1
|
Peng K, Moussavi Z, Karunakaran KD, Borsook D, Lesage F, Nguyen DK. iVR-fNIRS: studying brain functions in a fully immersive virtual environment. NEUROPHOTONICS 2024; 11:020601. [PMID: 38577629 PMCID: PMC10993907 DOI: 10.1117/1.nph.11.2.020601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 04/06/2024]
Abstract
Immersive virtual reality (iVR) employs head-mounted displays or cave-like environments to create a sensory-rich virtual experience that simulates the physical presence of a user in a digital space. The technology holds immense promise in neuroscience research and therapy. In particular, virtual reality (VR) technologies facilitate the development of diverse tasks and scenarios closely mirroring real-life situations to stimulate the brain within a controlled and secure setting. It also offers a cost-effective solution in providing a similar sense of interaction to users when conventional stimulation methods are limited or unfeasible. Although combining iVR with traditional brain imaging techniques may be difficult due to signal interference or instrumental issues, recent work has proposed the use of functional near infrared spectroscopy (fNIRS) in conjunction with iVR for versatile brain stimulation paradigms and flexible examination of brain responses. We present a comprehensive review of current research studies employing an iVR-fNIRS setup, covering device types, stimulation approaches, data analysis methods, and major scientific findings. The literature demonstrates a high potential for iVR-fNIRS to explore various types of cognitive, behavioral, and motor functions in a fully immersive VR (iVR) environment. Such studies should set a foundation for adaptive iVR programs for both training (e.g., in novel environments) and clinical therapeutics (e.g., pain, motor and sensory disorders and other psychiatric conditions).
Collapse
Affiliation(s)
- Ke Peng
- University of Manitoba, Department of Electrical and Computer Engineering, Price Faculty of Engineering, Winnipeg, Manitoba, Canada
| | - Zahra Moussavi
- University of Manitoba, Department of Electrical and Computer Engineering, Price Faculty of Engineering, Winnipeg, Manitoba, Canada
| | - Keerthana Deepti Karunakaran
- Massachusetts General Hospital, Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, United States
| | - David Borsook
- Massachusetts General Hospital, Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, United States
- Massachusetts General Hospital, Harvard Medical School, Department of Radiology, Boston, Massachusetts, United States
| | - Frédéric Lesage
- University of Montreal, Institute of Biomedical Engineering, Department of Electrical Engineering, Ecole Polytechnique, Montreal, Quebec, Canada
- Montreal Heart Institute, Montreal, Quebec, Canada
| | - Dang Khoa Nguyen
- University of Montreal, Department of Neurosciences, Montreal, Quebec, Canada
- Research Center of the Hospital Center of the University of Montreal, Department of Neurology, Montreal, Quebec, Canada
| |
Collapse
|
2
|
Cortez-Vázquez G, Adriaanse M, Burchell GL, Ostelo R, Panayiotou G, Vlemincx E. Virtual Reality Breathing Interventions for Mental Health: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Appl Psychophysiol Biofeedback 2024; 49:1-21. [PMID: 38236355 PMCID: PMC10869395 DOI: 10.1007/s10484-023-09611-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2023] [Indexed: 01/19/2024]
Abstract
Breathing exercises have been shown to reduce mental health problems among clinical and non-clinical populations. Although virtual reality (VR) breathing interventions are assumed to have potential benefits, it remains unclear whether VR breathing interventions are more effective at improving mental health than non-VR breathing interventions. We conducted a systematic literature search in six electronic databases (Web of Science, PsycINFO, Embase, Cochrane Central Register of Controlled Trials, Scopus, and PubMed) from inception to 30th September, 2022. We included randomized controlled trials in adults evaluating effects of VR compared to non-VR breathing interventions on primary outcomes of mental health (stress, anxiety and mood), and secondary outcomes of physiological stress measures (e.g., heart rate (HR), heart rate variability (HRV)). Within these selected studies, we explored differences in likeability and future use between VR and non-VR breathing interventions. 2.848 records were identified of which 65 full-text articles were assessed. Six RCTs were included, of which five were suitable for meta-analyses. Comparing VR to non-VR breathing interventions, there were no significant differences in overall mental health, stress, anxiety or mood, nor in HR or HRV. There was no evidence that participants liked VR breathing interventions more than non-VR, nor would use them more in the future. These results suggest that there is no evidence that VR breathing interventions are more effective than non-VR in improving mental health outcomes, HR, HRV. Further research is required to determine whether there may be advantages to longer-term VR-implementation and practice, and explore possible mechanisms.
