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Xu R, Zhang H, Liu S, Meng L, Ming D. cTBS over primary motor cortex increased contralateral corticomuscular coupling and interhemispheric functional connection. J Neural Eng 2024; 21:016012. [PMID: 38211343 DOI: 10.1088/1741-2552/ad1dc4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 01/11/2024] [Indexed: 01/13/2024]
Abstract
Objective.Transcranial magnetic stimulation is a non-invasive brain stimulation technique that changes the activity of the cerebral cortex. Contralesional continuous theta burst stimulation (cTBS) has been proposed and verified beneficial to stroke motor recovery. However, the underlying mechanism is still unclear.Approach.20 healthy right-handed subjects were recruited in this study, receiving real-cTBS over their left primary motor cortex or sham-cTBS. We designed the finger tapping task (FTT) before and after stimulation and recorded the accuracy and reaction time (RT) of the task. The electroencephalogram and surface electromyogram signals were recorded during the left finger pinching task (FPT) before and after stimulation. We calculated cortico-muscular coherence (CMC) in the contralateral hemisphere and cortico-cortical coherence (CCC) in the bilateral hemisphere. The two-way repeated measures analysis of variance was used to analyze the effect of cTBS.Main results.In the FTT, there was a significant main effect of 'time' on RT (F(1, 38) = 24.739,p< 0.001). In the FPT, the results showed that there was a significant interaction effect on the CMC peak and area in the beta band (peak:F(1, 38) = 8.562,p= 0.006; area:F(1, 38) = 5.273,p= 0.027), on the CCC peak in the alpha band (F(1, 38) = 4.815,p= 0.034) and area in the beta band (F(1, 38) = 4.822,p= 0.034). The post hoc tests showed that the CMC peak (W= 20,p= 0.002), the CMC area (W= 13,p= 0.003) and the CCC peak (t= -2.696,p= 0.014) increased significantly after real-cTBS. However, there was no significant decrease or increase after sham-cTBS.Significance.Our study found that cTBS can improve CMC of contralateral hemisphere and CCC of bilateral hemisphere, indicating that cTBS can strengthen cortico-muscular and cortico-cortical coupling.
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Affiliation(s)
- Rui Xu
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin 300072, People's Republic of China
| | - Haichao Zhang
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin 300072, People's Republic of China
| | - Shizhong Liu
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin 300072, People's Republic of China
- Department of Rehabilitation, Tianjin Medical University General Hospital, Tianjin 300052, People's Republic of China
| | - Lin Meng
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin 300072, People's Republic of China
| | - Dong Ming
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin 300072, People's Republic of China
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Peng RHT, He D, James SA, Williamson JN, Skadden C, Jain S, Hassaneen W, Miranpuri A, Kaur A, Sarol JN, Yang Y. Determining the effects of targeted high-definition transcranial direct current stimulation on reducing post-stroke upper limb motor impairments-a randomized cross-over study. Trials 2024; 25:34. [PMID: 38195605 PMCID: PMC10775560 DOI: 10.1186/s13063-023-07886-w] [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: 10/16/2023] [Accepted: 12/15/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Stroke is one of the leading causes of death in the USA and is a major cause of serious disability for adults. This randomized crossover study examines the effect of targeted high-definition transcranial direct current transcranial brain stimulation (tDCS) on upper extremity motor recovery in patients in the post-acute phase of stroke recovery. METHODS This randomized double-blinded cross-over study includes four intervention arms: anodal, cathodal, and bilateral brain stimulation, as well as a placebo stimulation. Participants receive each intervention in a randomized order, with a 2-week washout period between each intervention. The primary outcome measure is change in Motor Evoked Potential. Secondary outcome measures include the Fugl-Meyer Upper Extremity (FM-UE) score, a subset of FM-UE (A), related to the muscle synergies, and the Modified Ashworth Scale. DISCUSSION We hypothesize that anodal stimulation to the ipsilesional primary motor cortex will increase the excitability of the damaged cortico-spinal tract, reducing the UE flexion synergy and enhancing UE motor function. We further hypothesize that targeted cathodal stimulation to the contralesional premotor cortex will decrease activation of the cortico-reticulospinal tract (CRST) and the expression of the upper extremity (UE) flexion synergy and spasticity. Finally, we hypothesize bilateral stimulation will achieve both results simultaneously. Results from this study could improve understanding of the mechanism behind motor impairment and recovery in stroke and perfect the targeting of tDCS as a potential stroke intervention. With the use of appropriate screening, we anticipate no ethical or safety concerns. We plan to disseminate these research results to journals related to stroke recovery, engineering, and medicine. TRIAL REGISTRATION ClinicalTrials.gov NCT05479006 . Registered on 26 July 2022.
