Elevation of intracranial pressure affects the relationship between hemoglobin concentration and neuronal activation in human somatosensory cortex

Functional MRI for Acute Covert Consciousness: Emerging Data and Implementation Case Series

Although research studies have begun to demonstrate relationships between disorders of consciousness and brain network biomarkers, there are limited data on the practical aspects of obtaining such network biomarkers to potentially guide care. As the state of knowledge continues to evolve, guidelines from professional societies such as the American and European Academies of Neurology and many experts have advocated that the risk-benefit ratio for the assessment of network biomarkers has begun to favor their application toward potentially detecting covert consciousness. Given the lack of detailed operationalization guidance and the context of the ethical implications, herein we offer a roadmap based on local institutional experience with the implementation of functional MRI in the neonatal, pediatric, and adult intensive care units of our local government-supported health system. We provide a case-based demonstrative approach intended to review the current literature and to assist with the initiation of such services at other facilities.

Modified Valsalva maneuver after burr-hole drainage of chronic subdural hematomas: A single-center cohort study

Background

Previous studies on the management of chronic subdural hematoma (cSDH) mainly focused on the risk of postoperative recurrence and measures to prevent it. In this study, we propose the use of a non-invasive postoperative treatment method, the modified Valsalva maneuver (MVM), as a means of reducing the recurrence of cSDH. This study aims to clarify the effects of MVM on functional outcomes and recurrence rates.

Methods

A prospective study was conducted at the Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from November 2016 to December 2020. The study included 285 adult patients who underwent burr-hole drainage for the treatment of cSDH and received subdural drains. These patients were divided into two groups: the MVM group (n = 117) and the control group (n = 98). In the MVM group, patients received treatment with a customized MVM device for at least 10 times per hour, 12 h per day. The study's primary endpoint was the recurrence rate of SDH, while functional outcomes and morbidity 3 months after surgery were the secondary outcomes.

Results

In the current study, 9 out of 117 patients (7.7%) in the MVM group experienced a recurrence of SDH, while 19 out of 98 patients (19.4%, p < 0.05) in the HC group experienced a recurrence of SDH. Additionally, the infection rate of diseases such as pneumonia (1.7%) was significantly lower in the MVM group compared to the HC group (9.2%, p < 0.001, odds ratio (OR = 0.1). After 3 months of the surgery, 109 out of 117 patients (93.2%) in the MVM group achieved a favorable prognosis, compared to 80 out of 98 patients (81.6%) in the HC group (p = 0.008, with an OR of 2.9). Additionally, infection rate (with an OR of 0.2) and age (with an OR of 0.9) are independent predictors of a favorable prognosis at the follow-up stage.

Conclusions

The use of MVM in the postoperative management of cSDHs has been shown to be safe and effective, resulting in reduced rates of cSDH recurrence and infection following burr-hole drainage. These findings suggest that MVM treatment may lead to a more favorable prognosis at the follow-up stage.

Viewing neurovascular coupling through the lens of combined EEG-fNIRS: A systematic review of current methods

Neurovascular coupling is a key physiological mechanism that occurs in the healthy human brain, and understanding this process has implications for understanding the aging and neuropsychiatric populations. Combined electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS) has emerged as a promising, noninvasive tool for probing neurovascular interactions in humans. However, the utility of this approach critically depends on the methodological quality used for multimodal integration. Despite a growing number of combined EEG-fNIRS applications reported in recent years, the methodological rigor of past studies remains unclear, limiting the accurate interpretation of reported findings and hindering the translational application of this multimodal approach. To fill this knowledge gap, we critically evaluated various methodological aspects of previous combined EEG-fNIRS studies performed in healthy individuals. A literature search was conducted using PubMed and PsycINFO on June 28, 2021. Studies involving concurrent EEG and fNIRS measurements in awake and healthy individuals were selected. After screening and eligibility assessment, 96 studies were included in the methodological evaluation. Specifically, we critically reviewed various aspects of participant sampling, experimental design, signal acquisition, data preprocessing, outcome selection, data analysis, and results presentation reported in these studies. Altogether, we identified several notable strengths and limitations of the existing EEG-fNIRS literature. In light of these limitations and the features of combined EEG-fNIRS, recommendations are made to improve and standardize research practices to facilitate the use of combined EEG-fNIRS when studying healthy neurovascular coupling processes and alterations in neurovascular coupling among various populations.