Collapse
Affiliation(s)
- Gabriela Cortez-Vázquez
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Marcel Adriaanse
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | | | - Raymond Ostelo
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC location, Vrije Universiteit, Amsterdam, The Netherlands
| | - Georgia Panayiotou
- Department of Psychology and Center for Applied Neuroscience, University of Cyprus, Nicosia, Cyprus
| | - Elke Vlemincx
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
- Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands.
- Health Psychology, KU Leuven, Leuven, Belgium.
| |
Collapse
|
3
|
Srinivasan S, Acharya D, Butters E, Collins-Jones L, Mancini F, Bale G. Subject-specific information enhances spatial accuracy of high-density diffuse optical tomography. FRONTIERS IN NEUROERGONOMICS 2024; 5:1283290. [PMID: 38444841 PMCID: PMC10910052 DOI: 10.3389/fnrgo.2024.1283290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/02/2024] [Indexed: 03/07/2024]
Abstract
Functional near-infrared spectroscopy (fNIRS) is a widely used imaging method for mapping brain activation based on cerebral hemodynamics. The accurate quantification of cortical activation using fNIRS data is highly dependent on the ability to correctly localize the positions of light sources and photodetectors on the scalp surface. Variations in head size and shape across participants greatly impact the precise locations of these optodes and consequently, the regions of the cortical surface being reached. Such variations can therefore influence the conclusions drawn in NIRS studies that attempt to explore specific cortical regions. In order to preserve the spatial identity of each NIRS channel, subject-specific differences in NIRS array registration must be considered. Using high-density diffuse optical tomography (HD-DOT), we have demonstrated the inter-subject variability of the same HD-DOT array applied to ten participants recorded in the resting state. We have also compared three-dimensional image reconstruction results obtained using subject-specific positioning information to those obtained using generic optode locations. To mitigate the error introduced by using generic information for all participants, photogrammetry was used to identify specific optode locations per-participant. The present work demonstrates the large variation between subjects in terms of which cortical parcels are sampled by equivalent channels in the HD-DOT array. In particular, motor cortex recordings suffered from the largest optode localization errors, with a median localization error of 27.4 mm between generic and subject-specific optodes, leading to large differences in parcel sensitivity. These results illustrate the importance of collecting subject-specific optode locations for all wearable NIRS experiments, in order to perform accurate group-level analysis using cortical parcellation.
Collapse
Affiliation(s)
- Sruthi Srinivasan
- Department of Engineering, University of Cambridge, Cambridge, United Kingdom
| | - Deepshikha Acharya
- Department of Engineering, University of Cambridge, Cambridge, United Kingdom
| | - Emilia Butters
- Department of Engineering, University of Cambridge, Cambridge, United Kingdom
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Liam Collins-Jones
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Flavia Mancini
- Department of Engineering, University of Cambridge, Cambridge, United Kingdom
| | - Gemma Bale
- Department of Engineering, University of Cambridge, Cambridge, United Kingdom
- Department of Physics, University of Cambridge, Cambridge, United Kingdom
| |
Collapse
|
4
|
Mao W, Chen W, Wang Y. Effect of virtual reality-based mindfulness training model on anxiety, depression, and cancer-related fatigue in ovarian cancer patients during chemotherapy. Technol Health Care 2024; 32:1135-1148. [PMID: 37781832 PMCID: PMC11002720 DOI: 10.3233/thc-230735] [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: 06/06/2023] [Accepted: 08/05/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Although the prognosis of ovarian cancer can be significantly improved through standardized surgery and chemotherapy, 70% of epithelial ovarian cancer (EOC) patients would suffer from drug resistance and recurrence during the long chemotherapy cycle. OBJECTIVE To explore the impact of a training mode based on the integration of virtual reality technology and mindfulness on anxiety, depression, and cancer-related fatigue in ovarian cancer patients during chemotherapy. METHOD Through virtual reality technology, a mindfulness training software was designed and developed, and a mindfulness training mode based on virtual reality technology was constructed. Using a self-controlled design, 48 ovarian cancer patients undergoing chemotherapy who were hospitalized in a tertiary hospital in Beijing from August 2022 to May 2023 were conveniently selected as the research subjects. The patients were subjected to four weeks of mindfulness training based on virtual reality technology, and the acceptance of the mindfulness training mode using virtual reality technology was evaluated. The Hospital Anxiety and Depression Scale (HADS) and Cancer Related Fatigue Scale (CRF) were used to evaluate the anxiety, depression, and fatigue of patients before and after intervention. RESULTS The virtual reality based mindfulness training mode includes four functional modules: personalized curriculum, intelligent monitoring, emotion tracking, and Funny Games. 48 patients had a high acceptance score (139.21 ± 10.47), and after using mindfulness training mode based on virtual reality technology, anxiety, depression, and cancer-related fatigue in ovarian cancer patients during chemotherapy were significantly reduced, with a statistically significant difference (p< 0.001). CONCLUSION Ovarian cancer patients during chemotherapy have a high acceptance of virtual reality based mindfulness training mode. The application of this mode can reduce the psychological problems of anxiety, depression, and cancer-related fatigue in ovarian cancer patients during chemotherapy, and is worth promoting and using.
