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Cerebellar transcranial magnetic stimulation facilitates excitability of spinal reflex, but does not affect cerebellar inhibition and facilitation in spinocerebellar ataxia

Matsugi, Akiyoshia; Kikuchi, Yutakab; Kaneko, Kentac; Seko, Yutac; Odagaki, Masatod

doi: 10.1097/WNR.0000000000001036

Transcranial magnetic stimulation (TMS) over the cerebellum facilitates the spinal reflex in healthy humans. The aim of this study was to investigate whether such cerebellar spinal facilitation (CSpF) appears in patients with spinocerebellar ataxia (SCA) presenting with atrophy in the cerebellar gray matter and dentate nucleus. One patient with SCA type 6 and another with SCA type 31 participated in this study. TMS over the right primary motor cortex was used to induce motor-evoked potentials in the right first dorsal interosseous muscle, which were detected using electromyography. Conditioning TMS using interstimulus intervals of 1–8 ms was performed over the right cerebellum as a test to measure cerebellar brain inhibition (CBI). To assess the H-reflex and the M-wave recruitment curve of the right soleus muscle, we performed electrical stimulation of the right tibial nerve. The stimulation intensity was set to that at the center of the H-reflex curve of the ascending limb. To measure CSpF, we delivered TMS over the right cerebellum 100, 110, 120, and 130 ms before the right tibial nerve stimulation. Voxel-based morphometry was used to verify the presence of atrophy in the cerebellar gray matter and dentate nucleus. CBI was absent in both cases. However, a significant facilitation of the H-reflex occurred with an interstimulus interval of 120 ms in both cases. These findings indicate that the pathways associated with the induction of CSpF and CBI are different, and that the cerebellar gray matter and dentate nucleus are not needed for the induction of CSpF. The possible origin of CSpF may be examined by stimulation of other cerebellar deep nuclei or the brainstem.

aFaculty of Rehabilitation, Shijonawate Gakuen University, Daitou City, Osaka

bDepartment of Rehabilitation for Intractable Neurological Disorders, Institute of Brain and Blood Vessels Mihara Memorial Hospital, Isesaki City

cGraduate School of Engineering, Maebashi Institute of Technology

dMaebashi Institute of Technology, Maebashi, Gunma Prefecture, Japan

Correspondence to Akiyoshi Matsugi, PhD, Faculty of Rehabilitation, Shijonawate Gakuen University, Hojo 5-11-10, Daitou City 574-0011, Osaka Prefecture, Japan Tel: +81 72 863 5043; fax: +81 72 863 5022; e-mail:

Received February 24, 2018

Accepted February 26, 2018

© 2018 Wolters Kluwer Health | Lippincott Williams & Wilkins