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Wang Q, Pan M, Kreiss L, Samaei S, Carp SA, Johansson JD, Zhang Y, Wu M, Horstmeyer R, Diop M, Li DDU. A comprehensive overview of diffuse correlation spectroscopy: Theoretical framework, recent advances in hardware, analysis, and applications. Neuroimage 2024; 298:120793. [PMID: 39153520 DOI: 10.1016/j.neuroimage.2024.120793] [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: 05/19/2024] [Revised: 07/23/2024] [Accepted: 08/14/2024] [Indexed: 08/19/2024] Open
Abstract
Diffuse correlation spectroscopy (DCS) is a powerful tool for assessing microvascular hemodynamic in deep tissues. Recent advances in sensors, lasers, and deep learning have further boosted the development of new DCS methods. However, newcomers might feel overwhelmed, not only by the already-complex DCS theoretical framework but also by the broad range of component options and system architectures. To facilitate new entry to this exciting field, we present a comprehensive review of DCS hardware architectures (continuous-wave, frequency-domain, and time-domain) and summarize corresponding theoretical models. Further, we discuss new applications of highly integrated silicon single-photon avalanche diode (SPAD) sensors in DCS, compare SPADs with existing sensors, and review other components (lasers, sensors, and correlators), as well as data analysis tools, including deep learning. Potential applications in medical diagnosis are discussed and an outlook for the future directions is provided, to offer effective guidance to embark on DCS research.
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Affiliation(s)
- Quan Wang
- Department of Biomedical Engineering, Faculty of Engineering, University of Strathclyde, Glasgow, United Kingdom
| | - Mingliang Pan
- Department of Biomedical Engineering, Faculty of Engineering, University of Strathclyde, Glasgow, United Kingdom
| | - Lucas Kreiss
- Department of Biomedical Engineering, Duke University, Durham, NC, United States
| | - Saeed Samaei
- Department of Medical and Biophysics, Schulich School of Medical & Dentistry, Western University, London, Ontario, Canada; Lawson Health Research Institute, Imaging Program, London, Ontario, Canada
| | - Stefan A Carp
- Massachusetts General Hospital, Optics at Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, Charlestown, MA, United States
| | | | - Yuanzhe Zhang
- Department of Biomedical Engineering, Faculty of Engineering, University of Strathclyde, Glasgow, United Kingdom
| | - Melissa Wu
- Department of Biomedical Engineering, Duke University, Durham, NC, United States
| | - Roarke Horstmeyer
- Department of Biomedical Engineering, Duke University, Durham, NC, United States
| | - Mamadou Diop
- Department of Medical and Biophysics, Schulich School of Medical & Dentistry, Western University, London, Ontario, Canada; Lawson Health Research Institute, Imaging Program, London, Ontario, Canada
| | - David Day-Uei Li
- Department of Biomedical Engineering, Faculty of Engineering, University of Strathclyde, Glasgow, United Kingdom.
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Matlis GC, Zhang Q, Benson EJ, Weeks MK, Andersen K, Jahnavi J, Lafontant A, Breimann J, Hallowell T, Lin Y, Licht DJ, Yodh AG, Kilbaugh TJ, Forti RM, White BR, Baker WB, Xiao R, Ko TS. Chassis-based fiber-coupled optical probe design for reproducible quantitative diffuse optical spectroscopy measurements. PLoS One 2024; 19:e0305254. [PMID: 39052686 PMCID: PMC11271963 DOI: 10.1371/journal.pone.0305254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/27/2024] [Indexed: 07/27/2024] Open
Abstract
Advanced optical neuromonitoring of cerebral hemodynamics with hybrid diffuse optical spectroscopy (DOS) and diffuse correlation spectroscopy (DCS) methods holds promise for non-invasive characterization of brain health in critically ill patients. However, the methods' fiber-coupled patient interfaces (probes) are challenging to apply in emergent clinical scenarios that require rapid and reproducible attachment to the head. To address this challenge, we developed a novel chassis-based optical probe design for DOS/DCS measurements and validated its measurement accuracy and reproducibility against conventional, manually held measurements of cerebral hemodynamics in pediatric swine (n = 20). The chassis-based probe design comprises a detachable fiber housing which snaps into a 3D-printed, circumferential chassis piece that is secured to the skin. To validate its reproducibility, eight measurement repetitions of cerebral tissue blood flow index (BFI), oxygen saturation (StO2), and oxy-, deoxy- and total hemoglobin concentration were acquired at the same demarcated measurement location for each pig. The probe was detached after each measurement. Of the eight measurements, four were acquired by placing the probe into a secured chassis, and four were visually aligned and manually held. We compared the absolute value and intra-subject coefficient of variation (CV) of chassis versus manual measurements. No significant differences were observed in either absolute value or CV between chassis and manual measurements (p > 0.05). However, the CV for BFI (mean ± SD: manual, 19.5% ± 9.6; chassis, 19.0% ± 10.8) was significantly higher than StO2 (manual, 5.8% ± 6.7; chassis, 6.6% ± 7.1) regardless of measurement methodology (p<0.001). The chassis-based DOS/DCS probe design facilitated rapid probe attachment/re-attachment and demonstrated comparable accuracy and reproducibility to conventional, manual alignment. In the future, this design may be adapted for clinical applications to allow for non-invasive monitoring of cerebral health during pediatric critical care.
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Affiliation(s)
- Giselle C. Matlis
- Division of Neurology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Qihuang Zhang
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, United States of America
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Emilie J. Benson
- Division of Neurology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA, United States of America
| | - M. Katie Weeks
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Kristen Andersen
- Division of Neurology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Jharna Jahnavi
- Division of Neurology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Alec Lafontant
- Division of Neurology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Jake Breimann
- Division of Neurology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Thomas Hallowell
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Yuxi Lin
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Daniel J. Licht
- Division of Neurology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America
- Division of Neurology, Department of Pediatrics, Children’s National, Washington, District of Columbia, United States of America
- Division of Neurology, George Washington University, Washington, District of Columbia, United States of America
| | - Arjun G. Yodh
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Todd J. Kilbaugh
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America
| | - Rodrigo M. Forti
- Division of Neurology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Brian R. White
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America
- Division of Pediatric Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Wesley B. Baker
- Division of Neurology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America
| | - Rui Xiao
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, United States of America
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America
| | - Tiffany S. Ko
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
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Chen SY, Tsou MH, Chen KY, Liu YC, Lin MT. Impact of repetitive transcranial magnetic stimulation on cortical activity: a systematic review and meta-analysis utilizing functional near-infrared spectroscopy evaluation. J Neuroeng Rehabil 2024; 21:108. [PMID: 38915003 PMCID: PMC11194950 DOI: 10.1186/s12984-024-01407-9] [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: 03/10/2024] [Accepted: 06/19/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Repeated transcranial magnetic stimulation (rTMS) could induce alterations in cortical excitability and promote neuroplasticity. To precisely quantify these effects, functional near-infrared spectroscopy (fNIRS), an optical neuroimaging modality adept at detecting changes in cortical hemodynamic responses, has been employed concurrently alongside rTMS to measure and tailor the impact of diverse rTMS protocols on the brain cortex. OBJECTIVE This systematic review and meta-analysis aimed to elucidate the effects of rTMS on cortical hemodynamic responses over the primary motor cortex (M1) as detected by fNIRS. METHODS Original articles that utilized rTMS to stimulate the M1 cortex in combination with fNIRS for the assessment of cortical activity were systematically searched across the PubMed, Embase, and Scopus databases. The search encompassed records from the inception of these databases up until April, 2024. The assessment for risk of bias was also conducted. A meta-analysis was also conducted in studies with extractable raw data. RESULTS Among 312 studies, 14 articles were eligible for qualitative review. 7 studies were eligible for meta-analysis. A variety of rTMS protocols was employed on M1 cortex. In inhibitory rTMS, multiple studies observed a reduction in the concentration of oxygenated hemoglobin [HbO] at the ipsilateral M1, contrasted by an elevation at the contralateral M1. Meta-analysis also corroborated this consistent trend. Nevertheless, certain investigations unveiled diminished [HbO] in bilateral M1. Several studies also depicted intricate inhibitory or excitatory interplay among distinct cortical regions. CONCLUSION Diverse rTMS protocols led to varied patterns of cortical activity detected by fNIRS. Meta-analysis revealed a trend of increasing [HbO] in the contralateral cortices and decreasing [HbO] in the ipsilateral cortices following low frequency inhibitory rTMS. However, due to the heterogeneity between studies, further research is necessary to comprehensively understand rTMS-induced alterations in brain activity.
