1
|
Lang S, Gan LS, McLennan C, Kirton A, Monchi O, Kelly JJP. Preoperative Transcranial Direct Current Stimulation in Glioma Patients: A Proof of Concept Pilot Study. Front Neurol 2020; 11:593950. [PMID: 33329346 PMCID: PMC7710969 DOI: 10.3389/fneur.2020.593950] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/22/2020] [Indexed: 01/24/2023] Open
Abstract
Background: Transcranial direct current stimulation (tDCS) has been used extensively in patient populations to facilitate motor network plasticity. However, it has not been studied in patients with brain tumors. We aimed to determine the feasibility of a preoperative motor training and tDCS intervention in patients with glioma. In an exploratory manner, we assessed changes in motor network connectivity following this intervention and related these changes to predicted electrical field strength from the stimulated motor cortex. Methods: Patients with left-sided glioma (n=8) were recruited in an open label proof of concept pilot trial and participated in four consecutive days of motor training combined with tDCS. The motor training consisted of a 60-min period where the subject learned to play the piano with their right hand. Concurrently, they received 40 min of 2 mA anodal tDCS of the left motor cortex. Patients underwent task and resting state fMRI before and after this intervention. Changes in both the connectivity of primary motor cortex (M1) and general connectivity across the brain were assessed. Patient specific finite element models were created and the predicted electrical field (EF) resulting from stimulation was computed. The magnitude of the EF was extracted from left M1 and correlated to the observed changes in functional connectivity. Results: There were no adverse events and all subjects successfully completed the study protocol. Left M1 increased both local and global connectivity. Voxel-wide measures, not constrained by a specific region, revealed increased global connectivity of the frontal pole and decreased global connectivity of the supplementary motor area. The magnitude of EF applied to the left M1 correlated with changes in global connectivity of the right M1. Conclusion: In this proof of concept pilot study, we demonstrate for the first time that tDCS appears to be feasible in glioma patients. In our exploratory analysis, we show preoperative motor training combined with tDCS may alter sensorimotor network connectivity. Patient specific modeling of EF in the presence of tumor may contribute to understanding the dose-response relationship of this intervention. Overall, this suggests the possibility of modulating neural networks in glioma patients.
Collapse
Affiliation(s)
- Stefan Lang
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Non-invasive Neurostimulation Network, University of Calgary, Calgary, AB, Canada
| | - Liu Shi Gan
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Non-invasive Neurostimulation Network, University of Calgary, Calgary, AB, Canada
| | - Cael McLennan
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Adam Kirton
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Non-invasive Neurostimulation Network, University of Calgary, Calgary, AB, Canada
| | - Oury Monchi
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Non-invasive Neurostimulation Network, University of Calgary, Calgary, AB, Canada
| | - John J P Kelly
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Charbonneau Cancer Institute, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
3
|
Burnett W, Kontulainen S, McLennan C, Hazel D, Talmo C, Hunter D, Wilson D, Johnston J. Patella bone density is lower in knee osteoarthritis patients experiencing moderate-to-severe pain at rest. J Musculoskelet Neuronal Interact 2016; 16:33-9. [PMID: 26944821 PMCID: PMC5089452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine differences in patellar subchondral bone mineral density (BMD) between knee osteoarthritis (OA) patients with differing levels of pain at rest. METHODS The preoperative knee of 41 total knee replacement (TKR) patients was scanned using QCT and scored for pain using Western Ontario McMasters Osteoarthritis Index (WOMAC). 'Pain at rest' was defined as average pain while lying//sitting and nocturnal pain. Participants were divided into groups: 'mild-to-no pain at rest' and 'moderate-to-severe pain at rest'. We used a depth-specific CT-based mapping technique to measure patellar subchondral BMD at depths of 0-2.5 mm, 2.5-5 mm, and 5-7.5 mm from the subchondral surface. Mean lateral and medial facet BMD were compared between groups using MANCOVA. RESULTS Mean adjusted BMD was lower in participants with 'moderate-to-severe pain at rest' over the total lateral facet at depths of 0-2.5 mm (10% lower, p=0.041), 2.5-5 mm (20% lower, p=0.017), and 5-7.5 mm (25% lower, p=0.004), and over the total medial facet at 2.5-5 mm (22% lower, p=0.033) and 5-7.5 mm (28% lower, p=0.016). CONCLUSIONS In OA patients with 'moderate-to-severe pain at rest', depth-specific density measures demonstrated up to 28% lower lateral and medial subchondral BMD. Patients with high levels of pain at rest may have reduced amounts of native bone prior to TKR.
