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Zhuang Y, Zhai W, Li Q, Jiao H, Ge Q, Rong P, He J. Effects of simultaneous transcutaneous auricular vagus nerve stimulation and high-definition transcranial direct current stimulation on disorders of consciousness: a study protocol. Front Neurol 2023; 14:1165145. [PMID: 37693756 PMCID: PMC10483839 DOI: 10.3389/fneur.2023.1165145] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/08/2023] [Indexed: 09/12/2023] Open
Abstract
Background Non-invasive brain stimulation (NIBS) techniques are now widely used in patients with disorders of consciousness (DOC) for accelerating their recovery of consciousness, especially minimally conscious state (MCS). However, the effectiveness of single NIBS techniques for consciousness rehabilitation needs further improvement. In this regard, we propose to enhance from bottom to top the thalamic-cortical connection by using transcutaneous auricular vagus nerve stimulation (taVNS) and increase from top to bottom cortical-cortical connections using simultaneous high-definition transcranial direct current stimulation (HD-tDCS) to reproduce the network of consciousness. Methods/design The study will investigate the effect and safety of simultaneous joint stimulation (SJS) of taVNS and HD-tDCS for the recovery of consciousness. We will enroll 84 MCS patients and randomize them into two groups: a single stimulation group (taVNS and HD-tDCS) and a combined stimulation group (SJS and sham stimulation). All patients will undergo a 4-week treatment. The primary outcome will be assessed using the coma recovery scale-revised (CRS-R) at four time points to quantify the effect of treatment: before treatment (T0), after 1 week of treatment (T1), after 2 weeks of treatment (T2), and after 4 weeks of treatment (T3). At the same time, nociception coma scale-revised (NCS-R) and adverse effects (AEs) will be collected to verify the safety of the treatment. The secondary outcome will involve an analysis of electroencephalogram (EEG) microstates to assess the response mechanisms of dynamic brain networks to SJS. Additionally, CRS-R and AEs will continue to be obtained for a 3-month follow-up (T4) after the end of the treatment. Discussion This study protocol aims to innovatively develop a full-time and multi-brain region combined neuromodulation paradigm based on the mesocircuit model to steadily promote consciousness recovery by restoring thalamocortical and cortical-cortical interconnections.
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Affiliation(s)
- Yutong Zhuang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, The Second Clinical College of Southern Medical University, Guangzhou, China
| | - Weihang Zhai
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Qinghua Li
- College of Anesthesiology, Shanxi Medical University, Taiyuan, China
| | - Haoyang Jiao
- Institute of Documentation, Chinese Academy of Traditional Chinese Medicine, Beijing, China
| | - Qianqian Ge
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Peijing Rong
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jianghong He
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Wang J, Xu L, Ge Q, Xue L, Liu Y, Wang C, Wu Y, Liu Y, Chen L, Zhuang Y, Geng X, Chen X, Wang B, Yu Q, He J, Zhao X. EEG microstate changes during hyperbaric oxygen therapy in patients with chronic disorders of consciousness. Front Neurosci 2023; 17:1145065. [PMID: 37123360 PMCID: PMC10130513 DOI: 10.3389/fnins.2023.1145065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/14/2023] [Indexed: 05/02/2023] Open
Abstract
Hyperbaric oxygen (HBO) therapy is an effective treatment for patients with disorders of consciousness (DOC). In this study, real-time electroencephalogram (EEG) recordings were obtained from patients with DOC during HBO therapy. EEG microstate indicators including mean microstate duration (MMD), ratio of total time covered (RTT), global explained variance (GEV), transition probability, mean occurrence, and mean global field power (GFP) were compared before and during HBO therapy. The results showed that the duration of microstate C in all patients with DOC increased after 20 min of HBO therapy (p < 0.05). Further statistical analysis found that the duration of microstate C was longer in the higher CRS-R group (≥8, 17 cases) than in the lower group (<8, 24 cases) during HBO treatment. In the higher CRS-R group, the transition probabilities from microstate A to microstate C and from microstate C to microstate A also increased significantly compared with the probability before treatment (p < 0.05). Microstate C is generally considered to be related to a salience network; an increase in the transition probability between microstate A and microstate C indicates increased information exchange between the auditory network and the salience network. The results of this study show that HBO therapy has a specific activating effect on attention and cognitive control in patients and causes increased activity in the primary sensory cortex (temporal lobe and occipital lobe). This study demonstrates that real-time EEG detection and analysis during HBO is a clinically feasible method for assessing brain function in patients with DOC. During HBO therapy, some EEG microstate indicators show significant changes related to the state of consciousness in patients with chronic DOC. This will be complementary to important electrophysiological indicators for assessing consciousness and may also provide an objective foundation for the precise treatment of patients with DOC.
