Y P O C T O N O D E Mar Cortes, MD S Assistant Professor, - PowerPoint PPT Presentation

Y P O C T O N O D E Mar Cortes, MD S Assistant Professor, Rehabilitation & Human Performance Department Co-Director, Abilities Research Center A Icahn School of Medicine at Mount Sinai, New York mar.cortes@mountsinai.org E L P

Y P Investigating Hebbian principles of neural plasticity in humans O "Cells that fire together, wire together" C T How can we induce plastic changes at the brain level? O N Paired Associative Stimulation (PAS) Or when the peripheral stimulation meets the MEP O D How can we induce plastic changes at the spinal level? E S Spinal Associative Stimulation (SAS) A Or when the central stimulation meets the H-reflex E L P

Y P How do we measure cortical excitability? The MEP O C TMS T O M1 N MEP α Magnetic O Stimulator D E STIMULUS S A E L EMG P Instrument

Y PAS protocol P O C T O N O D E S A E L P

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Y P PAS summary: O C • The increase of cortical excitability (MEP amplitude) was T dependent on the synchronous timing between the afferent O and the magnetic stimulation N • Plasticity induced by PAS O – 1. evolved rapidly (within 30 min), D – 2. was persistent (minimum duration 30-60 min) yet reversible, and – 3. was topographically specific E S properties signature of associative long-term potentiation (LTP ). A E L P

Y P How do we measure spinal excitability? The H-REFLEX O C T O N O D E S A E L P

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Y SAS protocol P O C T O N PRE POST INTERVENTION O (15 min) H-Reflex RC H-Reflex RC D TMS PNS E 20ms 90 0.1 Hz S paired stimuli A E sec 0 10 20 30 40 50 890 900 L P

Y Peripheral stimulation of somatosensory afferents conditioned by low frequency TMS, P increases spinal excitability O C T O Magnetic Stimulator N O Dorsal root (sensory) D Ia afferents Ventral root fibers E (motor) S Efferent A motor fibers E L P Electrical Stimulator Cortes et al, Clin Neurophys, 2011

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Y SAS experimental set up P O C T O N O D E S A E L P

Y Pharmacology of PAS P O C T O N O D E S A E L P

Y Pharmacology of PAS P O C T O N O D E S A E L P

Y PAS clinical applications P O C T O N O D E S A E L P

Y PAS clinical applications P O C T O N O D E S A E L P

Y Modified PAS protocols P O C T O N O D E S A E L P

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