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Clinical feasibility of motor hotspot localization based on electroencephalography using convolutional neural networks in stroke

Tue, 31 Dec 2024 15:00:00 GMT

Title: Clinical feasibility of motor hotspot localization based on electroencephalography using convolutional neural networks in stroke Author(s): Ga-Young Choi; Jeong-Kweon Seo; Kyoung Tae Kim; Won Kee Chang; Sung Whan Yoon; Nam-Jong Paik; Won-Seok Kim; Han-Jeong Hwang Abstract: Background: Although transcranial magnetic stimulation (TMS) is the optimal tool for identifying individual motor hotspots–specific regions of the brain that are essential for controlling voluntary muscle movements–it involves a cumbersome procedure that requires patients to visit the hospital regularly and relies on expert judgment. To address this, we propose an advanced electroencephalography (EEG)-based motor hotspot identification algorithm using a deep-learning and assess its clinical feasibility and benefits by applying it to EEGs for stroke patients, considering the noticeable variations in EEG patterns between stroke patients and healthy controls. Methods: Motor hotspot locations were estimated using a two-dimensional convolutional neural network (CNN) model. We utilized various types of input data, depending on the five processing levels, the five types of input data, depending on the processing levels, to assess the signal processing capability of our proposed deep-learning model using EEGs of thirty healthy subjects measured during a simple hand movement task. Furthermore, we applied our proposed deep-learning algorithm to the hand-movement-related EEGs of twenty-nine stroke patients. Results: The mean error distance between the motor hotspot locations identified by TMS and our approach for healthy subjects was 0.35 ± 0.04 mm when utilizing power spectral density (PSD) features. The mean error distance was 2.27 ± 0.27 mm for healthy subjects and 1.64 ± 0.14 mm for stroke patients, when using raw data without any feature engineering. Our proposed motor hotspot identification algorithm showed robustness concerning the number of electrodes; the mean error distance was 2.34 ± 0.19 mm when using only 9 channels around the motor area for healthy subjects, and 1.77 ± 0.15 mm using only 5 channels around the motor area for stroke patients. Conclusion: We demonstrate that our EEG-based deep-learning approach can effectively identify individual motor hotspots, and the clinical feasibility of our algorithm by successfully applying the proposed approach to stroke patients. It can be used as an alternative to TMS for identifying motor hotspots, potentially enhancing the effectiveness of rehabilitation strategies.

PIK3CA-related overgrowth spectrum: From genetic mechanisms to targeted treatment with alpelisib

Tue, 31 Dec 2024 15:00:00 GMT

Title: PIK3CA-related overgrowth spectrum: From genetic mechanisms to targeted treatment with alpelisib Author(s): Ye Jee Shim; Jang Hyuk Cho Abstract: PIK3CA-related overgrowth spectrum (PROS) encompasses a range of rare disorders caused by somatic gain-of-function mutations in the PIK3CA gene, leading to extensive tissue overgrowth and complex vascular malformations. These conditions exhibit wide clinical variability and often present with asymmetric segmental overgrowth involving multiple tissue types, including fat, muscle, bone, and nervous tissues. Conventional treatments, such as debulking surgery or mammalian target of rapamycin inhibitors such as sirolimus, offer only limited, temporary benefits and have potential side effects. Recently, alpelisib, a selective phosphatidylinositol 3-kinase α inhibitor, has emerged as a promising targeted therapy for PROS, demonstrating significant clinical improvements in reducing lesion size and symptom severity in patients with severe cases. The Food and Drug Administration’s accelerated approval of alpelisib for PROS by 2022 underscores its therapeutic potential; however, its long-term safety profile and applications in infants remain under investigation. This review examines the heterogeneous phenotypes, genetic and molecular basis of PROS, current evidence supporting alpelisib, and general prognosis of patients with PROS. Advances in genetic testing combined with a multidisciplinary approach to care offer promising avenues for enhancing both the management and quality of life of individuals affected by this complex spectrum of disorders.

