Papers by Fioravante Capone
Brain stimulation
Significant changes in neurophysiological and clinical outcomes in chronic stroke had been report... more Significant changes in neurophysiological and clinical outcomes in chronic stroke had been reported after tDCS; but there is a paucity of data in acute stroke. We aimed to evaluate whether a tDCS-induced modulation of primary motor cortex excitability in patients with acute stroke enhances motor recovery associated with rehabilitation and induces differential neuroplasticity. We conducted two experiments in acute stroke patients. In experiment 1 (14 patients), we tested the immediate effects of bilateral tDCS alone as compared to sham tDCS on recovery. Experiment 2 (20 patients) was designed to assess effects of bilateral tDCS delivered together with constraint-induced movement therapy (CIMT). In this experiment, we included a longer follow-up (3 months) and measured, in addition to the same clinical outcomes of experiment 1, changes of motor cortex excitability and the amount of promoted LTP-like activity. Despite the expected improvement at 1 week, none of the clinical measures sh...
Nature Reviews Neurology, 2014
Noninvasive brain stimulation (NIBS) techniques can be used to monitor and modulate the excitabil... more Noninvasive brain stimulation (NIBS) techniques can be used to monitor and modulate the excitability of intracortical neuronal circuits. Long periods of cortical stimulation can produce lasting effects on brain function, paving the way for therapeutic applications of NIBS in chronic neurological disease. The potential of NIBS in stroke rehabilitation has been of particular interest, because stroke is the main cause of permanent disability in industrial nations, and treatment outcomes often fail to meet the expectations of patients. Despite promising reports from many clinical trials on NIBS for stroke recovery, the number of studies reporting a null effect remains a concern. One possible explanation is that the interhemispheric competition model--which posits that suppressing the excitability of the hemisphere not affected by stroke will enhance recovery by reducing interhemispheric inhibition of the stroke hemisphere, and forms the rationale for many studies--is oversimplified or even incorrect. Here, we critically review the proposed mechanisms of synaptic and functional reorganization after stroke, and suggest a bimodal balance-recovery model that links interhemispheric balancing and functional recovery to the structural reserve spared by the lesion. The proposed model could enable NIBS to be tailored to the needs of individual patients.
Parkinsonism Relat Disord, 2012
Costello Syndrome is a rare multiple congenital anomaly disorder caused by de novo heterozygous m... more Costello Syndrome is a rare multiple congenital anomaly disorder caused by de novo heterozygous mutations in the v-Ha-ras Harvey rat sarcoma viral oncogene homolog (HRAS) gene. Recent studies seem to support apparent autosomal dominant inheritance and somatic mosaicism and an association with advanced parental age. Abnormal hand posture has been reported as a typical feature of Costello Syndrome but the pathophysiology of this is unclear. We evaluated and described posture and movement in six consecutive subjects with genetically proven Costello Syndrome, in order to better characterize the phenomenology of the associated postural abnormalities and any related motor abnormalities. We also evaluated motor cortex plasticity by applying Paired Associative Stimulation. All the patients presented the typical postural abnormalities reported in Costello Syndrome, in particular the ulnar deviation of fingers. The latter was reducible and not fixed. In addition, patients exhibited more explicit dystonic features of the face, limbs and trunk and altered sensorimotor plasticity consistent with generalized dystonia. These findings suggest that dystonia may underlie the abnormal postures described in Costello Syndrome patients.
Brain Stimulation, 2015
Background: BDNF gene polymorphism impacts human motor cortex function and plasticity.
Stroke, 2006
Background and Purpose-Preliminary studies suggest that electrical stimulation of the damaged cor... more Background and Purpose-Preliminary studies suggest that electrical stimulation of the damaged cortex may be able to enhance motor recovery after stroke. The hypothesis has been that this increases cortical excitability, making it easier for the system to respond to and learn from conventional physiotherapy. However, there is no direct evidence that the cortex of patients with stroke can respond in this fashion; hence, the basis of these new approaches has been questioned. Methods-We had the opportunity to evaluate directly the effects of noninvasive cortical stimulation on the excitability of corticospinal output from the damaged hemisphere of a chronic stroke patient who had epidural electrodes implanted in the upper dorsal cord for treatment of pain. Results-We found that it was possible to enhance corticospinal activity evoked by single test stimuli. Conclusions-This study confirms directly that it is possible to noninvasively manipulate cortical excitability in stroke.
Neuroscience Letters, 2009
Preliminary data suggest that repetitive transcranial magnetic stimulation (rTMS) of the brain ma... more Preliminary data suggest that repetitive transcranial magnetic stimulation (rTMS) of the brain may produce a modest slowing of disease progression in amyotrophic lateral sclerosis (ALS). The present study was designed to test the hypothesis that rTMS given as continuous theta burst stimulation (cTBS), repeated monthly for one year, would affect ALS progression. We performed a double blind, placebo-controlled trial. Twenty patients with ALS were randomly allocated to blinded real or placebo stimulation. cTBS of the motor cortex was performed for five consecutive days every month for one year. Primary outcome was the rate of decline as evaluated with the revised ALS functional rating scale (ALSFRS-R). Treatment was well tolerated. There was no significant difference in the ALSFRS-R score deterioration between patients treated with real or placebo stimulation. ALSFRS-R mean scores declined from 32.0 (SD 7.1) at study entry to 23.1 (SD 6.3) at 12 months in patients receiving real cTBS and from 31.3 (SD 6.9) to 21.2 (SD 6.0) in those receiving placebo stimulation. Although cTBS proved a safe procedure, on the basis of the present findings a larger randomized confirmatory trial seems unjustified in ALS patients, at least in advanced stage of the disease.
