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Busby N, Newman-Norlund S, Sayers S, Rorden C, Newman-Norlund R, Wilmskoetter J, Roth R, Wilson S, Schwen-Blackett D, Kristinsson S, Teghipco A, Fridriksson J, Bonilha L. Regional brain aging: premature aging of the domain general system predicts aphasia severity. Commun Biol 2024; 7:718. [PMID: 38862747 PMCID: PMC11167062 DOI: 10.1038/s42003-024-06211-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 04/17/2024] [Indexed: 06/13/2024] Open
Abstract
Premature brain aging is associated with poorer cognitive reserve and lower resilience to injury. When there are focal brain lesions, brain regions may age at different rates within the same individual. Therefore, we hypothesize that reduced gray matter volume within specific brain systems commonly associated with language recovery may be important for long-term aphasia severity. Here we show that individuals with stroke aphasia have a premature brain aging in intact regions of the lesioned hemisphere. In left domain-general regions, premature brain aging, gray matter volume, lesion volume and age were all significant predictors of aphasia severity. Increased brain age following a stroke is driven by the lesioned hemisphere. The relationship between brain age in left domain-general regions and aphasia severity suggests that degradation is possible to specific brain regions and isolated aging matters for behavior.
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Affiliation(s)
- Natalie Busby
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA.
| | - Sarah Newman-Norlund
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Sara Sayers
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Chris Rorden
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | | | - Janina Wilmskoetter
- Department of Health and Rehabilitation Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Rebecca Roth
- Department of Neurology, Emory University, Atlanta, GA, USA
| | - Sarah Wilson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Deena Schwen-Blackett
- Department of Health and Rehabilitation Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Sigfus Kristinsson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Alex Teghipco
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Leonardo Bonilha
- School of Medicine, University of South Carolina, Columbia, SC, USA
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2
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Sihvonen AJ, Pitkäniemi A, Siponkoski ST, Kuusela L, Martínez-Molina N, Laitinen S, Särkämö ER, Pekkola J, Melkas S, Schlaug G, Sairanen V, Särkämö T. Structural Neuroplasticity Effects of Singing in Chronic Aphasia. eNeuro 2024; 11:ENEURO.0408-23.2024. [PMID: 38688718 DOI: 10.1523/eneuro.0408-23.2024] [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: 10/13/2023] [Revised: 02/28/2024] [Accepted: 04/18/2024] [Indexed: 05/02/2024] Open
Abstract
Singing-based treatments of aphasia can improve language outcomes, but the neural benefits of group-based singing in aphasia are unknown. Here, we set out to determine the structural neuroplasticity changes underpinning group-based singing-induced treatment effects in chronic aphasia. Twenty-eight patients with at least mild nonfluent poststroke aphasia were randomized into two groups that received a 4-month multicomponent singing intervention (singing group) or standard care (control group). High-resolution T1 images and multishell diffusion-weighted MRI data were collected in two time points (baseline/5 months). Structural gray matter (GM) and white matter (WM) neuroplasticity changes were assessed using language network region of interest-based voxel-based morphometry (VBM) and quantitative anisotropy-based connectometry, and their associations to improved language outcomes (Western Aphasia Battery Naming and Repetition) were evaluated. Connectometry analyses showed that the singing group enhanced structural WM connectivity in the left arcuate fasciculus (AF) and corpus callosum as well as in the frontal aslant tract (FAT), superior longitudinal fasciculus, and corticostriatal tract bilaterally compared with the control group. Moreover, in VBM, the singing group showed GM volume increase in the left inferior frontal cortex (Brodmann area 44) compared with the control group. The neuroplasticity effects in the left BA44, AF, and FAT correlated with improved naming abilities after the intervention. These findings suggest that in the poststroke aphasia group, singing can bring about structural neuroplasticity changes in left frontal language areas and in bilateral language pathways, which underpin treatment-induced improvement in speech production.
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Affiliation(s)
- Aleksi J Sihvonen
- Cognitive Brain Research Unit and Centre of Excellence in Music, Mind, Body and Brain, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki 00014, Finland
- School of Health and Rehabilitation Sciences, Queensland Aphasia Research Centre and UQ Centre for Clinical Research, The University of Queensland, Brisbane QLD 4072, Australia
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki 00029, Finland
| | - Anni Pitkäniemi
- Cognitive Brain Research Unit and Centre of Excellence in Music, Mind, Body and Brain, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki 00014, Finland
| | - Sini-Tuuli Siponkoski
- Cognitive Brain Research Unit and Centre of Excellence in Music, Mind, Body and Brain, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki 00014, Finland
| | - Linda Kuusela
- HUS Helsinki Medical Imaging Center, Helsinki University Hospital, Helsinki 00029, Finland
| | - Noelia Martínez-Molina
- Cognitive Brain Research Unit and Centre of Excellence in Music, Mind, Body and Brain, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki 00014, Finland
| | | | | | - Johanna Pekkola
- HUS Helsinki Medical Imaging Center, Helsinki University Hospital, Helsinki 00029, Finland
| | - Susanna Melkas
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki 00029, Finland
| | - Gottfried Schlaug
- Department of Neurology, UMass Medical School, Springfield, Massachusetts 01655
- Department of Biomedical Engineering and Institute of Applied Life Sciences, UMass Amherst, Amherst, Massachusetts 01655
| | - Viljami Sairanen
- HUS Helsinki Medical Imaging Center, Helsinki University Hospital, Helsinki 00029, Finland
| | - Teppo Särkämö
- Cognitive Brain Research Unit and Centre of Excellence in Music, Mind, Body and Brain, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki 00014, Finland
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Johnson L, Newman-Norlund R, Teghipco A, Rorden C, Bonilha L, Fridriksson J. Progressive lesion necrosis is related to increasing aphasia severity in chronic stroke. Neuroimage Clin 2024; 41:103566. [PMID: 38280310 PMCID: PMC10835598 DOI: 10.1016/j.nicl.2024.103566] [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: 06/29/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Volumetric investigations of cortical damage resulting from stroke indicate that lesion size and shape continue to change even in the chronic stage of recovery. However, the potential clinical relevance of continued lesion growth has yet to be examined. In the present study, we investigated the prevalence of lesion expansion and the relationship between expansion and changes in aphasia severity in a large sample of individuals in the chronic stage of aphasia recovery. METHODS Retrospective structural MRI scans from 104 S survivors with at least 2 observations (k = 301 observations; mean time between scans = 31 months) were included. Lesion demarcation was performed using an automated lesion segmentation software and lesion volumes at each timepoint were subsequently calculated. A linear mixed effects model was conducted to investigate the effect of days between scan on lesion expansion. Finally, we investigated the association between lesion expansion and changes on the Western Aphasia Battery (WAB) in a group of participants assessed and scanned at 2 timepoints (N = 54) using a GLM. RESULTS Most participants (81 %) showed evidence of lesion expansion. The mixed effects model revealed lesion volumes significantly increase, on average, by 0.02 cc each day (7.3 cc per year) following a scan (p < 0.0001). Change on language performance was significantly associated with change in lesion volume (p = 0.025) and age at stroke (p = 0.031). The results suggest that with every 10 cc increase in lesion size, language performance decreases by 0.9 points, and for every 10-year increase in age at stroke, language performance decreases by 1.9 points. CONCLUSIONS The present study confirms and extends prior reports that lesion expansion occurs well into the chronic stage of stroke. For the first time, we present evidence that expansion is predictive of longitudinal changes in language performance in individuals with aphasia. Future research should focus on the potential mechanisms that may lead to necrosis in areas surrounding the chronic stroke lesion.
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Sperber C, Gallucci L, Mirman D, Arnold M, Umarova RM. Stroke lesion size - Still a useful biomarker for stroke severity and outcome in times of high-dimensional models. Neuroimage Clin 2023; 40:103511. [PMID: 37741168 PMCID: PMC10520672 DOI: 10.1016/j.nicl.2023.103511] [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: 07/09/2023] [Revised: 09/05/2023] [Accepted: 09/16/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND The volumetric size of a brain lesion is a frequently used stroke biomarker. It stands out among most imaging biomarkers for being a one-dimensional variable that is applicable in simple statistical models. In times of machine learning algorithms, the question arises of whether such a simple variable is still useful, or whether high-dimensional models on spatial lesion information are superior. METHODS We included 753 first-ever anterior circulation ischemic stroke patients (age 68.4±15.2 years; NIHSS at 24 h 4.4±5.1; modified Rankin Scale (mRS) at 3-months median[IQR] 1[0.75;3]) and traced lesions on diffusion-weighted MRI. In an out-of-sample model validation scheme, we predicted stroke severity as measured by NIHSS 24 h and functional stroke outcome as measured by mRS at 3 months either from spatial lesion features or lesion size. RESULTS For stroke severity, the best regression model based on lesion size performed significantly above chance (p < 0.0001) with R2 = 0.322, but models with spatial lesion features performed significantly better with R2 = 0.363 (t(752) = 2.889; p = 0.004). For stroke outcome, the best classification model based on lesion size again performed significantly above chance (p < 0.0001) with an accuracy of 62.8%, which was not different from the best model with spatial lesion features (62.6%, p = 0.80). With smaller training data sets of only 150 or 50 patients, the performance of high-dimensional models with spatial lesion features decreased up to the point of being equivalent or even inferior to models trained on lesion size. The combination of lesion size and spatial lesion features in one model did not improve predictions. CONCLUSIONS Lesion size is a decent biomarker for stroke outcome and severity that is slightly inferior to spatial lesion features but is particularly suited in studies with small samples. When low-dimensional models are desired, lesion size provides a viable proxy biomarker for spatial lesion features, whereas high-precision prediction models in personalised prognostic medicine should operate with high-dimensional spatial imaging features in large samples.
