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Wang Y, Liu W, Wang Y, Ouyang G, Guo Y. Long-term HD-tDCS modulates dynamic changes of brain activity on patients with disorders of consciousness: A resting-state EEG study. Comput Biol Med 2024; 170:108084. [PMID: 38295471 DOI: 10.1016/j.compbiomed.2024.108084] [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: 11/30/2023] [Revised: 01/10/2024] [Accepted: 01/27/2024] [Indexed: 02/02/2024]
Abstract
OBJECTIVE High-definition transcranial direct current stimulation (HD-tDCS) has been an effective neurostimulation method in the treatment of disorders of consciousness (DOC). However, the effects and mechanism of HD-tDCS are still unclear. METHODS This study recruited 8 DOC patients and applied 20-min sessions of 2 mA HD-tDCS (central anode electrode at Pz) for 14 consecutive days. We record DOC patients' EEG data and Coma Recovery Scale-Revised (CRS-R) values at four time point: baseline (T0), after 1 day's and 7,14 days' parietal HD-tDCS treatment (T1, T2, T3). Power spectral density (PSD), relative power (RP), spectral entropy and spectral exponent were calculated to evaluate the EEG dynamic changes of DOC patients during long-term parietal HD-tDCS. At last, we calculated the correlation between changes of EEG features and changes of CRS-R values. RESULT After 1 day's parietal HD-tDCS, DOC patients' CRS-R value had not changed (8.25 ± 1.91). HD-tDCS improved DOC patients' CRS-R value at T2 (9.75 ± 1.91, p < 0.05) and at T3 (11.38 ± 2.77, p < 0.05), compared with that at T0 (8.25 ± 1.91). As the treatment time increased, the EEG PSD decayed more slowly. Specifically, the delta frequency band RP decreased, while the alpha, beta, and gamma frequency bands RP increased. EEG oscillation characteristics changed but not significant at T1 (p > 0.05), and showed significant changes at T2 and T3 (p < 0.05). The spectral entropy continuously increased and the spectral exponent continuously decreased from T0 to T3. Specifically, the spectral entropy and spectral exponent of the parietal and occipital regions were significantly higher at T2 and T3 than that at T0 (p < 0.05). In addition, The changes in EEG features of the parietal and occipital lobes were correlated with changes in CRS-R value, especially between T2 and T0. CONCLUSION Long-term parietal HD-tDCS can improve the consciousness level and brain activity in DOC patients. Resting-state EEG can evaluate the dynamic changes of brain activity in DOC patients during HD-tDCS. EEG oscillation and non-oscillatory activity might be used to explain the mechanism of HD-tDCS on DOC patients.
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Affiliation(s)
- Yong Wang
- Zhuhai UM Science & Technology Research Institute, Zhuhai, China
| | - Wanqing Liu
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingying Wang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing, Normal University, Beijing, China
| | - Gaoxiang Ouyang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing, Normal University, Beijing, China.
| | - Yongkun Guo
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Henan Key Laboratory of Brain Science and Brain Computer Interface Technology, Zhengzhou, China.
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Cheng XR, Zhang YB, Sun DJ, Peng XY, Bao YC, Zhang F, Wang MX. Long-term repetitive transcranial direct current stimulation in patients with disorders of consciousness: a preliminary study. Brain Inj 2024; 38:68-75. [PMID: 38329075 DOI: 10.1080/02699052.2024.2304872] [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: 01/03/2023] [Accepted: 01/09/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVES To investigate the effects of long-term repetitive transcranial direct current stimulation on patients with DOC in the subacute phase. METHODS In a randomized, double-blind, controlled study, 33 patients were randomly assigned to the active or sham group, and 28 patients completed the study. Patients in the active group received anodal stimulation over the DLPFC, while patients in the sham group received placebo stimulation (20 min/day, 5 days/week, for 4 weeks). The level of consciousness among patients was assessed with the Coma Recovery Scale-Revised (CRS-R) at baseline and at the end of every week from the first to the fourth week. RESULTS The CRS-R scores of both the active and sham groups showed a consistent increasing trend over time; however, the treatment effect of the active group was better than that of the sham group. In addition, there was a statistically significant difference in the total CRS-R score between the two groups at weeks 1, 2, 3 and 4. Moreover, 10 patients (71.4%) in the active group and 3 patients (21.4%) in the sham group were regarded as responders. CONCLUSION Long-term tDCS could improve the level of consciousness of patients with DOC in the subacute stage.
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Affiliation(s)
- Xiao Rong Cheng
- Department of Rehabilitation, The Second Hospital of Lanzhou University, Lan Zhou, Gan Su Province, China
| | - Yi Bao Zhang
- Department of Rehabilitation, The Second Hospital of Lanzhou University, Lan Zhou, Gan Su Province, China
| | - Deng Juan Sun
- Department of Rehabilitation, The Second Hospital of Lanzhou University, Lan Zhou, Gan Su Province, China
| | - Xiao Yun Peng
- Department of Rehabilitation, The Second Hospital of Lanzhou University, Lan Zhou, Gan Su Province, China
| | - Ying Cun Bao
- Department of Rehabilitation, The Second Hospital of Lanzhou University, Lan Zhou, Gan Su Province, China
| | - Fang Zhang
- Department of Rehabilitation, The Second Hospital of Lanzhou University, Lan Zhou, Gan Su Province, China
| | - Man Xia Wang
- Department of Neurology, The Second Hospital of Lanzhou University, Lan Zhou, Gan Su Province, China
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Vatrano M, Nemirovsky IE, Tonin P, Riganello F. Assessing Consciousness through Neurofeedback and Neuromodulation: Possibilities and Challenges. Life (Basel) 2023; 13:1675. [PMID: 37629532 PMCID: PMC10455583 DOI: 10.3390/life13081675] [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: 07/03/2023] [Revised: 07/27/2023] [Accepted: 07/30/2023] [Indexed: 08/27/2023] Open
Abstract
Neurofeedback is a non-invasive therapeutic approach that has gained traction in recent years, showing promising results for various neurological and psychiatric conditions. It involves real-time monitoring of brain activity, allowing individuals to gain control over their own brainwaves and improve cognitive performance or alleviate symptoms. The use of electroencephalography (EEG), such as brain-computer interface (BCI), transcranial direct current stimulation (tDCS), and transcranial magnetic stimulation (TMS), has been instrumental in developing neurofeedback techniques. However, the application of these tools in patients with disorders of consciousness (DoC) presents unique challenges. In this narrative review, we explore the use of neurofeedback in treating patients with DoC. More specifically, we discuss the advantages and challenges of using tools such as EEG neurofeedback, tDCS, TMS, and BCI for these conditions. Ultimately, we hope to provide the neuroscientific community with a comprehensive overview of neurofeedback and emphasize its potential therapeutic applications in severe cases of impaired consciousness levels.
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Affiliation(s)
- Martina Vatrano
- S. Anna Institute, Research in Advanced Neurorehabilitation, Via Siris, 11, 88900 Crotone, Italy;
| | - Idan Efim Nemirovsky
- Department of Physics and Astronomy, Brain and Mind Institute, University of Western Ontario, London, ON N6A 3K7, Canada;
| | - Paolo Tonin
- S. Anna Institute, Research in Advanced Neurorehabilitation, Via Siris, 11, 88900 Crotone, Italy;
| | - Francesco Riganello
- S. Anna Institute, Research in Advanced Neurorehabilitation, Via Siris, 11, 88900 Crotone, Italy;
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Effects of psychoeducation combined with transcranial direct current stimulation on reducing cigarette craving and consumption in male smokers. Addict Behav 2023; 141:107643. [PMID: 36791642 DOI: 10.1016/j.addbeh.2023.107643] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/20/2022] [Accepted: 02/02/2023] [Indexed: 02/09/2023]
Abstract
Psychoeducation (PE) has been widely used in smoking interventions, but its long-term effects are limited. Recent studies have reported that, in some fields, a combination of transcranial direct current stimulation (tDCS) and cognitive training (e.g., working memory tasks) may improve cognitive outcomes; thus, we aimed to investigate whether such a combined intervention has a better effect than a PE intervention for reducing smoking cravings and cigarette consumption. In Exp. 1, 19 male smokers received four types of interventions at one-week intervals. In each session, participants were presented with audio PE (or control) while receiving 2-mA active (or sham) tDCS of the dorsolateral prefrontal cortex (DLPFC). In Exp. 2, 48 male smokers were randomized into four experimental groups (PE + Active, Control + Active, PE + Sham, or Control + Sham). Each participant received one type of five-day intervention (i.e., watching a five-minute PE/Control video twice while receiving 2-mA active/sham tDCS) and was followed up for one week. The results showed (a) an enhancement effect of tDCS on PE's ability to reduce cigarette consumption; (b) that repeated PE has a cumulative effect on reducing both craving and cigarette consumption during the intervention period; and (c) that, compared with PE alone, PE combined with tDCS is capable of helping participants maintain a low intake of cigarettes over one week. These findings suggest that repeated interventions of PE combined with tDCS may be effective in reducing smoking consumption and that further studies are warranted to confirm its application.