A remotely delivered exercise-based rehabilitation program for patients with persistent chemotherapy-induced peripheral neuropathy (EX-CIPN): Protocol for a phase I feasibility trial

Tue, 31 Dec 2024 15:00:00 GMT

Title: A remotely delivered exercise-based rehabilitation program for patients with persistent chemotherapy-induced peripheral neuropathy (EX-CIPN): Protocol for a phase I feasibility trial Author(s): Eric M Antonen; Michelle B Nadler; David M Langelier; Kristin L Campbell; David Flamer; Jang Hyuk Cho; Scott Capozza; Lisa Avery; Kelcey A Bland; Scott Leatherdale; Jackie Manthorne; Jennifer M Jones Abstract: Background: Chemotherapy-induced peripheral neurotoxicity (CIPN) is a prevalent adverse effect of chemotherapy agents that is estimated to be present in 2/3 of patients who receive neurotoxic chemotherapy. In 30–40% of these patients, CIPN signs and symptoms can persist for months or years post-treatment. Recent studies have supported exercise as a feasible and possibly effective intervention for CIPN; however, more rigorous studies are needed to confirm feasibility, estimate efficacy, and clarify risk. In response, we developed an innovative virtual exercise-based rehabilitation program (EX-CIPN) for cancer survivors with persistent CIPN. Methods: This study is a phase I study conducted at the Princess Margaret Cancer Centre in cancer survivors with persistent CIPN, with a focus on feasibility, acceptability, and safety. A total of 40 patients aged 18 or older, with persistent CIPN at least 6 months after chemotherapy completion will be recruited and receive the EX-CIPN program. The EX-CIPN program is a 10-week virtual home-based intervention that includes an individualized exercise program supported with a mobile application (Physitrack), wearable technology (FitBit), and weekly virtual check-ins with an oncology exercise specialist. The primary outcome of feasibility will be assessed by examining accrual, retention, and adherence rates. Acceptability will be assessed through qualitative interviews. Safety events will be monitored and reported based on CTCAE v5. Secondary outcomes will be collected using questionnaires and physiological assessments at baseline (T1), after the intervention (T2), and 3-months after intervention (T3). Conclusion: This phase I study will determine intervention feasibility, acceptability, and safety and will inform the planning for a future Phase II RCT with the EX-CIPN intervention.

Effect of electroencephalography-based motor imagery neurofeedback on mu suppression during motor attempt in patients with stroke

Tue, 31 Dec 2024 15:00:00 GMT

Title: Effect of electroencephalography-based motor imagery neurofeedback on mu suppression during motor attempt in patients with stroke Author(s): Seungwoo Cha; Kyoung Tae Kim; Won Kee Chang; Nam-Jong Paik; Ji Soo Choi; Hyunmi Lim; Won-Seok Kim; Jeonghun Ku Abstract: Objective: The primary aim of this study was to explore the neurophysiological effects of motor imagery neurofeedback using electroencephalography (EEG), specifically focusing on mu suppression during serial motor attempts, and to assess its potential benefits in patients with subacute stroke. Methods: A total of 15 patients with hemiplegia following subacute ischemic stroke were prospectively enrolled in this randomized cross-over study. This study comprised two experiments: neurofeedback and sham. Each experiment included four blocks: three blocks of resting, grasp, resting, and an interventional task, followed by one block of resting and grasp. During the resting sessions, participants fixated on a white cross on a black background for 2 min without moving their upper extremities. In the grasp sessions, participants were instructed to grasp and release their paretic hand at a frequency of about 1 Hz for 3 min while maintaining fixation on the white cross. During the interventional task, the neurofeedback presented a punching image using the affected upper limb, corresponding to the mu suppression induced by imagined movement for 3 min. In contrast, the sham presented an image based on mu suppression data from randomly selected participants. EEG data were recorded throughout the experiment, and data from electrodes C3/C4 and P3/P4 were analyzed to compare the degree of mu suppression between the neurofeedback and sham experiments. Results: Significant mu suppression was observed in the bilateral motor and parietal cortices during the neurofeedback experiment compared with the sham across serial sessions (p < 0.001). Following neurofeedback, real grasping sessions showed progressive strengthening of mu suppression in the ipsilesional motor cortex and bilateral parietal cortices compared to sessions following sham (p < 0.05). This effect was not observed in the contralesional motor cortex. Conclusions: Motor imagery neurofeedback significantly enhances mu suppression in the ipsilesional motor and bilateral parietal cortices during motor attempts in patients with subacute stroke. These findings suggest that motor imagery neurofeedback could serve as a promising adjunctive therapy to enhance motor-related cortical activity and support motor rehabilitation in patients with stroke.