Structure, place, and clinical efficacy of the interactive brain therapy (stimulation) technology in cerebrovascular diseases

Highlights. Interactive brain stimulation is the next step in neurofeedback technology, it implies the possibility of volitional regulation of the hemodynamic response of specific brain region in order to transform entire brain network and obtain the desired clinical and behavioral dynamics in patients (subjects). One of the indications for using the technology is post-stroke movements disorders when the volitional influence is focused on the motor area of the brain. Background. Neurofeedback and closely related concepts of neural interface system and “interactive brain” are considered as the foundation for developing algorithms for controlling neuroplasticity. Interactive brain therapy (stimulation) is a recently developed type of neurofeedback therapy, which implies dependence of feedback on a hemodynamic response signal recorded by functional magnetic resonance imaging (fMRI). The technology focuses on the region of interest with good accuracy and enables teaching the subject to control the activity of both individual cerebral structures and the functional connectivity between them, causing behavioral metamorphoses. Aim. To demonstrate the study design involving interactive stimulation of secondary motor areas of the brain using a bimodal fMRI-electroencephalography platform, and to describe the dynamics of the motor networks during treatment in patients with hemiparesis in the early period of recovery from stroke. Methods. The study involved 11 patients who were trained to regulate the activity of the secondary motor area and premotor cortex of the affected hemisphere, receiving feedback on the fMRI signal and the activity of the mu- (8–13 Hz) and beta2 (18–26 Hz) EEG ranges of the areas of interest. The block-designed training consisted of 6 sessions (imagination of movement – rest) with an interval of 2–3 days. During treatment the dynamics of the hemodynamic response of the areas of interest was analyzed. In test sessions (before treatment, immediately after the end, and six months later) functional connections within the motor network were reconstructed and hand function was assessed (grip strength, Fugle-Meyer Assessment, Box and Blocks test). Results. Upon completion of treatment, an increase in grip strength and dexterity was achieved; there was an increase in the fMRI signal of the premotor cortex of the ipsilateral hemisphere, and a strengthening of the interhemispheric functional connectivity of the secondary motor areas. Conclusion. fMRI and the interactive brain therapy technology built on its basis, on the one hand, provide the technological foundation for the “interactive brain” and the transformation of spontaneous neuroplasticity into a controlled one, and on the other hand, serve as an important tool for monitoring the process of restructuring of cerebral networks after a stroke, providing the ability to record the emergence (or disappearance) of connectivity between brain regions, and to measure its strength in dynamics, that is, to give a numerical description of neuroplasticity.