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Redinbaugh MJ, Saalmann YB. Contributions of Basal Ganglia Circuits to Perception, Attention, and Consciousness. J Cogn Neurosci 2024; 36:1620-1642. [PMID: 38695762 PMCID: PMC11223727 DOI: 10.1162/jocn_a_02177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
Research into ascending sensory pathways and cortical networks has generated detailed models of perception. These same cortical regions are strongly connected to subcortical structures, such as the basal ganglia (BG), which have been conceptualized as playing key roles in reinforcement learning and action selection. However, because the BG amasses experiential evidence from higher and lower levels of cortical hierarchies, as well as higher-order thalamus, it is well positioned to dynamically influence perception. Here, we review anatomical, functional, and clinical evidence to demonstrate how the BG can influence perceptual processing and conscious states. This depends on the integrative relationship between cortex, BG, and thalamus, which allows contributions to sensory gating, predictive processing, selective attention, and representation of the temporal structure of events.
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Affiliation(s)
| | - Yuri B Saalmann
- University of Wisconsin-Madison
- Wisconsin National Primate Research Center
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Ghanem K, Saltoun K, Suvrathan A, Draganski B, Bzdok D. Longitudinal microstructural changes in 18 amygdala nuclei resonate with cortical circuits and phenomics. Commun Biol 2024; 7:477. [PMID: 38637627 PMCID: PMC11026520 DOI: 10.1038/s42003-024-06187-5] [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: 05/23/2023] [Accepted: 04/11/2024] [Indexed: 04/20/2024] Open
Abstract
The amygdala nuclei modulate distributed neural circuits that most likely evolved to respond to environmental threats and opportunities. So far, the specific role of unique amygdala nuclei in the context processing of salient environmental cues lacks adequate characterization across neural systems and over time. Here, we present amygdala nuclei morphometry and behavioral findings from longitudinal population data (>1400 subjects, age range 40-69 years, sampled 2-3 years apart): the UK Biobank offers exceptionally rich phenotyping along with brain morphology scans. This allows us to quantify how 18 microanatomical amygdala subregions undergo plastic changes in tandem with coupled neural systems and delineating their associated phenome-wide profiles. In the context of population change, the basal, lateral, accessory basal, and paralaminar nuclei change in lockstep with the prefrontal cortex, a region that subserves planning and decision-making. The central, medial and cortical nuclei are structurally coupled with the insular and anterior-cingulate nodes of the salience network, in addition to the MT/V5, basal ganglia, and putamen, areas proposed to represent internal bodily states and mediate attention to environmental cues. The central nucleus and anterior amygdaloid area are longitudinally tied with the inferior parietal lobule, known for a role in bodily awareness and social attention. These population-level amygdala-brain plasticity regimes in turn are linked with unique collections of phenotypes, ranging from social status and employment to sleep habits and risk taking. The obtained structural plasticity findings motivate hypotheses about the specific functions of distinct amygdala nuclei in humans.
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Affiliation(s)
- Karam Ghanem
- The Neuro - Montreal Neurological Institute (MNI), McConnell Brain Imaging Centre, Department of Biomedical Engineering, Faculty of Medicine, School of Computer Science, McGill University, Montreal, Canada.
- Mila - Quebec Artificial Intelligence Institute, Montreal, QC, Canada.
| | - Karin Saltoun
- The Neuro - Montreal Neurological Institute (MNI), McConnell Brain Imaging Centre, Department of Biomedical Engineering, Faculty of Medicine, School of Computer Science, McGill University, Montreal, Canada
- Mila - Quebec Artificial Intelligence Institute, Montreal, QC, Canada
| | - Aparna Suvrathan
- Department of Neurology and Neurosurgery, Department of Pediatrics, McGill University, Montreal, QC, Canada
- Brain Repair and Integrative Neuroscience (BRaIN) Research Program, Montreal, QC, Canada
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Bogdan Draganski
- LREN, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
- Neurology Department, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Danilo Bzdok
- The Neuro - Montreal Neurological Institute (MNI), McConnell Brain Imaging Centre, Department of Biomedical Engineering, Faculty of Medicine, School of Computer Science, McGill University, Montreal, Canada.
- Mila - Quebec Artificial Intelligence Institute, Montreal, QC, Canada.
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Hadi Z, Mahmud M, Seemungal BM. Brain Mechanisms Explaining Postural Imbalance in Traumatic Brain Injury: A Systematic Review. Brain Connect 2024; 14:144-177. [PMID: 38343363 DOI: 10.1089/brain.2023.0064] [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: 03/27/2024] Open
Abstract
Introduction: Persisting imbalance and falls in community-dwelling traumatic brain injury (TBI) survivors are linked to reduced long-term survival. However, a detailed understanding of the impact of TBI upon the brain mechanisms mediating imbalance is lacking. To understand the state of the art concerning the brain mechanisms mediating imbalance in TBI, we performed a systematic review of the literature. Methods: PubMed, Web of Science, and Scopus were searched and peer-reviewed research articles in humans, with any severity of TBI (mild, moderate, severe, or concussion), which linked a postural balance assessment (objective or subjective) with brain imaging (through computed tomography, T1-weighted imaging, functional magnetic resonance imaging [fMRI], resting-state fMRI, diffusion tensor imaging, magnetic resonance spectroscopy, single-photon emission computed tomography, electroencephalography, magnetoencephalography, near-infrared spectroscopy, and evoked potentials) were included. Out of 1940 articles, 60 were retrieved and screened, and 25 articles fulfilling inclusion criteria were included. Results: The most consistent finding was the link between imbalance and the cerebellum; however, the regions within the cerebellum were inconsistent. Discussion: The lack of consistent findings could reflect that imbalance in TBI is due to a widespread brain network dysfunction, as opposed to focal cortical damage. The inconsistency in the reported findings may also be attributed to heterogeneity of methodology, including data analytical techniques, small sample sizes, and choice of control groups. Future studies should include a detailed clinical phenotyping of vestibular function in TBI patients to account for the confounding effect of peripheral vestibular disorders on imbalance and brain imaging.
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Affiliation(s)
- Zaeem Hadi
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Mohammad Mahmud
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Barry M Seemungal
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, London, United Kingdom
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Tang QY, Huang BL, Huang X. Altered functional connectivity between the default mode network in primary angle-closure glaucoma patients. Neuroreport 2024; 35:129-135. [PMID: 38251458 DOI: 10.1097/wnr.0000000000001995] [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: 01/23/2024]
Abstract
Previous studies have recognized glaucoma as a neurodegenerative disease that causes extensive brain damage and is closely associated with cognitive function. In this study, we employed functional MRI to examine the intrinsic functional connectivity patterns of the default mode network (DMN) in patients diagnosed with primary angle-closure glaucoma (PACG), exploring its association with cognitive dysfunction. A total of 34 patients diagnosed with PACG and 34 healthy controls (HC), who were matched in terms of sex, age, and education, were included in the control group. The posterior cingulate cortex (PCC) was selected as the region of interest to examine functional connectivity alterations. Compared with the HC group, functional connectivity was attenuated in left anterior cingulum cortex and left paracentral lobule between with PCC in the PACG group, the results are statistically significant. Our study revealed that patients with PACG exhibit weakened functional connectivity within the DMN. This finding suggests the presence of a neurological mechanism that is associated with both visual dysfunction and cognitive impairments in PACG patients. Furthermore, our study provides neuroimaging evidence that can aid in the exploration of spontaneous neurological alterations and facilitate a deeper investigation of alterations in the visual conduction pathways of PACG patients.
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Affiliation(s)
- Qiu-Yu Tang
- College of Clinical Medicine, Jiangxi University of Chinese Medicine
| | - Bing-Lin Huang
- College of Clinical Medicine, Jiangxi University of Chinese Medicine
| | - Xin Huang
- Department of Ophthalmology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
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Xu LB, Hampton S, Fischer D. Neuroimaging in Disorders of Consciousness and Recovery. Phys Med Rehabil Clin N Am 2024; 35:51-64. [PMID: 37993193 DOI: 10.1016/j.pmr.2023.06.017] [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] [Indexed: 11/24/2023]
Abstract
There is a clinical need for more accurate diagnosis and prognostication in patients with disorders of consciousness (DoC). There are several neuroimaging modalities that enable detailed, quantitative assessment of structural and functional brain injury, with demonstrated diagnostic and prognostic value. Additionally, longitudinal neuroimaging studies have hinted at quantifiable structural and functional neuroimaging biomarkers of recovery, with potential implications for the management of DoC.
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Affiliation(s)
- Linda B Xu
- Department of Neurology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| | - Stephen Hampton
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania, 1800 Lombard Street, Philadelphia, PA 19146, USA
| | - David Fischer
- Department of Neurology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Yang Y, Dai Y, He Q, Wang S, Chen X, Geng X, He J, Duan F. Altered brain functional connectivity in vegetative state and minimally conscious state. Front Aging Neurosci 2023; 15:1213904. [PMID: 37469954 PMCID: PMC10352323 DOI: 10.3389/fnagi.2023.1213904] [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: 04/28/2023] [Accepted: 06/06/2023] [Indexed: 07/21/2023] Open
Abstract
Objectives The pathological mechanism for a disorder of consciousness (DoC) is still not fully understood. Based on traditional behavioral scales, there is a high rate of misdiagnosis for subtypes of DoC. We aimed to explore whether topological characterization may explain the pathological mechanisms of DoC and be effective in diagnosing the subtypes of DoC. Methods Using resting-state functional magnetic resonance imaging data, the weighted brain functional networks for normal control subjects and patients with vegetative state (VS) and minimally conscious state (MCS) were constructed. Global and local network characteristics of each group were analyzed. A support vector machine was employed to identify MCS and VS patients. Results The average connection strength was reduced in DoC patients and roughly equivalent in MCS and VS groups. Global efficiency, local efficiency, and clustering coefficients were reduced, and characteristic path length was increased in DoC patients (p < 0.05). For patients of both groups, global network measures were not significantly different (p > 0.05). Nodal efficiency, nodal local efficiency, and nodal clustering coefficient were reduced in frontoparietal brain areas, limbic structures, and occipital and temporal brain areas (p < 0.05). The comparison of nodal centrality suggested that DoC causes reorganization of the network structure on a large scale, especially the thalamus. Lobal network measures emphasized that the differences between the two groups of patients mainly involved frontoparietal brain areas. The accuracy, sensitivity, and specificity of the classifier for identifying MCS and VS patients were 89.83, 78.95, and 95%, respectively. Conclusion There is an association between altered network structures and clinical symptoms of DoC. With the help of network metrics, it is feasible to differentiate MCS and VS patients.
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Affiliation(s)
- Yi Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Chinese Institute for Brain Research, Beijing, China
- Beijing Institute of Brain Disorders, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yangyang Dai
- Tianjin Key Laboratory of Brain Science and Intelligent Rehabilitation, College of Artificial Intelligence, Nankai University, Tianjin, China
| | - Qiheng He
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shan Wang
- Department of Information and Communications Engineering, School of Engineering, Tokyo Institute of Technology, Yokohama, Kanagawa, Japan
| | - Xueling Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoli Geng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jianghong He
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Feng Duan
- Tianjin Key Laboratory of Brain Science and Intelligent Rehabilitation, College of Artificial Intelligence, Nankai University, Tianjin, China
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Jang S, Choi E. Relationship between Coma Recovery Scale-Revised and the Thalamocortical Tract of Ascending Reticular Activating System in Hypoxic-Ischemic Brain Injury: A Pilot Study. Healthcare (Basel) 2023; 11:healthcare11081148. [PMID: 37107982 PMCID: PMC10137777 DOI: 10.3390/healthcare11081148] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND This pilot study examined the relationship between the Coma Recovery Scale-Revised (CRS-R) and the five subparts of the thalamocortical tract in chronic patients with hypoxic-ischemic brain injury by diffusion tensor tractography (DTT). METHODS Seventeen consecutive chronic patients with hypoxic-ischemic brain injury were recruited. The consciousness state was evaluated using CRS-R. The five subparts of the thalamocortical tract (the prefrontal cortex, the premotor cortex, the primary motor cortex, the primary somatosensory cortex, and the posterior parietal cortex) were reconstructed using DTT. Fractional anisotropy and the tract volume of each subpart of the thalamocortical tract were estimated. RESULTS The CRS-R score showed a moderate positive correlation with the tract volume of the prefrontal cortex part of the thalamocortical tract (p < 0.05). In addition, the tract volume of the prefrontal cortex component of the thalamocortical tract could explain the variability in the CRS-R score (p < 0.05). CONCLUSION The prefrontal cortex part was closely related to the CRS-R score in chronic patients with hypoxic-ischemic brain injury. In addition, the change in the remaining number of neural fibers of the prefrontal cortex part appeared to be related to the change in conscious state.
