1
|
Connelly N, Welsby E, Lange B, Hordacre B. Virtual Reality Action Observation and Motor Imagery to Enhance Neuroplastic Capacity in the Human Motor Cortex: A Pilot Double-blind, Randomized Cross-over Trial. Neuroscience 2024; 549:92-100. [PMID: 38705350 DOI: 10.1016/j.neuroscience.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/13/2024] [Accepted: 04/25/2024] [Indexed: 05/07/2024]
Abstract
Neuroplasticity is important for learning, development and recovery from injury. Therapies that can upregulate neuroplasticity are therefore of interest across a range of fields. We developed a novel virtual reality action observation and motor imagery (VR-AOMI) intervention and evaluated whether it could enhance the efficacy of mechanisms of neuroplasticity in the human motor cortex of healthy adults. A secondary question was to explore predictors of the change in neuroplasticity following VR-AOMI. A pre-registered, pilot randomized controlled cross-over trial was performed. Twenty right-handed adults (13 females; mean age: 23.0 ± 4.53 years) completed two experimental conditions in separate sessions; VR-AOMI and control. We used intermittent theta burst stimulation (iTBS) to induce long term potentiation-like plasticity in the motor cortex and recorded motor evoked potentials at multiple timepoints as a measure of corticospinal excitability. The VR-AOMI task did not significantly increase the change in MEP amplitude following iTBS when compared to the control task (Group × Timepoint interaction p = 0.17). However, regression analysis identified the change in iTBS response following VR-AOMI was significantly predicted by the baseline iTBS response in the control task. Specifically, participants that did not exhibit the expected increase in MEP amplitude following iTBS in the control condition appear to have greater excitability following iTBS in the VR-AOMI condition (r = -0.72, p < 0.001). Engaging in VR-AOMI might enhance capacity for neuroplasticity in some people who typically do not respond to iTBS. VR-AOMI may prime the brain for enhanced neuroplasticity in this sub-group.
Collapse
Affiliation(s)
- Niamh Connelly
- Innovation, Implementation and Clinical Translation (IIMPACT) in Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Ellana Welsby
- Innovation, Implementation and Clinical Translation (IIMPACT) in Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Belinda Lange
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Brenton Hordacre
- Innovation, Implementation and Clinical Translation (IIMPACT) in Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia.
| |
Collapse
|
2
|
Mancuso M, Cruciani A, Sveva V, Casula EP, Brown K, Rothwell JC, Di Lazzaro V, Koch G, Rocchi L. Somatosensory input in the context of transcranial magnetic stimulation coupled with electroencephalography: An evidence-based overview. Neurosci Biobehav Rev 2023; 155:105434. [PMID: 37890602 DOI: 10.1016/j.neubiorev.2023.105434] [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: 06/18/2023] [Revised: 10/11/2023] [Accepted: 10/22/2023] [Indexed: 10/29/2023]
Abstract
The transcranial evoked potential (TEP) is a powerful technique to investigate brain dynamics, but some methodological issues limit its interpretation. A possible contamination of the TEP by electroencephalographic (EEG) responses evoked by the somatosensory input generated by transcranial magnetic stimulation (TMS) has been postulated; nonetheless, a characterization of these responses is lacking. The aim of this work was to review current evidence about possible somatosensory evoked potentials (SEP) induced by sources of somatosensory input in the craniofacial region. Among these, only contraction of craniofacial muscle and stimulation of free cutaneous nerve endings may be able to induce EEG responses, but direct evidence is lacking due to experimental difficulties in isolating these inputs. Notably, EEG evoked activity in this context is represented by a N100/P200 complex, reflecting a saliency-related multimodal response, rather than specific activation of the primary somatosensory cortex. Strategies to minimize or remove these responses by EEG processing still yield uncertain results; therefore, data inspection is of paramount importance to judge a possible contamination of the TEP by multimodal potentials caused by somatosensory input.
