Stimulation of the Pre-SMA Influences Cerebral Blood Flow in Frontal Areas Involved With Inhibitory Control of Action.

Stimulation of the Pre-SMA Influences Cerebral Blood Flow in Frontal Areas Involved with Inhibitory Control of Action.

Brain Stimul. 2013 Mar 21;
Obeso I, Cho SS, Antonelli F, Houle S, Jahanshahi M, Ko JH, Strafella AP

Selection of the most appropriate response necessitates inhibition of competing or prepotent responses. It is important to characterize which cortical areas are relevant to achieve response inhibition. Using the stop signal task, previous imaging studies revealed consistent activation in the right pre-supplementary motor area (pre-SMA). However, imaging alone suffers from the limitation that it can only provide neuronal correlates and cannot establish causality between brain activation and behavior. Repetitive transcranial magnetic stimulation (rTMS) can be used to temporarily interfere with the function of a cortical area considered to play a specific role in the behavior. Thus, we combined rTMS with H2(15)O positron emission tomography (PET) scans during the stop signal task, to test whether rTMS-induced changes in excitability of the right pre-SMA influenced response inhibition. We found that rTMS over the pre-SMA increased the efficiency of the inhibitory control over prepotent ongoing responses. A significant interaction was present in the left inferior frontal gyrus (IFG) along with an increase in regional cerebral blood flow (rCBF) in the left pre-SMA, left IFG, right premotor and right inferior parietal cortex. These areas best fitted the path analysis model in the effective connectivity model. The results of this study suggest that stimulation of the right pre-SMA, by interfering with its activity, may have a significant impact on response inhibition. HubMed – addiction

Knowledge of addiction medicine among internal medicine residents and medical students.

Tenn Med. 2013 Mar; 106(3): 31-3
Brown AT, Kolade VO, Staton LJ, Patel NK

More than 22 million Americans are living with addiction, including nearly seven million who misuse prescription medications. However, most medical schools and residency programs provide little to no education addressing alcohol and drug addiction. Implementation of a new addiction medicine curriculum at a single internal medicine program provided an opportunity for knowledge assessment in a select population of health professionals. We hypothesized that knowledge of addiction medicine would not differ by training level or geographical location of medical school, but that knowledge would improve following a structured curriculum.Study participants included internal medicine and transitional year residents, as well as a group of medical students who were enrolled in a single internal medicine program at the time of the didactic series. A pre-test was administered prior to a four-week structured curriculum. The topics addressed included but were not limited to: 1) an overview of addiction, 2) opioids and chronic pain, 3) benzodiazepines and illicit stimulants, and 4) alcohol. A panel discussion was convened at the end of the fourth session. Following participation in the symposium, participants completed an online post-test. ANOVA was used to compare means. Paired t-tests were used to compare pre-test and post-test scores.36 of 44 eligible medical students and residents completed the pre-test. Mean pre-test percentage scores were 64 percent for fourth year medical students and 62.5 percent for all residents. For residents, U.S. medical school trainees answered 65 percent of the pre-test questions correctly, versus 58.6 percent correct responses among their international medical graduate peers. No inter-group differences were statistically significant. Of the 36 participants, 20 completed both pre-tests and post-tests. The mean post-test score of 68.75 percent was higher than the mean pre-test score of 61.75 percent, p = 0.009.Knowledge of addiction medicine can be improved for medical students and residents in an academic medicine department. Significant improvements were observed following completion of eight hours of interactive didactics. HubMed – addiction

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