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Weitzel L, Bavishi S. Disorders of Consciousness. Phys Med Rehabil Clin N Am 2024; 35:493-506. [PMID: 38945646 DOI: 10.1016/j.pmr.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
This article reviews the definition, assessment, neuroimaging, treatment, and rehabilitation for disorders of consciousness after an acquired brain injury. It also explores special considerations and new neuromodulation treatment options.
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Affiliation(s)
- Levi Weitzel
- Department of Physical Medicine and Rehabilitation, Ohio State University College of Medicine, 370 W 9th Avenue, Columbus, OH 43210, USA.
| | - Sheital Bavishi
- Department of Physical Medicine and Rehabilitation, Brain Injury Program, Dodd Inpatient Rehabilitation Hospital, Ohio State University Wexner Medical Center, 480 Medical Center Drive, Room 1036, Columbus, OH 43210, USA
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Qu S, Wu X, Tang Y, Zhang Q, Huang L, Cui B, Jiao S, Sun Q, Zeng F. Analyzing brain-activation responses to auditory stimuli improves the diagnosis of a disorder of consciousness by non-linear dynamic analysis of the EEG. Sci Rep 2024; 14:17446. [PMID: 39075138 PMCID: PMC11286939 DOI: 10.1038/s41598-024-67825-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 07/16/2024] [Indexed: 07/31/2024] Open
Abstract
Although auditory stimuli benefit patients with disorders of consciousness (DOC), the optimal stimulus remains unclear. We explored the most effective electroencephalography (EEG)-tracking method for eliciting brain responses to auditory stimuli and assessed its potential as a neural marker to improve DOC diagnosis. We collected 58 EEG recordings from patients with DOC to evaluate the classification model's performance and optimal auditory stimulus. Using non-linear dynamic analysis (approximate entropy [ApEn]), we assessed EEG responses to various auditory stimuli (resting state, preferred music, subject's own name [SON], and familiar music) in 40 patients. The diagnostic performance of the optimal stimulus-induced EEG classification for vegetative state (VS)/unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS) was compared with the Coma Recovery Scale-Revision in 18 patients using the machine learning cascade forward backpropagation neural network model. Regardless of patient status, preferred music significantly activated the cerebral cortex. Patients in MCS showed increased activity in the prefrontal pole and central, occipital, and temporal cortices, whereas those in VS/UWS showed activity in the prefrontal and anterior temporal lobes. Patients in VS/UWS exhibited the lowest preferred music-induced ApEn differences in the central, middle, and posterior temporal lobes compared with those in MCS. The resting state ApEn value of the prefrontal pole (0.77) distinguished VS/UWS from MCS with 61.11% accuracy. The cascade forward backpropagation neural network tested for ApEn values in the resting state and preferred music-induced ApEn differences achieved an average of 83.33% accuracy in distinguishing VS/UWS from MCS (based on K-fold cross-validation). EEG non-linear analysis quantifies cortical responses in patients with DOC, with preferred music inducing more intense EEG responses than SON and familiar music. Machine learning algorithms combined with auditory stimuli showed strong potential for improving DOC diagnosis. Future studies should explore the optimal multimodal sensory stimuli tailored for individual patients.Trial registration: The study is registered in the Chinese Registry of Clinical Trials (Approval no: KYLL-2023-414, Registration code: ChiCTR2300079310).
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Affiliation(s)
- Sheng Qu
- Department of Rehabilitation, Second Hospital of Shandong University, No. 247, Beiyuan Avenue, Jinan, 250033, Shandong, China
| | - Xinchun Wu
- Department of Rehabilitation, Second Hospital of Shandong University, No. 247, Beiyuan Avenue, Jinan, 250033, Shandong, China
| | - Yaxiu Tang
- Department of Rehabilitation, Second Hospital of Shandong University, No. 247, Beiyuan Avenue, Jinan, 250033, Shandong, China
| | - Qi Zhang
- Department of Rehabilitation, Second Hospital of Shandong University, No. 247, Beiyuan Avenue, Jinan, 250033, Shandong, China
| | - Laigang Huang
- Department of Rehabilitation, Second Hospital of Shandong University, No. 247, Beiyuan Avenue, Jinan, 250033, Shandong, China
| | - Baojuan Cui
- Department of Rehabilitation, Second Hospital of Shandong University, No. 247, Beiyuan Avenue, Jinan, 250033, Shandong, China
| | - Shengxiu Jiao
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Jingwuwei 7Th Road, Jinan, 250000, Shandong, China
| | - Qiangsan Sun
- Department of Rehabilitation, Second Hospital of Shandong University, No. 247, Beiyuan Avenue, Jinan, 250033, Shandong, China
| | - Fanshuo Zeng
- Department of Rehabilitation, Second Hospital of Shandong University, No. 247, Beiyuan Avenue, Jinan, 250033, Shandong, China.
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Guo K, Zhang Q, Quan Z, Wang Y, Ma T, Jiang J, Kang F, Wang J. Whole-brain glucose metabolic pattern differentiates minimally conscious state from unresponsive wakefulness syndrome. CNS Neurosci Ther 2024; 30:e14787. [PMID: 38894559 PMCID: PMC11187933 DOI: 10.1111/cns.14787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/05/2024] [Accepted: 05/14/2024] [Indexed: 06/21/2024] Open
Abstract
AIMS The patient being minimally conscious state (MCS) may benefit from wake-up interventions aimed at improving quality of life and have a higher probability of recovering higher level of consciousness compared to patients with the unresponsive wakefulness syndrome (UWS). However, differentiation of the MCS and UWS poses challenge in clinical practice. This study aimed to explore glucose metabolic pattern (GMP) obtained from 18F-labeled-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) in distinguishing between UWS and MCS. METHODS Fifty-seven patients with disorders of consciousness (21 cases of UWS and 36 cases of MCS) who had undergone repeated standardized Coma Recovery Scale-Revised (CRS-R) evaluations were enrolled in this prospective study. 18F-FDG-PET was carried out in all patients and healthy controls (HCs). Voxel-based scaled subprofile model/principal component analysis (SSM/PCA) was used to generate GMPs. The expression score of whole-brain GMP was obtained, and its diagnostic accuracy was compared with the standardized uptake value ratio (SUVR). The diagnostic efficiency was validated by one-year later clinical outcomes. RESULTS UWS-MCS GMP exhibited hypometabolism in the frontal-parietal cortex, along with hypermetabolism in the unilateral lentiform nucleus, putamen, and anterior cingulate gyrus. The UWS-MCS-GMP expression score was significantly higher in UWS compared to MCS patients (0.90 ± 0.85 vs. 0 ± 0.93, p < 0.001). UWS-MCS-GMP expression score achieved an area under the curve (AUC) of 0.77 to distinguish MCS from UWS, surpassing that of SUVR based on the frontoparietal cortex (AUC = 0.623). UWS-MCS-GMP expression score was significantly correlated with the CRS-R score (r = -0.45, p = 0.004) and accurately predicted the one-year outcome in 73.7% of patients. CONCLUSION UWS and MCS exhibit specific glucose metabolism patterns, the UWS-MCS-GMP expression score significantly distinguishes MCS from UWS, making SSM/PCA a potential diagnostic methods in clinical practice for individual patients.
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Affiliation(s)
- Kun Guo
- Department of Nuclear Medicine, Xijing HospitalFourth Military Medical UniversityXi'anChina
| | - Qi Zhang
- School of Communication & Information EngineeringShanghai UniversityShanghaiChina
| | - Zhiyong Quan
- Department of Nuclear Medicine, Xijing HospitalFourth Military Medical UniversityXi'anChina
| | - Yirong Wang
- Department of Nuclear Medicine, Xijing HospitalFourth Military Medical UniversityXi'anChina
| | - Taoqi Ma
- Department of Nuclear Medicine, Xijing HospitalFourth Military Medical UniversityXi'anChina
| | - Jiehui Jiang
- School of Life SciencesShanghai UniversityShanghaiChina
| | - Fei Kang
- Department of Nuclear Medicine, Xijing HospitalFourth Military Medical UniversityXi'anChina
| | - Jing Wang
- Department of Nuclear Medicine, Xijing HospitalFourth Military Medical UniversityXi'anChina
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Huang Y, Xia X, Meng X, Bai Y, Feng Z. Single session of intermittent theta burst stimulation alters brain activity of patients in vegetative state. Aging (Albany NY) 2024; 16:7119-7130. [PMID: 38643463 PMCID: PMC11087117 DOI: 10.18632/aging.205746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 03/18/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Non-invasive brain stimulation is considered as a promising technology for treating patients with disorders of consciousness (DOC). Various approaches and protocols have been proposed; however, few of them have shown potential effects on patients with vegetative state (VS). This study aimed to explore the neuro-modulation effects of intermittent theta burst stimulation (iTBS) on the brains of patients with VS and to provide a pilot investigation into its possible role in treating such patients. METHODS We conducted a sham-controlled crossover study, a real and a sham session of iTBS were delivered over the left dorsolateral prefrontal cortex of such patients. A measurement of an electroencephalography (EEG) and a behavioral assessment of the Coma Recovery Scale-Revised (CRS-R) were applied to evaluate the modulation effects of iTBS before and after stimulation. RESULTS No meaningful changes of CRS-R were found. The iTBS altered the spectrum, complexity and functional connectivity of the patients. The real stimulation induced a trend of decreasing of delta power at T1 and T2 in the frontal region, significant increasing of permutation entropy at the T2 in the left frontal region. In addition, brain functional connectivity, particularly inter-hemispheric connectivity, was strengthened between the electrodes of the frontal region. The sham stimulation, however, did not induce any significant changes of the brain activity. CONCLUSIONS One session of iTBS significantly altered the oscillation power, complexity and functional connectivity of brain activity of VS patients. It may be a valuable tool on modulating the brain activities of patients with VS.
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Affiliation(s)
- Ying Huang
- The Affiliated Rehabilitation Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330003, Jiangxi, China
- Rehabilitation Medicine Clinical Research Center of Jiangxi Province, Nanchang 330003, Jiangxi, China
| | - Xiaoyu Xia
- Department of Neurosurgery, The Seventh Medical Center of PLA General Hospital, Beijing 100700, China
| | - Xiangqiang Meng
- The Affiliated Rehabilitation Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330003, Jiangxi, China
- Rehabilitation Medicine Clinical Research Center of Jiangxi Province, Nanchang 330003, Jiangxi, China
| | - Yang Bai
- The Affiliated Rehabilitation Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330003, Jiangxi, China
- Rehabilitation Medicine Clinical Research Center of Jiangxi Province, Nanchang 330003, Jiangxi, China
| | - Zhen Feng
- The Affiliated Rehabilitation Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330003, Jiangxi, China
- Rehabilitation Medicine Clinical Research Center of Jiangxi Province, Nanchang 330003, Jiangxi, China
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Wang Y, Liu W, Wang Y, Ouyang G, Guo Y. Long-term HD-tDCS modulates dynamic changes of brain activity on patients with disorders of consciousness: A resting-state EEG study. Comput Biol Med 2024; 170:108084. [PMID: 38295471 DOI: 10.1016/j.compbiomed.2024.108084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/10/2024] [Accepted: 01/27/2024] [Indexed: 02/02/2024]
Abstract
OBJECTIVE High-definition transcranial direct current stimulation (HD-tDCS) has been an effective neurostimulation method in the treatment of disorders of consciousness (DOC). However, the effects and mechanism of HD-tDCS are still unclear. METHODS This study recruited 8 DOC patients and applied 20-min sessions of 2 mA HD-tDCS (central anode electrode at Pz) for 14 consecutive days. We record DOC patients' EEG data and Coma Recovery Scale-Revised (CRS-R) values at four time point: baseline (T0), after 1 day's and 7,14 days' parietal HD-tDCS treatment (T1, T2, T3). Power spectral density (PSD), relative power (RP), spectral entropy and spectral exponent were calculated to evaluate the EEG dynamic changes of DOC patients during long-term parietal HD-tDCS. At last, we calculated the correlation between changes of EEG features and changes of CRS-R values. RESULT After 1 day's parietal HD-tDCS, DOC patients' CRS-R value had not changed (8.25 ± 1.91). HD-tDCS improved DOC patients' CRS-R value at T2 (9.75 ± 1.91, p < 0.05) and at T3 (11.38 ± 2.77, p < 0.05), compared with that at T0 (8.25 ± 1.91). As the treatment time increased, the EEG PSD decayed more slowly. Specifically, the delta frequency band RP decreased, while the alpha, beta, and gamma frequency bands RP increased. EEG oscillation characteristics changed but not significant at T1 (p > 0.05), and showed significant changes at T2 and T3 (p < 0.05). The spectral entropy continuously increased and the spectral exponent continuously decreased from T0 to T3. Specifically, the spectral entropy and spectral exponent of the parietal and occipital regions were significantly higher at T2 and T3 than that at T0 (p < 0.05). In addition, The changes in EEG features of the parietal and occipital lobes were correlated with changes in CRS-R value, especially between T2 and T0. CONCLUSION Long-term parietal HD-tDCS can improve the consciousness level and brain activity in DOC patients. Resting-state EEG can evaluate the dynamic changes of brain activity in DOC patients during HD-tDCS. EEG oscillation and non-oscillatory activity might be used to explain the mechanism of HD-tDCS on DOC patients.
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Affiliation(s)
- Yong Wang
- Zhuhai UM Science & Technology Research Institute, Zhuhai, China
| | - Wanqing Liu
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingying Wang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing, Normal University, Beijing, China
| | - Gaoxiang Ouyang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing, Normal University, Beijing, China.
| | - Yongkun Guo
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Henan Key Laboratory of Brain Science and Brain Computer Interface Technology, Zhengzhou, China.
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Cheng XR, Zhang YB, Sun DJ, Peng XY, Bao YC, Zhang F, Wang MX. Long-term repetitive transcranial direct current stimulation in patients with disorders of consciousness: a preliminary study. Brain Inj 2024; 38:68-75. [PMID: 38329075 DOI: 10.1080/02699052.2024.2304872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/09/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVES To investigate the effects of long-term repetitive transcranial direct current stimulation on patients with DOC in the subacute phase. METHODS In a randomized, double-blind, controlled study, 33 patients were randomly assigned to the active or sham group, and 28 patients completed the study. Patients in the active group received anodal stimulation over the DLPFC, while patients in the sham group received placebo stimulation (20 min/day, 5 days/week, for 4 weeks). The level of consciousness among patients was assessed with the Coma Recovery Scale-Revised (CRS-R) at baseline and at the end of every week from the first to the fourth week. RESULTS The CRS-R scores of both the active and sham groups showed a consistent increasing trend over time; however, the treatment effect of the active group was better than that of the sham group. In addition, there was a statistically significant difference in the total CRS-R score between the two groups at weeks 1, 2, 3 and 4. Moreover, 10 patients (71.4%) in the active group and 3 patients (21.4%) in the sham group were regarded as responders. CONCLUSION Long-term tDCS could improve the level of consciousness of patients with DOC in the subacute stage.
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Affiliation(s)
- Xiao Rong Cheng
- Department of Rehabilitation, The Second Hospital of Lanzhou University, Lan Zhou, Gan Su Province, China
| | - Yi Bao Zhang
- Department of Rehabilitation, The Second Hospital of Lanzhou University, Lan Zhou, Gan Su Province, China
| | - Deng Juan Sun
- Department of Rehabilitation, The Second Hospital of Lanzhou University, Lan Zhou, Gan Su Province, China
| | - Xiao Yun Peng
- Department of Rehabilitation, The Second Hospital of Lanzhou University, Lan Zhou, Gan Su Province, China
| | - Ying Cun Bao
- Department of Rehabilitation, The Second Hospital of Lanzhou University, Lan Zhou, Gan Su Province, China
| | - Fang Zhang
- Department of Rehabilitation, The Second Hospital of Lanzhou University, Lan Zhou, Gan Su Province, China
| | - Man Xia Wang
- Department of Neurology, The Second Hospital of Lanzhou University, Lan Zhou, Gan Su Province, China
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Guo B, Han Q, Ni J, Yan Z. Research hotspots and frontiers of neuromodulation techniques in disorders of consciousness: a bibliometric analysis. Front Neurosci 2024; 17:1343471. [PMID: 38260028 PMCID: PMC10800698 DOI: 10.3389/fnins.2023.1343471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024] Open
Abstract
Background The characteristics of disorders of consciousness (DOC) are changes in arousal and/or awareness caused by severe brain injuries. To date, the management of DOC patients remains a complex and challenging task, and neuromodulation techniques offer a promising solution. However, a bibliometric analysis focusing on neuromodulation techniques in DOC is currently absent. The aim of this study is to provide a bibliometric visualization analysis to investigate the research hotspots and frontiers in the field of neuromodulation techniques in DOC from 2012 to 2022. Methods The publications were collected and retrieved from the Web of Science (WoS) from 2012 to 2022. CiteSpace and Microsoft Excel were utilized perform the first global bibliographic analysis of the literature related to neuromodulation techniques for DOC. Results The analysis included a total of 338 publications. From 2012 to 2022, a consistent yet irregular increase in the number of articles published on neuromodulation techniques in DOC was observed. Frontiers in Neurology published the highest number of papers (n = 16). Neurosciences represented the main research hotspot category (n = 170). The most prolific country, institution, and author were the USA (n = 105), the University of Liege (n = 41), and Laureys Steven (n = 38), respectively. An analysis of keywords revealed that UWS/VS, MCS, and TMS constituted the primary research trends and focal points within this domain. Conclusion This bibliometric study sheds light on the current progress and emerging trends of neuromodulation techniques in DOC from 2012 to 2022. The focal topics in this domain encompass the precise diagnosis of consciousness levels in patients suffering from DOC and the pursuit of efficacious neuromodulation-based evaluation and treatment protocols for such patients.
