Cumulative effect of 5 daily sessions of theta burst stimulation on corticospinal excitability in amyotrophic lateral sclerosis

Authors

  • Moniek A.M. Munneke MSc,

    Corresponding author
    1. Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology/Clinical Neurophysiology, Nijmegen, The Netherlands
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  • Jan J. Rongen MSc,

    1. Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology/Clinical Neurophysiology, Nijmegen, The Netherlands
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  • Sebastiaan Overeem MD, PhD,

    1. Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology/Clinical Neurophysiology, Nijmegen, The Netherlands
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  • H. Jurgen Schelhaas MD, PhD,

    1. Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology/Clinical Neurophysiology, Nijmegen, The Netherlands
    2. Epilepsy Centre Kempenhaeghe, Heeze, the Netherlands
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  • Machiel J. Zwarts MD, PhD,

    1. Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology/Clinical Neurophysiology, Nijmegen, The Netherlands
    2. Epilepsy Centre Kempenhaeghe, Heeze, the Netherlands
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  • Dick F. Stegeman PhD

    1. Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology/Clinical Neurophysiology, Nijmegen, The Netherlands
    2. Faculty of Human Movement Sciences, Research Institute MOVE, VU University, Amsterdam, the Netherlands
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  • The study was supported by a grant from the ALS Centre of the Netherlands (M.A.M.M.).

  • The authors report no conflicts of interest.

ABSTRACT

Introduction: Excitotoxicity plays an important role in the pathogenesis of the preferential motor neuron death observed in amyotrophic lateral sclerosis (ALS). Continuous theta burst stimulation (cTBS) by transcranial magnetic stimulation has an inhibitory effect on corticospinal excitability (CSE). We characterized the neurophysiological changes induced by cTBS in ALS. Methods: The patients received 5 daily sessions of cTBS. CSE was assessed at baseline and after each session of cTBS. Results: The amplitude of a single pulse motor evoked potential was significantly decreased (34%) over the days. The amplitude returned to baseline a week after the last session. The resting motor threshold increased significantly, whereas intracortical inhibition and facilitation did not change over the sessions. Conclusions: Daily cTBS has a cumulative depressing effect on CSE in patients with ALS. These results suggest that modulation of CSE in ALS is possible, but repetitive sessions are needed to maintain the effect. Muscle Nerve 48:733–738, 2013

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