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Namgung E, Kwon SU, Han M, Kim G, Kim HY, Park K, Cho M, Choi H, Nah H, Lim HT, Kang D. Digital therapeutics using virtual reality-based visual perceptual learning for visual field defects in stroke: A double-blind randomized trial. Brain Behav 2024; 14:e3525. [PMID: 38773793 PMCID: PMC11109502 DOI: 10.1002/brb3.3525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 04/04/2024] [Accepted: 04/19/2024] [Indexed: 05/24/2024] Open
Abstract
INTRODUCTION Visual field defects (VFDs) represent a debilitating poststroke complication, characterized by unseen parts of the visual field. Visual perceptual learning (VPL), involving repetitive visual training in blind visual fields, may effectively restore visual field sensitivity in cortical blindness. This current multicenter, double-blind, randomized, controlled clinical trial investigated the efficacy and safety of VPL-based digital therapeutics (Nunap Vision [NV]) for treating poststroke VFDs. METHODS Stroke outpatients with VFDs (>6 months after stroke onset) were randomized into NV (defective field training) or Nunap Vision-Control (NV-C, central field training) groups. Both interventions provided visual perceptual training, consisting of orientation, rotation, and depth discrimination, through a virtual reality head-mounted display device 5 days a week for 12 weeks. The two groups received VFD assessments using Humphrey visual field (HVF) tests at baseline and 12-week follow-up. The final analysis included those completed the study (NV, n = 40; NV-C, n = 35). Efficacy measures included improved visual area (sensitivity ≥6 dB) and changes in the HVF scores during the 12-week period. RESULTS With a high compliance rate, NV and NV-C training improved the visual areas in the defective hemifield (>72 degrees2) and the whole field (>108 degrees2), which are clinically meaningful improvements despite no significant between-group differences. According to within-group analyses, mean total deviation scores in the defective hemifield improved after NV training (p = .03) but not after NV-C training (p = .12). CONCLUSIONS The current trial suggests that VPL-based digital therapeutics may induce clinically meaningful visual improvements in patients with poststroke VFDs. Yet, between-group differences in therapeutic efficacy were not found as NV-C training exhibited unexpected improvement comparable to NV training, possibly due to learning transfer effects.
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Affiliation(s)
- Eun Namgung
- Asan Institute for Life SciencesAsan Medical CenterSeoulSouth Korea
| | - Sun U. Kwon
- Department of Neurology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
| | - Moon‐Ku Han
- Department of NeurologySeoul National University Bundang Hospital, Seoul National University College of MedicineSeongnamSouth Korea
| | - Gyeong‐Moon Kim
- Department of Neurology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
| | - Hahn Young Kim
- Department of NeurologyKonkuk University Medical Center, Konkuk University College of MedicineSeoulSouth Korea
| | - Kwang‐Yeol Park
- Department of NeurologyChung‐Ang University Hospital, Chung‐Ang University College of MedicineSeoulSouth Korea
| | | | | | - Hyun‐Wook Nah
- Department of NeurologyChungnam National University Sejong Hospital, Chungnam National University College of MedicineSejongSouth Korea
| | - Hyun Taek Lim
- Department of Ophthalmology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
| | - Dong‐Wha Kang
- Department of Neurology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
- Nunaps Inc.SeoulSouth Korea
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Namgung E, Kim YH, Lee EJ, Sasaki Y, Watanabe T, Kang DW. Functional connectivity interacts with visual perceptual learning for visual field recovery in chronic stroke. Sci Rep 2024; 14:3247. [PMID: 38332042 PMCID: PMC10853510 DOI: 10.1038/s41598-024-52778-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/23/2024] [Indexed: 02/10/2024] Open
Abstract
A reciprocal relationship between perceptual learning and functional brain changes towards perceptual learning effectiveness has been demonstrated previously; however, the underlying neural correlates remain unclear. Further, visual perceptual learning (VPL) is implicated in visual field defect (VFD) recovery following chronic stroke. We investigated resting-state functional connectivity (RSFC) in the visual cortices associated with mean total deviation (MTD) scores for VPL-induced VFD recovery in chronic stroke. Patients with VFD due to chronic ischemic stroke in the visual cortex received 24 VPL training sessions over 2 months, which is a dual discrimination task of orientation and letters. At baseline and two months later, the RSFC in the ipsilesional, interhemispheric, and contralesional visual cortices and MTD scores in the affected hemi-field were assessed. Interhemispheric visual RSFC at baseline showed the strongest correlation with MTD scores post-2-month VPL training. Notably, only the subgroup with high baseline interhemispheric visual RSFC showed significant VFD improvement following the VPL training. The interactions between the interhemispheric visual RSFC at baseline and VPL led to improvement in MTD scores and largely influenced the degree of VFD recovery. The interhemispheric visual RSFC at baseline could be a promising brain biomarker for the effectiveness of VPL-induced VFD recovery.