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Affiliation(s)
- Bilian Guo
- Department of Rehabilitation Medicine, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Rehabilitation Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Qiong Han
- Department of Rehabilitation Medicine, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Rehabilitation Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Jun Ni
- Department of Rehabilitation Medicine, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Rehabilitation Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Zhipeng Yan
- Department of Rehabilitation Medicine, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Rehabilitation Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
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Straudi S, Antonioni A, Baroni A, Bonsangue V, Lavezzi S, Koch G, Tisato V, Ziliotto N, Basaglia N, Secchiero P, Manfredini F, Lamberti N. Anti-Inflammatory and Cortical Responses after Transcranial Direct Current Stimulation in Disorders of Consciousness: An Exploratory Study. J Clin Med 2023; 13:108. [PMID: 38202115 PMCID: PMC10779892 DOI: 10.3390/jcm13010108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/06/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
Disorders of consciousness (DoC) due to severe traumatic brain injury (TBI) are associated with severe disability and an alteration of cortical activation, angiogenesis, and inflammation, which are crucial elements for behavioural recovery. This exploratory study aimed to evaluate anti-inflammatory and cortical responses after transcranial direct current stimulation (tDCS) in traumatic prolonged disorders of consciousness. Ten minimally conscious state (MCS) patients underwent ten sessions of anodal tDCS (five sessions/week, two weeks, 40 min/session) on the primary motor cortex bilaterally. Clinical evaluations were performed using the Coma Recovery Scale-Revised (CRS-R) pre- and post-treatment. In contrast, after single and multiple tDCS sessions, the haemodynamic cortical response was obtained with functional near-infrared spectroscopy (fNIRS). Moreover, angiogenesis (angiopoietin-2, BMP9, endoglin, HbEFG, HGF, IL8, Leptin, PLGF, VEGF-A, and VEGF-C) and inflammation (GM-CSF, IFNg, IP10, MCP1, and TNFα) circulating biomarkers were collected. A significant haemodynamic response was observed after a single tDCS session, with an increased activation from 4.4 (3.1-6.1) to 7.6 (2.9-15.7) a.u. (p = 0.035). After ten tDCS sessions, a significant reduction of angiopoietin-2, VEGF-C, and IP-10 was detected. Moreover, a correlation between behavioural (CRS-R), TNFα (r = 0.89; p = 0.007), and IP10 (r = 0.81; p = 0.014) variation was found. In conclusion, a single tDCS session can increase the cortical activation in MCS patients. Moreover, multiple tDCS sessions showed an anti-inflammatory effect related to behavioural improvement.
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Affiliation(s)
- Sofia Straudi
- Department of Neuroscience and Rehabilitation, Ferrara University, 44121 Ferrara, Italy; (S.S.); (A.A.); (A.B.); (G.K.); (N.B.)
- Department of Neuroscience, Ferrara University Hospital, 44124 Ferrara, Italy; (V.B.); (S.L.)
| | - Annibale Antonioni
- Department of Neuroscience and Rehabilitation, Ferrara University, 44121 Ferrara, Italy; (S.S.); (A.A.); (A.B.); (G.K.); (N.B.)
- Doctoral Program in Translational Neurosciences and Neurotechnologies, Ferrara University, 44121 Ferrara, Italy
| | - Andrea Baroni
- Department of Neuroscience and Rehabilitation, Ferrara University, 44121 Ferrara, Italy; (S.S.); (A.A.); (A.B.); (G.K.); (N.B.)
- Department of Neuroscience, Ferrara University Hospital, 44124 Ferrara, Italy; (V.B.); (S.L.)
| | - Valentina Bonsangue
- Department of Neuroscience, Ferrara University Hospital, 44124 Ferrara, Italy; (V.B.); (S.L.)
| | - Susanna Lavezzi
- Department of Neuroscience, Ferrara University Hospital, 44124 Ferrara, Italy; (V.B.); (S.L.)
| | - Giacomo Koch
- Department of Neuroscience and Rehabilitation, Ferrara University, 44121 Ferrara, Italy; (S.S.); (A.A.); (A.B.); (G.K.); (N.B.)
| | - Veronica Tisato
- Department of Translational Medicine, Ferrara University, 44121 Ferrara, Italy
| | - Nicole Ziliotto
- Department of Pharmacy, University of Pisa, 56126 Pisa, Italy;
| | - Nino Basaglia
- Department of Neuroscience and Rehabilitation, Ferrara University, 44121 Ferrara, Italy; (S.S.); (A.A.); (A.B.); (G.K.); (N.B.)
- Department of Neuroscience, Ferrara University Hospital, 44124 Ferrara, Italy; (V.B.); (S.L.)
| | - Paola Secchiero
- Department of Translational Medicine, Ferrara University, 44121 Ferrara, Italy
| | - Fabio Manfredini
- Department of Neuroscience and Rehabilitation, Ferrara University, 44121 Ferrara, Italy; (S.S.); (A.A.); (A.B.); (G.K.); (N.B.)
- Department of Neuroscience, Ferrara University Hospital, 44124 Ferrara, Italy; (V.B.); (S.L.)
| | - Nicola Lamberti
- Department of Neuroscience and Rehabilitation, Ferrara University, 44121 Ferrara, Italy; (S.S.); (A.A.); (A.B.); (G.K.); (N.B.)
- Department of Neuroscience, Ferrara University Hospital, 44124 Ferrara, Italy; (V.B.); (S.L.)
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Fan W, Fan Y, Liao Z, Yin Y. Effect of Transcranial Direct Current Stimulation on Patients With Disorders of Consciousness: A Systematic Review and Meta-analysis. Am J Phys Med Rehabil 2023; 102:1102-1110. [PMID: 37205736 DOI: 10.1097/phm.0000000000002290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
OBJECTIVES The aims of this study are to evaluate the efficacy of transcranial direct current stimulation for improving disorders of consciousness and to compare efficacy of the different etiologies of disorders of consciousness. DESIGN Randomized controlled trials or crossover trials examining effects of transcranial direct current stimulation in patients with disorders of consciousness were searched in PubMed, Embase, Cochrane Library, and Web of Science. The sample characteristics, etiology, transcranial direct current stimulation treatment characteristics, and outcomes were extracted. Meta-analysis was performed using the RevMan software. RESULTS We included nine trials providing data with 331 participants and found that transcranial direct current stimulation improved the Coma Recovery Scale-Revised score of disorders of consciousness patients. We found a significant improvement of Coma Recovery Scale-Revised score in the minimally conscious state group (weighted mean difference = 0.77, 95% confidence interval = 0.30-1.23, P = 0.001), but not in the vegetative state or unresponsive wakefulness syndrome group. The effects of transcranial direct current stimulation are related to etiology, as the Coma Recovery Scale-Revised score was improved in the traumatic brain injury group (weighted mean difference = 1.18, 95% confidence interval = 0.60-1.75, P < 0.001), but not in vascular accident and anoxia groups. CONCLUSIONS This meta-analysis revealed the evidence for positive effects of transcranial direct current stimulation on disorders of consciousness without adverse effects observed in minimally conscious state patients. In particular, transcranial direct current stimulation may be an effective treatment in rehabilitating cognitive functions in people with traumatic brain injury.
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Affiliation(s)
- Wei Fan
- From the Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Techonology, Wuhan, China (WF, YY); Department of Neurology, Zhongnan Hospital, Wuhan University, Wuhan, China (YF); and Department of Rehabilitation, Liucheng Hospital of Traditional Chinese Medicine, Liuzhou, China (ZL)
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Piedade GS, Assumpcao de Monaco B, Guest JD, Cordeiro JG. Review of spinal cord stimulation for disorders of consciousness. Curr Opin Neurol 2023; 36:507-515. [PMID: 37889524 DOI: 10.1097/wco.0000000000001222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
PURPOSE OF REVIEW High-cervical spinal cord stimulation can alter cortical activity and cerebral metabolism. These effects are potentially beneficial for disorders of consciousness. A better understanding of the effects of clinical application of stimulation is needed. We aimed to evaluate the existing literature to determine the state of available knowledge. We performed a literature review of clinical studies assessing cervical spinal cord epidural stimulation for disorders of consciousness. Only peer-reviewed articles reporting preoperative and postoperative clinical status were included. RECENT FINDINGS Nineteen studies were included. A total of 532 cases were reported, and 255 patients were considered responsive (47.9%). Considering only studies published after the definition of minimally conscious state (MCS) as an entity, 402 individuals in unresponsive wakefulness syndrome (UWS) and 113 in MCS were reported. Responsiveness to SCS was reported in 170 UWS patients (42.3%) and in 78 MCS cases (69.0%), although the criteria for responsiveness and outcome measures varied among publications. SUMMARY Cervical SCS yielded encouraging results in patients with disorders of consciousness and seems to be more effective in MCS. More extensive investigation is needed to understand its potential role in clinical practice.
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Affiliation(s)
| | | | - James D Guest
- Department of Neurosurgery, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami
- The Miami Project to Cure Paralysis, Miller School of Medicine, Miami, Florida, USA
| | - Joacir Graciolli Cordeiro
- Department of Neurosurgery, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami
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Thibaut A, Fregni F, Estraneo A, Fiorenza S, Noe E, Llorens R, Ferri J, Formisano R, Morone G, Bender A, Rosenfelder M, Lamberti G, Kodratyeva E, Kondratyev S, Legostaeva L, Suponeva N, Krewer C, Müller F, Dardenne N, Jedidi H, Laureys S, Gosseries O, Lejeune N, Martens G. Sham-controlled randomized multicentre trial of transcranial direct current stimulation for prolonged disorders of consciousness. Eur J Neurol 2023; 30:3016-3031. [PMID: 37515394 DOI: 10.1111/ene.15974] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 06/01/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND AND PURPOSE Transcranial direct current stimulation (tDCS) has been shown to improve signs of consciousness in a subset of patients with disorders of consciousness (DoC). However, no multicentre study confirmed its efficacy when applied during rehabilitation. In this randomized controlled double-blind study, the effects of tDCS whilst patients were in rehabilitation were tested at the group level and according to their diagnosis and aetiology to better target DoC patients who might repond to tDCS. METHODS Patients received 2 mA tDCS or sham applied over the left prefrontal cortex for 4 weeks. Behavioural assessments were performed weekly and up to 3 months' follow-up. Analyses were conducted at the group and subgroup levels based on the diagnosis (minimally conscious state [MCS] and unresponsive wakefulness syndrome) and the aetiology (traumatic or non-traumatic). Interim analyses were planned to continue or stop the trial. RESULTS The trial was stopped for futility when 62 patients from 10 centres were enrolled (44 ± 14 years, 37 ± 24.5 weeks post-injury, 18 women, 32 MCS, 39 non-traumatic). Whilst, at the group level, no treatment effect was found, the subgroup analyses at 3 months' follow-up revealed a significant improvement for patients in MCS and with traumatic aetiology. CONCLUSIONS Transcranial direct current stimulation during rehabilitation does not seem to enhance patients' recovery. However, diagnosis and aetiology appear to be important factors leading to a response to the treatment. These findings bring novel insights into possible cortical plasticity changes in DoC patients given these differential results according to the subgroups of patients.
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Affiliation(s)
- Aurore Thibaut
- Coma Science Group, GIGA-Consciousness, Centre du Cerveau2, University and University Hospital of Liège, Liège, Belgium
| | - Felipe Fregni
- Neuromodulation Lab, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anna Estraneo
- Neurorehabilitation Department, Scientific Institute for Research and Health Care, Don Carlo Gnocchi Foundation, Sant'Angelo dei Lombardi, Florence, Italy
| | - Salvatore Fiorenza
- Neurorehabilitation Department, Scientific Institute for Research and Health Care, Don Carlo Gnocchi Foundation, Sant'Angelo dei Lombardi, Florence, Italy
| | - Enrique Noe
- IRENEA Instituto de Rehabilitación Neurológica, Fundación Hospitales Vithas, Valéncia, Spain
| | - Roberto Llorens
- IRENEA Instituto de Rehabilitación Neurológica, Fundación Hospitales Vithas, Valéncia, Spain
- Neurorehabilitation and Brain Research Group, Instituto Universitario de Investigación en Tecnología Centrada en el Ser Humano, Universitat Politècnica de València, Valencia, Spain
| | - Joan Ferri
- IRENEA Instituto de Rehabilitación Neurológica, Fundación Hospitales Vithas, Valéncia, Spain
| | - Rita Formisano
- Santa Lucia Foundation, Neurorehabilitation and Scientific Institute for Research, Rome, Italy
| | - Giovanni Morone
- Santa Lucia Foundation, Neurorehabilitation and Scientific Institute for Research, Rome, Italy
| | - Andreas Bender
- Therapiezentrum Burgau, Burgau, Germany
- Department of Neurology, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Martin Rosenfelder
- Therapiezentrum Burgau, Burgau, Germany
- Clinical and Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Gianfranco Lamberti
- Neurorehabilitation Department AUSL Piacenza - University of Parma, Piacenza, Italy
| | | | | | | | | | - Carmen Krewer
- Department for Neurology, Research Group, Schoen Clinic Bad Aibling, Bad Aibling, Germany
- Chair of Human Movement Science, Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany
| | - Friedemann Müller
- Department for Neurology, Research Group, Schoen Clinic Bad Aibling, Bad Aibling, Germany
| | - Nadia Dardenne
- University and Hospital Biostatistics Center (B-STAT), Faculty of Medicine, University of Liège, Liège, Belgium
| | | | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, Centre du Cerveau2, University and University Hospital of Liège, Liège, Belgium
- Joint International Research Unit on Consciousness, CERVO Brain Research Centre, CIUSS, University Laval, Quebec, Canada
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness, Centre du Cerveau2, University and University Hospital of Liège, Liège, Belgium
| | - Nicolas Lejeune
- Coma Science Group, GIGA-Consciousness, Centre du Cerveau2, University and University Hospital of Liège, Liège, Belgium
- Centre Hospitalier Neurologique William Lennox, Ottignies-Louvain-la-Neuve, Belgium
| | - Géraldine Martens
- Coma Science Group, GIGA-Consciousness, Centre du Cerveau2, University and University Hospital of Liège, Liège, Belgium
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12
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Wan X, Wang Y, Zhang Y, Song W. A Comparison of the Neuromodulation Effects of Frontal and Parietal Transcranial Direct Current Stimulation on Disorders of Consciousness. Brain Sci 2023; 13:1295. [PMID: 37759896 PMCID: PMC10527338 DOI: 10.3390/brainsci13091295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023] Open
Abstract
Frontal transcranial direct current stimulation (tDCS) and parietal tDCS are effective for treating disorders of consciousness (DoC); however, the relative efficacies of these techniques have yet to be determined. This paper compares the neuromodulation effects of frontal and parietal tDCS on DoC. Twenty patients with DoC were recruited and randomly assigned to two groups. One group received single-session frontal tDCS and single-session sham tDCS. The other group received single-session parietal tDCS and single-session sham tDCS. Before and after every tDCS session, we recorded coma recovery scale-revised (CRS-R) values and an electroencephalogram. CRS-R was also used to evaluate the state of consciousness at 9-12-month follow-up. Both single-session frontal and parietal tDCS caused significant changes in the genuine permutation cross-mutual information (G_PCMI) of local frontal and across brain regions (p < 0.05). Furthermore, the changes in G_PCMI values were significantly correlated to the CRS-R scores at 9-12-month follow-up after frontal and parietal tDCS (p < 0.05). The changes in G_PCMI and CRS-R scores were also correlated (p < 0.05). Both frontal tDCS and parietal tDCS exert neuromodulatory effects in DoC and induce significant changes in electrophysiology. G_PCMI can be used to evaluate the neuromodulation effects of tDCS.
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Affiliation(s)
- Xiaoping Wan
- Department of Rehabilitation Medicine, Xuan Wu Hospital, Capital Medical University, No. 45 Chang Chun Street, Beijing 100053, China; (X.W.); (Y.Z.)
| | - Yong Wang
- Zhuhai UM Science & Technology Research Institute, No. 1889 Huandao East Road, Zhuhai 519031, China;
| | - Ye Zhang
- Department of Rehabilitation Medicine, Xuan Wu Hospital, Capital Medical University, No. 45 Chang Chun Street, Beijing 100053, China; (X.W.); (Y.Z.)
| | - Weiqun Song
- Department of Rehabilitation Medicine, Xuan Wu Hospital, Capital Medical University, No. 45 Chang Chun Street, Beijing 100053, China; (X.W.); (Y.Z.)
