• The Korean Journal of Pain
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• 제27권3호
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• pp.285-289
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• 2014

Transcranial magnetic stimulation (TMS) is a noninvasive and safe technique for motor cortex stimulation. TMS is used to treat neurological and psychiatric disorders, including mood and movement disorders. TMS can also treat several types of chronic neuropathic pain. The pain relief mechanism of cortical stimulation is caused by modifications in neuronal excitability. Depression is a common co-morbidity with chronic pain. Pain and depression should be treated concurrently to achieve a positive outcome. Insomnia also frequently occurs with chronic lower back pain. Several studies have proposed hypotheses for TMS pain management. Herein, we report two cases with positive results for the treatment of depression and insomnia with chronic low back pain by TMS.

• The Journal of Korean Physical Therapy
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• 제22권5호
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• pp.103-108
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• 2010

Purpose: The aim of this study is to investigate whether motor cortex excitability by transcranial direct current stimulation (tDCS) over primary motor cortex (M1) affects motor performance of serial reaction task. Methods: Cathodal, anodal and sham tDCS (1 mA) are applied over right M1 of 24 subjects for 30 minutes including 11minutes for task period time. We applied two electrodes at the same position to both an experimental group and a sham-controlled group, and we made 2 groups recognize to be applicated of stimulation. Flexion, extension of wrist and thumb flexion are carried out following colors of arrows on the monitor. Serial reaction time task was applied to confirm the difference of the reaction time between 2 groups. Results: Reaction time is decreased in both tDCS-group and Sham-controlled tDCS group, and the degree of reduction is much greater in the post-test than pre-test. Reduction of reaction time between groupsis statistically significant. Conclusion: We consider that anodal tDCS increased the cortical excitability of the underlying motor cortex and it can be helpful to modulate motor performance. It seems that tDCS is an effective modality to modulate brain function, and it will be great help to mediate strategy for the brain injury patients.

• Annals of Clinical Neurophysiology
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• 제13권1호
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• pp.1-12
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• 2011

Transcranial magnetic stimulation (TMS) is a non-invasive tool used to study aspects of human brain physiology, including motor function and the pathophysiology of various brain disorders. A brief electric current passed through a magnetic coil produces a high-intensity magnetic field, which can excite or inhibit the cerebral cortex. Although various brain regions can be evaluated by TMS, most studies have focused on the motor cortex where motor evoked potentials (MEPs) are produced. Single-pulse and paired-pulse TMS can be used to measure the excitability of the motor cortex via various parameters, while repetitive TMS induces cortical plasticity via long-term potentiation or long-term depression-like mechanisms. Therefore, TMS is useful in the evaluation of physiological mechanisms of various neurological diseases, including movement disorders and epilepsy. In addition, it has diagnostic utility in spinal cord diseases, amyotrophic lateral sclerosis and demyelinating diseases. The therapeutic effects of repetitive TMS on stroke, Parkinson disease and focal hand dystonia are limited since the duration and clinical benefits seem to be temporary. New TMS techniques, which may improve clinical utility, are being developed to enhance clinical utilities in various neurological diseases.

• 신경정신의학
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• 제57권2호
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• pp.119-132
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• 2018

Despite the fact that pharmacotherapy depressive disorders have proven efficacy, a substantial number of patients are resistant to conventional management. As neuroscientific research about pathophysiology of depression have accumulated, repeated transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) have emerged as an important mechanism-based treatment modality. This overview provides a review of therapeutic application of rTMS and tDCS in patients with depression. The clinical and basic studies of rTMS and tDCS in depression were reviewed and integrated using a literature review and interview with experts. rTMS is a noninvasive procedure of a localized pulsed magnetic field to the surface of the head to cause a depolarization of neurons in the brain cortex. tDCS has a mechanism of modulating cortical excitability in a polarity-specific manner without eliciting action potentials. rTMS and tDCS seem promising for treating depression. Although therapeutic parameters and further technical improvement remain to be systematically investigated, rTMS and tDCS would be a safe and effective intervention to treat depression.

