Poster No:
30
Submission Type:
Abstract Submission
Authors:
Minoo Sharbafshaaer1,2,3, Koen Cuypers3,4, Raf L J Meesen3,4, Gioacchino Tedeschi1,2, Francesca Trojsi1,2
Institutions:
1Advanced Medical and Surgical Sciences, MRI Research Center, University of Campania Luigi Vanvitelli, Naples, Italy, 2First Division of Neurology, Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy, 3Neuroplasticity and Movement Control, Rehabilitation Research Institute (REVAL), Hasselt University, Diepenbeek, Belgium, 4Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, Leuven, Belgium
First Author:
Minoo Sharbafshaaer
Advanced Medical and Surgical Sciences, MRI Research Center, University of Campania Luigi Vanvitelli|First Division of Neurology, Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli|Neuroplasticity and Movement Control, Rehabilitation Research Institute (REVAL), Hasselt University
Naples, Italy|Naples, Italy|Diepenbeek, Belgium
Co-Author(s):
Koen Cuypers
Neuroplasticity and Movement Control, Rehabilitation Research Institute (REVAL), Hasselt University|Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences
Diepenbeek, Belgium|Leuven, Belgium
Raf L J Meesen
Neuroplasticity and Movement Control, Rehabilitation Research Institute (REVAL), Hasselt University|Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences
Diepenbeek, Belgium|Leuven, Belgium
Gioacchino Tedeschi
Advanced Medical and Surgical Sciences, MRI Research Center, University of Campania Luigi Vanvitelli|First Division of Neurology, Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli
Naples, Italy|Naples, Italy
Francesca Trojsi
Advanced Medical and Surgical Sciences, MRI Research Center, University of Campania Luigi Vanvitelli|First Division of Neurology, Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli
Naples, Italy|Naples, Italy
Introduction:
Parkinson's disease (PD) is a neurodegenerative disorder characterized by a broad spectrum of motor and non-motor symptoms. PD-related impairments are linked to functional connectivity (FC) disruptions and alterations in the default mode network (DMN) (Ruppert et al., 2021), particularly affecting cognitive domains. Inhibitory neuromodulation techniques such as continuous theta-burst stimulation (cTBS) and low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) (Ji et al., 2021), targeting the motor cortex, have shown promise in enhancing motor learning and modulating cortical excitability (Nieuwboer et al, 2009). Evidence suggests that inhibitory TMS induces behavioral improvements by local inhibition of the stimulated region through distributed effects on FC across motor and associative learning networks (Steel et al., 2016). Here, we aim to interpret the mechanisms underlying these network-level effects based on neuroimaging evidence, providing a foundation for advancing neuromodulation strategies in PD neurorehabilitation.
Methods:
This systematic review adhered to PRISMA guidelines, with the protocol registered on PROSPERO. A comprehensive search was conducted in the PubMed database using keywords related to Parkinson's disease, neuromodulation (e.g., cTBS, LF-rTMS), motor learning, FC, and DMN, focusing on studies investigating their effects on motor and cognitive impairments. Two independent reviewers screened titles and abstracts, followed by full-text assessments for eligibility based on predefined inclusion criteria. Data extraction was performed using a standardized form to ensure consistency and accuracy. The quality of the included studies was evaluated using the Critical Appraisal Skills Programme (CASP) checklist, assessing methodological rigor and relevance to the research question. This systematic approach aimed to synthesize evidence on the potential of neuromodulation techniques to enhance motor and cognitive functions by modulation of FC in PD.
Results:
During the initial screening, 72 studies were identified, of which 8 met the eligibility criteria and were included in the systematic review. These studies demonstrated that cTBS and LF-rTMS effectively inhibit the motor cortex and modulate functional connectivity (FC), particularly by restoring dynamics within the default mode network (DMN) in Parkinson's disease. The results indicated that these neuromodulation techniques reduced cortical hyperexcitability, facilitating enhanced communication between motor and cognitive networks, and leading to improved motor and cognitive functions. Sensitivity analysis confirmed the robustness of these effects across studies, suggesting that motor cortex inhibition may provide sustained benefits in PD. Thus, cTBS and LF-rTMS represent promising therapeutic strategies for improving motor and cognitive outcomes in Parkinson's disease through the modulation of FC.
