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Salinet ASM, Haunton VJ, Panerai RB, Robinson TG. A systematic review of cerebral hemodynamic responses to neural activation following stroke. J Neurol 2013; 260:2715-21. [DOI: 10.1007/s00415-013-6836-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 01/04/2013] [Indexed: 10/27/2022]
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Calautti C, Jones PS, Guincestre JY, Naccarato M, Sharma N, Day DJ, Carpenter TA, Warburton EA, Baron JC. The neural substrates of impaired finger tapping regularity after stroke. Neuroimage 2010; 50:1-6. [DOI: 10.1016/j.neuroimage.2009.12.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Revised: 11/30/2009] [Accepted: 12/01/2009] [Indexed: 10/20/2022] Open
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3
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Funktionelle Bildgebung in der Neurorehabilitation. NeuroRehabilitation 2010. [DOI: 10.1007/978-3-642-12915-5_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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4
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Ring A, Rajandran H, Harvey A, Ghosh S. Changes in electrical thresholds for evoking movements from the cat cerebral cortex following lesions of the sensori-motor area. Somatosens Mot Res 2009; 21:117-36. [PMID: 15370092 DOI: 10.1080/08990220410001721275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We evaluated motor maps in the cerebral cortex and motor performance in cats before and after lesions of the forelimb representation in the primary motor area. After the lesion there was a reduction in the use of the affected forelimb and loss of accuracy in prehension tasks using the forelimb; some recovery occurred during the mapping study. Electrode tracts and lesion sites were located in cytoarchitectonically identified cortical areas 4gamma, 4delta, 6aalpha, 6agamma, 3a. The lesions were mainly in area 4gamma. In the lesioned hemisphere there were many points around the lesion site (in areas 4gamma and 3a) from which movements could not be evoked. In some areas distant from the lesion site (e.g. area 6agamma) the mean thresholds for evoking forelimb movements were significantly elevated. Mean thresholds for evoking hindlimb and facial movements were not different from before. In the contralateral hemisphere mean thresholds for evoking forelimb, but not hindlimb or facial movements, were significantly elevated in several sensorimotor areas (area 4gamma, 6agamma and 3a). Mean thresholds for evoking forelimb movements appeared to progressively increase during the time of study. Minimal currents required to evoke forelimb movements from the cerebral cortex increase (possibly progressively) following a lesion of the forelimb representation in the primary motor area, affecting many interconnected motor areas in the hemispheres ipsilateral and contralateral to the lesioned site. This increase in thresholds may play a role in the changes in cortical control of the affected and contralateral limbs following brain lesions and explain the increased sense of effort required to produce movements.
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Affiliation(s)
- A Ring
- Centre for Neuromuscular & Neurological Disorders, University of Western Australia, Perth, WA 6009, Australia
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5
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Dijkerman HC, Vargha-Khadem F, Polkey CE, Weiskrantz L. Ipsilesional and contralesional sensorimotor function after hemispherectomy: differences between distal and proximal function. Neuropsychologia 2007; 46:886-901. [PMID: 18191958 DOI: 10.1016/j.neuropsychologia.2007.11.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2007] [Revised: 11/07/2007] [Accepted: 11/29/2007] [Indexed: 11/24/2022]
Abstract
Previous studies have reported mainly on contralesional somatosensory and motor function after hemispherectomy. So far, ipsilesional impairments have received little attention even though these have been reported in patients with less extensive lesions. In the current study we assessed ipsilesional and contralesional sensorimotor function in a group of 12 patients with hemispherectomy. In addition, we focused on differences between distal and proximal function and investigated several factors that may have contributed to individual differences between patients. The tests included tapping, force production, tactile double simultaneous stimulation, pressure sensitivity, passive joint movement sense and sensitivity to hot and cold. Ipsilesional impairments were found on all tests, except passive joint movement sense. Unexpectedly, no significant ipsilateral distal-proximal gradient was found for any of the measures. Both the removal of the diseased cerebral hemisphere and possible changes to the remaining brain structures may have affected ipsilesional sensorimotor function. Contralesional performance was impaired on all tests except for passive joint movement in the shoulder. The contralesional impairments were characterized by a distal-proximal gradient measured on all tests, except that of sensitivity to hot and cold. Distal function was always most impaired. The difference between distal and proximal motor function is in agreement with the established concepts of the motor pathways, with the motoneurons innervating proximal muscles receiving bilateral cortical and subcortical input. Age at onset of original brain damage correlated significantly with passive joint movement sense. Patients with known abnormalities to the remaining brain structures performed inferior on the tapping test only. No effect was found of the hemispheric side of removal.
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Affiliation(s)
- H C Dijkerman
- Experimental Psychology, Helmholtz Instituut, Utrecht University, Heidelbergbaan 2, 3584 CS Utrecht, The Netherlands.
