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Diana L, Casati C, Melzi L, Bianchi Marzoli S, Bolognini N. The effects of occipital and parietal tDCS on chronic visual field defects after brain injury. Front Neurol 2024; 15:1340365. [PMID: 38419713 PMCID: PMC10899507 DOI: 10.3389/fneur.2024.1340365] [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: 11/17/2023] [Accepted: 01/24/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction Homonymous visual field defects (HVFDs) following acquired brain lesions affect independent living by hampering several activities of everyday life. Available treatments are intensive and week- or month-long. Transcranial Direct current stimulation (tDCS), a plasticity-modulating non-invasive brain stimulation technique, could be combined with behavioral trainings to boost their efficacy or reduce treatment duration. Some promising attempts have been made pairing occipital tDCS with visual restitution training, however less is knows about which area/network should be best stimulated in association with compensatory approaches, aimed at improving exploratory abilities, such as multisensory trainings. Methods In a proof-of-principle, sham-controlled, single-blind study, 15 participants with chronic HVFDs underwent four one-shot sessions of active or sham anodal tDCS applied over the ipsilesional occipital cortex, the ipsilesional or contralesional posterior parietal cortex. tDCS was delivered during a compensatory multisensory (audiovisual) training. Before and immediately after each tDCS session, participants carried out a visual detection task, and two visual search tasks (EF and Triangles search tests). Accuracy (ACC) and response times (RTs) were analyzed with generalized mixed models. We investigated differences in baseline performance, clinical-demographic and lesion factors between tDCS responders and non-responders, based on post-tDCS behavioral improvements. Lastly, we conducted exploratory analyses to compare left and right brain-damaged participants. Results RTs improved after active ipsilesional occipital and parietal tDCS in the visual search tasks, while no changes in ACC were detected. Responders to ipsilesional occipital tDCS (Triangle task) had shorter disease duration and smaller lesions of the parietal cortex and the superior longitudinal fasciculus. On the other end, on the EF test, those participants with larger damage of the temporo-parietal cortex or the fronto-occipital white matter tracts showed a larger benefit from contralesional parietal tDCS. Overall, the visual search RTs improvements were larger in participants with right-sided hemispheric lesions. Conclusion The present result shows the facilitatory effects of occipital and parietal tDCS combined with compensatory multisensory training on visual field exploration in HVFDs, suggesting a potential for the development of new neuromodulation treatments to improve visual scanning behavior in brain-injured patients.
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Affiliation(s)
- Lorenzo Diana
- Laboratory of Neuropsychology, Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Carlotta Casati
- Laboratory of Neuropsychology, Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Lisa Melzi
- Neuro-Ophthalmology Center and Ocular Electrophysiology Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Stefania Bianchi Marzoli
- Neuro-Ophthalmology Center and Ocular Electrophysiology Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Nadia Bolognini
- Laboratory of Neuropsychology, Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Psychology, University of Milano-Bicocca and NeuroMI, Milan, Italy
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Toth AJ, Harvey C, Gullane H, Kelly N, Bruton A, Campbell MJ. The effect of bipolar bihemispheric tDCS on executive function and working memory abilities. Front Psychol 2024; 14:1275878. [PMID: 38235279 PMCID: PMC10791995 DOI: 10.3389/fpsyg.2023.1275878] [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: 08/10/2023] [Accepted: 12/04/2023] [Indexed: 01/19/2024] Open
Abstract
Introduction Cognitive functioning is central to the ability to learn, problem solve, remember, and use information in a rapid and accurate manner and cognitive abilities are fundamental for communication, autonomy, and quality of life. Transcranial electric stimulation (tES) is a very promising tool shown to improve various motor and cognitive functions. When applied as a direct current stimulus (transcranial direct current stimulation; tDCS) over the dorsolateral pre-frontal cortex (DLPFC), this form of neurostimulation has mixed results regarding its ability to slow cognitive deterioration and potentially enhance cognitive functioning, requiring further investigation. This study set out to comprehensively investigate the effect that anodal and cathodal bipolar bihemispheric tDCS have on executive function and working memory abilities. Methods 72 healthy young adults were recruited, and each participant was randomly allocated to either a control group (CON), a placebo group (SHAM) or one of two neurostimulation groups (Anodal; A-STIM and Cathodal; C-STIM). All participants undertook cognitive tests (Stroop & N Back) before and after a 30-minute stimulation/ sham/ control protocol. Results Overall, our results add further evidence that tDCS may not be as efficacious for enhancing cognitive functioning as it has been shown to be for enhancing motor learning when applied over M1. We also provide evidence that the effect of neurostimulation on cognitive functioning may be moderated by sex, with males demonstrating a benefit from both anodal and cathodal stimulation when considering performance on simple attention trial types within the Stroop task. Discussion Considering this finding, we propose a new avenue for tDCS research, that the potential that sex may moderate the efficacy of neurostimulation on cognitive functioning.
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Affiliation(s)
- Adam J. Toth
- Department of Physical Education and Sport Sciences, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Lero Institute, University of Limerick, Limerick, Ireland
| | - Cliodhna Harvey
- Department of Physical Education and Sport Sciences, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Hannah Gullane
- Department of Physical Education and Sport Sciences, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Niall Kelly
- Department of Physical Education and Sport Sciences, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Adam Bruton
- Department of Life Sciences, Brunel University London, Uxbridge, United Kingdom
- School of Life and Health Sciences, University of Roehampton, London, United Kingdom
| | - Mark J. Campbell
- Department of Physical Education and Sport Sciences, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- The Science Foundation Ireland Center for Software Research, Lero Institute, University of Limerick, Limerick, Ireland
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Smaczny S, Bauder D, Sperber C, Karnath HO, de Haan B. Reducing alertness does not affect line bisection bias in neurotypical participants. Exp Brain Res 2024; 242:195-204. [PMID: 37994915 PMCID: PMC10786967 DOI: 10.1007/s00221-023-06738-y] [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: 06/02/2023] [Accepted: 10/31/2023] [Indexed: 11/24/2023]
Abstract
Alertness, or one's general readiness to respond to stimulation, has previously been shown to affect spatial attention. However, most of this previous research focused on speeded, laboratory-based reaction tasks, as opposed to the classical line bisection task typically used to diagnose deficits of spatial attention in clinical settings. McIntosh et al. (Cogn Brain Res 25:833-850, 2005) provide a form of line bisection task which they argue can more sensitively assess spatial attention. Ninety-eight participants were presented with this line bisection task, once with and once without spatial cues, and both before and after a 50-min vigilance task that aimed to decrease alertness. A single participant was excluded due to potentially inconsistent behaviour in the task, leaving 97 participants for the full analyses. While participants were, on a group level, less alert after the 50-min vigilance task, they showed none of the hypothesised effects of reduced alertness on spatial attention in the line bisection task, regardless of with or without spatial cues. Yet, they did show the proposed effect of decreased alertness leading to a lower level of general attention. This suggests that alertness has no effect on spatial attention, as measured by a line bisection task, in neurotypical participants. We thus conclude that, in neurotypical participants, the effect of alertness on spatial attention can be examined more sensitively with tasks requiring a speeded response compared to unspeeded tasks.
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Affiliation(s)
- Stefan Smaczny
- Center of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Dominik Bauder
- Center of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Christoph Sperber
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Hans-Otto Karnath
- Center of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Department of Psychology, University of South Carolina, Columbia, USA
| | - Bianca de Haan
- Division of Psychology, Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Kingston Lane, Uxbridge, UB8 3PH, UK.
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Campos B, Choi H, DeMarco AT, Seydell-Greenwald A, Hussain SJ, Joy MT, Turkeltaub PE, Zeiger W. Rethinking Remapping: Circuit Mechanisms of Recovery after Stroke. J Neurosci 2023; 43:7489-7500. [PMID: 37940595 PMCID: PMC10634578 DOI: 10.1523/jneurosci.1425-23.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 11/10/2023] Open
Abstract
Stroke is one of the most common causes of disability, and there are few treatments that can improve recovery after stroke. Therapeutic development has been hindered because of a lack of understanding of precisely how neural circuits are affected by stroke, and how these circuits change to mediate recovery. Indeed, some of the hypotheses for how the CNS changes to mediate recovery, including remapping, redundancy, and diaschisis, date to more than a century ago. Recent technological advances have enabled the interrogation of neural circuits with ever greater temporal and spatial resolution. These techniques are increasingly being applied across animal models of stroke and to human stroke survivors, and are shedding light on the molecular, structural, and functional changes that neural circuits undergo after stroke. Here we review these studies and highlight important mechanisms that underlie impairment and recovery after stroke. We begin by summarizing knowledge about changes in neural activity that occur in the peri-infarct cortex, specifically considering evidence for the functional remapping hypothesis of recovery. Next, we describe the importance of neural population dynamics, disruptions in these dynamics after stroke, and how allocation of neurons into spared circuits can restore functionality. On a more global scale, we then discuss how effects on long-range pathways, including interhemispheric interactions and corticospinal tract transmission, contribute to post-stroke impairments. Finally, we look forward and consider how a deeper understanding of neural circuit mechanisms of recovery may lead to novel treatments to reduce disability and improve recovery after stroke.
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Affiliation(s)
- Baruc Campos
- Department of Neurology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California 90095
| | - Hoseok Choi
- Department of Neurology, Weill Institute for Neuroscience, University of California-San Francisco, San Francisco, California 94158
| | - Andrew T DeMarco
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Georgetown University, Washington, DC 20057
- Department of Rehabilitation Medicine, Georgetown University Medical Center, Georgetown University, Washington, DC 20057
| | - Anna Seydell-Greenwald
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Georgetown University, Washington, DC 20057
- MedStar National Rehabilitation Hospital, Washington, DC 20010
| | - Sara J Hussain
- Movement and Cognitive Rehabilitation Science Program, Department of Kinesiology and Health Education, University of Texas at Austin, Austin, Texas 78712
| | - Mary T Joy
- The Jackson Laboratory, Bar Harbor, Maine 04609
| | - Peter E Turkeltaub
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Georgetown University, Washington, DC 20057
- MedStar National Rehabilitation Hospital, Washington, DC 20010
| | - William Zeiger
- Department of Neurology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California 90095
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Millot S, Beis JM, Pierret J, Badin M, Sabau V, Bensoussan L, Paysant J, Ceyte H. Innovative Therapy Combining Neck Muscle Vibration and Transcranial Direct Current Stimulation in Association with Conventional Rehabilitation in Left Unilateral Spatial Neglect Patients: HEMISTIM Protocol for a Randomized Controlled Trial. Brain Sci 2023; 13:brainsci13040678. [PMID: 37190643 DOI: 10.3390/brainsci13040678] [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: 03/26/2023] [Revised: 04/15/2023] [Accepted: 04/16/2023] [Indexed: 05/17/2023] Open
Abstract
Unilateral spatial neglect (USN) rehabilitation requires the development of new methods that can be easily integrated into conventional practice. The aim of the HEMISTIM protocol is to assess immediate and long-term recovery induced by an innovative association of left-side neck-muscle vibration (NMV) and anodal transcranial Direct Current Stimulation (tDCS) on the ipsilesional posterior parietal cortex during occupational therapy sessions in patients with left USN. Participants will be randomly assigned to four groups: control, Left-NMV, Left-NMV + sham-tDCS or Left-NMV + anodal-tDCS. NMV and tDCS will be applied during the first 15 min of occupational therapy sessions, three days a week for three weeks. USN will be assessed at baseline, just at the end of the first experimental session, after the first and third weeks of the protocol and three weeks after its ending. Our primary outcome will be the evolution of the functional Catherine Bergego Scale score. Secondary outcome measures include five tests that investigate different neuropsychological aspects of USN. Left NMV, by activating multisensory integration neuronal networks, might enhance effects obtained by conventional therapy since post-effects were shown when it was combined with upper limb movements. We expect to reinforce lasting intermodal recalibration through LTP-like plasticity induced by anodal tDCS.