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Affiliation(s)
- Eun Namgung
- Asan Institute for Life Sciences, Asan Medical Center, Seoul, South Korea
| | | | - Eun-Jae Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yuka Sasaki
- Department of Cognitive, Linguistic and Psychological Sciences, Brown University, Providence, USA
| | - Takeo Watanabe
- Department of Cognitive, Linguistic and Psychological Sciences, Brown University, Providence, USA
| | - Dong-Wha Kang
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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Namgung E, Lee EJ, Kim YH, Kang DW. White Matter Structural Connectivity Associated With Visual Field Recovery After Stroke. J Stroke 2024; 26:116-120. [PMID: 38246721 PMCID: PMC10850453 DOI: 10.5853/jos.2023.02222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/05/2023] [Accepted: 10/18/2023] [Indexed: 01/23/2024] Open
Affiliation(s)
- Eun Namgung
- Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - Eun-Jae Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | - Dong-Wha Kang
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Nunaps Inc., Seoul, Korea
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Alkolfat F, Abdel Galeel A, Bassiouny AR, Eldeeb H, Radwan A, Ashram YA. Patterns of Visual Task-based Functional MRI Activation in Chronic Posterior Cerebral Artery Stroke Patients. Clin Neuroradiol 2023; 33:769-781. [PMID: 36867244 PMCID: PMC10449980 DOI: 10.1007/s00062-023-01274-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 01/29/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE Stroke is a principal cause of disability worldwide. In motor stroke, the tools for stratification and prognostication are plentiful. Conversely, in stroke causing mainly visual and cognitive problems, there is still no gold standard modality to use. The purpose of this study was to explore the fMRI recruitment pattern in chronic posterior cerebral artery (PCA) stroke patients and to investigate fMRI as a biomarker of disability in these patients. METHODS The study included 10 chronic PCA stroke patients and another 10 age-matched volunteer controls. The clinical presentation, cognitive state, and performance in visual perceptual skills battery (TVPS-3) were determined for both patients and control groups. Task-based fMRI scans were acquired while performing a passive visual task. Individual and group analyses of the fMRI scans as well as correlation analysis with the clinical and behavioral data were done. RESULTS At the level of behavioral assessment there was non-selective global impairment in all visual skills subtests. On visual task-based fMRI, patients recruited more brain areas than controls. These activations were present in the ipsilesional side distributed in the ipsilesional cerebellum, dorsolateral prefrontal cortex mainly Brodmann area (BA) 9, superior parietal lobule (somatosensory associative cortex, BA 7), superior temporal gyrus (BA 22), supramarginal gyrus (BA 40), and contralesional associative visual cortex (BA 19). Spearman's rank correlation was computed to assess the relationship between the TVPS scores and the numbers of fMRI neuronal clusters in each patient above the main control activations, there was a negative correlation between the two variables, r(10) = -0.85, p ≤ 0.001. CONCLUSION In chronic PCA stroke patients with residual visual impairments, the brain attempts to recruit more neighboring and distant functional areas for executing the impaired visual skill. This intense recruitment pattern in poorly recovering patients appears to be a sign of failed compensation. Consequently, fMRI has the potential for clinically relevant prognostic assessment in patients surviving PCA stroke; however, as this study included no longitudinal data, this potential should be further investigated in longitudinal imaging studies, with a larger cohort, and multiple time points.