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Affiliation(s)
- Christoph Sperber
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
| | - Laura Gallucci
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Daniel Mirman
- Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom
| | - Marcel Arnold
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Roza M Umarova
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
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5
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Hill G, Johnson F, Uy J, Serrada I, Benyamin B, Van Den Berg M, Hordacre B. Moderate intensity aerobic exercise may enhance neuroplasticity of the contralesional hemisphere after stroke: a randomised controlled study. Sci Rep 2023; 13:14440. [PMID: 37660093 PMCID: PMC10475034 DOI: 10.1038/s41598-023-40902-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 08/18/2023] [Indexed: 09/04/2023] Open
Abstract
Upregulation of neuroplasticity might help maximize stroke recovery. One intervention that appears worthy of investigation is aerobic exercise. This study aimed to determine whether a single bout of moderate intensity aerobic exercise can enhance neuroplasticity in people with stroke. Participants were randomly assigned (1:1) to a 20-min moderate intensity exercise intervention or remained sedentary (control). Transcranial magnetic stimulation measured corticospinal excitability of the contralesional hemisphere by recording motor evoked potentials (MEPs). Intermittent Theta Burst Stimulation (iTBS) was used to repetitively activate synapses in the contralesional primary motor cortex, initiating the early stages of neuroplasticity and increasing excitability. It was surmised that if exercise increased neuroplasticity, there would be a greater facilitation of MEPs following iTBS. Thirty-three people with stroke participated in this study (aged 63.87 ± 10.30 years, 20 male, 6.13 ± 4.33 years since stroke). There was an interaction between Time*Group on MEP amplitudes (P = 0.009). Participants allocated to aerobic exercise had a stronger increase in MEP amplitude following iTBS. A non-significant trend indicated time since stroke might moderate this interaction (P = 0.055). Exploratory analysis suggested participants who were 2-7.5 years post stroke had a strong MEP facilitation following iTBS (P < 0.001). There was no effect of age, sex, resting motor threshold, self-reported physical activity levels, lesion volume or weighted lesion load (all P > 0.208). Moderate intensity cycling may enhance neuroplasticity in people with stroke. This therapy adjuvant could provide opportunities to maximize stroke recovery.
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Affiliation(s)
- Gabrielle Hill
- Clinical Rehabilitation, College of Nursing and Health Sciences, Flinders University, Adelaide, 5042, Australia
| | - Finn Johnson
- Allied Health and Human Performance, University of South Australia, Adelaide, 5000, Australia
| | - Jeric Uy
- Allied Health and Human Performance, University of South Australia, Adelaide, 5000, Australia
| | - Ines Serrada
- Allied Health and Human Performance, University of South Australia, Adelaide, 5000, Australia
| | - Beben Benyamin
- Australian Centre for Precision Health, Allied Health and Human Performance, University of South Australia, Adelaide, 5000, Australia
- South Australian Health and Medical Research Institute, Adelaide, 5000, Australia
| | - Maayken Van Den Berg
- Clinical Rehabilitation, College of Nursing and Health Sciences, Flinders University, Adelaide, 5042, Australia
| | - Brenton Hordacre
- Innovation, IMPlementation and Clinical Translation (IIMPACT) in Health, University of South Australia, City East Campus, GPO Box 2471, Adelaide, 5001, Australia.
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Seghier ML, Price CJ. Interpreting and validating complexity and causality in lesion-symptom prognoses. Brain Commun 2023; 5:fcad178. [PMID: 37346231 PMCID: PMC10279811 DOI: 10.1093/braincomms/fcad178] [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: 04/13/2023] [Revised: 05/08/2023] [Accepted: 06/04/2023] [Indexed: 06/23/2023] Open
Abstract
This paper considers the steps needed to generate pragmatic and interpretable lesion-symptom mappings that can be used for clinically reliable prognoses. The novel contributions are 3-fold. We first define and inter-relate five neurobiological and five methodological constraints that need to be accounted for when interpreting lesion-symptom associations and generating synthetic lesion data. The first implication is that, because of these constraints, lesion-symptom mapping needs to focus on probabilistic relationships between Lesion and Symptom, with Lesion as a multivariate spatial pattern, Symptom as a time-dependent behavioural profile and evidence that Lesion raises the probability of Symptom. The second implication is that in order to assess the strength of probabilistic causality, we need to distinguish between causal lesion sites, incidental lesion sites, spared but dysfunctional sites and intact sites, all of which might affect the accuracy of the predictions and prognoses generated. We then formulate lesion-symptom mappings in logical notations, including combinatorial rules, that are then used to evaluate and better understand complex brain-behaviour relationships. The logical and theoretical framework presented applies to any type of neurological disorder but is primarily discussed in relationship to stroke damage. Accommodating the identified constraints, we discuss how the 1965 Bradford Hill criteria for inferring probabilistic causality, post hoc, from observed correlations in epidemiology-can be applied to lesion-symptom mapping in stroke survivors. Finally, we propose that rather than rely on post hoc evaluation of how well the causality criteria have been met, the neurobiological and methodological constraints should be addressed, a priori, by changing the experimental design of lesion-symptom mappings and setting up an open platform to share and validate the discovery of reliable and accurate lesion rules that are clinically useful.
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Affiliation(s)
- Mohamed L Seghier
- Correspondence to: Mohamed Seghier Department of Biomedical Engineering Khalifa University of Science and Technology PO BOX: 127788, Abu Dhabi, UAE E-mail:
| | - Cathy J Price
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, UK
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7
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Xiong Y, Khlif MS, Egorova-Brumley N, Brodtmann A, Stark BC. Neural correlates of verbal fluency revealed by longitudinal T1, T2 and FLAIR imaging in stroke. Neuroimage Clin 2023; 38:103406. [PMID: 37104929 PMCID: PMC10165164 DOI: 10.1016/j.nicl.2023.103406] [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: 12/19/2022] [Revised: 03/24/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023]
Abstract
Diffusion-weighted imaging has been widely used in the research on post-stroke verbal fluency but acquiring diffusion data is not always clinically feasible. Achieving comparable reliability for detecting brain variables associated with verbal fluency impairments, based on more readily available anatomical, non-diffusion images (T1, T2 and FLAIR), enables clinical practitioners to have complementary neurophysiological information at hand to facilitate diagnosis and treatment of language impairment. Meanwhile, although the predominant focus in the stroke recovery literature has been on cortical contributions to verbal fluency, it remains unclear how subcortical regions and white matter disconnection are related to verbal fluency. Our study thus utilized anatomical scans of ischaemic stroke survivors (n = 121) to identify longitudinal relationships between subcortical volume, white matter tract disconnection, and verbal fluency performance at 3- and 12-months post-stroke. Subcortical grey matter volume was derived from FreeSurfer. We used an indirect probabilistic approach to quantify white matter disconnection in terms of disconnection severity, the proportion of lesioned voxel volume to the total volume of a tract, and disconnection probability, the probability of the overlap between the stroke lesion and a tract. These disconnection variables of each subject were identified based on the disconnectome map of the BCBToolkit. Using a linear mixed multiple regression method with 5-fold cross-validations, we correlated the semantic and phonemic fluency scores with longitudinal measurements of subcortical grey matter volume and 22 bilateral white matter tracts, while controlling for demographic variables (age, sex, handedness and education), total brain volume, lesion volume, and cortical thickness. The results showed that the right subcortical grey matter volume was positively correlated with phonemic fluency averaged over 3 months and 12 months. The finding generalized well on the test data. The disconnection probability of left superior longitudinal fasciculus II and left posterior arcuate fasciculus was negatively associated with semantic fluency only on the training data, but the result aligned with our previous study using diffusion scans in the same clinical population. In sum, our results presented evidence that routinely acquired anatomical scans can serve as a reliable source for deriving neural variables of post-stroke verbal fluency performance. The use of this method might provide an ecologically valid and more readily implementable analysis tool.
