151
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Lee J, Park E, Lee A, Chang WH, Kim DS, Kim YH. Prediction of motor recovery using indirect connectivity in a lesion network after ischemic stroke. Ther Adv Neurol Disord 2020; 13:1756286420925679. [PMID: 32499835 PMCID: PMC7243376 DOI: 10.1177/1756286420925679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 04/20/2020] [Indexed: 01/20/2023] Open
Abstract
Background: Recovery prediction can assist in the planning for impairment-focused rehabilitation after a stroke. This study investigated a new prediction model based on a lesion network analysis. To predict the potential for recovery, we focused on the next link-step connectivity of the direct neighbors of a lesion. Methods: We hypothesized that this connectivity would contribute to recovery after stroke onset. Each lesion in a patient who had suffered a stroke was transferred to a healthy subject. First link-step connectivity was identified by observing voxels functionally connected to each lesion. Next (second) link-step connectivity of the first link-step connectivity was extracted by calculating statistical dependencies between time courses of regions not directly connected to a lesion and regions identified as first link-step connectivity. Lesion impact on second link-step connectivity was quantified by comparing the lesion network and reference network. Results: The lower the impact of a lesion was on second link-step connectivity in the brain network, the better the improvement in motor function during recovery. A prediction model containing a proposed predictor, initial motor function, age, and lesion volume was established. A multivariate analysis revealed that this model accurately predicted recovery at 3 months poststroke (R 2 = 0.788; cross-validation, R 2 = 0.746, RMSE = 13.15). Conclusion: This model can potentially be used in clinical practice to develop individually tailored rehabilitation programs for patients suffering from motor impairments after stroke.
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Affiliation(s)
- Jungsoo Lee
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eunhee Park
- Department of Physical and Rehabilitation Medicine, Kyungpook National University Medical Center, Daegu, Republic of Korea
| | - Ahee Lee
- Department of Health Sciences and Technology, Department of Medical Device Management & Research, Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dae-Shik Kim
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Department of Health Sciences and Technology, Department of Medical Device Management & Research, Department of Digital Health, SAIHST, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
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152
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Tscherpel C, Dern S, Hensel L, Ziemann U, Fink GR, Grefkes C. Brain responsivity provides an individual readout for motor recovery after stroke. Brain 2020; 143:1873-1888. [PMID: 32375172 PMCID: PMC7296846 DOI: 10.1093/brain/awaa127] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 01/30/2020] [Accepted: 03/01/2020] [Indexed: 12/17/2022] Open
Abstract
Promoting the recovery of motor function and optimizing rehabilitation strategies for stroke patients is closely associated with the challenge of individual prediction. To date, stroke research has identified critical pathophysiological neural underpinnings at the cellular level as well as with regard to network reorganization. However, in order to generate reliable readouts at the level of individual patients and thereby realize translation from bench to bedside, we are still in a need for innovative methods. The combined use of transcranial magnetic stimulation (TMS) and EEG has proven powerful to record both local and network responses at an individual's level. To elucidate the potential of TMS-EEG to assess motor recovery after stroke, we used neuronavigated TMS-EEG over ipsilesional primary motor cortex (M1) in 28 stroke patients in the first days after stroke. Twenty-five of these patients were reassessed after >3 months post-stroke. In the early post-stroke phase (6.7 ± 2.5 days), the TMS-evoked EEG responses featured two markedly different response morphologies upon TMS to ipsilesional M1. In the first group of patients, TMS elicited a differentiated and sustained EEG response with a series of deflections sequentially involving both hemispheres. This response type resembled the patterns of bilateral activation as observed in the healthy comparison group. By contrast, in a subgroup of severely affected patients, TMS evoked a slow and simplified local response. Quantifying the TMS-EEG responses in the time and time-frequency domain revealed that stroke patients exhibited slower and simple responses with higher amplitudes compared to healthy controls. Importantly, these patterns of activity changes after stroke were not only linked to the initial motor deficit, but also to motor recovery after >3 months post-stroke. Thus, the data revealed a substantial impairment of local effects as well as causal interactions within the motor network early after stroke. Additionally, for severely affected patients with absent motor evoked potentials and identical clinical phenotype, TMS-EEG provided differential response patterns indicative of the individual potential for recovery of function. Thereby, TMS-EEG extends the methodological repertoire in stroke research by allowing the assessment of individual response profiles.
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Affiliation(s)
- Caroline Tscherpel
- Medical Faculty, University of Cologne, and Department of Neurology, University Hospital Cologne, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Sebastian Dern
- Medical Faculty, University of Cologne, and Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Lukas Hensel
- Medical Faculty, University of Cologne, and Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Ulf Ziemann
- Department of Neurology and Stroke, and Hertie Institute for Clinical Brain Research, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Gereon R Fink
- Medical Faculty, University of Cologne, and Department of Neurology, University Hospital Cologne, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Christian Grefkes
- Medical Faculty, University of Cologne, and Department of Neurology, University Hospital Cologne, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
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153
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Ando D, Yokota C, Koshino K, Yasuno F, Sato T, Yamamoto A, Odani H, Nakajima T, Higuchi T, Tatsumi E. Microstructural white matter changes following gait training with Hybrid Assistive Limb initiated within 1 week of stroke onset. J Neurol Sci 2020; 415:116939. [PMID: 32480076 DOI: 10.1016/j.jns.2020.116939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/16/2020] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
Abstract
The early initiation of robot-assisted gait training in patients with acute stroke could promote neuroplasticity. The aim of this study was to clarify the microstructural changes of white matter associated with gait training using Hybrid Assistive Limb (HAL) by diffusion tensor imaging (DTI). Patients with first-ever stroke and requiring a walking aid started gait training within 1 week of stroke onset. The patients were quasi-randomly assigned either to the conventional physical therapy (CPT) group or gait training using HAL (HAL) group. Motor function and DTI were examined at baseline and after 3-5 months. Voxel-based statistical analyses of fractional anisotropy (FA) images were performed using diffusion metric voxel-wise analyses. Volume of interest (VOI)-based analyses were used to assess changes in FA (ΔFA). Twenty-seven patients (17 in the CPT group and 10 in the HAL group) completed the study. There were improvements in motor function and independency in the CPT and HAL groups (p < .001). Compared to baseline, there were decreases in FA in the ipsi-lesional cerebral peduncle in the CPT group (p < .001) and increases in the contra-lesional rostrum of the corpus callosum in the HAL group (p < .001) at the second assessment, consistent with the mean ΔFA in each group from VOI analysis (CPT/HAL: cerebral peduncle, -0.066/-0.027, p = .027; corpus callosum, 0.002/0.042, p < .001). Gait training using HAL initiated within 1 week after stroke onset facilitated the recovery of inter-hemispheric communication and prevented the progression of Wallerian degeneration of the affected pyramidal tract.
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Affiliation(s)
- Daisuke Ando
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Chiaki Yokota
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Stroke Rehabilitation, National Cerebral and Cardiovascular Center, Suita, Japan.
| | - Kazuhiro Koshino
- Department of Systems and Informatics, Hokkaido Information University, Ebetsu, Japan.
| | - Fumihiko Yasuno
- Department of Psychiatry, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.
| | - Takeo Sato
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Akihide Yamamoto
- Department of Industrial-Academic Collaboration, Open Innovation Center, National Cerebral and Cardiovascular Center, Suita, Japan.
| | - Hirotaka Odani
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takashi Nakajima
- Department of Neurology, National Hospital Organization Niigata National Hospital, Kashiwazaki, Japan.
| | - Takahiro Higuchi
- Department of Nuclear Medicine and Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany
| | - Eisuke Tatsumi
- Open Innovation Center, National Cerebral and Cardiovascular Center, Suita, Japan.
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154
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Tumor grade-related language and control network reorganization in patients with left cerebral glioma. Cortex 2020; 129:141-157. [PMID: 32473401 DOI: 10.1016/j.cortex.2020.04.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 01/17/2020] [Accepted: 04/21/2020] [Indexed: 12/25/2022]
Abstract
Language processing relies on both a functionally specialized language network and a domain-general cognitive control network. Yet, how the two networks reorganize after damage resulting from diffuse and progressive glioma remains largely unknown. To address this issue, 130 patients with left cerebral gliomas, including 77 patients with low-grade glioma (LGG, WHO grade Ⅰ/II), 53 patients with high-grade glioma (HGG, WHO grade III/IV) and 38 healthy controls (HC) were adopted. The changes in resting-state functional connectivity (rsFC) of the language network and the cingulo-opercular/fronto-parietal (CO-FP) network were examined using network-based statistics. We found that tumor grade negatively correlated with language scores and language network integrity. Compared with HCs, patients with LGGs exhibited slight language deficits, both decreased and increased changes in rsFC of language network, and nearly normal CO-FP network. Patients with HGGs had significantly lower language scores than those with LGG and exhibited more severe language and CO-FP network disruptions than HCs or patients with LGGs. Moreover, we found that in patients with HGGs, the decreased rsFCs of language network were positively correlated with language scores. Together, our findings suggest tumor grade-related network reorganization of both language and control networks underlie the different levels of language impairments observed in patients with gliomas.
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155
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Bonkhoff AK, Espinoza FA, Gazula H, Vergara VM, Hensel L, Michely J, Paul T, Rehme AK, Volz LJ, Fink GR, Calhoun VD, Grefkes C. Acute ischaemic stroke alters the brain's preference for distinct dynamic connectivity states. Brain 2020; 143:1525-1540. [PMID: 32357220 PMCID: PMC7241954 DOI: 10.1093/brain/awaa101] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/26/2020] [Accepted: 02/16/2020] [Indexed: 01/01/2023] Open
Abstract
Acute ischaemic stroke disturbs healthy brain organization, prompting subsequent plasticity and reorganization to compensate for the loss of specialized neural tissue and function. Static resting state functional MRI studies have already furthered our understanding of cerebral reorganization by estimating stroke-induced changes in network connectivity aggregated over the duration of several minutes. In this study, we used dynamic resting state functional MRI analyses to increase temporal resolution to seconds and explore transient configurations of motor network connectivity in acute stroke. To this end, we collected resting state functional MRI data of 31 patients with acute ischaemic stroke and 17 age-matched healthy control subjects. Stroke patients presented with moderate to severe hand motor deficits. By estimating dynamic functional connectivity within a sliding window framework, we identified three distinct connectivity configurations of motor-related networks. Motor networks were organized into three regional domains, i.e. a cortical, subcortical and cerebellar domain. The dynamic connectivity patterns of stroke patients diverged from those of healthy controls depending on the severity of the initial motor impairment. Moderately affected patients (n = 18) spent significantly more time in a weakly connected configuration that was characterized by low levels of connectivity, both locally as well as between distant regions. In contrast, severely affected patients (n = 13) showed a significant preference for transitions into a spatially segregated connectivity configuration. This configuration featured particularly high levels of local connectivity within the three regional domains as well as anti-correlated connectivity between distant networks across domains. A third connectivity configuration represented an intermediate connectivity pattern compared to the preceding two, and predominantly encompassed decreased interhemispheric connectivity between cortical motor networks independent of individual deficit severity. Alterations within this third configuration thus closely resembled previously reported ones originating from static resting state functional MRI studies post-stroke. In summary, acute ischaemic stroke not only prompted changes in connectivity between distinct networks, but it also caused characteristic changes in temporal properties of large-scale network interactions depending on the severity of the individual deficit. These findings offer new vistas on the dynamic neural mechanisms underlying acute neurological symptoms, cortical reorganization and treatment effects in stroke patients.
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Affiliation(s)
- Anna K Bonkhoff
- Department of Neurology, University Hospital Cologne and Medical Faculty, University of Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Juelich, Juelich, Germany
- Queen Square Institute of Neurology, University College London, London, UK
| | | | - Harshvardhan Gazula
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, Georgia, USA
| | - Victor M Vergara
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, Georgia, USA
| | - Lukas Hensel
- Department of Neurology, University Hospital Cologne and Medical Faculty, University of Cologne, Germany
| | - Jochen Michely
- Department of Neurology, University Hospital Cologne and Medical Faculty, University of Cologne, Germany
| | - Theresa Paul
- Department of Neurology, University Hospital Cologne and Medical Faculty, University of Cologne, Germany
| | - Anne K Rehme
- Department of Neurology, University Hospital Cologne and Medical Faculty, University of Cologne, Germany
| | - Lukas J Volz
- Department of Neurology, University Hospital Cologne and Medical Faculty, University of Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, University Hospital Cologne and Medical Faculty, University of Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Juelich, Juelich, Germany
| | - Vince D Calhoun
- The Mind Research Network, Albuquerque, New Mexico, USA
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, Georgia, USA
| | - Christian Grefkes
- Department of Neurology, University Hospital Cologne and Medical Faculty, University of Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Juelich, Juelich, Germany
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156
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Navid MS, Niazi IK, Lelic D, Nedergaard RB, Holt K, Amjad I, Drewes AM, Haavik H. Investigating the Effects of Chiropractic Spinal Manipulation on EEG in Stroke Patients. Brain Sci 2020; 10:brainsci10050253. [PMID: 32349288 PMCID: PMC7288271 DOI: 10.3390/brainsci10050253] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/14/2020] [Accepted: 04/26/2020] [Indexed: 12/16/2022] Open
Abstract
: Objective: The purpose of this study was to evaluate the impact of chiropractic spinal manipulation on the early somatosensory evoked potentials (SEPs) and resting-state electroencephalography (EEG) recorded from chronic stroke patients. Methods: Seventeen male patients (53 ± 12 years old) participated in this randomized cross-over study. The patients received chiropractic spinal manipulation and control intervention, in random order, separated by at least 24 hours. EEG was recorded before and after each intervention during rest and stimulation of the non-paretic median nerve. For resting-state EEG, the delta-alpha ratio, brain-symmetry index, and power-spectra were calculated. For SEPs, the amplitudes and latencies of N20 and N30 peaks were assessed. Source localization was performed on the power-spectra of resting-state EEG and the N30 SEP peak. Results: Following spinal manipulation, the N30 amplitude increased by 39%, which was a significant increase compared to the control intervention (p < 0.01). The latency and changes to the strength of the cortical sources underlying the N30 peak were not significant. The N20 peak, the resting-state power-spectra, delta-alpha ratio, brain-symmetry index, and resting-state source localization showed no significant changes after either intervention. Conclusion: A single session of chiropractic spinal manipulation increased the amplitude of the N30 SEP peak in a group of chronic stroke patients, which may reflect changes to early sensorimotor function. More research is required to investigate the long-term effects of chiropractic spinal manipulation, to better understand what impact it may have on the neurological function of stroke survivors.