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Affiliation(s)
- Sungho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea
| | - Eunbi Choi
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea
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Chen H, Miao G, Wang S, Zheng J, Zhang X, Lin J, Hao C, Huang H, Jiang T, Gong Y, Liao W. Disturbed functional connectivity and topological properties of the frontal lobe in minimally conscious state based on resting-state fNIRS. Front Neurosci 2023; 17:1118395. [PMID: 36845431 PMCID: PMC9950516 DOI: 10.3389/fnins.2023.1118395] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/30/2023] [Indexed: 02/12/2023] Open
Abstract
Background Patients in minimally conscious state (MCS) exist measurable evidence of consciousness. The frontal lobe is a crucial part of the brain that encodes abstract information and is closely related to the conscious state. We hypothesized that the disturbance of the frontal functional network exists in MCS patients. Methods We collected the resting-state functional near-infrared spectroscopy (fNIRS) data of fifteen MCS patients and sixteen age- and gender-matched healthy controls (HC). The Coma Recovery Scale-Revised (CRS-R) scale of MCS patients was also composed. The topology of the frontal functional network was analyzed in two groups. Results Compared with HC, the MCS patients showed widely disrupted functional connectivity in the frontal lobe, especially in the frontopolar area and right dorsolateral prefrontal cortex. Moreover, the MCS patients displayed lower clustering coefficient, global efficiency, local efficiency, and higher characteristic path length. In addition, the nodal clustering coefficient and nodal local efficiency in the left frontopolar area and right dorsolateral prefrontal cortex were significantly reduced in MCS patients. Furthermore, the nodal clustering coefficient and nodal local efficiency in the right dorsolateral prefrontal cortex were positively correlated to auditory subscale scores. Conclusion This study reveals that MCS patients' frontal functional network is synergistically dysfunctional. And the balance between information separation and integration in the frontal lobe is broken, especially the local information transmission in the prefrontal cortex. These findings help us to understand the pathological mechanism of MCS patients better.
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Affiliation(s)
| | | | - Sirui Wang
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jun Zheng
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Xin Zhang
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Junbin Lin
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Chizi Hao
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Hailong Huang
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Ting Jiang
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
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Pozeg P, Alemán-Goméz Y, Jöhr J, Muresanu D, Pincherle A, Ryvlin P, Hagmann P, Diserens K, Dunet V. Structural connectivity in recovery after coma: Connectome atlas approach. Neuroimage Clin 2023; 37:103358. [PMID: 36868043 PMCID: PMC9996111 DOI: 10.1016/j.nicl.2023.103358] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/06/2023] [Accepted: 02/20/2023] [Indexed: 03/05/2023]
Abstract
AIM Pathological states of recovery after coma as a result of a severe brain injury are marked with changes in structural connectivity of the brain. This study aimed to identify a topological correlation between white matter integrity and the level of functional and cognitive impairment in patients recovering after coma. METHODS Structural connectomes were computed based on fractional anisotropy maps from 40 patients using a probabilistic human connectome atlas. We used a network based statistics approach to identify potential brain networks associated with a more favorable outcome, assessed with clinical neurobehavioral scores at the patient's discharge from the acute neurorehabilitation unit. RESULTS We identified a subnetwork whose strength of connectivity correlated with a more favorable outcome as measured with the Disability Rating Scale (network based statistics: t >3.5, P =.010). The subnetwork predominated in the left hemisphere and included the thalamic nuclei, putamen, precentral and postcentral gyri, and medial parietal regions. Spearman correlation between the mean fractional anisotropy value of the subnetwork and the score was ρ = -0.60 (P <.0001). A less extensive overlapping subnetwork correlated with the Coma Recovery Scale Revised score, consisting mostly of the left hemisphere connectivity between the thalamic nuclei and pre- and post-central gyri (network based statistics: t >3.5, P =.033; Spearman's ρ = 0.58, P <.0001). CONCLUSION The present findings suggest an important role of structural connectivity between the thalamus, putamen and somatomotor cortex in the recovery from coma as evaluated with neurobehavioral scores. These structures are part of the motor circuit involved in the generation and modulation of voluntary movement, as well as the forebrain mesocircuit supposedly underlying the maintenance of consciousness. As behavioural assessment of consciousness depends heavily on the signs of voluntary motor behaviour, further work will elucidate whether the identified subnetwork reflects the structural architecture underlying the recovery of consciousness or rather the ability to communicate its content.
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Affiliation(s)
- Polona Pozeg
- Department of Radiology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne 1011, Switzerland; Connectomics Lab, Department of Radiology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne 1011, Switzerland
| | - Yasser Alemán-Goméz
- Department of Radiology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne 1011, Switzerland; Connectomics Lab, Department of Radiology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne 1011, Switzerland
| | - Jane Jöhr
- Neurology and Acute Neurorehabilitation Unit, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne 1011, Switzerland
| | - Dafin Muresanu
- Department of Neuroscience, Luliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca 400347, Romania
| | - Alessandro Pincherle
- Neurology Unit, Department of Medicine, Hôpitaux Robert Schuman, Luxembourg 2540, Luxembourg
| | - Philippe Ryvlin
- Laboratory of Cortical Excitability and Arousal Disorders, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne 1011, Switzerland
| | - Patric Hagmann
- Department of Radiology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne 1011, Switzerland; Connectomics Lab, Department of Radiology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne 1011, Switzerland
| | - Karin Diserens
- Neurology and Acute Neurorehabilitation Unit, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne 1011, Switzerland
| | - Vincent Dunet
- Department of Radiology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne 1011, Switzerland.
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Zheng R, Qi Z, Thibaut A, Wang Z, Xu Z, Di H, Wu X, Mao Y, Laureys S. Clinical application of neuromodulation therapy in patients with disorder of consciousness: A pooled analysis of 544 participants. NeuroRehabilitation 2023; 53:491-503. [PMID: 37927281 DOI: 10.3233/nre-230103] [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: 11/07/2023]
Abstract
BACKGROUND The number of patients with disorders of consciousness (DoC) has increased dramatically with the advancement of intensive care and emergency medicine, which brings tremendous economic burdens and even ethical issues to families and society. OBJECTIVE To evaluate the effectiveness of neuromodulation therapy for patients with DoC. METHODS First, we conducted a literature review of individual patient data (IPD) on PubMed, EMBASE, and Cochrane-controlled trials following PRISMA guidelines. Then, we collected neuromodulation cases from our institution. Finally, we conducted a pooled analysis using the participants from the medical literature (n = 522) and our local institutions (n = 22). RESULTS In this pooled analysis of 544 patients with DoC with a mean age of 46.33 years, our results revealed that patients have improved CRS-R scores [1.0 points (95% CI, 0.57-1.42)] after neuromodulation. Among them, patients have better effectiveness in traumatic than non-traumatic etiology (P < 0.05). The effectiveness of consciousness improvement could be affected by the age, baseline consciousness state, and duration of stimulation. Compared with non-invasive intervention, an invasive intervention can bring more behavioral improvement (P < 0.0001) to MCS rather than UWS/VS patients. Importantly, neuromodulation is a valuable therapy even years after the onset of DoC. CONCLUSION This pooled analysis spotlights that the application of neuromodulation can improve the behavioral performance of patients with DoC. A preliminary trend is that age, etiology, baseline consciousness state, and stimulation duration could impact its effectiveness.
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Affiliation(s)
- Ruizhe Zheng
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- School of Basic Medical Sciences, Institutes of Brain Science, State Key Laboratory of Medical Neurobiology and Ministry of Education's (MOE) Frontiers Center for Brain Science, Fudan University, Shanghai, China
| | - Zengxin Qi
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- School of Basic Medical Sciences, Institutes of Brain Science, State Key Laboratory of Medical Neurobiology and Ministry of Education's (MOE) Frontiers Center for Brain Science, Fudan University, Shanghai, China
| | - Aurore Thibaut
- GIGA Consciousness Research Unit, Coma Science Group, Liège University, Liège, Belgium
- GIGA Consciousness, Centre du Cerveau, Liège University Hospital, Liège, Belgium
| | - Zhe Wang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- School of Basic Medical Sciences, Institutes of Brain Science, State Key Laboratory of Medical Neurobiology and Ministry of Education's (MOE) Frontiers Center for Brain Science, Fudan University, Shanghai, China
| | - Zeyu Xu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- School of Basic Medical Sciences, Institutes of Brain Science, State Key Laboratory of Medical Neurobiology and Ministry of Education's (MOE) Frontiers Center for Brain Science, Fudan University, Shanghai, China
| | - Haibo Di
- International Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Xuehai Wu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- School of Basic Medical Sciences, Institutes of Brain Science, State Key Laboratory of Medical Neurobiology and Ministry of Education's (MOE) Frontiers Center for Brain Science, Fudan University, Shanghai, China
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- School of Basic Medical Sciences, Institutes of Brain Science, State Key Laboratory of Medical Neurobiology and Ministry of Education's (MOE) Frontiers Center for Brain Science, Fudan University, Shanghai, China
| | - Steven Laureys
- GIGA Consciousness Research Unit, Coma Science Group, Liège University, Liège, Belgium
- GIGA Consciousness, Centre du Cerveau, Liège University Hospital, Liège, Belgium
- International Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
- Joint International Research Unit on Consciousness, CERVO Brain Research Centre, Laval University, Quebec, QC, Canada
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Xia N, He C, Wei X, Li YA, Lou W, Gu M, Chen Z, Xu J, Liu Y, Han X, Huang X. Altered frontoparietal activity in acoustic startle priming tasks during reticulospinal tract facilitation: An fNIRS study. Front Neurosci 2023; 17:1112046. [PMID: 36875651 PMCID: PMC9978531 DOI: 10.3389/fnins.2023.1112046] [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: 11/30/2022] [Accepted: 02/02/2023] [Indexed: 02/18/2023] Open
Abstract
Background Because it is one of the important pathways for promoting motor recovery after cortical injury, the function of the reticulospinal tract (RST) has received increasing attention in recent years. However, the central regulatory mechanism of RST facilitation and reduction of apparent response time is not well understood. Objectives To explore the potential role of RST facilitation in the acoustic startle priming (ASP) paradigm and observe the cortical changes induced by ASP reaching tasks. Methods Twenty healthy participants were included in this study. The reaching tasks were performed with their left and right hands. Participants were instructed to get ready after the warning cue and complete the reach as soon as they heard the Go cue. Half of the testing trials were set as control trials with an 80-dB Go cue. The other half of the trials had the Go cue replaced with 114-dB white noise to evoke the StartleReact effect, inducing reticulospinal tract facilitation. The response of the bilateral sternocleidomastoid muscle (SCM) and the anterior deltoid was recorded via surface electromyography. Startle trials were labeled as exhibiting a positive or negative StartleReact effect, according to whether the SCM was activated early (30-130 ms after the Go cue) or late, respectively. Functional near-infrared spectroscopy was used to synchronously record the oxyhemoglobin and deoxyhemoglobin fluctuations in bilateral motor-related cortical regions. The β values representing cortical responses were estimated via the statistical parametric mapping technique and included in the final analyses. Results Separate analyses of data from movements of the left or right side revealed significant activation of the right dorsolateral prefrontal cortex during RST facilitation. Moreover, left frontopolar cortex activation was greater in positive startle trials than in control or negative startle trials during left-side movements. Furthermore, decreased activity of the ipsilateral primary motor cortex in positive startle trials during ASP reaching tasks was observed. Conclusion The right dorsolateral prefrontal cortex and the frontoparietal network to which it belongs may be the regulatory center for the StartleReact effect and RST facilitation. In addition, the ascending reticular activating system may be involved. The decreased activity of the ipsilateral primary motor cortex suggests enhanced inhibition of the non-moving side during the ASP reaching task. These findings provide further insight into the SE and into RST facilitation.
