Bilobed Gracilis Flap: A Novel Alternative for Pelvic and Perineal Reconstruction.

Perineal reconstruction historically has been guided by the vertical rectus abdominis myocutaneous flap. In oncologic patients, because of prior surgical intervention, this donor site is often unavailable, the pelvis has been irradiated, and defects can be deep or irregularly contoured. Using plastic surgery principles of perforators, geometrically defined local tissue rearrangement, and flap inset, the authors have developed a modification of the gracilis flap to include a second soft-tissue arm similar to a bilobed flap.

Short Intracortical Inhibition During Voluntary Movement Reveals Persistent Impairment Post-stroke.

Short intracortical inhibition (SICI) is a GABA-mediated phenomenon, argued to mediate selective muscle activation during coordinated motor activity. Markedly reduced SICI has been observed in the acute period following stroke and, based on findings in animal models, it has been posited this disinhibitory phenomenon may facilitate neural plasticity and contribute to early motor recovery. However, it remains unresolved whether SICI normalizes over time, as part of the natural course of stroke recovery.

Does inhibitory repetitive transcranial magnetic stimulation augment functional task practice to improve arm recovery in chronic stroke?

Introduction. Restoration of upper extremity (UE) functional use remains a challenge for individuals following stroke. Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive modality that modulates cortical excitability and is being explored as a means to potentially ameliorate these deficits.

Cognitive effects of treatment of depression with repetitive transcranial magnetic stimulation.

Background And Objective: We previously reported a randomized, sham-controlled trial of 5 Hz dorsolateral prefrontal left- and right-side repetitive transcranial magnetic stimulation (rTMS) in 48 participants with a medically refractory major depressive disorder. Depression improved most with right-side cranial stimulation, both rTMS and sham, and to a lesser degree with left rTMS. Because depression is often associated with cognitive impairment, in this study we sought to determine whether our earlier participants had treatment-induced changes in cognition, which cognitive domains (language, executive, visuospatial, verbal episodic memory, attention) were affected, and whether treatment-induced cognitive changes were related either to improvement in depression or to other treatment variables, such as right versus left treatment and rTMS versus sham.

Motor evoked potential depression following repetitive central motor initiation.

Prior reports have described a transient and focal decline in transcranial magnetic stimulation (TMS)-induced motor evoked potential (MEP) amplitude following fatiguing motor tasks. However, the neurophysiological causes of this change in MEP amplitude are unknown. The aim of this study was to determine whether post-task depression of MEPs is associated with repetitive central motor initiation.

Repetitive transcranial magnetic stimulation of motor cortex after stroke: a focused review.

Repetitive Transcranial Magnetic Stimulation (rTMS) is known to modulate cortical excitability and has thus been suggested to be a therapeutic approach for improving the efficacy of rehabilitation for motor recovery after stroke. In addition to producing effects on cortical excitability, stroke may affect the balance of transcallosal inhibitory pathways between motor primary areas in both hemispheres: the affected hemisphere (AH) may be disrupted not only by the infarct itself but also by the resulting asymmetric inhibition from the unaffected hemisphere, further reducing the excitability of the AH. Conceptually, therefore, rTMS could be used therapeutically to restore the balance of interhemispheric inhibition after stroke.

Variable changes in PET activity before and after rTMS treatment for tinnitus.

Objectives/hypothesis: The objective was to determine whether low-frequency repetitive transcranial magnetic stimulation (rTMS) improves tinnitus by decreasing neural activity in auditory processing regions of the temporal cortex and the utility of positron emission tomography (PET) for targeting treatment.

Study Design: Randomized, sham-controlled crossover.

Methods: Patients received a five-day course of active and sham 1-Hz rTMS (1800 pulses at 110% of motor threshold) to the temporal cortex, with a week separating active and sham treatment.

Right and left dorsolateral pre-frontal rTMS treatment of refractory depression: a randomized, sham-controlled trial.

We conducted a prospective, randomized, sham-controlled, double blind, parallel group study of right or left pre-frontal rTMS in 48 subjects with medication-resistant depression. Two thousand (50x8-s trains of 5Hz) stimuli at MEP threshold were delivered each weekday for 2weeks. We employed a sham coil and simultaneous electrical stimulation of the scalp to simulate rTMS.

Sham Transcranial Magnetic Stimulation Using Electrical Stimulation of the Scalp.

BACKGROUND: Most methods of sham, repetitive transcranial magnetic stimulation (rTMS) fail to replicate the look, sound, and feel of active stimulation in the absence of a significant magnetic field. OBJECTIVE/HYPOTHESIS: To develop and validate a new method of sham rTMS appropriate for a double-blind, placebo-controlled study with subject crossover. METHODS: The look and sound of active rTMS was replicated using a matched, air-cooled sham TMS coil.

Reliability of transcranial magnetic stimulation for mapping swallowing musculature in the human motor cortex.

