1
|
Nägele FL, Petersen M, Mayer C, Bönstrup M, Schulz R, Gerloff C, Thomalla G, Cheng B. Longitudinal microstructural alterations surrounding subcortical ischemic stroke lesions detected by free-water imaging. Hum Brain Mapp 2024; 45:e26722. [PMID: 38780442 PMCID: PMC11114091 DOI: 10.1002/hbm.26722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 03/20/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024] Open
Abstract
In this study we explore the spatio-temporal trajectory and clinical relevance of microstructural white matter changes within and beyond subcortical stroke lesions detected by free-water imaging. Twenty-seven patients with subcortical infarct with mean age of 66.73 (SD 11.57) and median initial NIHSS score of 4 (IQR 3-7) received diffusion MRI 3-5 days, 1 month, 3 months, and 12 months after symptom-onset. Extracellular free-water and fractional anisotropy of the tissue (FAT) were averaged within stroke lesions and the surrounding tissue. Linear models showed increased free-water and decreased FAT in the white matter of patients with subcortical stroke (lesion [free-water/FAT, mean relative difference in %, ipsilesional vs. contralesional hemisphere at 3-5 days, 1 month, 3 months, and 12 months after symptom-onset]: +41/-34, +111/-37, +208/-26, +251/-18; perilesional tissue [range in %]: +[5-24]/-[0.2-7], +[2-20]/-[3-16], +[5-43]/-[2-16], +[10-110]/-[2-12]). Microstructural changes were most prominent within the lesion and gradually became less pronounced with increasing distance from the lesion. While free-water elevations continuously increased over time and peaked after 12 months, FAT decreases were most evident 1 month post-stroke, gradually returning to baseline values thereafter. Higher perilesional free-water and higher lesional FAT at baseline were correlated with greater reductions in lesion size (rho = -0.51, p = .03) in unadjusted analyses only, while there were no associations with clinical measures. In summary, we find a characteristic spatio-temporal pattern of extracellular and cellular alterations beyond subcortical stroke lesions, indicating a dynamic parenchymal response to ischemia characterized by vasogenic edema, cellular damage, and white matter atrophy.
Collapse
Affiliation(s)
- Felix L. Nägele
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Marvin Petersen
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Carola Mayer
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Marlene Bönstrup
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- Department of NeurologyUniversity of Leipzig Medical CenterLeipzigGermany
| | - Robert Schulz
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Christian Gerloff
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Götz Thomalla
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Bastian Cheng
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| |
Collapse
|
2
|
Liu H, Xu Y, Jiang W, Hu F, Zhou Y, Pan L, Zhou F, Yin Y, Tan B. Effects of task-based mirror therapy on upper limb motor function in hemiplegia: study protocol for a randomized controlled clinical trial. Trials 2024; 25:254. [PMID: 38605413 PMCID: PMC11010366 DOI: 10.1186/s13063-024-08081-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 03/29/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND AND PURPOSE Research to date has lacked definitive evidence to determine whether mirror therapy promotes the recovery of upper extremity function after stroke. Considering that previous studies did not stratify patients based on structural retention, this may be one of the reasons for the negative results obtained in many trials. The goal evaluates the efficacy of TBMT (utilizing an innovatively designed mirror) versus standard occupational therapy for stroke patient's upper limb functionality. METHODS AND ANALYSIS This single-center randomized controlled trial will involve 50 patients with stroke. All patients will be randomly assigned to either the task-based mirror therapy or the control group. The interventions will be performed 5 days per week for 4 weeks. The primary outcomes will be the mean change in scores on both the FMA-UE and modified Barthel Index (MBI) from baseline to 4 weeks intervention and at 12 weeks follow-up between the two groups and within groups. The other outcomes will include the Action Research Arm Test (ARAT), the Nine Hole Peg Test (9HPT), the Functional Independence Measure, and MRI. DISCUSSION This trial will not only to establish that task-based mirror therapy (TBMT) could improve the recovery of hand function after stroke but also to explore the underlying mechanisms. We expect that this finding will clarify the brain activation and brain network mechanisms underlying the improvement of hand function with task-oriented mirror therapy and lead to new ideas for stroke hand function rehabilitation. TRIAL REGISTRATION URL: https://www.chictr.org.cn ; Unique identifier: ChiCTR2300068855. Registered on March 1, 2023.
Collapse
Affiliation(s)
- Hongzhen Liu
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Lin Jiang Road, Chongqing, 40010, China
| | - Yangjie Xu
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Lin Jiang Road, Chongqing, 40010, China
| | - Wei Jiang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Lin Jiang Road, Chongqing, 40010, China
| | - Fangchao Hu
- Department of Mechanical Engineering, Chongqing University of Technology, No. 69 Hongguang Avenue, Chongqing, 400054, China
| | - Yi Zhou
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Lin Jiang Road, Chongqing, 40010, China
| | - Lu Pan
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Lin Jiang Road, Chongqing, 40010, China
| | - Feng Zhou
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Lin Jiang Road, Chongqing, 40010, China
| | - Ying Yin
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Lin Jiang Road, Chongqing, 40010, China
| | - Botao Tan
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Lin Jiang Road, Chongqing, 40010, China.
| |
Collapse
|
3
|
Yu Z, Yang X, Qin F, Ma T, Zhang J, Leng X, Bi H, Liu X. Effects of acupuncture synchronized rehabilitation therapy on upper limb motor and sensory function after stroke: a study protocol for a single-center, 2 × 2 factorial design, randomized controlled trial. Front Neurol 2023; 14:1162168. [PMID: 37840941 PMCID: PMC10569312 DOI: 10.3389/fneur.2023.1162168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 09/11/2023] [Indexed: 10/17/2023] Open
Abstract
Background Upper limb function reconstruction has been an important issue in the field of stroke rehabilitation. Due to the complexity of upper extremity dysfunction in stroke patients, the clinical efficacy produced by central or peripheral stimulation alone is limited. For this reason, our group has proposed acupuncture synchronized rehabilitation therapy (ASRT), i.e., simultaneous scalp acupuncture and intradermal acupuncture during rehabilitation. Pre-experiments results showed that this therapy can effectively improve the motor and sensory functions of upper limbs in post-stroke patients, but the clinical efficacy and safety of ASRT need to be further verified, and whether there is a synergistic effect between scalp acupuncture and intradermal acupuncture also needs to be studied in depth. Therefore, we designed a randomized controlled trial to compare the efficacy and safety of different therapies to explore a more scientific "synchronous treatment model." Methods This is a single-center, randomized controlled trial using a 2 × 2 factorial design. We will recruit 136 stroke survivors with upper extremity dysfunction and randomize them into four groups (n = 34). All subjects will undergo routine treatment, based on which the Experimental Group 1: rehabilitation training synchronized with intradermal acupuncture treatment of the affected upper limb; Experimental Group 2: rehabilitation training of the affected upper limb synchronized with focal-side scalp acupuncture treatment, and Experimental Group 3: rehabilitation training synchronized with intradermal acupuncture treatment of the affected upper limb synchronized with focal-side scalp acupuncture treatment; Control Group: rehabilitation training of the affected upper limb only. The intervention will last for 4 weeks, 5 times a week. Both acupuncture treatments will be performed according to the Revised Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA). The primary outcome indicators for this trial are Fugl-Meyer Assessment-Upper Extremity and Somatosensory Evoked Potential. Secondary outcome indicators include Wolf Motor Function Test, Upper Extremity Function Test, revised Nottingham Sensory Assessment Scale, Diffusion Tensor Imaging, and Modified Barthel Index. The incidence of adverse events will be used as the indicator of safety. Discussion The study will provide high-quality clinical evidence on whether ASRT improves upper limb motor and sensory function and activities of daily living (ADL) in stroke patients, and determine whether scalp acupuncture and intradermal acupuncture have synergistic effects. Clinical trial registration https://www.chictr.org.cn/, Chinese Clinical Trial Registry [ChiCTR2200066646].
Collapse
Affiliation(s)
- Zifu Yu
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xiaoxia Yang
- School of Nursing, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Fang Qin
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Tiantian Ma
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jie Zhang
- The First Clinical Medical College of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xiaoxuan Leng
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Hongyan Bi
- Department of Rehabilitation, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xihua Liu
- Department of Rehabilitation, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| |
Collapse
|
4
|
Miyawaki Y, Yoneta M, Okawada M, Kawakami M, Liu M, Kaneko F. Neural bases characterizing chronic and severe upper-limb motor deficits after brain lesion. J Neural Transm (Vienna) 2023; 130:663-677. [PMID: 36943506 DOI: 10.1007/s00702-023-02622-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/14/2023] [Indexed: 03/23/2023]
Abstract
Chronic and severe upper-limb motor deficits can result from damage to the corticospinal tract. However, it remains unclear what their characteristics are and whether only corticospinal tract damage determines their characteristics. This study aimed to investigate the clinical characteristics and neural bases of chronic and severe upper-limb motor deficits. Motor deficits, including spasticity, of 45 patients with brain lesions were assessed using clinical scales. Regarding their scores, we conducted a principal component analysis that statistically extracted the clinical characteristics as two principal components. Using these principal components, we investigated the neural bases underlying their characteristics through lesion analyses of lesion volume, lesion sites, corticospinal tract, or other regional white-matter integrity. Principal component analysis showed that the clinical characteristics of chronic and severe upper-limb motor deficits could be described as a comprehensive severity and a trade-off relationship between proximal motor functions and wrist/finger spasticity. Lesion analyses revealed that the comprehensive severity was correlated with corticospinal tract integrity, and the trade-off relationship was associated with the integrity of other regional white matter located anterior to the posterior internal capsule, such as the anterior internal capsule. This study indicates that the severity of chronic and severe upper-limb motor deficits can be determined according to the corticospinal tract integrity, and such motor deficits may be further characterized by the integrity of other white matter, where the corticoreticular pathway can pass through, by forming a trade-off relationship where patients have higher proximal motor functions but more severe wrist/finger spasticity, and vice versa.
Collapse
Affiliation(s)
- Yu Miyawaki
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Physical Therapy, Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10 Higashi-Oku, Arakawa-ku, Tokyo, 116-8551, Japan
- Human Augmentation Research Center, National Institute of Advanced Industrial Science and Technology, Chiba, Japan
| | - Masaki Yoneta
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Megumi Okawada
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Physical Therapy, Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10 Higashi-Oku, Arakawa-ku, Tokyo, 116-8551, Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Meigen Liu
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Fuminari Kaneko
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
- Department of Physical Therapy, Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10 Higashi-Oku, Arakawa-ku, Tokyo, 116-8551, Japan.
| |
Collapse
|
5
|
White matter abnormalities in first-episode patients with depersonalization/derealization disorder: A tract-based spatial statistics study. J Affect Disord 2022; 309:19-26. [PMID: 35469908 DOI: 10.1016/j.jad.2022.04.127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 04/16/2022] [Accepted: 04/19/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Neuroimaging studies on depersonalization / derealization disorder (DPD) have revealed that there are structural and functional alterations across numerous brain regions. However, to date, the exact white matter abnormalities that are associated with different clinical symptoms and cognitive impairments in first-episode, drug-naïve patients with DPD remain unclear. METHODS Overall, 25 first-episode, drug-naïve patients with DPD and 23 healthy controls were recruited and underwent DTI scans. The tract-based spatial statistics analysis was conducted in order to determine white matter microstructural changes between the two groups. Correlation analysis was conducted between the fractional anisotropy (FA) of abnormal WM fibers and the total score of the 30-item Cambridge Depersonalization Scale (CDS-30), cognitive assessments. RESULTS Patients with DPD demonstrated higher FA in the right corpus callosum (CC), and posterior corona radiate (CR), compared to healthy controls. The FA in the right CC demonstrated a positive correlation with total score of CDS-30, numbing, unreality of self, perceptual alterations, and temporal disintegration, respectively. FA in the right CR region indicated a positive correlation with the total score of CDS-30, unreality of self, perceptual alterations, and temporal disintegration, respectively. Furthermore, FA in the right CR region was found to be negatively correlated with the Continuous Performance Test and the Stroop color-word test. CONCLUSION The altered white matter microstructure and cognitive impairments of medication naïve DPD patients were observed. Abnormalities in the integrity of CC and CR were associated with severity of symptoms and cognitive impairments, which may provide a potential biomarker for clinical studies on DPD.
Collapse
|
6
|
Kancheva I, Buma F, Kwakkel G, Kancheva A, Ramsey N, Raemaekers M. Investigating secondary white matter degeneration following ischemic stroke by modelling affected fiber tracts. Neuroimage Clin 2022; 33:102945. [PMID: 35124524 PMCID: PMC8829801 DOI: 10.1016/j.nicl.2022.102945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/27/2021] [Accepted: 01/17/2022] [Indexed: 11/27/2022]
Abstract
Secondary white matter degeneration was studied in 11 ischemic stroke patients. We used a custom-developed approach to model damaged fibers associated with a lesion. This approach tackles the inter-subject variability in lesion size and location. Findings suggest that secondary degeneration spreads along an entire fiber’s length.
Secondary white matter degeneration is a common occurrence after ischemic stroke, as identified by Diffusion Tensor Imaging (DTI). However, despite recent advances, the time course of the process is not completely understood. The primary aim of this study was to assess secondary degeneration using an approach whereby we create a patient-specific model of damaged fibers based on the volumetric characteristics of lesions. We also examined the effects of secondary degeneration along the modelled streamlines at different distances from the primary infarction using DTI. Eleven patients who presented with upper limb motor deficits at the time of a first-ever ischemic stroke were included. They underwent scanning at weeks 6 and 29 post-stroke. The fractional anisotropy (FA), mean diffusivity (MD), primary eigenvalue (λ1), and transverse eigenvalue (λ23) were measured. Using regions of interest based on the simulation output, the differences between the modelled fibers and matched contralateral areas were analyzed. The longitudinal change between the two time points and across five distances from the primary lesion was also assessed using the ratios of diffusion quantities (rFA, rMD, rλ1, and rλ23) between the ipsilesional and contralesional hemisphere. At week 6 post-stroke, significantly decreased λ1 was found along the ipsilesional corticospinal tract (CST) with a trend towards lower FA, reduced MD and λ23. At week 29 post-stroke, significantly decreased FA was shown relative to the non-lesioned side, with a trend towards lower λ1, unchanged MD, and higher λ23. Along the ipsilesional tract, the rFA diminished, whereas the rMD, rλ1, and rλ23 significantly increased over time. No significant variations in the time progressive effect with distance were demonstrated. The findings support previously described mechanisms of secondary degeneration and suggest that it spreads along the entire length of a damaged tract. Future investigations using higher-order tractography techniques can further explain the intravoxel alterations caused by ischemic injury.
