Stroke is the leading cause of long-term disability in the United States and less than 50% of survivors regain independent ambulation. While lower extremity performance is a prime target of rehabilitation, little is known about patterns of neural function and structure which may influence, or be influenced by recovery of coordinated, lower extremity function. In this pilot study, we are developing a paradigm to measure lower extremity movement on brain function. Heathy controls will undergo 2 MRI scans wherein we will measure the brain activity associated with lower extremity movement.
The study will use a new method for non-invasively examining the brain called Transcranial Magnetic Stimulation (TMS). TMS involves placing a coil of wire above the scalp and intermittently passing a very powerful current through it. This current produces energy in the form of a magnetic field that passes through the scalp. The magnetic field, in turn, induces a much weaker electrical current in the brain, causing the neurons directly under the coil to activate for a brief period of time. The U.S. Federal Drug Administration has approved TMS as a method for treating depression since 2008. By using TMS, we can evaluate how well your brain is controlling one of your hand or leg muscles. One way to measure this is by recording activity via electrodes on the hand opposite the side of the brain being stimulated. For example we will be stimulating on the left side of the brain and recording from electrodes on your right hand. In this study we are determining the effects of different types of repetitive Transcranial Magnetic Stimulation (rTMS) protocols on hand movement. rTMS means that the magnetic pulses are applied consecutively, and at a specified pace- the frequency. The specific type of rTMS you will receive is called "theta-burst stimulation" (TBS). TBS is characterized by a specific frequency of stimulation.
PROJECT SUMMARY Chronic use of opiates is a rapidly escalating crisis in the United States, with over 4.3 million Americans dependent on opiate analgesic, an escalating rate of opiate overdose deaths, and a resurgence of intravenous heroin use leading to total societal cost exceeding $55 billion. The struggle to break the addiction cycle is likely due to factors that affect neural circuits that govern craving and cognitive control. There is growing interest in the utilization of prefrontal cortex repetitive transcranial magnetic stimulation (rTMS) as a novel, non-invasive, non-pharmacologic approach to decreasing craving among chronic opiate users. At this early stage of development, however, it is unclear if the best TMS strategy is to (Strategy 1, Aim 1) increase activity in the dorsolateral prefrontal cortex, or (Strategy 2, Aim 2) decrease activity in the ventromedial prefrontal cortex. To parametrically evaluate these two promising treatment strategies, we have developed a three-visit crossover design wherein a cohort of buprenorphine-maintained (as a therapeutic technique to address opiate dependence) opiate dependent individuals will receive interleaved TMS/BOLD imaging and our established MRI-based thermal pain paradigm immediately before and after rTMS. We will also measure subjective pain and opiate craving ratings. The relative efficacy of Strategy 1 vs 2 will directly translate to development of a large clinical trial of rTMS as an innovative, new treatment option for pain in opiate dependent individuals.
Currently there is an interest in optimizing rTMS protocols and in particular theta burst stimulation as both a therapeutic and investigational research tool. In a recent publication by Gamboa et al. 2010 it was shown that extended theta-burst stimulation duration (80 seconds) might have reverse effects on cortical excitability when compared to the original Huang et al. 2005 publication (40 seconds). While the post treatment effects of the original Huang et al. 2005 protocol were successfully replicated, when cTBS protocols were doubled to 1200 pulses over 80 seconds and the iTBS protocols were doubled to 1200 pulses over 390 seconds, there was increased facilitation after the prolonged cTBS and decreased excitability after prolonged iTBS. In Hanlon et al. 2015 a novel theta burst paradigm (5 minutes) is described in which two trains of 1800 pulses of cTBS, separated by a one-minute interval. This study aims to replicate the findings of the Gamboa and Huang protocols as well as investigate how novel theta burst stimulation paradigms such as those described in Hanlon et al. 2015, which are currently being explored as therapeutic methods in addiction change cortical excitability.
This study examines the effects of non-invasive brain stimulation as a tool to change the brain's response to alcohol cues. There are 3 study visits. At each study visit participants will receive a single session of real or sham transcranial magnetic stimulation (TMS) followed by an MRI scan. This study does not involve alcohol treatment. Interested individuals must be referred for participation by the Charleston Alcohol Research Center Clinical Intake and Assessment Core. For more information, call 792-1222 or email firstname.lastname@example.org.
The goal of this pilot study is to determine if, in treatment-seeking substance dependent individuals, ten sessions of continuous theta burst transcranial magnetic brain stimulation (cTBS) over a brain region involved in craving (medial prefrontal cortex) can lower an individual's craving and brain response to drug-related cues. This study involves a screening visit, followed by one MRI visit, followed by ten cTBS treatment visits on consecutive days. There will be three follow-up MRI visits: the first will immediately follow completion of a 28-day outpatient treatment program, while the second and third will be one month and two months post-treatment.
The goal of this study is to determine whether transcranial magnetic stimulation (TMS) is an effective treatment in decreasing craving in individuals who habitually smoke cigarettes. The study consists of six total visits to MUSC; one for the consent process, two that will include MRI scans, and five that will include TMS administration. Compensation will be provided for each visit.
The purpose of this study is to develop repetitive transcranial magnetic stimulation (rTMS) as a potential treatment for opiate dependence addiction. Repetitive TMS is a non-invasive technique that uses magnetic pulses to temporarily stimulate specific brain areas in awake people (without the need for surgery, anesthetic, or other invasive procedures). This study will test whether rTMS over the prefrontal cortex can produce a reduction in your perception of pain, your desire to use opiates, and your brain's response to opiate cues. TMS has been approved by the FDA as an investigational tool as well a therapy for depression.
The purpose of this proposal is to determine the relationship between baseline brain connectivity on short and longer term outcomes in treatment seeking substance-dependent individuals. This longitudinal neuroimaging study will assess brain function at 4 timepoints before after a 28-day intensive outpatient substance abuse treatment program (CDAP) at MUSC. Controls will also be recruited as a comparison group.
The purpose of this study is to use transcranial magnetic stimulation (TMS) as a tool to examine how brain activity changes following a dose of repetitive TMS (rTMS) similar to those approved by the Food and Drug Administration (FDA) for treatment-resistant depression. Healthy individuals 18-45 years of age may be eligible to participate in this imaging research study. The time commitment is approximately 2 hours per experiment. Two experiments are required. Compensation is available.
There is an additional substudy investigating single pulses of TMS. Healthy individuals, ages 18 - 45, may be eligible to participate. There will be two experiments, each lasting approximately 2 hours. Compensation is available.