Collapse
Affiliation(s)
- M Mancuso
- Department of Human Neurosciences, University of Rome "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - A Cruciani
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology, and Psychiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - V Sveva
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, University of Rome "Sapienza", Piazzale Aldo Moro, 5, 00185 Rome, Italy
| | - E P Casula
- Department of System Medicine, "Tor Vergata" University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - K Brown
- Department of Kinesiology, University of Waterloo, 200 University Ave W, N2L 3G5 Waterloo, ON, Canada
| | - J C Rothwell
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, WC1N 3BG London, United Kingdom
| | - V Di Lazzaro
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology, and Psychiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - G Koch
- Non-Invasive Brain Stimulation Unit, IRCCS Santa Lucia Foundation, Via Ardeatina, 306/354, 00179 Rome, Italy
| | - L Rocchi
- Department of Medical Sciences and Public Health, University of Cagliari, Cittadella Universitaria di Monserrato Blocco I S.S, 554 bivio per Sestu 09042, Monserrato, Cagliari, Italy.
| |
Collapse
|
3
|
Bigoni C, Beanato E, Harquel S, Hervé J, Oflar M, Crema A, Espinosa A, Evangelista GG, Koch P, Bonvin C, Turlan JL, Guggisberg A, Morishita T, Wessel MJ, Zandvliet SB, Hummel FC. Novel personalized treatment strategy for patients with chronic stroke with severe upper-extremity impairment: The first patient of the AVANCER trial. MED 2023; 4:591-599.e3. [PMID: 37437575 DOI: 10.1016/j.medj.2023.06.006] [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: 05/26/2023] [Revised: 06/12/2023] [Accepted: 06/15/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Around 25% of patients who have had a stroke suffer from severe upper-limb impairment and lack effective rehabilitation strategies. The AVANCER proof-of-concept clinical trial (NCT04448483) tackles this issue through an intensive and personalized-dosage cumulative intervention that combines multiple non-invasive neurotechnologies. METHODS The therapy consists of two sequential interventions, lasting until the patient shows no further motor improvement, for a minimum of 11 sessions each. The first phase involves a brain-computer interface governing an exoskeleton and multi-channel functional electrical stimulation enabling full upper-limb movements. The second phase adds anodal transcranial direct current stimulation of the motor cortex of the lesioned hemisphere. Clinical, electrophysiological, and neuroimaging examinations are performed before, between, and after the two interventions (T0, T1, and T2). This case report presents the results from the first patient of the study. FINDINGS The primary outcome (i.e., 4-point improvement in the Fugl-Meyer assessment of the upper extremity) was met in the first patient, with an increase from 6 to 11 points between T0 and T2. This improvement was paralleled by changes in motor-network structure and function. Resting-state and transcranial magnetic stimulation-evoked electroencephalography revealed brain functional changes, and magnetic resonance imaging (MRI) measures detected structural and task-related functional changes. CONCLUSIONS These first results are promising, pointing to feasibility, safety, and potential efficacy of this personalized approach acting synergistically on the nervous and musculoskeletal systems. Integrating multi-modal data may provide valuable insights into underlying mechanisms driving the improvements and providing predictive information regarding treatment response and outcomes. FUNDING This work was funded by the Wyss-Center for Bio and Neuro Engineering (WCP-030), the Defitech Foundation, PHRT-#2017-205, ERA-NET-NEURON (Discover), and SNSF (320030L_197899, NiBS-iCog).
Collapse
Affiliation(s)
- Claudia Bigoni
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne Valais (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland
| | - Elena Beanato
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne Valais (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland
| | - Sylvain Harquel
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne Valais (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland
| | - Julie Hervé
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne Valais (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland
| | - Meltem Oflar
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne Valais (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland
| | - Andrea Crema
- Clinical Neuroscience, University of Geneva Medical School, 1202 Geneva, Switzerland; Bertarelli Foundation Chair in Translational Neuroengineering, Neuro-X Institute (INX) and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Arnau Espinosa
- Wyss Center for Bio and Neuroengineering, Chemin des Mines 9, 1202 Geneva, Switzerland
| | - Giorgia G Evangelista
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne Valais (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland
| | - Philipp Koch
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | | | - Jean-Luc Turlan
- Department of Neurological Rehabilitation, Clinique Romande de Réadaptation SUVA, 1951 Sion, Switzerland
| | - Adrian Guggisberg
- Universitäre Neurorehabilitation, Universitätsklinik für Neurologie, Inselspital, University Hospital Berne, Bern, Switzerland
| | - Takuya Morishita
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne Valais (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland
| | - Maximilian J Wessel
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne Valais (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland
| | - Sarah B Zandvliet
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne Valais (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland; Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Friedhelm C Hummel
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne Valais (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland; Clinical Neuroscience, University of Geneva Medical School, 1202 Geneva, Switzerland.