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Affiliation(s)
- Shao-Yu Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7 Chung-Shan South Road, Taipei City, 10002, Taiwan
| | - Meng-Hsuan Tsou
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, 3F., No.17, Xuzhou Rd., Zhongzheng Dist, Taipei City, 10002, Taiwan
| | - Kuan-Yu Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7 Chung-Shan South Road, Taipei City, 10002, Taiwan
| | - Yan-Ci Liu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, 3F., No.17, Xuzhou Rd., Zhongzheng Dist, Taipei City, 10002, Taiwan.
- Physical Therapy Center, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 1, Changde St., Zhongzheng Dist, Taipei City, 10022, Taiwan.
| | - Meng-Ting Lin
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7 Chung-Shan South Road, Taipei City, 10002, Taiwan.
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Lee KZ, Vinit S. Modulatory effect of trans-spinal magnetic intermittent theta burst stimulation on diaphragmatic activity following cervical spinal cord contusion in the rat. Spine J 2024; 24:352-372. [PMID: 37774983 DOI: 10.1016/j.spinee.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/17/2023] [Accepted: 09/18/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND CONTEXT Magnetic stimulation can noninvasively modulate the neuronal excitability through different stimulatory patterns. PURPOSE The present study hypothesized that trans-spinal magnetic stimulation with intermittent theta burst stimulatory pattern can modulate respiratory motor outputs in a pre-clinical rat model of cervical spinal cord injury. STUDY DESIGN In vivo animal study. METHODS The effect of trans-spinal magnetic intermittent theta burst stimulation on diaphragmatic activity was assessed in adult rats with unilateral cervical spinal cord contusion at 2 weeks postinjury. RESULTS The results demonstrated that unilateral cervical spinal cord contusion significantly attenuated the inspiratory activity and motor evoked potential of the diaphragm. Trans-spinal magnetic intermittent theta burst stimulation significantly increased the inspiratory activity of the diaphragm in cervical spinal cord contused rats. Inspiratory bursting was also recruited by trans-spinal magnetic intermittent theta burst stimulation in the rats without diaphragmatic activity after cervical spinal cord injury. In addition, trans-spinal magnetic intermittent theta burst stimulation is associated with increases in oxygen consumption and carbon dioxide production. CONCLUSIONS These results suggest that trans-spinal magnetic intermittent theta burst stimulation can induce respiratory neuroplasticity. CLINICAL SIGNIFICANCE We propose that trans-spinal theta burst magnetic stimulation may be considered a potential rehabilitative strategy for improving the respiratory activity after cervical spinal cord injury. This will require future clinical study.
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Affiliation(s)
- Kun-Ze Lee
- Department of Biological Sciences, National Sun Yat-sen University, #70 Lien-Hai Rd, Kaohsiung, 804 Taiwan; Department of Biomedical Science and Environmental Biology, Kaohsiung Medical University, 9F, First Teaching Building, 100, Shih-Chuan 1st Road, Kaohsiung, 807, Taiwan.
| | - Stéphane Vinit
- END-ICAP, UVSQ, Inserm, Université Paris-Saclay, Versailles 78000, France
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Yang T, Li X, Xia P, Wang X, Lu J, Wang L. Effects of rTMS combined with rPMS on stroke patients with arm paralysis after contralateral seventh cervical nerve transfer: a case-series. Int J Neurosci 2023; 133:999-1007. [PMID: 35094616 DOI: 10.1080/00207454.2022.2032044] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/25/2021] [Accepted: 01/14/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We conducted this study to evaluate the effect of rTMS combined with rPMS on stroke patients with arm paralysis after CSCNTS. METHODS A case-series of four stroke patients with arm paralysis, ages ranging from 39 to 51 years, that underwent CSCNTS was conducted. Patients were treated with 10 HZ rTMS on the contralesional primary motor cortex combined with 20 HZ rPMS on groups of elbow and wrist muscles for 15 days. RESULTS The muscle tone of elbow flexor muscle (EFM), elbow extensor muscle (EEM), wrist flexor muscle (WFM) and flexor digitorum (FD) reduced immediately after operation followed by increasing gradually. After rehabilitation, the muscle tone of EEM and EFM reduced by 14% and 11%, respectively. There was a 13% and 45% change ratio in WFM and FD. The numeric rating scale (mean = 5.75 ± 1.71) was significantly lower (mean = 3.25 ± 1.90, t = 8.66, p = .00). Grip and pinch strength (mean = 23.65 ± 4.91; mean = 4.9 ± 0.59) were significantly higher (mean = 34.63 ± 5.23, t = -61.07, p = .00; mean = 7.1 ± 0.73, t = -13.91, p = .00). CONCLUSIONS The rehabilitation of stroke patients with arm paralysis after CSCNTS is a long, complicated process which includes great change of neuropathic pain, muscle tone, and muscle strength. In order to enhance the neural connection between the contralesional hemisphere and the hemiplegic limb, alleviate postoperative complications, as well as accelerate the rehabilitation process, we can consider to use rTMS combined with rPMS.
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Affiliation(s)
- Ting Yang
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
- Department of Rehabilitation Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xueping Li
- Department of Rehabilitation Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Peng Xia
- Department of Rehabilitation Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiaoju Wang
- Department of Rehabilitation Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jianqiang Lu
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Lin Wang
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
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Gorban C, Zhang Z, Mensen A, Khatami R. The Comparison of Early Hemodynamic Response to Single-Pulse Transcranial Magnetic Stimulation following Inhibitory or Excitatory Theta Burst Stimulation on Motor Cortex. Brain Sci 2023; 13:1609. [PMID: 38002568 PMCID: PMC10670137 DOI: 10.3390/brainsci13111609] [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: 10/12/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
We present a new study design aiming to enhance the understanding of the mechanism by which continuous theta burst stimulation (cTBS) or intermittent theta burst stimulation (iTBS) paradigms elicit cortical modulation. Using near-infrared spectroscopy (NIRS), we compared the cortical hemodynamics of the previously inhibited (after cTBS) or excited (after iTBS) left primary motor cortex (M1) as elicited by single-pulse TMS (spTMS) in a cross-over design. Mean relative changes in hemodynamics within 6 s of the stimulus were compared using a two-sample t-test (p < 0.05) and linear mixed model between real and sham stimuli and between stimuli after cTBS and iTBS. Only spTMS after cTBS resulted in a significant increase (p = 0.04) in blood volume (BV) compared to baseline. There were no significant changes in other hemodynamic parameters (oxygenated/deoxygenated hemoglobin). spTMS after cTBS induced a larger increase in BV than spTMS after iTBS (p = 0.021) and sham stimulus after cTBS (p = 0.009). BV showed no significant difference between real and sham stimuli after iTBS (p = 0.37). The greater hemodynamic changes suggest increased vasomotor reactivity after cTBS compared to iTBS. In addition, cTBS could decrease lateral inhibition, allowing activation of surrounding areas after cTBS.
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Affiliation(s)
- Corina Gorban
- Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid, 5017 Barmelweid, Switzerland; (C.G.); (A.M.); (R.K.)
- Department of Neurology, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
| | - Zhongxing Zhang
- Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid, 5017 Barmelweid, Switzerland; (C.G.); (A.M.); (R.K.)
| | - Armand Mensen
- Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid, 5017 Barmelweid, Switzerland; (C.G.); (A.M.); (R.K.)
| | - Ramin Khatami
- Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid, 5017 Barmelweid, Switzerland; (C.G.); (A.M.); (R.K.)
