Publications by authors named "Kirveskari E"

Article Synopsis
  • A new technique called high-PAS combines high-frequency peripheral nerve stimulation (PNS) and high-intensity transcranial magnetic stimulation (TMS) to potentially enhance motor function in patients with incomplete spinal cord injuries.
  • The interstimulus interval (ISI) in high-PAS allows for flexibility, making it easier to implement in clinical settings where precise timing is tough, but this also creates challenges for measuring its effectiveness.
  • Research with ten healthy participants showed that high-PAS improved motor-evoked potentials (MEPs) and significantly increased spinal excitability (measured by H-reflex amplitudes) during spinal-targeted sessions, but not in cortical-targeted sessions.
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Article Synopsis
  • Paired associative stimulation (PAS) combines transcranial magnetic stimulation (TMS) and peripheral nerve stimulation (PNS) to enhance motor-evoked potentials (MEPs) and promote spinal plasticity, particularly beneficial for rehabilitation after spinal cord injury (SCI).
  • A new high-frequency variant of PAS, called "high-PAS," was tested alongside noninvasive auricular vagus nerve stimulation (aVNS) to see if it could further boost MEP enhancement.
  • While PAS significantly improved MEPs compared to aVNS alone, the combined effects did not yield significant results, indicating that more optimization of the aVNS setup is needed for potential use in SCI patients.
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Objective: A novel protocol for paired associative stimulation (PAS), called high PAS, consists of high-intensity transcranial magnetic stimulation (TMS) and high-frequency peripheral nerve stimulation (PNS). High PAS was developed for spinal cord injury rehabilitation and targets plastic changes in stimulated pathways in the corticospinal tract, which improves motor function. As therapy interventions can last many weeks, it is important to fully understand the effects of high PAS, including its effect on the cardiovascular system.

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Article Synopsis
  • Accurate preoperative mapping of language areas is essential for surgeries involving brain tumors or epilepsy, aiding in planning and reducing risks.
  • While invasive methods like direct cortical stimulation (DCS) are used to identify critical speech areas, non-invasive techniques such as MRI, fMRI, MEG, and PET offer alternative options for patients who cannot undergo awake surgeries.
  • The outlined protocol for non-invasive speech cortical mapping using repetitive transcranial magnetic stimulation (rTMS) and neuronavigation (nrTMS) allows for precise localization of speech-related functions and can adapt to individual patient needs.
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  • The study investigates the impact of surveillance for intraductal papillary mucinous neoplasms (IPMNs) on patients' health-related quality of life (HRQoL) and anxiety levels.
  • A subgroup of 232 out of 899 patients completed HRQoL and anxiety questionnaires before and three months after follow-up, revealing minimal negative effects on their well-being.
  • The findings suggest that regular monitoring of patients with IPMNs is manageable and unlikely to significantly worsen their quality of life or anxiety, even as the number of patients under surveillance rises.
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Article Synopsis
  • High-frequency peripheral nerve stimulation (PNS), termed "high-PAS," effectively enhances motor-evoked potentials (MEPs) and muscle functionality in both healthy individuals and patients with incomplete spinal cord injuries.
  • Data on the optimal PNS intensity for effective paired associative stimulation (PAS) is limited, prompting researchers to explore how varying PNS intensity settings impact PAS outcomes.
  • Two experiments were conducted with healthy participants, revealing that using a baseline PNS intensity (1/10 F-response persistence) or a slightly reduced intensity (25% lower) resulted in significant MEP potentiation, while higher or lower intensities did not show notable effects.
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Article Synopsis
  • The study investigates the effectiveness of navigated repetitive transcranial magnetic stimulation (nrTMS) aimed at the secondary somatosensory cortex (S2) for treating central poststroke pain (CPSP), a challenging neuropathic pain condition.
  • Despite a placebo effect observed across all stimulation types, nrTMS targeting S2 provided a significant long-term pain reduction in some participants, indicating its potential as a treatment option.
  • Additionally, the study suggests that the DRD2 T/T genotype could serve as a biomarker to predict responses to M1 nrTMS.
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  • A prospective interventional case series was conducted to assess the effects of long-term paired associative stimulation (PAS) on cortical sensorimotor oscillations in individuals with spinal cord injury (SCI).
  • Five patients with chronic incomplete SCI underwent PAS treatment to their upper limb over 16-22 days, with their brain activity monitored before and after the intervention.
  • The results indicated that PAS improved the modulation of sensorimotor oscillations during active hand movements in four patients, while responses to tactile stimuli remained unchanged, suggesting PAS has a significant effect on motor functions and brain activity in SCI patients.
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Article Synopsis
  • In recent years, many therapies for spinal cord injury (SCI) have emerged, but few are widely used in clinical settings, highlighting the need for innovative treatment methods.
  • A new therapy called high-PAS combines non-invasive high-intensity transcranial magnetic stimulation (TMS) and high-frequency electrical peripheral nerve stimulation (PNS), showing promising therapeutic effects in 20 patients with varying degrees of incomplete SCI.
  • Results indicated significant improvements in motor scores, functional hand and walking tests, and overall independence, with ongoing research aiming to refine the method and understand how it works.
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Introduction: Paired associative stimulation (PAS) is a combination of transcranial magnetic stimulation (TMS) and peripheral nerve stimulation (PNS) and induces plastic changes in the human corticospinal tract. We have previously shown that PAS consisting of TMS pulses given at 100% of stimulator output and high-frequency PNS is beneficial for motor rehabilitation of patients with a chronic incomplete spinal cord injury (SCI). The therapeutic possibilities of this PAS variant for walking rehabilitation of paraplegic patients are unexplored.

