Research on the effect of multi-modal transcranial direct current stimulation on stroke based on electroencephalogram_Journal of Biomedical Engineering

Authors：

YU Hongli ^1,2 ,  ZHANG Shaoqian ^1,2 , WANG Chunfang ³ , GUO Lei ^1,2 , XU Guizhi ^1,2

1. State Key Laboratory of Reliability and Intelligence of Electrical Equipment, Hebei University of Technology, Tianjin 300130, P. R. China;
2. Tianjin Key Laboratory of Bioelectromagnetic Technology and Intelligent Health, Hebei University of Technology, Tianjin 300130, P. R. China;
3. Rehabilitation Medical Department, Tianjin Union Medical Center, Tianjin 300121, P. R. China;

Corresponding author：

ZHANG Shaoqian, Email: chfwang@tju.edu

Keywords：

Transcranial direct current stimulation; Stroke; Electroencephalogram; Multi-scale intrinsic fuzzy entropy

DOI：

10.7507/1001-5515.202206018

Video：

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As an emerging non-invasive brain stimulation technique, transcranial direct current stimulation (tDCS) has received increasing attention in the field of stroke disease rehabilitation. However, its efficacy needs to be further studied. The tDCS has three stimulation modes: bipolar-stimulation mode, anode-stimulation mode and cathode-stimulation mode. Nineteen stroke patients were included in this research (10 with left-hemisphere lesion and 9 with right). Resting electroencephalogram (EEG) signals were collected from subjects before and after bipolar-stimulation, anodal-stimulation, cathodal-stimulation, and pseudo-stimulation, with pseudo-stimulation serving as the control group. The changes of multi-scale intrinsic fuzzy entropy (MIFE) of EEG signals before and after stimulation were compared. The results revealed that MIFE was significantly greater in the frontal and central regions after bipolar-stimulation (P < 0.05), in the left central region after anodal-stimulation (P < 0.05), and in the frontal and right central regions after cathodal-stimulation (P < 0.05) in patients with left-hemisphere lesions. MIFE was significantly greater in the frontal, central and parieto-occipital joint regions after bipolar-stimulation (P < 0.05), in the left frontal and right central regions after anodal- stimulation (P < 0.05), and in the central and right occipital regions after cathodal-stimulation (P < 0.05) in patients with right-hemisphere lesions. However, the difference before and after pseudo-stimulation was not statistically significant (P > 0.05). The results of this paper showed that the bipolar stimulation pattern affected the largest range of brain areas, and it might provide a reference for the clinical study of rehabilitation after stroke.

Citation： YU Hongli, ZHANG Shaoqian, WANG Chunfang, GUO Lei, XU Guizhi. Research on the effect of multi-modal transcranial direct current stimulation on stroke based on electroencephalogram. Journal of Biomedical Engineering, 2022, 39(5): 966-973. doi: 10.7507/1001-5515.202206018 Copy

