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Jung DH, Lee JH, Lee HJ, Park JW, Jung YJ, Shin HK, Choi BT. Therapeutic effects of a novel electrode for transcranial direct current stimulation in ischemic stroke mice. Theranostics 2024; 14:1325-1343. [PMID: 38389833 PMCID: PMC10879864 DOI: 10.7150/thno.90779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/16/2024] [Indexed: 02/24/2024] Open
Abstract
Rationale: Non-invasive transcranial direct current stimulation (tDCS), a promising stimulation tool to modulate a wide range of brain disorders, has major limitations, such as poor cortical stimulation intensity and focality. We designed a novel electrode for tDCS by conjugating a needle to a conventional ring-based high-definition (HD) electrode to enhance cortical stimulation efficacy. Method: HD-tDCS (43 µA/mm2, charge density 51.6 kC/m2, 20 min) was administered to male C57BL/6J mice subjected to early-stage ischemic stroke. Behavioral tests were employed to determine the therapeutic effects, and the underlying mechanisms of HD-tDCS were determined by performing RNA sequencing and other biomedical analyses. Results: The new HD-tDCS application, showing a higher electric potential and spatial focality based on computational modeling, demonstrated better therapeutic effects than conventional HD-tDCS in alleviating motor and cognitive deficits, with a decrease in infarct volume and inflammatory response. We assessed different electrode configurations in the new HD electrode; the configurations variously showed potent therapeutic effects, ameliorating neuronal death in the peri-infarct region via N-methyl-D-aspartate-dependent sterol regulatory element-binding protein 1 signaling and related inflammatory factors, further alleviating motor and cognitive deficits in stroke. Conclusion: This new HD-tDCS application showed better therapeutic effects than those with conventional HD-tDCS in early-stage stroke via the amelioration of neuronal death in the penumbra. It may be applied in the early stages of stroke to alleviate neurological impairment.
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Affiliation(s)
- Da Hee Jung
- Department of Korean Medical Science, School of Korean Medicine, Pusan National University, Yangsan 50612, Republic of Korea
- Graduate Training Program of Korean Medical Therapeutics for Healthy Aging, Pusan National University, Yangsan 50612, Republic of Korea
| | - Jae Ho Lee
- Department of Korean Medical Science, School of Korean Medicine, Pusan National University, Yangsan 50612, Republic of Korea
- Graduate Training Program of Korean Medical Therapeutics for Healthy Aging, Pusan National University, Yangsan 50612, Republic of Korea
| | - Hong Ju Lee
- Department of Korean Medical Science, School of Korean Medicine, Pusan National University, Yangsan 50612, Republic of Korea
| | - Jang Woo Park
- Korea Radioisotope Center for Pharmaceuticals, Korea Institute of Radiological & Medical Sciences, Seoul 01812, Republic of Korea
| | - Young-Jin Jung
- School of Healthcare and Biomedical Engineering, Chonnam National University, Yeosu 59626, Republic of Korea
| | - Hwa Kyoung Shin
- Department of Korean Medical Science, School of Korean Medicine, Pusan National University, Yangsan 50612, Republic of Korea
- Graduate Training Program of Korean Medical Therapeutics for Healthy Aging, Pusan National University, Yangsan 50612, Republic of Korea
| | - Byung Tae Choi
- Department of Korean Medical Science, School of Korean Medicine, Pusan National University, Yangsan 50612, Republic of Korea
- Graduate Training Program of Korean Medical Therapeutics for Healthy Aging, Pusan National University, Yangsan 50612, Republic of Korea
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Williams EER, Sghirripa S, Rogasch NC, Hordacre B, Attrill S. Non-invasive brain stimulation in the treatment of post-stroke aphasia: a scoping review. Disabil Rehabil 2023:1-22. [PMID: 37828899 DOI: 10.1080/09638288.2023.2259299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 09/10/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE Aphasia is an acquired language impairment that commonly results from stroke. Non-invasive brain stimulation (NIBS) might accelerate aphasia recovery trajectories and has seen mounting popularity in recent aphasia rehabilitation research. The present review aimed to: (1) summarise all existing literature on NIBS as a post-stroke aphasia treatment; and (2) provide recommendations for future NIBS-aphasia research. MATERIALS AND METHODS Databases for published and grey literature were searched using scoping review methodology. 278 journal articles, conference abstracts/posters, and books, and 38 items of grey literature, were included for analysis. RESULTS Quantitative analysis revealed that ipsilesional anodal transcranial direct current stimulation and contralesional 1-Hz repetitive transcranial magnetic stimulation were the most widely used forms of NIBS, while qualitative analysis identified four key themes including: the roles of the hemispheres in aphasia recovery and their relationship with NIBS; heterogeneity of individuals but homogeneity of subpopulations; individualisation of stimulation parameters; and much remains under-explored in the NIBS-aphasia literature. CONCLUSIONS Taken together, these results highlighted systemic challenges across the field such as small sample sizes, inter-individual variability, lack of protocol optimisation/standardisation, and inadequate focus on aphasiology. Four key recommendations are outlined herein to guide future research and refine NIBS methods for post-stroke aphasia treatment.