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6
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Addamo PK, Farrow M, Hoy KE, Bradshaw JL, Georgiou-Karistianis N. The effects of age and attention on motor overflow production—A review. ACTA ACUST UNITED AC 2007; 54:189-204. [PMID: 17300842 DOI: 10.1016/j.brainresrev.2007.01.004] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Revised: 01/11/2007] [Accepted: 01/15/2007] [Indexed: 12/29/2022]
Abstract
Motor overflow refers to overt involuntary movement, or covert muscle activity, that sometimes co-occurs with voluntary movement. Various clinical populations exhibit overflow. Motor overflow is also present in healthy children and the elderly, although in young adults, overt overflow is considered abnormal unless elicited under conditions of extreme force or muscle fatigue. Current theories of overflow imply that the corpus callosum may mediate production of this phenomenon. However, given that the corpus callosum is a conduit enabling the transfer of cortical information, surprisingly few studies have considered the cortical or subcortical structures underlying overflow. This review considers the developmental trend of motor overflow production, specifically in the upper-limbs, and the mechanisms thought to underlie this age-related phenomenon. Potential neurological correlates of motor overflow will be discussed in conjunction with higher order attentional processes which also regulate motor overflow production. Future research investigating the impact of attentional processes on overflow production may be particularly valuable for designing rehabilitation strategies for patients experiencing induced pathological overflow or conversely, to develop techniques to encourage the recovery of movement function in individuals with paretic limbs.
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Affiliation(s)
- Patricia K Addamo
- Experimental Neuropsychology Research Unit, School of Psychology, Psychiatry and Psychological Medicine, Monash University, Clayton, 3800, Victoria, Australia.
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Loubinoux I, Dechaumont-Palacin S, Castel-Lacanal E, De Boissezon X, Marque P, Pariente J, Albucher JF, Berry I, Chollet F. Prognostic Value of fMRI in Recovery of Hand Function in Subcortical Stroke Patients. Cereb Cortex 2007; 17:2980-7. [PMID: 17389628 DOI: 10.1093/cercor/bhm023] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The first objective of the study was to determine whether functional magnetic resonance imaging (fMRI) signal was correlated with motor performance at different stages of poststroke recovery. The second objective was to assess the existence of prognostic factors for recovery in early functional MR images. Eight right-handed patients with pure motor deficit secondary to a first lacunar infarct localized on the pyramidal tract were included. This study concerned moderately impaired patients and recovery of handgrip strength and finger-tapping speed. The fMRI task was a calibrated flexion-extension movement. Ten healthy subjects served as a control group. The intensity of the activation in the "classical" motor network (ipsilesional S1M1, ipsilesional ventral premotor cortex [BA 6], contralesional cerebellum) 20 days after stroke was indicative of the performance (positive correlation). The cluster in M1 was posterior and circumscribed to BA 4p. No area was associated with bad performance (negative correlation). No correlation was found 4 and 12 months after stroke. Prognosis factors were evidenced. The higher early the activation in the ipsilesional M1 (BA 4p), S1, and insula, the better the recovery 1 year after stroke. Although the lesions partly deefferented the primary motor cortex, patients who activated the posterior primary motor cortex early had a better recovery of hand function. This suggests that there is benefit in increasing ipsilesional M1 activity shortly after stroke as a rehabilitative approach in mildly impaired patients.
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Ward NS, Newton JM, Swayne OBC, Lee L, Frackowiak RSJ, Thompson AJ, Greenwood RJ, Rothwell JC. The relationship between brain activity and peak grip force is modulated by corticospinal system integrity after subcortical stroke. Eur J Neurosci 2007; 25:1865-73. [PMID: 17432972 PMCID: PMC3715370 DOI: 10.1111/j.1460-9568.2007.05434.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In healthy human subjects, the relative contribution of cortical regions to motor performance varies with the task parameters. Additionally, after stroke, recruitment of cortical areas during a simple motor task varies with corticospinal system integrity. We investigated whether the pattern of motor system recruitment in a task involving increasingly forceful hand grips is influenced by the degree of corticospinal system damage. Nine chronic subcortical stroke patients and nine age-matched controls underwent functional magnetic brain imaging whilst performing repetitive isometric hand grips. Target grip forces were varied between 15% and 45% of individual maximum grip force. Corticospinal system functional integrity was assessed with transcranial magnetic stimulation. Averaged across all forces, there was more task-related activation compared with rest in the secondary motor areas of patients with greater corticospinal system damage, confirming previous reports. However, here we were primarily interested in regional brain activation, which covaried with the amount of force generated, implying a prominent executive role in force production. We found that in control subjects and patients with lesser corticospinal system damage, signal change increased linearly with increasing force output in contralateral primary motor cortex, supplementary motor area and ipsilateral cerebellum. In contrast, in patients with greater corticospinal system damage, force-related signal changes were seen mainly in contralesional dorsolateral premotor cortex, bilateral ventrolateral premotor cortices and contralesional cerebellum, but not ipsilesional primary motor cortex. These findings suggest that the premotor cortices might play a new and functionally relevant role in controlling force production in patients with more severe corticospinal system disruption.