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Affiliation(s)
- Nan Xia
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,World Health Organization Collaborating Centre for Training and Research in Rehabilitation, Wuhan, China
| | - Chang He
- Institute of Medical Equipment Science and Engineering, Huazhong University of Science and Technology, Wuhan, Hubei, China.,State Key Lab of Digital Manufacturing Equipment and Technology, Institute of Rehabilitation and Medical Robotics, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiupan Wei
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,World Health Organization Collaborating Centre for Training and Research in Rehabilitation, Wuhan, China
| | - Yang-An Li
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,World Health Organization Collaborating Centre for Training and Research in Rehabilitation, Wuhan, China
| | - Weiwei Lou
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,World Health Organization Collaborating Centre for Training and Research in Rehabilitation, Wuhan, China
| | - Minghui Gu
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,World Health Organization Collaborating Centre for Training and Research in Rehabilitation, Wuhan, China
| | - Zejian Chen
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,World Health Organization Collaborating Centre for Training and Research in Rehabilitation, Wuhan, China
| | - Jiang Xu
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,World Health Organization Collaborating Centre for Training and Research in Rehabilitation, Wuhan, China
| | - Yali Liu
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,World Health Organization Collaborating Centre for Training and Research in Rehabilitation, Wuhan, China
| | - Xiaohua Han
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,World Health Organization Collaborating Centre for Training and Research in Rehabilitation, Wuhan, China
| | - Xiaolin Huang
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,World Health Organization Collaborating Centre for Training and Research in Rehabilitation, Wuhan, China
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12
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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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13
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Jang SH, Choi EB. Relationship between the consciousness level and the structural neural connectivity of the medial prefrontal cortex in hypoxic-ischemic brain injury: a pilot study. Neuroreport 2022; 33:750-755. [PMID: 36250436 PMCID: PMC9622375 DOI: 10.1097/wnr.0000000000001841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/11/2022] [Indexed: 11/06/2022]
Abstract
This pilot study investigated the relationship between the consciousness level and the structural neural connectivity of the medial prefrontal cortex (mPFC SNC) in patients with hypoxic-ischemic brain injury (HI-BI), using diffusion tensor tractography (DTT). Twenty-three patients with HI-BI were recruited into the study based on predefined inclusion criteria. Their consciousness levels were evaluated using the Glasgow Coma Scale (GCS) and the Coma Recovery Scale-Revised (CRS-R). Using DTT, the mPFC SNC was reconstructed for each patient. The average of the fractional anisotropy (FA), apparent diffusion coefficient (ADC), and voxel number (VN) for the mPFC SNC in both hemispheres were determined. The GCS score showed moderate positive correlations with the FA value and VN of the mPFC SNC [(FA) r = 0.439; (VN) r = 0.466; P < 0.05], and a strong negative correlation with ADC value ( r = -0.531; P < 0.05). The CRS-R score had a strong positive and negative correlation with the FA and ADC values of the mPFC SNC, respectively, [(FA) r = 0.540; (ADC) r = -0.614; P < 0.05] and a moderate positive correlation with the VN of the mPFC SNC ( r = 0.488; P < 0.05). We found that the severity of the injury to the mPFC SNC was closely related to the consciousness level. Our results suggest that the mPFC SNC appears to be a neural correlate for the control of consciousness in patients with HI-BI. Based on these results, we believe that the mPFC could be a target area for noninvasive neurostimulation therapies for patients with impaired consciousness following HI-BI.
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Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Eun Bi Choi
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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14
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Panda R, Thibaut A, Lopez-Gonzalez A, Escrichs A, Bahri MA, Hillebrand A, Deco G, Laureys S, Gosseries O, Annen J, Tewarie P. Disruption in structural-functional network repertoire and time-resolved subcortical fronto-temporoparietal connectivity in disorders of consciousness. eLife 2022; 11:77462. [PMID: 35916363 PMCID: PMC9385205 DOI: 10.7554/elife.77462] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Understanding recovery of consciousness and elucidating its underlying mechanism is believed to be crucial in the field of basic neuroscience and medicine. Ideas such as the global neuronal workspace (GNW) and the mesocircuit theory hypothesize that failure of recovery in conscious states coincide with loss of connectivity between subcortical and frontoparietal areas, a loss of the repertoire of functional networks states and metastable brain activation. We adopted a time-resolved functional connectivity framework to explore these ideas and assessed the repertoire of functional network states as a potential marker of consciousness and its potential ability to tell apart patients in the unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS). In addition, the prediction of these functional network states by underlying hidden spatial patterns in the anatomical network, that is so-called eigenmodes, was supplemented as potential markers. By analysing time-resolved functional connectivity from functional MRI data, we demonstrated a reduction of metastability and functional network repertoire in UWS compared to MCS patients. This was expressed in terms of diminished dwell times and loss of nonstationarity in the default mode network and subcortical fronto-temporoparietal network in UWS compared to MCS patients. We further demonstrated that these findings co-occurred with a loss of dynamic interplay between structural eigenmodes and emerging time-resolved functional connectivity in UWS. These results are, amongst others, in support of the GNW theory and the mesocircuit hypothesis, underpinning the role of time-resolved thalamo-cortical connections and metastability in the recovery of consciousness.
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Affiliation(s)
| | | | - Ane Lopez-Gonzalez
- Center for Brain and Cognition, Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Mohamed Ali Bahri
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, Liège, Belgium
| | - Arjan Hillebrand
- Department of Clinical Neurophysiology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Gustavo Deco
- Center for Brain and Cognition, Universitat Pompeu Fabra, Barcelona, Spain
| | | | | | - Jitka Annen
- Coma Science Group, University of Liège, Liège, Belgium
| | - Prejaas Tewarie
- School of Physics, University of Nottingham, Nottingham, United Kingdom
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15
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White matter connectometry in patients with disorders of consciousness revealed by 7-Tesla magnetic resonance imaging. Brain Imaging Behav 2022; 16:1983-1991. [DOI: 10.1007/s11682-022-00668-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 03/01/2022] [Accepted: 03/21/2022] [Indexed: 11/02/2022]
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16
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Fischer D, Newcombe V, Fernandez-Espejo D, Snider SB. Applications of Advanced MRI to Disorders of Consciousness. Semin Neurol 2022; 42:325-334. [PMID: 35790201 DOI: 10.1055/a-1892-1894] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Disorder of consciousness (DoC) after severe brain injury presents numerous challenges to clinicians, as the diagnosis, prognosis, and management are often uncertain. Magnetic resonance imaging (MRI) has long been used to evaluate brain structure in patients with DoC. More recently, advances in MRI technology have permitted more detailed investigations of the brain's structural integrity (via diffusion MRI) and function (via functional MRI). A growing literature has begun to show that these advanced forms of MRI may improve our understanding of DoC pathophysiology, facilitate the identification of patient consciousness, and improve the accuracy of clinical prognostication. Here we review the emerging evidence for the application of advanced MRI for patients with DoC.
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Affiliation(s)
- David Fischer
- Division of Neurocritical Care, Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Virginia Newcombe
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Davinia Fernandez-Espejo
- School of Psychology and Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
| | - Samuel B Snider
- Division of Neurocritical Care, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
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17
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Luppi AI, Mediano PAM, Rosas FE, Allanson J, Pickard JD, Williams GB, Craig MM, Finoia P, Peattie ARD, Coppola P, Owen AM, Naci L, Menon DK, Bor D, Stamatakis EA. Whole-brain modelling identifies distinct but convergent paths to unconsciousness in anaesthesia and disorders of consciousness. Commun Biol 2022; 5:384. [PMID: 35444252 PMCID: PMC9021270 DOI: 10.1038/s42003-022-03330-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 03/30/2022] [Indexed: 12/02/2022] Open
Abstract
The human brain entertains rich spatiotemporal dynamics, which are drastically reconfigured when consciousness is lost due to anaesthesia or disorders of consciousness (DOC). Here, we sought to identify the neurobiological mechanisms that explain how transient pharmacological intervention and chronic neuroanatomical injury can lead to common reconfigurations of neural activity. We developed and systematically perturbed a neurobiologically realistic model of whole-brain haemodynamic signals. By incorporating PET data about the cortical distribution of GABA receptors, our computational model reveals a key role of spatially-specific local inhibition for reproducing the functional MRI activity observed during anaesthesia with the GABA-ergic agent propofol. Additionally, incorporating diffusion MRI data obtained from DOC patients reveals that the dynamics that characterise loss of consciousness can also emerge from randomised neuroanatomical connectivity. Our results generalise between anaesthesia and DOC datasets, demonstrating how increased inhibition and connectome perturbation represent distinct neurobiological paths towards the characteristic activity of the unconscious brain. Perturbations in a large-scale whole-brain model suggest that anesthesia and injury may be imparting functionally similar effects in terms of brain dynamics.
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Affiliation(s)
- Andrea I Luppi
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Cambridge, UK. .,Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK. .,Leverhulme Centre for the Future of Intelligence, University of Cambridge, Cambridge, UK. .,The Alan Turing Institute, London, UK.
| | - Pedro A M Mediano
- Department of Psychology, University of Cambridge, Cambridge, UK.,Department of Psychology, Queen Mary University of London, London, UK
| | - Fernando E Rosas
- Center for Psychedelic Research, Department of Brain Science, Imperial College London, London, UK.,Data Science Institute, Imperial College London, London, UK.,Centre for Complexity Science, Imperial College London, London, UK
| | - Judith Allanson
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Department of Neurosciences, Cambridge University Hospitals NHS Foundation, Addenbrooke's Hospital, Cambridge, UK
| | - John D Pickard
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Division of Neurosurgery, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Guy B Williams
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - Michael M Craig
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Cambridge, UK.,Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Paola Finoia
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Alexander R D Peattie
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Cambridge, UK.,Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Peter Coppola
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Cambridge, UK.,Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Adrian M Owen
- The Brain and Mind Institute, University of Western Ontario, London, ON, Canada
| | - Lorina Naci
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - David K Menon
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Cambridge, UK.,Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - Daniel Bor
- Department of Psychology, University of Cambridge, Cambridge, UK.,Department of Psychology, Queen Mary University of London, London, UK
| | - Emmanuel A Stamatakis
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Cambridge, UK.,Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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18
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Coppola P, Spindler LRB, Luppi AI, Adapa R, Naci L, Allanson J, Finoia P, Williams GB, Pickard JD, Owen AM, Menon DK, Stamatakis EA. Network dynamics scale with levels of awareness. Neuroimage 2022; 254:119128. [PMID: 35331869 DOI: 10.1016/j.neuroimage.2022.119128] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 02/10/2022] [Accepted: 03/20/2022] [Indexed: 02/04/2023] Open
Abstract
Small world topologies are thought to provide a valuable insight into human brain organisation and consciousness. However, functional magnetic resonance imaging studies in consciousness have not yielded consistent results. Given the importance of dynamics for both consciousness and cognition, here we investigate how the diversity of small world dynamics (quantified by sample entropy; dSW-E1) scales with decreasing levels of awareness (i.e., sedation and disorders of consciousness). Paying particular attention to result reproducibility, we show that dSW-E is a consistent predictor of levels of awareness even when controlling for the underlying functional connectivity dynamics. We find that dSW-E of subcortical and cortical areas are predictive, with the former showing higher and more robust effect sizes across analyses. We find that the network dynamics of intermodular communication in the cerebellum also have unique predictive power for levels of awareness. Consequently, we propose that the dynamic reorganisation of the functional information architecture, in particular of the subcortex, is a characteristic that emerges with awareness and has explanatory power beyond that of the complexity of dynamic functional connectivity.