- Department of Neurology, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
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Yuan Y, Wu Q, Wang X, Liu M, Yan J, Ji H. Low-intensity ultrasound stimulation modulates time-frequency patterns of cerebral blood oxygenation and neurovascular coupling of mouse under peripheral sensory stimulation state. Neuroimage 2023; 270:119979. [PMID: 36863547 DOI: 10.1016/j.neuroimage.2023.119979] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 02/03/2023] [Accepted: 02/23/2023] [Indexed: 03/04/2023] Open
Abstract
Previous studies have demonstrated that transcranial ultrasound stimulation (TUS) not only modulates cerebral hemodynamics, neural activity, and neurovascular coupling characteristics in resting samples but also exerts a significant inhibitory effect on the neural activity in task samples. However, the effect of TUS on cerebral blood oxygenation and neurovascular coupling in task samples remains to be elucidated. To answer this question, we first used forepaw electrical stimulation of the mice to elicit the corresponding cortical excitation, and then stimulated this cortical region using different modes of TUS, and simultaneously recorded the local field potential using electrophysiological acquisition and hemodynamics using optical intrinsic signal imaging. The results indicate that for the mice under peripheral sensory stimulation state, TUS with a duty cycle of 50% can (1) enhance the amplitude of cerebral blood oxygenation signal, (2) reduce the time-frequency characteristics of evoked potential, (3) reduce the strength of neurovascular coupling in time domain, (4) enhance the strength of neurovascular coupling in frequency domain, and (5) reduce the time-frequency cross-coupling of neurovasculature. The results of this study indicate that TUS can modulate the cerebral blood oxygenation and neurovascular coupling in peripheral sensory stimulation state mice under specific parameters. This study opens up a new area of investigation for potential applicability of TUS in brain diseases related to cerebral blood oxygenation and neurovascular coupling.
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Affiliation(s)
- Yi Yuan
- School of Electrical Engineering, Yanshan University, Qinhuangdao 066004, China; Key Laboratory of Intelligent Rehabilitation and Neuromodulation of Hebei Province, Yanshan University, Qinhuangdao 066004, China.
| | - Qianqian Wu
- School of Electrical Engineering, Yanshan University, Qinhuangdao 066004, China; Key Laboratory of Intelligent Rehabilitation and Neuromodulation of Hebei Province, Yanshan University, Qinhuangdao 066004, China
| | - Xingran Wang
- School of Electrical Engineering, Yanshan University, Qinhuangdao 066004, China; Key Laboratory of Intelligent Rehabilitation and Neuromodulation of Hebei Province, Yanshan University, Qinhuangdao 066004, China
| | - Mengyang Liu
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna 1090, Austria
| | - Jiaqing Yan
- College of Electrical and Control Engineering, North China University of Technology, Beijing 100041, China.
| | - Hui Ji
- Department of Neurology, the Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China.
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Dong H, Guo L, Yang H, Zhu W, Liu F, Xie Y, Zhang Y, Xue K, Li Q, Liang M, Zhang N, Qin W. Association between gray matter atrophy, cerebral hypoperfusion, and cognitive impairment in Alzheimer's disease. Front Aging Neurosci 2023; 15:1129051. [PMID: 37091519 PMCID: PMC10117777 DOI: 10.3389/fnagi.2023.1129051] [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: 12/21/2022] [Accepted: 03/15/2023] [Indexed: 04/25/2023] Open
Abstract
Background Alzheimer's disease (AD) is one of the most severe neurodegenerative diseases leading to dementia in the elderly. Cerebral atrophy and hypoperfusion are two important pathophysiological characteristics. However, it is still unknown about the area-specific causal pathways between regional gray matter atrophy, cerebral hypoperfusion, and cognitive impairment in AD patients. Method Forty-two qualified AD patients and 49 healthy controls (HC) were recruited in this study. First, we explored voxel-wise inter-group differences in gray matter volume (GMV) and arterial spin labeling (ASL) -derived cerebral blood flow (CBF). Then we explored the voxel-wise associations between GMV and Mini-Mental State Examination (MMSE) score, GMV and CBF, and CBF and MMSE to identify brain targets contributing to cognitive impairment in AD patients. Finally, a mediation analysis was applied to test the causal pathways among atrophied GMV, hypoperfusion, and cognitive impairment in AD. Results Voxel-wise permutation test identified that the left middle temporal gyrus (MTG) had both decreased GMV and CBF in the AD. Moreover, the GMV of this region was positively correlated with MMSE and its CBF, and CBF of this region was also positively correlated with MMSE in AD (p < 0.05, corrected). Finally, mediation analysis revealed that gray matter atrophy of left MTG drives cognitive impairment of AD via the mediation of CBF (proportion of mediation = 55.82%, β = 0.242, 95% confidence interval by bias-corrected and accelerated bootstrap: 0.082 to 0.530). Conclusion Our findings indicated suggested that left MTG is an important hub linking gray matter atrophy, hypoperfusion, and cognitive impairment for AD, and might be a potential treatment target for AD.
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Affiliation(s)
- Haoyang Dong
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Lining Guo
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Hailei Yang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Wenshuang Zhu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Fang Liu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yingying Xie
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Yu Zhang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Kaizhong Xue
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Qiang Li
- Technical College for the Deaf, Tianjin University of Technology, Tianjin, China
| | - Meng Liang
- School of Medical Imaging, Tianjin Medical University, Tianjin, China
| | - Nan Zhang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
- *Correspondence: Nan Zhang,
| | - Wen Qin
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
- Wen Qin,
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Zamar AC, Kouimtsidis C, Lulsegged A, Roberts R, Koutsomitros T, Stahl D. A New Treatment Protocol of Combined High-Dose Levothyroxine and Repetitive Transcranial Magnetic Stimulation for the Treatment of Rapid-Cycling Bipolar Spectrum Disorders: A Cohort Evaluation of 55 Patients. J Clin Med 2022; 11:jcm11195830. [PMID: 36233698 PMCID: PMC9572106 DOI: 10.3390/jcm11195830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/05/2022] [Accepted: 09/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Bipolar spectrum disorders (BSD) are highly disabling, with rapid cycling being treatment resistant. High-dose levothyroxine (HDT) has been reported to be effective. Diagnosis is associated with mutations in thyroid-activating enzymes and cerebral transporter protein carrier. Repetitive transcranial magnetic stimulation (rTMS) has neuroplastic effects. Methods: We report data on 55 severely symptomatic patients with rapid-cycling BSD treated with a combination protocol of HDT and rTMS. Of the patients, 31 patients (56.4%) were female and 40 (72.7%) had at least one additional diagnosis. Results: Patients were evaluated at three monthly intervals after acute treatment. Remission was measured using the Sheehan Disability Scale (SDS). The average number of medications prescribed was 1.8, with 32 patients (58.2%) needing only levothyroxine. The average dose of levothyroxine was 303.7 mcg (50 mcg−1000 mcg). A total of 53 patients were in remission (96.4%), with an average duration of 2.0 years. The SDS scores decreased significantly (Cohen’s d = 2.61 (95% C.I. 1.81 to 2.83, p < 0.001). One patient had reversible side effects. A total of 52 (94.3%) patients had Deiodinase 1 and 2 (DiO1/DiO2) or SLCO1C1 protein carrier gene mutations. Conclusion: The data support the safety and acceptability of combined HDT/rTMS. Patients achieved long remissions with substantial improvements in quality of life.
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Affiliation(s)
- Antonis C. Zamar
- The London Psychiatry Centre, London W1G 7HG, UK
- Correspondence: ; Tel.: +44-2075804224
| | - Christos Kouimtsidis
- The London Psychiatry Centre, London W1G 7HG, UK
- Imperial College, London SW7 2BX, UK
| | | | | | - Theodoros Koutsomitros
- Greek rTMS Clinic, Medical Psychotherapeutic Centre (ΙΨΚ), 546 24 Thessaloniki, Greece
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, 6211 LK Maastricht, The Netherlands
| | - Daniel Stahl
- Statistics Kings College, Strand, London WC2R 2LS, UK
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Cember ATJ, Deck BL, Kelkar A, Faseyitan O, Zimmerman JP, Erickson B, Elliott MA, Coslett HB, Hamilton RH, Reddy R, Medaglia JD. Glutamate-Weighted Magnetic Resonance Imaging (GluCEST) Detects Effects of Transcranial Magnetic Stimulation to the Motor Cortex. Neuroimage 2022; 256:119191. [PMID: 35413447 DOI: 10.1016/j.neuroimage.2022.119191] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 03/18/2022] [Accepted: 04/05/2022] [Indexed: 11/18/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) is used in several FDA-approved treatments and, increasingly, to treat neurological disorders in off-label uses. However, the mechanism by which TMS causes physiological change is unclear, as are the origins of response variability in the general population. Ideally, objective in vivo biomarkers could shed light on these unknowns and eventually inform personalized interventions. Continuous theta-burst stimulation (cTBS) is a form of TMS observed to reduce motor evoked potentials (MEPs) for 60 min or longer post-stimulation, although the consistency of this effect and its mechanism continue to be under debate. Here, we use glutamate-weighted chemical exchange saturation transfer (gluCEST) magnetic resonance imaging (MRI) at ultra-high magnetic field (7T) to measure changes in glutamate concentration at the site of cTBS. We find that the gluCEST signal in the ipsilateral hemisphere of the brain generally decreases in response to cTBS, whereas consistent changes were not detected in the contralateral region of interest (ROI) or in subjects receiving sham stimulation.
