Neural Correlates of Cognitive Dysfunctions in Cervical Spondylotic Myelopathy Patients: A Resting-State fMRI Study
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SUBMITTER: Zhao R
PROVIDER: S-EPMC7785814 | biostudies-literature | 2020 Jan
REPOSITORIES: biostudies-literature
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Project description:Background: Changes in regional neural activity and functional connectivity in cervical spondylotic myelopathy (CSM) patients have been reported. However, resting-state cerebral blood flow (CBF) changes and coupling between CBF and functional connectivity in CSM patients are largely unknown. Methods: Twenty-seven CSM patients and 24 sex/age-matched healthy participants underwent resting-state functional MRI and arterial spin labeling imaging to compare functional connectivity strength (FCS) and CBF between the two groups. The CBF-FCS coupling of the whole gray matter and specific regions of interest was also compared between the groups. Results: Compared with healthy individuals, CBF-FCS coupling was significantly lower in CSM patients. The decrease in CBF-FCS coupling in CSM patients was observed in the superior frontal gyrus, bilateral thalamus, and right calcarine cortex, whereas the increase in CBF-FCS coupling was observed in the middle frontal gyrus. Moreover, low CBF and high FCS were observed in sensorimotor cortices and visual cortices, respectively. Conclusion: In general, neurovascular decoupling at cortical level may be a potential neuropathological mechanism of CSM.
| S-EPMC8455933 | biostudies-literature
Project description:Recently, there has been increasing interest in strategies to predict neurological recovery in cervical myelopathy (CM) based on clinical images of the cervical spine. In this study, we aimed to explore potential preoperative brain biomarkers that can predict postoperative neurological recovery in CM patients by using resting-state functional magnetic resonance imaging (rs-fMRI) and functional connectivity (FC) analysis. Twenty-eight patients with CM and 28 age- and sex-matched healthy controls (HCs) underwent rs-fMRI (twice for CM patients, before and six months after surgery). A seed-to-voxel analysis was performed, and the following three statistical analyses were conducted: (i) FC comparisons between preoperative CM and HC; (ii) correlation analysis between preoperative FCs and clinical scores; and (iii) postoperative FC changes in CM. Our analyses identified three FCs between the visual cortex and the right superior frontal gyrus based on the conjunction of the first two analyses [(i) and (ii)]. These FCs may act as potential biomarkers for postoperative gain in the 10-second test and might be sufficient to provide a prediction formula for potential recovery. Our findings provide preliminary evidence supporting the possibility of novel predictive measures for neurological recovery in CM using rs-fMRI.
| S-EPMC6639260 | biostudies-literature
Project description:Cervical spondylotic myelopathy (CSM) is the leading cause of myelopathy in patients over age 50 years. Despite advances, CSM remains a clinical diagnosis and its natural history remains unclear. The treatment of CSM is controversial, especially in patients with mild or moderate clinical disease without rapid progression of symptoms. Herein, we begin with a clinical vignette followed by a brief description of the clinical problems. We discuss evaluation, treatment, and recommendations for the treatment of CSM. Emphasis is drawn to areas of uncertainty and present level of evidence for the treatment modalities of CSM.
| S-EPMC5764527 | biostudies-literature
Project description:MethodsTwenty patients with CSM and 17 controls were recruited. Clinical scores of modified Japanese Orthopedic Association (mJOA) and Nurick were collected. MRI based compression grades such as cord distortion were assessed. Hand dysfunction was tested using a custom motorized apparatus. Subject's forearm was placed in a cast and positioned such that their metacarpophalangeal (MCP) joint was vertically aligned with the motor shaft. Surface electromyographic sensors were placed on flexor digitorum superficialis (FDS) and extensor digitorum communis muscles. Hyperreflexia was measured as the FDS muscle activation during reflex when the MCP joint was moved from flexion to extension at 300°/sec. Proprioception was quantified as the angle of detection in absence of visual or auditory cues (subjects were blindfolded and given noise-cancelling headphones). Strength was measured as the maximum isometric force at the MCP joint. 2-sample t-test (p<0.05) were performed to assess significant differences in reflexes, proprioception and strength among patients and controls (SPSS software version 24).ResultsPatients reported higher Nurick (1.90±1.0 vs 0±0, p<0.001) and lower mJOA scores (14.3±1.9 vs 18.0±0, p<0.001) as compared to controls. Similarly, patients with CSM had increased reflexes (peak FDS EMG) (0.073±0.096 vs. 0.014±0.010, p = 0.019). Patient proprioception was significantly worse; mean angle of detection was greater than twice as high in patients (9.6± 9.43°) compared to controls (4.0± 2.3°), p = 0.022. MRI based compression ratio (CR) was a significant predictor of hyperreflexia, CR<0.44 resulted in steep increase in reflex activity. Fifteen of the 20 patients who completed follow up testing at 6 months after surgery show substantial clinical improvement in reflexes and proprioceptive angle, while repeated testing in controls were unchanged.ConclusionIn conclusion, hyperreflexia and decline in proprioception are the main drivers of hand disability in patients with CSM. Of multiple scales, only a select few MRI scales (such as compression ratio) were predictive of increased reflexes. The study describes a pre-clinical testing apparatus to quantitatively and objectively assess primary presenting symptoms in CSM. This pilot apparatus has the potential to evaluate treatment efficacy through repeated testing. Objective testing of hand dysfunction can help inform the design of clinically feasible devices, guide MRI biomarker analysis, and improve our understanding of the progression of neurological injury in this patient population.