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2.	Feigin V L, Nguyen G, K Cercy, et al. Global, regional, and country-specific lifetime risks of stroke, 1990 and 2016. The New England journal of Medicine, 2018, 379(25): 2429-2437.
3.	Lou M, Ding J, Hu B, et al. Chinese Stroke association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update on organizational stroke management. Stroke and Vascular Neurology, 2020, 5(3): 260-269.
4.	Wolf S, Winstein C, Miller J, et al. Effect of constraint induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. Journal of the American Medical Association, 2006, 296(17): 2095-2104.
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9.	Bao S C, Wong W W, Leung T, et al. Cortico-muscular coherence modulated by high-definition transcranial direct current stimulation in people with chronic stroke. IEEE Transactions on Neural Systems and Rehabilitation Engineering, 2019, 27(2): 304-313.
10.	Muffel T, Shih P C, Kalloch B, et al. Differential effects of anodal and dual tDCS on sensorimotor functions in chronic hemiparetic stroke patients. Brain Stimulation, 2022, 15(2): 509-522.
11.	Wong P L, Yang Y R, Tang S C, et al. Comparing different montages of transcranial direct current stimulation on dual-task walking and cortical activity in chronic stroke: double-blinded randomized controlled trial. BMC Neurol, 2022, 22(1): 119.
12.	Bai X, Guo Z, He L, et al. Different therapeutic effects of transcranial direct current stimulation on upper and lower limb recovery of stroke patients with motor dysfunction: a meta-analysis. Neural Plast, 2019, 2019: 1372138.
13.	王伟, 宋为群, 张艳明, 等. 经颅直流电刺激对脑卒中患者上肢运动功能康复的效果. 中国康复理论与实践, 2021, 27(9): 1082-1086.
14.	刘蒙蒙, 徐桂芝, 于洪丽, 等. 经颅直流电刺激下脑卒中患者康复期脑功能网络特性研究. 生物医学工程学杂志, 2021, 38(3): 498-506.
15.	Wang C F, Chen Y Y, Zhang Y, et al. Quantitative EEG abnormalities in major depressive disorder with basal ganglia stroke with lesions in different hemispheres. Journal of Affective Disorders, 2017, 215: 172-178.
16.	Gottlibe M, Rosen O, Weller B, et al. Stroke identification using a portable EEG device–a pilot study. Neurophysiologie Clinique, 2020, 50(1): 21-25.
17.	Wang J, Wu D Y, Cheng Y N, et al. Effects of transcranial direct current stimulation on apraxia of speech and cortical activation in patients with stroke: a randomized sham-controlled study. American journal of speech-language pathology, 2019, 28(4): 1625-1637.
18.	王耀辉, 吕喆, 张重阳, 等. 基于脑电信号样本熵的急性脑梗死患者溶栓效果评价. 中国医学物理学杂志, 2022, 39(01): 81-86.
19.	Cao Z H, Lin C T, Lai K L, et al. Extraction of SSVEPs-based inherent fuzzy entropy using a wearable headband EEG in migraine patients. IEEE Transactions on Fuzzy Systems, 2020, 28(1): 14-27.
20.	Miskovic V, MacDonald K J, Rhodes L J, et al. Changes in EEG multiscale entropy and power-law frequency scaling during the human sleep cycle. Human Brain Mapping, 2019, 40(2): 538-551.
21.	Cao Z H, Ding W P, Wang Y K, et al. Effects of repetitive SSVEPs on EEG complexity using multiscale inherent fuzzy entropy. Neurocomputing, 2018, 389: 198-206.
22.	Yuan Y, Wang J, Wu D Y, et al. Effect of transcranial direct current stimulation on swallowing apraxia and cortical excitability in stroke patients. Topics in stroke rehabilitation, 2017, 24(7): 503-509.
23.	Wang Z T, Li J, Wang X L, et al. Effect of transcranial direct-current stimulation on executive function and resting EEG after stroke: A pilot randomized controlled study. Journal of Clinical Neuroscience, 2022, 103: 141-147.
24.	Wang C F, Chen Y Y, Song P Q, et al. Varied response of EEG rhythm to different tDCS protocols and lesion hemispheres in stroke subjects with upper limb dysfunction. Neural Plasticity, 2022, 2022: 7790730.
25.	Raspopovic S, Capogrosso M, Petrini FM, et al. Restoring natural sensory feedback in real-time bidirectional hand prostheses. Sci Transl Med, 2014, 6(222): 222ra19.
26.	Bouton C E, Shaikhouni A, Annetta N V, et al. Restoring cortical control of functional movement in a human with quadriplegia. Nature, 2016, 533(7602): 247-250.
27.	Fleming M K, Rothwell J C, Sztriha L, et al. The effect of transcranial direct current stimulation on motor sequence learning and upper limb function after stroke. Clinical Neurophysiology, 2017, 128(7): 1389-1398.
28.	Woods A J, Antal A, Bikson M, et al. A technical guide to tDCS, and related non-invasive brain stimulation tools. Clinical Neurophysiology, 2016, 127(2): 1031-1048.
29.	Voigt M B, Kral A. Cathodic-leading pulses are more effective than anodic-leading pulses in intracortical microstimulation of the auditory cortex. Journal of Neural Engineering, 2019, 16(3): 036002.
30.	Lindenberg R, Renga V, Zhu L L, et al. Bihemispheric brain stimulation facilitates motor recovery in chronic stroke patients. Neurology, 2010, 75(24): 2176-2184.

