Early brain stimulation may help stroke survivors recover language function

Non-invasive brain stimulation may help stroke survivors recover speech and language function, according to new research in the American Heart Association journal Stroke.

Between 20 percent to 30 percent of stroke survivors have aphasia, a disorder that affects the ability to grasp language, read, write or speak. It’s most often caused by strokes that occur in areas of the brain that control speech and language.

“For decades, skilled speech and language therapy has been the only therapeutic option for stroke survivors with aphasia,” said Alexander Thiel, M.D., study lead author and associate professor of neurology and neurosurgery at McGill University in Montreal, Quebec, Canada. “We are entering exciting times where we might be able in the near future to combine speech and language therapy with non-invasive brain stimulation earlier in the recovery. This could result in earlier and more efficient aphasia recovery and also have an economic impact.”

In the small study, researchers treated 24 stroke survivors with several types of aphasia at the rehabilitation hospital Rehanova and the Max-Planck-Institute for neurological research in Cologne, Germany. Thirteen received transcranial magnetic stimulation (TMS) and 11 got sham stimulation.

The TMS device is a handheld magnetic coil that delivers low intensity stimulation and elicits muscle contractions when applied over the motor cortex.

During sham stimulation the coil is placed over the top of the head in the midline where there is a large venous blood vessel and not a language-related brain region. The intensity for stimulation was lower intensity so that participants still had the same sensation on the skin but no effective electrical currents were induced in the brain tissue.

Patients received 20 minutes of TMS or sham stimulation followed by 45 minutes of speech and language therapy for 10 days.

The TMS groups’ improvements were on average three times greater than the non-TMS group, researchers said. They used German language aphasia tests, which are similar to those in the United States, to measure language performance of the patients.

“TMS had the biggest impact on improvement in anomia, the inability to name objects, which is one of the most debilitating aphasia symptoms,” Thiel said.

Researchers, in essence, shut down the working part of the brain so that the stroke-affected side could relearn language. “This is similar to physical rehabilitation where the unaffected limb is immobilized with a splint so that the patients must use the affected limb during the therapy session,” Thiel said.

“We believe brain stimulation should be most effective early, within about five weeks after stroke, because genes controlling the recovery process are active during this time window,” he said.

Fast and painless way to better mental arithmetic? Yes, there might actually be a way

In the future, if you want to improve your ability to manipulate numbers in your head, you might just plug yourself in. So say researchers who report in the Cell Press journal Current Biology on May 16 on studies of a harmless form of brain stimulation applied to an area known to be important for math ability.

"With just five days of cognitive training and noninvasive, painless brain stimulation, we were able to bring about long-lasting improvements in cognitive and brain functions," says Roi Cohen Kadosh of the University of Oxford.

Incredibly, the improvements held for a period of six months after training. No one knows exactly how this relatively new method of stimulation, called transcranial random noise stimulation (TRNS), works. But the researchers say the evidence suggests that it allows the brain to work more efficiently by making neurons fire more synchronously.

Cohen Kadosh and his colleagues had shown previously that another form of brain stimulation could make people better at learning and processing new numbers. But, he says, TRNS is even less perceptible to those receiving it. TRNS also has the potential to help even more people. That’s because it has been shown to improve mental arithmetic—the ability to add, subtract, or multiply a string of numbers in your head, for example—not just new number learning. Mental arithmetic is a more complex and challenging task, which more than 20 percent of people struggle with.

Ultimately, Cohen Kadosh says, with better integration of neuroscience and education, this line of study could really help humans reach our cognitive potential in math and beyond. It might also be of particular help to those suffering with neurodegenerative illness, stroke, or learning difficulties.

"Maths is a highly complex cognitive faculty that is based on a myriad of different abilities," Cohen Kadosh says. "If we can enhance mathematics, therefore, there is a good chance that we will be able to enhance simpler cognitive functions."