Collapse
Affiliation(s)
- Ivana Kancheva
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, PO Box 85060, 3508AB Utrecht, The Netherlands.
| | - Floor Buma
- Department of Anatomy and Neurosciences, MOVE Research Institute Amsterdam, VU University Medical Center, PO Box 7057, 1007MB Amsterdam, The Netherlands
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, VU University Medical Center, PO Box 7057, 1007MB Amsterdam, The Netherlands
| | - Angelina Kancheva
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, PO Box 85060, 3508AB Utrecht, The Netherlands
| | - Nick Ramsey
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, PO Box 85060, 3508AB Utrecht, The Netherlands
| | - Mathijs Raemaekers
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, PO Box 85060, 3508AB Utrecht, The Netherlands
| |
Collapse
|
7
|
Liu J, Wang C. Microstructure and Genetic Polymorphisms: Role in Motor Rehabilitation After Subcortical Stroke. Front Aging Neurosci 2022; 14:813756. [PMID: 35177977 PMCID: PMC8843845 DOI: 10.3389/fnagi.2022.813756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/07/2022] [Indexed: 01/09/2023] Open
Abstract
Background and Purpose: Motor deficits are the most common disability after stroke, and early prediction of motor outcomes is critical for guiding the choice of early interventions. Two main factors that may impact the response to rehabilitation are variations in the microstructure of the affected corticospinal tract (CST) and genetic polymorphisms in brain-derived neurotrophic factor (BDNF). The purpose of this article was to review the role of these factors in stroke recovery, which will be useful for constructing a predictive model of rehabilitation outcomes.Summary of Review: We review the microstructure of the CST, including its origins in the primary motor area (M1), primary sensory area (S1), premotor cortex (PMC), and supplementary motor area (SMA). Damage to these fibers is disease-causing and can directly affect rehabilitation after subcortical stroke. BDNF polymorphisms are not disease-causing but can indirectly affect neuroplasticity and thus motor recovery. Both factors are known to be correlated with motor recovery. Further work is needed using large longitudinal patient samples and animal experiments to better establish the role of these two factors in stroke rehabilitation.Conclusions: Microstructure and genetic polymorphisms should be considered possible predictors or covariates in studies investigating motor recovery after subcortical stroke. Future predictive models of stroke recovery will likely include a combination of structural and genetic factors to allow precise individualization of stroke rehabilitation strategies.
Collapse
Affiliation(s)
- Jingchun Liu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Caihong Wang
- Department of MRI, Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Caihong Wang
| |
Collapse
|
8
|
Li Y, Hou Y, Li Q, Tang J, Lu J. Optimized Tractography Mapping and Quantitative Evaluation of Pyramidal Tracts for Surgical Resection of Insular Gliomas: a Correlative Study with Diffusion Tensor Imaging–Derived Metrics and Patient Motor Strength. J Digit Imaging 2022; 35:356-364. [PMID: 35064370 PMCID: PMC8921407 DOI: 10.1007/s10278-021-00578-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 12/22/2021] [Accepted: 12/27/2021] [Indexed: 11/25/2022] Open
Abstract
We investigate the correlation between diffusion tensor imaging (DTI)-derived metric statistics and motor strength grade of insular glioma patients after optimizing the pyramidal tract (PT) delineation. Motor strength grades of 45 insular glioma patients were assessed. All the patients underwent structural and diffusion MRI examination before and after surgery. We co-registered pre- and post-op datasets, and a two-tensor unscented Kalman filter (UKF) algorithm was employed to delineate bilateral PTs after DWI pre-processing. The tractography results were voxelized, and their labelmaps were cropped according to the location of frontal and insular parts of the lesion. Both the whole and cropped labelmaps were used as regions of interest to analyze fractional anisotropy (FA) and Trace statistics; hence, their ratios were calculated (lesional side tract/contralateral normal tract). The combination of DWI pre-processing and two-tensor UKF algorithm successfully delineated bilateral PTs of all the patients. It effectively accomplished both full fiber delineation within the edema and an extensive lateral fanning that had a favorable correspondence to the bilateral motor cortices. Before surgery, correlations were found between patients' motor strength grades and ratios of PT volume and FA standard deviation (SD). Nearly 3 months after surgery, correlations were found between motor strength grades and the ratios of metric statistics as follows: whole PT volume, whole mean FA, and FA SD. We substantiated the correlation between DTI-derived metric statistics and motor strength grades of insular glioma patients. Moreover, we posed a workflow for comprehensive pre- and post-op DTI quantitative research of glioma patients.
Collapse
Affiliation(s)
- Ye Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100853, China
| | - Yuanzheng Hou
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100853, China
| | - Qiongge Li
- Department of Radiology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100853, China
| | - Jie Tang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100853, China.
| | - Jie Lu
- Department of Radiology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100853, China.
| |
Collapse
|
9
|
Branscheidt M, Ejaz N, Xu J, Widmer M, Harran MD, Cortés JC, Kitago T, Celnik PA, Hernandez-Castillo C, Diedrichsen J, Luft AR, Krakauer JW. No evidence for motor recovery-related cortical connectivity changes after stroke using resting-state fMRI. J Neurophysiol 2021; 127:637-650. [PMID: 34965743 PMCID: PMC8896990 DOI: 10.1152/jn.00148.2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
It has been proposed that a form of cortical reorganization (changes in functional connectivity between brain areas) can be assessed with resting-state (rs) fMRI. Here we report a longitudinal data-set collected from 19 patients with subcortical stroke and 11 controls. Patients were imaged up to five times over one year. We found no evidence, using rs-fMRI, for post-stroke cortical connectivity changes despite substantial behavioral recovery. These results could be construed as questioning the value of resting-state imaging. Here we argue instead that they are consistent with other emerging reasons to challenge the idea of motor recovery-related cortical reorganization post-stroke when conceived of as changes in connectivity between cortical areas.
Collapse
Affiliation(s)
- Meret Branscheidt
- Brain Physiology and Stimulation Laboratory, Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, United States.,Department of Neurology, University Hospital Zurich, Zürich, Switzerland.,Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Naveed Ejaz
- Brain and Mind Institute, Western University, London, Ontario, Canada
| | - Jing Xu
- Department of Neuroscience, Johns Hopkins University, Baltimore, MD, United States.,Malone Center for Engineering in Healthcare, Johns Hopkins University, Baltimore, MD, United States
| | - Mario Widmer
- Department of Neurology, University Hospital Zurich, Zürich, Switzerland
| | - Michelle D Harran
- Department of Neuroscience, Johns Hopkins University, Baltimore, MD, United States
| | - Juan Camilo Cortés
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Tomoko Kitago
- Burke Neurological Institute and Weill Cornell Medicine, White Plains, NY, United States
| | - Pablo A Celnik
- Brain Physiology and Stimulation Laboratory, Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, United States
| | | | - Jörn Diedrichsen
- Brain and Mind Institute, Western University, London, Ontario, Canada
| | - Andreas R Luft
- Department of Neurology, University Hospital Zurich, Zürich, Switzerland.,Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - John W Krakauer
- Department of Neuroscience, Johns Hopkins University, Baltimore, MD, United States.,Malone Center for Engineering in Healthcare, Johns Hopkins University, Baltimore, MD, United States.,Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| |
Collapse
|
10
|
Upper and Lower Limb Motor Function Correlates with Ipsilesional Corticospinal Tract and Red Nucleus Structural Integrity in Chronic Stroke: A Cross-Sectional, ROI-Based MRI Study. Behav Neurol 2021; 2021:3010555. [PMID: 34804258 PMCID: PMC8601844 DOI: 10.1155/2021/3010555] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/27/2021] [Indexed: 12/31/2022] Open
Abstract
Background Structural integrity of the ipsilesional corticospinal tract (CST) is important for upper limb motor recovery after stroke. However, additional neuromechanisms associated with motor function poststroke are less well understood, especially regarding the lower limb. Objective To investigate the neural basis of upper/lower limb motor deficits poststroke by correlating measures of motor function with diffusion tensor imaging-derived indices of white matter integrity (fractional anisotropy (FA), mean diffusivity (MD)) in primary and secondary motor tracts/structures. Methods Forty-three individuals with chronic stroke (time poststroke, 64.4 ± 58.8 months) underwent a comprehensive motor assessment and MRI scanning. Correlation and multiple regression analyses were performed to examine relationships between FA/MD in a priori motor tracts/structures and motor function. Results FA in the ipsilesional CST and red nucleus (RN) was positively correlated with motor function of both the affected upper and lower limb (r = 0.36‐0.55, p ≤ 0.01), while only ipsilesional RN FA was associated with gait speed (r = 0.50). Ipsilesional CST FA explained 37.3% of the variance in grip strength (p < 0.001) and 31.5% of the variance in Arm Motricity Index (p = 0.004). Measures of MD were not predictors of motor performance. Conclusions Microstructural integrity of the ipsilesional CST is associated with both upper and lower limb motor function poststroke, but appears less important for gait speed. Integrity of the ipsilesional RN was also associated with motor performance, suggesting increased contributions from secondary motor areas may play a role in supporting chronic motor function and could become a target for interventions.
Collapse
|
11
|
Jang SH, Choi EB. Relation Between the Corticospinal Tract State and Activities of Daily Living in Patients With Intracerebral Hemorrhage. Stroke 2021; 53:544-551. [PMID: 34538084 PMCID: PMC8785518 DOI: 10.1161/strokeaha.121.034939] [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] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose: We investigated the relation between the ipsilesional corticospinal tract (CST) state and activity of daily living independence in patients with chronic intracerebral hemorrhage. Methods: Fifty-six consecutive patients with unilateral intracerebral hemorrhage and 38 healthy control subjects were recruited for this study. The Motricity index and the modified Barthel index were used to evaluate motor function of the affected extremities and activity of daily living independence, respectively. The diffusion tensor imaging parameter values for fractional anisotropy (FA) and voxel number (VN) of the CST were determined. Ratios of the ipsilesional to the contralesional CST measures were calculated and are presented as the CST-ratio (FA value and VN). Results: The FA value and VN of the ipsilesional CST and the CST-ratio in the patient group were lower than those of the control group (P<0.05). There was a strong positive correlation between the Motricity index score of the affected extremities and the modified Barthel index score (P<0.05), while the FA value and VN of the ipsilesional CST and the CST-ratio showed moderate and strong positive correlations with the Motricity index and modified Barthel index scores, respectively (P<0.05). In addition, the VN of the ipsilesional CST showed excellent utility as a classifier, whereas the FA value of the ipsilesional CST and the FA value and VN of the CST-ratio showed good classifier utility (P<0.05). Conclusions: We demonstrated that impairment of activity of daily living independency was closely related to the injury severity of the ipsilesional CST in patients with chronic intracerebral hemorrhage. In addition, the injury severity of the ipsilesional CST can be used to classify the degree of activity of daily living independency. Registration: URL: http://www.e-irb.com/index.jsp; Unique identifier: 2021-03-014.
Collapse
Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Republic of Korea
| | - Eun Bi Choi
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Republic of Korea
| |
Collapse
|
12
|
Yu F, Huang T, Ran Y, Li D, Ye L, Tian G, Xi J, Liu Z. New Insights Into the Roles of Microglial Regulation in Brain Plasticity-Dependent Stroke Recovery. Front Cell Neurosci 2021; 15:727899. [PMID: 34421544 PMCID: PMC8374071 DOI: 10.3389/fncel.2021.727899] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 07/13/2021] [Indexed: 01/07/2023] Open
Abstract
Stroke remains the leading cause of long-term disability worldwide with significant long-term sequelae. However, there is no highly effective treatment to enhance post-stroke recovery despite extensive efforts in exploring rehabilitative therapies. Neurorehabilitation is recognized as the cornerstone of functional restoration therapy in stroke, where treatments are focused on neuroplastic regulation to reverse neural structural disruption and improve neurofunctional networks. Post-stroke neuroplasticity changes begin within hours of symptom onset and reaches a plateau by 3 to 4 weeks within the global brain in animal studies. It plays a determining role in spontaneous stroke recovery. Microglia are immediately activated following cerebral ischemia, which has been found both proximal to the primary ischemic injury and at the remote brain regions which have functional connections to the primary injury area. Microglia exhibit different activation profiles based on the microenvironment and adaptively switch their phenotypes in a spatiotemporal manner in response to brain injuries. Microglial activation coincides with neuroplasticity after stroke, which provides the fundamental base for the microglia-mediated inflammatory responses involved in the entire neural network rewiring and brain repair. Microglial activation exerts important effects on spontaneous recovery after stroke, including structural and functional reestablishment of neurovascular networks, neurogenesis, axonal remodeling, and blood vessel regeneration. In this review, we focus on the crosstalk between microglial activation and endogenous neuroplasticity, with a special focus on the plastic alterations in the whole brain network and their implications for structural and functional restoration after stroke. We then summarize recent advances in the impacts of microglial phenotype polarization on brain plasticity, trying to discuss the potential efficacy of microglia-based extrinsic restorative interventions in promoting post-stroke recovery.
Collapse
Affiliation(s)
- Fang Yu
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Anesthesiology, Westchester Medical Center, New York Medical College, Valhalla, NY, United States
| | - Tingting Huang
- Department of Anesthesiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuanyuan Ran
- Department of Rehabilitation, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Da Li
- Department of Rehabilitation, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Lin Ye
- School of Materials Science and Engineering, Beijing Institute of Technology, Beijing, China
| | - Guiqin Tian
- Department of Rehabilitation, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Jianing Xi
- Department of Rehabilitation, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Zongjian Liu
- Department of Rehabilitation, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
13
|
Vahdat S, Pendharkar AV, Chiang T, Harvey S, Uchino H, Cao Z, Kim A, Choy M, Chen H, Lee HJ, Cheng MY, Lee JH, Steinberg GK. Brain-wide neural dynamics of poststroke recovery induced by optogenetic stimulation. SCIENCE ADVANCES 2021; 7:eabd9465. [PMID: 34380610 PMCID: PMC8357234 DOI: 10.1126/sciadv.abd9465] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 06/23/2021] [Indexed: 05/18/2023]
Abstract
Poststroke optogenetic stimulations can promote functional recovery. However, the circuit mechanisms underlying recovery remain unclear. Elucidating key neural circuits involved in recovery will be invaluable for translating neuromodulation strategies after stroke. Here, we used optogenetic functional magnetic resonance imaging to map brain-wide neural circuit dynamics after stroke in mice treated with and without optogenetic excitatory neuronal stimulations in the ipsilesional primary motor cortex (iM1). We identified key sensorimotor circuits affected by stroke. iM1 stimulation treatment restored activation of the ipsilesional corticothalamic and corticocortical circuits, and the extent of activation was correlated with functional recovery. Furthermore, stimulated mice exhibited higher expression of axonal growth-associated protein 43 in the ipsilesional thalamus and showed increased Synaptophysin+/channelrhodopsin+ presynaptic axonal terminals in the corticothalamic circuit. Selective stimulation of the corticothalamic circuit was sufficient to improve functional recovery. Together, these findings suggest early involvement of corticothalamic circuit as an important mediator of poststroke recovery.
