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Huang K, Chandak P, Wang Q, Havaldar S, Vaid A, Leskovec J, Nadkarni GN, Glicksberg BS, Gehlenborg N, Zitnik M. A foundation model for clinician-centered drug repurposing. Nat Med 2024:10.1038/s41591-024-03233-x. [PMID: 39322717 DOI: 10.1038/s41591-024-03233-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 08/05/2024] [Indexed: 09/27/2024]
Abstract
Drug repurposing-identifying new therapeutic uses for approved drugs-is often a serendipitous and opportunistic endeavour to expand the use of drugs for new diseases. The clinical utility of drug-repurposing artificial intelligence (AI) models remains limited because these models focus narrowly on diseases for which some drugs already exist. Here we introduce TxGNN, a graph foundation model for zero-shot drug repurposing, identifying therapeutic candidates even for diseases with limited treatment options or no existing drugs. Trained on a medical knowledge graph, TxGNN uses a graph neural network and metric learning module to rank drugs as potential indications and contraindications for 17,080 diseases. When benchmarked against 8 methods, TxGNN improves prediction accuracy for indications by 49.2% and contraindications by 35.1% under stringent zero-shot evaluation. To facilitate model interpretation, TxGNN's Explainer module offers transparent insights into multi-hop medical knowledge paths that form TxGNN's predictive rationales. Human evaluation of TxGNN's Explainer showed that TxGNN's predictions and explanations perform encouragingly on multiple axes of performance beyond accuracy. Many of TxGNN's new predictions align well with off-label prescriptions that clinicians previously made in a large healthcare system. TxGNN's drug-repurposing predictions are accurate, consistent with off-label drug use, and can be investigated by human experts through multi-hop interpretable rationales.
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Affiliation(s)
- Kexin Huang
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
- Department of Computer Science, Stanford University, Stanford, CA, USA
| | - Payal Chandak
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA, USA
| | - Qianwen Wang
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Shreyas Havaldar
- Hasso Plattner Institute for Digital Health, Icahn School of Medicine at Mount Sinai, Mount Sinai, NY, USA
| | - Akhil Vaid
- Hasso Plattner Institute for Digital Health, Icahn School of Medicine at Mount Sinai, Mount Sinai, NY, USA
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai, NY, USA
| | - Jure Leskovec
- Department of Computer Science, Stanford University, Stanford, CA, USA
| | - Girish N Nadkarni
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai, NY, USA
| | - Benjamin S Glicksberg
- Hasso Plattner Institute for Digital Health, Icahn School of Medicine at Mount Sinai, Mount Sinai, NY, USA
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai, NY, USA
| | - Nils Gehlenborg
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Marinka Zitnik
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Harvard Data Science Initiative, Cambridge, MA, USA.
- Kempner Institute for the Study of Natural and Artificial Intelligence, Harvard University, Cambridge, MA, USA.
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2
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Karatoprak DE, Engin R, Sahin S, İclek İ, Durak MA. Investigation of Neuroprotective Efficacy of Dexpanthenol in an Experimental Head Injury Model. J Korean Neurosurg Soc 2024; 67:521-530. [PMID: 38449284 PMCID: PMC11375073 DOI: 10.3340/jkns.2023.0219] [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: 10/23/2023] [Accepted: 12/16/2023] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVE Dexpanthenol (DXP), which has known neuroprotective effects, has been shown to be beneficial in various experimental models and ischaemic diseases. The aim of this study was to investigate the possible neuroprotective effects of DXP in a traumatic brain injury (TBI) model. METHODS Thirty-six Wistar-Albino female rats, approximately 6 months old, weighing 220-285 g were used. All rats were subjected to closed head trauma by dropping a weight of 350 g on the parietal region from a height of 50 cm at an angle of 180 degrees in the prepared head trauma model setup. The rats were divided into four groups as control (group 1), trauma (group 2), trauma + DXP (group 3), and DXP (group 4). In group 3, DXP was administered intraperitoneally at a dose of 500 mg/kg for six times at 30 minutes, 6, 12, 24, 36, and 48 hours. In group 4, DXP was administered intraperitoneally simultaneously with group 3 without causing head trauma. Blood samples were taken from all rats 72 hours later for biochemical examination. After blood samples were taken, rats were decapitated under general anaesthesia. Cerebral tissue samples were taken from decapitated rats for immunohistochemical and histopathological examination. RESULTS Cytokine markers were found to be increased in posttraumatic brain tissue. Malondialdehyde and glutathione reductase levels were lower in group 3 compared to group 2. In addition, superoxide dismutase, glutathione peroxidase and catalase levels were significantly higher in group 3 compared to group 2. In histological evaluation, congestion in the piamater layer, cell infiltration, vascular congestion, hemorrhage and neuronal degeneration were significantly decreased in group 3 compared to group 2. DXP seems to be beneficial in neurological recovery in terms of histological and oxidative changes after head trauma in rats. CONCLUSION DXP should be further evaluated for its possible therapeutic effect in TBI.
