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Zhang JJY, Ang J, Saffari SE, Tor PC, Lo YL, Wan KR. Repetitive Transcranial Magnetic Stimulation for Motor Recovery After Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials With Low Risk of Bias. Neuromodulation 2024:S1094-7159(24)00665-2. [PMID: 39320286 DOI: 10.1016/j.neurom.2024.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 07/07/2024] [Accepted: 07/29/2024] [Indexed: 09/26/2024]
Abstract
OBJECTIVES Repetitive transcranial magnetic stimulation (rTMS) has shown promising results in enhancing motor recovery after stroke, but nuances regarding its use, such as the impact of the type and site of stimulation, are not yet established. We aimed to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) with low risk of bias to investigate the effect of rTMS on motor recovery after both ischemic and hemorrhagic stroke. MATERIALS AND METHODS Three databases were searched systematically for all RCTs reporting comparisons between rTMS (including theta-burst stimulation) and either no stimulation or sham stimulation up to August 19, 2022. The primary outcome measure was the Fugl-Meyer Assessment for Upper Extremity (FMA-UE). Secondary outcome measures comprised the Action Research Arm Test, Box and Block Test, Modified Ashworth Scale for the wrist, and modified Rankin Scale (mRS). RESULTS A total of 37 articles reporting 48 unique comparisons were included. Pooled mean FMA-UE scores were significantly higher in the experimental group than the control group after intervention (MD = 5.4 [MD = 10.7 after correction of potential publication bias], p < 0.001) and at the last follow-up (MD = 5.2, p = 0.031). On subgroup analysis, the improvements in FMA-UE scores, both after intervention and at the last follow-up, were significant in the acute/subacute stage of stroke (within six months) and for patients with more severe baseline motor impairment. Both contralesional and ipsilesional stimulation yielded significant improvements in FMA-UE at the first assessment after rTMS but not at the last follow-up, while the improvements from bilateral rTMS only achieved statistical significance at the last follow-up. Among the secondary outcome measures, only mRS was significantly improved in the rTMS group after intervention (MD = -0.5, p = 0.013) and at the last follow-up (MD = -0.9, p = 0.001). CONCLUSIONS Current literature supports the use of rTMS for motor recovery after stroke, especially when done within six months and for patients with more severe stroke at baseline. Future studies with larger sample sizes may be helpful in clarifying the potential of rTMS in poststroke rehabilitation.
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Affiliation(s)
- John J Y Zhang
- Department of Neurosurgery, National Neuroscience Institute, Singapore; Department of Neurosurgery, National Neuroscience Institute, Singapore General Hospital, Singapore.
| | - Jensen Ang
- Department of Neurosurgery, National Neuroscience Institute, Singapore; Department of Neurosurgery, National Neuroscience Institute, Singapore General Hospital, Singapore
| | - Seyed Ehsan Saffari
- Centre for Quantitative Medicine, Duke-National University of Singapore Medical School, Singapore; Program in Health Services and Systems Research, Duke-National University of Singapore Medical School, Singapore
| | - Phern-Chern Tor
- Department of Mood and Anxiety, Institute of Mental Health, Singapore
| | - Yew Long Lo
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore; Duke-National University of Singapore Medical School, Singapore
| | - Kai Rui Wan
- Department of Neurosurgery, National Neuroscience Institute, Singapore; Department of Neurosurgery, National Neuroscience Institute, Singapore General Hospital, Singapore
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Yu P, Dong R, Wang X, Tang Y, Liu Y, Wang C, Zhao L. Neuroimaging of motor recovery after ischemic stroke - functional reorganization of motor network. Neuroimage Clin 2024; 43:103636. [PMID: 38950504 PMCID: PMC11267109 DOI: 10.1016/j.nicl.2024.103636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 06/01/2024] [Accepted: 06/27/2024] [Indexed: 07/03/2024]
Abstract
The long-term motor outcome of acute stroke patients may be correlated to the reorganization of brain motor network. Abundant neuroimaging studies contribute to understand the pathological changes and recovery of motor networks after stroke. In this review, we summarized how current neuroimaging studies have increased understanding of reorganization and plasticity in post stroke motor recovery. Firstly, we discussed the changes in the motor network over time during the motor-activation and resting states, as well as the overall functional integration trend of the motor network. These studies indicate that the motor network undergoes dynamic bilateral hemispheric functional reorganization, as well as a trend towards network randomization. In the second part, we summarized the current study progress in the application of neuroimaging technology to early predict the post-stroke motor outcome. In the third part, we discuss the neuroimaging techniques commonly used in the post-stroke recovery. These methods provide direct or indirect visualization patterns to understand the neural mechanisms of post-stroke motor recovery, opening up new avenues for studying spontaneous and treatment-induced recovery and plasticity after stroke.
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Affiliation(s)
- Pei Yu
- School of Acupuncture and Massage, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Ruoyu Dong
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Xiao Wang
- School of Acupuncture and Massage, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yuqi Tang
- School of Acupuncture and Massage, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yaning Liu
- School of Acupuncture and Massage, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Can Wang
- School of Acupuncture and Massage, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Ling Zhao
- School of Acupuncture and Massage, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
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3
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Qi Y, Xu Y, Wang H, Wang Q, Li M, Han B, Liu H. Network Reorganization for Neurophysiological and Behavioral Recovery Following Stroke. Cent Nerv Syst Agents Med Chem 2024; 24:117-128. [PMID: 38299298 DOI: 10.2174/0118715249277597231226064144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/15/2023] [Accepted: 12/06/2023] [Indexed: 02/02/2024]
Abstract
Stroke continues to be the main cause of motor disability worldwide. While rehabilitation has been promised to improve recovery after stroke, efficacy in clinical trials has been mixed. We need to understand the cortical recombination framework to understand how biomarkers for neurophysiological reorganized neurotechnologies alter network activity. Here, we summarize the principles of the movement network, including the current evidence of changes in the connections and function of encephalic regions, recovery from stroke and the therapeutic effects of rehabilitation. Overall, improvements or therapeutic effects in limb motor control following stroke are correlated with the effects of interhemispheric competition or compensatory models of the motor supplementary cortex. This review suggests that future research should focus on cross-regional communication and provide fundamental insights into further treatment and rehabilitation for post-stroke patients.
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Affiliation(s)
- Yuan Qi
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing CN, China
| | - Yujie Xu
- Chengde Medical College Affiliated Hospital, Chengde, Hebei, CN, China
| | - Huailu Wang
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing CN, China
| | - Qiujia Wang
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing CN, China
| | - Meijie Li
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing CN, China
| | - Bo Han
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing CN, China
| | - Haijie Liu
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing CN, China
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4
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Alkolfat F, Abdel Galeel A, Bassiouny AR, Eldeeb H, Radwan A, Ashram YA. Patterns of Visual Task-based Functional MRI Activation in Chronic Posterior Cerebral Artery Stroke Patients. Clin Neuroradiol 2023; 33:769-781. [PMID: 36867244 PMCID: PMC10449980 DOI: 10.1007/s00062-023-01274-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 01/29/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE Stroke is a principal cause of disability worldwide. In motor stroke, the tools for stratification and prognostication are plentiful. Conversely, in stroke causing mainly visual and cognitive problems, there is still no gold standard modality to use. The purpose of this study was to explore the fMRI recruitment pattern in chronic posterior cerebral artery (PCA) stroke patients and to investigate fMRI as a biomarker of disability in these patients. METHODS The study included 10 chronic PCA stroke patients and another 10 age-matched volunteer controls. The clinical presentation, cognitive state, and performance in visual perceptual skills battery (TVPS-3) were determined for both patients and control groups. Task-based fMRI scans were acquired while performing a passive visual task. Individual and group analyses of the fMRI scans as well as correlation analysis with the clinical and behavioral data were done. RESULTS At the level of behavioral assessment there was non-selective global impairment in all visual skills subtests. On visual task-based fMRI, patients recruited more brain areas than controls. These activations were present in the ipsilesional side distributed in the ipsilesional cerebellum, dorsolateral prefrontal cortex mainly Brodmann area (BA) 9, superior parietal lobule (somatosensory associative cortex, BA 7), superior temporal gyrus (BA 22), supramarginal gyrus (BA 40), and contralesional associative visual cortex (BA 19). Spearman's rank correlation was computed to assess the relationship between the TVPS scores and the numbers of fMRI neuronal clusters in each patient above the main control activations, there was a negative correlation between the two variables, r(10) = -0.85, p ≤ 0.001. CONCLUSION In chronic PCA stroke patients with residual visual impairments, the brain attempts to recruit more neighboring and distant functional areas for executing the impaired visual skill. This intense recruitment pattern in poorly recovering patients appears to be a sign of failed compensation. Consequently, fMRI has the potential for clinically relevant prognostic assessment in patients surviving PCA stroke; however, as this study included no longitudinal data, this potential should be further investigated in longitudinal imaging studies, with a larger cohort, and multiple time points.
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Affiliation(s)
- Fatma Alkolfat
- Department of Neurology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Aya Abdel Galeel
- Department of Radiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmad R. Bassiouny
- Department of Biochemistry, Faculty of Science, Alexandria University, Alexandria, Egypt
| | - Hany Eldeeb
- Department of Neurology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmed Radwan
- Department of Imaging and Pathology, Translational MRI, KU Leuven, Leuven, Belgium
- Leuven Brain Institute (LBI), Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Yasmine A. Ashram
- Department of Physiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Wang X, Zhou H, Hu Y. Altered neural associations with cognitive and emotional functions in cannabis dependence. Cereb Cortex 2023; 33:8724-8733. [PMID: 37143177 PMCID: PMC10505425 DOI: 10.1093/cercor/bhad153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 04/14/2023] [Accepted: 04/16/2023] [Indexed: 05/06/2023] Open
Abstract
Negative emotional state has been found to correlate with poor cognitive performance in cannabis-dependent (CD) individuals, but not healthy controls (HCs). To examine the neural substrates underlying such unusual emotion-cognition coupling, we analyzed the behavioral and resting state fMRI data from the Human Connectome Project and found opposite brain-behavior associations in the CD and HC groups: (i) although the cognitive performance was positively correlated with the within-network functional connectivity strength and segregation (i.e. clustering coefficient and local efficiency) of the cognitive network in HCs, these correlations were inversed in CDs; (ii) although the cognitive performance was positively correlated with the within-network Granger effective connectivity strength and integration (i.e. characteristic path length) of the cognitive network in CDs, such associations were not significant in HCs. In addition, we also found that the effective connectivity strength within cognition network mediated the behavioral coupling between emotional state and cognitive performance. These results indicate a disorganization of the cognition network in CDs, and may help improve our understanding of substance use disorder.
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Affiliation(s)
- Xinying Wang
- Department of Psychology and Behavioral Sciences, Zhejiang University, Zijingang Campus, 866 Yuhangtang Road, Hangzhou, Zhejiang Province 310058, China
| | - Hui Zhou
- Department of Psychology and Behavioral Sciences, Zhejiang University, Zijingang Campus, 866 Yuhangtang Road, Hangzhou, Zhejiang Province 310058, China
| | - Yuzheng Hu
- Department of Psychology and Behavioral Sciences, Zhejiang University, Zijingang Campus, 866 Yuhangtang Road, Hangzhou, Zhejiang Province 310058, China
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Cheng S, Xin R, Zhao Y, Wang P, Feng W, Liu P. Evaluation of fMRI activation in post-stroke patients with movement disorders after repetitive transcranial magnetic stimulation: a scoping review. Front Neurol 2023; 14:1192545. [PMID: 37404941 PMCID: PMC10315664 DOI: 10.3389/fneur.2023.1192545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/25/2023] [Indexed: 07/06/2023] Open
Abstract
Background Movement disorders are one of the most common stroke residual effects, which cause a major stress on their families and society. Repetitive transcranial magnetic stimulation (rTMS) could change neuroplasticity, which has been suggested as an alternative rehabilitative treatment for enhancing stroke recovery. Functional magnetic resonance imaging (fMRI) is a promising tool to explore neural mechanisms underlying rTMS intervention. Object Our primary goal is to better understand the neuroplastic mechanisms of rTMS in stroke rehabilitation, this paper provides a scoping review of recent studies, which investigate the alteration of brain activity using fMRI after the application of rTMS over the primary motor area (M1) in movement disorders patients after stroke. Method The database PubMed, Embase, Web of Science, WanFang Chinese database, ZhiWang Chinese database from establishment of each database until December 2022 were included. Two researchers reviewed the study, collected the information and the relevant characteristic extracted to a summary table. Two researchers also assessed the quality of literature with the Downs and Black criteria. When the two researchers unable to reach an agreement, a third researcher would have been consulted. Results Seven hundred and eleven studies in all were discovered in the databases, and nine were finally enrolled. They were of good quality or fair quality. The literature mainly involved the therapeutic effect and imaging mechanisms of rTMS on improving movement disorders after stroke. In all of them, there was improvement of the motor function post-rTMS treatment. Both high-frequency rTMS (HF-rTMS) and low-frequency rTMS (LF-rTMS) can induce increased functional connectivity, which may not directly correspond to the impact of rTMS on the activation of the stimulated brain areas. Comparing real rTMS with sham group, the neuroplastic effect of real rTMS can lead to better functional connectivity in the brain network in assisting stroke recovery. Conclusion rTMS allows the excitation and synchronization of neural activity, promotes the reorganization of brain function, and achieves the motor function recovery. fMRI can observe the influence of rTMS on brain networks and reveal the neuroplasticity mechanism of post-stroke rehabilitation. The scoping review helps us to put forward a series of recommendations that might guide future researchers exploring the effect of motor stroke treatments on brain connectivity.
