METHOD AND SYSTEM FOR MAPPING BRAIN DYSFUNCTION FOR PSYCHIATRIC AND NEUROLOGICAL DISORDERS
20210045645 ยท 2021-02-18
Inventors
Cpc classification
A61B5/4848
HUMAN NECESSITIES
A61B5/4088
HUMAN NECESSITIES
A61B5/4082
HUMAN NECESSITIES
G16H50/20
PHYSICS
G16H20/10
PHYSICS
A61B5/72
HUMAN NECESSITIES
A61B5/4094
HUMAN NECESSITIES
International classification
A61B5/00
HUMAN NECESSITIES
G16H20/10
PHYSICS
Abstract
A brain mapping system and methods for providing personalized therapy for a broad range of brain dysfunctions by determining the location and the extent of the brain regions that have to be therapeutically targeted in each subject. The present invention includes means to record specific characteristics of brain activity, detect and display brain regions that present signatures of disease or dysfunctions by using a computing system. The therapy is tuned to target detected brain regions to restore specific connectivity characteristics using invasive, non-invasive stimulation, neurofeedback or drug administration. While connectivity characteristics are estimated based on resting state recordings the therapy will be performed in successive steps to alter network fragmentation in dysfunctional brain regions. The improved treatment is tailored to individual patients that will learn how to reshape specific connectivity characteristics to target the determined location and the extent of brain regions and maximize the therapeutic potential. The brain mapping technology is suited for different technologies and not limited to electroencephalography (EEG) or magneto electroencephalography (MEG).
Claims
1. A brain mapping system that allows to provide personalized, precise therapy for a broad range of brain dysfunctions that includes: a. An electroencephalograph (EEG) and a computing system (device) that maps the location and the extent of the brain regions that have to be therapeutically targeted; b. The computing system determines the location of the brain region that have to be therapeutically targeted by mapping a complexity measure, e.g. network fragmentation to provide successful therapy for each patient; c. The network fragmentation of control subjects is used as reference for further comparisons to determine if the network fragmentation map of a given subject displays network dysfunctions;
2. The system as set forth in claim 1, wherein said it includes a computing device with display and allows physicians and technicians to identify before therapy which brain regions have to be therapeutically targeted by drugs, invasive or non-invasive stimulation; a. The presence of network dysfunction (injury) can be rapidly identified by comparing the innate resting-state network fragmentation with subject's network fragmentation map; b. Based on network fragmentation maps the occurrence of side effects can be predicted and avoided in time; c. Based on network fragmentation maps the patients that have high risk to develop motor dysfunctions if serotonin reuptake inhibitor therapy is continued and can be identified; d. The brain mapping system reveals specific locations of network dysfunctions in case of very different brain dysfunctions (epilepsy, major depression, stroke, traumatic brain injury, Alzheimer's, Parkinson, multiple sclerosis, Tourette syndrome; tinnitus; fibromyalgia); e. The brain mapping system can identify a broad range of brain dysfunctions at an early stage; f. The therapy that targets and removes brain injuries (network dysfunctions) is individualized, precise and leads to a drop in symptom severity;
3. The system as set forth in claim 1, wherein said it can be used to monitor the progress of therapy, determine deep brain structures that are injured and evaluate the clinical value of drug products; a. The brain maps predict desirable and undesirable effects of treatments e.g. serotonin reuptake inhibitor therapy; b. Network fragmentation maps precisely locate the foci and the extension of network injuries within subcortical structures based on estimated values of network fragmentation; c. Network fragmentation maps are used to avoid therapeutic blunders either in non-invasive stimulation or drug therapy. d. Network fragmentation or measures of complexity are directly mapped to stereotaxic brain space registered to the Montreal Neurological Institute (MN) by using volume-based finite difference model (FDM) and triangulation;
4. The system as set forth in claim 1, wherein said network fragmentation maps are used to determine the location of abnormal network fragmentation and predict which patients have high risk to develop motor dysfunctions if serotonin reuptake inhibitor therapy is continued. a. Network fragmentation maps are used to adjust and tailor the therapy that may include noninvasive, invasive stimulation and/or drug therapy until specific characteristics of connectivity determined based on complexity measures are restored and brain dysfunctions or network injuries cannot be detected; b. The neurofeedback stimulation requires active patient participation in the therapy by reinforcing the change in the brain regions with abnormal network fragmentation.