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Affiliation(s)
- Peter Coppola
- Division of Anaesthesia, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Hills Rd., Cambridge CB2 0QQ, UK; Department of Clinical Neurosciences, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Hills Rd., Cambridge CB2 0QQ, UK
| | - Lennart R B Spindler
- Division of Anaesthesia, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Hills Rd., Cambridge CB2 0QQ, UK; Department of Clinical Neurosciences, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Hills Rd., Cambridge CB2 0QQ, UK
| | - Andrea I Luppi
- Division of Anaesthesia, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Hills Rd., Cambridge CB2 0QQ, UK; Department of Clinical Neurosciences, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Hills Rd., Cambridge CB2 0QQ, UK
| | - Ram Adapa
- Division of Anaesthesia, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Hills Rd., Cambridge CB2 0QQ, UK; Division of Neurosurgery, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Hills Rd., Cambridge CB2 0QQ, UK
| | - Lorina Naci
- Trinity College Institute of Neuroscience, School of Psychology, Trinity College Dublin, Lloyd Building, Dublin 2, Ireland
| | - Judith Allanson
- Department of Clinical Neurosciences, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Hills Rd., Cambridge CB2 0QQ, UK; Department of Neurosciences, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation, Hills Rd., Cambridge, CB2 0QQ, UK
| | - Paola Finoia
- Division of Anaesthesia, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Hills Rd., Cambridge CB2 0QQ, UK; Division of Neurosurgery, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Hills Rd., Cambridge CB2 0QQ, UK
| | - Guy B Williams
- Department of Clinical Neurosciences, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Hills Rd., Cambridge CB2 0QQ, UK; Wolfson Brain Imaging Centre, University of Cambridge, Cambridge Biomedical Campus (Box 65), Cambridge CB2 0QQ, UK
| | - John D Pickard
- Department of Clinical Neurosciences, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Hills Rd., Cambridge CB2 0QQ, UK; Division of Neurosurgery, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Hills Rd., Cambridge CB2 0QQ, UK; Wolfson Brain Imaging Centre, University of Cambridge, Cambridge Biomedical Campus (Box 65), Cambridge CB2 0QQ, UK
| | - Adrian M Owen
- The Brain and Mind Institute, Western Interdisciplinary Research Building, University of Western Ontario, London, ON N6A 5B7, Canada
| | - David K Menon
- Division of Anaesthesia, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Hills Rd., Cambridge CB2 0QQ, UK; Wolfson Brain Imaging Centre, University of Cambridge, Cambridge Biomedical Campus (Box 65), Cambridge CB2 0QQ, UK
| | - Emmanuel A Stamatakis
- Division of Anaesthesia, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Hills Rd., Cambridge CB2 0QQ, UK; Department of Clinical Neurosciences, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Hills Rd., Cambridge CB2 0QQ, UK.
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19
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Wang L, Wu Q, Yang Z, Yang Y, Luo Y, Cao Y, Wu L, Xie Y, Wang Y. Preliminary Study of Vagus Nerve Magnetic Modulation in Patients with Prolonged Disorders of Consciousness. Neuropsychiatr Dis Treat 2022; 18:2171-2179. [PMID: 36187561 PMCID: PMC9522480 DOI: 10.2147/ndt.s381681] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/14/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The number of patients with prolonged disorders of consciousness (pDOC) is increasing. However, its clinical treatment remains challenging. To date, no studies have reported the effect of vagus nerve modulation (VNM) using repetitive transcranial magnetic stimulation (rTMS) in patients with pDOC. We aimed to evaluate the effect of vagus nerve magnetic modulation (VNMM) on pDOC patients. METHODS We performed VNMM in 17 pDOC patients. The Revised Coma Recovery Scale (CRS-R), Glasgow scale (GCS), somatosensory evoked potentials (SEP) and brainstem auditory evoked potentials (BAEP) were assessed before and after treatment. RESULTS Both CRS-R and GCS results showed significant improvement in p DOC patients after VNMM treatment. The CRS-R improved from 7.88 ± 2.93 to 11.53 ± 4.94. The GCS score also improved from 7.65 ± 1.9 to 9.18 ± 2.65. The number of BAEP grades I increased from 3 to 5 after treatment. The number of BAEP grades I increased from 3 to 5, grade II increased by 1, and grade III decreased from 4 to 1. CONCLUSION This study provides a preliminary indication of the potential of VNMM in the rehabilitation of pDOC patients. It provides the basis for a Phase 2 or Phase 3 study of VNMM in patients with pDOC.
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Affiliation(s)
- Lingling Wang
- Department of Rehabilitation Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, People's Republic of China.,Department of Clinical Medicine, North Sichuan Medical College, Nanchong, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Qing Wu
- Department of Rehabilitation Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, People's Republic of China
| | - Zhenglei Yang
- Department of Rehabilitation Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, People's Republic of China.,Department of Clinical Medicine, North Sichuan Medical College, Nanchong, People's Republic of China
| | - Yuxuan Yang
- Department of Clinical Medicine, North Sichuan Medical College, Nanchong, People's Republic of China.,Nanchong Central Hospital, Nanchong, People's Republic of China
| | - Yaomin Luo
- Department of Rehabilitation Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, People's Republic of China.,Department of Clinical Medicine, North Sichuan Medical College, Nanchong, People's Republic of China
| | - Yuhong Cao
- Department of Rehabilitation Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, People's Republic of China.,Department of Clinical Medicine, North Sichuan Medical College, Nanchong, People's Republic of China
| | - Li Wu
- Department of Rehabilitation Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, People's Republic of China.,Department of Clinical Medicine, North Sichuan Medical College, Nanchong, People's Republic of China
| | - Yulei Xie
- Department of Rehabilitation Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, People's Republic of China.,School of Rehabilitation, Capital Medical University, China Rehabilitation Research Center, Beijing city, Beijing province, China (mainland)
| | - Yinxu Wang
- Department of Rehabilitation Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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20
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Jang SH, Kim SH, Kim JW, Lee HD, Cho MK. Difference in the ascending reticular activating system between vegetative and minimally conscious states following traumatic brain injury. Neuroreport 2021; 32:1423-1427. [PMID: 34743167 PMCID: PMC8719505 DOI: 10.1097/wnr.0000000000001747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/01/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We investigated differences in the ascending reticular activating system (ARAS) between vegetative state (VS) and minimally conscious state (MCS) in patients with traumatic brain injury (TBI) by using diffusion tensor tractography. METHODS We recruited TBI patients and normal subjects. We reconstructed the lower ARAS and five parts of upper ARAS [prefrontal cortex (PFC), premotor cortex, primary motor cortex, primary somatosensory cortex, and posterior parietal cortex]. RESULTS Significant differences were observed in the fractional anisotropy (FA) and fiber number (FN) values of the five parts of upper ARAS between the VS and control groups and between the MCS and control groups (P < 0.05), but no differences were detected in the lower ARAS (P > 0.05). The FA and FN values of the PFC in the upper ARAS were significantly different between the VS and MCS groups (P < 0.05). No other significant differences in FA and FN values were detected among the other segments of the upper ARAS or in the lower ARAS (P > 0.05). CONCLUSION The results indicate that the prefrontal portion of the upper ARAS is the critical area for distinguishing between VS and MCS in patients with TBI.
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Affiliation(s)
- Sung Ho Jang
- Departments of Physical Medicine and Rehabilitation
| | | | - Jae Woon Kim
- Diagnostic Radiology, College of Medicine, Yeungnam University, Daegu
| | - Han Do Lee
- Department of Physical Therapy, College of natural science, Ulsan college University, Ulsan, Republic of Korea
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21
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Yu Y, Zheng W, Tan X, Li X, Zhang X, Gao J, Pan G, Wu D, Luo B. Microstructural profiles of thalamus and thalamocortical connectivity in patients with disorder of consciousness. J Neurosci Res 2021; 99:3261-3273. [PMID: 34766648 DOI: 10.1002/jnr.24921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 06/04/2021] [Accepted: 06/24/2021] [Indexed: 01/01/2023]
Abstract
Thalamus and thalamocortical connectivity are crucial for consciousness; however, their microstructural changes in patients with a disorder of consciousness (DOC) have not yet been thoroughly characterized. In the present study, we applied the novel fixel-based analysis to comprehensively investigate the thalamus-related microstructural abnormalities in 10 patients with DOC using 7-T diffusion-weighted imaging data. We found that compared to healthy controls, patients with DOC showed reduced fiber density (FD) and fiber density and cross-section (FDC) in the mediodorsal, anterior, and ventral anterior thalamic nuclei, while fiber-bundle cross-section (FC) was not significantly altered in the thalamus. Impaired thalamocortical connectivity in the DOC cohort was mainly connected to the middle frontal gyrus, anterior cingulate gyrus, fusiform gyrus, and sensorimotor cortices, including the precentral gyrus and postcentral gyrus, with predominant microstructural abnormalities in FD and FDC. Correlation analysis showed that FC of the right mediodorsal thalamus was negatively correlated with the level of consciousness. Our results suggest that microstructural abnormalities of thalamus and thalamocortical connectivity in DOC were mainly attributed to axonal injury. In particular, the microstructural integrity of the thalamus is a vital factor in consciousness generation.
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Affiliation(s)
- Yamei Yu
- Department of Neurology and Brain Medical Centre, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Weihao Zheng
- School of Information Science and Egineering, Lanzhou University, Lanzhou, China
| | - Xufei Tan
- Department of Clinical Medicine, School of Medicine, Zhejiang University City College, Hangzhou, China
| | - Xiaoxia Li
- Department of Neurology and Brain Medical Centre, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaotong Zhang
- Interdisciplinary Institute of Neuroscience and Technology, Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China
| | - Jian Gao
- Hangzhou Ming Zhou Nao Kang Rehabilitation Hospital, Hangzhou, China
| | - Gang Pan
- College of Computer Science and Technology, Zhejiang University, Hangzhou, China
| | - Dan Wu
- Department of Neurology and Brain Medical Centre, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Benyan Luo
- Department of Neurology and Brain Medical Centre, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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22
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Song L, Yang H, Yang M, Liu D, Ge Y, Long J, Dong P. Professional chess expertise modulates whole brain functional connectivity pattern homogeneity and couplings. Brain Imaging Behav 2021; 16:587-595. [PMID: 34453664 DOI: 10.1007/s11682-021-00537-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2021] [Indexed: 11/26/2022]
Abstract
Previous studies have revealed changed functional connectivity patterns between brain areas in chess players using resting-state functional magnetic resonance imaging (rs-fMRI). However, how to exactly characterize the voxel-wise whole brain functional connectivity pattern changes in chess players remains unclear. It could provide more convincing evidence for establishing the relationship between long-term chess practice and brain function changes. In this study, we employed newly developed whole brain functional connectivity pattern homogeneity (FcHo) method to identify the voxel-wise changes of functional connectivity patterns in 28 chess master players and 27 healthy novices. Seed-based functional connectivity analysis was used to identify the alteration of corresponding functional couplings. FcHo analysis revealed significantly increased whole brain functional connectivity pattern similarity in anterior cingulate cortex (ACC), anterior middle temporal gyrus (aMTG), primary visual cortex (V1), and decreased FcHo in thalamus and precentral gyrus in chess players. Resting-state functional connectivity analyses identified chess players showing decreased functional connections between V1 and precentral gyrus. Besides, a linear support vector machine (SVM) based classification achieved an accuracy of 85.45%, a sensitivity of 85.71% and a specificity of 85.19% to differentiate chess players from novices by leave-one-out cross-validation. Finally, correlation analyses revealed that the mean FcHo values of thalamus were significantly negatively correlated with the training time. Our findings provide new evidences for the important roles of ACC, aMTG, V1, thalamus and precentral gyrus in chess players. The findings also indicate that long-term professional chess training may enhance the semantic and episodic processing, efficiency of visual-motor transformation, and cognitive ability.
