Neural networks &
reorganization as a
Basis for
Rehabilitation of
Movement
Disorders
KAAT ALAERTS & MORAN GILAT
Jana Brabants
[BEDRIJFSNAAM] | [BEDRIJFSADRES]
,DOELEN (ALGEMENE DOELEN VAN DE CURSUS) ............................................................................................... 8
NEUROWETENSCHAPPELIJKE METHODEN ........................................................................................................ 8
MRI: MAGNETIC RESONANCE IMAGING ....................................................................................................................... 9
fMRI is geen bumpologie ................................................................................................................................. 9
Fmri is niet gedachten lezen .......................................................................................................................... 10
fMRI is niet invasief ....................................................................................................................................... 10
Wat is (f)MRI ................................................................................................................................................. 10
3 verschillende modaliteiten ......................................................................................................................... 10
geschiedenis of (f) (c) MRI ............................................................................................................................. 11
Biologische basis van MRI ............................................................................................................................. 11
MRI: voorbeeld van applicatie....................................................................................................................... 14
fMRI ............................................................................................................................................................... 14
BIOLOGISCHE BASIS VOOR FMRI ................................................................................................................... 15
Functioneel connectiviteit MRI (fcMRI) ......................................................................................................... 21
DIFFUSION MAGNETIC RESONANCE IMAGING (DMRI) .................................................................................................. 23
dMRI .............................................................................................................................................................. 23
Meting van diffusie binnen Voxels ................................................................................................................ 23
Fiber tractografie .......................................................................................................................................... 25
Diffusion Magnetic Resonance Imaging (dMRI)µ .......................................................................................... 26
Voordeel van Constrained spherical deconvolution (CSD) ............................................................................. 27
dMRI-applicaties ........................................................................................................................................... 27
FUNCTIONAL NEAR-INFRARED SPECTROSCOPY (FNIRS) ................................................................................................. 28
ELECTRO-ENCEPHALOGRAPHY (EEG)......................................................................................................................... 29
Geschiedenis.................................................................................................................................................. 30
materiaal ....................................................................................................................................................... 30
Neurofysiologische basis ............................................................................................................................... 31
interpretatie/analyse .................................................................................................................................... 33
TRANSCRANIAL MAGNETIC STIMULATION (TMS) ......................................................................................................... 37
Neurofysiologische basis - Stimulatie over 'primaire motorische cortex' (M1) ............................................. 37
ONDERZOEKSTOEPASSINGEN........................................................................................................................ 39
KLINISCHE TOEPASSINGEN ............................................................................................................................ 39
NIET-INVASIEVE HERSENSTIMULATIE ............................................................................................................. 42
INHOUD ......................................................................................................................................................... 42
GESCHIEDENIS NIBS ........................................................................................................................................ 43
TRANSCRANIËLE MAGNETISCHE STIMULATIE (TMS) ....................................................................................... 43
VERSCHILLENDE SOORTEN TMS ................................................................................................................................ 43
SINGLE PULSE TMS ................................................................................................................................................ 44
REPETITIVE TMS .................................................................................................................................................... 44
FACILITERING – HOOGFREQUENT RTMS ........................................................................................................... 46
REPETITIEF TMS .................................................................................................................................................... 46
NIET-SYNAPISCHE MECHANISMEN VOOR HET INDUCEREN VAN PLASTICITEIT ............................................ 46
TRANSCRANIAL DIRECT CURRENT STIMULATION (TDCS) ................................................................................ 47
TDCS – IN VITRO HERSENWEEFSEL VAN HERSENWEEFSEL ................................................................................................ 48