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Affiliation(s)
- Siman Cheng
- Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Rong Xin
- Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Yan Zhao
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Pu Wang
- Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Wuwei Feng
- Department of Neurology, Medical University of South Carolina, Charleston, SC, United States
| | - Peng Liu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
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7
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Kajtazi NI, Bafaquh M, Rizvi T, Sheikh SE, Ghamdi JA, Amoudi RA, Jabbar AA, Shammari KA, Saqqur M, Ghamdi SA, Khoja W, Demchuk A, Senani FA, Luft AR. Ipsilateral weakness caused by ipsilateral stroke: A case series. J Stroke Cerebrovasc Dis 2023; 32:107090. [PMID: 37105128 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/10/2023] [Accepted: 03/19/2023] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION There are few reported cases of ipsilateral weakness following ischemic or hemorrhagic stroke. In these rare cases, ipsilateral weakness is typically the result of damage to uncrossed components of the corticospinal tract (CST) which were recruited in response to previous CST injury. PATIENTS AND METHODS We report a series of six cases of acute ipsilateral weakness or numbness following a hemorrhagic or ischemic stroke from three medical institutions in Saudi Arabia. RESULTS Three of these patients presented with right-sided weakness caused by an ipsilateral right hemispheric stroke, while two exhibited left-sided symptoms and one had only left-sided numbness. In all six cases, the ipsilateral corona radiata, internal capsule, basal ganglia, insula, and thalamus were involved. No concomitant opposite hemisphere or brainstem lesion in none of the patients was evident. Two patients had previous strokes affecting the brainstem and left corona radiata, respectively. Complete stroke workup to reveal the cause of stroke was carried out, however no functional MRI was performed. CONCLUSION Ischemic or hemorrhagic stroke may indeed result in ipsilateral weakness or numbness, though in very rare cases. We assume that the most likely mechanism of their ipsilateral weakness subsequent to the ipsilateral stroke was a functional reorganization favoring CST pathways within the ipsilateral hemisphere.
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Affiliation(s)
- Naim I Kajtazi
- Department of Neurology, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia; Department of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
| | - Mohammed Bafaquh
- Department of Neurosurgery, National Neurosciences Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Tanvir Rizvi
- Department of Medical Imaging, Neuroradiology, University of Virginia, United States
| | - Souda El Sheikh
- Department of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Juman Al Ghamdi
- Intervention Neuroradiology, Medical Imaging Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Razan Al Amoudi
- Intervention Neuroradiology, Medical Imaging Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Asma Al Jabbar
- Department of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Kareem Al Shammari
- Department of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Maher Saqqur
- Department of Neurology, University of Alberta, Canada
| | - Saeed Al Ghamdi
- Department of Neurology, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Waleed Khoja
- Department of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | | | - Fahmi Al Senani
- Department of Neurology, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia; Intervention Neuroradiology, Medical Imaging Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Andreas R Luft
- Department of Neurology, Switzerland & Cereneo Center for Neurology and Rehabilitation, University of Zürich, Vitznau, Switzerland
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8
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Buetefisch CM, Haut MW, Revill KP, Shaeffer S, Edwards L, Barany DA, Belagaje SR, Nahab F, Shenvi N, Easley K. Stroke Lesion Volume and Injury to Motor Cortex Output Determines Extent of Contralesional Motor Cortex Reorganization. Neurorehabil Neural Repair 2023; 37:119-130. [PMID: 36786394 PMCID: PMC10079613 DOI: 10.1177/15459683231152816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND After stroke, increases in contralesional primary motor cortex (M1CL) activity and excitability have been reported. In pre-clinical studies, M1CL reorganization is related to the extent of ipsilesional M1 (M1IL) injury, but this has yet to be tested clinically. OBJECTIVES We tested the hypothesis that the extent of damage to the ipsilesional M1 and/or its corticospinal tract (CST) determines the magnitude of M1CL reorganization and its relationship to affected hand function in humans recovering from stroke. METHODS Thirty-five participants with a single subacute ischemic stroke affecting M1 or CST and hand paresis underwent MRI scans of the brain to measure lesion volume and CST lesion load. Transcranial magnetic stimulation (TMS) of M1IL was used to determine the presence of an electromyographic response (motor evoked potential (MEP+ and MEP-)). M1CL reorganization was determined by TMS applied to M1CL at increasing intensities. Hand function was quantified with the Jebsen Taylor Hand Function Test. RESULTS The extent of M1CL reorganization was related to greater lesion volume in the MEP- group, but not in the MEP+ group. Greater M1CL reorganization was associated with more impaired hand function in MEP- but not MEP+ participants. Absence of an MEP (MEP-), larger lesion volumes and higher lesion loads in CST, particularly in CST fibers originating in M1 were associated with greater impairment of hand function. CONCLUSIONS In the subacute post-stroke period, stroke volume and M1IL output determine the extent of M1CL reorganization and its relationship to affected hand function, consistent with pre-clinical evidence.ClinicalTrials.gov Identifier: NCT02544503.
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Affiliation(s)
- Cathrin M Buetefisch
- Department of Neurology, Emory University, Atlanta, GA, USA.,Department of Rehabilitation Medicine, Emory University, Atlanta, GA, USA
| | - Marc W Haut
- Department of Behavioral Medicine and Psychiatry, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA.,Department of Neurology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA.,Department of Radiology, West Virginia University, Morgantown, WV, USA
| | - Kate P Revill
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Scott Shaeffer
- Department of Neurology, Emory University, Atlanta, GA, USA
| | - Lauren Edwards
- Department of Neurology, Emory University, Atlanta, GA, USA
| | | | - Samir R Belagaje
- Department of Neurology, Emory University, Atlanta, GA, USA.,Department of Rehabilitation Medicine, Emory University, Atlanta, GA, USA.,Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA, USA
| | - Fadi Nahab
- Department of Neurology, Emory University, Atlanta, GA, USA
| | - Neeta Shenvi
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kirk Easley
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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9
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Thompson AE, Thompson PD. Frontal lobe motor syndromes. HANDBOOK OF CLINICAL NEUROLOGY 2023; 196:443-455. [PMID: 37620084 DOI: 10.1016/b978-0-323-98817-9.00008-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
The motor phenomena accompanying frontal lobe disease are diverse, reflecting the various roles the frontal lobes play in the organization of motor control. The principal frontal motor areas, the primary motor cortex, the premotor cortex, and the supplementary motor area, have different but interrelated functions in motor control. The principal efferent pathway of the primary motor cortex is the corticospinal tract which conducts fine motor control. Damage to the primary motor cortex and the corticospinal tract results in paralysis and loss of skilled, particularly distal, motor function. Lesions of the premotor cortex interfere with the preparation for the execution of movements and coordinating sequences of limb movement. Mediated through cortico-reticulospinal pathways, the premotor cortex adjusts axial and limb muscle activities. The fine motor skills of the corticospinal tract are superimposed upon these stabilizing movements. Supplementary motor area lesions interrupt self-initiated movements, release alien limb behaviors, and result in grasping. Paralysis, primitive reflexes, and frontal gait disorders are readily observed on examination, but difficulties initiating and sequencing movements are more subtle signs of perturbed higher motor control and require special examination procedures. Prefrontal motor syndromes include motor behaviors that only become apparent when the subject performs spontaneous or self-directed activities, unconstrained by instructions from the examiner. Clinical observation also reveals a slowness to respond to instruction with long delays before initiating action (inertia), but once underway they may be unable to stop (perseveration). Patients sit motionless without spontaneous movement or interest in their surrounds (apathy), yet exhibit distractibility, diverting attention to an incidental peripheral stimulus or an object with which they may then fiddle (environmental dependency and utilization behavior). Little spontaneous speech is initiated (abulia) but echolalia may be stimulated by the examiner's conversation. Restlessness, distractibility, perseveration, and environmentally dependent utilization behaviors coexist with apathy, inertia, and abulia. Mutism and akinesia may alternate with stereotypies and agitation in catatonia. These paradoxical combinations are of considerable diagnostic significance in recognizing frontal lobe motor syndromes.
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10
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Younger DS. Motor sequela of adult and pediatric stroke: Imminent losses and ultimate gains. HANDBOOK OF CLINICAL NEUROLOGY 2023; 196:305-346. [PMID: 37620077 DOI: 10.1016/b978-0-323-98817-9.00025-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Stroke is the leading cause of neurological disability in the United States and worldwide. Remarkable advances have been made over the past 20 years in acute vascular treatments to reduce infarct size and improve neurological outcome. Substantially less progress has been made in the understanding and clinical approaches to neurological recovery after stroke. This chapter reviews the epidemiology, bedside examination, localization approaches, and classification of stroke, with an emphasis on motor stroke presentations and management, and promising research approaches to enhancing motor aspects of stroke recovery.
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Affiliation(s)
- David S Younger
- Department of Clinical Medicine and Neuroscience, CUNY School of Medicine, New York, NY, United States; Department of Medicine, Section of Internal Medicine and Neurology, White Plains Hospital, White Plains, NY, United States.
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11
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Hosp JA, Dressing A, Engesser A, Glauche V, Kümmerer D, Vaidelyte EB, Musso M, Rijntjes M, Weiller C. The Role of Ascending Ventral-Tegmental Fibers for Recovery after Stroke. Ann Neurol 2022; 93:922-933. [PMID: 36585896 DOI: 10.1002/ana.26595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 12/29/2022] [Accepted: 12/30/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The integrity of cortical motor networks and their descending effector pathway (the corticospinal tract [CST]) is a major determinant motor recovery after stroke. However, this view neglects the importance of ascending tracts and their modulatory effects on cortical physiology. Here, we explore the role of such a tract that connects dopaminergic ventral tegmental midbrain nuclei to the motor cortex (the VTMC tract) for post-stroke recovery. METHODS Lesion data and diffusivity parameters (fractional anisotropy) of the ipsi- and contralesional VTMC tract and CST were obtained from 133 patients (63.9 ± 13.4 years, 45 women) during the acute and chronic stage after the first ever ischemic stroke in the middle cerebral artery territory. Degeneration of VTMC tract and CST was quantified and related to clinical outcome parameters (National Institute of Health Stroke Scale with motor and cortical symptom subscores; modified Fugl-Meyer upper extremity score; modified Ranking Scale [mRS]). RESULTS A significant post-stroke degeneration occurred in both tracts, but only VTMC degeneration was associated with lesion size. Using multiple regression models, we dissected the impact of particular tracts on recovery: Changes in VTMC tract integrity were stronger associated with independence in daily activities (mRS), upper limb motor impairment (modified Fugl-Meyer upper extremity score) and cortical symptoms (aphasia, neglect) captured by National Institute of Health Stroke Scale compared to CST. Changes in CST integrity merely were associated with the degree of hemiparesis (National Institute of Health Stroke Scale motor subscale). INTERPRETATION Post-stroke outcome is influenced by ascending (VTMC) and descending (CST) fiber tracts. Favorable outcome regarding independence (modified Ranking Scale), upper limb motor function (modified Fugl-Meyer upper extremity score), and cortical symptoms (aphasia, neglect) was more strongly related to the ascending than descending tract. ANN NEUROL 2023.
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Affiliation(s)
- Jonas A Hosp
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Andrea Dressing
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany.,Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anika Engesser
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Volkmar Glauche
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany.,Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dorothee Kümmerer
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany.,Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ema B Vaidelyte
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Mariachristina Musso
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany.,Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michel Rijntjes
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany.,Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Cornelius Weiller
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany.,Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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12
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Application of Robotic Recovery Techniques to Stroke Survivors-Bibliometric Analysis. J Pers Med 2022; 12:jpm12122066. [PMID: 36556286 PMCID: PMC9788322 DOI: 10.3390/jpm12122066] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/11/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Stroke is a significant disability and death cause worldwide and is conventionally defined as a neurological impairment relating to the intense focal harm of the central nervous system (CNS) by vascular causative components. Although the applicability of robotic rehabilitation is a topic with considerable practical significance because it has produced noticeably higher improvements in motor function than regular (physical and occupational) therapy and exempted the therapists, most of the existing bibliometric papers were not focused on stroke survivors. Additionally, a modular system is designed by joining several medical end-effector devices to a single limb segment, which addresses the issue of potentially dangerous pathological compensatory motions. Searching the Web of Science database, 31,930 papers were identified, and using the VOSviewer software and science mapping technology, data were extracted on the most prolific countries, the connections between them, the most valuable journals according to certain factors, their average year of publication, the most influential papers, and the most relevant topical issues (bubble map of term occurrence). The most prolific country in the analyzed field and over the entire period evaluated (1975-2022) is the United States, and the most prolific journal is Neurorehabilitation and Neural Repair, observing a marked increase in the three periods of scientific interest for this field. The present paper assesses numerous scientific publications to provide, through statistical interpretation of the data, a detailed description of the use of robotic rehabilitation in stroke survivors. The findings may aid scientists, academics, and clinicians in establishing precise goals in the optimization of the management of stroke survivors via robotic rehabilitation, but also through easier access to scientifically validated literature.