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Li C, Wang Y, Li W, Yang Y, Xia X. Measure functional network and cortical excitability in post-anoxic patients with unresponsive wakefulness syndrome diagnosed by behavioral scales. Front Neurosci 2023; 16:1071594. [PMID: 36711155 PMCID: PMC9874310 DOI: 10.3389/fnins.2022.1071594] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
Background Brain assessment shows great values in prognosis, treatment, resource allocation, and decision-making for patients with disorders of consciousness (DOC). However, less research focused on cortical conditions of patients with unresponsive wakefulness syndrome (UWS). Methods We recorded resting-state EEG and TMS-EEG from post-anoxic patients with UWS, diagnosed by repeated Coma Recovery Scale-Revised (CRS-R). Measurements of functional connectivity and networks were performed by phase lock value (PLV) and network parameters of graph theory (average path length, clustering coefficient, and small-world). Global cortical reactivity values (GCRV) were used to assess cortical excitability. Results The coefficient of variation (CV) presented marked inter-individual variations of PLV (CV = 0.285), network parameters (CV > 0.2), and GCRV (CV = 0.929) within these patients. The patients' PLV and network parameters at theta and alpha bands significantly correlated with their GCRV values. Patients with higher PLV (r = 0.560, 0.406), as well as better preserved network (lower average path length (r = -0.522, -0.483), higher clustering coefficient (r = 0.522, 0.445), and small-world (r = 0.522, 0.445) at theta and alpha bands, presented higher GCRV. The functional connectivity, which is significantly correlated with frontal GCRV, is also mainly located in the frontal region. These correlations were not significant at other frequency bands: Delta, beta, and gamma bands. Conclusion These findings suggested that the CRS-R-diagnosed post-anoxic patients with UWS had very different cortical conditions. Functional networks and cortical excitability measured by TMS-EEG could complement behavioral assessment to assess these patients' cortical conditions. Significance It provides a deeper understanding of neurophysiological dysfunction in patients with UWS and hints to the clinics that neural-electrophysiological assessment for such patients may be necessary to acquire their brain conditions, which may benefit stratified management for them.
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Affiliation(s)
- Chen Li
- Department of Interventional and Vascular Neurosurgery, The Characteristic Medical Center of People’s Liberation Army (PLA) Rocket Force, Beijing, China
| | - Yong Wang
- Zhuhai University of Macau (UM) Science & Technology Research Institute, Zhuhai, China
| | - Wende Li
- Senior Department of Neurosurgery, The First Medical Center of People’s Liberation Army (PLA) General Hospital, Beijing, China,Department of Neurosurgery, The Seventh Medical Center of People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Yi Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Beijing, China
| | - Xiaoyu Xia
- Senior Department of Neurosurgery, The First Medical Center of People’s Liberation Army (PLA) General Hospital, Beijing, China,Department of Neurosurgery, The Seventh Medical Center of People’s Liberation Army (PLA) General Hospital, Beijing, China,*Correspondence: Xiaoyu Xia,
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Tao M, Zhang S, Han Y, Li C, Wei Q, Chen D, Zhao Q, Yang J, Liu R, Fang J, Li X, Zhang H, Liu H, Cao JL. Efficacy of transcranial direct current stimulation on postoperative delirium in elderly patients undergoing lower limb major arthroplasty: A randomized controlled trial. Brain Stimul 2023; 16:88-96. [PMID: 36682718 DOI: 10.1016/j.brs.2023.01.839] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/26/2022] [Accepted: 01/13/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Postoperative delirium (POD) is a common and severe postoperative complication in elderly patients undergoing major surgery linked to increased morbidity and mortality. It is reported that transcranial direct current stimulation (tDCS) effectively enhances cognitive function and improves impaired consciousness. OBJECTIVE This study aimed to evaluate the efficacy of tDCS on POD in elderly patients undergoing lower limb major arthroplasty, including total hip arthroplasty (THA) or total knee arthroplasty (TKA). METHODS Patients aged ≥65 years scheduled for THA or TKA were randomly assigned to receive 2 mA tDCS for 20 min active-tDCS (n = 61) or sham-tDCS (n = 61). The primary outcome was the incidence of POD during the first 3 postoperative days. RESULTS All 122 patients (median age, 70 years; 80 women [65.6%]) completed the trial. The incident delirium risk was 4.9% (n = 3) vs. 19.7% (n = 12) in active-tDCS and sham-tDCS groups, respectively (relative risk, 0.250; 95% CI, 0.074 to 0.842; P = 0.013). Compared to the sham-tDCS group, the anxiety and depression scores of patients in the active-tDCS group were lower at 2 h and one day after surgery (P < 0.001 for each), and pain scores of patients in the active-tDCS group were lower during the first three days after surgery (P < 0.05). CONCLUSION One session of anodal tDCS over the left dorsolateral prefrontal cortex may decrease the incidence of POD in elderly patients undergoing lower limb major arthroplasty.
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Affiliation(s)
- Mingshu Tao
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China; NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs & Jiangsu Province Key Laboratory of Anesthesiology & Jiangsu Key Laboratory of Applied Technology of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, China
| | - Song Zhang
- Department of Anesthesiology, Renji Hospital School of Medicine Shanghai Jiao Tong University, Shanghai, China
| | - Yuan Han
- Department of Anesthesiology, Eye & ENT Hospital of Fudan University, Shanghai, China.
| | - Chunyan Li
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China; NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs & Jiangsu Province Key Laboratory of Anesthesiology & Jiangsu Key Laboratory of Applied Technology of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, China
| | - Qi Wei
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China; NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs & Jiangsu Province Key Laboratory of Anesthesiology & Jiangsu Key Laboratory of Applied Technology of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, China
| | - Dexian Chen
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China; NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs & Jiangsu Province Key Laboratory of Anesthesiology & Jiangsu Key Laboratory of Applied Technology of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, China
| | - Qiu Zhao
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China; NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs & Jiangsu Province Key Laboratory of Anesthesiology & Jiangsu Key Laboratory of Applied Technology of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, China
| | - Jie Yang
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China; NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs & Jiangsu Province Key Laboratory of Anesthesiology & Jiangsu Key Laboratory of Applied Technology of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, China
| | - Rongguang Liu
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China; NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs & Jiangsu Province Key Laboratory of Anesthesiology & Jiangsu Key Laboratory of Applied Technology of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, China
| | - Jiaxing Fang
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China; NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs & Jiangsu Province Key Laboratory of Anesthesiology & Jiangsu Key Laboratory of Applied Technology of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, China
| | - Xiang Li
- Department of Anesthesiology, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Hongxing Zhang
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs & Jiangsu Province Key Laboratory of Anesthesiology & Jiangsu Key Laboratory of Applied Technology of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, China
| | - He Liu
- Department of Anesthesiology & Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation, Huzhou Central Hospital, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Affiliated Central Hospital Huzhou University, Huzhou, China.
| | - Jun-Li Cao
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China; NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs & Jiangsu Province Key Laboratory of Anesthesiology & Jiangsu Key Laboratory of Applied Technology of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, China.
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Xu Z, Zheng R, Xia T, Qi Z, Zang D, Wang Z, Wu X. Behavioral effects in disorders of consciousness following transcranial direct current stimulation: A systematic review and individual patient data meta-analysis of randomized clinical trials. Front Neurol 2022; 13:940361. [PMID: 36247787 PMCID: PMC9558708 DOI: 10.3389/fneur.2022.940361] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/18/2022] [Indexed: 11/29/2022] Open
Abstract
Background In patients with Disorders of Consciousness (DoC), recent evidence suggests that transcranial direct current stimulation (tDCS) can be a promising intervention for them. However, there has been little agreement on the treatment effect and the optimal treatment strategy for the tDCS in patients with DoC. Objective In this meta-analysis of individual patient data (IPD), we assess whether tDCS could improve DoC patients' behavioral performance. We also determine whether these treatment effects could be modified by patient characteristics or tDCS protocol. Methods We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials until 7 April 2022 using the terms “persistent vegetative state,” “minimally conscious state,” “disorder of consciousness,” or “unresponsive wakefulness syndrome,” and “transcranial direct current stimulation” to identify Randomized Controlled Trials (RCTs) in English-language publications. Studies were eligible for inclusion if they reported pre- and post-tDCS Coma Recovery Scale-Revised (CRS-R) scores. From the included studies, patients who had incomplete data were excluded. We performed a meta-analysis to assess the treatment effect of the tDCS compared with sham control. Additionally, various subgroup analyses were performed to determine whether specific patient characteristics could modify the treatment effect and to find out the optimal tDCS protocol. Results We identified 145 papers, but eventually eight trials (including 181 patients) were included in the analysis, and one individual data were excluded because of incomplete data. Our meta-analysis demonstrated a mean difference change in the CRS-R score of 0.89 (95% CI, 0.17–1.61) between tDCS and sham-control, favoring tDCS. The subgroup analysis showed that patients who were male or with a minimally conscious state (MCS) diagnosis were associated with a greater improvement in CRS-R score. We also found that patients who underwent five or more sessions of tDCS protocol had a better treatment effect than just one session. Conclusion The result shows that tDCS can improve the behavioral performance of DoC patients. The heterogeneity of the treatment effect existed within the patients' baseline conditions and the stimulation protocol. More explorative studies on the optimal tDCS protocol and the most beneficial patient group based on the mechanism of tDCS are required in the future. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42022331241.