Anode kant + ................................................................................................................................................. 49
Kathode kant – .............................................................................................................................................. 49
EFFECT VAN TDCS OVER M1 OP CORTICOMOTORISCHE PRIKKELBAARHEID ......................................................................... 49
1
, IMPACT OP GABA-NEUROTRANSMITTER .................................................................................................................... 51
SYNAPTISCH MECHANISME ....................................................................................................................................... 52
TMS EN TDCS: BEWIJS VOOR TOEPASSING BIJ BEROERTE .............................................................................. 52
INTERHEMISFERISCH COMPETITIEMODEL ..................................................................................................................... 53
VOORGESTELDE STRATEGIE .............................................................................................................................. 53
AANDACHTSPUNTEN ............................................................................................................................................... 53
Waar te stimuleren?...................................................................................................................................... 53
tijdvenster ..................................................................................................................................................... 55
2019 META-ANALYSE – FUNCTIONELE BALANS EN POSTRUAL CONTROL .................................................... 60
CONCLUSIE – BEROERTE .......................................................................................................................................... 62
META-ANALYSE NAAR NEUROFYSIOLOGISCHE EFFECTEN VAN RTMS ................................................................................. 63
Althans op neurofysiologisch niveau ............................................................................................................. 64
TMS EN TDCS: BEWIJS VOOR TOEPASSING BIJ PARKINSON ............................................................................ 64
PARKINSON’S DISEASE (PD) ..................................................................................................................................... 64
ALTERNATIEF: NIET-INVASIEVE NEUROSTIMULATIE TER HOOGTE VAN DE HOOFDHUID! ......................................................... 65
DOELEN VAN NEUROSTIMULATIE BIJ DE ZIEKTE VAN PARKINSON....................................................................................... 65
VOORBEELD RTMS-ONDERZOEK – MIST ....................................................................................................... 66
META-ANALYSE – FYSIEKE FUNCTIE EN MOTORISCHE TEKENS ..................................................................... 67
TDCS VOOR PARKINSON’S DISEASE ........................................................................................................................... 71
META-ANALYSE – FUNCTIONELE VOORTBEWEGING .................................................................................... 71
ALGEMENE CONCLUSIES OVER DE TOEPASSING VAN TDCS/RTMS BIJ BEROERTE/PARKINSON ................................................ 73
OPMERKINGEN OVER TOEPASSELIJKHEID/VERDRAAGBAARHEID ........................................................................................ 73
VOOR TDCS KAN DE TIMING VAN STIMULATIE ECHTER ERG BELANGRIJK ZIJN!..................................................................... 73
TRANSCRANIAL ALTERNATING CURRENT STIMULATION (TACS) ..................................................................... 74
BEWIJS VOOR TAC’S ............................................................................................................................................... 75
VOORBEELDSTUDIE – VISUELE AANDACHTSTAKEN ...................................................................................... 75
STUDIE – TAC'S VOOR Beroerte ..................................................................................................................... 76
STUDIE – TAC'S VOOR DE ZIEKTE VAN PARKINSON ....................................................................................... 76
EEG-BASED NEUROFEEDBACK ........................................................................................................................ 77
CHRONISCHE PIJN ................................................................................................................................................... 80
Studie effect neurofeedback bij chronische pijn ............................................................................................ 80
TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS) (+VAGAL NERVE STIMULATION (VNS)) ........... 81
VOORBEELD STUDIE ................................................................................................................................................ 81
SPECIFIEK GEVAL VAN TENS: STIMULATIE VAN DE NERVUS VAGUS ................................................................................... 81
VALIDATIE VAN TRANSCUTANE AURICULAIRE VNS ....................................................................................... 82
VOORBEELDSTUDIE VOOR BEROERTEREVALIDATIE - VNS ............................................................................ 83
WAT IS VEROUDERING? EEN BIOLOGISCH PERSPECTIEF ................................................................................. 84
VEROUDERING OP HET NIVEAU VAN HET HERSENSYSTEEM ........................................................................... 85
ANATOMISCHE VERANDERINGEN ............................................................................................................................... 85
volumeverlies in zowel grijze stof als witte stof ............................................................................................ 85
DIFFUSION TENSOR IMAGING – DTI .............................................................................................................. 85
conclusie ANATOMISCHE VERANDERINGEN ................................................................................................. 86
INTRINSIEKE FUNCTIONELE VERANDERINGEN ................................................................................................................ 86