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Affiliation(s)
- Sarah Millot
- UGECAM Nord-Est, Institut Régional de Médecine Physique et de Réadaptation, Centre de Médecine Physique et de Réadaptation, Lay Saint-Christophe, France
- Université de Lorraine, DevAH, Nancy, France
| | - Jean-Marie Beis
- UGECAM Nord-Est, Institut Régional de Médecine Physique et de Réadaptation, Centre de Médecine Physique et de Réadaptation, Lay Saint-Christophe, France
- Université de Lorraine, DevAH, Nancy, France
| | - Jonathan Pierret
- UGECAM Nord-Est, Institut Régional de Médecine Physique et de Réadaptation, Centre de Médecine Physique et de Réadaptation, Lay Saint-Christophe, France
- Université de Lorraine, DevAH, Nancy, France
| | - Marina Badin
- UGECAM Nord-Est, Institut Régional de Médecine Physique et de Réadaptation, Centre de Médecine Physique et de Réadaptation, Lay Saint-Christophe, France
| | - Verginia Sabau
- UGECAM PACA-Corse, Centre Helio Marin, Vallauris, France
| | - Laurent Bensoussan
- Aix Marseille Univ, CNRS, INT, Marseille, France
- UGECAM PACA, Institut Universitaire de Réadaptation de Valmante Sud, Marseille, France
| | - Jean Paysant
- UGECAM Nord-Est, Institut Régional de Médecine Physique et de Réadaptation, Centre de Médecine Physique et de Réadaptation, Lay Saint-Christophe, France
- Université de Lorraine, DevAH, Nancy, France
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6
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Zhao Y, Li W, Huang D, Zhang W, Zhang S, Liu Q, Lv P, Yin Y. The therapeutic effect of transcranial direct current stimulation combined with cognitive training on patients with unilateral neglect after stroke. NeuroRehabilitation 2023; 52:477-483. [PMID: 37005898 DOI: 10.3233/nre-220265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
BACKGROUND: Unilateral neglect (UN) is a frequent cognitive disability following a stroke. Additional research is needed to determine the most effective cognitive rehabilitation techniques. OBJECTIVE: Based on the unilateral neglect neural network, we aim to explore the effect of a new model of transcranial direct current stimulation (tDCS) combined with cognitive training on stroke patients with unilateral neglect. METHODS: Thirty stroke patients with UN after stroke were randomly divided into three groups. All patients received cognitive training for UN and transcranial direct current stimulation with an anode placed on the corresponding part of the right hemisphere for 2 weeks. Treatment group A received multi-site tDCS from the inferior parietal lobule, middle temporal gyrus to prefrontal lobe. Group B received single-site tDCS of the inferior parietal lobule. The improvement of UN symptoms was evaluated by the scores of the Deviation index and Behavioral Inattention Test conventional tests. RESULTS: All groups showed improvements in all tests, and the scores of the treatment groups were statistically significant compared with the control group. CONCLUSION: Both single-site tDCS and multi-site tDCS have therapeutic effects on UN after stroke, and the difference in the therapeutic effects of the two modes still needs to be further explored.
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Affiliation(s)
- Yue Zhao
- North China University of Science and Technology, Tangshan, China
- Hebei Medical University, Shijiazhuang, China
| | - Weibo Li
- The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Dai Huang
- Hebei General Hospital, Shijiazhuang, China
| | | | - Shaohua Zhang
- The Eighth Hospital of Hebei Province, Shijiazhuang, China
| | | | - Peiyuan Lv
- Hebei General Hospital, Shijiazhuang, China
- Hebei Provincial Key Laboratory of Cerebral Networks and Cognitive Disorders, Shijiazhuang, China
| | - Yu Yin
- North China University of Science and Technology, Tangshan, China
- Hebei Medical University, Shijiazhuang, China
- Hebei General Hospital, Shijiazhuang, China
- Hebei Provincial Key Laboratory of Cerebral Networks and Cognitive Disorders, Shijiazhuang, China
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7
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The structural connectivity of the human angular gyrus as revealed by microdissection and diffusion tractography. Brain Struct Funct 2023; 228:103-120. [PMID: 35995880 DOI: 10.1007/s00429-022-02551-5] [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] [Received: 03/06/2022] [Accepted: 08/03/2022] [Indexed: 01/07/2023]
Abstract
The angular gyrus (AG) has been described in numerous studies to be consistently activated in various functional tasks. The angular gyrus is a critical connector epicenter linking multiple functional networks due to its location in the posterior part of the inferior parietal cortex, namely at the junction between the parietal, temporal, and occipital lobes. It is thus crucial to identify the different pathways that anatomically connect this high-order association region to the rest of the brain. Our study revisits the three-dimensional architecture of the structural AG connectivity by combining state-of-the-art postmortem blunt microdissection with advanced in vivo diffusion tractography to comprehensively describe the association, projection, and commissural fibers that connect the human angular gyrus. AG appears as a posterior "angular stone" of associative connections belonging to mid- and long-range dorsal and ventral fibers of the superior and inferior longitudinal systems, respectively, to short-range parietal, occipital, and temporal fibers, including U-shaped fibers in the posterior transverse system. Thus, AG is at a pivotal dorso-ventral position reflecting its critical role in the different functional networks, particularly in language elaboration and spatial attention and awareness in the left and right hemispheres, respectively. We also reveal striatal, thalamic, and brainstem connections and a typical inter-hemispheric homotopic callosal connectivity supporting the suggested AG role in the integration of sensory input for modulating motor control and planning. The present description of AG's highly distributed wiring diagram may drastically improve intraoperative subcortical testing and post-operative neurologic outcomes related to surgery in and around the angular gyrus.
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8
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González-Rodriguez B, Serradell-Ribé N, Viejo-Sobera R, Romero-Muñoz JP, Marron EM. Transcranial direct current stimulation in neglect rehabilitation after stroke: a systematic review. J Neurol 2022; 269:6310-6329. [PMID: 36138161 PMCID: PMC9618519 DOI: 10.1007/s00415-022-11338-x] [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: 05/09/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/22/2022]
Abstract
Hemispatial neglect is one of the most frequent attention disorders after stroke. The presence of neglect is associated with longer hospital stays, extended rehabilitation periods, and poorer functional recovery. Transcranial direct current stimulation (tDCS) is a new technique with promising results in neglect rehabilitation; therefore, the objective of this systematic review, performed following the PRISMA guidelines, is to evaluate the effectiveness of tDCS on neglect recovery after stroke. The search was done in MEDLINE (PubMed), Web of Science, Scopus, Cochrane Library, and BioMed Central databases. A total of 311 articles were found; only 11 met the inclusion criteria, including 152 post-stroke patients in total. Methodological quality and risk of bias were assessed for all the studies, and methodological characteristics of the studies, sample sizes, methods, main results, and other relevant data were extracted. tDCS intervention ranged from one to twenty sessions distributed in 1 day to 4 weeks, with intensity ranged from 1 to 2 mA. We found moderate evidence for the efficacy of tDCS in the rehabilitation of hemispatial neglect after a stroke, being more effective in combination with other interventions. Nonetheless, the limited number of studies and some studies' design characteristics makes it risky to draw categorical conclusions. Since scientific evidence is still scarce, further research is needed to determine the advantage of this treatment in acute, sub-acute and chronic stroke patients. Future studies should include larger samples, longer follow-ups, and broader neurophysiological assessments, with the final aim of establishing the appropriate use of tDCS as an adjuvant intervention in neurorehabilitation settings.
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Affiliation(s)
- B González-Rodriguez
- Brain Damage Unit, Beata María Ana Hospital, Madrid, Spain.,Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | - N Serradell-Ribé
- Faculty of Health Sciences, Cognitive NeuroLab, Universitat Oberta de Catalunya, Madrid, Barcelona, Spain
| | - R Viejo-Sobera
- Faculty of Health Sciences, Cognitive NeuroLab, Universitat Oberta de Catalunya, Madrid, Barcelona, Spain
| | - J P Romero-Muñoz
- Brain Damage Unit, Beata María Ana Hospital, Madrid, Spain.,Faculty of Experimental Sciences, Universidad Francisco de Vitoria, Madrid, Spain
| | - Elena M Marron
- Faculty of Health Sciences, Cognitive NeuroLab, Universitat Oberta de Catalunya, Madrid, Barcelona, Spain.
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80 Hz but not 40 Hz, transcranial alternating current stimulation of 80 Hz over right intraparietal sulcus increases visuospatial working memory capacity. Sci Rep 2022; 12:13762. [PMID: 35962011 PMCID: PMC9374770 DOI: 10.1038/s41598-022-17965-8] [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: 05/07/2022] [Accepted: 08/03/2022] [Indexed: 11/08/2022] Open
Abstract
Working memory (WM) is a complex cognitive function involved in the temporary storage and manipulation of information, which has been one of the target cognitive functions to be restored in neurorehabilitation. WM capacity is known to be proportional to the number of gamma cycles nested in a single theta cycle. Therefore, gamma-band transcranial alternating current stimulation (tACS) should be dependent of the stimulation frequency; however, the results of previous studies that employed 40 Hz tACS have not been consistent. The optimal locations and injection currents of multiple scalp electrodes were determined based on numerical simulations of electric field. Experiments were conducted with 20 healthy participants. The order of three stimulation conditions (40 Hz tACS, 80 Hz tACS, and sham stimulation) were randomized but counterbalanced. Visual hemifield-specific visual WM capacity was assessed using a delayed visual match to the sample task. High gamma tACS significantly increased WM capacity, while low gamma tACS had no significant effect. Notably, 80 Hz tACS increased WM capacity on both the left and right visual hemifields, while previous tACS studies only reported the effects of tACS on contralateral hemifields. This is the first study to investigate the frequency-dependent effect of gamma-band tACS on WM capacity. Our findings also suggest that high gamma tACS might influence not only WM capacity but also communication between interhemispheric cortical regions. It is expected that high gamma tACS could be a promising neurorehabilitation method to enhance higher-order cognitive functions with similar mechanisms.
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Moretti J, Marinovic W, Harvey AR, Rodger J, Visser TAW. Offline Parietal Intermittent Theta Burst Stimulation or Alpha Frequency Transcranial Alternating Current Stimulation Has No Effect on Visuospatial or Temporal Attention. Front Neurosci 2022; 16:903977. [PMID: 35774555 PMCID: PMC9237453 DOI: 10.3389/fnins.2022.903977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Abstract
Non-invasive brain stimulation is a growing field with potentially wide-ranging clinical and basic science applications due to its ability to transiently and safely change brain excitability. In this study we include two types of stimulation: repetitive transcranial magnetic stimulation (rTMS) and transcranial alternating current stimulation (tACS). Single session stimulations with either technique have previously been reported to induce changes in attention. To better understand and compare the effectiveness of each technique and the basis of their effects on cognition we assessed changes to both temporal and visuospatial attention using an attentional blink task and a line bisection task following offline stimulation with an intermittent theta burst (iTBS) rTMS protocol or 10 Hz tACS. Additionally, we included a novel rTMS stimulation technique, low-intensity (LI-)rTMS, also using an iTBS protocol, which uses stimulation intensities an order of magnitude below conventional rTMS. Animal models show that low-intensity rTMS modulates cortical excitability despite sub-action potential threshold stimulation. Stimulation was delivered in healthy participants over the right posterior parietal cortex (rPPC) using a within-subjects design (n = 24). Analyses showed no evidence for an effect of any stimulation technique on spatial biases in the line bisection task or on magnitude of the attentional blink. Our results suggests that rTMS and LI-rTMS using iTBS protocol and 10 Hz tACS over rPPC do not modulate performance in tasks assessing visuospatial or temporal attention.