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13
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Yamamoto K, Sarica C, Elias GJB, Boutet A, Germann J, Loh A, Joel SE, Bigioni L, Gwun D, Gramer R, Li SX, Zemmar A, Vetkas A, Algarni M, Devenyi G, Chakravarty M, Hynynen K, Scantlebury N, Schwartz ML, Lozano AM, Fasano A. Ipsilateral and axial tremor response to focused ultrasound thalamotomy for essential tremor: clinical outcomes and probabilistic mapping. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2021-328459. [PMID: 35995551 DOI: 10.1136/jnnp-2021-328459] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 05/25/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND MR-guided focused ultrasound (MRgFUS) thalamotomy has been shown to be a safe and effective treatment for essential tremor (ET). OBJECTIVE To investigate the effects of MRgFUS in patients with ET with an emphasis on ipsilateral-hand and axial tremor subscores. METHODS Tremor scores and adverse effects of 100 patients treated between 2012 and 2018 were assessed at 1 week, 3, 12, and 24 months. A subgroup analysis of ipsilateral-hand tremor responders (defined as patients with ≥30% improvement at any time point) and non-responders was performed. Correlations and predictive factors for improvement were analysed. Weighted probabilistic maps of improvement were generated. RESULTS Significant improvement in axial, contralateral-hand and total tremor scores was observed at all study visits from baseline (p<0.0001). There was no significant improvement in ipsilateral subscores. A subset of patients (n=20) exhibited group-level ipsilateral-hand improvement that remained significant through all follow-ups (p<0.001). Multivariate regression analysis revealed that higher baseline scores predict better improvement in ipsilateral-hand and axial tremor. Probabilistic maps demonstrated that the lesion hotspot for axial improvement was situated more medially than that for contralateral improvement. CONCLUSION MRgFUS significantly improved axial, contralateral-hand and total tremor scores. In a subset of patients, a consistent group-level treatment effect was observed for ipsilateral-hand tremor. While ipsilateral improvement seemed to be less directly related to lesion location, a spatial relationship between lesion location and axial and contralateral improvement was observed that proved consistent with the somatotopic organisation of the ventral intermediate nucleus. TRIAL REGISTRATION NUMBERS NCT01932463, NCT01827904, and NCT02252380.
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Affiliation(s)
- Kazuaki Yamamoto
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Can Sarica
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Gavin J B Elias
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Jurgen Germann
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Aaron Loh
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Luca Bigioni
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Dave Gwun
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Robert Gramer
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Ajmal Zemmar
- Department of Neurosurgery, University of Louisville School of Medicine, Louisville, Kentucky, USA
- Department of Neurosurgery, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Artur Vetkas
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
- Department of Neurosurgery, University of Tartu, Tartu, Tartumaa, Estonia
| | - Musleh Algarni
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Gabriel Devenyi
- Cerebral Imaging Center, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal, Quebec, Canada
| | - Mallar Chakravarty
- Cerebral Imaging Center, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal, Quebec, Canada
| | - Kullervo Hynynen
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Nadia Scantlebury
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Michael L Schwartz
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
- Krembil Research Institute, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
- Krembil Research Institute, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
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14
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Frost SB, Chen D, Barbay S, Friel KM, Plautz EJ, Nudo RJ. Reorganization of Ventral Premotor Cortex After Ischemic Brain Injury: Effects of Forced Use. Neurorehabil Neural Repair 2022; 36:514-524. [PMID: 35559809 PMCID: PMC9378490 DOI: 10.1177/15459683221101622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Physical use of the affected upper extremity can have a beneficial effect on motor recovery in people after stroke. Few studies have examined neurological mechanisms underlying the effects of forced use in non-human primates. In particular, the ventral premotor cortex (PMV) has been previously implicated in recovery after injury. OBJECTIVE To examine changes in motor maps in PMV after a period of forced use following ischemic infarct in primary motor cortex (M1). METHODS Intracortical microstimulation (ICMS) techniques were used to derive motor maps in PMV of four adult squirrel monkeys before and after an experimentally induced ischemic infarct in the M1 distal forelimb area (DFL) in the dominant hemisphere. Monkeys wore a sleeved jacket (generally 24 hrs/day) that forced limb use contralateral to the infarct in tasks requiring skilled digit use. No specific rehabilitative training was provided. RESULTS At 3 mos post-infarct, ICMS maps revealed a significant expansion of the DFL representation in PMV relative to pre-infarct baseline (mean = +77.3%; n = 3). Regression analysis revealed that the magnitude of PMV changes was largely driven by M1 lesion size, with a modest effect of forced use. One additional monkey examined after ∼18 months of forced use demonstrated a 201.7% increase, unprecedented in non-human primate studies. CONCLUSIONS Functional reorganization in PMV following an ischemic infarct in the M1 DFL is primarily driven by M1 lesion size. Additional expansion occurs in PMV with extremely long periods of forced use but such extended constraint is not considered clinically feasible.
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Affiliation(s)
- Shawn B. Frost
- Dept. Rehabilitation Medicine; Univ. of Kansas Medical Center, Kansas City, KS 66160
- Landon Center on Aging; Univ. of Kansas Medical Center, Kansas City, KS 66160
- Dept. of Molecular and Integrative Physiology; Univ. of Kansas Medical Center, Kansas City, KS 66160
| | - Daofen Chen
- Landon Center on Aging; Univ. of Kansas Medical Center, Kansas City, KS 66160
- Physical Therapy & Rehabilitation Science; Univ. of Kansas Medical Center, Kansas City, KS 66160
| | - Scott Barbay
- Dept. Rehabilitation Medicine; Univ. of Kansas Medical Center, Kansas City, KS 66160
- Landon Center on Aging; Univ. of Kansas Medical Center, Kansas City, KS 66160
- Dept. of Molecular and Integrative Physiology; Univ. of Kansas Medical Center, Kansas City, KS 66160
| | - Kathleen M. Friel
- Landon Center on Aging; Univ. of Kansas Medical Center, Kansas City, KS 66160
- Dept. of Molecular and Integrative Physiology; Univ. of Kansas Medical Center, Kansas City, KS 66160
| | - Erik J. Plautz
- Landon Center on Aging; Univ. of Kansas Medical Center, Kansas City, KS 66160
- Dept. of Molecular and Integrative Physiology; Univ. of Kansas Medical Center, Kansas City, KS 66160
| | - Randolph J. Nudo
- Dept. Rehabilitation Medicine; Univ. of Kansas Medical Center, Kansas City, KS 66160
- Landon Center on Aging; Univ. of Kansas Medical Center, Kansas City, KS 66160
- Dept. of Molecular and Integrative Physiology; Univ. of Kansas Medical Center, Kansas City, KS 66160
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15
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Revill KP, Barany DA, Vernon I, Rellick S, Caliban A, Tran J, Belagaje SR, Nahab F, Haut MW, Buetefisch CM. Evaluating the Abnormality of Bilateral Motor Cortex Activity in Subacute Stroke Patients Executing a Unimanual Motor Task With Increasing Demand on Precision. Front Neurol 2022; 13:836716. [PMID: 35693005 PMCID: PMC9174784 DOI: 10.3389/fneur.2022.836716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/22/2022] [Indexed: 12/02/2022] Open
Abstract
Abnormal contralesional M1 activity is consistently reported in patients with compromised upper limb and hand function after stroke. The underlying mechanisms and functional implications of this activity are not clear, which hampers the development of treatment strategies targeting this brain area. The goal of the present study was to determine the extent to which contralesional M1 activity can be explained by the demand of a motor task, given recent evidence for increasing ipsilateral M1 activity with increasing demand in healthy age-matched controls. We hypothesized that higher activity in contralesional M1 is related to greater demand on precision in a hand motor task. fMRI data were collected from 19 patients with ischemic stroke affecting hand function in the subacute recovery phase and 31 healthy, right-handed, age-matched controls. The hand motor task was designed to parametrically modulate the demand on movement precision. Electromyography data confirmed strictly unilateral task performance by all participants. Patients showed significant impairment relative to controls in their ability to perform the task in the fMRI scanner. However, patients and controls responded similarly to an increase in demand for precision, with better performance for larger targets and poorer performance for smaller targets. Patients did not show evidence of elevated ipsilesional or contralesional M1 blood oxygenation level-dependent (BOLD) activation relative to healthy controls and mean BOLD activation levels were not elevated for patients with poorer performance relative to patients with better task performance. While both patients and healthy controls showed demand-dependent increases in BOLD activation in both ipsilesional/contralateral and contralesional/ipsilateral hemispheres, patients with stroke were less likely to show evidence of a linear relationship between the demand on precision and BOLD activation in contralesional M1 than healthy controls. Taken together, the findings suggest that task demand affects the BOLD response in contralesional M1 in patients with stroke, though perhaps less strongly than in healthy controls. This has implications for the interpretation of reported abnormal bilateral M1 activation in patients with stroke because in addition to contralesional M1 reorganization processes it could be partially related to a response to the relatively higher demand of a motor task when completed by patients rather than by healthy controls.
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Affiliation(s)
- Kate Pirog Revill
- Department of Psychology, Emory University, Atlanta, GA, United States
| | - Deborah A. Barany
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Isabelle Vernon
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Stephanie Rellick
- Department of Behavioral Medicine and Psychiatry, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States
| | - Alexandra Caliban
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Julie Tran
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Samir R. Belagaje
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Fadi Nahab
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Marc W. Haut
- Department of Behavioral Medicine and Psychiatry, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States
- Department of Neurology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States
- Department of Radiology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States
| | - Cathrin M. Buetefisch
- Department of Neurology, Emory University, Atlanta, GA, United States
- Department of Rehabilitation Medicine, Emory University, Atlanta, GA, United States
- Department of Radiology, Emory University, Atlanta, GA, United States
- *Correspondence: Cathrin M. Buetefisch
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16
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El nahas N, Roushdy TM, Shokri HM, Moustafa RR, Elsayed AM, Amin RM, Ashour AA, Abd Eldayem EH, Elhawary GA, Elbokl AM. Lateralized readiness potentials can identify hemisphere of recovery in stroke patients. Restor Neurol Neurosci 2022; 40:63-71. [PMID: 35634815 DOI: 10.3233/rnn-211222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Highlights • In healthy adults, the lateralized readiness potential (LRP) is localized to the hemisphere contralateral to a moving limb. • In stroke, the LRP can lateralize contra-, or ipsilateral to the paretic limb depending on the stage of recovery. • Identification of hemisphere of recovery can guide further measures for enhancing brain plasticity. Background: Event related cortical potentials related to motor action are referred to as movement related cortical potentials. The late component of which is the readiness potential (RP) and its polarity is more negative in the hemisphere responsible for planning of motor action. This lateralized nature of RP during unilateral hand movement is studied as lateralized readiness potential (LRP) by calculating the contralateral-minus-ipsilateral difference wave for each hand. Objective: The aim was to identify the hemisphere contributing to motor recovery in acute and chronic stroke patients through recording LRPs. Methods: Twenty-nine cases with cerebrovascular stroke (15 acute and 14 chronic) were included in the study. EEG was recorded in response to self-cued button presses by the paretic side to obtain the averaged LRP amplitude. The hemisphere with greater negativity was considered the side of recovery. Functional recovery was assessed by Fugl Meyer test. Results: In acute cases, recovery was more related to LRP activity in the contralesional hemisphere (73% ), whereas lateralization was equal in chronic cases; 50% in either group. LRP amplitude was higher in the contralesional hemisphere (p = 0.02). Functional recovery assessed by the Fugl Meyer test (FM) was similar whether recovery was ipsi- or contralesional. Conclusions: Early after stroke, motor recovery is more likely to involve compensatory activity in the contralesional hemisphere, while in the chronic phase, the ipsilesional hemisphere may recover its function and become more active. Further research is needed to verify if the technique mentioned in our study could be used to guide customized NIBS protocols tailoring the optimal site and parameters for each patient.
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Affiliation(s)
- Nevine El nahas
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Tamer M. Roushdy
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hossam M. Shokri
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ramez R. Moustafa
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed M. Elsayed
- Department of Neurology, El Mataria Teaching Hospital, Cairo, Egypt
| | - Randa M. Amin
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Aya A. Ashour
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Eman H. Abd Eldayem
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Ahmed M. Elbokl
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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17
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Hensel L, Lange F, Tscherpel C, Viswanathan S, Freytag J, Volz LJ, Eickhoff SB, Fink GR, Grefkes C. Recovered grasping performance after stroke depends on interhemispheric frontoparietal connectivity. Brain 2022; 146:1006-1020. [PMID: 35485480 PMCID: PMC9976969 DOI: 10.1093/brain/awac157] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/19/2022] [Accepted: 04/14/2022] [Indexed: 01/11/2023] Open
Abstract
Activity changes in the ipsi- and contralesional parietal cortex and abnormal interhemispheric connectivity between these regions are commonly observed after stroke, however, their significance for motor recovery remains poorly understood. We here assessed the contribution of ipsilesional and contralesional anterior intraparietal cortex (aIPS) for hand motor function in 18 recovered chronic stroke patients and 18 healthy control subjects using a multimodal assessment consisting of resting-state functional MRI, motor task functional MRI, online-repetitive transcranial magnetic stimulation (rTMS) interference, and 3D movement kinematics. Effects were compared against two control stimulation sites, i.e. contralesional M1 and a sham stimulation condition. We found that patients with good motor outcome compared to patients with more substantial residual deficits featured increased resting-state connectivity between ipsilesional aIPS and contralesional aIPS as well as between ipsilesional aIPS and dorsal premotor cortex. Moreover, interhemispheric connectivity between ipsilesional M1 and contralesional M1 as well as ipsilesional aIPS and contralesional M1 correlated with better motor performance across tasks. TMS interference at individual aIPS and M1 coordinates led to differential effects depending on the motor task that was tested, i.e. index finger-tapping, rapid pointing movements, or a reach-grasp-lift task. Interfering with contralesional aIPS deteriorated the accuracy of grasping, especially in patients featuring higher connectivity between ipsi- and contralesional aIPS. In contrast, interference with the contralesional M1 led to impaired grasping speed in patients featuring higher connectivity between bilateral M1. These findings suggest differential roles of contralesional M1 and aIPS for distinct aspects of recovered hand motor function, depending on the reorganization of interhemispheric connectivity.
