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Stam CJ. Hub overload and failure as a final common pathway in neurological brain network disorders. Netw Neurosci 2024; 8:1-23. [PMID: 38562292 PMCID: PMC10861166 DOI: 10.1162/netn_a_00339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/26/2023] [Indexed: 04/04/2024] Open
Abstract
Understanding the concept of network hubs and their role in brain disease is now rapidly becoming important for clinical neurology. Hub nodes in brain networks are areas highly connected to the rest of the brain, which handle a large part of all the network traffic. They also show high levels of neural activity and metabolism, which makes them vulnerable to many different types of pathology. The present review examines recent evidence for the prevalence and nature of hub involvement in a variety of neurological disorders, emphasizing common themes across different types of pathology. In focal epilepsy, pathological hubs may play a role in spreading of seizure activity, and removal of such hub nodes is associated with improved outcome. In stroke, damage to hubs is associated with impaired cognitive recovery. Breakdown of optimal brain network organization in multiple sclerosis is accompanied by cognitive dysfunction. In Alzheimer's disease, hyperactive hub nodes are directly associated with amyloid-beta and tau pathology. Early and reliable detection of hub pathology and disturbed connectivity in Alzheimer's disease with imaging and neurophysiological techniques opens up opportunities to detect patients with a network hyperexcitability profile, who could benefit from treatment with anti-epileptic drugs.
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Affiliation(s)
- Cornelis Jan Stam
- Clinical Neurophysiology and MEG Center, Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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2
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Evangelista GG, Egger P, Brügger J, Beanato E, Koch PJ, Ceroni M, Fleury L, Cadic-Melchior A, Meyer NH, Rodríguez DDL, Girard G, Léger B, Turlan JL, Mühl A, Vuadens P, Adolphsen J, Jagella CE, Constantin C, Alvarez V, San Millán D, Bonvin C, Morishita T, Wessel MJ, Van De Ville D, Hummel FC. Differential Impact of Brain Network Efficiency on Poststroke Motor and Attentional Deficits. Stroke 2023; 54:955-963. [PMID: 36846963 PMCID: PMC10662579 DOI: 10.1161/strokeaha.122.040001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 12/01/2022] [Accepted: 12/15/2022] [Indexed: 03/01/2023]
Abstract
BACKGROUND Most studies on stroke have been designed to examine one deficit in isolation; yet, survivors often have multiple deficits in different domains. While the mechanisms underlying multiple-domain deficits remain poorly understood, network-theoretical methods may open new avenues of understanding. METHODS Fifty subacute stroke patients (7±3days poststroke) underwent diffusion-weighted magnetic resonance imaging and a battery of clinical tests of motor and cognitive functions. We defined indices of impairment in strength, dexterity, and attention. We also computed imaging-based probabilistic tractography and whole-brain connectomes. To efficiently integrate inputs from different sources, brain networks rely on a rich-club of a few hub nodes. Lesions harm efficiency, particularly when they target the rich-club. Overlaying individual lesion masks onto the tractograms enabled us to split the connectomes into their affected and unaffected parts and associate them to impairment. RESULTS We computed efficiency of the unaffected connectome and found it was more strongly correlated to impairment in strength, dexterity, and attention than efficiency of the total connectome. The magnitude of the correlation between efficiency and impairment followed the order attention>dexterity ≈ strength (strength: |r|=.03, P=0.02, dexterity: |r|=.30, P=0.05, attention: |r|=.55, P<0.001). Network weights associated with the rich-club were more strongly correlated to efficiency than non-rich-club weights. CONCLUSIONS Attentional impairment is more sensitive to disruption of coordinated networks between brain regions than motor impairment, which is sensitive to disruption of localized networks. Providing more accurate reflections of actually functioning parts of the network enables the incorporation of information about the impact of brain lesions on connectomics contributing to a better understanding of underlying stroke mechanisms.
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Affiliation(s)
- Giorgia G. Evangelista
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX), École polytechnique fédérale de Lausanne (EPFL), Geneva, Switzerland (G.G.E., P.E., J.B., E.B., M.C., L.F., A.C.-M., D.d.L.R., T.M., M.J.W., F.C.H.)
- Defitech Chair of Clinical Neuroengineering, INX, EPFL Valais, Clinique Romande de Réadaptation, Switzerland (G.G.E., P.E., J.B., E.B., M.C., L.F., A.C.-M., T.M., D.d.L.R., M.J.W., F.C.H.)
| | - Philip Egger
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX), École polytechnique fédérale de Lausanne (EPFL), Geneva, Switzerland (G.G.E., P.E., J.B., E.B., M.C., L.F., A.C.-M., D.d.L.R., T.M., M.J.W., F.C.H.)
- Defitech Chair of Clinical Neuroengineering, INX, EPFL Valais, Clinique Romande de Réadaptation, Switzerland (G.G.E., P.E., J.B., E.B., M.C., L.F., A.C.-M., T.M., D.d.L.R., M.J.W., F.C.H.)
| | - Julia Brügger
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX), École polytechnique fédérale de Lausanne (EPFL), Geneva, Switzerland (G.G.E., P.E., J.B., E.B., M.C., L.F., A.C.-M., D.d.L.R., T.M., M.J.W., F.C.H.)
- Defitech Chair of Clinical Neuroengineering, INX, EPFL Valais, Clinique Romande de Réadaptation, Switzerland (G.G.E., P.E., J.B., E.B., M.C., L.F., A.C.-M., T.M., D.d.L.R., M.J.W., F.C.H.)
| | - Elena Beanato
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX), École polytechnique fédérale de Lausanne (EPFL), Geneva, Switzerland (G.G.E., P.E., J.B., E.B., M.C., L.F., A.C.-M., D.d.L.R., T.M., M.J.W., F.C.H.)
- Defitech Chair of Clinical Neuroengineering, INX, EPFL Valais, Clinique Romande de Réadaptation, Switzerland (G.G.E., P.E., J.B., E.B., M.C., L.F., A.C.-M., T.M., D.d.L.R., M.J.W., F.C.H.)
| | - Philipp J. Koch
- Department of Neurology, University of Lübeck, Germany (P.J.K.)
- Center of Brain, Behavior and Metabolism, University of Lübeck, Germany (P.J.K.)
| | - Martino Ceroni
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX), École polytechnique fédérale de Lausanne (EPFL), Geneva, Switzerland (G.G.E., P.E., J.B., E.B., M.C., L.F., A.C.-M., D.d.L.R., T.M., M.J.W., F.C.H.)
- Defitech Chair of Clinical Neuroengineering, INX, EPFL Valais, Clinique Romande de Réadaptation, Switzerland (G.G.E., P.E., J.B., E.B., M.C., L.F., A.C.-M., T.M., D.d.L.R., M.J.W., F.C.H.)
| | - Lisa Fleury
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX), École polytechnique fédérale de Lausanne (EPFL), Geneva, Switzerland (G.G.E., P.E., J.B., E.B., M.C., L.F., A.C.-M., D.d.L.R., T.M., M.J.W., F.C.H.)
- Defitech Chair of Clinical Neuroengineering, INX, EPFL Valais, Clinique Romande de Réadaptation, Switzerland (G.G.E., P.E., J.B., E.B., M.C., L.F., A.C.-M., T.M., D.d.L.R., M.J.W., F.C.H.)
| | - Andéol Cadic-Melchior
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX), École polytechnique fédérale de Lausanne (EPFL), Geneva, Switzerland (G.G.E., P.E., J.B., E.B., M.C., L.F., A.C.-M., D.d.L.R., T.M., M.J.W., F.C.H.)
- Defitech Chair of Clinical Neuroengineering, INX, EPFL Valais, Clinique Romande de Réadaptation, Switzerland (G.G.E., P.E., J.B., E.B., M.C., L.F., A.C.-M., T.M., D.d.L.R., M.J.W., F.C.H.)
| | - Nathalie H. Meyer
- Laboratory of Cognitive Neuroscience, CNP and BMI, EPFL, Switzerland (N.H.M., D.d.L.R.)
| | - Diego de León Rodríguez
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX), École polytechnique fédérale de Lausanne (EPFL), Geneva, Switzerland (G.G.E., P.E., J.B., E.B., M.C., L.F., A.C.-M., D.d.L.R., T.M., M.J.W., F.C.H.)
- Defitech Chair of Clinical Neuroengineering, INX, EPFL Valais, Clinique Romande de Réadaptation, Switzerland (G.G.E., P.E., J.B., E.B., M.C., L.F., A.C.-M., T.M., D.d.L.R., M.J.W., F.C.H.)
