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Adingupu DD, Soroush A, Hansen A, Twomey R, Dunn JF. Brain hypoxia, neurocognitive impairment, and quality of life in people post-COVID-19. J Neurol 2023:10.1007/s00415-023-11767-2. [PMID: 37210689 DOI: 10.1007/s00415-023-11767-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVE Systemic hypoxia occurs in COVID-19 infection; however, it is unknown if cerebral hypoxia occurs in convalescent individuals. We have evidence from other conditions associated with central nervous system inflammation that hypoxia may occur in the brain. If so, hypoxia could reduce the quality of life and brain function. This study was undertaken to assess if brain hypoxia occurs in individuals after recovery from acute COVID-19 infection and if this hypoxia is associated with neurocognitive impairment and reduced quality of life. METHODS Using frequency-domain near-infrared spectroscopy (fdNIRS), we measured cerebral tissue oxygen saturation (StO2) (a measure of hypoxia) in participants who had contracted COVID-19 at least 8 weeks prior to the study visit and healthy controls. We also conducted neuropsychological assessments and health-related quality of life assessments, fatigue, and depression. RESULTS Fifty-six percent of the post-COVID-19 participants self-reported having persistent symptoms (from a list of 18), with the most reported symptom being fatigue and brain fog. There was a gradation in the decrease of oxyhemoglobin between controls, and normoxic and hypoxic post-COVID-19 groups (31.7 ± 8.3 μM, 27.8 ± 7.0 μM and 21.1 ± 7.2 μM, respectively, p = 0.028, p = 0.005, and p = 0.081). We detected that 24% of convalescent individuals' post-COVID-19 infection had reduced StO2 in the brain and that this relates to reduced neurological function and quality of life. INTERPRETATION We believe that the hypoxia reported here will have health consequences for these individuals, and this is reflected in the correlation of hypoxia with greater symptomology. With the fdNIRS technology, combined with neuropsychological assessment, we may be able to identify individuals at risk of hypoxia-related symptomology and target individuals that are likely to respond to treatments aimed at improving cerebral oxygenation.
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Affiliation(s)
- Damilola D Adingupu
- Department of Radiology, University of Calgary, Calgary, Canada.
- Hotchkiss Brain Institute (HBI), University of Calgary, Calgary, Canada.
| | - Ateyeh Soroush
- Department of Radiology, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute (HBI), University of Calgary, Calgary, Canada
- Department Of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Ayden Hansen
- Department of Radiology, University of Calgary, Calgary, Canada
- Department Of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Rosie Twomey
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Jeff F Dunn
- Department of Radiology, University of Calgary, Calgary, Canada.
- Hotchkiss Brain Institute (HBI), University of Calgary, Calgary, Canada.
- Department Of Clinical Neurosciences, University of Calgary, Calgary, Canada.
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Iwata S, Katayama R, Tsuda K, Lin YC, Kurata T, Kinoshita M, Kawase K, Kato T, Kato S, Hisano T, Oda M, Ohmae E, Takashima S, Araki Y, Saitoh S, Iwata O. Near-infrared light scattering and water diffusion in newborn brains. Ann Clin Transl Neurol 2022; 9:1417-1427. [PMID: 35943446 PMCID: PMC9463954 DOI: 10.1002/acn3.51641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/19/2022] [Indexed: 11/26/2022] Open
Abstract
Objective MRI provides useful information regarding brain maturation and injury in newborn infants. However, MRI studies are generally restricted during acute phase, resulting in uncertainty around upstream clinical events responsible for subtle cerebral injuries. Time‐resolved near‐infrared spectroscopy non‐invasively provides the reduced scattering coefficient (μs′), which theoretically reflects tissue structural complexity. This study aimed to test whether μs′ values of the newborn head reflected MRI findings. Methods Between June 2009 and January 2015, 77 hospitalised newborn infants (31.7 ± 3.8 weeks gestation) were assessed at 38.8 ± 1.3 weeks post‐conceptional age. Associations of μs′ values with MRI scores, mean diffusivity and fractional anisotropy were assessed. Results Univariable analysis showed that μs′ values were associated with gestational week (p = 0.035; regression coefficient [B], 0.065; 95% confidence interval [CI], 0.005–0.125), fractional anisotropy in the cortical grey matter (p = 0.020; B, −5.994; 95%CI, −11.032 to −0.957), average diffusivity in the cortical grey matter (p < 0.001; B, −4.728; 95%CI, −7.063 to −2.394) and subcortical white matter (p = 0.001; B, −2.071; 95%CI, −3.311 to −0.832), subarachnoid space (p < 0.001; B, −0.289; 95%CI, −0.376 to −0.201) and absence of brain abnormality (p = 0.042; B, −0.422; 95%CI, −0.829 to −0.015). The multivariable model to explain μs′ values comprised average diffusivity in the subcortical white matter (p < 0.001; B, −2.066; 95%CI, −3.200 to −0.932), subarachnoid space (p < 0.001; B, −0.314; 95%CI, −0.412 to −0.216) and absence of brain abnormality (p = 0.021; B, −0.400; 95%CI, −0.739 to −0.061). Interpretation Light scattering was associated with brain structure indicated by MRI‐assessed brain abnormality and diffusion‐tensor‐imaging‐assessed water diffusivity. When serially assessed in a larger population, μs′ values might help identify covert clinical events responsible for subtle cerebral injury.
