Search Results (287)

Background: Transcranial direct current stimulation (tDCS) has emerged as a promising neuromodulatory tool for language rehabilitation in chronic aphasia. However, the effects of bi-hemispheric, multisite stimulation remain largely unexplored, especially in people with chronic and treatment-resistant language impairments. The goal of this study is to look at the effects on behavior and brain activity of an individualized language training program that combines bi-hemispheric multisite anodal tDCS with personalized language training for Albert, a patient with long-standing, treatment-resistant non-fluent aphasia. Methods: Albert, a right-handed retired physician, had transcortical motor aphasia (TCMA) subsequent to a left-hemispheric ischemic stroke occurring more than six years before the operation. Even after years of traditional treatment, his expressive and receptive language deficits remained severe and persistent despite multiple rounds of traditional therapy. He had 15 sessions of bi-hemispheric multisite anodal tDCS aimed at bilateral dorsal language streams, administered simultaneously with language training customized to address his particular phonological and syntactic deficiencies. Psycholinguistic evaluations were performed at baseline, immediately following the intervention, and at 1, 2, 3, and 6 months post-intervention. Resting-state fMRI was conducted at baseline and following the intervention to evaluate alterations in functional connectivity (FC). Results: We noted statistically significant enhancements in auditory sentence comprehension and oral reading, particularly at the 1- and 3-month follow-ups. Neuroimaging showed decreased functional connectivity (FC) in the left inferior frontal and precentral regions (dorsal stream) and in maladaptive right superior temporal regions, alongside increased FC in left superior temporal areas (ventral stream). This pattern suggests that language networks may be reorganizing in a more efficient way. There was no significant improvement in phonological processing, which may indicate reduced connectivity in the left inferior frontal areas. Conclusions: This case underscores the potential of combining individualized, network-targeted language training with bi-hemispheric multisite tDCS to enhance recovery in chronic, treatment-resistant aphasia. The convergence of behavioral gains and neuroplasticity highlights the importance of precision neuromodulation approaches. However, findings are preliminary and warrant further validation through controlled studies to establish broader efficacy and sustainability of outcomes. Full article

Background: Dystonic cerebral palsy (DCP) is a complex, disabling manifestation of secondary dystonia, which significantly impacts motor function, quality of life, and well-being. Conventional pharmacologic therapies frequently do not relieve symptoms sufficiently. Deep brain stimulation (DBS) of the globus pallidus internal segment (GPi) has gained increasing attention as a neuromodulatory therapy for refractory dystonia. Still, the experience of the effect of GPi DBS treatment in adults with DCP has, until recently, been limited. Methods: We performed a retrospective, two-center case series of 11 adult patients with medically refractory DCP who underwent bilateral GPi-DBS. The clinical outcomes were evaluated based on the Burke–Fahn–Marsden Dystonia Rating Scale (BFMDRS), the Functional Independence Measure (FIM), the Gross Motor Function Classification System (GMFCS), and the Caregiver Burden Scale (CBS). The assessments were done preoperatively and at 1-year follow-up. Changes in continuous variables were analyzed using paired t-tests. Results: At the 1-year follow-up, the mean BFMDRS score improved from 69.6 ± 27.6 to 54.3 ± 36.5 (p = 0.001), indicating a significant reduction in overall dystonia severity. Functional independence also improved, demonstrated by the rise in FIM scores from 65.3 ± 33.9 to 79.2 ± 43.4 (p = 0.006). Although GMFCS levels did not change in most patients (p = 0.125), the burden on caregivers decreased significantly, with CBS scores falling from 35.7 ± 18.8 to 32.0 ± 17.1 (p = 0.015). There were no surgical complications. Conclusions: In adults, bilateral GPi-DBS is a safe and effective intervention for DCP, improving motor control and increasing functional independence while decreasing caregiver burden. These findings lend support to its role in the multidisciplinary management of DCP. Full article

