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Shali RK, Setarehdan SK, Seifi B. Functional near-infrared spectroscopy based blood pressure variations and hemodynamic activity of brain monitoring following postural changes: A systematic review. Physiol Behav 2024; 281:114574. [PMID: 38697274 DOI: 10.1016/j.physbeh.2024.114574] [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: 12/19/2023] [Revised: 04/03/2024] [Accepted: 04/26/2024] [Indexed: 05/04/2024]
Abstract
Postural change from supine or sitting to standing up leads to displacement of 300 to 1000 mL of blood from the central parts of the body to the lower limb, which causes a decrease in venous return to the heart, hence decrease in cardiac output, causing a drop in blood pressure. This may lead to falling down, syncope, and in general reducing the quality of daily activities, especially in the elderly and anyone suffering from nervous system disorders such as Parkinson's or orthostatic hypotension (OH). Among different modalities to study brain function, functional near-infrared spectroscopy (fNIRS) is a neuroimaging method that optically measures the hemodynamic response in brain tissue. Concentration changes in oxygenated hemoglobin (HbO2) and deoxygenated hemoglobin (HHb) are associated with brain neural activity. fNIRS is significantly more tolerant to motion artifacts compared to fMRI, PET, and EEG. At the same time, it is portable, has a simple structure and usage, is safer, and much more economical. In this article, we systematically reviewed the literature to examine the history of using fNIRS in monitoring brain oxygenation changes caused by sudden changes in body position and its relationship with the blood pressure changes. First, the theory behind brain hemodynamics monitoring using fNIRS and its advantages and disadvantages are presented. Then, a study of blood pressure variations as a result of postural changes using fNIRS is described. It is observed that only 58 % of the references concluded a positive correlation between brain oxygenation changes and blood pressure changes. At the same time, 3 % showed a negative correlation, and 39 % did not show any correlation between them.
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Affiliation(s)
- Roya Kheyrkhah Shali
- School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran.
| | - Seyed Kamaledin Setarehdan
- School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Behjat Seifi
- Faculty of Medical Science, University of Tehran, Tehran, Iran
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Phillips V Z, Canoy RJ, Paik SH, Lee SH, Kim BM. Functional Near-Infrared Spectroscopy as a Personalized Digital Healthcare Tool for Brain Monitoring. J Clin Neurol 2023; 19:115-124. [PMID: 36854332 PMCID: PMC9982178 DOI: 10.3988/jcn.2022.0406] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 03/02/2023] Open
Abstract
The sustained growth of digital healthcare in the field of neurology relies on portable and cost-effective brain monitoring tools that can accurately monitor brain function in real time. Functional near-infrared spectroscopy (fNIRS) is one such tool that has become popular among researchers and clinicians as a practical alternative to functional magnetic resonance imaging, and as a complementary tool to modalities such as electroencephalography. This review covers the contribution of fNIRS to the personalized goals of digital healthcare in neurology by identifying two major trends that drive current fNIRS research. The first major trend is multimodal monitoring using fNIRS, which allows clinicians to access more data that will help them to understand the interconnection between the cerebral hemodynamics and other physiological phenomena in patients. This allows clinicians to make an overall assessment of physical health to obtain a more-detailed and individualized diagnosis. The second major trend is that fNIRS research is being conducted with naturalistic experimental paradigms that involve multisensory stimulation in familiar settings. Cerebral monitoring of multisensory stimulation during dynamic activities or within virtual reality helps to understand the complex brain activities that occur in everyday life. Finally, the scope of future fNIRS studies is discussed to facilitate more-accurate assessments of brain activation and the wider clinical acceptance of fNIRS as a medical device for digital healthcare.
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Affiliation(s)
- Zephaniah Phillips V
- Global Health Technology Research Center, College of Health Science, Korea University, Seoul, Korea.
