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BMC Neurology Feb 2024Various post-stroke dysfunctions often result in poor long-term outcomes for stroke survivors, but the effect of conventional treatments is limited. In recent years,...
Various post-stroke dysfunctions often result in poor long-term outcomes for stroke survivors, but the effect of conventional treatments is limited. In recent years, lots of studies have confirmed the effect of repetitive transcranial magnetic stimulation (rTMS) in stroke rehabilitation. As a new pattern of rTMS, theta burst stimulation (TBS) was proved recently to yield more pronounced and long-lasting after-effects than the conventional pattern at a shorter stimulation duration. To explore the role of TBS in stroke rehabilitation, this review summarizes the existing evidence from all the randomized controlled trials (RCTs) so far on the efficacy of TBS applied to different post-stroke dysfunctions, including cognitive impairment, visuospatial neglect, aphasia, dysphagia, spasticity, and motor dysfunction. Overall, TBS promotes the progress of stroke rehabilitation and may serve as a preferable alternative to traditional rTMS. However, it's hard to recommend a specific paradigm of TBS due to the limited number of current studies and their heterogeneity. Further high-quality clinical RCTs are needed to determine the optimal technical settings and intervention time in stroke survivors.
Topics: Humans; Stroke Rehabilitation; Transcranial Magnetic Stimulation; Stroke; Time Factors
PubMed: 38297193
DOI: 10.1186/s12883-023-03492-0 -
Journal of Neurosurgery Jan 2024The authors report on the anterior transpetrosal approach (ATPA) and the results of surgeries performed over a 33-year period for petroclival tumors, including...
OBJECTIVE
The authors report on the anterior transpetrosal approach (ATPA) and the results of surgeries performed over a 33-year period for petroclival tumors, including meningioma, trigeminal schwannoma, chordoma, and epidermoid tumor. They analyze early postoperative neurological changes, surgical complications, and trends over the decades.
METHODS
A retrospective analysis of 274 surgical cases that had undergone the ATPA from January 1984 to March 2017 was conducted. Data were collected from charts, clinical summaries, operative records, and operative videos. The analyzed parameters included patient diagnosis, tumor size, disease location, operation date, tumor removal rate, pre- and postoperative neurological symptoms (consciousness level, motor and sensory deficits of the limbs, sensory aphasia, and cranial nerve III-VIII injuries), surgical deaths, and radiologically recognized brain injuries after the operation (contusion, infarction, hemorrhage).
RESULTS
Gross-total resection (GTR) was achieved in 53.5% of the 243 tumors with available data. The GTR rate for meningiomas (148 cases) was 54.1%. Trigeminal schwannomas had a high GTR rate of 87.1%, whereas chordomas had a low GTR rate of 14.3%. The rate of early neurological deterioration immediately after the ATPA, referred to as "early neurological change," was as follows: consciousness disturbance in 1.9% of cases (5 cases), improvement of hemiparesis in 45.0% of cases but deterioration in 8.1% of cases, sensory aphasia in 2.3% of cases due to temporal lobe injury, improvement of cerebellar symptoms in 39.3% of cases with rare deterioration (1.9% of cases), worsening of preoperative diplopia in 49.4% of patients and rarely improving, improvement of trigeminal symptoms in 19.1% of cases (mostly trigeminal neuralgia) among the 43.7% of patients who had them preoperatively, and deterioration of facial hypesthesia and/or paresthesia in 27.4% of cases. Early neurological deterioration was monitored in 183 patients for 6 months to determine the surgical complications of ATPA. Consciousness disturbance recovered in half of the cases but persisted in 3 (1.5%). Hemiparesis fully recovered in 63.2% of cases, resulting in a complication rate of 3.0%. The most frequent complication was diplopia (36.4%), with a complete remission rate of 26.4%. The second most frequent complication was facial hypesthesia (24.0%), with a recovery rate of 16.1%. Facial nerve palsy improved in 63.0% of cases and had a complication rate of 4.9%. Cerebellar symptoms showed complete recovery in all cases.
CONCLUSIONS
The ATPA allows the removal of petroclival tumors extending into Meckel's cave and the middle fossa, making it preferred for dumbbell trigeminal schwannomas and meningiomas. However, the ATPA's aggressive tumor removal can risk a lower recovery of cranial nerve IV-VI deficits. For benign meningiomas, initial observation with regular follow-up is recommended. Surgery is appropriate for high-growth cases aiming for total removal, accompanied by a thorough explanation of the risks. If the risks are not accepted, subtotal removal can be considered, and radiosurgery is suggested for residual tumor.
