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Katsurayama M, Silva LS, de Campos BM, Avelar WM, Cendes F, Yasuda CL. Disruption of Resting-State Functional Connectivity in Acute Ischemic Stroke: Comparisons Between Right and Left Hemispheric Insults. Brain Topogr 2024; 37:881-888. [PMID: 38302770 DOI: 10.1007/s10548-024-01033-7] [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: 10/29/2022] [Accepted: 01/01/2024] [Indexed: 02/03/2024]
Abstract
Few resting-state functional magnetic resonance imaging (RS-fMRI) studies evaluated the impact of acute ischemic changes on cerebral functional connectivity (FC) and its relationship with functional outcomes after acute ischemic stroke (AIS), considering the side of lesions. To characterize alterations of FC of patients with AIS by analyzing 12 large-scale brain networks (NWs) with RS-fMRI. Additionally, we evaluated the impact of the side (right (RH) or left (LH) hemisphere) of insult on the disruption of brain NWs. 38 patients diagnosed with AIS (17 RH and 21 LH) who performed 3T MRI scans up to 72 h after stroke were compared to 44 healthy controls. Images were processed and analyzed with the software toolbox UF2C with SPM12. For the first level, we generated individual matrices based on the time series extraction from 70 regions of interest (ROIs) from 12 functional NWs, constructing Pearson's cross-correlation; the second-level analysis included an analysis of covariance (ANCOVA) to investigate differences between groups. The statistical significance was determined with p < 0.05, after correction for multiple comparisons with false discovery rate (FDR) correction. Overall, individuals with LH insults developed poorer clinical outcomes after six months. A widespread pattern of lower FC was observed in the presence of LH insults, while a contralateral pattern of increased FC was identified in the group with RH insults. Our findings suggest that LH stroke causes a severe and widespread pattern of reduction of brain networks' FC, presumably related to the impairment in their long-term recovery.
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Affiliation(s)
- Marilise Katsurayama
- Laboratory of Neuroimaging, Department of Neurology, University of Campinas, Cidade Universitária, Campinas, SP, 13083-970, Brazil
| | - Lucas Scárdua Silva
- Laboratory of Neuroimaging, Department of Neurology, University of Campinas, Cidade Universitária, Campinas, SP, 13083-970, Brazil
| | - Brunno Machado de Campos
- Laboratory of Neuroimaging, Department of Neurology, University of Campinas, Cidade Universitária, Campinas, SP, 13083-970, Brazil
| | - Wagner Mauad Avelar
- Laboratory of Neuroimaging, Department of Neurology, University of Campinas, Cidade Universitária, Campinas, SP, 13083-970, Brazil
| | - Fernando Cendes
- Laboratory of Neuroimaging, Department of Neurology, University of Campinas, Cidade Universitária, Campinas, SP, 13083-970, Brazil
| | - Clarissa Lin Yasuda
- Laboratory of Neuroimaging, Department of Neurology, University of Campinas, Cidade Universitária, Campinas, SP, 13083-970, Brazil.
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2
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Tam PK, Oey NE, Tang N, Ramamurthy G, Chew E. Facilitating Corticomotor Excitability of the Contralesional Hemisphere Using Non-Invasive Brain Stimulation to Improve Upper Limb Motor Recovery from Stroke-A Scoping Review. J Clin Med 2024; 13:4420. [PMID: 39124687 PMCID: PMC11313572 DOI: 10.3390/jcm13154420] [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: 06/29/2024] [Revised: 07/18/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024] Open
Abstract
Upper limb weakness following stroke poses a significant global psychosocial and economic burden. Non-invasive brain stimulation (NIBS) is a potential adjunctive treatment in rehabilitation. However, traditional approaches to rebalance interhemispheric inhibition may not be effective for all patients. The supportive role of the contralesional hemisphere in recovery of upper limb motor function has been supported by animal and clinical studies, particularly for those with severe strokes. This review aims to provide an overview of the facilitation role of the contralesional hemisphere for post-stroke motor recovery. While more studies are required to predict responses and inform the choice of NIBS approach, contralesional facilitation may offer new hope for patients in whom traditional rehabilitation and NIBS approaches have failed.
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Affiliation(s)
- Pui Kit Tam
- Division of Rehabilitation Medicine, Department of Medicine, National University Hospital, Singapore 119228, Singapore; (P.K.T.); (N.E.O.); (N.T.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117549, Singapore
| | - Nicodemus Edrick Oey
- Division of Rehabilitation Medicine, Department of Medicine, National University Hospital, Singapore 119228, Singapore; (P.K.T.); (N.E.O.); (N.T.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117549, Singapore
| | - Ning Tang
- Division of Rehabilitation Medicine, Department of Medicine, National University Hospital, Singapore 119228, Singapore; (P.K.T.); (N.E.O.); (N.T.)
| | - Guhan Ramamurthy
- BG Institute of Neurosciences, BG Hospital, Tiruchendur, Tuticorin 628216, Tamil Nadu, India;
| | - Effie Chew
- Division of Rehabilitation Medicine, Department of Medicine, National University Hospital, Singapore 119228, Singapore; (P.K.T.); (N.E.O.); (N.T.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117549, Singapore
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3
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Han D, Cheng J, Chen Y, Du H, Lin Z, Zhong R, Liu Z. Evidence for Intermittent Theta Burst Transcranial Magnetic Stimulation for Dysphagia after Stroke: A Systematic Review and Meta-analysis. Dysphagia 2024:10.1007/s00455-024-10729-8. [PMID: 39008039 DOI: 10.1007/s00455-024-10729-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 06/14/2024] [Indexed: 07/16/2024]
Abstract
Dysphagia is the most common serious complication after stroke, with an incidence of about 37-78%, which seriously affects the independence of patients in daily life and clinical recovery. Repetitive transcranial magnetic stimulation (rTMS), as a non-invasive neuromodulation technique, is an emerging option for post-stroke dysphagia. Theta burst stimulation (TBS) is a new mode of transcranial magnetic stimulation that simulates the frequency of pulses released in the hippocampus.Intermittent theta burst stimulation (iTBS) has been shown to increase cortical excitability and improve swallowing function in patients. Our study sought to summarize existing clinical randomized controlled trials to provide evidence-based medical evidence for the clinical use of iTBS. A computer search was conducted on 4 Chinese (Chinese Biomedical Literature Database, VIP Information Resource System, CNKI, and Wanfang Medical Science) and 4 English (including Cochrane Library, Embase, PubMed, Web of Science) databases to retrieve all randomized controlled trials in Chinese and English that explored the effects of Intermittent Theta Burst Stimulation for post-stroke dysphagia. The retrieval years are from database construction to 23 November 2023. The primary outcome measure was a change in Penetration/Aspiration Scale (PAS), Standardized Swallowing Assessment (SSA) and Functional Oral Intake Scale (FOIS), Secondary outcomes included Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS), water-swallowing test (WST) etc. A meta-analysis by Standardized Mean Difference (SMD) and 95% confidence interval (CI) was performed with RevMan 5.3. we appraise risk of bias(RoB) of each study with the Cochrane RoB tool. Detailed instructions for using the Cochrane RoB tool are provided in the Cochrane Handbook for Systematic Reviews of Interventions (The Cochrane Handbook). Nine studies were obtained from eight databases after screening by inclusion and exclusion criteria, 567 patients from 9 studies were included in the meta-analysis, and one study was included in the qualitative analysis due to different control groups. Two of the nine studies had an unclear risk of bias, and four studies were at low risk. The results showed that iTBS significantly improved SSA, PAS, FOIS, and PAS scores in stroke patients compared to the control group(P < 0.05), and promoted swallowing function recovery. Our systematic review provides the first evidence of the efficacy of iTBS in improving dysphagia in stroke patients. However, the number of available studies limits the persuasiveness of the evidence and further validation by additional randomized controlled trials is needed.
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Affiliation(s)
- Dongmiao Han
- Department of Rehabilitation Therapy Teaching and Research, Gannan Healthcare Vocational College, Ganzhou, Jiangxi Province, 341000, China
| | - Jinling Cheng
- Department of Rehabilitation Medicine, Shaoguan First People's Hospital, Shaoguan, Guangdong Province, 512000, China
| | - Yanfeng Chen
- Rehabilitation School of Gannan Medical University, Ganzhou, Jiangxi Province, 341000, China
| | - Hui Du
- Rehabilitation School of Gannan Medical University, Ganzhou, Jiangxi Province, 341000, China
| | - Zhanxiang Lin
- Rehabilitation School of Gannan Medical University, Ganzhou, Jiangxi Province, 341000, China
| | - Renlong Zhong
- Department of Rehabilitation Therapy Teaching and Research, Gannan Healthcare Vocational College, Ganzhou, Jiangxi Province, 341000, China.
| | - Zicai Liu
- Department of Rehabilitation Medicine, Shaoguan First People's Hospital, Shaoguan, Guangdong Province, 512000, China.
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4
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Yu P, Dong R, Wang X, Tang Y, Liu Y, Wang C, Zhao L. Neuroimaging of motor recovery after ischemic stroke - functional reorganization of motor network. Neuroimage Clin 2024; 43:103636. [PMID: 38950504 PMCID: PMC11267109 DOI: 10.1016/j.nicl.2024.103636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 06/01/2024] [Accepted: 06/27/2024] [Indexed: 07/03/2024]
Abstract
The long-term motor outcome of acute stroke patients may be correlated to the reorganization of brain motor network. Abundant neuroimaging studies contribute to understand the pathological changes and recovery of motor networks after stroke. In this review, we summarized how current neuroimaging studies have increased understanding of reorganization and plasticity in post stroke motor recovery. Firstly, we discussed the changes in the motor network over time during the motor-activation and resting states, as well as the overall functional integration trend of the motor network. These studies indicate that the motor network undergoes dynamic bilateral hemispheric functional reorganization, as well as a trend towards network randomization. In the second part, we summarized the current study progress in the application of neuroimaging technology to early predict the post-stroke motor outcome. In the third part, we discuss the neuroimaging techniques commonly used in the post-stroke recovery. These methods provide direct or indirect visualization patterns to understand the neural mechanisms of post-stroke motor recovery, opening up new avenues for studying spontaneous and treatment-induced recovery and plasticity after stroke.
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Affiliation(s)
- Pei Yu
- School of Acupuncture and Massage, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Ruoyu Dong
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Xiao Wang
- School of Acupuncture and Massage, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yuqi Tang
- School of Acupuncture and Massage, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yaning Liu
- School of Acupuncture and Massage, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Can Wang
- School of Acupuncture and Massage, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Ling Zhao
- School of Acupuncture and Massage, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
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5
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Bandet MV, Winship IR. Aberrant cortical activity, functional connectivity, and neural assembly architecture after photothrombotic stroke in mice. eLife 2024; 12:RP90080. [PMID: 38687189 PMCID: PMC11060715 DOI: 10.7554/elife.90080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
Despite substantial progress in mapping the trajectory of network plasticity resulting from focal ischemic stroke, the extent and nature of changes in neuronal excitability and activity within the peri-infarct cortex of mice remains poorly defined. Most of the available data have been acquired from anesthetized animals, acute tissue slices, or infer changes in excitability from immunoassays on extracted tissue, and thus may not reflect cortical activity dynamics in the intact cortex of an awake animal. Here, in vivo two-photon calcium imaging in awake, behaving mice was used to longitudinally track cortical activity, network functional connectivity, and neural assembly architecture for 2 months following photothrombotic stroke targeting the forelimb somatosensory cortex. Sensorimotor recovery was tracked over the weeks following stroke, allowing us to relate network changes to behavior. Our data revealed spatially restricted but long-lasting alterations in somatosensory neural network function and connectivity. Specifically, we demonstrate significant and long-lasting disruptions in neural assembly architecture concurrent with a deficit in functional connectivity between individual neurons. Reductions in neuronal spiking in peri-infarct cortex were transient but predictive of impairment in skilled locomotion measured in the tapered beam task. Notably, altered neural networks were highly localized, with assembly architecture and neural connectivity relatively unaltered a short distance from the peri-infarct cortex, even in regions within 'remapped' forelimb functional representations identified using mesoscale imaging with anaesthetized preparations 8 weeks after stroke. Thus, using longitudinal two-photon microscopy in awake animals, these data show a complex spatiotemporal relationship between peri-infarct neuronal network function and behavioral recovery. Moreover, the data highlight an apparent disconnect between dramatic functional remapping identified using strong sensory stimulation in anaesthetized mice compared to more subtle and spatially restricted changes in individual neuron and local network function in awake mice during stroke recovery.
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Affiliation(s)
- Mischa Vance Bandet
- Neuroscience and Mental Health Institute, University of AlbertaEdmontonCanada
- Neurochemical Research Unit, University of AlbertaEdmontonCanada
- Department of Psychiatry, University of AlbertaEdmontonCanada
| | - Ian Robert Winship
- Neuroscience and Mental Health Institute, University of AlbertaEdmontonCanada
- Neurochemical Research Unit, University of AlbertaEdmontonCanada
- Department of Psychiatry, University of AlbertaEdmontonCanada
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6
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Dahms C, Noll A, Wagner F, Schmidt A, Brodoehl S, Klingner CM. Connecting the dots: Motor and default mode network crossroads in post-stroke motor learning deficits. Neuroimage Clin 2024; 42:103601. [PMID: 38579595 PMCID: PMC11004993 DOI: 10.1016/j.nicl.2024.103601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 03/20/2024] [Accepted: 04/01/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Strokes frequently result in long-term motor deficits, imposing significant personal and economic burdens. However, our understanding of the underlying neural mechanisms governing motor learning in stroke survivors remains limited - a fact that poses significant challenges to the development and optimisation of therapeutic strategies. OBJECTIVE This study investigates the diversity in motor learning aptitude and its associated neurological mechanisms. We hypothesised that stroke patients exhibit compromised overall motor learning capacity, which is associated with altered activity and connectivity patterns in the motor- and default-mode-network in the brain. METHODS We assessed a cohort of 40 chronic-stage, mildly impaired stroke survivors and 39 age-matched healthy controls using functional Magnetic Resonance Imaging (fMRI) and connectivity analyses. We focused on neural activity and connectivity patterns during an unilateral motor sequence learning task performed with the unimpaired or non-dominant hand. Primary outcome measures included task-induced changes in neural activity and network connectivity. RESULTS Compared to controls, stroke patients showed significantly reduced motor learning capacity, associated with diminished cerebral lateralization. Task induced activity modulation was reduced in the motor network but increased in the default mode network. The modulated activation strength was associated with an opposing trend in task-induced functional connectivity, with increased connectivity in the motor network and decreased connectivity in the DMN. CONCLUSIONS Stroke patients demonstrate altered neural activity and connectivity patterns during motor learning with their unaffected hand, potentially contributing to globally impaired motor learning skills. The reduced ability to lateralize cerebral activation, along with the enhanced connectivity between the right and left motor cortices in these patients, may signify maladaptive neural processes that impede motor adaptation, possibly affecting long-term rehabilitation post-stroke. The contrasting pattern of activity modulation and connectivity alteration in the default mode network suggests a nuanced role of this network in post-stroke motor learning. These insights could have significant implications for the development of customised rehabilitation strategies for stroke patients.
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Affiliation(s)
- Christiane Dahms
- Department of Neurology, Jena University Hospital, Germany; Biomagnetic Center, Jena University Hospital, Germany.
| | - Alexander Noll
- Department of Neurology, Jena University Hospital, Germany; Biomagnetic Center, Jena University Hospital, Germany
| | - Franziska Wagner
- Department of Neurology, Jena University Hospital, Germany; Biomagnetic Center, Jena University Hospital, Germany
| | - Alexander Schmidt
- Department of Neurology, Jena University Hospital, Germany; Biomagnetic Center, Jena University Hospital, Germany
| | - Stefan Brodoehl
- Department of Neurology, Jena University Hospital, Germany; Biomagnetic Center, Jena University Hospital, Germany
| | - Carsten M Klingner
- Department of Neurology, Jena University Hospital, Germany; Biomagnetic Center, Jena University Hospital, Germany
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7
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Raj A, Sipes BS, Verma P, Mathalon DH, Biswal B, Nagarajan S. Spectral graph model for fMRI: a biophysical, connectivity-based generative model for the analysis of frequency-resolved resting state fMRI. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.22.586305. [PMID: 38586057 PMCID: PMC10996488 DOI: 10.1101/2024.03.22.586305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Resting state functional MRI (rs-fMRI) is a popular and widely used technique to explore the brain's functional organization and to examine if it is altered in neurological or mental disorders. The most common approach for its analysis targets the measurement of the synchronized fluctuations between brain regions, characterized as functional connectivity (FC), typically relying on pairwise correlations in activity across different brain regions. While hugely successful in exploring state- and disease-dependent network alterations, these statistical graph theory tools suffer from two key limitations. First, they discard useful information about the rich frequency content of the fMRI signal. The rich spectral information now achievable from advances in fast multiband acquisitions is consequently being under-utilized. Second, the analyzed FCs are phenomenological without a direct neurobiological underpinning in the underlying structures and processes in the brain. There does not currently exist a complete generative model framework for whole brain resting fMRI that is informed by its underlying biological basis in the structural connectome. Here we propose that a different approach can solve both challenges at once: the use of an appropriately realistic yet parsimonious biophysical signal generation model followed by graph spectral (i.e. eigen) decomposition. We call this model a Spectral Graph Model (SGM) for fMRI, using which we can not only quantify the structure-function relationship in individual subjects, but also condense the variable and individual-specific repertoire of fMRI signal's spectral and spatial features into a small number of biophysically-interpretable parameters. We expect this model-based inference of rs-fMRI that seamlessly integrates with structure can be used to examine state and trait characteristics of structure-function relations in a variety of brain disorders.
