Welcome to the WCN 2021 Interactive Program
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Please note that all sessions will run at their scheduled time and be followed by a LIVE Q&A/Discussion at the end
The viewing of sessions, cannot be accessed from this conference calendar. All sessions are accessible via the Virtual Platform
- Walter Paulus (Germany)
NON-INVASIVE BRAIN STIMULATION IN NEUROREHABILITATION
- Walter Paulus (Germany)
Transcranial electric stimulation techniques (tDCS; tACS; tRNS) and repetitive transcranial magnetic stimulation (rTMS) allow increasing or decreasing the excitability of corticospinal or cortico-cortical pathways depending on variables such as intensity, stimulation duration, number and frequency of stimulation pulses in rTMS and others. Electric techniques provide the potential for home treatment whereas rTMS techniques are bound to outpatient medical infrastructure. Transcranial ultrasound stimulation is on the way to supplement the therapeutic repertoire. Different techniques may be combined. The largest medical need in neurorehabilitation concerns motor stroke and aphasia. Local strokes not only impede the affected but also remote areas. Essentially two techniques can be pursued, facilitating directly the affected area or modulating remote areas providing either facilitatory or inhibitory input to the target area. Electric interference stimulation may be used to selectively stimulate deeper areas to a certain extent. Network analysis methods provide information on disturbed network activities usually by either EEG or fMRI. Multichannel electric stimulation methods may try to restitute normal network activity. Co-application of drugs may impede or facilitate stimulation effects. An overview will be given on these technical aspects and on already validated techniques in clinical neurorehabilitation. Most promising near future stimulation prospects will be addressed also in the context of cost-effectiveness.
EPILEPSY AND TMS
- Yoshikazu Ugawa (Japan)
NBS has been used for epilepsy in three aspects: pathophysiology, antiepileptic drugs, and treatment.
Pathophysiological analysis by TMS
Several parameters of transcranial magnetic stimulation (TMS) studies are considered to reflect a specific electrophysiological function at the motor cortex. The motor threshold may represent sodium channel function; the short interval intracortical inhibition (SICI), GABAA function; intracortical facilitation (ICF), glutamate function. These functional abnormalities have been shown in several epileptic disorders. I will show GABAA dysfunction in patients with myoclonus epilepsy.
Antiepileptic drugs and TMS
The above methods TMS were used for studying the mechanism of action of most anti-epileptic drugs. The above functions were compared between real drug intake and placebo intake in normal subjects. Some drugs are compatible with sodium channel blocker, some others are enhancer of BAGAergic function, and some of them show glutamate blocker (AMPA blocker). These physiological speculations from human experiments are all compatible with their proposed mechanism action speculated from animal experiments. I will show the results of perampanel.
Treatment by NBS
Several NBS methods have been applied to patients with epilepsy. Repetitive TMS and transcranial magnetic stimulation (tDCS) were used for this purpose. I will describe quadripulse stimulation (QPS) and show an aggravation of epilepsy by LTD induction by QPS. We have no consensus about the effectiveness of rTMSs for epilepsy. Critical review of tDCS treatment of epilepsy concluded that no recommendation can be made about the potential efficacy of tDCS in the treatment of any type of epilepsy.
NON-INVASIVE BRAIN STIMULATION AND PSYCHIATRIC SYMPTOMS IN NEUROLOGICAL DISORDERS
- Sarah H. Lisanby (United States of America)
Psychiatric disorders are increasingly recognized as resulting from dysfunction in distributed neural circuitry. The ability of noninvasive brain stimulation to selectively target the circuitry underlying psychiatric disorders has made them valuable tools to study and treat a growing list of conditions including treatment resistant depression, obsessive compulsive disorder, and smoking dependence. FDA approved noninvasive devices for clinical treatment in psychiatry include transcranial magnetic stimulation (TMS), electroconvulsive therapy (ECT), and vagus nerve stimulation (VNS). There is also a range of other noninvasive brain stimulation tools at various stages of research that show promise, including transcranial direct current stimulation (tDCS), magnetic seizure therapy (MST), and focused ultrasound (FUS). Since the initial approval of TMS in 2008, a growing number of devices, coils, and dosing strategies have become available that have the potential to reach a broader range of brain regions and accelerate therapeutic response. Research demonstrates that certain forms of TMS, when given simultaneously with cognitive training, may improve selected cognitive functions. Given the high degree of co-morbidity between neurological and psychiatric disorders, these development in noninvasive neuromodulation tools offer alternatives for neurological patients experiencing psychiatric symptoms. The availability to target neuromodulation via neuronavigation may be particularly useful in neurological patients with focal brain lesions. This presentation will review the state of the art of non-invasive neuromodulation tools in psychiatric care and will highlight the latest work with TMS for depression and cognitive function in patients with neurological disorders such as traumatic brain injury, stroke, and neurodegenerative disorders.