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Affiliation(s)
- Jessica Moretti
- School of Biological Sciences, The University of Western Australia, Perth, WA, Australia
- Perron Institute for Neurological and Translational Science, Perth, WA, Australia
| | - Welber Marinovic
- School of Population Health, Curtin University, Perth, WA, Australia
| | - Alan R. Harvey
- Perron Institute for Neurological and Translational Science, Perth, WA, Australia
- School of Human Sciences, The University of Western Australia, Perth, WA, Australia
- Lions Eye Institute, Perth, WA, Australia
| | - Jennifer Rodger
- School of Biological Sciences, The University of Western Australia, Perth, WA, Australia
- Perron Institute for Neurological and Translational Science, Perth, WA, Australia
| | - Troy A. W. Visser
- School of Psychological Science, The University of Western Australia, Perth, WA, Australia
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da Silva TR, de Carvalho Nunes HR, Martins LG, da Costa RDM, de Souza JT, Winckler FC, Sartor LCA, Modolo GP, Ferreira NC, da Silva Rodrigues JC, Kanda R, Fogarolli MO, Borges GF, Rizzatti GRS, Ribeiro PW, Favoretto DB, Aguiar L, Zanati Bazan SG, Betting LEG, de Oliveira Antunes LC, Mendes Pereira V, Santos TEG, Pontes-Neto O, Conforto AB, Bazan R, Luvizutto GJ. Brain stimulation can reduce unilateral spatial neglect after stroke: ELETRON trial. Ann Neurol 2022; 92:400-410. [PMID: 35688801 DOI: 10.1002/ana.26430] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 06/04/2022] [Accepted: 06/06/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Rehabilitation top-down techniques based on brain stimulation present variable outcomes in unilateral spatial neglect (USN) after stroke. This study aimed to examine the effects of physical therapy after anodal and cathodal direct current stimulation (A-tDCS and C-tDCS, respectively) to improve visuospatial and functional impairments in individuals with USN after stroke. METHODS This double-blinded, pilot randomized clinical trial enrolled patients with USN after ischemic stroke. Randomization was stratified according to Behavior Inattention Test Conventional (BIT-C) and Catherine Bergego Scale (CBS). Outpatient physical therapy was conducted for 7.5 weeks after 20 min of tDCS. The primary outcome was the USN degree evaluated by the BIT-C. Secondary outcomes were the difference in CBS score, stroke severity [National Institutes of Health Stroke Scale (NIHSS)], disability [modified Rankin Scale (mRS)], autonomy [Barthel Index (BI), functional independence measure (FIM)], and quality of life (EQ-5D). Outcomes were analyzed using ANCOVA model corrected by age, baseline NIHSS and baseline BIT-C. Pairwise posthoc comparisons were performed using Bonferroni correction. RESULTS In the primary outcomes, A-tDCS led to greater improvement in BIT-C after intervention (MD: 18.4; 95%CI: 3.9-32.8; p=0.008) compared to sham. However, no significant differences were observed between A-tDCS and C-tDCS (MD: 13.9; 95%CI: -0.3-28.1; p=0.057), or C-tDCS and sham (MD: 4.5; 95%CI: -9.7-18.8; p=0.99). There were no significant differences between groups in terms of secondary outcomes. CONCLUSIONS A-tDCS associated with physical therapy can decrease the severity of USN after stroke. However, these preliminary findings must be confirmed by collecting additional evidence in a larger phase III trial. REGISTRATION URL: https://ensaiosclinicos.gov.br/; Unique Identifier RBR-78jvzx This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Rafael Kanda
- Department of Neurology, Psychology and Psychiatry at Botucatu Medical School (UNESP)
| | | | | | | | | | - Diandra B Favoretto
- Department of Neurosciences and Behavioural Sciences, Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Luan Aguiar
- Department of Neurosciences and Behavioural Sciences, Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | | | | | | | - Taiza E Grespan Santos
- Department of Neurosciences and Behavioural Sciences, Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Octávio Pontes-Neto
- Department of Neurosciences and Behavioural Sciences, Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Adriana Bastos Conforto
- Hospital das Clínicas São Paulo University and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Rodrigo Bazan
- Department of Neurology, Psychology and Psychiatry at Botucatu Medical School (UNESP)
| | - Gustavo José Luvizutto
- Department of Applied Physical Therapy, Federal University of Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
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12
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Olgiati E, Malhotra PA. Using non-invasive transcranial direct current stimulation for neglect and associated attentional deficits following stroke. Neuropsychol Rehabil 2022; 32:732-763. [PMID: 32892712 DOI: 10.1080/09602011.2020.1805335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Neglect is a disabling neuropsychological syndrome that is frequently observed following right-hemispheric stroke. Affected individuals often present with multiple attentional deficits, ranging from reduced orienting towards contralesional space to a generalized impairment in maintaining attention over time. Although a degree of spontaneous recovery occurs in most patients, in some individuals this condition can be treatment-resistant with prominent ongoing non-spatial deficits. Further, there is a large inter-individual variability in response to different therapeutic approaches. Given its potential to alter neuronal excitability and affect neuroplasticity, non-invasive brain stimulation is a promising tool that could potentially be utilized to facilitate recovery. However, there are many outstanding questions regarding its implementation in this heterogeneous patient group. Here we provide a critical overview of the available evidence on the use of non-invasive electrical brain stimulation, focussing on transcranial direct current stimulation (tDCS), to improve neglect and associated attentional deficits after right-hemispheric stroke. At present, there is insufficient robust evidence supporting the clinical use of tDCS to alleviate symptoms of neglect. Future research would benefit from careful study design, enhanced precision of electrical montages, multi-modal approaches exploring predictors of response, tailored dose-control applications and increased efforts to evaluate standalone tDCS versus its incorporation into combination therapy.
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Affiliation(s)
- Elena Olgiati
- Department of Brain Sciences, Imperial College London, London, UK.,Imperial College Healthcare NHS Trust, London, UK
| | - Paresh A Malhotra
- Department of Brain Sciences, Imperial College London, London, UK.,Imperial College Healthcare NHS Trust, London, UK.,UK Dementia Research Institute, Care Research & Technology Centre, Imperial College London and University of Surrey, London, UK
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13
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Gorsler A, Grittner U, Rackoll T, Külzow N. Efficacy of Unilateral and Bilateral Parietal Transcranial Direct Current Stimulation on Right Hemispheric Stroke Patients With Neglect Symptoms: A Proof-of-Principle Study. BRAIN & NEUROREHABILITATION 2022; 15:e19. [PMID: 36743202 PMCID: PMC9833469 DOI: 10.12786/bn.2022.15.e19] [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: 01/21/2022] [Revised: 04/02/2022] [Accepted: 04/10/2022] [Indexed: 11/08/2022] Open
Abstract
Different transcranial direct current stimulation (tDCS) protocols have been tested to improve visuospatial neglect (VSN). So far, methodological heterogenity limits reliable conclusions about optimal stimualtion set-up. With this proof-of-principle study behavioral effects of two promising (uni- vs. bilateral) stimulation protocols were directly compared to gain more data for an appropriate tDCS protocol in subacute neglect patients. Notably, each tDCS set-up was combined with an identical sham condition to improve comparability. In a double-blind sham-controlled cross-over study 11 subacute post-stroke neglect patients received 20 minutes or 30 seconds (sham) tDCS (2 mA, 0.8 A/m2) parallel to neglect therapy randomized in unilateral (anode-reference: P4-Fp2 10-20 electroencephalography [EEG] system) and bilateral manner (anode-cathode: P4-P3) and 48h wash-out in-between. Before and immediately after stimulation performance were measured in cancellation task (bell test), and line bisection (deviation error). Significant difference between active and assigned sham condition was found in line bisection but not cancellation task. Particularly, deviation error was reduced after bilateral tDCS (hedges g* = 0.6) compared to bilateral sham, no such advantage were obtained for unilateral stimulation (hedges g* = 0.2). Using a direct comparison approach findings add further evidence that stimulating both hemispheres (bilateral) is superior in alleviating VSN symptoms than unilateral stimulation in subacute neglect.
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Affiliation(s)
- Anna Gorsler
- Kliniken Beelitz GmbH, Clinic for Neurological Rehabilitation, Beelitz-Heilstätten, Germany
| | - Ulrike Grittner
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Torsten Rackoll
- BIH-QUEST Center for Responsible Research, Charité-Universitätsmedizin, Berlin, Berlin, Germany
| | - Nadine Külzow
- Kliniken Beelitz GmbH, Clinic for Neurological Rehabilitation, Beelitz-Heilstätten, Germany
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14
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Arshad Q, Saman Y, Sharif M, Kaski D, Staab JP. Magnitude Estimates Orchestrate Hierarchal Construction of Context-Dependent Representational Maps for Vestibular Space and Time: Theoretical Implications for Functional Dizziness. Front Integr Neurosci 2022; 15:806940. [PMID: 35185485 PMCID: PMC8855482 DOI: 10.3389/fnint.2021.806940] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/20/2021] [Indexed: 12/24/2022] Open
Abstract
Maintaining balance necessitates an accurate perceptual map of the external world. Neuro-physiological mechanisms of locomotor control, sensory perception, and anxiety systems have been viewed as separate entities that can on occasion affect each other (i.e., walking on ice). Emerging models are more integrated, that envision sensory perception and threat assessment as a fundamental component of balance. Here we present an empirically based theoretical argument that vestibular cortical areas construct magnitude estimates of our environment via neural integration of incoming sensory signals. In turn, these cortically derived magnitude estimates, construct context-dependent vestibulo-spatial and vestibulo-temporal, representational maps of the external world, and ensure an appropriate online scaling factor for associated action-perceptual risk. Thus, threat signals are able to exert continuous influence on planning movements, predicting outcomes of motion of self and surrounding objects, and adjusting tolerances for discrepancies between predicted and actual estimates. Such a process affects the degree of conscious attention directed to spatial and temporal aspects of motion stimuli, implying that maintaining balance may follow a Bayesian approach in which the relative weighting of vestibulo-spatial and vestibulo-temporal signals and tolerance for discrepancies are adjusted in accordance with the level of threat assessment. Here, we seek to mechanistically explain this process with our novel empirical concept of a Brainstem Cortical Scaling Metric (BCSM), which we developed from a series of neurophysiological studies illustrating the central role of interhemispheric vestibulo-cortical asymmetries for balance control. We conclude by using the BCSM to derive theoretical predictions of how a dysfunctional BCSM can mechanistically account for functional dizziness.
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Affiliation(s)
- Qadeer Arshad
- Neuro-Otology Unit, Department of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, London, United Kingdom
- inAmind Laboratory, Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, United Kingdom
- Department of Clinical and Motor Neurosciences, Institute of Neurology, University College London, London, United Kingdom
| | - Yougan Saman
- inAmind Laboratory, Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, United Kingdom
| | - Mishaal Sharif
- inAmind Laboratory, Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, United Kingdom
| | - Diego Kaski
- Department of Clinical and Motor Neurosciences, Institute of Neurology, University College London, London, United Kingdom
| | - Jeffrey P. Staab
- Departments of Psychiatry and Psychology and Otorhinolaryngology – Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States
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15
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Diana L, Scotti G, Aiello EN, Pilastro P, Eberhard-Moscicka AK, Müri RM, Bolognini N. Conventional and HD-tDCS May (or May Not) Modulate Overt Attentional Orienting: An Integrated Spatio-Temporal Approach and Methodological Reflections. Brain Sci 2021; 12:brainsci12010071. [PMID: 35053814 PMCID: PMC8773815 DOI: 10.3390/brainsci12010071] [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: 11/08/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 11/16/2022] Open
Abstract
Transcranial Direct Current Stimulation (tDCS) has been employed to modulate visuo-spatial attentional asymmetries, however, further investigation is needed to characterize tDCS-associated variability in more ecological settings. In the present research, we tested the effects of offline, anodal conventional tDCS (Experiment 1) and HD-tDCS (Experiment 2) delivered over the posterior parietal cortex (PPC) and Frontal Eye Field (FEF) of the right hemisphere in healthy participants. Attentional asymmetries were measured by means of an eye tracking-based, ecological paradigm, that is, a Free Visual Exploration task of naturalistic pictures. Data were analyzed from a spatiotemporal perspective. In Experiment 1, a pre-post linear mixed model (LMM) indicated a leftward attentional shift after PPC tDCS; this effect was not confirmed when the individual baseline performance was considered. In Experiment 2, FEF HD-tDCS was shown to induce a significant leftward shift of gaze position, which emerged after 6 s of picture exploration and lasted for 200 ms. The present results do not allow us to conclude on a clear efficacy of offline conventional tDCS and HD-tDCS in modulating overt visuospatial attention in an ecological setting. Nonetheless, our findings highlight a complex relationship among stimulated area, focality of stimulation, spatiotemporal aspects of deployment of attention, and the role of individual baseline performance in shaping the effects of tDCS.
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Affiliation(s)
- Lorenzo Diana
- Ph.D. Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy;
- Correspondence:
| | - Giulia Scotti
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy; (G.S.); (P.P.)
| | - Edoardo N. Aiello
- Ph.D. Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy;
| | - Patrick Pilastro
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy; (G.S.); (P.P.)
| | - Aleksandra K. Eberhard-Moscicka
- Perception and Eye Movement Laboratory, Departments of Neurology and BioMedical Research, Bern University Hospital Inselspital, University of Bern, 3010 Bern, Switzerland; (A.K.E.-M.); (R.M.M.)
- Department of Neurology, Bern University Hospital Inselspital, University of Bern, 3010 Bern, Switzerland
| | - René M. Müri
- Perception and Eye Movement Laboratory, Departments of Neurology and BioMedical Research, Bern University Hospital Inselspital, University of Bern, 3010 Bern, Switzerland; (A.K.E.-M.); (R.M.M.)
