2
|
Otten ML, Mikell CB, Youngerman BE, Liston C, Sisti MB, Bruce JN, Small SA, McKhann GM. Motor deficits correlate with resting state motor network connectivity in patients with brain tumours. ACTA ACUST UNITED AC 2012; 135:1017-26. [PMID: 22408270 PMCID: PMC3326259 DOI: 10.1093/brain/aws041] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
While a tumour in or abutting primary motor cortex leads to motor weakness, how tumours elsewhere in the frontal or parietal lobes affect functional connectivity in a weak patient is less clear. We hypothesized that diminished functional connectivity in a distributed network of motor centres would correlate with motor weakness in subjects with brain masses. Furthermore, we hypothesized that interhemispheric connections would be most vulnerable to subtle disruptions in functional connectivity. We used task-free functional magnetic resonance imaging connectivity to probe motor networks in control subjects and patients with brain tumours (n = 22). Using a control dataset, we developed a method for automated detection of key nodes in the motor network, including the primary motor cortex, supplementary motor area, premotor area and superior parietal lobule, based on the anatomic location of the hand-motor knob in the primary motor cortex. We then calculated functional connectivity between motor network nodes in control subjects, as well as patients with and without brain masses. We used this information to construct weighted, undirected graphs, which were then compared to variables of interest, including performance on a motor task, the grooved pegboard. Strong connectivity was observed within the identified motor networks between all nodes bilaterally, and especially between the primary motor cortex and supplementary motor area. Reduced connectivity was observed in subjects with motor weakness versus subjects with normal strength (P < 0.001). This difference was driven mostly by decreases in interhemispheric connectivity between the primary motor cortices (P < 0.05) and between the left primary motor cortex and the right premotor area (P < 0.05), as well as other premotor area connections. In the subjects without motor weakness, however, performance on the grooved pegboard did not relate to interhemispheric connectivity, but rather was inversely correlated with connectivity between the left premotor area and left supplementary motor area, for both the left and the right hands (P < 0.01). Finally, two subjects who experienced severe weakness following surgery for their brain tumours were followed longitudinally, and the subject who recovered showed reconstitution of her motor network at follow-up. The subject who was persistently weak did not reconstitute his motor network. Motor weakness in subjects with brain tumours that do not involve primary motor structures is associated with decreased connectivity within motor functional networks, particularly interhemispheric connections. Motor networks become weaker as the subjects become weaker, and may become strong again during motor recovery.
Collapse
Affiliation(s)
- Marc L Otten
- Department of Neurosurgery, Columbia University, 710 West 168th Street, Suite 4-404, New York, NY 10032, USA.
| | | | | | | | | | | | | | | |
Collapse
|
3
|
Joubert J, Prentice LF, Moulin T, Liaw ST, Joubert LB, Preux PM, Ware D, Medeiros de Bustos E, McLean A. Stroke in Rural Areas and Small Communities. Stroke 2008; 39:1920-8. [DOI: 10.1161/strokeaha.107.501643] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The management of stroke in rural and regional areas is variable in both the developed and developing world. Informed by best-practice guidelines and recommendations for systems of stroke care, adaptable models of care that are appropriate for local needs should be devised for rural and regional settings. This review addresses the issue of the provision of appropriate services in rural and regional settings, with particular attention to the barriers involved, according to the classification of Low Human Development Country (LHDC), Medium Human Development Country (MHDC) and High Human Development Country (HHDC). We discuss the need and feasibility of developing implementing stroke care in rural settings according to best-practice recommendations, within models of care adapted to local conditions.
Collapse
Affiliation(s)
- Jacques Joubert
- From the Division of Neurology, Royal Melbourne Hospital (J.J.); Department of Epidemiology and Preventive Medicine, Monash University, Melbourne (L.F.P.); Faculty Information Unit and School of Rural Health, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne (S.-T.L.); School of Nursing and Social Work, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne (L.B.J.); University of Limoges, Institute of Neuroepidemiology and Tropical Neurology,
| | - Louise F. Prentice
- From the Division of Neurology, Royal Melbourne Hospital (J.J.); Department of Epidemiology and Preventive Medicine, Monash University, Melbourne (L.F.P.); Faculty Information Unit and School of Rural Health, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne (S.-T.L.); School of Nursing and Social Work, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne (L.B.J.); University of Limoges, Institute of Neuroepidemiology and Tropical Neurology,
| | - Thierry Moulin
- From the Division of Neurology, Royal Melbourne Hospital (J.J.); Department of Epidemiology and Preventive Medicine, Monash University, Melbourne (L.F.P.); Faculty Information Unit and School of Rural Health, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne (S.-T.L.); School of Nursing and Social Work, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne (L.B.J.); University of Limoges, Institute of Neuroepidemiology and Tropical Neurology,
| | - Siaw-Teng Liaw
- From the Division of Neurology, Royal Melbourne Hospital (J.J.); Department of Epidemiology and Preventive Medicine, Monash University, Melbourne (L.F.P.); Faculty Information Unit and School of Rural Health, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne (S.-T.L.); School of Nursing and Social Work, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne (L.B.J.); University of Limoges, Institute of Neuroepidemiology and Tropical Neurology,
| | - Lynette B. Joubert
- From the Division of Neurology, Royal Melbourne Hospital (J.J.); Department of Epidemiology and Preventive Medicine, Monash University, Melbourne (L.F.P.); Faculty Information Unit and School of Rural Health, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne (S.-T.L.); School of Nursing and Social Work, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne (L.B.J.); University of Limoges, Institute of Neuroepidemiology and Tropical Neurology,
| | - Pierre-Marie Preux
- From the Division of Neurology, Royal Melbourne Hospital (J.J.); Department of Epidemiology and Preventive Medicine, Monash University, Melbourne (L.F.P.); Faculty Information Unit and School of Rural Health, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne (S.-T.L.); School of Nursing and Social Work, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne (L.B.J.); University of Limoges, Institute of Neuroepidemiology and Tropical Neurology,
| | - Dallas Ware
- From the Division of Neurology, Royal Melbourne Hospital (J.J.); Department of Epidemiology and Preventive Medicine, Monash University, Melbourne (L.F.P.); Faculty Information Unit and School of Rural Health, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne (S.-T.L.); School of Nursing and Social Work, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne (L.B.J.); University of Limoges, Institute of Neuroepidemiology and Tropical Neurology,
| | - Elizabeth Medeiros de Bustos
- From the Division of Neurology, Royal Melbourne Hospital (J.J.); Department of Epidemiology and Preventive Medicine, Monash University, Melbourne (L.F.P.); Faculty Information Unit and School of Rural Health, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne (S.-T.L.); School of Nursing and Social Work, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne (L.B.J.); University of Limoges, Institute of Neuroepidemiology and Tropical Neurology,
| | - Allan McLean
- From the Division of Neurology, Royal Melbourne Hospital (J.J.); Department of Epidemiology and Preventive Medicine, Monash University, Melbourne (L.F.P.); Faculty Information Unit and School of Rural Health, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne (S.-T.L.); School of Nursing and Social Work, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne (L.B.J.); University of Limoges, Institute of Neuroepidemiology and Tropical Neurology,
| |
Collapse
|