Collapse
Affiliation(s)
- Shahabeddin Vahdat
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
- Stanford Stroke Center, Stanford, CA, USA
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Arjun Vivek Pendharkar
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
- Stanford Stroke Center, Stanford, CA, USA
| | - Terrance Chiang
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
- Stanford Stroke Center, Stanford, CA, USA
| | - Sean Harvey
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
- Stanford Stroke Center, Stanford, CA, USA
| | - Haruto Uchino
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
- Stanford Stroke Center, Stanford, CA, USA
| | - Zhijuan Cao
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
- Stanford Stroke Center, Stanford, CA, USA
| | - Anika Kim
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
- Stanford Stroke Center, Stanford, CA, USA
| | - ManKin Choy
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
- Stanford Stroke Center, Stanford, CA, USA
| | - Hansen Chen
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
- Stanford Stroke Center, Stanford, CA, USA
| | - Hyun Joo Lee
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Michelle Y Cheng
- Department of Neurosurgery, Stanford University, Stanford, CA, USA.
- Stanford Stroke Center, Stanford, CA, USA
| | - Jin Hyung Lee
- Department of Neurosurgery, Stanford University, Stanford, CA, USA.
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
- Department of Bioengineering, Stanford University, Stanford, CA, USA
- Department of Electrical Engineering, Stanford University, Stanford, CA, USA
| | - Gary K Steinberg
- Department of Neurosurgery, Stanford University, Stanford, CA, USA.
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
- Stanford Stroke Center, Stanford, CA, USA
| |
Collapse
|
14
|
Haque ME, Hasan KM, George S, Sitton C, Boren S, Arevalo OD, Vahidy F, Zhang X, Cox CS, Alderman S, Aronowski J, Grotta JC, Savitz SI. Longitudinal neuroimaging evaluation of the corticospinal tract in patients with stroke treated with autologous bone marrow cells. Stem Cells Transl Med 2021; 10:943-955. [PMID: 33689219 PMCID: PMC8235123 DOI: 10.1002/sctm.20-0369] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 12/30/2020] [Accepted: 01/18/2021] [Indexed: 12/15/2022] Open
Abstract
Bone marrow mononuclear cells (MNCs) attenuate secondary degeneration and enhance recovery in stroke animal models. In a nonrandomized clinical trial, we imaged 37 patients with stroke: 17 patients treated with MNCs (treated) and 20 patients who received standard of care (nontreated) at 1, 3, and 12 months onset of stroke on 3.0T MRI system. Three-dimensional anatomical and diffusion tensor images were obtained. The integrity of the corticospinal tract was assessed by measuring absolute and relative fractional anisotropy (FA) and mean diffusivity (MD) in the rostral pons (RP), posterior limb of the internal capsule, and corona radiata by drawing regions of interest. Infarct volume and stroke severity, which was assessed via the NIH Stroke Scale (NIHSS), were higher in the MNC group compared with the nontreated patients, which is a major limitation. Overall, the relative FA (rFA) of the nontreated patients exhibited continued reduction and an increase in relative MD (rMD) from 1 to 12 months, whereas despite larger infarcts and higher severity, treated patients displayed an increase in rFA from 3 to 12 months and no change in rMD. Contrary to the nontreated group, the treated patients' rFA was also significantly correlated (P < .05) with NIHSS score in the RP at all time points, whereas rMD at the last two.
Collapse
Affiliation(s)
- Muhammad E. Haque
- Institute for Stroke and Cerebrovascular DiseasesMcGovern Medical School and University of Texas Health Science CenterHoustonTexasUSA
| | - Khader M. Hasan
- Department of Diagnostic and Interventional ImagingMcGovern Medical School and University of Texas Health Science CenterHoustonTexasUSA
| | - Sarah George
- Institute for Stroke and Cerebrovascular DiseasesMcGovern Medical School and University of Texas Health Science CenterHoustonTexasUSA
| | - Clark Sitton
- Department of Diagnostic and Interventional ImagingMcGovern Medical School and University of Texas Health Science CenterHoustonTexasUSA
| | - Seth Boren
- Institute for Stroke and Cerebrovascular DiseasesMcGovern Medical School and University of Texas Health Science CenterHoustonTexasUSA
| | - Octavio D. Arevalo
- Department of Diagnostic and Interventional ImagingMcGovern Medical School and University of Texas Health Science CenterHoustonTexasUSA
| | - Farhaan Vahidy
- Institute for Stroke and Cerebrovascular DiseasesMcGovern Medical School and University of Texas Health Science CenterHoustonTexasUSA
| | - Xu Zhang
- Department of Biostatistics, Epidemiology, and Research Design Component of the Center for Clinical and Translational SciencesMcGovern Medical School and University of Texas Health Science CenterHoustonTexasUSA
| | - Charles S. Cox
- Department of Pediatric SurgeryMcGovern Medical School and University of Texas Health Science CenterHoustonTexasUSA
| | - Susan Alderman
- Institute for Stroke and Cerebrovascular DiseasesMcGovern Medical School and University of Texas Health Science CenterHoustonTexasUSA
| | - Jaroslaw Aronowski
- Institute for Stroke and Cerebrovascular DiseasesMcGovern Medical School and University of Texas Health Science CenterHoustonTexasUSA
| | | | - Sean I. Savitz
- Institute for Stroke and Cerebrovascular DiseasesMcGovern Medical School and University of Texas Health Science CenterHoustonTexasUSA
| |
Collapse
|
15
|
Berndt MT, Pürner D, Maegerlein C, Wunderlich S, Friedrich B, Zimmer C, Sepp D, Kaesmacher J, Boeckh-Behrens T. Basal Ganglia versus Peripheral Infarcts: Predictive Value of Early Fiber Alterations. AJNR Am J Neuroradiol 2021; 42:264-270. [PMID: 33303519 DOI: 10.3174/ajnr.a6886] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 09/07/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Impairment of fiber integrity of the corticospinal tract in the subacute and chronic phases after ischemic stroke has been linked to poor motor outcome. The aim of the study was an assessment of fiber integrity in the acute poststroke phase and an evaluation of its association with the clinical course dependent on the infarction pattern (subtypes: peripheral versus basal ganglia infarction). MATERIALS AND METHODS All patients who underwent mechanical recanalization of a large-vessel occlusion in the anterior circulation and postinterventional DTI were included (n = 165). The fractional anisotropy index of the patient-specific corticospinal tract within the posterior limb of the internal capsule was correlated to clinical parameters (NIHSS scores/mRS at 90 days), and the interaction of stroke subtype (peripheral infarcts versus basal ganglia infarction) was tested in a moderation analysis. RESULTS The fractional anisotropy index was reduced in the acute poststroke phase with a correlation to clinical presentation, especially in case of peripheral infarcts (eg, with the NIHSS motor subscore: r = -0.4, P < .001). This correlation was absent for basal ganglia infarction (r = -0.008, P > .05). There was a significant association between the fractional anisotropy index and clinical outcome (mRS after 90 days, P < .01), which is moderated by stroke subtype with significant effects only for peripheral infarcts. CONCLUSIONS Corticospinal tract abnormalities can be observed in the early stage after mechanical recanalization and have prognostic capacity. This finding increases the clinical value of early DTI imaging parameters. Because the effects observed were limited to peripheral infarcts, further and longitudinal evaluation of fiber integrities within basal ganglia infarction is required.
Collapse
Affiliation(s)
- M T Berndt
- From the Departments of Neuroradiology (M.T.B., C.M., B.F., C.Z., D.S., T.B.-B.)
| | - D Pürner
- Neurology (D.P., S.W.), Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - C Maegerlein
- From the Departments of Neuroradiology (M.T.B., C.M., B.F., C.Z., D.S., T.B.-B.)
| | - S Wunderlich
- Neurology (D.P., S.W.), Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - B Friedrich
- From the Departments of Neuroradiology (M.T.B., C.M., B.F., C.Z., D.S., T.B.-B.)
| | - C Zimmer
- From the Departments of Neuroradiology (M.T.B., C.M., B.F., C.Z., D.S., T.B.-B.)
| | - D Sepp
- From the Departments of Neuroradiology (M.T.B., C.M., B.F., C.Z., D.S., T.B.-B.)
| | - J Kaesmacher
- Department of Neuroradiology (J.K.), Inselspital, University Hospital Bern, University Bern, Bern, Switzerland
| | - T Boeckh-Behrens
- From the Departments of Neuroradiology (M.T.B., C.M., B.F., C.Z., D.S., T.B.-B.)
| |
Collapse
|
16
|
Liu J, Wang C, Qin W, Ding H, Guo J, Han T, Cheng J, Yu C. Corticospinal Fibers With Different Origins Impact Motor Outcome and Brain After Subcortical Stroke. Stroke 2020; 51:2170-2178. [PMID: 32568657 DOI: 10.1161/strokeaha.120.029508] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Motor deficit is the most common disability after stroke, and early prediction of motor outcome is critical for early interventions. Here, we constructed a fine map of the corticospinal tract (CST) for early prediction of motor outcome and for understanding the secondary brain changes after subcortical stroke. METHODS Diffusion spectrum imaging data from 50 healthy adults were used to reconstruct fine maps of CST with different origins, including primary motor area (M1), primary sensory area (S1), premotor cortex, and supplementary motor area (SMA). Their diffusion properties correlated with motor functions in healthy adults. The impacts of the impairments of different CST on motor outcomes and on structural and functional changes of brain were investigated in 136 patients with subcortical stroke by combining CST damage-symptom association study and voxel-based lesion-symptom mapping. RESULTS In healthy adults, the isotropy of M1 fiber correlated with walking endurance and that of SMA fiber with motor dexterity. In chronic stroke patients, the integrity of M1 and SMA fibers showed the most significant correlation with motor deficits. The percentage of early damage of M1 and SMA fibers correlated with that of chronic motor deficits. Voxel-based lesion-symptom mapping revealed that acute stroke lesions in the bilateral M1 and right SMA fibers were associated with chronic motor deficits. The early damage of M1 fiber negatively correlated with the integrity of M1-M1 fiber, and the early damage of SMA fiber negatively correlated with gray matter volume of the contralateral cerebellum in the chronic stage. CONCLUSIONS The CST that originated from the M1 and SMA are closely associated with motor outcomes and brain structural changes, and the fine maps of CST from these 2 cortical areas are useful in assessing and predicting long-term motor outcome in patients with subcortical stroke.
Collapse
Affiliation(s)
- Jingchun Liu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, China (J.L., W.Q., H.D., C.Y.)
| | - Caihong Wang
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Henan, China (C.W., J.C.)
| | - Wen Qin
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, China (J.L., W.Q., H.D., C.Y.)
| | - Hao Ding
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, China (J.L., W.Q., H.D., C.Y.)
| | - Jun Guo
- Department of Medical Imaging, Tianjin Medical University, China (H.D.). Department of Radiology, Tianjin Huanhu Hospital, China (J.G., T.H.)
| | - Tong Han
- Department of Medical Imaging, Tianjin Medical University, China (H.D.). Department of Radiology, Tianjin Huanhu Hospital, China (J.G., T.H.)
| | - Jingliang Cheng
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Henan, China (C.W., J.C.)
| | - Chunshui Yu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, China (J.L., W.Q., H.D., C.Y.)
| |
Collapse
|
17
|
Hamzei F, Erath G, Kücking U, Weiller C, Rijntjes M. Anatomy of brain lesions after stroke predicts effectiveness of mirror therapy. Eur J Neurosci 2020; 52:3628-3641. [PMID: 32031282 DOI: 10.1111/ejn.14698] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/16/2020] [Accepted: 01/31/2020] [Indexed: 11/27/2022]
Abstract
To improve clinical outcome, one longstanding goal in treating stroke patients has been an individual therapy based on functional and anatomical knowledge of the single patient. Therefore, in this study brain imaging of 36 chronic stroke patients was analyzed to identify parameters predicting clinical recovery. T1-weighted MRI was acquired to assess the lesion; functional MRI was used to visualize existing resources; DTI for the integrity of the corticospinal tract (CST) and long association tracts. These data were related to the clinical course. All patients were treated intensively with the mirror therapy (MT) only. After the training period, we analyzed which patient's feature would predict a beneficial course. Patients as a group improved after MT, but according to the fMRI activation of primary sensorimotor cortex (SMC), they could be divided in two groups with very diverging clinical outcome: those with ipsilesional SMC activation showed a noticeable increase of clinical scores, accompanied with ipsilesional activation in the frontal projection areas of the dorsal and ventral streams during action observation in fMRI. Those with contralesional SMC activation had lesions affecting both the dorsal and ventral stream and did not benefit from MT. The outcome for this therapy was not related to affection of CST. This study demonstrates that only in patients in which dorsal and ventral streams are not affected and therefore an interaction between these streams in post- and prerolandic regions is possible, MT can induce clinical improvement. Consequently, knowledge of the anatomical lesion can predict the beneficial course of MT.
