396 Abstracts / Brain Stimulation 10 (2017) 346e540

[0241] [0244]
CORTICAL TREATMENT OF NEUROPATHIC WITH RTMS AND TDCS: FROM THE EFFECT OF SUBTHALAMIC DEEP BRAIN STIMULATION ON
ANECDOTE TO EVIDENCE EXECUTIVE AND MEMORY FUNCTIONS IN PARKINSON'S DISEASE

L. Garcia-Larrea*. Inserm and University Of Lyon, France
cs 1, I. Vala

G. Demeter*1, 2, P. Pajkossy 1, 2, A. Szollosi 1, A. Luka
lik 1, M.
Racsma
ny 1, 2. 1 Budapest University of Technology and Economics, Hungary;
2
Following the description of epidural motor cortex stimulation for the Hungarian Academy of Sciences, Hungary
treatment of neuropathic pain (NP), attempts to mimic its effects with
non-invasive procedures were rapidly launched. rTMS was initially meant Introduction: The aim of the present study was to asses the effect of
to select optimal candidates to implanted stimulation, but has now been bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN)
gaining a place as a stand-alone therapy. The bulk of published evidence on executive and memory functions in patients with Parkinsons disease
led a European Task Force to assign A-level of proof to rTMS of the motor (PD).
cortex as a therapeutic option for chronic NP, while the value of tDCS re- Methods: PD patients with DBS implantation (DBS group) and PD wait-
mains under scrutiny. Both techniques continue to evolve, and new targets listed patients (control group) participated in the study. A neuropsycho-
and procedures are continuously tested. Regarding motor rTMS, there is logical battery was used to assess cognitive functions. Each task was
consensus that signicant pain relief is achieved when stimulating antero- administered twice: before and after surgery in the DBS group with the
posteriorly with focal coils at high frequencies (5 Hz) whereas low-fre- stimulators on and with a similar time interval between the two task-
quency stimulation (1 Hz) does not induce pain relief. Daily sessions over administration points in the control group. Surgical procedure was based
5-10 days may yield benet lasting up to two months, and single sessions on planning with custom-developed Vister-3D software frameless MRI to
repeated every two weeks might also allow long-term analgesia. The CT image fusion and with RM and MHT stereotactic systems. Intra-
motor cortex remains the preferred rTMS target in NP, while S1, pre-motor operatively 3 to 5-channel microelectrode recording has been applied with
cortex, SMA and dorsolateral prefrontal cortex have been tested with registration of Neurospot (Neurostar) recording equipment. Model 3389
mainly negative results. Trials aiming at targeting deep regions such as the electrodes were implanted bilaterally in all cases and were connected to
posterior insular cortex are currently in progress. The evidence appears Activa PC dual channel implantable pulse generators.
solid that rTMS can alleviate chronic NP in a proportion of patients; trials Results: There was no signicant difference between the DBS and the
in bromyalgia or diffuse pains have yielded mixed results, and this option control groups performance in tasks measuring short-term and working
is not yet supported by high-level evidence. Whether rTMS can decrease memory and main executive functions. The DBS group showed a signi-
experimental pain remains a matter of debate, and a recent prospective cant decline on the semantic verbal uency task after surgery compared to
study suggested that rTMS may not modify acute heat pain in healthy its own baseline level (p < .05). Additionally, the DBS group showed a
subjects. rTMS might behave like other anti-neuropathic drugs, which act decreased execution cost score at the second assessment point of the
upon abnormal mechanisms of sensitization, rather than on physiological prospective memory task, compared to the control group (p < .05).
nociception. Finding solutions to perpetuate the analgesic effects is a Discussion: Our results provide support for the cognitive safety of the STN
current major challenge, and home-based neurostimulation systems are DBS using a wait-listed PD control group. The DBS group showed impaired
now undergoing clinical trials. performance after the surgery only on the semantic verbal uency task
Keywords: Neuropathic pain, Home-based neurostimualtion, rTMS, tDCS which is in line with ndings of previous studies. Furthermore, to the best
of our knowledge, this is the rst study to show that DBS of the STN boosts
[0243] prospective memory, in particular intention execution functions.
LOW INTENSITY RTMS DOES NOT CHANGE EXCITABILITY IN CORTICAL Keywords: Parkinsons disease, Deep brain stimulation, executive func-
LAYER V AS MEASURED BY IN VIVO LOCAL FIELD POTENTIALS tions, memory

