Structure, place, and clinical efficacy of the interactive brain therapy (stimulation) technology in cerebrovascular diseases

A. Savelov, N. A. Khrushcheva, K. Kalgin, L. I. Kozlova, D. Bezmaternykh, M. E. Melnikov, K. Mazhirina, A. Shurunova, E. V. Predtechenskaya, M. Shtark
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Abstract

Highlights. Interactive brain stimulation is the next step in neurofeedback technology, it implies the possibility of volitional regulation of the hemodynamic response of specific brain region in order to transform entire brain network and obtain the desired clinical and behavioral dynamics in patients (subjects). One of the indications for using the technology is post-stroke movements disorders when the volitional influence is focused on the motor area of the brain.Background. Neurofeedback and closely related concepts of neural interface system and “interactive brain” are considered as the foundation for developing algorithms for controlling neuroplasticity. Interactive brain therapy (stimulation) is a recently developed type of neurofeedback therapy, which implies dependence of feedback on a hemodynamic response signal recorded by functional magnetic resonance imaging (fMRI). The technology focuses on the region of interest with good accuracy and enables teaching the subject to control the activity of both individual cerebral structures and the functional connectivity between them, causing behavioral metamorphoses.Aim. To demonstrate the study design involving interactive stimulation of secondary motor areas of the brain using a bimodal fMRI-electroencephalography platform, and to describe the dynamics of the motor networks during treatment in patients with hemiparesis in the early period of recovery from stroke.Methods. The study involved 11 patients who were trained to regulate the activity of the secondary motor area and premotor cortex of the affected hemisphere, receiving feedback on the fMRI signal and the activity of the mu- (8–13 Hz) and beta2 (18–26 Hz) EEG ranges of the areas of interest. The block-designed training consisted of 6 sessions (imagination of movement – rest) with an interval of 2–3 days. During treatment the dynamics of the hemodynamic response of the areas of interest was analyzed. In test sessions (before treatment, immediately after the end, and six months later) functional connections within the motor network were reconstructed and hand function was assessed (grip strength, Fugle-Meyer Assessment, Box and Blocks test).Results. Upon completion of treatment, an increase in grip strength and dexterity was achieved; there was an increase in the fMRI signal of the premotor cortex of the ipsilateral hemisphere, and a strengthening of the interhemispheric functional connectivity of the secondary motor areas.Conclusion. fMRI and the interactive brain therapy technology built on its basis, on the one hand, provide the technological foundation for the “interactive brain” and the transformation of spontaneous neuroplasticity into a controlled one, and on the other hand, serve as an important tool for monitoring the process of restructuring of cerebral networks after a stroke, providing the ability to record the emergence (or disappearance) of connectivity between brain regions, and to measure its strength in dynamics, that is, to give a numerical description of neuroplasticity.
脑血管病互动式脑治疗(刺激)技术的结构、位置及临床疗效
高光。交互脑刺激是神经反馈技术的下一步发展方向,它意味着通过意志调节特定脑区域的血流动力学反应,从而改变整个脑网络,获得患者(被试)期望的临床和行为动态。使用该技术的适应症之一是中风后的运动障碍,当意志影响集中在大脑的运动区域时。背景。神经反馈以及与之密切相关的神经接口系统和“交互大脑”等概念被认为是开发控制神经可塑性算法的基础。互动脑治疗(刺激)是最近发展起来的一种神经反馈疗法,它意味着反馈依赖于功能磁共振成像(fMRI)记录的血流动力学反应信号。该技术以较高的准确性聚焦于感兴趣的区域,并使教学对象能够控制个体大脑结构的活动及其之间的功能连接,从而导致行为变态。目的:展示使用双峰fmri脑电图平台对大脑次级运动区域进行交互刺激的研究设计,并描述中风恢复早期偏瘫患者在治疗期间运动网络的动态。这项研究涉及11名患者,他们被训练来调节受影响半球的次级运动区和运动前皮层的活动,接收fMRI信号和感兴趣区域的mu- (8-13 Hz)和β 2 (18-26 Hz)脑电图范围的活动反馈。分块设计的训练包括6个阶段(动作想象-休息),间隔2-3天。在治疗过程中,分析了感兴趣区域的血流动力学反应。在测试阶段(治疗前、结束后和六个月后),运动网络内的功能连接被重建,手功能被评估(握力、Fugle-Meyer评估、盒块测试)。治疗完成后,握力和灵巧度均有所提高;同侧半球运动前皮层的fMRI信号增强,次级运动区半球间功能连通性增强。fMRI及其基础上建立的互动性脑治疗技术,一方面为“互动性脑”和自发神经可塑性向受控神经可塑性的转化提供了技术基础,另一方面,作为监测脑卒中后大脑网络重构过程的重要工具,提供了记录脑区域间连通性出现(或消失)的能力。为了测量它在动力学上的强度,也就是给出神经可塑性的数值描述。
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