Description
BRIEF DESCRIPTION OF THE DRAWINGS
[0019] The accompanying drawings illustrate non-limiting examples of the present invention.
[0020]
[0021]
[0022]
[0023]
[0024] In one embodiment healthy people (control subjects) are used to provide a basis for comparison.
[0025]
[0026]
[0027]
[0028]
[0029]
[0030]
[0031]
[0032]
DETAILED DESCRIPTION OF THE INVENTION
[0033] The next description provides details and examples to provide an understanding of the patent. The invention can be presented in different forms and not all unnecessarily details have been shown or described to avoid obscuring the invention. The drawings and specifications are explanatory, rather than restrictive.
[0034]
[0035] In another embodiment of the invention, NFMs are used to identify and detect the location of injured networks in traumatic brain injury. The NFMs were topographically plotted to show the difference between 1-week post TBI and 1-year post TBI, see
[0036]
[0037] In this case detected network dysfunctions (injuries) behave no different than Phineas Gage injury (Ratiu et al., 2004). Psychiatric, mental or neurological dysfunctions are clinically expressed as pathological disconnection or over-connection patterns that can be easily detected in NFMs. The Innate resting-state Network Fragmentation (INF) is the representation of topographic map of mean network fragmentation of control subjects as shown in 330. This representation can be regarded as a reference of network interactions within a healthy brain. The INF is used as reference for further comparisons to determine if a given brain map presents network dysfunctions (injuries).
[0038] In another embodiment, the system and methods described herein may be used to provide precise therapy. Personalized therapy consist of non-invasive or invasive therapy, drug therapy or any other form of therapy that targets the location of brain dysfunctions which are detected using complexity measures (e.g. network fragmentation). The therapy becomes individualized, precise if it targets and removes network injuries (abnormal increased or decreased network fragmentation) and leads to a significant drop in symptom severity. The topographic representation of NFM shows regions with high, abnormal values where network injuries are located in case of different brain conditions. The stimulation or drug therapy has to target detected locations and their extensions to remove network dysfunctions (injuries).
[0039] Once the location of network dysfunction (injury) is known the physician can provide precise, personalized therapy. Different types of therapy such as infrared light, ultrasound, electromagnetic stimulation will generate a desired biological response in any of a variety of medical conditions including but not limited to mental health conditions (e.g. chronic depression, traumatic brain injury (TBI), chronic traumatic encephalopathy (CTE). autism spectrum disorders (ASD), post-traumatic stress disorder (PTSD), Alzheimer's, dementia, Parkinson. tinnitus, etc.) or various pain conditions if the therapy targets the regions with increased network fragmentation. Topographic representation of NFMs are used to monitor and evaluate the effect of therapy and can be correlated with different depression scales (see, Hawley et al., 2013).
[0040]
[0041] In another embodiment brain maps of network fragmentation can be used to compare control subjects and patients with mental health problems.
[0042]
[0043] In another embodiment the presented technique and NFM are used to monitor the effects of drug therapy.
[0044]
[0045] In another embodiment NFMs are used to predict and explain the effects of drug therapy. Linear mixed-effects models (see, Pinherio and Bates, 1996; Bates et al., 2014) are used to determine the brain regions for which drug therapy has a significant effect in major depressive disorder. The relationship between the scalar variable represented by the drop of Montgomery-sberg Depression Rating Scale (MADRS), and explanatory variables represented by changes of network fragmentation were estimated at each EEG electrode after two months of drug administration. The significance of the F-test indicates if linear regression model provides a better fit to the data than the model that contains no explanatory variables. The linear mixed-effects model was corrected for confounding factors such as age, sex.
[0046]
[0047] A similar linear regression technique can be used to determine the effects of different drugs in Parkinson, epilepsy or Alzheimer's disease. The Unified Parkinson's Disease Rating Scale (UPDRS) in Parkinson (Goetz et al., 2008). seizure rating scales in epilepsy or mini-mental state examination (MMSE) in Alzheimer. see (Kurlowicz & Wallace 1999, Robert et al., 2010) or similar measures will be used instead of MADRS.