Collapse
Affiliation(s)
- Farsin Hamzei
- Section of Neurological Rehabilitation, Hans Berger Clinic of Neurology, Department of Neurology, Jena University Hospital, Jena, Germany.,Department of Neurology, Moritz Klinik, Bad Klosterlausnitz, Germany
| | - Gabriele Erath
- Department of Neurology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ursula Kücking
- Department of Neurology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Cornelius Weiller
- Department of Neurology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michel Rijntjes
- Department of Neurology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| |
Collapse
|
18
|
Oey NE, Samuel GS, Lim JKW, VanDongen AM, Ng YS, Zhou J. Whole Brain White Matter Microstructure and Upper Limb Function: Longitudinal Changes in Fractional Anisotropy and Axial Diffusivity in Post-Stroke Patients. J Cent Nerv Syst Dis 2019; 11:1179573519863428. [PMID: 31391787 PMCID: PMC6668170 DOI: 10.1177/1179573519863428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 06/23/2019] [Indexed: 12/15/2022] Open
Abstract
Background Diffusion tensor imaging (DTI) magnetic resonance imaging (MRI) measuring fractional anisotropy (FA) and axial diffusivity (AD) may be a useful biomarker for monitoring changes in white matter after stroke, but its associations with upper-limb motor recovery have not been well studied. We aim to describe changes in the whole-brain FA and AD in five post-stroke patients in relation to kinematic measures of elbow flexion to better understand the relationship between FA and AD changes and clinico-kinematic measures of upper limb motor recovery. Methods We performed DTI MRI at two timepoints during the acute phase of stroke, measuring FA and AD across 48 different white matter tract regions in the brains of five hemiparetic patients with infarcts in the cortex, pons, basal ganglia, thalamus, and corona radiata. We tracked the progress of these patients using clinical Fugl-Meyer Assessments and kinematic measures of elbow flexion at the acute phase within 14 (mean: 9.4 ± 2.49) days of stroke symptom onset and at a follow-up appointment 2 weeks later (mean: 16 ± 1.54) days. Results Changes in FA and AD in 48 brain regions occurring during stroke rehabilitation are described in relation to motor recovery. In this case series, one patient with a hemipontine infarct showed an increase in FA of the ipsilateral and contralateral corticospinal tract, whereas other patients with lesions involving the corona radiata and middle cerebral artery showed widespread decreases in perilesional FA. On the whole, FA and AD seemed to behave inversely to each other. Conclusions This case series describes longitudinal changes in perilesional and remote FA and AD in relation to kinematic parameters of elbow flexion at the subacute post-stroke period. Although studies with larger sample sizes are needed, our findings indicate that longitudinally measured changes in DTI-based measurements of white matter microstructural integrity may aid in the prognostication of patients affected by motor stroke.
Collapse
Affiliation(s)
- Nicodemus Edrick Oey
- Singapore Health Services, Singapore.,Programme in Neuroscience and Behavioural Disorders, Center for Cognitive Neuroscience, Duke-NUS Medical School, Singapore
| | | | - Joseph Kai Wei Lim
- Programme in Neuroscience and Behavioural Disorders, Center for Cognitive Neuroscience, Duke-NUS Medical School, Singapore
| | - Antonius Mj VanDongen
- Programme in Neuroscience and Behavioural Disorders, Center for Cognitive Neuroscience, Duke-NUS Medical School, Singapore
| | - Yee Sien Ng
- Department of Rehabilitation Medicine, Singapore General Hospital, Singapore
| | - Juan Zhou
- Programme in Neuroscience and Behavioural Disorders, Center for Cognitive Neuroscience, Duke-NUS Medical School, Singapore.,Clinical Imaging Research Center, Agency for Science, Technology and Research (ASTAR), Singapore
| |
Collapse
|
19
|
Moura LM, Luccas R, de Paiva JPQ, Amaro E, Leemans A, Leite CDC, Otaduy MCG, Conforto AB. Diffusion Tensor Imaging Biomarkers to Predict Motor Outcomes in Stroke: A Narrative Review. Front Neurol 2019; 10:445. [PMID: 31156529 PMCID: PMC6530391 DOI: 10.3389/fneur.2019.00445] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/12/2019] [Indexed: 12/14/2022] Open
Abstract
Stroke is a leading cause of disability worldwide. Motor impairments occur in most of the patients with stroke in the acute phase and contribute substantially to disability. Diffusion tensor imaging (DTI) biomarkers such as fractional anisotropy (FA) measured at an early phase after stroke have emerged as potential predictors of motor recovery. In this narrative review, we: (1) review key concepts of diffusion MRI (dMRI); (2) present an overview of state-of-art methodological aspects of data collection, analysis and reporting; and (3) critically review challenges of DTI in stroke as well as results of studies that investigated the correlation between DTI metrics within the corticospinal tract and motor outcomes at different stages after stroke. We reviewed studies published between January, 2008 and December, 2018, that reported correlations between DTI metrics collected within the first 24 h (hyperacute), 2-7 days (acute), and >7-90 days (early subacute) after stroke. Nineteen studies were included. Our review shows that there is no consensus about gold standards for DTI data collection or processing. We found great methodological differences across studies that evaluated DTI metrics within the corticospinal tract. Despite heterogeneity in stroke lesions and analysis approaches, the majority of studies reported significant correlations between DTI biomarkers and motor impairments. It remains to be determined whether DTI results could enhance the predictive value of motor disability models based on clinical and neurophysiological variables.
Collapse
Affiliation(s)
- Luciana M. Moura
- Neurostimulation Laboratory, Neurology Department, Hospital das Clínicas/São Paulo University, São Paulo, Brazil
| | - Rafael Luccas
- Neurostimulation Laboratory, Neurology Department, Hospital das Clínicas/São Paulo University, São Paulo, Brazil
| | | | - Edson Amaro
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Lim 44, Department of Radiology and Oncology, Faculdade de Medicina, Hospital das Clínicas/São Paulo University, São Paulo, Brazil
| | - Alexander Leemans
- PROVIDI Lab, Image Sciences Institute, UMC Utrecht, Utrecht, Netherlands
| | - Claudia da C. Leite
- Lim 44, Department of Radiology and Oncology, Faculdade de Medicina, Hospital das Clínicas/São Paulo University, São Paulo, Brazil
| | - Maria C. G. Otaduy
- Lim 44, Department of Radiology and Oncology, Faculdade de Medicina, Hospital das Clínicas/São Paulo University, São Paulo, Brazil
| | - Adriana B. Conforto
- Neurostimulation Laboratory, Neurology Department, Hospital das Clínicas/São Paulo University, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| |
Collapse
|
20
|
Guggisberg AG, Koch PJ, Hummel FC, Buetefisch CM. Brain networks and their relevance for stroke rehabilitation. Clin Neurophysiol 2019; 130:1098-1124. [PMID: 31082786 DOI: 10.1016/j.clinph.2019.04.004] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 03/04/2019] [Accepted: 04/08/2019] [Indexed: 12/21/2022]
Abstract
Stroke has long been regarded as focal disease with circumscribed damage leading to neurological deficits. However, advances in methods for assessing the human brain and in statistics have enabled new tools for the examination of the consequences of stroke on brain structure and function. Thereby, it has become evident that stroke has impact on the entire brain and its network properties and can therefore be considered as a network disease. The present review first gives an overview of current methodological opportunities and pitfalls for assessing stroke-induced changes and reorganization in the human brain. We then summarize principles of plasticity after stroke that have emerged from the assessment of networks. Thereby, it is shown that neurological deficits do not only arise from focal tissue damage but also from local and remote changes in white-matter tracts and in neural interactions among wide-spread networks. Similarly, plasticity and clinical improvements are associated with specific compensatory structural and functional patterns of neural network interactions. Innovative treatment approaches have started to target such network patterns to enhance recovery. Network assessments to predict treatment response and to individualize rehabilitation is a promising way to enhance specific treatment effects and overall outcome after stroke.
Collapse
Affiliation(s)
- Adrian G Guggisberg
- Division of Neurorehabilitation, Department of Clinical Neurosciences, University Hospital Geneva, Switzerland.
| | - Philipp J Koch
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), 1202 Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology Valais (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland
| | - Friedhelm C Hummel
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), 1202 Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology Valais (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland; Department of Clinical Neuroscience, University Hospital Geneva, 1202 Geneva, Switzerland
| | - Cathrin M Buetefisch
- Depts of Neurology, Rehabilitation Medicine, Radiology, Emory University, Atlanta, GA, USA
| |
Collapse
|
21
|
Nyffeler T, Vanbellingen T, Kaufmann BC, Pflugshaupt T, Bauer D, Frey J, Chechlacz M, Bohlhalter S, Müri RM, Nef T, Cazzoli D. Theta burst stimulation in neglect after stroke: functional outcome and response variability origins. Brain 2019; 142:992-1008. [DOI: 10.1093/brain/awz029] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/07/2018] [Accepted: 12/21/2018] [Indexed: 01/05/2023] Open
Affiliation(s)
- Thomas Nyffeler
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland
- Perception and Eye Movement Laboratory, Department of Neurology, University of Bern, Switzerland
- Neurocenter, Luzerner Kantonsspital, Switzerland
| | - Tim Vanbellingen
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland
- Perception and Eye Movement Laboratory, Department of Neurology, University of Bern, Switzerland
- Neurocenter, Luzerner Kantonsspital, Switzerland
| | - Brigitte C Kaufmann
- Perception and Eye Movement Laboratory, Department of Neurology, University of Bern, Switzerland
- Neurocenter, Luzerner Kantonsspital, Switzerland
| | | | - Daniel Bauer
- Neurocenter, Luzerner Kantonsspital, Switzerland
| | - Julia Frey
- Neurocenter, Luzerner Kantonsspital, Switzerland
| | | | | | - René M Müri
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland
- Perception and Eye Movement Laboratory, Department of Neurology, University of Bern, Switzerland
| | - Tobias Nef
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland
| | - Dario Cazzoli
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland
- Perception and Eye Movement Laboratory, Department of Neurology, University of Bern, Switzerland
| |
Collapse
|
22
|
Koh CL, Tang PF, Chen HI, Hsu YC, Hsieh CL, Tseng WYI. Impaired Callosal Motor Fiber Integrity and Upper Extremity Motor Impairment Are Associated With Stroke Lesion Location. Neurorehabil Neural Repair 2019; 32:602-612. [PMID: 30016930 DOI: 10.1177/1545968318779730] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Damage to the callosal motor fibers (CMFs) may affect motor recovery in patients with stroke. However, whether the severity of CMF impairment varies with lesion locations remains unclear. OBJECTIVE To investigate (1) whether CMF impairment occurs after stroke and whether the impairment varies with lesion locations and (2) the associations of CMF impairment and upper extremity (UE) motor impairment. METHODS Twenty-nine patients with lesions involving the corticospinal tract (CST) were categorized into 2 groups: lesions involving the CMFs (CMF group, n = 15), and lesions not involving the CMFs (non-CMF group, n = 14). Thirteen healthy adults served as the control group. Tract integrity, assessed by the mean generalized fractional anisotropy (mGFA) using diffusion spectrum imaging, of the CMFs and the CST above the internal capsule (CSTABOVE) of the ipsilesional hemisphere were compared. RESULTS After accounting for the effect of lesion load on the CST, the CMF group exhibited a significantly lower mGFA of the CMFs than did the control and non-CMF groups (post hoc P = .005 and .001, respectively). No significant difference was observed between the non-CMF and control groups (post hoc P = .999). The CST and CMF impairment accounted for 56% of the variance of UE motor impairment in the CMF group ( P = .007), whereas no significant association was observed in the non-CMF group ( P = .570). CONCLUSIONS CMF impairment after stroke depends on lesion locations and CMF integrity has an incremental contribution to the severity of UE motor impairment in the CMF group.
Collapse
Affiliation(s)
- Chia-Lin Koh
- 1 National Taiwan University, Taipei, Taiwan.,2 Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Pei-Fang Tang
- 1 National Taiwan University, Taipei, Taiwan.,3 National Taiwan University Hospital, Taipei, Taiwan
| | | | | | - Ching-Lin Hsieh
- 1 National Taiwan University, Taipei, Taiwan.,3 National Taiwan University Hospital, Taipei, Taiwan
| | | |
Collapse
|
23
|
Is VLSM a valid tool for determining the functional anatomy of the brain? Usefulness of additional Bayesian network analysis. Neuropsychologia 2018; 121:69-78. [DOI: 10.1016/j.neuropsychologia.2018.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 08/16/2018] [Accepted: 10/01/2018] [Indexed: 12/21/2022]
|
24
|
Heit JJ, Wintermark M. New developments in clinical ischemic stroke prevention and treatment and their imaging implications. J Cereb Blood Flow Metab 2018; 38:1533-1550. [PMID: 28195500 PMCID: PMC6125964 DOI: 10.1177/0271678x17694046] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Acute ischemic stroke results from blockage of a cerebral artery or impaired cerebral blood flow due to cervical or intracranial arterial stenosis. Ischemic stroke prevention seeks to minimize the risk of developing impaired cerebral perfusion by controlling vascular and cardiac disease risk factors. Similarly, ischemic stroke treatment aims to restore cerebral blood flow through recanalization of an occluded artery or dilation of a severely narrowed artery that supplies cerebral tissue. Stroke prevention and treatment are increasingly informed by imaging studies, and neurovascular and cerebral perfusion imaging has become essential in in guiding ischemic stroke prevention and treatment. Here we review the latest advances in ischemic stroke prevention and treatment with an emphasis on the neuroimaging principles emphasized in recent randomized trials. Future research directions that should be explored in ischemic stroke prevention and treatment are also discussed.
Collapse
Affiliation(s)
- Jeremy J Heit
- Department of Radiology, Neuroimaging and Neurointervention Division, Stanford University Hospital, Stanford, CA, USA
| | - Max Wintermark
- Department of Radiology, Neuroimaging and Neurointervention Division, Stanford University Hospital, Stanford, CA, USA
| |
Collapse
|
25
|
Kulesh A, Drobakha V, Kuklina E, Nekrasova I, Shestakov V. Cytokine Response, Tract-Specific Fractional Anisotropy, and Brain Morphometry in Post-Stroke Cognitive Impairment. J Stroke Cerebrovasc Dis 2018; 27:1752-1759. [PMID: 29610037 DOI: 10.1016/j.jstrokecerebrovasdis.2018.02.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 01/04/2018] [Accepted: 02/03/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Post-stroke cognitive impairment is a clinically heterogeneous condition and its types have a different course and prognosis. The aim of the present study is to address the roles of inflammation, white matter pathology, and brain atrophy in different neuropsychological types of cognitive impairment in the acute period of ischemic stroke. METHODS In 92 patients, we performed an assessment of the cognitive status and measured concentrations of cytokines (interleukin [IL]-1β, IL-6, tumor necrosis factor-alpha, IL-10) in liquor and serum, as well as a number of magnetic resonance imaging (MRI) morphometric parameters and fractional anisotropy. The control group consisted of 14 individuals without cerebrovascular disease. RESULTS All patients had a higher level of IL-10 in serum than the control group. Patients with dysexecutive cognitive impairment had a higher concentration of IL-1β and IL-10 in liquor, IL-6 level in serum, and a lower fractional anisotropy of the ipsilateral thalamus than patients with normal cognition. Patients with mixed cognitive impairment were characterized by a lower fractional anisotropy of contralateral fronto-occipital fasciculus, compared with patients with dysexecutive cognitive impairment. Patients with both dysexecutive and mixed cognitive deficit had a wide area of leukoaraiosis and a reduced fractional anisotropy of the contralateral cingulum, compared with patients without cognitive impairment. Also, we found numerous correlations between cognitive status and levels of cytokines, MRI morphometric parameters, and fractional anisotropy of certain regions of the brain. CONCLUSIONS The concentrations of cytokines in serum and cerebrospinal fluid studied in combination with MRI morphometric parameters and fractional anisotropy appear to be informative biomarkers of clinical types of post-stroke cognitive impairment.
