Effects of rTMS on balance and Higher-level Motor function in Cerebellar Ataxia: A Pilot Study
Poster No:
32
Submission Type:
Abstract Submission
Authors:
Sumin Lee1,2, Eunhee Park3, Yong Jeon Cheong1, Seonkyoung Lee1, Jihyeong Ro4,1, Jihyun Bae1, Ho-Won Lee5, Minyoung Jung1
Institutions:
1Korea Brain Research Institute, Daegu, Korea, Republic of, 2Department of Artificial Intelligence, Kyungpook National University, Daegu, Korea, Republic of, 3Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu, Korea, Republic of, 4Department of Biomedical Science, Kyungpook National University, Daegu, Korea, Republic of, 5Department of Neurology, Kyungpook National University Chilgok Hospital, Daegu, Korea, Republic of
First Author:
Sumin Lee
Korea Brain Research Institute|Department of Artificial Intelligence, Kyungpook National University
Daegu, Korea, Republic of|Daegu, Korea, Republic of
Korea Brain Research Institute|Department of Artificial Intelligence, Kyungpook National University
Daegu, Korea, Republic of|Daegu, Korea, Republic of
Co-Author(s):
Eunhee Park
Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University
Daegu, Korea, Republic of
Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University
Daegu, Korea, Republic of
Jihyeong Ro
Department of Biomedical Science, Kyungpook National University|Korea Brain Research Institute
Daegu, Korea, Republic of|Daegu, Korea, Republic of
Department of Biomedical Science, Kyungpook National University|Korea Brain Research Institute
Daegu, Korea, Republic of|Daegu, Korea, Republic of
Ho-Won Lee
Department of Neurology, Kyungpook National University Chilgok Hospital
Daegu, Korea, Republic of
Department of Neurology, Kyungpook National University Chilgok Hospital
Daegu, Korea, Republic of
Introduction:
Cerebellar ataxia (CA) is a neurodegenerative disorder caused by damage to the cerebellum. Patients with CA experience various motor symptoms, including gait instability, imbalance, and ataxic dysarthria(Parrell et al., 2017; Marsden, 2018). Repetitive transcranial magnetic stimulation (rTMS) targeting cerebellum has shown significant effects in improving motor functions in neurological disorders(Wang et al., 2024; Yao et al., 2022). Therefore, this study aims to explore the rTMS as a potential treatment for CA.
Methods:
Ten CA patients (4 males, age=58±9.07) had rTMS treatments targeting the cerebellum for five consecutive days. We collected two types of data, (1) Balance Trainer 4 (BT4; Hur, Finland) to assess static balance ability and (2) prefrontal neural activation to assess involvement of prefrontal cortex (PFC) in motor function, at three different time points: at baseline (T0), after the final treatment (T1), and at a 6-week follow-up (T2).
Using BT4, we evaluated the ability whether the patients could control their body to stand still for 30 seconds under both eyes-closed and eyes-open conditions. We then calculated how much the center of pressure moves for every 10ms in terms of lateral-medial plane (X-axis), anterior-posterior plane (Y-axis), and the displacement using Euclidean distance formula (d).
To identify the role of PFC in higher-level motor performance, we acquired hemodynamic responses in the frontal lobe using functional near-infrared spectroscopy (fNIRS; OBELAB, South Korea) while patients performed two tasks. First, patients were asked to tap either the left or right toe (single toe-tapping task). Second, the patients were asked to tap their toe while subtracting 3 from a given 3-digit number (dual task). Using NIRSIT Quest (OBELAB, South Korea), we preprocessed fNIRS data based on 3D-diffuse optical tomography procedure, which allowed us to calculate the beta values for ROIs defined by the Brainnetome Atlas(Fan et al., 2016) with MarsBaR(Brett et al., 2002).
Using BT4, we evaluated the ability whether the patients could control their body to stand still for 30 seconds under both eyes-closed and eyes-open conditions. We then calculated how much the center of pressure moves for every 10ms in terms of lateral-medial plane (X-axis), anterior-posterior plane (Y-axis), and the displacement using Euclidean distance formula (d).
To identify the role of PFC in higher-level motor performance, we acquired hemodynamic responses in the frontal lobe using functional near-infrared spectroscopy (fNIRS; OBELAB, South Korea) while patients performed two tasks. First, patients were asked to tap either the left or right toe (single toe-tapping task). Second, the patients were asked to tap their toe while subtracting 3 from a given 3-digit number (dual task). Using NIRSIT Quest (OBELAB, South Korea), we preprocessed fNIRS data based on 3D-diffuse optical tomography procedure, which allowed us to calculate the beta values for ROIs defined by the Brainnetome Atlas(Fan et al., 2016) with MarsBaR(Brett et al., 2002).
