1
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Schlemm E, Jensen M, Kuceyeski A, Jamison K, Ingwersen T, Mayer C, Königsberg A, Boutitie F, Ebinger M, Endres M, Fiebach JB, Fiehler J, Galinovic I, Lemmens R, Muir KW, Nighoghossian N, Pedraza S, Puig J, Simonsen CZ, Thijs V, Wouters A, Gerloff C, Thomalla G, Cheng B. Early effect of thrombolysis on structural brain network organisation after anterior‐circulation stroke in the randomized
WAKE‐UP
trial. Hum Brain Mapp 2022; 43:5053-5065. [PMID: 36102287 PMCID: PMC9582379 DOI: 10.1002/hbm.26073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 07/11/2022] [Accepted: 08/22/2022] [Indexed: 11/08/2022] Open
Abstract
The symptoms of acute ischemic stroke can be attributed to disruption of the brain network architecture. Systemic thrombolysis is an effective treatment that preserves structural connectivity in the first days after the event. Its effect on the evolution of global network organisation is, however, not well understood. We present a secondary analysis of 269 patients from the randomized WAKE‐UP trial, comparing 127 imaging‐selected patients treated with alteplase with 142 controls who received placebo. We used indirect network mapping to quantify the impact of ischemic lesions on structural brain network organisation in terms of both global parameters of segregation and integration, and local disruption of individual connections. Network damage was estimated before randomization and again 22 to 36 h after administration of either alteplase or placebo. Evolution of structural network organisation was characterised by a loss in integration and gain in segregation, and this trajectory was attenuated by the administration of alteplase. Preserved brain network organization was associated with excellent functional outcome. Furthermore, the protective effect of alteplase was spatio‐topologically nonuniform, concentrating on a subnetwork of high centrality supported in the salvageable white matter surrounding the ischemic cores. This interplay between the location of the lesion, the pathophysiology of the ischemic penumbra, and the spatial embedding of the brain network explains the observed potential of thrombolysis to attenuate topological network damage early after stroke. Our findings might, in the future, lead to new brain network‐informed imaging biomarkers and improved prognostication in ischemic stroke.
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Affiliation(s)
- Eckhard Schlemm
- Klinik und Poliklinik für Neurologie, Kopf‐ und Neurozentrum University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Märit Jensen
- Klinik und Poliklinik für Neurologie, Kopf‐ und Neurozentrum University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Amy Kuceyeski
- Department of Radiology Weill Cornell Medicine New York New York USA
| | - Keith Jamison
- Department of Radiology Weill Cornell Medicine New York New York USA
| | - Thies Ingwersen
- Klinik und Poliklinik für Neurologie, Kopf‐ und Neurozentrum University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Carola Mayer
- Klinik und Poliklinik für Neurologie, Kopf‐ und Neurozentrum University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Alina Königsberg
- Klinik und Poliklinik für Neurologie, Kopf‐ und Neurozentrum University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Florent Boutitie
- Department of Radiology Weill Cornell Medicine New York New York USA
- Hospices Civils de Lyon, Service de Biostatistique Lyon France
- Université Lyon 1 Villeurbanne France
- CNRS, UMR 5558 Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique‐Santé Villeurbanne France
| | - Martin Ebinger
- Centrum für Schlaganfallforschung Berlin (CSB) Charité ‐ Universitätsmedizin Berlin Berlin Germany
- Klinik für Neurologie Medical Park Berlin Humboldtmühle Berlin Germany
| | - Matthias Endres
- Centrum für Schlaganfallforschung Berlin (CSB) Charité ‐ Universitätsmedizin Berlin Berlin Germany
- Klinik und Hochschulambulanz für Neurologie Charité‐Universitätsmedizin Berlin Berlin Germany
- German Centre for Neurodegenerative Diseases (DZNE) Berlin Germany
- German Centre for Cardiovascular Research (DZHK) Berlin Germany
- ExcellenceCluster NeuroCure Berlin Germany
| | - Jochen B. Fiebach
- Centrum für Schlaganfallforschung Berlin (CSB) Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Ivana Galinovic
- Centrum für Schlaganfallforschung Berlin (CSB) Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - Robin Lemmens
- Department of Neurology University Hospitals Leuven Leuven Belgium
- Department of Neurosciences Division of Experimental Neurology KU Leuven—University of Leuven Leuven Belgium
- VIB, Centre for Brain & Disease Research Laboratory of Neurobiology Leuven Belgium
| | - Keith W. Muir
- Institute of Neuroscience & Psychology University of Glasgow Glasgow UK
| | - Norbert Nighoghossian
- Department of Stroke Medicine, Université Claude Bernard Lyon 1 CREATIS CNRS UMR 5220‐INSERM U1206, INSA‐Lyon Lyon France
| | - Salvador Pedraza
- Department of Radiology, Institut de Diagnostic per la Image (IDI) Hospital Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona (IDIBGI) Girona Spain