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Affiliation(s)
- Jiameng Wang
- AHU-IAI AI Joint Laboratory, Anhui University, Hefei, China
- Hefei Comprehensive National Science Center, Institute of Artificial Intelligence, Hefei, China
| | - Long Xu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Qianqian Ge
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lianbi Xue
- Department of Hyperbaric Oxygenation, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yaling Liu
- Department of Hyperbaric Oxygenation, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Cong Wang
- Department of Hyperbaric Oxygenation, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yue Wu
- AHU-IAI AI Joint Laboratory, Anhui University, Hefei, China
- Hefei Comprehensive National Science Center, Institute of Artificial Intelligence, Hefei, China
| | - Yun Liu
- Hefei Comprehensive National Science Center, Institute of Artificial Intelligence, Hefei, China
| | - Lichao Chen
- Department of Hyperbaric Oxygenation, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Hyperbaric Oxygen, Liaocheng People’s Hospital, Liaocheng, China
| | - Yutong Zhuang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoli Geng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xueling Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bo Wang
- Hefei Comprehensive National Science Center, Institute of Artificial Intelligence, Hefei, China
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Qiuhong Yu
- Department of Hyperbaric Oxygenation, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- *Correspondence: Qiuhong Yu,
| | - Jianghong He
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Jianghong He,
| | - Xudong Zhao
- Hefei Comprehensive National Science Center, Institute of Artificial Intelligence, Hefei, China
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
- Xudong Zhao,
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Zhang C, Yang Y, Han S, Xu L, Chen X, Geng X, Bie L, He J. The temporal dynamics of Large-Scale brain network changes in disorders of consciousness: A Microstate-Based study. CNS Neurosci Ther 2022; 29:296-305. [PMID: 36317719 PMCID: PMC9804064 DOI: 10.1111/cns.14003] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/27/2022] [Accepted: 09/30/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The resting-state brain is composed of several discrete networks, which remain stable for 10-100 ms. These functional microstates are considered the building blocks of spontaneous consciousness. Electroencephalography (EEG) microstate analysis may provide insight into the altered brain dynamics underlying consciousness recovery in patients with disorders of consciousness (DOC). We aimed to analyze microstates in the resting-state EEG source space in patients with DOC, the relationship between state-specific features and consciousness levels, and the corresponding patterns of microstates and functional networks. METHODS We obtained resting-state EEG data from 84 patients with DOC (27 in a minimally conscious state [MCS] and 57 in a vegetative state [VS] or with unresponsive wakefulness syndrome). We conducted a microstate analysis of the resting-state (EEG) source space and developed a state-transition analysis protocol for patients with DOC. RESULTS We identified seven microstates with distinct spatial distributions of cortical activation. Multivariate pattern analyses revealed that different functional connectivity patterns were associated with source-level microstates. There were significant differences in the microstate properties, including spatial activation patterns, temporal dynamics, state shifts, and connectivity construction, between the MCS and VS groups. DISCUSSION Our findings suggest that consciousness depends on complex dynamics within the brain and may originate from the anterior cortex.
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Affiliation(s)
- Chunyun Zhang
- Department of NeurosurgeryThe First Hospital of Jilin UniversityChangchunChina
| | - Yi Yang
- Department of NeurosurgeryBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina,Chinese Institute for Brain ResearchBeijingChina,Beijing Institute of Brain DisordersBeijingChina,China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Shuai Han
- Department of NeurosurgeryThe First Hospital of Jilin UniversityChangchunChina
| | - Long Xu
- Department of NeurosurgeryBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Xueling Chen
- Department of NeurosurgeryBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Xiaoli Geng
- Department of NeurosurgeryBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Li Bie
- Department of NeurosurgeryThe First Hospital of Jilin UniversityChangchunChina
| | - Jianghong He
- Department of NeurosurgeryBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina,China National Clinical Research Center for Neurological DiseasesBeijingChina
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Liu Y, Li Z, Bai Y. Frontal and parietal lobes play crucial roles in understanding the disorder of consciousness: A perspective from electroencephalogram studies. Front Neurosci 2022; 16:1024278. [PMID: 36778900 PMCID: PMC9909102 DOI: 10.3389/fnins.2022.1024278] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 12/19/2022] [Indexed: 01/27/2023] Open
Abstract
Background Electroencephalogram (EEG) studies have established many characteristics relevant to consciousness levels of patients with disorder of consciousness (DOC). Although the frontal and parietal brain regions were often highlighted in DOC studies, their electro-neurophysiological roles in constructing human consciousness remain unclear because of the fragmented information from literatures and the complexity of EEG characteristics. Methods Existing EEG studies of DOC patients were reviewed and summarized. Relevant findings and results about the frontal and parietal regions were filtered, compared, and concluded to clarify their roles in consciousness classification and outcomes. The evidence covers multi-dimensional EEG characteristics including functional connectivity, non-linear dynamics, spectrum power, transcranial magnetic stimulation-electroencephalography (TMS-EEG), and event-related potential. Results and conclusion Electroencephalogram characteristics related to frontal and parietal regions consistently showed high relevance with consciousness: enhancement of low-frequency rhythms, suppression of high-frequency rhythms, reduction of dynamic complexity, and breakdown of networks accompanied with decreasing consciousness. Owing to the limitations of EEG, existing studies have not yet clarified which one between the frontal and parietal has priority in consciousness injury or recovery. Source reconstruction with high-density EEG, machine learning with large samples, and TMS-EEG mapping will be important approaches for refining EEG awareness locations.
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Affiliation(s)
- Yesong Liu
- School of Basic Medical Sciences, Hangzhou Normal University, Hangzhou, China.,Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Zhaoyi Li
- School of Basic Medical Sciences, Hangzhou Normal University, Hangzhou, China.,Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Yang Bai
- School of Basic Medical Sciences, Hangzhou Normal University, Hangzhou, China.,Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
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