- Department of Neurology, Bern University Hospital Inselspital, University of Bern, 3010 Bern, Switzerland
| | - Nadia Bolognini
- Department of Psychology & Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, 20126 Milan, Italy;
- Laboratory of Neuropsychology, Istituto Auxologico Italiano, IRCCS, 20122 Milan, Italy
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16
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Miraglia F, Vecchio F, Pellicciari MC, Cespon J, Rossini PM. Brain Networks Modulation in Young and Old Subjects During Transcranial Direct Current Stimulation Applied on Prefrontal and Parietal Cortex. Int J Neural Syst 2021; 32:2150056. [PMID: 34651550 DOI: 10.1142/s0129065721500568] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Evidence indicates that the transcranial direct current stimulation (tDCS) has the potential to transiently modulate cognitive function, including age-related changes in brain performance. Only a small number of studies have explored the interaction between the stimulation sites on the scalp, task performance, and brain network connectivity within the frame of physiological aging. We aimed to evaluate the spread of brain activation in both young and older adults in response to anodal tDCS applied to two different scalp stimulation sites: Prefrontal cortex (PFC) and posterior parietal cortex (PPC). EEG data were recorded during tDCS stimulation and evaluated using the Small World (SW) index as a graph theory metric. Before and after tDCS, participants performed a behavioral task; a performance accuracy index was computed and correlated with the SW index. Results showed that the SW index increased during tDCS of the PPC compared to the PFC at higher EEG frequencies only in young participants. tDCS at the PPC site did not exert significant effects on the performance, while tDCS at the PFC site appeared to influence task reaction times in the same direction in both young and older participants. In conclusion, studies using tDCS to modulate functional connectivity and influence behavior can help identify suitable protocols for the aging brain.
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Affiliation(s)
- Francesca Miraglia
- Brain Connectivity Laboratory, Department of Neuroscience and Neurorehabilitation, IRCCS San Raffaele Roma Rome, Italy
| | - Fabrizio Vecchio
- Brain Connectivity Laboratory, Department of Neuroscience and Neurorehabilitation, IRCCS San Raffaele Roma Rome, Italy.,eCampus University, Novedrate (Como), Italy
| | | | - Jesus Cespon
- Basque Center on Cognition, Brain and Language, San Sebastian, Spain
| | - Paolo Maria Rossini
- Brain Connectivity Laboratory, Department of Neuroscience and Neurorehabilitation, IRCCS San Raffaele Roma Rome, Italy
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17
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Montoro CI, Winterholler C, Terrasa JL, Montoya P. Somatosensory Gating Is Modulated by Anodal Transcranial Direct Current Stimulation. Front Neurosci 2021; 15:651253. [PMID: 34557064 PMCID: PMC8452934 DOI: 10.3389/fnins.2021.651253] [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: 01/09/2021] [Accepted: 08/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background Anodal transcranial direct current stimulation (tDCS) of the somatosensory cortex causes cerebral hyperexcitability and a significant enhancement in pain thresholds and tactile spatial acuity. Sensory gating is a brain mechanism to suppress irrelevant incoming inputs, which is elicited by presenting pairs of identical stimuli (S1 and S2) within short time intervals between stimuli (e.g., 500 ms). Objectives/Hypothesis The present study addressed the question of whether tDCS could modulate the brain correlates of this inhibitory mechanism. Methods Forty-one healthy individuals aged 18–26 years participated in the study and were randomly assigned to tDCS (n = 21) or SHAM (n = 20). Somatosensory evoked potentials (SEP) elicited by S1 and S2 pneumatic stimuli (duration of 100 ms, ISI 550 ± 50 ms) and applied to the index finger of the dominant hand were recorded before and after tDCS. Results Before the intervention, the second tactile stimuli significantly attenuated the amplitudes of P50, N100, and the late positive complex (LPC, mean amplitude in the time window 150–350) compared to the first stimuli. This confirmed that sensory gating is a widespread brain inhibitory mechanism that can affect early- and middle-latency components of SEPs. Furthermore, our data revealed that this response attenuation or sensory gating (computed as S1 minus S2) was improved after tDCS for LPC, while no changes were found in participants who received SHAM. Conclusion All these findings suggested that anodal tDCS might modulate brain excitability leading to an enhancement of inhibitory mechanisms elicited in response to repetitive somatosensory stimuli during late stages of information processing.
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Affiliation(s)
- Casandra I Montoro
- Research Institute of Health Sciences (IUNICS), Balearic Islands Health Research Institute (IdISBa), University of the Balearic Islands (UIB), Palma, Spain
| | - Christine Winterholler
- Research Institute of Health Sciences (IUNICS), Balearic Islands Health Research Institute (IdISBa), University of the Balearic Islands (UIB), Palma, Spain
| | - Juan L Terrasa
- Research Institute of Health Sciences (IUNICS), Balearic Islands Health Research Institute (IdISBa), University of the Balearic Islands (UIB), Palma, Spain
| | - Pedro Montoya
- Research Institute of Health Sciences (IUNICS), Balearic Islands Health Research Institute (IdISBa), University of the Balearic Islands (UIB), Palma, Spain
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18
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Ofir-Geva S, Serfaty C, Sacher Y, Soroker N. Unilateral Spatial Neglect without Hemiplegia: The Output-Mode Effect Revisited. J Stroke Cerebrovasc Dis 2021; 30:105777. [PMID: 33957604 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105777] [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: 09/20/2020] [Revised: 03/05/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND The occurrence of unilateral spatial neglect (USN) in non-hemiplegic right-hemisphere damaged patients is rare. Earlier studies of such patients revealed a significant advantage when typical neglect tests were performed by the patient's left hand as compared to the dominant right hand. The mechanism underlying this "output-mode effect" remains elusive. METHODS We analyzed the temporal dynamics of this effect using line-bisection task in 9 non-hemiplegic stroke patients with left-USN. RESULTS In 4 patients tested shortly after stroke onset (≤ 6 weeks), the impact of hand laterality was variable (left-hand advantage in one patient; right-hand advantage in 2 patients; similar performance in both hands in one patient). Only later (> 6 weeks) a clear advantage of the left hand emerged in the majority of patients, similar to the earlier reports which were all based on late testing. CONCLUSIONS We found variable dynamics in the expression of the output-mode effect in the first weeks following stroke onset, which may reflect changes of inter-hemispheric balance, related to recovery processes. We propose that therapeutic interventions aiming to manipulate the inter-hemispheric balance (e.g., by non-invasive brain stimulation) take into account the existence of such dynamics and their highly variate nature.
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Affiliation(s)
- Shay Ofir-Geva
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Medical Center, 278 Ahuza, Raanana 4355840, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Corinne Serfaty
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Medical Center, 278 Ahuza, Raanana 4355840, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Yaron Sacher
- Department of Traumatic Brain Injury Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana 4355840, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Nachum Soroker
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Medical Center, 278 Ahuza, Raanana 4355840, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
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19
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Wang T, Peeters R, Mantini D, Gillebert CR. Modulating the interhemispheric activity balance in the intraparietal sulcus using real-time fMRI neurofeedback: Development and proof-of-concept. NEUROIMAGE-CLINICAL 2021; 28:102513. [PMID: 33396000 PMCID: PMC7941162 DOI: 10.1016/j.nicl.2020.102513] [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: 06/30/2020] [Revised: 10/15/2020] [Accepted: 11/20/2020] [Indexed: 10/31/2022]
Abstract
The intraparietal sulcus (IPS) plays a key role in the distribution of attention across the visual field. In stroke patients, an imbalance between left and right IPS activity has been related to a spatial bias in visual attention characteristic of hemispatial neglect. In this study, we describe the development and implementation of a real-time functional magnetic resonance imaging neurofeedback protocol to noninvasively and volitionally control the interhemispheric IPS activity balance in neurologically healthy participants. Six participants performed three neurofeedback training sessions across three weeks. Half of them trained to voluntarily increase brain activity in left relative to right IPS, while the other half trained to regulate the IPS activity balance in the opposite direction. Before and after the training, we estimated the distribution of attention across the visual field using a whole and partial report task. Over the course of the training, two of the three participants in the left-IPS group increased the activity in the left relative to the right IPS, while the participants in the right-IPS group were not able to regulate the interhemispheric IPS activity balance. We found no evidence for a decrease in resting-state functional connectivity between left and right IPS, and the spatial distribution of attention did not change over the course of the experiment. This study indicates the possibility to voluntarily modulate the interhemispheric IPS activity balance. Further research is warranted to examine the effectiveness of this technique in the rehabilitation of post-stroke hemispatial neglect.
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Affiliation(s)
- Tianlu Wang
- Brain and Cognition, KU Leuven, Leuven, Belgium; Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Ronald Peeters
- Radiology Department, University Hospitals Leuven, Leuven, Belgium
| | - Dante Mantini
- Research Centre for Motor Control and Neuroplasticity, KU Leuven, Leuven, Belgium; Brain Imaging and Neural Dynamics Research Group, IRCCS San Camillo Hospital, Venice, Italy
| | - Céline R Gillebert
- Brain and Cognition, KU Leuven, Leuven, Belgium; Leuven Brain Institute, KU Leuven, Leuven, Belgium.
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20
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Boetzel C, Herrmann CS. Potential targets for the treatment of ADHD using transcranial electrical current stimulation. PROGRESS IN BRAIN RESEARCH 2021; 264:151-170. [PMID: 34167654 DOI: 10.1016/bs.pbr.2021.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) is a psychiatric disease with a prevalence of 2%-7.5% among the population. It is characterized by three core symptoms: hyperactivity, impulsivity, and inattention. Although the majority of ADHD patients respond to a combination of psychotherapy and standard pharmacotherapy with Methylphenidate, there is a significant minority of patients that do not respond to these substances. Additionally, the treatment with Methylphenidate can cause a variety of side effects like insomnia, headache, decreased appetite, and xerostomia. It would be favorable to have an alternative treatment-option that could circumnavigate the shortcomings of traditional pharmacological treatments. Recent results show that transcranial electrical stimulation (tES) might offer a promising approach. Since research has shown that ADHD is associated with various alterations in brain activity, brain stimulation methods targeting different facets of neuronal functions are currently under investigation. In this article, we briefly review different tES techniques like transcranial random noise stimulation (tRNS), transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS) and explain the modes of action of these brain stimulations. We will specifically focus on transcranial alternating current stimulation (tACS) as a potential method of treating ADHD.
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Affiliation(s)
- Cindy Boetzel
- Experimental Psychology Lab, Department of Psychology, European Medical School, Cluster of Excellence "Hearing for All," Carl von Ossietzky University, Oldenburg, Germany
| | - Christoph S Herrmann
- Experimental Psychology Lab, Department of Psychology, European Medical School, Cluster of Excellence "Hearing for All," Carl von Ossietzky University, Oldenburg, Germany; Neuroimaging Unit, European Medical School, Carl von Ossietzky University, Oldenburg, Germany; Research Center Neurosensory Science, Carl von Ossietzky University, Oldenburg, Germany.
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21
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Terruzzi S, Crivelli D, Pisoni A, Mattavelli G, Romero Lauro LJ, Bolognini N, Vallar G. The role of the right posterior parietal cortex in prism adaptation and its aftereffects. Neuropsychologia 2020; 150:107672. [PMID: 33188788 DOI: 10.1016/j.neuropsychologia.2020.107672] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 06/26/2020] [Accepted: 11/04/2020] [Indexed: 11/28/2022]
Abstract
Adaptation to optical prisms (Prismatic Adaptation, PA) displacing the visual scene laterally, on one side of visual space, is both a procedure for investigating visuo-motor plasticity and a powerful tool for the rehabilitation of Unilateral Spatial Neglect (USN). Two processes are involved in PA: i) recalibration (the reduction of the error of manual pointings toward the direction of the prism-induced displacement of the visual scene); ii) the successive realignment after prisms' removal, indexed by the Aftereffects (AEs, in egocentric straight-ahead pointing tasks, the deviation in a direction opposite to the visual displacement previously induced by prisms). This study investigated the role of the posterior parietal cortex (PPC) of the right hemisphere in PA and AEs, by means of low frequency repetitive Transcranial Magnetic Stimulation (rTMS). Proprioceptive and Visuo-proprioceptive egocentric straight-ahead pointing tasks were used to assess the presence and magnitude of AEs. The primary right visual cortex (V1) was also stimulated, to assess the selectivity of the PPC effects on the two processes of PA (recalibration and realignment) in comparison with a cortical region involved in visual processing. Results showed a slower adaptation to prisms when rTMS was delivered before PA, regardless of target site (right PPC or V1). AEs were reduced only by PPC rTMS applied before or after PA, as compared to a sham stimulation. These findings suggest a functional and neural dissociation between realignment and recalibration. Indeed, PA interference was induced by rTMS to both the PPC and V1, indicating that recalibration is supported by a parieto-occipital network. Conversely, AEs were disrupted only by rTMS delivered to the PPC, thus unveiling a relevant role of this region in the development and maintenance of the realignment.