Background: Invasive and non-invasive neuromodulation in psychiatry represents a burgeoning field that leverages advanced neuromodulation techniques to address substance use disorders (SUDs). Aims: This narrative review synthesizes findings from multiple reviews to evaluate the efficacy of neuromodulation in treating SUDs. Methods: A comprehensive literature search was conducted between December 2024 and April 2025, focusing on systematic reviews and meta-analyses that examined various neuromodulation modalities, including repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), and deep brain stimulation (DBS). The selected reviews were analyzed to identify common themes, outcomes, and gaps in the current understanding of these treatments for SUDs. Results: 11 reviews met the final inclusion criteria; 5 focused on non-invasive neuromodulation (rTMS, tDCS) and 6 on invasive neuromodulation (DBS). Non-invasive neurostimulation was associated with modest improvements in craving and cognitive dysfunction in individuals with SUDs. Similarly, invasive neuromodulation (DBS), through high-frequency stimulation of the bilateral nucleus accumbens, appeared to reduce cravings and improve comorbid psychiatric symptoms in both preclinical and human studies. Importantly, small sample sizes, heterogeneity in targets and stimulation protocols, and short follow-up periods significantly limit the generalizability of current findings from both non-invasive and invasive neuromodulation studies. Conclusions: As novel and more effective therapies for the treatment of SUD are desperately needed, procedural interventional psychiatry holds promise. However, despite encouraging results, existing evidence is still preliminary, and larger, rigorously designed studies are warranted to further establish the safety and efficacy of neuromodulatory interventions for SUD treatment. Full article

Neurophysiological techniques, particularly somatosensory evoked potentials (SEPs) and electroencephalography (EEG), are essential tools for the functional and prognostic evaluation of patients with prolonged disorders of consciousness (DoC) in intensive neurorehabilitation settings. This narrative review critically analyzes the most relevant evidence regarding the use of SEPs and EEG in the management of post-comatose patients, highlighting the strategic role of physiatrists in integrating these assessments into individualized rehabilitation plans. A systematic search was conducted across major international databases (PubMed, Embase, Scopus, Cinahl, and DiTA) until December 2024, selecting consensus documents, official guidelines (including the 2021 ERC/ESICM guidelines), systematic reviews, observational studies, and significant Italian neurophysiological contributions. The literature supports the strong prognostic value of the bilateral presence of the N20 component in SEPs, while its early bilateral absence, particularly in post-anoxic cases, is a robust predictor of poor neurological outcomes. EEG provides complementary information, with continuous, reactive, and symmetrical patterns associated with favorable outcomes, while pathological patterns, such as burst suppression or isoelectric activity, predict a worse prognosis. Combining SEP and EEG assessments significantly improves prognostic sensitivity and specificity, especially in sedated or metabolically compromised patients. Additionally, the use of direct muscle stimulation (DMS) and nerve conduction studies enables accurate differentiation between central and peripheral impairments, which is crucial for effective rehabilitation planning. Overall, SEPs and EEG should be systematically incorporated into the evaluation and follow-up of DoC patients, and the acquisition of neurophysiological competencies by physiatrists represents a strategic priority for modern, effective, and personalized neurorehabilitation. Full article

Background: Newborns’ plasticity allows the brain to adapt and reorganize in response to external stimuli; therefore, tactile stimuli could generate brain changes. The objective of this study was to verify the feasibility of using fNIRS to measure the degree of brain oxygenation with tactile techniques in babies. Methods: Oxygenation was recorded continuously and bilaterally before, during, and after the interventions (massage protocol and Reflex Locomotion Therapy) with functional near-infrared spectroscopy in 11-week-old babies. Results: Preliminary data suggested that the massage intervention decreased the activity bilaterally (first minute of the intervention) and then increased it bilaterally (second minute), where it continued to increase in the left hemisphere (third minute) before decreasing bilaterally (fourth minute). Finally, the activity continued to decrease in the right hemisphere but increased in the most dorsal area of the left hemisphere (fifth minute). For the Reflex Locomotion intervention, the activity substantially increased bilaterally (first minute of the intervention) and then decreased bilaterally, but more pronouncedly in the left hemisphere (second minute). Then, the activity decreased to pre-intervention values (third minute) and increased bilaterally again, but pronouncedly in the right hemisphere (fourth minute). In the fifth minute, the activity in the right hemisphere drastically decreased, but it increased in the left hemisphere. During the post-intervention resting period, in the massage intervention, the activity increased in the right hemisphere and in the most ventral part of the left hemisphere; in Reflex Locomotion Therapy, the activity decreased only in the left hemisphere. Conclusions: Both techniques achieve a potential increase in oxyhemoglobin concentration bilaterally during stimulation, but while the effects decrease with Reflex Locomotion Therapy, the effects are maintained with massage. More studies are needed to establish the neurophysiological basis of these therapies in pediatrics. Full article