| | - Raymart Jay Canoy
- Program in Biomicro System Technology, College of Engineering, Korea University, Seoul, Korea
| | - Seung-ho Paik
- Global Health Technology Research Center, College of Health Science, Korea University, Seoul, Korea.,KLIEN Inc., Seoul Biohub, Seoul, Korea
| | - Seung Hyun Lee
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul, Korea
| | - Beop-Min Kim
- Department of Bio-Convergence Engineering, Korea University, Seoul, Korea
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Kim YH, Paik SH, Kim Y, Yoon J, Cho YS, Kym D, Hur J, Chun W, Kim BM, Kim BJ. Clinical application of functional near-infrared spectroscopy for burn assessment. Front Bioeng Biotechnol 2023; 11:1127563. [PMID: 37064241 PMCID: PMC10098203 DOI: 10.3389/fbioe.2023.1127563] [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: 12/19/2022] [Accepted: 03/21/2023] [Indexed: 04/18/2023] Open
Abstract
Significance: Early assessment of local tissue oxygen saturation is essential for clinicians to determine the burn wound severity. Background: We assessed the burn extent and depth in the skin of the extremities using a custom-built 36-channel functional near-infrared spectroscopy system in patients with burns. Methods: A total of nine patients with burns were analyzed in this study. All second-degree burns were categorized as superficial, intermediate, and deep burns; non-burned skin on the burned side; and healthy skin on the contralateral non-burned side. Hemodynamic tissue signals from functional near-infrared spectroscopy attached to the burn site were measured during fNIRS using a blood pressure cuff. A nerve conduction study was conducted to check for nerve damage. Results: All second-degree burns were categorized into superficial, intermediate, and deep burns; non-burned skin on the burned side and healthy skin on the contralateral non-burned side showed a significant difference distinguishable using functional near-infrared spectroscopy. Hemodynamic measurements using functional near-infrared spectroscopy were more consistent with the diagnosis of burns 1 week later than that of the degree of burns diagnosed visually at the time of admission. Conclusion: Functional near-infrared spectroscopy may help with the early judgment of burn extent and depth by reflecting differences in the oxygen saturation levels in the skin.
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Affiliation(s)
- Yoo Hwan Kim
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
- Department of Neurology, Graduate School, Korea University, Seoul, Republic of Korea
| | - Seung-Ho Paik
- Department of Bio-convergence Engineering, Korea University College of Health Science, Seoul, Republic of Korea
| | - Youngmin Kim
- Department of Surgery, Burn and Trauma Center, Daein Surgery and Medical Hospital, Seongnam, Republic of Korea
| | - Jaechul Yoon
- Department of Surgery, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Yong Suk Cho
- Department of Surgery, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Dohern Kym
- Department of Surgery, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jun Hur
- Department of Surgery, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Wook Chun
- Department of Surgery, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Beop-Min Kim
- Department of Bio-convergence Engineering, Korea University College of Health Science, Seoul, Republic of Korea
| | - Byung-Jo Kim
- Department of Neurology, Korea University Anam Hospital, Seoul, Republic of Korea
- BK21 FOUR Program in Learning Health Systems, Korea University, Seoul, Republic of Korea
- *Correspondence: Byung-Jo Kim,
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Kim YH, Kim Y, Yoon J, Cho YS, Kym D, Hur J, Chun W, Kim BJ. Frontal lobe hemodynamics detected by functional near-infrared spectroscopy during head-up tilt table tests in patients with electrical burns. Front Hum Neurosci 2022; 16:986230. [PMID: 36158619 PMCID: PMC9493373 DOI: 10.3389/fnhum.2022.986230] [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: 07/04/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
Significance Electrical burns can cause severe damage to the nervous system, resulting in autonomic dysfunction with reduced cerebral perfusion. However, few studies have investigated these consequences. Aim To elucidate changes in prefrontal cerebral hemodynamics using functional near-infrared spectroscopy (fNIRS) during the head-up tilt table test (HUT) for patients with electrical burns. Approach We recruited 17 patients with acute electrical burns within 1 week after their accidents and 10 healthy volunteers. The NIRS parameters acquired using an fNIRS device attached to the forehead were analyzed in five distinct HUT phases. Results Based on their HUT response patterns, patients with electrical burns were classified into the group with abnormal HUT results (APG, n = 4) or normal HUT results (NPG, n = 13) and compared with the healthy control (HC, n = 10) participants. We found trends in hemodynamic changes during the HUT that distinguished HC, NPG, and APG. Reduced cerebral perfusion and decreased blood oxygenation during the HUT were found in both the NPG and APG groups. Patients with electrical burns had autonomic dysfunction compared to the HC participants. Conclusions Using fNIRS, we observed that acute-stage electrical burn injuries could affect cerebral perfusion.
