Restorative Neurology and Neuroscience - Volume 39, issue 3

Authors: Huang, Hong | Li, Wenyang | Qin, Zheng | Shen, Hui | Li, Xiaomeng | Wang, Wei

Article Type: Research Article

Abstract: Background: Physical exercise can improve cognitive dysfunction. Its specific mechanism remains unknown. Recent studies have indicated that elevating or peripherally overexpressing brain-derived neurotrophic factors (BDNF) improve cognitive impairment. Objective: This meta-analysis aimed to investigate whether physical exercise improves cognitive performance in patients with cognitive dysfunction, such as mild cognitive impairment (MCI) or Alzheimer’s disease (AD), by increasing peripheral BDNF. Methods: PubMed, Embase, Cochrane Library, and Web of Science were searched up to June 2020 for studies that assayed the changes in peripheral BDNF levels in MCI and AD patients after exercise training. Results: Peripheral …BDNF levels were significantly elevated after a single exercise session (SMD = 0.469, 95% CI: 0.150–0.787, P  = 0.004) or regular exercise interventions (SMD = 0.418, 95% CI: 0.105–0.731, P  = 0.009). Subgroup analysis showed that only regular aerobic exercise interventions (SMD = 0.543, 95% CI: 0.038–1.049, P  = 0.035) and intervention duration of 16 weeks or greater (SMD = 0.443, 95% CI: 0.154 –0.733, P  = 0.003) significantly increased peripheral BDNF levels. Only plasma BDNF levels (SMD = 0.365, 95% CI:0.066–0.664, P  = 0.017) were significantly increased after exercise interventions. Conclusions: Acute and chronic physical exercises may improve cognitive impairment by increasing peripheral BDNF levels. Aerobic exercises and a longer duration of exercising increased BDNF levels. These findings also suggest that BDNF may be a suitable biomarker for evaluating the effect of exercise in patients with cognitive impairment, such as AD or MCI. Show more

Keywords: Brain-derived neurotrophic factor, exercise, cognitive impairment, Alzheimer’s disease, meta-analysis

DOI: 10.3233/RNN-201060

Citation: Restorative Neurology and Neuroscience, vol. 39, no. 3, pp. 159-171, 2021

Authors: Minami, Seigo | Fukumoto, Yoshihiro | Kobayashi, Ryuji | Aoki, Hideaki | Aoyama, Tomoki

Article Type: Research Article

Abstract: Background: In this trial we combined the effect of purposeful activity and electrical stimulation therapy (PA-EST) to promote transition of severely hemiparetic upper limb to auxiliary upper limb in chronic stroke survivors in a single-case study. Objective: The purpose of this study was to examine the effect of PA-EST on the upper limb motor function in a crossover randomized controlled trial. Methods: The study included eight stroke survivors (age: 63.1±10.9 years) who were receiving home-based visiting occupational therapy. The average time since stroke onset was 8.8±5.6 years. All participants had severely hemiparetic upper limb, with the …Fugl–Meyer Assessment upper extremity (FMA-U) score of 21.3±8.5. Participants were randomly assigned to group A or B. Group A received PA-EST for 3 months (phase 1), followed by standard stretching and exercise for 3 months (phase 2), whereas group B had the inverse order of treatments. To avoid carry-over effect, 1-month washout period was provided between the phase 1 and 2. Two-way analysis of variance (ANOVA) with repeated measures was used for the analysis. The primary outcome was FMA-U, and the secondary outcomes were, Motor Activity Log (MAL; amount of use [AOU] and quality of movement [QOM]), and Goal attainment scale-light (GAS-light). Results: Repeated measures-ANOVA revealed a significant interaction between type of intervention and time for FMA-U (F = 16.303, P = 0.005), MAL AOU (F = 7.966, P = 0.026) and QOM (F = 6.408, P = 0.039), and GAS-light (F = 6.905, P = 0.034), where PA-EST was associated with significantly improved motor function and goal achievement compared with standard stretching. Conclusions: The PA-EST may have greater effects than stretch/exercise in the recovery of hand function as reflected in FMA-U, MAL, and GAS-light. Our results suggest that PA-EST is an important and useful home-based rehabilitation program for promoting the use of the severely hemiparetic upper limb in chronic stroke survivors. Show more

DOI: 10.3233/RNN-211157

Citation: Restorative Neurology and Neuroscience, vol. 39, no. 3, pp. 173-180, 2021

Authors: Naro, Antonino | Pignolo, Loris | Lucca, Lucia Francesca | Calabrò, Rocco Salvatore

