PubMed · 10025771
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M H Schieber. 1999. Rethinking the motor cortex.. https://doi.org/10.1212/wnl.52.3.445
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Abnormalities in brain plasticity, including abnormal information processing by disturbed cortical inhibition and facilitation in schizophrenia, have been described several times in the past. Transcranial magnetic stimulation (TMS) provides a neurophysiological technique for the measurement of cortical excitability, especially of the motoneural system. With TMS it is possible to explore important aspects of the pathophysiological mechanisms underlying schizophrenia using recently developed paradigms (paired pulse method, cortical silent period). This review summarizes the results of available diagnostic TMS studies in schizophrenia. Studies investigating the efficacy of therapeutic repetitive magnetic stimulation in patients with treatment resistant hallucinations or predominantly negative symptoms were not considered. The reviewed studies support the assumption of reduced cortical inhibition, probably caused by GABAergic deficit, in schizophrenia. Factors influencing the study results, the limitations of this promising technique in schizophrenia, and further research options are discussed.
Using transcranial magnetic stimulation (TMS), we have tested the time needed for the perceived onset of spontaneous motor intention to be fully determined. We found that TMS applied over the presupplementary motor area after the execution of a simple spontaneous action shifted the perceived onset of the motor intention backward in time, and shifted the perceived time of action execution forward in time. The size of the effect was similar regardless of whether TMS was applied immediately after the action or 200 msec after. The results of three control studies suggest that this effect is time-limited, specific to modality, and also specific to the anatomical site of stimulation. We conclude that the perceived onset of intention depends, at least in part, on neural activity that takes place after the execution of action. A model, which is based on the mechanism of cue integration under the presence of noise, is offered to explain the results. The implications for the conscious control of spontaneous actions are discussed.
The objective of this study is to assess the safety and efficacy of repetitive transcranial magnetic stimulation (rTMS) for gait and bradykinesia in patients with Parkinson's disease (PD). In a double-blind placebo-controlled study, we evaluated the effects of 25 Hz rTMS in 18 PD patients. Eight rTMS sessions were performed over a 4-week period. Four cortical targets (left and right motor and dorsolateral prefrontal cortex) were stimulated in each session, with 300 pulses each, 100% of motor threshold intensity. Left motor cortex (MC) excitability was assessed using motor evoked potentials (MEPs) from the abductor pollicis brevis. During the 4 weeks, times for executing walking and complex hand movements tests gradually decreased. The therapeutic rTMS effect lasted for at least 1 month after treatment ended. Right-hand bradykinesia improvement correlated with increased MEP amplitude evoked by left MC rTMS after individual sessions, but improvement overall did not correlate with MC excitability. rTMS sessions appear to have a cumulative benefit for improving gait, as well as reducing upper limb bradykinesia in PD patients. Although short-term benefit may be due to MC excitability enhancement, the mechanism of cumulative benefit must have another explanation.