- Laboratory of Cognitive Neuroscience, CNP and BMI, EPFL, Switzerland (N.H.M., D.d.L.R.)
- Department of Neurology, Hôpital du Valais, Switzerland (C.C., V.A., D.d.L.R., D.S.M., C.B.)
| | - Gabriel Girard
- Signal Processing Laboratory (LTS5), School of Engineering, EPFL, Switzerland (G.G.)
- Center for Biomedical Imaging (CIBM), Switzerland (G.G.)
- Department of Radiology, CHUV, Switzerland (G.G.)
| | - Bertrand Léger
- Clinique Romande de Réadaptation, Switzerland (B.L., A.M., P.V., J.-L.T.)
| | - Jean-Luc Turlan
- Clinique Romande de Réadaptation, Switzerland (B.L., A.M., P.V., J.-L.T.)
| | - Andreas Mühl
- Clinique Romande de Réadaptation, Switzerland (B.L., A.M., P.V., J.-L.T.)
| | - Philippe Vuadens
- Clinique Romande de Réadaptation, Switzerland (B.L., A.M., P.V., J.-L.T.)
| | | | | | - Christophe Constantin
- Department of Neurology, Hôpital du Valais, Switzerland (C.C., V.A., D.d.L.R., D.S.M., C.B.)
| | - Vincent Alvarez
- Department of Neurology, Hôpital du Valais, Switzerland (C.C., V.A., D.d.L.R., D.S.M., C.B.)
| | - Diego San Millán
- Department of Neurology, Hôpital du Valais, Switzerland (C.C., V.A., D.d.L.R., D.S.M., C.B.)
| | - Christophe Bonvin
- Department of Neurology, Hôpital du Valais, Switzerland (C.C., V.A., D.d.L.R., D.S.M., C.B.)
| | - Takuya Morishita
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX), École polytechnique fédérale de Lausanne (EPFL), Geneva, Switzerland (G.G.E., P.E., J.B., E.B., M.C., L.F., A.C.-M., D.d.L.R., T.M., M.J.W., F.C.H.)
- Defitech Chair of Clinical Neuroengineering, INX, EPFL Valais, Clinique Romande de Réadaptation, Switzerland (G.G.E., P.E., J.B., E.B., M.C., L.F., A.C.-M., T.M., D.d.L.R., M.J.W., F.C.H.)
| | - Maximilian J. Wessel
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX), École polytechnique fédérale de Lausanne (EPFL), Geneva, Switzerland (G.G.E., P.E., J.B., E.B., M.C., L.F., A.C.-M., D.d.L.R., T.M., M.J.W., F.C.H.)
- Defitech Chair of Clinical Neuroengineering, INX, EPFL Valais, Clinique Romande de Réadaptation, Switzerland (G.G.E., P.E., J.B., E.B., M.C., L.F., A.C.-M., T.M., D.d.L.R., M.J.W., F.C.H.)
- Department of Neurology, University Hospital Würzburg, Germany (M.J.W.)
| | - Dimitri Van De Ville
- Medical Image Processing Laboratory, Institute of Bioengineering, EPFL, Switzerland (D.V.D.V.)
- Department of Radiology and Medical Informatics, University of Geneva (UNIGE), Switzerland (D.V.D.V.)
| | - Friedhelm C. Hummel
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX), École polytechnique fédérale de Lausanne (EPFL), Geneva, Switzerland (G.G.E., P.E., J.B., E.B., M.C., L.F., A.C.-M., D.d.L.R., T.M., M.J.W., F.C.H.)
- Defitech Chair of Clinical Neuroengineering, INX, EPFL Valais, Clinique Romande de Réadaptation, Switzerland (G.G.E., P.E., J.B., E.B., M.C., L.F., A.C.-M., T.M., D.d.L.R., M.J.W., F.C.H.)
- Clinical Neuroscience, Geneva University Hospital (HUG), Switzerland (F.C.H.)
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3
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Bonkhoff AK, Schirmer MD, Bretzner M, Hong S, Regenhardt RW, Donahue KL, Nardin MJ, Dalca AV, Giese A, Etherton MR, Hancock BL, Mocking SJT, McIntosh EC, Attia J, Cole JW, Donatti A, Griessenauer CJ, Heitsch L, Holmegaard L, Jood K, Jimenez‐Conde J, Kittner SJ, Lemmens R, Levi CR, McDonough CW, Meschia JF, Phuah C, Ropele S, Rosand J, Roquer J, Rundek T, Sacco RL, Schmidt R, Sharma P, Slowik A, Sousa A, Stanne TM, Strbian D, Tatlisumak T, Thijs V, Vagal A, Wasselius J, Woo D, Zand R, McArdle PF, Worrall BB, Jern C, Lindgren AG, Maguire J, Wu O, Rost NS. The relevance of rich club regions for functional outcome post-stroke is enhanced in women. Hum Brain Mapp 2023; 44:1579-1592. [PMID: 36440953 PMCID: PMC9921242 DOI: 10.1002/hbm.26159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/24/2022] [Accepted: 11/11/2022] [Indexed: 11/30/2022] Open
Abstract
This study aimed to investigate the influence of stroke lesions in predefined highly interconnected (rich-club) brain regions on functional outcome post-stroke, determine their spatial specificity and explore the effects of biological sex on their relevance. We analyzed MRI data recorded at index stroke and ~3-months modified Rankin Scale (mRS) data from patients with acute ischemic stroke enrolled in the multisite MRI-GENIE study. Spatially normalized structural stroke lesions were parcellated into 108 atlas-defined bilateral (sub)cortical brain regions. Unfavorable outcome (mRS > 2) was modeled in a Bayesian logistic regression framework. Effects of individual brain regions were captured as two compound effects for (i) six bilateral rich club and (ii) all further non-rich club regions. In spatial specificity analyses, we randomized the split into "rich club" and "non-rich club" regions and compared the effect of the actual rich club regions to the distribution of effects from 1000 combinations of six random regions. In sex-specific analyses, we introduced an additional hierarchical level in our model structure to compare male and female-specific rich club effects. A total of 822 patients (age: 64.7[15.0], 39% women) were analyzed. Rich club regions had substantial relevance in explaining unfavorable functional outcome (mean of posterior distribution: 0.08, area under the curve: 0.8). In particular, the rich club-combination had a higher relevance than 98.4% of random constellations. Rich club regions were substantially more important in explaining long-term outcome in women than in men. All in all, lesions in rich club regions were associated with increased odds of unfavorable outcome. These effects were spatially specific and more pronounced in women.