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Affiliation(s)
- Ashish Raj
- Department of Radiology and Biomedical Imaging, and Graduate Program in Bio-engineering, University of California, San Francisco, San Francisco, CA 94143
| | - Benjamin S Sipes
- Department of Radiology and Biomedical Imaging, and Graduate Program in Bio-engineering, University of California, San Francisco, San Francisco, CA 94143
| | - Parul Verma
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA 94143
| | - Daniel H Mathalon
- Department of Psychiatry and Behavioral Sciences, UCSF, University of California, San Francisco, and Veterans Affairs San Francisco Health Care System, San Francisco, CA 94121
| | - Bharat Biswal
- Department of Biomedical Engineering, New Jersey Institute of Technology, 619 Fenster Hall, Newark, NJ 07102
| | - Srikantan Nagarajan
- Department of Radiology and Biomedical Imaging, and Graduate Program in Bio-engineering, University of California, San Francisco, San Francisco, CA 94143
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Koukalova L, Chmelova M, Amlerova Z, Vargova L. Out of the core: the impact of focal ischemia in regions beyond the penumbra. Front Cell Neurosci 2024; 18:1336886. [PMID: 38504666 PMCID: PMC10948541 DOI: 10.3389/fncel.2024.1336886] [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: 11/11/2023] [Accepted: 02/08/2024] [Indexed: 03/21/2024] Open
Abstract
The changes in the necrotic core and the penumbra following induction of focal ischemia have been the focus of attention for some time. However, evidence shows, that ischemic injury is not confined to the primarily affected structures and may influence the remote areas as well. Yet many studies fail to probe into the structures beyond the penumbra, and possibly do not even find any significant results due to their short-term design, as secondary damage occurs later. This slower reaction can be perceived as a therapeutic opportunity, in contrast to the ischemic core defined as irreversibly damaged tissue, where the window for salvation is comparatively short. The pathologies in remote structures occur relatively frequently and are clearly linked to the post-stroke neurological outcome. In order to develop efficient therapies, a deeper understanding of what exactly happens in the exo-focal regions is necessary. The mechanisms of glia contribution to the ischemic damage in core/penumbra are relatively well described and include impaired ion homeostasis, excessive cell swelling, glutamate excitotoxic mechanism, release of pro-inflammatory cytokines and phagocytosis or damage propagation via astrocytic syncytia. However, little is known about glia involvement in post-ischemic processes in remote areas. In this literature review, we discuss the definitions of the terms "ischemic core", "penumbra" and "remote areas." Furthermore, we present evidence showing the array of structural and functional changes in the more remote regions from the primary site of focal ischemia, with a special focus on glia and the extracellular matrix. The collected information is compared with the processes commonly occurring in the ischemic core or in the penumbra. Moreover, the possible causes of this phenomenon and the approaches for investigation are described, and finally, we evaluate the efficacy of therapies, which have been studied for their anti-ischemic effect in remote areas in recent years.
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Affiliation(s)
- Ludmila Koukalova
- Department of Neuroscience, Second Faculty of Medicine, Charles University, Prague, Czechia
| | - Martina Chmelova
- Department of Neuroscience, Second Faculty of Medicine, Charles University, Prague, Czechia
- Department of Cellular Neurophysiology, Institute of Experimental Medicine of the Czech Academy of Sciences, Prague, Czechia
| | - Zuzana Amlerova
- Department of Neuroscience, Second Faculty of Medicine, Charles University, Prague, Czechia
| | - Lydia Vargova
- Department of Neuroscience, Second Faculty of Medicine, Charles University, Prague, Czechia
- Department of Cellular Neurophysiology, Institute of Experimental Medicine of the Czech Academy of Sciences, Prague, Czechia
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9
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Rösch J, Emanuel Vetter D, Baldassarre A, Souza VH, Lioumis P, Roine T, Jooß A, Baur D, Kozák G, Blair Jovellar D, Vaalto S, Romani GL, Ilmoniemi RJ, Ziemann U. Individualized treatment of motor stroke: A perspective on open-loop, closed-loop and adaptive closed-loop brain state-dependent TMS. Clin Neurophysiol 2024; 158:204-211. [PMID: 37945452 DOI: 10.1016/j.clinph.2023.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/11/2023] [Accepted: 10/18/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Johanna Rösch
- Department of Neurology and Stroke, University of Tübingen, Tübingen, Germany; Hertie-Institute for Clinical Brain Research, Tübingen, Germany
| | - David Emanuel Vetter
- Department of Neurology and Stroke, University of Tübingen, Tübingen, Germany; Hertie-Institute for Clinical Brain Research, Tübingen, Germany
| | - Antonello Baldassarre
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Victor H Souza
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland; BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki, Aalto University and Helsinki University Hospital, Helsinki, Finland
| | - Pantelis Lioumis
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland; BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki, Aalto University and Helsinki University Hospital, Helsinki, Finland
| | - Timo Roine
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland; BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki, Aalto University and Helsinki University Hospital, Helsinki, Finland
| | - Andreas Jooß
- Department of Neurology and Stroke, University of Tübingen, Tübingen, Germany; Hertie-Institute for Clinical Brain Research, Tübingen, Germany
| | - David Baur
- Department of Neurology and Stroke, University of Tübingen, Tübingen, Germany; Hertie-Institute for Clinical Brain Research, Tübingen, Germany
| | - Gábor Kozák
- Department of Neurology and Stroke, University of Tübingen, Tübingen, Germany; Hertie-Institute for Clinical Brain Research, Tübingen, Germany
| | - D Blair Jovellar
- Department of Neurology and Stroke, University of Tübingen, Tübingen, Germany; Hertie-Institute for Clinical Brain Research, Tübingen, Germany
| | - Selja Vaalto
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland; HUS Diagnostic Center, Clinical Neurophysiology, Clinical Neurosciences, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Gian Luca Romani
- Institute for Advanced Biomedical Technologies, University of Chieti-Pescara, Chieti, Italy
| | - Risto J Ilmoniemi
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland; BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki, Aalto University and Helsinki University Hospital, Helsinki, Finland
| | - Ulf Ziemann
- Department of Neurology and Stroke, University of Tübingen, Tübingen, Germany; Hertie-Institute for Clinical Brain Research, Tübingen, Germany.
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10
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Ye C, Kwapong WR, Tang B, Liu J, Tao W, Lu K, Pan R, Wang A, Liao L, Yang T, Cao L, Wang Y, Jiang S, Zhang X, Liu M, Wu B. Association between functional network connectivity, retina structure and microvasculature, and visual performance in patients after thalamic stroke: An exploratory multi-modality study. Brain Behav 2024; 14:e3385. [PMID: 38376035 PMCID: PMC10794127 DOI: 10.1002/brb3.3385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/06/2023] [Accepted: 12/21/2023] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Neuro-ophthalmologic symptoms and retinal changes have been increasingly observed following thalamic stroke, and there is mounting evidence indicating distinct alterations occurring in the vision-related functional network. However, the intrinsic correlations between these changes are not yet fully understood. Our objective was to explore the altered patterns of functional network connectivity and retina parameters, and their correlations with visual performance in patients with thalamic stroke. METHODS We utilized resting-state functional MRI to obtain multi-modular functional connectivity (FC), and optical coherence tomography-angiography to measure various retina parameters, such as the retinal nerve fiber layer (RNFL), ganglion cell-inner plexiform layer (GCIPL), superficial vascular complex (SVC), and deep vascular complex. Visual acuity (VA) was used as a metric for visual performance. RESULTS We included 46 patients with first-ever unilateral thalamic stroke (mean age 59.74 ± 10.02 years, 33 males). Significant associations were found between FC of attention-to-default mode and SVC, RNFL, and GCIPL, as well as between FC of attention-to-visual and RNFL (p < .05). Both RNFL and GCIPL exhibited significant associations with FC of visual-to-visual (p < .05). Only GCIPL showed an association with VA (p = .038). Stratified analysis based on a disease duration of 6 months revealed distinct and significant linking patterns in multi-modular FC and specific retina parameters, with varying correlations with VA in each subgroup. CONCLUSION These findings provide valuable insight into the neural basis of the associations between brain network dysfunction and impaired visual performance in patients with thalamic stroke. Our novel findings have the potential to inform future targeted and individualized therapies. However, further comprehensive studies are necessary to validate our results.
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Affiliation(s)
- Chen Ye
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - William Robert Kwapong
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - Biqiu Tang
- Department of Radiology, Huaxi MR Research Center (HMRRC)West China Hospital, Sichuan UniversityChengduChina
| | - Junfeng Liu
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - Wendan Tao
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - Kun Lu
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Ruosu Pan
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Anmo Wang
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Lanhua Liao
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Tang Yang
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Le Cao
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Youjie Wang
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Shuai Jiang
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Xuening Zhang
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Ming Liu
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - Bo Wu
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
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11
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Qi Y, Xu Y, Wang H, Wang Q, Li M, Han B, Liu H. Network Reorganization for Neurophysiological and Behavioral Recovery Following Stroke. Cent Nerv Syst Agents Med Chem 2024; 24:117-128. [PMID: 38299298 DOI: 10.2174/0118715249277597231226064144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/15/2023] [Accepted: 12/06/2023] [Indexed: 02/02/2024]
Abstract
Stroke continues to be the main cause of motor disability worldwide. While rehabilitation has been promised to improve recovery after stroke, efficacy in clinical trials has been mixed. We need to understand the cortical recombination framework to understand how biomarkers for neurophysiological reorganized neurotechnologies alter network activity. Here, we summarize the principles of the movement network, including the current evidence of changes in the connections and function of encephalic regions, recovery from stroke and the therapeutic effects of rehabilitation. Overall, improvements or therapeutic effects in limb motor control following stroke are correlated with the effects of interhemispheric competition or compensatory models of the motor supplementary cortex. This review suggests that future research should focus on cross-regional communication and provide fundamental insights into further treatment and rehabilitation for post-stroke patients.
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Affiliation(s)
- Yuan Qi
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing CN, China
| | - Yujie Xu
- Chengde Medical College Affiliated Hospital, Chengde, Hebei, CN, China
| | - Huailu Wang
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing CN, China
| | - Qiujia Wang
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing CN, China
| | - Meijie Li
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing CN, China
| | - Bo Han
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing CN, China
| | - Haijie Liu
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing CN, China
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12
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Xie H, Li X, Xu G, Huo C, Fan Y, Li Z, Dou Z. Effects of transcranial magnetic stimulation on dynamic functional networks in stroke patients as assessed by functional near-infrared spectroscopy: a randomized controlled clinical trial. Cereb Cortex 2023; 33:11668-11678. [PMID: 37885140 DOI: 10.1093/cercor/bhad404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/28/2023] Open
Abstract
Studies have shown that there is heterogeneity in the efficacy bewteen the low-frequency (LF) and high-frequency (HF) repetitive transcranial magnetic stimulation (rTMS), but the neural mechanisms underlying the differences in efficacy remain unclear. This study aimed to investigate the specific effects of LF- and HF-rTMS on cortial functional network and the process of neural regulation. A total of sixty-eight patients with hemiplegic motor impairment after stroke were randomly allocated to one of three groups: the LF-rTMS, HF-rTMS, and sham groups. Tissue concentrations of oxyhaemoglobin and deoxyhaemoglobin oscillations in cerebral cortex regions were measured by functional near-infrared spectroscopy (fNIRS) in the resting and rTMS states. Four specific time-windows were divided from the trial duration to observe dynamic changes in cortical haemodynamic responses. Compared with sham, LF-rTMS significantly induced the activation of the contralesional superior frontal cortex and premotor cortex, and continuously regulated ipsilesional hemisphere functional networks in stroke patients. However, HF-rTMS did not induce a significant neurovascular coupling response. Our study provided evidence that LF- and HF-rTMS interventions induced different neurovascular coupling responses and demonstrated the cortical functional network change process of rTMS in specific time-windows. These findings may help to understand the differences in the efficacy of rTMS modalities.
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Affiliation(s)
- Hui Xie
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing 100086, China
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing 100176, China
| | - Xin Li
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Gongcheng Xu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing 100086, China
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing 100176, China
| | - Congcong Huo
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing 100086, China
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing 100176, China
| | - Yubo Fan
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing 100086, China
| | - Zengyong Li
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing 100176, China
| | - Zulin Dou
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
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13
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Wang H, Yu M, Ren J, Zhong X, Xu D, Gao L, Xu H. Neuroanatomical correlates of cognitive impairment following basal ganglia-thalamic post-hemorrhagic stroke: Uncovering network-wide alterations in hemispheric gray matter asymmetry. Brain Res 2023; 1820:148559. [PMID: 37652090 DOI: 10.1016/j.brainres.2023.148559] [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: 04/12/2023] [Revised: 08/16/2023] [Accepted: 08/26/2023] [Indexed: 09/02/2023]
Abstract
Cognitive impairment and recovery are central issues in hemorrhagic stroke. This study aimed to investigate whether post-hemorrhagic stroke cognitive impairment (PhSCI) is associated with cortical gray matter (GM) loss and hemispheric asymmetry changes and whether these changes could predict improvements in cognitive function during the recovery. Nineteen patients with PhSCI, comprising 10 with basal ganglia hemorrhage and 9 with thalamic hemorrhage, were recruited. Among them, 9 completed a course of repetitive transcranial magnetic stimulation (rTMS). Additionally, 19 demographically and comorbidity-matched healthy controls were also included. Structural brain MRI and cognitive assessments were performed. Voxel-wise GM volume and hemispheric asymmetry were analyzed. The PhSCI patients exhibited bilateral, yet asymmetric, GM losses in the hippocampus, fusiform, lateral temporal, prefrontal, somatomotor, and inferior parietal regions. The analysis of GM asymmetry revealed that patients showed rightward GM in the lateral temporal, somatomotor, and inferior parietal regions. Among the 9 PhSCI patients who completed rTMS, there was a marginal trend of regional GM increase and leftward GM, and these changes were in parallel with the improvements in cognitive tests. Further lesion connectivity and metanalytic mapping identified two interconnected systems linked to the lesions, which were anchored in the default mode, somatomotor, and salience/cognitive control networks and in the cognitive domains of memory, language, decision-making, and executive function. In conclusion, PhSCI patients exhibited network-wide cortical GM losses, distal to subcortical hemorrhagic lesions, and hemisphere asymmetry changes. These changes appear to predict rTMS-related cognitive improvements, suggesting that even subcortical focal lesions can lead to alterations in distal cortical neuroanatomical architecture. Our preliminary findings provide new insights into the neuroanatomical basis of PhSCI.
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Affiliation(s)
- Huan Wang
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan City 430071, Hubei Province, China
| | - Minhua Yu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan City 430071, Hubei Province, China
| | - Jinxia Ren
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan City 430071, Hubei Province, China
| | - Xiaoli Zhong
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan City 430071, Hubei Province, China
| | - Dan Xu
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan City 430071, Hubei Province, China
| | - Lei Gao
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan City 430071, Hubei Province, China.
| | - Haibo Xu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan City 430071, Hubei Province, China.
