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Teghipco A, Newman-Norlund R, Fridriksson J, Rorden C, Bonilha L. Distinct brain morphometry patterns revealed by deep learning improve prediction of post-stroke aphasia severity. COMMUNICATIONS MEDICINE 2024; 4:115. [PMID: 38866977 PMCID: PMC11169346 DOI: 10.1038/s43856-024-00541-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 06/03/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Emerging evidence suggests that post-stroke aphasia severity depends on the integrity of the brain beyond the lesion. While measures of lesion anatomy and brain integrity combine synergistically to explain aphasic symptoms, substantial interindividual variability remains unaccounted. One explanatory factor may be the spatial distribution of morphometry beyond the lesion (e.g., atrophy), including not just specific brain areas, but distinct three-dimensional patterns. METHODS Here, we test whether deep learning with Convolutional Neural Networks (CNNs) on whole brain morphometry (i.e., segmented tissue volumes) and lesion anatomy better predicts chronic stroke individuals with severe aphasia (N = 231) than classical machine learning (Support Vector Machines; SVMs), evaluating whether encoding spatial dependencies identifies uniquely predictive patterns. RESULTS CNNs achieve higher balanced accuracy and F1 scores, even when SVMs are nonlinear or integrate linear or nonlinear dimensionality reduction. Parity only occurs when SVMs access features learned by CNNs. Saliency maps demonstrate that CNNs leverage distributed morphometry patterns, whereas SVMs focus on the area around the lesion. Ensemble clustering of CNN saliencies reveals distinct morphometry patterns unrelated to lesion size, consistent across individuals, and which implicate unique networks associated with different cognitive processes as measured by the wider neuroimaging literature. Individualized predictions depend on both ipsilateral and contralateral features outside the lesion. CONCLUSIONS Three-dimensional network distributions of morphometry are directly associated with aphasia severity, underscoring the potential for CNNs to improve outcome prognostication from neuroimaging data, and highlighting the prospective benefits of interrogating spatial dependence at different scales in multivariate feature space.
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Affiliation(s)
- Alex Teghipco
- Department of Communication Sciences and Disorders, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - Roger Newman-Norlund
- Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, SC, USA
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Christopher Rorden
- Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, SC, USA
| | - Leonardo Bonilha
- Department of Neurology, School of Medicine, University of South Carolina, Columbia, SC, USA
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2
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Feng J, Lv M, Ma X, Li T, Xu M, Yang J, Su F, Hu R, Li J, Qiu Y, Liu Y, Shen Y, Xu W. Change of function and brain activity in patients of right spastic arm paralysis combined with aphasia after contralateral cervical seventh nerve transfer surgery. Eur J Neurosci 2024. [PMID: 38830753 DOI: 10.1111/ejn.16436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 05/07/2024] [Accepted: 05/16/2024] [Indexed: 06/05/2024]
Abstract
Left hemisphere injury can cause right spastic arm paralysis and aphasia, and recovery of both motor and language functions shares similar compensatory mechanisms and processes. Contralateral cervical seventh cross transfer (CC7) surgery can provide motor recovery for spastic arm paralysis by triggering interhemispheric plasticity, and self-reports from patients indicate spontaneous improvement in language function but still need to be verified. To explore the improvements in motor and language function after CC7 surgery, we performed this prospective observational cohort study. The Upper Extremity part of Fugl-Meyer scale (UEFM) and Modified Ashworth Scale were used to evaluate motor function, and Aphasia Quotient calculated by Mandarin version of the Western Aphasia Battery (WAB-AQ, larger score indicates better language function) was assessed for language function. In 20 patients included, the average scores of UEFM increased by .40 and 3.70 points from baseline to 1-week and 6-month post-surgery, respectively. The spasticity of the elbow and fingers decreased significantly at 1-week post-surgery, although partially recurred at 6-month follow-up. The average scores of WAB-AQ were increased by 9.14 and 10.69 points at 1-week and 6-month post-surgery (P < .001 for both), respectively. Post-surgical fMRI scans revealed increased activity in the bilateral hemispheres related to language centrals, including the right precentral cortex and right gyrus rectus. These findings suggest that CC7 surgery not only enhances motor function but may also improve the aphasia quotient in patients with right arm paralysis and aphasia due to left hemisphere injuries.
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Affiliation(s)
- Juntao Feng
- Department of Hand Surgery, Department of Rehabilitation, Jing'an District Central Hospital, branch of Huashan Hospital, the National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, China
| | - Minzhi Lv
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Xingyi Ma
- Department of Hand Surgery, Department of Rehabilitation, Jing'an District Central Hospital, branch of Huashan Hospital, the National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, China
| | - Tie Li
- Department of Hand Surgery, Department of Rehabilitation, Jing'an District Central Hospital, branch of Huashan Hospital, the National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, China
| | - Miaomiao Xu
- Department of Hand Surgery, Department of Rehabilitation, Jing'an District Central Hospital, branch of Huashan Hospital, the National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, China
| | - Jingrui Yang
- Department of Hand Surgery, Department of Rehabilitation, Jing'an District Central Hospital, branch of Huashan Hospital, the National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, China
| | - Fan Su
- Department of Hand Surgery, Department of Rehabilitation, Jing'an District Central Hospital, branch of Huashan Hospital, the National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, China
| | - Ruiping Hu
- Department of Hand Surgery, Department of Rehabilitation, Jing'an District Central Hospital, branch of Huashan Hospital, the National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, China
| | - Jie Li
- Department of Hand Surgery, Department of Rehabilitation, Jing'an District Central Hospital, branch of Huashan Hospital, the National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, China
| | - Yanqun Qiu
- Department of Hand Surgery, Department of Rehabilitation, Jing'an District Central Hospital, branch of Huashan Hospital, the National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, China
| | - Ying Liu
- Department of Hand Surgery, Department of Rehabilitation, Jing'an District Central Hospital, branch of Huashan Hospital, the National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, China
| | - Yundong Shen
- Department of Hand Surgery, Department of Rehabilitation, Jing'an District Central Hospital, branch of Huashan Hospital, the National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, China
- Institute of Brain Science, State Key Laboratory of Medical Neurobiology and Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China
| | - Wendong Xu
- Department of Hand Surgery, Department of Rehabilitation, Jing'an District Central Hospital, branch of Huashan Hospital, the National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, China
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
- Research Unit of Synergistic Reconstruction of Upper and Lower Limbs After Brain Injury, Chinese Academy of Medical Sciences, Shanghai, China
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Hildesheim FE, Ophey A, Zumbansen A, Funck T, Schuster T, Jamison KW, Kuceyeski A, Thiel A. Predicting Language Function Post-Stroke: A Model-Based Structural Connectivity Approach. Neurorehabil Neural Repair 2024; 38:447-459. [PMID: 38602161 PMCID: PMC11097606 DOI: 10.1177/15459683241245410] [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: 04/12/2024]
Abstract
BACKGROUND The prediction of post-stroke language function is essential for the development of individualized treatment plans based on the personal recovery potential of aphasic stroke patients. OBJECTIVE To establish a framework for integrating information on connectivity disruption of the language network based on routinely collected clinical magnetic resonance (MR) images into Random Forest modeling to predict post-stroke language function. METHODS Language function was assessed in 76 stroke patients from the Non-Invasive Repeated Therapeutic Stimulation for Aphasia Recovery trial, using the Token Test (TT), Boston Naming Test (BNT), and Semantic Verbal Fluency (sVF) Test as primary outcome measures. Individual infarct masks were superimposed onto a diffusion tensor imaging tractogram reference set to calculate Change in Connectivity scores of language-relevant gray matter regions as estimates of structural connectivity disruption. Multivariable Random Forest models were derived to predict language function. RESULTS Random Forest models explained moderate to high amount of variance at baseline and follow-up for the TT (62.7% and 76.2%), BNT (47.0% and 84.3%), and sVF (52.2% and 61.1%). Initial language function and non-verbal cognitive ability were the most important variables to predict language function. Connectivity disruption explained additional variance, resulting in a prediction error increase of up to 12.8% with variable omission. Left middle temporal gyrus (12.8%) and supramarginal gyrus (9.8%) were identified as among the most important network nodes. CONCLUSION Connectivity disruption of the language network adds predictive value beyond lesion volume, initial language function, and non-verbal cognitive ability. Obtaining information on connectivity disruption based on routine clinical MR images constitutes a significant advancement toward practical clinical application.
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Affiliation(s)
- Franziska E. Hildesheim
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
- Department of Neurology & Neurosurgery, McGill University, Montréal, QC, Canada
- Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim), Montréal, QC, Canada
| | - Anja Ophey
- Department of Medical Psychology | Neuropsychology and Gender Studies, Center for Neuropsychological Diagnostics and Intervention, University Hospital Cologne, Medical Faculty of the University of Cologne, Cologne, Germany
| | - Anna Zumbansen
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
- Music and Health Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Thomas Funck
- Institute of Neurosciences and Medicine INM-1, Research Centre Jülich, Jülich, Germany
| | - Tibor Schuster
- Department of Family Medicine, McGill University, Montréal, QC, Canada
| | - Keith W. Jamison
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Amy Kuceyeski
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Alexander Thiel
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
- Department of Neurology & Neurosurgery, McGill University, Montréal, QC, Canada
- Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim), Montréal, QC, Canada
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4
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Han Y, Jing Y, Shi Y, Mo H, Wan Y, Zhou H, Deng F. The role of language-related functional brain regions and white matter tracts in network plasticity of post-stroke aphasia. J Neurol 2024; 271:3095-3115. [PMID: 38607432 DOI: 10.1007/s00415-024-12358-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/13/2024]
Abstract
The neural mechanisms underlying language recovery after a stroke remain controversial. This review aimed to summarize the plasticity and reorganization mechanisms of the language network through neuroimaging studies. Initially, we discussed the involvement of right language homologues, perilesional tissue, and domain-general networks. Subsequently, we summarized the white matter functional mapping and remodeling mechanisms associated with language subskills. Finally, we explored how non-invasive brain stimulation (NIBS) promoted language recovery by inducing neural network plasticity. It was observed that the recruitment of right hemisphere language area homologues played a pivotal role in the early stages of frontal post-stroke aphasia (PSA), particularly in patients with larger lesions. Perilesional plasticity correlated with improved speech performance and prognosis. The domain-general networks could respond to increased "effort" in a task-dependent manner from the top-down when the downstream language network was impaired. Fluency, repetition, comprehension, naming, and reading skills exhibited overlapping and unique dual-pathway functional mapping models. In the acute phase, the structural remodeling of white matter tracts became challenging, with recovery predominantly dependent on cortical activation. Similar to the pattern of cortical activation, during the subacute and chronic phases, improvements in language functions depended, respectively, on the remodeling of right white matter tracts and the restoration of left-lateralized language structural network patterns. Moreover, the midline superior frontal gyrus/dorsal anterior cingulate cortex emerged as a promising target for NIBS. These findings offered theoretical insights for the early personalized treatment of aphasia after stroke.
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Affiliation(s)
- Yue Han
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yuanyuan Jing
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yanmin Shi
- Health Management (Physical Examination) Center, The Second Norman Bethune Hospital of Jilin University, Changchun, China
| | - Hongbin Mo
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yafei Wan
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Hongwei Zhou
- Department of Radiology, The First Hospital of Jilin University, Changchun, China.
| | - Fang Deng
- Department of Neurology, The First Hospital of Jilin University, Changchun, China.
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5
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Han C, Pan J, Du J, Feng L, Ma H, Tang J. Efficacy of different rehabilitation therapies on post-stroke aphasia patients: A network meta-analysis. Medicine (Baltimore) 2024; 103:e38255. [PMID: 38787993 PMCID: PMC11124600 DOI: 10.1097/md.0000000000038255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 04/25/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Although several rehabilitation interventions are effective in post-stroke aphasia (PSA), the efficacy of different rehabilitation interventions compared to each other remains controversial. Here, we aimed to compare the effectiveness of varying rehabilitation interventions in PSA. METHODS Randomized controlled trials on 8 kinds of rehabilitation interventions to improve speech function in patients with PSA were searched by computer from 10 databases, including PubMed, Web of Science, Cochrane, OVID, CINAHL, Embase, CNKI, WanFang, CBM, and VIP. The search scope was from the establishment of the database to August 2023. The literature screening, extraction of basic information, and quality assessment of the literature were conducted independently by 2 researchers. Network meta-analysis (NMA) was performed using Stata 17.0 software. RESULTS Fifty-four studies involving 2688 patients with PSA were included. The results of NMA showed that: ① in terms of improving the severity of aphasia, the therapeutic effects of repetitive transcranial magnetic stimulation were the most significant; ② motor imagery therapy was the most effective in improving spontaneous speech, repetition, and naming ability; ③ in terms of improving listening comprehension ability, the therapeutic effects of mirror neuron therapy was the most significant. CONCLUSION The 8 rehabilitation interventions have different focuses in improving the speech function of PSA patients, and the clinical therapists can select the optimal rehabilitation interventions in a targeted manner according to the results of this NMA and the patients' conditions and other relevant factors.
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Affiliation(s)
- Congli Han
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Jienuo Pan
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Jinchao Du
- College of Rehabilitation, Weifang Medical University, Weifang, Shandong, China
| | - Luye Feng
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Hengqin Ma
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Jiqin Tang
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- The First Clinical Medical College of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
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6
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Kaufmann BC, Pastore-Wapp M, Bartolomeo P, Geiser N, Nyffeler T, Cazzoli D. Severity-Dependent Interhemispheric White Matter Connectivity Predicts Poststroke Neglect Recovery. J Neurosci 2024; 44:e1311232024. [PMID: 38565290 PMCID: PMC11112644 DOI: 10.1523/jneurosci.1311-23.2024] [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: 07/13/2023] [Revised: 12/15/2023] [Accepted: 03/15/2024] [Indexed: 04/04/2024] Open
Abstract
Left-sided spatial neglect is a very common and challenging issue after right-hemispheric stroke, which strongly and negatively affects daily living behavior and recovery of stroke survivors. The mechanisms underlying recovery of spatial neglect remain controversial, particularly regarding the involvement of the intact, contralesional hemisphere, with potential contributions ranging from maladaptive to compensatory. In the present prospective, observational study, we assessed neglect severity in 54 right-hemispheric stroke patients (32 male; 22 female) at admission to and discharge from inpatient neurorehabilitation. We demonstrate that the interaction of initial neglect severity and spared white matter (dis)connectivity resulting from individual lesions (as assessed by diffusion tensor imaging, DTI) explains a significant portion of the variability of poststroke neglect recovery. In mildly impaired patients, spared structural connectivity within the lesioned hemisphere is sufficient to attain good recovery. Conversely, in patients with severe impairment, successful recovery critically depends on structural connectivity within the intact hemisphere and between hemispheres. These distinct patterns, mediated by their respective white matter connections, may help to reconcile the dichotomous perspectives regarding the role of the contralesional hemisphere as exclusively compensatory or not. Instead, they suggest a unified viewpoint wherein the contralesional hemisphere can - but must not necessarily - assume a compensatory role. This would depend on initial impairment severity and on the available, spared structural connectivity. In the future, our findings could serve as a prognostic biomarker for neglect recovery and guide patient-tailored therapeutic approaches.