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Affiliation(s)
- Durmus E Karatoprak
- Brain and Nerve Surgery Clinic, Ministry of Health Necip Fazıl City Hospital, Kahramanmaraş, Turkey
| | - Recai Engin
- Brain and Nerve Surgery Clinic, Ministry of Health Necip Fazıl City Hospital, Kahramanmaraş, Turkey
| | - Sarp Sahin
- Brain and Nerve Surgery Clinic, Ministry of Health Karadeniz Ereğli State Hospital, Zonguldak, Turkey
| | - İsmail İclek
- Department of Neurosurgery, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Mehmet A Durak
- Department of Neurosurgery, Inonu University Faculty of Medicine, Malatya, Turkey
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Huang K, Chandak P, Wang Q, Havaldar S, Vaid A, Leskovec J, Nadkarni G, Glicksberg BS, Gehlenborg N, Zitnik M. A foundation model for clinician-centered drug repurposing. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.03.19.23287458. [PMID: 39148855 PMCID: PMC11326339 DOI: 10.1101/2023.03.19.23287458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
Drug repurposing - identifying new therapeutic uses for approved drugs - is often serendipitous and opportunistic, expanding the use of drugs for new diseases. The clinical utility of drug repurposing AI models remains limited because the models focus narrowly on diseases for which some drugs already exist. Here, we introduce TXGNN, a graph foundation model for zero-shot drug repurposing, identifying therapeutic candidates even for diseases with limited treatment options or no existing drugs. Trained on a medical knowledge graph, TXGNN utilizes a graph neural network and metric-learning module to rank drugs as potential indications and contraindications across 17,080 diseases. When benchmarked against eight methods, TXGNN improves prediction accuracy for indications by 49.2% and contraindications by 35.1% under stringent zero-shot evaluation. To facilitate model interpretation, TXGNN's Explainer module offers transparent insights into multi-hop medical knowledge paths that form TXGNN's predictive rationales. Human evaluation of TXGNN's Explainer showed that TXGNN's predictions and explanations perform encouragingly on multiple axes of performance beyond accuracy. Many of TxGNN's novel predictions align with off-label prescriptions clinicians make in a large healthcare system. TXGNN's drug repurposing predictions are accurate, consistent with off-label drug use, and can be investigated by human experts through multi-hop interpretable rationales.
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Affiliation(s)
- Kexin Huang
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA 02115
| | - Payal Chandak
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA 02139
| | - Qianwen Wang
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA 02115
| | - Shreyas Havaldar
- Hasso Plattner Institute for Digital Health, Icahn School of Medicine at Mount Sinai, NY 10029
| | - Akhil Vaid
- Hasso Plattner Institute for Digital Health, Icahn School of Medicine at Mount Sinai, NY 10029
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, NY 10029
| | - Jure Leskovec
- Department of Computer Science, Stanford University, Stanford, CA 94305
| | - Girish Nadkarni
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, NY 10029
| | - Benjamin S. Glicksberg
- Hasso Plattner Institute for Digital Health, Icahn School of Medicine at Mount Sinai, NY 10029
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, NY 10029
| | - Nils Gehlenborg
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA 02115
| | - Marinka Zitnik
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA 02115
- Broad Institute of MIT and Harvard, Cambridge, MA 02142
- Harvard Data Science Initiative, Cambridge, MA 02138
- Kempner Institute for the Study of Natural and Artificial Intelligence, Harvard University, MA 02134
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4
