Intraoperative Resting-State Functional Connectivity Based on RGB Imaging

RGB optical imaging is a marker-free, contactless, and non-invasive technique that is able to monitor hemodynamic brain response following neuronal activation using task-based and resting-state procedures. Magnetic resonance imaging (fMRI) and functional near infra-red spectroscopy (fNIRS) resting-state procedures cannot be used intraoperatively but RGB imaging provides an ideal solution to identify resting-state networks during a neurosurgical operation. We applied resting-state methodologies to intraoperative RGB imaging and evaluated their ability to identify resting-state networks. We adapted two resting-state methodologies from fMRI for the identification of resting-state networks using intraoperative RGB imaging. Measurements were performed in 3 patients who underwent resection of lesions adjacent to motor sites. The resting-state networks were compared to the identifications provided by RGB task-based imaging and electrical brain stimulation. Intraoperative RGB resting-state networks corresponded to RGB task-based imaging (DICE:0.55±0.29). Resting state procedures showed a strong correspondence between them (DICE:0.66±0.11) and with electrical brain stimulation. RGB imaging is a relevant technique for intraoperative resting-state networks identification. Intraoperative resting-state imaging has several advantages compared to functional task-based analyses: data acquisition is shorter, less complex, and less demanding for the patients, especially for those unable to perform the tasks.

Electrical Brain Stimulation and Continuous Behavioral State Tracking in Ambulatory Humans

Electrical brain stimulation (EBS) is an established treatment for patients with drug-resistant epilepsy. Sleep disorders are common in people with epilepsy and EBS therapies may actually further disturb normal sleep patterns and sleep quality. Novel devices capable of EBS and continuous intracranial EEG (iEEG) telemetry enable detailed assessments of therapy efficacy and tracking of sleep and comorbidities. Here, we investigate the feasibility of automated sleep classification using continuous iEEG data recorded from Papez's circuit in four patients with drug resistant mesial temporal lobe epilepsy using an investigational implantable sensing and stimulation device with electrodes implanted in bilateral hippocampus (HPC) and anterior nucleus of thalamus (ANT). The iEEG recorded from HPC are used to classify sleep during concurent ANT stimulation. Simultaneous polysomnography and HPC sensing was were used to train, validate and test an automated classifier for a range of ANT EBS frequencies (2 Hz, 7Hz, 100Hz, and 145 Hz). We show that it is possible to build a patient specific automated sleep staging classifier using power in band features extracted from one HPC sensing channel. The patient specific classifiers performed well under all thalamic EBS frequencies with an average F1-score 0.894, and provided viable classification into major sleep categories (Awake, NREM, REM). Within this project, we retrospectively analyzed classification performance with gold-standard polysomnography annotations, and then prospectively deployed the classifier on chronic continuous iEEG data spanning multiple months to characterize sleep patterns in ambulatory patients living in their home environment. The ability to continuously track behavioral state and fully characterize sleep should prove useful for optimizing EBS for epilepsy and associated sleep, cognitive and mood comorbidities.

Non-invasive electrical brain stimulation for vision restoration after stroke: An exploratory randomized trial (REVIS)

Background: Occipital strokes often cause permanent homonymous hemianopia leading to significant disability. In previous studies, non-invasive electrical brain stimulation (NIBS) has improved vision after optic nerve damage and in combination with training after stroke. Objective: We explored different NIBS modalities for rehabilitation of hemianopia after chronic stroke. Methods: In a randomized, double-blinded, sham-controlled, three-armed trial, altogether 56 patients with homonymous hemianopia were recruited. The three experiments were: i) repetitive transorbital alternating current stimulation (rtACS, n = 8) vs. rtACS with prior cathodal transcranial direct current stimulation over the intact visual cortex (tDCS/rtACS, n = 8) vs. sham (n = 8); ii) rtACS (n = 9) vs. sham (n = 9); and iii) tDCS of the visual cortex (n = 7) vs. sham (n = 7). Visual functions were evaluated before and after the intervention, and after eight weeks follow-up. The primary outcome was change in visual field assessed by high-resolution and standard perimetries. The individual modalities were compared within each experimental arm. Results: Primary outcomes in Experiments 1 and 2 were negative. Only significant between-group change was observed in Experiment 3, where tDCS increased visual field of the contralesional eye compared to sham. tDCS/rtACS improved dynamic vision, reading, and visual field of the contralesional eye, but was not superior to other groups. rtACS alone increased foveal sensitivity, but was otherwise ineffective. All trial-related procedures were tolerated well. Conclusions: This exploratory trial showed safety but no main effect of NIBS on vision restoration after stroke. However, tDCS and combined tDCS/rtACS induced improvements in visually guided performance that need to be confirmed in larger-sample trials. NCT01418820 (clinicaltrials.gov)