M. Sykes*1, 2, A. Tang 2, J. Rodger 2, J.N.J. Reynolds 1. 1 University of Otago, [0245]

New Zealand; 2 University of Western Australia, Australia CHANGES IN THE LEVEL OF VOLUNTARY ACTIVATION AFTER FATIGUING
FINGER TAPPING
Repetitive transcranial magnetic stimulation is a method commonly
applied to non-invasively modulate cortical excitability, using strong (~1 ~ a, Spain
A. Madrid*, E. Medinabeitia, J. Cudeiro, P. Arias. Universidade da Corun
tesla) magnetic pulses. Outside of the targeted, focal zone, however, are
broad areas exposed to a lower strength magnetic eld, for many neurons Introduction: Finger-tapping (FT) frequency at maximal-rate decreases in
below the threshold for direct depolarisation. Increasing evidence has few seconds after task beginning. This form of fatigue seems to take place at
emerged to suggest that elds 100 milliTesla or lower are able, however, to supraspinal levels (1), but central-fatigue (CF) induced by fast and brief FT
modulate cellular properties such as calcium levels and ring thresholds in has not been evaluated with the twitch-interpolation technique. This
vitro. In vivo, 10Hz rTMS at this strength has also been shown to increase technique assesses the level of voluntary activation (VA), gold-standard for
motor evoked potential amplitude in anaesthetised rats. To better under- CF testing. Herein, we explored the changes in VA induced by maximal-rate
stand the effects of low-intensity rTMS within the cortex, we made elec- FT. Fatigue during FT was dened as the drop in tapping rate during several
trophysiological recordings using exible metal wire electrodes in place of brief sets of maximal-rate FT. The VA was evaluated during maximal
traditional, inexible glass microelectrodes. We recorded local eld po- voluntary contractions (MVC) executed before and just following FT (no
tentials from layer V in the motor cortex of urethane-anaesthetised rats. gap). Our hypothesis predicted a reduction in the VA after fatiguing FT.
Electrical stimulation of the contralateral cortical layer V produced evoked Methods: 12 participants (18-49 yrs; 3 women) used a 3D-printed hand-x-
responses which were subsequently analysed. The metal wire electrode ation system to execute index-FT on a force sensor, with the thumb secured in
was attened against the skull, to make way for a custom 8mm rodent abduction. Participants performed 12 sets of 30s, with 3min rest. We moni-
rTMS coil, to deliver elds up to ~120milliTesla. Rats were treated with tored index range of motion and rst dorsal interosseous (FDI) EMG-activity.
either one or two rounds of quadripulse (QPS-50ms or sham followed by In some sets, ulnar nerve supramaximal stimulation (UNS) was applied at
QPS-5ms) or theta burst stimulation (iTBS or sham followed by iTBS). the elbow (3 stimuli at 100 Hz), in other sets transcranial magnetic stim-
Slopes of the evoked potentials, paired pulse ratio and input/output curves ulation (TMS) was applied on M1-FDI hot-spot, at intensity to obtain
were used to measure changes in the state of the recorded neuronal motor-evoked potential amplitudes z50% of the Compound Muscle Action
population. In all cases, no changes were observed as a result of low in- Potential in the fresh muscle; another sets included TMS+UNS or
tensity rTMS, after either one or two rounds of magnetic stimulation. UNS+TMS. Stimulation types were counterbalanced in order. Stimulation
These results suggest that low intensity rTMS, at levels previously shown was automatically applied during MVC (pre and post FT), at the point of
to elicit MEPs, does not have a substantial effect on the excitability of layer force-peak, when force-plateau just started.
V neurons, measurable under these circumstances. Results: FT rate signicantly decreased along the 30s of nger tapping while
Keywords: low intensity TMS, local eld potentials, quadripulse, theta burst TMS silent-periods enlarged from pre to post; set effects were absent. MVC
reduced at post and also set after set. The VA was no signicantly modied.