Neurorehabilitation and Neural Repair, 2010
Motor disability continues to be a major cause of morbidity after stroke. The neural underpinning... more Motor disability continues to be a major cause of morbidity after stroke. The neural underpinnings of disability and of functional recovery are still unclear. Here, we review recent evidence obtained using transcranial magnetic stimulation (TMS) that provides new insight into these mechanisms. We briefly discuss the use of TMS in the diagnosis, prognosis, and therapy of post-stroke motor disability. Differently from previous reviews, particular emphasis is placed in the discussion of the use of TMS as a tool to explore in detailed mechanisms of neuroplasticity during spontaneous and treatmentinduced recovery of motor function. TMS can be used to acquire the understanding of these mechanisms required for the development of more rational and clinically useful interventions in stroke neurorehabilitation.
Neurobiology of Learning and Memory, 2014
Random number generation (RNG) is a procedurally-simple task related to specific executive functi... more Random number generation (RNG) is a procedurally-simple task related to specific executive functions, such as updating and monitoring of information and inhibition of automatic responses.
Journal of Neurology, Neurosurgery & Psychiatry, 2009
Journal of Neurology, 2009
... Iorio Æ Fioravante Capone Æ Elisabetta Iannaccone Æ Hugh John Willison Æ Anna Modoni Æ ... of... more ... Iorio Æ Fioravante Capone Æ Elisabetta Iannaccone Æ Hugh John Willison Æ Anna Modoni Æ ... of inappropriate secretion of antidiuretic hormone (SIADH) in a patient with the Miller Fisher syndrome ... 16:340347 6. Inoue K, Kohriyama T, Ikeda J, Maruyama H, Nakamura S (2002 ...
Journal of Neural Transmission, 2009
Behavioral and neurophysiological changes have been reported after exposure to extremely low freq... more Behavioral and neurophysiological changes have been reported after exposure to extremely low frequency magnetic fields (ELF-MF) both in animals and in humans. The physiological bases of these effects are still poorly understood. In vitro studies analyzed the effect of ELF-MF applied in pulsed mode (PEMFs) on neuronal cultures showing an increase in excitatory neurotransmission. Using transcranial brain stimulation, we studied noninvasively the effect of PEMFs on several measures of cortical excitability in 22 healthy volunteers, in 14 of the subjects we also evaluated the effects of sham field exposure. After 45 min of PEMF exposure, intracortical facilitation produced by paired pulse brain stimulation was significantly enhanced with an increase of about 20%, while other parameters of cortical excitability remained unchanged. Sham field exposure produced no effects. The increase in paired-pulse facilitation, a physiological parameter related to cortical glutamatergic activity, suggests that PEMFs exposure may produce an enhancement in cortical excitatory neurotransmission. This study suggests that PEMFs may produce functional changes in human brain.
Expert Review of Neurotherapeutics, 2007
Preliminary studies suggest that stimulation of the motor cortex enhances motor recovery after st... more Preliminary studies suggest that stimulation of the motor cortex enhances motor recovery after stroke. Most of these studies employed transcranial magnetic stimulation of the brain and two different approaches have been evaluated. The first approach is based on the use of protocols of stimulation that increase cortical excitability, targeting the hemisphere in which the stroke occurred in order to enhance the output of the motor cortex and the response to physiotherapy. The second approach is based on the use of protocols of stimulation that suppress cortical excitability, targeting the intact hemisphere in order to counteract the imbalance due to the increased interhemispheric inhibition onto the lesioned cortex, and reducing the potential negative interference of the intact hemisphere with the function of the affected one. Cumulatively, preliminary studies suggest that transcranial magnetic stimulation might be a suitable method to combine with physiotherapy and improve recovery of useful limb function in stroke patients. However, further studies are needed to determine the best stimulation parameters and how to select patients who are likely to respond to this treatment.
Experimental Brain Research, 2009
Paired associative stimulation (PAS), in which peripheral nerve stimuli are followed by transcran... more Paired associative stimulation (PAS), in which peripheral nerve stimuli are followed by transcranial magnetic stimulation (TMS) of the motor cortex, may produce a long lasting change in cortical excitability. At an interstimulus interval slightly shorter than the time needed for the afferent inputs to reach cerebral cortex (10 ms), motor cortex excitability decreases. Indirect data support the hypothesis that PAS at this interval (PAS10) involves LTD like-changes in cortical synapses. The aim of present paper was to investigate more directly PAS10 effects. We recorded corticospinal descending volleys evoked by single pulse TMS before and after PAS10 in two conscious subjects who had a high cervical epidural electrode implanted for pain control. These synchronous volleys provide a measure of cortical synaptic activity. PAS10 significantly reduced the amplitude of later descending waves while the earliest descending wave was not modified. Present results confirm the cortical origin of the effect of PAS10.
Epilepsy Research, 2009
F. Pilato et al.
Clinical Neurophysiology, 2008
Clinical Neurophysiology, 2008
Purpose: Although production of emotional prosody is a cognitive function of high clinical and so... more Purpose: Although production of emotional prosody is a cognitive function of high clinical and social importance, its underlying neural principles are not yet fully understood. The goal of this study was to get an insight into these mechanisms using repetitive transcranial stimulation (rTMS).
Clinical Neurophysiology, 2008
Clinical Neurophysiology, 2008
Clinical Neurophysiology, 2007
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Papers by Fioravante Capone