Enhanced effective connectivity in mild occipital stroke patients with hemianopia

Study of vision-related resting-state activity in suprasellar tumor patients with postoperative visual damage

INTRODUCTION

The objective of this study was to investigate changes in vision-related resting-state activity in patients with suprasellar tumors (ST) who experienced vision deterioration after surgery.

METHODS

Twelve patients with ST and vision deterioration after surgery were included in the study. Resting-state functional connectivity (FC) was compared before and after surgery using a seed-based analysis with a priori specified regions of interest (ROIs) within the visual areas. The differences between the two groups were identified using a paired t-test.

RESULTS

The data showed a decrease in FC within and between the dorsal and ventral pathways, as well as in the third pathway in ST patients. The middle temporal visual cortex (MT+) showed a decreased FC with more regions than other visual ROIs. The data also revealed an increase in FC between the visual ROIs and higher-order cortex. The superior frontal gyrus/BA8 showed an increased FC with more ROIs than other high-order regions, and the hOC4d was involved in an increased FC with more high-order regions than other ROIs.

CONCLUSIONS

The study results indicate significant neural reorganization in the vision-related cortex of ST patients with postoperative vision damage. Most subareas within the visual cortex showed remarkable neural dysfunction, and some highe-order cortex may be primarily involved in top-down control of the subareas within the visual cortex. The hot zones may arise in the processing of "top-down" influence.

Alterations in resting-state functional connectivity after brain posterior lesions reflect the functionality of the visual system in hemianopic patients

Emerging evidence suggests a role of the posterior cortices in regulating alpha oscillatory activity and organizing low-level processing in non-alpha frequency bands. Therefore, posterior brain lesions, which damage the neural circuits of the visual system, might affect functional connectivity patterns of brain rhythms. To test this hypothesis, eyes-closed resting state EEG signal was acquired from patients with hemianopia with left and right posterior lesions, patients without hemianopia with more anterior lesions and healthy controls. Left-lesioned hemianopics showed reduced intrahemispheric connectivity in the range of upper alpha only in the lesioned hemisphere, whereas right-lesioned hemianopics exhibited reduced intrahemispheric alpha connectivity in both hemispheres. In terms of network topology, these impairments were characterized by reduced local functional segregation, with no associated change in global functional integration. This suggests a crucial role of posterior cortices in promoting functional connectivity in the range of alpha. Right-lesioned hemianopics revealed also additional impairments in the theta range, with increased connectivity in this frequency band, characterized by both increased local segregated activity and decreased global integration. This indicates that lesions to right posterior cortices lead to stronger impairments in alpha connectivity and induce additional alterations in local and global low-level processing, suggesting a specialization of the right hemisphere in generating alpha oscillations and in coordinating complex interplays with lower frequency bands. Importantly, hemianopic patient's visual performance in the blind field was linked to alpha functional connectivity, corroborating the notion that alpha oscillatory patterns represent a biomarker of the integrity and the functioning of the underlying visual system.

Resting State EEG Directed Functional Connectivity Unveils Changes in Motor Network Organization in Subacute Stroke Patients After Rehabilitation