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Affiliation(s)
- Rita Huan-Ting Peng
- Department of Bioengineering, Grainger College of Engineering, University of Illinois Urbana-Champaign, Urbana, IL, USA
- Carle Foundation Hospital, Urbana, IL, USA
| | - Dorothy He
- The University of Oklahoma College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Shirley A James
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jordan N Williamson
- Department of Bioengineering, Grainger College of Engineering, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | | | - Sanjiv Jain
- Carle Foundation Hospital, Urbana, IL, USA
- Carle Illinois College of Medicine, Urbana, IL, USA
| | - Wael Hassaneen
- Carle Foundation Hospital, Urbana, IL, USA
- Carle Illinois College of Medicine, Urbana, IL, USA
| | - Amrendra Miranpuri
- Carle Foundation Hospital, Urbana, IL, USA
- Carle Illinois College of Medicine, Urbana, IL, USA
| | - Amandeep Kaur
- Interdisciplinary Health Sciences Institute, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Jesus N Sarol
- Interdisciplinary Health Sciences Institute, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Yuan Yang
- Department of Bioengineering, Grainger College of Engineering, University of Illinois Urbana-Champaign, Urbana, IL, USA.
- Carle Foundation Hospital, Urbana, IL, USA.
- Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL, USA.
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA.
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Safdar A, Smith MC, Byblow WD, Stinear CM. Applications of Repetitive Transcranial Magnetic Stimulation to Improve Upper Limb Motor Performance After Stroke: A Systematic Review. Neurorehabil Neural Repair 2023; 37:837-849. [PMID: 37947106 PMCID: PMC10685705 DOI: 10.1177/15459683231209722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
BACKGROUND Noninvasive brain stimulation (NIBS) is a promising technique for improving upper limb motor performance post-stroke. Its application has been guided by the interhemispheric competition model and typically involves suppression of contralesional motor cortex. However, the bimodal balance recovery model prompts a more tailored application of NIBS based on ipsilesional corticomotor function. OBJECTIVE To review and assess the application of repetitive transcranial magnetic stimulation (rTMS) protocols that aimed to improve upper limb motor performance after stroke. METHODS A PubMed search was conducted for studies published between 1st January 2005 and 1st November 2022 using rTMS to improve upper limb motor performance of human adults after stroke. Studies were grouped according to whether facilitatory or suppressive rTMS was applied to the contralesional hemisphere. RESULTS Of the 492 studies identified, 70 were included in this review. Only 2 studies did not conform to the interhemispheric competition model, and facilitated the contralesional hemisphere. Only 21 out of 70 (30%) studies reported motor evoked potential (MEP) status as a biomarker of ipsilesional corticomotor function. Around half of the studies (37/70, 53%) checked whether rTMS had the expected effect by measuring corticomotor excitability (CME) after application. CONCLUSION The interhemispheric competition model dominates the application of rTMS post-stroke. The majority of recent and current studies do not consider bimodal balance recovery model for the application of rTMS. Evaluating CME after the application rTMS could confirm that the intervention had the intended neurophysiological effect. Future studies could select patients and apply rTMS protocols based on ipsilesional MEP status.
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Affiliation(s)
- Afifa Safdar
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Marie-Claire Smith
- Department of Exercise Sciences, University of Auckland, Auckland, New Zealand
| | - Winston D. Byblow
- Department of Exercise Sciences, University of Auckland, Auckland, New Zealand
| | - Cathy M. Stinear
- Department of Medicine, University of Auckland, Auckland, New Zealand
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Williamson JN, James SA, He D, Li S, Sidorov EV, Yang Y. High-definition transcranial direct current stimulation for upper extremity rehabilitation in moderate-to-severe ischemic stroke: a pilot study. Front Hum Neurosci 2023; 17:1286238. [PMID: 37900725 PMCID: PMC10602806 DOI: 10.3389/fnhum.2023.1286238] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/20/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Previous studies found that post-stroke motor impairments are associated with damage to the lesioned corticospinal tract (CST) and hyperexcitability of the contralesional cortico-reticulospinal tract (CRST). This proof-of-concept study aims to develop a non-invasive brain stimulation protocol that facilitates the lesioned CST and inhibits the contralesional CRST to improve upper extremity rehabilitation in individuals with moderate-to-severe motor impairments post-stroke. Methods Fourteen individuals (minimum 3 months post ischemic stroke) consented. Physician decision of the participants baseline assessment qualified eight to continue in a randomized, double-blind cross-over pilot trial (ClinicalTrials.gov Identifier: NCT05174949) with: (1) anodal high-definition transcranial direct stimulation (HD-tDCS) over the ipsilesional primary motor cortex (M1), (2) cathodal HD-tDCS over contralesional dorsal premotor cortex (PMd), (3) sham stimulation, with a two-week washout period in-between. Subject-specific MR images and computer simulation were used to guide HD-tDCS and verified by Transcranial Magnetic Stimulation (TMS) induced Motor Evoked Potential (MEP). The motor behavior outcome was evaluated by an Fugl-Meyer Upper Extremity score (primary outcome measure) and the excitability of the ipslesoinal CST and contralesional CRST was determined by the change of MEP latencies and amplitude (secondary outcome measures). Results The baseline ipsilesional M1 MEP latency and amplitude were correlated with FM-UE. FM-UE scores were improved post HD-tDCS, in comparison to sham stimulation. Both anodal and cathodal HD-tDCS reduced the latency of the ipsilesional M1 MEP. The contralesional PMd MEP disappeared/delayed after HD-tDCS. Discussion These results suggest that HD-tDCS could improve the function of the lesioned corticospinal tract and reduce the excitability of the contralesional cortico-reticulospinal tract, thus, improving motor function of the upper extremity in more severely impaired individuals.
