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Yaşa İC, Maviş İ, Şalçini C, Midi İ. Comparing the efficiency of speech and language therapy and transcranial magnetic stimulation for treating Broca's aphasia. J Stroke Cerebrovasc Dis 2023; 32:107108. [PMID: 37068324 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107108] [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: 02/01/2023] [Revised: 03/25/2023] [Accepted: 03/28/2023] [Indexed: 04/19/2023] Open
Abstract
OBJECTIVES Aphasia is an acquired language-cognitive disorder that highly affects an individual's speech, language, and communication skills. Recovery from aphasia requires attentive treatment since it is a long and dynamic process. This study aimed to show interactive benefits of combining classical intervention strategies with new technological approaches and demonstrating their effectiveness. MATERIALS AND METHODS A total of 40 individuals with Broca's aphasia were included in the study. The participants were divided into Application-1 Speech and Language Therapy, Application-2 Transcranial Magnetic Stimulation, Application-3 (consecutive Transcranial Magnetic Stimulation and Speech and Language Therapy), and Application-4 (Control Group) experimental groups, with 10 participants in each group. RESULTS Analysis indicated that individuals in the group in which Transcranial Magnetic Stimulation and Speech and Language Therapy were applied consecutively had further increases in speech fluency, repetition, and naming scores from pre-test to post-test (p<0.01). Picture naming and quality-of-life communication scores of individuals in the group in which Speech and Language Therapy was performed increased further from pre-test to post-test (p<0.01). CONCLUSIONS The results of the study showed a positive effect on language skills, naming scores, and participation in social life of Turkish-speaking aphasic individuals with the Speech and Language Therapy and Transcranial Magnetic Stimulation methods. The use of Transcranial Magnetic Stimulation alone is insufficient in this context. Although Speech and Language Therapy alone is effective in naming ability, Transcranial Magnetic Stimulation in addition to Speech and Language Therapy significantly increases the gain obtained with therapies.
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Affiliation(s)
- İbrahim Can Yaşa
- Bahçeşehir University, Faculty of Health Sciences, Speech and Language Therapy Department, İstanbul, Türkiye.
| | - İlknur Maviş
- Anadolu University, Faculty of Health Sciences, Speech and Language Therapy Department, Eskişehir, Türkiye
| | - Celal Şalçini
- Üsküdar University Brain Hospital, Neurology Department, İstanbul, Türkiye
| | - İpek Midi
- Marmara University, Faculty of Medicine, Neurology Department, İstanbul, Türkiye
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Lee S, Park J, Choi DS, Lim S, Kwak Y, Jang DP, Kim DH, Ji HB, Choy YB, Im CH. Feasibility of epidural temporal interference stimulation for minimally invasive electrical deep brain stimulation: simulation and phantom experimental studies. J Neural Eng 2022; 19. [PMID: 36066021 DOI: 10.1088/1741-2552/ac8503] [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: 03/24/2022] [Accepted: 07/28/2022] [Indexed: 11/11/2022]
Abstract
Objective. Temporal interference stimulation (TIS) has shown the potential as a new method for selective stimulation of deep brain structures in small animal experiments. However, it is challenging to deliver a sufficient temporal interference (TI) current to directly induce an action potential in the deep area of the human brain when electrodes are attached to the scalp because the amount of injection current is generally limited due to safety issues. Thus, we propose a novel method called epidural TIS (eTIS) to address this issue; in this method, the electrodes are attached to the epidural surface under the skull.Approach. We employed finite element method (FEM)-based electric field simulations to demonstrate the feasibility of eTIS. We first optimized the electrode conditions to deliver maximum TI currents to each of the three different targets (anterior hippocampus, subthalamic nucleus, and ventral intermediate nucleus) based on FEM, and compared the stimulation focality between eTIS and transcranial TIS (tTIS). Moreover, we conducted realistic skull-phantom experiments for validating the accuracy of the computational simulation for eTIS.Main results. Our simulation results showed that eTIS has the advantage of avoiding the delivery of TI currents over unwanted neocortical regions compared with tTIS for all three targets. It was shown that the optimized eTIS could induce neural action potentials at each of the three targets when a sufficiently large current equivalent to that for epidural cortical stimulation is injected. Additionally, the simulated results and measured results via the phantom experiments were in good agreement.Significance. We demonstrated the feasibility of eTIS, facilitating more focalized and stronger electrical stimulation of deep brain regions than tTIS, with the relatively less invasive placement of electrodes than conventional deep brain stimulation via computational simulation and realistic skull phantom experiments.