Collapse
Affiliation(s)
- Aleksey Kulesh
- Perm State Medical University named after academician E.A. Wagner, Department of Neurology, Perm, Russian Federation.
| | - Viktor Drobakha
- Perm State Medical University named after academician E.A. Wagner, Department of Neurology, Perm, Russian Federation
| | - Elena Kuklina
- Institute of Ecology and Genetics of Microorganisms, Ural Branch of the Russian Academy of Sciences, Laboratory of Immunomodulation, Perm, Russian Federation
| | - Irina Nekrasova
- Institute of Ecology and Genetics of Microorganisms, Ural Branch of the Russian Academy of Sciences, Laboratory of Immunomodulation, Perm, Russian Federation
| | - Vladimir Shestakov
- Perm State Medical University named after academician E.A. Wagner, Department of Neurology, Perm, Russian Federation
| |
Collapse
|
26
|
Liu G, Peng K, Dang C, Tan S, Chen H, Xie C, Xing S, Zeng J. Axial diffusivity changes in the motor pathway above stroke foci and functional recovery after subcortical infarction. Restor Neurol Neurosci 2018. [PMID: 29526853 DOI: 10.3233/rnn-170747] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Secondary degeneration of the fiber tract of the motor pathway below infarct foci and functional recovery after stroke have been well demonstrated, but the role of the fiber tract above stroke foci remains unclear. OBJECTIVE This study aimed to investigate diffusion changes in motor fibers above the lesion and identify predictors of motor improvement within 12 weeks after subcortical infarction. METHODS Diffusion tensor imaging and the Fugl-Meyer (FM) scale were conducted 1, 4, and 12 weeks (W) after a subcortical infarct. Proportional recovery model residuals were used to assign patients to proportional recovery and poor recovery groups. Region of interest analysis was used to assess diffusion changes in the motor pathway above and below a stroke lesion. Multivariable linear regression was employed to identify predictors of motor improvement within 12 weeks after stroke. RESULTS Axial diffusivity (AD) in the underlying white matter of the ipsilesional primary motor area (PMA) and cerebral peduncle (CP) in both proportional and poor recovery groups was lower at W1 compared to the controls and values in the contralesional PMA and CP (all P < 0.05). Subsequently, AD in the ipsilesional CP became relatively stable, while AD in the ipsilesional PMA significantly increased from W4 to W12 after stroke (P < 0.05). In all of the patients, changes in the FM scores were greater in those with higher changes in AD of the ipsilesional PMA. Only initial impairment or lesion volume was predictive of motor improvement within 12 weeks after stroke in patients with proportional or poor recovery. CONCLUSION Increases of AD in the motor pathway above stroke foci may be associated with motor recovery after subcortical infarction. Early measurement of diffusion metrics in the ipsilesional non-ischemic motor pathway has limited value in predicting future motor improvement patterns (proportional or poor recovery).
Collapse
Affiliation(s)
- Gang Liu
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Kangqiang Peng
- Department of Medical Imaging, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Chao Dang
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Shuangquan Tan
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Hongbing Chen
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Chuanmiao Xie
- Department of Medical Imaging, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Shihui Xing
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jinsheng Zeng
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| |
Collapse
|
27
|
Takebayashi T, Marumoto K, Takahashi K, Domen K. Differences in neural pathways are related to the short- or long-term benefits of constraint-induced movement therapy in patients with chronic stroke and hemiparesis: a pilot cohort study. Top Stroke Rehabil 2017; 25:203-208. [DOI: 10.1080/10749357.2017.1399231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Takashi Takebayashi
- Graduate Course of Rehabilitation Science, Hyogo College of Medicine, Nishinomiya, Japan
- Department of Occupational Therapy, School of Health Science and Social Welfare, Kibi International University, Takahashi, Japan
| | - Kohei Marumoto
- Department of Rehabilitation Medicine, Hyogo Prefectural Rehabilitation Center at Nishi-harima, Tatsuno, Japan
| | - Kayoko Takahashi
- Department of Rehabilitation, School of Allied Health Science, Kitasato University, Minami-ku, Sagamihara, Japan
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| |
Collapse
|
28
|
Peters DM, Fridriksson J, Stewart JC, Richardson JD, Rorden C, Bonilha L, Middleton A, Gleichgerrcht E, Fritz SL. Cortical disconnection of the ipsilesional primary motor cortex is associated with gait speed and upper extremity motor impairment in chronic left hemispheric stroke. Hum Brain Mapp 2017; 39:120-132. [PMID: 28980355 DOI: 10.1002/hbm.23829] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 09/14/2017] [Accepted: 09/18/2017] [Indexed: 12/11/2022] Open
Abstract
Advances in neuroimaging have enabled the mapping of white matter connections across the entire brain, allowing for a more thorough examination of the extent of white matter disconnection after stroke. To assess how cortical disconnection contributes to motor impairments, we examined the relationship between structural brain connectivity and upper and lower extremity motor function in individuals with chronic stroke. Forty-three participants [mean age: 59.7 (±11.2) years; time poststroke: 64.4 (±58.8) months] underwent clinical motor assessments and MRI scanning. Nonparametric correlation analyses were performed to examine the relationship between structural connectivity amid a subsection of the motor network and upper/lower extremity motor function. Standard multiple linear regression analyses were performed to examine the relationship between cortical necrosis and disconnection of three main cortical areas of motor control [primary motor cortex (M1), premotor cortex (PMC), and supplementary motor area (SMA)] and motor function. Anatomical connectivity between ipsilesional M1/SMA and the (1) cerebral peduncle, (2) thalamus, and (3) red nucleus were significantly correlated with upper and lower extremity motor performance (P ≤ 0.003). M1-M1 interhemispheric connectivity was also significantly correlated with gross manual dexterity of the affected upper extremity (P = 0.001). Regression models with M1 lesion load and M1 disconnection (adjusted for time poststroke) explained a significant amount of variance in upper extremity motor performance (R2 = 0.36-0.46) and gait speed (R2 = 0.46), with M1 disconnection an independent predictor of motor performance. Cortical disconnection, especially of ipsilesional M1, could significantly contribute to variability seen in locomotor and upper extremity motor function and recovery in chronic stroke. Hum Brain Mapp 39:120-132, 2018. © 2017 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Denise M Peters
- Department of Exercise Science, Physical Therapy Program, University of South Carolina, 921 Assembly Street, Columbia, South Carolina
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, 915 Greene Street, Columbia, South Carolina
| | - Jill C Stewart
- Department of Exercise Science, Physical Therapy Program, University of South Carolina, 921 Assembly Street, Columbia, South Carolina
| | - Jessica D Richardson
- Department of Communication Sciences and Disorders, University of South Carolina, 915 Greene Street, Columbia, South Carolina
| | - Chris Rorden
- Department of Psychology, University of South Carolina, 1512 Pendleton Street, Columbia, South Carolina
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, South Carolina
| | - Addie Middleton
- Department of Exercise Science, Physical Therapy Program, University of South Carolina, 921 Assembly Street, Columbia, South Carolina
| | - Ezequiel Gleichgerrcht
- Department of Neurology, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, South Carolina
| | - Stacy L Fritz
- Department of Exercise Science, Physical Therapy Program, University of South Carolina, 921 Assembly Street, Columbia, South Carolina
| |
Collapse
|
29
|
Heiss WD. Contribution of Neuro-Imaging for Prediction of Functional Recovery after Ischemic Stroke. Cerebrovasc Dis 2017; 44:266-276. [PMID: 28869961 DOI: 10.1159/000479594] [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] [Received: 06/13/2017] [Accepted: 07/18/2017] [Indexed: 12/23/2022] Open
Abstract
Prediction measures of recovery and outcome after stroke perform with only modest levels of accuracy if based only on clinical data. Prediction scores can be improved by including morphologic imaging data, where size, location, and development of the ischemic lesion is best documented by magnetic resonance imaging. In addition to the primary lesion, the involvement of fiber tracts contributes to prognosis, and consequently the use of diffusion tensor imaging (DTI) to assess primary and secondary pathways improves the prediction of outcome and of therapeutic effects. The recovery of ischemic tissue and the progression of damage are dependent on the quality of blood supply. Therefore, the status of the supplying arteries and of the collateral flow is not only crucial for determining eligibility for acute interventions, but also has an impact on the potential to integrate areas surrounding the lesion that are not typically part of a functional network into the recovery process. The changes in these functional networks after a localized lesion are assessed by functional imaging methods, which additionally show altered pathways and activated secondary centers related to residual functions and demonstrate changes in activation patterns within these networks with improved performance. These strategies in some instances record activation in secondary centers of a network, for example, also in homolog contralateral areas, which might be inhibitory to the recovery of primary centers. Such findings might have therapeutic consequences, for example, image-guided inhibitory stimulation of these areas. In the future, a combination of morphological imaging including DTI of fiber tracts and activation studies during specific tasks might yield the best information on residual function, reserve capacity, and prospects for recovery after ischemic stroke.
Collapse
|
30
|
Hodge J, Goodyear B, Carlson H, Wei XC, Kirton A. Segmental Diffusion Properties of the Corticospinal Tract and Motor Outcome in Hemiparetic Children With Perinatal Stroke. J Child Neurol 2017; 32:550-559. [PMID: 28424004 DOI: 10.1177/0883073817696815] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Perinatal stroke injures developing motor systems, resulting in hemiparetic cerebral palsy. Diffusion tensor imaging can explore structural connectivity. We used diffusion tensor imaging to assess corticospinal tract diffusion in hemiparetic children with perinatal stroke. Twenty-eight children (6-18 years) with unilateral stroke underwent diffusion tensor imaging. Four corticospinal tract assessments included full tract, partial tract, minitract and region of interest. Diffusion characteristics (fractional anisotropy, mean, axial, and radial diffusivity) were calculated. Ratios (lesioned/nonlesioned) were compared across segments and to validated long-term motor outcomes (Pediatric Stroke Outcome Measure, Assisting Hand Assessment, Melbourne Assessment). Fractional anisotropy and radial diffusivity ratios decreased as tract size decreased, while mean diffusivity showed consistent symmetry. Poor motor outcomes were associated with lower fractional anisotropy in all segments and radial diffusivity correlated with both Assisting Hand Assessment and Melbourne Assessment. Diffusion imaging of segmented corticospinal tracts is feasible in hemiparetic children with perinatal stroke. Correlations with disability support clinical relevance and utility in model development for personalized rehabilitation.
Collapse
Affiliation(s)
- Jacquie Hodge
- 1 Calgary Pediatric Stroke Program, University of Calgary, Calgary, AB, Canada
| | - Bradley Goodyear
- 2 Department of Radiology, University of Calgary, Calgary, AB, Canada.,3 Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Helen Carlson
- 1 Calgary Pediatric Stroke Program, University of Calgary, Calgary, AB, Canada.,4 Alberta Children's Hospital Research Institute, Alberta Children's Hospital, Calgary, AB, Canada
| | - Xing-Chang Wei
- 2 Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Adam Kirton
- 1 Calgary Pediatric Stroke Program, University of Calgary, Calgary, AB, Canada.,4 Alberta Children's Hospital Research Institute, Alberta Children's Hospital, Calgary, AB, Canada
| |
Collapse
|
31
|
Kirton A. Advancing non-invasive neuromodulation clinical trials in children: Lessons from perinatal stroke. Eur J Paediatr Neurol 2017; 21:75-103. [PMID: 27470654 DOI: 10.1016/j.ejpn.2016.07.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 06/21/2016] [Accepted: 07/02/2016] [Indexed: 12/18/2022]
Abstract
Applications of non-invasive brain stimulation including therapeutic neuromodulation are expanding at an alarming rate. Increasingly established scientific principles, including directional modulation of well-informed cortical targets, are advancing clinical trial development. However, high levels of disease burden coupled with zealous enthusiasm may be getting ahead of rational research and evidence. Experience is limited in the developing brain where additional issues must be considered. Properly designed and meticulously executed clinical trials are essential and required to advance and optimize the potential of non-invasive neuromodulation without risking the well-being of children and families. Perinatal stroke causes most hemiplegic cerebral palsy and, as a focal injury of defined timing in an otherwise healthy brain, is an ideal human model of developmental plasticity. Advanced models of how the motor systems of young brains develop following early stroke are affording novel windows of opportunity for neuromodulation clinical trials, possibly directing neuroplasticity toward better outcomes. Reviewing the principles of clinical trial design relevant to neuromodulation and using perinatal stroke as a model, this article reviews the current and future issues of advancing such trials in children.
Collapse
Affiliation(s)
- Adam Kirton
- Departments of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, 2888 Shaganappi Trail NW, Calgary, AB T3B6A8, Canada.
| |
Collapse
|
32
|
Jin JF, Guo ZT, Zhang YP, Chen YY. Prediction of motor recovery after ischemic stroke using diffusion tensor imaging: A meta-analysis. World J Emerg Med 2017; 8:99-105. [PMID: 28458752 PMCID: PMC5409242 DOI: 10.5847/wjem.j.1920-8642.2017.02.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/18/2017] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND This systematic review aims to investigate the prediction value of diffusion tensor imaging for motor function recovery of ischemic stroke patients. METHODS Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2016, Issue 9), PubMed, Embase, Clarivate Analytics, Scopus, CINAHL, Chinese Biomedical Literature Database, China National Knowledge Infrastructure and Google Scholar were searched for either motor recovery or corticospinal tract integrity by diffusion tensor imaging in different stroke phase from January 1, 1970, to October 31, 2016. The study design and participants were subjected to metrological analysis. Correlation coefficient (r) was used for evaluating the relationship between fractional anisotropy (FA) and motor function outcome. Correlation coefficient values were extracted from each study, and 95% confidence intervals (CIs) were calculated by Fisher's z transformation. Meta-analysis was conducted by STATA software. RESULTS Fifteen studies with a total of 414 patients were included. Meta-analysis showed that FA in the subacute phase had the significant correlation with motor function outcome (ES=0.75, 95%CI 0.62-0.87), which showed moderate quality based on GRADE system. The weight correlation coefficient revealed that an effect size (ES) of FA in acute phase and chronic phase was 0.51 (95%CI 0.33-0.68) and 0.62 (95%CI 0.47-0.77) respectively. CONCLUSION This meta-analysis reveals that FA in the subacute phase after ischemic stroke is a good predictor for functional motor recovery, which shows moderate quality based on the GRADE system.