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Affiliation(s)
- Muhammad Samran Navid
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, 9000 Aalborg, Denmark; (M.S.N.); (D.L.); (R.B.N.); (A.M.D.)
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand; (K.H.); (I.A.); (H.H.)
| | - Imran Khan Niazi
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand; (K.H.); (I.A.); (H.H.)
- Faculty of Health & Environmental Sciences, Health & Rehabilitation Research Institute, AUT University, Auckland 0627, New Zealand
- Centre for Sensory-Motor Interactions, Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark
- Correspondence: ; Tel.: +64-9-3939-875
| | - Dina Lelic
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, 9000 Aalborg, Denmark; (M.S.N.); (D.L.); (R.B.N.); (A.M.D.)
| | - Rasmus Bach Nedergaard
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, 9000 Aalborg, Denmark; (M.S.N.); (D.L.); (R.B.N.); (A.M.D.)
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand; (K.H.); (I.A.); (H.H.)
| | - Kelly Holt
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand; (K.H.); (I.A.); (H.H.)
| | - Imran Amjad
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand; (K.H.); (I.A.); (H.H.)
- Riphah College of Rehabilitation Sciences, Riphah International University, Islamabad 46000, Pakistan
| | - Asbjørn Mohr Drewes
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, 9000 Aalborg, Denmark; (M.S.N.); (D.L.); (R.B.N.); (A.M.D.)
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
| | - Heidi Haavik
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand; (K.H.); (I.A.); (H.H.)
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157
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Treatment with Mesenchymal-Derived Extracellular Vesicles Reduces Injury-Related Pathology in Pyramidal Neurons of Monkey Perilesional Ventral Premotor Cortex. J Neurosci 2020; 40:3385-3407. [PMID: 32241837 DOI: 10.1523/jneurosci.2226-19.2020] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 03/11/2020] [Accepted: 03/16/2020] [Indexed: 02/06/2023] Open
Abstract
Functional recovery after cortical injury, such as stroke, is associated with neural circuit reorganization, but the underlying mechanisms and efficacy of therapeutic interventions promoting neural plasticity in primates are not well understood. Bone marrow mesenchymal stem cell-derived extracellular vesicles (MSC-EVs), which mediate cell-to-cell inflammatory and trophic signaling, are thought be viable therapeutic targets. We recently showed, in aged female rhesus monkeys, that systemic administration of MSC-EVs enhances recovery of function after injury of the primary motor cortex, likely through enhancing plasticity in perilesional motor and premotor cortices. Here, using in vitro whole-cell patch-clamp recording and intracellular filling in acute slices of ventral premotor cortex (vPMC) from rhesus monkeys (Macaca mulatta) of either sex, we demonstrate that MSC-EVs reduce injury-related physiological and morphologic changes in perilesional layer 3 pyramidal neurons. At 14-16 weeks after injury, vPMC neurons from both vehicle- and EV-treated lesioned monkeys exhibited significant hyperexcitability and predominance of inhibitory synaptic currents, compared with neurons from nonlesioned control brains. However, compared with vehicle-treated monkeys, neurons from EV-treated monkeys showed lower firing rates, greater spike frequency adaptation, and excitatory:inhibitory ratio. Further, EV treatment was associated with greater apical dendritic branching complexity, spine density, and inhibition, indicative of enhanced dendritic plasticity and filtering of signals integrated at the soma. Importantly, the degree of EV-mediated reduction of injury-related pathology in vPMC was significantly correlated with measures of behavioral recovery. These data show that EV treatment dampens injury-related hyperexcitability and restores excitatory:inhibitory balance in vPMC, thereby normalizing activity within cortical networks for motor function.SIGNIFICANCE STATEMENT Neuronal plasticity can facilitate recovery of function after cortical injury, but the underlying mechanisms and efficacy of therapeutic interventions promoting this plasticity in primates are not well understood. Our recent work has shown that intravenous infusions of mesenchymal-derived extracellular vesicles (EVs) that are involved in cell-to-cell inflammatory and trophic signaling can enhance recovery of motor function after injury in monkey primary motor cortex. This study shows that this EV-mediated enhancement of recovery is associated with amelioration of injury-related hyperexcitability and restoration of excitatory-inhibitory balance in perilesional ventral premotor cortex. These findings demonstrate the efficacy of mesenchymal EVs as a therapeutic to reduce injury-related pathologic changes in the physiology and structure of premotor pyramidal neurons and support recovery of function.
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158
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Liang L, Hu R, Luo X, Feng B, Long W, Song R. Reduced Complexity in Stroke with Motor Deficits: A Resting-State fMRI Study. Neuroscience 2020; 434:35-43. [PMID: 32194224 DOI: 10.1016/j.neuroscience.2020.03.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 01/02/2023]
Abstract
Recently, alterations of complexity due to brain disorders have been demonstrated using brain entropy (BEN), while the changes of brain complexity in stroke, a common cerebrovascular disease, remain unclear. In this research, resting-state functional magnetic resonance imaging (fMRI) was performed to explore the alterations of brain complexity using BEN in twenty stroke patients with motor deficits and nineteen matched healthy controls. The sample entropy (SampEn) was applied to build the BEN mapping for each participant. Compared with healthy controls, stroke patients exhibited lower BEN values in the contralesional precentral gyrus (preCG), bilateral dorsolateral frontal gyrus (SFGdor) and bilateral supplementary motor area (SMA). Moreover, significantly positive correlations between BEN values and Fugl-Meyer Assessment scores were detected in the ipsilesional SFGdor and ipsilesional SMA. Mutual information independence was observed between BEN and regional homogeneity (ReHo), amplitude of low-frequency fluctuations (ALFF), respectively, in the stroke patients. Our findings implied that brain complexity had been impacted after stroke, and also suggested that BEN could be a complementary tool for evaluating the motor impairment after stroke.
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Affiliation(s)
- Liuke Liang
- Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, School of Biomedical Engineering, Sun Yat-sen University, Guangzhou 510006, China
| | - Rongliang Hu
- Department of Rehabilitation Medicine, Jiangmen Central Hospital, Jiangmen, Guangdong, China
| | - Xuemao Luo
- Department of Radiology, Jiangmen Central Hospital, Jiangmen, Guangdong, China
| | - Bao Feng
- Department of Radiology, Jiangmen Central Hospital, Jiangmen, Guangdong, China
| | - Wansheng Long
- Department of Radiology, Jiangmen Central Hospital, Jiangmen, Guangdong, China
| | - Rong Song
- Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, School of Biomedical Engineering, Sun Yat-sen University, Guangzhou 510006, China; Shenzhen Research Institute of Sun Yat-sen University, Shenzhen, Guangdong, China.
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159
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Liu H, Cai W, Xu L, Li W, Qin W. Differential Reorganization of SMA Subregions After Stroke: A Subregional Level Resting-State Functional Connectivity Study. Front Hum Neurosci 2020; 13:468. [PMID: 32184712 PMCID: PMC7059000 DOI: 10.3389/fnhum.2019.00468] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 12/19/2019] [Indexed: 01/01/2023] Open
Abstract
Background and Purpose: The human supplementary motor area (SMA) contains two functional subregions of the SMA proper and preSMA; however, the reorganization patterns of the two SMA subregions after stroke remain uncertain. Meanwhile, a focal subcortical lesion may affect the overall functional reorganization of brain networks. We sought to identify the differential reorganization of the SMA subregions after subcortical stroke using the resting-state functional connectivity (rsFC) analysis. Methods: Resting-state functional MRI was conducted in 25 patients with chronic capsular stroke exhibiting well-recovered global motor function (Fugl-Meyer score >90). The SMA proper and preSMA were identified by the rsFC-based parcellation, and the rsFCs of each SMA subregion were compared between stroke patients and healthy controls. Results: Despite common rsFC with the fronto-insular cortex (FIC), the SMA proper and preSMA were mainly correlated with the sensorimotor areas and cognitive-related regions, respectively. In stroke patients, the SMA proper and preSMA exhibited completely different functional reorganization patterns: the former showed increased rsFCs with the primary sensorimotor area and caudal cingulate motor area (CMA) of the motor execution network, whereas the latter showed increased rsFC with the rostral CMA of the motor control network. Both of the two SMA subregions showed decreased rsFC with the FIC in stroke patients; the preSMA additionally showed decreased rsFC with the prefrontal cortex (PFC). Conclusion: Although both SMA subregions exhibit functional disconnection with the cognitive-related areas, the SMA proper is implicated in the functional reorganization within the motor execution network, whereas the preSMA is involved in the functional reorganization within the motor control network in stroke patients.
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Affiliation(s)
- Huaigui Liu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Wangli Cai
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lixue Xu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wei Li
- Department of Radiology, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Wen Qin
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
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160
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Diao Q, Liu J, Zhang X. Enhanced positive functional connectivity strength in left-sided chronic subcortical stroke. Brain Res 2020; 1733:146727. [PMID: 32061738 DOI: 10.1016/j.brainres.2020.146727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 02/08/2020] [Accepted: 02/13/2020] [Indexed: 01/20/2023]
Abstract
Patients with stroke often exhibit evidence of abnormal functional connectivity (FC). However, whether and how anatomical distance affects FC at rest remains unclear in patients with chronic subcortical stroke. Eighty-six patients with chronic (more than six months post-onset) subcortical stroke (44 left-sided patients and 42 right-sided patients) with different degrees of functional recovery, and 75 matched healthy controls underwent resting-state functional magnetic resonance imaging scanning. Positive functional connectivity strength (FCS) was computed for each voxel in the brain using a data-driven whole-brain resting state FCS method, which was further divided into short- and long-range FCS. Compared with healthy controls, patients with left-sided infarctions exhibited stronger global- and long-range FCS in the left sensorimotor cortex (SMC), and no significant intergroup difference was found for short-range FCS. No significant differences were found between the patients with right-sided infarctions and healthy controls for global, long- and short-range FCS. These findings suggested that the positive FCS alteration was connection-distance dependent within patients with left-sided chronic subcortical stroke. Also, a positive correlation was found between the FCS in the left SMC and the accuracy of the Flanker test, reflecting a compensatory FCS alteration for altered attention and executive function abilities exhibited by those with left-sided stroke.
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Affiliation(s)
- Qingqing Diao
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Jingchun Liu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Xuejun Zhang
- School of Medical Imaging, Tianjin Medical University, Tianjin, China.
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161
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Chernoff BL, Teghipco A, Garcea FE, Belkhir R, Sims MH, Paul DA, Tivarus ME, Smith SO, Hintz E, Pilcher WH, Mahon BZ. Reorganized language network connectivity after left arcuate fasciculus resection: A case study. Cortex 2020; 123:173-184. [PMID: 31812105 DOI: 10.1016/j.cortex.2019.07.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/18/2019] [Accepted: 07/02/2019] [Indexed: 01/07/2023]
Abstract
Understanding the neural mechanisms that support spontaneous recovery of cognitive abilities can place important constraints on mechanistic theories of brain organization and function, and holds potential to inform clinical interventions. Connectivity-based MRI measures have emerged as a way to study how recovery from brain injury is modulated by changes in intra- and inter-hemispheric connectivity. Here we report a detailed and multi-modal case study of a 26 year-old male who presented with a left inferior parietal glioma infiltrating the left arcuate fasciculus. The patient underwent pre- and post-operative functional MRI and Diffusion Tensor Imaging, as well as behavioral assessments of language, motor, vision and praxis. The surgery for removal of the tumor was carried out with the patient awake, and direct electrical stimulation mapping was used to evaluate cortical language centers. The patient developed a specific difficulty with repeating sentences toward the end of the surgery, after resection of the tumor and partial transection of the arcuate fasciculus. The patient recovered from the sentence repetition impairments over several months after the operation. Coincident with the patient's cognitive recovery, we document a pattern whereby intra-hemispheric functional connectivity was reduced in the left hemisphere, while inter-hemispheric connectivity increased between classic left hemisphere language regions and their right hemisphere homologues. These findings suggest that increased synchrony between the two hemispheres, in the setting of focal transection of the left arcuate fasciculus, can facilitate functional recovery.
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Affiliation(s)
| | - Alex Teghipco
- Department of Cognitive Sciences, University of California Irvine, USA
| | | | - Raouf Belkhir
- Department of Psychology, Carnegie Mellon University, USA
| | - Max H Sims
- Department of Neurology, University of Rochester, USA
| | - David A Paul
- Department of Neurosurgery, University of Rochester Medical Center, USA
| | - Madalina E Tivarus
- Department of Imaging Sciences, University of Rochester Medical Center, USA; Department of Neuroscience, University of Rochester Medical Center, USA
| | - Susan O Smith
- Department of Neurosurgery, University of Rochester Medical Center, USA
| | - Eric Hintz
- Department of Neurosurgery, University of Rochester Medical Center, USA
| | - Webster H Pilcher
- Department of Neurosurgery, University of Rochester Medical Center, USA
| | - Bradford Z Mahon
- Department of Psychology, Carnegie Mellon University, USA; Department of Neurology, University of Rochester, USA; Department of Neurosurgery, University of Rochester Medical Center, USA.
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162
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Wei W, Zhu T, Wang X, Li L, Zou Q, Lv Y. Altered Topological Organization in the Sensorimotor Network After Application of Different Frequency rTMS. Front Neurosci 2020; 13:1377. [PMID: 31920525 PMCID: PMC6930905 DOI: 10.3389/fnins.2019.01377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 12/05/2019] [Indexed: 12/18/2022] Open
Abstract
The application of repetitive transcranial magnetic stimulation (rTMS) over the primary motor cortex (M1) could influence the intrinsic brain activity in the sensorimotor network (SMN). However, how rTMS modulates the topological organization of the SMN remains unclear. In this study, we employed resting-state fMRI to investigate the topological alterations in the functional SMN after application of different frequency rTMS over the left M1. To accomplish this, we collected MRI data from 45 healthy participants who were randomly divided into three groups based on rTMS frequency (HF, high-frequency 3 Hz; LF, low-frequency 1 Hz; and SHAM). Individual large-scale functional SMN was constructed by correlating the mean time series among 29 regions of interest (ROI) in the SMN and was fed into graph-based network analyses at multiple levels of global organization and nodal centrality. Our results showed that compared with the network metrics before rTMS stimulation, the left paracentral lobule (PCL) exhibited reduced nodal degree and betweenness centrality in the LF group after rTMS, while the right supplementary motor area (SMA) exhibited reduced nodal betweenness centrality in the HF group after rTMS. Moreover, rTMS-related alterations in nodal metrics might have been attributable to the changes in connectivity patterns and local activity of the affected nodes. These findings reflected the potential of using rTMS over M1 as an effective intervention to promote motor function rehabilitation.
