Optimized high-definition tDCS in patients with skull defects and skull plates.
Optimized high-definition tDCS in patients with skull defects and skull plates.
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DOI：
10.3389/fnhum.2023.1239105
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发表时间：
2023
影响因子：
2.9
通讯作者：
Huang, Yu
中科院分区：
文献类型：
--
作者：
Guillen, Alexander;Truong, Dennis Q.;Datta, Abhishek;Huang, Yu
关键词：
经颅直流电刺激（tDCS）已被证明对脑病变或创伤性脑损伤（TBI）患者有益。这些患者通常有不同大小和电导率的颅骨缺损。文献中很少有数据显示如何最佳地刺激这些存在颅骨缺损的患者。在这里，我们利用高分辨率（1毫米）逼真的头部模型来探索最佳蒙太奇，针对不同尺寸和导电性的颅骨缺陷。具体来说，使用开源软件ROAST来求解公开可用的MIDA模型上的领先字段。四种不同的颅骨缺损/板以右侧初级运动皮质为中心建模：较大的缺损（直径10 cm）模型为钛板或丙烯酸板，较小的缺损（直径2.5 cm）模型为急性状态填充脑脊液（CSF）或慢性状态伴瘢痕组织。以右侧初级运动皮层为靶点，进行最大强度优化刺激。我们发现，与未优化的蒙太奇（M1-SO或4×1）相比，优化的高清蒙太奇在目标处的刺激强度平均提高了0.3 V/m。钛板或亚克力板的颅骨大缺损可显著降低约80%的刺激强度，而急性（CSF）或慢性（疤痕）组织的小缺损可显著增加约200%的刺激强度。此外，当颅骨有较大的钛板缺损时，使用M1-SO可以获得与优化蒙太奇几乎相同的刺激强度，对于颅骨有瘢痕组织的小缺损，4×1蒙太奇与优化蒙太奇的刺激强度无显著差异。基于这项工作，未来利用颅骨缺损个体解剖的建模研究可能有助于指导颅骨缺损和颅骨板患者的tDCS实践。
Transcranial direct current stimulation (tDCS) has been shown to benefit patients with brain lesions or traumatic brain injury (TBI). These patients usually have skull defects with different sizes and electrical conductivities. There is very little data in the literature that show how to optimally stimulate these patients with the presence of skull defects. Here we leveraged high-resolution (1 mm) realistic head models to explore the best montages targeting right beneath the skull defects with different sizes and conductivities. Specifically, open-source software ROAST was used to solve for the lead field on the publicly available MIDA model. Four different skull defects/plates were modeled with the center above the right primary motor cortex: a larger defect (10 cm diameter) modeled as either titanium or acrylic plate, and a smaller defect (2.5 cm diameter) modeled as either acute state filled with cerebrospinal fluid (CSF) or chronic state with scar tissue. Optimized stimulation with maximal intensity was run using ROAST targeting the right primary motor cortex. We show that optimized high-definition montages can achieve an average of 0.3 V/m higher stimulation intensities at the target compared to un-optimized montages (M1-SO or 4×1). Large skull defects with titanium or acrylic plates significantly reduce the stimulation intensity by about 80%, while small defects with acute (CSF) or chronic (scar) tissues significantly increase the stimulation intensity by about 200%. Furthermore, one can use M1-SO to achieve almost the same stimulation strength as the optimized montage if the skull has a large defect with titanium plate, and there is no significant difference in stimulation intensity between 4×1 montage and the optimized montage for small skull defects with scar tissue. Based on this work, future modeling studies leveraging individual anatomy of skull defects may help guide tDCS practice on patients with skull defects and skull plates.
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