1
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Brown AA, Ferguson BJ, Jones V, Green BE, Pearre JD, Anunoby IA, Beversdorf DQ, Barohn RJ, Cirstea CM. Pilot Study of Real-World Monitoring of the Heart Rate Variability in Amyotrophic Lateral Sclerosis. Front Artif Intell 2022; 5:910049. [PMID: 35875194 PMCID: PMC9301244 DOI: 10.3389/frai.2022.910049] [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: 03/31/2022] [Accepted: 06/15/2022] [Indexed: 12/03/2022] Open
Abstract
Aims Cardiovascular dysautonomia may impact the quality of life and survival in amyotrophic lateral sclerosis (ALS). Such dysfunction is not systematically assessed in these patients. Wearable devices could help. The feasibility of a wearable biosensor to detect heart rate variability (HRV), a physiological marker of sympathovagal balance, was studied for the first time in real-world settings in ALS. Methods Five ALS patients (two early/three late; one bulbar-onset; mildly-to-moderately disabled) and five age/sex/BMI/comorbidities-matched controls underwent assessment of 3-day HRV via VitalConnect biosensor (worn on the left thorax). De-identified data captured by the biosensor were transferred to a secure cloud server via a relay Bluetooth device. Baseline ALS severity/anxiety and physical activity during testing were documented/quantified. Time-domain HRV measures (i.e., pNN50) were analyzed. Results An overall 3-day abnormal HRV (pNN50 < 3%), was found in three out of five patients (mean ± SD for the group, 2.49 ± 1.51). Similar changes were reported in controls (12.32 ± 21.14%). There were no statistically significant relationships between pNN50 values and baseline anxiety or physical activity during the tested days (p > 0.05 for both groups). A negative correlation was found between pNN50 values and age in patients (p = 0.01) and controls (p = 0.09), which is similar with what is found in the general population. In line with prior studies, pNN50 values were independent of disease stage (p = 0.6) and disability (p = 0.4). Conclusions These preliminary results suggest that remote HRV measures using the VitalConnect is feasible and may constitute an improved strategy to provide insights into sympathovagal balance in ALS. Further work with larger sample sizes is warranted.
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Affiliation(s)
- Alexander A. Brown
- Department of Psychological Sciences, College of Arts and Science, University of Missouri, Columbia, MO, United States
| | - Bradley J. Ferguson
- Department of Health Psychology, School of Health Professions, University of Missouri, Columbia, MO, United States
- Department of Radiology, School of Medicine, University of Missouri, Columbia, MO, United States
| | - Vovanti Jones
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Missouri, Columbia, MO, United States
| | - Bruce E. Green
- School of Medicine, University of Missouri, Columbia, MO, United States
| | - Justin D. Pearre
- School of Medicine, University of Missouri, Columbia, MO, United States
| | - Ifeoma A. Anunoby
- College of Arts and Science, University of Missouri, Columbia, MO, United States
| | - David Q. Beversdorf
- Department of Health Psychology, School of Health Professions, University of Missouri, Columbia, MO, United States
- Department of Radiology, School of Medicine, University of Missouri, Columbia, MO, United States
- Department of Neurology, School of Medicine, University of Missouri, Columbia, MO, United States
| | - Richard J. Barohn
- Department of Neurology, School of Medicine, University of Missouri, Columbia, MO, United States
| | - Carmen M. Cirstea
- Department of Health Psychology, School of Health Professions, University of Missouri, Columbia, MO, United States
- *Correspondence: Carmen M. Cirstea
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2
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Ferris JK, Neva JL, Vavasour IM, Attard KJ, Greeley B, Hayward KS, Wadden KP, MacKay AL, Boyd LA. Cortical N-acetylaspartate concentrations are impacted in chronic stroke but do not relate to motor impairment: A magnetic resonance spectroscopy study. Hum Brain Mapp 2021; 42:3119-3130. [PMID: 33939206 PMCID: PMC8193507 DOI: 10.1002/hbm.25421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/24/2021] [Accepted: 03/08/2021] [Indexed: 12/11/2022] Open
Abstract