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Affiliation(s)
- Yanyu Xiong
- Department of Speech, Language and Hearing Sciences, Indiana University, Bloomington IN 47408, USA.
| | - Mohamed Salah Khlif
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Natalia Egorova-Brumley
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Amy Brodtmann
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Brielle C Stark
- Department of Speech, Language and Hearing Sciences, Indiana University, Bloomington IN 47408, USA
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8
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Seghier ML. The elusive metric of lesion load. Brain Struct Funct 2023; 228:703-716. [PMID: 36947181 DOI: 10.1007/s00429-023-02630-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/15/2023] [Indexed: 03/23/2023]
Abstract
One of the widely used metrics in lesion-symptom mapping is lesion load that codes the amount of damage to a given brain region of interest. Lesion load aims to reduce the complex 3D lesion information into a feature that can reflect both site of damage, defined by the location of the region of interest, and size of damage within that region of interest. Basically, the process of estimation of lesion load converts a voxel-based lesion map into a region-based lesion map, with regions defined as atlas-based or data-driven spatial patterns. Here, after examining current definitions of lesion load, four methodological issues are discussed: (1) lesion load is agnostic to the location of damage within the region of interest, and it disregards damage outside the region of interest, (2) lesion load estimates are prone to errors introduced by the uncertainty in lesion delineation, spatial warping of the lesion/region, and binarization of the lesion/region, (3) lesion load calculation depends on brain parcellation selection, and (4) lesion load does not necessarily reflect a white matter disconnection. Overall, lesion load, when calculated in a robust way, can serve as a clinically-useful feature for explaining and predicting post-stroke outcome and recovery.
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Affiliation(s)
- Mohamed L Seghier
- Department of Biomedical Engineering, Khalifa University of Science and Technology, Abu Dhabi, UAE.
- Healthcare Engineering Innovation Center (HEIC), Khalifa University of Science and Technology, Abu Dhabi, UAE.
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9
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Sperber C, Griffis J, Kasties V. Indirect structural disconnection-symptom mapping. Brain Struct Funct 2022; 227:3129-3144. [PMID: 36048282 DOI: 10.1007/s00429-022-02559-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 08/24/2022] [Indexed: 01/01/2023]
Abstract
In vivo tracking of white matter fibres catalysed a modern perspective on the pivotal role of brain connectome disruption in neuropsychological deficits. However, the examination of white matter integrity in neurological patients by diffusion-weighted magnetic resonance imaging bears conceptual limitations and is not widely applicable, as it requires imaging-compatible patients and resources beyond the capabilities of many researchers. The indirect estimation of structural disconnection offers an elegant and economical alternative. For this approach, a patient's structural lesion information and normative connectome data are combined to estimate different measures of lesion-induced structural disconnection. Using one of several toolboxes, this method is relatively easy to implement and is even available to scientists without expertise in fibre tracking analyses. Nevertheless, the anatomo-behavioural statistical mapping of structural brain disconnection requires analysis steps that are not covered by these toolboxes. In this paper, we first review the current state of indirect lesion disconnection estimation, the different existing measures, and the available software. Second, we aim to fill the remaining methodological gap in statistical disconnection-symptom mapping by providing an overview and guide to disconnection data and the statistical mapping of their relationship to behavioural measurements using either univariate or multivariate statistical modelling. To assist in the practical implementation of statistical analyses, we have included software tutorials and analysis scripts.
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Affiliation(s)
- Christoph Sperber
- University of Tubingen: Eberhard Karls Universitat Tubingen, Tubingen, Germany.
| | - Joseph Griffis
- University of Tubingen: Eberhard Karls Universitat Tubingen, Tubingen, Germany
| | - Vanessa Kasties
- Centre of Neurology, Hertie-Institute for Clinical Brain Research, University of Tubingen, Tubingen, Germany
- Child Development Center, University Childrens Hospital Zurich, University of Zurich, Zurich, Switzerland
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10
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Sideris E, Kioulaphides S, Wilson K, Yu A, Chen J, Carmichael ST, Segura T. Particle hydrogels decrease cerebral atrophy and attenuate astrocyte and microglia/macrophage reactivity after stroke. ADVANCED THERAPEUTICS 2022; 5:2200048. [PMID: 36589207 PMCID: PMC9797126 DOI: 10.1002/adtp.202200048] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Increasing numbers of individuals live with stroke related disabilities. Following stroke, highly reactive astrocytes and pro-inflammatory microglia can release cytokines and lead to a cytotoxic environment that causes further brain damage and prevents endogenous repair. Paradoxically, these same cells also activate pro-repair mechanisms that contribute to endogenous repair and brain plasticity. Here, we show that the direct injection of a hyaluronic acid based microporous annealed particle (MAP) hydrogel into the stroke core in mice reduces the percent of highly reactive astrocytes, increases the percent of alternatively activated microglia, decreases cerebral atrophy and preserves NF200 axonal bundles. Further, we show that MAP hydrogel promotes reparative astrocyte infiltration into the lesion, which directly coincides with axonal penetration into the lesion. This work shows that the injection of a porous scaffold into the stroke core can lead to clinically relevant decrease in cerebral atrophy and modulates astrocytes and microglia towards a pro-repair phenotype.
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Affiliation(s)
- Elias Sideris
- Department of Chemical and Biomolecular Engineering, University of California Los Angeles, Los Angeles, CA, United States
| | - Sophia Kioulaphides
- Departments of Biomedical Engineering, Neurology, and Dermatology, Duke University, Durham, NC, United States
| | - Katrina Wilson
- Departments of Biomedical Engineering, Neurology, and Dermatology, Duke University, Durham, NC, United States
| | - Aaron Yu
- Department of Chemical and Biomolecular Engineering, University of California Los Angeles, Los Angeles, CA, United States
| | - Jun Chen
- Departments of Biomedical Engineering, Neurology, and Dermatology, Duke University, Durham, NC, United States
| | - S Thomas Carmichael
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Tatiana Segura
- Departments of Biomedical Engineering, Neurology, and Dermatology, Duke University, Durham, NC, United States,Corresponding author: Tel.: +1 919-660-2901,
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11
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Artificially-reconstructed brain images with stroke lesions from non-imaging data: modeling in categorized patients based on lesion occurrence and sparsity. Sci Rep 2022; 12:10116. [PMID: 35710703 PMCID: PMC9203453 DOI: 10.1038/s41598-022-14249-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 06/03/2022] [Indexed: 11/08/2022] Open
Abstract
Brain imaging is necessary for understanding disease symptoms, including stroke. However, frequent imaging procedures encounter practical limitations. Estimating the brain information (e.g., lesions) without imaging sessions is beneficial for this scenario. Prospective estimating variables are non-imaging data collected from standard tests. Therefore, the current study aims to examine the variable feasibility for modelling lesion locations. Heterogeneous variables were employed in the multivariate logistic regression. Furthermore, patients were categorized (i.e., unsupervised clustering through k-means method) by the charasteristics of lesion occurrence (i.e., ratio between the lesioned and total regions) and sparsity (i.e., density measure of lesion occurrences across regions). Considering those charasteristics in models improved estimation performances. Lesions (116 regions in Automated Anatomical Labeling) were adequately predicted (sensitivity: 80.0-87.5% in median). We confirmed that the usability of models was extendable to different resolution levels in the brain region of interest (e.g., lobes, hemispheres). Patients' charateristics (i.e., occurrence and sparsity) might also be explained by the non-imaging data as well. Advantages of the current approach can be experienced by any patients (i.e., with or without imaging sessions) in any clinical facilities (i.e., with or without imaging instrumentation).
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12
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Egorova-Brumley N, Khlif MS, Werden E, Bird LJ, Brodtmann A. Grey and white matter atrophy one year after stroke aphasia. Brain Commun 2022; 4:fcac061. [PMID: 35368613 PMCID: PMC8971893 DOI: 10.1093/braincomms/fcac061] [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: 09/20/2021] [Revised: 12/23/2021] [Accepted: 03/15/2022] [Indexed: 11/20/2022] Open
Abstract
Dynamic whole-brain changes occur following stroke, and not just in association with recovery. We tested the hypothesis that the presence of a specific behavioural deficit after stroke would be associated with structural decline (atrophy) in the brain regions supporting the affected function, by examining language deficits post-stroke. We quantified whole-brain structural volume changes longitudinally (3–12 months) in stroke participants with (N = 32) and without aphasia (N = 59) as assessed by the Token Test at 3 months post-stroke, compared with a healthy control group (N = 29). While no significant difference in language decline rates (change in Token Test scores from 3 to 12 months) was observed between groups and some participants in the aphasic group improved their scores, stroke participants with aphasia symptoms at 3 months showed significant atrophy (>2%, P = 0.0001) of the left inferior frontal gyrus not observed in either healthy control or non-aphasic groups over the 3–12 months period. We found significant group differences in the inferior frontal gyrus volume, accounting for age, sex, stroke severity at baseline, education and total intracranial volume (Bonferroni-corrected P = 0.0003). In a subset of participants (aphasic N = 14, non-aphasic N = 36, and healthy control N = 25) with available diffusion-weighted imaging data, we found significant atrophy in the corpus callosum and the left superior longitudinal fasciculus in the aphasic compared with the healthy control group. Language deficits at 3 months post-stroke are associated with accelerated structural decline specific to the left inferior frontal gyrus, highlighting that known functional brain reorganization underlying behavioural improvement may occur in parallel with atrophy of brain regions supporting the language function.