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Li J, Li H, Peng C, Xu W, Chen Q, Liu G. Paradoxical cognitive and language function recovery by zolpidem in a patient with traumatic brain injury: A case report. Medicine (Baltimore) 2024; 103:e38964. [PMID: 38996115 PMCID: PMC11245188 DOI: 10.1097/md.0000000000038964] [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: 03/04/2024] [Accepted: 06/11/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is a significant public health issue, often resulting from traffic accidents and falls, leading to a wide spectrum of outcomes from mild concussions to severe brain damage. The neurorehabilitation of TBI focuses on enhancing recovery and improving quality of life. Zolpidem, traditionally used for short-term management of insomnia, has shown potential in improving cognitive functions and language in TBI patients. Advances in neuroimaging techniques, such as functional near-infrared spectroscopy (fNIRS), have facilitated the exploration of the effects of therapeutic interventions on brain activity and functional connectivity in TBI patients. CASE SUMMARY We present the case of a 34-year-old male who sustained a TBI from a traffic collision. Despite severe impairments in cognitive and language functions, administration of 10 mg of zolpidem resulted in temporary but significant improvements in these areas, as evidenced by increased Mini-Mental State Examination scores and observed behavioral changes. fNIRS assessments before and after zolpidem administration revealed notable changes in cerebral cortex activity, including increased left hemisphere activation and a shift in functional connectivity to the bilateral frontal lobes, corresponding with the patient's improvement. CONCLUSION This case study highlights the potential of zolpidem, a medication traditionally used for insomnia, in enhancing cognitive and verbal functions in a patient with TBI, suggesting a potential therapeutic role for zolpidem in neurorehabilitation, supported by changes in brain activity and connectivity observed through fNIRS. However, further investigation is warranted to validate these findings and elucidate zolpidem's long-term effects on cognitive and functional outcomes in TBI patients.
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Affiliation(s)
- Jia Li
- Department of Rehabilitation Medicine, Shanghai Zhongye Hospital, Shanghai, China
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Haozheng Li
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Cheng Peng
- Department of Rehabilitation Medicine, Shanghai Zhongye Hospital, Shanghai, China
- Department of Health and Medical Sciences, School of Boertala Polytechnic, Xinjiang, China
| | - Weijian Xu
- Department of Rehabilitation Medicine, Shanghai Zhongye Hospital, Shanghai, China
| | - Qiang Chen
- Department of Rehabilitation Medicine, Shanghai Zhongye Hospital, Shanghai, China
| | - Gang Liu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
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5
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Zhou Y, Altonji KA, Kakkanatt A, Greenwald BD. Speech recovery after single-dose zolpidem in two minimally conscious patients with severe traumatic brain injuries: a case report. Brain Inj 2024; 38:337-340. [PMID: 38308526 DOI: 10.1080/02699052.2024.2311342] [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: 05/23/2023] [Accepted: 01/24/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND In rare cases, zolpidem administration has been found to paradoxically improve cognition in patients with brain injury in disorders of consciousness. CASE PRESENTATION Two minimally conscious plus (MCS+) patients at baseline, a 24-year-old woman 8 weeks post-traumatic brain injury (TBI) and 23-year-old man 6 weeks post-TBI, demonstrated behavioral improvements after off-label, single-dose administration of 10 mg of zolpidem. DISCUSSION/CONCLUSION The patients demonstrated improved cognition on Coma Recovery Scale-Revised assessment after ingesting zolpidem. In particular, speech was substantially restored as one patient recovered functional communication and both demonstrated intelligible verbalizations for the first-time post-injuries following zolpidem. Overall, evidence is limited regarding the underlying mechanisms of various cognitive improvements in zolpidem response although studies incorporating neuroimaging are promising. The outcomes and similarities between these cases contribute to the current literature and highlight the need for rigorous studies in the future to guide zolpidem trials in patient care for those with DOC.