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Affiliation(s)
- Zeyu Xu
- Department of Neurosurgery, Shanghai Medical College, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Ruizhe Zheng
- Department of Neurosurgery, Shanghai Medical College, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Tiantong Xia
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Zengxin Qi
- Department of Neurosurgery, Shanghai Medical College, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Di Zang
- Department of Neurosurgery, Shanghai Medical College, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Zhe Wang
- Department of Neurosurgery, Shanghai Medical College, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Xuehai Wu
- Department of Neurosurgery, Shanghai Medical College, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- *Correspondence: Xuehai Wu
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Liu S, Gao Q, Guan M, Chen Y, Cheng S, Yang L, Meng W, Lu C, Li B. Effectiveness of transcranial direct current stimulation over dorsolateral prefrontal cortex in patients with prolonged disorders of consciousness: A systematic review and meta-analysis. Front Neurol 2022; 13:998953. [PMID: 36226076 PMCID: PMC9549167 DOI: 10.3389/fneur.2022.998953] [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: 07/20/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022] Open
Abstract
Background Transcranial direct current stimulation (tDCS) has been widely studied for treatment of patients with prolonged disorders of consciousness (PDOC). The dorsolateral prefrontal cortex (DLPFC) is a hot target for intervention, but some controversies remain. Purpose This review aimed to systematically investigate the therapeutic effects of DLPFC-anodal-tDCS for patients with PDOC through a meta-analysis approach. Data sources Searches for relevant articles available in English were conducted using EMBASE, Medline, Web of Science, EBSCO, and Cochrane Central Register of Controlled Trials from inception until March 26, 2022. Study selection All randomized parallel or cross-over controlled trials comparing the effect of intervention with active-tDCS and Sham-tDCS on Coma Recovery Scale Revised (CRS-R) score in individuals with PDOC were included. Data extraction Two authors independently extracted data, assessed the methodological quality, and rated each study. Data synthesis Ten randomized parallel or cross-over controlled trials were eligible for systematic review, and eight of the studies involving 165 individuals were identified as eligible for meta-analysis. Compared with Sham-tDCS, the use of anode-tDCS over DLPFC improved the CRS-R score (SMD = 0.71; 95% CI: 0.47–0.95, I2 = 10%). Patients with PDOC classified as MCS and clinically diagnosed as CVA or TBI may benefit from anode-tDCS. Limitations Failure to evaluate the long-term effects and lack of quantitative analysis of neurological examination are the main limitations for the application of anode-tDCS. Conclusions Anodal-tDCS over the left DLPFC may be advantageous to the recovery of patients with MCS and clinically diagnosed with CVA or TBI. There is a lack of evidence to support the duration of the disease course will limit the performance of the treatment. Further studies are needed to explore the diversity of stimulation targets and help to improve the mesocircuit model. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=279391, identifier: CRD42022279391.
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Functional Connectivity Increases in Response to High-Definition Transcranial Direct Current Stimulation in Patients with Chronic Disorder of Consciousness. Brain Sci 2022; 12:brainsci12081095. [PMID: 36009158 PMCID: PMC9405975 DOI: 10.3390/brainsci12081095] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/10/2022] [Accepted: 08/16/2022] [Indexed: 11/17/2022] Open
Abstract
Highlights Functional connectivity induced by HD-tDCS in DLPFC has different trends in CRS-R score improvers and non-improvers. An increase in theta PLV in the left frontal–parietooccipital region was significantly associated with CRS-R changes. DOC patients with increased PLV of the alpha band in the intra-bifrontal region have a better prognosis than those without.
Abstract High-definition transcranial direct current stimulation (HD-tDCS) has been shown to play an important role in improving consciousness in patients with disorders of consciousness (DOCs), but its neuroelectrophysiological evidence is still lacking. To better explain the electrophysiological mechanisms of the effects of HD-tDCS on patients with DOCs, 22 DOC patients underwent 10 anodal HD-tDCS sessions of the left dorsolateral prefrontal cortex (DLPFC). This study used the Coma Recovery Scale-Revised (CRS-R) to assess the level of consciousness in DOC patients. According to whether the CRS-R score increased before and after stimulation, DOC patients were divided into a responsive group and a non-responsive group. By comparing the differences in resting-state EEG functional connectivity between different frequency bands and brain regions, as well as the relationship between functional connectivity values and clinical scores, the electrophysiological mechanism of the clinical effects of HD-tDCS was further explored. The change of the phase locking value (PLV) on the theta frequency band in the left frontal–parietooccipital region was positively correlated with the change in the CRS-R scores. As the number of interventions increased, we observed that in the responsive group, the change in PLV showed an upward trend, and the increase in the PLV appeared in the left frontal–parietooccipital region at 4–8 Hz and in the intra-bifrontal region at 8–13 Hz. In the non-responsive group, although the CRS-R scores did not change after stimulation, the PLV showed a downward trend, and the decrease in the PLV appeared in the intra-bifrontal region at 8–13 Hz. In addition, at the three-month follow-up, patients with increased PLV in the intra-bifrontal region at 8–13 Hz after repeated HD-tDCS stimulation had better outcomes than those without. Repeated anodal stimulation of the left DLPFC with HD-tDCS resulted in improved consciousness in some patients with DOCs. The increase in functional connectivity in the brain regions may be associated with the improvement of related awareness after HD-tDCS and may be a predictor of better long-term outcomes.
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Liu B, Zhang X, Li Y, Duan G, Hou J, Zhao J, Guo T, Wu D. tDCS-EEG for Predicting Outcome in Patients With Unresponsive Wakefulness Syndrome. Front Neurosci 2022; 16:771393. [PMID: 35812233 PMCID: PMC9263392 DOI: 10.3389/fnins.2022.771393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives We aimed to assess the role of transcranial direct current stimulation (tDCS) combined with electroencephalogram (EEG) for predicting prognosis in UWS cases. Methods This was a historical control study that enrolled 85 patients with UWS. The subjects were assigned to the control (without tDCS) and tDCS groups. Conventional treatments were implemented in both the control and tDCS groups, along with 40 multi-target tDCS sessions only in the tDCS group. Coma Recovery Scale-Revised (CRS-R) was applied at admission. The non-linear EEG index was evaluated after treatment. The modified Glasgow Outcome Scale (mGOS) was applied 12 months after disease onset. Results The mGOS improvement rate in the tDCS group (37.1%) was higher than the control value (22.0%). Linear regression analysis revealed that the local and remote cortical networks under unaffected pain stimulation conditions and the remote cortical network under affected pain stimulation conditions were the main relevant factors for mGOS improvement. Furthermore, the difference in prefrontal-parietal cortical network was used to examine the sensitivity of prognostic assessment in UWS patients. The results showed that prognostic sensitivity could be increased from 54.5% (control group) to 84.6% (tDCS group). Conclusions This study proposes a tDCS-EEG protocol for predicting the prognosis of UWS. With multi-target tDCS combined with EEG, the sensitivity of prognostic assessment in patients with UWS was improved. The recovery might be related to improved prefrontal-parietal cortical networks of the unaffected hemisphere.