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Affiliation(s)
- Jordan N. Williamson
- Department of Bioengineering, Grainger College of Engineering, University of Illinois Urbana-Champaign, Urbana, IL, United States
| | - Shirley A. James
- University of Oklahoma Health Sciences Center, Hudson College of Public Health, Oklahoma City, OK, United States
| | - Dorothy He
- University of Oklahoma Health Sciences Center, College of Medicine, Oklahoma City, OK, United States
| | - Sheng Li
- Department of Physical Medicine and Rehabilitation, UT Health Huston, McGovern Medical School, Houston, TX, United States
| | - Evgeny V. Sidorov
- Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Yuan Yang
- Department of Bioengineering, Grainger College of Engineering, University of Illinois Urbana-Champaign, Urbana, IL, United States
- Clinical Imaging Research Center, Stephenson Family Clinical Research Institute, Carle Foundation Hospital, Urbana, IL, United States
- Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL, United States
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, United States
- Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Gallogly College of Engineering, Stephenson School of Biomedical Engineering, University of Oklahoma, Oklahoma City, OK, United States
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Kong E, Park D, Chang MC. Prediction of motor outcome based on brain perfusion single photon emission computed tomography in corona radiata infarct. Int J Neurosci 2023:1-7. [PMID: 37812028 DOI: 10.1080/00207454.2023.2269476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/06/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND There is limited information on brain perfusion single-photon emission computed tomography (SPECT) findings related to motor outcomes in patients with stroke. We aimed to investigate whether brain SPECT can be used to determine motor outcomes after corona radiata infarction. METHODS Eighty-nine patients were recruited in this study. Brain SPECT and diffusion tensor tractography (DTT) were conducted to evaluate the state of the corticospinal tract (CST) within 7-30 days of corona radiata infarct. Motor outcome was measured 6 months after infarct onset and was evaluated using the modified Brunnstrom classification (MBC) and functional ambulation category (FAC) for motor function of the upper and lower extremities, respectively. The presence of hypoperfusion on brain SPECT was evaluated in the frontal lobe, temporal lobe, parietal lobe, basal ganglia, thalamus, and cerebellum on both the ipsilesional and contralesional sides. Statistical analysis was performed using multivariate logistic regression, comparing patients in which CST was spared versus interrupted. RESULTS Hypoperfusion in the contralesional cerebellum was indicative of poor recovery in both the upper and lower extremities after corona radiata infarction when the CST was interrupted. Additionally, when the CST was preserved, hypoperfusion in the ipsilesional thalamus was indicative of poor recovery of the lower extremities. CONCLUSION Brain SPECT evaluation was shown to be a useful tool for predicting motor outcomes in patients with corona radiata infarcts.
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Affiliation(s)
- Eunjung Kong
- Department of Nuclear Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Donghwi Park
- Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Min Cheol Chang
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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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].
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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
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Reibelt A, Quandt F, Schulz R. Posterior parietal cortical areas and recovery after motor stroke: a scoping review. Brain Commun 2023; 5:fcad250. [PMID: 37810465 PMCID: PMC10551853 DOI: 10.1093/braincomms/fcad250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/25/2023] [Accepted: 09/25/2023] [Indexed: 10/10/2023] Open
Abstract
Brain imaging and electrophysiology have significantly enhanced our current understanding of stroke-related changes in brain structure and function and their implications for recovery processes. In the motor domain, most studies have focused on key motor areas of the frontal lobe including the primary and secondary motor cortices. Time- and recovery-dependent alterations in regional anatomy, brain activity and inter-regional connectivity have been related to recovery. In contrast, the involvement of posterior parietal cortical areas in stroke recovery is poorly understood although these regions are similarly important for important aspects of motor functioning in the healthy brain. Just in recent years, the field has increasingly started to explore to what extent posterior parietal cortical areas might undergo equivalent changes in task-related activation, regional brain structure and inter-regional functional and structural connectivity after stroke. The aim of this scoping review is to give an update on available data covering these aspects and thereby providing novel insights into parieto-frontal interactions for systems neuroscience stroke recovery research in the upper limb motor domain.