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Affiliation(s)
- Natalia Egorova-Brumley
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
- The University of Melbourne, Melbourne, Australia
| | - Mohamed Salah Khlif
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Emilio Werden
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Laura J. Bird
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Amy Brodtmann
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
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Bu N, Churilov L, Khlif MS, Lemmens R, Wouters A, Fiebach JB, Chamorro A, Ringelstein EB, Norrving B, Laage R, Grond M, Wilms G, Brodtmann A, Thijs V. Early Brain Volume Changes After Stroke: Subgroup Analysis From the AXIS-2 Trial. Front Neurol 2022; 12:747343. [PMID: 35153972 PMCID: PMC8832974 DOI: 10.3389/fneur.2021.747343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 12/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background and PurposeThe evolution of total brain volume early after stroke is not well understood. We investigated the associations between age and imaging features and brain volume change in the first month after stroke.MethodsWe retrospectively studied patients with acute ischemic stroke enrolled in the AXIS-2 trial. Total brain volume change from hyperacute MRI data to the first month after stroke was assessed using unified segmentation in SPM12. We hypothesized that age, ischemic brain lesion size, and white matter (WM) changes were associated with larger brain volume change. Enlarged perivascular spaces (EPVSs) and white matter hyperintensities (WMHs) were rated visually and the presence of lacunes was assessed.ResultsWe enrolled 173 patients with a mean age of 67 ± 11 years, 44% were women. There was a median 6 ml decrease in volume (25th percentile −1 ml to 75th percentile 21 ml) over time, equivalent to a median 0.5% (interquartile range [IQR], −0.07%−1.4%), decrease in brain volume. Age was associated with larger brain volume loss (per 10 years of age, 5 ml 95% CI 2–8 ml). Baseline diffusion weighted imaging (DWI) lesion volume was not associated with greater volume loss per 10 ml of lesion volume, change by 0 ml (95% CI −0.1 to 0.1 ml). Increasing Fazekas scores of deep WMH were associated with greater tissue loss (5 ml, 95% CI 1–10 ml).ConclusionsTotal brain volume changes in a heterogenous fashion after stroke. Volume loss occurs over 1 month after stroke and is associated with age and deep WM disease. We did not find evidence that more severe strokes lead to increased early tissue loss.
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Affiliation(s)
- Ning Bu
- Department of Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Leonid Churilov
- Department of Medicine and Neurology, Melbourne Brain Centre, University of Melbourne, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Mohamed Salah Khlif
- Dementia Theme, The Florey Institute for Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Robin Lemmens
- Department of Neurosciences, Experimental Neurology, KU Leuven – University of Leuven, Leuven, Belgium
- Laboratory of Neurobiology, VIB, Center for Brain & Disease Research, Leuven, Belgium
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Anke Wouters
- Department of Neurosciences, Experimental Neurology, KU Leuven – University of Leuven, Leuven, Belgium
- Laboratory of Neurobiology, VIB, Center for Brain & Disease Research, Leuven, Belgium
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Jochen B. Fiebach
- Center for Stroke Research, Charité University Medicine Berlin, Berlin, Germany
| | - Angel Chamorro
- Department of Neurology, University of Barcelona, Barcelona, Spain
| | | | - Bo Norrving
- Section of Neurology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Rico Laage
- Department of Clinical Research, Guided Development GmbH, Heidelberg, Germany
| | - Martin Grond
- Department of Neurology, Kreisklinikum Siegen, University of Marburg Germany, Marburg, Germany
| | - Guido Wilms
- Department of Radiology, University Hospitals of Leuven, Leuven, Belgium
| | - Amy Brodtmann
- Dementia Theme, The Florey Institute for Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Vincent Thijs
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
- *Correspondence: Vincent Thijs
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14
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Sperber C. The strange role of brain lesion size in cognitive neuropsychology. Cortex 2021; 146:216-226. [PMID: 34902680 DOI: 10.1016/j.cortex.2021.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 07/11/2021] [Accepted: 11/03/2021] [Indexed: 11/18/2022]
Abstract
The size of brain lesions is a variable that is frequently considered in cognitive neuropsychology. In particular, lesion-deficit inference studies often control for lesion size, and the association of lesion size with post-stroke cognitive deficits and its predictive value are studied. In the present article, the role of lesion size in cognitive deficits and its computational or design-wise consideration is discussed and questioned. First, I argue that the commonly discussed role or effect of lesion size in cognitive deficits eludes us. A generally valid understanding of the causal relation of lesion size, lesion location, and cognitive deficits is unachievable. Second, founded on the theory of causal inference, I argue that lesion size control is no generally appropriate covariate control. Instead, it is identified as a procedure with only situational benefits, which is supported by empirical data. This theoretical background is used to suggest possible research practices in lesion-deficit inference, post-stroke outcome prediction, and behavioural studies. Last, control for lesion size is put into a bigger historical context - it is identified to relate to a long-known association problem in neuropsychology, which was previously discussed from the perspectives of a mislocalisation in lesion-deficit mapping and the symptom complex approach.
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Affiliation(s)
- Christoph Sperber
- Centre of Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.
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15
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Ermine CM, Nithianantharajah J, O'Brien K, Kauhausen JA, Frausin S, Oman A, Parsons MW, Brait VH, Brodtmann A, Thompson LH. Hemispheric cortical atrophy and chronic microglial activation following mild focal ischemic stroke in adult male rats. J Neurosci Res 2021; 99:3222-3237. [PMID: 34651338 DOI: 10.1002/jnr.24939] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 01/05/2023]
Abstract
Animal modeling has played an important role in our understanding of the pathobiology of stroke. The vast majority of this research has focused on the acute phase following severe forms of stroke that result in clear behavioral deficits. Human stroke, however, can vary widely in severity and clinical outcome. There is a rapidly building body of work suggesting that milder ischemic insults can precipitate functional impairment, including cognitive decline, that continues through the chronic phase after injury. Here we show that a small infarction localized to the frontal motor cortex of rats following injection of endothelin-1 results in an essentially asymptomatic state based on motor and cognitive testing, and yet produces significant histopathological change including remote atrophy and inflammation that persists up to 1 year. While there is understandably a major focus in stroke research on mitigating the acute consequences of primary infarction, these results point to progressive atrophy and chronic inflammation as additional targets for intervention in the chronic phase after injury. The present rodent model provides an important platform for further work in this area.
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Affiliation(s)
- Charlotte M Ermine
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Jess Nithianantharajah
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Katrina O'Brien
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Jessica A Kauhausen
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Stefano Frausin
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Alexander Oman
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Mark W Parsons
- Melbourne Brain Centre, University of Melbourne, Melbourne, VIC, Australia.,Department of Neurology, University of New Wales South Western Clinical School, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Vanessa H Brait
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Amy Brodtmann
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia.,Department of Neurology, Austin Health, Melbourne, VIC, Australia.,Eastern Cognitive Disorders Clinic, Eastern Health, Monash University, Clayton, VIC, Australia
| | - Lachlan H Thompson
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
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16
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Brait VH, Wright DK, Nategh M, Oman A, Syeda WT, Ermine CM, O'Brien KR, Werden E, Churilov L, Johnston LA, Thompson LH, Nithianantharajah J, Jackman KA, Brodtmann A. Longitudinal hippocampal volumetric changes in mice following brain infarction. Sci Rep 2021; 11:10269. [PMID: 33986303 PMCID: PMC8119705 DOI: 10.1038/s41598-021-88284-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 04/05/2021] [Indexed: 01/14/2023] Open
Abstract
Hippocampal atrophy is increasingly described in many neurodegenerative syndromes in humans, including stroke and vascular cognitive impairment. However, the progression of brain volume changes after stroke in rodent models is poorly characterized. We aimed to monitor hippocampal atrophy occurring in mice up to 48-weeks post-stroke. Male C57BL/6J mice were subjected to an intraluminal filament-induced middle cerebral artery occlusion (MCAO). At baseline, 3-days, and 1-, 4-, 12-, 24-, 36- and 48-weeks post-surgery, we measured sensorimotor behavior and hippocampal volumes from T2-weighted MRI scans. Hippocampal volume-both ipsilateral and contralateral-increased over the life-span of sham-operated mice. In MCAO-subjected mice, different trajectories of ipsilateral hippocampal volume change were observed dependent on whether the hippocampus contained direct infarction, with a decrease in directly infarcted tissue and an increase in non-infarcted tissue. To further investigate these volume changes, neuronal and glial cell densities were assessed in histological brain sections from the subset of MCAO mice lacking hippocampal infarction. Our findings demonstrate previously uncharacterized changes in hippocampal volume and potentially brain parenchymal cell density up to 48-weeks in both sham- and MCAO-operated mice.