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Affiliation(s)
- Brigitte C Kaufmann
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris 75013, France
- Neurocenter, Luzerner Kantonsspital, Lucerne 6016, Switzerland
| | - Manuela Pastore-Wapp
- Neurocenter, Luzerner Kantonsspital, Lucerne 6016, Switzerland
- ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University of Bern, Bern 3010, Switzerland
| | - Paolo Bartolomeo
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris 75013, France
| | - Nora Geiser
- Neurocenter, Luzerner Kantonsspital, Lucerne 6016, Switzerland
- ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University of Bern, Bern 3010, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern 3012, Switzerland
| | - Thomas Nyffeler
- Neurocenter, Luzerner Kantonsspital, Lucerne 6016, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern 3012, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern 3010, Switzerland
| | - Dario Cazzoli
- Neurocenter, Luzerner Kantonsspital, Lucerne 6016, Switzerland
- ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University of Bern, Bern 3010, Switzerland
- Department of Psychology, University of Bern, Bern 3012, Switzerland
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7
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Liu Q, Li W, Chen Y, Zhang S, Sun Z, Yang Y, Lv P, Yin Y. Effects of repetitive transcranial magnetic stimulation combined with music therapy in non-fluent aphasia after stroke: A randomised controlled study. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024; 59:1211-1222. [PMID: 38088533 DOI: 10.1111/1460-6984.12991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 11/11/2023] [Indexed: 05/09/2024]
Abstract
BACKGROUND Although existing studies have shown that both repetitive transcranial magnetic stimulation (rTMS) and music therapy have advantages in the treatment of non-fluent aphasia, the efficacy of the combination of these two methods remains to be investigated. AIMS To investigate the clinical efficacy of low-frequency rTMS combined with music therapy on language function and depression in patients with non-fluent aphasia after stroke. METHODS & PROCEDURES A single-blind parallel randomised controlled trial was conducted. Sixty patients (mean duration = 93.78 days) with non-fluent aphasia after stroke were randomly divided into a traditional therapy group (n = 20), a music therapy group (n = 20) and a combined therapy group (n = 20, 1 Hz). The language function and depression were evaluated before and 3 weeks after treatment with the Chinese version of the Western Aphasia Battery scale, Boston Diagnostic Aphasia Examination scale and Stroke Aphasic Depression Questionnaire Hospital Version scale. OUTCOMES & RESULTS The combined therapy group was significantly better in all outcomes than the traditional therapy group and was significantly better in depression than the music therapy group. The music therapy group was significantly better in repetition and depression than the traditional therapy group. Language improvement was positively correlated with depression improvement. For adverse events, only two patients in the combined therapy group showed slight dizziness during rTMS treatment and their symptoms improved after rest. CONCLUSIONS & IMPLICATIONS Our preliminary randomised controlled study indicates that low-frequency rTMS combined with music therapy is feasible and safe in improving language function and depression in non-fluent aphasia patients after stroke. WHAT THIS PAPER ADDS What is already known on this subject Repetitive transcranial magnetic stimulation (rTMS) and music therapy respectively have advantages in the treatment of non-fluent aphasia after stroke, but whether the combination of the two methods is more effective is still unknown. What this paper adds to the existing knowledge This is one of the first randomised control trials to investigate whether the clinical efficacy of low-frequency rTMS combined music therapy for non-fluent aphasia is better. The findings show that low-frequency rTMS combined music therapy is superior to traditional therapy in spontaneous speech, auditory comprehension, repetition, naming, aphasia quotient, functional language level and depression, and superior to music therapy in depression, while music therapy is superior to traditional therapy in repetition and depression. What are the potential or actual clinical implications of this work? Low-frequency rTMS combined music therapy may be a better method for treatment of non-fluent aphasia.
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Affiliation(s)
- Qingqing Liu
- Department of Rehabilitation Medicine, Hebei General Hospital, Shijiazhuang, China
- Hebei Provincial Key Laboratory of Cerebral Networks and Cognitive Disorders, Shijiazhuang, China
| | - Weibo Li
- Department of Gastrointestinal Surgery, the Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yuanwu Chen
- Department of Rehabilitation Medicine, Hebei General Hospital, Shijiazhuang, China
- Hebei Provincial Key Laboratory of Cerebral Networks and Cognitive Disorders, Shijiazhuang, China
| | - Shaohua Zhang
- The Eighth People's Hospital of Hebei Province, Shijiazhuang, China
| | - Zengxin Sun
- Department of Rehabilitation Medicine, Hebei General Hospital, Shijiazhuang, China
- Hebei Provincial Key Laboratory of Cerebral Networks and Cognitive Disorders, Shijiazhuang, China
| | - Yuhui Yang
- Department of Rehabilitation Medicine, Hebei General Hospital, Shijiazhuang, China
- Hebei Provincial Key Laboratory of Cerebral Networks and Cognitive Disorders, Shijiazhuang, China
| | - Peiyuan Lv
- Hebei Provincial Key Laboratory of Cerebral Networks and Cognitive Disorders, Shijiazhuang, China
- Department of Neurology, Hebei General Hospital, Shijiazhuang, China
| | - Yu Yin
- Department of Rehabilitation Medicine, Hebei General Hospital, Shijiazhuang, China
- Hebei Provincial Key Laboratory of Cerebral Networks and Cognitive Disorders, Shijiazhuang, China
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Sihvonen AJ, Pitkäniemi A, Siponkoski ST, Kuusela L, Martínez-Molina N, Laitinen S, Särkämö ER, Pekkola J, Melkas S, Schlaug G, Sairanen V, Särkämö T. Structural Neuroplasticity Effects of Singing in Chronic Aphasia. eNeuro 2024; 11:ENEURO.0408-23.2024. [PMID: 38688718 DOI: 10.1523/eneuro.0408-23.2024] [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: 10/13/2023] [Revised: 02/28/2024] [Accepted: 04/18/2024] [Indexed: 05/02/2024] Open
Abstract
Singing-based treatments of aphasia can improve language outcomes, but the neural benefits of group-based singing in aphasia are unknown. Here, we set out to determine the structural neuroplasticity changes underpinning group-based singing-induced treatment effects in chronic aphasia. Twenty-eight patients with at least mild nonfluent poststroke aphasia were randomized into two groups that received a 4-month multicomponent singing intervention (singing group) or standard care (control group). High-resolution T1 images and multishell diffusion-weighted MRI data were collected in two time points (baseline/5 months). Structural gray matter (GM) and white matter (WM) neuroplasticity changes were assessed using language network region of interest-based voxel-based morphometry (VBM) and quantitative anisotropy-based connectometry, and their associations to improved language outcomes (Western Aphasia Battery Naming and Repetition) were evaluated. Connectometry analyses showed that the singing group enhanced structural WM connectivity in the left arcuate fasciculus (AF) and corpus callosum as well as in the frontal aslant tract (FAT), superior longitudinal fasciculus, and corticostriatal tract bilaterally compared with the control group. Moreover, in VBM, the singing group showed GM volume increase in the left inferior frontal cortex (Brodmann area 44) compared with the control group. The neuroplasticity effects in the left BA44, AF, and FAT correlated with improved naming abilities after the intervention. These findings suggest that in the poststroke aphasia group, singing can bring about structural neuroplasticity changes in left frontal language areas and in bilateral language pathways, which underpin treatment-induced improvement in speech production.
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Affiliation(s)
- Aleksi J Sihvonen
- Cognitive Brain Research Unit and Centre of Excellence in Music, Mind, Body and Brain, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki 00014, Finland
- School of Health and Rehabilitation Sciences, Queensland Aphasia Research Centre and UQ Centre for Clinical Research, The University of Queensland, Brisbane QLD 4072, Australia
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki 00029, Finland
| | - Anni Pitkäniemi
- Cognitive Brain Research Unit and Centre of Excellence in Music, Mind, Body and Brain, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki 00014, Finland
| | - Sini-Tuuli Siponkoski
- Cognitive Brain Research Unit and Centre of Excellence in Music, Mind, Body and Brain, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki 00014, Finland
| | - Linda Kuusela
- HUS Helsinki Medical Imaging Center, Helsinki University Hospital, Helsinki 00029, Finland
| | - Noelia Martínez-Molina
- Cognitive Brain Research Unit and Centre of Excellence in Music, Mind, Body and Brain, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki 00014, Finland
| | | | | | - Johanna Pekkola
- HUS Helsinki Medical Imaging Center, Helsinki University Hospital, Helsinki 00029, Finland
| | - Susanna Melkas
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki 00029, Finland
| | - Gottfried Schlaug
- Department of Neurology, UMass Medical School, Springfield, Massachusetts 01655
- Department of Biomedical Engineering and Institute of Applied Life Sciences, UMass Amherst, Amherst, Massachusetts 01655
| | - Viljami Sairanen
- HUS Helsinki Medical Imaging Center, Helsinki University Hospital, Helsinki 00029, Finland
| | - Teppo Särkämö
- Cognitive Brain Research Unit and Centre of Excellence in Music, Mind, Body and Brain, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki 00014, Finland
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9
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Fedorenko E, Ivanova AA, Regev TI. The language network as a natural kind within the broader landscape of the human brain. Nat Rev Neurosci 2024; 25:289-312. [PMID: 38609551 DOI: 10.1038/s41583-024-00802-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 04/14/2024]
Abstract
Language behaviour is complex, but neuroscientific evidence disentangles it into distinct components supported by dedicated brain areas or networks. In this Review, we describe the 'core' language network, which includes left-hemisphere frontal and temporal areas, and show that it is strongly interconnected, independent of input and output modalities, causally important for language and language-selective. We discuss evidence that this language network plausibly stores language knowledge and supports core linguistic computations related to accessing words and constructions from memory and combining them to interpret (decode) or generate (encode) linguistic messages. We emphasize that the language network works closely with, but is distinct from, both lower-level - perceptual and motor - mechanisms and higher-level systems of knowledge and reasoning. The perceptual and motor mechanisms process linguistic signals, but, in contrast to the language network, are sensitive only to these signals' surface properties, not their meanings; the systems of knowledge and reasoning (such as the system that supports social reasoning) are sometimes engaged during language use but are not language-selective. This Review lays a foundation both for in-depth investigations of these different components of the language processing pipeline and for probing inter-component interactions.
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Affiliation(s)
- Evelina Fedorenko
- Brain and Cognitive Sciences Department, Massachusetts Institute of Technology, Cambridge, MA, USA.
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA.
- The Program in Speech and Hearing in Bioscience and Technology, Harvard University, Cambridge, MA, USA.
| | - Anna A Ivanova
- School of Psychology, Georgia Institute of Technology, Atlanta, GA, USA
| | - Tamar I Regev
- Brain and Cognitive Sciences Department, Massachusetts Institute of Technology, Cambridge, MA, USA
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA
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10
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Hartwigsen G, Lim JS, Bae HJ, Yu KH, Kuijf HJ, Weaver NA, Biesbroek JM, Kopal J, Bzdok D. Bayesian modelling disentangles language versus executive control disruption in stroke. Brain Commun 2024; 6:fcae129. [PMID: 38707712 PMCID: PMC11069117 DOI: 10.1093/braincomms/fcae129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 02/06/2024] [Accepted: 04/09/2024] [Indexed: 05/07/2024] Open
Abstract
Stroke is the leading cause of long-term disability worldwide. Incurred brain damage can disrupt cognition, often with persisting deficits in language and executive capacities. Yet, despite their clinical relevance, the commonalities and differences between language versus executive control impairments remain under-specified. To fill this gap, we tailored a Bayesian hierarchical modelling solution in a largest-of-its-kind cohort (1080 patients with stroke) to deconvolve language and executive control with respect to the stroke topology. Cognitive function was assessed with a rich neuropsychological test battery including global cognitive function (tested with the Mini-Mental State Exam), language (assessed with a picture naming task), executive speech function (tested with verbal fluency tasks), executive control functions (Trail Making Test and Digit Symbol Coding Task), visuospatial functioning (Rey Complex Figure), as well as verbal learning and memory function (Soul Verbal Learning). Bayesian modelling predicted interindividual differences in eight cognitive outcome scores three months after stroke based on specific tissue lesion topologies. A multivariate factor analysis extracted four distinct cognitive factors that distinguish left- and right-hemispheric contributions to ischaemic tissue lesions. These factors were labelled according to the neuropsychological tests that had the strongest factor loadings: One factor delineated language and general cognitive performance and was mainly associated with damage to left-hemispheric brain regions in the frontal and temporal cortex. A factor for executive control summarized mental flexibility, task switching and visual-constructional abilities. This factor was strongly related to right-hemispheric brain damage of posterior regions in the occipital cortex. The interplay of language and executive control was reflected in two distinct factors that were labelled as executive speech functions and verbal memory. Impairments on both factors were mainly linked to left-hemispheric lesions. These findings shed light onto the causal implications of hemispheric specialization for cognition; and make steps towards subgroup-specific treatment protocols after stroke.
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Affiliation(s)
- Gesa Hartwigsen
- Wilhelm Wundt Institute for Psychology, Leipzig University, 04109 Leipzig, Germany
- Research Group Cognition and Plasticity, Max Planck Institute for Human Cognitive and Brain Sciences, 04103 Leipzig, Germany
| | - Jae-Sung Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, South Korea
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, 13620, South Korea
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, 14068, Republic of Korea
| | - Hugo J Kuijf
- Image Sciences Institute, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Nick A Weaver
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - J Matthijs Biesbroek
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Department of Neurology, Diakonessenhuis Hospital, 3582 KE Utrecht, The Netherlands
| | - Jakub Kopal
- Department of Biomedical Engineering, Faculty of Medicine, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec H3A 2BA, Canada
- Mila—Quebec Artificial Intelligence Institute, Montreal, Quebec H2S 3H1, Canada
| | - Danilo Bzdok
- Department of Biomedical Engineering, Faculty of Medicine, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec H3A 2BA, Canada
- Mila—Quebec Artificial Intelligence Institute, Montreal, Quebec H2S 3H1, Canada
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11
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Brownsett SLE, Carey LM, Copland D, Walsh A, Sihvonen AJ. Structural brain networks correlating with poststroke cognition. Hum Brain Mapp 2024; 45:e26665. [PMID: 38520376 PMCID: PMC10960554 DOI: 10.1002/hbm.26665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/03/2024] [Accepted: 03/08/2024] [Indexed: 03/25/2024] Open
Abstract
Cognitive deficits are a common and debilitating consequence of stroke, yet our understanding of the structural neurobiological biomarkers predicting recovery of cognition after stroke remains limited. In this longitudinal observational study, we set out to investigate the effect of both focal lesions and structural connectivity on poststroke cognition. Sixty-two patients with stroke underwent advanced brain imaging and cognitive assessment, utilizing the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE), at 3-month and 12-month poststroke. We first evaluated the relationship between lesions and cognition at 3 months using voxel-based lesion-symptom mapping. Next, a novel correlational tractography approach, using multi-shell diffusion-weighted magnetic resonance imaging (MRI) data collected at both time points, was used to evaluate the relationship between the white matter connectome and cognition cross-sectionally at 3 months, and longitudinally (12 minus 3 months). Lesion-symptom mapping did not yield significant findings. In turn, correlational tractography analyses revealed positive associations between both MoCA and MMSE scores and bilateral cingulum and the corpus callosum, both cross-sectionally at the 3-month stage, and longitudinally. These results demonstrate that rather than focal neural structures, a consistent structural connectome underpins the performance of two frequently used cognitive screening tools, the MoCA and the MMSE, in people after stroke. This finding should encourage clinicians and researchers to not only suspect cognitive decline when lesions affect these tracts, but also to refine their investigation of novel approaches to differentially diagnosing pathology associated with cognitive decline, regardless of the aetiology.