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Affiliation(s)
- Yi Zhou
- Department of Physical Medicine and Rehabilitation, JFK Johnson Rehabilitation Institute, Edison, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Kathryn A Altonji
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | - Ashley Kakkanatt
- Department of Physical Medicine and Rehabilitation, JFK Johnson Rehabilitation Institute, Edison, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Brian D Greenwald
- Department of Physical Medicine and Rehabilitation, JFK Johnson Rehabilitation Institute, Edison, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Maschke C, Duclos C, Owen AM, Jerbi K, Blain-Moraes S. Aperiodic brain activity and response to anesthesia vary in disorders of consciousness. Neuroimage 2023; 275:120154. [PMID: 37209758 DOI: 10.1016/j.neuroimage.2023.120154] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/28/2023] [Accepted: 05/02/2023] [Indexed: 05/22/2023] Open
Abstract
In the human electroencephalogram (EEG), oscillatory power peaks co-exist with non-oscillatory, aperiodic activity. Although EEG analysis has traditionally focused exclusively on oscillatory power, recent investigations have shown that the aperiodic EEG component can distinguish conscious wakefulness from sleep and anesthetic-induced unconsciousness. This study investigates the aperiodic EEG component of individuals in a disorder of consciousness (DOC); how it changes in response to exposure to anesthesia; and how it relates to the brain's information richness and criticality. High-density EEG was recorded from 43 individuals in a DOC, with 16 of these individuals undergoing a protocol of propofol anesthesia. The aperiodic component was defined by the spectral slope of the power spectral density. Our results demonstrate that the EEG aperiodic component is more informative about the participants' level of consciousness than the oscillatory component, especially for patients that suffered from a stroke. Importantly, the pharmacologically induced change in the spectral slope from 30-45 Hz positively correlated with individual's pre-anesthetic level of consciousness. The pharmacologically induced loss of information-richness and criticality was associated with individual's pre-anesthetic aperiodic component. During exposure to anesthesia, the aperiodic component was correlated with 3-month recovery status for individuals with DOC. The aperiodic EEG component has been historically neglected; this research highlights the necessity of considering this measure for the assessment of individuals in DOC and future research that seeks to understand the neurophysiological underpinnings of consciousness.
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Affiliation(s)
- Charlotte Maschke
- Montreal General Hospital, McGill University Health Centre, Montreal, Canada; Integrated Program in Neuroscience, McGill University, Montreal, Canada
| | - Catherine Duclos
- Hôpital du Sacré-Cœur de Montréal, Centre intégré universitaire de Santé et de Services Sociaux du Nord-de-l'île-de-Montréal, Montréal, Québec Canada; Department of Anesthesiology and Pain Medicine, Université de Montréal, Montréal, Québec Canada
| | - Adrian M Owen
- Department of Physiology and Pharmacology, Western University, London, Ontario, Canada; Western Institute for Neuroscience, Western University, London, Ontario, Canada; Department of Psychology, Western University, London, Ontario, Canada
| | - Karim Jerbi
- Cognitive & Computational Neuroscience Lab, Psychology Department, University of Montreal, Québec, Canada; MILA (Québec Artificial Intelligence Institute), Montréal, Québec, Canada; Centre UNIQUE (Union Neurosciences & Intelligence Artificielle), Montréal, Québec, Canada
| | - Stefanie Blain-Moraes
- Montreal General Hospital, McGill University Health Centre, Montreal, Canada; School of Physical and Occupational Therapy, McGill University, Montreal, Canada.
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Zheng RZ, Qi ZX, Wang Z, Xu ZY, Wu XH, Mao Y. Clinical Decision on Disorders of Consciousness After Acquired Brain Injury: Stepping Forward. Neurosci Bull 2023; 39:138-162. [PMID: 35804219 PMCID: PMC9849546 DOI: 10.1007/s12264-022-00909-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/10/2022] [Indexed: 01/22/2023] Open
Abstract
Major advances have been made over the past few decades in identifying and managing disorders of consciousness (DOC) in patients with acquired brain injury (ABI), bringing the transformation from a conceptualized definition to a complex clinical scenario worthy of scientific exploration. Given the continuously-evolving framework of precision medicine that integrates valuable behavioral assessment tools, sophisticated neuroimaging, and electrophysiological techniques, a considerably higher diagnostic accuracy rate of DOC may now be reached. During the treatment of patients with DOC, a variety of intervention methods are available, including amantadine and transcranial direct current stimulation, which have both provided class II evidence, zolpidem, which is also of high quality, and non-invasive stimulation, which appears to be more encouraging than pharmacological therapy. However, heterogeneity is profoundly ingrained in study designs, and only rare schemes have been recommended by authoritative institutions. There is still a lack of an effective clinical protocol for managing patients with DOC following ABI. To advance future clinical studies on DOC, we present a comprehensive review of the progress in clinical identification and management as well as some challenges in the pathophysiology of DOC. We propose a preliminary clinical decision protocol, which could serve as an ideal reference tool for many medical institutions.