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14
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Paul T, Wiemer VM, Hensel L, Cieslak M, Tscherpel C, Grefkes C, Grafton ST, Fink GR, Volz LJ. Interhemispheric Structural Connectivity Underlies Motor Recovery after Stroke. Ann Neurol 2023; 94:785-797. [PMID: 37402647 DOI: 10.1002/ana.26737] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 06/29/2023] [Accepted: 06/29/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVE Although ample evidence highlights that the ipsilesional corticospinal tract (CST) plays a crucial role in motor recovery after stroke, studies on cortico-cortical motor connections remain scarce and provide inconclusive results. Given their unique potential to serve as structural reserve enabling motor network reorganization, the question arises whether cortico-cortical connections may facilitate motor control depending on CST damage. METHODS Diffusion spectrum imaging (DSI) and a novel compartment-wise analysis approach were used to quantify structural connectivity between bilateral cortical core motor regions in chronic stroke patients. Basal and complex motor control were differentially assessed. RESULTS Both basal and complex motor performance were correlated with structural connectivity between bilateral premotor areas and ipsilesional primary motor cortex (M1) as well as interhemispheric M1 to M1 connectivity. Whereas complex motor skills depended on CST integrity, a strong association between M1 to M1 connectivity and basal motor control was observed independent of CST integrity especially in patients who underwent substantial motor recovery. Harnessing the informational wealth of cortico-cortical connectivity facilitated the explanation of both basal and complex motor control. INTERPRETATION We demonstrate for the first time that distinct aspects of cortical structural reserve enable basal and complex motor control after stroke. In particular, recovery of basal motor control may be supported via an alternative route through contralesional M1 and non-crossing fibers of the contralesional CST. Our findings help to explain previous conflicting interpretations regarding the functional role of the contralesional M1 and highlight the potential of cortico-cortical structural connectivity as a future biomarker for motor recovery post-stroke. ANN NEUROL 2023;94:785-797.
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Affiliation(s)
- Theresa Paul
- Medical Faculty, University of Cologne, and Department of Neurology, University Hospital Cologne, Cologne, Germany
- Institute of Neuroscience and Medicine, Cognitive Neuroscience (INM-3), Research Centre Juelich, Juelich, Germany
| | - Valerie M Wiemer
- Medical Faculty, University of Cologne, and Department of Neurology, University Hospital Cologne, Cologne, Germany
- Institute of Neuroscience and Medicine, Cognitive Neuroscience (INM-3), Research Centre Juelich, Juelich, Germany
| | - Lukas Hensel
- Medical Faculty, University of Cologne, and Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Matthew Cieslak
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Caroline Tscherpel
- Medical Faculty, University of Cologne, and Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Christian Grefkes
- Department of Neurology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Scott T Grafton
- Department of Psychological & Brain Sciences, University of California, Santa Barbara, CA
| | - Gereon R Fink
- Medical Faculty, University of Cologne, and Department of Neurology, University Hospital Cologne, Cologne, Germany
- Institute of Neuroscience and Medicine, Cognitive Neuroscience (INM-3), Research Centre Juelich, Juelich, Germany
| | - Lukas J Volz
- Medical Faculty, University of Cologne, and Department of Neurology, University Hospital Cologne, Cologne, Germany
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15
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Reibelt A, Quandt F, Schulz R. Posterior parietal cortical areas and recovery after motor stroke: a scoping review. Brain Commun 2023; 5:fcad250. [PMID: 37810465 PMCID: PMC10551853 DOI: 10.1093/braincomms/fcad250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/25/2023] [Accepted: 09/25/2023] [Indexed: 10/10/2023] Open
Abstract
Brain imaging and electrophysiology have significantly enhanced our current understanding of stroke-related changes in brain structure and function and their implications for recovery processes. In the motor domain, most studies have focused on key motor areas of the frontal lobe including the primary and secondary motor cortices. Time- and recovery-dependent alterations in regional anatomy, brain activity and inter-regional connectivity have been related to recovery. In contrast, the involvement of posterior parietal cortical areas in stroke recovery is poorly understood although these regions are similarly important for important aspects of motor functioning in the healthy brain. Just in recent years, the field has increasingly started to explore to what extent posterior parietal cortical areas might undergo equivalent changes in task-related activation, regional brain structure and inter-regional functional and structural connectivity after stroke. The aim of this scoping review is to give an update on available data covering these aspects and thereby providing novel insights into parieto-frontal interactions for systems neuroscience stroke recovery research in the upper limb motor domain.
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Affiliation(s)
- Antonia Reibelt
- Experimental Electrophysiology and Neuroimaging Lab, Department of Neurology, University Medical Center Hamburg Eppendorf, 20246 Hamburg, Germany
| | - Fanny Quandt
- Experimental Electrophysiology and Neuroimaging Lab, Department of Neurology, University Medical Center Hamburg Eppendorf, 20246 Hamburg, Germany
| | - Robert Schulz
- Experimental Electrophysiology and Neuroimaging Lab, Department of Neurology, University Medical Center Hamburg Eppendorf, 20246 Hamburg, Germany
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16
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Cleland BT, Giffhorn M, Jayaraman A, Madhavan S. Understanding corticomotor mechanisms for activation of non-target muscles during unilateral isometric contractions of leg muscles after stroke. Int J Neurosci 2023:1-10. [PMID: 37750212 PMCID: PMC10963339 DOI: 10.1080/00207454.2023.2263817] [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: 06/23/2023] [Accepted: 09/22/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE Muscle activation often occurs in muscles ipsilateral to a voluntarily activated muscle and to a greater extent after stroke. In this study, we measured muscle activation in non-target, ipsilateral leg muscles and used transcranial magnetic stimulation (TMS) to provide insight into whether corticomotor pathways contribute to involuntary activation. MATERIALS AND METHODS Individuals with stroke performed unilateral isometric ankle dorsiflexion, ankle plantarflexion, knee extension, and knee flexion. To quantify involuntary muscle activation in non-target muscles, muscle activation was measured during contractions from the ipsilateral tibialis anterior (TA), medial gastrocnemius (MG), rectus femoris (RF), and biceps femoris (BF) and normalized to resting muscle activity. To provide insight into mechanisms of involuntary non-target muscle activation, TMS was applied to the contralateral hemisphere, and motor evoked potentials (MEPs) were recorded. RESULTS We found significant muscle activation in nearly every non-target muscle during isometric unilateral contractions. MEPs were frequently observed in non-target muscles, but greater non-target MEP amplitude was not associated with greater non-target muscle activation. CONCLUSIONS Our results suggest that non-target muscle activation occurs frequently in individuals with chronic stroke. The lack of association between non-target TMS responses and non-target muscle activation suggests that non-target muscle activation may have a subcortical or spinal origin. Non-target muscle activation has important clinical implications because it may impair torque production, out-of-synergy movement, and muscle activation timing.
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Affiliation(s)
- Brice T Cleland
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences University of Illinois Chicago, Chicago, IL, USA
| | - Matt Giffhorn
- Max Nader Center for Rehabilitation Technologies & Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Arun Jayaraman
- Max Nader Center for Rehabilitation Technologies & Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Sangeetha Madhavan
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences University of Illinois Chicago, Chicago, IL, USA
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17
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Qi F, Nitsche MA, Ren X, Wang D, Wang L. Top-down and bottom-up stimulation techniques combined with action observation treatment in stroke rehabilitation: a perspective. Front Neurol 2023; 14:1156987. [PMID: 37497013 PMCID: PMC10367110 DOI: 10.3389/fneur.2023.1156987] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/26/2023] [Indexed: 07/28/2023] Open
Abstract
Stroke is a central nervous system disease that causes structural lesions and functional impairments of the brain, resulting in varying types, and degrees of dysfunction. The bimodal balance-recovery model (interhemispheric competition model and vicariation model) has been proposed as the mechanism of functional recovery after a stroke. We analyzed how combinations of motor observation treatment approaches, transcranial electrical (TES) or magnetic (TMS) stimulation and peripheral electrical (PES) or magnetic (PMS) stimulation techniques can be taken as accessorial physical therapy methods on symptom reduction of stroke patients. We suggest that top-down and bottom-up stimulation techniques combined with action observation treatment synergistically might develop into valuable physical therapy strategies in neurorehabilitation after stroke. We explored how TES or TMS intervention over the contralesional hemisphere or the lesioned hemisphere combined with PES or PMS of the paretic limbs during motor observation followed by action execution have super-additive effects to potentiate the effect of conventional treatment in stroke patients. The proposed paradigm could be an innovative and adjunctive approach to potentiate the effect of conventional rehabilitation treatment, especially for those patients with severe motor deficits.
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Affiliation(s)
- Fengxue Qi
- Sports, Exercise and Brain Sciences Laboratory, Beijing Sport University, Beijing, China
| | - Michael A. Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Xiping Ren
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, China
| | - Duanwei Wang
- Shandong Mental Health Center, Shandong University, Jinan, Shandong, China
| | - Lijuan Wang
- Key Laboratory of Exercise and Physical Fitness, Ministry of Education, Beijing Sport University, Beijing, China
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
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18
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Braaß H, Gutgesell L, Backhaus W, Higgen FL, Quandt F, Choe CU, Gerloff C, Schulz R. Early functional connectivity alterations in contralesional motor networks influence outcome after severe stroke: a preliminary analysis. Sci Rep 2023; 13:11010. [PMID: 37419966 PMCID: PMC10328915 DOI: 10.1038/s41598-023-38066-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 07/02/2023] [Indexed: 07/09/2023] Open
Abstract
Connectivity studies have significantly extended the knowledge on motor network alterations after stroke. Compared to interhemispheric or ipsilesional networks, changes in the contralesional hemisphere are poorly understood. Data obtained in the acute stage after stroke and in severely impaired patients are remarkably limited. This exploratory, preliminary study aimed to investigate early functional connectivity changes of the contralesional parieto-frontal motor network and their relevance for the functional outcome after severe motor stroke. Resting-state functional imaging data were acquired in 19 patients within the first 2 weeks after severe stroke. Nineteen healthy participants served as a control group. Functional connectivity was calculated from five key motor areas of the parieto-frontal network on the contralesional hemisphere as seed regions and compared between the groups. Connections exhibiting stroke-related alterations were correlated with clinical follow-up data obtained after 3-6 months. The main finding was an increase in coupling strength between the contralesional supplementary motor area and the sensorimotor cortex. This increase was linked to persistent clinical deficits at follow-up. Thus, an upregulation in contralesional motor network connectivity might be an early pattern in severely impaired stroke patients. It might carry relevant information regarding the outcome which adds to the current concepts of brain network alterations and recovery processes after severe stroke.
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Affiliation(s)
- Hanna Braaß
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Lily Gutgesell
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Winifried Backhaus
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Focko L Higgen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Fanny Quandt
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Chi-Un Choe
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Robert Schulz
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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19
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Chen R, Dadario NB, Cook B, Sun L, Wang X, Li Y, Hu X, Zhang X, Sughrue ME. Connectomic insight into unique stroke patient recovery after rTMS treatment. Front Neurol 2023; 14:1063408. [PMID: 37483442 PMCID: PMC10359072 DOI: 10.3389/fneur.2023.1063408] [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: 10/07/2022] [Accepted: 06/13/2023] [Indexed: 07/25/2023] Open
Abstract
An improved understanding of the neuroplastic potential of the brain has allowed advancements in neuromodulatory treatments for acute stroke patients. However, there remains a poor understanding of individual differences in treatment-induced recovery. Individualized information on connectivity disturbances may help predict differences in treatment response and recovery phenotypes. We studied the medical data of 22 ischemic stroke patients who received MRI scans and started repetitive transcranial magnetic stimulation (rTMS) treatment on the same day. The functional and motor outcomes were assessed at admission day, 1 day after treatment, 30 days after treatment, and 90 days after treatment using four validated standardized stroke outcome scales. Each patient underwent detailed baseline connectivity analyses to identify structural and functional connectivity disturbances. An unsupervised machine learning (ML) agglomerative hierarchical clustering method was utilized to group patients according to outcomes at four-time points to identify individual phenotypes in recovery trajectory. Differences in connectivity features were examined between individual clusters. Patients were a median age of 64, 50% female, and had a median hospital length of stay of 9.5 days. A significant improvement between all time points was demonstrated post treatment in three of four validated stroke scales utilized. ML-based analyses identified distinct clusters representing unique patient trajectories for each scale. Quantitative differences were found to exist in structural and functional connectivity analyses of the motor network and subcortical structures between individual clusters which could explain these unique trajectories on the Barthel Index (BI) scale but not on other stroke scales. This study demonstrates for the first time the feasibility of using individualized connectivity analyses in differentiating unique phenotypes in rTMS treatment responses and recovery. This personalized connectomic approach may be utilized in the future to better understand patient recovery trajectories with neuromodulatory treatment.
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Affiliation(s)
- Rong Chen
- The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Nicholas B. Dadario
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, United States
| | - Brennan Cook
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, United States
| | - Lichun Sun
- The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Xiaolong Wang
- The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Yujie Li
- The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Xiaorong Hu
- Xijia Medical Technology Company Limited, Shenzhen, China
| | - Xia Zhang
- Xijia Medical Technology Company Limited, Shenzhen, China
- International Joint Research Center on Precision Brain Medicine, XD Group Hospital, Xi'an, Shaanxi, China
| | - Michael E. Sughrue
- International Joint Research Center on Precision Brain Medicine, XD Group Hospital, Xi'an, Shaanxi, China
- Omniscient Neurotechnology, Sydney, NSW, Australia
- Cingulum Health, Sydney, NSW, Australia
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20
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Wang X, Luo Z, Zhang M, Zhao W, Xie S, Wong SF, Hu H, Li L. The interaction between changes of muscle activation and cortical network dynamics during isometric elbow contraction: a sEMG and fNIRS study. Front Bioeng Biotechnol 2023; 11:1176054. [PMID: 37180038 PMCID: PMC10167054 DOI: 10.3389/fbioe.2023.1176054] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/14/2023] [Indexed: 05/15/2023] Open
Abstract
Objective: The relationship between muscle activation during motor tasks and cerebral cortical activity remains poorly understood. The aim of this study was to investigate the correlation between brain network connectivity and the non-linear characteristics of muscle activation changes during different levels of isometric contractions. Methods: Twenty-one healthy subjects were recruited and were asked to perform isometric elbow contractions in both dominant and non-dominant sides. Blood oxygen concentrations in brain from functional Near-infrared Spectroscopy (fNIRS) and surface electromyography (sEMG) signals in the biceps brachii (BIC) and triceps brachii (TRI) muscles were recorded simultaneously and compared during 80% and 20% of maximum voluntary contraction (MVC). Functional connectivity, effective connectivity, and graph theory indicators were used to measure information interaction in brain activity during motor tasks. The non-linear characteristics of sEMG signals, fuzzy approximate entropy (fApEn), were used to evaluate the signal complexity changes in motor tasks. Pearson correlation analysis was used to examine the correlation between brain network characteristic values and sEMG parameters under different task conditions. Results: The effective connectivity between brain regions in motor tasks in dominant side was significantly higher than that in non-dominant side under different contractions (p < 0.05). The results of graph theory analysis showed that the clustering coefficient and node-local efficiency of the contralateral motor cortex were significantly varied under different contractions (p < 0.01). fApEn and co-contraction index (CCI) of sEMG under 80% MVC condition were significantly higher than that under 20% MVC condition (p < 0.05). There was a significant positive correlation between the fApEn and the blood oxygen value in the contralateral brain regions in both dominant or non-dominant sides (p < 0.001). The node-local efficiency of the contralateral motor cortex in the dominant side was positively correlated with the fApEn of the EMG signals (p < 0.05). Conclusion: In this study, the mapping relationship between brain network related indicators and non-linear characteristic of sEMG in different motor tasks was verified. These findings provide evidence for further exploration of the interaction between the brain activity and the execution of motor tasks, and the parameters might be useful in evaluation of rehabilitation intervention.
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Affiliation(s)
- Xiaohan Wang
- Institute of Medical Research, Northwestern Polytechnical University, Xi’an, China
| | - Zichong Luo
- Faculty of Science and Technology, University of Macau, Taipa, China
| | - Mingxia Zhang
- Institute of Medical Research, Northwestern Polytechnical University, Xi’an, China
| | - Weihua Zhao
- Hospital of Northwestern Polytechnical University, Xi’an, China
| | - Songyun Xie
- School of Electronics and Information, Northwestern Polytechnical University, Xi’an, China
| | - Seng Fat Wong
- Faculty of Science and Technology, University of Macau, Taipa, China
| | - Huijing Hu
- Institute of Medical Research, Northwestern Polytechnical University, Xi’an, China
| | - Le Li
- Institute of Medical Research, Northwestern Polytechnical University, Xi’an, China
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21
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Yüksel MM, Sun S, Latchoumane C, Bloch J, Courtine G, Raffin EE, Hummel FC. Low-Intensity Focused Ultrasound Neuromodulation for Stroke Recovery: A Novel Deep Brain Stimulation Approach for Neurorehabilitation? IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2023; 4:300-318. [PMID: 38196977 PMCID: PMC10776095 DOI: 10.1109/ojemb.2023.3263690] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/17/2023] [Accepted: 03/24/2023] [Indexed: 01/11/2024] Open
Abstract
Stroke as the leading cause of adult long-term disability and has a significant impact on patients, society and socio-economics. Non-invasive brain stimulation (NIBS) approaches such as transcranial magnetic stimulation (TMS) or transcranial electrical stimulation (tES) are considered as potential therapeutic options to enhance functional reorganization and augment the effects of neurorehabilitation. However, non-invasive electrical and magnetic stimulation paradigms are limited by their depth focality trade-off function that does not allow to target deep key brain structures critically important for recovery processes. Transcranial ultrasound stimulation (TUS) is an emerging approach for non-invasive deep brain neuromodulation. Using non-ionizing, ultrasonic waves with millimeter-accuracy spatial resolution, excellent steering capacity and long penetration depth, TUS has the potential to serve as a novel non-invasive deep brain stimulation method to establish unprecedented neuromodulation and novel neurorehabilitation protocols. The purpose of the present review is to provide an overview on the current knowledge about the neuromodulatory effects of TUS while discussing the potential of TUS in the field of stroke recovery, with respect to existing NIBS methods. We will address and discuss critically crucial open questions and remaining challenges that need to be addressed before establishing TUS as a new clinical neurorehabilitation approach for motor stroke recovery.