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Affiliation(s)
- Antonia Reibelt
- Experimental Electrophysiology and Neuroimaging Lab, Department of Neurology, University Medical Center Hamburg Eppendorf, 20246 Hamburg, Germany
| | - Fanny Quandt
- Experimental Electrophysiology and Neuroimaging Lab, Department of Neurology, University Medical Center Hamburg Eppendorf, 20246 Hamburg, Germany
| | - Robert Schulz
- Experimental Electrophysiology and Neuroimaging Lab, Department of Neurology, University Medical Center Hamburg Eppendorf, 20246 Hamburg, Germany
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Veverka T, Hok P, Trnečková M, Otruba P, Zapletalová J, Tüdös Z, Lotze M, Kaňovský P, Hluštík P. Interhemispheric parietal cortex connectivity reflects improvement in post-stroke spasticity due to treatment with botulinum toxin-A. J Neurol Sci 2023; 446:120588. [PMID: 36827809 DOI: 10.1016/j.jns.2023.120588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 02/10/2023] [Accepted: 02/12/2023] [Indexed: 02/17/2023]
Abstract
In post-stroke spasticity (PSS), effective treatment with botulinum neurotoxin (BoNT) is associated with transient decrease in activation of the ipsilesional superior parietal lobule (SPL) and intraparietal sulcus (IPS). We hypothesized that this would be reflected in changes in resting-state functional connectivity (rsFC) of the SPL/IPS. Our aim was therefore to assess rsFC of the ipsilesional SPL/IPS in chronic stroke patients with hemiparesis both with and without PSS and to explore the relationship between SPL/IPS rsFC and PSS severity. To this end, fourteen chronic stroke patients with upper limb weakness and PSS (the PSS group) and 8 patients with comparable weakness but no PSS (the control group) underwent clinical evaluation and 3 fMRI examinations, at baseline (W0) and 4 and 11 weeks after BoNT (W4 and W11, respectively). Seed-based rsFC of the atlas-based SPL and IPS was evaluated using a group×time interaction analysis and a correlation analysis with PSS severity (modified Ashworth scale), integrity of the ipsilesional somatosensory afferent pathway (evoked potential N20 latency), and age. In the PSS group, transient improvement in PSS was associated with increase in rsFC between the ipsilesional IPS and the contralesional SPL at W4. The interhemispheric connectivity was negatively correlated with PSS severity at baseline and with PSS improvement at W4. We propose adaptation of the internal forward model as the putative underlying mechanism and discuss its possible association with increased limb use, diminished spastic dystonia, or improved motor performance, as well as its potential contribution to the clinical effects of BoNT.
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Affiliation(s)
- Tomáš Veverka
- Department of Neurology, Faculty of Medicine and Dentistry, Palacký University Olomouc and University Hospital Olomouc, I. P. Pavlova 185/6, 779 00 Olomouc, Czechia.
| | - Pavel Hok
- Department of Neurology, Faculty of Medicine and Dentistry, Palacký University Olomouc and University Hospital Olomouc, I. P. Pavlova 185/6, 779 00 Olomouc, Czechia; Functional Imaging Unit, Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Walther-Rathenau-Str. 46, 17475 Greifswald, Germany.
| | - Markéta Trnečková
- Department of Computer Science, Faculty of Science, Palacký University Olomouc, 17. listopadu 1192/12 779 00 Olomouc, Olomouc, Czechia
| | - Pavel Otruba
- Department of Neurology, Faculty of Medicine and Dentistry, Palacký University Olomouc and University Hospital Olomouc, I. P. Pavlova 185/6, 779 00 Olomouc, Czechia.
| | - Jana Zapletalová
- Department of Biophysics, Biometry and Statistics, Faculty of Medicine and Dentistry, Palacký University Olomouc and University Hospital Olomouc, I. P. Pavlova 185/6, 779 00 Olomouc, Czechia.
| | - Zbyněk Tüdös
- Department of Radiology, Faculty of Medicine and Dentistry, Palacký University Olomouc and University Hospital Olomouc, I. P. Pavlova 185/6, 779 00 Olomouc, Czechia.
| | - Martin Lotze
- Functional Imaging Unit, Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Walther-Rathenau-Str. 46, 17475 Greifswald, Germany.
| | - Petr Kaňovský
- Department of Neurology, Faculty of Medicine and Dentistry, Palacký University Olomouc and University Hospital Olomouc, I. P. Pavlova 185/6, 779 00 Olomouc, Czechia.
| | - Petr Hluštík
- Department of Neurology, Faculty of Medicine and Dentistry, Palacký University Olomouc and University Hospital Olomouc, I. P. Pavlova 185/6, 779 00 Olomouc, Czechia.