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Affiliation(s)
- Wei Wei
- Institutes of Psychological Sciences, Hangzhou Normal University, Hangzhou, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China
| | - Tingting Zhu
- Institutes of Psychological Sciences, Hangzhou Normal University, Hangzhou, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China
| | - Xiaoyu Wang
- Institutes of Psychological Sciences, Hangzhou Normal University, Hangzhou, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China
| | - Lingyu Li
- Institutes of Psychological Sciences, Hangzhou Normal University, Hangzhou, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China
| | - Qihong Zou
- Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Yating Lv
- Institutes of Psychological Sciences, Hangzhou Normal University, Hangzhou, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China
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163
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Schlemm E, Schulz R, Bönstrup M, Krawinkel L, Fiehler J, Gerloff C, Thomalla G, Cheng B. Structural brain networks and functional motor outcome after stroke-a prospective cohort study. Brain Commun 2020; 2:fcaa001. [PMID: 32954275 PMCID: PMC7425342 DOI: 10.1093/braincomms/fcaa001] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 10/08/2019] [Accepted: 12/02/2019] [Indexed: 01/27/2023] Open
Abstract
The time course of topological reorganization that occurs in the structural connectome after an ischaemic stroke is currently not well understood. We aimed to determine the evolution of structural brain networks in stroke patients with motor deficits and relate changes in their global topology to residual symptom burden and functional impairment. In this prospective cohort study, ischaemic stroke patients with supratentorial infarcts and motor symptoms were assessed longitudinally by advanced diffusion MRI and detailed clinical testing of upper extremity motor function at four time points from the acute to the chronic stage. For each time point, structural connectomes were reconstructed, and whole-hemisphere global network topology was quantified in terms of integration and segregation parameters. Using non-linear joint mixed-effects regression modelling, network evolution was related to lesion volume and clinical outcome. Thirty patients were included for analysis. Graph-theoretical analysis demonstrated that, over time, brain networks became less integrated and more segregated with decreasing global efficiency and increasing modularity. Changes occurred in both stroke and intact hemispheres and, in the latter, were positively associated with lesion volume. Greater change in topology was associated with larger residual symptom burden and greater motor impairment 1, 3 and 12 months after stroke. After ischaemic stroke, brain networks underwent characteristic changes in both ipsi- and contralesional hemispheres. Topological network changes reflect the severity of damage to the structural network and are associated with functional outcome beyond the impact of lesion volume.
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Affiliation(s)
- Eckhard Schlemm
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg–Eppendorf, 20246 Hamburg, Germany
| | - Robert Schulz
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg–Eppendorf, 20246 Hamburg, Germany
| | - Marlene Bönstrup
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg–Eppendorf, 20246 Hamburg, Germany
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Lutz Krawinkel
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg–Eppendorf, 20246 Hamburg, Germany
| | - Jens Fiehler
- Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Universitätsklinikum Hamburg–Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg–Eppendorf, 20246 Hamburg, Germany
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg–Eppendorf, 20246 Hamburg, Germany
| | - Bastian Cheng
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg–Eppendorf, 20246 Hamburg, Germany
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164
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Yang YW, Pan WX, Xie Q. Combined effect of repetitive transcranial magnetic stimulation and physical exercise on cortical plasticity. Neural Regen Res 2020; 15:1986-1994. [PMID: 32394946 PMCID: PMC7716032 DOI: 10.4103/1673-5374.282239] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Physical exercise can minimize dysfunction and optimize functional motor recovery after stroke by modulating cortical plasticity. However, the limitation of physical exercise is that large amounts of time and effort are necessary to significantly improve motor function, and even then, substantial exercise may not be sufficient to normalize the observed improvements. Thus, interventions that could be used to strengthen physical exercise-induced neuroplasticity may be valuable in treating hemiplegia after stroke. Repetitive transcranial magnetic stimulation seems to be a viable strategy for enhancing such plasticity. As a non-invasive cortical stimulation technique, repetitive transcranial magnetic stimulation is able to induce long-term plastic changes in the motor system. Recently, repetitive transcranial magnetic stimulation was found to optimize the plastic changes caused by motor training, thereby enhancing the long-term effects of physical exercise in stroke patients. Therefore, it is believed that the combination of repetitive transcranial magnetic stimulation and physical exercise may represent a superior method for restoring motor function after stroke.
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Affiliation(s)
- Ya-Wen Yang
- Department of Rehabilitation Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wen-Xiu Pan
- Department of Rehabilitation Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qing Xie
- Department of Rehabilitation Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University; Department of Rehabilitation Medicine, Shanghai Ruijin Rehabilitation Hospital, Shanghai, China
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165
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Kaneko F, Shindo K, Yoneta M, Okawada M, Akaboshi K, Liu M. A Case Series Clinical Trial of a Novel Approach Using Augmented Reality That Inspires Self-body Cognition in Patients With Stroke: Effects on Motor Function and Resting-State Brain Functional Connectivity. Front Syst Neurosci 2019; 13:76. [PMID: 31920571 PMCID: PMC6929676 DOI: 10.3389/fnsys.2019.00076] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 11/27/2019] [Indexed: 12/13/2022] Open
Abstract
Barring a few studies, there are not enough established treatments to improve upper limb motor function in patients with severe impairments due to chronic stroke. This study aimed to clarify the effect of the kinesthetic perceptional illusion induced by visual stimulation (KINVIS) on upper limb motor function and the relationship between motor function and resting-state brain networks. Eleven patients with severe paralysis of upper limb motor function in the chronic phase (seven men and four women; age: 54.7 ± 10.8 years; 44.0 ± 29.0 months post-stroke) participated in the study. Patients underwent an intervention consisting of therapy using KINVIS and conventional therapeutic exercise (TherEX) for 10 days. Our originally developed KiNvis™ system was applied to induce KINVIS while watching the movement of the artificial hand. Clinical outcomes were examined to evaluate motor functions and resting-state brain functional connectivity (rsFC) by analyzing blood-oxygen-level-dependent (BOLD) signals measured using functional magnetic resonance imaging (fMRI). The outcomes of motor function (Fugle-Meyer Assessment, FMA) and spasticity (Modified Ashworth Scale, MAS) significantly improved after the intervention. The improvement in MAS scores for the fingers and the wrist flexors reached a minimum of clinically important differences. Before the intervention, strong and significant negative correlations between the motor functions and rsFC of the inferior parietal lobule (IPL) and premotor cortex (PMd) in the unaffected hemisphere was demonstrated. These strong correlations were disappeared after the intervention. A negative and strong correlation between the motor function and rsFC of the bilateral inferior parietal sulcus (IPS) significantly changed to strong and positive correlation after the intervention. These results may suggest that the combination approach of KINVIS therapy and TherEX improved motor functions and decreased spasticity in the paralyzed upper extremity after stroke in the chronic phase, possibly indicating the contribution of embodied-visual stimulation. The rsFC for the interhemispheric IPS and intrahemispheric IPL and PMd may be a possible regulatory factor for improving motor function and spasticity. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT01274117.
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Affiliation(s)
- Fuminari Kaneko
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.,Department of Rehabilitation, Shonan Keiiku Hospital, Fujisawa, Japan
| | - Keiichiro Shindo
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.,Department of Rehabilitation, Shonan Keiiku Hospital, Fujisawa, Japan
| | - Masaki Yoneta
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.,Department of Rehabilitation, Shonan Keiiku Hospital, Fujisawa, Japan.,Hokuto Social Medical Corporation, Obihiro, Japan
| | - Megumi Okawada
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.,Department of Rehabilitation, Shonan Keiiku Hospital, Fujisawa, Japan.,Hokuto Social Medical Corporation, Obihiro, Japan
| | - Kazuto Akaboshi
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.,Department of Rehabilitation, Shonan Keiiku Hospital, Fujisawa, Japan.,Hokuto Social Medical Corporation, Obihiro, Japan
| | - Meigen Liu
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
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166
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Allart E, Viard R, Lopes R, Devanne H, Delval A. Influence of Motor Deficiency and Spatial Neglect on the Contralesional Posterior Parietal Cortex Functional and Structural Connectivity in Stroke Patients. Brain Topogr 2019; 33:176-190. [PMID: 31832813 DOI: 10.1007/s10548-019-00749-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 11/27/2019] [Indexed: 02/06/2023]
Abstract
The posterior parietal cortex (PPC) is a key structure for visual attention and upper limb function, two features that could be impaired after stroke, and could be implied in their recovery. If it is well established that stroke is responsible for intra- and interhemispheric connectivity troubles, little is known about those existing for the contralesional PPC. In this study, we aimed at mapping the functional (using resting state fMRI) and structural (using diffusion tensor imagery) networks from 3 subparts of the PPC of the contralesional hemisphere (the anterior intraparietal sulcus), the posterior intraparietal sulcus and the superior parieto-occipital cortex to bilateral frontal areas and ipsilesional homologous PPC parts in 11 chronic stroke patients compared to 13 healthy controls. We also aimed at assessing the relationship between connectivity and the severity of visuospatial and motor deficiencies. We showed that interhemispheric functional and structural connectivity between PPCs was altered in stroke patients compared to controls, without any specificity among seeds. Alterations of parieto-frontal intra- and interhemispheric connectivity were less observed. Neglect severity was associated with several alterations in intra- and interhemispheric connectivity, whereas we did not find any behavioral/connectivity correlations for motor deficiency. The results of this exploratory study shed a new light on the influence of the contralesional PPC in post-stroke patients, they have to be confirmed and refined in further larger studies.
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Affiliation(s)
- Etienne Allart
- Neurorehabilitation Unit, Lille University Medical Center, 59000, Lille, France. .,Inserm U1171-Degenerative and Vascular Cognitive Disorders, University Lille, 59000, Lille, France.
| | - Romain Viard
- Inserm U1171-Degenerative and Vascular Cognitive Disorders, University Lille, 59000, Lille, France.,Clinical Imaging Core FaCility, Lille University Medical Center, 59000, Lille, France
| | - Renaud Lopes
- Inserm U1171-Degenerative and Vascular Cognitive Disorders, University Lille, 59000, Lille, France.,Clinical Imaging Core FaCility, Lille University Medical Center, 59000, Lille, France
| | - Hervé Devanne
- Department of Clinical Neurophysiology, Lille University Medical Center, 59000, Lille, France.,URePSSS Unité de Recherche Pluridisciplinaire Sport Santé Société (EA7369), ULCO, 62228, Calais, France
| | - Arnaud Delval
- Inserm U1171-Degenerative and Vascular Cognitive Disorders, University Lille, 59000, Lille, France.,Department of Clinical Neurophysiology, Lille University Medical Center, 59000, Lille, France
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167
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Spontaneous Functional Recovery after Focal Damage in Neuronal Cultures. eNeuro 2019; 7:ENEURO.0254-19.2019. [PMID: 31818830 PMCID: PMC6984807 DOI: 10.1523/eneuro.0254-19.2019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 11/18/2019] [Accepted: 11/29/2019] [Indexed: 12/02/2022] Open
Abstract
Damage in biological neuronal networks triggers a complex functional reorganization whose mechanisms are still poorly understood. To delineate this reorganization process, here we investigate the functional alterations of in vitro rat cortical circuits following localized laser ablation. The analysis of the functional network configuration before and after ablation allowed us to quantify the extent of functional alterations and the characteristic spatial and temporal scales along recovery. We observed that damage precipitated a fast rerouting of information flow that restored network’s communicability in about 15 min. Functional restoration was led by the immediate neighbors around trauma but was orchestrated by the entire network. Our in vitro setup exposes the ability of neuronal circuits to articulate fast responses to acute damage, and may serve as a proxy to devise recovery strategies in actual brain circuits. Moreover, this biological setup can become a benchmark to empirically test network theories about the spontaneous recovery in dynamical networks.
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168
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Diverse functional connectivity patterns of resting-state brain networks associated with good and poor hand outcomes following stroke. NEUROIMAGE-CLINICAL 2019; 24:102065. [PMID: 31795061 PMCID: PMC6889370 DOI: 10.1016/j.nicl.2019.102065] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 10/23/2019] [Accepted: 11/03/2019] [Indexed: 11/21/2022]
Abstract
Stroke patients with good and poor hand outcomes show different connectivity patterns. Disrupted functional network connectivity is associated with hand outcomes. The findings may motivate the development of noninvasive, targeted brain stimulation.
Motor stroke has been characterized by disruptions in multiple large-scale functional brain networks. However, it remains unclear whether stroke patients with good hand outcomes show different connectivity profiles within and between networks from those with poor hand outcomes. In this cross-sectional study, we recruited 52 chronic subcortical stroke patients [illness duration (mean ± SD): 16 ± 16.2 months] and 52 healthy controls from the local hospital and community from June 2010 to August 2016. We first performed independent component analysis (ICA) on resting-state fMRI data to extract fifteen resting-state networks. Then, we compared the functional connectivity within and between networks across 52 healthy controls, 26 patients with a partially paralyzed hand (PPH), and 26 patients with a completely paralyzed hand (CPH). Compared to the patients with a PPH, the patients with a CPH showed increased connectivity in the contralesional sensorimotor cortex within the contralesional sensorimotor network; the increased connectivity was negatively correlated with the performance of the paretic hand. Moreover, the patients with a CPH, compared to those with a PPH, showed decreased strengths of connectivity between the ipsilesional sensorimotor network and both the dorsal sensorimotor network and ventral visual network; the decreased strengths of connectivity were positively correlated with the performance of the paretic hand. Collectively, our findings suggest that stroke patients with different hand outcomes show distinct functional reorganization patterns in large-scale brain networks. These findings shed light on the network-level neuromechanisms that help explain why stroke survivors in the chronic stage show different hand outcomes.
