The oscillatory effects of rhythmic median nerve stimulation

Houlgreave, Mairi; Maiquez, Bàrbara Morera; Brookes, Matthew J.; Jackson, Stephen R.

doi:10.1016/j.neuroimage.2022.118990

Cited by 12 publications

(19 citation statements)

References 53 publications

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“…Prior to commencing the trial, we had piloted the sham stimulation condition to confirm that it differed from active stimulation. Specifically, we used MEG (magnetoencephalography) to investigate whether sham stimulation led to the entrainment of 10‐Hz brain oscillations that we observe during active stimulation (Houlgreave et al, 2022). We were able to confirm that, in contrast to active stimulation, 10‐Hz sham stimulation delivered at 50% of threshold produces no change in 10‐Hz power or phase synchrony.…”

Section: Resultsmentioning

confidence: 99%

“…First, using both EEG and MEG recording methods, it was shown that pulse trains of rhythmic MNS are effective in entraining sensorimotor 12 Hz oscillations (i.e. increasing the amplitude and phase synchronization of oscillations at the frequency of stimulation), whereas pulse trains of arrhythmic MNS do not (Houlgreave et al, 2022; Morera Maiquez et al, 2020). Second, in two separate studies that compared the effects of rhythmic versus arrhythmic MNS on the initiation of volitional movements, it was demonstrated, in both studies, that rhythmic MNS slowed movement initiation compared to arrhythmic MNS (Morera Maiquez et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

“…In recent work using electroencephalography (EEG), we have successfully shown that pulses of electrical stimulation delivered to the median nerve are capable of entraining neural oscillations within the sensorimotor cortex (Morera Maiquez et al, 2020). Houlgreave and colleagues have shown the same effect in healthy adults using magnetoencephalography (MEG; Houlgreave et al, 2022). Specifically, they demonstrated entrainment of oscillatory activity within the (8-14 Hz) alpha band and the (15-30 Hz) beta band, which are associated with sensorimotor function (Armstrong et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

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A double‐blind, sham‐controlled, trial of home‐administered rhythmic 10‐Hz median nerve stimulation for the reduction of tics, and suppression of the urge‐to‐tic, in individuals with Tourette syndrome and chronic tic disorder

Maiquez

Smith

Dyke

et al. 2023

Journal of Neuropsychology

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Tourette syndrome (TS) and chronic tic disorder (CTD) are neurological disorders of childhood onset characterized by the occurrence of tics; repetitive, purposeless, movements or vocalizations of short duration which can occur many times throughout a day. Currently, effective treatment for tic disorders is an area of considerable unmet clinical need. We aimed to evaluate the efficacy of a home‐administered neuromodulation treatment for tics involving the delivery of rhythmic pulse trains of median nerve stimulation (MNS) delivered via a wearable ‘watch‐like’ device worn at the wrist. We conducted a UK‐wide parallel double‐blind sham‐controlled trial for the reduction of tics in individuals with tic disorder. The device was programmed to deliver rhythmic (10 Hz) trains of low‐intensity (1–19 mA) electrical stimulation to the median nerve for a pre‐determined duration each day, and was intended to be used by each participant in their home once each day, 5 days each week, for a period of 4 weeks. Between 18th March 2022 and 26th September 2022, 135 participants (45 per group) were initially allocated, using stratified randomization, to one of the following groups; active stimulation; sham stimulation or to a waitlist (i.e. treatment as usual) control group. Recruited participants were individuals with confirmed or suspected TS/CTD aged 12 years of age or upward with moderate to severe tics. Researchers involved in the collection or processing of measurement outcomes and assessing the outcomes, as well as participants in the active and sham groups and their legal guardians were all blind to the group allocation. The primary outcome measure used to assess the ‘offline’ or treatment effect of stimulation was the Yale Global Tic Severity Scale–Total Tic Severity Score (YGTSS–TTSS) assessed at the conclusion of 4 weeks of stimulation. The primary outcome measure used to assess the ‘online’ effects of stimulation was tic frequency, measured as the number of tics per minute (TPM) observed, based upon blind analysis of daily video recordings obtained while stimulation was delivered. The results demonstrated that after 4‐week stimulation, tic severity (YGTSS‐TTSS) had reduced by 7.1 points (35 percentile reduction) for the active stimulation group compared to 2.13/2.11 points for the sham stimulation and waitlist control groups. The reduction in YGTSS–TTSS for the active stimulation group was substantially larger, clinically meaningful (effect size = .5) and statistically significant (p = .02) compared to both the sham stimulation and waitlist control groups, which did not differ from one another (effect size = −.03). Furthermore, blind analyses of video recordings demonstrated that tic frequency (tics per minute) reduced substantially (−15.6 TPM) during active stimulation compared to sham stimulation (−7.7 TPM). This difference represents a statistically significant (p < .03) and clinically meaningful reduction in tic frequency (>25 percentile reduction: effect size = .3). These findings indicate that home‐administered rhythmic MNS delivered through a wearable wrist‐worn device has the potential to be an effective community‐based treatment for tic disorders.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A double‐blind, sham‐controlled, trial of home‐administered rhythmic 10‐Hz median nerve stimulation for the reduction of tics, and suppression of the urge‐to‐tic, in individuals with Tourette syndrome and chronic tic disorder