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Affiliation(s)
- Abigail T J Cember
- Center for Advanced Metabolic Imaging in Precision Medicine, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Benjamin L Deck
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, USA
| | - Apoorva Kelkar
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, USA
| | - Olu Faseyitan
- Department of Neurology, Laboratory for Cognition and Neural Stimulation, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jared P Zimmerman
- Department of Neurology, Laboratory for Cognition and Neural Stimulation, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Brian Erickson
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, USA
| | - Mark A Elliott
- Center for Advanced Metabolic Imaging in Precision Medicine, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - H Branch Coslett
- Department of Neurology, Laboratory for Cognition and Neural Stimulation, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Roy H Hamilton
- Department of Neurology, Laboratory for Cognition and Neural Stimulation, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ravinder Reddy
- Center for Advanced Metabolic Imaging in Precision Medicine, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - John D Medaglia
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, USA; Department of Neurology, Laboratory for Cognition and Neural Stimulation, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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11
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Zamar A, Lulsegged A, Kouimtsidis C. A new approach for the treatment of subthreshold bipolar disorders: Targeted high dose levothyroxine and repetitive transcranial magnetic stimulation for mitochondrial treatment. Front Psychiatry 2022; 13:976544. [PMID: 36311500 PMCID: PMC9606762 DOI: 10.3389/fpsyt.2022.976544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/16/2022] [Indexed: 11/18/2022] Open
Abstract
Bipolar spectrum disorder includes Bipolar I, Bipolar II and subthreshold bipolar disorders (BD). The condition is highly prevalent, disabling and associated with high mortality. Failure of diagnosis is high. Subthreshold presentations present as 4 or more changes in polarity, are generally less responsive to standard treatment and as a result, drug combinations are often needed. High Dose Levothyroxine (HDT) has been reported to be safe and effective with this condition. Treatment response has been associated with mutations in thyroid activating enzymes and intra cerebral transporter protein carrier. Repetitive Transcranial Magnetic Stimulation (rTMS) has been shown to be effective in bipolar depression and has been proved to have neuroplastic effect. Present authors had reported clinical evidence of safe and effective use of a combination treatment protocol. Potential mechanisms of action of the combined treatment protocol and the role of mitochondria function are discussed.
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Affiliation(s)
- Andy Zamar
- Consultant Psychiatrist, The London Psychiatry Centre, London, United Kingdom
| | - Abbi Lulsegged
- Consultant Endocrinologist Health 121 Ltd., London, United Kingdom
| | - Christos Kouimtsidis
- Consultant Psychiatrist, The London Psychiatry Centre, London, United Kingdom.,Honorary Senior Lecturer Imperial College London, London, United Kingdom
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12
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Mantovani A, Neri F, D'Urso G, Mencarelli L, Tatti E, Momi D, Menardi A, Sprugnoli G, Santarnecchi E, Rossi S. Functional connectivity changes and symptoms improvement after personalized, double-daily dosing, repetitive transcranial magnetic stimulation in obsessive-compulsive disorder: A pilot study. J Psychiatr Res 2021; 136:560-570. [PMID: 33158554 DOI: 10.1016/j.jpsychires.2020.10.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND intrusive thoughts and compulsive behaviors that characterize obsessive compulsive disorder (OCD) are associated to aberrant resting state functional connectivity (rsFC) patterns within the cortico-striatal-thalamo-cortical (CSTC) circuits. A high percentage of OCD patients do not respond to conventional pharmacological treatments or psychotherapy. In these patients, inhibitory repetitive transcranial magnetic stimulation (rTMS) of the Supplementary Motor Area (SMA) resulted in a significant clinical benefit. METHODS In the current study, we applied a novel protocol of 1-week MRI-guided individualized double-daily sessions of rTMS treatment (1-Hz; 110% of resting Motor Threshold/7200 pulses/day), to bilateral SMA in 9 OCD patients. We tested its (i) feasibility-safety, (ii) clinical efficacy and (iii) rsFC related changes. RESULTS Patients reported no side effects during and after rTMS. Personalized rTMS treatment led to a significant improvement of OCD symptoms (average 25%; p = .005) and persistence of benefit up to 3-month follow-up. rsFC analysis revealed a significant reduction of connectivity patterns between bilateral SMA and subcortical regions, specifically in the basal ganglia and thalamus. Additional analysis showed that OCD symptoms severity correlates with a higher connectivity pattern between bilateral SMA and subcortical regions. CONCLUSIONS rTMS double-daily sessions are safe, feasible and effective in OCD. The clinical outcomes, that are consistent with those found in our previous RCT, are linked to a decreased connectivity between SMA and subcortical brain areas implicated in control over obsessions and maladaptive compulsive behavior.
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Affiliation(s)
- Antonio Mantovani
- Department of Molecular, Cellular and Biomedical Sciences, CUNY, School of Medicine, New York, USA
| | - Francesco Neri
- Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Unit of Neurology and Clinical Neurophysiology, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy.
| | - Giordano D'Urso
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Lucia Mencarelli
- Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Unit of Neurology and Clinical Neurophysiology, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy; Berenson-Allen Center for Non-Invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Elisa Tatti
- Department of Molecular, Cellular and Biomedical Sciences, CUNY, School of Medicine, New York, USA
| | - Davide Momi
- Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Unit of Neurology and Clinical Neurophysiology, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy; Berenson-Allen Center for Non-Invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Arianna Menardi
- Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Unit of Neurology and Clinical Neurophysiology, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy; Berenson-Allen Center for Non-Invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Giulia Sprugnoli
- Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Unit of Neurology and Clinical Neurophysiology, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Emiliano Santarnecchi
- Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Unit of Neurology and Clinical Neurophysiology, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy; Berenson-Allen Center for Non-Invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Simone Rossi
- Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Unit of Neurology and Clinical Neurophysiology, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy; Department of Medicine, Surgery and Neuroscience, University of Siena School of Medicine, Siena, Italy
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13
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Kim J, Kim H, Lee J, Lee HJ, Na Y, Chang WH, Kim YH. Comparison of hemodynamic changes after repetitive transcranial magnetic stimulation over the anatomical hand knob and hand motor hotspot: A functional near-infrared spectroscopy study. Restor Neurol Neurosci 2020; 38:407-417. [PMID: 33285650 PMCID: PMC7902962 DOI: 10.3233/rnn-201032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Low-frequency rTMS can induce upregulation of excitability in the contralateral hemisphere by interhemispheric interaction. OBJECTIVE The aim of this study was to compare the effects of interhemispheric modulation on hemodynamic changes after applying low-frequency rTMS over the anatomical hand knob (HK) and the hand motor hotspot (hMHS) in the dominant motor cortex. METHODS Ten healthy right-handed participants without a history of neurological or psychiatric symptoms (five males; 29.8±2.8 years) participated in this single-blind, randomized, cross-over study. rTMS was applied under three conditions over the dominant (left) hemisphere for 20 minutes: 1) 1 Hz rTMS stimulation on the HK (HK-rTMS), 2) 1 Hz rTMS stimulation on the hMHS (hMHS-rTMS), and 3) sham stimulation (Sham-rTMS). For all participants, functional near-infrared spectroscopy (fNIRS) was applied for measurement of cerebral oxyhemoglobin (oxyHb) and deoxyhemoglobin (deoxyHb) concentration over the non-dominant (right) hemisphere during a serial reaction time task (SRTT) with the non-dominant (left) hand before and after each condition. RESULTS The average coordinates of the hMHS (x = - 39.60 mm, y = - 17.11 mm, z = 66.40 mm) were anterior and lateral to the HK (x = - 36.72 mm, y = - 28.87 mm, z = 56.41 mm). In fNIRS time-series analysis, the integral value of oxyHb wassignificantly increased over the motor cortical region of the non-dominant hemisphere after the hMHS-rTMS compared with Sham-rTMS. The HK-rTMS also showed slight increment of oxyHb concentration but without statistical significance. The SPM group analysis showed greater magnitude of the activity in hMHS-rTMS than that of HK-rTMS after stimulation (p < 0.05). CONCLUSIONS These results demonstrated an interhemispheric modulation effect of hemodynamic changes by 1 Hz rTMS. The hMHS produced a more robust modulation effect of 1 Hz rTMS on the contralateral hemisphere than did the HK. Therefore, the rTMS can be considered a better stimulation target than the HK.