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169
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Li W, Li C, Xiang Y, Ji L, Hu H, Liu Y. Study of the activation in sensorimotor cortex and topological properties of functional brain network following focal vibration on healthy subjects and subacute stroke patients: An EEG study. Brain Res 2019; 1722:146338. [PMID: 31323197 DOI: 10.1016/j.brainres.2019.146338] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 07/12/2019] [Accepted: 07/15/2019] [Indexed: 12/16/2022]
Abstract
Modulation on cerebral cortex and cerebral networks can induce reorganization of the brain, which contributes to rehabilitation. Previous studies have proved that focal vibration (FV) on limb muscles can modulate the activities of sensorimotor cortex in healthy subjects (HS). The objective of this paper is to study the modulatory effects of FV on the sensorimotor cortex and cerebral network in HS and subacute stroke patients (SP). An experiment was designed and conducted, during which FV of 75 Hz was applied over biceps muscle of right limb of 10 HS and 10 SP with right hemiplegia. Electroencephalography (EEG) was recorded in the following phases: before FV, control condition and three sessions of FV. EEG analysis showed a significant decrease in motor-related power desynchronization (MRPD) of contralesional primary sensorimotor cortex (contralesional S1-M1) in the beta2 band (18-21 Hz) for SP during FV sessions, as well as in MRPD of bilateral S1-M1 in the beta1 (13-18 Hz) and the beta2 band for HS. Moreover, MRPD of contralesional S1-M1 was significantly lower than MRPD of ipsilesional S1-M1 during FV. Besides, a significant increase of global efficiency (E) and decrease of characteristic path length (L) were identified in the beta1 band for SP, whereas a significant increase of L was identified for HS. The results indicated that FV could enhance the excitability of contralesional S1-M1 and alter topological properties of functional brain network for SP, which was different in HS. This indication can contribute to understanding the modulatory effects of FV on cerebral cortex and cerebral network.
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Affiliation(s)
- Wei Li
- Division of Intelligent and Biomechanical System, State Key Laboratory of Tribology, Department of Mechanical Engineering, Tsinghua University, Haidian, Beijing, China.
| | - Chong Li
- Division of Intelligent and Biomechanical System, State Key Laboratory of Tribology, Department of Mechanical Engineering, Tsinghua University, Haidian, Beijing, China.
| | - Yun Xiang
- Department of Rehabilitation Medicine, Shenzhen Nanshan People's Hospital and the 6th Affiliated Hospital of Shenzhen University Health Science Center, China
| | - Linhong Ji
- Division of Intelligent and Biomechanical System, State Key Laboratory of Tribology, Department of Mechanical Engineering, Tsinghua University, Haidian, Beijing, China.
| | - Hui Hu
- Department of Rehabilitation Medicine, Shenzhen Nanshan People's Hospital and the 6th Affiliated Hospital of Shenzhen University Health Science Center, China
| | - Yali Liu
- Department of Mechanical and Electrical Engineering, Beijing Institute of Technology, Haidian, Beijing, China
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170
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Wong WW, Fang Y, Chu WCW, Shi L, Tong KY. What Kind of Brain Structural Connectivity Remodeling Can Relate to Residual Motor Function After Stroke? Front Neurol 2019; 10:1111. [PMID: 31708857 PMCID: PMC6819511 DOI: 10.3389/fneur.2019.01111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 10/04/2019] [Indexed: 01/19/2023] Open
Abstract
Recent findings showed that brain networks far away from a lesion could be altered to adapt changes after stroke. This study examined 13 chronic stroke patients with moderate to severe motor impairment and 13 age-comparable healthy controls using diffusion tensor imaging to investigate the stroke impact on the reorganization of structural connectivity. Each subject's brain was segmented into 68 cortical and 12 subcortical regions of interest (ROIs), and connectivity measures including fractional anisotropy (FA), regional FA (rFA), connection weight (CW) and connection strength (CS) were adopted to compare two subject groups. Correlations between these measures and clinical scores of motor functions (Action Research Arm Test and Fugl-Meyer Assessment for upper extremity) were done. Network-based statistic (NBS) was conducted to identify the connectivity differences between patients and controls from the perspective of whole-brain network. The results showed that both rFAs and CSs demonstrated significant differences between patients and controls in the ipsilesional sensory-motor areas and subcortical network, and bilateral attention and default mode networks. Significant positive correlations were found between the paretic motor functions and the rFAs/CSs of the contralesional medial orbitofrontal cortex (mOFC) and rostral anterior cingulate cortex (rACC), and remained significant even after removing the effect of the ipsilesional corticospinal tract. Additionally, all the connections linked with the contralesional mOFC and rACC showed significantly higher FA/CW values in the stroke patients compared to the healthy controls from the NBS results. These findings indicated that these contralesional prefrontal areas exhibited stronger connections after stroke and strongly related to the residual motor function of the stroke patients.
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Affiliation(s)
- Wan-Wa Wong
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, Hong Kong.,Department of Psychiatry and Biobehavioural Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Yuqi Fang
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Winnie C W Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Lin Shi
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kai-Yu Tong
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, Hong Kong.,Brain and Mind Institute, The Chinese University of Hong Kong, Shatin, Hong Kong
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171
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Wang H, Xu G, Wang X, Sun C, Zhu B, Fan M, Jia J, Guo X, Sun L. The Reorganization of Resting-State Brain Networks Associated With Motor Imagery Training in Chronic Stroke Patients. IEEE Trans Neural Syst Rehabil Eng 2019; 27:2237-2245. [DOI: 10.1109/tnsre.2019.2940980] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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172
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Ktena SI, Schirmer MD, Etherton MR, Giese AK, Tuozzo C, Mills BB, Rueckert D, Wu O, Rost NS. Brain Connectivity Measures Improve Modeling of Functional Outcome After Acute Ischemic Stroke. Stroke 2019; 50:2761-2767. [PMID: 31510905 PMCID: PMC6756947 DOI: 10.1161/strokeaha.119.025738] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background and Purpose- The ability to model long-term functional outcomes after acute ischemic stroke represents a major clinical challenge. One approach to potentially improve prediction modeling involves the analysis of connectomics. The field of connectomics represents the brain's connectivity as a graph, whose topological properties have helped uncover underlying mechanisms of brain function in health and disease. Specifically, we assessed the impact of stroke lesions on rich club organization, a high capacity backbone system of brain function. Methods- In a hospital-based cohort of 41 acute ischemic stroke patients, we investigated the effect of acute infarcts on the brain's prestroke rich club backbone and poststroke functional connectomes with respect to poststroke outcome. Functional connectomes were created using 3 anatomic atlases, and characteristic path-length (L) was calculated for each connectome. The number of rich club regions affected were manually determined using each patient's diffusion weighted image. We investigated differences in L with respect to outcome (modified Rankin Scale score; 90 days) and the National Institutes of Health Stroke Scale (NIHSS; early: 2-5 days; late: 90-day follow-up). Furthermore, we assessed the effect of including number of rich club regions and L in outcome models, using linear regression and assessing the explained variance (R2). Results- Of 41 patients (mean age [range]: 70 [45-89] years), 61% were male. Lower L was generally associated with better outcome. Including number of rich club regions in the backward selection models of outcome, R2 increased between 1.3- and 2.6-fold beyond that of traditional markers (age and acute lesion volume) for NIHSS and modified Rankin Scale score. Conclusions- In this proof-of-concept study, we showed that information on network topology can be leveraged to improve modeling of poststroke functional outcome. Future studies are warranted to validate this approach in larger prospective studies of outcome prediction in stroke.
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Affiliation(s)
- Sofia Ira Ktena
- From the Stroke Division and Massachusetts General Hospital, J. Philip Kistler Stroke Research Center, Harvard Medical School, Boston (S.I.K., M.D.S., M.R.E., A.-K.G., C.T., B.B.M., N.S.R.)
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, United Kingdom (S.I.K., D.R.)
| | - Markus D Schirmer
- From the Stroke Division and Massachusetts General Hospital, J. Philip Kistler Stroke Research Center, Harvard Medical School, Boston (S.I.K., M.D.S., M.R.E., A.-K.G., C.T., B.B.M., N.S.R.)
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge (M.D.S.)
- Department of Population Health Sciences, German Centre for Neurodegenerative Diseases (DZNE), Bonn, Germany (M.D.S.)
| | - Mark R Etherton
- From the Stroke Division and Massachusetts General Hospital, J. Philip Kistler Stroke Research Center, Harvard Medical School, Boston (S.I.K., M.D.S., M.R.E., A.-K.G., C.T., B.B.M., N.S.R.)
| | - Anne-Katrin Giese
- From the Stroke Division and Massachusetts General Hospital, J. Philip Kistler Stroke Research Center, Harvard Medical School, Boston (S.I.K., M.D.S., M.R.E., A.-K.G., C.T., B.B.M., N.S.R.)
| | - Carissa Tuozzo
- From the Stroke Division and Massachusetts General Hospital, J. Philip Kistler Stroke Research Center, Harvard Medical School, Boston (S.I.K., M.D.S., M.R.E., A.-K.G., C.T., B.B.M., N.S.R.)
| | - Brittany B Mills
- From the Stroke Division and Massachusetts General Hospital, J. Philip Kistler Stroke Research Center, Harvard Medical School, Boston (S.I.K., M.D.S., M.R.E., A.-K.G., C.T., B.B.M., N.S.R.)
| | - Daniel Rueckert
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, United Kingdom (S.I.K., D.R.)
| | - Ona Wu
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (O.W.)
| | - Natalia S Rost
- From the Stroke Division and Massachusetts General Hospital, J. Philip Kistler Stroke Research Center, Harvard Medical School, Boston (S.I.K., M.D.S., M.R.E., A.-K.G., C.T., B.B.M., N.S.R.)
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173
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Enhancing sensorimotor BCI performance with assistive afferent activity: An online evaluation. Neuroimage 2019; 199:375-386. [DOI: 10.1016/j.neuroimage.2019.05.074] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/08/2019] [Accepted: 05/28/2019] [Indexed: 12/26/2022] Open
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174
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Huo C, Li X, Jing J, Ma Y, Li W, Wang Y, Liu W, Fan Y, Yue S, Wang Y, Li Z. Median Nerve Electrical Stimulation-Induced Changes in Effective Connectivity in Patients With Stroke as Assessed With Functional Near-Infrared Spectroscopy. Neurorehabil Neural Repair 2019; 33:1008-1017. [PMID: 31550986 DOI: 10.1177/1545968319875952] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background. The cortical plastic changes in response to median nerve electrical stimulation (MNES) in stroke patients have not been entirely illustrated. Objective. This study aimed to investigate MNES-related changes in effective connectivity (EC) within a cortical network after stroke by using functional near-infrared spectroscopy (fNIRS). Methods. The cerebral oxygenation signals in the bilateral prefrontal cortex (LPFC/RPFC), motor cortex (LMC/RMC), and occipital lobe (LOL/ROL) of 20 stroke patients with right hemiplegia were measured by fNIRS in 2 conditions: (1) resting state and (2) MNES applied to the right wrist. Coupling function together with dynamical Bayesian inference was used to assess MNES-related changes in EC among the cerebral low-frequency fluctuations. Results. Compared with the resting state, EC from LPFC and RPFC to LOL was significantly increased during the MNES state in stroke patients. Additionally, MNES triggered significantly higher coupling strengths from LMC and LOL to RPFC. The interregional main coupling direction was observed from LPFC to bilateral motor and occipital areas in responding to MNES, suggesting that MNES could promote the regulation function of ipsilesional prefrontal areas in the functional network. MNES can induce muscle twitch of the stroke-affected hand involving a decreased neural coupling of the contralesional motor area on the ipsilesional MC. Conclusions. MNES can trigger sensorimotor stimulations of the affected hand that sequentially involved functional reorganization of distant cortical areas after stroke. Investigating MNES-related changes in EC after stroke may help further our understanding of the neural mechanisms underlying MNES.
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Affiliation(s)
- Congcong Huo
- Qilu Hospital, Shandong University, Jinan, China.,National Research Center for Rehabilitation Technical Aids, Beijing, China.,Beihang University, Beijing, China
| | - Xinglou Li
- Qilu Hospital, Shandong University, Jinan, China
| | - Jing Jing
- Qilu Hospital, Shandong University, Jinan, China
| | - Yanping Ma
- Qilu Hospital, Shandong University, Jinan, China
| | | | - Yanqin Wang
- Qilu Hospital, Shandong University, Jinan, China
| | - Wanlin Liu
- Qilu Hospital, Shandong University, Jinan, China
| | - Yubo Fan
- National Research Center for Rehabilitation Technical Aids, Beijing, China.,Key Laboratory of Rehabilitation Aids Technology and System of the Ministry of Civil Affairs, Beijing, China
| | - Shouwei Yue
- Qilu Hospital, Shandong University, Jinan, China
| | - Yonghui Wang
- Qilu Hospital, Shandong University, Jinan, China
| | - Zengyong Li
- National Research Center for Rehabilitation Technical Aids, Beijing, China.,Key Laboratory of Rehabilitation Aids Technology and System of the Ministry of Civil Affairs, Beijing, China
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175
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He W, Wang H, Zhao C, Tian X, Li L, Wang H. Role of liraglutide in brain repair promotion through Sirt1-mediated mitochondrial improvement in stroke. J Cell Physiol 2019; 235:2986-3001. [PMID: 31535381 DOI: 10.1002/jcp.29204] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 09/03/2019] [Indexed: 12/21/2022]
Abstract
Brain repair, especially axonal sprouting, is critical to restore motor function in disabled stroke patients. Liraglutide (LG) is a new kind of long-acting analogue of glucagon-like peptide-1 (GLP-1) and has potential protective effects in stroke. The mitochondria participate in brain repair after cerebral injury. However, the mechanism of the effect of LG on brain repair and its potential influence on mitochondria in stroke remains obscure. Here, in focal cerebral cortical ischemic mice model, LG improved the motor functional recovery and promoted axonal sprouting by restoring the activities of isocitrate dehydrogenase, α-ketoglutarate dehydrogenase, and succinate dehydrogenase. Moreover, LG remarkably increased the cell survival rate and revived the NeuN and GAP-43 levels in cortical neurons under hydrogen peroxide (H2 O2 ) exposure. It was also observed that LG reduced the generation of reactive oxygen species, stabilized the mitochondrial membrane potential, enhanced the levels of adenosine triphosphate, enhanced activities of mitochondrial complex-I, and decreased protein expression levels of fission-1 in H2 O2 -injured cortical neurons. Additionally, LG suppressed the expressions of sirtuin 1 (Sirt1) in cortical neurons exposed to H2 O2 . Furthermore, knockdown of Sirt1 by short interfering RNA facilitated the LG-mediated mitochondrial protection in cortical neurons under H2 O2 . Collectively, this data from the present study illustrated that LG exerted a promoting influence on brain repair, after cerebral ischemic injury, through Sirt1-mediated mitochondrial improvement.
