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Diagnostic and prognostic value of blood neurofilament light chain in ischemic stroke: an individual patient data meta-analysis
(2026-06-01)
Barba, Lorenzo
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Romoli, Michele
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Benkert, Pascal
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Hofer, Lisa
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Maia, Luis F.
Background: We aimed to conduct an individual patient data meta-analysis on blood neurofilament light chain (NfL) in ischemic stroke (IS) to enhance its clinical applicability. Methods: We performed a systematic literature search of studies on blood NfL measured in adult patients within 30 days after IS onset and derived age- and BMI-adjusted Z-scores based on a previously published reference population of healthy controls. We collected clinical, radiological and biochemical parameters of IS patients and tested associations of NfL at defined timepoints after IS onset (D1: < 24 h; D2: 24–48 h; D3: 48–72 h; D4–5: 72–120 h; D6–7: 120–168 h; D8–30: > 168 h) with baseline characteristics and 3-month follow-up outcomes (modified Rankin Scale, mRS; survival). Results: We included 4081 blood NfL values from 2872 participants (IS n = 1985, transient ischemic attack n = 88, healthy controls n = 799) of 18 published studies and 3 unpublished cohorts. In patients with IS, NfL Z-score progressively increased from D1 [median: 2.0 (IQR: 0.9–2.9)] to D6–7 [median: 3.5 (IQR: 3.0–3.8)], with discriminative ability being high for IS vs. controls (AUC: 0.79–0.97) and fair for IS vs. TIA (AUC: 0.64–0.80). Higher NfL Z-score at D1 was associated with greater risk of symptomatic intracranial hemorrhage (aOR = 1.33, p = 0.014) and, from D2 onwards, with larger infarct lesion volume (highest Spearman’s rho: 0.795 at D6-7). NfL independently predicted a mRS > 2 (aOR = 1.31, p < 0.001) and mortality (aOR = 1.67, p < 0.001) at 3 months. Conclusions: Blood NfL level was progressively elevated after IS, could discriminate IS from healthy controls with high accuracy and had prognostic value for intra-hospital complications and 3-month clinical outcomes in IS.
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Task Oriented Training Activities Post Stroke Will Produce Measurable Alterations in Brain Plasticity Concurrent with Skill Improvement
(2022-01-01)
Rungseethanakul, Somchanok
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Tretriluxana, Jarugool
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Piriyaprasarth, Pagamas
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Pakaprot, Narawut
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Jitaree, Khanitha
Background: Task-oriented training with upper extremity (UE) skilled movements has been established as a method to regain function post stroke. Although improved UE function has been shown after this type of therapy, there is minimal evidence that brain plasticity is associated with this training. The accelerated skill acquisition program (ASAP) is an example of an approach for promoting UE function using targeting movements. Objective: To investigate the effects of a single 2-hour session of ASAP in individuals with stroke on measures of brain plasticity as represented by corticospinal excitability (CE) and determine associations with reach-to-grasp (RTG) performance. Methods: Eighteen post-acute stroke patients were randomized to two groups. Experimental group (n = 9) underwent ASAP for 2 hours, while the control group (n = 9) received dose equivalent usual and customary care. Both groups were evaluated for CE and RTG performance prior to the session and then four times after training: immediately, 1 day, 6 days, and 12 days. Results: Significant alterations in CE were found in the peak-to-peak of Motor Evoked Potential amplitude of elbow and wrist extensor muscles in the lesioned hemisphere. The experimental group also demonstrated improved execution (shortened total movement time, TMT), feed-forward mechanism (deceleration time, DT) and planning (lengthened relative time to maximum hand aperture, RTApmax) compared to the control group Conclusion: Alterations in brain plasticity occur concurrently with improvements in RTG performance in post-acute stroke patients with mild impairment after a single 2-hour session of task-oriented training and persist for at least 12 days.