This study investigates the evolutionary mechanisms and equilibrium character-istics of the China–US trade dispute through an improved ecological competition model. By quantifying tariff policies as competition intensity regulators and introducing trade elasticity parameters, we construct a dynamic system that captures the nonlinear feedback between economic rivals. Key findings are as follows. (1) When both nations implement reciprocal tariff measures with similar economic sensitivities, the system converges to a stable equilibrium where bilateral economic outputs stabilize at reduced levels compared to pre-conflict states, provided the product of adjusted competition coefficients remains below critical thresholds. (2) Excessive tariff escalation beyond identifiable tipping points triggers winner-takes-all outcomes, validating the “Thucydides Trap” hypothesis in eco-nomic conflicts. (3) Empirical simulations using 2018–2023 trade data demonstrate that China’s tit-for-tat tariff strategy effectively maintains competitive balance, while domestic market expansion measures (evidenced by a 6.3% average annual growth in China’s do-mestic consumption) significantly mitigate trade diversion effects. The study establishes theoretical connections with optimal tariff theory and strategic trade policy literature while providing policymakers with quantitative tools to assess trade policy impacts. Our find-ings theoretically validate China’s policy combination of calibrated reciprocity and domestic demand stimulation, offering new insights into managing great-power economic competition. Full article

Background/Objectives: Chronic attention problems occur in approximately 25% of children after acquired brain injury (ABI). When delivered daily, transcranial direct current stimulation (tDCS) may improve attention; however, access to daily in-clinic tDCS treatment can be limited by other commitments, including concurrent therapy, school commitments, and caregiver schedules. Treatment access can be improved through home-based interventions, though these require several practical and safety considerations in a pediatric ABI population. This study evaluated the safety, feasibility, and tolerability of remotely monitored at-home tDCS during online gamified attention training in pediatric ABI. Methods: We conducted a randomized, single-blind, dose-controlled clinical trial of at home tDCS in Brisbane, Australia (10 tDCS sessions; 20 min; 1 mA or 2 mA; bilateral dorsolateral prefrontal cortex). Participants attended our clinic at baseline for clinical assessments, fitting of the personalized tDCS headband, and training in how to use tDCS at home. All sessions were remotely supervised using live videoconferencing. We assessed the feasibility and tolerability of at-home tDCS and our customized, personalized at-home tDCS headband as primary outcomes. As secondary outcomes, we evaluated changes in functional connectivity (fc) and reaction time (RT). Results: Seventy-three participants were contacted over six months (January-June 2023) and ten were enrolled (5 males; mean age: 12.10 y [SD: 2.9]), satisfying a priori recruitment timelines (CONSORT reporting). All families successfully set up tDCS and completed attention training with excellent protocol adherence. There were no serious adverse events over the 100 total sessions. Nine participants completed all stimulation sessions (1 mA: n = 5, 2 mA: n = 4). Participants in the 2 mA group reported greater tingling, itching, and discomfort (all p < 0.05). One participant in the 1 mA group was unable to complete all sessions due to tolerability challenges; however, these challenges were resolved in the second half of the intervention by gradually increasing the stimulation duration across the 10 days alongside additional coaching and support. Conclusions: Overall, daily remotely supervised at-home tDCS in patients with pediatric ABI is safe, feasible, and tolerable. Our results support larger, sham-controlled efficacy trials and provide a foundation for the development of safe and effective at-home stimulation therapeutics that may offer targeted improvement of neurocognitive symptoms in children. Full article