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Affiliation(s)
- Weiliang He
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Haoyuan Wang
- School of Basic Medical, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Congying Zhao
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Xiaochao Tian
- Department of Cardiology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Litao Li
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Hebo Wang
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China.,School of Basic Medical, Hebei Medical University, Shijiazhuang, Hebei, China
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176
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Puig J, Blasco G, Alberich-Bayarri A, Schlaug G, Deco G, Biarnes C, Navas-Martí M, Rivero M, Gich J, Figueras J, Torres C, Daunis-I-Estadella P, Oramas-Requejo CL, Serena J, Stinear CM, Kuceyeski A, Soriano-Mas C, Thomalla G, Essig M, Figley CR, Menon B, Demchuk A, Nael K, Wintermark M, Liebeskind DS, Pedraza S. Resting-State Functional Connectivity Magnetic Resonance Imaging and Outcome After Acute Stroke. Stroke 2019; 49:2353-2360. [PMID: 30355087 DOI: 10.1161/strokeaha.118.021319] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Physiological effects of stroke are best assessed over entire brain networks rather than just focally at the site of structural damage. Resting-state functional magnetic resonance imaging can map functional-anatomic networks by analyzing spontaneously correlated low-frequency activity fluctuations across the brain, but its potential usefulness in predicting functional outcome after acute stroke remains unknown. We assessed the ability of resting-state functional magnetic resonance imaging to predict functional outcome after acute stroke. Methods- We scanned 37 consecutive reperfused stroke patients (age, 69±14 years; 14 females; 3-day National Institutes of Health Stroke Scale score, 6±5) on day 3 after symptom onset. After imaging preprocessing, we used a whole-brain mask to calculate the correlation coefficient matrices for every paired region using the Harvard-Oxford probabilistic atlas. To evaluate functional outcome, we applied the modified Rankin Scale at 90 days. We used region of interest analyses to explore the functional connectivity between regions and graph-computation analysis to detect differences in functional connectivity between patients with good functional outcome (modified Rankin Scale score ≤2) and those with poor outcome (modified Rankin Scale score >2). Results- Patients with good outcome had greater functional connectivity than patients with poor outcome. Although 3-day National Institutes of Health Stroke Scale score was the most accurate independent predictor of 90-day modified Rankin Scale (84.2%), adding functional connectivity increased accuracy to 94.7%. Preserved bilateral interhemispheric connectivity between the anterior inferior temporal gyrus and superior frontal gyrus and decreased connectivity between the caudate and anterior inferior temporal gyrus in the left hemisphere had the greatest impact in favoring good prognosis. Conclusions- These data suggest that information about functional connectivity from resting-state functional magnetic resonance imaging may help predict 90-day stroke outcome.
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Affiliation(s)
- Josep Puig
- From the Imaging Research Unit, Department of Radiology (Girona Biomedical Research Institute) Girona Biomedical Research Institute, Diagnostic Imaging Institute (IDI) (J.P., G.B., C.B., M.N.-M., C.L.O.-R., S.P.), Dr Josep Trueta University Hospital, Girona, Spain
| | - Gerard Blasco
- From the Imaging Research Unit, Department of Radiology (Girona Biomedical Research Institute) Girona Biomedical Research Institute, Diagnostic Imaging Institute (IDI) (J.P., G.B., C.B., M.N.-M., C.L.O.-R., S.P.), Dr Josep Trueta University Hospital, Girona, Spain
| | - Angel Alberich-Bayarri
- Quantitative Imaging Biomarkers In Medicine, La Fe Health Research Institute, La Fe Polytechnics and University Hospital, Valencia, Spain (A.A.-B.)
| | - Gottfried Schlaug
- Neuroimaging and Stroke Recovery Laboratory, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (G.S.)
| | - Gustavo Deco
- Center for Brain and Cognition, Universitat Pompeu Fabra, Barcelona, Spain (G.D.).,ICREA Institut Catalan de Recerca i Estudis Avançats, Barcelona, Spain (G.D.)
| | - Carles Biarnes
- From the Imaging Research Unit, Department of Radiology (Girona Biomedical Research Institute) Girona Biomedical Research Institute, Diagnostic Imaging Institute (IDI) (J.P., G.B., C.B., M.N.-M., C.L.O.-R., S.P.), Dr Josep Trueta University Hospital, Girona, Spain
| | - Marian Navas-Martí
- From the Imaging Research Unit, Department of Radiology (Girona Biomedical Research Institute) Girona Biomedical Research Institute, Diagnostic Imaging Institute (IDI) (J.P., G.B., C.B., M.N.-M., C.L.O.-R., S.P.), Dr Josep Trueta University Hospital, Girona, Spain
| | - Mireia Rivero
- Department of Neurology, Girona Biomedical Research Institute (M.R., J.G., J.S.), Dr Josep Trueta University Hospital, Girona, Spain
| | - Jordi Gich
- Department of Neurology, Girona Biomedical Research Institute (M.R., J.G., J.S.), Dr Josep Trueta University Hospital, Girona, Spain
| | - Jaume Figueras
- Department of Rehabilitation (J.F., C.T.), Dr Josep Trueta University Hospital, Girona, Spain
| | - Cristina Torres
- Department of Rehabilitation (J.F., C.T.), Dr Josep Trueta University Hospital, Girona, Spain
| | - Pepus Daunis-I-Estadella
- Department of Computer Science, Applied Mathematics, and Statistics, University of Girona, Spain (P.D.-i.-E.)
| | - Celia L Oramas-Requejo
- From the Imaging Research Unit, Department of Radiology (Girona Biomedical Research Institute) Girona Biomedical Research Institute, Diagnostic Imaging Institute (IDI) (J.P., G.B., C.B., M.N.-M., C.L.O.-R., S.P.), Dr Josep Trueta University Hospital, Girona, Spain
| | - Joaquín Serena
- Department of Neurology, Girona Biomedical Research Institute (M.R., J.G., J.S.), Dr Josep Trueta University Hospital, Girona, Spain
| | - Cathy M Stinear
- Department of Medicine, Centre for Brain Research, University of Auckland, New Zealand (C.M.S.)
| | - Amy Kuceyeski
- Department of Radiology, Weill Cornell Medical College, NY (A.K.)
| | - Carles Soriano-Mas
- Department of Psychiatry, Bellvitge University Hospital-Instituto de Investigación Biomédica de Bellvitge, Hospitalet del Llobregat, Barcelona, Spain (C.S.-M.).,Centro de Investigación en Salud Mental, Barcelona, Spain (C.S.-M.).,Department of Psychobiology and Methodology in Health Sciences, Universitat Autonoma de Barcelona, Spain (C.S.-M.)
| | - Götz Thomalla
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany (G.T.)
| | - Marco Essig
- Department of Radiology, University of Manitoba, Winnipeg, Canada (M.E., C.R.F.)
| | - Chase R Figley
- Department of Radiology, University of Manitoba, Winnipeg, Canada (M.E., C.R.F.)
| | - Bijoy Menon
- Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (B.M., A.D.)
| | - Andrew Demchuk
- Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (B.M., A.D.)
| | - Kambiz Nael
- Department of Radiology, Icahn School of Medicine at Mount Sinai, NY (K.N.)
| | - Max Wintermark
- Neuroradiology Division, Department of Radiology, Stanford University, Palo Alto, CA (M.W.)
| | - David S Liebeskind
- Neurovascular Imaging Research Core and University of California Los Angeles Stroke Center, Los Angeles, CA (D.S.L.)
| | - Salvador Pedraza
- From the Imaging Research Unit, Department of Radiology (Girona Biomedical Research Institute) Girona Biomedical Research Institute, Diagnostic Imaging Institute (IDI) (J.P., G.B., C.B., M.N.-M., C.L.O.-R., S.P.), Dr Josep Trueta University Hospital, Girona, Spain
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177
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Wang X, Seguin C, Zalesky A, Wong WW, Chu WCW, Tong RKY. Synchronization lag in post stroke: relation to motor function and structural connectivity. Netw Neurosci 2019; 3:1121-1140. [PMID: 31637341 PMCID: PMC6777982 DOI: 10.1162/netn_a_00105] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 07/25/2019] [Indexed: 12/20/2022] Open
Abstract
Stroke is characterized by delays in the resting-state hemodynamic response, resulting in synchronization lag in neural activity between brain regions. However, the structural basis of this lag remains unclear. In this study, we used resting-state functional MRI (rs-fMRI) to characterize synchronization lag profiles between homotopic regions in 15 individuals (14 males, 1 female) with brain lesions consequent to stroke as well as a group of healthy comparison individuals. We tested whether the network communication efficiency of each individual's structural brain network (connectome) could explain interindividual and interregional variation in synchronization lag profiles. To this end, connectomes were mapped using diffusion MRI data, and communication measures were evaluated under two schemes: shortest paths and navigation. We found that interindividual variation in synchronization lags was inversely associated with communication efficiency under both schemes. Interregional variation in lag was related to navigation efficiency and navigation distance, reflecting its dependence on both distance and structural constraints. Moreover, severity of motor deficits significantly correlated with average synchronization lag in stroke. Our results provide a structural basis for the delay of information transfer between homotopic regions inferred from rs-fMRI and provide insight into the clinical significance of structural-functional relationships in stroke individuals.
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Affiliation(s)
- Xin Wang
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong, China
| | - Caio Seguin
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Andrew Zalesky
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, Australia
- Department of Biomedical Engineering, University of Melbourne, Melbourne, Australia
| | - Wan-wa Wong
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong, China
| | - Winnie Chiu-wing Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Raymond Kai-yu Tong
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong, China
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178
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Peng Y, Liu J, Hua M, Liang M, Yu C. Enhanced Effective Connectivity From Ipsilesional to Contralesional M1 in Well-Recovered Subcortical Stroke Patients. Front Neurol 2019; 10:909. [PMID: 31551901 PMCID: PMC6736556 DOI: 10.3389/fneur.2019.00909] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 08/05/2019] [Indexed: 01/28/2023] Open
Abstract
Background and Purpose: Interhemispheric imbalance may provide a framework for developing new strategies to facilitate post-stroke motor recovery especially for patients in chronic stage. Using effective connectivity analysis, we aimed to investigate interactions between the bilateral primary motor cortices (M1) and their correlations with motor function and M1-related structural and functional changes in well-recovered patients with chronic subcortical ischemic stroke. Methods: Twenty subcortical stroke patients and 20 normal controls underwent multimodal magnetic resonance imaging (MRI) examinations. During the movement of the affected hand, functional MRI was used to calculate the M1 activation and M1-M1 effective connectivity. Diffusion tensor imaging was used to compute the fractional anisotropy (FA) of the affected corticospinal tract (CST) and M1-M1 anatomical connection. After intergroup comparisons, we tested whether the altered M1-M1 effective connectivity was correlated with the motor function, M1 activation and FA of the affected CST and M1-M1 anatomical connection in patients. Results: Compared to normal controls, stroke patients exhibited increased excitatory effective connectivity from ipsilesional to contralesional M1 and increased ipsilesional M1 activation; however, they showed reduced FA values in the affected CST and M1-M1 anatomical connection. The increased effective connectivity was positively correlated with motor score and the FA of the M1-M1 anatomical connection, but not with the M1 activation or the FA of the affected CST in these patients. Conclusions: These findings suggest that the enhancement of M1-M1 effective connectivity from ipsilesional to contralesional hemisphere depends on the integrity of the underlying M1-M1 anatomical connection (i.e., less deficits of the M1-M1 anatomical connection, greater enhancement of the corresponding effective connectivity), and such M1-M1 effective connectivity enhancement plays a supportive role in motor function in chronic subcortical stroke.
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Affiliation(s)
- Yanmin Peng
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China.,School of Medical Imaging, Tianjin Medical University, Tianjin, China
| | - Jingchun Liu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Minghui Hua
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China.,School of Medical Imaging, Tianjin Medical University, Tianjin, China
| | - Meng Liang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China.,School of Medical Imaging, Tianjin Medical University, Tianjin, China
| | - Chunshui Yu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China.,School of Medical Imaging, Tianjin Medical University, Tianjin, China
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179
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Abstract
The development of robotic devices for rehabilitation is a fast-growing field. Nowadays, thanks to novel technologies that have improved robots’ capabilities and offered more cost-effective solutions, robotic devices are increasingly being employed during clinical practice, with the goal of boosting patients’ recovery. Robotic rehabilitation is also widely used in the context of neurological disorders, where it is often provided in a variety of different fashions, depending on the specific function to be restored. Indeed, the effect of robot-aided neurorehabilitation can be maximized when used in combination with a proper training regimen (based on motor control paradigms) or with non-invasive brain machine interfaces. Therapy-induced changes in neural activity and behavioral performance, which may suggest underlying changes in neural plasticity, can be quantified by multimodal assessments of both sensorimotor performance and brain/muscular activity pre/post or during intervention. Here, we provide an overview of the most common robotic devices for upper and lower limb rehabilitation and we describe the aforementioned neurorehabilitation scenarios. We also review assessment techniques for the evaluation of robotic therapy. Additional exploitation of these research areas will highlight the crucial contribution of rehabilitation robotics for promoting recovery and answering questions about reorganization of brain functions in response to disease.
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180
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Tsuchimoto S, Shindo K, Hotta F, Hanakawa T, Liu M, Ushiba J. Sensorimotor Connectivity after Motor Exercise with Neurofeedback in Post-Stroke Patients with Hemiplegia. Neuroscience 2019; 416:109-125. [PMID: 31356896 DOI: 10.1016/j.neuroscience.2019.07.037] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 07/21/2019] [Accepted: 07/23/2019] [Indexed: 11/27/2022]
Abstract
Impaired finger motor function in post-stroke hemiplegia is a debilitating condition with no evidence-based or accessible treatments. Here, we evaluated the neurophysiological effectiveness of direct brain control of robotic exoskeleton that provides movement support contingent with brain activity. To elucidate the mechanisms underlying the neurofeedback intervention, we assessed resting-state functional connectivity with functional magnetic resonance imaging (rsfcMRI) between the ipsilesional sensory and motor cortices before and after a single 1-h intervention. Eighteen stroke patients were randomly assigned to crossover interventions in a double-blind and sham-controlled design. One patient dropped out midway through the study, and 17 patients were included in this analysis. Interventions involved motor imagery, robotic assistance, and neuromuscular electrical stimulation administered to a paretic finger. The neurofeedback intervention delivered stimulations contingent on desynchronized ipsilesional electroencephalographic (EEG) oscillations during imagined movement, and the control intervention delivered sensorimotor stimulations that were independent of EEG oscillations. There was a significant time × intervention interaction in rsfcMRI in the ipsilesional sensorimotor cortex. Post-hoc analysis showed a larger gain in increased functional connectivity during the neurofeedback intervention. Although the neurofeedback intervention delivered fewer total sensorimotor stimulations compared to the sham-control, rsfcMRI in the ipsilesional sensorimotor cortices was increased during the neurofeedback intervention compared to the sham-control. Higher coactivation of the sensory and motor cortices during neurofeedback intervention enhanced rsfcMRI in the ipsilesional sensorimotor cortices. This study showed neurophysiological evidence that EEG-contingent neurofeedback is a promising strategy to induce intrinsic ipsilesional sensorimotor reorganization, supporting the importance of integrating closed-loop sensorimotor processing at a neurophysiological level.