Collapse
Affiliation(s)
- Jing-fen Jin
- Nursing Department, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Zhi-ting Guo
- Neurology Department, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Yu-ping Zhang
- Nursing Department, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Yuan-yuan Chen
- Neurology Department, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| |
Collapse
|
33
|
Zhang Y, Li KS, Ning YZ, Fu CH, Liu HW, Han X, Cui FY, Ren Y, Zou YH. Altered structural and functional connectivity between the bilateral primary motor cortex in unilateral subcortical stroke: A multimodal magnetic resonance imaging study. Medicine (Baltimore) 2016; 95:e4534. [PMID: 27495109 PMCID: PMC4979863 DOI: 10.1097/md.0000000000004534] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
A large number of functional imaging studies have focused on the understanding of motor-related neural activities after ischemic stroke. However, the knowledge is still limited in the structural and functional changes of the interhemispheric connections of the bilateral primary motor cortices (M1s) and their potential influence on motor function recovery following stroke.Twenty-four stroke patients with right hemispheric subcortical infarcts and 25 control subjects were recruited to undergo multimodal magnetic resonance imaging examinations. Structural impairments between the bilateral M1s were measured by fractional anisotropy. Functional changes of the bilateral M1s were assessed via M1-M1 resting-state functional connectivity. Task-evoked activation analysis was applied to identify the roles of the bilateral hemispheres in motor function recovery. Compared with control subjects, unilateral subcortical stroke patients revealed significantly decreased fractional anisotropy and functional connectivity between the bilateral M1s. Stroke patients also revealed higher activations in multiple brain regions in both hemispheres and that more regions were located in the contralesional hemisphere.This study increased our understanding of the structural and functional alterations between the bilateral M1s that occur in unilateral subcortical stroke and provided further evidence for the compensatory role played by the contralesional hemisphere for these alterations during motor function recovery.
Collapse
Affiliation(s)
- Yong Zhang
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine
| | - Kuang-Shi Li
- Department of Emergency, Beijing Gulou Hospital of Traditional Chinese Medicine, Beijing, China
| | - Yan-Zhe Ning
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine
| | - Cai-Hong Fu
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine
| | - Hong-Wei Liu
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine
| | - Xiao Han
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine
| | - Fang-Yuan Cui
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine
| | - Yi Ren
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine
| | - Yi-Huai Zou
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine
- Correspondence: Yihuai Zou, Department of Neurology and Stroke Center, Dongzhimen Hospital, No 5, Haiyuncang, Dongcheng District, Beijing 100700, China (e-mail: )
| |
Collapse
|
34
|
Wen H, Alshikho MJ, Wang Y, Luo X, Zafonte R, Herbert MR, Wang QM. Correlation of Fractional Anisotropy With Motor Recovery in Patients With Stroke After Postacute Rehabilitation. Arch Phys Med Rehabil 2016; 97:1487-1495. [PMID: 27178097 DOI: 10.1016/j.apmr.2016.04.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/13/2016] [Accepted: 04/15/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To investigate the relation between fractional anisotropy (FA), a suggested biomarker for tissue integrity, and motor recovery in patients with stroke after postacute rehabilitation. DESIGN Retrospective study. SETTING Acute rehabilitation hospital. PARTICIPANTS Subjects (N=43) diagnosed with ischemic stroke (n=28) and hemorrhagic stroke (n=15). The average age for subjects was 68±14 years. INTERVENTIONS Magnetic resonance imaging and diffusion tensor imaging were conducted on all patients. MAIN OUTCOME MEASURES The admission and discharge motor subscores of the FIM were obtained from medical records, and relative gain was calculated using the Montebello Rehabilitation Factor Score (MRFS). K-means cluster analysis (K=3) using both the MRFS and the gain of the FIM motor subscore (ΔFIM) was performed. Analysis of variance was used to determine the difference in FA among the clusters. Spearman analysis was conducted to examine the relation between FA, ΔFIM, and MRFS in each cluster. RESULTS FA was significantly higher in the clusters of good and moderate recovery in the corticospinal tract (CST), peduncle, and posterior limb of the internal capsule bilaterally (all P<.05) compared with the poor recovery group. Significant positive correlations were observed in multiple regions along the CST between FA, ΔFIM, and MRFS in the clusters of good and moderate recovery, but not in the poor recovery group. CONCLUSIONS Our results showed an association between FA values within the corticospinal tract and motor recovery in patients with stroke undergoing postacute rehabilitation. This finding may help to identify novel targets for new interventions to promote stroke recovery.
Collapse
Affiliation(s)
- Hongmei Wen
- Stroke Biological Recovery Laboratory, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA; Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Mohamad J Alshikho
- Transcend Research Laboratory, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA
| | - Yao Wang
- Stroke Biological Recovery Laboratory, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA; Department of Rehabilitation Medicine, Nan'ao People's Hospital of Shenzhen, The First Affiliated Hospital, Shenzhen University, Shenzhen, China
| | - Xun Luo
- Department of Rehabilitation Medicine, Nan'ao People's Hospital of Shenzhen, The First Affiliated Hospital, Shenzhen University, Shenzhen, China; Kerry Rehabilitation Medicine Research Institute, Shenzhen, China
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA
| | - Martha R Herbert
- Transcend Research Laboratory, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA
| | - Qing Mei Wang
- Stroke Biological Recovery Laboratory, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA.
| |
Collapse
|
35
|
Doughty C, Wang J, Feng W, Hackney D, Pani E, Schlaug G. Detection and Predictive Value of Fractional Anisotropy Changes of the Corticospinal Tract in the Acute Phase of a Stroke. Stroke 2016; 47:1520-6. [PMID: 27217504 DOI: 10.1161/strokeaha.115.012088] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 04/05/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE A decrease in fractional anisotropy (FA) of the ipsilesional corticospinal tract (CST) distal to stroke lesions in the subacute (eg, 30 days) and chronic phase has been correlated with poor motor outcomes, but it is unclear whether FA values obtained within the acute stroke phase (here defined as 80 hours after onset) can predict later outcome. METHODS Fifty-eight patients underwent an assessment of motor impairment in the acute phase and at 3 months using the upper extremity Fugl-Meyer assessment. FA values, obtained within 80 hours after stroke onset, were determined in 2 regions of interest: cerebral peduncle and a stretch of the CST caudal to each stroke lesion (nearest-5-slices). RESULTS The FA laterality index for the cerebral peduncle-regions of interest was a poor predictor of 3-month outcome (R(2)=0.044; P=0.137), whereas the slope over the FA laterality index of the nearest-5-slices showed a relatively weak but significant prediction (R(2)=0.11; P=0.022) with the affected side having lower FA values. Initial upper extremity Fugl-Meyer (R(2)=0.69; P<0.001) and the weighted CST lesion load (R(2)=0.71; P<0.001) were strong predictors of 3-month outcome. In multivariate analyses, controlling for initial upper extremity Fugl-Meyer, weighted CST lesion load, and days-of-therapy, neither the FA laterality index of the cerebral peduncle nor the slope over the FA laterality index of the nearest-5-slices significantly contributed to the prediction of 86% of the variance in the upper extremity Fugl-Meyer at 3 months. CONCLUSIONS FA reductions of the CST can be detected near the ischemic lesion in the acute stroke phase, but offer minimal predictive value to motor outcomes at 3 months.
Collapse
Affiliation(s)
- Christopher Doughty
- From the Neuroimaging and Stroke Recovery Laboratory, Department of Neurology (C.D., J.W., W.F., E.P., G.S.) and Department of Radiology (D.H.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; and MUSC Stroke Center, Department of Neurology, Medical University of South Carolina, Charleston (W.F.)
| | - Jasmine Wang
- From the Neuroimaging and Stroke Recovery Laboratory, Department of Neurology (C.D., J.W., W.F., E.P., G.S.) and Department of Radiology (D.H.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; and MUSC Stroke Center, Department of Neurology, Medical University of South Carolina, Charleston (W.F.)
| | - Wuwei Feng
- From the Neuroimaging and Stroke Recovery Laboratory, Department of Neurology (C.D., J.W., W.F., E.P., G.S.) and Department of Radiology (D.H.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; and MUSC Stroke Center, Department of Neurology, Medical University of South Carolina, Charleston (W.F.)
| | - David Hackney
- From the Neuroimaging and Stroke Recovery Laboratory, Department of Neurology (C.D., J.W., W.F., E.P., G.S.) and Department of Radiology (D.H.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; and MUSC Stroke Center, Department of Neurology, Medical University of South Carolina, Charleston (W.F.)
| | - Ethan Pani
- From the Neuroimaging and Stroke Recovery Laboratory, Department of Neurology (C.D., J.W., W.F., E.P., G.S.) and Department of Radiology (D.H.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; and MUSC Stroke Center, Department of Neurology, Medical University of South Carolina, Charleston (W.F.)
| | - Gottfried Schlaug
- From the Neuroimaging and Stroke Recovery Laboratory, Department of Neurology (C.D., J.W., W.F., E.P., G.S.) and Department of Radiology (D.H.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; and MUSC Stroke Center, Department of Neurology, Medical University of South Carolina, Charleston (W.F.).
| |
Collapse
|
36
|
Reinkensmeyer DJ, Burdet E, Casadio M, Krakauer JW, Kwakkel G, Lang CE, Swinnen SP, Ward NS, Schweighofer N. Computational neurorehabilitation: modeling plasticity and learning to predict recovery. J Neuroeng Rehabil 2016; 13:42. [PMID: 27130577 PMCID: PMC4851823 DOI: 10.1186/s12984-016-0148-3] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 04/13/2016] [Indexed: 01/19/2023] Open
Abstract
Despite progress in using computational approaches to inform medicine and neuroscience in the last 30 years, there have been few attempts to model the mechanisms underlying sensorimotor rehabilitation. We argue that a fundamental understanding of neurologic recovery, and as a result accurate predictions at the individual level, will be facilitated by developing computational models of the salient neural processes, including plasticity and learning systems of the brain, and integrating them into a context specific to rehabilitation. Here, we therefore discuss Computational Neurorehabilitation, a newly emerging field aimed at modeling plasticity and motor learning to understand and improve movement recovery of individuals with neurologic impairment. We first explain how the emergence of robotics and wearable sensors for rehabilitation is providing data that make development and testing of such models increasingly feasible. We then review key aspects of plasticity and motor learning that such models will incorporate. We proceed by discussing how computational neurorehabilitation models relate to the current benchmark in rehabilitation modeling - regression-based, prognostic modeling. We then critically discuss the first computational neurorehabilitation models, which have primarily focused on modeling rehabilitation of the upper extremity after stroke, and show how even simple models have produced novel ideas for future investigation. Finally, we conclude with key directions for future research, anticipating that soon we will see the emergence of mechanistic models of motor recovery that are informed by clinical imaging results and driven by the actual movement content of rehabilitation therapy as well as wearable sensor-based records of daily activity.
Collapse
Affiliation(s)
- David J Reinkensmeyer
- Departments of Anatomy and Neurobiology, Mechanical and Aerospace Engineering, Biomedical Engineering, and Physical Medicine and Rehabilitation, University of California, Irvine, USA.
| | - Etienne Burdet
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, UK
| | - Maura Casadio
- Department Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
| | - John W Krakauer
- Departments of Neurology and Neuroscience, John Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
- Reade, Centre for Rehabilitation and Rheumatology, Amsterdam, The Netherlands
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Catherine E Lang
- Department of Neurology, Program in Physical Therapy, Program in Occupational Therapy, Washington University School of Medicine, St Louis, MO, USA
| | - Stephan P Swinnen
- Department of Kinesiology, KU Leuven Movement Control & Neuroplasticity Research Group, Leuven, KU, Belgium
- Leuven Research Institute for Neuroscience & Disease (LIND), KU, Leuven, Belgium
| | - Nick S Ward
- Sobell Department of Motor Neuroscience and UCLPartners Centre for Neurorehabilitation, UCL Institute of Neurology, Queen Square, London, UK
| | - Nicolas Schweighofer
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, USA
| |
Collapse
|
37
|
Park W, Kwon GH, Kim YH, Lee JH, Kim L. EEG response varies with lesion location in patients with chronic stroke. J Neuroeng Rehabil 2016; 13:21. [PMID: 26935230 PMCID: PMC4776402 DOI: 10.1186/s12984-016-0120-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 02/01/2016] [Indexed: 11/23/2022] Open
Abstract
Background Brain activation differs according to lesion location in functional magnetic resonance imaging (fMRI) studies, but lesion location-dependent electroencephalographic (EEG) alterations are unclear. Because of the increasing use of EEG-based brain-computer-interface rehabilitation, we examined lesion location-dependent EEG patterns in patients with stroke while they performed motor tasks. Methods Twelve patients with chronic stroke were divided into three subgroups according to their lesion locations: supratentorial lesions that included M1 (SM1+), supratentorial lesions that excluded M1 (SM1-), and infratentorial (INF) lesions. Participants performed three motor tasks [active, passive, and motor imagery (MI)] with supination and grasping movements. The hemispheric asymmetric indexes, which were calculated with laterality coefficients (LCs), the temporal changes in the event-related desynchronization (ERD) patterns in the bilateral motor cortex, and the topographical distributions in the 28-channel EEG patterns around the supplementary motor area and bilateral motor cortex of the three participant subgroups were compared with those of the 12 age-matched healthy controls. Results The SM1+ group exhibited negative LC values in the active and MI motor tasks, while the other patient subgroups exhibited positive LC values. Negative LC values indicate that the ERD/ERS intensity of the ipsilateral hemisphere is higher than the contralateral hemisphere, whereas positive LC values indicate that the ERD/ERS intensity of the contralateral hemisphere is higher than the ipsilateral hemisphere. The LC values of SM1+ and healthy controls differed significantly (rank-sum test, p < 0.05) in both the supination and grasping movements in the active task. The three patient subgroups differed distinctly from each other in the topography analysis. Conclusions The hemispheric asymmetry and topographic characteristics of the beta band power patterns in the patients with stroke differed according to the location of the lesion, which suggested that EEG analyses of neurorehabilitation should be implemented according to lesion location. Electronic supplementary material The online version of this article (doi:10.1186/s12984-016-0120-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Wanjoo Park
- Center for Bionics, Korea Institute of Science and Technology, Seoul, 02792, Korea.,Department of Brain and Cognitive Engineering, Korea University, Seoul, 02841, Korea
| | - Gyu Hyun Kwon
- Graduate School of Technology and Innovation Management, Hanyang University, Seoul, 04763, Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine, Seoul, 06351, Korea.,Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, 06351, Korea
| | - Jong-Hwan Lee
- Department of Brain and Cognitive Engineering, Korea University, Seoul, 02841, Korea.
| | - Laehyun Kim
- Center for Bionics, Korea Institute of Science and Technology, Seoul, 02792, Korea. .,Department of HCI & Robotics, University of Science and Technology, Daejeon, 34113, Korea.
| |
Collapse
|
38
|
Koch P, Schulz R, Hummel FC. Structural connectivity analyses in motor recovery research after stroke. Ann Clin Transl Neurol 2016; 3:233-44. [PMID: 27042683 PMCID: PMC4774263 DOI: 10.1002/acn3.278] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 11/19/2015] [Accepted: 11/20/2015] [Indexed: 01/10/2023] Open
Abstract
Structural connectivity analyses by means of diffusion‐weighted imaging have substantially advanced the understanding of stroke‐related network alterations and their implications for motor recovery processes and residual motor function. Analyses of the corticospinal tract, alternate corticofugal pathways as well as intrahemispheric and interhemispheric corticocortical connections have not only been related to residual motor function in cross‐sectional studies, but have also been evaluated to predict functional recovery after stroke in longitudinal studies. This review will consist of an update on the available literature about structural connectivity analyses after ischemic motor stroke, followed by an outlook of possible future directions of research and applications.