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Affiliation(s)
- Sonia L. E. Brownsett
- Centre of Research Excellence in Aphasia Recovery and RehabilitationLa Trobe UniversityMelbourneVictoriaAustralia
- Queensland Aphasia Research CentreSurgical, Treatment and Rehabilitation Service, University of QueenslandBrisbaneQueenslandAustralia
- School of Health and Rehabilitation SciencesUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Leeanne M. Carey
- Occupational Therapy, School of Allied Health Human Services and SportLa Trobe UniversityMelbourneVictoriaAustralia
- Neurorehabilitation and Recovery GroupThe FloreyMelbourneVictoriaAustralia
| | - David Copland
- Centre of Research Excellence in Aphasia Recovery and RehabilitationLa Trobe UniversityMelbourneVictoriaAustralia
- Queensland Aphasia Research CentreSurgical, Treatment and Rehabilitation Service, University of QueenslandBrisbaneQueenslandAustralia
- School of Health and Rehabilitation SciencesUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Alistair Walsh
- Occupational Therapy, School of Allied Health Human Services and SportLa Trobe UniversityMelbourneVictoriaAustralia
- Neurorehabilitation and Recovery GroupThe FloreyMelbourneVictoriaAustralia
| | - Aleksi J. Sihvonen
- Centre of Research Excellence in Aphasia Recovery and RehabilitationLa Trobe UniversityMelbourneVictoriaAustralia
- Queensland Aphasia Research CentreSurgical, Treatment and Rehabilitation Service, University of QueenslandBrisbaneQueenslandAustralia
- School of Health and Rehabilitation SciencesUniversity of QueenslandBrisbaneQueenslandAustralia
- Centre of Excellence in Music, Mind, Body and Brain, Cognitive Brain Research Unit (CBRU)University of HelsinkiHelsinkiFinland
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12
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Upton E, Doogan C, Fleming V, Leyton PQ, Barbera D, Zeidman P, Hope T, Latham W, Coley-Fisher H, Price C, Crinion J, Leff A. Efficacy of a gamified digital therapy for speech production in people with chronic aphasia (iTalkBetter): behavioural and imaging outcomes of a phase II item-randomised clinical trial. EClinicalMedicine 2024; 70:102483. [PMID: 38685927 PMCID: PMC11056404 DOI: 10.1016/j.eclinm.2024.102483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/26/2024] [Accepted: 01/26/2024] [Indexed: 05/02/2024] Open
Abstract
Background Aphasia is among the most debilitating of symptoms affecting stroke survivors. Speech and language therapy (SLT) is effective, but many hours of practice are required to make clinically meaningful gains. One solution to this 'dosage' problem is to automate therapeutic approaches via self-supporting apps so people with aphasia (PWA) can amass practice as it suits them. However, response to therapy is variable and no clinical trial has yet identified the key brain regions required to engage with word-retrieval therapy. Methods Between Sep 7, 2020 and Mar 1, 2022 at University College London in the UK, we carried out a phase II, item-randomised clinical trial in 27 PWA using a novel, self-led app, 'iTalkBetter', which utilises confrontation naming therapy. Unlike previously reported apps, it has a real-time utterance verification system that drives its adaptive therapy algorithm. Therapy items were individually randomised to provide balanced lists of 'trained' and 'untrained' items matched on key psycholinguistic variables and baseline performance. PWA practised with iTalkBetter over a 6-week therapy block. Structural and functional MRI data were collected to identify therapy-related changes in brain states. A repeated-measures design was employed. The trial was registered at ClinicalTrials.gov (NCT04566081). Findings iTalkBetter significantly improved naming ability by 13% for trained items compared with no change for untrained items, an average increase of 29 words (SD = 26) per person; beneficial effects persisted at three months. PWA's propositional speech also significantly improved. iTalkBetter use was associated with brain volume increases in right auditory and left anterior prefrontal cortices. Task-based fMRI identified dose-related activity in the right temporoparietal junction. Interpretation Our findings suggested that iTalkBetter significantly improves PWAs' naming ability on trained items. The effect size is similar to a previous RCT of computerised therapy, but this is the first study to show transfer to a naturalistic speaking task. iTalkBetter usage and dose caused observable changes in brain structure and function to key parts of the surviving language perception, production and control networks. iTalkBetter is being rolled-out as an app for all PWA and anomia: https://www.ucl.ac.uk/icn/research/research-groups/neurotherapeutics/projects/digital-interventions-neuro-rehabilitation-0 so that they can increase their dosage of practice-based SLT. Funding National Institute for Health and Care Research, Wellcome Centre for Human Neuroimaging.
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Affiliation(s)
- Emily Upton
- UCL Queen Square Institute of Neurology, University College London, UK
- Institute of Cognitive Neuroscience, University College London, UK
- Department of Psychology and Language Sciences, University College London, UK
| | - Catherine Doogan
- UCL Queen Square Institute of Neurology, University College London, UK
- Institute of Cognitive Neuroscience, University College London, UK
- St George’s, University of London, UK
| | - Victoria Fleming
- Department of Psychology and Language Sciences, University College London, UK
| | | | - David Barbera
- Institute of Cognitive Neuroscience, University College London, UK
| | - Peter Zeidman
- Wellcome Centre for Human Neuroimaging, University College London, UK
| | - Tom Hope
- Wellcome Centre for Human Neuroimaging, University College London, UK
- Department of Psychology and Social Science, John Cabot University, Rome, Italy
| | - William Latham
- Department of Computing, Goldsmiths, University of London, UK
| | | | - Cathy Price
- Wellcome Centre for Human Neuroimaging, University College London, UK
| | - Jennifer Crinion
- Institute of Cognitive Neuroscience, University College London, UK
- Department of Psychology and Language Sciences, University College London, UK
| | - Alex Leff
- UCL Queen Square Institute of Neurology, University College London, UK
- Institute of Cognitive Neuroscience, University College London, UK
- University College London Hospitals NHS Trust, UK
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13
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Billot A, Kiran S. Disentangling neuroplasticity mechanisms in post-stroke language recovery. BRAIN AND LANGUAGE 2024; 251:105381. [PMID: 38401381 PMCID: PMC10981555 DOI: 10.1016/j.bandl.2024.105381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/28/2023] [Accepted: 01/12/2024] [Indexed: 02/26/2024]
Abstract
A major objective in post-stroke aphasia research is to gain a deeper understanding of neuroplastic mechanisms that drive language recovery, with the ultimate goal of enhancing treatment outcomes. Subsequent to recent advances in neuroimaging techniques, we now have the ability to examine more closely how neural activity patterns change after a stroke. However, the way these neural activity changes relate to language impairments and language recovery is still debated. The aim of this review is to provide a theoretical framework to better investigate and interpret neuroplasticity mechanisms underlying language recovery in post-stroke aphasia. We detail two sets of neuroplasticity mechanisms observed at the synaptic level that may explain functional neuroimaging findings in post-stroke aphasia recovery at the network level: feedback-based homeostatic plasticity and associative Hebbian plasticity. In conjunction with these plasticity mechanisms, higher-order cognitive control processes dynamically modulate neural activity in other regions to meet communication demands, despite reduced neural resources. This work provides a network-level neurobiological framework for understanding neural changes observed in post-stroke aphasia and can be used to define guidelines for personalized treatment development.
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Affiliation(s)
- Anne Billot
- Center for Brain Recovery, Boston University, Boston, USA; Department of Psychology, Center for Brain Science, Harvard University, Cambridge, Massachusetts, USA; Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Swathi Kiran
- Center for Brain Recovery, Boston University, Boston, USA.
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14
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Fan D, Zhao H, Liu H, Niu H, Liu T, Wang Y. Abnormal brain activities of cognitive processes in cerebral small vessel disease: A systematic review of task fMRI studies. J Neuroradiol 2024; 51:155-167. [PMID: 37844660 DOI: 10.1016/j.neurad.2023.10.005] [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: 06/08/2023] [Revised: 10/13/2023] [Accepted: 10/13/2023] [Indexed: 10/18/2023]
Abstract
Cerebral small vessel disease (CSVD) is characterized by widespread functional changes in the brain, as evident from abnormal brain activations during cognitive tasks. However, the existing findings in this area are not yet conclusive. We systematically reviewed 25 studies reporting task-related fMRI in five cognitive domains in CSVD, namely executive function, working memory, processing speed, motor, and affective processing. The findings highlighted: (1) CSVD affects cognitive processes in a domain-specific manner; (2) Compensatory and regulatory effects were observed simultaneously in CSVD, which may reflect the interplay between the negative impact of brain lesion and the positive impact of cognitive reserve. Combined with behavioral and functional findings in CSVD, we proposed an integrated model to illustrate the relationship between altered activations and behavioral performance in different stages of CSVD: functional brain changes may precede and be more sensitive than behavioral impairments in the early pre-symptomatic stage; Meanwhile, compensatory and regulatory mechanisms often occur in the early stages of the disease, while dysfunction/decompensation and dysregulation often occur in the late stages. Overall, abnormal hyper-/hypo-activations are crucial for understanding the mechanisms of small vessel lesion-induced behavioral dysfunction, identifying potential neuromarker and developing interventions to mitigate the impact of CSVD on cognitive function.
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Affiliation(s)
- Dongqiong Fan
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Haichao Zhao
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China; Faculty of Psychology, MOE Key Laboratory of Cognition and Personality, Southwest University, Chongqing, China
| | - Hao Liu
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Haijun Niu
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Tao Liu
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.
| | - Yilong Wang
- Department of Neurology, Beijing TianTan Hospital, Capital Medical University, Beijing, China; Chinese Institute for Brain Research, Beijing, China; National Center for Neurological Disorders, Beijing, China.
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15
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Alemanno F, Fedeli D, Monti A, Houdayer E, Della Rosa PA, Zangrillo F, Emedoli D, Pelagallo E, Corbo M, Iannaccone S, Abutalebi J. Increased interhemispheric functional connectivity after right anodal tDCS in chronic non-fluent aphasia: preliminary findings. Front Neurosci 2024; 18:1346095. [PMID: 38406588 PMCID: PMC10884287 DOI: 10.3389/fnins.2024.1346095] [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: 11/28/2023] [Accepted: 01/23/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction Anodal transcranial Direct Current Stimulation (tDCS) is a non-invasive, low-cost and environment-friendly brain neuromodulation technique that increases cortical excitability. In post-stroke aphasia, the role of the right hemisphere in language recovery remains debated. In this preliminary study, we aimed to investigate the efficacy of excitatory tDCS on the right hemisphere in chronic aphasic patients. Methods We applied anodal tDCS to the right homologous region of Broca's area in four chronic aphasic patients while performing a one-month naming rehabilitation treatment. Longitudinal data on language assessment and naming performance were collected. Resting-state fMRI images were acquired before and after treatment to measure changes in functional connectivity. Results Results showed enhanced positive functional connectivity of the right Broca homologous with the left middle frontal and middle temporal gyri. Every patient showed improvements in language functions, but no major changes in naming performance. Conclusion These preliminary findings suggest that tDCS applied over the unaffected hemisphere may result in longitudinal inter-hemispheric functional neuroplastic changes that could specifically improve language recovery and could potentially be included in therapeutic neurorehabilitative plans.
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Affiliation(s)
- Federica Alemanno
- Neuropsychology Service, Department of Rehabilitation and Functional Recovery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Davide Fedeli
- Centre for Neurolinguistics and Psycholinguistics, Scientific Institute San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Alessia Monti
- Department of Neurorehabilitation Sciences, Casa di Cura Igea, Milan, Italy
| | - Elise Houdayer
- Neuropsychology Service, Department of Rehabilitation and Functional Recovery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Federica Zangrillo
- Neuropsychology Service, Department of Rehabilitation and Functional Recovery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Daniele Emedoli
- Neuropsychology Service, Department of Rehabilitation and Functional Recovery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Elisabetta Pelagallo
- Neuropsychology Service, Department of Rehabilitation and Functional Recovery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Corbo
- Department of Neurorehabilitation Sciences, Casa di Cura Igea, Milan, Italy
| | - Sandro Iannaccone
- Neuropsychology Service, Department of Rehabilitation and Functional Recovery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Jubin Abutalebi
- Neuropsychology Service, Department of Rehabilitation and Functional Recovery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- Centre for Neurolinguistics and Psycholinguistics, Scientific Institute San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
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16
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Lammers B, Sydnor MJ, Cust S, Kim JH, Yenokyan G, Hillis AE, Sebastian R. Protocol for Cerebellar Stimulation for Aphasia Rehabilitation (CeSAR): A randomized, double-blind, sham-controlled trial. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.05.24302365. [PMID: 38370630 PMCID: PMC10871367 DOI: 10.1101/2024.02.05.24302365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
In this randomized, double-blind, sham-controlled trial of Cerebellar Stimulation for Aphasia Rehabilitation (CeSAR), we will determine the effectiveness of cathodal tDCS (transcranial direct current stimulation) to the right cerebellum for the treatment of chronic aphasia (>6 months post stroke). We will test the hypothesis that cerebellar tDCS in combination with an evidenced-based anomia treatment (semantic feature analysis, SFA) will be associated with greater improvement in naming untrained pictures (as measured by the change in Philadelphia Picture Naming Test), 1-week post treatment, compared to sham plus SFA. We will also evaluate the effects of cerebellar tDCS on naming trained items as well as the effects on functional communication, content, efficiency, and word-retrieval of picture description, and quality of life. Finally, we will identify imaging and linguistic biomarkers to determine the characteristics of stroke patients that benefit from cerebellar tDCS and SFA treatment. We expect to enroll 60 participants over five years. Participants will receive 15, 25-minute sessions of cerebellar tDCS (3-5 sessions per week) or sham tDCS combined with 1 hour of SFA treatment. Participants will be evaluated prior to the start of treatment, one-week post-treatment, 1-, 3-, and 6-months post treatment on primary and secondary outcome variables. The long-term aim of this study is to provide the basis for a Phase III randomized controlled trial of cerebellar tDCS vs sham with concurrent language therapy for treatment of chronic aphasia. Trial registration: The trial is registered with ClinicalTrials.gov NCT05093673.
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Affiliation(s)
- Becky Lammers
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Myra J. Sydnor
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Sarah Cust
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Ji Hyun Kim
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Gayane Yenokyan
- Johns Hopkins Biostatistics Center, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Argye E. Hillis
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD
- Department of Cognitive Science, Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD
| | - Rajani Sebastian
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD
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17
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Han C, Tang J, Tang B, Han T, Pan J, Wang N. The effectiveness and safety of noninvasive brain stimulation technology combined with speech training on aphasia after stroke: A systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e36880. [PMID: 38215135 PMCID: PMC10783273 DOI: 10.1097/md.0000000000036880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 12/15/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Although the effectiveness of noninvasive brain stimulation (NIBS) technology in assisting rehabilitation is widely recognized, its therapeutic efficacy in patients with poststroke aphasia (PSA) requires further validation. Here, we aimed to explore the efficacy and safety of the NIBS technique combined with speech training in PSA by traditional Meta-analysis and to compare the intervention effects of the 2 NIBS techniques by Network meta-analysis. METHODS Randomized controlled trials of the NIBS technique combined with speech training for treating PSA in 9 databases, including Web of Science, PubMed, and CNKI, and 2 clinical trial registries were searched by computer. Literature screening was performed using EndNote X9 software, and data analysis and presentation of results were performed using RevMan 5.4.1 and Stata 17.0 software. RESULTS Screening yielded 17 studies with 1013 patients with PSA. Meta-analysis showed that aphasia quotient scores were higher in the intervention group than in the control group [standardized mean difference (SMD) = 1.06, 95% confidence interval (CI) (0.63, 1.49), Z = 4.80, P < .00001]; Western aphasia battery scores on all 4 subscales were higher than those of the control group, the spontaneous language score is [SMD = 0.62, 95% CI (0.46, 0.78), Z = 7.52, P < .00001], the listening comprehension score is [SMD = 0.46, 95% CI (0.30, 0.62), Z = 5.62, P < .00001], the repetition score is [SMD = 1.14, 95% CI (0.59, 1.70), Z = 4.04, P < .0001], the naming score is [SMD = 1.06, 95% CI (0.79, 1.32), Z = 7.85, P < .00001]; The effective rate of the intervention group was higher than that of the control group [odd ratio = 4.19, 95% CI (2.39, 7.37), Z = 4.99, P < .00001]. The results of the Network meta-analysis showed that the best probability ranking of the 2 NIBS techniques combined with speech training in improving aphasia quotient scores was repetitive transcranial magnetic stimulation group (92.2%) > transcranial direct current stimulation group (55.7%). Regarding safety, it was not found that the NIBS technique combined with speech training to treat PSA increases the risk of adverse reactions. CONCLUSION The NIBS technique combined with speech training can effectively improve the recovery of language function in PSA patients with minimal adverse effects, and the clinic can give priority to r TMS combined with speech training in treating PSA.
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Affiliation(s)
- Congli Han
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Jiqin Tang
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- The First Clinical Medical College of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Bingshun Tang
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Tao Han
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Jienuo Pan
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Nan Wang
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
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18
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Močilnik V, Rutar Gorišek V, Sajovic J, Pretnar Oblak J, Drevenšek G, Rogelj P. Integrating EEG and Machine Learning to Analyze Brain Changes during the Rehabilitation of Broca's Aphasia. SENSORS (BASEL, SWITZERLAND) 2024; 24:329. [PMID: 38257423 PMCID: PMC10818958 DOI: 10.3390/s24020329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/27/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024]
Abstract
The fusion of electroencephalography (EEG) with machine learning is transforming rehabilitation. Our study introduces a neural network model proficient in distinguishing pre- and post-rehabilitation states in patients with Broca's aphasia, based on brain connectivity metrics derived from EEG recordings during verbal and spatial working memory tasks. The Granger causality (GC), phase-locking value (PLV), weighted phase-lag index (wPLI), mutual information (MI), and complex Pearson correlation coefficient (CPCC) across the delta, theta, and low- and high-gamma bands were used (excluding GC, which spanned the entire frequency spectrum). Across eight participants, employing leave-one-out validation for each, we evaluated the intersubject prediction accuracy across all connectivity methods and frequency bands. GC, MI theta, and PLV low-gamma emerged as the top performers, achieving 89.4%, 85.8%, and 82.7% accuracy in classifying verbal working memory task data. Intriguingly, measures designed to eliminate volume conduction exhibited the poorest performance in predicting rehabilitation-induced brain changes. This observation, coupled with variations in model performance across frequency bands, implies that different connectivity measures capture distinct brain processes involved in rehabilitation. The results of this paper contribute to current knowledge by presenting a clear strategy of utilizing limited data to achieve valid and meaningful results of machine learning on post-stroke rehabilitation EEG data, and they show that the differences in classification accuracy likely reflect distinct brain processes underlying rehabilitation after stroke.