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Affiliation(s)
- Jinuk Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Heegoo Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jungsoo Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hwang-Jae Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Yoonju Na
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea.,Department of Medical Device Management & Research, Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
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14
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Optics Based Label-Free Techniques and Applications in Brain Monitoring. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10062196] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Functional near-infrared spectroscopy (fNIRS) has been utilized already around three decades for monitoring the brain, in particular, oxygenation changes in the cerebral cortex. In addition, other optical techniques are currently developed for in vivo imaging and in the near future can be potentially used more in human brain research. This paper reviews the most common label-free optical technologies exploited in brain monitoring and their current and potential clinical applications. Label-free tissue monitoring techniques do not require the addition of dyes or molecular contrast agents. The following optical techniques are considered: fNIRS, diffuse correlations spectroscopy (DCS), photoacoustic imaging (PAI) and optical coherence tomography (OCT). Furthermore, wearable optical brain monitoring with the most common applications is discussed.
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15
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Chatterjee K, Carman-Esparza CM, Munson JM. Methods to measure, model and manipulate fluid flow in brain. J Neurosci Methods 2020; 333:108541. [PMID: 31838183 PMCID: PMC7607555 DOI: 10.1016/j.jneumeth.2019.108541] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/01/2019] [Accepted: 12/04/2019] [Indexed: 01/15/2023]
Abstract
The brain consists of a complex network of cells and matrix that is cushioned and nourished by multiple types of fluids: cerebrospinal fluid, blood, and interstitial fluid. The movement of these fluids through the tissues has recently gained more attention due to implications in Alzheimer's Disease and glioblastoma. Therefore, methods to study these fluid flows are necessary and timely for the current study of neuroscience. Imaging modalities such as magnetic resonance imaging have been used clinically and pre-clinically to image flows in healthy and diseased brains. These measurements have been used to both parameterize and validate models of fluid flow both computational and in vitro. Both of these models can elucidate the changes to fluid flow that occur during disease and can assist in linking the compartments of fluid flow with one another, a difficult challenge experimentally. In vitro models, though in limited use with fluid flow, allow the examination of cellular responses to physiological flow. To determine causation, in vivo methods have been developed to manipulate flow, including both physical and pharmacological manipulations, at each point of fluid movement of origination resulting in exciting findings in the preclinical setting. With new targets, such as the brain-draining lymphatics and glymphatic system, fluid flow and tissue drainage within the brain is an exciting and growing research area. In this review, we discuss the methods that currently exist to examine and test hypotheses related to fluid flow in the brain as we attempt to determine its impact on neural function.
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Affiliation(s)
- Krishnashis Chatterjee
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Cora M Carman-Esparza
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Jennifer M Munson
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States.
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16
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Favilla CG, Forti RM, Zamzam A, Detre JA, Mullen MT, Yodh AG, Kasner SE, Busch DR, Baker WB, Mesquita RC, Kung D, Messé SR. Perfusion Enhancement with Respiratory Impedance After Stroke (PERI-Stroke). Neurotherapeutics 2019; 16:1296-1303. [PMID: 31140115 PMCID: PMC6985403 DOI: 10.1007/s13311-019-00744-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Intrathoracic pressure influences cardiac output and may affect cerebral blood flow (CBF). We aimed to quantify the cerebral hemodynamic response to intrathoracic pressure reduction in patients with acute ischemic stroke using a noninvasive respiratory impedance (RI) device. We assessed low-level (6 cm H2O) and high-level (12 cm H2O) RI in 17 spontaneously breathing patients within 72 h of anterior circulation acute ischemic stroke. Average age was 65 years, and 35% were female. Frontal lobe tissue perfusion and middle cerebral artery velocity (MCAv) were continuously monitored with optical diffuse correlation spectroscopy (DCS) and transcranial Doppler ultrasound, respectively. High-level RI resulted in a 7% increase in MCAv (p = 0.004). MCAv varied across all studied levels (baseline vs low-level vs high-level, p = 0.006), with a significant test of trend (p = 0.002). Changes were not seen in DCS measured tissue perfusion by nonparametric pairwise comparison. Mixed effects regression analysis identified a small increase in both MCAv (low-level RI: β 2.1, p < 0.001; high-level RI: β 5.0, p < 0.001) and tissue-level flow (low-level RI: β 5.4, p < 0.001; high-level RI: β 5.9, p < 0.001). There was a small increase in mean arterial pressure during low-level and high-level RI, 4% (p = 0.013) and 4% (p = 0.017), respectively. End-tidal CO2 remained stable throughout the protocol. RI was well tolerated. Manipulating intrathoracic pressure via noninvasive RI was safe and produced a small but measurable increase in cerebral perfusion in acute ischemic stroke patients. Future studies are warranted to assess whether RI is feasible and tolerable for prolonged use in hyperacute stroke management.
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Affiliation(s)
- Christopher G Favilla
- Department of Neurology, University of Pennsylvania, Philadelphia, USA.
- Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce St, 3 West Gates, Philadelphia, PA, 19104-4283, USA.
| | - Rodrigo M Forti
- Department of Physics & Astronomy, University of Pennsylvania, Philadelphia, USA
- Institute of Physics, University of Campinas, Campinas, 13083-859, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, 13083-888, Brazil
| | - Ahmad Zamzam
- Department of Neurology, University of Pennsylvania, Philadelphia, USA
| | - John A Detre
- Department of Neurology, University of Pennsylvania, Philadelphia, USA
- Department of Radiology, University of Pennsylvania, Philadelphia, USA
| | - Michael T Mullen
- Department of Neurology, University of Pennsylvania, Philadelphia, USA
| | - Arjun G Yodh
- Department of Physics & Astronomy, University of Pennsylvania, Philadelphia, USA
| | - Scott E Kasner
- Department of Neurology, University of Pennsylvania, Philadelphia, USA
| | - David R Busch
- Department of Physics & Astronomy, University of Pennsylvania, Philadelphia, USA
- Department of Anesthesiology & Pain Management, University of Texas Southwestern, Dallas, USA
- Department Neurology & Neurotherapeutics, University of Texas Southwestern, Dallas, USA
| | - Wesley B Baker
- Department of Physics & Astronomy, University of Pennsylvania, Philadelphia, USA
- Department of Neurology, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Rickson C Mesquita
- Institute of Physics, University of Campinas, Campinas, 13083-859, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, 13083-888, Brazil
| | - David Kung
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, USA
| | - Steven R Messé
- Department of Neurology, University of Pennsylvania, Philadelphia, USA
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17
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Caglayan AB, Beker MC, Caglayan B, Yalcin E, Caglayan A, Yulug B, Hanoglu L, Kutlu S, Doeppner TR, Hermann DM, Kilic E. Acute and Post-acute Neuromodulation Induces Stroke Recovery by Promoting Survival Signaling, Neurogenesis, and Pyramidal Tract Plasticity. Front Cell Neurosci 2019; 13:144. [PMID: 31031599 PMCID: PMC6474396 DOI: 10.3389/fncel.2019.00144] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/22/2019] [Indexed: 01/19/2023] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) has gained interest as a non-invasive treatment for stroke based on the data promoting its effects on functional recovery. However, the exact action mechanisms by which the rTMS exert beneficial effects in cellular and molecular aspect are largely unknown. To elucidate the effects of high- and low-frequency rTMS in the acute-ischemic brain, we examined how rTMS influences injury development, cerebral blood flow (CBF), DNA fragmentation, neuronal survival, pro- and anti-apoptotic protein activations after 30 and 90 min of focal cerebral ischemia. In addition, inflammation, angiogenesis, growth factors and axonal outgrowth related gene expressions, were analyzed. Furthermore, we have investigated the effects of rTMS on post-acute ischemic brain, particularly on spontaneous locomotor activity, perilesional tissue remodeling, axonal sprouting of corticobulbar tracts, glial scar formation and cell proliferation, in which rTMS was applied starting 3 days after the stroke onset for 28 days. In the high-frequency rTMS received animals reduced DNA fragmentation, infarct volume and improved CBF were observed, which were associated with increased Bcl-xL activity and reduced Bax, caspase-1, and caspase-3 activations. Moreover, increased angiogenesis, growth factors; and reduced inflammation and axonal sprouting related gene expressions were observed. These results correlated with reduced microglial activation, neuronal degeneration, glial scar formation and improved functional recovery, tissue remodeling, contralesional pyramidal tract plasticity and neurogenesis in the subacute rTMS treated animals. Overall, we propose that high-frequency rTMS in stroke patients can be used to promote functional recovery by inducing the endogenous repair and recovery mechanisms of the brain.