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Affiliation(s)
- Lukas Hensel
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany
| | - Fabian Lange
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany
| | - Caroline Tscherpel
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Shivakumar Viswanathan
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Jana Freytag
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany
| | - Lukas J Volz
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany
| | - Simon B Eickhoff
- Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany,Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany
| | - Gereon R Fink
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Christian Grefkes
- Correspondence to: Christian Grefkes Institute of Neuroscience and Medicine - Cognitive Neuroscience (INM-3) Research Centre Juelich, Juelich, Germany E-mail:
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18
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Obando C, Rosso C, Siegel J, Corbetta M, De Vico Fallani F. Temporal exponential random graph models of longitudinal brain networks after stroke. J R Soc Interface 2022; 19:20210850. [PMID: 35232279 PMCID: PMC8889176 DOI: 10.1098/rsif.2021.0850] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Plasticity after stroke is a complex phenomenon. Functional reorganization occurs not only in the perilesional tissue but throughout the brain. However, the local connection mechanisms generating such global network changes remain largely unknown. To address this question, time must be considered as a formal variable of the problem rather than a simple repeated observation. Here, we hypothesized that the presence of temporal connection motifs, such as the formation of temporal triangles (T) and edges (E) over time, would explain large-scale brain reorganization after stroke. To test our hypothesis, we adopted a statistical framework based on temporal exponential random graph models (tERGMs), where the aforementioned temporal motifs were implemented as parameters and adapted to capture global network changes after stroke. We first validated the performance on synthetic time-varying networks as compared to standard static approaches. Then, using real functional brain networks, we showed that estimates of tERGM parameters were sufficient to reproduce brain network changes from 2 weeks to 1 year after stroke. These temporal connection signatures, reflecting within-hemisphere segregation (T) and between hemisphere integration (E), were associated with patients' future behaviour. In particular, interhemispheric temporal edges significantly correlated with the chronic language and visual outcome in subcortical and cortical stroke, respectively. Our results indicate the importance of time-varying connection properties when modelling dynamic complex systems and provide fresh insights into modelling of brain network mechanisms after stroke.
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Affiliation(s)
- Catalina Obando
- Sorbonne Université, Institut du Cerveau, Paris Brain Institute, ICM, CNRS, Inria, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, 75013 Paris, France
| | - Charlotte Rosso
- Sorbonne Université, Institut du Cerveau, Paris Brain Institute, ICM, CNRS, Inria, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, 75013 Paris, France,AP-HP, Urgences Cerebro-Vasculaires, Hopital Pitie-Salpetriere, Paris, France,ICM Infrastructure Stroke Network, STAR team, Hopital Pitie-Salpetriere, Paris, France
| | - Joshua Siegel
- Department of Psychiatry, Washington University, St Louis, MO, USA
| | - Maurizio Corbetta
- Department of Neuroscience and Padova Neuroscience Center, University of Padova, Padova, Italy,Venetian Institute of Molecular Medicine (VIMM), Padova, Italy
| | - Fabrizio De Vico Fallani
- Sorbonne Université, Institut du Cerveau, Paris Brain Institute, ICM, CNRS, Inria, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, 75013 Paris, France
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19
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Michiels L, Mertens N, Thijs L, Radwan A, Sunaert S, Vandenbulcke M, Verheyden G, Koole M, Van Laere K, Lemmens R. Changes in synaptic density in the subacute phase after ischemic stroke: A 11C-UCB-J PET/MR study. J Cereb Blood Flow Metab 2022; 42:303-314. [PMID: 34550834 PMCID: PMC9122519 DOI: 10.1177/0271678x211047759] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Functional alterations after ischemic stroke have been described with Magnetic Resonance Imaging (MRI) and perfusion Positron Emission Tomography (PET), but no data on in vivo synaptic changes exist. Recently, imaging of synaptic density became available by targeting synaptic vesicle protein 2 A, a protein ubiquitously expressed in all presynaptic nerve terminals. We hypothesized that in subacute ischemic stroke loss of synaptic density can be evaluated with 11C-UCB-J PET in the ischemic tissue and that alterations in synaptic density can be present in brain regions beyond the ischemic core. We recruited ischemic stroke patients to undergo 11C-UCB-J PET/MR imaging 21 ± 8 days after stroke onset to investigate regional 11C-UCB-J SUVR (standardized uptake value ratio). There was a decrease (but residual signal) of 11C-UCB-J SUVR within the lesion of 16 stroke patients compared to 40 healthy controls (ratiolesion/controls = 0.67 ± 0.28, p = 0.00023). Moreover, 11C-UCB-J SUVR was lower in the non-lesioned tissue of the affected hemisphere compared to the unaffected hemisphere (ΔSUVR = -0.17, p = 0.0035). The contralesional cerebellar hemisphere showed a lower 11C-UCB-J SUVR compared to the ipsilesional cerebellar hemisphere (ΔSUVR = -0.14, p = 0.0048). In 8 out of 16 patients, the asymmetry index suggested crossed cerebellar diaschisis. Future research is required to longitudinally study these changes in synaptic density and their association with outcome.
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Affiliation(s)
- Laura Michiels
- Department of Neurosciences, KU Leuven, Leuven, Belgium.,VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium.,Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Nathalie Mertens
- Nuclear Medicine and Molecular Imaging, 26657KU Leuven, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Liselot Thijs
- Department of Rehabilitation Sciences, 26657KU Leuven, KU Leuven, Leuven, Belgium
| | - Ahmed Radwan
- Translational MRI, 26657KU Leuven, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Stefan Sunaert
- Translational MRI, 26657KU Leuven, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.,Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Mathieu Vandenbulcke
- VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium.,Department of Geriatric Psychiatry, University Psychiatric Centre, KU Leuven, Leuven, Belgium
| | - Geert Verheyden
- Department of Rehabilitation Sciences, 26657KU Leuven, KU Leuven, Leuven, Belgium
| | - Michel Koole
- Nuclear Medicine and Molecular Imaging, 26657KU Leuven, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Koen Van Laere
- Nuclear Medicine and Molecular Imaging, 26657KU Leuven, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.,Division of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Robin Lemmens
- Department of Neurosciences, KU Leuven, Leuven, Belgium.,VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium.,Department of Neurology, University Hospitals Leuven, Leuven, Belgium
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20
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Motolese F, Capone F, Di Lazzaro V. New tools for shaping plasticity to enhance recovery after stroke. HANDBOOK OF CLINICAL NEUROLOGY 2022; 184:299-315. [PMID: 35034743 DOI: 10.1016/b978-0-12-819410-2.00016-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Stroke is the second most common cause of death worldwide and its prevalence is projected to increase in the coming years in parallel with the increase of life expectancy. Despite the great improvements in the management of the acute phase of stroke, some residual disability persists in most patients thus requiring rehabilitation. One third of patients do not reach the maximal recovery potential and different approaches have been explored with the aim to boost up recovery. In this regard, noninvasive brain stimulation techniques have been widely used to induce neuroplasticity phenomena. Different protocols of repetitive transcranial magnetic stimulation (rTMS) and transcranial electrical stimulation (tES) can induce short- and long-term changes of synaptic excitability and are promising tools for enhancing recovery in stroke patients. New options for neuromodulation are currently under investigation. They include: vagal nerve stimulation (VNS) that can be delivered invasively, with implanted stimulators and noninvasively with transcutaneous VNS (tVNS); and extremely low-frequency (1-300Hz) magnetic fields. This chapter will provide an overview on the new techniques that are used for neuroprotection and for enhancing recovery after stroke.
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Affiliation(s)
- Francesco Motolese
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Fioravante Capone
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Vincenzo Di Lazzaro
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy.
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21
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Pavlova E, Semenov R, Pavlova-Deb M, Guekht A. Transcranial direct current stimulation of the premotor cortex aimed to improve hand motor function in chronic stroke patients. Brain Res 2022; 1780:147790. [DOI: 10.1016/j.brainres.2022.147790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 12/16/2021] [Accepted: 01/12/2022] [Indexed: 11/27/2022]
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22
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Liew SL, Lin DJ, Cramer SC. Interventions to Improve Recovery After Stroke. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00061-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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23
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Ursino M, Ricci G, Astolfi L, Pichiorri F, Petti M, Magosso E. A Novel Method to Assess Motor Cortex Connectivity and Event Related Desynchronization Based on Mass Models. Brain Sci 2021; 11:brainsci11111479. [PMID: 34827478 PMCID: PMC8615480 DOI: 10.3390/brainsci11111479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 10/28/2021] [Accepted: 11/03/2021] [Indexed: 11/16/2022] Open
Abstract
Knowledge of motor cortex connectivity is of great value in cognitive neuroscience, in order to provide a better understanding of motor organization and its alterations in pathological conditions. Traditional methods provide connectivity estimations which may vary depending on the task. This work aims to propose a new method for motor connectivity assessment based on the hypothesis of a task-independent connectivity network, assuming nonlinear behavior. The model considers six cortical regions of interest (ROIs) involved in hand movement. The dynamics of each region is simulated using a neural mass model, which reproduces the oscillatory activity through the interaction among four neural populations. Parameters of the model have been assigned to simulate both power spectral densities and coherences of a patient with left-hemisphere stroke during resting condition, movement of the affected, and movement of the unaffected hand. The presented model can simulate the three conditions using a single set of connectivity parameters, assuming that only inputs to the ROIs change from one condition to the other. The proposed procedure represents an innovative method to assess a brain circuit, which does not rely on a task-dependent connectivity network and allows brain rhythms and desynchronization to be assessed on a quantitative basis.
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Affiliation(s)
- Mauro Ursino
- Department of Electrical, Electronic and Information Engineering Guglielmo Marconi, Campus of Cesena, University of Bologna, Via Dell’Università 50, 47521 Cesena, Italy; (G.R.); (E.M.)
- Correspondence:
| | - Giulia Ricci
- Department of Electrical, Electronic and Information Engineering Guglielmo Marconi, Campus of Cesena, University of Bologna, Via Dell’Università 50, 47521 Cesena, Italy; (G.R.); (E.M.)
| | - Laura Astolfi
- Department of Computer, Control and Management Engineering, Sapienza University of Rome, Via Ariosto, 25, 00185 Roma, Italy; (L.A.); (M.P.)
- Fondazione Santa Lucia, IRCCS Via Ardeatina 306/354, 00179 Roma, Italy;
| | | | - Manuela Petti
- Department of Computer, Control and Management Engineering, Sapienza University of Rome, Via Ariosto, 25, 00185 Roma, Italy; (L.A.); (M.P.)
- Fondazione Santa Lucia, IRCCS Via Ardeatina 306/354, 00179 Roma, Italy;
| | - Elisa Magosso
- Department of Electrical, Electronic and Information Engineering Guglielmo Marconi, Campus of Cesena, University of Bologna, Via Dell’Università 50, 47521 Cesena, Italy; (G.R.); (E.M.)
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24
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Vargas P, Sitaram R, Sepúlveda P, Montalba C, Rana M, Torres R, Tejos C, Ruiz S. Weighted neurofeedback facilitates greater self-regulation of functional connectivity between the primary motor area and cerebellum. J Neural Eng 2021; 18. [PMID: 34587606 DOI: 10.1088/1741-2552/ac2b7e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 09/29/2021] [Indexed: 11/12/2022]
Abstract
Objective.Brain-computer interface (BCI) is a tool that can be used to train brain self-regulation and influence specific activity patterns, including functional connectivity, through neurofeedback. The functional connectivity of the primary motor area (M1) and cerebellum play a critical role in motor recovery after a brain injury, such as stroke. The objective of this study was to determine the feasibility of achieving control of the functional connectivity between M1 and the cerebellum in healthy subjects. Additionally, we aimed to compare the brain self-regulation of two different feedback modalities and their effects on motor performance.Approach.Nine subjects were trained with a real-time functional magnetic resonance imaging BCI system. Two groups were conformed: equal feedback group (EFG), which received neurofeedback that weighted the contribution of both regions of interest (ROIs) equally, and weighted feedback group (WFG) that weighted each ROI differentially (30% cerebellum; 70% M1). The magnitude of the brain activity induced by self-regulation was evaluated with the blood-oxygen-level-dependent (BOLD) percent change (BPC). Functional connectivity was assessed using temporal correlations between the BOLD signal of both ROIs. A finger-tapping task was included to evaluate the effect of brain self-regulation on motor performance.Main results.A comparison between the feedback modalities showed that WFG achieved significantly higher BPC in M1 than EFG. The functional connectivity between ROIs during up-regulation in WFG was significantly higher than EFG. In general, both groups showed better tapping speed in the third session compared to the first. For WFG, there were significant correlations between functional connectivity and tapping speed.Significance.The results show that it is possible to train healthy individuals to control M1-cerebellum functional connectivity with rtfMRI-BCI. Besides, it is also possible to use a weighted feedback approach to facilitate a higher activity of one region over another.