The Hidden Costs of Cognitive Enhancement

Gentle electrical zaps to the brain can accelerate learning and boost performance on a wide range of mental tasks, scientists have reported in recent years. But a new study suggests there may be a hidden price: Gains in one aspect of cognition may come with deficits in another.

Researchers who study transcranial electrical stimulation, which uses electrodes placed on the scalp, see it as a potentially promising way to enhance cognition in neurological patients, struggling students, and perhaps even ordinary people. Scientists have used it to speed up rehab in people whose speech or movement has been affected by a stroke, and DARPA has studied it as a way to accelerate learning in intelligence analysts or soldiers on the lookout for bad guys and bombs.

Until now, the papers coming out of this field have reported one good-news finding after another.

“This is the first paper to my knowledge to show a cost associated with the gains in cognitive function,” said neuropsychologist Rex Jung of the University of New Mexico, who was not associated with the study. “It’s a really nice demonstration.”

Cognitive neuroscientist Roi Cohen Kadosh of the University of Oxford, who led the study, has been investigating brain stimulation to boost mathematical abilities. He has applied for a patent on a brain stimulator he hopes could help math-challenged students get a better grip on the basics, or even help the mathematically inclined perform even better.

Cohen Kadosh and his colleague Teresa Iuculano investigated 19 volunteers as they learned a new numerical system by trial and error. The new system was based on arbitrary symbols: A cylinder represented the number five, for example, and a triangle represented the number nine. In several training sessions the volunteers viewed pairs of symbols on a computer screen and pressed a key to indicate which one represented a bigger quantity. At first they had to guess, but they eventually learned which symbols corresponded with which numbers.

All of the volunteers wore electrodes on their scalp during these training session. Some received mild electrical stimulation that targeted the posterior parietal cortex, an area implicated in previous studies of numerical cognition. Others received stimulation of the dorsolateral prefrontal cortex, an area involved in a wide range of functions, including learning and memory. A third group received sham stimulation that caused a slight tingling of the skin but no change in brain activity.

Those who had the parietal area involved in numerical cognition stimulated learned the new number system more quickly than those who got sham stimulation, the researchers report in the Journal of Neuroscience. But at the end of the weeklong study their reaction times were slower when they had to put their newfound knowledge to use to solve a new task that they hadn’t seen during the training sessions. ”They had trouble accessing what they’d learned,” Cohen Kadosh said.

The volunteers who had the prefrontal area involved in learning and memory stimulated showed the opposite pattern. They were slower than the control group to learn the new numerical system, but they performed faster on the new test at the end of the experiment. The bottom line, says Cohen Kadosh, is that stimulating either brain region had both benefits and drawbacks. ”Just like with drugs, there seem to be side effects,” he said.

Going forward, Cohen Kadosh says, more work is needed on how to maximize the benefits and minimize the costs of electrical brain stimulation. He thinks the approach has promise, but only when it’s used strategically, by picking the right brain regions to target and stimulating them while a person is training on the skill they want to improve. ”I think it’s going to be useless unless you pair it with some type of cognitive training,” he said.

But that’s not stopping some people from giving it a try on their own. Although it should be obvious that DIY brain stimulation is a bad idea, both Jung and Cohen Kadosh say there seems to be growing interest in the general public in using it for cognitive enhancement.

“There are some do it yourself websites I’ve stumbled across that are pretty frightening,” Jung said. “People are definitely tinkering around with this in their garage.”

The new study suggests one way that could backfire. And that’s not all, said Jung. ”You can burn yourself if nothing else.”

Parkinson’s Disease Brain Rhythms Detected

A team of scientists and clinicians at UC San Francisco has discovered how to detect abnormal brain rhythms associated with Parkinson’s by implanting electrodes within the brains of people with the disease.

The work may lead to developing the next generation of brain stimulation devices to alleviate symptoms for people with the disease.

Described this week in the journal Proceedings of the National Academy of Sciences (PNAS), the work sheds light on how Parkinson’s disease affects the brain, and is the first time anyone has been able to measure a quantitative signal from the disease within the cerebral cortex – the outermost layers of the brain that helps govern memory, physical movement and consciousness.

