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Cognitive decline is one of the main clinical symptoms of neurodegenerative diseases. There is no specific drug treatment, which seriously affects the quality of life and rehabilitation process of these patients. Non-invasive brain stimulation (NIBS) technology such as transcranial magnetic stimulation and transcranial electrical stimulation known as its advantages of non-invasive, painless, and easy to operate, has been used in clinical treatment of cognitive disorders. In particular, it has a good effect on improving cognitive functions such as memory, attention, orientation and language ability. In recent years, the study of cerebellar involvement in learning and memory through brain-cerebellar circuit has attracted much attention, and cerebellum has become a new target for NIBS technology exploration. However, the correlation between cerebellar NIBS and cognitive function regulation is still unclear. This paper aims to provide the evidences of the anatomic and functional basis of cerebellar involvement in cognitive function regulation and cerebellar non-invasive stimulation on cognitive function regulation.
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Transcranial electrical stimulation (tES) is a non-invasive neural modulation technique known for its high safety, patient compliance, and portability. It holds promise as a potential non-pharmacological method for analgesia. However, challenges persist in utilizing tES for pain management, including inconsistent research findings and limited understanding of its analgesic mechanisms. Therefore, by summarizing the advances in the analgesic researches employing the 3 primary tES techniques, transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS), and transcranial random noise stimulation (tRNS), we reviewed the analgesic effects on both acute and chronic pain, as well as the neural mechanisms underlying the analgesic effect of each technique. Accumulating evidence suggests that the analgesic effects of tDCS are significant, but studies on analgesic effects of tACS and tRNS remain limited. And the exact mechanisms of pain relief through tES turned out to be not yet well established. Furthermore, we systematically discussed the limitations of analgesia-related studies employing tES techniques across various aspects, involving research design, stimulation protocol formulation, neural response observation, analgesic effect assessment, and safety considerations. To address these limitations and advance clinical translation, we emphasized utilizing promising stimulation techniques and offered practical suggestions for future research endeavors. Specifically, employing numerical simulation of electric field guided by magnetic resonance imaging (MRI) would reduce variability of outcomes due to individual differences in head anatomy. For this purpose, it is advisable to establish standardized head models based on MRI data from the Chinese populations and validate simulated electric field results in tES research to diminish confounding factors concerning anatomy. Meanwhile, novel techniques like multi-site brain stimulation and interferential stimulation (IFS) could broaden the range of stimulation sites in both scope and depth. Multi-site brain stimulation facilitates modulation of entire neural networks, enabling more sophisticated investigations into the complexity of pain. IFS can reach deep brain tissues without invasive surgical procedures, achieving more comprehensive modulation. Regarding neural response observations, establishing a tES-neuroimaging synchronized platform would enable revealing its mechanisms and personalizing protocols based on inter-subject neural response variability detected through recordings. By integrating tES with various neuroimaging techniques, such as functional MRI, electroencephalography (EEG) and magnetoencephalography, into one unified platform, researchers could examine brain activities in baseline before stimulation, dynamic changes in brain activities during stimulation, and sustained brain responses after stimulation. Additionally, collecting finer-grained data on participant characteristics and pain intensity would enhance the sensitivity of future studies. In designing clinical trials to evaluate chronic pain treatments and reporting the results, adopting the six core outcome domain measures recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) could prove beneficial. Lastly, safety considerations can never be overemphasized in future tES studies especially when combining tES with MRI and EEG techniques. These efforts may help to broaden the research scope, reconcile inconsistencies in findings and elucidate the analgesic mechanisms of tES, thus facilitating the development of pragmatic pain management strategies such as combination therapies and home therapies. Ultimately, these suggestions will maximize the clinical application value of tES in pain treatment to achieve pain relief for patients.
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Existing neuroregulatory techniques can achieve precise stimulation of the whole brain or cortex, but high-focus deep brain stimulation has been a technical bottleneck in this field. In this paper, based on the theory of negative permeability emerged in recent years, a simulation model of magnetic replicator is established to study the distribution of the induced electric field in the deep brain and explore the possibility of deep focusing, which is compared with the traditional magnetic stimulation method. Simulation results show that a single magnetic replicator realized remote magnetic source. Under the condition of the same position and compared with the traditional method of stimulating, the former generated smaller induced electric field which sharply reduced with distance. By superposition of the magnetic field replicator, the induced electric field intensity could be increased and the focus could be improved, reducing the number of peripheral wires while guaranteeing good focus. The magnetic replicator model established in this paper provides a new idea for precise deep brain stimulation, which can be combined with neuroregulatory techniques in the future to lay a foundation for clinical application.