| |
Collapse
|
4
|
Chirumamilla VC, Gonzalez-Escamilla G, Meyer B, Anwar AR, Ding H, Radetz A, Bonertz T, Groppa S, Muthuraman M. Inhibitory and excitatory responses in the dorso-medial prefrontal cortex during threat processing. Front Neurosci 2023; 16:1065469. [PMID: 36699539 PMCID: PMC9868831 DOI: 10.3389/fnins.2022.1065469] [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: 10/09/2022] [Accepted: 12/20/2022] [Indexed: 01/12/2023] Open
Abstract
Objective To evaluate cortical excitability during instructed threat processing. Methods Single and paired transcranial magnetic stimulation (TMS) pulses were applied to the right dorsomedial prefrontal cortex (dmPFC) during high-density electroencephalography (EEG) recording in young healthy participants (n = 17) performing an instructed threat paradigm in which one of two conditioned stimuli (CS+ but not CS-) was paired with an electric shock (unconditioned stimulus [US]). We assessed TMS-induced EEG responses with spectral power (both at electrode and source level) and information flow (effective connectivity) using Time-resolved Partial Directed Coherence (TPDC). Support vector regression (SVR) was used to predict behavioral fear ratings for CS+ based on TMS impact on excitability. Results During intracortical facilitation (ICF), frontal lobe theta power was enhanced for CS+ compared to single pulse TMS for the time window 0-0.5 s after TMS pulse onset (t(16) = 3.9, p < 0.05). At source level, ICF led to an increase and short intracortical inhibition (SICI) to a decrease of theta power in the bilateral dmPFC, relative to single pulse TMS during 0-0.5 s. Compared to single pulse TMS, ICF increased information flows, whereas SICI reduced the information flows in theta band between dmPFC, amygdala, and hippocampus (all at p < 0.05). The magnitude of information flows between dmPFC to amygdala and dmPFC to hippocampus during ICF (0-0.5 s), predicted individual behavioral fear ratings (CS+; coefficient above 0.75). Conclusion Distinct excitatory and inhibitory mechanisms take place in the dmPFC. These findings may facilitate future research attempting to investigate inhibitory/facilitatory mechanisms alterations in psychiatric disorders and their behavioral correlates.
Collapse
Affiliation(s)
- Venkata C. Chirumamilla
- Section of Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Gabriel Gonzalez-Escamilla
- Section of Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Benjamin Meyer
- Neuroimaging Center Mainz, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Abdul Rauf Anwar
- Section of Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Hao Ding
- Section of Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Angela Radetz
- Section of Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Tamara Bonertz
- Section of Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sergiu Groppa
- Section of Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Muthuraman Muthuraman
- Section of Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany,*Correspondence: Muthuraman Muthuraman,
| |
Collapse
|
5
|
Motolese F, Lanzone J, Todisco A, Rossi M, Santoro F, Cruciani A, Capone F, Di Lazzaro V, Pilato F. The role of neurophysiological tools in the evaluation of ischemic stroke evolution: a narrative review. Front Neurol 2023; 14:1178408. [PMID: 37181549 PMCID: PMC10172480 DOI: 10.3389/fneur.2023.1178408] [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: 03/02/2023] [Accepted: 03/23/2023] [Indexed: 05/16/2023] Open
Abstract
Ischemic stroke is characterized by a complex cascade of events starting from vessel occlusion. The term "penumbra" denotes the area of severely hypo-perfused brain tissue surrounding the ischemic core that can be potentially recovered if blood flow is reestablished. From the neurophysiological perspective, there are local alterations-reflecting the loss of function of the core and the penumbra-and widespread changes in neural networks functioning, since structural and functional connectivity is disrupted. These dynamic changes are closely related to blood flow in the affected area. However, the pathological process of stroke does not end after the acute phase, but it determines a long-term cascade of events, including changes of cortical excitability, that are quite precocious and might precede clinical evolution. Neurophysiological tools-such as Transcranial Magnetic Stimulation (TMS) or Electroencephalography (EEG)-have enough time resolution to efficiently reflect the pathological changes occurring after stroke. Even if they do not have a role in acute stroke management, EEG and TMS might be helpful for monitoring ischemia evolution-also in the sub-acute and chronic stages. The present review aims to describe the changes occurring in the infarcted area after stroke from the neurophysiological perspective, starting from the acute to the chronic phase.