Magnetic resonance spectroscopy (MRS) measures cerebral metabolite concentrations, which can inform our understanding of the neurobiological processes associated with stroke recovery. Here, we investigated whether metabolite concentrations in primary motor and somatosensory cortices (sensorimotor cortex) are impacted by stroke and relate to upper‐extremity motor impairment in 45 individuals with chronic stroke. Cerebral metabolite estimates were adjusted for cerebrospinal fluid and brain tissue composition in the MRS voxel. Upper‐extremity motor impairment was indexed with the Fugl‐Meyer (FM) scale. N‐acetylaspartate (NAA) concentration was reduced bilaterally in stroke participants with right hemisphere lesions (n = 23), relative to right‐handed healthy older adults (n = 15; p = .006). Within the entire stroke sample (n = 45) NAA and glutamate/glutamine (GLX) were lower in the ipsilesional sensorimotor cortex, relative to the contralesional cortex (NAA: p < .001; GLX: p = .003). Lower ipsilesional NAA was related to greater extent of corticospinal tract (CST) injury, quantified by a weighted CST lesion load (p = .006). Cortical NAA and GLX concentrations did not relate to the severity of chronic upper‐extremity impairment (p > .05), including after a sensitivity analysis imputing missing metabolite data for individuals with large cortical lesions (n = 5). Our results suggest that NAA, a marker of neuronal integrity, is sensitive to stroke‐related cortical damage and may provide mechanistic insights into cellular processes of cortical adaptation to stroke. However, cortical MRS metabolites may have limited clinical utility as prospective biomarkers of upper‐extremity outcomes in chronic stroke.
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Affiliation(s)
- Jennifer K Ferris
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason L Neva
- École de Kinésiologie et des Sciences de l'activité Physique, Université of Montréal, Montreal, Quebec, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-sud-de-I'île de Montréal, Montreal, Quebec, Canada
| | - Irene M Vavasour
- Faculty of Medicine, UBC MRI Research Center, University of British Columbia, Vancouver, BC, Canada
| | - Kaitlin J Attard
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian Greeley
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kathryn S Hayward
- School of Health Sciences, Florey Institute of Neuroscience and Mental Health, NHMRC CRE in Stroke Rehabilitation and Brain Recovery, The University of Melbourne, Parkville, Victoria, Australia
| | - Katie P Wadden
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Alex L MacKay
- Faculty of Medicine, UBC MRI Research Center, University of British Columbia, Vancouver, BC, Canada
| | - Lara A Boyd
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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3
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Mostafa MM, Awad EM, Hazzou AM, Elewa MKA, Aziz TTA, Samy DM. Biochemical and structural magnetic resonance imaging in chronic stroke and the relationship with upper extremity motor function. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-00183-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Recovery of upper extremity (UE) motor function after stroke is variable from one to another due to heterogeneity of stroke pathology. Structural and biochemical magnetic resonance imaging of the primary motor cortex (M1) have been used to document reorganization of neural activity after stroke.
Objective
To assess cortical biochemical and structural causes of delayed recovery of UE motor function impairment in chronic subcortical ischemic stroke patients.
Methodology
A cross-sectional study with fifty patients were enrolled: thirty patients with chronic (> 6 months) subcortical ischemic stroke suffering from persistent UE motor function impairment (not improved group) and twenty patients with chronic subcortical ischemic stroke and improved UE motor function (improved group). We recruited a group of (16) age-matched healthy subjects. Single voxel proton magnetic resonance spectroscopy (1H-MRS) was performed to measure n-acetylaspartate (NAA) and glutamate+glutamine (Glx) ratios relative to creatine (Cr) in the precentral gyrus which represent M1of hand area in both ipsilesional and contralesional hemispheres. Brain magnetic resonance imaging (MRI) to measure precentral gyral thickness is representing the M1of hand area. UE motor function assessment is using the Fugl Meyer Assessment (FMA-UE) Scale.
Results
The current study found that ipslesional cortical thickness was significantly lower than contralesional cortical thickness among all stroke patients. Our study found that ipsilesional NAA/Cr ratio was lower than contralesional NAA/Cr among stroke patients. UE and hand motor function by FMA-UE showed highly statistically significant correlation with ipsilesional cortical thickness and ipsilesional NAA/Cr ratio, more powerful with NAA/Cr ratio.
Conclusion
We concluded that persistent motor impairment in individuals with chronic subcortical stroke may be at least in part related to ipsilesional structural and biochemical changes in motor areas remote from infarction in form of decreased cortical thickness and NAA/Cr ratio which had the strongest relationship with that impairment.