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Affiliation(s)
- Ellen E R Williams
- School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Sabrina Sghirripa
- School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Nigel C Rogasch
- School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
- Turner Institute of Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Brenton Hordacre
- Innovation, IMPlementation and Clinical Translation (IIMPACT) in Health, Allied Health and Human Performance, The University of South Australia, Adelaide, Australia
| | - Stacie Attrill
- Speech Pathology, School of Allied Health Science and Practice, The University of Adelaide, Adelaide, Australia
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Optimized APPS-tDCS electrode position, size, and distance doubles the on-target stimulation magnitude in 3000 electric field models. Sci Rep 2022; 12:20116. [PMID: 36418438 PMCID: PMC9684449 DOI: 10.1038/s41598-022-24618-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 11/17/2022] [Indexed: 11/24/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) is a widely used noninvasive brain stimulation technique with mixed results to date. A potential solution is to apply more efficient stimulation to ensure that each participant receives sufficient cortical activation. In this four-part study, we used electric field (E-field) modeling to systematically investigate the cortical effects of conventional and novel tDCS electrode montages, with the goal of creating a new easily adoptable form of tDCS that induces higher and more focal E-fields. We computed 3000 anatomically accurate, MRI-based E-field models using 2 mA tDCS to target the left primary motor cortex in 200 Human Connectome Project (HCP) participants and tested the effects of: 1. Novel Electrode Position, 2. Electrode Size, and 3. Inter-Electrode Distance on E-field magnitude and focality. In particular, we examined the effects of placing electrodes surrounding the corticomotor target in the anterior and posterior direction (anterior posterior pad surround tDCS; APPS-tDCS). We found that electrode position, electrode size, and inter-electrode distance all significantly impact the cortical E-field magnitude and focality of stimulation (all p < 0.0001). At the same 2 mA scalp stimulation intensity, APPS-tDCS with smaller than conventional 1 × 1 cm electrodes surrounding the neural target deliver more than double the on-target cortical E-field (APPS-tDCS: average of 0.55 V/m from 2 mA; M1-SO and bilateral M1: both 0.27 V/m from 2 mA) while stimulating only a fraction of the off-target brain regions; 2 mA optimized APPS-tDCS produces 4.08 mA-like cortical E-fields. In sum, this new optimized APPS-tDCS method produces much stronger cortical stimulation intensities at the same 2 mA scalp intensity. APPS-tDCS also more focally stimulates the cortex at the intended target, using simple EEG coordinate locations and without MRI scans. This APPS-tDCS method is adoptable to any existing, commercially available tDCS device and can be used to ensure sufficient cortical activation in each person. Future directions include testing whether APPS-tDCS produces larger and more consistent therapeutic tDCS effects.
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Popova M, Fakhar K, Braun W. ‘One region to control them all'- the surprising effectiveness of network control theory in predicting post-stroke recovery from aphasia. Front Comput Neurosci 2022; 16:943396. [PMID: 36034934 PMCID: PMC9399645 DOI: 10.3389/fncom.2022.943396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/26/2022] [Indexed: 12/05/2022] Open
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High definition transcranial direct current stimulation modulates abnormal neurophysiological activity in post-stroke aphasia. Sci Rep 2020; 10:19625. [PMID: 33184382 PMCID: PMC7665190 DOI: 10.1038/s41598-020-76533-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 10/23/2020] [Indexed: 12/20/2022] Open
Abstract
Recent findings indicate that measures derived from resting-state magnetoencephalography (rsMEG) are sensitive to cortical dysfunction in post-stroke aphasia. Spectral power and multiscale entropy (MSE) measures show that left-hemispheric areas surrounding the stroke lesion (perilesional) exhibit pathological oscillatory slowing and alterations in signal complexity. In the current study, we tested whether individually-targeted high-definition transcranial direct current stimulation (HD-tDCS) can reduce MEG abnormalities and transiently improve language performance. In eleven chronic aphasia survivors, we devised a method to localize perilesional areas exhibiting peak MSE abnormalities, and subsequently targeted these areas with excitatory/anodal-tDCS, or targeted the contralateral homolog areas with inhibitory/cathodal-tDCS, based on prominent theories of stroke recovery. Pathological MEG slowing in these patients was correlated with aphasia severity. Sentence/phrase repetition accuracy was assessed before and after tDCS. A delayed word reading task was administered inside MEG to assess tDCS-induced neurophysiological changes in relative power and MSE computed on the pre-stimulus and delay task time windows. Results indicated increases in repetition accuracy, decreases in contralateral theta (4–7 Hz) and coarse-scale MSE (slow activity), and increases in perilesional low-gamma (25–50 Hz) and fine-scale MSE (fast activity) after anodal-tDCS, indicating reversal of pathological abnormalities. RsMEG may be a sensitive measure for guiding therapeutic tDCS.