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Affiliation(s)
- Sangjun Lee
- Department of Electronic Engineering, Hanyang University, Seoul, Republic of Korea
| | - Jimin Park
- Department of Electronic Engineering, Hanyang University, Seoul, Republic of Korea
| | - Da Som Choi
- Department of Electronic Engineering, Hanyang University, Seoul, Republic of Korea
| | - Seokbeen Lim
- Department of Biomedical Engineering, Hanyang University, Seoul, Republic of Korea
| | - Youngjong Kwak
- Department of Biomedical Engineering, Hanyang University, Seoul, Republic of Korea
| | - Dong Pyo Jang
- Department of Biomedical Engineering, Hanyang University, Seoul, Republic of Korea
| | - Dong Hwan Kim
- Center for Intelligent and Interactive Robotics, Korea Institute of Science and Technology, Seoul, Republic of Korea
| | - Han Bi Ji
- Interdisciplinary Program in Bioengineering, College of Engineering, Seoul National University, Seoul 08826, Republic of Korea
| | - Young Bin Choy
- Interdisciplinary Program in Bioengineering, College of Engineering, Seoul National University, Seoul 08826, Republic of Korea.,Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, Seoul 03080, Republic of Korea.,Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Chang-Hwan Im
- Department of Electronic Engineering, Hanyang University, Seoul, Republic of Korea.,Department of Biomedical Engineering, Hanyang University, Seoul, Republic of Korea
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Invasive cortical stimulation. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2021; 159:23-45. [PMID: 34446248 DOI: 10.1016/bs.irn.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The field of neuromodulation, at its essence, aims to apply electrical stimulation to the brain to ameliorate various pathology. Many methods of applying this stimulation exist, including invasive and non-invasive means. In the realm of invasive stimulation, stimulation of the cortex remains one of the earliest techniques investigated, yet one of the most underutilized today. Evidence for the efficacy of direct invasive cortical stimulation continues to mount, especially in recent years. In this chapter we will review the evidence for the use of invasive cortical stimulation as it applies to neuropathic pain, epilepsy, psychiatric disease, movement disorders, tinnitus, and post-stroke recovery, as well explore some potential mechanisms and future directions of the technique.
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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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Kellmeyer P, Vry MS, Ball T. A transcallosal fibre system between homotopic inferior frontal regions supports complex linguistic processing. Eur J Neurosci 2019; 50:3544-3556. [PMID: 31209927 PMCID: PMC6899774 DOI: 10.1111/ejn.14486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/20/2019] [Accepted: 05/30/2019] [Indexed: 12/31/2022]
Abstract
Inferior frontal regions in the left and right hemisphere support different aspects of language processing. In the canonical model, left inferior frontal regions are mostly involved in processing based on phonological, syntactic and semantic features of language, whereas the right inferior frontal regions process paralinguistic aspects like affective prosody. Using diffusion tensor imaging (DTI)‐based probabilistic fibre tracking in 20 healthy volunteers, we identify a callosal fibre system connecting left and right inferior frontal regions that are involved in linguistic processing of varying complexity. Anatomically, we show that the interhemispheric fibres are highly aligned and distributed along a rostral to caudal gradient in the body and genu of the corpus callosum to connect homotopic inferior frontal regions. In the light of converging data, taking previous DTI‐based tracking studies and clinical case studies into account, our findings suggest that the right inferior frontal cortex not only processes paralinguistic aspects of language (such as affective prosody), as purported by the canonical model, but also supports the computation of linguistic aspects of varying complexity in the human brain. Our model may explain patterns of right‐hemispheric contribution to stroke recovery as well as disorders of prosodic processing. Beyond language‐related brain function, we discuss how inter‐species differences in interhemispheric connectivity and fibre density, including the system we described here may also explain differences in transcallosal information transfer and cognitive abilities across different mammalian species.
