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Zhang H, Yang X, Yao L, Liu Q, Lu Y, Chen X, Wang T. EEG microstates analysis after TMS in patients with subacute stroke during the resting state. Cereb Cortex 2024; 34:bhad480. [PMID: 38112223 PMCID: PMC10793572 DOI: 10.1093/cercor/bhad480] [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: 09/01/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 12/21/2023] Open
Abstract
To investigate whether intermittent theta burst stimulation over the cerebellum induces changes in resting-state electroencephalography microstates in patients with subacute stroke and its correlation with cognitive and emotional function. Twenty-four stroke patients and 17 healthy controls were included in this study. Patients and healthy controls were assessed at baseline, including resting-state electroencephalography and neuropsychological scales. Fifteen patients received lateral cerebellar intermittent theta burst stimulation as well as routine rehabilitation training (intermittent theta burst stimulation-RRT group), whereas 9 patients received only conventional rehabilitation training (routine rehabilitation training group). After 2 wk, baseline data were recorded again in both groups. Stroke patients exhibited reduced parameters in microstate D and increased parameters in microstate C compared with healthy controls. However, after the administration of intermittent theta burst stimulation over the lateral cerebellum, significant alterations were observed in the majority of metrics for both microstates D and C. Lateral cerebellar intermittent theta burst stimulation combined with conventional rehabilitation has a stronger tendency to improve emotional and cognitive function in patients with subacute stroke than conventional rehabilitation. The improvement of mood and cognitive function was significantly associated with microstates C and D. We identified electroencephalography microstate spatiotemporal dynamics associated with clinical improvement following a course of intermittent theta burst stimulation therapy.
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Affiliation(s)
- Hongmei Zhang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan, China
| | - Xue Yang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan, China
| | - Liqing Yao
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan, China
| | - Qian Liu
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan, China
| | - Yihuan Lu
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan, China
| | - Xueting Chen
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan, China
| | - Tianling Wang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan, China
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Kalyuzhnaya Y, Khaitin A, Demyanenko S. Modeling transient ischemic attack via photothrombosis. Biophys Rev 2023; 15:1279-1286. [PMID: 37974996 PMCID: PMC10643708 DOI: 10.1007/s12551-023-01121-1] [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: 06/13/2023] [Accepted: 08/18/2023] [Indexed: 11/19/2023] Open
Abstract
The health significance of transient ischemic attacks (TIAs) is largely underestimated. Often, TIAs are not given significant importance, and in vain, because TIAs are a predictor of the development of serious cardiovascular diseases and even death. Because of this, and because of the difficulty in diagnosing the disease, TIAs and related microinfarcts are poorly investigated. Photothrombotic models of stroke and TIA allow reproducing the occlusion of small brain vessels, even single ones. When dosing the concentration of photosensitizer, intensity and irradiation time, it is possible to achieve occlusion of well-defined small vessels with high reproducibility, and with the help of modern methods of blood flow assessment it is possible to achieve spontaneous restoration of blood flow without vessel rupture. In this review, we discuss the features of microinfarcts and the contemporary experimental approaches used to model TIA and microinfarcts, with an emphasis on models using the principle of photothrombosis of brain vessels. We review modern techniques for in vivo detection of blood flow in small brain vessels, as well as biomarkers of microinfarcts.
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Affiliation(s)
- Y.N. Kalyuzhnaya
- Southern Federal University, Academy of Biology and Biotechnology, Rostov-on-Don, Russia
| | - A.M. Khaitin
- Southern Federal University, Academy of Biology and Biotechnology, Rostov-on-Don, Russia
| | - S.V. Demyanenko
- Southern Federal University, Academy of Biology and Biotechnology, Rostov-on-Don, Russia
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Wagner F, Rogenz J, Opitz L, Maas J, Schmidt A, Brodoehl S, Ullsperger M, Klingner CM. Reward network dysfunction is associated with cognitive impairment after stroke. Neuroimage Clin 2023; 39:103446. [PMID: 37307650 PMCID: PMC10276182 DOI: 10.1016/j.nicl.2023.103446] [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: 03/15/2023] [Revised: 05/23/2023] [Accepted: 05/27/2023] [Indexed: 06/14/2023]
Abstract
Stroke survivors not only suffer from severe motor, speech and neurocognitive deficits, but in many cases also from a "lack of pleasure" and a reduced motivational level. Especially apathy and anhedonic symptoms can be linked to a dysfunction of the reward system. Rewards are considered as important co-factor for learning, so the question arises as to why and how this affects the rehabilitation of stroke patients. We investigated reward behaviour, learning ability and brain network connectivity in acute (3-7d) mild to moderate stroke patients (n = 28) and age-matched healthy controls (n = 26). Reward system activity was assessed using the Monetary Incentive Delay task (MID) during magnetoencephalography (MEG). Coherence analyses were used to demonstrate reward effects on brain functional network connectivity. The MID-task showed that stroke survivors had lower reward sensitivity and required greater monetary incentives to improve performance and showed deficits in learning improvement. MEG-analyses showed a reduced network connectivity in frontal and temporoparietal regions. All three effects (reduced reward sensitivity, reduced learning ability and altered cerebral connectivity) were found to be closely related and differed strongly from the healthy group. Our results reinforce the notion that acute stroke induces reward network dysfunction, leading to functional impairment of behavioural systems. These findings are representative of a general pattern in mild strokes and are independent of the specific lesion localisation. For stroke rehabilitation, these results represent an important point to identify the reduced learning capacity after stroke and to implement individualised recovery exercises accordingly.