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Affiliation(s)
- Shohei Tsuchimoto
- School of Fundamental Science and Technology, Graduate School of Keio University, Kanagawa, 223-8522, Japan; Japan Society for the Promotion of Science, Tokyo, 102-0083, Japan
| | - Keiichiro Shindo
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, 160-8582, Japan; Shonan Keiiku Hospital, Kanagawa, 252-0816, Japan
| | - Fujiko Hotta
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, 160-8582, Japan; Tokyo Metropolitan Rehabilitation Hospital, Tokyo, 131-0034, Japan
| | - Takashi Hanakawa
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, 187-8551, Japan; Japan Science and Technology Agency, Precursory Research for Embryonic Science and Technology, 332-0012, Saitama, Japan
| | - Meigen Liu
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Junichi Ushiba
- Department of Biosciences and Informatics, Faculty of Science and Technology, Keio University, Kanagawa, 223-8522, Japan; Keio Institute of Pure and Applied Sciences, Faculty of Science and Technology Graduate School of Science and Technology, Keio University, Kanagawa, 223-8522, Japan.
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181
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Bayrak Ş, Khalil AA, Villringer K, Fiebach JB, Villringer A, Margulies DS, Ovadia-Caro S. The impact of ischemic stroke on connectivity gradients. Neuroimage Clin 2019; 24:101947. [PMID: 31376644 PMCID: PMC6676042 DOI: 10.1016/j.nicl.2019.101947] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/08/2019] [Accepted: 07/17/2019] [Indexed: 11/19/2022]
Abstract
The functional organization of the brain can be represented as a low-dimensional space that reflects its macroscale hierarchy. The dimensions of this space, described as connectivity gradients, capture the similarity of areas' connections along a continuous space. Studying how pathological perturbations with known effects on functional connectivity affect these connectivity gradients provides support for their biological relevance. Previous work has shown that localized lesions cause widespread functional connectivity alterations in structurally intact areas, affecting a network of interconnected regions. By using acute stroke as a model of the effects of focal lesions on the connectome, we apply the connectivity gradient framework to depict how functional reorganization occurs throughout the brain, unrestricted by traditional definitions of functional network boundaries. We define a three-dimensional connectivity space template based on functional connectivity data from healthy controls. By projecting lesion locations into this space, we demonstrate that ischemic strokes result in dimension-specific alterations in functional connectivity over the first week after symptom onset. Specifically, changes in functional connectivity were captured along connectivity Gradients 1 and 3. The degree of functional connectivity change was associated with the distance from the lesion along these connectivity gradients (a measure of functional similarity) regardless of the anatomical distance from the lesion. Together, these results provide support for the biological validity of connectivity gradients and suggest a novel framework to characterize connectivity alterations after stroke.
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Affiliation(s)
- Şeyma Bayrak
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Department of Cognitive Neurology, University Hospital Leipzig and Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Ahmed A Khalil
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany; Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Kersten Villringer
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jochen B Fiebach
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Arno Villringer
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Department of Cognitive Neurology, University Hospital Leipzig and Faculty of Medicine, University of Leipzig, Leipzig, Germany; Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany; Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Daniel S Margulies
- Centre National de la Recherche Scientifique (CNRS) UMR 7225, Frontlab, Institut du Cerveau et de la Moelle épinière, Paris, France.
| | - Smadar Ovadia-Caro
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany; Department of Neurology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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182
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Khambhati AN, Kahn AE, Costantini J, Ezzyat Y, Solomon EA, Gross RE, Jobst BC, Sheth SA, Zaghloul KA, Worrell G, Seger S, Lega BC, Weiss S, Sperling MR, Gorniak R, Das SR, Stein JM, Rizzuto DS, Kahana MJ, Lucas TH, Davis KA, Tracy JI, Bassett DS. Functional control of electrophysiological network architecture using direct neurostimulation in humans. Netw Neurosci 2019; 3:848-877. [PMID: 31410383 PMCID: PMC6663306 DOI: 10.1162/netn_a_00089] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 04/14/2019] [Indexed: 01/30/2023] Open
Abstract
Chronically implantable neurostimulation devices are becoming a clinically viable option for treating patients with neurological disease and psychiatric disorders. Neurostimulation offers the ability to probe and manipulate distributed networks of interacting brain areas in dysfunctional circuits. Here, we use tools from network control theory to examine the dynamic reconfiguration of functionally interacting neuronal ensembles during targeted neurostimulation of cortical and subcortical brain structures. By integrating multimodal intracranial recordings and diffusion-weighted imaging from patients with drug-resistant epilepsy, we test hypothesized structural and functional rules that predict altered patterns of synchronized local field potentials. We demonstrate the ability to predictably reconfigure functional interactions depending on stimulation strength and location. Stimulation of areas with structurally weak connections largely modulates the functional hubness of downstream areas and concurrently propels the brain towards more difficult-to-reach dynamical states. By using focal perturbations to bridge large-scale structure, function, and markers of behavior, our findings suggest that stimulation may be tuned to influence different scales of network interactions driving cognition. Brain stimulation devices capable of perturbing the physiological state of neural systems are rapidly gaining popularity for their potential to treat neurological and psychiatric disease. A root problem is that underlying dysfunction spans a large-scale network of brain regions, requiring the ability to control the complex interactions between multiple brain areas. Here, we use tools from network control theory to examine the dynamic reconfiguration of functionally interacting neuronal ensembles during targeted neurostimulation of cortical and subcortical brain structures. We demonstrate the ability to predictably reconfigure patterns of interactions between functional brain areas by modulating the strength and location of stimulation. Our findings have high significance for designing stimulation protocols capable of modulating distributed neural circuits in the human brain.
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Affiliation(s)
- Ankit N Khambhati
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Ari E Kahn
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Julia Costantini
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Youssef Ezzyat
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Ethan A Solomon
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert E Gross
- Department of Neurosurgery, Emory University Hospital, Atlanta, GA, USA
| | - Barbara C Jobst
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Kareem A Zaghloul
- Surgical Neurology Branch, National Institutes of Health, Bethesda, MD, USA
| | | | - Sarah Seger
- Department of Neurosurgery, University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | - Bradley C Lega
- Department of Neurosurgery, University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | - Shennan Weiss
- Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Michael R Sperling
- Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Richard Gorniak
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Sandhitsu R Das
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Joel M Stein
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel S Rizzuto
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael J Kahana
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Timothy H Lucas
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Kathryn A Davis
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph I Tracy
- Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Danielle S Bassett
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
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183
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Bhinge S, Mowakeaa R, Calhoun VD, Adalı T. Extraction of Time-Varying Spatiotemporal Networks Using Parameter-Tuned Constrained IVA. IEEE TRANSACTIONS ON MEDICAL IMAGING 2019; 38:1715-1725. [PMID: 30676948 PMCID: PMC7060979 DOI: 10.1109/tmi.2019.2893651] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Dynamic functional connectivity analysis is an effective way to capture the networks that are functionally associated and continuously changing over the scanning period. However, these methods mostly analyze the dynamic associations across the activation patterns of the spatial networks while assuming that the spatial networks are stationary. Hence, a model that allows for the variability in both domains and reduces the assumptions imposed on the data provides an effective way for extracting spatiotemporal networks. Independent vector analysis (IVA) is a joint blind source separation technique that allows for estimation of spatial and temporal features while successfully preserving variability. However, its performance is affected for higher number of datasets. Hence, we develop an effective two-stage method to extract time-varying spatial and temporal features using IVA, mitigating the problems with higher number of datasets while preserving the variability across subjects and time. The first stage is used to extract reference signals using group-independent component analysis (GICA) that are used in a parameter-tuned constrained IVA framework to estimate time-varying representations of these signals by preserving the variability through tuning the constraint parameter. This approach effectively captures variability across time from a large-scale resting-state fMRI data acquired from healthy controls and patients with schizophrenia and identifies more functionally relevant connections that are significantly different among healthy controls and patients with schizophrenia, compared with the widely used GICA method alone.
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Affiliation(s)
| | - Rami Mowakeaa
- Department of Electrical and Computer Engineering, University of Maryland, Baltimore County, Baltimore, MD 21250 USA
| | - Vince D. Calhoun
- The Mind Research Network, Albuquerque, NM 87106 USA
- Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, NM 87131 USA
| | - Tülay Adalı
- Department of Electrical and Computer Engineering, University of Maryland, Baltimore County, Baltimore, MD 21250 USA
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184
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Kalinosky BT, Vinehout K, Sotelo MR, Hyngstrom AS, Schmit BD. Tasked-Based Functional Brain Connectivity in Multisensory Control of Wrist Movement After Stroke. Front Neurol 2019; 10:609. [PMID: 31263444 PMCID: PMC6585311 DOI: 10.3389/fneur.2019.00609] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 05/23/2019] [Indexed: 01/07/2023] Open
Abstract
In this study we documented brain connectivity associated with multisensory integration during wrist control in healthy young adults, aged matched controls and stroke survivors. A novel functional MRI task paradigm involving wrist movement was developed to gain insight into the effects of multimodal sensory feedback on brain functional networks in stroke participants. This paradigm consisted of an intermittent position search task using the wrist during fMRI signal acquisition with visual and auditory feedback of proximity to a target position. We enrolled 12 young adults, 10 participants with chronic post-stroke hemiparesis, and nine age-matched controls. Activation maps were obtained, and functional connectivity networks were calculated using an independent component analysis (ICA) approach. Task-based networks were identified using activation maps, and nodes were obtained from the ICA components. These nodes were subsequently used for connectivity analyses. Stroke participants demonstrated significantly greater contralesional activation than controls during the visual feedback condition and less ipsilesional activity than controls during the auditory feedback condition. The sensorimotor component obtained from the ICA differed between rest and task for control and stroke participants: task-related lateralization to the contralateral cortex was observed in controls, but not in stroke participants. Connectivity analyses between the lesioned sensorimotor cortex and the contralesional cerebellum demonstrated decreased functional connectivity in stroke participants (p < 0.005), which was positively correlated the Box and Blocks arm function test (r2 = 0.59). These results suggest that task-based functional connectivity provides detail on changes in brain networks in stroke survivors. The data also highlight the importance of cerebellar connections for recovery of arm function after stroke.
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Affiliation(s)
- Benjamin T Kalinosky
- Integrative Neural Engineering and Rehabilitation Laboratory, Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, United States
| | - Kaleb Vinehout
- Integrative Neural Engineering and Rehabilitation Laboratory, Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, United States
| | - Miguel R Sotelo
- Integrative Neural Engineering and Rehabilitation Laboratory, Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, United States
| | - Allison S Hyngstrom
- Integrative Neural Engineering and Rehabilitation Laboratory, Department of Physical Therapy, Marquette University, Milwaukee, WI, United States
| | - Brian D Schmit
- Integrative Neural Engineering and Rehabilitation Laboratory, Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, United States
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185
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Relationship between motor function improvements and white matter structure after low-frequency repetitive transcranial magnetic stimulation plus intensive occupational therapy in chronic subcortical stroke patients. Neuroreport 2019; 30:485-490. [DOI: 10.1097/wnr.0000000000001227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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186
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Lv Y, Han X, Song Y, Han Y, Zhou C, Zhou D, Zhang F, Xue Q, Liu J, Zhao L, Zhang C, Li L, Wang J. Toward neuroimaging-based network biomarkers for transient ischemic attack. Hum Brain Mapp 2019; 40:3347-3361. [PMID: 31004388 DOI: 10.1002/hbm.24602] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/07/2019] [Accepted: 04/08/2019] [Indexed: 12/23/2022] Open
Abstract
Stroke is associated with topological disruptions of large-scale functional brain networks. However, whether these disruptions occur in transient ischemic attack (TIA), an important risk factor for stroke, remains largely unknown. Combining multimodal MRI techniques, we systematically examined TIA-related topological alterations of functional brain networks, and tested their reproducibility, structural, and metabolic substrates, associations with clinical risk factors and abilities as diagnostic and prognostic biomarkers. We found that functional networks in patients with TIA exhibited decreased whole-brain network efficiency, reduced nodal centralities in the bilateral insula and basal ganglia, and impaired connectivity of inter-hemispheric communication. These alterations remained largely unchanged when using different brain parcellation schemes or correcting for micro head motion or for regional gray matter volume, cerebral blood flow or hemodynamic lag of BOLD signals in the patients. Moreover, some alterations correlated with the levels of high-density lipoprotein cholesterol (an index related to ischemic attacks via modulation of atherosclerosis) in the patients, distinguished the patients from healthy individuals, and predicted future ischemic attacks in the patients. Collectively, these findings highlight the emergence of characteristic network dysfunctions in TIA, which may aid in elucidating pathological mechanisms and establishing diagnostic and prognostic biomarkers for the disease.