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Performance Analysis and Comparison of Cerebral Stroke Prediction Models on Imbalanced Datasets
(2022-01-01)
Phankokkruad, Manop
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Wacharawichanant, Sirirat
A cerebral stroke is an interrupt blood flow to the brain leading cause of death. A number of risk factors increase the risk of stroke occurence because of lifestyle. Machine learning is effective techniques can be applied in prediction of stroke. The different kind of algorithms give the various accuracy and performance in the prediction. This study has proposed the four machine learning algorithm for classifiers to predict of cerebral stroke. The proposed model with various classifier has considered the risk factors such as age, hypertension, heart disease, average glucose level, BMI, and smoking status as feature attributes to predict cerebral stroke. This study conducted on two stroke datasets, and improve the imbalanced of between classes by using SMOTE. The result shows that XGBoost provided the highest accuracy of around 98.08% and 96.73% by comparing to the other machine learning algorithms. In addition, this study evaluates the models by analyzing the statistical parameters include accuracy, precision, sensitivity, F1 score, and AUC. The evaluation reveals that the XGBoost, Random Forest, AdaBoost and KNN classifier achieved the average AUC value of 0.851, 0.868, 0.670 and 0.851, respectively. All models provided the high confidence values, whereas the model with XGBoost classifier gave the highest performance.
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Automated segmentation of infarct lesions in t1‐weighted mri scans using variational mode decomposition and deep learning
(2021-03-02)
Paing, May Phu
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Tungjitkusolmun, Supan
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Bui, Toan Huy
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Visitsattapongse, Sarinporn
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Pintavirooj, Chuchart
Automated segmentation methods are critical for early detection, prompt actions, and immediate treatments in reducing disability and death risks of brain infarction. This paper aims to develop a fully automated method to segment the infarct lesions from T1‐weighted brain scans. As a key novelty, the proposed method combines variational mode decomposition and deep learning-based segmentation to take advantages of both methods and provide better results. There are three main technical contributions in this paper. First, variational mode decomposition is applied as a pre-processing to discriminate the infarct lesions from unwanted non‐infarct tissues. Second, overlapped patches strategy is proposed to reduce the workload of the deep‐learning‐based segmentation task. Finally, a three‐dimensional U‐Net model is developed to perform patch‐wise segmentation of infarct lesions. A total of 239 brain scans from a public dataset are utilized to develop and evaluate the proposed method. Empirical results reveal that the proposed automated segmentation can provide promising performances with an average dice similarity coefficient (DSC) of 0.6684, intersection over union (IoU) of 0.5022, and average symmetric surface distance (ASSD) of 0.3932, respectively.
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The persisted effects of low-frequency repetitive transcranial magnetic stimulation to augment task-specific induced hand recovery following subacute stroke: Extended study
(2018-12-01)
Tretriluxana, Jarugool
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Thanakamchokchai, Jenjira
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Jalayondeja, Chutima
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Pakaprot, Narawut
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Tretriluxana, Suradej
Objective To examine the long-term effects of the low-frequency repetitive transcranial magnetic stimulation (LFrTMS) combined with task-specific training on paretic hand function following subacute stroke. Methods Sixteen participants were randomly selected and grouped into two: the experimental group (real LFrTMS) and the control group (sham LF-rTMS). All the 16 participants were then taken through a 1-hour taskspecific training of the paretic hand. The corticospinal excitability (motor evoke potential [MEP] amplitude) of the non-lesioned hemisphere, and the paretic hand performance (Wolf Motor Function Test total movement time [WMFT-TMT]) were evaluated at baseline, after the LF-rTMS, immediately after task-specific training, 1 and 2 weeks after the training. Results Groups comparisons showed a significant difference in the MEP after LF-rTMS and after the training. Compared to the baseline, the MEP of the experimental group significantly decreased after LF-rTMS and after the training and that effect was maintained for 2 weeks. Group comparisons showed significant difference in WMFT-TMT after the training. Only in the experimental group, the WMFT-TMT of the can lifting item significantly reduced compared to the baseline and the effect was sustained for 2 weeks. Conclusion The results of this study established that the improvement in paretic hand after task-specific training was enhanced by LF-rTMS and it persisted for at least 2 weeks.