Collapse
Affiliation(s)
- Wenjuan Mao
- Department of Gynaecology, Peking University International Hospital, Beijing, China
| | - Wenduo Chen
- Department of Gynaecology, Peking University International Hospital, Beijing, China
| | - Yanbo Wang
- Obstetrics and Gynecology Clinic, Peking University International Hospital, Beijing, China
| |
Collapse
|
5
|
Phillips V Z, Canoy RJ, Paik SH, Lee SH, Kim BM. Functional Near-Infrared Spectroscopy as a Personalized Digital Healthcare Tool for Brain Monitoring. J Clin Neurol 2023; 19:115-124. [PMID: 36854332 PMCID: PMC9982178 DOI: 10.3988/jcn.2022.0406] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 03/02/2023] Open
Abstract
The sustained growth of digital healthcare in the field of neurology relies on portable and cost-effective brain monitoring tools that can accurately monitor brain function in real time. Functional near-infrared spectroscopy (fNIRS) is one such tool that has become popular among researchers and clinicians as a practical alternative to functional magnetic resonance imaging, and as a complementary tool to modalities such as electroencephalography. This review covers the contribution of fNIRS to the personalized goals of digital healthcare in neurology by identifying two major trends that drive current fNIRS research. The first major trend is multimodal monitoring using fNIRS, which allows clinicians to access more data that will help them to understand the interconnection between the cerebral hemodynamics and other physiological phenomena in patients. This allows clinicians to make an overall assessment of physical health to obtain a more-detailed and individualized diagnosis. The second major trend is that fNIRS research is being conducted with naturalistic experimental paradigms that involve multisensory stimulation in familiar settings. Cerebral monitoring of multisensory stimulation during dynamic activities or within virtual reality helps to understand the complex brain activities that occur in everyday life. Finally, the scope of future fNIRS studies is discussed to facilitate more-accurate assessments of brain activation and the wider clinical acceptance of fNIRS as a medical device for digital healthcare.
Collapse
Affiliation(s)
- Zephaniah Phillips V
- Global Health Technology Research Center, College of Health Science, Korea University, Seoul, Korea.
| | - Raymart Jay Canoy
- Program in Biomicro System Technology, College of Engineering, Korea University, Seoul, Korea
| | - Seung-ho Paik
- Global Health Technology Research Center, College of Health Science, Korea University, Seoul, Korea.,KLIEN Inc., Seoul Biohub, Seoul, Korea
| | - Seung Hyun Lee
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul, Korea
| | - Beop-Min Kim
- Department of Bio-Convergence Engineering, Korea University, Seoul, Korea
| |
Collapse
|
6
|
Deng X, Jian C, Yang Q, Jiang N, Huang Z, Zhao S. The analgesic effect of different interactive modes of virtual reality: A prospective functional near-infrared spectroscopy (fNIRS) study. Front Neurosci 2022; 16:1033155. [PMID: 36458040 PMCID: PMC9707398 DOI: 10.3389/fnins.2022.1033155] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/20/2022] [Indexed: 02/25/2024] Open
Abstract
UNLABELLED Virtual reality has demonstrated its analgesic effectiveness. However, its optimal interactive mode for pain relief is yet unclear, with rare objective measurements that were performed to explore its neural mechanism. OBJECTIVE This study primarily aimed at investigating the analgesic effect of different VR interactive modes via functional near-infrared spectroscopy (fNIRS) and exploring its correlations with the subjectively reported VR experience through a self-rating questionnaire. METHODS Fifteen healthy volunteers (Age: 21.93 ± 0.59 years, 11 female, 4 male) were enrolled in this prospective study. Three rounds of interactive mode, including active mode, motor imagery (MI) mode, and passive mode, were successively facilitated under consistent noxious electrical stimuli (electrical intensity: 23.67 ± 5.69 mA). Repeated-measures of analysis of variance (ANOVA) was performed to examine its pain relief status and cortical activation, with post hoc analysis after Bonferroni correction performed. Spearman's correlation test was conducted to explore the relationship between VR questionnaire (VRQ) items and cortical activation. RESULTS A larger analgesic effect on the active (-1.4(95%CI, -2.23 to -0.57), p = 0.001) and MI modes (-0.667(95%CI, -1.165 to -0.168), p = 0.012) was observed compared to the passive mode in the self-rating pain score, with no significant difference reported between the two modes (-0.733(95%CI, -1.631 to.165), p = 0.131), associated with diverse activated cortical region of interest (ROI) in charge of motor and cognitive functions, including the left primary motor cortex (LM1), left dorsal-lateral prefrontal cortex (LDLPFC), left primary somatosensory cortex (LS1), left visual cortex at occipital lobe (LOL), and left premotor cortex (LPMC). On the other hand, significant correlations were found between VRQ items and different cortical ROIs (r = -0.629 to 0.722, p < 0.05) as well as its corresponding channels (r = -0.599 to 0.788, p < 0.05). CONCLUSION Our findings suggest that VR can be considered as an effective non-invasive approach for pain relief by modulating cortical pain processing. A better analgesic effect can be obtained by exciting and integrating cortical ROIs in charge of motor and cognitive functions. The interactive mode can be easily tailored to be in line with the client's characteristics, in spite of the diverse cortical activation status when an equivalent analgesic effect can be obtained.