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Affiliation(s)
- Yoo Hwan Kim
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
- Department of Neurology, Graduate School, Korea University, Seoul, South Korea
| | - Youngmin Kim
- Department of Surgery, Burn and Trauma Center, Daein Surgery and Medical Hospital, Seongnam, South Korea
| | - Jaechul Yoon
- Department of Surgery, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Yong Suk Cho
- Department of Surgery, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Dohern Kym
- Department of Surgery, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Jun Hur
- Department of Surgery, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Wook Chun
- Department of Surgery, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Byung-Jo Kim
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
- BK21FOUR R&E Center for Learning Health Systems, Korea University, Seoul, South Korea
- *Correspondence: Byung-Jo Kim
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Phillips Z, Kim JB, Paik SH, Kang SY, Jeon NJ, Kim BM, Kim BJ. Regional analysis of cerebral hemodynamic changes during the head-up tilt test in Parkinson's disease patients with orthostatic intolerance. NEUROPHOTONICS 2020; 7:045006. [PMID: 33163544 PMCID: PMC7595744 DOI: 10.1117/1.nph.7.4.045006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/16/2020] [Indexed: 06/11/2023]
Abstract
Significance: Cerebral oxygenation changes in the superior, middle, and medial gyri were used to elucidate spatial impairments of autonomic hemodynamic recovery during the head-up tilt table test (HUTT) in Parkinson's disease (PD) patients with orthostatic intolerance (OI) symptoms. Aim: To analyze dynamic oxygenation changes during the HUTT and classify PD patients with OI symptoms using clinical and oxygenation features. Approach: Thirty-nine PD patients with OI symptoms [10: orthostatic hypotension (PD-OH); 29: normal HUTT results (PD-NOR)] and seven healthy controls (HCs) were recruited. Prefrontal oxyhemoglobin (HbO) changes during the HUTT were reconstructed with diffuse optical tomography and segmented using the automated anatomical labeling system. Decision trees were used for classification. Results: HCs and PD-NOR patients with positive rates of HbO change (PD-POS) showed the greatest HbO recovery in the superior frontal gyrus (SFG) during tilt. PD-OH and PD-NOR patients with negative rates of HbO change (PD-NEG) showed asymmetric reoxygenation. The classification accuracy was 89.4% for PD-POS versus PD-NEG, 71% for PD-NOR versus PD-OH, and 55.8% for PD-POS versus PD-NEG versus PD-OH. The oxygenation features were more discriminative than the clinical features. Conclusions: PD-OH showed decreased right SFG function, which may be associated with impaired compensatory autonomic responses to orthostatic stress.
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Affiliation(s)
- Zephaniah Phillips
- Korea University, Department of Bio-Convergence Engineering, Seoul, Republic of Korea
| | - Jung Bin Kim
- Korea University Anam Hospital, Department of Neurology, Seoul, Republic of Korea
| | - Seung-Ho Paik
- Korea University, Department of Bio-Convergence Engineering, Seoul, Republic of Korea
- KLIEN Inc., Seoul Biohub, Seoul, Republic of Korea
| | - Shin-Young Kang
- Korea University, Department of Bio-Convergence Engineering, Seoul, Republic of Korea
| | - Nam-Joon Jeon
- Korea University Anam Hospital, Neurophysiology Laboratory, Seoul, Republic of Korea
| | - Beop-Min Kim
- Korea University, Department of Bio-Convergence Engineering, Seoul, Republic of Korea
| | - Byung-Jo Kim
- Korea University Anam Hospital, Department of Neurology, Seoul, Republic of Korea
- Korea University Anam Hospital, Brain Convergence Research Center, Seoul, Republic of Korea
- Korea University, BK21 FOUR Program in Learning Health Systems, Seoul, Republic of Korea
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Evaluation of microvascular changes in optic disc and retina by optical coherence tomography angiography during Valsalva maneuver. Int Ophthalmol 2020; 40:2743-2749. [PMID: 32533453 DOI: 10.1007/s10792-020-01461-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/02/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Optical coherence tomography angiography (OCTA) is an increasingly widespread imaging tool that allows the visualization of the microvascular structures of the eye. It should be kept in mind in clinical practice, Valsalva maneuver (VM) may have an effect on OCTA findings. We aimed to evaluate the effect of VM on the optic nerve and retinal blood flow parameters measured by OCTA. METHODS Sixty age- and sex-matched healthy volunteers were included into this prospective study. Optic disc status for radial peripapillary capillary (RPC) network [whole image, inside disc and peripapillary capillary densities], superficial and deep capillary plexus whole, foveal, parafoveal and perifoveal densities and foveal avascular zone (FAZ) densities of volunteers were examined by OCTA both at rest and during VM. RESULTS The mean age of the subjects was 31.48 ± 7.49 (18-50) years and 51.7% were male. Superficial whole, parafoveal and perifoveal vessel densities were found to be significantly decreased during VM (p = 0.008, p= 0.015, p = 0.017, respectively). Lower levels of deep whole, parafoveal and perifoveal vessel densities were also detected while VM (p < 0.001 for all). However, there were no significant differences in terms of foveal vessel and FAZ densities. Additionally, VM significantly decreased RPC densities for whole image, inside and peripapillary capillary (p = 0.005, p < 0.001, p = 0.039, respectively). CONCLUSION VM may cause a significant decrease in optic nerve and para-perifoveal blood flow. Therefore, patient instruction about not holding breath is required before OCTA scanning.