Collapse
Affiliation(s)
- Francesco Motolese
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- *Correspondence: Francesco Motolese,
| | - Jacopo Lanzone
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit of Milan Institute, Milan, Italy
| | - Antonio Todisco
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Mariagrazia Rossi
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Francesca Santoro
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Alessandro Cruciani
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Fioravante Capone
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Vincenzo Di Lazzaro
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Fabio Pilato
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| |
Collapse
|
6
|
Keser Z, Buchl SC, Seven NA, Markota M, Clark HM, Jones DT, Lanzino G, Brown RD, Worrell GA, Lundstrom BN. Electroencephalogram (EEG) With or Without Transcranial Magnetic Stimulation (TMS) as Biomarkers for Post-stroke Recovery: A Narrative Review. Front Neurol 2022; 13:827866. [PMID: 35273559 PMCID: PMC8902309 DOI: 10.3389/fneur.2022.827866] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/31/2022] [Indexed: 01/20/2023] Open
Abstract
Stroke is one of the leading causes of death and disability. Despite the high prevalence of stroke, characterizing the acute neural recovery patterns that follow stroke and predicting long-term recovery remains challenging. Objective methods to quantify and characterize neural injury are still lacking. Since neuroimaging methods have a poor temporal resolution, EEG has been used as a method for characterizing post-stroke recovery mechanisms for various deficits including motor, language, and cognition as well as predicting treatment response to experimental therapies. In addition, transcranial magnetic stimulation (TMS), a form of non-invasive brain stimulation, has been used in conjunction with EEG (TMS-EEG) to evaluate neurophysiology for a variety of indications. TMS-EEG has significant potential for exploring brain connectivity using focal TMS-evoked potentials and oscillations, which may allow for the system-specific delineation of recovery patterns after stroke. In this review, we summarize the use of EEG alone or in combination with TMS in post-stroke motor, language, cognition, and functional/global recovery. Overall, stroke leads to a reduction in higher frequency activity (≥8 Hz) and intra-hemispheric connectivity in the lesioned hemisphere, which creates an activity imbalance between non-lesioned and lesioned hemispheres. Compensatory activity in the non-lesioned hemisphere leads mostly to unfavorable outcomes and further aggravated interhemispheric imbalance. Balanced interhemispheric activity with increased intrahemispheric coherence in the lesioned networks correlates with improved post-stroke recovery. TMS-EEG studies reveal the clinical importance of cortical reactivity and functional connectivity within the sensorimotor cortex for motor recovery after stroke. Although post-stroke motor studies support the prognostic value of TMS-EEG, more studies are needed to determine its utility as a biomarker for recovery across domains including language, cognition, and hemispatial neglect. As a complement to MRI-based technologies, EEG-based technologies are accessible and valuable non-invasive clinical tools in stroke neurology.