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Affiliation(s)
- Limei Song
- School of Medical Imaging, Weifang Medical University, Weifang, 261053, Shandong, China.
| | - Huadong Yang
- Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Mingdong Yang
- Shouguang People's Hospital, Shouguang, 262700, China
| | - Dianmei Liu
- School of Medical Imaging, Weifang Medical University, Weifang, 261053, Shandong, China
- Medical Imaging Center, Affiliated Hospital of Weifang Medical University, Weifang, 261031, China
| | - Yanming Ge
- School of Medical Imaging, Weifang Medical University, Weifang, 261053, Shandong, China
- Medical Imaging Center, Affiliated Hospital of Weifang Medical University, Weifang, 261031, China
| | - Jinfeng Long
- School of Medical Imaging, Weifang Medical University, Weifang, 261053, Shandong, China
| | - Peng Dong
- School of Medical Imaging, Weifang Medical University, Weifang, 261053, Shandong, China.
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Abstract
PURPOSE OF REVIEW In the study of brain-injured patients with disorders of consciousness (DoC), structural and functional MRI seek to provide insights into the neural correlates of consciousness, identify neurophysiologic signatures of covert consciousness, and identify biomarkers for recovery of consciousness. RECENT FINDINGS Cortical volume, white matter volume and integrity, and structural connectivity across many grey and white matter regions have been shown to vary with level of awareness in brain-injured patients. Resting-state functional connectivity (rs-FC) within and between canonical cortical networks also correlates with DoC patients' level of awareness. Stimulus-based and motor-imagery fMRI paradigms have identified some behaviorally unresponsive DoC patients with cortical processing and activation patterns that mirror healthy controls. Emerging techniques like dynamic rs-FC have begun to identify temporal trends in brain-wide connectivity that may represent novel neural correlates of consciousness. SUMMARY Structural and functional MRI will continue to advance our understanding of brain regions supporting human consciousness. Measures of regional and global white matter integrity and rs-FC in particular networks have shown significant improvement over clinical features in identifying acute and chronic DoC patients likely to recover awareness. As they are refined, functional MRI paradigms may additionally provide opportunities for interacting with behaviorally unresponsive patients.
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24
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Morozova A, Zorkina Y, Pavlov K, Pavlova O, Abramova O, Ushakova V, Mudrak AV, Zozulya S, Otman I, Sarmanova Z, Klyushnik T, Reznik A, Kostyuk G, Chekhonin V. Associations of Genetic Polymorphisms and Neuroimmune Markers With Some Parameters of Frontal Lobe Dysfunction in Schizophrenia. Front Psychiatry 2021; 12:655178. [PMID: 34025476 PMCID: PMC8138937 DOI: 10.3389/fpsyt.2021.655178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/07/2021] [Indexed: 11/15/2022] Open
Abstract
We investigated the associations of DRD3 rs6280, HTR1A rs6295, BDNF rs6265, SCL6A4 rs16965628, and 5HT2A rs7322347 with schizophrenia in a case-control study, and associations of these genetic variants with several clinical features. We also investigated markers of inflammatory response (C-reactive protein, IL-2, IL-6, IL-10), the activity of leukocytic elastase (LE) and α1-proteinase inhibitor (a1-PI), antibodies to S100B and myelin basic protein (MBP) in schizophrenia. Clinical symptoms were assessed on three scales: Positive and Negative Syndrome Scale, The Bush - Francis Catatonia Rating Scale and Frontal Assessment Battery. All SNPs were typed using predesigned TaqMan SNP genotyping assays. The biomarkers related to the immune system were routinely tested using ELISA kits. The association with schizophrenia was found for DRD3 rs6280 (p = 0.05) and HTR2A rs7322347 (p = 0.0013). We found differences between groups by parameters of LE and a1-PI and LE/a1-PI (p < 0.001). And IL-6 was evaluated in the schizophrenia group (p < 0.001). We showed that patients with the TT allele (BDNF rs6265) had more severe impairments in frontal lobe function. a1-PI can serve as a marker for assessing the severity of frontal lobe damage in patients with frontal dementia. We found some biological parameters reflecting the severity of frontal dysfunction in schizophrenia.
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Affiliation(s)
- Anna Morozova
- Department Basic and Applied Neurobiology, V. P. Serbsky Federal Medical Research Centre of Psychiatry and Narcology, Moscow, Russia
- Mental-Health Clinic No. 1 Named After N. A. Alexeev of Moscow Healthcare Department, Moscow, Russia
| | - Yana Zorkina
- Department Basic and Applied Neurobiology, V. P. Serbsky Federal Medical Research Centre of Psychiatry and Narcology, Moscow, Russia
- Mental-Health Clinic No. 1 Named After N. A. Alexeev of Moscow Healthcare Department, Moscow, Russia
| | - Konstantine Pavlov
- Department Basic and Applied Neurobiology, V. P. Serbsky Federal Medical Research Centre of Psychiatry and Narcology, Moscow, Russia
| | - Olga Pavlova
- Department Basic and Applied Neurobiology, V. P. Serbsky Federal Medical Research Centre of Psychiatry and Narcology, Moscow, Russia
| | - Olga Abramova
- Department Basic and Applied Neurobiology, V. P. Serbsky Federal Medical Research Centre of Psychiatry and Narcology, Moscow, Russia
- Mental-Health Clinic No. 1 Named After N. A. Alexeev of Moscow Healthcare Department, Moscow, Russia
| | - Valeria Ushakova
- Department Basic and Applied Neurobiology, V. P. Serbsky Federal Medical Research Centre of Psychiatry and Narcology, Moscow, Russia
- Mental-Health Clinic No. 1 Named After N. A. Alexeev of Moscow Healthcare Department, Moscow, Russia
- Department of Biology, Lomonosov Moscow State University, Moscow, Russia
| | - Alexander V. Mudrak
- Mental-Health Clinic No. 1 Named After N. A. Alexeev of Moscow Healthcare Department, Moscow, Russia
| | | | - Irina Otman
- Mental Health Research Center, Moscow, Russia
| | | | | | - Alexander Reznik
- Mental-Health Clinic No. 1 Named After N. A. Alexeev of Moscow Healthcare Department, Moscow, Russia
- Institute of Medical and Social Technologies, Moscow, Russia
| | - Georgiy Kostyuk
- Mental-Health Clinic No. 1 Named After N. A. Alexeev of Moscow Healthcare Department, Moscow, Russia
| | - Vladimir Chekhonin
- Department Basic and Applied Neurobiology, V. P. Serbsky Federal Medical Research Centre of Psychiatry and Narcology, Moscow, Russia
- Department of Medical Nanobiotechnology, Pirogov Russian National Research Medical University, Moscow, Russia
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25
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Luppi AI, Craig MM, Coppola P, Peattie ARD, Finoia P, Williams GB, Allanson J, Pickard JD, Menon DK, Stamatakis EA. Preserved fractal character of structural brain networks is associated with covert consciousness after severe brain injury. NEUROIMAGE-CLINICAL 2021; 30:102682. [PMID: 34215152 PMCID: PMC8102619 DOI: 10.1016/j.nicl.2021.102682] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/30/2021] [Accepted: 04/18/2021] [Indexed: 12/24/2022]
Abstract
We study structural brain networks in patients with disorders of consciousness (DOC) Structural brain networks are less fractal (self-similar) in patients than controls. Preserved fractal dimension is associated with covert consciousness in DOC patients.
Self-similarity is ubiquitous throughout natural phenomena, including the human brain. Recent evidence indicates that fractal dimension of functional brain networks, a measure of self-similarity, is diminished in patients diagnosed with disorders of consciousness arising from severe brain injury. Here, we set out to investigate whether loss of self-similarity is observed in the structural connectome of patients with disorders of consciousness. Using diffusion MRI tractography from N = 11 patients in a minimally conscious state (MCS), N = 10 patients diagnosed with unresponsive wakefulness syndrome (UWS), and N = 20 healthy controls, we show that fractal dimension of structural brain networks is diminished in DOC patients. Remarkably, we also show that fractal dimension of structural brain networks is preserved in patients who exhibit evidence of covert consciousness by performing mental imagery tasks during functional MRI scanning. These results demonstrate that differences in fractal dimension of structural brain networks are quantitatively associated with chronic loss of consciousness induced by severe brain injury, highlighting the close connection between structural organisation of the human brain and its ability to support cognitive function.
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Affiliation(s)
- Andrea I Luppi
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, CB2 0SP, Cambridge, United Kingdom; Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, CB2 0SP, Cambridge, United Kingdom.
| | - Michael M Craig
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, CB2 0SP, Cambridge, United Kingdom; Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, CB2 0SP, Cambridge, United Kingdom
| | - Peter Coppola
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, CB2 0SP, Cambridge, United Kingdom; Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, CB2 0SP, Cambridge, United Kingdom
| | - Alexander R D Peattie
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, CB2 0SP, Cambridge, United Kingdom; Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, CB2 0SP, Cambridge, United Kingdom
| | - Paola Finoia
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, CB2 0SP, Cambridge, United Kingdom; Division of Neurosurgery, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, CB2 0SP, Cambridge, United Kingdom
| | - Guy B Williams
- Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, CB2 0SP, Cambridge, United Kingdom; Wolfson Brain Imaging Centre, University of Cambridge, Cambridge Biomedical Campus (Box 65), Cambridge CB2 0QQ, United Kingdom
| | - Judith Allanson
- Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, CB2 0SP, Cambridge, United Kingdom; Department of Neurosciences, Cambridge University Hospitals NHS Foundation, Addenbrooke's Hospital, Hills Rd, CB2 0SP, Cambridge, United Kingdom
| | - John D Pickard
- Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, CB2 0SP, Cambridge, United Kingdom; Division of Neurosurgery, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, CB2 0SP, Cambridge, United Kingdom; Wolfson Brain Imaging Centre, University of Cambridge, Cambridge Biomedical Campus (Box 65), Cambridge CB2 0QQ, United Kingdom
| | - David K Menon
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, CB2 0SP, Cambridge, United Kingdom; Wolfson Brain Imaging Centre, University of Cambridge, Cambridge Biomedical Campus (Box 65), Cambridge CB2 0QQ, United Kingdom
| | - Emmanuel A Stamatakis
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, CB2 0SP, Cambridge, United Kingdom; Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, CB2 0SP, Cambridge, United Kingdom
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26
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Zheng W, Tan X, Liu T, Li X, Gao J, Hong L, Zhang X, Zhao Z, Yu Y, Zhang Y, Luo B, Wu D. Individualized Thalamic Parcellation Reveals Alterations in Shape and Microstructure of Thalamic Nuclei in Patients with Disorder of Consciousness. Cereb Cortex Commun 2021; 2:tgab024. [PMID: 34296169 PMCID: PMC8152869 DOI: 10.1093/texcom/tgab024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/25/2021] [Accepted: 03/28/2021] [Indexed: 12/02/2022] Open
Abstract
The thalamus plays crucial roles in consciousness generation and information processing. Previous evidence suggests that disorder of consciousness (DOC) caused by severe brain injury, is potentially related to thalamic abnormalities. However, how the morphology and microstructure change in thalamic subfields and thalamocortical fiber pathways in patients with DOC, and the relationships between these changes and the consciousness status remain unclear. Here, we generated the individual-specific thalamic parcellation in 10 DOC patients and 10 healthy controls (HC) via a novel thalamic segmentation framework based on the fiber orientation distribution (FOD) derived from 7-Tesla diffusion MRI, and investigated the shape deformation of thalamic nuclei as well as the microstructural changes associated with thalamic nuclei and thalamocortical pathways in patients with DOC. Enlargement of dorsal posterior nucleus and atrophy of anterior nucleus in the right thalamus were observed in DOC cohort relative to the HCs, and the former was closely linked to the consciousness level of the patients. We also found significant reductions of fiber density, but not fiber bundle cross-section, within several thalamic nuclei and most of the thalamocortical fiber pathways, suggesting that loss of axons might take primary responsibility for the impaired thalamocortical connections in patients with DOC rather than the change in fiber-bundle morphology. Furthermore, the individual-specific thalamic parcellation achieved 80% accuracy in classifying patients at the minimally conscious state from the vegetative state, compared with ~60% accuracy based on group-level parcellations. Our findings provide the first evidence for the shape deformation of thalamic nuclei in DOC patients and the microstructural basis of the disrupted thalamocortical connections.