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Affiliation(s)
- Nick S Ward
- Wellcome Department of Imaging Neuroscience, and Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK.
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Bütefisch CM, Kleiser R, Seitz RJ. Post-lesional cerebral reorganisation: evidence from functional neuroimaging and transcranial magnetic stimulation. ACTA ACUST UNITED AC 2006; 99:437-54. [PMID: 16723211 DOI: 10.1016/j.jphysparis.2006.03.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Reorganisation of cerebral representations has been hypothesised to underlie the recovery from ischaemic brain infarction. The mechanisms can be investigated non-invasively in the human brain using functional neuroimaging and transcranial magnetic stimulation (TMS). Functional neuroimaging showed that reorganisation is a dynamic process beginning after stroke manifestation. In the acute stage, the mismatch between a large perfusion deficit and a smaller area with impaired water diffusion signifies the brain tissue that potentially enables recovery subsequent to early reperfusion as in thrombolysis. Single-pulse TMS showed that the integrity of the cortico-spinal tract system was critical for motor recovery within the first four weeks, irrespective of a concomitant affection of the somatosensory system. Follow-up studies over several months revealed that ischaemia results in atrophy of brain tissue adjacent to and of brain areas remote from the infarct lesion. In patients with hemiparetic stroke activation of premotor cortical areas in both cerebral hemispheres was found to underlie recovery of finger movements with the affected hand. Paired-pulse TMS showed regression of perilesional inhibition as well as intracortical disinhibition of the motor cortex contralateral to the infarction as mechanisms related to recovery. Training strategies can employ post-lesional brain plasticity resulting in enhanced perilesional activations and modulation of large-scale bihemispheric circuits.
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Scheuer KH, Nielsen JE, Krabbe K, Paulson OB, Law I. Motor activation in SPG4-linked hereditary spastic paraplegia. J Neurol Sci 2006; 244:31-9. [PMID: 16571355 DOI: 10.1016/j.jns.2005.12.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2005] [Revised: 12/08/2005] [Accepted: 12/12/2005] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the extent of motor cortical functional reorganisation in patients with SPG4-linked hereditary spastic paraplegia by exploring cortical motor activation related to movements of clinically affected (lower) and unaffected (upper) limbs. METHODS Thirteen patients and 13 normal controls matched for age, gender and handedness underwent O15-labelled water positron emission tomography during (1) right ankle flexion-extension, (2) right shoulder flexion-extension and (3) rest. Within-group comparisons of movement vs. rest (simple main effects) and between-group comparisons of movement vs. rest (group x behavioural state interaction) were performed using a random effects approach and statistical parametric mapping (SPM99). RESULTS Patterns of motor activation were generally comparable between groups during both tasks, although patients had a tendency towards more widespread activation in sensorimotor cortical and cerebellar regions. Statistically significant differences were restricted to the ankle movement response, however, where patients showed significantly increased regional cerebral blood flow in the right and left primary motor cortices, the supplementary motor areas and the right premotor cortex compared to controls. CONCLUSIONS Motor cortical reorganisation may explain this result, but as no significant differences were recognised in the motor response of the unaffected limb, differences in functional demands should also be considered.
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Affiliation(s)
- Kristin H Scheuer
- The Neurobiology Research Unit, N 9201, Copenhagen University Hospital, Denmark
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11
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Hamzei F, Liepert J, Dettmers C, Weiller C, Rijntjes M. Two different reorganization patterns after rehabilitative therapy: an exploratory study with fMRI and TMS. Neuroimage 2006; 31:710-20. [PMID: 16516499 DOI: 10.1016/j.neuroimage.2005.12.035] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2005] [Revised: 12/13/2005] [Accepted: 12/15/2005] [Indexed: 12/01/2022] Open
Abstract
We used two complementary methods to investigate cortical reorganization in chronic stroke patients during treatment with a defined motor rehabilitation program. BOLD ("blood oxygenation level dependent") sensitive functional magnetic resonance imaging (fMRI) and intracortical inhibition (ICI) and facilitation (ICF) measured with transcranial magnetic stimulation (TMS) via paired pulse stimulation were used to investigate cortical reorganization before and after "constraint-induced movement therapy" (CI). The motor hand function improved in all subjects after CI. BOLD signal intensity changes within affected primary sensorimotor cortex (SMC) before and after CI showed a close correlation with ICI (r = 0.93) and ICF (r = 0.76) difference before and after therapy. Difference in number of voxels and ICI difference before and after CI also showed a close correlation (r = 0.92) in the affected SMC over the time period of training. A single subject analysis revealed that patients with intact hand area of M1 ("the hand knob") and its descending motor fibers (these patients revealed normal motor evoked potentials [MEP] from the affected hand) showed decreasing ipsilesional SMC activation which was paralleled by an increase in intracortical excitability. This pattern putatively reflects increasing synaptic efficiency. When M1 or its descending pyramidal tract was lesioned (MEP from the affected hand was pathologic) ipsilesional SMC activation increased, accompanied by decreased intracortical excitability. We suggest that an increase in synaptic efficiency is not possible here, which leads to reorganization with extension, shift and recruitment of additional cortical areas of the sensorimotor network. The inverse dynamic process between both complementary methods (activation in fMRI and intracortical excitability determined by TMS) over the time period of CI illustrates the value of combining methods for understanding brain reorganization.
