Implantable Multi-Modality Probe for Subdural Simultaneous Measurement of Electrophysiology, Hemodynamics, and Temperature Distribution

Functional Near-Infrared Spectroscopy as a Personalized Digital Healthcare Tool for Brain Monitoring

The sustained growth of digital healthcare in the field of neurology relies on portable and cost-effective brain monitoring tools that can accurately monitor brain function in real time. Functional near-infrared spectroscopy (fNIRS) is one such tool that has become popular among researchers and clinicians as a practical alternative to functional magnetic resonance imaging, and as a complementary tool to modalities such as electroencephalography. This review covers the contribution of fNIRS to the personalized goals of digital healthcare in neurology by identifying two major trends that drive current fNIRS research. The first major trend is multimodal monitoring using fNIRS, which allows clinicians to access more data that will help them to understand the interconnection between the cerebral hemodynamics and other physiological phenomena in patients. This allows clinicians to make an overall assessment of physical health to obtain a more-detailed and individualized diagnosis. The second major trend is that fNIRS research is being conducted with naturalistic experimental paradigms that involve multisensory stimulation in familiar settings. Cerebral monitoring of multisensory stimulation during dynamic activities or within virtual reality helps to understand the complex brain activities that occur in everyday life. Finally, the scope of future fNIRS studies is discussed to facilitate more-accurate assessments of brain activation and the wider clinical acceptance of fNIRS as a medical device for digital healthcare.

Epileptic seizure–related changes in electrocorticogram, cortical temperature, and cerebral hemodynamics obtained via an implantable multimodal multichannel probe during preoperative monitoring: illustrative case

BACKGROUND

Electrocorticography (EcoG) plays an essential role in the preoperative evaluation of epilepsy, despite its high invasiveness. Brain temperature and cerebral hemodynamics also reflect brain activity. This study examined whether a multimodal multichannel probe that simultaneously records EcoG, cortical temperature, and cerebral hemodynamics can contribute to improving the assessment of epileptic seizures. After preoperative monitoring was performed in a patient with epilepsy, three generalized seizures and two focal seizures were observed.

OBSERVATIONS

A short-term power increase in the alternating current spectrogram, high-amplitude slow waves in direct current potential, an increase in cortical temperature, an increase in oxyhemoglobin (HbO₂) concentration and total hemoglobin (HbT) concentration, and a decrease in deoxyhemoglobin (HHb) concentration, followed by a decrease in HbO₂ and HbT concentrations and an increase in HHb concentration, were observed in generalized seizures. However, no changes in these pathophysiological signals were observed in focal seizures.

LESSONS

Seizure-related changes regarding generalized seizures were consistent with the results of previous studies. The results of generalized and focal seizures indicate that epileptic brain activity propagated from the epileptic focus in the right frontal lobe to the measurement area near the motor cortex in generalized seizures but not in focal seizures.

An Inkjet Printed Flexible Electrocorticography (ECoG) Microelectrode Array on a Thin Parylene-C Film

Electrocorticography (ECoG) is a conventional, invasive technique for recording brain signals from the cortical surface using an array of electrodes. In this study, we developed a highly flexible 22-channel ECoG microelectrode array on a thin Parylene film using novel fabrication techniques. Narrow (<40 µm) and thin (<500 nm) microelectrode patterns were first printed on PDMS, then the patterns were transferred onto Parylene films via vapor deposition and peeling. A custom-designed, 3D-printed connector was built and assembled with the Parylene-based flexible ECoG microelectrode array without soldering. The impedance of the assembled ECoG electrode array was measured in vitro by electrochemical impedance spectroscopy, and the result was consistent. In addition, we conducted in vivo studies by implanting the flexible ECoG sensor in a rat and successfully recording brain signals.

Diffuse Optical Tomography Using fNIRS Signals Measured from the Skull Surface of the Macaque Monkey

Diffuse optical tomography (DOT), as a functional near-infrared spectroscopy (fNIRS) technique, can estimate three-dimensional (3D) images of the functional hemodynamic response in brain volume from measured optical signals. In this study, we applied DOT algorithms to the fNIRS data recorded from the surface of macaque monkeys’ skulls when the animals performed food retrieval tasks using either the left- or right-hand under head-free conditions. The hemodynamic response images, reconstructed by DOT with a high sampling rate and fine voxel size, demonstrated significant activations at the upper limb regions of the primary motor area in the central sulcus and premotor, and parietal areas contralateral to the hands used in the tasks. The results were also reliable in terms of consistency across different recording dates. Time-series analyses of each brain area revealed preceding activity of premotor area to primary motor area consistent with previous physiological studies. Therefore, the fNIRS–DOT protocol demonstrated in this study provides reliable 3D functional brain images over a period of days under head-free conditions for region-of-interest–based time-series analysis.

Dual-modality Volume Measurement integrated on a Ventricular Assist Device

OBJECTIVE

Ventricular assist devices (VADs) are implanted in patients suffering from end-stage heart failure to sustain the blood circulation. Real-time volume measurement could be a valuable tool to monitor patients and enable physiological control strategies to provide individualized therapy. However, volume measurement using one sensor modality requires re-calibration in the critical time post VAD implantation.

METHODS

To overcome this limitation, we have integrated ultrasound and impedance volume measurement techniques into a cannula of an apical VAD. We tested both modalities across a volume range from 140-420 mL using two differently sized and shaped biventricular silicon heart phantoms, which were subjected to physiological pressures in an in-vitro test bench. We compared results from standard calibrated measurements with calculations found by a quadratic optimization for the single modality and their combination (dual-modality) and validated the results using twofold cross-validation.

RESULTS

The dual-modality approach resulted in most favorable limits of agreement (LOA) of -0.83 ± 1.54% compared to -13.88 ± 5.90% for ultrasound and -43.45 ± 10.28% for electric impedance, separately.

CONCLUSION

The results of the dual-modality approach were as accurate as the standard calibrated measurement and valid over a large range of volumes (140-420 mL). In this in-vitro study, we show how a dual-modality ventricular volume measurement of ultrasound and electric impedance increases the robustness and renders calibration obsolete.

SIGNIFICANCE

Ventricular volumes could be measured accurately in the critical period post VAD implantation despite ventricular remodeling.