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Affiliation(s)
- Baohu Liu
- Department of Rehabilitation, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Xu Zhang
- Department of Rehabilitation, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuanyuan Li
- Department of Rehabilitation, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Guoping Duan
- Department of Rehabilitation, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Jun Hou
- Department of Rehabilitation, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiayi Zhao
- Department of Rehabilitation, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Tongtong Guo
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Dongyu Wu
- Department of Rehabilitation, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Dongyu Wu
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11
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Han J, Chen C, Zheng S, Yan X, Wang C, Wang K, Hu Y. High-Definition Transcranial Direct Current Stimulation of the Dorsolateral Prefrontal Cortex Modulates the Electroencephalography Rhythmic Activity of Parietal Occipital Lobe in Patients With Chronic Disorders of Consciousness. Front Hum Neurosci 2022; 16:889023. [PMID: 35712532 PMCID: PMC9196904 DOI: 10.3389/fnhum.2022.889023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundDisorders of consciousness (DOC) are a spectrum of pathologies affecting one’s ability to interact with the external world. At present, High-Definition Transcranial Direct Current Stimulation (HD-tDCS) is used in many patients with DOC as a non-invasive treatment, but electrophysiological research on the effect of HD-tDCS on patients with DOC is limited.ObjectivesTo explore how HD-tDCS affects the cerebral cortex and examine the possible electrophysiological mechanisms underlying the effects of HD-tDCS on the cerebral cortex.MethodsA total of 19 DOC patients were assigned to HD-tDCS stimulation. Each of them underwent 10 anodal HD-tDCS sessions of the left dorsolateral prefrontal cortex (DLPFC) over 5 consecutive days. Coma Recovery Scale-Revision (CRS-R) scores were recorded to evaluate the consciousness level before and after HD-tDCS, while resting-state electroencephalography (EEG) recordings were obtained immediately before and after single and multiple HD-tDCS stimuli. Depending on whether the CRS-R score increased after stimulation, we classified the subjects into responsive (RE) and non-responsive (N-RE) groups and compared the differences in power spectral density (PSD) between the groups in different frequency bands and brain regions, and also examined the relationship between PSD values and CRS-R scores.ResultsFor the RE group, the PSD value of the parieto-occipital region increased significantly in the 6–8 Hz frequency band after multiple stimulations by HD-tDCS. After a single stimulation, an increase in PSD was observed at 10–13 and 13–30 Hz. In addition, for all subjects, a positive correlation was observed between the change in PSD value in the parieto-occipital region at 10–13 and 6–8 Hz frequency band and the change in CRS-R score after a single stimulation.ConclusionRepeated anodal HD-tDCS of the left DLPFC can improve clinical outcomes in patients with DOC, and HD-tDCS-related increased levels of consciousness were associated with increased parieto-occipital PSD.
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Affiliation(s)
- Jinying Han
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Chen Chen
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Shuang Zheng
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Xiaoxiang Yan
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Changqing Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Hefei Comprehensive National Science Center, Institute of Artificial Intelligence, Hefei, China
- *Correspondence: Kai Wang,
| | - Yajuan Hu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Yajuan Hu,
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12
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fMRI and transcranial electrical stimulation (tES): A systematic review of parameter space and outcomes. Prog Neuropsychopharmacol Biol Psychiatry 2021; 107:110149. [PMID: 33096158 DOI: 10.1016/j.pnpbp.2020.110149] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 08/12/2020] [Accepted: 10/17/2020] [Indexed: 12/12/2022]
Abstract
The combination of non-invasive brain stimulation interventions with human brain mapping methods have supported research beyond correlational associations between brain activity and behavior. Functional MRI (fMRI) partnered with transcranial electrical stimulation (tES) methods, i.e., transcranial direct current (tDCS), transcranial alternating current (tACS), and transcranial random noise (tRNS) stimulation, explore the neuromodulatory effects of tES in the targeted brain regions and their interconnected networks and provide opportunities for individualized interventions. Advances in the field of tES-fMRI can be hampered by the methodological variability between studies that confounds comparability/replicability. In order to explore variability in the tES-fMRI methodological parameter space (MPS), we conducted a systematic review of 222 tES-fMRI experiments (181 tDCS, 39 tACS and 2 tRNS) published before February 1, 2019, and suggested a framework to systematically report main elements of MPS across studies. Publications dedicated to tRNS-fMRI were not considered in this systematic review. We have organized main findings in terms of fMRI modulation by tES. tES modulates activation and connectivity beyond the stimulated areas particularly with prefrontal stimulation. There were no two studies with the same MPS to replicate findings. We discuss how to harmonize the MPS to promote replication in future studies.
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13
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Abstract
Background: Reviving patients with prolonged disorders of consciousness (DOCs) has always been focused and challenging in medical research. Owing to the limited effectiveness of available medicine, recent research has increasingly turned towards neuromodulatory therapies, involving the stimulation of neural circuits. We summarised the progression of research regarding neuromodulatory therapies in the field of DOCs, compared the differences among different studies, in an attempt to explore optimal stimulation patterns and parameters, and analyzed the major limitations of the relevant studies to facilitate future research. Methods: We performed a search in the PubMed database, using the concepts of DOCs and neuromodulation. Inclusion criteria were: articles in English, published after 2002, and reporting clinical trials of neuromodulatory therapies in human patients with DOCs. Results: Overall, 187 published articles met the search criteria, and 60 articles met the inclusion criteria. There are differences among these studies regarding the clinical efficacies of neurostimulation techniques for patients with DOCs, and large-sample studies are still lacking. Conclusions: Neuromodulatory techniques were used as trial therapies for DOCs wherein their curative effects were controversial. The difficulties in detecting residual consciousness, the confounding effect between the natural course of the disease and therapeutic effect, and the heterogeneity across patients are the major limitations. Large-sample, well-designed studies, and innovations for both treatment and assessment are anticipated in future research.
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14
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Chen J, Qin J, He Q, Zou Z. A Meta-Analysis of Transcranial Direct Current Stimulation on Substance and Food Craving: What Effect Do Modulators Have? Front Psychiatry 2020; 11:598. [PMID: 32670118 PMCID: PMC7332543 DOI: 10.3389/fpsyt.2020.00598] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/09/2020] [Indexed: 12/22/2022] Open
Abstract
Substance addiction and food addiction are significant social problems worldwide. In previous studies of substance addiction, transcranial direct current stimulation (tDCS) has been used to influence craving of substance or food. However, the reported effects are not always consistent due to inconsistent experimental settings. The way modulators influence the effect of tDCS on substance addiction is worth exploring. This meta-analysis was conducted to estimate the effect size of tDCS on substance and food craving and to investigate the influence of potential modulators. We systemically identified and reviewed studies on substance/food craving using tDCS that were published between January 2008 to January 2020. A total of 32 eligible studies were identified. Hedges' g was computed as an indicator of the effect of tDCS and some potential moderators (substance type, stimulation sites, current intensities, number of sessions, duration of stimulation, and study design) were examined using subgroup analysis. Random effects analysis revealed a total medium effect size [Hedges' g = 0.536, 95% confidence interval (CI): 0.389-0.683, after adjusting Hedges' g = 0.416, 95% CI: 0.262-0.570] preferring active over sham stimulation to reduce craving. A significant difference was observed between the number of sessions (repeated stimulation was better than single stimulation). The duration of stimulation may have a positive influence on the effects of tDCS. No other significant differences were found in other subgroups analysis. In conclusion, our results provided evidence that tDCS can be an effective way to reduce craving of substance or food, and longer multiple stimulus durations in all can more effectively reduce craving; however, the influences of modulators still need be to be examined in depth in future.
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Affiliation(s)
| | | | | | - Zhiling Zou
- Faculty of Psychology, Southwest University, Chongqing, China
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15
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Esmaeilpour Z, Shereen AD, Ghobadi‐Azbari P, Datta A, Woods AJ, Ironside M, O'Shea J, Kirk U, Bikson M, Ekhtiari H. Methodology for tDCS integration with fMRI. Hum Brain Mapp 2020; 41:1950-1967. [PMID: 31872943 PMCID: PMC7267907 DOI: 10.1002/hbm.24908] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 11/09/2019] [Accepted: 12/10/2019] [Indexed: 12/28/2022] Open
Abstract
Understanding and reducing variability of response to transcranial direct current stimulation (tDCS) requires measuring what factors predetermine sensitivity to tDCS and tracking individual response to tDCS. Human trials, animal models, and computational models suggest structural traits and functional states of neural systems are the major sources of this variance. There are 118 published tDCS studies (up to October 1, 2018) that used fMRI as a proxy measure of neural activation to answer mechanistic, predictive, and localization questions about how brain activity is modulated by tDCS. FMRI can potentially contribute as: a measure of cognitive state-level variance in baseline brain activation before tDCS; inform the design of stimulation montages that aim to target functional networks during specific tasks; and act as an outcome measure of functional response to tDCS. In this systematic review, we explore methodological parameter space of tDCS integration with fMRI spanning: (a) fMRI timing relative to tDCS (pre, post, concurrent); (b) study design (parallel, crossover); (c) control condition (sham, active control); (d) number of tDCS sessions; (e) number of follow up scans; (f) stimulation dose and combination with task; (g) functional imaging sequence (BOLD, ASL, resting); and (h) additional behavioral (cognitive, clinical) or quantitative (neurophysiological, biomarker) measurements. Existing tDCS-fMRI literature shows little replication across these permutations; few studies used comparable study designs. Here, we use a representative sample study with both task and resting state fMRI before and after tDCS in a crossover design to discuss methodological confounds. We further outline how computational models of current flow should be combined with imaging data to understand sources of variability. Through the representative sample study, we demonstrate how modeling and imaging methodology can be integrated for individualized analysis. Finally, we discuss the importance of conducting tDCS-fMRI with stimulation equipment certified as safe to use inside the MR scanner, and of correcting for image artifacts caused by tDCS. tDCS-fMRI can address important questions on the functional mechanisms of tDCS action (e.g., target engagement) and has the potential to support enhancement of behavioral interventions, provided studies are designed rationally.