FMRI IN RUSTTOESTAND ............................................................................................................................... 86
2
, RUSTTOESTAND EEG ..................................................................................................................................... 88
TAAKGERELATEERDE HERSENACTIVITEIT (FMRI) TIJDENS BIMANUELE TAKEN ................................................. 89
FMRI TIJDENS INTERLIMB COÖRDINATIE ...................................................................................................... 90
'HYPERACTIVERINGEN' .................................................................................................................................. 90
MOGELIJKE INTERPRETATIES ......................................................................................................................... 90
'HYPERACTIVATIES' ZIJN COMPENSEREND – HOE? ....................................................................................... 91
KORT: VEROUDERING VERANDERT DE HERSENEN ......................................................................................................... 97
KAN HET VEROUDERINGSPROCES WORDEN VERANDERD? ............................................................................................... 98
Meta-analytische rapporten: bevestigen verband tussen fysieke activiteit en gezond ouder worden ......... 98
Longitudinaal onderzoek naar gunstige effecten van lichaamsbeweging op normale veroudering............. 99
ONDERLIGGENDE MECHANISMEN VAN RELATIE ........................................................................................ 100
HET VEROUDERINGSPROCES AANPAKKEN... ............................................................................................... 101
NEUROPLASTICITEIT EN MOTORISCH LEREN IN HET JONGE EN OUDER WORDENDE BREIN .......................... 101
NEUROPLASTICITEIT .............................................................................................................................................. 101
MOTORISCH LEREN ............................................................................................................................................... 101
(MOTOR) LEREN EN NEUROPLASTICITEIT ........................................................................................................ 102
LEERGEÏNDUCEERDE NEUROPLASTICITEIT – ENKELE ALGEMENE OVERWEGINGEN ................................................................ 103
UITBREIDINGS- EN RENORMALISATIEMODEL ............................................................................................. 104
SLAAP EN (VERSNELD) OUDER WORDEN ...................................................................................................... 106
SLAAPVERSCHILLEN BIJ OUDEREN ............................................................................................................................. 106
SLAAP EN HET GLYMFATISCH SYSTEEM ...................................................................................................................... 106
BELANG VAN SLAAP EN HET GLYMFATISCH SYSTEEM BIJ NEURODEGENERATIE .................................................................... 107
NEUROPATHOFYSIOLOGIE VAN EEN BEROERTE ........................................................................................... 108
ALGEMENE INLEIDING - INCIDENTIE VAN BEROERTES .................................................................................................... 108
NEURO-PATHOFYSIOLOGIE VAN ISCHEMISCHE BEROERTE .............................................................................................. 108
NEUROPATHOFYSIOLOGIE VAN HEMORRAGISCHE BEROERTE .......................................................................................... 109
NEURO-IMAGING VAN BEROERTE-LAESIES (ACUTE TOT CHRONISCHE EVOLUTIE) ........................................ 111
ACUTE MONITORING VAN BEROERTE-LAESIE .............................................................................................................. 111
COMPUTED TOMOGRAPHY (CT) .............................................................................................................................. 111
HYPERACUTE BEELDVORMING VAN EEN ISHEMISCHE BEROERTE ...................................................................................... 112
BEELDVORMING VAN DE EVOLUTIE VAN ISCHEMISCHE BEROERTE .................................................................................... 112
INCIDENTIE - HEMORRAGISCHE BEROERTE (HYPERTENSIEF) ........................................................................................... 113
HYPERACUTE BEELDVORMING VAN HEMORRAGISCHE BEROERTE .................................................................................... 114
BEELDVORMING VAN DE EVOLUTIE VAN HEMORRAGISCHE BEROERTE .............................................................................. 114
EVOLUTIE HEMORRAGISCHE BEROERTE ..................................................................................................................... 115
PRINCIPES VAN HERSTEL .............................................................................................................................. 116
REGIONALE/NETWORK IMPACT ............................................................................................................................... 117
Om welke regio/welk netwerk gaat het? .................................................................................................... 117
Dysconnectie ............................................................................................................................................... 118
diaschisis ..................................................................................................................................................... 118
Cerebellaire diaschisis ................................................................................................................................. 118
Om welke regio/welk netwerk gaat het? .................................................................................................... 120
THEORIEËN OVER HERSTEL ..................................................................................................................................... 120
PRINCIPES VAN CORTICALE REORGANISATIE................................................................................................................ 120
Theorieën over herstel – Corticale reorganisatie ........................................................................................ 120