Objective: Although transcranial magnetic stimulation (TMS) has been widely used to study motor cortex organization and excitability, the reliability of this technique has not been thoroughly investigated. Furthermore, previous reports of TMS reliability have been restricted to upper limb musculature. We sought to determine the test-retest reliability for TMS mapping of motor representations for swallowing musculature.

Maintenance repetitive transcranial magnetic stimulation can inhibit the return of tinnitus.

Objectives/hypothesis: A single patient was tested to examine the safety and feasibility of using maintenance sessions of low-frequency repetitive transcranial magnetic stimulation (1 Hz rTMS) to reduce tinnitus loudness and prevent its return over time.

Study Design: Interrupted time series with multiple replications.

Methods: Tinnitus loudness was assessed using a visual analogue rating (VAR) with 0 = no tinnitus, and 100 = loudest tinnitus experienced; 1,800 TMS pulses delivered at 1 Hz and 110% of motor threshold were administered over the posterior, superior lateral temporal gyrus of the subject's right hemisphere until subjective tinnitus fell to a VAR of 25.

The clinical diagnostic utility of transcranial magnetic stimulation: report of an IFCN committee.

The review focuses on the clinical diagnostic utility of transcranial magnetic stimulation (TMS). The central motor conduction time (CMCT) is a sensitive method to detect myelopathy and abnormalities may be detected in the absence of radiological changes. CMCT may also detect upper motor neuron involvement in amyotrophic lateral sclerosis.

Use of transcranial magnetic stimulation to influence behavior.

Transcranial magnetic stimulation (TMS) is a noninvasive technique that allows researchers to induce electrical currents in focal areas of the cerebral cortex. These currents can transiently activate or inhibit focal cortical areas and thus influence behavior. In the 20 years since its introduction, TMS has been applied to the study and treatment of a wide variety of neurologic and psychiatric conditions.

Dissociation of neglect subtypes with transcranial magnetic stimulation.

Objective: To identify two forms of hemispatial neglect, attentional and intentional, in healthy volunteers using frontal and parietal repetitive transcranial magnetic stimulation (rTMS).

Methods: Ten healthy volunteers performed line bisection tasks while viewing stimuli on closed circuit TV. Direct view of the exploring hand and the target was precluded and the TV monitor guided performance.

Repetitive transcranial magnetic stimulation as an adjunct to constraint-induced therapy: an exploratory randomized controlled trial.

Objective: To test the potential adjuvant effect of repetitive transcranial magnetic stimulation (rTMS) on motor learning in a group of stroke survivors undergoing constraint-induced therapy (CIT) for upper-limb hemiparesis.

Design: This was a prospective randomized, double-blind, sham-controlled, parallel group study. Nineteen individuals, one or more years poststroke, were randomized to either a rTMS + CIT (n = 9) or a sham rTMS + CIT (n = 10) group and participated in the 2-wk intervention.

Repetitive transcranial magnetic stimulation for tinnitus: a pilot study.

Objectives/hypothesis: Low-frequency repetitive transcranial magnetic stimulation (rTMS) has been shown to alleviate tinnitus perception, presumably by inhibiting cortical activity associated with tinnitus. We conducted a pilot study to assess effectiveness of neuronavigated rTMS and its effects on attentional deficits and cortical asymmetry in four patients with chronic tinnitus using objective and subjective measures and employing an optimization technique refined in our laboratory.

Study Design: Randomized, placebo-controlled (sham stimulation) crossover study.

Ipsilateral motor activation during unimanual and bimanual motor tasks.

Objective: To test for the presence and possible asymmetry of ipsilateral motor activation during unimanual and bimanual motor tasks.

Methods: Twelve right-handed healthy subjects underwent motor evoked potential (MEP) measurement of one hand (target-hand) while the other hand (task-hand) performed different motor tasks. The target-hand was either at rest (first experiment) or performed a Perdue PegBoard task (second experiment).

Repetitive transcranial magnetic stimulation for tinnitus: a case study.

Objectives/hypothesis: Correlate subjective improvements in tinnitus severity with restoration of cortical symmetry and sustained attention after neuronavigated low-frequency, repetitive transcranial magnetic stimulation (rTMS).

Study Design: Case study.

Methods: Positron emission tomography and computed tomography imaging (PET-CT) guided rTMS was performed on a 43-year-old white male with more than a 30 year history of bilateral tinnitus.

Reliability of motor cortex transcranial magnetic stimulation in four muscle representations.

Objective: Motor cortex plasticity may underlie motor recovery after stroke. Numerous studies have used transcranial magnetic stimulation (TMS) to investigate motor system plasticity. However, research on the reliability of TMS measures of motor cortex organization and excitability is limited.

Diagnosis and Treatment of Chronic Immune-mediated Neuropathies.

The chronic autoimmune neuropathies are a diverse group of disorders, whose diagnosis and classification is based on the clinical presentations and results of ancillary tests. In chronic inflammatory demyelinating polyneuropathy, controlled therapeutic trials demonstrated efficacy for intravenous gamma-globulins, corticosteroids, and plasmaphereis. In multifocal motor neuropathy, intravenous gamma-globulins have been shown to be effective.