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Affiliation(s)
- Vanesa Močilnik
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia (J.P.O.); (G.D.)
| | | | - Jakob Sajovic
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia (J.P.O.); (G.D.)
- University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia;
| | - Janja Pretnar Oblak
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia (J.P.O.); (G.D.)
- University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia;
| | - Gorazd Drevenšek
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia (J.P.O.); (G.D.)
- Faculty of Mathematics, Natural Sciences and Information Technologies, University of Primorska, 6000 Koper, Slovenia;
| | - Peter Rogelj
- Faculty of Mathematics, Natural Sciences and Information Technologies, University of Primorska, 6000 Koper, Slovenia;
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Riccardi N, Zhao X, den Ouden DB, Fridriksson J, Desai RH, Wang Y. Network-based statistics distinguish anomic and Broca's aphasia. Brain Struct Funct 2023:10.1007/s00429-023-02738-4. [PMID: 38160205 DOI: 10.1007/s00429-023-02738-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 11/21/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Aphasia is a speech-language impairment commonly caused by damage to the left hemisphere. The neural mechanisms that underpin different types of aphasia and their symptoms are still not fully understood. This study aims to identify differences in resting-state functional connectivity between anomic and Broca's aphasia measured through resting-state functional magnetic resonance imaging (rs-fMRI). METHODS We used the network-based statistic (NBS) method, as well as voxel- and connectome-based lesion symptom mapping (V-, CLSM), to identify distinct neural correlates of the anomic and Broca's groups. To control for lesion effect, we included lesion volume as a covariate in both the NBS method and LSM. RESULTS NBS identified a subnetwork located in the dorsal language stream bilaterally, including supramarginal gyrus, primary sensory, motor, and auditory cortices, and insula. The connections in the subnetwork were weaker in the Broca's group than the anomic group. The properties of the subnetwork were examined through complex network measures, which indicated that regions in right inferior frontal sulcus, right paracentral lobule, and bilateral superior temporal gyrus exhibit intensive interaction. Left superior temporal gyrus, right postcentral gyrus, and left supramarginal gyrus play an important role in information flow and overall communication efficiency. Disruption of this network underlies the constellation of symptoms associated with Broca's aphasia. Whole-brain CLSM did not detect any significant connections, suggesting an advantage of NBS when thousands of connections are considered. However, CLSM identified connections that differentiated Broca's from anomic aphasia when analysis was restricted to a hypothesized network of interest. DISCUSSION We identified novel signatures of resting-state brain network differences between groups of individuals with anomic and Broca's aphasia. We identified a subnetwork of connections that statistically differentiated the resting-state brain networks of the two groups, in comparison with standard CLSM results that yielded isolated connections. Network-level analyses are useful tools for the investigation of the neural correlates of language deficits post-stroke.
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Affiliation(s)
- Nicholas Riccardi
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Xingpei Zhao
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - Dirk-Bart den Ouden
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Rutvik H Desai
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Yuan Wang
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA.
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20
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Voets NL, Bartsch AJ, Plaha P. Functional MRI applications for intra-axial brain tumours: uses and nuances in surgical practise. Br J Neurosurg 2023; 37:1544-1559. [PMID: 36148501 DOI: 10.1080/02688697.2022.2123893] [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: 03/18/2022] [Accepted: 09/07/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Functional MRI (fMRI) has well-established uses to inform risks and plan maximally safe approaches in neurosurgery. In the field of brain tumour surgery, however, fMRI is currently in a state of clinical equipoise due to debate around both its sensitivity and specificity. MATERIALS AND METHODS In this review, we summarise the role and our experience of fMRI in neurosurgery for gliomas and metastases. We discuss nuances in the conduct and interpretation of fMRI that, based on our practise, most directly impact fMRI's usefulness in the neurosurgical setting. RESULTS Illustrated examples in which fMRI in our hands directly influences the neurosurgical treatment of brain tumours include evaluating the probability and nature of functional risks, especially for language functions. These presurgical risk assessments, in turn, help to predict the resectability of tumours, select or deselect patients for awake surgery, indicate the need for neurophysiological monitoring and guide the optimal use of intra-operative stimulation mapping. A further emerging application of fMRI is in measuring functional adaptation of functional networks after (partial) surgery, of potential use in the timing of further surgery. CONCLUSIONS In appropriately selected patients with a clearly defined surgical question, fMRI offers a valuable complementary tool in the pre-surgical evaluation of brain tumours. However, there is a great need for standards in the administration and analysis of fMRI as much as in the techniques that it is commonly evaluated against. Surprisingly little data exists that evaluates the accuracy of fMRI not just against complementary methods, but in terms of its ultimate clinical aim of minimising post-surgical morbidity.
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Affiliation(s)
- Natalie L Voets
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- GenesisCare Ltd, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Andreas J Bartsch
- Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany
| | - Puneet Plaha
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Neurosurgery, University of Oxford, Oxford, UK
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21
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Wang C, Nie P, Wang P, Wang Y, Zang Y, Zhang Y. The Therapeutic Effect of Transcranial Magnetic Stimulation on Post-stroke Aphasia and the Optimal Treatment Parameters: A Meta-analysis. Arch Phys Med Rehabil 2023:S0003-9993(23)00659-7. [PMID: 37984539 DOI: 10.1016/j.apmr.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/23/2023] [Accepted: 11/10/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE This meta-analysis aimed to examine the overall effectiveness of TMS on post-stroke aphasia using a meta-analysis approach, as well as examine the effect of moderating variables (eg, study design, TMS protocol) on the effectiveness of TMS. DATA SOURCES A keyword search was conducted in 5 databases: ERIC, Google Scholar, PsycINFO, MEDLINE, and ProQuest (01/1985-12/2022). The search algorithm included all possible combinations of relevant keywords. Full-text articles were thoroughly examined using forward/backward search methods. STUDY SELECTION Studies were thoroughly screened using the following inclusion criteria: patients were diagnosed with post-stroke aphasia; studies focused on the effect of TMS on post-stroke aphasia; language assessments were conducted at pretest and posttest for TMS treatment and data were reported; studies included both an experimental group (ie, a group with TMS treatment) and a control group (ie, a group without TMS treatment). DATA EXTRACTION Information was extracted from each study including authors, publication year, first language of participants, study design, stroke duration, demographics of participants, TMS protocol, stimulation site, targeting, and statistical data of language performance pre- and post-TMS treatment. DATA SYNTHESIS A total of 17 studies were included in the final review, involving 682 patients with post-stroke aphasia (348 in the experimental group, 334 in the control group). The results showed that TMS treatment has significant immediate (Hedges' g=0.37) and maintenance (Hedges' g=0.34) effects on post-stroke aphasia. Additionally, the moderating variables showed a moderation effect on the effectiveness of TMS. CONCLUSION TMS treatment can significantly improve language ability for post-stroke aphasia. Additionally, this study provides an important reference for selecting the optimal TMS treatment parameters in treating post-stroke aphasia. Specifically, administering 15 sessions of rTMS lasting 10 min over the mirror area within Broca's area may produce the best TMS treatment outcomes.
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Affiliation(s)
- Cuicui Wang
- Zhejiang Philosophy and Social Science Laboratory for Research in Early Development and Childcare, Hangzhou Normal University, Hangzhou, China; College of Education, Hangzhou Normal University, Hangzhou, China; TMS Center, Deqing Hospital of Hangzhou Normal University, China; Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Peixin Nie
- Cognitive Brain Research Unit, Faculty of Medicine, University of Helsinki, Finland; Centre of Excellence in Music, Mind, Body, and Brain, Faculty of Medicine, University of Helsinki, Finland
| | - Peng Wang
- Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China; University of Greifswald, Institute of Psychology, Greifswald, Germany
| | - Yunxia Wang
- Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Yufeng Zang
- TMS Center, Deqing Hospital of Hangzhou Normal University, China; Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China; Institute of Psychological Sciences, Hangzhou Normal University, Hangzhou, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou Normal University, Hangzhou, China
| | - Ye Zhang
- Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China; Institute of Psychological Sciences, Hangzhou Normal University, Hangzhou, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou Normal University, Hangzhou, China.
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22
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Brito AC, Levy DF, Schneck SM, Entrup JL, Onuscheck CF, Casilio M, de Riesthal M, Davis LT, Wilson SM. Leukoaraiosis Is Not Associated With Recovery From Aphasia in the First Year After Stroke. NEUROBIOLOGY OF LANGUAGE (CAMBRIDGE, MASS.) 2023; 4:536-549. [PMID: 37946731 PMCID: PMC10631799 DOI: 10.1162/nol_a_00115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 06/28/2023] [Indexed: 11/12/2023]
Abstract
After a stroke, individuals with aphasia often recover to a certain extent over time. This recovery process may be dependent on the health of surviving brain regions. Leukoaraiosis (white matter hyperintensities on MRI reflecting cerebral small vessel disease) is one indication of compromised brain health and is associated with cognitive and motor impairment. Previous studies have suggested that leukoaraiosis may be a clinically relevant predictor of aphasia outcomes and recovery, although findings have been inconsistent. We investigated the relationship between leukoaraiosis and aphasia in the first year after stroke. We recruited 267 patients with acute left hemispheric stroke and coincident fluid attenuated inversion recovery MRI. Patients were evaluated for aphasia within 5 days of stroke, and 174 patients presented with aphasia acutely. Of these, 84 patients were evaluated at ∼3 months post-stroke or later to assess longer-term speech and language outcomes. Multivariable regression models were fit to the data to identify any relationships between leukoaraiosis and initial aphasia severity, extent of recovery, or longer-term aphasia severity. We found that leukoaraiosis was present to varying degrees in 90% of patients. However, leukoaraiosis did not predict initial aphasia severity, aphasia recovery, or longer-term aphasia severity. The lack of any relationship between leukoaraiosis severity and aphasia recovery may reflect the anatomical distribution of cerebral small vessel disease, which is largely medial to the white matter pathways that are critical for speech and language function.
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Affiliation(s)
| | - Deborah F. Levy
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah M. Schneck
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jillian L. Entrup
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Caitlin F. Onuscheck
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Marianne Casilio
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael de Riesthal
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - L. Taylor Davis
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephen M. Wilson
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
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23
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Williams EER, Sghirripa S, Rogasch NC, Hordacre B, Attrill S. Non-invasive brain stimulation in the treatment of post-stroke aphasia: a scoping review. Disabil Rehabil 2023:1-22. [PMID: 37828899 DOI: 10.1080/09638288.2023.2259299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 09/10/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE Aphasia is an acquired language impairment that commonly results from stroke. Non-invasive brain stimulation (NIBS) might accelerate aphasia recovery trajectories and has seen mounting popularity in recent aphasia rehabilitation research. The present review aimed to: (1) summarise all existing literature on NIBS as a post-stroke aphasia treatment; and (2) provide recommendations for future NIBS-aphasia research. MATERIALS AND METHODS Databases for published and grey literature were searched using scoping review methodology. 278 journal articles, conference abstracts/posters, and books, and 38 items of grey literature, were included for analysis. RESULTS Quantitative analysis revealed that ipsilesional anodal transcranial direct current stimulation and contralesional 1-Hz repetitive transcranial magnetic stimulation were the most widely used forms of NIBS, while qualitative analysis identified four key themes including: the roles of the hemispheres in aphasia recovery and their relationship with NIBS; heterogeneity of individuals but homogeneity of subpopulations; individualisation of stimulation parameters; and much remains under-explored in the NIBS-aphasia literature. CONCLUSIONS Taken together, these results highlighted systemic challenges across the field such as small sample sizes, inter-individual variability, lack of protocol optimisation/standardisation, and inadequate focus on aphasiology. Four key recommendations are outlined herein to guide future research and refine NIBS methods for post-stroke aphasia treatment.
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Affiliation(s)
- Ellen E R Williams
- School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Sabrina Sghirripa
- School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Nigel C Rogasch
- School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
- Turner Institute of Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Brenton Hordacre
- Innovation, IMPlementation and Clinical Translation (IIMPACT) in Health, Allied Health and Human Performance, The University of South Australia, Adelaide, Australia
| | - Stacie Attrill
- Speech Pathology, School of Allied Health Science and Practice, The University of Adelaide, Adelaide, Australia
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24
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Hartwigsen G, Lim JS, Bae HJ, Yu KH, Kuijf HJ, Weaver NA, Biesbroek JM, Kopal J, Bzdok D. Bayesian modeling disentangles language versus executive control disruption in stroke. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.08.06.552147. [PMID: 37609325 PMCID: PMC10441359 DOI: 10.1101/2023.08.06.552147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Stroke is the leading cause of long-term disability worldwide. Incurred brain damage disrupts cognition, often with persisting deficits in language and executive capacities. Despite their clinical relevance, the commonalities, and differences of language versus executive control impairments remain under-specified. We tailored a Bayesian hierarchical modeling solution in a largest-of-its-kind cohort (1080 stroke patients) to deconvolve language and executive control in the brain substrates of stroke insults. Four cognitive factors distinguished left- and right-hemispheric contributions to ischemic tissue lesion. One factor delineated language and general cognitive performance and was mainly associated with damage to left-hemispheric brain regions in the frontal and temporal cortex. A factor for executive control summarized control and visual-constructional abilities. This factor was strongly related to right-hemispheric brain damage of posterior regions in the occipital cortex. The interplay of language and executive control was reflected in two factors: executive speech functions and verbal memory. Impairments on both were mainly linked to left-hemispheric lesions. These findings shed light onto the causal implications of hemispheric specialization for cognition; and make steps towards subgroup-specific treatment protocols after stroke.
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25
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Georgiou AM, Kambanaros M. Therapies and Challenges in the Post-Stroke Aphasia Rehabilitation Arena: Current and Future Prospects. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1674. [PMID: 37763793 PMCID: PMC10537631 DOI: 10.3390/medicina59091674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/11/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023]
Abstract
Aphasia is a serious consequence of stroke that results in a breakdown in communication. The course of aphasia recovery differs between afflicted individuals, and responsiveness to treatment cannot be predicted. Aphasiologists continue to investigate numerous behavioral treatment protocols that have shifted their focus to complimentary rehabilitation strategies. The aim of this study is threefold. First, to summarize the different categories of aphasia interventions post-stroke, considering their respective protocols, and present available evidence on the effectiveness of those protocols. Second, to document the challenges regarding the prediction of aphasia treatment response post-stroke in individual patients. Third, to report the challenges faced by researchers in recruiting people with aphasia (PWA) for treatment studies, and provide recommendations on how to increase participant recruitment and retention. This study provides up-to-date information on (i) effective therapies and aphasia recovery processes, and (ii) research recruitment hurdles together with potential strategies for overcoming them.
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Affiliation(s)
- Anastasios M. Georgiou
- The Brain and Neurorehabilitation Lab, Department of Rehabilitation Sciences, Cyprus University of Technology, 3041 Limassol, Cyprus;
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26
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Simic T, Desjardins MÈ, Courson M, Bedetti C, Houzé B, Brambati SM. Treatment-induced neuroplasticity after anomia therapy in post-stroke aphasia: A systematic review of neuroimaging studies. BRAIN AND LANGUAGE 2023; 244:105300. [PMID: 37633250 DOI: 10.1016/j.bandl.2023.105300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 05/02/2023] [Accepted: 06/21/2023] [Indexed: 08/28/2023]
Abstract
We systematically reviewed the literature on neural changes following anomia treatment post-stroke. We conducted electronic searches of CINAHL, Cochrane Trials, Embase, Ovid MEDLINE, MEDLINE-in-Process and PsycINFO databases; two independent raters assessed all abstracts and full texts. Accepted studies reported original data on adults with post-stroke aphasia, who received behavioural treatment for anomia, and magnetic resonance brain imaging (MRI) pre- and post-treatment. Search results yielded 2481 citations; 33 studies were accepted. Most studies employed functional MRI and the quality of reporting neuroimaging methodology was variable, particularly for pre-processing steps and statistical analyses. The most methodologically robust data were synthesized, focusing on pre- versus post-treatment contrasts. Studies more commonly reported increases (versus decreases) in activation following naming therapy, primarily in the left supramarginal gyrus, and left/bilateral precunei. Our findings highlight the methodological heterogeneity across MRI studies, and the paucity of robust evidence demonstrating direct links between brain and behaviour in anomia rehabilitation.