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Affiliation(s)
- Stefano Terruzzi
- Department of Psychology, University of Milano-Bicocca, Milan, Italy; CeRiN, Unversity of Trento, Rovereto, Italy.
| | - Damiano Crivelli
- Department of Psychology, University of Milano-Bicocca, Milan, Italy; Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Alberto Pisoni
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | | | | | - Nadia Bolognini
- Department of Psychology, University of Milano-Bicocca, Milan, Italy; Neuropsychological Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Giuseppe Vallar
- Department of Psychology, University of Milano-Bicocca, Milan, Italy; Neuropsychological Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy.
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22
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Nydam AS, Sewell DK, Dux PE. Effects of tDCS on visual statistical learning. Neuropsychologia 2020; 148:107652. [PMID: 33069791 DOI: 10.1016/j.neuropsychologia.2020.107652] [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: 04/03/2020] [Revised: 09/25/2020] [Accepted: 10/03/2020] [Indexed: 11/25/2022]
Abstract
Visual statistical learning describes the encoding of structure in sensory input, and it has important consequences for cognition and behaviour. Higher-order brain regions in the prefrontal and posterior parietal cortices have been associated with statistical learning behaviours. Yet causal evidence of a cortical contribution remains limited. In a recent study, the modulation of cortical activity by transcranial direct current stimulation (tDCS) disrupted statistical learning in a spatial contextual cueing phenomenon; supporting a cortical role. Here, we examined whether the same tDCS protocol would influence statistical learning assessed by the Visual Statistical Learning phenomenon (i.e., Fiser and Aslin, 2001), which uses identity-based regularities while controlling for spatial location. In Experiment 1, we employed the popular exposure-test design to tap the learning of structure after passive viewing. Using a large sample (N = 150), we found no effect of the tDCS protocol when compared to a sham control nor to an active control region. In Experiment 2 (N = 80), we developed an online task that was sensitive to the timecourse of learning. Under these task conditions, we did observe a stimulation effect on learning, consistent with the previous work. The way tDCS affected learning appeared to be task-specific; expediting statistical learning in this case. Together with the existing evidence, these findings support the hypothesis that cortical areas are involved in the visual statistical learning process, and suggest the mechanisms of cortical involvement may be task-dependent and dynamic across time.
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Affiliation(s)
- Abbey S Nydam
- School of Psychology, The University of Queensland, Brisbane, Australia.
| | - David K Sewell
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Paul E Dux
- School of Psychology, The University of Queensland, Brisbane, Australia
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23
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Asymmetric Contributions of the Fronto-Parietal Network to Emotional Conflict in the Word–Face Interference Task. Symmetry (Basel) 2020. [DOI: 10.3390/sym12101701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The fronto-parietal network is involved in top-down and bottom-up processes necessary to achieve cognitive control. We investigated the role of asymmetric enhancement of the left dorsolateral prefrontal cortex (lDLPFC) and right posterior parietal cortex (rPPC) in cognitive control under conditions of emotional conflict arising from emotional distractors. The effects of anodal tDCS over the lDLPFC/cathodal over the rPPC and the effects of anodal tDCS over the rPPC/cathodal over the lDLPFC were compared to sham tDCS in a double-blind design. The findings showed that anodal stimulation over the lDLPFC reduced interference from emotional distractors, but only when participants had already gained experience with the task. In contrast, having already performed the task only eliminated facilitation effects for positive stimuli. Importantly, anodal stimulation of the rPPC did not affect distractors’ interference. Therefore, the present findings indicate that the lDLPFC plays a crucial role in implementing top-down control to resolve emotional conflict, but that experience with the task is necessary to reveal this role.
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24
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Mengotti P, Käsbauer AS, Fink GR, Vossel S. Lateralization, functional specialization, and dysfunction of attentional networks. Cortex 2020; 132:206-222. [PMID: 32998061 DOI: 10.1016/j.cortex.2020.08.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 04/20/2020] [Accepted: 08/31/2020] [Indexed: 12/11/2022]
Abstract
The present review covers the latest findings on the lateralization of the dorsal and ventral attention systems, their functional specialization, and their clinical relevance for stroke-induced attentional dysfunction. First, the original assumption of a bilateral dorsal system for top-down attention and a right-lateralized ventral system for stimulus-driven attention is critically reviewed. The evidence for the involvement of the left parietal cortex in attentional functions is discussed and findings on putative pathways linking the dorsal and ventral network are presented. In the second part of the review, we focus on the different attentional subsystems and their lateralization, discussing the differences between spatial, feature- and object-based attention, and motor attention. We also review studies based on predictive coding frameworks of attentional functions. Finally, in the third section, we provide an overview of the consequences of specific disruption within the attention networks after stroke. The role of the interhemispheric (im)balance is discussed, and the results of new promising therapeutic approaches employing brain stimulation techniques such as transcranial magnetic stimulation (TMS) or transcranial direct current stimulation (tDCS) are presented.
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Affiliation(s)
- Paola Mengotti
- Cognitive Neuroscience, Institute of Neuroscience & Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany.
| | - Anne-Sophie Käsbauer
- Cognitive Neuroscience, Institute of Neuroscience & Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany
| | - Gereon R Fink
- Cognitive Neuroscience, Institute of Neuroscience & Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany; Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Simone Vossel
- Cognitive Neuroscience, Institute of Neuroscience & Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany; Department of Psychology, Faculty of Human Sciences, University of Cologne, Cologne, Germany
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25
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Hensel L, Tscherpel C, Freytag J, Ritter S, Rehme AK, Volz LJ, Eickhoff SB, Fink GR, Grefkes C. Connectivity-Related Roles of Contralesional Brain Regions for Motor Performance Early after Stroke. Cereb Cortex 2020; 31:993-1007. [DOI: 10.1093/cercor/bhaa270] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 08/22/2020] [Accepted: 08/25/2020] [Indexed: 02/07/2023] Open
Abstract
Abstract
Hemiparesis after stroke is associated with increased neural activity not only in the lesioned but also in the contralesional hemisphere. While most studies have focused on the role of contralesional primary motor cortex (M1) activity for motor performance, data on other areas within the unaffected hemisphere are scarce, especially early after stroke. We here combined functional magnetic resonance imaging (fMRI) and transcranial magnetic stimulation (TMS) to elucidate the contribution of contralesional M1, dorsal premotor cortex (dPMC), and anterior intraparietal sulcus (aIPS) for the stroke-affected hand within the first 10 days after stroke. We used “online” TMS to interfere with neural activity at subject-specific fMRI coordinates while recording 3D movement kinematics. Interfering with aIPS activity improved tapping performance in patients, but not healthy controls, suggesting a maladaptive role of this region early poststroke. Analyzing effective connectivity parameters using a Lasso prediction model revealed that behavioral TMS effects were predicted by the coupling of the stimulated aIPS with dPMC and ipsilesional M1. In conclusion, we found a strong link between patterns of frontoparietal connectivity and TMS effects, indicating a detrimental influence of the contralesional aIPS on motor performance early after stroke.
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Affiliation(s)
- Lukas Hensel
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, 50931 Cologne, Germany
| | - Caroline Tscherpel
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, 50931 Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, 52428 Jülich, Germany
| | - Jana Freytag
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, 50931 Cologne, Germany
| | - Stella Ritter
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, 50931 Cologne, Germany
| | - Anne K Rehme
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, 50931 Cologne, Germany
| | - Lukas J Volz
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, 50931 Cologne, Germany
| | - Simon B Eickhoff
- Medical Faculty, Institute of Systems Neuroscience, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
- Brain and Behaviour, Institute of Neuroscience and Medicine, (INM-7), Research Centre Jülich, 52428 Jülich, Germany
| | - Gereon R Fink
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, 50931 Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, 52428 Jülich, Germany
| | - Christian Grefkes
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, 50931 Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, 52428 Jülich, Germany
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26
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Toba MN, Godefroy O, Rushmore RJ, Zavaglia M, Maatoug R, Hilgetag CC, Valero-Cabré A. Revisiting 'brain modes' in a new computational era: approaches for the characterization of brain-behavioural associations. Brain 2020; 143:1088-1098. [PMID: 31764975 DOI: 10.1093/brain/awz343] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 08/07/2019] [Accepted: 08/28/2019] [Indexed: 11/12/2022] Open
Abstract
The study of brain-function relationships is undergoing a conceptual and methodological transformation due to the emergence of network neuroscience and the development of multivariate methods for lesion-deficit inferences. Anticipating this process, in 1998 Godefroy and co-workers conceptualized the potential of four elementary typologies of brain-behaviour relationships named 'brain modes' (unicity, equivalence, association, summation) as building blocks able to describe the association between intact or lesioned brain regions and cognitive processes or neurological deficits. In the light of new multivariate lesion inference and network approaches, we critically revisit and update the original theoretical notion of brain modes, and provide real-life clinical examples that support their existence. To improve the characterization of elementary units of brain-behavioural relationships further, we extend such conceptualization with a fifth brain mode (mutual inhibition/masking summation). We critically assess the ability of these five brain modes to account for any type of brain-function relationship, and discuss past versus future contributions in redefining the anatomical basis of human cognition. We also address the potential of brain modes for predicting the behavioural consequences of lesions and their future role in the design of cognitive neurorehabilitation therapies.
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Affiliation(s)
- Monica N Toba
- Laboratory of Functional Neurosciences (EA 4559), University Hospital of Amiens and University of Picardy Jules Verne, Amiens, France
| | - Olivier Godefroy
- Laboratory of Functional Neurosciences (EA 4559), University Hospital of Amiens and University of Picardy Jules Verne, Amiens, France
| | - R Jarrett Rushmore
- Laboratory of Cerebral Dynamics, Plasticity and Rehabilitation, Boston University School of Medicine, Boston, MA 02118, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Boston, MA, USA
| | - Melissa Zavaglia
- Institute of Computational Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Focus Area Health, Jacobs University Bremen, Germany
| | - Redwan Maatoug
- Cerebral Dynamics, Plasticity and Rehabilitation Group, FRONTLAB Team, Brain and Spine Institute, ICM, Paris, France.,Sorbonne Université, INSERM UMR S 1127, CNRS UMR 7225, F-75013, and IHU-A-ICM, Paris, France
| | - Claus C Hilgetag
- Institute of Computational Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Health Sciences Department, Boston University, 635 Commonwealth Ave. Boston, MA 02215, USA
| | - Antoni Valero-Cabré
- Laboratory of Cerebral Dynamics, Plasticity and Rehabilitation, Boston University School of Medicine, Boston, MA 02118, USA.,Cerebral Dynamics, Plasticity and Rehabilitation Group, FRONTLAB Team, Brain and Spine Institute, ICM, Paris, France.,Sorbonne Université, INSERM UMR S 1127, CNRS UMR 7225, F-75013, and IHU-A-ICM, Paris, France.,Cognitive Neuroscience and Information Technology Research Program, Open University of Catalonia (UOC), Barcelona, Catalunya, Spain
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27
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Learmonth G, Benwell CSY, Märker G, Dascalu D, Checketts M, Santosh C, Barber M, Walters M, Muir KW, Harvey M. Non-invasive brain stimulation in Stroke patients (NIBS): A prospective randomized open blinded end-point (PROBE) feasibility trial using transcranial direct current stimulation (tDCS) in post-stroke hemispatial neglect. Neuropsychol Rehabil 2020; 31:1163-1189. [PMID: 32498606 PMCID: PMC8372288 DOI: 10.1080/09602011.2020.1767161] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Up to 80% of people who experience a right-hemisphere stroke suffer from hemispatial neglect. This syndrome is debilitating and impedes rehabilitation. We carried out a clinical feasibility trial of transcranial direct current stimulation (tDCS) and a behavioural rehabilitation programme, alone or in combination, in patients with neglect. Patients >4 weeks post right hemisphere stroke were randomized to 10 sessions of tDCS, 10 sessions of a behavioural intervention, combined intervention, or a control task. Primary outcomes were recruitment and retention rates, with secondary outcomes effect sizes on measures of neglect and quality of life, assessed directly after the interventions, and at 6 months follow up. Of 288 confirmed stroke cases referred (representing 7% of confirmed strokes), we randomized 8% (0.6% of stroke cases overall). The largest number of exclusions (91/288 (34%)) were due to medical comorbidities that prevented patients from undergoing 10 intervention sessions. We recruited 24 patients over 29 months, with 87% completing immediate post-intervention and 67% 6 month evaluations. We established poor feasibility of a clinical trial requiring repeated hospital-based tDCS within a UK hospital healthcare setting, either with or without behavioural training, over a sustained time period. Future trials should consider intensity, duration and location of tDCS neglect interventions.Trial registration: ClinicalTrials.gov identifier: NCT02401724.