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Performance evaluation using laser doppler vibrometer sensing technique on advanced lead magnesium niobate-lead titanate piezoelectric-material-based microactuator for hard drive head
(2018-01-01)
Wattananukulchai, Parinya
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Isarakorn, Don
This paper presents a microactuator for a dual-stage actuator (DSA) of hard disk drive (HDD) based on a lead magnesium niobate-lead titanate (PMN-PT) piezoelectric material and a comparative evaluation of its performance versus that of a traditional lead zirconate titanate (PZT) microactuator using the laser Doppler vibrometer (LDV) sensing technique. PZT microactuator technology has commonly been implemented in the read/write (R/W) magnetic head of HDD. It has a significant function, that is, it moves the magnetic head rapidly and accurately. In order to achieve both accurate positioning control on data tracks and high-speed access across another data track, advanced high-performance actuators and servo control technologies are necessary. An actuator with a wide stroke travel range is essential for HDD as it gives a high-speed access performance. In this study, we focused on comparing the proposed dual-stage PMN-PT head-based actuator with the existing PZT actuator that were mounted on a commercial head gimbal assembly (HGA) using an LDV to determine whether the proposed device could be a worthy replacement of the traditional PZT microactuator. Our experimental results show that the proposed PMN-PT microactuator provided more than twofold improvement in the stroke travel of the R/W magnetic head. Moreover, its dynamic behavior was suitable for assembling a high-density HDD in the future for big data storage without any needs to redesign the HGA nor to costly invest in new assembling machines in a production line. The comparative data of dynamic and static behaviors of PMN-PT versus PZT obtained in this study may be put to good use by sensor designers. Moreover, for many cyber-physical system designers, our data may make them take interest in PMN-PT as a better-performing sensor and an actuator for their systems.
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Low frequency repetitive transcranial magnetic stimulation to the non-lesioned hemisphere improves paretic arm reach-to-grasp performance after chronic stroke
(2013-03-01)
Tretriluxana, Jarugool
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Kantak, Shailesh
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Tretriluxana, Suradej
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Wu, Allan D.
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Fisher, Beth E.
Purpose: To investigate the effect of inhibitory low frequency repetitive Transcranial Magnetic Stimulation (rTMS) applied to the non-lesioned hemisphere on kinematics and coordination of paretic arm reach-to-grasp (RTG) actions in individuals with stroke. Relevance: This study is designed as a phase I trial to determine the feasibility and efficacy of low frequency rTMS applied to the non-lesioned hemisphere for the recovery of reach-to-grasp actions in individuals with hemiparesis secondary to stroke. The results have important implications for the use of rTMS in parallel with complex paretic arm skill practice. Participants: Nine adults, anterior circulation unilateral stroke. Their average age was 59 years, the average time since stroke was 4.8 years. Method and analysis: Two TMS treatments were performed on two separate days: active rTMS and sham rTMS. Cortico-motor excitability (CE) of the non-lesioned hemisphere as well as RTG kinematics of the paretic hand as participants reached for a dowel of 1.2 cm in diameter was assessed before and after the rTMS treatments. In the active condition, rTMS was applied over the "hot spot" of the extensor digitorum communis muscle (EDC) in primary motor cortex (M1) of the non-lesioned hemisphere at 90% resting motor threshold. TMS pulses were delivered at 1 Hz for 20 min. In the sham condition, a sham coil was positioned similar to the active condition; TMS clicking noise was produced but no TMS pulse was delivered. Dependent measures: CE was measured as peak-to-peak amplitude of the motor evoked potential at 120% of resting motor threshold. RTG kinematics included movement time, peak transport velocity, peak aperture, time of peak transport velocity and time of peak aperture. RTG coordination was captured by cross correlation coefficient between transport velocity and grasp aperture size. Results: While 1 Hz rTMS applied over non-lesioned M1 significantly decreased the MEP amplitude of non-paretic EDC, sham TMS did not have a significant effect on MEP amplitude. Active rTMS significantly decreased total movement time and increased peak grasp aperture. There were no changes in peak transport velocity or the time of peak transport velocity or the time of peak aperture after application of active rTMS. Additionally, the participants completed RTG actions with a more coordinated pattern after undergoing active rTMS. Following sham TMS, there were no changes in CE, RTG kinematics or coordination. While there were no significant correlation between changes in cortico-motor excitability and RTG kinematics, the decrease in cortico-motor excitability of the non-lesioned hemisphere showed a strong correlation with an increase in cross-correlation coefficient. Conclusions and implications: The findings demonstrate the feasibility and efficacy of low frequency rTMS applied to the non-lesioned hemisphere for the recovery of reach-to-grasp actions in individuals with hemiparesis secondary to stroke. The inhibitory effect of low frequency rTMS resulted in improved paretic hand reach-to-grasp performance with faster movement time and more coordinated reach-to-grasp pattern. These results have important implications for the use of rTMS for stroke rehabilitation. Implications for Rehabilitation Low frequency repetitive transcranial magnetic stimulation (LF-rTMS) to the non-lesioned hemisphere improves paretic arm reach-to-grasp performance. The preliminary results have important implications for the use of LF-rTMS as conjunctive intervention for stroke rehabilitation. © 2013 Informa UK, Ltd.