Article Type: Research Article

Abstract: Background: The evaluation of motor imagery in persons with prolonged Disorders of Consciousness (pDOC) is a practical approach to differentiate between patients with Minimally Conscious State (MCS) and Unresponsive Wakefulness Syndrome (UWS) and to identify residual awareness even in individuals with UWS. Investigating the influence of motor observation on motor imagery could be helpful in this regard. Objective: In order to corroborate the clinical diagnosis and identify misdiagnosed individuals, we used EEG recordings, to assess the influence of the low-level perceptual and motoric mechanisms on motor observation on motor imagery, taking into account the role of the high-level …cognitive mechanisms in patients with pDOC. Methods: We assessed the influence of motor observation of walking in first-person or third-person view (by a video provision) on motor imagery of walking in the first-person view on the visual N190 (expression of motor observation processing), the readiness potential (RP) (expressing motor preparation), and the P3 component (high-level cognitive processes) in a sample of 10 persons with MCS, 10 with UWS, and 10 healthy controls (CG). Specifically, the video showed a first-view or third-view walk down the street while the participants were asked to imagine a first-view walking down the street. Results: CG showed greater N190 response (low-level sensorimotor processing) in the non-matching than in the matching condition. Conversely, the P3 and RP responses (high-level sensorimotor processing) were greater in the matching than in the non-matching condition. Remarkably, 6 out of 10 patients with MCS showed the preservation of both high- and low-level sensorimotor processing. One UWS patient showed responses similar to those six patients, suggesting a preservation of cognitively-mediated sensorimotor processing despite a detrimental motor preparation process. The remaining patients with MCS did not show diversified EEG responses, suggesting limited cognitive functioning. Conclusions: Our study suggests that identifying the low-level visual and high-level motor preparation processes in response to a simple influence of motor observation of motor imagery tasks potentially supports the clinical differential diagnosis of with MCS and UWS. This might help identify UWS patients which were misdiagnosed and who deserve more sophisticated diagnoses. Show more

Keywords: Motor observation, motor imagery, minimally conscious state (MCS), unresponsive wakefulness syndrome (UWS), prolonged disorders of consciousness (pDOC) misdiagnosis

DOI: 10.3233/RNN-201130

Citation: Restorative Neurology and Neuroscience, vol. 39, no. 3, pp. 181-197, 2021

Authors: El Nahas, Nevine | Elbokl, Ahmed M. | Abd Eldayem, Eman Hamid | Roushdy, Tamer M. | Amin, Randa M. | Helmy, Shahinaz M. | Akl, Ahmed Zaki | Ashour, Aya Ahmed | Samy, Shady | Amgad, Alaa | Emara, Tamer H. | Nowara, Mohamed | Kenawy, Fatma Fathalla

Article Type: Research Article

Abstract: Background: Visual field defects (VFD) usually do not show improvement beyond 12 weeks from their onset. It has been shown that repetitive presentation of a stimulus to areas of residual vision in cases of visual field defect can improve vision. The counterpart of these areas in the brain are the partially damaged brain regions at the perilesional areas where plasticity can be enhanced. Objective: We aimed to study the effect of navigated repetitive transcranial magnetic stimulation (rTMS) applied to perilesional areas on the recovery of patients with cortical VFD. Methods: Thirty-two patients with cortical VFD secondary …to stroke of more than 3 months duration received 16 sessions of either active or sham high frequency navigated perilesional rTMS. Automated perimetry and visual functioning questionnaire (VFQ-25) were performed at baseline and after completion of the sessions. Results: The active group showed significant improvement after intervention, compared to the sham group, in both mean deviation (MD), visual field index (VFI) and in the VFQ-25 scores. Conclusions: Navigated rTMS is a new treatment option for post-stroke VFD as it can selectively stimulate areas of residual vision around the infarcted tissue, improving the threshold of visual stimulus detection which could be used alone or in combination with existing therapies. Show more

Keywords: rTMS, stroke, visual field defect, restoration, perimetry, navigated

DOI: 10.3233/RNN-211181

Citation: Restorative Neurology and Neuroscience, vol. 39, no. 3, pp. 199-207, 2021

Authors: Mao, Yanfang | Qu, Yang | Wang, Qingdong

Article Type: Research Article

Abstract: This article has been retracted, and the online PDF has been watermarked “RETRACTED”. A retraction notice is available at DOI: 10.3233/RNN-239001 .

DOI: 10.3233/RNN-201070

Citation: Restorative Neurology and Neuroscience, vol. 39, no. 3, pp. 209-220, 2021

Authors: Räty, Silja | Borrmann, Carolin | Granata, Giuseppe | Cárdenas-Morales, Lizbeth | Schoenfeld, Ariel | Sailer, Michael | Silvennoinen, Katri | Holopainen, Juha | De Rossi, Francesca | Antal, Andrea | Rossini, Paolo M. | Tatlisumak, Turgut | Sabel, Bernhard A.

Article Type: Research Article

Abstract: 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) Show more

Keywords: Electrical stimulation, homonymous hemianopia, randomized controlled trial, rehabilitation, occipital stroke, vision restoration

DOI: 10.3233/RNN-211198

Citation: Restorative Neurology and Neuroscience, vol. 39, no. 3, pp. 221-235, 2021