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Affiliation(s)
- Farsin Hamzei
- Department of Neurology, University Medical Center Hamburg Eppendorf, Germany.
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12
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Abstract
Recovery of function after a stroke is attributable to several factors, including events in the first few days (eg, reabsorption of perilesional oedema, tissue reperfusion). However, consistent reorganisation and recovery after a stroke takes weeks or months. In the early stages, recovery from stroke can vary greatly among patients with identical clinical symptoms. Neuroimaging techniques that enable us to assess baseline and task-related functions, and neurophysiological techniques that measure brain function in "real time", can be used to study the recovery of brain lesions after a stroke. In this review, we discuss important neuroimaging and neurophysiological studies of post-stroke brain reorganisation.
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Ward NS, Brown MM, Thompson AJ, Frackowiak RSJ. Neural correlates of outcome after stroke: a cross-sectional fMRI study. Brain 2003; 126:1430-48. [PMID: 12764063 PMCID: PMC3717456 DOI: 10.1093/brain/awg145] [Citation(s) in RCA: 451] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Recovery of motor function after stroke may occur over weeks or months and is often attributed to neuronal reorganization. Functional imaging studies investigating patients who have made a good recovery after stroke have suggested that recruitment of other motor-related networks underlies this recovery. However, patients with less complete recovery have rarely been studied, or else the degree of recovery has not been taken into account. We set out to investigate the relationship between the degree of recovery after stroke and the pattern of recruitment of brain regions during a motor task as measured using functional MRI. We recruited 20 patients who were at least 3 months after their first ever stroke, and 26 right-handed age-matched control subjects. None of our patients had infarcts involving the hand region of the primary motor cortex. All subjects were scanned whilst performing an isometric, dynamic visually paced handgrip task. The degree of functional recovery of each patient was assessed using a battery of outcome measures. Single-patient versus control group analysis revealed that patients with poor recovery were more likely to recruit a number of motor-related brain regions over and above those seen in the control group during the motor task, whereas patients with more complete recovery were more likely to have 'normal' task-related brain activation. Across the whole patient group and across stroke subtypes, we were able to demonstrate a negative correlation between outcome and the degree of task-related activation in regions such as the supplementary motor area, cingulate motor areas, premotor cortex, posterior parietal cortex, and cerebellum. This negative correlation was also seen in parts of both contralateral and ipsilateral primary motor cortex. These results further our understanding of the recovery process by demonstrating for the first time a clear relationship between task-related activation of the motor system and outcome after stroke.
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Affiliation(s)
- N S Ward
- Wellcome Department of Imaging Neuroscience, Institute of Neurology, University College London, London, UK.
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14
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Abstract
BACKGROUND The precise mechanisms of and biological basis for motor recovery after stroke in adults are still largely unknown. Reorganization of the motor system after stroke as assessed by functional neuroimaging is an intriguing but challenging new field of research. Provocative but equivocal findings have been reported to date. SUMMARY OF REVIEW We present an overview of functional neuroimaging studies (positron emission tomography or functional MRI) of motor tasks in patients recovered or still recovering from motor deficit after stroke. After a brief account of the connectivity of motor systems and the imaging findings in normal subjects, the literature concerning stroke patients is reviewed and discussed, and a general model is proposed. CONCLUSIONS Both cross-sectional and longitudinal studies have demonstrated that the damaged adult brain is able to reorganize to compensate for motor deficits. Rather than a complete substitution of function, the main mechanism underlying recovery of motor abilities involves enhanced activity in preexisting networks, including the disconnected motor cortex in subcortical stroke and the infarct rim after cortical stroke. Involvement of nonmotor and contralesional motor areas has been consistently reported, with the emerging notion that the greater the involvement of the ipsilesional motor network, the better is the recovery. This hypothesis is supported by the enhanced activity of the ipsilesional primary motor cortex induced by motor training and acute pharmacological interventions, in parallel with improved motor function. Further longitudinal studies assessing the relationships between such changes and actual recovery, as well as manipulating such changes by rehabilitation or pharmacological maneuvers, should provide further information on these fundamental questions. This review closes with some perspectives for future research.