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Affiliation(s)
- Zeinab Esmaeilpour
- Neural Engineering Laboratory, Department of Biomedical EngineeringThe City College of the City University of New York, City College Center for Discovery and InnovationNew YorkNew York
| | - A. Duke Shereen
- Advanced Science Research Center, The Graduate CenterCity University of New YorkNew YorkNew York
| | | | | | - Adam J. Woods
- Center for Cognitive Aging and Memory, McKnight Brain Institute, Department of Clinical and Health PsychologyUniversity of FloridaGainesvilleFlorida
| | - Maria Ironside
- Center for Depression, Anxiety and Stress Research, McLean HospitalBelmontMassachusetts
- Department of PsychiatryHarvard Medical SchoolBostonMassachusetts
| | - Jacinta O'Shea
- Nuffield Department of Clinical Neuroscience, Medical Science DivisionUniversity of OxfordOxfordEnglandUK
| | - Ulrich Kirk
- Department of PsychologyUniversity of Southern DenmarkOdenseDenmark
| | - Marom Bikson
- Neural Engineering Laboratory, Department of Biomedical EngineeringThe City College of the City University of New York, City College Center for Discovery and InnovationNew YorkNew York
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16
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Shou Z, Li Z, Wang X, Chen M, Bai Y, Di H. Non-invasive brain intervention techniques used in patients with disorders of consciousness. Int J Neurosci 2020; 131:390-404. [PMID: 32238043 DOI: 10.1080/00207454.2020.1744598] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Aim of the study: With the development of emergency medicine and intensive care technology, the number of people who survive with disorders of consciousness (DOC) has dramatically increased. The diagnosis and treatment of such patients have attracted much attention from the medical community. From the latest evidence-based guidelines, non-invasive brain intervention (NIBI) techniques may be valuable and promising in the diagnosis and conscious rehabilitation of DOC patients.Methods: This work reviews the studies on NIBI techniques for the assessment and intervention of DOC patients.Results: A large number of studies have explored the application of NIBI techniques in DOC patients. The NIBI techniques include transcranial magnetic stimulation, transcranial electric stimulation, music stimulation, near-infrared laser stimulation, focused shock wave therapy, low-intensity focused ultrasound pulsation and transcutaneous auricular vagus nerve stimulation.Conclusions: NIBI techniques present numerous advantages such as being painless, safe and inexpensive; having adjustable parameters and targets; and having broad development prospects in treating DOC patients.
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Affiliation(s)
- Zeyu Shou
- International Vegetative State and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China.,Key Laboratory of Aging and Cancer Biology of Zhejiang Province, Hangzhou Normal University, Hangzhou, China
| | - Zhilong Li
- International Vegetative State and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China.,Key Laboratory of Aging and Cancer Biology of Zhejiang Province, Hangzhou Normal University, Hangzhou, China
| | - Xueying Wang
- International Vegetative State and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China.,Key Laboratory of Aging and Cancer Biology of Zhejiang Province, Hangzhou Normal University, Hangzhou, China
| | - Miaoyang Chen
- International Vegetative State and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China.,Key Laboratory of Aging and Cancer Biology of Zhejiang Province, Hangzhou Normal University, Hangzhou, China
| | - Yang Bai
- International Vegetative State and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China.,Key Laboratory of Aging and Cancer Biology of Zhejiang Province, Hangzhou Normal University, Hangzhou, China
| | - Haibo Di
- International Vegetative State and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China.,Key Laboratory of Aging and Cancer Biology of Zhejiang Province, Hangzhou Normal University, Hangzhou, China
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17
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Cavaliere C, Aiello M, Soddu A, Laureys S, Reislev NL, Ptito M, Kupers R. Organization of the commissural fiber system in congenital and late-onset blindness. NEUROIMAGE-CLINICAL 2019; 25:102133. [PMID: 31945651 PMCID: PMC6965724 DOI: 10.1016/j.nicl.2019.102133] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 12/04/2019] [Accepted: 12/13/2019] [Indexed: 11/13/2022]
Abstract
Larger anterior commissure (AC) in congenitally (CB) and late blind (LB) subjects. Decreased fractional anisotropy (FA) of the posterior part of AC (pAC) in CB and LB. Decreased FA in pAC is paralleled by increased number of pAC streamlines in CB only. Selective reduction of the splenium of the corpus callosum (CC) in CB and LB. Reduction of splenium correlated with decrease in streamlines and tract volume.
We investigated the effects of blindness on the structural and functional integrity of the corpus callosum and the anterior commissure (AC), which together form the two major components of the commissural pathways. Twelve congenitally blind (CB), 15 late blind (LB; mean onset of blindness of 16.6 ± 8.9 years), and 15 matched normally sighted controls (SC) participated in a multimodal brain imaging study. Magnetic resonance imaging(MRI) data were acquired using a 3T scanner, and included a structural brain scan, resting state functional MRI, and diffusion-weighted imaging. We used tractography to divide the AC into its anterior (aAC) and posterior (pAC) branch. Virtual tract dissection was performed using a deterministic spherical deconvolution tractography algorithm. The corpus callosum was subdivided into five subregions based on the criteria described by Witelson and modified by Bermudez and Zatorre. Our data revealed decreased fractional anisotropy of the pAC in CB and LB compared to SC, together with an increase in the number of streamlines in CB only. In addition, the AC surface area was significantly larger in CB compared to SC and LB, and correlated with the number of streamlines in pAC (rho = 0.55) and tract volume (rho = 0.46). As for the corpus callosum, the splenial part was significantly smaller in CB and LB, and fewer streamlines passed through it. We did not find group differences in functional connectivity of cortical areas connected by fibers crossing any of the five callosal subregions. The present data suggest that the two main components of the commissural system undergo neuroplastic changes, irrespective of the age of onset of blindness, although the alterations observed in the AC are more important in congenital than late-onset blindness.
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Affiliation(s)
- Carlo Cavaliere
- IRCCS SDN, Via E. Gianturco 113, 80143 Naples, Italy; GIGA-Consciousness - Coma Science Group, GIGA-Research and Neurology Department, University and University Hospital of Liège, Liège, Belgium.
| | - Marco Aiello
- IRCCS SDN, Via E. Gianturco 113, 80143 Naples, Italy
| | - Andrea Soddu
- Brain and Mind Institute, The Department of Physics and Astronomy, University of Western Ontario London, ON, Canada
| | - Steven Laureys
- GIGA-Consciousness - Coma Science Group, GIGA-Research and Neurology Department, University and University Hospital of Liège, Liège, Belgium
| | - Nina L Reislev
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, 2650 Hvidovre, Denmark
| | - Maurice Ptito
- Ecole d'Optométrie, Université de Montréal, Montréal, Québec, Canada; Department of nuclear Medicine, University of Southern Denmark, Odense, Denmark; BRAINlab, Institute of Neuroscience, Panum Institute, Faculty of Health and Medical Sciences, University of Copenhagen, Nørre Allé 10, 2200 Copenhagen,Denmark
| | - Ron Kupers
- Ecole d'Optométrie, Université de Montréal, Montréal, Québec, Canada; BRAINlab, Institute of Neuroscience, Panum Institute, Faculty of Health and Medical Sciences, University of Copenhagen, Nørre Allé 10, 2200 Copenhagen,Denmark; Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium.
