Abstracts / Brain Stimulation 10 (2017) 346e540
Results: There was a reduction in the VAS scores from baseline to
endpoint, but it had a marginal statistical signicance (p0.061).
Compared to baseline, signicant improvements in HDRS (p0.001), SSI
(p0.014), ISI (p0.010), and EQ-5D (p0.023) scores were shown
respectively at endpoint. The treatment was generally well tolerated.
Headache and nausea were common adverse effects. Only one patient was
dropped out due to memory loss.
Conclusion: Although these are preliminary ndings in an open trial, this
study shows a possible efcacy of ECT for the treatment-refractory
depressed patient with CRPS type 1. Adequate sample size will be war-
ranted to conrm these clinical benets.
Keywords: electroconvulsive therapy, complex regional pain syndrome,
depression, quality of life
[0237]
TRANSCUTANEOUS VAGAL NERVE STIMULATION TO PROMOTE THE
EXTINCTION OF FEAR
B. Verkuil 1, A.M. Burger*1, I. van Diest 2, B. Vervliet 3, W. van der Does 1, J.F.
Thayer 4, J.F. Brosschot 1. 1 Leiden University, The Netherlands; 2 KU Leuven,
Belgium; 3 Harvard Medical School, USA; 4 The Ohio State University, USA
Introduction: A critical component of the treatment for anxiety disorders is
the extinction of fear via repeated exposure to the feared stimulus. This
process is strongly dependent on successful memory formation and consol-
idation. Stimulation of the vagus nerve (VNS) has been proposed to enhance
extinction memory through the increase of noradrenergic transmission.
Method: We conducted two studies (N 38 & N 41) to assess whether
transcutaneous stimulation of the vagus nerve (tVNS) can accelerate
extinction memory formation and retention in fear conditioned humans.
To assess fear conditioning and subsequent fear extinction, we assessed US
expectancy ratings, fear potentiated startle responses and skin conduc-
tance levels. After fear conditioning, participants were randomly assigned
to receive tVNS or sham stimulation during the extinction phase (study 1:
extinction directly followed acquisition; study 2: extinction followed 24
hours later). Retention of extinction memory was tested 24 hours later.
Results: In both studies, tVNS accelerated explicit fear extinction (US ex-
pectancy ratings). In study 2, spontaneous recovery for the skin conduc-
tance response occurred only in the sham group, but no differences were
observed for the other outcomes during retention.
Discussion: These ndings support the hypothesis that tVNS accelerates
declarative extinction learning. The ndings are preliminary but consistent
with recent studies that indicate that tVNS may be a tool to improve fear
extinction.
Keywords: transcutaneous vagus nerve stimulation, fear extinction,
memory, anxiety
[0239]
THE SPATIAL REPRESENTATION OF TIME IN VISUAL CORTEX
nel-Pierre 2, M.M. Murray 2, D. Bueti 1. 1 International
G. Fortunato*1, T. Ke
School for Advanced Studies (SISSA), Neuroscience Area, Italy; 2 University
Hospital of Lausanne, Switzerland
Performing a timed movement like dancing, playing a musical instrument
or simply walking requires for the brain the integration of both temporal
and spatial information. How and where the human brain synergistically
links these two types of information remains unclear. Previous studies
have shown that primary visual cortex (V1) and extrastriate visual area V5/
MT are both involved in the encoding of temporal information of visual
stimuli. However these studies do not clarify how time is encoded in these
areas and whether V1 and V5/MT encode time differently. Here we tested
the hypothesis that V1 and V5/MT encode time in different spatial co-
ordinates, i.e. head-centred versus eye-centred. To this purpose we asked
healthy volunteers to perform a temporal discrimination task of visual
stimuli that were presented at varying combinations of retinotopic and
head-centred spatiotopic positions. While participants were engaged in
this task we interfered with the activity of the right dorsal V1 and the right
V5/MT by mean of paired-pulse Transcranial Magnetic Stimulation
(ppTMS). The results showed that ppTMS over both areas impaired tem-
poral discrimination thresholds of visual stimuli presented at different
395
retinotopic coordinates. V1 TMS affected temporal discrimination of
stimuli presented in the lower left visual quadrant whereas V5/MT TMS
the discrimination of stimuli presented in both the upper and the lower
left visual quadrants. These results show that both V1 and V5/MT encode
visual temporal information in retinotopic spatial frames, but the repre-
sentation of time is quadrant specic for V1 and hemield specic for V5/
MT. These results represent the rst neurophysiological evidence of a link
between space and time in human visual cortex.
Keywords: Time, Space, paired-pulse TMS
[0240]
PAIRED ASSOCIATIVE QUADRIPULSE STIMULATION (PAS-QPS) - A NEW
PROTOCOL COMBINING HOMO- AND HETERO-SYNAPTIC PLASTICITY
W. Wiratman*1, 2, T. Murakami 1, S. Kobayashi 1, H. Enomoto 1, Y.
Ugawa 1. 1 Fukushima Medical University, Japan; 2 Universitas Indonesia,
Indonesia
Background: Repeated bursts of four monophasic TMS pulses (QPS) are
known to induce long-term depression (LTD) in the motor cortex (M1)
when the interstimulus interval is 50ms (QPSLTD, homosynaptic plasticity).
It is also known that paired associative stimulation (PAS), a combination of
monophasic TMS over the M1 and electric stimulation of the peripheral
nerve, induces LTD or long-term potentiation (LTP), depending on the
interpair interval (PASLTD at N20-5ms and PASLTP at N20+2ms; hetero-
synaptic plasticity).
Objective: To investigate how the motor cortical excitability is modulated
by combining QPS and PAS.
Methods: Nine healthy subjects were examined with three intervention
protocols; simple QPSLTD, combined PASLTD-QPSLTD, and combined PASLTP-
QPSLTD applied to the M1. We measured TMS-elicited motor evoked po-
tentials (MEPs) before and after the intervention up to 60 minutes. First,
we conducted one-way ANOVA (time) to nd the effective time window of
each intervention. To compare the effects of different interventions, we
then applied one-way ANOVA (intervention) to the MEPs averaged in the
dened time window.
Results: ANOVA (time) showed a signicant main effect (p<0.05). Post-hoc
tests revealed signicant MEP depression after QPSLTD (10 to 40, and 60
minutes) and PASLTD-QPSLTD (10 to 60 minutes). PASLTP-QPSLTD induced no
signicant MEP changes. ANOVA (intervention) applied to the mean MEPs
in the effective time window showed a signicant main effect (p<0.01).
PASLTD-QPSLTD depressed MEPs to a greater degree than the other in-
terventions (p<0.05). QPSLTD induced signicantly greater depression than
PASLTP-QPSLTD (p<0.05).
Discussion: When we combined the LTD-inducing PAS and the LTD-
inducing QPS, the depressive effects on MEP were additive. In contrast,
when we combined the LTP-inducing PAS and LTD-inducing QPS, plasticity
effects cancelled out. The combination protocol turned out to be a
powerful method to induce MEP changes, which presumably involves
physiologically distinct processes of homo- and hetero-synaptic plasticity.
Keywords: heterosynaptic plasticity, homosynaptic plasticity, LTD, QPS