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4
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Sun C, Liu X, Bao C, Wei F, Gong Y, Li Y, Liu J. Advanced non-invasive MRI of neuroplasticity in ischemic stroke: Techniques and applications. Life Sci 2020; 261:118365. [PMID: 32871181 DOI: 10.1016/j.lfs.2020.118365] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 12/27/2022]
Abstract
Ischemic stroke represents a serious medical condition which could cause survivors suffer from long-term and even lifetime disabilities. After a stroke attack, the brain would undergo varying degrees of recovery, in which the central nervous system could be reorganized spontaneously or with the help of appropriate rehabilitation. Magnetic resonance imaging (MRI) is a non-invasive technique which can provide comprehensive information on structural, functional and metabolic features of brain tissue. In the last decade, there has been an increased technical advancement in MR techniques such as voxel-based morphological analysis (VBM), diffusion magnetic resonance imaging (dMRI), functional magnetic resonance imaging (fMRI), arterial spin-labeled perfusion imaging (ASL), magnetic sensitivity weighted imaging (SWI), quantitative sensitivity magnetization (QSM) and magnetic resonance spectroscopy (MRS) which have been proven to be a valuable tool to study the brain tissue reorganization. Due to MRI indices of neuroplasticity related to neurological outcome could be translated to the clinic. The ultimate goal of this review is to equip readers with a fundamental understanding of advanced MR techniques and their corresponding clinical application for improving the ability to predict neuroplasticity that are most suitable for stroke management.
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Affiliation(s)
- Chao Sun
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, PR China
| | - Xuehuan Liu
- Department of Radiology, Tianjin Union Medical Center, Tianjin 300121, PR China
| | - Cuiping Bao
- Department of Radiology, Tianjin Union Medical Center, Tianjin 300121, PR China
| | - Feng Wei
- Department of Radiology, Tianjin Union Medical Center, Tianjin 300121, PR China
| | - Yi Gong
- Department of Radiology, Tianjin Union Medical Center, Tianjin 300121, PR China
| | - Yiming Li
- Department of Radiology, Tianjin Union Medical Center, Tianjin 300121, PR China
| | - Jun Liu
- Department of Radiology, Tianjin Union Medical Center, Tianjin 300121, PR China.
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5
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Mueangson O, Vongvaivanichakul P, Kamdee K, Jansakun C, Chulrik W, Pongpanitanont P, Sathirapanya P, Chunglok W. Malondialdehyde as a Useful Biomarker of Low Hand Grip Strength in Community-Dwelling Stroke Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217918. [PMID: 33126675 PMCID: PMC7663701 DOI: 10.3390/ijerph17217918] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/23/2020] [Accepted: 10/24/2020] [Indexed: 12/12/2022]
Abstract
The assessment of muscle strength by hand grip strength (HGS) is used to evaluate muscle weakness and wasting among stroke patients. This study aimed to investigate the association of oxidative stress/oxidative damage and inflammatory biomarkers with muscle strength and wasting, as evaluated by HGS, among community-dwelling post-stroke patients. The HGS of both paretic and non-paretic limbs was negatively associated with modified Rankin scale (mRS) values. The serum levels of catalase activity and malondialdehyde (MDA), and plasma tumor necrosis factor (TNF)-α levels were significantly increased in post-stroke patients compared with non-stroke controls. Further analysis highlighted that hydrogen peroxide was positively correlated with HGS in the paretic limbs. Interestingly, an elevated MDA level, excluding advanced age and high mRS, increased the risk of low HGS in the non-paretic limbs of stroke patients. This study suggests that there is a detrimental association between MDA and muscle strength and early muscle wasting among post-stroke patients. Hence, MDA is a potentially useful biomarker of muscle weakness and wasting in post-stroke patients living in the community.