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Affiliation(s)
- Fatma Alkolfat
- Department of Neurology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Aya Abdel Galeel
- Department of Radiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmad R. Bassiouny
- Department of Biochemistry, Faculty of Science, Alexandria University, Alexandria, Egypt
| | - Hany Eldeeb
- Department of Neurology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmed Radwan
- Department of Imaging and Pathology, Translational MRI, KU Leuven, Leuven, Belgium
- Leuven Brain Institute (LBI), Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Yasmine A. Ashram
- Department of Physiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Lu JJ, Xing XX, Qu J, Wu JJ, Hua XY, Zheng MX, Xu JG. Morphological alterations of contralesional hemisphere relate to functional outcomes after stroke. Eur J Neurosci 2023; 58:3347-3361. [PMID: 37489657 DOI: 10.1111/ejn.16097] [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: 01/29/2023] [Revised: 06/05/2023] [Accepted: 07/06/2023] [Indexed: 07/26/2023]
Abstract
The present study aimed to investigate poststroke morphological alterations contralesionally and correlations with functional outcomes. Structural magnetic resonance images were obtained from 27 poststroke patients (24 males, 50.21 ± 10.97 years) and 20 healthy controls (13 males, 46.63 ± 12.18 years). Voxel-based and surface-based morphometry analysis were conducted to detect alterations of contralesional grey matter volume (GMV), cortical thickness (CT), gyrification index (GI), sulcus depth (SD), and fractal dimension (FD) in poststroke patients. Partial correlation analysis was used to explore the relationship between regions with significant structural differences and scores of clinical assessments, including Modified Barthel Index (MBI), Berg Balance Scale (BBS), Fugl-Meyer Assessment of Upper Extremity (FMA-UE), Mini-Mental State Examination (MMSE), and Montreal Cognitive Assessment (MoCA). Correction for multiplicity was conducted within each parameter and for all tests. GMV significantly decreased in the contralesional motor-related, occipital and temporal cortex, limbic system, and cerebellum lobe (P < 0.01, family-wise error [FWE] correction). Lower CT was found in the contralesional precentral and lingual gyrus (P < 0.01, FWE correction), while lower GI found in the contralesional superior temporal gyrus and insula (P < 0.01, FWE correction). There were significant correlations between GMV of contralesional lingual gyrus and MBI (P = 0.031, r = 0.441), and BBS (P = 0.047, r = 0.409) scores, and GMV of contralesional hippocampus and FMA-UE scores (P = 0.048, r = 0.408). In conclusion, stroke patients exhibited wide grey matter loss and cortical morphological changes in the contralesional hemisphere, which correlated with sensorimotor functions and the ability of daily living.
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Affiliation(s)
- Juan-Juan Lu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiang-Xin Xing
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jiao Qu
- Department of Radiology, Shanghai Songjiang District Central Hospital, Shanghai, China
| | - Jia-Jia Wu
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xu-Yun Hua
- Department of Traumatology and Orthopedics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Mou-Xiong Zheng
- Department of Traumatology and Orthopedics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jian-Guang Xu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
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Zhang J, Chang Y. Alterations of static and dynamic functional network connectivity in acute ischemic brainstem stroke. Acta Radiol 2022; 64:1623-1630. [PMID: 36113019 DOI: 10.1177/02841851221127271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Prior studies have shown abnormal brain functional network changes in patients with acute ischemic stroke. However, the alterations of dynamic functional network connectivity (FNC) in brainstem strokes have not been elucidated. Purpose To assess alterations of static and dynamic FNCs and determine the relationships between these and upper limb movement performance in patients with acute brainstem ischemic stroke. Material and Methods In total, 50 patients with acute brainstem ischemic stroke and 50 age- and sex-matched healthy controls were enrolled in the present study and underwent resting-state functional magnetic resonance imaging (rs-fMRI). Independent component analysis was conducted to assess static and dynamic FNC patterns based on seven resting-state networks, namely, the default mode network (DMN), executive control network (ECN), attention network (AN), somatomotor network (SMN), visual network (VN), auditory network (AUN), and cerebellum network (CN). Results Compared with controls, patients with acute brainstem ischemic stroke exhibited wide aberrations of static FNC, including increased FNC in DMN–ECN, DMN–VN, ECN–VN, ECN–AN and AN–AUN pairs. Patients with acute brainstem ischemic stroke showed aberrant dynamic FNC in State 1, involving increased FNC aberrance in the DMN with AN, DMN with ECN, and reduced FNC in SMN–VN pairs. In State 5, patients with acute brainstem ischemic stroke showed increased FNC in DMN–VN and AN–AUN, and decreased FNC in AN–SMN pairs. Conclusion This study suggests that static and dynamic FNC impairment and aberrant connections exist in acute brainstem ischemic stroke, which expands what is known regarding the relationship between stroke and FNC from static and dynamic perspectives.