| | - Josep Puig
- Department of Radiology, Institut de Diagnostic per la Image (IDI) Hospital Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona (IDIBGI) Girona Spain
| | | | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health University of Melbourne Heidelberg Victoria Australia
- Department of Neurology Austin Health Heidelberg Victoria Australia
| | - Anke Wouters
- Department of Neurology University Hospitals Leuven Leuven Belgium
- Department of Neurosciences Division of Experimental Neurology KU Leuven—University of Leuven Leuven Belgium
- VIB, Centre for Brain & Disease Research Laboratory of Neurobiology Leuven Belgium
- Department of Neurology Amsterdam UMC University of Amsterdam Amsterdam Netherlands
| | - Christian Gerloff
- Klinik und Poliklinik für Neurologie, Kopf‐ und Neurozentrum University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Kopf‐ und Neurozentrum University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Bastian Cheng
- Klinik und Poliklinik für Neurologie, Kopf‐ und Neurozentrum University Medical Centre Hamburg‐Eppendorf Hamburg Germany
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2
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Bice AR, Xiao Q, Kong J, Yan P, Rosenthal ZP, Kraft AW, Smith KP, Wieloch T, Lee JM, Culver JP, Bauer AQ. Homotopic contralesional excitation suppresses spontaneous circuit repair and global network reconnections following ischemic stroke. eLife 2022; 11:e68852. [PMID: 35723585 PMCID: PMC9333991 DOI: 10.7554/elife.68852] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/14/2022] [Indexed: 11/16/2022] Open
Abstract
Understanding circuit-level manipulations that affect the brain's capacity for plasticity will inform the design of targeted interventions that enhance recovery after stroke. Following stroke, increased contralesional activity (e.g. use of the unaffected limb) can negatively influence recovery, but it is unknown which specific neural connections exert this influence, and to what extent increased contralesional activity affects systems- and molecular-level biomarkers of recovery. Here, we combine optogenetic photostimulation with optical intrinsic signal imaging to examine how contralesional excitatory activity affects cortical remodeling after stroke in mice. Following photothrombosis of left primary somatosensory forepaw (S1FP) cortex, mice either recovered spontaneously or received chronic optogenetic excitation of right S1FP over the course of 4 weeks. Contralesional excitation suppressed perilesional S1FP remapping and was associated with abnormal patterns of stimulus-evoked activity in the unaffected limb. This maneuver also prevented the restoration of resting-state functional connectivity (RSFC) within the S1FP network, RSFC in several networks functionally distinct from somatomotor regions, and resulted in persistent limb-use asymmetry. In stimulated mice, perilesional tissue exhibited transcriptional changes in several genes relevant for recovery. Our results suggest that contralesional excitation impedes local and global circuit reconnection through suppression of cortical activity and several neuroplasticity-related genes after stroke, and highlight the importance of site selection for targeted therapeutic interventions after focal ischemia.
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Affiliation(s)
- Annie R Bice
- Department of Radiology, Washington University in St. LouisSaint LouisUnited States
| | - Qingli Xiao
- Department of Neurology, Washington University in St. LouisSaint LouisUnited States
| | - Justin Kong
- Department of Biology, Washington University in St. LouisSaint LouisUnited States
| | - Ping Yan
- Department of Neurology, Washington University in St. LouisSaint LouisUnited States
| | | | - Andrew W Kraft
- Department of Neurology, Washington University in St. LouisSaint LouisUnited States
| | - Karen P Smith
- Department of Neurology, Washington University in St. LouisSaint LouisUnited States
| | | | - Jin-Moo Lee
- Department of Neurology, Washington University in St. LouisSaint LouisUnited States
| | - Joseph P Culver
- Department of Radiology, Washington University in St. LouisSt. LouisUnited States
| | - Adam Q Bauer
- Department of Radiology, Washington University in St. LouisSaint LouisUnited States
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3
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van Assche M, Klug J, Dirren E, Richiardi J, Carrera E. Preparing for a Second Attack: A Lesion Simulation Study on Network Resilience After Stroke. Stroke 2022; 53:2038-2047. [DOI: 10.1161/strokeaha.121.037372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Does the brain become more resilient after a first stroke to reduce the consequences of a new lesion? Although recurrent strokes are a major clinical issue, whether and how the brain prepares for a second attack is unknown. This is due to the difficulties to obtain an appropriate dataset of stroke patients with comparable lesions, imaged at the same interval after onset. Furthermore, timing of the recurrent event remains unpredictable.
