Key result
Inhibitory continuous theta burst stimulation of the supplementary motor area significantly reduced the amplitude of diaphragm motor evoked potentials from 327.5 μV at baseline to 243.3 μV at post-1 (p=0.002), whereas excitatory 5 Hz stimulation increased them.
Why the study?
Does conditioning the supplementary motor area with cTBS or 5 Hz rTMS modulate corticospinal projections to phrenic motoneurons in awake humans?
Does conditioning the supplementary motor area with cTBS or 5 Hz rTMS modulate corticospinal projections to phrenic motoneurons in awake humans?
Absolute Event Rate: 243.3% vs 327.5%
p-value: p=0.002
The supplementary motor area exerts a tonic excitatory influence on corticospinal projections to phrenic motoneurons, which can be bidirectionally modulated by magnetic stimulation.
INTRODUCTION: In humans, cortical mechanisms can interfere with autonomic breathing. Respiratory-related activation of the supplementary motor area (SMA) has been documented during voluntary breathing and in response to inspiratory constraints. The SMA could therefore participate in the increased resting state of the respiratory motor system during wake (i.e. "wakefulness drive to breathe"). METHODS: The SMA was conditioned by continuous theta burst magnetic stimulation (cTBS, inhibitory) and 5 Hz conventional rTMS (5 Hz, excitatory). The ensuing effects were described in terms of the diaphragm motor evoked response (DiMEPs) to single-pulse transcranial magnetic stimulation over the motor cortex. DiMEPs were recorded at baseline, and at 3 time-points ("post1", "post2", "post3") up to 15 minutes following conditioning of the SMA. RESULTS: cTBS reduced the amplitude of DiMEPs from 327.5 ± 159.8 µV at baseline to 243.3 ± 118.7 µV, 217.8 ± 102.9 µV and 240.6 ± 123.9 µV at post 1, post 2 and post 3, respectively (F = 6.341, p = 0.002). 5 Hz conditioning increased the amplitude of DiMEPs from 184.7 ± 96.5 µV at baseline to 270.7 ± 135.4 µV at post 3 (F = 4.844, p = 0.009). CONCLUSIONS: The corticospinal pathway to the diaphragm can be modulated in both directions by conditioning the SMA. This suggests that the baseline respiratory activity of the SMA represents an equipoise from which it is possible to move in either direction. The resting corticofugal outflow from the SMA to phrenic motoneurones that this study evidences could putatively contribute to the wakefulness drive to breathe.
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Laviolette et al. (2013) studied Healthy subjects (n=12). Continuous theta burst magnetic stimulation (cTBS) and 5 Hz rTMS over the supplementary motor area vs. Baseline (pre-stimulation) was evaluated on Amplitude of diaphragm motor evoked response (DiMEPs) (p=0.002). Inhibitory continuous theta burst stimulation of the supplementary motor area significantly reduced the amplitude of diaphragm motor evoked potentials from 327.5 μV at baseline to 243.3 μV at post-1 (p=0.002), whereas excitatory 5 Hz stimulation increased them.
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