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Leinders S, Vansteensel MJ, Piantoni G, Branco MP, Freudenburg ZV, Gebbink TA, Pels EGM, Raemaekers MAH, Schippers A, Aarnoutse EJ, Ramsey NF. Using fMRI to localize target regions for implanted brain-computer interfaces in locked-in syndrome. Clin Neurophysiol 2023; 155:1-15. [PMID: 37657190 DOI: 10.1016/j.clinph.2023.08.003] [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: 02/10/2023] [Revised: 06/29/2023] [Accepted: 08/09/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE Electrocorticography (ECoG)-based brain-computer interface (BCI) systems have the potential to improve quality of life of people with locked-in syndrome (LIS) by restoring their ability to communicate independently. Before implantation of such a system, it is important to localize ECoG electrode target regions. Here, we assessed the predictive value of functional magnetic resonance imaging (fMRI) for the localization of suitable target regions on the sensorimotor cortex for ECoG-based BCI in people with locked-in syndrome. METHODS Three people with locked-in syndrome were implanted with a chronic, fully implantable ECoG-BCI system. We compared pre-surgical fMRI activity with post-implantation ECoG activity from areas known to be active and inactive during attempted hand movement (sensorimotor hand region and dorsolateral prefrontal cortex, respectively). RESULTS Results showed a spatial match between fMRI activity and changes in ECoG low and high frequency band power (10 - 30 and 65 - 95 Hz, respectively) during attempted movement. Also, we found that fMRI can be used to select a sub-set of electrodes that show strong task-related signal changes that are therefore likely to generate adequate BCI control. CONCLUSIONS Our findings indicate that fMRI is a useful non-invasive tool for the pre-surgical workup of BCI implant candidates. SIGNIFICANCE If these results are confirmed in more BCI studies, fMRI might be used for more efficient surgical BCI procedures with focused cortical coverage and lower participant burden.
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Affiliation(s)
- Sacha Leinders
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, 3584 CX, Utrecht, The Netherlands
| | - Mariska J Vansteensel
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, 3584 CX, Utrecht, The Netherlands
| | - Giovanni Piantoni
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, 3584 CX, Utrecht, The Netherlands
| | - Mariana P Branco
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, 3584 CX, Utrecht, The Netherlands
| | - Zac V Freudenburg
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, 3584 CX, Utrecht, The Netherlands
| | - Tineke A Gebbink
- Department of Clinical Neurophysiology, University Medical Center Utrecht Brain Center, Utrecht University, 3584 CX, Utrecht, The Netherlands
| | - Elmar G M Pels
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, 3584 CX, Utrecht, The Netherlands
| | - Mathijs A H Raemaekers
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, 3584 CX, Utrecht, The Netherlands
| | - Anouck Schippers
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, 3584 CX, Utrecht, The Netherlands
| | - Erik J Aarnoutse
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, 3584 CX, Utrecht, The Netherlands
| | - Nick F Ramsey
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, 3584 CX, Utrecht, The Netherlands.
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Wróbel PP, Guder S, Feldheim JF, Graterol Pérez JA, Frey BM, Choe CU, Bönstrup M, Cheng B, Rathi Y, Pasternak O, Thomalla G, Gerloff C, Shenton ME, Schulz R. Altered microstructure of the contralesional ventral premotor cortex and motor output after stroke. Brain Commun 2023; 5:fcad160. [PMID: 37265601 PMCID: PMC10231803 DOI: 10.1093/braincomms/fcad160] [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: 08/18/2022] [Revised: 03/17/2023] [Accepted: 05/15/2023] [Indexed: 06/03/2023] Open
Abstract
Cortical thickness analyses have provided valuable insights into changes in cortical brain structure after stroke and their association with recovery. Across studies though, relationships between cortical structure and function show inconsistent results. Recent developments in diffusion-weighted imaging of the cortex have paved the way to uncover hidden aspects of stroke-related alterations in cortical microstructure, going beyond cortical thickness as a surrogate for cortical macrostructure. We re-analysed clinical and imaging data of 42 well-recovered chronic stroke patients from 2 independent cohorts (mean age 64 years, 4 left-handed, 71% male, 16 right-sided strokes) and 33 healthy controls of similar age and gender. Cortical fractional anisotropy and cortical thickness values were obtained for six key sensorimotor areas of the contralesional hemisphere. The regions included the primary motor cortex, dorsal and ventral premotor cortex, supplementary and pre-supplementary motor areas, and primary somatosensory cortex. Linear models were estimated for group comparisons between patients and controls and for correlations between cortical fractional anisotropy and cortical thickness and clinical scores. Compared with controls, stroke patients exhibited a reduction in fractional anisotropy in the contralesional ventral premotor cortex (P = 0.005). Fractional anisotropy of the other regions and cortical thickness did not show a comparable group difference. Higher fractional anisotropy of the ventral premotor cortex, but not cortical thickness, was positively associated with residual grip force in the stroke patients. These data provide novel evidence that the contralesional ventral premotor cortex might constitute a key sensorimotor area particularly susceptible to stroke-related alterations in cortical microstructure as measured by diffusion MRI and they suggest a link between these changes and residual motor output after stroke.