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Affiliation(s)
- Cinzia Calautti
- Department of Neurology, University of Cambridge, Cambrid, UK
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15
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Liepert J. Chapter 37 TMS in stroke. ACTA ACUST UNITED AC 2003. [DOI: 10.1016/s1567-424x(09)70240-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
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Newton J, Sunderland A, Butterworth SE, Peters AM, Peck KK, Gowland PA. A pilot study of event-related functional magnetic resonance imaging of monitored wrist movements in patients with partial recovery. Stroke 2002; 33:2881-7. [PMID: 12468786 DOI: 10.1161/01.str.0000042660.38883.56] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Previous functional imaging studies of motor recovery after stroke have investigated cerebral activation during periods of repetitive, often complex, movement. This article reports the use of an event-related approach to study activation associated with isolated simple movements (wrist extension). This allows investigation of the pattern of the motor response and corresponding brain activation on a trial-by-trial basis. Patients with partial recovery can be assessed, and allowance can be made for abnormalities in the shape of hemodynamic responses. METHODS Functional MRI at 3 T was performed during a series of isolated, near-isometric wrist extension movements. A visual tracking procedure was used to elicit forces of 10% and 20% of maximum voluntary contraction. Force output from both wrists was monitored continuously. A voxel-wise procedure was used to fit the optimum hemodynamic response functions in each case. RESULTS Three chronic stage patients with partial recovery were successfully scanned and compared with 8 healthy controls. The patients showed well-lateralized motor responses but inaccurate control of force. During movement of the paretic wrist, we observed excessive activation of the ipsilateral primary motor cortex and increased relative activation of the supplementary motor area compared with movement of the nonparetic side. In the primary motor area, hemodynamic responses peaked more quickly on the ipsilateral side in 2 patients for movements of the paretic hand, whereas controls showed the opposite trend. CONCLUSIONS An event-related approach can be used to study the relationship between motor responses and cerebral activation in patients with partial recovery. These preliminary findings suggest that excessive activation in ipsilateral motor cortex and secondary motor areas remains evident under these tightly controlled conditions and cannot be ascribed to mirror movements or abnormalities in the timing of the blood oxygen level-dependent (BOLD) response. However, close monitoring of motor responses also makes evident continuing impairment in motor skill, which makes comparison with activation in normal controls difficult.
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Affiliation(s)
- J Newton
- Division of Stroke Medicine, University of Nottingham, Notttingham, United Kingdom
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Cramer SC, Mark A, Barquist K, Nhan H, Stegbauer KC, Price R, Bell K, Odderson IR, Esselman P, Maravilla KR. Motor cortex activation is preserved in patients with chronic hemiplegic stroke. Ann Neurol 2002; 52:607-16. [PMID: 12402258 DOI: 10.1002/ana.10351] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Many central nervous system conditions that cause weakness, including many strokes, injure corticospinal tract but leave motor cortex intact. Little is known about the functional properties of surviving cortical regions in this setting, in part because many studies have used probes reliant on the corticospinal tract. We hypothesized that many features of motor cortex function would be preserved when assessed independent of the stroke-affected corticospinal tract. Functional MRI was used to study 11 patients with chronic hemiplegia after unilateral stroke that spared regions of motor cortex. Activation in stroke-affected hemisphere was evaluated using 3 probes independent of affected corticospinal tract: passive finger movement, a hand-related visuomotor stimulus, and tapping by the nonstroke index finger. The site and magnitude of cortical activation were similar when comparing the stroke hemisphere to findings in 19 control subjects. Patients activated each of 8 cortical regions with similar frequency as compared to controls, generally with a smaller activation volume. In some cases, clinical measures correlated with the size or the site of stroke hemisphere activation. The results suggest that, despite stroke producing contralateral hemiplegia, surviving regions of motor cortex actively participate in the same proprioceptive, visuomotor, and bilateral movement control processes seen in control subjects.
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Affiliation(s)
- Steven C Cramer
- Department of Neurology, University of Washington, 1959 NE Pacific Street, Room RR650, Box 356465, Seattle, WA 98195-6565, USA.