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Affiliation(s)
- Sachiko Iwata
- Center for Human Development and Family Science, Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, 467-8601, Japan.,Department of Paediatrics and Child Health, Centre for Developmental and Cognitive Neuroscience, Kurume University School of Medicine, Kurume, Fukuoka, 830-0011, Japan
| | - Reiji Katayama
- Centre for the Study of Medical Education, Kurume University School of Medicine, Kurume, Fukuoka, 830-0011, Japan
| | - Kennosuke Tsuda
- Center for Human Development and Family Science, Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, 467-8601, Japan.,Department of Paediatrics and Child Health, Centre for Developmental and Cognitive Neuroscience, Kurume University School of Medicine, Kurume, Fukuoka, 830-0011, Japan
| | - Yung-Chieh Lin
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng-Kung University, Tainan, 70457, Taiwan
| | - Tsuyoshi Kurata
- Department of Paediatrics and Child Health, Centre for Developmental and Cognitive Neuroscience, Kurume University School of Medicine, Kurume, Fukuoka, 830-0011, Japan
| | - Masahiro Kinoshita
- Department of Paediatrics and Child Health, Centre for Developmental and Cognitive Neuroscience, Kurume University School of Medicine, Kurume, Fukuoka, 830-0011, Japan
| | - Koya Kawase
- Center for Human Development and Family Science, Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, 467-8601, Japan
| | - Takenori Kato
- Center for Human Development and Family Science, Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, 467-8601, Japan
| | - Shin Kato
- Center for Human Development and Family Science, Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, 467-8601, Japan
| | - Tadashi Hisano
- Center for Human Development and Family Science, Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, 467-8601, Japan
| | - Motoki Oda
- Central Research Laboratory, Hamamatsu Photonics K.K., Hamamatsu, Shizuoka, 434-8601, Japan
| | - Etsuko Ohmae
- Central Research Laboratory, Hamamatsu Photonics K.K., Hamamatsu, Shizuoka, 434-8601, Japan
| | - Sachio Takashima
- Yanagawa Institute for Developmental Disabilities, International University of Health and Welfare, Yanagawa, Fukuoka, 832-0813, Japan
| | - Yuko Araki
- Graduate School of Information Sciences, Tohoku University, Sendai City, Miyagi, 980-8579, Japan
| | - Shinji Saitoh
- Center for Human Development and Family Science, Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, 467-8601, Japan
| | - Osuke Iwata
- Center for Human Development and Family Science, Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, 467-8601, Japan.,Department of Paediatrics and Child Health, Centre for Developmental and Cognitive Neuroscience, Kurume University School of Medicine, Kurume, Fukuoka, 830-0011, Japan
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Verma V, Lange F, Bainbridge A, Harvey-Jones K, Robertson NJ, Tachtsidis I, Mitra S. Brain temperature monitoring in newborn infants: Current methodologies and prospects. Front Pediatr 2022; 10:1008539. [PMID: 36268041 PMCID: PMC9577084 DOI: 10.3389/fped.2022.1008539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/15/2022] [Indexed: 02/02/2023] Open
Abstract
Brain tissue temperature is a dynamic balance between heat generation from metabolism, passive loss of energy to the environment, and thermoregulatory processes such as perfusion. Perinatal brain injuries, particularly neonatal encephalopathy, and seizures, have a significant impact on the metabolic and haemodynamic state of the developing brain, and thereby likely induce changes in brain temperature. In healthy newborn brains, brain temperature is higher than the core temperature. Magnetic resonance spectroscopy (MRS) has been used as a viable, non-invasive tool to measure temperature in the newborn brain with a reported accuracy of up to 0.2 degrees Celcius and a precision of 0.3 degrees Celcius. This measurement is based on the separation of chemical shifts between the temperature-sensitive water peaks and temperature-insensitive singlet metabolite peaks. MRS thermometry requires transport to an MRI scanner and a lengthy single-point measurement. Optical monitoring, using near infrared spectroscopy (NIRS), offers an alternative which overcomes this limitation in its ability to monitor newborn brain tissue temperature continuously at the cot side in real-time. Near infrared spectroscopy uses linear temperature-dependent changes in water absorption spectra in the near infrared range to estimate the tissue temperature. This review focuses on the currently available methodologies and their viability for accurate measurement, the potential benefits of monitoring newborn brain temperature in the neonatal intensive care unit, and the important challenges that still need to be addressed.