Background/Objectives: Transcranial Direct Current Stimulation (tDCS) has proven to be a promising intervention for major depressive disorder (MDD). Even so, the specific neurophysiological mechanisms underlying its therapeutic effects, particularly regarding frontal EEG markers, remain insufficiently understood. This pilot study investigated both the clinical efficacy and neurophysiological impact of frontal tDCS in individuals with mild to severe depression, with particular focus on mood changes and alterations in Frontal Alpha Asymmetry (FAA), Beta Symmetry, and Theta/Alpha Ratios at the F3 and F4 electrode sites. Methods: A total of thirty–one participants were enrolled and completed a standardized Flow Neuroscience tDCS protocol targeting the dorsolateral prefrontal cortex using a bilateral F3/F4 montage. The intervention included an active phase of five stimulations per week for three weeks, followed by a Strengthening Phase with two stimulations per week. Clinical outcomes were assessed using the Montgomery–Åsberg Depression Rating Scale (MADRS), while neurophysiological changes were evaluated via standardized quantitative EEG (QEEG) recordings obtained before and after the treatment course. Among the participants, fourteen individuals had a baseline MADRS score of ≥20, indicating moderate to severe depressive symptoms. Results: Following tDCS treatment, significant reductions in MADRS scores were observed across the cohort, with clinical response rates notably higher in the moderate/severe group (71.4%) compared to the mild depression group (20.0%). Neurophysiological effects were modest: no significant changes were detected in FAA or Beta Symmetry measures. However, a substantial reduction in the Theta/Alpha Ratio at F4 was found in participants with moderate to severe depression (p = 0.018, Cohen’s d = −0.72), suggesting enhanced frontal cortical activation associated with clinical improvement. Conclusions: These findings indicate that frontal tDCS is effective in reducing depressive symptoms, particularly in cases of moderate to severe depression. While improvements in FAA and Beta Symmetry were not significant, changes in the Theta/Alpha Ratio at F4 point toward dynamic neurophysiological reorganization potentially linked to therapeutic outcomes. The Theta/Alpha Ratio may serve as a promising biomarker for tracking tDCS response, whereas other EEG metrics might represent more stable trait characteristics. Future research should prioritize individualized stimulation protocols and incorporate more sensitive neurophysiological assessments, including functional connectivity analyses and task-evoked EEG paradigms, to understand the mechanisms underlying clinical improvements. Full article

Background/Objectives: Transcranial magnetic stimulation (TMS) is a non-invasive and well-tolerated treatment, offering an effective alternative for elderly patients with depression, especially when side effects or comorbidities limit medication. Methods: This scoping review analyzes 16 studies published over the past seven years, to evaluate the efficacy, safety, and clinical applications of TMS in older adults with depression. Results: The review examines various TMS modalities, including repetitive TMS (rTMS), deep TMS, and theta burst stimulation (TBS), with most protocols targeting the dorsolateral prefrontal cortex (DLPFC). Adverse effects were rare, mild, and transient, supporting the treatment’s safety profile. Pharmacological co-treatment was common but not essential for clinical improvement, highlighting TMS’s potential as a standalone therapy. A subset of studies used neuroplasticity (SICI, ICF, CSP) or neuroimaging measures (MRI and MRI-based neuronavigation), revealing that age-related cortical inhibition may limit plasticity rather than depression itself. Conclusions: Overall, TMS demonstrates promising effectiveness and tolerability in managing late-life depression. Across studies, remission rates varied from 20% to 63%, with higher efficacy generally observed in bilateral stimulation or high-frequency protocols. Standardization of protocols and further research into individualized targeting and long-term outcomes are warranted to support broader clinical adoption. Full article