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Affiliation(s)
- Vanessa H Brait
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia.
| | - David K Wright
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia.,The Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Mohsen Nategh
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Alexander Oman
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Warda T Syeda
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Charlotte M Ermine
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Katrina R O'Brien
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Emilio Werden
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Leonid Churilov
- Melbourne Medical School, University of Melbourne, Parkville, VIC, Australia
| | - Leigh A Johnston
- Department of Biomedical Engineering, University of Melbourne, Parkville, VIC, Australia.,Melbourne Brain Centre Imaging Unit, University of Melbourne, Parkville, VIC, Australia
| | - Lachlan H Thompson
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Jess Nithianantharajah
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Katherine A Jackman
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Amy Brodtmann
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia.
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17
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Fleming V, Brownsett S, Krason A, Maegli MA, Coley-Fisher H, Ong YH, Nardo D, Leach R, Howard D, Robson H, Warburton E, Ashburner J, Price CJ, Crinion JT, Leff AP. Efficacy of spoken word comprehension therapy in patients with chronic aphasia: a cross-over randomised controlled trial with structural imaging. J Neurol Neurosurg Psychiatry 2020; 92:jnnp-2020-324256. [PMID: 33154182 PMCID: PMC7611712 DOI: 10.1136/jnnp-2020-324256] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/17/2020] [Accepted: 10/07/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The efficacy of spoken language comprehension therapies for persons with aphasia remains equivocal. We investigated the efficacy of a self-led therapy app, 'Listen-In', and examined the relation between brain structure and therapy response. METHODS A cross-over randomised repeated measures trial with five testing time points (12-week intervals), conducted at the university or participants' homes, captured baseline (T1), therapy (T2-T4) and maintenance (T5) effects. Participants with chronic poststroke aphasia and spoken language comprehension impairments completed consecutive Listen-In and standard care blocks (both 12 weeks with order randomised). Repeated measures analyses of variance compared change in spoken language comprehension on two co-primary outcomes over therapy versus standard care. Three structural MRI scans (T2-T4) for each participant (subgroup, n=25) were analysed using cross-sectional and longitudinal voxel-based morphometry. RESULTS Thirty-five participants completed, on average, 85 hours (IQR=70-100) of Listen-In (therapy first, n=18). The first study-specific co-primary outcome (Auditory Comprehension Test (ACT)) showed large and significant improvements for trained spoken words over therapy versus standard care (11%, Cohen's d=1.12). Gains were largely maintained at 12 and 24 weeks. There were no therapy effects on the second standardised co-primary outcome (Comprehensive Aphasia Test: Spoken Words and Sentences). Change on ACT trained words was associated with volume of pretherapy right hemisphere white matter and post-therapy grey matter tissue density changes in bilateral temporal lobes. CONCLUSIONS Individuals with chronic aphasia can improve their spoken word comprehension many years after stroke. Results contribute to hemispheric debates implicating the right hemisphere in therapy-driven language recovery. Listen-In will soon be available on GooglePlay. TRIAL REGISTRATION NUMBER NCT02540889.
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Affiliation(s)
- Victoria Fleming
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Sonia Brownsett
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Victoria, Australia
| | - Anna Krason
- Department of Psychology and Language Sciences, University College London, London, UK
| | - Maria A Maegli
- Department of Psychology, Universidad del Valle de Guatemala, Guatemala, Guatemala
| | - Henry Coley-Fisher
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Yean-Hoon Ong
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Davide Nardo
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Rupert Leach
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - David Howard
- School of Education, Communication and Language Sciences, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Holly Robson
- Psychology and Clinical Language Sciences, University of Reading, Reading, Berkshire, UK
| | - Elizabeth Warburton
- Department of Medicine, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - John Ashburner
- Wellcome Centre for Human Neuroimaging, University College London, London, UK
| | - Cathy J Price
- Wellcome Centre for Human Neuroimaging, University College London, London, UK
| | - Jenny T Crinion
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Alexander P Leff
- UCL Queen Square Institute of Neurology, University College London, London, UK
- Institute of Cognitive Neuroscience, University College London, London, UK
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18
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Ermine CM, Somaa F, Wang TY, Kagan BJ, Parish CL, Thompson LH. Long-Term Motor Deficit and Diffuse Cortical Atrophy Following Focal Cortical Ischemia in Athymic Rats. Front Cell Neurosci 2019; 13:552. [PMID: 31920553 PMCID: PMC6927997 DOI: 10.3389/fncel.2019.00552] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/29/2019] [Indexed: 12/24/2022] Open
Abstract
Development of new stroke therapies requires animal models that recapitulate the pathophysiological and functional consequences of ischemic brain damage over time-frames relevant to the therapeutic intervention. This is particularly relevant for the rapidly developing area of stem cell therapies, where functional replacement of circuitry will require maturation of transplanted human cells over months. An additional challenge is the establishment of models of ischemia with stable behavioral phenotypes in chronically immune-suppressed animals to allow for long-term survival of human cell grafts. Here we report that microinjection of endothelin-1 into the sensorimotor cortex of athymic rats results in ischemic damage with a sustained deficit in function of the contralateral forepaw that persists for up to 9 months. The histological post-mortem analysis revealed chronic and diffuse atrophy of the ischemic cortical hemisphere that continued to progress over 9 months. Secondary atrophy remote to the primary site of injury and its relationship with long-term cognitive and functional decline is now recognized in human populations. Thus, focal cortical infarction in athymic rats mirrors important pathophysiological and functional features relevant to human stroke, and will be valuable for assessing efficacy of stem cell based therapies.
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Affiliation(s)
- Charlotte M Ermine
- Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Fahad Somaa
- Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Ting-Yi Wang
- Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Brett J Kagan
- Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Clare L Parish
- Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Lachlan H Thompson
- Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
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19
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Khlif MS, Werden E, Egorova N, Boccardi M, Redolfi A, Bird L, Brodtmann A. Assessment of longitudinal hippocampal atrophy in the first year after ischemic stroke using automatic segmentation techniques. NEUROIMAGE-CLINICAL 2019; 24:102008. [PMID: 31711030 PMCID: PMC6849411 DOI: 10.1016/j.nicl.2019.102008] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 08/21/2019] [Accepted: 09/17/2019] [Indexed: 12/11/2022]
Abstract
First-year hippocampal atrophy in stroke is more accelerated ipsi-lesionally. Volume estimation is not impacted by hemisphere side, study group, or scan timepoint. Segmentation method-hippocampal size interaction determines volume estimation. FreeSurfer/Subfields and fsl/FIRST segmentations agreed best with manual tracing.
We assessed first-year hippocampal atrophy in stroke patients and healthy controls using manual and automated segmentations: AdaBoost, FIRST (fsl/v5.0.8), FreeSurfer/v5.3 and v6.0, and Subfields (in FreeSurfer/v6.0). We estimated hippocampal volumes in 39 healthy controls and 124 stroke participants at three months, and 38 controls and 113 stroke participants at one year. We used intra-class correlation, concordance, and reduced major axis regression to assess agreement between automated and ‘Manual’ estimations. A linear mixed-effect model was used to characterize hippocampal atrophy. Overall, hippocampal volumes were reduced by 3.9% in first-ever stroke and 9.2% in recurrent stroke at three months post-stroke, with comparable ipsi-and contra-lesional reductions in first-ever stroke. Mean atrophy rates between time points were 0.5% for controls and 1.0% for stroke patients (0.6% contra-lesionally, 1.4% ipsi-lesionally). Atrophy rates in left and right-hemisphere strokes were comparable. All methods revealed significant volume change in first-ever and ipsi-lesional stroke (p < 0.001). Hippocampal volume estimation was not impacted by hemisphere, study group, or scan time point, but rather, by the interaction between the automated segmentation method and hippocampal size. Compared to Manual, Subfields and FIRST recorded the lowest bias. FreeSurfer/v5.3 overestimated volumes the most for large hippocampi, while FIRST was the most accurate in estimating small volumes. AdaBoost performance was average. Our findings suggest that first-year ipsi-lesional hippocampal atrophy rate especially in first-ever stroke, is greater than atrophy rates in healthy controls and contra-lesional stroke. Subfields and FIRST can complementarily be effective in characterizing the hippocampal atrophy in healthy and stroke cohorts.
