Prediction of Motor Function Recovery after Subcortical Stroke: Case Series of Activation PET and TMS Studies
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Objective: To examine whether the pattern of brain activation induced by a motor task and the motor responses to transcranial magnetic stimulation (TMS) have prognostic implications for motor recovery after stroke.Method: Ten patients with first-ever subcortical stroke (55.7±17.3 years, 5 ischemic and 5 hemorrhagic) underwent 2 FDG PET studies under different conditions (1: rest, 2: activation with a specific motor task) at 37.7±25.2 days after stroke. The regions showing more than a 10% increase in glucose metabolism on subtraction images during activation and rest were considered to be significantly activated. Cortical excitability of intracortical inhibition (ICI) and intracortical facilitation (ICF) were assessed using the TMS from both abductor pollicis brevis muscles within 7 days of PET scans. Recovery of motor function was assessed at the point of the neurological plateau. Results: The presence of a motor response at the plegic site to TMS and normal intracortical inhibition, and facili-tation patterns in the unaffected hemisphere were found to be related to good recovery. An association between an ipsilesional activation on PET and good motor recovery was also observed, but this was significantly weaker than that between TMS measured cortical excitability and motor recovery. Conclusion: Integrity of the ipsilesional corticospinal pathway, normalized contralesional intracortical excitability, and task-related activation in the ipsilesional hemisphere were found to predict post-stroke motor recovery signifi-cantly.
Abstract
Objective: To examine whether the pattern of brain activation induced by a motor task and the motor responses to transcranial magnetic stimulation (TMS) have prognostic implications for motor recovery after stroke.Method: Ten patients with first-ever subcortical stroke (55.7±17.3 years, 5 ischemic and 5 hemorrhagic) underwent 2 FDG PET studies under different conditions (1: rest, 2: activation with a specific motor task) at 37.7±25.2 days after stroke. The regions showing more than a 10% increase in glucose metabolism on subtraction images during activation and rest were considered to be significantly activated. Cortical excitability of intracortical inhibition (ICI) and intracortical facilitation (ICF) were assessed using the TMS from both abductor pollicis brevis muscles within 7 days of PET scans. Recovery of motor function was assessed at the point of the neurological plateau. Results: The presence of a motor response at the plegic site to TMS and normal intracortical inhibition, and facili-tation patterns in the unaffected hemisphere were found to be related to good recovery. An association between an ipsilesional activation on PET and good motor recovery was also observed, but this was significantly weaker than that between TMS measured cortical excitability and motor recovery. Conclusion: Integrity of the ipsilesional corticospinal pathway, normalized contralesional intracortical excitability, and task-related activation in the ipsilesional hemisphere were found to predict post-stroke motor recovery signifi-cantly.
참고문헌 (34)
- Karni A, "Functional MRI evidence for adult motor cortex plasticity during motor skill learning", Nature, 14, pp.155~158 (1995)
- Mattay VS, "Organization of the human motor system as studied by functional magnetic resonance imaging", Eur J Radiol, 30, pp.105~114 (1999)
- Calautti C, "Sequential activation brain mapping after subcortical stroke: changes in hemispheric balance and recovery", Neuroreport, 12, pp.3883~3886 (2001)
- Loubinoux I, "Correlation between cerebral reorganization and motor recovery after subcortical infarcts", Neuroimage, 20, pp.2166~2180 (2003)
- Brouwer BJ, "Hand function and motor cortical output poststroke: are they related?", Arch Phys Med Rehabil, 87, pp.627~634 (2006)
- Rossini PM, "Neuromagnetic integrated methods tracking human brain mechanisms of sensorimotor areas ‘plastic’ reorganisation", Brain Res Brain Res Rev, 33, pp.131~154 (2000)