Maiquez

Smith

Dyke

et al. 2023

Journal of Neuropsychology

Self Cite

View full text Add to dashboard Cite

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“…The stimulation created small but statistically significant dampening of the initiation of voluntary movements, but did not cause meaningful distraction, as measured by performance on a cognitively demanding test. A follow-up study found similar effects of MNS on cortical activity using magnetoencephalography [8]. In 19 TS patients treated with 10 Hz MNS, blinded video ratings showed significant reduction in tic counts and tic severity during stimulation.…”

Section: Introductionmentioning

confidence: 88%

Peripheral nerve induction of inhibitory brain circuits to treat Tourette syndrome: A randomized crossover trial

Iverson

Arbuckle

Ueda

et al. 2023

Preprint

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A prior study showed that rhythmic, but not arrhythmic, 12 Hz stimulation of the median nerve (MNS) entrained EEG power, and found that 10 Hz MNS improved tics in Tourette syndrome (TS). However, no control condition was tested and stimulation blocks lasted only 1 minute. We set out to replicate the TS results and to test whether tic improvement occurs by the proposed cortical entrainment mechanism. Thirty-two people with TS, age 15-64, completed two study visits with repeated MNS on and off blocks in random order, one visit for rhythmic and one for arrhythmic MNS. Subjects and staff were blind to order; a video rater was additionally blind to stimulation and to order of visits and blocks. Rhythmic MNS at 10 Hz improved tics. Both rhythmic and arrhythmic 12 Hz MNS improved tic frequency, intensity and urges without significant difference. Participant masking was effective and there was no carryover effect. Several participants described dramatic benefit. Discomfort was minimal. MNS benefit did not persist after the end of stimulation. These results replicate the tic benefit from MNS, but show that the EEG entrainment hypothesis cannot explain that benefit. Another electrophysiological mechanism may explain benefit; alternatively, these data do not exclude a placebo effect.

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“…The stimulation created small but statistically significant dampening of the initiation of voluntary movements, but did not cause meaningful distraction, as measured by performance on a cognitively demanding test. A follow-up study found similar effects of MNS on cortical activity using magnetoencephalography [ 8 ]. In 19 TS patients treated with 10 Hz MNS, blinded video ratings showed a significant reduction in tic counts and tic severity during stimulation.…”

Section: Introductionmentioning

confidence: 96%

Median Nerve Stimulation for Treatment of Tics: Randomized, Controlled, Crossover Trial

Iverson

Arbuckle

Ueda

et al. 2023

JCM

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A prior study showed that rhythmic, but not arrhythmic, 12 Hz stimulation of the median nerve (MNS) entrained the sensorimotor cortex EEG signal and found that 10 Hz MNS improved tics in Tourette syndrome (TS). However, no control condition was tested, and stimulation blocks lasted only 1 min. We set out to replicate the TS results and to test whether tic improvement occurs by the proposed cortical entrainment mechanism. Preregistration was completed at ClinicalTrials.gov, under number NCT04731714. Thirty-two people with TS, age 15–64, completed two study visits with repeated MNS on and off blocks in random order, one visit for rhythmic and one for arrhythmic MNS. Subjects and staff were blind to order; a video rater was additionally blind to stimulation and to the order of visits and blocks. Rhythmic MNS at 10 Hz improved tics. Both rhythmic and arrhythmic 12 Hz MNS improved tic frequency, intensity, and urges, but the two treatments did not differ significantly. Participant masking was effective, and there was no carryover effect. Several participants described a dramatic benefit. Discomfort was minimal. There was no evidence that the MNS benefit persisted after stimulation ended. These results replicate the tic benefit from MNS but show that the EEG entrainment hypothesis cannot explain that benefit. Another electrophysiological mechanism may explain the benefit; alternatively, these data do not exclude a placebo effect.

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The oscillatory effects of rhythmic median nerve stimulation

Cited by 12 publications

References 53 publications

A double‐blind, sham‐controlled, trial of home‐administered rhythmic 10‐Hz median nerve stimulation for the reduction of tics, and suppression of the urge‐to‐tic, in individuals with Tourette syndrome and chronic tic disorder

A double‐blind, sham‐controlled, trial of home‐administered rhythmic 10‐Hz median nerve stimulation for the reduction of tics, and suppression of the urge‐to‐tic, in individuals with Tourette syndrome and chronic tic disorder

Peripheral nerve induction of inhibitory brain circuits to treat Tourette syndrome: A randomized crossover trial

Median Nerve Stimulation for Treatment of Tics: Randomized, Controlled, Crossover Trial

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