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Affiliation(s)
- Mahmut Martin Yüksel
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute and Brain Mind InstituteÉcole Polytechnique Fédérale de LausanneGeneva1201Switzerland
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute and Brain Mind InstituteÉcole Polytechnique Fédérale de Lausanne Valais, Clinique Romande de Réadaptation Sion1951Switzerland
| | - Shiqi Sun
- Neuro-X Institute and Brain Mind Institute, School of Life SciencesSwiss Federal Institute of Technology (EPFL)Lausanne1015Switzerland
- Department of Clinical NeuroscienceLausanne University Hospital (CHUV) and the University of Lausanne (UNIL)Lausanne1011Switzerland
- Defitech Center for Interventional Neurotherapies (NeuroRestore)EPFL/CHUV/UNILLausanne1011Switzerland
| | - Charles Latchoumane
- Neuro-X Institute and Brain Mind Institute, School of Life SciencesSwiss Federal Institute of Technology (EPFL)Lausanne1015Switzerland
- Department of Clinical NeuroscienceLausanne University Hospital (CHUV) and the University of Lausanne (UNIL)Lausanne1011Switzerland
- Defitech Center for Interventional Neurotherapies (NeuroRestore)EPFL/CHUV/UNILLausanne1011Switzerland
| | - Jocelyne Bloch
- Neuro-X Institute and Brain Mind Institute, School of Life SciencesSwiss Federal Institute of Technology (EPFL)Lausanne1015Switzerland
- Department of Clinical NeuroscienceLausanne University Hospital (CHUV) and the University of Lausanne (UNIL)Lausanne1015Switzerland
- Defitech Center for Interventional Neurotherapies (NeuroRestore)EPFL/CHUV/UNILLausanne1015Switzerland
- Department of NeurosurgeryLausanne University HospitalLausanne1011Switzerland
| | - Gregoire Courtine
- Department of Clinical NeuroscienceLausanne University Hospital (CHUV) and the University of Lausanne (UNIL)Lausanne1015Switzerland
- Defitech Center for Interventional Neurotherapies (NeuroRestore)EPFL/CHUV/UNILLausanne1015Switzerland
- Department of NeurosurgeryLausanne University HospitalLausanne1011Switzerland
| | - Estelle Emeline Raffin
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute and Brain Mind InstituteÉcole Polytechnique Fédérale de LausanneGeneva1201Switzerland
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute and Brain Mind InstituteÉcole Polytechnique Fédérale de Lausanne Valais, Clinique Romande de Réadaptation Sion1951Switzerland
| | - Friedhelm Christoph Hummel
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute and Brain Mind InstituteÉcole Polytechnique Fédérale de LausanneGeneva1202Switzerland
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute and Brain Mind InstituteÉcole Polytechnique Fédérale de Lausanne Valais, Clinique Romande de Réadaptation Sion1951Switzerland
- Clinical NeuroscienceUniversity of Geneva Medical SchoolGeneva1211Switzerland
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22
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Kolmos M, Madsen MJ, Liu ML, Karabanov A, Johansen KL, Thielscher A, Gandrup K, Lundell H, Fuglsang S, Thade E, Christensen H, Iversen HK, Siebner HR, Kruuse C. Patient-tailored transcranial direct current stimulation to improve stroke rehabilitation: study protocol of a randomized sham-controlled trial. Trials 2023; 24:216. [PMID: 36949490 PMCID: PMC10035265 DOI: 10.1186/s13063-023-07234-y] [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: 02/11/2023] [Accepted: 03/09/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Many patients do not fully regain motor function after ischemic stroke. Transcranial direct current stimulation (TDCS) targeting the motor cortex may improve motor outcome as an add-on intervention to physical rehabilitation. However, beneficial effects on motor function vary largely among patients within and across TDCS trials. In addition to a large heterogeneity of study designs, this variability may be caused by the fact that TDCS was given as a one-size-fits-all protocol without accounting for anatomical differences between subjects. The efficacy and consistency of TDCS might be improved by a patient-tailored design that ensures precise targeting of a physiologically relevant area with an appropriate current strength. METHODS In a randomized, double-blinded, sham-controlled trial, patients with subacute ischemic stroke and residual upper-extremity paresis will receive two times 20 min of focal TDCS of ipsilesional primary motor hand area (M1-HAND) during supervised rehabilitation training three times weekly for 4 weeks. Anticipated 60 patients will be randomly assigned to active or sham TDCS of ipsilesional M1-HAND, using a central anode and four equidistant cathodes. The placement of the electrode grid on the scalp and current strength at each cathode will be personalized based on individual electrical field models to induce an electrical current of 0.2 V/m in the cortical target region resulting in current strengths between 1 and 4 mA. Primary endpoint will be the difference in change of Fugl-Meyer Assessment of Upper Extremity (FMA-UE) score between active TDCS and sham at the end of the intervention. Exploratory endpoints will include UE-FMA at 12 weeks. Effects of TDCS on motor network connectivity and interhemispheric inhibition will be assessed with functional MRI and transcranial magnetic stimulation. DISCUSSION The study will show the feasibility and test the efficacy of personalized, multi-electrode anodal TDCS of M1-HAND in patients with subacute stroke patients with upper-extremity paresis. Concurrent multimodal brain mapping will shed light into the mechanisms of action of therapeutic personalized TDCS of M1-HAND. Together, the results from this trial may inform future personalized TDCS studies in patients with focal neurological deficits after stroke.
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Affiliation(s)
- Mia Kolmos
- Neurovascular Research Unit (NVRU), Department of Neurology, Copenhagen University Hospital -Herlev and Gentofte, Copenhagen, Denmark
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark
| | - Mads Just Madsen
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark
| | - Marie Louise Liu
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark
| | - Anke Karabanov
- Department of Nutrition, Exercise and Sport (NEXS), Copenhagen University, Copenhagen, Denmark
| | - Katrine Lyders Johansen
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
| | - Axel Thielscher
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark
- Department of Health Technology, Technical University of Denmark, Kgs Lyngby, Denmark
| | - Karen Gandrup
- Department of Radiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
| | - Henrik Lundell
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark
| | - Søren Fuglsang
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark
| | - Esben Thade
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark
- Department of Health Technology, Technical University of Denmark, Kgs Lyngby, Denmark
| | - Hanne Christensen
- Department of Neurology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Helle Klingenberg Iversen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Hartwig Roman Siebner
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark
- Department of Neurology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christina Kruuse
- Neurovascular Research Unit (NVRU), Department of Neurology, Copenhagen University Hospital -Herlev and Gentofte, Copenhagen, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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23
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Zhang X, Liu C, Ou N, Zeng X, Zhuo Z, Duan Y, Xiong X, Yu Y, Liu Z, Liu Y, Ye C. CarveMix: A simple data augmentation method for brain lesion segmentation. Neuroimage 2023; 271:120041. [PMID: 36933626 DOI: 10.1016/j.neuroimage.2023.120041] [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: 01/20/2023] [Revised: 03/01/2023] [Accepted: 03/15/2023] [Indexed: 03/18/2023] Open
Abstract
Brain lesion segmentation provides a valuable tool for clinical diagnosis and research, and convolutional neural networks (CNNs) have achieved unprecedented success in the segmentation task. Data augmentation is a widely used strategy to improve the training of CNNs. In particular, data augmentation approaches that mix pairs of annotated training images have been developed. These methods are easy to implement and have achieved promising results in various image processing tasks. However, existing data augmentation approaches based on image mixing are not designed for brain lesions and may not perform well for brain lesion segmentation. Thus, the design of this type of simple data augmentation method for brain lesion segmentation is still an open problem. In this work, we propose a simple yet effective data augmentation approach, dubbed as CarveMix, for CNN-based brain lesion segmentation. Like other mixing-based methods, CarveMix stochastically combines two existing annotated images (annotated for brain lesions only) to obtain new labeled samples. To make our method more suitable for brain lesion segmentation, CarveMix is lesion-aware, where the image combination is performed with a focus on the lesions and preserves the lesion information. Specifically, from one annotated image we carve a region of interest (ROI) according to the lesion location and geometry with a variable ROI size. The carved ROI then replaces the corresponding voxels in a second annotated image to synthesize new labeled images for network training, and additional harmonization steps are applied for heterogeneous data where the two annotated images can originate from different sources. Besides, we further propose to model the mass effect that is unique to whole brain tumor segmentation during image mixing. To evaluate the proposed method, experiments were performed on multiple publicly available or private datasets, and the results show that our method improves the accuracy of brain lesion segmentation. The code of the proposed method is available at https://github.com/ZhangxinruBIT/CarveMix.git.
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Affiliation(s)
- Xinru Zhang
- School of Integrated Circuits and Electronics, Beijing Institute of Technology, Beijing, China
| | - Chenghao Liu
- School of Integrated Circuits and Electronics, Beijing Institute of Technology, Beijing, China
| | - Ni Ou
- School of Automation, Beijing Institute of Technology, Beijing, China
| | - Xiangzhu Zeng
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Zhizheng Zhuo
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yunyun Duan
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | | | | | - Zhiwen Liu
- School of Integrated Circuits and Electronics, Beijing Institute of Technology, Beijing, China.
| | - Yaou Liu
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Chuyang Ye
- School of Integrated Circuits and Electronics, Beijing Institute of Technology, Beijing, China.
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24
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Altered static and dynamic functional network connectivity in post-stroke cognitive impairment. Neurosci Lett 2023; 799:137097. [PMID: 36716911 DOI: 10.1016/j.neulet.2023.137097] [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: 11/20/2022] [Revised: 01/20/2023] [Accepted: 01/24/2023] [Indexed: 01/29/2023]
Abstract
Post-stroke cognitive impairment (PSCI) is a common symptom following brain stroke, yet the mechanisms remain unknown. This study aimed to investigate alterations of static and dynamic functional network connectivity (sFNC and dFNC) in PSCI patients. We prospectively recruited 17 PSCI patients and 24 Healthy controls (HC). Restingstate fMRI (rs-fMRI) and Mini-Mental State Examination (MMSE) were performed. Independent component analysis combined with sliding-window and K-means clustering approach were applied to examine the FNC among 11 resting-state networks: auditory network (AUDN), left executive control network (lECN), language network (LN), precuneus network (PCUN), right executive control network (rECN), salience network (SN), visuospatial network (VN), dorsal default mode network (dDMN), higher visual network (hVIS), primary visual network (pVIS), and ventral mode network (vDMN). The FNC and dynamic indices (fraction time, mean dwell time, transition number) were calculated. Static and dynamic measures were compared between two groups and the correlation between clinical and imaging indicators was analyzed. For sFNC, PSCI group showed decreased interactions in dDMN-vDMN, vDMN-SN, dDMN-hVIS, AUDN-rECN, and AUDN-VN. For dFNC, we derived 3 states of FNC that occurred repeatedly. Significant group differences were found, including decreased interactions in the AUDN-VN, AUDN-pVIS in state 2 and dDMN-VN in state 3. The mean dwell time in PSCI group was longer in state 1, and negatively correlated with MMSE score. These results demonstrated that PSCI patients are characterized with altered sFNC and dFNC, which could help us explore the neural mechanisms of the PSCI from a new perspective.
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25
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Peng SJ, Chen YW, Hung A, Wang KW, Tsai JZ. Connectome-based predictive modeling for functional recovery of acute ischemic stroke. Neuroimage Clin 2023; 38:103369. [PMID: 36917922 PMCID: PMC10011051 DOI: 10.1016/j.nicl.2023.103369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 02/08/2023] [Accepted: 03/03/2023] [Indexed: 03/09/2023]
Abstract
Patients of acute ischemic stroke possess considerable chance of recovery of various levels in the first several weeks after stroke onset. Prognosis of functional recovery is important for decision-making in poststroke patient care and placement. Poststroke functional recovery has conventionally been based on demographic and clinical variables such as age, gender, and severity of stroke impairment. On the other hand, the concept of connectome has become a basis of interpreting the functional impairment and recovery of stroke patients. In this research, the connectome-based predictive modeling was used to provide predictive models for prognosing poststroke functional recovery. Predictive models were developed to use the brain connectivity at stroke onset to predict functional assessment scores at one or three months later, or to use the brain connectivity one-month poststroke to predict functional assessment scores at three months after stroke onset. The brain connectivity was computed from the resting-state fMRI signals. The functional assessment scores used in this research included modified Rankin Scale (mRS) and Barthel Index (BI). This research found significant models that used the brain connectivity at onset to predict the mRS one-month poststroke and to predict the BI three-month poststroke for patients with supratentorial infarction, as well as predictive models that used the brain connectivity one-month poststroke to predict the mRS three-month poststroke for patients with supratentorial infarction in the right hemisphere. The connectome-based predictive modeling could provide clinical value in prognosis of acute ischemic stroke.
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Affiliation(s)
- Syu-Jyun Peng
- Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Wei Chen
- Department of Neurology, Landseed International Hospital, Taoyuan, Taiwan; Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
| | - Andrew Hung
- Department of Electrical Engineering, National Central University, Taoyuan, Taiwan
| | - Kuo-Wei Wang
- Department of General Affairs, Landseed International Hospital, Taoyuan, Taiwan
| | - Jang-Zern Tsai
- Department of Electrical Engineering, National Central University, Taoyuan, Taiwan.
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26
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Tarchi L, Damiani S, Vittori PLT, Frick A, Castellini G, Politi P, Fusar-Poli P, Ricca V. Progressive Voxel-Wise Homotopic Connectivity from childhood to adulthood: Age-related functional asymmetry in resting-state functional magnetic resonance imaging. Dev Psychobiol 2023; 65:e22366. [PMID: 36811370 DOI: 10.1002/dev.22366] [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: 12/18/2021] [Revised: 10/11/2022] [Accepted: 09/21/2022] [Indexed: 01/12/2023]
Abstract
Homotopic connectivity during resting state has been proposed as a risk marker for neurologic and psychiatric conditions, but a precise characterization of its trajectory through development is currently lacking. Voxel-Mirrored Homotopic Connectivity (VMHC) was evaluated in a sample of 85 neurotypical individuals aged 7-18 years. VMHC associations with age, handedness, sex, and motion were explored at the voxel-wise level. VMHC correlates were also explored within 14 functional networks. Primary and secondary outcomes were repeated in a sample of 107 adults aged 21-50 years. In adults, VMHC was negatively correlated with age only in the posterior insula (false discovery rate p < .05, >30-voxel clusters), while a distributed effect among the medial axis was observed in minors. Four out of 14 considered networks showed significant negative correlations between VMHC and age in minors (basal ganglia r = -.280, p = .010; anterior salience r = -.245, p = .024; language r = -.222, p = .041; primary visual r = -.257, p = .017), but not adults. In minors, a positive effect of motion on VMHC was observed only in the putamen. Sex did not significantly influence age effects on VMHC. The current study showed a specific decrease in VMHC for minors as a function of age, but not adults, supporting the notion that interhemispheric interactions can shape late neurodevelopment.
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Affiliation(s)
- Livio Tarchi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Stefano Damiani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | - Andreas Frick
- Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Paolo Fusar-Poli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
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27
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Asadi B, Fard KR, Ansari NN, Marco Á, Calvo S, Herrero P. The Effect of dry Needling in Chronic Stroke with a complex Network Approach: A Case Study. Clin EEG Neurosci 2023; 54:179-188. [PMID: 35957591 DOI: 10.1177/15500594221120136] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: Dry Needling (DN) has been demonstrated to be effective in improving sensorimotor function and spasticity in patients with chronic stroke. Electroencephalogram (EEG) has been used to analyze if DN has effects on the central nervous system of patients with stroke. There are no studies on how DN works in patients with chronic stroke based on EEG analysis using complex networks. Objective: The aim of this study was to assess how DN works when it is applied in a patient with stroke, using the graph theory. Methods: One session of DN was applied to the spastic brachialis muscle of a 62-year-old man with right hemiplegia after stroke. EEG was used to analyze the effects of DN following metrics that measure the topological configuration: 1) network density, 2) clustering coefficient, 3) average shortest path length, 4) betweenness centrality, and 5) small-worldness. Measurements were taken before and during DN. Results: An improvement of the brain activity was observed in this patient with stroke after the application of DN, which led to variations of local parameters of the brain network in the delta, theta and alpha bands, and inclined towards those of the healthy control bands. Conclusions: This case study showed the positive effects of DN on brain network of a patient with chronic stroke.