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Rojas Albert A, Backhaus W, Graterol Pérez JA, Braaβ H, Schön G, Choe CU, Feldheim J, Bönstrup M, Cheng B, Thomalla G, Gerloff C, Schulz R. Cortical thickness of contralesional cortices positively relates to future outcome after severe stroke. Cereb Cortex 2022; 32:5622-5627. [PMID: 35169830 DOI: 10.1093/cercor/bhac040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 01/25/2023] Open
Abstract
Imaging studies have evidenced that contralesional cortices are involved in recovery after motor stroke. Cortical thickness (CT) analysis has proven its potential to capture the changes of cortical anatomy, which have been related to recovery and treatment gains under therapy. An open question is whether CT obtained in the acute phase after stroke might inform correlational models to explain outcome variability. Data of 38 severely impaired (median NIH Stroke Scale 9, interquartile range: 6-13) acute stroke patients of 2 independent cohorts were reanalyzed. Structural imaging data were processed via the FreeSurfer pipeline to quantify regional CT of the contralesional hemisphere. Ordinal logistic regression models were fit to relate CT to modified Rankin Scale as an established measure of global disability after 3-6 months, adjusted for the initial deficit, lesion volume, and age. The data show that CT of contralesional cortices, such as the precentral gyrus, the superior frontal sulcus, and temporal and cingulate cortices, positively relates to the outcome after stroke. This work shows that the baseline cortical anatomy of selected contralesional cortices can explain the outcome variability after severe stroke, which further contributes to the concept of structural brain reserve with respect to contralesional cortices to promote recovery.
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Affiliation(s)
- Alina Rojas Albert
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Winifried Backhaus
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - José A Graterol Pérez
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Hanna Braaβ
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Gerhard Schön
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Chi-Un Choe
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Jan Feldheim
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Marlene Bönstrup
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany.,Department of Neurology, University Medical Center, Leipzig 04103, Germany
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Robert Schulz
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
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Olafson E, Russello G, Jamison KW, Liu H, Wang D, Bruss JE, Boes AD, Kuceyeski A. Frontoparietal network activation is associated with motor recovery in ischemic stroke patients. Commun Biol 2022; 5:993. [PMID: 36131012 PMCID: PMC9492673 DOI: 10.1038/s42003-022-03950-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022] Open
Abstract
Strokes cause lesions that damage brain tissue, disrupt normal brain activity patterns and can lead to impairments in motor function. Although modulation of cortical activity is central to stimulation-based rehabilitative therapies, aberrant and adaptive patterns of brain activity after stroke have not yet been fully characterized. Here, we apply a brain dynamics analysis approach to study longitudinal brain activity patterns in individuals with ischemic pontine stroke. We first found 4 commonly occurring brain states largely characterized by high amplitude activations in the visual, frontoparietal, default mode, and motor networks. Stroke subjects spent less time in the frontoparietal state compared to controls. For individuals with dominant-hand CST damage, more time spent in the frontoparietal state from 1 week to 3-6 months post-stroke was associated with better motor recovery over the same time period, an association which was independent of baseline impairment. Furthermore, the amount of time spent in brain states was linked empirically to functional connectivity. This work suggests that when the dominant-hand CST is compromised in stroke, resting state configurations may include increased activation of the frontoparietal network, which may facilitate compensatory neural pathways that support recovery of motor function when traditional motor circuits of the dominant-hemisphere are compromised.
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Affiliation(s)
- Emily Olafson
- Department of Radiology, Weill Cornell Medicine, New York City, NY, 10021, USA.
| | - Georgia Russello
- Pelham Memorial High School, 575 Colonial Ave, Village of Pelham, NY, 10803, USA
| | - Keith W Jamison
- Department of Radiology, Weill Cornell Medicine, New York City, NY, 10021, USA
| | - Hesheng Liu
- Department of Radiology, Harvard Medical School, Boston, MA, 02115, USA
| | - Danhong Wang
- Department of Radiology, Harvard Medical School, Boston, MA, 02115, USA
| | - Joel E Bruss
- Department of Neurology, University of Iowa, Iowa City, IA, 52242, USA
| | - Aaron D Boes
- Department of Neurology, University of Iowa, Iowa City, IA, 52242, USA
| | - Amy Kuceyeski
- Department of Radiology, Weill Cornell Medicine, New York City, NY, 10021, USA
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11
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Kleineberg NN, Tscherpel C, Fink GR, Grefkes C, Weiss PH. Different facets of object-use pantomime: online TMS evidence on the role of the supramarginal gyrus. Cortex 2022; 156:13-25. [DOI: 10.1016/j.cortex.2022.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 03/31/2022] [Accepted: 06/22/2022] [Indexed: 11/24/2022]
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12
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Hensel L, Lange F, Tscherpel C, Viswanathan S, Freytag J, Volz LJ, Eickhoff SB, Fink GR, Grefkes C. Recovered grasping performance after stroke depends on interhemispheric frontoparietal connectivity. Brain 2022; 146:1006-1020. [PMID: 35485480 PMCID: PMC9976969 DOI: 10.1093/brain/awac157] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/19/2022] [Accepted: 04/14/2022] [Indexed: 01/11/2023] Open
Abstract
Activity changes in the ipsi- and contralesional parietal cortex and abnormal interhemispheric connectivity between these regions are commonly observed after stroke, however, their significance for motor recovery remains poorly understood. We here assessed the contribution of ipsilesional and contralesional anterior intraparietal cortex (aIPS) for hand motor function in 18 recovered chronic stroke patients and 18 healthy control subjects using a multimodal assessment consisting of resting-state functional MRI, motor task functional MRI, online-repetitive transcranial magnetic stimulation (rTMS) interference, and 3D movement kinematics. Effects were compared against two control stimulation sites, i.e. contralesional M1 and a sham stimulation condition. We found that patients with good motor outcome compared to patients with more substantial residual deficits featured increased resting-state connectivity between ipsilesional aIPS and contralesional aIPS as well as between ipsilesional aIPS and dorsal premotor cortex. Moreover, interhemispheric connectivity between ipsilesional M1 and contralesional M1 as well as ipsilesional aIPS and contralesional M1 correlated with better motor performance across tasks. TMS interference at individual aIPS and M1 coordinates led to differential effects depending on the motor task that was tested, i.e. index finger-tapping, rapid pointing movements, or a reach-grasp-lift task. Interfering with contralesional aIPS deteriorated the accuracy of grasping, especially in patients featuring higher connectivity between ipsi- and contralesional aIPS. In contrast, interference with the contralesional M1 led to impaired grasping speed in patients featuring higher connectivity between bilateral M1. These findings suggest differential roles of contralesional M1 and aIPS for distinct aspects of recovered hand motor function, depending on the reorganization of interhemispheric connectivity.