- Cramer SC, "A functional MRI study of subjects recovered from hemiparetic stroke", Stroke, 28, pp.2518~2527 (1997)
- Seitz RJ, "Role of the premotor cortex in recovery from middle cerebral artery infarction", Arch Neurol, 55, pp.1081~1088 (1998)
- Johansen-Berg H, "Correlation between motor improvements and altered fMRI activity after rehabilitative therapy", Brain, 125, pp.2731~2742 (2002)
- Cramer SC, "Functional imaging in stroke recovery", Stroke, 35, pp.2695~2698 (2004)
- Marshall RS, "Evolution of cortical activation during recovery from corticospinal tract infarction", Stroke, 31, pp.656~661 (2000)
- Bütefisch CM, "Remote changes in cortical excitability after stroke", Brain, 126, pp.470~481 (2003)
- Zemke AC, "Motor cortex organization after stroke is related to side of stroke and level of recovery", Stroke, 34, pp.23~28 (2003)
- Herholz K, "Evaluation of a calibrated (18)F-FDG PET score as a biomarker for progression in Alzheimer disease and mild cognitive impairment", J Nucl Med, 52, pp.1218~1226 (2011)
- Bashir S, "Assessment and modulation of neural plasticity in rehabilitation with transcranial magnetic stimulation", PM R, 2, pp.253~268 (2010)
- Oldfield RC, "The assessment and analysis of handedness: the Edinburgh inventory", Neuropsychologia, 9, pp.97~113 (1971)
- -2-fluoro-2-deoxy-dglucose method in resting, healthy human subjects, "Eur J Nucl Med", 1990, 267~273
- Tombari D, "A longitudinal fMRI study: in recovering and then in clinically stable sub-cortical stroke patients", Neuroimage, 23, pp.827~839 (2004)
- Heiss WD, "Differential capacity of left and right hemispheric areas for compensation of poststroke aphasia", Ann Neurol, 45, pp.430~438 (1999)
- Cao Y, "Cortical language activation in stroke patients recovering from aphasia with functional MRI", Stroke, 30, pp.2331~2340 (1999)
- Carey LM, "Motor impairment and recovery in the upper limb after stroke: behavioral and neuroanatomical correlates", Stroke, 36, pp.625~629 (2005)
- Richards LG, "Movement-dependent stroke recovery: a systematic review and meta-analysis of TMS and fMRI evidence", Neuropsychologia, 46, pp.3~11 (2008)
- Triggs WJ, "Transcranial magnetic stimulation reveals a hemispheric asymmetry correlate of intermanual differences in motor performance", Neuropsychologia, 35, pp.1355~1363 (1997)
- Hendricks HT, "Motor evoked potentials of the lower extremity in predicting motor recovery and ambulation after stroke: a cohort study", Arch Phys Med Rehabil, 84, pp.1373~1379 (2003)
- van Kuijk AA, "How salient is the silent period? The role of the silent period in the prognosis of upper extremity motor recovery after severe stroke", J Clin Neurophysiol, 22, pp.10~24 (2005)
- Seitz RJ, "Role of the premotor cortex in recovery from middle cerebral artery infarction", Arch Neurol, 55, pp.1081~1088 (1998)
- Stinear C, "Prediction of recovery of motor function after stroke", Lancet Neurol, 9, pp.1228~1232 (2010)
- Coupar F, "Predictors of upper limb recovery after stroke: a systematic review and meta-analysis", Clin Rehabil, 26, pp.291~313 (2012)
- Pennisi G, "Absence of response to early transcranial magnetic stimulation in ischemic stroke patients: prognostic value for hand motor recovery", Stroke, 30, pp.2666~2670 (1999)
- Hendricks HT, "Analysis of recovery processes after stroke by means of transcranial magnetic stimulation", J Clin Neurophysiol, 20, pp.188~195 (2003)
- van Kuijk AA, "Predicting hand motor recovery in severe stroke: the role of motor evoked potentials in relation to early clinical assessment", Neurorehabi Neural Repair, 23, pp.45~51 (2009)
- Cicinelli P, "Interhemispheric asymmetries of motor cortex excitability in the postacute stroke stage: a paired-pulse transcranial magnetic stimulation study", Stroke, 34, pp.2653~2658 (2003)
- Talelli P, "Arm function after stroke: neurophysiological correlates and recovery mechanisms assessed by transcranial magnetic stimulation", Clin Neurophysiol, 117, pp.1641~1659 (2006)
- Lioumis P, "Probing modifications of cortical excitability during stroke recovery with navigated transcranial magnetic stimulation", Top Stroke Rehabil, 19, pp.182~192 (2012)