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The effects and mechanisms of transcranial ultrasound stimulation combined with cognitive rehabilitation on post-stroke cognitive impairment

Yao Wang, Fei Li, Ming-Jun He, Shang-Jie Chen

Neurological Sciences 2022, 43, 4315-4321 · 10.1007/s10072-022-05906-2

human patientstrokeeeg megclinical scaleother

Abstract

Objective To investigate whether transcranial ultrasound stimulation (TUS) could improve post-stroke cognitive impairment (PSCI) and the potential mechanisms through which this can be achieved. Method Sixty patients with PSCI were selected and randomly divided into a control and observation group, respectively, with 30 cases in each group. Conventional cognitive rehabilitation training combined with TUS intervention was conducted in the observation group, while conventional cognitive rehabilitation training and sham-TUS stimulation were given to patients in the control group. Results The Mini-Mental State Exam, Modified Barthel Index score, P300 latency, and wave amplitude, as well as the serum brain-derived neurotrophic factor (BDNF) levels, were significantly higher in both groups after treatment compared with those before treatment (P Conclusion Transcranial ultrasound stimulation combined with conventional cognitive rehabilitation therapy improved the PSCI condition with better efficacy than conventional cognitive rehabilitation therapy only. The mechanism involved may be correlated with the upregulation of BDNF and P300 induced by TUS.

Abstract via europepmc.

Specieshuman
Subjects30 participants
Sessions per subjectnot reported
Randomisedyes
Blindingsingle
Sham / controlundescribed
Auditory controlnot reported
Readout timingoffline
Anaesthesianot applicable
Readoutseeg meg, clinical scale, otherP300 event-related potential (latency and amplitude); Mini-Mental State Exam (MMSE); Montreal Cognitive Assessment (MoCA); Modified Barthel Index (MBI); serum brain-derived neurotrophic factor (BDNF, ELISA)
Direction of effectexcitatoryActive TUS combined with cognitive rehabilitation produced greater improvements than sham-TUS plus rehabilitation in MMSE, MBI, MoCA sub-scores, P300 amplitude (increased) and latency (shortened), and serum BDNF (increased).
Adverse eventsnot reported

Exposures

Exposure 1: Active TUS to bilateral forehead combined with cognitive rehabilitation

Target: frontal lobe — “forehead (five probes, dual-channel device)
Device: other named manufacturer · Shengxiang Technology · 838B-M-C-II

Pulse timing
Waveformnot reported
Fundamental frequency (kHz)not reported
Pulse duration (ms)not reported
Pulse repetition frequency (Hz)not reported
Duty cycle (%)not reported
Sonication duration (s)1,200✓✓
Pressure and intensity, by domain
Free-field pressure (kPa)not reported
Free-field Isppa (W/cm²)not reported
Free-field Ispta (W/cm²)not reported
In-situ estimatenot reported
In-situ pressure (kPa)not reported
In-situ Isppa (W/cm²)not reported
In-situ Ispta (W/cm²)not reported
Isppa, domain unspecified (W/cm²)1.75?
Protocol, in the paper’s words

Five probes with a diameter of 2 cm were placed on the forehead of each participant (dual-channel 838B-M-C-II; Shengxiang Technology). Treatment was given for 20 min once per day, for 5 days over 6 weeks, at a sound intensity of 1.75 W/cm2 in the active-TUS group; the sham-control group received sham-TUS (stimulation stopped after the first 30 s).

Flags from extraction

  • exposures[0].fundamental_frequency_khzThe ultrasound frequency is not stated anywhere in the paper.
  • exposures[0].unspecified_domain.isppa_w_cm2The paper states only a generic 'sound intensity' of 1.75 W/cm2 without specifying whether this is ISPTA or ISPPA, or the measurement domain (free-field vs in-situ).
  • n_sessions_per_subjectThe paper states treatment was given 'once per day, which lasted for 5 days over 6 weeks' - the total number of sessions is not explicitly stated and would require multiplying 5 days/week by 6 weeks, which was not done here.
  • sham_typeThe sham mechanism is only described as stimulation being 'stopped' after the first 30 s, without stating whether the transducer output was truly inactive, damped, or otherwise; classified as 'other'.
  • direction_of_effectDirection of effect is inferred from clinical/cognitive and biomarker (BDNF, P300) improvements rather than from a direct measure of neuronal excitability.