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18
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Lin Y, Liu T, Huang Q, Su Y, Chen W, Gao D, Tian X, Huang T, Zhen Z, Han T, Ye H, Wang Y. Electroencephalography and Functional Magnetic Resonance Imaging-Guided Simultaneous Transcranial Direct Current Stimulation and Repetitive Transcranial Magnetic Stimulation in a Patient With Minimally Conscious State. Front Neurosci 2019; 13:746. [PMID: 31417339 PMCID: PMC6685103 DOI: 10.3389/fnins.2019.00746] [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: 11/20/2018] [Accepted: 07/05/2019] [Indexed: 12/23/2022] Open
Abstract
Objective A minimally conscious state (MCS) is characterized by discernible behavioral evidence of consciousness that cannot be reproduced consistently. This condition is highly challenging to treat. Recent studies have demonstrated the potential therapeutic effect of non-invasive brain stimulation in patients with MCS. In one patient in an MCS, we delivered simultaneous transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) based on an individual brain network analysis and evaluated the therapeutic effect. Methods The directional transfer function (DTF) was calculated based on electroencephalograph (EEG) analysis. Global brain connectivity was calculated based on functional magnetic resonance imaging (fMRI) analysis. By referring to the EEG and fMRI results, we identified inferior parietal lobes (IPLs) as targets. In the 2-week treatment period, 14 sessions were applied to the identified bilateral parietal regions. Simultaneous 1.5-mA anodal tDCS and 5-Hz rTMS were delivered for 20 min per hemisphere in each session. Clinical evaluation scores were recorded weekly throughout the treatment. A second patient given the routine treatment was evaluated as a control. Results The clinical scores of patient 1 with MCS improved after 2 weeks of stimulation treatment, and the effect lasted for up to 1 month. EEG analysis showed a significant increase (p < 0.001) in the DTF value in the gamma band in a bilateral set of posterior regions, and fMRI showed a trend toward normalized activity in the IPLs. The clinical scores of patient 2 with coma did not improve much after 2 weeks of routine treatment. The EEG analysis showed a significant increase (p = 0.021) in the DTF value in the gamma band in a bilateral set of posterior regions. Conclusion The application of EEG and fMRI to characterize the functional connectivity features of the network in an MCS patient provided a reasonable and accurate stimulation target and verified the changes in functional connectivity resulting from stimulation.
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Affiliation(s)
- Yicong Lin
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tiaotiao Liu
- School of Biomedical Engineering, Tianjin Medical University, Tianjin, China
| | - Qian Huang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yingying Su
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Weibi Chen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Daiquan Gao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xin Tian
- School of Biomedical Engineering, Tianjin Medical University, Tianjin, China
| | - Taicheng Huang
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Zonglei Zhen
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Tao Han
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hong Ye
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,The Beijing Key Laboratory of Neuromodulation, Beijing, China.,Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
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19
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Bourdillon P, Hermann B, Sitt JD, Naccache L. Electromagnetic Brain Stimulation in Patients With Disorders of Consciousness. Front Neurosci 2019; 13:223. [PMID: 30936822 PMCID: PMC6432925 DOI: 10.3389/fnins.2019.00223] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 02/26/2019] [Indexed: 12/27/2022] Open
Abstract
Severe brain injury is a common cause of coma. In some cases, despite vigilance improvement, disorders of consciousness (DoC) persist. Several states of impaired consciousness have been defined, according to whether the patient exhibits only reflexive behaviors as in the vegetative state/unresponsive wakefulness syndrome (VS/UWS) or purposeful behaviors distinct from reflexes as in the minimally conscious state (MCS). Recently, this clinical distinction has been enriched by electrophysiological and neuroimaging data resulting from a better understanding of the physiopathology of DoC. However, therapeutic options, especially pharmacological ones, remain very limited. In this context, electroceuticals, a new category of therapeutic agents which act by targeting the neural circuits with electromagnetic stimulations, started to develop in the field of DoC. We performed a systematic review of the studies evaluating therapeutics relying on the direct or indirect electro-magnetic stimulation of the brain in DoC patients. Current evidence seems to support the efficacy of deep brain stimulation (DBS) and non-invasive brain stimulation (NIBS) on consciousness in some of these patients. However, while the latter is non-invasive and well tolerated, the former is associated with potential major side effects. We propose that all chronic DoC patients should be given the possibility to benefit from NIBS, and that transcranial direct current stimulation (tDCS) should be preferred over repetitive transcranial magnetic stimulation (rTMS), based on the literature and its simple use. Surgical techniques less invasive than DBS, such as vagus nerve stimulation (VNS) might represent a good compromise between efficacy and invasiveness but still need to be further investigated.
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Affiliation(s)
- Pierre Bourdillon
- Department of Neurosurgery, Adolphe de Rothschild Foundation, Paris, France
- Sorbonne Université, Faculté de Médecine Pitié-Salpêtrière, Paris, France
- Institut du Cerveau et de la Moelle Épinière, ICM, PICNIC Lab, Paris, France
- Inserm U 1127, Paris, France
- CNRS, UMR 7225, Paris, France
| | - Bertrand Hermann
- Sorbonne Université, Faculté de Médecine Pitié-Salpêtrière, Paris, France
- Institut du Cerveau et de la Moelle Épinière, ICM, PICNIC Lab, Paris, France
- Inserm U 1127, Paris, France
- CNRS, UMR 7225, Paris, France
- Department of Neurology, Neuro ICU, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - Jacobo D. Sitt
- Institut du Cerveau et de la Moelle Épinière, ICM, PICNIC Lab, Paris, France
- Inserm U 1127, Paris, France
- CNRS, UMR 7225, Paris, France
| | - Lionel Naccache
- Sorbonne Université, Faculté de Médecine Pitié-Salpêtrière, Paris, France
- Institut du Cerveau et de la Moelle Épinière, ICM, PICNIC Lab, Paris, France
- Inserm U 1127, Paris, France
- CNRS, UMR 7225, Paris, France
- Department of Neurophysiology, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
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20
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Cavaliere C, Kandeepan S, Aiello M, Ribeiro de Paula D, Marchitelli R, Fiorenza S, Orsini M, Trojano L, Masotta O, St Lawrence K, Loreto V, Chronik BA, Nicolai E, Soddu A, Estraneo A. Multimodal Neuroimaging Approach to Variability of Functional Connectivity in Disorders of Consciousness: A PET/MRI Pilot Study. Front Neurol 2018; 9:861. [PMID: 30405513 PMCID: PMC6200912 DOI: 10.3389/fneur.2018.00861] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 09/24/2018] [Indexed: 12/18/2022] Open
Abstract
Behavioral assessments could not suffice to provide accurate diagnostic information in individuals with disorders of consciousness (DoC). Multimodal neuroimaging markers have been developed to support clinical assessments of these patients. Here we present findings obtained by hybrid fludeoxyglucose (FDG-)PET/MR imaging in three severely brain-injured patients, one in an unresponsive wakefulness syndrome (UWS), one in a minimally conscious state (MCS), and one patient emerged from MCS (EMCS). Repeated behavioral assessment by means of Coma Recovery Scale-Revised and neurophysiological evaluation were performed in the two weeks before and after neuroimaging acquisition, to ascertain that clinical diagnosis was stable. The three patients underwent one imaging session, during which two resting-state fMRI (rs-fMRI) blocks were run with a temporal gap of about 30 min. rs-fMRI data were analyzed with a graph theory approach applied to nine independent networks. We also analyzed the benefits of concatenating the two acquisitions for each patient or to select for each network the graph strength map with a higher ratio of fitness. Finally, as for clinical assessment, we considered the best functional connectivity pattern for each network and correlated graph strength maps to FDG uptake. Functional connectivity analysis showed several differences between the two rs-fMRI acquisitions, affecting in a different way each network and with a different variability for the three patients, as assessed by ratio of fitness. Moreover, combined PET/fMRI analysis demonstrated a higher functional/metabolic correlation for patients in EMCS and MCS compared to UWS. In conclusion, we observed for the first time, through a test-retest approach, a variability in the appearance and temporal/spatial patterns of resting-state networks in severely brain-injured patients, proposing a new method to select the most informative connectivity pattern.