Collapse
Affiliation(s)
- Philipp Koch
- Brain Imaging and Neuro Stimulation (BINS) Laboratory Department of Neurology University Medical Center Hamburg-Eppendorf Martini str. 52 20246 Hamburg Germany
| | - Robert Schulz
- Brain Imaging and Neuro Stimulation (BINS) Laboratory Department of Neurology University Medical Center Hamburg-Eppendorf Martini str. 52 20246 Hamburg Germany
| | - Friedhelm C Hummel
- Brain Imaging and Neuro Stimulation (BINS) Laboratory Department of Neurology University Medical Center Hamburg-Eppendorf Martini str. 52 20246 Hamburg Germany
| |
Collapse
|
39
|
Hirai KK, Groisser BN, Copen WA, Singhal AB, Schaechter JD. Comparing prognostic strength of acute corticospinal tract injury measured by a new diffusion tensor imaging based template approach versus common approaches. J Neurosci Methods 2016; 257:204-13. [PMID: 26386285 PMCID: PMC4666681 DOI: 10.1016/j.jneumeth.2015.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 09/02/2015] [Accepted: 09/04/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Long-term motor outcome of acute stroke patients with severe motor impairment is difficult to predict. While measure of corticospinal tract (CST) injury based on diffusion tensor imaging (DTI) in subacute stroke patients strongly predicts motor outcome, its predictive value in acute stroke patients is unclear. Using a new DTI-based, density-weighted CST template approach, we demonstrated recently that CST injury measured in acute stroke patients with moderately-severe to severe motor impairment of the upper limb strongly predicts motor outcome of the limb at 6 months. NEW METHOD The current study compared the prognostic strength of CST injury measured in 10 acute stroke patients with moderately-severe to severe motor impairment of the upper limb by the new density-weighted CST template approach versus several variants of commonly used DTI-based approaches. RESULTS AND COMPARISON WITH EXISTING METHODS Use of the density-weighted CST template approach yielded measurements of acute CST injury that correlated most strongly, in absolute magnitude, with 6-month upper limb strength (rs=0.93), grip (rs=0.94) and dexterity (rs=0.89) compared to all other 11 approaches. Formal statistical comparison of correlation coefficients revealed that acute CST injury measured by the density-weighted CST template approach correlated significantly more strongly with 6-month upper limb strength, grip and dexterity than 9, 10 and 6 of the 11 alternative measurements, respectively. CONCLUSIONS Measurements of CST injury in acute stroke patients with substantial motor impairment by the density-weighted CST template approach may have clinical utility for anticipating healthcare needs and improving clinical trial design.
Collapse
Affiliation(s)
- Kelsi K Hirai
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Benjamin N Groisser
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - William A Copen
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Aneesh B Singhal
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Judith D Schaechter
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
| |
Collapse
|
40
|
|
41
|
Reginold W, Luedke AC, Tam A, Itorralba J, Fernandez-Ruiz J, Reginold J, Islam O, Garcia A. Cognitive Function and 3-Tesla Magnetic Resonance Imaging Tractography of White Matter Hyperintensities in Elderly Persons. Dement Geriatr Cogn Dis Extra 2015; 5:387-94. [PMID: 26628897 PMCID: PMC4662291 DOI: 10.1159/000439045] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background/Aims This study used 3-Tesla magnetic resonance imaging (MRI) tractography to determine if there was an association between tracts crossing white matter hyperintensities (WMH) and cognitive function in elderly persons. Methods Brain T2-weighted fluid-attenuated inversion recovery (FLAIR) and diffusion tensor MRI scans were acquired in participants above the age of 60 years. Twenty-six persons had WMH identified on T2 FLAIR scans. They completed a battery of neuropsychological tests and were classified as normal controls (n = 15) or with Alzheimer's dementia (n = 11). Tractography was generated by the Fiber Assignment by Continuous Tracking method. All tracts that crossed WMH were segmented. The average fractional anisotropy and average mean diffusivity of these tracts were quantified. We studied the association between cognitive test scores with the average mean diffusivity and average fractional anisotropy of tracts while controlling for age, total WMH volume and diagnosis. Results An increased mean diffusivity of tracts crossing WMH was associated with worse performance on the Wechsler Memory Scale-III Longest Span Forward (p = 0.02). There was no association between the fractional anisotropy of tracts and performance on cognitive testing. Conclusion The mean diffusivity of tracts crossing WMH measured by tractography is a novel correlate of performance on the Wechsler Memory Scale-III Longest Span Forward in elderly persons.
Collapse
Affiliation(s)
- William Reginold
- Memory Clinics, Division of Geriatric Medicine, Department of Medicine, Ont., Canada
| | - Angela C Luedke
- Centre for Neuroscience Studies, Kingston General Hospital, Queen's University, Kingston, Ont., Canada
| | - Angela Tam
- Centre for Neuroscience Studies, Kingston General Hospital, Queen's University, Kingston, Ont., Canada
| | - Justine Itorralba
- Centre for Neuroscience Studies, Kingston General Hospital, Queen's University, Kingston, Ont., Canada
| | - Juan Fernandez-Ruiz
- Centre for Neuroscience Studies, Kingston General Hospital, Queen's University, Kingston, Ont., Canada
| | | | - Omar Islam
- Department of Diagnostic Radiology, Kingston General Hospital, Queen's University, Kingston, Ont., Canada
| | - Angeles Garcia
- Memory Clinics, Division of Geriatric Medicine, Department of Medicine, Ont., Canada ; Centre for Neuroscience Studies, Kingston General Hospital, Queen's University, Kingston, Ont., Canada
| |
Collapse
|
42
|
Nelles M, Urbach H, Sassen R, Schöne-Bake JC, Tschampa H, Träber F, Delev D, Elger CE, Jurcoane A, Hattingen E. Functional hemispherectomy: postoperative motor state and correlation to preoperative DTI. Neuroradiology 2015; 57:1093-102. [PMID: 26263839 DOI: 10.1007/s00234-015-1564-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 07/12/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Functional hemispherectomy (FH) is an infrequent method to reduce seizure frequency in patients with intractable epilepsy. The risk that hemispherotomy injures brain structures involved in residual motor function is challenging to predict. Our purpose was to evaluate MR diffusion tensor imaging (DTI) to preoperatively assess residual ipsilateral motor function prior to FH. METHODS We applied DTI in 34 patients scheduled for FH to perform fiber tracking in healthy and damaged hemispheres of the corticospinal tracts (CSTs) and of the corpus callosum. We assessed the CSTs and the commissural fibers for streamline count, for fractional anisotropy (FA), and for respective ratios (affected/unaffected side). We correlated these DTI values to post-to-prior changes of muscle strength and evaluated their diagnostic accuracy. RESULTS FA of the affected CSTs and of commissural fibers was significantly higher in patients with postoperative loss of muscle strength compared to patients without (p = 0.014 and p = 0.008). In contrast, CST FA from healthy hemispheres was not different between both groups. Ratios of streamline counts and FA from CSTs were higher in patients with postoperative reduced muscle strength compared to those without (1.14 ± 0.22 vs. 0.58 ± 0.14, p = 0.040; 0.93 ± 0.05 vs. 0.74 ± 0.03, p = 0.003). CSTs' normalized FA ratio greater than -0.085 predicted loss of muscle strength with 80 % sensitivity and 69.6 % specificity. CONCLUSION Preoperative tracking of the CST and of commissural fibers contributes to the prediction of postoperative motor outcome after functional hemispherectomy.
Collapse
Affiliation(s)
- M Nelles
- Department of Radiology, University of Bonn Medical Center, Sigmund Freud Str. 25, D - 53105, Bonn, Germany.
| | - H Urbach
- Department of Radiology, University of Bonn Medical Center, Sigmund Freud Str. 25, D - 53105, Bonn, Germany
| | - R Sassen
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
| | - J C Schöne-Bake
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
| | - H Tschampa
- Department of Radiology, University of Bonn Medical Center, Sigmund Freud Str. 25, D - 53105, Bonn, Germany
| | - F Träber
- Department of Radiology, University of Bonn Medical Center, Sigmund Freud Str. 25, D - 53105, Bonn, Germany
| | - D Delev
- Department of Neurosurgery, University of Bonn Medical Center, Bonn, Germany
| | - C E Elger
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
| | - A Jurcoane
- Department of Radiology, University of Bonn Medical Center, Sigmund Freud Str. 25, D - 53105, Bonn, Germany
| | - E Hattingen
- Department of Radiology, University of Bonn Medical Center, Sigmund Freud Str. 25, D - 53105, Bonn, Germany
| |
Collapse
|
43
|
A comparative study of fractional anisotropy measures and ICH score in predicting functional outcomes after intracerebral hemorrhage. Neurocrit Care 2015; 21:417-25. [PMID: 24962895 DOI: 10.1007/s12028-014-9999-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Improved prognostication during the acute phase of intracerebral hemorrhage (ICH) could influence goals of care. We investigated the utility of diffusion tensor imaging (DTI)-derived data obtained during the acute phase of ICH in predicting outcome, compared with the ICH score. METHODS We measured fractional anisotropy (FA) values in 5 slices below the level of the lesion on the affected and unaffected corticospinal tracts (CST) and in the cerebral peduncles (CPs) in 32 patients with supratentorial ICH who had DTI MRI within 4 days after ictus. We calculated the FA ratio (rFA = FAaffected side/FAunaffected side), and examined the value of the ICH score and rFA in predicting functional outcome assessed by modified Ranking Scale (mRS) at follow-up, using ROC analyses. RESULTS The rFA values at the CPs level, but not the 5 slices below the lesion, were significantly lower in the group with poor functional outcome (defined as mRS > 2) than in those with good functional outcome (0.96 ± 0.14 vs. 0.99 ± 0.08, p = 0.025). The ICH score had greater areas under ROC curve in predicting functional outcome compared to the mean rFA (AUC 0.74 vs. 0.44; p = 0.01 for mRS > 2; and 0.84 vs. 0.40; p < 0.001 for mRS > 3). CONCLUSIONS The prognostic value of the ICH score surpassed that of DTI-derived data during the acute phase of ICH in this cohort of patients. Prospective and larger studies are needed to validate our findings and to assess the prognostic role of various DTI-derived measures at different times following ICH.
Collapse
|
44
|
Auriat AM, Borich MR, Snow NJ, Wadden KP, Boyd LA. Comparing a diffusion tensor and non-tensor approach to white matter fiber tractography in chronic stroke. NEUROIMAGE-CLINICAL 2015; 7:771-81. [PMID: 25844329 PMCID: PMC4375634 DOI: 10.1016/j.nicl.2015.03.007] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 02/21/2015] [Accepted: 03/11/2015] [Indexed: 11/17/2022]
Abstract
Diffusion tensor imaging (DTI)-based tractography has been used to demonstrate functionally relevant differences in white matter pathway status after stroke. However, it is now known that the tensor model is insensitive to the complex fiber architectures found in the vast majority of voxels in the human brain. The inability to resolve intra-voxel fiber orientations may have important implications for the utility of standard DTI-based tract reconstruction methods. Intra-voxel fiber orientations can now be identified using novel, tensor-free approaches. Constrained spherical deconvolution (CSD) is one approach to characterize intra-voxel diffusion behavior. In the current study, we performed DTI- and CSD-based tract reconstruction of the corticospinal tract (CST) and corpus callosum (CC) to test the hypothesis that characterization of complex fiber orientations may improve the robustness of fiber tract reconstruction and increase the sensitivity to identify functionally relevant white matter abnormalities in individuals with chronic stroke. Diffusion weighted magnetic resonance imaging was performed in 27 chronic post-stroke participants and 12 healthy controls. Transcallosal pathways and the CST bilaterally were reconstructed using DTI- and CSD-based tractography. Mean fractional anisotropy (FA), apparent diffusion coefficient (ADC), axial diffusivity (AD), and radial diffusivity (RD) were calculated across the tracts of interest. The total number and volume of reconstructed tracts was also determined. Diffusion measures were compared between groups (Stroke, Control) and methods (CSD, DTI). The relationship between post-stroke motor behavior and diffusion measures was evaluated. Overall, CSD methods identified more tracts than the DTI-based approach for both CC and CST pathways. Mean FA, ADC, and RD differed between DTI and CSD for CC-mediated tracts. In these tracts, we discovered a difference in FA for the CC between stroke and healthy control groups using CSD but not DTI. CSD identified ipsilesional CST pathways in 9 stroke participants who did not have tracts identified with DTI. Additionally, CSD differentiated between stroke ipsilesional and healthy control non-dominant CST for several measures (number of tracts, tract volume, FA, ADC, and RD) whereas DTI only detected group differences for number of tracts. In the stroke group, motor behavior correlated with fewer diffusion metrics derived from the DTI as compared to CSD-reconstructed ipsilesional CST and CC. CSD is superior to DTI-based tractography in detecting differences in diffusion characteristics between the nondominant healthy control and ipsilesional CST. CSD measures of microstructure tissue properties related to more motor outcomes than DTI measures did. Our results suggest the potential utility and functional relevance of characterizing complex fiber organization using tensor-free diffusion modeling approaches to investigate white matter pathways in the brain after stroke. Compared tensor and tensor-free tractography methods in stroke participants Tensor-free method detected white matter tracts in more individuals with stroke Superior identification of white matter abnormalities with tensor-free method Relationship between white matter and motor outcome revealed with tensor-free method Tensor-free method is a sensitive tractography method for studying chronic stroke.
