Personalizing tDCS Dose in Healthy Adults and Chronic Ischemic Stroke

健康成人和慢性缺血性中风的个性化 tDCS 剂量

• 批准号: 10539257
• 负责人: Kevin A. Caulfield
• 金额: $ 4.77万
• 依托单位: MEDICAL UNIVERSITY OF SOUTH CAROLINA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-12-09 至 2023-12-08
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10539257
• 关键词: Accounting; Acute; Adopted; Adult; Anatomy; Behavior Therapy; Brain; Cause of Death; Centers of Research Excellence; Cerebrospinal Fluid; Chronic; Clinical; Contralateral; Cross-Over Studies; Dose; Double-Blind Method; Educational process of instructing; Electroconvulsive Therapy; Electrodes; Functional Magnetic Resonance Imaging; Future; Grant; Hand; Individual; Ischemic Stroke; Left; Lesion; Limb structure; Linear Regressions; Location; MRI Scans; Magnetic Resonance Imaging; Measures; Medical; Mentorship; Methods; Modeling; Motor; Motor Cortex; Motor Evoked Potentials; Nature; Neuroanatomy; Neurologic; Outcome; Outcome Measure; Paralysed; Paresis; Participant; Patients; Persons; Prevalence; Psychiatric therapeutic procedure; Recording of previous events; Rehabilitation Outcome; Research; Research Personnel; Rest; Sampling; Scalp structure; Scientist; Seizures; Side; South Carolina; Standardization; Stroke; Study models; Technical Expertise; Testing; Therapeutic; Training; Transcranial magnetic stimulation; United States; United States National Institutes of Health; Universities; Variant; Visit; Writing; career; chronic stroke; cost; disability; dosage; electric field; functional MRI scan; gray matter; hemiparesis; improved; motor control; motor impairment; motor recovery; motor rehabilitation; neuroimaging; noninvasive brain stimulation; post stroke; primary outcome; prospective; prospective test; recruit; statistics; stroke patient; stroke recovery; stroke rehabilitation; stroke-induced aphasia; tool; training opportunity; transcranial direct current stimulation; white matter

PROJECT SUMMARY Stroke is a leading cause of death and disability worldwide. The most common post-stroke disability is weakness or paralysis in the opposite limbs, which persists chronically (more than 6 months post-stroke) in approximately 60% of patients. There is an ongoing need for more effective post-stroke motor recovery treatments. Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation tool that can increase cortical excitability by applying weak, uniform 1 or 2 milliamp (mA) currents through scalp electrodes. In some existing studies, tDCS has shown promise for treating post-stroke aphasia and motor impairments by applying stimulation to the perilesional cortex. However, tDCS outcomes in stroke patients have been inconsistent between individuals and across studies. This may be due to the lack of personalized dosing. Typically, tDCS studies apply the same mA dosage to each person. The current one-size fits all approach likely results in underdosing for many individuals. Early modeling studies on magnetic resonance imaging (MRI) scans, including those in our lab, have shown that applying a standard 2mA tDCS dose across healthy or stroke participants results in heterogenous cortical electric fields (E-fields) at the intended target. A solution for personalizing tDCS dose may be reverse-calculation E-field modeling. This approach accounts for anatomical differences by calculating the individualized mA dosage at the scalp needed to produce the same E-field in the brain between participants. Thus, using reverse-calculation E- field modeling could potentially make tDCS more effective for post-stroke motor rehabilitation by personalizing tDCS dose to ensure that each person gets the E-field they need at the cortical target. While this reverse- calculation approach is promising, it has only been tested retrospectively. This F31 proposes to prospectively test the within-subjects effects of personalizing tDCS dose, compared to standard 2mA and sham, on motor excitability in healthy adults (Aim 1) and chronic ischemic stroke patients (Aim 2). We hypothesize that personalizing dose with reverse-calculation E-field modeling will produce significantly more consistent tDCS- induced motor excitability changes (as measured by motor evoked potentials; MEPs) than a standard 2mA dose or sham stimulation will. An Exploratory Aim will investigate the relationship between baseline functional MRI (fMRI) measures (resting state functional connectivity strength within the targeted somatomotor network) and the degree of tDCS-induced motor excitability change. The proposed research will take place at the Medical University of South Carolina (MUSC) in the Brain Stimulation Lab (BSL), which has a long history of pioneering brain stimulation treatments for neurological and psychiatric conditions. This F31 proposal incorporates a wide breadth of training opportunities, including technical skill advancement in neuroimaging and E-field modeling, advanced statistics, writing and presentation ability, grant writing, and teaching/mentorship. The training within this F31 application will help the investigator become a leader in personalizing brain stimulation for post-stroke motor rehabilitation, and launch a career as an independent scientist.

项目摘要 中风是全球死亡和残疾的主要原因。中风后残疾最常见的是弱点 或瘫痪在相对的四肢，大约长期存在（击球后超过6个月） 60％的患者。持续不断需要更有效的中风后运动恢复治疗。经颅 直接电流刺激（TDCS）是一种无创的脑刺激工具，可以通过 通过头皮电极施加弱，均匀的1或2毫安（MA）电流。在一些现有研究中，TDCS 通过将刺激应用于 周围皮质。但是，中风患者的TDC结果在个人之间并不一致，并且 跨研究。这可能是由于缺乏个性化给药。通常，TDCS研究应用相同的MA 每个人的剂量。当前的一种尺寸适合所有方法，可能会导致许多人的服用不足。 包括我们实验室中的磁共振成像（MRI）扫描的磁共振成像（MRI）扫描的早期建模研究表明 在健康或中风参与者中应用标准的2MA TDC剂量会导致异源皮质电气 在预期目标处的字段（电子场）。个性化TDC剂量的解决方案可能是反向计算的电子场地 造型。通过计算在 头皮需要在参与者之间在大脑中产生相同的电子场地。因此，使用反向计算E- 现场建模有可能通过个性化使TDCS对中风后电动机康复更有效 TDC剂量确保每个人都能在皮质靶标获得所需的电子场地。而这个反向 计算方法是有希望的，仅回顾性测试。这个F31提出了前瞻性的 与标准2MA和假手术相比，测试个性化TDC剂量的受试者内部效果 健康成年人的运动兴奋性（AIM 1）和慢性缺血性中风患者（AIM 2）。我们假设 用反向计算电子场建模的个性化剂量将产生更一致的TDCS- 与标准2mA剂量相比 或假刺激会。探索目的将调查基线功能之间的关系 MRI（fMRI）测量（靶向体积运动中的静止状态功能连接强度 网络）和TDCS诱导的运动兴奋性变化的程度。拟议的研究将进行 在大脑刺激实验室（BSL）的南卡罗来纳州医科大学（MUSC），历史悠久 针对神经系统和精神病的开创性大脑刺激治疗。这个F31提案 融合了广泛的培训机会，包括神经影像学方面的技术技能进步 电子场景建模，高级统计，写作和演示能力，赠款写作以及教学/指导。 该F31应用程序中的培训将帮助调查人员成为个性化大脑的领导者 刺激冲程后运动康复，并从事独立科学家的职业。