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Affiliation(s)
- Ahmet B Caglayan
- Department of Physiology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey.,Regenerative and Restorative Medical Research Center, Istanbul, Turkey
| | - Mustafa C Beker
- Department of Physiology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey.,Regenerative and Restorative Medical Research Center, Istanbul, Turkey
| | - Berrak Caglayan
- Regenerative and Restorative Medical Research Center, Istanbul, Turkey.,Department of Medical Biology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Esra Yalcin
- Department of Physiology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey.,Regenerative and Restorative Medical Research Center, Istanbul, Turkey
| | - Aysun Caglayan
- Department of Physiology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey.,Regenerative and Restorative Medical Research Center, Istanbul, Turkey
| | - Burak Yulug
- Department of Neurology, Faculty of Medicine, Alanya Alaaddin Keykubat University, Antalya, Turkey
| | - Lutfu Hanoglu
- Department of Neurology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Selim Kutlu
- Department of Physiology, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Thorsten R Doeppner
- Regenerative and Restorative Medical Research Center, Istanbul, Turkey.,Department of Neurology, Faculty of Medicine, University of Goettingen, Göttingen, Germany
| | - Dirk M Hermann
- Department of Neurology, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Ertugrul Kilic
- Department of Physiology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey.,Regenerative and Restorative Medical Research Center, Istanbul, Turkey
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18
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Curtin A, Tong S, Sun J, Wang J, Onaral B, Ayaz H. A Systematic Review of Integrated Functional Near-Infrared Spectroscopy (fNIRS) and Transcranial Magnetic Stimulation (TMS) Studies. Front Neurosci 2019; 13:84. [PMID: 30872985 PMCID: PMC6403189 DOI: 10.3389/fnins.2019.00084] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/25/2019] [Indexed: 01/10/2023] Open
Abstract
Background: The capacity for TMS to elicit neural activity and manipulate cortical excitability has created significant expectation regarding its use in both cognitive and clinical neuroscience. However, the absence of an ability to quantify stimulation effects, particularly outside of the motor cortex, has led clinicians and researchers to pair noninvasive brain stimulation with noninvasive neuroimaging techniques. fNIRS, as an optical and wearable neuroimaging technique, is an ideal candidate for integrated use with TMS. Together, TMS+fNIRS may offer a hybrid alternative to "blind" stimulation to assess NIBS in therapy and research. Objective: In this systematic review, the current body of research into the transient and prolonged effects of TMS on fNIRS-based cortical hemodynamic measures while at rest and during tasks are discussed. Additionally, studies investigating the relation of fNIRS to measures of cortical excitability as produced by TMS-evoked Motor-Evoked-Potential (MEP) are evaluated. The aim of this review is to outline the integrated use of TMS+fNIRS and consolidate findings related to use of fNIRS to monitor changes attributed to TMS and the relationship of fNIRS to cortical excitability itself. Methods: Key terms were searched in PubMed and Web-of-Science to identify studies investigating the use of both fNIRS and TMS. Works from Google-Scholar and referenced works in identified papers were also assessed for relevance. All published experimental studies using both fNIRS and TMS techniques in the study methodology were included. Results: A combined literature search of neuroimaging and neurostimulation studies identified 53 papers detailing the joint use of fNIRS and TMS. 22/53 investigated the immediate effects of TMS at rest in the DLPFC and M1 as measured by fNIRS. 21/22 studies reported a significant effect in [HbO] for 40/54 stimulation conditions with 14 resulting an increase and 26 in a decrease. While 15/22 studies also reported [HbR], only 5/37 conditions were significant. Task effects of fNIRS+TMS were detailed in 16 studies, including 10 with clinical populations. Most studies only reported significant changes in [HbO] related measures. Studies comparing fNIRS to changes in MEP-measured cortical excitability suggest that fNIRS measures may be spatially more diffuse but share similar traits. Conclusion: This review summarizes the progress in the development of this emerging hybrid neuroimaging & neurostimulation methodology and its applications. Despite encouraging progress and novel applications, a lack of replicated works, along with highly disparate methodological approaches, highlight the need for further controlled studies. Interpretation of current research directions, technical challenges of TMS+fNIRS, and recommendations regarding future works are discussed.
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Affiliation(s)
- Adrian Curtin
- Drexel University, School of Biomedical Engineering, Science and Health Systems, Philadelphia, PA, United States.,School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Shanbao Tong
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Junfeng Sun
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jijun Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Banu Onaral
- Drexel University, School of Biomedical Engineering, Science and Health Systems, Philadelphia, PA, United States
| | - Hasan Ayaz
- Drexel University, School of Biomedical Engineering, Science and Health Systems, Philadelphia, PA, United States.,Department of Family and Community Health, University of Pennsylvania, Philadelphia, PA, United States.,Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, United States
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19
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Portable Near-Infrared Technologies and Devices for Noninvasive Assessment of Tissue Hemodynamics. JOURNAL OF HEALTHCARE ENGINEERING 2019; 2019:3750495. [PMID: 30891170 PMCID: PMC6390246 DOI: 10.1155/2019/3750495] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 12/24/2018] [Accepted: 01/14/2019] [Indexed: 12/29/2022]
Abstract
Tissue hemodynamics, including the blood flow, oxygenation, and oxygen metabolism, are closely associated with many diseases. As one of the portable optical technologies to explore human physiology and assist in healthcare, near-infrared diffuse optical spectroscopy (NIRS) for tissue oxygenation measurement has been developed for four decades. In recent years, a dynamic NIRS technology, namely, diffuse correlation spectroscopy (DCS), has been emerging as a portable tool for tissue blood flow measurement. In this article, we briefly describe the basic principle and algorithms for static NIRS and dynamic NIRS (i.e., DCS). Then, we elaborate on the NIRS instrumentation, either commercially available or custom-made, as well as their applications to physiological studies and clinic. The extension of NIRS/DCS from spectroscopy to imaging was depicted, followed by introductions of advanced algorithms that were recently proposed. The future prospective of the NIRS/DCS and their feasibilities for routine utilization in hospital is finally discussed.
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Hernandez-Martin E, Marcano F, Modroño-Pascual C, Casanova-González O, Plata-Bello J, González-Mora JL. Is it possible to measure hemodynamic changes in the prefrontal cortex through the frontal sinus using continuous wave DOT systems? BIOMEDICAL OPTICS EXPRESS 2019; 10:817-837. [PMID: 30800517 PMCID: PMC6377888 DOI: 10.1364/boe.10.000817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/11/2018] [Accepted: 12/23/2018] [Indexed: 05/20/2023]
Abstract
The present work shows the capability of near infrared (NIR) light to reach the cerebral cortex through the frontal sinus using continuous-wave techniques (CW-DOT) in a dual study. On the one hand, changes in time during the tracking of a blood dye in the prefrontal cortex were monitored. On the other hand, hemodynamic changes induced by low frequency of transcranial magnetic stimulation applied on the prefrontal cortex were recorded. The results show how NIR light projected through the frontal sinus reaches the cerebral cortex target, providing enough information to have a reliable measurement of cortical hemodynamic changes using CW-DOT.
