• Annals of Clinical Neurophysiology
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• v.5 no.1
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• pp.21-26
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• 2003

Background & Objectives: Hyperexcitablity of motor system is a well-established characteristic pathophysiologic finding of amyotrophic lateral sclerosis (ALS). Whereas little is known about the source of excitability according to the progression of the disease. We evaluated the excitability and its source in advanced ALS patients using transcranial magnetic stimulation (TMS). Meterial & Methods: Motor evoked potentials (MEP) by TMS were recorded for abductor pollicis brevis muscles in 20 patients, 11 men and 9 women, with ALS. Mean age was $54.2{\pm}12.1years$, and mean disease duration was $13.9{\pm}13.4years$. Serial magnetic stimulations were applied to get the parameters; excitability threshold (ET), amplitude and latency of MEP. We also had a facilitated MEP (fMEP). Results: The parameters were analyzed according to the clinical settings. ET was higher in ALS(mean $63.5{\pm}18.1$) than normal control (mean $46.0{\pm}8.4$, p<0.01). Amplitudes of MEP were reduced in ALS ($2.6{\pm}3.6mV$; control $6.5{\pm}3.1mV$, p<0.01). Duration of the disease and ET showed significant inverse correlation (Spearson correlation coefficient = -0.57, p<0.01). Duration of the disease and fMEP/MEP ratio showed less but also significant inverse correlation (Spearson correlation coefficient, r = -0.52, p < 0.05). Conclusions: Lower ET in advanced ALS patients, in spite of decreased fMEP/MEP ratio, may indicate the hyperexcitability of lower motor neurons in these patients. This study suggests that lower motor neurons is hyperexcitable due to upper motor neuron dysfunction at advanced stage.

• The Korean Society of Law and Medicine
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• v.21 no.2
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• pp.209-244
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• 2020

TMS and tDCS are non-invasive devices that treat the diseases of patients or individual users, and manage or improve their health by applying stimulation to a brain through magnetism and electricity. The effect and safety of these devices have proved to be valid in several diseases, but research in this area is still much going on. Despite increasing cases of their application, legislations directly regulating TMS and tDCS are hard to find. Legal regulation regarding TMS and tDCS in the United States, Germany and Japan reveals that while TMS has been approved as a medical device with a moderate risk, tDCS has not yet earned approval as a medical device. However, the recent FDA guidance, European MDR changes, recalls in the US, and relevant legal provisions of Germany and Japan, as well as recommendations from expert groups all show signs of tDCS growing closer to getting approved as a medical device. Of course, safety and efficacy of tDCS can still be regulated as a general product instead of as a medical device. Considering multiple potential impacts on a human brain, however, the need for independent regulation is urgent. South Korea also lacks legal provisions explicitly regulating TMS and tDCS, but they fall into the category of the grade 3 medical devices according to the notifications of the Korean Ministry of Food and Drug Safety. And safety and efficacy of TMS are to be evaluated in compliance with the US FDA guidance. But no specific guidelines exist for tDCS yet. Given that tDCS devices are used in some hospitals in reality, and also at home by individual buyers, such a regulatory gap must quickly be addressed. In a longer term, legal system needs to be in place capable of independently regulating non-invasive brain stimulating devices.

• Investigative Magnetic Resonance Imaging
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• v.17 no.3
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• pp.169-180
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• 2013

Purpose : The purpose of this study was to setup a concuurent transcranial magnetic stimulation (TMS)-functional MRI (fMRI) system for understanding causality of the functional brain network. Materials and Methods: We manufactured a TMS coil holder using nonmagnetic polyether ether ketone (PEEK). We simulated magnetic field distributions in the MR scanner according to TMS coil positions and angles. To minimize image distortions caused by TMS application, we controlled fMRI acquisition and TMS sequences to trigger TMS during inter-volume intervals. Results: Simulation showed that the magnetic field below the center of the coil was dramatically decreased with distance. Through the MR phantom study, we confirmed that TMS application around inter-volume acquisition time = 100 miliseconds reduced imaging distortion. Finally, the applicability of the concurrent TMS-fMRI was tested in preliminary studies with a healthy subject conducting a motor task within TMS-fMRI and passive motor movement induced by TMS in fMRI. Conclusion: In this study, we confirmed that the developed system allows use of TMS inside an fMRI system, which would contribute to the research of brain activation changes and causality in brain connectivity.