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18
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Morecraft RJ, Herrick JL, Stilwell-Morecraft KS, Louie JL, Schroeder CM, Ottenbacher JG, Schoolfield MW. Localization of arm representation in the corona radiata and internal capsule in the non-human primate. Brain 2002; 125:176-98. [PMID: 11834603 DOI: 10.1093/brain/awf011] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Localization of the corticofugal projection in the corona radiata (CR) and internal capsule (IC) can assist in evaluating a patient's residual motor capacity following subtotal brain damage and predicting their potential for functional restitution. To advance our understanding of the organization of the corticofugal projection in this critical brain region, we studied the trajectories of the projection arising from six different cortical arm representations in rhesus monkeys. They included the arm representation of the primary (M1), ventral lateral pre- (LPMCv), dorsolateral pre- (LPMCd), supplementary (M2), rostral cingulate (M3) and caudal cingulate (M4) motor cortices. In the CR, each pathway was segregated as medial motor area fibres arched over the caudate and lateral motor area fibres arched over the putamen. In the IC, the individual corticofugal pathways were found to be widespread, topographically organized and partially overlapping. At superior levels of the IC, the corticofugal projection from the arm representation of M3 coursed through the middle and posterior portion of the anterior limb (ICa). The projection from M2 passed through the posterior portion of the ICa and the genu (ICg). The projection from LPMCv travelled through the genu and anterior portion of the posterior limb (ICp). The projection from LPMCd occupied the anterior portion of the ICp. The projection from M4 descended through the mid-portion of the ICp. Fibres from M1 also travelled in the ICp, positioned immediately posterior to the M4 projection. As each fibre system progressed inferiorly within the IC, all fibres shifted posteriorly to occupy the ICp. Within the ICp, the projections from M3, M2, LPMCv, LPMCd, M4 and M1 maintained their anterior to posterior orientation, respectively. M2, LPMCd and LPMCv fibres overlapped extensively, as did fibres from M4 and M1. Our data suggest that CR and superior capsular lesions may correlate with more favourable levels of functional recovery due to the widespread nature of arm representation. In contrast, the extensive overlap and comparatively condensed organization of arm representation at inferior capsular levels suggest that lesions seated inferiorly are likely to correlate with poorer levels of recovery of upper limb movement. Based on the relative density of corticospinal neurones associated with the motor areas studied, our findings also suggest that motor deficit severity is likely to increase as a lesion occupies progressively more posterior regions of the IC.
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Affiliation(s)
- Robert J Morecraft
- Division of Basic Biomedical Sciences, The University of South Dakota School of Medicine, Vermillion, SD 57069, USA.
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Veizovic T, Beech JS, Stroemer RP, Watson WP, Hodges H. Resolution of stroke deficits following contralateral grafts of conditionally immortal neuroepithelial stem cells. Stroke 2001; 32:1012-9. [PMID: 11283405 DOI: 10.1161/01.str.32.4.1012] [Citation(s) in RCA: 128] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Grafts of MHP36 cells have previously been shown to reduce dysfunction after global ischemia in rats. To test their efficacy after focal ischemia, MHP36 cells were grafted 2 to 3 weeks after transient intraluminal middle cerebral artery occlusion (tMCAO) in rats. METHODS MHP36 cells were implanted into the hemisphere contralateral to the lesion, with 8 deposits of 3 microL of cell suspension (25 000 cells per microliter). Sham grafted rats received equivalent volumes of vehicle. Three groups, sham-operated controls (n=11), MCAO+sham grafts (n=10), and MCAO+MHP36 grafts (n=11), were compared in 3 behavioral tests. RESULTS In the bilateral asymmetry test, MCAO+MHP36 grafted rats exhibited neglect before grafting but subsequently showed no significant dysfunction, whereas MCAO+sham grafted rats showed stable sensorimotor deficits over 18 weeks relative to controls. MCAO+sham grafted rats demonstrated spontaneous motor asymmetry and increased rotational bias after injection of dopamine agonists. MCAO+MHP36 and control groups exhibited no bias in either spontaneous or drug-induced rotation. In contrast to motor recovery, MCAO+MHP36 grafted rats showed no improvement relative to MCAO+sham grafted rats in spatial learning and memory in the water maze. MCAO produced large striatal and cortical cavitations in both occluded groups. Lesion volume was significantly reduced (P<0.05) in the MCAO+MHP36 grafted group. The majority of MHP36 cells were identified within the intact grafted hemisphere. However, MHP36 cells were also seen in the cortex, striatum, and corpus callosum of the lesioned hemisphere. CONCLUSIONS MHP36 cells may improve functional outcome after MCAO by assisting spontaneous reorganization in both the damaged and intact hemispheres.
