Post-stroke enriched auditory environment induces structural connectome plasticity : secondary analysis from a randomized controlled trial

Post-stroke neuroplasticity and cognitive recovery can be enhanced by multimodal stimulation via environmental enrichment. In this vein, recent studies have shown that enriched sound environment (i.e., listening to music) during the subacute post-stroke stage improves cognitive outcomes compared to standard care. The beneficial effects of post-stroke music listening are further pronounced when listening to music containing singing, which enhances language recovery coupled with structural and functional connectivity changes within the language network. However, outside the language network, virtually nothing is known about the effects of enriched sound environment on the structural connectome of the recovering post-stroke brain. Here, we report secondary outcomes from a single-blind randomized controlled trial (NCT01749709) in patients with ischaemic or haemorrhagic stroke (N = 38) who were randomly assigned to listen to vocal music, instrumental music, or audiobooks during the first 3 post-stroke months. Utilizing the longitudinal diffusion-weighted MRI data of the trial, the present study aimed to determine whether the music listening interventions induce changes on structural white matter connectome compared to the control audiobook intervention. Both vocal and instrumental music groups increased quantitative anisotropy longitudinally in multiple left dorsal and ventral tracts as well as in the corpus callosum, and also in the right hemisphere compared to the audiobook group. Audiobook group did not show increased structural connectivity changes compared to both vocal and instrumental music groups. This study shows that listening to music, either vocal or instrumental promotes wide-spread structural connectivity changes in the post-stroke brain, providing a fertile ground for functional restoration.Peer reviewe

The essence of the first 2.5 h in the treatment of generalized convulsive status epilepticus

Purpose: This study was designed to find realistic cut-offs of the delays predicting outcome after generalized convulsive status epilepticus (GCSE) and serving protocol streamlining of GCSE patients. Method: This retrospective study includes all consecutive adult (>16 years) patients (N = 70) diagnosed with GCSE in Helsinki University Central Hospital emergency department over 2 years. We defined ten specific delay parameters in the management of GCSE and determined functional outcome and mortality at hospital discharge. Functional outcome was assessed with Glasgow Outcome Scale (GOS1-3 for poor outcome, GOS > 3 for good outcome) and also defined as condition relative to baseline (worse-than baseline vs. baseline). Univariate and multivariate regression models were used to analyze the relations between delays and outcome. Delay cut-offs predicting outcome were determined using ROC-Curves. Results: In univariate analysis long onset-to-tertiary-hospital time (p = 0.034) was a significant risk factor for worse-than-baseline condition. Long delays in onset-to-diagnosis (p = 0.032), onset-to-second-stage medication (p = 0.023), onset-to-consciousness (p = 0.027) and long total-anesthesia-time (0 = 0.043) were risk factors for low GOS score (1-3). Short delay in onset-to-initial-treatment (p = 0.047), long onset-to-anesthesia (p = 0.003) and onset-to-consciousness (p = 0.008) times were risk factors for in hospital mortality. Multivariate analysis showed no significant factors. Cut-offs for increased risk of poor outcome were onset-to-diagnosis 2.4 h (p = 0.011), onset-to-second stage-medication 2.5 h (p = 0.001), onset-to-consciousness 41.5 h (p = 0.009) times and total-anesthesia time 45.5 h (p = 0.003). The delay over 2.1 h in onset-to-tertiary-hospital time increased the risk of worse than-baseline condition (p = 0.028). Conclusions: GCSE treatment is a dynamic process, where every delay component needs to be optimized. We suggest that GCSE patients should be handled with high priority and transported directly to hospital ED with neurological expertise. Critical steps in the treatment, such as diagnosing GCSE and starting progressive antiepileptic medication on stages 1 through 3, if needed, should be accomplished within 2.5 h. (C) 2017 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.Peer reviewe

Delays and Factors Related to Cessation of Generalized Convulsive Status Epilepticus

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Resting-state language network neuroplasticity in post-stroke music listening: A randomized controlled trial

Recent evidence suggests that post-stroke vocal music listening can aid language recovery, but the network-level functional neuroplasticity mechanisms of this effect are unknown. Here, we sought to determine if improved language recovery observed after post-stroke listening to vocal music is driven by changes in longitudinal resting-state functional connectivity within the language network. Using data from a single-blind randomized controlled trial on stroke patients (N = 38), we compared the effects of daily listening to self-selected vocal music, instrumental music and audio books on changes of the resting-state functional connectivity within the language network and their correlation to improved language skills and verbal memory during the first 3 months post-stroke. From acute to 3-month stage, the vocal music and instrumental music groups increased functional connectivity between a cluster comprising the left inferior parietal areas and the language network more than the audio book group. However, the functional connectivity increase correlated with improved verbal memory only in the vocal music group cluster. This study shows that listening to vocal music post-stroke promotes recovery of verbal memory by inducing changes in longitudinal functional connectivity in the language network. Our results conform to the variable neurodisplacement theory underpinning aphasia recovery.Peer reviewe

Musiikillinen häiriö aivovaurion jälkeen - yleinen mutta harvoin tunnistettu oire?