Sujet(s)
Encéphale , Cortex cérébral , Simulation numérique , Électricité , Champs magnétiquesRÉSUMÉ
Non-invasive brain stimulation (NIBS) is one of the fastest-growing fields of medicine today. Recent studies have highlighted the potential of NIBS as an innovative, safe, and cost-effective treatment method applied to insomnia. Starting from treatment mechanism and clinical effect, we summarize the current research status of repetitive transcranial magnetic stimulation and transcranial electrical stimulation, the two most common NIBSs used in insomnia treatment, and analyze the existing research limitations and its future development direction, in order to provide references for further promoting the clinical application of NIBS in insomnia treatment.
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Objective To explore the effect of different transcranial pulse current stimulation(tPCS)program on the elimination of fatigue in physical cognitive mixed tasks.Methods Thirty healthy college athletes were randomly divided into group Ⅰ'and groupⅡ',each of 15.Then,both groups of sub-jects exercised on power bicycles.Ten subjects were screened from Group Ⅰ'and Ⅱ'meeting the crite-ria of moderate and severe physical cognitive mixed task fatigue using the Rating of Perceived Exer-tion respectively.Both groups received five tPCS interventions.Before and after each intervention,the subjects were tested for heart rate variability(HRV)and oxygenated hemoglobin(HbO2)concentration,and the effect of different stimulations on the fatigue elimination in physical cognitive mixed tasks of different severities were measured.Meanwhile,the HRV measurements included root mean square of difference between adjacent R-R intervals(RMSSD),standard deviation of all normal-to-normal inter-vals(SDNN),high frequency(HF)and low frequency(LF).Results①After tPCS intervention,the aver-age SDNN,HF and HbO2 increased significantly(P<0.05),while the average IF decreased significantly(P<0.05).②In physical cognitive mixed task of moderate fatigue,the biggest change of each index ap-peared after the tPCS program D(20 min,sensory intensity).③In the physical cognitive mixed task of severe fatigue,the change range of each index was the largest after the tPCS program C(20 min,sensory intensity + 0.2 mA).Conclusion ①After physical cognitive mixed tasks,different tPCS stimu-lation programs have different effects on the elimination of fatigue with an optimal"stimulant dose".②The effects of five intervention programs on the elimination of physical fatigue of athletes are as fol-lows:For the elimination of moderate fatigue of physical cognitive mixed task,program D of tPCS(20 min,sensory intensity)has the greatest effect,while for the elimination of severe fatigue of physical cognitive mixed task,program C of tPCS(20 min,sensory intensity + 0.2 mA)has the greatest effect.
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Objective:To observe any effect of transcranial direct current stimulation (tDCS) on the speed and accuracy of picture naming and on the phonological fluency of aphasic stroke survivors.Methods:Twenty-four stroke survivors with aphasia were randomly divided into an observation group and a control group, each of 12. In addition to language training and picture naming training, the observation group received 20 minutes of tDCS over the left dorsolateral prefrontal cortex (DLPFC) daily, 5 days a week for 2 weeks. The control group was given sham stimulation. Before and after the 2 weeks of treatment, both groups were tested for picture naming and phonological fluency.Results:Significant improvement in the number of accurately pronounced high-frequency words and in reaction time was observed in both groups, but the observation group′s average reaction time for high-frequency words was significantly shorter than the control group′s average. The observation group′s average reaction time for low-frequency words had also improved significantly. After the 2 weeks of treatment, the phonological fluency of the observation group was significantly better than before the treatment and better than that of the control group.Conclusions:tDCS applied over the left DLPFC of stroke survivors with aphasia can promote lexical retrieval and strengthen their executive and control functioning.