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Affiliation(s)
- Gemma Learmonth
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK.,School of Psychology, University of Glasgow, Glasgow, UK
| | - Christopher S Y Benwell
- School of Psychology, University of Glasgow, Glasgow, UK.,Division of Psychology, School of Social Sciences, University of Dundee, Dundee, UK
| | - Gesine Märker
- School of Psychology, University of Glasgow, Glasgow, UK
| | - Diana Dascalu
- School of Psychology, University of Glasgow, Glasgow, UK
| | - Matthew Checketts
- School of Psychology, University of Glasgow, Glasgow, UK.,Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | | | - Mark Barber
- University Hospital Monklands, Lanarkshire, UK
| | - Matthew Walters
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Keith W Muir
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
| | - Monika Harvey
- School of Psychology, University of Glasgow, Glasgow, UK
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28
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Transcranial Direct Current Stimulation for Motor Recovery Following Brain Injury. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00262-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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29
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Holczer A, Németh VL, Vékony T, Vécsei L, Klivényi P, Must A. Non-invasive Brain Stimulation in Alzheimer's Disease and Mild Cognitive Impairment-A State-of-the-Art Review on Methodological Characteristics and Stimulation Parameters. Front Hum Neurosci 2020; 14:179. [PMID: 32523520 PMCID: PMC7261902 DOI: 10.3389/fnhum.2020.00179] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/21/2020] [Indexed: 12/28/2022] Open
Abstract
Background: Transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) have been proposed as a new therapeutic way to enhance the cognition of patients with dementia. However, serious methodological limitations appear to affect the estimates of their efficacy. We reviewed the stimulation parameters and methods of studies that used TMS or tDCS to alleviate the cognitive symptoms of patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI). Moreover, we evaluated the risk of bias in these studies. Our aim was to highlight the current vulnerabilities of the field and to formulate recommendations on how to manage these issues when designing studies. Methods: Electronic databases and citation searching were used to identify studies administering TMS or tDCS on patients with AD or MCI to enhance cognitive function. Data were extracted by one review author into summary tables with the supervision of the authors. The risk of bias analysis of randomized-controlled trials was conducted by two independent assessors with version 2 of the Cochrane risk-of-bias tool for randomized trials. Results: Overall, 36 trials were identified of which 23 randomized-controlled trials underwent a risk of bias assessment. More than 75% of randomized-controlled trials involved some levels of bias in at least one domain. Stimulation parameters were highly variable with some ranges of effectiveness emerging. Studies with low risk of bias indicated TMS to be potentially effective for patients with AD or MCI while questioned the efficacy of tDCS. Conclusions: The presence and extent of methodical issues affecting TMS and tDCS research involving patients with AD and MCI were examined for the first time. The risk of bias frequently affected the domains of the randomization process and selection of the reported data while missing outcome was rare. Unclear reporting was present involving randomization, allocation concealment, and blinding. Methodological awareness can potentially reduce the high variability of the estimates regarding the effectiveness of TMS and tDCS. Studies with low risk of bias delineate a range within TMS parameters seem to be effective but question the efficacy of tDCS.
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Affiliation(s)
- Adrienn Holczer
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Health Center, University of Szeged, Szeged, Hungary
| | - Viola Luca Németh
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Health Center, University of Szeged, Szeged, Hungary
| | - Teodóra Vékony
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Health Center, University of Szeged, Szeged, Hungary
| | - László Vécsei
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Health Center, University of Szeged, Szeged, Hungary
- MTA-SZTE Neuroscience Research Group, Szeged, Hungary
- Interdisciplinary Centre of Excellence, University of Szeged, Szeged, Hungary
| | - Péter Klivényi
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Health Center, University of Szeged, Szeged, Hungary
| | - Anita Must
- MTA-SZTE Neuroscience Research Group, Szeged, Hungary
- Faculty of Arts, Institute of Psychology, University of Szeged, Szeged, Hungary
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30
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Contingency awareness, aging, and the parietal lobe. Neurobiol Aging 2020; 91:125-135. [PMID: 32241582 DOI: 10.1016/j.neurobiolaging.2020.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 02/21/2020] [Accepted: 02/22/2020] [Indexed: 11/20/2022]
Abstract
Contingency awareness is thought to rely on an intact medial temporal lobe and also appears to be a function of age, as older subjects tend to be less aware. The current investigation used functional magnetic resonance imaging, transcranial direct current stimulation, and eyeblink classical conditioning to study brain processes related to contingency awareness as a function of age. Older adults were significantly less aware of the relationship between the tone-airpuff pairings than younger adults. Greater right parietal functional magnetic resonance imaging activation was associated with higher levels of contingency awareness for younger and older subjects. Cathodal transcranial direct current stimulation over the right parietal lobe led to lower levels of awareness in younger subjects without disrupting conditioned responses. Older adults exhibited hyperactivations in the parietal and medial temporal lobes, despite showing no conditioning deficits. These findings strongly support the idea that the parietal cortex serves as a substrate for contingency awareness and that age-related disruption of this region is sufficient to impair awareness, which may be a manifestation of some form of naturally occurring age-related neglect.
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31
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Wang S, Itthipuripat S, Ku Y. Encoding strategy mediates the effect of electrical stimulation over posterior parietal cortex on visual short-term memory. Cortex 2020; 128:203-217. [PMID: 32361592 DOI: 10.1016/j.cortex.2020.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 02/08/2020] [Accepted: 03/10/2020] [Indexed: 01/20/2023]
Abstract
Over past decades, converging neuroimaging and electrophysiological findings have suggested a crucial role of posterior parietal cortex (PPC) in supporting the storage capacity of visual short-term memory (VSTM). Moreover, a few recent studies have shown that electrical stimulation over PPC can enhance VSTM capacity, making it a promising method for improving VSTM function. However, the reliability of these results is still in question because null findings have also been observed. Among studies that reported significant effects, some found increased VSTM capacity only in people with low capacity. Here, we hypothesized that subjects' encoding strategy might be a key source of these variable results. To directly test this hypothesis, we stimulated PPC using transcranial direct-current stimulation (tDCS) in male and female human subjects instructed to employ different encoding strategies during a VSTM recall task. We found that VSTM capacity was higher in subjects who were instructed to remember all items in the supra-capacity array of visual stimuli (i.e., the remember-all group), compared to subjects who were told to focus on a subset of these stimuli (i.e., the remember-subset group). As predicted, anodal tDCS over PPC significantly enhanced VSTM capacity only in the remember-subset group, but not in the remember-all group. Additionally, no effect of encoding strategy or its interaction with electrical stimulation was found on VSTM precision. Together, these results suggest that encoding strategy has a selective influence on VSTM capacity and this influence of encoding strategy mediates the effect of electrical stimulation over PPC on VSTM function.
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Affiliation(s)
- Sisi Wang
- Guangdong Provincial Key Laboratory of Social Cognitive Neuroscience and Mental Health, Department of Psychology, Sun Yat-Sen University, Guangzhou, China; Peng Cheng Laboratory, Shenzhen, China; Shanghai Key Laboratory of Brain Functional Genomics, Shanghai Changning-ECNU Mental Health Center, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China; Department of Psychology, Vanderbilt University, Nashville, TN, USA.
| | - Sirawaj Itthipuripat
- Department of Psychology, Vanderbilt University, Nashville, TN, USA; Learning Institute, King Mongkut's University of Technology Thonburi, Bangkok, Thailand; Futuristic Research in Enigmatic Aesthetics Knowledge Laboratory, King Mongkut's University of Technology Thonburi, Bangkok, Thailand.
| | - Yixuan Ku
- Guangdong Provincial Key Laboratory of Social Cognitive Neuroscience and Mental Health, Department of Psychology, Sun Yat-Sen University, Guangzhou, China; Peng Cheng Laboratory, Shenzhen, China; Shanghai Key Laboratory of Brain Functional Genomics, Shanghai Changning-ECNU Mental Health Center, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China; NYU-ECNU Institute of Brain and Cognitive Science, NYU Shanghai and Collaborative Innovation Center for Brain Science, Shanghai, China.
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32
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Kleineberg NN, Richter MK, Becker I, Weiss PH, Fink GR. Verum versus sham tDCS in the treatment of stroke-induced apraxia: study protocol of the randomized controlled trial RAdiCS -"Rehabilitating (stroke-induced) Apraxia with direct Current Stimulation". Neurol Res Pract 2020; 2:7. [PMID: 33324913 PMCID: PMC7650086 DOI: 10.1186/s42466-020-0052-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 02/03/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Stroke is the leading cause of acquired disability in western societies. (Motor) cognitive deficits like apraxia significantly contribute to disability after stroke, harming activities of daily living and rehabilitation outcome. To date, efficient therapeutic options for apraxia remain sparse. Thus, randomized controlled trials (RCTs) are warranted. METHODS Based on promising results of a pilot study, the on-going RAdiCS (Rehabilitating stroke-induced Apraxia with direct Current Stimulation) study is a randomized controlled trial, which follows a double-blinded (investigator and patient), two-arm parallel interventional model. It is designed to include 110 apraxic patients (as diagnosed by the Cologne Apraxia Screening, KAS) in the subacute phase after a left hemisphere (LH) stroke. The University of Cologne initiated the trial, which is conducted in two German Neurorehabilitation Centers.The study aims to evaluate the effect of anodal (versus sham) transcranial direct current stimulation (tDCS) applied over the left posterior parietal cortex (PPC) with an intensity of 2 mA for 10 min on five consecutive days on apraxic deficits. In addition to anodal or sham tDCS, all LH stroke patients undergo a motor (cognitive) training that is performed before and after the stimulation (off-line stimulation).The primary outcome measure is the (differential) change in the overall KAS score after five daily sessions of anodal versus sham tDCS when compared to the baseline assessment before tDCS. Secondary study outcomes include further apraxia scores, aphasia severity, and measures of motor performance and disability after stroke. All outcome measures are obtained in the post-stimulation assessment as well as during follow-up (3-4 months after tDCS). PERSPECTIVE The RCT RAdiCS shall evaluate in a large number of LH stroke patients whether anodal tDCS (compared to sham tDCS) expedites the rehabilitation of apraxia - over and above additional motor (cognitive) training and standard care. A positive study outcome would provide a new strategy for the treatment of apraxia, which hopefully ameliorates the negative impact of apraxia on daily living and long-term outcome. TRIAL REGISTRATION Clinical Trials Gov: NCT03185234, registered 14 June 2017 ; Deutsches Register für Klinische Studien: DRKS00012292, registered 01 June 2017. TRIAL STATUS Participant enrollment began on 22 June 2017. The trial is expected to be completed on 30 June 2022.
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Affiliation(s)
- Nina N. Kleineberg
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany
| | - Monika K. Richter
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany
| | - Ingrid Becker
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Peter H. Weiss
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany
| | - Gereon R. Fink
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany
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Transcranial electric stimulation optimizes the balance of visual attention across space. Clin Neurophysiol 2020; 131:912-920. [PMID: 32078920 DOI: 10.1016/j.clinph.2019.12.415] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 11/28/2019] [Accepted: 12/11/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Transcranial direct current stimulation (tDCS) provides a way to modulate spatial attention by enhancing the ratio of neural activity between the left and right hemispheres, with a potential benefit for the rehabilitation of visual neglect. METHODS We tested the effect of bilateral tDCS in healthy individuals performing a visual detection task. This protocol consists in the positioning of the anode and cathode on mirror positions over the left and right parietal areas. The stimulation was repeated over three days to maximize the chance to observe a bias to the hemispace controlateral to the anode. RESULTS Compared to a sham treatment, left anodal - right cathodal stimulation enhanced attention across the full range of space, since the first day with no build-up effect on the next days, and modified the balance of left-right omissions when stimuli appeared at the same time. CONCLUSION Bilateral tDCS improved detection in both visual fields, with no privileged processing of one side, except when concurrent stimuli were presented. The results provide partial support to the hemispheric rivalry hypothesis. SIGNIFICANCE The technique has the potential to boost attention in neglect patients but should be used as an adjuvant rather than as an alternative to functional rehabilitation.