3
reorganization as a
Basis for
Rehabilitation of
Movement
Disorders
KAAT ALAERTS & MORAN GILAT
Jana Brabants
[BEDRIJFSNAAM] | [BEDRIJFSADRES]
,DOELEN (ALGEMENE DOELEN VAN DE CURSUS) ............................................................................................... 8
NEUROWETENSCHAPPELIJKE METHODEN ........................................................................................................ 8
MRI: MAGNETIC RESONANCE IMAGING ....................................................................................................................... 9
fMRI is geen bumpologie ................................................................................................................................. 9
Fmri is niet gedachten lezen .......................................................................................................................... 10
fMRI is niet invasief ....................................................................................................................................... 10
Wat is (f)MRI ................................................................................................................................................. 10
3 verschillende modaliteiten ......................................................................................................................... 10
geschiedenis of (f) (c) MRI ............................................................................................................................. 11
Biologische basis van MRI ............................................................................................................................. 11
MRI: voorbeeld van applicatie....................................................................................................................... 14
fMRI ............................................................................................................................................................... 14
BIOLOGISCHE BASIS VOOR FMRI ................................................................................................................... 15
Functioneel connectiviteit MRI (fcMRI) ......................................................................................................... 21
DIFFUSION MAGNETIC RESONANCE IMAGING (DMRI) .................................................................................................. 23
dMRI .............................................................................................................................................................. 23
Meting van diffusie binnen Voxels ................................................................................................................ 23
Fiber tractografie .......................................................................................................................................... 25
Diffusion Magnetic Resonance Imaging (dMRI)µ .......................................................................................... 26
Voordeel van Constrained spherical deconvolution (CSD) ............................................................................. 27
dMRI-applicaties ........................................................................................................................................... 27
FUNCTIONAL NEAR-INFRARED SPECTROSCOPY (FNIRS) ................................................................................................. 28
ELECTRO-ENCEPHALOGRAPHY (EEG)......................................................................................................................... 29
Geschiedenis.................................................................................................................................................. 30
materiaal ....................................................................................................................................................... 30
Neurofysiologische basis ............................................................................................................................... 31
interpretatie/analyse .................................................................................................................................... 33
TRANSCRANIAL MAGNETIC STIMULATION (TMS) ......................................................................................................... 37
Neurofysiologische basis - Stimulatie over 'primaire motorische cortex' (M1) ............................................. 37
ONDERZOEKSTOEPASSINGEN........................................................................................................................ 39
KLINISCHE TOEPASSINGEN ............................................................................................................................ 39
NIET-INVASIEVE HERSENSTIMULATIE ............................................................................................................. 42
INHOUD ......................................................................................................................................................... 42
GESCHIEDENIS NIBS ........................................................................................................................................ 43
TRANSCRANIËLE MAGNETISCHE STIMULATIE (TMS) ....................................................................................... 43
VERSCHILLENDE SOORTEN TMS ................................................................................................................................ 43
SINGLE PULSE TMS ................................................................................................................................................ 44
REPETITIVE TMS .................................................................................................................................................... 44
FACILITERING – HOOGFREQUENT RTMS ........................................................................................................... 46
REPETITIEF TMS .................................................................................................................................................... 46
NIET-SYNAPISCHE MECHANISMEN VOOR HET INDUCEREN VAN PLASTICITEIT ............................................ 46
TRANSCRANIAL DIRECT CURRENT STIMULATION (TDCS) ................................................................................ 47
TDCS – IN VITRO HERSENWEEFSEL VAN HERSENWEEFSEL ................................................................................................ 48