Collapse
Affiliation(s)
- Xue Deng
- Department of Rehabilitation Medicine, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China
| | - Chuyao Jian
- Department of Rehabilitation Medicine, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China
| | - Qinglu Yang
- Department of Rehabilitation Medicine, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China
| | - Naifu Jiang
- Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences (CAS), Shenzhen, China
| | - Zhaoyin Huang
- Department of Rehabilitation Medicine, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China
| | - Shaofeng Zhao
- Department of Rehabilitation Medicine, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China
| |
Collapse
|
7
|
DaSilva AF, Robinson MA, Shi W, McCauley LK. The Forefront of Dentistry-Promising Tech-Innovations and New Treatments. JDR Clin Trans Res 2022; 7:16S-24S. [PMID: 36121134 PMCID: PMC9793430 DOI: 10.1177/23800844221116850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
KNOWLEDGE TRANSFER STATEMENT This article discusses innovations in technology and treatments that have enormous potential to revolutionize our dental care, including novel concepts in electronic health records, communication between dentists and patients, biologics around diagnosis and treatment, digital dentistry, and, finally, the real-time optimization of information technology. The early implementation and validation of these innovations can drive down their costs and provide better dental and medical services to all members of our society.
Collapse
Affiliation(s)
- A F DaSilva
- Learning Health Systems, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - M A Robinson
- University of Alabama at Birmingham School of Dentistry, Birmingham, AL, USA
- University of Alabama at Birmingham School of Education, Birmingham, AL, USA
| | - W Shi
- The Forsyth Institute, Cambridge, MA, USA
| | - L K McCauley
- University of Michigan School of Dentistry, Ann Arbor, MI, USA
| |
Collapse
|
8
|
Zhang YN, Xing XX, Chen L, Dong X, Pan HT, Hua XY, Wang K. Brain Functional Alteration at Different Stages of Neuropathic Pain With Allodynia and Emotional Disorders. Front Neurol 2022; 13:843815. [PMID: 35585842 PMCID: PMC9108233 DOI: 10.3389/fneur.2022.843815] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/30/2022] [Indexed: 12/20/2022] Open
Abstract
Neuropathic pain (NeuP), a challenging medical condition, has been suggested by neuroimaging studies to be associated with abnormalities of neural activities in some brain regions. However, aberrancies in brain functional alterations underlying the sensory-discriminative abnormalities and negative emotions in the setting of NeuP remain unexplored. Here, we aimed to investigate the functional alterations in neural activity relevant to pain as well as pain-related depressive-like and anxiety-like behaviors in NeuP by combining amplitude of low frequency fluctuation (ALFF) and degree centrality (DC) analyses methods based on resting-state functional magnetic resonance imaging (rs-fMRI). A rat model of NeuP was established via chronic constriction injury (CCI) of the sciatic nerve. Results revealed that the robust mechanical allodynia occurred early and persisted throughout the entire observational period. Depressive and anxiety-like behaviors did not appear until 4 weeks after injury. When the maximum allodynia was apparent early, CCI rats exhibited decreased ALFF and DC values in the left somatosensory and nucleus accumbens shell (ACbSh), respectively, as compared with sham rats. Both values were significantly positively correlated with mechanical withdrawal thresholds (MWT). At 4 weeks post-CCI, negative emotional states were apparent and CCI rats were noted to exhibit increased ALFF values in the left somatosensory and medial prefrontal cortex (mPFC) as well as increased DC values in the right motor cortex, as compared with sham rats. At 4 weeks post-CCI, ALFF values in the left somatosensory cortex and DC values in the right motor cortex were noted to negatively correlate with MWT and exhibition of anxiety-like behavior on an open-field test (OFT); values were found to positively correlate with the exhibition of depressive-like behavior on forced swimming test (FST). The mPFC ALFF values were found to negatively correlate with the exhibition of anxiety-like behavior on OFT and positively correlate with the exhibition of depressive-like behavior on FST. Our findings detail characteristic alterations of neural activity patterns induced by chronic NeuP and underscore the important role of the left somatosensory cortex, as well as its related networks, in the mediation of subsequent emotional dysregulation due to NeuP.