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Affiliation(s)
- Yating Lv
- Institutes of Psychological Sciences, Hangzhou Normal University, Zhejiang, Hangzhou, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Zhejiang, Hangzhou, China.,Department of Neurology, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Xiujie Han
- Department of Neurology, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Yulin Song
- Department of Neurology, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Yu Han
- Department of Neurology, the First Affiliated Hospital, Dalian Medical University, Dalian, Liaoning, China
| | - Chengshu Zhou
- Department of Neurology, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Dan Zhou
- Department of Neurology, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Fuding Zhang
- Department of Neurology, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Qiming Xue
- Department of Image, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Jinling Liu
- Department of Ultrasonics, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Lijuan Zhao
- Department of Neurology, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Cairong Zhang
- Department of Neurology, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Lingyu Li
- Institutes of Psychological Sciences, Hangzhou Normal University, Zhejiang, Hangzhou, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Zhejiang, Hangzhou, China.,Department of Neurology, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Jinhui Wang
- Institute for Brain Research and Rehabilitation, Guangdong Key Laboratory of Mental Health and Cognitive Science, Center for Studies of Psychological Application, South China Normal University, Guangzhou, China
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187
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Huo C, Xu G, Li Z, Lv Z, Liu Q, Li W, Ma H, Wang D, Fan Y. Limb linkage rehabilitation training-related changes in cortical activation and effective connectivity after stroke: A functional near-infrared spectroscopy study. Sci Rep 2019; 9:6226. [PMID: 30996244 PMCID: PMC6470232 DOI: 10.1038/s41598-019-42674-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 04/02/2019] [Indexed: 01/04/2023] Open
Abstract
Stroke remains the leading cause of long-term disability worldwide. Rehabilitation training is essential for motor function recovery following stroke. Specifically, limb linkage rehabilitation training can stimulate motor function in the upper and lower limbs simultaneously. This study aimed to investigate limb linkage rehabilitation task-related changes in cortical activation and effective connectivity (EC) within a functional brain network after stroke by using functional near-infrared spectroscopy (fNIRS) imaging. Thirteen stroke patients with either left hemiparesis (L-H group, n = 6) and or right hemiparesis (R-H group, n = 7) and 16 healthy individuals (control group) participated in this study. A multichannel fNIRS system was used to measure changes in cerebral oxygenated hemoglobin (delta HbO2) and deoxygenated hemoglobin (delta HHb) in the bilateral prefrontal cortices (PFCs), motor cortices (MCs), and occipital lobes (OLs) during (1) the resting state and (2) a motor rehabilitation task with upper and lower limb linkage (first 10 min [task_S1], last 10 min [task_S2]). The frequency-specific EC among the brain regions was calculated based on coupling functions and dynamic Bayesian inference in frequency intervals: high-frequency I (0.6-2 Hz) and II (0.145-0.6 Hz), low-frequency III (0.052-0.145 Hz), and very-low-frequency IV (0.021-0.052 Hz). The results showed that the stroke patients exhibited an asymmetric (greater activation in the contralesional versus ipsilesional motor region) cortical activation pattern versus healthy controls. Compared with the healthy controls, the stroke patients showed significantly lower EC (p < 0.025) in intervals I and II in the resting and task states. The EC from the MC and OL to the right PFC in interval IV was significantly higher in the R-H group than in the control group during the resting and task states (p < 0.025). Furthermore, the L-H group showed significantly higher EC from the MC and OL to the left PFC in intervals III and IV during the task states compared with the control group (p < 0.025). The significantly increased influence of the MC and OL on the contralesional PFC in low- and very-low-frequency bands suggested that plastic reorganization of cognitive resources severed to compensate for impairment in stroke patients during the motor rehabilitation task. This study can serve as a basis for understanding task-related reorganization of functional brain networks and developing novel assessment techniques for stroke rehabilitation.
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Affiliation(s)
- Congcong Huo
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing, 100176, China
| | - Gongcheng Xu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, 100086, Beijing, China
| | - Zengyong Li
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing, 100176, China.
- Key Laboratory of Rehabilitation Aids Technology and System of the Ministry of Civil Affairs, Beijing, 100176, China.
| | - Zeping Lv
- Rehabilitation Hospital, National Research Center for Rehabilitation Technical Aids, Beijing, 100176, China
| | - Qianying Liu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, 100086, Beijing, China
| | - Wenhao Li
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, 100086, Beijing, China
| | - Hongzhuo Ma
- Rehabilitation Hospital, National Research Center for Rehabilitation Technical Aids, Beijing, 100176, China
| | - Daifa Wang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, 100086, Beijing, China.
- Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, 100083, China.
| | - Yubo Fan
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing, 100176, China.
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, 100086, Beijing, China.
- Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, 100083, China.
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188
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Guggisberg AG, Koch PJ, Hummel FC, Buetefisch CM. Brain networks and their relevance for stroke rehabilitation. Clin Neurophysiol 2019; 130:1098-1124. [PMID: 31082786 DOI: 10.1016/j.clinph.2019.04.004] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 03/04/2019] [Accepted: 04/08/2019] [Indexed: 12/21/2022]
Abstract
Stroke has long been regarded as focal disease with circumscribed damage leading to neurological deficits. However, advances in methods for assessing the human brain and in statistics have enabled new tools for the examination of the consequences of stroke on brain structure and function. Thereby, it has become evident that stroke has impact on the entire brain and its network properties and can therefore be considered as a network disease. The present review first gives an overview of current methodological opportunities and pitfalls for assessing stroke-induced changes and reorganization in the human brain. We then summarize principles of plasticity after stroke that have emerged from the assessment of networks. Thereby, it is shown that neurological deficits do not only arise from focal tissue damage but also from local and remote changes in white-matter tracts and in neural interactions among wide-spread networks. Similarly, plasticity and clinical improvements are associated with specific compensatory structural and functional patterns of neural network interactions. Innovative treatment approaches have started to target such network patterns to enhance recovery. Network assessments to predict treatment response and to individualize rehabilitation is a promising way to enhance specific treatment effects and overall outcome after stroke.
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Affiliation(s)
- Adrian G Guggisberg
- Division of Neurorehabilitation, Department of Clinical Neurosciences, University Hospital Geneva, Switzerland.
| | - Philipp J Koch
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), 1202 Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology Valais (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland
| | - Friedhelm C Hummel
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), 1202 Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology Valais (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland; Department of Clinical Neuroscience, University Hospital Geneva, 1202 Geneva, Switzerland
| | - Cathrin M Buetefisch
- Depts of Neurology, Rehabilitation Medicine, Radiology, Emory University, Atlanta, GA, USA
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189
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Allart E, Devanne H, Delval A. Contribution of transcranial magnetic stimulation in assessing parietofrontal connectivity during gesture production in healthy individuals and brain-injured patients. Neurophysiol Clin 2019; 49:115-123. [DOI: 10.1016/j.neucli.2018.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 01/30/2023] Open
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190
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Ding L, Wang X, Chen S, Wang H, Tian J, Rong J, Shao P, Tong S, Guo X, Jia J. Camera-Based Mirror Visual Input for Priming Promotes Motor Recovery, Daily Function, and Brain Network Segregation in Subacute Stroke Patients. Neurorehabil Neural Repair 2019; 33:307-318. [PMID: 30909797 DOI: 10.1177/1545968319836207] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Camera technique-based mirror visual feedback (MVF) is an optimal interface for mirror therapy. However, its efficiency for stroke rehabilitation and the underlying neural mechanisms remain unclear. OBJECTIVE To investigate the possible treatment benefits of camera-based MVF (camMVF) for priming prior to hand function exercise in subacute stroke patients, and to reveal topological reorganization of brain network in response to the intervention. METHODS Twenty subacute stroke patients were assigned randomly to the camMVF group (MG, N = 10) or a conventional group (CG, N = 10). Before, and after 2 and 4 weeks of intervention, the Fugl-Meyer Assessment Upper Limb subscale (FMA_UL), the Functional Independence Measure (FIM), the modified Ashworth Scale (MAS), manual muscle testing (MMT), and the Berg Balance Scale (BBS) were measured. Resting-state electroencephalography (EEG) signals were recorded before and after 4-week intervention. RESULTS The MG showed more improvements in the FMA_UL, the FMA_WH (wrist and hand), and the FIM than the CG. The clustering coefficient (CC) of the resting EEG network in the alpha band was increased globally in the MG after intervention but not in the CG. Nodal CC analyses revealed that the CC in the MG tended to increase in the ipsilesional occipital and temporal areas, and the bilateral central and parietal areas, suggesting improved local efficiency of communication in the visual, somatosensory, and motor areas. The changes of nodal CC at TP8 and PO8 were significantly positively correlated with the motor recovery. CONCLUSIONS The camMVF-based priming could improve the motor recovery, daily function, and brain network segregation in subacute stroke patients.
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Affiliation(s)
- Li Ding
- 1 Huashan Hospital, Fudan University, Shanghai, China
| | - Xu Wang
- 2 Shanghai Jiaotong University, Shanghai, China
| | - Shugeng Chen
- 1 Huashan Hospital, Fudan University, Shanghai, China
| | - Hewei Wang
- 1 Huashan Hospital, Fudan University, Shanghai, China
| | - Jing Tian
- 1 Huashan Hospital, Fudan University, Shanghai, China
| | - Jifeng Rong
- 3 The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Peng Shao
- 1 Huashan Hospital, Fudan University, Shanghai, China
| | | | - Xiaoli Guo
- 2 Shanghai Jiaotong University, Shanghai, China
| | - Jie Jia
- 1 Huashan Hospital, Fudan University, Shanghai, China
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191
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Dynamics of brain connectivity after stroke. Rev Neurosci 2019; 30:605-623. [DOI: 10.1515/revneuro-2018-0082] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 11/18/2018] [Indexed: 01/04/2023]
Abstract
Abstract
Recovery from a stroke is a dynamic time-dependent process, in which the central nervous system reorganises to accommodate for the impact of the injury. The purpose of this paper is to review recent longitudinal studies of changes in brain connectivity after stroke. A systematic review of research papers reporting functional or effective connectivity at two or more time points in stroke patients was conducted. Stroke leads to an early reduction of connectivity in the motor network. With recovery time, the connectivity increases and can reach the same levels as in healthy participants. The increase in connectivity is correlated with functional motor gains. A new, more randomised pattern of connectivity may then emerge in the longer term. In some instances, a pattern of increased connectivity even higher than in healthy controls can be observed, and is related either to a specific time point or to a specific neural structure. Rehabilitation interventions can help improve connectivity between specific regions. Moreover, motor network connectivity undergoes reorganisation during recovery from a stroke and can be related to behavioural recovery. A detailed analysis of changes in connectivity pattern may enable a better understanding of adaptation to a stroke and how compensatory mechanisms in the brain may be supported by rehabilitation.
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192
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Zhang X, Yu X, Bao Q, Yang L, Sun Y, Qi P. Multimodal neuroimaging study reveals dissociable processes between structural and functional networks in patients with subacute intracerebral hemorrhage. Med Biol Eng Comput 2019; 57:1285-1295. [DOI: 10.1007/s11517-019-01953-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 01/16/2019] [Indexed: 12/19/2022]
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Huang Q, Wu W, Chen X, Wu B, Wu L, Huang X, Jiang S, Huang L. Evaluating the effect and mechanism of upper limb motor function recovery induced by immersive virtual-reality-based rehabilitation for subacute stroke subjects: study protocol for a randomized controlled trial. Trials 2019; 20:104. [PMID: 30728055 PMCID: PMC6366030 DOI: 10.1186/s13063-019-3177-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 01/03/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is compelling evidence of beneficial effects of non-immersive virtual reality (VR)-based intervention in the rehabilitation of patients with stroke, whereby patients experience both the real world and the virtual environment. However, to date, research on immersive VR-based rehabilitation is minimal. This study aims to design a randomized controlled trial to assess the effectiveness of immersive VR-based upper extremity rehabilitation in patients with subacute stroke and explore the underlying brain mechanisms of immersive VR-based rehabilitation. METHODS Subjects (n = 60) with subacute stroke (defined as more than 1 week and less than 12 weeks after stroke onset) will be recruited to participate in a single-blinded, randomized controlled trial. Subjects will be randomized 1:1 to either (1) an experimental intervention group, or (2) a conventional group (control). Over a 3-week time period immediately following baseline assessments and randomization, subjects in the experimental group will receive both immersive VR and conventional rehabilitation, while those in the control group will receive conventional rehabilitation only. During the rehabilitation period and over the following 12 weeks, upper extremity function, cognitive function, mental status, and daily living activity performance will be evaluated in the form of questionnaires. To trace brain reorganization in which upper extremity functions previously performed by ischemic-related brain areas are assumed by other brain areas, subjects will have brain scans immediately following enrollment but before randomization, immediately following the conclusion of rehabilitation, and 12 weeks after rehabilitation has concluded. DISCUSSION Effectiveness is assessed by evaluating motor improvement using the arm motor section of the Fugl-Meyer assessment. The study utilizes a cutting-edge brain neuroimaging approach to longitudinally trace the effectiveness of both VR-based and conventional training on stroke rehabilitation, which will hopefully describe the effects of the brain mechanisms of the intervention on recovery from stroke. Findings from the trial will greatly contribute to evidence on the use of immersive-VR-based training for stroke rehabilitation. TRIAL REGISTRATION ClinicalTrials.gov, NCT03086889 . Registered on March 22, 2017.
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Affiliation(s)
- Qianqian Huang
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109, Xueyuan W Road, Wenzhou, Zhejiang, 325027, China
| | - Wei Wu
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109, Xueyuan W Road, Wenzhou, Zhejiang, 325027, China
| | - Xiaolong Chen
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109, Xueyuan W Road, Wenzhou, Zhejiang, 325027, China
| | - Bo Wu
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109, Xueyuan W Road, Wenzhou, Zhejiang, 325027, China.,China-USA Neuroimaging Research Institute, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China
| | - Longqiang Wu
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109, Xueyuan W Road, Wenzhou, Zhejiang, 325027, China
| | - Xiaoli Huang
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109, Xueyuan W Road, Wenzhou, Zhejiang, 325027, China
| | - Songhe Jiang
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109, Xueyuan W Road, Wenzhou, Zhejiang, 325027, China. .,Integrative & Optimized Medicine Research Center, China-USA Institute for Acupuncture and Rehabilitation, Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China.
| | - Lejian Huang
- China-USA Neuroimaging Research Institute, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China. .,Department of Physiology, Northwestern University, Chicago, IL, 60611, USA.