Methods:
Here, we used a novel clinical lesion simulation approach to test the hypothesis that resilience in brain networks increases during stroke recovery. Sixteen highly selected patients with a lesion restricted to the primary motor cortex were recruited. At 3 time points of the index event (10 days, 3 weeks, 3 months), we mimicked recurrent infarcts by deletion of nodes in brain networks (resting-state functional magnetic resonance imaging). Graph measures were applied to determine resilience (global efficiency after attack) and wiring cost (mean degree) of the network.
Results:
At 10 days and 3 weeks after stroke, resilience was similar in patients and controls. However, at 3 months, although motor function had fully recovered, resilience to clinically representative simulated lesions was higher compared to controls (cortical lesion
P
=0.012; subcortical:
P
=0.009; cortico-subcortical:
P
=0.009). Similar results were found after random (
P
=0.012) and targeted (
P
=0.015) attacks.
Conclusions:
Our results suggest that, in this highly selected cohort of patients with lesions restricted to the primary motor cortex, brain networks reconfigure to increase resilience to future insults. Lesion simulation is an innovative approach, which may have major implications for stroke therapy. Individualized neuromodulation strategies could be developed to foster resilient network reconfigurations after a first stroke to limit the consequences of future attacks.
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Affiliation(s)
- Mitsouko van Assche
- Stroke Research Group, Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva, Switzerland (M.v.A., J.K., E.D., E.C.)
| | - Julian Klug
- Stroke Research Group, Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva, Switzerland (M.v.A., J.K., E.D., E.C.)
| | - Elisabeth Dirren
- Stroke Research Group, Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva, Switzerland (M.v.A., J.K., E.D., E.C.)
| | - Jonas Richiardi
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Switzerland (J.R.)
| | - Emmanuel Carrera
- Stroke Research Group, Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva, Switzerland (M.v.A., J.K., E.D., E.C.)
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4
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Chen Q, Lv H, Wang Z, Wei X, Liu J, Liu F, Zhao P, Yang Z, Gong S, Wang Z. Distinct brain structural-functional network topological coupling explains different outcomes in tinnitus patients treated with sound therapy. Hum Brain Mapp 2022; 43:3245-3256. [PMID: 35332961 PMCID: PMC9189078 DOI: 10.1002/hbm.25848] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/02/2022] [Accepted: 03/16/2022] [Indexed: 12/13/2022] Open
Abstract
Topological properties, which serve as the core of the neural network, and their couplings can reflect different therapeutic effects in tinnitus patients. We hypothesized that tinnitus patients with different outcomes after sound therapy (narrowband noise) would have distinct brain network topological alterations. Diffusion tensor imaging and resting‐state functional magnetic resonance imaging (fMRI) were prospectively performed in 60 patients with idiopathic tinnitus and 57 healthy controls (HCs). Graph‐theoretical network analyses of structural connectivity (SC), functional connectivity (FC), and SC and FC coupling were performed. Associations between clinical performance and graph‐theoretical features were also analyzed. Treatment was effective (effective group; EG) in 28 patients and ineffective (ineffective group; IG) in 32 patients. For FC, the patients in the EG showed higher local efficiency than patients in the IG. For SC, patients in both the EG and IG displayed lower normalized characteristic path length, characteristic path length, and global efficiency than the HCs. More importantly, patients in the IG had higher coupling than the HCs, whereas there was no difference in coupling between patients in the EG and HCs. Additionally, there were significant associations between the SC features and clinical performance in patients in the EG. Our findings demonstrate that tinnitus patients exhibited significant brain network topological alterations, especially in the structural brain network. More importantly, patients who demonstrated different curative effects showed distinct SC‐FC topological coupling properties. SC‐FC coupling could be an indicator that could be used to predict prognoses in patients with idiopathic tinnitus before sound therapy.