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Affiliation(s)
- Rui-Zhe Zheng
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China
- National Center for Neurological Disorders, Shanghai, 200040, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China
- State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai, 200032, China
| | - Zeng-Xin Qi
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China
- National Center for Neurological Disorders, Shanghai, 200040, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China
- State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai, 200032, China
| | - Zhe Wang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China
- National Center for Neurological Disorders, Shanghai, 200040, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China
- State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai, 200032, China
| | - Ze-Yu Xu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China
- National Center for Neurological Disorders, Shanghai, 200040, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China
- State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai, 200032, China
| | - Xue-Hai Wu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China.
- National Center for Neurological Disorders, Shanghai, 200040, China.
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China.
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China.
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China.
- State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai, 200032, China.
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China.
- National Center for Neurological Disorders, Shanghai, 200040, China.
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China.
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China.
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China.
- State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai, 200032, China.
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8
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Maschke C, Duclos C, Blain-Moraes S. Paradoxical markers of conscious levels: Effects of propofol on patients in disorders of consciousness. Front Hum Neurosci 2022; 16:992649. [PMID: 36277055 PMCID: PMC9584648 DOI: 10.3389/fnhum.2022.992649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
Human consciousness is widely understood to be underpinned by rich and diverse functional networks, whose breakdown results in unconsciousness. Candidate neural correlates of anesthetic-induced unconsciousness include: (1) disrupted frontoparietal functional connectivity; (2) disrupted brain network hubs; and (3) reduced spatiotemporal complexity. However, emerging counterexamples have revealed that these markers may appear outside of the state they are associated with, challenging both their inclusion as markers of conscious level, and the theories of consciousness that rely on their evidence. In this study, we present a case series of three individuals in disorders of consciousness (DOC) who exhibit paradoxical brain responses to exposure to anesthesia. High-density electroencephalographic data were recorded from three patients with unresponsive wakefulness syndrome (UWS) while they underwent a protocol of propofol anesthesia with a targeted effect site concentration of 2 μg/ml. Network hubs and directionality of functional connectivity in the alpha frequency band (8–13 Hz), were estimated using the weighted phase lag index (wPLI) and directed phase lag index (dPLI). The spatiotemporal signal complexity was estimated using three types of Lempel-Ziv complexity (LZC). Our results illustrate that exposure to propofol anesthesia can paradoxically result in: (1) increased frontoparietal feedback-dominant connectivity; (2) posterior network hubs; and (3) increased spatiotemporal complexity. The case examples presented in this paper challenge the role of functional connectivity and spatiotemporal complexity in theories of consciousness and for the clinical evaluation of levels of human consciousness.
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Affiliation(s)
- Charlotte Maschke
- Montreal General Hospital, McGill University Health Centre, Montreal, QC, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada
| | - Catherine Duclos
- Hôpital du Sacré-Cœur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’île-de-Montréal, Montreal, QC, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, QC, Canada
| | - Stefanie Blain-Moraes
- Montreal General Hospital, McGill University Health Centre, Montreal, QC, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- *Correspondence: Stefanie Blain-Moraes,
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9
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Hao Z, Xia X, Bai Y, Wang Y, Dou W. EEG Evidence Reveals Zolpidem-Related Alterations and Prognostic Value in Disorders of Consciousness. Front Neurosci 2022; 16:863016. [PMID: 35573300 PMCID: PMC9093050 DOI: 10.3389/fnins.2022.863016] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/15/2022] [Indexed: 02/02/2023] Open
Abstract
Effective treatment and accurate long-term prognostication of patients with disorders of consciousness (DOC) remain pivotal clinical issues and challenges in neuroscience. Previous studies have shown that zolpidem produces paradoxical recovery and induces similar change patterns in specific electrophysiological features in some DOC (∼6%). However, whether these specific features are neural markers of responders, and how neural features evolve over time remain unclear. Here, we capitalized on static and dynamic EEG analysis techniques to fully uncover zolpidem-induced alterations in eight patients with DOC and constructed machine-learning models to predict long-term outcomes at the single-subject level. We observed consistent patterns of change across all patients in several static features (e.g., decreased relative theta power and weakened alpha-band functional connectivity) after zolpidem administration, albeit none zolpidem responders. Based on the current evidence, previously published electrophysiological features are not neural markers for zolpidem responders. Moreover, we found that the temporal dynamics of the brain slowed down after zolpidem intake. Brain states before and after zolpidem administration could be completely characterized by the EEG features. Furthermore, long-term outcomes were accurately predicted using connectivity features. Our findings suggest that EEG neural signatures have huge potential to assess consciousness states and predict fine-grained outcomes. In summary, our results extend the understanding of the effects of zolpidem on the brain and open avenues for the application prospect of zolpidem and EEG in patients with DOC.