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Low frequency repetitive transcranial magnetic stimulation to the non-lesioned hemisphere improved paretic arm reach-to-grasp performance after chronic stroke
(2011-12-28)
Tretriluxana, Jarugool
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Tretriluxana, Suradej
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Kantak, Shailesh
;
Wu, Allan D.
;
Fisher, Beth E.
Purpose: To investigate the effect of inhibitory low frequency repetitive Transcranial Magnetic Stimulation (rTMS) applied to the non-lesioned hemisphere on kinematics and coordination of paretic arm reach-to-grasp (RTG) actions in individuals with stroke. Relevance: This study is designed as a phase I trial to determine the feasibility and efficacy of low frequency rTMS applied to the non-lesioned hemisphere for the recovery of reach-to-grasp actions in individuals with hemiparesis secondary to stroke. The results have important implications for the use of rTMS in parallel with complex paretic arm skill practice. Participants: Nine adults, anterior circulation unilateral stroke. Their average age was 59 years, the average time since stroke was 4.8 years. Method and analysis: Two TMS treatments were performed on two separate days: active rTMS and sham rTMS. Cortico-motor excitability (CE) of the non-lesioned hemisphere as well as RTG kinematics of the paretic hand as participants reached for a dowel of 1.2 cm in diameter was assessed before and after the rTMS treatments. In the active condition, rTMS was applied over the "hot spot" of the extensor digitorum communis muscle (EDC) in primary motor cortex (M1) of the non-lesioned hemisphere at 90% resting motor threshold. TMS pulses were delivered at 1 Hz for 20 minutes. In the sham condition, a sham coil was positioned similar to the active condition; TMS clicking noise was produced but no TMS pulse was delivered. Dependent measures: CE was measured as peak-to-peak amplitude of the motor evoked potential at 120% of resting motor threshold. RTG kinematics included movement time, peak transport velocity, peak aperture, time of peak transport velocity and time of peak aperture. RTG coordination was captured by cross correlation coefficient between transport velocity and grasp aperture size. Results: While 1 Hz rTMS applied over non-lesioned M1 significantly decreased the MEP amplitude of non-paretic EDC, sham TMS did not have a significant effect on MEP amplitude. Active rTMS significantly decreased total movement time and increased peak grasp aperture. There were no changes in peak transport velocity or the time of peak transport velocity or the time of peak aperture after application of active rTMS. Additionally, the participants completed RTG actions with a more coordinated pattern after undergoing active rTMS. Following sham TMS, there were no changes in CE, RTG kinematics or coordination. Conclusions and implications: The findings demonstrate the feasibility and efficacy of low frequency rTMS applied to the non-lesioned hemisphere for the recovery of reach-to-grasp actions in individuals with hemiparesis secondary to stroke. The inhibitory effect of low frequency rTMS resulted in improved paretic hand reach-to-grasp performance with faster movement time and more coordinated reach-to-grasp pattern. These results have important implications for the use of rTMS for stroke rehabilitation.

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