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13
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Vatrano M, Nemirovsky IE, Tonin P, Riganello F. Assessing Consciousness through Neurofeedback and Neuromodulation: Possibilities and Challenges. Life (Basel) 2023; 13:1675. [PMID: 37629532 PMCID: PMC10455583 DOI: 10.3390/life13081675] [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: 07/03/2023] [Revised: 07/27/2023] [Accepted: 07/30/2023] [Indexed: 08/27/2023] Open
Abstract
Neurofeedback is a non-invasive therapeutic approach that has gained traction in recent years, showing promising results for various neurological and psychiatric conditions. It involves real-time monitoring of brain activity, allowing individuals to gain control over their own brainwaves and improve cognitive performance or alleviate symptoms. The use of electroencephalography (EEG), such as brain-computer interface (BCI), transcranial direct current stimulation (tDCS), and transcranial magnetic stimulation (TMS), has been instrumental in developing neurofeedback techniques. However, the application of these tools in patients with disorders of consciousness (DoC) presents unique challenges. In this narrative review, we explore the use of neurofeedback in treating patients with DoC. More specifically, we discuss the advantages and challenges of using tools such as EEG neurofeedback, tDCS, TMS, and BCI for these conditions. Ultimately, we hope to provide the neuroscientific community with a comprehensive overview of neurofeedback and emphasize its potential therapeutic applications in severe cases of impaired consciousness levels.
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Affiliation(s)
- Martina Vatrano
- S. Anna Institute, Research in Advanced Neurorehabilitation, Via Siris, 11, 88900 Crotone, Italy;
| | - Idan Efim Nemirovsky
- Department of Physics and Astronomy, Brain and Mind Institute, University of Western Ontario, London, ON N6A 3K7, Canada;
| | - Paolo Tonin
- S. Anna Institute, Research in Advanced Neurorehabilitation, Via Siris, 11, 88900 Crotone, Italy;
| | - Francesco Riganello
- S. Anna Institute, Research in Advanced Neurorehabilitation, Via Siris, 11, 88900 Crotone, Italy;
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14
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Yoon MJ, Oh HM, Kim T, Choi SJ, Choi WH, Jung HS, Lim SC, Yoo YJ, Park HJ, Hong BY, Park GY, Kim D, Kim TW, Im S, Lim SH. Safety and therapeutic effects of personalized transcranial direct current stimulation based on electrical field simulation for prolonged disorders of consciousness: study protocol for a multi-center, double-blind, randomized controlled trial. Front Neurol 2023; 14:1184998. [PMID: 37456633 PMCID: PMC10344463 DOI: 10.3389/fneur.2023.1184998] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/15/2023] [Indexed: 07/18/2023] Open
Abstract
Background Disorders of consciousness (DOC) resulting from acquired brain injury (ABI) increase the mortality rate of patients, complicate rehabilitation, and increase the physical and economic burden that DOC imposes on patients and their families. Thus, treatment to promote early awakening from DOC is vital. Transcranial direct current stimulation (tDCS) has shown great potential for promoting neuro-electrochemical activity. However, previous tDCS studies did not consider structural damage or head and brain lesions, so the applicability of the results to all DOC patients was limited. In this study, to establish a patient-specific tDCS treatment plan considering the brain lesions of and damage sustained by DOC patients, we considered the electric field calculated by a the "finite electric" three-dimensional brain model based on magnetic resonance images. This protocol was developed to aid tDCS treatment of actual patients, and to verify its safety and effectiveness. Methods/design Twenty-four patients with DOC after ABI will be enrolled in this cross-over trial. All participants will receive typical rehabilitation combined with sham tDCS and typical rehabilitation plus personalized tDCS (P-tDCS). Each interventional period will last 2 weeks (30 min/day, 5 days/week). The primary outcome [score on the Korean version of the Coma Recovery Scale-Revised (K-CRS-R)] will be assessed at baseline and the end of the first day of the intervention. Secondary outcomes (K-CRS-R at 1 week and 2 weeks after experimental session and quantitative EEG changes quantitative electroencephalography changes) will be measured at baseline and the end of week 4. Adverse events will be recorded during each treatment session. Discussion For patients with neurological disorders, tDCS has served as a painless, non-invasive, easily applied, and effective therapy for several decades, and there is some evidence that it can improve the level of consciousness of patients with DOC. However, variability in the effects on consciousness among subjects have been reported and personalized strategies are lacking. This protocol is for a randomized controlled trial designed to validate the effectiveness and safety of P-tDCS combined with typical rehabilitation for DOC. Clinical trial registration https://cris.nih.go.kr, identifier KCT0007157.
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Affiliation(s)
- Mi-Jeong Yoon
- Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyun Mi Oh
- Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Gyeongki-do, Republic of Korea
| | - TaeYeong Kim
- Research Institute, NEUROPHET Inc, Seoul, Republic of Korea
| | - Soo-Jin Choi
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Woo Hee Choi
- Division of Nuclear Medicine, Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hong Soo Jung
- Department of Anesthesiology and Pain Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Chul Lim
- Department of Neurology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yeun Jie Yoo
- Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hye Jung Park
- Department of Rehabilitation Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Bo Young Hong
- Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Geun-Young Park
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Donghyeon Kim
- Research Institute, NEUROPHET Inc, Seoul, Republic of Korea
| | - Tae-Woo Kim
- Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Gyeongki-do, Republic of Korea
| | - Sun Im
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seong Hoon Lim
- Department of Rehabilitation Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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15
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Perl YS, Pallavicini C, Piccinini J, Demertzi A, Bonhomme V, Martial C, Panda R, Alnagger N, Annen J, Gosseries O, Ibañez A, Laufs H, Sitt JD, Jirsa VK, Kringelbach ML, Laureys S, Deco G, Tagliazucchi E. Low-dimensional organization of global brain states of reduced consciousness. Cell Rep 2023; 42:112491. [PMID: 37171963 PMCID: PMC11220841 DOI: 10.1016/j.celrep.2023.112491] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/19/2023] [Accepted: 04/24/2023] [Indexed: 05/14/2023] Open
Abstract
Brain states are frequently represented using a unidimensional scale measuring the richness of subjective experience (level of consciousness). This description assumes a mapping between the high-dimensional space of whole-brain configurations and the trajectories of brain states associated with changes in consciousness, yet this mapping and its properties remain unclear. We combine whole-brain modeling, data augmentation, and deep learning for dimensionality reduction to determine a mapping representing states of consciousness in a low-dimensional space, where distances parallel similarities between states. An orderly trajectory from wakefulness to patients with brain injury is revealed in a latent space whose coordinates represent metrics related to functional modularity and structure-function coupling, increasing alongside loss of consciousness. Finally, we investigate the effects of model perturbations, providing geometrical interpretation for the stability and reversibility of states. We conclude that conscious awareness depends on functional patterns encoded as a low-dimensional trajectory within the vast space of brain configurations.
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Affiliation(s)
- Yonatan Sanz Perl
- Department of Physics, University of Buenos Aires, Intendente Guiraldes 2160 (Ciudad Universitaria), Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), CABA, Buenos Aires, Argentina; Cognitive Neuroscience Center (CNC), Universidad de San Andrés, Buenos Aires, Argentina; Center for Brain and Cognition, Computational Neuroscience Group, Universitat Pompeu Fabra, Barcelona, Spain; Paris Brain Institute (ICM), Paris, France.
| | - Carla Pallavicini
- Department of Physics, University of Buenos Aires, Intendente Guiraldes 2160 (Ciudad Universitaria), Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), CABA, Buenos Aires, Argentina; Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (FLENI), Buenos Aires, Argentina
| | - Juan Piccinini
- Department of Physics, University of Buenos Aires, Intendente Guiraldes 2160 (Ciudad Universitaria), Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), CABA, Buenos Aires, Argentina
| | - Athena Demertzi
- Physiology of Cognition Research Lab, GIGA CRC-In Vivo Imaging Center, GIGA Institute, University of Liège, Liège, Belgium
| | - Vincent Bonhomme
- Anesthesia and Intensive Care Laboratory, GIGA-Consciousness, GIGA Institute, University of Liège, Liège, Belgium; University Department of Anesthesia and Intensive Care Medicine, Centre Hospitalier Régional de la Citadelle (CHR Citadelle), Liège, Belgium; Department of Anesthesia and Intensive Care Medicine, Centre Hospitalier Universitaire de Liège (CHU Liège), Liège, Belgium
| | - Charlotte Martial
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau(2), Centre Hospitalier Universitaire de Liège (CHU Liège), Liège, Belgium
| | - Rajanikant Panda
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau(2), Centre Hospitalier Universitaire de Liège (CHU Liège), Liège, Belgium
| | - Naji Alnagger
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau(2), Centre Hospitalier Universitaire de Liège (CHU Liège), Liège, Belgium
| | - Jitka Annen
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau(2), Centre Hospitalier Universitaire de Liège (CHU Liège), Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau(2), Centre Hospitalier Universitaire de Liège (CHU Liège), Liège, Belgium
| | - Agustin Ibañez
- National Scientific and Technical Research Council (CONICET), CABA, Buenos Aires, Argentina; Cognitive Neuroscience Center (CNC), Universidad de San Andrés, Buenos Aires, Argentina; Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile; Global Brain Health Institute (GBHI), University of California-San Francisco (UCSF), San Francisco, CA, USA; Trinity College, Dublin, Ireland
| | - Helmut Laufs
- Department of Neurology and Brain Imaging Center, Goethe University, Frankfurt am Main, Germany; Department of Neurology, Christian Albrechts University, Kiel, Germany
| | - Jacobo D Sitt
- Paris Brain Institute (ICM), Paris, France; INSERM U 1127, Paris, France; CNRS UMR 7225, Paris, France
| | - Viktor K Jirsa
- Institut de Neurosciences des Systèmes, Aix Marseille Université, Marseille, France
| | - Morten L Kringelbach
- Department of Psychiatry, University of Oxford, Oxford, UK; Center for Music in the Brain, Department of Clinical Medicine, Aarhus University, Århus, Denmark; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; Centre for Eudaimonia and Human Flourishing, University of Oxford, Oxford, UK
| | - Steven Laureys
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau(2), Centre Hospitalier Universitaire de Liège (CHU Liège), Liège, Belgium
| | - Gustavo Deco
- Center for Brain and Cognition, Computational Neuroscience Group, Universitat Pompeu Fabra, Barcelona, Spain; Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain; Institució Catalana de la Recerca i Estudis Avancats (ICREA), Barcelona, Spain
| | - Enzo Tagliazucchi
- Department of Physics, University of Buenos Aires, Intendente Guiraldes 2160 (Ciudad Universitaria), Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), CABA, Buenos Aires, Argentina; Centre du Cerveau(2), Centre Hospitalier Universitaire de Liège (CHU Liège), Liège, Belgium.
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Charvet L, Harrison AT, Mangold K, Moore RD, Guo S, Zhang J, Datta A, Androulakis XM. Remotely supervised at-home tDCS for veterans with persistent post-traumatic headache: a double-blind, sham-controlled randomized pilot clinical trial. Front Neurol 2023; 14:1184056. [PMID: 37213913 PMCID: PMC10196360 DOI: 10.3389/fneur.2023.1184056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/14/2023] [Indexed: 05/23/2023] Open
Abstract
Background Currently, there are no FDA approved therapies for persistent post-traumatic headache (PPTH) secondary to traumatic brain injury (TBI). As such neither headache nor TBI specialists have an effective means to manage PPTH. Thus, the objective of the present pilot trial was to evaluate the feasibility and preliminary efficacy of a four-week at-home remotely supervised transcranial direct current stimulation (RS-tDCS) intervention for veterans with PPTH. Methods Twenty-five (m = 46.6 ± 8.7 years) veterans with PPTH were randomized into two groups and received either active (n = 12) or sham (n = 13) RS-tDCS, with anodal stimulation over left dlPFC and cathodal over occipital pole. Following a four-week baseline, participants completed 20-sessions of active or sham RS-tDCS with real-time video monitoring over a period of four-weeks. Participants were assessed again at the end of the intervention and at four-weeks post-intervention. Primary outcomes were overall adherence rate (feasibility) and change in moderate-to-severe headache days per month (efficacy). Secondary outcomes were changes in total number of headache days, and PPTH-related functional outcomes. Results Adherence rate was high with 88% of participants (active = 10/12; sham = 12/13) fully completing tDCS interventions. Importantly, there was no significant difference in adherence between active and sham groups (p = 0.59). Moderate-to-severe headache days were significantly reduced within the active RS-tDCS group (p = 0.004), compared to sham during treatment (-2.5 ± 3.5 vs. 2.3 ± 3.4), and 4-week follow-up (-3.9 ± 6.4 vs. 1.2 ± 6.5). Total number of headache days was significantly reduced within the active RS-tDCS (p = 0.03), compared to sham during-treatment (-4.0 ± 5.2 vs. 1.5 ± 3.8), and 4-week follow-up (-2.1 ± 7.2 vs. -0.2 ± 4.4). Conclusion The current results indicate our RS-tDCS paradigm provides a safe and effective means for reducing the severity and number of headache days in veterans with PPTH. High treatment adherence rate and the remote nature of our paradigm indicate RS-tDCS may be a feasible means to reduce PPTH, especially for veterans with limited access to medical facilities.Clinical Trial Registration: ClinicalTrials.gov, identifier [NCT04012853].
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Affiliation(s)
- Leigh Charvet
- Department of Neurology, New York University Langone Health, New York, NY, United States
| | - Adam T. Harrison
- Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Department of Neurology, Columbia VA Healthcare System, Columbia, SC, United States
| | - Kiersten Mangold
- Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Department of Neurology, Columbia VA Healthcare System, Columbia, SC, United States
| | - Robert Davis Moore
- Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Siyuan Guo
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC, United States
| | - Jiajia Zhang
- Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Abhishek Datta
- Research and Development, Soterix Medical, Inc., Woodbridge, NJ, United States
- Department of Biomedical Engineering, City College of New York, New York, NY, United States
| | - X. Michelle Androulakis
- Department of Neurology, Columbia VA Healthcare System, Columbia, SC, United States
- Headache Centers of Excellence Program, US Department of Veterans Affairs, Columbia, SC, United States
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17
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Havlík M, Hlinka J, Klírová M, Adámek P, Horáček J. Towards causal mechanisms of consciousness through focused transcranial brain stimulation. Neurosci Conscious 2023; 2023:niad008. [PMID: 37089451 PMCID: PMC10120840 DOI: 10.1093/nc/niad008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 01/10/2023] [Accepted: 03/30/2023] [Indexed: 04/25/2023] Open
Abstract
Conscious experience represents one of the most elusive problems of empirical science, namely neuroscience. The main objective of empirical studies of consciousness has been to describe the minimal sets of neural events necessary for a specific neuronal state to become consciously experienced. The current state of the art still does not meet this objective but rather consists of highly speculative theories based on correlates of consciousness and an ever-growing list of knowledge gaps. The current state of the art is defined by the limitations of past stimulation techniques and the emphasis on the observational approach. However, looking at the current stimulation technologies that are becoming more accurate, it is time to consider an alternative approach to studying consciousness, which builds on the methodology of causal explanations via causal alterations. The aim of this methodology is to move beyond the correlates of consciousness and focus directly on the mechanisms of consciousness with the help of the currently focused brain stimulation techniques, such as geodesic transcranial electric neuromodulation. This approach not only overcomes the limitations of the correlational methodology but will also become another firm step in the following science of consciousness.
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Affiliation(s)
- Marek Havlík
- Center for Advanced Studies of Brain and Consciousness, National Institute of Mental Health, Topolová 748, Klecany 250 67, Czech Republic
| | - Jaroslav Hlinka
- Center for Advanced Studies of Brain and Consciousness, National Institute of Mental Health, Topolová 748, Klecany 250 67, Czech Republic
- Department of Complex Systems, Institute of Computer Science of the Czech Academy of Sciences, Pod Vodárenskou věží 271/2, Prague 182 07, Czech Republic
| | - Monika Klírová
- Center for Advanced Studies of Brain and Consciousness, National Institute of Mental Health, Topolová 748, Klecany 250 67, Czech Republic
- Third Faculty of Medicine, Charles University, Ruská 87, Prague 10 100 00, Czech Republic
| | - Petr Adámek
- Center for Advanced Studies of Brain and Consciousness, National Institute of Mental Health, Topolová 748, Klecany 250 67, Czech Republic
- Third Faculty of Medicine, Charles University, Ruská 87, Prague 10 100 00, Czech Republic
| | - Jiří Horáček
- Center for Advanced Studies of Brain and Consciousness, National Institute of Mental Health, Topolová 748, Klecany 250 67, Czech Republic
- Third Faculty of Medicine, Charles University, Ruská 87, Prague 10 100 00, Czech Republic
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18
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Li C, Wang Y, Li W, Yang Y, Xia X. Measure functional network and cortical excitability in post-anoxic patients with unresponsive wakefulness syndrome diagnosed by behavioral scales. Front Neurosci 2023; 16:1071594. [PMID: 36711155 PMCID: PMC9874310 DOI: 10.3389/fnins.2022.1071594] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
Background Brain assessment shows great values in prognosis, treatment, resource allocation, and decision-making for patients with disorders of consciousness (DOC). However, less research focused on cortical conditions of patients with unresponsive wakefulness syndrome (UWS). Methods We recorded resting-state EEG and TMS-EEG from post-anoxic patients with UWS, diagnosed by repeated Coma Recovery Scale-Revised (CRS-R). Measurements of functional connectivity and networks were performed by phase lock value (PLV) and network parameters of graph theory (average path length, clustering coefficient, and small-world). Global cortical reactivity values (GCRV) were used to assess cortical excitability. Results The coefficient of variation (CV) presented marked inter-individual variations of PLV (CV = 0.285), network parameters (CV > 0.2), and GCRV (CV = 0.929) within these patients. The patients' PLV and network parameters at theta and alpha bands significantly correlated with their GCRV values. Patients with higher PLV (r = 0.560, 0.406), as well as better preserved network (lower average path length (r = -0.522, -0.483), higher clustering coefficient (r = 0.522, 0.445), and small-world (r = 0.522, 0.445) at theta and alpha bands, presented higher GCRV. The functional connectivity, which is significantly correlated with frontal GCRV, is also mainly located in the frontal region. These correlations were not significant at other frequency bands: Delta, beta, and gamma bands. Conclusion These findings suggested that the CRS-R-diagnosed post-anoxic patients with UWS had very different cortical conditions. Functional networks and cortical excitability measured by TMS-EEG could complement behavioral assessment to assess these patients' cortical conditions. Significance It provides a deeper understanding of neurophysiological dysfunction in patients with UWS and hints to the clinics that neural-electrophysiological assessment for such patients may be necessary to acquire their brain conditions, which may benefit stratified management for them.