Brain plasticity and functional reorganization are mechanisms behind functional motor recovery of patients after an ischemic stroke. The study of resting-state motor network functional connectivity by means of EEG proved to be useful in investigating changes occurring in the information flow and find correlation with motor function recovery. In the literature, most studies applying EEG to post-stroke patients investigated the undirected functional connectivity of interacting brain regions. Quite recently, works started to investigate the directionality of the connections and many approaches or features have been proposed, each of them being more suitable to describe different aspects, e.g., direct or indirect information flow between network nodes, the coupling strength or its characteristic oscillation frequency. Each work chose one specific measure, despite in literature there is not an agreed consensus, and the selection of the most appropriate measure is still an open issue. In an attempt to shed light on this methodological aspect, we propose here to combine the information of direct and indirect coupling provided by two frequency-domain measures based on Granger’s causality, i.e., the directed coherence (DC) and the generalized partial directed coherence (gPDC), to investigate the longitudinal changes of resting-state directed connectivity associated with sensorimotor rhythms α and β, occurring in 18 sub-acute ischemic stroke patients who followed a rehabilitation treatment. Our results showed a relevant role of the information flow through the pre-motor regions in the reorganization of the motor network after the rehabilitation in the sub-acute stage. In particular, DC highlighted an increase in intra-hemispheric coupling strength between pre-motor and primary motor areas, especially in ipsi-lesional hemisphere in both α and β frequency bands, whereas gPDC was more sensitive in the detection of those connection whose variation was mostly represented within the population. A decreased causal flow from contra-lesional premotor cortex towards supplementary motor area was detected in both α and β frequency bands and a significant reinforced inter-hemispheric connection from ipsi to contra-lesional pre-motor cortex was observed in β frequency. Interestingly, the connection from contra towards ipsilesional pre-motor area correlated with upper limb motor recovery in α band. The usage of two different measures of directed connectivity allowed a better comprehension of those coupling changes between brain motor regions, either direct or mediated, which mostly were influenced by the rehabilitation, revealing a particular involvement of the pre-motor areas in the cerebral functional reorganization.

Immersive Virtual Reality Simulations of Bionic Vision

Bionic vision uses neuroprostheses to restore useful vision to people living with incurable blindness. However, a major outstanding challenge is predicting what people "see" when they use their devices. The limited field of view of current devices necessitates head movements to scan the scene, which is difficult to simulate on a computer screen. In addition, many computational models of bionic vision lack biological realism. To address these challenges, we present VR-SPV, an open-source virtual reality toolbox for simulated prosthetic vision that uses a psychophysically validated computational model to allow sighted participants to "see through the eyes" of a bionic eye user. To demonstrate its utility, we systematically evaluated how clinically reported visual distortions affect performance in a letter recognition and an immersive obstacle avoidance task. Our results highlight the importance of using an appropriate phosphene model when predicting visual outcomes for bionic vision.

Interhemispheric Cortical Network Connectivity Reorganization Predicts Vision Impairment in Stroke

Stroke is one of the main causes of disability in human beings, and when the occipital lobe is affected, this leads to partial vision loss (homonymous hemianopia). To understand brain mechanisms of vision loss and recovery, graph theory-based brain functional connectivity network (FCN) analysis was recently introduced. However, few brain network studies exist that have studied if the strength of the damaged FCN can predict the extent of functional impairment. We now characterized the brain FCN using deep neural network analysis to describe multiscale brain networks and explore their corresponding physiological patterns. In a group of 24 patients and 24 controls, Bi-directional long short-term memory (Bi-LSTM) was evaluated to reveal the cortical network pattern learning efficiency compared with other traditional algorithms. Bi-LSTM achieved the best balanced-overall accuracy of 73% with sensitivity of 70% and specificity and 75% in the low alpha band. This demonstrates that bi-directional learning can capture the brain network feature representation of both hemispheres. It shows that brain damage leads to reorganized FCN patterns with a greater number of functional connections of intermediate density in the high alpha band. Future studies should explore how this understanding of brain FCN can be used for clinical diagnostics and rehabilitation.

Weakened Effective Connectivity Related to Electroacupuncture in Stroke Patients with Prolonged Flaccid Paralysis: An EEG Pilot Study

Flaccid paralysis in the upper extremity is a severe motor impairment after stroke, which exists for weeks, months, or even years. Electroacupuncture treatment is one of the most widely used TCM therapeutic interventions for poststroke flaccid paralysis. However, the response to electroacupuncture in different durations of flaccid stage poststroke as well as in the topological configuration of the cortical network remains unclear. The objectives of this study are to explore the disruption of the cortical network in patients in different durations of flaccid stage and observe dynamic network reorganization during and after electroacupuncture. Resting-state networks were constructed from 18 subjects with flaccid upper extremity by partial directed coherence (PDC) analysis of multichannel EEG. They were allocated to three groups according to time after flaccid paralysis: the short-duration group (those with flaccidity for less than two months), the medium-duration group (those with flaccidity between two months and six months), and the long-duration group (those with flaccidity over six months). Compared with short-duration flaccid subjects, weakened effective connectivity was presented in medium-duration and long-duration groups before electroacupuncture. The long-duration group has no response in the cortical network during electroacupuncture. The global network measures of EEG data (sPDC, mPDC, and N) indicated that there was no significant difference among the three groups. These results suggested that the network connectivity reduced and weakly responded to electroacupuncture in patients with flaccid paralysis for over six months. These findings may help us to modulate the formulation of electroacupuncture treatment according to different durations of the flaccid upper extremity.