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Affiliation(s)
- Borhan Asadi
- Department of Computer Engineering and Information Technology, 185151University of Qom, Qom, Iran
| | - Kheirollah Rahsepar Fard
- Department of Computer Engineering and Information Technology, 185151University of Qom, Qom, Iran
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, 48439Tehran University of Medical Sciences, Tehran, Iran.,Research Center for War-affected People, 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Álvaro Marco
- Department of Electronic Engineering and Communications, Aragon Institute of Engineering Research, 16765University of Zaragoza, Zaragoza, Spain
| | - Sandra Calvo
- Department of Physiatry and Nursing, Faculty of Health Sciences, IIS Aragon, 16765University of Zaragoza, Zaragoza, Spain
| | - Pablo Herrero
- Department of Physiatry and Nursing, Faculty of Health Sciences, IIS Aragon, 16765University of Zaragoza, Zaragoza, Spain
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28
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de Freitas Zanona A, Romeiro da Silva AC, Baltar do Rego Maciel A, Shirahige Gomes do Nascimento L, Bezerra da Silva A, Piscitelli D, Monte-Silva K. Sensory and motor cortical excitability changes induced by rTMS and sensory stimulation in stroke: A randomized clinical trial. Front Neurosci 2023; 16:985754. [PMID: 36760794 PMCID: PMC9907709 DOI: 10.3389/fnins.2022.985754] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 12/29/2022] [Indexed: 01/26/2023] Open
Abstract
Background The ability to produce coordinated movement is dependent on dynamic interactions through transcallosal fibers between the two cerebral hemispheres of the brain. Although typically unilateral, stroke induces changes in functional and effective connectivity across hemispheres, which are related to sensorimotor impairment and stroke recovery. Previous studies have focused almost exclusively on interhemispheric interactions in the primary motor cortex (M1). Objective To identify the presence of interhemispheric asymmetry (ASY) of somatosensory cortex (S1) excitability and to investigate whether S1 repetitive transcranial magnetic stimulation (rTMS) combined with sensory stimulation (SS) changes excitability in S1 and M1, as well as S1 ASY, in individuals with subacute stroke. Methods A randomized clinical trial. Participants with a single episode of stroke, in the subacute phase, between 35 and 75 years old, were allocated, randomly and equally balanced, to four groups: rTMS/sham SS, sham rTMS/SS, rTMS/SS, and sham rTMS/Sham SS. Participants underwent 10 sessions of S1 rTMS of the lesioned hemisphere (10 Hz, 1,500 pulses) followed by SS. SS was applied to the paretic upper limb (UL) (active SS) or non-paretic UL (sham SS). TMS-induced motor evoked potentials (MEPs) of the paretic UL and somatosensory evoked potential (SSEP) of both ULs assessed M1 and S1 cortical excitability, respectively. The S1 ASY index was measured before and after intervention. Evaluator, participants and the statistician were blinded. Results Thirty-six participants divided equally into groups (nine participants per group). Seven patients were excluded from MEP analysis because of failure to produce consistent MEP. One participant was excluded in the SSEP analysis because no SSEP was detected. All somatosensory stimulation groups had decreased S1 ASY except for the sham rTMS/Sham SS group. When compared with baseline, M1 excitability increased only in the rTMS/SS group. Conclusion S1 rTMS and SS alone or in combination changed S1 excitability and decreased ASY, but it was only their combination that increased M1 excitability. Clinical trial registration clinicaltrials.gov, identifier (NCT03329807).
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Affiliation(s)
- Aristela de Freitas Zanona
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil,Occupational Therapy Department and Post-Graduate Program in Applied Health Sciences, Universidade Federal de Sergipe, São Cristóvão, Brazil
| | | | - Adriana Baltar do Rego Maciel
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | | | - Amanda Bezerra da Silva
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Daniele Piscitelli
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy,Department of Kinesiology, University of Connecticut, Storrs, CT, United States,*Correspondence: Daniele Piscitelli, ,
| | - Katia Monte-Silva
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
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29
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Ni J, Jiang W, Gong X, Fan Y, Qiu H, Dou J, Zhang J, Wang H, Li C, Su M. Effect of rTMS intervention on upper limb motor function after stroke: A study based on fNIRS. Front Aging Neurosci 2023; 14:1077218. [PMID: 36711205 PMCID: PMC9880218 DOI: 10.3389/fnagi.2022.1077218] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 12/19/2022] [Indexed: 01/15/2023] Open
Abstract
Background Stroke is a disease with a high fatality rate worldwide and a major cause of long-term disability. In the rehabilitation of limb motor function after stroke, the rehabilitation of upper limb function takes a long time and the recovery progress is slow, which seriously affects the patients' self-care ability in daily life. Repeated transcranial magnetic stimulation (rTMS) has been increasingly used to improve limb dysfunction in patients with stroke. However, a standardized reference for selecting a magnetic stimulation regimen is not available. Whether to increase the inhibition of the contralateral hemispheric motor cortex remains controversial. This study has evaluated the effects of different rTMS stimulation programs on upper limb function and corresponding brain functional network characteristics of patients with stroke and sought a new objective standard based on changes in brain network parameters to guide accurate rTMS stimulation programs. Method Thirty-six patients with stroke were selected and divided into control group and treatment group by number table method, with 18 patients in each group, and 3 patients in the control group were turned out and lost due to changes in disease condition. The treatment group was divided into two groups. TMS1 group was given 1 Hz magnetic stimulation in the M1 region of the contralesional hemisphere +10 Hz magnetic stimulation in the M1 region of the affected hemisphere, and the TMS2 group was given 10 Hz magnetic stimulation in the M1 region of the affected hemisphere. The control group was given false stimulation. The treatment course was once a day for 5 days a week for 4 weeks. The Fugl-Meyer Assessment for upper extremity (FMA-UE) sand near-infrared brain function were collected before treatment, 2 weeks after treatment, and 4 weeks after treatment, and the brain function network was constructed. Changes in brain oxygenated hemoglobin concentration and brain network parameters were analyzed with the recovery of motor function (i.e., increased FMA score). Meanwhile, according to the average increment of brain network parameters, the rTMS stimulation group was divided into two groups with good efficacy and poor efficacy. Network parameters of the two groups before and after rTMS treatment were analyzed statistically. Results (1) Before treatment, there was no statistical difference in Fugl-Meyer score between the control group and the magnetic stimulation group (p = 0.178).Compared with before treatment, Fugl-Meyer scores of 2 and 4 weeks after treatment were significantly increased in both groups (p <0.001), and FMA scores of 4 weeks after treatment were significantly improved compared with 2 weeks after treatment (p < 0.001). FMA scores increased faster in the magnetic stimulation group at 2 and 4 weeks compared with the control group at the same time point (p <0.001).TMS1 and TMS2 were compared at the same time point, FMA score in TMS2 group increased more significantly after 4 weeks of treatment (p = 0.010). (2) Before treatment, HbO2 content in healthy sensory motor cortex (SMC) area of magnetic stimulation group and control group was higher than that in other region of interest (ROI) area, but there was no significant difference in ROI between the two groups. After 4 weeks of treatment, the HbO2 content in the healthy SMC area was significantly decreased (p < 0.001), while the HbO2 content in the affected SMC area was significantly increased, and the change was more significant in the magnetic stimulation group (p < 0.001). (3) In-depth study found that with the recovery of motor function (FMA upper limb score increase ≥4 points) after magnetic stimulation intervention, brain network parameters were significantly improved. The mean increment of network parameters in TMS1 group and TMS2 group was significantly different (χ 2 = 5.844, p = 0.016). TMS2 group was more advantageous than TMS1 group in improving the mean increment of brain network parameters. Conclusion (1) The rTMS treatment is beneficial to the recovery of upper limb motor function in stroke patients, and can significantly improve the intensity of brain network connection and reduce the island area. The island area refers to an isolated activated brain area that cannot transmit excitation to other related brain areas. (2) When the node degree of M1_Healthy region less than 0.52, it is suggested to perform promotion therapy only in the affected hemisphere. While the node degree greater than 0.52, and much larger than that in the M1_affected region. it is suggested that both inhibition in the contralesional hemisphere and high-frequency excitatory magnetic stimulation in the affected hemisphere can be performed. (3) In different brain functional network connection states, corresponding adjustment should be made to the treatment plan of rTMS to achieve optimal therapeutic effect and precise rehabilitation treatment.
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Affiliation(s)
- Jing Ni
- Department of Physical Medicine and Rehabilitation, Dushu Lake Hospital Affiliated of Soochow University, Suzhou, Jiangsu, China,Department of Physical Medicine and Rehabilitation, Jiangsu Rongjun Hospital, Wuxi, Jiangsu, China
| | - Wei Jiang
- Department of Physical Medicine and Rehabilitation, Dushu Lake Hospital Affiliated of Soochow University, Suzhou, Jiangsu, China,Department of Physical Medicine and Rehabilitation, Jiangsu Rongjun Hospital, Wuxi, Jiangsu, China
| | - Xueyang Gong
- Department of Physical Medicine and Rehabilitation, Dushu Lake Hospital Affiliated of Soochow University, Suzhou, Jiangsu, China,Department of Physical Medicine and Rehabilitation, Wuxi International Tongren Rehabilitation Hospital, Wuxi, Jiangsu, China
| | - Yingjie Fan
- Department of Physical Medicine and Rehabilitation, Dushu Lake Hospital Affiliated of Soochow University, Suzhou, Jiangsu, China,Institute of Rehabilitation Soochow University, Suzhou, Jiangsu, China
| | - Hao Qiu
- Department of Physical Medicine and Rehabilitation, Dushu Lake Hospital Affiliated of Soochow University, Suzhou, Jiangsu, China,Institute of Rehabilitation Soochow University, Suzhou, Jiangsu, China
| | - Jiaming Dou
- Department of Physical Medicine and Rehabilitation, Dushu Lake Hospital Affiliated of Soochow University, Suzhou, Jiangsu, China,Department of Physical Medicine and Rehabilitation, Wuxi International Tongren Rehabilitation Hospital, Wuxi, Jiangsu, China
| | - Juan Zhang
- Department of Physical Medicine and Rehabilitation, Dushu Lake Hospital Affiliated of Soochow University, Suzhou, Jiangsu, China,First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Hongxing Wang
- Department of Rehabilitation Medicine, Zhongda Hospital Southeast University, Nanjing, Jiangsu, China,*Correspondence: Hongxing Wang, ✉
| | - Chunguang Li
- The Key Laboratory of Robotics and System of Jiangsu Province, School of Mechanical and Electric Engineering, Soochow University, Suzhou, Jiangsu, China,Chunguang Li, ✉
| | - Min Su
- Department of Physical Medicine and Rehabilitation, Dushu Lake Hospital Affiliated of Soochow University, Suzhou, Jiangsu, China,Institute of Rehabilitation Soochow University, Suzhou, Jiangsu, China,First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China,Min Su, ✉
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Garrido M M, Álvarez E E, Acevedo P F, Moyano V Á, Castillo N N, Cavada Ch G. Early transcranial direct current stimulation with modified constraint-induced movement therapy for motor and functional upper limb recovery in hospitalized patients with stroke: A randomized, multicentre, double-blind, clinical trial. Brain Stimul 2023; 16:40-47. [PMID: 36584748 DOI: 10.1016/j.brs.2022.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 12/13/2022] [Accepted: 12/18/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Constraint-induced movement therapy (CIMT) and transcranial direct current stimulation (tDCS) are used to reduce interhemispheric imbalance after stroke, which is why the combination of these therapies has been used for neurological recovery, but not in the acute phase. OBJECTIVES To evaluate the effectiveness of combining active or sham bihemispheric tDCS with modified CIMT (mCIMT) for the recovery of the Upper Limb (UL) in hospitalized patients with acute and subacute stroke. METHODS This randomized controlled, double-blind, placebo-controlled, parallel group clinical trial was executed between September 2018 to March 2021 recruited 70 patients. The patients were randomized to one of two groups to receive treatment for 7 consecutive days, which included 20 min of active or sham bihemispheric tDCS daily (anodal ipsilesional and cathodal contralesional), with an mCIMT protocol. The primary outcome was the difference in the evolution of motor and functional upper limb recovery with assessment on days 0, 5, 7, 10 and 90. The secondary outcomes were independence in activities of daily living (ADL) and quality of life. RESULTS The active group presented a statistically significant gap compared to the simulated group throughout the trend in the scores of the FMA (motor function and joint pain) and WMFT (functional ability and weight to box) (p < 0.05) and showed a minimal clinically important difference (FMA: difference between groups of 4.9 points [CI: 0.007- 9.799]; WMFT: difference between groups of 6.54 points [CI: 1.10-14.15]). In the secondary outcomes, there was a significant difference between the groups in ADL independence (Functional Independence Measure: difference of 8.63 [CI: 1.37-18.64]) and perceived recovery of quality of life evaluated at 90 days (p = 0.0176). CONCLUSIONS Combining mCIMT with bihemispheric tDCS in patients hospitalized with acute-subacute stroke allows us to maximize the motor and functional recovery of the paretic upper limb in the early stages and independence in ADL, maintaining the effects over time.
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Affiliation(s)
- Maricel Garrido M
- Servicio de Medicina Física y Rehabilitación, Hospital Clínico Universidad de Chile, Santiago, Chile.
| | - Evelyn Álvarez E
- Facultad de Ciencias de la Salud, Universidad Central de Chile, Santiago, Chile; Departamento de Terapia Ocupacional y Ciencia de la Ocupación, Universidad de Chile, Santiago, Chile.
| | - Fabrizio Acevedo P
- Servicio de Medicina Física y Rehabilitación, Hospital San José, Santiago, Chile.
| | - Álvaro Moyano V
- Servicio de Medicina Física y Rehabilitación, Hospital Clínico Universidad de Chile, Santiago, Chile.
| | - Natalia Castillo N
- Departamento de Terapia Ocupacional y Ciencia de la Ocupación, Universidad de Chile, Santiago, Chile.
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31
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Lee Friesen C, Lawrence M, Ingram TGJ, Boe SG. Home-based portable fNIRS-derived cortical laterality correlates with impairment and function in chronic stroke. Front Hum Neurosci 2022; 16:1023246. [PMID: 36569472 PMCID: PMC9780676 DOI: 10.3389/fnhum.2022.1023246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction Improved understanding of the relationship between post-stroke rehabilitation interventions and functional motor outcomes could result in improvements in the efficacy of post-stroke physical rehabilitation. The laterality of motor cortex activity (M1-LAT) during paretic upper-extremity movement has been documented as a useful biomarker of post-stroke motor recovery. However, the expensive, labor intensive, and laboratory-based equipment required to take measurements of M1-LAT limit its potential clinical utility in improving post-stroke physical rehabilitation. The present study tested the ability of a mobile functional near-infrared spectroscopy (fNIRS) system (designed to enable independent measurement by stroke survivors) to measure cerebral hemodynamics at the motor cortex in the homes of chronic stroke survivors. Methods Eleven chronic stroke survivors, ranging widely in their level of upper-extremity motor deficit, used their stroke-affected upper-extremity to perform a simple unilateral movement protocol in their homes while a wireless prototype fNIRS headband took measurements at the motor cortex. Measures of participants' upper-extremity impairment and function were taken. Results Participants demonstrated either a typically lateralized response, with an increase in contralateral relative oxyhemoglobin (ΔHbO), or response showing a bilateral pattern of increase in ΔHbO during the motor task. During the simple unilateral task, M1-LAT correlated significantly with measures of both upper-extremity impairment and function, indicating that participants with more severe motor deficits had more a more atypical (i.e., bilateral) pattern of lateralization. Discussion These results indicate it is feasible to gain M1-LAT measures from stroke survivors in their homes using fNIRS. These findings represent a preliminary step toward the goals of using ergonomic functional neuroimaging to improve post-stroke rehabilitative care, via the capture of neural biomarkers of post-stroke motor recovery, and/or via use as part of an accessible rehabilitation brain-computer-interface.