Conclusions:
Motor cortex inhibition through cTBS and LF-rTMS shows promise in enhancing motor functions and cognitive performance in Parkinson's disease (PD) by modulating functional connectivity, restoring default mode network (DMN) dynamics, and reducing cortical hyperexcitability, ultimately rebalancing motor-cognitive networks. Future research should expand on these findings to explore the long-term effects and broader applications of motor cortex inhibition. For instance, Di Lazzaro et al. (2024) demonstrated its role in reducing glutamatergic hyperactivity in ALS, Lo et al. (2024) highlighted its potential in managing spasticity, fatigue, and balance in MS, and Nakaya et al. (2024) showed its efficacy in treating hemichorea-hemiballism in Huntington's disease. These studies underscore the therapeutic potential of motor cortex inhibition across various neurodegenerative conditions and highlight the need for further investigation into its mechanisms and clinical applications.
Brain Stimulation:
Non-invasive Magnetic/TMS 1
Disorders of the Nervous System:
Neurodegenerative/ Late Life (eg. Parkinson’s, Alzheimer’s)
Learning and Memory:
Neural Plasticity and Recovery of Function 2
Motor Behavior:
Motor Behavior Other
Neuroanatomy, Physiology, Metabolism and Neurotransmission:
White Matter Anatomy, Fiber Pathways and Connectivity
Keywords:
Aging
Motor
Plasticity
Transcranial Magnetic Stimulation (TMS)
Other
1|2Indicates the priority used for review
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Please indicate below if your study was a "resting state" or "task-activation” study.
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Healthy subjects only or patients (note that patient studies may also involve healthy subjects):
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Was this research conducted in the United States?
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Were any human subjects research approved by the relevant Institutional Review Board or ethics panel?
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Please indicate which methods were used in your research:
Functional MRI
TMS
Provide references using APA citation style.
Di Lazzaro, V., Ranieri, F., Doretti, A., Boscarino, M., Maderna, L., Colombo, E., . . . Silani, V. (2024). Transcranial static magnetic stimulation for amyotrophic lateral sclerosis: a bicentric, randomised, double-blind placebo-controlled phase 2 trial. Lancet Reg Health Eur, 45, 101019. doi:10.1016/j.lanepe.2024.101019
Ji, G. J., Liu, T., Li, Y., Liu, P., Sun, J., Chen, X., . . . Hu, P. (2021). Structural correlates underlying accelerated magnetic stimulation in Parkinson's disease. Hum Brain Mapp, 42(6), 1670-1681. doi:10.1002/hbm.25319
Lo, D. F., Palhang, M., Gawash, A., Zia, H., Goodwin, B. J., Patel, K., & White, C. P. (2024). Unlocking Therapeutic Potential: The Role of Theta Burst Stimulation in Multiple Sclerosis Management. Prim Care Companion CNS Disord, 26(2). doi:10.4088/PCC.23r03645
Nakaya, Y., Hayashi, K., Suzuki, A., Asano, R., Hayashi, K., Fujita, K., . . . Sato, M. (2024). Treatment of Intracranial Hemorrhage Induced Hemichorea- Hemiballism by Low-Frequency Repetitive Transcranial Magnetic Stimulation. Acta Neurol Taiwan, 33(2), 93-94.
Nieuwboer, A., Rochester, L., Müncks, L., & Swinnen, S. P. (2009). Motor learning in Parkinson's disease: limitations and potential for rehabilitation. Parkinsonism & Related Disorders, 15, S53-S58. doi:https://doi.org/10.1016/S1353-8020(09)70781-3
Ruppert, M. C., Greuel, A., Freigang, J., Tahmasian, M., Maier, F., Hammes, J., . . . Eggers, C. (2021). The default mode network and cognition in Parkinson's disease: A multimodal resting-state network approach. Hum Brain Mapp, 42(8), 2623-2641. doi:10.1002/hbm.25393
Steel, A., Song, S., Bageac, D., Knutson, K. M., Keisler, A., Saad, Z. S., . . . Wilkinson, L. (2016). Shifts in connectivity during procedural learning after motor cortex stimulation: A combined transcranial magnetic stimulation/functional magnetic resonance imaging study. Cortex, 74, 134-148. doi:10.1016/j.cortex.2015.10.004
Yes
Please select the country that the first author on this abstract resides and works in from the UNESCO Institute of Statistics and World Bank List of Low and Middle Income Countries (based on gross national income per capita).
Iran, Islamic Rep.