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Kim JB, Phillips Z, Paik SH, Kang SY, Jeon NJ, Kim BJ, Kim BM. Cerebral hemodynamic monitoring of Parkinson's disease patients with orthostatic intolerance during head-up tilt test. NEUROPHOTONICS 2020; 7:025002. [PMID: 32411811 PMCID: PMC7202364 DOI: 10.1117/1.nph.7.2.025002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/20/2020] [Indexed: 06/11/2023]
Abstract
Significance: Monitoring of cerebral perfusion rather than blood pressure changes during a head-up tilt test (HUTT) is proposed to understand the pathophysiological effect of orthostatic intolerance (OI), including orthostatic hypotension (OH), in Parkinson's disease (PD) patients. Aim: We aim to characterize and distinguish the cerebral perfusion response to a HUTT for healthy controls (HCs) and PD patients with OI symptoms. Approach: Thirty-nine PD patients with OI symptoms [10 PD patients with OH (PD-OH) and 29 PD patients with normal HUTT results (PD-NOR)], along with seven HCs participated. A 108-channel diffuse optical tomography (DOT) system was used to reconstruct prefrontal oxyhemoglobin (HbO), deoxyhemoglobin (Hb), and total hemoglobin (HbT) changes during dynamic tilt (from supine to 70-deg tilt) and static tilt (remained tilted at 70 deg). Results: HCs showed rapid recovery of cerebral perfusion in the early stages of static tilt. PD-OH patients showed decreasing HbO and HbT during dynamic tilt, continuing into the static tilt period. The rate of HbO change from dynamic tilt to static tilt is the distinguishing feature between HCs and PD-OH patients. Accordingly, PD-NOR patients were subgrouped based on positive-rate and negative-rate of HbO change. PD patients with a negative rate of HbO change were more likely to report severe OI symptoms in the COMPASS questionnaire. Conclusions: Our findings showcase the usability of DOT for sensitive detection and quantification of autonomic dysfunction in PD patients with OI symptoms, even those with normal HUTT results.
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Affiliation(s)
- Jung Bin Kim
- Korea University Anam Hospital, Department of Neurology, Seoul, Republic of Korea
| | - Zephaniah Phillips
- Korea University, Department of Bio-Convergence Engineering, Seoul, Republic of Korea
| | - Seung-ho Paik
- Korea University, Department of Bio-Convergence Engineering, Seoul, Republic of Korea
- KLIEN Inc., Seoul Biohub, Seoul, Republic of Korea
| | - Shin-young Kang
- Korea University, Department of Bio-Convergence Engineering, Seoul, Republic of Korea
| | - Nam-Joon Jeon
- Korea University Anam Hospital, Neurophysiology Laboratory, Seoul, Republic of Korea
| | - Byung-Jo Kim
- Korea University Anam Hospital, Department of Neurology, Seoul, Republic of Korea
- Korea University Anam Hospital, Brain Convergence Research Center, Seoul, Republic of Korea
| | - Beop-Min Kim
- Korea University Anam Hospital, Department of Neurology, Seoul, Republic of Korea
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Kim JB, Kim H, Sung JH, Baek SH, Kim BJ. Heart-Rate-Based Machine-Learning Algorithms for Screening Orthostatic Hypotension. J Clin Neurol 2020; 16:448-454. [PMID: 32657066 PMCID: PMC7354974 DOI: 10.3988/jcn.2020.16.3.448] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/05/2020] [Accepted: 04/08/2020] [Indexed: 12/15/2022] Open
Abstract
Background and Purpose Many elderly patients are unable to actively stand up by themselves and have contraindications to performing the head-up tilt test (HUTT). We aimed to develop screening algorithms for diagnosing orthostatic hypotension (OH) before performing the HUTT. Methods This study recruited 663 patients with orthostatic intolerance (78 with and 585 without OH, as confirmed by the HUTT) and compared their clinical characteristics. Univariate and multivariate analyses were performed to investigate potential predictors of an OH diagnosis. Machine-learning algorithms were applied to determine whether the accuracy of OH prediction could be used for screening OH without performing the HUTT. Results Differences between expiration and