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BackgroundCognitive impairment is a common dysfunction following stroke, significantly affecting patients’ quality of life. Studies suggest that post-stroke cognitive impairment (PSCI) may be related to neural activity in specific brain regions. However, the neural mechanisms remain to be further explored. This study aimed to investigate the alterations in brain function in patients with PSCI.MethodsThis was a case–control study. Thirty patients with PSCI, thirty with non-PSCI (NPSCI), and thirty age- and gender-matched healthy controls (HCs) were selected in a 1:1:1 ratio. Resting-state functional magnetic resonance imaging (rs-fMRI) were acquired from all participants to study the potential neural mechanisms of PSCI patients by comparing the differences in fractional amplitude of low-frequency fluctuation (fALFF), Kendall’s coefficient of concordance-regional homogeneity (KCC-ReHo), and seed-based functional connectivity (FC). Additionally, the Montreal Cognitive Assessment (MoCA) scores of PSCI patients were collected, and Pearson correlation was used to analyze the correlation between functional indicators and cognitive performance in PSCI patients.ResultsfALFF analysis revealed that the PSCI group had decreased zfALFF values in the left caudate, right inferior temporal gyrus (ITG), anterior cingulate cortex (ACC), left putamen, and left superior temporal gyrus. In contrast, increased zfALFF values were observed in the right Cerebellum_6. KCC-ReHo analysis indicated that the PSCI group had decreased SzKCC-ReHo values in the right middle frontal gyrus (MFG) and left postcentral lobe, while increased SzKCC-ReHo values in the left cerebellum_ crus 1, and left cerebellum_4–5. Furthermore, seed-based FC analysis revealed decreased zFC values between brain regions in the PSCI group, especially between the angular gyrus and precuneus. Additionally, correlation analysis showed that the zfALFF value of ACC was positively correlated with MoCA scores in the PSCI group.ConclusionThis study demonstrated significant changes in the spontaneous neural activity intensity, regional homogeneity, and FC of multiple cognition-related brain regions in PSCI patients, shedding light on the underlying neural mechanisms of brain function in PSCI.

IntroductionPrognostication in patients with prolonged disorders of consciousness (pDoC) remains a challenging task. Electroencephalography (EEG) is a neurophysiological method that provides objective information for evaluating overall brain function. In this study, we aim to investigate the multiple features of pDoC using EEG and evaluate the prognostic values of these indicators.MethodsWe analyzed the EEG features: (i) spectral power; (ii) microstates; and (iii) mismatch negativity (MMN) and P3a of healthy controls, patients in minimally conscious state (MCS), and unresponsive wakefulness syndrome (UWS). Patients were followed up for 6 months. A combination of machine learning and SHapley Additive exPlanations (SHAP) were used to develop predictive model and interpret the results.ResultsThe results indicated significant abnormalities in low-frequency spectral power, microstate parameters, and amplitudes of MMN and P3a in MCS and UWS. A predictive model constructed using support vector machine achieved an area under the curve (AUC) of 0.95, with the top 10 SHAP values being associated with transition probability (TP) from state C to F, time coverage of state E, TP from state D to F and D to F, mean duration of state A, TP from state F to C, amplitude of MMN, time coverage of state F, TP from state C to D, and mean duration of state E. Predictive models constructed for each component using support vector machine revealed that microstates had the highest AUC (0.95), followed by MMN and P3a (0.65), and finally spectral power (0.05).DiscussionThis study provides preliminary evidence for the application of microstate-based multiple EEG features for prognosis prediction in pDoC.Clinical trial registrationchictr.org.cn, identifier ChiCTR2200064099.

ObjectiveThe aim of this study is to evaluate the efficacy of non-invasive brain stimulation (NIBS) in patients with disorders of consciousness (DoC) and compare differences in efficacy between different stimulation modalities.MethodsWe searched the PubMed, Cochrane Library, Web of Science, and EMBASE databases for all studies published in English from inception to April 2023. Literature screening and quality assessment were performed independently by two investigators. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were used to evaluate the therapeutic effects of NIBS. The Cochrane Q test and I2 statistic were used to evaluate heterogeneity between studies. Subgroup analysis was performed to identify the source of heterogeneity, and differences in efficacy between different stimulation modalities were compared by Bayesian analysis.ResultsA total of 17 studies with 377 DoC patients were included. NIBS significantly improved the state of consciousness in DoC patients when compared to sham stimulation (WMD: 0.81; 95% CI: 0.46, 1.17; I2 = 78.2%, p = 0.000). When divided into subgroups according to stimulation modalities, the heterogeneity of each subgroup was significantly lower than before (I2: 0.00–30.4%, p >0.05); different stimulation modalities may be the main source of such heterogeneity. Bayesian analysis, based on different stimulation modalities, indicated that a patient’s state of consciousness improved most significantly after repetitive transcranial magnetic stimulation (rTMS) of the left dorsolateral prefrontal cortex (DLPFC). Diagnosis-based subgroup analysis showed that NIBS significantly improved the state of consciousness in patients with a minimal consciousness state (WMD: 1.11; 95% CI: 0.37, 1.86) but not in patients with unresponsive wakefulness syndrome or a vegetative state (WMD: 0.31; 95% CI: −0.09, 0.71). Subgroup analysis based on observation time showed that single treatment did not improve the state of consciousness in DoC patients (WMD: 0.28; 95% CI: −0.27, 0.82) while multiple treatments could (WMD: 1.05; 95% CI: 0.49, 1.61). Furthermore, NIBS had long-term effects on DoC patients (WMD: 0.79; 95% CI: 0.08–1.49).ConclusionAvailable evidence suggests that the use of NIBS on patients with DoC is more effective than sham stimulation, and that rTMS of the left DLPFC may be the most prominent stimulation modality.