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Affiliation(s)
- Qian Chen
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Han Lv
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhaodi Wang
- Department of Otolaryngology, Beijing Jingmei Group General Hospital, Beijing, China
| | - Xuan Wei
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jiao Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Fang Liu
- Department of Otolaryngology, Beijing Hospital, National Center of Gerontology, Beijing, China.,Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Pengfei Zhao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shusheng Gong
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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5
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Hipólito I. Cognition Without Neural Representation: Dynamics of a Complex System. Front Psychol 2022; 12:643276. [PMID: 35095629 PMCID: PMC8789682 DOI: 10.3389/fpsyg.2021.643276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 10/31/2021] [Indexed: 12/26/2022] Open
Abstract
This paper proposes an account of neurocognitive activity without leveraging the notion of neural representation. Neural representation is a concept that results from assuming that the properties of the models used in computational cognitive neuroscience (e.g., information, representation, etc.) must literally exist the system being modelled (e.g., the brain). Computational models are important tools to test a theory about how the collected data (e.g., behavioural or neuroimaging) has been generated. While the usefulness of computational models is unquestionable, it does not follow that neurocognitive activity should literally entail the properties construed in the model (e.g., information, representation). While this is an assumption present in computationalist accounts, it is not held across the board in neuroscience. In the last section, the paper offers a dynamical account of neurocognitive activity with Dynamical Causal Modelling (DCM) that combines dynamical systems theory (DST) mathematical formalisms with the theoretical contextualisation provided by Embodied and Enactive Cognitive Science (EECS).
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Affiliation(s)
- Inês Hipólito
- Berlin School of Mind and Brain, Institut für Philosophie, Humboldt-Universität zu Berlin, Berlin, Germany
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6
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Cassidy JM, Mark JI, Cramer SC. Functional connectivity drives stroke recovery: shifting the paradigm from correlation to causation. Brain 2021; 145:1211-1228. [PMID: 34932786 DOI: 10.1093/brain/awab469] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/20/2021] [Accepted: 11/26/2021] [Indexed: 11/14/2022] Open
Abstract
Stroke is a leading cause of disability, with deficits encompassing multiple functional domains. The heterogeneity underlying stroke poses significant challenges in the prediction of post-stroke recovery, prompting the development of neuroimaging-based biomarkers. Structural neuroimaging measurements, particularly those reflecting corticospinal tract injury, are well-documented in the literature as potential biomarker candidates of post-stroke motor recovery. Consistent with the view of stroke as a 'circuitopathy', functional neuroimaging measures probing functional connectivity may also prove informative in post-stroke recovery. An important step in the development of biomarkers based on functional neural network connectivity is the establishment of causality between connectivity and post-stroke recovery. Current evidence predominantly involves statistical correlations between connectivity measures and post-stroke behavioral status, either cross-sectionally or serially over time. However, the advancement of functional connectivity application in stroke depends on devising experiments that infer causality. In 1965, Sir Austin Bradford Hill introduced nine viewpoints to consider when determining the causality of an association: [1] Strength, [2] Consistency [3] Specificity, [4] Temporality, [5] Biological gradient, [6] Plausibility, [7] Coherence, [8] Experiment, and [9] Analogy. Collectively referred to as the Bradford Hill Criteria, these points have been widely adopted in epidemiology. In this review, we assert the value of implementing Bradford Hill's framework to stroke rehabilitation and neuroimaging. We focus on the role of neural network connectivity measurements acquired from task-oriented and resting-state functional magnetic resonance imaging, electroencephalography, magnetoencephalography, and functional near-infrared spectroscopy in describing and predicting post-stroke behavioral status and recovery. We also identify research opportunities within each Bradford Hill tenet to shift the experimental paradigm from correlation to causation.
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Affiliation(s)
- Jessica M Cassidy
- Department of Allied Health Sciences, Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Jasper I Mark
- Department of Allied Health Sciences, Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Steven C Cramer
- Department of Neurology, University of California, Los Angeles; and California Rehabilitation Institute, Los Angeles, CA USA
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7
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Chen H, Geng W, Shang S, Shi M, Zhou L, Jiang L, Wang P, Yin X, Chen YC. Alterations of brain network topology and structural connectivity-functional connectivity coupling in capsular versus pontine stroke. Eur J Neurol 2021; 28:1967-1976. [PMID: 33657258 DOI: 10.1111/ene.14794] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/25/2021] [Accepted: 02/27/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND PURPOSE This study was conducted to investigate whether capsular stroke (CS) and pontine stroke (PS) have different topological alterations of structural connectivity (SC) and functional connectivity (FC), as well as correlations of SC-FC coupling with movement assessment scores. METHODS Resting-state functional magnetic resonance imaging and diffusion tensor imaging were prospectively acquired in 46 patients with CS, 36 with PS, and 29 healthy controls (HCs). Graph theoretical network analyses of SC and FC were performed. Patients with left and right lesions were analyzed separately. RESULTS With regard to FC, the PS and CS groups both showed higher local efficiency than the HCs, and the CS group also had a higher clustering coefficient (Cp) than the HCs in the right lesion analysis. With regard to SC, the PS and CS groups both showed different normalized clustering coefficient (γ), small-worldness (σ), and characteristic path length (Lp) compared with the HC group. Additionally, the CS group showed higher normalized characteristic path length (λ) and a lower Cp than the HCs and the PS group showed higher λ and lower global efficiency than the HCs in the right-lesion analysis. However, γ, σ, Cp and Lp were only significantly different in the PS and CS groups compared with the HC group in the right-lesion analysis. Importantly, the CS group was found to have a weaker SC-FC coupling than the PS group and the HC group in the right-lesion analysis. In addition, both patient groups had weaker structural-functional connectome correlation than the HCs. CONCLUSIONS The CS and PS groups both showed FC and SC disruption and the CS group had a weaker SC-FC coupling than the PS group in the right lesion analysis. This may provide useful information for individualized rehabilitative strategies.
