Improved visual function in a case of ultra-low vision following ischemic encephalopathy following transcranial electrical stimulation; A case study

Publish Year: 1398
نوع سند: مقاله کنفرانسی
زبان: English
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NSCMED08_205

تاریخ نمایه سازی: 15 دی 1398

Abstract:

Background and Aim : Cortical visual impairment is amongst causes of pediatric visual abnormalities predominantly resulting from hypoxic-ischemic brain injury. Such an injury results in profound visual impairments which severely impairs patients’ quality of life. Given the nature of the pathology, treatments are mostly limited to rehabilitation strategies such as transcranial electrical (tES) stimulation and visual rehabilitation therapy.Methods : Here we present an 11 year-old girl who was suffering from ultra-low vision following occipital ischemic insult and ischemic optic neuropathy since the age of 6 following a bout of prolonged seizure attack. The eye examination before treatment was within normal limits except for strabismus, visual field defect, and decreased visual acuity (VA). The basic Quantitative Electroencephalography (QEEG) with concurrent photic stimulation (1-36 Hz, white flashes at 40 cm distance) was performed before stimulation. Based on the QEEG finding, the therapy protocol was formulated. The treatment protocol comprised five sessions of transcranial Direct Current Stimulation (tDCS) in the morning followed by transcranial Alternating Current Stimulation (tACS) in the afternoon over five consecutive days. In addition, the patient was prescribed nootropics and eye supplements including sodium valproate, Modafinil, and PRESERVISION 3™. post-tES QEEG and VA were assessed to evaluate the improvement. The patient’s follow-up involved the use of prescribed drugs, a self-training eye exercise named Fit Eye, and mirror-tracing task over a 60-day follow-up period. The patient completed the questionnaire of Vision-Related Quality of Life (VRQOL) before treatment and after two months follow- up. Pre- and Post-tES current density values were analyzed using IBM SPSS statistics V.22. Wilcoxon signed rank test.Results : VA measures for near sight were 4/20 and 8/20 for left and right eye before intervention and was measured following every session and turned to be 12/20 and 16/20 for left and right eyes at the end of the final session and the most recent follow-up session. Background EEG activity was normal in lights on/off states with no epileptic activity or abnormal discharges. Post-tES QEEG indicated an uptrained gamma activity in the primary visual cortex and enhanced beta-3 coherence within the visual network. VRQOL questionnaire revealed amelioration in her VRQOL two months after therapy. Current Spectral Density (CSD) map and functional connectivity pattern within the visual cortex shows that the CSD center value at Brodmann areas 17, 18, and 19 has significantly gained in both hemispheres following a course of tES. In addition, post-tES values (mean= 1.22, SD= 0.11) was significantly higher than those of the pre-tES (mean= 2.70, SD=0.05)Conclusion : Though there is no definite cure for ischemia-induced CVI, available restoration therapies may improve visual impairments in case-by-case basis. Since alterations in cortical excitability and its neuroplasticity result in many neuropsychiatric diseases, tDCS and tACS might also be therapeutic options to potentially modify cortical activity in conditions such as cerebral stroke-related vision loss. however, Randomized sham-controlled studies would be required to support this initial step towards developing inexpensive, effective, and available rehabilitation protocols for resource limited communities.

Authors

Mohammad Nami

Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran; DANA Brain Health Institute, Iranian Neuroscience Society-Fars Branch, Shiraz, Iran; Neuroscience Laboratory, NSL (Brain

Mohammad Javad Gholamzadeh

Neuroscience Laboratory, NSL (Brain, Cognition and Behavior), Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran; Students’ Research Committee, Shiraz University of Medical

Seyedeh Zahra Mousavi

Neuroscience Laboratory, NSL (Brain, Cognition and Behavior), Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran; Students’ Research Committee, Shiraz University of Medical

Maryam Vasaghi Gharamaleki

Neuroscience Laboratory, NSL (Brain, Cognition and Behavior), Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran; Students’ Research Committee, Shiraz University of Medical

Ali Mohammad Kamali

Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran; DANA Brain Health Institute, Iranian Neuroscience Society-Fars Branch, Shiraz, Iran; Neuroscience Laboratory, NSL (Brain