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Affiliation(s)
- Zexuan Hao
- Department of Electronic Engineering, Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing, China
| | - Xiaoyu Xia
- Department of Neurosurgery, The First Medical Center of PLA General Hospital, Beijing, China
- Department of Neurosurgery, Hainan Hospital of PLA General Hospital, Sanya, China
| | - Yang Bai
- Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Yong Wang
- Key Laboratory of Intelligent Rehabilitation and Neuromodulation of Hebei Province, Department of Electrical Engineering, Yanshan University, Qinhuangdao, China
| | - Weibei Dou
- Department of Electronic Engineering, Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing, China
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10
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Treating Traumatic Brain Injuries with Electroceuticals: Implications for the Neuroanatomy of Consciousness. NEUROSCI 2021. [DOI: 10.3390/neurosci2030018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
According to the Centers for Disease Control and Prevention (CDC), traumatic brain injury (TBI) is the leading cause of loss of consciousness, long-term disability, and death in children and young adults (age 1 to 44). Currently, there are no United States Food and Drug Administration (FDA) approved pharmacological treatments for post-TBI regeneration and recovery, particularly related to permanent disability and level of consciousness. In some cases, long-term disorders of consciousness (DoC) exist, including the vegetative state/unresponsive wakefulness syndrome (VS/UWS) characterized by the exhibition of reflexive behaviors only or a minimally conscious state (MCS) with few purposeful movements and reflexive behaviors. Electroceuticals, including non-invasive brain stimulation (NIBS), vagus nerve stimulation (VNS), and deep brain stimulation (DBS) have proved efficacious in some patients with TBI and DoC. In this review, we examine how electroceuticals have improved our understanding of the neuroanatomy of consciousness. However, the level of improvements in general arousal or basic bodily and visual pursuit that constitute clinically meaningful recovery on the Coma Recovery Scale-Revised (CRS-R) remain undefined. Nevertheless, these advancements demonstrate the importance of the vagal nerve, thalamus, reticular activating system, and cortico-striatal-thalamic-cortical loop in the process of consciousness recovery.
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Ceccherini-Nelli A, Bucuci E, Burback L, Li D, Alikouzehgaran M, Latif Z, Morin K, Ganapathy K, Salsali M, Abdullah U, Westwood W, Orris J, White PJ. Retrospective Observational Study of Daytime Add-On Administration of Zopiclone to Difficult-to-Treat Psychiatric Inpatients With Unpredictable Aggressive Behavior, With or Without EEG Dysrhythmia. Front Psychiatry 2021; 12:693788. [PMID: 34483989 PMCID: PMC8415882 DOI: 10.3389/fpsyt.2021.693788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/22/2021] [Indexed: 11/18/2022] Open
Abstract
Managing violent behavior is a particularly challenging aspect of hospital psychiatric care. Available pharmacological interventions are often unsatisfactory. Aim: To assess the effectiveness and safety of daytime zopiclone add-on administration in violent and difficult-to-treat psychiatric inpatients. Methods: Chart review of inpatients treated with daytime zopiclone, between 2014 and 2018, with up to 12 weeks follow-up. Effectiveness was retrospectively assessed with the Clinical Global Impression rating scale (CGI) and the frequency and severity of aggressive incidents recorded with the Staff Observation Aggression Scale-Revised (SOAS-R). Results: Forty-five (30 male, 15 female) cases, 18-69 years age range, average (SD) baseline CGI-S score of 5.4 (1.0), and a variety of diagnoses. Sixty-nine percent showed CGI-S improvement of any degree. For patients with at least one aggressive incident within 7 days prior to initiation of zopiclone (N = 22), average (SD) SOAS-R-Severity LOCF to baseline change was -3.5 (2.7) P < 0.0001. Most patients reported no side effects; 24% reported one or more side effects, and 11% discontinued zopiclone due to sedation (4), insomnia (1) or slurred speech (1). No SAEs were recorded. Zopiclone maximum daily dose correlated with CGI-S baseline-to-LOCF change (rho = -0.5, P = 0.0003). The ROC AUC of zopiclone maximum daily dose and improvement on CGI-S was 0.84 (95% CI 0.70-0.93, P < 0.0001). The ROC AUC of zopiclone maximum daily dose and SOAS-R-N improvement was 0.80 (95% CI 0.58-0.92; P = 0.0008) and maximum Youden's index value was achieved at a dose of >30 mg. Conclusions: Zopiclone doses >30 mg daily achieved the best anti-aggressive effect.
