The Reliability of Transcranial Magnetic Stimulation-Derived Corticomotor Inhibition as a Brain Health Evaluation Tool in Soccer Players

Background The suitability of corticomotor inhibition and corticospinal excitability to measure brain health outcomes and recovery of sport-related head impact (concussion and subconcussion) depends on good inter-day reliability, which is evaluated in this study. Transcranial magnetic stimulation (TMS) reliability in soccer players is assessed by comparing soccer players, for whom reliability on this measure may be reduced due to exposure to head impacts, to generally active individuals not engaged in contact sport. Methods TMS-derived corticomotor inhibition and corticospinal excitability were recorded from the rectus femoris muscle during two testing sessions, spaced 1–2 weeks apart in 19 soccer players (SOC—age 22 ± 3 years) and 20 generally active (CON—age 24 ± 4 years) healthy volunteers. Inter-day reliability between the two time points was quantified by using intra-class correlation coefficients (ICC). Intra-group reliability and group differences on actual measurement values were also explored. Results Good inter-day reliability was evident for corticomotor inhibition (ICCSOC = 0.61; ICCCON = 0.70) and corticospinal excitability (ICCSOC = 0.59; ICCCON = 0.70) in both generally active individuals and soccer players routinely exposed to sport-related head impacts. Corticomotor inhibition showed lower coefficients of variation than excitability for both groups (InhibSOC = 15.2%; InhibCON = 9.7%; ExcitabSOC = 41.6%; ExcitabCON = 39.5%). No group differences between soccer players and generally active individuals were found on the corticomotor inhibition value (p > 0.05), but levels of corticospinal excitability were significantly lower in soccer players (45.1 ± 20.8 vs 85.4 ± 6.2%Mmax, p < 0.0001). Corticomotor inhibition also showed excellent inter-rater reliability (ICC = 0.87). Conclusions Corticomotor inhibition and corticospinal excitability are stable and maintain good degrees of reliability when assessed over different days in soccer players, despite their routine exposure to head impacts. However, based on intra-group reliability and group differences of the levels of excitability, we conclude that corticomotor inhibition is best suited for the evaluation of neuromuscular alterations associated with head impacts in contact sports.

Low-Frequency vs. Theta Burst Transcranial Magnetic Stimulation for the Treatment of Chronic Non-fluent Aphasia in Stroke: A Proof-of-Concept Study

BackgroundAlthough low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) has shown promise in the treatment of poststroke aphasia, the efficacy of high-frequency rTMS (HF-rTMS) has yet to be determined.PurposeWe investigated the efficacy of intermittent theta burst stimulation (iTBS) in ameliorating chronic non-fluent aphasia and compared it with that of LF-rTMS.MethodsWe randomly assigned patients with poststroke non-fluent aphasia to an ipsilesional iTBS (n = 29), contralesional 1-Hz rTMS (n = 27), or sham (n = 29) group. Each group received the rTMS protocol executed in 10 daily sessions over 2 weeks. We evaluated language function before and after the intervention by using the Concise Chinese Aphasia Test (CCAT).ResultsCompared with the sham group, the iTBS group exhibited significant improvements in conversation, description, and expression scores (P = 0.0004–0.031), which characterize verbal production, as well as in auditory comprehension, reading comprehension, and matching scores (P &lt; 0.01), which characterize language perception. The 1-Hz group exhibited superior improvements in expression, reading comprehension, and imitation writing scores compared with the sham group (P &lt; 0.05). The iTBS group had significantly superior results in CCAT total score, matching and auditory comprehension (P &lt; 0.05) relative to the 1-Hz group.ConclusionOur study findings contribute to a growing body of evidence that ipsilesional iTBS enhances the language recovery of patients with non-fluent aphasia after a chronic stroke. Auditory comprehension was more preferentially enhanced by iTBS compared with the 1-Hz protocol. Our findings highlight the importance of ipsilesional modulation through excitatory rTMS for the recovery of non-fluent aphasia in patients with chronic stroke.Clinical Trial Registration:[www.ClinicalTrials.gov], identifier [NCT03059225].

A 4 × 4 array multichannel magnetic stimulation system using submillimeter sized planar square spiral coils: The spatial distribution of electromagnetic field

Multi-coil magnetic stimulation has advantages over single-coil magnetic stimulation, such as more accurate targeting and larger stimulation range. In this paper, a 4 × 4 array multichannel magnetic stimulation system based on a submillimeter planar square spiral coil is proposed. The effects of multiple currents with different directions on the electromagnetic field strength and the focusing zone of the array-structured magnetic stimulation system are studied. The spatial distribution characteristics of the electromagnetic field are discussed. In addition, a method is proposed that can predict the spatial distributions of the electric and magnetic fields when currents in different directions are applied to the array-structured magnetic stimulation system. The study results show that in the section of z = 2 μm, the maximum and average magnetic field strengths of the array-structured magnetic stimulation system are 6.39 mT and 2.68 mT, respectively. The maximum and average electric field strengths are 614.7 mV/m and 122.82 mV/m, respectively, where 84.39% of the measured electric field values are greater than 73 mV/m. The average magnetic field strength of the focusing zone, i.e., the zone in between the two coils, is 3.38 mT with a mean square deviation of 0.18. Therefore, the array-structured multi-channel magnetic stimulation system based on a planar square spiral coil can have a small size of 412 μm × 412 μm × 1.7 μm, which helps improving the spatial distribution of electromagnetic field and increase the effectiveness of magnetic stimulation. The main contribution of this paper is a method for designing multichannel micro-magnetic stimulation devices.