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BACKGROUND: Alzheimer’s disease is a progressive neurological degenerative disease characterized by cognitive decline. Cognitive decline can make the elderly gradually losing their self-care ability, which eventually affects daily life and activities. Mild cognitive impairment is a precursor state of Alzheimer’s disease, and to diagnose and treat mild cognitive impairment as soon as possible has great significance in preventing the development of Alzheimer’s disease. OBJECTIVE: To summarize the development and future prospects of the assessment and treatment of semantic memory disorders due to mild cognitive impairment. METHODS: A computer-based retrieval of PubMed, Web of Science, CNKI, and WanFang was performed for related studies on the evaluation and treatment of mild cognitive impairment in semantic memory. The keywords were “mild cognitive impairment, semantic memory impairment, semantic memory deficit” in English and Chinese, respectively. The retrieval time was from January 2009 to November 2019. RESULTS AND CONCLUSION: Semantic memory disorder is one of the main clinical symptoms of mild cognitive impairment, and has certain specificity. At present, there are different types of memory scales that can be used as neurophysiological measures of semantic memory disorder due to mild cognitive impairment. The temporal lobe, frontal lobe, and premotor region may participate in the semantic memory loop. Targeted semantic memory neurophysiology and auxiliary examinations, and targeted semantic memory rehabilitation training can be helpful for early identification of the occurrence and transformation of mild cognitive impairment.
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Transcranial electrical stimulation-motor evoked potential (TES-MEP) is a valuable intraoperative monitoring technique during brain tumor surgery. However, TES can stimulate deep subcortical areas located far from the motor cortex. There is a concern about false-negative results from the use of TES-MEP during resection of those tumors adjacent to the primary motor cortex. Our study reports three cases of TES-MEP monitoring with false-negative results due to deep axonal stimulation during brain tumor resection. Although no significant change in TES-MEP was observed during surgery, study subjects experienced muscle weakness after surgery. Deep axonal stimulation of TES could give false-negative results. Therefore, a combined method of TES-MEP and direct cortical stimulation-motor evoked potential (DCS-MEP) or direct subcortical stimulation should be considered to overcome the limitation of TES-MEP.
Sujet(s)
Axones , Tumeurs du cerveau , Encéphale , Potentiels évoqués , Méthodes , Surveillance peropératoire , Cortex moteur , Faiblesse musculaire , Stimulation transcrânienne par courant continuRÉSUMÉ
Objective To design a new type of rehabilitation device to execute electrode fixation and precision positioning during transcranial electrical stimulation.Methods The device was composed of a positioning cap,a soft rubber keel scaffold, an inlaid nut,a unionbolt,an electrical stimulation shim and etc.The electrode was put into the shim at the target site,and fixation and positioning were realized by regulating the depth of the bolt into the slot to change the attachment between the electrode fixing cushion and cranial skin,and then electrical stimulation therapy could be carried out reliably and accurately. Results The device gained advantages over the traditional means in fixation time in one time, dropping-off rate, patient satisfaction and easy operation.Conclusion This device behaves well in simple structure,easy manufacture,low cost,fixation and large applicability to kinds of population and electrical stimulators,and enhances the reliability of transcranial electrical stimulation therapy to some extent.
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Objective To investigate the success rate and safety of transcranial electrical stimulation motor evoked potentials (TES-MEP) and somatosensory evoked potential(SEP) in the monitor of the spinal operation.Methods A total of 98 patients with spinal surgery in our hospital from December 2015 to December 2016 were selected and divided into observation group and control group according to the intraoperative monitoring method,49 cases in each group.SEP conbined with TES-MEP were used in the observation group,and SEP monitoring was used in the control group.Intravenous anesthesia was used in all patients to observe and record the amplitude and latency of SEP and TES-MEP.The results of the two groups were compared with those of the postoperative spinal motor and sensory function and the complications.Results The successful detection rate of the observation group and the control group were respectively 100％ and 91.84％,and the difference was statistically significant(P ＜ 0.05).The sensitivity,specificity and Youden index of the spinal cord movement were significantly higher in the observation group than those in the control group,the difference was not significant(P ＞ 0.05).In addition,the sensitivity,specificity and Youden index of the sensory function were higher than those in the control group,and the differences were statistically significant (P ＜ 0.05).There was no significant difference in postoperation complication between the two groups (P ＞ 0.05).Conclusion SEP combined with TES-MEP in monitoring function changes of the spine during spinal surgery on sensitivity and specificity are higher than the SEP monitoring,which can accurately reflect the function of the spine in the operation state,and provide a good reference for surgery.