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Affiliation(s)
- Patricia Vargas
- Interdisciplinary Center for Neuroscience, Department of Psychiatry, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Laboratory for Brain-Machine Interfaces and Neuromodulation, Pontificia Universidad Católica de Chile, Santiago, Chile.,Biomedical Imaging Center, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ranganatha Sitaram
- Interdisciplinary Center for Neuroscience, Department of Psychiatry, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Laboratory for Brain-Machine Interfaces and Neuromodulation, Pontificia Universidad Católica de Chile, Santiago, Chile.,Institute for Biological and Medical Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile.,Multimodal Functional Brain Imaging Hub, St. Jude Children's Research Hospital, Memphis, TN, United States of America
| | - Pradyumna Sepúlveda
- Institute of Cognitive Neuroscience (ICN), University College London, London, England
| | - Cristian Montalba
- Biomedical Imaging Center, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mohit Rana
- Interdisciplinary Center for Neuroscience, Department of Psychiatry, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Laboratory for Brain-Machine Interfaces and Neuromodulation, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rafael Torres
- Interdisciplinary Center for Neuroscience, Department of Psychiatry, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristián Tejos
- Biomedical Imaging Center, Pontificia Universidad Católica de Chile, Santiago, Chile.,Department of Electrical Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sergio Ruiz
- Interdisciplinary Center for Neuroscience, Department of Psychiatry, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Laboratory for Brain-Machine Interfaces and Neuromodulation, Pontificia Universidad Católica de Chile, Santiago, Chile
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25
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Milosevic M, Nakanishi T, Sasaki A, Yamaguchi A, Nomura T, Popovic MR, Nakazawa K. Cortical Re-organization After Traumatic Brain Injury Elicited Using Functional Electrical Stimulation Therapy: A Case Report. Front Neurosci 2021; 15:693861. [PMID: 34489624 PMCID: PMC8417438 DOI: 10.3389/fnins.2021.693861] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/26/2021] [Indexed: 01/17/2023] Open
Abstract
Functional electrical stimulation therapy (FEST) can improve motor function after neurological injuries. However, little is known about cortical changes after FEST and weather it can improve motor function after traumatic brain injury (TBI). Our study examined cortical changes and motor improvements in one male participant with chronic TBI suffering from mild motor impairment affecting the right upper-limb during 3-months of FEST and during 3-months follow-up. In total, 36 sessions of FEST were applied to enable upper-limb grasping and reaching movements. Short-term assessments carried out using transcranial magnetic stimulation (TMS) showed reduced cortical silent period (CSP), indicating cortical and/or subcortical inhibition after each intervention. At the same time, no changes in motor evoked potentials (MEPs) were observed. Long-term assessments showed increased MEP corticospinal excitability after 12-weeks of FEST, which seemed to remain during both follow-ups, while no changes in CSP were observed. Similarly, long-term assessments using TMS mapping showed larger hand MEP area in the primary motor cortex (M1) after 12-weeks of FEST as well as during both follow-ups. Corroborating TMS results, functional magnetic resonance imaging (fMRI) data showed M1 activations increased during hand grip and finger pinch tasks after 12-weeks of FEST, while gradual reduction of activity compared to after the intervention was seen during follow-ups. Widespread changes were seen not only in the M1, but also sensory, parietal rostroventral, supplementary motor, and premotor areas in both contralateral and ipsilateral hemispheres, especially during the finger pinch task. Drawing test performance showed improvements after the intervention and during follow-ups. Our findings suggest that task-specific and repetitive FEST can effectively increase cortical activations by integrating voluntary motor commands and sensorimotor network through functional electrical stimulation (FES). Overall, our results demonstrated cortical re-organization in an individual with chronic TBI after FEST.
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Affiliation(s)
- Matija Milosevic
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, Osaka, Japan
| | - Tomoya Nakanishi
- Department of Life Sciences, Graduate School of Arts and Sciences, University of Tokyo, Tokyo, Japan.,Japan Society for the Promotion of Science, Tokyo, Japan
| | - Atsushi Sasaki
- Department of Life Sciences, Graduate School of Arts and Sciences, University of Tokyo, Tokyo, Japan.,Japan Society for the Promotion of Science, Tokyo, Japan
| | - Akiko Yamaguchi
- Department of Life Sciences, Graduate School of Arts and Sciences, University of Tokyo, Tokyo, Japan
| | - Taishin Nomura
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, Osaka, Japan
| | - Milos R Popovic
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada.,KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,CRANIA, University Health Network, Toronto, ON, Canada
| | - Kimitaka Nakazawa
- Department of Life Sciences, Graduate School of Arts and Sciences, University of Tokyo, Tokyo, Japan
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26
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Hao J, Xie H, Harp K, Chen Z, Siu KC. Effects of virtual reality intervention on neural plasticity in stroke rehabilitation: a systematic review. Arch Phys Med Rehabil 2021; 103:523-541. [PMID: 34352269 DOI: 10.1016/j.apmr.2021.06.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To systematically review and examine the current literature regarding the effects of Virtual Reality (VR)-based rehabilitation on neural plasticity changes in stroke survivors. DATA SOURCES Six bioscience and engineering databases were searched, including Medline via Ebsco, Embase, PsycINFO, IEEE Explore, Cumulative Index of Nursing and Allied Health, and Scopus. STUDY SELECTION Studies reporting on the pre-post assessment of a VR intervention with neural plasticity measures published between 2000-2021 were included. DATA EXTRACTION Two independent reviewers conducted study selection, data extraction and quality assessment. Methodological quality of controlled trials was assessed using the Physiotherapy Evidence Database scale. Risk of bias of pre-post intervention and case studies was evaluated using the National Institutes of Health Quality Assessment Tool. DATA SYNTHESIS Twenty-seven studies (Total n=232) were included. Seven randomized controlled trials were rated as good quality while the two clinical controlled trials were moderate. Based on the risk of bias assessment, one pre-post study and one case study were graded as good quality, one pre-post study and one case study were poor, the other 14 studies were all at fair. After the VR intervention, main neurophysiological findings across studies include: (1) improved interhemispheric balance, (2) enhanced cortical connectivity, (3) increased cortical mapping of the affected limb muscles, (4) the improved neural plasticity measures were correlated to the enhanced behavior outcomes, (5) increased activation of regions in frontal cortex and (6) the mirror neuron system may be involved. CONCLUSIONS Virtual reality induced changes in neural plasticity for stroke survivors. Positive correlations between the neural plasticity changes and functional recovery elucidates the mechanisms of VR's therapeutic effects in stroke rehabilitation. This review prompts systematic understanding of the neurophysiological mechanisms of VR-based stroke rehabilitation and summarizes the emerging evidence for ongoing innovation of VR systems and application in stroke rehabilitation.
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Affiliation(s)
- Jie Hao
- Division of Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, United States
| | - Haoyu Xie
- Division of Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, United States
| | - Kimberly Harp
- Leon S. McGoogan Health Sciences Library, University of Nebraska Medical Center, Omaha, United States
| | - Zhen Chen
- Department of Neurorehabilitation, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Ka-Chun Siu
- Division of Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, United States.
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27
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Dressing A, Kaller CP, Martin M, Nitschke K, Kuemmerer D, Beume LA, Schmidt CSM, Musso M, Urbach H, Rijntjes M, Weiller C. Anatomical correlates of recovery in apraxia: A longitudinal lesion-mapping study in stroke patients. Cortex 2021; 142:104-121. [PMID: 34265734 DOI: 10.1016/j.cortex.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 05/07/2021] [Accepted: 06/01/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study investigates the clinical course of recovery of apraxia after left-hemisphere stroke and the underlying neuroanatomical correlates for persisting or recovering deficits in relation to the major processing streams in the network for motor cognition. METHODS 90 patients were examined during the acute (4.74 ± 2.73 days) and chronic (14.3 ± 15.39 months) stage after left-hemisphere stroke for deficits in meaningless imitation, as well as production and conceptual errors in tool use pantomime. Lesion correlates for persisting or recovering deficits were analyzed with an extension of the non-parametric Brunner-Munzel rank-order test for multi-factorial designs (two-way repeated-measures ANOVA) using acute images. RESULTS Meaningless imitation and tool use production deficits persisted into the chronic stage. Conceptual errors in tool use pantomime showed an almost complete recovery. Imitation errors persisted after occipitotemporal and superior temporal lesions in the dorso-dorsal stream. Chronic pantomime production errors were related to the supramarginal gyrus, the key structure of the ventro-dorsal stream. More anterior lesions in the ventro-dorsal stream (ventral premotor cortex) were additionally associated with poor recovery of production errors in pantomime. Conceptual errors in pantomime after temporal and supramarginal gyrus lesions persisted into the chronic stage. However, they resolved completely when related to angular gyrus or insular lesions. CONCLUSION The diverging courses of recovery in different apraxia tasks can be related to different mechanisms. Critical lesions to key structures of the network or entrance areas of the processing streams lead to persisting deficits in the corresponding tasks. Contrary, lesions located outside the core network but inducing a temporary network dysfunction allow good recovery e.g., of conceptual errors in pantomime. The identification of lesion correlates for different long-term recovery patterns in apraxia might also allow early clinical prediction of the course of recovery.
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Affiliation(s)
- Andrea Dressing
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany.
| | - Christoph P Kaller
- Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany; Dept. of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Markus Martin
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany
| | - Kai Nitschke
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dorothee Kuemmerer
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lena-A Beume
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Charlotte S M Schmidt
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Mariacristina Musso
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany
| | - Horst Urbach
- Dept. of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michel Rijntjes
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Cornelius Weiller
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany
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28
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Braun RG, Wittenberg GF. Motor Recovery: How Rehabilitation Techniques and Technologies Can Enhance Recovery and Neuroplasticity. Semin Neurol 2021; 41:167-176. [PMID: 33663001 DOI: 10.1055/s-0041-1725138] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
There are now a large number of technological and methodological approaches to the rehabilitation of motor function after stroke. It is important to employ these approaches in a manner that is tailored to specific patient impairments and desired functional outcomes, while avoiding the hype of overly broad or unsubstantiated claims for efficacy. Here we review the evidence for poststroke plasticity, including therapy-related plasticity and functional imaging data. Early demonstrations of remapping in somatomotor and somatosensory representations have been succeeded by findings of white matter plasticity and a focus on activity-dependent changes in neuronal properties and connections. The methods employed in neurorehabilitation have their roots in early understanding of neuronal circuitry and plasticity, and therapies involving large numbers of repetitions, such as robotic therapy and constraint-induced movement therapy (CIMT), change measurable nervous systems properties. Other methods that involve stimulation of brain and peripheral excitable structures have the potential to harness neuroplastic mechanisms, but remain experimental. Gaps in our understanding of the neural substrates targeted by neurorehabilitation technology and techniques remain, preventing their prescriptive application in individual patients as well as their general refinement. However, with ongoing research-facilitated in part by technologies that can capture quantitative information about motor performance-this gap is narrowing. These research approaches can improve efforts to attain the shared goal of better functional recovery after stroke.
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Affiliation(s)
- Robynne G Braun
- Department of Neurology, University of Maryland School of Medicine, University of Maryland Rehabilitation & Orthopaedic Institute, Baltimore, Maryland
| | - George F Wittenberg
- Department of Neurology, Rehab Neural Engineering Labs, Center for the Neural Basis of Cognition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Human Engineering Research Laboratory, Geriatrics Research Education and Clinical Center, VA Pittsburgh HealthCare System, Pittsburgh, Pennsylvania
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29
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Affiliation(s)
- Helen Mayberg
- University of Texas Health Science Center San Antonio, Texas
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30
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Lin DJ, Cramer SC. Principles of Neural Repair and Their Application to Stroke Recovery Trials. Semin Neurol 2021; 41:157-166. [PMID: 33663003 DOI: 10.1055/s-0041-1725140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Neural repair is the underlying therapeutic strategy for many treatments currently under investigation to improve recovery after stroke. Repair-based therapies are distinct from acute stroke strategies: instead of salvaging threatened brain tissue, the goal is to improve behavioral outcomes on the basis of experience-dependent brain plasticity. Furthermore, timing, concomitant behavioral experiences, modality specific outcome measures, and careful patient selection are fundamental concepts for stroke recovery trials that can be deduced from principles of neural repair. Here we discuss core principles of neural repair and their implications for stroke recovery trials, highlighting related issues from key studies in humans. Research suggests a future in which neural repair therapies are personalized based on measures of brain structure and function, genetics, and lifestyle factors.
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Affiliation(s)
- David J Lin
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts.,VA RR&D Center for Neurorestoration and Neurotechnology, Rehabilitation R&D Service, Department of VA Medical Center, Providence, Rhode Island
| | - Steven C Cramer
- Department of Neurology, University of California, Los Angeles, California.,California Rehabilitation Institute, Los Angeles, California
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31
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Binder E, Leimbach M, Pool EM, Volz LJ, Eickhoff SB, Fink GR, Grefkes C. Cortical reorganization after motor stroke: A pilot study on differences between the upper and lower limbs. Hum Brain Mapp 2020; 42:1013-1033. [PMID: 33165996 PMCID: PMC7856649 DOI: 10.1002/hbm.25275] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/03/2020] [Accepted: 09/29/2020] [Indexed: 11/11/2022] Open
Abstract
Stroke patients suffering from hemiparesis may show substantial recovery in the first months poststroke due to neural reorganization. While reorganization driving improvement of upper hand motor function has been frequently investigated, much less is known about the changes underlying recovery of lower limb function. We, therefore, investigated neural network dynamics giving rise to movements of both the hands and feet in 12 well-recovered left-hemispheric chronic stroke patients and 12 healthy participants using a functional magnetic resonance imaging sparse sampling design and dynamic causal modeling (DCM). We found that the level of neural activity underlying movements of the affected right hand and foot positively correlated with residual motor impairment, in both ipsilesional and contralesional premotor as well as left primary motor (M1) regions. Furthermore, M1 representations of the affected limb showed significantly stronger increase in BOLD activity compared to healthy controls and compared to the respective other limb. DCM revealed reduced endogenous connectivity of M1 of both limbs in patients compared to controls. However, when testing for the specific effect of movement on interregional connectivity, interhemispheric inhibition of the contralesional M1 during movements of the affected hand was not detected in patients whereas no differences in condition-dependent connectivity were found for foot movements compared to controls. In contrast, both groups featured positive interhemispheric M1 coupling, that is, facilitation of neural activity, mediating movements of the affected foot. These exploratory findings help to explain why functional recovery of the upper and lower limbs often develops differently after stroke, supporting limb-specific rehabilitative strategies.