Collapse
Affiliation(s)
- Zafer Keser
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Samuel C. Buchl
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Nathan A. Seven
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Matej Markota
- Department of Psychiatry, Mayo Clinic, Rochester, MN, United States
| | - Heather M. Clark
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - David T. Jones
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Giuseppe Lanzino
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, United States
| | - Robert D. Brown
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | | | | |
Collapse
|
7
|
Rolle CE, Baumer FM, Jordan JT, Berry K, Garcia M, Monusko K, Trivedi H, Wu W, Toll R, Buckwalter MS, Lansberg M, Etkin A. Mapping causal circuit dynamics in stroke using simultaneous electroencephalography and transcranial magnetic stimulation. BMC Neurol 2021; 21:280. [PMID: 34271872 PMCID: PMC8283835 DOI: 10.1186/s12883-021-02319-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 05/16/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Motor impairment after stroke is due not only to direct tissue loss but also to disrupted connectivity within the motor network. Mixed results from studies attempting to enhance motor recovery with Transcranial Magnetic Stimulation (TMS) highlight the need for a better understanding of both connectivity after stroke and the impact of TMS on this connectivity. This study used TMS-EEG to map the causal information flow in the motor network of healthy adult subjects and define how stroke alters these circuits. METHODS Fourteen stroke patients and 12 controls received TMS to two sites (bilateral primary motor cortices) during two motor tasks (paretic/dominant hand movement vs. rest) while EEG measured the cortical response to TMS pulses. TMS-EEG based connectivity measurements were derived for each hemisphere and the change in connectivity (ΔC) between the two motor tasks was calculated. We analyzed if ΔC for each hemisphere differed between the stroke and control groups or across TMS sites, and whether ΔC correlated with arm function in stroke patients. RESULTS Right hand movement increased connectivity in the left compared to the right hemisphere in controls, while hand movement did not significantly change connectivity in either hemisphere in stroke. Stroke patients with the largest increase in healthy hemisphere connectivity during paretic hand movement had the best arm function. CONCLUSIONS TMS-EEG measurements are sensitive to movement-induced changes in brain connectivity. These measurements may characterize clinically meaningful changes in circuit dynamics after stroke, thus providing specific targets for trials of TMS in post-stroke rehabilitation.
Collapse
Affiliation(s)
- Camarin E Rolle
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, MC: 5797, Stanford, CA, 94305-5797, USA.,Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA.,Sierra-Pacific Mental Illness Research, Education, and Clinical Centers (MIRECC), Palo Alto Veterans Health Care Administration, Palo Alto, CA, USA
| | - Fiona M Baumer
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA.,Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Joshua T Jordan
- Department of Psychiatry, University of California At San Francisco, San Francisco, CA, USA
| | - Ketura Berry
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Madelleine Garcia
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Karen Monusko
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, MC: 5797, Stanford, CA, 94305-5797, USA
| | - Hersh Trivedi
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, MC: 5797, Stanford, CA, 94305-5797, USA
| | - Wei Wu
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, MC: 5797, Stanford, CA, 94305-5797, USA.,Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA.,Sierra-Pacific Mental Illness Research, Education, and Clinical Centers (MIRECC), Palo Alto Veterans Health Care Administration, Palo Alto, CA, USA
| | - Russell Toll
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, MC: 5797, Stanford, CA, 94305-5797, USA.,Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA.,Sierra-Pacific Mental Illness Research, Education, and Clinical Centers (MIRECC), Palo Alto Veterans Health Care Administration, Palo Alto, CA, USA
| | - Marion S Buckwalter
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA.,Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Maarten Lansberg
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Amit Etkin
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, MC: 5797, Stanford, CA, 94305-5797, USA. .,Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA. .,Sierra-Pacific Mental Illness Research, Education, and Clinical Centers (MIRECC), Palo Alto Veterans Health Care Administration, Palo Alto, CA, USA.
| |
Collapse
|
8
|
Jee S. Brain Oscillations and Their Implications for Neurorehabilitation. BRAIN & NEUROREHABILITATION 2021; 14:e7. [PMID: 36742108 PMCID: PMC9879411 DOI: 10.12786/bn.2021.14.e7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 02/14/2021] [Accepted: 03/05/2021] [Indexed: 11/08/2022] Open
Abstract
Neural oscillation is rhythmic or repetitive neural activities, which can be observed at all levels of the central nervous system (CNS). The large-scale oscillations measured by electroencephalography have long been used in clinical practice and may have a potential for the usage in neurorehabilitation for people with various CNS disorders. The recent advancement of computational neuroscience has opened up new opportunities to explore clinical application of the results of neural oscillatory activity analysis to evaluation and diagnosis; monitoring the rehab progress; prognostication; and personalized rehabilitation planning in neurorehabilitation. In addition, neural oscillation is catching more attention to its role as a target of noninvasive neuromodulation in neurological disorders.