Objectives: This study aimed to develop a semi-automated registration method for aligning preoperative non-contrast T2-weighted MRI with postoperative high-resolution cone-beam CT (DynaCT) in patients undergoing directional deep brain stimulation (dDBS) surgery targeting the subthalamic nucleus (STN). The aim was to facilitate image-guided programming of DBS devices and postoperative verification of the alignment of segmented contacts. Materials and Methods: A dataset of ten patients undergoing bilateral dDBS implantation was retrospectively collected, including DynaCT (acquired postoperatively) and non-contrast T2-weighted MRI (obtained preoperatively). A semi-automated registration method was used, employing manual initialization due to dissimilar anatomical information between DynaCT and T2-weighted MRI. Image visualization, initial alignment using a centered transformation initializer, and single-resolution image registration involving the Simple Insight Toolkit (SimpleITK) library were performed. Manual landmark-based alignment based on anatomical landmarks and evaluation metrics such as Target Registration Error (TRE) assessed alignment accuracy. Results: The registration method successfully aligned all images. Quantitative evaluation revealed an average of the mean TRE of 1.48 mm across all subjects, indicating satisfactory alignment quality. Multiplanar reformations (MPRs) based on electrode-oriented normal vectors visualized segmented contacts for accurate electrode placement. Conclusions: The developed method demonstrated successful registration between preoperative non-contrast T2-weighted MRI and postoperative DynaCT, despite dissimilar anatomical information. This approach facilitates accurate alignment crucial for DBS programming and postoperative verification, potentially reducing the programming time of the DBS. The study underscores the importance of image quality, manual initialization and semi-automated registration methods for successful multimodal image registration in dDBS procedures targeting the STN. Full article

(1) Background: Ischemic stroke is a major global public-health concern with complex pathogenesis. Current treatment strategies face challenges. Low-intensity pulsed ultrasound stimulation (LIPUS), a non-invasive neuromodulation technology, shows promise in treating ischemic stroke, yet its underlying mechanisms lack in-depth investigation, especially in quantitative efficacy evaluation. (2) Methods: This study aimed to develop a neuromuscular functional coupling-based dynamic time warping (DTW) model to evaluate LIPUS’s neuroprotective effects in a mouse model of ischemic stroke. A bilateral carotid artery occlusion (BCAO) model in mice was established, and LIPUS treatment was given. Time- and frequency-domain analyses of local field potentials (LFPs) and electromyography (EMG) were conducted, and outcomes were quantified using a percentage-based scoring system. (3) Results: The BCAO+LIPUS group scored significantly higher than the BCAO group. (4) Conclusions: This study demonstrated that LIPUS is neuroprotective in BCAO mice and that the DTW-100 assessment evaluation model can quantify the neuroprotective effects of LIPUS. Full article

Background and Objectives: Periodontal regeneration involves techniques intended at restoring the lost supporting tissue around a periodontally weakened tooth. These regenerative methods frequently utilize periosteal grafts to stimulate the evolvement of vital adjacent tissues. This paper intended to evaluate the use of autogenous periosteal grafts in treating grade II furcation defects (Glickman Classification 1953) in patients with chronic periodontitis. Materials and Methods: The databases MEDLINE (via PubMed), Cochrane, EBSCO, and Google Scholar were searched for papers published in English from January 1991 till December 2022. Three individuals examined the reclaimed articles according to the inclusion norms. Randomized controlled trials (RCTs) assessing the efficacy of autogenous periosteal grafts for treating Grade II furcation defects in chronic periodontitis patients were involved. Only four related studies were identified for data extraction, involving 80 patients aged 18 to 52 years. Outcome variables measured included horizontal bone loss (HD), vertical bone loss (VD), pocket depth (PD), clinical attachment level (CAL), bone height (BH), gingival recession (GR), plaque index (PI), and gingival index (GI). Data were examined using RevMan 5.4.1 software. Mean differences and 95% confidence intervals were employed to estimate effect sizes. Results: Both groups showed similar results for reductions in PI, GI, and BOP. However, The periosteal graft also yielded better outcomes for CAL gain, BH, and GR. The meta-analysis showed a significant overall effect of Periosteal Barrier Membrane (PBM) on horizontal and vertical bony change levels, but subgroup differences between unilateral and bilateral applications were not statistically significant due to high heterogeneity. Although the bilateral subgroup demonstrated significant benefits of PBM treatment, the overall findings across the clinical attachment level group remain inconclusive. Conclusion: Current evidence suggests that while PBM may benefit bilateral mandibular sites, and autogenous periosteal grafts offer no added advantage over OFD alone in Grade II furcation defects, the overall findings remain inconclusive. Full article