inspiration (E-I differences), expiration:inspiration ratios (E:I ratios), and Valsalva ratios were smaller in patients with OH than in those without OH. The univariate analysis showed that increased age and baseline systolic blood pressure (BP) as well as decreased E-I difference, E:I ratio, and Valsalva ratio were correlated with OH. In the multivariate analysis, increased baseline systolic BP and decreased Valsalva ratio were found to be independent predictors of OH. Using those variables as input features, the classification accuracies of the support vector machine, k-nearest neighbors, and random forest methods were 84.4%, 84.4%, and 90.6%, respectively. Conclusions We have identified clinical parameters that are strongly associated with OH. Machine-learning analysis using those parameters was highly accurate in differentiating OH from non-OH patients. These parameters could be useful screening factors for OH in patients who are unable to perform the HUTT.
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Affiliation(s)
- Jung Bin Kim
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hayom Kim
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Joo Hye Sung
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seol Hee Baek
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Byung Jo Kim
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
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Kim YH, Paik SH, V ZP, Jeon NJ, Kim BJ, Kim BM. Cerebral Perfusion Monitoring Using Near-Infrared Spectroscopy During Head-Up Tilt Table Test in Patients With Orthostatic Intolerance. Front Hum Neurosci 2019; 13:55. [PMID: 30837856 PMCID: PMC6389826 DOI: 10.3389/fnhum.2019.00055] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 01/31/2019] [Indexed: 11/13/2022] Open
Abstract
The head-up tilt table test (HUT) is one of the primary clinical examinations for evaluating orthostatic intolerance (OI). HUT can be divided into three phases: dynamic tilt phase (supine to tilt up), static tilt phase (remain tilted at 70°), and post tilt phase (tilt down back to supine position). Commonly, blood pressure (BP) and heart rate (HR) are monitored to observe for OI symptoms, but are indirect measurements of cerebral perfusion and can lead to inaccurate HUT evaluation. In this study, we implemented a 108-channel near-infrared spectroscopy (NIRS) probe to characterize HUT performance by monitoring cerebral hemodynamic changes for healthy controls (HCs), OI patients with normal HUT results, and OI patients with positive HUT results: vasovagal syncope (VS), postural orthostatic tachycardia syndrome (POTS), orthostatic hypotension (OH), and orthostatic hypertension (OHT). By the end of the static tilt phase, OI patients typically did not show a complete recovery back to baseline cerebral oxygenation and total blood volume compared to HCs. We characterized the return to cerebral homeostasis by polynomial fitting total blood volume changes and determining the inflection point. The OI patients with normal HUT results, VS, OH, or OHT showed a delay in the return to cerebral homeostasis compared to the HC group during HUT.
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Affiliation(s)
- Yoo Hwan Kim
- Department of Neurology, Hallym University College of Medicine, Seoul, South Korea.,Department of Neurology, Korea University Medical Center, Seoul, South Korea
| | - Seung-Ho Paik
- Department of Bio-convergence Engineering, Korea University College of Health Science, Seoul, South Korea
| | - Zephaniah Phillips V
- Department of Bio-convergence Engineering, Korea University College of Health Science, Seoul, South Korea
| | - Nam-Joon Jeon
- Neurophysiology Laboratory, Korea University Anam Hospital, Seoul, South Korea
| | - Byung-Jo Kim
- Department of Neurology, Korea University Medical Center, Seoul, South Korea.,Brain Convergence Research Center, Korea University Anam Hospital, Seoul, South Korea
| | - Beop-Min Kim
- Department of Bio-convergence Engineering, Korea University College of Health Science, Seoul, South Korea
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