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Affiliation(s)
- Chen Li
- Department of Interventional and Vascular Neurosurgery, The Characteristic Medical Center of People’s Liberation Army (PLA) Rocket Force, Beijing, China
| | - Yong Wang
- Zhuhai University of Macau (UM) Science & Technology Research Institute, Zhuhai, China
| | - Wende Li
- Senior Department of Neurosurgery, The First Medical Center of People’s Liberation Army (PLA) General Hospital, Beijing, China,Department of Neurosurgery, The Seventh Medical Center of People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Yi Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Beijing, China
| | - Xiaoyu Xia
- Senior Department of Neurosurgery, The First Medical Center of People’s Liberation Army (PLA) General Hospital, Beijing, China,Department of Neurosurgery, The Seventh Medical Center of People’s Liberation Army (PLA) General Hospital, Beijing, China,*Correspondence: Xiaoyu Xia,
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19
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Zheng RZ, Qi ZX, Wang Z, Xu ZY, Wu XH, Mao Y. Clinical Decision on Disorders of Consciousness After Acquired Brain Injury: Stepping Forward. Neurosci Bull 2023; 39:138-162. [PMID: 35804219 PMCID: PMC9849546 DOI: 10.1007/s12264-022-00909-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/10/2022] [Indexed: 01/22/2023] Open
Abstract
Major advances have been made over the past few decades in identifying and managing disorders of consciousness (DOC) in patients with acquired brain injury (ABI), bringing the transformation from a conceptualized definition to a complex clinical scenario worthy of scientific exploration. Given the continuously-evolving framework of precision medicine that integrates valuable behavioral assessment tools, sophisticated neuroimaging, and electrophysiological techniques, a considerably higher diagnostic accuracy rate of DOC may now be reached. During the treatment of patients with DOC, a variety of intervention methods are available, including amantadine and transcranial direct current stimulation, which have both provided class II evidence, zolpidem, which is also of high quality, and non-invasive stimulation, which appears to be more encouraging than pharmacological therapy. However, heterogeneity is profoundly ingrained in study designs, and only rare schemes have been recommended by authoritative institutions. There is still a lack of an effective clinical protocol for managing patients with DOC following ABI. To advance future clinical studies on DOC, we present a comprehensive review of the progress in clinical identification and management as well as some challenges in the pathophysiology of DOC. We propose a preliminary clinical decision protocol, which could serve as an ideal reference tool for many medical institutions.
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Affiliation(s)
- Rui-Zhe Zheng
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China
- National Center for Neurological Disorders, Shanghai, 200040, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China
- State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai, 200032, China
| | - Zeng-Xin Qi
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China
- National Center for Neurological Disorders, Shanghai, 200040, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China
- State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai, 200032, China
| | - Zhe Wang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China
- National Center for Neurological Disorders, Shanghai, 200040, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China
- State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai, 200032, China
| | - Ze-Yu Xu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China
- National Center for Neurological Disorders, Shanghai, 200040, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China
- State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai, 200032, China
| | - Xue-Hai Wu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China.
- National Center for Neurological Disorders, Shanghai, 200040, China.
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China.
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China.
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China.
- State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai, 200032, China.
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China.
- National Center for Neurological Disorders, Shanghai, 200040, China.
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China.
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China.
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China.
- State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai, 200032, China.
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20
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Escrichs A, Sanz Perl Y, Martínez-Molina N, Biarnes C, Garre-Olmo J, Fernández-Real JM, Ramos R, Martí R, Pamplona R, Brugada R, Serena J, Ramió-Torrentà L, Coll-De-Tuero G, Gallart L, Barretina J, Vilanova JC, Mayneris-Perxachs J, Saba L, Pedraza S, Kringelbach ML, Puig J, Deco G. The effect of external stimulation on functional networks in the aging healthy human brain. Cereb Cortex 2022; 33:235-245. [PMID: 35311898 DOI: 10.1093/cercor/bhac064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 11/13/2022] Open
Abstract
Understanding the brain changes occurring during aging can provide new insights for developing treatments that alleviate or reverse cognitive decline. Neurostimulation techniques have emerged as potential treatments for brain disorders and to improve cognitive functions. Nevertheless, given the ethical restrictions of neurostimulation approaches, in silico perturbation protocols based on causal whole-brain models are fundamental to gaining a mechanistic understanding of brain dynamics. Furthermore, this strategy could serve to identify neurophysiological biomarkers differentiating between age groups through an exhaustive exploration of the global effect of all possible local perturbations. Here, we used a resting-state fMRI dataset divided into middle-aged (N =310, <65 years) and older adults (N =310, $\geq $65) to characterize brain states in each group as a probabilistic metastable substate (PMS) space. We showed that the older group exhibited a reduced capability to access a metastable substate that overlaps with the rich club. Then, we fitted the PMS to a whole-brain model and applied in silico stimulations in each node to force transitions from the brain states of the older- to the middle-aged group. We found that the precuneus was the best stimulation target. Overall, these findings could have important implications for designing neurostimulation interventions for reversing the effects of aging on whole-brain dynamics.
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Affiliation(s)
- Anira Escrichs
- Computational Neuroscience Group, Center for Brain and Cognition, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
| | - Yonatan Sanz Perl
- Computational Neuroscience Group, Center for Brain and Cognition, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
| | - Noelia Martínez-Molina
- Computational Neuroscience Group, Center for Brain and Cognition, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
| | - Carles Biarnes
- Department of Radiology (IDI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain.,Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain
| | - Josep Garre-Olmo
- Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain.,Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain.,Institut d'Assistència Sanitària, Salt, Girona, Spain
| | - José Manuel Fernández-Real
- Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain.,Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain.,Department of Diabetes, Endocrinology and Nutrition, IDIBGI, Hospital Universitari de Girona Dr Josep Trueta, and CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Girona, Spain
| | - Rafel Ramos
- Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain.,Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain.,Vascular Health Research Group of Girona (ISV-Girona), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain.,Primary Care Services, Catalan Institute of Health (ICS), Girona, Spain
| | - Ruth Martí
- Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain.,Vascular Health Research Group of Girona (ISV-Girona), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain.,Primary Care Services, Catalan Institute of Health (ICS), Girona, Spain
| | - Reinald Pamplona
- Department of Experimental Medicine, Faculty of Medicine, University of Lleida-IRBLleida, Lleida, Spain
| | - Ramon Brugada
- Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain.,Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain.,Cardiovascular Genetics Center, IDIBGI, CIBER-CV, Girona, Spain
| | - Joaquin Serena
- Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain.,Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain.,Department of Neurology, Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain
| | - Lluís Ramió-Torrentà
- Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain.,Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain.,Department of Neurology, Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain
| | - Gabriel Coll-De-Tuero
- Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain.,Vascular Health Research Group of Girona (ISV-Girona), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Luís Gallart
- Biobanc, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Jordi Barretina
- Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain
| | - Joan C Vilanova
- Department of Radiology (IDI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain.,Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain.,Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain
| | - Jordi Mayneris-Perxachs
- Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain.,Department of Diabetes, Endocrinology and Nutrition, IDIBGI, Hospital Universitari de Girona Dr Josep Trueta, and CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Girona, Spain
| | - Luca Saba
- Department of Radiology, AOU Cagliari, University of Cagliari, Italy
| | - Salvador Pedraza
- Department of Radiology (IDI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain.,Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain.,Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain
| | - Morten L Kringelbach
- Centre for Eudaimonia and Human Flourishing, University of Oxford, Oxford, UK.,Department of Psychiatry, University of Oxford, Oxford, UK.,Center for Music in the Brain, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Josep Puig
- Department of Radiology (IDI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain.,Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain.,Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain.,Institut d'Assistència Sanitària, Salt, Girona, Spain
| | - Gustavo Deco
- Computational Neuroscience Group, Center for Brain and Cognition, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain.,Institució Catalana de la Recerca i Estudis Avancats (ICREA), Barcelona, Catalonia, Spain.,Department of Neuropsychology, Max Planck Institute for human Cognitive and Brain Sciences, Leipzig, Germany.,Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
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21
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Huang W, Chen Q, Liu J, Liu L, Tang J, Zou M, Zeng T, Li H, Jiang Q, Jiang Q. Transcranial Magnetic Stimulation in Disorders of Consciousness: An Update and Perspectives. Aging Dis 2022:AD.2022.1114. [PMID: 37163434 PMCID: PMC10389824 DOI: 10.14336/ad.2022.1114] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/14/2022] [Indexed: 05/12/2023] Open
Abstract
Disorders of consciousness (DOC) is a state in which consciousness is affected by brain injuries, leading to dysfunction in vigilance, awareness, and behavior. DOC encompasses coma, vegetative state, and minimally conscious state based on neurobehavioral function. Currently, DOC is one of the most common neurological disorders with a rapidly increasing incidence worldwide. Therefore, DOC not only impacts the lives of individuals and their families but is also becoming a serious public health threat. Repetitive transcranial magnetic stimulation (rTMS) can stimulate electrical activity using a pulsed magnetic field in the brain, with great value in the treatment of chronic pain, neurological diseases, and mental illnesses. However, the clinical application of rTMS in patients with DOC is debatable. Herein, we report the recent main findings of the clinical therapeutics of rTMS for DOC, including its efficacy and possible mechanisms. In addition, we discuss the potential key parameters (timing, location, frequency, strength, and secession of rTMS applications) that affect the therapeutic efficiency of rTMS in patients with DOC. This review may help develop clinical guidelines for the therapeutic application of rTMS in DOC.
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Affiliation(s)
| | | | - Jun Liu
- Department of Neurosurgery, Ganzhou People's Hospital, Jiangxi, China
| | - Lin Liu
- Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases of Ministry of Education, Gannan Medical University, Jiangxi, China
| | - Jianhong Tang
- Laboratory Animal Engineering Research Center of Ganzhou, Gannan Medical University, Jiangxi, China
| | - Mingang Zou
- Department of Neurosurgery, Ganzhou People's Hospital, Jiangxi, China
| | - Tianxiang Zeng
- Department of Neurosurgery, Ganzhou People's Hospital, Jiangxi, China
| | - Huichen Li
- Department of Neurosurgery, Ganzhou People's Hospital, Jiangxi, China
| | - Qing Jiang
- Department of Neurosurgery, Ganzhou People's Hospital, Jiangxi, China
| | - QiuHua Jiang
- Department of Neurosurgery, Ganzhou People's Hospital, Jiangxi, China
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22
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Influence of High-Frequency Repetitive Transcranial Magnetic Stimulation on Neurobehavioral and Electrophysiology in Patients with Disorders of Consciousness. Neural Plast 2022; 2022:7195699. [PMID: 36437902 PMCID: PMC9699789 DOI: 10.1155/2022/7195699] [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: 08/27/2022] [Revised: 10/21/2022] [Accepted: 10/28/2022] [Indexed: 11/17/2022] Open
Abstract
Objective High-frequency repetitive transcranial magnetic stimulation (HF-rTMS) has been proposed as a promising therapeutic intervention for patients with disorders of consciousness (DOC). However, its therapeutic effects in the literature are inconsistently documented. The primary aim of this study was to explore the alterations in neural connectivity and neurobehavioral reactivity during rTMS modulation in patients with DOC. In addition, safety was investigated as a secondary aim. Methods The presence of bilateral N20 components in DOC patients was determined by somatosensory-evoked potential (SEP) before enrollment in the study. A total of 64 patients were enrolled and randomly placed into the active and sham groups. Ultimately, 50 patients completed the study. Twenty-five patients in the active group underwent real HF-rTMS, and 25 patients in the sham group underwent sham HF-rTMS, which was delivered over the left dorsolateral prefrontal cortex (DLPFC). The outcome measures of performed pre- and postintervention included the latencies of the N20 and N20-P25 amplitudes of SEP, brainstem auditory-evoked potential (BAEP) grade, JFK Coma Recovery Scale-Revised (CRS-R) score, and Glasgow Coma Scale (GCS) score; any adverse events were recorded at any time during the intervention. Result Following six weeks of treatment, a significant increase was observed in the total CRS-R and GCS scores, and the N20-P25 amplitudes of patients in the two groups were compared with that obtained from preintervention (all p values < 0.05). The waves of BAEP in the two groups also showed a trend toward normalized activity compared with preintervention grades (p values < 0.05). A significant decrease in the latencies of N20 (p values < 0.001) was observed in the active group compared with measurements obtained from preintervention, whereas no significant decrease was observed in the sham group (p values = 0.013). The improvement in total CRS-R scores (p values = 0.002), total GCS scores (p values = 0.023), and N20-P25 amplitudes (p values = 0.011) as well as the decrease in latencies of N20 (p values = 0.018) and change in BAEP grades (p values = 0.013) were significantly different between the two groups. The parameters in neural connectivity (N20-P25 amplitudes, N20 latencies, and BAEP grades) were significantly correlated with the total CRS-R and GCS scores at postintervention, and the changes of CRS-R before and after interventions have a positive relationship with N20-P25 amplitudes. No adverse events related to the rTMS protocol were recorded. Conclusion Neural connectivity levels are affected by HF-rTMS and are significantly related to clinical responses in DOC patients with the presence of bilateral N20. The elevation of neural connectivity levels may lay a foundation for successful HF-rTMS treatment for DOC patients.
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23
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Strength-dependent perturbation of whole-brain model working in different regimes reveals the role of fluctuations in brain dynamics. PLoS Comput Biol 2022; 18:e1010662. [PMID: 36322525 PMCID: PMC9629648 DOI: 10.1371/journal.pcbi.1010662] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 10/17/2022] [Indexed: 01/15/2023] Open
Abstract
Despite decades of research, there is still a lack of understanding of the role and generating mechanisms of the ubiquitous fluctuations and oscillations found in recordings of brain dynamics. Here, we used whole-brain computational models capable of presenting different dynamical regimes to reproduce empirical data's turbulence level. We showed that the model's fluctuations regime fitted to turbulence more faithfully reproduces the empirical functional connectivity compared to oscillatory and noise regimes. By applying global and local strength-dependent perturbations and subsequently measuring the responsiveness of the model, we revealed each regime's computational capacity demonstrating that brain dynamics is shifted towards fluctuations to provide much-needed flexibility. Importantly, fluctuation regime stimulation in a brain region within a given resting state network modulates that network, aligned with previous empirical and computational studies. Furthermore, this framework generates specific, testable empirical predictions for human stimulation studies using strength-dependent rather than constant perturbation. Overall, the whole-brain models fitted to the level of empirical turbulence together with functional connectivity unveil that the fluctuation regime best captures empirical data, and the strength-dependent perturbative framework demonstrates how this regime provides maximal flexibility to the human brain.
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24
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Xu Z, Zheng R, Xia T, Qi Z, Zang D, Wang Z, Wu X. Behavioral effects in disorders of consciousness following transcranial direct current stimulation: A systematic review and individual patient data meta-analysis of randomized clinical trials. Front Neurol 2022; 13:940361. [PMID: 36247787 PMCID: PMC9558708 DOI: 10.3389/fneur.2022.940361] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/18/2022] [Indexed: 11/29/2022] Open
Abstract
Background In patients with Disorders of Consciousness (DoC), recent evidence suggests that transcranial direct current stimulation (tDCS) can be a promising intervention for them. However, there has been little agreement on the treatment effect and the optimal treatment strategy for the tDCS in patients with DoC. Objective In this meta-analysis of individual patient data (IPD), we assess whether tDCS could improve DoC patients' behavioral performance. We also determine whether these treatment effects could be modified by patient characteristics or tDCS protocol. Methods We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials until 7 April 2022 using the terms “persistent vegetative state,” “minimally conscious state,” “disorder of consciousness,” or “unresponsive wakefulness syndrome,” and “transcranial direct current stimulation” to identify Randomized Controlled Trials (RCTs) in English-language publications. Studies were eligible for inclusion if they reported pre- and post-tDCS Coma Recovery Scale-Revised (CRS-R) scores. From the included studies, patients who had incomplete data were excluded. We performed a meta-analysis to assess the treatment effect of the tDCS compared with sham control. Additionally, various subgroup analyses were performed to determine whether specific patient characteristics could modify the treatment effect and to find out the optimal tDCS protocol. Results We identified 145 papers, but eventually eight trials (including 181 patients) were included in the analysis, and one individual data were excluded because of incomplete data. Our meta-analysis demonstrated a mean difference change in the CRS-R score of 0.89 (95% CI, 0.17–1.61) between tDCS and sham-control, favoring tDCS. The subgroup analysis showed that patients who were male or with a minimally conscious state (MCS) diagnosis were associated with a greater improvement in CRS-R score. We also found that patients who underwent five or more sessions of tDCS protocol had a better treatment effect than just one session. Conclusion The result shows that tDCS can improve the behavioral performance of DoC patients. The heterogeneity of the treatment effect existed within the patients' baseline conditions and the stimulation protocol. More explorative studies on the optimal tDCS protocol and the most beneficial patient group based on the mechanism of tDCS are required in the future. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42022331241.