Collapse
Affiliation(s)
- Sungju Jee
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon, Korea.,Daejeon Chungcheong Regional Medical Rehabilitation Center, Chungnam National University Hospital, Daejeon, Korea.,Daejeon Chungcheong Regional Cardiocerebrovascular Center, Chungnam National University Hospital, Daejeon, Korea
| |
Collapse
|
9
|
Hordacre B, Lotze M, Jenkinson M, Lazari A, Barras CD, Boyd L, Hillier S. Fronto-parietal involvement in chronic stroke motor performance when corticospinal tract integrity is compromised. NEUROIMAGE-CLINICAL 2021; 29:102558. [PMID: 33513561 PMCID: PMC7841401 DOI: 10.1016/j.nicl.2021.102558] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/16/2020] [Accepted: 01/06/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Preserved integrity of the corticospinal tract (CST) is a marker of good upper-limb behavior and recovery following stroke. However, there is less understanding of neural mechanisms that might help facilitate upper-limb motor recovery in stroke survivors with extensive CST damage. OBJECTIVE The purpose of this study was to investigate resting state functional connectivity in chronic stroke survivors with different levels of CST damage and to explore neural correlates of greater upper-limb motor performance in stroke survivors with compromised ipsilesional CST integrity. METHODS Thirty chronic stroke survivors (24 males, aged 64.7 ± 10.8 years) participated in this study. Three experimental sessions were conducted to: 1) obtain anatomical (T1, T2) structural (diffusion) and functional (resting state) MRI sequences, 2) determine CST integrity with transcranial magnetic stimulation (TMS) and conduct assessments of upper-limb behavior, and 3) reconfirm CST integrity status. Participants were divided into groups according to the extent of CST damage. Those in the extensive CST damage group did not show TMS evoked responses and had significantly lower ipsilesional fractional anisotropy. RESULTS Of the 30 chronic stroke survivors, 12 were categorized as having extensive CST damage. Stroke survivors with extensive CST damage had weaker functional connectivity in the ipsilesional sensorimotor network and greater functional connectivity in the ipsilesional fronto-parietal network compared to those with preserved CST integrity. For participants with extensive CST damage, improved motor performance was associated with greater functional connectivity of the ipsilesional fronto-parietal network and higher fractional anisotropy of the ipsilesional rostral superior longitudinal fasciculus. CONCLUSIONS Stroke survivors with extensive CST damage have greater resting state functional connectivity of an ipsilesional fronto-parietal network that appears to be a behaviorally relevant neural mechanism that improves upper-limb motor performance.
Collapse
Affiliation(s)
- Brenton Hordacre
- University of South Australia, IIMPACT in Health, Adelaide, Australia.
| | - Martín Lotze
- Functional Imaging Unit, Center for Diagnostic Radiology, University Medicine Greifswald, Greifswald, Germany
| | - Mark Jenkinson
- Wellcome Centre for Integrative Neuroimaging, Centre for Functional MRI of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Alberto Lazari
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Christen D Barras
- South Australian Health and Medical Research Institute, Adelaide, Australia; The University of Adelaide, Adelaide, Australia
| | - Lara Boyd
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Susan Hillier
- University of South Australia, IIMPACT in Health, Adelaide, Australia
| |
Collapse
|
10
|
Levy-Lamdan O, Zifman N, Sasson E, Efrati S, Hack DC, Tanne D, Dolev I, Fogel H. Evaluation of White Matter Integrity Utilizing the DELPHI (TMS-EEG) System. Front Neurosci 2020; 14:589107. [PMID: 33408607 PMCID: PMC7779791 DOI: 10.3389/fnins.2020.589107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/16/2020] [Indexed: 01/18/2023] Open
Abstract
Objective The aim of this study was to evaluate brain white matter (WM) fibers connectivity damage in stroke and traumatic brain injury (TBI) subjects by direct electrophysiological imaging (DELPHI) that analyzes transcranial magnetic stimulation (TMS)-evoked potentials (TEPs). Methods The study included 123 participants, out of which 53 subjects with WM-related pathologies (39 stroke, 14 TBI) and 70 healthy age-related controls. All subjects underwent DELPHI brain network evaluations of TMS-electroencephalogram (EEG)-evoked potentials and diffusion tensor imaging (DTI) scans for quantification of WM microstructure fractional anisotropy (FA). Results DELPHI output measures show a significant difference between the healthy and stroke/TBI groups. A multidimensional approach was able to classify healthy from unhealthy with a balanced accuracy of 0.81 ± 0.02 and area under the curve (AUC) of 0.88 ± 0.01. Moreover, a multivariant regression model of DELPHI output measures achieved prediction of WM microstructure changes measured by FA with the highest correlations observed for fibers proximal to the stimulation area, such as frontal corpus callosum (r = 0.7 ± 0.02), anterior internal capsule (r = 0.7 ± 0.02), and fronto-occipital fasciculus (r = 0.65 ± 0.03). Conclusion These results indicate that features of TMS-evoked response are correlated to WM microstructure changes observed in pathological conditions, such as stroke and TBI, and that a multidimensional approach combining these features in supervised learning methods serves as a strong indicator for abnormalities and changes in WM integrity.