Fluoxetine-induced recovery of serotonin and norepinephrine projections in a mouse model of post-stroke depression

Chronic treatment with fluoxetine (FLX) is required for its antidepressant effects, but the role of serotonin (5-HT) axonal plasticity in FLX action is unknown. To address this, we examined mice with a stroke in the left medial prefrontal cortex (mPFC) resulting in persistent anxiety-like and depression-like behaviors and memory deficits as a model of post-stroke depression. Chronic treatment with FLX (but not exercise) completely reversed the behavioral phenotype and partially reversed changes in FosB-labeled cells in the mPFC, nucleus accumbens, septum, hippocampus, basolateral amygdala (BLA), and dorsal raphe. In these regions, 5-HT or norepinephrine (NE) innervation was quantified by staining for 5-HT or NE transporters, respectively. 5-HT synapses and synaptic triads were identified as synaptophysin-stained sites on 5-HT axons located proximal to gephyrin-stained or PSD95-stained spines. A week after stroke, 5-HT innervation was greatly reduced at the stroke site (left cingulate gyrus (CG) of the mPFC) and the left BLA. Chronically, 5-HT and NE innervation was reduced at the left CG, nucleus accumbens, and BLA, with no changes in other regions. In these areas, pre-synaptic and post-synaptic 5-HT synapses and triads to inhibitory (gephyrin+) sites were reduced, while 5-HT contacts at excitatory (PSD95+) sites were reduced in the CG and prelimbic mPFC. Chronic FLX, but not exercise, reversed these reductions in 5-HT innervation but incompletely restored NE projections. Changes in 5-HT innervation were verified using YFP staining in mice expressing YFP-tagged channelrhodopsin in 5-HT neurons. Thus, FLX-induced 5-HT axonal neuroplasticity of forebrain projections may help mediate recovery from brain injury.

Functional interactions in patients with hemianopia: A graph theory-based connectivity study of resting fMRI signal

The assessment of task-independent functional connectivity (FC) after a lesion causing hemianopia remains an uncovered topic and represents a crucial point to better understand the neural basis of blindsight (i.e. unconscious visually triggered behavior) and visual awareness. In this light, we evaluated functional connectivity (FC) in 10 hemianopic patients and 10 healthy controls in a resting state paradigm. The main aim of this study is twofold: first of all we focused on the description and assessment of density and intensity of functional connectivity and network topology with and without a lesion affecting the visual pathway, and then we extracted and statistically compared network metrics, focusing on functional segregation, integration and specialization. Moreover, a study of 3-cycle triangles with prominent connectivity was conducted to analyze functional segregation calculated as the area of each triangle created connecting three neighboring nodes. To achieve these purposes we applied a graph theory-based approach, starting from Pearson correlation coefficients extracted from pairs of regions of interest. In these analyses we focused on the FC extracted by the whole brain as well as by four resting state networks: The Visual (VN), Salience (SN), Attention (AN) and Default Mode Network (DMN), to assess brain functional reorganization following the injury. The results showed a general decrease in density and intensity of functional connections, that leads to a less compact structure characterized by decrease in functional integration, segregation and in the number of interconnected hubs in both the Visual Network and the whole brain, despite an increase in long-range inter-modules connections (occipito-frontal connections). Indeed, the VN was the most affected network, characterized by a decrease in intra- and inter-network connections and by a less compact topology, with less interconnected nodes. Surprisingly, we observed a higher functional integration in the DMN and in the AN regardless of the lesion extent, that may indicate a functional reorganization of the brain following the injury, trying to compensate for the general reduced connectivity. Finally we observed an increase in functional specialization (lower between-network connectivity) and in inter-networks functional segregation, which is reflected in a less compact network topology, highly organized in functional clusters. These descriptive findings provide new insight on the spontaneous brain activity in hemianopic patients by showing an alteration in the intrinsic architecture of a large-scale brain system that goes beyond the impairment of a single RSN.