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Klaus J, Hartwigsen G. Failure to Improve Verbal Fluency with Transcranial Direct Current Stimulation. Neuroscience 2020; 449:123-133. [DOI: 10.1016/j.neuroscience.2020.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 08/28/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
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Solomons CD, Shanmugasundaram V. Transcranial direct current stimulation: A review of electrode characteristics and materials. Med Eng Phys 2020; 85:63-74. [PMID: 33081965 DOI: 10.1016/j.medengphy.2020.09.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/10/2020] [Accepted: 09/25/2020] [Indexed: 12/15/2022]
Abstract
Electrode characteristics are crucial in transcranial direct current stimulation (tDCS) since electrode design and placement determine the cortical area being modulated, current density and spatial resolution of stimulation. Early research on tDCS sought to determine optimal parameters for stimulation by specifying maximum current, duration and sizes of electrodes. Further research focused on determining efficient ways to deliver stimulation to targeted regions on the cortex with minimal discomfort to the user by altering electrode size, placement, shape and material. This review aims to give an insight on the main characteristics of electrodes used in tDCS and on the variability found in electrode parameters and placements from tDCS to high definition tDCS (HD-tDCS) applications and beyond.
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Affiliation(s)
- Cassandra D Solomons
- School of Electrical Engineering, Vellore Institute of Technology, Vellore 632014, India
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Bikson M, Hanlon CA, Woods AJ, Gillick BT, Charvet L, Lamm C, Madeo G, Holczer A, Almeida J, Antal A, Ay MR, Baeken C, Blumberger DM, Campanella S, Camprodon JA, Christiansen L, Loo C, Crinion JT, Fitzgerald P, Gallimberti L, Ghobadi-Azbari P, Ghodratitoostani I, Grabner RH, Hartwigsen G, Hirata A, Kirton A, Knotkova H, Krupitsky E, Marangolo P, Nakamura-Palacios EM, Potok W, Praharaj SK, Ruff CC, Schlaug G, Siebner HR, Stagg CJ, Thielscher A, Wenderoth N, Yuan TF, Zhang X, Ekhtiari H. Guidelines for TMS/tES clinical services and research through the COVID-19 pandemic. Brain Stimul 2020; 13:1124-1149. [PMID: 32413554 PMCID: PMC7217075 DOI: 10.1016/j.brs.2020.05.010] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/10/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has broadly disrupted biomedical treatment and research including non-invasive brain stimulation (NIBS). Moreover, the rapid onset of societal disruption and evolving regulatory restrictions may not have allowed for systematic planning of how clinical and research work may continue throughout the pandemic or be restarted as restrictions are abated. The urgency to provide and develop NIBS as an intervention for diverse neurological and mental health indications, and as a catalyst of fundamental brain research, is not dampened by the parallel efforts to address the most life-threatening aspects of COVID-19; rather in many cases the need for NIBS is heightened including the potential to mitigate mental health consequences related to COVID-19. OBJECTIVE To facilitate the re-establishment of access to NIBS clinical services and research operations during the current COVID-19 pandemic and possible future outbreaks, we develop and discuss a framework for balancing the importance of NIBS operations with safety considerations, while addressing the needs of all stakeholders. We focus on Transcranial Magnetic Stimulation (TMS) and low intensity transcranial Electrical Stimulation (tES) - including transcranial Direct Current Stimulation (tDCS) and transcranial Alternating Current Stimulation (tACS). METHODS The present consensus paper provides guidelines and good practices for managing and reopening NIBS clinics and laboratories through the immediate and ongoing stages of COVID-19. The document reflects the analysis of experts with domain-relevant expertise spanning NIBS technology, clinical services, and basic and clinical research - with an international perspective. We outline regulatory aspects, human resources, NIBS optimization, as well as accommodations for specific demographics. RESULTS A model based on three phases (early COVID-19 impact, current practices, and future preparation) with an 11-step checklist (spanning removing or streamlining in-person protocols, incorporating telemedicine, and addressing COVID-19-associated adverse events) is proposed. Recommendations on implementing social distancing and sterilization of NIBS related equipment, specific considerations of COVID-19 positive populations including mental health comorbidities, as well as considerations regarding regulatory and human resource in the era of COVID-19 are outlined. We discuss COVID-19 considerations specifically for clinical (sub-)populations including pediatric, stroke, addiction, and the elderly. Numerous case-examples across the world are described. CONCLUSION There is an evident, and in cases urgent, need to maintain NIBS operations through the COVID-19 pandemic, including anticipating future pandemic waves and addressing effects of COVID-19 on brain and mind. The proposed robust and structured strategy aims to address the current and anticipated future challenges while maintaining scientific rigor and managing risk.