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Affiliation(s)
- T Veizovic
- ReNeuron Ltd, Department of Psychology, Institute of Psychiatry, King's College, London
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Dobkin BH. Spinal and supraspinal plasticity after incomplete spinal cord injury: correlations between functional magnetic resonance imaging and engaged locomotor networks. PROGRESS IN BRAIN RESEARCH 2001; 128:99-111. [PMID: 11105672 DOI: 10.1016/s0079-6123(00)28010-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- B H Dobkin
- Department of Neurology, University of California, Los Angeles 90095, USA.
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Pizzamiglio L, Galati G, Committeri G. The contribution of functional neuroimaging to recovery after brain damage: a review. Cortex 2001; 37:11-31. [PMID: 11292157 DOI: 10.1016/s0010-9452(08)70555-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The introduction of functional neuroimaging techniques has contributed to understanding the neural correlates of recovery of motor, sensory and cognitive functions after brain damage. In this paper, we review the literature of the past twenty years, with particular emphasis on quantitative studies of cerebral blood flow and metabolism. Studies are presented that examine recovery from hemiparesis, aphasia, spatial hemineglect and sensory disorders. The contribution of this research is critically discussed in a methodological perspective. A basic distinction is made between cerebral plasticity and recovery of functions. It is also argued that the most frequently used experimental designs do not permit directly relating changes in brain activity to functional recovery. The importance of accurate behavioural measures is underlined. Alternative experimental designs are proposed, based on correlations between behavioural performance and brain activations.
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Affiliation(s)
- L Pizzamiglio
- Fondazione Santa Lucia, and Department of Psychology, Universita La Sapienza, Roma, Italy.
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Bragoni M, Caltagirone C, Troisi E, Matteis M, Vernieri F, Silvestrini M. Correlation of cerebral hemodynamic changes during mental activity and recovery after stroke. Neurology 2000; 55:35-40. [PMID: 10891901 DOI: 10.1212/wnl.55.1.35] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the correlation between changes in cerebral functional activity during mental engagement and the potential for neurologic recovery after stroke. BACKGROUND Transcranial Doppler ultrasonography (TCD) makes it possible to detect the dynamic adjustment of cerebral perfusion related to functional neuronal changes. METHODS TCD monitoring of flow velocity changes in the middle cerebral artery of 29 ischemic stroke patients was performed during an object recognition task. The study took place within 4 weeks from stroke onset. Based on recovery occurring after 2 months, the patients were divided into four groups depending on the side of hemispheric lesion and the presence or absence of neurologic recovery. Ten healthy subjects served as control subjects. RESULTS During the recognition task, control subjects showed a bilateral increase in flow velocity with respect to the rest phase (right side, 7.02 +/- 1.3%; left side, 6.65 +/- 1. 1%), with no side-to-side difference. In patients who experienced recovery, a similar pattern of bilateral activation was observed, irrespective of the side of the lesion. Conversely, in patients with no recovery, the increase of flow velocity was significantly higher on the side contralateral to the brain lesion (p < 0.0001) with respect to the lesion side. Performance during the recognition task was comparable in the four groups of patients. CONCLUSIONS These findings suggest that satisfactory recovery from a neurologic deficit requires the persistence of functional activity in the damaged hemisphere despite the presence of an anatomic lesion. The possibility of obtaining early prognostic indications with TCD may be relevant for an early selection of patients with the best probability of benefiting from rehabilitation therapy.
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Liepert J, Bauder H, Wolfgang HR, Miltner WH, Taub E, Weiller C. Treatment-induced cortical reorganization after stroke in humans. Stroke 2000; 31:1210-6. [PMID: 10835434 DOI: 10.1161/01.str.31.6.1210] [Citation(s) in RCA: 766] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Injury-induced cortical reorganization is a widely recognized phenomenon. In contrast, there is almost no information on treatment-induced plastic changes in the human brain. The aim of the present study was to evaluate reorganization in the motor cortex of stroke patients that was induced with an efficacious rehabilitation treatment. METHODS We used focal transcranial magnetic stimulation to map the cortical motor output area of a hand muscle on both sides in 13 stroke patients in the chronic stage of their illness before and after a 12-day-period of constraint-induced movement therapy. RESULTS Before treatment, the cortical representation area of the affected hand muscle was significantly smaller than the contralateral side. After treatment, the muscle output area size in the affected hemisphere was significantly enlarged, corresponding to a greatly improved motor performance of the paretic limb. Shifts of the center of the output map in the affected hemisphere suggested the recruitment of adjacent brain areas. In follow-up examinations up to 6 months after treatment, motor performance remained at a high level, whereas the cortical area sizes in the 2 hemispheres became almost identical, representing a return of the balance of excitability between the 2 hemispheres toward a normal condition. CONCLUSIONS This is the first demonstration in humans of a long-term alteration in brain function associated with a therapy-induced improvement in the rehabilitation of movement after neurological injury.
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Affiliation(s)
- J Liepert
- Department of Neurology, Friedrich-Schiller-University of Jena, Germany.
