Brain Neurorehabil.  2015 Sep;8(2):90-95. 10.12786/bn.2015.8.2.90.

Application of Non-invasive Brain Stimulation for Neurorehabilitation: Cerebellar Stimulation

• Hahn SJ
• Paik NJ

• KMID: 2165196
• DOI: http://doi.org/10.12786/bn.2015.8.2.90

Abstract

Cerebellum serves an important function in diverse domain of motor, cognition control. Cerebellar non-invasive brain stimulation (NIBS) can provide a better comprehension of cerebellar circuity connecting to primary motor cortex. Cerebellar transcranial magnetic stimulation (TMS) activates Purkinje cells, causing increased inhibition of dentato-thalamo-cortical pathway. Assessing cerebellar-brain inhibition is useful for evaluating normal cerebellar functions and for understanding specific pathophysiology. Transcranial direct current stimulation (tDCS) has the polarity specific effect on cerebellar activity. Both TMS and tDCS can modulate cerebellar functions: motor learning, visuomotor adaptation, motor coordination, working memory and other cognitive domains. Further studies are encouraged to accumulate clinical and molecular evidences of neural plasticity induced by cerebellar NIBS. In the near future, cerebellar NIBS would play a crucial role in the field of neurorehabiliation.

Keyword

cerebellum; neuronal plasticity; purkinje cells; transcranial direct current stimulation; transcranial magnetic stimulation

MeSH Terms

Brain*
Cerebellum
Cognition
Comprehension
Learning
Memory, Short-Term
Motor Cortex
Neuronal Plasticity
Plastics
Purkinje Cells
Transcranial Magnetic Stimulation
Plastics

Figure

• 

  Fig. 1 Scheme of cerebellar-primary motor cortex (M1) connectivity. Left line indicates afferent cerebellar pathways and right indicates efferent pathways. The efferent dentate-thalamo-cortical pathway acts as excitatory fiber, while fibers from Purkinje cells inhibit the dentate nucleus. Therefore, activation of cerebellar cortex results inhibition of primary motor cortex (Cerebellar-Brain inhibition). Mid. Peduncle: middle peduncle, Inf. Peduncle: inferior peduncle, Sup. Peduncle: superior peduncle.

• 

  Fig. 2 Cerebellar-Brain inhibition. Amplitude of motor evoked potentials (MEP) reduced after sequential cerebellar-M1 TMS stimulation. A TMS pulse over cerebellar cortex activates Purkinje cells, leading inhibition of primary motor cortex via dentate nucleus. The decreased MEP amplitude represents the amount of cerebellar-brain inhibition. The phenomena maximized when cerebellar TMS stimuli precedes M1 TMS by 5 to 7 ms. TMS: transcranial magnetic stimulation, M1 TMS: primary motor cortex TMS, CBI: cerebellar brain inhibition.

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  Fig. 3 Polarity dependent effects of cerebellar tDCS. (A) The efferent fibers from Purkinje cells inhibits dentate nucleus, while dentate-thalamo-cortical fiber activates primary motor cortex. (B) Anodal cerebellar tDCS increase Purkinje cell activity. In this situation, reduced stimuli drive to cerebral cortical areas. (C) Cathodal cerebellar tDCS decreases cerebellar activity. Thus dentate nucleus become disinhibited, resulting increased stimuli drive to cerebral cortex. tDCS: transcranial direct current stimulation.

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