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Affiliation(s)
- Tijana Simic
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), 4545 Queen Mary R.d., Montréal, QC H3W 1W4, Canada; Département de Psychologie, Université de Montréal, 90 Vincent-d'Indy Avenue, Montréal, QC H2V 2S9, Canada; Hôpital du Sacré-Cœur de Montréal (HSCM), 5400 Boul Gouin O, Montréal, QC H4J 1C5, Canada.
| | - Marie-Ève Desjardins
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), 4545 Queen Mary R.d., Montréal, QC H3W 1W4, Canada; Département de Psychologie, Université de Montréal, 90 Vincent-d'Indy Avenue, Montréal, QC H2V 2S9, Canada; Hôpital du Sacré-Cœur de Montréal (HSCM), 5400 Boul Gouin O, Montréal, QC H4J 1C5, Canada
| | - Melody Courson
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), 4545 Queen Mary R.d., Montréal, QC H3W 1W4, Canada; Département de Psychologie, Université de Montréal, 90 Vincent-d'Indy Avenue, Montréal, QC H2V 2S9, Canada
| | - Christophe Bedetti
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), 4545 Queen Mary R.d., Montréal, QC H3W 1W4, Canada
| | - Bérengère Houzé
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), 4545 Queen Mary R.d., Montréal, QC H3W 1W4, Canada; Département de Psychologie, Université de Montréal, 90 Vincent-d'Indy Avenue, Montréal, QC H2V 2S9, Canada
| | - Simona Maria Brambati
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), 4545 Queen Mary R.d., Montréal, QC H3W 1W4, Canada; Département de Psychologie, Université de Montréal, 90 Vincent-d'Indy Avenue, Montréal, QC H2V 2S9, Canada; Hôpital du Sacré-Cœur de Montréal (HSCM), 5400 Boul Gouin O, Montréal, QC H4J 1C5, Canada
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27
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Liang B, Li Y, Zhao W, Du Y. Bilateral human laryngeal motor cortex in perceptual decision of lexical tone and voicing of consonant. Nat Commun 2023; 14:4710. [PMID: 37543659 PMCID: PMC10404239 DOI: 10.1038/s41467-023-40445-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 07/27/2023] [Indexed: 08/07/2023] Open
Abstract
Speech perception is believed to recruit the left motor cortex. However, the exact role of the laryngeal subregion and its right counterpart in speech perception, as well as their temporal patterns of involvement remain unclear. To address these questions, we conducted a hypothesis-driven study, utilizing transcranial magnetic stimulation on the left or right dorsal laryngeal motor cortex (dLMC) when participants performed perceptual decision on Mandarin lexical tone or consonant (voicing contrast) presented with or without noise. We used psychometric function and hierarchical drift-diffusion model to disentangle perceptual sensitivity and dynamic decision-making parameters. Results showed that bilateral dLMCs were engaged with effector specificity, and this engagement was left-lateralized with right upregulation in noise. Furthermore, the dLMC contributed to various decision stages depending on the hemisphere and task difficulty. These findings substantially advance our understanding of the hemispherical lateralization and temporal dynamics of bilateral dLMC in sensorimotor integration during speech perceptual decision-making.
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Affiliation(s)
- Baishen Liang
- Institute of Psychology, CAS Key Laboratory of Behavioral Science, Chinese Academy of Sciences, Beijing, 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Yanchang Li
- Institute of Psychology, CAS Key Laboratory of Behavioral Science, Chinese Academy of Sciences, Beijing, 100101, China
| | - Wanying Zhao
- Institute of Psychology, CAS Key Laboratory of Behavioral Science, Chinese Academy of Sciences, Beijing, 100101, China
| | - Yi Du
- Institute of Psychology, CAS Key Laboratory of Behavioral Science, Chinese Academy of Sciences, Beijing, 100101, China.
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100049, China.
- CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai, 200031, China.
- Chinese Institute for Brain Research, Beijing, 102206, China.
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28
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Thomas G, McMahon KL, Finch E, Copland DA. Interindividual variability and consistency of language mapping paradigms for presurgical use. BRAIN AND LANGUAGE 2023; 243:105299. [PMID: 37413742 DOI: 10.1016/j.bandl.2023.105299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 04/08/2023] [Accepted: 06/21/2023] [Indexed: 07/08/2023]
Abstract
Most functional MRI studies of language processing have focussed on group-level inference, but for clinical use, the aim is to predict outcomes at an individual patient level. This requires being able to identify atypical activation and understand how differences relate to language outcomes. A language mapping paradigm that selectively activates left hemisphere language regions in healthy individuals allows atypical activation in a patient to be more easily identified. We investigated the interindividual variability and consistency of language activation in 12 healthy participants using three tasks-verb generation, responsive naming, and sentence comprehension-for future presurgical use. Responsive naming produced the most consistent left-lateralised activation across participants in frontal and temporal regions that postsurgical voxel-based lesion-symptom mapping studies suggest are most critical for language outcomes. Studies with a long-term clinical aim of predicting language outcomes in neurosurgical patients and stroke patients should first establish paradigm validity at an individual level in healthy participants.
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Affiliation(s)
- Georgia Thomas
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia; Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
| | - Katie L McMahon
- School of Clinical Sciences, Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Australia; Herston Imaging Research Facility, The University of Queensland, Brisbane, Australia
| | - Emma Finch
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia; Research and Innovation, West Moreton Health, Ipswich, Australia; Speech Pathology Department, Princess Alexandra Hospital, Brisbane, Australia
| | - David A Copland
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia; Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia; Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
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29
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Ng S, Valdes PA, Moritz-Gasser S, Lemaitre AL, Duffau H, Herbet G. Intraoperative functional remapping unveils evolving patterns of cortical plasticity. Brain 2023; 146:3088-3100. [PMID: 37029961 DOI: 10.1093/brain/awad116] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/18/2023] [Accepted: 03/23/2023] [Indexed: 04/09/2023] Open
Abstract
The efficiency with which the brain reorganizes following injury not only depends on the extent and the severity of the lesion, but also on its temporal features. It is established that diffuse low-grade gliomas (DLGG), brain tumours with a slow-growth rate, induce a compensatory modulation of the anatomo-functional architecture, making this kind of tumours an ideal lesion model to study the dynamics of neuroplasticity. Direct electrostimulation (DES) mapping is a well-tried procedure used during awake resection surgeries to identify and spare cortical epicentres which are critical for a range of functions. Because DLGG is a chronic disease, it inevitably relapses years after the initial surgery, and thus requires a second surgery to reduce tumour volume again. In this context, contrasting the cortical mappings obtained during two sequential neurosurgeries offers a unique opportunity to both identify and characterize the dynamic (i.e. re-evolving) patterns of cortical re-arrangements. Here, we capitalized on an unprecedented series of 101 DLGG patients who benefited from two DES-guided neurosurgeries usually spaced several years apart, resulting in a large DES dataset of 2082 cortical sites. All sites (either non-functional or associated with language, speech, motor, somatosensory and semantic processing) were recorded in Montreal Neurological Institute (MNI) space. Next, we used a multi-step approach to generate probabilistic neuroplasticity maps that reflected the dynamic rearrangements of cortical mappings from one surgery to another, both at the population and individual level. Voxel-wise neuroplasticity maps revealed regions with a relatively high potential of evolving reorganizations at the population level, including the supplementary motor area (SMA, Pmax = 0.63), the dorsolateral prefrontal cortex (dlPFC, Pmax = 0.61), the anterior ventral premotor cortex (vPMC, Pmax = 0.43) and the middle superior temporal gyrus (STG Pmax = 0.36). Parcel-wise neuroplasticity maps confirmed this potential for the dlPFC (Fisher's exact test, PFDR-corrected = 6.6 × 10-5), the anterior (PFDR-corrected = 0.0039) and the ventral precentral gyrus (PFDR-corrected = 0.0058). A series of clustering analyses revealed a topological migration of clusters, especially within the left dlPFC and STG (language sites); the left vPMC (speech arrest/dysarthria sites) and the right SMA (negative motor response sites). At the individual level, these dynamic changes were confirmed for the dlPFC (bilateral), the left vPMC and the anterior left STG (threshold free cluster enhancement, 5000 permutations, family-wise error-corrected). Taken as a whole, our results provide a critical insight into the dynamic potential of DLGG-induced continuing rearrangements of the cerebral cortex, with considerable implications for re-operations.
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Affiliation(s)
- Sam Ng
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, F-34095 Montpellier, France
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, F-34094 Montpellier, France
| | - Pablo A Valdes
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, TX 78701-2982, USA
| | - Sylvie Moritz-Gasser
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, F-34095 Montpellier, France
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, F-34094 Montpellier, France
| | - Anne-Laure Lemaitre
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, F-34095 Montpellier, France
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, F-34094 Montpellier, France
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, F-34095 Montpellier, France
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, F-34094 Montpellier, France
| | - Guillaume Herbet
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, F-34095 Montpellier, France
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, F-34094 Montpellier, France
- Praxiling Laboratory, UMR 5267, CNRS, UPVM, F-34199 Montpellier, France
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Dávila G, Torres-Prioris MJ, López-Barroso D, Berthier ML. Turning the Spotlight to Cholinergic Pharmacotherapy of the Human Language System. CNS Drugs 2023; 37:599-637. [PMID: 37341896 PMCID: PMC10374790 DOI: 10.1007/s40263-023-01017-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 06/22/2023]
Abstract
Even though language is essential in human communication, research on pharmacological therapies for language deficits in highly prevalent neurodegenerative and vascular brain diseases has received little attention. Emerging scientific evidence suggests that disruption of the cholinergic system may play an essential role in language deficits associated with Alzheimer's disease and vascular cognitive impairment, including post-stroke aphasia. Therefore, current models of cognitive processing are beginning to appraise the implications of the brain modulator acetylcholine in human language functions. Future work should be directed further to analyze the interplay between the cholinergic system and language, focusing on identifying brain regions receiving cholinergic innervation susceptible to modulation with pharmacotherapy to improve affected language domains. The evaluation of language deficits in pharmacological cholinergic trials for Alzheimer's disease and vascular cognitive impairment has thus far been limited to coarse-grained methods. More precise, fine-grained language testing is needed to refine patient selection for pharmacotherapy to detect subtle deficits in the initial phases of cognitive decline. Additionally, noninvasive biomarkers can help identify cholinergic depletion. However, despite the investigation of cholinergic treatment for language deficits in Alzheimer's disease and vascular cognitive impairment, data on its effectiveness are insufficient and controversial. In the case of post-stroke aphasia, cholinergic agents are showing promise, particularly when combined with speech-language therapy to promote trained-dependent neural plasticity. Future research should explore the potential benefits of cholinergic pharmacotherapy in language deficits and investigate optimal strategies for combining these agents with other therapeutic approaches.
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Affiliation(s)
- Guadalupe Dávila
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Marqués de Beccaria 3, 29010, Malaga, Spain
- Instituto de Investigación Biomédica de Malaga-IBIMA, Malaga, Spain
- Department of Psychobiology and Methodology of Behavioral Sciences, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
- Language Neuroscience Research Laboratory, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
| | - María José Torres-Prioris
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Marqués de Beccaria 3, 29010, Malaga, Spain
- Instituto de Investigación Biomédica de Malaga-IBIMA, Malaga, Spain
- Department of Psychobiology and Methodology of Behavioral Sciences, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
- Language Neuroscience Research Laboratory, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
| | - Diana López-Barroso
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Marqués de Beccaria 3, 29010, Malaga, Spain
- Instituto de Investigación Biomédica de Malaga-IBIMA, Malaga, Spain
- Department of Psychobiology and Methodology of Behavioral Sciences, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
- Language Neuroscience Research Laboratory, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
| | - Marcelo L Berthier
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Marqués de Beccaria 3, 29010, Malaga, Spain.
- Instituto de Investigación Biomédica de Malaga-IBIMA, Malaga, Spain.
- Language Neuroscience Research Laboratory, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain.
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Wang H, Cai Z, Li S, Zheng J, Xie Y, He Y, Li C, Zheng D. Research hotspots and frontiers of post-stroke aphasia rehabilitation: a bibliometric study and visualization analysis. Front Hum Neurosci 2023; 17:1176923. [PMID: 37250700 PMCID: PMC10213773 DOI: 10.3389/fnhum.2023.1176923] [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: 03/01/2023] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Background Aphasia is a common complication of stroke and is associated with high morbidity and mortality rates. Rehabilitation plays a crucial role in the comprehensive management of post-stroke aphasia and its consequences. However, bibliometric analysis in the field of post-stroke aphasia rehabilitation is still lacking. This study aimed to comprehensively identify assistance networks, analyze research trends, focus on hot and cutting-edge health topics related to post-stroke aphasia rehabilitation, and inform future research guidelines. Methods The Web of Science Core Collection (WoSCC) electronic database was searched from inception to January 4, 2023 to identify studies related to post-stroke aphasia rehabilitation. Bibliometric analysis and visualization of country, institution, journal, author, reference, and keywords were performed using CiteSpace and VOSviewer software. Results A total of 2,325 papers were included in the analysis, with a progressive increase in the number of articles published each year. The USA was the country with the most publications (809 articles), and the University of Queensland was the institution with the most publications (137 articles). The subject area of post-stroke aphasia rehabilitation is dominated by clinical neurology (882 articles). Aphasiology was the journal with the most publications (254 articles) and the most cited journal (6,893 citations). Worrall L was the most prolific author (51 publications), and Frideriksson J was the most cited author (804 citations). Conclusion By using bibliometrics, we provided a comprehensive review of studies related to post-stroke aphasia rehabilitation. Future research hotspots on topics related to post-stroke aphasia rehabilitation will mainly focus on the plasticity mechanisms of neurolinguistics networks, language function assessment, language rehabilitation modalities, and patients' rehabilitation needs and participation experiences in post-stroke aphasia. This paper provides systematic information that is worth exploring in the future.
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Affiliation(s)
- Huan Wang
- College of Nursing, Jinan University, Guangzhou, China
| | - Ziping Cai
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Shengjuan Li
- College of Nursing, Jinan University, Guangzhou, China
| | - Jiaxing Zheng
- College of Rehabilitation, Jinan University, Guangzhou, China
| | - Yuyao Xie
- College of Nursing, Jinan University, Guangzhou, China
| | - Yuanyuan He
- College of Nursing, Jinan University, Guangzhou, China
| | - Chen Li
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Dongxiang Zheng
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
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Xu L, Wei H, Sun Z, Chu T, Li M, Liu R, Jiang L, Liang Z. Dynamic alterations of spontaneous neural activity in post-stroke aphasia: a resting-state functional magnetic resonance imaging study. Front Neurosci 2023; 17:1177930. [PMID: 37250389 PMCID: PMC10213748 DOI: 10.3389/fnins.2023.1177930] [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: 04/20/2023] [Indexed: 05/31/2023] Open
Abstract
Background and purpose The dynamic alterations in spontaneous neural activity of the brain during the acute phase of post-stroke aphasia (PSA) remain unclear. Therefore, in this study, dynamic amplitude of low-frequency fluctuation (dALFF) was applied to explore abnormal temporal variability in local functional activity of the brain during acute PSA. Materials and methods Resting-state functional magnetic resonance imaging (rs-fMRI) data from 26 patients with PSA and 25 healthy controls (HCs) were acquired. The sliding window method was used to assess dALFF, with the k-means clustering method used to identify dALFF states. The two-sample t-test was applied to compare differences in dALFF variability and state metrics between the PSA and HC groups. Results (1) In the PSA group, greater variance of dALFF in the cerebellar network (CBN) and left fronto-temporo-parietal network (FTPN) was observed. (2) Three dALFF states were identified among all subjects. States 1 and 2 were identified in the PSA patients, and the two dALFF states shared a similar proportion. Moreover, the number of transitions between the two dALFF states was higher in the patients compared with that in HCs. Conclusion The results of this study provide valuable insights into brain dysfunction that occurs during the acute phase (6.00 ± 3.52 days) of PSA. The observed increase in variability of local functional activities in CBN and left FTPN may be related to the spontaneous functional recovery of language during acute PSA, and it also suggests that cerebellum plays an important role in language.
