was applied (3-ms inter-pulse interval, at 90% of motor threshold) for inducing transient and safe interferences over the left or right DLPFCs during encoding or retrieval. Data analysis showed a reduced discrimination rate following TMS over the left DLPFC during encoding, as compared to a sham condition. Both hit and discrimination rates were also reduced after TMS over the right DLPFC, compared to TMS over left DLPFC, during retrieval. There was no difference between verbal and non-verbal material. Our results showed that the left and the right DLPFC play a critical role respectively in episodic encoding and retrieval processes for both verbal and non-verbal materials. Our findings are discussed in light of the findings obtained from other complementary approaches.

Task-specificity of bilateral anticipatory activation of the deep abdominal muscles in healthy and chronic low back pain populations

STUDY DESIGN Cross-sectional study of lumbopelvic muscle activation during rapid limb movements in chronic low back pain (CLBP) patients and healthy controls. INTRODUCTION Controversy exists over whether bilateral anticipatory activation of the deep abdominal muscles represents a normal motor control strategy prior to all rapid limb movements, or if this is simply a task-specific strategy appropriate for only certain movement conditions. OBJECTIVE To assess the onset timing of the transversus abdominis/internal oblique muscles (TrA/IO) during two rapid limb movement tasks with different postural demands - bilateral shoulder flexion in standing, unilateral hip extension in prone lying - as well as differences between CLBP and controls. METHODS Twelve CLBP and 13 controls performed the two tasks in response to an auditory cue. Surface EMG was acquired bilaterally from five muscles, including TrA/IO. RESULTS In both groups, 50% of bilateral shoulder flexion trials showed bilateral anticipatory TrA/IO activation. This was rare, however, in unilateral hip extension for which only the TrA/IO contralateral to the moving leg showed anticipatory activation. The only significant difference in lumbo-pelvic muscle onset timing between CLBP and controls was a delay in semitendinosus activation during bilateral shoulder flexion in standing. CONCLUSION Our data suggest that bilateral anticipatory TrA/IO activation is a task-specific motor control strategy, appropriate for only certain rapid limb movement conditions. Furthermore, the presence of altered semitendinosus onset timing in the CLBP group during bilateral shoulder flexion may be reflective of other possible lumbo-pelvic motor control alterations among this population.

Dynamic influence of wrist flexion and extension on the intracortical inhibition of the first dorsal interosseus muscle during precision grip

This work questioned further the influence of wrist movements on the control of precision grip. Seated subjects wearing a full-arm orthosis with the wrist and hand free were instructed to maintain a thumb/index finger opposition corresponding to 15% of maximal voluntary contraction for the first dorsal interosseus (FDI). Paired-pulse transcranial magnetic stimulation eliciting conditioned MEPs of FDI was used to determine the modulation of short intracortical inhibition (SICI) during cyclic active and passive wrist flexion and extension and during a static condition (no wrist movement, hand in the neutral position). The FDI active motor threshold (AMT) and the conditioning stimulus (0.8 AMT) were assessed in each series of FDI SICI measurements and the test stimulus (TS) was adjusted to match the amplitudes of test FDI MEPs across conditions. An increase of FDI background EMG during active wrist flexion compared to extension in some subjects did not influence FDI SICI as tested at matched EMG levels in the static condition. FDI SICI was reduced during wrist flexion (whether active or passive) compared to wrist extension, the latter being of equivalent FDI SICI as in the static condition. We suggest that wrist flexion and precision grip could be linked in a functional proximo-distal synergy. Indeed, coupling the activity between M1 sites of wrist flexors and FDI muscle via cortico-cortical disinhibition of FDI site may help recruit the interjoint synergy. Also, the salience of afferent information from wrist muscles may contribute to the phase-dependent modulation of SICI in the preactivated FDI muscle.

Psychometric evidence of spasticity measurement tools in cerebral palsy children and adolescents: a systematic review.