Selective serotonin reuptake inhibitors for functional recovery after stroke: similarities with the critical period and the role of experience-dependent plasticity

There has been a growing interest in the potential for plasticity-inducing pharmacological interventions to enhance post-stroke recovery. One group of drugs that continues to garner a great deal of attention in this regard is a class of antidepressants called the selective serotonin reuptake inhibitors. Here we propose a model for the mechanism by which these drugs may enhance plasticity after ischemic brain injury. First, we review the research in animal models demonstrating how selective serotonin reuptake inhibitors reopen the critical period for ocular dominance plasticity in adulthood. We then compare this period of heightened plasticity to the cellular and biochemical milieu of perilesional tissue after an ischemic event in the adult brain. We argue that selective serotonin reuptake inhibitors administered acutely after an ischemic stroke alter excitatory-inhibitory balance in perilesional tissue and reinstate a type of plasticity reminiscent of the critical period in development. Finally, we discuss opportunities for future research in this area in both the preclinical and clinical realms.

Brain network disintegration as a final common pathway for delirium: a systematic review and qualitative meta-analysis

Delirium is an acute neuropsychiatric syndrome characterized by altered levels of attention and awareness with cognitive deficits. It is most prevalent in elderly hospitalized patients and related to poor outcomes. Predisposing risk factors, such as older age, determine the baseline vulnerability for delirium, while precipitating factors, such as use of sedatives, trigger the syndrome. Risk factors are heterogeneous and the underlying biological mechanisms leading to vulnerability for delirium are poorly understood. We tested the hypothesis that delirium and its risk factors are associated with consistent brain network changes. We performed a systematic review and qualitative meta-analysis and included 126 brain network publications on delirium and its risk factors. Findings were evaluated after an assessment of methodological quality, providing N=99 studies of good or excellent quality on predisposing risk factors, N=10 on precipitation risk factors and N=7 on delirium. Delirium was consistently associated with functional network disruptions, including lower EEG connectivity strength and decreased fMRI network integration. Risk factors for delirium were associated with lower structural connectivity strength and less efficient structural network organization. Decreased connectivity strength and efficiency appear to characterize structural brain networks of patients at risk for delirium, possibly impairing the functional network, while functional network disintegration seems to be a final common pathway for the syndrome.

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Delirium is consistently associated with functional network impairments.

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Risk factors are associated with lower structural connectivity strength.

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Risk factors are associated with a less efficient structural network organization.

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Structural impairments make the functional network more vulnerable to deterioration.

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Functional network disintegration seems to be a final common pathway for delirium.

Coenzyme Q10 treatment improved visual field after homonymous quadrantanopia caused by occipital lobe infarction

Purpose

To report the clinical findings and management of a case of occipital lobe infarction with homonymous quadrantanopia in a patient treated with vitamins and coenzyme Q10.

Observations

A currently 69-years-old patient presenting in 2007 left inferior quadrantanopia following a right occipital lobe stroke with initial visual field index of 82% and 79% in the right and left eyes, respectively. From 2007 to 2010 was treated with vitamin and antioxidant complexes, without specific signs of changes observed in the visual field (81% right eye, 79% left eye). In 2011 was treated for the first time with coenzyme Q10 (Active complex^® Q10 Gold 100 mg) in addition to the vitamin and antioxidant supplementation. A promptly slight improvement of the visual field in both eyes was observed. In 2013, a remarkable improvement was noticed observing a slight scotoma where previously presented the quadrantanopia. Thereafter, in the successive one-year follow-up examinations the patient experienced an exponential improvement in the visual field with gradually fading of the scotoma. Currently the patient no longer presents any sign of quadrantanopia, with normal visual field in both eyes (99% right eye, 98% left eye).