Collapse
Affiliation(s)
- W. Burnett
- University of Saskatchewan, Division of Biomedical Engineering,Corresponding authors: 57 Campus Drive, Saskatoon, Saskatchewan, S7N 5A9, Canada E-mail: (W. Burnett); (J. Johnston)
| | | | | | | | | | - D. Hunter
- University of Sydney, Institute of Bone and Joint Research, Kolling Institute; Royal North Shore Hospital, Rheumatology Department
| | - D. Wilson
- University of British Columbia, Rheumatology Department; Vancouver Coastal Health Research Institute, Centre for Hip Health and Mobility
| | - J. Johnston
- University of Saskatchewan, College of Engineering; Department of Mechanical Engineering
| |
Collapse
|
5
|
Vandenberg T, Smith A, McLennan C, Wilcock L, Nayler J, Coakley N, DeGrasse C, Green E, Sawka C, Trudeau ME. Regional models of care for systemic therapy: Standards for organization and delivery. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.17057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
17057 Background: Rapidly expanding indications for cancer systemic therapy combined with human resource and facility constraints require innovative approaches to deliver safe, patient-centred, and evidence-based care across Ontario, a province covering 1 million sq km, organized into 14 regions, each with about 1 million inhabitants. A systemic therapy project team recommended the best way to organize the delivery of ambulatory systemic therapy in Ontario. Methods: A core multidisciplinary panel reviewed the evidence and developed standards. The panel used evidence-based analysis of relevant publications, an environmental scan of other existing recommendations and expert opinion based on experience and consensus to formulate a standards document to guide treatment delivery. This was reviewed and amended by the full project team. The document was circulated to oncologists, family practitioners, internists, pharmacists, nurses and administrators who work in or have responsibility for systemic therapy in the regions for practitioner feedback. Results: A Regional Systemic Therapy Program (STP) Model was developed in which Integrated Cancer programs (ICPs) provide comprehensive cancer services, leadership of quality and overall organisation/coordination for the region. STPs include ICPs directly linked to satellite centres and also affiliated to centres with their own systemic therapy programs to provide appropriate systemic therapy services for all regions under a common set of standards. Five levels of care are recommended, with complexity and availability of services differentiating the levels. For each level, standards were established for; 1-Providers and their roles, 2-Education for providers, 3-Service type and complexity, 4-Service volumes, 5- Quality assurance and safety, 6-Facility requirements, 7-Administrative and organizational responsibilities. The intent is to provide the same standard of care in the most appropriate setting within the appropriate time frame. STPs will implement, monitor and evaluate quality indicators. Conclusions: A detailed review of the document including results of practitioner feedback as well as survey results from the 14 STPs to determine whether standards are being currently met will be presented. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- T. Vandenberg
- Cancer Care Ontario, London, ON, Canada; Cancer Care Ontario, Kingston, ON, Canada; Cancer Care Ontario, Renfrew, ON, Canada; Cancer Care Ontario, Oshawa, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; Cancer Care Ontario, Hamilton, ON, Canada; Cancer Care Ontario, Ottawa, ON, Canada
| | - A. Smith
- Cancer Care Ontario, London, ON, Canada; Cancer Care Ontario, Kingston, ON, Canada; Cancer Care Ontario, Renfrew, ON, Canada; Cancer Care Ontario, Oshawa, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; Cancer Care Ontario, Hamilton, ON, Canada; Cancer Care Ontario, Ottawa, ON, Canada
| | - C. McLennan
- Cancer Care Ontario, London, ON, Canada; Cancer Care Ontario, Kingston, ON, Canada; Cancer Care Ontario, Renfrew, ON, Canada; Cancer Care Ontario, Oshawa, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; Cancer Care Ontario, Hamilton, ON, Canada; Cancer Care Ontario, Ottawa, ON, Canada
| | - L. Wilcock
- Cancer Care Ontario, London, ON, Canada; Cancer Care Ontario, Kingston, ON, Canada; Cancer Care Ontario, Renfrew, ON, Canada; Cancer Care Ontario, Oshawa, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; Cancer Care Ontario, Hamilton, ON, Canada; Cancer Care Ontario, Ottawa, ON, Canada
| | - J. Nayler
- Cancer Care Ontario, London, ON, Canada; Cancer Care Ontario, Kingston, ON, Canada; Cancer Care Ontario, Renfrew, ON, Canada; Cancer Care Ontario, Oshawa, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; Cancer Care Ontario, Hamilton, ON, Canada; Cancer Care Ontario, Ottawa, ON, Canada
| | - N. Coakley
- Cancer Care Ontario, London, ON, Canada; Cancer Care Ontario, Kingston, ON, Canada; Cancer Care Ontario, Renfrew, ON, Canada; Cancer Care Ontario, Oshawa, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; Cancer Care Ontario, Hamilton, ON, Canada; Cancer Care Ontario, Ottawa, ON, Canada
| | - C. DeGrasse
- Cancer Care Ontario, London, ON, Canada; Cancer Care Ontario, Kingston, ON, Canada; Cancer Care Ontario, Renfrew, ON, Canada; Cancer Care Ontario, Oshawa, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; Cancer Care Ontario, Hamilton, ON, Canada; Cancer Care Ontario, Ottawa, ON, Canada
| | - E. Green
- Cancer Care Ontario, London, ON, Canada; Cancer Care Ontario, Kingston, ON, Canada; Cancer Care Ontario, Renfrew, ON, Canada; Cancer Care Ontario, Oshawa, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; Cancer Care Ontario, Hamilton, ON, Canada; Cancer Care Ontario, Ottawa, ON, Canada
| | - C. Sawka
- Cancer Care Ontario, London, ON, Canada; Cancer Care Ontario, Kingston, ON, Canada; Cancer Care Ontario, Renfrew, ON, Canada; Cancer Care Ontario, Oshawa, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; Cancer Care Ontario, Hamilton, ON, Canada; Cancer Care Ontario, Ottawa, ON, Canada
| | - M. E. Trudeau
- Cancer Care Ontario, London, ON, Canada; Cancer Care Ontario, Kingston, ON, Canada; Cancer Care Ontario, Renfrew, ON, Canada; Cancer Care Ontario, Oshawa, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; Cancer Care Ontario, Hamilton, ON, Canada; Cancer Care Ontario, Ottawa, ON, Canada
| |
Collapse
|