1. Krishnamurthi R V, Ikeda T, Feigin V L. Global, regional and country-specific burden of ischaemic stroke, intracerebral haemorrhage and subarachnoid haemorrhage: a systematic analysis of the global burden of disease study 2017. Neuroepidemiology, 2020, 54(2): 171-179.
2. Feigin V L, Nguyen G, K Cercy, et al. Global, regional, and country-specific lifetime risks of stroke, 1990 and 2016. The New England journal of Medicine, 2018, 379(25): 2429-2437.
3. Lou M, Ding J, Hu B, et al. Chinese Stroke association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update on organizational stroke management. Stroke and Vascular Neurology, 2020, 5(3): 260-269.
4. Wolf S, Winstein C, Miller J, et al. Effect of constraint induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. Journal of the American Medical Association, 2006, 296(17): 2095-2104.
5. Bastani A, Jaberzadeh S. Does anodal transcranial direct current stimulation enhance excitability of the motor cortex and motor function in healthy individuals and subjects with stroke: A systematic review and meta-analysis. Clinical Neurophysiology, 2012, 123(4): 644-657.
6. 吴宏健, 李莉娜, 李龙, 等. 脑卒中后手功能康复机器人综合干预研究进展. 生物医学工程学杂志, 2019, 36(1): 151-156.
7. 王萌亚, 王仲朋, 陈龙, 等. 卒中后运动神经反馈康复训练研究进展与前景. 中国生物医学工程学报, 2019, 38(6): 742-752.
8. Matar S J, Newton C, Sorinola I O, et al. Transcranial direct-current stimulation as an adjunct to verb network strengthening treatment in post-stroke chronic aphasia: a double-blinded randomized feasibility study. Frontiers in Neurology, 2022, 13: 722404.
9. Bao S C, Wong W W, Leung T, et al. Cortico-muscular coherence modulated by high-definition transcranial direct current stimulation in people with chronic stroke. IEEE Transactions on Neural Systems and Rehabilitation Engineering, 2019, 27(2): 304-313.
10. Muffel T, Shih P C, Kalloch B, et al. Differential effects of anodal and dual tDCS on sensorimotor functions in chronic hemiparetic stroke patients. Brain Stimulation, 2022, 15(2): 509-522.
11. Wong P L, Yang Y R, Tang S C, et al. Comparing different montages of transcranial direct current stimulation on dual-task walking and cortical activity in chronic stroke: double-blinded randomized controlled trial. BMC Neurol, 2022, 22(1): 119.
12. Bai X, Guo Z, He L, et al. Different therapeutic effects of transcranial direct current stimulation on upper and lower limb recovery of stroke patients with motor dysfunction: a meta-analysis. Neural Plast, 2019, 2019: 1372138.
13. 王伟, 宋为群, 张艳明, 等. 经颅直流电刺激对脑卒中患者上肢运动功能康复的效果. 中国康复理论与实践, 2021, 27(9): 1082-1086.
14. 刘蒙蒙, 徐桂芝, 于洪丽, 等. 经颅直流电刺激下脑卒中患者康复期脑功能网络特性研究. 生物医学工程学杂志, 2021, 38(3): 498-506.
15. Wang C F, Chen Y Y, Zhang Y, et al. Quantitative EEG abnormalities in major depressive disorder with basal ganglia stroke with lesions in different hemispheres. Journal of Affective Disorders, 2017, 215: 172-178.
16. Gottlibe M, Rosen O, Weller B, et al. Stroke identification using a portable EEG device–a pilot study. Neurophysiologie Clinique, 2020, 50(1): 21-25.
17. Wang J, Wu D Y, Cheng Y N, et al. Effects of transcranial direct current stimulation on apraxia of speech and cortical activation in patients with stroke: a randomized sham-controlled study. American journal of speech-language pathology, 2019, 28(4): 1625-1637.
18. 王耀辉, 吕喆, 张重阳, 等. 基于脑电信号样本熵的急性脑梗死患者溶栓效果评价. 中国医学物理学杂志, 2022, 39(01): 81-86.
19. Cao Z H, Lin C T, Lai K L, et al. Extraction of SSVEPs-based inherent fuzzy entropy using a wearable headband EEG in migraine patients. IEEE Transactions on Fuzzy Systems, 2020, 28(1): 14-27.
20. Miskovic V, MacDonald K J, Rhodes L J, et al. Changes in EEG multiscale entropy and power-law frequency scaling during the human sleep cycle. Human Brain Mapping, 2019, 40(2): 538-551.
21. Cao Z H, Ding W P, Wang Y K, et al. Effects of repetitive SSVEPs on EEG complexity using multiscale inherent fuzzy entropy. Neurocomputing, 2018, 389: 198-206.
22. Yuan Y, Wang J, Wu D Y, et al. Effect of transcranial direct current stimulation on swallowing apraxia and cortical excitability in stroke patients. Topics in stroke rehabilitation, 2017, 24(7): 503-509.
23. Wang Z T, Li J, Wang X L, et al. Effect of transcranial direct-current stimulation on executive function and resting EEG after stroke: A pilot randomized controlled study. Journal of Clinical Neuroscience, 2022, 103: 141-147.
24. Wang C F, Chen Y Y, Song P Q, et al. Varied response of EEG rhythm to different tDCS protocols and lesion hemispheres in stroke subjects with upper limb dysfunction. Neural Plasticity, 2022, 2022: 7790730.
25. Raspopovic S, Capogrosso M, Petrini FM, et al. Restoring natural sensory feedback in real-time bidirectional hand prostheses. Sci Transl Med, 2014, 6(222): 222ra19.
26. Bouton C E, Shaikhouni A, Annetta N V, et al. Restoring cortical control of functional movement in a human with quadriplegia. Nature, 2016, 533(7602): 247-250.
27. Fleming M K, Rothwell J C, Sztriha L, et al. The effect of transcranial direct current stimulation on motor sequence learning and upper limb function after stroke. Clinical Neurophysiology, 2017, 128(7): 1389-1398.
28. Woods A J, Antal A, Bikson M, et al. A technical guide to tDCS, and related non-invasive brain stimulation tools. Clinical Neurophysiology, 2016, 127(2): 1031-1048.
29. Voigt M B, Kral A. Cathodic-leading pulses are more effective than anodic-leading pulses in intracortical microstimulation of the auditory cortex. Journal of Neural Engineering, 2019, 16(3): 036002.
30. Lindenberg R, Renga V, Zhu L L, et al. Bihemispheric brain stimulation facilitates motor recovery in chronic stroke patients. Neurology, 2010, 75(24): 2176-2184.

Journal of Biomedical Engineering

Research on the effect of multi-modal transcranial direct current stimulation on stroke based on electroencephalogram

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