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Affiliation(s)
- Lukas Hensel
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany
| | - Fabian Lange
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany
| | - Caroline Tscherpel
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Shivakumar Viswanathan
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Jana Freytag
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany
| | - Lukas J Volz
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany
| | - Simon B Eickhoff
- Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany,Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany
| | - Gereon R Fink
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Christian Grefkes
- Correspondence to: Christian Grefkes Institute of Neuroscience and Medicine - Cognitive Neuroscience (INM-3) Research Centre Juelich, Juelich, Germany E-mail:
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13
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Predictive models for response to non-invasive brain stimulation in stroke: A critical review of opportunities and pitfalls. Brain Stimul 2021; 14:1456-1466. [PMID: 34560317 DOI: 10.1016/j.brs.2021.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 08/13/2021] [Accepted: 09/17/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Noninvasive brain stimulation has been successfully applied to improve stroke-related impairments in different behavioral domains. Yet, clinical translation is limited by heterogenous outcomes within and across studies. It has been proposed to develop and apply noninvasive brain stimulation in a patient-tailored, precision medicine-guided fashion to maximize response rates and effect magnitude. An important prerequisite for this task is the ability to accurately predict the expected response of the individual patient. OBJECTIVE This review aims to discuss current approaches studying noninvasive brain stimulation in stroke and challenges associated with the development of predictive models of responsiveness to noninvasive brain stimulation. METHODS Narrative review. RESULTS Currently, the field largely relies on in-sample associational studies to assess the impact of different influencing factors. However, the associational approach is not valid for making claims of prediction, which generalize out-of-sample. We will discuss crucial requirements for valid predictive modeling in particular the presence of sufficiently large sample sizes. CONCLUSION Modern predictive models are powerful tools that must be wielded with great care. Open science, including data sharing across research units to obtain sufficiently large and unbiased samples, could provide a solid framework for addressing the task of building robust predictive models for noninvasive brain stimulation responsiveness.
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14
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Backhaus W, Braaß H, Higgen FL, Gerloff C, Schulz R. Early parietofrontal network upregulation relates to future persistent deficits after severe stroke-a prospective cohort study. Brain Commun 2021; 3:fcab097. [PMID: 34056601 PMCID: PMC8154858 DOI: 10.1093/braincomms/fcab097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 01/12/2023] Open
Abstract
Recent brain imaging has evidenced that parietofrontal networks show alterations after stroke which also relate to motor recovery processes. There is converging evidence for an upregulation of parietofrontal coupling between parietal brain regions and frontal motor cortices. The majority of studies though have included only moderately to mildly affected patients, particularly in the subacute or chronic stage. Whether these network alterations will also be present in severely affected patients and early after stroke and whether such information can improve correlative models to infer motor recovery remains unclear. In this prospective cohort study, 19 severely affected first-ever stroke patients (mean age 74 years, 12 females) were analysed which underwent resting-state functional MRI and clinical testing during the initial week after the event. Clinical evaluation of neurological and motor impairment as well as global disability was repeated after three and six months. Nineteen healthy participants of similar age and gender were also recruited. MRI data were used to calculate functional connectivity values between the ipsilesional primary motor cortex, the ventral premotor cortex, the supplementary motor area and the anterior and caudal intraparietal sulcus of the ipsilesional hemisphere. Linear regression models were estimated to compare parietofrontal functional connectivity between stroke patients and healthy controls and to relate them to motor recovery. The main finding was a significant increase in ipsilesional parietofrontal coupling between anterior intraparietal sulcus and the primary motor cortex in severely affected stroke patients (P < 0.003). This upregulation significantly contributed to correlative models explaining variability in subsequent neurological and global disability as quantified by National Institute of Health Stroke Scale and modified Rankin Scale, respectively. Patients with increased parietofrontal coupling in the acute stage showed higher levels of persistent deficits in the late subacute stage of recovery (P < 0.05). This study provides novel insights that parietofrontal networks of the ipsilesional hemisphere undergo neuroplastic alteration already very early after severe motor stroke. The association between early parietofrontal upregulation and future levels of persistent functional deficits and dependence from help in daily living might be useful in models to enhance clinical neurorehabilitative decision making.
