Laboratory of Clinical Neurophysiology and non-Invasive Brain Stimulation

Dr David Benninger

Our lab, directed by David Benninger is interested in clinical neurophysiology, brain stimulation and the human motor control. As clinicians, we care about patients and are interested in better understanding the physiology of the motor system and the pathophysiology of movement and neuromuscular disorders, to develop diagnostic tests and to explore the therapeutic potential of non-invasive brain stimulation.

We apply various methods including transcranial magnetic (TMS) and direct current stiumlation (tDCS), electroneuromyography (ENMG), electroencephalography (EEG) and combined EMG-EEG (electromyography-electroencephalography) recordings, kinematic analysis of movements and motor activity with inertial monitors, robotic devices and writing tablets, and - in collaboration - of gait and postural control. The lab is fully equipped including a state-of-the-art neuro-navigation system.

We collaborate with other labs and institutions within the CHUV, University of Lausanne & EPFL, at national (University Hospitals of Bern and Basel, SuvaCare - Clinique romande de réadaptation) and international levels (National Institutes of Health (NIH) and Portland State University, USA).

Research projects underway relate to Parkinson's disease, tremor, dystonia, complex regional pain syndrome, muscle fatigue, other neuromuscular and movement disorders, and tinnitus.

We offer clinical, neurophysiological and kinematic investigations of neuromuscular and movement disorders and their therapy.

Unisciences Link

Transcranial magnetic stimulation (TMS)

TMS is a non-invasive method of brain stimulation. It is based upon electromagnetic induction using a coil placed over the scalp. The coil generates short magnetic pulses that pass painlessly through the skull targeting a specific brain region, producing short lasting electric impulse changes in brain activity.

Transcranial direct current stimulation (tDCS)

Transcranial direct current stimulation is a painless non-invasive brain stiumlation technique whereby a direct current is applied which modulates the brain activity. Surface electrodes are placed over the scalp and deliver low current stimulation that has been found to safely induce reversible changes in cortical plasticity and to promote learning.

Electroneuromyography (ENMG)

Electroneuromyography is a tool used in clinical routine to examine the peripheral nervous system and muscle function.

Electroencephalography (EEG)

Electroencephalography is a non-invasive method used in clinical routine to monitor electrical activity in the brain.

Muscle Tone Assessment

The muscle tone assessment allows an objective quantification of rigidity and spasticity. An automated device is used to induce wrist jerks and records the resistance to movement through intergrated sensors.

Tremor recordings

Different devices allow recording of tremor. We apply surface EMG electrodes, accelerometers and inertial monitor to record tremor at rest and postural tremor, while action tremor during handwriting and fine movements can be recorded on a writing tablet.

Randomized controlled therapeutic clinical trial on tDCS for the treatment of the freezing of gait (FOG) in Parkinson's disease

Freezing of gait in Parkinson's disease (PD) is a major cause of disability and falls and responds often incompletely to conventional therapy. The pathogenesis remains largely unknown and therapeutic alternatives are needed. Rehabilitative interventions that consist of learning cognitive strategies with sensory cueing to prevent and to overcome FOG represent the most efficacious intervention, but difficulties in learning and execution of these cognitive strategies are the main cause of failure. Transcranial direct current stiumulation (tDCS) enhances motor task learning and execution in patients with PD and might enhance the efficacy of rehabilitative interventions. This clinical trial investigates wheter tDCS improves the efficacy of the state-of-the-art rehabilitative intervention for freezing of gait.

What causes rest tremor in Parkinson's disease?

Rest tremor in Parkinson's disease (PD) is disabling and often responds incompletely to conventional therapy. The pathogenesis remains largely unknown and therapeutic alternatives are needed. This brain stimulation study explores the contribution of the cerebellum in rest tremor.

Tremor / rigidity assessment in Parkinson's disease

Rigidity and tremor are two of the cardinal symptoms of PD but the ways they interact with each other remain mainly unknown, although some clinical observations, as the cog-wheel phenomenon, are thought to arise from this interaction. Our research tries to understand the way these symptoms interact with quantitative recording of tremor (accelerometers, EMG, analysis) and novel objective measure of rigidity.

Investigation of motor cortex physiology using the triple stimulation technique (TST)

Transcranial magnetic stiumlation (TMS) has become a well-established method for the evaluation of brain physiology and pathophysiology of various disorders, both in research and clinical studies. Particularly, paired-pulse stimulation paradigm has advanced our knowledge on intra-cortical excitability and the interaction of various cortical areas. The triple stimulation technique (TST) allows a more accurate evaluation. In our lab, we combine the paired-pulse stimulation paradigm with the triple stimulation technique. The current study intends to explore whether repetitive spinal motor neuron discharges contribute to intra-cortical facilitation.

Is focal dystonia in the complex regional pain syndrome an organic disease or a psychogenice disorder?

The complex regional pain syndrom (CRPS) is a major complication of trauma and an important cause of post-traumatic disability. Focal dystonia can complicate CRPS and intensifies disability. Focal dystonia in CRPS often responds little or not to most of the therapies. The pathogenesis of CRPS and focal dystonia, and the nature of their association remain largely unknown. There is controversy whether focal dystonia in CRPS is an organic disease, secondary to the peripheral trauma and, therefore, considered a post-traumatic dystonia, or a psychogenic disorder. This study will deepen our understanding of these complex disorders and may contribute to a novel therapeutic approach.

Eleni T.Batzianouli, PhD student

Leonardo Caranzano, Dr, Medical Doctorant

Aurélie M. Stephan, PhD student

Baptiste Miaz, master student

Olivier Milliet, master student

Alejandro-Nicolas Santos, master student

• Michele Bedulli, physician
• Gianandrea Gajo, physician
• Nathalie A. Nguepnjo Nguissi, MSc
• Marina Pagliaro
• Natassja Pal
• Alessandro Patelli
• Marianne Anke Stephan, PhD

• Lausanne Movement Disorders Network: Pr François Vingerhoets, Pr Bogdan Draganski
• PD Dr Raphaël Maire (CHUV), Ricardo Chavarriaga, PhD (EPFL), Nicolas Place, PhD (UNIL)
• Pr François Herrmann (HUG), Pr Tobias Nef (University of Bern, University Hospital Bern), Dr Philippe Vuadens and Dr Michel Konzelmann (CRR-SUVA), Victor Candia, PhD (ETHZ)
• Dr Mark Hallett (NIH), Pr James McNames (USA)

• Therapeutic potential of non-invasive brain stimulation (FR)
• Parkinson's disease : new approaches regarding research and therapies (in German)

Swiss Association for Parkinson Disease

Swiss Accident Insurance (SUVA)

Baasch-Medicus Foundation

Swiss Dystonia Society