Collapse
Affiliation(s)
- Ya-Nan Zhang
- Acupuncture Anesthesia Clinical Research Institute, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiang-Xin Xing
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China,Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
| | - Liu Chen
- Acupuncture Anesthesia Clinical Research Institute, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xin Dong
- Acupuncture Anesthesia Clinical Research Institute, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hao-Tian Pan
- Acupuncture Anesthesia Clinical Research Institute, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xu-Yun Hua
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China,Department of Traumatology and Orthopedics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China,*Correspondence: Xu-Yun Hua
| | - Ke Wang
- Acupuncture Anesthesia Clinical Research Institute, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China,Ke Wang
| |
Collapse
|
9
|
Sommer C. ["COVID-19" and "Anxiety and Virtual Reality"]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2021; 89:605-606. [PMID: 34872129 DOI: 10.1055/a-1653-8400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Das Thema COVID-19 und neurologische Erkrankungen lässt uns so schnell nicht los. Nach unserem Themenheft im Juni dieses Jahres greifen Gülke und Gerloff das Thema im aktuellen Heft noch einmal auf, mit einem instruktiven Fallbeispiel, und setzten den Fokus auf die Auswirkungen einer COVID-19 Erkrankung bei Patienten mit neurologischen Vorerkrankungen 1. Die neurologischen Symptome bei COVID-19 Erkrankung werden derzeit durch verschiedene Pathomechanismen erklärt: a) Direkte Bindung an ACE2-Rezeptoren und somit Funktionsstörung von Neuronen, die solche Rezeptoren exprimieren, b) Hyperkoagulabilität und c) der Zytokinsturm, der auch für die schwere Lungenbeteiligung verantwortlich gemacht wird 2. Anosmie und Ageusie, Schlaganfälle und Enzephalopathie sind somit pathophysiologisch plausible und inzwischen in der internationalen Literatur gut beschriebene Komplikationen der COVID-19 Erkrankung. Im peripheren Nervensystem kommen noch einige Erkrankungen dazu. Eine Critical-illness Neuropathie ist eine häufige Komplikation bei allen intensivmedizinisch behandelten Patienten, insbesondere, wenn auch eine Sepsis vorliegt 3, und somit auch bei COVID-19 erkrankten Intensivpatienten. Ob das Guillain-Barré-Syndrom (GBS, oder akute inflammatorische demyelinisierende Polyradikuloneuropathie (AIDP)) im Zusammenhang mit COVID-19 Erkrankungen häufiger vorkommt als sonst, wird in der Literatur kontrovers diskutiert, während z. B. der Anstieg von GBS-Fällen in endemischen Gebieten der ZIKA-Erkrankung vor einigen Jahren eindeutig war 4. Im Zusammenhang mit COVID-19 Erkrankung wurde in Großbritannien sogar ein Rückgang der GBS-Fälle beobachtet 5, während eine rezente Metaanalyse ein erhöhtes GBS-Risiko nach COVID-19 Erkrankung fand 6. Auch Fälle von neuaufgetretenen neuropathisch oder myogen verursachten Schmerzen nach COVID-19 Erkrankung sind beschrieben worden 7. Ein interessantes Phänomen ist die vorübergehende Hyp- oder Analgesie unter und nach COVID-19 Erkrankung, für die man einen ähnlichen Mechanismus annimmt wie für die Anosmie. Hierzu wurde kürzlich eine Fallserie publiziert 8, und auch wir konnten einen solchen Fall beobachten 9. Aus den vielfältigen Wirkungen von SARS-CoV-2 und der COVID-19 Erkrankung auf das Nervensystem werden wir also noch viele pathophysiologische Erkenntnisse ziehen können. Ein großes Rätsel sind weiterhin die Symptome des Post-COVID-19-Syndroms, insbesondere Fatigue und die kognitiven Störungen 1.
Collapse
|