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Affiliation(s)
- Marom Bikson
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, NY, USA
| | - Colleen A Hanlon
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Adam J Woods
- Center for Cognitive Aging and Memory, McKnight Brain Institute, Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Bernadette T Gillick
- Department of Rehabilitation Medicine, School of Medicine, University of Minnesota, MN, Minneapolis, USA
| | - Leigh Charvet
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
| | - Claus Lamm
- Social, Cognitive and Affective Neuroscience Unit, Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | | | - Adrienn Holczer
- Department of Neurology, Albert Szent-Györgyi Health Center, Faculty of Medicine, University of Szeged, Hungary
| | - Jorge Almeida
- Proaction Lab, Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal; CINEICC, Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal
| | - Andrea Antal
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Göttingen, Germany; Institute of Medical Psychology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Mohammad Reza Ay
- Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Iran
| | - Chris Baeken
- Faculty of Medicine and Health Sciences, Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium; Department of Psychiatry, University Hospital (UZBrussel), Brussels, Belgium; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Salvatore Campanella
- Laboratoire de Psychologie Médicale et D'Addiction, ULB Neuroscience Institute (UNI), Université Libre de Bruxelles (ULB), Place Vangehuchten, B-1020, Brussels, Belgium
| | - Joan A Camprodon
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lasse Christiansen
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Colleen Loo
- School of Psychiatry & Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Jennifer T Crinion
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Paul Fitzgerald
- Epworth Centre for Innovation in Mental Health, Epworth HealthCare and Department of Psychiatry, Monash University, Camberwell, Victoria, Australia
| | | | - Peyman Ghobadi-Azbari
- Department of Biomedical Engineering, Shahed University, Tehran, Iran; Iranian National Center for Addiction Studies (INCAS), Tehran, Iran
| | - Iman Ghodratitoostani
- Neurocognitive Engineering Laboratory (NEL), Center for Mathematical Sciences Applied to Industry, Institute of Mathematical and Computer Sciences, University of Sao Paulo, Brazil
| | - Roland H Grabner
- Educational Neuroscience, Institute of Psychology, University of Graz, Austria
| | - Gesa Hartwigsen
- Lise Meitner Research Group Cognition and Plasticity, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Akimasa Hirata
- Department of Electrical and Mechanical Engineering, Nagoya Institute of Technology, Nagoya, Japan
| | - Adam Kirton
- Departments of Pediatrics and Clinical Neuroscience, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Helena Knotkova
- MJHS Institute for Innovation in Palliative Care, New York, NY, USA; Department of Family and Social Medicine, Albert Einstein College of Medicine, The Bronx, NY, USA
| | - Evgeny Krupitsky
- First Pavlov State Medical University, V. M. Bekhterev National Research Medical Center for Psychiatry and Neurology, St. Petersburg, Russia
| | - Paola Marangolo
- Department of Humanities Studies, University Federico II, Naples, Italy; Aphasia Research Lab, IRCCS Santa Lucia Foundation, Rome, Italy
| | | | - Weronika Potok
- Neural Control of Movement Lab, Department of Health Science and Technology, ETH Zurich, Switzerland
| | - Samir K Praharaj
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Christian C Ruff
- Zurich Center for Neuroeconomics (ZNE), Department of Economics, University of Zurich, Zurich, Switzerland
| | - Gottfried Schlaug
- Neuroimaging-Neuromodulation and Stroke Recovery Laboratory, Department of Neurology, Beth Israel Deaconess Medical Center and Baystate Medical Center, UMass Medical School, MA, USA
| | - Hartwig R Siebner
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Institute of Clinical Medicine, Faculty of Health Sciences and Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte J Stagg
- Wellcome Centre for Integrative Neuroimaging and MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Axel Thielscher
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Department of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Nicole Wenderoth
- Neural Control of Movement Lab, Department of Health Science and Technology, ETH Zurich, Switzerland
| | - Ti-Fei Yuan
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaochu Zhang
- CAS Key Laboratory of Brain Function and Disease and School of Life Sciences, Division of Life Science and Medicine, University of Science & Technology of China, Hefei, China
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Carrière M, Barra A, Mortaheb S, Binda Fossati M, Martens G, Bodien Y, Morales-Quezada L, Fregni F, Giacino J, Laureys S, Thibaut A. P181 Neurophysiological effects and behavioral outcomes after tPCS and tDCS in a patient in minimally conscious state. Clin Neurophysiol 2020. [DOI: 10.1016/j.clinph.2019.12.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Beuter A, Balossier A, Vassal F, Hemm S, Volpert V. Cortical stimulation in aphasia following ischemic stroke: toward model-guided electrical neuromodulation. BIOLOGICAL CYBERNETICS 2020; 114:5-21. [PMID: 32020368 DOI: 10.1007/s00422-020-00818-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 01/28/2020] [Indexed: 06/10/2023]
Abstract