PubMed: 38277661
DOI: 10.3171/2023.11.JNS231532 -
Frontiers in Neurology 2023Stroke is a common neurological disorder worldwide that can cause significant disabilities. Transcranial alternating current stimulation (tACS) is an emerging... (Review)
Review
Stroke is a common neurological disorder worldwide that can cause significant disabilities. Transcranial alternating current stimulation (tACS) is an emerging non-invasive neuromodulation technique that regulates brain oscillations and reshapes brain rhythms. This study aimed to investigate the effect of tACS on functional recovery in patients with stroke. The MEDLINE (PubMed), Cochrane Library, Embase, SCOPUS, and Web of Science databases were searched for English-language articles on tACS and stroke, published up to October 20, 2023. The following key search phrases were combined to identify potentially relevant articles: 'tACS,' 'transcranial alternating current stimulation,' 'stroke,' 'cerebral infarct,' and 'intracerebral hemorrhage.' The inclusion criteria for study selection were as follows: (1) studies involving patients with stroke and (2) studies that used tACS for functional recovery. A total of 34 potentially relevant studies were identified. Five articles were included in this review after reading the titles and abstracts and assessing their eligibility based on the full-text articles. Among the included studies, one investigated the improvement in overall functional status in patients with stroke after tACS, and two investigated the effect of tACS on motor function and gait patterns. Moreover, one study reported the efficacy of tACS on aphasia recovery, and one study evaluated the effect of tACS on hemispatial neglect. Our findings suggest that tACS improves functional recovery in patients with stroke. The application of tACS was associated with improved overall functional recovery, sensorimotor impairment, aphasia, and hemispatial neglect. The potential clinical application of tACS should be supported by high-quality, evidence-based studies.
PubMed: 38269003
DOI: 10.3389/fneur.2023.1327383 -
Sensors (Basel, Switzerland) Jan 2024The fusion of electroencephalography (EEG) with machine learning is transforming rehabilitation. Our study introduces a neural network model proficient in distinguishing...
The fusion of electroencephalography (EEG) with machine learning is transforming rehabilitation. Our study introduces a neural network model proficient in distinguishing pre- and post-rehabilitation states in patients with Broca's aphasia, based on brain connectivity metrics derived from EEG recordings during verbal and spatial working memory tasks. The Granger causality (GC), phase-locking value (PLV), weighted phase-lag index (wPLI), mutual information (MI), and complex Pearson correlation coefficient (CPCC) across the delta, theta, and low- and high-gamma bands were used (excluding GC, which spanned the entire frequency spectrum). Across eight participants, employing leave-one-out validation for each, we evaluated the intersubject prediction accuracy across all connectivity methods and frequency bands. GC, MI theta, and PLV low-gamma emerged as the top performers, achieving 89.4%, 85.8%, and 82.7% accuracy in classifying verbal working memory task data. Intriguingly, measures designed to eliminate volume conduction exhibited the poorest performance in predicting rehabilitation-induced brain changes. This observation, coupled with variations in model performance across frequency bands, implies that different connectivity measures capture distinct brain processes involved in rehabilitation. The results of this paper contribute to current knowledge by presenting a clear strategy of utilizing limited data to achieve valid and meaningful results of machine learning on post-stroke rehabilitation EEG data, and they show that the differences in classification accuracy likely reflect distinct brain processes underlying rehabilitation after stroke.
Topics: Humans; Brain; Machine Learning; Memory, Short-Term; Electroencephalography; Aphasia
PubMed: 38257423
DOI: 10.3390/s24020329 -
JAMA Network Open Jan 2024Motor aphasia is common among patients with stroke. Acupuncture is recommended as an alternative therapy for poststroke aphasia, but its efficacy remains uncertain. (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Motor aphasia is common among patients with stroke. Acupuncture is recommended as an alternative therapy for poststroke aphasia, but its efficacy remains uncertain.
OBJECTIVE
To investigate the effects of acupuncture on language function, neurological function, and quality of life in patients with poststroke motor aphasia.
DESIGN, SETTING, AND PARTICIPANTS
This multicenter, sham-controlled, randomized clinical trial was conducted in 3 tertiary hospitals in China from October 21, 2019, to November 13, 2021. Adult patients with poststroke motor aphasia were enrolled. Data analysis was performed from February to April 2023.
INTERVENTIONS
Eligible participants were randomly allocated (1:1) to manual acupuncture (MA) or sham acupuncture (SA) groups. Both groups underwent language training and conventional treatments.
MAIN OUTCOMES AND MEASURES
The primary outcomes were the aphasia quotient (AQ) of the Western Aphasia Battery (WAB) and scores on the Chinese Functional Communication Profile (CFCP) at 6 weeks. Secondary outcomes included WAB subitems, Boston Diagnostic Aphasia Examination, National Institutes of Health Stroke Scale, Stroke-Specific Quality of Life Scale, Stroke and Aphasia Quality of Life Scale-39, and Health Scale of Traditional Chinese Medicine scores at 6 weeks and 6 months after onset. All statistical analyses were performed according to the intention-to-treat principle.
