Prospects of Synchronous fMRI-EEG Recording as the Basis for Neurofeedback (Exemplified on Patient with Stroke Sequelae).

Synchronous fMRI-EEG mapping of cerebral activity in stroke patients made it possible to implement neurofeedback, a novel and promising therapeutic technology. This method integrates a real-time monitoring of cerebral activity by EEG and fMRI signals and training of the patients to control this activity simultaneously or alternatively via neurofeedback. The targets of such cerebral stimulation are cortical regions controlling arbitrary movements (Brodmann area 4), whereas its aim is optimization of activity in these regions in order to achieve better rehabilitation of stroke patients. The paper discusses the methodical details, advantages, and promise of bimodal neurofeedback treatment.

Dynamics of fMRI and EEG Parameters in a Stroke Patient Assessed during a Neurofeedback Course Focused on Brodmann Area 4 (M1).

A course of interactive stimulation of primary motor cortex (Brodmann area 4) in the brain of a stroke patient resulted in recovery of locomotion volume in the paretic extremities and in improvement of general health accompanied with diverse changes in cerebral activity. During the training course, the magnitude of response in the visual fields of Brodmann areas 17 and 18 decreased; in parallel, the motor areas were supplemented with other ones such as area 24 (the ventral surface of anterior cingulate gyrus responsible for self-regulation of human brain activity and implicated into synthesis of tactile and special information) in company with Brodmann areas 40, 41, 43, 44, and 45. EEG data showed that neurofeedback sessions persistently increased the θ rhythm power in Brodmann areas 7, 39, 40, and 47, while the corresponding powers progressively decreased during a real motion. Both real motion and its virtual sibling constructed by interactive stimulation via neurofeedback were characterized with decreasing powers of the EEG ß rhythm in Brodmann areas 6 and 8. The neurofeedback course decreased the coherence between the left Brodmann area 6 and some other ones examined in α and θ ranges. In the context of real motions, the coherence assessed in the EEG ß range generally increased. Overall, the EEG and fMRI parameters attest to growing similarity between the moieties of functional communications effected in real and imaginary movements during neurofeedback course. The data open the vista for interactive stimulation to rehabilitate stroke patients; they highlight the important role of Brodmann areas in rearrangement of the brain in such patients; finally, the present results revealed the "common nervous pathway" that can be used to restore the capability for imaginary and real movements by a neurofeedback course after stroke.

[Epidemiology of stroke in Siberia]. / Epidemiologiia mozgovogo insul'ta v Sibiri.

Based on WHO MONICA methods and diagnostic criteria, it is shown that first-ever stroke incidence and mortality in Siberia (a total number of residents included in the analysis varied from 450,000 to about 800,000) that are among the highest in the world. In Novosibirsk, for the period from 1982 through 1991 there was a trend towards decreasing stroke incidence and mortality rates, but for the period from 1992 through 1997 there was a trend towards increasing there rates in both men and women. Age-standardized (US white population was used as a standard) stroke incidence rates increased from west to east and from south to north across Siberia, with a corresponding increase in the proportion of hemorrhagic strokes. In 1987-1988, age-adjusted stroke incidence rate in Novosibirsk was 212 per 100,000 residents per year, in Krasnoyarsk--325, in Tynda--329, in Anadyr--348. Stroke-case fatality rates ranged from 28% in Tynda to 41% in Anadyr. A multivariate regression analysis revealed that hypertension, left ventricular hypertrophy, ischemic heart disease. mitral valve disease, current cigarette smoking, excessing body mass index, winter season, and low ambient temperature are all significant and independent risk factors for the occurrence of ischemic stroke in Novosibirsk. A significant association between stroke occurrence and air pressure/geomagnetic activity change was found. Possible reasons for such unfavorable trends in stroke incidence in Siberia are discussed, and an optimal approach for improving organization of cerebrovascular disease care is suggested.