The aim of this paper is to integrate different bodies of research including brain traveling waves, brain neuromodulation, neural field modeling and post-stroke language disorders in order to explore the opportunity of implementing model-guided, cortical neuromodulation for the treatment of post-stroke aphasia. Worldwide according to WHO, strokes are the second leading cause of death and the third leading cause of disability. In ischemic stroke, there is not enough blood supply to provide enough oxygen and nutrients to parts of the brain, while in hemorrhagic stroke, there is bleeding within the enclosed cranial cavity. The present paper focuses on ischemic stroke. We first review accumulating observations of traveling waves occurring spontaneously or triggered by external stimuli in healthy subjects as well as in patients with brain disorders. We examine the putative functions of these waves and focus on post-stroke aphasia observed when brain language networks become fragmented and/or partly silent, thus perturbing the progression of traveling waves across perilesional areas. Secondly, we focus on a simplified model based on the current literature in the field and describe cortical traveling wave dynamics and their modulation. This model uses a biophysically realistic integro-differential equation describing spatially distributed and synaptically coupled neural networks producing traveling wave solutions. The model is used to calculate wave parameters (speed, amplitude and/or frequency) and to guide the reconstruction of the perturbed wave. A stimulation term is included in the model to restore wave propagation to a reasonably good level. Thirdly, we examine various issues related to the implementation model-guided neuromodulation in the treatment of post-stroke aphasia given that closed-loop invasive brain stimulation studies have recently produced encouraging results. Finally, we suggest that modulating traveling waves by acting selectively and dynamically across space and time to facilitate wave propagation is a promising therapeutic strategy especially at a time when a new generation of closed-loop cortical stimulation systems is about to arrive on the market.
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Affiliation(s)
- Anne Beuter
- Bordeaux INP, University of Bordeaux, Bordeaux, France.
| | - Anne Balossier
- Service de neurochirurgie fonctionnelle et stéréotaxique, AP-HM La Timone, Aix-Marseille University, Marseille, France
| | - François Vassal
- INSERM U1028 Neuropain, UMR 5292, Centre de Recherche en Neurosciences, Universités Lyon 1 et Saint-Etienne, Saint-Étienne, France
- Service de Neurochirurgie, Hôpital Nord, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Étienne, France
| | - Simone Hemm
- School of Life Sciences, Institute for Medical Engineering and Medical Informatics, University of Applied Sciences and Arts Northwestern Switzerland, 4132, Muttenz, Switzerland
| | - Vitaly Volpert
- Institut Camille Jordan, UMR 5208 CNRS, University Lyon 1, 69622, Villeurbanne, France
- INRIA Team Dracula, INRIA Lyon La Doua, 69603, Villeurbanne, France
- People's Friendship University of Russia (RUDN University), Miklukho-Maklaya St, Moscow, Russian Federation, 117198
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From Broca and Wernicke to the Neuromodulation Era: Insights of Brain Language Networks for Neurorehabilitation. Behav Neurol 2019; 2019:9894571. [PMID: 31428210 PMCID: PMC6679886 DOI: 10.1155/2019/9894571] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 06/18/2019] [Accepted: 07/05/2019] [Indexed: 12/30/2022] Open
Abstract
Communication in humans activates almost every part of the brain. Of course, the use of language predominates, but other cognitive functions such as attention, memory, emotion, and executive processes are also involved. However, in order to explain how our brain "understands," "speaks," and "writes," and in order to rehabilitate aphasic disorders, neuroscience has faced the challenge for years to reveal the responsible neural networks. Broca and Wernicke (and Lichtheim and many others), during the 19th century, when brain research was mainly observational and autopsy driven, offered fundamental knowledge about the brain and language, so the Wernicke-Geschwind model appeared and aphasiology during the 20th century was based on it. This model is still useful for a first approach into the classical categorization of aphasic syndromes, but it is outdated, because it does not adequately describe the neural networks relevant for language, and it offers a modular perspective, focusing mainly on cortical structures. During the last three decades, neuroscience conquered new imaging, recording, and manipulation techniques for brain research, and a new model of the functional neuroanatomy of language was developed, the dual stream model, consisting of two interacting networks ("streams"), one ventral, bilaterally organized, for language comprehension, and one dorsal, left hemisphere dominant, for production. This new model also has its limitations but helps us to understand, among others, why patients with different brain lesions can have similar language impairments. Furthermore, interesting aspects arise from studying language functions in aging brains (and also in young, developing brains) and in cognitively impaired patients and neuromodulation effects on reorganization of brain networks subserving language. In this selective review, we discuss methods for coupling new knowledge regarding the functional reorganization of the brain with sophisticated techniques capable of activating the available supportive networks in order to provide improved neurorehabilitation strategies for people suffering from neurogenic communication disorders.