Collapse
Affiliation(s)
| | - Noa Zifman
- QuantalX Neuroscience, Beer-Yaacov, Israel
| | - Efrat Sasson
- Sagol Center for Hyperbaric Medicine and Research, Shamir Medical Center, Zerifin, Israel
| | - Shai Efrati
- Sagol Center for Hyperbaric Medicine and Research, Shamir Medical Center, Zerifin, Israel.,Sackler School of Medicine and Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Dallas C Hack
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States
| | - David Tanne
- Sackler School of Medicine and Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel.,Stroke and Cognition Institute, Rambam Healthcare Campus, Haifa, Israel
| | | | | |
Collapse
|
11
|
Alam RU, Zhao H, Goodwin A, Kavehei O, McEwan A. Differences in Power Spectral Densities and Phase Quantities Due to Processing of EEG Signals. SENSORS (BASEL, SWITZERLAND) 2020; 20:E6285. [PMID: 33158213 PMCID: PMC7662261 DOI: 10.3390/s20216285] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/27/2020] [Accepted: 11/03/2020] [Indexed: 12/27/2022]
Abstract
There has been a growing interest in computational electroencephalogram (EEG) signal processing in a diverse set of domains, such as cortical excitability analysis, event-related synchronization, or desynchronization analysis. In recent years, several inconsistencies were found across different EEG studies, which authors often attributed to methodological differences. However, the assessment of such discrepancies is deeply underexplored. It is currently unknown if methodological differences can fully explain emerging differences and the nature of these differences. This study aims to contrast widely used methodological approaches in EEG processing and compare their effects on the outcome variables. To this end, two publicly available datasets were collected, each having unique traits so as to validate the results in two different EEG territories. The first dataset included signals with event-related potentials (visual stimulation) from 45 subjects. The second dataset included resting state EEG signals from 16 subjects. Five EEG processing steps, involved in the computation of power and phase quantities of EEG frequency bands, were explored in this study: artifact removal choices (with and without artifact removal), EEG signal transformation choices (raw EEG channels, Hjorth transformed channels, and averaged channels across primary motor cortex), filtering algorithms (Butterworth filter and Blackman-Harris window), EEG time window choices (-750 ms to 0 ms and -250 ms to 0 ms), and power spectral density (PSD) estimation algorithms (Welch's method, Fast Fourier Transform, and Burg's method). Powers and phases estimated by carrying out variations of these five methods were analyzed statistically for all subjects. The results indicated that the choices in EEG transformation and time-window can strongly affect the PSD quantities in a variety of ways. Additionally, EEG transformation and filter choices can influence phase quantities significantly. These results raise the need for a consistent and standard EEG processing pipeline for computational EEG studies. Consistency of signal processing methods cannot only help produce comparable results and reproducible research, but also pave the way for federated machine learning methods, e.g., where model parameters rather than data are shared.
Collapse
Affiliation(s)
- Raquib-ul Alam
- School of Electrical and Information Engineering, University of Sydney, Sydney, NSW 2006, Australia
| | - Haifeng Zhao
- School of Biomedical Engineering, University of Sydney, Sydney, NSW 2006, Australia; (H.Z.); (A.G.); (O.K.); (A.M.)
| | - Andrew Goodwin
- School of Biomedical Engineering, University of Sydney, Sydney, NSW 2006, Australia; (H.Z.); (A.G.); (O.K.); (A.M.)
| | - Omid Kavehei
- School of Biomedical Engineering, University of Sydney, Sydney, NSW 2006, Australia; (H.Z.); (A.G.); (O.K.); (A.M.)