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Affiliation(s)
- Onchuma Mueangson
- School of Allied Health Sciences and Research Institute for Health Sciences, Walailak University, Nakhon Si Thammarat 80161, Thailand; (O.M.); (P.V.); (K.K.); (C.J.); (W.C.); (P.P.)
| | - Parinya Vongvaivanichakul
- School of Allied Health Sciences and Research Institute for Health Sciences, Walailak University, Nakhon Si Thammarat 80161, Thailand; (O.M.); (P.V.); (K.K.); (C.J.); (W.C.); (P.P.)
| | - Kornyok Kamdee
- School of Allied Health Sciences and Research Institute for Health Sciences, Walailak University, Nakhon Si Thammarat 80161, Thailand; (O.M.); (P.V.); (K.K.); (C.J.); (W.C.); (P.P.)
| | - Chutima Jansakun
- School of Allied Health Sciences and Research Institute for Health Sciences, Walailak University, Nakhon Si Thammarat 80161, Thailand; (O.M.); (P.V.); (K.K.); (C.J.); (W.C.); (P.P.)
| | - Wanatsanan Chulrik
- School of Allied Health Sciences and Research Institute for Health Sciences, Walailak University, Nakhon Si Thammarat 80161, Thailand; (O.M.); (P.V.); (K.K.); (C.J.); (W.C.); (P.P.)
| | - Pongphan Pongpanitanont
- School of Allied Health Sciences and Research Institute for Health Sciences, Walailak University, Nakhon Si Thammarat 80161, Thailand; (O.M.); (P.V.); (K.K.); (C.J.); (W.C.); (P.P.)
| | - Pornchai Sathirapanya
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkla 90110, Thailand;
| | - Warangkana Chunglok
- School of Allied Health Sciences and Research Institute for Health Sciences, Walailak University, Nakhon Si Thammarat 80161, Thailand; (O.M.); (P.V.); (K.K.); (C.J.); (W.C.); (P.P.)
- Correspondence: ; Tel.: +66-7567-2681
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6
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Respiratory Function and Grip Strength in the Acute Phase of Stroke Are Associated with Stroke Severity and Disability at Hospital Discharge. Rehabil Res Pract 2020; 2020:1636540. [PMID: 32089889 PMCID: PMC7023719 DOI: 10.1155/2020/1636540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/07/2020] [Accepted: 01/24/2020] [Indexed: 01/25/2023] Open
Abstract
Introduction. Stroke can lead to musculoskeletal and respiratory dysfunction, chronic deconditioning, and functional limitations, as well as long-term complications.
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7
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Wei XE, Shang K, Zhou J, Zhou YJ, Li YH. Acute Subcortical Infarcts Cause Secondary Degeneration in the Remote Non-involved Cortex and Connecting Fiber Tracts. Front Neurol 2019; 10:860. [PMID: 31440202 PMCID: PMC6693082 DOI: 10.3389/fneur.2019.00860] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 07/25/2019] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose: Remote white matter and cortex reorganization may contribute to functional reorganization and clinical outcome after acute infarcts. To determine the microstructural changes in the remote intact corticospinal tract (CST) and precentral gyrus cortex connected to the acute infarct after subcortical stroke involving the CST over 6 months. Methods: Twenty-two patients with subcortical stroke involving the CST underwent magnetic resonance imaging (MRI) and clinical assessment in the acute phase (baseline) and 6 months (follow-up) after the stroke. The MRI sequences included T1-weighted imaging, T2-weighted imaging, fluid-attenuated inversion recovery, diffusion tensor imaging (DTI), and diffusion kurtosis imaging. Fractional anisotropy (FA) and track-density imaging (TDI) values were generated using DTI data for the centrum semiovale, corona radiata, posterior limb of internal capsule, and cerebral peduncle. The mean kurtosis (MK) value of the precentral gyrus cortex was calculated. Changes in the FA, TDI, and MK values between the baseline and follow-up and the relationship between these changes were analyzed. Results: The TDI and FA values of all parts of the ipsilesional (IL) CST, including the noninvolved upper and lower parts, decreased at the 6-month follow-up (P < 0.001). The MK values of the stroke lesion (P < 0.001) and IL precentral gyrus cortex (P = 0.002) were lower at follow-up than at the baseline. The ΔTDI (r = 0.689, P < 0.001) and Δ FA values (r = 0.463, P = 0.03) of the noninvolved upper part of the IL CST were positively correlated with the ΔMK value of the IL precentral gyrus cortex. Conclusion: Secondary degeneration occurred in the remote part of the CST and the remote IL precentral gyrus cortex after subcortical stroke involving the CST. The secondary degeneration in the upper part of the CST was correlated with that in the IL precentral gyrus cortex.