Background/Objectives: Upper airway patency is a key pathophysiological factor in obstructive sleep apnea (OSA). Research has primarily focused on the role of the genioglossus muscle in maintaining airway patency in OSA. However, hypoglossal nerve stimulation (HNS) therapy, which activates the genioglossus muscle, has been associated with poor outcomes in patients with lateral oropharyngeal collapse. The stylopharyngeus muscle is an upper airway dilator muscle that supports the lateral pharyngeal wall. Its role in maintaining upper airway patency and its effect on normal respiratory airflow is unclear. We hypothesize that bilateral transection of the stylopharyngeus muscles disrupts normal breathing. Currently, no animal model depicting lateral pharyngeal collapse has been reported. This study aims to introduce a novel rodent model with bilateral transection of the stylopharyngeus muscles to examine its effect on respiratory airflow and tracing. Methods: Adult male Sprague Dawley rats were divided into two groups: (1) bilateral stylopharyngeus muscle transection (n = 4) and (2) sham surgery (n = 2). Under anesthesia, the stylopharyngeus muscle was transected bilaterally in the transection group, while only exposure of the muscle was performed in the sham group. Respiratory airflow was measured using whole-body plethysmography before and after surgery, and airflow tracings were analyzed. Results: Significant alterations in respiratory airflow and tracings, particularly a flattening in inspiratory flow and sharp expiratory peaks, were observed on the first post-operative day in the transection group. The flattening of the inspiratory flow persisted over 3 days. No significant changes were noted in the sham group. Conclusions: Bilateral stylopharyngeus muscle transection alters normal airflow in a conscious rodent model, supporting the hypothesis that stylopharyngeus muscle plays a vital role in shaping respiratory airflow. The flattening of the inspiratory airflow is an indication of flow limitations through the upper airway patency due to the loss of stylopharyngeus function. Full article

Background/Objectives: Part-to-whole object completion and search guidance by salient, integrated objects has been proposed to require attentional resources, as shown by studies of neglect patients suffering from right-parietal brain damage. The current study was performed to provide further causal evidence for the link between attention and object integration. Methods: Healthy observers detected targets in the left and/or right hemifields, and these targets were in turn embedded in various Kanizsa-type configurations that systematically varied in the extent to which individual items could be integrated into a complete, whole object. Moreover, repetitive transcranial magnetic stimulation (rTMS) was applied over the right intraparietal sulcus (IPS) and compared to both active and passive baseline conditions. Results: The results showed that target detection was substantially facilitated when the to-be detected item(s) were fully embedded in a salient, grouped Kanizsa figure, either a unilateral triangle or a bilateral diamond. However, object groupings in one hemifield did not facilitate target detection to the same extent when there were bilateral targets, one inside the (triangle) grouping and the other outside of the grouped object. These results extend previous findings from neglect patients. Moreover, a subgroup of observers was found to be particularly sensitive to IPS stimulation, revealing neglect-like extinction behavior with the single-hemifield triangle groupings and bilateral targets. Conversely, a second subgroup showed the opposite effect, namely an overall, IPS-dependent improvement in performance. Conclusions: These explorative analyses show that the parietal cortex, in particular IPS, seems to modulate the processing of object groupings by up- and downregulating the deployment of attention to spatial regions were to-be-grouped items necessitate attentional resources for object completion. Full article

This study examined transient effects of transcranial direct current stimulation (tDCS) on bilateral force control in lower extremities. We recruited 14 healthy young adults and administered bilateral ankle-dorsiflexion force control tasks at 10% of maximal voluntary contraction. Participants were able to use real-time visual information on a targeted force level and forces produced by both feet. While performing bilateral force control, we provided active- and sham-tDCS in a random order. Bilateral tDCS protocol used for this study included anodal and cathodal stimulation targeting left and right leg areas of the primary motor cortex between hemispheres. Bilateral force control capabilities were estimated by calculating force accuracy, variability and regularity. In addition, we determined whether force control patterns differed between feet across active- and sham-tDCS conditions. The findings revealed that force accuracy and variability were significantly improved after applying active-tDCS protocol as compared with those for sham-tDCS condition. However, no differences in force control between feet were observed. These findings suggest that bilateral tDCS protocols may be a viable option for improving motor functions of lower limbs. Full article