Collapse
Affiliation(s)
- A M Auriat
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - M R Borich
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, USA
| | - N J Snow
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - K P Wadden
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - L A Boyd
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| |
Collapse
|
45
|
Liu J, Qin W, Zhang J, Zhang X, Yu C. Enhanced interhemispheric functional connectivity compensates for anatomical connection damages in subcortical stroke. Stroke 2015; 46:1045-51. [PMID: 25721013 DOI: 10.1161/strokeaha.114.007044] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Motor recovery after stroke has been shown to be correlated with both the fractional anisotropy (FA) of the affected corticospinal tract (CST) and the interhemispheric resting-state functional connectivity (rsFC) of the primary motor cortex (M1). However, the role of the restoration or enhancement of the M1-M1 rsFC in motor recovery remains largely unknown. We aimed to clarify this issue by investigating the correlations between the M1-M1 rsFC and the integrity of the M1-M1 anatomic connection and the affected CST in chronic subcortical stroke patients with good motor outcomes. METHODS Twenty patients and 16 healthy controls underwent multimodal magnetic resonance imaging examinations. Diffusion tensor imaging was used to reconstruct the M1-M1 anatomic connection and bilateral CSTs. White matter integrity of these tracts was assessed using FA. Resting-state functional magnetic resonance imaging was used to calculate M1-M1 rsFC. Group differences in these measures were compared. Correlations between M1-M1 rsFC and FA of the M1-M1 anatomic connection and the affected CST were analyzed in patients with stroke. RESULTS Compared with healthy controls, patients with stroke exhibited significantly reduced FA in the affected CST and the M1-M1 anatomic connection and a significantly increased M1-M1 rsFC. The FA values of the affected CST were positively correlated with the M1-M1 anatomic connection, and these FA values were negatively correlated with the M1-M1 rsFC in these patients. CONCLUSIONS Our findings suggest that the M1-M1 anatomic connection impairment is secondary to CST damage, and the M1-M1 rsFC enhancement may reflect compensatory or reactive neural plasticity in stroke patients with CST impairment.
Collapse
Affiliation(s)
- Jingchun Liu
- From the Departments of Radiology and Tianjin Key Laboratory of Functional Imaging (J.L., W.Q., J.Z., C.Y.), Tianjin Medical University General Hospital, Tianjin, China; and Department of Medical Imaging, School of Medical Imaging, Tianjin Medical University, Tianjin, China (X.Z.)
| | - Wen Qin
- From the Departments of Radiology and Tianjin Key Laboratory of Functional Imaging (J.L., W.Q., J.Z., C.Y.), Tianjin Medical University General Hospital, Tianjin, China; and Department of Medical Imaging, School of Medical Imaging, Tianjin Medical University, Tianjin, China (X.Z.)
| | - Jing Zhang
- From the Departments of Radiology and Tianjin Key Laboratory of Functional Imaging (J.L., W.Q., J.Z., C.Y.), Tianjin Medical University General Hospital, Tianjin, China; and Department of Medical Imaging, School of Medical Imaging, Tianjin Medical University, Tianjin, China (X.Z.)
| | - Xuejun Zhang
- From the Departments of Radiology and Tianjin Key Laboratory of Functional Imaging (J.L., W.Q., J.Z., C.Y.), Tianjin Medical University General Hospital, Tianjin, China; and Department of Medical Imaging, School of Medical Imaging, Tianjin Medical University, Tianjin, China (X.Z.).
| | - Chunshui Yu
- From the Departments of Radiology and Tianjin Key Laboratory of Functional Imaging (J.L., W.Q., J.Z., C.Y.), Tianjin Medical University General Hospital, Tianjin, China; and Department of Medical Imaging, School of Medical Imaging, Tianjin Medical University, Tianjin, China (X.Z.).
| |
Collapse
|
46
|
Thiel A, Vahdat S. Structural and resting-state brain connectivity of motor networks after stroke. Stroke 2014; 46:296-301. [PMID: 25477218 DOI: 10.1161/strokeaha.114.006307] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Alexander Thiel
- From the Department of Neurology and Neurosurgery (A.T.) and Department of Psychology (S.V.), McGill University, Montreal, Canada; Department of Neuroscience, Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, Canada (A.T.); and Functional Neuroimaging Unit, Department of Neuroscience, University of Montreal, Montreal, Canada (S.V.).
| | - Shahabeddin Vahdat
- From the Department of Neurology and Neurosurgery (A.T.) and Department of Psychology (S.V.), McGill University, Montreal, Canada; Department of Neuroscience, Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, Canada (A.T.); and Functional Neuroimaging Unit, Department of Neuroscience, University of Montreal, Montreal, Canada (S.V.)
| |
Collapse
|
47
|
Maraka S, Jiang Q, Jafari-Khouzani K, Li L, Malik S, Hamidian H, Zhang T, Lu M, Soltanian-Zadeh H, Chopp M, Mitsias PD. Degree of corticospinal tract damage correlates with motor function after stroke. Ann Clin Transl Neurol 2014; 1:891-9. [PMID: 25540803 PMCID: PMC4265060 DOI: 10.1002/acn3.132] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 09/03/2014] [Accepted: 09/19/2014] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Direct injury to the corticospinal tract (CST) is a major factor defining motor impairment after stroke. Diffusion tensor imaging (DTI) tractography allows definition of the CST. We sought to determine whether DTI-based assessment of the degree of CST damage correlates with motor impairment at each phase of ischemic stroke. METHODS We evaluated patients at the acute (3-7 days), subacute (30 days), and chronic (90 days) phases of ischemic stroke with DTI and clinical motor scores (upper extremity Fugl-Myer test [UE-FM], motor items of the National Institutes of Health Stroke Scale [mNIHSS]). The CST was identified and virtual fiber numbers (FN) were calculated for the affected and contralateral CST. We used Spearman correlation to study the relationship of FN ratio (FNr) (affected/unaffected CST) with motor scores at each time point, and the regression model to study the association of the acute parameters with chronic motor scores. RESULTS We studied 23 patients. Mean age was 66.7 (±12) years. FNr correlated with UE-FM score in the acute (r = 0.50, P = 0.032), subacute (r = 0.57, P = 0.007), and chronic (r = 0.67, P = 0.0008) phase, and with mNIHSS in the acute (r = -0.48, P = 0.043), subacute (r = -0.58, P = 0.006), and chronic (r = -0.75, P = 0.0001) phase. The combination of acute NIHSS and FNr significantly predicted chronic UE-FM score (r = 0.74, P = 0.0001). INTERPRETATION DTI-defined degree of CST injury correlates with motor impairment at each phase of ischemic stroke. The combination of baseline FNr and NIHSS predicts motor outcome. DTI-derived CST assessment could become a surrogate marker of motor impairment in the design of neurorestorative clinical trials.
Collapse
Affiliation(s)
- Stefania Maraka
- Department of Neurology, Henry Ford Hospital Detroit, Michigan
| | - Quan Jiang
- Department of Neurology, Henry Ford Hospital Detroit, Michigan
| | - Kourosh Jafari-Khouzani
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School Boston, Massachusetts ; Department of Radiology, Henry Ford Hospital Detroit, Michigan
| | - Lian Li
- Department of Neurology, Henry Ford Hospital Detroit, Michigan
| | - Shaneela Malik
- Department of Neurology, Henry Ford Hospital Detroit, Michigan ; Stroke and Neurovascular Center, Neurosciences Institute, Henry Ford Health System Detroit, Michigan
| | - Hajar Hamidian
- Department of Radiology, Henry Ford Hospital Detroit, Michigan ; Department of Computer Science, Wayne State University Detroit, Michigan
| | - Talan Zhang
- Department of Public Health Sciences, Henry Ford Health System Detroit, Michigan
| | - Mei Lu
- Department of Public Health Sciences, Henry Ford Health System Detroit, Michigan
| | | | - Michael Chopp
- Department of Neurology, Henry Ford Hospital Detroit, Michigan
| | - Panayiotis D Mitsias
- Department of Neurology, Henry Ford Hospital Detroit, Michigan ; Stroke and Neurovascular Center, Neurosciences Institute, Henry Ford Health System Detroit, Michigan
| |
Collapse
|
48
|
Groisser BN, Copen WA, Singhal AB, Hirai KK, Schaechter JD. Corticospinal tract diffusion abnormalities early after stroke predict motor outcome. Neurorehabil Neural Repair 2014; 28:751-60. [PMID: 24519021 PMCID: PMC4128905 DOI: 10.1177/1545968314521896] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Prognosis of long-term motor outcome of acute stroke patients with severe motor impairment is difficult to determine. OBJECTIVE Our primary goal was to evaluate the prognostic value of corticospinal tract (CST) injury on motor outcome of the upper limb compared with motor impairment level and lesion volume. METHODS In all, 10 acute stroke patients with moderately severe to severe motor impairment of the upper limb underwent diffusion tensor imaging (DTI) and testing of upper limb strength and dexterity at acute, subacute, and chronic poststroke time points. A density-weighted CST atlas was constructed using DTI tractography data from normal participants. This CST atlas was applied, using a largely automated process, to DTI data from patients to quantify CST injury at each time point. Differences in axial diffusivity (AD), radial diffusivity (RD), and fractional anisotropy (FA) of the ipsilesional CST relative to the contralesional CST were measured. RESULTS Acute loss in CST AD correlated most strongly and significantly with subacute and chronic strength and dexterity and remained significant after adjusting for acute motor impairment or lesion volume. Subacute loss in CST FA correlated most strongly with chronic dexterity, whereas subacute behavioral measures of limb strength correlated most strongly with chronic strength measures. CONCLUSIONS Loss in acute CST AD and subacute CST FA are strong prognostic indicators of future motor functions of the upper limb for stroke patients with substantial initial motor impairment. DTI-derived measure of CST injury early after stroke may have utility in health care planning and in design of acute stroke clinical trials.
Collapse
Affiliation(s)
- Benjamin N Groisser
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - William A Copen
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Aneesh B Singhal
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Kelsi K Hirai
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Judith D Schaechter
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
49
|
Thiel A, Cechetto DF, Heiss WD, Hachinski V, Whitehead SN. Amyloid burden, neuroinflammation, and links to cognitive decline after ischemic stroke. Stroke 2014; 45:2825-9. [PMID: 25005439 DOI: 10.1161/strokeaha.114.004285] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Alexander Thiel
- From the Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada (A.T.); Vulnerable Brain Laboratory, Department of Anatomy and Cell Biology (D.F.C., S.N.W.), and Department of Clinical Neurological Sciences, London Health Sciences Centre (V.H., S.N.W.), Western University, London, Ontario, Canada; and Max Planck Institute for Neurological Research, Cologne, Germany (W.-D.H.)
| | - David F Cechetto
- From the Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada (A.T.); Vulnerable Brain Laboratory, Department of Anatomy and Cell Biology (D.F.C., S.N.W.), and Department of Clinical Neurological Sciences, London Health Sciences Centre (V.H., S.N.W.), Western University, London, Ontario, Canada; and Max Planck Institute for Neurological Research, Cologne, Germany (W.-D.H.)
| | - Wolf-Dieter Heiss
- From the Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada (A.T.); Vulnerable Brain Laboratory, Department of Anatomy and Cell Biology (D.F.C., S.N.W.), and Department of Clinical Neurological Sciences, London Health Sciences Centre (V.H., S.N.W.), Western University, London, Ontario, Canada; and Max Planck Institute for Neurological Research, Cologne, Germany (W.-D.H.)
| | - Vladimir Hachinski
- From the Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada (A.T.); Vulnerable Brain Laboratory, Department of Anatomy and Cell Biology (D.F.C., S.N.W.), and Department of Clinical Neurological Sciences, London Health Sciences Centre (V.H., S.N.W.), Western University, London, Ontario, Canada; and Max Planck Institute for Neurological Research, Cologne, Germany (W.-D.H.)
| | - Shawn N Whitehead
- From the Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada (A.T.); Vulnerable Brain Laboratory, Department of Anatomy and Cell Biology (D.F.C., S.N.W.), and Department of Clinical Neurological Sciences, London Health Sciences Centre (V.H., S.N.W.), Western University, London, Ontario, Canada; and Max Planck Institute for Neurological Research, Cologne, Germany (W.-D.H.).
| |
Collapse
|
50
|
Domin M, Langner S, Hosten N, Lotze M. Comparison of parameter threshold combinations for diffusion tensor tractography in chronic stroke patients and healthy subjects. PLoS One 2014; 9:e98211. [PMID: 24853163 PMCID: PMC4031143 DOI: 10.1371/journal.pone.0098211] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 04/30/2014] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Although quantitative evaluation of diffusion tensor imaging (DTI) data seemed to be extremely important for clinical research its application is under debate. Besides fractional anisotropy (FA) the quantitative comparison between hemispheres of the number of fibers reconstructed by means of diffusion tensor tractography (DTT) is commonly used. However, the tractography-related parameters FA, minimum tract length (LENGTH) and the angle between two contiguous tracking steps (ANGLE) are inconsistently applied. Using 18 combinations we tested for the influence of parameter thresholds on the amount of reconstructed fibers for the posterior pyramidal tract in both hemispheres in order to obtain meaningful thresholds for DTT. RESULTS In 14 chronic stroke patients with unilateral lesions of the pyramidal tract around the height of the internal capsule and considerable motor deficits a 3-way repeated-measures ANOVA showed a significant interaction between the effects of FA and ANGLE level on reconstructed fiber lateralization, F (2.9, 37.67) = 3.01, p = 0.044, and a significant main effect FA, F (1.4, 18.1) = 11.58, p = 0.001. Post-hoc pairwise comparisons showed that this interaction was completely driven by FA. In 22 right-handed healthy subjects no significant interactions or main effects could be found. CONCLUSION The parameter threshold combinations with highest FA showed highest effect. ANGLE and LENGTH insofar influenced the lateralization effect when selected as liberal as possible, short LENGTH and large ANGLE thresholds. The DTT approach should be used with great care since results are highly dependent on the thresholds applied.
Collapse
Affiliation(s)
- Martin Domin
- Functional Imaging Unit, Center for Diagnostic Radiology and Neuroradiology, University Medicine, Greifswald, M/V, Germany
| | - Sönke Langner
- Center for Diagnostic Radiology and Neuroradiology, University Medicine, Greifswald, M/V, Germany
| | - Norbert Hosten
- Center for Diagnostic Radiology and Neuroradiology, University Medicine, Greifswald, M/V, Germany
| | - Martin Lotze
- Functional Imaging Unit, Center for Diagnostic Radiology and Neuroradiology, University Medicine, Greifswald, M/V, Germany
| |
Collapse
|