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Affiliation(s)
- Weihao Zheng
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, 310027, P.R. China
| | - Xufei Tan
- Department of Clinical Medicine, School of Medicine, Zhejiang University City College, Hangzhou, 310015, P.R. China
| | - Tingting Liu
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, 310027, P.R. China
| | - Xiaoxia Li
- Department of Neurology and Brain Medical Centre, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, P.R. China
| | - Jian Gao
- Department of Rehabilitation, Hospital of Zhejiang Armed Police Corps, Hangzhou, 310051, P.R. China
| | - Lirong Hong
- Department of Rehabilitation, Hospital of Zhejiang Armed Police Corps, Hangzhou, 310051, P.R. China
| | - Xiaotong Zhang
- Interdisciplinary Institute of Neuroscience and Technology, Qiushi Academy for Advanced Studies, Zhejiang University, Hangzhou, 310029, P.R. China
| | - Zhiyong Zhao
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, 310027, P.R. China
| | - Yamei Yu
- Department of Neurology and Brain Medical Centre, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, P.R. China
| | - Yi Zhang
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, 310027, P.R. China
| | - Benyan Luo
- Department of Neurology and Brain Medical Centre, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, P.R. China
| | - Dan Wu
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, 310027, P.R. China
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27
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Disrupted Pallido-Thalamo-Cortical Functional Connectivity in Chronic Disorders of Consciousness. Brain Sci 2021; 11:brainsci11030356. [PMID: 33799582 PMCID: PMC7999530 DOI: 10.3390/brainsci11030356] [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: 01/20/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 12/04/2022] Open
Abstract
Chronic disorders of consciousness (DOC) encompass unresponsive wakefulness syndrome and minimally conscious state. Their anatomo-functional correlates are not clearly defined yet, although impairments of functional cortical networks have been reported, as well as the implication of the thalamus and deep brain structures. However, the pallidal functional connectivity with the thalamus and the cortical networks has not been studied so far. Using resting-state functional MRI, we conducted a functional connectivity study between the pallidum, the thalamus and the cortical networks in 13 patients with chronic DOC and 19 healthy subjects. We observed in chronic DOC patients that the thalami were no longer connected to the cortical networks, nor to the pallidums. Concerning the functional connectivity of pallidums, we reported an abolition of the negative correlation with the default mode network, and of the positive correlation with the salience network. The disrupted functional connectivity observed in chronic DOC patients between subcortical structures and cortical networks could be related to the mesocircuit model. A better understanding of the DOC underlying physiopathology could provide food for thought for future therapeutic proposals.
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28
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Specific white matter connectomic changes in schizophrenia compared with psychotic bipolar disorder. Asian J Psychiatr 2021; 55:102468. [PMID: 33183989 DOI: 10.1016/j.ajp.2020.102468] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/10/2020] [Accepted: 10/29/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Schizophrenia (SZ) and bipolar disorder with psychosis (BDP) can be clinically confusing. The specific connectomic changes in SZ compared with BDP may lead to a deeper comprehension of the pathophysiological core of SZ. Therefore, this study explored the common and distinct white matter (WM) structural connectomic alterations between these two diseases. METHOD Diffusion tensor imaging data were collected from 19 drug-naïve patients with first episode SZ, 19 drug-naïve patients with BDP, and 19 healthy controls (HC). A graph theoretical approach was used to assess the brain WM network properties. RESULTS Except for the clustering coefficients, no significant differences in the global parameters was found between SZ and BDP. Five brain regions, the right precentral, right post-cingulum, right insula, left superior occipital, and left inferior temporal gyri, showed specific differences in the nodal parameters in SZ compared with BDP and HC. Nine brain regions, the left rectus, left lingual, right inferior parietal, left superior temporal, right precentral, right postcentral, bilateral middle frontal, and right post-cingulum gyri, showed specific differences in the nodal parameters in BDP. Significant correlations between clinical symptoms and connectomic changes were detected in the right insula and left superior occipital gyrus in patients with SZ but in the left lingual gyrus in patients with BDP. CONCLUSIONS Identifying shared and distinct WM structural networks between SZ and BDP may improve the understanding of the neuroanatomy of mental diseases. Specifically, the insula, the inferior temporal, superior temporal, and the lingual gyri may help to distinguish between SZ and BDP.
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Zheng Q, Chen X, Xie M, Fu J, Han Y, Wang J, Zeng C, Li Y. Altered structural networks in neuromyelitis optica spectrum disorder related with cognition impairment and clinical features. Mult Scler Relat Disord 2020; 48:102714. [PMID: 33422915 DOI: 10.1016/j.msard.2020.102714] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 11/19/2020] [Accepted: 12/19/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the topological properties alterations of white matter (WM) network in neuromyelitis optica spectrum disorder (NMOSD) patients and its correlation with clinical and cognitive performance. METHODS Forty-eight NMOSD patients and fifty healthy controls (HC) underwent DTI and 3D-T1 scan on a 3.0 T MRI and clinical data and cognitive scales were collected. Structural networks were constructed and analyzed by using graph theory. The network metrics between-group comparisons were examined by using GRETNA. Differences in network parameters between two groups and grouped patients according to disease duration (DD) were compared to examine the impact of DD on WM network. The relationships between the network characteristics and clinical data and cognitive performances were also analyzed by partial correlation analysis. RESULTS The NMOSD patients exhibited decreased global and local network efficiency and increased characteristic path length, which were pronounced more in long DD patients. Furthermore, altered nodal efficiencies were observed in several brain regions, which were mainly distributed in default mode and visual systems. The Expanded Disability Status Scale was positively related to nodal shortest path. NMOSD patients showed decreased cognitive performance in attention, short-term memory and verbal memory, which were associated with significantly decreased degree centrality, nodal efficiency and increased nodal shortest path of several brain regions (all p<0.05). CONCLUSIONS This study illustrated the relationship between WM disruption and cognitive impairment in NMOSD patients, which advance the understanding of disrupted WM networks and provide insight into subtle WM pathology to cognitive impairment in NMOSD.
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Affiliation(s)
- Qiao Zheng
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Xiaoya Chen
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Min Xie
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Jialiang Fu
- Department of Radiology, Chongqing Health Center for Women and Children, 120 Longshan Road, Yubei District, Chongqing 401120, China
| | - Yongliang Han
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Jingjie Wang
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Chun Zeng
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China.
| | - Yongmei Li
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China.
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Wang Y, Zuo C, Wang D, Tao S, Hao L. Reduced Thalamus Volume and Enhanced Thalamus and Fronto-Parietal Network Integration in the Chess Experts. Cereb Cortex 2020; 30:5560-5569. [PMID: 32488242 DOI: 10.1093/cercor/bhaa140] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/01/2020] [Accepted: 05/01/2020] [Indexed: 01/07/2023] Open
Abstract
The ability of chess experts depends to a large extent on spatial visual processing, attention, and working memory, all of which are thought to be mediated by the thalamus. This study explored whether continued practice and rehearsal over a long period of time results in structural changes in the thalamic region. We found smaller gray matter volume regions in the thalami of expert Chinese chess players in comparison with novice players. We then used these regions as seeds for resting-state functional connectivity analysis and observed significantly strengthened integration between the thalamus and fronto-parietal network in expert Chinese chess players. This strengthened integration that includes a group of brain regions showing an increase in activation to external stimulation, particularly during tasks relying on working memory and attention. Our findings demonstrate structural changes in the thalamus caused by a wide range of engagement in chess problem solving, and that this strengthened functional integration with widely distributed circuitry better supports high-level cognitive control of behavior.
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Affiliation(s)
- Yanpei Wang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, 100875, China.,IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, 100875, China
| | - Chenyi Zuo
- College of Educational Science, Anhui Normal University, Wuhu, Anhui, 241000, China
| | - Daoyang Wang
- College of Educational Science, Anhui Normal University, Wuhu, Anhui, 241000, China
| | - Sha Tao
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, 100875, China.,IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, 100875, China
| | - Lei Hao
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, 100875, China.,IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, 100875, China
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31
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Cai L, Wang J, Guo Y, Lu M, Dong Y, Wei X. Altered inter-frequency dynamics of brain networks in disorder of consciousness. J Neural Eng 2020; 17:036006. [PMID: 32311694 DOI: 10.1088/1741-2552/ab8b2c] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Growing evidence have linked disorders of consciousness (DOC) with the changes in frequency-specific functional networks. However, the alteration of inter-frequency dynamics in brain networks remain largely unknown. In this study, we investigated the network integration and segregation across frequency bands in a multiplex network framework. APPROACH Resting-state EEG data were recorded and analysed from 19 patients in minimally conscious state, 35 patients in unresponsive wakefulness syndrome (UWS) and 23 healthy controls. Frequency-based multiplex (cross-frequency) networks were reconstructed by integrating the five frequency-specific networks. Multiplex graph metrics, named multiplex participation coefficient and multiplex clustering coefficient, were employed to assess the network topology of subjects with different levels of consciousness. MAIN RESULTS Results revealed DOC networks, compared to those of healthy controls, may work at a less optimal point (closer to complete disorder) with increased integration and decreased segregation considering inter-frequency dynamics. Both metrics show increased spatial and temporal variability with the consciousness levels. Moreover, significant correlation can be found between the alteration of cross-frequency networks in DOC patients and their behavioural performance at both local and global scales. SIGNIFICANCE These findings may contribute to the development of EEG network study and benefit our understanding of the processes of consciousness and their pathophysiology for DOC.