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Affiliation(s)
- Winifried Backhaus
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Hanna Braaß
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Focko L Higgen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Robert Schulz
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
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15
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Tscherpel C, Grefkes C. Funktionserholung nach Schlaganfall und die therapeutische Rolle der nicht-invasiven Hirnstimulation. KLIN NEUROPHYSIOL 2020. [DOI: 10.1055/a-1272-9435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ZusammenfassungIm Bereich der non-invasiven Hirnstimulation stellen die transkranielle Magnetstimulation (engl. transcranial magnetic stimulation, TMS) sowie die transkranielle Gleichstromstimulation (engl. transcranial direct current stimulation, tDCS) bis heute die wichtigsten Techniken zur Modulation kortikaler Erregbarkeit dar. Beide Verfahren induzieren Nacheffekte, welche die Zeit der reinen Stimulation überdauern, und ebnen damit den Weg für ihren therapeutischen Einsatz beim Schlaganfall. In diesem Übersichtsartikel diskutieren wir die aktuelle Datenlage TMS- und tDCS-vermittelter Therapien für die häufigsten schlaganfallbedingten Defizite wie Hemiparese, Aphasie und Neglect. Darüber hinaus adressieren wir mögliche Einschränkungen der gegenwärtigen Ansätze und zeigen Ansatzpunkte auf, um Neuromodulation nach Schlaganfall effektiver zu gestalten und damit das Outcome der Patienten zu verbessern.
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Affiliation(s)
- Caroline Tscherpel
- Klinik und Poliklinik für Neurologie, Universitätsklinik Köln
- Institut für Neurowissenschaften und Medizin (INM-3), Forschungszentrum Jülich
| | - Christian Grefkes
- Klinik und Poliklinik für Neurologie, Universitätsklinik Köln
- Institut für Neurowissenschaften und Medizin (INM-3), Forschungszentrum Jülich
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16
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Hartwigsen G, Volz LJ. Probing rapid network reorganization of motor and language functions via neuromodulation and neuroimaging. Neuroimage 2020; 224:117449. [PMID: 33059054 DOI: 10.1016/j.neuroimage.2020.117449] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/17/2020] [Accepted: 10/07/2020] [Indexed: 12/22/2022] Open
Abstract
Motor and cognitive functions are organized in large-scale networks in the human brain that interact to enable flexible adaptation of information exchange to ever-changing environmental conditions. In this review, we discuss the unique potential of the consecutive combination of repetitive transcranial magnetic stimulation (rTMS) and functional neuroimaging to probe network organization and reorganization in the healthy and lesioned brain. First, we summarize findings highlighting the flexible (re-)distribution and short-term reorganization in motor and cognitive networks in the healthy brain. Plastic after-effects of rTMS result in large-scale changes on the network level affecting both local and remote activity within the stimulated network as well as interactions between the stimulated and distinct functional networks. While the number of combined rTMS-fMRI studies in patients with brain lesions remains scarce, preliminary evidence suggests that the lesioned brain flexibly (re-)distributes its computational capacities to functionally reorganize impaired brain functions, using a similar set of mechanisms to achieve adaptive network plasticity compared to short-term reorganization observed in the healthy brain after rTMS. In general, both short-term reorganization in the healthy brain and stroke-induced reorganization seem to rely on three general mechanisms of adaptive network plasticity that allow to maintain and recover function: i) interhemispheric changes, including increased contribution of homologous regions in the contralateral hemisphere and increased interhemispheric connectivity, ii) increased interactions between differentially specialized networks and iii) increased contributions of domain-general networks after disruption of more specific functions. These mechanisms may allow for computational flexibility of large-scale neural networks underlying motor and cognitive functions. Future studies should use complementary approaches to address the functional relevance of adaptive network plasticity and further delineate how these general mechanisms interact to enable network flexibility. Besides furthering our neurophysiological insights into brain network interactions, identifying approaches to support and enhance adaptive network plasticity may result in clinically relevant diagnostic and treatment approaches.
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Affiliation(s)
- Gesa Hartwigsen
- Lise Meitner Research Group "Cognition and Plasticity", Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstrasse 1a, D-04103 Leipzig, Germany.
| | - Lukas J Volz
- Department of Neurology, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany.