Imagined speech increases the hemodynamic response and functional connectivity of the dorsal motor cortex

Objective. Decoding imagined speech from brain signals could provide a more natural, user-friendly way for developing the next generation of the brain-computer interface (BCI). With the advantages of non-invasive, portable, relatively high spatial resolution and insensitivity to motion artifacts, the functional near-infrared spectroscopy (fNIRS) shows great potential for developing the non-invasive speech BCI. However, there is a lack of fNIRS evidence in uncovering the neural mechanism of imagined speech. Our goal is to investigate the specific brain regions and the corresponding cortico-cortical functional connectivity features during imagined speech with fNIRS.Approach. fNIRS signals were recorded from 13 subjects' bilateral motor and prefrontal cortex during overtly and covertly repeating words. Cortical activation was determined through the mean oxygen-hemoglobin concentration changes, and functional connectivity was calculated by Pearson's correlation coefficient.Main results. (a) The bilateral dorsal motor cortex was significantly activated during the covert speech, whereas the bilateral ventral motor cortex was significantly activated during the overt speech. (b) As a subregion of the motor cortex, sensorimotor cortex (SMC) showed a dominant dorsal response to covert speech condition, whereas a dominant ventral response to overt speech condition. (c) Broca's area was deactivated during the covert speech but activated during the overt speech. (d) Compared to overt speech, dorsal SMC(dSMC)-related functional connections were enhanced during the covert speech.Significance. We provide fNIRS evidence for the involvement of dSMC in speech imagery. dSMC is the speech imagery network's key hub and is probably involved in the sensorimotor information processing during the covert speech. This study could inspire the BCI community to focus on the potential contribution of dSMC during speech imagery.

Individual Differences in Hemodynamic Responses Measured on the Head Due to a Long-Term Stimulation Involving Colored Light Exposure and a Cognitive Task: A SPA-fNIRS Study

When brain activity is measured by neuroimaging, the canonical hemodynamic response (increase in oxygenated hemoglobin ([O2Hb]) and decrease in deoxygenated hemoglobin ([HHb]) is not always seen in every subject. The reason for this intersubject-variability of the responses is still not completely understood. This study is performed with 32 healthy subjects, using the systemic physiology augmented functional near-infrared spectroscopy (SPA-fNIRS) approach. We investigate the intersubject variability of hemodynamic and systemic physiological responses, due to a verbal fluency task (VFT) under colored light exposure (CLE; blue and red). Five and seven different hemodynamic response patterns were detected in the subgroup analysis of the blue and red light exposure, respectively. We also found that arterial oxygen saturation and mean arterial pressure were positively correlated with [O2Hb] at the prefrontal cortex during the CLE-VFT independent of the color of light and classification of the subjects. Our study finds that there is substantial intersubject-variability of cerebral hemodynamic responses, which is partially explained by subject-specific systemic physiological changes induced by the CLE-VFT. This means that both subgroup analyses and the additional assessment of systemic physiology are of crucial importance to achieve a comprehensive understanding of the effects of a CLE-VFT on human subjects.

Elevation of intracranial pressure affects the relationship between hemoglobin concentration and neuronal activation in human somatosensory cortex

During neuronal activation, a local decrease of deoxygenated hemoglobin concentration (deoxy‐Hb) occurs which is the basis of functional brain imaging with blood oxygenation level dependent functional magnetic resonance imaging (BOLD‐fMRI). Elevated intracranial pressure (eICP) has been shown to impair functional deoxy‐Hb changes. This study investigated this effect and its relation to the underlying neuronal activity in the human primary somatosensory cortex (SI). Functional near‐infrared spectroscopy (fNIRS) during somatosensory evoked potentials (SEP) monitoring was performed on 75 subjects during conditions of median nerve stimulation (MNS) and resting state, combined with normal breathing (NB) and eICP by escalating breathing maneuvers (breath holding [BH], Valsalva maneuver with 15 mmHg [V15] and 35 mmHg expiratory pressure [V35]). During NB, fNIRS revealed a typical oxygenated hemoglobin concentration (oxy‐Hb) increase with deoxy‐Hb decrease during MNS enabling SI brain mapping. Breathing maneuvers associated eICP produced a known global change of oxy‐Hb and deoxy‐Hb with and without MNS. When subtracting measurements during resting state from measurements during MNS, neither functional oxy‐Hb nor deoxy‐Hb changes could be recovered while SEPs remained unchanged. In conclusion, Valsalva‐induced eICP prevents oxy‐Hb and deoxy‐Hb changes during neuronal activation in SI. This finding raises questions on the validity of oxy‐Hb‐ and deoxy‐Hb‐based brain imaging (e.g., BOLD‐fMRI) during eICP.