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Affiliation(s)
- Lihui Cai
- School of Electrical and Information Engineering, Tianjin University, Tianjin, People's Republic of China
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32
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Huang Y, Hu K, Green AL, Ma X, Gillies MJ, Wang S, Fitzgerald JJ, Pan Y, Martin S, Huang P, Zhan S, Li D, Tan H, Aziz TZ, Sun B. Dynamic changes in rhythmic and arrhythmic neural signatures in the subthalamic nucleus induced by anaesthesia and tracheal intubation. Br J Anaesth 2020; 125:67-76. [PMID: 32336475 DOI: 10.1016/j.bja.2020.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 03/16/2020] [Accepted: 03/19/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Subcortical structures, including the basal ganglia, have been proposed to be crucial for arousal, consciousness, and behavioural responsiveness. How the basal ganglia contribute to the loss and recovery of consciousness during anaesthesia has, however, not yet been well characterised. METHODS Twelve patients with advanced Parkinson's disease, who were undergoing deep brain stimulation (DBS) electrode implantation in the subthalamic nucleus (STN), were included in this study. Local field potentials (LFPs) were recorded from the DBS electrodes and EEG was recorded from the scalp during induction of general anaesthesia (with propofol and sufentanil) and during tracheal intubation. Neural signatures of loss of consciousness and of the expected arousal during intubation were sought in the STN and EEG recordings. RESULTS Propofol-sufentanil anaesthesia resulted in power increases in delta, theta, and alpha frequencies, and broadband power decreases in higher frequencies in both STN and frontal cortical areas. This was accompanied by increased STN-frontal cortical coherence only in the alpha frequency band (119 [68]%; P=0.0049). We observed temporal activity changes in STN after tracheal intubation, including power increases in high-beta (22-40 Hz) frequency (98 [123]%; P=0.0064) and changes in the power-law exponent in the power spectra at lower frequencies (2-80 Hz), which were not observed in the frontal cortex. During anaesthesia, the dynamic changes in the high-gamma power in STN LFPs correlated with the power-law exponent in the power spectra at lower frequencies (2-80 Hz). CONCLUSIONS Apart from similar activity changes in both STN and cortex associated with anaesthesia-induced unresponsiveness, we observed specific neuronal activity changes in the STN in response to the anaesthesia and tracheal intubation. We also show that the power-law exponent in the power spectra in the STN was modulated by tracheal intubation in anaesthesia. Our results support the hypothesis that subcortical nuclei may play an important role in the loss and return of responsiveness.
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Affiliation(s)
- Yongzhi Huang
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, UK.
| | - Kejia Hu
- Center of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Alexander L Green
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Xin Ma
- Department of Anesthesiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Martin J Gillies
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Shouyan Wang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - James J Fitzgerald
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Yixin Pan
- Center of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sean Martin
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Peng Huang
- Center of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shikun Zhan
- Center of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dianyou Li
- Center of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huiling Tan
- Medical Research Council Brain Network Dynamics Unit at the University of Oxford, Oxford, UK; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK.
| | - Tipu Z Aziz
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Bomin Sun
- Center of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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33
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Modolo J, Hassan M, Wendling F, Benquet P. Decoding the circuitry of consciousness: From local microcircuits to brain-scale networks. Netw Neurosci 2020; 4:315-337. [PMID: 32537530 PMCID: PMC7286300 DOI: 10.1162/netn_a_00119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 12/09/2019] [Indexed: 01/25/2023] Open
Abstract
Identifying the physiological processes underlying the emergence and maintenance of consciousness is one of the most fundamental problems of neuroscience, with implications ranging from fundamental neuroscience to the treatment of patients with disorders of consciousness (DOCs). One major challenge is to understand how cortical circuits at drastically different spatial scales, from local networks to brain-scale networks, operate in concert to enable consciousness, and how those processes are impaired in DOC patients. In this review, we attempt to relate available neurophysiological and clinical data with existing theoretical models of consciousness, while linking the micro- and macrocircuit levels. First, we address the relationships between awareness and wakefulness on the one hand, and cortico-cortical and thalamo-cortical connectivity on the other hand. Second, we discuss the role of three main types of GABAergic interneurons in specific circuits responsible for the dynamical reorganization of functional networks. Third, we explore advances in the functional role of nested oscillations for neural synchronization and communication, emphasizing the importance of the balance between local (high-frequency) and distant (low-frequency) activity for efficient information processing. The clinical implications of these theoretical considerations are presented. We propose that such cellular-scale mechanisms could extend current theories of consciousness.
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Affiliation(s)
- Julien Modolo
- University of Rennes, INSERM, LTSI-U1099, Rennes, France
| | - Mahmoud Hassan
- University of Rennes, INSERM, LTSI-U1099, Rennes, France
| | | | - Pascal Benquet
- University of Rennes, INSERM, LTSI-U1099, Rennes, France
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34
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Abnormal dynamic properties of functional connectivity in disorders of consciousness. NEUROIMAGE-CLINICAL 2019; 24:102071. [PMID: 31795053 PMCID: PMC6881656 DOI: 10.1016/j.nicl.2019.102071] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/09/2019] [Accepted: 11/04/2019] [Indexed: 01/01/2023]
Abstract
The DOC showed reduced dFC in sensorimotor network compared with the HC. The dFC could be used to predict the clinical scores of the DOC. The different in number of transitions indicated an instable brain state in the DOC.
Resting-state functional magnetic resonance imaging (rs-fMRI) is widely used to research abnormal functional connectivity (FC) in patients with disorders of consciousness (DOC). However, most studies assumed steady spatial-temporal signal interactions between distinct brain regions during the scan period. The aim of this study was to explore abnormal dynamic functional connectivity (dFC) in DOC patients. After excluding 26 patients’ data that failed to meet the requirements of imaging quality, we retained 19 DOC patients (12 with unresponsive wakefulness syndrome and 7 in a minimally conscious state, diagnosed with the Coma Recovery Scale-Revised [CRS-R]) for the dFC analysis. We used the sliding windows approach to construct dFC matrices. Then these matrices were clustered into distinct states using the k-means clustering algorithm. We found that the DOC patients showed decreased dFC in the sensory and somatomotor networks compared with the healthy controls. There were also significant differences in temporal properties, the mean dwell time (MDT) and the number of transitions (NT), between the DOC patients and the healthy controls. In addition, we also used a hidden Markov model (HMM) to test the robustness of the results. With the connectome-based predictive modeling (CPM) approach, we found that the properties of abnormal dynamic network can be used to predict the CRS-R scores of the patients after severe brain injury. These findings may contribute to a better understanding of the abnormal brain networks in DOC patients.
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35
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Luppi AI, Craig MM, Pappas I, Finoia P, Williams GB, Allanson J, Pickard JD, Owen AM, Naci L, Menon DK, Stamatakis EA. Consciousness-specific dynamic interactions of brain integration and functional diversity. Nat Commun 2019; 10:4616. [PMID: 31601811 PMCID: PMC6787094 DOI: 10.1038/s41467-019-12658-9] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/16/2019] [Indexed: 12/26/2022] Open
Abstract
Prominent theories of consciousness emphasise different aspects of neurobiology, such as the integration and diversity of information processing within the brain. Here, we combine graph theory and dynamic functional connectivity to compare resting-state functional MRI data from awake volunteers, propofol-anaesthetised volunteers, and patients with disorders of consciousness, in order to identify consciousness-specific patterns of brain function. We demonstrate that cortical networks are especially affected by loss of consciousness during temporal states of high integration, exhibiting reduced functional diversity and compromised informational capacity, whereas thalamo-cortical functional disconnections emerge during states of higher segregation. Spatially, posterior regions of the brain’s default mode network exhibit reductions in both functional diversity and integration with the rest of the brain during unconsciousness. These results show that human consciousness relies on spatio-temporal interactions between brain integration and functional diversity, whose breakdown may represent a generalisable biomarker of loss of consciousness, with potential relevance for clinical practice. How do diversity (entropy) and integration of activity across brain regions interact to support consciousness? Here the authors show that anaesthetised individuals and patients with disorders of consciousness exhibit overlapping reductions in both diversity and integration in the brain’s default mode network.
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Affiliation(s)
- Andrea I Luppi
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, CB2 0SP, Cambridge, UK.,Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, CB2 0SP, Cambridge, UK
| | - Michael M Craig
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, CB2 0SP, Cambridge, UK.,Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, CB2 0SP, Cambridge, UK
| | - Ioannis Pappas
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, CB2 0SP, Cambridge, UK.,Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, CB2 0SP, Cambridge, UK.,Helen Wills Neuroscience Institute, 210 Barker Hall, University of California - Berkeley, 94720, Berkeley, CA, USA
| | - Paola Finoia
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, CB2 0SP, Cambridge, UK.,Division of Neurosurgery, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, CB2 0SP, Cambridge, UK
| | - Guy B Williams
- Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, CB2 0SP, Cambridge, UK.,Wolfson Brain Imaging Centre, University of Cambridge, Cambridge Biomedical Campus (Box 65), CB2 0QQ, Cambridge, UK
| | - Judith Allanson
- Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, CB2 0SP, Cambridge, UK.,Department of Neurosciences, Cambridge University Hospitals NHS Foundation, Addenbrooke's Hospital, Hills Rd, CB2 0SP, Cambridge, UK
| | - John D Pickard
- Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, CB2 0SP, Cambridge, UK.,Division of Neurosurgery, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, CB2 0SP, Cambridge, UK.,Wolfson Brain Imaging Centre, University of Cambridge, Cambridge Biomedical Campus (Box 65), CB2 0QQ, Cambridge, UK
| | - Adrian M Owen
- The Brain and Mind Institute, Western Interdisciplinary Research Building, N6A 5B7 University of Western Ontario, London, ON, Canada
| | - Lorina Naci
- Trinity College Institute of Neuroscience, School of Psychology, Lloyd Building, Trinity College Dublin, Dublin, Dublin 2, Ireland
| | - David K Menon
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, CB2 0SP, Cambridge, UK.,Wolfson Brain Imaging Centre, University of Cambridge, Cambridge Biomedical Campus (Box 65), CB2 0QQ, Cambridge, UK
| | - Emmanuel A Stamatakis
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, CB2 0SP, Cambridge, UK. .,Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, CB2 0SP, Cambridge, UK.
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36
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Propofol inhibits the local activity and connectivity of nuclei in the cortico-reticulo-thalamic loop in rats. J Anesth 2019; 33:572-578. [DOI: 10.1007/s00540-019-02667-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 07/22/2019] [Indexed: 01/06/2023]
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37
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Efficiency of Repetitive Transcranial Direct Current Stimulation of the Dorsolateral Prefrontal Cortex in Disorders of Consciousness: A Randomized Sham-Controlled Study. Neural Plast 2019; 2019:7089543. [PMID: 31308848 PMCID: PMC6594311 DOI: 10.1155/2019/7089543] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/26/2019] [Accepted: 05/23/2019] [Indexed: 12/20/2022] Open
Abstract
Conventional transcranial direct current stimulation (tDCS) targeting the left dorsolateral prefrontal cortex (DLPFC) could improve arousal in disorders of consciousness (DOC). However, the comparative effectiveness of anodal stimulation of the left DLPFC and the electrophysiological effect of tDCS are yet to be determined. In this randomized sham-controlled design, patients were separated into three groups (left/right anodal tDCS, sham). Data on the clinical assessments and EEG were collected at baseline and after 2 weeks of tDCS. The outcome at 3-month follow-up was evaluated using the Glasgow Outcome Scale-Extended. Results showed that sessions of the left tDCS facilitated the excitability of the prefrontal cortex, whereas only one patient had a positive outcome. Targeting the right DLPFC was less effective, merely leading to activation of the stimulation site, with no effect on the state of arousal. Moreover, sham stimulation had minimal or no effect on any of the outcomes. These results provide evidence for a hemispheric asymmetry of tDCS effects in patients with DOC. Left anodal tDCS might be more effective for modulating cortical excitability compared to tDCS on the right DLPFC. However, future studies with large sample sizes are needed to confirm these findings. This trial is registered with NCT03809936.