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Bucur M, Papagno C. Are transcranial brain stimulation effects long-lasting in post-stroke aphasia? A comparative systematic review and meta-analysis on naming performance. Neurosci Biobehav Rev 2019; 102:264-289. [DOI: 10.1016/j.neubiorev.2019.04.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/12/2019] [Accepted: 04/24/2019] [Indexed: 12/13/2022]
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Elsner B, Kugler J, Pohl M, Mehrholz J. Transcranial direct current stimulation (tDCS) for improving aphasia in adults with aphasia after stroke. Cochrane Database Syst Rev 2019; 5:CD009760. [PMID: 31111960 PMCID: PMC6528187 DOI: 10.1002/14651858.cd009760.pub4] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Stroke is one of the leading causes of disability worldwide and aphasia among survivors is common. Current speech and language therapy (SLT) strategies have only limited effectiveness in improving aphasia. A possible adjunct to SLT for improving SLT outcomes might be non-invasive brain stimulation by transcranial direct current stimulation (tDCS) to modulate cortical excitability and hence to improve aphasia. OBJECTIVES To assess the effects of tDCS for improving aphasia in people who have had a stroke. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (June 2018), CENTRAL (Cochrane Library, June 2018), MEDLINE (1948 to June 2018), Embase (1980 to June 2018), CINAHL (1982 to June 2018), AMED (1985 to June 2018), Science Citation Index (1899 to June 2018), and seven additional databases. We also searched trial registers and reference lists, handsearched conference proceedings and contacted authors and equipment manufacturers. SELECTION CRITERIA We included only randomised controlled trials (RCTs) and randomised controlled cross-over trials (from which we only analysed the first period as a parallel group design) comparing tDCS versus control in adults with aphasia due to stroke. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and risk of bias, and extracted data. If necessary, we contacted study authors for additional information. We collected information on dropouts and adverse events from the trials. MAIN RESULTS We included 21 trials involving 421 participants in the qualitative synthesis. Three studies with 112 participants used formal outcome measures for our primary outcome measure of functional communication - that is, measuring aphasia in a real-life communicative setting. There was no evidence of an effect (standardised mean difference (SMD) 0.17, 95% confidence interval (CI) -0.20 to 0.55; P = 0.37; I² = 0%; low quality of evidence; inverse variance method with random-effects model; higher SMD reflecting benefit from tDCS; moderate quality of evidence). At follow-up, there also was no evidence of an effect (SMD 0.14, 95% CI -0.31 to 0.58; P = 0.55; 80 participants ; 2 studies; I² = 0%; very low quality of evidence; higher SMD reflecting benefit from tDCS; moderate quality of evidence).For our secondary outcome measure, accuracy in naming nouns at the end of intervention, there was evidence of an effect (SMD 0.42, 95% CI 0.19 to 0.66; P = 0.0005; I² = 0%; 298 participants; 11 studies; inverse variance method with random-effects model; higher SMD reflecting benefit from tDCS; moderate quality of evidence). There was an effect for the accuracy in naming nouns at follow-up (SMD 0.87, 95% CI 0.25 to 1.48; P = 0.006; 80 participants; 2 studies; I² = 32%; low quality of evidence); however the results were not statistically significant in our sensitivity analysis regarding the assumptions of the underlying correlation coefficient for imputing missing standard deviations of change scores. There was no evidence of an effect regarding accuracy in naming verbs post intervention (SMD 0.19, 95% CI -0.68 to 1.06; P = 0.67; I² = 0%; 21 participants; 3 studies; very low quality of evidence). We found no studies examining the effect of tDCS on cognition in people with aphasia after stroke. We did not find reported serious adverse events and the proportion of dropouts and adverse events was comparable between groups (odds ratio (OR) 0.54, 95% CI 0.21 to 1.37; P = 0.19; I² = 0%; Mantel-Haenszel method with random-effects model; 345 participants; 15 studies; low quality of evidence). AUTHORS' CONCLUSIONS Currently there is no evidence of the effectiveness of tDCS (anodal tDCS, cathodal tDCS and Dual-tDCS) versus control (sham tDCS) for improving functional communication in people with aphasia after stroke (low quality of evidence). However, there is limited evidence that tDCS may improve naming performance in naming nouns (moderate quality of evidence), but not verbs (very low quality of evidence) at the end of the intervention period and possibly also at follow-up. Further methodologically rigorous RCTs with adequate sample size calculation are needed in this area to determine the effectiveness of this intervention. Data on functional communication and on adverse events should routinely be collected and presented in further publications as well as data at follow-up. Further study on the relationship between language/aphasia and cognition may be required, and improved cognitive assessments for patients with aphasia developed, prior to the use of tDCS to directly target cognition in aphasia. Authors should state total values at post-intervention as well as their corresponding change scores with standard deviations.