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Affiliation(s)
- Xiao-Er Wei
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Kai Shang
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jia Zhou
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Ya-Jun Zhou
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yue-Hua Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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8
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Molle Da Costa RD, Luvizutto GJ, Martins LG, Thomaz De Souza J, Regina Da Silva T, Alvarez Sartor LC, Winckler FC, Modolo GP, Molle ERDSD, Dos Anjos SM, Bazan SGZ, Cuadrado LM, Bazan R. Clinical factors associated with the development of nonuse learned after stroke: a prospective study. Top Stroke Rehabil 2019; 26:511-517. [PMID: 31230583 DOI: 10.1080/10749357.2019.1631605] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: Upper extremity impairment is present in most of people with stroke. The use of the affected upper extremity can be impacted not only by physical impairment but also by abehavioral phenomenon called learned nonuse. Objective: The aim of this study was to evaluate which clinical factors in the acute phase are associated with the development of learned nonuse in the upper extremity after stroke. Methods: This cohort study included 38 patients with ischemic stroke. Hospital discharge data were collected for clinical aspects, scales of severity, incapacity and autonomy, as well as for neuromuscular and sensory evaluations. At 90 days after hospital discharge, the score on the Motor Activity Log scale for detecting learned nonuse was obtained, and life quality was evaluated by the EuroQol. The individuals with and without learned nonuse were compared by attest for univariate analysis, and ageneralized linear model was employed to find possible predictors, which were considered significant p <0.05. Results: In the statistical model, age (p= .006), severity at discharge (p= .036), handgrip strength (p= .000), altered sensitivity (p= .011), incapacity at discharge (p= .009) and autonomy at discharge (p= .011) were found to be associated with learned nonuse. In relation to quality of life, mobility, personal care, usual activities, anxiety, depression and perception had lower mean values in the learned nonuse group. Conclusion: Age, severity of stroke, incapacity and neuromuscular and sensory compromises are associated with upper extremity learned nonuse in stroke patients.
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Affiliation(s)
| | - Gustavo José Luvizutto
- Department of Applied Physical Therapy, Federal University of Triângulo Mineiro , Uberaba , Brazil
| | | | | | - Taís Regina Da Silva
- Department of rehabilitation Center, Botucatu Medical School , Botucatu , Brazil
| | | | | | - Gabriel Pinheiro Modolo
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School , Botucatu , Brazil
| | | | - Sarah M Dos Anjos
- Department of Medicine, University of Alabama , Birmingham , AL , USA
| | | | | | - Rodrigo Bazan
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School , Botucatu , Brazil
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9
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Cirstea CM, Lee P, Craciunas SC, Choi IY, Burris JE, Nudo RJ. Pre-therapy Neural State of Bilateral Motor and Premotor Cortices Predicts Therapy Gain After Subcortical Stroke: A Pilot Study. Am J Phys Med Rehabil 2017; 97:23-33. [PMID: 28737516 DOI: 10.1097/phm.0000000000000791] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of the study was to examine whether neural state of spared motor and premotor cortices captured before a therapy predicts therapy-related motor gains in chronic subcortical stroke. DESIGN Ten survivors, presenting chronic moderate upper limb impairment, underwent proton magnetic resonance spectroscopy, magnetic resonance imaging, clinical, and kinematics assessments before a 4-wk impairment-oriented training. Clinical/kinematics assessments were repeated after therapy, and motor gain was defined as positive values of clinical upper limb/elbow motion changes and negative values of trunk motion changes. Candidate predictors were N-acetylaspartate-neuronal marker, glutamate-glutamine-indicator of glutamatergic neurotransmission, and myo-inositol-glial marker, measured bilaterally within the upper limb territory in motor and premotor (premotor cortex, supplementary motor area) cortices. Traditional predictors (age, stroke length, pre-therapy upper limb clinical impairment, infarct volume) were also investigated. RESULTS Poor motor gain was associated with lower glutamate-glutamine levels in ipsilesional primary motor cortex and premotor cortex (r = 0.77, P = 0.01 and r = 0.78, P = 0.008, respectively), lower N-acetylaspartate in ipsilesional premotor cortex (r = 0.69, P = 0.02), higher glutamate-glutamine in contralesional primary motor cortex (r = -0.68, P = 0.03), and lower glutamate-glutamine in contralesional supplementary motor area (r = 0.64, P = 0.04). These predictors outperformed myo-inositol metrics and traditional predictors (P ≈ 0.05-1.0). CONCLUSIONS Glutamatergic state of bilateral motor and premotor cortices and neuronal state of ipsilesional premotor cortex may be important for predicting motor outcome in the context of a restorative therapy.