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Elkin-Frankston S, Rushmore RJ, Valero-Cabré A. Low frequency transcranial magnetic stimulation of right posterior parietal cortex reduces reaction time to perithreshold low spatial frequency visual stimuli. Sci Rep 2020; 10:3162. [PMID: 32081939 PMCID: PMC7035391 DOI: 10.1038/s41598-020-59662-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 01/14/2020] [Indexed: 11/26/2022] Open
Abstract
Research in humans and animal models suggests that visual responses in early visual cortical areas may be modulated by top-down influences from distant cortical areas, particularly in the frontal and parietal regions. The right posterior parietal cortex is part of a broad cortical network involved in aspects of visual search and attention, but its role in modulating activity in early visual cortical areas is less well understood. This study evaluated the influence of right posterior parietal cortex (PPC) on a direct measure of visual processing in humans. Contrast sensitivity (CS) and detection response times were recorded using a visual detection paradigm to two types of centrally-presented stimuli. Participants were tested on the detection task before, after, and 1 hour after low-frequency repetitive transcranial magnetic stimulation (rTMS) to the right PPC or to the scalp vertex. Low-frequency rTMS to the right PPC did not significantly change measures of contrast sensitivity, but increased the speed at which participants responded to visual stimuli of low spatial frequency. Response times returned to baseline 1-hour after rTMS. These data indicate that low frequency rTMS to the right PPC speeds up aspects of early visual processing, likely due to a disinhibition of the homotopic left posterior parietal cortex.
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Affiliation(s)
- Seth Elkin-Frankston
- Laboratory of Cerebral Dynamics, Plasticity and Rehabilitation, Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, United States.,U.S. Army Combat Capabilities Development Command Soldier Center, Natick, MA, United States
| | - Richard J Rushmore
- Laboratory of Cerebral Dynamics, Plasticity and Rehabilitation, Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, United States. .,Psychiatric Neuroimaging Laboratory, Brigham and Women's Hospital, Boston, MA, United States. .,Center for Morphometric Analysis, Massachusetts General Hospital, Boston, MA, United States.
| | - Antoni Valero-Cabré
- Laboratory of Cerebral Dynamics, Plasticity and Rehabilitation, Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, United States. .,Cerebral Dynamics Plasticity and Rehabilitation Group, FRONTLAB Team ICM & CNRS UMR 7225, INSERM UMR 1127, Sorbone Universtité & LPNC CNRS UMR 5105-TREAT vision, Service de Neurologie, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France. .,Cognitive Neuroscience and Information Technology Research Program, Open University of Catalonia (UOC), Barcelona, Spain.
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35
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Käsbauer AS, Mengotti P, Fink GR, Vossel S. Resting-state Functional Connectivity of the Right Temporoparietal Junction Relates to Belief Updating and Reorienting during Spatial Attention. J Cogn Neurosci 2020; 32:1130-1141. [PMID: 32027583 DOI: 10.1162/jocn_a_01543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Although multiple studies characterized the resting-state functional connectivity (rsFC) of the right temporoparietal junction (rTPJ), little is known about the link between rTPJ rsFC and cognitive functions. Given a putative involvement of rTPJ in both reorienting of attention and the updating of probabilistic beliefs, this study characterized the relationship between rsFC of rTPJ with dorsal and ventral attention systems and these two cognitive processes. Twenty-three healthy young participants performed a modified location-cueing paradigm with true and false prior information about the percentage of cue validity to assess belief updating and attentional reorienting. Resting-state fMRI was recorded before and after the task. Seed-based correlation analysis was employed, and correlations of each behavioral parameter with rsFC before the task, as well as with changes in rsFC after the task, were assessed in an ROI-based approach. Weaker rsFC between rTPJ and right intraparietal sulcus before the task was associated with relatively faster updating of the belief that the cue will be valid after false prior information. Moreover, relatively faster belief updating, as well as faster reorienting, were related to an increase in the interhemispheric rsFC between rTPJ and left TPJ after the task. These findings are in line with task-based connectivity studies on related attentional functions and extend results from stroke patients demonstrating the importance of interhemispheric parietal interactions for behavioral performance. The present results not only highlight the essential role of parietal rsFC for attentional functions but also suggest that cognitive processing during a task changes connectivity patterns in a performance-dependent manner.
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Affiliation(s)
| | - Paola Mengotti
- Institute of Neuroscience and Medicine (INM-3), Research Centre Juelich
| | - Gereon R Fink
- Institute of Neuroscience and Medicine (INM-3), Research Centre Juelich.,Faculty of Medicine and University Hospital Cologne, University of Cologne
| | - Simone Vossel
- Institute of Neuroscience and Medicine (INM-3), Research Centre Juelich.,Faculty of Human Sciences, University of Cologne
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36
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Tscherpel C, Hensel L, Lemberg K, Vollmer M, Volz LJ, Fink GR, Grefkes C. The differential roles of contralesional frontoparietal areas in cortical reorganization after stroke. Brain Stimul 2020; 13:614-624. [PMID: 32289686 DOI: 10.1016/j.brs.2020.01.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 01/10/2020] [Accepted: 01/28/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Studies examining the contribution of contralesional brain regions to motor recovery after stroke have revealed conflicting results comprising both supporting and disturbing influences. Especially the relevance of contralesional brain regions beyond primary motor cortex (M1) has rarely been studied, particularly concerning the temporal dynamics post-stroke. METHODS We, therefore, used online transcranial magnetic stimulation (TMS) interference to longitudinally assess the role of contralesional (right) frontoparietal areas for recovery of hand motor function after left hemispheric stroke: contralesional M1, contralesional dorsal premotor cortex (dPMC), and contralesional anterior intraparietal sulcus (IPS). Fourteen stroke patients and sixteen age-matched healthy subjects performed motor tasks of varying complexity with their (paretic) right hand. Motor performance was quantified using three-dimensional kinematic data. All patients were assessed twice, (i) in the first week, and (ii) after more than three months post-stroke. RESULTS While we did not observe a significant effect of TMS interference on movement kinematics following the stimulation of contralesional M1 and dPMC in the first week post-stroke, we found improvements of motor performance upon interference with contralesional IPS across motor tasks early after stroke, an effect that persisted into the later phase. By contrast, for dPMC, TMS-induced deterioration of motor performance was only evident three months post-stroke, suggesting that a supportive role of contralesional premotor cortex might evolve with reorganization. CONCLUSION We here highlight time-sensitive and region-specific effects of contralesional frontoparietal areas after left hemisphere stroke, which may influence on neuromodulation regimes aiming at supporting recovery of motor function post-stroke.
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Affiliation(s)
- Caroline Tscherpel
- Department of Neurology, University Hospital Cologne, Cologne, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Lukas Hensel
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Katharina Lemberg
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Mattias Vollmer
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Lukas J Volz
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, University Hospital Cologne, Cologne, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Christian Grefkes
- Department of Neurology, University Hospital Cologne, Cologne, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany.
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37
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On the mechanisms underlying Prism Adaptation: A review of neuro-imaging and neuro-stimulation studies. Cortex 2020; 123:57-71. [DOI: 10.1016/j.cortex.2019.10.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/19/2019] [Accepted: 10/16/2019] [Indexed: 01/09/2023]
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38
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Abstract
BACKGROUND Noninvasive brain stimulation can modulate neural processing within the motor cortex and thereby might be beneficial in the rehabilitation of hemispatial neglect after stroke. METHODS We review the pertinent literature regarding the use of transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation in order to facilitate recovery of hemispatial neglect after stroke. RESULTS Twenty controlled trials (including 443 stroke patients) matched our inclusion criteria. Methodology and results of each study are presented in a comparative approach. Current data seem to indicate a better efficiency of repetitive transcranial magnetic stimulation, compared to tDCS to ameliorate hemispatial neglect after stroke. CONCLUSIONS Noninvasive brain stimulation has the potential to facilitate recovery of hemispatial neglect after stroke, but until today, there are not enough data to claim its routine use.
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39
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Non-invasive brain stimulation to enhance cognitive rehabilitation after stroke. Neurosci Lett 2020; 719:133678. [DOI: 10.1016/j.neulet.2018.06.047] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 06/26/2018] [Indexed: 11/19/2022]
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40
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Rezaee Z, Dutta A. Lobule‐Specific Dosage Considerations for Cerebellar Transcranial Direct Current Stimulation During Healthy Aging: A Computational Modeling Study Using Age‐Specific Magnetic Resonance Imaging Templates. Neuromodulation 2020; 23:341-365. [DOI: 10.1111/ner.13098] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 12/02/2019] [Accepted: 12/18/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Zeynab Rezaee
- Department of Biomedical Engineering University at Buffalo Buffalo NY USA
| | - Anirban Dutta
- Department of Biomedical Engineering University at Buffalo Buffalo NY USA
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41
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Gammeri R, Iacono C, Ricci R, Salatino A. Unilateral Spatial Neglect After Stroke: Current Insights. Neuropsychiatr Dis Treat 2020; 16:131-152. [PMID: 32021206 PMCID: PMC6959493 DOI: 10.2147/ndt.s171461] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 12/24/2019] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Unilateral spatial neglect (USN) is a disorder of contralesional space awareness which often follows unilateral brain lesion. Since USN impairs awareness of contralesional space/body and often of concomitant motor disorders, its presence represents a negative prognostic factor of functional recovery. Thus, the disorder needs to be carefully diagnosed and treated. Here, we attempted to present a clear and concise picture of current insights in the comprehension and rehabilitation of USN. METHODS We first provided an updated overview of USN clinical and neuroanatomical features and then highlighted recent progresses in the diagnosis and rehabilitation of the disease. In relation to USN rehabilitation, we conducted a MEDLINE literature research on three of the most promising interventions for USN rehabilitation: prismatic adaptation (PA), non-invasive brain stimulation (NIBS), and virtual reality (VR). The identified studies were classified according to the strength of their methods. RESULTS The last years have witnessed a relative decrement of interest in the study of neuropsychological disorders of spatial awareness in USN, but a relative increase in the study of potential interventions for its rehabilitation. Although optimal protocols still need to be defined, high-quality studies have demonstrated the efficacy of PA, TMS and tDCS interventions for the treatment of USN. In addition, preliminary investigations are suggesting the potentials of GVS and VR approaches for USN rehabilitation. CONCLUSION Advancing neuropsychological and neuroscience tools to investigate USN pathophysiology is a necessary step to identify effective rehabilitation treatments and to foster our understanding of neurofunctional bases of spatial cognition in the healthy brain.
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Affiliation(s)
- Roberto Gammeri
- Department of Psychology, SAMBA (SpAtial, Motor and Bodily Awareness) Research Group, University of Turin, Turin, Italy
| | - Claudio Iacono
- Department of Psychology, SAMBA (SpAtial, Motor and Bodily Awareness) Research Group, University of Turin, Turin, Italy
| | - Raffaella Ricci
- Department of Psychology, SAMBA (SpAtial, Motor and Bodily Awareness) Research Group, University of Turin, Turin, Italy
- Neuroscience Institute of Turin (NIT), University of Turin, Turin, Italy
| | - Adriana Salatino
- Department of Psychology, SAMBA (SpAtial, Motor and Bodily Awareness) Research Group, University of Turin, Turin, Italy
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42
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Zebhauser PT, Vernet M, Unterburger E, Brem AK. Visuospatial Neglect - a Theory-Informed Overview of Current and Emerging Strategies and a Systematic Review on the Therapeutic Use of Non-invasive Brain Stimulation. Neuropsychol Rev 2019; 29:397-420. [PMID: 31748841 PMCID: PMC6892765 DOI: 10.1007/s11065-019-09417-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 09/27/2019] [Indexed: 01/12/2023]
Abstract
Visuospatial neglect constitutes a supramodal cognitive deficit characterized by reduction or loss of spatial awareness for the contralesional space. It occurs in over 40% of right- and 20% of left-brain-lesioned stroke patients with lesions located mostly in parietal, frontal and subcortical brain areas. Visuospatial neglect is a multifaceted syndrome - symptoms can be divided into sensory, motor and representational neglect - and therefore requires an individually adapted diagnostic and therapeutic approach. Several models try to explain the origins of visuospatial neglect, of which the "interhemispheric rivalry model" is strongly supported by animal and human research. This model proposes that allocation of spatial attention is balanced by transcallosal inhibition and both hemispheres compete to direct attention to the contralateral hemi-space. Accordingly, a brain lesion causes an interhemispheric imbalance, which may be re-installed by activation of lesioned, or deactivation of unlesioned (over-activated) brain areas through noninvasive brain stimulation. Research in larger patient samples is needed to confirm whether noninvasive brain stimulation can improve long-term outcomes and whether these also affect activities of daily living and discharge destination.
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Affiliation(s)
- Paul Theo Zebhauser
- Department of Neuropsychology, Max-Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804, Munich, Germany
- Department of Psychiatry and Psychotherapy, Klinikum Rechts der Isar der Technischen Universität, Munich, Germany
| | - Marine Vernet
- Section on Neurocircuitry, Laboratory of Brain and Cognition, NIMH/NIH, Bethesda, MD, USA
| | - Evelyn Unterburger
- Division of Neuropsychology, Universitätsklinik Zürich USZ, Frauenklinikstrasse 26, Zurich, Switzerland
| | - Anna-Katharine Brem
- Department of Neuropsychology, Max-Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804, Munich, Germany.