Results:
In terms of the balance assessment, the Friedman test revealed significant differences across the three time points. Regardless of the eye conditions, all significant features show U-shape curves (Figure 1A, 1B). For the eyes-open condition, the mean value of ∆Y (Q=8.6, p=0.014, W=0.43) and the standard deviation (STD; Q=7.2, p=0.027, W=0.36) value of ∆d showed significance. For the eyes-closed condition, the mean value of ∆X (Q=6.2, p=0.045, W=0.31) and the STD value of ∆X (Q=7.2, p=0.027, W=0.36) were significant.
Similarly to data for BT4, the prefrontal activations for dual task, especially for left, showed a U-shaped pattern (Figure 1C). The Friedman test (p<0.01) revealed significant neural activation in the right middle frontal gyrus (R.MFG) during dual-task, including left toe-tapping with subtraction (LDT; Q=14.3, p<0.001, W=0.72), left or right toe-tapping with subtraction (DT; Q=11.4, p=0.003, W=0.57), LDT compared to left toe-tapping alone (LDT-LTT; Q=11.4, p=0.003, W=0.57), and DT compared to left or right toe-tapping alone (DT-TT; Q=9.8, p=0.007, W=0.49).
Similarly to data for BT4, the prefrontal activations for dual task, especially for left, showed a U-shaped pattern (Figure 1C). The Friedman test (p<0.01) revealed significant neural activation in the right middle frontal gyrus (R.MFG) during dual-task, including left toe-tapping with subtraction (LDT; Q=14.3, p<0.001, W=0.72), left or right toe-tapping with subtraction (DT; Q=11.4, p=0.003, W=0.57), LDT compared to left toe-tapping alone (LDT-LTT; Q=11.4, p=0.003, W=0.57), and DT compared to left or right toe-tapping alone (DT-TT; Q=9.8, p=0.007, W=0.49).
Conclusions:
This study demonstrates that rTMS treatment positively affects the lower limb movement with and without cognitive load, reflecting neural plasticity through a U-shaped pattern across treatment phases. However, the effects were temporary, emphasizing the need for persistent treatment or additional rehabilitation strategies. Regarding our findings of left lateralized PFC activation, the previous study reported that cognitive loads have a greater effect on the non-dominant limb compared to the dominant limb(Al-Quraishi et al., 2022).
These results emphasize the potential of rTMS in neurorehabilitation and highlight the importance of further research to explore its long-term efficacy and mechanisms that the cerebellar activation induced by rTMS affects motor function and the motor involvement of the PFC.
These results emphasize the potential of rTMS in neurorehabilitation and highlight the importance of further research to explore its long-term efficacy and mechanisms that the cerebellar activation induced by rTMS affects motor function and the motor involvement of the PFC.
Brain Stimulation:
Non-invasive Magnetic/TMS 1
Disorders of the Nervous System:
Neurodegenerative/ Late Life (eg. Parkinson’s, Alzheimer’s) 2
Modeling and Analysis Methods:
Activation (eg. BOLD task-fMRI)
Motor Behavior:
Motor Planning and Execution
Perception, Attention and Motor Behavior:
Attention: Auditory/Tactile/Motor
Keywords:
Behavioral Therapy
Cerebellar Syndromes
Cerebellum
Degenerative Disease
Motor
Movement Disorder
Near Infra-Red Spectroscopy (NIRS)
Therapy
Transcranial Magnetic Stimulation (TMS)
1|2Indicates the priority used for review
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Provide references using APA citation style.
Brett, M., Anton, J.-L., Valabregue, R., & Poline, J.-B. (2002). Region of interest analysis using an SPM toolbox. 8th International Conference on Functional Mapping of the Human Brain, 16(2), 497.
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Marsden, J. F. (2018). Chapter 17—Cerebellar ataxia. In B. L. Day & S. R. Lord (Eds.), Handbook of Clinical Neurology (Vol. 159, pp. 261–281). Elsevier. https://doi.org/10.1016/B978-0-444-63916-5.00017-3
Parrell, B., Agnew, Z., Nagarajan, S., Houde, J., & Ivry, R. B. (2017). Impaired Feedforward Control and Enhanced Feedback Control of Speech in Patients with Cerebellar Degeneration. Journal of Neuroscience, 37(38), 9249–9258. https://doi.org/10.1523/JNEUROSCI.3363-16.2017
Wang, J., Wu, Z., Hong, S., Ye, H., Zhang, Y., Lin, Q., Chen, Z., Zheng, L., & Qin, J. (2024). Cerebellar transcranial magnetic stimulation for improving balance capacity and activity of daily living in stroke patients: A systematic review and meta-analysis. BMC Neurology, 24(1), 205. https://doi.org/10.1186/s12883-024-03720-1
Yao, Q., Tang, F., Wang, Y., Yan, Y., Dong, L., Wang, T., Zhu, D., Tian, M., Lin, X., & Shi, J. (2022). Effect of cerebellum stimulation on cognitive recovery in patients with Alzheimer disease: A randomized clinical trial. Brain Stimulation, 15(4), 910–920. https://doi.org/10.1016/j.brs.2022.06.004