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Affiliation(s)
- Philipp Kellmeyer
- Neuromedical Artificial Intelligence Lab, Department of Neurosurgery, Medical Center-University of Freiburg, Freiburg im Breisgau, Germany.,Cluster of Excellence BrainLinks-BrainTools, University of Freiburg, Freiburg im Breisgau, Germany
| | - Magnus-Sebastian Vry
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center-University of Freiburg, Freiburg im Breisgau, Germany
| | - Tonio Ball
- Neuromedical Artificial Intelligence Lab, Department of Neurosurgery, Medical Center-University of Freiburg, Freiburg im Breisgau, Germany.,Cluster of Excellence BrainLinks-BrainTools, University of Freiburg, Freiburg im Breisgau, Germany
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Beuter A, Balossier A, Trofimchuk S, Volpert V. Modeling of post-stroke stimulation of cortical tissue. Math Biosci 2018; 305:146-159. [DOI: 10.1016/j.mbs.2018.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 08/23/2018] [Accepted: 08/29/2018] [Indexed: 11/28/2022]
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Haghighi M, Mazdeh M, Ranjbar N, Seifrabie MA. Further Evidence of the Positive Influence of Repetitive Transcranial Magnetic Stimulation on Speech and Language in Patients with Aphasia after Stroke: Results from a Double-Blind Intervention with Sham Condition. Neuropsychobiology 2018; 75:185-192. [PMID: 29402816 DOI: 10.1159/000486144] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 11/30/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND After a stroke, up to 20% of patients suffer from aphasia. The preferred treatment for stroke-related aphasia (SRA) is regular speech and language training (SLT). In the present study, we investigated to what extent adjuvant repetitive transcranial magnetic stimulation (rTMS) might enhance recovery. While there is growing evidence of the positive effect of adjuvant rTMS on aphasia, no study has yet been based on an Iranian sample. METHOD A total of 12 patients (mean age: 55 years; right-handed; 7 women) underwent treatment for SRA 1 month after stroke. The standard treatment consisted of regular 45-min SLT sessions 5 times a week for 2 consecutive weeks. Additionally, patients were randomly assigned either to adjuvant rTMS (5 times a week for 30 min) or to a sham condition (5 times a week for 30 min). At baseline and after 2 weeks of intervention, the degree of aphasia was assessed with the Farsi version of the Western Aphasia Battery. rTMS was applied to the inferior posterior frontal gyrus of the right hemisphere. RESULTS Speech and language improved over time, but more so in the rTMS than in the sham condition. Large effect sizes were observed for content, fluency, and the aphasia quotient; medium effect sizes were observed for command comprehension and repetition, while effect sizes were small for auditory comprehension and naming. CONCLUSIONS Among patients with SRA, compared to a sham condition, adjuvant rTMS improved speech and language skills. The present results add to the accumulating evidence that rTMS as a neuromodulation technique has the capacity to enhance the effect of conventional SLT.
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Affiliation(s)
- Mohammad Haghighi
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mehrdokht Mazdeh
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Nazila Ranjbar
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
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Guler S, Dannhauer M, Roig-Solvas B, Gkogkidis A, Macleod R, Ball T, Ojemann JG, Brooks DH. Computationally optimized ECoG stimulation with local safety constraints. Neuroimage 2018; 173:35-48. [PMID: 29427847 PMCID: PMC5911187 DOI: 10.1016/j.neuroimage.2018.01.088] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 01/03/2018] [Accepted: 01/31/2018] [Indexed: 12/22/2022] Open
Abstract
Direct stimulation of the cortical surface is used clinically for cortical mapping and modulation of local activity. Future applications of cortical modulation and brain-computer interfaces may also use cortical stimulation methods. One common method to deliver current is through electrocorticography (ECoG) stimulation in which a dense array of electrodes are placed subdurally or epidurally to stimulate the cortex. However, proximity to cortical tissue limits the amount of current that can be delivered safely. It may be desirable to deliver higher current to a specific local region of interest (ROI) while limiting current to other local areas more stringently than is guaranteed by global safety limits. Two commonly used global safety constraints bound the total injected current and individual electrode currents. However, these two sets of constraints may not be sufficient to prevent high current density locally (hot-spots). In this work, we propose an efficient approach that prevents current density hot-spots in the entire brain while optimizing ECoG stimulus patterns for targeted stimulation. Specifically, we maximize the current along a particular desired directional field in the ROI while respecting three safety constraints: one on the total injected current, one on individual electrode currents, and the third on the local current density magnitude in the brain. This third set of constraints creates a computational barrier due to the huge number of constraints needed to bound the current density at every point in the entire brain. We overcome this barrier by adopting an efficient two-step approach. In the first step, the proposed method identifies the safe brain region, which cannot contain any hot-spots solely based on the global bounds on total injected current and individual electrode currents. In the second step, the proposed algorithm iteratively adjusts the stimulus pattern to arrive at a solution that exhibits no hot-spots in the remaining brain. We report on simulations on a realistic finite element (FE) head model with five anatomical ROIs and two desired directional fields. We also report on the effect of ROI depth and desired directional field on the focality of the stimulation. Finally, we provide an analysis of optimization runtime as a function of different safety and modeling parameters. Our results suggest that optimized stimulus patterns tend to differ from those used in clinical practice.
