Article Text

Download PDFPDF
Abnormal motor cortex plasticity in premanifest and very early manifest Huntington disease
  1. Michael Orth1,4,
  2. Sven Schippling1,2,
  3. Susanne A Schneider1,
  4. Kailash P Bhatia1,
  5. Penelope Talelli1,
  6. Sarah J Tabrizi3,
  7. John C Rothwell1
  1. 1Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, Queen Square, London, UK
  2. 2Department of Neurology, Universitätsklinikum Eppendorf, Hamburg, Germany
  3. 3Department of Neurodegenerative Diseases, Institute of Neurology, Queen Square, London, UK
  4. 4Department of Neurology and European Huntington's Disease Network, Universitätsklinikum Ulm, Ulm, Germany
  1. Correspondence to Dr Michael Orth, Department of Neurology, Universitätsklinikum Ulm, Oberer Eselsberg 45/1, 89081 Ulm, Germany; michael.orth{at}


Background Cognition is affected early in Huntington disease (HD), and in HD animal models there is evidence that this reflects abnormal synaptic plasticity. The authors investigated whether there is any evidence for abnormal synaptic plasticity using the human motor cortex-rTMS model and, if so, if there is any difference between premanifest HD gene carriers and very early manifest HD patients or any relationship with ratings of the severity of motor signs.

Methods Fifteen HD gene carriers (seven premanifest, eight very early manifest) and 14 control participants were given a continuous train of 100 bursts of theta burst stimulation (cTBS: three pulses at 50 Hz and 80% AMT repeated every 200 ms). The size of the motor-evoked potential was measured at regular intervals until 21 min after cTBS.

Results HD gene carriers and controls responded differently to theta burst stimulation (F4.9,131.9=1.37, p=0.048) with controls having more inhibition than HD gene carriers (F1,27=13.3, p=0.001). Across all time points, mean inhibition differed between the groups (F2,26=6.32, p=0.006); controls had more inhibition than either HD gene carrier subgroup (p=0.006 for premanifest and p=0.009 for early symptomatic), whereas there was no difference between premanifest and early symptomatic HD gene carriers. The measure of cortical plasticity was not associated with any clinical ratings (Unified Huntington Disease Rating Scale motor score, estimate of age at onset).

Conclusions Motor cortex plasticity is abnormal in HD gene carriers but is not closely linked to the development of motor signs of HD.

  • Repetitive transcranial magnetic stimulation
  • Huntington's disease
  • synaptic plasticity
  • theta burst stimulation
  • physiology
  • hutingtons

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding SJT is funded by the Medical Research Council, the Wellcome Trust, the Brain Research Trust, the UK Huntington's disease association and the High Q Foundation. Some of this work was undertaken at UCLH/UCL who received a proportion of funding from the Department of Health's NIHR Biomedical Research Centres funding scheme.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Joint Ethics Committee of the National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.

  • Provenance and peer review Not commissioned; externally peer reviewed.