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Affiliation(s)
- Franziska Wagner
- Department of Neurology, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany; Biomagnetic Centre, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany.
| | - Jenny Rogenz
- Department of Neurology, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany; Biomagnetic Centre, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Laura Opitz
- Department of Neurology, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany; Biomagnetic Centre, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Johanna Maas
- Department of Neurology, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany; Biomagnetic Centre, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Alexander Schmidt
- Department of Neurology, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany; Biomagnetic Centre, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Stefan Brodoehl
- Department of Neurology, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany; Biomagnetic Centre, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Markus Ullsperger
- Faculty of Natural Sciences, Institute of Psychology, 39106 Magdeburg, Germany; Center for Behavioral Brain Sciences, Magdeburg, Otto-von-Guericke University Magdeburg, Germany
| | - Carsten M Klingner
- Department of Neurology, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany; Biomagnetic Centre, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany
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Marsh EB, Girgenti S, Llinas EJ, Brunson AO. Outcomes in Patients with Minor Stroke: Diagnosis and Management in the Post-thrombectomy Era. Neurotherapeutics 2023; 20:732-743. [PMID: 36752947 PMCID: PMC10275835 DOI: 10.1007/s13311-023-01349-5] [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] [Accepted: 01/24/2023] [Indexed: 02/09/2023] Open
Abstract
In the era of mechanical thrombectomy and better preventative strategies, a higher number of patients are being discharged home from the hospital with the so-called minor strokes. This has significantly changed the landscape of stroke recovery. Unfortunately, while symptoms may be categorized as mild compared to individuals with higher NIH Stroke Scale scores, the physical, cognitive, and emotional sequelae can be disabling and result in failure to return to work and poor quality of life in a population with significant potential to recover fully. In this review, we discuss the current state of minor stroke, the most common pattern of resulting deficits, what is known about the underlying pathophysiology that leads to a relatively global pattern of impaired cognition following an infarct in any location, and special considerations for treatment based on this population's unique needs. Raising awareness of the current morbidity associated with minor stroke, the need for a uniform definition that allows for comparisons of individuals across studies, and further research focused on this population to optimize outcomes, has the potential to significantly improve recovery.
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Affiliation(s)
- Elisabeth B Marsh
- Department of Neurology, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD 21287, USA.
| | - Sophia Girgenti
- Department of Neurology, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD 21287, USA
| | - Edward J Llinas
- Department of Neurology, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD 21287, USA
| | - Autumn O Brunson
- Department of Neurology, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD 21287, USA
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Yedavalli VS, Hamam O, Gudenkauf J, Wang R, Llinas R, Marsh EB, Caplan J, Nael K, Urrutia V. Assessing the Efficacy of Mechanical Thrombectomy in Patients with an NIHSS < 6 Presenting with Proximal Middle Cerebral Artery Vessel Occlusion as Compared to Best Medical Management. Brain Sci 2023; 13:brainsci13020214. [PMID: 36831757 PMCID: PMC9953866 DOI: 10.3390/brainsci13020214] [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: 01/13/2023] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND AND PURPOSE Minor acute ischemic stroke (AIS) patients-defined by an NIHSS score < 6-presenting with proximal middle cerebral artery large vessel occlusions (MCA-LVO) is a subgroup for which treatment is still debated. Although these patients present with minor symptoms initially, studies have shown that several patients afflicted with MCA-LVO in this subgroup experience cognitive and functional decline. Although mechanical thrombectomy (MT) is the standard of care for patients with an NIHSS score of 6 or higher, treatment in the minor stroke subgroup is still being explored. The purpose of this preliminary study is to report our center's experience in evaluating the potential benefit of mechanical thrombectomy (MT) in minor stroke patients when compared to medical management (MM). METHODS We performed a retrospective study with two comprehensive stroke centers within our hospital enterprise of consecutive patients presenting with minor AIS secondary to MCA-LVO (defined as M1 or proximal M2 segments of MCA). We subsequently evaluated patients who received MT versus those who received MM. RESULTS Between January 2017 and July 2021, we identified 46 AIS patients (11 treated with MT and 35 treated with MM) who presented with an NIHSS score < 6 secondary to MCA-LVO (47.8% 22/46 female, mean age 62.3 years, range 49-75 years). MT was associated with a significantly lower mRS at 90 days (median: 1.0 [IQR 0.0-2.0] versus 3.0 [IQR 1.0-4.0], p = <0.001), a favorable NIHSS shift (-4.0 [IQR -10.0--2.0] versus 0.0 [IQR -2.0-1.0], p = 0.002), favorable NIHSS shift dichotomization (5/11, 45.5% versus 3/35, 8.6%, p = 0.003) and favorable mRS dichotomization (7/11, 63.6% versus 14/35, 40.0%, p = 0.024). CONCLUSIONS In our center's preliminary experience, for AIS patients presenting with an NIHSS score < 6 secondary to MCA-LVO, MT may be associated with improved clinical outcomes when compared to MM only.
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Affiliation(s)
- Vivek Srikar Yedavalli
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, 600 N Wolfe Street, Baltimore, MD 21287, USA
| | - Omar Hamam
- Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, Baltimore, MD 21205, USA
| | - Julie Gudenkauf
- Department Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD 21287, USA
| | - Richard Wang
- Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, Baltimore, MD 21205, USA
| | - Rafael Llinas
- Department Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD 21287, USA
| | - Elisabeth Breese Marsh
- Department Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD 21287, USA
| | - Justin Caplan
- Department Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD 21287, USA
| | - Kambiz Nael
- Department of Radiology, University of California, Los Angeles, CA 90095, USA
| | - Victor Urrutia
- Department Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD 21287, USA
- Correspondence:
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