“Normally the individual cells of the brain are functioning independently much of the time, working together only for specific tasks,” said neurosurgeon Philip Starr, MD, PhD, a professor of neurological surgery at UCSF and senior author of the paper. But in Parkinson’s disease, he said, many brain cells display “excessive synchronization,” firing together inappropriately most of the time.

“They are locked into playing the same note as everyone else without exploring their own music,” Starr explained. This excessive synchronization leads to movement problems and other symptoms characteristic of the disease.

The new work also shows how deep brain stimulation (DBS), which electrifies regions deeper in the brain, below the cortex, can affect the cortex, itself. This discovery may change how DBS is used to treat Parkinson’s and other neurologically based movement disorders, and it may help refine the technique for other types of treatment.

How electrodes in the brain block obsessive behaviour

Deep brain stimulation helps some people with obsessive-compulsive disorder (OCD), but no one was quite sure why it is effective. A new study offers an explanation: the stimulation has surprisingly pervasive effects, fixing abnormal signalling between different parts of the brain.

A small number of people with difficult-to-treat OCD have had electrodes permanently implanted deep within their brain. Stimulating these electrodes reduces their symptoms.

To work out why stimulation has this effect, Damiaan Denys and Martijn Figee at the Academic Medical Center in Amsterdam, the Netherlands, and colleagues recorded neural activity in people with electrodes implanted into a part of the brain called the nucleus accumbens. This region is vital for conveying motivational and emotional information to the frontal cortex to guide decisions on what actions to take next. In some people with OCD, feedback loops between the two get jammed, leading them to do the same task repeatedly to reduce anxiety.

The researchers took fMRI scans as participants rested. In 13 people with OCD and implanted electrodes, there was continuous and excessive exchange of signals between the nucleus accumbens and the frontal cortex that was not seen in 11 control subjects. When the electrodes were activated, though, the neural activity of both brain regions in the people with OCD became virtually identical to that in the controls.

The researchers also used EEGs to monitor electrical activity in the brain as the 13 people with OCD viewed images linked with their obsessions, such as cleaning toilets. This time, the team observed excessive activity in the frontal cortex – and again, this activity disappeared when the electrodes were activated.

"The most striking thing is that stimulation doesn’t just affect the nucleus accumbens, but the whole network linked up with the cortex," says Figee.

The study suggests that the electrodes do more than normalise brain activity at the site where they are implanted, as had been assumed. Rather, they appear to repair entire brain circuits that had been faulty. “It resets and normalises these circuits,” says Figee.

Thomas Schlaepfer at the University of Bonn, Germany, points out that such work may allow researchers to use deep brain stimulation to learn about the causes of OCD as they treat it. “It will serve as a research platform informing us about the underlying neurobiology of such disorders,” he says.

(Image courtesy: Michael S. Okun)

Same neurons at work in sleep and under anesthesia

Anesthesiologists aren’t totally lying when they say they’re going to put you to sleep. Some anesthetics directly tap into sleep-promoting neurons in the brain, a study in mice reveals.

The results may help clarify how drugs that have been used around the world for decades actually put someone under. “It’s kind of shocking that after 170 years, we still don’t understand why they work,” says study coauthor Max Kelz of the University of Pennsylvania in Philadelphia.

Most neurons in the brain appear to be calmed by anesthetics, says neuropharmacologist and anesthesiologist Hugh Hemmings Jr. of Weill Cornell Medical College in New York City. But the new results, published online October 25 in Current Biology, show that two common anesthetics actually stimulate sleep-inducing neurons. “It’s unusual for neurons to be excited by anesthetics,” Hemmings says.

In the study, Kelz, Jason Moore, also of the University of Pennsylvania, and colleagues studied the effects of the anesthetics isoflurane and halothane. Mice given the drugs soon became sleepy, as expected. Along with this drowsiness came a jump in nerve cell activity in a part of the brain’s hypothalamus called the ventrolateral preoptic nucleus, or VLPO.