[0048] The proposed method and system to locate the network injury can be extended to patients with epilepsy, Parkinson and Alzheimer's. The brain mapping allows to detect the regions and brain circuitry that need to be therapeutically targeted either using drug therapy or have to be invasively or no-invasively stimulated. Mental state examination (MMSE) can be used in case of Alzheimer (Kurlowicz Wallace 1999) or similar measures. The presented method uses statistical measures, in combination with linear regression, NFM and severity scales to provide the regions that have to be therapeutically targeted either by using drugs or brain stimulation in case of very different brain dysfunctions.
[0049] The injury with a large iron rod of Phineas Gage has been at the origin of cerebral functions localization widely presented by physicians and anatomists (Ratiu et al., 2014) and detected network injuries behave no different than Phineas Gage. Importantly, based on the location of such network injuries different psychiatric and neurological disorders are triggered. Therefore, the system and methods described herein can be used to provide diagnostic in case of different brain conditions or used as an adjunct to standard clinical practice.
[0050] Another example shows that non-invasive stimulation of healthy brain regions can increase the severity of depression. Having identified the injured networks before therapy is highly important since the stimulation of healthy regions can increase symptom severity of depression.
[0051] If the network injury is located in the right primary motor region at electrode C4 the severity of depression will increase if antidepressants are administered. The effects of drug therapy can be monitored after drug administration by mapping network fragmentation (see,
[0052] In addition, most techniques used for neurofeedback therapy are not reliable. Too often such techniques pick changes of noise levels and the brain maps show increased or decreased brain activity. The determination of brain regions that have to be targeted by therapy is unreliable due to volume conduction and noise presence in EEG recordings.
[0053] The assumptions about the nature of signals or electrical sources (e.g., number of sources. stationarity, smoothness, correlation, sparsity. spatial extent constraints, etc.) and the presence of spurious connectivity due to volume conduction make most techniques weak in detecting pathological network disconnection. They led to inconsistent, contradictory results, however, only lately these issues have been thoroughly recognized (see Anzolin et al., 2019).
[0054] In addition, the training effects of neurofeedback from one location spread to other electrode locations (brain regions). The proposed solution in this patent avoids using such techniques that have been found to have limited therapeutic potential (see, Gruzelier, 2014). Since the estimation of network fragmentation is immune to volume conduction and intrinsic noise the proposed solution can be used to improve the therapeutic potential of neurofeedback systems by using a modulating sound. The neurofeedback is applied after the computing system has determined for each individual subject the location and the extent of the brain regions that have to be stimulated based on resting-state activity recordings. Based on NFM the frequency of the sound is tuned to inform the patient when and whether the changes of network fragmentation occur in the desired direction in a brain region that was previously determined. If the patient is unable to learn how to change specific characteristics of connectivity non-invasive stimulation will be used to target the region with low-dose currents trans-cranially applied on the EEG electrode in specific, predetermined brain regions as presented above.
[0055] The present invention can be extended to locate the network injury within subcortical structures in patients with epilepsy, Parkinson and Alzheimer's disease based on NFM. The proposed method maps network fragmentation directly to the stereotaxic brain space. The acquired scalp positions of different EEG system the 10/20, 10/10 and 10/5 systems were registered to the Montreal Neurological Institute (MNI) stereotactic coordinates. Volume-based finite difference model (FDM) and triangulation are used to map network fragmentation and register EEG data to the stereotaxic brain space (Neuner et al., 2014; Aur and Jog, 2010). In addition, NFMs are used detect the location of injured regions within subcortical structure in case of different brain conditions that may include epilepsy, Alzheimer's disease or Parkinson as presented in
[0056] Since the brain maps are registered to the Montreal Neurological Institute (MNI) stereotactic coordinates, they show which brain circuits are injured in each patient. The NFMs precisely locate the foci and the extension of network dysfunctions (injuries) within subcortical structures based on the estimated values of network fragmentation. In addition, 3D brain mappings and sagittal brain views can be used to understand the effects of therapy on network injury. Importantly, these brain maps indicate if appropriate levels of drug are in the brain, and if the administered drug targets the required injured region. The changes of drug concentrations in specific brain regions can be estimated based on changes that occur in the mapped networks by comparing longitudinal data as presented in
[0057] In the examples provided herein, dynamic cross entropy is used without limiting the invention since other complexity measures could also be used to estimate dynamic fragmentation of the network e.g. Lyapunov exponent, algorithmic complexity measures such as Lempel-Ziv complexity, auto-mutual information, sample entropy. Tsallis entropy, approximate entropy, multiscale entropy (Vitanyi & Li, 1997; Mizuno et al. 2010) or fractal measures (Edgar, 1998; Zhao et al., 2016).
