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    Item type:Publication,
    Multimodal neuroimaging of fatigability development
    (MIT Press, 2025)
    Patrick Bedard
    ;
    Kristine M. Knutson
    ;
    Patrick M. McGurrin
    ;
    ;
    Traian Popa
    Fatigability refers to the inability of the neuromuscular system to generate enough force to produce movements to meet task challenges. Fatigability has a central and a peripheral component linked via the neuromuscular system, but how these two components interact as fatigue develops lacks a complete understanding. The effects of fatigability are experienced in healthy humans but also accompany various disorders, often exacerbating their symptoms. We studied how fatigability develops in the neuromuscular system using multimodal neuroimaging. We recruited healthy participants to perform a fatiguing grip force task, while recording force, electromyography of forearm muscles (EMG), electroencephalography (EEG), and functional magnetic resonance imaging (fMRI) in 30-second blocks of grip task alternating with 30 seconds of rest. The task entailed maintaining 50% of the maximum force. We combined EMG and EEG to compute corticomuscular coherence and combined EEG and fMRI to compute EEG-informed fMRI. We selected eight task blocks specific to each participant to represent how the neuromuscular system adapted from pre-fatigability to actual fatigability. Those included five blocks for pre-fatigability in which participants could generate enough force to match the required 50% of maximum force and three blocks when the force fell below that limit. Across blocks of the grip force task, we observed changes in the neuromuscular system that preceded grip force changes. We found that electromyography of arm muscles shifted from high to low frequency, EEG in the channel covering the contralateral sensorimotor area increased steadily up to the fifth block and then plateaued, and fMRI signal also increased in the cerebellum. Corticomuscular coherence increased within each of the 30-second blocks of the grip task. EEG-informed fMRI revealed areas of the brain that the traditional regression did not, including the bilateral sensorimotor cortex, temporal-parietal junction, and supplementary motor area. Thus, as fatigability developed, the neuromuscular system experienced changes earlier than the actual behavior. While we found evidence for fatigability of central and peripheral origins, peripheral fatigue seems to occur first.
      2
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    Patterns of brain activity in choice or instructed go and no-go tasks
    (Springer Science and Business Media LLC, 2025-02-21)
    Sanaz Attaripour Isfahani
    ;
    Patrick McGurrin
    ;
    ;
    Mark Hallett
    The goal of this study was to investigate the decision making process for choosing what movements to make. We used electroencephalography (EEG) to investigate patterns of the contingent negative variation (CNV) associated with free-choice decisions to move or abstain, comparing them to conditions where actions were commanded. Our primary hypothesis was that choice tasks would differ significantly from each other and exhibit EEG patterns akin to their command-driven counterparts after the decisions were made, at least, in the 50 ms block of time prior to movement. A secondary analysis evaluated post hoc comparisons of time, in 50 ms blocks, to understand the temporal development of the CNV for each condition. We also conducted an exploratory analysis of EEG event-related desynchronization (ERD) to identify patterns of brain activity associated with the decision-making process. This approach was taken due to the exploratory nature of our hypotheses concerning the spatial and temporal characteristics of EEG activity during these free-choice versus commanded tasks. We studied 12 right-handed healthy volunteers (7 women, mean age 53 years, range 39–73 years) with no prior history of neurological or major psychiatric illness. A CNV paradigm encompassing commanded and choice tasks was devised, with a 2500 ms interval between S1 and S2, while recording EEG and electromyography (EMG). S1 provided full information about the upcoming task, which was to be executed at the time of S2. We assessed CNV and explored whole scalp EEG activity, including both voltage as well as power in the alpha and beta frequency ranges. Clear and similar CNVs were observed for command and choice go tasks prior to the movements, contrasting with near-zero CNVs for the command and choice no-go tasks. Separation of CNVs for command go and no-go tasks occurred around 1600 ms post-S1, and choice CNVs separated about 2150 ms post-S1. Exploratory analysis revealed that beta power provided information about decision and preparation processes much earlier. The left dorsolateral prefrontal cortex (DLPFC) exhibited the initial sign of decision approximately 500 ms post-S1 for all tasks, with subsequent preparation for movement or restraint involving distinct activity in various brain regions. The localization of effects in the left DLPFC was determined by visual analysis of the informative electrode sites. The CNVs separate about 2 s after S1, and it appears that this process represents preparation for movement (or no movement). Exploration of the beta activity suggests an earlier decision process which leads eventually to subsequent task preparation and activation. Choice decisions lag slightly behind command decisions, with the CNV apparently reflecting motor implementation rather than the decision-making process. In a simple motor task with an exploratory analysis, both commanded and choice-based decisions are rapidly initiated in the left DLPFC. While the CNV distinguishes between go and no-go conditions, it primarily appears to signify preparation for implementation of the task following the earlier decision. Further controlled studies will be needed to confirm these results.