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Affiliation(s)
- Anna K. Bonkhoff
- J. Philip Kistler Stroke Research CenterMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Markus D. Schirmer
- J. Philip Kistler Stroke Research CenterMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Martin Bretzner
- J. Philip Kistler Stroke Research CenterMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Univ. Lille, Inserm, CHU Lille, U1171 – LilNCog (JPARC) – Lille Neurosciences & CognitionLilleFrance
| | - Sungmin Hong
- J. Philip Kistler Stroke Research CenterMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Robert W. Regenhardt
- J. Philip Kistler Stroke Research CenterMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Kathleen L. Donahue
- J. Philip Kistler Stroke Research CenterMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Marco J. Nardin
- J. Philip Kistler Stroke Research CenterMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Adrian V. Dalca
- Computer Science and Artificial Intelligence LabMassachusetts Institute of TechnologyBostonMassachusettsUSA
- Athinoula A. Martinos Center for Biomedical Imaging, Department of RadiologyMassachusetts General HospitalCharlestownMassachusettsUSA
| | - Anne‐Katrin Giese
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Mark R. Etherton
- J. Philip Kistler Stroke Research CenterMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Brandon L. Hancock
- Athinoula A. Martinos Center for Biomedical Imaging, Department of RadiologyMassachusetts General HospitalCharlestownMassachusettsUSA
| | - Steven J. T. Mocking
- Athinoula A. Martinos Center for Biomedical Imaging, Department of RadiologyMassachusetts General HospitalCharlestownMassachusettsUSA
| | - Elissa C. McIntosh
- Department of PsychiatryJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - John Attia
- Hunter Medical Research InstituteNewcastleNew South WalesAustralia
- School of Medicine and Public HealthUniversity of NewcastleNewcastleNew South WalesAustralia
| | - John W. Cole
- Department of NeurologyUniversity of Maryland School of Medicine and Veterans Affairs Maryland Health Care SystemBaltimoreMarylandUSA
| | - Amanda Donatti
- School of Medical SciencesUniversity of Campinas (UNICAMP) and the Brazilian Institute of Neuroscience and Neurotechnology (BRAINN)CampinasSão PauloBrazil
| | - Christoph J. Griessenauer
- Department of NeurosurgeryGeisingerDanvillePennsylvaniaUSA
- Research Institute of NeurointerventionParacelsus Medical UniversitySalzburgAustria
| | - Laura Heitsch
- Department of Emergency MedicineWashington University School of MedicineSt LouisMissouriUSA
- Department of NeurologyWashington University School of Medicine & Barnes‐Jewish HospitalSt LouisMissouriUSA
| | - Lukas Holmegaard
- Department of Clinical NeuroscienceInstitute of Neuroscience and Physiology, Sahlgrenska Academy, University of GothenburgGothenburgSweden
- Department of NeurologySahlgrenska University HospitalGothenburgSweden
| | - Katarina Jood
- Department of Clinical NeuroscienceInstitute of Neuroscience and Physiology, Sahlgrenska Academy, University of GothenburgGothenburgSweden
- Department of NeurologySahlgrenska University HospitalGothenburgSweden
| | - Jordi Jimenez‐Conde
- Department of Neurology, Neurovascular Research Group (NEUVAS), IMIM‐Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques). Department of Medicine and Life Sciences (MELIS)Universitat Pompeu FabraBarcelonaSpain
| | - Steven J. Kittner
- Department of NeurologyUniversity of Maryland School of Medicine and Veterans Affairs Maryland Health Care SystemBaltimoreMarylandUSA
| | - Robin Lemmens
- Department of NeurosciencesKU Leuven – University of Leuven, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND)LeuvenBelgium
- Department of Neurology, VIB, Vesalius Research CenterLaboratory of Neurobiology, University Hospitals LeuvenLeuvenBelgium
| | - Christopher R. Levi
- School of Medicine and Public HealthUniversity of NewcastleNewcastleNew South WalesAustralia
- Department of NeurologyJohn Hunter HospitalNewcastleNew South WalesAustralia
| | - Caitrin W. McDonough
- Department of Pharmacotherapy and Translational Research and Center for PharmacogenomicsUniversity of FloridaGainesvilleFloridaUSA
| | | | - Chia‐Ling Phuah
- Department of NeurologyWashington University School of Medicine & Barnes‐Jewish HospitalSt LouisMissouriUSA
| | - Stefan Ropele
- Department of Neurology, Clinical Division of NeurogeriatricsMedical University GrazGrazAustria
| | - Jonathan Rosand
- J. Philip Kistler Stroke Research CenterMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Athinoula A. Martinos Center for Biomedical Imaging, Department of RadiologyMassachusetts General HospitalCharlestownMassachusettsUSA
- Henry and Allison McCance Center for Brain HealthMassachusetts General HospitalBostonMassachusettsUSA
| | - Jaume Roquer
- Department of Neurology, Neurovascular Research Group (NEUVAS), IMIM‐Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques). Department of Medicine and Life Sciences (MELIS)Universitat Pompeu FabraBarcelonaSpain
| | - Tatjana Rundek
- Department of Neurology and Evelyn F. McKnight Brain Institute, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | - Ralph L. Sacco
- Department of Neurology and Evelyn F. McKnight Brain Institute, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | - Reinhold Schmidt
- Department of Neurology, Clinical Division of NeurogeriatricsMedical University GrazGrazAustria
| | - Pankaj Sharma
- Institute of Cardiovascular Research, Royal Holloway University of London (ICR2UL)EghamUK
- St Peter's and Ashford HospitalsAshfordUK
| | - Agnieszka Slowik
- Department of NeurologyJagiellonian University Medical CollegeKrakowPoland
| | - Alessandro Sousa
- School of Medical SciencesUniversity of Campinas (UNICAMP) and the Brazilian Institute of Neuroscience and Neurotechnology (BRAINN)CampinasSão PauloBrazil
| | - Tara M. Stanne
- Department of Laboratory Medicine, Institute of Biomedicine, the Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Daniel Strbian
- Department of NeurologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Turgut Tatlisumak
- Department of Clinical NeuroscienceInstitute of Neuroscience and Physiology, Sahlgrenska Academy, University of GothenburgGothenburgSweden
- Department of NeurologySahlgrenska University HospitalGothenburgSweden
| | - Vincent Thijs
- Stroke DivisionFlorey Institute of Neuroscience and Mental HealthHeidelbergAustralia
- Department of NeurologyAustin HealthHeidelbergAustralia
| | - Achala Vagal
- Department of RadiologyUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Johan Wasselius
- Department of Clinical Sciences Lund, RadiologyLund UniversityLundSweden
- Department of Radiology, NeuroradiologySkåne University HospitalLundSweden
| | - Daniel Woo
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Ramin Zand
- Department of NeurologyPennsylvania State UniversityHersheyPennsylvaniaUSA
| | - Patrick F. McArdle
- Division of Endocrinology, Diabetes and Nutrition, Department of MedicineUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Bradford B. Worrall
- Departments of Neurology and Public Health SciencesUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Christina Jern
- Department of NeurologyJagiellonian University Medical CollegeKrakowPoland
- Department of Clinical Genetics and GenomicsSahlgrenska University HospitalGothenburgSweden
| | - Arne G. Lindgren
- Department of NeurologySkåne University HospitalLundSweden
- Department of Clinical Sciences Lund, NeurologyLund UniversityLundSweden
| | | | - Ona Wu
- Athinoula A. Martinos Center for Biomedical Imaging, Department of RadiologyMassachusetts General HospitalCharlestownMassachusettsUSA
| | - Natalia S. Rost
- J. Philip Kistler Stroke Research CenterMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
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4
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Schlemm E, Jensen M, Kuceyeski A, Jamison K, Ingwersen T, Mayer C, Königsberg A, Boutitie F, Ebinger M, Endres M, Fiebach JB, Fiehler J, Galinovic I, Lemmens R, Muir KW, Nighoghossian N, Pedraza S, Puig J, Simonsen CZ, Thijs V, Wouters A, Gerloff C, Thomalla G, Cheng B. Early effect of thrombolysis on structural brain network organisation after anterior‐circulation stroke in the randomized
WAKE‐UP
trial. Hum Brain Mapp 2022; 43:5053-5065. [PMID: 36102287 PMCID: PMC9582379 DOI: 10.1002/hbm.26073] [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: 05/08/2022] [Revised: 07/11/2022] [Accepted: 08/22/2022] [Indexed: 11/08/2022] Open
Abstract
The symptoms of acute ischemic stroke can be attributed to disruption of the brain network architecture. Systemic thrombolysis is an effective treatment that preserves structural connectivity in the first days after the event. Its effect on the evolution of global network organisation is, however, not well understood. We present a secondary analysis of 269 patients from the randomized WAKE‐UP trial, comparing 127 imaging‐selected patients treated with alteplase with 142 controls who received placebo. We used indirect network mapping to quantify the impact of ischemic lesions on structural brain network organisation in terms of both global parameters of segregation and integration, and local disruption of individual connections. Network damage was estimated before randomization and again 22 to 36 h after administration of either alteplase or placebo. Evolution of structural network organisation was characterised by a loss in integration and gain in segregation, and this trajectory was attenuated by the administration of alteplase. Preserved brain network organization was associated with excellent functional outcome. Furthermore, the protective effect of alteplase was spatio‐topologically nonuniform, concentrating on a subnetwork of high centrality supported in the salvageable white matter surrounding the ischemic cores. This interplay between the location of the lesion, the pathophysiology of the ischemic penumbra, and the spatial embedding of the brain network explains the observed potential of thrombolysis to attenuate topological network damage early after stroke. Our findings might, in the future, lead to new brain network‐informed imaging biomarkers and improved prognostication in ischemic stroke.