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Objective To investigate the efficacy of combined monitoring of motor evoked potentials with transcranial electrical stimulation (TES-MEP),somatosensory evoked potentials (SEP) and spontaneous electromyo-graphy (s-EMG) in tuberculosis surgery involving the thoracic,lumbar and sacral vertebrae.Methods Twenty-seven patients with tuberculosis of the thoracic vertebrae (T2-L2) received intra-operative SEP and TES-MEP monito-ring.Combined SEP,TES-MEP and spontaneous EMG monitoring were employed in 11 patients with tuberculosis of the lumbar or/and sacral vertebrae (L3-S1).SEP and TES-MEP were used to precisely observe the status of the sen-sory and motor pathways; s-EMG responses were used to more accurately localize nerve root irritation.ResuIts (1) SEP monitoring was successful in all of the operations.TES-MEPs were successfully monitored in 35 of them (92.1％).Combined motor and sensory monitoring was successfully achieved in 35 cases (92.1％).Abnormal SEPs were observed in 3 cases (7.9％),while abnormal MEPs were observed in 11 cases (28.9％).Abnormality in both the SEP and TES-MEP occurred in 2 cases (5.3％).There were 9 cases (23.7％) where the SEPs were nor-mal and the TES-MEPs were abnormal.In only 1 case (2.6％) was the SEP normal and the MEP abnormal.The false negative rate was 0％ with combined SEP and TES-MEP monitoring,while the false positive rate was 5.3％.There were 2 cases complicated by post-operative neurological deficits.(2) Spontaneous EMG monitoring can accu-rately determine the functioning of lumbar nerve roots during lumbar or lumbosacral tuberculosis surgery.Among 5 cases where EMG responses were observed,4 cases occurred during the spinal canal and nerve root decompression,1 case occurred in the orthopedic reset phase.Conclusions (1) During tuberculosis surgery involving thoracic,lumbar or sacral vertebrae,combined monitoring of SEPs and TES-MEPs can reflect the physiological and pathological condition of the spinal cord after ruling out interfering factors.This can improve monitoring and help assure the safety of lumbar surgery.(2) Intra-operative s-EMG monitoring can accurately reveal nerve root function in real time,help-ing to avert nerve root injury in lumbar and lumbosacral tuberculosis surgery.
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Objective To assess the influence of transcranial electric stimulation (TES) on the recovery of motor function after cerebral focal ischemia and reperfusion and to explore the mechanisms in terms of neural plasticity.Methods An acute focal ischemia-reperfusion model was established by transient occlusion of the right middle cerebral artery (MCAO).Seventy-two male Sprague-Dawley rats were randomly divided into a TES group,a model group,a sham-operation group and a normal group.The TES group was given TES 24 h after MCAO;the model group received the operation without any treatment.Forelimb placing (FPT) and beam walking (BWT) were mea-sured at the 3rd,7th,14th and 28th day after reperfusion.Microtubule-associated protein-2 (MAP-2) and growth-associated protein-43 (GAP-43) and grey levels of reaction products in the peri-infarct region were examined by immunohistochemical techniques.Results The TES group rats had markedly better FPT and BWT performance at the 7th,14th and 28th day after MCAO,compared with the model group.Expression of MAP-2 had increased significantly more at the 14th and 28th day in the peri-infarct region in the TES group compared with the model group.Expression of GAP-43 was significantly elevated in the peri-infarct region in the TES group compared with the model group at all time points.Conclusions TES can improve motor function and neural plasticity following cerebral ischemia and reperfusion damage.The functional enhancement may be partly due to up-regulation of the expression of GAP-43 and MAP-2 in the peri-infarct region.
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@#ObjectiveTo assess how transcranial electrical stimulation (TES) concurrent with rehabilitation training influences brain plasticity and behavioral functional performance in rats following a focal ischemic infarction.MethodsAfter an acute focal ischemic infarction by transient occlusion of right middle cerebral artery (MCAO), the electric stimulation concurrent with rehabilitation group was given TES, balancing and rotating and walking exercise everyday; the rehabilitation group was given only balancing and rotating and walking exercise everyday; the control group received no treatment. Growth associated protein 43(GAP-43) was examined by immunohistochemical techniques, and density of reaction product and forelimb placing test (FPT) were measured on the 3rd, 7th, 14th and 28th day after infarction respectively.ResultsThe electrical stimulation concurrent with rehabilitation group provided marked improvement in FPT on the 7th, 14th and 28th day compared with the rehabilitation group and the control group (P<0.01～0.05). The GAP-43 demonstrated statistically significant increase on the 3rd, 7th, and 14th day in the peri-infarct region in the electrical stimulation concurrent with rehabilitation group compared with other two groups(P<<0.01～0.05).ConclusionThe efficacy of transcranial electrical stimulation combining with rehabilitation training can improve functional outcome and neuronal plasticity following ischemic cerebral damage. The mechanism may be partly due to the upregulation of the expression of GAP-43 in the peri-infarct region. Meanwhile, the efficacy is superior to rehabilitation training only.