ObjectiveWe aimed to investigate the effects and mechanisms of swallowing-related brain regions using resting-state functional magnetic resonance imaging (rs-fMRI) in healthy subjects who underwent intermittent theta burst stimulation (iTBS) on dominant or non-dominant cerebellar hemispheres.MethodsThirty-nine healthy subjects were randomized into three groups that completed different iTBS protocols (dominant cerebellum group, non-dominant cerebellum group and sham group). Before iTBS, the resting motor threshold (rMT) was measured by single-pulse transcranial magnetic stimulation (sTMS) on the cerebellar representation of the suprahyoid muscles, and the dominant cerebellar hemisphere for swallowing was determined. Forty-eight hours after elution, iTBS protocols were completed: in the dominant cerebellum group, iTBS was administered to the dominant cerebellar hemisphere, and the non-dominant cerebellar hemisphere was given sham stimulation; in the non-dominant cerebellum group, iTBS was administered to the non-dominant cerebellar hemisphere, and sham stimulation was delivered to the dominant cerebellar hemisphere; in the sham group, sham stimulation was applied to the cerebellum bilaterally. Rs-fMRI was performed before and after iTBS stimulation to observe changes in the fractional amplitude of low-frequency fluctuation (fALFF) in the whole brain.ResultsCompared with baseline, the dominant cerebellum group showed increased fALFF in the ipsilateral cerebellum, and decreased fALFF in the ipsilateral middle temporal gyrus and contralateral precuneus after iTBS; the iTBS of the non-dominant cerebellum group induced increased fALFF in the ipsilateral superior frontal gyrus, the calcarine fissure and the surrounding cortex, and the contralateral inferior parietal lobule; and in the sham group, there was no significant difference in fALFF. Exploring the effects induced by iTBS among groups, the dominant cerebellum group showed decreased fALFF in the contralateral calcarine fissure, and surrounding cortex compared with the sham group.ConclusionIntermittent theta burst stimulation of the dominant cerebellar hemisphere for swallowing excited the ipsilateral cerebellum, and stimulation of the non-dominant cerebellar hemisphere increased the spontaneous neural activity of multiple cerebrocortical areas related to swallowing. In conclusion, regardless of which side of the cerebellum is stimulated, iTBS can facilitate part of the brain neural network related to swallowing. Our findings provide supporting evidence that cerebellar iTBS can be used as a potential method to modulate human swallowing movement.

Prolonged disorders of consciousness (DoC) are characterized by extended disruptions of brain activities that sustain wakefulness and awareness and are caused by various etiologies. During the past decades, neuroimaging has been a practical method of investigation in basic and clinical research to identify how brain properties interact in different levels of consciousness. Resting-state functional connectivity within and between canonical cortical networks correlates with consciousness by a calculation of the associated temporal blood oxygen level-dependent (BOLD) signal process during functional MRI (fMRI) and reveals the brain function of patients with prolonged DoC. There are certain brain networks including the default mode, dorsal attention, executive control, salience, auditory, visual, and sensorimotor networks that have been reported to be altered in low-level states of consciousness under either pathological or physiological states. Analysis of brain network connections based on functional imaging contributes to more accurate judgments of consciousness level and prognosis at the brain level. In this review, neurobehavioral evaluation of prolonged DoC and the functional connectivity within brain networks based on resting-state fMRI were reviewed to provide reference values for clinical diagnosis and prognostic evaluation.

ObjectiveThe effects and possible mechanisms of cerebellar high-frequency repetitive transcranial magnetic stimulation (rTMS) on swallowing-related neural networks were studied using resting-state functional magnetic resonance imaging (rs-fMRI).MethodA total of 23 healthy volunteers were recruited, and 19 healthy volunteers were finally included for the statistical analysis. Before stimulation, the cerebellar hemisphere dominant for swallowing was determined by the single-pulse TMS. The cerebellar representation of the suprahyoid muscles of this hemisphere was selected as the target for stimulation with 10 Hz rTMS, 100% resting motor threshold (rMT), and 250 pulses, with every 1 s of stimulation followed by an interval of 9 s. The motor evoked potential (MEP) amplitude of the suprahyoid muscles in the bilateral cerebral cortex was measured before and after stimulation to evaluate the cortical excitability. Forty-eight hours after elution, rTMS was reapplied on the dominant cerebellar representation of the suprahyoid muscles with the same stimulation parameters. Rs-fMRI was performed before and after stimulation to observe the changes in amplitude of low-frequency fluctuation (ALFF) and regional homology (ReHo) at 0.01–0.08 Hz, 0.01–0.027 Hz, and 0.027–0.073 Hz.ResultsAfter cerebellar high-frequency rTMS, MEP recorded from swallowing-related bilateral cerebral cortex was increased. The results of rs-fMRI showed that at 0.01–0.08 Hz, ALFF was increased at the pons, right cerebellum, and medulla and decreased at the left temporal lobe, and ReHo was decreased at the left insular lobe, right temporal lobe, and corpus callosum. At 0.01–0.027 Hz, ALFF was decreased at the left temporal lobe, and ReHo was decreased at the right temporal lobe, left putamen, and left supplementary motor area.ConclusionRepetitive transcranial magnetic stimulation of the swallowing cortex in the dominant cerebellar hemisphere increased the bilateral cerebral swallowing cortex excitability and enhanced pontine, bulbar, and cerebellar spontaneous neural activity, suggesting that unilateral high-frequency stimulation of the cerebellum can excite both brainstem and cortical swallowing centers. These findings all provide favorable support for the application of cerebellar rTMS in the clinical practice.