EEG and Neuronal Activity Topography analysis can predict effectiveness of shunt operation in idiopathic normal pressure hydrocephalus patients.
EEG and Neuronal Activity Topography analysis can predict effectiveness of shunt operation in idiopathic normal pressure hydrocephalus patients.
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DOI：
10.1016/j.nicl.2013.10.009
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发表时间：
2013
影响因子：
4.2
通讯作者：
Takeda, Masatoshi
中科院分区：
文献类型：
--
作者：
Aoki, Yasunori;Kazui, Hiroaki;Tanaka, Toshihisa;Ishii, Ryouhei;Wada, Tamiki;Ikeda, Shunichiro;Hata, Masahiro;Canuet, Leonides;Musha, Toshimitsu;Matsuzaki, Haruyasu;Imajo, Kaoru;Yoshiyama, Kenji;Yoshida, Tetsuhiko;Shimizu, Yoshiro;Nomura, Keiko;Iwase, Masao;Takeda, Masatoshi
关键词：
特发性正常压力脑积水（iNPH）是一种以步态障碍、认知障碍和尿失禁为特征的神经精神综合征，影响老年人。这些症状可以通过脑脊液（CSF）引流或分流术逆转。分流手术前，通常进行少量脑脊液引流或“脑脊液穿刺”，以确定手术效果。不幸的是，传统的神经成像方法，如单光子发射计算机断层扫描（SPECT）和功能性磁共振成像（fMRI），以及脑电图（EEG）功率分析似乎未能检测到脑脊液对脑功能的影响。在这项工作中，我们提出了使用神经元活动地形图（NAT）分析，计算归一化功率方差（NPV）的EEG波，检测皮质功能的变化引起的脑脊液轻敲iNPH。基于CSF穿刺和分流术的临床改善，我们将24例iNPH患者分为应答者（N = 11）和无应答者（N = 13），并进行EEG功率分析和NAT分析。我们还评估了脑脊液穿刺前后NPV变化与步态和认知量表功能评分变化之间的相关性。NAT分析显示，CSF采集后，应答者内侧额叶皮质（FC）（Fz）的α NPV显著降低，而无应答者右侧背外侧前额叶皮质（DLPFC）的α NPV增加（F8）。此外，我们发现皮质功能变化和临床症状之间的相关性。特别是，左背侧FC（F3）的δ和α NPV变化与步态状态的变化相关，而右前额叶皮层（PFC）（Fp2）和左DLPFC（F7）的α和β NPV变化以及内侧FC（Fz）的α NPV变化与步态速度的变化相关。此外，iNPH患者右侧DLPFC（F8）的α NPV变化与WMS-R精神控制评分的变化相关。结合左背侧FC的α NPV值变化的附加分析（α-F3-NPV）和中间FC（α-Fz-NPV）（α-F3-NPV + α-Fz-NPV的临界值= 0），可正确识别"分流反应者"和"分流无反应者"，阳性预测值为100%（10/10），阴性预测值为66%（2/3）。与此相反，脑电功率谱分析显示，在前额叶皮质的皮质活动没有功能相关的变化，脑脊液轻敲后。这些结果表明，iNPH患者中CSF敲击诱导的步态和反应抑制的临床变化表现为NPV变化，特别是在α波段，而不是EEG功率变化。我们的研究结果表明，NAT分析可以检测到CSF灌注诱导的皮质活动功能变化，到目前为止，还没有其他神经影像学方法能够做到这一点，并可以预测iNPH患者分流术的临床反应。我们的目的是通过脑脊液穿刺检测iNPH患者的脑功能变化。额叶皮层的α NPV变化与脑功能变化相关。这些NPV的变化可以预测iNPH患者分流术的反应。
Idiopathic normal pressure hydrocephalus (iNPH) is a neuropsychiatric syndrome characterized by gait disturbance, cognitive impairment and urinary incontinence that affect elderly individuals. These symptoms can potentially be reversed by cerebrospinal fluid (CSF) drainage or shunt operation. Prior to shunt operation, drainage of a small amount of CSF or “CSF tapping” is usually performed to ascertain the effect of the operation. Unfortunately, conventional neuroimaging methods such as single photon emission computed tomography (SPECT) and functional magnetic resonance imaging (fMRI), as well as electroencephalogram (EEG) power analysis seem to have failed to detect the effect of CSF tapping on brain function. In this work, we propose the use of Neuronal Activity Topography (NAT) analysis, which calculates normalized power variance (NPV) of EEG waves, to detect cortical functional changes induced by CSF tapping in iNPH. Based on clinical improvement by CSF tapping and shunt operation, we classified 24 iNPH patients into responders (N = 11) and nonresponders (N = 13), and performed both EEG power analysis and NAT analysis. We also assessed correlations between changes in NPV and changes in functional scores on gait and cognition scales before and after CSF tapping. NAT analysis showed that after CSF tapping there was a significant decrease in alpha NPV at the medial frontal cortex (FC) (Fz) in responders, while nonresponders exhibited an increase in alpha NPV at the right dorsolateral prefrontal cortex (DLPFC) (F8). Furthermore, we found correlations between cortical functional changes and clinical symptoms. In particular, delta and alpha NPV changes in the left-dorsal FC (F3) correlated with changes in gait status, while alpha and beta NPV changes in the right anterior prefrontal cortex (PFC) (Fp2) and left DLPFC (F7) as well as alpha NPV changes in the medial FC (Fz) correlated with changes in gait velocity. In addition, alpha NPV changes in the right DLPFC (F8) correlated with changes in WMS-R Mental Control scores in iNPH patients. An additional analysis combining the changes in values of alpha NPV over the left-dorsal FC (∆alpha-F3-NPV) and the medial FC (∆alpha-Fz-NPV) induced by CSF tapping (cut-off value of ∆alpha-F3-NPV + ∆alpha-Fz-NPV = 0), could correctly identified “shunt responders” and “shunt nonresponders” with a positive predictive value of 100% (10/10) and a negative predictive value of 66% (2/3). In contrast, EEG power spectral analysis showed no function related changes in cortical activity at the frontal cortex before and after CSF tapping. These results indicate that the clinical changes in gait and response suppression induced by CSF tapping in iNPH patients manifest as NPV changes, particularly in the alpha band, rather than as EEG power changes. Our findings suggest that NAT analysis can detect CSF tapping-induced functional changes in cortical activity, in a way that no other neuroimaging methods have been able to do so far, and can predict clinical response to shunt operation in patients with iNPH. We aimed to detect brain functional changes by CSF tapping in iNPH patients. Alpha NPV changes in the frontal cortex correlated with brain functional changes. These NPV changes could predict the response of shunt operation in iNPH patients.
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影响因子：
3.7
作者：
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通讯作者：
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作者：
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影响因子：
3.7
作者：
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通讯作者：
Takeda M