RESULTS
Among 252 randomized patients (198 men [78.6%]; mean [SD] age, 60.7 [7.5] years), 231 were included in the modified intention-to-treat analysis (115 in the MA group and 116 in the SA group). Compared with the SA group, the MA group had significant increases in AQ (difference, 7.99 points; 95% CI, 3.42-12.55 points; P = .001) and CFCP (difference, 23.51 points; 95% CI, 11.10-35.93 points; P < .001) scores at week 6 and showed significant improvements in AQ (difference, 10.34; 95% CI, 5.75-14.93; P < .001) and CFCP (difference, 27.43; 95% CI, 14.75-40.10; P < .001) scores at the end of follow-up.
CONCLUSIONS AND RELEVANCE
In this randomized clinical trial, patients with poststroke motor aphasia who received 6 weeks of MA compared with those who received SA demonstrated statistically significant improvements in language function, quality of life, and neurological impairment from week 6 of treatment to the end of follow-up at 6 months after onset.
TRIAL REGISTRATION
Chinese Clinical Trial Registry: ChiCTR1900026740.
Topics: United States; Adult; Male; Humans; Middle Aged; Aphasia, Broca; Quality of Life; Acupuncture Therapy; Communication; Stroke
PubMed: 38252438
DOI: 10.1001/jamanetworkopen.2023.52580 -
Brain Sciences Jan 2024Apraxia of speech is a persistent speech motor disorder that affects speech intelligibility. Studies on speech motor disorders with transcranial Direct Current...
Enhancing Speech Rehabilitation in a Young Adult with Trisomy 21: Integrating Transcranial Direct Current Stimulation (tDCS) with Rapid Syllable Transition Training for Apraxia of Speech.
Apraxia of speech is a persistent speech motor disorder that affects speech intelligibility. Studies on speech motor disorders with transcranial Direct Current Stimulation (tDCS) have been mostly directed toward examining post-stroke aphasia. Only a few tDCS studies have focused on apraxia of speech or childhood apraxia of speech (CAS), and no study has investigated individuals with CAS and Trisomy 21 (T21, Down syndrome). This N-of-1 randomized trial examined the effects of tDCS combined with a motor learning task in developmental apraxia of speech co-existing with T21 (ReBEC RBR-5435x9). The accuracy of speech sound production of nonsense words (NSWs) during Rapid Syllable Transition Training (ReST) over 10 sessions of anodal tDCS (1.5 mA, 25 cm) over Broca's area with the cathode over the contralateral region was compared to 10 sessions of sham-tDCS and four control sessions in a 20-year-old male individual with T21 presenting moderate-severe childhood apraxia of speech (CAS). The accuracy for NSW production progressively improved (gain of 40%) under tDCS (sham-tDCS and control sessions showed < 20% gain). A decrease in speech severity from moderate-severe to mild-moderate indicated transfer effects in speech production. Speech accuracy under tDCS was correlated with Wernicke's area activation (P3 current source density), which in turn was correlated with the activation of the left supramarginal gyrus and the Sylvian parietal-temporal junction. Repetitive bihemispheric tDCS paired with ReST may have facilitated speech sound acquisition in a young adult with T21 and CAS, possibly through activating brain regions required for phonological working memory.
PubMed: 38248273
DOI: 10.3390/brainsci14010058 -
Cerebellum (London, England) Jan 2024The cerebellum is traditionally known to subserve motor functions. However, for several decades, the concept of the "cerebellar cognitive affective syndrome" has...
The cerebellum is traditionally known to subserve motor functions. However, for several decades, the concept of the "cerebellar cognitive affective syndrome" has evolved. Studies in healthy participants and patients have confirmed the cerebellar role in language. The exact involvement of the cerebellum regarding cerebellar aphasia remains uncertain. We included 43 cerebellar stroke patients who were tested at 3 months post-onset with the Boston Naming Test (BNT), the Token Test (TT), and the Diagnostic Instrument for Mild Aphasia (DIMA). Lesion side (left/right) and volume (cm) were investigated. Patients significantly deviated on the following: BNT (p<0.001), TT (p<0.05), DIMA subtests: sentences repetition (p=0.001), semantic odd-picture-out (p<0.05), sentence completion (p<0.05) without an effect of lesion location (left/right) or volume (cm) (p>0.05). Our clinical study confirms a non-lateralized cerebellar aphasia post-stroke, characterized by impairments in word retrieval, phonology, semantics, and syntax resembling cerebral-induced aphasia. The integral cerebellum appears to interact with eloquent cortico-subcortical language areas.