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Affiliation(s)
- Paweł P Wróbel
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20251, Germany
| | - Stephanie Guder
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20251, Germany
| | - Jan F Feldheim
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20251, Germany
| | - José A Graterol Pérez
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20251, Germany
| | - Benedikt M Frey
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20251, Germany
| | - Chi-un Choe
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20251, Germany
| | - Marlene Bönstrup
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20251, Germany
- Department of Neurology, University Medical Center, Leipzig 04103, Germany
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20251, Germany
| | - Yogesh Rathi
- Psychiatry Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston 02115, MA, USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston 02115, MA, USA
| | - Ofer Pasternak
- Psychiatry Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston 02115, MA, USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston 02115, MA, USA
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20251, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20251, Germany
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston 02115, MA, USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston 02115, MA, USA
| | - Robert Schulz
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20251, Germany
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Rojas Albert A, Backhaus W, Graterol Pérez JA, Braaβ H, Schön G, Choe CU, Feldheim J, Bönstrup M, Cheng B, Thomalla G, Gerloff C, Schulz R. Cortical thickness of contralesional cortices positively relates to future outcome after severe stroke. Cereb Cortex 2022; 32:5622-5627. [PMID: 35169830 DOI: 10.1093/cercor/bhac040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 01/25/2023] Open
Abstract
Imaging studies have evidenced that contralesional cortices are involved in recovery after motor stroke. Cortical thickness (CT) analysis has proven its potential to capture the changes of cortical anatomy, which have been related to recovery and treatment gains under therapy. An open question is whether CT obtained in the acute phase after stroke might inform correlational models to explain outcome variability. Data of 38 severely impaired (median NIH Stroke Scale 9, interquartile range: 6-13) acute stroke patients of 2 independent cohorts were reanalyzed. Structural imaging data were processed via the FreeSurfer pipeline to quantify regional CT of the contralesional hemisphere. Ordinal logistic regression models were fit to relate CT to modified Rankin Scale as an established measure of global disability after 3-6 months, adjusted for the initial deficit, lesion volume, and age. The data show that CT of contralesional cortices, such as the precentral gyrus, the superior frontal sulcus, and temporal and cingulate cortices, positively relates to the outcome after stroke. This work shows that the baseline cortical anatomy of selected contralesional cortices can explain the outcome variability after severe stroke, which further contributes to the concept of structural brain reserve with respect to contralesional cortices to promote recovery.