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Affiliation(s)
- Luyao Xu
- Department of Neurology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, Shandong, China
| | - Hongchun Wei
- Department of Neurology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, Shandong, China
| | - Zhongwen Sun
- Department of Neurology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, Shandong, China
| | - Tongpeng Chu
- Department of Radiology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, Shandong, China
| | - Min Li
- Department of Neurology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, Shandong, China
| | - Ruhui Liu
- Department of Neurology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, Shandong, China
| | - Li Jiang
- Department of Neurology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, Shandong, China
| | - Zhigang Liang
- Department of Neurology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, Shandong, China
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Li T, Feng J, Hu R, Lv M, Chang W, Ma X, Qi W, Zhang Y, Chen X, Ding L, Gu Y, Xu W. Effect and safety of C7 neurotomy at the intervertebral foramen in patients with chronic poststroke aphasia: a multicentre, randomised, controlled study protocol. BMJ Open 2023; 13:e065173. [PMID: 37130672 PMCID: PMC10163524 DOI: 10.1136/bmjopen-2022-065173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
INTRODUCTION Aphasia affects many stroke survivors; therefore, effective treatments are urgently needed. Preliminary clinical findings have suggested an association between contralateral C7-C7 cross nerve transfer and recovery from chronic aphasia. Randomised controlled trials supporting the efficacy of C7 neurotomy (NC7) are lacking. This study will explore the efficacy of NC7 at the intervertebral foramen for improving chronic poststroke aphasia. METHODS AND ANALYSIS This study protocol reports a multicentre, randomised, assessor-blinded active-controlled trial. A total of 50 patients with chronic poststroke aphasia for over 1 year and with a aphasia quotient calculated by Western Aphasia Battery Aphasia Quotient (WAB-AQ) score below 93.8 will be recruited. Participants will be randomly assigned to 1 of 2 groups (25 individuals each) to receive NC7 plus intensive speech and language therapy (iSLT), or iSLT alone programme. The primary outcome is the change in Boston Naming Test score from baseline to the first follow-up after NC7 plus 3 weeks of iSLT or iSLT alone. The secondary outcomes include the changes in the WAB-AQ, Communication Activities of Daily Living-3, International Classification of Functioning, Disability and Health (ICF) speech language function, Barthel Index, Stroke Aphasic Depression Questionnaire-hospital version and sensorimotor assessments. The study will also collect functional imaging outcomes of naming and semantic violation tasks through functional MRI and electroencephalogram to evaluate the intervention-induced neuroplasticity. ETHICS AND DISSEMINATION This study was approved by the institutional review boards of Huashan Hospital, Fudan University, and all participating institutions. The study findings will be disseminated through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER ChiCTR2200057180.
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Affiliation(s)
- Tie Li
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
- Department of Hand and Upper Extremity Surgery, Limb Function Reconstruction Center, Jing'an District Central Hospital, Shanghai, People's Republic of China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
- Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, People's Republic of China
| | - Juntao Feng
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
- Department of Hand and Upper Extremity Surgery, Limb Function Reconstruction Center, Jing'an District Central Hospital, Shanghai, People's Republic of China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
- Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, People's Republic of China
| | - Ruiping Hu
- Department of Rehabilitation, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Minzhi Lv
- Center of Evidence-Based Medicine, Department of Biostatistics, School of Public Health, Fudan University, Shanghai, People's Republic of China
| | - Wenshuo Chang
- Institute of Linguistics, Shanghai International Studies University, Shanghai, People's Republic of China
| | - Xingyi Ma
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Wenjun Qi
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Ying Zhang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, People's Republic of China
| | - Xiuen Chen
- Department of Rehabilitation, Huadong Hospital Affiliated to Fudan University, Shanghai, People's Republic of China
| | - Ling Ding
- Department of Rehabilitation, Shanghai Pudong Hospital, Shanghai, People's Republic of China
| | - Yudong Gu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
- Department of Hand and Upper Extremity Surgery, Limb Function Reconstruction Center, Jing'an District Central Hospital, Shanghai, People's Republic of China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
- Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, People's Republic of China
| | - Wendong Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
- Department of Hand and Upper Extremity Surgery, Limb Function Reconstruction Center, Jing'an District Central Hospital, Shanghai, People's Republic of China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
- Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, People's Republic of China
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Vadinova V, Sihvonen AJ, Garden KL, Ziraldo L, Roxbury T, O'Brien K, Copland DA, McMahon KL, Brownsett SLE. Early Subacute White Matter Hyperintensities and Recovery of Language After Stroke. Neurorehabil Neural Repair 2023; 37:218-227. [PMID: 37083133 PMCID: PMC10152219 DOI: 10.1177/15459683231168384] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
BACKGROUND White matter hyperintensities (WMH) are considered to contribute to diminished brain reserve, negatively impacting on stroke recovery. While WMH identified in the chronic phase after stroke have been associated with post-stroke aphasia, the contribution of premorbid WMH to the early recovery of language across production and comprehension has not been investigated. OBJECTIVE To investigate the relationship between premorbid WMH severity and longitudinal comprehension and production outcomes in aphasia, after controlling for stroke lesion variables. METHODS Longitudinal behavioral data from individuals with a left-hemisphere stroke were included at the early subacute (n = 37) and chronic (n = 28) stage. Spoken language comprehension and production abilities were assessed at both timepoints using word and sentence-level tasks. Magnetic resonance imaging (MRI) was performed at the early subacute stage to derive stroke lesion variables (volume and proportion damage to critical regions) and WMH severity rating. RESULTS The presence of severe WMH explained an additional 18% and 25% variance in early subacute (t = -3.00, p = .004) and chronic (t = -3.60, P = .001) language comprehension abilities respectively, after controlling for stroke lesion variables. WMH did not predict additional variance of language production scores. CONCLUSIONS Subacute clinical MRI can be used to improve prognoses of recovery of aphasia after stroke. We demonstrate that severe early subacute WMH add to the prediction of impaired longitudinal language recovery in comprehension, but not production. This emphasizes the need to consider different domains of language when investigating novel neurobiological predictors of aphasia recovery.
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Affiliation(s)
- Veronika Vadinova
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
| | - Aleksi J Sihvonen
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Australia
- Cognitive Brain Research Unit (CBRU), University of Helsinki, Helsinki, Finland
- Centre of Excellence in Music, Mind, Body and Brain, University of Helsinki, Helsinki, Finland
| | - Kimberley L Garden
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
| | - Laura Ziraldo
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
| | - Tracy Roxbury
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
| | - Kate O'Brien
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
| | - David A Copland
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Australia
| | - Katie L McMahon
- School of Clinical Sciences, Centre for Biomedical Technologies, Queensland University of Technology, Queensland, Australia
| | - Sonia L E Brownsett
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Australia
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de Zubicaray GI, Brownsett SLE, Copland DA, Drummond K, Jeffree RL, Olson S, Murton E, Ong B, Robinson GA, Tolkacheva V, McMahon KL. Chronic aphasias after left-hemisphere resective surgery. BRAIN AND LANGUAGE 2023; 239:105244. [PMID: 36889018 DOI: 10.1016/j.bandl.2023.105244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/23/2023] [Accepted: 02/23/2023] [Indexed: 05/10/2023]
Abstract
Surgical resection of brain tumours is associated with an increased risk of aphasia. However, relatively little is known about outcomes in the chronic phase (i.e., >6 months). Using voxel-based lesion symptom mapping (VLSM) in 46 patients, we investigated whether chronic language impairments are related to the location of surgical resection, residual tumour characteristics (e.g., peri-resection treatment effects, progressive infiltration, oedema) or both. Approximately 72% of patients scored below the cut-off for aphasia. Action naming and spoken sentence comprehension deficits were associated with lesions in the left anterior temporal and inferior parietal lobes, respectively. Voxel-wise analyses revealed significant associations between ventral language pathways and action naming deficits. Reading impairments were also associated with increasing disconnection of cerebellar pathways. The results indicate chronic post-surgical aphasias reflect a combination of resected tissue and tumour infiltration of language-related white matter tracts, implicating progressive disconnection as the critical mechanism of impairment.
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Affiliation(s)
- Greig I de Zubicaray
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD 4059, Australia.
| | - Sonia L E Brownsett
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD 4072, Australia; Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia
| | - David A Copland
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD 4072, Australia; Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia
| | - Kate Drummond
- Royal Melbourne Hospital, Melbourne, VIC 3050, Australia
| | | | - Sarah Olson
- Princess Alexandra Hospital, Brisbane, QLD 4102, Australia
| | - Emma Murton
- Royal Melbourne Hospital, Melbourne, VIC 3050, Australia
| | - Benjamin Ong
- Princess Alexandra Hospital, Brisbane, QLD 4102, Australia
| | - Gail A Robinson
- Queensland Brain Institute and School of Psychology, University of Queensland, Brisbane, QLD 4072, Australia
| | - Valeriya Tolkacheva
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Katie L McMahon
- School of Clinical Sciences, Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4059, Australia; Herston Imaging Research Facility, Royal Brisbane & Women's Hospital, Brisbane, QLD 4029, Australia
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Prat CS, Gallée J, Yamasaki BL. Getting language right: Relating individual differences in right hemisphere contributions to language learning and relearning. BRAIN AND LANGUAGE 2023; 239:105242. [PMID: 36931111 DOI: 10.1016/j.bandl.2023.105242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 05/10/2023]
Abstract
Language, or the diverse set of dynamic processes through which symbolic, perceptual codes are linked to meaning representations in memory, has long been assumed to be lateralized to the left hemisphere (LH). However, after over 150 years of investigation, we still lack a unifying account of when, and for whom, a particular linguistic process relies upon LH or right hemisphere (RH) computations, or both. With a focus on individual differences, this article integrates existing theories of hemispheric contributions to language and cognition into a novel proposed framework for understanding how, when, and for whom the RH contributes to linguistic processes. We use evidence from first and second language learning and language relearning following focal brain damage to highlight the critical contributions of the RH.
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Affiliation(s)
- Chantel S Prat
- Department of Psychology, Institute for Learning and Brain Sciences, University of Washington, Seattle, WA, USA.
| | - Jeanne Gallée
- Department of Psychology, Institute for Learning and Brain Sciences, University of Washington, Seattle, WA, USA
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Altered Spontaneous Brain Activity in Poststroke Aphasia: A Resting-State fMRI Study. Brain Sci 2023; 13:brainsci13020300. [PMID: 36831843 PMCID: PMC9954170 DOI: 10.3390/brainsci13020300] [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: 12/10/2022] [Revised: 02/04/2023] [Accepted: 02/09/2023] [Indexed: 02/12/2023] Open
Abstract
PURPOSE Brain areas frequently implicated in language recovery after stroke comprise perilesional sites in the left hemisphere and homotopic regions in the right hemisphere. However, the neuronal mechanisms underlying language restoration are still largely unclear. METHODS AND MATERIALS In the present study, we investigated the brain function in 15 patients with poststroke aphasia and 30 matched control subjects by combining the regional homogeneity (ReHo) and amplitudes of low-frequency fluctuation (ALFF) analysis methods based on resting-state fMRI. RESULTS Compared to the control subjects, the patients with aphasia exhibited increased ReHo and ALFF values in the ipsilateral perilesional areas and increased ReHo in the contralesional right middle frontal gyrus. CONCLUSIONS The increased spontaneous brain activity in patients with poststroke aphasia during the recovery period, specifically in the ipsilateral perilesional regions and the homologous language regions of the right hemisphere, has potential implications for the treatment of patients with aphasia.
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Barbieri E, Thompson CK, Higgins J, Caplan D, Kiran S, Rapp B, Parrish T. Treatment-induced neural reorganization in aphasia is language-domain specific: Evidence from a large-scale fMRI study. Cortex 2023; 159:75-100. [PMID: 36610109 PMCID: PMC9931666 DOI: 10.1016/j.cortex.2022.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 08/14/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022]
Abstract
Studies investigating the effects of language intervention on the re-organization of language networks in chronic aphasia have resulted in mixed findings, likely related to-among other factors-the language function targeted during treatment. The present study investigated the effects of the type of treatment provided on neural reorganization. Seventy individuals with chronic stroke-induced aphasia, recruited from three research laboratories and meeting criteria for agrammatism, anomia or dysgraphia were assigned to either treatment (N = 51) or control (N = 19) groups. Participants in the treatment group received 12-weeks of language intervention targeting sentence comprehension/production, naming, or spelling. At baseline and post-testing, all participants performed an fMRI story comprehension task, with blocks of auditorily-presented stories alternated with blocks of reversed speech. Participants in the treatment, but not control, group significantly improved in the treated language domain. FMRI region-of-interest (ROI) analyses, conducted within regions that were either active (or homologous to active) regions in a group of 22 healthy participants on the story comprehension task, revealed a significant increase in activation from pre-to post-treatment in right-hemisphere homologues of these regions for participants in the sentence and spelling, but not naming, treatment groups, not predicted by left-hemisphere lesion size. For the sentence (but not the spelling) treatment group, activation changes within right-hemisphere homologues of language regions were positively associated with changes in measures of verb and sentence comprehension. These findings support previous research pointing to recruitment of right hemisphere tissue as a viable route for language recovery and suggest that sentence-level treatment may promote greater neuroplasticity on naturalistic, language comprehension tasks, compared to word-level treatment.
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Affiliation(s)
- Elena Barbieri
- Center for the Neurobiology of Language Recovery, Northwestern University, 2240 Campus Drive, Evanston, IL 60208, USA; Department of Communication Sciences and Disorders, School of Communication, Northwestern University, 70 Arts Circle Drive, Evanston, IL 60208, USA.
| | - Cynthia K Thompson
- Center for the Neurobiology of Language Recovery, Northwestern University, 2240 Campus Drive, Evanston, IL 60208, USA; Department of Communication Sciences and Disorders, School of Communication, Northwestern University, 70 Arts Circle Drive, Evanston, IL 60208, USA; Department of Neurology, Feinberg School of Medicine, Northwestern University, 303 East Chicago Avenue, Chicago, IL 60611, USA
| | - James Higgins
- Center for the Neurobiology of Language Recovery, Northwestern University, 2240 Campus Drive, Evanston, IL 60208, USA; Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Avenue, Chicago, IL 60611, USA
| | - David Caplan
- Center for the Neurobiology of Language Recovery, Northwestern University, 2240 Campus Drive, Evanston, IL 60208, USA; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 15 Parkman Street, Boston, MA 02114, USA
| | - Swathi Kiran
- Center for the Neurobiology of Language Recovery, Northwestern University, 2240 Campus Drive, Evanston, IL 60208, USA; Department of Speech, Language, And Hearing, College of Health & Rehabilitation, Boston University, 635 Commonwealth Avenue, Boston, MA 02215, USA
| | - Brenda Rapp
- Center for the Neurobiology of Language Recovery, Northwestern University, 2240 Campus Drive, Evanston, IL 60208, USA; Department of Cognitive Science, Krieger School of Arts & Sciences, Johns Hopkins Univeristy, 3400 N Charles Street, Baltimore, MD 21218, USA
| | - Todd Parrish
- Center for the Neurobiology of Language Recovery, Northwestern University, 2240 Campus Drive, Evanston, IL 60208, USA; Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Avenue, Chicago, IL 60611, USA
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Nieberlein L, Rampp S, Gussew A, Prell J, Hartwigsen G. Reorganization and Plasticity of the Language Network in Patients with Cerebral Gliomas. Neuroimage Clin 2023; 37:103326. [PMID: 36736198 PMCID: PMC9926312 DOI: 10.1016/j.nicl.2023.103326] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/15/2022] [Accepted: 01/16/2023] [Indexed: 01/19/2023]
Abstract
Language is organized in large-scale networks in the human brain that show a strong potential for flexible interactions and adaptation. Neuroplasticity is the central mechanism that allows such dynamic modulation to changing conditions across the life span and is particularly important for network reorganization after brain lesions. Most studies on language reorganization focused on language recovery after stroke. Yet, a strong degree of adaptive neuroplasticity can also be observed in patients with brain tumors in language-eloquent brain areas. This review discusses key mechanisms for neural reorganization in patients with brain tumors. Our main aim is to elucidate the underlying mechanisms for intra- and interhemispheric plasticity in the language network in these patients. The following reorganization patterns are discussed: 1) Persisting function within the tumor; 2) Reorganization in perilesional regions; 3) Reorganization in a distributed network of the affected hemisphere; 4) Reorganization to the contralesional hemisphere. In this context, we shed light on language-related reorganization patterns in frontal and temporo-parietal areas and discuss their functional relevance. We also address tumor-related changes in structural and functional connectivity between eloquent brain regions. Thereby, we aim to expand the general understanding of the plastic potential of the neural language network and facilitate clinical decision-making processes for effective, function-preserving tumor treatment.