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Article Synopsis
  • The study examined the impact of long-term paired associative stimulation (PAS) on leg muscle strength and walking in individuals with chronic incomplete spinal cord injuries.
  • Five participants with traumatic tetraplegia underwent PAS for 2 months, and assessments showed significant improvements in Manual Muscle Test (MMT) and AIS motor scores, which remained stable during the follow-up period.
  • Despite these positive outcomes, other measures like sensory scores and overall independence did not show significant changes, highlighting the need for larger trials to further investigate PAS effects on recovery in spinal cord injury patients.
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  • The study aimed to assess the effectiveness of a new method (SAMepi) for localizing brain activity in patients with parietal lobe epilepsy and compared it to conventional analysis methods.
  • A total of 17 patients' preoperative MEG data were analyzed using visual analysis, current dipole models, and SAMepi, with results compared to surgical outcomes.
  • The findings indicated that SAMepi effectively detected interictal spikes similarly to standard methods, suggesting it could be a valuable tool in epilepsy evaluation before surgery.
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Article Synopsis
  • Long-term paired associative stimulation (PAS) improves hand motor function in individuals with non-traumatic tetraplegia, showing positive results over a 6-week treatment period.
  • Five patients underwent PAS treatment on their weaker upper limb, with significant improvements observed in manual muscle testing and other functional assessments at various follow-ups.
  • This study is the first to highlight PAS as a promising therapy for enhancing hand function in patients with neurological spinal cord injuries.
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Introduction: This case study explores the gains in hand function in an individual with a chronic spinal cord injury (SCI). The intervention was long-term paired associative simulation (PAS). We aimed to provide PAS until full recovery of hand muscle strength occurred, or until improvements ceased.