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Affiliation(s)
- Mohamed Salah Khlif
- The Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Emilio Werden
- The Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Natalia Egorova
- The Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Marina Boccardi
- LANVIE-Laboratory of Neuroimaging of Aging, University of Geneva, Geneva, Switzerland; Laboratory of Alzheimer's Neuroimaging and Epidemiology (LANE), IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Alberto Redolfi
- Laboratory of Alzheimer's Neuroimaging and Epidemiology (LANE), IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Laboratory of Neuroinformatics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Laura Bird
- The Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Amy Brodtmann
- The Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia; Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
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20
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Loughnan R, Lorca-Puls DL, Gajardo-Vidal A, Espejo-Videla V, Gillebert CR, Mantini D, Price CJ, Hope TMH. Generalizing post-stroke prognoses from research data to clinical data. NEUROIMAGE-CLINICAL 2019; 24:102005. [PMID: 31670072 PMCID: PMC6831940 DOI: 10.1016/j.nicl.2019.102005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 09/10/2019] [Accepted: 09/14/2019] [Indexed: 11/29/2022]
Abstract
Lesion-symptom models for aphasia must generalize, if they are to be useful. We show that these models can generalize across countries, native languages, neuroimaging technology and from chronic to acute scans. The result depends on modelling lesion growth over years post-stroke. Lesion growth may be a more significant confound, in previous lesion-symptom analyses, than previously thought.
Around a third of stroke survivors suffer from acquired language disorders (aphasia), but current medicine cannot predict whether or when they might recover. Prognostic research in this area increasingly draws on datasets associating structural brain imaging data with outcome scores for ever-larger samples of stroke patients. The aim is to learn brain-behaviour trends from these data, and generalize those trends to predict outcomes for new patients. The practical significance of this work depends on the expected breadth of that generalization. Here, we show that these models can generalize across countries and native languages (from British patients tested in English to Chilean patients tested in Spanish), across neuroimaging technology (from MRI to CT), and from scans collected months or years after stroke for research purposes, to scans collected days or weeks after stroke for clinical purposes.
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Affiliation(s)
- Robert Loughnan
- Department of Cognitive Science, University of California, San Diego, USA
| | - Diego L Lorca-Puls
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, 12 Queen Square, London WC1N 3AR, UK; Department of Speech, Language and Hearing Sciences, Faculty of Medicine, Universidad de Concepcion, Concepcion, Chile
| | - Andrea Gajardo-Vidal
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, 12 Queen Square, London WC1N 3AR, UK; Department of Speech, Language and Hearing Sciences, Faculty of Medicine, Universidad de Concepcion, Concepcion, Chile; Faculty of Health Sciences, Universidad del Desarrollo, Concepcion, Chile
| | - Valeria Espejo-Videla
- Department of Speech, Language and Hearing Sciences, Faculty of Medicine, Universidad de Concepcion, Concepcion, Chile
| | - Céline R Gillebert
- Department of Experimental Psychology, University of Oxford, Oxford, UK; Department of Brain and Cognition, University of Leuven, Leuven, Belgium
| | - Dante Mantini
- Department of Experimental Psychology, University of Oxford, Oxford, UK; Research Center for Movement Control and Neuroplasticity, University of Leuven, Leuven, Belgium; Functional Neuroimaging Laboratory, IRCCS San Camillo Hospital Foundation, Venice, Italy
| | - Cathy J Price
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, 12 Queen Square, London WC1N 3AR, UK
| | - Thomas M H Hope
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, 12 Queen Square, London WC1N 3AR, UK.
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21
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22
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Kiran S, Thompson CK. Neuroplasticity of Language Networks in Aphasia: Advances, Updates, and Future Challenges. Front Neurol 2019; 10:295. [PMID: 31001187 PMCID: PMC6454116 DOI: 10.3389/fneur.2019.00295] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 03/06/2019] [Indexed: 11/13/2022] Open
Abstract
Researchers have sought to understand how language is processed in the brain, how brain damage affects language abilities, and what can be expected during the recovery period since the early 19th century. In this review, we first discuss mechanisms of damage and plasticity in the post-stroke brain, both in the acute and the chronic phase of recovery. We then review factors that are associated with recovery. First, we review organism intrinsic variables such as age, lesion volume and location and structural integrity that influence language recovery. Next, we review organism extrinsic factors such as treatment that influence language recovery. Here, we discuss recent advances in our understanding of language recovery and highlight recent work that emphasizes a network perspective of language recovery. Finally, we propose our interpretation of the principles of neuroplasticity, originally proposed by Kleim and Jones (1) in the context of extant literature in aphasia recovery and rehabilitation. Ultimately, we encourage researchers to propose sophisticated intervention studies that bring us closer to the goal of providing precision treatment for patients with aphasia and a better understanding of the neural mechanisms that underlie successful neuroplasticity.
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Affiliation(s)
- Swathi Kiran
- Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, United States
| | - Cynthia K. Thompson
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
- Department of Neurology, The Cognitive Neurology and Alzheimer's Disease Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Chen L, Luo T, Wang K, Zhang Y, Shi D, Lv F, Li Y, Li Y, Li Q, Fang W, Zhang Z, Peng J, Yang H. Effects of thalamic infarction on the structural and functional connectivity of the ipsilesional primary somatosensory cortex. Eur Radiol 2019; 29:4904-4913. [PMID: 30840103 DOI: 10.1007/s00330-019-06068-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/04/2019] [Accepted: 02/04/2019] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To identify regions causally influenced by thalamic stroke by measuring white matter integrity, cortical volume, and functional connectivity (FC) among patients with thalamic infarction (TI) and to determine the association between structural/functional alteration and somatosensory dysfunction. METHODS Thirty-one cases with TI-induced somatosensory dysfunction and 32 healthy controls underwent magnetic resonance imaging scanning. We reconstructed the ipsilesional central thalamic radiation (CTR) and assessed its integrity using fractional anisotropy (FA), assessed S1 ipsilesional changes with cortical volume, and identified brain regions functionally connected to TI locations and regions without TI to examine the potential effects on somatosensory symptoms. RESULTS Compared with controls, TI patients showed decreased FA (F = 17.626, p < 0.001) in the ipsilesional CTR. TI patients exhibited significantly decreased cortical volume in the ipsilesional top S1. Both affected CTR (r = 0.460, p = 0.012) and S1 volume (r = 0.375, p = 0.049) were positively correlated with somatosensory impairment in TI patients. In controls, the TI region was highly functionally connected to atrophic top S1 and less connected to the adjacent middle S1 region in FC mapping. However, T1 patients demonstrated significantly increased FC between the ipsilesional thalamus and middle S1 area, which was adjacent to the atrophic S1 region. CONCLUSIONS TI induces remote changes in the S1, and this network of abnormality underlies the cause of the sensory deficits. However, our other finding that there is stronger connectivity in pathways adjacent to the damaged ones is likely responsible for at least some of the recovery of function. KEY POINTS • TI led to secondary impairment in the CTR and cortical atrophy in the ipsilesional top of S1. • TI patients exhibited significantly higher functional connectivity with the ipsilateral middle S1 which was mainly located within the non-atrophic area of S1. • Our results provide neuroimaging markers for non-invasive treatment and predict somatosensory recovery.