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Affiliation(s)
- Laura Nieberlein
- Lise Meitner Research Group Cognition and Plasticity, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
| | - Stefan Rampp
- Department of Neurosurgery, University Hospital Halle (Saale), Germany; Department of Neurosurgery, University Hospital Erlangen, Germany
| | - Alexander Gussew
- Department of Medical Physics, University Hospital Halle (Saale), Germany
| | - Julian Prell
- Department of Neurosurgery, University Hospital Halle (Saale), Germany
| | - Gesa Hartwigsen
- Lise Meitner Research Group Cognition and Plasticity, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Wilhelm Wundt Institute for Psychology, Leipzig University, Germany
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Shah-Basak P, Boukrina O, Li XR, Jebahi F, Kielar A. Targeted neurorehabilitation strategies in post-stroke aphasia. Restor Neurol Neurosci 2023; 41:129-191. [PMID: 37980575 PMCID: PMC10741339 DOI: 10.3233/rnn-231344] [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: 11/21/2023]
Abstract
BACKGROUND Aphasia is a debilitating language impairment, affecting millions of people worldwide. About 40% of stroke survivors develop chronic aphasia, resulting in life-long disability. OBJECTIVE This review examines extrinsic and intrinsic neuromodulation techniques, aimed at enhancing the effects of speech and language therapies in stroke survivors with aphasia. METHODS We discuss the available evidence supporting the use of transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation, and functional MRI (fMRI) real-time neurofeedback in aphasia rehabilitation. RESULTS This review systematically evaluates studies focusing on efficacy and implementation of specialized methods for post-treatment outcome optimization and transfer to functional skills. It considers stimulation target determination and various targeting approaches. The translation of neuromodulation interventions to clinical practice is explored, emphasizing generalization and functional communication. The review also covers real-time fMRI neurofeedback, discussing current evidence for efficacy and essential implementation parameters. Finally, we address future directions for neuromodulation research in aphasia. CONCLUSIONS This comprehensive review aims to serve as a resource for a broad audience of researchers and clinicians interested in incorporating neuromodulation for advancing aphasia care.
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Affiliation(s)
| | - Olga Boukrina
- Kessler Foundation, Center for Stroke Rehabilitation Research, West Orange, NJ, USA
| | - Xin Ran Li
- School of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Fatima Jebahi
- Department of Speech, Languageand Hearing Sciences, University of Arizona, Tucson, AZ, USA
| | - Aneta Kielar
- Department of Speech, Languageand Hearing Sciences, University of Arizona, Tucson, AZ, USA
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Tahmi M, Kane VA, Pavol MA, Naqvi IA. Neuroimaging biomarkers of cognitive recovery after ischemic stroke. Front Neurol 2022; 13:923942. [PMID: 36588894 PMCID: PMC9796574 DOI: 10.3389/fneur.2022.923942] [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: 04/19/2022] [Accepted: 11/23/2022] [Indexed: 12/15/2022] Open
Abstract
Post-stroke cognitive impairment affects more than one-third of patients after an ischemic stroke (IS). Identifying markers of potential cognitive recovery after ischemic stroke can guide patients' selection for treatments, enrollment in clinical trials, and cognitive rehabilitation methods to restore cognitive abilities in post-stroke patients. Despite the burden of post-stroke cognitive impairment, biomarkers of cognitive recovery are an understudied area of research. This narrative review summarizes and critically reviews the current literature on the use and utility of neuroimaging as a predictive biomarker of cognitive recovery after IS. Most studies included in this review utilized structural Magnetic Resonance Imaging (MRI) to predict cognitive recovery after IS; these studies highlighted baseline markers of cerebral small vessel disease and cortical atrophy as predictors of cognitive recovery. Functional Magnetic Resonance Imaging (fMRI) using resting-state functional connectivity and Diffusion Imaging are potential biomarkers of cognitive recovery after IS, although more precise predictive tools are needed. Comparison of these studies is limited by heterogeneity in cognitive assessments. For all modalities, current findings need replication in larger samples. Although no neuroimaging tool is ready for use as a biomarker at this stage, these studies suggest a clinically meaningful role for neuroimaging in predicting post-stroke cognitive recovery.
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Affiliation(s)
- Mouna Tahmi
- Department of Neurology, State University of New York Downstate Health Sciences University, New York, NY, United States
| | - Veronica A. Kane
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, United States
| | - Marykay A. Pavol
- Department of Neurology and Rehabilitation and Regenerative Medicine, Columbia University, New York, NY, United States
| | - Imama A. Naqvi
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Columbia University, New York, NY, United States,*Correspondence: Imama A. Naqvi
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Qu X, Wang Z, Cheng Y, Xue Q, Li Z, Li L, Feng L, Hartwigsen G, Chen L. Neuromodulatory effects of transcranial magnetic stimulation on language performance in healthy participants: Systematic review and meta-analysis. Front Hum Neurosci 2022; 16:1027446. [PMID: 36545349 PMCID: PMC9760723 DOI: 10.3389/fnhum.2022.1027446] [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: 08/25/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
Background The causal relationships between neural substrates and human language have been investigated by transcranial magnetic stimulation (TMS). However, the robustness of TMS neuromodulatory effects is still largely unspecified. This study aims to systematically examine the efficacy of TMS on healthy participants' language performance. Methods For this meta-analysis, we searched PubMed, Web of Science, PsycINFO, Scopus, and Google Scholar from database inception until October 15, 2022 for eligible TMS studies on language comprehension and production in healthy adults published in English. The quality of the included studies was assessed with the Cochrane risk of bias tool. Potential publication biases were assessed by funnel plots and the Egger Test. We conducted overall as well as moderator meta-analyses. Effect sizes were estimated using Hedges'g (g) and entered into a three-level random effects model. Results Thirty-seven studies (797 participants) with 77 effect sizes were included. The three-level random effects model revealed significant overall TMS effects on language performance in healthy participants (RT: g = 0.16, 95% CI: 0.04-0.29; ACC: g = 0.14, 95% CI: 0.04-0.24). Further moderator analyses indicated that (a) for language tasks, TMS induced significant neuromodulatory effects on semantic and phonological tasks, but didn't show significance for syntactic tasks; (b) for cortical targets, TMS effects were not significant in left frontal, temporal or parietal regions, but were marginally significant in the inferior frontal gyrus in a finer-scale analysis; (c) for stimulation parameters, stimulation sites extracted from previous studies, rTMS, and intensities calibrated to the individual resting motor threshold are more prone to induce robust TMS effects. As for stimulation frequencies and timing, both high and low frequencies, online and offline stimulation elicited significant effects; (d) for experimental designs, studies adopting sham TMS or no TMS as the control condition and within-subject design obtained more significant effects. Discussion Overall, the results show that TMS may robustly modulate healthy adults' language performance and scrutinize the brain-and-language relation in a profound fashion. However, due to limited sample size and constraints in the current meta-analysis approach, analyses at a more comprehensive level were not conducted and results need to be confirmed by future studies. Systematic review registration [https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=366481], identifier [CRD42022366481].
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Affiliation(s)
- Xingfang Qu
- Max Planck Partner Group, School of International Chinese Language Education, Beijing Normal University, Beijing, China
| | - Zichao Wang
- Max Planck Partner Group, School of International Chinese Language Education, Beijing Normal University, Beijing, China
| | - Yao Cheng
- Max Planck Partner Group, School of International Chinese Language Education, Beijing Normal University, Beijing, China
| | - Qingwei Xue
- Max Planck Partner Group, School of International Chinese Language Education, Beijing Normal University, Beijing, China
| | - Zimu Li
- Max Planck Partner Group, School of International Chinese Language Education, Beijing Normal University, Beijing, China
| | - Lu Li
- Max Planck Partner Group, School of International Chinese Language Education, Beijing Normal University, Beijing, China
| | - Liping Feng
- Max Planck Partner Group, School of International Chinese Language Education, Beijing Normal University, Beijing, China
| | - Gesa Hartwigsen
- Lise Meitner Research Group Cognition and Plasticity, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Luyao Chen
- Max Planck Partner Group, School of International Chinese Language Education, Beijing Normal University, Beijing, China,*Correspondence: Luyao Chen,
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Hullett PW, Kandahari N, Shih TT, Kleen JK, Knowlton RC, Rao VR, Chang EF. Intact speech perception after resection of dominant hemisphere primary auditory cortex for the treatment of medically refractory epilepsy: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE22417. [PMID: 36443954 PMCID: PMC9705521 DOI: 10.3171/case22417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/27/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND In classic speech network models, the primary auditory cortex is the source of auditory input to Wernicke's area in the posterior superior temporal gyrus (pSTG). Because resection of the primary auditory cortex in the dominant hemisphere removes inputs to the pSTG, there is a risk of speech impairment. However, recent research has shown the existence of other, nonprimary auditory cortex inputs to the pSTG, potentially reducing the risk of primary auditory cortex resection in the dominant hemisphere. OBSERVATIONS Here, the authors present a clinical case of a woman with severe medically refractory epilepsy with a lesional epileptic focus in the left (dominant) Heschl's gyrus. Analysis of neural responses to speech stimuli was consistent with primary auditory cortex localization to Heschl's gyrus. Although the primary auditory cortex was within the proposed resection margins, she underwent lesionectomy with total resection of Heschl's gyrus. Postoperatively, she had no speech deficits and her seizures were fully controlled. LESSONS While resection of the dominant hemisphere Heschl's gyrus/primary auditory cortex warrants caution, this case illustrates the ability to resect the primary auditory cortex without speech impairment and supports recent models of multiple parallel inputs to the pSTG.
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Affiliation(s)
- Patrick W. Hullett
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California
| | - Nazineen Kandahari
- Department of Neurosurgery, University of California San Francisco, San Francisco, California; and ,Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California
| | - Tina T. Shih
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California
| | - Jonathan K. Kleen
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California
| | - Robert C. Knowlton
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California
| | - Vikram R. Rao
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California
| | - Edward F. Chang
- Department of Neurosurgery, University of California San Francisco, San Francisco, California; and
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Schevenels K, Gerrits R, Lemmens R, De Smedt B, Zink I, Vandermosten M. Early white matter connectivity and plasticity in post stroke aphasia recovery. Neuroimage Clin 2022; 36:103271. [PMID: 36510409 PMCID: PMC9723316 DOI: 10.1016/j.nicl.2022.103271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/30/2022] [Accepted: 11/17/2022] [Indexed: 11/21/2022]
Abstract
A disruption of white matter connectivity is negatively associated with language (recovery) in patients with aphasia after stroke, and behavioral gains have been shown to coincide with white matter neuroplasticity. However, most brain-behavior studies have been carried out in the chronic phase after stroke, with limited generalizability to earlier phases. Furthermore, few studies have investigated neuroplasticity patterns during spontaneous recovery (i.e., not related to a specific treatment) in the first months after stroke, hindering the investigation of potential early compensatory mechanisms. Finally, the majority of previous research has focused on damaged left hemisphere pathways, while neglecting the potential protective value of their right hemisphere counterparts for language recovery. To address these outstanding issues, we present a longitudinal study of thirty-two patients with aphasia (21 males and 11 females, M = 69.47 years, SD = 10.60 years) who were followed up for a period of 1 year with test moments in the acute (1-2 weeks), subacute (3-6 months) and chronic phase (9-12 months) after stroke. Constrained Spherical Deconvolution-based tractography was performed in the acute and subacute phase to measure Fiber Bundle Capacity (FBC), a quantitative connectivity measure that is valid in crossing fiber regions, in the bilateral dorsal arcuate fasciculus (AF) and the bilateral ventral inferior fronto-occipital fasciculus (IFOF). First, concurrent analyses revealed positive associations between the left AF and phonology, and between the bilateral IFOF and semantics in the acute - but not subacute - phase, supporting the dual-stream language model. Second, neuroplasticity analyses revealed a decrease in connection density of the bilateral AF - but not the IFOF - from the acute to the subacute phase, possibly reflecting post stroke white matter degeneration in areas adjacent to the lesion. Third, predictive analyses revealed no contribution of acute FBC measures to the prediction of later language outcomes over and above the initial language scores, suggesting no added value ofthe diffusion measures for languageprediction. Our study provides new insights on (changes in) connectivity of damaged and undamaged language pathways in patients with aphasia in the first months after stroke, as well as if/how such measures are related to language outcomes at different stages of recovery. Individual results are discussed in the light of current frameworks of language processing and aphasia recovery.
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Affiliation(s)
- Klara Schevenels
- Research Group Experimental Oto-Rhino-Laryngology, Department of Neurosciences, KU Leuven, Onderwijs en Navorsing 2 (O&N2), Herestraat 49 box 721, 3000 Leuven, Belgium,Leuven Brain Institute, KU Leuven, Onderwijs en Navorsing 5 (O&N 5), Herestraat 49 box 1020, 3000 Leuven, Belgium
| | - Robin Gerrits
- Department of Experimental Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium,Research Group Experimental Neurology, Department of Neurosciences, KU Leuven, Herestraat 49 box 7003, 3000 Leuven, Belgium,Laboratory of Neurobiology, VIB Center for Brain & Disease Research, Onderwijs en Navorsing 5 (O&N 5), Herestraat 49 box 602, 3000 Leuven, Belgium,Leuven Brain Institute, KU Leuven, Onderwijs en Navorsing 5 (O&N 5), Herestraat 49 box 1020, 3000 Leuven, Belgium
| | - Bert De Smedt
- Parenting and Special Education Research Unit, Faculty of Psychology and Educational Sciences, KU Leuven, Leopold Vanderkelenstraat 32 box 3765, 3000 Leuven, Belgium,Leuven Brain Institute, KU Leuven, Onderwijs en Navorsing 5 (O&N 5), Herestraat 49 box 1020, 3000 Leuven, Belgium
| | - Inge Zink
- Research Group Experimental Oto-Rhino-Laryngology, Department of Neurosciences, KU Leuven, Onderwijs en Navorsing 2 (O&N2), Herestraat 49 box 721, 3000 Leuven, Belgium,Leuven Brain Institute, KU Leuven, Onderwijs en Navorsing 5 (O&N 5), Herestraat 49 box 1020, 3000 Leuven, Belgium
| | - Maaike Vandermosten
- Research Group Experimental Oto-Rhino-Laryngology, Department of Neurosciences, KU Leuven, Onderwijs en Navorsing 2 (O&N2), Herestraat 49 box 721, 3000 Leuven, Belgium,Leuven Brain Institute, KU Leuven, Onderwijs en Navorsing 5 (O&N 5), Herestraat 49 box 1020, 3000 Leuven, Belgium,Corresponding author at: Research Group Experimental Oto-Rhino-Laryngology, Department of Neurosciences, KU Leuven, Onderwijs en Navorsing 2 (O&N2), Herestraat 49 box 721, 3000 Leuven, Belgium.