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Affiliation(s)
- Alina Rojas Albert
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Winifried Backhaus
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - José A Graterol Pérez
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Hanna Braaβ
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Gerhard Schön
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Chi-Un Choe
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Jan Feldheim
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Marlene Bönstrup
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany.,Department of Neurology, University Medical Center, Leipzig 04103, Germany
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Robert Schulz
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
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Salah Khlif M, Egorova-Brumley N, Bird LJ, Werden E, Brodtmann A. Cortical thinning 3 years after ischaemic stroke is associated with cognitive impairment and APOE ε4. Neuroimage Clin 2022; 36:103200. [PMID: 36116165 PMCID: PMC9486118 DOI: 10.1016/j.nicl.2022.103200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/11/2022] [Accepted: 09/13/2022] [Indexed: 12/14/2022]
Abstract
Cortical thinning has been described in many neurodegenerative diseases and used for both diagnosis and disease monitoring. The imaging signatures of post-stroke vascular cognitive impairment have not been well described. We investigated the trajectory of cortical thickness over 3 years following ischaemic stroke compared to healthy stroke-free age- and sex-matched controls. We also compared cortical thickness between cognitively normal and impaired stroke survivors, and between APOE ɛ4 carriers and non-carriers. T1-weighted MRI and cognitive data for 90 stroke survivors and 36 controls from the Cognition And Neocortical Volume After Stroke (CANVAS) study were used. Cortical thickness was estimated using FreeSurfer volumetric reconstruction according to the Desikan-Killiany parcellation atlas. Segmentation inaccuracies were manually corrected and infarcted ipsilesional vertices in cortical thickness maps were identified and excluded using stroke lesion masks traced a-priori. Mixed-effects regression was used to compare cortical thickness cross-sectionally between groups and longitudinally between timepoints. Healthy control and stroke groups did not differ on demographics and most clinical characteristics, though controls were less likely to have atrial fibrillation. Age was negatively associated with global mean cortical thickness independent of sex or group, with women in both groups having significantly thicker cortex. Three months post-stroke, cortical thinning was limited and focal. From 3 months to 3 years, the rate of cortical thinning in stroke was faster compared to that in healthy controls. However, this difference in cortical thinning rate could not survive family-wise correction for multiple comparisons. Yet, cortical thinning at 3 years was found more spread especially in ipsilesional hemispheres in regions implicated in motor, sensory, and memory processing and recovery. The cognitively impaired stroke survivors showed greater cortical thinning, compared to controls, than those who were cognitively normal at 3 years. Also, carriers of the APOE ɛ4 allele in stroke exhibited greater cortical thinning independent of cognitive status. The temporal changes of cortical thickness in both healthy and stroke cohorts followed previously reported patterns of cortical thickness asymmetry loss across the human adult life. However, this loss of thickness asymmetry was amplified in stroke. The post-stroke trajectories of cortical thickness reported in this study may contribute to our understanding of imaging signatures of vascular cognitive impairment.
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Affiliation(s)
- Mohamed Salah Khlif
- Cognitive Health Initiative, Central Clinical School (CCS), Monash University, Melbourne, VIC 3004, Australia,The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC 3052, Australia
| | - Natalia Egorova-Brumley
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC 3052, Australia,Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC 3010, Australia
| | - Laura J. Bird
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC 3800, Australia
| | - Emilio Werden
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC 3052, Australia
| | - Amy Brodtmann
- Cognitive Health Initiative, Central Clinical School (CCS), Monash University, Melbourne, VIC 3004, Australia,The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC 3052, Australia,Eastern Cognitive Disorders Clinic, Box Hill Hospital, Monash University, Box Hill, VIC 3128, Australia,Department of Neurology, Royal Melbourne Hospital, Parkville, VIC 3052, Australia,Corresponding author at: Central Clinical School (CCS), Monash University, 99 Commercial Road, Melbourne, VIC 3004, Australia.
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Graterol Pérez JA, Guder S, Choe CU, Gerloff C, Schulz R. Relationship Between Cortical Excitability Changes and Cortical Thickness in Subcortical Chronic Stroke. Front Neurol 2022; 13:802113. [PMID: 35345406 PMCID: PMC8957093 DOI: 10.3389/fneur.2022.802113] [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: 10/26/2021] [Accepted: 01/31/2022] [Indexed: 11/21/2022] Open
Abstract
Ischemic stroke leads to excitability changes of the motor network as probed by means of transcranial magnetic stimulation (TMS). There is still limited data that shows to what extent structural alterations of the motor network might be linked to excitability changes. Previous results argue that the microstructural state of specific corticofugal motor tracts such as the corticospinal tract associate with cortical excitability in chronic stroke patients. The relationship between changes of cortical anatomy after stroke, as operationalized by means of decreases or increases in local cortical thickness (CT), has scarcely been addressed. In the present study, we re-analyzed TMS data and recruitment curve properties of motor evoked potentials and CT data in a group of 14 well-recovered chronic stroke patients with isolated supratentorial subcortical lesions. CT data of the stroke patients were compared to CT data of 17 healthy controls. Whole-brain and region-of-interest based analyses were conducted to relate CT data to measures of motor cortical excitability and clinical data. We found that stroke patients exhibited significantly reduced CT not only in the ipsilesional primary motor cortex but also in numerous secondary motor and non-motor brain regions, particularly in the ipsilesional hemisphere including areas along the central sulcus, the inferior frontal sulcus, the intraparietal sulcus, and cingulate cortices. We could not detect any significant relationship between the extent of CT reduction and stroke-related excitability changes of the motor network or clinical scores.
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Affiliation(s)
- José A Graterol Pérez
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stephanie Guder
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Chi-Un Choe
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Robert Schulz
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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