Anode kant + ................................................................................................................................................. 49
Kathode kant – .............................................................................................................................................. 49
EFFECT VAN TDCS OVER M1 OP CORTICOMOTORISCHE PRIKKELBAARHEID ......................................................................... 49
1
, IMPACT OP GABA-NEUROTRANSMITTER .................................................................................................................... 51
SYNAPTISCH MECHANISME ....................................................................................................................................... 52
TMS EN TDCS: BEWIJS VOOR TOEPASSING BIJ BEROERTE .............................................................................. 52
INTERHEMISFERISCH COMPETITIEMODEL ..................................................................................................................... 53
VOORGESTELDE STRATEGIE .............................................................................................................................. 53
AANDACHTSPUNTEN ............................................................................................................................................... 53
Waar te stimuleren?...................................................................................................................................... 53
tijdvenster ..................................................................................................................................................... 55
2019 META-ANALYSE – FUNCTIONELE BALANS EN POSTRUAL CONTROL .................................................... 60
CONCLUSIE – BEROERTE .......................................................................................................................................... 62
META-ANALYSE NAAR NEUROFYSIOLOGISCHE EFFECTEN VAN RTMS ................................................................................. 63
Althans op neurofysiologisch niveau ............................................................................................................. 64
TMS EN TDCS: BEWIJS VOOR TOEPASSING BIJ PARKINSON ............................................................................ 64
PARKINSON’S DISEASE (PD) ..................................................................................................................................... 64
ALTERNATIEF: NIET-INVASIEVE NEUROSTIMULATIE TER HOOGTE VAN DE HOOFDHUID! ......................................................... 65
DOELEN VAN NEUROSTIMULATIE BIJ DE ZIEKTE VAN PARKINSON....................................................................................... 65
VOORBEELD RTMS-ONDERZOEK – MIST ....................................................................................................... 66
META-ANALYSE – FYSIEKE FUNCTIE EN MOTORISCHE TEKENS ..................................................................... 67
TDCS VOOR PARKINSON’S DISEASE ........................................................................................................................... 71
META-ANALYSE – FUNCTIONELE VOORTBEWEGING .................................................................................... 71
ALGEMENE CONCLUSIES OVER DE TOEPASSING VAN TDCS/RTMS BIJ BEROERTE/PARKINSON ................................................ 73
OPMERKINGEN OVER TOEPASSELIJKHEID/VERDRAAGBAARHEID ........................................................................................ 73
VOOR TDCS KAN DE TIMING VAN STIMULATIE ECHTER ERG BELANGRIJK ZIJN!..................................................................... 73
TRANSCRANIAL ALTERNATING CURRENT STIMULATION (TACS) ..................................................................... 74
BEWIJS VOOR TAC’S ............................................................................................................................................... 75
VOORBEELDSTUDIE – VISUELE AANDACHTSTAKEN ...................................................................................... 75
STUDIE – TAC'S VOOR Beroerte ..................................................................................................................... 76
STUDIE – TAC'S VOOR DE ZIEKTE VAN PARKINSON ....................................................................................... 76
EEG-BASED NEUROFEEDBACK ........................................................................................................................ 77
CHRONISCHE PIJN ................................................................................................................................................... 80
Studie effect neurofeedback bij chronische pijn ............................................................................................ 80
TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS) (+VAGAL NERVE STIMULATION (VNS)) ........... 81
VOORBEELD STUDIE ................................................................................................................................................ 81
SPECIFIEK GEVAL VAN TENS: STIMULATIE VAN DE NERVUS VAGUS ................................................................................... 81
VALIDATIE VAN TRANSCUTANE AURICULAIRE VNS ....................................................................................... 82
VOORBEELDSTUDIE VOOR BEROERTEREVALIDATIE - VNS ............................................................................ 83
WAT IS VEROUDERING? EEN BIOLOGISCH PERSPECTIEF ................................................................................. 84
VEROUDERING OP HET NIVEAU VAN HET HERSENSYSTEEM ........................................................................... 85
ANATOMISCHE VERANDERINGEN ............................................................................................................................... 85
volumeverlies in zowel grijze stof als witte stof ............................................................................................ 85
DIFFUSION TENSOR IMAGING – DTI .............................................................................................................. 85
conclusie ANATOMISCHE VERANDERINGEN ................................................................................................. 86
INTRINSIEKE FUNCTIONELE VERANDERINGEN ................................................................................................................ 86