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Affiliation(s)
- Vinita Verma
- Institute for Women's Health, University College London, London, United Kingdom
| | - Frederic Lange
- Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Alan Bainbridge
- Medical Physics and Engineering, University College London Hospital, London, United Kingdom
| | - Kelly Harvey-Jones
- Institute for Women's Health, University College London, London, United Kingdom
| | - Nicola J Robertson
- Institute for Women's Health, University College London, London, United Kingdom
| | - Ilias Tachtsidis
- Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Subhabrata Mitra
- Institute for Women's Health, University College London, London, United Kingdom
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Cury J, Vande Perre L, Smets H, Stumpp L, Vespa S, Vanhoestenberghe A, Doguet P, Delbeke J, El Tahry R, Gorza SP, Nonclercq A. Infrared neurostimulation in ex-vivorat sciatic nerve using 1470 nm wavelength. J Neural Eng 2021; 18. [PMID: 33770780 DOI: 10.1088/1741-2552/abf28f] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 03/26/2021] [Indexed: 12/22/2022]
Abstract
Objective.To design and implement a setup forex-vivooptical stimulation for exploring the effect of several key parameters (optical power and pulse duration), activation features (threshold, spatial selectivity) and recovery characteristics (repeated stimuli) in peripheral nerves.Approach.A nerve chamber allowing ex-vivo electrical and optical stimulation was designed and built. A 1470 nm light source was chosen to stimulate the nerve. A photodiode module was implemented for synchronization of the electrical and optical channels.Main results. Compound neural action potentials (CNAPs) were successfully generated with infrared light pulses of 200-2000µs duration and power in the range of 3-10 W. These parameters determine a radiant exposure for stimulation in the range 1.59-4.78 J cm-2. Recruitment curves were obtained by increasing durations at a constant power level. Neural activation threshold is reached at a mean radiant exposure of 3.16 ± 0.68 J cm-2and mean pulse energy of 3.79 ± 0.72 mJ. Repetition rates of 2-10 Hz have been explored. In eight out of ten sciatic nerves (SNs), repeated light stimuli induced a sensitization effect in that the CNAP amplitude progressively grows, representing an increasing number of recruited fibres. In two out of ten SNs, CNAPs were composed of a succession of peaks corresponding to different conduction velocities.Significance.The reported sensitization effect could shed light on the mechanism underlying infrared neurostimulation. Our results suggest that, in sharp contrast with electrical stimuli, optical pulses could recruit slow fibres early on. This more physiological order of recruitment opens the perspective for specific neuromodulation of fibre population who remained poorly accessible until now. Short high-power light pulses at wavelengths below 1.5µm offer interesting perspectives for neurostimulation.