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Affiliation(s)
- Christopher Lee Friesen
- Laboratory for Brain Recovery and Function, Dalhousie University, Halifax, NS, Canada
- Axem Neurotechnology, Halifax, NS, Canada
- School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | - Michael Lawrence
- Laboratory for Brain Recovery and Function, Dalhousie University, Halifax, NS, Canada
- Axem Neurotechnology, Halifax, NS, Canada
- School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | - Tony Gerald Joseph Ingram
- Laboratory for Brain Recovery and Function, Dalhousie University, Halifax, NS, Canada
- Axem Neurotechnology, Halifax, NS, Canada
- School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | - Shaun Gregory Boe
- Laboratory for Brain Recovery and Function, Dalhousie University, Halifax, NS, Canada
- School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
- School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
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Yan S, Li Y, Lu J, Tian T, Zhang G, Zhou Y, Wu D, Zhang S, Zhu W. Structural and functional alterations within the Papez circuit in subacute stroke patients. Brain Imaging Behav 2022; 16:2681-2689. [PMID: 36222964 DOI: 10.1007/s11682-022-00727-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2022] [Indexed: 11/26/2022]
Abstract
Beyond causing local injury, stroke disrupts structural and functional organization of the brain networks, exposing patients to a high risk of cognitive impairment by affecting the neural network activity. However, the impact of these pathological changes on cognition-related neural circuits is not well understood. In this study, we mainly focused on structures and directed functional connectivity within the Papez circuit in subacute stroke patients. Forty-five stroke patients and thirty-four age-, sex-matched healthy controls were included in our study. The Papez circuit gray matter were measured to explore ischemia-induced structural alterations. And Granger causality analysis with the hippocampus as seed regions was performed to identify alterations of directional functional connectivity within the neural circuit. We also explored the associations between cerebral changes with cognitive status. Compared with healthy controls, stroke patients revealed marked atrophy in gray matter of the Papez circuit, including ipsilateral hippocampus, amygdala, thalamus, and caudal anterior cingulate gyrus. Additionally, there are alterations in the directed functional connections between the bilateral hippocampus and cingulate gyrus within the Papez circuit. These altered effective connectivities were correlated with cognitive function after cerebrovascular event. Taken together, in the early post-stroke period, disruptions of the Papez circuit in both architecture and directed functional connectivity have already occurred and might affect the cognitive function. These findings have prompted researchers to better understand the potential mechanisms underlying vascular cognitive impairment and to investigate new therapeutic targets that could reduce cognitive burden.
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Affiliation(s)
- Su Yan
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Avenue, Wuhan, 430030, China
| | - Yuanhao Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Avenue, Wuhan, 430030, China
| | - Jun Lu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Avenue, Wuhan, 430030, China
- Department of CT & MRI, The First Affiliated Hospital, College of Medicine, Shihezi University, 107 North Second Road, Shihezi, China
| | - Tian Tian
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Avenue, Wuhan, 430030, China
| | - Guiling Zhang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Avenue, Wuhan, 430030, China
| | - Yiran Zhou
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Avenue, Wuhan, 430030, China
| | - Di Wu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Avenue, Wuhan, 430030, China
| | - Shun Zhang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Avenue, Wuhan, 430030, China
| | - Wenzhen Zhu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Avenue, Wuhan, 430030, China.
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33
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Li Y, Yu Z, Zhou X, Wu P, Chen J. Aberrant interhemispheric functional reciprocities of the default mode network and motor network in subcortical ischemic stroke patients with motor impairment: A longitudinal study. Front Neurol 2022; 13:996621. [PMID: 36267883 PMCID: PMC9577250 DOI: 10.3389/fneur.2022.996621] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/15/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of the present study was to explore the longitudinal changes in functional homotopy in the default mode network (DMN) and motor network and its relationships with clinical characteristics in patients with stroke. Methods Resting-state functional magnetic resonance imaging was performed in stroke patients with subcortical ischemic lesions and healthy controls. The voxel-mirrored homotopic connectivity (VMHC) method was used to examine the differences in functional homotopy in patients with stroke between the two time points. Support vector machine (SVM) and correlation analyses were also applied to investigate whether the detected significant changes in VMHC were the specific feature in patients with stroke. Results The patients with stroke had significantly lower VMHC in the DMN and motor-related regions than the controls, including in the precuneus, parahippocampus, precentral gyrus, supplementary motor area, and middle frontal gyrus. Longitudinal analysis revealed that the impaired VMHC of the superior precuneus showed a significant increase at the second time point, which was no longer significantly different from the controls. Between the two time points, the changes in VMHC in the superior precuneus were significantly correlated with the changes in clinical scores. SVM analysis revealed that the VMHC of the superior precuneus could be used to correctly identify the patients with stroke from the controls with a statistically significant accuracy of 81.25% (P ≤ 0.003). Conclusions Our findings indicated that the increased VMHC in the superior precuneus could be regarded as the neuroimaging manifestation of functional recovery. The significant correlation and the discriminative power in classification results might provide novel evidence to understand the neural mechanisms responsible for brain reorganization after stroke.
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Affiliation(s)
- Yongxin Li
- School of Traditional Chinese Medicine, Formula-Pattern Research Center, Jinan University, Guangzhou, China
- *Correspondence: Yongxin Li
| | - Zeyun Yu
- Acupuncture and Tuina School/Tird Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xuan Zhou
- School of Traditional Chinese Medicine, Formula-Pattern Research Center, Jinan University, Guangzhou, China
| | - Ping Wu
- Acupuncture and Tuina School/Tird Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Ping Wu
| | - Jiaxu Chen
- School of Traditional Chinese Medicine, Formula-Pattern Research Center, Jinan University, Guangzhou, China
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Fleury L, Koch PJ, Wessel MJ, Bonvin C, San Millan D, Constantin C, Vuadens P, Adolphsen J, Cadic Melchior A, Brügger J, Beanato E, Ceroni M, Menoud P, De Leon Rodriguez D, Zufferey V, Meyer NH, Egger P, Harquel S, Popa T, Raffin E, Girard G, Thiran JP, Vaney C, Alvarez V, Turlan JL, Mühl A, Léger B, Morishita T, Micera S, Blanke O, Van De Ville D, Hummel FC. Toward individualized medicine in stroke—The TiMeS project: Protocol of longitudinal, multi-modal, multi-domain study in stroke. Front Neurol 2022; 13:939640. [PMID: 36226086 PMCID: PMC9549862 DOI: 10.3389/fneur.2022.939640] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
Despite recent improvements, complete motor recovery occurs in <15% of stroke patients. To improve the therapeutic outcomes, there is a strong need to tailor treatments to each individual patient. However, there is a lack of knowledge concerning the precise neuronal mechanisms underlying the degree and course of motor recovery and its individual differences, especially in the view of brain network properties despite the fact that it became more and more clear that stroke is a network disorder. The TiMeS project is a longitudinal exploratory study aiming at characterizing stroke phenotypes of a large, representative stroke cohort through an extensive, multi-modal and multi-domain evaluation. The ultimate goal of the study is to identify prognostic biomarkers allowing to predict the individual degree and course of motor recovery and its underlying neuronal mechanisms paving the way for novel interventions and treatment stratification for the individual patients. A total of up to 100 patients will be assessed at 4 timepoints over the first year after the stroke: during the first (T1) and third (T2) week, then three (T3) and twelve (T4) months after stroke onset. To assess underlying mechanisms of recovery with a focus on network analyses and brain connectivity, we will apply synergistic state-of-the-art systems neuroscience methods including functional, diffusion, and structural magnetic resonance imaging (MRI), and electrophysiological evaluation based on transcranial magnetic stimulation (TMS) coupled with electroencephalography (EEG) and electromyography (EMG). In addition, an extensive, multi-domain neuropsychological evaluation will be performed at each timepoint, covering all sensorimotor and cognitive domains. This project will significantly add to the understanding of underlying mechanisms of motor recovery with a strong focus on the interactions between the motor and other cognitive domains and multimodal network analyses. The population-based, multi-dimensional dataset will serve as a basis to develop biomarkers to predict outcome and promote personalized stratification toward individually tailored treatment concepts using neuro-technologies, thus paving the way toward personalized precision medicine approaches in stroke rehabilitation.
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Affiliation(s)
- Lisa Fleury
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Philipp J. Koch
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Maximilian J. Wessel
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
- Department of Neurology, University Hospital and Julius-Maximilians-University, Wuerzburg, Germany
| | | | | | | | | | | | - Andéol Cadic Melchior
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Julia Brügger
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Elena Beanato
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Martino Ceroni
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Pauline Menoud
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Diego De Leon Rodriguez
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Valérie Zufferey
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Nathalie H. Meyer
- Laboratory of Cognitive Neuroscience, INX and BMI, EPFL, Campus Biotech, Geneva, Switzerland
| | - Philip Egger
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Sylvain Harquel
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Traian Popa
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Estelle Raffin
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Gabriel Girard
- CIBM Center for Biomedical Imaging, Lausanne, Switzerland
- Department of Radiology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
- Signal Processing Laboratory (LTS5), EPFL, Lausanne, Switzerland
| | - Jean-Philippe Thiran
- CIBM Center for Biomedical Imaging, Lausanne, Switzerland
- Department of Radiology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
- Signal Processing Laboratory (LTS5), EPFL, Lausanne, Switzerland
| | | | | | | | - Andreas Mühl
- Clinique Romande de Réadaptation, Sion, Switzerland
| | | | - Takuya Morishita
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Silvestro Micera
- The Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
- Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, EPFL, Lausanne, Switzerland
| | - Olaf Blanke
- Laboratory of Cognitive Neuroscience, INX and BMI, EPFL, Campus Biotech, Geneva, Switzerland
- Department of Clinical Neurosciences, University of Geneva (UNIGE), Geneva, Switzerland
| | - Dimitri Van De Ville
- CIBM Center for Biomedical Imaging, Lausanne, Switzerland
- Medical Image Processing Lab, Center for Neuroprosthetics, Institute of Bioengineering, EPFL, Lausanne, Switzerland
- Department of Radiology and Medical Informatics, University of Geneva (UNIGE), Geneva, Switzerland
| | - Friedhelm C. Hummel
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
- Clinical Neuroscience, Geneva University Hospital, Geneva, Switzerland
- *Correspondence: Friedhelm C. Hummel
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Li Y, Yu Z, Wu P, Chen J. Ability of an altered functional coupling between resting-state networks to predict behavioral outcomes in subcortical ischemic stroke: A longitudinal study. Front Aging Neurosci 2022; 14:933567. [PMID: 36185473 PMCID: PMC9520312 DOI: 10.3389/fnagi.2022.933567] [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: 05/01/2022] [Accepted: 08/16/2022] [Indexed: 11/22/2022] Open
Abstract
Stroke can be viewed as an acute disruption of an individual's connectome caused by a focal or widespread loss of blood flow. Although individuals exhibit connectivity changes in multiple functional networks after stroke, the neural mechanisms that underlie the longitudinal reorganization of the connectivity patterns are still unclear. The study aimed to determine whether brain network connectivity patterns after stroke can predict longitudinal behavioral outcomes. Nineteen patients with stroke with subcortical lesions underwent two sessions of resting-state functional magnetic resonance imaging scanning at a 1-month interval. By independent component analysis, the functional connectivity within and between multiple brain networks (including the default mode network, the dorsal attention network, the limbic network, the visual network, and the frontoparietal network) was disrupted after stroke and partial recovery at the second time point. Additionally, regression analyses revealed that the connectivity between the limbic and dorsal attention networks at the first time point showed sufficient reliability in predicting the clinical scores (Fugl-Meyer Assessment and Neurological Deficit Scores) at the second time point. The overall findings suggest that functional coupling between the dorsal attention and limbic networks after stroke can be regarded as a biomarker to predict longitudinal clinical outcomes in motor function and the degree of neurological functional deficit. Overall, the present study provided a novel opportunity to improve prognostic ability after subcortical strokes.
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Affiliation(s)
- Yongxin Li
- Guangzhou Key Laboratory of Formula-Pattern of Traditional Chinese Medicine, Formula-Pattern Research Center, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Zeyun Yu
- Acupuncture and Tuina School/Third Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ping Wu
- Acupuncture and Tuina School/Third Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jiaxu Chen
- Guangzhou Key Laboratory of Formula-Pattern of Traditional Chinese Medicine, Formula-Pattern Research Center, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
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Liu F, Chen C, Bai Z, Hong W, Wang S, Tang C. Specific subsystems of the inferior parietal lobule are associated with hand dysfunction following stroke: A cross-sectional resting-state fMRI study. CNS Neurosci Ther 2022; 28:2116-2128. [PMID: 35996952 PMCID: PMC9627383 DOI: 10.1111/cns.13946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/02/2022] [Accepted: 08/05/2022] [Indexed: 02/06/2023] Open
Abstract
AIM The inferior parietal lobule (IPL) plays important roles in reaching and grasping during hand movements, but how reorganizations of IPL subsystems underlie the paretic hand remains unclear. We aimed to explore whether specific IPL subsystems were disrupted and associated with hand performance after chronic stroke. METHODS In this cross-sectional study, we recruited 65 patients who had chronic subcortical strokes and 40 healthy controls from China. Each participant underwent the Fugl-Meyer Assessment of Hand and Wrist and resting-state fMRI at baseline. We mainly explored the group differences in resting-state effective connectivity (EC) patterns for six IPL subregions in each hemisphere, and we correlated these EC patterns with paretic hand performance across the whole stroke group and stroke subgroups. Moreover, we used receiver operating characteristic curve analysis to distinguish the stroke subgroups with partially (PPH) and completely (CPH) paretic hands. RESULTS Stroke patients exhibited abnormal EC patterns with ipsilesional PFt and bilateral PGa, and five sensorimotor-parietal/two parietal-temporal subsystems were positively or negatively correlated with hand performance. Compared with CPH patients, PPH patients exhibited abnormal EC patterns with the contralesional PFop. The PPH patients had one motor-parietal subsystem, while the CPH patients had one sensorimotor-parietal and three parietal-occipital subsystems that were associated with hand performance. Notably, the EC strength from the contralesional PFop to the ipsilesional superior frontal gyrus could distinguish patients with PPH from patients with CPH. CONCLUSIONS The IPL subsystems manifest specific functional reorganization and are associated with hand dysfunction following chronic stroke.
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Affiliation(s)
- FeiWen Liu
- Department of Rehabilitation MedicineChengdu Second People's HospitalChengduChina
| | - ChangCheng Chen
- Department of Rehabilitation MedicineQingtian People's HospitalLishuiChina
| | - ZhongFei Bai
- Yangzhi Rehabilitation Hospital Affiliated to Tongji University (Shanghai Sunshine Rehabilitation Center)ShanghaiChina
| | - WenJun Hong
- Department of Rehabilitation Medicine, Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
| | - SiZhong Wang
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of PhysiotherapyUniversity of OtagoDunedinNew Zealand
| | - ChaoZheng Tang
- Capacity Building and Continuing Education CenterNational Health Commission of the People's Republic of ChinaBeijingChina
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Kolskår KK, Ulrichsen KM, Richard G, Dørum ES, de Schotten MT, Rokicki J, Monereo‐Sánchez J, Engvig A, Hansen HI, Nordvik JE, Westlye LT, Alnæs D. Structural disconnectome mapping of cognitive function in poststroke patients. Brain Behav 2022; 12:e2707. [PMID: 35861657 PMCID: PMC9392540 DOI: 10.1002/brb3.2707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/19/2022] [Accepted: 06/25/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND AND PURPOSE Sequalae following stroke represents a significant challenge in current rehabilitation. The location and size of focal lesions are only moderately predictive of the diverse cognitive outcome after stroke. One explanation building on recent work on brain networks proposes that the cognitive consequences of focal lesions are caused by damages to anatomically distributed brain networks supporting cognition rather than specific lesion locations. METHODS To investigate the association between poststroke structural disconnectivity and cognitive performance, we estimated individual level whole-brain disconnectivity probability maps based on lesion maps from 102 stroke patients using normative data from healthy controls. Cognitive performance was assessed in the whole sample using Montreal Cognitive Assessment, and a more comprehensive computerized test protocol was performed on a subset (n = 82). RESULTS Multivariate analysis using Partial Least Squares on the disconnectome maps revealed that higher disconnectivity in right insular and frontal operculum, superior temporal gyrus and putamen was associated with poorer MoCA performance, indicating that lesions in regions connected with these brain regions are more likely to cause cognitive impairment. Furthermore, our results indicated that disconnectivity within these clusters was associated with poorer performance across multiple cognitive domains. CONCLUSIONS These findings demonstrate that the extent and distribution of structural disconnectivity following stroke are sensitive to cognitive deficits and may provide important clinical information predicting poststroke cognitive sequalae.