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17
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Hensel L, Tscherpel C, Freytag J, Ritter S, Rehme AK, Volz LJ, Eickhoff SB, Fink GR, Grefkes C. Connectivity-Related Roles of Contralesional Brain Regions for Motor Performance Early after Stroke. Cereb Cortex 2020; 31:993-1007. [DOI: 10.1093/cercor/bhaa270] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 08/22/2020] [Accepted: 08/25/2020] [Indexed: 02/07/2023] Open
Abstract
Abstract
Hemiparesis after stroke is associated with increased neural activity not only in the lesioned but also in the contralesional hemisphere. While most studies have focused on the role of contralesional primary motor cortex (M1) activity for motor performance, data on other areas within the unaffected hemisphere are scarce, especially early after stroke. We here combined functional magnetic resonance imaging (fMRI) and transcranial magnetic stimulation (TMS) to elucidate the contribution of contralesional M1, dorsal premotor cortex (dPMC), and anterior intraparietal sulcus (aIPS) for the stroke-affected hand within the first 10 days after stroke. We used “online” TMS to interfere with neural activity at subject-specific fMRI coordinates while recording 3D movement kinematics. Interfering with aIPS activity improved tapping performance in patients, but not healthy controls, suggesting a maladaptive role of this region early poststroke. Analyzing effective connectivity parameters using a Lasso prediction model revealed that behavioral TMS effects were predicted by the coupling of the stimulated aIPS with dPMC and ipsilesional M1. In conclusion, we found a strong link between patterns of frontoparietal connectivity and TMS effects, indicating a detrimental influence of the contralesional aIPS on motor performance early after stroke.
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Affiliation(s)
- Lukas Hensel
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, 50931 Cologne, Germany
| | - Caroline Tscherpel
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, 50931 Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, 52428 Jülich, Germany
| | - Jana Freytag
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, 50931 Cologne, Germany
| | - Stella Ritter
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, 50931 Cologne, Germany
| | - Anne K Rehme
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, 50931 Cologne, Germany
| | - Lukas J Volz
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, 50931 Cologne, Germany
| | - Simon B Eickhoff
- Medical Faculty, Institute of Systems Neuroscience, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
- Brain and Behaviour, Institute of Neuroscience and Medicine, (INM-7), Research Centre Jülich, 52428 Jülich, Germany
| | - Gereon R Fink
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, 50931 Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, 52428 Jülich, Germany
| | - Christian Grefkes
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, 50931 Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, 52428 Jülich, Germany
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18
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Di Pino G, Di Lazzaro V. The balance recovery bimodal model in stroke patients between evidence and speculation: Do recent studies support it? Clin Neurophysiol 2020; 131:2488-2490. [PMID: 32747189 DOI: 10.1016/j.clinph.2020.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Giovanni Di Pino
- Research Unit of Neurophysiology and Neuroengineering of Human-Technology Interaction (NeXTlab), Università Campus Bio-Medico di Roma, Rome, Italy.
| | - Vincenzo Di Lazzaro
- Research Unit of Neurology, Neurophysiology, Neurobiology, Università Campus Bio-Medico di Roma, Rome, Italy.
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19
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Human brain connectivity: Clinical applications for clinical neurophysiology. Clin Neurophysiol 2020; 131:1621-1651. [DOI: 10.1016/j.clinph.2020.03.031] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 03/13/2020] [Accepted: 03/17/2020] [Indexed: 12/12/2022]
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20
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Grefkes C, Fink GR. Recovery from stroke: current concepts and future perspectives. Neurol Res Pract 2020; 2:17. [PMID: 33324923 PMCID: PMC7650109 DOI: 10.1186/s42466-020-00060-6] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 04/22/2020] [Indexed: 12/31/2022] Open
Abstract
Stroke is a leading cause of acquired, permanent disability worldwide. Although the treatment of acute stroke has been improved considerably, the majority of patients to date are left disabled with a considerable impact on functional independence and quality of life. As the absolute number of stroke survivors is likely to further increase due to the demographic changes in our aging societies, new strategies are needed in order to improve neurorehabilitation. The most critical driver of functional recovery post-stroke is neural reorganization. For developing novel, neurobiologically informed strategies to promote recovery of function, an improved understanding of the mechanisms enabling plasticity and recovery is mandatory. This review provides a comprehensive survey of recent developments in the field of stroke recovery using neuroimaging and non-invasive brain stimulation. We discuss current concepts of how the brain reorganizes its functional architecture to overcome stroke-induced deficits, and also present evidence for maladaptive effects interfering with recovery. We demonstrate that the combination of neuroimaging and neurostimulation techniques allows a better understanding of how brain plasticity can be modulated to promote the reorganization of neural networks. Finally, neurotechnology-based treatment strategies allowing patient-tailored interventions to achieve enhanced treatment responses are discussed. The review also highlights important limitations of current models, and finally closes with possible solutions and future directions.
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Affiliation(s)
- Christian Grefkes
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, 52425 Jülich, Germany.,Medical Faculty, University of Cologne & Department of Neurology, University Hospital Cologne, 50924 Cologne, Germany
| | - Gereon R Fink
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, 52425 Jülich, Germany.,Medical Faculty, University of Cologne & Department of Neurology, University Hospital Cologne, 50924 Cologne, Germany
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