PubMed: 38244134
DOI: 10.1007/s12311-024-01658-1 -
Applied Neuropsychology. Adult Jan 2024Approximately 50% of patients with amyotrophic lateral sclerosis (ALS) experience cognitive decline, with frontotemporal dementia (FTD) accounting for up to 15% of these...
OBJECTIVE
Approximately 50% of patients with amyotrophic lateral sclerosis (ALS) experience cognitive decline, with frontotemporal dementia (FTD) accounting for up to 15% of these cases. Despite this, there is considerable delay in diagnosis, which affects patient care.
METHODS
We report longitudinal results of neuropsychological evaluations in a patient diagnosed with non-fluent/agrammatic primary progressive aphasia (nfvPPA) and amyotrophic lateral sclerosis (ALS). The patient, Ms. X, presented with progressive speech difficulties starting in her late-60's. Initial diagnosis was nfvPPA. After 4-5 years of progressive swallowing difficulties, as well as facial weakness, her diagnosis was modified to PPA-ALS.
RESULTS
Ms. X underwent neuropsychological evaluations three times over a period of five years. Results of evaluations were intact and stable over time, except for progressive loss of speech impacting her performance on a sentence repetition task.
CONCLUSION
This case study provides valuable insight into the overlap between PPA-ALS from a neuropsychological standpoint. The results reflect preserved cognitive skills in the context of loss of speech and motor abilities. This case study also shows the length of time between onset of symptoms and clear diagnosis, which often requires an immense amount of health literacy and personal advocacy on the part of the patient.
PubMed: 38241787
DOI: 10.1080/23279095.2024.2302833 -
Journal of Epilepsy Research Dec 2023In aphasic status epilepticus (ASE), aphasia is the sole manifestation of seizure in patients with this disorder. Alzheimer's disease (AD) is one of neurological...
In aphasic status epilepticus (ASE), aphasia is the sole manifestation of seizure in patients with this disorder. Alzheimer's disease (AD) is one of neurological disorders causing ASE. Herein, we report two cases of ASE associated with AD, and discuss their clinical characteristics. Patient 1 presented Broca's aphasia, and patient 2 presented global aphasia during the ictal period. Both patients exhibited atypical ictal electroencephalographic (EEG) patterns, which improved after antiepileptic drug administration. ASE was the presenting symptom of AD in patient 1. ASE can develop at any stage of AD. Alterations in clinical symptoms and EEG patterns after treatment with antiepileptic drug are the key to diagnosis. Prompt diagnosis and treatment are critical for preventing further consciousness dysfunction.
PubMed: 38223360
DOI: 10.14581/jer.23009 -
Aphasiology 2023Speech of individuals with non-fluent, including Broca's, aphasia is often characterized as "agrammatic" because their output mostly consists of nouns and, to a lesser...
BACKGROUND
Speech of individuals with non-fluent, including Broca's, aphasia is often characterized as "agrammatic" because their output mostly consists of nouns and, to a lesser extent, verbs and lacks function words, like articles and prepositions, and correct morphological endings. Among the earliest accounts of agrammatic output in the early 1900s was the "economy of effort" idea whereby agrammatic output is construed as a way of coping with increases in the cost of language production. This idea resurfaced in the 1980s, but in general, the field of language research has largely focused on accounts of agrammatism that postulated core deficits in syntactic knowledge.
AIMS
We here revisit the economy of effort hypothesis in light of increasing emphasis in cognitive science on rational and efficient behavior.
MAIN CONTRIBUTION
The critical idea is as follows: there is a cost per unit of linguistic output, and this cost is greater for patients with non-fluent aphasia. For a rational agent, this increase leads to shorter messages. Critically, the informative parts of the message should be preserved and the redundant ones (like the function words and inflectional markers) should be omitted. Although economy of effort is unlikely to provide a unifying account of agrammatic output in all patients-the relevant population is too heterogeneous and the empirical landscape too complex for any single-factor explanation-we argue that the idea of agrammatic output as a rational behavior was dismissed prematurely and appears to provide a plausible explanation for a large subset of the reported cases of expressive aphasia.
CONCLUSIONS
The rational account of expressive agrammatism should be evaluated more carefully and systematically. On the basic research side, pursuing this hypothesis may reveal how the human mind and brain optimize communicative efficiency in the presence of production difficulties. And on the applied side, this construal of expressive agrammatism emphasizes the strengths of some patients to flexibly adapt utterances in order to communicate in spite of grammatical difficulties; and focusing on these strengths may be more effective than trying to "fix" their grammar.
PubMed: 38213953
DOI: 10.1080/02687038.2022.2143233