OBJECTIVE To conduct a systematic review using validated critical appraisal scales to analyze both the quality and content of the psychometric evidence of spasticity measurement tools in cerebral palsy children and adolescents. DATA SOURCES The literature search was performed in 3 databases (Pubmed, CINAHL, Embase) up to March 2012. STUDY SELECTION To be retained for detailed review, studies had to report on at least one psychometric property of one or many spasticity assessment tool(s) used to evaluate cerebral palsy children and adolescents. DATA EXTRACTION Two raters independently reviewed admissible articles using a critical appraisal scale and a structured data extraction form. DATA SYNTHESIS A total of 19 studies examining 17 spasticity assessment tools in cerebral palsy children and adolescents were reviewed. None of the reviewed tools demonstrated satisfactory results for all psychometric properties evaluated, and a major lack of evidence concerning responsiveness was emphasized. However, neurophysiological tools demonstrated the most promising results in terms of reliability and discriminating validity. CONCLUSIONS This systematic review revealed insufficient psychometric evidence for a single spasticity assessment tool to be recommended over the others in pediatric and adolescent populations.

Corticomotor control of lumbar multifidus muscles is impaired in chronic low back pain: concurrent evidence from ultrasound imaging and double-pulse transcranial magnetic stimulation

Chronic low back pain (CLBP) is often associated with impaired control of deep trunk muscles and reorganization of the primary motor areas (M1). Precisely, functional changes of the lumbar multifidus muscles (MF) involved in spine stability may be of special interest in rehabilitation. Therefore, we tested MF corticomotor control using double transcranial magnetic stimulation (TMS) paradigms for the first time in this muscle and examined its link with MF volitional activation. Eleven individuals with lateralized CLBP and 13 pain-free participants were recruited. Ultrasound imaging enabled measurement of MF volitional isometric contraction in prone lying. TMS of MF M1 area was used to test hemispheric excitability and mechanisms in relation to motor programming, i.e., active motor threshold (AMT), amplitude of motor-evoked potentials and short-interval intracortical inhibition (SICI) and facilitation (SICF). In CLBP, SICI level was lower in the left hemisphere and MF volitional contraction was not related to AMT (M1 excitability), conversely to what was observed in the pain-free group. No other between-group difference was detected. These original findings support a plasticity of cortical maps controlling paravertebral muscles and likely including a different motor strategy for the control of MF. Changes of M1 function may thus underlie impaired motor control of lumbopelvic spine and pain persistence in CLBP.

Reliability and minimal detectable change of transcranial magnetic stimulation outcomes in healthy adults: A systematic review

BACKGROUND Transcranial magnetic stimulation (TMS) is used worldwide for noninvasively testing human motor systems but its psychometric properties remain unclear. OBJECTIVE/HYPOTHESIS This work systematically reviewed studies on the reliability of TMS outcome measures of primary motor cortex (M1) excitability in healthy humans, with an emphasis on retrieving minimal detectable changes (MDC). METHODS The literature search was performed in three databases (Pubmed, CINAHL, Embase) up to June 2016 and additional studies were identified through hand-searching. French and English-written studies had to report the reliability of at least one TMS outcome of M1 in healthy humans. Two independent raters assessed the eligibility of potential studies, and eligible articles were reviewed using a structured data extraction form and two critical appraisal scales. RESULTS A total of 34 articles met the selection criteria, which tested the intra- and inter-rater reliability (relative and absolute subtypes) of several TMS outcomes. However, our critical appraisal of studies raised concerns on the applicability and generalization of results because of methodological and statistical pitfalls. Importantly, MDC were generally large and likely affected by various factors, especially time elapsed between sessions and number of stimuli delivered. CONCLUSIONS This systematic review underlined that the evidence about the reliability of TMS outcomes is scarce and affected by several methodological and statistical problems. Data and knowledge of the review provided however relevant insights on the ability of TMS outcomes to track plastic changes within an individual or within a group, and recommendations were made to level up the quality of future work in the field.