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Affiliation(s)
- Joaquin Cury
- Bio, Electro and Mechanical Systems (BEAMS), Université libre de Bruxelles, Brussels, Belgium.,Opera Photonics, Université libre de Bruxelles, Brussels, Belgium
| | - Louis Vande Perre
- Bio, Electro and Mechanical Systems (BEAMS), Université libre de Bruxelles, Brussels, Belgium
| | - Hugo Smets
- Bio, Electro and Mechanical Systems (BEAMS), Université libre de Bruxelles, Brussels, Belgium
| | - Lars Stumpp
- Institute of Neurosciences (IONS), Université Catholique de Louvain, Belgium-Cliniques Universitaires Saint Luc, Department of Neurology, Brussels, Belgium
| | - Simone Vespa
- Institute of Neurosciences (IONS), Université Catholique de Louvain, Belgium-Cliniques Universitaires Saint Luc, Department of Neurology, Brussels, Belgium
| | - Anne Vanhoestenberghe
- Aspire Centre for Rehabilitation Engineering and Assistive Technology, University College London, London, United Kingdom
| | | | - Jean Delbeke
- Institute of Neurosciences (IONS), Université Catholique de Louvain, Belgium-Cliniques Universitaires Saint Luc, Department of Neurology, Brussels, Belgium
| | - Riëm El Tahry
- Institute of Neurosciences (IONS), Université Catholique de Louvain, Belgium-Cliniques Universitaires Saint Luc, Department of Neurology, Brussels, Belgium
| | | | - Antoine Nonclercq
- Bio, Electro and Mechanical Systems (BEAMS), Université libre de Bruxelles, Brussels, Belgium
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Investigation of Confounding Factors in Measuring Tissue Saturation with NIRS Spatially Resolved Spectroscopy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1072:307-312. [PMID: 30178363 PMCID: PMC6142855 DOI: 10.1007/978-3-319-91287-5_49] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Performing absolute measurements of tissue saturation of the brain with near-infrared spectroscopy (NIRS) is a clinically desirable brain monitoring tool. Tissue oxygenation index (TOI) is an indicator of absolute tissue mixed arterial and venous oxygen saturation, and can be calculated using a NIRS technique called spatially resolved spectroscopy (SRS). SRS instruments measure the change of light attenuation with distance by using multiple light source-detector distances at two or more wavelengths. The aim of the study is to use broadband NIRS SRS data to investigate the effects on the calculation of TOI of different parameters: wavelength selection, scattering dependence, source-detector distance, and resolving for water. In total, 55 neonates with hypoxic-ischemic encephalopathy were monitored using a broadband multi-distance continuous wave NIRS system; 172 datasets were recorded. Using a "Standard" approach, TOI values between 0 and 100% ("good") were calculated in 157/172 datasets with a mean TOI of 50%. By changing the wavelength selection, the number of "good" data sets increases to 165/172 with a mean of 60%. Alteration of the dependence of scattering on wavelength acts as a constant which shifts the absolute value of TOI significantly (p < 0.05), demonstrating the importance of having a subject-appropriate estimation of scattering dependence. In general, changing the combination of source-detector distances does not significantly alter the TOI (the mean TOI ranges from 41% to 53%) which suggests that the algorithm is robust to different source-detector combinations. The study shows the broadband NIRS SRS algorithm gives the opportunity to explore the calculation of TOI and could further improve the measurement of tissue saturation in a clinical setting.
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Scholkmann F, Zohdi H, Nasseri N, Wolf U. Absolute Values of Optical Properties (μ a, μ΄ s, μ eff and DPF) of Human Head Tissue: Dependence on Head Region and Individual. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1072:325-330. [PMID: 30178366 DOI: 10.1007/978-3-319-91287-5_52] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Absolute optical properties (i.e., the absorption coefficient, μa, and the reduced scattering coefficient, [Formula: see text]) of head tissue can be measured with frequency-domain near-infrared spectroscopy (FD-NIRS). AIM We investigated how the absolute optical properties depend on the individual subject and the head region. MATERIALS AND METHODS The data set used for the analysis comprised 31 single FD-NIRS measurements of 14 healthy subjects (9 men, 5 women, aged 33.4 ± 10.5 years). From an 8-min measurement (resting-state; FD-NIRS device: Imagent, ISS Inc.; bilateral over the prefrontal cortex, PFC, and visual cortex, VC) median values were calculated for μa and [Formula: see text] as well as the effective attenuation coefficient (μeff) and the differential pathlength factor (DPF). The measurement was done for each subject one to three times with at least 24 h between the measurements. RESULTS (i) A Bayesian ANOVA analysis revealed that head region and subject were the most significant main effects on μa, [Formula: see text] and μeff, as well as DPF, respectively. (ii) At the VC, μa, [Formula: see text] and μeff had higher values compared to the PFC. (iii) The differences in the optical properties between PFC and VC were age-dependent. (iv) All optical properties also were age-dependent. This was strongest for the properties of the PFC compared to the VC. DISCUSSION AND CONCLUSION Our analysis demonstrates that all optical head tissue properties (μa, [Formula: see text], μeff and DPF) were dependent on the head region, individual subject and age. The optical properties of the head are like a 'fingerprint' for the individual subject. Assuming constant optical properties for the whole head should be carefully reconsidered.