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Affiliation(s)
- Eckhard Schlemm
- Klinik und Poliklinik für Neurologie, Kopf‐ und Neurozentrum University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Märit Jensen
- Klinik und Poliklinik für Neurologie, Kopf‐ und Neurozentrum University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Amy Kuceyeski
- Department of Radiology Weill Cornell Medicine New York New York USA
| | - Keith Jamison
- Department of Radiology Weill Cornell Medicine New York New York USA
| | - Thies Ingwersen
- Klinik und Poliklinik für Neurologie, Kopf‐ und Neurozentrum University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Carola Mayer
- Klinik und Poliklinik für Neurologie, Kopf‐ und Neurozentrum University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Alina Königsberg
- Klinik und Poliklinik für Neurologie, Kopf‐ und Neurozentrum University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Florent Boutitie
- Department of Radiology Weill Cornell Medicine New York New York USA
- Hospices Civils de Lyon, Service de Biostatistique Lyon France
- Université Lyon 1 Villeurbanne France
- CNRS, UMR 5558 Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique‐Santé Villeurbanne France
| | - Martin Ebinger
- Centrum für Schlaganfallforschung Berlin (CSB) Charité ‐ Universitätsmedizin Berlin Berlin Germany
- Klinik für Neurologie Medical Park Berlin Humboldtmühle Berlin Germany
| | - Matthias Endres
- Centrum für Schlaganfallforschung Berlin (CSB) Charité ‐ Universitätsmedizin Berlin Berlin Germany
- Klinik und Hochschulambulanz für Neurologie Charité‐Universitätsmedizin Berlin Berlin Germany
- German Centre for Neurodegenerative Diseases (DZNE) Berlin Germany
- German Centre for Cardiovascular Research (DZHK) Berlin Germany
- ExcellenceCluster NeuroCure Berlin Germany
| | - Jochen B. Fiebach
- Centrum für Schlaganfallforschung Berlin (CSB) Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Ivana Galinovic
- Centrum für Schlaganfallforschung Berlin (CSB) Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - Robin Lemmens
- Department of Neurology University Hospitals Leuven Leuven Belgium
- Department of Neurosciences Division of Experimental Neurology KU Leuven—University of Leuven Leuven Belgium
- VIB, Centre for Brain & Disease Research Laboratory of Neurobiology Leuven Belgium
| | - Keith W. Muir
- Institute of Neuroscience & Psychology University of Glasgow Glasgow UK
| | - Norbert Nighoghossian
- Department of Stroke Medicine, Université Claude Bernard Lyon 1 CREATIS CNRS UMR 5220‐INSERM U1206, INSA‐Lyon Lyon France
| | - Salvador Pedraza
- Department of Radiology, Institut de Diagnostic per la Image (IDI) Hospital Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona (IDIBGI) Girona Spain
| | - Josep Puig
- Department of Radiology, Institut de Diagnostic per la Image (IDI) Hospital Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona (IDIBGI) Girona Spain
| | | | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health University of Melbourne Heidelberg Victoria Australia
- Department of Neurology Austin Health Heidelberg Victoria Australia
| | - Anke Wouters
- Department of Neurology University Hospitals Leuven Leuven Belgium
- Department of Neurosciences Division of Experimental Neurology KU Leuven—University of Leuven Leuven Belgium
- VIB, Centre for Brain & Disease Research Laboratory of Neurobiology Leuven Belgium
- Department of Neurology Amsterdam UMC University of Amsterdam Amsterdam Netherlands
| | - Christian Gerloff
- Klinik und Poliklinik für Neurologie, Kopf‐ und Neurozentrum University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Kopf‐ und Neurozentrum University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Bastian Cheng
- Klinik und Poliklinik für Neurologie, Kopf‐ und Neurozentrum University Medical Centre Hamburg‐Eppendorf Hamburg Germany
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5
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Kolskår KK, Ulrichsen KM, Richard G, Dørum ES, de Schotten MT, Rokicki J, Monereo-Sánchez J, Engvig A, Hansen HI, Nordvik JE, Westlye LT, Alnaes D. Structural disconnectome mapping of cognitive function in poststroke patients. Brain Behav 2022; 12:e2707. [PMID: 35861657 PMCID: PMC9392540 DOI: 10.1002/brb3.2707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/19/2022] [Accepted: 06/25/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND AND PURPOSE Sequalae following stroke represents a significant challenge in current rehabilitation. The location and size of focal lesions are only moderately predictive of the diverse cognitive outcome after stroke. One explanation building on recent work on brain networks proposes that the cognitive consequences of focal lesions are caused by damages to anatomically distributed brain networks supporting cognition rather than specific lesion locations. METHODS To investigate the association between poststroke structural disconnectivity and cognitive performance, we estimated individual level whole-brain disconnectivity probability maps based on lesion maps from 102 stroke patients using normative data from healthy controls. Cognitive performance was assessed in the whole sample using Montreal Cognitive Assessment, and a more comprehensive computerized test protocol was performed on a subset (n = 82). RESULTS Multivariate analysis using Partial Least Squares on the disconnectome maps revealed that higher disconnectivity in right insular and frontal operculum, superior temporal gyrus and putamen was associated with poorer MoCA performance, indicating that lesions in regions connected with these brain regions are more likely to cause cognitive impairment. Furthermore, our results indicated that disconnectivity within these clusters was associated with poorer performance across multiple cognitive domains. CONCLUSIONS These findings demonstrate that the extent and distribution of structural disconnectivity following stroke are sensitive to cognitive deficits and may provide important clinical information predicting poststroke cognitive sequalae.
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Affiliation(s)
- Knut K Kolskår
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway.,Sunnaas Rehabilitation Hospital HT, Nesodden, Norway
| | - Kristine M Ulrichsen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway.,Sunnaas Rehabilitation Hospital HT, Nesodden, Norway
| | - Genevieve Richard
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Erlend S Dørum
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway.,Sunnaas Rehabilitation Hospital HT, Nesodden, Norway
| | - Michel Thiebaut de Schotten
- Brain Connectivity and Behaviour Laboratory, Sorbonne Universities, Paris, France.,Groupe d'Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives-UMR 5293, CNRS, CEA University of Bordeaux, Bordeaux, France
| | - Jaroslav Rokicki
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway.,Centre of Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Jennifer Monereo-Sánchez
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, the Netherlands
| | - Andreas Engvig
- Department of Nephrology, Oslo University Hospital, Ullevål, Norway.,Department of Medicine, Diakonhjemmet Hospital, Oslo, Norway
| | | | - Jan Egil Nordvik
- CatoSenteret Rehabilitation Center, Son, Norway.,Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Lars T Westlye
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway.,KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
| | - Dag Alnaes
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Bjørknes College, Oslo, Norway
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6
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Li F, Liu Y, Lu L, Shang S, Chen H, Haidari NA, Wang P, Yin X, Chen YC. Rich-club reorganization of functional brain networks in acute mild traumatic brain injury with cognitive impairment. Quant Imaging Med Surg 2022; 12:3932-3946. [PMID: 35782237 PMCID: PMC9246720 DOI: 10.21037/qims-21-915] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/30/2022] [Indexed: 06/12/2024]
Abstract
BACKGROUND Mild traumatic brain injury (mTBI) is typically characterized by temporally limited cognitive impairment and regarded as a brain connectome disorder. Recent findings have suggested that a higher level of organization named the "rich-club" may play a central role in enabling the integration of information and efficient communication across different systems of the brain. However, the alterations in rich-club organization and hub topology in mTBI and its relationship with cognitive impairment after mTBI have been scarcely elucidated. METHODS Resting-state functional magnetic resonance imaging (rs-fMRI) data were collected from 88 patients with mTBI and 85 matched healthy controls (HCs). Large-scale functional brain networks were established for each participant. Rich-club organizations and network properties were assessed and analyzed between groups. Finally, we analyzed the correlations between the cognitive performance and changes in rich-club organization and network properties. RESULTS Both mTBI and HCs groups showed significant rich-club organization. Meanwhile, the rich-club organization was aberrant, with enhanced functional connectivity (FC) among rich-club nodes and peripheral regions in acute mTBI. In addition, significant differences in partial global and local network topological property measures were found between mTBI patients and HCs (P<0.01). In patients with mTBI, changes in rich-club organization and network properties were found to be related to early cognitive impairment after mTBI (P<0.05). CONCLUSIONS Our findings suggest that such patterns of disruption and reorganization will provide the basic functional architecture for cognitive function, which may subsequently be used as an earlier biomarker for cognitive impairment after mTBI.