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Affiliation(s)
- Ellen Binder
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-1, INM-3), Research Centre Juelich, Juelich, Germany
| | - Martha Leimbach
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Eva-Maria Pool
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-1, INM-3), Research Centre Juelich, Juelich, Germany
| | - Lukas J Volz
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Department of Psychological and Brain Sciences, University of California, Santa Barbara, California, USA
| | - Simon B Eickhoff
- Institute of Neuroscience and Medicine (INM-1, INM-3), Research Centre Juelich, Juelich, Germany.,Institute for Clinical Neuroscience, Heinrich-Heine-University, Duesseldorf, Germany
| | - Gereon R Fink
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-1, INM-3), Research Centre Juelich, Juelich, Germany
| | - Christian Grefkes
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-1, INM-3), Research Centre Juelich, Juelich, Germany
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Milosevic M, Marquez-Chin C, Masani K, Hirata M, Nomura T, Popovic MR, Nakazawa K. Why brain-controlled neuroprosthetics matter: mechanisms underlying electrical stimulation of muscles and nerves in rehabilitation. Biomed Eng Online 2020; 19:81. [PMID: 33148270 PMCID: PMC7641791 DOI: 10.1186/s12938-020-00824-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 10/10/2020] [Indexed: 12/11/2022] Open
Abstract
Delivering short trains of electric pulses to the muscles and nerves can elicit action potentials resulting in muscle contractions. When the stimulations are sequenced to generate functional movements, such as grasping or walking, the application is referred to as functional electrical stimulation (FES). Implications of the motor and sensory recruitment of muscles using FES go beyond simple contraction of muscles. Evidence suggests that FES can induce short- and long-term neurophysiological changes in the central nervous system by varying the stimulation parameters and delivery methods. By taking advantage of this, FES has been used to restore voluntary movement in individuals with neurological injuries with a technique called FES therapy (FEST). However, long-lasting cortical re-organization (neuroplasticity) depends on the ability to synchronize the descending (voluntary) commands and the successful execution of the intended task using a FES. Brain-computer interface (BCI) technologies offer a way to synchronize cortical commands and movements generated by FES, which can be advantageous for inducing neuroplasticity. Therefore, the aim of this review paper is to discuss the neurophysiological mechanisms of electrical stimulation of muscles and nerves and how BCI-controlled FES can be used in rehabilitation to improve motor function.
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Affiliation(s)
- Matija Milosevic
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, 1-3 Machikaneyama-cho, Toyonaka, Osaka, 560-8531, Japan.
| | - Cesar Marquez-Chin
- Institute of Biomedical Engineering, University of Toronto, 164 College Street, Toronto, ON, M5S 3G9, Canada
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, 520 Sutherland Drive, Toronto, ON, M4G 3V9, Canada
- CRANIA, University Health Network & University of Toronto, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Kei Masani
- Institute of Biomedical Engineering, University of Toronto, 164 College Street, Toronto, ON, M5S 3G9, Canada
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, 520 Sutherland Drive, Toronto, ON, M4G 3V9, Canada
- CRANIA, University Health Network & University of Toronto, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Masayuki Hirata
- Department of Neurological Diagnosis and Restoration, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Taishin Nomura
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, 1-3 Machikaneyama-cho, Toyonaka, Osaka, 560-8531, Japan
| | - Milos R Popovic
- Institute of Biomedical Engineering, University of Toronto, 164 College Street, Toronto, ON, M5S 3G9, Canada
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, 520 Sutherland Drive, Toronto, ON, M4G 3V9, Canada
- CRANIA, University Health Network & University of Toronto, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Kimitaka Nakazawa
- Department of Life Sciences, Graduate School of Arts and Sciences, University of Tokyo, 3-8-1 Komaba, Meguro, Tokyo, 153-8902, Japan
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Balan PF, Gerits A, Zhu Q, Kolster H, Orban GA, Wardak C, Vanduffel W. Fast Compensatory Functional Network Changes Caused by Reversible Inactivation of Monkey Parietal Cortex. Cereb Cortex 2020; 29:2588-2606. [PMID: 29901747 DOI: 10.1093/cercor/bhy128] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 04/30/2018] [Accepted: 05/09/2018] [Indexed: 11/13/2022] Open
Abstract
The brain has a remarkable capacity to recover after lesions. However, little is known about compensatory neural adaptations at the systems level. We addressed this question by investigating behavioral and (correlated) functional changes throughout the cortex that are induced by focal, reversible inactivations. Specifically, monkeys performed a demanding covert spatial attention task while the lateral intraparietal area (LIP) was inactivated with muscimol and whole-brain fMRI activity was recorded. The inactivation caused LIP-specific decreases in task-related fMRI activity. In addition, these local effects triggered large-scale network changes. Unlike most studies in which animals were mainly passive relative to the stimuli, we observed heterogeneous effects with more profound muscimol-induced increases of task-related fMRI activity in areas connected to LIP, especially FEF. Furthermore, in areas such as FEF and V4, muscimol-induced changes in fMRI activity correlated with changes in behavioral performance. Notably, the activity changes in remote areas did not correlate with the decreased activity at the site of the inactivation, suggesting that such changes arise via neuronal mechanisms lying in the intact portion of the functional task network, with FEF a likely key player. The excitation-inhibition dynamics unmasking existing excitatory connections across the functional network might initiate these rapid adaptive changes.
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Affiliation(s)
- Puiu F Balan
- Laboratorium voor Neuro- en Psychofysiologie, KU Leuven Medical School, Campus Gasthuisberg, Leuven, Belgium.,Leuven Brain Institute, Leuven, Belgium
| | - Annelies Gerits
- Laboratorium voor Neuro- en Psychofysiologie, KU Leuven Medical School, Campus Gasthuisberg, Leuven, Belgium
| | - Qi Zhu
- Laboratorium voor Neuro- en Psychofysiologie, KU Leuven Medical School, Campus Gasthuisberg, Leuven, Belgium.,Leuven Brain Institute, Leuven, Belgium
| | - Hauke Kolster
- Laboratorium voor Neuro- en Psychofysiologie, KU Leuven Medical School, Campus Gasthuisberg, Leuven, Belgium
| | - Guy A Orban
- Laboratorium voor Neuro- en Psychofysiologie, KU Leuven Medical School, Campus Gasthuisberg, Leuven, Belgium.,Department of Medicine and Surgery, University of Parma, via Volturno, 39E Parma, Italy
| | - Claire Wardak
- Laboratorium voor Neuro- en Psychofysiologie, KU Leuven Medical School, Campus Gasthuisberg, Leuven, Belgium
| | - Wim Vanduffel
- Laboratorium voor Neuro- en Psychofysiologie, KU Leuven Medical School, Campus Gasthuisberg, Leuven, Belgium.,Leuven Brain Institute, Leuven, Belgium.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.,Department of Radiology, Harvard Medical School, Charlestown, MA, USA
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Neurofeedback of scalp bi-hemispheric EEG sensorimotor rhythm guides hemispheric activation of sensorimotor cortex in the targeted hemisphere. Neuroimage 2020; 223:117298. [PMID: 32828924 DOI: 10.1016/j.neuroimage.2020.117298] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/04/2020] [Accepted: 08/16/2020] [Indexed: 12/26/2022] Open
Abstract
Oscillatory electroencephalographic (EEG) activity is associated with the excitability of cortical regions. Visual feedback of EEG-oscillations may promote sensorimotor cortical activation, but its spatial specificity is not truly guaranteed due to signal interaction among interhemispheric brain regions. Guiding spatially specific activation is important for facilitating neural rehabilitation processes. Here, we tested whether users could explicitly guide sensorimotor cortical activity to the contralateral or ipsilateral hemisphere using a spatially bivariate EEG-based neurofeedback that monitors bi-hemispheric sensorimotor cortical activities for healthy participants. Two different motor imageries (shoulder and hand MIs) were selected to see how differences in intrinsic corticomuscular projection patterns might influence activity lateralization. We showed sensorimotor cortical activities during shoulder, but not hand MI, can be brought under ipsilateral control with guided EEG-based neurofeedback. These results are compatible with neuroanatomy; shoulder muscles are innervated bihemispherically, whereas hand muscles are mostly innervated contralaterally. We demonstrate the neuroanatomically-inspired approach enables us to investigate potent neural remodeling functions that underlie EEG-based neurofeedback via a BCI.
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35
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Human brain connectivity: Clinical applications for clinical neurophysiology. Clin Neurophysiol 2020; 131:1621-1651. [DOI: 10.1016/j.clinph.2020.03.031] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 03/13/2020] [Accepted: 03/17/2020] [Indexed: 12/12/2022]
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Guo Z, Qian Q, Wong K, Zhu H, Huang Y, Hu X, Zheng Y. Altered Corticomuscular Coherence (CMCoh) Pattern in the Upper Limb During Finger Movements After Stroke. Front Neurol 2020; 11:410. [PMID: 32477257 PMCID: PMC7240065 DOI: 10.3389/fneur.2020.00410] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/20/2020] [Indexed: 01/15/2023] Open
Abstract
Background: Proximal compensation to the distal movements is commonly observed in the affected upper extremity (UE) of patients with chronic stroke. However, the cortical origin of this compensation has not been well-understood. In this study, corticomuscular coherence (CMCoh) and electromyography (EMG) analysis were adopted to investigate the corticomuscular coordinating pattern of proximal UE compensatory activities when conducting distal UE movements in chronic stroke. Method: Fourteen chronic stroke subjects and 10 age-matched unimpaired controls conducted isometric finger extensions and flexions at 20 and 40% of maximal voluntary contractions. Electroencephalogram (EEG) data were recorded from the sensorimotor area and EMG signals were captured from extensor digitorum (ED), flexor digitorum (FD), triceps brachii (TRI), and biceps brachii (BIC) to investigate the CMCoh peak values in the Beta band. EMG parameters, i.e., the EMG activation level and co-contraction index (CI), were analyzed to evaluate the compensatory muscular patterns in the upper limb. Result: The peak CMCoh with statistical significance (P < 0.05) was found shifted from the ipsilesional side to the contralesional side in the proximal UE muscles, while to the central regions in the distal UE muscle in chronic strokes. Significant differences (P < 0.05) were observed in both peak ED and FD CMCohs during finger extensions between the two groups. The unimpaired controls exhibited significant intragroup differences between 20 and 40% levels in extensions for peak ED and FD CMCohs (P < 0.05). The stroke subjects showed significant differences in peak TRI and BIC CMCohs (P < 0.01). No significant inter- or intra-group difference was observed in peak CMCoh during finger flexions. EMG parameters showed higher EMG activation levels in TRI and BIC muscles (P < 0.05), and higher CI values in the muscle pairs involving TRI and BIC during all the extension and flexion tasks in the stroke group than those in the control group (P < 0.05). Conclusion: The post-stroke proximal muscular compensations from the elbow to the finger movements were cortically originated, with the center mainly located in the contralesional hemisphere.
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Affiliation(s)
- Ziqi Guo
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Qiuyang Qian
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Kiufung Wong
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Hanlin Zhu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Yanhuan Huang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Xiaoling Hu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Yongping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Interhemispheric compensation: A hypothesis of TMS-induced effects on language-related areas. Eur Psychiatry 2020; 23:281-8. [DOI: 10.1016/j.eurpsy.2007.10.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Revised: 10/01/2007] [Accepted: 10/07/2007] [Indexed: 11/22/2022] Open
Abstract
AbstractRepetitive transcranial magnetic stimulation (rTMS) applied over brain regions responsible for language processing is used to curtail potentially auditory hallucinations in schizophrenia patients and to investigate the functional organisation of language-related areas. Variability of effects is, however, marked across studies and between subjects. Furthermore, the mechanisms of action of rTMS are poorly understood.Here, we reviewed different factors related to the structural and functional organisation of the brain that might influence rTMS-induced effects. Then, by analogy with aphasia studies, and the plastic-adaptive changes in both the left and right hemispheres following aphasia recovery, a hypothesis is proposed about rTMS mechanisms over language-related areas (e.g. Wernicke, Broca). We proposed that the local interference induced by rTMS in language-related areas might be analogous to aphasic stroke and might lead to a functional reorganisation in areas connected to the virtual lesion for language recovery.
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38
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Yang H, Zhou H, Miao J. Uncrossed corticospinal tracts in a patient with ichthyosis and hemiparesis: a case report. BMC Neurol 2020; 20:120. [PMID: 32252685 PMCID: PMC7132884 DOI: 10.1186/s12883-020-01698-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 03/26/2020] [Indexed: 11/10/2022] Open
Abstract
Background Anomalies of pyramidal tract decussation are rare phenomena that can be caused by ectodermal dysplasia. Herein, we describe a patient with ichthyosis who exhibited ipsilateral hemiparesis after stroke and whose neuroimaging results showed evidence of motor control being provided by the ipsilateral motor cortex. Case presentation A 24-year-old right-handed man presented with skin abnormalities, sudden-onset left hemiparesis, and dysarthria. He exhibited a mild-to-moderate left-sided weakness (grade 4 on the Medical Research Council scale). Magnetic resonance imaging revealed an acute infarct in the left corona radiata. Diffusion tensor imaging revealed uncrossed corticospinal tracts. Next-generation sequencing identified heterozygous FLG mutations. The patient was diagnosed with cerebral infarction and ichthyosis vulgaris and was treated with aspirin (100 mg/d). His symptoms gradually dissipated. Conclusions This case suggests that pyramidal decussation anomalies can be associated with ichthyosis. Patients with ichthyosis should therefore be evaluated for nerve involvement.