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Affiliation(s)
- Knut K. Kolskår
- NORMENT, Division of Mental Health and AddictionOslo University Hospital & Institute of Clinical Medicine, University of OsloOsloNorway
- Department of PsychologyUniversity of OsloOsloNorway
- Sunnaas Rehabilitation Hospital HTNesoddenNorway
| | - Kristine M. Ulrichsen
- NORMENT, Division of Mental Health and AddictionOslo University Hospital & Institute of Clinical Medicine, University of OsloOsloNorway
- Department of PsychologyUniversity of OsloOsloNorway
- Sunnaas Rehabilitation Hospital HTNesoddenNorway
| | - Genevieve Richard
- NORMENT, Division of Mental Health and AddictionOslo University Hospital & Institute of Clinical Medicine, University of OsloOsloNorway
| | - Erlend S. Dørum
- NORMENT, Division of Mental Health and AddictionOslo University Hospital & Institute of Clinical Medicine, University of OsloOsloNorway
- Department of PsychologyUniversity of OsloOsloNorway
- Sunnaas Rehabilitation Hospital HTNesoddenNorway
| | - Michel Thiebaut de Schotten
- Brain Connectivity and Behaviour LaboratorySorbonne UniversitiesParisFrance
- Groupe d'Imagerie NeurofonctionnelleInstitut des Maladies Neurodégénératives—UMR 5293, CNRS, CEA University of BordeauxBordeauxFrance
| | - Jaroslav Rokicki
- NORMENT, Division of Mental Health and AddictionOslo University Hospital & Institute of Clinical Medicine, University of OsloOsloNorway
- Department of PsychologyUniversity of OsloOsloNorway
- Centre of Research and Education in Forensic PsychiatryOslo University HospitalOsloNorway
| | - Jennifer Monereo‐Sánchez
- NORMENT, Division of Mental Health and AddictionOslo University Hospital & Institute of Clinical Medicine, University of OsloOsloNorway
- Faculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtthe Netherlands
- Department of Radiology and Nuclear MedicineMaastricht University Medical Centerthe Netherlands
| | - Andreas Engvig
- Department of NephrologyOslo University HospitalUllevålNorway
- Department of MedicineDiakonhjemmet HospitalOsloNorway
| | | | - Jan Egil Nordvik
- CatoSenteret Rehabilitation CenterSonNorway
- Faculty of Health SciencesOslo Metropolitan UniversityOsloNorway
| | - Lars T. Westlye
- NORMENT, Division of Mental Health and AddictionOslo University Hospital & Institute of Clinical Medicine, University of OsloOsloNorway
- Department of PsychologyUniversity of OsloOsloNorway
- KG Jebsen Centre for Neurodevelopmental DisordersUniversity of OsloOsloNorway
| | - Dag Alnæs
- NORMENT, Division of Mental Health and AddictionOslo University Hospital & Institute of Clinical Medicine, University of OsloOsloNorway
- Bjørknes CollegeOsloNorway
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Cleland BT, Madhavan S. Motor overflow in the lower limb after stroke: insights into mechanisms. Eur J Neurosci 2022; 56:4455-4468. [PMID: 35775788 PMCID: PMC9380181 DOI: 10.1111/ejn.15753] [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: 01/19/2022] [Revised: 06/06/2022] [Accepted: 06/21/2022] [Indexed: 11/29/2022]
Abstract
Motor overflow (involuntary muscle activation) is common after stroke, particularly in the non-paretic upper limb. Two potential cortical mechanisms are: 1) the contralesional hemisphere controls both limbs, and 2) inhibition from the ipsilesional to the contralesional hemisphere is diminished. Few studies have differentiated between these hypotheses or investigated motor overflow in the lower limb after stroke. To investigate these potential mechanisms, individuals with chronic stroke performed unilateral isometric and dynamic dorsiflexion. Motor overflow was quantified in the contralateral, resting (non-target) ankle. Transcranial magnetic stimulation was applied, and responses were measured in both legs. Relations between motor overflow, excitability of ipsilateral motor pathways, and interhemispheric inhibition were assessed. Non-target muscle activity (motor overflow) was greater during isometric and dynamic conditions than rest in both legs (p≤0.001) and was higher in the non-paretic than the paretic leg (p=0.03). Some participants (25%) had motor overflow >4SD above the group mean in the non-paretic leg. Greater motor overflow in the non-paretic leg was associated with lesser inhibition from the ipsilesional to the contralesional hemisphere (p=0.04). In both legs, non-target TMS responses were greater during the isometric and dynamic than the rest condition (p≤0.01), but not when normalized to background muscle activity. Overall, motor overflow occurred in both legs after stroke, suggesting a common bilateral mechanism. Our correlational results suggest that alterations in interhemispheric inhibition may contribute to motor overflow. Furthermore, the lack of differences in non-target MEPs between rest, isometric, and dynamic conditions, suggests that subcortical and/or spinal pathways may contribute to motor overflow.
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Affiliation(s)
- Brice T Cleland
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences University of Illinois at Chicago, Chicago, IL, USA
| | - Sangeetha Madhavan
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences University of Illinois at Chicago, Chicago, IL, USA
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Pirovano I, Mastropietro A, Guanziroli E, Molteni F, Faes L, Rizzo G. Comparison between directed causal flow metrics for the assessment of resting-state EEG motor network connectivity in subacute stroke patients. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:44-47. [PMID: 36085760 DOI: 10.1109/embc48229.2022.9870885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Isolated effective coherence (iCoh) is a measure of neural causal functional connectivity from EEG signals that was proven to overperform the Generalized Partial Directed Coherence (gPDC). However, iCoh sensitivity in the identification of reliable functional neural connections with respect to random links was not investigated. This study aims to compare the sensitivity of iCoh and gPDC with a statistical surrogates' approach. The cerebral motor network topology of a cohort of subjects in sub-acute stage after stroke was investigated. iCoh showed enhanced statistical discriminative power of the relevant connections within the motor network with respect to gPDC. This property influenced the assessment of ipsilesional intra-hemispheric topographic variations occurring in the population after a physical rehabilitation program.
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Yuan Z, Xu W, Bao J, Gao H, Li W, Peng Y, Wang L, Zhao Y, Song S, Qiao J, Wang G. Task-State Cortical Motor Network Characteristics by Functional Near-Infrared Spectroscopy in Subacute Stroke Show Hemispheric Dominance. Front Aging Neurosci 2022; 14:932318. [PMID: 35813955 PMCID: PMC9263394 DOI: 10.3389/fnagi.2022.932318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
Background There was a reorganization of the brain network after stroke. Some studies have compared the characteristics of activation or functional connectivity (FC) of cortical and subcortical regions between the dominant and non-dominant hemisphere stroke. Objectives To analyze hemispheric dominance differences in task-state motor network properties in subacute stroke by functional near-infrared spectroscopy (fNIRS). Materials and Methods Patients with first ischemic stroke in the basal ganglia within 1–3 months after onset and age- and sex-matched right-handed healthy subjects (HS) were enrolled. fNIRS with 29 channels was used to detect the oxyhemoglobin concentration changes when performing the hand grasping task. Activation patterns of motor cortex and two macroscale and two mesoscale brain network indicators based on graph theory were compared between dominant and non-dominant hemisphere stroke. Results We enrolled 17 subjects in each of left hemisphere stroke (LHS), right hemisphere stroke (RHS), and HS groups. Both patient groups showed bilateral activation. The average weighted clustering coefficient and global efficiency of patients were lower than those of healthy people, and the inter-density was higher than that of the HS group, but the significance was different between LHS and RHS groups. The intra-density changes in the RHS group were opposite to those in the LHS group. The correlation between mesoscale indicators and motor function differed between dominant and non-dominant hemisphere stroke. Conclusion The changes in macroscale cortical network indicators were similar between the two patient groups, while those of the mesoscale indicators were different. The mesoscale brain network characteristics were affected by the severity of dysfunction to varying degrees in the LHS and RHS patients.
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Affiliation(s)
- Ziwen Yuan
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Biomedical Engineering, School of Life Sciences and Technology, Xi’an Jiaotong University, Xi’an, China
- Department of Rehabilitation, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Weiwei Xu
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Biomedical Engineering, School of Life Sciences and Technology, Xi’an Jiaotong University, Xi’an, China
| | - Jiameng Bao
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Biomedical Engineering, School of Life Sciences and Technology, Xi’an Jiaotong University, Xi’an, China
| | - Hui Gao
- College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Wen Li
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Biomedical Engineering, School of Life Sciences and Technology, Xi’an Jiaotong University, Xi’an, China
| | - Yu Peng
- Department of Rehabilitation, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Lisha Wang
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Biomedical Engineering, School of Life Sciences and Technology, Xi’an Jiaotong University, Xi’an, China
- Department of Rehabilitation, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Ye Zhao
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Biomedical Engineering, School of Life Sciences and Technology, Xi’an Jiaotong University, Xi’an, China
- Department of Rehabilitation, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Siming Song
- Department of Rehabilitation, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Jin Qiao
- Department of Rehabilitation, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Jin Qiao,
| | - Gang Wang
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Biomedical Engineering, School of Life Sciences and Technology, Xi’an Jiaotong University, Xi’an, China
- Gang Wang,
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Shared and distinct voxel-based lesion-symptom mappings for spasticity and impaired movement in the hemiparetic upper limb. Sci Rep 2022; 12:10169. [PMID: 35715476 PMCID: PMC9206020 DOI: 10.1038/s41598-022-14359-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 06/06/2022] [Indexed: 12/17/2022] Open
Abstract
Hemiparesis and spasticity are common co-occurring manifestations of hemispheric stroke. The relationship between impaired precision and force in voluntary movement (hemiparesis) and the increment in muscle tone that stems from dysregulated activity of the stretch reflex (spasticity) is far from clear. Here we aimed to elucidate whether variation in lesion topography affects hemiparesis and spasticity in a similar or dis-similar manner. Voxel-based lesion-symptom mapping (VLSM) was used to assess the impact of lesion topography on (a) upper limb paresis, as reflected by the Fugl-Meyer Assessment scale for the upper limb and (b) elbow flexor spasticity, as reflected by the Tonic Stretch Reflex Threshold, in 41 patients with first-ever stroke. Hemiparesis and spasticity were affected by damage to peri-Sylvian cortical and subcortical regions and the putamen. Hemiparesis (but not spasticity) was affected by damage to the corticospinal tract at corona-radiata and capsular levels, and by damage to white-matter association tracts and additional regions in the temporal cortex and pallidum. VLSM conjunction analysis showed only a minor overlap of brain voxels where the existence of damage affected both hemiparesis and spasticity, suggesting that control of voluntary movement and regulation of muscle tone at rest involve largely separate parts of the motor network.
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Wang Y, Wang L, Wang Y, Lu M, Xu L, Liu R, Wei J, Wan J, Zhang H, Zou Y. Sensorimotor Responses in Post-Stroke Hemiplegic Patients Modulated by Acupuncture at Yanglingquan (GB34): A fMRI Study Using Intersubject Functional Correlation (ISFC) Analysis. Front Neurol 2022; 13:900520. [PMID: 35734477 PMCID: PMC9208550 DOI: 10.3389/fneur.2022.900520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/02/2022] [Indexed: 11/29/2022] Open
Abstract
Motor dysfunction is common in patients with stroke. Acupuncture has become an acceptable alternative method for stroke rehabilitation. Previous studies have shown various functional connectivity changes activated by acupuncture. We introduced intersubject correlation (ISC) and intersubject functional correlation (ISFC) analyses into the functional magnetic resonance imaging (fMRI) for ischemic stroke to seek a common activation and suppression pattern triggered by acupuncture. In this study, 63 ischemic stroke patients with motor dysfunction and 42 normal controls were analyzed. Three functional scans were conducted during the resting state, motor task, and acupuncture at Yanglingquan (GB34) task. Twenty-two sensory, motor, and movement-imagination cortices in the bilateral hemispheres were selected as the region of interest (ROI). We performed ISC and ISFC analyses among these ROIs in three fMRI runs on patients and controls. Subgroup analyses by course or severity were also conducted. The results showed that acupuncture at GB34 triggered ISFC among upper limb motor, upper limb/hand/face, lower limb, tongue/larynx sensory, and movement imagination regions in the patient group. Subgroup ISC and ISFC analyses showed that patients tended to have increasing responses in the early stage of stroke (within 1 month) and decreasing responses afterward (1–3 months). Patients with mild clinical functional damage (NIHSS 2–4) tended to generate more responses via acupuncture than those with moderate damage (NIHSS 5–15). Our findings may help understand the clinical effects and modulatory features of acupuncture based on the group-level post-stroke neuroplasticity.
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Cassidy JM, Mark JI, Cramer SC. Functional connectivity drives stroke recovery: shifting the paradigm from correlation to causation. Brain 2022; 145:1211-1228. [PMID: 34932786 PMCID: PMC9630718 DOI: 10.1093/brain/awab469] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/20/2021] [Accepted: 11/26/2021] [Indexed: 11/14/2022] Open
Abstract
Stroke is a leading cause of disability, with deficits encompassing multiple functional domains. The heterogeneity underlying stroke poses significant challenges in the prediction of post-stroke recovery, prompting the development of neuroimaging-based biomarkers. Structural neuroimaging measurements, particularly those reflecting corticospinal tract injury, are well-documented in the literature as potential biomarker candidates of post-stroke motor recovery. Consistent with the view of stroke as a 'circuitopathy', functional neuroimaging measures probing functional connectivity may also prove informative in post-stroke recovery. An important step in the development of biomarkers based on functional neural network connectivity is the establishment of causality between connectivity and post-stroke recovery. Current evidence predominantly involves statistical correlations between connectivity measures and post-stroke behavioural status, either cross-sectionally or serially over time. However, the advancement of functional connectivity application in stroke depends on devising experiments that infer causality. In 1965, Sir Austin Bradford Hill introduced nine viewpoints to consider when determining the causality of an association: (i) strength; (ii) consistency; (iii) specificity; (iv) temporality; (v) biological gradient; (vi) plausibility; (vii) coherence; (viii) experiment; and (ix) analogy. Collectively referred to as the Bradford Hill Criteria, these points have been widely adopted in epidemiology. In this review, we assert the value of implementing Bradford Hill's framework to stroke rehabilitation and neuroimaging. We focus on the role of neural network connectivity measurements acquired from task-oriented and resting-state functional MRI, EEG, magnetoencephalography and functional near-infrared spectroscopy in describing and predicting post-stroke behavioural status and recovery. We also identify research opportunities within each Bradford Hill tenet to shift the experimental paradigm from correlation to causation.
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Affiliation(s)
- Jessica M Cassidy
- Department of Allied Health Sciences, Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jasper I Mark
- Department of Allied Health Sciences, Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Steven C Cramer
- Department of Neurology, University of California, Los Angeles; and California Rehabilitation Institute, Los Angeles, CA, USA
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Mariman JJ, Lorca E, Biancardi C, Burgos P, Álvarez-Ruf J. Brain’s Energy After Stroke: From a Cellular Perspective Toward Behavior. Front Integr Neurosci 2022; 16:826728. [PMID: 35651830 PMCID: PMC9149581 DOI: 10.3389/fnint.2022.826728] [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: 12/01/2021] [Accepted: 03/18/2022] [Indexed: 11/13/2022] Open
Abstract
Stroke is a neurological condition that impacts activity performance and quality of life for survivors. While neurological impairments after the event explain the performance of patients in specific activities, the origin of such impairments has traditionally been explained as a consequence of structural and functional damage to the nervous system. However, there are important mechanisms related to energy efficiency (trade-off between biological functions and energy consumption) at different levels that can be related to these impairments and restrictions: first, at the neuronal level, where the availability of energy resources is the initial cause of the event, as well as determines the possibilities of spontaneous recovery. Second, at the level of neural networks, where the “small world” operation of the network is compromised after the stroke, implicating a high energetic cost and inefficiency in the information transfer, which is related to the neurological recovery and clinical status. Finally, at the behavioral level, the performance limitations are related to the highest cost of energy or augmented energy expenditure during the tasks to maintain the stability of the segment, system, body, and finally, the behavior of the patients. In other words, the postural homeostasis. In this way, we intend to provide a synthetic vision of the energy impact of stroke, from the particularities of the operation of the nervous system, its implications, as one of the determinant factors in the possibilities of neurological, functional, and behavioral recovery of our patients.