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Affiliation(s)
| | | | - Liyan Lu
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Song’an Shang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Huiyou Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Nasir Ahmad Haidari
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Peng Wang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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7
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Huang Q, Lin D, Huang S, Cao Y, Jin Y, Wu B, Fan L, Tu W, Huang L, Jiang S. Brain Functional Topology Alteration in Right Lateral Occipital Cortex Is Associated With Upper Extremity Motor Recovery. Front Neurol 2022; 13:780966. [PMID: 35309550 PMCID: PMC8927543 DOI: 10.3389/fneur.2022.780966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/17/2022] [Indexed: 12/02/2022] Open
Abstract
Stroke is a chief cause of sudden brain damage that severely disrupts the whole-brain network. However, the potential mechanisms of motor recovery after stroke are uncertain and the prognosis of poststroke upper extremity recovery is still a challenge. This study investigated the global and local topological properties of the brain functional connectome in patients with subacute ischemic stroke and their associations with the clinical measurements. A total of 57 patients, consisting of 29 left-sided and 28 right-sided stroke patients, and 32 age- and gender-matched healthy controls (HCs) were recruited to undergo a resting-state functional magnetic resonance imaging (rs-fMRI) study; patients were also clinically evaluated with the Upper Extremity Fugl-Meyer Assessment (FMA_UE). The assessment was repeated at 15 weeks to assess upper extremity functional recovery for the patient remaining in the study (12 left- 20 right-sided stroke patients). Global graph topological disruption indices of stroke patients were significantly decreased compared with HCs but these indices were not significantly associated with FMA_UE. In addition, local brain network structure of stroke patients was altered, and the altered regions were dependent on the stroke site. Significant associations between local degree and motor performance and its recovery were observed in the right lateral occipital cortex (R LOC) in the right-sided stroke patients. Our findings suggested that brain functional topologies alterations in R LOC are promising as prognostic biomarkers for right-sided subacute stroke. This cortical area might be a potential target to be further validated for non-invasive brain stimulation treatment to improve poststroke upper extremity recovery.
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Affiliation(s)
- Qianqian Huang
- Rehabilitation Medicine Center, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Intelligent Rehabilitation Research Center, China-USA Institute for Acupuncture and Rehabilitation, Wenzhou Medical University, Wenzhou, China
| | - Dinghong Lin
- Rehabilitation Medicine Center, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Intelligent Rehabilitation Research Center, China-USA Institute for Acupuncture and Rehabilitation, Wenzhou Medical University, Wenzhou, China
| | - Shishi Huang
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yungang Cao
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yun Jin
- Rehabilitation Medicine Center, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Intelligent Rehabilitation Research Center, China-USA Institute for Acupuncture and Rehabilitation, Wenzhou Medical University, Wenzhou, China
| | - Bo Wu
- Department of Information, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Linyu Fan
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wenzhan Tu
- Rehabilitation Medicine Center, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Intelligent Rehabilitation Research Center, China-USA Institute for Acupuncture and Rehabilitation, Wenzhou Medical University, Wenzhou, China
| | - Lejian Huang
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- *Correspondence: Lejian Huang
| | - Songhe Jiang
- Rehabilitation Medicine Center, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Intelligent Rehabilitation Research Center, China-USA Institute for Acupuncture and Rehabilitation, Wenzhou Medical University, Wenzhou, China
- Songhe Jiang
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8
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Liu F, Chen C, Hong W, Bai Z, Wang S, Lu H, Lin Q, Zhao Z, Tang C. Selectively disrupted sensorimotor circuits in chronic stroke with hand dysfunction. CNS Neurosci Ther 2022; 28:677-689. [PMID: 35005843 PMCID: PMC8981435 DOI: 10.1111/cns.13799] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 12/24/2022] Open
Abstract
Aim To investigate the directional and selective disconnection of the sensorimotor cortex (SMC) subregions in chronic stroke patients with hand dysfunction. Methods We mapped the resting‐state fMRI effective connectivity (EC) patterns for seven SMC subregions in each hemisphere of 65 chronic stroke patients and 40 healthy participants and correlated these patterns with paretic hand performance. Results Compared with controls, patients demonstrated disrupted EC in the ipsilesional primary motor cortex_4p, ipsilesional primary somatosensory cortex_2 (PSC_2), and contralesional PSC_3a. Moreover, we found that EC values of the contralesional PSC_1 to contralesional precuneus, the ipsilesional inferior temporal gyrus to ipsilesional PSC_1, and the ipsilesional PSC_1 to contralesional postcentral gyrus were correlated with paretic hand performance across all patients. We further divided patients into partially (PPH) and completely (CPH) paretic hand subgroups. Compared with CPH patients, PPH patients demonstrated decreased EC in the ipsilesional premotor_6 and ipsilesional PSC_1. Interestingly, we found that paretic hand performance was positively correlated with seven sensorimotor circuits in PPH patients, while it was negatively correlated with five sensorimotor circuits in CPH patients. Conclusion SMC neurocircuitry was selectively disrupted after chronic stroke and associated with diverse hand outcomes, which deepens the understanding of SMC reorganization.
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Affiliation(s)
- FeiWen Liu
- Department of Rehabilitation Medicine, Chengdu Second People's Hospital, Chengdu, China
| | - ChangCheng Chen
- Department of Rehabilitation Medicine, Qingtian People's Hospital, Lishui, China
| | - WenJun Hong
- Department of Rehabilitation Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - ZhongFei Bai
- Yangzhi Rehabilitation Hospital Affiliated to Tongji University (Shanghai Sunshine Rehabilitation Center), Shanghai, China
| | - SiZhong Wang
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, The University of Otago, Dunedin, New Zealand
| | - HanNa Lu
- Neuromodulation Laboratory, Department of Psychiatry, School of Medicine, The Chinese University of Hong Kong, HKSAR, China.,Guangzhou Brain Hospital, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - QiXiang Lin
- Department of Neurology, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - ZhiYong Zhao
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
| | - ChaoZheng Tang
- Capacity Building and Continuing Education Center, National Health Commission of the People's Republic of China, Beijing, China
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9
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Nemati PR, Backhaus W, Feldheim J, Bönstrup M, Cheng B, Thomalla G, Gerloff C, Schulz R. OUP accepted manuscript. Brain Commun 2022; 4:fcac049. [PMID: 35274100 PMCID: PMC8905614 DOI: 10.1093/braincomms/fcac049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/10/2021] [Accepted: 02/21/2022] [Indexed: 11/17/2022] Open
Abstract
Analyses of alterations of brain networks have gained an increasing interest in stroke rehabilitation research. Compared with functional networks derived from resting-state analyses, there is limited knowledge of how structural network topology might undergo changes after stroke and, more importantly, if structural network information obtained early after stroke could enhance recovery models to infer later outcomes. The present work re-analysed cross-sectional structural imaging data, obtained within the first 2 weeks, of 45 acute stroke patients (22 females, 24 right-sided strokes, age 68 ± 13 years). Whole-brain tractography was performed to reconstruct structural connectomes and graph-theoretical analyses were employed to quantify global network organization with a focus on parameters of network integration and modular processing. Graph measures were compared between stroke patients and 34 healthy controls (15 females, aged 69 ± 10 years) and they were integrated with four clinical scores of the late subacute stage, covering neurological symptom burden (National Institutes of Health Stroke Scale), global disability (modified Rankin Scale), activity-related disability (Barthel Index) and motor functions (Upper-Extremity Score of the Fugl-Meyer Assessment). The analyses were employed across the complete cohort and, based on clustering analysis, separately within subgroups stratified in mild to moderate (n = 21) and severe (n = 24) initial deficits. The main findings were (i) a significant reduction of network’s global efficiency, specifically in patients with severe deficits compared with controls (P = 0.010) and (ii) a significant negative correlation of network efficiency with the extent of persistent functional deficits at follow-up after 3–6 months (P ≤ 0.032). Specifically, regression models revealed that this measure was capable to increase the explained variance in future deficits by 18% for the modified Rankin Scale, up to 24% for National Institutes of Health Stroke Scale, and 16% for Barthel Index when compared with models including the initial deficits and the lesion volume. Patients with mild to moderate deficits did not exhibit a similar impact of network efficiency on outcome inference. Clustering coefficient and modularity, measures of segregation and modular processing, did not exhibit comparable structure–outcome relationships, neither in severely nor in mildly affected patients. This study provides empirical evidence that structural network efficiency as a graph-theoretical marker of large-scale network topology, quantified early after stroke, relates to recovery. Notably, this contribution was only evident in severely but not mildly affected stroke patients. This suggests that the initial clinical deficit might shape the dependency of recovery on global network topology after stroke.