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Affiliation(s)
- Carlo Cavaliere
- IRCCS SDN, Istituto di Ricerca Diagnostica e Nucleare, Naples, Italy.,Coma Science Group, GIGA-Research, University and University Hospital of Liege, Liege, Belgium
| | - Sivayini Kandeepan
- Department of Physics and Astronomy, Brain and Mind Institute, Western University, London, ON, Canada
| | - Marco Aiello
- IRCCS SDN, Istituto di Ricerca Diagnostica e Nucleare, Naples, Italy
| | | | - Rocco Marchitelli
- IRCCS SDN, Istituto di Ricerca Diagnostica e Nucleare, Naples, Italy
| | - Salvatore Fiorenza
- Neurorehabilitation Unit and Research Laboratory for Disorder of Consciousness, Maugeri ICS, IRCCS, Telese Terme, Italy
| | - Mario Orsini
- IRCCS SDN, Istituto di Ricerca Diagnostica e Nucleare, Naples, Italy
| | - Luigi Trojano
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Orsola Masotta
- Neurorehabilitation Unit and Research Laboratory for Disorder of Consciousness, Maugeri ICS, IRCCS, Telese Terme, Italy
| | - Keith St Lawrence
- Lawson Health Research Institute London, Medical Biophysics, University of Western Ontario, London, ON, Canada
| | - Vincenzo Loreto
- Neurorehabilitation Unit and Research Laboratory for Disorder of Consciousness, Maugeri ICS, IRCCS, Telese Terme, Italy
| | - Blaine Alexander Chronik
- Department of Physics and Astronomy, Brain and Mind Institute, Western University, London, ON, Canada
| | - Emanuele Nicolai
- IRCCS SDN, Istituto di Ricerca Diagnostica e Nucleare, Naples, Italy
| | - Andrea Soddu
- Department of Physics and Astronomy, Brain and Mind Institute, Western University, London, ON, Canada
| | - Anna Estraneo
- Neurorehabilitation Unit and Research Laboratory for Disorder of Consciousness, Maugeri ICS, IRCCS, Telese Terme, Italy
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21
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Welsby E, Ridding M, Hillier S, Hordacre B. Connectivity as a Predictor of Responsiveness to Transcranial Direct Current Stimulation in People with Stroke: Protocol for a Double-Blind Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e10848. [PMID: 30341044 PMCID: PMC6231838 DOI: 10.2196/10848] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/31/2018] [Accepted: 08/01/2018] [Indexed: 01/24/2023] Open
Abstract
Background Stroke can have devastating consequences for an individual’s quality of life. Interventions capable of enhancing response to therapy would be highly valuable to the field of neurological rehabilitation. One approach is to use noninvasive brain stimulation techniques, such as transcranial direct current stimulation, to induce a neuroplastic response. When delivered in combination with rehabilitation exercises, there is some evidence that transcranial direct current stimulation is beneficial. However, responses to stimulation are highly variable. Therefore biomarkers predictive of response to stimulation would be valuable to help select appropriate people for this potentially beneficial treatment. Objective The objective of this study is to investigate connectivity of the stimulation target, the ipsilesional motor cortex, as a biomarker predictive of response to anodal transcranial direct current stimulation in people with stroke. Methods This study is a double blind, randomized controlled trial (RCT), with two parallel groups. A total of 68 participants with first ever ischemic stroke with motor impairment will undertake a two week (14 session) treatment for upper limb function (Graded Repetitive Arm Supplementary Program; GRASP). Participants will be randomized 2:1 to active:sham treatment groups. Those in the active treatment group will receive anodal transcranial direct current stimulation to the ipsilesional motor cortex at the start of each GRASP session. Those allocated to the sham treatment group will receive sham transcranial direct current stimulation. Behavioural assessments of upper limb function will be performed at baseline, post treatment, 1 month follow-up and 3 months follow-up. Neurophysiological assessments will include magnetic resonance imaging (MRI), electroencephalography (EEG) and transcranial magnetic stimulation (TMS) and will be performed at baseline, post treatment, 1 month follow-up (EEG and TMS only) and 3 months follow-up (EEG and TMS only). Results Participants will be recruited between March 2018 and December 2018, with experimental testing concluding in March 2019. Conclusions Identifying a biomarker predictive of response to transcranial direct current stimulation would greatly assist clinical utility of this novel treatment approach. Trial Registration Australia New Zealand Clinical Trials Registry ACTRN12618000443291; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618000443291 (Archived by WebCite at http://www.webcitation.org/737QOXXxt) Registered Report Identifier RR1-10.2196/10848
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Affiliation(s)
- Ellana Welsby
- The Sansom Institute for Health Research, School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Michael Ridding
- Neuromotor Plasticity and Development Group, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Susan Hillier
- The Sansom Institute for Health Research, School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Brenton Hordacre
- The Sansom Institute for Health Research, School of Health Sciences, University of South Australia, Adelaide, Australia
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22
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Testing assumptions on prefrontal transcranial direct current stimulation: Comparison of electrode montages using multimodal fMRI. Brain Stimul 2018; 11:998-1007. [DOI: 10.1016/j.brs.2018.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 03/25/2018] [Accepted: 05/01/2018] [Indexed: 11/19/2022] Open
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23
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Shahbabaie A, Ebrahimpoor M, Hariri A, Nitsche MA, Hatami J, Fatemizadeh E, Oghabian MA, Ekhtiari H. Transcranial DC stimulation modifies functional connectivity of large-scale brain networks in abstinent methamphetamine users. Brain Behav 2018; 8:e00922. [PMID: 29541538 PMCID: PMC5840443 DOI: 10.1002/brb3.922] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 12/06/2017] [Accepted: 12/18/2017] [Indexed: 12/14/2022] Open
Abstract
Background Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation tool suited to alter cortical excitability and activity via the application of weak direct electrical currents. An increasing number of studies in the addiction literature suggests that tDCS modulates subjective self-reported craving through stimulation of dorsolateral prefrontal cortex (DLPFC). The major goal of this study was to explore effects of bilateral DLPFC stimulation on resting state networks (RSNs) in association with drug craving modulation. We targeted three large-scale RSNs; the default mode network (DMN), the executive control network (ECN), and the salience network (SN). Methods Fifteen males were recruited after signing written informed consent. We conducted a double-blinded sham-controlled crossover study. Twenty-minute "real" and "sham" tDCS (2 mA) were applied over the DLPFC on two separate days in random order. Each subject received both stimulation conditions with a 1-week washout period. The anode and cathode electrodes were located over the right and left DLPFC, respectively. Resting state fMRI was acquired before and after real and sham stimulation. Subjective craving was assessed before and after each fMRI scan. The RSNs were identified using seed-based analysis and were compared using a generalized linear model. Results Subjective craving decreased significantly after real tDCS compared to sham stimulation (p = .03). Moreover, the analysis shows significant modulation of DMN, ECN, and SN after real tDCS compared to sham stimulation. Additionally, alteration of subjective craving score was correlated with modified activation of the three networks. Discussion Given the observed alteration of the targeted functional brain networks in methamphetamine users, new potentials are highlighted for tDCS as a network intervention strategy and rsfMRI as a suitable monitoring method for these interventions.
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Affiliation(s)
- Alireza Shahbabaie
- Institute for Cognitive Science StudiesTehranIran
- Neuroimaging and Analysis GroupResearch Center for Cellular and Molecular ImagingTehran University of Medical SciencesTehranIran
- Iranian National Center for Addiction StudiesTehran University of Medical SciencesTehranIran
- Department of Psychology and NeurosciencesLeibniz Research Center for Working Environment and Human FactorsDortmundGermany
| | - Mitra Ebrahimpoor
- Neuroimaging and Analysis GroupResearch Center for Cellular and Molecular ImagingTehran University of Medical SciencesTehranIran
- Department of Medical Statistics and BioinformaticsLeiden University Medical CenterLeidenthe Netherlands
| | - Ali Hariri
- Department of NanoEngineering and Materials Science and Engineering ProgramUniversity of California San DiegoLa JollaCAUSA
- Department of Electrical EngineeringSharif University of TechnologyTehranIran
| | - Michael A. Nitsche
- Department of Psychology and NeurosciencesLeibniz Research Center for Working Environment and Human FactorsDortmundGermany
| | - Javad Hatami
- Institute for Cognitive Science StudiesTehranIran
- Department of Psychology and Educational SciencesUniversity of TehranTehranIran
| | - Emad Fatemizadeh
- Department of Electrical EngineeringSharif University of TechnologyTehranIran
| | - Mohammad Ali Oghabian
- Neuroimaging and Analysis GroupResearch Center for Cellular and Molecular ImagingTehran University of Medical SciencesTehranIran
| | - Hamed Ekhtiari
- Institute for Cognitive Science StudiesTehranIran
- Neuroimaging and Analysis GroupResearch Center for Cellular and Molecular ImagingTehran University of Medical SciencesTehranIran
- Iranian National Center for Addiction StudiesTehran University of Medical SciencesTehranIran
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24
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Zhang Y, Song W, Du J, Huo S, Shan G, Li R. Transcranial Direct Current Stimulation in Patients with Prolonged Disorders of Consciousness: Combined Behavioral and Event-Related Potential Evidence. Front Neurol 2017; 8:620. [PMID: 29209270 PMCID: PMC5702306 DOI: 10.3389/fneur.2017.00620] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 11/06/2017] [Indexed: 12/13/2022] Open
Abstract
Background The electrophysiological evidence supporting the therapeutic efficacy of multiple transcranial direct current stimulation (tDCS) sessions on consciousness improvement in patients with prolonged disorders of consciousness (DOCs) has not been firmly established. Objectives To assess the effects of repeated tDCS in patients with prolonged DOCs by Coma Recovery Scale-Revised (CRS-R) score and event-related potential (ERP). Method Using a sham-controlled randomized double-blind design, 26 patients were randomly assigned to either a real [five vegetative state (VS) and eight minimally conscious state (MCS) patients] or sham (six VS and seven MCS patients) stimulation group. The patients in the real stimulation group underwent 20 anodal tDCS sessions of the left dorsolateral prefrontal cortex (DLPFC) over 10 consecutive working days. The CRS-R score and P300 amplitude and latency in a hierarchical cognitive assessment were recorded to evaluate the consciousness level before tDCS and immediately after the 20 sessions. Results The intra-group CRS-R analysis revealed a clinically significant improvement in the MCS patients in the real stimulation group. The inter-group CRS-R analysis showed a significant difference in CRS-R between VS and MCS patients at baseline in both the real and sham stimulation groups. The intra-group ERP analysis revealed a significant increase in P300 amplitude after tDCS in the MCS patients in the real stimulation group, but no significant differences in P300 latency. For the inter-group ERP analysis, we observed significant differences regarding the presence of P300 at baseline between the VS and MCS patients in both groups. Conclusion The repeated anodal tDCS of the left DLPFC could produce clinically significant improvements in MCS patients. The observed tDCS-related consciousness improvements might be related to improvements in attention resource allocation (reflected by the P300 amplitude). The findings support the use of tDCS in clinical practice and ERP might serve as an efficient electrophysiological assessment tool in patients with DOCs.