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Affiliation(s)
- Huijia Yang
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, 130021, China
| | - Hongwei Zhou
- Department of Radiology, The First Hospital of Jilin University, Changchun, 130021, China
| | - Jing Miao
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, 130021, China.
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Hamzei F, Erath G, Kücking U, Weiller C, Rijntjes M. Anatomy of brain lesions after stroke predicts effectiveness of mirror therapy. Eur J Neurosci 2020; 52:3628-3641. [PMID: 32031282 DOI: 10.1111/ejn.14698] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/16/2020] [Accepted: 01/31/2020] [Indexed: 11/27/2022]
Abstract
To improve clinical outcome, one longstanding goal in treating stroke patients has been an individual therapy based on functional and anatomical knowledge of the single patient. Therefore, in this study brain imaging of 36 chronic stroke patients was analyzed to identify parameters predicting clinical recovery. T1-weighted MRI was acquired to assess the lesion; functional MRI was used to visualize existing resources; DTI for the integrity of the corticospinal tract (CST) and long association tracts. These data were related to the clinical course. All patients were treated intensively with the mirror therapy (MT) only. After the training period, we analyzed which patient's feature would predict a beneficial course. Patients as a group improved after MT, but according to the fMRI activation of primary sensorimotor cortex (SMC), they could be divided in two groups with very diverging clinical outcome: those with ipsilesional SMC activation showed a noticeable increase of clinical scores, accompanied with ipsilesional activation in the frontal projection areas of the dorsal and ventral streams during action observation in fMRI. Those with contralesional SMC activation had lesions affecting both the dorsal and ventral stream and did not benefit from MT. The outcome for this therapy was not related to affection of CST. This study demonstrates that only in patients in which dorsal and ventral streams are not affected and therefore an interaction between these streams in post- and prerolandic regions is possible, MT can induce clinical improvement. Consequently, knowledge of the anatomical lesion can predict the beneficial course of MT.
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Affiliation(s)
- Farsin Hamzei
- Section of Neurological Rehabilitation, Hans Berger Clinic of Neurology, Department of Neurology, Jena University Hospital, Jena, Germany.,Department of Neurology, Moritz Klinik, Bad Klosterlausnitz, Germany
| | - Gabriele Erath
- Department of Neurology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ursula Kücking
- Department of Neurology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Cornelius Weiller
- Department of Neurology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michel Rijntjes
- Department of Neurology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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40
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Kantak S, Luchmee D. Contralesional motor cortex is causally engaged during more dexterous actions of the paretic hand after stroke-A Preliminary report. Neurosci Lett 2020; 720:134751. [PMID: 31931032 DOI: 10.1016/j.neulet.2020.134751] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/21/2019] [Accepted: 01/08/2020] [Indexed: 12/27/2022]
Abstract
Bilateral activation in motor cortex is observed during paretic hand performance after stroke; however the functional significance of contralesional motor cortex (C-M1) activation is highly debated. Particularly, it is not known if task characteristics such as dexterity influence the causal engagement of C-M1 during paretic hand performance. Transcranial magnetic stimulation (TMS) was used to quantify motor corticospinal physiology of the CM1 projecting to the contralateral resting extensor carpi radialis brevis (ECRB) and first dorsal interosseous (FDI) while eleven participants with unilateral stroke performed unimanual tasks of differing dexterity with their paretic hand. The novel finding was that compared to rest and less dexterous task (LDT), more dexterous task (MDT) performance led to increased corticospinal excitability and decreased intracortical inhibition of the C-M1 projecting to the resting FDI, but not resting ECRB. Further, using trains of repetitive TMS during MDT and LDT, we tested the behavioral relevance of C-M1 for paretic hand performance. Online rTMS perturbation to C-M1, but not to the vertex or sham stimulation led to significantly more movement errors during MDT without consistently affecting LDT performance. The present results argue for a beneficial role of C-M1 for accurate performance during dexterous motor actions with the paretic hand after stroke.
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Affiliation(s)
- Shailesh Kantak
- Neuroplasticity and Motor Behavior Laboratory, Moss Rehabilitation Research Institute, Elkins Park, PA, United States; Department of Physical Therapy, Arcadia University, Glenside, PA, United States.
| | - Dustin Luchmee
- Neuroplasticity and Motor Behavior Laboratory, Moss Rehabilitation Research Institute, Elkins Park, PA, United States
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Tscherpel C, Hensel L, Lemberg K, Vollmer M, Volz LJ, Fink GR, Grefkes C. The differential roles of contralesional frontoparietal areas in cortical reorganization after stroke. Brain Stimul 2020; 13:614-624. [PMID: 32289686 DOI: 10.1016/j.brs.2020.01.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 01/10/2020] [Accepted: 01/28/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Studies examining the contribution of contralesional brain regions to motor recovery after stroke have revealed conflicting results comprising both supporting and disturbing influences. Especially the relevance of contralesional brain regions beyond primary motor cortex (M1) has rarely been studied, particularly concerning the temporal dynamics post-stroke. METHODS We, therefore, used online transcranial magnetic stimulation (TMS) interference to longitudinally assess the role of contralesional (right) frontoparietal areas for recovery of hand motor function after left hemispheric stroke: contralesional M1, contralesional dorsal premotor cortex (dPMC), and contralesional anterior intraparietal sulcus (IPS). Fourteen stroke patients and sixteen age-matched healthy subjects performed motor tasks of varying complexity with their (paretic) right hand. Motor performance was quantified using three-dimensional kinematic data. All patients were assessed twice, (i) in the first week, and (ii) after more than three months post-stroke. RESULTS While we did not observe a significant effect of TMS interference on movement kinematics following the stimulation of contralesional M1 and dPMC in the first week post-stroke, we found improvements of motor performance upon interference with contralesional IPS across motor tasks early after stroke, an effect that persisted into the later phase. By contrast, for dPMC, TMS-induced deterioration of motor performance was only evident three months post-stroke, suggesting that a supportive role of contralesional premotor cortex might evolve with reorganization. CONCLUSION We here highlight time-sensitive and region-specific effects of contralesional frontoparietal areas after left hemisphere stroke, which may influence on neuromodulation regimes aiming at supporting recovery of motor function post-stroke.
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Affiliation(s)
- Caroline Tscherpel
- Department of Neurology, University Hospital Cologne, Cologne, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Lukas Hensel
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Katharina Lemberg
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Mattias Vollmer
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Lukas J Volz
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, University Hospital Cologne, Cologne, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Christian Grefkes
- Department of Neurology, University Hospital Cologne, Cologne, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany.
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Halakoo S, Ehsani F, Hosnian M, Zoghi M, Jaberzadeh S. The comparative effects of unilateral and bilateral transcranial direct current stimulation on motor learning and motor performance: A systematic review of literature and meta-analysis. J Clin Neurosci 2020; 72:8-14. [PMID: 31973922 DOI: 10.1016/j.jocn.2019.12.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 12/01/2019] [Indexed: 11/17/2022]
Abstract
Application of unilateral tDCS (Uni-tDCS) vs. bilateral tDCS (Bi-tDCS) is another important factor that can affect the physiological results of tDCS intervention on motor learning and motor performance. According to the evidence, some studies indicated that motor performance or motor learning are facilitated in healthy individuals by application of the Bi-tDCS more than the Uni-tDCS. On the other hand, some studies showed that there was no significant differences between Uni-tDCS and Bi-tDCS; and both techniques were more effective than sham stimulation. In contrast, the other studies have shown more significant effectiveness of Uni-tDCS than Bi-tDCS on motor performance and motor learning. The aim of this study was to systematically review the studies which investigated the effectiveness of Uni-tDCS and Bi-tDCS intervention on the motor learning and motor performance. The search was performed from databases in the Google Scholar, PubMed, Elsevier, Medline, Ovid and Science Direct with the keywords of motor behavior, motor performance, motor learning, Bi-tDCS or bilateral tDCS, dual tDCS, Uni-tDCS or unilateral tDCS, anodal tDCS and cathodal tDCS from 2000 to 2019. The results indicated that the study population was a key factor in determining study's findings. Data meta-analysis showed that Uni-tDCS was more effective than Bi-tDCS in patients with stroke, while, Bi-tDCS was more effective than Uni-tDCS to improve motor learning and motor performance in healthy individuals.
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Affiliation(s)
- Sara Halakoo
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Fatemeh Ehsani
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran.
| | - Motahareh Hosnian
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Zoghi
- Discipline of Physiotherapy, Department of Rehabilitation, Nutrition and Sport, School of Allied Health, La Trobe University, Bundoora, Victoria 3086, Australia
| | - Shapour Jaberzadeh
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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Gao BY, Xu DS, Liu PL, Li C, Du L, Hua Y, Hu J, Hou JY, Bai YL. Modified constraint-induced movement therapy alters synaptic plasticity of rat contralateral hippocampus following middle cerebral artery occlusion. Neural Regen Res 2020; 15:1045-1057. [PMID: 31823884 PMCID: PMC7034265 DOI: 10.4103/1673-5374.270312] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Modified constraint-induced movement therapy is an effective treatment for neurological and motor impairments in patients with stroke by increasing the use of their affected limb and limiting the contralateral limb. However, the molecular mechanism underlying its efficacy remains unclear. In this study, a middle cerebral artery occlusion (MCAO) rat model was produced by the suture method. Rats received modified constraint-induced movement therapy 1 hour a day for 14 consecutive days, starting from the 7th day after middle cerebral artery occlusion. Day 1 of treatment lasted for 10 minutes at 2 r/min, day 2 for 20 minutes at 2 r/min, and from day 3 onward for 20 minutes at 4 r/min. CatWalk gait analysis, adhesive removal test, and Y-maze test were used to investigate motor function, sensory function as well as cognitive function in rodent animals from the 1st day before MCAO to the 21st day after MCAO. On the 21st day after MCAO, the neurotransmitter receptor-related genes from both contralateral and ipsilateral hippocampi were tested by micro-array and then verified by western blot assay. The glutamate related receptor was shown by transmission electron microscopy and the glutamate content was determined by high-performance liquid chromatography. The results of behavior tests showed that modified constraint-induced movement therapy promoted motor and sensory functional recovery in the middle cerebral artery-occluded rats, but had no effect on cognitive function. The modified constraint-induced movement therapy upregulated the expression of glutamate ionotropic receptor AMPA type subunit 3 (Gria3) in the hippocampus and downregulated the expression of the beta3-adrenergic receptor gene Adrb3 and arginine vasopressin receptor 1A, Avpr1a in the middle cerebral artery-occluded rats. In the ipsilateral hippocampus, only Adra2a was downregulated, and there was no significant change in Gria3. Transmission electron microscopy revealed a denser distribution the more distribution of postsynaptic glutamate receptor 2/3, which is an α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid receptor, within 240 nm of the postsynaptic density in the contralateral cornu ammonis 3 region. The size and distribution of the synaptic vesicles within 100 nm of the presynaptic active zone were unchanged. Western blot analysis showed that modified constraint-induced movement therapy also increased the expression of glutamate receptor 2/3 and brain-derived neurotrophic factor in the hippocampus of rats with middle cerebral artery occlusion, but had no effect on Synapsin I levels. Besides, we also found modified constraint-induced movement therapy effectively reduced glutamate content in the contralateral hippocampus. This study demonstrated that modified constraint-induced movement therapy is an effective rehabilitation therapy in middle cerebral artery-occluded rats, and suggests that these positive effects occur via the upregulation of the postsynaptic membrane α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid receptor expression. This study was approved by the Institutional Animal Care and Use Committee of Fudan University, China (approval No. 201802173S) on March 3, 2018.
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Affiliation(s)
- Bei-Yao Gao
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Dong-Sheng Xu
- Rehabilitation Section, Department of Spine Surgery, Tongji Hospital of Tongji University; Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration (Tongji University) Ministry of Education, Shanghai, China
| | - Pei-Le Liu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Ce Li
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Liang Du
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yan Hua
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jian Hu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jia-Yun Hou
- Zhongshan Hospital Institute of Clinical Science, Fudan University, Shanghai, China
| | - Yu-Long Bai
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
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44
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Tan ZR, Zhang C, Tian FF. Spectrum of clinical features and neuroimaging findings in acute cerebral infarction patients with unusual ipsilateral motor impairment- a series of 22 cases. BMC Neurol 2019; 19:279. [PMID: 31718589 PMCID: PMC6849325 DOI: 10.1186/s12883-019-1516-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/28/2019] [Indexed: 01/15/2023] Open
Abstract
Background Cerebral infarction occurs when the arteries to brain are obstructed, and motor impairment contralateral to responsible lesion is commonly recognized. Few studies have profiled the characteristics of cases with ipsilateral motor impairment. We sought to characterize clinical features of patients with motor dysfunction caused by ipsilateral ischemic stroke. Methods We retrieved and analyzed the medical data for patients with ipsilateral cerebral infarction. Patients were regarded as having ipsilateral cerebral infarction if motor impairment is ipsilateral to recent stroke lesions. Results Only 22 patients with unusual ipsilateral cerebral infarction were included in this study. Ipsilateral limb paralysis was observed in all cases, and one case showed central facioplegia. Majority of patients with limb paralysis (90.9%, 20/22) presented with mild muscle strength deficits (MRC grading of 4 or more). Most of the patients (72.7%, 16/22) had a past history of stroke, and previous strokes were contralateral to the side of the recent stroke in 14 out of 16 patients (87.5%). No history of stroke or cerebral injury was identified in seven patients. With aspect of MRI findings, recent infarct lesions of all cases were located along the corticospinal tract. Conclusions History of stroke plays an important role in the pathogenesis of ipsilateral motor impairment, and cortical reorganization in the unaffected hemisphere may contribute to the compensation of motor function after stroke. Besides that, some cases with first stroke may be due to impairment of ipsilateral uncrossed corticospinal fibers.