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Affiliation(s)
- Paul R. Nemati
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Winifried Backhaus
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Jan Feldheim
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Marlene Bönstrup
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
- Department of Neurology, University Medical Center, 04103 Leipzig, Germany
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Robert Schulz
- Correspondence to: Robert Schulz, MD University Medical Center Hamburg-Eppendorf Martinistraße 52, 20246 Hamburg, Germany E-mail:
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10
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Bonkhoff AK, Schirmer MD, Bretzner M, Etherton M, Donahue K, Tuozzo C, Nardin M, Giese A, Wu O, D. Calhoun V, Grefkes C, Rost NS. Abnormal dynamic functional connectivity is linked to recovery after acute ischemic stroke. Hum Brain Mapp 2021; 42:2278-2291. [PMID: 33650754 PMCID: PMC8046120 DOI: 10.1002/hbm.25366] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 12/30/2022] Open
Abstract
The aim of the current study was to explore the whole-brain dynamic functional connectivity patterns in acute ischemic stroke (AIS) patients and their relation to short and long-term stroke severity. We investigated resting-state functional MRI-based dynamic functional connectivity of 41 AIS patients two to five days after symptom onset. Re-occurring dynamic connectivity configurations were obtained using a sliding window approach and k-means clustering. We evaluated differences in dynamic patterns between three NIHSS-stroke severity defined groups (mildly, moderately, and severely affected patients). Furthermore, we built Bayesian hierarchical models to evaluate the predictive capacity of dynamic connectivity and examine the interrelation with clinical measures, such as white matter hyperintensity lesions. Finally, we established correlation analyses between dynamic connectivity and AIS severity as well as 90-day neurological recovery (ΔNIHSS). We identified three distinct dynamic connectivity configurations acutely post-stroke. More severely affected patients spent significantly more time in a configuration that was characterized by particularly strong connectivity and isolated processing of functional brain domains (three-level ANOVA: p < .05, post hoc t tests: p < .05, FDR-corrected). Configuration-specific time estimates possessed predictive capacity of stroke severity in addition to the one of clinical measures. Recovery, as indexed by the realized change of the NIHSS over time, was significantly linked to the dynamic connectivity between bilateral intraparietal lobule and left angular gyrus (Pearson's r = -.68, p = .003, FDR-corrected). Our findings demonstrate transiently increased isolated information processing in multiple functional domains in case of severe AIS. Dynamic connectivity involving default mode network components significantly correlated with recovery in the first 3 months poststroke.
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Affiliation(s)
- Anna K. Bonkhoff
- J. Philip Kistler Stroke Research CenterMassachusetts General HospitalBostonMassachusettsUSA
- Cognitive NeuroscienceInstitute of Neuroscience and Medicine (INM‐3), Research Centre JuelichJuelichGermany
| | - Markus D. Schirmer
- J. Philip Kistler Stroke Research CenterMassachusetts General HospitalBostonMassachusettsUSA
- Department of Population Health SciencesGerman Centre for Neurodegenerative Diseases (DZNE)Germany
| | - Martin Bretzner
- J. Philip Kistler Stroke Research CenterMassachusetts General HospitalBostonMassachusettsUSA
- Neurosciences and CognitionUniversity of LilleLilleFrance
| | - Mark Etherton
- J. Philip Kistler Stroke Research CenterMassachusetts General HospitalBostonMassachusettsUSA
| | - Kathleen Donahue
- J. Philip Kistler Stroke Research CenterMassachusetts General HospitalBostonMassachusettsUSA
| | - Carissa Tuozzo
- J. Philip Kistler Stroke Research CenterMassachusetts General HospitalBostonMassachusettsUSA
| | - Marco Nardin
- J. Philip Kistler Stroke Research CenterMassachusetts General HospitalBostonMassachusettsUSA
| | - Anne‐Katrin Giese
- J. Philip Kistler Stroke Research CenterMassachusetts General HospitalBostonMassachusettsUSA
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Ona Wu
- Athinoula A. Martinos Center for Biomedical Imaging, Department of RadiologyMassachusetts General HospitalCharlestownMassachusettsUSA
| | - Vince D. Calhoun
- Tri‐institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of TechnologyEmory UniversityAtlantaGeorgiaUSA
| | - Christian Grefkes
- Cognitive NeuroscienceInstitute of Neuroscience and Medicine (INM‐3), Research Centre JuelichJuelichGermany
- Department of NeurologyUniversity Hospital CologneCologneGermany
| | - Natalia S. Rost
- J. Philip Kistler Stroke Research CenterMassachusetts General HospitalBostonMassachusettsUSA
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11
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Egger P, Evangelista GG, Koch PJ, Park CH, Levin-Gleba L, Girard G, Beanato E, Lee J, Choirat C, Guggisberg AG, Kim YH, Hummel FC. Disconnectomics of the Rich Club Impacts Motor Recovery After Stroke. Stroke 2021; 52:2115-2124. [PMID: 33902299 DOI: 10.1161/strokeaha.120.031541] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Structural brain networks possess a few hubs, which are not only highly connected to the rest of the brain but are also highly connected to each other. These hubs, which form a rich-club, play a central role in global brain organization. To investigate whether the concept of rich-club sheds new light on poststroke recovery, we applied a novel network-theoretical quantification of lesions to patients with stroke and compared the outcomes with what lesion size alone would indicate. METHODS Whole-brain structural networks of 73 patients with ischemic stroke were reconstructed using diffusion-weighted imaging data. Disconnectomes, a new type of network analyses, were constructed using only those fibers that pass through the lesion. Fugl-Meyer upper extremity scores and their changes were used to determine whether the patients show natural recovery or not. RESULTS Cluster analysis revealed 3 patient clusters: small-lesion-good-recovery, midsized-lesion-poor-recovery (MLPR), and large-lesion-poor-recovery (LLPR). The small-lesion-good-recovery consisted of subjects whose lesions were small, and whose prospects for recovery were relatively good. To explain the nondifference in recovery between the MLPR and LLPR clusters despite the difference (LLPR>MLPR) in lesion volume, we defined the [Formula: see text] metric to be the sum of the entries in the disconnectome and, more importantly, the [Formula: see text] to be the sum of all entries in the disconnectome corresponding to edges with at least one node in the rich-club. Unlike lesion volume and corticospinal tract damage (MLPR<LLPR), for [Formula: see text], this relationship was reversed (MLPR>LLPR) or showed no difference for [Formula: see text]. CONCLUSIONS Smaller lesions that focus on the rich-club can be just as devastating as much larger lesions that do not focus on the rich-club, pointing to the role of the rich-club as a backbone for functional communication within brain networks and for recovery from stroke.
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Affiliation(s)
- Philip Egger
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland (P.E., G.G.E., P.J.K., C.-H.P., E.B., F.C.H.).,Defitech Chair of Clinical Neuroengineering, CNP and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland (P.E., G.G.E., P.J.K., C.-H.P., E.B., F.C.H.)
| | - Giorgia G Evangelista
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland (P.E., G.G.E., P.J.K., C.-H.P., E.B., F.C.H.).,Defitech Chair of Clinical Neuroengineering, CNP and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland (P.E., G.G.E., P.J.K., C.-H.P., E.B., F.C.H.)
| | - Philipp J Koch
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland (P.E., G.G.E., P.J.K., C.-H.P., E.B., F.C.H.).,Defitech Chair of Clinical Neuroengineering, CNP and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland (P.E., G.G.E., P.J.K., C.-H.P., E.B., F.C.H.).,Department of Neurology, University of Lübeck, Germany (P.J.K.)
| | - Chang-Hyun Park
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland (P.E., G.G.E., P.J.K., C.-H.P., E.B., F.C.H.).,Defitech Chair of Clinical Neuroengineering, CNP and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland (P.E., G.G.E., P.J.K., C.-H.P., E.B., F.C.H.)
| | - Laura Levin-Gleba
- Swiss Data Science Center, EPFL, Lausanne, Switzerland (L.L.-G., C.C.)
| | - Gabriel Girard
- Signal Processing Laboratory, School of Engineering, EPFL, Lausanne, Switzerland (G.G.).,Center for Biomedical Imaging, Lausanne, Switzerland (G.G.).,Radiology Department, Lausanne University Hospital, Switzerland (G.G.)
| | - Elena Beanato
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland (P.E., G.G.E., P.J.K., C.-H.P., E.B., F.C.H.).,Defitech Chair of Clinical Neuroengineering, CNP and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland (P.E., G.G.E., P.J.K., C.-H.P., E.B., F.C.H.)
| | - Jungsoo Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.L., Y.-H.K.)
| | - Christine Choirat
- Swiss Data Science Center, EPFL, Lausanne, Switzerland (L.L.-G., C.C.)
| | - Adrian G Guggisberg
- Department of Clinical Neurosciences, Geneva University Hospital, Switzerland (A.G.G., F.C.H.)
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.L., Y.-H.K.).,Department of Health Sciences and Technology, Department of Medical Device Management & Research, Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea (Y.-H.K.)
| | - Friedhelm C Hummel
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland (P.E., G.G.E., P.J.K., C.-H.P., E.B., F.C.H.).,Defitech Chair of Clinical Neuroengineering, CNP and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland (P.E., G.G.E., P.J.K., C.-H.P., E.B., F.C.H.).,Department of Clinical Neurosciences, Geneva University Hospital, Switzerland (A.G.G., F.C.H.)