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Affiliation(s)
- Bernhard Elsner
- Technical University DresdenDepartment of Public Health, Dresden Medical SchoolDresdenGermany
| | - Joachim Kugler
- Technical University DresdenDepartment of Public Health, Dresden Medical SchoolDresdenGermany
| | - Marcus Pohl
- Helios Klinik Schloss PulsnitzNeurological RehabilitationWittgensteiner Str. 1PulsnitzSaxonyGermany01896
| | - Jan Mehrholz
- Technical University DresdenDepartment of Public Health, Dresden Medical SchoolDresdenGermany
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Anderlini D, Wallis G, Marinovic W. Language as a Predictor of Motor Recovery: The Case for a More Global Approach to Stroke Rehabilitation. Neurorehabil Neural Repair 2019; 33:167-178. [PMID: 30757952 DOI: 10.1177/1545968319829454] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Stroke is the third leading cause of death in the developed world and the primary cause of adult disability. The most common site of stroke is the middle cerebral artery (MCA), an artery that supplies a range of areas involved in both language and motor function. As a consequence, many stroke patients experience a combination of language and motor deficits. Indeed, those suffering from Broca's aphasia have an 80% chance of also suffering hemiplegia. Despite the prevalence of multifaceted disability in patients, the current trend in both clinical trials and clinical practice is toward compartmentalization of dysfunction. In this article, we review evidence that aphasia and hemiplegia do not just coexist, but that they interact. We review a number of clinical reports describing how therapies for one type of deficit can improve recovery in the other and vice versa. We go on to describe how language deficits should be seen as a warning to clinicians that the patient is likely to experience motor impairment and slower motor recovery, aiding clinicians to optimize their choice of therapy. We explore these findings and offer a tentative link between language and arm function through their shared need for sequential action, which we term fluency. We propose that area BA44 (part of Broca's area) acts as a hub for fluency in both movement and language, both in terms of production and comprehension.
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Affiliation(s)
- Deanna Anderlini
- 1 The University of Queensland, St Lucia, Queensland, Australia.,2 Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Guy Wallis
- 1 The University of Queensland, St Lucia, Queensland, Australia
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15
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Buchwald A, Calhoun H, Rimikis S, Lowe MS, Wellner R, Edwards DJ. Using tDCS to facilitate motor learning in speech production: The role of timing. Cortex 2018; 111:274-285. [PMID: 30551048 DOI: 10.1016/j.cortex.2018.11.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 09/14/2018] [Accepted: 11/05/2018] [Indexed: 11/16/2022]
Abstract
There exists debate regarding the extent to which transcranial direct current stimulation (tDCS) can affect or enhance human behavior. Here, we examined a previously unexplored domain: speech motor learning. We investigated whether speech motor learning in unimpaired participants can be enhanced using a single-session tDCS experiment, and investigated whether the timing of tDCS relative to a behavioral task affected performance. Participants (N = 80) performed a twenty minute learning task with nonwords containing non-native consonant clusters (e.g., GDEEVOO), and were assigned to groups receiving either sham or active tDCS either immediately before or during the task. Both accuracy and properties of errors were examined throughout the course of the practice task, and then practice was compared to a retention period 30 min later (R1) and two days later (R2). For cluster and whole-(non)word accuracy measures, acquisition was observed for all groups during the practice session. Compared to the beginning of practice, the tDCS-Before group showed significantly greater improvement than both the sham group and the tDCS-During group at R1. An effect was also observed for vowel duration in errors (/gdivu/ → [gədivu]), with the tDCS-Before group showing significant shortening of vowel errors throughout practice. Overall, the findings suggest that tDCS can improve speech motor learning, and that the improvement may be greater when tDCS is applied immediately before practice, warranting further exploration of this new domain for tDCS research.