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Affiliation(s)
- Zhe-Ren Tan
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China
| | - Chen Zhang
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China
| | - Fa-Fa Tian
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China.
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45
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Gao X, Zhang X, Cui L, Chen R, Zhang C, Xue J, Zhang L, He W, Li J, Wei S, Wei M, Cui H. Ginsenoside Rb1 Promotes Motor Functional Recovery and Axonal Regeneration in Post-stroke Mice through cAMP/PKA/CREB Signaling Pathway. Brain Res Bull 2019; 154:51-60. [PMID: 31715311 DOI: 10.1016/j.brainresbull.2019.10.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 09/29/2019] [Accepted: 10/19/2019] [Indexed: 11/29/2022]
Abstract
The central nervous system (CNS) has a poor self-repairing capability after injury because of the inhibition of axonal regeneration by many myelin-associated inhibitory factors. Therefore, ischemic stroke usually leads to disability. Previous studies reported that Ginsenoside Rb1 (GRb1) plays a role in neuronal protection in acute phase after ischemic stroke, but its efficacy in post-stroke and the underlying mechanism are not clear. Recent evidences demonstrated GRb1 promotes neurotransmitter release through the cAMP-depend protein kinase A (PKA) pathway, which is related to axonal regeneration. The present study aimed to determine whether GRb1 improves long-term motor functional recovery and promotes cortical axon regeneration in post-stroke. Adult male C57BL/6 mice were subjected to distal middle cerebral artery occlusion (dMCAO). GRb1 solution (5 mg/ml) or equal volume of normal saline was injected intraperitoneally for the first time at 24 h after surgery, and then daily injected until day 14. Day 3, 7, 14 and 28 after dMCAO were used as observation time points. Motor functional recovery was assessed with Rota-rod test and grid walking task. The expression of growth-associated protein 43 (GAP43) and biotinylated dextran amine (BDA) was measured to evaluate axonal regeneration. The levels of cyclic AMP (cAMP) and PKA were measured by Elisa, PKAc and phosphorylated cAMP response element protein (pCREB) were determined by western blot. Our results shown that GRb1 treatment improved motor function and increased the expression of GAP43 and BDA in ipsilesional and contralateral cortex. GRb1 significantly elevated cAMP and PKA, increased the protein expression of PKAc and pCREB. However, the effects of GRb1 were eliminated by H89 intervention (a PKA inhibitor). These results suggested that GRb1 improved functional recovery in post-stroke by stimulating axonal regeneration and brain repair. The underlying mechanism might be up-regulating the expression of cAMP/PKA/CREB pathway.
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Affiliation(s)
- Xuan Gao
- Department of Neurology, Second Hospital of Hebei Medical University, 215 Hepingxi Road, Shijiazhuang, Hebei, 050000, PR China
| | - Xiangjian Zhang
- Department of Neurology, Second Hospital of Hebei Medical University, 215 Hepingxi Road, Shijiazhuang, Hebei, 050000, PR China; Hebei Key Laboratory of Vascular Homeostasis and Hebei Collaborative Innovation Center for Cardio-cerebrovascular Disease, 215 Hepingxi Road, Shijiazhuang, Hebei, 050000, PR China.
| | - Lili Cui
- Department of Neurology, Second Hospital of Hebei Medical University, 215 Hepingxi Road, Shijiazhuang, Hebei, 050000, PR China; Hebei Key Laboratory of Vascular Homeostasis and Hebei Collaborative Innovation Center for Cardio-cerebrovascular Disease, 215 Hepingxi Road, Shijiazhuang, Hebei, 050000, PR China
| | - Rong Chen
- Department of Neurology, Second Hospital of Hebei Medical University, 215 Hepingxi Road, Shijiazhuang, Hebei, 050000, PR China; Hebei Key Laboratory of Vascular Homeostasis and Hebei Collaborative Innovation Center for Cardio-cerebrovascular Disease, 215 Hepingxi Road, Shijiazhuang, Hebei, 050000, PR China
| | - Cong Zhang
- Department of Neurology, Second Hospital of Hebei Medical University, 215 Hepingxi Road, Shijiazhuang, Hebei, 050000, PR China
| | - Jing Xue
- Department of Neurology, Second Hospital of Hebei Medical University, 215 Hepingxi Road, Shijiazhuang, Hebei, 050000, PR China
| | - Lan Zhang
- Department of Neurology, Second Hospital of Hebei Medical University, 215 Hepingxi Road, Shijiazhuang, Hebei, 050000, PR China
| | - Weiliang He
- Department of Neurology, Second Hospital of Hebei Medical University, 215 Hepingxi Road, Shijiazhuang, Hebei, 050000, PR China
| | - Jiamin Li
- Department of Neurology, Second Hospital of Hebei Medical University, 215 Hepingxi Road, Shijiazhuang, Hebei, 050000, PR China
| | - Shanshan Wei
- Department of Neurology, Second Hospital of Hebei Medical University, 215 Hepingxi Road, Shijiazhuang, Hebei, 050000, PR China
| | - Mengmeng Wei
- Department of Neurology, Second Hospital of Hebei Medical University, 215 Hepingxi Road, Shijiazhuang, Hebei, 050000, PR China
| | - Hemei Cui
- Department of Neurology, Second Hospital of Hebei Medical University, 215 Hepingxi Road, Shijiazhuang, Hebei, 050000, PR China
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46
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Dressing A, Kaller CP, Nitschke K, Beume LA, Kuemmerer D, Schmidt CS, Bormann T, Umarova RM, Egger K, Rijntjes M, Weiller C, Martin M. Neural correlates of acute apraxia: Evidence from lesion data and functional MRI in stroke patients. Cortex 2019; 120:1-21. [DOI: 10.1016/j.cortex.2019.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 02/28/2019] [Accepted: 05/07/2019] [Indexed: 10/26/2022]
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47
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Crofts A, Kelly ME, Gibson CL. Imaging Functional Recovery Following Ischemic Stroke: Clinical and Preclinical fMRI Studies. J Neuroimaging 2019; 30:5-14. [PMID: 31608550 PMCID: PMC7003729 DOI: 10.1111/jon.12668] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 09/12/2019] [Accepted: 09/25/2019] [Indexed: 12/18/2022] Open
Abstract
Disability and effectiveness of physical therapy are highly variable following ischemic stroke due to different brain regions being affected. Functional magnetic resonance imaging (fMRI) studies of patients in the months and years following stroke have given some insight into how the brain recovers lost functions. Initially, new pathways are recruited to compensate for the lost region, showing as a brighter blood oxygen‐level‐dependent (BOLD) signal over a larger area during a task than in healthy controls. Subsequently, activity is reduced to baseline levels as pathways become more efficient, mimicking the process of learning typically seen during development. Preclinical models of ischemic stroke aim to enhance understanding of the biology underlying recovery following stroke. However, the pattern of recruitment and focusing seen in humans has not been observed in preclinical fMRI studies that are highly variable methodologically. Resting‐state fMRI studies show more consistency; however, there are still confounding factors to address. Anesthesia and method of stroke induction are the two main sources of variability in preclinical studies; improvements here can reduce variability and increase the intensity and reproducibility of the BOLD response detected by fMRI. Differences in task or stimulus and differences in analysis method also present a source of variability. This review compares clinical and preclinical fMRI studies of recovery following stroke and focuses on how refinement of preclinical models and MRI methods may obtain more representative fMRI data in relation to human studies.
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Affiliation(s)
- Andrew Crofts
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Michael E Kelly
- Preclinical Imaging Facility, Core Biotechnology Services, University of Leicester, Leicester, UK
| | - Claire L Gibson
- School of Psychology, University of Nottingham, Nottingham, UK
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48
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Kraft AW, Bauer AQ, Culver JP, Lee JM. Sensory deprivation after focal ischemia in mice accelerates brain remapping and improves functional recovery through Arc-dependent synaptic plasticity. Sci Transl Med 2019; 10:10/426/eaag1328. [PMID: 29386356 DOI: 10.1126/scitranslmed.aag1328] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 06/22/2017] [Accepted: 10/04/2017] [Indexed: 12/18/2022]
Abstract
Recovery after stroke, a major cause of adult disability, is often unpredictable and incomplete. Behavioral recovery is associated with functional reorganization (remapping) in perilesional regions, suggesting that promoting this process might be an effective strategy to enhance recovery. However, the molecular mechanisms underlying remapping after brain injury and the consequences of its modulation are poorly understood. Focal sensory loss or deprivation has been shown to induce remapping in the corresponding brain areas through activity-regulated cytoskeleton-associated protein (Arc)-mediated synaptic plasticity. We show that targeted sensory deprivation via whisker trimming in mice after induction of ischemic stroke in the somatosensory cortex representing forepaw accelerates remapping into the whisker barrel cortex and improves sensorimotor recovery. These improvements persisted even after focal sensory deprivation ended (whiskers allowed to regrow). Mice deficient in Arc, a gene critical for activity-dependent synaptic plasticity, failed to remap or recover sensorimotor function. These results indicate that post-stroke remapping occurs through Arc-mediated synaptic plasticity and is required for behavioral recovery. Furthermore, our findings suggest that enhancing perilesional cortical plasticity via focal sensory deprivation improves recovery after ischemic stroke in mice.
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Affiliation(s)
- Andrew W Kraft
- Department of Neurology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8111, St. Louis, MO 63110, USA
| | - Adam Q Bauer
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Joseph P Culver
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA.,Department of Biomedical Engineering, Washington University School of Medicine, St. Louis, MO 63110, USA.,Department of Physics, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Jin-Moo Lee
- Department of Neurology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8111, St. Louis, MO 63110, USA. .,Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA.,Department of Biomedical Engineering, Washington University School of Medicine, St. Louis, MO 63110, USA
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49
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Brainstem and spinal cord MRI identifies altered sensorimotor pathways post-stroke. Nat Commun 2019; 10:3524. [PMID: 31388003 PMCID: PMC6684621 DOI: 10.1038/s41467-019-11244-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 06/27/2019] [Indexed: 02/06/2023] Open
Abstract
Damage to the corticospinal tract is widely studied following unilateral subcortical stroke, whereas less is known about changes to other sensorimotor pathways. This may be due to the fact that many studies investigated morphological changes in the brain, where the majority of descending and ascending brain pathways are overlapping, and did not investigate the brainstem where they separate. Moreover, these pathways continue passing through separate regions in the spinal cord. Here, using a high-resolution structural MRI of both the brainstem and the cervical spinal cord, we were able to identify a number of microstructurally altered pathways, in addition to the corticospinal tract, post stroke. Moreover, decreases in ipsi-lesional corticospinal tract integrity and increases in contra-lesional medial reticulospinal tract integrity were correlated with motor impairment severity in individuals with stroke. There are few studies of structural changes in ascending and descending sensorimotor pathways after stroke, beyond the corticospinal tract, in the brain. Here the authors identify changes in white matter structure in brainstem and spinal cord following stroke, and show its relationship to motor impairment.
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50
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Delorme M, Vergotte G, Perrey S, Froger J, Laffont I. Time course of sensorimotor cortex reorganization during upper extremity task accompanying motor recovery early after stroke: An fNIRS study. Restor Neurol Neurosci 2019; 37:207-218. [PMID: 31227675 DOI: 10.3233/rnn-180877] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND The acute phase of stroke is accompanied by functional changes and interplay of both hemispheres. However, our understanding of how the time course of upper limb functional motor recovery is related to the progression of brain reorganization in the sensorimotor areas remains limited. This study aimed to assess the time course of hemodynamic patterns of cortical sensorimotor areas using functional near infrared spectroscopy (fNIRS) and motor recovery within three months after a stroke. METHOD Eight right-handed first ischemic/hemorrhagic stroke patients (60±8 years, 3 women) with mild to severe hemiparesis were examined with repetitive fNIRS measurements and motor recovery tests (Fugl-Meyer score) during two months. Hemodynamic changes over the ipsilesional and contralesional sensorimotor areas were collected from a multi-channel fNIRS system during intermittent isometric muscle contractions at self-selected submaximal force levels for each arm. Lateralization index was computed to evaluate the changes in the interhemispheric balance between the cortical sensorimotor areas. RESULTS Lateralization index values during non-paretic arm movements showed no significant changes over time in patients and were comparable to those observed in eight healthy controls. Paretic-arm movements were associated early with a bilateral cortical activity before shifting to ipsilesional patterns (p < 0.01). Progressive lateralization observed over the two months (p < 0.05) evolved concomitantly with an increase in the Fugl-Meyer score (p < 0.001). CONCLUSIONS Cortical reorganization monitoring using fNIRS during the first weeks after stroke may be applied for assessing progressive brain plasticity in addition to clinical measures of performance.
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Affiliation(s)
- Marion Delorme
- EuroMov, Univ. Montpellier, Montpellier, France.,Nîmes University Hospital, Department of Physical Medicine and Rehabilitation, Nîmes, France
| | | | | | - Jérôme Froger
- EuroMov, Univ. Montpellier, Montpellier, France.,Nîmes University Hospital, Department of Physical Medicine and Rehabilitation, Nîmes, France
| | - Isabelle Laffont
- EuroMov, Univ. Montpellier, Montpellier, France.,Montpellier University Hospital, Department of Physical Medicine and Rehabilitation, Montpellier, France
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