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Affiliation(s)
- Jian Zhang
- Department of Radiology, Taizhou People’s Hospital, Fifth Affiliated Hospital of Nantong University, Taizhou, Jiangsu, PR China
| | - Yi Chang
- Department of Radiology, Taizhou People’s Hospital, Fifth Affiliated Hospital of Nantong University, Taizhou, Jiangsu, PR China
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Kim Y, Im S, Oh J, Jung Y, Jun SY. Detection of post-stroke visual field loss by quantification of the retrogeniculate visual pathway. J Neurol Sci 2022; 439:120297. [DOI: 10.1016/j.jns.2022.120297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/28/2022] [Accepted: 05/22/2022] [Indexed: 11/28/2022]
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Räty S, Ruuth R, Silvennoinen K, Sabel BA, Tatlisumak T, Vanni S. Resting-state Functional Connectivity After Occipital Stroke. Neurorehabil Neural Repair 2021; 36:151-163. [PMID: 34949135 DOI: 10.1177/15459683211062897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Resting-state functional magnetic resonance imaging (rsfMRI) reflects spontaneous activation of cortical networks. After stroke, these networks reorganize, both due to structural lesion and reorganization of functional connectivity (FC). OBJECTIVE We studied FC in chronic phase occipital stroke patients with homonymous visual field defects before and after repetitive transorbital alternating current stimulation (rtACS). METHODS This spin-off study, embedded in the randomized, sham-controlled REVIS trial, comprised 16 chronic occipital stroke patients with visual field defect and 12 healthy control subjects. The patients underwent rsfMRI at baseline, after two weeks of rtACS or sham treatment, and after two months of treatment-free follow-up, whereas the control subjects were measured once. We used a multivariate regression connectivity model to determine mutual prediction accuracy between 74 cortical regions of interest. Additionally, the model parameters were included into a graph to analyze average path length, centrality eigenvector, centrality degree, and clustering of the network. The patients and controls at baseline and the two treatment groups were compared with multilevel modeling. RESULTS Before treatment, the patients and controls had similar whole-network prediction accuracy and network parameters, whereas centrality eigenvector differed in perilesional regions, indicating local modification in connectivity. In line with behavioral results, neither prediction accuracy nor any network parameter changed systematically as a result of rtACS rehabilitation compared to sham. CONCLUSIONS Whole-network FC showed no difference between occipital stroke patients and healthy population, congruent with the peripheral location of the visual network in relation to the high-density cortical core. rtACS treatment in the given setting did not affect FC.
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Affiliation(s)
- Silja Räty
- Department of Neurology, 3836Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Advanced Magnetic Imaging Centre, 174277Aalto University, Espoo, Finland
| | - Riikka Ruuth
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Katri Silvennoinen
- Department of Neurology, 3836Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Department of Clinical and Experimental Epilepsy, 61554UCL Queen Square Institute of Neurology, London, UK
| | - Bernhard A Sabel
- Institute of Medical Psychology, Medical Faculty, Otto-v, -Guericke University of Magdeburg, Magdeburg, Germany
| | - Turgut Tatlisumak
- Department of Clinical Neurosciences/Neurology, 70712Institute of Neurosciences and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Simo Vanni
- Department of Neurology, 3836Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Abstract
PURPOSE OF REVIEW Homonymous visual field defects are a common sequela of stroke, and are assumed to be permanent within a few weeks of the event. Because consensus about the efficacy of rehabilitation is lacking, visual therapy is rarely prescribed. Here, we review current rehabilitation options and strategies in the translational pipeline that could change these perspectives. RECENT FINDINGS The mainstays of available therapy for homonymous visual defects are compensation training and substitution, which allow patients to better use their spared vision. However, early clinical studies suggest that vision can partially recover following intensive training inside the blind field. Research into the relative efficacy of different restorative approaches continues, providing insights into neurophysiologic substrates of recovery and its limitations. This, in turn, has led to new work examining the possible benefits of earlier intervention, advanced training procedures, noninvasive brain stimulation, and pharmacological adjuvants, all of which remain to be vetted through properly powered, randomized, clinical trials. SUMMARY Research has uncovered substantial visual plasticity after occipital strokes, suggesting that rehabilitative strategies for this condition should be more aggressive. For maximal benefit, poststroke vision-restorative interventions should begin early, and in parallel with strategies that optimize everyday use of an expanding field of view.