FMRI IN RUSTTOESTAND ............................................................................................................................... 86
2
, RUSTTOESTAND EEG ..................................................................................................................................... 88
TAAKGERELATEERDE HERSENACTIVITEIT (FMRI) TIJDENS BIMANUELE TAKEN ................................................. 89
FMRI TIJDENS INTERLIMB COÖRDINATIE ...................................................................................................... 90
'HYPERACTIVERINGEN' .................................................................................................................................. 90
MOGELIJKE INTERPRETATIES ......................................................................................................................... 90
'HYPERACTIVATIES' ZIJN COMPENSEREND – HOE? ....................................................................................... 91
KORT: VEROUDERING VERANDERT DE HERSENEN ......................................................................................................... 97
KAN HET VEROUDERINGSPROCES WORDEN VERANDERD? ............................................................................................... 98
Meta-analytische rapporten: bevestigen verband tussen fysieke activiteit en gezond ouder worden ......... 98
Longitudinaal onderzoek naar gunstige effecten van lichaamsbeweging op normale veroudering............. 99
ONDERLIGGENDE MECHANISMEN VAN RELATIE ........................................................................................ 100
HET VEROUDERINGSPROCES AANPAKKEN... ............................................................................................... 101
NEUROPLASTICITEIT EN MOTORISCH LEREN IN HET JONGE EN OUDER WORDENDE BREIN .......................... 101
NEUROPLASTICITEIT .............................................................................................................................................. 101
MOTORISCH LEREN ............................................................................................................................................... 101
(MOTOR) LEREN EN NEUROPLASTICITEIT ........................................................................................................ 102
LEERGEÏNDUCEERDE NEUROPLASTICITEIT – ENKELE ALGEMENE OVERWEGINGEN ................................................................ 103
UITBREIDINGS- EN RENORMALISATIEMODEL ............................................................................................. 104
SLAAP EN (VERSNELD) OUDER WORDEN ...................................................................................................... 106
SLAAPVERSCHILLEN BIJ OUDEREN ............................................................................................................................. 106
SLAAP EN HET GLYMFATISCH SYSTEEM ...................................................................................................................... 106
BELANG VAN SLAAP EN HET GLYMFATISCH SYSTEEM BIJ NEURODEGENERATIE .................................................................... 107
NEUROPATHOFYSIOLOGIE VAN EEN BEROERTE ........................................................................................... 108
ALGEMENE INLEIDING - INCIDENTIE VAN BEROERTES .................................................................................................... 108
NEURO-PATHOFYSIOLOGIE VAN ISCHEMISCHE BEROERTE .............................................................................................. 108
NEUROPATHOFYSIOLOGIE VAN HEMORRAGISCHE BEROERTE .......................................................................................... 109
NEURO-IMAGING VAN BEROERTE-LAESIES (ACUTE TOT CHRONISCHE EVOLUTIE) ........................................ 111
ACUTE MONITORING VAN BEROERTE-LAESIE .............................................................................................................. 111
COMPUTED TOMOGRAPHY (CT) .............................................................................................................................. 111
HYPERACUTE BEELDVORMING VAN EEN ISHEMISCHE BEROERTE ...................................................................................... 112
BEELDVORMING VAN DE EVOLUTIE VAN ISCHEMISCHE BEROERTE .................................................................................... 112
INCIDENTIE - HEMORRAGISCHE BEROERTE (HYPERTENSIEF) ........................................................................................... 113
HYPERACUTE BEELDVORMING VAN HEMORRAGISCHE BEROERTE .................................................................................... 114
BEELDVORMING VAN DE EVOLUTIE VAN HEMORRAGISCHE BEROERTE .............................................................................. 114
EVOLUTIE HEMORRAGISCHE BEROERTE ..................................................................................................................... 115
PRINCIPES VAN HERSTEL .............................................................................................................................. 116
REGIONALE/NETWORK IMPACT ............................................................................................................................... 117
Om welke regio/welk netwerk gaat het? .................................................................................................... 117
Dysconnectie ............................................................................................................................................... 118
diaschisis ..................................................................................................................................................... 118
Cerebellaire diaschisis ................................................................................................................................. 118
Om welke regio/welk netwerk gaat het? .................................................................................................... 120
THEORIEËN OVER HERSTEL ..................................................................................................................................... 120
PRINCIPES VAN CORTICALE REORGANISATIE................................................................................................................ 120
Theorieën over herstel – Corticale reorganisatie ........................................................................................ 120
3
