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Olgiati E, Violante IR, Xu S, Sinclair TG, Li LM, Crow JN, Kapsetaki ME, Calvo R, Li K, Nayar M, Grossman N, Patel MC, Wise RJS, Malhotra PA. Targeted non-invasive brain stimulation boosts attention and modulates contralesional brain networks following right hemisphere stroke. Neuroimage Clin 2024; 42:103599. [PMID: 38608376 PMCID: PMC11019269 DOI: 10.1016/j.nicl.2024.103599] [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: 03/01/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024]
Abstract
Right hemisphere stroke patients frequently present with a combination of lateralised and non-lateralised attentional deficits characteristic of the neglect syndrome. Attentional deficits are associated with poor functional outcome and are challenging to treat, with non-lateralised deficits often persisting into the chronic stage and representing a common complaint among patients and families. In this study, we investigated the effects of non-invasive brain stimulation on non-lateralised attentional deficits in right-hemispheric stroke. In a randomised double-blind sham-controlled crossover study, twenty-two patients received real and sham transcranial Direct Current Stimulation (tDCS) whilst performing a non-lateralised attentional task. A high definition tDCS montage guided by stimulation modelling was employed to maximise current delivery over the right dorsolateral prefrontal cortex, a key node in the vigilance network. In a parallel study, we examined brain network response to this tDCS montage by carrying out concurrent fMRI during stimulation in healthy participants and patients. At the group level, stimulation improved target detection in patients, reducing overall error rate when compared with sham stimulation. TDCS boosted performance throughout the duration of the task, with its effects briefly outlasting stimulation cessation. Exploratory lesion analysis indicated that response to stimulation was related to lesion location rather than volume. In particular, reduced stimulation response was associated with damage to the thalamus and postcentral gyrus. Concurrent stimulation-fMRI revealed that tDCS did not affect local connectivity but influenced functional connectivity within large-scale networks in the contralesional hemisphere. This combined behavioural and functional imaging approach shows that brain stimulation targeted to surviving tissue in the ipsilesional hemisphere improves non-lateralised attentional deficits following stroke. This effect may be exerted via contralesional network effects.
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Affiliation(s)
- Elena Olgiati
- Imperial College London, Department of Brain Sciences, UK; Imperial College Healthcare NHS Trust, UK.
| | - Ines R Violante
- Imperial College London, Department of Brain Sciences, UK; University of Surrey, Department of Psychology, UK
| | - Shuler Xu
- Imperial College London, Department of Brain Sciences, UK; University College London, UK
| | | | - Lucia M Li
- Imperial College London, Department of Brain Sciences, UK; UK Dementia Research Institute Care Research and Technology Centre, Imperial College London and the University of Surrey, London, UK
| | - Jennifer N Crow
- Imperial College London, Department of Brain Sciences, UK; Imperial College Healthcare NHS Trust, UK
| | | | - Roberta Calvo
- UTHealth, Department of Neurobiology and Anatomy, McGovern Medical School, Houston, US
| | - Korina Li
- Imperial College London, Department of Brain Sciences, UK; University College London, UK
| | | | - Nir Grossman
- Imperial College London, Department of Brain Sciences, UK; UK Dementia Research Institute Care Research and Technology Centre, Imperial College London and the University of Surrey, London, UK
| | - Maneesh C Patel
- Imperial College London, Department of Brain Sciences, UK; Imperial College Healthcare NHS Trust, UK
| | - Richard J S Wise
- Imperial College London, Department of Brain Sciences, UK; Imperial College Healthcare NHS Trust, UK
| | - Paresh A Malhotra
- Imperial College London, Department of Brain Sciences, UK; Imperial College Healthcare NHS Trust, UK; UK Dementia Research Institute Care Research and Technology Centre, Imperial College London and the University of Surrey, London, UK
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Norwood MF, Painter DR, Marsh CH, Reid C, Hine T, Harvie DS, Jones S, Dungey K, Chen B, Libera M, Gan L, Bernhardt J, Kendall E, Zeeman H. The attention atlas virtual reality platform maps three-dimensional (3D) attention in unilateral spatial neglect patients: a protocol. BRAIN IMPAIR 2023; 24:548-567. [PMID: 38167362 DOI: 10.1017/brimp.2022.15] [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] [Indexed: 11/06/2022]
Abstract
BACKGROUND Deficits in visuospatial attention, known as neglect, are common following brain injury, but underdiagnosed and poorly treated, resulting in long-term cognitive disability. In clinical settings, neglect is often assessed using simple pen-and-paper tests. While convenient, these cannot characterise the full spectrum of neglect. This protocol reports a research programme that compares traditional neglect assessments with a novel virtual reality attention assessment platform: The Attention Atlas (AA). METHODS/DESIGN The AA was codesigned by researchers and clinicians to meet the clinical need for improved neglect assessment. The AA uses a visual search paradigm to map the attended space in three dimensions and seeks to identify the optimal parameters that best distinguish neglect from non-neglect, and the spectrum of neglect, by providing near-time feedback to clinicians on system-level behavioural performance. A series of experiments will address procedural, scientific, patient, and clinical feasibility domains. RESULTS Analyses focuses on descriptive measures of reaction time, accuracy data for target localisation, and histogram-based raycast attentional mapping analysis; which measures the individual's orientation in space, and inter- and intra-individual variation of visuospatial attention. We will compare neglect and control data using parametric between-subjects analyses. We present example individual-level results produced in near-time during visual search. CONCLUSIONS The development and validation of the AA is part of a new generation of translational neuroscience that exploits the latest advances in technology and brain science, including technology repurposed from the consumer gaming market. This approach to rehabilitation has the potential for highly accurate, highly engaging, personalised care.
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Affiliation(s)
- Michael Francis Norwood
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Meadowbrook, QLD, Australia
| | - David Ross Painter
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Meadowbrook, QLD, Australia
| | - Chelsea Hannah Marsh
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Meadowbrook, QLD, Australia
- School of Applied Psychology, Griffith University, Gold Coast, QLD, Australia
| | - Connor Reid
- Technical Partners Health (TPH), Griffith University, Nathan, QLD, Australia
| | - Trevor Hine
- School of Applied Psychology, Griffith University, Mt Gravatt, QLD, Australia
| | - Daniel S Harvie
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Meadowbrook, QLD, Australia
- Innovation, Implementation and Clinical Translation in Health (IIMPACT in Health), Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Susan Jones
- Neurosciences Rehabilitation Unit, Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Kelly Dungey
- Neurosciences Rehabilitation Unit, Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Ben Chen
- Allied Health and Rehabilitation, Emergency and Specialty Services, Gold Coast Health, Gold Coast, QLD, Australia
| | - Marilia Libera
- Psychology Department, Logan Hospital, Logan, QLD, Australia
| | - Leslie Gan
- Rehabilitation Unit, Logan Hospital, Meadowbrook, QLD, Australia
| | - Julie Bernhardt
- Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
| | - Elizabeth Kendall
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Meadowbrook, QLD, Australia
| | - Heidi Zeeman
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Meadowbrook, QLD, Australia
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