Conclusion and importance

Spontaneous improvement more than 6 months after stroke is thought to be unlikely. However, we observed, for the first time, an amelioration of the visual field after 10 years of an occipital lobe stroke. The combination of vitamins and coenzyme Q10 (100 mg) improved the prognosis with significant recovery of the visual field, which is impossible to recover under current knowledge.

Altered white matter connectivity associated with visual hallucinations following occipital stroke

INTRODUCTION

Visual hallucinations that arise following vision loss stem from aberrant functional activity in visual cortices and an imbalance of activity across associated cortical and subcortical networks subsequent to visual pathway damage. We sought to determine if structural changes in white matter connectivity play a role in cases of chronic visual hallucinations associated with visual cortical damage.

METHODS

We performed diffusion tensor imaging (DTI) and probabilistic fiber tractography to assess white matter connectivity in a patient suffering from continuous and disruptive phosphene (simple) visual hallucinations for more than 2 years following right occipital stroke. We compared these data to that of healthy age-matched controls.

RESULTS

Probabilistic tractography to reconstruct white matter tracts suggests regeneration of terminal fibers of the ipsilesional optic radiations in the patient. However, arrangement of the converse reconstruction of these tracts, which were seeded from the ipsilesional visual cortex to the intrahemispheric lateral geniculate body, remained disrupted. We further observed compromised structural characteristics, and changes in diffusion (measured using diffusion tensor indices) of white matter tracts in the patient connecting the visual cortex with frontal and temporal regions, and also in interhemispheric connectivity between visual cortices.

CONCLUSIONS

Cortical remapping and the disruption of communication between visual cortices and remote regions are consistent with our previous functional magnetic resonance imaging (fMRI) data showing imbalanced functional activity of the same regions in this patient (Rafique et al, 2016, Neurology, 87, 1493-1500). Long-term adaptive and disruptive changes in white matter connectivity may account for the rare nature of cases presenting with chronic and continuous visual hallucinations.

Robust Granger Analysis in Lp Norm Space for Directed EEG Network Analysis

Granger analysis (GA) is widely used to construct directed brain networks based on various physiological recordings, such as functional magnetic resonance imaging, and electroencephalogram (EEG). However, in real applications, EEGs are inevitably contaminated by unexpected artifacts that may distort the networks because of the L2 norm structure utilized in GAs when estimating directed links. Compared with the L2 norm, the Lp ( ) norm can compress outlier effects. In this paper, an extended GA is constructed by applying the Lp ( ) norm strategy to estimate robust causalities under outlier conditions, and a feasible iteration procedure is utilized to solve the new GA model. A quantitative evaluation using a predefined simulation network demonstrates smaller bias errors and higher linkage consistence for the Lp ( , 0.8, 0.6, 0.4, 0.2) -GAs compared with both the Lasso- and L2-GAs under various simulated outlier conditions. Applications in resting-state EEGs that contain ocular artifacts also show that the proposed GA can effectively compress the ocular outlier influence and recover the reliable networks. The proposed Lp-GA may be helpful in capturing the reliable network structure when EEGs are contaminated with artifacts in related studies.

A Novel Brain Network Construction Method for Exploring Age-Related Functional Reorganization

The human brain undergoes complex reorganization and changes during aging. Using graph theory, scientists can find differences in topological properties of functional brain networks between young and elderly adults. However, these differences are sometimes significant and sometimes not. Several studies have even identified disparate differences in topological properties during normal aging or in age-related diseases. One possible reason for this issue is that existing brain network construction methods cannot fully extract the "intrinsic edges" to prevent useful signals from being buried into noises. This paper proposes a new subnetwork voting (SNV) method with sliding window to construct functional brain networks for young and elderly adults. Differences in the topological properties of brain networks constructed from the classic and SNV methods were consistent. Statistical analysis showed that the SNV method can identify much more statistically significant differences between groups than the classic method. Moreover, support vector machine was utilized to classify young and elderly adults; its accuracy, based on the SNV method, reached 89.3%, significantly higher than that with classic method. Therefore, the SNV method can improve consistency within a group and highlight differences between groups, which can be valuable for the exploration and auxiliary diagnosis of aging and age-related diseases.