[0058] The theoretical framework, the model of computation that estimates network fragmentation is general. This model can be applied to detect network dysfunctions for different brain conditions and insights regarding network and injured neural circuits (Aur and Jog, 2010; Aur et al., 2011, Aur and Tuszynski, 2017). The regions with increased network fragmentation can be separated and shown in transparent views which allows to determine the extension of dysfunctional regions.
[0059] Targeting detected injured networks with non-invasive stimulation and electric or magnetic patterns will change the brain rhythms immediately. If non-invasive stimulation is periodically repeated it will plastically alter the molecular structure within neurons, synapses and glial cells (Aur and Jog, 2010, Aur et al., 2011, Aur et al., 2016) and remove network dysfunctions (injuries) and decrease the symptoms in case of different brain conditions. The new resulting brain structure after stimulation will generate new rhythms and restore the brain function. The application of non-invasive stimulation will eliminate abnormal levels of network fragmentation in patients with major depression as long as the correct brain region is identified and targeted by therapy.
[0060] For various brain conditions the system and the presented method provide brain maps which include the location of brain dysfunctions that have to be targeted by therapy to improve the brain function.
EXAMPLES
Example 1: Detection of Injured Networks in Parkinson with Network Fragmentation Maps
[0061] Network fragmentation quantifies the randomness of brain interactions estimated based on dynamic cross-entropy (DCE) values. Network injuries are located in brain regions with high, abnormal values of network fragmentation. Resting state EEG was recorded using a 32-electrode cap with Ag/AgCl electrodes and then amplified. The bandwidth of the amplifiers was between (0.016-500 Hz) and data was sampled at 1000 Hz. An additional 250 Hz low-pass band filter was used and the impedance at all recording electrodes was less than 5 k. Horizontal eye movements and vertical eye movements were recorded with electrodes placed near the outer cantus of each eye respectively above and below the center of the left bottom eyelid. The common average reference is used to decrease the confounding effect of brain activity.
[0062] For each data set the raw EFG resting state data is split into segments of 1-second duration and segments that contain artifacts are detected and excluded from analysis. Since the presence of broadband high-frequency can be an indicator of electromyographic contamination to minimize the influence of artifacts an automatic deartifacting method that filters out regions with broadband high-frequency and widespread low-frequency power increase was used. Periods having activity three standard deviations away from the mean were removed from the data. On average 160 remaining segments of resting state data were used. A notch filter at 60 Hz was used to remove the line noise.
[0063] Network fragmentation is estimated as the inverse of dynamic cross entropy (DCE) in delta band and directly mapped to the stereotaxic brain space. The brain maps in
Example 2: Detection of Injured Networks in Parkinson with Network Fragmentation Maps
[0064] In another embodiment of the invention, the regions with increased network fragmentation can be separated. This novel method is used to identify the injured brain circuitry and presented in transparent views.
[0065] For the selected patient with Parkinson and severe motor disability
[0066] Once the location of injured brain network is known, either non-invasive stimulation or various drugs can provide therapy. The method can also be used to monitor the effects of therapy and measure the effect of therapy on injured networks, or if the drug has targeted the required region. Drug concentrations in specific brain regions can be estimated based on changes that occur in these networks by comparing the baseline reference of network fragmentation and gray (colored) scales over repeated cross-longitudinaldata.
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