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Tao Y, Tsapkini K, Rapp B. Inter-hemispheric synchronicity and symmetry: The functional connectivity consequences of stroke and neurodegenerative disease. NEUROIMAGE: CLINICAL 2022; 36:103263. [PMID: 36451366 PMCID: PMC9668669 DOI: 10.1016/j.nicl.2022.103263] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/02/2022] [Accepted: 11/06/2022] [Indexed: 11/09/2022] Open
Abstract
Stroke and neurodegenerative diseases differ along several dimensions, including their temporal trajectories -abrupt onset versus slow disease progression. Despite these differences, they can give rise to very similar cognitive impairments, such as specific forms of aphasia. What has been scarcely investigated, however, is the extent to which the underlying functional neuroplastic consequences are similar or different for these diseases. Here, for the first time, we directly compare changes in the brain's functional network connectivity, measured with resting-state fMRI, in stroke and progressive neurological disease. Specifically, we examined two groups of individuals with chronic post-stroke aphasia or non-fluent primary progressive aphasia, matched for their behavioral profiles and distribution of left-hemisphere damage. Using previous proposals regarding the neural functional connectivity (FC) phenotype of stroke as a starting point, we compared the two diseases in terms of homotopic FC, intra-hemispheric FC changes and also the symmetry of the FC patterns between the two hemispheres. We found, first, that progressive disease showed significantly higher levels of homotopic connectivity than neurotypical controls and, further, that stroke showed the reverse pattern. For both groups these effects were found to be behaviorally relevant. In addition, within the directly impacted left hemisphere, FC changes for the two diseases were significantly correlated. In contrast, in the right hemisphere, the FC changes differed markedly between the two groups, with the progressive disease group exhibiting rather symmetrical FC changes across the hemispheres whereas the post-stroke group showed asymmetrical FC changes across the hemispheres. These findings constitute novel evidence that the functional connectivity consequences of stroke and neurodegenerative disease can be very different despite similar behavioral outcomes and damage foci. Specifically, stroke may lead to greater independence of hemispheric responses, while neurodegenerative disease may produce more symmetrical changes across the hemispheres and more synchronized activity between the two hemispheres.
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Affiliation(s)
- Yuan Tao
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD 21218, USA,Corresponding author.
| | - Kyrana Tsapkini
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD 21218, USA,Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21217, USA
| | - Brenda Rapp
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD 21218, USA,Department of Psychological and Brain Sciences, Johns Hopkins University, Baltimore, MD 21218, USA,Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD 21218, USA
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Schevenels K, Michiels L, Lemmens R, De Smedt B, Zink I, Vandermosten M. The role of the hippocampus in statistical learning and language recovery in persons with post stroke aphasia. Neuroimage Clin 2022; 36:103243. [PMID: 36306718 PMCID: PMC9668653 DOI: 10.1016/j.nicl.2022.103243] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022]
Abstract
Although several studies have aimed for accurate predictions of language recovery in post stroke aphasia, individual language outcomes remain hard to predict. Large-scale prediction models are built using data from patients mainly in the chronic phase after stroke, although it is clinically more relevant to consider data from the acute phase. Previous research has mainly focused on deficits, i.e., behavioral deficits or specific brain damage, rather than compensatory mechanisms, i.e., intact cognitive skills or undamaged brain regions. One such unexplored brain region that might support language (re)learning in aphasia is the hippocampus, a region that has commonly been associated with an individual's learning potential, including statistical learning. This refers to a set of mechanisms upon which we rely heavily in daily life to learn a range of regularities across cognitive domains. Against this background, thirty-three patients with aphasia (22 males and 11 females, M = 69.76 years, SD = 10.57 years) were followed for 1 year in the acute (1-2 weeks), subacute (3-6 months) and chronic phase (9-12 months) post stroke. We evaluated the unique predictive value of early structural hippocampal measures for short-term and long-term language outcomes (measured by the ANELT). In addition, we investigated whether statistical learning abilities were intact in patients with aphasia using three different tasks: an auditory-linguistic and visual task based on the computation of transitional probabilities and a visuomotor serial reaction time task. Finally, we examined the association of individuals' statistical learning potential with acute measures of hippocampal gray and white matter. Using Bayesian statistics, we found moderate evidence for the contribution of left hippocampal gray matter in the acute phase to the prediction of long-term language outcomes, over and above information on the lesion and the initial language deficit (measured by the ScreeLing). Non-linguistic statistical learning in patients with aphasia, measured in the subacute phase, was intact at the group level compared to 23 healthy older controls (8 males and 15 females, M = 74.09 years, SD = 6.76 years). Visuomotor statistical learning correlated with acute hippocampal gray and white matter. These findings reveal that particularly left hippocampal gray matter in the acute phase is a potential marker of language recovery after stroke, possibly through its statistical learning ability.
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Affiliation(s)
- Klara Schevenels
- Research Group Experimental Oto-Rhino-Laryngology, Department of Neurosciences, KU Leuven, Onderwijs en Navorsing 2 (O&N2), Herestraat 49 box 721, Leuven 3000, Belgium; Leuven Brain Institute, KU Leuven, Onderwijs en Navorsing 5 (O&N 5), Herestraat 49 box 1020, Leuven 3000, Belgium.
| | - Laura Michiels
- Department of Neurology, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium; Research Group Experimental Neurology, Department of Neurosciences, KU Leuven, Herestraat 49 box 7003, Leuven 3000, Belgium; Laboratory of Neurobiology, VIB Center for Brain & Disease Research, Onderwijs en Navorsing 5 (O&N 5), Herestraat 49 box 602, Leuven 3000, Belgium; Leuven Brain Institute, KU Leuven, Onderwijs en Navorsing 5 (O&N 5), Herestraat 49 box 1020, Leuven 3000, Belgium.
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium; Research Group Experimental Neurology, Department of Neurosciences, KU Leuven, Herestraat 49 box 7003, Leuven 3000, Belgium; Laboratory of Neurobiology, VIB Center for Brain & Disease Research, Onderwijs en Navorsing 5 (O&N 5), Herestraat 49 box 602, Leuven 3000, Belgium; Leuven Brain Institute, KU Leuven, Onderwijs en Navorsing 5 (O&N 5), Herestraat 49 box 1020, Leuven 3000, Belgium.
| | - Bert De Smedt
- Parenting and Special Education Research Unit, Faculty of Psychology and Educational Sciences, KU leuven, Leopold Vanderkelenstraat 32 box 3765, Leuven 3000, Belgium; Leuven Brain Institute, KU Leuven, Onderwijs en Navorsing 5 (O&N 5), Herestraat 49 box 1020, Leuven 3000, Belgium.
| | - Inge Zink
- Research Group Experimental Oto-Rhino-Laryngology, Department of Neurosciences, KU Leuven, Onderwijs en Navorsing 2 (O&N2), Herestraat 49 box 721, Leuven 3000, Belgium; Leuven Brain Institute, KU Leuven, Onderwijs en Navorsing 5 (O&N 5), Herestraat 49 box 1020, Leuven 3000, Belgium.
| | - Maaike Vandermosten
- Research Group Experimental Oto-Rhino-Laryngology, Department of Neurosciences, KU Leuven, Onderwijs en Navorsing 2 (O&N2), Herestraat 49 box 721, Leuven 3000, Belgium; Leuven Brain Institute, KU Leuven, Onderwijs en Navorsing 5 (O&N 5), Herestraat 49 box 1020, Leuven 3000, Belgium.
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47
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Chupina I, Sierpowska J, Zheng XY, Dewenter A, Piastra M, Piai V. Time course of right-hemisphere recruitment during word production following left-hemisphere damage: A single case of young stroke. Eur J Neurosci 2022; 56:5235-5259. [PMID: 36028218 PMCID: PMC9826534 DOI: 10.1111/ejn.15813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 08/19/2022] [Accepted: 08/25/2022] [Indexed: 01/11/2023]
Abstract
Our understanding of post-stroke language function is largely based on older age groups, who show increasing age-related brain pathology and neural reorganisation. To illustrate language outcomes in the young-adult brain, we present the case of J., a 23-year-old woman with chronic aphasia from a left-hemisphere stroke affecting the temporal lobe. Diffusion MRI-based tractography indicated that J.'s language-relevant white-matter structures were severely damaged. Employing magnetoencephalography (MEG), we explored J.'s conceptual preparation and word planning abilities using context-driven and bare picture-naming tasks. These revealed naming deficits, manifesting as word-finding difficulties and semantic paraphasias about half of the time. Naming was however facilitated by semantically constraining lead-in sentences. Altogether, this pattern indicates disrupted lexical-semantic and phonological retrieval abilities. MEG revealed that J.'s conceptual and naming-related neural responses were supported by the right hemisphere, compared to the typical left-lateralised brain response of a matched control. Differential recruitment of right-hemisphere structures (330-440 ms post-picture onset) was found concurrently during successful naming (right mid-to-posterior temporal lobe) and word-finding attempts (right inferior frontal gyrus). Disconnection of the temporal lobes via corpus callosum was not critical for recruitment of the right hemisphere in visually guided naming, possibly due to neural activity right lateralising from the outset. Although J.'s right hemisphere responded in a timely manner during word planning, its lexical and phonological retrieval abilities remained modest.
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Affiliation(s)
- Irina Chupina
- Donders Centre for CognitionRadboud UniversityNijmegenThe Netherlands
| | - Joanna Sierpowska
- Donders Centre for CognitionRadboud UniversityNijmegenThe Netherlands,Cognition and Brain Plasticity Unit, Department of Cognition, Development and Educational PsychologyInstitut de Neurociències, Universitat de BarcelonaBarcelonaSpain
| | - Xiaochen Y. Zheng
- Donders Centre for Cognitive NeuroimagingRadboud UniversityNijmegenThe Netherlands
| | - Anna Dewenter
- Institute for Stroke and Dementia Research (ISD)University Hospital, LMU MunichMunichGermany
| | - Maria‐Carla Piastra
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and BehaviourRadboud University Medical CenterNijmegenThe Netherlands,Department of Neuroinformatics, Donders Institute for Brain, Cognition and BehaviourRadboud UniversityNijmegenThe Netherlands,Clinical Neurophysiology, Technical Medical Centre, Faculty of Science and TechnologyUniversity of TwenteEnschedeThe Netherlands
| | - Vitória Piai
- Donders Centre for CognitionRadboud UniversityNijmegenThe Netherlands,Department of Medical Psychology, Donders Centre for Medical NeuroscienceRadboud University Medical CenterNijmegenThe Netherlands
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48
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Pillay SB, Gross WL, Heffernan J, Book DS, Binder JR. Semantic network activation facilitates oral word reading in chronic aphasia. BRAIN AND LANGUAGE 2022; 233:105164. [PMID: 35933744 PMCID: PMC9948519 DOI: 10.1016/j.bandl.2022.105164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 03/22/2022] [Accepted: 07/24/2022] [Indexed: 06/15/2023]
Abstract
People with aphasia often show partial impairments on a given task. This trial-to-trial variability offers a potential window into understanding how damaged language networks function. We test the hypothesis that successful word reading in participants with phonological system damage reflects semantic system recruitment. Residual semantic and phonological networks were defined with fMRI in 21 stroke participants with phonological damage using semantic- and rhyme-matching tasks. Participants performed an oral word reading task, and activation was compared between correct and incorrect trials within the semantic and phonological networks. The results showed a significant interaction between hemisphere, network activation, and reading success. Activation in the left hemisphere semantic network was higher when participants successfully read words. Residual phonological regions showed no difference in activation between correct and incorrect trials on the word reading task. The results provide evidence that semantic processing supports successful phonological retrieval in participants with phonological impairment.
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Affiliation(s)
- Sara B Pillay
- Department of Neurology and the Center for Imaging Research, Medical College of Wisconsin, Milwaukee, WI 53226, United States.
| | - William L Gross
- Department of Neurology and the Center for Imaging Research, Medical College of Wisconsin, Milwaukee, WI 53226, United States; Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI 53226, United States
| | - Joseph Heffernan
- Department of Neurology and the Center for Imaging Research, Medical College of Wisconsin, Milwaukee, WI 53226, United States
| | - Diane S Book
- Department of Neurology and the Center for Imaging Research, Medical College of Wisconsin, Milwaukee, WI 53226, United States
| | - Jeffrey R Binder
- Department of Neurology and the Center for Imaging Research, Medical College of Wisconsin, Milwaukee, WI 53226, United States
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49
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Ren W, Jia C, Zhou Y, Zhao J, Wang B, Yu W, Li S, Hu Y, Zhang H. A precise language network revealed by the independent component-based lesion mapping in post-stroke aphasia. Front Neurol 2022; 13:981653. [PMID: 36247758 PMCID: PMC9561861 DOI: 10.3389/fneur.2022.981653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/09/2022] [Indexed: 11/17/2022] Open
Abstract
Brain lesion mapping studies have provided the strongest evidence regarding the neural basis of cognition. However, it remained a problem to identify symptom-specific brain networks accounting for observed clinical and neuroanatomical heterogeneity. Independent component analysis (ICA) is a statistical method that decomposes mixed signals into multiple independent components. We aimed to solve this issue by proposing an independent component-based lesion mapping (ICLM) method to identify the language network in patients with moderate to severe post-stroke aphasia. Lesions were first extracted from 49 patients with post-stroke aphasia as masks applied to fMRI data in a cohort of healthy participants to calculate the functional connectivity (FC) within the masks and non-mask brain voxels. ICA was further performed on a reformatted FC matrix to extract multiple independent networks. Specifically, we found that one of the lesion-related independent components (ICs) highly resembled classical language networks. Moreover, the damaged level within the language-related lesioned network is strongly associated with language deficits, including aphasia quotient, naming, and auditory comprehension scores. In comparison, none of the other two traditional lesion mapping methods found any regions responsible for language dysfunction. The language-related lesioned network extracted with the ICLM method showed high specificity in detecting aphasia symptoms compared with the performance of resting ICs and classical language networks. In total, we detected a precise language network in patients with aphasia and proved its efficiency in the relationship with language symptoms. In general, our ICLM could successfully identify multiple lesion-related networks from complicated brain diseases, and be used as an effective tool to study brain-behavior relationships and provide potential biomarkers of particular clinical behavioral deficits.
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Affiliation(s)
- Weijing Ren
- School of Rehabilitation, Capital Medical University, Beijing, China
- Department of Neurorehabilitation, China Rehabilitation Research Center, Beijing Bo'ai Hospital, Beijing, China
- University of Health and Rehabilitation Sciences, Qingdao, China
| | - Chunying Jia
- Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Ying Zhou
- Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Jingdu Zhao
- School of Rehabilitation, Capital Medical University, Beijing, China
- Department of Neurorehabilitation, China Rehabilitation Research Center, Beijing Bo'ai Hospital, Beijing, China
| | - Bo Wang
- Department of Hearing and Language Rehabilitation, China Rehabilitation Research Center, Beijing Bo'ai Hospital, Beijing, China
| | - Weiyong Yu
- Department of Radiology, China Rehabilitation Research Center, Beijing Bo'ai Hospital, Beijing, China
| | - Shiyi Li
- Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Yiru Hu
- Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Hao Zhang
- School of Rehabilitation, Capital Medical University, Beijing, China
- Department of Neurorehabilitation, China Rehabilitation Research Center, Beijing Bo'ai Hospital, Beijing, China
- University of Health and Rehabilitation Sciences, Qingdao, China
- *Correspondence: Hao Zhang
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50
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Ulanov M, Shtyrov Y. Oscillatory beta/alpha band modulations: A potential biomarker of functional language and motor recovery in chronic stroke? Front Hum Neurosci 2022; 16:940845. [PMID: 36226263 PMCID: PMC9549964 DOI: 10.3389/fnhum.2022.940845] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
Stroke remains one of the leading causes of various disabilities, including debilitating motor and language impairments. Though various treatments exist, post-stroke impairments frequently become chronic, dramatically reducing daily life quality, and requiring specific rehabilitation. A critical goal of chronic stroke rehabilitation is to induce, usually through behavioral training, experience-dependent plasticity processes in order to promote functional recovery. However, the efficiency of such interventions is typically modest, and very little is known regarding the neural dynamics underpinning recovery processes and possible biomarkers of their efficiency. Some studies have emphasized specific alterations of excitatory–inhibitory balance within distributed neural networks as an important recovery correlate. Neural processes sensitive to these alterations, such as task-dependent oscillatory activity in beta as well as alpha bands, may be candidate biomarkers of chronic stroke functional recovery. In this review, we discuss the results of studies on motor and language recovery with a focus on oscillatory processes centered around the beta band and their modulations during functional recovery in chronic stroke. The discussion is based on a framework where task-dependent modulations of beta and alpha oscillatory activity, generated by the deep cortical excitatory–inhibitory microcircuits, serve as a neural mechanism of domain-general top-down control processes. We discuss the findings, their limitations, and possible directions for future research.
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Affiliation(s)
- Maxim Ulanov
- Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, HSE University, Moscow, Russia
- *Correspondence: Maxim Ulanov,
| | - Yury Shtyrov
- Center of Functionally Integrative Neuroscience (CFIN), Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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