Altered motor cortical plasticity in patients with hepatic encephalopathy: A paired associative stimulation study |
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| Affiliation: | 1. Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany;2. Department of Neurology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany;3. Neuroscience Institute, New York University School of Medicine, New York, USA;4. Department of Neurology, Medical Faculty, Assiut University Hospital, Assiut, Egypt;5. Department of Health Sciences and Technology, ETH Zürich, Switzerland;6. Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany |
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| Abstract: | ObjectiveHepatic encephalopathy (HE) is a potentially reversible brain dysfunction caused by liver failure. Altered synaptic plasticity is supposed to play a major role in the pathophysiology of HE. Here, we used paired associative stimulation with an inter-stimulus interval of 25 ms (PAS25), a transcranial magnetic stimulation (TMS) protocol, to test synaptic plasticity of the motor cortex in patients with manifest HE.Methods23 HE-patients and 23 healthy controls were enrolled in the study. Motor evoked potential (MEP) amplitudes were assessed as measure for cortical excitability. Time courses of MEP amplitude changes after the PAS25 intervention were compared between both groups.ResultsMEP-amplitudes increased after PAS25 in the control group, indicating PAS25-induced synaptic plasticity in healthy controls, as expected. In contrast, MEP-amplitudes within the HE group did not change and were lower than in the control group, indicating no induction of plasticity.ConclusionsOur study revealed reduced synaptic plasticity of the primary motor cortex in HE.SignificanceReduced synaptic plasticity in HE provides a link between pathological changes on the molecular level and early clinical symptoms of the disease. This decrease may be caused by disturbances in the glutamatergic neurotransmission due to the known hyperammonemia in HE patients. |
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| Keywords: | Transcranial magnetic stimulation Paired associative stimulation Hepatic encephalopathy Critical flicker frequency Motor evoked potential Synaptic plasticity AMPA" },{" #name" :" keyword" ," $" :{" id" :" k0040" }," $$" :[{" #name" :" text" ," _" :" Alpha-Amino-3-Hydroxy-5-Methyl-4-Isoxazole Propionic Acid APB" },{" #name" :" keyword" ," $" :{" id" :" k0050" }," $$" :[{" #name" :" text" ," _" :" abductor pollicis brevis CFF" },{" #name" :" keyword" ," $" :{" id" :" k0060" }," $$" :[{" #name" :" text" ," _" :" critical flicker frequency EMG" },{" #name" :" keyword" ," $" :{" id" :" k0070" }," $$" :[{" #name" :" text" ," _" :" electromyography GEE" },{" #name" :" keyword" ," $" :{" id" :" k0080" }," $$" :[{" #name" :" text" ," _" :" generalized estimating equations HE" },{" #name" :" keyword" ," $" :{" id" :" k0090" }," $$" :[{" #name" :" text" ," _" :" hepatic encephalopathy ICF" },{" #name" :" keyword" ," $" :{" id" :" k0100" }," $$" :[{" #name" :" text" ," _" :" intracortical facilitation ISI" },{" #name" :" keyword" ," $" :{" id" :" k0110" }," $$" :[{" #name" :" text" ," _" :" interstimulus interval mHE" },{" #name" :" keyword" ," $" :{" id" :" k0120" }," $$" :[{" #name" :" text" ," _" :" minimal hepatic encephalopathy HE1" },{" #name" :" keyword" ," $" :{" id" :" k0130" }," $$" :[{" #name" :" text" ," _" :" hepatic encephalopathy in grade one HE2" },{" #name" :" keyword" ," $" :{" id" :" k0140" }," $$" :[{" #name" :" text" ," _" :" hepatic encephalopathy in grade two LTD" },{" #name" :" keyword" ," $" :{" id" :" k0150" }," $$" :[{" #name" :" text" ," _" :" long-term depression LTP" },{" #name" :" keyword" ," $" :{" id" :" k0160" }," $$" :[{" #name" :" text" ," _" :" long-term potentiation M1" },{" #name" :" keyword" ," $" :{" id" :" k0170" }," $$" :[{" #name" :" text" ," _" :" motor cortex MEP" },{" #name" :" keyword" ," $" :{" id" :" k0180" }," $$" :[{" #name" :" text" ," _" :" motor evoked potential NMDA" },{" #name" :" keyword" ," $" :{" id" :" k0190" }," $$" :[{" #name" :" text" ," _" :" N-methyl-D-aspartate PAS" },{" #name" :" keyword" ," $" :{" id" :" k0200" }," $$" :[{" #name" :" text" ," _" :" paired associative stimulation PAS25" },{" #name" :" keyword" ," $" :{" id" :" k0210" }," $$" :[{" #name" :" text" ," _" :" paired associative stimulation with an inter-stimulus interval of 25 ms paired associative stimulation with an inter-stimulus interval of 25ms, resulting in long-term potentiation paired associative stimulation with an inter-stimulus interval of 25ms, resulting in long-term depression ROS" },{" #name" :" keyword" ," $" :{" id" :" k0240" }," $$" :[{" #name" :" text" ," _" :" reactive oxygen species RMT" },{" #name" :" keyword" ," $" :{" id" :" k0250" }," $$" :[{" #name" :" text" ," _" :" resting motor threshold STDP" },{" #name" :" keyword" ," $" :{" id" :" k0260" }," $$" :[{" #name" :" text" ," _" :" spike timing dependent plasticity SICI" },{" #name" :" keyword" ," $" :{" id" :" k0270" }," $$" :[{" #name" :" text" ," _" :" short-interval intracortical inhibition TBS" },{" #name" :" keyword" ," $" :{" id" :" k0280" }," $$" :[{" #name" :" text" ," _" :" theta-burst stimulation cTBS" },{" #name" :" keyword" ," $" :{" id" :" k0290" }," $$" :[{" #name" :" text" ," _" :" continuous theta-burst stimulation iTBS" },{" #name" :" keyword" ," $" :{" id" :" k0300" }," $$" :[{" #name" :" text" ," _" :" intermittent theta burst stimulation TMS" },{" #name" :" keyword" ," $" :{" id" :" k0310" }," $$" :[{" #name" :" text" ," _" :" transcranial magnetic stimulation |
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