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194
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White Matter Biomarkers Associated with Motor Change in Individuals with Stroke: A Continuous Theta Burst Stimulation Study. Neural Plast 2019; 2019:7092496. [PMID: 30863437 PMCID: PMC6378804 DOI: 10.1155/2019/7092496] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 11/08/2018] [Indexed: 11/18/2022] Open
Abstract
Continuous theta burst stimulation (cTBS) is a form of noninvasive repetitive brain stimulation that, when delivered over the contralesional hemisphere, can influence the excitability of the ipsilesional hemisphere in individuals with stroke. cTBS applied prior to skilled motor practice interventions may augment motor learning; however, there is a high degree of variability in individual response to this intervention. The main objective of the present study was to assess white matter biomarkers of response to cTBS paired with skilled motor practice in individuals with chronic stroke. We tested the effects of stimulation of the contralesional hemisphere at the site of the primary motor cortex (M1c) or primary somatosensory cortex (S1c) and a third group who received sham stimulation. Within each stimulation group, individuals were categorized into responders or nonresponders based on their capacity for motor skill change. Baseline diffusion tensor imaging (DTI) indexed the underlying white matter microstructure of a previously known motor learning network, named the constrained motor connectome (CMC), as well as the corticospinal tract (CST) of lesioned and nonlesioned hemispheres. Across practice, there were no differential group effects. However, when categorized as responders vs. nonresponders using change in motor behaviour, we demonstrated a significant difference in CMC microstructural properties (as measured by fractional anisotropy (FA)) for individuals in M1c and S1c groups. There were no significant differences between responders and nonresponders in clinical baseline measures or microstructural properties (FA) in the CST. The present study identifies a white matter biomarker, which extends beyond the CST, advancing our understanding of the importance of white matter networks for motor after stroke.
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195
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Yang Y, Chen Y, Chen K, Wei D, Li P, Zeng W, Pei J, Mao H, Jia J, Zhang Z. Increased intrinsic connectivity for structural atrophy and functional maintenance after acute ischaemic stroke. Eur J Neurol 2019; 26:935-942. [PMID: 30681762 DOI: 10.1111/ene.13913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 01/21/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Significant clinical recovery has commonly been observed in ischaemic stroke patients with irreversible brain structural damage. However, brain mechanisms that help to maintain clinical function remain unclear. METHODS Sixty-two patients with acute ischaemic stroke underwent longitudinal clinical assessments and magnetic resonance scanning. The clinical recovery trajectory was evaluated using a hierarchical linear model and intrinsic connectivity was analysed with a seed-based approach to examine its changing pattern based on the regional volume changes calculated using voxel-wise analysis. RESULTS It was observed that clinical outcome measures improved mainly in the short-term period (baseline versus 3 weeks) and then remained stable. Grey matter volume was reduced significantly in the bilateral caudate over the entire 3-year long-term period. Significant intrinsic connectivity increases were observed in the caudate-middle cingulum over the short-term period and in the caudate-precuneus and caudate-calcarine over the long-term period. Finally, it was found that increased caudate-calcarine connectivity was associated with reduced right caudate volume, and a positive correlation was found between increased caudate-middle cingulum connectivity and the amount of modified Rankin score changes. CONCLUSIONS The increased intrinsic connectivity found in this study tends to be a compensatory mechanism for post-stroke structural damage, associated with clinical recovery. The study helps in understanding the significance of enhanced intrinsic connectivity in post-stroke long-term assessment and rehabilitation.
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Affiliation(s)
- Y Yang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China.,Beijing Ageing Brain Rejuvenation Initiative Centre, Beijing Normal University, Beijing, China
| | - Y Chen
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China.,Beijing Ageing Brain Rejuvenation Initiative Centre, Beijing Normal University, Beijing, China
| | - K Chen
- Beijing Ageing Brain Rejuvenation Initiative Centre, Beijing Normal University, Beijing, China.,Banner Alzheimer's Institute, Phoenix, AZ, USA
| | - D Wei
- Beijing Ageing Brain Rejuvenation Initiative Centre, Beijing Normal University, Beijing, China.,Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - P Li
- Laboratory Research Center of Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - W Zeng
- Department of Geriatric Neurology, Chinese PLA General Hospital, Beijing, China
| | - J Pei
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China.,Beijing Ageing Brain Rejuvenation Initiative Centre, Beijing Normal University, Beijing, China
| | - H Mao
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China.,Beijing Ageing Brain Rejuvenation Initiative Centre, Beijing Normal University, Beijing, China
| | - J Jia
- Department of Geriatric Neurology, Chinese PLA General Hospital, Beijing, China
| | - Z Zhang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China.,Beijing Ageing Brain Rejuvenation Initiative Centre, Beijing Normal University, Beijing, China
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196
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Karnath HO, Sperber C, Rorden C. Reprint of: Mapping human brain lesions and their functional consequences. Neuroimage 2019; 190:4-13. [PMID: 30686616 DOI: 10.1016/j.neuroimage.2019.01.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 10/10/2017] [Accepted: 10/13/2017] [Indexed: 12/17/2022] Open
Abstract
Neuroscience has a long history of inferring brain function by examining the relationship between brain injury and subsequent behavioral impairments. The primary advantage of this method over correlative methods is that it can tell us if a certain brain region is necessary for a given cognitive function. In addition, lesion-based analyses provide unique insights into clinical deficits. In the last decade, statistical voxel-based lesion behavior mapping (VLBM) emerged as a powerful method for understanding the architecture of the human brain. This review illustrates how VLBM improves our knowledge of functional brain architecture, as well as how it is inherently limited by its mass-univariate approach. A wide array of recently developed methods appear to supplement traditional VLBM. This paper provides an overview of these new methods, including the use of specialized imaging modalities, the combination of structural imaging with normative connectome data, as well as multivariate analyses of structural imaging data. We see these new methods as complementing rather than replacing traditional VLBM, providing synergistic tools to answer related questions. Finally, we discuss the potential for these methods to become established in cognitive neuroscience and in clinical applications.
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Affiliation(s)
- Hans-Otto Karnath
- Centre of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; Department of Psychology, University of South Carolina, Columbia, SC 29208, USA.
| | - Christoph Sperber
- Centre of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Christopher Rorden
- Department of Psychology, University of South Carolina, Columbia, SC 29208, USA
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197
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Hara S, Hori M, Ueda R, Hayashi S, Inaji M, Tanaka Y, Maehara T, Ishii K, Aoki S, Nariai T. Unraveling Specific Brain Microstructural Damage in Moyamoya Disease Using Diffusion Magnetic Resonance Imaging and Positron Emission Tomography. J Stroke Cerebrovasc Dis 2019; 28:1113-1125. [PMID: 30679013 DOI: 10.1016/j.jstrokecerebrovasdis.2018.12.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 12/04/2018] [Accepted: 12/27/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND PURPOSE Chronic ischemia may induce brain microstructural damage and lead to neurocognitive dysfunction in patients with Moyamoya disease (MMD). We applied neurite orientation dispersion and density imaging (NODDI) and 15O-gas positron emission tomography (PET) to elucidate the specific ischemic brain microstructural damage of MMD in the cortex and the white matter. MATERIALS AND METHODS Thirty-one patients (16-63years old, 9 males) and 20 age- and sex-matched normal controls were enrolled in this study. NODDI evaluates quantitative parameters reflecting neurite and axonal density, network complexity and the interstitial fluid in all participants. Of 31 patients, 12 newly diagnosed patients were evaluated with PET, also. We evaluated correlations between the microstructural parameters of NODDI and the hemodynamic and metabolic parameters of PET, the relationship between NODDI and clinical severity of each hemisphere (Normal, Asymtpomatic, Symptomatic, and Infarcted) as well as neurocognitive performance. RESULTS All NODDI parameters significantly correlated with PET parameters (absolute r = 0.46-0.83, P ≤ .048) and clinical severity (P < .001), suggesting that neurite and axonal density and network complexity decreased, and the interstitial fluid increased, as the ischemic burden became severe. NODDI parameters reflecting neurite and axonal density and network complexity significantly correlated with neurocognitive profiles (r = 0.36-0.64, P ≤ .048), but the interstitial fluid component did not. CONCLUSIONS Chronic ischemia in patients with MMD may induce decreased neurite and axonal density, simplified network complexity, and may lead to neurocognitive dysfunction. The increased interstitial fluid accompanying hemodynamic impairment may not be identical to the decreased neurite density and might be driven by another mechanism.
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Affiliation(s)
- Shoko Hara
- Department of Neurosurgery, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan; Department of Radiology, Juntendo University, Bunkyo-ku, Tokyo, Japan.
| | - Masaaki Hori
- Department of Radiology, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Ryo Ueda
- Department of Radiology, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Shihori Hayashi
- Department of Neurosurgery, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan; Team for Neuroimaging Research, Tokyo Metropolitan Institute of Gerontology, Itabashi-ku, Tokyo, Japan
| | - Motoki Inaji
- Department of Neurosurgery, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan; Team for Neuroimaging Research, Tokyo Metropolitan Institute of Gerontology, Itabashi-ku, Tokyo, Japan
| | - Yoji Tanaka
- Department of Neurosurgery, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Taketoshi Maehara
- Department of Neurosurgery, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Kenji Ishii
- Team for Neuroimaging Research, Tokyo Metropolitan Institute of Gerontology, Itabashi-ku, Tokyo, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Tadashi Nariai
- Department of Neurosurgery, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan; Team for Neuroimaging Research, Tokyo Metropolitan Institute of Gerontology, Itabashi-ku, Tokyo, Japan
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198
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Woodward KE, Carlson HL, Kuczynski A, Saunders J, Hodge J, Kirton A. Sensory-motor network functional connectivity in children with unilateral cerebral palsy secondary to perinatal stroke. Neuroimage Clin 2019; 21:101670. [PMID: 30642756 PMCID: PMC6412078 DOI: 10.1016/j.nicl.2019.101670] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 12/23/2018] [Accepted: 01/07/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Perinatal stroke is the most common cause of unilateral cerebral palsy. Mechanisms of post-stroke developmental plasticity in children are poorly understood. To better understand the relationship between functional connectivity and disability, we used resting-state fMRI to compare sensorimotor connectivity with clinical dysfunction. METHODS School-aged children with periventricular venous infarction (PVI) and unilateral cerebral palsy were compared to controls. Resting-state BOLD signal was acquired on 3 T MRI and analyzed using CONN in SPM12. Functional connectivity was computed between S1, M1, supplementary motor area (SMA), and thalamus of the left/non-lesioned and right/lesioned hemisphere. Primary outcome was connectivity expressed as a Fisher-transformed correlation coefficient. Motor function was measured using the Assisting Hand Assessment (AHA), and Melbourne Assessment (MA). Proprioceptive function was measured using a robotic position matching task (VarXY). RESULTS Participants included 15 PVI and 21 controls. AHA and MA in stroke patients were negatively correlated with connectivity (increased connectivity = poorer performance). Position sense was inversely correlated with connectivity (increased connectivity = improved performance) between the non-lesioned S1 and thalamus/SMA. In controls, VarXY was positively correlated with connectivity between the thalamus and bilateral sensorimotor regions. CONCLUSIONS Resting state fMRI measures of sensorimotor connectivity are associated with clinical sensorimotor function in children with unilateral cerebral palsy secondary to PVI. Greater insight into understanding reorganization of brain networks following perinatal stroke may facilitate personalized rehabilitation.
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Affiliation(s)
- K E Woodward
- Department of Clinical Neurosciences, Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary, 2888 Shaganappi Trial NW, Calgary, AB T3B6A8, Canada.
| | - H L Carlson
- Department of Clinical Neurosciences, Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary, 2888 Shaganappi Trial NW, Calgary, AB T3B6A8, Canada.
| | - A Kuczynski
- Department of Neurosciences and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N4N1, Canada.
| | - J Saunders
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, University of Calgary, 2888 Shaganappi Trial NW, Calgary, AB T3B6A8, Canada.
| | - J Hodge
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, University of Calgary, 2888 Shaganappi Trial NW, Calgary, AB T3B6A8, Canada.
| | - A Kirton
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, University of Calgary, 2888 Shaganappi Trial NW, Calgary, AB T3B6A8, Canada; Department of Clinical Neurosciences, Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary, 2888 Shaganappi Trial NW, Calgary, AB T3B6A8, Canada; Department of Neurosciences and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N4N1, Canada.
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199
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Chen J, Sun D, Shi Y, Jin W, Wang Y, Xi Q, Ren C. Dynamic Alterations in Spontaneous Neural Activity in Multiple Brain Networks in Subacute Stroke Patients: A Resting-State fMRI Study. Front Neurosci 2019; 12:994. [PMID: 30666181 PMCID: PMC6330292 DOI: 10.3389/fnins.2018.00994] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 12/11/2018] [Indexed: 01/09/2023] Open
Abstract
Objective: To examine whether subacute stroke patients would exhibit abnormal dynamic characteristics of brain activity relative to healthy controls (HC) and to investigate whether the altered dynamic regional indexes were associated with clinical behavior in stroke patients. Methods: The dynamic amplitude of low-frequency fluctuations (dALFF) and dynamic regional homogeneity (dReHo) in 42 subacute stroke patients and 55 healthy controls were compared. Correlation analyses between dALFF and dReHo in regions showing significant intergroup differences and clinical scores (i.e., the National Institutes of Health Stroke Scale, Fugl-Meyer assessment and lesion volume size) were conducted in stroke patients. Receiver operating characteristic (ROC) curve analysis was used to determine the potential value of altered dynamic regional indexes to identify stroke patients. Results: Significantly dALFF in the bilateral cerebellum posterior lobe (CPL), ipsilesional superior parietal lobe, ipsilesional inferior temporal gyrus (ITG), the midline supplementary motor area (SMA), ipsilesional putamen and lentiform nucleus were detected in stroke patients compared to HC. Relative to the HC group, the stroke patients showed significant differences in dReHo in the contralesional rectal gyrus, contralesional ITG, contralesional pons, ipsilesional middle frontal gyrus (MFG). Significant correlations between dALFF variability in midline SMA and Fugl-Meyer assessment (FMA) scores or between dReHo variability in the ipsilesional MFG and FMA scores were detected in stroke patients. Furthermore, the ROC curve revealed that dynamic ALFF at SMA and ReHo at ipsilesional MFG might have the potential to distinguish stroke patients. Conclusion: The pattern of intrinsic brain activity variability is altered in stroke patients compared with HC, and dynamic ALFF/ReHo might be potential tools to assess stroke patients' motor function.
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Affiliation(s)
- Jing Chen
- Department of Neurology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
| | - Dalong Sun
- Division of Gastroenterology, Department of Internal Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yonghui Shi
- Department of Neurology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
| | - Wei Jin
- Department of Neurology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
| | - Yanbin Wang
- Department of Radiology, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Qian Xi
- Department of Radiology, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Chuancheng Ren
- Department of Neurology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
- Department of Neurology, Shanghai East Hospital, Tongji University, Shanghai, China
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200
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Schjetnan AGP, Gidyk DC, Metz GA, Luczak A. Anodal transcranial direct current stimulation with monopolar pulses improves limb use after stroke by enhancing inter-hemispheric coherence. Acta Neurobiol Exp (Wars) 2019. [DOI: 10.21307/ane-2019-027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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