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Affiliation(s)
- Li Chen
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, No. 63 Wenhua Street, Nanchong, 637000, China.,Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Tianyou Luo
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
| | - Kangcheng Wang
- Department of Psychology, Southwest University, Chongqing, China
| | - Yong Zhang
- School of Foreign Languages, Southwest University of Political Science and Law, Chongqing, China
| | - Dandan Shi
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Fajin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Yang Li
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, No. 63 Wenhua Street, Nanchong, 637000, China
| | - Yongmei Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Qi Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Weidong Fang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Zhiwei Zhang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Juan Peng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Hanfeng Yang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, No. 63 Wenhua Street, Nanchong, 637000, China
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Haque ME, Gabr RE, Hasan KM, George S, Arevalo OD, Zha A, Alderman S, Jeevarajan J, Mas MF, Zhang X, Satani N, Friedman ER, Sitton CW, Savitz S. Ongoing Secondary Degeneration of the Limbic System in Patients With Ischemic Stroke: A Longitudinal MRI Study. Front Neurol 2019; 10:154. [PMID: 30890995 PMCID: PMC6411642 DOI: 10.3389/fneur.2019.00154] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 02/06/2019] [Indexed: 01/08/2023] Open
Abstract
Purpose: Ongoing post-stroke structural degeneration and neuronal loss preceding neuropsychological symptoms such as cognitive decline and depression are poorly understood. Various substructures of the limbic system have been linked to cognitive impairment. In this longitudinal study, we investigated the post-stroke macro- and micro-structural integrity of the limbic system using structural and diffusion tensor magnetic resonance imaging. Materials and Methods: Nineteen ischemic stroke patients (11 men, 8 women, average age 53.4 ± 12.3, range 18–75 years), with lesions remote from the limbic system, were serially imaged three times over 1 year. Structural and diffusion-tensor images (DTI) were obtained on a 3.0 T MRI system. The cortical thickness, subcortical volume, mean diffusivity (MD), and fractional anisotropy (FA) were measured in eight different regions of the limbic system. The National Institutes of Health Stroke Scale (NIHSS) was used for clinical assessment. A mixed model for multiple factors was used for statistical analysis, and p-values <0.05 was considered significant. Results: All patients demonstrated improved NIHSS values over time. The ipsilesional subcortical volumes of the thalamus, hippocampus, and amygdala significantly decreased (p < 0.05) and MD significantly increased (p < 0.05). The ipsilesional cortical thickness of the entorhinal and perirhinal cortices was significantly smaller than the contralesional hemisphere at 12 months (p < 0.05). The cortical thickness of the cingulate gyrus at 12 months was significantly decreased at the caudal and isthmus regions as compared to the 1 month assessment (p < 0.05). The cingulum fibers had elevated MD at the ipsilesional caudal-anterior and posterior regions compared to the corresponding contralesional regions. Conclusion: Despite the decreasing NIHSS scores, we found ongoing unilateral neuronal loss/secondary degeneration in the limbic system, irrespective of the lesion location. These results suggest a possible anatomical basis for post stroke psychiatric complications.
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Affiliation(s)
- Muhammad E Haque
- Institute for Stroke and Cerebrovascular Diseases, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Refaat E Gabr
- Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Khader M Hasan
- Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Sarah George
- Institute for Stroke and Cerebrovascular Diseases, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Octavio D Arevalo
- Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Alicia Zha
- Institute for Stroke and Cerebrovascular Diseases, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Susan Alderman
- Institute for Stroke and Cerebrovascular Diseases, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jerome Jeevarajan
- Institute for Stroke and Cerebrovascular Diseases, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Manual F Mas
- TIRR Memorial Hermann Rehabilitation and Research, Houston, TX, United States
| | - Xu Zhang
- Biostatistics/Epidemiology/Research Design Component, Center for Clinical and Translational Sciences, McGovern Medical School at University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States
| | - Nikunj Satani
- Institute for Stroke and Cerebrovascular Diseases, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Elliott R Friedman
- Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Clark W Sitton
- Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Sean Savitz
- Institute for Stroke and Cerebrovascular Diseases, University of Texas Health Science Center at Houston, Houston, TX, United States
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Nisbet DR, Wang TY, Bruggeman KF, Niclis JC, Somaa FA, Penna V, Hunt CPJ, Wang Y, Kauhausen JA, Williams RJ, Thompson LH, Parish CL. Shear Containment of BDNF within Molecular Hydrogels Promotes Human Stem Cell Engraftment and Postinfarction Remodeling in Stroke. ACTA ACUST UNITED AC 2018. [DOI: 10.1002/adbi.201800113] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- D. R. Nisbet
- Laboratory of Advanced Materials Research School of Engineering The Australian National University Canberra 2601 Australia
- Biofab3D Aikenhead Center for Medical Discovery St. Vincent's Hospital Melbourne Victoria 3065 Australia
| | - T. Y. Wang
- The Florey Institute of Neuroscience and Mental Health The University of Melbourne Parkville Victoria 3010 Australia
| | - K. F. Bruggeman
- Laboratory of Advanced Materials Research School of Engineering The Australian National University Canberra 2601 Australia
| | - J. C. Niclis
- The Florey Institute of Neuroscience and Mental Health The University of Melbourne Parkville Victoria 3010 Australia
| | - F. A. Somaa
- The Florey Institute of Neuroscience and Mental Health The University of Melbourne Parkville Victoria 3010 Australia
| | - V. Penna
- The Florey Institute of Neuroscience and Mental Health The University of Melbourne Parkville Victoria 3010 Australia
| | - C. P. J. Hunt
- The Florey Institute of Neuroscience and Mental Health The University of Melbourne Parkville Victoria 3010 Australia
| | - Y. Wang
- Laboratory of Advanced Materials Research School of Engineering The Australian National University Canberra 2601 Australia
| | - J. A. Kauhausen
- The Florey Institute of Neuroscience and Mental Health The University of Melbourne Parkville Victoria 3010 Australia
| | - R. J. Williams
- Biofab3D Aikenhead Center for Medical Discovery St. Vincent's Hospital Melbourne Victoria 3065 Australia
- School of Engineering RMIT University Melbourne 3001 Australia
| | - L. H. Thompson
- The Florey Institute of Neuroscience and Mental Health The University of Melbourne Parkville Victoria 3010 Australia
| | - C. L. Parish
- The Florey Institute of Neuroscience and Mental Health The University of Melbourne Parkville Victoria 3010 Australia
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Volumetric analysis of day of injury computed tomography is associated with rehabilitation outcomes after traumatic brain injury. J Trauma Acute Care Surg 2017; 82:80-92. [PMID: 27805992 DOI: 10.1097/ta.0000000000001263] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Day-of-injury (DOI) brain lesion volumes in traumatic brain injury (TBI) patients are rarely used to predict long-term outcomes in the acute setting. The purpose of this study was to investigate the relationship between acute brain injury lesion volume and rehabilitation outcomes in patients with TBI at a level one trauma center. METHODS Patients with TBI who were admitted to our rehabilitation unit after the acute care trauma service from February 2009-July 2011 were eligible for the study. Demographic data and outcome variables including cognitive and motor Functional Independence Measure (FIM) scores, length of stay (LOS) in the rehabilitation unit, and ability to return to home were obtained. The DOI quantitative injury lesion volumes and degree of midline shift were obtained from DOI brain computed tomography scans. A multiple stepwise regression model including 13 independent variables was created. This model was used to predict postrehabilitation outcomes, including FIM scores and ability to return to home. A p value less than 0.05 was considered significant. RESULTS Ninety-six patients were enrolled in the study. Mean age was 43 ± 21 years, admission Glasgow Coma Score was 8.4 ± 4.8, Injury Severity Score was 24.7 ± 9.9, and head Abbreviated Injury Scale score was 3.73 ± 0.97. Acute hospital LOS was 12.3 ± 8.9 days, and rehabilitation LOS was 15.9 ± 9.3 days. Day-of-injury TBI lesion volumes were inversely associated with cognitive FIM scores at rehabilitation admission (p = 0.004) and discharge (p = 0.004) and inversely associated with ability to be discharged to home after rehabilitation (p = 0.006). CONCLUSION In a cohort of patients with moderate to severe TBI requiring a rehabilitation unit stay after the acute care hospital stay, DOI brain injury lesion volumes are associated with worse cognitive FIM scores at the time of rehabilitation admission and discharge. Smaller-injury volumes were associated with eventual discharge to home. Volumetric neuroimaging in the acute injury phase may improve surgeons' ultimate outcome predictions in TBI patients. LEVEL OF EVIDENCE Prognostic/epidemiologic study, level V.
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Boisserand LSB, Lemasson B, Hirschler L, Moisan A, Hubert V, Barbier EL, Rémy C, Detante O. Multiparametric magnetic resonance imaging including oxygenation mapping of experimental ischaemic stroke. J Cereb Blood Flow Metab 2017; 37:2196-2207. [PMID: 27466373 PMCID: PMC5464712 DOI: 10.1177/0271678x16662044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Recent advances in MRI methodology, such as microvascular and brain oxygenation (StO2) imaging, may prove useful in obtaining information about the severity of the acute stroke. We assessed the potential of StO2 to detect the ischaemic core in the acute phase compared to apparent diffusion coefficient and to predict the final necrosis. Sprague-Dawley rats (n = 38) were imaged during acute stroke (D0) and 21 days after (D21). A multiparametric MRI protocol was performed at 4.7T to characterize brain damage within three region of interest: 'LesionD0' (diffusion), 'Mismatch' representing penumbra (perfusion/diffusion) and 'Hypoxia' (voxels < 40% of StO2 within the region of interest LesionD0). Voxel-based analysis of stroke revealed heterogeneity of the region of interest LesionD0, which included voxels with different degrees of oxygenation decrease. This finding was supported by a dramatic decrease of vascular and perfusion parameters within the region of interest hypoxia. This zone presented the lowest values of almost all parameters analysed, indicating a higher severity. Our study demonstrates the potential of StO2 magnetic resonance imaging to more accurately detect the ischaemic core without the inclusion of any reversible ischaemic damage. Our follow-up study indicates that apparent diffusion coefficient imaging overestimated the final necrosis while StO2 imaging did not.