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Affiliation(s)
- Zeyu Xu
- Department of Neurosurgery, Shanghai Medical College, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Ruizhe Zheng
- Department of Neurosurgery, Shanghai Medical College, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Tiantong Xia
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Zengxin Qi
- Department of Neurosurgery, Shanghai Medical College, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Di Zang
- Department of Neurosurgery, Shanghai Medical College, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Zhe Wang
- Department of Neurosurgery, Shanghai Medical College, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Xuehai Wu
- Department of Neurosurgery, Shanghai Medical College, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- *Correspondence: Xuehai Wu
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25
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Functional Connectivity Increases in Response to High-Definition Transcranial Direct Current Stimulation in Patients with Chronic Disorder of Consciousness. Brain Sci 2022; 12:brainsci12081095. [PMID: 36009158 PMCID: PMC9405975 DOI: 10.3390/brainsci12081095] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/10/2022] [Accepted: 08/16/2022] [Indexed: 11/17/2022] Open
Abstract
Highlights Functional connectivity induced by HD-tDCS in DLPFC has different trends in CRS-R score improvers and non-improvers. An increase in theta PLV in the left frontal–parietooccipital region was significantly associated with CRS-R changes. DOC patients with increased PLV of the alpha band in the intra-bifrontal region have a better prognosis than those without.
Abstract High-definition transcranial direct current stimulation (HD-tDCS) has been shown to play an important role in improving consciousness in patients with disorders of consciousness (DOCs), but its neuroelectrophysiological evidence is still lacking. To better explain the electrophysiological mechanisms of the effects of HD-tDCS on patients with DOCs, 22 DOC patients underwent 10 anodal HD-tDCS sessions of the left dorsolateral prefrontal cortex (DLPFC). This study used the Coma Recovery Scale-Revised (CRS-R) to assess the level of consciousness in DOC patients. According to whether the CRS-R score increased before and after stimulation, DOC patients were divided into a responsive group and a non-responsive group. By comparing the differences in resting-state EEG functional connectivity between different frequency bands and brain regions, as well as the relationship between functional connectivity values and clinical scores, the electrophysiological mechanism of the clinical effects of HD-tDCS was further explored. The change of the phase locking value (PLV) on the theta frequency band in the left frontal–parietooccipital region was positively correlated with the change in the CRS-R scores. As the number of interventions increased, we observed that in the responsive group, the change in PLV showed an upward trend, and the increase in the PLV appeared in the left frontal–parietooccipital region at 4–8 Hz and in the intra-bifrontal region at 8–13 Hz. In the non-responsive group, although the CRS-R scores did not change after stimulation, the PLV showed a downward trend, and the decrease in the PLV appeared in the intra-bifrontal region at 8–13 Hz. In addition, at the three-month follow-up, patients with increased PLV in the intra-bifrontal region at 8–13 Hz after repeated HD-tDCS stimulation had better outcomes than those without. Repeated anodal stimulation of the left DLPFC with HD-tDCS resulted in improved consciousness in some patients with DOCs. The increase in functional connectivity in the brain regions may be associated with the improvement of related awareness after HD-tDCS and may be a predictor of better long-term outcomes.
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Min JH, Shin YI. Treatment and Rehabilitation for Traumatic Brain Injury: Current Update. BRAIN & NEUROREHABILITATION 2022; 15:e14. [PMID: 36743200 PMCID: PMC9833473 DOI: 10.12786/bn.2022.15.e14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 11/08/2022] Open
Abstract
Traumatic brain injury (TBI) is an acquired injury to the brain caused by external mechanical forces, which can cause temporary or permanent disability. TBI and its potential long-term consequences are serious public health concerns. This review seeks to provide updated information on the current methods of management of patients with TBI to improve patient care.
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Affiliation(s)
- Ji Hong Min
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Rehabilitation Medicine, Pusan National University School of Medicine, Busan, Korea
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Liu B, Zhang X, Li Y, Duan G, Hou J, Zhao J, Guo T, Wu D. tDCS-EEG for Predicting Outcome in Patients With Unresponsive Wakefulness Syndrome. Front Neurosci 2022; 16:771393. [PMID: 35812233 PMCID: PMC9263392 DOI: 10.3389/fnins.2022.771393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives We aimed to assess the role of transcranial direct current stimulation (tDCS) combined with electroencephalogram (EEG) for predicting prognosis in UWS cases. Methods This was a historical control study that enrolled 85 patients with UWS. The subjects were assigned to the control (without tDCS) and tDCS groups. Conventional treatments were implemented in both the control and tDCS groups, along with 40 multi-target tDCS sessions only in the tDCS group. Coma Recovery Scale-Revised (CRS-R) was applied at admission. The non-linear EEG index was evaluated after treatment. The modified Glasgow Outcome Scale (mGOS) was applied 12 months after disease onset. Results The mGOS improvement rate in the tDCS group (37.1%) was higher than the control value (22.0%). Linear regression analysis revealed that the local and remote cortical networks under unaffected pain stimulation conditions and the remote cortical network under affected pain stimulation conditions were the main relevant factors for mGOS improvement. Furthermore, the difference in prefrontal-parietal cortical network was used to examine the sensitivity of prognostic assessment in UWS patients. The results showed that prognostic sensitivity could be increased from 54.5% (control group) to 84.6% (tDCS group). Conclusions This study proposes a tDCS-EEG protocol for predicting the prognosis of UWS. With multi-target tDCS combined with EEG, the sensitivity of prognostic assessment in patients with UWS was improved. The recovery might be related to improved prefrontal-parietal cortical networks of the unaffected hemisphere.
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Affiliation(s)
- Baohu Liu
- Department of Rehabilitation, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Xu Zhang
- Department of Rehabilitation, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuanyuan Li
- Department of Rehabilitation, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Guoping Duan
- Department of Rehabilitation, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Jun Hou
- Department of Rehabilitation, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiayi Zhao
- Department of Rehabilitation, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Tongtong Guo
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Dongyu Wu
- Department of Rehabilitation, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Dongyu Wu
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Barra A, Monti M, Thibaut A. Noninvasive Brain Stimulation Therapies to Promote Recovery of Consciousness: Where We Are and Where We Should Go. Semin Neurol 2022; 42:348-362. [PMID: 36100229 DOI: 10.1055/s-0042-1755562] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Therapeutic options for patients with disorders of consciousness (DoC) are still underexplored. Noninvasive brain stimulation (NIBS) techniques modulate neural activity of targeted brain areas and hold promise for the treatment of patients with DoC. In this review, we provide a summary of published research using NIBS as therapeutic intervention for DoC patients, with a focus on (but not limited to) randomized controlled trials (RCT). We aim to identify current challenges and knowledge gaps specific to NIBS research in DoC. Furthermore, we propose possible solutions and perspectives for this field. Thus far, the most studied technique remains transcranial electrical stimulation; however, its effect remains moderate. The identified key points that NIBS researchers should focus on in future studies are (1) the lack of large-scale RCTs; (2) the importance of identifying the endotypes of responders; and (3) the optimization of stimulation parameters to maximize the benefits of NIBS.
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Affiliation(s)
- Alice Barra
- Coma Science Group, GIGA Consciousness - GIGA Research, University of Liège, Liège, Belgium.,Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Martin Monti
- Department of Psychology, University of California Los Angeles, Los Angeles, California.,Department of Neurosurgery, UCLA Brain Injury Research Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Aurore Thibaut
- Coma Science Group, GIGA Consciousness - GIGA Research, University of Liège, Liège, Belgium.,Centre du Cerveau, University Hospital of Liège, Liège, Belgium
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Han J, Chen C, Zheng S, Yan X, Wang C, Wang K, Hu Y. High-Definition Transcranial Direct Current Stimulation of the Dorsolateral Prefrontal Cortex Modulates the Electroencephalography Rhythmic Activity of Parietal Occipital Lobe in Patients With Chronic Disorders of Consciousness. Front Hum Neurosci 2022; 16:889023. [PMID: 35712532 PMCID: PMC9196904 DOI: 10.3389/fnhum.2022.889023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundDisorders of consciousness (DOC) are a spectrum of pathologies affecting one’s ability to interact with the external world. At present, High-Definition Transcranial Direct Current Stimulation (HD-tDCS) is used in many patients with DOC as a non-invasive treatment, but electrophysiological research on the effect of HD-tDCS on patients with DOC is limited.ObjectivesTo explore how HD-tDCS affects the cerebral cortex and examine the possible electrophysiological mechanisms underlying the effects of HD-tDCS on the cerebral cortex.MethodsA total of 19 DOC patients were assigned to HD-tDCS stimulation. Each of them underwent 10 anodal HD-tDCS sessions of the left dorsolateral prefrontal cortex (DLPFC) over 5 consecutive days. Coma Recovery Scale-Revision (CRS-R) scores were recorded to evaluate the consciousness level before and after HD-tDCS, while resting-state electroencephalography (EEG) recordings were obtained immediately before and after single and multiple HD-tDCS stimuli. Depending on whether the CRS-R score increased after stimulation, we classified the subjects into responsive (RE) and non-responsive (N-RE) groups and compared the differences in power spectral density (PSD) between the groups in different frequency bands and brain regions, and also examined the relationship between PSD values and CRS-R scores.ResultsFor the RE group, the PSD value of the parieto-occipital region increased significantly in the 6–8 Hz frequency band after multiple stimulations by HD-tDCS. After a single stimulation, an increase in PSD was observed at 10–13 and 13–30 Hz. In addition, for all subjects, a positive correlation was observed between the change in PSD value in the parieto-occipital region at 10–13 and 6–8 Hz frequency band and the change in CRS-R score after a single stimulation.ConclusionRepeated anodal HD-tDCS of the left DLPFC can improve clinical outcomes in patients with DOC, and HD-tDCS-related increased levels of consciousness were associated with increased parieto-occipital PSD.
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Affiliation(s)
- Jinying Han
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Chen Chen
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Shuang Zheng
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Xiaoxiang Yan
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Changqing Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Hefei Comprehensive National Science Center, Institute of Artificial Intelligence, Hefei, China
- *Correspondence: Kai Wang,
| | - Yajuan Hu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Yajuan Hu,
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Barra A, Rosenfelder M, Mortaheb S, Carrière M, Martens G, Bodien YG, Morales-Quezada L, Bender A, Laureys S, Thibaut A, Fregni F. Transcranial Pulsed-Current Stimulation versus Transcranial Direct Current Stimulation in Patients with Disorders of Consciousness: A Pilot, Sham-Controlled Cross-Over Double-Blind Study. Brain Sci 2022; 12:429. [PMID: 35447961 PMCID: PMC9031379 DOI: 10.3390/brainsci12040429] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 02/01/2023] Open
Abstract
Transcranial direct-current stimulation (tDCS) over the prefrontal cortex can improve signs of consciousness in patients in a minimally conscious state. Transcranial pulsed-current stimulation (tPCS) over the mastoids can modulate brain activity and connectivity in healthy controls. This study investigated the feasibility of tPCS as a therapeutic tool in patients with disorders of consciousness (DoC) and compared its neurophysiological and behavioral effects with prefrontal tDCS. This pilot study was a randomized, double-blind sham-controlled clinical trial with three sessions: bi-mastoid tPCS, prefrontal tDCS, and sham. Electroencephalography (EEG) and behavioral assessments were collected before and after each stimulation session. Post minus pre differences were compared using Kruskal-Wallis and Wilcoxon signed-rank tests. Twelve patients with DoC were included in the study (eight females, four traumatic brain injury, 50.3 ± 14 y.o., 8.8 ± 10.5 months post-injury). We did not observe any side-effects following tPCS, nor tDCS, and confirmed their feasibility and safety. We did not find a significant effect of the stimulation on EEG nor behavioral outcomes for tPCS. However, consistent with prior findings, our exploratory analyses suggest that tDCS induces behavioral improvements and an increase in theta frontal functional connectivity.
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Affiliation(s)
- Alice Barra
- Coma Science Group, GIGA Consciousness-GIGA Research, University of Liège, 4000 Liège, Belgium; (A.B.); (S.M.); (M.C.); (G.M.); (S.L.)
- Centre du Cerveau, University Hospital of Liège, 4000 Liège, Belgium
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02114, USA; (Y.G.B.); (L.M.-Q.)
| | - Martin Rosenfelder
- Department of Neurology, Therapiezentrum Burgau, Kapuzinerstrasse 34, 89331 Burgau, Germany; (M.R.); (A.B.)
- Clinical and Biological Psychology, Institute of Psychology and Education, Ulm University, 89081 Ulm, Germany
| | - Sepehr Mortaheb
- Coma Science Group, GIGA Consciousness-GIGA Research, University of Liège, 4000 Liège, Belgium; (A.B.); (S.M.); (M.C.); (G.M.); (S.L.)
- Physiology of Cognition Lab, GIGA-Consciousness, University of Liège, 4000 Liège, Belgium
| | - Manon Carrière
- Coma Science Group, GIGA Consciousness-GIGA Research, University of Liège, 4000 Liège, Belgium; (A.B.); (S.M.); (M.C.); (G.M.); (S.L.)
- Centre du Cerveau, University Hospital of Liège, 4000 Liège, Belgium
| | - Geraldine Martens
- Coma Science Group, GIGA Consciousness-GIGA Research, University of Liège, 4000 Liège, Belgium; (A.B.); (S.M.); (M.C.); (G.M.); (S.L.)
- Centre du Cerveau, University Hospital of Liège, 4000 Liège, Belgium
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02114, USA; (Y.G.B.); (L.M.-Q.)
| | - Yelena G. Bodien
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02114, USA; (Y.G.B.); (L.M.-Q.)
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Leon Morales-Quezada
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02114, USA; (Y.G.B.); (L.M.-Q.)
- Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02114, USA;
| | - Andreas Bender
- Department of Neurology, Therapiezentrum Burgau, Kapuzinerstrasse 34, 89331 Burgau, Germany; (M.R.); (A.B.)
- Department of Neurology, Ludwig-Maximilians University (LMU), 81377 Munich, Germany
| | - Steven Laureys
- Coma Science Group, GIGA Consciousness-GIGA Research, University of Liège, 4000 Liège, Belgium; (A.B.); (S.M.); (M.C.); (G.M.); (S.L.)
- Centre du Cerveau, University Hospital of Liège, 4000 Liège, Belgium
- Joint International Research Unit on Consciousness, CERVO Brain Research Centre CIUSS, University Laval, Quebec, QC G1E1T2, Canada
| | - Aurore Thibaut
- Coma Science Group, GIGA Consciousness-GIGA Research, University of Liège, 4000 Liège, Belgium; (A.B.); (S.M.); (M.C.); (G.M.); (S.L.)
- Centre du Cerveau, University Hospital of Liège, 4000 Liège, Belgium
- Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02114, USA;
| | - Felipe Fregni
- Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02114, USA;
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Sun X, Dong X, Yuan Q, Yu G, Shuai L, Ma C, Sun W. Effects of transcranial direct current stimulation on patients with post-stroke fatigue: a study protocol for a double-blind randomized controlled trial. Trials 2022; 23:200. [PMID: 35248120 PMCID: PMC8898477 DOI: 10.1186/s13063-022-06128-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 02/23/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Post-stroke fatigue (PSF) is an abnormal, persistent, and unexplained physical and psychological tiredness in patients after stroke. It is a common symptom of stroke patients with poor quality of life and bleak prognosis, and the incidence rate is up to 39% to 72%. It has been widely reported that medicine treatments achieved a lot of progress, there still needs to develop more powerful new strategies to more powerful effect. The transcranial direct-current stimulation (tDCS) shows great potential for the treatment of PSF. This study proposes to apply a double-blind randomized controlled clinical trial to explore the effect and safety of tDCS combined with routine rehabilitation for PSF. Methods and analysis One hundred patients with PSF will be randomly divided into two groups. One of the groups will receive conventional rehabilitation therapy and active tDCS, whereas another group will receive conventional rehabilitation treatment and sham tDCS. Both groups will receive the intervention for 4 weeks, during which time they will undergo either active or sham tDCS 20 min a day, 6 days a week. Primary outcome: Fatigue Severity Scale (FSS) will be measured at baseline every weekend during the intervention period. Secondary results: Fatigue Impact Scale (FIS), Functional Assessment Chronic Illness Therapy (Fatigue) (FACIT-F), and Specialized Quality of Life Scale in Stroke (SS-QOL) will be measured at baseline and at the end of the intervention time of 4 weeks. Throughout the study, adverse events and adverse reactions will be measured during every treatment. The research study “Effects of transcranial direct current stimulation on patients with post-stroke fatigue” has been approved by the Ethics Committee of the First Affiliated Hospital of Nanchang University: Clinical Medicine Ethics Review [2015]043 in Nov 2015. Discussion This study will provide insight into the efficacy of transcranial direct-current stimulation for post-stroke fatigue. This is a double-blind randomized controlled trial whose aim is to assess the effects of tDCS on PSF. This study can provide more information about the treatment of PSF. This study has a period of follow-up, which allows for greater accuracy. It is a single-center trial, and this may be a limitation. The other limitation of this study is the relatively small number of participants; thus, the influence of chance on experimental results cannot be completely ruled out. Trial registration Chinese Clinical Trial Registry ChiCTR2000031120. Registered on March 22, 2020. This protocol version number is V1.1.