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Real-time measurement of cerebral blood flow during and after repetitive transcranial magnetic stimulation: A near-infrared spectroscopy study. Neurosci Lett 2017; 653:78-83. [DOI: 10.1016/j.neulet.2017.05.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 05/15/2017] [Accepted: 05/19/2017] [Indexed: 11/22/2022]
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Favilla CG, Parthasarathy AB, Detre JA, Yodh AG, Mullen MT, Kasner SE, Gannon K, Messé SR. Non-Invasive Respiratory Impedance Enhances Cerebral Perfusion in Healthy Adults. Front Neurol 2017; 8:45. [PMID: 28261153 PMCID: PMC5311047 DOI: 10.3389/fneur.2017.00045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 01/31/2017] [Indexed: 11/22/2022] Open
Abstract
Optimization of cerebral blood flow (CBF) is the cornerstone of clinical management in a number of neurologic diseases, most notably ischemic stroke. Intrathoracic pressure influences cardiac output and has the potential to impact CBF. Here, we aim to quantify cerebral hemodynamic changes in response to increased respiratory impedance (RI) using a non-invasive respiratory device. We measured cerebral perfusion under varying levels of RI (6 cm H2O, 9 cm H2O, and 12 cm H2O) in 20 healthy volunteers. Simultaneous measurements of microvascular CBF and middle cerebral artery mean flow velocity (MFV), respectively, were performed with optical diffuse correlation spectroscopy and transcranial Doppler ultrasound. At a high level of RI, MFV increased by 6.4% compared to baseline (p = 0.004), but changes in cortical CBF were non-significant. In a multivariable linear regression model accounting for end-tidal CO2, RI was associated with increases in both MFV (coefficient: 0.49, p < 0.001) and cortical CBF (coefficient: 0.13, p < 0.001), although the magnitude of the effect was small. Manipulating intrathoracic pressure via non-invasive RI was well tolerated and produced a small but measurable increase in cerebral perfusion in healthy individuals. Future studies in acute ischemic stroke patients with impaired cerebral autoregulation are warranted in order to assess whether RI is feasible as a novel non-invasive therapy for stroke.
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Affiliation(s)
| | - Ashwin B Parthasarathy
- Department of Physics and Astronomy, University of Pennsylvania , Philadelphia, PA , USA
| | - John A Detre
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA; Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Arjun G Yodh
- Department of Physics and Astronomy, University of Pennsylvania , Philadelphia, PA , USA
| | - Michael T Mullen
- Department of Neurology, University of Pennsylvania , Philadelphia, PA , USA
| | - Scott E Kasner
- Department of Neurology, University of Pennsylvania , Philadelphia, PA , USA
| | - Kimberly Gannon
- Department of Neurology, University of Pennsylvania , Philadelphia, PA , USA
| | - Steven R Messé
- Department of Neurology, University of Pennsylvania , Philadelphia, PA , USA
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Short-term effects of repetitive transcranial magnetic stimulation on sleep bruxism - a pilot study. Int J Oral Sci 2016; 8:61-5. [PMID: 27025267 PMCID: PMC4822180 DOI: 10.1038/ijos.2015.35] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2015] [Indexed: 11/24/2022] Open
Abstract
The purpose of this study was to investigate the effects of repetitive transcranial magnetic stimulation (rTMS) on patients with sleep bruxism (SB). Twelve patients with SB were included in an open, single-intervention pilot study. rTMS at 1 Hz and an intensity of 80% of the active motor threshold was applied to the ‘hot spot' of the masseter muscle representation at the primary motor cortex bilaterally for 20 min per side each day for 5 consecutive days. The jaw-closing muscle electromyographic (EMG) activity during sleep was recorded with a portable EMG recorder at baseline, during rTMS treatment and at follow-up for 5 days. In addition, patients scored their jaw-closing muscle soreness on a 0–10 numerical rating scale (NRS). Data were analysed with analysis of variance. The intensity of the EMG activity was suppressed during and after rTMS compared to the baseline (P = 0.04; P = 0.02, respectively). The NRS score of soreness decreased significantly during and after rTMS compared with baseline (P < 0.01). These findings indicated a significant inhibition of jaw-closing muscle activity during sleep along with a decrease of muscle soreness. This pilot study raises the possibility of therapeutic benefits from rTMS in patients with bruxism and calls for further and more controlled studies.
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Wang D, Parthasarathy AB, Baker WB, Gannon K, Kavuri V, Ko T, Schenkel S, Li Z, Li Z, Mullen MT, Detre JA, Yodh AG. Fast blood flow monitoring in deep tissues with real-time software correlators. BIOMEDICAL OPTICS EXPRESS 2016; 7:776-97. [PMID: 27231588 PMCID: PMC4866455 DOI: 10.1364/boe.7.000776] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 01/20/2016] [Accepted: 01/21/2016] [Indexed: 05/19/2023]
Abstract
We introduce, validate and demonstrate a new software correlator for high-speed measurement of blood flow in deep tissues based on diffuse correlation spectroscopy (DCS). The software correlator scheme employs standard PC-based data acquisition boards to measure temporal intensity autocorrelation functions continuously at 50 - 100 Hz, the fastest blood flow measurements reported with DCS to date. The data streams, obtained in vivo for typical source-detector separations of 2.5 cm, easily resolve pulsatile heart-beat fluctuations in blood flow which were previously considered to be noise. We employ the device to separate tissue blood flow from tissue absorption/scattering dynamics and thereby show that the origin of the pulsatile DCS signal is primarily flow, and we monitor cerebral autoregulation dynamics in healthy volunteers more accurately than with traditional instrumentation as a result of increased data acquisition rates. Finally, we characterize measurement signal-to-noise ratio and identify count rate and averaging parameters needed for optimal performance.
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Affiliation(s)
- Detian Wang
- Dept. of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104
USA
- Interdisciplinary Laboratory of Physics and Biomedicine, Institute of Fluid Physics, China Academy of Engineering Physics, Mianyang 621900,
China
| | | | - Wesley B. Baker
- Dept. of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104
USA
| | - Kimberly Gannon
- Div. of Stroke and Neurocritical Care, Hospital of the University of Pennsylvania, Philadelphia, PA 19104
USA
| | - Venki Kavuri
- Dept. of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104
USA
| | - Tiffany Ko
- Dept. of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104
USA
| | - Steven Schenkel
- Dept. of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104
USA
| | - Zhe Li
- Dept. of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104
USA
- State Key Laboratory of Precision Measurement Technology and Instruments, Tianjin University, Tianjin 300072,
China
| | - Zeren Li
- Interdisciplinary Laboratory of Physics and Biomedicine, Institute of Fluid Physics, China Academy of Engineering Physics, Mianyang 621900,
China
| | - Michael T. Mullen
- Div. of Stroke and Neurocritical Care, Hospital of the University of Pennsylvania, Philadelphia, PA 19104
USA
| | - John A. Detre
- Div. of Stroke and Neurocritical Care, Hospital of the University of Pennsylvania, Philadelphia, PA 19104
USA
| | - Arjun G. Yodh
- Dept. of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104
USA
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Zhang D, Ma Y. Repetitive transcranial magnetic stimulation improves both hearing function and tinnitus perception in sudden sensorineural hearing loss patients. Sci Rep 2015; 5:14796. [PMID: 26463446 PMCID: PMC4604476 DOI: 10.1038/srep14796] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 09/09/2015] [Indexed: 11/17/2022] Open
Abstract
The occurrence of sudden sensorineural hearing loss (SSHL) affects not only cochlear activity but also neural activity in the central auditory system. Repetitive transcranial magnetic stimulation (rTMS) above the auditory cortex has been reported to improve auditory processing and to reduce the perception of tinnitus, which results from network dysfunction involving both auditory and non-auditory brain regions. SSHL patients who were refractory to standard corticosteroid therapy (SCT) and hyperbaric oxygen (HBO) therapy received 20 sessions of 1 Hz rTMS to the temporoparietal junction ipsilateral to the symptomatic ear (rTMS group). RTMS therapy administered in addition to SCT and HBO therapy resulted in significantly greater recovery of hearing function and improvement of tinnitus perception compared SCT and HBO therapy without rTMS therapy. Additionally, the single photon emission computed tomography (SPECT) measurements obtained in a subgroup of patients suggested that the rTMS therapy could have alleviated the decrease in regional cerebral brain flow (rCBF) in SSHL patients. RTMS appears to be an effective, practical, and safe treatment strategy for SSHL.