• Journal of Yeungnam Medical Science
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• v.22 no.1
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• pp.96-103
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• 2005

The motor recovery mechanism of a 21-year-old male monoparetic patient with cerebral palsy, who had complained of a mild weakness on his right hand since infancy, was examined using functional Magnetic Resonance Imaging (fMRI) and Transcranial Magnetic Stimulation (TMS). The patient showed mild motor impairment on the right hand. MRI located the main lesion on the left precentral knob of the brain. fMRI was performed on this patient as well as 8 control subjects using the Blood Oxygen Level Dependent technique at 1.5 T with a standard head coil. The motor activation task consisted of finger flexionextension exercises at 1 Hz cycles. TMS was carried out using a round coil. The anterior portion of the coil was applied tangentially to the scalp at a 1.0 cm separation. Magnetic stimulation was carried out with the maximal output. The Motor Evoked Potentials (MEPs) from both Abductor Pollicis Brevis muscles (APB) were obtained simultaneously. fMRI revealed that the unaffected (right) primary sensori-motor cortex (SM1), which was centered on precentral knob, was activated by the hand movements of the control subjects as well as by the unaffected (left) hand movements of the patient. However, the affected(right) hand movements of the patient activated the medial portion of the injured precentral knob of the left SM1. The optimal scalp site for the affected (right) APB was located at 1 cm medial to that of the unaffected (left) APB. When the optimal scalp site was stimulated, the MEP characteristics from the affected (right) APB showed a delayed latency, lower amplitude, and a distorted figure compared with that of the unaffected (left) APB. Therefore, the motor function of the affected (right) hand was shown to be reorganized in the medial portion of the injured precentral knob.

• Journal of the Korean Society of Physical Medicine
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• v.15 no.1
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• pp.65-76
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• 2020

PURPOSE: The purpose of this study were to determine an intervention that involves proprioceptive exercises combined with cognitive task completion for adults with chronic ankle instability and to investigate the effects of the exercises on the static balance, dynamic balance, and ankle function of such individuals. METHODS: A total of 30 adults suffering from the aforementioned condition were randomly divided into experimental (n=15) and control (n=15) groups. The experimental group performed proprioceptive exercises in combination with cognitive tasks for 15 minutes in each session that was held three times a week for four 4 weeks, whereas the control group carried out only proprioceptive exercises. A Wii Balance Board, which enables examining the fluctuation area distance, and speed, was used to determine static balance; a Y-balance test kit was employed to measure dynamic balance; and the side hop, figure-of-8 hop, and square hop tests were conducted to ascertain ankle function. RESULTS: The results showed that the static balance, dynamic balance, and ankle function of both the experimental and control groups significantly improved. The participants were instructed to perform one-leg postural exercises with and without vision blocking for the affected leg. The experimental group showed more significant improvement than did the controls in terms of the fluctuation distance, speed, and area of static balance. CONCLUSION: In conclusion, although combined proprioceptive exercises and cognitive tasks were insufficient to enhance all types of balance among the subjects, it effectively reinforced their static balance.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.15 no.12
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• pp.7239-7247
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• 2014

This study repeated low-frequency transcranial magnetic stimulation (rTMS) to evaluate the effects on cognitive function in chronic stroke patients. Among the chronic stroke patients, 30 patients selected by MMSE-K and BCRS-K were divided randomly into 3 groups. Group I (n=10) had only sound applied, group II (n=10) were applied 1 Hz rTMS on the damaged side and group III (n=10) were applied to 1 Hz rTMS on the opposite side for total 2 weeks, 20 minutes per a day, five times per a week. To examine the change in cognitive function, CREAD-K scores were measured before, 1 week, 2 weeks, and then 3 months after the intervention. The CREAD-K scores were measured before and 1 week, 2 weeks and 3 months after the interventions. The immediate recall memory showed a significant difference after 2 weeks and 3 months in groups II and III (p<.05), The recognition memory showed a significant difference after 2 weeks and 3 months in group III (p<.05). The delayed recall memory showed significant differences after 3 months in group III than in group I (p<.05). Therefore, the application of low-frequency rTMS has a positive influence on the cognitive rehabilitation of chronic stroke patients.