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Affiliation(s)
- Huiyou Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Wen Geng
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Song'an Shang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Mengye Shi
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Leilei Zhou
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Liang Jiang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Peng Wang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yu-Chen Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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8
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Schlemm E, Schulz R, Bönstrup M, Krawinkel L, Fiehler J, Gerloff C, Thomalla G, Cheng B. Structural brain networks and functional motor outcome after stroke-a prospective cohort study. Brain Commun 2020; 2:fcaa001. [PMID: 32954275 PMCID: PMC7425342 DOI: 10.1093/braincomms/fcaa001] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 10/08/2019] [Accepted: 12/02/2019] [Indexed: 01/27/2023] Open
Abstract
The time course of topological reorganization that occurs in the structural connectome after an ischaemic stroke is currently not well understood. We aimed to determine the evolution of structural brain networks in stroke patients with motor deficits and relate changes in their global topology to residual symptom burden and functional impairment. In this prospective cohort study, ischaemic stroke patients with supratentorial infarcts and motor symptoms were assessed longitudinally by advanced diffusion MRI and detailed clinical testing of upper extremity motor function at four time points from the acute to the chronic stage. For each time point, structural connectomes were reconstructed, and whole-hemisphere global network topology was quantified in terms of integration and segregation parameters. Using non-linear joint mixed-effects regression modelling, network evolution was related to lesion volume and clinical outcome. Thirty patients were included for analysis. Graph-theoretical analysis demonstrated that, over time, brain networks became less integrated and more segregated with decreasing global efficiency and increasing modularity. Changes occurred in both stroke and intact hemispheres and, in the latter, were positively associated with lesion volume. Greater change in topology was associated with larger residual symptom burden and greater motor impairment 1, 3 and 12 months after stroke. After ischaemic stroke, brain networks underwent characteristic changes in both ipsi- and contralesional hemispheres. Topological network changes reflect the severity of damage to the structural network and are associated with functional outcome beyond the impact of lesion volume.
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Affiliation(s)
- Eckhard Schlemm
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg–Eppendorf, 20246 Hamburg, Germany
| | - Robert Schulz
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg–Eppendorf, 20246 Hamburg, Germany
| | - Marlene Bönstrup
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg–Eppendorf, 20246 Hamburg, Germany
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Lutz Krawinkel
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg–Eppendorf, 20246 Hamburg, Germany
| | - Jens Fiehler
- Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Universitätsklinikum Hamburg–Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg–Eppendorf, 20246 Hamburg, Germany
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg–Eppendorf, 20246 Hamburg, Germany
| | - Bastian Cheng
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg–Eppendorf, 20246 Hamburg, Germany
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9
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Baltan S, Shi Y, Keep RF, Chen J. The effect of aging on brain injury and recovery after stroke. Neurobiol Dis 2019; 126:1-2. [PMID: 31010535 DOI: 10.1016/j.nbd.2019.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Selva Baltan
- Department of Neurosciences, Cleveland Clinic, Cleveland, OH 44195
| | - Yejie Shi
- Pittsburgh Institute of Brain Disorders & Recovery and Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213; Geriatric Research, Education and Clinical Center, Veterans Affairs Pittsburgh Health Care System, Pittsburgh, PA 15261
| | - Richard F Keep
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI 48109
| | - Jun Chen
- Pittsburgh Institute of Brain Disorders & Recovery and Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213; Geriatric Research, Education and Clinical Center, Veterans Affairs Pittsburgh Health Care System, Pittsburgh, PA 15261
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