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Wu H, Qi Z, Wu X, Zhang J, Wu C, Huang Z, Zang D, Fogel S, Tanabe S, Hudetz AG, Northoff G, Mao Y, Qin P. Anterior precuneus related to the recovery of consciousness. Neuroimage Clin 2022; 33:102951. [PMID: 35134706 PMCID: PMC8856921 DOI: 10.1016/j.nicl.2022.102951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/22/2022] [Accepted: 01/25/2022] [Indexed: 11/28/2022]
Abstract
Degree centrality of anterior precuneus correlated with Glasgow Outcome Scale scores. Anterior precuneus was shown as a hub in multiple recoverable unconscious states. Anterior precuneus had similar connectivity pattern in recoverable unconscious states.
The neural mechanism that enables the recovery of consciousness in patients with unresponsive wakefulness syndrome (UWS) remains unclear. The aim of the current study is to characterize the cortical hub regions related to the recovery of consciousness. In the current fMRI study, voxel-wise degree centrality analysis was adopted to identify the cortical hubs related to the recovery of consciousness, for which a total of 27 UWS patients were recruited, including 13 patients who emerged from UWS (UWS-E), and 14 patients who remained in UWS (UWS-R) at least three months after the experiment performance. Furthermore, other recoverable unconscious states were adopted as validation groups, including three independent N3 sleep datasets (n = 12, 9, 9 respectively) and three independent anesthesia datasets (n = 27, 14, 6 respectively). Spatial similarity of the hub characteristic with the validation groups between the UWS-E and UWS-R was compared using the dice coefficient. Finally, with the cortical regions persistently shown as hubs across UWS-E and validation states, functional connectivity analysis was further performed to explore the connectivity patterns underlying the recovery of consciousness. The results identified four cortical hubs in the UWS-E, which showed significantly higher degree centrality for UWS-E than UWS-R, including the anterior precuneus, left inferior parietal lobule, left inferior frontal gyrus, and left middle frontal gyrus, of which the degree centrality value also positively correlated with the patients’ Glasgow Outcome Scale (GOS) score that assessed global brain functioning outcome after a brain injury. Furthermore, the anterior precuneus was found with significantly higher similarity of hub characteristics as well as functional connectivity patterns between UWS-E and the validation groups. The results suggest that the recovery of consciousness may be relevant to the integrity of cortical hubs in the recoverable unconscious states, especially the anterior precuneus. The identified cortical hub regions could serve as potential treatment targets for patients with UWS.
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Affiliation(s)
- Hang Wu
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, Guangdong 510631, China
| | - Zengxin Qi
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200433, China; Neurosurgical Institute of Fudan University, Shanghai Clinical Medical Center of Neurosurgery, Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai 200433, China; State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai 200433, China
| | - Xuehai Wu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200433, China; Neurosurgical Institute of Fudan University, Shanghai Clinical Medical Center of Neurosurgery, Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai 200433, China; State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai 200433, China; Pazhou Lab, Guangzhou 510335, China
| | - Jun Zhang
- Department of Anesthesiology, Fudan University Shanghai Cancer Center Shanghai, 200433, China
| | - Changwei Wu
- Research Center for Brain and Consciousness, Taipei Medical University, Taipei 11031, Taiwan; Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei 11031, Taiwan; Shuang-Ho Hospital, Taipei Medical University, New Taipei 23561, Taiwan
| | - Zirui Huang
- Department of Anesthesiology and Center for Consciousness Science, University of Michigan, Ann Arbor, MI 48105, USA
| | - Di Zang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200433, China; Neurosurgical Institute of Fudan University, Shanghai Clinical Medical Center of Neurosurgery, Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai 200433, China; State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai 200433, China
| | - Stuart Fogel
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Sean Tanabe
- Department of Anesthesiology and Center for Consciousness Science, University of Michigan, Ann Arbor, MI 48105, USA
| | - Anthony G Hudetz
- Department of Anesthesiology and Center for Consciousness Science, University of Michigan, Ann Arbor, MI 48105, USA
| | - Georg Northoff
- Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, ON K1Z 7K4, Canada; Mental Health Centre, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200433, China; Neurosurgical Institute of Fudan University, Shanghai Clinical Medical Center of Neurosurgery, Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai 200433, China; State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai 200433, China.
| | - Pengmin Qin
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, Guangdong 510631, China; Pazhou Lab, Guangzhou 510335, China.
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Peng Y, Zhao J, Lu X, Dong J, Zhang S, Zhang J, Liu H, Zheng X, Wang X, Lan Y, Yan T. Efficacy of Transcranial Direct Current Stimulation Over Dorsolateral Prefrontal Cortex in Patients With Minimally Conscious State. Front Neurol 2022; 13:821286. [PMID: 35250824 PMCID: PMC8894202 DOI: 10.3389/fneur.2022.821286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/14/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe treatment of patients in a minimally conscious state (MCS) remains challenging. Transcranial direct current stimulation (tDCS) is a non-invasive therapeutic method in treating neurologic diseases by regulating the cortical excitability. The aim is to investigate the effect of tDCS in patients with MCS in this study.MethodsEleven patients in MCS were enrolled in the study. All the patients received 5 daily sessions of 20-min sham tDCS, followed by 10 sessions of 20-min real tDCS. The anodal electrode and cathodal electrodes were placed over the left dorsolateral prefrontal cortex (DLPFC) and the right eyebrow, respectively. Assessment of Coma Recovery Scale-Revised (CRS-R) scores and resting-state functional MRI (rs-fMRI) scans was conducted three times in each patient: before tDCS (baseline, T0), post-sham tDCS at week 1 (T1), and post-real tDCS at week 2 (T2). The whole-brain functional connectivity (FC) was obtained by bilaterally computing FC from six seed regions: precuneus, middle frontal gyrus, supplemental motor area, angular gyrus, superior temporal gyrus, and occipital lobe. One-way repeated measure ANOVA was used to compare the differences of CRS-R scores and FC at T0, T1, and T2. The false discovery rate correction of p < 0.001 was adopted for controlling multiple comparisons in FC analysis.ResultsFive patients with MCS showed obvious clinical improvement represented by increased CRS-R scores post- 2-week real tDCS. The CRS-R scores did not change post- 1-week sham treatment. No side effects were reported during the study. The FC of the bilateral supplementary motor area, right angular gyrus, and right superior temporal gyrus were significantly enhanced after 2-week real tDCS compared with that after 1-week sham-tDCS. In addition, FC of bilateral occipital lobe and right precuneus were significantly enhanced post- 2-week real tDCS compared with the baseline.ConclusionOur findings indicated that tDCS over DLPFC could serve as a potentially effective therapy for improving the consciousness state in patients with MCS. The FC in rs-fMRI can be modulated by tDCS at both the stimulation site (left DLPFC) and the distant regions.
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Affiliation(s)
- Yuan Peng
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Jingpu Zhao
- Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Xiao Lu
- Department of Rehabilitation Medicine, Guangdong 999 Brain Hospital, Guangzhou, China
| | - Juntao Dong
- Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Shunxi Zhang
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Jin Zhang
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Huihua Liu
- Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiuyuan Zheng
- Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xin Wang
- Department of Rehabilitation Medicine, Clinical Medical College, Yangzhou University, Yangzhou, China
- *Correspondence: Xin Wang
| | - Yue Lan
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
- Yue Lan
| | - Tiebin Yan
- Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Tiebin Yan
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Irzan H, Pozzi M, Chikhladze N, Cebanu S, Tadevosyan A, Calcii C, Tsiskaridze A, Melbourne A, Strazzer S, Modat M, Molteni E. Emerging Treatments for Disorders of Consciousness in Paediatric Age. Brain Sci 2022; 12:198. [PMID: 35203961 PMCID: PMC8870410 DOI: 10.3390/brainsci12020198] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/28/2022] [Accepted: 01/29/2022] [Indexed: 11/17/2022] Open
Abstract
The number of paediatric patients living with a prolonged Disorder of Consciousness (DoC) is growing in high-income countries, thanks to substantial improvement in intensive care. Life expectancy is extending due to the clinical and nursing management achievements of chronic phase needs, including infections. However, long-known pharmacological therapies such as amantadine and zolpidem, as well as novel instrumental approaches using direct current stimulation and, more recently, stem cell transplantation, are applied in the absence of large paediatric clinical trials and rigorous age-balanced and dose-escalated validations. With evidence building up mainly through case reports and observational studies, there is a need for well-designed paediatric clinical trials and specific research on 0-4-year-old children. At such an early age, assessing residual and recovered abilities is most challenging due to the early developmental stage, incompletely learnt motor and cognitive skills, and unreliable communication; treatment options are also less explored in early age. In middle-income countries, the lack of rehabilitation services and professionals focusing on paediatric age hampers the overall good assistance provision. Young and fast-evolving health insurance systems prevent universal access to chronic care in some countries. In low-income countries, rescue networks are often inadequate, and there is a lack of specialised and intensive care, difficulty in providing specific pharmaceuticals, and lower compliance to intensive care hygiene standards. Despite this, paediatric cases with DoC are reported, albeit in fewer numbers than in countries with better-resourced healthcare systems. For patients with a poor prospect of recovery, withdrawal of care is inhomogeneous across countries and still heavily conditioned by treatment costs as well as ethical and cultural factors, rather than reliant on protocols for assessment and standardised treatments. In summary, there is a strong call for multicentric, international, and global health initiatives on DoC to devote resources to the paediatric age, as there is now scope for funders to invest in themes specific to DoC affecting the early years of the life course.
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Affiliation(s)
- Hassna Irzan
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London WC2R 2LS, UK; (H.I.); (A.M.); (M.M.)
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 7JE, UK
| | - Marco Pozzi
- Scientific Institute IRCCS E. Medea, Acquired Brain Injury Unit, 22040 Bosisio Parini, Italy; (M.P.); (S.S.)
| | - Nino Chikhladze
- Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi 0179, Georgia; (N.C.); (A.T.)
| | - Serghei Cebanu
- Faculty of Medicine, Nicolae Testemitanu State University of Medicine and Pharmacy, MD-2004 Chišināu, Moldova; (S.C.); (C.C.)
| | - Artashes Tadevosyan
- Department of Public Health and Healthcare Organization, Yerevan State Medical University, Yerevan 0025, Armenia;
| | - Cornelia Calcii
- Faculty of Medicine, Nicolae Testemitanu State University of Medicine and Pharmacy, MD-2004 Chišināu, Moldova; (S.C.); (C.C.)
| | - Alexander Tsiskaridze
- Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi 0179, Georgia; (N.C.); (A.T.)
| | - Andrew Melbourne
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London WC2R 2LS, UK; (H.I.); (A.M.); (M.M.)
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 7JE, UK
| | - Sandra Strazzer
- Scientific Institute IRCCS E. Medea, Acquired Brain Injury Unit, 22040 Bosisio Parini, Italy; (M.P.); (S.S.)
- Rehabilitation Service, “Usratuna” Health and Rehabilitation Centre, Juba, South Sudan
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London WC2R 2LS, UK; (H.I.); (A.M.); (M.M.)
| | - Erika Molteni
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London WC2R 2LS, UK; (H.I.); (A.M.); (M.M.)
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35
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Liang P, Xu H, Li S, Ren L, Zhao X. Virtual Reality-Based Sensory Stimulation for Pediatric Disorders of Consciousness: A Pilot Study. Front Pediatr 2022; 10:879422. [PMID: 35769213 PMCID: PMC9234395 DOI: 10.3389/fped.2022.879422] [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: 02/19/2022] [Accepted: 05/16/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The purpose of this study was to determine whether virtual reality-based sensory stimulation has the ability to improve the level of consciousness in pediatric disorders of consciousness compared with general rehabilitation. METHODS Thirty subjects were divided into a virtual reality (VR) group (n = 15) and a control group (n = 15). Subjects in the VR group received both general rehabilitation and exposure to VR videos; the control group received only general rehabilitation. The Glasgow Coma Scale (GCS), Coma Recovery Scale-Revised (CRS-R), and amplitude-integrated electroencephalogram (EEG) (aEEG) were used to measure the clinical behavioral response and neuroelectrophysiology before and after the treatment. The Glasgow Outcome Scale Extended Pediatric Revised (GOS-E Peds) was used to measure the social and personal functional ability after 3 months. RESULTS After 2 weeks of treatment, the CRS-R and GCS improved in both groups. However, the VR group had better results than the control group in the CRS-R (p = 0.003) and GCS (p = 0.045). There were no significant differences on aEEG in the two groups after treatment. According to the GOS-E Peds, the improvement of social and personal functional ability had no significant differences in the two groups. Additionally, there were no obvious adverse reactions in the two group during the treatment. CONCLUSIONS This pilot study indicates potential benefit from the addition of VR to standard rehabilitation in pediatric disorders of consciousness. To further explore the efficacy of VR, a large-sample randomized controlled trial is warranted.
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Affiliation(s)
- Piao Liang
- Department of Rehabilitation, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Hong Xu
- Department of Rehabilitation, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Sinan Li
- Department of Rehabilitation, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Lei Ren
- Department of Nursing, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaoke Zhao
- Department of Rehabilitation, Children's Hospital of Nanjing Medical University, Nanjing, China
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36
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Quinn DK, Story-Remer J, Brandt E, Fratzke V, Rieger R, Wilson JK, Gill D, Mertens N, Hunter M, Upston J, Jones TR, Richardson JD, Myers O, Arciniegas DB, Campbell R, Clark VP, Yeo RA, Shuttleworth CW, Mayer AR. Transcranial direct current stimulation modulates working memory and prefrontal-insula connectivity after mild-moderate traumatic brain injury. Front Hum Neurosci 2022; 16:1026639. [PMID: 36310843 PMCID: PMC9608772 DOI: 10.3389/fnhum.2022.1026639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Persistent posttraumatic symptoms (PPS) may manifest after a mild-moderate traumatic brain injury (mmTBI) even when standard brain imaging appears normal. Transcranial direct current stimulation (tDCS) represents a promising treatment that may ameliorate pathophysiological processes contributing to PPS. Objective/Hypothesis: We hypothesized that in a mmTBI population, active tDCS combined with training would result in greater improvement in executive functions and post-TBI cognitive symptoms and increased resting state connectivity of the stimulated region, i.e., left dorsolateral prefrontal cortex (DLPFC) compared to control tDCS. Methods: Thirty-four subjects with mmTBI underwent baseline assessments of demographics, symptoms, and cognitive function as well as resting state functional magnetic resonance imaging (rsfMRI) in a subset of patients (n = 24). Primary outcome measures included NIH EXAMINER composite scores, and the Neurobehavioral Symptom Inventory (NSI). All participants received 10 daily sessions of 30 min of executive function training coupled with active or control tDCS (2 mA, anode F3, cathode right deltoid). Imaging and assessments were re-obtained after the final training session, and assessments were repeated after 1 month. Mixed-models linear regression and repeated measures analyses of variance were calculated for main effects and interactions. Results: Both active and control groups demonstrated improvements in executive function (EXAMINER composite: p < 0.001) and posttraumatic symptoms (NSI cognitive: p = 0.01) from baseline to 1 month. Active anodal tDCS was associated with greater improvements in working memory reaction time compared to control (p = 0.007). Reaction time improvement correlated significantly with the degree of connectivity change between the right DLPFC and the left anterior insula (p = 0.02). Conclusion: Anodal tDCS improved reaction time on an online working memory task in a mmTBI population, and decreased connectivity between executive network and salience network nodes. These findings generate important hypotheses for the mechanism of recovery from PPS after mild-moderate TBI.