    Scopus© Citations 3  1
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    Item type:Publication,
    Global Perceptions and Utilization of Clinical Neurophysiology in Movement Disorders
    (2024)
    Panagiotis Kassavetis
    ;
    Robert Chen
    ;
    Christos Ganos
    ;
    Mark Hallett
    ;
    Masashi Hamada
    <jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Clinical neurophysiology (CNP) involves the use of neurophysiological techniques to make an accurate clinical diagnosis, to quantify the severity, and to measure the treatment response. Despite several studies showing CNP to be a useful diagnostic tool in Movement Disorders (MD), its more widespread utilization in clinical practice has been limited.</jats:p></jats:sec><jats:sec><jats:title>Objectives</jats:title><jats:p>To better understand the current availability, global perceptions, and challenges for implementation of diagnostic CNP in the clinical practice of MD.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>The International Parkinson and Movement Disorders Society (IPMDS) formed a Task Force on CNP. The Task Force distributed an online survey via email to all the members of the IPMDS between August 5 and 30, 2021. Descriptive statistics were used for analysis of the survey results. Some results are presented by IPMDS geographical sections namely PanAmerican (PAS), European (ES), African (AFR), Asian and Oceanian (AOS).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Four hundred and ninety‐one IPMDS members (52% males), from 196 countries, responded. The majority of responders from the AFR (65%) and PAS (63%) sections had no formal training in diagnostic CNP (40% for AOS and 37% for ES). The most commonly used techniques are electroencephalography (EEG) (72%) followed by surface EMG (71%). The majority of responders think that CNP is somewhat valuable or very valuable in the assessment of MD. All the sections identified “lack of training” as one of the biggest challenges for diagnostic CNP studies in MD.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>CNP is perceived to be a useful diagnostic tool in MD. Several challenges were identified that prevent widespread utilization of CNP in MD.</jats:p></jats:sec>
    Scopus© Citations 6  4
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    Item type:Publication,
    Deep phenotyping of post-infectious myalgic encephalomyelitis/chronic fatigue syndrome
    (2024)
    Brian Walitt
    ;
    Komudi Singh
    ;
    Samuel R. LaMunion
    ;
    Mark Hallett
    ;
    Steve Jacobson
    <jats:title>Abstract</jats:title><jats:p>Post-infectious myalgic encephalomyelitis/chronic fatigue syndrome (PI-ME/CFS) is a disabling disorder, yet the clinical phenotype is poorly defined, the pathophysiology is unknown, and no disease-modifying treatments are available. We used rigorous criteria to recruit PI-ME/CFS participants with matched controls to conduct deep phenotyping. Among the many physical and cognitive complaints, one defining feature of PI-ME/CFS was an alteration of effort preference, rather than physical or central fatigue, due to dysfunction of integrative brain regions potentially associated with central catechol pathway dysregulation, with consequences on autonomic functioning and physical conditioning. Immune profiling suggested chronic antigenic stimulation with increase in naïve and decrease in switched memory B-cells. Alterations in gene expression profiles of peripheral blood mononuclear cells and metabolic pathways were consistent with cellular phenotypic studies and demonstrated differences according to sex. Together these clinical abnormalities and biomarker differences provide unique insight into the underlying pathophysiology of PI-ME/CFS, which may guide future intervention.</jats:p>
    Scopus© Citations 116  3
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    Item type:Publication,
    How to Do an Electrophysiological Study of Myoclonus
    (2022) ;
    Shabbir Hussain I. Merchant
    ;
    Patrick McGurrin