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Affiliation(s)
- Adam Buchwald
- New York University, Department of Communicative Sciences and Disorders, New York, NY, USA.
| | - Holly Calhoun
- New York University, Department of Communicative Sciences and Disorders, New York, NY, USA
| | - Stacey Rimikis
- New York University, Department of Communicative Sciences and Disorders, New York, NY, USA
| | - Mara Steinberg Lowe
- New York University, Department of Communicative Sciences and Disorders, New York, NY, USA
| | - Rebecca Wellner
- New York University, Department of Communicative Sciences and Disorders, New York, NY, USA
| | - Dylan J Edwards
- Burke Medical Research Institute, Edith Cowan University and Weill Cornell Medicine, White Plains, NY, USA; Moss Rehabilitation Research Institute, Philadelphia, PA, USA
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16
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Pestalozzi MI, Di Pietro M, Martins Gaytanidis C, Spierer L, Schnider A, Chouiter L, Colombo F, Annoni JM, Jost LB. Effects of Prefrontal Transcranial Direct Current Stimulation on Lexical Access in Chronic Poststroke Aphasia. Neurorehabil Neural Repair 2018; 32:913-923. [DOI: 10.1177/1545968318801551] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background. A successful interplay between prefrontal and domain-specific language areas is critical for language processing. Previous studies involving people with aphasia have shown that executive control processes might act on lexical-semantic representations during retrieval. Modulating the prefrontal control network by means of noninvasive brain stimulation might, therefore, improve lexical access in people with aphasia. Objective. The present study investigates the effects of prefrontal transcranial direct current stimulation (tDCS) on lexical access in chronic poststroke aphasia. Methods. We report data of 14 participants with chronic poststroke aphasia. We used a sham-tDCS (S-tDCS) controlled and double-blind within-subjects design. Performances in picture naming, verbal fluency, and word repetition were assessed immediately after stimulation. Results. As compared with S-tDCS, anodal tDCS (A-tDCS) improved verbal fluency as well as the speed of naming high frequency words, but not word repetition. Conclusion. The results of our study suggest that the brain network dedicated to lexical retrieval processing can be facilitated by A-tDCS over the left dorsolateral prefrontal cortex. This finding supports the notion that strengthening executive control functions after stroke could complement speech and language-focused therapy.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Lea B. Jost
- University of Fribourg, Switzerland
- Fribourg Hospital, Switzerland
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17
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Wortman-Jutt S, Edwards D. On the generalizability of post-stroke proportional recovery. Eur J Neurol 2018; 24:e83-e84. [PMID: 29148225 DOI: 10.1111/ene.13408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 07/25/2017] [Indexed: 01/11/2023]
Affiliation(s)
| | - D Edwards
- Non-Invasive Brain Stimulation and Human Motor Control Laboratory, Burke Medical Research Institute, White Plains, NY, USA.,Department of Neurology, Weill Cornell Medicine, NY, USA.,Berenson-Allen Center for Noninvasive Brain Stimulation, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.,School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
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18
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Abstract
PURPOSE OF REVIEW Aphasia is a common feature of stroke, affecting 21-38% of acute stroke patients and an estimated 1 million stroke survivors. Although stroke, as a syndrome, is the leading cause of disability in the USA, less is known about the independent impact of aphasia on stroke outcomes. RECENT FINDINGS During the acute stroke period, aphasia has been found to increase length of stay, inpatient complications, overall neurological disability, mortality, and to alter discharge disposition. Outcomes during the sub-acute and chronic stroke periods show that aphasia is associated with lower Functional Independence Measures (FIM) scores, longer stays in rehabilitation settings, poorer function in activities of daily living, and mortality. Factors that complicate the analysis of aphasia on post-stroke outcomes, however, include widely different systems of care across international settings that result in varying admission patterns to acute stroke units, allowable length of stays based on reimbursement, and criteria for rehabilitation placement. Aphasia arising from stroke is associated with worse outcomes both in the acute and chronic periods. Future research will have to incorporate disparate patterns in analytic models, and to take into account specific aphasia profiles and evolving methods of post-stroke speech-language therapy.
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Affiliation(s)
- Ronald M Lazar
- Department of Neurology, University of Alabama at Birmingham, 1720 7th Ave S-SC 650, Birmingham, AL, 35294, USA.
| | - Amelia K Boehme
- Department of Neurology, Columbia University Medical Center, 710 W168th St, New York, NY, 10032, USA
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