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Affiliation(s)
- Davin K Quinn
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Jacqueline Story-Remer
- Center for Brain Recovery and Repair, University of New Mexico, Albuquerque, NM, United States
| | - Emma Brandt
- Center for Brain Recovery and Repair, University of New Mexico, Albuquerque, NM, United States
| | - Violet Fratzke
- Center for Brain Recovery and Repair, University of New Mexico, Albuquerque, NM, United States
| | - Rebecca Rieger
- Department of Psychology, University of New Mexico, Albuquerque, NM, United States
| | - John Kevin Wilson
- Center for Brain Recovery and Repair, University of New Mexico, Albuquerque, NM, United States
| | - Darbi Gill
- Center for Brain Recovery and Repair, University of New Mexico, Albuquerque, NM, United States
| | - Nickolas Mertens
- Center for Brain Recovery and Repair, University of New Mexico, Albuquerque, NM, United States.,Department of Psychology, University of New Mexico, Albuquerque, NM, United States
| | - Michael Hunter
- Center for Brain Recovery and Repair, University of New Mexico, Albuquerque, NM, United States
| | - Joel Upston
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Thomas R Jones
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Jessica D Richardson
- Department of Speech and Hearing Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Orrin Myers
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, United States
| | - David B Arciniegas
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Richard Campbell
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, United States.,Center for Brain Recovery and Repair, University of New Mexico, Albuquerque, NM, United States
| | - Vincent P Clark
- Department of Psychology, University of New Mexico, Albuquerque, NM, United States.,Mind Research Network, Albuquerque, NM, United States
| | - Ronald A Yeo
- Center for Brain Recovery and Repair, University of New Mexico, Albuquerque, NM, United States.,Department of Psychology, University of New Mexico, Albuquerque, NM, United States
| | - C William Shuttleworth
- Center for Brain Recovery and Repair, University of New Mexico, Albuquerque, NM, United States.,Department of Neurosciences, University of New Mexico, Albuquerque, NM, United States
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Naccache L, Luauté J, Silva S, Sitt JD, Rohaut B. Toward a coherent structuration of disorders of consciousness expertise at a country scale: A proposal for France. Rev Neurol (Paris) 2021; 178:9-20. [PMID: 34980510 DOI: 10.1016/j.neurol.2021.12.004] [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: 12/15/2021] [Accepted: 12/15/2021] [Indexed: 12/23/2022]
Abstract
Probing consciousness and cognitive abilities in non-communicating patients is one of the most challenging diagnostic issues. A fast growing medical and scientific literature explores the various facets of this challenge, often coined under the generic expression of 'Disorders of Consciousness' (DoC). Crucially, a set of independent converging results demonstrated both (1) the diagnostic and prognostic importance of this expertise, and (2) the need to combine behavioural measures with brain structure and activity data to improve diagnostic and prognostication accuracy as well as potential therapeutic intervention. Thus, probing consciousness in DoC patients appears as a crucial activity rich of human, medical, economic and ethical consequences, but this activity needs to be organized in order to offer this expertise to each concerned patient. More precisely, diagnosis of consciousness differs in difficulty across patients: while a minimal set of data can be sufficient to reach a confident result, some patients need a higher level of expertise that relies on additional behavioural and brain activity and brain structure measures. In order to enable this service on a systematic mode, we present two complementary proposals in the present article. First, we sketch a structuration of DoC expertise at a country-scale, namely France. More precisely, we suggest that a 2-tiers network composed of local (Tier-1) and regional (Tier-2) centers backed by distant electronic databases and algorithmic centers could optimally enable the systematic implementation of DoC expertise in France. Second, we propose to create a national common register of DoC patients in order to better monitor this activity, to improve its performance on the basis of nation-wide collected evidence, and to promote rational decision-making.
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Affiliation(s)
- L Naccache
- Sorbonne université, institut du cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France; Sorbonne université, UPMC Univ Paris 06, faculté de médecine Pitié-Salpêtrière, Paris, France; AP-HP, hôpital groupe hospitalier Pitié-Salpêtrière, DMU neurosciences, department of clinical neurophysiology, Paris, France; AP-HP, hôpital groupe hospitalier Pitié-Salpêtrière, DMU neurosciences, department of neurology, Neuro ICU, Paris, France.
| | - J Luauté
- Service de médecine physique et réadaptation, hôpital Henry-Gabrielle, Hospices Civils de Lyon, Saint-Genis Laval, France; Équipe « Trajectoires », centre de recherche en neurosciences de Lyon, Inserm UMR-S 1028, CNRS UMR 5292, université de Lyon, université Lyon 1, Bron, France
| | - S Silva
- Intensive Care Unit, Purpan University Hospital, 31000 Toulouse, France; Toulouse NeuroImaging Center (ToNIC lab) URM UPS/INSERM 1214, 31000 Toulouse, France
| | - J D Sitt
- Sorbonne université, institut du cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France; Sorbonne université, UPMC Univ Paris 06, faculté de médecine Pitié-Salpêtrière, Paris, France
| | - B Rohaut
- Sorbonne université, institut du cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France; Sorbonne université, UPMC Univ Paris 06, faculté de médecine Pitié-Salpêtrière, Paris, France; AP-HP, hôpital groupe hospitalier Pitié-Salpêtrière, DMU neurosciences, department of neurology, Neuro ICU, Paris, France
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Ronconi L, Maniglia M, Battaglini L, Melcher D. Editorial: Neural Modulation of Conscious Perception: Emerging Approaches From Basic Research to Clinical Translation. Front Psychol 2021; 12:779798. [PMID: 34744954 PMCID: PMC8569245 DOI: 10.3389/fpsyg.2021.779798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Luca Ronconi
- School of Psychology, Vita-Salute San Raffaele University, Milan, Italy.,Division of Neuroscience, Scientific Institute San Raffaele Hospital, Milan, Italy
| | - Marcello Maniglia
- Department of Psychology, University of California, Riverside, Riverside, CA, United States.,Department of Neurobiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Luca Battaglini
- Department of General Psychology, University of Padua, Padua, Italy.,Neuro Vis. U.S. Laboratory, University of Padua, Padua, Italy.,Department of Physics and Astronomy "Galileo Galilei," University of Padua, Padua, Italy
| | - David Melcher
- Department of Psychology and Cognitive Science, University of Trento, Trento, Italy.,Psychology Program, Division of Science, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
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Dong XL, Sun X, Sun WM, Yuan Q, Yu GH, Shuai L, Yuan YF. A randomized controlled trial to explore the efficacy and safety of transcranial direct current stimulation on patients with post-stroke fatigue. Medicine (Baltimore) 2021; 100:e27504. [PMID: 34731132 PMCID: PMC8519229 DOI: 10.1097/md.0000000000027504] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/25/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Post-stroke fatigue seriously affects the quality of life for stroke patients. There is no effective treatment at present. transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation which may have therapeutic effect on post-stroke fatigue. This study will explore about this. METHOD A total of 60 patients with post-stroke fatigue were randomly divided into the control group and the treatment group with 30 patients each by minimization randomization. Both groups received basic treatment and conventional rehabilitation. In the treatment group, patients were treated with active tDCS, while in the control group, sham tDCS. Both active and sham tDCS were administered 6 times a week for 4 weeks. Before and after the trial, the Fatigue Severity Scale (FSS), Fugl-Meyer Assessment (FMA) and Modified Barthel Index (MBI) were evaluated and analyzed. And comparisons were made among groups. And there were an 8-week follow-up after the intervention. RESULT Before the intervention, there were no significant differences in baseline data and assessment scores between the groups (P > 0.05). After 4 weeks of intervention, FSS scores in the treatment group were significantly lower than those in the control group (P = 0.012), and FMA and BMI scores were significantly higher than those in the control group (P < 0.05). There was no significant change in FSS scores after 8 months of follow-up (P > 0.05). DISCUSSION TDCS is a safe treatment that can effectively reduce the degree of fatigue after stroke, improve the motor function and daily activity ability of patients after stroke, and the efficacy is better than only routine rehabilitation training. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Registry, ChiCTR2000031120. Registered on March 22, 2020.
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Affiliation(s)
- Xiang-Li Dong
- Department of Psychosomatic Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xing Sun
- First Clinical Medical School, Nanchang University, Nanchang, China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei-Ming Sun
- First Clinical Medical School, Nanchang University, Nanchang, China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qin Yuan
- Department of Psychology, Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi Province, China
| | - Guo-Hua Yu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lang Shuai
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ye-Feng Yuan
- First Clinical Medical School, Nanchang University, Nanchang, China
- Department of Psychosomatic Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
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Zhang X, Liu B, Li Y, Duan G, Hou J, Wu D. Multi-Target and Multi-Session Transcranial Direct Current Stimulation in Patients With Prolonged Disorders of Consciousness: A Controlled Study. Front Neurosci 2021; 15:641951. [PMID: 34566555 PMCID: PMC8456025 DOI: 10.3389/fnins.2021.641951] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 08/17/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives: To investigate the effect of multi-session transcranial direct current stimulation (tDCS) over the prefrontal area, left dorsolateral prefrontal cortex (DLPFC), and bilateral fronto-temporo-parietal cortices (FTPCs) in patients with prolonged disorders of consciousness (DOC) and to examine the altered cortical interconnections using non-linear electroencephalography (EEG). Methods: In this open-label controlled study, conventional treatments were implemented in both the control and tDCS groups, together with 80 tDCS sessions only in the tDCS group. The order of tDCS targets was as follows: prefrontal area, left FTPC, right FTPC, and left DLPFC. The Coma Recovery Scale-Revised (CRS-R) and non-linear EEG index were evaluated before and after the treatment. Additionally, the modified Glasgow Outcome Scale (mGOS) was used as a follow-up evaluation at 12 months after the disease onset. Results: The CRS-R improved significantly in both groups after the treatment. However, the CRS-R and mGOS were more significantly improved in the tDCS group than in the control group. Among the cross approximate entropy (C-ApEn) indices, the local CA-PA and CA-FA under the affected painful stimulus condition and all local and remote indices of the unaffected side under the unaffected painful stimulus condition were significantly higher in the tDCS group than in the control group. Multivariate logistic regression analysis revealed that group and type were the main relevant factors based on mGOS improvement. Multivariate linear regression analysis revealed that group, CA-FA, and CU-MTU were the main relevant factors based on CRS-R improvement under the affected painful stimulus conditions, whereas only CU-MTU and CU-FPU were relevant under the unaffected painful stimulus condition. Conclusion: Multi-target and multi-session tDCS could improve the cortical connections between the primary sensorimotor and frontal cortices of the affected hemisphere and the prefrontal-parietal and temporo-parietal associative cortical networks of the unaffected hemisphere. Thus, this tDCS protocol may be used as an add-on treatment for prolonged DOC.
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Affiliation(s)
- Xu Zhang
- Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Baohu Liu
- Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuanyuan Li
- Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Guoping Duan
- Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jun Hou
- Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Dongyu Wu
- Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Lejeune N, Zasler N, Formisano R, Estraneo A, Bodart O, Magee WL, Thibaut A. Epilepsy in prolonged disorders of consciousness: a systematic review. Brain Inj 2021; 35:1485-1495. [PMID: 34499571 DOI: 10.1080/02699052.2021.1973104] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
To date, no guideline exists for the management of epilepsy in patients with prolonged Disorders of Consciousness (DoC). This review aimed to assess the occurrence of epilepsy and epileptic abnormalities (EA) in these patients, to determine their impact on recovery; and to review the effect of antiepileptic drugs (AED) and therapeutic interventions on seizure occurrence and consciousness recovery. A structured search for studies on prolonged DoC and epilepsy was undertaken following PRISMA guidelines. From an initial search resulting in 5,775 titles, twelve studies met inclusion criteria. The occurrence of epilepsy and EA in DoC was poorly and inconsistently reported across studies. The results estimated a seizure prevalence of 27% in DoC. No conclusive data were found for the effects of AED on recovery nor on the influence of any therapeutic interventions on seizure occurrence. Given the scarcity of data, it is premature to make evidence-based recommendations on epilepsy in prolonged DoC. Based on this review and current clinical practices the following are recommended: (1) repeated standard EEG for detecting seizures and EA; (2) treating epilepsy while avoiding AEDs with sedating or cognitive side-effects. Future research should use standardized classification systems for seizures and EA.
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Affiliation(s)
- Nicolas Lejeune
- GIGA-Consciousness, University of Liège, Liège, Belgium.,Centre Du Cerveau2, University Hospital of Liège, Liège, Belgium.,Institute of NeuroScience, Université Catholique De Louvain, Brussels, Belgium.,Centre Hospitalier Neurologique William Lennox, Ottignies-Louvain-la-Neuve, Belgium
| | - Nathan Zasler
- Concussion Care Centre of Virginia and Tree of Life Services. Department of PM&R, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Anna Estraneo
- Neurology Unit, Santa Maria Della Pietà General Hospital, Nola, Italy.,IRCCS Fondazione Don Carlo Gnocchi Onlus, Florence, Italy
| | - Olivier Bodart
- GIGA-Consciousness, University of Liège, Liège, Belgium.,Centre Du Cerveau2, University Hospital of Liège, Liège, Belgium.,Epileptology Unit, Neurology Department, University Hospital of Liège, Liège, Belgium
| | - Wendy L Magee
- Boyer College of Music and Dance, Temple University; Philadelphia, PA USA
| | - Aurore Thibaut
- GIGA-Consciousness, University of Liège, Liège, Belgium.,Centre Du Cerveau2, University Hospital of Liège, Liège, Belgium
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42
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Sanz Perl Y, Pallavicini C, Pérez Ipiña I, Demertzi A, Bonhomme V, Martial C, Panda R, Annen J, Ibañez A, Kringelbach M, Deco G, Laufs H, Sitt J, Laureys S, Tagliazucchi E. Perturbations in dynamical models of whole-brain activity dissociate between the level and stability of consciousness. PLoS Comput Biol 2021; 17:e1009139. [PMID: 34314430 PMCID: PMC8315553 DOI: 10.1371/journal.pcbi.1009139] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 06/01/2021] [Indexed: 01/07/2023] Open
Abstract
Consciousness transiently fades away during deep sleep, more stably under anesthesia, and sometimes permanently due to brain injury. The development of an index to quantify the level of consciousness across these different states is regarded as a key problem both in basic and clinical neuroscience. We argue that this problem is ill-defined since such an index would not exhaust all the relevant information about a given state of consciousness. While the level of consciousness can be taken to describe the actual brain state, a complete characterization should also include its potential behavior against external perturbations. We developed and analyzed whole-brain computational models to show that the stability of conscious states provides information complementary to their similarity to conscious wakefulness. Our work leads to a novel methodological framework to sort out different brain states by their stability and reversibility, and illustrates its usefulness to dissociate between physiological (sleep), pathological (brain-injured patients), and pharmacologically-induced (anesthesia) loss of consciousness.
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Affiliation(s)
- Yonatan Sanz Perl
- Department of Physics, University of Buenos Aires, Intendente Güiraldes 2160—Ciudad Universitaria—Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), CABA, Buenos Aires, Argentina
- Cognitive Neuroscience Center (CNC), Universidad de San Andrés, Buenos Aires, Argentina
- Center for Brain and Cognition, Computational Neuroscience Group, Universitat Pompeu Fabra, Barcelona, Spain
- * E-mail: (YSP); (ET)
| | - Carla Pallavicini
- Department of Physics, University of Buenos Aires, Intendente Güiraldes 2160—Ciudad Universitaria—Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), CABA, Buenos Aires, Argentina
- Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (FLENI), Buenos Aires, Argentina
| | - Ignacio Pérez Ipiña
- Department of Physics, University of Buenos Aires, Intendente Güiraldes 2160—Ciudad Universitaria—Buenos Aires, Argentina
- Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (FLENI), Buenos Aires, Argentina
| | - Athena Demertzi
- Physiology of Cognition Research Lab, GIGA-Consciousness, GIGA Institute, University of Liège, Liège, Belgium
| | - Vincent Bonhomme
- Anesthesia and Intensive Care Laboratory, GIGA-Consciousness, GIGA Institute, University of Liège, Liège, Belgium
- University Department of Anesthesia and Intensive Care Medicine, Centre Hospitalier Régional de la Citadelle (CHR Citadelle), Liège, Belgium
- Department of Anesthesia and Intensive Care Medicine, Centre Hospitalier Universitaire de Liège (CHU Liège), Liège, Belgium
| | - Charlotte Martial
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau², Centre Hospitalier Universitaire de Liège (CHU Liège), Liège, Belgium
| | - Rajanikant Panda
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau², Centre Hospitalier Universitaire de Liège (CHU Liège), Liège, Belgium
| | - Jitka Annen
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau², Centre Hospitalier Universitaire de Liège (CHU Liège), Liège, Belgium
| | - Agustin Ibañez
- National Scientific and Technical Research Council (CONICET), CABA, Buenos Aires, Argentina
- Cognitive Neuroscience Center (CNC), Universidad de San Andrés, Buenos Aires, Argentina
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile
- Global Brain Health Institute (GBHI), University of California-San Francisco (UCSF), San Francisco, California, United States and Trinity College Dublin, Ireland
| | - Morten Kringelbach
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Center for Music in the Brain, Department of Clinical Medicine, Aarhus University, Århus, Denmark
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- Centre for Eudaimonia and Human Flourishing, University of Oxford, Oxford, United Kingdom
| | - Gustavo Deco
- Center for Brain and Cognition, Computational Neuroscience Group, Universitat Pompeu Fabra, Barcelona, Spain
- Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
- Institució Catalana de la Recerca i Estudis Avançats (ICREA), Barcelona, Spain
- Department of Neuropsychology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Helmut Laufs
- Department of Neurology and Brain Imaging Center, Goethe University, Frankfurt am Main, Germany
- Department of Neurology, Christian Albrechts University, Kiel, Germany
| | - Jacobo Sitt
- Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
- Inserm U 1127, Paris, France
- CNRS UMR 7225, Paris, France
| | - Steven Laureys
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau², Centre Hospitalier Universitaire de Liège (CHU Liège), Liège, Belgium
| | - Enzo Tagliazucchi
- Department of Physics, University of Buenos Aires, Intendente Güiraldes 2160—Ciudad Universitaria—Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), CABA, Buenos Aires, Argentina
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile
- Department of Neurology, Christian Albrechts University, Kiel, Germany
- * E-mail: (YSP); (ET)
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43
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Treating Traumatic Brain Injuries with Electroceuticals: Implications for the Neuroanatomy of Consciousness. NEUROSCI 2021. [DOI: 10.3390/neurosci2030018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
According to the Centers for Disease Control and Prevention (CDC), traumatic brain injury (TBI) is the leading cause of loss of consciousness, long-term disability, and death in children and young adults (age 1 to 44). Currently, there are no United States Food and Drug Administration (FDA) approved pharmacological treatments for post-TBI regeneration and recovery, particularly related to permanent disability and level of consciousness. In some cases, long-term disorders of consciousness (DoC) exist, including the vegetative state/unresponsive wakefulness syndrome (VS/UWS) characterized by the exhibition of reflexive behaviors only or a minimally conscious state (MCS) with few purposeful movements and reflexive behaviors. Electroceuticals, including non-invasive brain stimulation (NIBS), vagus nerve stimulation (VNS), and deep brain stimulation (DBS) have proved efficacious in some patients with TBI and DoC. In this review, we examine how electroceuticals have improved our understanding of the neuroanatomy of consciousness. However, the level of improvements in general arousal or basic bodily and visual pursuit that constitute clinically meaningful recovery on the Coma Recovery Scale-Revised (CRS-R) remain undefined. Nevertheless, these advancements demonstrate the importance of the vagal nerve, thalamus, reticular activating system, and cortico-striatal-thalamic-cortical loop in the process of consciousness recovery.