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Affiliation(s)
- Ye Zhang
- Department of Rehabilitation Medicine, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Weiqun Song
- Department of Rehabilitation Medicine, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Jubao Du
- Department of Rehabilitation Medicine, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Su Huo
- Department of Rehabilitation Medicine, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Guixiang Shan
- Department of Rehabilitation Medicine, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Ran Li
- Department of Rehabilitation Medicine, Xuan Wu Hospital, Capital Medical University, Beijing, China
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25
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Zhang Y, Song W. Transcranial direct current stimulation in disorders of consciousness: a review. Int J Neurosci 2017; 128:255-261. [PMID: 28918680 DOI: 10.1080/00207454.2017.1381094] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ye Zhang
- Department of Rehabilitation Medicine, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Weiqun Song
- Department of Rehabilitation Medicine, Xuan Wu Hospital, Capital Medical University, Beijing, China
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26
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Abstract
Severe brain injury may cause disruption of neural networks that sustain arousal and awareness, the two essential components of consciousness. Despite the potentially devastating immediate and long-term consequences, disorders of consciousness (DoC) are poorly understood in terms of their underlying neurobiology, the relationship between pathophysiology and recovery, and the predictors of treatment efficacy. Recent advances in neuroimaging techniques have enabled the study of network connectivity, providing great potential to improve the clinical care of patients with DoC. Initial discoveries in this field were made using positron emission tomography (PET). More recently, functional magnetic resonance (fMRI) techniques have added to our understanding of functional network dynamics in this population. Both methods have shown that whether at rest or performing a goal-oriented task, functional networks essential for processing intrinsic thoughts and extrinsic stimuli are disrupted in patients with DoC compared with healthy subjects. Atypical connectivity has been well established in the default mode network as well as in other cortical and subcortical networks that may be required for consciousness. Moreover, the degree of altered connectivity may be related to the severity of impaired consciousness, and recovery of consciousness has been shown to be associated with restoration of connectivity. In this review, we discuss PET and fMRI studies of functional and effective connectivity in patients with DoC and suggest how this field can move toward clinical application of functional network mapping in the future.
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Affiliation(s)
- Yelena G. Bodien
- Center for Neurotechnology and Neurorecovery, Department of
Neurology, Massachusetts General Hospital, Boston, MA
- Department of Physical Medicine and Rehabilitation, Spaulding
Rehabilitation Hospital, Charlestown, MA
- Harvard Medical School, Boston, MA
| | - Camille Chatelle
- Center for Neurotechnology and Neurorecovery, Department of
Neurology, Massachusetts General Hospital, Boston, MA
- Coma Science Group, GIGA-Research, University of Liège
& Neurology Department, University Hospital of Liège, Liège,
Belgium
| | - Brian L. Edlow
- Center for Neurotechnology and Neurorecovery, Department of
Neurology, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts
General Hospital, Charlestown, MA
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27
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Coherence in P300 as a predictor for the recovery from disorders of consciousness. Neurosci Lett 2017; 653:332-336. [PMID: 28610950 DOI: 10.1016/j.neulet.2017.06.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/24/2017] [Accepted: 06/09/2017] [Indexed: 12/21/2022]
Abstract
Accurate and reliable prognostic judgments for disorders of consciousness (DOCs) can provide useful information for clinicians in the establishment of appropriate care plan, and may affect end-of-life decisions of caregivers. But until now no certain or standardized prognostic indicator has been constructed to predict the probability of awareness recovery. This study aims to assess higher-order cortical information processing in DOCs by event-related potential (ERP) and determine the value of P300 to predict the long-term prognosis. Two locked-in (LIS) patients and eighteen DOCs were evaluated with a hierarchical cognitive assessment by ERP. We used subject's own name (SON) as a deviant stimulus, 1000Hz tone and subject's derived name (SDN) as a standard stimulus in two paradigms respectively. P300 elicited by SON was used to assess the information processing. The patients' clinical outcomes were followed up at 2, 6 and 12 months after ERP recordings. The results showed that a P300 component was observed in both paradigms in two LIS patients. All of MCS and four out of nine UWS/VS showed an intact P300 in either paradigm. All of the five patients with P300 in both paradigms were finally awake after 12 months, while none of the eight patients without P300 regained consciousness. A highly significant relationship between P300 and subsequent recovery was found. The results provide evidence that P300 in the hierarchical bedside neurophysiologic oddball procedure can accurately characterize the level of cognitive preservation, and may serve as an alternative tool to predict the likelihood of recovery of DOCs.
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28
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Zhao H, Qiao L, Fan D, Zhang S, Turel O, Li Y, Li J, Xue G, Chen A, He Q. Modulation of Brain Activity with Noninvasive Transcranial Direct Current Stimulation (tDCS): Clinical Applications and Safety Concerns. Front Psychol 2017; 8:685. [PMID: 28539894 PMCID: PMC5423956 DOI: 10.3389/fpsyg.2017.00685] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 04/19/2017] [Indexed: 11/13/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) is a widely-used tool to induce neuroplasticity and modulate cortical function by applying weak direct current over the scalp. In this review, we first introduce the underlying mechanism of action, the brief history from discovery to clinical scientific research, electrode positioning and montages, and parameter setup of tDCS. Then, we review tDCS application in clinical samples including people with drug addiction, major depression disorder, Alzheimer's disease, as well as in children. This review covers the typical characteristics and the underlying neural mechanisms of tDCS treatment in such studies. This is followed by a discussion of safety, especially when the current intensity is increased or the stimulation duration is prolonged. Given such concerns, we provide detailed suggestions regarding safety procedures for tDCS operation. Lastly, future research directions are discussed. They include foci on the development of multi-tech combination with tDCS such as with TMS and fMRI; long-term behavioral and morphological changes; possible applications in other research domains, and more animal research to deepen the understanding of the biological and physiological mechanisms of tDCS stimulation.
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Affiliation(s)
- Haichao Zhao
- Faculty of Psychology, Southwest UniversityChongqing, China
| | - Lei Qiao
- Faculty of Psychology, Southwest UniversityChongqing, China
| | - Dongqiong Fan
- Faculty of Psychology, Southwest UniversityChongqing, China
| | - Shuyue Zhang
- School of Education, Guangxi UniversityNanning, China
| | - Ofir Turel
- Department of Information systems and Decision Sciences, College of Business and Economics, California State University, FullertonFullerton, CA, USA
| | - Yonghui Li
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of SciencesBeijing, China
| | - Jun Li
- National Key Laboratory of Cognitive Neuroscience and Learning, IDG/McGovern Institute for Brain Research, Beijing Normal UniversityBeijing, China
| | - Gui Xue
- National Key Laboratory of Cognitive Neuroscience and Learning, IDG/McGovern Institute for Brain Research, Beijing Normal UniversityBeijing, China
| | - Antao Chen
- Faculty of Psychology, Southwest UniversityChongqing, China
| | - Qinghua He
- Faculty of Psychology, Southwest UniversityChongqing, China.,Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of SciencesBeijing, China.,Southwest University Branch, Collaborative Innovation Center of Assessment toward Basic Education Quality at Beijing Normal UniversityChongqing, China
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