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Affiliation(s)
- Felix Scholkmann
- University of Bern, Institute of Complementary Medicine, Bern, Switzerland.
- University Hospital Zurich, University of Zurich, Department of Neonatology, Biomedical Optics Research Laboratory, Zurich, Switzerland.
| | - Hamoon Zohdi
- University of Bern, Institute of Complementary Medicine, Bern, Switzerland
| | - Nassim Nasseri
- University of Bern, Institute of Complementary Medicine, Bern, Switzerland
| | - Ursula Wolf
- University of Bern, Institute of Complementary Medicine, Bern, Switzerland
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Phan P, Highton D, Lai J, Smith M, Elwell C, Tachtsidis I. Multi-channel multi-distance broadband near-infrared spectroscopy system to measure the spatial response of cellular oxygen metabolism and tissue oxygenation. BIOMEDICAL OPTICS EXPRESS 2016; 7:4424-4440. [PMID: 27895985 PMCID: PMC5119585 DOI: 10.1364/boe.7.004424] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 09/22/2016] [Accepted: 09/26/2016] [Indexed: 05/22/2023]
Abstract
We present a multi-channel, multi-distance broadband near-infrared spectroscopy (NIRS) system with the capability of measuring changes in haemoglobin concentrations (Δ[HbO2], Δ[HHb]), oxidation state of cytochrome-c-oxidase (Δ[oxCCO]) and tissue oxygen saturation (TOI) in the adult human brain. The main components of the instrument are two customized spectrographs and two light sources. Each spectrograph is lens-based to improve light throughput, has a grating enhanced to optimise reflection in the near-infrared (NIR) spectral region and uses a front illuminated cooled CCD camera (-70° C) with a square chip dimension of 12.3 x 12.3 mm (512 x 512 pixels). Each light source uses a 50W halogen bulb with a gold plated mirror to increase the intensity of the NIR light. Each light source was connected to a custom-built bifurcated fibre bundle to create two source fibre bundles (3.2 mm diameter each). Each spectrograph received light input from another custom-built fibre bundle comprised of six individual bundles (one with 0.6 mm diameter and the other five with 1.5 mm diameter). All fibre bundles were fixed on a 3D printed optode holder (two light sources x two fibre bundles each = four probes; and two spectrographs x six fibre bundles each = 12 probes) that allowed 24 multi-distance channels across the forehead (six channels at 20 mm, three channels at 30 mm and 15 channels at 35 mm) and six TOI measurements. We demonstrated the use of the system in a cohort of nine healthy adult volunteers during prefrontal cortex functional activation using the Stroop task. We have observed functional responses identified as significant increase in Δ[HbO2], decrease in Δ[HHb] and increase in Δ[oxCCO] in five channels (out of 12), that overlay the left and right dorsolateral prefrontal cortices. There was no observable TOI functional response and we have shown small variations in TOI across different sites within the same subject and within the same site across subjects.
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Affiliation(s)
- Phong Phan
- Department of Medical Physics and Biomedical Engineering, UCL, London WC1E 6BT, UK
| | - David Highton
- Neurocritical Care Unit, The National Hospital for Neurology and Neurosurgery, University College London Hospitals, Queen Square, London WC1N 3BG, UK
| | - Jonathan Lai
- Department of Medical Physics and Biomedical Engineering, UCL, London WC1E 6BT, UK
| | - Martin Smith
- Department of Medical Physics and Biomedical Engineering, UCL, London WC1E 6BT, UK
- Neurocritical Care Unit, The National Hospital for Neurology and Neurosurgery, University College London Hospitals, Queen Square, London WC1N 3BG, UK
| | - Clare Elwell
- Department of Medical Physics and Biomedical Engineering, UCL, London WC1E 6BT, UK
| | - Ilias Tachtsidis
- Department of Medical Physics and Biomedical Engineering, UCL, London WC1E 6BT, UK
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