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Article Synopsis
  • Accurate coil positioning during cervical magnetic stimulation is crucial yet challenging, and previous methods using external landmarks are often cumbersome.
  • A novel technique was developed that uses a figure-of-eight coil and anatomy-specific models to enhance corticospinal excitability probing at the cervical spinal level, demonstrated through experiments on 9 healthy subjects.
  • The new method showed high reproducibility of motor-evoked potentials (MEPs) with an intra-class correlation coefficient (ICC) indicating strong reliability in group 1 and moderate reliability in group 2, suggesting potential improvements for navigated spinal stimulation protocols.
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Article Synopsis
  • The intracarotid amobarbital procedure (IAP) is currently the standard method for assessing language lateralization in candidates for epilepsy surgery, but it is invasive and has limitations.
  • A noninvasive language lateralization test using magnetoencephalography (MEG) was conducted on 16 epilepsy surgery candidates who previously underwent IAP, analyzing their brain responses to vowels and tones.
  • The MEG results revealed a strong correlation with left-hemispheric language dominance, achieving 100% specificity and up to 78% sensitivity, suggesting that this noninvasive MEG approach could reduce reliance on the invasive IAP for future assessments.
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Article Synopsis
  • A significant number of spinal cord injuries are incomplete, meaning some neural connections are still intact but not functioning optimally, highlighting the need for therapies to enhance motor performance.
  • This study investigated the effectiveness of paired associative stimulation (PAS), which combines transcranial magnetic stimulation and peripheral nerve stimulation, compared to standard peripheral nerve stimulation in improving hand function in patients with chronic tetraplegia.
  • Results showed that the PAS-treated hands had a notable improvement after 4 weeks of treatment, demonstrating enhanced motor output, which suggests that PAS could be a promising therapy for improving function in incomplete spinal cord injury cases, warranting further research with larger groups.
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Article Synopsis
  • Emerging therapies for spinal cord injury focus on preserving or restoring spinal connections, particularly in the corticospinal tract, to improve movement.
  • Paired associative stimulation (PAS) is a noninvasive method involving synchronized brain and nerve stimulation that can induce temporary plastic changes in the brain and spinal cord.
  • In a study of two patients with chronic spinal cord injuries, PAS led to significant recovery of voluntary movement, indicating it may strengthen neural connections and hold potential for rehabilitation, though further research is necessary.
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Article Synopsis
  • Spinal paired associative stimulation (PAS) uses transcranial magnetic stimulation (TMS) and peripheral nerve stimulation (PNS) to induce changes in the spinal cord that facilitate motor control, but requires individualized timing protocols due to variability in nerve conductivity.
  • A new approach for lower limbs involves estimating the interstimulus interval (ISI) using F-response and motor-evoked potential (MEP) latencies, improving the accuracy of the stimulation process.
  • This method successfully increased MEP amplitude by an average of 186% in healthy subjects, marking the first individualized ISI estimation for lower limb spinal PAS, thereby enhancing corticospinal transmission effectively.
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Background: Patients with widespread unilateral chronic pain associated with recurrent herpes simplex virus (HSV) infections show functional and/or structural changes in the insula, anterior cingulate cortex, frontal and prefrontal cortices, as well as the thalamus, suggesting central dysfunction of the pain system in these patients. Central pain has been associated with attenuated laser-evoked cortical responses. We aimed to clarify whether the observed deficient activation of these areas to acute nociceptive stimuli is due to a lesion at a lower level of pain processing pathways.

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  • Spontaneous brain oscillations can indicate brain issues or predict recovery, but their changes over time and significance are not fully understood.
  • A study tracked 16 stroke patients over 3 months, finding significant clinical improvement and increased 10-Hz oscillations in the affected brain area during recovery.
  • Abnormal low-frequency magnetic activity (ALFMA) was observed in some patients, with persistence linked to larger lesions and poorer outcomes, highlighting its potential as a negative recovery indicator.
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Article Synopsis
  • The study investigates how sensory input impacts motor cortex excitability and recovery of hand function in stroke patients over time.
  • Using magnetoencephalography (MEG), researchers assessed the motor cortex's beta rhythm response to tactile stimulation in 23 stroke survivors at multiple points post-stroke.
  • Findings show that decreased motor cortex excitability initially after stroke improved with recovery, highlighting the interconnected recovery of sensory and motor systems for better hand function.
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  • The study aimed to monitor median nerve integrity in carpal tunnel syndrome patients using pre- and post-operative diffusion tensor imaging (DTI).
  • Pre-operative results showed significant differences in nerve characteristics between patients and controls, especially at the distal nerve, indicating issues like increased diffusivity and decreased anisotropy.
  • DTI may complement traditional diagnostics, but age-related changes in nerve properties can affect its specificity, making slice-wise analysis important for assessing local nerve integrity.
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Article Synopsis
  • Motor recovery after a stroke depends on strong interactions between motor and sensory systems, requiring integration of sensory feedback for adjusting movement dynamics.
  • Researchers recorded somatosensory evoked fields (SEFs) in 23 acute stroke patients at different recovery stages to study the impact of somatosensory network deficits on motor recovery.
  • The findings indicated that whilst standard SEF measures from the primary somatosensory cortex did not correlate with functional recovery, the amplitude of activation in the contralateral parietal opercula was significantly associated with hand function during the acute phase and subsequent recovery.
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Article Synopsis
  • Stroke leads to changes in the primary somatosensory cortex, which are important for understanding recovery in motor functions after a stroke.
  • Researchers studied 15 stroke patients by measuring somatosensory responses and hand function at different recovery stages post-stroke.
  • Findings indicated that the affected hand's representation in the cortex temporarily enlarges during the early recovery phase, correlating with improved hand function, but later normalizes as rehabilitation progresses.
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