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Affiliation(s)
- Carmen M Cirstea
- From the Departments of Neurology (CMC, I-YC), Molecular & Integrative Physiology (PL), Physical Medicine & Rehabilitation (RJN); Hoglund Brain Imaging Center (CMC, PL, SCC, I-YC), Landon Center on Aging (RJN), University of Kansas Medical Center, Kansas City, Kansas; and Department of Physical Medicine and Rehabilitation, University of Missouri, Columbia, Missouri (CMC, JEB)
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10
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Cirstea CM, Choi IY, Lee P, Peng H, Kaufman CL, Frey SH. Magnetic resonance spectroscopy of current hand amputees reveals evidence for neuronal-level changes in former sensorimotor cortex. J Neurophysiol 2017; 117:1821-1830. [PMID: 28179478 DOI: 10.1152/jn.00329.2016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 01/23/2017] [Accepted: 01/23/2017] [Indexed: 11/22/2022] Open
Abstract
Deafferentation is accompanied by large-scale functional reorganization of maps in the primary sensory and motor areas of the hemisphere contralateral to injury. Animal models of deafferentation suggest a variety of cellular-level changes including depression of neuronal metabolism and even neuronal death. Whether similar neuronal changes contribute to patterns of reorganization within the contralateral sensorimotor cortex of chronic human amputees is uncertain. We used functional MRI-guided proton magnetic resonance spectroscopy to test the hypothesis that unilateral deafferentation is associated with lower levels of N-acetylaspartate (NAA, a putative marker of neuronal integrity) in the sensorimotor hand territory located contralateral to the missing hand in chronic amputees (n = 19) compared with the analogous hand territory of age- and sex-matched healthy controls (n = 28). We also tested whether former amputees [i.e., recipients of replanted (n = 3) or transplanted (n = 2) hands] exhibit NAA levels that are indistinguishable from controls, possible evidence for reversal of the effects of deafferentation. As predicted, relative to controls, current amputees exhibited lower levels of NAA that were negatively and significantly correlated with the time after amputation. Contrary to our prediction, NAA levels in both replanted and transplanted patients fell within the range of the current amputees. We suggest that lower levels of NAA in current amputees reflects altered neuronal integrity consequent to chronic deafferentation. Thus local changes in NAA levels may provide a means of assessing neuroplastic changes in deafferented cortex. Results from former amputees suggest that these changes may not be readily reversible through reafferentation.NEW & NOTEWORTHY This study is the first to use functional magnetic resonance-guided magnetic resonance spectroscopy to examine neurochemical mechanisms underlying functional reorganization in the primary somatosensory and motor cortices consequent to upper extremity amputation and its potential reversal through hand replantation or transplantation. We provide evidence for selective alteration of cortical neuronal integrity associated with amputation-related deafferentation that may not be reversible.
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Affiliation(s)
- Carmen M Cirstea
- Department of Physical Medicine and Rehabilitation, University of Missouri, Columbia, Missouri; .,Department of Neurology, Kansas University Medical Center, Kansas City, Kansas
| | - In-Young Choi
- Department of Neurology, Kansas University Medical Center, Kansas City, Kansas
| | - Phil Lee
- Department of Molecular and Integrative Physiology, Kansas University Medical Center, Kansas City, Kansas
| | - Huiling Peng
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri.,Brain Imaging Center, University of Missouri, Columbia, Missouri; and
| | | | - Scott H Frey
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri
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11
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Craciunas SC, Gorgan MR, Ianosi B, Lee P, Burris J, Cirstea CM. Remote motor system metabolic profile and surgery outcome in cervical spondylotic myelopathy. J Neurosurg Spine 2017; 26:668-678. [PMID: 28304238 DOI: 10.3171/2016.10.spine16479] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE In patients with cervical spondylotic myelopathy (CSM), the motor system may undergo progressive functional/structural changes rostral to the lesion, and these changes may be associated with clinical disability. The extent to which these changes have a prognostic value in the clinical recovery after surgical treatment is not yet known. In this study, magnetic resonance spectroscopy (MRS) was used to test 2 primary hypotheses. 1) Based on evidence of corticospinal and spinocerebellar, rubro-, or reticulospinal tract degeneration/dysfunction during chronic spinal cord compression, the authors hypothesized that the metabolic profile of the primary motor cortices (M1s) and cerebellum, respectively, would be altered in patients with CSM, and these alterations would be associated with the extent of the neurological disabilities. 