• Toxicological Research
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• 제23권1호
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• pp.33-38
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• 2007

Zinc is an endogenous transition metal that can be synaptically released during neuronal activity. However, zinc may contribute to the neuropathology associated with a variety of conditions. Carnosine expressed in glial cells can modulate the effects of zinc on neuronal excitability as a zinc chelator. We hypothesize that carnosine may protect against neurotoxicity of zinc in cortical neuronal cells. The cortical neuronal cells from newborn rats were prepared and exposed to zinc chloride and/or carnosine at various concentrations. Zinc at the doses of 0 to $500{\mu}M$ decreased neuronal cell viability in a dose-dependent manner. Additionally, at the concentrations of 100 and $200{\mu}M$, it significantly decreased cell viability in an exposed time-dependent manner (p < 0.05). Treatment with carnosine at the concentrations of 20 and $200{\mu}M$ significantly increased neuronal cell proliferation by approximately 14% and 20%, respectively, compared to the control (p < 0.05). At the concentrations of 100 and $200{\mu}M$ zinc, $20{\mu}M$ carnosine significantly increased the viability of neuronal cells by 18.3% and 12.1 %, and $200{\mu}M$ carnosine also increased it by 33.5% and 28.6%, respectively, compared to the normal control group (p < 0.01). These results suggest that carnosine at a physiologically relevant level may protect against zinc-mediated toxicity in neuronal cells as an endogenous neuroprotective agent.

• 대한통합의학회지
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• 제7권3호
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• pp.171-180
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• 2019

Purpose : The purpose of this study was to investigate the difference in motor cortical excitability during mental practice and action observation in subjects with forward head posture. Methods : This study was performed in two groups, a forward head posture group (n=17) and a normal posture group (n=17). Electroencephalography (EEG) was conducted to investigate cerebral cortex activity, and six electrodes were attached to Fp1, Fp2, C1, C2, C3, and C4 to measure the relative alpha power, relative beta power, relative gamma power, and mu rhythms. The subjects were requested to perform the four different conditions, which were eye opening, eye closing, mental practice, and action observation for 300 seconds. Results : The results showed that the relative alpha waves showed a significant difference between the normal and forward head posture groups in the C1, C2, C3, and C4 regions with the eyes open (p<.05). The relative beta waves also showed a significant difference between the two groups in the Fp1 and Fp2 regions during action observation (p<.05). The relative gamma waves were significantly different between the normal and forward head posture groups in the Fp1 and Fp2 regions during action observation (p<.05) in C1, C2, and C3 with eyes closed (p<.05) and in C1, C2, C3, and C4 with eyes open (p<.05). Conclusion : The results of this study showed that EEG change in the forward head posture group was different from that in the normal control group in action observation rather than in mental practice. Therefore, we are expected to provide a neurophysiological basis for applying action observation to motor skill learning during exercise for correcting forward head posture.

• Physical Therapy Rehabilitation Science
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• 제10권1호
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• pp.1-9
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• 2021

Objective: Joint mobilization for arthrokinematics altered by the positional fault of chronic ankle instability (CAI) is an effective intervention for stabilization. In this study, we compared the effects of ankle dorsi flexion range of motion (DFROM) and dynamic balance ability (DBA) in CAI patients via passive joint mobilization (PJM), a method traditionally performed in previous studies, and active joint mobilization (AJM), a method that can have a greater effect on cortical excitability with spontaneous movements. Design: Single-blind two-arm randomized controlled trial Methods: A total of 30 participants were registered: 15 each to the PJM and AJM groups. Each participant received a total of 10 intervention sessions, 10 minutes per session, 5 times a week for 2 weeks. PJM used Maitland's mobilization method to apply joint mobilization with talus in the posterior direction and AJM used an angular joint motion to induce patient's voluntary motion of medial malleolus anterior gliding and lateral malleolus posterior gliding, respectively. DFROM of the ankle was measured by using tape and DBA was evaluated by using the balance system. Results: Significant improvement was observed after intervention in both the PJM and AJM groups except for the DBA-anterior and DBA-right variables of the PJM group. There were statistically significant differences between the AJM and PJM groups in the DFROM, DBA-anterior, DBA-posterior, and DBA-right variables. Conclusions: The overall improvement of DFROM and DBA was found to be more effective in joint mobilization including voluntary movement. When it is accompanied by voluntary movement, it further affects the neuromuscular system of the ankle.