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Mosier K, Patel R, Liu WC, Kalnin A, Maldjian J, Baredes S. Cortical representation of swallowing in normal adults: functional implications. Laryngoscope 1999; 109:1417-23. [PMID: 10499047 DOI: 10.1097/00005537-199909000-00011] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Dysphagia of neurogenic or postsurgical origin presents management and therapeutic challenges to the otolaryngologist. Improvements in management and therapeutic approaches may be facilitated by understanding how the central nervous system controls swallowing. The purpose of this investigation was to utilize functional magnetic resonance imaging to determine patterns of cortical activity during swallowing in normal, healthy adult subjects. STUDY DESIGN Functional magnetic resonance imaging (fMRI) was performed on eight healthy adult subjects using conventional BOLD (blood oxygenation level dependent) techniques. METHODS Subjects performed three different swallowing tasks including dry and bolus swallows, and performed a control finger movement task. Statistical maps of cortical activation were generated using a cross-correlation analysis. One-way and two-way ANOVA statistical analyses were performed to compare activated areas among the different tasks and to determine the effects of task sequence. RESULTS Activation during the three swallowing tasks occurred in the primary motor cortex, primary somatosensory cortex, and other cortical and subcortical sites. Cortical representation of swallowing and finger movement followed somatotopic maps. Differential distribution of cortical activation was observed for the different swallowing tasks. CONCLUSIONS Activation of the primary motor and somatosensory cortices, as well as other sensory-motor areas, occurs with swallowing in normal adults. Differential distribution of cortical activity with different swallowing tasks suggests differential functional organization for different swallowing tasks. Understanding these mechanisms may facilitate improved management and therapeutic intervention for neurogenic and postsurgical dysphagia.
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Affiliation(s)
- K Mosier
- Department of Oral Pathology, Biology, and Diagnostic Sciences, New Jersey Dental School, USA.
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Dettmers C, Liepert J, Adler T, Rzanny R, Rijntjes M, van Schayck R, Kaiser W, Brückner L, Weiller C. Abnormal motor cortex organization contralateral to early upper limb amputation in humans. Neurosci Lett 1999; 263:41-4. [PMID: 10218906 DOI: 10.1016/s0304-3940(99)00105-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We performed both a functional magnetic resonance imaging (fMRI) study using single slice FLASH technique and an investigation with transcranial magnetic stimulation (TMS) in a 21-year-old patient. He had suffered a left upper extremity amputation at age 7. Anteflexion of the amputation stump produced an unusual, broad activation contralateral to the movement. TMS revealed an enlarged cortical motor output area of the deltoid muscle at the amputation stump. Application of paired magnetic stimulation demonstrated decreased intracortical inhibition (ICI). A T1-weighted image indicated a lack of the characteristic shape of the central sulcus contralateral to the amputation. In addition to previous functional studies, these new structural data suggest that maturation of the central sulcus develops in response to daily practice of the contralateral hand, possibly until adolescence.
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Affiliation(s)
- C Dettmers
- Neurologie, Friedrich-Schiller-Universität, Jena, Germany.
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Dobkin BH. Driving cognitive and motor gains with rehabilitation after brain and spinal cord injury. Curr Opin Neurol 1998; 11:639-41. [PMID: 9870130 DOI: 10.1097/00019052-199812000-00005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Liepert J, Miltner WH, Bauder H, Sommer M, Dettmers C, Taub E, Weiller C. Motor cortex plasticity during constraint-induced movement therapy in stroke patients. Neurosci Lett 1998; 250:5-8. [PMID: 9696052 DOI: 10.1016/s0304-3940(98)00386-3] [Citation(s) in RCA: 424] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Stroke patients in the chronic phase received constraint-induced (CI) movement therapy. The motor cortex was spatially mapped using focal transcranial magnetic stimulation (TMS) before and after 2 weeks of treatment. Motor-output areas of the abductor pollicis brevis muscle, motor evoked potential (MEP) amplitudes and location of centre of gravity (CoG) of motor cortex output were studied. After CI therapy, motor performance improved substantially in all patients. There was also an increase of motor output area size and MEP amplitudes, indicating enhanced neuronal excitability in the damaged hemisphere for the target muscles. The mean centre of gravity of the motor output maps was shifted considerably after the rehabilitation, indicating the recruitment of motor areas adjacent to the original location. Thus, even in chronic stroke patients, reduced motor cortex representations of an affected body part can be enlarged and increased in level of excitability by an effective rehabilitation procedure. The data therefore demonstrate a CNS correlate of therapy-induced recovery of function after nervous system damage in humans.
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Affiliation(s)
- J Liepert
- Department of Neurology, Friedrich-Schiller-University of Jena, Germany.
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