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Affiliation(s)
- Alfonso Ceccherini-Nelli
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada.,Alberta Health Care Services, Edmonton, AB, Canada
| | - Elena Bucuci
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada.,Alberta Health Care Services, Edmonton, AB, Canada
| | - Lisa Burback
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada.,Alberta Health Care Services, Edmonton, AB, Canada
| | - Daniel Li
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada.,Alberta Health Care Services, Edmonton, AB, Canada
| | - Maryam Alikouzehgaran
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada.,Alberta Health Care Services, Edmonton, AB, Canada
| | - Zahid Latif
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada.,Alberta Health Care Services, Edmonton, AB, Canada
| | - Kevin Morin
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada.,Alberta Health Care Services, Edmonton, AB, Canada
| | - Karthikeyan Ganapathy
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada.,Alberta Health Care Services, Edmonton, AB, Canada
| | - Manhaz Salsali
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada.,Alberta Health Care Services, Edmonton, AB, Canada
| | - Ubaid Abdullah
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada.,Alberta Health Care Services, Edmonton, AB, Canada
| | | | - Janice Orris
- Alberta Health Care Services, Edmonton, AB, Canada
| | - Patrick J White
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada.,Alberta Health Care Services, Edmonton, AB, Canada
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Arnts H, van Erp WS, Boon LI, Bosman CA, Admiraal MM, Schrantee A, Pennartz CMA, Schuurman R, Stam CJ, van Rootselaar AF, Hillebrand A, van den Munckhof P. Awakening after a sleeping pill: Restoring functional brain networks after severe brain injury. Cortex 2020; 132:135-146. [PMID: 32979847 DOI: 10.1016/j.cortex.2020.08.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/09/2020] [Accepted: 08/11/2020] [Indexed: 12/11/2022]
Abstract
Some patients with severe brain injury show short-term neurological improvements, such as recovery of consciousness, motor function, or speech after administering zolpidem, a GABA receptor agonist. The working mechanism of this paradoxical phenomenon remains unknown. In this study, we used electroencephalography and magnetoencephalography to investigate a spectacular zolpidem-induced awakening, including the recovery of functional communication and the ability to walk in a patient with severe hypoxic-ischemic brain injury. We show that cognitive deficits, speech loss, and motor impairments after severe brain injury are associated with stronger beta band connectivity throughout the brain and suggest that neurological recovery after zolpidem occurs with the restoration of beta band connectivity. This exploratory work proposes an essential role for beta rhythms in goal-directed behavior and cognition. It advocates further fundamental and clinical research on the role of increased beta band connectivity in the development of neurological deficits after severe brain injury.
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Affiliation(s)
- Hisse Arnts
- Amsterdam UMC, University of Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, Amsterdam, the Netherlands.
| | - Willemijn S van Erp
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Lennard I Boon
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Clinical Neurophysiology and Magnetoencephalography Center, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Conrado A Bosman
- Cognitive and Systems Neuroscience Group, Swammerdam Institute, Center for Neuroscience, University of Amsterdam, Amsterdam, the Netherlands
| | - Marjolein M Admiraal
- Amsterdam UMC, University of Amsterdam, Department of Neurology and Clinical Neurophysiology, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Anouk Schrantee
- Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam, the Netherlands
| | - Cyriel M A Pennartz
- Cognitive and Systems Neuroscience Group, Swammerdam Institute, Center for Neuroscience, University of Amsterdam, Amsterdam, the Netherlands
| | - Rick Schuurman
- Amsterdam UMC, University of Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Cornelis J Stam
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Clinical Neurophysiology and Magnetoencephalography Center, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Anne-Fleur van Rootselaar
- Amsterdam UMC, University of Amsterdam, Department of Neurology and Clinical Neurophysiology, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Arjan Hillebrand
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Clinical Neurophysiology and Magnetoencephalography Center, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Pepijn van den Munckhof
- Amsterdam UMC, University of Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, Amsterdam, the Netherlands
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