EEG microstate as a biomarker of post-stroke depression with acupuncture treatment

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EEG microstate as a biomarker of post-stroke depression with acupuncture treatment

Conghui WeiQu YangJinling ChenXiuqin RaoQingsong LiJun Luo^*

• Department of Rehabilitation Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China

Background: Post-stroke depression (PSD) is a prevalent psychiatric complication among stroke survivors. The PSD researches focus on pathogenesis, new treatment methods and efficacy prediction. This study explored the electroencephalography (EEG) microstates in PSD and assessed their changes after acupuncture treatment, aiming to find the biological characteristics and the predictors of treatment efficacy of PSD.

Methods: A 64-channel resting EEG data was collected from 70 PSD patients (PSD group) and 40 healthy controls (HC group) to explore the neuro-electrophysiological mechanism of PSD. The PSD patients received 6 weeks of acupuncture treatment. EEG data was collected from 60 PSD patients after acupuncture treatment (MA group) to verify whether acupuncture had a modulating effect on abnormal EEG microstates. Finally, the MA group was divided into two groups: the remission prediction group (RP group) and the non-remission prediction group (NRP group) according to the 24-Item Hamilton Depression Scale (HAMD-24) reduction rate. A prediction model for acupuncture treatment was established by baseline EEG microstates.

Results: The duration of microstate D along with the occurrence and contribution of microstate C were reduced in PSD patients. Acupuncture treatment partially normalized abnormal EEG microstates in PSD patients. Baseline EEG microstates predicted the efficacy of acupuncture treatment with an area under the curve (AUC) of 0.964.

Conclusion: This study provides a novel viewpoint on the neurophysiological mechanisms of PSD and emphasizes the potential of EEG microstates as a functional biomarker. Additionally, we anticipated the therapeutic outcomes of acupuncture by analyzing the baseline microstates, which holds significant practical implication for the PSD treatment.

Introduction

PSD is an abnormal manifestation of mood depression, loneliness, and sleep disturbance in stroke patients (1, 2). Epidemiological studies indicate that approximately 31% of stroke patients experience varying degrees of depressive symptoms (3, 4). The mental status of PSD patients can significantly affect their physical recovery and life quality. Additionally, the severity of depression correlates with stroke severity and mortality rates (5). In clinical practice, depressive symptoms are commonly alleviated by taking monoamine oxidase inhibitors, 5-hydroxytryptamine (5-HT) reuptake inhibitors and tricyclic antidepressants (6). However, the complex pathogenesis and susceptible recurrence of PSD, combined with potential toxic side effects from prolonged medication use, often undermine patients’ adherence to treatment (7). Therefore, it is imperative to employ alternative methods to more effectively manage depressive symptoms in PSD patients.

Various viable alternatives have been investigated for the treatment of PSD, among which acupuncture has been widely adopted globally for its efficacy and safety (8). In China, acupuncture is recommended as a complementary therapy for both PSD and post-stroke insomnia (PSI) (9). Functional magnetic resonance imaging (fMRI) studies have demonstrated that acupuncture modulates the interconnected dysfunctions associated with depressive symptoms, thereby facilitating sustained clinical improvement (10).

Individual differences in resting-state brain functional connectivity are associated with different types of depression, which shown by previous fMRI examinations (11, 12). Recent research indicates that EEG microstates can distinguish between depressive subtypes (13). EEG microstates can reflect dynamic changes in large-scale brain networks, characterized as semi-stable, transient voltage topographies that recur during resting-state EEG recordings (14). Persistent repetitive microstates likely arise from repeated co-activation of interconnected brain regions, each lasting approximately 80 ms before transitioning to another temporarily stable pattern. The four typical microstates (A-D) were present in almost all subjects, representing the synchronized activity within large-scale network nodes (15).

On the relationship between EEG microstates and the treatment of depression, Damborsk et al. (16) demonstrated a significant positive correlation between the microstates occurrence and medication amount. The usage of antipsychotics, antidepressants, and mood stabilizers was markedly associated with the occurrence of microstate E. Additionally, another study indicated that variations in the duration of microstate C and microstate D were strongly predictors of the response to electroconvulsive therapy (ECT) (17). Therefore, EEG microstates hold promise as biomarkers for assessing the effectiveness of therapeutic interventions in various neurological disorders.

Previous studies have primarily examined the differences between PSD patients and normal subjects, with limited focus on the prediction of depression efficacy (18, 19). Therefore, we investigated the EEG microstates of PSD patients and evaluated the changes of EEG microstates after acupuncture treatment to identify the biological characteristics and the predictors of PSD treatment efficacy.

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