| S-EPMC6816552 | biostudies-literature
Project description:Skin conductance responses (SCRs) reliably occur in the absence of external stimulation. However, the neural correlates of these non-specific SCRs have been less explored than brain activity associated with stimulus-elicited SCRs. This study modeled spontaneous skin conductance responses observed during an unstructured resting state fMRI scan in 58 adolescents. A Finite Impulse Response (FIR) fMRI model was used to detect any type of hemodynamic response shape time-locked to non-specific SCRs; the shape of these responses was then carefully characterized. The strongest evidence for signal change was found in several sub-regions of sensorimotor cortex. There also was evidence for engagement of discrete areas within the lateral surfaces of the parietal lobe, cingulate cortex, fronto-insular operculum, and both visual and auditory primary processing areas. The hemodynamic profile measured by FIR modeling clearly resembled an event-related response. However, it was a complex response, best explained by two quickly successive, but opposing neuronal impulses across all brain regions - a brief positive response that begins several seconds prior to the SCR with a much longer negative neuronal impulse beginning shortly after the SCR onset. Post hoc exploratory analyses linked these two hemodynamic response phases to different emotion-related individual differences. In conclusion, this study shows the neural correlates of non-specific SCRs are a widespread, cortical network of brain regions engaged in a complex, seemingly biphasic fashion. This bimodal response profile should be considered in replication studies that attempt to directly link brain activity to possible homeostatic mechanisms or seek evidence for alternative mechanisms.
| S-EPMC7263940 | biostudies-literature
Project description:STUDY DESIGN:Review. OBJECTIVES:Cervical spondylotic myelopathy (CSM) is a major cause of disability, particular in elderly patients. Awareness and understanding of CSM is imperative to facilitate early diagnosis and management. This review article addresses CSM with regard to its epidemiology, anatomical considerations, pathophysiology, clinical manifestations, imaging characteristics, treatment approaches and outcomes, and the cost-effectiveness of surgical options. METHODS:The authors performed an extensive review of the peer-reviewed literature addressing the aforementioned objectives. RESULTS:The clinical presentation and natural history of CSM is variable, alternating between quiescent and insidious to stepwise decline or rapid neurological deterioration. For mild CSM, conservative options could be employed with careful observation. However, surgical intervention has shown to be superior for moderate to severe CSM. The success of operative or conservative management of CSM is multifactorial and high-quality studies are lacking. The optimal surgical approach is still under debate, and can vary depending on the number of levels involved, location of the pathology and baseline cervical sagittal alignment. CONCLUSIONS:Early recognition and treatment of CSM, before the onset of spinal cord damage, is essential for optimal outcomes. The goal of surgery is to decompress the cord with expansion of the spinal canal, while restoring cervical lordosis, and stabilizing when the risk of cervical kyphosis is high. Further high-quality randomized clinical studies with long-term follow up are still needed to further define the natural history and help predict the ideal surgical strategy.
| S-EPMC5582708 | biostudies-literature
Project description:AimCognitive-attentional syndrome (CAS) is the main factor underlying depressive and anxiety disorders in the metacognitive approach to psychopathology and psychotherapy. This study explore neural correlates of this syndrome during induced negative thinking, abstract thinking, and resting states.Methodsn = 25 people with high levels of CAS and n = 33 people with low levels of CAS were chosen from a population-based sample (N = 1225). These groups filled-in a series of measures of CAS, negative affect, and psychopathology; they also underwent a modified rumination induction procedure and a resting state fMRI session. Resonance imaging data were analyzed using static general linear model and functional connectivity approaches.ResultsThe two groups differed with large effect sizes on all used measures of CAS, negative affect, and psychopathology. We did not find any group differences in general linear model analyses. Functional connectivity analyses showed that high levels of CAS were related to disrupted patterns of connectivity within and between various brain networks: the default mode network, the salience network, and the central executive network.ConclusionWe showed that low- and high-CAS groups differed in functional connectivity during induced negative and abstract thinking and also in resting state fMRI. Overall, our results suggest that people with high levels of CAS tend to have disrupted neural processing related to self-referential processing, task-oriented processing, and emotional processing.