2) Considering that damage and/or plasticity in the remote motor system may contribute to clinical recovery, they hypothesized that M1 and cerebellar metabolic profiles would predict, at least in part, surgical outcome. METHODS The metabolic profile, consisting of N-acetylaspartate (NAA; marker of neuronal integrity), myoinositol (glial marker), choline (cell membrane synthesis and turnover), and glutamate-glutamine (glutamatergic system), of the M1 hand/arm territory in each hemisphere and the cerebellum vermis was investigated prior to surgery in 21 patients exhibiting weakness of the upper extremities and/or gait abnormalities. Age- and sex-matched controls (n = 16) were also evaluated to estimate the pre-CSM metabolic profile of these areas. Correlation and regression analyses were performed between preoperative metabolite levels and clinical status 6 months after surgery. RESULTS Relative to controls, patients exhibited significantly higher levels of choline but no difference in the levels of other metabolites across M1s. Cerebellar metabolite levels were indistinguishable from control levels. Certain metabolites-myo-inositol and choline across M1s, NAA and glutamate-glutamine in the left M1, and myo-inositol and glutamate-glutamine in the cerebellum-were significantly associated with postoperative clinical status. These associations were greatly improved by including preoperative clinical metrics into the models. Likewise, these models improved the predictive value of preoperative clinical metrics alone. CONCLUSIONS These preliminary findings demonstrate relationships between the preoperative metabolic profiles of two remote motor areas and surgical outcome in CSM patients. Including preoperative clinical metrics in the models significantly strengthened the predictive value. Although further studies are needed, this investigation provides an important starting point to understand how the changes upstream from the injury may influence the effect of spinal cord decompression.
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Affiliation(s)
- Sorin C Craciunas
- Department of Neurosurgery, Bagdasar-Arseni Hospital, Bucharest, Romania
| | - Mircea R Gorgan
- Department of Neurosurgery, Bagdasar-Arseni Hospital, Bucharest, Romania
| | - Bogdan Ianosi
- Department of Neurology, Elbe Kliniken Hospital, University Medical Center Hamburg-Eppendorf, Germany.,Romanian National Institute of Neurology and Neurovascular Diseases, Bucharest, Romania
| | - Phil Lee
- Departments of 4 Molecular and Integrative Physiology and
| | - Joseph Burris
- Department of Physical Medicine & Rehabilitation, University of Missouri, Columbia, Missouri
| | - Carmen M Cirstea
- Neurology, Kansas University Medical Center, Kansas City, Kansas; and.,Department of Physical Medicine & Rehabilitation, University of Missouri, Columbia, Missouri
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Physical Exercise as a Diagnostic, Rehabilitation, and Preventive Tool: Influence on Neuroplasticity and Motor Recovery after Stroke. Neural Plast 2015; 2015:608581. [PMID: 26682073 PMCID: PMC4670869 DOI: 10.1155/2015/608581] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 06/03/2015] [Accepted: 06/18/2015] [Indexed: 01/19/2023] Open
Abstract
Stroke remains a leading cause of adult motor disabilities in the world and accounts for the greatest number of hospitalizations for neurological disease. Stroke treatments/therapies need to promote neuroplasticity to improve motor function. Physical exercise is considered as a major candidate for ultimately promoting neural plasticity and could be used for different purposes in human and animal experiments. First, acute exercise could be used as a diagnostic tool to understand new neural mechanisms underlying stroke physiopathology. Indeed, better knowledge of stroke mechanisms that affect movements is crucial for enhancing treatment/rehabilitation effectiveness. Secondly, it is well established that physical exercise training is advised as an effective rehabilitation tool. Indeed, it reduces inflammatory processes and apoptotic marker expression, promotes brain angiogenesis and expression of some growth factors, and improves the activation of affected muscles during exercise. Nevertheless, exercise training might also aggravate sensorimotor deficits and brain injury depending on the chosen exercise parameters. For the last few years, physical training has been combined with pharmacological treatments to accentuate and/or accelerate beneficial neural and motor effects. Finally, physical exercise might also be considered as a major nonpharmacological preventive strategy that provides neuroprotective effects reducing adverse effects of brain ischemia. Therefore, prestroke regular physical activity may also decrease the motor outcome severity of stroke.
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