Vertaisarvioitu.Musiikin havaitsemisen ja tuottamisen häiriö (amusia) ei ole tavanomaisessa kliinisessä työssä arvioitu oire, vaikka sitä esiintyy jopa puolella akuutin aivoverenkiertohäiriön sairastaneista potilaista. Amusiaa esiintyy yleisimmin oikean ohimo- ja otsalohkon sekä aivosaaren (insula) vaurioiden jälkeen, mutta sitä tavataan myös vasemman aivopuoliskon vaurion yhteydessä, joskin usein lievempänä ja ohimenevänä. Amusiaan liittyvät oikean aivopuoliskon valkean aineen ratojen, etenkin ventraalisen radaston, vaurio sekä ohimo- ja otsalohkon harmaan aineen atrofia ja toiminnalliset muutokset. Amusiassa myös puheen prosodisten piirteiden käsittely häiriintyy, mikä heikentää potilaiden arkipäivän kommunikointia ja sosiaalista kanssakäymistä. Laulaminen vaikuttaa lupaavalta amusian kuntoutusmuodolta, mutta aivovauriopotilaita käsitteleviä interventiotutkimuksia ei ole vielä julkaistu.Peer reviewe

Musiikillinen häiriö aivovaurion jälkeen - yleinen mutta harvoin tunnistettu oire?

Musiikin havaitsemisen ja tuottamisen häiriö (amusia) ei ole tavanomaisessa kliinisessä työssä arvioitu oire, vaikka sitä esiintyy jopa puolella akuutin aivoverenkiertohäiriön sairastaneista potilaista. Amusiaa esiintyy yleisimmin oikean ohimo- ja otsalohkon sekä aivosaaren (insula) vaurioiden jälkeen, mutta sitä tavataan myös vasemman aivopuoliskon vaurion yhteydessä, joskin usein lievempänä ja ohimenevänä. Amusiaan liittyvät oikean aivopuoliskon valkean aineen ratojen, etenkin ventraalisen radaston, vaurio sekä ohimo- ja otsalohkon harmaan aineen atrofia ja toiminnalliset muutokset. Amusiassa myös puheen prosodisten piirteiden käsittely häiriintyy, mikä heikentää potilaiden arkipäivän kommunikointia ja sosiaalista kanssakäymistä. Laulaminen vaikuttaa lupaavalta amusian kuntoutusmuodolta, mutta aivovauriopotilaita käsitteleviä interventiotutkimuksia ei ole vielä julkaistu

Revisiting the Neural Basis of Acquired Amusia : Lesion Patterns and Structural Changes Underlying Amusia Recovery

Although, acquired amusia is a common deficit following stroke, relatively little is still known about its precise neural basis, let alone to its recovery. Recently, we performed a voxel-based lesion-symptom mapping (VLSM) and morphometry (VBM) study which revealed a right lateralized lesion pattern, and longitudinal gray matter volume (GMV) and white matter volume (WMV) changes that were specifically associated with acquired amusia after stroke. In the present study, using a larger sample of stroke patients (N = 90), we aimed to replicate and extend the previous structural findings as well as to determine the lesion patterns and volumetric changes associated with amusia recovery. Structural MRIs were acquired at acute and 6-month post-stroke stages. Music perception was behaviorally assessed at acute and 3-month post-stroke stages using the Scale and Rhythm subtests of the Montreal Battery of Evaluation of Amusia (MBEA). Using these scores, the patients were classified as non-amusic, recovered amusic, and non-recovered amusic. The results of the acute stage VLSM analyses and the longitudinal VBM analyses converged to show that more severe and persistent (non-recovered) amusia was associated with an extensive pattern of lesions and GMV/WMV decrease in right temporal, frontal, parietal, striatal, and limbic areas. In contrast, less severe and transient (recovered) amusia was linked to lesions specifically in left inferior frontal gyrus as well as to a GMV decrease in right parietal areas. Separate continuous analyses of MBEA Scale and Rhythm scores showed extensively overlapping lesion pattern in right temporal, frontal, and subcortical structures as well as in the right insula. Interestingly, the recovered pitch amusia was related to smaller GMV decreases in the temporoparietal junction whereas the recovered rhythm amusia was associated to smaller GMV decreases in the inferior temporal pole. Overall, the results provide a more comprehensive picture of the lesions and longitudinal structural changes associated with different recovery trajectories of acquired amusia.Peer reviewe

Music-based interventions in neurological rehabilitation

During the past ten years, an increasing number of controlled studies have assessed the potential rehabilitative effects of music-based interventions, such as music listening, singing, or playing an instrument, in several neurological diseases. Although the number of studies and extent of available evidence is greatest in stroke and dementia, there is also evidence for the effects of music-based interventions on supporting cognition, motor function, or emotional wellbeing in people with Parkinson's disease, epilepsy, or multiple sclerosis. Music-based interventions can affect divergent functions such as motor performance, speech, or cognition in these patient groups. However, the psychological effects and neurobiological mechanisms underlying the effects of music interventions are likely to share common neural systems for reward, arousal, affect regulation, learning, and activity-driven plasticity. Although further controlled studies are needed to establish the efficacy of music in neurological recovery, music-based interventions are emerging as promising rehabilitation strategies.Peer reviewe

Music-based interventions ­in pain management

Vertaisarvioitu. English summary.Peer reviewe