| S-EPMC6443848 | biostudies-literature
Project description:BackgroundCervical spondylosis is now recognised as the leading cause of myelopathy and spinal cord dysfunction worldwide. Chronic spinal cord compression results in chronic inflammation, cellular apoptosis, and microvacular insufficiency, which are thought to the biologic basis for cervical spondylotic myelopathy (CSM).Questions/purposesOur purpose was to address the key principles of CSM, including natural history and presentation, pathogenesis, optimal surgical approach, results and complication rates of posterior surgical approaches for CSM so that the rationale for addressing CSM by a posterior approach can be fully understood.MethodsWe conducted a systematic search of PubMed/MEDLINE and the Cochrane Collaboration Library for literature published through February 2014 to identify articles that evaluated CSM and its management. Reasons for exclusion included patients with ossification of the posterior longitudinal ligament (OPLL), patients with degenerative disc disease without CSM, and patients with spine tumor, trauma and infection. Meeting abstracts/proceedings, white articles and editorials were additionally excluded.ResultsThe search strategy yielded 1,292 articles, which was reduced to 52 articles, after our exclusion criteria were introduced. CSM is considered to be a surgical disorder due to its progressive nature. There is currently no consensus in the literature whether multilevel spondylotic compression is best treated via an anterior or posterior surgical approach.ConclusionMultilevel CSM may be safely and effectively treated using a posterior approach, either by laminoplasty or with a laminectomy and fusion technique.
| S-EPMC4342399 | biostudies-literature
Project description:BackgroundCervical spondylotic myelopathy (CSM) is a common indication for cervical spine surgery. Surgical options include anterior, posterior, or combined procedures each with specific advantages and disadvantages.Questions/purposesThis article will provide a description of the various anterior alternatives and discuss the available evidence used in guiding the surgical decision making process with the aim of answering the following questions: (1) What anatomical/disease related factors favor anterior over posterior surgeries? (2) What are the common anterior procedures and how safe and effective are they? (3) What are the most effective options for multilevel CSM? (4) Is there a role for motion preservation? An additional objective is to discuss technical advances that have improved success rates for anterior procedures.MethodsThe PubMed database was searched. Keywords were CSM and anterior surgery. Three hundred eighty two articles were found one hundred three were reviewed. Articles describing anterior cervical techniques were selected along with studies describing the various anterior techniques or comparisons of anterior to posterior techniques.ResultsAnterior decompression and fusion procedures are more effective than posterior procedures for patients with primarily ventrally located compression especially in the presence of cervical kyphosis. ACDF, ACCF, and hybrid combinations are safe and effective treatment options for multilevel CSM. Anterior procedures may be more cost effective and result in significantly improved postoperative quality of life and health-related quality of life measures compared to posterior procedures.ConclusionAnterior cervical decompression techniques are safe and effective in the treatment of CSM. Anterior surgeries may be preferable to posterior approaches, when considering health-related quality of life measures and cost effectiveness.
| S-EPMC4342400 | biostudies-literature
Project description:Currently, strategies to diagnose patients and predict neurological recovery in cervical spondylotic myelopathy (CSM) using MR images of the cervical spine are urgently required. In light of this, this study aimed at exploring potential preoperative brain biomarkers that can be used to diagnose and predict neurological recovery in CSM patients using functional connectivity (FC) analysis of a resting-state functional MRI (rs-fMRI) data. Two independent datasets, including total of 53 patients with CSM and 47 age- and sex-matched healthy controls (HCs), underwent the preoperative rs-fMRI procedure. The FC was calculated from the automated anatomical labeling (AAL) template and used as features for machine learning analysis. After that, three analyses were used, namely, the classification of CSM patients from healthy adults using the support vector machine (SVM) within and across datasets, the prediction of preoperative neurological function in CSM patients via support vector regression (SVR) within and across datasets, and the prediction of neurological recovery in CSM patients via SVR within and across datasets. The results showed that CSM patients could be successfully identified from HCs with high classification accuracies (84.2% for dataset 1, 95.2% for dataset 2, and 73.0% for cross-site validation). Furthermore, the rs-FC combined with SVR could successfully predict the neurological recovery in CSM patients. Additionally, our results from cross-site validation analyses exhibited good reproducibility and generalization across the two datasets. Therefore, our findings provide preliminary evidence toward the development of novel strategies to predict neurological recovery in CSM patients using rs-fMRI and machine learning technique.
| S-EPMC8531403 | biostudies-literature