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12
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Wang L, Xu X, Kai Lau K, Li LSW, Kwun Wong Y, Yau C, Mak HKF, Hui ES. Relation between rich-club organization versus brain functions and functional recovery after acute ischemic stroke. Brain Res 2021; 1763:147441. [PMID: 33753065 DOI: 10.1016/j.brainres.2021.147441] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 03/08/2021] [Accepted: 03/13/2021] [Indexed: 02/04/2023]
Abstract
Studies have shown the brain's rich-club organization may underpin brain function and be associated with various brain disorders. In this study, we aimed to investigate the relation between poststroke brain functions and functional recovery versus the rich-club organization of the structural brain network of patients after first-time acute ischemic stroke. A cohort of 16 acute ischemic stroke patients (11 males) was recruited. Structural brain networks were measured using diffusion tensor imaging within 1 week and at 1, 3 and 6 months after stroke. Motor impairment was assessed using the Upper-Extremity Fugl-Meyer motor scale and activities of daily living using the Barthel Index at the same time points as MRI. The rich-club regions that were stable over the course of stroke recovery included the bilateral dorsolateral superior frontal gyri, right supplementary motor area, and left median cingulate and paracingulate gyri. The network properties that correlated with poststroke brain functions were mainly the ratio between communication cost ratio and density ratio of rich-club, feeder and local connections. The recovery of both motor functions and activities of daily living were correlated with higher normalized rich club coefficients and a shorter length of local connections within a week after stroke. The communication cost ratio of feeder connections, the length of rich-club and local connections, and normalized rich club coefficients were found to be potential prognostic indicators of stroke recovery. Our results provide additional support to the notion that different types of network connections play different roles in brain functions as well as functional recovery.
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Affiliation(s)
- Lu Wang
- Department of Diagnostic Radiology, University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region
| | - Xiaopei Xu
- Department of Radiology, Second Affiliated Hospital, Zhejiang University, Zhejiang, China
| | - Kui Kai Lau
- Department of Medicine, University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region
| | - Leonard S W Li
- Department of Medicine, University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region
| | - Yuen Kwun Wong
- Department of Medicine, University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region
| | - Christina Yau
- Department of Occupational Therapy, Tung Wah Hospital, Hong Kong Special Administrative Region
| | - Henry K F Mak
- Department of Diagnostic Radiology, University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region; State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region
| | - Edward S Hui
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong Special Administrative Region.
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13
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Scheulin KM, Jurgielewicz BJ, Spellicy SE, Waters ES, Baker EW, Kinder HA, Simchick GA, Sneed SE, Grimes JA, Zhao Q, Stice SL, West FD. Exploring the predictive value of lesion topology on motor function outcomes in a porcine ischemic stroke model. Sci Rep 2021; 11:3814. [PMID: 33589720 PMCID: PMC7884696 DOI: 10.1038/s41598-021-83432-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 02/02/2021] [Indexed: 12/11/2022] Open
Abstract
Harnessing the maximum diagnostic potential of magnetic resonance imaging (MRI) by including stroke lesion location in relation to specific structures that are associated with particular functions will likely increase the potential to predict functional deficit type, severity, and recovery in stroke patients. This exploratory study aims to identify key structures lesioned by a middle cerebral artery occlusion (MCAO) that impact stroke recovery and to strengthen the predictive capacity of neuroimaging techniques that characterize stroke outcomes in a translational porcine model. Clinically relevant MRI measures showed significant lesion volumes, midline shifts, and decreased white matter integrity post-MCAO. Using a pig brain atlas, damaged brain structures included the insular cortex, somatosensory cortices, temporal gyri, claustrum, and visual cortices, among others. MCAO resulted in severely impaired spatiotemporal gait parameters, decreased voluntary movement in open field testing, and higher modified Rankin Scale scores at acute timepoints. Pearson correlation analyses at acute timepoints between standard MRI metrics (e.g., lesion volume) and functional outcomes displayed moderate R values to functional gait outcomes. Moreover, Pearson correlation analyses showed higher R values between functional gait deficits and increased lesioning of structures associated with motor function, such as the putamen, globus pallidus, and primary somatosensory cortex. This correlation analysis approach helped identify neuroanatomical structures predictive of stroke outcomes and may lead to the translation of this topological analysis approach from preclinical stroke assessment to a clinical biomarker.
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Affiliation(s)
- Kelly M Scheulin
- Regenerative Bioscience Center, University of Georgia, Athens, GA, USA
- Department of Animal and Dairy Sciences, University of Georgia, Athens, GA, USA
- Biomedical and Health Sciences Institute, Neuroscience Program, University of Georgia, Athens, GA, USA
| | - Brian J Jurgielewicz
- Regenerative Bioscience Center, University of Georgia, Athens, GA, USA
- Department of Animal and Dairy Sciences, University of Georgia, Athens, GA, USA
- Biomedical and Health Sciences Institute, Neuroscience Program, University of Georgia, Athens, GA, USA
| | - Samantha E Spellicy
- Regenerative Bioscience Center, University of Georgia, Athens, GA, USA
- Department of Animal and Dairy Sciences, University of Georgia, Athens, GA, USA
- Biomedical and Health Sciences Institute, Neuroscience Program, University of Georgia, Athens, GA, USA
| | - Elizabeth S Waters
- Regenerative Bioscience Center, University of Georgia, Athens, GA, USA
- Department of Animal and Dairy Sciences, University of Georgia, Athens, GA, USA
- Biomedical and Health Sciences Institute, Neuroscience Program, University of Georgia, Athens, GA, USA
| | | | - Holly A Kinder
- Regenerative Bioscience Center, University of Georgia, Athens, GA, USA
- Department of Animal and Dairy Sciences, University of Georgia, Athens, GA, USA
| | - Gregory A Simchick
- Regenerative Bioscience Center, University of Georgia, Athens, GA, USA
- Department of Physics, University of Georgia, Athens, GA, USA
| | - Sydney E Sneed
- Regenerative Bioscience Center, University of Georgia, Athens, GA, USA
- Department of Animal and Dairy Sciences, University of Georgia, Athens, GA, USA
| | - Janet A Grimes
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - Qun Zhao
- Regenerative Bioscience Center, University of Georgia, Athens, GA, USA
- Department of Physics, University of Georgia, Athens, GA, USA
| | - Steven L Stice
- Regenerative Bioscience Center, University of Georgia, Athens, GA, USA
- Department of Animal and Dairy Sciences, University of Georgia, Athens, GA, USA
- Biomedical and Health Sciences Institute, Neuroscience Program, University of Georgia, Athens, GA, USA
- Aruna Bio Inc, Athens, GA, USA
| | - Franklin D West
- Regenerative Bioscience Center, University of Georgia, Athens, GA, USA.
- Department of Animal and Dairy Sciences, University of Georgia, Athens, GA, USA.
- Biomedical and Health Sciences Institute, Neuroscience Program, University of Georgia, Athens, GA, USA.
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14
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Romeo Z, Mantini D, Durgoni E, Passarini L, Meneghello F, Zorzi M. Electrophysiological signatures of resting state networks predict cognitive deficits in stroke. Cortex 2021; 138:59-71. [PMID: 33677328 DOI: 10.1016/j.cortex.2021.01.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 09/28/2020] [Accepted: 01/29/2021] [Indexed: 01/01/2023]
Abstract
Localized damage to different brain regions can cause specific cognitive deficits. However, stroke lesions can also induce modifications in the functional connectivity of intrinsic brain networks, which could be responsible for the behavioral impairment. Though resting state networks (RSNs) are typically mapped using fMRI, it has been recently shown that they can also be detected from high-density EEG. We build on a state-of-the-art approach to extract RSNs from 64-channels EEG activity in a group of right stroke patients and to identify neural predictors of their cognitive performance. Fourteen RSNs previously found in fMRI and high-density EEG studies on healthy participants were successfully reconstructed from our patients' EEG recordings. We then correlated EEG-RSNs functional connectivity with neuropsychological scores, first considering a wide frequency band (1-80 Hz) and then specific frequency ranges in order to examine the association between each EEG rhythm and the behavioral impairment. We found that visuo-spatial and motor impairments were primarily associated with the dorsal attention network, with contribution dependent on the specific EEG band. These findings are in line with the hypothesis that there is a core system of brain networks involved in specific cognitive domains. Moreover, our results pave the way for low-cost EEG-based monitoring of intrinsic brain networks' functioning in neurological patients to complement clinical-behavioral measures.