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Affiliation(s)
- Dai Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Yuewen Ma
- Department of Rehabilitation Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
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Selb J, Boas DA, Chan ST, Evans KC, Buckley EM, Carp SA. Sensitivity of near-infrared spectroscopy and diffuse correlation spectroscopy to brain hemodynamics: simulations and experimental findings during hypercapnia. NEUROPHOTONICS 2014; 1:015005. [PMID: 25453036 PMCID: PMC4247161 DOI: 10.1117/1.nph.1.1.015005] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 06/12/2014] [Accepted: 06/25/2014] [Indexed: 05/18/2023]
Abstract
Near-infrared spectroscopy (NIRS) and diffuse correlation spectroscopy (DCS) are two diffuse optical technologies for brain imaging that are sensitive to changes in hemoglobin concentrations and blood flow, respectively. Measurements for both modalities are acquired on the scalp, and therefore hemodynamic processes in the extracerebral vasculature confound the interpretation of cortical hemodynamic signals. The sensitivity of NIRS to the brain versus the extracerebral tissue and the contrast-to-noise ratio (CNR) of NIRS to cerebral hemodynamic responses have been well characterized, but the same has not been evaluated for DCS. This is important to assess in order to understand their relative capabilities in measuring cerebral physiological changes. We present Monte Carlo simulations on a head model that demonstrate that the relative brain-to-scalp sensitivity is about three times higher for DCS (0.3 at 3 cm) than for NIRS (0.1 at 3 cm). However, because DCS has higher levels of noise due to photon-counting detection, the CNR is similar for both modalities in response to a physiologically realistic simulation of brain activation. Even so, we also observed higher CNR of the hemodynamic response during graded hypercapnia in adult subjects with DCS than with NIRS.
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Affiliation(s)
- Juliette Selb
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Department of Radiology, Optics Division, 149 13th Street, Charlestown, Massachusetts 02129, United States
- Address all correspondence to: Juliette Selb, E-mail:
| | - David A. Boas
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Department of Radiology, Optics Division, 149 13th Street, Charlestown, Massachusetts 02129, United States
| | - Suk-Tak Chan
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Department of Radiology, Optics Division, 149 13th Street, Charlestown, Massachusetts 02129, United States
| | - Karleyton C. Evans
- Massachusetts General Hospital, Harvard Medical School, Department of Psychiatry, 149 13th Street, Charlestown, Massachusetts 02129, United States
| | - Erin M. Buckley
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Department of Radiology, Optics Division, 149 13th Street, Charlestown, Massachusetts 02129, United States
| | - Stefan A. Carp
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Department of Radiology, Optics Division, 149 13th Street, Charlestown, Massachusetts 02129, United States
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Buckley EM, Parthasarathy AB, Grant PE, Yodh AG, Franceschini MA. Diffuse correlation spectroscopy for measurement of cerebral blood flow: future prospects. NEUROPHOTONICS 2014; 1:011009. [PMID: 25593978 PMCID: PMC4292799 DOI: 10.1117/1.nph.1.1.011009] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Diffuse correlation spectroscopy (DCS) is an emerging optical modality used to measure cortical cerebral blood flow. This outlook presents a brief overview of the technology, summarizing the advantages and limitations of the method, and describing its recent applications to animal, adult, and infant cohorts. At last, the paper highlights future applications where DCS may play a pivotal role individualizing patient management and enhancing our understanding of neurovascular coupling, activation, and brain development.
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Affiliation(s)
- Erin M. Buckley
- Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Charlestown, Massachusetts 02129
- Address all correspondence to: Erin M. Buckley,
| | - Ashwin B. Parthasarathy
- University of Pennsylvania, Department of Physics and Astronomy, Philadelphia, Pennsylvania 19104
| | - P. Ellen Grant
- Boston Children’s Hospital, Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston, Massachusetts 02115
| | - Arjun G. Yodh
- University of Pennsylvania, Department of Physics and Astronomy, Philadelphia, Pennsylvania 19104
| | - Maria Angela Franceschini
- Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Charlestown, Massachusetts 02129
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Favilla CG, Mesquita RC, Mullen M, Durduran T, Lu X, Kim MN, Minkoff DL, Kasner SE, Greenberg JH, Yodh AG, Detre JA. Optical bedside monitoring of cerebral blood flow in acute ischemic stroke patients during head-of-bed manipulation. Stroke 2014; 45:1269-74. [PMID: 24652308 DOI: 10.1161/strokeaha.113.004116] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE A primary goal of acute ischemic stroke (AIS) management is to maximize perfusion in the affected region and surrounding ischemic penumbra. However, interventions to maximize perfusion, such as flat head-of-bed (HOB) positioning, are currently prescribed empirically. Bedside monitoring of cerebral blood flow (CBF) allows the effects of interventions such as flat HOB to be monitored and may ultimately be used to guide clinical management. METHODS Cerebral perfusion was measured during HOB manipulations in 17 patients with unilateral AIS affecting large cortical territories in the anterior circulation. Simultaneous measurements of frontal CBF and arterial flow velocity were performed with diffuse correlation spectroscopy and transcranial Doppler ultrasound, respectively. Results were analyzed in the context of available clinical data and a previous study. RESULTS Frontal CBF, averaged over the patient cohort, decreased by 17% (P=0.034) and 15% (P=0.011) in the ipsilesional and contralesional hemispheres, respectively, when HOB was changed from flat to 30°. Significant (cohort-averaged) changes in blood velocity were not observed. Individually, varying responses to HOB manipulation were observed, including paradoxical increases in CBF with increasing HOB angle. Clinical features, stroke volume, and distance to the optical probe could not explain this paradoxical response. CONCLUSIONS A lower HOB angle results in an increase in cortical CBF without a significant change in arterial flow velocity in AIS, but there is variability across patients in this response. Bedside CBF monitoring with diffuse correlation spectroscopy provides a potential means to individualize interventions designed to optimize CBF in AIS.
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Affiliation(s)
- Christopher G Favilla
- From the Departments of Neurology (C.G.F., M.M., X.L., S.E.K., J.H.G., J.A.D.), Physics and Astronomy (R.C.M., M.N.K., D.L.M., A.G.Y.), and Radiology (J.A.D.), University of Pennsylvania, Philadelphia, PA; Institute of Physics, University of Campinas, Campinas, Brazil (R.C.M.); and ICFO-Institut de Ciències Fotòniques, Castelldefels, Barcelona, Spain (T.D.)
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Durduran T, Yodh AG. Diffuse correlation spectroscopy for non-invasive, micro-vascular cerebral blood flow measurement. Neuroimage 2014; 85 Pt 1:51-63. [PMID: 23770408 PMCID: PMC3991554 DOI: 10.1016/j.neuroimage.2013.06.017] [Citation(s) in RCA: 299] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 05/10/2013] [Accepted: 06/06/2013] [Indexed: 12/25/2022] Open
Abstract
Diffuse correlation spectroscopy (DCS) uses the temporal fluctuations of near-infrared (NIR) light to measure cerebral blood flow (CBF) non-invasively. Here, we provide a brief history of DCS applications in the brain with an emphasis on the underlying physical ideas, common instrumentation and validation. Then we describe recent clinical research that employs DCS-measured CBF as a biomarker of patient well-being, and as an indicator of hemodynamic and metabolic responses to functional stimuli.
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Affiliation(s)
- Turgut Durduran
- ICFO- Institut de Ciències Fotòniques, Mediterranean Technology Park, 08860 Castelldefels, Barcelona, Spain.
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