- The University of Sydney Nano Institute, The University of Sydney, Sydney, NSW 2006, Australia
| | - Alistair McEwan
- School of Biomedical Engineering, University of Sydney, Sydney, NSW 2006, Australia; (H.Z.); (A.G.); (O.K.); (A.M.)
| |
Collapse
|
12
|
Grefkes C, Fink GR. Recovery from stroke: current concepts and future perspectives. Neurol Res Pract 2020; 2:17. [PMID: 33324923 PMCID: PMC7650109 DOI: 10.1186/s42466-020-00060-6] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 04/22/2020] [Indexed: 12/31/2022] Open
Abstract
Stroke is a leading cause of acquired, permanent disability worldwide. Although the treatment of acute stroke has been improved considerably, the majority of patients to date are left disabled with a considerable impact on functional independence and quality of life. As the absolute number of stroke survivors is likely to further increase due to the demographic changes in our aging societies, new strategies are needed in order to improve neurorehabilitation. The most critical driver of functional recovery post-stroke is neural reorganization. For developing novel, neurobiologically informed strategies to promote recovery of function, an improved understanding of the mechanisms enabling plasticity and recovery is mandatory. This review provides a comprehensive survey of recent developments in the field of stroke recovery using neuroimaging and non-invasive brain stimulation. We discuss current concepts of how the brain reorganizes its functional architecture to overcome stroke-induced deficits, and also present evidence for maladaptive effects interfering with recovery. We demonstrate that the combination of neuroimaging and neurostimulation techniques allows a better understanding of how brain plasticity can be modulated to promote the reorganization of neural networks. Finally, neurotechnology-based treatment strategies allowing patient-tailored interventions to achieve enhanced treatment responses are discussed. The review also highlights important limitations of current models, and finally closes with possible solutions and future directions.
Collapse
Affiliation(s)
- Christian Grefkes
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, 52425 Jülich, Germany
- Medical Faculty, University of Cologne & Department of Neurology, University Hospital Cologne, 50924 Cologne, Germany
| | - Gereon R. Fink
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, 52425 Jülich, Germany
- Medical Faculty, University of Cologne & Department of Neurology, University Hospital Cologne, 50924 Cologne, Germany
| |
Collapse
|
13
|
Gowan S, Hordacre B. Transcranial Direct Current Stimulation to Facilitate Lower Limb Recovery Following Stroke: Current Evidence and Future Directions. Brain Sci 2020; 10:brainsci10050310. [PMID: 32455671 PMCID: PMC7287858 DOI: 10.3390/brainsci10050310] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 12/30/2022] Open
Abstract
Stroke remains a global leading cause of disability. Novel treatment approaches are required to alleviate impairment and promote greater functional recovery. One potential candidate is transcranial direct current stimulation (tDCS), which is thought to non-invasively promote neuroplasticity within the human cortex by transiently altering the resting membrane potential of cortical neurons. To date, much work involving tDCS has focused on upper limb recovery following stroke. However, lower limb rehabilitation is important for regaining mobility, balance, and independence and could equally benefit from tDCS. The purpose of this review is to discuss tDCS as a technique to modulate brain activity and promote recovery of lower limb function following stroke. Preliminary evidence from both healthy adults and stroke survivors indicates that tDCS is a promising intervention to support recovery of lower limb function. Studies provide some indication of both behavioral and physiological changes in brain activity following tDCS. However, much work still remains to be performed to demonstrate the clinical potential of this neuromodulatory intervention. Future studies should consider treatment targets based on individual lesion characteristics, stage of recovery (acute vs. chronic), and residual white matter integrity while accounting for known determinants and biomarkers of tDCS response.
Collapse
Affiliation(s)
- Samuel Gowan
- Interdisciplinary Neuroscience Program, Department of Biology, University of Wisconsin—La Crosse, La Crosse, WI 54601, USA
- Correspondence: ; Tel.: +61-8-83021286
| | - Brenton Hordacre
- IIMPACT in Health, University of South Australia, Adelaide, SA 5001, Australia;
| |
Collapse
|