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Affiliation(s)
| | - Dante Mantini
- IRCCS San Camillo Hospital, Venice, Italy; Laboratory of Movement Control and Neuroplasticity, Department of Movement Sciences, KU Leuven, Belgium
| | | | | | | | - Marco Zorzi
- IRCCS San Camillo Hospital, Venice, Italy; Department of General Psychology and Padova Neuroscience Center, University of Padova, Italy.
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15
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Schirmer MD, Venkataraman A, Rekik I, Kim M, Mostofsky SH, Nebel MB, Rosch K, Seymour K, Crocetti D, Irzan H, Hütel M, Ourselin S, Marlow N, Melbourne A, Levchenko E, Zhou S, Kunda M, Lu H, Dvornek NC, Zhuang J, Pinto G, Samal S, Zhang J, Bernal-Rusiel JL, Pienaar R, Chung AW. Neuropsychiatric disease classification using functional connectomics - results of the connectomics in neuroimaging transfer learning challenge. Med Image Anal 2021; 70:101972. [PMID: 33677261 DOI: 10.1016/j.media.2021.101972] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 11/25/2020] [Accepted: 01/11/2021] [Indexed: 01/26/2023]
Abstract
Large, open-source datasets, such as the Human Connectome Project and the Autism Brain Imaging Data Exchange, have spurred the development of new and increasingly powerful machine learning approaches for brain connectomics. However, one key question remains: are we capturing biologically relevant and generalizable information about the brain, or are we simply overfitting to the data? To answer this, we organized a scientific challenge, the Connectomics in NeuroImaging Transfer Learning Challenge (CNI-TLC), held in conjunction with MICCAI 2019. CNI-TLC included two classification tasks: (1) diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD) within a pre-adolescent cohort; and (2) transference of the ADHD model to a related cohort of Autism Spectrum Disorder (ASD) patients with an ADHD comorbidity. In total, 240 resting-state fMRI (rsfMRI) time series averaged according to three standard parcellation atlases, along with clinical diagnosis, were released for training and validation (120 neurotypical controls and 120 ADHD). We also provided Challenge participants with demographic information of age, sex, IQ, and handedness. The second set of 100 subjects (50 neurotypical controls, 25 ADHD, and 25 ASD with ADHD comorbidity) was used for testing. Classification methodologies were submitted in a standardized format as containerized Docker images through ChRIS, an open-source image analysis platform. Utilizing an inclusive approach, we ranked the methods based on 16 metrics: accuracy, area under the curve, F1-score, false discovery rate, false negative rate, false omission rate, false positive rate, geometric mean, informedness, markedness, Matthew's correlation coefficient, negative predictive value, optimized precision, precision, sensitivity, and specificity. The final rank was calculated using the rank product for each participant across all measures. Furthermore, we assessed the calibration curves of each methodology. Five participants submitted their method for evaluation, with one outperforming all other methods in both ADHD and ASD classification. However, further improvements are still needed to reach the clinical translation of functional connectomics. We have kept the CNI-TLC open as a publicly available resource for developing and validating new classification methodologies in the field of connectomics.
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Affiliation(s)
- Markus D Schirmer
- Massachusetts General Hospital, Harvard Medical School, Boston, USA; German Center for Neurodegenerative Diseases, Bonn, Germany; Clinic for Neuroradiology, University Hospital Bonn, Germany; Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, USA.
| | - Archana Venkataraman
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, USA; Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, USA
| | - Islem Rekik
- BASIRA lab, Faculty of Computer and Informatics, Istanbul Technical University, Istanbul, Turkey; School of Science and Engineering, Computing, University of Dundee, UK; Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, USA
| | - Minjeong Kim
- Department of Computer Science, University of North Carolina at Greensboro, USA; Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, USA
| | - Stewart H Mostofsky
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, USA; Department of Neurology, Johns Hopkins School of Medicine, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, USA; Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, USA
| | - Mary Beth Nebel
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, USA; Department of Neurology, Johns Hopkins School of Medicine, USA; Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, USA
| | - Keri Rosch
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, USA; Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, USA; Department of Radiology, Boston Children's Hospital,Harvard Medical School, Boston, MA, USA
| | - Karen Seymour
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, USA; Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, USA
| | - Deana Crocetti
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, USA; Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, USA
| | - Hassna Irzan
- Department of Medical Physics and Biomedical Engineering, University College London, UK; School of Biomedical Engineering and Imaging Sciences, King's College London, UK; Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, USA
| | - Michael Hütel
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK; Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, USA
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK; Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, USA
| | - Neil Marlow
- Institute for Women's Health, University College London, UK; Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, USA
| | - Andrew Melbourne
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK; Department of Medical Physics and Biomedical Engineering, University College London, UK; Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, USA
| | - Egor Levchenko
- Institute for Cognitive Neuroscience, Higher School of Economics, Moscow, Russia; Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, USA
| | - Shuo Zhou
- Department of Computer Science, The University of Sheffield, Sheffield, UK; Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, USA
| | - Mwiza Kunda
- Department of Computer Science, The University of Sheffield, Sheffield, UK; Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, USA
| | - Haiping Lu
- Department of Computer Science, The University of Sheffield, Sheffield, UK; Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, USA
| | - Nicha C Dvornek
- Department of Radiology & Biomedical Imaging, Yale University, New Haven, CT, USA; Department of Biomedical Engineering, Yale University, New Haven, CT, USA; Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, USA
| | - Juntang Zhuang
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA; Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, USA
| | - Gideon Pinto
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, USA
| | - Sandip Samal
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, USA
| | - Jennings Zhang
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, USA
| | - Jorge L Bernal-Rusiel
- Teradyte LLC, Coral Gables, FL, USA; Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, USA
| | - Rudolph Pienaar
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Boston Children's Hospital,Harvard Medical School, Boston, MA, USA; Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, USA
| | - Ai Wern Chung
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, USA.
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16
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Fields ME, Mirro AE, Guilliams KP, Binkley MM, Gil Diaz L, Tan J, Fellah S, Eldeniz C, Chen Y, Ford AL, Shimony JS, King AA, An H, Smyser CD, Lee JM. Functional Connectivity Decreases with Metabolic Stress in Sickle Cell Disease. Ann Neurol 2020; 88:995-1008. [PMID: 32869335 PMCID: PMC7592195 DOI: 10.1002/ana.25891] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 07/16/2020] [Accepted: 08/22/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Children with sickle cell disease (SCD) experience cognitive deficits even when unaffected by stroke. Using functional connectivity magnetic resonance imaging (MRI) as a potential biomarker of cognitive function, we tested our hypothesis that children with SCD would have decreased functional connectivity, and that children experiencing the greatest metabolic stress, indicated by elevated oxygen extraction fraction, would have the lowest connectivity. METHODS We prospectively obtained brain MRIs and cognitive testing in healthy controls and children with SCD. RESULTS We analyzed data from 60 participants (20 controls and 40 with sickle cell disease). There was no difference in global cognition or cognitive subdomains between cohorts. However, we found decreased functional connectivity within the sensory-motor, lateral sensory-motor, auditory, salience, and subcortical networks in participants with SCD compared with controls. Further, as white matter oxygen extraction fraction increased, connectivity within the visual (p = 0.008, parameter estimate = -0.760 [95% CI = -1.297, -0.224]), default mode (p = 0.012, parameter estimate = -0.417 [95% CI = -0.731, -0.104]), and cingulo-opercular (p = 0.009, parameter estimate = -0.883 [95% CI = -1.517, -0.250]) networks decreased. INTERPRETATION We conclude that there is diminished functional connectivity within these anatomically contiguous networks in children with SCD compared with controls, even when differences are not seen with cognitive testing. Increased white matter oxygen extraction fraction was associated with decreased connectivity in select networks. These data suggest that elevated oxygen extraction fraction and disrupted functional connectivity are potentially presymptomatic neuroimaging biomarkers for cognitive decline in SCD. ANN NEUROL 2020;88:995-1008.
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Affiliation(s)
- Melanie E Fields
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Amy E Mirro
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Kristin P Guilliams
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael M Binkley
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Luisa Gil Diaz
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jessica Tan
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Slim Fellah
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Cihat Eldeniz
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Yasheng Chen
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Andria L Ford
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Allison A King
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
- Program of Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Hongyu An
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Christopher D Smyser
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jin-Moo Lee
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Biomedical Engineering, Washington University School of Medicine, St. Louis, MO, USA
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