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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Ni A, Zhou R, Tian F. Modulation of human visuospatial attention analysis by transcranial direct current stimulation (tDCS) in the line bisection performance. Saudi J Biol Sci 2019; 26:1956-1960. [PMID: 31885486 PMCID: PMC6921300 DOI: 10.1016/j.sjbs.2019.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/06/2019] [Accepted: 06/12/2019] [Indexed: 11/30/2022] Open
Abstract
The general population shows physiologic biases in the line bisection performance for visuospatial attention, almost to the left known as pseudoneglect. Previous studies have shown that tDCS affects visuospatial attention in line bisection. This research applies tDCS over left posterior parietal cortice (P3) or right posterior parietal cortice (P4) to explore the effect on pseudoneglect. Subjects randomly were divided into five groups by stimulation distribution: (i) P3-anodal (P3A), (ii) P3-cathodal (P3C), (iii) P4-anodal (P4A), (iv) P4-cathodal (P4C), (v) sham. Participants respectively finished the post-tDCS line-bisection assignment (lines on the left/right side of the monitor (LL/LR), and lines in the center of the monitor (LC)) the same as the pre-tDCS task over the session (P3A, P3C, P4A, P4C and sham) tDCS condition. The principal findings were that P3A tDCS reduced the leftward shift in the horizontal line bisection task, as well as P4C tDCS reduced the leftward shift in LL. Sham stimulation as well as P3C and P4A stimulation didn't have systematic improvements in the line bisection tasks. Therefore, an activation-orientation model of pseudoneglect is corroborated by these findings. Activation of intact structures in the rebalance of left and right parietal cortex might impose modulating effects on tDCS.
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Affiliation(s)
- Aijuan Ni
- Institute of Medical Support Technology, Academy of Military Sciences, Tianjin 300161, China
| | - Rongchao Zhou
- Department of Radiology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin 300120, China
| | - Feng Tian
- Institute of Medical Support Technology, Academy of Military Sciences, Tianjin 300161, China
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44
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Lucente G, Valls-Sole J, Murillo N, Rothwell J, Coll J, Davalos A, Kumru H. Noninvasive Brain Stimulation and Noninvasive Peripheral Stimulation for Neglect Syndrome Following Acquired Brain Injury. Neuromodulation 2019; 23:312-323. [PMID: 31725939 DOI: 10.1111/ner.13062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/10/2019] [Accepted: 09/10/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Hemispatial neglect is a frequent condition usually following nondominant hemispheric brain injury. It strongly affects rehabilitation strategies and everyday life activities. It is associated with behavioral and cognitive disability with a strong impact on patient's life. METHODS We reviewed the published literature on the use of noninvasive brain stimulation, including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), and of noninvasive peripheral muscle stimulation, as therapeutic strategies for rehabilitation of neglect after acquired brain injury, such as in stroke or in traumatic injuries. The studies were grouped as controlled or uncontrolled studies in each stimulation techniques. RESULTS Thirty-four studies were identified and 16 on rTMS, 10 on tDCS, and 8 on vibration. All studies were conducted in adult patients who suffered a stroke, except for one that was conducted in a patient suffering traumatic acquired brain injury and another that was conducted in a patient with brain tumor. In spite of significant variability in treatment protocols, patients' features and assessment of neglect, improvement was reported in almost all studies with no side-effects. CONCLUSIONS Noninvasive brain stimulation and neuromuscular vibration are promising therapeutic neuromodulatory approaches for neglect. Further randomized-controlled studies are needed to corroborate their effectiveness as separate and combined techniques.
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Affiliation(s)
- Giuseppe Lucente
- Department of Neuroscience, Hospital Germans Trias i Pujol, Badalona, Spain.,Grup de Recerca en Malalties Neuromusculars i Neuropediatriques, Department of Neurosciences, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain.,Medicine Department, Universitat Autonoma de Barcelona, 08193, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Josep Valls-Sole
- EMG Department, Hospital Clinic, Carrer de Villarroel, 170, 08036 Barcelona, Spain
| | - Narda Murillo
- Medicine Department, Universitat Autonoma de Barcelona, 08193, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain.,Fundación Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, 08916, Badalona, Spain
| | - John Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, Queen Square, University College London, London, UK
| | - Jaume Coll
- Department of Neuroscience, Hospital Germans Trias i Pujol, Badalona, Spain.,Grup de Recerca en Malalties Neuromusculars i Neuropediatriques, Department of Neurosciences, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain.,Medicine Department, Universitat Autonoma de Barcelona, 08193, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Antoni Davalos
- Department of Neuroscience, Hospital Germans Trias i Pujol, Badalona, Spain.,Medicine Department, Universitat Autonoma de Barcelona, 08193, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Hatice Kumru
- Medicine Department, Universitat Autonoma de Barcelona, 08193, Bellaterra (Cerdanyola del Vallès), Spain.,Fundación Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, 08916, Badalona, Spain
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Rabenstein M, Unverricht-Yeboah M, Keuters MH, Pikhovych A, Hucklenbroich J, Vay SU, Blaschke S, Ladwig A, Walter HL, Beiderbeck M, Fink GR, Schroeter M, Kriehuber R, Rueger MA. Transcranial Current Stimulation Alters the Expression of Immune-Mediating Genes. Front Cell Neurosci 2019; 13:461. [PMID: 31708742 PMCID: PMC6824260 DOI: 10.3389/fncel.2019.00461] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 09/27/2019] [Indexed: 11/13/2022] Open
Abstract
Despite its extensive use in clinical studies, the molecular mechanisms underlying the effects of transcranial direct current stimulation (tDCS) remain to be elucidated. We previously described subacute effects of tDCS on immune- and stem cells in the rat brain. To investigate the more immediate effects of tDCS regulating those cellular responses, we treated rats with a single session of either anodal or cathodal tDCS, and analyzed the gene expression by microarray; sham-stimulated rats served as control. Anodal tDCS increased expression of several genes coding for the major histocompatibility complex I (MHC I), while cathodal tDCS increased the expression of the immunoregulatory protein osteopontin (OPN). We confirmed the effects of gene upregulation by immunohistochemistry at the protein level. Thus, our data show a novel mechanism for the actions of tDCS on immune- and inflammatory processes, providing a target for future therapeutic studies.
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Affiliation(s)
- Monika Rabenstein
- Department of Neurology, University Hospital of Cologne, Cologne, Germany
| | - Marcus Unverricht-Yeboah
- Radiation Biology Unit, Department of Safety and Radiation Protection, Research Centre Jülich, Jülich, Germany
| | - Meike Hedwig Keuters
- Department of Neurology, University Hospital of Cologne, Cologne, Germany.,Max Planck Institute for Metabolism Research, Cologne, Germany.,A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Anton Pikhovych
- Department of Neurology, University Hospital of Cologne, Cologne, Germany.,Max Planck Institute for Metabolism Research, Cologne, Germany
| | - Joerg Hucklenbroich
- Department of Neurology, University Hospital of Cologne, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Sabine Ulrike Vay
- Department of Neurology, University Hospital of Cologne, Cologne, Germany
| | - Stefan Blaschke
- Department of Neurology, University Hospital of Cologne, Cologne, Germany.,Max Planck Institute for Metabolism Research, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Anne Ladwig
- Department of Neurology, University Hospital of Cologne, Cologne, Germany.,Max Planck Institute for Metabolism Research, Cologne, Germany
| | | | | | - Gereon Rudolf Fink
- Department of Neurology, University Hospital of Cologne, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Michael Schroeter
- Department of Neurology, University Hospital of Cologne, Cologne, Germany.,Max Planck Institute for Metabolism Research, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Ralf Kriehuber
- Radiation Biology Unit, Department of Safety and Radiation Protection, Research Centre Jülich, Jülich, Germany
| | - Maria Adele Rueger
- Department of Neurology, University Hospital of Cologne, Cologne, Germany.,Max Planck Institute for Metabolism Research, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
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46
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Bashir S, Al‐Hussain F, Hamza A, Asim Niaz T, Albaradie R, Habib SS. Cognitive function assessment during 2 mA transcranial direct current stimulation in DLPFC in healthy volunteers. Physiol Rep 2019; 7:e14264. [PMID: 31660693 PMCID: PMC6817993 DOI: 10.14814/phy2.14264] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 12/26/2022] Open
Abstract
Although cognitive function has been reported to change following the anodal transcranial direct current stimulation (tDCS) but still variable results have been reported in healthy subject and there is paucity of data on the cognitive effects of online tDCS. Therefore, we aimed to assess the online effect of tDCS over the left dorsolateral prefrontal cortex (DLPFC) on cognitive function and obtain safety data in healthy adults. We recruited 36 healthy (20 male) participants for this double-blind, sham-controlled parallel design. We used Stop Signal Task (SST) Go Trial and Pattern Recognition Memory (PRM) tests to evaluate cognitive function during 2 mA (20 min) anodal or sham tDCS stimulation over the left DLPFC. In active conditions, left dorsolateral prefrontal cortex was selected for electrode placement with reference over right supraorbital cortex. All related tasks were done during the online tDCS section in both groups (active/sham). There were statistically significant differences in cognitive function according to the PRM test (P = 0.003), SST (P = 0.021), and SST correct response time on Go Trials (P = 0.02) during active stimulation compared to the sham group. Our results reveal that cognitive performance is affected by a single dose of active online tDCS over DLPFC area compared to sham stimulation. In our study, tDCS is well-tolerated and safe that further supports the safety of tDCS in local healthy population.
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Affiliation(s)
- Shahid Bashir
- Neuroscience CenterKing Fahad Specialist Hospital DammamDammamSaudi Arabia
| | - Fawaz Al‐Hussain
- Department of NeurologyCollege of MedicineKing Saud UniversityRiyadhSaudi Arabia
| | - Ali Hamza
- Department of Electrical EngineeringNational University of Computer and Emerging SciencesLahorePakistan
| | - Talha Asim Niaz
- Neuroscience CenterKing Fahad Specialist Hospital DammamDammamSaudi Arabia
| | - Raidah Albaradie
- Neuroscience CenterKing Fahad Specialist Hospital DammamDammamSaudi Arabia
| | - Syed S. Habib
- Department of PhysiologyCollege of MedicineKing Saud UniversityRiyadhSaudi Arabia
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Transcranial direct current stimulation of default mode network parietal nodes decreases negative mind-wandering about the past. COGNITIVE THERAPY AND RESEARCH 2019; 44:10-20. [PMID: 33456096 DOI: 10.1007/s10608-019-10044-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Mind-wandering is a cognitive process in which people spontaneously have thoughts that are unrelated to their current activities. The types of mind-wandering thoughts that people have when affected by a negative mood resemble thoughts associated with mood disorders (e.g., negative thoughts about the past). Transcranial direct current stimulation (tDCS) is a form of noninvasive brain stimulation that can modulate cognition and affect in healthy and clinical populations. Ninety participants received either excitatory, inhibitory, or sham tDCS to bilateral inferior parietal lobe (IPL) nodes of the default mode network (DMN) to assess changes in maladaptive mind-wandering following criticism. tDCS did not change mind-wandering frequency after hearing criticism, but it did change what people mind-wandered about. Specifically, cathodal stimulation decreased the frequency of negative mind-wandering thoughts about the past. Future studies could investigate tDCS of DMN regions as an intervention for patients with mood disorders who suffer from negative, past-oriented cognitions.
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Fehring DJ, Illipparampil R, Acevedo N, Jaberzadeh S, Fitzgerald PB, Mansouri FA. Interaction of task-related learning and transcranial direct current stimulation of the prefrontal cortex in modulating executive functions. Neuropsychologia 2019; 131:148-159. [DOI: 10.1016/j.neuropsychologia.2019.05.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 04/08/2019] [Accepted: 05/10/2019] [Indexed: 01/24/2023]
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Adult Neurogenesis in the Subventricular Zone and Its Regulation After Ischemic Stroke: Implications for Therapeutic Approaches. Transl Stroke Res 2019; 11:60-79. [DOI: 10.1007/s12975-019-00717-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/13/2019] [Accepted: 06/27/2019] [Indexed: 12/21/2022]
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50
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No Effect of cathodal tDCS of the posterior parietal cortex on parafoveal preprocessing of words. Neurosci Lett 2019; 705:219-226. [DOI: 10.1016/j.neulet.2019.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 04/12/2019] [Accepted: 05/03/2019] [Indexed: 11/19/2022]
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