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Martens G, Ibáñez-Soria D, Barra A, Soria-Frisch A, Piarulli A, Gosseries O, Salvador R, Rojas A, Nitsche MA, Kroupi E, Laureys S, Ruffini G, Thibaut A. A novel closed-loop EEG-tDCS approach to promote responsiveness of patients in minimally conscious state: A study protocol. Behav Brain Res 2021; 409:113311. [PMID: 33878429 DOI: 10.1016/j.bbr.2021.113311] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 03/10/2021] [Accepted: 04/15/2021] [Indexed: 01/28/2023]
Abstract
Transcranial direct current stimulation (tDCS) applied over the prefrontal cortex has been shown to improve behavioral responsiveness in patients with disorders of consciousness following severe brain injury, especially those in minimally conscious state (MCS). However, one potential barrier of clinical response to tDCS is the timing of stimulation with regard to the fluctuations of vigilance that characterize this population. Indeed, a previous study showed that the vigilance of MCS patients has periodic average cycles of 70 min (range 57-80 min), potentially preventing them to be in an optimal neural state to benefit from tDCS when applied randomly. To tackle this issue, we propose a new protocol to optimize the application of tDCS by selectively stimulating at high and low vigilance states. Electroencephalography (EEG) real-time spectral entropy will be used as a marker of vigilance and to trigger tDCS, in a closed-loop fashion. We will conduct a randomized controlled crossover clinical trial on 16 patients in prolonged MCS who will undergo three EEG-tDCS sessions 5 days apart (1. tDCS applied at high vigilance; 2. tDCS applied at low vigilance; 3. tDCS applied at a random moment). Behavioral effects will be assessed using the Coma Recovery Scale-Revised at baseline and right after the stimulations. EEG will be recorded throughout the session and for 30 min after the end of the stimulation. This unique and novel approach will provide patients' tailored treatment options, currently lacking in the field of disorders of consciousness.
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Affiliation(s)
- Géraldine Martens
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium; Centre du cerveau², University Hospital of Liège, Liège, Belgium.
| | | | - Alice Barra
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium; Centre du cerveau², University Hospital of Liège, Liège, Belgium
| | | | - Andrea Piarulli
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Italy
| | - Olivia Gosseries
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium; Centre du cerveau², University Hospital of Liège, Liège, Belgium
| | | | | | - Michael A Nitsche
- Dept. Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany; Dept. Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany
| | | | - Steven Laureys
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium; Centre du cerveau², University Hospital of Liège, Liège, Belgium
| | | | - Aurore Thibaut
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium; Centre du cerveau², University Hospital of Liège, Liège, Belgium
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Huels ER, Groenhout T, Fields CW, Liu T, Mashour GA, Pal D. Inactivation of Prefrontal Cortex Delays Emergence From Sevoflurane Anesthesia. Front Syst Neurosci 2021; 15:690717. [PMID: 34305541 PMCID: PMC8299111 DOI: 10.3389/fnsys.2021.690717] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 06/10/2021] [Indexed: 01/21/2023] Open
Abstract
Studies aimed at investigating brain regions involved in arousal state control have been traditionally limited to subcortical structures. In the current study, we tested the hypothesis that inactivation of prefrontal cortex, but not two subregions within parietal cortex—somatosensory barrel field and medial/lateral parietal association cortex—would suppress arousal, as measured by an increase in anesthetic sensitivity. Male and female Sprague Dawley rats were surgically prepared for recording electroencephalogram and bilateral infusion into prefrontal cortex (N = 13), somatosensory barrel field (N = 10), or medial/lateral parietal association cortex (N = 9). After at least 10 days of post-surgical recovery, 156 μM tetrodotoxin or saline was microinjected into one of the cortical sites. Ninety minutes after injection, rats were anesthetized with 2.5% sevoflurane and the time to loss of righting reflex, a surrogate for loss of consciousness, was measured. Sevoflurane was stopped after 45 min and the time to return of righting reflex, a surrogate for return of consciousness, was measured. Tetrodotoxin-mediated inactivation of all three cortical sites decreased (p < 0.05) the time to loss of righting reflex. By contrast, only inactivation of prefrontal cortex, but not somatosensory barrel field or medial/lateral parietal association cortex, increased (p < 0.001) the time to return of righting reflex. Burst suppression ratio was not altered following inactivation of any of the cortical sites, suggesting that there was no global effect due to pharmacologic lesion. These findings demonstrate that prefrontal cortex plays a causal role in emergence from anesthesia and behavioral arousal.
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Affiliation(s)
- Emma R Huels
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States.,Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, United States.,Center for Consciousness Science, University of Michigan, Ann Arbor, MI, United States
| | - Trent Groenhout
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - Christopher W Fields
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - Tiecheng Liu
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - George A Mashour
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States.,Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, United States.,Center for Consciousness Science, University of Michigan, Ann Arbor, MI, United States
| | - Dinesh Pal
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States.,Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, United States.,Center for Consciousness Science, University of Michigan, Ann Arbor, MI, United States
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46
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Aloi D, della Rocchetta AI, Ditchfield A, Coulborn S, Fernández-Espejo D. Therapeutic Use of Transcranial Direct Current Stimulation in the Rehabilitation of Prolonged Disorders of Consciousness. Front Neurol 2021; 12:632572. [PMID: 33897592 PMCID: PMC8058460 DOI: 10.3389/fneur.2021.632572] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/09/2021] [Indexed: 12/20/2022] Open
Abstract
Patients with Prolonged Disorders of Consciousness (PDOC) have catastrophic disabilities and very complex needs for care. Therapeutic options are very limited, and patients often show little functional improvement over time. Neuroimaging studies have demonstrated that a significant number of PDOC patients retain a high level of cognitive functioning, and in some cases even awareness, and are simply unable to show this with their external behavior - a condition known as cognitive-motor dissociation (CMD). Despite vast implications for diagnosis, the discovery of covert cognition in PDOC patients is not typically associated with a more favorable prognosis, and the majority of patients will remain in a permanent state of low responsiveness. Recently, transcranial direct current stimulation (tDCS) has attracted attention as a potential therapeutic tool in PDOC. Research to date suggests that tDCS can lead to clinical improvements in patients with a minimally conscious state (MCS), especially when administered over multiple sessions. While promising, the outcomes of these studies have been highly inconsistent, partially due to small sample sizes, heterogeneous methodologies (in terms of both tDCS parameters and outcome measures), and limitations related to electrode placement and heterogeneity of brain damage inherent to PDOC. In addition, we argue that neuroimaging and electrophysiological assessments may serve as more sensitive biomarkers to identify changes after tDCS that are not yet apparent behaviorally. Finally, given the evidence that concurrent brain stimulation and physical therapy can enhance motor rehabilitation, we argue that future studies should focus on the integration of tDCS with conventional rehabilitation programmes from the subacute phase of care onwards, to ascertain whether any synergies exist.
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Affiliation(s)
- Davide Aloi
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
- Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
| | | | - Alice Ditchfield
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
- Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
| | - Sean Coulborn
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
- Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
| | - Davinia Fernández-Espejo
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
- Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
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47
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Abstract
Background: Reviving patients with prolonged disorders of consciousness (DOCs) has always been focused and challenging in medical research. Owing to the limited effectiveness of available medicine, recent research has increasingly turned towards neuromodulatory therapies, involving the stimulation of neural circuits. We summarised the progression of research regarding neuromodulatory therapies in the field of DOCs, compared the differences among different studies, in an attempt to explore optimal stimulation patterns and parameters, and analyzed the major limitations of the relevant studies to facilitate future research. Methods: We performed a search in the PubMed database, using the concepts of DOCs and neuromodulation. Inclusion criteria were: articles in English, published after 2002, and reporting clinical trials of neuromodulatory therapies in human patients with DOCs. Results: Overall, 187 published articles met the search criteria, and 60 articles met the inclusion criteria. There are differences among these studies regarding the clinical efficacies of neurostimulation techniques for patients with DOCs, and large-sample studies are still lacking. Conclusions: Neuromodulatory techniques were used as trial therapies for DOCs wherein their curative effects were controversial. The difficulties in detecting residual consciousness, the confounding effect between the natural course of the disease and therapeutic effect, and the heterogeneity across patients are the major limitations. Large-sample, well-designed studies, and innovations for both treatment and assessment are anticipated in future research.
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48
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Li Y, He J, Yang B, Zhang H, Yang Z, Fu J, Huang L, Chen H, Yang X, Bao Y. Clinical diagnosis guidelines and neurorestorative treatment for chronic disorders of consciousness (2021 China version). JOURNAL OF NEURORESTORATOLOGY 2021. [DOI: 10.26599/jnr.2021.9040006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Chronic disorders of consciousness (DOC) include the vegetative state and the minimally consciousness state. The DOC diagnosis mainly relies on the evaluation of clinical behavioral scales, electrophysiological testing, and neuroimaging examinations. No specifically effective neurorestorative methods for chronic DOC currently exist. Any valuable exploration therapies of being able to repair functions and/or structures in the consciousness loop (e.g., drugs, hyperbaric medicines, noninvasive neurostimulation, sensory and environmental stimulation, invasive neuromodulation therapy, and cell transplantation) may become effective neurorestorative strategies for chronic DOC. In the viewpoint of Neurorestoratology, this guideline proposes the diagnostic and neurorestorative therapeutic suggestions and future exploration direction for this disease following the review of the existing treatment exploration achievements for chronic DOC.
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49
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Sinitsyn DO, Poydasheva AG, Bakulin IS, Legostaeva LA, Iazeva EG, Sergeev DV, Sergeeva AN, Kremneva EI, Morozova SN, Lagoda DY, Casarotto S, Comanducci A, Ryabinkina YV, Suponeva NA, Piradov MA. Detecting the Potential for Consciousness in Unresponsive Patients Using the Perturbational Complexity Index. Brain Sci 2020; 10:E917. [PMID: 33260944 PMCID: PMC7760168 DOI: 10.3390/brainsci10120917] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/24/2020] [Accepted: 11/24/2020] [Indexed: 12/26/2022] Open
Abstract
The difficulties of behavioral evaluation of prolonged disorders of consciousness (DOC) motivate the development of brain-based diagnostic approaches. The perturbational complexity index (PCI), which measures the complexity of electroencephalographic (EEG) responses to transcranial magnetic stimulation (TMS), showed a remarkable sensitivity in detecting minimal signs of consciousness in previous studies. Here, we tested the reliability of PCI in an independently collected sample of 24 severely brain-injured patients, including 11 unresponsive wakefulness syndrome (UWS), 12 minimally conscious state (MCS) patients, and 1 emergence from MCS patient. We found that the individual maximum PCI value across stimulation sites fell within the consciousness range (i.e., was higher than PCI*, which is an empirical cutoff previously validated on a benchmark population) in 11 MCS patients, yielding a sensitivity of 92% that surpassed qualitative evaluation of resting EEG. Most UWS patients (n = 7, 64%) showed a slow and stereotypical TMS-EEG response, associated with low-complexity PCI values (i.e., ≤PCI*). Four UWS patients (36%) provided high-complexity PCI values, which might suggest a covert capacity for consciousness. In conclusion, this study successfully replicated the performance of PCI in discriminating between UWS and MCS patients, further motivating the application of TMS-EEG in the workflow of DOC evaluation.
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Affiliation(s)
- Dmitry O. Sinitsyn
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.G.P.); (I.S.B.); (L.A.L.); (E.G.I.); (D.V.S.); (A.N.S.); (E.I.K.); (S.N.M.); (D.Y.L.); (Y.V.R.); (N.A.S.); (M.A.P.)
| | - Alexandra G. Poydasheva
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.G.P.); (I.S.B.); (L.A.L.); (E.G.I.); (D.V.S.); (A.N.S.); (E.I.K.); (S.N.M.); (D.Y.L.); (Y.V.R.); (N.A.S.); (M.A.P.)
| | - Ilya S. Bakulin
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.G.P.); (I.S.B.); (L.A.L.); (E.G.I.); (D.V.S.); (A.N.S.); (E.I.K.); (S.N.M.); (D.Y.L.); (Y.V.R.); (N.A.S.); (M.A.P.)
| | - Liudmila A. Legostaeva
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.G.P.); (I.S.B.); (L.A.L.); (E.G.I.); (D.V.S.); (A.N.S.); (E.I.K.); (S.N.M.); (D.Y.L.); (Y.V.R.); (N.A.S.); (M.A.P.)
| | - Elizaveta G. Iazeva
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.G.P.); (I.S.B.); (L.A.L.); (E.G.I.); (D.V.S.); (A.N.S.); (E.I.K.); (S.N.M.); (D.Y.L.); (Y.V.R.); (N.A.S.); (M.A.P.)
| | - Dmitry V. Sergeev
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.G.P.); (I.S.B.); (L.A.L.); (E.G.I.); (D.V.S.); (A.N.S.); (E.I.K.); (S.N.M.); (D.Y.L.); (Y.V.R.); (N.A.S.); (M.A.P.)
| | - Anastasia N. Sergeeva
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.G.P.); (I.S.B.); (L.A.L.); (E.G.I.); (D.V.S.); (A.N.S.); (E.I.K.); (S.N.M.); (D.Y.L.); (Y.V.R.); (N.A.S.); (M.A.P.)
| | - Elena I. Kremneva
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.G.P.); (I.S.B.); (L.A.L.); (E.G.I.); (D.V.S.); (A.N.S.); (E.I.K.); (S.N.M.); (D.Y.L.); (Y.V.R.); (N.A.S.); (M.A.P.)
| | - Sofya N. Morozova
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.G.P.); (I.S.B.); (L.A.L.); (E.G.I.); (D.V.S.); (A.N.S.); (E.I.K.); (S.N.M.); (D.Y.L.); (Y.V.R.); (N.A.S.); (M.A.P.)
| | - Dmitry Yu. Lagoda
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.G.P.); (I.S.B.); (L.A.L.); (E.G.I.); (D.V.S.); (A.N.S.); (E.I.K.); (S.N.M.); (D.Y.L.); (Y.V.R.); (N.A.S.); (M.A.P.)
| | - Silvia Casarotto
- Department of Biomedical and Clinical Sciences “L. Sacco”, University of Milan, 20157 Milan, Italy;
| | | | - Yulia V. Ryabinkina
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.G.P.); (I.S.B.); (L.A.L.); (E.G.I.); (D.V.S.); (A.N.S.); (E.I.K.); (S.N.M.); (D.Y.L.); (Y.V.R.); (N.A.S.); (M.A.P.)
| | - Natalia A. Suponeva
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.G.P.); (I.S.B.); (L.A.L.); (E.G.I.); (D.V.S.); (A.N.S.); (E.I.K.); (S.N.M.); (D.Y.L.); (Y.V.R.); (N.A.S.); (M.A.P.)
| | - Michael A. Piradov
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.G.P.); (I.S.B.); (L.A.L.); (E.G.I.); (D.V.S.); (A.N.S.); (E.I.K.); (S.N.M.); (D.Y.L.); (Y.V.R.); (N.A.S.); (M.A.P.)
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50
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Sex Differences in Neuromodulation Treatment Approaches for Traumatic Brain Injury: A Scoping Review. J Head Trauma Rehabil 2020; 35:412-429. [PMID: 33165154 DOI: 10.1097/htr.0000000000000631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Neuromodulatory brain stimulation interventions for traumatic brain injury (TBI)-related health sequelae, such as psychiatric, cognitive, and pain disorders, are on the rise. Because of disproportionate recruitment and epidemiological reporting of TBI-related research in men, there is limited understanding of TBI development, pathophysiology, and treatment intervention outcomes in women. With data suggesting sex-related variances in treatment outcomes, it is important that these gaps are addressed in emerging, neuromodulatory treatment approaches for TBI populations. METHODS Four research databases (PubMED, EMBASE, CINAHL, and PsycINFO) were electronically searched in February 2020. DESIGN This PRISMA Scoping Review (PRISMA-ScR)-guided report contextualizes the importance of reporting sex differences in TBI + neuromodulatory intervention studies and summarizes the current state of reporting sex differences when investigating 3 emerging interventions for TBI outcomes. RESULTS Fifty-four studies were identified for the final review including 12 controlled trials, 16 single or case series reports, and 26 empirical studies. Across all studies reviewed, 68% of participants were male, and only 7 studies reported sex differences as a part of their methodological approach, analysis, or discussion. CONCLUSION This review is hoped to update the TBI community on the current state of evidence in reporting sex differences across these 3 neuromodulatory treatments of post-TBI sequelae. The proposed recommendations aim to improve future research and clinical treatment of all individuals suffering from post-TBI sequelae.
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