• 생물정신의학
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• 제24권3호
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• pp.95-109
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• 2017

본 종설에서는 우울증에서의 rTMS 임상연구를 임상특성과 TMS 적용방법을 고려하여 체계적으로 고찰하였으며 새로운 TMS 치료기법에 대해 살펴보았다. rTMS는 항우울제에 반응이 적은 단극성 우울증 환자의 치료에 병용 혹은 단독요법으로 사용될 수 있는 안전하고 비침습적인 뇌조절술이다. rTMS는 고빈도 좌측 DLPFC, 저빈도 우측 DLPFC, 그리고 양측성 DLPFC 적용방법이 비슷한 수준으로 허위자극에 비해 유의하게 항우울효과를 가지고 있다. 그러나 치료저항성 단극성 우울증에 대한 항우울효과 크기는 작았다. 또한 정신병적 증상이 동반된 우울증의 치료와 양극성 장애의 우울삽화에 대해서는 치료효과가 불분명하다. 기존 rTMS의 항우울효과 크기는 작은 정도로 그 효과를 증진시키기 위해 고용량의 자극, 보다 깊이 자극할 수 있는 코일을 이용한 rTMS 치료, 표적영역에 보다 정확하게 코일을 위치시키는 신경항법 등을 이용한 TMS 적용 등의 새로운 시도들이 진행되고 있다. 또한 세타돌발자극과 자기경련치료와 같은 새로운 치료기법을 이용한 시도가 우울증 치료의 새로운 장을 열고 있다. 비록 현재까지 rTMS의 항우울효과가 만족할 만한 수준은 아니지만 임상양상을 세분화한 치료적용과 개선된 치료기법의 적용 등을 통해 더 많은 후속 연구가 이루어질 필요가 있다. 또한 여러 형태의 TMS 기법에 대해 잘 설계된 허위자극에 대한 통제연구뿐만 아니라 서로의 비교연구를 통해 우울증 치료에서의 근거수준을 높일 수 있을 것으로 기대한다.

• 재활치료과학
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• 제7권3호
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• pp.23-33
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• 2018

목적 : 본 연구는 국외 학술지를 대상으로 한 체계적 문헌고찰 연구를 통해 경직을 가지고 있는 뇌졸중 환자를 대상으로 진동자극의 효과를 제시하는 데에 목적이 있다. 연구방법 : 전자 데이터베이스인 NDSL과 RISS를 사용하여 2009년 4월부터 2017년 10월까지의 논문을 검색하였다. 주요 검색 용어로 'Vibration therapy', 'Focal vibration ', 'Somatosensory', 'Upper limb'와 'Spasticity after stroke를 사용하였다. 선정기준과 배제기준을 통해 최종적으로 6개의 논문이 선정하였다. 결과 : 국소 진동자극의 효과를 알아보기 위한 중재방법으로는 진동자극만을 적용한 중재부터 과제기반 진동자극 중재부터 다양하였다. 중재효과를 알아보기 위해 경직, 상지기능, 일상생활동작 평가도구가 사용되었다. 국소 진동자극은 뇌졸중 환자의 경직 감소와 상지기능에 긍정적인 영향이 있는 것으로 나타났으며, 대뇌피질의 활성화에도 유의미한 효과가 있는 것으로 나타났다. 결론 : 본 연구를 통해 치료사들은 국소 진동자극 적용에 필요한 정보 및 근거를 찾을 수 있을 것이다. 하지만 다양한 국소 진동자극의 적용 방법으로 인해 효율적인 진동수, 진폭의 크기 및 진동을 적용할 위치를 확인하는 데에는 어려움이 있었다. 향후 국내연구에서는 국소 진동자극의 효과를 극대화 할 수 있는 체계적인 중재 프로토콜에 대한 연구가 필요하다.

• 대한임상검사과학회지
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• 제52권3호
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• pp.194-201
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• 2020

잠복기와 전위는 MMN의 측정 매개변수이다. 이 매개변수의 수치는 자극방안에 따라 민감하게 변한다. MMN 검사를 위해 주파수 차이를 자극변이로 이용하는 자극방안이 잘 알려져 있다. 이 자극방안을 이용하여 건강하고 젊은 성인에서 MMN 검사를 하고 매개변수의 참고치를 구하는 것이 본 연구의 목적이다. 저자들은 10명의 정상성인을 모집하였다. 이들의 연령은 평균 25.5세이고, 3명은 여성 7명은 남성이었다. MMN 검사를 위한 청각 자극방안에서 표준소리의 주파수는 1,000 Hz, 변이소리의 주파수는 1,032 Hz였다. MMN의 평균잠복기와 평균전위가 Fz에서 202 ms 와 1.88 ㎶, Cz에서 207 ms와 1.46 ㎶, C3에서 212 ms와 1.10 ㎶, 그리고 C4에서 214 ms와 1.45 ㎶였다. MMN의 잠복기와 전위사이에 상관성은 관찰되지 않았다. 본 연구는 적용하기 쉬운 표준자극방안으로 검사한 MMN의 잠복기와 전위의 참고치를 제시하였다. 이 정보는 임상과 기초연구에서 MMN의 유용성을 높일 것이다.