    ;
    Mark Hallett
      1Scopus© Citations 6
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    Item type:Publication,
    Electrophysiological Characterization of a <scp><i>MYH7</i></scp> Variant with Tremor Phenotype
    (2023) ;
    Patrick McGurrin
    ;
    Thomas Osterholt
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    Debra J. Ehrlich
    ;
    Susan T. Iannacone
    Scopus© Citations 2  1
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    Item type:Publication,
    Tremoroton, a new free online platform for tremor analysis
    (2020) ;
    Patrick McGurrin
    ;
    Thomas Osterholt
    ;
    Debra Ehrlich
    ;
    Dietrich Haubenberger
    Scopus© Citations 4  16
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    Item type:Publication,
    BacAv, a new free online platform for clinical back-averaging
    (2020) ;
    Sanaz Attaripour
    ;
    Patrick McGurrin
    ;
    Mark Hallett
    Scopus© Citations 6  4
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    Item type:Publication,
    Scopus© Citations 7  1
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    Item type:Publication,
    The role of the inferior parietal lobule in writer’s cramp
    (2020)
    Shabbir Hussain I Merchant
    ;
    Eleni Frangos
    ;
    Jacob Parker
    ;
    Megan Bradson
    ;
    Tianxia Wu
    <jats:title>Abstract</jats:title> <jats:p>Humans have a distinguishing ability for fine motor control that is subserved by a highly evolved cortico-motor neuronal network. The acquisition of a particular motor skill involves a long series of practice movements, trial and error, adjustment and refinement. At the cortical level, this acquisition begins in the parieto-temporal sensory regions and is subsequently consolidated and stratified in the premotor-motor cortex. Task-specific dystonia can be viewed as a corruption or loss of motor control confined to a single motor skill. Using a multimodal experimental approach combining neuroimaging and non-invasive brain stimulation, we explored interactions between the principal nodes of the fine motor control network in patients with writer’s cramp and healthy matched controls. Patients and healthy volunteers underwent clinical assessment, diffusion-weighted MRI for tractography, and functional MRI during a finger tapping task. Activation maps from the task-functional MRI scans were used for target selection and neuro-navigation of the transcranial magnetic stimulation. Single- and double-pulse TMS evaluation included measurement of the input-output recruitment curve, cortical silent period, and amplitude of the motor evoked potentials conditioned by cortico-cortical interactions between premotor ventral (PMv)-motor cortex (M1), anterior inferior parietal lobule (aIPL)-M1, and dorsal inferior parietal lobule (dIPL)-M1 before and after inducing a long term depression-like plastic change to dIPL node with continuous theta-burst transcranial magnetic stimulation in a randomized, sham-controlled design. Baseline dIPL-M1 and aIPL-M1 cortico-cortical interactions were facilitatory and inhibitory, respectively, in healthy volunteers, whereas the interactions were converse and significantly different in writer’s cramp. Baseline PMv-M1 interactions were inhibitory and similar between the groups. The dIPL-PMv resting state functional connectivity was increased in patients compared to controls, but no differences in structural connectivity between the nodes were observed. Cortical silent period was significantly prolonged in writer’s cramp. Making a long term depression-like plastic change to dIPL node transformed the aIPL-M1 interaction to inhibitory (similar to healthy volunteers) and cancelled the PMv-M1 inhibition only in the writer’s cramp group. These findings suggest that the parietal multimodal sensory association region could have an aberrant downstream influence on the fine motor control network in writer’s cramp, which could be artificially restored to its normal function.</jats:p>
    Scopus© Citations 33  1