Interaction Between Simultaneously Applied Neuromodulatory Interventions in Humans
Interaction Between Simultaneously Applied Neuromodulatory Interventions in Humans
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DOI：
10.1016/j.brs.2012.09.009
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发表时间：
2013-07-01
影响因子：
7.7
通讯作者：
Hodges, Paul W.
中科院分区：
文献类型：
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作者：
Schabrun, Siobhan M.;Chipchase, Lucinda S.;Hodges, Paul W.
背景：经颅直流电刺激(TDC)是一种神经调节技术，有可能提高神经肌肉电刺激(NMES)等传统疗法的疗效。然而，同时应用tdcs/nmes也可能激活内环境平衡机制，阻断或逆转对皮质醇兴奋性的影响。目前尚不清楚tDCs和NMES在人类初级运动皮质(M1)中如何相互作用，以及作用是总结性的(增加皮质运动兴奋性而不是单独应用tDCSs或NMES)还是竞争性的(阻断或降低单独应用tDCSs或NMES的皮质运动兴奋性效应)。目的：观察同时应用增强(阳极型tDC)或抑制(阴极型tDCs)兴奋性的tDCS方案后NMES对NMES的反应。方法：我们采用经颅磁刺激(TMS)检测同时应用以下两种方案前后的皮质运动兴奋性：i)NMES与阴极型tDC联合应用；以及ii)NMES与阴极型DCs同时应用。结果：同时应用两种单独应用时增强兴奋性的方案(NMES和阳极型tDCs)并不能像稳态可塑性机制所预测的那样对皮质运动兴奋性产生总和效应。联合使用阴极tDCs和NMES可抑制NMES诱导的兴奋增强，这种作用可能由钙依赖的抗门模型来解释。结论：这些新的发现突出了两种神经调节技术联合使用时涉及的复杂机制，提示在临床应用之前，有必要对联合干预措施进行仔细的测试。Crown版权所有(C)2013由Elsevier Inc.出版。保留所有权利。
Background: Transcranial direct current stimulation (tDCS) is a neuromodulatory technique with the potential to enhance the efficacy of traditional therapies such as neuromuscular electrical stimulation (NMES). Yet, concurrent application of tDCS/NMES may also activate homeostatic mechanisms that block or reverse effects on corticomotor excitability. It is unknown how tDCS and NMES interact in the human primary motor cortex (M1) and whether effects are summative (increase corticomotor excitability beyond that of tDCS or NMES applied alone) or competitive (block or reduce corticomotor excitability effects of tDCS or NMES applied alone).Objective: To investigate corticomotor excitability in response to NMES after concurrent application of tDCS protocols that enhance (anodal tDCS) or suppress (cathodal tDCS) excitability of M1.Methods: We used transcranial magnetic stimulation (TMS) to examine corticomotor excitability before and after the concurrent application of: i) NMES with anodal tDCS; and ii) NMES with cathodal tDCS. Effects were contrasted to four control conditions: i) NMES alone, ii) anodal tDCS alone, iii) cathodal tDCS alone, and iv) sham stimulation.Results: Concurrent application of two protocols that enhance excitability when applied alone (NMES and anodal tDCS) failed to induce summative effects on corticomotor excitability, as predicted by homeostatic plasticity mechanisms. Combined cathodal tDCS and NMES suppressed the enhanced excitation induced by NMES, an effect that might be explained by calcium dependent anti-gating models.Conclusions: These novel findings highlight the complex mechanisms involved when two neuromodulatory techniques are combined and suggest that careful testing of combined interventions is necessary before application in clinical contexts. Crown Copyright (C) 2013 Published by Elsevier Inc. All rights reserved.