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Affiliation(s)
- Juan José Mariman
- Laboratorio de Cognición y Comportamiento Sensoriomotor, Departamento de Kinesiología, Facultad de Artes y Educación Física, Universidad Metropolitana de Ciencias de la Educación, Santiago, Chile
- Departamento de Kinesiología, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Enrique Lorca
- Laboratorio de Cognición y Comportamiento Sensoriomotor, Departamento de Kinesiología, Facultad de Artes y Educación Física, Universidad Metropolitana de Ciencias de la Educación, Santiago, Chile
- Escuela de Enfermería, Facultad de Medicina, Universidad Finis Terrae, Santiago, Chile
| | - Carlo Biancardi
- Biomechanics Lab, Departamento de Ciencias Biológicas, CENUR Litoral Norte, Universidad de la República, Paysandú, Uruguay
| | - Pablo Burgos
- Departamento de Kinesiología, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Departamento de Neurociencias, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Joel Álvarez-Ruf
- Laboratorio de Cognición y Comportamiento Sensoriomotor, Departamento de Kinesiología, Facultad de Artes y Educación Física, Universidad Metropolitana de Ciencias de la Educación, Santiago, Chile
- Laboratorio de Biomecánica Clínica, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- *Correspondence: Joel Álvarez-Ruf,
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Hensel L, Lange F, Tscherpel C, Viswanathan S, Freytag J, Volz LJ, Eickhoff SB, Fink GR, Grefkes C. Recovered grasping performance after stroke depends on interhemispheric frontoparietal connectivity. Brain 2022; 146:1006-1020. [PMID: 35485480 PMCID: PMC9976969 DOI: 10.1093/brain/awac157] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/19/2022] [Accepted: 04/14/2022] [Indexed: 01/11/2023] Open
Abstract
Activity changes in the ipsi- and contralesional parietal cortex and abnormal interhemispheric connectivity between these regions are commonly observed after stroke, however, their significance for motor recovery remains poorly understood. We here assessed the contribution of ipsilesional and contralesional anterior intraparietal cortex (aIPS) for hand motor function in 18 recovered chronic stroke patients and 18 healthy control subjects using a multimodal assessment consisting of resting-state functional MRI, motor task functional MRI, online-repetitive transcranial magnetic stimulation (rTMS) interference, and 3D movement kinematics. Effects were compared against two control stimulation sites, i.e. contralesional M1 and a sham stimulation condition. We found that patients with good motor outcome compared to patients with more substantial residual deficits featured increased resting-state connectivity between ipsilesional aIPS and contralesional aIPS as well as between ipsilesional aIPS and dorsal premotor cortex. Moreover, interhemispheric connectivity between ipsilesional M1 and contralesional M1 as well as ipsilesional aIPS and contralesional M1 correlated with better motor performance across tasks. TMS interference at individual aIPS and M1 coordinates led to differential effects depending on the motor task that was tested, i.e. index finger-tapping, rapid pointing movements, or a reach-grasp-lift task. Interfering with contralesional aIPS deteriorated the accuracy of grasping, especially in patients featuring higher connectivity between ipsi- and contralesional aIPS. In contrast, interference with the contralesional M1 led to impaired grasping speed in patients featuring higher connectivity between bilateral M1. These findings suggest differential roles of contralesional M1 and aIPS for distinct aspects of recovered hand motor function, depending on the reorganization of interhemispheric connectivity.
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Affiliation(s)
- Lukas Hensel
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany
| | - Fabian Lange
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany
| | - Caroline Tscherpel
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Shivakumar Viswanathan
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Jana Freytag
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany
| | - Lukas J Volz
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany
| | - Simon B Eickhoff
- Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany,Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany
| | - Gereon R Fink
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Christian Grefkes
- Correspondence to: Christian Grefkes Institute of Neuroscience and Medicine - Cognitive Neuroscience (INM-3) Research Centre Juelich, Juelich, Germany E-mail:
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46
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Steiner L, Federspiel A, Slavova N, Wiest R, Grunt S, Steinlin M, Everts R. Cognitive outcome is related to functional thalamo-cortical connectivity after pediatric stroke. Brain Commun 2022; 4:fcac110. [PMID: 35611308 PMCID: PMC9122536 DOI: 10.1093/braincomms/fcac110] [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: 04/20/2021] [Revised: 03/07/2022] [Accepted: 04/27/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
The thalamus has complex connections with the cortex and is involved in various cognitive processes. Despite increasing interest in the thalamus and the underlying thalamo-cortical interaction, little is known about thalamo-cortical connections after pediatric arterial ischemic stroke. Therefore, the aim of this study was to investigate thalamo-cortical connections and their association with cognitive performance after arterial ischemic stroke.
Twenty patients in the chronic phase after pediatric arterial ischemic stroke (≥ 2 years after diagnosis, diagnosed <16 years; aged 5–23 years, mean 15.1 years) and twenty healthy controls matched for age and sex were examined in a cross-sectional study design. Cognitive performance (selective attention, inhibition, working memory, and cognitive flexibility) was evaluated using standardized neuropsychological tests. Resting-state functional magnetic resonance imaging was used to examine functional thalamo-cortical connectivity. Lesion masks were integrated in the preprocessing pipeline to ensure that structurally damaged voxels did not influence functional connectivity analyses.
Cognitive performance (selective attention, inhibition and working memory) was significantly reduced in patients compared to controls. Network analyses revealed significantly lower thalamo-cortical connectivity for the motor, auditory, visual, default mode network, salience, left/right executive and dorsal attention network in patients compared to controls. Interestingly, analyses revealed as well higher thalamo-cortical connectivity in some subdivisions of the thalamus for the default mode network (medial nuclei), motor (lateral nuclei), dorsal attention (anterior nuclei), and the left executive network (posterior nuclei) in patients compared to controls. Increased and decreased thalamo-cortical connectivity strength within the same networks was, however, found in different thalamic sub-divisions. Thus, alterations in thalamo-cortical connectivity strength after pediatric stroke seem to point in both directions, with stronger as well as weaker thalamo-cortical connectivity in patients compared to controls. Multivariate linear regression, with lesion size and age as covariates, revealed significant correlations between cognitive performance (selective attention, inhibition, and working memory) and the strength of thalamo-cortical connectivity in the motor, auditory, visual, default mode network, posterior default mode network, salience, left/right executive, and dorsal attention network after childhood stroke.
Our data suggest that the interaction between different sub-nuclei of the thalamus and several cortical networks relates to post-stroke cognition. The variability in cognitive outcomes after pediatric stroke might partly be explained by functional thalamo-cortical connectivity strength.
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Affiliation(s)
- Leonie Steiner
- Division of Neuropaediatrics, Development and Rehabilitation, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Switzerland
- Graduate School for Health Science, University of Bern, Bern, Switzerland
| | - Andrea Federspiel
- Psychiatric Neuroimaging Unit, Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Nedelina Slavova
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
- Pediatric Radiology, University Children's Hospital Basel and University of Basel, Basel, Switzerland
| | - Roland Wiest
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Sebastian Grunt
- Division of Neuropaediatrics, Development and Rehabilitation, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Maja Steinlin
- Division of Neuropaediatrics, Development and Rehabilitation, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Regula Everts
- Division of Neuropaediatrics, Development and Rehabilitation, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Switzerland
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
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47
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Pirovano I, Mastropietro A, Antonacci Y, Barà C, Guanziroli E, Molteni F, Faes L, Rizzo G. Resting State EEG Directed Functional Connectivity Unveils Changes in Motor Network Organization in Subacute Stroke Patients After Rehabilitation. Front Physiol 2022; 13:862207. [PMID: 35450158 PMCID: PMC9016279 DOI: 10.3389/fphys.2022.862207] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/14/2022] [Indexed: 01/01/2023] Open
Abstract
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.
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Affiliation(s)
- Ileana Pirovano
- Istituto di Tecnologie Biomediche, Consiglio Nazionale delle Ricerche, Segrate, Italy
| | - Alfonso Mastropietro
- Istituto di Tecnologie Biomediche, Consiglio Nazionale delle Ricerche, Segrate, Italy
- *Correspondence: Alfonso Mastropietro,
| | - Yuri Antonacci
- Dipartimento di Ingegneria, Università di Palermo, Palermo, Italy
| | - Chiara Barà
- Dipartimento di Ingegneria, Università di Palermo, Palermo, Italy
| | | | - Franco Molteni
- Centro Riabilitativo Villa Beretta, Ospedale Valduce, Costa Masnaga, Italy
| | - Luca Faes
- Dipartimento di Ingegneria, Università di Palermo, Palermo, Italy
| | - Giovanna Rizzo
- Istituto di Tecnologie Biomediche, Consiglio Nazionale delle Ricerche, Segrate, Italy
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48
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Gongcheng X, Congcong H, Jiahui Y, Wenhao L, Hui X, Xiangyang L, Zengyong L, Yonghui W, Daifa W. Effective brain network analysis in unilateral and bilateral upper limb exercise training in subjects with stroke. Med Phys 2022; 49:3333-3346. [PMID: 35262918 DOI: 10.1002/mp.15570] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/23/2021] [Accepted: 02/01/2022] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Knowing the patterns of brain activation that occur and networks involved under different interventions is important for motor recovery in subjects with stroke. This study aimed to study the patterns of brain activation and networks in two interventions, affected upper limb side and bilateral exercise training, using concurrent functional near-infrared spectroscopy (fNIRS) imaging. METHODS Thirty-two patients in the early subacute stage were randomly divided into two groups: unilateral and bilateral groups. The patients in the unilateral group underwent isokinetic muscle strength training on the affected upper limb side and patients in the bilateral group underwent bilateral upper limb training. Oxyhemoglobin and deoxyhemoglobin concentration changes (ΔHbO2 and ΔHbR, respectively) were recorded in the ipsilateral and contralateral prefrontal cortex (IPFC and CPFC, respectively) and ipsilateral and contralateral motor cortex (IMC and CMC, respectively) by fNIRS equipment in the resting state and training conditions. The phase information of a 0.01-0.08 Hz fNIRS signal was extracted by the wavelet transform method. Dynamic Bayesian inference was adopted to calculate the coupling strength and direction of effective connectivity. The network threshold was determined by surrogate signal method, the global (weighted clustering coefficient, global efficiency and small-worldness) and local (degree, betweenness centrality and local efficiency) network metrics were calculated. The degree of cerebral lateralization was also compared between the two groups. RESULTS The results of covariance analysis showed that, compared with bilateral training, the coupling effect of CMC→IMC was significantly enhanced (p = 0.03); also, the local efficiency of the IMC (p = 0.01), IPFC (p<0.001), and CPFC (p = 0.006) and the hemispheric autonomy index of IPFC (p = 0.007) were significantly increased in unilateral training. In addition, there was a significant positive correlation between the coupling intensity of the inter-hemispheric motor area and the shifted local efficiency. CONCLUSIONS The results indicated that unilateral upper limb training could more effectively promote the interaction and balance of bilateral motor hemispheres and help brain reorganization in the IMC and prefrontal cortex in stroke patients. The method provided in this study could be used to evaluate dynamic brain activation and network reorganization under different interventions, thus improving the strategy of rehabilitation intervention in a timely manner and resulting in better motor recovery. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Xu Gongcheng
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100086, China.,Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing, 100176, China
| | - Huo Congcong
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100086, China
| | - Yin Jiahui
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing, 100176, China
| | - Li Wenhao
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100086, China
| | - Xie Hui
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100086, China.,Key Laboratory of Neuro-functional Information and Rehabilitation Engineering of the Ministry of Civil Affairs, Beijing, 100176, China
| | - Li Xiangyang
- Nanchang Key Laboratory of Medical and Technology Research, Nanchang University, Nanchang, 330031, China
| | - Li Zengyong
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing, 100176, China.,Key Laboratory of Neuro-functional Information and Rehabilitation Engineering of the Ministry of Civil Affairs, Beijing, 100176, China
| | - Wang Yonghui
- Department of physical medicine and rehabilitation, Qilu hospital, Shandong University, Jinan, 250061, China
| | - Wang Daifa
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100086, China.,Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, 100083, China
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49
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Huang Q, Lin D, Huang S, Cao Y, Jin Y, Wu B, Fan L, Tu W, Huang L, Jiang S. Brain Functional Topology Alteration in Right Lateral Occipital Cortex Is Associated With Upper Extremity Motor Recovery. Front Neurol 2022; 13:780966. [PMID: 35309550 PMCID: PMC8927543 DOI: 10.3389/fneur.2022.780966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/17/2022] [Indexed: 12/02/2022] Open
Abstract
Stroke is a chief cause of sudden brain damage that severely disrupts the whole-brain network. However, the potential mechanisms of motor recovery after stroke are uncertain and the prognosis of poststroke upper extremity recovery is still a challenge. This study investigated the global and local topological properties of the brain functional connectome in patients with subacute ischemic stroke and their associations with the clinical measurements. A total of 57 patients, consisting of 29 left-sided and 28 right-sided stroke patients, and 32 age- and gender-matched healthy controls (HCs) were recruited to undergo a resting-state functional magnetic resonance imaging (rs-fMRI) study; patients were also clinically evaluated with the Upper Extremity Fugl-Meyer Assessment (FMA_UE). The assessment was repeated at 15 weeks to assess upper extremity functional recovery for the patient remaining in the study (12 left- 20 right-sided stroke patients). Global graph topological disruption indices of stroke patients were significantly decreased compared with HCs but these indices were not significantly associated with FMA_UE. In addition, local brain network structure of stroke patients was altered, and the altered regions were dependent on the stroke site. Significant associations between local degree and motor performance and its recovery were observed in the right lateral occipital cortex (R LOC) in the right-sided stroke patients. Our findings suggested that brain functional topologies alterations in R LOC are promising as prognostic biomarkers for right-sided subacute stroke. This cortical area might be a potential target to be further validated for non-invasive brain stimulation treatment to improve poststroke upper extremity recovery.
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Affiliation(s)
- Qianqian Huang
- Rehabilitation Medicine Center, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Intelligent Rehabilitation Research Center, China-USA Institute for Acupuncture and Rehabilitation, Wenzhou Medical University, Wenzhou, China
| | - Dinghong Lin
- Rehabilitation Medicine Center, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Intelligent Rehabilitation Research Center, China-USA Institute for Acupuncture and Rehabilitation, Wenzhou Medical University, Wenzhou, China
| | - Shishi Huang
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yungang Cao
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yun Jin
- Rehabilitation Medicine Center, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Intelligent Rehabilitation Research Center, China-USA Institute for Acupuncture and Rehabilitation, Wenzhou Medical University, Wenzhou, China
| | - Bo Wu
- Department of Information, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Linyu Fan
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wenzhan Tu
- Rehabilitation Medicine Center, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Intelligent Rehabilitation Research Center, China-USA Institute for Acupuncture and Rehabilitation, Wenzhou Medical University, Wenzhou, China
| | - Lejian Huang
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- *Correspondence: Lejian Huang
| | - Songhe Jiang
- Rehabilitation Medicine Center, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Intelligent Rehabilitation Research Center, China-USA Institute for Acupuncture and Rehabilitation, Wenzhou Medical University, Wenzhou, China
- Songhe Jiang
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50
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Miao G, Rao B, Wang S, Fang P, Chen Z, Chen L, Zhang X, Zheng J, Xu H, Liao W. Decreased Functional Connectivities of Low-Degree Level Rich Club Organization and Caudate in Post-stroke Cognitive Impairment Based on Resting-State fMRI and Radiomics Features. Front Neurosci 2022; 15:796530. [PMID: 35250435 PMCID: PMC8890030 DOI: 10.3389/fnins.2021.796530] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 12/31/2021] [Indexed: 11/13/2022] Open
Abstract
BackgroundStroke is an important cause of cognitive impairment. Rich club organization, a highly interconnected network brain core region, is closely related to cognition. We hypothesized that the disturbance of rich club organization exists in patients with post-stroke cognitive impairment (PSCI).MethodsWe collected data on resting-state functional magnetic resonance imaging (rs-fMRI) with 21 healthy controls (HC), 16 hemorrhagic stroke (hPSCI), and 21 infarct stroke (iPSCI). 3D shape features and first-order statistics of stroke lesions were extracted using 3D slicer software. Additionally, we assessed cognitive function using the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE).ResultsNormalized rich club coefficients were higher in hPSCI and iPSCI than HC at low-degree k-levels (k = 1–8 in iPSCI, k = 2–8 in hPSCI). Feeder and local connections were significantly decreased in PSCI patients versus HC, mainly distributed in salience network (SN), default-mode network (DMN), cerebellum network (CN), and orbitofrontal cortex (ORB), especially involving the right and left caudate with changed nodal efficiency. The feeder and local connections of significantly between-group difference were positively related to MMSE and MoCA scores, primarily distributed in the sensorimotor network (SMN) and visual network (VN) in hPSCI, SN, and DMN in iPSCI. Additionally, decreased local connections and low-degree ϕnorm(k) were correlated to 3D shape features and first-order statistics of stroke lesions.ConclusionThis study reveals the disrupted low-degree level rich club organization and relatively preserved functional core network in PSCI patients. Decreased feeder and local connections in cognition-related networks (DMN, SN, CN, and ORB), particularly involving the caudate nucleus, may offer insight into pathological mechanism of PSCI patients. The shape and signal features of stroke lesions may provide an essential clue for the damage of functional connectivity and the whole brain networks.
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Affiliation(s)
- Guofu Miao
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Bo Rao
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Sirui Wang
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Pinyan Fang
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Radiology, TEDA International Cardiovascular Hospital, Tianjin, China
| | - Zhuo Chen
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Linglong Chen
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xin Zhang
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jun Zheng
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Haibo Xu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
- *Correspondence: Haibo Xu,
| | - Weijing Liao
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Weijing Liao,
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