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Affiliation(s)
- Seyhmus Guler
- Computational Radiology Laboratory (CRL), Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Moritz Dannhauer
- Center for Integrative Biomedical Computing (CIBC), University of Utah, Salt Lake City, UT, USA; Scientific Computing Institute (SCI), University of Utah, Salt Lake City, UT, USA
| | - Biel Roig-Solvas
- SPIRAL Group, Department of Electrical and Computer Engineering, Northeastern University, Boston, MA, USA
| | - Alexis Gkogkidis
- Intracranial EEG and Brain Imaging Lab, Epilepsy Center, University Hospital Freiburg, Freiburg, Germany; BrainLinks-BrainTools Cluster of Excellence and Bernstein Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Rob Macleod
- Center for Integrative Biomedical Computing (CIBC), University of Utah, Salt Lake City, UT, USA; Scientific Computing Institute (SCI), University of Utah, Salt Lake City, UT, USA
| | - Tonio Ball
- Intracranial EEG and Brain Imaging Lab, Epilepsy Center, University Hospital Freiburg, Freiburg, Germany; BrainLinks-BrainTools Cluster of Excellence and Bernstein Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Jeffrey G Ojemann
- Department of Neurological Surgery and the Center for Sensorimotor Neural Engineering, University of Washington, Seattle, WA, USA
| | - Dana H Brooks
- Center for Integrative Biomedical Computing (CIBC), University of Utah, Salt Lake City, UT, USA; SPIRAL Group, Department of Electrical and Computer Engineering, Northeastern University, Boston, MA, USA
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Cherney LR. Epidural Cortical Stimulation as Adjunctive Treatment for Nonfluent Aphasia. Neurorehabil Neural Repair 2015; 30:131-42. [PMID: 26704258 DOI: 10.1177/1545968315622574] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. There is increasing interest in the application of cortical stimulation (CS) as an adjuvant strategy in aphasia rehabilitation. Epidural CS, although more invasive than other methods, can provide high-frequency ipsilesional stimulation with greater spatial specificity. Objective. We review methods and results of a phase 1 study of epidural CS in combination with rehabilitation therapy in aphasia and provide new objective and self-report data collected between 6 and 21 months after the end of treatment. Methods. Eight stroke survivors with nonfluent aphasia received intensive language therapy, 3 hours a day, for 6 weeks. Four participants also underwent surgical implantation of an epidural stimulation device that was activated only during therapy sessions. Behavioral data were collected before treatment, at the end of treatment, and at 6 and 12 weeks after the end of treatment. Of the 8 participants, 7 also participated in the longer-term follow-up visit. Results. Changes in objective scores from baseline were larger in investigational participants than controls at all assessments, including the longer-term follow-up visit. Satisfaction ratings and ratings of overall improvement by investigational participants and their companions were more varied than those of the controls, but all indicated that they would recommend the investigational treatment to others with aphasia. Conclusions. Improvements were generally maintained for at least 12 weeks posttreatment and possibly as long as 21 months posttreatment. Epidural CS is a potentially safe, feasible adjunctive intervention for persons with chronic nonfluent aphasia that spares the ventral premotor cortex and warrants further investigation.
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Affiliation(s)
- Leora R. Cherney
- Center for Aphasia Research and Treatment, Rehabilitation Institute of Chicago, Chicago, IL, USA
- Northwestern University, Chicago, IL, USA
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