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Results: There was a reduction in the VAS scores from baseline to retinotopic coordinates. V1 TMS affected temporal discrimination of
endpoint, but it had a marginal statistical signicance (p0.061). stimuli presented in the lower left visual quadrant whereas V5/MT TMS
Compared to baseline, signicant improvements in HDRS (p0.001), SSI the discrimination of stimuli presented in both the upper and the lower
(p0.014), ISI (p0.010), and EQ-5D (p0.023) scores were shown left visual quadrants. These results show that both V1 and V5/MT encode
respectively at endpoint. The treatment was generally well tolerated. visual temporal information in retinotopic spatial frames, but the repre-
Headache and nausea were common adverse effects. Only one patient was sentation of time is quadrant specic for V1 and hemield specic for V5/
dropped out due to memory loss. MT. These results represent the rst neurophysiological evidence of a link
Conclusion: Although these are preliminary ndings in an open trial, this between space and time in human visual cortex.
study shows a possible efcacy of ECT for the treatment-refractory Keywords: Time, Space, paired-pulse TMS
depressed patient with CRPS type 1. Adequate sample size will be war-
ranted to conrm these clinical benets. [0240]
Keywords: electroconvulsive therapy, complex regional pain syndrome, PAIRED ASSOCIATIVE QUADRIPULSE STIMULATION (PAS-QPS) - A NEW
depression, quality of life PROTOCOL COMBINING HOMO- AND HETERO-SYNAPTIC PLASTICITY
B. Verkuil 1, A.M. Burger*1, I. van Diest 2, B. Vervliet 3, W. van der Does 1, J.F. Background: Repeated bursts of four monophasic TMS pulses (QPS) are
Thayer 4, J.F. Brosschot 1. 1 Leiden University, The Netherlands; 2 KU Leuven, known to induce long-term depression (LTD) in the motor cortex (M1)
Belgium; 3 Harvard Medical School, USA; 4 The Ohio State University, USA when the interstimulus interval is 50ms (QPSLTD, homosynaptic plasticity).
It is also known that paired associative stimulation (PAS), a combination of
Introduction: A critical component of the treatment for anxiety disorders is monophasic TMS over the M1 and electric stimulation of the peripheral
the extinction of fear via repeated exposure to the feared stimulus. This nerve, induces LTD or long-term potentiation (LTP), depending on the
process is strongly dependent on successful memory formation and consol- interpair interval (PASLTD at N20-5ms and PASLTP at N20+2ms; hetero-
idation. Stimulation of the vagus nerve (VNS) has been proposed to enhance synaptic plasticity).
extinction memory through the increase of noradrenergic transmission. Objective: To investigate how the motor cortical excitability is modulated
Method: We conducted two studies (N 38 & N 41) to assess whether by combining QPS and PAS.
transcutaneous stimulation of the vagus nerve (tVNS) can accelerate Methods: Nine healthy subjects were examined with three intervention
extinction memory formation and retention in fear conditioned humans. protocols; simple QPSLTD, combined PASLTD-QPSLTD, and combined PASLTP-
To assess fear conditioning and subsequent fear extinction, we assessed US QPSLTD applied to the M1. We measured TMS-elicited motor evoked po-
expectancy ratings, fear potentiated startle responses and skin conduc- tentials (MEPs) before and after the intervention up to 60 minutes. First,
tance levels. After fear conditioning, participants were randomly assigned we conducted one-way ANOVA (time) to nd the effective time window of
to receive tVNS or sham stimulation during the extinction phase (study 1: each intervention. To compare the effects of different interventions, we
extinction directly followed acquisition; study 2: extinction followed 24 then applied one-way ANOVA (intervention) to the MEPs averaged in the
hours later). Retention of extinction memory was tested 24 hours later. dened time window.
Results: In both studies, tVNS accelerated explicit fear extinction (US ex- Results: ANOVA (time) showed a signicant main effect (p<0.05). Post-hoc
pectancy ratings). In study 2, spontaneous recovery for the skin conduc- tests revealed signicant MEP depression after QPSLTD (10 to 40, and 60
tance response occurred only in the sham group, but no differences were minutes) and PASLTD-QPSLTD (10 to 60 minutes). PASLTP-QPSLTD induced no
observed for the other outcomes during retention. signicant MEP changes. ANOVA (intervention) applied to the mean MEPs
Discussion: These ndings support the hypothesis that tVNS accelerates in the effective time window showed a signicant main effect (p<0.01).
declarative extinction learning. The ndings are preliminary but consistent PASLTD-QPSLTD depressed MEPs to a greater degree than the other in-
with recent studies that indicate that tVNS may be a tool to improve fear terventions (p<0.05). QPSLTD induced signicantly greater depression than
extinction. PASLTP-QPSLTD (p<0.05).
Keywords: transcutaneous vagus nerve stimulation, fear extinction,
memory, anxiety
[0239]
THE SPATIAL REPRESENTATION OF TIME IN VISUAL CORTEX