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38
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Bourdillon P, Hermann B, Sitt JD, Naccache L. Electromagnetic Brain Stimulation in Patients With Disorders of Consciousness. Front Neurosci 2019; 13:223. [PMID: 30936822 PMCID: PMC6432925 DOI: 10.3389/fnins.2019.00223] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 02/26/2019] [Indexed: 12/27/2022] Open
Abstract
Severe brain injury is a common cause of coma. In some cases, despite vigilance improvement, disorders of consciousness (DoC) persist. Several states of impaired consciousness have been defined, according to whether the patient exhibits only reflexive behaviors as in the vegetative state/unresponsive wakefulness syndrome (VS/UWS) or purposeful behaviors distinct from reflexes as in the minimally conscious state (MCS). Recently, this clinical distinction has been enriched by electrophysiological and neuroimaging data resulting from a better understanding of the physiopathology of DoC. However, therapeutic options, especially pharmacological ones, remain very limited. In this context, electroceuticals, a new category of therapeutic agents which act by targeting the neural circuits with electromagnetic stimulations, started to develop in the field of DoC. We performed a systematic review of the studies evaluating therapeutics relying on the direct or indirect electro-magnetic stimulation of the brain in DoC patients. Current evidence seems to support the efficacy of deep brain stimulation (DBS) and non-invasive brain stimulation (NIBS) on consciousness in some of these patients. However, while the latter is non-invasive and well tolerated, the former is associated with potential major side effects. We propose that all chronic DoC patients should be given the possibility to benefit from NIBS, and that transcranial direct current stimulation (tDCS) should be preferred over repetitive transcranial magnetic stimulation (rTMS), based on the literature and its simple use. Surgical techniques less invasive than DBS, such as vagus nerve stimulation (VNS) might represent a good compromise between efficacy and invasiveness but still need to be further investigated.
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Affiliation(s)
- Pierre Bourdillon
- Department of Neurosurgery, Adolphe de Rothschild Foundation, Paris, France
- Sorbonne Université, Faculté de Médecine Pitié-Salpêtrière, Paris, France
- Institut du Cerveau et de la Moelle Épinière, ICM, PICNIC Lab, Paris, France
- Inserm U 1127, Paris, France
- CNRS, UMR 7225, Paris, France
| | - Bertrand Hermann
- Sorbonne Université, Faculté de Médecine Pitié-Salpêtrière, Paris, France
- Institut du Cerveau et de la Moelle Épinière, ICM, PICNIC Lab, Paris, France
- Inserm U 1127, Paris, France
- CNRS, UMR 7225, Paris, France
- Department of Neurology, Neuro ICU, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - Jacobo D. Sitt
- Institut du Cerveau et de la Moelle Épinière, ICM, PICNIC Lab, Paris, France
- Inserm U 1127, Paris, France
- CNRS, UMR 7225, Paris, France
| | - Lionel Naccache
- Sorbonne Université, Faculté de Médecine Pitié-Salpêtrière, Paris, France
- Institut du Cerveau et de la Moelle Épinière, ICM, PICNIC Lab, Paris, France
- Inserm U 1127, Paris, France
- CNRS, UMR 7225, Paris, France
- Department of Neurophysiology, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
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39
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Spatially Overlapping Regions Show Abnormal Thalamo-frontal Circuit and Abnormal Precuneus in Disorders of Consciousness. Brain Topogr 2019; 32:445-460. [DOI: 10.1007/s10548-018-0693-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 12/11/2018] [Indexed: 01/14/2023]
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40
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Tan X, Zhou Z, Gao J, Meng F, Yu Y, Zhang J, He F, Wei R, Wang J, Peng G, Zhang X, Pan G, Luo B. Structural connectome alterations in patients with disorders of consciousness revealed by 7-tesla magnetic resonance imaging. NEUROIMAGE-CLINICAL 2019; 22:101702. [PMID: 30711681 PMCID: PMC6360803 DOI: 10.1016/j.nicl.2019.101702] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 01/25/2019] [Accepted: 01/28/2019] [Indexed: 02/04/2023]
Abstract
Although the functional connectivity of patients with disorders of consciousness (DOC) has been widely examined, less is known about brain white matter connectivity. The aim of this study was to explore structural network alterations for the diagnosis and prognosis of patients with chronic DOC. Eleven DOC patients and 11 sex- and age-matched controls were included in the study. Participants underwent diffusion magnetic resonance imaging (MRI) and T1-weighted structural MRI at 7 tesla (7 T). Graph-theoretical analysis and network-based statistics were used to analyze the group differences. Two patients were scanned twice for a longitudinal study to examine the relationship between connectome metrics and the patients' prognoses. Compared with healthy controls, DOC patients showed significantly elevated transitivity (p < .001), local efficiency (p = .009), and clustering coefficient (p = .039). When comparing the connectome metrics within the three groups (healthy controls, minimally conscious state (MCS), and vegetative state/unresponsive wakefulness syndrome (VS/UWS)), significant group differences were observed in transitivity (p < .001) and local efficiency (p = .031). Significantly increased transitivity was observed in vegetative state/unresponsive wakefulness syndrome compared with minimally conscious state (p = .0217, Bonferroni corrected). Transitivity showed significant negative correlations with the Coma Recovery Scale-Revised score (r = -0.6902, p = .023), consistent with the longitudinal study results. A subnetwork with significantly decreased structural connections was identified using network-based statistical analysis comparing DOC patients with healthy controls, which was mainly located in the frontal cortex, limbic system, and occipital and parietal lobes. This preliminary study suggests that graph theoretical approaches for assessing white matter connectivity may enable various states of DOC to be distinguished. Of the metrics analyzed, transitivity had a critical role in distinguishing the diagnostic groups. Larger cohorts will be necessary to confirm the predictive value of 7 T MRI in the prognosis of DOC patients.
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Affiliation(s)
- Xufei Tan
- Department of Neurology, Brain Medical Centre, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhen Zhou
- State Key Lab of CAD&CG, Zhejiang University, Hangzhou, China; College of Computer Science and Technology, Zhejiang University, Hangzhou, China
| | - Jian Gao
- Department of Rehabilitation, Hangzhou Hospital of Zhejiang CAPR, Hangzhou, China
| | - Fanxia Meng
- Department of Neurology, Brain Medical Centre, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yamei Yu
- Department of Neurology, Brain Medical Centre, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jie Zhang
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Fangping He
- Department of Neurology, Brain Medical Centre, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ruili Wei
- Department of Neurology, Brain Medical Centre, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Junyang Wang
- Department of Neurology, Brain Medical Centre, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Guoping Peng
- Department of Neurology, Brain Medical Centre, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaotong Zhang
- Interdisciplinary Institute of Neuroscience and Technology, Qiushi Academy for Advanced Studies, Zhejiang University, Hangzhou, China; Center for Brain Imaging Science and Technology, College of Biomedical Engineering and Instrumental Science, Zhejiang University, Hangzhou, China
| | - Gang Pan
- State Key Lab of CAD&CG, Zhejiang University, Hangzhou, China; College of Computer Science and Technology, Zhejiang University, Hangzhou, China.
| | - Benyan Luo
- Department of Neurology, Brain Medical Centre, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China; School of Medicine, Zhejiang University, Collaborative Innovation Center for Brain Science, Hangzhou, China.
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41
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Abstract
With the development of modern international medicine, the subject of disorders of consciousness (DOCs) has begun to be raised in mainland China. Much progress has been made to date in several specialties related to the management of chronic DOC patients in China. In this article, we briefly review the present status of DOC studies in China, specifically concerning diagnosis, prognosis, therapy, and rehabilitation. The development of DOC-related scientific organizations and activities in China are introduced. Some weaknesses that need improvement are also noted. The current program provides a good foundation for future development.
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Affiliation(s)
- Jizong Zhao
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China.
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42
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Can they Feel? The Capacity for Pain and Pleasure in Patients with Cognitive Motor Dissociation. NEUROETHICS-NETH 2018; 12:153-169. [PMID: 31983931 PMCID: PMC6951816 DOI: 10.1007/s12152-018-9361-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/27/2018] [Indexed: 01/18/2023]
Abstract
Unresponsive wakefulness syndrome is a disorder of consciousness wherein a patient is awake, but completely non-responsive at the bedside. However, research has shown that a minority of these patients remain aware, and can demonstrate their awareness via functional neuroimaging; these patients are referred to as having ‘cognitive motor dissociation’ (CMD). Unfortunately, we have little insight into the subjective experiences of these patients, making it difficult to determine how best to promote their well-being. In this paper, I argue that the capacity to experience pain or pleasure (sentience) is a key component of well-being for these patients. While patients with unresponsive wakefulness syndrome are believed to be incapable of experiencing pain or pleasure, I argue that there is evidence to support the notion that CMD patients likely can experience pain and pleasure. I analyze current neuroscientific research into the mechanisms of pain experience in patients with disorders of consciousness, and provide an explanation for why CMD patients likely can experience physical pain. I then do the same for physical pleasure. I conclude that providing these patients with pleasurable experiences, and avoiding subjecting them to pain, are viable means of promoting their well-being.
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Wu B, Yang Y, Zhou S, Wang W, Wang Z, Hu G, He J, Wu X. Could Arterial Spin Labeling Distinguish Patients in Minimally Conscious State from Patients in Vegetative State? Front Neurol 2018; 9:110. [PMID: 29551989 PMCID: PMC5840257 DOI: 10.3389/fneur.2018.00110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 02/14/2018] [Indexed: 01/12/2023] Open
Abstract
Purpose Diagnostic error is common among patients with vegetative state (VS) and minimally conscious state (MCS). The purpose of this article is to use three-dimensional pseudo-continuous arterial spin labeling (pcASL) to compare cerebral blood flow (CBF) patterns in patients in MCS with those in VS. Methods Patients meeting MCS and VS criteria were identified. Two post-labeling delay (PLD) time pcASL on 3.0-Tesla magnetic resonance imaging scanner system were performed with patients in the resting awake state. After registration to T1WI structure imaging, multiple brain regions of interest of ASL CBF map were automatically separated. The average CBF value of every brain region was calculated and compared between the MCS and VS groups with t-tests. Results Fifteen patients with VS were identified, with ages ranging from 33 to 71 years. Eight patients who met the MCS criteria ranged in age from 23 to 61 years. Compared with VS, the regional CBF for MCS had a pattern of significantly increased CBF in the regions including the putamen, anterior cingulate gyrus, and medial frontal cortex. A left-lateralized pattern was observed to differentiate MCS from VS. CBF with PLD 2.5 s could find more regions of pattern differentiating MCS from VS than with PLD 1.5 s, except for the pallidum. Conclusion MCS might be differentiated from VS by different ranges of regional CBF as measured by ASL. Multi-PLD ASL may serve as an adjunct method to separate MCS from VS and assess functional reserve in patients recovering from severe brain injuries.
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Affiliation(s)
- Bing Wu
- Department of Radiology, PLA Army General Hospital, Beijing, China
| | - Yi Yang
- Department of Neurosurgery, PLA Army General Hospital, Beijing, China
| | - Shuai Zhou
- Inner Mongolia Medical University, Hohhot, China
| | - Wei Wang
- Department of Radiology, PLA Army General Hospital, Beijing, China
| | - Zizhen Wang
- Department of Radiology, PLA Army General Hospital, Beijing, China
| | - Gang Hu
- Department of Radiology, PLA Army General Hospital, Beijing, China
| | - Jianghong He
- Department of Neurosurgery, PLA Army General Hospital, Beijing, China
| | - Xinhuai Wu
- Department of Radiology, PLA Army General Hospital, Beijing, China.,Inner Mongolia Medical University, Hohhot, China
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Wang L, Yang Y, Chen S, Ge M, He J, Yang Z, Lin P, Wu X. White matter integrity correlates with residual consciousness in patients with severe brain injury. Brain Imaging Behav 2018; 12:1669-1677. [DOI: 10.1007/s11682-018-9832-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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