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Affiliation(s)
| | - Steven E Feldon
- Flaum Eye Institute
- Center for Visual Science, University of Rochester, Rochester, NY, USA
| | - Krystel R Huxlin
- Flaum Eye Institute
- Center for Visual Science, University of Rochester, Rochester, NY, USA
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Pedersini CA, Guàrdia-Olmos J, Montalà-Flaquer M, Cardobi N, Sanchez-Lopez J, Parisi G, Savazzi S, Marzi CA. Functional interactions in patients with hemianopia: A graph theory-based connectivity study of resting fMRI signal. PLoS One 2020; 15:e0226816. [PMID: 31905211 PMCID: PMC6944357 DOI: 10.1371/journal.pone.0226816] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 12/05/2019] [Indexed: 12/12/2022] Open
Abstract
The assessment of task-independent functional connectivity (FC) after a lesion causing hemianopia remains an uncovered topic and represents a crucial point to better understand the neural basis of blindsight (i.e. unconscious visually triggered behavior) and visual awareness. In this light, we evaluated functional connectivity (FC) in 10 hemianopic patients and 10 healthy controls in a resting state paradigm. The main aim of this study is twofold: first of all we focused on the description and assessment of density and intensity of functional connectivity and network topology with and without a lesion affecting the visual pathway, and then we extracted and statistically compared network metrics, focusing on functional segregation, integration and specialization. Moreover, a study of 3-cycle triangles with prominent connectivity was conducted to analyze functional segregation calculated as the area of each triangle created connecting three neighboring nodes. To achieve these purposes we applied a graph theory-based approach, starting from Pearson correlation coefficients extracted from pairs of regions of interest. In these analyses we focused on the FC extracted by the whole brain as well as by four resting state networks: The Visual (VN), Salience (SN), Attention (AN) and Default Mode Network (DMN), to assess brain functional reorganization following the injury. The results showed a general decrease in density and intensity of functional connections, that leads to a less compact structure characterized by decrease in functional integration, segregation and in the number of interconnected hubs in both the Visual Network and the whole brain, despite an increase in long-range inter-modules connections (occipito-frontal connections). Indeed, the VN was the most affected network, characterized by a decrease in intra- and inter-network connections and by a less compact topology, with less interconnected nodes. Surprisingly, we observed a higher functional integration in the DMN and in the AN regardless of the lesion extent, that may indicate a functional reorganization of the brain following the injury, trying to compensate for the general reduced connectivity. Finally we observed an increase in functional specialization (lower between-network connectivity) and in inter-networks functional segregation, which is reflected in a less compact network topology, highly organized in functional clusters. These descriptive findings provide new insight on the spontaneous brain activity in hemianopic patients by showing an alteration in the intrinsic architecture of a large-scale brain system that goes beyond the impairment of a single RSN.
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Affiliation(s)
- Caterina A. Pedersini
- Physiology and Psychology Section, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Joan Guàrdia-Olmos
- Department of Social Psychology and Quantitative Psychology, School of Psychology, Institute of Neuroscience, Institute of Complex Systems, University of Barcelona, Barcelona, Spain
| | - Marc Montalà-Flaquer
- Department of Social Psychology and Quantitative Psychology, School of Psychology, Institute of Complex Systems, University of Barcelona, Barcelona, Spain
| | - Nicolò Cardobi
- Physiology and Psychology Section, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Javier Sanchez-Lopez
- Physiology and Psychology Section, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giorgia Parisi
- Physiology and Psychology Section, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Silvia Savazzi
- Physiology and Psychology Section, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Perception and Awareness (PandA) Laboratory, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- National Institute of Neuroscience, Verona, Italy
| | - Carlo A. Marzi
- Physiology and Psychology Section, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- National Institute of Neuroscience, Verona, Italy
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