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Affiliation(s)
- Ligia Simões Braga Boisserand
- 1 Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France.,2 Inserm, U1216, Grenoble, France.,3 CAPES Foundation, Ministry of Education of Brazil, Brasilia, Brazil
| | - Benjamin Lemasson
- 1 Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France.,2 Inserm, U1216, Grenoble, France
| | - Lydiane Hirschler
- 1 Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France.,2 Inserm, U1216, Grenoble, France.,4 Bruker Biospin, Ettlingen, Germany
| | - Anaïck Moisan
- 1 Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France.,2 Inserm, U1216, Grenoble, France.,5 Cell Therapy and Engineering Unit, EFS Rhône Alpes, Saint Ismier, France
| | - Violaine Hubert
- 1 Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France
| | - Emmanuel L Barbier
- 1 Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France.,2 Inserm, U1216, Grenoble, France
| | - Chantal Rémy
- 1 Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France.,2 Inserm, U1216, Grenoble, France
| | - Olivier Detante
- 1 Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France.,2 Inserm, U1216, Grenoble, France.,6 CHU Grenoble Alpes, Grenoble, France
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Minjoli S, Saturnino GB, Blicher JU, Stagg CJ, Siebner HR, Antunes A, Thielscher A. The impact of large structural brain changes in chronic stroke patients on the electric field caused by transcranial brain stimulation. NEUROIMAGE-CLINICAL 2017; 15:106-117. [PMID: 28516033 PMCID: PMC5426045 DOI: 10.1016/j.nicl.2017.04.014] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 04/03/2017] [Accepted: 04/15/2017] [Indexed: 11/02/2022]
Abstract
Transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (TDCS) are two types of non-invasive transcranial brain stimulation (TBS). They are useful tools for stroke research and may be potential adjunct therapies for functional recovery. However, stroke often causes large cerebral lesions, which are commonly accompanied by a secondary enlargement of the ventricles and atrophy. These structural alterations substantially change the conductivity distribution inside the head, which may have potentially important consequences for both brain stimulation methods. We therefore aimed to characterize the impact of these changes on the spatial distribution of the electric field generated by both TBS methods. In addition to confirming the safety of TBS in the presence of large stroke-related structural changes, our aim was to clarify whether targeted stimulation is still possible. Realistic head models containing large cortical and subcortical stroke lesions in the right parietal cortex were created using MR images of two patients. For TMS, the electric field of a double coil was simulated using the finite-element method. Systematic variations of the coil position relative to the lesion were tested. For TDCS, the finite-element method was used to simulate a standard approach with two electrode pads, and the position of one electrode was systematically varied. For both TMS and TDCS, the lesion caused electric field "hot spots" in the cortex. However, these maxima were not substantially stronger than those seen in a healthy control. The electric field pattern induced by TMS was not substantially changed by the lesions. However, the average field strength generated by TDCS was substantially decreased. This effect occurred for both head models and even when both electrodes were distant to the lesion, caused by increased current shunting through the lesion and enlarged ventricles. Judging from the similar peak field strengths compared to the healthy control, both TBS methods are safe in patients with large brain lesions (in practice, however, additional factors such as potentially lowered thresholds for seizure-induction have to be considered). Focused stimulation by TMS seems to be possible, but standard tDCS protocols appear to be less efficient than they are in healthy subjects, strongly suggesting that tDCS studies in this population might benefit from individualized treatment planning based on realistic field calculations.
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Affiliation(s)
- Sena Minjoli
- Danish Research Center for Magnetic Resonance, Copenhagen University Hospital, Hvidovre, Denmark
| | - Guilherme B Saturnino
- Danish Research Center for Magnetic Resonance, Copenhagen University Hospital, Hvidovre, Denmark; Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Jakob Udby Blicher
- Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Aarhus University, Denmark; Department of Neurology, Aalborg University Hospital, Aalborg, Denmark
| | - Charlotte J Stagg
- Centre for Functional MRI of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, UK; Oxford Centre for Human Brain Activity (OHBA), Department of Psychiatry, University of Oxford, UK
| | - Hartwig R Siebner
- Danish Research Center for Magnetic Resonance, Copenhagen University Hospital, Hvidovre, Denmark; Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - André Antunes
- Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Axel Thielscher
- Danish Research Center for Magnetic Resonance, Copenhagen University Hospital, Hvidovre, Denmark; Max Planck Institute for Biological Cybernetics, Tübingen, Germany; Center for Magnetic Resonance, Technical University of Denmark, Kgs. Lyngby, Denmark.
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Price CJ, Hope TM, Seghier ML. Ten problems and solutions when predicting individual outcome from lesion site after stroke. Neuroimage 2016; 145:200-208. [PMID: 27502048 DOI: 10.1016/j.neuroimage.2016.08.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 07/08/2016] [Accepted: 08/04/2016] [Indexed: 12/17/2022] Open
Abstract
In this paper, we consider solutions to ten of the challenges faced when trying to predict an individual's functional outcome after stroke on the basis of lesion site. A primary goal is to find lesion-outcome associations that are consistently observed in large populations of stroke patients because consistent associations maximise confidence in future individualised predictions. To understand and control multiple sources of inter-patient variability, we need to systematically investigate each contributing factor and how each factor depends on other factors. This requires very large cohorts of patients, who differ from one another in typical and measurable ways, including lesion site, lesion size, functional outcome and time post stroke (weeks to decades). These multivariate investigations are complex, particularly when the contributions of different variables interact with one another. Machine learning algorithms can help to identify the most influential variables and indicate dependencies between different factors. Multivariate lesion analyses are needed to understand how the effect of damage to one brain region depends on damage or preservation in other brain regions. Such data-led investigations can reveal predictive relationships between lesion site and outcome. However, to understand and improve the predictions we need explanatory models of the neural networks and degenerate pathways that support functions of interest. This will entail integrating the results of lesion analyses with those from functional imaging (fMRI, MEG), transcranial magnetic stimulation (TMS) and diffusor tensor imaging (DTI) studies of healthy participants and patients.
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Affiliation(s)
- Cathy J Price
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology, UCL, UK.
| | - Thomas M Hope
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology, UCL, UK
| | - Mohamed L Seghier
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology, UCL, UK; Educational Neuroscience Research Centre, ECAE, Abu Dhabi, United Arab Emirates
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Doyle KP. Unraveling the pathophysiology of chronic stroke lesions could yield treatments for stroke-related dementia. FUTURE NEUROLOGY 2016. [DOI: 10.2217/fnl.15.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Kristian P Doyle
- Department of Immunobiology, Department of Neurology, & the Arizona Center on Aging, University of Arizona, Tucson, AZ, USA
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Yassi N, Campbell BCV, Moffat BA, Steward C, Churilov L, Parsons MW, Desmond PM, Davis SM, Bivard A. Know your tools--concordance of different methods for measuring brain volume change after ischemic stroke. Neuroradiology 2015; 57:685-95. [PMID: 25850861 DOI: 10.1007/s00234-015-1522-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/20/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Longitudinal brain volume changes have been investigated in a number of cerebral disorders as a surrogate marker of clinical outcome. In stroke, unique methodological challenges are posed by dynamic structural changes occurring after onset, particularly those relating to the infarct lesion. We aimed to evaluate agreement between different analysis methods for the measurement of post-stroke brain volume change, and to explore technical challenges inherent to these methods. METHODS Fifteen patients with anterior circulation stroke underwent magnetic resonance imaging within 1 week of onset and at 1 and 3 months. Whole-brain as well as grey- and white-matter volume were estimated separately using both an intensity-based and a surface watershed-based algorithm. In the case of the intensity-based algorithm, the analysis was also performed with and without exclusion of the infarct lesion. Due to the effects of peri-infarct edema at the baseline scan, longitudinal volume change was measured as percentage change between the 1 and 3-month scans. Intra-class and concordance correlation coefficients were used to assess agreement between the different analysis methods. Reduced major axis regression was used to inspect the nature of bias between measurements. RESULTS Overall agreement between methods was modest with strong disagreement between some techniques. Measurements were variably impacted by procedures performed to account for infarct lesions. CONCLUSIONS Improvements in volumetric methods and consensus between methodologies employed in different studies are necessary in order to increase the validity of conclusions derived from post-stroke cerebral volumetric studies. Readers should be aware of the potential impact of different methods on study conclusions.
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Affiliation(s)
- Nawaf Yassi
- Departments of Medicine and Neurology, Melbourne Brain Centre @ The Royal Melbourne Hospital, The University of Melbourne, Grattan St, Parkville, Victoria, 3050, Australia,
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